Talk:Acupuncture

Rate of serious adverse events

Restored[1] a source from 2004 that estimated a rate of SAE's of 5 in one million. For this area of research, 2004 seems fine, since it's consistent with later reviews like Xu et.al.,2013, which just didn't mention a specific number. Some things change quickly; this doesn't appear to be one. --Middle 8 (talk) 21:35, 21 November 2013 (UTC)

The 2004 is too old. It failed MEDRS. That is your opinion that the source from 2004 is consistent with recent reviews. The recent reviews covering safety did not think it was important to discuss the specific numbers. You were using the older source to argue against the later reviews. You thought the recent reviews were wrong so you used the 2004 source to argue against recent reviews. QuackGuru (talk) 21:46, 21 November 2013 (UTC)

It's not a MEDRS failure for the reasons I stated; it is consistent with recent reviews. There is no basis in fact for your other assertions, nor have you even attempted to provide one. --Middle 8 (talk) 12:06, 22 November 2013 (UTC)

You know there are recent reviews covering safety including the 2013 you mentioned. QuackGuru (talk) 18:00, 22 November 2013 (UTC)

You know that older sources are fine under MEDRS in a lot of situations. A1candidate put it well just below. --Middle 8 (talk) 01:43, 23 November 2013 (UTC)

I haven't got the time to study both articles in-depth, but I think its wrong to remove a source just for being several years old, especially when taking into account the lack of similar reviews published in medical literature. Unless there's an overwhelming increase in the number of acupunctural reviews being published in the previous weeks/months that explicitly contradicts this particular review, I don't see why it should be removed. Scientific consensus usually takes years, if not decades, to be shaped. A 2004 publication year seems to be fine. -A1candidate (talk) 15:37, 22 November 2013 (UTC)

Your comments show that the reference is indeed several years old. There is no compelling reason to ignore MEDRS. QuackGuru (talk) 18:00, 22 November 2013 (UTC)

And still more IDHT from you. I'm restoring the ref. If other editors agree with me, they'll make sure it stays. Don't expect your edits (inclusions or removals) to stick unless you're willing and able to discuss them. --Middle 8 (talk) 01:43, 23 November 2013 (UTC) Follow-up comment: haven't yet put it back in. More good reasons to add the source have emerged below. --Middle 8 (talk) 12:30, 26 November 2013 (UTC)

I agree with Middle 8 - no BS making up criteria on the fly - discuss here first please.Herbxue (talk) 03:09, 23 November 2013 (UTC)

Per WP:MEDRS:

• Look for reviews published in the last five years or so, preferably in the last two or three years. The range of reviews you examine should be wide enough to catch at least one full review cycle, containing newer reviews written and published in the light of older ones and of more-recent primary studies.
• Within this range, assessing them may be difficult. While the most-recent reviews include later research results, do not automatically give more weight to the review that happens to have been published most recently, as this is recentism.
• Prefer recent reviews to older primary sources on the same topic. If recent reviews do not mention an older primary source, the older source is dubious. Conversely, an older primary source that is seminal, replicated, and often-cited in reviews can be mentioned in the main text in a context established by reviews. For example, the article genetics might mention Darwin's 1859 book On the Origin of Species as part of a discussion supported by recent reviews.

According to WP:MEDRS we use recent reviews. Wikipedia does not engage in death pacts with almost ten-year-old sources. We don't have to say anything about the numbers. The recent reviews decided what is important. There is never a requirement that dubious, potentially misleading, but sourced text must appear, simply because an old source mentioned something several years ago when we know the recent reviews did not make the same point. Even if true, there is no reason to use the older source. Some things may change or may not change; but this is not the job of Wikipedians to make that determination. QuackGuru (talk) 06:29, 23 November 2013 (UTC)

MEDRS also says:

• "These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published."

From PubMed, reviews on adverse events in acupuncture, most recent first:

• Xu, 2013-03 (English language, 6 databases, systematic, 25 countries & regions, 2000-2010; sequel to earlier review up to 2000)
• He, 2012-10 (Chinese language, 1956-2010)
• Wheway, 2012-01 (U.K., review of reports to National Patient Safety Agency, 2009-2011)
• Adams, 2011-12 (Pediatric, all languages, 18 databases, systematic, inception-Sept. 2010)
• Ernst, 2011-04 (Serious adverse events, all languages, 11 databases, 2000-ca.2010)
• Zhang, 2010-12 (Chinese language, 3 databases, 1980-2009)
• Capilli, 2010-01 (clinical trials focusing on pain)
• White, 2004-09 (Review of reviews; computerised databases, previous reviews of case reports, population surveys, prospective surveys, textbooks; English language; inception- 1990-2000)) (note: this is the one I propose to restore; includes estimated rate of serious AE's = 5 in 10^6)
• ... and six or seven more, from 1999-2003.

So since White's general review (2004), there were seven reviews, three of which (Wheway, Adama and Capilli) were about subsets of acupuncture care (pediatric, specific databases), and thus not comparable to White. Of the remaining four, two were in the Chinese literature and thus also not comparable to White, since there are fewer adverse effects in the West. That leaves two comparable to White: Xu-2013 and Ernst-2011. That would certainly qualify as a case of "few reviews are being published", i.e., reasons given in MEDRS to relax to five-year window. I think that pretty much settles the issue. Comments? --Middle 8 (talk) 15:30, 23 November 2013 (UTC)

I think you clarified this very nicely. --Mallexikon (talk) 05:03, 24 November 2013 (UTC)

I think the "few reviews are being published" exception is to allow a 5 year plus review when there is not a more recent one, or a more recent one that is comparable available. Why would it be appropriate to use a 10 year old review when there is one that is from this year and one that is from two years ago? That you have shown seven reviews from 2010 to the present pretty much negates the idea that few reviews are being published. But again the relaxing of the 5 year rule IMO is to allow use of a older study when there is not a more current one available.

If the more recent one doesn't have all the data you are looking for I would suggest a statement about Xu 2013 or Ernst 2011 followed by a mention of the data from White 2004. Alternatively you could argue that White 2004 is a superior source as a review of reviews and the most recent source at that level. - - MrBill3 (talk) 07:08, 24 November 2013 (UTC)

I wasn't suggesting ignoring Xu 2013 or Ernst 2011, but rather augmenting them with White 2004's "5 in one million" figure (for rate of serious AE's). (White is otherwise consistent with Xu and Ernst.) I did explain why the other five reviews aren't comparable to White: there are many different places to dig for data, e.g. language and databases, type of AE, population treated, care setting. Given all those variables, reviews are scarce. --Middle 8 (talk) 12:30, 26 November 2013 (UTC)

This proposal to use the fringe journal Acupuncture in Medicine makes no sense. There is information in the article about the numbers. Why include the same information twice in the article? I already explained that the recent reviews cover this. I think I clarified this very nicely. QuackGuru (talk) 18:48, 24 November 2013 (UTC)

Thanks for putting that number in the article, QG, but the source you used -- Adams 2011, the Pediatrics review -- credits it to White 2004; we should cite the latter since it's the original source. The very fact that Adams cites White shows that Acupuncture in Medicine is not a "fringe journal". Its publications are also used by, e.g., the Cochrane Collaboration[2], and Adams and Vickers each cite it multiple times. We should leave the judgement about "fringe-ness" to the literature. (Some of the stuff published by Acupunct. Med. might not pass MEDRS, but that's true of any journal, e.g. case reports). --Middle 8 (talk) 12:30, 26 November 2013 (UTC)

I agree that if Adams is citing a number from White it should be sourced to White. With that change, as the numbers are in the article, have we reached consensus. - - MrBill3 (talk) 15:49, 26 November 2013 (UTC)

See WP:MEDDATE: Look for reviews published in the last five years or so, preferably in the last two or three years.

The fringe journal Acupuncture in Medicine is still a fringe journal. We must use independent sources. There is no reason to use the 2004 source when we have a much newer source for the numbers. We don't cite older sources unless it is a good source like a Cochrane review. QuackGuru (talk) 17:19, 26 November 2013 (UTC)

QG, I think you are too quick with damning sources you don't like, especially with your assessments regarding "fringe". This is a reliable source as pointed out several times above, even though you think anything acupuncture is evil. If you believe the consensus here is unacceptable, please take it to the reliable sources noticeboard. --Mallexikon (talk) 05:00, 27 November 2013 (UTC)

Acupuncture in Medicine is published by BMJ Group, which can hardly be characterized as fringe. TimidGuy (talk) 11:23, 27 November 2013 (UTC)

I pointed out the source is way too old. In 2014, it would be 10 years old. QuackGuru (talk) 19:28, 27 November 2013 (UTC)

If the source (White 2004) is being cited by Adams in 2011 that supports its use as the best review currently available per the MEDRS exceptions discussed above. I agree that blanket condemnation of a journal as a source is inappropriate and / or a matter that should go to the RS Noticeboard. A published article should be evaluated on its merits for a specific article or fact therein. If a fact / number is used, the reference should not be a citation of that number but the original study. The citation of the number in a more recent source is a matter for editorial discussion about including that fact. - - MrBill3 (talk) 11:01, 28 November 2013 (UTC)

@QG: Your concerns about the age and mainstream-ness of the source have already been addressed, QG. No need to go in circles; consensus isn't always unanimity, and by all indications we have a consensus. I'll restore White 2004 per my earlier edit when I get a chance. --Middle 8 (talk) 13:35, 28 November 2013 (UTC)

MrBill3 said "a matter that should go to the RS Noticeboard." I thought you wanted to include the source. Your earlier edit deleted text from a 2011 source that was not about the numbers. There is a big difference between including the source and rewriting the text. You have not given a reason to rewrite the text.

"A 2011 meta-review showed that serious adverse events, including death have been reported, are frequently due to practitioner error, is rare, and diverse.[16]"

I object to deleting this text or replacing it with the dated source. I don't see an argument to replace the 2011 meta-review. QuackGuru (talk) 17:52, 28 November 2013 (UTC)

Again you're repeating yourself and ignoring points made above (e.g., that White is the original source for the 5-on-one-million number, and as such, should be cited). You also mischaracterize my edit, which did not "delete text from a 2011 source"; you may have misread the diff. That can happen, but with you it's been happening a lot. When you keep misreading/misrepresenting policies and edits, it gets disruptive. --Middle 8 (talk) 03:14, 29 November 2013 (UTC)

Your edit replaced the 2011 meta-review and your edit was OR. For example, the "exceedingly" rare was OR. Replacing the meta-review was against MEDRS. Your proposal does not seem to match your edit. You did not give a good reason to replace the the meta-review when it is a newer source. The 2011 meta-review said nothing about the 5-in-one-million number. IMO, your proposal does not make much sense. QuackGuru (talk) 03:34, 29 November 2013 (UTC)

You're misreading that diff. And above (early in this thread) you misread WP:MEDDATE; in fact, the bullet points that you pasted in come right after the "few reviews being published" exception, so I can't see how you could have missed that without being careless or bad-faith. This is disruptive. --Middle 8 (talk) 03:56, 29 November 2013 (UTC)

Where is your explanation for deleting/replacing the 2011 meta-review. I thought your proposal was to include the numbers but you still want to do this? Again, the meta-review is not about the numbers so what reason is there to replace it. Your original proposal was to include the numbers because you thought the newer sources just don't mention a specific number. But the newer sources do. There are two sources that mention the numbers. I included the numbers using one of the newer sources that explicitly states the 5 in 1 million numbers. The source you used does not explicitly state the 5 in 1 million numbers. QuackGuru (talk) 04:29, 29 November 2013 (UTC)

Enough! We have consensus; you've excluded yourself from it with persistent IDHT. And I think we're near the point where we need some local or global user-conduct consideration. Locally, it might simply involve an emerging understanding that you, QG, aren't the most trustworthy editor and therefore your mainspace edits won't stick unless there's explicit consensus; globally, well, the usual. But that may not be necessary unless you continue disrupting the talk page. --Middle 8 (talk) 10:02, 1 December 2013 (UTC)

To be clear, there's nothing personal here, nor am I generalizing unfairly. QG is good at finding sources, and frequently makes reasonable edits. It's just that he also frequently gets sidetracked, makes factual errors (the correction of which he tends to ignore), and IDHT's (intensely). --Middle 8 (talk) 10:44, 1 December 2013 (UTC)

The 2011 meta-review does not discuss the numbers but you did replace the source with an older source. Are you planning to delete/replace the 2011 meta-review again? The newer source that is about the numbers gives a better explanation about the numbers. The newer source does specify the numbers, including children and adults. See Adams 2011. I did explain the older source you wanted to restore does not explicitly state the 5-in-1 million number. QuackGuru (talk) 18:49, 1 December 2013 (UTC)

The White 2004 dated source is confusing because it said "acupuncture is estimated to be 0.05 per 10 000 treatments, and 0.55 per 10 000 individual patients."[3] This shows the older source did not explicitly state it was 5-in-1 million.

