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::As I said, it's not redundant. Read it, compare to Cochrane. And 2015 ≠ "old". Exactly, no deadline, leave MEDRS in till we get the newer one. Would you remove a 2015 Harrison's cite from [[chiropractic]] saying it didn't work because the new one might say differently? This isn't how we do things. --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 18:43, 6 January 2019 (UTC) |
::As I said, it's not redundant. Read it, compare to Cochrane. And 2015 ≠ "old". Exactly, no deadline, leave MEDRS in till we get the newer one. Would you remove a 2015 Harrison's cite from [[chiropractic]] saying it didn't work because the new one might say differently? This isn't how we do things. --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 18:43, 6 January 2019 (UTC) |
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::: Yes, it pretty much is. Harrison's says it does not work, in weak language. We have better and more recent sources saying the same thing. <b>[[User Talk:JzG|Guy]]</b> <small>([[User:JzG/help|Help!]])</small> 18:55, 6 January 2019 (UTC) |
::: Yes, it pretty much is. Harrison's says it does not work, in weak language. We have better and more recent sources saying the same thing. <b>[[User Talk:JzG|Guy]]</b> <small>([[User:JzG/help|Help!]])</small> 18:55, 6 January 2019 (UTC) |
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:::: Exact quote - {{tq|"There is no evidence for the efficacy of acupuncture." <sup>p.2594</sup>}} Weak? Read the Cochrane, it says moderate evidence that acu does work. --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 19:31, 6 January 2019 (UTC) |
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::: The chapter Harrison's is out of date since it says wrt headache "There is no evidence for the efficacy of acupuncture" - but the later Cochrane review(s) discuss evidence. And for the last time, can we stop citing it as "Harrison's" as though The Book speaks. This is a collection of chapters written by named people and must be cited properly, if we're to cite it at all. [[User:Alexbrn|Alexbrn]] ([[User talk:Alexbrn|talk]]) 18:59, 6 January 2019 (UTC) |
::: The chapter Harrison's is out of date since it says wrt headache "There is no evidence for the efficacy of acupuncture" - but the later Cochrane review(s) discuss evidence. And for the last time, can we stop citing it as "Harrison's" as though The Book speaks. This is a collection of chapters written by named people and must be cited properly, if we're to cite it at all. [[User:Alexbrn|Alexbrn]] ([[User talk:Alexbrn|talk]]) 18:59, 6 January 2019 (UTC) |
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::::Different sources reach different conclusions all the time -- Harrison's may well have thought weak(ish) evidence to be essentially none. "If we're to cite it at all"? So we add the chapter authors, no reason to remove the cite. --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 19:31, 6 January 2019 (UTC) |
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::::I've asked about this at '''[[WT:MED]]''' --[[User:Middle 8|Middle 8]] <small>([[User talk:Middle 8|t]] • [[Special:Contributions/Middle_8|c]] | [[User:Middle_8/Privacy|privacy]] • [[User:Middle_8/COI|acupuncture COI?]])</small> 19:31, 6 January 2019 (UTC) |
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Removal of a 2017 review
I recently added this 2017 review article to the section on Effectiveness (specifically the subsection thereof "Pain"). But this edit was soon reverted by MPants at work, apparently because it is too recent to have made a significant impact, and is "a little fishy, to boot". MPants further cited WP:DUE to justify his removal of this article. [1] However, there appears to be no reason to believe that the conclusions of this review article, positive though they may be regarding acupuncture, are "fringe" views that thus need to be minimized. It appears that this source, far from being the sort of fringe publication that should be excluded by WP:DUE, is the sort of recently-published review article in a reputable peer-reviewed journal (Current Opinion in Anesthesiology) that we should be trying to include per WP:MEDRS. But if MPants or anyone else wishes to explain why this sources is "fishy" or should be excluded for another reason I'm all ears. IntoThinAir (formerly Everymorning) talk 00:14, 17 July 2018 (UTC)
- Just as a point of fact, by definition, sources that support the efficacy of acupuncture have fringe conclusions. That doesn't make them invalid, but the mainstream view is that acupuncture is not effective, hence the conclusions of this study are fringe. However, that's not so much the problem in this case, per se. The WP:DUE reason here is that there's nothing about this study that makes it at all clear why it was picked. It's just one, random study by a couple of unremarkable researchers claiming to show that acupuncture is effective, tacked on to the end of a paragraph about the effectiveness of accupuncture that, for the most part, clearly disagrees with the results of this study. (That's leaving out the use of language like "growing evidence".) As for the date: It's a 2017 review. It hasn't had a chance to establish an impact in the field. It's just one of the things that make this study unremarkable. We generally prefer studies and surveys that have been around a few years and gathered up a bunch of citations; preferably those which have had their results duplicated.
- Finally the fishiness: the review starts by exclaiming that acupuncture is effective. It then "finds" that acupuncture is effective. <sound of crickets chirping> That's not just a red flag, that's a guy in a red suit with a red face from drinking frantically waving a red flag soaked in his own urine while blathering about aliens and anal probes. Good science never sets out to answer a question by stating that one answer is true in unambiguous terms. Of course, this is actually par for the course with acupuncture research.
- Then there's the usual "Multiple Asian authors and one Westerner", with the Asian contributors clearly the actual authors (Author information says: Acupuncture Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea, yet Buchheit is with The Pain Society of the Carolinas) used to make acupuncture research look more legitimate by making it look less Asian. Then, it's published in a relatively low-impact journal (there's another journal by the same publisher, covering the same field with twice the impact factor). Like I said, it's just fishy. It might turn out to be okay, but I highly doubt that any credible researchers would give this study the time of day. Of course, in a few years, we might see that I was wrong, when this article has hundreds of cites and is referenced as establishing the scientific consen- Oh, wait. I just saw how it concludes. Further studies on its use as an adjunct or alternative to opioids, and in perioperative settings are needed. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 02:59, 17 July 2018 (UTC)
- Do you have a reliable source to support your clearly extraordinary claim that "the mainstream view is that acupuncture is not effective"? Without such a source any claim that "by definition, sources that support the efficacy of acupuncture have fringe conclusions" is clearly untenable. Dismissing the article as being by "unremarkable researchers" is of course an ad hominem that has no bearing on whether or to what extent the conclusions of the article are valid. Notably, you failed to address the point I made regarding the fact that WP:MEDRS (specifically the section WP:MEDDATE) recommends that recent literature reviews be included, meaning the complaint about this article not having had enough time to get a lot of citations is invalid: that it was published recently is a strength, not a weakness. In addition, their statement that more research is needed appears to be with reference not to acupuncture's effectiveness in general, or with respect to chronic pain, but rather with respect to its use "an adjunct or alternative to opioids, and in perioperative settings" (as shown in the quote you yourself cited above). That two of the three authors are of Asian descent seems of little to no relevance to the credibility of the article's conclusions--I am aware of the issue of almost all Chinese studies producing positive results, but none of the authors have any affiliations in China. So I am, in general, skeptical of the argument that this should be excluded. IntoThinAir (formerly Everymorning) talk 03:31, 17 July 2018 (UTC)
- The new review discusses five new human trials (most of the papers reviewed are animal trials, or publications that are not clinical trials). And one of those trials only had 8 people and no control group. And the only of the five with more than 100 subjects wasn't even designed to test efficacy. It contributes literally nothing to the body of knowledge on acupuncture effectiveness, except to point out that people continue to publish studies from which no conclusions can be drawn. Someguy1221 (talk) 03:43, 17 July 2018 (UTC)
Do you have a reliable source to support your clearly extraordinary claim that "the mainstream view is that acupuncture is not effective"?
Ahh, so you were POV pushing with that addition. That explains it. But to answer your question:- Myint Swe Khine (2011) Advances in Nature of Science Research: Concepts and Methodologies Springer Science & Business Media, New York, NY
- Baran G.R., Kiani M.F., Samuel S.P. (2014) Science, Pseudoscience, and Not Science: How Do They Differ?. In: Healthcare and Biomedical Technology in the 21st Century. Springer, New York, NY
- Barrett, Stephen M.D. Be Wary of Acupuncture, Qigong, and "Chinese Medicine" http://www.quackwatch.org/01QuackeryRelatedTopics/acu.html (this one has it's own list of references worth checking out)
- Brian M. Berman, M.D., Helene M. Langevin, M.D., Claudia M. Witt, M.D., M.B.A., and Ronald Dubner, D.D.S., Ph.D. (2010) Acupuncture for Chronic Low Back Pain New England Journal of Medicine 2010; Volume 363, pages 454-461
- Andrew C. Ahn, Agatha P. Colbert, Belinda J. Anderson, Ørjan G. Martinsen, Richard Hammerschlag, Steve Cina, Peter M. Wayne, Helene M. Langevin (2008) Electrical properties of acupuncture points and meridians: A systematic review Bioelectromagnetics Volume 29, Issue 4
- Christopher J. Standaert; Janna Friedly; Mark W. Erwin; Michael J. Lee; Glenn Rechtine; Nora B. Henrikson; Daniel C. Norvell (2011) Comparative Effectiveness of Exercise, Acupuncture, and Spinal Manipulation for Low Back Pain Spine, Volume 36, Pages 120-130
- E. Ernst (2005) Acupuncture – a critical analysis Journal of Internal Medicine Volume 259, Pages 125-137
- Shu-Ming Wang, Zeev N. Kain, Paul F. White (2008) Acupuncture Analgesia: II. Clinical Considerations Anesthesia & Analgesia, Volume 106(2) Pages 611-621
- Ernst, E.; Lee, Myeong Sooa; Choi, Tae-Youngb (2011) Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews Pain, Volume 152(4), Pages 755-764
- Ernst, Edzard (2009) Acupuncture: What Does the Most Reliable Evidence Tell Us? Journal of Pain and Symptom Management, Volume 37(4), Pages 709-714
- There's plenty more where that came from.
Dismissing the article as being by "unremarkable researchers" is of course an ad hominem that has no bearing on whether or to what extent the conclusions of the article are valid.
Cherry picking, are we now? Don't pretend to call out "fallacies" in another editors argument if you can't be bothered to maintain a higher level of integrity, yourself. Either quote me in context or don't quote me at all, thanks.Notably, you failed to address the point I made regarding the fact that WP:MEDRS (specifically the section WP:MEDDATE) recommends that recent literature reviews be included
I thought you had already read WP:RECENTISM, which is explicitly warned against in WP:MEDRS. If I was mistaken in that assumption, I apologize. So let me address your concern now: WP:RECENTISM.In addition, their statement that more research is needed
Using a higher level of specificity only transforms a vague and meaningless statement into a less vague but still meaningless statement.I am aware of the issue of almost all Chinese studies producing positive results, but none of the authors have any affiliations in China.
