Talk:Interstitial cystitis/Archive 1

Link
Nothing new here, just another link
 * I moved this here from the main talk page as it was outside of the area automatically archived, but was a really old comment of limited value. --  Transity (talk &bull; contribs) 15:45, 12 January 2011 (UTC)

Citations, references and OR need a clean up

 * The citations and references on this page are not formatted correctly. Can someone clean them up? I can also see quite a bit of original research that should be deleted. Skoppensboer 16:26, 25 November 2006 (UTC)

Pentosan
http://archinte.ama-assn.org/cgi/content/abstract/167/18/1922?etoc Systematic review finds pentosan moderately effective. JFW | T@lk  05:24, 9 October 2007 (UTC)

Additional External Link
I think a good reference for those who want to read more about IC outside of Wikipedia is the Interstitial Cystitis Association (ICA). I would like to add this in as an External Link. Kat Malone (talk) 21:38, 4 January 2008 (UTC)


 * That link is available from the existing link. Unfortunately, WP does not allow links like that from within articles, see WikiProject_Medicine/Reliable_sources. ► RATEL ◄ 04:19, 2 May 2008 (UTC)

Misleading claims
"Research has determined that the quality of life of IC patients is equivalent to those with end stage renal failure."

This is true for a sizable percentage of people diagnosed with IC, but not all. Some patients experience lighter, less frequent problems, and different symptom triggers. Some IC sufferers can avoid symptoms altogether simply by changing their diets. I think it's important to elaborate on this and avoid generalizing the symptoms too much. 74.242.122.25 (talk) 22:43, 26 July 2008 (UTC)


 * This is a medical page on Wikipedia. We do not go by what people think is important, but rather by what research has stated. ► RATEL ◄ 02:07, 27 July 2008 (UTC)


 * This is what medical research has already concluded about IC. I'm just surprised it hasn't already been elaborated on. I will add the information and references myself. 74.242.122.25 (talk) 17:46, 27 July 2008 (UTC)

Mild and even moderate IC are largely ignored in statements like the one above. I think this is because until very recently, only people who had extremely severe IC were diagnosed with the condition. It is unfortunate because I think it needlessly frightens many people with IC symptoms about what their lives may become. —Preceding unsigned comment added by 216.251.190.157 (talk) 20:55, 23 September 2008 (UTC)

Pain Control
I am undoing the undo on my changes re: CAM and pain control. Just saying "there is evidence, go check PubMed" doesn't cut it. Provide references, or stop making these claims. Specifically, provide references to studies published in reputable, peer-reviewed journals that show that acupuncture, biofeedback, and massage have been shown to alleviate pain in people suffering from interstitial cystitis. All I've found are studies that do not show any effects like this one. -- Transity  ( talk &bull; contribs ) 03:03, 7 April 2009 (UTC)


 * It's a shame you are not prepared to do a proper job for the encyclopedia. I'm putting it back with citations. Do not revert until I am finished, 24hrs. ► RATEL ◄ 03:27, 7 April 2009 (UTC)


 * It's a shame that you don't seem to understand how citations are supposed to work. One would think that bit of knowledge was critical to doing a "proper job for the encyclopedia," and one might question who is really failing to do a proper job here.
 * Please do add your references - that way they can be properly checked. Asking readers to do the legwork to support unsupported claims is clearly unacceptable, and I honestly don't know how you can say otherwise.
 * I'll gladly give you as much time as you need to find proper sources - if you need more than 24 hours, that's fine. Just let me know when you're done. Depending on what you provide, and how my week goes, it could take me some time to review them. All I ask is that you provide links so that I can actually read the studies (and not just summaries without the actual information).
 * I await your response. -- Transity  ( talk &bull; contribs ) 03:54, 7 April 2009 (UTC)
 * Hahaha! "Asking the readers to do the legwork" -- what do you think I am, other than a reader too? You have not the most basic understanding of how this community encyclopedia works. Funny. ► RATEL ◄ 03:56, 7 April 2009 (UTC)


 * Oh and BTW, there is no requirement in Wikipedia that I link you to the full study texts. Links to published abstracts suffice. ► RATEL ◄ 04:00, 7 April 2009 (UTC)


 * What do I think you are other than a reader? I'll avoid the temptation to be impolite (clearly not an important Wikipedia guideline to you) and instead state the obvious: in this case, you are acting as an editor and not merely as a reader. In your capacity as an editor, you were defending statements that had no references and asking others to go do the legwork that you didn't want to do. I'm pretty sure if you check the policies that references need to be more than "go check on pubmed."


