Talk:Acupuncture/Archive 15

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Summarize

The lead is supposed to be a simple summary.

" A systematic review of systematic reviews highlighted recent high-quality randomized controlled trials which" can be summarized as "A systematic review"

Because a "systematic review of systematic reviews highlighted recent high-quality randomized controlled trials" is a type of systematic review. We can get into the specifics in the body of the article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:19, 31 August 2014 (UTC)

Agree it was too much detail for the lede. QuackGuru (talk) 04:34, 31 August 2014 (UTC)

Only problem is that it's now inaccurate. Here's the deal -- Doc, hope you're reading:

Efficacy is defined as real acu being better than sham -- that's the thing readers need to know, that we aren't telling them.
Ernst '11 found that a majority of the reviews he looked at were positive for pain, but then caveated that finding -- by pointing to findings from more recent and better trials. Agreed that that level of detail belongs in the body, not the lede.
Some trials for pain show sham = real, and meta-analyses vary in their conclusions. We already say that in the lede when we talk about efficacy.

So what we need to in the lede is simple -- drop the statement in question and replace it with a statement along the lines of #1. --Middle 8 (POV-pushing • COI) 05:31, 31 August 2014 (UTC)

So what are you proposing? Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:39, 31 August 2014 (UTC)

How about this? (good timing of your comment :-) --Middle 8 (POV-pushing • COI) 05:47, 31 August 2014 (UTC)

The proposal is now ambiguous and deleted sourced text that summerised the body. Now the text does not summarise the body. Middle 8 has had a problem with deleting sourced text. User:Jmh649, maybe we should also shorten the body. It says "The review also highlighted recent high-quality randomized controlled trials which found that for reducing pain, real acupuncture was no better than sham acupuncture.[6]" It is a bit too wordy. See Acupuncture#Pain. QuackGuru (talk) 06:03, 31 August 2014 (UTC)

You need to use references per WP:V and WP:MEDRS. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:03, 31 August 2014 (UTC)

We don't source every statement in the lede... and naive readers aren't going to know what sham acu is. (I do hope for the sake of the article that you understand it's a true statement... it's acu study design 101.) --Middle 8 (POV-pushing • COI) 08:25, 31 August 2014 (UTC)

I previously explained the text you added to the lede did not summarise the body. QuackGuru (talk) 08:29, 31 August 2014 (UTC)

You claim readers won't know what sham is. See https://en.wikipedia.org/wiki/Acupuncture#cite_note-Madsen2009-11 QuackGuru (talk) 10:13, 31 August 2014 (UTC)

An accurate claim at the time [1], seeing you added that note subsequently [2] -- which is a good addition, though I think the reader would be better served if it were in the lede and not a note. --Middle 8 (POV-pushing • COI) 07:41, 1 September 2014 (UTC)

We should also tell the reader that another form of sham acu is the use of real needled at non-acupoint locations. --Middle 8 (POV-pushing • COI) 07:52, 1 September 2014 (UTC)

Anyway just noticed that we said the same thing already in the paragraph using that ref? So deleted it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:07, 31 August 2014 (UTC)

The statement is different from the other text. It is comparing sham versus real acupuncture. QuackGuru (talk) 06:20, 31 August 2014 (UTC)

This "while a systematic review of systematic reviews found little evidence that acupuncture is an effective treatment for reducing pain"

Is more or less the same as "A systematic review found that for reducing pain real acupuncture was no better than sham acupuncture."

When one says that there is little evidence for something one needs a comparator and that comparator is sham acupuncture. IMO we do not need to say both in the lead. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:10, 31 August 2014 (UTC)

I will compromise and merge the other statement so there will only be one sentence. QuackGuru (talk) 07:33, 31 August 2014 (UTC)

The wording is simplified and adjusted. QuackGuru (talk) 08:12, 31 August 2014 (UTC)

It is incorrect. Newer meta-analysis concludes that significant, but modest differences exist between sham and verum. -A1candidate (talk) 15:28, 31 August 2014 (UTC)

"Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, said the study "impressively and clearly" showed that the effects of acupuncture were mostly due to placebo. "The differences between the results obtained with real and sham acupuncture are small and not clinically relevant. Crucially, they are probably due to residual bias in these studies."

Jha, Alok (10 September 2012). "Acupuncture useful, but overall of little benefit, study shows". The Guardian. {{cite news}}: Italic or bold markup not allowed in: |newspaper= (help)

"What really matters is that Vickers et al showed that the difference is far too small to be of the slightest clinical interest."

Colquhoun, David (17 September 2012). "Re: Risks of acupuncture range from stray needles to pneumothorax, finds study". BMJ.

A systematic review of systematic reviews is a higher quality authoritative source. The author of this source is Edzard Ernst. He invalided the Vickers study.

That Vickers study shows no meaningful difference according to which experts on the subject? See above. QuackGuru (talk) 17:32, 31 August 2014 (UTC)

Ernst's review couldn't have "invalided" Vickers because the latter hadn't even been written yet. --Middle 8 (POV-pushing • COI) 06:19, 1 September 2014 (UTC)

The source says "We found acupuncture to be superior to both no-acupuncture control and sham acupuncture for the treatment of chronic pain," wrote Vickers in the September 10 edition of the Archives of Internal Medicine."[3] Ernst was reviewing Vickers. QuackGuru (talk) 06:27, 1 September 2014 (UTC)

Newspapers and news reports of BMJ aren't MEDRS compliant. An older review (2011) cannot be used to disqualify a newer meta-analysis (2012). -A1candidate (talk) 17:54, 31 August 2014 (UTC)

You disagree that a systematic review of systematic reviews is a higher quality source?

This is a newer 2013 meta-analysis written in part by Vickers: "When comparing acupuncture to sham controls, there was little evidence that the effects of acupuncture on pain were modified by any of the acupuncture characteristics evaluated, including style of acupuncture, the number or placement of needles, the number, frequency or duration of sessions, patient-practitioner interactions and the experience of the acupuncturist..."

MacPherson, Hugh; Maschino, Alexandra C; Lewith, George; Foster, Nadine E; Witt, Claudia; Vickers, Andrew J; Acupuncture Trialists' Collaboration (2013). Eldabe, Sam (ed.). "Characteristics of Acupuncture Treatment Associated with Outcome: An Individual Patient Meta-Analysis of 17,922 Patients with Chronic Pain in Randomised Controlled Trials". PLoS ONE. 8 (10): e77438. doi:10.1371/journal.pone.0077438. PMC 3795671. PMID 24146995.{{cite journal}}: CS1 maint: unflagged free DOI (link)

According to your previous argument a 2012 is the newer meta-analysis. That is incorrect. See (PMID 24146995). QuackGuru (talk) 18:09, 31 August 2014 (UTC)

You conveniently ignored the fact that "Increased number of needles and more sessions appear to be associated with better outcomes when comparing acupuncture to non-acupuncture controls. This suggests that the dose of acupuncture is important", as they concluded in the 2013 meta-analysis. -A1candidate (talk) 18:34, 31 August 2014 (UTC)

This detail is in the body. See Acupuncture#Scientific view on TCM theory. The lede should be kept a summary. That would be too much detail for the lede and we are using a better source (a systematic review of systematic reviews) for the main point. QuackGuru (talk) 18:47, 31 August 2014 (UTC)

A newer meta-analysis of 18,000 patients carries more weight than older systematic review of reviews. -A1candidate (talk) 19:21, 31 August 2014 (UTC)

Or at least it would if there was a remotely plausible mechanism of action, and solid evidence for the existence of qi and meridians, and evidence that the location of needling makes any difference. But there isn't.

You have made it rather plain that you are a True Believer, and the review you promote was also written by True Believers. Oddly, when anyone who is not a True Believer conducts the test, the effect seems to vanish. I wonder why that is? Guy (Help!) 23:17, 31 August 2014 (UTC)

Yes, I'm a True Believer in science, if that's what you're trying to say. -A1candidate (talk) 23:58, 31 August 2014 (UTC)

Guy, even if it is written by true believers (and I'm not sure that's wholly true), it still passed peer review, and is still part of the literature that we seek to represent. The "effect" in this case -- the statistical significance of their findings -- is not belief-dependent. Nobody has suggested that if a non-true believer re-crunched the numbers, their findings would change; only the interpretation of those findings is contested. AFAIK, it's the only meta-analysis of individual patient data in acu research, which is the gold standard of meta-analysis.[4], so it does weigh considerably. And in order for acu to have a small specific effect, prescientific Chinese ideas don't have to be true; how else would you expect them to have explained acu in their time? With reference to fascia and endorphins? ;-) --Middle 8 (POV-pushing • COI) 06:16, 1 September 2014 (UTC)

All this speculation about "true believers" is totally useless. If there is such a bias, it sure have been studied and one could find a source for it. If it's not, then we don't speculate on that either.

I do agree with Middle 8 about the weight of that meta-analysis though. Jayaguru-Shishya (talk) 11:57, 1 September 2014 (UTC)

(e/c) A1Candidate almost always brings really good MEDRS's to the discussion, but shoots themselves in the foot by overstating their weight relative to other sources. But they still weigh. Multiple editors have commented that there is POV-pushing from both sides, but while the pro-acu side inevitably gets called out, the anti-acu side (no matter how extreme) gets a free pass. --Middle 8 (POV-pushing • COI) 06:47, 1 September 2014 (UTC)

The main point of (PMID 24146995) is redundant. The lede says more or less the same thing that there is little difference between sham and acupuncture. QuackGuru (talk) 06:33, 1 September 2014 (UTC)

It depends on which trial or review one is talking about. Efficacy (to whatever degree it may exist) is defined as the (statistically significant) difference between sham and real -- period. Whatever generalization we make about sham should be nothing more or less than what we say about efficacy. And efficacy is handled reasonably well in the lede. Let's not act as if sham is some new thing to be hashed out and weighted. 2/0, A1Candidate, Brangifer, Jaya-S, Doc James and Guy will know what I'm saying, even if you, QG, claim not to. --Middle 8 (POV-pushing • COI) 11:56, 2 September 2014 (UTC)

Utter rubbish. Efficacy is the extent to which a treatment has a positive effect. Period. You're confusing the fact that 'sham acu' (a placebo) is effective, as is 'real acu' for exactly the same reason. What you're not prepared to accept is that any attempt to explain a mechanism for differential action between sham and real will inevitably be laughed at as unscientific mumbo-jumbo. --RexxS (talk) 16:45, 2 September 2014 (UTC)

Hi RexxS. Of course sham acu is effective! When I say "Efficacy is the extent...." I mean "efficacy beyond placebo", which is what researchers are interested in. Ask 2/0 or Brangifer if you don't believe me. And tone down your rhetoric please. --Middle 8 (POV-pushing • COI) 17:08, 2 September 2014 (UTC)

Fixed wording to reflect source [5] -- ES self-explanatory, and I'm that any science-literate editors willing to look at the source will see that it's accurate. But this being Wikipedia, who can say if that will happen? --Middle 8 (POV-pushing • COI) 08:01, 1 September 2014 (UTC)

A systematic review of systematic reviews found real acupuncture was no better than sham acupuncture and concluded that their is little evidence that acupuncture is an effective treatment for reducing pain.

A systematic review of systematic reviews of acupuncture for pain concluded that there is little evidence that acupuncture is an effective treatment, i.e. that real acupuncture may be no better than sham acupuncture.

You added original research. You recently tried to add OR to the lede and now you are doing it again.

The source does not say it "may be" be no better. The other part was also misleading and ambiguous. The source says "In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain." Please stop adding original research to the lede. QuackGuru (talk) 17:01, 1 September 2014 (UTC)

Neither of those diffs is OR; please see your talk page. --Middle 8 (POV-pushing • COI) 08:41, 2 September 2014 (UTC)

Thanks for accurately quoting his conclusion (see PMID 21440191). Why not cite that? I don't see any mention of sham in the conclusion or the abstract. --Middle 8 (POV-pushing • COI) 04:33, 2 September 2014 (UTC)

Sham acu is a worthy topic but this paper doesn't support what you seem to want to say. You've been pushing this sentence for months and arguing that Moffet, then Ernst support it, but they don't. --Middle 8 (POV-pushing • COI) 04:36, 2 September 2014 (UTC)

The part you added "may be" no better I could not verify.[6] The current text is accurately summarised. You claimed RexxS's ad hominem & general drama is a confession of weakness. You had a discussion on User:RexxS's talk page too. See User_talk:RexxS/Archive_25#Ernst_re_pain..._and_talk.... We already had a discussion about this. See Wikipedia_talk:WikiProject_Medicine/Archive_51#Acupuncture_again. QuackGuru (talk) 14:33, 2 September 2014 (UTC)

Again why use wording that's not in the abstract or conclusion, and not supported by the text? Especially when you demand that others meet that standard? [7] (Nothing against RexxS, but he was wrong in that case, and Imperfectly Informed was correct. There aren't two correct answers. We could go to RSN if editors here don't figure it out.) --Middle 8 (POV-pushing • COI) 16:19, 2 September 2014 (UTC)

No, I was not wrong. No matter how many times you try to deny it, you can't invalidate the conclusions of a reliable secondary source that you dislike by making your own amateur analysis to try to discredit it. Ernst is never in any doubt that real acu is no better than sham acu and we all know that any differences are so small as to be insignificant both statistically and clinically. That's the correct answer and that's what should be reflected in the lead if we should need that much detail (which we don't). --RexxS (talk) 16:45, 2 September 2014 (UTC)

Sure you were wrong; you made several mistakes interpreting the paper in the original discussion, and this is another. See User:Middle_8/Ernst-11. And of course sham acu is sometimes better than real acu: the majority of the 57 reviews he studied were positive for acupuncture, if you recall. (Positive meaning "showing efficacy", i.e. "efficacy beyond placebo", i.e. "real acu being superior to sham to a statistically significant degree.) Read the lede; of course there's still some debate over efficacy, mainly for pain and nausea, although that may be due to artifact. --Middle 8 (POV-pushing • COI) 17:14, 2 September 2014 (UTC)

The source does not specifically state "sham acu is sometimes better than real acu". QuackGuru (talk) 17:18, 2 September 2014 (UTC)

Not in those exact words, no. But that's what it found. I cover all that and more at User:Middle_8/Ernst-11, which I hope you and others find helpful. -Middle 8 (POV-pushing • COI) 19:24, 2 September 2014 (UTC)

You want to replace verified text in accordance with V with your own SYN/OR interpretation? QuackGuru (talk) 19:34, 2 September 2014 (UTC)

I would like to restore the comment that was deleted. QuackGuru (talk) 16:48, 2 September 2014 (UTC)

To QuackGuru (and all editors here): Most humble apologies for my overwrite of your edit, QG! https://en.wikipedia.org/w/index.php?title=Talk:Acupuncture&diff=prev&oldid=623878169] I would never, ever do such a thing intentionally. In this instance, the buttons on my trackball are a bit sticky, so I must have accidentally selected your comment, not realized I'd done so, and then deleted it as soon as I started typing. To make matters worse, Doc James asked me what was the deal with that edit, and I simply explained the text I added, being sufficiently out of it that I didn't see from the diff that I'd actually overwritten QG's comment. Have been editing a lot today, obviously need a break. Apologies to all for the distraction and any misunderstandings caused. --Middle 8 (POV-pushing • COI) 12:53, 3 September 2014 (UTC)

According to this comment on 19:10, 2 September 2014 you got upset about my comment. That was your initial reaction after I restored my comment on 16:50, 2 September 2014 you deleted early on 16:19, 2 September 2014. You added OR research to the lede twice recently.[8][9] Is this a pattern? QuackGuru (talk) 17:16, 3 September 2014 (UTC)

No, QG, as I said I had absolutely no idea what I'd done until Jytdog clued me into what Doc James meant by posting on my page asking, rightly, what was the deal. I'm sorry you choose to take my apology in bad faith. I didn't agree with your post (hence that first diff you cite [10]) but I sure as heck didn't delete it on purpose!

I'm very disappointed that in response to my apology you'd reply with a post like this, implying ulterior motive, and repeating an inaccurate allegation that I added "OR to the lede". It takes some gall for you to do that, frankly, because I posted on your user talk speifically refuting that exact same assertion. Here is the diff; short version: Please stop calling it OR every time an editor merely uses wording that is not your exact preferred wording, or is not verbatim from a source. There's this thing called "paraphrasing".