Then you should be aware that this tends to apply to Korean studies to a somewhat lesser extent, and to studies from institutes dedicated to promoting acupuncture to a much higher extent. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:53, 17 July 2018 (UTC)- MPants at work, I'm curious to know where you heard this about Korean studies. Do you have a link to this information? TylerDurden8823 (talk) 08:31, 6 August 2018 (UTC)
- @TylerDurden8823: I've seen comparisons between Chinese and Korean science wrt acupuncture in numerous places. Off the top of my head, this is one example that actually goes into some detail about what the specific problems with Korean studies are. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:31, 13 August 2018 (UTC)
- @MPants at work:, I don't see anything about the state of the medical literature from Korea in the cited article. Are you sure you cited the correct study? It looks like it's an older article examining the state of Korean literature specifically about acupuncture. Granted, it looks like it's mainly lower level evidence (e.g., case reports, series, uncontrolled/suboptimally controlled studies, etc, which still have some value (case reports can be a helpful type of evidence)) but it doesn't necessarily speak to the original question of whether medical literature from Korea suffers from similar questions about its overall integrity when compared to that of China. TylerDurden8823 (talk) 08:02, 21 August 2018 (UTC)
- It's a paper that weighs the results and analyses the methodology of literally every acupuncture study published in all Korean journals, and found the facts that they almost always show a positive result and they are virtually always of low methodological quality notable enough to mention in the abstract (not even saving it for the results). I don't see how that's at all ambiguous. Sure, an analysis of the overall state of Korean literature might not have been the stated goal of the authors, but that doesn't really matter when such an analysis was a part of their methodology, now does it? ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 01:26, 22 August 2018 (UTC)
- Well, I think it matters. I wouldn't necessarily extrapolate the poor quality of the Korean literature in the field of acupuncture to Korean literature in all other medical subjects. The article you provided certainly speaks volumes about the quality of the Korean literature on acupuncture. I'm not suggesting it's ambiguous about that. TylerDurden8823 (talk) 07:19, 22 August 2018 (UTC)
- I was only referring to the qualities of Korean medical science wrt acupuncture. I have no particular problem with, for example, a Korean new drug study. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:29, 22 August 2018 (UTC)
- Well, I think it matters. I wouldn't necessarily extrapolate the poor quality of the Korean literature in the field of acupuncture to Korean literature in all other medical subjects. The article you provided certainly speaks volumes about the quality of the Korean literature on acupuncture. I'm not suggesting it's ambiguous about that. TylerDurden8823 (talk) 07:19, 22 August 2018 (UTC)
- It's a paper that weighs the results and analyses the methodology of literally every acupuncture study published in all Korean journals, and found the facts that they almost always show a positive result and they are virtually always of low methodological quality notable enough to mention in the abstract (not even saving it for the results). I don't see how that's at all ambiguous. Sure, an analysis of the overall state of Korean literature might not have been the stated goal of the authors, but that doesn't really matter when such an analysis was a part of their methodology, now does it? ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 01:26, 22 August 2018 (UTC)
- @MPants at work:, I don't see anything about the state of the medical literature from Korea in the cited article. Are you sure you cited the correct study? It looks like it's an older article examining the state of Korean literature specifically about acupuncture. Granted, it looks like it's mainly lower level evidence (e.g., case reports, series, uncontrolled/suboptimally controlled studies, etc, which still have some value (case reports can be a helpful type of evidence)) but it doesn't necessarily speak to the original question of whether medical literature from Korea suffers from similar questions about its overall integrity when compared to that of China. TylerDurden8823 (talk) 08:02, 21 August 2018 (UTC)
- @TylerDurden8823: I've seen comparisons between Chinese and Korean science wrt acupuncture in numerous places. Off the top of my head, this is one example that actually goes into some detail about what the specific problems with Korean studies are. ᛗᛁᛟᛚᚾᛁᚱPants Tell me all about it. 12:31, 13 August 2018 (UTC)
- (belated, but FWIW) MPants' comment above that WP:RECENTISM precludes the use of recent literature reviews is fundamentally wrong. WP:MEDRS applies, not RECENTISM: the latter says not to give undue weight to breaking news. It doesn't say "don't use up-to-date science". Just saying. --Middle 8 (t • c | privacy • acupuncture COI?) 09:49, 30 December 2018 (UTC)
- New scientific publications that have not had a chance to be commented on or replicated by other scientists are not "up-to-date science". You seem to have no idea how science achieves its results and how it avoids coming to wrong conclusions. --Hob Gadling (talk) 10:32, 30 December 2018 (UTC)
- @Hob Gadling: The pertinent phrase = "recent literature reviews." Sec sources not primary ones. (see WP:MEDDATE) --Middle 8 (t • c | privacy • acupuncture COI?) 11:34, 30 December 2018 (UTC)
- Secondary sources are not magically immune to mistakes. --Hob Gadling (talk) 11:57, 30 December 2018 (UTC)
- Come on Hob, you cannot expect a True Believer to understand Science. -Roxy, the dog. wooF 12:21, 30 December 2018 (UTC)
- @Hob Gadling: MEDDATE >> RECENTISM for sci reviews (in fact, applying RECENTISM is so far afield it's "not even wrong"). Ask at WT:MED if in doubt about this. --Middle 8 (t • c | privacy • acupuncture COI?) 12:55, 30 December 2018 (UTC)
- Please stop pinging me. I have a watchlist.
- It is not my job to do and ask people. I do not want to put stuff in the article. And there are enough medicine experts here already. --Hob Gadling (talk) 13:03, 30 December 2018 (UTC)
- Secondary sources are not magically immune to mistakes. --Hob Gadling (talk) 11:57, 30 December 2018 (UTC)
- @Hob Gadling: The pertinent phrase = "recent literature reviews." Sec sources not primary ones. (see WP:MEDDATE) --Middle 8 (t • c | privacy • acupuncture COI?) 11:34, 30 December 2018 (UTC)
- New scientific publications that have not had a chance to be commented on or replicated by other scientists are not "up-to-date science". You seem to have no idea how science achieves its results and how it avoids coming to wrong conclusions. --Hob Gadling (talk) 10:32, 30 December 2018 (UTC)
- MPants at work, I'm curious to know where you heard this about Korean studies. Do you have a link to this information? TylerDurden8823 (talk) 08:31, 6 August 2018 (UTC)
- Do you have a reliable source to support your clearly extraordinary claim that "the mainstream view is that acupuncture is not effective"? Without such a source any claim that "by definition, sources that support the efficacy of acupuncture have fringe conclusions" is clearly untenable. Dismissing the article as being by "unremarkable researchers" is of course an ad hominem that has no bearing on whether or to what extent the conclusions of the article are valid. Notably, you failed to address the point I made regarding the fact that WP:MEDRS (specifically the section WP:MEDDATE) recommends that recent literature reviews be included, meaning the complaint about this article not having had enough time to get a lot of citations is invalid: that it was published recently is a strength, not a weakness. In addition, their statement that more research is needed appears to be with reference not to acupuncture's effectiveness in general, or with respect to chronic pain, but rather with respect to its use "an adjunct or alternative to opioids, and in perioperative settings" (as shown in the quote you yourself cited above). That two of the three authors are of Asian descent seems of little to no relevance to the credibility of the article's conclusions--I am aware of the issue of almost all Chinese studies producing positive results, but none of the authors have any affiliations in China. So I am, in general, skeptical of the argument that this should be excluded. IntoThinAir (formerly Everymorning) talk 03:31, 17 July 2018 (UTC)
We should evaluate sources based on their quality not their conclusions. Re mainstream: NICE guidelines recommend acupuncture for chronic tension-type headaches and migraines [2]. Harrison's (2015 pdf) recommends it for several conditions including dysmennorhea, knee OA and chronic flank, back, or abdominal pain due to renal enlargement in ADPKD. NICE and Harrison's are as mainstream as it gets last I checked. --Middle 8 (t • c | privacy • acupuncture COI?) 09:03, 1 December 2018 (UTC)
- To be clear i do get that for most other conditions there's "evidence of no efficacy" or "no evidence of efficacy", and caveats re possible false positives, etc etc. --Middle 8 (t • c | privacy • acupuncture COI?) 02:52, 3 December 2018 (UTC) (revised 11:26, 3 December 2018 (UTC))
- And if you look at the history of NICE guidance on acupuncture, the recommendations are being crossed off one by one. Example: https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain Guy (Help!) 13:13, 3 December 2018 (UTC)
- Yep. Unlike the acupuncturists themselves, at least NICE is slowly recognizing and resolving its green-jelly-bean problem. TenOfAllTrades(talk) 13:28, 3 December 2018 (UTC)
- @JzG: Yes, that is the overall trend for the evidence base. Wikipedia not being a crystal ball, how would you handle what NICE and Harrison's say now, as opposed to what they'll probably say in the future? --Middle 8 (t • c | privacy • acupuncture COI?) 10:21, 4 December 2018 (UTC)
- We ignore it, because there is good reason to think that sources like this are merely behind the trajectory. They are the equivalent of the few sources that continued to publish Heartland-funded industry driven climate change denialism after the publication of Merchants of Doubt. Quackademic medicine is a large and well funded enterprise, but the ability of acupuncture to manipulate nonexistent qi along nonexistent meridians, cherished though it is by the integrative medicine cargo cult, is no longer a matter of serious scientific inquiry, only of marketing studies by true believers. All these continued studies do is prove how hard it is to properly double blind an invasive procedure. Guy (Help!) 12:42, 4 December 2018 (UTC)
- @JzG: Harrison's and NICE are the equivalent of climate change deniers?!? Now there's a fringe view! Acu, like anything else on WP, is to be depicted according to what properly weighted (MED)RS say. Not according to the pejoratives other (lesser!) sources (let alone editors!) fling at such MEDRS. Or what other sources/editors predict they'll say. --Middle 8 (t • c | privacy • acupuncture COI?) 10:40, 10 December 2018 (UTC)
- No, they are the equivalent of the reviews of climate science that noted the positions of climate change deniers before the whole fossil fuel lobby funded fraud was exposed. Guy (Help!) 11:03, 10 December 2018 (UTC)
- Right. An unproven conspiracy to hijack the best MEDRS. Definitely the stuff of mainspace. --Middle 8 (t • c | privacy • acupuncture COI?) 11:12, 10 December 2018 (UTC)
- Scarcely unproven. The problems with quackademic medicine are well documented. Guy (Help!) 23:43, 17 December 2018 (UTC)
- So there is a source weighty enough to balance (let alone justify excluding) NICE? Let's see it. --Middle 8 (t • c | privacy • acupuncture COI?) 00:46, 18 December 2018 (UTC)
- Have you noticed how NICE recommendations for acupuncture are dropping one by one? Guy (Help!) 00:51, 18 December 2018 (UTC)
- Ah, Guy's comment on the trend, an excellent MEDRS (/sarcasm). FWIW & IIRC, they had a couple a decade-ish ago, then they added a couple (I think following Vickers), then they removed one (the most recent one, for low back pain). Even if/though you're right about the overall trend and its implications, "citation needed". --Middle 8 (t • c | privacy • acupuncture COI?) 01:18, 18 December 2018 (UTC)
- Have you noticed how NICE recommendations for acupuncture are dropping one by one? Guy (Help!) 00:51, 18 December 2018 (UTC)
- So there is a source weighty enough to balance (let alone justify excluding) NICE? Let's see it. --Middle 8 (t • c | privacy • acupuncture COI?) 00:46, 18 December 2018 (UTC)
- Scarcely unproven. The problems with quackademic medicine are well documented. Guy (Help!) 23:43, 17 December 2018 (UTC)
- Right. An unproven conspiracy to hijack the best MEDRS. Definitely the stuff of mainspace. --Middle 8 (t • c | privacy • acupuncture COI?) 11:12, 10 December 2018 (UTC)
- No, they are the equivalent of the reviews of climate science that noted the positions of climate change deniers before the whole fossil fuel lobby funded fraud was exposed. Guy (Help!) 11:03, 10 December 2018 (UTC)
- @JzG: Harrison's and NICE are the equivalent of climate change deniers?!? Now there's a fringe view! Acu, like anything else on WP, is to be depicted according to what properly weighted (MED)RS say. Not according to the pejoratives other (lesser!) sources (let alone editors!) fling at such MEDRS. Or what other sources/editors predict they'll say. --Middle 8 (t • c | privacy • acupuncture COI?) 10:40, 10 December 2018 (UTC)
- We ignore it, because there is good reason to think that sources like this are merely behind the trajectory. They are the equivalent of the few sources that continued to publish Heartland-funded industry driven climate change denialism after the publication of Merchants of Doubt. Quackademic medicine is a large and well funded enterprise, but the ability of acupuncture to manipulate nonexistent qi along nonexistent meridians, cherished though it is by the integrative medicine cargo cult, is no longer a matter of serious scientific inquiry, only of marketing studies by true believers. All these continued studies do is prove how hard it is to properly double blind an invasive procedure. Guy (Help!) 12:42, 4 December 2018 (UTC)
- And if you look at the history of NICE guidance on acupuncture, the recommendations are being crossed off one by one. Example: https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain Guy (Help!) 13:13, 3 December 2018 (UTC)
- Author affiliation: "Acupuncture Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul". That ends the conversation. Korean acupuncture studies are as biased as Chinese ones. Everyone is familiar with the acupuncture anaesthesia hoax, I hope? Guy (Help!) 13:10, 3 December 2018 (UTC)
- Ends which conversation exactly? --Middle 8 (t • c | privacy • acupuncture COI?) 10:21, 4 December 2018 (UTC)
- An unfounded derogatory assertion aimed at the author of a paper is not a valid critique of a source. I agree with Middle 8. Both NICE and Harrisons currently recommend acupuncture. They are reliable sources. Let's avoid crystal ball gazing and cite what they say now instead of wondering what they might say in the future. Morgan Leigh | Talk 22:15, 10 December 2018 (UTC)
- Nope. "Acupuncture meridian science" is an oxymoron. Acupuncture meridians don't exist, so any centre set up to study them is, by definition, actually part of the pseudoscience industry of SCAM promotion. Guy (Help!) 19:35, 12 December 2018 (UTC)
- @ Guy Another red herring. The point is what the NICE guidelines say, and they're cited on NHS website on multiple pages. Here's another (scroll to section Uses of acupuncture). WP:MEDSCI mentions NICE specifically as MEDRS. --Middle 8 (t • c | privacy • acupuncture COI?) 08:48, 13 December 2018 (UTC)
- Not quite. We know that NICE lags behind the science, and always has. It took NICE a long time to finally remove all support for homeopathy. But we can see that the NICE recommendations for acupuncture are being removed one by one. The trajectory is firmly towards the reality-based view that acupuncture is nonsense and against the usually crappy industry-funded, practitioner-run studies which support its use. Guy (Help!) 09:17, 13 December 2018 (UTC)
- Maybe they will go that way in the future, but we have to go with what they say now. Otherwise we are crystal ball gazing and that's magic not science. You don't want to advocate for magic do you?Morgan Leigh | Talk 10:22, 13 December 2018 (UTC)
- @JzG|Guy No, the way to handle NICE is to cite it along with whatever MEDRS make the point about the trend. --Middle 8 (t • c | privacy • acupuncture COI?) 14:45, 13 December 2018 (UTC)
- Which is what we do. NICE is in conflict with the determination in MEDRS complaint scientific sources that acupuncture is bollocks, so we don't confuse the reader by giving undue weight to the ever-reducing set of NICE guidelines that conflict with reality-based sources. Guy (Help!) 15:43, 13 December 2018 (UTC)
- Actually what we do when there are contradictory sources is cite both of them and say what each one says. They are both based in reality, you just don't want to cite the bits you have decided are bogus. Your opinion is not more important than sources. Morgan Leigh | Talk 09:41, 14 December 2018 (UTC)
- Guy wrote above:
Which is what we do.
