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I wouldn't call its affiliated procedures (moxibustion, cupping etc.) medical, but acupuncture itself probably is... (it's also listed in WP's Medical procedure article). If no one objects I'd change the lead sentence accordingly. Cheers, -- Mallexikon ( talk) 06:09, 23 June 2013 (UTC)
I support using the term medical procedure. "Medicine" is not a term that exclusively applies to contemporary biomedicine, which itself is not exclusively evidence-based. Herbxue ( talk) 03:32, 25 June 2013 (UTC)
The question at hand - "Is acupuncture a medical procedure" - is not answered by your opinion that it is practiced by "quacks", you are labeling people with an insult in order to argue that the word "medical" is inappropriate. That is what I am calling ad hominem, acknowledging it is a group rather than a person you are attacking. I personally think many docs who take gifts in exchange for promoting certain medications are quacks and dangerous opportunists, but that does not mean that what they are doing is not an attempt at practicing medicine. The opinion on the group is irrelevant to the question at hand. Herbxue ( talk) 21:44, 25 June 2013 (UTC)
I'd like to see the sources we'd use to call it a "medical procedure". TippyGoomba ( talk) 03:18, 26 June 2013 (UTC)
I can't find any highly cited reliable sources referring to acupuncture as a medical procedure, these for example do not:
All of which have hundreds of citations each. (Sorry for the formatting) Samwalton9 ( talk) 20:10, 26 June 2013 (UTC)
I wasn't suggesting you edit the article, clearly it would get reverted. I just wanted something concrete to discuss.
Two of the three references you give fail WP:RS. But this passes the smell test. It states Acupuncture is one of the oldest, most commonly used medical procedures in the world which it sources to nccam.nih.gov, which fails WP:RS. TippyGoomba ( talk) 04:44, 27 June 2013 (UTC)
I'm not proposing the edit, I'm supporting it - creating consensus. Herbxue ( talk) 02:52, 28 June 2013 (UTC)
Not in sources. TippyGoomba ( talk) 05:08, 30 June 2013 (UTC)
Man, can't even ask you a simple question. I did not come to a conclusion, I asked you a question. Mallexikon presented sources calling acupuncture "alternative medicine", citing them to propose an edit calling it an "alternative medical procedure", then you said it is "classic synth" - now, I'm asking you, what is the synthesis you are referring to? Herbxue ( talk) 15:50, 2 July 2013 (UTC)
Chinese steal everything. Acupuncture was actually invented by Korean during Gojoseon era. Ancient Chinese doctors traveled to Korea and learn from Korean master. — Preceding unsigned comment added by 99.225.190.42 ( talk) 06:20, 27 June 2013 (UTC)
Since DR/N declined to deliver a judgement whether the sources I've contributed so far do or do not support the change I intended: let's start from scratch. I propose to change the lede sentence to: "Acupuncture is a medical technique involving..." My sources are:
And no, trying to argue that "medical procedure" does not automatically imply "medical technique" will not fly. Cheers, -- Mallexikon ( talk) 10:43, 4 July 2013 (UTC)
I haven't been following this particular discussion, but this is a no brainer. Of course it's a medical procedure. It could also be qualified as a TCM medical procedure. Here are the current two first sentences, with TCM mentioned earlier:
That could even be shortened to remove superfluous content that really says nothing:
How's that? Note that we're already calling it a "healing practice," which is far more dubious than just calling it a TCM procedure. -- Brangifer ( talk) 16:57, 4 July 2013 (UTC)
Im the guy from DR/N, and the above proposal by brangifier looks like a reasonable compromise (and has wider acceptance amongst editors here). Ill close the DRN now -- Nbound ( talk) 05:42, 5 July 2013 (UTC)
Acupuncture in the military
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According to The Washington Times, the U.S. Military's first encounter with acupuncture occurred during the Vietnam War, when an Army surgeon wrote in the 1967 edition of Military Medicine magazine about local physicians who were allowed to practice at a U.S. Army surgical hospital and administered acupuncture to Vietnamese patients. [4] In 1995, Dr. Richard Niemtzow, a retired U.S. Air Force colonel who had earlier practiced medicine as a radiation oncologist, began offering acupuncture to military personnel stationed at the McGuire Air Force Base in New Jersey. [5] A few years later, Niemtzow became the first full-time military medical acupuncturist for the U.S. Navy. [4] In 2009, the U.S. Air Force set up the Air Force Acupuncture Center at the Joint Base Andrews in Maryland to practice and teach "battlefield acupuncture" to physicians and other medical personal. [5] [6] That year, the Naval Medical Center San Diego reported that its pain management clinic had provided acupuncture to more than 2,600 beneficiaries. [7] As of 2012, over a hundred medical professionals in the U.S. Air Force have been trained to use acupuncture techniques. While the pratice of acupuncture was mostly limited to the U.S. Air Force, it soon spread to other departments of the U.S. Military including the U.S. Navy and the U.S. Army. In late 2012, the Office of the Secretary of Defense officially approved a visit by U.S. military physicians to the Beijing University of Chinese Medicine in order to strengthen Sino-American military relations and to "exchange acupuncture information". [9]
Since 2010, acupuncture has been practised by the German Bundeswehr in several military hospitals. [10] In the People's Republic of China, acupuncture has been used by the People's Liberation Army to aid in the treatment of battlefield injuries. [11] |
Would the section above, regarding acupuncture in the military, be a desirable addition? - A1candidate ( talk) 08:39, 17 June 2013 (UTC)
TippyGoomba objects to "alternative ... on the basis that it's a deceptive euphemism." While I agree that it's a misuse of the term (per the standard skeptical position expressed here), RS still use that descriptor, so we must do the same. I have now checked the article for use of the descriptor "alternative medicine" and find it is mentioned far too little in the article, and should be mentioned more prominently in the lead. It comes far too late there. How can we mention it earlier in the lead? -- Brangifer ( talk) 05:55, 5 July 2013 (UTC)
There is no such thing as "alternative" medicine - Either something works as a true medical procedure or its simply a placebo-based sham procedure, and should be labelled as such. The reality is that researchers do not really know how acupuncture works and this should be acknowledged in the article. For millions of people across East and Southeast Asia, TCM is less of an "alternative" medicine and more like the only treatment that is affordable to them. - A1candidate ( talk) 20:22, 5 July 2013 (UTC)
I prefer Mallexikon's more inclusive phrasing due to the fact that while acupuncture grows out of and is most common to Chinese medicine (itself a broader descriptor than the specifically 20th-century systematized "TCM"), it is not exclusively a TCM practice. Herbxue ( talk) 18:00, 9 July 2013 (UTC) -Actually, the current wording is ok except for a couple things - most importantly the first sentence does not indicate that acupuncture is performed with a therapeutic/medical/healing intent, just that it is a procedure involving needles (which could imply things like tattoos or piercing). This is why I support Mallexikon's current proposal, even though I like "traditional Chinese medical procedures". Also, could we change "involving" to "including" - in most cases acupuncture does include moxa, cupping, electro, ion pumping, etc. Herbxue ( talk) 21:08, 9 July 2013 (UTC)
According to the article, acupuncture "carries a very low risk of serious adverse effects." However, this does not seem to jibe with a review by Edzard Ernst, one of the most cited authors in this article, who was able to dig up 296 cases of traumatic events, and these are just in China. Furthermore, 201 of those were just from pneumothorax. Should we include mention of it here? Jinkinson ( talk) 01:09, 20 July 2013 (UTC)
We have a new section that implies that there are many "theories" that attempt to explain the mechanism of the alleged effects of acupuncture. My first concern is that, as presented, none of these could be called "theories" as they do not seem to present a cohesive, explanatory, widely supported synthesis of anything. Perhaps more important, they seem to have been presented many years ago and there is no mention about their current acceptance. I would either just remove this whole section, shorten it to a paragraph, or, at least, refer to these as "ideas" or "suggestions about mechanism of action". Do the sources refer to these as "theories"? Desoto10 ( talk) 17:37, 2 August 2013 (UTC)
These probably all fail WP:MEDRS, but here you go:
Obviously all these researchers are just trying to promote a form of pseudoscience that is based on nothing more than quackery - A1candidate ( talk) 18:25, 2 August 2013 (UTC)
Actually, the same can be said about the sources used to support the health risks of acupuncture at Acupuncture#Adverse_events. I dont have time to go through all of them but I'll just quote from the last references: "Acupuncture remains associated with serious adverse effects". Fails the "correlation is not causation test". Should it therefore be removed? - A1candidate ( talk) 18:54, 2 August 2013 (UTC)
Please don't do that. It is not appropriate to use one source to negate other's ongoing work. One paper's conclusion that there is no mechanism does not justify eliminating good sources that show the ongoing work to try to identify a mechanism. And by the way, the section is called "proposed" mechanisms, which they are. THis is important, ongoing research that adds to the article. Herbxue ( talk) 19:25, 3 August 2013 (UTC)
Acupuncture is based on the placebo effect. Period. End of discussion. (While there are studies that show otherwise, there's no point trying to reach a consensus on Wikipedia until consensus is first reached within the scientific community. All other discussion is futile) - A1candidate ( talk) 21:32, 3 August 2013 (UTC)
Obviously, there's nothing wrong with asking other editors to give their opinions but please do it in a neutral manner and not like this , this, and this
- A1candidate ( talk) 19:21, 2 August 2013 (UTC)
Well, WP:CANVAS says:
This page in a nutshell: When notifying other editors of discussions, keep the number of notifications small, keep the message text neutral, and don't preselect recipients according to their established opinions. |
My main concern is that statements like these aren't neutral - A1candidate ( talk) 19:37, 2 August 2013 (UTC)
A couple years ago I was accused of sockpuppetry and page banned for a similar recruitment attempt. The fact that you assume an air of authority as part of a noticeboard does not mean that you seek out unreliable sources in an unbiased manner. I am not accusing you of doing so, but Dominus did not assume good faith of the active editors of this page and recruited like-minded people. You can save the "we follow sources" lecture - I perfectly understand it - I just don't agree that it serves the project to censor out interesting and valuable information in primary sources if they are not making a claim of efficacy. Drug articles, for example, are loaded with primary sources. So the term "cherry picking" goes both ways. Herbxue ( talk) 15:33, 5 August 2013 (UTC)
THe first paragraph says it is one of the oldest healing practices in the world. The reference says no such thing. — Preceding unsigned comment added by 122.61.245.213 ( talk) 02:05, 23 August 2013 (UTC)
I have removed this statement from the effectiveness section because it is a definitive statement that is unproven, and only one of the 3 cited sources even suggests that its effects are due to placebo (the Ernst paper). None, even the Ernst, suggests that placebo is the only mechanism by which it works, therefore the statement is unsupported by the sources. Herbxue ( talk) 19:42, 5 August 2013 (UTC)
You guys are still reverting me, returning to a version that is not supported by the sources. Its not even supported by Ernst, the man on a mission to discredit acupuncture does not even go so far as to say "it's effects are due to placebo" - if you ever intend to say "we follow the sources" with a straight face again, I suggest you read the fucking sources before reverting me, or propose and edit, supported by the sources. A1candidate made that edit erroneously and I have corrected it numerous times. Dominus and Tippy keep supporting the erroneous edit without actually reading the source that supposedly supports it, or intentionally misrepresenting what the source actually says. That basically means you are liars. Herbxue ( talk) 03:15, 12 August 2013 (UTC)
"Default position" of who? Can you show that conventional medicine holds drugs and surgical procedures to such a standard? You have a tendency to invent criteria for inclusion or exclusion of information based on your POV, yet you still have not acknowledged that the cited sources do not support your reversions of my edits. Ernst himself, a controversial figure, is far more careful to qualify and nuance his statements than you, and he is clearly on a mission. Have you read any of Kapchuck's work? You are trying to prevent the reader from coming to their own conclusions about issues that clearly do not have a definitive answer. I am amenable to the possibility that the general reader may have a bias towards "believing" in unproven things, but that does not justify falsifying the facts to prevent them from believing something that hasn't been proven to be false. The edit you defend does just that. Herbxue ( talk) 05:03, 16 August 2013 (UTC)
Your opinion is shared by many, but the writers of the systematic reviews are simply not willing to conclude that placebo is the only explanation for the positive effects of acupuncture. The edit you keep supporting is not supported by the sources (which is the topic of this thread). Herbxue ( talk) 05:04, 17 August 2013 (UTC)
I think that concluding the sweeping statement that "General scientific consensus maintains that the effects of acupuncture has not been shown to be due to anything more than placebo, and is therefore dependent on a patient's expectation of treatment outcomes" from the sources Ernst 2006, Madsen et al. 2009 and Furlan et al. 2008 as stated in the article is a synthesis. Besides this, several studies that find statisticaly significant advantages of acupuncture over placebo seem to make this sweeping statement too generalized (such as Albrecht, Vickers, Crew, Manheimer) Ochiwar ( talk) 19:47, 19 August 2013 (UTC)
Pain science - those who spend their lives studying the biology, psychology and sociology of pain - is open to the probability that needling will have some, probably minor, probably temporary, effect on pain. This is because of the well-attested phenomenon, diffuse noxious inhibitory control (pain, in some circumstances, raises the global pain threshold). If needling elicits pain, it may have a just-measurable above-placebo effect on the perceived intensity of pain resulting from another stimulus.