 * And yes, I know you're not required to link to full studies. It just tends to make references more useful for readers and editors alike. But of course you are free to stick to the minimum effort required for your contributions, as your reply makes clear.


 * I'll review your sources when I can, and I'll let you know what I find. Since only two of six are linked, you've made my job (and the job of the readers, I might add) more difficult, as I'm sure you realize. But by all means, keep laughing. Well done. -- Transity  ( talk &bull; contribs ) 04:24, 7 April 2009 (UTC)


 * By editing out material as you have done, you too are an editor. Surprise, surprise! That's why you are doing a bad job, not checking pubmed and improving WP by adding the citations yourself. But looking at your history, I see you are a SPA with an agenda, so no wonder. ► RATEL ◄ 04:51, 7 April 2009 (UTC)
 * You also incorrectly say that "only 2 of the 6 are linked". They are all linked. You are clearly new at this, aren't you? ► RATEL ◄ 05:03, 7 April 2009 (UTC)

Yes, I am also a reader and an editor. That obvious point didn't escape me. The same way that the obvious point that you are also a reader didn't escape me a few paragraphs up. But please go ahead and continue to erroneously treat these points as "revelations" to me so that you can laugh and pretend it's at my expense. And please continue to criticize my editing practices when you tried to use "there is evidence, go check PubMed" written in a history as a reference. I'm sure that's just how it's supposed to be done. And yes, I do have an agenda. My agenda is to make sure that misinformation and patent nonsense don't make their way into Wikipedia. Shame on me. I am rightfully chastised.

You are correct that all six are linked. It didn't appear that way on my BlackBerry last night. So yes, I also understand what a link is, how html works, how to use a mouse, and what colors are, before you decide to make your own day by building a few more useless, inane straw men. I honestly have nothing more to say to you until I review your references.

To that end, I have looked at your references for massage. One is a study that included 10 patients with IC. That seems to me to be a terribly low number. In part, that's because only a small subset of those studied had IC, while the rest had other conditions. I would recommend removing that reference. The other study had 21 participants, also not great, but better than 10. That said, it indicated that Thiele Massage was statistically effective for their participants. How about we modify the wording so that thiele massage is called out as beneficial to some patients? That way, it doesn't sound like we're saying that a Swedish massage or reflexology can make the pain go away?

I also checked your acupuncture references. One is a review that states: "There are hardly any controlled studies on alternative curative procedures although rather good results have been obtained in chronic pelvic pain syndrome with acupuncture as an additional therapeutic modality." That's all the abstract says and the review (not a study) isn't focused on acupuncture at all. The other review leans on acupuncture as actually manipulating Yin and Yang in the body, even though there is no scientific evidence that Yin and Yang (or chi or meridiens) exist. The review refers to a 1987 study that I can't locate online (not surprisingly). I checked the main article on acupuncture, and I would suggest the following expansion to this section for both massage and acupuncture:


 * Theile massage has shown promise in relieving the pain associated with Interstitial cystitis, though studies with larger sample sizes are needed.


 * Although acupuncture has been reported to alleviate pain associated with Interstitial cystitis in several cases, it is important to note that there is no known anatomical or histological basis for the existence of acupuncture points or meridians. In addition, at least one study found that acupuncture "seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body" and concluded that some of acupuncture's effects may be due to the placebo effect.