-- Um no, citing NICE is not the same as not citing NICE.[3] --Middle 8 (t • c | privacy • acupuncture COI?) 19:28, 16 December 2018 (UTC)
- Which is what we do. NICE is in conflict with the determination in MEDRS complaint scientific sources that acupuncture is bollocks, so we don't confuse the reader by giving undue weight to the ever-reducing set of NICE guidelines that conflict with reality-based sources. Guy (Help!) 15:43, 13 December 2018 (UTC)
- Not quite. We know that NICE lags behind the science, and always has. It took NICE a long time to finally remove all support for homeopathy. But we can see that the NICE recommendations for acupuncture are being removed one by one. The trajectory is firmly towards the reality-based view that acupuncture is nonsense and against the usually crappy industry-funded, practitioner-run studies which support its use. Guy (Help!) 09:17, 13 December 2018 (UTC)
- @ Guy Another red herring. The point is what the NICE guidelines say, and they're cited on NHS website on multiple pages. Here's another (scroll to section Uses of acupuncture). WP:MEDSCI mentions NICE specifically as MEDRS. --Middle 8 (t • c | privacy • acupuncture COI?) 08:48, 13 December 2018 (UTC)
- Nope. "Acupuncture meridian science" is an oxymoron. Acupuncture meridians don't exist, so any centre set up to study them is, by definition, actually part of the pseudoscience industry of SCAM promotion. Guy (Help!) 19:35, 12 December 2018 (UTC)
A proposed edit with recent sources
I agree that the section above has gotten off topic. Here is a discrete proposal for an edit to the article with recent sources that no one has yet actually addressed, except @Middle 8: who described the Vickers paper as "the highest-quality meta-analysis there is ". I'm putting here again because I notice I made a transposition error in when posting it above. It's odd no one noticed that. It's almost as if no one read it...
I suggest we change the present text from;
- "A systematic review found little evidence of acupuncture's effectiveness in treating pain."
- which cites this source Ernst E, Lee MS, Choi TY (April 2011). "Acupuncture: does it alleviate pain and are there serious risks? A review of reviews" (PDF). Pain. 152 (4): 755–64. doi:10.1016/j.pain.2010.11.004.
- to,
- "A 2011 systematic review found little evidence of acupuncture's effectiveness in treating pain (Citing Ernst E, Lee MS, Choi TY (April 2011). "Acupuncture: does it alleviate pain and are there serious risks? A review of reviews" (PDF). Pain. 152 (4): 755–64), while others have found it to be effective. (Citing Vickers, Cronin, Maschino, et al, (2012), Acupuncture for Chronic Pain:Individual Patient Data Meta-analysis, Arch Intern Med. 2012;172(19):1444-1453. doi:10.1001/archinternmed.2012.3654
- Hopton, MacPherson, (2010), Acupuncture for Chronic Pain: Is Acupuncture More than an Effective Placebo? A Systematic Review of Pooled Data from Meta‐analyses, Pain Practice, Volume 10, Issue 2, March/April 2010, Pages 94-102
- Kwon, Pittler, Ernst, (2006), Acupuncture for peripheral joint osteoarthritis: A systematic review and meta-analysis, Rheumatology, Volume 45, Issue 11, 1 November 2006, Pages 1331–1337)Morgan Leigh | Talk 01:39, 9 December 2018 (UTC)
- WP:BLUDGEON applies. Alexbrn (talk) 04:36, 9 December 2018 (UTC)
- Yes I think so too, but I wasn't going to bandy around labels just because people keep repeating their personal opinions, ofttimes using the exact same words, without addressing the sources. Morgan Leigh | Talk 05:50, 9 December 2018 (UTC)
- Nope. For the reasons cited above, and multiple times in the past. We don't "balance" pragmatic, reality-based views with the optimistic findings of True Believers. Guy (Help!) 10:45, 10 December 2018 (UTC)
- Please confine your remarks to directly addressing the sources at issue @JzG: rather than, once again, expressing your personal opinion and deriding those with a view you don't agree with by labeling them "true believers" and implying they aren't in touch with reality. Morgan Leigh | Talk 21:59, 10 December 2018 (UTC)
- Stop sealioning. Guy (Help!) 22:28, 10 December 2018 (UTC)
- Instead of making personal attacks please address the sources. Morgan Leigh | Talk 00:13, 11 December 2018 (UTC)
- Stop sealioning. Guy (Help!) 00:35, 11 December 2018 (UTC)
- Morgan Leigh's objection (repeated because the objectionable behavior is repeated) is reasonable. See 2nd sentence in lede of WP:TPG, and WP:TPNO last bullet point. It's not sealioning to ask an editor to stop that. Nor to point out misunderstandings of WP:WEIGHT. --Middle 8 (t • c | privacy • acupuncture COI?) 02:34, 11 December 2018 (UTC); add to cmt 03:25, 11 December 2018 (UTC)
- Stop sealioning. Guy (Help!) 00:35, 11 December 2018 (UTC)
- Instead of making personal attacks please address the sources. Morgan Leigh | Talk 00:13, 11 December 2018 (UTC)
- Stop sealioning. Guy (Help!) 22:28, 10 December 2018 (UTC)
- @ Guy Re Vickers: WP:WEIGHT doesn't mean discounting MEDRS because some other source criticized it. Most crits of Vickers aren't peer-reviewed anyway and thus aren't very good MEDRS (if they're MEDRS at all) or even very good RS. Hence using them de-weight and discount an IPD meta-analysis is absurd. --Middle 8 (t • c | privacy • acupuncture COI?) 02:34, 11 December 2018 (UTC)
- Please confine your remarks to directly addressing the sources at issue @JzG: rather than, once again, expressing your personal opinion and deriding those with a view you don't agree with by labeling them "true believers" and implying they aren't in touch with reality. Morgan Leigh | Talk 21:59, 10 December 2018 (UTC)
- Not really, for a start I doubt this is the only review that has found it ineffective. But I do not agree the other sources can be rejected if they are recognized and qualified medical professionals or professors.Slatersteven (talk) 11:21, 10 December 2018 (UTC)
- Indeed there are many. I draw your attention to the 12 citations in the above section, seven of which are Cochrane reviews. Morgan Leigh | Talk 21:59, 10 December 2018 (UTC)
- One Cochrane review you cite above is about "Acupuncture for schizophrenia": All results of this review are categorised as 'very low quality' or 'low quality evidence', except for 'time spent in hospital' which was 'moderate level' but that was just 1 RCT. "Very low quality evidence" in GRADE (https://bestpractice.bmj.com/info/us/toolkit/learn-ebm/what-is-grade/) means "The true effect is probably markedly different from the estimated effect"; "low quality evidence" means "The true effect might be markedly different from the estimated effect". In other words, this review provides no support for the clinical application of acupuncture in Schizophrenia.
- Another Cochrane review you cite is "Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting". Again, all comparisons between acupuncture and sham were categorised as "low quality evidence".
- Low quality evidence is still evidence, it's not no evidence, nor is it evidence that it doesn't work. And I'm totally good with mentioning the quality of any given piece of evidence that in the article. I'm not trying to say that acupuncture is a panacea, because it clearly isn't. What I am saying is, if you have a whole lot of studies with some evidence it is a thing worth investigating further. Not a thing that is "bonkers" and can be put in a box labelled 'pseudoscience, do not ever look inside'. Rather it should be investigated further, and that is why more research has been done and the Vickers paper is one result of that. Do you agree that Vickers is a good quality paper that should be cited?Morgan Leigh | Talk 23:53, 11 December 2018 (UTC)
- It is very easy to concoct a low-quality study with low-quality evidence for anything you wish. All you need is money and time; randomness does the rest. Therefore, mentioning such trash in the article would be misleading. Saying that there is low-quality evidence is okay, but one does not have to mention what it is. --Hob Gadling (talk) 06:53, 12 December 2018 (UTC)
- Low quality evidence means that the results are unreliable. Reported treatment effects based on low quality evidence may be due to statistical fluctuations, bias (e.g. lack of sufficient blinding) etc. instead of the treatment actually working; further explanations in the BMJ article I linked in my previous post. As Hob Gadling said, it's not worth reporting and can be misleading.