The pain of needling may also, plausibly, minimally affect the perceived " unpleasantness" (a different subjective phenomenon and neural network from "sensation intensity") of other negative homeostatic emotions such as nausea and itch too, because the "unpleasantness" of all homeostatic emotions is embodied in one common neural network and if pain diminishes global perceived "unpleasantness", which is uncertain, then it will affect the perceived unpleasantness of nausea, etc. too.
I realise this unsourced rant is probably outside Wikipedia:Talk page guidelines, but I'm hoping to pour a little oil on these troubled waters. I agree it is implausible that acupuncture may have an impact on bubonic plague or Down syndrome, but would appreciate it if the skeptics here could step back a little and exercise genuine objectivity when it comes to (a) the plausibility that the minimal pain of acupuncture may minimally affect the perceived intensity or unpleasantness of other pains or other homeostatic emotions, and (b) the scientific evidence (or lack of it) regarding this purported psychophysical effect. -- Anthonyhcole ( talk · contribs · email) 08:31, 20 August 2013 (UTC)
There is considerable controversy about the validity of the methods used to study acupuncture. For instance, sham controls are highly controversial and while many outsiders view these as reasonable controls which equate with biomedical placebos, those in the industry seem to have a completely different opinion. STRICTA standards are a good example of this. There is a system of acupuncture, Master Tung-style, which needles acupoints in many different places: between traditional points, between meridians, etc. Every portion of the body, according to the system, is a potential acupoint. Several other styles, such as Kiiko-style Japanese acupuncture may also utilize any point on the skin. Therefore, studies which utilize sham-controls, could actually be seen as studying traditional TCM points versus random Tung-style points or Kiiko-style points, not "placebos". Given this fact, it seems a decision should be made. Since there is no "consensus" within the field, do we remove all talk about sham studies and acupuncture not being more than placebo, or do we instead confine all this interesting debate to another section or article titled "acupuncture studies" or the like? Egamirorrimeht ( talk) 23:11, 11 September 2013 (UTC)
pruning the article with a chainsawwill be met with resistance unless you can give a better argument that the sources are indeed unreliable. Can you point to published reliable sourcing that questions the validity of the sham studies? That'd be a good start.
Zad
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03:44, 13 September 2013 (UTC)
This is all very interesting and relevant. Do you have specific changes for the article? I suspect that the best thing for you to do would be to make a change and see how it flies. I would advise against wholesale changes all at one time. Desoto10 ( talk) 03:27, 14 September 2013 (UTC)
I'm sorry, but I don't understand this sentence. Maybe it's the semicolon throwing me off? A semicolon works more or less like a period--whatever follows it should be a complete thought. But even when the semicolon is removed, the sentence doesn't make sense.
"A number of studies comparing traditional acupuncture to sham procedures found that both sham and traditional acupuncture were superior to usual care but were themselves equivalent; findings apparently at odds with traditional Chinese theories regarding acupuncture point specificity." — Preceding unsigned comment added by 2602:30B:8266:2759:C9A6:A59B:2619:204 ( talk) 22:42, 12 September 2013 (UTC)
The most recent revision to the lede is a substantial change to what had been stable wording consistent with sources. Now it says that the evidence says acupuncture is no more effective than placebo, and this statement is not sourced to the best quality MEDRS's, which also happen to be old ('05, '05, '08). The new wording uses these sources to rebut several sources saying acu is effective, but none mention the UK NHS source, a superior MEDRS that postdates them all; this is a bad change that introduces OR and strays from sources. Additionally, the article body cites better MEDRS's that says it is effective, e.g several at Acupuncture#Pain. Reverting to this revision from Oct. 27. Please get consensus here before making substantial changes. -- Middle 8 ( talk) 11:19, 30 October 2013 (UTC)
Thanks to User:Middle 8 for pointing out that the Acupuncture#Pain section has been using cherry-picked and poorly-vetted sources to try to claim that there is something more to acupuncture than the placebo effect. I notice that the gold-standard study by Ernst is being marginalized. And the Journal of Saudi Medicine? Tsk, tsk. The lack of mechanistic basis is enough to preference a null hypothesis in a Bayesian sense, so Ernst's review remains the best. Sorry. I've POV-section tagged the thing until it can be cleaned up. There is no evidence for acupuncture being effective for anything but people who are wide-eyed and credulous believers in the subject. jps ( talk) 02:06, 31 October 2013 (UTC)
The entire article is littered with old references. There are newer sources on safety, for example. QuackGuru ( talk) 03:01, 31 October 2013 (UTC)
Sounds like an assumption. You're basing this on....? Herbxue ( talk) 15:43, 31 October 2013 (UTC)
There is no specific argument against including this source. So I am going to add the source to the article. QuackGuru ( talk) 17:37, 31 October 2013 (UTC)
On the basis of this:
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.”
jps ( talk) 02:24, 31 October 2013 (UTC)
I should point out that MEDRS policy demands that we do this as well: Wikipedia:Identifying_reliable_sources_(medicine)#Use_independent_sources. The fact is that this source is promulgated by acupuncture supporters in a way that is highly problematic and very gaming-the-system. Ernst said this here: [3]. The source has been roundly impeached. It should be removed. jps ( talk) 02:41, 31 October 2013 (UTC)
Neither criticism, Barrett or the latter, truly refutes Vickers' conclusions. To say that NSAID's do better against pill placebos than acupuncture does against sham acupuncture is apples and oranges. Additionally, the GERAC study and others conclude that acupuncture beats standard of care (including NSAIDS) for knee and back pain. I still see nothing that convincingly discredits Vickers. Herbxue ( talk) 06:33, 31 October 2013 (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." [4]
It looks like the study was funded or ran by alternative medicine promoters. I am not sure. QuackGuru ( talk) 18:05, 31 October 2013 (UTC)
Instead of reducing this article into a Vickers vs. Ernst quarrel, why dont we summarize the scientific consensus from reputable institutions instead? If we can't agree on using the World Health Organization's statement about acupuncture, than we should try citing from a similarly neutral institution like this one. I don't understand why Vickers or Ernst should be considered more trustworthy than a national health organization. - A1candidate ( talk) 18:29, 31 October 2013 (UTC)
The following information has been repeatedly removed:
Nancy Snyderman, chief medical editor for the Today Show, finds acupuncture to be safe and effective. She states that doctors have found it to be effective for treating chronic pain, nausea, and migraines; she also uses it in the treatment of many of her cancer patients. [6] Snyderman states, "We know that acupuncture, when the needles are placed correctly, can affect the nervous system of the body. Though the reason that acupuncture helps may be somewhat of a mystery, it is a serious study that deserves attention." [7]
The summary notes given were "Using anecdotes as evidence?" and the other called the information "nonsense". While a couple of Wikipedia editors may not agree with Snyderman, apparently the Today Show finds her opinions credible or they wouldn't employ her as the spokesperson for their medical information. It is not Wikipedia's place to censor the veiws of very well-known medical experts. Gandydancer ( talk) 18:34, 31 October 2013 (UTC)
Zad
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18:53, 31 October 2013 (UTC)
We can't delete this and then keep the other nonsense in the article. QuackGuru ( talk) 03:19, 1 November 2013 (UTC)
"A 2007 review article noted that superficial needling, the primary form of traditional acupuncture in Japan, can stimulate endogenous production of opioids which could result in non-specific analgesia.[119]" [8]
Not sure about the text. QuackGuru ( talk) 16:49, 2 November 2013 (UTC)
This edit summary seems to be referencing Vickers which is a source that does not trump Ernst in the least. I recommend reverting the revert. This is terrible POV-pushing. Really disgraceful. jps ( talk) 03:25, 31 October 2013 (UTC)
Not enough context, and not close enough to the source. Source: "Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response." - that statement is in line with a previous line in the abstract that there is "heterogeneity" in the research. The statement about a majority failing to show significant difference between sham and verum specifically refers to a specific subset of studies. Therefore, using Ernst to state that the "majority of studies suggest it is no more than placebo" is an example of original research and not true to the source. Herbxue ( talk) 05:46, 31 October 2013 (UTC)
The dated references must go. QuackGuru ( talk) 17:51, 31 October 2013 (UTC)
Recent is almost always better, but some things don't change, and the inherent safety of needling (with proper training and precautions) seems like one of those things. Maybe there are better newer studies, but really good older ones ought to do, IMO. Anyway, a more recent source: "Acupuncture can be considered inherently safe in the hands of well trained practitioners." ( WHO Bulletin, 2010, incl. everyone's favorite alt-med EBM guy as coauthor). -- Middle 8 ( talk) 01:42, 3 November 2013 (UTC)
Just in case you missed it, I added the disagreement with Vickers. QuackGuru ( talk) 19:05, 31 October 2013 (UTC)
I have no problem "balancing" Vickers with Ernst as long as we don't do it this way: "A peer-reviewed meta-analysis concluded so-and-so, BUT Distinguished Professor X said he disagrees, and here is his exact quote ...(....)." -- Middle 8 ( talk) 02:00, 3 November 2013 (UTC)
I'm a bit concerned by the lack of clarity around the use of the above terms in the pain section of this article. For instance, in their review, Vickers et al. make it clear the significance they discern in the effect of acupuncture is statistical significance, and their comments about the modesty of the effect, while not saying anything explicit about clinical significance certainly allows that the effect is clinically insignificant. Laymen will read "effective" differently than researchers. A researcher will describe an intervention as effective if only a miniscule, clinically irrelevant, statistically-reliable improvement can be demonstrated. A layman is likely to read "effective" as meaning at least of some practical use. Similarly "improvement" and "benefit".
