Undid revision 595780792 by Cjrhoads (talk) DO NOT MOVE OTHER EDITORS COMMENTS. |
→COI, SPA: new section |
||
Line 531: | Line 531: | ||
:: Why would you say this thread is moot? I'm not sure I understand that. I thought we were making good progress. Perhaps you would like to share your opinion of the different options? Or better yet, provide an alternative wording? [[User:Cjrhoads|CJ]] ([[User talk:Cjrhoads|talk]]) 21:39, 16 February 2014 (UTC) |
:: Why would you say this thread is moot? I'm not sure I understand that. I thought we were making good progress. Perhaps you would like to share your opinion of the different options? Or better yet, provide an alternative wording? [[User:Cjrhoads|CJ]] ([[User talk:Cjrhoads|talk]]) 21:39, 16 February 2014 (UTC) |
||
== COI, SPA == |
|||
I am not a big tagger, but I want to point out that as I have discussed with [[User:Cjrhoads]] on [[User_talk:Cjrhoads#COI_guidelines|her talk page]], I believe she has a clear COI here. I also [[User talk:NatHealth1|pointed out]] to [[User:NatHealth1]] that the account fits the definition of [[WP:SPA]]. [[User:Jytdog|Jytdog]] ([[User talk:Jytdog|talk]]) 22:33, 16 February 2014 (UTC) |
Revision as of 22:33, 16 February 2014
![]() | This article is of interest to the following WikiProjects: | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Health Benefit
Agree that the statement "Possible health benefits of qigong have been studied in various medical conditions. Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials." in the summary section is a scientific one. But it is just one of the points for "The main arguments from the view of skeptics against the correlation between qigong practices and health-related results are:". It should be grouped under the same section. So1308 (talk) 16:46, 20 October 2013 (UTC)
- Thanks for starting a conversation, So1308.
- Here is the blow by blow. You removed the brief statement of the medical consensus from the lead, in this dif and an IP address (you?) deleted again after I reverted you, in this dif. The first edit note said "not appropriate to highlight just one point of the controversy in a summary" and the second said "rephrase reason for moving the paragraph to the controversy section - this is just one of the points from skeptics.".
- I reverted twice, first in this dif and then in this dif with edit notes reading "statements of the scientific consensus are not part of a controversy. we state those in wikipedia's voice, and prominently" and "No, this is not a "statement by skeptics" It is a statement of the medical consensus. Please see Talk and please read WP:MEDRS."
- The sentence is "Possible health benefits of qigong have been studied in various medical conditions. Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials." with the source being " Lee MS, Oh B, Ernst E (2011). "Qigong for healthcare: an overview of systematic reviews". JRSM Short Rep. 2 (2): 7. doi:10.1258/shorts.2010.010091. PMC 3046559. PMID 21369525.
{{cite journal}}
: CS1 maint: multiple names: authors list (link)
- This article is discussing health matters, so WP:MEDRS applies. MEDRS states that "Wikipedia's articles, while not intended to provide medical advice, are nonetheless an important and widely used source of health information.[1] Therefore, it is vital that the biomedical information in all types of articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge. Ideal sources for such content includes literature reviews or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies."
- The source for this statement, is as excellent as it gets under MEDRS - it is not just a review, but a review of reviews. This sentence states the medical consensus on what we know about the health benefits of Qigong with a neutral point of view (please see WP:NPOV). And yes, it belongs in the lead as per WP:LEAD, which says "The lead section (also known as the lead, introduction or intro) of a Wikipedia article is the section before the table of contents and the first heading. The lead serves as an introduction to the article and a summary of its most important aspects." The medical consensus on what we know about health benefits is definitely among the "most important aspects" of an article that spends so much space discussing effects on health.
- Please explain, based on Wikipedia's policies and guidelines, why the sentence does not belong in the lead. This is not a "statement by skeptics" - it is a consensus statement on the science. Thanks! Jytdog (talk) 16:50, 20 October 2013 (UTC)
- A skeptic is just a person who questions the validity, authenticity, or truth of something. Being a scientist and a skeptic has no conflict. The conclusion from the review is just "inconclusive due to the poor quality of the clinical trials" (as of 2011). The subject is still open and there are many new studies by the medical community. The point is still just one point from the skeptics. The other four points from skeptics are equally strong and valid. So1308 (talk) 18:34, 20 October 2013 (UTC)
- Thanks for continuing to talk! I am not sure what "other four points" you are talking about, sorry. The scientific perspective is inherently skeptical - I agree with you. If someone makes a health claim, that X is good for Y, that has to be backed up with data; if there is currently insufficient data to make a judgement as to whether the claim is true, a scientist acknowledges that. And this is exactly what the subject sentence says - "evidence of effectiveness is inconclusive". As long as this article makes health claims, the scientific perspective (what you call "the skeptics") must be front and center. That is what WP:MEDRS says... right? Jytdog (talk) 21:24, 20 October 2013 (UTC)
Please discuss
Twice now my addition has been reverted, and I would like to discuss it before filing a dispute. I feel that erasing my additional quote is allowing an incorrect and biased quote taken out of context to remain, while erasing my quote from the same article. When Yobol undid one of my edits because I "cherry picked" a quote from a journal article that contradicted the conclusion. However, I read the entire article, not just the abstract summary, and in my opinion the other quote was the one that was "cherry picked". Rather than erase the misleading quote, I added another quote from the conclusion of the article that more fairly represented the overall views of the investigators. With both quotes, I felt there was a much more balanced representation of the conclusion of the article. Please undo you revert and allow the more accurate portrayal of the article to stand. CJ (talk) 01:38, 9 January 2014 (UTC)
- It appears you are misreading the "Conclusions" section, which states, in full, "Due to limited number of RCTs in the field and methodological problems and high risk of bias in the included studies, it is still too early to reach a conclusion about the efficacy and the effectiveness of qigong exercise as a form of health practice adopted by the cancer patients during their curative, palliative, and rehabilitative phases of the cancer journey. Since qigong exercise is preferred and widely practiced among patients with various cancers in China and Asia, further well designed large-scale placebo-controlled, randomized studies with validated outcome measures are particularly needed." The sentence you added is not from the conclusions section, but from the discussion. Your additional sentence seems to suggest that the studies on immune function were not covered by the limitations stated (methodological flaws, high risk of bias), which they most definitely are. Taking one sentence out of the "Discussion" section and trying to use it to debunk a sentence from the "Conclusions" is a definite no-no. Yobol (talk) 04:44, 9 January 2014 (UTC)
- Yobol's reasoning is solid.Jytdog (talk) 13:49, 9 January 2014 (UTC)
- Indeed. --Roxy the dog (resonate) 15:32, 9 January 2014 (UTC)
- Yobol's reasoning is solid.Jytdog (talk) 13:49, 9 January 2014 (UTC)
- But if you read the entire article, it is much more "positive" about the likelihood that there actually is a positive health benefit to daily Qigong practice, there just hasn't (yet) been enough well designed large-scale placebo-controlled randomized studies to make that conclusion. Since funding for such studies has some inherent difficulty (as I've reported in my own article published in a peer reviewed medical journal, which I'd like to discuss with you in the Integrative Medicine talk page) I'd like to find a way to, not "debunk", but rather put the statement quoted in perspective. I thought adding the statement I did was a non-controversial way of doing that, but you obviously disagree. I'm open to other suggestions.
- Within the last year several really high quality, well-designed placebo-controlled randomized studies have been published in major medical journals identifying significant positive benefits for specific practices that many people call Qigong or Tai Chi. I plan on adding references to those when I have time, and quoting from those articles. I'll put the info here first, however, if you think there should be discussion on it.
- The other change I'd like to make (but thought I would discuss it here first), is to change the sentence:
- "with almost all evidence based on poor quality data, making any firm conclusions impossible to reach"
- While this statement was true five years ago, it is no longer true. There are now several firm conclusions that can be stated about Tai Chi and its impact on the immune system, systolic blood pressure, Fibromyalgia, and shingles. Until I get time to compile the list of well-designed studies, however, I'd still like to change this sentence to read:
- "until recently, most studies were poorly designed and therefore it was impossible to reach any firm conclusions. However, as evidence-based tai chi forms are being well-documented and used in research more often, studies are beginning to appear with strong indications of a positive effect."
- The problem here, is that you are trying to adjust the summary of the sources to fit your perception of what this article should say. This, of course, is opposite of what we as editors ought to be doing; our jobs is to summarize the highest quality sources (in this case, WP:MEDRS compliant sources) as best we can, regardless of what our personal feelings are. In this context, I would object to any changes that are not neutral summaries of the conclusions of WP:MEDRS compliant sourcing (noting now that any primary papers such as individual RCT that have not been evaluated in secondary sources would be premature to include here), and therefore object to the proposals mentioned above. Yobol (talk) 22:47, 9 January 2014 (UTC)
- CJ, you are trying to put the cart before the horse, as Yobol has eloquently explained. You cannot change the article in this way without sources to back up your assertions. I personally doubt you have such sources, so to agree to a change of the article in this way in anticipation that you will bring such sources, but can't be bothered to find them at the moment, is not the way to go about it. --Roxy the dog (resonate) 23:59, 9 January 2014 (UTC)
- Cjrhoads,you write: "But if you read the entire article, it is much more "positive" about the likelihood that there actually is a positive health benefit to daily Qigong practice there just hasn't (yet) been enough well designed large-scale placebo-controlled randomized studies to make that conclusion." We don't do "crystal ball" here; there is either evidence to make health claims, or there is not. As you acknowledge, currently we don't have evidence to say much about Qigong good or bad. If there is never money for studies, we will never know which means the wikipedia article will need to remain equally silent. Jytdog (talk) 05:45, 10 January 2014 (UTC)
- I tend to agreed with Yobol , Roxy the dog, and Jytdog and try to maintain a more neutral tone for the health benefits of qigong. There is no scientific consensus on the benefits of qigong and this extends to almost any topic relating to alternative medicine. The current article provided a delicate balance providing information from both advocates and skeptics. ottawakungfu (talk) 21:23, 11 January 2014 (UTC)
- I agree we should maintain a neutral tone - but the current tone is not neutral, but leans toward the negative. Keep in mind that Qigong is more specifically aligned with Integrative Medicine, which is not Alternative Medicine. Since there has been quite a bit of activity surrounding Integrative Medicine recently, including scientific evidence of the effectiveness of mind-body practices, I believe it is to everyone's benefit to review the impression the articles gives. I'll start a new section to discuss some changes (below) CJ (talk) 16:59, 11 February 2014 (UTC)
- A couple of points CJ. The current tone is neutral enough, and certainly doesn't lean towards the negative. What we have is Wikipedia taking the mainstream view on an exercise program which proponents want to turn into a medical modality. Taking this mainstream POV is what Wikipedia obliges us to do. It becomes fringe or Alt med when you make claims for the modality that cannot be substantiated by good evidence. You have not as yet presented any good evidence in the form of sources that show real beneficial results for quigong beyond the obvious benefits of any kind of exercise.
- You must also remember that the difference between Alt Med and Integretive Med is just Altmed trying to get mainstream acceptance and inclusion into mainstream use for their unproven therapies. I look forward to any reliable sources that you have showing any alternative practises turning into real medicine. --Roxy the dog (resonate) 17:52, 11 February 2014 (UTC)
- (UTC)There is more evidence/research on Qigong and T'ai Chi and this needs to be reflected in the description. The current article is not neutral. CJ is not making false or dramatic claims and this article needs to be updated. "Real medicine" definition has changed throughout time and it is now time to update the benefits of Qigong. Are the editors who are reacting so strongly to not making changes, non-practitioners of Qigong or T'ai Chi? Please advise as it is sounding like there is an unspoken agenda here. NatHealth1 (talk) 23:25, 13 February 2014
- I agree, NatHealth1. Thanks for your support. Roxy the dog - are you saying that in the history of medicine, there has never been a case where a practice that was originally thought to be ineffective and unscientific turned out to be an effective and accepted medical practice? Didn't the medical community laugh at the concept that doctors should wash their hands between patients?
- Again, it really sounds to me like you are pushing an agenda, and not looking at the evidence. I simply ask that you go to the medical websites--
http://www.webmd.com/balance/guide/health-benefits-tai-chi-qigong
http://www.amazon.com/The-Harvard-Medical-School-Guide/dp/1590309421
http://www.ncbi.nlm.nih.gov/pubmed/15006825?dopt=Abstract
http://www.mdanderson.org/publications/inside-integrative-medicine/issues/dec-2012.pdf
I could give you dozens more. Everyone says the same thing - positive results, growing evidence, not enough clinical studies, nothing definitive. Shouldn't Wikipedia's article say the same thing?
