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Request for Comment re: 'Quackery' in the lede for Acupuncture

Should the term "quackery" be used in the lede for acupuncture? The term pseudoscience is already used and it has been described as non-scientific in that same paragraph/sentence. Does using the term 'quackery' provide additional information that is not already there, or is it making a value-based call that compromises the neutrality of an encyclopedia? CranberryMuffin (talk) 16:57, 18 September 2023 (UTC) WP:SOCK comments stricken

I see no problem with the current wording. The subjunctive mood even leaves open the door to people not describing it as quackery. awkwafaba (📥) 17:52, 18 September 2023 (UTC)
  • Uninvolved editor drawn here by a bot. On the face of it, it seems fine to me. @EEng:, is there another high-quality example you qan drop here that qalls quackery quackery in the lede? Awkwafaba (talk · contribs) points to the passive voice as kind of an “out” — I feel a bit different, and think it might be preferable to state that e.g. “the medical establishment [eastern? western? worldwide? does it matter]? and/or International Council of Skeptics? Whomever... characterize acupuncture as quackery.” i.e. ditched the passive/non-attribution. I believe our MOS still generally frowns on citations in the lede, but if the quackery assertion is tendentious (I could imagine it being so), an exception might be appropriate here. --EEMIV (talk) 17:59, 18 September 2023 (UTC)
    Qan I give an example of an article that qualls quackery quackery in the lead? I don't think I qan. EEng 19:20, 19 September 2023 (UTC)
    😁 Ldm1954 (talk) 19:24, 19 September 2023 (UTC)
  • TCM acupuncture clearly is quackery, as it depends on things that don't exist (qi and meridians). No evidence is given that "modern" acupuncture does anything else differently, even if it doesn't use the terms. Black Kite (talk) 17:58, 18 September 2023 (UTC)
    This is like saying we can't see radio waves, so they must not exist. There is plenty of evidence that acupuncture is therapeutic in the medical literature. That said, a poor understanding of Chinese Medicine has led to a plethora of poorly designed studies in the western medical literature.
    Here is a simple example of a study demonstrating that there is often a difference in the electrical resistance of the skin at an acupuncture point when compared to the surrounding skin. (It would be not be expected to see this all the time because every person has different energetic properties or blockages happening/not happening at any given time on every aspect of their body...thus why one seeks out a professional for proper diagnosis.) https://pubmed.ncbi.nlm.nih.gov/19422323/
    A 20 second search reveals another example -- this is an overview of systematic reviews of acupuncture in the treatment of knee osteoarthritis demonstrating its superiority ("the effectiveness of electroacupuncture was better than that of western medicine") to mainstream treatment: https://pubmed.ncbi.nlm.nih.gov/31305415/
    Until Wikipedia figures out how to write less biased nonsense (acupuncture is "quackery" and "pseudoscience"), it will struggle to receive fundraising support from the well educated public. 2600:1700:64A0:1340:A408:6F28:68C1:5C23 (talk) 22:36, 14 December 2023 (UTC)
    This is like saying No, it's not. Read it again, the difference is not that difficult to understand.
    We follow the scientific consensus, and that is neither found in primary studies like your first link, nor in papers written by authors working for a pro-quackery institution in a pro-quackery dictatorship, like your second link. I do not know how influential Medicine (Lippincott Williams & Wilkins journal) is, but the paper itself does not seem to have made of lot of waves. --Hob Gadling (talk) 15:47, 16 December 2023 (UTC)
  • Yes, quackery is an appropriate word to use. --Tryptofish (talk) 18:30, 18 September 2023 (UTC)
  • Seems reasonable to me. "Quackery" and "pseudoscience" aren't really synonyms and this is both, so why not describe it as such? What alternative term would one use? "Fake medicine" perhaps, but I think the current term is clearer. Anaxial (talk) 18:43, 18 September 2023 (UTC)
    Well, my only contention here is that quackery brings to mind an intentional and dishonest deceit whereas traditional Chinese medicine practitioners may truly believe in what they are doing without any malice or deceit. So in that sense it is more neutral as pseudoscience than something sinister like quackery. CranberryMuffin (talk) 19:51, 18 September 2023 (UTC) WP:SOCK comments stricken
    Very few quacks are actually aware they are doing harm. Professional con artists might know they harm people, yet many quacks seem to sincerely believe that their quackery actually heals people. tgeorgescu (talk) 20:04, 18 September 2023 (UTC)
    Osteopathic manipulative therapy (OMT) by DO physicians in the United States believe that you can treat asthma by manipulating the back with pressure points. It is also a form of alternative medicine, but because it has Western origins it is much more widely accepted. Anyway, this is run by consensus and if most editors believe in using the term quackery for mostly Eastern stuff then so be it. CranberryMuffin (talk) 20:28, 18 September 2023 (UTC) WP:SOCK comments stricken
An independent view. The term quackery is clearly inappropriate and should be deleted without hesitation. The term implies deliberate fraud. There is no evidence that a multibillion industry is all deliberate fraud. The term is very definitely inappropriate for any Wikipedia article except, perhaps, for someone convicted of fraud. Ldm1954 (talk) 20:35, 18 September 2023 (UTC)
I disagree about the choice of following the majority here. The term quackery is clearly not WP:NPOV, plus could be termed WP:OR and other violations. Ldm1954 (talk) 20:38, 18 September 2023 (UTC)
https://sciencebasedmedicine.org/how-do-scientists-become-cranks-and-doctors-quacks/
And I agree there's room for nuance: in the Antiquity, acupuncture wasn't quackery. It is only quackery in the 20th and 21st century, when we know better. The power of "mainstream" or "Western" medicine is its relentless fight against myths and superstitions, even when such myths/superstitions happened to be mainstream/Western. Yup, just 200-300 years ago "Western" medicine wasn't all that great. In doubt, read the medical advertisements from old editions of the Boy Scout Handbook. tgeorgescu (talk) 21:17, 18 September 2023 (UTC)
Agreed. Sometimes on WP we need to be neutral for topics/models etc even when we know they are wrong. State, then point out the flaws gently but firmly. Ldm1954 (talk) 21:20, 18 September 2023 (UTC)
The difference between Western medicine and modern TCM is that Western countries were prepared to "kill their darlings", i.e. sacrifice their previous beloved ideas upon the altar of modern science. Of course, Western countries allow some freedom to the SCAM industry, but their mainstream science never endorses SCAM. In the PRC, TCM is officially endorsed by scientists and claiming that it does not work amounts to a political crime (rebellion against the political order). Source: https://www.theguardian.com/world/2020/jun/03/beijing-draws-up-plans-to-outlaw-criticism-of-traditional-chinese-medicine and https://www.cfr.org/blog/traditional-chinese-medicine-cure-chinas-soft-power-woes And even if it is not officially a crime, no Chinese scientist wants to attract the ire of the functionaries of the Party. tgeorgescu (talk) 00:58, 19 September 2023 (UTC)

Personally I think it's a bit hubristic for an article everyone knows is written by volunteers with no necessary expertise to contain such vehement language in such a prominent place, even if true. ByVarying | talk 22:57, 18 September 2023 (UTC)

I think it's worth pointing out that we don't say it in Wikipedia's voice. It's attributed. --Tryptofish (talk) 23:02, 18 September 2023 (UTC)

 Question: is the RfC still applicable as openend by an already blocked sockpuppet? --Julius Senegal (talk) 11:13, 19 September 2023 (UTC)

I removed the RfC template, so it's no longer listed as an active RfC, but I guess there's no reason why editors cannot discuss it if they really want to. --Tryptofish (talk) 15:10, 19 September 2023 (UTC)

Article is biased

In the efficacy chapter, it only cherrypicks and gives the entire weight to just one guy who is a renowned skeptic who already made his mind or doesn't want to believe eastern medicine works, and put a tremendous amount of vested time and effort in claiming it doesn't work, and even creates an online blog. He doesn't actually do any studies or conduct experiments. Meanwhile there are actual academic institutions like Harvard, who consist of many researchers who had done better studies and high quality methodologies and confirmed benefits are not due to placebo and it reduces inflammation.https://www.harvardmagazine.com/2020/12/right-now-acupuncture-relieves-inflammation + https://www.thecrimson.com/article/2021/11/23/cytokine-storm/ Also the article puts too much weight in outdated systematic reviews. But it doesn't give much mention to more recent systematic reviews that confirm it is effective on chronic pain during opioid addiction. https://www.painmedicinenews.com/Complementary-and-Alternative/Article/03-23/Acupuncture-Helps-Stem-Opioid-Addiction-While-Treating-Acute-Pain/69736 Even if you don't believe in the underlying philosophy, it's possible that placebo effect is not the only explanation, given how many people feel a real difference and you can't just cherrypick one skeptic and have him dominate the article. Other researchers who have confirmed its effectiveness like Harvard and Pain Journal should have a mention in the efficacy chapter. Why is the article so dominated by one guy who overrides all the experts that should have more say than him. Harvard is a highly trusted institution and they contradict him completely in these past few years. Renfieldaccusome (talk) 06:10, 3 January 2024 (UTC)

I don't know why I can't edit the accupuncture page. What do I need to do to edit? I already even registered an account. Yet it still gives the prompt that the 'page is protected from vandalism'. I just want to add in that Boston scientists used MRI scans and accupuncture on the wrist. They found real accupuncture has truly helped to rewire the brain physically and improves outcome in carpal tunnel syndrome. They found that real accupuncture works but sham accupuncture failed to have the same long term effect on the brain remapping. Personally I had crippling carpal tunnel syndrome and have accupuncture to thank for it improving where I can do things with noticeable less symptoms and why I really believe it works. And very disappointed to see the accupuncture page have a great deal of skepticism dominating it, and so ask whoever is in charge of Wikipedia affairs, to read my arguments and add it into the article info for efficacy. I quickly googled these links just now and it supports what I written above. https://www.medicalnewstoday.com/articles/can-acupuncture-help-carpal-tunnel-syndrome-2#effectiveness and https://www.discovermagazine.com/health/acupuncture-works-by-re-wiring-the-brain-evidence-suggests and https://time.com/4690200/acupuncture-carpal-tunnel-syndrome/ Renfieldaccusome (talk) 07:01, 3 January 2024 (UTC)
The reason you cannot edit it, is that it is semi-protected. Please see also WP:MEDRS, which defines the kinds of sources we will use here. The sources you cite above fail those criteria, so the edit you propose would end up being reverted. --Tryptofish (talk) 22:06, 3 January 2024 (UTC)

Add Emerging Theory Suggests that the Fascia Network may be the Anatomical Basis for Acupuncture Points and the Meridians.

See article published in medical journal in 2011: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092510/

See also "The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine" by Daniel Keown, published in 2014 2600:1700:64A0:1340:A408:6F28:68C1:5C23 (talk) 22:47, 14 December 2023 (UTC)

No. — SamX [talk · contribs] 22:49, 14 December 2023 (UTC)
Wikipedia depends on verifiable sources to support its content. A study that has not been replicated or repeated is not ultimately, verifiable. It might be that later on certain kinds of content is verified by repeated and or replicated results or alternately will be found to be not-replicable. Until then, Wikipedia, to protect the safety of its readers, only uses health-related, content sources that have been vetted in this way. Littleolive oil (talk) 17:03, 16 December 2023 (UTC)
Safety of readers? If you read the public health department's words for accupuncture, they say it's generally safe and many well-designed studies have found that acupuncture can help with certain conditions, such as back pain, knee pain, headaches and osteoarthritis. https://newsinhealth.nih.gov/2011/02/understanding-acupuncture I don't think a US gov body would be recommending accupuncture to people for no good reason at all. Renfieldaccusome (talk) 06:16, 3 January 2024 (UTC)
Your high opinion of the governmental institutions of some random country cannot be the foundation for an article about a medical subject. See WP:MEDRS. --Hob Gadling (talk) 09:39, 20 January 2024 (UTC)
To be more precise, the information about what many well-designed studies have found comes from the NCCAM, which is the NIH's quackery branch it has to suffer for political reasons. --Hob Gadling (talk) 12:35, 20 January 2024 (UTC)

Theatrical Placebo

Acupuncture (in the US at least) is usually used for pain management, as the article states. At least some doctors are reasonably sure it is a theatrical placebo. This seems right to me. But since we are specifically in the realm of pain management, where the placebo effect can, in fact, work, I'm wondering if we have to be more careful about some of our statements about its efficacy. I'm thinking in particular the fourth paragraph of the lead: "The conclusions of trials and systematic reviews of acupuncture generally provide no good evidence of benefit, which suggests that it is not an effective method of healthcare."

