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Rate of serious adverse events

Restored 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. Misplaced Pages 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, 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."

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." 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,..." 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."

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

Hi, new editor here, just offering my help and advice if it would be useful around here ^^. I add weight to the consensus described by Middle 8. Arthur Longshanks (talk) 10:21, 21 March 2014 (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 Misplaced Pages should follow RS. Or are there sources saying meridians and qi are part of real science? Alexbrn 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 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 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 Misplaced Pages: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". 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: Misplaced Pages: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 Misplaced Pages. 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 Misplaced Pages'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, 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 -- which, cf. Dawkins' blog, 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 Misplaced Pages: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:

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 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." (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) Misplaced Pages's rules:/_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) Misplaced Pages's rules:/_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 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 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 Misplaced Pages 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 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 Misplaced Pages being encyclopedic will cover them both, but it does complicate the pseudoscience categorization ... Alexbrn 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, and that he considers Shermer, Pigliucci et. al. either "acuapologists" or irrelevant, 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) Misplaced Pages's rules:/_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: . --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 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 discusses it in relation to pseudoscience. Here he describes it as having "pseudoscientific origins". : "Although many acupuncture practioners assume the existence of such meridians no convincing scientific evidence has been found in support of their existence". 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) Misplaced Pages's rules:/_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) Misplaced Pages's rules:/_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) Misplaced Pages's rules:/_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 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 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 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 Misplaced Pages. Never mind the Wiki-lawyering, it's just wrong. Alexbrn 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. "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 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) Misplaced Pages's rules:/_complex 18:36, 26 February 2014 (UTC)

Hi WLU, new editor here, I just want to articulate a different point of view of mine which you might like to consider: that being than qi can't be "pseudoscientific nonsense", because its a philosophic concept which predates science. Same as on the Humorism wikipedia page, the four humors of Hippocratic medicine are not described as being "pseudoscientfic nonsense", because we accept that the ancients lived in a different environment of knowledge and thus had different terminology than what we would use. In the case of Traditional Chinese Medicine, we must consider that not only were its origins deeply rooted in ancient culture, this culture was also highly foreign to the sort of European, Anglo-centric culture which permeates us today. Therefore we need to use cultural sensitivity and lose the chip on our shoulder with regards to trying to "burn heretics" like you seem to be trying to do, and try to use a bit of empathy to understand the other point of view. Cheers! Arthur Longshanks (talk) 10:32, 21 March 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 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 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 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) Misplaced Pages's rules:/_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) Misplaced Pages's rules:/_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 Misplaced Pages 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) Misplaced Pages's rules:/_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) Misplaced Pages's rules:/_complex 18:24, 26 February 2014 (UTC)

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

An article addressing point specificity is a big deal, not because it means acu is suddenly effective or something like that.... but rather, it's important insofar it overturns assumptions that have been widely-held, at least in some quarters, e.g. among self-identified skeptics, whose statement we've cited on the matter. Wang et. al. also mention such findings in their "pro" editorial in Anesthesia & Analgesia -- something like, stimulation of verum acupoints gives rise to different, measurable brain activity than stimulation of non-acupoints. Novella and Colquhoun, in their "anti" editorial, also note these findings while noting the same caveat Jytdog does re: actual health effects. Interesting stuff.... RS's are certainly good; this should definitely go in, properly framed of course. --Middle 8 (leave me alone • talk to me • COI?) 18:17, 15 March 2014 (UTC)

Another source cited this study. Commenting on this study, "In fact, these areas have not been found to be activated by the acupuncture stimulus in healthy volunteers70." The source says a lot about the brain response. QuackGuru (talk) 18:43, 15 March 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 Misplaced Pages 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." 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)

I was the one who did the trim, in this dif. My edit note was "this section is getting too much WP:WEIGHT for something that is rare. removed paragraph on older systematic review. 1 paragraph on English review, 1 on Chinese, 1 on kids. that is plenty". Matters of weight are admittedly judgement calls. But it was jarring to me to read the first line (that complications are rare) and then see scads of text about these rare events. First line says "A 2013 systematic review of English-language found that serious adverse events associated with acupuncture are rare, but acupuncture is not without risk." Based on that, yes my "perceived thoughts" are that adverse events are rare - but I hope yours are too! :) Also, the work that has led to building up these sections to their current state seems kind of ax-grindy to me (as in articles concerning certain corporations, where certain editors contribute with a strangely single-minded, negative focus and the negative content grows and grows). Again, adverse events are rare, as per our own article. Jytdog (talk) 12:04, 11 March 2014 (UTC)