I don't want to go too far in describing acupuncture on this page, but I do think it's important to let people know more than "acupuncture is beneficial to some patients." There is no evidence for the entire premise of acupuncture (chi, meridiens, etc.), and the reviews cited don't make their case anywhere near well enough to eschew that fact. I was okay with the addition of my general statement that these treatments lack scientific evidence, but since that was removed, the only other thing I can think of is expanding the descriptions thusly.

I'll post what I learn as a result of the biofeedback references, and make appropriate suggestions for that section at that time. For now, I'll open the above two modifications for comment. -- Transity  ( talk &bull; contribs ) 14:35, 7 April 2009 (UTC)


 * This is not the place for original research or a synthesis of available studies and our own judgement as to what is worthwhile. Please review WP:MEDRS. WP is a tertiary source, and we rely mostly on secondary sources, especially where medical topics are concerned. If there is a peer-reviewed, published review study that reports acupuncture or staring at the Moon as beneficial, we insert it, even if we think it is hogwash. This is not the place for you to give free reign to your hatred of alternative and traditional healing methods like acupuncture (ironically with links to papers that in fact validate "modern" acupuncture). So we insert such data. And for that purpose, abstracts are perfectly acceptable. Now you are encouraged to insert countervailing studies that suggest otherwise, of course. Regarding massage, yes, it should be more specific in describing what sort of massage is being discussed. Are you aware of the new research linking UCPPS (includes IC) to trigger points, thereby validating both internal and external pelvic massage? I'm not sure of your training, but unless you are a urologist, best not to barge in here. On second thoughts, even if you are a uro, take care, because many are not up to speed on the latest research. ► RATEL ◄ 15:11, 7 April 2009 (UTC)


 * Indeed this is not the place for original research. What do you view as original research in my suggested text? I added a statement saying that there is no proof for the existence of chi or meridiens (surely that isn't the part you are questioning as there are no studies that prove that these energies exist), and another stating that a meta-analysis (not done by me) found that acupuncture doesn't differ from sham acupuncture, with a link to an article (should have linked to the BMJ abstract here instead. The only thing I can think of that you feel is original research is the statement that the placebo effect is at work, but that is also discussed in the article I linked to. So what original research are you talking about? I don't see any.


 * And yes, I'm fine inserting the references you provided for acupuncture (which is why I left them intact in my version), but simply inserting them and walking away isn't enough, in my opinion. The statements I made after those references are also valid, and are also backed up by references. So by your own logic, they must also be included here.


 * And no, I'm not aware of the other massage research you mentioned. Nor are the readers of Wikipedia at this time. What I am aware of is that Thiele massage has been shown to have some effect here (with small sample sizes), and I think that is a perfectly valid statement to make. If and when studies for other types of massage are referenced, they can also be reviewed and added as appropriate. Are you okay with the modification proposed re: Thiele massage? -- Transity  ( talk &bull; contribs ) 15:42, 7 April 2009 (UTC)


 * I do see a problem with my text, though it's with the massage section and not the acupuncture section. My statement that larger sample sizes are needed reads like my opinion. So if this is what you mean, Ratel, I concur.


 * Alternatives would seem to be to either to backup that claim, or to change the wording to just point out the nature of the study cited without drawing any further inferences. I'm fine with the latter. That said, the fact that the sample size was small, there was no control group, and no blinding in this study is important (yes, I agree it is probably difficult to enact proper blinding with a treatment like this). So how about:


 * Thiele massage, a form of transvaginal massage, has shown promise in relieving the pain associated with Interstitial cystitis in preliminary studies.


 * Finally, I'd prefer to move this one away from acupuncture and biofeedback. Massage, used in this way, isn't CAM. It's more physical therapy. Thoughts? -- Transity  ( talk &bull; contribs ) 17:05, 7 April 2009 (UTC)


 * Alternately, we could describe the study instead of calling it preliminary:


 * Thiele massage, a form of transvaginal massage, has shown promise in relieving the pain associated with Interstitial cystitis in at least one uncontrolled, unblinded, open trial.


