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::::::{{ping|Hob Gadling}} The pertinent phrase = "recent literature reviews." Sec sources not primary ones. (see [[WP:MEDDATE]]) --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 11:34, 30 December 2018 (UTC) |
::::::{{ping|Hob Gadling}} The pertinent phrase = "recent literature reviews." Sec sources not primary ones. (see [[WP:MEDDATE]]) --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 11:34, 30 December 2018 (UTC) |
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:::::::Secondary sources are not magically immune to mistakes. --[[User:Hob Gadling|Hob Gadling]] ([[User talk:Hob Gadling|talk]]) 11:57, 30 December 2018 (UTC) |
:::::::Secondary sources are not magically immune to mistakes. --[[User:Hob Gadling|Hob Gadling]] ([[User talk:Hob Gadling|talk]]) 11:57, 30 December 2018 (UTC) |
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::::::::Come on Hob, you cannot expect a True Believer to understand Science. -[[User:Roxy the dog|'''Roxy,''' <small>the dog</small>.]] [[User talk:Roxy the dog|'''wooF''']] 12:21, 30 December 2018 (UTC) |
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We should evaluate sources based on their quality not their conclusions. Re mainstream: [[NICE]] guidelines recommend acupuncture for chronic tension-type headaches and migraines [https://www.nhs.uk/news/medical-practice/experts-debate-whether-acupuncture-can-relieve-chronic-pain/]. [[Harrison's]] (2015 pdf) recommends it for several conditions including dysmennorhea, knee OA and chronic flank, back, or abdominal pain due to renal enlargement in [[ADPKD]]. NICE and Harrison's are as mainstream as it gets last I checked. --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 09:03, 1 December 2018 (UTC) |
We should evaluate sources based on their quality not their conclusions. Re mainstream: [[NICE]] guidelines recommend acupuncture for chronic tension-type headaches and migraines [https://www.nhs.uk/news/medical-practice/experts-debate-whether-acupuncture-can-relieve-chronic-pain/]. [[Harrison's]] (2015 pdf) recommends it for several conditions including dysmennorhea, knee OA and chronic flank, back, or abdominal pain due to renal enlargement in [[ADPKD]]. NICE and Harrison's are as mainstream as it gets last I checked. --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 09:03, 1 December 2018 (UTC) |
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:To be clear i do get that for most other conditions there's "evidence of no efficacy" or "no evidence of efficacy", and caveats re possible false positives, etc etc. --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 02:52, 3 December 2018 (UTC) <small>(revised 11:26, 3 December 2018 (UTC))</small> |
:To be clear i do get that for most other conditions there's "evidence of no efficacy" or "no evidence of efficacy", and caveats re possible false positives, etc etc. --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 02:52, 3 December 2018 (UTC) <small>(revised 11:26, 3 December 2018 (UTC))</small> |
Revision as of 12:21, 30 December 2018
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Removal of a 2017 review
I recently added this 2017 review article to the section on Effectiveness (specifically the subsection thereof "Pain"). But this edit was soon reverted by MPants at work, apparently because it is too recent to have made a significant impact, and is "a little fishy, to boot". MPants further cited WP:DUE to justify his removal of this article. [1] However, there appears to be no reason to believe that the conclusions of this review article, positive though they may be regarding acupuncture, are "fringe" views that thus need to be minimized. It appears that this source, far from being the sort of fringe publication that should be excluded by WP:DUE, is the sort of recently-published review article in a reputable peer-reviewed journal (Current Opinion in Anesthesiology) that we should be trying to include per WP:MEDRS. But if MPants or anyone else wishes to explain why this sources is "fishy" or should be excluded for another reason I'm all ears. IntoThinAir (formerly Everymorning) talk 00:14, 17 July 2018 (UTC)
- Just as a point of fact, by definition, sources that support the efficacy of acupuncture have fringe conclusions. That doesn't make them invalid, but the mainstream view is that acupuncture is not effective, hence the conclusions of this study are fringe. However, that's not so much the problem in this case, per se. The WP:DUE reason here is that there's nothing about this study that makes it at all clear why it was picked. It's just one, random study by a couple of unremarkable researchers claiming to show that acupuncture is effective, tacked on to the end of a paragraph about the effectiveness of accupuncture that, for the most part, clearly disagrees with the results of this study. (That's leaving out the use of language like "growing evidence".) As for the date: It's a 2017 review. It hasn't had a chance to establish an impact in the field. It's just one of the things that make this study unremarkable. We generally prefer studies and surveys that have been around a few years and gathered up a bunch of citations; preferably those which have had their results duplicated.
- Finally the fishiness: the review starts by exclaiming that acupuncture is effective. It then "finds" that acupuncture is effective. <sound of crickets chirping> That's not just a red flag, that's a guy in a red suit with a red face from drinking frantically waving a red flag soaked in his own urine while blathering about aliens and anal probes. Good science never sets out to answer a question by stating that one answer is true in unambiguous terms. Of course, this is actually par for the course with acupuncture research.
- Then there's the usual "Multiple Asian authors and one Westerner", with the Asian contributors clearly the actual authors (Author information says: Acupuncture Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea, yet Buchheit is with The Pain Society of the Carolinas) used to make acupuncture research look more legitimate by making it look less Asian. Then, it's published in a relatively low-impact journal (there's another journal by the same publisher, covering the same field with twice the impact factor). Like I said, it's just fishy. It might turn out to be okay, but I highly doubt that any credible researchers would give this study the time of day. Of course, in a few years, we might see that I was wrong, when this article has hundreds of cites and is referenced as establishing the scientific consen- Oh, wait. I just saw how it concludes. Further studies on its use as an adjunct or alternative to opioids, and in perioperative settings are needed. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 02:59, 17 July 2018 (UTC)
- Do you have a reliable source to support your clearly extraordinary claim that "the mainstream view is that acupuncture is not effective"? Without such a source any claim that "by definition, sources that support the efficacy of acupuncture have fringe conclusions" is clearly untenable. Dismissing the article as being by "unremarkable researchers" is of course an ad hominem that has no bearing on whether or to what extent the conclusions of the article are valid. Notably, you failed to address the point I made regarding the fact that WP:MEDRS (specifically the section WP:MEDDATE) recommends that recent literature reviews be included, meaning the complaint about this article not having had enough time to get a lot of citations is invalid: that it was published recently is a strength, not a weakness. In addition, their statement that more research is needed appears to be with reference not to acupuncture's effectiveness in general, or with respect to chronic pain, but rather with respect to its use "an adjunct or alternative to opioids, and in perioperative settings" (as shown in the quote you yourself cited above). That two of the three authors are of Asian descent seems of little to no relevance to the credibility of the article's conclusions--I am aware of the issue of almost all Chinese studies producing positive results, but none of the authors have any affiliations in China. So I am, in general, skeptical of the argument that this should be excluded. IntoThinAir (formerly Everymorning) talk 03:31, 17 July 2018 (UTC)
- The new review discusses five new human trials (most of the papers reviewed are animal trials, or publications that are not clinical trials). And one of those trials only had 8 people and no control group. And the only of the five with more than 100 subjects wasn't even designed to test efficacy. It contributes literally nothing to the body of knowledge on acupuncture effectiveness, except to point out that people continue to publish studies from which no conclusions can be drawn. Someguy1221 (talk) 03:43, 17 July 2018 (UTC)
Do you have a reliable source to support your clearly extraordinary claim that "the mainstream view is that acupuncture is not effective"?
Ahh, so you were POV pushing with that addition. That explains it. But to answer your question:- Myint Swe Khine (2011) Advances in Nature of Science Research: Concepts and Methodologies Springer Science & Business Media, New York, NY
- Baran G.R., Kiani M.F., Samuel S.P. (2014) Science, Pseudoscience, and Not Science: How Do They Differ?. In: Healthcare and Biomedical Technology in the 21st Century. Springer, New York, NY
- Barrett, Stephen M.D. Be Wary of Acupuncture, Qigong, and "Chinese Medicine" http://www.quackwatch.org/01QuackeryRelatedTopics/acu.html (this one has it's own list of references worth checking out)
- Brian M. Berman, M.D., Helene M. Langevin, M.D., Claudia M. Witt, M.D., M.B.A., and Ronald Dubner, D.D.S., Ph.D. (2010) Acupuncture for Chronic Low Back Pain New England Journal of Medicine 2010; Volume 363, pages 454-461
- Andrew C. Ahn, Agatha P. Colbert, Belinda J. Anderson, Ørjan G. Martinsen, Richard Hammerschlag, Steve Cina, Peter M. Wayne, Helene M. Langevin (2008) Electrical properties of acupuncture points and meridians: A systematic review Bioelectromagnetics Volume 29, Issue 4
- Christopher J. Standaert; Janna Friedly; Mark W. Erwin; Michael J. Lee; Glenn Rechtine; Nora B. Henrikson; Daniel C. Norvell (2011) Comparative Effectiveness of Exercise, Acupuncture, and Spinal Manipulation for Low Back Pain Spine, Volume 36, Pages 120-130
- E. Ernst (2005) Acupuncture – a critical analysis Journal of Internal Medicine Volume 259, Pages 125-137
- Shu-Ming Wang, Zeev N. Kain, Paul F. White (2008) Acupuncture Analgesia: II. Clinical Considerations Anesthesia & Analgesia, Volume 106(2) Pages 611-621
- Ernst, E.; Lee, Myeong Sooa; Choi, Tae-Youngb (2011) Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews Pain, Volume 152(4), Pages 755-764
- Ernst, Edzard (2009) Acupuncture: What Does the Most Reliable Evidence Tell Us? Journal of Pain and Symptom Management, Volume 37(4), Pages 709-714
- There's plenty more where that came from.
Dismissing the article as being by "unremarkable researchers" is of course an ad hominem that has no bearing on whether or to what extent the conclusions of the article are valid.
Cherry picking, are we now? Don't pretend to call out "fallacies" in another editors argument if you can't be bothered to maintain a higher level of integrity, yourself. Either quote me in context or don't quote me at all, thanks.Notably, you failed to address the point I made regarding the fact that WP:MEDRS (specifically the section WP:MEDDATE) recommends that recent literature reviews be included
I thought you had already read WP:RECENTISM, which is explicitly warned against in WP:MEDRS. If I was mistaken in that assumption, I apologize. So let me address your concern now: WP:RECENTISM.In addition, their statement that more research is needed
Using a higher level of specificity only transforms a vague and meaningless statement into a less vague but still meaningless statement.I am aware of the issue of almost all Chinese studies producing positive results, but none of the authors have any affiliations in China.