"The authors did not specify if this estimate included adults and children,..."[4] according to the newer Adams 2011 review. The newer review does specify the numbers, including children and adults.

Current text: "The incidence of serious adverse events was 5 per one million, which included children and adults.[166]"

The current text in the article is well written using the Adams 2011 review. The older text is indeed confusing and therefore not appropriate for inclusion in this article. QuackGuru (talk) 05:20, 2 December 2013 (UTC)

@QuackGuru: (1) You've just claimed (twice) that it's too confusing to convert 0.05/10,000 to 5/1,000,000. Among science editors. What do you take us for? (2) Re the newer source, you ignore this, from right above: Thanks for putting that number in the article, QG, but the source you used -- Adams 2011, the Pediatrics review -- credits it to White 2004; we should cite the latter since it's the original source. Then you ignore another editor's agreement with that comment. Pretending not to understand math is trolling for sure, and repeated IDHT-ing of comments (in the same thread) is probably also trolling, or else extreme incompetence. I've engaged you this far to allow you a choice, and you've repeatedly chosen disruption. Why should you be trusted? I won't engage your IDHT or "misunderstandings" further. As long as you behave this way, consensus will and should move along without you. --Middle 8 (talk) 07:10, 2 December 2013 (UTC)

@QG: Middle8 has a point. I would usually post this on your user page but you delete everything written there... We all honor your contributions here but I, too, feel kind of frustrated with your style. How about some good ol' WP:AGF from your side? --Mallexikon (talk) 07:28, 2 December 2013 (UTC)

@QuackGuru: I generally find your contentions reasonably well supported. I respect and value your editing and in many cases your opinion. I think you bring a sharp editors pencil to many places it is needed. That said I find your conduct on talk pages disruptive. Your level of IDHT at times defies belief and your follow up comments can be repetitive without any additional information. I am personally offended that you quoted me out of context. I was clear that if you contested White 2004, you should take it to the RS Noticeboard. Your comments and edit summaries all too often show a lack of civility. I encourage you to continue to contribute to WP but urge you to consider behaving in a more genial and constructive manner. Not wanting to get beyond the appropriate boundaries of a talk page I just want to add there are times and states of mind not conducive to editing. I hope all is well with you and look forward to a time when your participation in talk pages matches your acumen in editing. - - MrBill3 (talk) 07:36, 2 December 2013 (UTC)

Belatedly restored White 2004 and text per consensus above. --Middle 8 (talk) 08:10, 27 January 2014 (UTC)

Even more belated note, for the record: Consensus was joined by Mallexikon, A1Candidate, MrBill3, Herbxue, and myself. See above in this (unnecessarily lengthy) thread ... diffs can follow later... if needed. --Middle 8 (leave me alone • talk to me) 22:33, 14 February 2014 (UTC)

Section break for any additional discussion

Discuss further content issues here, if necessary.

Proposal to remove statement

I propose this statement "Commenting on this meta-analysis, professor Edzard Ernst stated that it demonstrated that the effects of acupuncture were principally due to placebo.[n 2]" from here "A 2012 meta-analysis found significant differences between true and sham acupuncture, which indicates that acupuncture is more than a placebo when treating chronic pain (even though the differences were modest).[99] Commenting on this meta-analysis, professor Edzard Ernst stated that it demonstrated that the effects of acupuncture were principally due to placebo.[n 2] " be deleted from the article. Concerns: --LT910001 (talk) 00:38, 27 December 2013 (UTC)

• Opinion of scientist in newspaper is a weak WP:MEDRS reliable source and should be replaced with a better one. See "The popular press is generally not a reliable source for scientific and medical information in articles", and "Roughly in descending order of quality, lower-quality evidence in medical research comes from individual RCTs; other controlled studies; quasi-experimental studies; non-experimental, observational studies, such as cohort studies and case control studies, followed by cross-sectional studies (surveys), and other correlation studies such as ecological studies; and non-evidence-based expert opinion or clinical experience." (WP:MEDASSESS, same page).
• This is WP:OR: "This includes any analysis or synthesis of published material that serves to advance a position not advanced by the sources. "
• This violates WP:UNDUE: "Do not combine material from multiple sources to reach or imply a conclusion not explicitly stated by any of the sources. If one reliable source says A, and another reliable source says B, do not join A and B together to imply a conclusion C that is not mentioned by either of the sources." Source A (Metaanalysis) says yes, source B (expert opinion in the Guardian) says no. It's improper to link them together like this.

Ernst is just about the most reliable source on this subject regardless of the venue. Proposal rejected. jps (talk) 00:54, 27 December 2013 (UTC)

Thanks for your input, but I would remind you that WP is build around consensus, so we'll need to wait for a few more users to chip in before we jump to that conclusion. Additionally, WP:MEDRS is a guideline for statements making claims about medicine on Wikipedia. Ernst may be very knowledgable, but his statements do not carry the same weight as meta-analyses and systematic reviews. --LT910001 (talk) 01:15, 27 December 2013 (UTC)

The review needs to be explained and Ernst is just the person to do it. jps (talk) 02:09, 27 December 2013 (UTC)

This was discussed before. Ernst is an expert on the topic. His evaluation on the meta-analysis maintains NPOV. QuackGuru (talk) 01:45, 27 December 2013 (UTC)

Um, not so sure. He clearly has a POV. I am not suggesting his studies be excluded (they are notable), but his commentary on someone else's study is not really worth including.Herbxue (talk) 06:27, 27 December 2013 (UTC)

Ernst is not reliable. -A1candidate (talk) 01:56, 27 December 2013 (UTC)

He sure is. He's the only person who has ever had a professorship in alternative medicine. In some ways, he is the only expert on this subject. jps (talk) 02:09, 27 December 2013 (UTC)

Ernst is very reliable, and an excellent expert to use as a source in this area. --Roxy the dog (resonate) 03:07, 27 December 2013 (UTC)

He is certainly notable and must be included, but for fuck's sake he is not an expert on acupuncture or TCM, and is definitely not the "only expert"! He's just the only source you like. One thing I like about him is that he is never so sloppy as to say "acupuncture is just placebo", I'm less pleased that he does indulge in every opportunity to suggest that it might be, in a manner that does not require him to prove it or be responsible for it, only suggest it. Herbxue (talk) 06:22, 27 December 2013 (UTC)

The discussion here is not about Ernst being notable or not (he sure is). The discussion is about whether it is permissible to add his comment here. We have a MEDRS (the Vickers study). And we have a newspaper article citing Ernst. The former obviously trumps the latter. Even if Ernst wrote a letter to the editors this source wouldn't trump a meta-review. We have to leave Ernst's comment out; otherwise, we set a bad precedent. For all the medicine-related articles on WP. --Mallexikon (talk) 07:29, 30 December 2013 (UTC)

Yes, it's massive undue weight; Vickers and individual expert commenters like Ernst occupy opposite ends of the spectrum of good medical sources. In fact they're so far apart that the only way I can see giving a sentence to Ernst is if we have at leas a couple para or more devoted to Vickers -- the spread is easily that big. There are other good sec sources with different findings, and therefore ample balance in the article. The literature obviously shows conflicting results and conclusions, and that's exactly what we should portray. --Middle 8 (talk) 10:54, 30 December 2013 (UTC)

Ernst's the go-to expert on all things acu* - his opinion (attributed as such) is worthy of inclusion I'd have thought. Alexbrn ^{talk|contribs|COI} 11:01, 30 December 2013 (UTC)

If you show me some reliably sourced evidence that Ernst is the internationally accepted "go-to expert on all things acu" - fine. Until then, he's not going to get any extra treatment. WP:MEDRS doesn't say "look for the one expert you can find on a given topic and try to insert his views and opinions as often as possible in an article". WP:MEDASSESS demands that "in general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, such as anecdotes or conventional wisdom. The medical guidelines or position statements produced by nationally or internationally recognised expert bodies often contain an assessment of the evidence as part of the report." No mention of single-expert opinions taken from a newspaper article. --Mallexikon (talk) 03:32, 31 December 2013 (UTC)

For starters, see Edzard Ernst#Work in complementary medicine. QuackGuru (talk) 03:41, 31 December 2013 (UTC)

Yep. Read it. This guy has been doing a lot of research (then again, that's what researchers do, no?). However, no reliably sourced evidence that Ernst is the internationally accepted "go-to expert on all things acu" yet. --Mallexikon (talk) 04:45, 31 December 2013 (UTC)

Well, The Guardian went to him for the opinion we're citing; the UK Parliament go to him when taking evidence on CAM; Exeter University went to him in appointing a CAM chair. He has been called a "leading critic of alternative medicine" in the BMJ and by The Times "a leading expert". Respected academic publishers repeatedly publish his work in books and journals, covering CAM topics in general and acupuncture in particular. Even CAM publications cite him as an authority, sometimes even as "Edzard Ernst himself"! And he's a trained acupuncturist. Really, the claim that Ernst doesn't represent noteworthy "expert opinion" appears rather tendentious. Alexbrn ^{talk|contribs|COI} 08:02, 31 December 2013 (UTC)

Yes, WP:MEDRS guides us what to do "in general"; and in this case in particular my assessment is that Ernst is good to have, especially considering the WP:FRINGE context of the topic as a whole. WP:MEDRS is a useful guideline, but WP:PSCI is mandatory policy. Because acu* is pseudoscience, we need to ensure that we frame all these medical investigations (which, in any case show it to be nothing-or-nearly-nothing) within the wider mainstream scientific context, which is that investigating acupuncture is an absurd endeavour (see PMID 20457720). Alexbrn ^{talk|contribs|COI} 07:20, 31 December 2013 (UTC)

1.) Acupuncture is not characterized as pseudoscience at WP (cf Category:Pseudoscience). Middle8 gave a very good overview on this (complex) situation at Wikipedia talk:WikiProject Medicine#WP:FRINGE/PS answers this question: No

2.) Yes, Ernst got a chair. Yes, he's a scientist published by respected scientific academic publishers. Yes, The Times has called him a "leading expert" (on whatever). But you still haven't produced any reliably sourced evidence that Ernst is the internationally accepted "go-to expert on all things acu". He's just one scientist among many, even though you love him. In comparison to Vickers meta-review, Ernst's commentary doesn't even constitute a MEDRS. Putting the two in direct context gives undue weight to an inferior source. --Mallexikon (talk) 08:36, 31 December 2013 (UTC)

Middle 8 gave an acupuncturist's view after everybody else had moved on. However the consensus on that thread is against it, as it is in RS: acupuncture is pseudoscience (or at the very least, as an altmed practice, fringe) and so falls under the WP:PSCI policy. As to Ernst, requiring some source that uses the exact words "internationally accepted 'go-to expert on all things acu'" is silly. By any reasonable measure, and as stated in RS, he's a "leading expert" on the topic for the reasons I have already given. If these reasons are not good enough for you, then we shall have to disagree; they're good enough for me. So in my view his opinion is worthy of inclusion. Alexbrn ^{talk|contribs|COI} 09:05, 31 December 2013 (UTC)

In addition, I would suggest that except for acupuncturists here, there is consensus that it is a pseudoscience, and we would expect people who practise this pseudoscience to want to defend this dubious 'medical' treatment. --Roxy the dog (resonate) 09:19, 31 December 2013 (UTC)

@Alexbrn - "Acupuncturist's view"? Oh really? By your logic, does the fact that I'm also a scientist give my words greater weight than your non-scientist's view, or do the science and woo cancel each other out? Ad hominem is lazy, and sure enough you offer no rebuttal to my argument. Of course you're right that it has fringe-aspects, but it also has non-fringe ones, and neither has to do with a semantic argument.