CJ (talk) 00:58, 14 February 2014 (UTC)
- I think the take home message here is "Nothing definitive", so to answer your question, no. --Roxy the dog (resonate) 07:51, 14 February 2014 (UTC)
- This is interesting. For years scientists/doctors did not know exactly how aspirin worked, yet it did, and they prescribed it anyhow. There are a number of medications out there with the same "Nothing definitive" explanation, but they work. Acupuncture works and is known primarily for alleviating pain and has been used for thousands of years. Research is just beginning to uncover a number of ways why acupuncture works. For those who say there just is not enough "science" behind it and they think it is the "placebo" effect, I ask when did animals learn about the "placebo" effect. If the editors here are not teachers or practitioners of Qigong, I would ask them to jump in and take a class. Something is amiss here and the dialogue is skewed and misleading. It's time to broaden the definition of Qigong and the health benefits.NatHealth1 (talk) 13:46, 14 February 2014 (UTC)
- User:NatHealth1 we do not base articles on editors' experiences from taking a class or any personal authority - please see WP:OR. All content must be based on reliable sources. For health related information, the sourcing is described in WP:MEDRS. We are discussing what the most recent and best MEDRS-compliant secondary sources say about qigong.Jytdog (talk) 13:51, 14 February 2014 (UTC)
User:JytdogI hear what you are saying about reliable sources and I also see a pattern of refuting any change whatsoever. CJ provided links for you to peruse as well as outlining and explaining at length her suggested changes. Was any of this material read or was an immediate rebuttal instituted without any regard for what was offered? Again, I don't believe this is a balanced discussion and any attempt to broaden the definition is ignored.NatHealth1 (talk) 14:10, 14 February 2014 (UTC)
- Nobody is trying to broaden the definition as far as I can see - the effort here is to make more definitive health claims, which I am saying that we cannot do, because yes, I have read the sources and they consistently say that we cannot make definitive statements about effectiveness. Jytdog (talk) 14:16, 14 February 2014 (UTC)
User:Jytdog Let's cooperate and meet half way. If the research is not enough to convince "you," then let's reference these studies and infer that there are strong indicators of health benefits. Surely, there is a way to word this that would meet both yours and CJs standards.NatHealth1 (talk) 15:14, 14 February 2014 (UTC)
- CJ and I and others here actually agree on what the literature says as a baseline; CJ's own proposal says that no firm conclusions can be drawn. CJ is trying to beyond that and say "there are positive results" but this is a firm conclusion. We cannot go there. Jytdog (talk) 15:26, 14 February 2014 (UTC)
I agree with CJ. The old text is not neutral, in my opinion. It is biased and negative, and gives the wrong impression regarding how the medical community views Qigong and Tai Chi. It is recommended by many respected and evidence-based medical resources - Harvard, Mayo Clinic, Cleveland Clinic. I support CJ's changes. — Preceding unsigned comment added by 173.212.31.167 (talk) 18:52, 14 February 2014 (UTC)
- CJ's text revision attempts to improve the current text in this article based on recent studies. Most of the comments fail to consider that qigong itself is a personal practice that may or may not have a healing effect. The practice of qigong also does no harm to the person and may actually help a given condition. The practice of qigong is also dependent on a person's mental state and their willingness to be diligent in their practice. Most of the comments are also identifying qigong as a defined process. Since there are thousands of different qigong types and practices, one qigong type may be effective for a condition for a person while another type may have no effect. Using the word "qigong" as a general term in a medical context almost any conclusion can be drawn since the practice itself is not defined and may vary on an individual basis. The conclusion is that qigong has been shown to help in some cases but more work needs to be done to establish results of the practice.(SequimTao (talk) 01:31, 15 February 2014 (UTC))
Evidence and Support Rewrite
I would like to start a more directed discussion on the medical evidence and support for Qigong in the talk pages before making changes. I've been talking with several people and some suggested the following change, which I think we should implement.
Old text: Possible health benefits of qigong have been studied in various medical conditions. Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials.[1]
New text: Claims about heath benefits of qigong practice are widespread and include improving cardiovascular function, healing specific acute diseases, and increasing longevity.[2][3][4] While a comprehensive review of random controlled trials shows that almost all studies showed positive benefits of qigong practice[5], an overview of systematic reviews concludes that “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”[1]
Would this change be acceptable to everyone? If not, what specifically is the problem with it, and how can we come to consensus on a more unbiased and balanced view of the Qigong research which, though not yet definitive, is highly supportive and provides some evidence.
I look forward to hearing your thoughts. CJ (talk) 16:55, 11 February 2014 (UTC)
On another note, we might want to consider the following:
I do believe that we might find something useful in Peter Wayne's recent book - Harvard Medical school Guide to Tai chi.
I agree CJ. I consider statements from Harvard Medical School researchers to have high credibility. Kleinpj (talk) 20:32, 14 February 2014 (UTC)
Conventional medical science on the Chinese art of Tai Chi now shows what Tai Chi masters have known for centuries: regular practice leads to more vigor and flexibility, better balance and mobility, and a sense of well-being. Cutting-edge research from Harvard Medical School also supports the long-standing claims that Tai Chi also has a beneficial impact on the health of the heart, bones, nerves and muscles, immune system, and the mind. This research provides fascinating insight into the underlying physiological mechanisms that explain how Tai Chi actually works. [6] However, nomenclature is a problem. We accept that qigong is a group of modalities: quiet meditation, moving meditation, self massage, external applications including a number of additional modalities such as cupping, tapping, 'sword finger' , even diet and herbal remedies. The vast majority of recent research is limited to moving meditation using tai chi postures. We can assume the premise that tai chi forms can cultivate qi and use the current research to our advantage to promote qigong with the caveat that this is a very limited inquiry.
Again - I'd like to hear your thoughts. CJ (talk) 17:21, 11 February 2014 (UTC)
- If by "unbiased" you mean that it must say that qigong is effective, we cannot do it. There are widespread claims made about many many things (magnet therapy, echinacea, drugs in clinical trials) and wikipedia does not parrot them. Unless something is proven to be safe and effective and there is a solid scientific consensus behind that, we cannot say that it is. Let me repeat that - unless something is proven safe and effective and there is a solid scientific consensus behind it, we cannot say that it is. If we did, Wikipedia goes to the dogs, both on the alt med (or integrative) side and the corporate side. In this case, the first half of the second sentence needs to go. I am very uncertain about the first sentence. Jytdog (talk) 17:26, 11 February 2014 (UTC)
- Of course I don't mean to indicate that it "must" say that qigong is effective. That has not yet been proven, so I agree with you. What I am saying is that, unlike magnet therapy and echinacea, qigong and other integrative health practices are beginning to demonstrate, in solid clinical trials, that it is safe, effective, and beneficial as an integrative health practice. (Not alternative, not even complimentary, but as part of a whole integrative medical perspective, taking into account the wellbeing of the whole person.) CJ (talk) 15:31, 13 February 2014 (UTC)
- My initial thoughts. Arguments from authority will not cut the mustard here, we need reliable sources. Your proposed edit is interesting, and could be used for any other forum of exercise. Consider ...
- "Claims about heath benefits of walking the dog are widespread and include improving cardiovascular function, healing specific acute diseases, and increasing longevity. While a comprehensive review of random controlled trials shows that almost all studies showed positive benefits of walking the dog, an overview of systematic reviews concludes that “effectiveness of walking the dog is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”
- Nobody disputes that exercise is a good thing, but equally, there is nothing to suggest that Qigong has anything over and above walking the dog, or any other form of structured or ad hoc exercise. I would not support your changes to current text. When there is some scientific explanation for the more extreme parts of this fringe pseudoscience as detailed in your Harvard quote I would be prepared to reconsider. We shouldn't say any more than the equivalent of "Exercise is good for you" in Wikipedia's voice. --Roxy the dog (resonate) 19:55, 11 February 2014 (UTC)
- I've removed references to the specific people with whom I spoke - it is irrelevent. However, I do disagree with your statement that there is nothing to suggest that Qigong has anything over and above walking the dog. What I'm saying is that recently a body of research is developing that says there is growing evidence that Qigong has additional benefits over exercise, and can be applied in more situations than just plain exercise (for example, with people who are bedridden, as there is are many Lying Down Qigong practices). Again, more research is needed. But the evidence is growing, and Harvard Medical School, Mayo Clinic, Vanderbilt Medical and hundreds of other highly regarded well-established medical communities are beginning to endorse Qigong and Tai Chi. CJ (talk) 15:31, 13 February 2014 (UTC)
- I think the old text is more neutral in tone. I agreed with the comments of Jytdog and Roxy the dog, the scientific consensus is just not there to make a more positive statement about qigong. The listed authority did not contribute any new information to change my opinion. I suggest we leave the tone of the article as is. ottawakungfu (talk) 03:02, 12 February 2014 (UTC)
- I'm sorry, but I completely disagree. The old text is not neutral, in my opinion. It is biased and negative, and gives the wrong impression regarding how the medical community views Qigong and Tai Chi. CJ (talk) 16:03, 13 February 2014 (UTC)
- The new text is clearly better and more neutral. Based on solid references, the lead statement concerning health should clearly state that claims of health benefits are widespread, that clinical studies consistently show benefits, but that systematic reviews cannot reach a definitive conclusions because of limitations of controlled trials. Please, let's be supportive of earnest efforts to improve the article. The language and tone of this discussion seems rather aggressive and biased, including labeling qigong as "fringe pseudoscience", and using unnecessarily challenging and cynical statements. First, indeed there are widespread claims about health benefits of qigong that are reviewed repeatedly in popular books about qigong as well as in the peer-reviewed medical literature, and most peer-reviewed papers start with a review of these claims, and the list "improving cardiovascular function, healing specific acute diseases, and increasing longevity" is representative and taken from a valid reference. Second, there is a substantial body of peer-reviewed literature in reputable journals that consistently finds positive benefits, and this is born out in a comprehensive review of randomized controlled trials. Third, the three quotes are taken directly from the conclusion of the overview of systematic reviews and the current wording is a paraphrase that gives a different tone than the reference. Note there is not a similar literature about walking dogs; no there is not a literature that equates qigong with exercise (though that may be a good opinion); and no it is not neutral to exclude a balance of the main view of references (even if you believe this is pseudoscience). Fourth, the reasons why “it would be unwise to draw firm conclusions at this stage” should be explicit, in particular lack of funding for research, impracticality of double blinding, and difficulty of standardized controls and treatment dosing (frequency, duration, and intensity of treatment). Fifth, many references emphasize advantages of low cost, low risk, and high accessibility. Yes, it could be good to extract conclusions and quotes from Peter Wayne's Harvard Medical School Guide to Tai Chi. TheProfessor (talk) 08:50, 12 February 2014 (UTC)
- Dear Professor: much of the literature compares qigong with excercise; it is often used as the intervention in one of the arms in clinical trials. You don't seem to be aware of what the literature actually says.... so it in unclear on what basis you are making any arguments here. Jytdog (talk) 13:19, 12 February 2014 (UTC)
- Hi Jytdog, greetings to you. Let's be specific about the substance of the article and what is being discussed, and not resort to trying to discredit me based on unsound and unfounded comments. Yes, I am aware of the literature, and no it is not fair of you to try to dismiss all I wrote with a sweeping statement like "it is unclear on what basis you are making any arguments here". Yes, many RTCs have an "exercise" group and often show similar beneficial effects. Rather, let's focus in on the proposed new text. The first sentence establishes that there are many claims about health benefits and provides a concise referenced list ("improving cardiovascular function, healing specific acute diseases, and increasing longevity"). Do you have a better list? In their short communication Qigong for healthcare: an overview of systematic reviews Lee et al. 2011 begin with a statement that "Proponents of qigong recommend it for a wide range of conditions, symptoms and situations, including stress management, hypertension, chronic pain, depression, insomnia, cardiac rehabilitation, immune function and for enhancing the quality of life (QOL) of cancer patients." and reference Sancier KM. Medical applications of qigong. Altern Ther Health Med 1996;2:40–6. Claims or beliefs concerning health benefits need to be introduced up front using similar neutral language. Second, there needs to be a clear statement about what medical literature exists (the comprehensive review is appropriate). Third, there needs to be a clear statement of medical conclusions (quotes from the systematic reviews and overview of systematic reviews are appropriate). TheProfessor (talk) 18:01, 12 February 2014 (UTC)
- Hi professor. When you mention "unsound and unfounded comments", are you referring to your statement that "no there is not a literature that equates qigong with exercise"? If so, I am willing to ignore that statement and move on. If you are referring to my calling that out, I don't understand; my question was reasonable - if you make such an error, so strongly, have you even read the literature, and if not, on what basis are you making any arguments at all? Confusing. Anyway let's do move on. Addressing the new matter. First. As pointed out by me and others above, there are many many things that "people say" have wonderful effects. Heck at one point "people said" smoking was good for you. Wikipedia should not repeat what "people say" in a section on health effects. That is why there is nothing like sentence 1 in the article; these things do not "need" to be stated at all. Second. The current 2nd sentence does not make "a clear statement about what medical literature exists"; instead, of describing the literature, it makes health claims. And I do not agree that a Wikipedia should even provide "a clear statement about what medical literature exists" - that is not typical Wikipedia article content. Third, indeed, this is what Wikipedia should do -- provide "a clear statement of medical conclusions". Yes to that! Jytdog (talk) 18:45, 12 February 2014 (UTC)
- Hi Jytdog, thanks for your input. I will consider further your perspective concerning CJ's suggestions, and add a bit more discussion that clarifies my perspective later. In the meantime, could you please supply us with the specific reference(s) and quoted text that in a medically sound way equates qigong with exercise? Thanks. TheProfessor (talk) 03:52, 13 February 2014 (UTC)
- So now you are showing that you have not even read our own article carefully nor looked at the sources that are already presented. Jytdog (talk) 11:09, 13 February 2014 (UTC)
- Nothing of the sort, Jytdog. Of course I have read our own article carefully, and yes I have done more than just look at the sources presented. Actually, if you look back over the past several years of my contributions I have been a major contributor to the Qigong article and have worked hard to ensure that it is clearly written, properly referenced, and neutral. This is not the question. I was only asking if you could supply us with specific reference(s) and quoted text that in a medically sound way equates qigong with exercise. Is that not a simple and civil request? TheProfessor (talk) 11:34, 13 February 2014 (UTC)
- Professor, I don't understand why you are asking me as though I am trying to introduce something new, that is not already clearly cited and discussed in the article and has been there a long time. If you want to make a point about this content and its sources please make it directly. Thanks. Jytdog (talk) 12:35, 13 February 2014 (UTC)
- If you need sources, Prof, I think you should find them yourself, rather than asking Jytdog to find them for you !! --Roxy the dog (resonate) 12:04, 13 February 2014 (UTC)
- Professor, I don't understand why you are asking me as though I am trying to introduce something new, that is not already clearly cited and discussed in the article and has been there a long time. If you want to make a point about this content and its sources please make it directly. Thanks. Jytdog (talk) 12:35, 13 February 2014 (UTC)