- Low quality evidence is still evidence, it's not no evidence, nor is it evidence that it doesn't work. And I'm totally good with mentioning the quality of any given piece of evidence that in the article. I'm not trying to say that acupuncture is a panacea, because it clearly isn't. What I am saying is, if you have a whole lot of studies with some evidence it is a thing worth investigating further. Not a thing that is "bonkers" and can be put in a box labelled 'pseudoscience, do not ever look inside'. Rather it should be investigated further, and that is why more research has been done and the Vickers paper is one result of that. Do you agree that Vickers is a good quality paper that should be cited?Morgan Leigh | Talk 23:53, 11 December 2018 (UTC)
- Re Vickers et al 2012 (cited above): effect sizes against sham are 0.23 SD, 0.16 SD and 0.15 SD for back and neck pain, osteoarthritis, and chronic headache. Firstly, these effect size are too small to be clinically relevant. In fact, already Madsen, Gøtzsche PC, Hróbjartsson A. (BMJ. 2009 Jan 27;338:a3115. doi: 10.1136/bmj.a3115. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. https://www.ncbi.nlm.nih.gov/pubmed/19174438) found a very similar effect size and concluded "A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias". Secondly, the small effect size may well be due to bias. Vickers et al results are based on trials which were not double blinded and in the included GERAC trials even the single blinding is questionable. I therefore do not support the change you suggest.Lucleon (talk) 08:16, 12 December 2018 (UTC)
- What Lucleon says. Plus, per WP:MEDRS we shouldn't be using sources older than 5 years old, when we have newer better sources that are relevant (in this case from NICE). Alexbrn (talk) 08:25, 12 December 2018 (UTC)
- @Alexbrn: Vickers was updated last year.[4] @Lucleon: Read it; they addressed both blinding and effect size. Blinding: Vickers found essentially the same results, blinded or not. Effect size: still statistically significant, and they concluded more than a placebo and a reasonable referral option -- because efficacy, which is w.r.t. control, isn't the same as effectiveness, which is w.r.t. no treatment (which is what the clinical decision is: whether to treat. Pragmatic trials look at that all the time). As for Madsen's conclusion about bias: of course we cite that (and I think Vickers addressed bias too), but there's this thing called NPOV that explains very clearly how to handle RS when they disagree. Hint: it doesn't mean citing just one side. --Middle 8 (t • c | privacy • acupuncture COI?) 10:55, 12 December 2018 (UTC)
- The effect sizes in Vickers et al 17 are approx. the same as in Vickers et al 12. To demonstrate a specific treatment effect the comparison to sham counts not the comparison to 'no treatment'. This is how other treatments are tested, I don't see why this should be different for acupuncture. Re blinding: in Vickers et al 17 they do exclude some trials with possible bias due to blinding and obtain the same effect size. Still, the remaining trials that were used were not double-blinded. Also, they find that smaller studies had larger effect sizes which can be the result of publication bias.
- @Alexbrn: Vickers was updated last year.[4] @Lucleon: Read it; they addressed both blinding and effect size. Blinding: Vickers found essentially the same results, blinded or not. Effect size: still statistically significant, and they concluded more than a placebo and a reasonable referral option -- because efficacy, which is w.r.t. control, isn't the same as effectiveness, which is w.r.t. no treatment (which is what the clinical decision is: whether to treat. Pragmatic trials look at that all the time). As for Madsen's conclusion about bias: of course we cite that (and I think Vickers addressed bias too), but there's this thing called NPOV that explains very clearly how to handle RS when they disagree. Hint: it doesn't mean citing just one side. --Middle 8 (t • c | privacy • acupuncture COI?) 10:55, 12 December 2018 (UTC)
- In light of the small effect sizes, the lack of a plausible mechanism of acupuncture and the overwhelming number of investigations reporting no, tiny or unreliable effect sizes for all kinds of medical conditions, the most parsimonious explanation of these results (Vickers et al.) is that acupuncture has no specific effect and the reported effects are due to biases. To demonstrate the opposite convincingly, much stronger experimental evidence would be needed imho.Lucleon (talk) 11:38, 13 December 2018 (UTC)
- @Lucleon: There's no reason to ignore trials without sham controls as long as you're clear what you're looking at. Efficacy measures the comparison to sham, and is what RCT's look at. Effectiveness measures the comparison to no treatment, aka the "real-world effect", and is what PCT's (pragmatic clinical trials) study. A trial can be both if it has both sham and no-treatment arms -- hence Vickers reports both efficacy and effectiveness, and the size of the latter is the basis for his conclusion that acu is a reasonable referral option for chronic pain patients. (A widely-held conclusion given the extent of mainstream acu practice in e.g. academic medical centers -- e.g. 9 out of the top 10 US med schools last I checked)
- On your 2nd para: These are reasonable points, and are relevant insofar as they've been stated by some (MED)RS. We cite those alongside Vickers (according to weight). That's how NPOV works. --Middle 8 (t • c | privacy • acupuncture COI?) 11:44, 16 December 2018 (UTC) | added to comment 12:02, 16 December 2018 (UTC)
- The comparison to 'no treatment' doesn't tell us whether the reduction in pain was due to acupuncture or something else, e.g. being take care of by someone, receiving treatment etc.. These latter causes seem quite plausible given that it was the subjective feeling of pain which was investigated and only small improvements were observed.Lucleon (talk) 13:55, 17 December 2018 (UTC)
- Indeed. Acupuncturists have invested much in building up the mythology of their craft, the average person almost certainly believes it works and it is very hard to blind both study participants and practitioners to whether real or fake acupuncture is being used. And when you do that convincingly, and show no difference, the acupuncturists claim that acupuncture is so powerful that even fake acupuncture works. Which is one hell of a get out of jail free card. Guy (Help!) 20:00, 17 December 2018 (UTC)
- @ User:Lucleon Right. Hence what I just said about the difference between an RCT and a PCT. And that acu is used in the real world anyway. Why? Because a lot of doctors find it gives their patients additional relief, and they care about that more than the placebo issue (read Jytdog's comment here) --Middle 8 (t • c | privacy • acupuncture COI?) 22:48, 17 December 2018 (UTC) | edit: ping removed, discussion moved to user talk fwiw 23:00, 17 December 2018 (UTC)
- There is a reason why quacks love PCTs. Homeopathists, especially. PCTs maximise the possibility of claiming regression to the mean, natural course of disease, expectation bias and observer bias, as treatment effects. They are possibly legitimate for comparing known valid therapies, but where the claims of a therapy are outlandish, as they are with acupuncture, they are not appropriate. To quote Ernst: "In some medical areas, for example complementary medicine, pragmatic trials tend to be conducted by practitioners or others with a strong interest in promoting their therapy. In such instances, the weak design and scope for ‘‘spin’’ in interpreting results render pragmatic trials highly susceptible to bias." Note also that "analysis of shams in migraine clearly indicate that sham acupuncture and sham surgery significantly outperform all other shams and placebos"[5] - an invasive fake treatment is more likely to trigger the cognitive biases that generate self-reported benefits than a non-invasive one. The fact that fake acupuncture has pretty much the same effect size as the real thing is a very big red flag, and would be very worrying for the needlers if they were not so blinded by belief that they actually claim this as validation. Guy (Help!) 08:18, 18 December 2018 (UTC)
- The comparison to 'no treatment' doesn't tell us whether the reduction in pain was due to acupuncture or something else, e.g. being take care of by someone, receiving treatment etc.. These latter causes seem quite plausible given that it was the subjective feeling of pain which was investigated and only small improvements were observed.Lucleon (talk) 13:55, 17 December 2018 (UTC)
- On your 2nd para: These are reasonable points, and are relevant insofar as they've been stated by some (MED)RS. We cite those alongside Vickers (according to weight). That's how NPOV works. --Middle 8 (t • c | privacy • acupuncture COI?) 11:44, 16 December 2018 (UTC) | added to comment 12:02, 16 December 2018 (UTC)
- Yes, obviously. Vickers is AFAIK acupuncture's only IPD meta-analysis (the "gold standard" of systematic review), cited all over the place and used to help guide practice recommendations. Of course it weighs, at least as heavily as the 2011 Ernst review, which is getting pretty outdated. --Middle 8 (t • c | privacy • acupuncture COI?) 02:34, 11 December 2018 (UTC); copy-edit 02:39, 11 December 2018 (UTC)
- In your opinion, as someone whose livelihood depends on acupuncture being portrayed as valid. Guy (Help!) 09:30, 11 December 2018 (UTC)
- It speaks well of Middle 8 that they have stated that they are an acupuncturist up front. And we have been down this road before, with IIRC a 2:1 weighting against experts having a COI in their subject area. If every MD couldn't write about medicine, if every lawyer couldn't write about the law, if every acupuncturist couldn't write about acupuncture we would soon be getting bombarded with information from whichever ignorant individual 1 who could shout fake news the loudest. Oh, wait... Morgan Leigh | Talk 23:53, 11 December 2018 (UTC)
- MDs can change the medicine they presribe; for acupuncturists the answer must always be Moar Acupunture. So it is with homeopath writing about homeopathy, Scientologists writing about Hubbard and so on. Policy is clear for fringe topics like acu (a pseudoscience) WP:FRIND applies. BTW, Ernst is very good on this topic.[6] Alexbrn (talk) 07:31, 12 December 2018 (UTC)
- You seem to be suggesting that there is no acupuncturist who is an MD and vice versa. This is absolutely not the case. The BMA has recommend for several years that information on acupuncture and its possible benefits should be included in both undergraduate and postgraduate medical education (See British Medical Association Board of Science and Education. Acupuncture: Efficacy, Safety and Practice. London: Harwood Academic, 2000, p96) and there are a growing number of MDs who are also trained acupuncturists. MDs can change the treatments they prescribe, and they sometimes prescribe acupuncture, and vice versa. Morgan Leigh | Talk 08:23, 12 December 2018 (UTC)
- Nice straw man. My point was that fringe adherents are not reliable sources of information about their pet fringe topic. Here we have WP:FRIND, so we're not - per our WP:PAGs - going to be using acupuncturists on acupuncture any more than we're going to be using 9/11 truthers on what happened to the World Trade Center. Alexbrn (talk) 08:31, 12 December 2018 (UTC)
- This. It's remarkable how often the "good" positive studies turn out to hae the same authors. Many, such as Witt, Lewith and so on, also appear on articles spruiking homeopathy and other quack cures. Guy (Help!) 11:01, 12 December 2018 (UTC)
- this is a time sink. Obviously authors who advocate fringe aren’t RS for fringe. The article already duly notes acupuncture’s role in pain relief and palatative care and recommendations pertaining to these. It is also duly comprised in large part of the tectonic slabs of writings from medrs, which say it is a bag of toss. There’s simply nothing more to be done here. This isn’t a conversation about article improvement. ~~~~ Edaham (talk) 13:09, 12 December 2018 (UTC)
- It's remarkable how studies who don't find evidence tend to be by the same authors. Ernst is cited 37 times in the article! Isn't Ernst the guy about who the editor of The Lancet wrote "Professor Ernst seems to have broken every professional code of scientific behaviour by disclosing correspondence referring to a document that is in the process of being reviewed and revised prior to publication. This breach of confidence is to be deplored." (The Times, Monday 29 August 2005)? Didn't he get 'early retired' out of his academic position because of this misconduct? Wasn't the journal of which he was editor in chief discontinued? Morgan Leigh | Talk 23:15, 12 December 2018 (UTC)
- Both time sink and red herring par excellence, because not a single one of the preceding comments under my !vote pertains to Vickers' IPD meta-analysis. (Note, meta-analysis, not opinion piece.) --Middle 8 (t • c | privacy • acupuncture COI?) 17:43, 12 December 2018 (UTC)
- We did address that, actually. As stated: we're not including Vickers to "balance" the reality-based consensus that acupuncture is bollocks, regardless of the effect on your income. Sorry.
