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Theories?
We have a new section that implies that there are many "theories" that attempt to explain the mechanism of the alleged effects of acupuncture. My first concern is that, as presented, none of these could be called "theories" as they do not seem to present a cohesive, explanatory, widely supported synthesis of anything. Perhaps more important, they seem to have been presented many years ago and there is no mention about their current acceptance. I would either just remove this whole section, shorten it to a paragraph, or, at least, refer to these as "ideas" or "suggestions about mechanism of action". Do the sources refer to these as "theories"? Desoto10 (talk) 17:37, 2 August 2013 (UTC)
- How about "hypothesis"? instead of "idea"? -A1candidate (talk) 17:50, 2 August 2013 (UTC)
- Thanks for discussing - in my edit summary I said these are hypotheses that are supported by some evidence and not disproven by evidence. I thought that qualified as a theory per the WP article on theory. I am willing to admit being wrong, but what is the exact criteria? Dominus mentioned "lots" of evidence, or that a theory must be "widely" accepted. How do we determine that? It seems subjective. Nonetheless, these are important lines of inquiry into the physiologic effects of needle insertion so they belong in the article, regardless of whether we label them theories or hypotheses. Herbxue (talk) 17:51, 2 August 2013 (UTC)
- A good test is whether something is widely discussed as a serious and supportive fashion in the secondary WP:MEDRS literature, that is, in several high-quality mainstream medical/scientific sources, and is backed up by a substantial amount of primary studies by different independent researchers who come to the same conclusions. By any measure, none of these come even remotely close to being a theory except for the placebo theory, and none are even quite at the hypothesis stage yet, so quibbling over the subjectivity of the words "a lot" is pointless. "Speculation" is probably the best word overall. For the best of them, "proposed explanations" may apply. For the rest, "clutching at straws" or "wild stabs in the dark" are even more accurate. Agree that the section should simply be removed. There's nothing really of encyclopedic interest here as far as we are concerned. If there were, it would have been substantially discussed in multiple independent reliable sources. Dominus Vobisdu (talk) 18:12, 2 August 2013 (UTC)
- A good test is whether something is widely discussed as a serious and supportive fashion in the secondary WP:MEDRS literature, that is, in several high-quality mainstream medical/scientific sources, and is backed up by a substantial amount of primary studies by different independent researchers who come to the same conclusions. By any measure, none of these come even remotely close to being a theory except for the placebo theory, and none are even quite at the hypothesis stage yet, so quibbling over the subjectivity of the words "a lot" is pointless. "Speculation" is probably the best word overall. For the best of them, "proposed explanations" may apply. For the rest, "clutching at straws" or "wild stabs in the dark" are even more accurate. Agree that the section should simply be removed. There's nothing really of encyclopedic interest here as far as we are concerned. If there were, it would have been substantially discussed in multiple independent reliable sources. Dominus Vobisdu (talk) 18:12, 2 August 2013 (UTC)
These probably all fail WP:MEDRS, but here you go:
- Medical textbook by Springer Publishing: "...Additional observations have implicated tissue release of nucleotides and adenosine in acupuncture analgesia, and shown analgesia results from peripheral actions at adenosine A1Rs... " (Source)
- Review article by Evidence-based Complementary and Alternative Medicine: "... These data strongly suggest that acupuncture-released ATP and its metabolite adenosine in local acupoint tissues block pain impulses from sites distal to needling point...." (Source)
- Review article by the Pflügers Archiv: European Journal of Physiology: ...In a separate study, the mechanistic action of acupuncture was observed by focusing on adenosine. It was found that insertion and manual rotation of acupuncture needles triggered a general increase in the extracellular concentration of purines, including the transmitter adenosine and ATP metabolites..." (Source)
- Review article by Neuropsychopharmacology (journal): "...In another recent study, Goldman et al. (2010) found that localized A1R activation underlies the antinociceptive effects of acupuncture. Manual stimulation of acupuncture needles resulted in localized extracellular increases in nucleotides (ATP, ADP, and AMP) and adenosine...'" (Source)
- The Lancet:"...After electroacupuncture in the patients with pain CSF β-endorphin levels rose significantly in all subjects, but met-enkephalin levels were unchanged. These results suggest that the analgesia observed after electroacupuncture in patients with recurrent pain may be mediated by the release into the CSF of the endogenous opiate, β-endorphin..."(Source)
- Peptides (journal):"..These data suggested that AVP (Arginine vasopressin) in the brain played a role in the process of acupuncture analgesia in combination with the endogenous opiate peptide system.." (Source)
- Radiology (journal):"...Results from human and animal studies (2,9–13) suggest that acupuncture acts as a neuromodulating input into the central nervous system (CNS) that can activate multiple analgesia systems and stimulate pain modulation systems to release neurotransmitters such as endogenous opioids..." (Source)
- The American Journal of Gastroenterology:"...The more remarkable modulation on the homeostatic afferent network, including the insula, ACC, and hypothalamus, might be the specific mechanism of acupuncture." (Source)
Obviously all these researchers are just trying to promote a form of pseudoscience that is based on nothing more than quackery -A1candidate (talk) 18:25, 2 August 2013 (UTC)
- None even come close to being more than merely suggestive or speculative. Dominus Vobisdu (talk) 18:44, 2 August 2013 (UTC)
- Theories do a lot more than "implicate" and "suggest", and the other two fail the correlation is not causation test. Aside form the placebo explanation, which is well supported, there are no other robust explanations. Dominus Vobisdu (talk) 18:34, 2 August 2013 (UTC)
- Posted at WP:FTN. Dominus Vobisdu (talk) 18:41, 2 August 2013 (UTC)
Actually, the same can be said about the sources used to support the health risks of acupuncture at Acupuncture#Adverse_events. I dont have time to go through all of them but I'll just quote from the last references: "Acupuncture remains associated with serious adverse effects". Fails the "correlation is not causation test". Should it therefore be removed? -A1candidate (talk) 18:54, 2 August 2013 (UTC)
- I think that the best solution would be to find a recent review article that actually summarizes the most significant current ideas about potential mechanisms and provide a summary of their summary in a paragraph. It would be best if these mechanisms had strong evidence from human studies, as opposed to animals or tissue-culture. Just for my own information, when they stick a needle in a mouse do they use a special "mouse acupuncture" needle, which would be much thinner than what is used for humans or do they just use a human needle? 66.201.49.79 (talk) 20:29, 2 August 2013 (UTC)Desoto10 (talk) 20:31, 2 August 2013 (UTC)
- That's an interesting question. Acu needles come in a wide range of sizes. I assume they used thin needles on the mouse. A trial comparing results in humans using thin vs. thick needles would be interesting (I'm sure its been done in China).