 * -- Transity  ( talk &bull; contribs ) 00:34, 8 April 2009 (UTC)


 * This is why a little knowledge can be dangerous. In the massage area, you are not even using the correct search terms on Pubmed because you are not aware of nomenclature changes and options for this condition. (Hint: ). ► RATEL ◄  05:02, 8 April 2009 (UTC)


 * What I can or cannot find on PubMed has nothing to do with this discussion. You provided these sources, not me. I just checked them. I have no idea what you're talking about here. Here are the opening sentences of the source you linked to:


 * OBJECTIVES: To evaluate the effectiveness of transvaginal manual therapy of the pelvic floor musculature (Thiele massage) in symptomatic female patients with interstitial cystitis and high-tone dysfunction of the pelvic floor. METHODS: A total of 21 women with documented interstitial cystitis and high-tone pelvic floor dysfunction underwent transvaginal massage using the Thiele technique twice a week for 5 weeks.


 * From this alone, it is clear that Thiele massage is a type of transvaginal manual therapy (or massage), that 21 women were included in the study, and that all 21 received the same treatment (hence uncontrolled, unblinded). Looking at another source for this same study (here), we can see that it is classified as a pilot study, which we can use in place of "preliminary study". So how about:


 * Thiele massage, a form of transvaginal massage, has shown promise in relieving the pain associated with Interstitial cystitis in at least one open, pilot study.


 * This has nothing to do with how well I understand IC - it is simply about checking a source and parsing what is written there. As such, my sample language for massage is valid. If you have a specific issue with it, please spell it out. If someone who knows more about, say, massage/PT and IC than either of us decides to weigh in, now or later, they can certainly do so. But until then, we have an obligation to make this the best section we can make it, and the way it reads today certainly doesn't qualify. So yes, I agree that someone with more knowledge in the field of PT and IC could improve this section greatly, but look at what's there today, and help me understand how my text isn't a clear improvement over that:


 * Complementary therapies such as acupuncture, massage, and biofeedback are also beneficial to some patients.


 * That tells readers next to nothing. In fact, it leaves the impression that massage is CAM (in this case, it certainly is not), and it leaves open what kinds of massage have been shown to be effective (Reflexology? Shiatsu? Swedish massage? I'd bet most people wouldn't come up with transvaginal massage from the statement above). In my version, I simply tried to accurately represent the study presented. And for the record, I have no issues with using targeted massage to treat specific pain. There is no scientific consensus that this type of treatment shouldn't work, so I'm not trying to make a case against this approach.  I'm just trying to improve on the vague, misleading (IMO) text that appears now.


 * For acupuncture, my language is likewise sourced and valid, and it complies with WP policies and guidelines on how to treat such issues (WP:UNDUE) - your source presents acupuncture as successful, and mine explains that acupuncture is not statistically different from sham acupuncture, and that there is no scientific evidence for chi or meridiens. One study makes a claim, another says "yes, but..." and the readers can decide what to make of it.


 * Acupuncture has been reported to alleviate pain associated with Interstitial cystitis in several cases. However, it is important to note that there is no known anatomical or histological basis for the existence of acupuncture points or meridians. In addition, at least one study found that acupuncture "seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body" and concluded that some of acupuncture's effects may be due to the placebo effect.


 * So if you have specific issues with any of my text, please spell them out. Otherwise, let's use them. -- Transity  ( talk &bull; contribs ) 14:12, 8 April 2009 (UTC)


 * I don't have the time for debating this with you. Go ahead and make your changes and I'll alter them in situ. ► RATEL ◄ 00:57, 9 April 2009 (UTC)

Okay - I'll review the biofeedback references, and rework that section similarly to how I reworked acupuncture. Then I'll add these into the Pain Control section, which will likely require some reorganization of the section (as I said, Thiele massage should probably be under PT, not CAM). It'll probably take me a day or two to get it done.

Despite what you may think, my goal is to improve this section, not to squash any mention of alt med. I hope you review my revisions in that light. -- Transity  ( talk &bull; contribs ) 03:28, 9 April 2009 (UTC)

Edits
My edits regarding Pain Control are now in place. Here's a summary of what I did, and my rationale for each change.