- Jytdog, I encourage us to keep the discussion focused on CJ's proposed new text, and I'll offer more input after we hear from others. To clarify, in a strict sense I know of no references that explicitly equate exercise and qigong, though as the Qigong article states "Studies that compared qigong and tai chi with other physical exercises found similar effects, and greatest effects were found in studies that compared qigong and tai chi to effects in low activity or inactive participants". We certainly could revisit whether this borders on OR in that it was extracted from a review and not the conclusions of the source, per se. So I genuinely would appreciate it if you have a medically sound reference that explicitly equates exercise and qigong. As you know, statistical equivalence of two treatments in an RTC does not necessarily mean that two treatments are the same, just that they have indistinguishable effects (possibly real, or possibly artifact, for example of small sample size or poor experimental design). In my own perspective, part of qigong/exercise equivalence is definitional, in that qigong could be called a special kind of exercise, and, according to what is taught by many qigong teachers, exercise and other activities can be performed as a kind of qigong. Another part involves a more sophisticated understanding that translates what is practiced to the language of science and medicine. Specifically, qigong could be viewed as different from "ordinary exercise" because it combines slow physical movement (or stillness), coordinated with controlled breathing, a meditative state, and mental focus that builds proprioception, new neural connections, and enhanced circulation. On the other hand, there is a lot of sophisticated exercise out there. And yes, there is a lot of hot air, belief, misinformation, hopeful thinking, investment in outcome, and sloppy thinking. New literature is emerging that emphasizes perspectives of other scientific approaches, and while double-blind RCTs are not necessarily practical, much of accepted scientific understanding is based on other kinds of "proof" (e.g., gravity, evolution, greenhouse effect...). Perhaps with time we will find conclusive health benefits or lack of benefits from qigong. Of course from a Wikipedia perspective we need to be careful to stay with what is verifiable. Please assume good faith. And please be supportive of new (and old) editors. I myself prefer a gentle and friendly tone. Thanks for your contributions. Hi Roxy the dog. TheProfessor (talk) 14:25, 13 February 2014 (UTC)
- Nothing of the sort, Jytdog. Of course I have read our own article carefully, and yes I have done more than just look at the sources presented. Actually, if you look back over the past several years of my contributions I have been a major contributor to the Qigong article and have worked hard to ensure that it is clearly written, properly referenced, and neutral. This is not the question. I was only asking if you could supply us with specific reference(s) and quoted text that in a medically sound way equates qigong with exercise. Is that not a simple and civil request? TheProfessor (talk) 11:34, 13 February 2014 (UTC)
- Four comments:
- *So you have been pulling a bill clinton and you are using "equate" with unsignalled formal precision. oy. OK a) the current article does not "equate" qigong with exercise and b) I know of no source that "equates" qigong with exercise either. So why are you bringing up this whole "equating" thing at all? (real question)
- No I am not "pulling a Bill Clinton". Please let's cut this derisive language. I'm more than happy to have a civil discussion, and I suspect you may be surprised how much we can actually agree upon. I value the scientific rigor, knowledge, and experience you bring to the group. While limited in time I can devote, I can make a significant contribution (I can tell you more about my background in academic science later, if you like). I'm not trying to defend fringe pseudoscience, but rather I'm interested in rigorous scientific understanding and representing current knowledge with integrity. In terms of integrity, I could not find any source that simply equates qigong to exercise, even though various Wikipedia editors pushed for this in past discussion, and I was satisfied for now with the language we crafted for the Qigong article, with the intention to improve it over time with a more sophisticated view from the literature. From my perspective dismissing qigong as simply exercise misses the observation that is made both in a traditional view, which emphasizes the coordination of controlled breath, slow relaxed movement, and a focus that involves vivid visualization and body awareness, and in the scientific/medical view, which recognizes that this combination may be especially effective in certain situation. I explain more above, including some implications for neurophysiology and healing. TheProfessor (talk) 07:10, 14 February 2014 (UTC)
- Don't care what your credentials are, nor should I. Nor should you care about mine. What matters is what we bring to the actual conversation with the words we write. If your background helps you make productive contributions, great. No one here has been asserting "equating" so I don't know why you are arguing about it. Not very productive.Jytdog (talk) 14:12, 14 February 2014 (UTC)
- You brought up equating qigong and ordinary exercise, in your walking the dog example and in questioning whether I was familiar with literature. Two points: First, I agree that it is important to consider whether qigong and ordinary exercise like walking the dog may produce similar results (and this is why I asked if you have any medically sound sources to support this, since I know on none). Second, questioning my credibility in the way you did was not founded (because I said I know of no source), and contrary to Wikipedia's practice of being polite and welcoming. Yes, let's focus on the proposed text, not unnecessarily diverting discussion to questioning my credibility or credentials.TheProfessor (talk) 16:29, 14 February 2014 (UTC)
- OK, so you are coming off a very narrow meaning of "equate". So I go back again to what I said earlier: the current wikipedia text explictly talks about studies that compared other forms of exercise to qigong and found the outcome similar. you are speaking in the present tense above: "I know of no source." The citation is right there for you to see. Why have you still not read it? Confusing. I am not questioning your personal credibility and would never do that. I have questioned why you are making arguments when you have not read the article we are discussing carefully nor studied its sources. It is a question about a) behavior and b) the basis for the arguments you are making. It is not personal. Jytdog (talk) 17:01, 14 February 2014 (UTC)
- Yes, for various studies qigong and exercise treatments have similar benefits. And yes I'm glad to know it is not personal. I understand you are referring to is the Jahnke et al. 2010 Comprehensive Review, and of course I read it and studied its sources (I'm the person who added it to the Qigong article). And no, as far as I can see it does not provide a medically sound conclusion that qigong is equivalent to exercise in either a narrow or a broad sense. Your comment "Why have you still not read it?" is unfounded. As I explained the issue of qigong and exercise is both definitional and scientific (which we could discuss more at another time if that is appropriate). For now, let's focus on the proposed changes. Yes, we need to be careful not to overstate or project our own conclusions (OR), and to represent medical conclusions properly. TheProfessor (talk) 20:21, 14 February 2014 (UTC)
- OK, so you are coming off a very narrow meaning of "equate". So I go back again to what I said earlier: the current wikipedia text explictly talks about studies that compared other forms of exercise to qigong and found the outcome similar. you are speaking in the present tense above: "I know of no source." The citation is right there for you to see. Why have you still not read it? Confusing. I am not questioning your personal credibility and would never do that. I have questioned why you are making arguments when you have not read the article we are discussing carefully nor studied its sources. It is a question about a) behavior and b) the basis for the arguments you are making. It is not personal. Jytdog (talk) 17:01, 14 February 2014 (UTC)
- You brought up equating qigong and ordinary exercise, in your walking the dog example and in questioning whether I was familiar with literature. Two points: First, I agree that it is important to consider whether qigong and ordinary exercise like walking the dog may produce similar results (and this is why I asked if you have any medically sound sources to support this, since I know on none). Second, questioning my credibility in the way you did was not founded (because I said I know of no source), and contrary to Wikipedia's practice of being polite and welcoming. Yes, let's focus on the proposed text, not unnecessarily diverting discussion to questioning my credibility or credentials.TheProfessor (talk) 16:29, 14 February 2014 (UTC)
- Don't care what your credentials are, nor should I. Nor should you care about mine. What matters is what we bring to the actual conversation with the words we write. If your background helps you make productive contributions, great. No one here has been asserting "equating" so I don't know why you are arguing about it. Not very productive.Jytdog (talk) 14:12, 14 February 2014 (UTC)
- No I am not "pulling a Bill Clinton". Please let's cut this derisive language. I'm more than happy to have a civil discussion, and I suspect you may be surprised how much we can actually agree upon. I value the scientific rigor, knowledge, and experience you bring to the group. While limited in time I can devote, I can make a significant contribution (I can tell you more about my background in academic science later, if you like). I'm not trying to defend fringe pseudoscience, but rather I'm interested in rigorous scientific understanding and representing current knowledge with integrity. In terms of integrity, I could not find any source that simply equates qigong to exercise, even though various Wikipedia editors pushed for this in past discussion, and I was satisfied for now with the language we crafted for the Qigong article, with the intention to improve it over time with a more sophisticated view from the literature. From my perspective dismissing qigong as simply exercise misses the observation that is made both in a traditional view, which emphasizes the coordination of controlled breath, slow relaxed movement, and a focus that involves vivid visualization and body awareness, and in the scientific/medical view, which recognizes that this combination may be especially effective in certain situation. I explain more above, including some implications for neurophysiology and healing. TheProfessor (talk) 07:10, 14 February 2014 (UTC)
- So now you are showing that you have not even read our own article carefully nor looked at the sources that are already presented. Jytdog (talk) 11:09, 13 February 2014 (UTC)
- *With respect to why there is not great RCT data - this is not relevant. We either have such data and can make definitive positive statements about health benefits, or we do not have it, and we cannot make definitive positive statements. In this case it is the latter, and it will continue being the latter until somebody who cares enough makes it happen.
- Yes, this is relevant, and various sources, including systematic reviews state so. TheProfessor (talk) 07:10, 14 February 2014 (UTC)
- My comment was addressed to why there is not great data. The why does not matter. The fact that there is not great data is very important.Jytdog (talk) 14:12, 14 February 2014 (UTC)
- Yes, I am saying why is relevant, which is part of the substance of the reviews. Explicitly, why includes lack of funding for research, impracticality of double blinding, and difficulty of standardized controls and treatment dosing (frequency, duration, and intensity of treatment). TheProfessor (talk) 16:29, 14 February 2014 (UTC)
- My comment was addressed to why there is not great data. The why does not matter. The fact that there is not great data is very important.Jytdog (talk) 14:12, 14 February 2014 (UTC)
- Yes, this is relevant, and various sources, including systematic reviews state so. TheProfessor (talk) 07:10, 14 February 2014 (UTC)
- *Your statement "New literature is emerging that emphasizes perspectives of other scientific approaches, and while double-blind RCTs are not necessarily practical, much of accepted scientific understanding is based on other kinds of "proof" (e.g., gravity, evolution, greenhouse effect...)" is so so crazy. The scientific method involves doing repeatable experiments to verify hypotheses. The scientific method has been used, for example, to identify and understand gravity, evolution, and the greenhouse effect. The entire point of evidence-based medicine, which is the basis for health-related content in Wikipedia, is to bring the rigor of the scientific method more clearly to bear on medicine. The field of medicine is exactly trying to move away from "other ways of knowing" and toward the scientific method - the way that gravity was discovered. So again I don't understand where you are coming from.
- No this is not some whacko statement, but rather informed by scientific literature and approaches within various disciplines. And yes, I advocate rigorous evidence-based approaches that use the scientific method. For example, the greenhouse effect as it applies to global climate change is being understood at different scales by virtue of synthetic approaches -- experiments where possible, predictive models, sensor networks, etc. No, it is not practical to do randomized controlled experiments at a planetary scale, or at the scale of time involved in evolution, in many complex systems, over the course of multiple human lifetimes, or for all the combinations scientists might want to explore. Yes, within limits we can derive rigorous scientific understanding. TheProfessor (talk) 07:10, 14 February 2014 (UTC)
- OK I see what you are saying. With some health-related matter - especially toxicology - we do rely on modeling because it is not ethical to test toxins in clinical trials. However we do not need to rely on modeling for therapeutic interventions; they can be tested in a clinical trial. Jytdog (talk) 14:12, 14 February 2014 (UTC)
- Clinical trials of qigong will always be limited by issues such as funding, inability to double blind, design issues of dosing, and other risk of bias. Other scientifically sound evidence-based approaches are important to overcome such limitations.TheProfessor (talk) 16:29, 14 February 2014 (UTC)
- OK I see what you are saying. With some health-related matter - especially toxicology - we do rely on modeling because it is not ethical to test toxins in clinical trials. However we do not need to rely on modeling for therapeutic interventions; they can be tested in a clinical trial. Jytdog (talk) 14:12, 14 February 2014 (UTC)
- No this is not some whacko statement, but rather informed by scientific literature and approaches within various disciplines. And yes, I advocate rigorous evidence-based approaches that use the scientific method. For example, the greenhouse effect as it applies to global climate change is being understood at different scales by virtue of synthetic approaches -- experiments where possible, predictive models, sensor networks, etc. No, it is not practical to do randomized controlled experiments at a planetary scale, or at the scale of time involved in evolution, in many complex systems, over the course of multiple human lifetimes, or for all the combinations scientists might want to explore. Yes, within limits we can derive rigorous scientific understanding. TheProfessor (talk) 07:10, 14 February 2014 (UTC)
- *I have already commented on the proposed text, saying why I find it unacceptable. You did too and I have been trying to understand your argument in favor of it. So far I have not understood your arguments.Jytdog (talk) 15:26, 13 February 2014 (UTC)
- Yes, I am in favor of the proposed text because 1) it summarizes the breadth of health claims (no these are not just arbitrary claims like you imply, but consistently mentioned in both popular and peer-reviewed literature); 2) it summarizes that there is a substantial body of literature that show consistent positive results (why would we want to pretend otherwise, when this is pointed out in a comprehensive review?); and 3) concise medical conclusions stated through well-written quotes (which we both agree are important to include). TheProfessor (talk) 07:10, 14 February 2014 (UTC)
- Usually using quotes in a Wikipedia article is the result of editors disagreeing about summary statements. It is actually suboptimal. I do agree we will need them in this article. Popular literature is only relevant insofar as we report on "what people say" but is irrelevant for how we actually describe effectiveness, which we will source using the best and most recent secondary sources as per MEDRS. As I wrote to cj, we cannot say there are "consistent positive results" because this is a "firm conclusion" and the most recent and best secondary sources say that "firm conclusions cannot be drawn" as even Cj's proposal statesJytdog (talk) 14:12, 14 February 2014 (UTC)
- Good points.TheProfessor (talk) 16:29, 14 February 2014 (UTC)
- Usually using quotes in a Wikipedia article is the result of editors disagreeing about summary statements. It is actually suboptimal. I do agree we will need them in this article. Popular literature is only relevant insofar as we report on "what people say" but is irrelevant for how we actually describe effectiveness, which we will source using the best and most recent secondary sources as per MEDRS. As I wrote to cj, we cannot say there are "consistent positive results" because this is a "firm conclusion" and the most recent and best secondary sources say that "firm conclusions cannot be drawn" as even Cj's proposal statesJytdog (talk) 14:12, 14 February 2014 (UTC)
- Yes, I am in favor of the proposed text because 1) it summarizes the breadth of health claims (no these are not just arbitrary claims like you imply, but consistently mentioned in both popular and peer-reviewed literature); 2) it summarizes that there is a substantial body of literature that show consistent positive results (why would we want to pretend otherwise, when this is pointed out in a comprehensive review?); and 3) concise medical conclusions stated through well-written quotes (which we both agree are important to include). TheProfessor (talk) 07:10, 14 February 2014 (UTC)
- *With respect to why there is not great RCT data - this is not relevant. We either have such data and can make definitive positive statements about health benefits, or we do not have it, and we cannot make definitive positive statements. In this case it is the latter, and it will continue being the latter until somebody who cares enough makes it happen.