Saying blankly, "effective for some but not all conditions", "effective for the treatment of chronic pain", "effective for some but not all kinds of pain", "more effective than routine care in the treatment of migraines," "benefit for acupuncture combined with exercise in treating shoulder pain after stroke", "pain relief and improvement compared to no treatment or sham therapy", and "effective for chronic low back pain" without an indication of the clinical relevance of the effect, improvement or benefit is at best remiss, and almost certainly misleading most of our readers.
I really can't be bothered reading the above discussion, so if this has been touched on already, I apologise, but my superficial reading of the sources in the pain section tells me that they are surprisingly consistent, when you clarify what each author says or implies about effect significance. -- Anthonyhcole ( talk · contribs · email) 09:57, 3 November 2013 (UTC)
The text is in effectiveness section: "A 2012 meta-analysis found significant differences between true and sham acupuncture, which indicates that acupuncture is more than a placebo when treating chronic pain (even though the differences were modest).[103]"
Since it is in the effectiveness section I removed the duplication. QuackGuru ( talk) 17:30, 3 November 2013 (UTC)
Low level details are not encyclopedic. We are not going to add an author's name to every source. QuackGuru ( talk) 06:06, 3 November 2013 (UTC)
The nonsense continues. QuackGuru ( talk) 06:12, 3 November 2013 (UTC)
If possible editors should try not to add quotes. I rewrote the text without the low level details about Ernst. QuackGuru ( talk) 06:44, 3 November 2013 (UTC)
"Proponents believe acupuncture can assist with fertility, pregnancy and childbirth, attributing various conditions of health and difficulty with the flow of qi through various meridians.[132]"
Not sure why this is in the article. QuackGuru ( talk) 04:43, 1 November 2013 (UTC)
Zad
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14:26, 1 November 2013 (UTC)I replaced the acupuncture book with a 2013 review. QuackGuru ( talk) 01:23, 5 November 2013 (UTC)
The reference section is loaded with extensive quotes. It should be broken out into a notes section and a references section using for example the Refn template. If I have the time I will try and work on it but if someone else has the time by all means go for it. - - MrBill3 ( talk) 00:26, 5 November 2013 (UTC)
I've done this and in the process found that there were unneeded quotes. It is not necessary to place a quote of the material paraphrased. Notes 3-6 are not needed and if there is no objection here I will remove them. They do not provide any additional useful details or clarification of the material in the article. - - MrBill3 ( talk) 03:47, 5 November 2013 (UTC)
The specific dispute with the conclusions was deleted. Now the reader will not know what was disputed. QuackGuru ( talk) 03:01, 4 November 2013 (UTC)
I restored the text but did not restore the quotes. I summarized the dispute. The previews version did not tell the reader anything. QuackGuru ( talk) 00:20, 5 November 2013 (UTC)
https://www.ncbi.nlm.nih.gov/pubmed/23573135
If this source is not already in the article then we could it. QuackGuru ( talk) 03:46, 1 November 2013 (UTC)
I removed the citation needed tag on the lead re "and carries a very low risk of serious adverse effects." I think this is supported adequately by the citations in the Safety section. If you ( User:QuackGuru or others) disagree replace it with explanation here. Alternatively suggest (or boldly edit) a more appropriate phrasing. If the tag was in reference to the entire sentence which starts with "There is general agreement" and there is no source stating there is any such general agreement then by all means replace the tag. Not trying to be contentious just trying to keep the article readable. - - MrBill3 ( talk) 14:01, 5 November 2013 (UTC)
I am also unclear on the MEDRS tag on the Adams 2011 article. Is it because it is a study on pediatric acupuncture being used on a more broad statement? Does using it to support the general safety of acupuncture (in conjunction with the other refs) WP:OR or not in keeping with policy for medical articles? - - MrBill3 ( talk) 14:08, 5 November 2013 (UTC)
Serious adverse events are exceedingly rare—on the order of five in one million—[27][unreliable medical source?] [11] [12]
I added two newer sources to the article but I did not rewrite text or deleted the older sources. The text needs to updated and the sources need to be formatted. See Acupuncture#Adverse events. QuackGuru ( talk) 16:59, 2 November 2013 (UTC)
There was no specific objection to updating the text using the newer source. QuackGuru ( talk) 05:38, 5 November 2013 (UTC)
These mass changes deleted MEDRS compliant references and deleted relevant safety information. QuackGuru ( talk) 16:45, 7 November 2013 (UTC)
I think I restored the relevant text. QuackGuru ( talk) 17:16, 7 November 2013 (UTC)
"The vast majority of adverse events from acupuncture are minor, and are estimated to occur in approximately 7% to 12% of treatments, both in adults and children.[174] The ones most commonly reported occur at the site of needle insertion: minor bleeding (3%), hematoma (2-3%), and pain from needling (up to 3%). Dizziness is reported in about 1% of treatments."
The text should be restored but rewritten using newer sources. QuackGuru ( talk) 19:17, 7 November 2013 (UTC)
I don't see any more discussion going on... Can we remove the templates that were put up a month ago? Cheers, -- Mallexikon ( talk) 01:24, 7 November 2013 (UTC)
Both peer-reviewed medical journals, and acupuncture journals reviewed by acupuncturists, stated that acupuncture can be painful.[87][88][89][90][not in citation given]
The ones most commonly reported occur at the site of needle insertion: minor bleeding (3%), hematoma (2-3%), and pain from needling (up to 3%). Dizziness is reported in about 1% of treatments.[175][176][177][178][179][not in citation given]
These sentences need updating using the newer sources. The older sources must go. QuackGuru ( talk) 01:59, 7 November 2013 (UTC)
German Acupuncture Trials seems to be non-notable. What is it doing in articlespace? QuackGuru ( talk) 06:10, 3 November 2013 (UTC)
I think it is time to AFD it. QuackGuru ( talk) 02:12, 19 November 2013 (UTC)
In the lede of Traditional Chinese medicine there are seven references to verify the text.[1][2][3][4][5][6][7][unreliable medical source?]
This seems pointy. QuackGuru ( talk) 06:56, 3 November 2013 (UTC)
I tried a compromise. QuackGuru ( talk) 19:26, 1 November 2013 (UTC)
"A 2013 meta-analysis determined that acupuncture is a cost-effective treatment strategy in patients with chronic low back pain."
The source: "Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included."
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link)The current text is not accurate. QuackGuru ( talk) 21:35, 8 November 2013 (UTC)
“ | ....According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost-effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP. | ” |
"The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham." [14] This study does not meet MEDRS. QuackGuru ( talk) 19:45, 21 November 2013 (UTC)
The study failed MEDRS. QuackGuru ( talk) 19:50, 21 November 2013 (UTC)
Removed from article & sticking here, pending resolution (re cost effectiveness vis-á-vis efficacy).
“ | A 2013 meta-analysis found that acupuncture for chronic low back pain was cost-effective as a complement to standard care, but not as a substitute for standard care. [12] | ” |
Description: Cmdr. Yevsey Goldberg conducts an acupuncture procedure on a patient aboard the amphibious transport dock ship USS New Orleans (LPD 18).
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In 2009 NMCSD's pain management clinic provided acupuncture to more than 2,600 beneficiaries. The clinic provides therapeutic and non-invasive pain management therapy to patients of all ages with chronic illness.
The visit was approved by the Office of the Secretary of Defense and Secretary of the Air Force/International Affairs Global Strategy. The purpose of the tour was to promote good will between our civilian and military Chinese colleague physicians and to exchange acupuncture information.
An den ausgewiesenen Akupunkturpunkten wurden Ansammlungen von feinen Nervenenden oder sonstigen Rezeptoren gefunden – diese Korrelate konnte man nachweisen. Dies bestätigt, dass sich die Akupunktur frei von jeder Einbildung auf den menschlichen Körper auswirkt – und nicht über den Placebo-Effekt.
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-- Middle 8 ( talk) 01:31, 23 November 2013 (UTC)
I have added some excerpts from the full-text of the article for your review. It seems to me that this is a MEDRS-compliant source that carried out 3 different meta-analyses and is quite acceptable for inclusion in this article:
Puhlaa ( talk) 21:39, 23 November 2013 (UTC)
The same review concluded that acupuncture can be considered inherently safe when practiced by properly trained practitioners.[168] "The same review also stated: However, there is a need to find effective ways to improve the practice of acupuncture and to monitor and minimize the health risks involved." [17]
The text may not summarise the source accurately. The text does not explain the "however" part. QuackGuru ( talk) 19:59, 27 November 2013 (UTC)
"One might argue that, in view of the popularity of acupuncture, the number of serious adverse effects is minute. We would counter, however, that even one avoidable adverse event is one too many. The key to making progress would be to train all acupuncturists to a high level of competency." [18]
A 2011 meta-review showed that serious adverse events, including death have been reported, are frequently due to practitioner error, is rare, and diverse.[16]
I removed the original research. I recommend we keep this source. A 2004 cumulative review should not be used to replace the 2011 meta-review. See WP:MEDDATE. QuackGuru ( talk) 18:09, 28 November 2013 (UTC)
Seems like both sources are fair game, which means that "exceedingly rare" is not original research. Quack Guru, please don't insult everyone else's intelligence. Just add good new info if it is sourced well, but don't dick around with the other good, well-sourced material before discussing it here first. Herbxue ( talk) 05:51, 2 December 2013 (UTC)
Just looking at Acupuncture#Pain. I'm finding an unacceptable vagueness in our portrayal of the significance of treatment effects. Can someone who has access to the Saudi review [19] please tell me whether they are using "significant" in their conclusion to refer to statistical significance or clinical significance, and whether they (or anyone else commenting on their review) say anything about the clinical significance of the difference between acupuncture and control? -- Anthonyhcole ( talk · contribs · email) 05:34, 8 December 2013 (UTC)
Alexbrn talk| contribs| COI 08:22, 15 December 2013 (UTC)
Vickers published a reply to Ernst and other critics in the journal Acupuncture in Medicine [20], which is a journal published by BMJ. Here's what he said:
(possible copyright vio removed)
Passing along in case it's useful. TimidGuy ( talk) 11:46, 8 November 2013 (UTC)
Of particular importance is that Vickers is citing a single study, this does not apply to the Meta Analysis overall. Also clinical significance is of primary importance. A back and forth between two individuals should be limited in a WP article. Does Vickers allege that the Meta Analysis is not compromised by the general lack of blinding or that the results indicate clinical significance? These would be important points. Has another source commented on the Meta Analysis? - - MrBill3 ( talk) 05:44, 21 November 2013 (UTC)
At the moment ( this version), we have a big undue weight problem: Vickers' meta-analysis is dwarfed by Ernst's remarks. (Vickers' reply to Ernst does not yet appear.) Remember that in the evidence-tier for both evidence-based medicine (EBM) and WP:MEDRS, meta-analysis ranks at the top and expert opinion at the bottom. Vickers' review is mentioned twice, and each time Ernst's reply gets not less weight, but considerably more. Note also WP:WTA in framing Ernst ("however"; "commented"), not to mention stating the title and position (when a wikilink would do) for one party but not the other.