As the Wikipedia article on placebos says, "[Placebos] can affect how patients perceive their condition and encourage the body's chemical processes for relieving pain." Maybe we should just say "no good evidence of benefit compared with a placebo"? AtavisticPillow (talk) 00:37, 23 January 2024 (UTC)

No, because that takes us in the direction of another quackery, whereby the 'power of placebo' is argued as a excuse for all fake medicine.[1] And in fact, most comparisons of acupuncture effect wrt pain are against sham acupuncture, not placebo, per PMID:36416820. Bon courage (talk) 02:10, 23 January 2024 (UTC)
Sham acupuncture is a variety of placebo, not something else entirely. I understand it is not Wikipedia's role to promote the power of the placebo, nor was I suggesting it do so. I was simply suggesting updating the description to more accurately reflect what the trials generally disclose: that acupuncture is no better than sham acupuncture. (You are right, though, that the distinction matters because the evidence that placebos have effects distinct from foregoing treatment is largely restricted to pain). Still, I have a hard time seeing how adding four words to more accurately characterize the results of a study constitutes moving in the direction of quackery. Later in the article a Novella piece is cited attributing acupuncture's effects to a placebo – hardly someone who could be said to take us in the direction of another quackery, and this adjustment would be even more modest than his claim: it would be a purely descriptive account of the results of a secondary source. AtavisticPillow (talk) 02:42, 23 January 2024 (UTC)
Went ahead and executed this edit since both sources for the sentence refer to lack of benefit relative to a placebo, not absolutely; I only added four words ("relative to a placebo"). AtavisticPillow (talk) 16:45, 23 January 2024 (UTC)
No, that is bad style likely to confuse readers. If you want to propose that all medical article need to have "compared to placebo" added into all discussions of efficacy, make a case at WT:MED, but it would add nothing to the Project in my view. Bon courage (talk) 16:46, 23 January 2024 (UTC)
I think readers can generally be expected to be familiar with the placebo effect? But anyway I don't think it matters in all discussions of efficacy, just for something that is predominantly used to treat pain. Per the Wiki article on placebos: "A 2010 Cochrane Collaboration review suggests that placebo effects are apparent only in subjective, continuous measures, and in the treatment of pain and related conditions." Considering this background, the meaning of the characterization of the review changes depending on our speaking in absolute terms or relative to the placebo.
But I will raise the issue at WT:MED. AtavisticPillow (talk) 16:54, 23 January 2024 (UTC)

Remove "quackery"

I would argue that this wording is not neutral or fair. Other reputable sources have described accupuncture as a 3000 year old respected form of traditional chinese medicine that is evidence based and even approved by WHO for assisting with various health conditions. 151.210.246.170 (talk) 22:30, 18 November 2023 (UTC)

See multiple discussions just above. --Tryptofish (talk) 23:23, 18 November 2023 (UTC)
See my reply to Black Kite above. 2600:1700:64A0:1340:A408:6F28:68C1:5C23 (talk) 22:48, 14 December 2023 (UTC)
Unfortunately science doesn't have the prowess to explain everything. But empirically it seems to work. I think the philosophy itself is quackery as I don't believe in that. But I do believe that the effects are real and that should not be dismissed. It's already proven to literally have long lasting remapping of the brain in MRI scans for real accupuncture vs sham. So philosophy may be illegitimate, but not the physical impacts it gives. Harvard writes a fair deal on it. https://news.harvard.edu/gazette/story/2017/03/study-reveals-differences-in-the-effects-of-real-and-sham-acupuncture/ Langevin and Wayne, both Harvard Medical School researchers, have suggested that although acupuncture has become more empirically legitimized, it is held back by the theory behind it. https://www.wired.com/story/machine-learning-chinese-medicine-acupuncture-study-design/ Renfieldaccusome (talk) 07:27, 3 January 2024 (UTC)
There is no good evidence it works; reliable sources invoke quackery. Wikipedia is obliged to reflect that. Bon courage (talk) 07:34, 3 January 2024 (UTC)
What "reliable sources" and what does "invoking quackery" even mean as a counter argument to published research and the fact that acupuncture is increasingly advised and incorporated in our mainstream medical establishment? Acupuncture is currently recommended in the evidence-based clinical practice guidelines of the American College of Physicians as appropriate, evidence-based treatment for low back pain. https://www.acponline.org/acp-newsroom/american-college-of-physicians-issues-guideline-for-treating-nonradicular-low-back-pain
Medicare currently reimburses for acupuncture in the treatment of low back pain-- not an easily won coverage without reams of high-level evidence. https://www.medicare.gov/coverage/acupuncture
The US Department for Veteran's Affairs provides acupuncture treatment to its patients and considers acupuncture evidence-based and appropriate care for a range of conditions. https://www.va.gov/WHOLEHEALTH/professional-resources/Acupuncture.asp
Acupuncturists are regulated medical professionals in the US, in most states requiring accredited Masters or Doctoral level education, board certification and state licensure.
This biased, shameful Wikipedia entry is not only culturally biased, it's borderline racist-- just because acupuncture originated from a culture outside of the West, it's somehow justifiable, in the year 2024, to ignore the reams of peer-reviewed
evidence that validate it, and ignorantly continue to label it "quackery"? 108.16.253.41 (talk) 18:35, 7 January 2024 (UTC)
It has been characterised as quackery is reliable sources. Wikipedia reflects that, to be neutral. You're making the WP:BIGMISTAKE. Bon courage (talk) 18:40, 7 January 2024 (UTC)
Just happened to see this and I'm not sure this is right. Source 7 in the article, a review of controlled trials of acupuncture used for pain relief, concluded that for some uses it was better than a placebo. Not sure if that necessitates changing the article considering other reviews in the sources have been less sanguine, but I wonder if the lede could do better to distinguish between the quack theory of acupuncture (chi, energies, rhythm, etc.) and areas where sources suggest it might have therapeutic potential, like acute pain management. AtavisticPillow (talk) 23:05, 7 January 2024 (UTC)
That doesn't 'cancel out' the sources characterizing it as quackery. Bon courage (talk) 06:51, 8 January 2024 (UTC)
Apologies, didn’t mean to suggest otherwise, was just wondering aloud if the lede as a whole was the most neutral reflection of sources AtavisticPillow (talk) 12:17, 8 January 2024 (UTC)
For pseudosciences, Wikipedia needs to be up-front with the rational perspective. Bon courage (talk) 13:06, 8 January 2024 (UTC)
Again, wasn't suggesting otherwise. I was simply noting that one of the sources had found evidence for statistically significant effectiveness with a subset of uses and wondering if this should be reflected in the lede. But Hob Gadling below is right that evidence of efficacy for acute pain management in one review could well be statistical noise and doesn't warrant changing the article. AtavisticPillow (talk) 16:02, 8 January 2024 (UTC)
Given there have been literally thousands of studies picking one or two old ones would seem odd. We have excellent up-to-date MEDRS giving an overview in the "Efficacy" section, and this may be summarized in the lede. Bon courage (talk) 16:06, 8 January 2024 (UTC)
Absolutely, I agree completely. AtavisticPillow (talk) 16:10, 8 January 2024 (UTC)
The phrase for some uses points every statistically literate person to the Texas sharpshooter fallacy. --Hob Gadling (talk) 08:08, 8 January 2024 (UTC)
Fair enough AtavisticPillow (talk) 12:23, 8 January 2024 (UTC)
All of the debates about the inclusion of the word 'Quackery' specifically in the introductory paragraph seem to devolve into a debate about whether acupuncture is effective. The efficacy question is not really relevant; the question is whether the statement itself is WP:NPOV. The specific word 'quackery' is non-disputably inflammatory and distracting to readers; evidently, every time the talk page is archived, a new discussion about the word appears. Evidence that the issue is mostly just that specific word is that there do not seem to be comparably strenuous objections to repeatedly describing acupuncture as 'pseudoscience', although it would seem to be nearly synonymous in this context. While merely being inflammatory and distracting would not be necessarily sufficient reason to omit a word, we should weigh whether the offending words inclusion does more harm than good.
So the question should be:
What additional value does describing acupuncture as 'quackery' in the introduction provide to the article beyond the description as 'pseudoscience' and discussing the issue in more nuance in later sections of the article?
The word 'pseudoscience' is sufficient to cover the premise that many practices and theories of acupuncture are largely or entirely not evidence based. To me, the primary additional connotation of 'quackery' is that is also implies 'fraudulent'. To the extent that 'fraudulent' is the primary additional intended meaning, I'm not sure that it is accurate, or at least sufficiently precise. No cited evidence supports the statement that all practitioners of acupuncture are generally regarded as fraudulent by a consensus of mainstream reputable sources:
1.) Most or all western countries (and US states) have at least some form of licensing for acupuncturists as a medical profession (as discussed in the "Regulation" section). A licensed medical professional operating within their scope of practice is, by definition, not fraudulent in the legal sense of the word. An unsourced general allegation of fraud against licensed professionals would strike me as potentially dangerously libelous.
2.) Speaking to the US, which I am most familiar with: Most major hospital systems in the US either have acupuncturists on staff or have physicians who routinely refer patients to acupuncturists; the article acknowledges this lower down "In the US, acupuncture is increasingly (as of 2014) used at academic medical centers". The majority of the US population is covered by health insurance plans that provide at least some coverage for acupuncture. As far as I can find, no mainstream professional medical organization or US federal agency denounces acupuncture as fraudulent; in fact, the article itself claims the opposite "CDC clinical practice guidelines from 2022 list acupuncture among the types of complementary and alternative medicines physicians should consider in preference to opioid prescription for certain kinds of pain." Nor does the World Health Organization. Therefore a statement that the practice is 'fraudulent' is outside the consensus of the article's mainstream sources.
3.) The introductory statement that acupuncture (at least as defined by the article as "the insertion of thin needles into the skin") is fraudulent is in tension with the body of the article. For example, the article below says "For example, the American Society of Anesthesiologists states it may be considered in the treatment for nonspecific, noninflammatory low back pain only in conjunction with conventional therapy." The article acknowledges that "spiritual elements of acupuncture that conflicted with scientific knowledge were sometimes abandoned" and "Some modern practitioners support the use of acupuncture to treat pain, but have abandoned the use of qi, meridians, yin, yang and other mystical energies as an explanatory frameworks", which are both inconsistent with a general blanket allegation that acupuncture is fraudulent.
Overall, I think that describing acupuncture as 'quackery' in the introductory paragraph adds no value to the article beyond the existing statement of 'pseudoscience', does not accurately reflect the rest of the article, and is distractingly non-neutral. Omitting the phrase ', and it has been characterized as quackery.' would improve the objectivity of the article without altering any of the article's substantive discussion of the evidentiary basis of acupuncture and criticisms thereof.
Mynameisntbob1 (talk) 20:07, 18 January 2024 (UTC)
@Mynameisntbob1: Only noobs read the prose of the Wikipedia articles; pros simply click upon the references. So, yeah, what makes Wikipedia great is not its prose, but being a repository of vetted citations. tgeorgescu (talk) 22:22, 19 January 2024 (UTC)
@Tgeorgescu If it is a repository of vetted citations, then would you say the article fails in that capacity here? Two of the three sources cited for the statement that it 'has been characterized as quackery' do not characterize acupuncture as quakery. The third does, but only offhandedly because it is an article about that is not about acupuncture. Should the first two sources be removed from the citation block? Or is it possible to surface more than a single reliable source that calls acupuncture quackery? Mynameisntbob1 (talk) 03:00, 22 January 2024 (UTC)
The second source does as well. The first cite corresponds to the clause before the comma, I moved it there. These citations should not be removed. MrOllie (talk) 03:10, 22 January 2024 (UTC)
The statement in the 'needle in the haystack' article is (paraphrasing) 'Although many scientists have called acupuncture quackery, it is not'. As discussed elsewhere in this thread, it feels like editorializing/a dishonest interpretation of the source to cherry pick just the first half of that statement to use it as a citation supporting a viewpoint that it explicitly rejects. The solution may be to just remove the citation if we do not want to be citing with pro-acupuncture sources (as said elsewhere, no one is advocating changing this article to reflect a false balance). Mynameisntbob1 (talk) 16:34, 22 January 2024 (UTC)
But that acupuncture is pseudoscience, and that it is described as "quackery" is the NPOV because that's what the reliable sources say. That American healthcare system includes pseudoscientific practices does not make them not quack practices and there are reliable medical experts saying that healthcare systems shouldn't be courting such dubious practices. GraemeLeggett (talk) 20:18, 18 January 2024 (UTC)
The question raised seems to be more about how to present NPOV in the opening paragraph, which has to introduce the topic and to some extent distill the rest of the article in a very short space. My intuition – which seems to be at odds with more seasoned Wikipedia science and medicine editors – is that Mynameisntbob1 is correct that stating the quackery characterization in the opening paragraph tends away from NPOV policy on preferring non-judgmental language, and that the pseudoscience characterization is more reflective of the rest of the article.
I realize that the NPOV policy distinguishes between stating that something is quackery, and stating that something has been characterized as quackery in an RS. But even the latter has to be applied with balance and careful judgment, and context matters. For that reason I don't think there is any issue with presenting the quackery claim in the body of the article, but I do think that stating it in the opening paragraph tends away from NPOV. AtavisticPillow (talk) 21:23, 18 January 2024 (UTC)
I'm not here to debate the efficacy issue, which I have no opinion on. However, I would not characterized the statement as being backed by WP:MEDRS sources. The sources are two blog posts (citations 6 and 8), and an editorial (7) challenging the notion that acupuncture is quackery, and concluding 'acupuncture practice should not be seen as a placebo intervention'. As I read it, WP:MEDRS specifically says blog posts are not reliable sources. All or almost all WP:MEDRS sources I can find that include the word 'quackery' are similar to source 7, in that they are generally arguing that acupuncture should not be termed 'quackery'.
Of course, I suppose you could argue that the fact that WP:MEDRS specifically deny that it is quackery is evidence for a statement that someone has 'characterized' it that way. That usage of 'characterized' strikes me as a bit of a WP:WEASEL word interpretation if it does not appear in the context of an actual discussion of the terminology issue.
Relatedly, I am also not arguing against the later use of the word 'quackery' that appears in the context of a (not very well fleshed out) discussion of the debate over whether the best description is 'quackery', 'pseudoscience', or something else. I am only arguing that the specific statement in the introductory paragraph is not WP:NPOV. Mynameisntbob1 (talk) 21:34, 18 January 2024 (UTC)
This sounds sensible and correct to my ears wrt to the quackery claim in the lede and the use of sources. Definitely agreed as well about this being a dishonest use of source 7.
Most good secondary sources show no evidence for efficacy of acupuncture, so I don't think anything warrants changing that information (raised this issue above because of source 7, but it seems to be an outlier). I realize you're not arguing to do so, just putting it out there. AtavisticPillow (talk) 21:51, 18 January 2024 (UTC)
This is a common misunderstanding of WP:NPOV. But neutral POV does not mean no POV and it does not mean false balance. When the reliable sources are harsh, so too will be Wikipedia. Quackwatch and Science-Based Medicine are not mere 'blogs' to be dismissed, they have a Wikipedia-wide consensus as reliable sources. And not everything needs a MEDRS-quality source - particularly not on a topic that deals with pseudoscience, where WP:PARITY applies. When debunking pseudoscientific claims, we do not hold the debunkers to a higher standard than the debunkee. MrOllie (talk) 22:05, 18 January 2024 (UTC)
I don't think anyone has suggested putting forward a false balance, nor backing off from including the statement that acupuncture has been characterized as quackery in the article. The only thing at issue is whether putting this fact in the opening paragraph is an appropriate application of WP:NPOV and its dictate to "prefer nonjudgmental language," considering the role of this paragraph is to introduce, and to some degree condense, the remainder of the article as a whole. AtavisticPillow (talk) 22:38, 18 January 2024 (UTC)
It is extremely important context that aids the reader in understanding the rest of the article, it should be right up front. MrOllie (talk) 22:41, 18 January 2024 (UTC)
Insofar as "extremely important context" matters here (introducing the topic of acupuncture), what seems relevant is (1) stating that acupuncture is a pseudo-science, which it quite clearly is, and (2) that evidence of its effectiveness is generally not born out by the best available data in the best available sources. What is less clear is that adding the statement "it has been characterized as 'quackery'" to the above undisputed claims in the opening paragraph is best reflective of WP:NPOV, since "quackery" is clearly not non-judgmental language. Again, context matters: there is no issue with the inclusion of this statement in a longer discussion of its dubious efficacy, questionable institutionalization in mainstream medicine, and so on. AtavisticPillow (talk) 22:57, 18 January 2024 (UTC)
I think the inclusion of the word 'quackery' is so distracting that it makes the article much less effective at 'debunking' acupuncture, because it clearly establishes a non-neutral POV, which discourages readers from continuing to read, or from taking the later information seriously. I myself am a scientist and came to this article looking to learn about the evidence surrounding acupuncture, and initially immediately stopped reading the article at that point due to the lack of neutrality. Note that by neutral POV I don't mean 'no' POV or even a 'non-negative' POV; an article could have a highly negative POV but still neutral, or, as in this case, be both negative and also not neutral. Omitting the word 'quackery' the paragraph will still have a clear POV because it still describes acupuncture as 'pseudoscience'.
To look for summary articles with a more neutral POV, I went to UpToDate, a service commonly used by physicians looking for current clinical guidance (a reliable source, but unfortunately not free), and read the first 20 or so articles that include the keyword. My takeaway:
No article that I read specifically recommends against referring patients to acupuncture, except in the presence of contraindications. Several articles recommend that physicians should write acupuncture referrals for pain management if patients are interested. Acupuncture is frequently discussed in close parallel with massage, in that both are described as having weak supporting evidence but both improve patient's self-reported satisfaction with pain management and have similarly low degrees of risk.
UpToDate does specifically recommend physicians discourage patients from visiting unlicensed practitioners and practitioners who are known to discourage patients from also continuing to pursue more conventional medical treatments. Comparing this advice with the definition given in Quackery:

A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, knowledge, qualification or credentials they do not possess; a charlatan or snake oil salesman".

I read the UpToDate guidance as discouraging patients from visiting specific practitioners who are quacks per the definition, but not saying that the practice itself is generally 'quackery'. By implication, the consensus viewpoint is that licensed acupuncture practitioners in general are not 'quacks', despite the practice being 'pseudoscience'. UpToDate is likely a better representation of the modern clinical consensus in western medicine than the two blog posts, even if both are relatively reputable blogs.
Basically, it seems to me that the description of acupuncture generally as 'quackery' is clearly outside the Western medical consensus, while describing it as 'pseudoscience' is within the consensus. Arguing that the Western medical consensus is wrong in either direction is WP:OR; it is not a WP:PARITY issue. As I also said, a discussion about the debate about the proper terminology is a fine section to have later in the article, and in fact that discussion should be expanded. I think we should not be deliberately injecting any non-consensus view about acupuncture in the first paragraph.
Mynameisntbob1 (talk) 20:23, 19 January 2024 (UTC)
This page doesn't even say that it is quackery (in Wikipedia's voice). What the page says is that it has been described as quackery, and we cite sources that describe it as such. --Tryptofish (talk) 21:15, 19 January 2024 (UTC)
But it's also been described as "effective" (at least for pain management) by numerous medical sources (Johns Hopkins, Penn Medicine, Cleveland Clinic, Mayo Clinic, Mount Sinai, etc. etc.). The article is in contradiction with itself. The lead clearly trying to "tell" the readers that it 100% does not work for anything, when, like it or not, the majority of neutral medical sources don't say anything like that. It's impossible not to read this article as having selective hearing when it comes to the sources. Pyrrho the Skipper (talk) 21:40, 19 January 2024 (UTC)
Perhaps a good way to handle this is by adding another footnote. What I mean is that there are three inline citations for sources that call it quackery. We could add a fourth inline cite, formatted like "But see also: source(s)." (If you look at citation #4 here: [2], you can see an example of what I mean.) --Tryptofish (talk) 21:45, 19 January 2024 (UTC)
This seems a weak response to the issues raised above. Considering the case Mynameisntbob1 is making seems quite reasonable, why not just remove the "it has been characterized as quackery" statement from the opening paragraph? The quackery characterization is repeated in the body, and no one is suggesting that be removed. AtavisticPillow (talk) 22:18, 19 January 2024 (UTC)
If the choice comes down to a binary one between keeping the page as is, or removing the words from the lead entirely, I'd prefer to leave the page as it is. --Tryptofish (talk) 22:27, 19 January 2024 (UTC)
Another option would be to contextualize the claim in the lead such that it is placed in the context of a larger debate about the institutionalization of acupuncture (general acceptance for pain relief and fibromyalgia only, but doubts about the quality of the data supporting its use across the board and suspicion that it is an elaborate placebo). That seems better suited for the body of the article though.
The problem is that announcing "it has been characterized as quackery" in the opening paragraph – even with the distancing implied by the "it has been characterized..." – is that it is obviously a deliberate attempt to discredit with non-neutral language the practice of acupuncture beyond the wide consensus that it is a pseudoscience. In the body of the article, in the proper context, the statement is just relevant information about how some doctors view acupuncture. AtavisticPillow (talk) 22:44, 19 January 2024 (UTC)
Quackery goes with pseudoscience (it is, if you like, simply pseudoscience that's sold) so it seems aptly placed. I think if the concept were surfaced later in the lede it would be disjointed. Quackery is a concept as much in the realm of health fraud and consumer rights as much as medicine. Bon courage (talk) 04:25, 20 January 2024 (UTC)
Agreed on that last sentence. Curious what you think of the case made above by Mynameisntbob. Not everything they said is 100% pertinent for Wikipedia purposes (case would have to be made with sources taken from, or added to, the page itself); but it seems clear to me that (1) statement of this characterization in the opening paragraph is loaded and tends away from WP:NPOV on non-judgmental language (specifically because of the editorial decision to include, of all possible statements, this one, right at the beginning, shorn of other context), and (2) that it is not reflective of the opinion of the medical community at large as disclosed by our sources as a whole. What seems like our best source, source 17, just says that instances of high quality data supporting the use of acupuncture are relatively rare. Novella, in source 18, reads this as saying "most of the acupuncture evidence is crap." That's fine of course – he's allowed to editorialize! – but I still think the quackery characterization in this specific context (the opening paragraph) tends too far in that direction. AtavisticPillow (talk) 13:19, 20 January 2024 (UTC)
Well those are biomedical questions, the 'quackery' question is more about the ethics of what happens when people are charged money for acupuncture to treat infertility/autism/cancer or whatever myriad conditions it is sold for. If for example "acupuncture in the United States is considered clinical quackery"[3] then that that's probably something worth (dispassionately) reporting. Bon courage (talk) 13:26, 20 January 2024 (UTC)
I agree, of course, which is why I think it should be stated quite clearly (at whatever length is deemed appropriate) in the article. But including it in the opening paragraph is clearly intended to color, or pre-judge, the remainder for anyone reading. I can't imagine another reason for being so adamant about the inclusion of this particular characterization at this particular point in the article. That is why it reads like editorializing (to me anyway), and why it seems like such a clear case of going against the spirit and the letter of NPOV. AtavisticPillow (talk) 13:55, 20 January 2024 (UTC)
I think arguing from suppositions about 'intent' is always futile on Wikipedia. What would be the 'intent' of not mentioning this? to whitewash acupuncture? Does acupuncture deserve special soft treatment as against (say) homeopathy, which has legions of followers and national backing in some countries? NPOV means mirroring what sources say, and for WP:FRINGESUBJECTS that means especially surfacing the mainstream take. Bon courage (talk) 14:01, 20 January 2024 (UTC)
Well as for intent I can only speak for myself, and in this case the lead read like editorializing to me (a relatively new and inexperienced Wikipedia editor it must be said), but I wasn't sure any policy was being violated. But then Mynameisntbob above made the case that it was against NPOV, which I found compelling, so I have been putting in my two cents.
In legal philosophy the distinction is often made between a rule (law) and the application of a rule, which cannot be specified by a further rule or you would have an infinite regress. What is needed is judgment (most of the legal system exists in this gray area); mirroring what sources say obviously involves a great deal of judgment about what to include and when to include it. I don't think acupuncture deserves special soft treatment, nor do I think it should be whitewashed; I just think that the pseudoscience statement and the lack of good evidence statement offer a more accurate and neutral characterization of the sources for the purposes of an opening paragraph.
My own view is that acupuncture is in all likelihood a placebo (but a particularly elaborate or theatrical one), which is why it probably is better than no-treatment in some cases, and probably why mainstream medicine tends to publicly claim it is a viable option for pain relief if practiced safely and in conjunction with standard treatments. But my own view doesn't matter for Wikipedia, and in any case I have wasted too much time here, so we may just have to agree to disagree. AtavisticPillow (talk) 14:25, 20 January 2024 (UTC)
Final point: to restate what I have said above without reference to intention, failing to include the quackery characterization in the article would clearly be whitewashing. No one is arguing otherwise. What is being argued is that (1) it reads like editorializing in the opening paragraph, because (2) ‘quackery’ is a little bit loaded and suggests fraud, which is not how sources as a whole characterize it (though some do), and therefore (3) its inclusion here lack relevant context for neutral description.
NPOV does not just mean mirroring what (some) sources say. Here is something it does say, in the section on avoiding non-judgmental language: “Do not editorialize. When editorial bias towards one particular point of view can be detected the article needs to be fixed. The only bias that should be evident is the bias attributed to the source.” Because of (3) above, the distancing implied by “it has been characterized as…” is not sufficient to meet the criterion stated in the final sentence of this quote. This is because, additionally, NPOV states: “Pay attention to headers, footnotes, or other formatting elements that might unduly favor one point of view or one aspect of the subject, and watch out for structural or stylistic aspects that make it difficult for a reader to fairly and equally assess the credibility of all relevant and related viewpoints.”
(For reference, I have already clarified what I mean when I speak of relevant context above. I am distinguishing, as many sources do, between quackery and a pseudoscientific practice that may or may not offer mildly better effects than a placebo for pain relief when practiced safely
and in conjunction with standard treatment). AtavisticPillow (talk) 16:00, 20 January 2024 (UTC)
For convenience, I'm copying the sentence in question to here: Acupuncture is a pseudoscience;[4][5] the theories and practices of TCM are not based on scientific knowledge, and it has been characterized as quackery.[6][7][8] If we have a rough consensus in favor of including the parts from the start of the sentence through to and including "not based on scientific knowledge", we are already using language that can have the effect of discrediting. Therefore, I'm not convinced that we need to remove the "quackery" part in order not to have the effect of discrediting. If we consider providing more context, I'm having difficulty seeing how to do it at that place in the article without becoming overly wordy and becoming WP:UNDUE. All I can come up with, that I could still support, is something along the lines of specifying that at least some sources are not so much calling all acupuncture practices quackery, but rather, some practices. Perhaps that could be done with something like changing "and it has been characterized as quackery" to "and some acupuncture practices have been characterized as quackery". I could support that (and I still could support the extra footnote). --Tryptofish (talk) 20:02, 20 January 2024 (UTC)