- Whoaaa - seems to be a lot of nastiness getting thrown around here!! Can we tone it down and focus just on improving the article with more recent information available? Perhaps it would be better/easier to go down into the details and modify that before we start changing the introductory paragraph. Next week, I'm going to jump down into the evidence and support area that will give more specific references for the summarization we'd like to modify. Quite frankly, I have done a ton of research on this topic, and can cite chapter and verse - I just need the time to put it into a format that matches Wikipedia's requirements, which I'm just now learning about. Please give me some time, and hold off on squashing the newby, please.
- As I noted, my goal is to have the article accurately reflect the current state of medical opinion about Qigong and Tai Chi, which is more positive than negative. Additionally, the comments about the reasons why there are few ramdomly controlled studies is certainly relevent. You made the case yourself, Jytdog. You said:
- As pointed out by me and others above, there are many many things that "people say" have wonderful effects. Heck at one point "people said" smoking was good for you. Wikipedia should not repeat what "people say" in a section on health effects
- The reason it took so long for the medical community to finally recognize how bad smoking is for humans is because it was impossible to do a randomly controlled scientific study; they only had correlational regression studies, which do not prove causation. There are still no quantifiable, well-designed scientific studies that prove that smoking is bad for you. But the evidence finally piled up even without that golden-certification of RCT, and the medical community now has gone 180 in recognition of the dangers of smoking.
- I suspect the same is happening for Qigong and Tai Chi. I know that there are many skeptics. We need skeptics to reign in the unwarranted "claims" of thousands of bad, dangerous, and unhealthy practices. Nothing bothers me more than Qigong Advocates making completely unfounded claims about miraculous faith-based healings due to some magical mystery force they call "qi". But let's not be blinded to the actual evidence and support that is growing for some health practices that are becoming part of integrative medicine. There is growing evidence of the benefits of the combination of deep breathing, focused intention, and slow purposeful movements which is the basis for Qigong. I'd like to focus on what the evidence shows, and doesn't show, about this healthful practice.
- I'm in the middle of another project right now, so I can't add the information this week - besides, I'd like to hear from some other people - perhaps some new people - on their opinions of making changes to the Qigong article. Anyone? CJ (talk) 15:49, 13 February 2014 (UTC)
- User:Cjrhoads and professor: sorry you feel that anything is uncivil here. My goal is not at all to be uncivil, but rather to be very clear. Discussion is essential to Wikipedia and I am not trying to stop it. I am trying to direct it productively. Cjrhoads the difference between smoking (or any toxic thing) and a therapeutic intervention (as you are wanting to describe qigong) is vast. We cannot ethically do clinical trials where we give people cigarettes; this is unethical since we do not expect any benefit from the intervention. So yes, we are forced to rely on getting data from epidemiological studies of humans and animal studies, and doing the best we can to work out toxicology. With qigong, we are considering it as an intervention and folks have a hypothesis that it is a safe and effective treatment for a number of things. Those are testable hypotheses. There is no bar to testing it. The fact that these hypotheses have not been adequately tested doesn't give us license to just go ahead and say "yes it is safe and effective". This would violate wikipedia guidelines and policies. It has nothing to do with how people feel about anything. It is a question of whether there is data to support a claim that qigong is "safe and effective" for any specific indication. The current text is very NPOV in describing what secondary sources say about the data we have today. We do not have sufficient data to know if any of these hypotheses are true. I am very unhappy with this effort to put a positive spin on something that "we do not know". We do not know! That is the answer. Jytdog (talk) 23:42, 13 February 2014 (UTC)
- and just to be really painfully clear, i am by no means recommending that the article say that people shouldn't do qigong. i am just saying that the current text, stating that there is insufficient data to recommend qigong to treat or prevent any disease or condition - is accurate, and efforts to go beyond that are spin. and we don't do spin. the article should not be "anti-qigong" and I am certainly not anti-qigong. I am just opposed to making unsupportable positive claims of health benefits.Jytdog (talk) 00:03, 14 February 2014 (UTC)
- User:Cjrhoads and professor: sorry you feel that anything is uncivil here. My goal is not at all to be uncivil, but rather to be very clear. Discussion is essential to Wikipedia and I am not trying to stop it. I am trying to direct it productively. Cjrhoads the difference between smoking (or any toxic thing) and a therapeutic intervention (as you are wanting to describe qigong) is vast. We cannot ethically do clinical trials where we give people cigarettes; this is unethical since we do not expect any benefit from the intervention. So yes, we are forced to rely on getting data from epidemiological studies of humans and animal studies, and doing the best we can to work out toxicology. With qigong, we are considering it as an intervention and folks have a hypothesis that it is a safe and effective treatment for a number of things. Those are testable hypotheses. There is no bar to testing it. The fact that these hypotheses have not been adequately tested doesn't give us license to just go ahead and say "yes it is safe and effective". This would violate wikipedia guidelines and policies. It has nothing to do with how people feel about anything. It is a question of whether there is data to support a claim that qigong is "safe and effective" for any specific indication. The current text is very NPOV in describing what secondary sources say about the data we have today. We do not have sufficient data to know if any of these hypotheses are true. I am very unhappy with this effort to put a positive spin on something that "we do not know". We do not know! That is the answer. Jytdog (talk) 23:42, 13 February 2014 (UTC)
Hi, Jytdog. I understand what you are saying. What I am saying is that I'm afraid that you haven't kept up on the research. Look at WebMD, Mayo Clinic, Harvard Medical School, Vanderbilt Medical School - I could go on and on. It's almost as if you close your eyes and say "it's not there, I can't see it". The overwhelming majority of hospitals and medical communities have come, within the last five years, to the determination that Qigong & Tai Chi is safe, effective, and has positive benefits as an integrative medical practice. The evidence is growing, and clear, but needs more clinical trials to be definitive. That's what just about every synthesis and meta-analysis about the topic has said for the past five years. Your comment that we do not have sufficient data appears to me to be disengenuous because even when people show you the data, you are unwilling to look at it. Additionally, you say there is no bar to testing the hypothesis that Qigong and Tai Chi are safe and effective, but the fact is that there is a huge bar to testing that hypothesis. Unlike pharmaceutical and medical device companies who can afford to fund clinical trials because they get a return on their investment, there is no money to be made on Qigong. Add the fact that it is very difficult (though not impossible, as I explain in my peer-reviewed article published in a medical journal) to do a double blind clinical study on a behavioral therapy, then you have quite adequate reason to understand why we don't have solid proof of the efficacy of Qigong --- yet. I just want the Qigong article to be unbiased and more accurately reflect the current status of research, which is positive but not definitive due to the difficulties involved in clinical trials and the poor quality of research available so far. That's not wishful thinking. That's not putting a positive spin on something. The growing body of evidence is simply a statement of fact. Based on many references and sources acceptable according to the Wikipedia guidelines. Let's look again at the text I am proposing (actually, I'm going to change it a bit to match more closely the sources): Old text:
- Possible health benefits of qigong have been studied in various medical conditions. Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials.[1]
A bald statement that evidence of effectiveness is inconclusive without any context as to why, and a poor quality of the clinical trials without any explanation or mention of positive trends in non-clinical research. New text:
- Claims about heath benefits of qigong practice include improving cardiovascular function, decreasing falls, improving immune response, lowering blood pressure and decreasing pain.[2][3][4]Cite error: The
<ref>
tag has too many names (see the help page). While a comprehensive review of random controlled trials shows that almost all studies showed positive benefits of qigong practice[5], an overview of systematic reviews concludes that “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”[1]
The same information, but within the context of where the researchers currently are. An indication that there may be positive benefits according to limited data, but more data is needed to draw firm conclusions. In my opinion, the second is the more unbiased statement, where as the first is a biased portrayal of the information because it is partial and incomplete. Since I thought impartial and unbiased was what we were trying for, it would make sense that the second statement would be more acceptable to the Wikipedia community as a whole. You appear to disagree, but I'm hoping for other people to be willing to consider the matter. I believe that it would be unfair for the article to be written solely based upon the opinion of someone who might not be as up to date in the research on this topic as I am. CJ (talk) 00:53, 14 February 2014 (UTC)
- Hi Cjrhoads. I don't mistake medical centers offering integrative medicine to meet market demand for alternative approaches as being evidence of those practices being effective to treat or prevent a disease; I don't think anybody should. With respect to the complaint that there is no funding from companies for clinical trials... this is, to be frank, just whining. Like complaining that it is raining. People work toward what their interests are. Companies invest in things that make them money. Nonprofits raise money to do things they think are worthwhile. If the community that supports qigong wants to prove that it is effective scientifically, it can raise the money to fund it. Or they can try to convince the NIH to fund it. But until there is solid evidence for an affirmative claim, we cannot make one in Wikipedia. We cannot say "almost all studies showed positive benefits" - this is a definitive, affirmative statement that is directly contradicted by the very next bit of what you wrote - we cannot draw "firm conclusions"! What can we say is exactly what the current text says "Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials"Jytdog (talk) 01:22, 14 February 2014 (UTC)
Hi, again. Jytdog. So now, despite the fact that well-respected medical centers such as Harvard Medical School, Mayo Clinic, Vanderbilt University, Tufts Medical school - despite the fact that they are all provide Integrative healthcare (NOT alternative medicine, which is not integrated into the whole medical care model, but integrative medicine, which is providing generally safe and effective mind-body therapies in treating the whole person, not just the disease) despite the fact that they support these therapies, you still cling to the notion that there is no widespread agreement in the medical community that there is value to these health practices? The current text seems to me to be stating only part of the truth, not the whole truth. Without the context, it seems just a bit misleading. Don't we want the beginning paragraphs to reflect as unbiased and accurate information as can make it?
Perhaps we could compromise on something in between. Why don't you give it a try, and draft a statement that is not as minimalist as the current text, but not as fully developed as my proposed text? CJ (talk) 02:10, 14 February 2014 (UTC)
- they are not offering them as effective treatments. there is a reason they are in "integrative medicine" (which is a fancy academic medical center term for "alternative medicine" - more marketing play there) -- there is a market demand for this stuff. i am not closing my eyes to anything, the place where i work offers it and my cousin is a provider of it in another state. i have no problem with any of that. i have a problem with trying to make more definitive statements about than is possible. you keep talking right past what i am saying. The minimalist statement is perfect for health effects. If you want a different section (not in "health effects") about the extent of its use and where it is used I have no problem with that. Jytdog (talk) 02:30, 14 February 2014 (UTC)
- It may be your opinion that they are not offering them as effective treatments. I doubt that the medical establishments that provide the treatments, nor the patients who receive them, would agree with you about their ineffectiveness. And your opinion is not supported by the growing body of evidence that says that SOMETHING is working (exactly what, we don't know yet. But the therapies make a difference). Why do you think there is a market demand? Because people want to waste their time and money? I don't think so. Perhaps it is because the therapies work. I'm not talking past what you are saying, Jytdog - I'm listening intently. I'd like to think that you are open to new ideas. I hope so. So how about offering some alternative wording that provide a more balanced and unbiased statement, that provides a little context? CJ (talk) 03:19, 14 February 2014 (UTC)
- You are making this black and white. I did not say that they are offering them as "ineffective". They are "complementary" (the other name for "integrative", right?) - they are not the actual treatment. I am not going to offer an opinion on why there is market demand. People take boatloads of supplements and there is also no definitive evidence that supplements do anything. Again, it might be interesting to have a section on qigong being offered as complementary/integrative medicine. Please hear me - I am not saying that they don't work - I am saying that the best evidence that we have is that we don't know if they work and this is what the current text says. That is very very different from saying that they don't work or are ineffective. It is not a question of "being open" it is a matter of listening to the data. The world is often grey, and this is very much one of those cases. Breathe. Live with the ambiguity. Jytdog (talk) 10:40, 14 February 2014 (UTC)
- It may be your opinion that they are not offering them as effective treatments. I doubt that the medical establishments that provide the treatments, nor the patients who receive them, would agree with you about their ineffectiveness. And your opinion is not supported by the growing body of evidence that says that SOMETHING is working (exactly what, we don't know yet. But the therapies make a difference). Why do you think there is a market demand? Because people want to waste their time and money? I don't think so. Perhaps it is because the therapies work. I'm not talking past what you are saying, Jytdog - I'm listening intently. I'd like to think that you are open to new ideas. I hope so. So how about offering some alternative wording that provide a more balanced and unbiased statement, that provides a little context? CJ (talk) 03:19, 14 February 2014 (UTC)
- User:DharmaWarriorI believe it is definitely possible to say "almost all studies showed positive benefits" if they truly did. Since no one seems to be disputing this empirical fact, then I must assume we accept it. We also seem to agree on the truth of "Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials" After reading all of the comments, it seems some people do not want to include information which may lead someone to a too-favorable conclusion about Qigong even though Wikipedia clearly says not to do this. However, if the language is correct, I do not believe we should be arguing over what conclusions people might make if they interpret the correct language incorrectly. Therefore, I find nothing wrong with the new wording. (talk) 14:25, 14 February 2014 (UTC)
- the purpose of using authoritative reviews is that they summarize and evaluate the primary literature. and what those reviews say is that the we cannot draw any definitive conclusions from the primary sources, due to flaws in those studies. So no we cannot say "almost all studies showed positive benefits" - instead we have to say that "we cannot tell anything from the studies." Jytdog (talk) 15:05, 14 February 2014 (UTC)
- User:DharmaWarriorI believe it is definitely possible to say "almost all studies showed positive benefits" if they truly did. Since no one seems to be disputing this empirical fact, then I must assume we accept it. We also seem to agree on the truth of "Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials" After reading all of the comments, it seems some people do not want to include information which may lead someone to a too-favorable conclusion about Qigong even though Wikipedia clearly says not to do this. However, if the language is correct, I do not believe we should be arguing over what conclusions people might make if they interpret the correct language incorrectly. Therefore, I find nothing wrong with the new wording. (talk) 14:25, 14 February 2014 (UTC)
- And this seems to be the crux of this discussion: Is noting the results of a study the same as stating "cause & effect"? You seem to believe it is. I do not believe stating the results is the same as drawing conclusions, especially if it is noted not to do so. (talk) 18:45, 14 February 2014 (UTC)
JytogFrom your statements above, it appears you are prejudiced against "alt. med." and that you are not recognizing the NIH, Mayo Clinic, or Harvard Medical School as being reputable sources. Your rigidity to stick with past research, distrust of "alternative/integrative" methods, and persistence to repeat old material is questionable. If the more current sources that the Professor, CJ, and others offer you are not proof enough that we need to move forward on this, I would respectfully ask you to reflect on how you are helping in this project,or is the intention to continually throw up roadblocks of archaic sources to keep us stuck in the past as well?NatHealth1 (talk) 21:42, 14 February 2014 (UTC)
- I am not prejudiced against alternative medicine. In wikipedia, if there are MEDRS compliant secondary sources that show that any intervention is safe and effective, it is great to say that in the article In the supplement/complementary medicine space, I am aware of very very few interventions where we have such sources (folic acid in pregancy is one). I would be interested to see any statement from the NIH saying that "qigong is effective to treat X" - the NIH is "a major medical or scientific body" and as such a statement from it is useful under MEDRS. Can you bring such a source? If Mayo or Harvard is simply offering qigong as complementary medicine, that is not a "source" that we use in Wikipedia. I hope you do not consider Wikipedia's sourcing policies and guidelines to be "archaic"; I certainly don't! Jytdog (talk) 21:58, 14 February 2014 (UTC)
User:Jytdog Thank you for your response and it is not that Wikipedia policies are at issue, it is that a number of people have already supplied sources/studies for you to peruse and yet the changes CJ suggest are continually rebuffed. The Professor also gave credible sources in support of the benefits of Qigong, and CJ changed the wording and diluted its strength. You were invited to help with the wording, to collaborate, and you appear to ignore any new studies presented. Others are chiming in, with support of the changes. Please review all the data given above as it appears it is not being examined, but dismissed. Appreciate your willingness to work together as a team so that we can move ahead.NatHealth1 (talk) 01:45, 15 February 2014 (UTC)
- Under MEDRS we rely on the most recent critical review. That is reference 6: Lee MS, Oh B, Ernst E (2011). "Qigong for healthcare: an overview of systematic reviews". JRSM Short Rep 2 (2): 7. doi:10.1258/shorts.2010.010091. PMC 3046559. PMID 21369525. That is the one that says "an overview of systematic reviews concludes that “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research" CJ is reaching back to an older review, that did not even review the quality of the studies, to get the "positive" statement. That is not how we do things. This is not about me, it is about sourcing policies. And others along with me are opposing this effort to make the article more positive. Please see WP:MEDASSESS.Jytdog (talk) 02:03, 15 February 2014 (UTC)
Thank you for coming to the heart of the matter. If this is the case, I again ask why are we not including Jahnke's meta-analysis or the Harvard Medical School's findings?NatHealth1 (talk) 13:33, 15 February 2014 (UTC)
Qigong general description
It is generally accepted that Qigong exercises have three components: a posture (whether moving or stationary) 調身, breathing techniques 調息, and mental focus on guiding qi through the body 調心. It is generally accepted that Qigong exercises have three components: a posture (whether moving or stationary) 調身, breathing techniques 調息, and mental intent on guiding qi through the body 調心 and possibly external to it.
