Talk:Acupuncture

Mild and controlled Wallerian degeneration

add that text after the paragraph Purported scientific basis

Acupuncture causes balanced symmetrically throughout the body, mild and controlled Wallerian degeneration. It (acupuncture) causes nerves to thicken a little bit, to become more myelinated, and to seek variant pathways and thus to initiate some maintaining. Also during the Wallerian degeneration process more neurotransmitters are forced to be secreted.

Patients that have axonal inabilities or degenerate axon growth may be harmed by acupuncture. We have to be precise though. Not all neuronal or axonal degenerate conditions render acupuncture a prohibited method. Only the degenerate conditions of which their corrupt Wallerian degeneration causes permanent and uncorrectable damage (regeneration not initiated) and also if the disoriented Wallerian stage had become either the final stage, or never stops until the patient paralyses or dies (very rare but substantial).

Wallerian degeneration is the only statistically significant acupuncture consequence, long enough in duration enough to cause an affect. — Preceding unsigned comment added by 2.84.218.210 (talk) 19:50, 18 October 2015 (UTC)

This looks like original research. Famous_dog (c) 11:38, 23 October 2015 (UTC)

Is there a review you'd recommend, 2.84.218.210? --Middle 8 (t • c | privacy • COI) 21:20, 27 October 2015 (UTC)

Interesting new editorial in the journal of family practice

A new editorial in The Journal of Family Practice: "The mainstreaming of alternative therapies" http://www.jfponline.com/specialty-focus/neurologic/article/the-mainstreaming-of-alternative-therapies/6dc51562474ba0332e6045351dbb876d.html 75.152.109.249 (talk) 20:17, 22 October 2015 (UTC)

An opinion piece, the author of which seems to be conflating 'popular' with 'valid'. he also seems to be under the impression that rebranding 'alternative medicine' as 'integrative medicine' somehow makes it 'real'. Famous_dog (c) 11:44, 23 October 2015 (UTC)

For what its worth, the more developed professions labeled CAM or "integrative" (acupuncture, chiropractic) are trying to mainstream themselves by weaving more inclusive evidence -informed practice concepts throughout their schools' curricula. Understanding research design and statistics have been included for a long time, but ACAOM (accreditor for acu schools) has increased the expectations in recent years. These free EIP modules offered by the U of Minnesota can give you a sense of one model of clinical decision making in these professions, if you are interested. The thing I think the non-clinician skeptic crowd is missing is that good MD's know that many medical conditions are humbling - with all our scientific advances there are patients suffering right now for whom there are no "proven" therapies. Those are situations where they (good MD's) are willing to try experimental therapies or refer to alternative therapies in the hope that they can relieve some suffering. The editorial you posted is by a doc that treats a particular stubborn condition, so that explains why he is relatively more open to unproven therapies. Herbxue (talk) 16:52, 23 October 2015 (UTC)

Ernst '11, real and sham ... redux redux

See archived talk: my opening comment, & scroll to "Everymorning" for their suggestion which was implemented with consensus at the time. As noted, Kww and LesVegas and Alexbrn and J-S and 2/0 and Herbxue and most other editors who have carefully read the paper have all agreed that the old wording is a misreading. restoring Everymorning's suggestion: [1] --Middle 8 (t • c | privacy • COI) 07:18, 26 October 2015 (UTC)

The old wording was:

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

The edit changed that to:

A systematic review of systematic reviews found numerous contradictions in the evidence regarding acupuncture's effectiveness for treating pain.