@Roxy the dog - there's exactly one acupuncturist here. And he's curious if you're going to clarify your assertion that acupuncture's good for nothing) in light of gold-standard sources that say otherwise. I see above you've perhaps walked it back to "dubious", which is actually about right, all things considered (i.e. given all the stuff it's said, falsely, to be good for). --Middle 8 (talk) 11:45, 31 December 2013 (UTC)

When you boil it down to basics, those "gold-standard" sources say it is good for a bit of placebo induced pain relief. That is all. It is bonkers that we big it up like we do. Also, and this goes to competence, how can a scientist actually be an acupuncturist? The former actually would be expected to totally obliterate any belief in the latter, assuming normal scientific understanding of the world. --Roxy the dog (resonate) 12:40, 31 December 2013 (UTC)

@Roxy - Funny how those same gold-standard sources (Ernst re Cochrane; Vickers '12) say it's good beyond (sham) placebo. For nausea, too ("Acupoint P6 reduces PONV"). I know others like Novella believe the import of those same sources (for pain, anyway) ultimately show placebo, but we have a well-documented range of views, and Cochrane's and Vickers' meta-analyses obviously have more weight than Novella's blog articles. Of course Novella may be right, but WP lags the science, and there's no sci consensus yet.

On your question, this isn't the place to dwell on my biography, but: (1) both the evidence and my understanding of EBM were different when I trained to be an L.Ac.; (2) my views have evolved and I now figure it's all up for grabs, and that it's a question of science not belief; (3) I'm not practicing anymore, (true; might change; but irrelevant) so even if it weren't the right thing, I can afford to put the science first; (strike knocking-down of ABF straw man) (4) as is obvious from even some of the better sources here, some scientists seem to find merit in it; ask one sometime -- scientific opinion isn't as homogeneous as opinion among non-scientist skeptics, FWIW. For example, the map (qi and meridians) isn't the same as the territory (results). Mechanism isn't that implausible; it's not like it's action at a distance or something. --Middle 8 (talk) 16:06, 31 December 2013 (UTC) edited --Middle 8 (leave me alone • talk to me) 16:16, 3 February 2014 (UTC)

@Middle 8 The presence of interested positions in a consensus-forming process distorts it which is why, at more serious venues than Wikipedia, declarations of interest are often required and conflicted people often withdraw. You are correct that I did not bother to rebut your argument (by which one could argue that homeopathy was not pseudoscience, since it has been subject to serious investigation). I think you'll find that there's more than 1 acupuncturist participating here - of which more soon ... Alexbrn ^{talk|contribs|COI} 12:53, 31 December 2013 (UTC)

@Alexbrn - Simply having a profession isn't considered a conflict on WP, and rightly so. See my comments above to Roxy-t-d, and bother to read them at Talk:GERAC, if you wonder about my interests and views. With respect to my qualifications, editors should be thanking me for having the topic and scientific literacy to actually make this a good article, and for caring enough to follow sources and talk pages. (But no good deed goes unpunished.)

Now I know that you haven't read WP:FRINGE/PS, because the determining factors don't include the presence of serious research (although that can be informative). We had an ArbCom ruling on pseudoscience (which adopted some of my suggestions on demarcation), and incorporated their points into NPOV and then NPOVFAQ and then over FRINGE, precisely to bypass endless arguing, based on dueling criteria. My post at WT:MED was nothing more than a straight recap of policy (or maybe it's technically guideline now, but it's basically NPOV) that nobody else had bothered to read. --Middle 8 (talk) 16:06, 31 December 2013 (UTC)

Belatedly @Roxy the dog: "I would suggest that except for acupuncturists here, there is consensus that it is a pseudoscience" -- demonstrably false, and anyway, we go by NPOV's guidelines on demarcation ([[WP:FRINGE/PS, and WP:RS/AC, per which acu isn't to be unambiguously depicted as a pseudoscience, although RS's saying it is are obviously fine to cite. Also, your use of scare quotes above -- "gold-standard" sources -- suggests you don't understand that Cochrane and other meta-analyses really are. No gold-standard source calls acu a pseudoscience, btw. --Middle 8 (talk) 13:57, 27 January 2014 (UTC)

Of course, Cochrane doesn't address the question of where topics lie on the science/pseudoscience continuum. We need to turn to expert RS that does deal with this. And acupuncture has its own entry in Shermer's encyclopedia of pseudoscience, I see. Alexbrn ^{talk|contribs|COI} 14:04, 27 January 2014 (UTC)

(Add) And in the Encyclopedia of Pseudoscience. I feel a category coming on ... Alexbrn ^{talk|contribs|COI} 14:22, 27 January 2014 (UTC)

Done --Roxy the dog (resonate) 16:27, 27 January 2014 (UTC)

You need a better RS than that. I've pointed you to the germaine policies already and it's been discussed plenty in the archives and elsewhere ... you guys are now into IDHT and approaching WP:POINT, not to mention a lovely ad hominem above from Alexbrn. This has been global consensus since WP:ARB/PS. I summarize generally-accepted logic explained on my user page -- User:Middle_8#Using_Category:pseudoscience -- if you can be arsed to read it. --Middle 8 (talk) 19:06, 27 January 2014 (UTC)

You haven't given a reason to use a better RS than that. The source is RS compliant. We can expand the article with the source. QuackGuru (talk) 20:07, 27 January 2014 (UTC)

Objective standards exist for this under NPOV, and that source fails. Please continue below at Talk:Acupuncture#Category:Pseudoscience_again. --Middle 8 (talk) 02:10, 28 January 2014 (UTC)

Hang on

But, looking at the article I see the Vickers study and Ernst's reaction to it is duplicated in two sections, and we have a socking great quote from Ernst in the reference. We don't need all that, just a brief summary will do. I've attempted to de-duplicate and slim Ernst down. See what you think ... Alexbrn ^{talk|contribs|COI} 09:54, 31 December 2013 (UTC)

Thank you. :-) A good start. I'd prefer that we give more space to discussing Vickers, and include his reply, for the sake of WP:WEIGHT and because it just lays out the areas od disagreement nicely. Here's my suggestion, including a minor reorg, putting the '12 efficacy study ahead of the '13 followup, for better flow and because it's an efficacy section.

On the disagreement with Ernst: Vickers' belief that the difference between real-acu and no-acu is more clinically relevant than the difference between real-acu and sham-acu is indeed perverse (per Novella et. al.) from the standpoints by which medicine ordinarily evaluates placebos, but it is a significant view in medicine -- e.g. also held by independent German body who evaluated the results of GERAC. (And in the case of GERAC, there was no statistically significant difference between sham and real acu. At least with Vickers, there is, though it roughly splits the difference between no-acu and real-acu, and is small. Vickers has pain relief at about 30%, 42.5% and 50%, respectively, for no acu, sham acu, and real acu. I mentioned this in my edit.) --Middle 8 (talk) 15:16, 31 December 2013 (UTC)

Sorry I mucked up the section headers, but anyway, we can continue below at Talk:Acupuncture#Pain_section. --Middle 8 (talk) 22:23, 31 December 2013 (UTC)

Category:Pseudoscience again

Every so often (see archives) the issue of whether to use category:pseudoscience comes up. We have specific standards for that at WP:FRINGE/PS, and acupuncture isn't "generally considered pseudoscientific by the scientific community". To show it is, we'd need a source so indicating, i.e. meeting WP:RS/AC. That logic has been accepted for several years, for this article and others (including alternative medicine).

Continuing from here, QuackGuru said, re Williams' Encyclopedia of Pseudoscience: "You haven't given a reason to use a better RS than that. The source is RS compliant. We can expand the article with the source." My response to that is: sure we can use the article according to its weight, but since it doesn't meet WP:RS/AC we can't use it to justify categorizing as pseudoscience. Also, Williams is dated (2000) and (IIRC) the entry on acupuncture is far from unequivocal. --Middle 8 (talk) 02:07, 28 January 2014 (UTC)

If you want us to take this seriously, I think you need to find some sources that acupuncture is a proven medical intervention for something more than a little lower back pain. Perhaps some sources that show that meridians and that can actually be found in the body, some sources that relate sticking pins in somebody to, you know, curing illness. Till you do, it is pseudoscience. Roxy the dog (resonate) 02:18, 28 January 2014 (UTC)

We don't have to meet your standards, we have to meet WP:FRINGE/PS and WP:RS/AC. (We had an ArbCom case, WP:ARB/PS, in part to clarify this exact issue.) Show me how under those policies, we can use category:pseudoscience. --Middle 8 (talk) 02:39, 28 January 2014 (UTC)

There is no policy or guidance which says WP:RS/AC is needed before a category can be assigned, that is a spurious argument (by which, BTW, hardly anything could ever be categorized). Acupuncture is "obvious pseudoscience"; RS from the portion of academia which considers pseudoscience says so, and Wikipedia should follow RS. Or are there sources saying meridians and qi are part of real science? Alexbrn ^{talk|contribs|COI} 06:44, 28 January 2014 (UTC)

Addressing your points in turn:

• (1) How else are you going to determine whether something is "generally considered pseudoscience by the scientific community", besides RS/AC?
• (2) Scientists (as opposed to many skeptics) are sparing when labelling things as pseudoscience. We follow the science.
• (3) "Obvious pseudoscience" is for tiny-minority things that have virtually no RS commentary and no following. Otherwise astrology would go under "obvious", but it doesn't. That's because proposals that "have a following" go under either "generally considered pseudo" or "questionable science". (See alsoWP:ARB/PS)
• (4) Show me MEDRS -- which we follow for scientific claims -- demonstrating that acu is generally considered science by the sci community. How many of the MEDRS commenting on acu call it pseudoscience?
• (5) Acupuncture isn't only meridians and qi. Those articles can go under category:pseudosci since they fall under vitalism. Acupuncture includes other facets/hypotheses, such as evidence for efficacy. If researchers thought acu, on the whole, to be pseudoscience, they wouldn't keep studying it. Instead, the voices we hear arguing that "acu is pseudoscience and therefore shouldn't be studied" are scattered throughout the skeptical blogosphere, most of which isn't RS let alone MEDRS. (The literature also addresses the "reasonable amount of debate" criterion.)

As I said earlier, read the archives. What I'm saying has long been accepted by most editors. The upshot is that under current policy category:pseudoscience cannot be populated as much as you think it should, and that's because categories are unambiguous (cf. WP:CLT#Disadvantages of a category. So what? There are plenty of other ways to convey the idea. --Middle 8 (talk) 09:37, 28 January 2014 (UTC)

In answer:

1. We look at what RS says which has considered the question.
2. See 1 - yes, pseudoscientific determination is a specialist area.
3. Is there any serious source (let alone serious person) claiming qi and meridians are really science? They are obviously pseudoscience.
4. MEDRS is for biomedical claims. Categorization of a system of thought is not biomedical.
5. We need to follow the sources rather then reason out for ourselves what the whole/part relationship is. The point about it being studied legitimizing it is just wrong: researchers study bollocks all the time. Just look here !!