The word focus is static, while the word intent is active. Most all literature about using Qigong techniques requires intent rather than focus to guide qi. Also, qi can be moved outside the body when it is directed to do so. There are many masters who refer to the existence of a Qi ball that can surround the body to provide both awareness and protection. There is also the whole topic of Qi healing that utilizes the qi from one person to affect the body of a patient. (SequimTao (talk) 06:37, 13 February 2014 (UTC))
- I completely agree that intention is the proper word here, not focus. However, I think we need to be careful here. As long as we view qi as a magical mystery force that can be thrown around outside of the body, we are fighting a losing battle. Qi is not a magical mystery force any more than gravity is a magical mystery force. I can "prove" the impact of gravity 100% of the time. It doesn't depend upon whether or not I "believe" that something will fall to the groud. If I lift something and let it fall, gravity is demonstrated.
- It may be possible that Qi can also be demonstrated, a preponderance of the time, in scientific clinical trials. Just as we can't see gravity but we can see its effect, we can't see Qi but we can see its effect. The effect may be (awaiting further proof, but identifying the evidence that is growing) 1. Lower blood pressure, 2. Increased lung capacity 3. Improved immune response, 4. Increased muscle tone and better balance, and 5) Improved production of neurotransmitters and hormones maintaining body systems such as digestion, cardiovascular, and the nervous sytem. But we need more research for proof.
- The evidence is beginning to show that Qigong activity, when practiced regularly, changes the type of brain waves typically exhibited in response to stress (beta). Types of brainwaves has a domino effect on the body. Beta waves cause an overabundance of CRH (corticotropin-releasing hormone), which causes cortisol, adrenaline to flood the bloodstream. Blood pressure and heart rate goes up. Respiration becomes shallow and the rate increases. The capillaries contract. Over long term, these hormones begin to cause damage; inhibiting the digestive system, restricting nutritional absorption, causing muscle fatigue and increasing pain. When the brain exhibits alpha and gamma waves, neurotransmitters such as dopamine, serotonin, nor adrenaline, acetylcholine, GABA, and endorphins are released into the bloodstream. These are often called the "feel good" hormones because they cause a feeling of contentment and well-being. They do more than make people feel good, however. The increased neurotransmitters prompts the vagus nerve to activate, which lowers the heart rate and blood pressure. (The vagus nerve is one of the largest, and wanders around the body from the brain stem to the colon.) When the heart rate and blood pressure are lowered, that prompts the lungs to expand more fully and breath more deeply, which activates the digestive system. A smooth-working digestive system, when combined with nutritional food, improves nutritional absorption.
- It may be that these underlying bodily functions are the "source" of the "magical powers" of what is called Qi. Can these effects be documented "external" to the body - i.e., the actions of one person causing the cascade of beneficial bodily changes in another person? Perhaps. But lets focus on getting documentation on the reproducable effects on one person before we start trying to heal the world, shall we? CJ (talk) 16:29, 13 February 2014 (UTC)
- I'm gratified that you support the change to intent rather than focus. While most of the remainder of the discussion is about what might happen in the body to produce external effects, I don't think this is relevant in the introductory paragraphs. The possible existence of qi external to the body needs to be developed in other paragraphs. This just lays the groundwork that qi is not necessarily confined to the practitioners body, as the original text implied. Also, there is no mention of any effects of qi in another person's body in this context, just that for some people, they can extend qi outside their body. One possible effect also is that physical phenomena caused by qi have been observed, but likely not in a laboratory setting. In this context, I'm not limiting the effect of qi for healing purposes, although it might be used as such.(SequimTao (talk) 19:24, 13 February 2014 (UTC))
- I think you guys have been watching too much "Star Wars." Certain, I am. --Roxy the dog (resonate) 17:10, 13 February 2014 (UTC)
- Well, I can understand that position, Roxy the dog. Certainly, if you had told me twenty years ago that I could drastically reduce the pain from my back injuries due to a car accident without opiate pain medication if I did this certain exercise, focused on a certain intention, and breathed deeply for 20 minutes a day, I would have laughed in your face or called you crazy as a loon. I am a scientist, through and through. So when practicing Tai Chi and Qigong daily actually decreased my pain significantly, I was not willing to accept that it was magic. There had to be a reason. That's why I've been doing research on it for the past 10 years, and feel that it is important that we separate the chafe from the wheat. There is something to it - we just have to do more research to find out exactly what. Luckily, in recent years I'm not the only one to notice the physical changes that impact pain relief from Qigong and Tai Chi. I suspect there is more than one way to cause the physical changes to occur, but first we have to reproduce the situation to make sure it can be considered an effective treatment, and not just yet-another-unconvincing anecdote. It's only been recently that several highly regarded medical communities have really started to look into it, which is why I'm so set on making sure that the legitimacy of this research is maintained and not dismissed along with angels and magnets and faith healing. I'd also like to see a clinical protocol established that can help ascertain whether there is any basis for use of these practices in the treatment of diseases and injuries. But FIRST we need to get much more accurate about the state of the research on this topic. I hope that you will help me do that. CJ (talk) 19:51, 13 February 2014 (UTC)
/* Health Benefit */ It seems to me that one premise of this continuing discussion is based on an 'all or nothing' belief. Fact: there is a growing body of evidence supporting the therapeutic benefit of qigong exercise. I support the proposed change as a more accurate representation of the 2014 state of research evidence. — Preceding unsigned comment added by Kleinpj (talk • contribs) 21:27, 13 February 2014 (UTC)
- My point exactly, Jytdog. Qi is ill-defined, unqualified, and refers to something upon which no one agrees on the measurement. But we don't need to talk about Qi to verify the growing body of evidence that supports Qigong and Tai Chi activities (or any other slow-moving, deep-breathing, focused intention activity). These practices are evidence-based. We just need to look at the studies, and the outcomes of those studies: lower blood pressure, increased muscle tone, improved circulation, improved lung capacity, improved digestion. Let's stick with the medical terms, shall we? CJ (talk) 01:08, 14 February 2014 (UTC)
Back To Basics: Which is less biased?
The conversation in other areas is getting a bit dense, so I'd like to bring it all together again in this new area.
The question: which of these provide a more unbiased, more accurate, impartial reflection of the current state of research for Qigong and other Integrative (not alternative, not complimentary, but integrative) health practices?
Old text: Possible health benefits of qigong have been studied in various medical conditions. Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials.
New text: Claims about heath benefits of qigong practice include improving cardiovascular function, decreasing falls, improving immune response, lowering blood pressure and decreasing pain. While a comprehensive review of random controlled trials shows that almost all studies showed positive benefits of qigong practice, an overview of systematic reviews concludes that “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”.
(I've taken out the references at this point - but each sentence has been appropriately referenced with an acceptable reference based upon Wikipedia guidelines.)
Some editors have proposed that we should not make changes because the current statement is as far as Wikipedians should go; "almost all studies showed positive benefits" is not definitive, whereas "Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials" is definitive. Both are true - that fact does not appear to be in dispute. What is in dispute is whether or not it is more or less biased to make any comments at all that describe positive benefits until and unless we can make definitive statements about the topic.
There appears to some editors who think the second is more accurate and fair. The second way of indicating the effectiveness (poor quality research, as opposed to inconclusive due to the poor quality of the clinical trials which seems to suggest that the RESULTS of the trials was poor rather than that the positive effects cannot necessarily be generalized because it is based on poorly designed studies) seems to be more impartial and unbiased.
How do we resolve this disagreement? Comments? CJ (talk) 17:26, 14 February 2014 (UTC)
- I am sorry but you have misrepresented my objection. I have been saying that "almost all studies showed positive benefits" is a definitive statement that we cannot make because it offers a firm conclusion ("showed positive benefits"). It is not true. "Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials" is a definitive statement we can make in that makes it clear that no conclusion can be drawn. It is true.Jytdog (talk) 18:03, 14 February 2014 (UTC)
- e/c The answer is easy. We go with WP:NPOV and WP:MEDRS, (MEDRS is particularly important if you want to try to make medical claims), and leave the article as it is, well sourced, and reasonably written. I suggest you try to understand what Jytdog has been so patiently explaining to yourself and the Prof. I admire his ability to remain polite in the face of extreme wilful refusal to listen WP:IDHT. Please read and try to understand.