That's a big change, and the new wording is so waffly that it has almost no meaning. I have only browsed the earlier discussion and would have to study it all to form a firm opinion, but while it may be true that the systematic review (that is, the Ernst reference) did not "find" that conclusion about sham acupuncture, a significant portion of the ref's discussion section was dedicated to outlining the "recent results" in a way that suggests Ernst believed that his outline of those results was consistent with the review. It looks as if the Ernst ref supports a stronger statement than the above edit. Johnuniq (talk) 10:11, 26 October 2015 (UTC)

Yes -- if you read the archived discussion (particularly my opening comments) and the relevant portions of article itself, I think you'll see that the new wording is a good summary. That is, it's a good summary of the source, which covers dated and often poorly-designed studies, which is a big point Ernst makes. --Middle 8 (t • c | privacy • COI) 11:20, 26 October 2015 (UTC)

N.B. Ernst didn't say that the "real = sham" result was consistent with his review. He predicted that, as methods improved, pain trials would trend in that direction, instead of being all over the place. --Middle 8 (t • c | privacy • COI) 12:44, 28 October 2015 (UTC)

OK just made another couple edits to summary so it now says

A systematic review of systematic reviews found little evidence of acupuncture's effectiveness in treating pain.

That's sufficient, I think, since inconsistency of evidence is mentioned above, and I added Ernst '11 as a source for that statement as well. (Contradictions in the evidence being one of the ways it's inconsistent.) --Middle 8 (t • c | privacy • COI) 12:38, 26 October 2015 (UTC)

I see that CFCF reverted with no explanation besides "No, the previous version was far superior" [2]; I've invited them to comment here. [3]. --Middle 8 (t • c | privacy • COI) 18:48, 27 October 2015 (UTC)

We should not hide that "fake" poking is as effective as "real" poking. -- TRPoD aka The Red Pen of Doom 21:47, 27 October 2015 (UTC)

When sources say that, yes. Did you read this one? --Middle 8 (t • c | privacy • COI) 21:56, 27 October 2015 (UTC)

IPD meta-analysis: weight issue

Meta-analyses are pretty much unsurpassed as MEDRS's, and the "gold standard" for meta-analysis is the kind using individual patient data (IPD).[4][5][6][7][8] For research on acupuncture's efficacy, there is one such study, Vickers et. al. 2012. It was four large IPD meta-analyses in one and there is plenty there to discuss. It's cited once in the article and isn't in the lede. Other meta-analyses are cited multiple times and are in the lede. This is pretty obviously a WP:WEIGHT problem.

This being a controversial area of research, there were multiple criticisms directed at Vickers, and some of them were valid and are included in the article. However, most of them weren't MEDRS, and those that were were on the low end (e.g., letters to the editor), and to that extent, weigh modestly. One wouldn't guess this from the article, though. Ernst, for example, criticized Vickers in a comment to The Guardian [9], yet the article gives that about the same space as Vickers itself. It's possible that Vickers' critics haven't put their criticisms in stronger MEDRS's because their criticisms are weak. As it happens, Steven Novella, a fairly well-known alt-med critic, said that he'd prepared a full paper criticizing Vickers, but that it was rejected for publication.

So the article is all out of whack with respect to Vickers, which is to be expected when tigers are afoot, as they so often are in CAM topics. This needs fixing; thoughts? --Middle 8 (t • c | privacy • COI) 11:02, 26 October 2015 (UTC)

Mainstream use (academia), undue weight again

Acupuncture is widely used academic medical centers; e.g. it's used and taught at Harvard Medical School [10][11], as well as Johns Hopkins, Stanford, UCLA and others [12]. Some scientists are critical of such usage, calling it "quackademic medicine". These facts are relevant, but we need to write about them without giving undue weight to either side. Right now we're giving considerably undue weight to one critic, David Gorski, by framing the issue just as he does:

Acupuncture is used at academic medical centers despite little scientific evidence for explicit effects for any condition that is discernible from placebo.[13]

That's all we say about it. I'm pretty sure that the views of docs and scientists at these medical centers qualify as significant views, and I doubt that they are outweighed by science bloggers. --Middle 8 (t • c | privacy • COI) 14:50, 26 October 2015 (UTC)