Alexbrn ^{talk|contribs|COI} 09:45, 28 January 2014 (UTC)

@Alexbrn on above points:

1. That's how you get confirmation bias. It's like googling for which politicians have "considered the question" of whether Obama should be impeached. You don't get a random sampling, or consensus of a non-self-selected group, that way.
2. Really? According to whom? What is the name of this specialty, and what qualifications are necessary to practice it? Note that a pubmed search for "acupuncture" and "pseudoscience" gives a single (and silly) hit, so this specialty must be rarefied indeed not to have its literature indexed by Medline!
3. Sure, but still, "Citation needed". That's why astrology (of all things) doesn't go under "obvious", at FRINGE/PS (and this, from which it sprang). The exception for "obvious pseudoscience" is made for extremely fringe topics that lack RS.
4. See #1. If you want to know what is "generally considered science by the scientific community", you have to meet RS/AC. (Which source would probably meet the looser criteria of MEDRS).
5. See #4 -- those sources are what we follow. WP:BURDEN. Generalizing from part to whole is your OR. We're talking about unambiguously calling something pseudoscience: that's what categorization is (per both FRINGE/PS and here, #8). Topics like acupuncture are handled by, e.g., List of topics characterized as pseudoscience, with annotation. More common sense: When groups like the NHS, NIH, American Cancer Society and WHO give even qualifed endorsements of acupuncture -- and while there are positive findings in reviews (unlike with homeopathy) -- WP should not be unambiguously calling it pseudoscience. --Middle 8 (talk) 02:52, 29 January 2014 (UTC)

Back at you:

1. That's politics, with its own crazy dynamics. We're interested here in science & scholarship. To find out what experts think, on this as on any scholarly topic, we look at RS. Most doctors are shruggies and so say nothing.
2. We'd use PubMed for biomedical information; what we need for this topic is experts in topics like human understanding of science, the sociology of science, etc. This new category has some good/relevant people in it.
3. You can stop after "Sure" :-) It's obvious it's obvious.
4. I've covered this before, and won't repeat myself. Applying this invented rule would mean de-categorizing Homeopathy and much else.
5. Again, we follow the sources - from which there is no doubt. Or, have you got counter-sources arguing that acupuncture is a real "science"? Alexbrn ^{talk|contribs|COI} 10:46, 29 January 2014 (UTC)

@Alexbrn Please excuse me for bailing on point-counterpoint; my long comment below ("Why acupuncture is a grey area, per RS") covers most of it. I don't agree with, but for the sake of argument do address, your preference for weighting individual RS. And no, of course I don't have sources defending TCM "theory" as science -- this is low-hanging fruit for critics; try swatting at the higher ones -- or saying acu as a whole is science. What I do have are very strong RS establishing that acu is in a grey area, with mixed elements of pseudo (qi etc.) and science (falsifiability, efficacy). These are enough to establish the "grey area" thing as a significant enough POV to preclude "generally considered pseudoscience". In a way, this has been a fun exchange, other than the lost productivity, and the realization that none of this would have even come up had I not poked a hornet's nest. :-/   :-) --Middle 8 (talk) 19:03, 29 January 2014 (UTC)

The more relevant guideline is Wikipedia:Categorization#Articles. --Enric Naval (talk) 11:11, 28 January 2014 (UTC)

No, the most relevant guideline (which comes out of WP:ARB/PS and NPOV) is the one I mentioned, WP:FRINGE/PS. How do I know that? Read the last sentence of WP:PSCI). But of course the one you mention also applies, especially the parts about NPOV and VER. Hence WP:FRINGE/PS and WP:RS/AC, respectively. --Middle 8 (talk) 02:52, 29 January 2014 (UTC)

Acupuncture is widely regarded as containing some kernel of truth enveloped in a lot of pseudoscientific thinking. (for example, see "A Beginner's Guide to Scientific Method"[5]. We are making a dis-service to readers by removing categories that are supported by our guidelines.

In google books and google scholar there are lots of sources with interesting takes on the matter --Enric Naval (talk) 11:53, 28 January 2014 (UTC)

@Enric Naval: I know that there are all kinds of sources calling acupuncture pseudoscience, but per WP:FRINGE/PS we need at least one that reliably shows the opinion of the scientific community at large (cf. WP:RS/AC). It's a matter of apples and oranges... --Middle 8 (talk) 02:52, 29 January 2014 (UTC)

@Alexbrn and Enric Naval: WP:FRINGE/PS is exactly the relevant policy for deciding whether a topic is appropriately classified as pseudoscience, and if the topic has a significant following -- even astrology! -- we don't say it's "obvious pseduoscience". See findings 14-18 of the ArbCom case: Wikipedia:ARB/PS#Serious_encyclopedias. If pseudoscience demarcation were as obvious as you say, it wouldn't have gone before the ArbCom. More later on above; anyway, sounds like we may need a request for clarification. --Middle 8 (talk) 22:28, 28 January 2014 (UTC)

Arbcom doesn't rule in content issues, and their decisions are not binding for policies nor guidelines. And you are still referring to the wrong guideline.....

How about these sources:

• "Science cannot be distinguished from pseudoscience simply on the basis of the results each produces (...) even if it turns out that something in acupuncture theory is right or even on the right track, the theory will remain an artifact of pseudoscientific thinking until it can be confirmed, modified, or rejected on the basis of controlled experimentation." (emphasis on the original) Stephen Carey (1 January 2011). A Beginner's Guide to Scientific Method. Cengage Learning. pp. 123–. ISBN 1-111-30555-2.
• "While used for centuries in Eastern cultures, alternative medicines are classified as pseudoscience because they have not been subjected to the same level of rigorous experimental designs as used in the medical profession. Acupuncture, as shown in figure 7.1, (...) To date, there is not significant evidence to support the claim that acupuncture helps any ailment. (...) The holistic-based outlook for curing places these alternative practitioners at odds with the science-minded ANA (American Medical Association). (...) The public continues to flock to these cures despite the lack of data in their support. Another pseudoscience with roots anchored in our science history is astrology." Peter Daempfle (2013). Good Science, Bad Science, Pseudoscience, and Just Plain Bunk: How to Tell the Difference. Rowman & Littlefield. pp. 112–114. ISBN 978-1-4422-1726-3.
• "Medical researchers often have little scientific interest in acupuncture because its theory depends on nonscientific notions such as vital energy. (...) Government research funds are limited because the scientific community remains skeptical of acupuncture theory and the validity of its method." Merck (14 December 2011). The Merck Manual Home Health Handbook. John Wiley & Sons. ISBN 978-1-118-17123-3.
• "(...) do not imply that drawing the boundary between science and non-science is an easy or straightforward task. For instance, the practice of acupuncture has a 'scientific' rationale in China, but in the west it remains a curious empirical technique at best." Willy Østreng (2010). Science Without Boundaries: Interdisciplinarity in Research, Society and Politics. University Press of America. pp. 10–. ISBN 978-0-7618-4830-1.
• "Why the Study of Pseudoscience Should Be Included in Nature of Science Studies (...) Believing in something like chiropractic or acupuncture really can help relieve pain to a small degree and for a short period of time, but many related claims of medical cures by these pseudosciences are bogus. By now it should be clear that belief and its resulting placebo effect can be a very important tool in the pseudoscience toolkit, specially where pain relief is involved. (...) Willingness and ability to critically analyze one's belief regarding pseudosciences like ID and chiropractic and astrology and parapsychology and acupuncture and magnetic healing and so on should be an important part of science literacy." Myint Swe Khine (18 September 2011). Advances in Nature of Science Research: Concepts and Methodologies. Springer. pp. 103, 105. ISBN 978-94-007-2457-0.
• "Whole 'disciplines' (as their followers would call them) have been rejected as pseudo-sciences, from astrology to scientology. Some of these disciplines were regarded as sciences in one period, only to be rejected as unscientific in another. Chinese medicine, for instance, including acupuncture, was taken seriously by European doctors in the seventeenth and eighteenth centuries. However, when western medicine was defined as scientific, alternative medicines were rejected. The European interest in acupuncture first 'subsided' and then became 'submerged'. It was only in the late 1960s and the 1970s that an interest in this technique revived in the West." Peter Burke (17 January 2012). A Social History of Knowledge II: From the Encyclopaedia to Wikipedia. Polity. pp. 152–. ISBN 978-0-7456-5043-2.

--Enric Naval (talk) 09:12, 29 January 2014 (UTC)

@Enric Naval: Well, the ArbCom did rule on this particular issue, probably to settle endless debates over NPOV, and it was by consensus incorporated into NPOV (then NPOVFAQ, and now FRINGE). And yes, WP:FRINGE/PS is exactly the right guideline, although the other one applies too. It's a special case. From WP:NPOV#Fringe_theories_and_pseudoscience (italics mine): "See Wikipedia's established pseudoscience guidelines to help with deciding whether a topic is appropriately classified as pseudoscience." --Middle 8 (talk) 09:22, 29 January 2014 (UTC)

Cool, because WP:FRINGE/PS says: "Generally considered pseudoscience: (...) may be categorized as pseudoscience.". --Enric Naval (talk) 09:50, 29 January 2014 (UTC)

Well, duh! That's what this whole thread is about - whether acu falls under "obvious...", "generally considered.." or "questionable...". Please re-read the thread. --Middle 8 (talk) 11:11, 29 January 2014 (UTC)

(e/c) @Enric Naval, and generally: Whether or not efficacy is part of demarcation is an interesting question. Here's an article on richarddawkins.net: "New Study Exposes Acupuncture As Pseudoscience" -- that says a lack of efficacy (in the study cited) is exactly what suggests acu is pseudoscience. On Dawkins' blog! So effectiveness and pseudoscience are tied together in some people's minds.

Opinions on demarcation vary, which is why on WP we write facts about opinions rather than inferring opinions -- like, e.g., "qi is obviously pseudoscientific, so acu in general must be as well". WP's standards for unambiguously calling something pseudoscience (which is what categorization is) are laid out in WP:FRINGE/PS, and they require us to find out whether or not it's generally held in the sci community that a topic is pseudoscience.

Enric, did you see my comment about apples and oranges? The sources you posted above are fine as far as they go, and we can use them, but not for this purpose: they don't tell us about general opinion. Do you really think that 5 more, or 10 more, hits from Google scholar is going to settle that question? Alexbrn suggests looking to RS's that have "considered the question", but that's likely to give skewed results, just as most Congressmen who have spoken about whether Obama should be impeaced tend to be in favor of it.

But let's step back here and remember that we're really only talking about category:pseudoscience here. That's the only thing connected with FRINGE/PS and unambiguous depiction. Everything else in article space stays the same.