I'm also disappointed that after I posted to Doc's user talk explaining my mistake, and he replied saying he was glad it was just a mistake, that you would then post there seeking to depict my mistake as intentional.[11] Why are you doing this? I'll repeat: what can we do to end this apparent bad blood between us? I posted a sincere olive branch to you last week [12], but you deleted it without comment [13]. --Middle 8 (POV-pushing • COI)

I went ahead and restored it. QuackGuru (talk) 16:51, 2 September 2014 (UTC)

QG, since you're insisting on rehashing past heat rather than light, I'll say this for the record: Now go back and read RexxS's hyperbole. My comments are WP:SPADE and comparatively quite tame. But why focus on old drama? Why not comment on the substance at hand? I've given ample food fr thought at User:Middle_8/Ernst-11. --Middle 8 (POV-pushing • COI) 19:10, 2 September 2014 (UTC)

Jha, Alok (10 September 2012). "Acupuncture useful, but overall of little benefit, study shows". The Guardian. Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, said the study "impressively and clearly" showed that the effects of acupuncture were mostly due to placebo. "The differences between the results obtained with real and sham acupuncture are small and not clinically relevant. Crucially, they are probably due to residual bias in these studies. Several investigations have shown that the verbal or non-verbal communication between the patient and the therapist is more important than the actual needling. If such factors would be accounted for, the effect of acupuncture on chronic pain might disappear completely." {{cite news}}: Italic or bold markup not allowed in: |newspaper= (help) Here is another source where Ernst makes a similar point. This is the same author who wrote the 2011 source. See (PMID 21440191). QuackGuru (talk) 19:53, 2 September 2014 (UTC)

The Guardian doesn't meet MEDRS for claims on medical efficiency, so we are not using it. Jayaguru-Shishya (talk) 20:19, 2 September 2014 (UTC)

Do you disagree that this is the same author who made a similar point? QuackGuru (talk) 20:35, 2 September 2014 (UTC)

(e/c)::@Jayaguru-Shishya - Well, the interpretation that has prevailed (and with which I've agreed) is that the source is Ernst himself (and the Guardian is considered reliable for reproducing his words), and per WP:SOURCES (I think), someone like Ernst can be an RS when self-publishing because he's an expert who has published under peer-review, as long as they're talking about their field of expertise (in which they've published). That said I am reconsidering whether such a quote is acceptable as a MEDRS (as opposed to RS) and leaning toward not. If Ernst really wants to refute that paper there's a way to do it: publish something. Colquhoun did, and we can cite that, and it says much the same thing, so deleting Ernst shouldn't be a big deal IMO. We should probably draw the line at MEDRS, and not allow Ernst, because otherwise we get an UNDUE problem whereby an expert's opinion is given the same weight as a carefully crafted MEDRS. In fact, the gold standard of MEDRS's: meta-analysis of individual patient data. Yes, I know the criticisms of Vickers are that the differences he find between sham and verum, though statistically significant, aren't clinically significant and may be artifactual (unblinding). Still it weighs, and significantly. After all, criticisms can be made of other MEDR's, such as their non-adherence to STRICTA, and we don't deprecate them nearly as much as Vickers has been deprecated. (Matter of fact, QG, some time back, fought the inclusion of nothing more than the four types of pain Vickers looked at. Vickers, a gold-standard source, the biggest and most exacting meta-analysis ever (AFAIK) for acu. Yet more double-standard. (whew -- need a timeout) --Middle 8 (POV-pushing • COI) 20:37, 2 September 2014 (UTC)

What Ernst said in the past and present has not changed. There is no debate over what Ernst said then. QuackGuru (talk) 20:44, 2 September 2014 (UTC)

Which is irrelevant to whether his comment is a MEDRS. (RS, yes, it is, but he is making a MEDRS claim in that quote.) Now, if he criticize Vickers in a more recent review -- which I may have missed -- then that supersedes the Guardian source. --Middle 8 (POV-pushing • COI) 21:01, 2 September 2014 (UTC)

Exactly, exactly.... Jayaguru-Shishya (talk) 21:05, 2 September 2014 (UTC)

Arbitrary break for more input

I've outlined the issue regarding Ernst '11 (PMID 21440191), and have filed at WT:MEDRS. (I don't remember if we discussed this there or elsewhere before but that does seem the best venue.) --Middle 8 (POV-pushing • COI) 17:49, 2 September 2014 (UTC)

See WT:MEDRS#Acupuncture_source. Have also explained the issue clearly at User:Middle_8/Ernst-11, and remember, you can email me (or any editor with access) for a copy. Let's go for more light and less heat, fellow editors! -Middle 8 (POV-pushing • COI) 18:01, 2 September 2014 (UTC)

Is Middle 8 canvassing editors on there talk page long after the discussion was over? Not sure why you are bringing it up again.

Do you remember you had a discussion on User:RexxS's talk page. See User_talk:RexxS/Archive_25#Ernst_re_pain..._and_talk.... We did have a long discussion on this talk page and at Wikipedia_talk:WikiProject_Medicine/Archive_51#Acupuncture_again. QuackGuru (talk) 17:59, 2 September 2014 (UTC)

If I understand the point being made, it is pretty straightforward. Many trials exist of acupuncture vs. sham or placebo, but proper blinding to the the controls is difficult if not impossible due tot he nature of acupuncture (e.g. the tendency to leave bruising for up to a fortnight afterwards, a dead giveaway). There's also the problem that negative results are virtually never published in the acupuncture / TCM journals, and most are published in China where there is a well documented systemic bias. You want to assert the primacy of the larger trials, despite the lack of any proven mechanism of effect. Ernst makes the point, quite forcefully, in numerous venues including this paper, that the positive results are weak and not getting any stronger, whereas increasingly sophisticated controls show ever more strongly that needling is ineffective (and this is additive to the finding that the location of needling is irrelevant, as expected form the absence of any empirical basis for the locations traditionally used, and lack of unanimity between traditions).

However, I find reading any argument by pro-quackery editors frustrating and I become impatient, so if someone could distil the actual question into a short sentence, I will email it to the source and ask (this is legitimate when it's a matter of clarifying our interpretation, rather than original research). Guy (Help!) 19:39, 2 September 2014 (UTC)

@ JzG: Here's a better, simpler summation than the below: should we cite Ernst's statement "real acupuncture was no better than sham" as being the conclusion of his review per se, or not. The statement appears in the first paragraph on p. 762 of PMID 21440191.

In context, it is apparent that his statement refers to some recent, high-quality trials that showed null results. Contrary to QG's reading, it does not refer to the reviews he looked at, and is not a general conclusion of his review. The majority of those reviews were actually positive for acu, but with numerous contradictions and caveats. That's why he said those result should be seen in light of recent, better trials. The highlighted text at User:Middle_8/Ernst-11 illustrates this context, and the unlikelihood of QG's reading. --Middle 8 (POV-pushing • COI) 05:09, 3 September 2014 (UTC)

And the answer is: yes, undoubtedly. That is his settled view, and you can read his blog yourself for plenty more to that effect. You are playing semantic games, when to an outsider it is very obvious what he means, and it is not in the least bit flattering or supportive of acupuncture. Guy (Help!) 21:55, 3 September 2014 (UTC)

@ JzG (talk · contribs)/Guy - We can get both the letter and spirit of the law right without doing violence to either. That's the hallmark of a good encyclopedia. Did Ernst reply to you? I'd like to see exactly what you asked and what he replied. Thanks, --Middle 8 (POV-pushing • COI) 05:00, 4 September 2014 (UTC) edited for wl 05:07, 4 September 2014 (UTC)

@ JzG (talk · contribs)/Guy - Another way to put it is, what does that phrase "real acupuncture was no better than sham" refer to? Answer: one particular trial authored by Suarez-Almazon et. al., 2010. And I know that the results of that trial are consistent with Ernst's overall (and unsupportive) take on acu [14]. I apologize for not asking the question as clearly as I should have. But I am not playing semantic games: I'm reading the source correctly. Read the source carefully if you doubt that, and AGF. --Middle 8 (contribs • COI) 09:18, 6 September 2014 (UTC)

Acu fans say "Even sham acupuncture works as well as the real thing! Acupuncture is amazing!" - whereas the reality based community has stripped away first placement of needles and then whether needles are even used, and it makes no difference to the outcome, meaning that acupuncture is a placebo intervention and the effects are due to the theatre not the needles. If you are wedded to the outcome, this is a Big Problem and you must find ways to wave it away. If you are wedded to the process - i.e. finding out whether a treatment is real or not and using only those that have definie specific efgfects - then you shrug your shoulders, stop using that treatment and move on. Science is not threatened by acupuncture, nor is it threatened by the finding that it doesn't work. Guy (Help!) 13:00, 6 September 2014 (UTC)

Yes, and? All this is obvious to me, and has jack-squat to do with reading the source. You've fooled yourself into thinking this is about POV-pushing, just as RexxS did. Since I posted at WT:MEDRS, the two people who have looked at the source -- 2/0 and Peter Coxhead -- agree with my reading. That number will inevitably increase; it's not a difficult call. The ONLY reason there's a debate is that QuackGuru is yet again insisting on his way, and another "skeptic" decided it was all about "taking sides" -- plus I posed the question unclearly because I was so annoyed with the situation, causing eyes to glaze over. This summary is pretty clear though, and see WT:MEDRS discussion. --Middle 8 (contribs • COI) 18:59, 6 September 2014 (UTC)

earlier, longer reply to Guy

@ JzG: (I hope you're not counting me as pro-quackery.) tl;dr: The question is simply one of context: what does the statement "real acupuncture was no better than sham" (the bolded sentence in the excerpt at User:Middle_8/Ernst-11) refer to: (a) the high-quality trials Ernst points to (whose negative results Ernst correctly predicted set the pattern for future high-quality trials) -- that's the right answer -- or (b) the findings of the 57-odd reviews that he reviews. (end tl;dr)

QuackGuru wants to cite all or part of that sentence as referring to (b), and by extension, all of the acu literature. But the literature, as we know, still has some reviews finding efficacy (however artifactual) for pain and nausea -- that's why there's so much controversy in the blogosphere, right? If it were slam-dunk like homeopathy is, Steve Novella wouldn't be skewering the extant reviews finding for efficacy. This isn't about how I or anyone might want it to be, it's what is the meaning of Ernst '11 and what is the current state of the literature, which is what we're obliged to depict. I mean, come on, per WP:ENC we don't play fast and loose with the meaning of Ernst's paper, even if that sentence is "the spirit of where Ernst thinks things are headed" (which is the source of much of the confusion). --Middle 8 (POV-pushing • COI) abridged 20:14, 2 September 2014 (UTC)

Not superior to sham for low back pain symptoms

"Acupuncture is considered to be a form of alternative or complementary medicine, and as noted above, it has not been established to be superior to sham acupuncture for the relief of symptoms of low back pain."[15] QuackGuru (talk) 06:26, 4 September 2014 (UTC)

~~A good source, which weighs, along~~ Being a ~~case study~~, a review of clinical practice with only a small part devoted to efficacy, and not a systematic review, this is not a very strong MEDRS relative to ~~with~~ our other MEDRS's on low back pain -- which are not unanimously negative. Some are more recent too I believe.

Remember, if MEDRS's were unanimously negative on efficacy this wouldn't be nearly as controversial a topic. But right now we have good MEDRS's finding for efficacy for pain (probably acu's most significant indication), and a lot of the dissent is in sources that aren't MEDRS or even clear-cut RS. That's a picture of a field with significant remaining controversy. I trust that is a common-sense observation.... --Middle 8 (POV-pushing • COI) 07:00, 4 September 2014 (UTC) edited: struck text and added new text 04:55, 7 September 2014 (UTC); edited said new text again11:13, 7 September 2014 (UTC)

This source is also good MEDRS. I don't get the objection. This is specifically for low back pain not pain in general. QuackGuru (talk) 07:14, 4 September 2014 (UTC)

~~It's not an objection.~~ I wasn't objecting when I thought the source was a meta-analysis. My second para is a general comment; my opinion on the source is in the first para. Yes, it's fine, again keeping in mind whatever other MEDRS's we have for low back pain. But remember that we treat low back pain as a subset of back pain: distinct in a sense but not wholly distinct. --Middle 8 (POV-pushing • COI) 08:45, 4 September 2014 (UTC) edited: struck text and added new text 04:55, 7 September 2014 (UTC)

I noticed you are still a little apprehensive about including this. QuackGuru (talk) 02:42, 6 September 2014 (UTC)

No, I just want to make sure we WEIGHT it properly. --Middle 8 (contribs • COI) 20:10, 6 September 2014 (UTC)

"Real accupuncture is not superior to sham acupuncture for alleviating low back pain symptoms." I summarised the text and the preceding sentence is a proposal.[16] QuackGuru (talk) 02:43, 6 September 2014 (UTC)

I thought it was a meta-analysis, but it's not, is it? It's a case study. Weak MEDRS. Instead we should find whatever source they used for that statement, and use attribution wording just as we do with other reviews on pain (because MEDRS's on pain aren't unanimous, and we don't use a source to speak in WP's voice when equally-strong sources disagree).

BTW, here's a game: "Find a statement that's incorrect/UNDUE/out-of-context but sounds like it should be correct, and propose it. If no one objects, put the POV edit in the article. If someone objects, depict their objection as a POV-push." But you wouldn't do something like that, right? --Middle 8 (contribs • COI) 20:10, 6 September 2014 (UTC) edited 04:55, 7 September 2014 (UTC)

The source is a review. I don't know why you think it is a case study. QuackGuru (talk) 05:02, 7 September 2014 (UTC)

OK, I've got it in front of me. Yes it's a review of multiple aspects of clinical practice, no it's not a systematic review. They cite seven sources, two of which are systematic reviews; these are superior and we should use them as well. They also cite five primary studies. So it's MEDRS but lower weight than systematic reviews. And no we do not speak in WP's voice with a source that is inferior to other MEDRS's including ones that contradict it. --Middle 8 (contribs • COI) 07:51, 7 September 2014 (UTC) edited 11:15, 7 September 2014 (UTC)

And it's not a proper summary of the paper; they're actually endorsing using acu for low back pain because it's "more effective than no treatment". And they review not only "Clinical Evidence" but also "Pathophysiology and Effect of Therapy", "Clinical Use", and other aspects. You appear very eager to get those words "real acupuncture... not superior to sham" in the article no matter what. But we let sources dictate wording, not the other way around. Your proposal is not unreasonable, but it's not the best way to summarize the source, either. What the reader needs to know about sham is that it's a control and that it involved either faux points of faux needling. IMO you need to follow sources more, and spend less time thinking of wording you'd like to see and then trying to find sources to fit it.

So I propose that instead of copying and pasting the phrase you've been pushing for, we get a copy of this source to other editors and figure out how best to summarize it. --Middle 8 (contribs • COI) 08:17, 7 September 2014 (UTC)

Rearrange

Section under "effectiveness" should be rearranged in a logical manner, either alphabetically or by physiologcally. The current arrangement appears random and unsystematic. -A1candidate (talk) 01:52, 1 September 2014 (UTC)

I think User:Jmh649 is best at arranging sections and articles. QuackGuru (talk) 03:25, 1 September 2014 (UTC)

IMO the one with the best evidence should go first. This means that pain should go first. No strong feeling about the ordering of the rest. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:37, 3 September 2014 (UTC)

After pain, low back pain goes next. QuackGuru (talk) 04:59, 9 September 2014 (UTC)

Safe?

With acupuncture "there is a risk of accidental puncture of nerves, which could lead to brain damage or strokes. Kidney damage can result from deep needling in the lower back, and unsterilised needles can transfer HIV and hepatitis." QuackGuru (talk) 17:28, 23 August 2014 (UTC)

Since when is The Daily Telegraph an MEDRS-compliant source? -A1candidate (talk) 01:16, 25 August 2014 (UTC)

Yeah, I'd like to hear that as well. Jayaguru-Shishya (talk) 12:10, 25 August 2014 (UTC)

Yes popular press should not be used for medical content. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:35, 25 August 2014 (UTC)

If an editor (who should know better) were to suggest using popular press as MEDRS for "pro-acupuncture" statements, an admin would use that to support sanctioning that editor under AE. Strange the converse doesn't seem to be true.... --Middle 8 (POV-pushing • COI) 08:47, 26 August 2014 (UTC)

You were using a primary source is engage in a "pro-acupuncture" statement. Do you think an admin would use that to support sanctioning you under AE? QuackGuru (talk) 20:23, 26 August 2014 (UTC)

Ummm.... that diff shows me using a peer-rev RS for a non-medical claim. ~~That's not quite the same as your proposal above to use a newspaper as a MEDRS.~~ (BTW, why is the link to your talk page in red? Redlinks imply that no such page exists; it's confusing.) --Middle 8 (POV-pushing • COI) 04:07, 27 August 2014 (UTC)

You added a primary source that violated WP:SECONDARY and WEIGHT. I did not make a proposal to use the source above. See WP:AGF. I was using the talk page to document what was missing from the article and added this. QuackGuru (talk) 04:14, 27 August 2014 (UTC)

If that was why you mentioned the news article, then you should have said so; three editors misunderstood you. In light of your clarification, I'm striking my comments about sourcing. With respect to the point you're trying to make, your quote was selective. The bit you quoted is preceded by "While most acupuncture causes little harm," is consistent with how the literature weights AE's. Omitting important context like that is not a great way to get others to AGF. More re which, please see your talk page. --Middle 8 (POV-pushing • COI) 07:18, 27 August 2014 (UTC)

I wasn't trying to make a point. I was making a note. We are not using that source. QuackGuru (talk) 07:28, 27 August 2014 (UTC)

Why did you post it at all then? Was it to show that the article needs to spend more time on infection and other adverse events?

Here's the full quote -- which is a pretty accurate depiction of our MEDRS's -- with the part you omitted in bold red:

"While most acupuncture causes little harm, there is a risk of accidental puncture of nerves, which could lead to brain damage or strokes. Kidney damage can result from deep needling in the lower back, and unsterilised needles can transfer HIV and hepatitis."

The bold red part -- which you omitted -- shows why it's an UNDUE problem to devote excessive coverage to infection and other serious adverse events. Why did you omit it? --Middle 8 (POV-pushing • COI) 10:21, 28 August 2014 (UTC)

On the contrary, I added "Acupuncture is generally safe when administered using clean technique and sterile single use needles.[3][16]" See diff. I previously explained, I left a note on the talk page. QuackGuru (talk) 19:08, 31 August 2014 (UTC)

I'm not talking about article space edits -- and that was a good article edit, although you didn't make it until you got called out here. Taking material out of context anywhere, including article talk, can create a biased impression. Here, you omitted the one part of the quote that gives the rest of the quote proper weight. Why? See WP:OPPONENT. --Middle 8 (POV-pushing • COI) 04:54, 2 September 2014 (UTC)

I did explain this was only a note. I did not omit anything from the note to myself. QuackGuru (talk) 03:13, 8 September 2014 (UTC)

Strange place for a note to "yourself". Others use this page too. And four editors responded before you explained yourself (and then only when called out). --Middle 8 (contribs • COI) 12:34, 9 September 2014 (UTC)
Re recent edits listing specific infections, please see Talk:Acupuncture#Infection below.