Then you should be aware that this tends to apply to Korean studies to a somewhat lesser extent, and to studies from institutes dedicated to promoting acupuncture to a much higher extent. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:53, 17 July 2018 (UTC)- MPants at work, I'm curious to know where you heard this about Korean studies. Do you have a link to this information? TylerDurden8823 (talk) 08:31, 6 August 2018 (UTC)
- @TylerDurden8823: I've seen comparisons between Chinese and Korean science wrt acupuncture in numerous places. Off the top of my head, this is one example that actually goes into some detail about what the specific problems with Korean studies are. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:31, 13 August 2018 (UTC)
- @MPants at work:, I don't see anything about the state of the medical literature from Korea in the cited article. Are you sure you cited the correct study? It looks like it's an older article examining the state of Korean literature specifically about acupuncture. Granted, it looks like it's mainly lower level evidence (e.g., case reports, series, uncontrolled/suboptimally controlled studies, etc, which still have some value (case reports can be a helpful type of evidence)) but it doesn't necessarily speak to the original question of whether medical literature from Korea suffers from similar questions about its overall integrity when compared to that of China. TylerDurden8823 (talk) 08:02, 21 August 2018 (UTC)
- It's a paper that weighs the results and analyses the methodology of literally every acupuncture study published in all Korean journals, and found the facts that they almost always show a positive result and they are virtually always of low methodological quality notable enough to mention in the abstract (not even saving it for the results). I don't see how that's at all ambiguous. Sure, an analysis of the overall state of Korean literature might not have been the stated goal of the authors, but that doesn't really matter when such an analysis was a part of their methodology, now does it? ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 01:26, 22 August 2018 (UTC)
- Well, I think it matters. I wouldn't necessarily extrapolate the poor quality of the Korean literature in the field of acupuncture to Korean literature in all other medical subjects. The article you provided certainly speaks volumes about the quality of the Korean literature on acupuncture. I'm not suggesting it's ambiguous about that. TylerDurden8823 (talk) 07:19, 22 August 2018 (UTC)
- I was only referring to the qualities of Korean medical science wrt acupuncture. I have no particular problem with, for example, a Korean new drug study. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:29, 22 August 2018 (UTC)
- Well, I think it matters. I wouldn't necessarily extrapolate the poor quality of the Korean literature in the field of acupuncture to Korean literature in all other medical subjects. The article you provided certainly speaks volumes about the quality of the Korean literature on acupuncture. I'm not suggesting it's ambiguous about that. TylerDurden8823 (talk) 07:19, 22 August 2018 (UTC)
- It's a paper that weighs the results and analyses the methodology of literally every acupuncture study published in all Korean journals, and found the facts that they almost always show a positive result and they are virtually always of low methodological quality notable enough to mention in the abstract (not even saving it for the results). I don't see how that's at all ambiguous. Sure, an analysis of the overall state of Korean literature might not have been the stated goal of the authors, but that doesn't really matter when such an analysis was a part of their methodology, now does it? ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 01:26, 22 August 2018 (UTC)
- @MPants at work:, I don't see anything about the state of the medical literature from Korea in the cited article. Are you sure you cited the correct study? It looks like it's an older article examining the state of Korean literature specifically about acupuncture. Granted, it looks like it's mainly lower level evidence (e.g., case reports, series, uncontrolled/suboptimally controlled studies, etc, which still have some value (case reports can be a helpful type of evidence)) but it doesn't necessarily speak to the original question of whether medical literature from Korea suffers from similar questions about its overall integrity when compared to that of China. TylerDurden8823 (talk) 08:02, 21 August 2018 (UTC)
- @TylerDurden8823: I've seen comparisons between Chinese and Korean science wrt acupuncture in numerous places. Off the top of my head, this is one example that actually goes into some detail about what the specific problems with Korean studies are. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:31, 13 August 2018 (UTC)
- (belated, but FWIW) MPants' comment above that WP:RECENTISM precludes the use of recent literature reviews is fundamentally wrong. WP:MEDRS applies, not RECENTISM: the latter says not to give undue weight to breaking news. It doesn't say "don't use up-to-date science". Just saying. --Middle 8 (t • c | privacy • acupuncture COI?) 09:49, 30 December 2018 (UTC)
- New scientific publications that have not had a chance to be commented on or replicated by other scientists are not "up-to-date science". You seem to have no idea how science achieves its results and how it avoids coming to wrong conclusions. --Hob Gadling (talk) 10:32, 30 December 2018 (UTC)
- @Hob Gadling: The pertinent phrase = "recent literature reviews." Sec sources not primary ones. (see WP:MEDDATE) --Middle 8 (t • c | privacy • acupuncture COI?) 11:34, 30 December 2018 (UTC)
- Secondary sources are not magically immune to mistakes. --Hob Gadling (talk) 11:57, 30 December 2018 (UTC)
- Come on Hob, you cannot expect a True Believer to understand Science. -Roxy, the dog. wooF 12:21, 30 December 2018 (UTC)
- Secondary sources are not magically immune to mistakes. --Hob Gadling (talk) 11:57, 30 December 2018 (UTC)
- @Hob Gadling: The pertinent phrase = "recent literature reviews." Sec sources not primary ones. (see WP:MEDDATE) --Middle 8 (t • c | privacy • acupuncture COI?) 11:34, 30 December 2018 (UTC)
- New scientific publications that have not had a chance to be commented on or replicated by other scientists are not "up-to-date science". You seem to have no idea how science achieves its results and how it avoids coming to wrong conclusions. --Hob Gadling (talk) 10:32, 30 December 2018 (UTC)
- MPants at work, I'm curious to know where you heard this about Korean studies. Do you have a link to this information? TylerDurden8823 (talk) 08:31, 6 August 2018 (UTC)
- Do you have a reliable source to support your clearly extraordinary claim that "the mainstream view is that acupuncture is not effective"? Without such a source any claim that "by definition, sources that support the efficacy of acupuncture have fringe conclusions" is clearly untenable. Dismissing the article as being by "unremarkable researchers" is of course an ad hominem that has no bearing on whether or to what extent the conclusions of the article are valid. Notably, you failed to address the point I made regarding the fact that WP:MEDRS (specifically the section WP:MEDDATE) recommends that recent literature reviews be included, meaning the complaint about this article not having had enough time to get a lot of citations is invalid: that it was published recently is a strength, not a weakness. In addition, their statement that more research is needed appears to be with reference not to acupuncture's effectiveness in general, or with respect to chronic pain, but rather with respect to its use "an adjunct or alternative to opioids, and in perioperative settings" (as shown in the quote you yourself cited above). That two of the three authors are of Asian descent seems of little to no relevance to the credibility of the article's conclusions--I am aware of the issue of almost all Chinese studies producing positive results, but none of the authors have any affiliations in China. So I am, in general, skeptical of the argument that this should be excluded. IntoThinAir (formerly Everymorning) talk 03:31, 17 July 2018 (UTC)
We should evaluate sources based on their quality not their conclusions. Re mainstream: NICE guidelines recommend acupuncture for chronic tension-type headaches and migraines [2]. Harrison's (2015 pdf) recommends it for several conditions including dysmennorhea, knee OA and chronic flank, back, or abdominal pain due to renal enlargement in ADPKD. NICE and Harrison's are as mainstream as it gets last I checked. --Middle 8 (t • c | privacy • acupuncture COI?) 09:03, 1 December 2018 (UTC)
- To be clear i do get that for most other conditions there's "evidence of no efficacy" or "no evidence of efficacy", and caveats re possible false positives, etc etc. --Middle 8 (t • c | privacy • acupuncture COI?) 02:52, 3 December 2018 (UTC) (revised 11:26, 3 December 2018 (UTC))
- And if you look at the history of NICE guidance on acupuncture, the recommendations are being crossed off one by one. Example: https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain Guy (Help!) 13:13, 3 December 2018 (UTC)
- Yep. Unlike the acupuncturists themselves, at least NICE is slowly recognizing and resolving its green-jelly-bean problem. TenOfAllTrades(talk) 13:28, 3 December 2018 (UTC)
- @JzG: Yes, that is the overall trend for the evidence base. Wikipedia not being a crystal ball, how would you handle what NICE and Harrison's say now, as opposed to what they'll probably say in the future? --Middle 8 (t • c | privacy • acupuncture COI?) 10:21, 4 December 2018 (UTC)
- We ignore it, because there is good reason to think that sources like this are merely behind the trajectory. They are the equivalent of the few sources that continued to publish Heartland-funded industry driven climate change denialism after the publication of Merchants of Doubt. Quackademic medicine is a large and well funded enterprise, but the ability of acupuncture to manipulate nonexistent qi along nonexistent meridians, cherished though it is by the integrative medicine cargo cult, is no longer a matter of serious scientific inquiry, only of marketing studies by true believers. All these continued studies do is prove how hard it is to properly double blind an invasive procedure. Guy (Help!) 12:42, 4 December 2018 (UTC)
- @JzG: Harrison's and NICE are the equivalent of climate change deniers?!? Now there's a fringe view! Acu, like anything else on WP, is to be depicted according to what properly weighted (MED)RS say. Not according to the pejoratives other (lesser!) sources (let alone editors!) fling at such MEDRS. Or what other sources/editors predict they'll say. --Middle 8 (t • c | privacy • acupuncture COI?) 10:40, 10 December 2018 (UTC)
- No, they are the equivalent of the reviews of climate science that noted the positions of climate change deniers before the whole fossil fuel lobby funded fraud was exposed. Guy (Help!) 11:03, 10 December 2018 (UTC)
- Right. An unproven conspiracy to hijack the best MEDRS. Definitely the stuff of mainspace. --Middle 8 (t • c | privacy • acupuncture COI?) 11:12, 10 December 2018 (UTC)
- Scarcely unproven. The problems with quackademic medicine are well documented. Guy (Help!) 23:43, 17 December 2018 (UTC)
- So there is a source weighty enough to balance (let alone justify excluding) NICE? Let's see it. --Middle 8 (t • c | privacy • acupuncture COI?) 00:46, 18 December 2018 (UTC)
- Have you noticed how NICE recommendations for acupuncture are dropping one by one? Guy (Help!) 00:51, 18 December 2018 (UTC)
- Ah, Guy's comment on the trend, an excellent MEDRS (/sarcasm). FWIW & IIRC, they had a couple a decade-ish ago, then they added a couple (I think following Vickers), then they removed one (the most recent one, for low back pain). Even if/though you're right about the overall trend and its implications, "citation needed". --Middle 8 (t • c | privacy • acupuncture COI?) 01:18, 18 December 2018 (UTC)
- Have you noticed how NICE recommendations for acupuncture are dropping one by one? Guy (Help!) 00:51, 18 December 2018 (UTC)
- So there is a source weighty enough to balance (let alone justify excluding) NICE? Let's see it. --Middle 8 (t • c | privacy • acupuncture COI?) 00:46, 18 December 2018 (UTC)
- Scarcely unproven. The problems with quackademic medicine are well documented. Guy (Help!) 23:43, 17 December 2018 (UTC)
- Right. An unproven conspiracy to hijack the best MEDRS. Definitely the stuff of mainspace. --Middle 8 (t • c | privacy • acupuncture COI?) 11:12, 10 December 2018 (UTC)
- No, they are the equivalent of the reviews of climate science that noted the positions of climate change deniers before the whole fossil fuel lobby funded fraud was exposed. Guy (Help!) 11:03, 10 December 2018 (UTC)
- @JzG: Harrison's and NICE are the equivalent of climate change deniers?!? Now there's a fringe view! Acu, like anything else on WP, is to be depicted according to what properly weighted (MED)RS say. Not according to the pejoratives other (lesser!) sources (let alone editors!) fling at such MEDRS. Or what other sources/editors predict they'll say. --Middle 8 (t • c | privacy • acupuncture COI?) 10:40, 10 December 2018 (UTC)
- We ignore it, because there is good reason to think that sources like this are merely behind the trajectory. They are the equivalent of the few sources that continued to publish Heartland-funded industry driven climate change denialism after the publication of Merchants of Doubt. Quackademic medicine is a large and well funded enterprise, but the ability of acupuncture to manipulate nonexistent qi along nonexistent meridians, cherished though it is by the integrative medicine cargo cult, is no longer a matter of serious scientific inquiry, only of marketing studies by true believers. All these continued studies do is prove how hard it is to properly double blind an invasive procedure. Guy (Help!) 12:42, 4 December 2018 (UTC)
- And if you look at the history of NICE guidance on acupuncture, the recommendations are being crossed off one by one. Example: https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain Guy (Help!) 13:13, 3 December 2018 (UTC)
- Author affiliation: "Acupuncture Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul". That ends the conversation. Korean acupuncture studies are as biased as Chinese ones. Everyone is familiar with the acupuncture anaesthesia hoax, I hope? Guy (Help!) 13:10, 3 December 2018 (UTC)
- Ends which conversation exactly? --Middle 8 (t • c | privacy • acupuncture COI?) 10:21, 4 December 2018 (UTC)
- An unfounded derogatory assertion aimed at the author of a paper is not a valid critique of a source. I agree with Middle 8. Both NICE and Harrisons currently recommend acupuncture. They are reliable sources. Let's avoid crystal ball gazing and cite what they say now instead of wondering what they might say in the future. Morgan Leigh | Talk 22:15, 10 December 2018 (UTC)
- Nope. "Acupuncture meridian science" is an oxymoron. Acupuncture meridians don't exist, so any centre set up to study them is, by definition, actually part of the pseudoscience industry of SCAM promotion. Guy (Help!) 19:35, 12 December 2018 (UTC)
- @ Guy Another red herring. The point is what the NICE guidelines say, and they're cited on NHS website on multiple pages. Here's another (scroll to section Uses of acupuncture). WP:MEDSCI mentions NICE specifically as MEDRS. --Middle 8 (t • c | privacy • acupuncture COI?) 08:48, 13 December 2018 (UTC)
- Not quite. We know that NICE lags behind the science, and always has. It took NICE a long time to finally remove all support for homeopathy. But we can see that the NICE recommendations for acupuncture are being removed one by one. The trajectory is firmly towards the reality-based view that acupuncture is nonsense and against the usually crappy industry-funded, practitioner-run studies which support its use. Guy (Help!) 09:17, 13 December 2018 (UTC)
- Maybe they will go that way in the future, but we have to go with what they say now. Otherwise we are crystal ball gazing and that's magic not science. You don't want to advocate for magic do you?Morgan Leigh | Talk 10:22, 13 December 2018 (UTC)
- @JzG|Guy No, the way to handle NICE is to cite it along with whatever MEDRS make the point about the trend. --Middle 8 (t • c | privacy • acupuncture COI?) 14:45, 13 December 2018 (UTC)
- Which is what we do. NICE is in conflict with the determination in MEDRS complaint scientific sources that acupuncture is bollocks, so we don't confuse the reader by giving undue weight to the ever-reducing set of NICE guidelines that conflict with reality-based sources. Guy (Help!) 15:43, 13 December 2018 (UTC)
- Actually what we do when there are contradictory sources is cite both of them and say what each one says. They are both based in reality, you just don't want to cite the bits you have decided are bogus. Your opinion is not more important than sources. Morgan Leigh | Talk 09:41, 14 December 2018 (UTC)
- Guy wrote above:
Which is what we do.
-- Um no, citing NICE is not the same as not citing NICE.[3] --Middle 8 (t • c | privacy • acupuncture COI?) 19:28, 16 December 2018 (UTC)
- Which is what we do. NICE is in conflict with the determination in MEDRS complaint scientific sources that acupuncture is bollocks, so we don't confuse the reader by giving undue weight to the ever-reducing set of NICE guidelines that conflict with reality-based sources. Guy (Help!) 15:43, 13 December 2018 (UTC)
- Not quite. We know that NICE lags behind the science, and always has. It took NICE a long time to finally remove all support for homeopathy. But we can see that the NICE recommendations for acupuncture are being removed one by one. The trajectory is firmly towards the reality-based view that acupuncture is nonsense and against the usually crappy industry-funded, practitioner-run studies which support its use. Guy (Help!) 09:17, 13 December 2018 (UTC)
- @ Guy Another red herring. The point is what the NICE guidelines say, and they're cited on NHS website on multiple pages. Here's another (scroll to section Uses of acupuncture). WP:MEDSCI mentions NICE specifically as MEDRS. --Middle 8 (t • c | privacy • acupuncture COI?) 08:48, 13 December 2018 (UTC)
- Nope. "Acupuncture meridian science" is an oxymoron. Acupuncture meridians don't exist, so any centre set up to study them is, by definition, actually part of the pseudoscience industry of SCAM promotion. Guy (Help!) 19:35, 12 December 2018 (UTC)
Removal of Category 'Medicine'
@Roxy the dog: Please explain why you have removed the category Medicine from this article. I refer you to the lead of the article that says that "Acupuncture is a form of alternative medicine". Morgan Leigh | Talk 01:54, 27 November 2018 (UTC)
- Yes, and the article is in the "Alternative Medecine" category. So all is good. --McSly (talk) 02:00, 27 November 2018 (UTC)
- What McSly said. -Roxy, the naughty dog. wooF 08:30, 27 November 2018 (UTC)
- I'd like to refer interested editors in general and @Coffee.sleep.repeat: in particular to this page where I explain that a correct understanding of how categories work is the root of this issue. Morgan Leigh | Talk 07:06, 3 December 2018 (UTC)
- So, now that you understand, are you going to stop adding spurious categories, or not? -Roxy, the naughty dog. wooF 08:42, 3 December 2018 (UTC)
- Actually for those who insist that alt-med be defined as what doesn't work, and medicine as what does, acu should be in both categories because it works for a few things. --Middle 8 (t • c | privacy • acupuncture COI?) 11:04, 3 December 2018 (UTC)
- No it doesn't. It doesn't matter where you put the needles or even whether you put them in or not, any "effects" are small, transient, and only affect subjective outcomes self-reported by the patients. It is an absolutely classic fake treatment. Guy (Help!) 13:07, 3 December 2018 (UTC)
- Can we have a source that supports that text? Morgan Leigh | Talk 22:58, 3 December 2018 (UTC)
- No it doesn't. It doesn't matter where you put the needles or even whether you put them in or not, any "effects" are small, transient, and only affect subjective outcomes self-reported by the patients. It is an absolutely classic fake treatment. Guy (Help!) 13:07, 3 December 2018 (UTC)
- Actually for those who insist that alt-med be defined as what doesn't work, and medicine as what does, acu should be in both categories because it works for a few things. --Middle 8 (t • c | privacy • acupuncture COI?) 11:04, 3 December 2018 (UTC)
- So, now that you understand, are you going to stop adding spurious categories, or not? -Roxy, the naughty dog. wooF 08:42, 3 December 2018 (UTC)
- I'd like to refer interested editors in general and @Coffee.sleep.repeat: in particular to this page where I explain that a correct understanding of how categories work is the root of this issue. Morgan Leigh | Talk 07:06, 3 December 2018 (UTC)
- What McSly said. -Roxy, the naughty dog. wooF 08:30, 27 November 2018 (UTC)
Perhaps you could start by reading the sources for the article. You will find that Guy has summarized the results of years of studies and reviews including the latest conclusions. I actually find that summary the best I have seen on acupuncture research in some time.MrBill3 (talk) 23:21, 3 December 2018 (UTC)
- I always consider the 'effect' the acu equivalent of going "Pat, Pat, - 'There There'." -Roxy, the dog. wooF 00:55, 4 December 2018 (UTC)
- @Roxy the dog: FWIW: WP:TALK 1st 2 sentences. Just sayin'. --Middle 8 (t • c | privacy • acupuncture COI?) 11:04, 4 December 2018 (UTC)
- @Middle 8:Hi M8, I've missed you. Have you seen our Sealioning article? -Roxy, the dog. wooF 14:10, 4 December 2018 (UTC)
- @Roxy the dog: FWIW: WP:TALK 1st 2 sentences. Just sayin'. --Middle 8 (t • c | privacy • acupuncture COI?) 11:04, 4 December 2018 (UTC)
- @JzG: Yes, I've read the blogs where that opinion is expressed. Are those the sources you'd use to answer Morgan Leigh's question? NICE and Harrison's (better sources) say differently. Remember scientists use blogs for opinions and peer review for findings, and here peer review hasn't "caught up" with opinions/predictions (however prescient they may be). @MrBill3: Did you read that diff I used just above? (Better link for NICE/NHS scroll to "Uses of acupuncture" here.) Any summary excluding such sources is inadequate (MEDRS don't get better/more mainstream). --Middle 8 (t • c | privacy • acupuncture COI?) 11:04, 4 December 2018 (UTC)
- The function of science communicators is to succinctly summarise the research in lay terms. And as a lay summary that is hard to beat. Ernst's stage dagger needles conclusively demonstrated that insertion or not makes no difference, backing a number of other studies using other methods; there are a large number of studies showing that position is unimportant, and this is indeed obvious from the existence of multiple acupuncture traditions with different dogmas. The conclusion that acupuncture "affects" only subjective symptoms is also well-supported, as is the existence of adverse events up to and including death. I know you are a believer, but your belief is misplaced and that succinct lay summary of the evidence shows exactly why. Guy (Help!) 12:50, 4 December 2018 (UTC)
- This is not about any editor's opinion as to the efficacy of Acupuncture. It is about the sources, using good ones and representing them accurately. The above comment sounds as if you are advocating using a blog rather than using peer reviewed sources. Morgan Leigh | Talk 22:15, 4 December 2018 (UTC)
- This is a talk page. It is perfectly reasonable to use a lay summary from a expert sources (in this case both Edzard Ernst and Steve Novella, both of whom have a stellar reputation for critiquing alternatives to medicine). Guy (Help!) 22:49, 4 December 2018 (UTC).