Meta-comment: The widespread use of acupuncture in academia isn't due to stupidity or credulity, no matter how convinced skeptics are that the forces of ignorance are encroaching. Rather, clinicians view things through a different lens: not whether real acu is better than sham, but whether their patients feel better when they get acu versus when they don't. This is a mainstream view, and it's being neglected, again due to tigers who are too attached to promoting or debunking acupuncture: and the debunking tigers are on a much longer leash around here. rest of "meta comment" placed in subsection below --Middle 8 (t • c | privacy • COI) 14:50, 26 October 2015 (UTC) copyedit 21:42, 26 October 2015 (UTC)

Always reliable for the acupuncturist point of view M8, it would appear though that you are unclear what 'widespread use' actually means, and a mainstream view without sources is just waffling. I am curious as to where in academia acupuncture is used? What the evidence for its efficacy is etc. you know, the sort of thing Wikipedia expects us to know about and understand so that our articles can be accurate. -Roxy the dog™ (Resonate) 13:13, 27 October 2015 (UTC)

The sampling mentioned at the beginning above is synonymous with top-tier med schools/clinics. --Middle 8 (t • c | privacy • COI) 18:59, 27 October 2015 (UTC)

These would not be considered WP:RS sources, go ahead and find a review article that states this and we can discuss. CFCF 💌 📧 23:33, 27 October 2015 (UTC)

When an academic medical center says on their own page that they use a modality, a review article isn't needed to verify that fact. Sphere of use isn't a MEDRS claim. We should first just state the fact that it's used, then the pro/con. --Middle 8 (t • c | privacy • COI) 02:51, 28 October 2015 (UTC)

No, but mentioning single institutions is undue. A review article would be needed to show that it is widely used. I also said WP:RS not MEDRS, specifically for this reason. CFCF 💌 📧 15:45, 28 October 2015 (UTC)

Got it. No, I'm not suggesting we have to say "widespread". But why a review article, as opposed to other kinds of (MED)RS? --Middle 8 (t • c | privacy • COI) 00:31, 29 October 2015 (UTC)

There is no weight violation in giving a peer-reviewed review article greater prominence than lower-quality sources. The new sources are fine for reporting the (appropriately qualified) fact that acupuncture is used at these locations, but not for disputing the conclusions of the higher-quality source. I would also avoid the framing in which these sources are implied to be in opposition, since if the new sources are used only to cite sphere of usage, then they don't contradict the statement about evidence - and if they are intended to directly address the evidence, then they would be excluded by MEDRS. This one might possibly be peer-reviewed, but even then it would only be acceptable for citing uncontroversial information, since it's outside the medical literature. Sunrise (talk) 04:35, 28 October 2015 (UTC)

Which higher-quality source are you referring to? If you mean Gorski, it's not a review article (I too assumed so initially), it's an opinion piece in Nature Reviews Cancer (screenshot). Still, it turns out to be a really good, wide-ranging source for CAM sphere of use. --Middle 8 (t • c | privacy • COI) 11:47, 28 October 2015 (UTC)

Aside: compare Britannica

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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On a related, general note, compare how Britannica handles acupuncture and TCM. WP's goal is the same as Britannica's, and they are doing it better. Some degree of quackery-debunking naturally figures into WP:ENC, especially to counter quackery-promotion, but it shouldn't be the dominant focus. --Middle 8 (t • c | privacy • COI) 14:50, 26 October 2015 (UTC)

No, a six paragraph article, light on details, is not "doing it better". --NeilN ^{talk to me} 15:24, 26 October 2015 (UTC)

What they're doing better, I should have said, is not getting bogged down in a tug of war over quackery. Other stuff they're not doing better, including their section on efficacy itself, which is outdated and repeats absurdly wrong PRC propaganda re anesthesia. Still, though... re our article's excesses, see e.g. 4th through 10th sentences (about Germany) in 2nd para at Acupuncture#Adoption. There's a place for some of that information, but it's at German acupuncture trials, not here, where it just makes eyes glaze over. That said, the trend is positive, something I want to encourage. --Middle 8 (t • c | privacy • COI) 16:48, 26 October 2015 (UTC)