- I would like to also address your contention that the article is biased in some way. It is clear that you and the Prof lack an understanding of what bias as wikipedia views it actually means. We do not give equal weight to both sides of an issue, we give weight to the mainstream view. That is, for emphasis in this case, that the theory and practise of Quigong beyond "exercise is good for you" is, and I'm sorry to have to say it, balderdash, utterly and completely. --Roxy the dog (resonate) 18:17, 14 February 2014 (UTC)
- Roxy the dog is wise. bobrayner (talk) 18:19, 14 February 2014 (UTC)
- CJRhodes is wise. The article is biased. — Preceding unsigned comment added by KathyL226 (talk • contribs) 19:03, 14 February 2014 (UTC)
- User:Roxy the dog you make too broad a claim when you say "the theory and practise of Quigong beyond "exercise is good for you" is, and I'm sorry to have to say it, balderdash, utterly and completely." Based on the best sources we have, we can say that we have insufficient data to say that qigong is effective for any of the indications we have been discussing; the trials have been poor, so the hypotheses that qigong is good for X, Y, or Z have been neither proven nor falsified; they simply remain hypotheses. Very different from what you said! (if the trials had been well-designed and conducted and had falsified the hypotheses you would be accurate, however) User:Bobrayner, Roxy was unwise here, and you to agree with him.Jytdog (talk) 22:20, 14 February 2014 (UTC)
- I would like to also address your contention that the article is biased in some way. It is clear that you and the Prof lack an understanding of what bias as wikipedia views it actually means. We do not give equal weight to both sides of an issue, we give weight to the mainstream view. That is, for emphasis in this case, that the theory and practise of Quigong beyond "exercise is good for you" is, and I'm sorry to have to say it, balderdash, utterly and completely. --Roxy the dog (resonate) 18:17, 14 February 2014 (UTC)
- A very wise old editor with white hair and a long beard, and a strange white linen suit once said to me, "Roxy, you need three things to edit successfully here at Wikipedia - sources, sources and sources. She was right, but I couldn't stop staring at her beard. However, I stand by my balderdash comment, as if it weren't so, we'd have the whole foundation of our understanding of the universe come crashing down because magic. As regards our approach to our current problem with this page, like you, I await good sources, and will of course support any changes required by them. If I may, I predict that nothing earth shattering will result. Also, Bob is entitled to his opinion. --Roxy the dog (resonate) 22:37, 14 February 2014 (UTC)
- Funny dog! To the extent qigong is exercise-y we all could do with exercise and there is no reason to balderdashize that; to the extent it is religion-y or philosophy-y it is kind of gratuitously mean to call it balderdash. To the extent people claim it is indeed most certainly good to treat X, that does goes beyond the data and is balderdashable but better to just say "that claim goes beyond the data". It is the broad application of the balderbrush that is unwise. But you have a sharper bark than i in general. and of course bob and everybody else can have their opinion including their opinion of others' opinions, this dog included. :) Jytdog (talk) 23:14, 14 February 2014 (UTC)
- A very wise old editor with white hair and a long beard, and a strange white linen suit once said to me, "Roxy, you need three things to edit successfully here at Wikipedia - sources, sources and sources. She was right, but I couldn't stop staring at her beard. However, I stand by my balderdash comment, as if it weren't so, we'd have the whole foundation of our understanding of the universe come crashing down because magic. As regards our approach to our current problem with this page, like you, I await good sources, and will of course support any changes required by them. If I may, I predict that nothing earth shattering will result. Also, Bob is entitled to his opinion. --Roxy the dog (resonate) 22:37, 14 February 2014 (UTC)
- Yes, I encourage everybody to be familiar with WP:NPOV and WP:MEDRS. Roxy the dog, I encourage you to be specific when you claim I lack understanding of what bias means in Wikipedia, and encourage you not to just group CJ and me together. I am concerned that we refine the discussion to specifics of sources, well-crafted text, and being true to Wikipedia standards. TheProfessor (talk) 20:47, 14 February 2014 (UTC)
- Comment: When it comes to controversial medical topics like these, it's best to stick to the recommendations of authoritative national heath organizations such as NIH, NHS, etc. I'm not familiar with the level of scientific research on Qigong, but I reckon that there seems to be relatively little work done so far in addition to the poor quality of trials, which is in line with what the current (old) text says. On the other hand, I believe in keeping things short and precise, and that means changing the phrase in the lead section from "poor quality of the clinical trials" to "poor quality research" as you've proposed.-A1candidate (talk) 19:20, 14 February 2014 (UTC)
Here is my suggested compromise : "Possible health benefits of qigong have been studied in various medical conditions including cardiovascular function, fall prevention, immune response, blood pressure control and pain control. In most cases, evidence of effectiveness is inconclusive from a scientific perspective due to the poor quality of the clinical trials. A comprehensive review of random controlled trials shows that almost all of the selected studies showed positive benefits of qigong practice. However, in another overview of systematic reviews concludes that “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”. It is more verbose but it added information from both sides. ottawakungfu (talk) 21:48, 14 February 2014 (UTC)
- We cannot say "A comprehensive review of random controlled trials shows that almost all of the selected studies showed positive benefits of qigong practice." If you are my husband and I ask you, "how much money do we have in the bank" and you say "I don't know, $10,000 maybe" I will not go buy a $9500 car. That would be a stupid decision with such uncertain information. As you acknowledge, the trials are too flawed to draw conclusions, so we cannot say "showed a positive benefit". I have said this about 10 times and you keep ignoring it. Again, we have only an ambiguous answer. we don't know if it works for anything or not. Please. stop. making. definitive. positive. claims. Please! Jytdog (talk) 22:03, 14 February 2014 (UTC)
- This is the conclusion from Jahnke et al. (2010) "Research has demonstrated consistent, significant results for a number of health benefits in RCTs, evidencing progress toward recognizing the similarity and equivalence of Qigong and Tai Chi." This paper has been peer reviewed. How can we include this information in Wikipedia? If you don't like the conclusions of Jahnke et al. take it up with the author and the journal. I have not ignore your arguments but I am seeking a compromise. ottawakungfu (talk) 23:48, 14 February 2014 (UTC)
I agree with Ottawakungfu. My understanding of Neutral Point of View is just that - nuetral. Not negative. Not positive. Just the facts, Ma'am. Am I wrong? It appears to me the the current wording is negative, not neutral. The wording that Ottawakungfu has suggested is more neutral (though I would say "due to the low quality of the design of the research". Few of them would qualify as "clinical trials".) The current wording makes it sound as if there have been lots of clinical trials, but they have not shown any quality conclusions. The fact is there have been only a few clinical trials. Some have shown strong high quality conclusions, but there have not been ENOUGH of them to say that their conclusions are definitive.
I have also read the MEDRS at length, and as far as I can tell, the statements that we are trying to make are completely within those guidelines. We have sources and more sources which fit into the MEDRS definition of reliable source. Published in fully qualified peer reviewed medical journals. These studies report positive benefits, more reliable than anectodal evidence and case studies, but limited in their generalizability because of the difficulties in establishing double blind protocols with behavioral therapies. That does not mean that they are not valid, nor that they cannot draw any conclusions. What it means is that the conclusions they draw is limited to the specific environment, with the specific population, with a limited scope.
Allow me to give a specific example. New England Journal of Medicine. (N Engl J Med 2010;363:743-54.) A Randomized Trial of Tai Chi for Fibromyalgia by Chenchen Wang, M.D., M.P.H., Christopher H. Schmid, Ph.D., Ramel Rones, B.S., Robert Kalish, M.D., Janeth Yinh, M.D., Don L. Goldenberg, M.D., Yoojin Lee, M.S., and Timothy McAlindon, M.D., M.P.H.. Of the 66 randomly assigned patients, the 33 in the tai chi group had clinically important improvements in the FIQ total score and quality of life. Mean (±SD)baseline and 12-week FIQ scores for the tai chi group were 62.9±15.5 and 35.1±18.8,respectively, versus 68.0±11 and 58.6±17.6, respectively, for the control group (change from baseline in the tai chi group vs. change from baseline in the control group,−18.4 points; P<0.001). The corresponding SF-36 physical-component scores were 28.5±8.4 and 37.0±10.5 for the tai chi/qigong group versus 28.0±7.8 and 29.4±7.4 for the control group (between-group difference, 7.1 points; P = 0.001), and the mental component scores were 42.6±12.2 and 50.3±10.2 for the tai chi group versus 37.8±10.5 and 39.4±11.9 for the control group (between-group difference, 6.1 points; P = 0.03). Improvements were maintained at 24 weeks (between-group difference in the FIQ score, −18.3 points; P<0.001). No adverse events were observed. Conclusion: Tai chi/Qigong may be a useful treatment for fibromyalgia and merits long-term study in larger study populations
Another example. Meditation Practices for Health: State of the Research. Investigators: Maria B. Ospina, B.Sc., M.Sc.; Kenneth Bond, B.Ed., M.A.; Mohammad Karkhaneh, M.D.;Lisa Tjosvold, B.A., M.L.I.S.;Ben Vandermeer, M.Sc.;Yuanyuan Liang, Ph.D.; Liza Bialy, B.Sc.; Nicola Hooton, B.Sc., M.P.H.; Nina Buscemi, Ph.D.; Donna M. Dryden, Ph.D. Terry P. Klassen, M.D., M.Sc., F.R.C.P.C. Research conducted by the University of Alberta Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0023). The report is filled with descriptions of the poor methodologies used by research and non-significant results for the 813 studies included in the meta-analysis, but they specifically pointed out one particular positive outcome: A few statistically significant results favoring meditation practices were found: both TM® (transcendental meditation) versus PMR (progressive muscle relaxation), and Qi Gong versus WL (waiting list) for DBP (diastolic blood pressure) and SBP (systolic blood pressure), Zen Buddhist meditation versus blood pressure checks for DBP, and Yoga versus HE (health education) to reduce stress. The positive results from these meta-analyses need to be interpreted with caution, as biases, such as expectancy bias, cannot be excluded.
Note that they said "interpreted with caution", not "there was no positive results".
When a study has a positive outcome, a conclusion can be drawn. But one or two studies is not enough to definitively say that Tai Chi/Qigong IS useful in a wide variety of circumstances, just that it MAY BE useful. Does this mean that we should report (1) "there is no evidence that Tai Chi/Qigong is helpful"? Does this mean that we should report (2) "Tai Chi/Qigong is an effective treatment"? I don't think either one of those statements fits in the NPOV or MEDRS as I understand them. I believe that the proper thing to do would be to report (3) "A positive outcome was reported, and Tai Chi/Qigong may be a useful treatment, but the topic merits long term study in larger study populations." Wouldn't anything else is a misrepresentation? What am I missing about NPOV or MEDRS which would warrant the first statement rather than the third? I'm not trying to be difficult. I truly want to understand what I am missing. CJ (talk) 23:59, 14 February 2014 (UTC)
- I'm not arguing at all. I'm trying to understand. Can you explain a little further? I realize it may seem that I'm being obtuse, but I'm not. I don't understand why a statement that impresses me as negative and biased would be considered neutral (by you), and a more carefully worded and explanatory statement that sounds neutral to me would be considered biased (by you). I know that you think that you've explained, but what you stated makes no sense to me. You said:
- I have been saying that "almost all studies showed positive benefits" is a definitive statement that we cannot make because it offers a firm conclusion ("showed positive benefits"). It is "not true".
- But I don't think that the statement "showed positive benefits" is a firm conclusion if it is surrounded with "However, in another overview of systematic reviews concludes that “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”. I think, instead, it provides a more balanced, unbiased, accurate view of the reality. What makes you say that it would not be appropriate to say that? I am just trying to understand, and I appreciate your patience. CJ (talk) 00:56, 15 February 2014 (UTC)
- You are saying the equivalent of: "It is a beautiful sunny day. I have not been outside nor can I see outside nor has anyone told me what the weather is like today." Jytdog (talk) 01:27, 15 February 2014 (UTC)
- But someone has told me what the weather is - the researchers who did the studies and the meta-analysis. Aren't I allowed to share what they stated?
CJ (talk) 01:47, 15 February 2014 (UTC)
- What the researchers are saying is: exactly "I cannot see outside": that is what the following means: “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage”". You cannot see outside but you want to say it is a sunny day - that the results are positive. But the results are not interpretable! Jytdog (talk) 01:55, 15 February 2014 (UTC)
- I really appreciate your time and effort, Jytdog. I want to thank you for hanging in there. I think I understand your point of view. You feel that wikipedia guidelines suggest that we have to be very very sure before we make any statements that would indicate firm conclusions. But it still appears to me that we don't have to to be quite so black and white. Isn't there room between all or nothing? To use your analogy, a few people are able to peak around the edges of the curtains, and are willing to posit that it might be a sunny day outside, but that we need to remove more of the curtain before we can be sure Am I wrong in thinking that it is better to share that early indications seem to demonstrate that there might be sun, based on the analysis of the researchers, but that it would be unwise to draw firm conclusions at this stage? Including both statements, as illustrated by the compromise that ottowakungfu shared - wouldn't that be okay? I've reworded the proposed change again to see if it is more acceptable to you. Would you please take a look?
- Are you willing to provide alternative wording that includes some additional information, Jytdog? At the present time, it appears that the choices are:
- I really appreciate your time and effort, Jytdog. I want to thank you for hanging in there. I think I understand your point of view. You feel that wikipedia guidelines suggest that we have to be very very sure before we make any statements that would indicate firm conclusions. But it still appears to me that we don't have to to be quite so black and white. Isn't there room between all or nothing? To use your analogy, a few people are able to peak around the edges of the curtains, and are willing to posit that it might be a sunny day outside, but that we need to remove more of the curtain before we can be sure Am I wrong in thinking that it is better to share that early indications seem to demonstrate that there might be sun, based on the analysis of the researchers, but that it would be unwise to draw firm conclusions at this stage? Including both statements, as illustrated by the compromise that ottowakungfu shared - wouldn't that be okay? I've reworded the proposed change again to see if it is more acceptable to you. Would you please take a look?
Possible health benefits of qigong have been studied in various medical conditions. Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials. OR Possible health benefits of qigong have been studied in various medical conditions including cardiovascular function, fall prevention, immune response, blood pressure control and pain control. A comprehensive review of random controlled trials shows that many of the selected studies showed positive benefits of qigong practice, but in most cases, strong evidence of effectiveness is inconclusive from a scientific perspective due to the inadequate design of the existing research. A systematic review concludes that “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”.