- Back to the question at hand, I am not interested in fighting about "theory". I do think hypothesis is supported by the definition of the work hypothesis. Regardless, we have already discussed the inclusion of the proposed mechanism section and consensus was that it was appropriate for the article as it describes the current status of the research. We should be careful not to extrapolate it into claims of medical efficacy, but we should also be careful not to eliminate useful information that is backed by RS and adds value to the article. Herbxue (talk) 21:08, 2 August 2013 (UTC)
- It's been pointed out that the references given contain speculation rather than a explanatory framework. Adding this kind of speculation would violate WP:WEIGHT. Do you have better sources or an alternative edit? TippyGoomba (talk) 07:03, 3 August 2013 (UTC)
- The same can be said about the sources used to support the health risks of acupuncture at Acupuncture#Adverse_events. I'll just quote from the last references: "Acupuncture remains associated with serious adverse effects". An association of acupuncture with serious adverse effects fails the "correlation is not causation test". Should it therefore be removed? -A1candidate (talk) 08:30, 3 August 2013 (UTC)
- Hell, yes, it should be removed! And I was under the impression that you HAD removed it already. I've read the paper and that is not at all an accurate paraphrase of the original text, which states basically that sereious side effects are rare and rarely due to the treatment itself, but rather to the fact that practioners are often incompetent.
- On the flip side, though, I'm removing the entire proposed mechanisms section, based on the same paper, which states that no plausible mechanisms have been proposed. As this is not only a top-notch secondary source, but, even better, a review of reviews, and is very recent, it carries a lot of weight. Far more than the inconclusive suggestive studies you mentioned above and currently used in the article. Dominus Vobisdu (talk) 09:22, 3 August 2013 (UTC)
Please don't do that. It is not appropriate to use one source to negate other's ongoing work. One paper's conclusion that there is no mechanism does not justify eliminating good sources that show the ongoing work to try to identify a mechanism. And by the way, the section is called "proposed" mechanisms, which they are. THis is important, ongoing research that adds to the article.Herbxue (talk) 19:25, 3 August 2013 (UTC)
- What you are proposing would grossly violate a big bunch of our policies. WP is not the place to present "continuing research", especially if that research is at the speculative and suggestive stage. We are not a new service. Being a tertiary source, we are the third man on the match. The information we get is based on what secondary sources say, which are based on what the primary sources say. Which, in turn, are based on what the preliminary sources say, which are based on what the suggestive sources say, which are based on what the speculative sources say. The material you wish to include comes from too low down the food chain to be of any encyclopedic value. If ifs and buts were candy and nuts, it would be Christmas every day. Dominus Vobisdu (talk) 19:58, 3 August 2013 (UTC)
- At what point does multiple violations of MEDRS to include tentative wordings from primary sources also constitute a violation of the whole idea behind WP:CRYSTAL? Seriously, we can't include guesswork about what the future holds, simply because so much (most?!) inconclusive research ends with wordings like "further research is needed". We really need to pare this down to what is actually known NOW, and use MEDRS compliant sources. -- Brangifer (talk) 19:51, 3 August 2013 (UTC)
- If you take a closer look at the sources above, half of them are review articles and the first one is a medical textbook (not an acupuncture textbook). I don't see how MEDRS is being violated in anyway. -A1candidate (talk) 20:02, 3 August 2013 (UTC)
- You already answered that question yourself. Speculation about possible connections is not acceptable regardless of the source. Even of the source meets our sourcing policy to a tee, as the above mentioned review of reviews does. That's why I deleted the sentence about acupuncture being asociated with deaths at your request. The problem is not the sources, but the type of material involved. Speculation is expressedly forbidden by WP:CRYSTALBALL. Dominus Vobisdu (talk) 20:08, 3 August 2013 (UTC)
- If I may quote from the sources above: "In another recent study, Goldman et al. (2010) found that localized A1R activation UNDERLIES the antinociceptive effects of acupuncture. Manual stimulation of acupuncture needles RESULTED in localized extracellular increases in nucleotides (ATP, ADP, and AMP) and adenosine." This is not speculation but a direct cause and effect -A1candidate (talk) 20:26, 3 August 2013 (UTC)
- Cherrypicking will get you nowhere. The sentence you picked is merely a summary of a primary study. Nothing more. Dominus Vobisdu (talk) 20:37, 3 August 2013 (UTC)
- I support inclusion of a 'mechanism of action' section that can review the current theories. If we look at another controversial treatment, such as antidepressants, we see the mechanisms of action section start with an admission: "For depression, the mechanism of action of antidepressants is unknown.", before the section reviews current 'theories'. Note that primary sources and animal studies make up the basis of the discussion! Despite the low-quality sources, IMO it is still helpful for the reader to have access to current theories that are under investigation. Similarly, I think that including a discussion of the theoretical mechanisms of action behind acupuncture is appropriate and helpful - as long as it is qualified as theory (rather than fact) and not associated with any medical claims of efficacy. The section should also begin with a qualification, as does the antidepressant article.Puhlaa (talk) 21:05, 3 August 2013 (UTC)
- If you want to be taken seriously, it would help if you took the time to learn what the word "theory" means before you carlessly bandy it about. After all, that's what this whole thread is about. It doesn't mean what you think it does. As for anti-depressants, WP:OTHERSTUFFEXISTS and is a not a very compelling argument, as is WP:ITSUSEFUL. Dominus Vobisdu (talk) 21:13, 3 August 2013 (UTC)