Enough said. Of course this is easy enough to fix; I'm just out of time right now. Will try later, or if someone else wants to, go for it. -- Middle 8 ( talk) 18:37, 21 November 2013 (UTC)
Here's the text of Vickers's reply:
(possible copyright vio removed)
With all these published, refereed sources available, it seems unnecessary to use a newspaper as a source. We can probably leave out Ernst (which in fact may not comply with the MEDRS proscription against popular media). TimidGuy ( talk) 11:30, 22 November 2013 (UTC)
Ok we obviously have a pundits' controversy here... And I see two questions: 1.) If we want to include this controversy, what rational criteria do we chose in regards to which opinion to include? (Because we obviously can't include all letters to the editors we can find. And while Avins probably ranks very high in terms of MEDRS criteria... not sure where Ernst would be placed) 2.) We don't usually include commentaries about reviews and I'm a little concerned about creating an original precendent... Should we maybe leave this controversy out altogether? -- Mallexikon ( talk) 03:18, 11 December 2013 (UTC)
I had a look at this article based on a discussion in WP:MED and found this article's use of quotations very odd. In particular, it seems to selectively quote from individuals in several places, which not only is an issue under WP:UNDUE and WP:MEDRS but also somewhat strange to read in a medical article. Here is a list of the quotations:
Acupuncture may be effective in some domains, however there appears to be enough medical evidence ( WP:MEDRS) for the lack of efficacy in many areas that many of these selective quotes could be replaced with sources more in keeping with WP:MEDRS. Kind regards, -- LT910001 ( talk) 11:04, 16 December 2013 (UTC)
You've got to be f****g kidding! You make such an absurd statement of intention, and one minute later you actually dare to do it! Have you no idea what vandalism is? Deletion of properly sourced material amounts to vandalism. Don't do it. EVER. Discuss your intentions first, and wait (a long time) to see what reaction you get. You must have extremely good reasons for deleting properly sourced material, and usually it's better to tweak the content, rather than delete it. Violating NPOV by deleting opposing POV is very wrong. -- Brangifer ( talk) 08:19, 22 December 2013 (UTC)
Comment - Agree with User:LT910001. Commentary fails WP:MEDRS - A1candidate ( talk) 08:58, 22 December 2013 (UTC)
Edit warring is bad; would encourage consensus-building where possible. For editors who have arrived from WP:MED, I have expressed a previous opinion about the article here ( Wikipedia_talk:WikiProject_Medicine#Concerns_of_LT910001) that elaborates on my concerns. -- LT910001 ( talk) 10:05, 22 December 2013 (UTC)
MrBill3, regarding your statement here: "They should not be removed unless and until there is material that indicates this is not the mainstream scientific consensus." - There are tonnes of mainstream academic sources indicating that the material being added is a false claim. I would be happy to show my sources to you, as well as anyone else who is willing to listen. - A1candidate ( talk) 15:33, 22 December 2013 (UTC)
Ernst's expert opinion is the mainstream POV. It must be kept to maintain NPOV. If editors want to tackle the real MEDRS violations they should look here. QuackGuru ( talk) 19:50, 22 December 2013 (UTC)
There does not appear to be the consensus among users for inclusion of certain content, regardless of whether the content does or does not reflect scientific consensus. On my current read of this situation: -- LT910001 ( talk) 00:47, 23 December 2013 (UTC)
MrBill3, the false claim is this:
"Commenting on this meta-analysis, professor Edzard Ernst stated that it demonstrated that the effects of acupuncture were principally due to placebo."
Ernst's commentary is a fringe viewpoint that is not accepted by the mainstream academic community. Are you willing to let me show you why? - A1candidate ( talk) 01:24, 23 December 2013 (UTC)
1.) The only rationale I've seen here for including Ernst's comment is that it's an "expert opinion reflecting mainstream consensus". Well it's definitely an expert opinion, but can you prove with a MEDRS that it's also "mainstream consensus"? 2.) Vickers study is a scientifically well done meta-review. Ergo, it's a MEDRS. Ergo, its conclusions already are mainstream consensus (because they're scientifically proven). The question here is, do we want to set a precedent? And have some professor's commentary added to the conclusions of every meta-review, just because those conclusions don't fit some people's world view? -- Mallexikon ( talk) 02:33, 23 December 2013 (UTC)
@ MrBill3 and Mann_jess - The challenge for me, really, is to decide what type of sources to present to both of you, whether it is the consensus of international health authorities, national health authorities or mainstream medical journals. For starters, let me quote from a mainstream medical textbook for physiology students:
"...Because the Chinese were content with anecdotal evidence for the success of AA (acupuncture analgesia), this phenomenon did not come under close scientific scrutiny until the last several decades, when European and American scientists started studying it. As a result of these efforts, an impressive body of rigorous scientific investigation supports the contention that AA really works (that is, by a physiologic rather than a placebo/ psychological effect)..."
— Human Physiology: From Cells to Systems (2013)
My experience of editing this page and my previous debates with many of the same editors have taught me that in most cases, it is futile to even start a discussion for various reasons. Having said that, I sincerely hope that both of you keep a fair and open mind, and I believe that both of you are willing to do so. Otherwise, we'll just be wasting all of our precious time. If you have any honest questions or issues which you would like to raise, I'll be happy to address them. - A1candidate ( talk) 02:49, 23 December 2013 (UTC)
"Several Cochrane reviews of acupuncture for a wide range of pain conditions have recently been published. All of these reviews were of high quality. Their results suggest that acupuncture is effective for some but not all types of pain." Source: Lee, MS; Ernst, E (2011). "Acupuncture for pain: An overview of Cochrane reviews". Chinese Journal of Integrative Medicine 17 (3): 187–9. [26] -- Mallexikon ( talk) 07:31, 23 December 2013 (UTC)
I wouldn't call the text A1Candidate cites a sci-consensus-level source; only statements from scientific academies and comparable bodies rank at that level (see Scientific opinion on climate change and List of scientific societies explicitly rejecting intelligent design for examples of such sources). But is an entirely acceptable MEDRS, and on the high end (i.e. closer to a meta-analysis of blinded RCT's than to a statement of expert opinion, because it's from a mainstream textbook and therefore has substantial editorial oversight). -- Middle 8 ( talk) 10:45, 23 December 2013 (UTC)
MrBill3 - Whether it's "boxed content" or non-boxed content seems to be a rather trivial issue to me. I don't think we should be arguing over how the authors decided to design their textbooks. Either the source is reliable, or it isn't. As for the part about acupuncture in the United States, the authors used the past form ("has not") instead of the present form ("is not") because they assert that the field of acupuncture has been accepted in recent years. Nobody (neither me nor the textbook authors) is claiming that acupuncture is scientifically proven to be based on meridians or whatsoever. - A1candidate ( talk) 18:06, 26 December 2013 (UTC)
An editor recently added material on the cost-effectiveness of acupuncture that was sourced to this large RCT conducted in Germany and published in 2008 in the European Journal of Health Economics. [27] There are some errors in the material added, but I don't want to take the time to fix the errors if the material will eventually be deleted due to this being a primary source. Thanks. TimidGuy ( talk) 12:05, 5 December 2013 (UTC)
http://onlinelibrary.wiley.com/doi/10.1002/cncr.28352/abstract
Consider adding it to the article.
jps ( talk) 00:03, 28 December 2013 (UTC)
jps, yes, it does contradict, but the source is not MEDRS compliant, so the text should be changed using other means and sources. It's still instructive, so thanks for sharing.
I just finished reading Paul Offit's book, Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine. Very interesting and well-written. Among many things he writes about acupuncture, he tells about Steven Novella's appearance on the Dr. Oz Show:
So, that's where it's at. It's the placebo effect, a very non-specific effect. When a method, like acupuncture, does not rise above the placebo effect, it is a universal truth in science and medicine that the method is itself considered ineffectual. In common parlance we just say that it doesn't work as claimed, and the claims are false. Something else is going on that could just as well be induced by numerous other methods. Since other, truly helpful, methods exist which actually do far more than stimulate the placebo response, they should be preferred, and failing to do so is to practice below the expected standard of care, and that's dead wrong, unethical, quackery, and in some cases illegal.
It really worries me (for their own sake, and especially for their patients' sake) that A1candidate doesn't understand this. This failure means they are practicing deception and substandard practice, which can have serious and even fatal consequences for their patients. As far as editing here is concerned, it also means they don't understand the workings of the scientific method well enough to be competent in understanding and editing the medical and scientific aspects of subjects. -- Brangifer ( talk) 06:55, 28 December 2013 (UTC)
While we're on the subject of non-specific effects, a parallel study about homeopathy makes the same point as with the acupuncture study:
I suspect this is the case with many methods where one sees an effect, but where there is no difference between control arms. "Doing something is better than doing nothing, but not better than doing anything else, and is worse than doing something effective." (you can quote me ) -- Brangifer ( talk) 18:23, 28 December 2013 (UTC)
(Meant this to be about nausea; was tired and typed "pain" above instead). The section on efficacy for nausea and vomiting has got some outdated cruft and could use a cleanup. Most recent Cochrane source on PONV is straightforward enough: P6 acupoint stimulation prevents postoperative nausea and vomiting with few side effects. Will suggest wording later. -- Middle 8 ( talk) 20:24, 31 December 2013 (UTC)
In 2006, German researchers published the results of one of the first and largest randomized controlled clinical trials.[194] As a result of the trial's conclusions, some insurance corporations in Germany no longer reimburse acupuncture treatments.[194] The trials also had a negative impact on acupuncture in the international community.[194]
"...some insurance companies in Germany stopped reimbursement for acupuncture treatment]." [29]
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help)As you can see from reading the 2013 review, the text is obviously sourced and is accurately written. Recently, I have noticed editors disagree with me every single time I start a new thread related to acupuncture. Let's see what happens this time. Remember, it does constitute a reliable source according to Mallexikon. QuackGuru ( talk) 02:13, 27 December 2013 (UTC)
This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 5 | ← | Archive 9 | Archive 10 | Archive 11 | Archive 12 | Archive 13 | → | Archive 15 |
I wouldn't call its affiliated procedures (moxibustion, cupping etc.) medical, but acupuncture itself probably is... (it's also listed in WP's Medical procedure article). If no one objects I'd change the lead sentence accordingly. Cheers, -- Mallexikon ( talk) 06:09, 23 June 2013 (UTC)
I support using the term medical procedure. "Medicine" is not a term that exclusively applies to contemporary biomedicine, which itself is not exclusively evidence-based. Herbxue ( talk) 03:32, 25 June 2013 (UTC)
The question at hand - "Is acupuncture a medical procedure" - is not answered by your opinion that it is practiced by "quacks", you are labeling people with an insult in order to argue that the word "medical" is inappropriate. That is what I am calling ad hominem, acknowledging it is a group rather than a person you are attacking. I personally think many docs who take gifts in exchange for promoting certain medications are quacks and dangerous opportunists, but that does not mean that what they are doing is not an attempt at practicing medicine. The opinion on the group is irrelevant to the question at hand. Herbxue ( talk) 21:44, 25 June 2013 (UTC)
I'd like to see the sources we'd use to call it a "medical procedure". TippyGoomba ( talk) 03:18, 26 June 2013 (UTC)
I can't find any highly cited reliable sources referring to acupuncture as a medical procedure, these for example do not:
All of which have hundreds of citations each. (Sorry for the formatting) Samwalton9 ( talk) 20:10, 26 June 2013 (UTC)
I wasn't suggesting you edit the article, clearly it would get reverted. I just wanted something concrete to discuss.
