Talk:Acupuncture/Archive 24

Ernst's review of reviews
[https://www.ncbi.nlm.nih.gov/pubmed/21440191 Acupuncture: does it alleviate pain and are there serious risks? A review of reviews] is certainly a very reliable source. However, we say multiple times in the article that it found that real acupuncture was no better than sham acupuncture for pain (presumably all kinds of pain). But I couldn't find any statement to this effect in the paper. Could someone point out where in this paper it says that real acupuncture is no better than sham acupuncture, with respect to pain in general? Everymorning  talk  14:41, 25 March 2015 (UTC)
 * "...but real acupuncture was no better than sham." Page 762. This is about "reducing pain" in general. QuackGuru  ( talk ) 18:20, 25 March 2015 (UTC)
 * I came across a critique of this study which I think should be added in: The critique is by Dr. William Morris and he addresses almost every aspect of Ernst's review of reviews. We have critiques by Novella and others of acupuncture studies throughout the article, yet we don't have one yet for probably the most cited source in the entire article. Where should we put this? LesVegas (talk) 20:47, 25 March 2015 (UTC)
 * A lot of reviews are critiqued but they are not MEDRS compliant. Nothing new here. QuackGuru  ( talk ) 20:49, 25 March 2015 (UTC)
 * Actually, we cite David Gorski critiquing reviews from a blog, Science Based Medicine. A blog like that isn't MEDRS, neither is Quackwatch. But we allow sources like these because they're not making medical claims. A critique of a review doesn't have to be MEDRS, unless it's actually making medical claims. So I don't see why we can't have this source if we're going to allow Science Based medicine to do the same thing. LesVegas (talk) 21:00, 25 March 2015 (UTC)
 * Fringe journal. Falls afoul of WP:FRIND for starters. Alexbrn talk 21:06, 25 March 2015 (UTC)
 * The Acupuncture Today (Huntingt Beach) magazine or whatever is rubbish. QuackGuru  ( talk ) 21:11, 25 March 2015 (UTC)
 * WP:FRIND could also be applied to science based medicine or Quackwatch. I don't think you guys can have it both ways. You can't critique only pro-acupuncture studies with the same level of sources as what you're disallowing. Should we remove the critiques from web blogs?LesVegas (talk) 21:14, 25 March 2015 (UTC)
 * Not so, you're falling into the WP:GEVAL trap; SBM and Quackwatch are mainstream sources for fringe subjects and good for us; fringey journals are generally not useful. Alexbrn talk 21:27, 25 March 2015 (UTC)
 * Ah, but a quick google search shows me that SBM did a piece on the Acupuncture Today criticism of Ernst. While I disagree with your rationale, by it, I could critique Ernst from Acupuncture Today from SBM, but not directly from Acupuncture Today. So either way, the critique would go in. So how do we proceed fro here? LesVegas (talk) 21:49, 25 March 2015 (UTC)
 * "In essence, Morris seems to be arguing that acupuncture is even less safe than Ernst et al. depicted." I don't think this adds much to the page. QuackGuru  ( talk ) 21:53, 25 March 2015 (UTC)
 * No, and especially not when a poor conclusion about Morris's article was drawn like this. But a statement like "“For data on efficacy, it doesn’t provide information about how the studies were controlled" would add quite a bit. LesVegas (talk) 22:05, 25 March 2015 (UTC)
 * No, and especially not when a poor conclusion about Morris's article was drawn like this. But a statement like "“For data on efficacy, it doesn’t provide information about how the studies were controlled" would add quite a bit. LesVegas (talk) 22:05, 25 March 2015 (UTC)

,,  et. al. -- in context, one sees that QuackGuru's quote (real = sham) isn't a finding of Ernst's review of reviews, but rather the finding of one particular, high-quality trial which he believes is more accurate. See p.761, §4 Discussion (1st para suffices), and then 1st para on p.762. --Middle 8 (contribs • COI) 00:45, 26 March 2015 (UTC)


 * Oh, you're right. Now the question is why do we have a primary source so prominently displayed? So you're saying this was discussed before? What was the argument there? If it was only that it was more accurate, that would seem to be a problem.LesVegas (talk) 02:47, 26 March 2015 (UTC)
 * "...but real acupuncture was no better than sham." This is a finding from the review. QuackGuru  ( talk ) 04:58, 26 March 2015 (UTC)
 * - Not in context, per just above. Don't  IDHT  please. --Middle 8 (contribs • COI) 05:43, 26 March 2015 (UTC)
 * - Yes, this has been discussed before, with the most recent, broad consensus (note that QuackGuru joined it) being to use this wording. But that wording was so awkward that editors kept "simplifying" it (in good faith), changing the meaning.  Good alternative suggestion:  --Middle 8 (contribs • COI) 05:43, 26 March 2015 (UTC)
 * This is a quote from the source: "...but real acupuncture was no better than sham." It is in context. QuackGuru  ( talk ) 05:50, 26 March 2015 (UTC)

Middle 8 was commenting about User:RexxS rather than focusing on content regarding same sentences way back in July 2014. See RexxS's ad hominem & general drama is a confession of weakness. See Wikipedia_talk:WikiProject_Medicine/Archive_51. Months later, Middle 8 is continuing to argue over the same text. For example, Middle 8 is accusing me of IDHT even though I directly quoted the source to verify the claim. QuackGuru ( talk ) 06:59, 26 March 2015 (UTC)
 * Who cares about >6 month old drama? I can link to hot stuff others have said too; so what?  It has nothing to do with WP:ENC.  You should stop trolling, and do as others are doing here, and focus on substance.  This is a legit content dispute; it's a flawed consensus -- one that another editor brought up BTW -- and on WP we can and should revisit content to whatever degree necessary till we get it right. Alert editors will note that you're insistently quoting just one part of a sentence, and thus failing to address the issue of context (hence the IDHT). --Middle 8 (contribs • COI) 11:51, 26 March 2015 (UTC)


 * This is really a mess. Ernst did not conclude that real acupuncture was no better than sham (but only alludes to it in a study) yet, not only do we say this in the article multiple times, (misleading the reader) but we also mislead editors here. Recently we had a long debate w/ Kww about this, and he was under the mistaken impression that Ernst concluded this and even wanted to exclude other research that was contrary to Ernst's "statement." Talk about an out of control snowball! How did it even get this way in the first place? And what do we do from here? Should we just delete this altogether? We could state it's an outcome from an RCT but that opens the door to using primary sources in the article, and I highly doubt editors here would like everyone to be doing that. But above all, we can't have primary research being quoted out of context as though it was a conclusion from a review. LesVegas (talk) 18:06, 26 March 2015 (UTC)