- I support inclusion of a 'mechanism of action' section that can review the current theories. If we look at another controversial treatment, such as antidepressants, we see the mechanisms of action section start with an admission: "For depression, the mechanism of action of antidepressants is unknown.", before the section reviews current 'theories'. Note that primary sources and animal studies make up the basis of the discussion! Despite the low-quality sources, IMO it is still helpful for the reader to have access to current theories that are under investigation. Similarly, I think that including a discussion of the theoretical mechanisms of action behind acupuncture is appropriate and helpful - as long as it is qualified as theory (rather than fact) and not associated with any medical claims of efficacy. The section should also begin with a qualification, as does the antidepressant article.Puhlaa (talk) 21:05, 3 August 2013 (UTC)
- Cherrypicking will get you nowhere. The sentence you picked is merely a summary of a primary study. Nothing more. Dominus Vobisdu (talk) 20:37, 3 August 2013 (UTC)
- If I may quote from the sources above: "In another recent study, Goldman et al. (2010) found that localized A1R activation UNDERLIES the antinociceptive effects of acupuncture. Manual stimulation of acupuncture needles RESULTED in localized extracellular increases in nucleotides (ATP, ADP, and AMP) and adenosine." This is not speculation but a direct cause and effect -A1candidate (talk) 20:26, 3 August 2013 (UTC)
- You already answered that question yourself. Speculation about possible connections is not acceptable regardless of the source. Even of the source meets our sourcing policy to a tee, as the above mentioned review of reviews does. That's why I deleted the sentence about acupuncture being asociated with deaths at your request. The problem is not the sources, but the type of material involved. Speculation is expressedly forbidden by WP:CRYSTALBALL. Dominus Vobisdu (talk) 20:08, 3 August 2013 (UTC)
- If you take a closer look at the sources above, half of them are review articles and the first one is a medical textbook (not an acupuncture textbook). I don't see how MEDRS is being violated in anyway. -A1candidate (talk) 20:02, 3 August 2013 (UTC)
Acupuncture is based on the placebo effect. Period. End of discussion. (While there are studies that show otherwise, there's no point trying to reach a consensus on Misplaced Pages until consensus is first reached within the scientific community. All other discussion is futile) -A1candidate (talk) 21:32, 3 August 2013 (UTC)
- Essentially, yes. By default. That is the only theory that has widespread support and is supported by the preponderance of the evidence, and data that contradict it are either inconclusive, tentative or unconfirmed, or originate from low-quality studies. Other explanations are not plausible or not supported by good evidence. Passing the "placebo" barrier is the first step that most alternative medicine methods, indeed all medicine methods, have to take, from homeopathy to zinc lozenges for colds. Passing the preliminary phases is relatively easy, as the experiments at that stage are designed to detect true positives at the cost of detecting false positives as well. Later stages are more rigorous. That's why we highly favor secondary studies over primary studies. Dominus Vobisdu (talk) 21:45, 3 August 2013 (UTC)
Attempts to recruit editors
Obviously, there's nothing wrong with asking other editors to give their opinions but please do it in a neutral manner and not like this , this, and this
-A1candidate (talk) 19:21, 2 August 2013 (UTC)
- The guidelines on this are at WP:CANVAS. I don't see anything improper having happened. Alexbrn 19:27, 2 August 2013 (UTC)
Well, WP:CANVAS says:
 | This page in a nutshell: When notifying other editors of discussions, keep the number of notifications small, keep the message text neutral, and don't preselect recipients according to their established opinions. |
My main concern is that statements like these aren't neutral -A1candidate (talk) 19:37, 2 August 2013 (UTC)
- I don't think raising concerns which are tied to WP's core policies (as seems to be the case here) is not "neutral" - quite the opposite, surely? Alexbrn 19:42, 2 August 2013 (UTC)
- the message presumes a violation of the policies, and encourages users to come redress those violations, and therefore is not neutral. Gaijin42 (talk) 19:46, 2 August 2013 (UTC)
- It also preselects a population known to be looking for things to label as fringe, which could be an example of WP:Votestacking. Herbxue (talk) 20:22, 2 August 2013 (UTC)
- The purpose of the fringe noticeboard is stated at the head of its page. This does not include "looking for things to label as fringe". In fact queries posted there are frequently resolved by determining that a topic in question is not subject to fringe guidelines. Posting to a noticeboard can never be an example of canvassing: they are specifically for "problems that editors encounter in writing and maintaining Misplaced Pages articles". Alexbrn 20:34, 2 August 2013 (UTC)
- Sorry, you are accusing wikiproject medicine and science of being a group "looking for things to label as fringe"? IRWolfie- (talk) 22:38, 2 August 2013 (UTC)
- No, it was also posted at the Fringe notice board. By its nature, that board seeks to identify what is or is not "mainstream", so alerting editors that monitor that page will naturally result in adding a bias towards discounting reliable RS because it is associated with, or used to help explain an alternative medicine subject. Herbxue (talk) 02:54, 3 August 2013 (UTC)
- Absolute nonsense. Sources which are not reliable will be discounted. That is all. IRWolfie- (talk) 21:50, 3 August 2013 (UTC)
- No, it was also posted at the Fringe notice board. By its nature, that board seeks to identify what is or is not "mainstream", so alerting editors that monitor that page will naturally result in adding a bias towards discounting reliable RS because it is associated with, or used to help explain an alternative medicine subject. Herbxue (talk) 02:54, 3 August 2013 (UTC)
A couple years ago I was accused of sockpuppetry and page banned for a similar recruitment attempt. The fact that you assume an air of authority as part of a noticeboard does not mean that you seek out unreliable sources in an unbiased manner. I am not accusing you of doing so, but Dominus did not assume good faith of the active editors of this page and recruited like-minded people. You can save the "we follow sources" lecture - I perfectly understand it - I just don't agree that it serves the project to censor out interesting and valuable information in primary sources if they are not making a claim of efficacy. Drug articles, for example, are loaded with primary sources. So the term "cherry picking" goes both ways. Herbxue (talk) 15:33, 5 August 2013 (UTC)