- We are not discussing the subject. We are discussing which sources are good to go in the article. In response to my post at the reliable sources noticeboard here you stated that acupuncture doesn't work but when asked there for a source to support your statement by @Slatersteven: you have offered nothing. I subsequently reiterated that question here when you said the same thing, using almost exactly the same words, to wit, "It doesn't matter where you put the needles or even whether you put them in or not, any "effects" are small, transient, and only affect subjective outcomes self-reported by the patients. It is an absolutely classic fake treatment."? You offered a blog in support of your proposition. I have provided three peer reviewed meta analyses that provide evidence of the efficacy of acupuncture for certain conditions. All three have been removed from the article with a claim that they are POV. I suggest that a blog is not a more reliable source than three peer reviewed meta analyses. Do you agree?
- This is a talk page. It is perfectly reasonable to use a lay summary from a expert sources (in this case both Edzard Ernst and Steve Novella, both of whom have a stellar reputation for critiquing alternatives to medicine). Guy (Help!) 22:49, 4 December 2018 (UTC).
- This is not about any editor's opinion as to the efficacy of Acupuncture. It is about the sources, using good ones and representing them accurately. The above comment sounds as if you are advocating using a blog rather than using peer reviewed sources. Morgan Leigh | Talk 22:15, 4 December 2018 (UTC)
- The function of science communicators is to succinctly summarise the research in lay terms. And as a lay summary that is hard to beat. Ernst's stage dagger needles conclusively demonstrated that insertion or not makes no difference, backing a number of other studies using other methods; there are a large number of studies showing that position is unimportant, and this is indeed obvious from the existence of multiple acupuncture traditions with different dogmas. The conclusion that acupuncture "affects" only subjective symptoms is also well-supported, as is the existence of adverse events up to and including death. I know you are a believer, but your belief is misplaced and that succinct lay summary of the evidence shows exactly why. Guy (Help!) 12:50, 4 December 2018 (UTC)
- As a reminder there are two changes to be considered.
- 1)The article currently says;
- "The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits." Citing this source Wang SM, Kain ZN, White PF (February 2008). "Acupuncture analgesia: II. Clinical considerations". Anesthesia and Analgesia. 106 (2): 611–21 doi:10.1213/ane.0b013e318160644d
- I suggest changing it to;
- "One systematic review found little evidence of acupuncture's effectiveness in treating pain(sourced to Ernst E, Lee MS, Choi TY (April 2011). "Acupuncture: does it alleviate pain and are there serious risks? A review of reviews" (PDF). Pain. 152 (4): 755–64), while others have found it to be effective.
- The sources I suggest citing for this change are;
- Vickers, Cronin, Maschino, et al, (2012), Acupuncture for Chronic Pain:Individual Patient Data Meta-analysis, Arch Intern Med. 2012;172(19):1444-1453. doi:10.1001/archinternmed.2012.3654
- Hopton, MacPherson, (2010), Acupuncture for Chronic Pain: Is Acupuncture More than an Effective Placebo? A Systematic Review of Pooled Data from Meta‐analyses, Pain Practice, Volume 10, Issue 2, March/April 2010, Pages 94-102
- Kwon, Pittler, Ernst, (2006), Acupuncture for peripheral joint osteoarthritis: A systematic review and meta-analysis, Rheumatology, Volume 45, Issue 11, 1 November 2006, Pages 1331–1337, https://doi.org/10.1093/rheumatology/kel207
- 2)The article currently says;
- "The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits." and cited this source Wang SM, Kain ZN, White PF (February 2008). "Acupuncture analgesia: II. Clinical considerations". Anesthesia and Analgesia. 106 (2): 611–21 doi:10.1213/ane.0b013e318160644d
- I propose we change it to more accurately represent the source to;
- "A review of randomized, sham-controlled clinical investigations found that treatment with acupuncture is "effective in the short-term management of low back pain, neck pain, and osteoarthritis involving the knee" but that it does not produce long-term benefits."
- I ask my fellow editors to please address these two proposed changes by answering these two questions, are these changes supported by these sources? Are these sources reliable for this text? Morgan Leigh | Talk 05:27, 5 December 2018 (UTC)
- Sure, I'll address them. No, and no.
- No because it replaces a factual summary with weasel words that make it sound as if only one or a few sources finds these facts. That's not true. There is no long term benefit from sticking needles into people, and it can cause adverse events up to and including death, so we don't give undue weight to the beliefs of those who fervently wish otherwise.
- A reminder: acupuncture is an alternative to medicine based on the idea that all diseases are caused by disturbances in the flow of qi through meridians that can be rebalanced by inserting needles at specific points in the body. Qi does not exist, meridians do not exist, competing schools of acupuncture have different acupoints, assiduous research shows that it doesn't matter where you put the needles or even whether you stick them in at all, there is no credible evidence of any long-term effect and no credible evidence of objective effect.
- It has taken a long time to design studies that properly blind and control, due to the invasive nature of acupuncture. The development of more sophisticated blinding and controls has fatally undermined the claims of acupuncture proponents. Acupuncture fans have spent years at this article trying to "balance" this with studies showing positive outcomes which virtually all share the same trifecta: 1. They deal with subjective outcomes; 2. they use self-reporting; 3. they are produced by people with a vested interest in acupuncture. Guy (Help!) 08:17, 5 December 2018 (UTC)
- I ask my fellow editors to please address these two proposed changes by answering these two questions, are these changes supported by these sources? Are these sources reliable for this text? Morgan Leigh | Talk 05:27, 5 December 2018 (UTC)
- Which words exactly do you contend are weasel words?
- If you are objecting to the use of the word one in the proposed sentence, "One systematic review found little evidence of acupuncture's effectiveness in treating pain, while others have found it to be effective." The word one is there because one review is cited for that statement whereas three are cited for the other statement. I note that the existing version says "The evidence suggests that..." which sounds as if all the evidence suggests, whereas in fact the statement is supported by one review. If you have more sources to cite for that finding I encourage you to add them and then it can say "Some reviews have found... while others..." which is super balanced. Morgan Leigh | Talk 08:51, 5 December 2018 (UTC)
- I think it's obvious to those of us who are not True Believers. Casting this as "this one review said X" when the one review actually reflects the reality-based consensus is weaselly. It's also worth remembering that when the Cochrane study said "there is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture", the reality-based community recognised that this means it doesn't work whereas the True Believers claimed it as validating acupuncture because it's so great that even fake acupuncture works. That is the perfect exemplar of how the SCAM community reviews evidence. Guy (Help!) 12:17, 7 December 2018 (UTC)
- If you are objecting to the use of the word one in the proposed sentence, "One systematic review found little evidence of acupuncture's effectiveness in treating pain, while others have found it to be effective." The word one is there because one review is cited for that statement whereas three are cited for the other statement. I note that the existing version says "The evidence suggests that..." which sounds as if all the evidence suggests, whereas in fact the statement is supported by one review. If you have more sources to cite for that finding I encourage you to add them and then it can say "Some reviews have found... while others..." which is super balanced. Morgan Leigh | Talk 08:51, 5 December 2018 (UTC)
There have been studies of acupuncture for decades. A very few studies have shown any effect and those results are evaporating as methodology evolves. There is what is called a preponderance of evidence that acupuncture has no long term benefit and that the short term benefits are slight and quite probably statistical anomalies or confounding factors. There is zero support for the theoretical underpinnings. There is zero evidence that the mechanisms proposed exist at all. There are significant risks and harm has resulted. The article must clearly represent that. Perhaps it is time to WP:Drop the stick. Take some time to read the archives and try not to rehash. Really this has been gone over. MrBill3 (talk) 10:22, 5 December 2018 (UTC)
- Instead of expressions of personal opinions can we please answer the question at hand? i.e. Are the specific sources I mentioned reliable and do they accurately represent the text proposed? Morgan Leigh | Talk 03:12, 7 December 2018 (UTC)
- As I see it, much of the problem is down to the plethora of studies carried out on acupuncture which say very little. In the past a problem that has plagued this article is having huge lists of citations yet conveying little or no knowledge to the reader. So I agree, this is one of those occasions where we need decent tertiary commentary (or a review of reviews) in order to build a coherent article. Most of the scholarly tertiary sources are quite old now, so it's reasonable to use something from Ernst etc. I think. More recently, I think this piece[4] done for the NHS offers a reasonable overview of the current situations ... executive summary: evidence for acupuncture helping pain is weak, and even then there is doubt whether it's useful and/or cost-effective. Alexbrn (talk) 10:32, 5 December 2018 (UTC)
- Not sure this has been posted already but here is a summary of all Cochrane reviews on acupuncture until Nov 2017: https://www.scienceinmedicine.org.au/wp-content/uploads/2018/01/Cochrane-acupuncture-2017.pdf. Says it all really... Lucleon (talk) 10:41, 5 December 2018 (UTC)
- What that list of reviews actually says is that you are presenting an incomplete list framed to a skeptical POV, complied by a renowned skeptic. That is not a complete list of all Cochrane reviews on acupuncture. If you go to the Cochrane site you will see that there are 122 Cochrane reviews about acupuncture while that list has only 42. The URL indicates the list you mentioned is from the Institute for Science in Medicine, which was founded by renowned skeptic David Gorski.
- Bearing this in mind it is unsurprising to note the summaries on that list are framed to be a negative as possible. For example this study on fibromyalgia is summarized on that list as
whereas the conclusions of the author's of the review say in full,The small sample size, scarcity of studies for each compassion, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implication
There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being. EA is probably better than MA for pain and stiffness reduction and improvement of global well-being, sleep and fatigue. The effect lasts up to one month, but is not maintained at six months follow-up. MA probably does not improve pain or physical functioning. Acupuncture appears safe. People with fibromyalgia may consider using EA alone or with exercise and medication. The small sample size, scarcity of studies for each comparison, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implications. Larger studies are warranted.