Sure, qi and meridians are archaic and not to be taken seriously, but that doesn't mean we can or should say the same about acupuncture as a whole. Maybe we will someday: the NHS is a source much closer to what we need, and they call homeopathy pseudoscience in all but name -- and that's a relatively recent development. Compare that with the tone and substance of their pages on acupuncture[6][7], which describe traditional beliefs (without bothering to bash them) and then say that some scientists and acu'ists believe there may be some neuromuscular mechanism. They also describe a spectrum of scientific views on efficacy[8] -- which, cf. Dawkins' blog[9], can go to demarcation -- and mention disagreements over study design. This is all consistent with a "grey zone" of demarcation, "gateway woo", not as obviously bogus on the whole as other alt-meds. The literature is obviously in flux with respect both to efficacy and mechanism. It would be misleading to depict acu as unambiguously pseudoscientific -- at least today -- unless we had a solid, sci-consensus source, because there are plausible arguments pro and con, and we're just guessing at general opinion. But again, with proper annotation, we can/should/do cover RS's mentioned in this thread. --Middle 8 (talk) 11:11, 29 January 2014 (UTC)

Sorry, Middle8, but I think that those sources are more than enough for "generally considered pseudoscience". There are a lot of interesting caveats and you are free to write them into the article. --Enric Naval (talk) 11:48, 29 January 2014 (UTC)

Those "interesting caveats" go directly to NPOV. Remember Wikipedia:Categorization#Articles? (itals mine) "Categorization must also maintain a neutral point of view. Categorizations appear on article pages without annotations or referencing to justify or explain their addition; editors should be conscious of the need to maintain a neutral point of view when creating categories or adding them to articles. Categorizations should generally be uncontroversial; if the category's topic is likely to spark controversy, then a list article (which can be annotated and referenced) is probably more appropriate." --Middle 8 (talk) 12:15, 29 January 2014 (UTC)

It's not controversial because the general opinion of scientists is that it's pseudoscience. I have provided several sources saying so.

And you haven't provided any source saying otherwise.

Where is the controversy? A category becomes controversial when an editor makes a lot of noise in the talk page? Even if he doesn't support his position with any source? --Enric Naval (talk) 13:34, 29 January 2014 (UTC)

There is no controversy. Unfortunately, Middle 8 can't let go of his COI. --Roxy the dog (resonate) 18:29, 29 January 2014 (UTC)

Woof! (equally in-depth comment, minus the ad hominem) Stay tuned for below where I will demolish your assertion. --Middle 8 (talk) 18:33, 29 January 2014 (UTC)

Why acupuncture is a grey area, per RS

@Enric Naval (and all) -- In turn: (1) You're putting the cart before the horse with your assertion that it's noncontroversial; the general opinion of scientists is what we're trying to establish. Your sources are the opinions of the authors, which we must weigh alongside other sources.

(2) Sure I can provide good sources.

• Michael Shermer, in a book edited by Massimo Pigliucci and M. Boudry (2013), classifies acupuncture as "borderlands science", in between science and pseudoscience. (cough WP:FRINGE/PS cough) He also says demarcation depends on a variety of factors, including attempts to test it. Shermer and Pigliucci are heavy hitters and this is the best source so far.
  
• Here's another name we've seen, Beyerstein, who also puts acu in a "grey area" of disciplines that are "clearly not pseudoscientific in their entirety". He says it's "plagued by a mix of pseudoscience with reliable research". Its "its traditional explanation must be placed firmly in the category of pseudoscience", but it also "undoubtedly works in some people as an analgesic."
  
• Whoa, now here is a seriously ass-kicking source publication: The Age of Expert Testimony, from a workshop of the United States National Research Council (see also here). From pp.17-18:

“ "A scientist at the workshop emphasized several reasons for this perception. He said that at one extreme of an imaginary spectrum are the “hard” sciences, such as molecular biology, physics, and chemistry. At the other end of the spectrum are the “pseudo-sciences,” such as astrology and numerology. In the middle, he said, are many topics whose status is less clear, including acupuncture, handwriting analysis, and psychological profiling. ”

The NRC source goes on to say that refutability is an important criterion in demarcation, and discusses further caveats in demarcation.
I'm sure there are more sources along the whole spectrum, but the weight of these, plus similar ones (just google-book acu and "demarcation", "gray area" etc.), is enough to balance others above, and establish a lack of general agreement about acu's demarcation. Which places it "firmly" in a grey area, a.k.a. "questionable science".

(3) Controversy? See #2, meets NPOV! We've already established that, for some sources, testability (cf. Popper) and efficacy go to demarcation, and that acupuncture -- almost uniquely among alt-meds -- is testable, and actually has some good evidence for efficacy (some here, not complete or balanced, but indicative).
So here are some BIG group statements on efficacy, all at least partly positive: NHS, American Cancer Society, National Institute of Neurological Disorders and Stroke. Heavy hitters indeed, far outweighing any individual source given so far. And we know that scupuncture is called "gateway woo" and "grey area" and "borderlands", etc., all of which go straight to "questionable science" under FRINGE/PS.

Are we done yet? Remember, this has little practical implication other than no category:pseudoscience -- and of course, not misleading our readers. --Middle 8 (talk) 18:46, 29 January 2014 (UTC)

Good find in the Shermer/Pigliucci book! This looks like a considerable complicator of a straightforward "pseudoscience" classification (I am less convinced by the other sources, and the invocation of effectiveness testing is irrelevant IMO). I am glad we are now looking at RS. In the light of this new source I think I am now tending towards being neutral as to whether we categorize acupuncture as PS or not (though the PS basis should be clear in the article text). What do others think? Alexbrn ^{talk|contribs|COI} 19:02, 29 January 2014 (UTC)

Thanks ... Just to be clear, the reason for the efficacy stuff is that Shermer/Pigliucci (among others mentioned, e.g. Beyerstein) list it as a criterion for demarcation:

• "Since membership in these categories is provisional, it is possible for theories to be moved and evaluated with changing evidence." [10](pp.205-206)

No doubt about it, evidence for efficacy can be a deciding factor in dermarcation. --Middle 8 (talk) 19:25, 29 January 2014 (UTC) edited, Middle 8 (talk) 09:59, 30 January 2014 (UTC)

Obvious Pseudoscience still trumps any of the Acuapologists in this talk page. --Roxy the dog (resonate) 23:33, 30 January 2014 (UTC)

You are appallingly ignorant if you think Shermer and Pigliucci, or any of the sources I just cited are acuapologists. --Middle 8 (privacy • talk) 12:49, 1 February 2014 (UTC)

The article covers qui/meridians that are obvious pseudoscience, with flawed studies that are bad science, with rigorous studies that are good science. Adding the category is unfair to one part of the article, removing it is unfair to other part. --Enric Naval (talk) 12:21, 31 January 2014 (UTC)

It is a strange brew. Same idea as chiropractic being a mix, cf. Brangifer's comments on that talk page. (Now let's see if any of our shoot-from-the-hip editors label that guy a chiroapologist.) I honestly think the solution is to use the category only on the topic pages where it clearly applies and use article space to explain the rest. There is also a problem with overuse of the term, insofar as it muddies the waters -- conflating really flagrant pseudoscience with mixed/borderline stuff is a good way to make people doubt demarcation altogether. It doesn't make sense to put the whole of acupuncture in the same boat as ID and global warming pseudoscience, without explanation. You can explain in article space but not in category space. --Middle 8 (privacy • talk) 12:49, 1 February 2014 (UTC)

Acupuncture has elements that are clearly pseudoscientific, qi, meridians and even points are up for debate. It is being seriously investigated as a non-pseudoscientific treatment for, at minimum, pain and nausea. I would agree that while it is not purely pseudoscientific, the aspects that are strongly so merits the category. This should be dealt with by having a section that discusses pseudoscientific aspects of it. There are numerous sources to expand such a section. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:27, 9 February 2014 (UTC)

@WLU - I agree we can address V RS's discussing pseudoscience in the article. On your categorization: do you think that your logic squares with WP's demarcations in WP:FRINGE/PS? That is, acu has to go under either "generally considered" or "questionable"; "obvious" is for tiny fringe areas with minimal following, which is why even astrology doesn't go there. Is acupuncture, on the whole, generally considered pseudoscientific by the scientific community? There is no sci-consensus level source (such as an academy of sciences) commenting on the question; among individual commentators, there's a range of opinion, and those who see demarcation as a fuzzy rather than bright line (which is the nuanced view most academics take) seem to put acu in the fuzzy area. --Middle 8 (leave me alone • talk to me) 05:35, 13 February 2014 (UTC)

This is not clear that acupuncture is pseudoscience. You are correct. QuackGuru (talk) 05:50, 13 February 2014 (UTC)

I think we can use common sense and recognize that the categorization of acupuncture as "pseudoscience" is accurate in several important ways, particularly in how its effectiveness is explained by many, many practitioners and even researchers. Since the categories on wikipedia do not allow for this distinction, we must choose to either use the category, or not. I think that until there is a sea change in the general community to drop the ideas of qi, acupuncture points, meridians and "energy", the use of "pseudoscience" is quite accurate, and the category should stay. It is a second-best option, the best option would be to have a way of alerting readers to the nuances of the category - but we can't really do that.

Certainly any subpages on qi and acupuncture points should be unambiguously labelled as pseudoscience, in the same way creationism is pseudoscience. WLU (t) (c) Wikipedia's rules:^simple/_complex 07:23, 13 February 2014 (UTC)

Certainly agree re appropriate subpages. I don't know if we're quite there with acupoints, but qi and stuff, sure.

Alerting readers to the nuances of the categorization is the rub. See WP:CAT#Articles:

"Categorization must also maintain a neutral point of view. Categorizations appear on article pages without annotations or referencing to justify or explain their addition; editors should be conscious of the need to maintain a neutral point of view when creating categories or adding them to articles. Categorizations should generally be uncontroversial; if the category's topic is likely to spark controversy, then a list article (which can be annotated and referenced) is probably more appropriate."

(See also WP:BLPCAT.) I think it can be fairly said that depicting acupuncture, on the whole, as unambiguously pseudoscientific would be controversial. Scroll up a bit to where Shermer, among other skeptics, says acupuncture is borderline (precisely because it's a mix: demarcation depends on multiple factors), and not unambiguously pseudoscientific. That sounds like FRINGE/PS's "questionable science". Category space doesn't allow the nuances to be explained, but article space certainly does, in lots of ways. It's not that big a deal, really, but I think it's misleading, particularly compared to other pseudoscientific topics. --Middle 8 (leave me alone • talk to me) 09:37, 13 February 2014 (UTC)

It could go either way - I think the way to avoid protracted discussion is to follow RS (on the topic of pseudoscience) and the fact that Shermer wavers in his categorization is enough for me to waver too. Alexbrn ^{talk|contribs|COI} 09:51, 13 February 2014 (UTC)

• I have to agree with Middle 8 over here. The grey area begins with the question of whether acupuncture is a placebo or not. There is considerable evidence proving that it is not a placebo. If I may quote from a mainstream medical textbook for physiology students:

"......Because the Chinese were content with anecdotal evidence for the success of AA (acupuncture analgesia), this phenomenon did not come under close scientific scrutiny until the last several decades, when European and American scientists started studying it. An impressive body of rigorous scientific investigation supports the contention that AA really works (that is, by a physiologic rather than a placebo/psychological effect)..."