- I got one too. I was pretty surprised to see the canvassing, given how illformed the suggested edit is. I'd be interested to hear from an admin on how canvassing should be done for pseudoscience/fringe topics. I'm not sure I understand the issue in this case, was there some set of users or wiki projects that should have been notified that weren't? TippyGoomba (talk) 04:45, 3 August 2013 (UTC)
- No, I don't think anyone was intentionally left out. In my opinion what happened was an editor in good faith changed "theories" to "ideas" and I (in good faith) reverted them because they changed established text and their edit was not sourced, and I thought "theories" was appropriate based on the WP definition of theory. I quickly established willingness to compromise on the terminology, but Dominus had already begun a drama-filled escalation of rhetoric at that point. A1Candidate shared RS that backed the inclusion of the sources in the article which were already well established after discussion and much work by other editors. In my opinion, Dominus is introducing theatrical drama in this situation to get support to remove well-sourced content on proposed mechanisms in order to push a POV that there is absolutely no basis for believing that needle insertion does anything to the human body. I think the whole thing has been blown way out of proportion and should have just been discussed here, instead of recruiting like-minded POV pushers at the fringe notice board. Herbxue (talk) 05:25, 3 August 2013 (UTC)
- I guess that's one version. Perhaps it's best if we all get back to discussing changes to the article, rather than user conduct. TippyGoomba (talk) 06:59, 3 August 2013 (UTC)
- No, I don't think anyone was intentionally left out. In my opinion what happened was an editor in good faith changed "theories" to "ideas" and I (in good faith) reverted them because they changed established text and their edit was not sourced, and I thought "theories" was appropriate based on the WP definition of theory. I quickly established willingness to compromise on the terminology, but Dominus had already begun a drama-filled escalation of rhetoric at that point. A1Candidate shared RS that backed the inclusion of the sources in the article which were already well established after discussion and much work by other editors. In my opinion, Dominus is introducing theatrical drama in this situation to get support to remove well-sourced content on proposed mechanisms in order to push a POV that there is absolutely no basis for believing that needle insertion does anything to the human body. I think the whole thing has been blown way out of proportion and should have just been discussed here, instead of recruiting like-minded POV pushers at the fringe notice board. Herbxue (talk) 05:25, 3 August 2013 (UTC)
"Its effects are due to placebo"
I have removed this statement from the effectiveness section because it is a definitive statement that is unproven, and only one of the 3 cited sources even suggests that its effects are due to placebo (the Ernst paper). None, even the Ernst, suggests that placebo is the only mechanism by which it works, therefore the statement is unsupported by the sources. Herbxue (talk) 19:42, 5 August 2013 (UTC)
- Dominus keeps reverting the edit, so I proposed a compromise to the inaccurate blanket statement that is not supported by the sources cited. Herbxue (talk) 20:09, 5 August 2013 (UTC)
- All three citations support the statement. Furthermore, it's the default position. Do you have more recent systemic reviews which demonstrate otherwise? TippyGoomba (talk) 05:28, 6 August 2013 (UTC)
- Only one even comes close, and its the Ernst, which more than one other editor has expressed concerns about undue weight. Even his paper does not make the blanket statement "acupuncture's effects are do to placebo" - it is careful to say there is the evidence suggests acupuncture may be nothing more than placebo, which is an admitted speculation. Show me a quote in multiple reviews that support a sweeping generalization like that. Herbxue (talk) 06:17, 6 August 2013 (UTC)
- All three citations support the statement. Furthermore, it's the default position. Do you have more recent systemic reviews which demonstrate otherwise? TippyGoomba (talk) 05:28, 6 August 2013 (UTC)
You guys are still reverting me, returning to a version that is not supported by the sources. Its not even supported by Ernst, the man on a mission to discredit acupuncture does not even go so far as to say "it's effects are due to placebo" - if you ever intend to say "we follow the sources" with a straight face again, I suggest you read the fucking sources before reverting me, or propose and edit, supported by the sources. A1candidate made that edit erroneously and I have corrected it numerous times. Dominus and Tippy keep supporting the erroneous edit without actually reading the source that supposedly supports it, or intentionally misrepresenting what the source actually says. That basically means you are liars. Herbxue (talk) 03:15, 12 August 2013 (UTC)
- no, u TippyGoomba (talk) 04:36, 12 August 2013 (UTC)
- Looking at the sources again, I wonder if it is overstating their case to say the effects are due. Ernst's blog on the topic from earlier this year contains the wording: "the evidence from the most rigorous clinical trials seems to suggest that much, if not all of the effects of acupuncture might be due to placebo". Alexbrn 07:31, 14 August 2013 (UTC)
- Since things have escalated, I've taken Herbxue to ANI, see WP:ANI#Herbxue. Please correct me there if I've missed something. TippyGoomba (talk) 03:20, 15 August 2013 (UTC)
- IMO, Dominus Vobisdu and TippyGoomba have not AGF at all and have continuously focused on the editor here instead of the edits. Interesting that neither Tippy or Dominus has felt it necessary to comment on the sources that Herbexue is referring to, they just keep drive-by reverting to a version that is not supported by those sources. TippyGoomba and Dominus Vobisdu have repeatedly restored the text in the lead that says "the effects of acupuncture are due to placebo", yet the sources do not support this text. The body of our article also does not support this text in the lead; our article says:
- "A 2012 meta-analysis found significant differences between true and sham acupuncture, which indicates that acupuncture is more than a placebo when treating chronic pain (even though the differences were modest). A 2010 systematic review also suggested that acupuncture is more than a placebo for commonly occurring chronic pain conditions, but the authors acknowledged that it is still unknown if the overall benefit is clinically meaningful or cost-effective."