- Not sure this has been posted already but here is a summary of all Cochrane reviews on acupuncture until Nov 2017: https://www.scienceinmedicine.org.au/wp-content/uploads/2018/01/Cochrane-acupuncture-2017.pdf. Says it all really... Lucleon (talk) 10:41, 5 December 2018 (UTC)
- This exemplifies what is going on in this article at present. Evidence is being skewed to a skeptical POV. Morgan Leigh | Talk 03:12, 7 December 2018 (UTC)
- Yes, the list is from a website made be renowned people, which makes the list only better in my opinion. Which Cochrane review on acupuncture are you missing? The 1-line summary from the website you single out is consistent with the complete summary: low to moderate-level evidence from studies with small sample size and a scarcity of studies for comparison.Lucleon (talk) 07:35, 7 December 2018 (UTC)
- A renowned skeptic. There are 80 reviews missing from that list. It is not consistent with the summary because the summary doesn't make any mention that "acupuncture improves pain and stiffness in people with fibromyalgia". Morgan Leigh | Talk 08:23, 7 December 2018 (UTC)
- "Scientific skepticism ... is a practical, epistemological position in which one questions the veracity of claims lacking empirical evidence." (Quote from Skeptical movement). I don't see what could be wrong with having such a position when we are discussing potential medical treatments. You are referring to 80 missing Cochrane reviews but it's not clear where this number comes from. Can you mention some of Cochrane reviews you are missing? Regarding the review you mentioned above: the point is that low to moderate-level evidence from a small number of studies with small sample size and a lack of an ideal sham acupuncture is not a basis to claim that "acupuncture improves pain and stiffness in people with fibromyalgia" without further elaboration. Lucleon (talk) 09:50, 7 December 2018 (UTC)
- If you go to the Cochrane reviews site and search for acupuncture you will find 122 reviews either specifically about acupuncture only or that mention acupuncture. Yes, I can mention them, see below. Re the fibromyalgia review, you seem to be arguing that a Cochrane review is not good enough to justify its findings. Is this the case? A skeptic who was true to the principles of science wouldn't need to present an abbreviated list as if it were a full list and wouldn't need to summarise the results omitting any mention of positive results. They also wouldn't need to try to discredit scholars based solely on the field in which they study. They wouldn't find it necessary to disparage other by labeling them "true believers' and claiming they weren't "reality based". That looks like an undesirable POV to me. Morgan Leigh | Talk 02:55, 8 December 2018 (UTC)
- "Scientific skepticism ... is a practical, epistemological position in which one questions the veracity of claims lacking empirical evidence." (Quote from Skeptical movement). I don't see what could be wrong with having such a position when we are discussing potential medical treatments. You are referring to 80 missing Cochrane reviews but it's not clear where this number comes from. Can you mention some of Cochrane reviews you are missing? Regarding the review you mentioned above: the point is that low to moderate-level evidence from a small number of studies with small sample size and a lack of an ideal sham acupuncture is not a basis to claim that "acupuncture improves pain and stiffness in people with fibromyalgia" without further elaboration. Lucleon (talk) 09:50, 7 December 2018 (UTC)
- Close. A scientific POV, which, in Wikipedia articles on science and medicine, is the same thing as the neutral POV. You know the old saying: extraordinary claims require extraordinary evidence. The claims of acupuncture are absolutely extraordinary: a 19th Century reworking of bloodletting, based on folk superstitions about life energy originated long before the modern science of anatomy, somehow resulted in a profound method of healing even though all the premises on which it is based are now definitively refuted. The evidence is not in the least bit extraordinary: True Believers conducting endless poorly controlled, poorly blinded studies measuring usually self-reported effects on subjective outcomes, contradicted by much more carefully designed studies by more skeptical researchers. If you believe in the thing and don't try too hard to disprove it, you end up "proving" the thing every time. These tactics kept homeopathy from the scrapheap for half a century, and it's only recently that publicly funded health bodies have started addressing that particular form of health fraud. The trajectory for acupuncture is the same. Guy (Help!) 12:12, 7 December 2018 (UTC)
- Once again you are expressing your own opinions and not addressing the specific sources. Morgan Leigh | Talk 02:55, 8 December 2018 (UTC)
- Close. A scientific POV, which, in Wikipedia articles on science and medicine, is the same thing as the neutral POV. You know the old saying: extraordinary claims require extraordinary evidence. The claims of acupuncture are absolutely extraordinary: a 19th Century reworking of bloodletting, based on folk superstitions about life energy originated long before the modern science of anatomy, somehow resulted in a profound method of healing even though all the premises on which it is based are now definitively refuted. The evidence is not in the least bit extraordinary: True Believers conducting endless poorly controlled, poorly blinded studies measuring usually self-reported effects on subjective outcomes, contradicted by much more carefully designed studies by more skeptical researchers. If you believe in the thing and don't try too hard to disprove it, you end up "proving" the thing every time. These tactics kept homeopathy from the scrapheap for half a century, and it's only recently that publicly funded health bodies have started addressing that particular form of health fraud. The trajectory for acupuncture is the same. Guy (Help!) 12:12, 7 December 2018 (UTC)
MY response was to a specific question about a specific source, not sources as a whole (nor is it a comment on acupuncture+.Slatersteven (talk) 10:43, 5 December 2018 (UTC)
@Alexbrn: That NHS piece is a balanced piece, but instead of citing it why don't we cite the paper it was based on? The paper is Cummings, Hróbjartsson & Ernst, (2018), BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k970. It's a recent paper reviewing the evidence that covers both sides of the debate. I note that I am trying to cite three recent meta reviews...Morgan Leigh | Talk 03:12, 7 December 2018 (UTC)
- The trouble with that is that it's got stuff from a acupuncture advocate which is bonkers. Although the BMJ can do this kind of "two sides" thing, we are prohibited from doing it by WP:GEVAL policy. We need to make sure that the pseudoscience is kept in its box. Alexbrn (talk) 04:23, 7 December 2018 (UTC)
- So the trouble with that paper is that it shows both sides? POV much. We are most certainly not prevented from explaining both side of any given position. By your usage of "bonkers" I am presuming that you feel the source might be biased. WP:BIASED says, "However, reliable sources are not required to be neutral, unbiased, or objective. Sometimes non-neutral sources are the best possible sources for supporting information about the different viewpoints held on a subject.". It is hard to see how a peer reviewed paper that presents both sides of a position is biased though... Moreover WP:GEVAL says "While it is important to account for all significant viewpoints on any topic, Wikipedia policy does not state or imply that every minority view or extraordinary claim needs to be presented along with commonly accepted mainstream scholarship as if they were of equal validity." That acupuncture has some level of effectiveness for some conditions is hardly a minority view nor an extraordinary claim. "The Earth is flat" is a minority view and an extraordinary claim. There is scientific evidence from reliable sources that acupuncture has some degree of efficacy for some conditions. Like the ones I am proposing to cite. Which takes me back to the actual question here, are the aforementioned changes supported by the sources? Are these sources reliable for this text? Morgan Leigh | Talk 05:25, 7 December 2018 (UTC)
- It's very fringey to argue that doctors "should" prescribe acupuncture for pain yes, so we're not going to frame that as just one side of "the debate" - it's not a debate being had in the real world. The situation is that whereas acupuncturists have historically made claims that it works for pretty much everything, today they have retreated to the last patch of ground, pain (notoriously difficult to assess via EBM) but even here as the source I mentioned states, the evidence - for a small effect - is weak. So the summary is that acupuncture doesn't work for anything except maybe pain relief, and there isn't even good evidence it works for that. I have already said how this could be sourced. Alexbrn (talk) 05:43, 7 December 2018 (UTC)
- Considering that it is a debate going on in the BMJ it is most certainly (a) a debate going on in the real world and (b) not fringey, the BMJ is as unfringey as it gets. I have offered peer reviewed papers that demonstrate some evidence of some effect for acupuncture for some conditions. You have suggested we only cite people with a particular view and that people who don't agree with that view are "bonkers". Science doesn't proceed with the assumption that people with a certain view are bonkers and so we should ignore their research. It tests claims and produces papers. I suggest we approach this as science does, one paper at a time. Starting with accurately representing what the papers already in the article say. Once again I ask, are the aforementioned changes supported by the sources? Are these sources reliable for this text? Morgan Leigh | Talk 08:23, 7 December 2018 (UTC)
- Well, if you're going to misrepresent my words there seems no point in continuing this discussion. I have suggested a way forward. Alexbrn (talk) 08:28, 7 December 2018 (UTC)
- Exactly how have I misrepresented your words? I sincerely hope I have misunderstood you, but it seems your way forward is to not cite evidence that supports the use of acupuncture. You suggested the NHS article. I suggested citing the paper it is based on and you said you couldn't do that because it contained information from someone who is bonkers. If this is not the case please explain what your way forward is. If its citing the NHS article, ok let's do that. How about we cite this quote from the NHS article "To summarise, evidence outlining the benefits of acupuncture does exist, but it is not strong evidence. There are also concerns the positive effects found in acupuncture research are only small and, arguably, due to a placebo effect.".Morgan Leigh | Talk 08:53, 7 December 2018 (UTC)
- @Alexbrn: Re GEVAL: Read GEVAL in the context of WP:NPOV of which it's a part, e.g. the first sentence of UNDUE. To the extent an RS GEVAL's, we GEVAL, when citing that source and according to its weight. Basic NPOV. --Middle 8 (t • c | privacy • acupuncture COI?) 09:56, 10 December 2018 (UTC)
- I'm sure we can spawn all kinds of alternatives to Wikipedia's WP:PAGs by creative invocations of "context"! Unfortunately for the acupuncturists here, GEVAL is explicit: even "plausible" but currently unaccepted theories should not be legitimized through comparison to accepted academic scholarship. So the fringe assertions of an acupuncturist (backed by their equally fringe publications) that acupuncture is in line with science are not going to be used to counterpoint basic scientific reality. This is doubly so when we have rock solid RS informing us that acupucture is pseudoscience. Alexbrn (talk) 10:12, 10 December 2018 (UTC)
- Yes, reading WP:NPOV all the way through, what a rad concept. Read right above GEVAL,
An article should not give undue weight to minor aspects of its subject, but should strive to treat each aspect with a weight proportional to its treatment in the body of reliable, published material on the subject.
BMJ is part of that body of material -- in fact the idea that acu is a powerful tool in pain management turns out to be a very mainstream view. --Middle 8 (t • c | privacy • acupuncture COI?) 10:39, 10 December 2018 (UTC)
- Yes, reading WP:NPOV all the way through, what a rad concept. Read right above GEVAL,
- I'm sure we can spawn all kinds of alternatives to Wikipedia's WP:PAGs by creative invocations of "context"! Unfortunately for the acupuncturists here, GEVAL is explicit: even "plausible" but currently unaccepted theories should not be legitimized through comparison to accepted academic scholarship. So the fringe assertions of an acupuncturist (backed by their equally fringe publications) that acupuncture is in line with science are not going to be used to counterpoint basic scientific reality. This is doubly so when we have rock solid RS informing us that acupucture is pseudoscience. Alexbrn (talk) 10:12, 10 December 2018 (UTC)
- Well, if you're going to misrepresent my words there seems no point in continuing this discussion. I have suggested a way forward. Alexbrn (talk) 08:28, 7 December 2018 (UTC)
- Considering that it is a debate going on in the BMJ it is most certainly (a) a debate going on in the real world and (b) not fringey, the BMJ is as unfringey as it gets. I have offered peer reviewed papers that demonstrate some evidence of some effect for acupuncture for some conditions. You have suggested we only cite people with a particular view and that people who don't agree with that view are "bonkers". Science doesn't proceed with the assumption that people with a certain view are bonkers and so we should ignore their research. It tests claims and produces papers. I suggest we approach this as science does, one paper at a time. Starting with accurately representing what the papers already in the article say. Once again I ask, are the aforementioned changes supported by the sources? Are these sources reliable for this text? Morgan Leigh | Talk 08:23, 7 December 2018 (UTC)
- It's very fringey to argue that doctors "should" prescribe acupuncture for pain yes, so we're not going to frame that as just one side of "the debate" - it's not a debate being had in the real world. The situation is that whereas acupuncturists have historically made claims that it works for pretty much everything, today they have retreated to the last patch of ground, pain (notoriously difficult to assess via EBM) but even here as the source I mentioned states, the evidence - for a small effect - is weak. So the summary is that acupuncture doesn't work for anything except maybe pain relief, and there isn't even good evidence it works for that. I have already said how this could be sourced. Alexbrn (talk) 05:43, 7 December 2018 (UTC)
- So the trouble with that paper is that it shows both sides? POV much. We are most certainly not prevented from explaining both side of any given position. By your usage of "bonkers" I am presuming that you feel the source might be biased. WP:BIASED says, "However, reliable sources are not required to be neutral, unbiased, or objective. Sometimes non-neutral sources are the best possible sources for supporting information about the different viewpoints held on a subject.". It is hard to see how a peer reviewed paper that presents both sides of a position is biased though... Moreover WP:GEVAL says "While it is important to account for all significant viewpoints on any topic, Wikipedia policy does not state or imply that every minority view or extraordinary claim needs to be presented along with commonly accepted mainstream scholarship as if they were of equal validity." That acupuncture has some level of effectiveness for some conditions is hardly a minority view nor an extraordinary claim. "The Earth is flat" is a minority view and an extraordinary claim. There is scientific evidence from reliable sources that acupuncture has some degree of efficacy for some conditions. Like the ones I am proposing to cite. Which takes me back to the actual question here, are the aforementioned changes supported by the sources? Are these sources reliable for this text? Morgan Leigh | Talk 05:25, 7 December 2018 (UTC)
"It’s a safe alternative to drugs that is under-researched because it lacks commercial interest, writes Mike Cummings, but Asbjørn Hróbjartsson and Edzard Ernst argue there is no convincing evidence of clinical benefit and that the potential risks and health service costs are unjustified" So I am not sure the paper can be used, as it seems to not be that clear cut. At best if could be used to show that Dr Mike Cummings think s it is medical useful, not that this represents any kind of consensus that it is. As such it could not be used toi show that the wider medical community thinks this is a valid form of medicine As opposed to alternative medicine)Slatersteven (talk) 15:31, 7 December 2018 (UTC)
- Yes. "Acupuncture advocate advocates for acupuncture" doesn't really help enlighten our readers. My favourite bit of the article is where Cummings asserts acupuncture is supported by basic science and cites in support – his own book! But again, "acupuncturist asserts acupuncture is scientificially sound" doesn't help our readers either. The whole Cummings side of this paper is not WP:FRINDependent. Alexbrn (talk) 15:40, 7 December 2018 (UTC)
- Cummings doesn't cite a book by him in this article. He cites a paper he published in the BMJ. [BMJ 2017. http://www.bmj.com/content/356/bmj.i6748/rr-6 Low back pain and sciatica: summary of NICE guidance] And Hróbjartsson cites himself and so does Ernst. A paper doesn't need to be clear cut to be cited. Such a paper is useful because it shows both side of an issue. I am familiar with the argument that people who study things skeptics don't agree with can't be cited because they are obviously biased. It gets reeled out a lot here lately. It akin to saying you can't cite a neurologist about neurology.
- If only there was more evidence that said acupuncture might be effective...
- Deare, Zheng etal. (2013) Acupuncture for fibromyalgia "There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia."
- Linde, Allais etal (2016) Acupuncture for preventing migraine attacks "The available evidence suggests that a course of acupuncture consisting of at least six treatment sessions can be a valuable option for people with migraine". "The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small."
- Vickers, Cronin, Maschino, et al, (2012), Acupuncture for Chronic Pain:Individual Patient Data Meta-analysis, Arch Intern Med. 2012;172(19):1444-1453. doi:10.1001/archinternmed.2012.3654 - "Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo."
- Hopton, MacPherson, (2010), Acupuncture for Chronic Pain: Is Acupuncture More than an Effective Placebo? A Systematic Review of Pooled Data from Meta‐analyses, Pain Practice, Volume 10, Issue 2, March/April 2010, Pages 94-102 - "...evidence from pooled data from recent meta analyses of acupuncture for chronic pain shows that there is accumulating evidence to support the contention that acupuncture has specific effects beyond the placebo."
- Kwon, Pittler, Ernst, (2006), Acupuncture for peripheral joint osteoarthritis: A systematic review and meta-analysis, Rheumatology, Volume 45, Issue 11, 1 November 2006, Pages 1331–1337, https://doi.org/10.1093/rheumatology/kel207 - " "... sham controlled RCTs suggest specific effects of accupuncture for pain control in paitens with peripheral joint OA. Considering its favourable safety profile, acupuncture seems an options worthy of consideration particularily for knee OA".
- Furlan, van Tulder et al. (2005) Acupuncture and dry‐needling for low back pain - "For chronic low‐back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short‐term only"
- Shen, Xia et al (2014) Acupuncture for schizophrenia - "Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects."
- Armour, Ee et al. (2018) Acupuncture and acupressure for premenstrual syndrome "The limited evidence available suggests that acupuncture and acupressure may improve both physical and psychological symptoms of PMS when compared to a sham control."
- Smith, Collins et al. (2011) Acupuncture or acupressure for pain management in labour - "Acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management.
- Lee, Chan et al. (2015) Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting "There is low‐quality evidence supporting the use of PC6 acupoint stimulation over sham."
- White, Foster et al. (2007) Acupuncture treatment for chronic knee pain: a systematic review - "Acupuncture that meets criteria for adequate treatment is significantly superior to sham acupuncture and to no additional intervention in improving pain and function in patients with chronic knee pain."
- Belivani, Dimitroula et al. Acupuncture in the treatment of obesity: a narrative review of the literature "Both experimental and current clinical data suggest that acupuncture (in different forms) exerts beneficial effects on obesity."