Later in the paragraph Ernst et al states "Real and sham acupuncture were both more effective in reducing pain than no acupuncture at all, but real acupuncture was no better than sham". The review is not quoting other studies, but is their own drawn conclusion, not referenced to any specific source, but a statement of what they had found in reviewing the current evidence. As editors we have to adhere to follow what reliable WP:MEDRS sources say, not place our own WP:SYN interpretations on them. QuackGuru ( talk ) 19:22, 26 March 2015 (UTC)

LesVegas, I misinterpreted nothing. Ernst and Vickers both came to the conclusion that the difference between acupuncture's total effectiveness and the placebo effect for acupuncture was between small and non-existent. The only argument science has over acupuncture is whether it's ethical to prescribe a treatment that is primarily placebo on the off-chance that the small delta is an actual benefit instead of a statistical anomaly.&mdash;Kww(talk) 20:07, 26 March 2015 (UTC)
 * , nobody is debating what Ernst or anybody else thinks about the state of acupuncture research today, the issue is what did he say in his review of reviews spanning 2000-2009, when study controls weren't as sophisticated.  --Middle 8 (contribs • COI) 01:35, 27 March 2015 (UTC)
 * I already explained this. Editors are not allowed to conduct their own interpretation of reviews. QuackGuru  ( talk ) 01:39, 27 March 2015 (UTC)
 * PDF here. See p.761, §4 Discussion (1st para suffices), and then 1st para on p.762. --Middle 8 (contribs • COI) 01:50, 27 March 2015 (UTC)


 * I'm sorry if I misquoted you, or misremembered the conversation here a couple of months ago, Kww. But yet again, you interpret Vickers and claim 'science' says when it's not the case at all. One thing I do remember clearly from that conversation long ago was that you never commented on the Hopton/Macpherson source which stated that "since acupuncture is more effective than placebo shouldn't the research towards shifting research priorities away from asking placebo-related questions and towards asking more practical questions about whether the overall benefit is clinically meaningful and cost-effective?" anyway, back to current matters: what are we going to do about the misrepresented Ernst comments? LesVegas (talk) 01:49, 27 March 2015 (UTC)
 * We need to correctly represent the CONCLUSION of Ernst's review, not quote his statement about a primary source. QG we've had this conversation before, and I recommend you carefully avoid misrepresenting the source. Do the right thing.Herbxue (talk) 15:57, 27 March 2015 (UTC)
 * Please read this comment. This was a conclusion of the review not a primary source. As editors we don't read different paragraphs and come to own personal opinion of the review. We don't conduct our own review on Wikipedia. QuackGuru  ( talk ) 18:07, 27 March 2015 (UTC)


 * No, QuackGuru, you're linking to another time you IDHT'd and from now whenever you IDHT, I think you lose your all valid objection and don't count in a consensus tally. If you don't want to be ignored in future discussions, I suggest you do is the courtesy to not ignore us. And since nobody else sees things your way (because they don't IDHT everyone else) let me point out that we're no longer talking about if Ernst was making a conclusion about a large amount of research, we're moving on to the question of what do we do with these statements? To that end, I say we work to reword them appropriately. If we can't do that, then we need to delete them because we don't make references to primary studies. LesVegas (talk) 21:37, 27 March 2015 (UTC)

Coming back to this discussion. First, User:LesVegas, my opinion about what people should study in the future isn't particularly relevant, but if you want it, here it is. Since research has adequately demonstrated that acupuncture is form of placebo, we should build on that to discover precisely why it is associated with such a strong placebo effect. What is it about the setting, the lies to the patient about mystic channels, the impressive looking needles or lasers, the impressive diplomas on the wall, that all combine to make the patient believe that he will feel better and how does that belief translate into something useful? When people discard the notion that acupuncture actually does anything they can begin to study something useful, because the key here is to learn how to control the patients' environment in a way that makes them feel better. It would be nice to know how to do that without lying to them.

That whole paragraph on pg. 762 is worth parsing.

The sentence in question, "Real and sham acupuncture were both more effective in reducing pain than no acupuncture at all, but real acupuncture was no better than sham" is a summary of Suarez-Almazor, not specifically Ernst's conclusion. That said, and the reason why I object to this mindless quote-pulling literalism we've allowed these articles to degenerate into, he does pull that particular conclusion as an important and representative conclusion, along with Cherkin's conclusion that he was dealing with a placebo effect, not a real effect. That, combined with his own prediction of what better controls would bring, makes it fair to characterize Ernst's personal conclusion as being that acupuncture is a placebo. It is not, however, the formal conclusion of the study.

If I were going to generate a lay summary of that conclusion, it would be "Ernst's efforts to come to definitive conclusions about the effectiveness of acupuncture were frustrated by the poor quality of the underlying studies, but indicated to him that adequately controlled studies were likely to demonstrate that acupuncture has no or few specific effects on pain". &mdash;Kww(talk) 15:19, 28 March 2015 (UTC)
 * There is some text in the lede and body about the placebo effects: "Some research results suggest acupuncture can alleviate pain, though other research consistently suggests that acupuncture's effects are mainly due to placebo.[3]" If you think the article is lacking enough information about the placebo effects it would be better to use a source that specifically discusses the placebo effects such as the 2006 review. See http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2005.01584.x/full The ref citation is .  QuackGuru  ( talk ) 18:21, 28 March 2015 (UTC)
 * , thank you for taking the time to read and parse that quote. I agree with your take on Ernst's intentions and summary.  As far as I'm concerned you can go ahead and add it, and finally we'll have resolved this misrepresentation.  "Mindless quote-pulling literalism" -- phrase of the week.  --Middle 8 (contribs • COI) 06:19, 29 March 2015 (UTC)
 * The source said "Adequately controlling for nonspecific effects in future is likely to demonstrate that acupuncture has no or few specific effects on pain [89]." A "future" prediction is not current evidence. Literally what the source determined as of today is verifiable and current evidence.
 * User:Dominus Vobisdu, User:McSly, User:Jim1138, User:Roxy the dog,, and User:Bobrayner preferred the concise wording for the text. QuackGuru  ( talk ) 06:55, 29 March 2015 (UTC)
 * It's perfectly possible for competent editors to get this wrong at first. 's reading, however, is essentially correct, and numerous editors who have read the source carefully have agreed.  I'm not going to link to them all.  Except one:   User:QuackGuru  .  Apparently you no longer trust that editor's take -- and I'm sure you're not alone.  --Middle 8 (contribs • COI) 07:58, 29 March 2015 (UTC) edited 08:57, 29 March 2015 (UTC)
 * Having read both the source and now a decent amount of the debate on this, I not only agree with KWW's reading, but I think his suggested change is the absolute best anyone has suggested while this debate has been going on. Excellent work, Kww! LesVegas (talk) 12:54, 29 March 2015 (UTC)