- As Alexbrn points out, even the well-known critic Ernst can only say that it "might be due to placebo". I would love to hear how Dominus or Tippy justify continuously restoring the text when it is not supported by the sources and refusing to engage in discussion here? and then have the nerve to report Herbexue to ANI? Puhlaa (talk) 04:47, 15 August 2013 (UTC)
- IMO, Dominus Vobisdu and TippyGoomba have not AGF at all and have continuously focused on the editor here instead of the edits. Interesting that neither Tippy or Dominus has felt it necessary to comment on the sources that Herbexue is referring to, they just keep drive-by reverting to a version that is not supported by those sources. TippyGoomba and Dominus Vobisdu have repeatedly restored the text in the lead that says "the effects of acupuncture are due to placebo", yet the sources do not support this text. The body of our article also does not support this text in the lead; our article says:
- Alt-med proponents love to take advantage of the public's lack of knowledge about what "placebo" is. Placebo is not something that has to be proved. It is the default conclusion of any medical trial, and remains true until it is disproved. The burden rests solely on alt med proponents to do so. They always try to shift the burden on scientists to prove that their method doesn't work, instead of providing credible evidence that it does work. So far, no convincing evidence has been produced. All of the studies to date have either been fundamently flawed because of faulty methodolgy or bias, or have produced weak, contradictory and non-reproducible evidence.
- They also prey on the public's lack of knowledge about what "effectiveness" is. If the effectiveness of a method is no better than placebo, that means it is not more effective than holy water or beads and rattles.
- None of the reliable studies performed to date have indicated that there is more at play than simple placebo efect, a fact that Ernst makes clear in his "review of reviews" www.dcscience.net/Ernst-2011-AcupunctAlleviatePainRiskReview.pdf, which has been removed from the article. The review of reviews states that recent high-quality studies indicate that the effects of accupuncure are due to "non-specific effects such as therapist conviction, patient enthusism, or receiving a treatment believed to be helpful", in other words, placebo. Or that "real" acupuncture works no better than sham (placebo) acupuncture. It goes on to state that if
- The Madsen metastudy says very clearly that sham accupuncture (placebo} worked better than no treatment, and that the difference between "real" and sham accupucture (placebo) was not clinically relevant and could not be distinguished from bias ].
- There is a quibble also on "may be due to placebo", another common ploy used by alt med proponents. In normal English, this means "may be due to causes other than placebo". It's a banal statement that is true in all medical trials, as it can never be disproved (it's unfalsifiable), only proved. This does not imply that it is caused by other causes, nor does it lend any credence to such conclusions. It's mere speculation that is inherent in the scienific method. Until credible evidence is produced that identifies other causes, it is basically a meaningless statement, and the conclusion that any effects are due to placebo remains the only valid conclusion. Dominus Vobisdu (talk) 02:41, 16 August 2013 (UTC)
"Default position" of who? Can you show that conventional medicine holds drugs and surgical procedures to such a standard? You have a tendency to invent criteria for inclusion or exclusion of information based on your POV, yet you still have not acknowledged that the cited sources do not support your reversions of my edits. Ernst himself, a controversial figure, is far more careful to qualify and nuance his statements than you, and he is clearly on a mission. Have you read any of Kapchuck's work? You are trying to prevent the reader from coming to their own conclusions about issues that clearly do not have a definitive answer. I am amenable to the possibility that the general reader may have a bias towards "believing" in unproven things, but that does not justify falsifying the facts to prevent them from believing something that hasn't been proven to be false. The edit you defend does just that. Herbxue (talk) 05:03, 16 August 2013 (UTC)
- Read Null hypothesis. Placebo is the null hypothesis of any medical trial, no exceptions. See Clinical trial. Bottom line, the effects of any treatment are by definition placebo effects until proven otherwise. Dominus Vobisdu (talk) 05:19, 16 August 2013 (UTC)
- The NCAHF put is this way: "There is no physiologic rationale for why acupuncture should work other than for its placebo or counter-irritant and distracting effects." Alexbrn 05:42, 16 August 2013 (UTC)
- Alexbrn that statement is from an era where the Internet had not even existed yet. I prefer the MEDLINE database's consensus of scientific evidence, not because I support pseudoscience based on quackery, but because its updated frequently: Researchers don't fully understand how acupuncture works. -A1candidate (talk) 08:22, 16 August 2013 (UTC)
- The statements are not incompatible. It seems many explanations are floating around, even regression to the mean. There is however, no accepted "physiologic rationale". Alexbrn 08:41, 16 August 2013 (UTC)
- "Mights" are dime a dozen in the world of science, the stuff pizza boxes and cocktail napkins are made for, and don't mean anything without evidence to back them up. Results talk, and bullshit walks. All we have here is a pathetic attempt to spin bullshit into results. Dominus Vobisdu (talk) 09:34, 16 August 2013 (UTC)
- Alexbrn that statement is from an era where the Internet had not even existed yet. I prefer the MEDLINE database's consensus of scientific evidence, not because I support pseudoscience based on quackery, but because its updated frequently: Researchers don't fully understand how acupuncture works. -A1candidate (talk) 08:22, 16 August 2013 (UTC)
- The NCAHF put is this way: "There is no physiologic rationale for why acupuncture should work other than for its placebo or counter-irritant and distracting effects." Alexbrn 05:42, 16 August 2013 (UTC)
Your opinion is shared by many, but the writers of the systematic reviews are simply not willing to conclude that placebo is the only explanation for the positive effects of acupuncture. The edit you keep supporting is not supported by the sources (which is the topic of this thread). Herbxue (talk) 05:04, 17 August 2013 (UTC)
I think that concluding the sweeping statement that "General scientific consensus maintains that the effects of acupuncture has not been shown to be due to anything more than placebo, and is therefore dependent on a patient's expectation of treatment outcomes" from the sources Ernst 2006, Madsen et al. 2009 and Furlan et al. 2008 as stated in the article is a synthesis. Besides this, several studies that find statisticaly significant advantages of acupuncture over placebo seem to make this sweeping statement too generalized (such as Albrecht, Vickers, Crew, Manheimer) Ochiwar (talk) 19:47, 19 August 2013 (UTC)