Agreed. It's clearly a nuanced topic, and adding the "some" aligns with that nuance. Simple as that, in my opinion. Pyrrho the Skipper (talk) 03:10, 21 January 2024 (UTC)
Thanks for replying, these are helpful suggestions. I think we all agree language can discredit, and there is broad consensus about acupuncture being pseudoscience and generally not being supported by strong evidence. These statements are negative, and do have the effect of discrediting acupuncture, but in my eyes remain NPOV, and furthermore they seem verifiably true.
I think “some” is a pretty good compromise too. It is a bit vague; it would be nice to clearly differentiate for readers between “possibly better than a placebo for pain management only, when practiced safely alongside standard treatments, but evidence is scarce” and the really quack quack stuff like curing cancer or whatever. But as you say piling details in the lead creates further problems, so I am ok with this compromise. AtavisticPillow (talk) 03:36, 21 January 2024 (UTC)
The only trouble is it's WP:OR, so that's prohibited by policy. The sources that characterize acupuncture as quackery do so overall, not in a selective way. Bon courage (talk) 06:38, 21 January 2024 (UTC)
Hmm. How about: “Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientific knowledge. Little evidence supports the use of acupuncture, although it may be better than a placebo at treating shoulder pain and pain-related symptoms of fibromyalgia. Due to the lack of supporting evidence, it has been characterized as ‘quackery.’”
Source for the added claim would be Source 17, probably our best source, and this reads more like a neutral presentation of the information. AtavisticPillow (talk) 12:54, 21 January 2024 (UTC)
It's still OR because you're supplying your own reasoning for WHY it's called quackery. I wouldn't mention the two things it might work for in the lede, as that buries the discussion about these being possible false positives. To be honest, I don't see any need for change and haven't heard any convincing reasons for one. Bon courage (talk) 13:01, 21 January 2024 (UTC)
I don’t think that’s OR, although the “some” characterization is. Pretty sure every source that calls it quackery refers to lack of evidence. You could argue that they also adduce other reasons (that the theory about chi or whatever is absurd for instance), but we’re summarizing here and the lack of evidence consistently seems to be the most important thing for the characterization.
I’m not sure what to tell you about the false positives thing. Our best source says that for these two conditions the evidence is good.
Seems there is just a philosophical disagreement here: you think Wikipedia WP:FRINGE necessitates citing Quackwatch style editorializing right at the front and apart from other context, I think that some instances of this are not WP:NPOV. We will probably never agree, but I have put in my two cents. AtavisticPillow (talk) 13:22, 21 January 2024 (UTC)
In fact there's no good evidence acu works for anything. As the SBM piece explains of the JAMA review, "There wasn’t a single indication which had a high number of high quality studies showing a positive effect." Bon courage (talk) 13:47, 21 January 2024 (UTC)
What is the Wikipedia policy on citing editorials offering interpretations of a good secondary source over the secondary source itself? AtavisticPillow (talk) 13:58, 21 January 2024 (UTC)
We're not citing anything "over" anything, but reliable sources can be good for providing additional analysis and insight. Bon courage (talk) 14:01, 21 January 2024 (UTC)
Well, as I said, clearly there is an intractable philosophical disagreement about how Wikipedia can most authoritatively and in line with policy present fringe medical practices. Now I have *really* spent too much time arguing about this, so happy editing everyone. AtavisticPillow (talk) 14:12, 21 January 2024 (UTC)
That seems to be the situation. There is no reason to change the wording. NPOV is met by accurately describing what RS say, and NPOV does not forbid the use of controversial or negative terms when they are from RS. It forbids that editors use such terms when trying to sneak in their own unsourced slant on things into the text. We are not doing that. So this section seems to have run its course. -- Valjean (talk) (PING me) 17:05, 21 January 2024 (UTC)
In the comment beginning "final point" above, I made my case that this characterization of how the policies are being applied is inadequate for this particular situation. But since there is no consensus to be had, not much more to say here. AtavisticPillow (talk) 17:31, 21 January 2024 (UTC)
The article never mentions infertility or autism, and mentions cancer only in a completely different context, that spinal cancer is a contraindication for acupuncture. Those would clearly be quack practices. A reader learning about acupuncture from this article would be unaware such practices even exist. I think that is fine; simply not giving quack practices oxygen at all seems to be consistent with how most reliable sources treat acupuncture.
Do any of the cited sources clearly describe acupuncture, in the sense defined in Acupuncture, as 'quackery'? Does a reliable medical sources that does describe it that way with specificity exist? Mynameisntbob1 (talk) 02:54, 22 January 2024 (UTC)
The cited editorial in a reputable journal says that's how many scientists view it; Wikipedia needs to relay that. Bon courage (talk) 16:39, 22 January 2024 (UTC)
Is it not a bit misleading to take this from a source that concludes it is not quackery? I imagine it would not be too hard to get a different source that makes the claim directly (i.e. "acupuncture is quackery") if that is what is sought after AtavisticPillow (talk) 16:54, 22 January 2024 (UTC)
It's a good source for saying what many scientists think; the next cited WP:SBM source says directly that acupucture is rank quackery. Bon courage (talk) 16:57, 22 January 2024 (UTC)
Cites only need to support what the article actually says. We should not move the goalposts such that the sources have to support something stronger than the article's actual statement - unless you are advocating to change the statement in the lead to a simple "Acupuncture is Quackery" supported by this hypothetical new source. MrOllie (talk) 17:15, 22 January 2024 (UTC)
I wasn't advocating changing the goalposts, I was just questioning whether it was best citational practice to cite without any qualifications "many scientists have characterized acupuncture as quackery" using an article whose thesis is effectively "many scientists have claimed that acupuncture is quackery, but here is some data to show that this is wrong." It is also true that the SBM source characterizes it as "the rankest quackery," although it only does so in passing, in an article that is not about acupuncture at all. Seems like it would be best to dig up a RS focused on acupuncture that directly characterizes it as quackery, no? AtavisticPillow (talk) 17:20, 22 January 2024 (UTC)
If you would like better sourcing, feel free to dig some up and present them on this talk page. MrOllie (talk) 17:25, 22 January 2024 (UTC)
Yes it's fine; the source is reliable for the "many scientists" claim we have much better WP:MEDRS for the efficacy claims. We have a duty to relay what scientists think about fringe topics. Bon courage (talk) 17:30, 22 January 2024 (UTC)
I have mixed feeling about your addition of the word "many". In my gut, I agree that it is true, but the sources cited don't really discuss numbers of scientists. You've raised the issue of OR regarding some things that I show below the arbitrary break to be sourced; here, I could argue that it is OR. --Tryptofish (talk) 23:21, 22 January 2024 (UTC)
The first cited source says

many within the field of science view acupuncture as “quackery” and “pseudoscience,” and its effect as “theatrical placebo"

So I don't think this is OR? Bon courage (talk) 02:44, 23 January 2024 (UTC)
You haven't engaged with what I said below the arbitrary break, which answers your question, and also refutes your revert of my edit. --Tryptofish (talk) 21:23, 23 January 2024 (UTC)
There's discussion above about looking for more sources. I've been doing that, yesterday and today. There may be some behind paywalls, that I didn't look at, but the only plausible one that I could find is this: [4]. --Tryptofish (talk) 22:00, 23 January 2024 (UTC)
I've added another WP:SBM source which simply asserts acupuncture is quackery.[5] See what you think. I do think the Analgesia editorial is valuable though, as it meets WP:RS/AC for telling us what 'many' scientists think.
One might also consider:
  • Naudet F, Falissard B, Boussageon R, Healy D (August 2015). "Has evidence-based medicine left quackery behind?". Intern Emerg Med. 10 (5): 631–4. doi:10.1007/s11739-015-1227-3. PMID 25828467.
which has

Treatments such as relaxation techniques, chiropractic, therapeutic massage, special diets, megavitamins, acupuncture, naturopathy, homeopathy, hypnosis and psychoanalysis are often considered as ‘‘pseudoscience’’ or ‘‘quackery’’ with no credible or respectable place in medicine, because in evaluation they have not been shown to ‘‘work’’

Bon courage (talk) 05:06, 24 January 2024 (UTC)
Yes, I think that both those sources, along with the one that I found, are sufficient to justify a broad statement of "quackery" in the lead. --Tryptofish (talk) 21:20, 24 January 2024 (UTC)

Arbitrary break

Above this break, my friend BC said: The only trouble is it's WP:OR, so that's prohibited by policy. The sources that characterize acupuncture as quackery do so overall, not in a selective way. That got me to look at the three sources that are cited in support of calling it "quackery", and while I still believe that we should call it that, well, we have some problems.

The first source cited is this: [6]. It's a good source to say that acupuncture is pseudoscientific and so forth, but as for quackery, I think it failed verification. Maybe I missed something, but I think the only place the source uses the word "quackery" is where it says: Harriet Hall, a retired family practitioner who is interested in quackery, has summed up the significance of acupuncture research in an interesting way: and then goes on to quote her at length. She says in part: Many acupuncture researchers are doing what I call Tooth Fairy science: measuring how much money is left under the pillow without bothering to ask if the Tooth Fairy is real. So she clearly is criticizing it harshly, but she never uses the word "quackery". So, unless I missed something, the source not only does not "characterize acupuncture as quackery... overall", it doesn't do it explicitly at all. It just quotes someone who "is interested in quackery" as not explicitly calling it "quackery".

The second source cited is this: [7]. It says: Although >40 disorders have been recognized by the World Health Organization as conditions that can benefit from acupuncture treatment, many within the field of science view acupuncture as "quackery" and "pseudoscience," and its effect as "theatrical placebo." That's saying it explicitly, although in a sentence that, on its face, is saying that it may not be quackery and the other bad things, for at least some conditions. That may be why the title of the source asks "is there a needle in the haystack?", and the source later says: In conclusion, clinical trials support the efficacy of acupuncture in reducing PONV and postoperative pain; however, evidence supporting acupuncture as a treatment for chronic pain conditions is mixed.