If we're going to summarize these things (which we damn well should), then I suggest we take care of Ernst and Vickers together. "Ernst's efforts to come to definitive conclusions about the effectiveness of acupuncture were frustrated by the poor quality of the underlying studies, but indicated to him that adequately controlled studies were likely to demonstrate that acupuncture has no or few specific effects on pain. Vickers later corroborated this view, finding that any specific effects of acupuncture were small in relation to the placebo effects". Then we can delete this long laundry list of individual studies.&mdash;Kww(talk) 16:06, 29 March 2015 (UTC)
 * , given how pointedly Ernst and Vickers have disagreed, saying they agree would do violence to both. (And while the laundry list can be condensed to, say, a table, some brief summary of the reviews shouldn't be removed, because unlike Ernst and Vickers, they're not just about pain. See also Hopton & MacPherson on chronic pain and Lee & Fan on PONV, who find for efficacy without significant caveats; I haven't seen you address either of these yet).  So your formulation goes against both WP:STICKTOTHESOURCE and WP:SYN.  And again... if there were general agreement, we wouldn't be seeing (i) fresh RCT's undertaken by Stanford Univ etc., nor (ii) epithets like "quackademic" (and similar criticisms) thrown around by lesser MEDR's critiquing better ones, nor (iii) invited pro/con editorials.  Kww, I'm honestly not how you concluded there was sci consensus here; who else has expressed your view that Ernst and Vickers substantially align, let alone that all tert sources do?  --Middle 8 (contribs • COI) 17:16, 29 March 2015 (UTC)
 * P.S. And there is a WEIGHT problem (insufficient coverage of [+]-efficacy views), when the article still (a) omits Hopton and (b) cites only the "con" editorial from Anesth. Analg. --Middle 8 (contribs • COI) 17:16, 29 March 2015 (UTC) edited 17:26, 29 March 2015 (UTC)
 * Vickers believes the small effects plus the base placebo effect are worth paying for, but still categorizes the effects as small. The discussion of the ethics of paying for placebos is completely separate from the discussion of whether the effects are primarily placebo. Vickers confirmed Ernst's conclusion, in that he found that any specific effects of acupuncture were smaller than the placebo effects, and small in any absolute terms as well. I've got no problem highlighting the difference in value judgements in any summary, but that should not be used to obscure the fact that they were in alignment on the fundamental results. A disagreement about ethics and social policy is not a disagreement on the underlying science.&mdash;Kww(talk) 17:31, 29 March 2015 (UTC)
 * Ernst said "This important analysis confirms impressively and clearly that the effects of acupuncture are mostly due to placebo" - which sounds like agreement in one direction. Did Vickers comment on Ernst? Alexbrn (talk) 17:37, 29 March 2015 (UTC)
 * On Ernst's original study, or to Ernst's response to Vickers. I'd have to dig around for quotes, but the main response I remember is similar to the argument I'm having with Middle 8, centering around Vickers's willingness to classify the small results as significant and worth paying for.&mdash;Kww(talk) 17:49, 29 March 2015 (UTC)
 * Something that has small results and is still worth paying for seems contradictory. QuackGuru  ( talk ) 17:51, 29 March 2015 (UTC)
 * (e/c's -- wow, active today), I get that there's some convergence; I do. And I agree we can add the points you make re the deltas, since they are echoed in some of the commentaries on Vickers.  BUT... we can't only frame Vickers that way.  Not only does he not say specific effects are clinically small, he doesn't say they're "small" relative to placebo: "smaller" (what Vickers' numbers show) ≠ "small" (your suggestion).  To be specific, 5.75 isn't exactly "small" relative to 8 (and these are in fact his deltas in pain scores for back and neck).  We need to present Vickers' conclusions the way he does (STICKTOTHESOURCE), and that's more than just an ethical difference.
 * Re Kww's proposal to remove the non-Ernst, non-Vickers stuff... to my & Les's counterexamples we can add (iv) responses like these to Vickers.
 * , here's Vickers' response to Ernst's comment. Vickers' review itself also shows points of divergence, c.f. "BUT..." above. --Middle 8 (contribs • COI) 18:09, 29 March 2015 (UTC)
 * Acupunct Med is a fringe journal. QuackGuru  ( talk ) 18:14, 29 March 2015 (UTC)
 * -- (a) Vickers' point is that the delta between verum and no-acu is the basis for the clinically relevant decision, not the delta between verum and sham. The former delta being greater than the MCID. (b) Per WP:SOURCES we can still quote experts even if their comments aren't in a great MEDRS. And we have parity with Ernst's comments since the latter weren't in a journal at all.  --Middle 8 (contribs • COI) 18:18, 29 March 2015 (UTC)