- A review by Hopton actually states " The accumulating evidence from recent reviews suggests that acupuncture is more than a placebo for commonly occurring chronic pain conditions" Ochiwar (talk) 20:15, 19 August 2013 (UTC) And Kong states "We believe our study provides brain imaging evidence for the existence of different mechanisms underlying acupuncture analgesia and expectancy evoked placebo analgesia" Ochiwar (talk) 20:29, 19 August 2013 (UTC)
- Note that this article and this particular statement is the subject of a discussion over at Misplaced Pages:ANI#Herbxue (permalink). To me this looks like a relatively extreme misrepresentation of sources and my hope is that out of the discussion over there, some action will take place to put pressure on the editors responsible to stick to sources in the future. I've already pinged the editors responsible (User:Dominus Vobisdu, TippyGoomba, and User:A1candidate) but so far none has really made a response. II | (t - c) 23:45, 19 August 2013 (UTC)
- A few of the sources provided state that the effect may be nothing more than placebo. I have toned the wording down to reflect this possibility. Agree that the bit on "scientific consensus" is over stating things a bit but am happy to AGF. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:39, 20 August 2013 (UTC)
- If there are still issues I would strongly suggest that those involved start a RfC rather than continue to revert. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:47, 20 August 2013 (UTC)
- A few of the sources provided state that the effect may be nothing more than placebo. I have toned the wording down to reflect this possibility. Agree that the bit on "scientific consensus" is over stating things a bit but am happy to AGF. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:39, 20 August 2013 (UTC)
- Why can't we just be honest and admit that Researchers don't fully understand how acupuncture works? Because not doing so allows us to completely ignore a plethora of reliable sources and disregard numerous peer reviewed studies showing that acupuncture is more than placebo. -A1candidate (talk) 08:42, 20 August 2013 (UTC)
- Stating that it is not clear how something works is different than stating that it is not known if it works or not. We should discuss both these aspects I agree. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:07, 21 August 2013 (UTC)
- In that case, I hope other editors would also agree with us that if we include the placebo effect as a possible mechanism for accupuncture, then in order to be fair, we should ideally include other mechanism as well as long as the source is reliable. In other words, should this removal be restored? I dont see the point of only including the placebo effect as a possible mechanism while ignoring the others. If there are concerns about the reliablity of some specific sources, then those should be replaced with better sources, which isn't that difficult at all. -A1candidate (talk) 16:00, 22 August 2013 (UTC)
- Stating that it is not clear how something works is different than stating that it is not known if it works or not. We should discuss both these aspects I agree. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:07, 21 August 2013 (UTC)
- I'll just comment on the reversion back to include the list of potential mechanisms for the "efficacy of acupuncture". First, the items in that list are not "theories", but more similar to conjecture or ideas or proposals. Second, by and large, they are represented by one or two papers each from many years ago; we need to include current ideas that are based on significant replication and newer studies. In other words, how are these ideas accepted today? Third, a list of proposals for "how acupuncture works" presupposes that it does work. If we embrace the rather weak consensus that acupuncture has some efficacy for some indications, for example, some pain and some nausea, then the proposals can only relate to these indications. Another issue is the combining of studies where different forms of acupuncture are used, for example, electro-acupuncture. There is no reason to expect that simple needling and needling combined with electrical stimulation would have the same underlying mechanism. Until these points are addressed, it is not clear that including a list of "potential mechanisms" is going to be useful. Desoto10 (talk) 23:30, 1 September 2013 (UTC)
- It does work, the question we are asking is whether it works by placebo or otherwise? Like I said, its not that difficult finding newer, reliable sources for that. And lastly, they do relate to pain and nausea (among others), and from what I know have nothing whatsoever to do with electroacupuncture -A1candidate (talk) 19:17, 8 September 2013 (UTC)
- I'll just comment on the reversion back to include the list of potential mechanisms for the "efficacy of acupuncture". First, the items in that list are not "theories", but more similar to conjecture or ideas or proposals. Second, by and large, they are represented by one or two papers each from many years ago; we need to include current ideas that are based on significant replication and newer studies. In other words, how are these ideas accepted today? Third, a list of proposals for "how acupuncture works" presupposes that it does work. If we embrace the rather weak consensus that acupuncture has some efficacy for some indications, for example, some pain and some nausea, then the proposals can only relate to these indications. Another issue is the combining of studies where different forms of acupuncture are used, for example, electro-acupuncture. There is no reason to expect that simple needling and needling combined with electrical stimulation would have the same underlying mechanism. Until these points are addressed, it is not clear that including a list of "potential mechanisms" is going to be useful. Desoto10 (talk) 23:30, 1 September 2013 (UTC)
- The Lancet paper referenced above is about electroacupuncture. The purine hypothesis (from the article that A1 refers to) does not explain "how acupuncture works" unless we are talking about just sticking needles into the skin anywhere. Note that the figures in that paper just have a needle poking the skin causing ATP release; there is no mention about special locations. I think we need to restrict the article to actual acupuncture explanations which require needling in specific locations and why those specific locations are important. The gate model of pain reduction by acupuncture, also referenced above, also does not directly relate to acupuncture as the effect can be elicited by stimulation anywhere. Desoto10 (talk) 03:42, 9 September 2013 (UTC)
Rant
Pain science - those who spend their lives studying the biology, psychology and sociology of pain - is open to the probability that needling will have some, probably minor, probably temporary, effect on pain. This is because of the well-attested phenomenon, diffuse noxious inhibitory control (pain, in some circumstances, raises the global pain threshold). If needling elicits pain, it may have a just-measurable above-placebo effect on the perceived intensity of pain resulting from another stimulus.