It doesn't matter whether they are rare or not, reliable sources devote weight to discussing them, so should we. Second Quantization (talk) 14:53, 11 March 2014 (UTC)

Please see my comment to QG, below, beginning with "It's not just about the weight a given RS gives..." thanks, Middle 8 (leave me alone • talk to me • COI?) 17:59, 15 March 2014 (UTC)

Misplaced Pages:Article_size#Content_removal: "Content should not be removed from articles simply to reduce length". Per WP:SPINOFF, when a section gets too long, or the article too long, the section can be spun off. Maybe next time assume good faith before going on the offensive. Second Quantization (talk) 14:53, 11 March 2014 (UTC)

Point well taken about AGF, my apologies. The guideline you cite is about articles getting too long though - the point about weight was not about the size of the article but rather undue attention to an aspect of the subject that is already covered accurately.Herbxue (talk) 22:57, 12 March 2014 (UTC)

Just a big sigh. you sound surprisingly and exactly like editors i have encountered who want to load scads of negative content into articles. You are not even acknowledging (just as those editors don't) that questions of WEIGHT are difficult and somewhat subjective and need to be worked through in discussion. Instead, you are 100% correct and I am 100% wrong and the issue is very black and white to you. Exasperating. I am not on the offensive. I made a bold change, was reverted, and am trying to have an actual discussion (not a shouting match) based on policies and guidelines. Jytdog (talk) 15:15, 11 March 2014 (UTC)

I was referring to Herbxue (and my indenting shows that) who specifically accused me of inventing guidelines. I was not addressing you. Second Quantization (talk) 15:20, 11 March 2014 (UTC)

stricken. Jytdog (talk) 15:33, 11 March 2014 (UTC)

I'm agreeing with Jytdog here. Reporting about adverse effects in this detail is a weight violation. There are a lot of aspects of acupuncture to criticize. But trying to portrait it as something dangerous when it obviously isn't (according to our own sources) is an invitation for POV accusations. --Mallexikon (talk) 07:28, 12 March 2014 (UTC)

A 2011 overview of systematic reviews (PMID 21440191), a 2013 systematic review (PMID 23435388) and a 2011 systematic review (PMID 21093944) are reviews of high-quality, and that cites other high-quality reviews. It should be cited appropriately and neutrally. For example, the high-quality review (PMID 21440191) was done by a serious mainstream researcher. The results should not be rejected; I was just giving the weight it is due. There is nothing extremist or flawed about the reviews per WP:MEDRS. Ernst's work is critical of CAM, and he gets criticized back; there is nothing surprising about this. Obviously, the reviews represent serious research that should not be ignored by any neutral summary of acupuncture safety issues. It is irrelevant whether deaths after acupuncture are rare. Safety/adverse events is a legitimate subtopic of concern with respect to acupuncture, and that removing the reviews will not bring justice to a serious encyclopedia. What is being portrayed is according to WP:V. QuackGuru (talk) 01:25, 14 March 2014 (UTC)

no question that they are good reviews. the objection raised was WP:WEIGHT. Frustrating when strawmen are set up and knocked down instead of the point made, addressed. Jytdog (talk) 01:52, 14 March 2014 (UTC)

I previously explained I was just giving the weight it is due because these high-quality reviews are devoting weight to discussing death after acupuncture. QuackGuru (talk) 02:01, 14 March 2014 (UTC)

It's not just about the weight a given RS gives, but rather the weight of the issue relative to the topic area. Just because an RS goes into deep detail on a given topic doesn't mean we necessarily should; it depends. And serious adverse events are, per RS's, very rare; see Talk:Acupuncture/Archive_12#Adverse_events.2C_redux. Therefore, we don't go on and on about them since they're so rare, even if it means omitting some sources, or paring them way down. regards, Middle 8 (leave me alone • talk to me • COI?) 17:59, 15 March 2014 (UTC)

Article Needs to Encompass International Studies

The body of scientific studies of acupuncture in Europe and Asia dwarf studies done so far in the United States. And they (as a broad generalization) paint a very different picture than studies done in the United States. European and Asian medical studies of acupuncture go back much farther in time as well. Cliffswallow-vaulting (talk) 20:33, 15 March 2014 (UTC)