Discussion had already begun below, and the above discussion about the newspaper is extraneous, except for the UNDUE issue. --Middle 8 (POV-pushing • COI) 10:21, 28 August 2014 (UTC)

Reliable source? - "From Alien Abductions to Zone Therapy"

What about this one: "From Alien Abductions to Zone Therapy", are we using books on extraterrestrials (!) now too? Jayaguru-Shishya (talk) 12:10, 25 August 2014 (UTC)

It is not a scientific source and we should not use it. -A1candidate (talk) 20:27, 26 August 2014 (UTC)

We are not using a book on extraterrestrials in general. QuackGuru (talk) 20:45, 26 August 2014 (UTC)

Copied from User talk:Jayaguru-Shishya#Encyclopedia of Pseudoscience is a reliable source

William F. Williams, ed. (2000). Acupuncture. Facts on File. pp. 3–4. ISBN 978-1579582074. {{cite encyclopedia}}: |work= ignored (help) This is not a random book. It is an encyclopedia.QuackGuru (talk) 16:10, 25 August 2014 (UTC)

I haven't yet found where to access that book. The name, however, implies that it has something to do with extraterrestrials, is that right? If so, are we using an encyclopedia on extraterrestrials to support claims on medical efficiency? Jayaguru-Shishya (talk) 09:35, 26 August 2014 (UTC)

The Encyclopedia of Pseudoscience is not a book about extraterrestrials in general. The encyclopedia covers pseudoscience from Alien abductions to zone therapy. The name does not imply it is a book on extraterrestrials in general. It covers a wide range of pseudoscience topics. Please don't get involved in an edit war or claim the source is not reliable. Did you read the Encyclopedia of Pseudoscience page? QuackGuru (talk) 19:40, 26 August 2014 (UTC)

Have I made even one single revert concerning your addition of this book? Jayaguru-Shishya (talk) 20:10, 26 August 2014 (UTC)

You have made a comment on the talk page which concerns me. Do you agree your comment on the talk page was misleading or you made a mistake? QuackGuru (talk) 20:16, 26 August 2014 (UTC)

This was copied from his talk page. QuackGuru (talk) 20:34, 26 August 2014 (UTC)

The discussion belongs here, not on his talk page. -A1candidate (talk) 20:38, 26 August 2014 (UTC)

He is misrepresenting the book. Do you concur? QuackGuru (talk) 20:45, 26 August 2014 (UTC)

I would agree that the book is certainly much more ~~about~~ than aliens and UFOs, but according to our article on Encyclopedia of Pseudoscience, many of its contributors hail from dubious institutions such as "Center for UFO Studies" and "Department of Religious Studies". The publisher does not sound very reputable either -A1candidate (talk) 20:58, 26 August 2014 (UTC)

You claim the book is much more about aliens and UFOs. No, I previously explained the encyclopedia covers many pseudosciences.

Do you think the encyclopedia is widely used on Wikipedia? QuackGuru (talk) 21:06, 26 August 2014 (UTC)

The publisher is in general a decent publisher and good enough to not disqualify one of its books on the basis of the publisher alone. But there do seem to be some perhaps reasonable grounds to question some of the content as per reviews in the article. It would help a lot if it was more clearly indicated what specific material from the book is being used as well as the name and reputation of the author of the specific article in question.John Carter (talk) 21:29, 26 August 2014 (UTC)

Copied from User talk:Jayaguru-Shishya#Encyclopedia of Pseudoscience is a reliable source

You changing your previous comment and questioning weather the book is reliable. You claimed "What about this one: "From Alien Abductions to Zone Therapy", are we using books on extraterrestrials (!) now too?."

I told you the book is not on extraterrestrials in general. See WP:IDHT. QuackGuru (talk) 20:29, 26 August 2014 (UTC)

You are not giving a valid reason for deleting sourced text. For example, you have not shown how the encyclopedia is unreliable. QuackGuru (talk) 21:10, 26 August 2014 (UTC)

I meant to say that the book is much more than aliens and UFOs. Being cited on Wikipedia has no relevance to its reliability and I don't think it qualifies as an actual medical textbook. -A1candidate (talk) 21:49, 26 August 2014 (UTC)

No need to include any extraterrestrial / UFO authors for medical claims, that's it! Please do find a better source. So simple, problem solved! Jayaguru-Shishya (talk) 21:44, 26 August 2014 (UTC)

The above comment seems to be taking the editors own assumptions as conclusions and such behavior is not considered acceptable here. In short the only problem in this topic is the problem of the editor who apparently is making completely unwarranted assumptions about the content of a book based apparently simply upon a misreading of the title. The real list of articles contained in the book beyond the names of the first and last alphabetical entries can be found at Wikipedia:WikiProject Skepticism/Encyclopedic articles#Encyclopedia of Pseudoscience. I might go further and say that it strikes me as being potentially problematic behavior to attempt to dismiss such a source on the extremely dubious rationale apparently being used here.John Carter (talk) 21:55, 26 August 2014 (UTC)

"Alien abductions", "extraterrestrial intelligence", "communication with extraterrestrial intelligence" ... are you pretty sure this is a medical textbook? So should we be using this as a medical source? Jayaguru-Shishya (talk) 22:10, 26 August 2014 (UTC)

I never said it was a medical textbook and I very strongly suggest that editors here refrain from any further disruptive editing of that type. I had asked a question regarding what content the source is being used to support in the article. It is in fact generally common practice to indicate that at the beginning of a thread to make discussion easier and I am rather surprised that the OP had not indicated that earlier in the thread. I find the questions asked above to be counterproductive because they seem to be making implicit assumptions about matters which have never been so far as I can see specifically introduced into discussion. Unfortunately such conduct can be seen as problematic. I would very much welcome seeing more clearly useful comments perhaps along the lines of directly responding to the questions I had asked earlier.John Carter (talk) 22:23, 26 August 2014 (UTC)

Jayaguru-Shishya, please stop the endlessly repetitive IDHT disruptive comments! When it comes to determining whether a source is a RS, it all depends on how it's used. No single source (even the New York Times) is considered reliable in every situation, and there is practically no single source that isn't considered a RS for some very limited purpose (such as the nonsensical insane Twitter speculations of a weirdo, used in an article about that weirdo, for the purpose of documenting their POV).

If you will check the two places where the Encyclopedia of Pseudoscience is being used in this article, it is used appropriately for the use intended in that context. Context is everything when determining whether a source is being used appropriately. If so, then it is a RS for that purpose. SMH...! (I really get tired of explaining this basic stuff when competence is lacking.) Can we hat this yet?! -- Brangifer (talk) 22:57, 26 August 2014 (UTC)

Its contributors are mostly from the humanities department. The book is not from a notable academic publisher and it is more than a decade old. Please read WP:MEDRS carefully. -A1candidate (talk) 23:40, 26 August 2014 (UTC)

MEDRS does not apply to the way this source is being used. This is documenting the POV of those who consider the subject worthy of being included in an encyclopedia about pseudoscience. MEDRS citations rarely deal with pseudoscience. They generally ignore it. -- Brangifer (talk) 00:03, 27 August 2014 (UTC)

All health content here is subject to WP:MEDRS. If you wish to edit Wikipedia, please respect our policies and guidelines. -A1candidate (talk) 00:24, 27 August 2014 (UTC)

Like I already said if you disagree and wish to resolve this matter the appropriate forum would be RSN. Also I believe you may be making a mistake of overgeneralization. Not all content in all articles relating to medicine broadly construed must necessarily always adhere to MEDRS and this particularly includes content relating to public perceptions and history and other material not of an explicitly medical nature.John Carter (talk) 00:33, 27 August 2014 (UTC)

The source is not being used for biomedical information it being used for how acupuncture is described/viewed. Please read the guidelines you cite. While your at it read the core policy NPOV which requires we present the significant published views on the subject. Might I also suggest reading Tendentious editing. As above the appropriate forum is RSN, be sure to specify what content is supported by the source and why you don't think it is a reliable source for that content. - - MrBill3 (talk) 00:39, 27 August 2014 (UTC)

The content backed up by the source is not just of a medical nature, it is also a direct health claim so WP:MEDRS applies. -A1candidate (talk) 00:42, 27 August 2014 (UTC)

A1candidate, there is another solution. Try to suggest altered wording which justifies using the source. You obviously believe the source is misused. How about suggesting tweaks of the wording? Maybe we can find a solution that way. Okay? -- Brangifer (talk) 00:51, 27 August 2014 (UTC)

Read the content some contemporary practitioners...have abandoned the concepts of qi and meridians as pseudoscientific." not a health claim but a description of the views and practices of some contemporary practitioners, and "Some modern practitioners...They, along with acupuncture researchers, explain the analgesic effects of acupuncture as caused by the release of endorphins, and recognize the lack of evidence that it can affect the course of any disease." again neither biomedical information presented as fact nor a health claim but the explanations and realizations of an identified specific group. The source is RS for what some practitioners think or say. Note also all of the information associated with this content that is of a biomedical nature is very well spelled out and supported with MEDRS quality sources when it is presented in terms of health claims and biomedical information. Your IDHT is becoming quite tendentious RSN has been suggested. This article is under discretionary sanctions. Consider this a notification of the PAG in relation to Tendentious editing and Discretionary sanctions A1candidate. Please consider this in your further editing. - - MrBill3 (talk) 01:03, 27 August 2014 (UTC)

I was referring to this content, not the one you quoted. -A1candidate (talk) 01:19, 27 August 2014 (UTC)

We can compromise and tweak the text. QuackGuru (talk) 05:19, 27 August 2014 (UTC)

Thank you for the clarification. It really helps when objecting to a source to specify what content is being challenged. The content I quoted is all that is currently in the article supported by this source.

I agree with A1candidate that the content in the diff provided above is difficult to justify supporting with Williams 2013. I agree a more MEDRS compliant source is appropriate for "There is no evidence that inserting needles can affect the course of any disease." I apologize for my contentiousness, it was due to a misunderstanding. - - MrBill3 (talk) 01:32, 27 August 2014 (UTC)

This comment was very helpful. I can tweak the text to a specific group. QuackGuru (talk) 05:17, 27 August 2014 (UTC)

The phrase in the article: 'lack of evidence that it can affect the course of any disease' is not consistent with a published Cochrane review. Tension-type headache are considered to be diseases by the current version of the WHO's ICD-10 (disease number G44.2). The 2009 Cochrane review of acupuncture for tension headache (www.ncbi.nlm.nih.gov/pubmed/19160338) states "acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches". The WP article actually refers to tension headaches in the Headaches and migraines section but incorrectly cites a Cochrane review on migraine and contradicts itself. With consensus, the latter incorrect citation should reasonably be corrected to cite the correct article and the contradictory statement should be removed. Is the Cochrane review on tension headache sufficient to withdraw the statement on lack of evidence that acupuncture can affect the course of any disease? Tzores (talk) 05:52, 27 August 2014 (UTC)

The Cochrane review does not clearly state benefit. "could be a valuable non-pharmacological tool" With respect to affected long term disease outcomes it states "Long-term effects (beyond 3 months) were not investigated" Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:46, 27 August 2014 (UTC)

The source we are working with [18]

It states "Orthodox researchers posit that the practice generates endorphines, chemicals imilar to narcotics, but they add that, although pain is reduced, there is no evidence that the application of needles can influence the course of any organic disease."

The source is from 2013. The publisher is "Routledge" which is well respect in the humanities.[19] Acupuncture being on the fringe of science is covered by the humanities and thus this source is not unreasonable.

The next question is how should we summarize it. Maybe "Western medicine, while accepting it may affect pain through increasing the bodies release of endorphins, does not consider acupuncture to alter the long term course of diseases" Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:54, 27 August 2014 (UTC)

The text you're proposing is an excellent example of WP:OR. All medical articles must rely on scientific sources. -A1candidate (talk) 07:43, 27 August 2014 (UTC)

Should not be too difficult to support this by other sources aswell I imagine. In fact we have "The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits" which is basically the same thing. [20] Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:06, 27 August 2014 (UTC)

Yes, this review is much better than the non-scientific source. I have no objections to using it for now, although I note that it is slightly past WP:MEDDATE so we should continue to look for more recent reviews. -A1candidate (talk) 07:43, 27 August 2014 (UTC)

I agree with A1candidate. The source is being used for claims on medical efficiency, and it is already outdated per WP:MEDDATE. We should not use outdated sources for such claims. Jayaguru-Shishya (talk) 17:22, 10 September 2014 (UTC)

My post below was almost e/c'd with A1C's post, and agree -- prefer the solid MEDRS. --Middle 8 (POV-pushing • COI) 07:57, 27 August 2014 (UTC)

A1candidate, if you agree then what was the reason you tried to delete the text from the lede along with other reviews? QuackGuru (talk) 08:47, 27 August 2014 (UTC)

It's not an unreasonable claim, and we should be able to work it in somehow. But acu isn't so fringe that we lack full-blown MEDRS's on it -- quite the contrary; it's been massively researched -- and I think we should use those whenever possible.

And I'm not so sure that the amelioration of pain and stress doesn't affect the long term course of chronic diseases -- it's just a very very non-specific effect. Isn't that why it's used as a complementary therapy in academic medical centers like Harvard [21] and U-Maryland [22] etc etc? Or is that just to make patients feel better... or is that the same thing? (Seriously, just because critics call such use "quackademic" doesn't change the fact that these settings are about as mainstream as it gets. We need to reflect that. Why is it used so widely? The answer isn't irreconcilable with systematic reviews.) --Middle 8 (POV-pushing • COI) 07:44, 27 August 2014 (UTC)

Yes agree we can just stick with the better source that says more or less the same thing. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:55, 27 August 2014 (UTC)

I also agree the source is reliable for the claim: "The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits". There is broad consensus to use the source for the claim but it was inappropriately tagged. I left a note on the Jayaguru-Shishya's talk page about the tag. QuackGuru (talk) 16:54, 10 September 2014 (UTC)

~~The source is outdated per WP:MEDDATE, and it's used to support claims on medical efficiency. We should not use outdated sources for that. Jayaguru-Shishya (talk) 17:22, 10 September 2014 (UTC)~~

There are no objections to using this source. See diff. QuackGuru (talk) 17:42, 10 September 2014 (UTC)

Oops, got mistaken. The discussion here is about replacing Williams by Wang et al. (2008). The Williams source is still being used, but there is no consensus for Wang et al. (2008) on claims about medical efficiency on another sentences. No consensus for that one, it's not even been discussed. Jayaguru-Shishya (talk) 18:16, 11 September 2014 (UTC)

Outdated reviews in the article

Greetings! I tagged the source "Ernst, E. (2006)" for being outdated per WP:MEDDATE [23]. The tag was first removed by 2/0 per "thank you, but this is a statement of history, not medicine; minor gmr"[24], even it is used in the text to support claims on medical efficiency. The text says:

"Ernst also described the statement in a 2006 peer reviewed article as "Perhaps the most obviously over-optimistic overview [of acupuncture]", noting that of the 35 conditions that the WHO stated acupuncture was effective for, 27 of the systematic reviews that the WHO report was based on found that acupuncture was not effective for treating the specified condition."

This can be found from the original review under the title "Clinical effectiveness". I don't really see why this would be about history, not efficiency. Anyway, the tag was later restored by user LesVeges[25] until it got removed again by QuackGuru per "The source is a review and reliable."[26]. QuackGuru, exactly. According to WP:MEDDATE:

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

The source is a 2006 review used for claims on medical efficiency, and therefore it's outdated. The review is also used at the Efficiency section. I think the source should be removed and we should look for more up-to-date sources instead. :P Jayaguru-Shishya (talk) 10:45, 10 September 2014 (UTC)

Efficacy section

That particular statement is describing that particular WHO report and the state of research at that point in time. The text does not seem to be misleading. No opinion on other uses of the source. - 2/0 (cont.) 10:54, 10 September 2014 (UTC)

Isn't that what you can say on every mention of an outdated source? "Well, it reported the state of research at that point in time"? Science is accumulative in nature, and like WP:MEDDATE puts it, we should only use sources that are recent enough. I'd understand something like: "In the 1930's it was still believed...", but now we are dealing with a 2006 review in the Journal of Internal Medicine. The review goes about the medical efficiency, and as such it is used in the article. Not just the review is outdated, I wonder why we are including such statements in the Ethics section? Jayaguru-Shishya (talk) 11:32, 10 September 2014 (UTC)

You seem to be misreading my position.