I look forward to hearing from you and anyone else who wishes to share their opinion. If we can't come to some kind of agreement on this, then perhaps it is time to ask some other editors. Isn't there a request for comments process we can use to help us work through this impasse? CJ (talk) 13:25, 15 February 2014 (UTC)
- You really are uncomfortably with ambiguity. If you cannot say "yes" or "no" because you don't know, you have to say "I don't know". It is not a bad thing to not know; it is the way things stand with many many things. The most recent and best review does not say it works, and it doesn't say it doesn't work. It says that we don't know. That is what we need to say. Why can you not accept this? I understand you believe that it must work because so many people do it and so many esteemed institutions offer it, but that is not how we source content in Wikipedia. You cannot say "show positive benefits." btw, I just looked again at reviews for qigong on pubmed, and there are a LOT related to its use in complementary/integrative medicine, for "quality of life" kinds of things. It seems pretty clear to me that you could generate a section on these kinds of uses (which remarkably does not exist - it should since this is how qigong is used at medical centers) and that you would be likely to be able to say something clearly positive. We'd need to dig deeper, but this seems more likely. The section you are trying to add positive content to is actually about treating diseases and conditions, and yes the bar is high to make a definitive positive statement for things like that. Jytdog (talk) 15:29, 15 February 2014 (UTC)
- What makes you say I am uncomfortable with ambiguity? I am not sure what you mean by that. And I disagree. You don't have to say "no", or even "I don't know". You can say "There are indicators, but I'm not sure". There's a difference, and it's a perfectly acceptable difference. I also don't understand why you are saying that I believe it must work. What I believe has absolutely nothing to do with it. What matters is the sources, and what the sources say. It seems to me that you want to hide what the sources say. I want to share what the sources say. I also don't understand your qualification of the difference between treating a chronic health problem and quality of life kinds of things. Just exactly how do they differ? If a patient decreases the amount of pain they are in because they do Qigong every day, isn't that both treating a condition and raising quality of life? If a person lowers their blood pressure because they do Qigong every day, is that treating a condition or raising quality of life? I'm not sure you can separate the two. In any case, it does sound like you are getting closer and closer to finding some way to word things so that the information presented is clearer. And there do seem to be more people sharing their opinion now than just you and me. Would you agree to disagree and allow me to make the change without reverting it? CJ (talk) 01:14, 16 February 2014 (UTC)
- I am ok with the second paragraph. Thanks everyone for an interesting discussion. ottawakungfu (talk) 14:03, 15 February 2014 (UTC)
- This is an improvement, but could we refine the language of the second sentence to take care of concerns? How about "A comprehensive review of random controlled trials reported that many studies observed positive benefits of qigong practice..."? The wording of the rest of that sentence could be improved. Also, would it make sense to adapt the first sentence from the review of systematic reviews? "Proponents of qigong recommend it for a wide range of conditions, symptoms and situations, including stress management, hypertension, chronic pain, depression, insomnia, cardiac rehabilitation, immune function and for enhancing the quality of life (QOL) of cancer patients." (Lee et al. 2011 Qigong for healthcare: an overview of systematic reviews). TheProfessor (talk) 17:02, 15 February 2014 (UTC)
- I disagree that "observed" is too definitive. Jytdog, please read Jahnke's research and Harvard Med. School's findings. Here is a dictionary definition of the word "observe":
ob·serve [uhb-zurv] Show IPA verb (used with object), ob·served, ob·serv·ing. 1. to see, watch, perceive, or notice: He observed the passersby in the street. 2. to regard with attention, especially so as to see or learn something: I want you to observe her reaction to the judge's question. 3. to watch, view, or note for a scientific, official, or other special purpose: to observe an eclipse. 4. to state by way of comment; remark: He observed frequently that clerks were not as courteous as they used to be. 5. to keep or maintain in one's action, conduct, etc.: You must observe quiet. NatHealth1 (talk) 23:29, 15 February 2014 (UTC)
User:Jytdog I don't get your shorthand. Are you saying you don't find the Jahnke study helpful nor interesting- (if so be specific on what is not helpful and "interesting" is subjective and has no place here) or do you not get the definition of "observe," because you stated you have a problem with its use in this context? You have stated a concern with its use, yet you won't acknowledge a dictionary's definition. Have you read Jahnke's study- yes or no?NatHealth1 (talk) 02:33, 16 February 2014 (UTC)
- I would like to close this and move toward consensus. If I were the only editor I would not include the Jahnke reference as it is not a critical review. But I cannot convince folks to let it go, so let's see if we can use it. I cannot speak for others here, but I would accept (with markup - strikeouts are deletions and italics are additions: "
Possible health benefitsThe effectiveness of qigonghavehas been studied in variousmedical conditionsindications including cardiovascular function, fall prevention, immune response,blood pressure control,and pain control. A 2011 review of randomized controlled trials that did not evaluate the quality of the RCTsshowsfound thatmany of the selected studies showed positive benefits ofqigong practice has some benefits(cite Jahnke), butin most cases, strong evidence of effectiveness is inconclusive from a scientific perspective due to the inadequate design of the existing research. A systematic review concludes thatan overview of systematic reviews published later in 2011 found that published reviews were themselves of poor quality, that any claim for “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”.(cite Lee) Without markup: "The effectiveness of qigong has been studied in various indications including cardiovascular function, fall prevention, immune response, and pain control. A 2011 review of randomized controlled trials that did not evaluate the quality of the RCTs found that qigong practice has some benefits(cite Jahnke), but an overview of systematic reviews published later in 2011 found that published reviews were themselves of poor quality, that any claim for “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”.(cite Lee) - key things
- cardiovascular function and blood pressure control overlap, so let's use the broader one
- if we cite jahnke, we have to point out that the authors did not evaluate the quality of the studies
- the only criteria that matter are scientific for health claims, so it is redundant and misleading to say "from a scientific perspective
- we point out that Lee is later, that they did evaluate the quality of both primary studies and reviews, and found both lacking.
- this is as far as I can go, and as I said I do not speak for the other editors who have opposed this addition. Jytdog (talk) 00:59, 16 February 2014 (UTC)
- I would like to close this and move toward consensus. If I were the only editor I would not include the Jahnke reference as it is not a critical review. But I cannot convince folks to let it go, so let's see if we can use it. I cannot speak for others here, but I would accept (with markup - strikeouts are deletions and italics are additions: "
- Well, I believe that is certainly a step forward. Of course, I've never seen the word "indications" used in that context, but if everyone else agrees that it works grammatically, I'm okay with that too. If I might simply add some parentheses and a modifier, I'd be okay with it:
The effectiveness of qigong has been studied in various indications including cardiovascular function, fall prevention, immune response, and pain control. A 2011 review of randomized controlled trials (that did not evaluate the quality of the RCTs) found that qigong practice has some benefits(cite Jahnke), but an overview of systematic reviews published later in 2011 found that some published reviews were themselves of poor quality, that any claim for “effectiveness of qigong is based on poor quality research”, that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”.(cite Lee)
- While certainly this is far from what I would like to see, I think it's an okay compromise for the introductory paragraph, and gets us far enough away from the solely negative statement that I'm willing to close this out - though, of course, I can only speak for myself and not the other editors. More information can be provided in a detailed section below which I can work on when I get more time.
- So - shall we close this out? Or are there further objections? CJ (talk) 01:31, 16 February 2014 (UTC)
Jahnke should not be used in the lead, and certainly not as discussed above. It does not do any due diligence about the quality of studies it reviews, which goes against the basics of how a systematic review should be run (see, for example, the PRISMA criteria); higher quality studies (read: more reliable sources) say that no conclusion can be reached due to the poor quality of the trials done. We have multiple higher quality reviews than Jahnke, there is no reason to use it in the lead, and certainly not as some counterweight to higher quality sources. I see numerous editors above objecting to changes to the subvert the now neutral sentence in the lead, and no consensus to change it. Yobol (talk) 02:42, 16 February 2014 (UTC)
- User:Cjrhoads if you have not seen "indications" used that way, that is a clear sign that you are not familiar with the medical literature, and if I were in your shoes I would be pushing much less harder than you are. Yobol has now articulated why we should not cite Jahnke more clearly than I could. My offer is withdrawn. Jytdog (talk) 02:57, 16 February 2014 (UTC)
- Correct they are, Jytdog and Yobol, my support they have. --Roxy the dog (resonate) 06:50, 16 February 2014 (UTC)
I disagree with Jytdog,et al and find that CJ and the Professor have provided enough detailed explanations of their suggested revisions to warrant a more positive opening paragraph. Those whom disagree, I respectfully ask why you chose Qigong as your platform to edit on Wikipedia. What is your goal, intent for this listing, and why Qigong? It may help us understand, so that we can better collaborate and update this. Please advise.NatHealth1 (talk) 14:14, 16 February 2014 (UTC)
JytdogI invite you to tone down your assumptions on whom you are jousting with as these comments are not adding to our discussion, but distracting. I don't need to defend CJ, as "they" can do that themselves, and I am very familiar with medical literature and the use of "indications" in this sentence is clumsy. Again, very interested on why you and your coterie are interested in Qigong on Wikipedia.NatHealth1 (talk) 14:14, 16 February 2014 (UTC)
- User:NatHealth1 What is clumsy? That is how the word is used in the literature that discusses testing health interventions. I am not "jousting" and have no interest in that. Unclear on why you are asking about motivation; we don't ask that here, we WP:AGF. (and this is now the second time you have raised issues along these lines) I have certainly not asked that of you. Please don't turn a disagreement about content into dark conspiracy theories. Everybody talking here should be basing arguments about content on reliable sources as they are defined in policy and guidelines, and on competent reading of those sources and our article in light of policies and guidelines. I apologize if I have been too sharp when people talking here have strayed from arguments made from those bases. We all have been talking quite a bit; there is not consensus that the most reliable sources support the content making a more broad positive statement that qigong is effective for treating the indications under discussion. Again, I think there may be a basis in recent MEDRS-compliant reviews to make a positive statement on improvement in quality of life of patients undergoing treatments for various disease and conditions, or recovering, when qigong is used as a complement -not when it is considered as the intervention to treat the disease or condition. Use as a complementary therapy is generally the way that qigong and other CAM modalities are deployed in the kinds of academic medical centers that you have mentioned. And there is no section on that - we don't discuss it at all. Why not concentrate where you may be able to get traction? Jytdog (talk) 14:46, 16 February 2014 (UTC)
Jytdog I hear you and agree with "as a complement." I don't believe anyone here has been implying otherwise.NatHealth1 (talk) 16:16, 16 February 2014 (UTC)
Medical Research Lead: Seeking Concensus
Let's try for consensus on something clean that strictly uses the systematic reviews and overview of systematic reviews as sources. Draft text:
- Medical research on qigong is increasing, and relates to a wide range of conditions, including cancer, pain, diabetes, Parkinson’s disease, hypertension, fibromyalgia, anxiety, depression, well-being, and general chronic conditions. While many of the clinical studies report positive effects, effectiveness is based on what is considered to be poor quality data, with the conclusion that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”.
Note that every condition listed corresponds to a referenced systematic review, and three recently published reviews need to be added: Lauche et al. 2013 concerning fibromyalgia, Wang et al. 2013 concerning anxiety, depression, and well-being, and Oh et al. 2013 concerning depression. All reviews address RCTs that report positive effects, and all report that primary data are of poor quality, typically because of small sample sizes and lack of proper control group. Also note, all systematic reviews (except the two on hypertension) are considered to be of poor quality based on the 2011 overview of systematic reviews, and of course systematic reviews since 2011 were not evaluated. The conclusion quotes come from this overview, and are representative of the conclusions of all the reviews. TheProfessor (talk) 14:58, 16 February 2014 (UTC)
- Thanks, TheProfessor. I would be fine that that one. What do the rest of you think? Yobol? Jytdog? Roxy the Dog? I would like to add that while the Professor was writing that, I was working on a different one, so allow me to add it in case it would be more acceptable to everyone. [Moved to separate section below, to untangle editing conflict] CJ (talk) 15:06, 16 February 2014 (UTC)
- Here are citations for these 3 new sources sources:
- Lauche R et al. A systematic review and meta-analysis of qigong for the fibromyalgia syndrome Evid Based Complement Alternat Med. 2013;2013:635182. PMID 24288564 Concluding statement of abstract: "This systematic review found that Qigong may be a useful approach for FMS patients. According to the quality of evidence, only a weak recommendation for Qigong can be made at this point. Further high quality RCTs are required for the conclusive judgment of its long-term effects."
- Wang CW, et al The effect of qigong on depressive and anxiety symptoms: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2013;2013:716094. PMID 23762156 Concluding statement of abstract: "Qigong may be potentially beneficial for management of depressive symptoms, but the results should be interpreted with caution due to the limited number of RCTs and associated methodological weaknesses. Further rigorously designed RCTs are warranted."
- Oh B et al. Effects of qigong on depression: a systemic review. Evid Based Complement Alternat Med. 2013;2013:134737. PMID 23533461 Concluding statement of abstract: "While the evidence suggests the potential effects of Qigong in the treatment of depression, the review of the literature shows inconclusive results. Further research using rigorous study designs is necessary to investigate the effectiveness of Qigong in depression."
- I am not sure we should use these sources as this journal is not MEDLINE indexed. They all seem to be well done and are recent. In any case none of these 3 articles justify a statement like "show positive health benefits". They all say things like "may be useful". Not "show positive health benefits". Those are such different statements! Subjunctive vs indicative mood. This is the ambiguity I keep talking about, that we have to convey in the article. If editors here demand the indicative mood, it can only be negative along the lines of "has not demonstrated effectiveness" - we do not have support for a statement in the indicative mood that states effectiveness. Jytdog (talk) 15:22, 16 February 2014 (UTC)
- Thanks, Jytdog. Yes, your point about using language like "show positive health benefits" is important. The individual RTCs and the outcomes in the reviews use language that commonly refer to "effect" or "positive effect", which is acceptable language for data analysis and reporting results. Is there other language you could suggest when referring to a positive, negative, or neutral effect observed in a treatment group? Indeed, careful qualification like "may be" is important in conclusions. I'll use more care with the word choice and modify what is proposed accordingly. TheProfessor (talk) 16:18, 16 February 2014 (UTC)
- Lets us be clear. The sources are very poor, and we could not use them for what CJ and The Prof would want us to, that is as reliable sources for Medical claims. We could use them for what Alt med believers think type comment. -Roxy the dog (resonate) 16:00, 16 February 2014 (UTC)
- Thanks, Roxy the dog. I'm not advocating using the three new references, and as far as I know CJ has not said anything about them. Why specifically are they "very poor"? Are there other systematic reviews that you recommend excluding from medical research discussion? Introducing the three references only adds more conditions to the list of conditions studied, but does not affect the rest of the text. TheProfessor (talk) 16:18, 16 February 2014 (UTC)
- Jytdog and Roxy the dog, please understand that I am trying to craft a medical research lead, based on the systematic reviews and the overview review, that specifically lists the conditions studied, states the general outcomes of the qigong treatment groups as compared to the other treatments, and states the conclusions. Is the language acceptable, and if not what specific changes do you suggest according to WP:MEDRS? TheProfessor (talk) 18:50, 16 February 2014 (UTC)
Medical Research Lead: Draft from CJ
I would like to add that while the Professor was writing that, I was working on a different one, so allow me to add it in case it would be more acceptable to everyone:
- Old text: Possible health benefits of qigong have been studied in various medical conditions. Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials.
- New text: Claims about heath benefits of qigong practice include improving cardiovascular function, decreasing falls, improving immune response, and decreasing pain. For example, two separate systematic meta-analysis (Cite: Yeh, Wang, Wayne, Phillips, Preventative Cardiology, 2008 and Ospina, et all, 2007 Meditation Practices for Health: State of the Research, AHRQ) found positive impact for qigong on cardiovascular systems in a few well-designed studies, and no adverse impacts. A meta-analysis of randomized studies indicated that tai chi and qigong practiced for 3 to 4 months is effective in improving balance, flexibility, muscle strength, activities of daily living, and fear of falling. (Cite: Park, Song, in Journal of Korean Academic Nursing, June 2013 J Korean Acad Nurs. 2013 Jun;43(3):341-51. doi: 10.4040/jkan.2013.43.3.341.) But strong evidence is inconclusive because there are not enough well-designed clinical trials. Ospina, et al, notes: "The results analyzed from methodologically stronger research include findings sufficiently favorable to emphasize the value of further research in this field. It is imperative that future studies on meditation practices be more rigorous in design, execution, and analysis, and in the reporting of the results." (Cite Ospina, pg 210) According to Lee “It would be unwise to draw firm conclusions at this stage.” (cite Lee)
It is more wordy, but specific enough to balance both sides of the issue and is not negatively biased as the original wording. If we don't want to include all that, I'm happy to go back to a general statement that many studies show some positive benefits without citation and put the details in the more detailed section, but Jytdog, Yobol, and Roxy the Dog may require the more specific statements that can be sourced from strongly supported NIH and PubMed articles. Alternatively, we can simply take out the negatively biased statement with a vague - "More information on the research-based evidence can be found in the Qigong Health Research section."