Two of the three references you give fail WP:RS. But this passes the smell test. It states Acupuncture is one of the oldest, most commonly used medical procedures in the world which it sources to nccam.nih.gov, which fails WP:RS. TippyGoomba ( talk) 04:44, 27 June 2013 (UTC)
I'm not proposing the edit, I'm supporting it - creating consensus. Herbxue ( talk) 02:52, 28 June 2013 (UTC)
Not in sources. TippyGoomba ( talk) 05:08, 30 June 2013 (UTC)
Man, can't even ask you a simple question. I did not come to a conclusion, I asked you a question. Mallexikon presented sources calling acupuncture "alternative medicine", citing them to propose an edit calling it an "alternative medical procedure", then you said it is "classic synth" - now, I'm asking you, what is the synthesis you are referring to? Herbxue ( talk) 15:50, 2 July 2013 (UTC)
Chinese steal everything. Acupuncture was actually invented by Korean during Gojoseon era. Ancient Chinese doctors traveled to Korea and learn from Korean master. — Preceding unsigned comment added by 99.225.190.42 ( talk) 06:20, 27 June 2013 (UTC)
Since DR/N declined to deliver a judgement whether the sources I've contributed so far do or do not support the change I intended: let's start from scratch. I propose to change the lede sentence to: "Acupuncture is a medical technique involving..." My sources are:
And no, trying to argue that "medical procedure" does not automatically imply "medical technique" will not fly. Cheers, -- Mallexikon ( talk) 10:43, 4 July 2013 (UTC)
I haven't been following this particular discussion, but this is a no brainer. Of course it's a medical procedure. It could also be qualified as a TCM medical procedure. Here are the current two first sentences, with TCM mentioned earlier:
That could even be shortened to remove superfluous content that really says nothing:
How's that? Note that we're already calling it a "healing practice," which is far more dubious than just calling it a TCM procedure. -- Brangifer ( talk) 16:57, 4 July 2013 (UTC)
Im the guy from DR/N, and the above proposal by brangifier looks like a reasonable compromise (and has wider acceptance amongst editors here). Ill close the DRN now -- Nbound ( talk) 05:42, 5 July 2013 (UTC)
Acupuncture in the military
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According to The Washington Times, the U.S. Military's first encounter with acupuncture occurred during the Vietnam War, when an Army surgeon wrote in the 1967 edition of Military Medicine magazine about local physicians who were allowed to practice at a U.S. Army surgical hospital and administered acupuncture to Vietnamese patients. [4] In 1995, Dr. Richard Niemtzow, a retired U.S. Air Force colonel who had earlier practiced medicine as a radiation oncologist, began offering acupuncture to military personnel stationed at the McGuire Air Force Base in New Jersey. [5] A few years later, Niemtzow became the first full-time military medical acupuncturist for the U.S. Navy. [4] In 2009, the U.S. Air Force set up the Air Force Acupuncture Center at the Joint Base Andrews in Maryland to practice and teach "battlefield acupuncture" to physicians and other medical personal. [5] [6] That year, the Naval Medical Center San Diego reported that its pain management clinic had provided acupuncture to more than 2,600 beneficiaries. [7] As of 2012, over a hundred medical professionals in the U.S. Air Force have been trained to use acupuncture techniques. While the pratice of acupuncture was mostly limited to the U.S. Air Force, it soon spread to other departments of the U.S. Military including the U.S. Navy and the U.S. Army. In late 2012, the Office of the Secretary of Defense officially approved a visit by U.S. military physicians to the Beijing University of Chinese Medicine in order to strengthen Sino-American military relations and to "exchange acupuncture information". [9]
Since 2010, acupuncture has been practised by the German Bundeswehr in several military hospitals. [10] In the People's Republic of China, acupuncture has been used by the People's Liberation Army to aid in the treatment of battlefield injuries. [11] |
Would the section above, regarding acupuncture in the military, be a desirable addition? - A1candidate ( talk) 08:39, 17 June 2013 (UTC)
TippyGoomba objects to "alternative ... on the basis that it's a deceptive euphemism." While I agree that it's a misuse of the term (per the standard skeptical position expressed here), RS still use that descriptor, so we must do the same. I have now checked the article for use of the descriptor "alternative medicine" and find it is mentioned far too little in the article, and should be mentioned more prominently in the lead. It comes far too late there. How can we mention it earlier in the lead? -- Brangifer ( talk) 05:55, 5 July 2013 (UTC)
There is no such thing as "alternative" medicine - Either something works as a true medical procedure or its simply a placebo-based sham procedure, and should be labelled as such. The reality is that researchers do not really know how acupuncture works and this should be acknowledged in the article. For millions of people across East and Southeast Asia, TCM is less of an "alternative" medicine and more like the only treatment that is affordable to them. - A1candidate ( talk) 20:22, 5 July 2013 (UTC)
I prefer Mallexikon's more inclusive phrasing due to the fact that while acupuncture grows out of and is most common to Chinese medicine (itself a broader descriptor than the specifically 20th-century systematized "TCM"), it is not exclusively a TCM practice. Herbxue ( talk) 18:00, 9 July 2013 (UTC) -Actually, the current wording is ok except for a couple things - most importantly the first sentence does not indicate that acupuncture is performed with a therapeutic/medical/healing intent, just that it is a procedure involving needles (which could imply things like tattoos or piercing). This is why I support Mallexikon's current proposal, even though I like "traditional Chinese medical procedures". Also, could we change "involving" to "including" - in most cases acupuncture does include moxa, cupping, electro, ion pumping, etc. Herbxue ( talk) 21:08, 9 July 2013 (UTC)
According to the article, acupuncture "carries a very low risk of serious adverse effects." However, this does not seem to jibe with a review by Edzard Ernst, one of the most cited authors in this article, who was able to dig up 296 cases of traumatic events, and these are just in China. Furthermore, 201 of those were just from pneumothorax. Should we include mention of it here? Jinkinson ( talk) 01:09, 20 July 2013 (UTC)
We have a new section that implies that there are many "theories" that attempt to explain the mechanism of the alleged effects of acupuncture. My first concern is that, as presented, none of these could be called "theories" as they do not seem to present a cohesive, explanatory, widely supported synthesis of anything. Perhaps more important, they seem to have been presented many years ago and there is no mention about their current acceptance. I would either just remove this whole section, shorten it to a paragraph, or, at least, refer to these as "ideas" or "suggestions about mechanism of action". Do the sources refer to these as "theories"? Desoto10 ( talk) 17:37, 2 August 2013 (UTC)
These probably all fail WP:MEDRS, but here you go:
Obviously all these researchers are just trying to promote a form of pseudoscience that is based on nothing more than quackery - A1candidate ( talk) 18:25, 2 August 2013 (UTC)
Actually, the same can be said about the sources used to support the health risks of acupuncture at Acupuncture#Adverse_events. I dont have time to go through all of them but I'll just quote from the last references: "Acupuncture remains associated with serious adverse effects". Fails the "correlation is not causation test". Should it therefore be removed? - A1candidate ( talk) 18:54, 2 August 2013 (UTC)
Please don't do that. It is not appropriate to use one source to negate other's ongoing work. One paper's conclusion that there is no mechanism does not justify eliminating good sources that show the ongoing work to try to identify a mechanism. And by the way, the section is called "proposed" mechanisms, which they are. THis is important, ongoing research that adds to the article. Herbxue ( talk) 19:25, 3 August 2013 (UTC)
Acupuncture is based on the placebo effect. Period. End of discussion. (While there are studies that show otherwise, there's no point trying to reach a consensus on Wikipedia until consensus is first reached within the scientific community. All other discussion is futile) - A1candidate ( talk) 21:32, 3 August 2013 (UTC)
Obviously, there's nothing wrong with asking other editors to give their opinions but please do it in a neutral manner and not like this , this, and this
- A1candidate ( talk) 19:21, 2 August 2013 (UTC)
Well, WP:CANVAS says:
This page in a nutshell: When notifying other editors of discussions, keep the number of notifications small, keep the message text neutral, and don't preselect recipients according to their established opinions. |
My main concern is that statements like these aren't neutral - A1candidate ( talk) 19:37, 2 August 2013 (UTC)
A couple years ago I was accused of sockpuppetry and page banned for a similar recruitment attempt. The fact that you assume an air of authority as part of a noticeboard does not mean that you seek out unreliable sources in an unbiased manner. I am not accusing you of doing so, but Dominus did not assume good faith of the active editors of this page and recruited like-minded people. You can save the "we follow sources" lecture - I perfectly understand it - I just don't agree that it serves the project to censor out interesting and valuable information in primary sources if they are not making a claim of efficacy. Drug articles, for example, are loaded with primary sources. So the term "cherry picking" goes both ways. Herbxue ( talk) 15:33, 5 August 2013 (UTC)
THe first paragraph says it is one of the oldest healing practices in the world. The reference says no such thing. — Preceding unsigned comment added by 122.61.245.213 ( talk) 02:05, 23 August 2013 (UTC)
I have removed this statement from the effectiveness section because it is a definitive statement that is unproven, and only one of the 3 cited sources even suggests that its effects are due to placebo (the Ernst paper). None, even the Ernst, suggests that placebo is the only mechanism by which it works, therefore the statement is unsupported by the sources. Herbxue ( talk) 19:42, 5 August 2013 (UTC)
You guys are still reverting me, returning to a version that is not supported by the sources. Its not even supported by Ernst, the man on a mission to discredit acupuncture does not even go so far as to say "it's effects are due to placebo" - if you ever intend to say "we follow the sources" with a straight face again, I suggest you read the fucking sources before reverting me, or propose and edit, supported by the sources. A1candidate made that edit erroneously and I have corrected it numerous times. Dominus and Tippy keep supporting the erroneous edit without actually reading the source that supposedly supports it, or intentionally misrepresenting what the source actually says. That basically means you are liars. Herbxue ( talk) 03:15, 12 August 2013 (UTC)
"Default position" of who? Can you show that conventional medicine holds drugs and surgical procedures to such a standard? You have a tendency to invent criteria for inclusion or exclusion of information based on your POV, yet you still have not acknowledged that the cited sources do not support your reversions of my edits. Ernst himself, a controversial figure, is far more careful to qualify and nuance his statements than you, and he is clearly on a mission. Have you read any of Kapchuck's work? You are trying to prevent the reader from coming to their own conclusions about issues that clearly do not have a definitive answer. I am amenable to the possibility that the general reader may have a bias towards "believing" in unproven things, but that does not justify falsifying the facts to prevent them from believing something that hasn't been proven to be false. The edit you defend does just that. Herbxue ( talk) 05:03, 16 August 2013 (UTC)
Your opinion is shared by many, but the writers of the systematic reviews are simply not willing to conclude that placebo is the only explanation for the positive effects of acupuncture. The edit you keep supporting is not supported by the sources (which is the topic of this thread). Herbxue ( talk) 05:04, 17 August 2013 (UTC)
I think that concluding the sweeping statement that "General scientific consensus maintains that the effects of acupuncture has not been shown to be due to anything more than placebo, and is therefore dependent on a patient's expectation of treatment outcomes" from the sources Ernst 2006, Madsen et al. 2009 and Furlan et al. 2008 as stated in the article is a synthesis. Besides this, several studies that find statisticaly significant advantages of acupuncture over placebo seem to make this sweeping statement too generalized (such as Albrecht, Vickers, Crew, Manheimer) Ochiwar ( talk) 19:47, 19 August 2013 (UTC)
Pain science - those who spend their lives studying the biology, psychology and sociology of pain - is open to the probability that needling will have some, probably minor, probably temporary, effect on pain. This is because of the well-attested phenomenon, diffuse noxious inhibitory control (pain, in some circumstances, raises the global pain threshold). If needling elicits pain, it may have a just-measurable above-placebo effect on the perceived intensity of pain resulting from another stimulus.