- I suggest we cite these papers for the quotes provided and ask, are these sources reliable for this text?Morgan Leigh | Talk 02:55, 8 December 2018 (UTC)
- Which text? -Roxy, the dog. wooF 06:05, 8 December 2018 (UTC)
- @Morgan Leigh: citing neurology to a neurologist is generally fine, but it's not fine citing acupuncutre material to an acupuncturist any more than it is citing astrology explanations to an astrologer, or history to a 9/11 Truther. That's rather the whole point of WP:FRIND. If there really were an accepted scientific basis for acupuncture, it would be easy to find it in stated in independent sources. Alexbrn (talk) 11:20, 8 December 2018 (UTC)
- So you assert that acupuncture is WP:FRINGE? Science is about examining the evidence. Suppressing information about whole subject areas because one has decided are dodgy is not science. There is a name for it though. It is a witch hunt. Morgan Leigh | Talk 01:39, 9 December 2018 (UTC)
- I am asking for agreement that the sources mentioned are reliable for the quotation following each citation. Should we arrive at some kind of consensus then explicit changes can be made. But if you want an explicit edit to start with then we might consider changing the present text,
- I suggest we cite these papers for the quotes provided and ask, are these sources reliable for this text?Morgan Leigh | Talk 02:55, 8 December 2018 (UTC)
- "A systematic review found little evidence of acupuncture's effectiveness in treating pain."
- which cites this source Ernst E, Lee MS, Choi TY (April 2011). "Acupuncture: does it alleviate pain and are there serious risks? A review of reviews" (PDF). Pain. 152 (4): 755–64. doi:10.1016/j.pain.2010.11.004.
- to,
- "A 2011 systematic review found little evidence of acupuncture's effectiveness in treating pain (Citing Ernst E, Lee MS, Choi TY (April 2011). "Acupuncture: does it alleviate pain and are there serious risks? A review of reviews" (PDF). Pain. 152 (4): 755–64), while others have found it to be effective. (Citing Vickers, Cronin, Maschino, et al, (2012), Acupuncture for Chronic Pain:Individual Patient Data Meta-analysis, Arch Intern Med. 2012;172(19):1444-1453. doi:10.1001/archinternmed.2012.3654
- Hopton, MacPherson, (2010), Acupuncture for Chronic Pain: Is Acupuncture More than an Effective Placebo? A Systematic Review of Pooled Data from Meta‐analyses, Pain Practice, Volume 10, Issue 2, March/April 2010, Pages 94-102
- Kwon, Pittler, Ernst, (2006), Acupuncture for peripheral joint osteoarthritis: A systematic review and meta-analysis, Rheumatology, Volume 45, Issue 11, 1 November 2006, Pages 1331–1337) Morgan Leigh | Talk 09:56, 8 December 2018 (UTC)
- A lot of old, and some fringe, sources there. The science has moved on. We should really be up-to-date by saying something along the lines of the (recent) piece for the NHS I've linked above. Something like (per the source): acupuncture doesn't work for anything except maybe pain, and even there the evidence of effect isn't good enough to be sure it's useful. That's the current knowledge, saying anything else strikes me as in danger of being WP:PROFRINGE especially since we know acupuncure is a pseudoscience, so per WP:REDFLAG any claim of effectiveness for any condition would require multiple sources of the very hightest quality. Alexbrn (talk) 10:59, 8 December 2018 (UTC)
- Opinion. Again. Please address the sources. Which ones do you contend are fringe? The oldest one is 2005. How is this too old? Morgan Leigh | Talk 01:39, 9 December 2018 (UTC)
- I have to agree with Alexbrn. And I oppose changing the wording of the article to equivocating. The evidence has been building for years and it is now widely accepted that with all the studies there just isn't any quality evidence that demonstrates any genuine effect. This overly long discussion is not related to the subject header. A new section with a concrete proposal for improving the encyclopedia is called for, or a dropping of the stick. FRIND, PROFINGE, DUE, MEDRS these guidelines and policies have been pointed to and correctly referred to. We really don't need to say they are planning to check past the edge of the flat earth to see if the proof acupuncture is an efficacious and beneficial thing to do to people. MrBill3 (talk) 12:22, 8 December 2018 (UTC)
- Opinion. Again. Please address the sources. Can you source your claim that it is "widely accepted"? How do you reconcile this asserting with the numerous peer reviewed sources I have mentioned?Morgan Leigh | Talk 01:39, 9 December 2018 (UTC)
- Yup. It doesn't matter where you put the needles, it doesn't matter whether you stick them in or not, the basis of claimed action was refuted over a century ago, there are no objective effects, subjective effects are short-lived and usually clinically irrelevant, and the difficulty of properly blinding makes it impossible to rule out bias and confounding in any of the positive studies. Any drug sold on this basis, and showing evidence of adverse effects, as acupuncture does, would be withdrawn. Guy (Help!) 15:35, 8 December 2018 (UTC)
- Opinion. Again. You have expressed this opinion three times now, in almost exactly the same words and each time you have been asked to provided sources that substantiate it and you have offered nothing. Morgan Leigh | Talk 01:39, 9 December 2018 (UTC)
- A lot of old, and some fringe, sources there. The science has moved on. We should really be up-to-date by saying something along the lines of the (recent) piece for the NHS I've linked above. Something like (per the source): acupuncture doesn't work for anything except maybe pain, and even there the evidence of effect isn't good enough to be sure it's useful. That's the current knowledge, saying anything else strikes me as in danger of being WP:PROFRINGE especially since we know acupuncure is a pseudoscience, so per WP:REDFLAG any claim of effectiveness for any condition would require multiple sources of the very hightest quality. Alexbrn (talk) 10:59, 8 December 2018 (UTC)
- That BMJ link is to a Rapid Response, i.e. a letter. By Mike Cummings. Guy (Help!) 15:35, 8 December 2018 (UTC)
- As it says in the paper, that BMJ link is a peer reviewed head to head commissioned by the BMJ and authored by Cummings, Hróbjartsson and Ernst.Morgan Leigh | Talk 01:39, 9 December 2018 (UTC)
- Science is not done by panel discussion. Guy (Help!) 11:02, 10 December 2018 (UTC)
- Is that your entire rebuttal of the inclusion of this peer reviewed paper, commissioned by and published in the BMJ?Morgan Leigh | Talk 22:04, 10 December 2018 (UTC)
- Acupuncture in Medicine (in which PMID 23153472 appears) is not the BMJ. BMJ Group publish many journals, some of them fringe journals we we do not use per WP:FRIND: like Acupuncture in Medicine. Per WP:MEDRS we should generally not be using any source more than 5 years old if newer pertinent material is available. We do not use weak primary sources (e.g. letters even in the real BMJ) for assertions about WP:Biomedical information. All of this is pretty basic. Alexbrn (talk) 08:18, 11 December 2018 (UTC)
- The paper to which you refer is "Acupuncture in the treatment of obesity: a narrative review of the literature.". No one has claimed it was in the BMJ. However I do contest your assertion that Acupuncture in Medicine is a fringe journal. Most importantly though we are referring here to "Should doctors recommend acupuncture for pain? BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k970 (Published 07 March 2018) BMJ 2018;360:k970".
- Acupuncture in Medicine (in which PMID 23153472 appears) is not the BMJ. BMJ Group publish many journals, some of them fringe journals we we do not use per WP:FRIND: like Acupuncture in Medicine. Per WP:MEDRS we should generally not be using any source more than 5 years old if newer pertinent material is available. We do not use weak primary sources (e.g. letters even in the real BMJ) for assertions about WP:Biomedical information. All of this is pretty basic. Alexbrn (talk) 08:18, 11 December 2018 (UTC)
- Is that your entire rebuttal of the inclusion of this peer reviewed paper, commissioned by and published in the BMJ?Morgan Leigh | Talk 22:04, 10 December 2018 (UTC)
- Science is not done by panel discussion. Guy (Help!) 11:02, 10 December 2018 (UTC)
- As it says in the paper, that BMJ link is a peer reviewed head to head commissioned by the BMJ and authored by Cummings, Hróbjartsson and Ernst.Morgan Leigh | Talk 01:39, 9 December 2018 (UTC)
- I note that WP:MEDRS says "Cochrane Library reviews are generally of high quality and are routinely maintained even if their initial publication dates fall outside the 5-year window". The 2005 source is a Cochrane review. WP:MEDRS doesn't say not to use sources older than five years but rather to "try to find those newer sources". I note that more than half the sources in the article are older than five years. One is 1987. Morgan Leigh | Talk 09:05, 11 December 2018 (UTC)
- "No one has claimed it was in the BMJ" Really? No one has asked "Is that your entire rebuttal of the inclusion of this peer reviewed paper, commissioned by and published in the BMJ?" --Hob Gadling (talk) 09:32, 11 December 2018 (UTC)
- Please read my post above more carefully. The not in the BMJ remark is in relation to Belivani, Dimitroula et al., "Acupuncture in the treatment of obesity: a narrative review of the literature.". The "peer reviewed paper, commissioned by and published in the BMJ?" remark is in relation to Cummings, Hróbjartsson & Ernst, (2018), "Should doctors recommend acupuncture for pain?", BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k970.Morgan Leigh | Talk 04:05, 12 December 2018 (UTC)
- Sorry, the whole thing was a bit confusing. --Hob Gadling (talk) 06:53, 12 December 2018 (UTC)
- Please read my post above more carefully. The not in the BMJ remark is in relation to Belivani, Dimitroula et al., "Acupuncture in the treatment of obesity: a narrative review of the literature.". The "peer reviewed paper, commissioned by and published in the BMJ?" remark is in relation to Cummings, Hróbjartsson & Ernst, (2018), "Should doctors recommend acupuncture for pain?", BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k970.Morgan Leigh | Talk 04:05, 12 December 2018 (UTC)
- "No one has claimed it was in the BMJ" Really? No one has asked "Is that your entire rebuttal of the inclusion of this peer reviewed paper, commissioned by and published in the BMJ?" --Hob Gadling (talk) 09:32, 11 December 2018 (UTC)
- I note that WP:MEDRS says "Cochrane Library reviews are generally of high quality and are routinely maintained even if their initial publication dates fall outside the 5-year window". The 2005 source is a Cochrane review. WP:MEDRS doesn't say not to use sources older than five years but rather to "try to find those newer sources". I note that more than half the sources in the article are older than five years. One is 1987. Morgan Leigh | Talk 09:05, 11 December 2018 (UTC)
A proposed edit with recent sources
I agree that the section above has gotten off topic. Here is a discrete proposal for an edit to the article with recent sources that no one has yet actually addressed, except @Middle 8: who described the Vickers paper as "the highest-quality meta-analysis there is ". I'm putting here again because I notice I made a transposition error in when posting it above. It's odd no one noticed that. It's almost as if no one read it...
I suggest we change the present text from;
- "A systematic review found little evidence of acupuncture's effectiveness in treating pain."
- which cites this source Ernst E, Lee MS, Choi TY (April 2011). "Acupuncture: does it alleviate pain and are there serious risks? A review of reviews" (PDF). Pain. 152 (4): 755–64. doi:10.1016/j.pain.2010.11.004.
- to,
- "A 2011 systematic review found little evidence of acupuncture's effectiveness in treating pain (Citing Ernst E, Lee MS, Choi TY (April 2011). "Acupuncture: does it alleviate pain and are there serious risks? A review of reviews" (PDF). Pain. 152 (4): 755–64), while others have found it to be effective. (Citing Vickers, Cronin, Maschino, et al, (2012), Acupuncture for Chronic Pain:Individual Patient Data Meta-analysis, Arch Intern Med. 2012;172(19):1444-1453. doi:10.1001/archinternmed.2012.3654
- Hopton, MacPherson, (2010), Acupuncture for Chronic Pain: Is Acupuncture More than an Effective Placebo? A Systematic Review of Pooled Data from Meta‐analyses, Pain Practice, Volume 10, Issue 2, March/April 2010, Pages 94-102
- Kwon, Pittler, Ernst, (2006), Acupuncture for peripheral joint osteoarthritis: A systematic review and meta-analysis, Rheumatology, Volume 45, Issue 11, 1 November 2006, Pages 1331–1337)Morgan Leigh | Talk 01:39, 9 December 2018 (UTC)
- WP:BLUDGEON applies. Alexbrn (talk) 04:36, 9 December 2018 (UTC)
- Yes I think so too, but I wasn't going to bandy around labels just because people keep repeating their personal opinions, ofttimes using the exact same words, without addressing the sources. Morgan Leigh | Talk 05:50, 9 December 2018 (UTC)
- Nope. For the reasons cited above, and multiple times in the past. We don't "balance" pragmatic, reality-based views with the optimistic findings of True Believers. Guy (Help!) 10:45, 10 December 2018 (UTC)
- Please confine your remarks to directly addressing the sources at issue @JzG: rather than, once again, expressing your personal opinion and deriding those with a view you don't agree with by labeling them "true believers" and implying they aren't in touch with reality. Morgan Leigh | Talk 21:59, 10 December 2018 (UTC)
- Stop sealioning. Guy (Help!) 22:28, 10 December 2018 (UTC)
- Instead of making personal attacks please address the sources. Morgan Leigh | Talk 00:13, 11 December 2018 (UTC)
- Stop sealioning. Guy (Help!) 00:35, 11 December 2018 (UTC)
- Morgan Leigh's objection (repeated because the objectionable behavior is repeated) is reasonable. See 2nd sentence in lede of WP:TPG, and WP:TPNO last bullet point. It's not sealioning to ask an editor to stop that. Nor to point out misunderstandings of WP:WEIGHT. --Middle 8 (t • c | privacy • acupuncture COI?) 02:34, 11 December 2018 (UTC); add to cmt 03:25, 11 December 2018 (UTC)
- Stop sealioning. Guy (Help!) 00:35, 11 December 2018 (UTC)
- Instead of making personal attacks please address the sources. Morgan Leigh | Talk 00:13, 11 December 2018 (UTC)
- Stop sealioning. Guy (Help!) 22:28, 10 December 2018 (UTC)
- @ Guy Re Vickers: WP:WEIGHT doesn't mean discounting MEDRS because some other source criticized it. Most crits of Vickers aren't peer-reviewed anyway and thus aren't very good MEDRS (if they're MEDRS at all) or even very good RS. Hence using them de-weight and discount an IPD meta-analysis is absurd. --Middle 8 (t • c | privacy • acupuncture COI?) 02:34, 11 December 2018 (UTC)
- Please confine your remarks to directly addressing the sources at issue @JzG: rather than, once again, expressing your personal opinion and deriding those with a view you don't agree with by labeling them "true believers" and implying they aren't in touch with reality. Morgan Leigh | Talk 21:59, 10 December 2018 (UTC)
- Not really, for a start I doubt this is the only review that has found it ineffective. But I do not agree the other sources can be rejected if they are recognized and qualified medical professionals or professors.Slatersteven (talk) 11:21, 10 December 2018 (UTC)
- Indeed there are many. I draw your attention to the 12 citations in the above section, seven of which are Cochrane reviews. Morgan Leigh | Talk 21:59, 10 December 2018 (UTC)
- One Cochrane review you cite above is about "Acupuncture for schizophrenia": All results of this review are categorised as 'very low quality' or 'low quality evidence', except for 'time spent in hospital' which was 'moderate level' but that was just 1 RCT. "Very low quality evidence" in GRADE (https://bestpractice.bmj.com/info/us/toolkit/learn-ebm/what-is-grade/) means "The true effect is probably markedly different from the estimated effect"; "low quality evidence" means "The true effect might be markedly different from the estimated effect". In other words, this review provides no support for the clinical application of acupuncture in Schizophrenia.