- More detailed reasons not to include have been given previously, including the fact that several of the authors are well known woomongers, and many of the reviewed papers were written by the reviewers themselves, and as Ernst said of this study, "[t]he differences between the results obtained with real and sham acupuncture are small and not clinically relevant. Crucially, they are probably due to residual bias in these studies. Several investigations have shown that the verbal or non-verbal communication between the patient and the therapist is more important than the actual needling. If such factors would be accounted for, the effect of acupuncture on chronic pain might disappear completely." Guy (Help!) 19:33, 12 December 2018 (UTC)
- So you contend that an IPD study is not reality based? That's odd because Cochrane Methods says they are of a higher standard than other reviews because they go back and examine the original data rather examining summaries. For this reason Vickers seems a better choice to cite than Madsen, Gøtzsche PC, Hróbjartsson A. (BMJ. 2009 Jan 27;338:a3115. doi: 10.1136/bmj.a3115. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. Moreover because Vickers was been updated this year and Madsen, Gøtzsche PC, Hróbjartsson A. is a 2009 paper it seems better to cite Vickers. I wonder why it is then that one of these papers is in the article while the other is omitted? Can you please name which specific papers are the subjects of your claim that reviewers have reviewed papers they have authored? Can you provide evidence of this? Can you cite a source that these authors are "woomongers"? Morgan Leigh | Talk 23:15, 12 December 2018 (UTC)
- Any study that proceeds from the premise that health can be influenced by manipulating the flow of qi through meridians is not reality-based. Any meta-analysis that does not exclude such studies automatically, on the grounds of transparent bias, is not reality-based. The criticisms of the Vickers paper by Ernst are compelling. It is, in short, an uncritical piece of work by authors who are generally True believers, and this is represented in the florid and unsupportable language of their conclusions, where a weak effect barely differentiated from sham is represented as compelling slam dunk proof that everybody should be promoting acupuncture. Guy (Help!) 23:24, 12 December 2018 (UTC)
- Every sentence in your reply, except the third, is your opinion and thus irrelevant. Given that the Vickers paper has been updated since Ernst's criticisms and that Vickers addressed the comments by Ernst i.e. Vickers found basically the same results regardless of blinding and that the effect size was still statistically significant, why shouldn't we be able to cite Vickers to, at the very least, show that they have addressed those concerns by Ernst? Morgan Leigh | Talk 04:46, 13 December 2018 (UTC)
- Nope, there is a broad consensus that qi has not been shown to exist, it's not just his opinion, but objectively true. So WP:REDFLAG. Tgeorgescu (talk) 04:53, 13 December 2018 (UTC)
- @Morgan Leigh: WP:REDFLAG. In order to say that a pseudoscience like acupuncture is effective for any condition, we would need multiple high-quality sources. Alexbrn (talk) 05:17, 13 December 2018 (UTC)
- Tgeorgescu: Straw man. No one is arguing Qi exists. Also you are not addressing the source in question. Alexbrn: You are not addressing the source in question. Science is a method, not a list of things that are right and things that are wrong. The scientific study of any phenomena is not pseudoscience. Pseudoscience is bad science. Science not done right. If the method is followed it is ipso facto science, no matter what it is studying. Seeing Vickers is an IPD meta study I think that's pretty good evidence that it's using the scientific method and thus science and not pseudoscience. So let's cite it. And redflag right back at you. To say an IPD review is pseudoscience is an exceptional claim and you need multiple high quality sources. If you want to put a whole bunch of stuff into a box labelled pseudoscience, even though it is being studied using the scientific method, then you are not doing science. You are doing pseudoskepticism. Let's be sciencey. Let's cite sources that use the scientific method. Let's cite Vickers. Morgan Leigh | Talk 10:14, 13 December 2018 (UTC)
- When you say "no one is arguing Qi exists", you are being disingenuous, since that is absolutely the view of many of the authors of papers under question here, and is also clearly implicit in the name of the acupuncture meridian science center. Moreover, in the absence of qi, there is no credible alternative hypothesis for the mechanism by which acupuncture "works". We're back in the homeopathy world of circular reasoning - we believe X, we set out to prove X and satisified our belief in X, therefore we must explain X in terms consistent with our belief in X - when in fact the most parsimonious explanation is not-X. We already know that it doesn't matter where you put the needles, or if you insert them or not, we know that effects are visible only in subjective outcomes, are generally restricted to self-reported results, effect size is small and not clinically relevant, and the more rigorously blinded and controlled a study is the less likely it is to show a positive outcome. In other words, it's bollocks.
- The only really compelling point in Vickers is the negligible difference between real and sham acupuncture. Sham acupuncture is hard to do and the blinding is plausibly broken without much effort (e.g. from the persistence of bruising, which can last weeks when needles are inserted), and yet the difference between real and fake acupuncture is clinically irrelevant. And we can#t use Vickers as a source for this important fact because they misrepresent this outcome as validation - as do several other True Believer sources, in fact, leading to absurdities like this NYT piece. Hint: if sham treatment and real treatment work as well as each other, you have proved that (a) neither works and (b) your experimental design failed to control for bias and confounding. Guy (Help!) 11:26, 13 December 2018 (UTC)
- I reject your claim that I am being disingenuous on the grounds that we are not discussing the subject area, for that is not what we are here to do. We are discussing whether or not a source is a good source to include. Moreover the question of whether Qi exists is not germane to this source. It is not what the paper is about. The paper is about whether or not a measurable result was found when following a given procedure. It does not mention Qi, nor does it discuss theories about potential causative mechanisms.
- Once again you are offering your opinion that this source is unreliable because it is by alleged "true believers". You are offering an ad hominum attack in order to suggest that a high quality IPD review is unfit to include. Moreover you make an unsubstantiated claim and accuse reputable scientists of misrepresentation because they don't agree with your opinion. You prefer your opinion about blinding to the outcome of a peer reviewed, high quality meta review. Even the NYT is an absurdity, according to you. All in all you are really grasping at straws. You say that Vickers makes a compelling point, shall we cite it for this point? Morgan Leigh | Talk 06:17, 14 December 2018 (UTC)
- @JzG and Tgeorgescu: Vickers and coauthors don't argue qi exists. Not in the paper. Which is all that matters when evaluating it as a source. --Middle 8 (t • c | privacy • acupuncture COI?) 12:19, 16 December 2018 (UTC)
- Again, per WP:FRINGE and WP:REDFLAG we're biased against Vickers's position. Wikipedia has an extraordinarily high standard for evidence which would allow us to say that acupuncture is really effective. Tgeorgescu (talk) 06:32, 14 December 2018 (UTC)
- @Tgeorgescu: No -- that reflects a misreading of Vickers. His results showing small advantage over sham are consistent w/ other reviews (naturally, since he's looking at the same trials). OTOH, his conclusion that acu is a reasonable referral option is based on the larger advantage over no-treatment (which is how clinical decisions are often made). --Middle 8 (t • c | privacy • acupuncture COI?) 12:24, 16 December 2018 (UTC)
- The problem is that Vickers makes grandiose claims such as "significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo", but the differences are not clinically relevant and are merely an indication that the more closely a control mimics acupuncture, the less difference there is between acupuncture and the control - which means that acupuncture doesn't work. The "acupuncture triallists' collaboration" set out to validate their pre-existing beliefs and, as SCAM studies generally do, succeeded in finding some clinically irrelevant results that they could then spin as validation. This is normal and expected, homeopathists have done the same thing for years, so we don't give it undue weight by citing its tendentious conclusions. Guy (Help!) 09:33, 17 December 2018 (UTC)
- @Guy If Vickers said the difference from sham was clinically significant, he was wrong (as balancing MEDRS will say) -- but I know he said it was statistically significant, which simply a finding from the data, and not a grandiose claim. He also said that the difference from no-treatment was clinically significant, and on that he was correct. Hence its use in mainstream settings and good MEDRS that suggest so doing. --Middle 8 (t • c | privacy • acupuncture COI?) 22:19, 17 December 2018 (UTC) | add to cmt Middle 8 (t • c | privacy • acupuncture COI?) 22:32, 17 December 2018 (UTC)
- The difference from no treatment is irrelevant, since the aim in any study must be to separate treatment from bias, and in no-treatment controls there is absolutely no hope of adequate blinding of either subject or experimenter. That is why so much effort has been put into developing a truly convincing sham acupuncture control. What Vickers' results show is that sham acupuncture controls are, by now, nearly good enough. As a true believer of course Vickers cannot bring himself to admit this - if indeed the cognitive dissonance even allows him to see it. There is no getting away from the fact that the actual result of Vickers is that the difference between real and fake acupuncture is clinically irrelevant. And in anyone other than a true believer, that is understood to mean that it doesn't work. Guy (Help!) 23:47, 17 December 2018 (UTC)
- @Guy If Vickers said the difference from sham was clinically significant, he was wrong (as balancing MEDRS will say) -- but I know he said it was statistically significant, which simply a finding from the data, and not a grandiose claim. He also said that the difference from no-treatment was clinically significant, and on that he was correct. Hence its use in mainstream settings and good MEDRS that suggest so doing. --Middle 8 (t • c | privacy • acupuncture COI?) 22:19, 17 December 2018 (UTC) | add to cmt Middle 8 (t • c | privacy • acupuncture COI?) 22:32, 17 December 2018 (UTC)
- The problem is that Vickers makes grandiose claims such as "significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo", but the differences are not clinically relevant and are merely an indication that the more closely a control mimics acupuncture, the less difference there is between acupuncture and the control - which means that acupuncture doesn't work. The "acupuncture triallists' collaboration" set out to validate their pre-existing beliefs and, as SCAM studies generally do, succeeded in finding some clinically irrelevant results that they could then spin as validation. This is normal and expected, homeopathists have done the same thing for years, so we don't give it undue weight by citing its tendentious conclusions. Guy (Help!) 09:33, 17 December 2018 (UTC)
- @Tgeorgescu: No -- that reflects a misreading of Vickers. His results showing small advantage over sham are consistent w/ other reviews (naturally, since he's looking at the same trials). OTOH, his conclusion that acu is a reasonable referral option is based on the larger advantage over no-treatment (which is how clinical decisions are often made). --Middle 8 (t • c | privacy • acupuncture COI?) 12:24, 16 December 2018 (UTC)
- Again, per WP:FRINGE and WP:REDFLAG we're biased against Vickers's position. Wikipedia has an extraordinarily high standard for evidence which would allow us to say that acupuncture is really effective. Tgeorgescu (talk) 06:32, 14 December 2018 (UTC)
- Tgeorgescu: Straw man. No one is arguing Qi exists. Also you are not addressing the source in question. Alexbrn: You are not addressing the source in question. Science is a method, not a list of things that are right and things that are wrong. The scientific study of any phenomena is not pseudoscience. Pseudoscience is bad science. Science not done right. If the method is followed it is ipso facto science, no matter what it is studying. Seeing Vickers is an IPD meta study I think that's pretty good evidence that it's using the scientific method and thus science and not pseudoscience. So let's cite it. And redflag right back at you. To say an IPD review is pseudoscience is an exceptional claim and you need multiple high quality sources. If you want to put a whole bunch of stuff into a box labelled pseudoscience, even though it is being studied using the scientific method, then you are not doing science. You are doing pseudoskepticism. Let's be sciencey. Let's cite sources that use the scientific method. Let's cite Vickers. Morgan Leigh | Talk 10:14, 13 December 2018 (UTC)
- Every sentence in your reply, except the third, is your opinion and thus irrelevant. Given that the Vickers paper has been updated since Ernst's criticisms and that Vickers addressed the comments by Ernst i.e. Vickers found basically the same results regardless of blinding and that the effect size was still statistically significant, why shouldn't we be able to cite Vickers to, at the very least, show that they have addressed those concerns by Ernst? Morgan Leigh | Talk 04:46, 13 December 2018 (UTC)