No, that article is horrible and a disgrace to an otherwise reputable encyclopaedia. We reference our content and don't report what "Western visitors have witnessed". Glazing over some of the most authoritative evidence that acupuncture lacks any efficacy whatsoever speaks of an already made up mind and of being immune to evidence. CFCF 💌 📧 12:28, 27 October 2015 (UTC)

"Western visitors have witnessed" = the PRC propaganda I criticized. But you know what, Britannica is a poor example for the point I wanted to make. --Middle 8 (t • c | privacy • COI) 19:18, 27 October 2015 (UTC)

What does PRC mean? -Roxy the dog™ (Resonate) 13:04, 27 October 2015 (UTC)

People's Republic of China? --McSly (talk) 13:10, 27 October 2015 (UTC)

Thx, and Oh, not that again. -Roxy the dog™ (Resonate) 13:15, 27 October 2015 (UTC)

Uninvolved editors passing by this article report that it reads less like an article about acupuncture and more like "wikipedians' problems with acupuncture". Of course reviews of RCT's need to be included, but the rhetoric in this article is like the nuclear arms buildup between the US and USSR in the 80's - its gotten out of hand. A real encyclopedia has restraint and a sense of priorities (description rather than persuasion). Herbxue (talk) 14:29, 27 October 2015 (UTC)

May I ask which uninvolved editors you refer to? Those that have a vested interest in promoting acupuncture? Wikipedia presents evidence, not anecdote. CFCF 💌 📧 18:47, 27 October 2015 (UTC)

...Sorry I started this tangent, CFCF. I'd like to talk about your thoughts on this source, though. --Middle 8 (t • c | privacy • COI) 19:37, 27 October 2015 (UTC)

A quote from a 'real' encyclopaedia ... assertions that acupuncture can actually cure disease defy rational clinical practice and have yet to be substantiated by Western medical researchers. -Roxy the dog™ (Resonate) 14:44, 27 October 2015 (UTC)

Yes, that's a reasonable sentence, though not the whole picture. I shouldn't have brought up the comparison -- see how editors are commenting on it but not the substantial issues re Ernst's review, the IPD meta-analysis and mainstream academic use. My bad for the Britannica red herring -- yes, they get the lack o' minutiae right, but not much else, so it's a crappy comparison that I made. --Middle 8 (t • c | privacy • COI) 19:18, 27 October 2015 (UTC)

So, Britannica = poor comparison, sorry I mentioned. There is some stuff above re content we could talk about, though. [14] [15] [16] --Middle 8 (t • c | privacy • COI) 19:29, 27 October 2015 (UTC)

Middle 8, I wouldn't worry too much about editors not taking to your Britannica suggestion. The Britannica article may have its own problems, but it's actually readable. WP's isn't. I think it's in need of a major overhaul myself. I recently suggested to Awilley (Adjwilley for you veterans), that the article be more Cochrane, NIH, and NHS based with regards to claims of efficacy or non-efficacy and the remainder of the article should be history and interesting facts, and that uninvolved and very reasonable editor thought it was an interesting idea. So I don't think you're off base at all here. Regarding Ernst '11, I think we may have to go the RfC route. Almost everybody agrees the current statement is highly inaccurate. I'm going to restore Everymorning's version because it stuck for a very long time before QG canvassed an editor here to make it for him. Unfortunately, the same editor seems to be making an edit only QG supported for the longest time. I'll restore it and if it doesn't stick, I suggest going another route. LesVegas (talk) 20:34, 27 October 2015 (UTC)

LesVegas, I would be careful about throwing around such allegations - you made quite a deal of noise trying to elbow in questionable content into WP:MEDRS to push your POV here. Wikipedia expresses what reputable sources say, and the above suggestions are detrimental to the article. CFCF 💌 📧 21:01, 27 October 2015 (UTC)

I won't make these allegations again. Next time edits QG notoriously supported are made by you or others, I will just notify the appropriate board and they will look into it. LesVegas (talk) 21:51, 27 October 2015 (UTC)

I started this unproductive thread, asked to end it and you guys ignored me, and am going to close it now. --Middle 8 (t • c | privacy • COI) 21:57, 27 October 2015 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.