The pain of needling may also, plausibly, minimally affect the perceived " unpleasantness" (a different subjective phenomenon and neural network from "sensation intensity") of other negative homeostatic emotions such as nausea and itch too, because the "unpleasantness" of all homeostatic emotions is embodied in one common neural network and if pain diminishes global perceived "unpleasantness", which is uncertain, then it will affect the perceived unpleasantness of nausea, etc. too.
I realise this unsourced rant is probably outside Wikipedia:Talk page guidelines, but I'm hoping to pour a little oil on these troubled waters. I agree it is implausible that acupuncture may have an impact on bubonic plague or Down syndrome, but would appreciate it if the skeptics here could step back a little and exercise genuine objectivity when it comes to (a) the plausibility that the minimal pain of acupuncture may minimally affect the perceived intensity or unpleasantness of other pains or other homeostatic emotions, and (b) the scientific evidence (or lack of it) regarding this purported psychophysical effect. -- Anthonyhcole ( talk · contribs · email) 08:31, 20 August 2013 (UTC)
There is considerable controversy about the validity of the methods used to study acupuncture. For instance, sham controls are highly controversial and while many outsiders view these as reasonable controls which equate with biomedical placebos, those in the industry seem to have a completely different opinion. STRICTA standards are a good example of this. There is a system of acupuncture, Master Tung-style, which needles acupoints in many different places: between traditional points, between meridians, etc. Every portion of the body, according to the system, is a potential acupoint. Several other styles, such as Kiiko-style Japanese acupuncture may also utilize any point on the skin. Therefore, studies which utilize sham-controls, could actually be seen as studying traditional TCM points versus random Tung-style points or Kiiko-style points, not "placebos". Given this fact, it seems a decision should be made. Since there is no "consensus" within the field, do we remove all talk about sham studies and acupuncture not being more than placebo, or do we instead confine all this interesting debate to another section or article titled "acupuncture studies" or the like? Egamirorrimeht ( talk) 23:11, 11 September 2013 (UTC)
pruning the article with a chainsawwill be met with resistance unless you can give a better argument that the sources are indeed unreliable. Can you point to published reliable sourcing that questions the validity of the sham studies? That'd be a good start.
Zad
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03:44, 13 September 2013 (UTC)
This is all very interesting and relevant. Do you have specific changes for the article? I suspect that the best thing for you to do would be to make a change and see how it flies. I would advise against wholesale changes all at one time. Desoto10 ( talk) 03:27, 14 September 2013 (UTC)
I'm sorry, but I don't understand this sentence. Maybe it's the semicolon throwing me off? A semicolon works more or less like a period--whatever follows it should be a complete thought. But even when the semicolon is removed, the sentence doesn't make sense.
"A number of studies comparing traditional acupuncture to sham procedures found that both sham and traditional acupuncture were superior to usual care but were themselves equivalent; findings apparently at odds with traditional Chinese theories regarding acupuncture point specificity." — Preceding unsigned comment added by 2602:30B:8266:2759:C9A6:A59B:2619:204 ( talk) 22:42, 12 September 2013 (UTC)
The most recent revision to the lede is a substantial change to what had been stable wording consistent with sources. Now it says that the evidence says acupuncture is no more effective than placebo, and this statement is not sourced to the best quality MEDRS's, which also happen to be old ('05, '05, '08). The new wording uses these sources to rebut several sources saying acu is effective, but none mention the UK NHS source, a superior MEDRS that postdates them all; this is a bad change that introduces OR and strays from sources. Additionally, the article body cites better MEDRS's that says it is effective, e.g several at Acupuncture#Pain. Reverting to this revision from Oct. 27. Please get consensus here before making substantial changes. -- Middle 8 ( talk) 11:19, 30 October 2013 (UTC)
Thanks to User:Middle 8 for pointing out that the Acupuncture#Pain section has been using cherry-picked and poorly-vetted sources to try to claim that there is something more to acupuncture than the placebo effect. I notice that the gold-standard study by Ernst is being marginalized. And the Journal of Saudi Medicine? Tsk, tsk. The lack of mechanistic basis is enough to preference a null hypothesis in a Bayesian sense, so Ernst's review remains the best. Sorry. I've POV-section tagged the thing until it can be cleaned up. There is no evidence for acupuncture being effective for anything but people who are wide-eyed and credulous believers in the subject. jps ( talk) 02:06, 31 October 2013 (UTC)
The entire article is littered with old references. There are newer sources on safety, for example. QuackGuru ( talk) 03:01, 31 October 2013 (UTC)
Sounds like an assumption. You're basing this on....? Herbxue ( talk) 15:43, 31 October 2013 (UTC)
There is no specific argument against including this source. So I am going to add the source to the article. QuackGuru ( talk) 17:37, 31 October 2013 (UTC)
On the basis of this:
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.”
jps ( talk) 02:24, 31 October 2013 (UTC)
I should point out that MEDRS policy demands that we do this as well: Wikipedia:Identifying_reliable_sources_(medicine)#Use_independent_sources. The fact is that this source is promulgated by acupuncture supporters in a way that is highly problematic and very gaming-the-system. Ernst said this here: [3]. The source has been roundly impeached. It should be removed. jps ( talk) 02:41, 31 October 2013 (UTC)
Neither criticism, Barrett or the latter, truly refutes Vickers' conclusions. To say that NSAID's do better against pill placebos than acupuncture does against sham acupuncture is apples and oranges. Additionally, the GERAC study and others conclude that acupuncture beats standard of care (including NSAIDS) for knee and back pain. I still see nothing that convincingly discredits Vickers. Herbxue ( talk) 06:33, 31 October 2013 (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." [4]
It looks like the study was funded or ran by alternative medicine promoters. I am not sure. QuackGuru ( talk) 18:05, 31 October 2013 (UTC)
Instead of reducing this article into a Vickers vs. Ernst quarrel, why dont we summarize the scientific consensus from reputable institutions instead? If we can't agree on using the World Health Organization's statement about acupuncture, than we should try citing from a similarly neutral institution like this one. I don't understand why Vickers or Ernst should be considered more trustworthy than a national health organization. - A1candidate ( talk) 18:29, 31 October 2013 (UTC)
The following information has been repeatedly removed:
Nancy Snyderman, chief medical editor for the Today Show, finds acupuncture to be safe and effective. She states that doctors have found it to be effective for treating chronic pain, nausea, and migraines; she also uses it in the treatment of many of her cancer patients. [6] Snyderman states, "We know that acupuncture, when the needles are placed correctly, can affect the nervous system of the body. Though the reason that acupuncture helps may be somewhat of a mystery, it is a serious study that deserves attention." [7]
The summary notes given were "Using anecdotes as evidence?" and the other called the information "nonsense". While a couple of Wikipedia editors may not agree with Snyderman, apparently the Today Show finds her opinions credible or they wouldn't employ her as the spokesperson for their medical information. It is not Wikipedia's place to censor the veiws of very well-known medical experts. Gandydancer ( talk) 18:34, 31 October 2013 (UTC)
Zad
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18:53, 31 October 2013 (UTC)
We can't delete this and then keep the other nonsense in the article. QuackGuru ( talk) 03:19, 1 November 2013 (UTC)
"A 2007 review article noted that superficial needling, the primary form of traditional acupuncture in Japan, can stimulate endogenous production of opioids which could result in non-specific analgesia.[119]" [8]
Not sure about the text. QuackGuru ( talk) 16:49, 2 November 2013 (UTC)
This edit summary seems to be referencing Vickers which is a source that does not trump Ernst in the least. I recommend reverting the revert. This is terrible POV-pushing. Really disgraceful. jps ( talk) 03:25, 31 October 2013 (UTC)
Not enough context, and not close enough to the source. Source: "Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response." - that statement is in line with a previous line in the abstract that there is "heterogeneity" in the research. The statement about a majority failing to show significant difference between sham and verum specifically refers to a specific subset of studies. Therefore, using Ernst to state that the "majority of studies suggest it is no more than placebo" is an example of original research and not true to the source. Herbxue ( talk) 05:46, 31 October 2013 (UTC)
The dated references must go. QuackGuru ( talk) 17:51, 31 October 2013 (UTC)
Recent is almost always better, but some things don't change, and the inherent safety of needling (with proper training and precautions) seems like one of those things. Maybe there are better newer studies, but really good older ones ought to do, IMO. Anyway, a more recent source: "Acupuncture can be considered inherently safe in the hands of well trained practitioners." ( WHO Bulletin, 2010, incl. everyone's favorite alt-med EBM guy as coauthor). -- Middle 8 ( talk) 01:42, 3 November 2013 (UTC)
Just in case you missed it, I added the disagreement with Vickers. QuackGuru ( talk) 19:05, 31 October 2013 (UTC)
I have no problem "balancing" Vickers with Ernst as long as we don't do it this way: "A peer-reviewed meta-analysis concluded so-and-so, BUT Distinguished Professor X said he disagrees, and here is his exact quote ...(....)." -- Middle 8 ( talk) 02:00, 3 November 2013 (UTC)
I'm a bit concerned by the lack of clarity around the use of the above terms in the pain section of this article. For instance, in their review, Vickers et al. make it clear the significance they discern in the effect of acupuncture is statistical significance, and their comments about the modesty of the effect, while not saying anything explicit about clinical significance certainly allows that the effect is clinically insignificant. Laymen will read "effective" differently than researchers. A researcher will describe an intervention as effective if only a miniscule, clinically irrelevant, statistically-reliable improvement can be demonstrated. A layman is likely to read "effective" as meaning at least of some practical use. Similarly "improvement" and "benefit".