The third source, this: [8], is quoted in the citation footnote, and it unambiguously refers to acupuncture in its entirety as "the rankest quackery".

So where that leaves us is where we can indeed do what I suggested earlier, although BC objected to it as OR, to say "and some acupuncture practices have been characterized as quackery". We have one source that says it's all quackery, one that calls it quackery, but qualifies the characterization and concludes that it's supported by clinical trials in some applications, and one that never really calls it that, at all. --Tryptofish (talk) 23:51, 21 January 2024 (UTC)

The issue with the second source (Source 7 in the article) for this claim was noted a couple different times above, but thanks for looking at all three. Wouldn't, technically, only a single RS characterizing it as quackery be needed to say "it has been characterized as 'quackery'"? In that case is there a problem removing the other two sources from this claim? Even if there were 100 sources not characterizing it as quackery, and one that were, it would still be literally true that "it has been characterized as quackery." AtavisticPillow (talk) 00:12, 22 January 2024 (UTC)
Unless I missed something, we have two sources characterizing it as quackery in some practices. I haven't looked to see if there are more sources. --Tryptofish (talk) 00:20, 22 January 2024 (UTC)
Seems to me that only the SBM source directly characterizes acupuncture as a whole as quackery, "Needle in a Haystack" article mentions that it has been characterized as such, and then independently goes on to claim that some uses are supported by evidence (which is not to my mind the same thing as denoting some uses quackery), and as you say the Quackwatch does not seem to call it quackery at all, although one might reasonably infer that the characterization is implicit from the rest of the article. So I'm not sure any sources directly claim that some uses are quackery; one source has clearly stated all acupuncture is. But is it not true that only one RS needs to have said so for Wikipedia to claim that it has been characterized as quackery? (This gets at some of my concerns earlier about why this specific claim shorn of other context might be smuggling in a less neutral point of view than it first appears: you only need one person to say it for it to be verifiably true, but then without context we are unable to judge how widespread a view it is) AtavisticPillow (talk) 00:42, 22 January 2024 (UTC)
The first cite corresponds to the wording before the comma, I moved it there. MrOllie (talk) 03:10, 22 January 2024 (UTC)
I agree, and that was a good edit, thanks. --Tryptofish (talk) 23:16, 22 January 2024 (UTC)
@Tryptofish

The third source, this: [5], is quoted in the citation footnote, and it unambiguously refers to acupuncture in its entirety as "the rankest quackery".

I'm not sure that even that source completely unambiguously describes all acupuncture as quackery. The title of the article is 'Ketogenic diet does not "beat chemo" for almost all cancers', the article is about cancer, and everything else in its list of 'rankest quackery' are clearly specifically quack treatments for cancer. The article is not about acupuncture, and never mentions acupuncture again, so I can't really say with confidence how globally the author intends the statement to be read. But at the very least, it is a pretty weak source to lean on as a citation for the fact that acupuncture in its entirety has been described as quackery. Mynameisntbob1 (talk) 03:16, 22 January 2024 (UTC)
I see your point, and the more that I think about it, the more I think that we do not currently have sourcing to justify saying that acupuncture in its entirety has been described as quackery. At the same time, I do still think we have sufficient sourcing to say that some practices have been described as quackery. For example, if I take your analysis as correct, that the source is talking about claims of cancer treatment that are quackery, then it follows that it says that acupuncture has been claimed to be useful for cancer, and that such claims are quackery. --Tryptofish (talk) 23:26, 22 January 2024 (UTC)
Indeed, to say 'some practices have been described as quackery' would be improper WP:SYNTHESIS; no source says that (that we cite, anyway). Bon courage (talk) 04:55, 24 January 2024 (UTC)
No, as I explained above, a plain reading of the existing sources supports that more measured wording. However, the new sources that you have found support the earlier, more broad wording, and I'm going to change it back. --Tryptofish (talk) 21:10, 24 January 2024 (UTC)
I think the key thing about the 'Needle in a haystck' article is that while it has its own view it also happens to tell us what the view of 'many within the field of science' is, and that is relevant given that WP:PSCI requires that "an explanation of how experts in the relevant field have reacted to such views should be prominently included". It's true we could say many scientists believe it's quackery, while an Editorial in Analgesia wondered if it might have some worth after all, but I think that would be undue, especially for the lede. Bon courage (talk) 03:20, 24 January 2024 (UTC)

Bias in the wording of the Efficacy section

My main problem is with this section:

"As of 2021 many thousands of papers had been published on the efficacy of acupuncture for the treatment of various adult health conditions, but there was no robust evidence it was beneficial for anything, except shoulder pain and fibromyalgia.[20]."

Problems:

  • If you read up until "no robust evidence that it was beneficial for anything" it basically says that acupuncture is worthless. This is very subtle, but, IMO, a bias in this text.
  • The text makes it look like acupuncture is not useful for anything, except for these 2 things. This is not what the cited source (SOURCE1) says. The source doesn't say that they couldn't find that acupuncture was useful, and instead, one of the main things it says is that research in this area should work towards being more certain than it currently is.
  • In the source, the authors main split was between high-or-moderate-certainty evidence vs low-or-very-low-certainty evidence. Here, the wiki text singles out high-certainty evidence (and names it "robust evidence") which in my opinion is a form of bias. In this aspect, the wiki text is closer to the skeptical article (which also singles out high-certainty evidence) (NOTE1, SOURCE3).
    • To complement the previous point, the source points to another similar paper, by Lu and colleagues (SOURCE2). This paper singles out interventions with large or moderate effects and splits between high-or-moderate-certainty evidence (which it calls "effective") and low-or-very-low-certainty evidence (which it calls "promising but unproven").
  • To present the data, SOURCE1 found:
    • 3 conclusions in which acupuncture was benefitial with high certainty (NOTE2),
    • 28 conclusions in which acupuncture was benefitial with moderate certainty, and,
    • >60 conclusions in which the certainty was low or very-low.
    • (I excluded, for simplicity, the 1 high certainty conclusion and 3 moderate certainty conclusions where acupuncture was found as no better than the comparator)
    • (One interesting thing is that about half of the conclusions where there is high-or-moderate-certainty evidence that acupuncture was effective were about painful conditions or pain outcomes).

I think that if the wiki text had those numbers instead of a "no robust evidence it was benefitial for anything" it would be more informative and less partial.

A reference to the skeptical article can still be maintained below (or maybe even expanded, as it is not clear that it references the source that we're talking about or what the main criticisms towards acupuncture are), providing counter-balance.

Notes:

  • NOTE1: In the text I will be referring to the Science Medicine Based text mentioned in the Efficacy section as "skeptical article" (SOURCE3). You can take it literally, as in it is an article written by a skeptic (Steven Novella, the president of New England Skeptical Society). I don't know much about this world, and I mean no offense in whatever I write here.
  • NOTE2: The wiki text excludes one of the conclusions in which acupuncture was benefitial with high certainty (for stroke), arriving at the number 2 for "robust evidence". This is probably because it was also excluded in the skeptical article. The skeptical article excludes it because it was electroacunpuncture. I will not question whether or not this exclusion should be made in the wiki text.

Sources:

CozyShrimp (talk) 23:57, 24 January 2024 (UTC)

IMO, a bias
which in my opinion is a form of bias
You seem to be saying that the article is biased because it deviates from your opinion. But that is not the criterion here.
the wiki text singles out high-certainty evidence Well, that is how science is done. Use the good studies, throw away the bad studies. And "good" and "bad" are not defined by outcome.
the wiki text is closer to the skeptical article (which also singles out high-certainty evidence) Good. So, it's how it should be. --Hob Gadling (talk) 07:51, 25 January 2024 (UTC)
The 'skeptical article' is from WP:SBM, and while it offers some useful commentary, Wikipedia is rather more circumspect that its "most of the acupuncture evidence is crap". What we have looks like a fair summary with respect to the sources. On Wikipedia, Electroacupuncture has a separate article. Bon courage (talk) 07:52, 25 January 2024 (UTC)
I agree with Hob Gadling and Bon Courage. I also closely considered the quoted sentence from the page, and I don't think that it is written in a biased manner. --Tryptofish (talk) 22:52, 25 January 2024 (UTC)
My main point previously was that the section had a POV that didn't conform to the data from SOURCE1.
After reading a bit more about Wikipedia policies (I'm a new contributor, so please don't mind me), my main concern now is that it has a POV that is different from the POV found in SOURCE1, and instead leans heavily towards the POV found in SOURCE3, while attributing it to SOURCE1 (I will try working a bit more on this @Bon courage and @Tryptofish). This goes against Wikipedia policies, as we're supposed to keep the POV from the source. If we wanna keep just Steven Novella's POV, I think we could remove the previous section (the one I'm complaining about) and that would be less misleading (this might look exaggerated, but I really believe this).
@Hob Gadling I think you either misunderstood or spun what I said. I'm not arguing about the passage being against acupuncture. I'm arguing about the passage misrepresenting its source (and sorry if that was not clear).
I will research a bit more on this topic (probably about bias, to try to pinpoint a bit clearer), and then maybe get back to this.
Thanks a lot by now :) CozyShrimp (talk) 17:08, 28 January 2024 (UTC)
I see that you are a new editor, so welcome to Wikipedia! I'm quite confident that I understand the NPOV policy, and that what I'm saying here conforms to it. We're not supposed to keep the POV from any given source, so much as to maintain a neutral POV as reflected by the preponderance of sources. --Tryptofish (talk) 19:49, 28 January 2024 (UTC)
If you look at the article's own "Key points" as published, then the "Meaning" they give is:

Despite acupuncture having been the subject of hundreds of randomized clinical trials and systematic reviews for dozens of adult health conditions, there were few conclusions that had greater than low certainty of evidence.

Seems well aligned, POV-wise, with what Wikipedia says (but we give a bit more detail). Bon courage (talk) 17:22, 28 January 2024 (UTC)
Compare:
- "few conclusions that had greater than low certainty of evidence" to "there was no robust evidence it was beneficial for anything, except shoulder pain and fibromyalgia", and,
- "many thousands of papers" to "hundreds of randomized clinical trials and systematic reviews"
The "Conclusions" session of the paper is still a little bit less critical, but, if the same source has 2 slightly different POVs, maybe keep both (not sure, I'm fine with just keeping the above). CozyShrimp (talk) 17:40, 28 January 2024 (UTC)
Part of the task here is translating dry EBM-speak into something suitable for a non-specialist audience. I think it's done well at the moment. Bon courage (talk) 18:01, 28 January 2024 (UTC)
Just to finalize this convo now, my impression is that it has been made in a misleading way.
I appreciate the responses, even though we have different POVs on this section of the wiki,I appreciate how clear you've been through this. CozyShrimp (talk) 18:33, 28 January 2024 (UTC)
@Bon courage Just a question, would you be willing consider an Edit request if I made, just to try to clear up the POVs of SOURCE1 and SOURCE3. I would try to mostly quote SOURCE1 (that, if you look at it, is still critical of acupuncture research), and maybe add something more about SOURCE3. CozyShrimp (talk) 17:21, 28 January 2024 (UTC)
I don't see any POV that needs "clearing up". We don't cite that BMJ Open paper and it looks like Chinese research on TCM, so that's a red flag. Bon courage (talk) 17:25, 28 January 2024 (UTC)
By SOURCE3 I mean the one from SBM.
But come on man, I think if I write something, it will be just slightly clearer and it will be easier than discussing some sort of bias (which is hard).
You can reject it w/out problem if you think it ain't better than the previous text :p CozyShrimp (talk) 17:42, 28 January 2024 (UTC)
I don't have any power or desire to stop you making any request and the content of this article is determined by WP:CONSENSUS (it has had > 2,000 editors in its time). Bon courage (talk) 17:46, 28 January 2024 (UTC)