- Another Cochrane review you cite is "Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting". Again, all comparisons between acupuncture and sham were categorised as "low quality evidence".
- Low quality evidence is still evidence, it's not no evidence, nor is it evidence that it doesn't work. And I'm totally good with mentioning the quality of any given piece of evidence that in the article. I'm not trying to say that acupuncture is a panacea, because it clearly isn't. What I am saying is, if you have a whole lot of studies with some evidence it is a thing worth investigating further. Not a thing that is "bonkers" and can be put in a box labelled 'pseudoscience, do not ever look inside'. Rather it should be investigated further, and that is why more research has been done and the Vickers paper is one result of that. Do you agree that Vickers is a good quality paper that should be cited?Morgan Leigh | Talk 23:53, 11 December 2018 (UTC)
- It is very easy to concoct a low-quality study with low-quality evidence for anything you wish. All you need is money and time; randomness does the rest. Therefore, mentioning such trash in the article would be misleading. Saying that there is low-quality evidence is okay, but one does not have to mention what it is. --Hob Gadling (talk) 06:53, 12 December 2018 (UTC)
- Low quality evidence means that the results are unreliable. Reported treatment effects based on low quality evidence may be due to statistical fluctuations, bias (e.g. lack of sufficient blinding) etc. instead of the treatment actually working; further explanations in the BMJ article I linked in my previous post. As Hob Gadling said, it's not worth reporting and can be misleading.
- Low quality evidence is still evidence, it's not no evidence, nor is it evidence that it doesn't work. And I'm totally good with mentioning the quality of any given piece of evidence that in the article. I'm not trying to say that acupuncture is a panacea, because it clearly isn't. What I am saying is, if you have a whole lot of studies with some evidence it is a thing worth investigating further. Not a thing that is "bonkers" and can be put in a box labelled 'pseudoscience, do not ever look inside'. Rather it should be investigated further, and that is why more research has been done and the Vickers paper is one result of that. Do you agree that Vickers is a good quality paper that should be cited?Morgan Leigh | Talk 23:53, 11 December 2018 (UTC)
- Re Vickers et al 2012 (cited above): effect sizes against sham are 0.23 SD, 0.16 SD and 0.15 SD for back and neck pain, osteoarthritis, and chronic headache. Firstly, these effect size are too small to be clinically relevant. In fact, already Madsen, Gøtzsche PC, Hróbjartsson A. (BMJ. 2009 Jan 27;338:a3115. doi: 10.1136/bmj.a3115. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. https://www.ncbi.nlm.nih.gov/pubmed/19174438) found a very similar effect size and concluded "A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias". Secondly, the small effect size may well be due to bias. Vickers et al results are based on trials which were not double blinded and in the included GERAC trials even the single blinding is questionable. I therefore do not support the change you suggest.Lucleon (talk) 08:16, 12 December 2018 (UTC)
- What Lucleon says. Plus, per WP:MEDRS we shouldn't be using sources older than 5 years old, when we have newer better sources that are relevant (in this case from NICE). Alexbrn (talk) 08:25, 12 December 2018 (UTC)
- @Alexbrn: Vickers was updated last year.[5] @Lucleon: Read it; they addressed both blinding and effect size. Blinding: Vickers found essentially the same results, blinded or not. Effect size: still statistically significant, and they concluded more than a placebo and a reasonable referral option -- because efficacy, which is w.r.t. control, isn't the same as effectiveness, which is w.r.t. no treatment (which is what the clinical decision is: whether to treat. Pragmatic trials look at that all the time). As for Madsen's conclusion about bias: of course we cite that (and I think Vickers addressed bias too), but there's this thing called NPOV that explains very clearly how to handle RS when they disagree. Hint: it doesn't mean citing just one side. --Middle 8 (t • c | privacy • acupuncture COI?) 10:55, 12 December 2018 (UTC)
- The effect sizes in Vickers et al 17 are approx. the same as in Vickers et al 12. To demonstrate a specific treatment effect the comparison to sham counts not the comparison to 'no treatment'. This is how other treatments are tested, I don't see why this should be different for acupuncture. Re blinding: in Vickers et al 17 they do exclude some trials with possible bias due to blinding and obtain the same effect size. Still, the remaining trials that were used were not double-blinded. Also, they find that smaller studies had larger effect sizes which can be the result of publication bias.
- @Alexbrn: Vickers was updated last year.[5] @Lucleon: Read it; they addressed both blinding and effect size. Blinding: Vickers found essentially the same results, blinded or not. Effect size: still statistically significant, and they concluded more than a placebo and a reasonable referral option -- because efficacy, which is w.r.t. control, isn't the same as effectiveness, which is w.r.t. no treatment (which is what the clinical decision is: whether to treat. Pragmatic trials look at that all the time). As for Madsen's conclusion about bias: of course we cite that (and I think Vickers addressed bias too), but there's this thing called NPOV that explains very clearly how to handle RS when they disagree. Hint: it doesn't mean citing just one side. --Middle 8 (t • c | privacy • acupuncture COI?) 10:55, 12 December 2018 (UTC)
- In light of the small effect sizes, the lack of a plausible mechanism of acupuncture and the overwhelming number of investigations reporting no, tiny or unreliable effect sizes for all kinds of medical conditions, the most parsimonious explanation of these results (Vickers et al.) is that acupuncture has no specific effect and the reported effects are due to biases. To demonstrate the opposite convincingly, much stronger experimental evidence would be needed imho.Lucleon (talk) 11:38, 13 December 2018 (UTC)
- @Lucleon: There's no reason to ignore trials without sham controls as long as you're clear what you're looking at. Efficacy measures the comparison to sham, and is what RCT's look at. Effectiveness measures the comparison to no treatment, aka the "real-world effect", and is what PCT's (pragmatic clinical trials) study. A trial can be both if it has both sham and no-treatment arms -- hence Vickers reports both efficacy and effectiveness, and the size of the latter is the basis for his conclusion that acu is a reasonable referral option for chronic pain patients. (A widely-held conclusion given the extent of mainstream acu practice in e.g. academic medical centers -- e.g. 9 out of the top 10 US med schools last I checked)
- On your 2nd para: These are reasonable points, and are relevant insofar as they've been stated by some (MED)RS. We cite those alongside Vickers (according to weight). That's how NPOV works. --Middle 8 (t • c | privacy • acupuncture COI?) 11:44, 16 December 2018 (UTC) | added to comment 12:02, 16 December 2018 (UTC)
- The comparison to 'no treatment' doesn't tell us whether the reduction in pain was due to acupuncture or something else, e.g. being take care of by someone, receiving treatment etc.. These latter causes seem quite plausible given that it was the subjective feeling of pain which was investigated and only small improvements were observed.Lucleon (talk) 13:55, 17 December 2018 (UTC)
- Indeed. Acupuncturists have invested much in building up the mythology of their craft, the average person almost certainly believes it works and it is very hard to blind both study participants and practitioners to whether real or fake acupuncture is being used. And when you do that convincingly, and show no difference, the acupuncturists claim that acupuncture is so powerful that even fake acupuncture works. Which is one hell of a get out of jail free card. Guy (Help!) 20:00, 17 December 2018 (UTC)
- @ User:Lucleon Right. Hence what I just said about the difference between an RCT and a PCT. And that acu is used in the real world anyway. Why? Because a lot of doctors find it gives their patients additional relief, and they care about that more than the placebo issue (read Jytdog's comment here) --Middle 8 (t • c | privacy • acupuncture COI?) 22:48, 17 December 2018 (UTC) | edit: ping removed, discussion moved to user talk fwiw 23:00, 17 December 2018 (UTC)
- There is a reason why quacks love PCTs. Homeopathists, especially. PCTs maximise the possibility of claiming regression to the mean, natural course of disease, expectation bias and observer bias, as treatment effects. They are possibly legitimate for comparing known valid therapies, but where the claims of a therapy are outlandish, as they are with acupuncture, they are not appropriate. To quote Ernst: "In some medical areas, for example complementary medicine, pragmatic trials tend to be conducted by practitioners or others with a strong interest in promoting their therapy. In such instances, the weak design and scope for ‘‘spin’’ in interpreting results render pragmatic trials highly susceptible to bias." Note also that "analysis of shams in migraine clearly indicate that sham acupuncture and sham surgery significantly outperform all other shams and placebos"[6] - an invasive fake treatment is more likely to trigger the cognitive biases that generate self-reported benefits than a non-invasive one. The fact that fake acupuncture has pretty much the same effect size as the real thing is a very big red flag, and would be very worrying for the needlers if they were not so blinded by belief that they actually claim this as validation. Guy (Help!) 08:18, 18 December 2018 (UTC)
- The comparison to 'no treatment' doesn't tell us whether the reduction in pain was due to acupuncture or something else, e.g. being take care of by someone, receiving treatment etc.. These latter causes seem quite plausible given that it was the subjective feeling of pain which was investigated and only small improvements were observed.Lucleon (talk) 13:55, 17 December 2018 (UTC)
- On your 2nd para: These are reasonable points, and are relevant insofar as they've been stated by some (MED)RS. We cite those alongside Vickers (according to weight). That's how NPOV works. --Middle 8 (t • c | privacy • acupuncture COI?) 11:44, 16 December 2018 (UTC) | added to comment 12:02, 16 December 2018 (UTC)
- Yes, obviously. Vickers is AFAIK acupuncture's only IPD meta-analysis (the "gold standard" of systematic review), cited all over the place and used to help guide practice recommendations. Of course it weighs, at least as heavily as the 2011 Ernst review, which is getting pretty outdated. --Middle 8 (t • c | privacy • acupuncture COI?) 02:34, 11 December 2018 (UTC); copy-edit 02:39, 11 December 2018 (UTC)
- In your opinion, as someone whose livelihood depends on acupuncture being portrayed as valid. Guy (Help!) 09:30, 11 December 2018 (UTC)
- It speaks well of Middle 8 that they have stated that they are an acupuncturist up front. And we have been down this road before, with IIRC a 2:1 weighting against experts having a COI in their subject area. If every MD couldn't write about medicine, if every lawyer couldn't write about the law, if every acupuncturist couldn't write about acupuncture we would soon be getting bombarded with information from whichever ignorant individual 1 who could shout fake news the loudest. Oh, wait... Morgan Leigh | Talk 23:53, 11 December 2018 (UTC)
- MDs can change the medicine they presribe; for acupuncturists the answer must always be Moar Acupunture. So it is with homeopath writing about homeopathy, Scientologists writing about Hubbard and so on. Policy is clear for fringe topics like acu (a pseudoscience) WP:FRIND applies. BTW, Ernst is very good on this topic.[7] Alexbrn (talk) 07:31, 12 December 2018 (UTC)
- You seem to be suggesting that there is no acupuncturist who is an MD and vice versa. This is absolutely not the case. The BMA has recommend for several years that information on acupuncture and its possible benefits should be included in both undergraduate and postgraduate medical education (See British Medical Association Board of Science and Education. Acupuncture: Efficacy, Safety and Practice. London: Harwood Academic, 2000, p96) and there are a growing number of MDs who are also trained acupuncturists. MDs can change the treatments they prescribe, and they sometimes prescribe acupuncture, and vice versa. Morgan Leigh | Talk 08:23, 12 December 2018 (UTC)
- Nice straw man. My point was that fringe adherents are not reliable sources of information about their pet fringe topic. Here we have WP:FRIND, so we're not - per our WP:PAGs - going to be using acupuncturists on acupuncture any more than we're going to be using 9/11 truthers on what happened to the World Trade Center. Alexbrn (talk) 08:31, 12 December 2018 (UTC)
- This. It's remarkable how often the "good" positive studies turn out to hae the same authors. Many, such as Witt, Lewith and so on, also appear on articles spruiking homeopathy and other quack cures. Guy (Help!) 11:01, 12 December 2018 (UTC)
- this is a time sink. Obviously authors who advocate fringe aren’t RS for fringe. The article already duly notes acupuncture’s role in pain relief and palatative care and recommendations pertaining to these. It is also duly comprised in large part of the tectonic slabs of writings from medrs, which say it is a bag of toss. There’s simply nothing more to be done here. This isn’t a conversation about article improvement. ~~~~ Edaham (talk) 13:09, 12 December 2018 (UTC)
- It's remarkable how studies who don't find evidence tend to be by the same authors. Ernst is cited 37 times in the article! Isn't Ernst the guy about who the editor of The Lancet wrote "Professor Ernst seems to have broken every professional code of scientific behaviour by disclosing correspondence referring to a document that is in the process of being reviewed and revised prior to publication. This breach of confidence is to be deplored." (The Times, Monday 29 August 2005)? Didn't he get 'early retired' out of his academic position because of this misconduct? Wasn't the journal of which he was editor in chief discontinued? Morgan Leigh | Talk 23:15, 12 December 2018 (UTC)
- Both time sink and red herring par excellence, because not a single one of the preceding comments under my !vote pertains to Vickers' IPD meta-analysis. (Note, meta-analysis, not opinion piece.) --Middle 8 (t • c | privacy • acupuncture COI?) 17:43, 12 December 2018 (UTC)
- We did address that, actually. As stated: we're not including Vickers to "balance" the reality-based consensus that acupuncture is bollocks, regardless of the effect on your income. Sorry.