Hi Cliffswallow-vaulting - please bring specific sources and suggestions; high-level comments like this don't help improve the article. thanks! Jytdog (talk) 22:14, 15 March 2014 (UTC)

Incidence

OK, in the adverse events section, QB used the word incidence several times. This is not an accurate use of the term and the Xu source specifically avoids that word. These articles do not report incidence, which requires also quantifying the number of procedures and providing a percentage. It is simply discussing what events happened and how many there are. Xu specifically says that his goal is providing the summary report is to identify what the adverse events are so that plans can be made to reduce them - -and he specifically notes that training programs in the US focused on reducing infections, and the literature shows that this program has reduced the number of them. Nothing here is about incidence rates. I left the incidence rate where it was actually stated, in the paragraph on pediatric use. Please do not edit war over this. Thanks. Jytdog (talk) 20:00, 16 March 2014 (UTC)

Xu S does say "Most reported incidents have been fairly minor, and incidence rates were low." QuackGuru (talk) 20:08, 16 March 2014 (UTC)

yep - that has nothing to do with the way you were using the word and he does not offer rates. He specifically is talking about what kinds of events and how many, again, to help eliminate them. Jytdog (talk) 20:35, 16 March 2014 (UTC)

Do you agree the text is sourced but only disagree with the wikilink? QuackGuru (talk) 20:39, 16 March 2014 (UTC)

the content you added was "The majority of the reported incidences were generally minor" which is non-scientific gobbledegook. We don't talk about the "majority" of a percentage. You are treating "incidence" as though it means a raw count, and it doesn't mean that. I don't know why you are so fixed on using the term, when it is not applicable to the content. Can you please say why it is important to you? (real question).Jytdog (talk) 20:52, 16 March 2014 (UTC)

I slightly rewrote the text. QuackGuru (talk) 20:54, 16 March 2014 (UTC)

That's ok, thanks. by the way, part of why i am struggling with your going into such detail on this, is that you seem to be trying to emphasize all the bad things that can happen, without regard for incidence rates. This is blowing up negative stuff all out of proportion. I work on other articles (related to companies and chemicals), and anti-corporate "toxic avenger" activists engage in this exact kind of behavior - expanding content on negative things all out of proportion to their appropriate WP:WEIGHT in MEDRS sources, because they come to the article with an ax to grind -- all they see is the negative and it is very important to them to expand that content in order to spread their message. Since you have worked more on the adverse events than anybody, would you please consider putting in some information on actual incidence rates so that we provide information to readers that corresponds to the real world? thanks. I am not saying we should bury anything - it is just that adverse events make little sense without an expression of incidence rates. Jytdog (talk) 21:01, 16 March 2014 (UTC)

Changes to lede

This change to the lede does not summarise the body and contradicts the body. QuackGuru (talk) 00:10, 18 March 2014 (UTC)

hmm i don't see it as such a dramatic change. i agree it adds content to the lead that is not in the body (which is easily fixed) but what in the body do you see it as actually contradicting? Jytdog (talk) 00:31, 18 March 2014 (UTC)

"Despite the scientific evidence against such mystical explanations, academic discussions of acupuncture still make reference to pseudoscientific concepts like qi and meridians, in practice making many scholarly efforts to integrate evidence for efficacy and discussions of the mechanism of impossible." It contradicts this in the body.

The source added to the lede is a primary source from a school. QuackGuru (talk) 00:37, 18 March 2014 (UTC)

Skepticism

I recently updated the article. I think it is time to delete the Acupuncture#Skepticism section QuackGuru (talk) 19:39, 22 March 2014 (UTC)

Citation error

Traditional Chinese medicine distinguishes not only one but several different kinds of qi.

The citation should point to page 11 but it points to page 110. QuackGuru (talk) 18:47, 23 March 2014 (UTC)

Series of problematic edits by one editor

This edit seems problematic, (diff).

The source is titled, "Acupuncture is a theatrical placebo."

It says, "Since it has proved impossible to find consistent evidence after more than 3000 trials, it is time to give up." and "A small excess of positive results after thousands of trials is most consistent with an inactive intervention. The small excess is predicted by poor study design and publication bias. Furthermore, Simmons et al. demonstrated that exploitation of “undisclosed flexibility in data collection and analysis” can produce statistically positive results even from a completely nonexistent effect."

This seems to clearly support the paraphrase in the previous content,

"The same editorial suggests that given the failure to find consistent results despite more than 3,000 studies of acupuncture, the treatment seems to be nothing more than a 'theatrical placebo' and the existing equivocal positive results are statistical noise one expects to see after a large number of studies are performed on an inert therapy."