- Any study that proceeds from the premise that health can be influenced by manipulating the flow of qi through meridians is not reality-based. Any meta-analysis that does not exclude such studies automatically, on the grounds of transparent bias, is not reality-based. The criticisms of the Vickers paper by Ernst are compelling. It is, in short, an uncritical piece of work by authors who are generally True believers, and this is represented in the florid and unsupportable language of their conclusions, where a weak effect barely differentiated from sham is represented as compelling slam dunk proof that everybody should be promoting acupuncture. Guy (Help!) 23:24, 12 December 2018 (UTC)
- So you contend that an IPD study is not reality based? That's odd because Cochrane Methods says they are of a higher standard than other reviews because they go back and examine the original data rather examining summaries. For this reason Vickers seems a better choice to cite than Madsen, Gøtzsche PC, Hróbjartsson A. (BMJ. 2009 Jan 27;338:a3115. doi: 10.1136/bmj.a3115. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. Moreover because Vickers was been updated this year and Madsen, Gøtzsche PC, Hróbjartsson A. is a 2009 paper it seems better to cite Vickers. I wonder why it is then that one of these papers is in the article while the other is omitted? Can you please name which specific papers are the subjects of your claim that reviewers have reviewed papers they have authored? Can you provide evidence of this? Can you cite a source that these authors are "woomongers"? Morgan Leigh | Talk 23:15, 12 December 2018 (UTC)
- Both time sink and red herring par excellence, because not a single one of the preceding comments under my !vote pertains to Vickers' IPD meta-analysis. (Note, meta-analysis, not opinion piece.) --Middle 8 (t • c | privacy • acupuncture COI?) 17:43, 12 December 2018 (UTC)
- This. It's remarkable how often the "good" positive studies turn out to hae the same authors. Many, such as Witt, Lewith and so on, also appear on articles spruiking homeopathy and other quack cures. Guy (Help!) 11:01, 12 December 2018 (UTC)
- Nice straw man. My point was that fringe adherents are not reliable sources of information about their pet fringe topic. Here we have WP:FRIND, so we're not - per our WP:PAGs - going to be using acupuncturists on acupuncture any more than we're going to be using 9/11 truthers on what happened to the World Trade Center. Alexbrn (talk) 08:31, 12 December 2018 (UTC)
- You seem to be suggesting that there is no acupuncturist who is an MD and vice versa. This is absolutely not the case. The BMA has recommend for several years that information on acupuncture and its possible benefits should be included in both undergraduate and postgraduate medical education (See British Medical Association Board of Science and Education. Acupuncture: Efficacy, Safety and Practice. London: Harwood Academic, 2000, p96) and there are a growing number of MDs who are also trained acupuncturists. MDs can change the treatments they prescribe, and they sometimes prescribe acupuncture, and vice versa. Morgan Leigh | Talk 08:23, 12 December 2018 (UTC)
- MDs can change the medicine they presribe; for acupuncturists the answer must always be Moar Acupunture. So it is with homeopath writing about homeopathy, Scientologists writing about Hubbard and so on. Policy is clear for fringe topics like acu (a pseudoscience) WP:FRIND applies. BTW, Ernst is very good on this topic.[6] Alexbrn (talk) 07:31, 12 December 2018 (UTC)
- It speaks well of Middle 8 that they have stated that they are an acupuncturist up front. And we have been down this road before, with IIRC a 2:1 weighting against experts having a COI in their subject area. If every MD couldn't write about medicine, if every lawyer couldn't write about the law, if every acupuncturist couldn't write about acupuncture we would soon be getting bombarded with information from whichever ignorant individual 1 who could shout fake news the loudest. Oh, wait... Morgan Leigh | Talk 23:53, 11 December 2018 (UTC)
- In your opinion, as someone whose livelihood depends on acupuncture being portrayed as valid. Guy (Help!) 09:30, 11 December 2018 (UTC)
You have been making it clearer and clearer that you don't like our NPOV policy, Til. That's your prerogative, but until you get it changed it isn't your prerogative to try and change it article by article. Dougweller (talk) 22:02, 11 March 2013 (UTC)
- Quoted by Tgeorgescu (talk) 06:39, 14 December 2018 (UTC)
- Do you contend that an IPD meta review is not a high standard review? Morgan Leigh | Talk 09:54, 14 December 2018 (UTC)
- A good method carried out by bad actors doesn't make a good source. We've pointed out the problems multiple times, your unwillingness to accept them is not really our problem by now. Guy (Help!) 14:15, 14 December 2018 (UTC)
- Yes, and it has been pointed out to you many times that your opinion that anyone who doesn't agree with you is bad is irrelevant. However your unwillingness to accept this is our problem. Do us a favour and read the talk page guidelines again please. You are asserting that reputable academics are "bad actors"? Sounds awfully like an ad hominem to me... And yet, you support the inclusion of Ernst, an academic who broke "every professional code of scientific behaviour", not my opinion here's a source, again (The Times, Monday 29 August 2005) because you agree with him. So it's not about "bad actors" really is it? It's about who you agree with. Morgan Leigh | Talk 00:33, 15 December 2018 (UTC)
- Then I advise you that you should complain at WP:AE. Mind of WP:BOOMERANG. But to come back at what you said, scientific truth and ethics are quite different matters. One can be a law-abiding citizen who lies like a dog, or a university president who pled guilty to making obscene, child-sex related phone calls to a daycare center. Tgeorgescu (talk) 01:09, 15 December 2018 (UTC)
- I notice you are not answering the question that is relevant to the source under discussion... Do you contend that an IPD meta review is not a high standard review?— Preceding unsigned comment added by Morgan Leigh (talk • contribs)
- Sooner or later this will go to WP:AE since both parties have made their points clear and cannot reach WP:CONSENSUS. Tgeorgescu (talk) 07:56, 15 December 2018 (UTC)
- Still avoiding the question... It's a pretty simple question really. I wonder why you don't want to answer? One reason we can't get consensus is continued avoidance of answering direct questions about sources. Morgan Leigh | Talk 23:13, 15 December 2018 (UTC)
- Actually we have consensus, but a tiny handful of acupuncture advocates and practitioners dislike it. They also dislike the removal of acupuncture from treatment guidelines. Not our problem. Guy (Help!) 09:51, 16 December 2018 (UTC)
- @Morgan Leigh: I think that you should stop repeating the question after it has received an answer. Tgeorgescu (talk) 11:30, 16 December 2018 (UTC)
- Actually we have consensus, but a tiny handful of acupuncture advocates and practitioners dislike it. They also dislike the removal of acupuncture from treatment guidelines. Not our problem. Guy (Help!) 09:51, 16 December 2018 (UTC)
- Agree w/ Tgeorgescu (re AE) --Middle 8 (t • c | privacy • acupuncture COI?) 11:52, 16 December 2018 (UTC)
- @Tgeorgescu: See past discussions. Basically the acupuncture fans have been trying to crowbar this into the article for years. Guy (Help!) 00:32, 18 December 2018 (UTC)
- Still avoiding the question... It's a pretty simple question really. I wonder why you don't want to answer? One reason we can't get consensus is continued avoidance of answering direct questions about sources. Morgan Leigh | Talk 23:13, 15 December 2018 (UTC)
- Sooner or later this will go to WP:AE since both parties have made their points clear and cannot reach WP:CONSENSUS. Tgeorgescu (talk) 07:56, 15 December 2018 (UTC)
- I notice you are not answering the question that is relevant to the source under discussion... Do you contend that an IPD meta review is not a high standard review?— Preceding unsigned comment added by Morgan Leigh (talk • contribs)
- Then I advise you that you should complain at WP:AE. Mind of WP:BOOMERANG. But to come back at what you said, scientific truth and ethics are quite different matters. One can be a law-abiding citizen who lies like a dog, or a university president who pled guilty to making obscene, child-sex related phone calls to a daycare center. Tgeorgescu (talk) 01:09, 15 December 2018 (UTC)
- Yes, and it has been pointed out to you many times that your opinion that anyone who doesn't agree with you is bad is irrelevant. However your unwillingness to accept this is our problem. Do us a favour and read the talk page guidelines again please. You are asserting that reputable academics are "bad actors"? Sounds awfully like an ad hominem to me... And yet, you support the inclusion of Ernst, an academic who broke "every professional code of scientific behaviour", not my opinion here's a source, again (The Times, Monday 29 August 2005) because you agree with him. So it's not about "bad actors" really is it? It's about who you agree with. Morgan Leigh | Talk 00:33, 15 December 2018 (UTC)
- A good method carried out by bad actors doesn't make a good source. We've pointed out the problems multiple times, your unwillingness to accept them is not really our problem by now. Guy (Help!) 14:15, 14 December 2018 (UTC)
- Do you contend that an IPD meta review is not a high standard review? Morgan Leigh | Talk 09:54, 14 December 2018 (UTC)
- I saw an exchange on Guy's talk page that made me curious about this whole dust-up. It's been an interesting read and I thought a pair of fresh eyes might help. I try to stay out of contentious topics like this, because no matter what I say I'll probably get shouted at by someone unhappy, but I must be a glutton for punishment today.
- I looked through the article and the sources, and found them all interesting if rather difficult to comprehend as someone who knows next to nothing about this stuff. To be fair, in my earlier years I poked my fair share of things with needles, mostly myself when I was bored, and I also pretended to poke things with needles, mostly my sister, but none of that's ever been published and she was never quite enthused. I searched the source in question, Vickers, on Google scholar and looked through some of the articles which cite it and how they cover it to get an idea of how we should cover it.
- I found this article from 2014 cited about 450 times. Interesting read, about treatment recommendations and algorithms which combines two things I don't know much about so also very interesting. It seems to view the source in question as corroborating the wording as it already is, saying: "...other studies suggest that the benefit of acupuncture is small, especially compared with sham acupuncture [cites vickers], and possibly due to expectation or placebo effect." I'm still rather curious how one would pretend to stick a needle in someone in a clinically controlled manner. Interesting concept since I for one think I would notice whether or not a needle was stuck into me.
- I also found an interesting 2013 article which looks at efficacy of treatments for cancer patients. Took me a while to figure out what "ROB" means (turns out it's "risk of bias" which sounds ominous). It had an interesting summary of work at the time, saying "Of the 11 trials examining acupuncture for pain, nine were positive, but eight had high ROB [risk of bias]." Not really sure how to interpret that, but given the ominous nature of ROB, I'm not bullish. It goes on to characterize the source in question saying: "Other reviews and meta-analyses have been published suggesting the utility of acupuncture for pain control in noncancer populations, [cites Vickers] but studies with low ROB [Risk of Bias] are needed to definitively assess its efficacy for pain management in patients with cancer." In my reading it seems to be saying that the source in question doesn't provide substantial evidence for efficacy, or at least not enough to use it on cancer patients. I don't hang with medical crowds much, but if I remember my IRB training well enough I assumed that experimental treatments on cancer patients were more accepted as the potential benefits of an unproven therapy tended to far outweigh the costs. That they didn't find enough evidence to support its use in cancer populations then also tends to make me a little suspicious of this wording.
- All of this is to say I'm not in favor of the proposed change as it seems to be going against the characterization I'm seeing in the literature. Our article doesn't say it's not effective or that there's no evidence at all, it says there's "little" evidence. Which all the sources, including Vickers itself, seem to also be saying. I want to quote something I found while going through the archives of this discussion said almost 4 years ago:
As for the rest of this discussion, I'll refrain from guessing at motives here, there seems to be enough of that already. Assuming no one here is biased, this whole thing seems to be a mountain out of a mole hill (I couldn't think of an acupuncture pun on that, and didn't think it was worth taking a stab at). The sources say there's little evidence, the article says there's little evidence, and Wikipedia shouldn't be responsible for being the reason someone decides that getting poked with needles will make them hurt less. Perhaps it's best if we just back away from this dead horse. Ping me if you need anything. Wugapodes [thɑk] [ˈkan.ˌʧɹɪbz] 04:03, 18 December 2018 (UTC)Ernst, Vickers, and Novella, certainly do agree that the bulk of acupuncture's effect is due to the placebo effect. Vicker's "Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects" and Novella's "the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance" are in substantial alignment, differing primarily in the value judgement of whether a trivial impact is worth paying for, not in whether the impact is trivial. Ernst's conclusions aren't much different. What widely noted review has claimed an effect for acupuncture that was large compared to the effect for placebo?
— User:KWW January 2015- I agree, though AGF can't obscure the fact that Middle8 has declared a financial interest in acupuncture.