More productively, do you have a suggestion for replacing each instance where the source is used? - 2/0 (cont.) 12:08, 10 September 2014 (UTC)

2/0, sorry if you feel like I was misreading your position, that wasn't my intention. To answer your question: no, I don't have anything to replace the source. As I said earlier, I think the source should be removed as an outdated one when it is used for claims on medical efficiency. If someone finds newer sources to support these claims, they'd be more than welcome. For statements like "Clinical practice varies depending on the country.", I think it suits just well. Jayaguru-Shishya (talk) 13:16, 10 September 2014 (UTC)

You are continuing to tag reliable sources even after consensus was reached the source is reliable for the claim. QuackGuru (talk) 16:59, 10 September 2014 (UTC)

QuackGuru, I'm very sorry but I have to agree with Jayaguru-Shisha on this one. Again, I appreciate how you cite everything you say on this here talk page, but in this instance I checked your links and don't see where any consensus was reached about this source. That's not the source he is talking about, it appears to be an older argument. I'm sorry if I'm mistaken when reading your link, but I see a different source that a few editors agreed upon, not this one. We need to tag sources older than 5 years and remove statements if they cannot be backed up with more recent sources. They may have been reliable in the past, but science moves fast and they are outdated now. You seem reasonable so I'm sure you can agree that we don't need any fossils decaying the page. LesVegas (talk) 03:45, 11 September 2014 (UTC)

We don't tag and delete sources just because they are older than five years. QuackGuru (talk) 03:50, 11 September 2014 (UTC)

Actually, that's not true, I see on acupuncture many times where this has happened. A few days ago, I went though and examined almost every single edit over the past year. Anyway, there are plenty of edits where outdated sources are removed. Please look here here here here here here and here. By the way, not to quibble, but most of those edits were yours. LesVegas (talk) 04:38, 11 September 2014 (UTC)

The older sources were removed when we had better sources. I deleted the older sources because I found another source. QuackGuru (talk) 04:45, 11 September 2014 (UTC)

Well that's exactly what we're trying to do with the tags. We are trying to find more current sources. Did you replace all the other sources with new ones too? Not that you're required to do that or anything, but I am just curious. But I think my links speak for themselves, and that you do agree old sources can't be used. LesVegas (talk) 04:56, 11 September 2014 (UTC)

No, first you should find other sources. If you can't find another source you should not tag the source or remove the source. QuackGuru (talk) 05:05, 11 September 2014 (UTC)

Now QuackGuru, be honest, did you do this in every instance? Did you replace the sources with new sources? Did other past editors in my list of links do it, such as Roxy the Dog or Jmh649? Not that you or they or anyone is required to do so, I don't see anywhere on WP:MEDDATE where it says you are required to replace outdated material with fresh material, only that sources should be 2-3 years old and definitely within 5 years old. I also don't see anywhere where you are required to tag it, I just think tagging is better than deleting it right away (which is what everyone in my list of links did.) To me, this seems very reasonable. I came onto this page tagging the article with a POV tag because all tags, used appropriately, are much more reasonable than the alternative. LesVegas (talk) 05:30, 11 September 2014 (UTC)

You should not delete any source because it is older. I previously explained to you that you should first find another source. QuackGuru (talk) 05:53, 11 September 2014 (UTC)

There is no such policy. We don't use outdated sources in the article. Jayaguru-Shishya (talk) 09:54, 11 September 2014 (UTC)

Of course we use older sources in articles. Only when a newer source is found we replace the older source with a newer source. QuackGuru (talk) 17:31, 11 September 2014 (UTC)

What about in these other instances? here here here here here and here If you could address all of these instances that would be helpful because I don't see that these were all replaced with new sourcing. Again, not that it's a requirement. I see nowhere in the policies where this is required, only that aged sourcing isn't allowed. But if we decided on a precedent somewhere, I don't see much evidence for it yet and am more than willing to hear your case out! LesVegas (talk) 17:52, 11 September 2014 (UTC)

According to LesVegas, QuackGuru is literally correct. QuackGuru (talk) 18:42, 11 September 2014 (UTC)

QuackGuru, I commended you earlier for citing everything you say, but when I actually click on what you cite, I have noticed that you repeatedly cite diffs which do not truly say what you claim. Please see WP:DISRUPTSIGNS for why this is a problem. When you do this repeatedly, as you have done recently by claiming a fellow editor has 4 reverts when he hasn't, when you falsely cite a claim of consensus, and when you say "do not delete any source because it is older" and I provide you diffs where you did just that, and you ignore them, it becomes problematic. I engaged in discussion with you on this thread for far too long. I repeatedly asked you questions and you repeatedly danced around them NOT GETTING IT and then you edited as you saw fit. I've been nothing but nice to you, but don't mistake that for being a pushover. LesVegas (talk) 04:24, 12 September 2014 (UTC)

Wang, Shu-Ming; Kain, Zeev N.; White, Paul F. (2008)

The source is an outdated one per WP:MEDDATE. Jayaguru-Shishya (talk) 19:27, 10 September 2014 (UTC)

Please don't move my comment again. QuackGuru (talk) 19:52, 10 September 2014 (UTC)

There is broad consensus to use the 2008 source. See Talk:Acupuncture#The_source_we_are_working_with_.5B39.5D. QuackGuru (talk) 17:31, 11 September 2014 (UTC)

Better not to WP:IDHT QuackGuru. You already made clear your stance at my Talk Page, where I replied to you that: "So far, it seems you, A1candidate, Middle 8, Doc James and I who have commented there. You and Doc James seem to be in favor of the source (even it's outdater per WP:MEDDATE), and I'd like to hear clarification from Middle 8 and A1candidate." Five editors commenting does not establish "a broad consensus", as you put it. Especially when User:A1candidateand User:Middle 8 are wished to provide clarification for their comments. And like User:Les Veges already said: "I checked your links and don't see where any consensus was reached about this source."[27]. Jayaguru-Shishya (talk) 18:15, 11 September 2014 (UTC)

Actually, see my latest post here. What you pertain as "consensus" has nothing to do with the the source that is tagged as outdated now. The original source being used is expressed here by Doc James: [28]. The replacement for it is being suggested here: [29]. The original is still being used. You have also been noticed about this by user LesVegas[30]. You are falsely claiming consensus.

. Anyway, the discussion about removal of Wang et al. (2008) is related to whole different uses of that source. At the moment, we are using an outdated source for medical claims. Cheers! Jayaguru-Shishya (talk) 18:30, 11 September 2014 (UTC)

Nope. See diffs.[31][32][33] QuackGuru (talk) 18:39, 11 September 2014 (UTC)

Jayaguru-Shishya was informed of the disruptive editing at the acupuncture page in April 2014. User:Jayaguru-Shishya was restoring a tag to another sentence. Revert 1. Deleting tags. Revert 2. Restoring a lot of tags. Revert 3. Restoring QuackGuru's edits and deleting material. Revert 4. After making edit after edit it suggests there may be no consensus for at least some of the changes. QuackGuru (talk) 20:24, 11 September 2014 (UTC)

Indeed, how does a notice from April - when I just had started editing here - does have to do with the issue on your mind? However, you just got warned by administrator last week. If I was you, I'd keep extremely careful; I hope you will learn from your mistakes.

" Revert 1. Deleting tags"? I reverted the edits by user LesVegas, and I informed about this on his/her Talk Page[34]. LesVegas agreed with my revert after the correction that I made. What's your problem with that?

"Revert 2. Restoring a lot of tags", what problem are you having there? As clearly stated in the edit summary after the 24 edits you made in a row: "Woa! 24 edits in a row! Anyway, I had the time to check up only the 4 first of your tag removals. The others should have be inspected as well. I'll recover the other edits you made with the next edit (even it took a lot of time)". Please state it clearly if you are unhappy with something. As these unsourced sentences are tagged, I and the rest of Wikipedia community has a change to review if those sources given later really do not verify the claims. I already removed some which I had time to take a look.

"Revert 3. Restoring QuackGuru's edits and deleting material" I reverted back to your edit :-) ! LOL!

Revert 4 ... ??? Jayaguru-Shishya (talk) 20:55, 11 September 2014 (UTC)

Where are the 4 reverts? I already showed 4 reverts. The 4 diffs show 4 reverts.[35][36][37][38] I already discussed it that the sources are reliable for the claim. QuackGuru (talk) 21:04, 11 September 2014 (UTC)

Why do you ask "Where are the 4 reverts" when you quote them straight afterwards? ...and you actually keep pertaining to those over and over again...

Anyway, please answer now honestly QuackGuru ("yes" or "no"). First, are the sources outdated per WP:MEDDATE (older than five years) to support any medical claims? Second, are the sources in question used to support medical claims (MERDS)? ~Thanks. Jayaguru-Shishya (talk) 21:23, 11 September 2014 (UTC)

Mao's "new acupuncture"

This material is directly supported by the source immediately following it. I might phrase it slightly differently, but that can wait until the article is unlocked. Would there be any objection to restoring the material through protection? - 2/0 (cont.) 18:43, 12 September 2014 (UTC)

Check the article history. A lot of text was deleted. We should go back to before the controversial edits were made. QuackGuru (talk) 18:52, 12 September 2014 (UTC)

1997 NIH statement

The 1997 NIH panel statement is really old and a bit unusual. We should not use it to represent anything modern, though perhaps it can be retained for some historical significance. Thoughts on removing the reference? - 2/0 (cont.) 19:13, 16 August 2014 (UTC)

Agree that it should be removed. There is an explicit warning against using it: "They were current when produced, but are no longer maintained and may now be outdated." -A1candidate (talk) 19:18, 16 August 2014 (UTC)

We are using the 2005 Quackwatch as a source now. See Acupuncture#Ethics. I recently fixed the text. QuackGuru (talk) 19:21, 16 August 2014 (UTC)

The statement was only being used to support some pretty basic and unlikely to be challenged information, so I boldly removed the reference. - 2/0 (cont.) 19:26, 16 August 2014 (UTC)

I requested a source for the non-controversial claims. QuackGuru (talk) 20:08, 16 August 2014 (UTC)

Why did you do that? We don't use sources for non-controversial claims. Such a request can be seen as disruptive, so why do it? You're not making sense. -- Brangifer (talk) 00:50, 17 August 2014 (UTC)

I am not making a request that we must use a source. I was stating when someone finds a source it can be added to the article. QuackGuru (talk) 00:58, 17 August 2014 (UTC)

Ooookaaay...? Then we can remove that CN, since it's not necessary. We don't clutter articles, especially the leads, with unnecessary things. If it's really necessary, the body will contain references. -- Brangifer (talk) 01:01, 17 August 2014 (UTC)

I agree no tag was needed so I removed the tag from the body along with other tags from the body. But now an editor without consensus is deleting lots of text in the body. This text is sourced. QuackGuru (talk) 23:23, 11 September 2014 (UTC)

Indeed, this piece of text was sourced after all. My apologies. I think, however, that your rapid editing makes it really difficult to follow up what's going on. Jayaguru-Shishya (talk) 11:08, 12 September 2014 (UTC)

{{edit protected}} Per the above two comments, it looks like this edit should be undone and the cn tag removed. - 2/0 (cont.) 18:00, 12 September 2014 (UTC)

I don't see consensus to revert only one edit. I disagree with this edit protection request. I strongly disagree with the unprotection request to revert only one edit. All the recent edits to add the tags and to delete the material was a mistake. We should go back to this version and unprotect the article. QuackGuru (talk) 18:19, 12 September 2014 (UTC)

Well, never mind then; turning off the template for now. QG, I agree that there are several recent edits that need to be examined in detail, but I think that we can handle them individually. I am not seeking to have the article unprotected (I just yesterday requested that it be locked), just to have this one change made. Do you disagree that the article as it currently stands would be improved by restoring that sentence about use of qi as an explanatory framework? - 2/0 (cont.) 18:40, 12 September 2014 (UTC)

I think we should go back to this version and it is a waste of time handling each edit individually. I don't see any reason to having this article locked. QuackGuru (talk) 18:47, 12 September 2014 (UTC)

~~I think you may have mixed up your pronouns there, as I do indeed think the article needs to be locked for now.~~ I would not necessarily be averse to reverting to that version, but the case would need to be made. - 2/0 (cont.) 18:57, 12 September 2014 (UTC)

I fixed the typo. This is what happened. I undid my own edits and removed the tags. Next, after the tags were restored sourced text was deleted. This is a strong case to removed the tags so this won't happen again. QuackGuru (talk) 20:11, 12 September 2014 (UTC)

Protected edit request on 12 September 2014

This edit request to Acupuncture has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

Listed on [39] Add "|displayauthors=9" where 9 authors are listed in a citation. Hamish59 (talk) 19:00, 12 September 2014 (UTC)

This can be done after the text is restored otherwise it may make it difficult to revert back to the previous version. QuackGuru (talk) 19:14, 12 September 2014 (UTC)

Done. If we revert over the change, it is easy enough to fix. - 2/0 (cont.) 19:16, 12 September 2014 (UTC)

I think "|displayauthors=4" is preferable there is no need to list nine authors. Four is pretty much standard on WP. Just my 2¢. - - MrBill3 (talk) 05:43, 14 September 2014 (UTC)

Low level details restored against consensus

"" Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.[40] The source says it was for chronic pain. So why delete text what the source said? See Acupuncture#Pain.

"We need to be sure not to imply this is for chronic pain in general either by specifying "kinds of pain" or enumerating those kinds. I prefer shorter, but it's no biggie." User:Alexbrn explained on January 4, 2014.[41]

The Vickers study was largely criticised by experts. Instead of deleting the controversial Vickers sources we reached a compromise with the wording. But now Middle 8 decided to add the extra details again. This edit was clearly against consensus when the previous discussion was against including it.

We already had a discussion about the details for the Vickers text.[42][43] The result of the discussion back in January 2014 was against including the extra details. See Talk:Acupuncture/Archive 12#Low level details.3F. QuackGuru (talk) 01:39, 7 September 2014 (UTC)

"Consensus" at that time was among three editors and is likely to change. Sure Vickers been criticized, but the way to handle that is to weight the criticism adequately. This type of source is the gold-standard of meta-analysis: it uses individual patient data (cf. [44]). Yet we give it less space than multiple studies of rare SAE's in the pain section. This imbalance is primarily a result of your WP:OWN and POV-pushing and needs to change.

My proposal: A 2012 meta-analysis of individual patient data conducted by the Acupuncture Trialists' Collaboration found "relatively modest" efficiency of acupuncture (in comparison to sham) for the treatment of back and neck pain, osteoarthritis, chronic headache, and shoulder pain, and on that basis concluded that it "is more than a placebo" and a reasonable referral option.

This is too sparse:

Your proposal: A 2012 meta-analysis conducted by the Acupuncture Trialists' Collaboration found "relatively modest" efficiency of acupuncture (in comparison to sham) for the treatment of four different types of chronic pain, and on that basis concluded that it "is more than a placebo" and a reasonable referral option."

So why omit the kinds of pain?? We give that detail for all our other reviews. Am tagging the efficacy section with Template:POV-section for this reason. --Middle 8 (contribs • COI) 02:41, 7 September 2014 (UTC)

@QuackGuru: - I tagged that section at 02:44, 7 September 2014‎, and you removed it less than 24 hours later (18:15, 7 September 2014‎) without any comment here. That's completely inappropriate! --Middle 8 (contribs • COI) 06:32, 9 September 2014 (UTC)

It is inappropriate to add a tag that disputed an entire section when it was only a dispute over one sentence. QuackGuru (talk) 06:37, 9 September 2014 (UTC)

So improve it, put in a better one. Respect other editors' effort at WP:DR and don't be so OWN-y and revert so much. --Middle 8 (contribs • COI) 11:19, 9 September 2014 (UTC)

We should omit the kinds of pain because there is no evidence that acupuncture is specific, and no reason to believe that the effect on subjective outcomes like pain is due to specific effects or indeed anything other than placebo effects and other confounders. Guy (Help!) 08:49, 8 September 2014 (UTC)

@JzG: That reasoning puts the cart before the horse. Yes, acu probably isn't specific, but the existence of MEDRS's like this is why the question is still debated. Even if/though you hate it, this paper passed peer review in a legit journal and found specificity to statistical significance, and weighs not insignificantly, because of the type of meta-analysis it is (this kind). Anyway, other meta-analysis we cite, we say what type of pain it studied, and Vickers was basically four reviews in one. Also, I'm restoring the tag that QG inappropriately removed. --Middle 8 (contribs • COI) 19:57, 8 September 2014 (UTC) edited20:27, 8 September 2014 (UTC)

IOW: Wikipedia lags sources. How would you handle that with acu? Would you depict it as being as settled (per MEDRS) as homeopathy? --Middle 8 (contribs • COI) 01:05, 9 September 2014 (UTC)

Funding/Support:The Acupuncture Trialists' Collaboration is funded by an R21 (AT004189I from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) to Dr Vickers) and by a grant from the Samueli Institute. Dr MacPherson's work has been supported in part by the UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10186). The views expressed in this publication are those of the author(s) and not necessarily those of the NCCAM NHS, the NIHR, or the Department of Health in England."[45]

Was the study was funded or ran by alternative medicine promoters? Is the funding of NCCAM notoriously indicative of very shoddy research? Were they exposed in the Skeptical Inquirer? QuackGuru (talk) 22:19, 8 September 2014 (UTC)

NCCAM funding indicates nothing other than that it pisses off some people; no V RS impeaches it definitively, it's just one view. Per NPOV we cover all views, we don't suppress major ones, especially when they pass peer review and are published in a good journal. And Skeptical Inquirer lacks PARITY with that journal. Even if you found a MEDRS of comparable weight to Vickers that impeached NCCAM, all that would mean is that we'd give the former equal coverage. Nice try. --Middle 8 (contribs • COI) 11:19, 9 September 2014 (UTC) (copy-edited, added sentence 05:34, 15 September 2014 (UTC))

Template POV: When to remove the tag

Hi guys, just so we're all on the same page here and there's no confusion, I wanted to post this information from Template:POV on when to remove a tag:

When to remove

This template is not meant to be a permanent resident on any article. You may remove this template whenever any one of the following is true:

There is consensus on the talkpage or the NPOV Noticeboard that the issue has been resolved.
It is not clear what the neutrality issue is, and no satisfactory explanation has been given.
In the absence of any discussion, or if the discussion has become dormant.