The pain of needling may also, plausibly, minimally affect the perceived "unpleasantness" (a different subjective phenomenon and neural network from "sensation intensity") of other negative homeostatic emotions such as nausea and itch too, because the "unpleasantness" of all homeostatic emotions is embodied in one common neural network and if pain diminishes global perceived "unpleasantness", which is uncertain, then it will affect the perceived unpleasantness of nausea, etc. too.
I realise this unsourced rant is probably outside Misplaced Pages:Talk page guidelines, but I'm hoping to pour a little oil on these troubled waters. I agree it is implausible that acupuncture may have an impact on bubonic plague or Down syndrome, but would appreciate it if the skeptics here could step back a little and exercise genuine objectivity when it comes to (a) the plausibility that the minimal pain of acupuncture may minimally affect the perceived intensity or unpleasantness of other pains or other homeostatic emotions, and (b) the scientific evidence (or lack of it) regarding this purported psychophysical effect. --Anthonyhcole (talk · contribs · email) 08:31, 20 August 2013 (UTC)
- Thank you for this, Anthony. I have followed your posts about pain for a couple years now (you weighed in during PPdd's reign of terror, in a way that I perceived was not helpful to TCM), and although you have generally not expressed approval of acupuncture, I greatly appreciate your call for "genuine objectivity". Obviously I am a proponent of acupuncture, but I think this is an issue worth insisting on an honest appraisal of the sources, rather than a political "science vs. woo" battle. Herbxue (talk) 04:01, 21 August 2013 (UTC)
Sham Studies
There is considerable controversy about the validity of the methods used to study acupuncture. For instance, sham controls are highly controversial and while many outsiders view these as reasonable controls which equate with biomedical placebos, those in the industry seem to have a completely different opinion. STRICTA standards are a good example of this. There is a system of acupuncture, Master Tung-style, which needles acupoints in many different places: between traditional points, between meridians, etc. Every portion of the body, according to the system, is a potential acupoint. Several other styles, such as Kiiko-style Japanese acupuncture may also utilize any point on the skin. Therefore, studies which utilize sham-controls, could actually be seen as studying traditional TCM points versus random Tung-style points or Kiiko-style points, not "placebos". Given this fact, it seems a decision should be made. Since there is no "consensus" within the field, do we remove all talk about sham studies and acupuncture not being more than placebo, or do we instead confine all this interesting debate to another section or article titled "acupuncture studies" or the like? Egamirorrimeht (talk) 23:11, 11 September 2013 (UTC)
- No, I don't see that a decision has to be made... we already have a section about the sham-acupuncture-problem. If you have (reliably sourced) material you'd like to add to it, please feel free to do so. Cheers, --Mallexikon (talk) 03:25, 12 September 2013 (UTC)
- I suppose that's a valid point. My concern, really, is the page appears very low quality and obviously amateurish. Modern scientific research on acupuncture is a subject with which I am very up to date with, and as the page reads it is embarrassing to anyone familiar to evidence based medicine in general. In many instances, there are statements that read as though "the science is settled and acupuncture is no more than a placebo" yet most of these statements find their basis in very controversial sham controls. Further, many of the cited studies do not pass STRICTA checklist standards on multiple counts. Seeing that STRICTA is the gold standard for acupuncture research, purporting consensus with flawed research causes this article to reek of dilettantism. Further, the studies used as source material to purport consensus are isolated studies and not meta-analyses. Again, low quality. I can certainly add much reliably sourced material to the page, but what it first needs is to have all the unreliably sourced material removed. I just think its prudent to air these concerns on the talk page first before pruning the article with a chainsaw. Egamirorrimeht (talk) 05:07, 12 September 2013 (UTC)
- As for adding material, perhaps you could add more about STRICTA standards?Herbxue (talk) 03:06, 13 September 2013 (UTC)
- I suppose that's a valid point. My concern, really, is the page appears very low quality and obviously amateurish. Modern scientific research on acupuncture is a subject with which I am very up to date with, and as the page reads it is embarrassing to anyone familiar to evidence based medicine in general. In many instances, there are statements that read as though "the science is settled and acupuncture is no more than a placebo" yet most of these statements find their basis in very controversial sham controls. Further, many of the cited studies do not pass STRICTA checklist standards on multiple counts. Seeing that STRICTA is the gold standard for acupuncture research, purporting consensus with flawed research causes this article to reek of dilettantism. Further, the studies used as source material to purport consensus are isolated studies and not meta-analyses. Again, low quality. I can certainly add much reliably sourced material to the page, but what it first needs is to have all the unreliably sourced material removed. I just think its prudent to air these concerns on the talk page first before pruning the article with a chainsaw. Egamirorrimeht (talk) 05:07, 12 September 2013 (UTC)
- Absolutely, I believe it will help this page considerably. Egamirorrimeht (talk) 17:58, 13 September 2013 (UTC)
- Yes, please provide the extent that STRICTA is embraced by the scientific community. Have major international scientific societies supported it? Is following these guidelines required for publication? Who has claimed that STRICTA is the "gold standard"? Thanks. Desoto10 (talk) 03:40, 13 September 2013 (UTC)