By my reading Ernst suspects future will research will show that the small effect of acupuncture will be due entirely to placebo; Vickers that it won't. I'm not sure where that leaves us on whether or not these fellows disagree about the current state of knowledge. Alexbrn (talk) 18:21, 29 March 2015 (UTC)
 * Right, which is why I always center around summaries like "non-existent or small". No one thinks the difference is large, or that any future study will suddenly find a large delta. Vickers's conclusion that we should be focusing on no treatment vs. acupuncture instead of sham acupuncture vs. acupuncture is what I keep referring to as the ethical debate. Vickers is comfortable recommending treatment even in the cases where he is aware the treatment is primarily placebo, while others are not. I have my personal opinion about that, but the article should neutrally frame that as a debate over ethics, and not take a position as to which side is right. Unfortunately, people (including Vickers and Ernst themselves) allow that ethical debate to colour their debates over the statistics. Middle 8, it would be nice if you could link to a summary or analysis of Vickers's response that isn't hidden behind a paywall. The paper you link to appears to be a response to the wide range of vitriol that he received for his conclusion, and it's not possible from the abstract to specifically identify a response to Ernst himself.&mdash;Kww(talk) 18:45, 29 March 2015 (UTC)
 * A free version's here. Alexbrn (talk) 19:20, 29 March 2015 (UTC)
 * OK, based on that: "Ernst's efforts to come to definitive conclusions about the effectiveness of acupuncture were frustrated by the poor quality of the underlying studies, but indicated to him that adequately controlled studies were likely to demonstrate that acupuncture has no or few specific effects on pain. Vickers later corroborated this view, finding that any specific effects of acupuncture were small in relation to the placebo effects. Upon review of Vickers's results, Ernst concluded that Vickers had overstated the positive nature of the results and that instead of supporting the position that the results were small, they supported the position that the specific effects were, in fact, insignificant. Vickers rejects that analysis, stating that while the effects were small, they were clinically significant".&mdash;Kww(talk) 19:41, 29 March 2015 (UTC)
 * For now I added the mainstream view per weight. See Acupuncture. QuackGuru  ( talk ) 02:51, 30 March 2015 (UTC)
 * Not even close to consensus for that at this point. More later --Middle 8 (contribs • COI) 05:47, 31 March 2015 (UTC)
 * Actually, it may be OK as long as we cover other views (cf my comments above); mulling over. --Middle 8 (contribs • COI) 05:59, 31 March 2015 (UTC)
 * I wasn't okay with using the fringe journal. I only added it because that is what editors wanted. In the future there will likely be a review covering the debate about the Vickers source and claims. When a better source is available in the future the fringe journal will probably be replaced. QuackGuru  ( talk ) 04:49, 1 April 2015 (UTC)

Back to the issue of fixing the misrepresentation of Ernst's comments on real & sham: any more comments? Any reason not to reword per Kww above? --Middle 8 (contribs • COI) 05:07, 2 April 2015 (UTC)
 * What was misrepresented? Any reason not to reword per Kww above? See WP:OR. QuackGuru  ( talk ) 05:10, 2 April 2015 (UTC)
 * The version we have does confuse the conclusion of a study quoted in the review with the conclusion of the review itself. My summary avoided that, and it doesn't violate WP:OR. You seem to believe that all summarization violates WP:OR. Where did you get that impression?&mdash;Kww(talk) 05:28, 2 April 2015 (UTC)
 * I read the source and then added to the article what the source said. I could not verify what you originally proposed. QuackGuru  ( talk ) 05:39, 2 April 2015 (UTC)
 * That's interesting. What were you unable to verify? How could you read that source and conclude that Vickers did not reject Ernst's analysis of Vickers's paper, or that Vickers does not continue to claim that the acupuncture has a small but statistically significant effect?&mdash;Kww(talk) 05:45, 2 April 2015 (UTC)
 * Current wording: "Edzard Ernst later stated that "I fear that, once we manage to eliminate this bias [that operators are not blind] … we might find that the effects of acupuncture exclusively are a placebo response."[81] Andrew Vickers, lead author of the original 2012 paper and chair of the Acupuncture Trialists' Collaboration, rejects that analysis, stating that the differences between acupuncture and sham acupuncture are statistically significant.[81]" Actually, a lot of what you wanted is already in the article. What was added was only sourced text. Not sure what you are proposing to change. What you originally proposed was too much editorializing. QuackGuru  ( talk ) 05:53, 2 April 2015 (UTC)
 * The bad text: "A systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture..."  Re which, this (per Kww): The version we have does confuse the conclusion of a study quoted in the review with the conclusion of the review itself.  Source: Ernst '11; see p.761, §4 Discussion (1st para suffices), and then 1st para on p.762.  Everymorning, Jytdog: please comment if possible; notified Alexbrn already. Thanks very much, in advance. --Middle 8 (contribs • COI) 16:07, 2 April 2015 (UTC)
 * OK, Alexbrn has been heard from, and still agrees with the in-context reading of the source that led to the last broad consensus at WT:MED  and on which all editors above, save one, agree.  The question is then how to summarize the source based on this correct reading, and it looks like editors favor Kww's proposal.  Any other comments before proposing specific edits to the lede and body?  --Middle 8 (contribs • COI) 05:22, 7 April 2015 (UTC)
 * https://en.wikipedia.org/w/index.php?title=User_talk:Alexbrn&diff=654755110&oldid=654727107 Alexbrn has been heard from, and now you are putting words in his mouth. He did not specifically comment about the current wording. Kww's proposal was not sourced to the review of reviews. QuackGuru  ( talk ) 18:52, 7 April 2015 (UTC)

None here. Just that I support Kww's wording entirely for the body. For the lede, though, I'm curious if there are any ideas on how to make it work per WP: WEIGHT? Commentary on a hypothesis isn't something we usually use in ledes, yet I want to keep the peace around here so I'm not proposing omitting it altogether from the lede, unless other editors feel similarly. I just wonder how we're going to work it into the lede? LesVegas (talk) 13:13, 7 April 2015 (UTC)
 * Agree that a prediction isn't as weighty as a finding, but we can still mention it: it wouldn't be fair just to say Ernst was unable to reach a conclusion. What I think we should do in the lede -- as a replacement for the inaccurate text -- is (a) stick close to the source's conclusions that are stated as such, and (b) define sham acupuncture. --Middle 8 (t • c &#124; privacy • COI) 05:13, 8 April 2015 (UTC)
 * You have not shown the text is "inaccurate". Stating that Ernst was unable to reach a conclusion is original research. The article does define sham acupuncture. See Acupuncture. QuackGuru  ( talk ) 05:19, 8 April 2015 (UTC)
 * Have you not read this thread? I briefly explained the problem  and why it's persisted, and addressed a common objection..  And Kww parsed it in detail:  here et. passim.  Don't  IDHT , please. If you have a rebuttal, please address these points using one of the top three tiers of Graham's hierarchy of disagreement.  (P.S.: Paraphrasing isn't OR.) --Middle 8 (t • c &#124; privacy • COI) 00:58, 11 April 2015 (UTC)
 * I'm not interested in addressing this in detail. We should not replace sourced text with OR. If you think the proposal is sourced then please try to verify the claim according to WP:V. There is information in the body with Vickers's response. See Acupuncture. QuackGuru  ( talk ) 01:29, 11 April 2015 (UTC)
 * Obviously, the burden's on you to justify keeping it. Since you're unable to do so, sounds like we have consensus to remove it then. --Middle 8 (t • c &#124; privacy • COI) 06:34, 11 April 2015 (UTC)
 * I asked "If you think the proposal is sourced then please try to verify the claim according to WP:V." You proposed new wording and you were unable to provide V. Editors previously discussed the wording for the lede and body and did provide V a long time ago. See Wikipedia_talk:WikiProject_Medicine/Archive_51. QuackGuru  ( talk ) 06:55, 11 April 2015 (UTC)
 * And this consensus result (the part about the systematic review and sham) was the outcome of that discussion, which you supported at the time. But as we've seen, that wording was so awkward that editors kept "simplifying" it (in good faith), which completely undid said consensus result.  Given your earlier agreement to change it, your insistence on keeping the current wording defies logic.  We need some alternative that is faithful to the consensus you once supported, like this, or something that gives proper weight in the lede to the numerous results that sham = real.  --Middle 8 (t • c &#124; privacy • COI) 02:26, 12 April 2015 (UTC)
 * User:Dominus Vobisdu, User:McSly, User:Jim1138, User:Roxy the dog, and User:Bobrayner preferred the more concise wording. We should not re-add overly detailed wording to the lede. User:Yobol stated that it does seem to be a conclusion Ernst is making and therefore citable as a source for that conclusion. The wording is just right. See Acupuncture. QuackGuru  ( talk ) 06:53, 12 April 2015 (UTC)