— Human Physiology: From Cells to Systems (2013)

If anyone disagrees, I respectfully ask that you cite a serious medical textbook or review (prefably the most convincing one) that supports your particular view. -A1candidate (talk) 09:50, 13 February 2014 (UTC)

Textbooks are good MEDRS's, but not the only ones; still, the sources for efficacy do weigh, assuming you think efficacy matters in demarcation. That's the thing about it.... some (like you, Shermer also) say efficacy is a critical factor; others say something can be pseudoscientific whether or not it's effective. There are multiple demarcation criteria, some of which are multifactorial, many of which are fuzzy. Some topics obviously fall outside the fuzzy area(s); it's hard to see how this does. Calling acu pseudoscience outright is like calling pot a hard drug. Which of course recalls the "gateway woo" designation for acu, and even that implies threshold-ness. The only way acu is for sure pseudoscience is if one accepts a single bright line for demarcation. Which isn't what most scholars seem to do... (cough RS cough). --Middle 8 (leave me alone • talk to me) 10:40, 13 February 2014 (UTC)

Yes, so it's lucky for us we can leave the complicated weighing-up to the RS pseudoscience experts, and then just: use their work. Alexbrn ^{talk|contribs|COI} 11:07, 13 February 2014 (UTC)

Pretty much my point (hence the fuzzy), though it does depend on how you demarcate this expertise, and I'm still dubious about this. If it's a real "specialty" then it should involve something... specific. Shouldn't it? An advanced degree in the sciences or medicine or philosophy or history is probably necessary. What else? Passing WP:N and having an opinion? --Middle 8 (leave me alone • talk to me) 12:46, 13 February 2014 (UTC)

e/c Are you guys all starting to agree that sticking pins in people to cure them might not be Pseudoscience? Yea, right. -Roxy the dog (resonate) 11:09, 13 February 2014 (UTC)

Personally, I would categorize it as PS (and wouldn't argue with this article being so categorized). However, as far as Wikipedia goes we need to take a strategic view and hold the line of allowing the category to flow from RS on pseudoscience. If Shermer wants it to be "borderland" rather than PS, then that's enough of a complication for me to say: "Meh" ... it is, after all, only a category: It is important OTOH that the pseudoscientific aspects of acupuncture are clear in the article text. That's where I am anyway. Alexbrn ^{talk|contribs|COI} 11:21, 13 February 2014 (UTC)

Agree, content here is about more than just showing up on the talk page with an opinion. The fact that we're an encyclopedia and use sources 'n stuff is... relevant. Have you looked at Brittanica's acu article? It doesn't have a "What Skeptics Say" section. What Scientists Say is weirdly considered enough. --Middle 8 (leave me alone • talk to me) 12:46, 13 February 2014 (UTC)

I guess Roxy adhere more to the Petr Skrabanek line (that we mention), that "ideas should be rejected out-of-hand that lacked a testable hypothesis". (Echoed by David Gorski in this video where he makes the case that CAM has blindsided evidence-based medicine). Other critics, such as Ernst, are totally invested in the evidence-based approach, thinking this is the way to go and supposing that once good trials have been designed, acupuncture will be shown to be ineffective - while we have to bide our time for now and report what the "flawed" trials say. Both "skeptic" approaches exist, and Wikipedia being encyclopedic will cover them both, but it does complicate the pseudoscience categorization ... Alexbrn ^{talk|contribs|COI} 13:26, 13 February 2014 (UTC)

Or they can be the same thing (efficacy being what you test, as opposed to whether qi exists,). There are all kinds of criteria depending on whom you ask, including the view that demarcation is impossible (cf. the NRC panelist above, who echoes the views of some philosophers). (Roxy's view? Who knows. He's indicated the he doesn't consider Cochrane reviews or Ernst's reviews of them to be gold-standard MEDRS/EBM sources[11], and that he considers Shermer, Pigliucci et. al. either "acuapologists" or irrelevant[12], so we know he's given these matters a certain degree of attention... Look, a squirrel!) --Middle 8 (leave me alone • talk to me) 16:15, 13 February 2014 (UTC)

The bigger point, though, is that the range of RS views, and the inherently mixed bag that acupuncture is, indicate a lack of general agreement. There's that, and WP:CAT#Articles seems pretty clear that the preference is to avoid categorization in these cases. I can't think of anything more to say and I agree this is getting distracting. --Middle 8 (leave me alone • talk to me) 16:42, 13 February 2014 (UTC)

The aspects of acupuncture that are pseudoscientific are not point selection or even whether or not it's placebo. The points that are unambiguously pseudoscientific are the explanations for how it "works" - the continued claims, cited in nearly every damned article, about the manipulation of a nonexistent energy that flows and stagnates in lines and points. That is utter nonsense, and that is by far the most salient and unambiguous piece of pseudoscience that is involved. The fact that there is a pretty vigorous debate over whether it does a damned thing is totally unnecessary for the purposes of this discussion. The entire section on theory is what causes acupuncture to be considered pseudoscience. The debate over efficacy is a debatable cherry on top, and one whose veracity is redundant and unnecessary to the discussion of the PS category. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:35, 13 February 2014 (UTC)

Thanks for sharing your view on what the single most important criterion for demarcation is, and your conclusion. We have RS with varying (and multiple) criteria and varying conclusions, e.g. Michael Shermer's recent book chapter on demarcation: [13]. --Middle 8 (leave me alone • talk to me) 06:38, 14 February 2014 (UTC)

After reviewing this matter again, I think User:WLU has made convincing arguments the cat can stay. QuackGuru (talk) 08:23, 15 February 2014 (UTC)

Again, I respectfully ask that you or anyone else cite a serious medical textbook or review (prefably the most convincing one) that supports your particular view of keeping the category. -A1candidate (talk) 08:48, 15 February 2014 (UTC)

We need to consult sources which directly address the pseudoscience question. Alexbrn ^{talk|contribs|COI} 08:50, 15 February 2014 (UTC)

A review or medical textbook would make absolutely no sense at all since that would be concerned about efficacy, not concerns about the purported explanations. Works on demarcation make the most sense. Qi and meridians are clearly pseudoscientific. You may think otherwise, but you are wrong. Your google search you used leads to a form of confirmation bias. You sought after demarcation issues instead of searching acupuncture pseudoscience. Book by Peter Daempfle [14] discusses it in relation to pseudoscience. Here [15] he describes it as having "pseudoscientific origins". [16]: "Although many acupuncture practioners assume the existence of such meridians no convincing scientific evidence has been found in support of their existence". [17] is an encyclopedia of pseudoscience and discusses acupuncture and "pseudoscientific trappings of yin and yang and the notion of an energy flow or life force". IRWolfie- (talk) 10:58, 15 February 2014 (UTC)

I respectfully ask you to look at the sources found here. Again, it is an imperfect situation because we can't label certain sections as pseudoscience, but on balance it makes sense to include the category until there is good evidence that these pseudoscientific explanations are abandoned by the majority of practitioners and researchers. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:11, 15 February 2014 (UTC)

@ IRWolfie - Depending on the search terms, sure we'll get different hits. We want good RS's; it doesn't matter how we find them. Why would we not include "demarcation" among our terms when that's the exact question? Such a search turned up the Shermer book chapter, in the 2013 Pigliucci book, which is an excellent source -- these guys have specific background that make them excellent RS's for demarcation. A provisional observation: scholarly sources tend to use fuzzier demarcation, and note that a "grey area" exists. This is a significant view (NPOV) ==> acu is not "generally considered pseudscience by the sci community" ==> per WP:FRINGE/PS, it falls under "questionable science", which means we shouldn't use the category. (The other guideline relevant to categorization, WP:Categorization#Articles, makes a very similar point about NPOV.) All of that follows if we agree that the conclusions of RS carry (a lot) more weight than individual editors' opinions on demarcation (to address WLU's considered opinion, which I respect, but for these purposes it's not in the same league as RS). I'm basing this analysis on RS and WP:PG; assuming that we should follow such things, is there a reason to keep the category? Thanks, --Middle 8 (leave me alone • talk to me) 06:28, 16 February 2014 (UTC)

P.S. @ IRWolfie- , just to be clear, of course we should use all sorts of search terms. I've done lots of searches including "pseudoscience" and gotten good RS's. A good search strategy is as broad as possible. --Middle 8 (leave me alone • talk to me • COI) 19:13, 21 February 2014 (UTC)

Middle 8, your analysis doesn't address my core point of why acupuncture can be categorized as pseudoscience - the use and invocation of pseudoscientific explanations for how it works. Qi, points, stagnation and meridians are pretty unambiguous pseudoscience, unless you've got some hitherto-unseen reference that revolutionizes biology through the discovery of a novel form of energy that doesn't behave like any other form of energy we've ever found in the universe. The sources pointing out the pseudoscientific nature of qi and whatnot are unambiguous and reliable, and there is no scientific debate I am aware of that defends these concepts. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:44, 17 February 2014 (UTC)

Actually, there is. If you're interested to know more, I can send you some links . -A1candidate (talk) 15:20, 19 February 2014 (UTC)

@WLU - Pretty sure I get it. You're saying that (a) the single most important (or only) criterion for demarcation of acupuncture is whether the traditional explanation for it (Qi and meridians and so on) is pseudoscientific, and that (b) said explanation is pseudoscientific, so that justifies the category. I'm not disputing (b), I'm saying that for (a) and the ensuing conclusions, we should look to RS's, not WP editors. --Middle 8 (leave me alone • talk to me • COI) 08:05, 20 February 2014 (UTC)

c) Since there are already reliable sources pointing out the pseudoscientific nature of the qi explanation, the discussion is pretty much over.

A1candidate, if you have sources that support qi existing as a real entity, please post them. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:04, 21 February 2014 (UTC)

@ WLU, needless to say, discussions are over when there is consensus. Of course there are RS's agreeing with (b) (that qi is PS), and I've seen sources agreeing with (a), the approach to demarcation you're suggesting. What we do is weigh the range of RS's, and RS's offer a variety of dermarcation criteria; some conclude acu is indeed PS and some say it's in a grey area, as Shermer does. If editors agree that Shermer and other "grey area" sources represent a significant view, and agree that that fact brings unambiguous demarcation into question, and agree that this means we shouldn't use the category, then we shouldn't use the category. So far I could Alexbrn, A1Candidate and myself agreeing with the "grey ==> no category" viewpoint, and yourself and IRWolfie- and (now) QG in "yes, let's use it" camp, FWIW. --Middle 8 (leave me alone • talk to me • COI) 19:42, 21 February 2014 (UTC)

To be strictly correct, I have no position on this: the sourcing is various enough for me not to want to bother arguing with the acupuncturists here. Alexbrn ^{talk|contribs|COI} 19:56, 21 February 2014 (UTC)

WP:NPA --Middle 8 (leave me alone • talk to me • COI) 20:00, 21 February 2014 (UTC)

Oh FFS! You're mentioned editors in your comment, so did I - and not in an "attacking" way either. Kindly don't misrepresent my position. COI matters, you know. Alexbrn ^{talk|contribs|COI} 20:12, 21 February 2014 (UTC)

Alex, you're intelligent enough. What part of "Comment on content, not on the contributor" don't you understand? --Middle 8 (leave me alone • talk to me • COI) 20:19, 21 February 2014 (UTC)

You are the one naming editors and (falsely) attributing views to 'em. Alexbrn ^{talk|contribs|COI} 20:32, 21 February 2014 (UTC)

Huh? Have you read the lede of WP:NPA? It's not about naming editors during talk page consensus discussions! It was inappropriate to slip in a snarky ad hominem when clarifying recent comment, which a reasonable person could easily interpret as I did. Time to clear the air a bit; see your user talk. --Middle 8 (leave me alone • talk to me • COI) 21:23, 21 February 2014 (UTC)

There is no "snark" about it. WP:COI is a behavioural guideline I take seriously. There are editors here who violate it and who consequently are a "fixed bit" constantly POV-pushing to the detriment of the article. Editors with a COI should follow WP:COIU. As far as I'm concerned we've too many editors with wallets fattened by acupuncture money trying to push an overly-positive view of it here on Wikipedia. Never mind the Wiki-lawyering, it's just wrong. Alexbrn ^{talk|contribs|COI} 21:36, 21 February 2014 (UTC)

"Editing in an area in which you have professional or academic expertise is not, in itself, a conflict of interest." That was part of WP:COI for quite awhile, and taken seriously. Here is where is disappeared, as part of one editor's general copy-edit. You've been quite clear that you disagree with that statement, and not only as it applies to acupuncture. I'm going to follow the community's take on this -- which is TBD, both with respect to that sentence and acupuncturists -- and not yours, unless of course the two coincide. Get it? I do and will follow WP:PG really carefully, but I'm not going to hew to your or anyone else's idiosyncratic takes on WP:PG, or harassment based on the same.[18] "Comment on content and not the contributor" is policy. You need to follow it. Address my edits on the merits. Thank you! --Middle 8 (leave me alone • talk to me • COI) 04:19, 22 February 2014 (UTC)

Alexbrn, please make a more sincere effort to assess the quality of edits by the actual people you are accusing of COI. I stand by all of my edits as true efforts to present the subject fairly. You yourself had to walk back your support of Dominus and TippyGoomba after I pointed out what the source (Ernst) actually said. Please be specific to edits and content, because the wide brush you paint with obscures the actual reality.Herbxue (talk) 18:23, 23 February 2014 (UTC)

Editors with a COI should respect WP:COIU, and I'd respect that. If they don't they're misbehaving. Alexbrn ^{talk|contribs|COI} 18:30, 23 February 2014 (UTC)

It is not just a real entity, but a physically measurable quantity (de-qi). -A1candidate (talk) 12:27, 21 February 2014 (UTC)

@ A1Candidate - Interesting... yes, even though qi is PS according to most (or at least many) sources, it's such a pervasive concept in Chinese culture that it is possible to translate it in multiple ways, and obviously not all of them are PS. It can mean "oxygen". It can mean "strength and vitality; absence of lassitude". "Xu Pi Qi" (or something like that" can mean that someone likely has diarrhea, lassitude, a tendency toward lassitude and feeling cold, and a pale tongue with little coating and tooth marks on the side, pretty much all of which are "intersubjectively verifiable" when taking a patient history. --Middle 8 (leave me alone • talk to me • COI) 19:42, 21 February 2014 (UTC)

1) If the local consensus is that the pseudoscientific nature of the standard explanation of acupuncture is not considered pseudoscientific, despite numerous reliable sources that verify this point, I will seek the larger consensus of the community through one of the noticeboards or a RFC.