Well? What do we think? Can we agree on this? If not, please provide ALTERNATIVE wording, don't just criticize the change. I believe we need to compromise on this issue, and I am sure that we can find a way to do that. CJ (talk) 15:06, 16 February 2014 (UTC)
CJ, it is great to want more positive wording but you have not been arguing from the sources. What source (other than Jahnke) do you have for making a positive statement in the indicative mood, and for what indication? I have not seen any. (and Jahnke is not acceptable) Jytdog (talk) 15:24, 16 February 2014 (UTC)
- Yeh GY et al The effect of tai chi exercise on blood pressure: a systematic review. Prev Cardiol. 2008 Spring;11(2):82-9. 18401235 Quote from conclusion in abstract: "No adverse effects were reported. Tai chi exercise may reduce BP and serve as a practical, nonpharmacologic adjunct to conventional hypertension management" Important question - are you now saying that this article should consider qigong and Tai Chi as the same thing? Most of our sources distinguish them and it is going to complicate this discussion (and open up what I imagine will be a much more difficult and much broader discussion among those who believe they are very distinct and should not be lumped) if we start lumping them. I don't think we should use this source.
- Ospina MB, et al Meditation practices for health: state of the research. Evid Rep Technol Assess (Full Rep). 2007 Jun;(155):1-263. PMID 17764203 "Many uncertainties surround the practice of meditation. Scientific research on meditation practices does not appear to have a common theoretical perspective and is characterized by poor methodological quality. Firm conclusions on the effects of meditation practices in healthcare cannot be drawn based on the available evidence. Future research on meditation practices must be more rigorous in the design and execution of studies and in the analysis and reporting of results." Where qigong is mentioned, it says "Meta-analyses based on low-quality studies and small numbers of hypertensive participants showed that TM®, Qi Gong and Zen Buddhist meditation significantly reduced blood pressure". And the end of the analytical results section ends with "Finally, the low methodological quality of all the studies included in the meta-analysis is an additional cause for interpreting all the results described here with caution." This is a great, albeit old, source.
- Park M, Song R. [Effects of Tai Chi on fall risk factors: a meta-analysis]. [Article in Korean] J Korean Acad Nurs. 2013 Jun;43(3):341-51. PMID 23893224. Yes, foreign language sources can be used in Wikipedia but it is not a good idea to bring a source in a foreign language for disputed content. From the abstract it does not appear that the authors critically reviewed the studies they analyzed and so like Jahnke we should not use it for that reason too).
- None of the acceptable sources here justify a positive statement in the indicative mood.Jytdog (talk) 15:53, 16 February 2014 (UTC)
{moved by CJ from next section because the issue was actually here, in the previous section} The comment was struck out earlier. It was so confusing I really didn't know who said what, which is why I started the next section. CJ (talk) 21:19, 16 February 2014 (UTC)
- I just reviewed this page and I don't see where I asked you for sources about anxiety. I'm not confused... Jytdog (talk) 18:09, 16 February 2014 (UTC)
Another Attempt at Consensus - Intro statement on Research
There so many conflicts in the last section that I am confused. Jytdog, for example, asked me for sources for qigong impact on anxiety when that was someone else's suggestion, not mine. Can we agree to refrain from criticisms and justifications and simply, one right after another, post alternative wording so that people can comment on which one(s) they would support? I think we've all heard all the arguments many times, and I'd like to bring this impasse to a close or ask for dispute resolution.
- I just reviewed this page and I don't see where I asked you for sources about anxiety. I'm not confused... Jytdog (talk) 18:09, 16 February 2014 (UTC)
Old text: Possible health benefits of qigong have been studied in various medical conditions. Evidence of effectiveness is inconclusive due to the poor quality of the clinical trials.
- User:CJ No. I don't think this accurately portrays the consensus in the literature, but rather may appear to be misleading as to the current research status.
- User:Yobol?
- User:Jytdog? This accurately portrays the consensus in the literature. Jytdog (talk) 18:09, 16 February 2014 (UTC)
- User:Roxy the dog?
- User:TheProfessor? No TheProfessor (talk) 19:29, 16 February 2014 (UTC)
- User:Ottawakungfu?
- User:NatHealth1? No
- User:So1308?
- User:SequimTao?
- User:Kleinpj?
- User:DharmaWarrior?
- KathyL226 No I disagree with the old text as it does not reflect the current state of research.
- Anyone else?
New text #1: Claims about heath benefits of qigong practice include improving cardiovascular function, decreasing falls, improving immune response, and decreasing pain. For example, two separate systematic meta-analysis (Cite: Yeh, Wang, Wayne, Phillips, Preventative Cardiology, 2008 and Ospina, et all, 2007 Meditation Practices for Health: State of the Research, AHRQ) found positive impact for qigong on cardiovascular systems in a few well-designed studies, and no adverse impacts. A meta-analysis of randomized studies indicated that tai chi and qigong practiced for 3 to 4 months is effective in improving balance, flexibility, muscle strength, activities of daily living, and fear of falling. (Cite: Park, Song, in Journal of Korean Academic Nursing, June 2013 J Korean Acad Nurs. 2013 Jun;43(3):341-51. doi: 10.4040/jkan.2013.43.3.341.) But strong evidence is inconclusive because there are not enough well-designed clinical trials. Ospina, et al, notes: "The results analyzed from methodologically stronger research include findings sufficiently favorable to emphasize the value of further research in this field. It is imperative that future studies on meditation practices be more rigorous in design, execution, and analysis, and in the reporting of the results." (Cite Ospina, pg 210) According to Lee “It would be unwise to draw firm conclusions at this stage.” (cite Lee)
- User:CJ Yes.
- User:Yobol?
- User:Jytdog? No way. This overstates when best sources (even the sources provided say only things in the subjective). Conflates tai chi and qigong and we do not want to open that can of worms. Makes concerns about quality of evidence seem just fussy when they are essential. Jytdog (talk) 18:09, 16 February 2014 (UTC)
- User:Roxy the dog?
- User:TheProfessor? No TheProfessor (talk) 19:29, 16 February 2014 (UTC)
- User:Ottawakungfu?
- User:NatHealth1? Yes
- User:So1308?
- User:SequimTao?
- User:Kleinpj?
- User:DharmaWarrior?
- KathyL226 Yes. I agree with the new text. I prefer #1
- Anyone else?
New text #2 Medical research on qigong is increasing, and relates to a wide range of conditions, including cancer, pain, diabetes, Parkinson’s disease, hypertension, fibromyalgia, anxiety, depression, well-being, and general chronic conditions. While many of the clinical studies report positive effects, effectiveness is based on what is considered to be poor quality data, with the conclusion that “it would be unwise to draw firm conclusions at this stage” and that "this area merits further rigorous research”.
- User:CJ Yes.
- User:Yobol?
- User:Jytdog? This is OK... would need to qualify "increasing" relative to something. and the weasel-words "what is considered to be" must go. Health-related content in Wikipedia is science-based and you cannot keep downplaying the science. and need to tie 1st clause and subsequent clause more closely together. Like, "While many of the clinical studies report positive effects, those claims are based on poor quality data."Jytdog (talk)
- User:Roxy the dog?
- User:TheProfessor? Yes (see alternative wording below). TheProfessor (talk) 19:29, 16 February 2014 (UTC)
- User:Ottawakungfu?
- User:NatHealth1? Yes
- User:So1308?
- User:SequimTao?
- User:Kleinpj?
- User:DharmaWarrior?
- User:TheProfessor?
- KathyL226 Yes. I prefer #1 but would accept #2. — Preceding unsigned comment added by KathyL226 (talk • contribs) 18:39, 16 February 2014 (UTC)
- Anyone else?
New Text #3 Scientific interest in qigong is growing, and published medical research relates to a wide range of medical conditions, including cancer, pain, diabetes, Parkinson’s disease, hypertension, fibromyalgia, anxiety, depression, well-being, and general chronic conditions. While many clinical studies report positive effects, the quality of most research is poor, typically due to small sample size and lack of proper control group. Thus "it would be unwise to draw firm conclusions at this stage" and "this area merits further rigorous research".
- User:TheProfessor Yes. Note that wording and substance come directly from the published overview of systematic reviews. TheProfessor (talk) 20:02, 16 February 2014 (UTC)
- User:CJ? Yes. This would be acceptable.
- User:Yobol?
- User:Jytdog?
- User:Roxy the dog?
- User:Ottawakungfu?
- User:NatHealth1?
- User:So1308?
- User:SequimTao?
- User:Kleinpj?
- User:DharmaWarrior?
- KathyL226?
- Anyone else?
Please add alternative wording suggestions here:
New Text #4
- User:TheProfessor?
- User:CJ?
- User:Yobol?
- User:Jytdog?
- User:Roxy the dog?
- User:Ottawakungfu?
- User:NatHealth1?
- User:So1308?
- User:SequimTao?
- User:Kleinpj?
- User:DharmaWarrior?
- User:KathyL226?
- Anyone else?
Can we reach a consensus on one of these? Please say yes or no for each one. Add a quick short reason if you feel you must, but we don't want discussion above, only below. Please add alternative wording in the section designated for that. CJ (talk) 15:44, 16 February 2014 (UTC)
Further Discussion Below
- I vote for new text#1 and appreciate the time and effort everyone in this discussion has offered.NatHealth1 (talk) 16:01, 16 February 2014 (UTC)
- Hi, NatHealth1. This is not really a "vote" per se. It's a straw poll. Please simply say yes or no for each of the choices, because you might find more than one acceptable. We are seeking consensus, not majority rule. And rather than continuously argue about sources, which is getting very tedious, I'd like to simply get people to provide an alternative that WOULD be acceptable to them if none of the choices available to replace the existing text would be acceptable. Jytdog did provide an acceptable alternative at one point, but he withdrew it. Can you try again, Jytdog? Anyone else? Again - I'm sure that we can come together on wording that we can all agree on if we give this a few days. The purpose is to replace the biased negative impression with an unbiased text that provides a more balanced view of the current status of research on this topic. Thanks. CJ (talk) 16:11, 16 February 2014 (UTC)
- And right here is what is the most frustrating in this whole conversation. 'The current text is not biased - it is accurate. You have not proved that it is biased using reliable sources. I understand that you would like a statement saying something a) in the indicative and b) that is positive. However, the only statement in the indicative that can be made based on acceptable sources we have discussed so far, is something like: '"qigong has not demonstrated effectiveness; RCTs to test effectiveness have been of insufficient quality to make a judgement." (in other words, there is a goal line called "proof of effectiveness" and qigong has not crossed that goal line) You might be able to get something positive in the subjunctive accepted, like "suggest qigong may be effective" in some specific indications, and you might be able to get a positive claim in the indicative accepted for a QOL claim. I am telling you how you can get something more positive that fits in with how we write health-content and thus may get consensus, but you are not going that way. You are very very close to WP:IDHT. I am grateful that you are just talking and have refrained from trying to actually edit the article. Thanks for that, at least. Jytdog (talk) 18:09, 16 February 2014 (UTC)
- I don't mean to frustrate you, Jytdog. But neither am I willing to accept that I am breaking WP:IDHT guidelines by commenting that I believe a certain statement appears biased to me. I am very open to your suggestions. Could you please do the wording? If I were to take your concept and try to word it appropriately, it would not be as good as your giving me wording that would be acceptable. CJ (talk) 21:21, 16 February 2014 (UTC)
- We don't do votes to achieve consensus. Like the vatican, we wait for consensus to emerge. This is becoming untoward and tendentious. --Roxy the dog (resonate) 16:24, 16 February 2014 (UTC)
- As I noted, this is not a vote. This is a straw poll that is designed to stick with the main issue and not get pulled off on tangents. It is also a way to allow use to review several different ideas and think about them with a simple thumbs up or thumbs down for each. I suggest that you can encourage consensus by suggesting wording that would be acceptable to you to replace the existing wording. I hope that it would also eliminate the issues we are having with too many people editing the same section. Less discussion, more wording alternatives, please Thanks. CJ (talk) 16:34, 16 February 2014 (UTC)
- User:NatHealth1 PLEASE TAKE MORE CARE. You have deleted a post I made to this thread. This is not acceptable behaviour. May I suggest that you practise editing in your user sandbox before returning to this thread. --Roxy the dog (resonate) 16:24, 16 February 2014 (UTC)
- Roxy the dog Excuse my learning curve and I don't know what I did or how that happened. I am finding my edits are disappearing as well.NatHealth1 (talk) 16:26, 16 February 2014 (UTC)
As this thread is moot in any case, I suggest it be closed and hatted, discussion should perhaps be aimed at Jytdog's idea, that CJ work on a way to get her medical theories into the body of the article, without the unevidenced claims that she (understandably) wants to make. You must remember that according to WP:MOS the lede should as far as possible be a precis of the body text of the article. To repeat myself, I can't see how you can go further than "Exercise is good for you." Sorry, I am. --Roxy the dog (resonate) 18:44, 16 February 2014 (UTC)
- Indeed, right you may be, Roxy the dog. TheProfessor (talk) 19:29, 16 February 2014 (UTC)
COI, SPA
I am not a big tagger, but I want to point out that as I have discussed with User:Cjrhoads on her talk page, I believe she has a clear COI here. I also pointed out to User:NatHealth1 that the account fits the definition of WP:SPA. Jytdog (talk) 22:33, 16 February 2014 (UTC)
- ^ a b c d Cite error: The named reference
Review
was invoked but never defined (see the help page). - ^ a b Cite error: The named reference
Cohen
was invoked but never defined (see the help page). - ^ a b Cite error: The named reference
Frantzis
was invoked but never defined (see the help page). - ^ a b Cite error: The named reference
YJM1
was invoked but never defined (see the help page). - ^ a b Cite error: The named reference
Jahnke_et_al_2010
was invoked but never defined (see the help page). - ^ Cite error: The named reference
Wayne
was invoked but never defined (see the help page).