- More detailed reasons not to include have been given previously, including the fact that several of the authors are well known woomongers, and many of the reviewed papers were written by the reviewers themselves, and as Ernst said of this study, "[t]he 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." Guy (Help!) 19:33, 12 December 2018 (UTC)
- So you contend that an IPD study is not reality based? That's odd because Cochrane Methods says they are of a higher standard than other reviews because they go back and examine the original data rather examining summaries. For this reason Vickers seems a better choice to cite than Madsen, Gøtzsche PC, Hróbjartsson A. (BMJ. 2009 Jan 27;338:a3115. doi: 10.1136/bmj.a3115. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. Moreover because Vickers was been updated this year and Madsen, Gøtzsche PC, Hróbjartsson A. is a 2009 paper it seems better to cite Vickers. I wonder why it is then that one of these papers is in the article while the other is omitted? Can you please name which specific papers are the subjects of your claim that reviewers have reviewed papers they have authored? Can you provide evidence of this? Can you cite a source that these authors are "woomongers"? Morgan Leigh | Talk 23:15, 12 December 2018 (UTC)
- Any study that proceeds from the premise that health can be influenced by manipulating the flow of qi through meridians is not reality-based. Any meta-analysis that does not exclude such studies automatically, on the grounds of transparent bias, is not reality-based. The criticisms of the Vickers paper by Ernst are compelling. It is, in short, an uncritical piece of work by authors who are generally True believers, and this is represented in the florid and unsupportable language of their conclusions, where a weak effect barely differentiated from sham is represented as compelling slam dunk proof that everybody should be promoting acupuncture. Guy (Help!) 23:24, 12 December 2018 (UTC)
- Every sentence in your reply, except the third, is your opinion and thus irrelevant. Given that the Vickers paper has been updated since Ernst's criticisms and that Vickers addressed the comments by Ernst i.e. Vickers found basically the same results regardless of blinding and that the effect size was still statistically significant, why shouldn't we be able to cite Vickers to, at the very least, show that they have addressed those concerns by Ernst? Morgan Leigh | Talk 04:46, 13 December 2018 (UTC)
- Nope, there is a broad consensus that qi has not been shown to exist, it's not just his opinion, but objectively true. So WP:REDFLAG. Tgeorgescu (talk) 04:53, 13 December 2018 (UTC)
- @Morgan Leigh: WP:REDFLAG. In order to say that a pseudoscience like acupuncture is effective for any condition, we would need multiple high-quality sources. Alexbrn (talk) 05:17, 13 December 2018 (UTC)
- Tgeorgescu: Straw man. No one is arguing Qi exists. Also you are not addressing the source in question. Alexbrn: You are not addressing the source in question. Science is a method, not a list of things that are right and things that are wrong. The scientific study of any phenomena is not pseudoscience. Pseudoscience is bad science. Science not done right. If the method is followed it is ipso facto science, no matter what it is studying. Seeing Vickers is an IPD meta study I think that's pretty good evidence that it's using the scientific method and thus science and not pseudoscience. So let's cite it. And redflag right back at you. To say an IPD review is pseudoscience is an exceptional claim and you need multiple high quality sources. If you want to put a whole bunch of stuff into a box labelled pseudoscience, even though it is being studied using the scientific method, then you are not doing science. You are doing pseudoskepticism. Let's be sciencey. Let's cite sources that use the scientific method. Let's cite Vickers. Morgan Leigh | Talk 10:14, 13 December 2018 (UTC)
- When you say "no one is arguing Qi exists", you are being disingenuous, since that is absolutely the view of many of the authors of papers under question here, and is also clearly implicit in the name of the acupuncture meridian science center. Moreover, in the absence of qi, there is no credible alternative hypothesis for the mechanism by which acupuncture "works". We're back in the homeopathy world of circular reasoning - we believe X, we set out to prove X and satisified our belief in X, therefore we must explain X in terms consistent with our belief in X - when in fact the most parsimonious explanation is not-X. We already know that it doesn't matter where you put the needles, or if you insert them or not, we know that effects are visible only in subjective outcomes, are generally restricted to self-reported results, effect size is small and not clinically relevant, and the more rigorously blinded and controlled a study is the less likely it is to show a positive outcome. In other words, it's bollocks.
- The only really compelling point in Vickers is the negligible difference between real and sham acupuncture. Sham acupuncture is hard to do and the blinding is plausibly broken without much effort (e.g. from the persistence of bruising, which can last weeks when needles are inserted), and yet the difference between real and fake acupuncture is clinically irrelevant. And we can#t use Vickers as a source for this important fact because they misrepresent this outcome as validation - as do several other True Believer sources, in fact, leading to absurdities like this NYT piece. Hint: if sham treatment and real treatment work as well as each other, you have proved that (a) neither works and (b) your experimental design failed to control for bias and confounding. Guy (Help!) 11:26, 13 December 2018 (UTC)
- I reject your claim that I am being disingenuous on the grounds that we are not discussing the subject area, for that is not what we are here to do. We are discussing whether or not a source is a good source to include. Moreover the question of whether Qi exists is not germane to this source. It is not what the paper is about. The paper is about whether or not a measurable result was found when following a given procedure. It does not mention Qi, nor does it discuss theories about potential causative mechanisms.
- Once again you are offering your opinion that this source is unreliable because it is by alleged "true believers". You are offering an ad hominum attack in order to suggest that a high quality IPD review is unfit to include. Moreover you make an unsubstantiated claim and accuse reputable scientists of misrepresentation because they don't agree with your opinion. You prefer your opinion about blinding to the outcome of a peer reviewed, high quality meta review. Even the NYT is an absurdity, according to you. All in all you are really grasping at straws. You say that Vickers makes a compelling point, shall we cite it for this point? Morgan Leigh | Talk 06:17, 14 December 2018 (UTC)
- @JzG and Tgeorgescu: Vickers and coauthors don't argue qi exists. Not in the paper. Which is all that matters when evaluating it as a source. --Middle 8 (t • c | privacy • acupuncture COI?) 12:19, 16 December 2018 (UTC)
- Again, per WP:FRINGE and WP:REDFLAG we're biased against Vickers's position. Wikipedia has an extraordinarily high standard for evidence which would allow us to say that acupuncture is really effective. Tgeorgescu (talk) 06:32, 14 December 2018 (UTC)
- @Tgeorgescu: No -- that reflects a misreading of Vickers. His results showing small advantage over sham are consistent w/ other reviews (naturally, since he's looking at the same trials). OTOH, his conclusion that acu is a reasonable referral option is based on the larger advantage over no-treatment (which is how clinical decisions are often made). --Middle 8 (t • c | privacy • acupuncture COI?) 12:24, 16 December 2018 (UTC)
- The problem is that Vickers makes grandiose claims such as "significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo", but the differences are not clinically relevant and are merely an indication that the more closely a control mimics acupuncture, the less difference there is between acupuncture and the control - which means that acupuncture doesn't work. The "acupuncture triallists' collaboration" set out to validate their pre-existing beliefs and, as SCAM studies generally do, succeeded in finding some clinically irrelevant results that they could then spin as validation. This is normal and expected, homeopathists have done the same thing for years, so we don't give it undue weight by citing its tendentious conclusions. Guy (Help!) 09:33, 17 December 2018 (UTC)
- @Guy If Vickers said the difference from sham was clinically significant, he was wrong (as balancing MEDRS will say) -- but I know he said it was statistically significant, which simply a finding from the data, and not a grandiose claim. He also said that the difference from no-treatment was clinically significant, and on that he was correct. Hence its use in mainstream settings and good MEDRS that suggest so doing. --Middle 8 (t • c | privacy • acupuncture COI?) 22:19, 17 December 2018 (UTC) | add to cmt Middle 8 (t • c | privacy • acupuncture COI?) 22:32, 17 December 2018 (UTC)
- The difference from no treatment is irrelevant, since the aim in any study must be to separate treatment from bias, and in no-treatment controls there is absolutely no hope of adequate blinding of either subject or experimenter. That is why so much effort has been put into developing a truly convincing sham acupuncture control. What Vickers' results show is that sham acupuncture controls are, by now, nearly good enough. As a true believer of course Vickers cannot bring himself to admit this - if indeed the cognitive dissonance even allows him to see it. There is no getting away from the fact that the actual result of Vickers is that the difference between real and fake acupuncture is clinically irrelevant. And in anyone other than a true believer, that is understood to mean that it doesn't work. Guy (Help!) 23:47, 17 December 2018 (UTC)
- @Guy If Vickers said the difference from sham was clinically significant, he was wrong (as balancing MEDRS will say) -- but I know he said it was statistically significant, which simply a finding from the data, and not a grandiose claim. He also said that the difference from no-treatment was clinically significant, and on that he was correct. Hence its use in mainstream settings and good MEDRS that suggest so doing. --Middle 8 (t • c | privacy • acupuncture COI?) 22:19, 17 December 2018 (UTC) | add to cmt Middle 8 (t • c | privacy • acupuncture COI?) 22:32, 17 December 2018 (UTC)
- The problem is that Vickers makes grandiose claims such as "significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo", but the differences are not clinically relevant and are merely an indication that the more closely a control mimics acupuncture, the less difference there is between acupuncture and the control - which means that acupuncture doesn't work. The "acupuncture triallists' collaboration" set out to validate their pre-existing beliefs and, as SCAM studies generally do, succeeded in finding some clinically irrelevant results that they could then spin as validation. This is normal and expected, homeopathists have done the same thing for years, so we don't give it undue weight by citing its tendentious conclusions. Guy (Help!) 09:33, 17 December 2018 (UTC)
- @Tgeorgescu: No -- that reflects a misreading of Vickers. His results showing small advantage over sham are consistent w/ other reviews (naturally, since he's looking at the same trials). OTOH, his conclusion that acu is a reasonable referral option is based on the larger advantage over no-treatment (which is how clinical decisions are often made). --Middle 8 (t • c | privacy • acupuncture COI?) 12:24, 16 December 2018 (UTC)
- Again, per WP:FRINGE and WP:REDFLAG we're biased against Vickers's position. Wikipedia has an extraordinarily high standard for evidence which would allow us to say that acupuncture is really effective. Tgeorgescu (talk) 06:32, 14 December 2018 (UTC)
- Tgeorgescu: Straw man. No one is arguing Qi exists. Also you are not addressing the source in question. Alexbrn: You are not addressing the source in question. Science is a method, not a list of things that are right and things that are wrong. The scientific study of any phenomena is not pseudoscience. Pseudoscience is bad science. Science not done right. If the method is followed it is ipso facto science, no matter what it is studying. Seeing Vickers is an IPD meta study I think that's pretty good evidence that it's using the scientific method and thus science and not pseudoscience. So let's cite it. And redflag right back at you. To say an IPD review is pseudoscience is an exceptional claim and you need multiple high quality sources. If you want to put a whole bunch of stuff into a box labelled pseudoscience, even though it is being studied using the scientific method, then you are not doing science. You are doing pseudoskepticism. Let's be sciencey. Let's cite sources that use the scientific method. Let's cite Vickers. Morgan Leigh | Talk 10:14, 13 December 2018 (UTC)
- Every sentence in your reply, except the third, is your opinion and thus irrelevant. Given that the Vickers paper has been updated since Ernst's criticisms and that Vickers addressed the comments by Ernst i.e. Vickers found basically the same results regardless of blinding and that the effect size was still statistically significant, why shouldn't we be able to cite Vickers to, at the very least, show that they have addressed those concerns by Ernst? Morgan Leigh | Talk 04:46, 13 December 2018 (UTC)
- Any study that proceeds from the premise that health can be influenced by manipulating the flow of qi through meridians is not reality-based. Any meta-analysis that does not exclude such studies automatically, on the grounds of transparent bias, is not reality-based. The criticisms of the Vickers paper by Ernst are compelling. It is, in short, an uncritical piece of work by authors who are generally True believers, and this is represented in the florid and unsupportable language of their conclusions, where a weak effect barely differentiated from sham is represented as compelling slam dunk proof that everybody should be promoting acupuncture. Guy (Help!) 23:24, 12 December 2018 (UTC)
- So you contend that an IPD study is not reality based? That's odd because Cochrane Methods says they are of a higher standard than other reviews because they go back and examine the original data rather examining summaries. For this reason Vickers seems a better choice to cite than Madsen, Gøtzsche PC, Hróbjartsson A. (BMJ. 2009 Jan 27;338:a3115. doi: 10.1136/bmj.a3115. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. Moreover because Vickers was been updated this year and Madsen, Gøtzsche PC, Hróbjartsson A. is a 2009 paper it seems better to cite Vickers. I wonder why it is then that one of these papers is in the article while the other is omitted? Can you please name which specific papers are the subjects of your claim that reviewers have reviewed papers they have authored? Can you provide evidence of this? Can you cite a source that these authors are "woomongers"? Morgan Leigh | Talk 23:15, 12 December 2018 (UTC)
- Both time sink and red herring par excellence, because not a single one of the preceding comments under my !vote pertains to Vickers' IPD meta-analysis. (Note, meta-analysis, not opinion piece.) --Middle 8 (t • c | privacy • acupuncture COI?) 17:43, 12 December 2018 (UTC)
- This. It's remarkable how often the "good" positive studies turn out to hae the same authors. Many, such as Witt, Lewith and so on, also appear on articles spruiking homeopathy and other quack cures. Guy (Help!) 11:01, 12 December 2018 (UTC)
- Nice straw man. My point was that fringe adherents are not reliable sources of information about their pet fringe topic. Here we have WP:FRIND, so we're not - per our WP:PAGs - going to be using acupuncturists on acupuncture any more than we're going to be using 9/11 truthers on what happened to the World Trade Center. Alexbrn (talk) 08:31, 12 December 2018 (UTC)
- You seem to be suggesting that there is no acupuncturist who is an MD and vice versa. This is absolutely not the case. The BMA has recommend for several years that information on acupuncture and its possible benefits should be included in both undergraduate and postgraduate medical education (See British Medical Association Board of Science and Education. Acupuncture: Efficacy, Safety and Practice. London: Harwood Academic, 2000, p96) and there are a growing number of MDs who are also trained acupuncturists. MDs can change the treatments they prescribe, and they sometimes prescribe acupuncture, and vice versa. Morgan Leigh | Talk 08:23, 12 December 2018 (UTC)
- MDs can change the medicine they presribe; for acupuncturists the answer must always be Moar Acupunture. So it is with homeopath writing about homeopathy, Scientologists writing about Hubbard and so on. Policy is clear for fringe topics like acu (a pseudoscience) WP:FRIND applies. BTW, Ernst is very good on this topic.[7] Alexbrn (talk) 07:31, 12 December 2018 (UTC)
- It speaks well of Middle 8 that they have stated that they are an acupuncturist up front. And we have been down this road before, with IIRC a 2:1 weighting against experts having a COI in their subject area. If every MD couldn't write about medicine, if every lawyer couldn't write about the law, if every acupuncturist couldn't write about acupuncture we would soon be getting bombarded with information from whichever ignorant individual 1 who could shout fake news the loudest. Oh, wait... Morgan Leigh | Talk 23:53, 11 December 2018 (UTC)
- In your opinion, as someone whose livelihood depends on acupuncture being portrayed as valid. Guy (Help!) 09:30, 11 December 2018 (UTC)
You have been making it clearer and clearer that you don't like our NPOV policy, Til. That's your prerogative, but until you get it changed it isn't your prerogative to try and change it article by article. Dougweller (talk) 22:02, 11 March 2013 (UTC)
- Quoted by Tgeorgescu (talk) 06:39, 14 December 2018 (UTC)