Saying blankly, "effective for some but not all conditions", "effective for the treatment of chronic pain", "effective for some but not all kinds of pain", "more effective than routine care in the treatment of migraines," "benefit for acupuncture combined with exercise in treating shoulder pain after stroke", "pain relief and improvement compared to no treatment or sham therapy", and "effective for chronic low back pain" without an indication of the clinical relevance of the effect, improvement or benefit is at best remiss, and almost certainly misleading most of our readers.
I really can't be bothered reading the above discussion, so if this has been touched on already, I apologise, but my superficial reading of the sources in the pain section tells me that they are surprisingly consistent, when you clarify what each author says or implies about effect significance. -- Anthonyhcole ( talk · contribs · email) 09:57, 3 November 2013 (UTC)
The text is in effectiveness section: "A 2012 meta-analysis found significant differences between true and sham acupuncture, which indicates that acupuncture is more than a placebo when treating chronic pain (even though the differences were modest).[103]"
Since it is in the effectiveness section I removed the duplication. QuackGuru ( talk) 17:30, 3 November 2013 (UTC)
Low level details are not encyclopedic. We are not going to add an author's name to every source. QuackGuru ( talk) 06:06, 3 November 2013 (UTC)
The nonsense continues. QuackGuru ( talk) 06:12, 3 November 2013 (UTC)
If possible editors should try not to add quotes. I rewrote the text without the low level details about Ernst. QuackGuru ( talk) 06:44, 3 November 2013 (UTC)
"Proponents believe acupuncture can assist with fertility, pregnancy and childbirth, attributing various conditions of health and difficulty with the flow of qi through various meridians.[132]"
Not sure why this is in the article. QuackGuru ( talk) 04:43, 1 November 2013 (UTC)
Zad
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14:26, 1 November 2013 (UTC)I replaced the acupuncture book with a 2013 review. QuackGuru ( talk) 01:23, 5 November 2013 (UTC)
The reference section is loaded with extensive quotes. It should be broken out into a notes section and a references section using for example the Refn template. If I have the time I will try and work on it but if someone else has the time by all means go for it. - - MrBill3 ( talk) 00:26, 5 November 2013 (UTC)
I've done this and in the process found that there were unneeded quotes. It is not necessary to place a quote of the material paraphrased. Notes 3-6 are not needed and if there is no objection here I will remove them. They do not provide any additional useful details or clarification of the material in the article. - - MrBill3 ( talk) 03:47, 5 November 2013 (UTC)
The specific dispute with the conclusions was deleted. Now the reader will not know what was disputed. QuackGuru ( talk) 03:01, 4 November 2013 (UTC)
I restored the text but did not restore the quotes. I summarized the dispute. The previews version did not tell the reader anything. QuackGuru ( talk) 00:20, 5 November 2013 (UTC)
https://www.ncbi.nlm.nih.gov/pubmed/23573135
If this source is not already in the article then we could it. QuackGuru ( talk) 03:46, 1 November 2013 (UTC)
I removed the citation needed tag on the lead re "and carries a very low risk of serious adverse effects." I think this is supported adequately by the citations in the Safety section. If you ( User:QuackGuru or others) disagree replace it with explanation here. Alternatively suggest (or boldly edit) a more appropriate phrasing. If the tag was in reference to the entire sentence which starts with "There is general agreement" and there is no source stating there is any such general agreement then by all means replace the tag. Not trying to be contentious just trying to keep the article readable. - - MrBill3 ( talk) 14:01, 5 November 2013 (UTC)
I am also unclear on the MEDRS tag on the Adams 2011 article. Is it because it is a study on pediatric acupuncture being used on a more broad statement? Does using it to support the general safety of acupuncture (in conjunction with the other refs) WP:OR or not in keeping with policy for medical articles? - - MrBill3 ( talk) 14:08, 5 November 2013 (UTC)
Serious adverse events are exceedingly rare—on the order of five in one million—[27][unreliable medical source?] [11] [12]
I added two newer sources to the article but I did not rewrite text or deleted the older sources. The text needs to updated and the sources need to be formatted. See Acupuncture#Adverse events. QuackGuru ( talk) 16:59, 2 November 2013 (UTC)
There was no specific objection to updating the text using the newer source. QuackGuru ( talk) 05:38, 5 November 2013 (UTC)
These mass changes deleted MEDRS compliant references and deleted relevant safety information. QuackGuru ( talk) 16:45, 7 November 2013 (UTC)
I think I restored the relevant text. QuackGuru ( talk) 17:16, 7 November 2013 (UTC)
"The vast majority of adverse events from acupuncture are minor, and are estimated to occur in approximately 7% to 12% of treatments, both in adults and children.[174] The ones most commonly reported occur at the site of needle insertion: minor bleeding (3%), hematoma (2-3%), and pain from needling (up to 3%). Dizziness is reported in about 1% of treatments."
The text should be restored but rewritten using newer sources. QuackGuru ( talk) 19:17, 7 November 2013 (UTC)
I don't see any more discussion going on... Can we remove the templates that were put up a month ago? Cheers, -- Mallexikon ( talk) 01:24, 7 November 2013 (UTC)
Both peer-reviewed medical journals, and acupuncture journals reviewed by acupuncturists, stated that acupuncture can be painful.[87][88][89][90][not in citation given]
The ones most commonly reported occur at the site of needle insertion: minor bleeding (3%), hematoma (2-3%), and pain from needling (up to 3%). Dizziness is reported in about 1% of treatments.[175][176][177][178][179][not in citation given]
These sentences need updating using the newer sources. The older sources must go. QuackGuru ( talk) 01:59, 7 November 2013 (UTC)
German Acupuncture Trials seems to be non-notable. What is it doing in articlespace? QuackGuru ( talk) 06:10, 3 November 2013 (UTC)
I think it is time to AFD it. QuackGuru ( talk) 02:12, 19 November 2013 (UTC)
In the lede of Traditional Chinese medicine there are seven references to verify the text.[1][2][3][4][5][6][7][unreliable medical source?]
This seems pointy. QuackGuru ( talk) 06:56, 3 November 2013 (UTC)
I tried a compromise. QuackGuru ( talk) 19:26, 1 November 2013 (UTC)
"A 2013 meta-analysis determined that acupuncture is a cost-effective treatment strategy in patients with chronic low back pain."
The source: "Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included."
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“ | ....According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost-effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP. | ” |
"The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham." [14] This study does not meet MEDRS. QuackGuru ( talk) 19:45, 21 November 2013 (UTC)
The study failed MEDRS. QuackGuru ( talk) 19:50, 21 November 2013 (UTC)
Removed from article & sticking here, pending resolution (re cost effectiveness vis-á-vis efficacy).
“ | A 2013 meta-analysis found that acupuncture for chronic low back pain was cost-effective as a complement to standard care, but not as a substitute for standard care. [12] | ” |
Description: Cmdr. Yevsey Goldberg conducts an acupuncture procedure on a patient aboard the amphibious transport dock ship USS New Orleans (LPD 18).
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In 2009 NMCSD's pain management clinic provided acupuncture to more than 2,600 beneficiaries. The clinic provides therapeutic and non-invasive pain management therapy to patients of all ages with chronic illness.
The visit was approved by the Office of the Secretary of Defense and Secretary of the Air Force/International Affairs Global Strategy. The purpose of the tour was to promote good will between our civilian and military Chinese colleague physicians and to exchange acupuncture information.
An den ausgewiesenen Akupunkturpunkten wurden Ansammlungen von feinen Nervenenden oder sonstigen Rezeptoren gefunden – diese Korrelate konnte man nachweisen. Dies bestätigt, dass sich die Akupunktur frei von jeder Einbildung auf den menschlichen Körper auswirkt – und nicht über den Placebo-Effekt.
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-- Middle 8 ( talk) 01:31, 23 November 2013 (UTC)
I have added some excerpts from the full-text of the article for your review. It seems to me that this is a MEDRS-compliant source that carried out 3 different meta-analyses and is quite acceptable for inclusion in this article:
Puhlaa ( talk) 21:39, 23 November 2013 (UTC)
The same review concluded that acupuncture can be considered inherently safe when practiced by properly trained practitioners.[168] "The same review also stated: However, there is a need to find effective ways to improve the practice of acupuncture and to monitor and minimize the health risks involved." [17]
The text may not summarise the source accurately. The text does not explain the "however" part. QuackGuru ( talk) 19:59, 27 November 2013 (UTC)
"One might argue that, in view of the popularity of acupuncture, the number of serious adverse effects is minute. We would counter, however, that even one avoidable adverse event is one too many. The key to making progress would be to train all acupuncturists to a high level of competency." [18]
A 2011 meta-review showed that serious adverse events, including death have been reported, are frequently due to practitioner error, is rare, and diverse.[16]
I removed the original research. I recommend we keep this source. A 2004 cumulative review should not be used to replace the 2011 meta-review. See WP:MEDDATE. QuackGuru ( talk) 18:09, 28 November 2013 (UTC)
Seems like both sources are fair game, which means that "exceedingly rare" is not original research. Quack Guru, please don't insult everyone else's intelligence. Just add good new info if it is sourced well, but don't dick around with the other good, well-sourced material before discussing it here first. Herbxue ( talk) 05:51, 2 December 2013 (UTC)
Just looking at Acupuncture#Pain. I'm finding an unacceptable vagueness in our portrayal of the significance of treatment effects. Can someone who has access to the Saudi review [19] please tell me whether they are using "significant" in their conclusion to refer to statistical significance or clinical significance, and whether they (or anyone else commenting on their review) say anything about the clinical significance of the difference between acupuncture and control? -- Anthonyhcole ( talk · contribs · email) 05:34, 8 December 2013 (UTC)
Alexbrn talk| contribs| COI 08:22, 15 December 2013 (UTC)
Vickers published a reply to Ernst and other critics in the journal Acupuncture in Medicine [20], which is a journal published by BMJ. Here's what he said:
(possible copyright vio removed)
Passing along in case it's useful. TimidGuy ( talk) 11:46, 8 November 2013 (UTC)
Of particular importance is that Vickers is citing a single study, this does not apply to the Meta Analysis overall. Also clinical significance is of primary importance. A back and forth between two individuals should be limited in a WP article. Does Vickers allege that the Meta Analysis is not compromised by the general lack of blinding or that the results indicate clinical significance? These would be important points. Has another source commented on the Meta Analysis? - - MrBill3 ( talk) 05:44, 21 November 2013 (UTC)
At the moment ( this version), we have a big undue weight problem: Vickers' meta-analysis is dwarfed by Ernst's remarks. (Vickers' reply to Ernst does not yet appear.) Remember that in the evidence-tier for both evidence-based medicine (EBM) and WP:MEDRS, meta-analysis ranks at the top and expert opinion at the bottom. Vickers' review is mentioned twice, and each time Ernst's reply gets not less weight, but considerably more. Note also WP:WTA in framing Ernst ("however"; "commented"), not to mention stating the title and position (when a wikilink would do) for one party but not the other.