Insufficient research

I think it's important to note there's insufficient research on accupuncture, and more research is needed to get a complete picture. Instead of giving the impression that research has been sufficient and conclusive and that it doesn't work and to let heavy skeptic sources dominate this article. Also the few studies have already yielded empirical results like showing improvement and real brain mapping changes on MRI scans that's not replicated in sham accupuncture, so something is obviously there. https://news.harvard.edu/gazette/story/2017/03/study-reveals-differences-in-the-effects-of-real-and-sham-acupuncture/ I read a generated ChatGPT answer to accupuncture. It presents a far more neutral tone where it acknowledge that some studies suggest it may help with chronic pain and inflammation. But more research is needed for a complete picture. That tone is what's needed in Wikipedia, which is sorely missing. I know ChatGPT is not a real source but it does however present a fair neutral tone that doesn't try to push a pov possibly prematurely that nobody should use acupuncture nor advocates that acupuncture works outright. And I think we should be learning and modelling our tone after it. Generally it notes, " Pain Relief and Inflammation Reduction:* Some studies suggest that acupuncture may help reduce inflammation, which is often associated with chronic pain conditions such as arthritis and fibromyalgia. And most importantly it writes - It's important to note that while many people report positive effects from acupuncture for chronic pain, individual responses may vary, and more research is needed to fully understand its mechanisms and effectiveness for different types of pain conditions. And that's factually fair and correct. As I had written before; science doesn't have the prowess to explain everything. But empirically newer studies show it's not a mere placebo effect. They found that acupuncture — but not sham — changed brain activity in terms of activating the receptors that bind opioids, which help control pain in the body. https://www.washingtonpost.com/wellness/2023/07/24/does-acupuncture-work-chronic-pain/ So I think the philosophy itself is quackery as I don't believe in that. But I do suspect that the effects are real and that should not be dismissed so easily. It's already proven to have long lasting remapping of the brain in MRI scans for real accupuncture vs sham for carpel tunnel syndrome research as I noted in the Harvard Gazette article link above. So philosophy may be illegitimate, but not the physical impacts it gives. Harvard above talks a fair deal on it. And given the empirical evidence, this article should be more neutral and not just turn this article into some kind of skeptic dominated article that tells readers to never believe it and that others are wrong to question this. As Langevin and Wayne, both Harvard Medical School researchers, have suggested that although acupuncture has become more empirically legitimized, it is held back by the theory behind it. The theory is likely wrong but the effects is emerging to be legitimate indeed and why this article needs to reform to be more neutral. Renfieldaccusome (talk) 01:29, 18 March 2024 (UTC)

Nope, there is a difference: only effects can be debunked, the philosophy can only be disbelieved. Same as there is no way to debunk elves and fairies, most people merely disbelieve them. I mean there are no recent, peer-reviewed scientific studies which offer the ultimate proof that elves and fairies do not exist.
To be more clear: effects are amenable to empirical falsification (Popper), while its philosophy simply does not match the paradigm of mainstream science (Kuhn). tgeorgescu (talk) 01:45, 18 March 2024 (UTC)
Thank you for your response. I posted here once and actually got many replies and for some reason, that thread is gone despite it was only two months ago I think. Sorry I don't usually use Wikipedia and probably didn't respond to all the replies. But just wanted to revisit a concern that this article needs to improve on its tone. And I propose that it's important to note there's insufficient research on accupuncture, and more research is needed to get a complete picture. Instead of giving the current impression that research has been sufficient and conclusive and that it doesn't work and to let heavy skeptic sources dominate this article. That fair context is missing but it's needed. And I don't think others can argue against including that context. I should repeat despite being few, professional studies have already yielded empirical positive results like showing improvement and real brain mapping changes on MRI scans that's not replicated in sham accupuncture, so something is obviously there. https://news.harvard.edu/gazette/story/2017/03/study-reveals-differences-in-the-effects-of-real-and-sham-acupuncture/ I also read they found that acupuncture — but not sham — changed brain activity in terms of activating the receptors that bind opioids, which help control pain in the body. https://www.washingtonpost.com/wellness/2023/07/24/does-acupuncture-work-chronic-pain/ So like I said, the theory is likely wrong and not going to dispute that. But the effects is emerging to be legitimate indeed and why this article deserves to at least be more open minded and not shut it down completely as impossible to work. Particularly when you consider that recent studies are showing such promising empirical results that can't be explained by mere placebo effect. That's all I am saying and hope you don't misunderstand. Renfieldaccusome (talk) 01:50, 18 March 2024 (UTC)
tgeorgescu, where do you find the patience? Drmies (talk) 01:51, 18 March 2024 (UTC)
@Drmies: I have lost my patience for repeating the same mantras, but sometimes I do find a newer approach. tgeorgescu (talk) 01:56, 18 March 2024 (UTC)
Is it okay to to use such a tone against other editors like this? I was just stating that research hasn't been conclusive but there's been enough promising empirical evidence to justify a more neutral tone. I already provided enough proof above in the links, which shows that real accupuncture differs from sham and has real hard results.Renfieldaccusome (talk) 02:12, 18 March 2024 (UTC)
Just in case I wasn't clear: I'm tired of me repeating the same mantras about WP:RULES. Often because I suspect that not all those who claim they are newbies are really newbies. So, I feel like I'm wasting my time, while troublemakers get a new IP or wait three months for their private data to expire. tgeorgescu (talk) 04:59, 18 March 2024 (UTC)
I see. I been busy and haven't even commented on this page for 2 months and assure you I am not them.
If you believe certain users are causing trouble then you should report their behaviour to Wikipedia admin for further investigation. But it's important to not make assumptions of users. I have not said anything unkind to you nor refusing to listen to your replies. And please don't misunderstand me. I have read this article from Washington Post, https://www.washingtonpost.com/wellness/2023/07/24/does-acupuncture-work-chronic-pain/ that cites a 2018 meta-analysis of over 20,000 patients in 39 high-quality randomized controlled trials found that acupuncture was superior to both sham and no acupuncture for back or neck pain, osteoarthritis, headaches and shoulder pain. And am also aware there are experts saying more evidence is needed to confirm this. But this is very different to what the current article is saying. And is why I only propose to include in the article that "researchers emphasize the need for more high-quality evidence to establish any effectiveness conclusively", instead of simply saying that it doesn't work and that it's a conclusive finding from sufficient evidence. Which is false. Renfieldaccusome (talk) 07:09, 18 March 2024 (UTC)
Renfieldaccusome, please stop mansplaining. Drmies (talk) 12:34, 18 March 2024 (UTC)
@Renfieldaccusome this is more pro-acupuncture POV-pushing based on non-WP:MEDRS sources. We already summarize the science well: despite the vast, vast, swathes of research there is little, if any, signal in the noise. As a matter of style, Wikipedia avoids the FRIN-like wording you are proposing. Bon courage (talk) 07:11, 18 March 2024 (UTC)
Thanks for your input. I agree it's important to maintain a balanced and evidence-based approach in our content. But National Institutes of Health (NIH) is from the US government and also the Journal of Pain, which I read is a peer-reviewed medical journal published by the American Pain Society. Those are not considered a good source for Wikipedia? If that is so, then that's surprising. Technically I see a very old study cited in Journal of Pain in the article right now. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154967/ So why even cite them today, despite they are so old, if they are as you claim the organisation is not neutral? The more recent studies such as 2018, published by that same journal had showed different conclusion, yet is not mentioned but they stated they confirmed that acupuncture has a clinically relevant, persistent effect on chronic pain that is not completely explained by placebo effects. What proof is there that American Pain Society are now even biased on their more recent studies and unacceptable? That 2018 study is still available to view on the US Gov national library of Medicine website today and has not been retracted. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927830/ Renfieldaccusome (talk) 08:14, 18 March 2024 (UTC)
See WP:MEDFAQ#PUBMEDRIGHT. We currently cite just one article in the efficacy section. There is no need to cherry pick older meta-analyses. Bon courage (talk) 08:21, 18 March 2024 (UTC)
We currently cite just one article in the efficacy section. Do you mean this one? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9685495/ Its main argument is saying what I have been saying and better. It writes; Despite the large literature on acupuncture, most reviews concluded that their confidence in the effect was limited. Thus, the most important research need is for better evidence to move these certainty-of-evidence assessments upward, such that clinicians, patients, and policy makers can have more confidence that acupuncture does, or does not, have benefit for a certain health condition." And "The field of acupuncture would be best moved forward with resources devoted to producing more high quality randomized clinical trials and producing fewer new systematic reviews" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9685495/ In other words, it itself is saying it's challenging to draw firm conclusions about the true effects of acupuncture based on the available evidence and studies. And there is currently a general lack of high quality randomized clinical trials being repeated again. Your respected source itself also adds that there is a need for more high quality randomized clinical trials (such as the relative newer large one in 2018). It wouldn't say this unless acupuncture already has enough high quality studies confirming its effectiveness or not, and so even your respectable source supports what I have proposed. Renfieldaccusome (talk) 10:04, 18 March 2024 (UTC)
The research will only be "sufficient" for acupuncture believers if the result of the research is "it works". As long as the result is "we found no robust effect", it will be "insufficient". It's the same for every other pseudoscience. --Hob Gadling (talk) 08:24, 18 March 2024 (UTC)
In your respectable source now cited in the article's efficacy section. It says the certainty of evidence is low or very low, but that does not necessarily mean that acupuncture does not work. It means there are limitations or weaknesses in the study design, data quality, or other factors that decreases professional confidence in the findings. And that's unsurprising as a lot of older studies are poor quality and there is currently a lack of high quality randomized clinical trials like the one more recent in 2018, which makes a minority. It demands more high quality studies and less reviews that is merely rehashing the older poor quality studies. However I would concede that a lack of evidence and high quality studies doesn't also mean that accupuncture works. So I would leave the article as it is and wait for further new higher quality studies to surface and then be reviewed later, which would either confirm if it works or not with higher improved certainty. Thank you for the discussion; let's conclude here. Renfieldaccusome (talk) 10:16, 18 March 2024 (UTC)
Stop wasting our time now. We have even a meta review of other meta reviews (PMID 36416820).
And stop using this "if not really really really disproved, maybe it still works" BS. It is the other way around: Unless efficacy is not proven, you cannot claim any benefit.
Go now to WP:STICK and good bye.--Julius Senegal (talk) 20:56, 18 March 2024 (UTC)

Semi-protected edit request on 29 May 2024

I would like to see some updated and specific data related to recent research and coverage for acupuncture in the United States Sam Collins 33 (talk) 19:05, 29 May 2024 (UTC)

Sam Collins 33 please don't dump massive walls of text that are copied directly from websites or published articles here - WP:COPYVIO covers this. Now, if you are going to make an edit request, you need to be specific - 'change X to Y', supported by a particular source. You don't need to copy the contents of the source here, you can just link to it. However, it looks like you are asking for sweeping changes to be made to the article, and an edit request isn't really suitable for that. You're going to need to discuss the changes you want to see made here, and the sourcing, and gain consensus for the change. Girth Summit (blether) 19:13, 29 May 2024 (UTC)

Reverse

Can you please tell us one by one what was wrong with the references provided supporting the text you removed?

I am an expert in meta analysis so I am happy to provide clarification and guidance on the parts you remove. Happy to provide more details on the scientific findings reported in the papers you removed and the effect sizes provided in them.