- Hello! STRICTA uses reporting guidelines, not strict requirements per se that a researcher or group must adhere to. This allows full transparency in research. For instance, in many studies where acupuncture is performed, a nurse, medical doctor or even a research scientist is the person performing acupuncture and not a trained acupuncturist. In this example, publications which use STRICTA reporting standards report not only report the profession but also the number of years one has in practice. Another example would be the description of needling involved. Oftentimes, studies only outline the points used. Under STRICTA reporting standards, the type of needle--length, gauge, serration, etc. are reported, as well as depth of insertion, type of needle manipulation used, whether sensations of "de qi" (also known as the arrival of qi) are experienced by the patient or not, needle retention time, etc, etc. As for journals that support STRICTA standards, you can find the list here. Not all acupuncture research is equal, or even credible. On the Misplaced Pages page, I would suggest that all research should be up to this standard. That is not to say that the publishing journal must be on STRICTA's participating list--that would be too exclusive--but that the cited research ought to be transparent. In other words, if a study does not specify who performed acupuncture on subjects, or does not specify how long needles are retained, then it should not be cited. Instead, a citation of transparent research should be used in its place in support of the claim. Egamirorrimeht (talk) 16:42, 13 September 2013 (UTC)
- Hi Egamirorrimeht, I think you're likely to find
pruning the article with a chainsaw
will be met with resistance unless you can give a better argument that the sources are indeed unreliable. Can you point to published reliable sourcing that questions the validity of the sham studies? That'd be a good start.Zad6803:44, 13 September 2013 (UTC)
- Hi Egamirorrimeht, I think you're likely to find
- Hi Zad! Here is an article regarding research conducted by the Osher Institute at Harvard Medical School showing that Sham acupuncture is not equal to placebo pills Egamirorrimeht (talk) 16:09, 13 September 2013 (UTC)
- That's an interesting result but it's an individual primary study. Can you point to a textbook or a review article or other such secondary source?
Zad6816:24, 13 September 2013 (UTC)
- That's an interesting result but it's an individual primary study. Can you point to a textbook or a review article or other such secondary source?
- Absolutely.. A textbook that talks about this phenomenon in detail is Acupuncture Research: Strategies for Establishing an Evidence Base by Hugh Macpherson. Egamirorrimeht (talk) 17:25, 13 September 2013 (UTC)
This is all very interesting and relevant. Do you have specific changes for the article? I suspect that the best thing for you to do would be to make a change and see how it flies. I would advise against wholesale changes all at one time. Desoto10 (talk) 03:27, 14 September 2013 (UTC)
the lede needs atttn
THe first paragraph says it is one of the oldest healing practices in the world. The reference says no such thing. — Preceding unsigned comment added by 122.61.245.213 (talk) 02:05, 23 August 2013 (UTC)
- You are correct, the cited source does not state that acupuncture is one of the oldest healing practices in the world. I do believe the statement is true, but it requires context and an appropriate source.Herbxue (talk) 06:07, 23 August 2013 (UTC)
What is this even saying
I'm sorry, but I don't understand this sentence. Maybe it's the semicolon throwing me off? A semicolon works more or less like a period--whatever follows it should be a complete thought. But even when the semicolon is removed, the sentence doesn't make sense.
"A number of studies comparing traditional acupuncture to sham procedures found that both sham and traditional acupuncture were superior to usual care but were themselves equivalent; findings apparently at odds with traditional Chinese theories regarding acupuncture point specificity." — Preceding unsigned comment added by 2602:30B:8266:2759:C9A6:A59B:2619:204 (talk) 22:42, 12 September 2013 (UTC)
Wording of lede needs to stick close to sources
The most recent revision to the lede is a substantial change to what had been stable wording consistent with sources. Now it says that the evidence says acupuncture is no more effective than placebo, and this statement is not sourced to the best quality MEDRS's, which also happen to be old ('05, '05, '08). The new wording uses these sources to rebut several sources saying acu is effective, but none mention the UK NHS source, a superior MEDRS that postdates them all; this is a bad change that introduces OR and strays from sources. Additionally, the article body cites better MEDRS's that says it is effective, e.g several at Acupuncture#Pain. Reverting to this revision from Oct. 27. Please get consensus here before making substantial changes. --Middle 8 (talk) 11:19, 30 October 2013 (UTC)
- "Some scientists" is OR. So you are not sticking close to the source. Do all or any of the sources say "Some scientists". QuackGuru (talk) 17:37, 30 October 2013 (UTC)
- I agree with QG. The previous version was alt med POV-pushing, and so I reverted back to the more neutral version to avoid the acupuncturist slant. jps (talk) 19:21, 30 October 2013 (UTC)
- The blatant OR I tagged has been removed. QuackGuru (talk) 19:30, 30 October 2013 (UTC)
- I'll take the blame for that one. ;) jps (talk) 19:47, 30 October 2013 (UTC)
- "Independent researchers have criticized these "endorsements"...
- Is there a better way to describe it than using the word "endorsements"? Maybe recommendations or reports will work. QuackGuru (talk) 20:01, 30 October 2013 (UTC)
- "Recommendations" or "reports" is good. "Independent scientists" is fine. One-liner "rv alt-med POV pushing" ES's don't address the concerns I raised above, viz.: The new wording uses these sources to rebut several sources saying acu is effective, but none mention the UK NHS source, a superior MEDRS that postdates them all; this is a bad change that introduces OR and strays from sources. Additionally, the article body cites better MEDRS's that says it is effective, e.g several at Acupuncture#Pain. Comments? --Middle 8 (talk) 22:04, 30 October 2013 (UTC)
- I'll take the blame for that one. ;) jps (talk) 19:47, 30 October 2013 (UTC)
- The blatant OR I tagged has been removed. QuackGuru (talk) 19:30, 30 October 2013 (UTC)
- I agree with QG. The previous version was alt med POV-pushing, and so I reverted back to the more neutral version to avoid the acupuncturist slant. jps (talk) 19:21, 30 October 2013 (UTC)
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