- Do you contend that an IPD meta review is not a high standard review? Morgan Leigh | Talk 09:54, 14 December 2018 (UTC)
- A good method carried out by bad actors doesn't make a good source. We've pointed out the problems multiple times, your unwillingness to accept them is not really our problem by now. Guy (Help!) 14:15, 14 December 2018 (UTC)
- Yes, and it has been pointed out to you many times that your opinion that anyone who doesn't agree with you is bad is irrelevant. However your unwillingness to accept this is our problem. Do us a favour and read the talk page guidelines again please. You are asserting that reputable academics are "bad actors"? Sounds awfully like an ad hominem to me... And yet, you support the inclusion of Ernst, an academic who broke "every professional code of scientific behaviour", not my opinion here's a source, again (The Times, Monday 29 August 2005) because you agree with him. So it's not about "bad actors" really is it? It's about who you agree with. Morgan Leigh | Talk 00:33, 15 December 2018 (UTC)
- Then I advise you that you should complain at WP:AE. Mind of WP:BOOMERANG. But to come back at what you said, scientific truth and ethics are quite different matters. One can be a law-abiding citizen who lies like a dog, or a university president who pled guilty to making obscene, child-sex related phone calls to a daycare center. Tgeorgescu (talk) 01:09, 15 December 2018 (UTC)
- I notice you are not answering the question that is relevant to the source under discussion... Do you contend that an IPD meta review is not a high standard review?— Preceding unsigned comment added by Morgan Leigh (talk • contribs)
- Sooner or later this will go to WP:AE since both parties have made their points clear and cannot reach WP:CONSENSUS. Tgeorgescu (talk) 07:56, 15 December 2018 (UTC)
- Still avoiding the question... It's a pretty simple question really. I wonder why you don't want to answer? One reason we can't get consensus is continued avoidance of answering direct questions about sources. Morgan Leigh | Talk 23:13, 15 December 2018 (UTC)
- Actually we have consensus, but a tiny handful of acupuncture advocates and practitioners dislike it. They also dislike the removal of acupuncture from treatment guidelines. Not our problem. Guy (Help!) 09:51, 16 December 2018 (UTC)
- @Morgan Leigh: I think that you should stop repeating the question after it has received an answer. Tgeorgescu (talk) 11:30, 16 December 2018 (UTC)
- Actually we have consensus, but a tiny handful of acupuncture advocates and practitioners dislike it. They also dislike the removal of acupuncture from treatment guidelines. Not our problem. Guy (Help!) 09:51, 16 December 2018 (UTC)
- Agree w/ Tgeorgescu (re AE) --Middle 8 (t • c | privacy • acupuncture COI?) 11:52, 16 December 2018 (UTC)
- @Tgeorgescu: See past discussions. Basically the acupuncture fans have been trying to crowbar this into the article for years. Guy (Help!) 00:32, 18 December 2018 (UTC)
- Still avoiding the question... It's a pretty simple question really. I wonder why you don't want to answer? One reason we can't get consensus is continued avoidance of answering direct questions about sources. Morgan Leigh | Talk 23:13, 15 December 2018 (UTC)
- Sooner or later this will go to WP:AE since both parties have made their points clear and cannot reach WP:CONSENSUS. Tgeorgescu (talk) 07:56, 15 December 2018 (UTC)
- I notice you are not answering the question that is relevant to the source under discussion... Do you contend that an IPD meta review is not a high standard review?— Preceding unsigned comment added by Morgan Leigh (talk • contribs)
- Then I advise you that you should complain at WP:AE. Mind of WP:BOOMERANG. But to come back at what you said, scientific truth and ethics are quite different matters. One can be a law-abiding citizen who lies like a dog, or a university president who pled guilty to making obscene, child-sex related phone calls to a daycare center. Tgeorgescu (talk) 01:09, 15 December 2018 (UTC)
- Yes, and it has been pointed out to you many times that your opinion that anyone who doesn't agree with you is bad is irrelevant. However your unwillingness to accept this is our problem. Do us a favour and read the talk page guidelines again please. You are asserting that reputable academics are "bad actors"? Sounds awfully like an ad hominem to me... And yet, you support the inclusion of Ernst, an academic who broke "every professional code of scientific behaviour", not my opinion here's a source, again (The Times, Monday 29 August 2005) because you agree with him. So it's not about "bad actors" really is it? It's about who you agree with. Morgan Leigh | Talk 00:33, 15 December 2018 (UTC)
- A good method carried out by bad actors doesn't make a good source. We've pointed out the problems multiple times, your unwillingness to accept them is not really our problem by now. Guy (Help!) 14:15, 14 December 2018 (UTC)
- Do you contend that an IPD meta review is not a high standard review? Morgan Leigh | Talk 09:54, 14 December 2018 (UTC)
- I saw an exchange on Guy's talk page that made me curious about this whole dust-up. It's been an interesting read and I thought a pair of fresh eyes might help. I try to stay out of contentious topics like this, because no matter what I say I'll probably get shouted at by someone unhappy, but I must be a glutton for punishment today.
- I looked through the article and the sources, and found them all interesting if rather difficult to comprehend as someone who knows next to nothing about this stuff. To be fair, in my earlier years I poked my fair share of things with needles, mostly myself when I was bored, and I also pretended to poke things with needles, mostly my sister, but none of that's ever been published and she was never quite enthused. I searched the source in question, Vickers, on Google scholar and looked through some of the articles which cite it and how they cover it to get an idea of how we should cover it.
- I found this article from 2014 cited about 450 times. Interesting read, about treatment recommendations and algorithms which combines two things I don't know much about so also very interesting. It seems to view the source in question as corroborating the wording as it already is, saying: "...other studies suggest that the benefit of acupuncture is small, especially compared with sham acupuncture [cites vickers], and possibly due to expectation or placebo effect." I'm still rather curious how one would pretend to stick a needle in someone in a clinically controlled manner. Interesting concept since I for one think I would notice whether or not a needle was stuck into me.
- I also found an interesting 2013 article which looks at efficacy of treatments for cancer patients. Took me a while to figure out what "ROB" means (turns out it's "risk of bias" which sounds ominous). It had an interesting summary of work at the time, saying "Of the 11 trials examining acupuncture for pain, nine were positive, but eight had high ROB [risk of bias]." Not really sure how to interpret that, but given the ominous nature of ROB, I'm not bullish. It goes on to characterize the source in question saying: "Other reviews and meta-analyses have been published suggesting the utility of acupuncture for pain control in noncancer populations, [cites Vickers] but studies with low ROB [Risk of Bias] are needed to definitively assess its efficacy for pain management in patients with cancer." In my reading it seems to be saying that the source in question doesn't provide substantial evidence for efficacy, or at least not enough to use it on cancer patients. I don't hang with medical crowds much, but if I remember my IRB training well enough I assumed that experimental treatments on cancer patients were more accepted as the potential benefits of an unproven therapy tended to far outweigh the costs. That they didn't find enough evidence to support its use in cancer populations then also tends to make me a little suspicious of this wording.
- All of this is to say I'm not in favor of the proposed change as it seems to be going against the characterization I'm seeing in the literature. Our article doesn't say it's not effective or that there's no evidence at all, it says there's "little" evidence. Which all the sources, including Vickers itself, seem to also be saying. I want to quote something I found while going through the archives of this discussion said almost 4 years ago:
As for the rest of this discussion, I'll refrain from guessing at motives here, there seems to be enough of that already. Assuming no one here is biased, this whole thing seems to be a mountain out of a mole hill (I couldn't think of an acupuncture pun on that, and didn't think it was worth taking a stab at). The sources say there's little evidence, the article says there's little evidence, and Wikipedia shouldn't be responsible for being the reason someone decides that getting poked with needles will make them hurt less. Perhaps it's best if we just back away from this dead horse. Ping me if you need anything. Wugapodes [thɑk] [ˈkan.ˌʧɹɪbz] 04:03, 18 December 2018 (UTC)Ernst, Vickers, and Novella, certainly do agree that the bulk of acupuncture's effect is due to the placebo effect. Vicker's "Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects" and Novella's "the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance" are in substantial alignment, differing primarily in the value judgement of whether a trivial impact is worth paying for, not in whether the impact is trivial. Ernst's conclusions aren't much different. What widely noted review has claimed an effect for acupuncture that was large compared to the effect for placebo?
— User:KWW January 2015- I agree, though AGF can't obscure the fact that Middle8 has declared a financial interest in acupuncture.
- The problem for me is that Vickers' conclusion is ass-backwards. The effects of needling are nonspecific. They are small, transient, and only affect subjective outcomes. The near-parity between real and fake acupuncture actually reveals two things: first, that acupuncture has a well known mythology around it, second, that it's hard to blind people and practitioners as to whether you are actually sticking needles in. Acupuncture fans love Vickers because it spreads the gospel. They have been trying to crowbar Vickers into this article for five years. But the reality-based interpretation of Vickers' findings is so far out of line with what the conclusions state, that it's unacceptable to include it here. What Vickers found is that real and fake acupuncture are almost indistinguishable, the difference is clearly clinically irrelevant, and the most parsimonious explanation for the residual difference is that sham acupuncture is hard to do really convincingly. The placebo effect is not a thing. It is a set of biases, not an actual effect. The co-authors include Lewith, Witt and Linde, all of whom have produced equally underwhelming studies in support of homeopathy, the quintessential fake treatment. Vickers' words here absolutely reveal the motivations behind the study. What they want is for patients to be referred to acupuncturists. Their main focus is the VA but they want it everywhere. It's almost as transparent as chiropractic practice-building.
- His statement that "[t]reatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects" is tendentious. Sham acupuncture studies - the only ones that reliably test against placebo - do not support long-term effects, are fully consistent with bias and nonspecific effects, and the placebo effect is not a thing, despite the years of efforts of acupuncturists like Ted Kaptchuk to prove it is. It's a classic SCAM marketing study, and the 2017 comment makes that absolutely explicit. Acupuncturists seem to be following homeopathists down the path of claiming to harness the nonexistent placebo effect in a unique way. Guy (Help!) 08:05, 18 December 2018 (UTC)
List Article
There is a pretty ugly area in the middle of the article that seems is ripe to be made into a list. Is there any reason a list article couldn't be made for other condition without strong evidence and then linked here. Or even better just remove the list of uselessness. AlmostFrancis (talk) 05:39, 23 December 2018 (UTC)
- From the context, I guess you mean Acupuncture#Other conditions. What is ugly about it? --Hob Gadling (talk) 05:45, 23 December 2018 (UTC)
- Maybe ugly was the wrong word. It seems odd to take up so much screen space saying that there is no evidence for effectiveness for this long list of randomness. It seems that this could be handled either with a sentence saying many conditions show no effectiveness or if necessary a list article of what has not been effective. AlmostFrancis (talk) 05:58, 23 December 2018 (UTC)
- However, the information is of encyclopedic value. For one thing, it is possible to search the article for an item of interest and it may be found in this list, along with a reliable source. That is useful. Johnuniq (talk) 06:11, 23 December 2018 (UTC)
- It also gives the reader a good picture of how well-researched this field is, how devastating the results are, and how many false-positive statistically significant results are to be expected (one for every nineteen insignificant ones). --Hob Gadling (talk) 08:44, 23 December 2018 (UTC)
- However, the information is of encyclopedic value. For one thing, it is possible to search the article for an item of interest and it may be found in this list, along with a reliable source. That is useful. Johnuniq (talk) 06:11, 23 December 2018 (UTC)
- Maybe ugly was the wrong word. It seems odd to take up so much screen space saying that there is no evidence for effectiveness for this long list of randomness. It seems that this could be handled either with a sentence saying many conditions show no effectiveness or if necessary a list article of what has not been effective. AlmostFrancis (talk) 05:58, 23 December 2018 (UTC)
Cochrane Collaboration Studies - sources feature prominently in Independent article questioning practices
Stumbled upon this article about Cochrane Collaboration studies (the sources cited in this article that suggest acupuncture is a psuedoscience). This Independent article from Sept. 2018 centers on the institute and it's practices, specifically a co-founder who's been expelled from the board by his colleagues. The questionable practices that led to his expulsion seem to have some bearing on the way said studies were conducted. From the article "Greenhalgh, a leading research methodologist, has criticised the Cochrane 'hierarchy of evidence', which places experimental trials above any other study design, and affords limited value to qualitative research. She urges a more inclusive approach to evidence-based practice: 'Facts are not self-interpreting; they are theory and value-laden.' " — Preceding unsigned comment added by Omgnora (talk • contribs) 18:44, 28 December 2018 (UTC)
- That is just a weak attempt at Poisoning the well. Internal differences of opinion do not invalidate the status of the Cochrane Collaboration as a reliable source. To do that, much worse things are needed. --Hob Gadling (talk) 18:48, 28 December 2018 (UTC)
- @Omgnora and Hob Gadling: Apart from Hob's unwarranted casting of aspersions on your intentions in mentioning this entirely pertinent information, I do agree with them that the present perturbations internal to the Cochrane review process are not sufficient for us to cast aside all Cochrane reviews. You might consider adding this information to the Cochrane (organisation) page as it would be entirely relevant there. Morgan Leigh | Talk 00:38, 30 December 2018 (UTC)
Removal of cited information
@AlmostFrancis and Johnuniq: Your removal of this cited information is erroneous. The Joint Commission page says:
"Additionally, it is important to have non-pharmacologic pain treatment modalities available for patients that refuse opioids or for whom physicians believe may benefit from complementary therapies. Non-pharmacologic strategies include, but are not limited to transcutaneous electrical nerve stimulation, physical modalities (i.e.: acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy) relaxation therapy, music therapy, aromatherapy, cognitive behavioral therapy, etc. The level of evidence for these therapies is highly variable, and it is evolving. Therefore, our standards do not mandate that any specific complementary options are provided, but allow organizations to determine what modality(s) to offer.
Please explain how "it is important to have" is not a recommendation of these treatments. Morgan Leigh | Talk 04:00, 30 December 2018 (UTC)
- The edit in question is diff which added (refs converted to links):
- The Joint Commission recommends acupuncture for pain management.[8] The American College of Occupational and Environmental Medicine recommends acupuncture[9]
- The text quoted above from the first ref does not verify "recommends acupuncture for pain management". They clearly say there is no evidence to justify a recommendation but nevertheless they list ten strategies for patients who refuse opioids or who may benefit from complementary therapies. Try WP:RSN and ask if that source verifies that statement if wanted, but the answer will be no.
- The second statement with its ref is even wilder. The ACOEM pdf is advice for how to use their guidelines which are somewhere else. There are no treatment recommendations in the pdf. Acupuncture is mentioned in the context of informing readers that treatment recommendations are made in various categories one of which is "Allied Health Interventions (e.g., acupuncture, manipulation)".
- Did you read the sources before adding the text? Johnuniq (talk) 06:18, 30 December 2018 (UTC)
- Agree we can't use the second (ACOEM) without the actual MDGuideline, but we can certainly use the first (Joint Commission) as long we stick close to its language. Bold(ish)ly restoring it with revised wording. (Diff) Edit: it might not be specific enough to acu to warrant inclusion however.--Middle 8 (t • c | privacy • acupuncture COI?) 10:29, 30 December 2018 (UTC) | added diff 10:48, 30 December 2018 (UTC) | added cmt 10:56, 30 December 2018 (UTC)