Many thanks Safetystuff (talk) 16:42, 30 June 2024 (UTC)

I'll leave it to the folks (Valjean, McSly, and Tryptofish) who reverted to explain their objections to the added material. I would suggest that instead of using studies showing effectiveness on specific conditions to claim that the technique is effective in generally, citations to such studies should only be used to support claims for the specific conditions under study. Many drugs and treatments are effective for a narrow set of diseases despite being studied in a wide range. It also helps the article be more neutral if instead of arguing over whether acupuncture is good or bad overall, it simply gives specific facts and lets readers draw their own conclusions.
Trying to put details into the intro about insurance coverage that are not mentioned in the body of the article is also a problem. This information would be better added to the Adoption section if it's added anywhere, though the phrasing made it sound like the author was trying to promote acupuncture on the grounds that it must be good if it's covered by insurance. Wording should be more neutral and also rules for English spelling and punctuation, and MOS:USA should be followed. I do think it's actually interesting to know where it's covered and most importantly on what grounds. Whether the grounds are "studies found effectiveness for certain conditions" or "people pay for the service even where it's not effective, and so insurance companies sell expensive insurance that includes the service" that is interesting and important to know.
Outside of the recent additions, I'd like to note for interested editors that the phrase in the intro "generally provide no good evidence of benefit" seems to contradict the Efficacy section, where two indications are given as an exception. It seems the intro should be re-worded to note the exceptions or the body should be re-worded to bring the statements into alignment (e.g. these were not meta-studies, they were poor quality, or whatever the case may be).
I also see that the Adoption section says German studies showed efficacy for certain uses. It seems like these should be mentioned in the Efficacy section, and also taken into account in the intro in the same way. -- Beland (talk) 18:14, 30 June 2024 (UTC)
I've added a summary of German acupuncture trials to the Efficacy section, and tagged the contradiction with the intro. -- Beland (talk) 19:04, 8 July 2024 (UTC)
@Valjean: Regarding this revert, the above comments are why I tagged the intro as having a contradiction; the Efficacy section seems to say there has been benefit shown for some conditions, though presumably for reasons other than manipulating qi. It could be clarified if this is simply a strong placebo effect, if there may be some physical effects, or if this is unknown or disputed. But if there's an no-efficacy exception, it should be noted in the intro. -- Beland (talk) 20:33, 8 July 2024 (UTC)
My reading of the current version of the Efficacy section is that it says that everything can be accounted for by the placebo effect. In that case, I'm not seeing a contradiction. --Tryptofish (talk) 21:08, 8 July 2024 (UTC)
@Beland: I may be wrong, but if, as Tryptofish says, we're talking about a placebo effect, then it's better not to note what may seem like a contradiction. It would be better to reword the "troublesome" content in the Efficacy section to make that plain. Does that make sense to you? As I said, I may be wrong, and won't object if my edit is reversed. I just want to draw attention to possible issues with that content. I believe it can be improved. -- Valjean (talk) (PING me) 21:17, 8 July 2024 (UTC)
Sure, then it would make sense to reword the intro so it says there's no benefit compared to placebo. That's different than no benefit, which in this case matters. Not sure the phrase "not an effective method of healthcare" would be needed, and might be problematic given it's a topic of current controversy whether or not strong placebos are a useful and effective technique in medicine, especially for pain. -- Beland (talk) 21:48, 8 July 2024 (UTC)
As I write this, I have a vague feeling that this exact language has been discussed on this talk page in the past. At any rate, it's worth looking at the two sources that are cited at the end of the sentence in the lead section. They really do say things that are accurately summarized by what the sentence says. It's awfully tricky to say, in Wikipedia's voice, that a placebo effect is "an effective method of healthcare". Perhaps there could be a better word than "effective". But I think that just saying that it's effective in the way that placebos are effective, without qualifying such a statement further, is an inaccurate presentation of the source material, and there's a limit to how much nuance can fit into the lead. --Tryptofish (talk) 22:32, 8 July 2024 (UTC)
We could just say "is a method of health care no more effective than placebo", if that was supported by sources. I checked the first RS listed as a citation for that claim, which seems to partially contradict that summary. It includes studies rated as high certainty that show:
  • “Verum acupuncture is more effective than sham acupuncture for pain relief, improving sleep quality, and improving general status in fibromyalgia syndrome posttreatment.”
  • “Acupuncture was superior to sham acupuncture in terms of pain relief.” for shoulder pain
  • “[There were] better effects of electroacupuncture plus western conventional treatments for improving National Institutes of Health Stroke Scale.” though I'm not sure what the comparitor was there.
The second source is not peer-reviewed, and is mostly just commentary on the first source.
While it seems clear the traditional qi theory has been disproven and there is no benefit over placebo for the vast majority of claimed conditions, it's unclear to me which of these is happening:
  • There are some studies picking up real benefits over placebo on a small number of conditions caused by other physical mechanisms related to jamming needles into tissue, and people rightly skeptical of acupuncture's traditional claims are tossing out that evidence as bunk in an overly hasty manner.
  • The reported benefits over placebo for a small number of conditions are artifacts of the research methods, despite some of the studies being rated as high-quality evidence. -- Beland (talk) 00:53, 9 July 2024 (UTC)
The second source is an analysis, as opposed to an original study, but I think it's an RS for mainstream scientific opinion. My reading of the first source is that the quotes you take from it sound, in isolation, as more positive than they do in context. As for "is a method of health care no more effective than placebo", that strikes me as a very odd thing to say, roughly like a diet of food that isn't nutritious. --Tryptofish (talk) 23:35, 9 July 2024 (UTC)
Well, since neither of us like that phrase, maybe we should just leave it out. How about: "Systematic reviews of acupuncture conclude there is no good evidence of benefit beyond placebo, except for a small number of conditions. Evidence of benefit beyond sham acupuncture for those conditions is disputed, and physical mechanisms that would explain any direct effects have not been confirmed." -- Beland (talk) 00:04, 10 July 2024 (UTC)
The "except for a small number of conditions" thing does not sound good.
If one uses statistical significance as a criterion, one will get 5% positive results in the absence of a real effect. That is the definition of statistical significance. Thus, if there is no real effect, it is to be expected that "a small number of conditions" have positive results. Everybody who is familiar with how those things work will know that, but for an average reader, the phrase "except for a small number of conditions" will be misleading. --Hob Gadling (talk) 07:10, 10 July 2024 (UTC)
Is there a source saying that's what has happened in this case? When that happens, we would also expect those studies fail to be replicated, right? Has that happened for those conditions? If random chance is the accepted explanation for positive results, then the Efficacy and Adoption sections would need to be changed to note this. The Adoption section says "the German acupuncture trials supported its efficacy for certain uses" and the Efficacy section says it is beneficial for shoulder pain and fibromyalgia.
I noted the 2007 German trials in the Efficacy section, but in this edit, Bon courage (hello there!) removed it with the edit summary "don't want this very dated". If the results of these trials have been disproven by later studies, that should be noted in the Adoption section. (This material can't be removed because it's part of the history of adoption in Germany.) -- Beland (talk) 15:33, 10 July 2024 (UTC)
The current state of knowledge is given in the efficacy section. This cannot be undercut with old unreliable sources, such as exist for GERAC. Bon courage (talk) 15:44, 10 July 2024 (UTC)
Sure, but that implies the Adoption section does not represent the current state of knowledge. We should update that section so readers aren't mislead by it, and so it doesn't appear to contradict the Efficacy section. -- Beland (talk) 15:48, 10 July 2024 (UTC)
Don't think there's a contradiction; historically some trials convinced Germany (a historically woo-friendly nation, particularly back then) to change some insurance rules. Trials don't represent settled science and even then they were criticised for being less then solid. Bon courage (talk) 17:09, 10 July 2024 (UTC)
I basically agree with BC and HG about this issue. I've been thinking hard about finding a way to improve upon the current wording, and I'm not comfortable with the changes proposed so far. I'm really OK with the wording as it is now, although I can see Beland's argument that it's not quite accurate to say that acupuncture is never "effective" (in the sense that placebos sometimes really do work). I've come up with this idea: change "which suggests that it is not an effective method of healthcare" to "which suggests that it is not a reliable method of healthcare", and leave the rest as is. Placebos can sometimes make people feel better, but they aren't reliable at making people feel better. Would that one-word change have consensus? --Tryptofish (talk) 17:35, 10 July 2024 (UTC)
Don't like that, as it implies it sometimes works, and for certain conditions (progressive diseases e.g.) it certainly doesn't. I think something not being better than placebo is (in a lay context) synonymous with being ineffective, and in any case the article does not (currently) say that acupuncture is never effective, rather that "The conclusions of trials and systematic reviews of acupuncture generally provide no good evidence of benefit, which suggests that it is not an effective method of healthcare", which is more nuanced. Bon courage (talk) 17:46, 10 July 2024 (UTC)
"Reliable" doesn't make sense; FDA-approved drugs aren't completely reliable either. And it doesn't distinguish between a direct effect and a placebo effect.
@Bon courage: If the German trials do not represent the current scientific consensus, then the Adoption section should make that clear. There is no way for non-experts to know that from the way it's currently written. So exactly how do we know that these trials are now considered to have reached incorrect conclusions? -- Beland (talk) 18:58, 10 July 2024 (UTC)
We know what recent reliable sources say, as opposed to very old unreliable ones, and for Wikipedia that's what matters. As I say, I don't see a particular problem with the Adoption section but if you want to clarify, have at it. Bon courage (talk) 19:03, 10 July 2024 (UTC)
Happy to do so, but I need a pointer to the reliable sources you're looking at. -- Beland (talk) 20:03, 10 July 2024 (UTC)
As for efficacy. The revert is absolutely justified.
We should stick to the best, newest metareviews. Although Ernst is reliable, one meta-review was published 2005. Too old. Just as example for cherry-picking in that case. PMID 36416820 shows the way.
Also, please keep in mind that metareviews from China are not trustworthy (see this or that).
Also, there is no "conflicting evidence", there is just no proof that acupuncture is better than placebo. Despite tons of studies. --Julius Senegal (talk) 19:32, 30 June 2024 (UTC)
There's a lot to respond to here. First, as already noted, it wasn't Beland who did the revert, but I appreciate what Beland has said (as well as what Julius S. said).
I fully agree with the revert that McSly made. It was reverting blatant POV-pushing.
I'm OK with the more sweeping revert that Valjean made, although I would also have been OK with leaving the version reverted to by McSly, which had the corrections I tried to make.
Here's a combined diff of the edits I made: [9]. Some of what I changed was simply a matter of good writing (fixing "subsidized subsidized", as an obvious example). That's also what I did in my subsequent edit, whose edit summary should be self-explanatory: [10]. But there were also much more substantive things that I needed to fix, where the content added completely misrepresented what the sources said:
  1. I removed the claim that Brazil subsidizes the costs of acupuncture, cited to this source: [11]. The source doesn't say that at all (as a self-described "expert" should have been able to readily see). It's a summary of primary research (not WP:MEDRS-compliant), that isn't about how costs are paid for. That should never have been put on the page.
  2. I moved a statement about Australia, sourced to this: [12]. The text that I had to correct said that the Australian government subsidizes acupuncture costs. But the source actually says coverage is mainly provided by some private insurance policies (or if the acupuncturist "is also a general practitioner").
  3. I changed the wording about New Zealand. The text that I had to correct said simply that NZ subsidizes acupuncture. And yet one of the cited sources, [13], actually says: "Traditional Chinese acupuncture is not regulated in New Zealand. Be careful when reading acupuncture websites and advertising... It's not recommended that you have acupuncture as a sole treatment for your health problem." Taking a source that prominently says that, and using it to say simply that NZ pays for acupuncture, is WP:Cherrypicking, and serious misrepresentation of the source material.
  4. And, perhaps most importantly, I changed the wording about the studies that had been presented as supporting the claim that acupuncture "has significant impact on pain relief and treating other disorders", and were used to justify saying that the evidence in favor of acupuncture was "not unanimous". Not unanimous makes it sound like there is just a little bit of evidence against acupuncture; the source material says the opposite. The first cited source, [14], actually says: "For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies... No evidence suggests that acupuncture is more effective than other active therapies." The second, [15], says: "Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture." The third, [16], says: "the evidence level was moderate or low." And the fourth, [17], in a relatively minor journal, says: "More studies with rigorous designs and larger sample size are warranted to verify the efficacy and safety of acupuncture for insomnia...". When I changed the wording on the page from "acupuncture has a significant impact" to "acupuncture has a measurable but modest impact... , albeit not superior to other methods of treatment", I was following the sources, and I think it was actually a rather gentle change.
  5. Also, when Safetystuff partially reverted where I said "and often negative", [18], I let that stand.
In context, I think the edits I made were indeed rather gentle, and I was motivated by an intention to try and preserve what I could from what Safetystuff had done. Valjean subsequently reverted all of it – and, as I said, that's OK with me. Looking at the edit summary, [19], I agree that the material about the Medicare (United States) subsidy was better sourced and more relevant than the rest. I could certainly make the case for only including that, although probably not in the lead section. (Some of the sources for other countries, I wasn't sure if they were government sites, or sites from individual practitioners.) As for the material on the meta-analyses showing some partially positive effects, my reasoning was that I would preserve a "both sides of the issue" version of the page, and see what other editors thought. But Valjean makes a point I can agree with: some of those analyses were from a pretty long time ago, so the sources already on the page (concluding that acupuncture "is not an effective method of healthcare") are more current, and therefore should be given greater weight. For the more recent ones, I also have reservations about giving them much weight, because they appear to be outliers relative to the meta-analyses that were already cited. Another point that supports the revert is that the lead section is supposed to summarize what is in the rest of the page. It shouldn't contain material just put there to argue a POV. --Tryptofish (talk) 21:02, 30 June 2024 (UTC)

Pseudoscience?