1) Created sub-headers under Pain Control. As discussed, Thiele massage isn't a CAM treatment, but really is Physical Therapy (that is made clear in the reference). As such, I created a sub-header for PT. I also moved the information about drugs to a Drug Treatment sub-header, and created a sub-header for CAM to house the information on acupuncture and biofeedback.

2) Moved Pain Control to the bottom of the Treatment section. Leaving it where it was made the flow of headers difficult to understand as it wasn't immediately clear that the following three headers were sub-headers to Pain Control and not their own sub-headers under Treatment.

3) Massage. I called out Thiele massage instead of just referring to massage since that is the technique that was used in the study referenced. I explained that Thiele massage is a form of transvaginal therapy to make it clear that we aren't talking about something you can get at a Day Spa. I did call out that the trial was open (no control, no blinding) and a pilot study (these qualifiers are stated in the study itself). I did this because, compared to the study referenced for drug therapy for example, it should be clear that currently there is significantly less evidence backing up this treatment.

4) TENS and PTNS. I moved these under PT as this is how they are categorized in their respective Wikipedia articles. I also marked these statements as needing citations. In addition, there is a statement listed under "Other Treatments" that says: "Neurostimulation techniques are not FDA approved for IC." TENS and PTNS are forms of neurostimulation. It is unclear what the FDA position is on using neurostimulation for IC symptoms - some sources I have seen say that some devices are approved for some symptoms. I have marked this statement as needing a reference for now, and moved it up to the bottom of the section on TENS and PTNS. Note that I haven't altered any of the material in this section - it is all still worded as I found it. I merely moved it all to one section, and added citation tags. In my opinion, everything stated in the TENS and PTNS section is in need of assistance.

5) Biofeedback. In the studies mentioned, and in line with the general understanding of what biofeedback is, I identified biofeedback as a relaxation technique aimed at allowing people to control various autonomic functions. The references both treated biofeedback as a complementary relaxation therapy to be used in addition to drugs and/or hydrodistention of the bladder - neither tested biofeedback as a standalone treatment. As such, I called out the tested use of biofeedback as one part of a multimodal approach.

6) Acupuncture. I left both references claiming that acupuncture is effective in alleviating IC pain. I then went on to mention that (contrary to one of these references) there is no scientific basis for the existence of acupuncture points or meridians (with references to backup that claim). I also linked to an analysis in the British Medical Journal that concluded that sham acupuncture works just as well as real acupuncture. This, I believe, is a properly balanced write-up on the use of acupuncture to treat IC pain as it presents information on both sides of the debate, weighted proportionately.

Please let me know if anyone has any questions or concerns. -- Transity  ( talk &bull; contribs ) 20:01, 9 April 2009 (UTC)


 * I reorganised most of it and removed the critique of acupuncture, which is not appropriate on this page (add it to the acupuncture page please). I'm still not happy with this page, which is waaaaay behind the page at CPPS, the male version of the condition. ► RATEL ◄ 00:45, 10 April 2009 (UTC)


 * Nice work. I think you've improved upon the entire treatment section significantly with your latest edit. But I don't agree with your edit on the acupuncture entry. As it reads right now, I believe the entry is giving undue weight to a minority view on the efficacy of acupuncture in general, and for this condition. This is what one of the cited sources says about acupuncture and IC:


 * "Acupuncture is over 5000 years old. Neuromodulation through acupuncture occurs by re-establishing a balanced flow of energy, termed Yin and Yang, throughout the body through 12 meridians and 1000 acupoints. A rebalance of energy flow is thought to occur by increasing endorphin production and pain ablation by stimulating A delta, large-diameter, myelinated sensory nerve fibers with the inhibition of unmyelinated sensory C-fibers. Rapkin and Kames reported the results of a study of 14 patients with pelvic pain who had 6–8 weeks of acupuncture therapy twice a week. Eleven patients had a >50% reduction in pain. Our experience at the Pelvic Floor Institute shows that IC patients need 10–20 acupuncture treatment sessions in order to achieve symptom relief. Further studies are needed to determine the efficacy of acupuncture therapy in patients with IC."