This makes the edit summary "keeping material in line with source" not accurate and supports revision to previous content.

Specifically, "it has proved impossible to find consistent evidence after more than 3000 trials" is fairly paraphrased by "given the failure to find consistent results despite more than 3,000 studies" and "given the failure to find consistent results despite more than 3,000 studies" and "can produce statistically positive results even from a completely nonexistent effect" and the editorial's title are fairly paraphrased by "nothing more than a 'theatrical placebo' and the existing equivocal positive results are statistical noise one expects to see after a large number of studies are performed on an inert therapy"

How was the previously existing content not in line with source? Isn't the link in the previously existing a good pointer to learn about the issue the source raised?

It seems there are a series of edits that reflect an unsupported POV. An example is the elimination of quotation marks around the word true in "'true' acupuntcture points" (diff no edit summary, diff with no edit summary). Is there a reliable source which validates acupuncture points as true? In fact a meta analysis and a review found the placement of needles, in other words the acupuncture points, had no effect. Doesn't this render, "true acupuncture points" an invalid statement? Aren't quotation marks appropriate?

Insertion of the same material twice, (diff with questionable edit summary).

The removal of a wikilinked clear explanation of false positives (wl'd to Type I and type II errors) and confounding (wl'd to confounding) and a change from "suggests" to "seems to" (diff). This last example is particularly troubling as the wl's provided the reader with an opportunity to click to explanations of issues related to acupuncture research.

Somewhat questionable edit summary, "clearer wording; highlighting the issue of placement of needles" (Diff).

I suggest future changes by this editor be proposed on this talk page before making edits, this would allow for consensus to be built and prevent the need for dispute resolution to go to the "drama boards". - - MrBill3 (talk) 08:33, 24 March 2014 (UTC)

Mr. Bill, this diff is my edit, and I'm a little confused as to why you're reacting so strongly here...? I mean, you really think it is appropriate to suggest that I should have to ask for permission at the talk page before any edit I make, because of this?

1.) The main reason for my paraphrasing was that the original text ("A 2013 editorial found that the inconsistency of results of acupuncture studies (i.e. acupuncture working for leg pain, but not arm pain) suggests that false positives, and...") was grammatically incorrect. On top that, it implied that acupuncture worked better for leg than arm pain, which is factually incorrect.

2.) "... given the failure to find consistent results despite more than 3,000 studies of acupuncture, the treatment seems to be nothing more than a 'theatrical placebo' and the existing equivocal positive results are statistical noise one expects to see after a large number of studies are performed on an inert therapy" wrongly implies that the reason why acupuncture is deemed a theatrical placebo is the fact that 3000 studies only found inconsistent results. That's not what the text said. The text very clearly bases its assumption on the fact that again and again, true and sham acupuncture don't seem to show any difference in performance ("The best controlled studies show a clear pattern, with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work. Everything else is the expected noise of clinical trials, and this noise seems particularly high with acupuncture research.") Apart from that, statistical noise is a term not used in the source.

3.) The reason why I deleted the quotation marks of "true" acupuncture points is that we use the terms "true acupuncture" and "sham acupuncture" throughout the text, but usually without quotation marks. I just wanted to unify the usage here (only use quotation marks the first time you introduce a new term in a text). How this should "reflect an unsupported POV" on my side is beyond me.

4.) Sorry about the removal of the wikilink to type I and II errors. I just thought this is too much information for explaining a simple "false positive" result. But I'll be happy to re-introduce the wikilink if you insist. --Mallexikon (talk) 10:01, 24 March 2014 (UTC)

After I tried to rewrite the text to avoid the copyright problem you restored the copyright violation. The 2013 meta-analysis was a follow up to the 2012 meta-analysis. As per previous discussion the 2013 meta-analysis should be right after the 2012 meta-analysis. It should not have been moved to another section over and over again. The paragraph beginning with "Using the same dataset as the 2012 meta-analysis,..." should be moved back to where it was before. QuackGuru (talk) 23:08, 24 March 2014 (UTC)

The review in question is addressing exactly the same subject as the one I paired it with. Is there a rational reason why you want it to be restored to its previous location? Or is this just opposition against my edits on principle, since you and MrBill3 seem to be convinced that I'm a POV acu-proponent? --Mallexikon (talk) 01:45, 25 March 2014 (UTC)