Didn't you bring this up at Kww's Talk Page in last October, QuackGuru  If I remember right, most of these "acts of support" were nothing else but blind reverts with no given rationale. Even back then, I notified you that what really counts is the quality of arguments; arguments, such as "I just don't like it" and "I just like it" carry no weight whatsoever. I have to agree with Middle8 here. I think it's okay to proceed in this matter. Cheers! Jayaguru-Shishya (talk) 10:18, 12 April 2015 (UTC)
 * I disagree with Jay and M8 here. It seems clear that in accordance with PAG, QG is correct. It is not OK to proceed. -Roxy the Viking dog™ (resonate) 11:45, 12 April 2015 (UTC)
 * J-G is exactly right. It's easy to get this wrong at first, partly because the wrong answer is truthy: hence the blind reverts.  But when one actually reads the source, it's clear enough, assuming literacy.  Only perhaps in the vaguest "spirit of the law" sense is the simple-but-wrong wording somehow OK -- and I'm cool with weighting null findings correctly i.e. strongly, but not with misrepresenting a source.  --Middle 8 (t • c &#124; privacy • COI) 20:42, 12 April 2015 (UTC)
 * It was too long at first to have the additional details in the lede. That was why it was eventually rejected. The shortened text is concise and therefore much better. QuackGuru  ( talk ) 00:52, 13 April 2015 (UTC)
 * Not when "simplifying" = removing text so as to alter the meaning. But you know that, because you have a big "thumbs up" to the accurate, and slightly longer, consensus result.  And I can't wait for Roxy to explain how Kww and I and the rest of us are so wrong about this -- but perhaps he hasn't looked at it that closely; others have been fooled too.  --Middle 8 (t • c &#124; privacy • COI) 01:39, 13 April 2015 (UTC)
 * Simplifying the wording improved the readability for the reader. Now that the text is no longer incoherent I don't understand why anyone would complain. QuackGuru  ( talk ) 01:46, 13 April 2015 (UTC)
 * So what's your real concern? Mentioning sham = real in the lede?  Defining sham in the lede?  We can do both without misrepresenting the source. --Middle 8 (t • c &#124; privacy • COI) 11:40, 14 April 2015 (UTC)

Evidence-based complementary and alternative medicine again
Quote from WP:MEDRS: ''An integral part of finding high quality sources is avoiding articles from journals without a reputation for fact-checking and accuracy. A red flag that a journal article is probably not reliable for health claims might be publication by a publisher that has a reputation for exhibiting "predatory" behavior, which includes questionable business practices and/or peer-review processes that raise concerns about the reliability of their journal articles. (See "References" section below for examples of such publishers.[16][17]) Other indications that a biomedical journal article may not be reliable are its publication in a journal that is not indexed in the bibliographic database MEDLINE,[18] or its content being outside the journal's normal scope (for instance, an article on the efficacy of a new cancer treatment in a psychiatric journal or the surgical techniques for hip replacement in a urology journal). Determining the reliability of any individual journal article may also take into account whether the article has garnered significant positive citations in sources of undisputed reliability, suggesting wider acceptance in the medical literature despite any red flags suggested here.''

The source is not currently MEDLINE indexed. The previous discussion resulted in no consensus. See Talk:Acupuncture/Archive_20. WP:EXCEPTIONAL claims require high-quality sources. It is usually better to use independent source. See WP:MEDINDY and see WP:FRIND. We are currently using better sources in that section. QuackGuru ( talk ) 21:07, 4 April 2015 (UTC)