Since #3 is clearly not applicable to this highly discussed page, and since #2 is not applicable since I listed the many outstanding neutrality issues, we have one way to remove the tag, which is to #1 resolve the neutrality issues with consensus. Now I know that may sound like an impossible task, but I believe everyone here is capable of collaboration. Now let's hold hands and sing Kumbaya! LesVegas (talk) 01:21, 6 September 2014 (UTC)

I agree. I don't see consensus to remove the tag, and edit-warring over a tag is VERY lame. There are good-faith and policy-based reasons to keep it, including integrating some of the sources A1Candidate has put forth. As I've said before, although A1C sometimes overstates the weight of those sources, they are MEDRS's, and properly weighted, generally should be integrated into the article. The tag invites more eyes, and more eyes are good: it's been hard to find a middle ground between excessively entrenched "pro" and "anti" acu views, and more than one very good editor [46][47] has become disillusioned about that state of affairs and left. So let's get more eyes on this article and break the logjam. --Middle 8 (contribs • COI) 04:18, 6 September 2014 (UTC)

Agree. I can't really see why the template should not be there. Jayaguru-Shishya (talk) 11:10, 6 September 2014 (UTC)

If that tag is really that offensive to some, perhaps a compromise choice of a different tag would work. --Middle 8 (contribs • COI) 04:25, 6 September 2014 (UTC)

A general note -- I'm really impressed with LesVegas's enthusiasm and being able and willing to provide specific ideas. They've been around for only two months, and that level of cluefulness and collaborative spirit is unusual in such a recently-joined editor. Once again, welcome LesVegas! Your contributions are very much appreciated! --Middle 8 (contribs • COI) 04:34, 6 September 2014 (UTC)

User:Dawn Bard explained "I don't see that a case has been made here for the POV tag." There is no need for any kind of tag. See Talk:Acupuncture#The tag was removed multiple times. QuackGuru (talk) 16:10, 6 September 2014 (UTC)

I should have gone a bit farther, actually, User:QuackGuru - not only do I not think a case has been made for the tag, but reading everything here, I do think a case has been made against the tag. Thanks to everyone who's participating here; it's clear a lot of effort has been made. Cheers, Dawn Bard (talk) 18:40, 6 September 2014 (UTC)

I think that there should be a {{alt-med}} template which implies a neutrality dispute, because it is implicit in any Wikipedia article touching on alternative medicine that it will either display a reality-based bias and thus be hated and reviled by the quacks that support the therapy, or it will not yet have gained attention from the reality based community and will therefore be non-compliant with NPOV. This may be a slightly cynical view... Guy (Help!) 22:24, 6 September 2014 (UTC)

Bias can go in any direction if there are WP:OWN issues and tendentiousness; it all depends upon the balance of editors. True for any article. --Middle 8 (contribs • COI) 03:03, 7 September 2014 (UTC)

So anyway, trying to determine consensus re the issues for which the article was tagged. As Les Vegas pasted in from Template:POV, it's ok to remove once "There is consensus on the talkpage or the NPOV Noticeboard that the issue has been resolved."

No NPOV concern; don't need tag - QuackGuru, Dawn Bird, Guy (I think), 2/0 (I think), Tgeorgescu (I think)
NPOV concern; do need tag - LesVegas, Jayaguru-Shishya, myself, A1Candidate (I think)

I may have missed a few, but even so I don't see consensus here. The reasons for concern are non-trivial: weighting of sources, specifically integrating A1Candidate's suggested MEDRS's, which do weigh even if A1C sometimes overestimates their weight. I would also add the concern of too much given to sources on adverse events. Kww, e.g., was dubious about putting <<5 known deaths in 10 years>> in the lede.

The explicit purpose for that tag is new editorial eyes. Surely THAT cannot be a bad idea. In order to avoid edit warring I'm not going to put it back right away. In the meantime: is this reasoning flawed? --Middle 8 (contribs • COI) 09:07, 7 September 2014 (UTC)

Well, in general it's a bad idea to rely much on counting editors, because (as it is said) consensus is not a vote (WP:CON, WP:VOTE, WP:DEM). But if the purpose is just to get new editorial eyes, an easy way around having to deal with this tag dispute would be to request input from a page like the NPOV noticeboard. Sunrise (talk) 00:23, 8 September 2014 (UTC)

@Sunrise: - Certainly true that consensus isn't only about numbers, but numbers can factor in; it's hard for me to see how ca. 35-45% of editors with NPOV concerns is compatible with concensus. I'm not going to insist on it, but my understanding has always been that the default is to keep an NPOV tag when a significant number of editors have good faith and comprehensible policy-based concerns. Do you disagree with that understanding, or do you think the concerns I mentioned in my post above (beginning with "So anyway, trying to...") aren't relevant, or what? Happy editing, --Middle 8 (contribs • COI) 20:42, 8 September 2014 (UTC)

Of course numbers can and do factor in, but they're never the end of the story. :-) Determining consensus is often pretty difficult - I have some experience as an RfC closer, and I would make two points: i) in a discussion as complicated as this one it might take hours of analysis for even the most experienced closers to determine a consensus, and ii) it is not that uncommon for consensus to be established even against the majority of editors in a discussion. I agree that the default is generally to keep a tag on the article if valid concerns have been shown, but then the question is whether the concerns are valid, and I don't think that has been established at this point. The POV tag is also somewhat of a special case that it pays to be cautious about, because it is so commonly misused as a "mark of shame." Sunrise (talk) 21:54, 8 September 2014 (UTC)

Yeah Sunrise! That's a great idea. I'll request input from the NPOV noticeboard so we can get some clarification! Thanks for your valuable suggestions! LesVegas (talk) 03:17, 8 September 2014 (UTC)

FWIW, my suggestion was that you could use it to draw attention to the article itself and any specific NPOV issues you see, and thus avoid dealing with a tag dispute. Tag disputes, not being directly related to article content, tend to be unproductive. The question you've posed at NPOVN might lead to a long dispute, but I wouldn't expect much to come out of it - we'll get a wider audience to look at the page, but it will be harder for them to contribute unless you can describe the issues that you see more clearly. Sunrise (talk) 19:14, 8 September 2014 (UTC)

@Sunrise: -- agree, when concerns are pervasive and general it's hard to boil them down for a noticeboard. Hence in part my preference for a tag; editors can browse the page and jump in and ask. What we really need is an infusion of ca. a half-dozen science-literate editors seeking a "reasonable middle", as Jytdog put it, and who aren't here to fight either side of the alt-med wars. --Middle 8 (contribs • COI) 20:42, 8 September 2014 (UTC)

I agree in part, but I would add that if specific concerns can't be established, other editors won't be able to tell whether you have a point or not, and will probably be inclined to assume that you don't. I would also add that since the ultimate goal is to accurately reflect the RS, in some cases the article may reflect somewhere between any two positions but in other cases it will not - e.g. Evolution and Global warming. Whether or not that's the case here I can't say, since I don't really want to get deep into the article content myself, although my superficial analysis is that the article is at least fairly close to neutrality on most issues. Sunrise (talk) 21:54, 8 September 2014 (UTC)

@Sunrise: This is probably stale, but I'll comment just for the record. This is probably more granular than you said you were interested in, but if you don't want to consider this further, someone else may at some point.

I agree with your two points (mentioned above in the post starting with "Of course numbers can...."), and with your observation about WP:GEVAL as applied to articles like evolution. The problem is that we have POV-warriors from the "skeptic" side who are eager to depict acupuncture research as being just as settled as that of homeopathy (i.e. that it doesn't work), and who are objecting to NPOV-tagging even subsections of the article [48] despite good reasons being given (see section above).

With acupuncture there is a real debate in the literature, even if one side is wrong. There exist MEDRS's of equal weight disputing whether or not acupuncture is effective for some types of pain and nausea; this is apparent in the lede and body. But the article is dominated by editors who take the stance that skeptic bloggers do -- that the MEDRS's finding for efficacy are all flawed -- and gives short shrift to sources finding that it works. If NPOV and VER mean anything, they mean that we should follow the debate as reflected in MEDRS's, not as depicted in blogs, many of which are barely V RS.

So that's some of the the context for my concerns expressed above in the post starting with "So anyway, ...". See also section above, where editors Guy and QuackGuru object to simply specifying the kinds of pain a review examined, the former misusing WP:GEVAL's reasoning.

Again, my comment is mostly for the record. I think that in almost any other topic area, the tag would be kept. In the current environment -- where, e.g., one editor is allowed to dominate the whole article with impunity [49] -- it's not even possible to keep the tag alive, let alone engage the debate that it's meant to indicate. --Middle 8 (contribs • COI) 07:01, 15 September 2014 (UTC)

Explaining sham acu to the reader in lede

[50] ES self-explanatory. We do need to tell the reader about both kinds of sham acu (faux needling and faux points). I made sure in this edit to explain exactly what it means when real is no better than sham, i.e. no efficacy. Also semi-boldly removed Ernst '11 with its inadequate depiction of context for statement re sham (it shouldn't be there anyway while it's being challenged; those who want it haven't met WP:BURDEN). (Now a certain editor may feel the need to evert, claiming this is OR....but please read on.)

Anyway, never let it be said that I oppose discussion of sham in the lede, and what it means when real acu is no better than sham. All I insist on is proper sourcing, especially not distorting sources. Here, we manage to get the job done by simply paraphrasing existing sources on study design (and obvious scientific principles about controls) to present an uncontroversial explanation. If editors feel that more sourcing is needed, try adding a fact tag instead of reverting. After all we should be improving each others' edits whenever possible, and not edit-warring, right? --Middle 8 (contribs • COI) 13:08, 7 September 2014 (UTC)

To clarify, use of Ernst '11 in the lede is being discussed at WT:MEDRS#Acupuncture_source. My objection is to citing it in the lede without saying what he's talking about (i.e., we shouldn't make it look like it's a general statement). Half of the people who have looked at it agree that Ernst's statement about sham is specifically about one paper, not the whole body of literature. Given that, I felt that those who wanted to keep it hand't met WP:BURDEN, so I removed it -- perhaps prematurely; I certainly didn't want it to lead to drama. --Middle 8 (contribs • COI) 12:53, 8 September 2014 (UTC)

Are continuing to edit against consensus? You are continuing to try to rewrite or delete the same sentence. This is going on far too long.[51][52][53][54] Now you replaced sourced text with SYN and OR. You have a failure of understanding you are repeatedly adding OR to this article. I will stop calling your edits original research when you stop adding original research to this article. QuackGuru (talk) 18:00, 7 September 2014 (UTC)

Well, SYN is a kind of OR. How is what I wrote OR? Its a rudimentary explanation of study design. --Middle 8 (contribs • COI) 03:25, 8 September 2014 (UTC)

In my impression, it is typical for you to call every edit that doesn't please you as OR. I can tell that from my own experience when you have failed to explain even I have asked you. You must learn to explain why you consider some specific edit as OR. That kind of editing is not helpful even despite of the good intentions. Jayaguru-Shishya (talk) 19:46, 8 September 2014 (UTC)

You were previously told you need a reference for when you made an edit to the lede on 31 August 2014. You made similar edit on 7 September 2014 and here we are again at the talk page. For starters, I previously explained here that the part "that indicates a lack of effectiveness" was SYN/OR.[55] I assume you read my comment when you made these comments but you still ask what was the original research. Your edit was also not a summary of the body in accordance with lede. Do you agree you will stop adding original research to this article? QuackGuru (talk) 03:47, 8 September 2014 (UTC)

Right, Doc James said that this edit of mine needed a reference, so in this edit I used Madsen as a ref (for sham as faux needling), and fact-tagged the other bit about sham at faux points (which should be easily findable). What's the problem?

Re OR, you're saying that this is OR: "when real acupuncture is found to be no better than sham acupuncture, that indicates a lack of effectiveness (i.e., compared to placebo)." WHAT??? Sham acu is the placebo! So my statement is the same as saying "when a treatment is no better than a placebo, the treatment is ineffective," which is about the same as saying "the sun is a big bright ball in the sky!"

I will address the diffs you cite above in another post. --Middle 8 (contribs • COI) 10:56, 8 September 2014 (UTC)

QuackGuru, you are making untruthful claims here. You said: "For starters, I previously explained here that the part "that indicates a lack of effectiveness" was SYN/OR.", but when taking a look at at the diff, you do not explain anything. Why do you do this? In that diff you merely repeat your opinion that it was SYN/OR. Where are the explanations that it is SYN/OR? Not only you fail to communicate yourself here, your diffs are misleading and disrupting the development of this article. Jayaguru-Shishya (talk) 19:46, 8 September 2014 (UTC)

https://en.wikipedia.org/wiki/Acupuncture#cite_note-Madsen2009-13

That text for Madsen2009 is in a note towards the bottom of the page. It does not belong in the lede.

This is the first sentence: Acupuncture (from Latin, 'acus' (needle) + 'punctura' (to puncture)[1]) is the stimulation of specific acupuncture points along the skin of the body involving various methods such as penetration by thin needles...

The text for non-acupoints does not belong in the lede and the reader already knows that acupuncture is stimulation at acupoints. Therefore, at non-acupoints it is not traditional acupuncture.

The part "when real acupuncture is found to be no better than sham acupuncture, that indicates a lack of effectiveness (i.e., compared to placebo)." is OR and had no citation at the end of the sentence. Do you understand now that you are replacing sourced text with OR and with text that did not summarise the body? The previous wording was sourced and is a summary of the body. QuackGuru (talk) 15:31, 8 September 2014 (UTC)

@QuackGuru: - Re Madsen, it sounds like you're objecting to my making a change simply because it changed something you'd written earlier. Madsen is a source explaining what sham is, and my edit used it that way, while you used it as a footnote. Either is acceptable. Yes, sham is different from real acu, and is a control, hence the need to explain the difference to the reader, since research is a hot topic. (There being two kinds of sham: faux needling and faux points.)

QG, no, I don't agree with you about your take on OR. Paraphrasing a source or explaining how a simple concept like a scientific control works with acu is not OR. --Middle 8 (contribs • COI) 20:19, 8 September 2014 (UTC)

Sham is placebo. We don't need a source for that, just like we don't need to cite Galileo Galilei when we say that the world is round. QuackGuru, you have been notified by admin NuclearWarfare already before about not getting stuck with specific wordings[56]. You show complete incompetence to paraphrase sources when it comes to your comments. It's not helping to develop the article. Jayaguru-Shishya (talk) 19:46, 8 September 2014 (UTC)

@Jayaguru-Shishya: - Great analogy! BTW, I agree (entirely!) re the importance of not getting stuck over specific wording, but I don't read the diff from NW as commenting on QG's wording. --Middle 8 (contribs • COI) 20:06, 8 September 2014 (UTC)

Oooh, perhaps I have understood something wrong about it? :O I guess I have to take another look. Jayaguru-Shishya (talk) 20:21, 8 September 2014 (UTC)

I previously explained The part "when real acupuncture is found to be no better than sham acupuncture, that indicates a lack of effectiveness (i.e., compared to placebo)." is OR and had no citation at the end of the sentence. Middle 8 claimed "QG, no, I don't agree with you about your take on OR." Middle 8 was not paraphrasing a source and the edit violated lede. See WP:CIR. QuackGuru (talk) 22:06, 8 September 2014 (UTC)

@ QG - I already explained my view re OR [57][58] and will only add that we have plenty of sources on study design and don't need to source every statement in the lede, especially obvious ones. CIR? Give me a break; you totally misread OR. --Middle 8 (contribs • COI) 11:21, 9 September 2014 (UTC) ...... comment moved to proper section 11:29, 9 September 2014 (UTC)

A study design in not a summary of the body and the edits were largely OR. The previous version before your edit was sourced. Your view on OR is to WP:IAR? QuackGuru (talk) 15:48, 9 September 2014 (UTC)

Not "a" study design. The general concept of a scientific control, as underlies all sham studies, where sham is the placebo control. --Middle 8 (contribs • COI) 16:20, 9 September 2014 (UTC)

Important: Could you clarify?

Hi QG, this is important, so please read it and respond.

At WT:MEDRS you wrote:

"To clarify, we do cite the systematic review 2011 not the older Suarez-Almazor 2010 source for the text. We usually don't use randomized controlled trials (RCTs) as good MEDRS. We typically use the reviews who cite the RCTs and/or other sources." [59]

First question: This sounds like you're acknowledging that when we cite Ernst '11 in the lede, we are citing it as a summation of what Suarze-Almador is saying, as opposed to his summary of the literature as a whole. Is that true? If not, could you explain your reasoning?

Second question: Would you please answer my question from WT:MEDRS, regarding your quote above -- and if not, again, could you explain your reasoning? Here:

"Are you agreeing that Ernst's statement "real acupuncture was no better than sham" can be cited for Suarez-Almazor 2010 and only for Suarez-Almazor 2010? If you and other editors agree, then we can close this. (In no way to I dispute what Ernst's view of the bigger picture is)." [60]

Thanks! Since you're accusing me of misconduct at Kww's user talk, I'm sure he (let alone I) would very much appreciate seeing a straight, clear answer from you, in order to know you're being clear and aboveboard. We all want to de-escalate and avoid drama, and open communication is the best way to do that. Feel free to either answer here or just cut and paste this and reply at my user talk. Also for question #2, obviously, please go ahead and reply at WT:MEDRS. But please don't ignore either question.... they are very important, imo, to WP:DR right now. --Middle 8 (contribs • COI) 12:11, 8 September 2014 (UTC)

The above comment by Middle 8 was moved from my talk page to here.