Hi, I personally don't know much about this topic, but I recently read an article by the NIH (https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know#:~:text=Acupuncture%20is%20a%20technique%20in,for%20at%20least%202%2C500%20years.) which states that acupuncture is to some degree supported by scientific research, so it surprises me that this Wikipedia article starts off saying that "acupuncture is a pseudoscience" when (apparently) it does have some support from a reputable health agency. Shaked13 (talk) 16:22, 2 June 2024 (UTC)

The article describes it as pseudoscience because appropriate reliable sources describe it as pseudoscience. And that's by the NCCIH, by the way, which is not quite the same as the NIH. Brunton (talk) 16:40, 2 June 2024 (UTC)
The NCCIH is part of the NIH.
I don't doubt that appropriate reliable sources describe it as a pseudoscience, it just seems that (at least one) (seemingly) appropriate reliable source describes it as not a pseudoscience.
Now I see that you and a few other editors seem to think that this is not a reliable source. What is the basis for that. I understand that being a government agency doesn't automatically make a source reliable but I was under the impression that the NIH is considered to be a reliable source. Shaked13 (talk) 17:45, 3 June 2024 (UTC)
Nope, NCCIH is a pro-quackery wing of the US government, and it is technically independent from being controlled by NIH. tgeorgescu (talk) 18:21, 3 June 2024 (UTC)
DEscribing the NCCIH as a reputable health agency is something of a stretch. I mean, it has a reputation, but it isn't a good one... Girth Summit (blether) 17:11, 2 June 2024 (UTC)
It's from NCCIH, so no fuzz about it, sole mumbo jumbo. --Julius Senegal (talk) 18:06, 2 June 2024 (UTC)
The categorization of acupuncture as pseudoscience and the fact that it has been studied scientifically can both be true. The ancient theory of why acupuncture works is certainly pseudoscience; there is plenty of evidence that there is no qi flowing through the human body, and that it is not necessary to poke needles into specific body points to access qi. The fact that acupuncture does reduce pain perception for some people has been shown scientifically, and as the NCCIH and Wikipedia articles explain, that's a placebo effect. Especially for people with incurable chronic pain, understanding placebo effects can help design useful placebo-based treatments. (NCCIH also mentions there "may" be direct effects on connective tissue; I'm not familiar with the evidence for or against that, but it's physically plausible that disturbing tissue stimulates it in some way, and unrelated to the qi theory.) -- Beland (talk) 17:52, 11 June 2024 (UTC)
Yes, I agree. I think a fair statement would be: Traditional acupuncture theories are prescienctific [ref] pseudoscience. The theories and practices of TCM are based on naturalist theories [ref] rather than on scientific knowledge.
[ref] = Kaptchuk, T. J. (2002). Acupuncture: theory, efficacy, and practice. Annals of internal medicine, 136(5), 374-383 Youhanna1111 (talk) 22:33, 7 July 2024 (UTC)
Correctly said, "Traditional acupuncture theories were prescientific until roughly 100 years ago. Now they are pseudoscience. The theories and practices of TCM are based on ideas which pass nowadays for Ancient superstitions. TCM is a hoax produced by Chairman Mao so that he didn't have to buy expensive medicines from foreign countries, and trick his totalitarian subjects into a false sense of getting medically treated. And he sent to the labor camp anyone who declared that anesthesia by acupuncture does not work." tgeorgescu (talk) 03:45, 8 July 2024 (UTC)
The article currently says Mao claimed the practice was based on scientific principles. It does not mention anything about motivation or labor camps. Can you point us to reliable sources that support those claims? I'm not sure acupuncture meets the definition given in superstition, and that term sounds pejorative. -- Beland (talk) 18:46, 8 July 2024 (UTC)
@Beland: See e.g. Unschuld, Paul U. (2010). Medicine in China: A History of Ideas. Comparative Studies of Health Systems and Medical Care. University of California Press. p. 364. ISBN 978-0-520-26613-1. Retrieved 8 July 2024. tgeorgescu (talk) 20:14, 8 July 2024 (UTC)
Ah, great. I'm afraid I'm not getting access to page 364; could you give a quote that supports the above claims? -- Beland (talk) 20:35, 8 July 2024 (UTC)
Okay: an eye surgeon was so foolish as to report to his superiors that anesthesia through acupuncture does not work; his report got labeled with "three hats" and he was subjected to "criticism of the masses". People, due to pain, were shouting political slogans during surgery. Because they were not allowed to say they feel pain.
And it is largely copy/pasted here. It says if one did not accept that anesthesia through acupuncture works, they were deemed counterrevolutionaries.
So, the Chinese medical consensus wasn't based upon empirical evidence, but upon argumentum ad baculum. CCP ideologues decided how the scientific consensus should be, real scientists had no say in this matter. Empirically investigating the effectiveness of acupuncture was a crime against the state (if the scientists dared to express politically taboo conclusions).
So, yes, "acupuncture does not work" was a taboo enforced through political policing and reeducation camp sentences. tgeorgescu (talk) 21:55, 8 July 2024 (UTC)
Mind you that Mao died half a century ago. 202.40.137.128 (talk) 10:00, 10 September 2024 (UTC)
That wasn't a direct quote, but I managed to get a copy of the page upon reloading. It doesn't say anything about Mao himself or labor camps or a law making empirical investigation a crime, but what it does say is interesting enough to add to the article. Any idea what "criticism of the masses" is supposed to mean? -- Beland (talk) 22:01, 8 July 2024 (UTC)
At the second RS mentioned by me: acceptance of anesthesia through acupuncture was one of the standards used to judge if someone was for Mao's revolution or against it. Of course, it does not say they were sentenced to labor camps, but you just have to know what happened to people deemed to be against Mao's revolution.
"Criticism of the masses" meant public humiliation (show trial), possibly accompanied by some torture, and losing one's job. tgeorgescu (talk) 22:08, 8 July 2024 (UTC)
If you want to mention labor camps in the article, then we need a reliable source that makes that connection with acupuncture specifically, to avoid original synthesis. Is there a realiable source which defines "criticism of the masses"? Presumably there is an underlying Chinese phrase which is being translated. -- Beland (talk) 00:10, 9 July 2024 (UTC)
We'll just say they were labeled counterrevolutionaries, which is WP:V, and people will have to look up for themselves what that entailed.
This source describes that "criticism by the masses" entailed violence, sometimes lethal: Paquet, Philippe; Rose, Julie; Barnes, Julian (2017). Simon Leys: Navigator between Worlds. Schwartz Books Pty. Limited. p. fn. 51. ISBN 978-1-925435-56-6. Retrieved 9 July 2024. tgeorgescu (talk) 00:24, 9 July 2024 (UTC)
I don't see the word "counterrevolutionary" in Unschuld. -- Beland (talk) 00:55, 9 July 2024 (UTC)
Prioreschi, Plinio (1996). A History of Medicine: Primitive and ancient medicine. A History of Medicine. Horatius Press. p. 178. ISBN 978-1-888456-01-1. Retrieved 9 July 2024. During the period of "Cultural Revolution," acupuncture anesthesia served politically as a standard to judge progress or backwardness, revolution or non-revolution. Physicians and patients were under the pressure of the political requirements of that time. They had no choice but to have exceptional courage in order to carry out or undergo surgery, especially as the patients who felt pain could not cry out. Also in Unschuld 2010, p. 364
Morals: acupuncture anesthesia simply means that Mao was a sadistic tyrant. tgeorgescu (talk) 01:20, 9 July 2024 (UTC)
Are you interpreting reference to "non-revolution" to imply the labelling of people as "counter-revolutionary"? -- Beland (talk) 01:23, 9 July 2024 (UTC)
From the context is quite clear that any dissent from acupuncture anesthesia was politically repressed.
To put it otherwise, backwardness and non-revolution were grave political felonies. They didn't think that backwardness means being a bit dumb, so one needs more help from functionaries. It was a brutal police state, and acupuncture anesthesia was its sacrosanct dogma. Compulsory state ideology led to mass madness, especially in the hands of such a tyrant. It was like the Inquisition, with Maoism instead of Christianity.
The Chinese consensus about acupuncture anesthesia was championed by yesmen and sycophants. tgeorgescu (talk) 05:01, 9 July 2024 (UTC)
I know, but the question is not how you or I would describe the situation, but precisely how it should be described in a neutral article based on reliable sources. You keep introducing new words into the conversation which are great for expressing an opinion in a colorful way, but don't follow the identified sources, and can't be used in the article. -- Beland (talk) 06:55, 9 July 2024 (UTC)
Political repression of disbelievers in acupuncture anesthesia is clearly WP:V in the WP:RS mentioned above. Who was targeted by it? Scientists, MDs, and even patients. Practically anyone who disbelieved it was a target for being repressed. Mao was in some respects outstandingly stupid, sadistic, or delusional. tgeorgescu (talk) 11:10, 9 July 2024 (UTC)
  • To bring this back on point, the premise of the question (that if something is subject to the scientific method, it is not pseudoscience) is fallacious. Many/most pseudosciences are subject to scientific research - there has been an an entire journal dedicated to homeopathy for example. More simply, for Wikipedia, it's required to follow the sources which consider the question of whether acupuncture is a pseudoscience or not. By them, it is; and we are required by policy to reflect that. Bon courage (talk) 07:01, 9 July 2024 (UTC)

Not a pseudoscience

As acupuncture was developed 3000 years ago, it is pre-scientific, not pseudoscientific. In the past 20+ years, the amount of acupuncture research has outpaced biomedical research. As this body of scientific knowledge grows, we are beginning to translate a traditional medicine into modern biomedical scientific language a piece at a time. https://www.evidencebasedacupuncture.org/acupuncture-scientific-evidence/

But we must be careful not assume a partial scientific exploration of a full system of medicine is complete - this an ongoing and developing project on a global scale. Acupuncture is the most widely practice traditional medicine in the world and is incorporated into the new ICD11 codes put out the World Health Organization (WHO).

The WHO and the NIH in the United States support the use of acupuncture and it is covered by insurance in all 50 states.

https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know

[20]https://www.who.int/publications/i/item/978-92-4-001688-0 https://holistic-health.org.uk/world-health-organisation-recommends-acupuncture-100-conditions/

Medicare covers acupuncture for low back pain due to the strong scientific evidence of efficacy: https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=295 https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2021.730322/full https://journals.sagepub.com/doi/10.1136/acupmed-2017-011445 https://www.kpwashingtonresearch.org/live-healthy/all-articles/live-healthy-2014/how-effective-acupuncture-chronic-back-pain


Acupuncturists are also a valid profession as defined by the Bureau of Labor Statistics. https://www.bls.gov/oes/current/oes291291.htm 66.235.16.199 (talk) 22:33, 5 August 2024 (UTC)

Sounds just like Mao Zedong Moxy🍁 22:43, 5 August 2024 (UTC)
I'd expect a valid argument. 31.205.18.117 (talk) 23:30, 21 September 2024 (UTC)
Acupuncture got banned in China as quackery, but then Mao revived it because he lacked money for real anesthetics. It is basically a hoax perpetrated for political reasons. tgeorgescu (talk) 00:25, 22 September 2024 (UTC)

Semi-protected edit request on 24 September 2024

Acupuncture According to the History of Medicine and the Huang Di Nei Jing, Shang Han Lun, Wen Bing was only practiced on the Royals and Emporers. The Name of the first text book is the Yellow Emporer's Internal Cannon. It was never for "Lower-Class." It is modernly labeled as 'Traditional' and sits next to 'Folk' Remedies as it shares Identical Single herb prescriptions with Many other Nationalities such as Many Native American tribal medicine maker. It Differs from Witch Doctor in that it is Closer to the History of Veterinary Medicine as it uses Snake anti-venums for problems with livestock being bitten. The concept of Low-Class cannot be confused with Folk or Traditional as it lends 'Poverty' the word to 'Nativity' the way of life. Because Emporer and Royal medicine also shares Identicality with Royal British Culinary arts. It also can Never be removed from Western civilization as High societied History of Tea. Provider Modernly make tea pills. The History of Medicine and Natural healing amongst Nations has sometimes nothing to do with class, even more interesting is the Shells themselves were once used in Africa As the Coin of choice, currancy. It was also golden medicine, golden shells. These are still Modernly Integrated. Golden Cabinet is the name of a text book.

It is Never Lower-Class. 50.125.109.26 (talk) 19:30, 24 September 2024 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Jamedeus (talk) 05:52, 25 September 2024 (UTC)
And to answer the objection: we don't judge it differently based upon whether it was meant for the lower class or for the very wealthy. That does not have the slightest bearing upon whether it is objectively effective. tgeorgescu (talk) 05:59, 25 September 2024 (UTC)
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