 * As said, "Evidence-based complementary and alternative medicine" is already used in the article (7 times, as far as I can count). Please do not edit war over the content that has already widely been accepted. Cheers and happy Easter,  QuackGuru . Jayaguru-Shishya (talk) 22:09, 4 April 2015 (UTC)
 * Perhaps those other seven references need to be removed as well. Care to individually justify precisely why we should consider these citations to be acceptable?&mdash;Kww(talk) 22:19, 4 April 2015 (UTC)
 * As Middle 8 pointed out, eCAM is used as a source in 84 different articles on Wikipedia. This shows global consensus beyond the borders of this article, in places that aren't POV war zones. Kww, should we remove it from those articles too? And on what grounds? Lack of Medline indexing? MEDRS doesn't say that that's a clear reliability issue, only a possible one, and when you consider the journal's impact factor the protestations become moot. I have a better idea: if you can convince the MEDRS folks that we need to change MEDRS to read, "Sources are absolutely unreliable if they aren't Medline indexed" and, if you can do it, I will personally remove the source all over this article. We should focus our efforts on making our sourcing rules more clear instead of arguing ad nauseum about each source from partisan standpoints. LesVegas (talk) 02:23, 5 April 2015 (UTC)
 * No, it doesn't work that way. The appearance of a use of a journal somewhere else doesn't make it automatically RS for use in every case here.  I started taking a look at that list of 84 uses, first one was as a primary source talking about animal studies, that should probably be removed; second was to describe the color of a substance bees make; third was one of two sources to support a general statement about some use people try to get out of a mushroom.  A source can never be blanket "reliable" or "unreliable", you have to look at each proposed use in context.  So, "84 uses" really holds absolutely zero weight here. To answer, Yes, each and every use of that journal's use here should be reviewed here, and if that journal is being used to support a biomedical claim, it really needs to be addressed, possibly removed.   03:01, 5 April 2015 (UTC)
 * I find it disappointing but not surprising that such a poor quality source has been used 8 times in this article. I'll take a look to see if the article can be improved by removing that poor source and the material that it supports. That a journal should call itself "Evidence Based Complementary And Alternative Medicine" is a source of endless amusement in this household. Imagine the excitement each month when the subscription arrives in it's brown envelope, the anticipation mounts as the package is ripped apart, the glossy well illustrated (normally a happy Merkian family eating salad) cover has so much promise, but when opened ... all the pages are blank.) -Roxy the dog™ (resonate) 10:05, 5 April 2015 (UTC)
 * No, Zad, it doesn't work that way either. There is no consensus to remove the source. It's currently subject to an edit war. We need to go about it another way, either an RfC (which likely won't show consensus, either) or, better, what I suggested which was an amendment to MEDRS. Why not get that through? LesVegas (talk) 12:31, 5 April 2015 (UTC)
 * "Consensus" must be based on arguments grounded in policy and guideline. 100 !votes or supports that aren't grounded in content policy and guideline carry no weight at all, and can be overturned by the first argument that is.  Regarding your MEDRS suggestion, you still aren't actually connecting to what I and others are saying.  You should read through the archives at WT:MEDRS regarding previous discussions about how MEDRS should address being indexed (or not) in MEDLINE and other services.  Getting MEDLINE-indexed is a particularly low bar, as there are a lot of not-particularly-great journals that are indexed.  One way to think of this is that if a journal is not MEDLINE-indexed, that puts the journal in doubt to start, and a strong case must be made for it using other parameters.  An impact factor of 2.175 does not in any way make it "moot."    16:53, 5 April 2015 (UTC)
 * But Zad, you're a smart guy. If we are to only use sources indexed in Medline, MEDRS should say so. It doesn't. So there is no policy or guideline that this is violating. It's just another silly edit war, really. LesVegas (talk) 17:41, 5 April 2015 (UTC)

Your responses continue not to connect to the points being made and so I am disinclined to continue the conversation. We'll start with the weakest use of inappropriate sources. 17:53, 5 April 2015 (UTC)
 * I did look at the MEDRS talk archives, but that's not a policy or guideline. Come on, if it's really a terrible source only because it's not in Medline yet, then it stands to reason it would be easy to change MEDRS to say that sources not in Medline are absolutely unreliable. Why is it that hard? And for the record, it's you who haven't addressed that question. Yes, MEDRS says that if its not Medline indexed, that's a possible red flag, but not a red alert. A red flag is only a warning to investigate further, not for supporters of the source to have to make a strong case for, and be dismissed for arbitrary reasons, all of which MEDRS says nothing about (like impact factor not being high enough). LesVegas (talk) 18:01, 5 April 2015 (UTC)
 * Actually, I would like to point something out. Here is MEDRS's language, in full:
 * Other indications that a biomedical journal article may not be reliable are its publication in a journal that is not indexed in the bibliographic database MEDLINE,[18] or its content being outside the journal's normal scope (for instance, an article on the efficacy of a new cancer treatment in a psychiatric journal or the surgical techniques for hip replacement in a urology journal).
 * Please note the word 'may', which MEDRS emphasizes in italics. Please also note the second part about "a journal's normal scope" and ask if Western biomedical journals like Nature or JAMA, prestigious as they are, are more appropriate than a CAM journal? Or should we only have acupuncture journals in an acupuncture article? How strict are we really going to choose to be with applying MEDRS? LesVegas (talk) 18:37, 5 April 2015 (UTC)
 * I think it's reasonable to be extremely strict with sources that promote magical thinking. It bears repeating that there is no such thing as "alternative medicine": when there is sufficient evidence that something works, it's just "medicine".&mdash;Kww(talk) 18:44, 5 April 2015 (UTC)
 * Why then did you want an allergy meta-analysis showing reductions in serum IgE deleted, even though it was published in an excellent journal.? Was it the magical thinking aspect or the medicine you objected to? LesVegas (talk) 19:04, 5 April 2015 (UTC)
 * Les, go and try this on with the medics please, and see what happens. Let us get on with editing the article. Believe me, it wont fly. -Roxy the Viking dog™ (resonate) 19:08, 5 April 2015 (UTC)
 * Wow! Viking dog? Why the change? Or was it a metamorphosis? By the way, you misspelled "own" as "on", but I'm not about to squabble with a freaking Viking Dog over something as paltry as spelling. LesVegas (talk) 19:20, 5 April 2015 (UTC)
 * Refresh my memory, Les. There are so many dubious studies being crammed into this article that I can't reproduce my objections to each one from memory.&mdash;Kww(talk) 20:44, 5 April 2015 (UTC)