We should cite the 2011 systematic review of systematic reviews for the text not the older source or another source. See diff. It is irrelevant to this discussion on Wikipedia what Ernst is citing for his conclusion. We should not continue to second guess MEDRS compliant sources and we should not use another source such as Suarze-Almador to cite the text. QuackGuru (talk) 15:31, 8 September 2014 (UTC)

@QuackGuru: QG, sorry, I don't understand what you mean. Both questions are "yes" or "no" questions. Could you start by stating "my answer to Middle 8's question one is [yes/no] and my answer to Middle 8's question 2 is [yes/no]", and then briefly explain your reasoning if the answer to either is "no"? I'd appreciate that very much. I think the answer to both may be yes, and we disagree on how to frame Ernst '11 in the lede, but I want to be sure. Thanks for your help here. --Middle 8 (contribs • COI) 19:50, 8 September 2014 (UTC)

Suarez-Almazor, Maria E.; Looney, Carol; Liu, Yanfang; Cox, Vanessa; Pietz, Kenneth; Marcus, Donald M.; Street, Richard L. (2010). "A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication". Arthritis Care & Research. 62 (9): 1229–1236. doi:10.1002/acr.20225. ISSN 2151-464X. PMID 20506122.

Ernst, E.; Lee, Myeong Soo; Choi, Tae-Young (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews" (PDF). PAIN. 152 (4): 755–764. doi:10.1016/j.pain.2010.11.004. ISSN 0304-3959. PMID 21440191.

What specifically does Ernst's statement "real acupuncture was no better than sham" refer to? It is not applicable to improving the acupuncture page whether Ersnt cited the Suarez-Almazor 2010 source for the text.

First question: It is completely irrelevant what Ernst cited. We don't question reliable sources.

Second question: According to MEDRS we cited recent reviews not RCTs or primary sources. We are using Ernst 2011 as a conclusion.

According to your Wikipedia:Disruptive editing [61][62][63][64][65] you think we should not use Ersnt 2011 for sham verus real acu or it seems you think we should add context that is your own personal interpretation or add unsourced text to the lede. There is a footnote that explains what sham is. It is not a summary for text in the lede. QuackGuru (talk) 22:06, 8 September 2014 (UTC)

@ QG - (see below re your WP:KETTLE-ish "disruption" allegations.) See, I was hoping you'd just give a straight answer, not dodge the question by saying "It is not applicable to improving the acupuncture page whether Ersnt cited the Suarez-Almazor 2010 source for the text." [66] It's this kind of unwillingness to have a simple dialogue that frustrates consensus-building, and is why I sometimes use bold edits: to try to get a productive discussion moving.

It makes a big difference what Ernst is referring to when he says "real acupuncture was no better than sham". Context matters, and to argue that it doesn't is not only tendentious, it's absurd. We can't just pick any statement made by Ernst in that review and then say "Ernst said that"; that's obvious. And of course we do say in the body that Ernst's statement is about more recent trials (actually just Suarez-Almador), so I think you know it is relevant.

I'm not saying Ernst is endorsing acupuncture at all; 2/0 got it exactly right at WT:MEDRS, [67] and I agree Ernst's prediction [68] is clear, is consistent with Suarez-Almador, and has largely proven correct. Nor do I want to keep sham out of the lede (obviously, per my last edit that so offended you). I'm just saying, let's get it right, per WP:ENC, and provide context.

All this argument over such a basic thing! No wonder most editors don't stick around here! --Middle 8 (contribs • COI) 12:24, 9 September 2014 (UTC)

To clarify: If we were to cite any given statement without context, we'd get contradictions: e.g. Ernst also said "The majority of the early reviews arrived at negative conclusions [85], while the majority of the 57 recent reviews were positive." That statement and the statement "real acupuncture was no better than sham" cannot both be true about the same thing. And of course the former (green) statement refers to the dataset (the 57 reviews) while the latter refers to the more recent trial by Suarez-Almador. So of course we need to say, in the lede, what Ernst's latter statement is referring to, and that's why Vzaak's bold compromise edit from 9 July was accepted.

So here I am, explaining how context matters to the editor who just said that it didn't. I doubt that you actually believe your statement "It is not applicable to improving the acupuncture page whether Ersnt cited the Suarez-Almazor 2010 source for the text." But the kind of disingenuous tendentiousness exhibited in your comment attracts no warning from admins. I know very well that some admins read these exchanges. Apparently, striking a "skeptic" pose allows an editor to get away with actions that harm the encyclopedia: in this case, allowing a content error to remain in the lede. --Middle 8 (contribs • COI) 06:03, 15 September 2014 (UTC)

@QuackGuru -- I'll discuss those "disruptive" diffs of mine that you posted [69]. First consider how dramatically you've affected the editing environment for anyone else here; see Wikichecker: acupuncture. You have 206 mainspace edits since May 29th. That's more than the next 10 editors combined. You dominate the article and you are not helpful at talk. Sometimes you don't reply, while ignoring other editors' concerns in mainspace: see above section, and here, and here. Or you reply inadequately, e.g. refusing to answer a simple question just above. Or you use the talk page in just plain odd ways, like here.

Under those circumstances, the occasional bold edit makes sense: see BRD: Cases for use. But you revert and then say I'm editing against consensus? Dude, a great deal of the "consensus" here is just you! Maybe the real problem is that I'm challenging your "ownership" and that pisses you off.

So here are the diffs, A, B, C, xx and D. (xx is a duplicate of B).

8 July, A: Bold and justified, and worked out well: Triggered a debate resulting in another bold edit by Vzaak [70], which was accepted; see talk: Bold edit to resolve the issue. Vzaak's edit: "A systematic review of systematic reviews highlighted recent high-quality randomized controlled trials which found that for reducing pain real acupuncture was no better than sham acupuncture." Addresses my concerns re context in the lede nicely (cf. above) and was fine by others too. You liked Vzaak's compromise also; your words: "It is a good compromise with the in-text attribution." [71] (Why the change of heart since?)
27 August, Doc James reverts, being (almost certainly) unaware of earlier discussion & consensus. 30 August, I notice that and revert back to consensus version by Vzaak: [72]. 31 August, Doc reverts again [73] and opens discussion above at Talk:Acupuncture#Summarize. I join discussion and make mildly bold edit B, which is my first edit attempting to define sham for the reader and explain the simple concept of placebos and efficacy -- the stuff you think is OR. However Doc James once again reverts, wanting a source [74], which I assume was meant for the two types of sham.
On 1 Sept, I make a moderately bold edit, rewording to satisfy Doc James while being faithful to the spirit of Vzaak's compromise: edit C, i.e. A systematic review of systematic reviews of acupuncture for pain concluded that there is little evidence that acupuncture is an effective treatment, i.e. that real acupuncture may be no better than sham acupuncture. This is a different angle, a shorthand way of describing Ernst's feelings that the results of newer trials may well generalize to future research; my ES implies this but could've been clearer. Pretty simple idea, that in the future we may see the general result of real = sham.... but given your highly literal and narrow take on OR, you disliked this, of course. And less than 9 hours later, you reverted [75], and complained at Talk about how we'd covered this, somehow forgetting about Vzaak's compromise edit that we all liked (except Doc James who wasn't around for the discussion). At this point, I file at WT:MEDRS and continue to discuss above.
7 September: Again to break an impasse I try a bold edit, this time improving on my edit B by using a source per request: edit D. This was like B except: (1) it partly sourced sham, using Madsen, which you'd added as a note to the header about sham as faux needling. (Yes, I know I changed your note around... it's a wiki). (2) I fact-tagged the other aspect of sham (faux points); not a disputed concept. (3) Removed Ernst's wording entirely -- and this I would not have done in hindsight, but the whole business of WT:MEDRS had me wikistressed and not thinking clearly. After "sleeping on it" I actually decided to self-rv, but you'd already done so. It would have been better to somehow retain the spirit of Vzaak's compromise, and I stand corrected, or rather reverted.

So all these edits are good ones, except part of D where I the outright removed of Ernst '11 rather than improving wording. I'm obviously sticking close to the consensus version and I'm improving rather than reverting outright. Yet you don't recognize good edits; you see only someone doing it differently than you, which you can't stand.

Why is it bad when I make changes, but not when other editors do? Others are outright reverting more than I am. Why do I get the special treatment of your clamoring to take me to AE?

Finally a general note: We need to remember that a certain amount of good-faith reverting is inevitable, and doesn't somehow "disrupt" the article when it's non-combative and infrequent, as here. In that situation, "disruption" just becomes a convenient excuse to go after "undesirable" editors (which is a bit reminiscent of when cops in places like Ferguson, Missouri arrest people for "trespassing" in public places, or "disorderly conduct" for peaceful gatherings).

So overall there's no disruption except in the world where you, QG, own this page and any challenge to your ownership is intolerable. You need to de-escalate with me specifically; don't ever do this selective evidence thing with me again . And you need to disengage from your extreme ownership of this page imo. --Middle 8 (contribs • COI) 16:24, 9 September 2014 (UTC) copy-edited 06:09, 15 September 2014 (UTC)

Don't worry, another user who quickly stopped by at the article, he also noticed the same thing[76]. :-) Jayaguru-Shishya (talk) 17:31, 9 September 2014 (UTC) This comment originally came right after the final bullet point in my post above dataed 16:24, 9 September 2014. Moving it so that it's not splitting latter comment --Middle 8 (contribs • COI) 22:23, 15 September 2014 (UTC)

The text for the systematic review of systematic reviews was redundant. It was simplified into one sentence rather than have two separate sentences. The edits by User:Middle 8 [77][78][79][80][81] did not improve the page. Ignoring WP:V and WP:LEDE is not productive. QuackGuru (talk) 16:33, 9 September 2014 (UTC)

And that comment takes the cake for IDHT, given how you just repeated yourself about those diffs so quickly after I discussed them in detail and refuted your claim. And no, omitting context is not redundant. Later. --Middle 8 (contribs • COI) 16:44, 9 September 2014 (UTC)

And those five diffs, how do they not improve the page? How do they ignore WP:Vand WP:LEDE? The thing that's not productive here is you. If you do not have the capability to communicate yourself, I'd advise you to choose an easier topic. I do assume good faith with you, but "The proverbial bull in a china shop might have good intentions, but he's clearly bad for business." WP:CIR Jayaguru-Shishya (talk) 17:36, 9 September 2014 (UTC)

I was not responding to your specific comment above. I was making a note about the redundant text and to explain to other editors that your edits violated V and LEDE. Middle 8 continued to violated original research and LEDE but does not acknowledge his mistakes. The reason he rearranged the part that real acupuncture is no better than sham is because he thinks the source doesn't support general statement. But the text is obviously sourced. QuackGuru (talk) 16:51, 9 September 2014 (UTC)

Efficacy and Safety of Needle Acupuncture for Treating Gynecologic and Obstetric Disorders: An Overview

Any thoughts on using this source for stating/supporting that the evidence for use for pelvic and low-back pain during pregnancy, pain during labor, primary dysmenorrhea, and menopausal symptoms is inconclusive? - 2/0 (cont.) 00:43, 16 September 2014 (UTC)

We don't need any more fringe journals. If we allow this then we can expect a huge flood. QuackGuru (talk) 02:46, 16 September 2014 (UTC)

Works for me, thanks. - 2/0 (cont.) 11:45, 16 September 2014 (UTC)

For effectiveness we have plenty of sources. For other sections it is a case by case basis. Sometimes we can use fringe journals to fill in the blanks. The flood is over for now. QuackGuru (talk) 15:20, 16 September 2014 (UTC)

Larger revert

Above, QuackGuru suggests that we revert to an earlier version of the article and discuss from there; diff of convenience. It looks like that would quell a bit of cite-bombing basic aspects of the article (good), some update-inline (discussed elsewhere), a restore wikilink to Quackwatch (I think that is the first instance in the article, so linking is indicated), and restore the three edits I just mentioned as accurately cited. A wholesale revert to this version would be fine with me, or we can work on it piecemeal. - 2/0 (cont.) 19:05, 12 September 2014 (UTC)

I think it'd be much easier to keep working from the current version of the article. The alternative would be this large wave of 24 subsequent edits. These edits have not been discussed at all. Compared to that, restoring three edits is a lot easier option. Jayaguru-Shishya (talk) 19:55, 12 September 2014 (UTC)

You wrote "These edits have not been discussed at all." So where is the previous discussion or consensus for the tags in the first place? I undid my own edits when I removed the tags. QuackGuru (talk) 19:57, 12 September 2014 (UTC)

"I had the time to check up only the 4 first of your tag removals. The others should have be inspected as well. I'll recover the other edits you made"[82]. Clear and simple, if there is a claim that we have unsourced material in the article, sure it needs to be inspected. Indeed, you could easily have explained at the Talk Page if you found unnecessary {{cn}} tags. Jayaguru-Shishya (talk) 20:08, 12 September 2014 (UTC)

You have not given a reason to have the unnecessary tags and they should be removed or do you want to delete more text? I explained it in my edit summary I undid my own edit. Were the tags discussed? See here. I was only undoing my own mistake. QuackGuru (talk) 20:20, 12 September 2014 (UTC)

2/0, I wouldn't mind reverting back to that version and taking out and altering problematic edits as you and QuackGuru suggest. However, this does bring up a larger question: when someone makes 24 rapid-fire, unchecked edits, in my view it becomes impossible not to do anything other than what Jayaguru-Shishya did in his large revert. If, out of those 24 edits, let's say 16 were good quality uncontroversial edits. How could an editor possibly handle what he thinks are 8 problematic edits piecemeal without going over the 3RR? I'm really not trying to bring up old history here, but old history is once again new history, as some other editors mentioned this sort of issue before so it seems that going forward we need something solid in place to prevent incidents like this from happening again. Jayaguru-Shishya, do you think that's a reasonable solution? Do you think we could revert back and discuss all the problematic edits? QuackGuru, what do you think could be done to prevent things like this from happening again? Or am I off base here? LesVegas (talk) 19:06, 13 September 2014 (UTC)

You haven't justified your revert. There was no 24 rapid-fire edits. QuackGuru (talk) 19:12, 13 September 2014 (UTC)

QuackGuru, you're right it wasn't 24 edits, it was actually 29. I'm trying not to go there again with you, I'm trying to have a reasonable discussion this time. LesVegas (talk) 19:24, 13 September 2014 (UTC)

QuackGuru also catches flak for making multiple changes in a single edit. I am sure neither of you, Jayaguru-Shishya and LesVegas, would bring such a complaint since it would be wildly inappropriate to try to institute a backdoor article ban in that way. Laziness is not a valid reason to revert, and the suggestion that it is smacks of trying to own the article content. We have a history function and there is no deadline.

To move the discussion back where it belongs, focusing on the content rather than the contributor: I did actually take the time to sort through the series of edits in question. It was neither difficult nor particularly time-consuming. The edit summaries were accurate and the content changes relatively simple and straightforward. Are there any policy-based objections to the changes? - 2/0 (cont.) 21:08, 13 September 2014 (UTC)

We have now had four independent MEDRS-savvy editors weigh in on tagging older sources where no better source has been identified. Does this give us consensus to go back to here and work from that base? - 2/0 (cont.) 11:55, 16 September 2014 (UTC)

There is consensus to go back this version and continue to improve the article. QuackGuru (talk) 15:17, 16 September 2014 (UTC)

You are right, I should have linked to the version sans tags. - 2/0 (cont.) 15:37, 16 September 2014 (UTC)

Well, it's possible to continue editing even if a larger revert is made. I still can't understand, however, why {{cn]] tags are being removed from sections where obviously no sources have been given. (See Acupuncture#Theory). The content of this edit (Acupuncture#Effectiveness) should equally be restored. Jayaguru-Shishya (talk) 18:35, 16 September 2014 (UTC)

Early superstition

The source given for this material appears to be in Chinese, but the text itself is readily supported by Taylor 2005 later in the paragraph. Would there be any objection to restoring the text using that as a source? - 2/0 (cont.) 18:49, 12 September 2014 (UTC)

We can request to go back to this version to fix all the problems rather than continue arguing or we can wait for the article to be unprotected. QuackGuru (talk) 18:56, 12 September 2014 (UTC)

Good. I find it important that the {{cn}} tags are kept. That helps the editors to evaluate the text and whether it's properly sourced or not. Jayaguru-Shishya (talk) 19:33, 12 September 2014 (UTC)

There is even unsourced text in the lede for mundane claims. The tag was used to delete the text. The tag is for editors. It is not for readers. QuackGuru (talk) 19:42, 12 September 2014 (UTC)

@Jayaguru-Shishya: I am having trouble parsing your comment as pertains to this discussion. Do you support restoring the text you removed using the source I verified? Do we have consensus to use {{editprotected}} to edit the material back into the article? - 2/0 (cont.) 17:38, 14 September 2014 (UTC)

I don't think we need a edit protected request. The incompetent editors who deleted sourced text and/or tag MEDRS compliant sources need a vacation from this article. If you insist on an edit protected request I support a larger revert before the incompetent edits were made. See Talk:Acupuncture#Larger revert. QuackGuru (talk) 17:48, 14 September 2014 (UTC)

Sorry for the late answer 2/0. Yes, we can use Taylor 2005 in order to restore the text. Would you suggest the old phrasing or something else? For example, the source goes as follows:

Mao called for the 'co-operation of Chinese and Western medical doctors' in Yan'an in 1944, but was not explicit as to how such a co-operation might be achieved. His slogan was interpreted as a general 'scientification of Chinese medicine and popularization of Western medicine. In order to remove the feudalist and superstitious elements of Chinese medicine, some physicians attempted a rigorous transformation of the medicine according to the foremost precepts of the Communist revolution, i.e. those of the 'new', 'scientific', and 'unified'. Acupuncture came to represent this 'new' medicine largely because of its practical value during wartime. [...] The term 'new' implied free from superstition and the heavy links to a feudal past. Instead of the components of the new culture would have to be forward-moving and enterprising. Mao advocated that such a change would be possible through the use of 'science'. By 'science' Mao was not so much referring to the science linked with the Western investigation of nature, but more to the Marxist ideal of science as the criteria for true knowledge. For Mao stated that 'this type of new democratic culture is scientific. It is opposed to all feudal and superstitious ideas: it stands for seeking the truth from facts, it stands for objective truth and for unity between theory and practice'.