2) Even if translated as "oxygen" or "strength" (the former of which is rather absurd - I wasn't aware that the Chinese were aware of even the atomic theory, let alone the existence of a specific element dissolved in blood, was it Joseph Needham that discovered this pre-Enlightenment knowledge of atomic theory?) neither oxygen nor "strength" stagnates in ways that can be manipulated with needles. The popular discussions of qi explicitly describe it as a form of pseudoscientific vitalist "energy", and if there is a discussion or sources to justify it being translated as some absurd projection of modern scientific knowledge into the ancient past, that is still not the mainstream or conventional use of the term. Qi is described by most popular sources as a form of vitalistic energy that can be manipulated with needles, an idea which is pseudoscientific nonsense. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:36, 26 February 2014 (UTC)

Acupuncture and related interventions for smoking cessation

A newish review:

• White AR, Rampes H, Liu JP, Stead LF, Campbell J (2014). "Acupuncture and related interventions for smoking cessation". Cochrane Database Syst Rev (Systematic review). 1: CD000009. doi:10.1002/14651858.CD000009.pub4. PMID 24459016.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Alexbrn ^{talk|contribs|COI} 16:15, 13 February 2014 (UTC)

Template:POV-lead

Because of concerns that I and others have expressed about the lede, especially the "current evidence is consistent with acu being no more than a placebo" and the relatively old sources used to support it, I've added this tag. It will take a little while to iron out the lede, so the tag may remain for a few weeks. --Middle 8 (leave me alone • talk to me) 21:54, 14 February 2014 (UTC)

How has the evidence base improved in the recent past such that acupuncture is not considered a placebo?

The placebo point will always be an issue given the difficulties of establishing adequate controls for acupuncture, and the number of items to be controlled for (penetration, location, depth, manipulation, needle size, electroacupuncture i.e. TENS, and my all-time favourite, practitioner enthusiasm), but for any indication for which there is evidence (let's face it, pain and nausea only, it's useless for everything else) the difference between "real" acupuncture (and also - which type of "real" acupuncture? Tibetan? Korean hand acupuncture? French ear acupuncture? Japanese filiform acupuncture? Chinese acupuncture? Thai acupuncture?) and "fake" acupuncture tends to come up nill - both are more effective than usual control, but neither is more effective than the other.

The evidence base for acupuncture being anything beyond placebo has been eroding steadily for years as the ability to control for different factors (most notably in the recent past - skin penetration and practitioner enthusiasm) has improved. Are there any new secondary sources that exist to support acupuncture suddenly being more than placebo? I'm not aware of any. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:07, 15 February 2014 (UTC)

To answer your first question, in part, see the Vickers review for pain, the most thorough meta-analyis to date, which for the first time shows real acu to be statistically superior to sham. While the clinical relevance of this difference is pretty dicey, the result is consistent with acu being more than a placebo. Same with PONV. I don't want to drift into yet another debate on the topic; this thread should be for proposing specific edits to the lede. --Middle 8 (leave me alone • talk to me) 06:03, 16 February 2014 (UTC)

Two studies of the same data set, published by the same researcher, that showed a clinically insignificant difference in pain? Given the diversity of conditions and uncertainty of double-blinding? I barely think it is worth noting in the lead, and if it is noted in the lead, the clinical insignificance of the findings and the questions about scientific controls would need to be addressed as well. And, of course, the large number of other meta-analyses that say the results are just placebo. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:19, 16 February 2014 (UTC)

That's original research coupled with a misinterpretation of the sources cited as references. -A1candidate (talk) 15:34, 16 February 2014 (UTC)

Actually, Novella and Colquhoun verifies most of these points rather nicely, and your comment doesn't make the large number of meta-analyses that declare acupuncture indistinguishable from placebo disappear. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:18, 16 February 2014 (UTC)

Anesthesia & Analgesia actually published 2 acupuncture articles in June 2013 - one is by Novella and Colquhoun, the other is by Wang and Harris. Both articles contradict each other, and we can't just cite one and deliberately ignore the other. -A1candidate (talk) 19:47, 16 February 2014 (UTC)

What the lede ought to do, if possible, is summarize the current range of scientific opinion, for which we need RS. Here is one, from the National Health Service: Evidence for its effectiveness. Other sources addressing this issue? --Middle 8 (leave me alone • talk to me) 05:24, 17 February 2014 (UTC)

As Novella and Colquhoun point out - Wang and Harris basically stick to defending two uses of acupuncture, POVN and pain. I'm uninterested in attempting to untangle the questionable and specious reasoning of Wang and Harris sufficient to add anything to the page. Feel free.

I'm not sure why we would place a lot of weight on the NHS page, particularly when that page says it is based on an eight-year-old book. I would prefer to stick with current meta-analyses.

And of course, there are numerous sources that state quite explicitly that acupuncture appears to be solely a placebo effect, not merely these. If there are newer sources, I'm not sure why you would not simply integrate them instead of tagging the lead. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:39, 17 February 2014 (UTC)

Was the thread-starter insufficient to explain? Naturally I'll remove it as soon as we reach consensus on something better. Specifically, I'd like to find sources for that one sentence, ones that are as "meta" in nature as that NHS page (which I thought was last reviewed <2 yrs and and is up for review in <6 months, but I'll check. But, please AGF, I'm briefly occupied with other WP things. --Middle 8 (leave me alone • talk to me) 01:46, 18 February 2014 (UTC)

Sounds like you need to find those sources then. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:23, 19 February 2014 (UTC)

That is a correct interpretation of the thread-starting comment, yes. :-) --Middle 8 (leave me alone • talk to me) 07:19, 19 February 2014 (UTC)

COI Discussion Notification

I filed this seeking feedback on whether I have a COI here due to being an acupuncturist: WP:COIN#Acupuncture --Middle 8 (leave me alone • talk to me) 23:14, 14 February 2014 (UTC)

Legal and political status

Both Middle8 and Mallexikon have accusing me of skewing the facts. Editors know I pay attention to what the sources says and do my best to write neutrally written text. I believe these are false allegations by both editors. See Wikipedia:Requests for comment/QuackGuru2#Skewing the facts because of anti-acupuncture bias.

Here was my first edit to the section which included an expand template. When I had time I expanded the section and eventually added in more details. Here is the current text. "The German acupuncture trials were a series of nationwide acupuncture trials set up in 2001 and published in 2006 on behalf of several German statutory health insurance companies due to a dispute as to the usefulness of acupuncture.[185] The trials were considered to be one of the largest clinical studies in the field of acupuncture.[185] As a result of the trials, acupuncture was paid for in Germany by the social insurance scheme for only low back pain and osteoarthritis of the knee.[186] This decision was made in part on the results of the trials and in part for socio-political reasons.[186] However, as a result of the trial's conclusions, some insurance corporations in Germany no longer reimburse acupuncture treatments.[187] The trials also had a negative impact on acupuncture in the international community.[187]" See Acupuncture#Legal and political status.

What is possibly wrong with the text? Middle8 and Mallexikon, please tell me what is wrong with the text or stop making false accusations. Please try to collaborate rather than point fingers at me. Believe me, I am the last editor on Wikipedia who would intentionally skew the facts. If the text can be improved please help improve it rather than make claims I am "Skewing the facts because of anti-acupuncture bias". QuackGuru (talk) 18:22, 15 February 2014 (UTC)

Suggestion: probably better to address the specific evidence given at the RfC. And do so at that page. -Middle 8 (leave me alone • talk to me)

I am interested in improving this page. It is a good idea to discuss article content here. So what text do you think is being skewing? If you are unable to reply to my inquiry then I assume the text is neutrally written and you actually don't have a problem with the text. QuackGuru (talk) 18:46, 16 February 2014 (UTC)

A double-blind placebo needle for acupuncture research

I am going to leave this hear and let those who have more familiarity with this topic decide if and where it fits in to this article:

A double-blind placebo needle for acupuncture research

--00:56, 18 February 2014 (UTC)

I know where I want to stick it ;) -Roxy the dog (resonate) 01:25, 18 February 2014 (UTC)

Fringe journal, primary source; not usable. Alexbrn ^{talk|contribs|COI} 07:48, 18 February 2014 (UTC)

http://books.google.com/books?id=bJfU8n_yKeYC&pg=PA100&lpg=PA100&dq=retractable+placebo+needle

http://books.google.com/books?id=O8djbHBva5IC&pg=PA90&dq=streitberger+needle

http://books.google.com/books?id=co8oAQAAMAAJ&q=placebo+streitberger+needle

http://books.google.com/books?id=OoXUdorz-AwC&pg=PA254&dq=streitberger+park+needle

http://books.google.com/books?id=GSX-yl4oQYUC&pg=PA128&dq=streitberger+needle+acupuncture

http://eprints.soton.ac.uk/24554/

--Guy Macon (talk) 08:58, 18 February 2014 (UTC)

Actually, sorry - what point is at issue here? Alexbrn ^{talk|contribs|COI} 09:17, 18 February 2014 (UTC)

You wrote "Fringe journal, primary source; not usable." I responded with several sources that addressed your objection.

We have an article on acupuncture that does not describe double-blind studies using retractable needles. We don't describe the retractable needles, we don't describe the double-blind methodology, and in fact our only mention of the subject is a paragraph that mentions site changes, superficial needling and "using retracting needles or non-needles (including toothpicks) to control for needle penetration and stimulation." And the sources for that information? The American Journal of Chinese Medicine, Complementary Therapies in Medicine, and Journal of the British Medical Acupuncture Society. Has there really been nothing published on this in the usual mainstream medical journals? No patents? No engineering articles about retractable needle design?