Sure, Kww. Here was your comment: '''This is an example of precisely why I think having this rack of individual studies distorts the POV of the article. If this new study had documented the prevailing view on acupuncture, would there have been such a rush to add it? I think not. Instead, because it takes the unusual point of view that jamming needles into one's body will impact the immune system, it gets presented here, well in advance of the remainder of the scientific community having an opportunity to examine and reject it.—Kww(talk) 20:27, 17 January 2015 (UTC)''' And: '''And while we wait, we get another advertisement for acupuncture. Funny how that works. I would suggest that we remove it unless and until it is confirmed by supporting studies.&mdash;Kww(talk) 05:52, 18 January 2015 (UTC)''' Anyway, their findings were real medicine if I've ever seen such a thing, even showing serum changes with extremely low P's. If memory serves me correctly, not only did you support deleting the source, you then attempted to have me and a few others topic banned for supporting it. LesVegas (talk) 20:55, 5 April 2015 (UTC)
 * I'll stand by my comment: if that study attracts supportive comments from reputable journals it's fine. If it had come to the prevailing conclusion (i.e., that jabbing needles into people doesn't have any particular effect on rhinitis), no one would have been eager to include it the moment of publication. The only reason that there was a push to include it so rapidly was because it came to the opposite conclusion. It's not that the source was unacceptable, it's that the inclusion was premature. It's been several months. Any interesting letters to the editor or similar responses that take any note of this study?&mdash;Kww(talk) 21:34, 5 April 2015 (UTC)
 * By the way, LesVegas, it's your support of pseudoscience that I believe should cause you to be banned from Wikipedia entirely. This particular study doesn't weigh heavily on that opinion one way or the other.&mdash;Kww(talk) 21:36, 5 April 2015 (UTC)
 * I guess it's too bad for you Arbcom saw differently, and you were roundly lambasted for bringing such a case to them. But anyway, just to be clear, where in MEDRS does it say anything about premature inclusion of meta-analyses, or that it needs letters to the editor? I'll find the letters if you find the MEDRS stipulation where we remove such sources. And not to change the subject, but we changed the subject. I was just asking editors here about where MEDRS requires journals to be indexed. Do you have anything to say about that? LesVegas (talk) 21:50, 5 April 2015 (UTC)
 * MEDRS is a minimum bar, and not the only criteria to be used. As for Medline, it mentions it solely as a red flag. That does shift the burden to people that wish to include it. As for an Arbcom decision that automatically brings all alternative medicine topics under that scope of discretionary sanctions, that was the best that I expected. That people are unwilling to block all pseudoscience advocates is a shame, but I recognized that aspect as a Hail Mary play. It would improve the lives of everyone on the project and the lives of everyone using Wikipedia as a source, but some apparently consider constant conflict to be preferable.&mdash;Kww(talk) 22:55, 5 April 2015 (UTC)
 * Hindawi is not on Beall's list of predatory publishers. Also, EBCAM has an impact factor assigned by JCR, something not typically associated with disreputable journals.  Everymorning   talk  23:40, 5 April 2015 (UTC)
 * Good point, if I remember correctly, there was already discussion about the same thing, maybe somewhere in between 6 and 12 months ago? :-P Jayaguru-Shishya (talk) 20:58, 8 April 2015 (UTC)
 * Kww, haven't you been ranting about that same stuff at Arbcomalready, where the case you filed miserably failed? I also remember similar threats[https://en.wikipedia.org/w/index.php?title=User_talk%3AKww&diff=652894137&oldid=652884244 you've made, not to mention the false administrative warnings over the subject. Time to drop the stick, don't you think? With due all respect, nobody is interested in your opinion. Please WP:STICKTOSOURCES. Cheers! Jayaguru-Shishya (talk) 20:37, 8 April 2015 (UTC)
 * I was replying to a direct statement on the topic, JG. I'm certain that you are uninterested in anything I have to say, and there's no reason to repeat that, either. I do promise to give anything you have to say the consideration it deserves.&mdash;Kww(talk) 20:48, 8 April 2015 (UTC)


 * Kww, you mean the editors you asked to be banned in your Arbcom case Let me see, you said that: "My view is diametrically to John's: that it is our role as administrators to actively detect the users that are attempting to block a reflection of scientific consensus in the article, block them as appropriate, and help provide an environment that will allow our scientifically-minded editors to prevail. I would resolve this problem by blocking or topic-banning LesVegas, Jayaguru-Shishya, A1candidate, and, indeed, any and all editors that attempted to portray acupuncture as having medical legitimacy."


 * I'd be careful if I were you, Kww. You are continuing to make similar claims as you did in your Arbcom case that did not succeed. There's a long list of such accusations even before that. As an admin you should know better. Please do throw your own considerations into the corner and focus on improving the article instead. Cheers! Jayaguru-Shishya (talk) 20:58, 8 April 2015 (UTC)
 * I do focus on improving the article. Please follow indentation standards, BTW: replies indented one step in relation to the comment they are replying to, inserted after the last thread that is also a reply to the same comment. LesVegas's comment at 21:05 is a reply to me, your comment at 20:37 was a reply to me, and the comments in between are at least indented to appear as if they were a reply to one of my subsequent comments (although it seems that they may not be). You should note that the Arbcom decision did make all alternative medicine articles subject to discretionary sanctions, which was a substantial step in and of itself. The next issue is to make those sanctions effective in reaching the goal set for all alternative medicine and pseudoscience articles on Wikipedia: that the article should reflect the scientific point of view on the topic, and take note of other views as existing, but not as being of equal merit.&mdash;Kww(talk) 22:25, 8 April 2015 (UTC)
 * @KWW. I would like to subscribe to your newsletter. -Roxy the Viking dog™ (resonate) 12:39, 9 April 2015 (UTC)