There was a previous discussion about the placement of the 2013 meta-analysis follow up to the 2012 meta-analysis. See Talk:Acupuncture/Archive 12#Pain section. QuackGuru (talk) 02:08, 25 March 2014 (UTC)

I don't care one bit about your pointing to previous discussions. If you have a rational argument, let's hear it. Otherwise, let's move on. --Mallexikon (talk) 02:49, 25 March 2014 (UTC)

I already made my rationale argument that is was a followup to the effectiveness 2012 study. The previous discussion resulted in the placement of the text after the 2012 meta-analysis. I did mention something about COPYVIO. QuackGuru (talk) 03:04, 25 March 2014 (UTC)

1.) This was not a follow-up to an effectiveness study. The study we're talking about has a totally different thrust: they take it as a fact that acupuncture relieves pain, and only want to see whether different types of acupuncture differ in this (alleged) efficacy. They just used the same data as the 2012 study.

2.) The previous text was as much of a copyvio as the new text, so I'm not sure why you're suddenly so concerned about it. But I'll try to paraphrase better. --Mallexikon (talk) 03:41, 25 March 2014 (UTC)

Recent evidence shows that acupuncture is effective for chronic pain. However we do not know whether there are characteristics of acupuncture or acupuncturists are associated with better or worse outcomes. It was a follow up to determine whether there are characteristics of acupuncturists that are associated with better or worse outcomes.

I did rewrite the text to avoid the copyright problem. The new text was not a copyvio. The text you repeatably restored was a copyright violation. This edit did not fix the copyright violations and the text has too much detail compared to the previous version. QuackGuru (talk) 04:03, 25 March 2014 (UTC)

1.) Yeah. As I said. Different vantage point. Different thrust. Different topic. Move on.

2.) What you deem to be "too much detail" (and chose to not mention in your insufficient summary of the text) is one of the few things that are actually important: that it doesn't make a difference whether you needle acu-points or random points. It's not just me who thinks that this is important: please cf. the 2013 editorial by Colquhoun & Novella. And why you think that my text is more of a copyvio than yours is beyond me. --Mallexikon (talk) 04:42, 25 March 2014 (UTC)

It was too much detail compared to the previous concise version. More the one editor wanted the 2013 meta-analysis follow up to be placed after the 2012 meta-analysis to benefit the reader according to the previous discusion. This edit removed the tags but did not fix the problems. The next sentence is a copyright violation. QuackGuru (talk) 05:00, 25 March 2014 (UTC)

The 2009 review is about migraines and is mostly duplication. The text should be deleted from that section and merged into Acupuncture#Headaches and migraines. QuackGuru (talk) 05:42, 25 March 2014 (UTC)

This copyvio was removed: "The same analysis also found that increased number of needles and more sessions appear to be associated with better outcomes when comparing acupuncture to non-acupuncture controls." Please don't restore the copyvio again. QuackGuru (talk) 08:26, 25 March 2014 (UTC)

I've tried to rewrite the contentious sentence in the Pain section to minimise the close paraphrasing. If you don't think it's an improvement, please feel free to alter it or revert (but the |quote= parameter needs to go - it's not there to make a POINT about copyvio). Cheers --RexxS (talk) 20:02, 25 March 2014 (UTC)

User:RexxS, the quote parameter you deleted has been restored and the text has been incorrectly moved to another section. I think the quote parameter should be deleted and the text should be moved to the appropriate section. QuackGuru (talk) 23:20, 27 March 2014 (UTC)

Sorry to over react. I have edited my comments. I will try to respond to replies in greater detail soon. - - MrBill3 (talk) 02:27, 25 March 2014 (UTC)

Paterson and Dieppe, 2005

Our current text summarized the Paterson & Dieppe source like this: "An analysis suggested that sham controlled trials may underestimate the total treatment effect of acupuncture (i.e. talking and listening), as the sham treatment is based on the hypothesis that only needling is the characteristic treatment element." This summary wrongly implies that the total treatment effect of acupuncture is talking and listening.
I tried to correct this error by writing this text: "It has also been suggested, however, that sham controlled trials may underestimate the efficiency of acupuncture, since they only measure the effect of the needling itself and don't account for the effects of "incidental" therapeutic factors (like talking and listening) which are inseparable from acupuncture treatment."
I've been reverted by this several times by QG who calls my text "poor" and "trash writing" .
1.) @User:Harizotoh9: May I ask why you helped QG in his revertions?
2.) Could someone else please take a look at this? The text as it is can IMO not stay that way. --Mallexikon (talk) 08:39, 27 March 2014 (UTC)