Enough said. Of course this is easy enough to fix; I'm just out of time right now. Will try later, or if someone else wants to, go for it. -- Middle 8 ( talk) 18:37, 21 November 2013 (UTC)
Here's the text of Vickers's reply:
(possible copyright vio removed)
With all these published, refereed sources available, it seems unnecessary to use a newspaper as a source. We can probably leave out Ernst (which in fact may not comply with the MEDRS proscription against popular media). TimidGuy ( talk) 11:30, 22 November 2013 (UTC)
Ok we obviously have a pundits' controversy here... And I see two questions: 1.) If we want to include this controversy, what rational criteria do we chose in regards to which opinion to include? (Because we obviously can't include all letters to the editors we can find. And while Avins probably ranks very high in terms of MEDRS criteria... not sure where Ernst would be placed) 2.) We don't usually include commentaries about reviews and I'm a little concerned about creating an original precendent... Should we maybe leave this controversy out altogether? -- Mallexikon ( talk) 03:18, 11 December 2013 (UTC)
I had a look at this article based on a discussion in WP:MED and found this article's use of quotations very odd. In particular, it seems to selectively quote from individuals in several places, which not only is an issue under WP:UNDUE and WP:MEDRS but also somewhat strange to read in a medical article. Here is a list of the quotations:
Acupuncture may be effective in some domains, however there appears to be enough medical evidence ( WP:MEDRS) for the lack of efficacy in many areas that many of these selective quotes could be replaced with sources more in keeping with WP:MEDRS. Kind regards, -- LT910001 ( talk) 11:04, 16 December 2013 (UTC)
You've got to be f****g kidding! You make such an absurd statement of intention, and one minute later you actually dare to do it! Have you no idea what vandalism is? Deletion of properly sourced material amounts to vandalism. Don't do it. EVER. Discuss your intentions first, and wait (a long time) to see what reaction you get. You must have extremely good reasons for deleting properly sourced material, and usually it's better to tweak the content, rather than delete it. Violating NPOV by deleting opposing POV is very wrong. -- Brangifer ( talk) 08:19, 22 December 2013 (UTC)
Comment - Agree with User:LT910001. Commentary fails WP:MEDRS - A1candidate ( talk) 08:58, 22 December 2013 (UTC)
Edit warring is bad; would encourage consensus-building where possible. For editors who have arrived from WP:MED, I have expressed a previous opinion about the article here ( Wikipedia_talk:WikiProject_Medicine#Concerns_of_LT910001) that elaborates on my concerns. -- LT910001 ( talk) 10:05, 22 December 2013 (UTC)
MrBill3, regarding your statement here: "They should not be removed unless and until there is material that indicates this is not the mainstream scientific consensus." - There are tonnes of mainstream academic sources indicating that the material being added is a false claim. I would be happy to show my sources to you, as well as anyone else who is willing to listen. - A1candidate ( talk) 15:33, 22 December 2013 (UTC)
Ernst's expert opinion is the mainstream POV. It must be kept to maintain NPOV. If editors want to tackle the real MEDRS violations they should look here. QuackGuru ( talk) 19:50, 22 December 2013 (UTC)
There does not appear to be the consensus among users for inclusion of certain content, regardless of whether the content does or does not reflect scientific consensus. On my current read of this situation: -- LT910001 ( talk) 00:47, 23 December 2013 (UTC)
MrBill3, the false claim is this:
"Commenting on this meta-analysis, professor Edzard Ernst stated that it demonstrated that the effects of acupuncture were principally due to placebo."
Ernst's commentary is a fringe viewpoint that is not accepted by the mainstream academic community. Are you willing to let me show you why? - A1candidate ( talk) 01:24, 23 December 2013 (UTC)
1.) The only rationale I've seen here for including Ernst's comment is that it's an "expert opinion reflecting mainstream consensus". Well it's definitely an expert opinion, but can you prove with a MEDRS that it's also "mainstream consensus"? 2.) Vickers study is a scientifically well done meta-review. Ergo, it's a MEDRS. Ergo, its conclusions already are mainstream consensus (because they're scientifically proven). The question here is, do we want to set a precedent? And have some professor's commentary added to the conclusions of every meta-review, just because those conclusions don't fit some people's world view? -- Mallexikon ( talk) 02:33, 23 December 2013 (UTC)
@ MrBill3 and Mann_jess - The challenge for me, really, is to decide what type of sources to present to both of you, whether it is the consensus of international health authorities, national health authorities or mainstream medical journals. For starters, let me quote from a mainstream medical textbook for physiology students:
"...Because the Chinese were content with anecdotal evidence for the success of AA (acupuncture analgesia), this phenomenon did not come under close scientific scrutiny until the last several decades, when European and American scientists started studying it. As a result of these efforts, an impressive body of rigorous scientific investigation supports the contention that AA really works (that is, by a physiologic rather than a placebo/ psychological effect)..."
— Human Physiology: From Cells to Systems (2013)
My experience of editing this page and my previous debates with many of the same editors have taught me that in most cases, it is futile to even start a discussion for various reasons. Having said that, I sincerely hope that both of you keep a fair and open mind, and I believe that both of you are willing to do so. Otherwise, we'll just be wasting all of our precious time. If you have any honest questions or issues which you would like to raise, I'll be happy to address them. - A1candidate ( talk) 02:49, 23 December 2013 (UTC)
"Several Cochrane reviews of acupuncture for a wide range of pain conditions have recently been published. All of these reviews were of high quality. Their results suggest that acupuncture is effective for some but not all types of pain." Source: Lee, MS; Ernst, E (2011). "Acupuncture for pain: An overview of Cochrane reviews". Chinese Journal of Integrative Medicine 17 (3): 187–9. [26] -- Mallexikon ( talk) 07:31, 23 December 2013 (UTC)
I wouldn't call the text A1Candidate cites a sci-consensus-level source; only statements from scientific academies and comparable bodies rank at that level (see Scientific opinion on climate change and List of scientific societies explicitly rejecting intelligent design for examples of such sources). But is an entirely acceptable MEDRS, and on the high end (i.e. closer to a meta-analysis of blinded RCT's than to a statement of expert opinion, because it's from a mainstream textbook and therefore has substantial editorial oversight). -- Middle 8 ( talk) 10:45, 23 December 2013 (UTC)
MrBill3 - Whether it's "boxed content" or non-boxed content seems to be a rather trivial issue to me. I don't think we should be arguing over how the authors decided to design their textbooks. Either the source is reliable, or it isn't. As for the part about acupuncture in the United States, the authors used the past form ("has not") instead of the present form ("is not") because they assert that the field of acupuncture has been accepted in recent years. Nobody (neither me nor the textbook authors) is claiming that acupuncture is scientifically proven to be based on meridians or whatsoever. - A1candidate ( talk) 18:06, 26 December 2013 (UTC)
An editor recently added material on the cost-effectiveness of acupuncture that was sourced to this large RCT conducted in Germany and published in 2008 in the European Journal of Health Economics. [27] There are some errors in the material added, but I don't want to take the time to fix the errors if the material will eventually be deleted due to this being a primary source. Thanks. TimidGuy ( talk) 12:05, 5 December 2013 (UTC)
http://onlinelibrary.wiley.com/doi/10.1002/cncr.28352/abstract
Consider adding it to the article.
jps ( talk) 00:03, 28 December 2013 (UTC)
jps, yes, it does contradict, but the source is not MEDRS compliant, so the text should be changed using other means and sources. It's still instructive, so thanks for sharing.
I just finished reading Paul Offit's book, Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine. Very interesting and well-written. Among many things he writes about acupuncture, he tells about Steven Novella's appearance on the Dr. Oz Show:
So, that's where it's at. It's the placebo effect, a very non-specific effect. When a method, like acupuncture, does not rise above the placebo effect, it is a universal truth in science and medicine that the method is itself considered ineffectual. In common parlance we just say that it doesn't work as claimed, and the claims are false. Something else is going on that could just as well be induced by numerous other methods. Since other, truly helpful, methods exist which actually do far more than stimulate the placebo response, they should be preferred, and failing to do so is to practice below the expected standard of care, and that's dead wrong, unethical, quackery, and in some cases illegal.
It really worries me (for their own sake, and especially for their patients' sake) that A1candidate doesn't understand this. This failure means they are practicing deception and substandard practice, which can have serious and even fatal consequences for their patients. As far as editing here is concerned, it also means they don't understand the workings of the scientific method well enough to be competent in understanding and editing the medical and scientific aspects of subjects. -- Brangifer ( talk) 06:55, 28 December 2013 (UTC)
While we're on the subject of non-specific effects, a parallel study about homeopathy makes the same point as with the acupuncture study:
I suspect this is the case with many methods where one sees an effect, but where there is no difference between control arms. "Doing something is better than doing nothing, but not better than doing anything else, and is worse than doing something effective." (you can quote me ) -- Brangifer ( talk) 18:23, 28 December 2013 (UTC)
(Meant this to be about nausea; was tired and typed "pain" above instead). The section on efficacy for nausea and vomiting has got some outdated cruft and could use a cleanup. Most recent Cochrane source on PONV is straightforward enough: P6 acupoint stimulation prevents postoperative nausea and vomiting with few side effects. Will suggest wording later. -- Middle 8 ( talk) 20:24, 31 December 2013 (UTC)
In 2006, German researchers published the results of one of the first and largest randomized controlled clinical trials.[194] As a result of the trial's conclusions, some insurance corporations in Germany no longer reimburse acupuncture treatments.[194] The trials also had a negative impact on acupuncture in the international community.[194]
"...some insurance companies in Germany stopped reimbursement for acupuncture treatment]." [29]
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help)As you can see from reading the 2013 review, the text is obviously sourced and is accurately written. Recently, I have noticed editors disagree with me every single time I start a new thread related to acupuncture. Let's see what happens this time. Remember, it does constitute a reliable source according to Mallexikon. QuackGuru ( talk) 02:13, 27 December 2013 (UTC)