KWW I don't think it is appropriate for an admin to be putting editors that disagree with you into a category and seeking to silence them. If JS, A1, or Les Vegas individually violated sanctions or are trying to push edits knowingly violating our sourcing guidelines (like QG, Tippy Goomba, and Dominus Vobisdu have done), that would be one thing. But this is the second time you have suggested wholesale banning of people your perceive to have similar POV's that are counter your own. It is not justifiable to say that because they agree in disagreeing with your reading of certain sources that means they are somehow behaving inappropriately or violating WP policies. Herbxue (talk) 21:05, 10 April 2015 (UTC)
 * I don't argue with anyone that disagrees with me over the reading of certain sources. I argue with editors that consistently attempt to incorporate material that portrays pseudoscience and mysticism as being based in fact, as such material is completely incompatible with the notion of an encyclopedia. It's been a consistent stance of mine, dating to before my adminship, and is much wider than acupuncture. There's no reason to tolerate editors that use Wikipedia to elevate such things.&mdash;Kww(talk) 23:20, 10 April 2015 (UTC)
 * We're getting off-track relative to article content. I'm still dubious about EBCAM but LesVegas's point about pay-to-play -- i.e. that it's used in non-predatory contexts -- weighs, along with EBCAM's having been accepted in the past, and the fact that it's not on Beall's list.  Thoughts?  --Middle 8 (t • c &#124; privacy • COI) 00:16, 11 April 2015 (UTC) typo fixed 06:27, 11 April 2015 (UTC)
 * The section is long and we are using Cochrane reviews among other independent reviews. We can use high-quality sources going forward. QuackGuru  ( talk ) 01:24, 11 April 2015 (UTC)
 * KWW if you want to talk about banning people, please cite specific instances of them acting inappropriately, instead of unfairly casting very different individuals in the same light.Herbxue (talk) 03:24, 11 April 2015 (UTC)
 * Please, let's take non-article discussions to a user talk page. --Middle 8 (t • c &#124; privacy • COI) 06:26, 11 April 2015 (UTC)
 * Yes, I agree. I don't even know how we got so off-topic. Regarding QG's objection, I agree that the section is a bit long, but then again, it is low back pain so if any section needs to be longer than all others, this is the one. The review Everymorning added was from 2015 so it's topical and relevant and if we're going to trim it would be better to take out older sources. Alexbrn objected that it's a fringe source, but I don't see that the argument has been made that MEDRS supports this idea. However, if anyone can find a policy or guideline statement that states otherwise, please post it here. Going forward, I think eCAM is a useful source and, since it deals in CAM topics, it might provide information that we can't find anywhere else. LesVegas (talk) 17:18, 11 April 2015 (UTC)
 * A non-MEDLINE indexed source devoted to fringe medicine has sufficient red flags that I would think the presumption would be that it is not a reliable source. When studies have sufficient merit to be included in journals devoted to medicine, they will appear there.&mdash;Kww(talk) 17:27, 11 April 2015 (UTC)
 * We can use high-quality sources going forward rather there any source for a mature lengthy article. See WP:MEDASSESS. QuackGuru  ( talk ) 17:53, 11 April 2015 (UTC)
 * I have to agree with Kww and QuackGuru here: eCam is not a MEDLINE indexed source, and therefore it sure does raise red flags. According to WP:MEDRS, though, this does not mean that the source would be unreliable. Instead, it means that one should look further into the source. That's a good cautious procedure we should embrace.
 * When we examine eCam a bit closer, we can rest easy: it is not on the Beall's list — a list mentioned at WP:MEDRS — that describes publications "by a publisher that has a reputation for exhibiting "predatory" behavior"". And like Everymorning well noticed earlier, eCam has a JCR assigned impact factor.
 * Summa summarum, 1) the source raised red flags (investigated), 2) it was not by a Beall-listed publisher "that has a reputation for exhibiting "predatory" behavior", 3) it has an impact factor assigned by JCR, and 4) the source is completely MEDRS compliant. Cheers! Jayaguru-Shishya (talk) 15:01, 12 April 2015 (UTC)
 * You didn't address the oxymoronic title or its inappropriate focus. Saying it is "completely MEDRS compliant" would appear to be a personal opinion.&mdash;Kww(talk) 21:04, 12 April 2015 (UTC)

Given that even if the journal met MEDRS it would be a poor one, I'm not sure why editors are arguing in favor of it when we have many unambiguous MEDRS that address the same topics. It's also unclear to me why absence from Beall's list is being cited as a point in its favor - it's a very low bar (the list is about questionable business practices, rather than being directly related to quality), and we have a statement from Beall himself published in Nature that it doesn't clear the bar by that much. Sunrise  (talk)  21:19, 12 April 2015 (UTC)
 * Well, not being on Beall's list is simply one point amongst several. You have to look at the many favorable aspects, one being a Thompson Reuters impact factor as well. JCR won't assign impact factors to journals that are predatory. It's used throughout Wikipedia with no contention anywhere I've seen, except here. LesVegas (talk) 17:48, 13 April 2015 (UTC)


 * Impact factor is not a very useful metric, as we discussed before, but feel free to raise this at WT:MED. Just having a JCR impact factor is also an extremely low bar, requiring only the "basic publishing standards" such as publishing on time, articles having references, and peer review. Exclusion of journals is typically only due to questionable citation practices (and predatory journals can definitely get included), so we return to the same point; I'm not sure why editors are arguing in favor of it when we have many unambiguous MEDRS that address the same topics. Unfortunately, it is very common for unacceptable sources to be used widely across Wikipedia before they can be removed - there actually used to be a "Long-term cleanup" section at the top of WP:RSN that was used for this sort of thing. Sunrise  (talk)  04:11, 15 April 2015 (UTC)

Use of edit summaries and uncivil behaviour (reintroduced)
user:Roxy the dog recently reverted an edit of mine and left the following edit summary "Dr. Chrissy needs to read wp:RS to brush up his primary sourcing." The WP:Edit summaries states "Avoid using edit summaries to carry on debates or negotiation over the content or to express opinions of the other users involved.". Furthermore, user:Roxy the dog left no discussion of this reversion on Talk page. I also object to the incorrect useage of my username. This is becoming uncivil behaviour__DrChrissy (talk) 12:47, 15 April 2015 (UTC).

Note: I previously posted the edit above here however, Zad68 deleted my edit without discussing this first - simply leaving a note at my Talk page hardly constitutes "discussion". This is extremely disruptive and uncivil. Please do not edit/delete my edits again without discussing them first. I have explained on my Talk page that I am following advice given in WP:Edit summary which states "Avoid using edit summaries to carry on debates or negotiation over the content or to express opinions of the other users involved. This creates an atmosphere where the only way to carry on discussion is to revert other editors! If you notice this happening, start a section on the talk page and place your comments there. This keeps discussions and debates away from the article page itself." (my bold). Zad68, I consider this editing/deletion of my edits to be uncivil behaviour. Please stop immediately. For anyone else considering deleting or reverting this edit, I will deem this also to be uncivil behaviour. __DrChrissy (talk) 17:27, 15 April 2015 (UTC)
 * Roxy, I happen to see how DrChrissy could view that edit summary comment as impolite and condescending and I agree that such a comment has no business in an edit summary. You should refrain from such behavior in the future as such comments serve no purpose but to inflame editors and create an unnecessarily tense atmosphere instead of a collaborative and respectful one as discussed on WP:Five pillars. This does seem to be an ongoing pattern of behavior despite numerous editors talking to you about this and many statements from you that you will work on these behaviors. Please refrain from further impolite or condescending comments. TylerDurden8823 (talk) 17:41, 15 April 2015 (UTC)

Page number required
The Routledge Companion to Philosophy of Science does not indicate the page number and the Google Books link does not provide anything about acupuncture. I have the 2008 edition of the work, and therein is nothing about acupuncture. Tgeorgescu (talk) 01:50, 16 April 2015 (UTC)


 * I copy/pasted the link in Google Chrome and indeed it is verified, but no page number is given. Tgeorgescu (talk) 01:55, 16 April 2015 (UTC)
 * I just verified the page # on Amazon's "look inside" feature. It's page # 470. LesVegas (talk) 02:25, 16 April 2015 (UTC)