The edit protect, I think the "Edit protected" template is not needed as long as we don't have to make a mass revert back to the version where all the {{cn}} tags were removed. It's much easier to make fixes to the current version rather than the version some 24-29 edits (?) ago. Cheers! Jayaguru-Shishya (talk) 17:52, 15 September 2014 (UTC)

The old phrasing or something else is not relevant to this discussion. It is much easier to revert back to the version before the mass tags were restored all over the place and before you deleted sourced text. You deleted sourced material per what? QuackGuru (talk) 18:39, 15 September 2014 (UTC)

Focusing specifically on this discrete improvement to the article, I find the old text adequate but would not object to something else along the same lines. That whole section could use more detail anyway.

@QuackGuru: if we decide to do a larger revert, the edit proposed here will just be subsumed in it - no harm done, easily fixed. In the meantime, it looks like we are much closer to consensus that this material improves the article. Would you be open to providing this material to our readers now while we finish discussing everything else? - 2/0 (cont.) 19:13, 15 September 2014 (UTC)

There never was consensus in the first place to delete the text or add tags all over the place. You can request WP:UNPROTECT now and we can move on. QuackGuru (talk) 19:21, 15 September 2014 (UTC)

No tags have been added, the existing ones just have been restored. Jayaguru-Shishya (talk) 19:30, 15 September 2014 (UTC)

I previously explained I self-reverted my own edit. Now you have to explain why you want tags everywhere. Are you adding tags to other articles? QuackGuru (talk) 18:44, 16 September 2014 (UTC)

Perhaps you should try to follow up the discussion more carefully, QuackGuru? Please see the latest discussion here. A quote from there: "I still can't understand, however, why {{cn]] tags are being removed from sections where obviously no sources have been given. (See Acupuncture#Theory)." Jayaguru-Shishya (talk) 18:57, 16 September 2014 (UTC)

I previously asked, "Are you adding tags to other articles?" Apparently not. QuackGuru (talk) 19:01, 16 September 2014 (UTC)

Quick MEDMOS fix

This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

At the end of the first paragraph of Acupuncture#Clinical practice, the sentence "For the majority of cases, the needles will stay in place for 10 to 20 minutes while you are lying still" should be replaced with "For the majority of cases, the needles will stay in place for 10 to 20 minutes while the patient remains still" per WP:MEDMOS. - 2/0 (cont.) 18:07, 16 September 2014 (UTC)

I think it should be person rather than patient. QuackGuru (talk) 18:25, 16 September 2014 (UTC)

Or just end the sentence after "20 minutes"? - 2/0 (cont.) 18:28, 16 September 2014 (UTC)

The person is also lying down. QuackGuru (talk) 18:30, 16 September 2014 (UTC)

The acupuncturist is presumably also a person, though.

What if we combine with the penultimate sentence: "A typical session entails lying still while approximately five to twenty needles are applied and left in place for ten to twenty minutes."? - 2/0 (cont.) 19:19, 16 September 2014 (UTC)

The two sentences are making separate points.

If you still don't like the word person we can use another word.

"For the majority of cases, the needles will stay in place for 10 to 20 minutes while the individual is lying still." QuackGuru (talk) 20:05, 16 September 2014 (UTC)

The points are different but not disparate. Having the extra clause in there breaks up the flow of the sentence in a somewhat awkward manner. Combining the sentences also helps with the synonym problem - we use "typically", "common", "regular", and "majority" in those four sentences cited to the same source to describe how a session usually progresses. We could try: "A typical session entails lying down while approximately five to twenty needles are inserted; for the majority of cases, the needles will be left in place for ten to twenty minutes." - 2/0 (cont.) 21:46, 16 September 2014 (UTC)

"A typical session entails lying still while approximately five to twenty needles are inserted; for the majority of cases, the needles will be left in place for ten to twenty minutes." QuackGuru (talk) 22:03, 16 September 2014 (UTC)

Very important this. Think of the complications that would ensue if the patient didn't lie still at a crucial moment, and the acupuncturist punctured the patient in the wrong place. Malpractice suits, treating patients for the wrong condition, it'd be awful. -Roxy the dog™ (resonate) 22:28, 16 September 2014 (UTC)

That wording looks good to me, thanks for working on this. - 2/0 (cont.) 23:32, 16 September 2014 (UTC)

A quick grammatical fix: the first clause of Acupuncture#Other conditions, "For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no strong evidence of benefit for" should be replaced with "For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no strong evidence of benefit:". - 2/0 (cont.) 18:27, 16 September 2014 (UTC)

Both

Done. — Mr. Stradivarius ^{♪ talk ♪} 06:09, 17 September 2014 (UTC)

Your change differs slightly from the proposal. QuackGuru (talk) 07:16, 17 September 2014 (UTC)

Eh? It looks right to me - what is missing? - 2/0 (cont.) 10:59, 17 September 2014 (UTC)

There was an additional change made to the ref. No worries. I fixed it in my sandbox. QuackGuru (talk) 15:57, 17 September 2014 (UTC)

New paper

Integrative oncology: really the best of both worlds?, David H. Gorski, Nature Reviews Cancer (2014) doi:10.1038/nrc3822, Published online 18 September 2014 - paywall though. The main relevant passage: "When acupuncture is tested in the clinic, overall, with possibly one exception (for example, to treat nausea123), recent evidence strongly suggests that its effects are nonspecific and indistinguishable from placebo effects124, 125, 126, 127, 128 that are highly dependent on practitioner–patient interaction129, 130. Moreover, meta-analyses almost always conclude that there is insufficient clinical evidence to make a determination of efficacy123, 131, 132, 133 and include studies with a high risk of bias134, 135, 136. Also, contrary to the claimed mechanism of redirecting the flow of qi through meridians, researchers usually find that it generally does not matter where the needles are inserted, how often (that is, no dose-response effect is observed)137, or even if needles are actually inserted138. In other words, 'sham' or 'placebo' acupuncture generally produces the same effects as 'real' acupuncture138, 139, 140, 141, 142 and, in some cases, does better143. Even what is arguably the most persuasive meta-analysis144 concluding that acupuncture has some efficacy against chronic pain included studies without sham acupuncture controls, and the reported difference due to acupuncture was still less than the minimal clinically important difference in pain for osteoarthritis145, 146, strongly suggesting that acupuncture effects are probably not clinically relevant. The most parsimonious explanation for this body of evidence is that acupuncture almost certainly has no specific effects greater than placebo for any condition19, with the possible exception of nausea123."

Refs in this:

122.Hurt, J. K. & Zylka, M. J. PAPupuncture has localized and long-lasting antinociceptive effects in mouse models of acute and chronic pain. Mol. Pain 8, 28 (2012). CAS

123.Garcia, M. K. et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J. Clin. Oncol. 31, 952–960 (2013). PubMed

124.Cho, S. H., Lee, H. & Ernst, E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 117, 907–920 (2010). PubMed

125.Ernst, E. Are the effects of acupuncture specific or nonspecific? Pain 152, 952 (2011). CAS

126.Ernst, E., Lee, M. S. & Choi, T. Y. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain 152, 755–764 (2011). CAS

127.Gilby, A. Y., Ernst, E. & Tani, K. A systematic review of reviews of systematic reviews of acupuncture. FACT 18, 8–18 (2013). Show context

128.Posadzki, P. et al. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer, 21, 2067–2073 (2013). PubMed

129.Street, R. L. Jr., Cox, V., Kallen, M. A. & Suarez-Almazor, M. E. Exploring communication pathways to better health: clinician communication of expectations for acupuncture effectiveness. Patient Educ. Couns. 89, 245–251 (2012). PubMed

130.White, P. et al. Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain 153, 455–462 (2012). PubMed

131.Dodin, S. et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst. Rev. 7, CD007410 (2013). PubMed

132.Franconi, G., Manni, L., Schroder, S., Marchetti, P. & Robinson, N. A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evid. Based Complement Alternat. Med. 2013, 516916 (2013).

133.O'Sullivan, E. M. & Higginson, I. J. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med. 28, 191–199 (2010). CAS

134.Cheuk, D. K. & Wong, V. Acupuncture for epilepsy. Cochrane Database Syst. Rev. 5, CD005062 (2014). PubMed

135.Kim, T. H. et al. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst. Rev. 6, CD009065 (2014). PubMed

136.White, A. R., Rampes, H., Liu, J. P., Stead, L. F. & Campbell, J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst. Rev. 1, CD000009 (2014). PubMed

137.Chiu, H. Y., Pan, C. H., Shyu, Y. K., Han, B. C. & Tsai, P. S. Effects of acupuncture on menopause-related symptoms and quality of life in women on natural menopause: a meta-analysis of randomized controlled trials. Menopause http://dx.doi.org/10.1097/GME.0000000000000260 (2014). Show context

138.Cherkin, D. C. et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch. Intern. Med. 169, 858–866 (2009). PubMed

139.Linde, K. et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 293, 2118–2125 (2005). CAS

140.Pastore, L. M., Williams, C. D., Jenkins, J. & Patrie, J. T. True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 96, 3143–3150 (2011). CAS

141.Manheimer, E. et al. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum. Reprod. Update 19, 696–713 (2013). PubMed

142.Bao, T. et al. Patient-reported outcomes in women with breast cancer enrolled in a dual-center, double-blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor-induced musculoskeletal symptoms. Cancer 120, 381–389 (2014). PubMed

143.Goldman, R. H. et al. Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial. Clin. J. Pain 24, 211–218 (2008). PubMed

144.Vickers, A. J. et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch. Intern. Med. 172, 1444–1453 (2012). PubMed

Wiki CRUK John (talk) 13:20, 22 September 2014 (UTC)

As of 2012, the impact factor was 35. I added a little something to Acupuncture#Ethics. QuackGuru (talk) 23:09, 22 September 2014 (UTC)

MEDDATE

The above section seems to have gone off the rails a bit, so I am starting a new one, with an admonishment to please stick to the talk page guidelines instead of sniping at each other (@Jayaguru-Shishya, @QuackGuru, @LesVegas).

My reading of the WP:MEDDATE guideline is right there in the header for the section: use up-to-date evidence. The bit about capturing a full review cycle seems key. The way we know that evidence is not up-to-date is that it has been superseded by a source of similar or higher quality; most of the time, updated sources will indicate that the text should be tweaked - scientific revolutions are rare. Rather than wholesale deleting verifiable material, I respectfully suggest that we use {{update inline}} and update the material as new sources are found. - 2/0 (cont.) 18:15, 12 September 2014 (UTC)

We don't wholesale delete verifiable material because it is older than five years and we don't tag sources older than five years. When newer sources are found then we update the material. You don't see on other articles editors tagging sources just because they are a bit old. Lost of articles have sources older than five years. The tag 'updateinline' wikilinks to Wikipedia:Manual of Style/Dates and numbers#Chronological items. That makes no sense. Tags for medical claims are only used to delete the source. QuackGuru (talk) 18:23, 12 September 2014 (UTC)

I agree with you 2/0. I think tagging the old sources is a lot better way than to just delete an outdated source straight away. This is how the other editors can easily pay attention to sources needing update as well. Jayaguru-Shishya (talk) 19:33, 12 September 2014 (UTC)

The tag you used is not about tagging older sources. I previously explained the tags are not relevant to medical claims and the tags for medical claims are typically used for deleting older sources when there are newer sources or for deleting unreliable sources. What is the benefit for a tag that wiklinks to Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items? QuackGuru (talk) 19:38, 12 September 2014 (UTC)

2/0, I want to thank you for having the article protected and for moderating this discussion. Yes, I completely agree, tagging outdated sources is what needs to be done here. Science changes all the time and we need to find updated sourcing. I don't agree that tags for medical claims are only used to delete the course, that is only one potential outcome amongst several. More likely, we find a new source to back it up, or we modify whatever statement is being made based on whatever the newer sourcing says. But a tag buys us time to do that. And I may be wrong here, but in Wikipedia's policies and guidelines I don't see anywhere where it says we are required to tag it, only that old medical sourcing can't be used. I just feel that tags are a much more reasonable solution than just going out and immediately deleting everything outdated. LesVegas (talk) 18:38, 13 September 2014 (UTC)

You have not given a reason to tag numerous sources. You wrote "I don't see anywhere where it says we are required to tag it". There is no need to tag source after source. QuackGuru (talk) 18:53, 13 September 2014 (UTC)

My point was we could just outright delete them. Would you prefer that or the tag? LesVegas (talk) 19:14, 13 September 2014 (UTC)

It is not appropriate to suggest we delete solid MEDRS compliant sources and you know it is not required to tag sources. QuackGuru (talk) 19:19, 13 September 2014 (UTC)

Part of MEDRS compliance is MEDDATE. I'm going to ask kindly that you please don't twist my words. LesVegas (talk) 19:29, 13 September 2014 (UTC)

Do you think it is required to tag solid MEDRS compliant sources? QuackGuru (talk) 19:34, 13 September 2014 (UTC)

No, because a solid MEDRS compliant source meets all requirements for reliability, including MEDDATE. And thank you for deescalating your questions, and giving me an actual question. I do appreciate it QuackGuru. LesVegas (talk) 19:39, 13 September 2014 (UTC)

Even if a source is over 10 (or even 20) years old, it is still a solid MEDRS source unless you can present a newer source. QuackGuru (talk) 19:59, 13 September 2014 (UTC)

Yes, well there are exceptions made for history sections, Cochrane Library reviews that have been updated and seminal works in the field. If it's an area where few reviews are being published in the field, then it's okay. If other, newer reviews are published, we use those instead and delete the older reviews. First we should tag them, though. And all other cases MEDDATE says we want sources to be within the last 5 years, but preferably the last 2-3. Further, review articles should use recent primary studies. I'm afraid I have to disagree with keeping it because it was once a solid MEDRS source. Some of these sources are aged rockstars with potbellies trying to sing well past their prime. LesVegas (talk) 20:47, 13 September 2014 (UTC)

I think you are still missing the point of MEDDATE, LesVegas and Jayaguru-Shishya. The timespans are given to provide context for what the guideline means by "recent"; the term is relative, and interpretation could be a point of contention if that context were lacking. A source is only actually outdated and in need of replacement if the research has moved on; that is why the focus on capturing a complete review cycle - different fields update at different rates. If further clarification is required, WT:MED or WT:MEDRS should be able to provide. - 2/0 (cont.) 21:24, 13 September 2014 (UTC)

Yes, MEDDATE does talk about looking for reviews within one full review cycle. But only relying on the idea of a review cycle creates a great deal of ambiguity. What are the date ranges we should be using? Do date ranges then not apply at all? This seems especially inapplicable since, worldwide, the acupuncture literature is updated on a very regular basis. Further, we have seen a recent increase in the reporting standards in acupuncture literature due to the STRICTA checklist becoming the official extension of CONSORT in 2010. Many reviews published before that time used studies which used poor quality reporting standards. Not all literature follows CONSORT, but now there's defined parameters, we know if they do not follow it, they can be criticized for not doing so. Coincidentally, it is now nearly 2015, and it's been five years after the adoption of these standards. All the more reason for us to follow Wikipedia's MEDDATE guidelines of 5 year maximum lifespan, there actually is wisdom in these numbers. Of course, I don't mind replacing the outdated literature with newer stuff myself. But when we're not sure if there's newer stuff, we should use {{update inline}} so we can get other editors on board to check. LesVegas (talk) 00:38, 14 September 2014 (UTC)

I previously explained that tag links to Wikipedia:Manual of Style/Dates and numbers#Chronological items. That makes the tag irrelevant to medical claims. You want to use a tag that is not applicable? Until there is a newer source the current source is reliable. QuackGuru (talk) 00:44, 14 September 2014 (UTC)

No it doesn't. Update inline wikilinks to here, explaining it needs an update. LesVegas (talk) 00:51, 14 September 2014 (UTC)

This is the Template:Update inline. Click where it says [needs update]. When you click on the tag it links to Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items. Click on the tag. QuackGuru (talk) 01:02, 14 September 2014 (UTC)

OK, you're right, when you click on that it does go to Manual of Style. I do apologize. But it does indicate there the need for updating, which is helpful. Alternatively, I see that we could use the ^{[unreliable medical source?]} tag, and since the source falls outside the range, it violates one aspect of MEDRS. Any opinions? LesVegas (talk) 01:18, 14 September 2014 (UTC)

The Update inline tag does not indicate there a need to use a newer source. That is not what the tag is used for. I created the MEDRS tag to tag an unreliable source. You haven't shown what source is unreliable. QuackGuru (talk) 01:32, 14 September 2014 (UTC)

The contention that a source is outdated needs to be supported by a more current source. Per MEDRS, "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." Consideration of the level of quality of the source is also appropriate, a brand new low quality source carries less due weight than a solid high quality source that is not as recent. Another consideration is the weight given the source in other publications. If an older source is frequently cited by recent publications it still carries weight. - - MrBill3 (talk) 05:53, 14 September 2014 (UTC)

I have requested clarification at WT:MED#MEDDATE when no newer sources have been identified. I have tried to accurately and neutrally represent the positions taken here; as we are seeking outside input, please only comment there to clarify if your position differs significantly from my summary. - 2/0 (cont.) 16:51, 14 September 2014 (UTC)

Like I stated here at WP:Med, "I think that WP:MEDDATE is clear on the matter; we should not remove a medical source simply because it's not published in the last five years or so. Unless, of course, more recent reviews are available. But WP:MEDDATE points out, "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." And it gives space to areas that are less researched, stating that sourcing "may need to be relaxed in areas where little progress is being made or few reviews are being published." My opinion on the particular case you are citing is that "we leave it alone until newer sources of similar caliber are identified." Flyer22 (talk) 17:03, 14 September 2014 (UTC)

The steps to take are fairly obvious to anyone used to dealing with MEDRS:

If a source is more than about five years old (less where the literature is extensive, more when it isn't), then identify the quality of the source by using the guidance at MEDRS.
Next start examining the best literature for a newer source of the same or better quality. Again MEDRS indicates what sort of journals and what type of secondary sources represent the highest quality.
If no newer sources of the same or better quality exist, then the old source remains the best we have and will stay. Never replace a source with one of a lower quality even if that one is newer. Never delete a source purely on the grounds of age. In some fields that I am familiar with, the seminal work was done 70 years ago.
If there is a newer source of equal or better quality, then see if the content needs to be amended (often a newer review comes to the same conclusions as the previous one). If no change is needed, you can just replace the older source.
If the newer source of equal or better quality indicates an amendment to the content, then make the changes and replace the old source with the new one. At that point, you will probably find you may have to justify both your summary of the newer source and your assumption that the newer source is no worse than the older one it replaces.