I agree. I can't see why your text was reverted. Your version makes more sense. TimidGuy (talk) 11:35, 27 March 2014 (UTC)

This summary does not imply that the total treatment effect of acupuncture is talking and listening. It is giving examples. QuackGuru (talk) 18:20, 27 March 2014 (UTC)

Yes of course one would no include "talk and listening" in a study of acupuncture as if that is the effective part than all one needs to do is talk and listen. So if needling is not the treatment element what is? Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:11, 29 March 2014 (UTC)

Animal pain relief and a single patient recommendation is a weight violation

MEDRS violation?

The details added about the 2010 summary discussing animals and a recommendation for a single patient is a gross weight violation. It is more of an article than a review? QuackGuru (talk) 01:56, 28 March 2014 (UTC)

Agree that this bit " However, it notes that acupuncture has been shown to have an analgesic effect in animals, and brain imaging studies in humans have shown that traditional acupuncture and sham acupuncture differ in their effect on limbic structures, while at the same time showed equivalent analgesic effects" is not the key part of the paper. Thus reverted these edits again Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:10, 28 March 2014 (UTC)

Misplaced text and deletion of images

SYN and MEDRS violations?

The recently added text belongs in the Acupuncture#Scientific view on TCM theory section. The text failed V and there is a misplaced source that is about electroacupuncture. The fv tag was removed but the text was not rewritten. A source about a patent update was added to this article. QuackGuru (talk) 03:51, 28 March 2014 (UTC)

There is NOT consensus that a separate section is warranted. This is a weight violation for a separate section for two sentences. The ref added is not specifically about acupuncture. These four edits makes no sense. QuackGuru (talk) 06:42, 29 March 2014 (UTC)

The entire section is based on primary sources, possibly with the exception of Gorgi and Nieri 2008 which is not about acupuncture - pure synthesis. --RexxS (talk) 16:32, 29 March 2014 (UTC)

When there is better sources available that are not SYN or that are specifically about acupuncture we can use them. Checking the edit history I see two images missing from the article. QuackGuru (talk) 17:43, 29 March 2014 (UTC)

The controversial text was restored again. I think we should wait for better sourcing. I agree with User:RexxS on this. QuackGuru (talk) 04:04, 31 March 2014 (UTC)

Now there is an edit war to restore it , but the text is still based on primary sources? And I haven't seen any comment about Gorgi and Nieri 2008. --Enric Naval (talk) 21:56, 4 April 2014 (UTC)

April 2014

The following citation is from Talk:Jayaguru-Shishya. It is dealing with the development of the article, so it belongs here:

Don't edit war. You have now reverted twice at Acupuncture today and you are obviously perfectly aware of 3RR from your edit summary. Three reverts per day is not an entitlement and as you are obviously not a new editor, you should know that you need to discuss on the talk page, not attempt to impose your version through edit-warring. Assuming good faith leads me to conclude you are a returning editor, so what is the name of your previous account? --RexxS (talk) 21:34, 4 April 2014 (UTC)

That text was discussed at Talk:Acupuncture#SYN_and_MEDRS_violations.3F. If you want to restore it, you should address the issues there. --Enric Naval (talk) 22:08, 4 April 2014 (UTC)

1. https://en.wikipedia.org/search/?title=Acupuncture&diff=602076157&oldid=602038847 - QuackGuru's reverts the version by A1candidate (talk) (1st revert)

1. https://en.wikipedia.org/search/?title=Acupuncture&diff=602763537&oldid=602076157 - I restore the version by A1candidate (talk)

1. https://en.wikipedia.org/search/?title=Acupuncture&diff=prev&oldid=602766281 - QuackGuru makes another revert (2nd revert)

" https://en.wikipedia.org/search/?title=Acupuncture&diff=next&oldid=602766281 - I restored the version by A1candidate ([[User talk:A1candidate|ta

Now RexxS (talk), where is the edit warring? Sorry, I'm a bit confused Jayaguru-Shishya (talk) 22:16, 4 April 2014 (UTC)

1. I did not post this here. This is about Jayaguru-Shishya's behaviour and belongs on his talk page. It has no place here.
2. I object strongly to my contributions being refactored out of context and request that this section be removed. --RexxS (talk) 23:27, 4 April 2014 (UTC)

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