 * This source is clearly stating that acupuncture points and meridians and chi (yin and yang here) are behind the success of acupuncture, in general and for IC. Belief in the existence of chi falls under the header of "generally considered pseudoscience", and it is clearly a minority point of view (WP:UNDUE). From the NPOV policy concerning pseudoscience and minority points of view:


 * "Please be clear on one thing: the Wikipedia neutrality policy certainly does not state, or imply, that we must 'give equal validity' to minority views. It does state that we must not take a stand on them as encyclopedia writers; but that does not stop us from describing the majority views as such; from fairly explaining the strong arguments against the pseudoscientific theory; from describing the strong moral repugnance that many people feel toward some morally repugnant views; and so forth."


 * So yes, I agree that this is not the place to debunk acupuncture. However, the deleted text concerning the majority view about chi and acupuncture points should be added back in order to properly balance the minority view with the current scientific consensus which is that chi and acupuncture points are not real. I haven't added it back at this time, and I welcome your comments, but I feel very strongly that it cannot be omitted. -- Transity  ( talk &bull; contribs ) 02:16, 10 April 2009 (UTC)


 * If you can find a study that criticises acu. in the context of IC/PBS, then go ahead and add it in. However, any criticism of acupuncture itself is a matter for the acupuncture page, otherwise it's merely you soapboxing. It's also verging on your own original research to state this argument in the IC context. And it's definitely a synthesis of data. (BTW, you seem unaware that one of the sources you gave states that acu. may work for complex neurological reasons, quite apart from all the chi/meridian mumbo-jumbo.) ► RATEL ◄ 03:27, 10 April 2009 (UTC)


 * I'm sorry, but I disagree with you on all counts. I'm not soapboxing, and this isn't even vaguely original research (that one's a real stretch) . It also isn't a synthesis of data as evidenced by the fact that I have sources that say exactly what I'm saying here. What data had to be synthesized? Here's a quote from the NIH Consensus document:


 * "Despite considerable efforts to understand the anatomy and physiology of the 'acupuncture points,' the definition and characterization of these points remain controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and other related theories, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture."


 * There's no need for me to synthesize data or do original research when the NIH document clearly states that there is no scientific basis for Qi, meridians, etc. So please stop leaning on the argument that I'm doing original research when that claim is demonstrably untrue.


 * Here's the thing: your source states quite plainly that acupuncture works by realigning Yin and Yang energies at work in the body. My sources states that this is not the majority view of science. And that's why it should be (and, frankly, needs to be) included. So no, I do not have to find a study that criticizes acupuncture in the context of treating IC - that's a red herring, plain and simple, and I reject that assertion outright. My text should be added back because leaving out my text gives undue weight to a minority view in pseudoscience. Including my text remedies that problem.


 * For the record (and off the record as this is merely my opinion), acupuncture may well be able to relieve pain through a combination of the placebo effect and one or more physiological affects (e.g. release of endorphins/opioids). So yes, I am quite aware of the other contents of the reference you are talking about - that's not a "gotcha" to me. Of course, any effects beyond placebo are still not proven, but that doesn't fall under the heading of pseudoscience. Chi does. If this article is going to claim that acupuncture works by way of these pseudoscientific claims by citing a source that says just that, then it must also take care to make the majority view of science abundantly clear. -- Transity  ( talk &bull; contribs ) 04:16, 10 April 2009 (UTC)


 * I think you'll find that adding your own cautionary words to modify the conclusions of a published study is indeed WP:SYN. It's not for us to find a conclusion here, a statement there, and tie them together to show cause. ► RATEL ◄ 04:27, 10 April 2009 (UTC)


 * I haven't added my words at all. I've explained where the information came from. I've referenced the WP policies that you mentioned and explained why this text isn't soapboxing, original research, or synthesis of data. Here's the description of synthesis of data:


 * "Do not put together information from multiple sources to reach a conclusion that is not stated explicitly by any of the sources."