The purpose of tagging is to attract more editors to an article; it is not to cast doubt on the content. If there is a lack of editors engaging at a particular subject, then tagging is justified; otherwise it isn't. In this case {{update}} and its section- and inline- variants really isn't the tag to warn of potential problems with MEDDATE.

In the event of disagreement, the article talk page is the first place to discuss issues. The talk page at WT:MED is watched by a editors with a broad range of interests and considerable experience with MEDMOS and MEDRS and is probably the best place to seek further opinions related to those topics. --RexxS (talk) 17:57, 14 September 2014 (UTC)

Okay, so now we have discussed the interpretation of MEDDATE and how strictly we should follow the 5 year limit. How about the {{inline update}} tag, what's the sentiment on that one? QuackGuru and RexxS seemed to agree that it should not be used. 2/0 said at some point that we can use it though. How about MrBill3 and LesVegas, what's your opinion? Jayaguru-Shishya (talk) 14:20, 21 September 2014 (UTC)

I was trying to reach for a compromise, but the consensus is crystal clear on both tags. - 2/0 (cont.) 16:06, 21 September 2014 (UTC)

I see the discussion going on about the {{cn}} tags, but not about the {{update inline}} tags. That's why I am asking for clarification from MrBill3 and LesVegas actually. I'd suggest that let's wait for their answers (and why not anybody else aswell) first. =P Jayaguru-Shishya (talk) 16:18, 21 September 2014 (UTC)

I don't think the "update inline" tag is appropriate unless there is good reason to believe the material has been superseded by more recent quality references. Perhaps when there are several recent lower quality sources and a more current review/meta-analysis is expected. The tag might be appropriate when there is a updated Cochrane review to call attention to an editor who has full access or another high quality source is available but not free, thus calling attention to the content so an editor with access can update it. For content that there is no more current, high quality source the tag is not appropriate. It is to call attention for editors to update the content from more current sources, not to insert an editor's opinion that the subject of the content should be studied again. If the academic/medical community considers the subject important enough or the earlier results/conclusions currently inadequate new studies will be done and they will be analyzed and discussed, otherwise the tag is based on WP editors' opinions. TLDR: MEDDATE and WP policy defer to the scientific consideration of the medical/academic consensus. - - MrBill3 (talk) 07:27, 22 September 2014 (UTC)

The "update inline" tag links to Wikipedia:Manual of Style/Dates and numbers#Chronological items. That makes the tag irrelevant to medical claims. The tag is not applicable in this situation. See Template:Update inline. QuackGuru (talk) 16:48, 22 September 2014 (UTC)

Yes, I agree with QuackGuru here in that update inline is a manual of style tag and we likely should not use it in these cases. We could use the unreliable MEDRS tag, but another user said we should only tag citations if the page has few editors. I'm starting to agree. Sources shouldn't be tagged on the acupuncture article, we should simply remove them if they are out of date and irrelevant, keep them if they are out of date and relevant, or replace them if they are out of date and there is a better source on the subject (whether it comes to the same conclusion or the opposite one). I could be wrong though and maybe there is precedent set for the use of this tag elsewhere? LesVegas (talk) 03:55, 26 September 2014 (UTC)

You don't exactly agree with me. We must not use a tag that is irrelevant to medical claims and no reason has been given to use the MEDRS tag I created. QuackGuru (talk) 04:01, 26 September 2014 (UTC)

If a source is indeed outdated and there is a strong belief that new sources are available, but are not yet on the article, then I think the MEDRS tag would be appropriate. You said you created the tag, but it's for unreliable sources. And MEDDATE, properly applied, pertains to reliability. Older sources are unreliable when newer ones are likely available. I noticed you used the MEDRS tag for old sources here and here. What was your reasoning in those two instances? Why did you use it to tag old sources there? What am I not understanding? LesVegas (talk) 05:19, 26 September 2014 (UTC)

There are newer sources that say relatively the same thing. QuackGuru (talk) 05:32, 26 September 2014 (UTC)

Regarding new consensus on MEDDATE's application

Hey all! I want to thank 2/0 for posting to the MEDRS board to get feedback regarding dating of sources. I also would like to ask questions amongst some editors here because there has been differing opinions on MEDDATE's application, even amongst individual editors here over time. Here is an example between this old diff which appears to have very different reasoning than this current diff. I would also like to highlight these edits here here here and here since they now differ with our current community consensus on how to apply MEDDATE to sourcing. Now I just want to make it clear, I'm not criticizing anyone or calling anyone a hypocrite because I believe we are all free to change our opinions, and hey, I happen to now agree, based on the reasoning of everyone at the MEDRS talk page. I also discovered this very subject was discussed during the drafting of MEDDATE With that in mind, I just want to get everyone's opinion on a matter. If this community now believes that we shouldn't regard the 5 year rule as sacrosanct how would everyone feel if I restored any of the content that was removed from any of the diffs showing removal of old sources, provided they are still reliable and there are no new updated sources on the subject? LesVegas (talk) 18:44, 17 September 2014 (UTC)

The old diff you cite shows you are mistaken. The ref that was older than ten years old and was replaced with a newer source. I already explained, that the older sources were removed because we are using newer sources. I don't see any reason to continue arguing about this. However, if a source was deleted that was not making a medical claim it could still be reliable. QuackGuru (talk) 19:36, 17 September 2014 (UTC)

New consensus same as the old - glad I am that we have that settled.

Your links [1] and [2] are arguing different points. Your protestation that you are not insinuating hypocrisy is appreciated.

[3]: The 1997 consensus statement is now only of historical interest. We discussed this not so long ago.

[4]: A banned tendentious sockmaster might on occasion make an edit that we would like to keep, but the present case is not the exception.

[5]: "dated" is stronger reasoning than merely "old".

[6]: I am not sure we should be according that source any weight anyway, but that is not a medical claim.

If you have a specific proposal for text or sourcing that should be added to the article, we should discuss that. - 2/0 (cont.) 15:34, 18 September 2014 (UTC)

2/0, please forgive me if I came across as ugly or sarcastic in any way in my post. That was not my intent in the least. I really wasn't trying to be sarcastic at all, but was trying to point out that when we come to a new consensus regarding posts we should take a moment to go back and review older edits where we operated under different beliefs about policy. Anywho, I'm sorry if I'm reading too much into your last post but it looked like you were being sarcastic about me claiming not to call others hypocritical. Seriously, that was not my intent at all. Regarding specific proposals, yes, I think we should add each of these references back in since they were removed when editors on this page believed MEDDATE states 5 year old sources must go and do not need to be replaced with new sources. I don't see where any of these were replaced with new sources, but I could be mistaken. And regarding example #5, you said "dated" is stronger reasoning than merely "old". While I don't understand what you mean by that in regards to MEDDATE, it did give me a new idea! I pulled up those instances by going to the revision history and doing a keyword search in the edit summaries for the word "dated" and that's how I pulled each of those edits up. Anywho, I just did a new keyword search for the word "old" and here are the edits I came up with: old 1 old 2 old3 old4 old5 and old6 As you can see, these edits were justified because of the "old" understanding we had about MEDDATE, but now that we have a new understanding we ought to discuss these as well. Just like the "dated" bunch I found before, this group was just over the past year alone. I'm sure there's more like these, but this will give us enough to discuss for now. And, just so you know, there were several edits I found where new sources were used to replace old ones. I didn't use those here because we all agree (at least I think!) that replacing old sources with new ones are appropriate uses of MEDDATE. LesVegas (talk) 04:46, 26 September 2014 (UTC)

There is nothing to add back in because the older sources were replaced with newer sources. QuackGuru (talk) 04:55, 26 September 2014 (UTC)

I'm sorry but I don't see it in any of these cases. I saw it in a few other cases and I didn't post those here, but with these, no new sources were added in. If I'm wrong, you are more than welcome to show me the diffs where old sourcing I'm claiming was removed for being too old, and show that it was actually replaced by new sourcing and we can talk from there. LesVegas (talk) 05:07, 26 September 2014 (UTC)

The older sources were removed for various reasons. The main reason was that new sources were found. We don't need to continue to talk about this. These are old issues there were resolved a long time ago. QuackGuru (talk) 05:17, 26 September 2014 (UTC)

What were the various reasons? All I see in the edit summaries were that they were "old" or "dated". From what I see there are no other reasons they were removed. Now that we have come to a new consensus, I see no reason they shouldn't be added back in. That is, unless you can show me the diffs that show justification beyond just "dated" or "old" sources. LesVegas (talk) 05:26, 26 September 2014 (UTC)

I think this is a good start for a new discussion. I am not sure which "consensus" we are talking about here now, but I think MrBill3 gave a pretty good summary earlier about the MEDDATE one[83].

When it comes to sources that have been removed already but still could be use in the article, I see no obstacles for those (providing that they are MEDRS or RS depending on the case). Jayaguru-Shishya (talk) 19:07, 28 September 2014 (UTC)

There is no new consensus and there is no reason to continue to explain every little thing. This is old news. QuackGuru (talk) 05:30, 26 September 2014 (UTC)

QuackGuru, I'm sorry but you did not explain these and show where new reviews have supplanted them. Therefore, according to MEDDATE's statement regarding review cycles, I see no reason why they shouldn't be in the article. I'm going to add these back in one at a time, as long as they're pertinent. Cheers! LesVegas (talk) 02:48, 2 October 2014 (UTC)

There may be a new consensus if we look into the new sources, if something's come in that isn't dated or old. I wanted to comment on the creation of tags. Considering that Acupuncture is a form of 'alternative medecine,' it's very possible that some of the sources might be reaching out of credibility. I read somewhere above that there is a strong belief that there are new sources being produced currently, and when regarding MEDDATE vs MEDRS, it seems appropriate to just represent the interests of both. — Preceding unsigned comment added by Chewbakadog (talk • contribs) 05:57, 26 September 2014 (UTC)

Possible original research and not a conclusion

The following sentence is in the article: The mechanism of action for acupuncture is still unclear.[192] Evidence suggests that acupuncture generates a sequence of events that include the release of endogenous opioid-like substances that modulate pain signals within the central nervous system.[192] See Acupuncture#Scientific view on TCM theory.

A dated 2007 was restored to the article against consensus. Here is the article. I could not verify the claim and there are newer sources for osteoarthritis of the knee. See Acupuncture#Extremity conditions. QuackGuru (talk) 03:22, 2 October 2014 (UTC)

Statement: Exhaust financial resources by pursuing ineffective treatment

I could not verify the statement, "As with other alternative medicines, unethical or naïve practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment." with this reference. Quackwatch is also a source, but Quackwatch does not meet MEDRS compliance. LesVegas (talk) 04:03, 2 October 2014 (UTC)

"Final Report, Report into Traditional Chinese Medicine" (PDF). Parliament of New South Wales. 9 November 2005. Retrieved 3 November 2010. The link works.

QW is reliable for the claim. QuackGuru (talk) 04:04, 2 October 2014 (UTC)

I'm sorry to have to be disagreeable in this instance, but QW is not reliable for this claim. In fact, here is what MEDRS says about it

Press releases, blogs, newsletters, advocacy and self-help publications, and other sources contain a wide range of biomedical information ranging from factual to fraudulent, with a high percentage being of low quality. Conference abstracts present incomplete and unpublished data and undergo varying levels of review; they are often unreviewed and their initial conclusions may have changed dramatically if and when the data are finally ready for publication.[25] Consequently, they are usually poor sources and should always be used with caution, never used to support surprising claims, and carefully identified in the text as preliminary work. Peer reviewed medical information resources such as WebMD, UpToDate, Mayo Clinic, and eMedicine are usually acceptable sources in themselves, and can be useful guides about the relevant medical literature and how much weight to give different sources; however, as much as possible Wikipedia articles should cite the more established literature directly.

LesVegas (talk) 04:14, 2 October 2014 (UTC)

The words "never to support surprising claims is most pertinent. We need to be quoting direct from peer-reviewed secondary sources only, as it tells us to do in the MEDRS passage above. LesVegas (talk) 04:19, 2 October 2014 (UTC)

There were previous discussions about QW as a source. The result was QW is reliable. QuackGuru (talk) 04:21, 2 October 2014 (UTC)

Can you show me this? Did they bring up the passage I quoted? I was not part of this discussion then, but I'd be glad to be part of it now. LesVegas (talk) 04:24, 2 October 2014 (UTC)

Here is one example: Talk:Acupuncture/Archive_14#Appropiateness_use_of_QuackWatch. QuackGuru (talk) 04:29, 2 October 2014 (UTC)

Thanks for providing that, I read it but see no consensus whatsoever. I see that another editor brought up my argument, but it wasn't addressed. Would you care to do so? Seriously, Wikipedia seems quite clear on this topic. You wouldn't want a pro-acupuncture website to be used as a source. That's why there's a policy on this. QuackWatch's citations are original research, and QW is a blog, not a peer-reviewed journal, and "should never be used to support surprising claims". It violates MEDRS on multiple counts. We should "cite established literature directly" not through QW. I see no policy that allows us to include it for claims like this, not by a long shot. LesVegas (talk) 04:52, 2 October 2014 (UTC)

As I recall, the article wording is paraphrased from the Australian PDF -- but I can't recall which statement/part exactly. QuackWatch -- is it being used as a MEDRS here? I wouldn't really say so.... and FWIW, exhaustion of resources on ineffective treatment is a genuine ethical concern and risk (both with alt-meds and experimental or off-label use of mainstream meds). --Middle 8 (contribs • COI) 13:26, 2 October 2014 (UTC)

There was an extensive discussion about the use of QuackWatch as as source here: Talk:Acupuncture#Quackwatch is a reliable source. I start to agree more and more with position of Bullrangifer and Middle 8: QuackWatch can be used as an RS (not MEDRS) on a case-by-case basis. Aside from that view, there was a strong opposition against using QuackWatch at all, and the other extreme basically labeled everyone objecting QuackWatch as "POV-pushers" or "advocates". I find Bullrangifer's and Middle 8's position the most constructive for consensus building though. Jayaguru-Shishya (talk) 13:54, 2 October 2014 (UTC)

This isn't a medical claim, so WP:MEDRS is irrelevant. I'm actually not sure whether QW should be considered reliable for this statement, but there are certainly adequate sources. — Arthur Rubin (talk) 18:38, 2 October 2014 (UTC)

Thanks everyone! You're all right, it's not a medical claim, and much thanks for pointing that out. Peace! LesVegas (talk) 00:10, 3 October 2014 (UTC)

Theatrical placebo

More research confirming that acupuncture is a theatrical placebo: JAMA. 2014 Oct 1;312(13):1313-22. doi: 10.1001/jama.2014.12660. Commentary here: More evidence to show that acupuncture is a ‘theatrical placebo’ Guy (Help!) 08:47, 4 October 2014 (UTC)

Duplication

There is similar information in the same section and general agreement was original research. For example, Acupuncture is generally safe when administered using clean technique and sterile single use needles.[4][18] QuackGuru (talk) 03:26, 2 October 2014 (UTC)

This is even more duplication. What is the point? QuackGuru (talk) 03:42, 2 October 2014 (UTC)

Hello QuackGuru, the review found that results from pediatric acupuncture AE's mirrored those of AE's in general, and that's relevant to that section. But I will modify it to only include information on AE's in general. I appreciate your input in this instance. LesVegas (talk) 03:51, 2 October 2014 (UTC)

The information is similar with text in another section using the same source. The text is also misleading according to the conclusions of full text. QuackGuru (talk) 04:00, 2 October 2014 (UTC)

The first sentence for Acupuncture#Adverse events says "Acupuncture is generally safe when administered by an experienced, appropriately trained practitioner using clean technique and sterile single use needles.[4][18]" QuackGuru (talk) 01:06, 7 October 2014 (UTC)