What we should have is a section on retractable needles, information on when they were developed and whether there are different types, information on tests to determine whether the patient or the acupuncturists could tell them apart, and a link saying "Main article: Blind experiment". The description of retractable-needle-placebo double-blind clinical trials should be separated from the results of such trials, which is another issue altogether, and more likely to generate disagreements. Nobody should have any objection to describing the methodology itself. --Guy Macon (talk) 19:24, 18 February 2014 (UTC)

O sure, there's load of stuff on that (surprised it's not in the article). The proposed source isn't good though. Jermery Howick has some interesting stuff on this too - as you mention ... (Add: the second paragraph of the "Effectiveness" section is where this kind of content is currently living.) Alexbrn ^{talk|contribs|COI} 20:30, 18 February 2014 (UTC)

I really don't know much about acupuncture or any alternative medicines (I am a strict "see a M.D. and do what he says to do" sort) but I am pretty sure that between the professional acupuncturists and the skeptics here we can create a really nice, well-sourced section on retractable placebo needles. And if we keep the results of any placebo trials elsewhere, there shouldn't be any conflict while creating the section. --Guy Macon (talk) 22:59, 18 February 2014 (UTC)

Retracting needles as a way of controlling for skin penetration is an aspect of the controlled-testing of acupuncture. It is already mentioned briefly, but it's only one aspect that requires control (the others include manipulation, location, practitioner characteristics, diagnosis, depth of penetration, and probably others). I don't think the initial article is really worth citing unless it's the "classic study" that first demonstrated retracting needles were an effective type of control, but secondary sources discussing its implications could certainly be used. Singh & Ernst discuss the impact of retractable needles on eroding much of the evidence based for acupuncture being a non-placebo intervention, if there are lengthier discussions (as this does seem to be a relatively important point) on the implications of this needle on the scientific research base then this is a valid inclusion. Howick seems to be the only relatively lengthy discussion on it, though Colloca could probably also be used. In fact, these sources might be used to create a Streitberger needle page.

As always, the thing to do is to follow the sources. If there are discussions in reliable sources that are relevant and can be included - include them! WLU (t) (c) Wikipedia's rules:^simple/_complex 00:21, 19 February 2014 (UTC)

Thanks! I hope that someone with some familiarity with the topic will grab the ball and run with it. It would be a big improvement to the article. I don't care which sources are chosen; I trust whoever is doing the editing to choose good sources.

Are Streitberger needles the only kind of retractable placebo needles available? I have no idea, but I bet our acupuncturist friends can name all of the available brands from memory. --Guy Macon (talk) 16:00, 19 February 2014 (UTC)

The best way to become familiar with a topic is to edit a well-developed wikipedia page. Just take the best and most detailed sources and summarize them fairly. I doubt practitioners would be the best people to know about retractable needles, since they use the skin-penetrating kind. Researchers would be the ones with the most expertise on this type of scientific control. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:06, 21 February 2014 (UTC)

Read what the books linked to actually say about sham needles. #1. Roberts et al. "There may be ingeneous ways to get around such problems, as in 'sham acupuncture..." May be is not exactly an endorsement. #2. Howick "One device touted as a placebo or 'sham' acupuncture. Touted is far from endorsement or validation. "Yet it is unclear whether the sham device is a legitimate placebo..." "The studies Kaptchuck et al. cite as evidence for validation provide only conditional support..." "40% of participants thought that the placebo acupuncture was different" "...sham device does not permit the trial to remain successfully masked..." and that practioners in single blinded studies could reveal. #3. Text not available at link. #4. Hester et al. "scientifically unacceptable to summarize the variety of approaches used in acupuncture trials as 'sham or placebo controls'..."#5. Miles et al. "One solution that has been proposed..." Proposed is not validated. Goes on to provide criticism of statistics in the White et al. study. #6. White et al. "nearly 40% were able to detect a difference in treatment type between needles. No major differences in outcome between real and placebo needling could be found. The fact that nearly 40% of subjects did not find that the two interventions were similar, however, raises some concerns with regard to the wholesale adoption of this instrument as a standard acupuncture placebo. Further work on inter-tester reliability and standardisation of technique is highly recommended before we can be confident about using this needle in further studies." Pretty much says this is unvalidated and raises serious questions about validity.

Sounds to me like these critiques pretty much rule out the supposed double blind placebo study as reliable. - - MrBill3 (talk) 14:40, 26 February 2014 (UTC)

Couple of comments on this thread. As for the link presented at the top; it is a primary source and we shouldn't use it. We should find a high quality peer reviewed secondary source that discusses sham needles that is not impeachable. User:MrBill3 the Howick book is a tertiary source (less than ideal) written by a professor at Oxford who is an advocate for CAM and has a website touting the yoga classes he offers. While the book has been pretty well-reviewed, his investment in CAM leaves his analysis open to the criticism that his dismissal of technology to conduct double-blinded studies is agenda driven - if there is no way to conduct rigorous studies to falsify a given hypothese that "acupuncture is useful to treat Y" then he and others can happily can keeping doing it in good faith that the "jury is still out". So it is not the best source for content discussing this. Jytdog (talk) 14:58, 26 February 2014 (UTC)

Dopamine mediates vagal modulation of the immune system by electroacupuncture

Dopamine mediates vagal modulation of the immune system by electroacupuncture

-A1candidate (talk) 12:35, 26 February 2014 (UTC)

Thanks for bringing this. However, it is a primary source and should be avoided for anything health related, as per WP:MEDRS Jytdog (talk) 13:04, 26 February 2014 (UTC)

@Jytdog See also: Effects of acupuncture needling with specific sensation on cerebral hemodynamics and autonomic nervous activity in humans -A1candidate (talk) 13:11, 26 February 2014 (UTC)

also a primary source, and not MEDLINE indexed.... a more inappropriate source than the Nature article above. 13:18, 26 February 2014 (UTC)

@Jytdog MEDLINE should not be our primary criteria for inclusion. See also: Characterizing acupuncture stimuli using brain imaging with FMRI--a systematic review and meta-analysis of the literature -A1candidate (talk) 13:27, 26 February 2014 (UTC)

MEDLINE is not a primary criteria but it is a very useful threshold test. Especially in a contested article like this, everybody should bring the best sources available - this is also explicitly stated in the "choosing sources" section of MEDRS: "A Wikipedia article should cite the best and most reliable sources...." We should strive to be great, and to bring sources that nobody on any side of a given issue can impeach. The last source you brought is acceptable to me (meta review published in indepedent, MEDLINE-indexed journal), again to support content on scientific investigations of underlying mechanisms, like the one below. Good find! Jytdog (talk) 13:47, 26 February 2014 (UTC)

At least this one controlled for sham acupuncture, will need to read the full article to see specifics. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:27, 26 February 2014 (UTC)

neither of the sources I said were OK were primary sources, but were reviews. unclear to me why you are discussing them like they are primary sources. strange! Jytdog (talk) 18:34, 26 February 2014 (UTC)

Meta-analysis of brain activity associated with acupuncture needle stimulation

A Meta-Analysis of Brain Activity Associated With Acupuncture Needle Stimulation

-A1candidate (talk) 12:48, 26 February 2014 (UTC)

In my view, this is a critical review published in a MEDLINE indexed, respected journal. Looks very good as a source for information about underlying mechanisms. We do have to be careful not to use it to support any phenotype discussion (in other words, any discussion of actual health effects). Thanks! Jytdog (talk) 13:07, 26 February 2014 (UTC)

@Jytdog I agree that it would be a misrepresentation of the review if we were to do so. Still, I do not see any good reason to omit its underlying mechanisms. -A1candidate (talk) 13:30, 26 February 2014 (UTC)

There should definitely be discussion of scientific investigation of mechanisms, using the best MEDRS sources we can find. Jytdog (talk) 13:40, 26 February 2014 (UTC)

The source itself, going from the abstract, suggests that "inserting needles into the body causes fMRI changes". Which is essentially identical to saying "the brain has a sensory cortex that responds to touch and pain receptors being stimulated". At best it appears to be saying "fMRI is different when you compare touch with skin penetration", which is hardly revolutionary and doesn't seem to say anything about acupuncture specifically. Is there anything in the actual article that suggests anything more? I hate studies and meta-studies like this, it's really not saying anything about acupuncture specifically unless you start teasing out things like point location (and at which point you have to start controlling for the somatosensory homunculus since needling the hand is, in neurological terms, vastly different from needling the middle of the back or buttock). And it appears by my reading of the abstract that they didn't test for point-specific characteristics.

Any discussion of the mechanism would, of course, have to include placebo effects as a possible mechanism. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:24, 26 February 2014 (UTC)

strange that you would prejudge without reading the article. Jytdog (talk) 18:41, 26 February 2014 (UTC)

Evidence map

A new souce that maps the evidence behind acupuncture has been published and may be helpful to you here. Full text is available: Evidence Map of Acupuncture Regards, Puhlaa (talk) 03:17, 1 March 2014 (UTC)

2014 - Time for an Update

A simple search of academic peer-reviewed journal articles 2010 and today shows 9,017 new research articles. There has been a tsunami of research on acupuncture since the citations in this Wikipedia entry. The Luddites have pretty much faded away in the scientific debate. Yes, Virginia, acupuncture does work for a variety of ailments and it is commonly used alongside western medicine in many countries. I beg someone to tackle the research and get the moderators to sit on the willfully ignorant compulsive naysayers. This article should not be about the beliefs of a couple of self-styled skeptics. We're not supposed to do original research here, remember? Just report on the studies by actual scientists, ok? Factsplz (talk) 09:48, 2 March 2014 (UTC)factsplz

Present your facts please, not just waffle. I look forward to an improvement of the article, using reliable sources. -Roxy the dog (resonate) 09:53, 2 March 2014 (UTC)

I agree Factspiz - the research available is not exactly flattering to acupuncture, but it certainly does show effectiveness above placebo in many cases and is generally a mixed and nuanced picture. Part of the delay is we can only use systematic reviews, so the positive primary sources are not fair game here. By the way, there are no "moderators" - its a free for all in here.Herbxue (talk) 15:42, 7 March 2014 (UTC)

This source just published in JAMA might help: Acupuncture for chronic painPuhlaa (talk) 03:28, 8 March 2014 (UTC)

That source is only commenting on a previous article. QuackGuru (talk) 17:21, 8 March 2014 (UTC)

Agreed that the new source in JAMA is commenting on Vickers Meta-analysis. However, considering that there is controversy being presented in the wikipedia article from non-peer-reviewed sources (ie: Ernst' opinion) with regard to the Vickers meta-analysis, I think this source, a peer-reviewed comment about Vicker's meta-analysis, may also be helpful here. Puhlaa (talk) 17:47, 8 March 2014 (UTC)

The source is not specifically commenting on the controversy and too much back and forth is unnecessary. QuackGuru (talk) 17:49, 8 March 2014 (UTC)

Hepatitis

• Zhang J, Shang H, Gao X, Ernst E (December 2010). "Acupuncture-related adverse events: a systematic review of the Chinese literature". Bull World Health Organ. 88 (12): 915–921C. doi:10.2471/BLT.10.076737. PMC 2995190. PMID 21124716.{{cite journal}}: CS1 maint: multiple names: authors list (link) This is a MEDRS compliant source.

"Infections (primarily hepatitis) after acupuncture are reported frequently in the English-language literature1 but relatively rarely in the Chinese-language literature, even though non-disposable acupuncture needles are still used in China. It is possible that in China acupuncture-related infections are underreported."[19] The text is sourced but it was deleted. QuackGuru (talk) 17:21, 8 March 2014 (UTC)

Removal of reviews

I do not understand the removal of reviews, which aren't being removed due to any unreliability but because of some perceived thoughts on rarity, despite the addition of reliable sources. There is a general rule that if you think a section is getting too large, then enlarge the other sections; don't drop good content citing reliable and up to date sources for no obvious reason. Second Quantization (talk) 08:13, 11 March 2014 (UTC)

Like quack guru you seem to be inventing guidelines on the fly. Show me a WP guideline that says weight issues should be resolved by fluffing up the size of articles.Herbxue (talk) 09:23, 11 March 2014 (UTC)