 * Here's what the source I referenced says:


 * "Despite considerable efforts to understand the anatomy and physiology of the 'acupuncture points,' the definition and characterization of these points remain controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and other related theories, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture."


 * Here's what I'd like to add to the article:


 * "However, it is important to note that there is no known anatomical or histological basis for the existence of acupuncture points or meridians"


 * It seems clear to me that this statement follows directly from the source material - the fact that there is no scientific basis for qi et al. But if you prefer, we can say:


 * "However, it is important to note that there is no known anatomical basis for acupuncture points, and that there is no scientific basis for the existence of qi or meridians."


 * This revised text now directly mirrors the source material, without simply copy/pasting it. Problem (whether it existed or not) solved.


 * And how about the rest of my deleted text? That reads:


 * "In addition, at least one study found that acupuncture 'seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body' and concluded that some of acupuncture's effects may be due to the placebo effect."


 * No synthesis of data there. This comes directly from the source materials. So again, let's add it back.


 * I've explained my rationale for why this text must be added back, and I've cited WP policies backing up my assertion. If you have no actual, valid arguments against adding this information back to the article, then we need to do so. The latest version of the deleted text now reads:


 * "However, it is important to note that there is no known anatomical basis for acupuncture points, and that there is no scientific basis for the existence of qi or meridians. In addition, at least one study found that acupuncture 'seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body' and concluded that some of acupuncture's effects may be due to the placebo effect."


 * I've dropped the Mann reference. I see why it was used in the acupuncture article (statement against interests and all), but I'm happy to rely on the NIH consensus statement here if it will help you to see that there is no synthesis of data. So let's add this text (above) back. -- Transity  ( talk &bull; contribs ) 13:26, 10 April 2009 (UTC)


 * No, it's not going back in and here's why: it is WP:SYN. You need to read the SYN page more carefully. I'll paste the relevant text:

"Editors should not make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article to reach conclusion C. This would be a synthesis of published material that advances a new position, and that constitutes original research. 'A and B, therefore C' is acceptable only if a reliable source has published the same argument in relation to the topic of the article."


 * So as I said, find a study that voices these warnings in relation to IC/PBS or it is a soapboxing piece of OR. Thank you. ► RATEL ◄ 14:06, 10 April 2009 (UTC)

Your example is patently incorrect, as I've explained already. I am not taking two sources and coming up with a statement. I am taking one source - the NIH Consensus - and using that one source to make a statement. I showed that definitively above. Simply repeating this assertion without acknowledging that fact isn't productive because your assertion doesn't apply at all to what I've actually done.

If you want to continue to make this assertion, then I assert that you have to step through what you see as my synthesis of data, or original research. Show me where and how I did that for my deleted text. Show me the two (or more) sources that I have combined. Show me how what I've said isn't stated in the NIH source alone. Frankly if my text was any more similar to the NIH text it would border on plagiarism, so I don't see how any rational person could come to the conclusion that it's WP:SYN.

There are two other statements made in my deleted text. One part says:

"In addition, at least one review of acupuncture studies found that acupuncture 'seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body' ..."

(Note that I replaced "study" with "review of acupuncture studies" above.) As indicated, this is a quote from the referenced source, which says the exact same thing:

"Acupuncture, the ancient Chinese practice of sticking needles into a patient at specific points to relieve pain and treat other conditions, seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body, a new analysis shows."

It's a direct quote. Nothing could be farther from WP:SYN. The other part of my deleted text says:

"...and concluded that some of acupuncture's effects may be due to the placebo effect."

Read the analysis - it clearly says that the placebo effect may be at work based on what they found. In fact, this is a pretty watered down statement, I think. The study also says, among other things:

"The analgesic effect of acupuncture is small and cannot be distinguished from bias resulting from incomplete blinding."

I didn't even address that part, though it's a clear conclusion of the review. If you'd rather use that in the text, I'm fine with that and it's a direct quote.