- The problem for me is that Vickers' conclusion is ass-backwards. The effects of needling are nonspecific. They are small, transient, and only affect subjective outcomes. The near-parity between real and fake acupuncture actually reveals two things: first, that acupuncture has a well known mythology around it, second, that it's hard to blind people and practitioners as to whether you are actually sticking needles in. Acupuncture fans love Vickers because it spreads the gospel. They have been trying to crowbar Vickers into this article for five years. But the reality-based interpretation of Vickers' findings is so far out of line with what the conclusions state, that it's unacceptable to include it here. What Vickers found is that real and fake acupuncture are almost indistinguishable, the difference is clearly clinically irrelevant, and the most parsimonious explanation for the residual difference is that sham acupuncture is hard to do really convincingly. The placebo effect is not a thing. It is a set of biases, not an actual effect. The co-authors include Lewith, Witt and Linde, all of whom have produced equally underwhelming studies in support of homeopathy, the quintessential fake treatment. Vickers' words here absolutely reveal the motivations behind the study. What they want is for patients to be referred to acupuncturists. Their main focus is the VA but they want it everywhere. It's almost as transparent as chiropractic practice-building.
- His statement that "[t]reatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects" is tendentious. Sham acupuncture studies - the only ones that reliably test against placebo - do not support long-term effects, are fully consistent with bias and nonspecific effects, and the placebo effect is not a thing, despite the years of efforts of acupuncturists like Ted Kaptchuk to prove it is. It's a classic SCAM marketing study, and the 2017 comment makes that absolutely explicit. Acupuncturists seem to be following homeopathists down the path of claiming to harness the nonexistent placebo effect in a unique way. Guy (Help!) 08:05, 18 December 2018 (UTC)
List Article
There is a pretty ugly area in the middle of the article that seems is ripe to be made into a list. Is there any reason a list article couldn't be made for other condition without strong evidence and then linked here. Or even better just remove the list of uselessness. AlmostFrancis (talk) 05:39, 23 December 2018 (UTC)
- From the context, I guess you mean Acupuncture#Other conditions. What is ugly about it? --Hob Gadling (talk) 05:45, 23 December 2018 (UTC)
- Maybe ugly was the wrong word. It seems odd to take up so much screen space saying that there is no evidence for effectiveness for this long list of randomness. It seems that this could be handled either with a sentence saying many conditions show no effectiveness or if necessary a list article of what has not been effective. AlmostFrancis (talk) 05:58, 23 December 2018 (UTC)
- However, the information is of encyclopedic value. For one thing, it is possible to search the article for an item of interest and it may be found in this list, along with a reliable source. That is useful. Johnuniq (talk) 06:11, 23 December 2018 (UTC)
- It also gives the reader a good picture of how well-researched this field is, how devastating the results are, and how many false-positive statistically significant results are to be expected (one for every nineteen insignificant ones). --Hob Gadling (talk) 08:44, 23 December 2018 (UTC)
- However, the information is of encyclopedic value. For one thing, it is possible to search the article for an item of interest and it may be found in this list, along with a reliable source. That is useful. Johnuniq (talk) 06:11, 23 December 2018 (UTC)
- Maybe ugly was the wrong word. It seems odd to take up so much screen space saying that there is no evidence for effectiveness for this long list of randomness. It seems that this could be handled either with a sentence saying many conditions show no effectiveness or if necessary a list article of what has not been effective. AlmostFrancis (talk) 05:58, 23 December 2018 (UTC)
- I agree that a list of things a given treatment is not useful for is a waste of space. If you want to keep this list, I ask you if you would support the inclusion of a huge list of the conditions that aspirin is not good for on the aspirin page? Morgan Leigh | Talk 03:55, 31 December 2018 (UTC)
- See WP:OTHERTHINGSEXIST. Regardless of that, if aspririn had as many attempts by its proponents to prove it could do stuff beyond its actual usefulness as acupuncture had, I for one would be interested in such a section.
- Journals have often refused unsuccessful studies because they regarded them as a "waste of space", leading to distortion of scientific literature (file drawer effect). You are probably not aware that this is a problem and that, in order to improve the quality of research, there are attempts to prevent that by pre-registration of studies. We should not counteract such attempts by falling back into habits now known to be error-prone and thoughtlessly and naively omitting to report those few negative results here. --Hob Gadling (talk) 06:44, 1 January 2019 (UTC)
Cochrane Collaboration Studies - sources feature prominently in Independent article questioning practices
Stumbled upon this article about Cochrane Collaboration studies (the sources cited in this article that suggest acupuncture is a psuedoscience). This Independent article from Sept. 2018 centers on the institute and it's practices, specifically a co-founder who's been expelled from the board by his colleagues. The questionable practices that led to his expulsion seem to have some bearing on the way said studies were conducted. From the article "Greenhalgh, a leading research methodologist, has criticised the Cochrane 'hierarchy of evidence', which places experimental trials above any other study design, and affords limited value to qualitative research. She urges a more inclusive approach to evidence-based practice: 'Facts are not self-interpreting; they are theory and value-laden.' " — Preceding unsigned comment added by Omgnora (talk • contribs) 18:44, 28 December 2018 (UTC)
- That is just a weak attempt at Poisoning the well. Internal differences of opinion do not invalidate the status of the Cochrane Collaboration as a reliable source. To do that, much worse things are needed. --Hob Gadling (talk) 18:48, 28 December 2018 (UTC)
- @Omgnora and Hob Gadling: Apart from Hob's unwarranted casting of aspersions on your intentions in mentioning this entirely pertinent information, I do agree with them that the present perturbations internal to the Cochrane review process are not sufficient for us to cast aside all Cochrane reviews. You might consider adding this information to the Cochrane (organisation) page as it would be entirely relevant there. Morgan Leigh | Talk 00:38, 30 December 2018 (UTC)
Removal of cited information
@AlmostFrancis and Johnuniq: Your removal of this cited information is erroneous. The Joint Commission page says:
"Additionally, it is important to have non-pharmacologic pain treatment modalities available for patients that refuse opioids or for whom physicians believe may benefit from complementary therapies. Non-pharmacologic strategies include, but are not limited to transcutaneous electrical nerve stimulation, physical modalities (i.e.: acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy) relaxation therapy, music therapy, aromatherapy, cognitive behavioral therapy, etc. The level of evidence for these therapies is highly variable, and it is evolving. Therefore, our standards do not mandate that any specific complementary options are provided, but allow organizations to determine what modality(s) to offer.
Please explain how "it is important to have" is not a recommendation of these treatments. Morgan Leigh | Talk 04:00, 30 December 2018 (UTC)
- The edit in question is diff which added (refs converted to links):
- The Joint Commission recommends acupuncture for pain management.[7] The American College of Occupational and Environmental Medicine recommends acupuncture[8]
- The text quoted above from the first ref does not verify "recommends acupuncture for pain management". They clearly say there is no evidence to justify a recommendation but nevertheless they list ten strategies for patients who refuse opioids or who may benefit from complementary therapies. Try WP:RSN and ask if that source verifies that statement if wanted, but the answer will be no.
- The second statement with its ref is even wilder. The ACOEM pdf is advice for how to use their guidelines which are somewhere else. There are no treatment recommendations in the pdf. Acupuncture is mentioned in the context of informing readers that treatment recommendations are made in various categories one of which is "Allied Health Interventions (e.g., acupuncture, manipulation)".
- Did you read the sources before adding the text? Johnuniq (talk) 06:18, 30 December 2018 (UTC)
- Agree we can't use the second (ACOEM) without the actual MDGuideline, but we can certainly use the first (Joint Commission) as long we stick close to its language. Bold(ish)ly restoring it with revised wording. (Diff) Edit: it might not be specific enough to acu to warrant inclusion however.--Middle 8 (t • c | privacy • acupuncture COI?) 10:29, 30 December 2018 (UTC) | added diff 10:48, 30 December 2018 (UTC) | added cmt 10:56, 30 December 2018 (UTC)
- @Johnuniq:You are misrepresenting the source. The joint commission source absolutely does not say that there is no evidence, it says the evidence is "variable and evolving", which is an entirely different thing. If a patient can't tolerate one treatment another is offered. A strategy of a different treatment option is still a recommendation, especially when it says "it is important to have". Morgan Leigh | Talk 04:00, 31 December 2018 (UTC)
- What I actually said is "no evidence to justify a recommendation". Reading the Joint Commission's brief statement shows that is obviously correct. The unstated background is that some patients should not rely on a pharmacologic pain treatment because of various potential problems, and doing anything the patient hopes might alleviate their condition could be better. Using their statement to write "recommends acupuncture for pain management" is completely wrong and failing to acknowledge that is perplexing. Johnuniq (talk) 06:00, 31 December 2018 (UTC)
- Yes, you did actually say that they say there is no evidence to justify a recommendation. However that is not what they say. They say the evidence is "variable and evolving". And they say "it is important to have" i.e. a recommendation.Morgan Leigh | Talk 10:32, 31 December 2018 (UTC)
- What I actually said is "no evidence to justify a recommendation". Reading the Joint Commission's brief statement shows that is obviously correct. The unstated background is that some patients should not rely on a pharmacologic pain treatment because of various potential problems, and doing anything the patient hopes might alleviate their condition could be better. Using their statement to write "recommends acupuncture for pain management" is completely wrong and failing to acknowledge that is perplexing. Johnuniq (talk) 06:00, 31 December 2018 (UTC)
- Oooooh, the Joint Commission thinks acupuncture is on a par with aromatherapy. That's... something of a non-endorsement. Guy (Help!) 17:33, 31 December 2018 (UTC)
Removal of cited information, allegation of COI?
The Joint Commission requires the organizations it accredits to provide complementary, non-pharmacologic pain treatments (e.g. acupuncture) for patients who may benefit from them, such use potentially reducing the need for opioids. The Joint Commission allows organizations to choose which type(s) of complementary treatment to provide — it mandates none in particular because the evidence base for these treatments varies widely and is incomplete. Cited to https://www.jointcommission.org/standards_information/jcfaqdetails.aspx?StandardsFaqId=1813&ProgramId=46
@Roxy the dog: why have you removed the abovementioned cited information without a valid reason? You originally justified your reversion by claiming the editor had a COI and suggested a non COI editor should make the edit. I made that edit and you have reverted it with the edit summary "As before". Are you claiming I have a COI? Morgan Leigh | Talk 11:01, 31 December 2018 (UTC)
- See Johnuniq's reply to you in the section above. -Roxy, the dog. wooF 11:03, 31 December 2018 (UTC)
- That reply is not pertinent as it refers to different text. Morgan Leigh | Talk 11:34, 31 December 2018 (UTC)
- Neither is a self-sourced statement on the website of a trade body that has clearly been the subject of industry lobbying. Guy (Help!) 17:30, 31 December 2018 (UTC)
- No true MEDRS says acupuncture is good for anything. --Middle 8 (t • c | privacy • acupuncture COI?) 20:11, 31 December 2018 (UTC)
- @JzG: You appear to be asserting that this is not a reliable source for this information. Is this the case? Morgan Leigh | Talk 21:58, 31 December 2018 (UTC)
- I am asserting that it is a non-neutral interpretation of a primary source. And in related news, I am now willing to bet you will be topic banned in the near future. Guy (Help!) 00:59, 1 January 2019 (UTC)
- Can you please be more specific? Which part is not a neutral representation of what the source says? Are you seriously asserting that a source cannot be cited for information about it's own policies? WP:PRIMARYCARE says "Material based on primary sources can be valuable and appropriate additions to articles. However, primary sources may only be used on Wikipedia to make straightforward, descriptive statements that any educated person—with access to the source but without specialist knowledge—will be able to verify are directly supported by the source." This source is being used in exactly this way. It is supporting a straightforward statement about the organisation's policy.
- In related news, you have been making false assertions about Middle 8 and I at the COI noticeboard. Fortunately others are on to you and have rectified your false claims. Morgan Leigh | Talk 04:41, 1 January 2019 (UTC)
- The text quoted in the OP has no place in this article because it says nothing about the topic other than that an organization mentioned acupuncture in a list of ten strategies for patients who refuse opioids or who may benefit from complementary therapies. Consider adding the text at an article about the organization or about pain treatment but adding it here would be wildly inappropriate. That is because it is cherry-picked boosterism which conveys a suggestion [that there is a reason to think acupuncture is an effective pain-relief treatment] that is not present in the source. Johnuniq (talk) 05:34, 1 January 2019 (UTC)
- I am asserting that it is a non-neutral interpretation of a primary source. And in related news, I am now willing to bet you will be topic banned in the near future. Guy (Help!) 00:59, 1 January 2019 (UTC)
- Neither is a self-sourced statement on the website of a trade body that has clearly been the subject of industry lobbying. Guy (Help!) 17:30, 31 December 2018 (UTC)
- That reply is not pertinent as it refers to different text. Morgan Leigh | Talk 11:34, 31 December 2018 (UTC)
- Sorry for the late reply. It is a primary source and therefore difficult to tell if the information is due. Acupuncture is only mentioned in an i.e. and not directly addressed. It states the modalities would be complementary not that they are by definition complementary medicine. Switching i.e. to e.g. is source misrepresentation. "Such as" implies that it is an example and not the only benefit mentioned... Basically it is a bad source that is barely about acupuncture that was aggressively misrepresented. AlmostFrancis (talk) 21:53, 4 January 2019 (UTC)
- I aggressively agree with leaving this out; it's not specific enough to acu (note, Morgan Leigh). No, the pipelink to CAM doesn't belong there; my error (added at last minute). If and wherever this is included, it needs to be clear these are not all CAM's. (Quibbles: It's an expert body's practice recommendation -- isn't it? -- and MEDRS doesn't deem these primary. Re i.e. vs. e.g.: pls see #2 in my reply under subsection "Harrison's".) --Middle 8 (t • c | privacy • acupuncture COI?) 10:45, 6 January 2019 (UTC); minor addition 14:41, 6 January 2019 (UTC)
RfC - Again
There is an RfC relevant to this topic at - the COI noticeboard Morgan Leigh | Talk 00:44, 1 January 2019 (UTC)
Harrison's
While no doubt a valued source Harrison's does not need its own section with a specific call out. The information should either be added to the earlier prose when showing value or added to the list when not. Also if you need two or three caveats for a recommendation better to leave it out. AlmostFrancis (talk) 06:35, 5 January 2019 (UTC)
- "According to Harrison's, acupuncture can be considered a useful adjunctive treatment in PTSD and comorbid depression in war veterans if, despite the lack of evidence, patients find it calming and relaxing". I love how this is taken ad endorsement rather than what it is, a plain statement that it doesn't work. Harrison's can be summarised thus: there's no good evidence of effectiveness. Guy (Help!) 09:22, 5 January 2019 (UTC)
- I see this a lot among homeopathic medicine sellers: The medicine works exactly as well as a placebo but, as is often the case, both the the placebo and the snake oil give better results than no treatment -- so the homeopathic pill pusher makes a big deal about it being more effective than no treatment. --Guy Macon (talk) 13:22, 5 January 2019 (UTC)
- Yes, Harrison's seems to be making the exact same type of argument, doesn't it? Here is the exact wording:
- A number of complementary alternative medicine approaches including acupuncture, mindfulness meditation, yoga, and massage are also being used in PTSD. Although not evidence-based treatments per se, if they facilitate a relaxation response and alleviation of hyperarousal or sleep symptoms, they can be considered useful adjunctive modalities.p.471-e5
- That is obviously not an endorsement of efficacy (which requires evidence from RCT's). What is it then? --Middle 8 (t • c | privacy • acupuncture COI?) 17:28, 5 January 2019 (UTC); added page # 17:31, 5 January 2019 (UTC)
- It's a statement of what people "can" consider. People "can" consider all kinds of things, so I guess it's like a shrug of the shoulders - kind of a nothing burger. I have some additional problems with the addition, as well as the undue aspect noted above. First, Harrison's should not be personified into some kind of speaking entity: it is a collection of monographs that each have authors and these should be cited properly. Harrison's now has a 20th edition so the 2015 is superseded (I don't have access to the newer one yet). Alexbrn (talk) 17:37, 5 January 2019 (UTC)
- "consider" at Wiktionary
- Here it's used in the sense of #3 (as a ditransitive verb), yes? For example "Acupuncture can be considered a pseudoscience" would probably be taken as the source deeming acu a pseudoscience (which is how I would take it). --Middle 8 (t • c | privacy • acupuncture COI?) 10:00, 6 January 2019 (UTC)
- The context is clear: acu is not evidence based "per se", but "can be considered useful". Donald Trump can consider he pulled off a diplomatic triumph in North Korea. People are irrational. Or it might mean something else. But I think if we're getting to the point where sources need to be tortured for meaning, it's time to move on. (Our pseudoscience sources are very direct about that classification, so I'm not sure if it's helpful to invoke them as though they aren't). Alexbrn (talk) 16:32, 6 January 2019 (UTC)
- Who said our PS sources were unclear?
- The point is this is a sig view about using acu clinically. Irrational it may be, but it exists -- one cannot deny acu's clinical scope, e.g. in US academic medical centers, no matter how much one wants to just focus on RCT's -- and Wikipedia is not the place to right that great wrong. Or to dispute the reliability of good sources (see also below, re the revert of good material on tension headache).
- Also, would you mind answering my good-faith question about the grammar, please?--Middle 8 (t • c | privacy • acupuncture COI?) 18:34, 6 January 2019 (UTC)
- The context is clear: acu is not evidence based "per se", but "can be considered useful". Donald Trump can consider he pulled off a diplomatic triumph in North Korea. People are irrational. Or it might mean something else. But I think if we're getting to the point where sources need to be tortured for meaning, it's time to move on. (Our pseudoscience sources are very direct about that classification, so I'm not sure if it's helpful to invoke them as though they aren't). Alexbrn (talk) 16:32, 6 January 2019 (UTC)
- My thought on that quote are three fold. First, once again you are misrepresenting sources. Somehow you translated "alleviation of hyperarousal or sleep symptoms" into calming. Their are a myriad ways in which those concepts do not mesh including their immediacy, amplitude, and scope. Second, once again you took something that was part of a list and only added it to one subject. This is an encyclopedia, if a concept does not even deserve its own structure in a source then probably it does not deserve one here. My third thought is granted a personal one. Please do not use the rather obvious pain of soldiers to further an agenda, it is unseemly.AlmostFrancis (talk) 04:45, 6 January 2019 (UTC)
- (1) Your point is overdone. If you have a better way of paraphrasing the idea for a lay audience, please just suggest it. (2) If Jones says "a number of fruits, including oranges, grapefruits, lemons, and limes, are high in Vitamin C", then in the article on limes we can say that Jones says limes are high in vitamin C. From context, one understands that the source is ascribing the given quality to each item in the list, not (only) to the set of all items taken together. (True both here and above.) (3) Please AGF. I believe the proper target for your concern is the source (which was not cherry-picked; all mentions of acu from Harrison's are cited in the diff). --Middle 8 (t • c | privacy • acupuncture COI?) 10:00, 6 January 2019 (UTC); punct. fix 10:05, 6 January 2019 (UTC)
- It's a statement of what people "can" consider. People "can" consider all kinds of things, so I guess it's like a shrug of the shoulders - kind of a nothing burger. I have some additional problems with the addition, as well as the undue aspect noted above. First, Harrison's should not be personified into some kind of speaking entity: it is a collection of monographs that each have authors and these should be cited properly. Harrison's now has a 20th edition so the 2015 is superseded (I don't have access to the newer one yet). Alexbrn (talk) 17:37, 5 January 2019 (UTC)
- Yes, Harrison's seems to be making the exact same type of argument, doesn't it? Here is the exact wording:
- I see this a lot among homeopathic medicine sellers: The medicine works exactly as well as a placebo but, as is often the case, both the the placebo and the snake oil give better results than no treatment -- so the homeopathic pill pusher makes a big deal about it being more effective than no treatment. --Guy Macon (talk) 13:22, 5 January 2019 (UTC)
This (ES: Why add older material than what we already cite; also see Talk comments raising conncers about citing an old edition of "Harrison's" like this) was a poor revert. We do not delete the previous edition of a MEDRS while waiting to get hold of the freshest one (2015 vs. 2018 for Harrison's). More importantly, Harrison's conclusion was unique (flat-out no efficacy) relative the Cochrane reviews (2016 and 2012[sic]) (as well as the NICE guidelines, which I'd added earlier, but were also reverted), and is thus valuable. One would almost think I'm not allowed to add MEDRS here. Can't imagine why. --Middle 8 (t • c | privacy • acupuncture COI?) 18:18, 6 January 2019 (UTC)
- Why would we add old material when we cite newer? Especially in a fast-changing field it's important to reflect up-to-date knowledge. This article is already over-stuffed with redundant sourcing, the last thing we need is yet more of that - especially if it seems to be part of some WP:POINTy stunt, as your parting words just above seem to suggest. I don't think we should be citing old editions either - it's possible (probably even) the new edition says the same, but it's best to check: there is no WP:DEADLINE. Alexbrn (talk) 18:30, 6 January 2019 (UTC)
- As I said, it's not redundant. Read it, compare to Cochrane. And 2015 ≠ "old". Exactly, no deadline, leave MEDRS in till we get the newer one. Would you remove a 2015 Harrison's cite from chiropractic saying it didn't work because the new one might say differently? This isn't how we do things. --Middle 8 (t • c | privacy • acupuncture COI?) 18:43, 6 January 2019 (UTC)
- Yes, it pretty much is. Harrison's says it does not work, in weak language. We have better and more recent sources saying the same thing. Guy (Help!) 18:55, 6 January 2019 (UTC)
- Exact quote -
"There is no evidence for the efficacy of acupuncture." p.2594
Weak? Read the Cochrane, it says moderate evidence that acu does work. --Middle 8 (t • c | privacy • acupuncture COI?) 19:31, 6 January 2019 (UTC)
- Exact quote -
- The chapter Harrison's is out of date since it says wrt headache "There is no evidence for the efficacy of acupuncture" - but the later Cochrane review(s) discuss evidence. And for the last time, can we stop citing it as "Harrison's" as though The Book speaks. This is a collection of chapters written by named people and must be cited properly, if we're to cite it at all. Alexbrn (talk) 18:59, 6 January 2019 (UTC)
- Different sources reach different conclusions all the time -- Harrison's may well have thought weak(ish) evidence to be essentially none. "If we're to cite it at all"? So we add the chapter authors, no reason to remove the cite. --Middle 8 (t • c | privacy • acupuncture COI?) 19:31, 6 January 2019 (UTC)
- I've asked about this at WT:MED --Middle 8 (t • c | privacy • acupuncture COI?) 19:31, 6 January 2019 (UTC)
- Yes, it pretty much is. Harrison's says it does not work, in weak language. We have better and more recent sources saying the same thing. Guy (Help!) 18:55, 6 January 2019 (UTC)
- As I said, it's not redundant. Read it, compare to Cochrane. And 2015 ≠ "old". Exactly, no deadline, leave MEDRS in till we get the newer one. Would you remove a 2015 Harrison's cite from chiropractic saying it didn't work because the new one might say differently? This isn't how we do things. --Middle 8 (t • c | privacy • acupuncture COI?) 18:43, 6 January 2019 (UTC)
Full protection
I have fully protected the article for two weeks to prevent any further problematic editing. This will allow discussion to take place without a background of edit-warring on the page itself. Any uncontroversial changes to the article (spelling, grammar etc.) may be requested here by using the template {{Edit fully-protected}}. Black Kite (talk) 18:24, 6 January 2019 (UTC)