The bottom line is that each part of my deleted text can be directly attributed to a single source. So please stop making this assertion.

I've read the WP:SYN page carefully. You, I think, need to look at what I've done more carefully. I stepped through each part of the the deleted text and showed precisely which single source each part came from. There is one source that backs up (and directly states) each position that I am asking to put back into the article. That isn't WP:SYN no matter how many times you say it is. So if that's the only argument you have against reinserting my text, then you don't have an argument. I'd love to be able to build a consensus here, and I don't want to get into an edit war, but frankly it doesn't seem that you're interested in rational discourse.

So if your position is "no, it's not going back in," then my position is that it is unacceptable to have the section as it is without my text or some reasonable version of it added back. The statement on acupuncture cannot stand as it is. Leaving it violates NPOV by giving undue weight to a minority, pseudoscientific view, as I explained above and to which you've never responded. So if you aren't willing to have an actual discussion on this, then the only thing to do is to temporarily remove the section until we can reach a consensus. I don't want to do that, but as it is right now, it is not acceptable. I am, as I have been, ready to discuss this rationally, whenever you are, and I hope we can agree on appropriate wording.

For the record, here's the way I'd like the section to read. There is definitively no synthesis of data, no original research and no soapboxing, and it conforms to the NPOV sections I linked to above:

"Acupuncture has been reported to alleviate pain associated with IC/PBS in several cases. However, it is important to note that there is no known anatomical basis for acupuncture points, and that there is no scientific basis for the existence of qi or meridians. In addition, at least one review of acupuncture studies found that acupuncture 'seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body' and concluded that 'the analgesic effect of acupuncture is small and cannot be distinguished from bias resulting from incomplete blinding.'"

If you want to change the last part back to the statement about the placebo effect at work, I'm fine with that, too. But the bottom line is that we have to add this back in, and let the readers make an informed decision. That's what this is all about.

I'm trying to reach an agreement here. All I ask is that you do the same. -- Transity  ( talk &bull; contribs ) 17:38, 10 April 2009 (UTC)

Synthesis not acceptable
You said that "Your example is patently incorrect, as I've explained already. I am not taking two sources and coming up with a statement. I am taking one source - the NIH Consensus - and using that one source to make a statement. I showed that definitively above. Simply repeating this assertion without acknowledging that fact isn't productive because your assertion doesn't apply at all to what I've actually done.

I'm going to explain this one last time. You are taking negative comments about acupuncture generally from one source (where IC/PBS is not discussed), then taking studies about IC/PBS from another source (where acupuncture is found to be beneficial), then using the negative source/s to qualify the positive sources. We cannot do that as editors of a tertiary source. You need to find a source that discusses the drawbacks of acu. in the context of IC/PBS. Unless you can find that, your attempts to insert this information here are your own synthesis of data. If you are not happy with this, put it to a RfC. ► RATEL ◄ 00:55, 11 April 2009 (UTC)


 * Let's say you make a statement that colorfully wrapped gifts appear under the tree at Christmas time in Bulgaria, and you link to an article as reference that says that gifts do, in fact, appear and that the method behind this appearance of gifts is a jolly old man called Santa Claus who rides in his sleigh around the world and drops off presents every Christmas Eve. Then let's say I see that, and add text stating that the consensus view is that there is no scientific basis for the existence of Santa Claus, with citations, thereby directly addressing the validity of your claim. Now, in this scenario, would you delete my text and tell me that unless I can find a study that explicitly addresses how Santa Claus doesn't deliver gifts in Bulgaria that my addition should be removed? Because that's what's going on here, and it's 100% improper, and logically unsound. You are wrong.


 * I am referring to a consensus view of the NIH on acupuncture. Do you understand what a consensus view is? It isn't limited to one condition - they looked at numerous studies across numerous conditions to derive a consensus view. You are speaking as if you aren't aware of that fact, though you certainly must be. How you can say that a consensus view of the NIH isn't relevant here is beyond me. And how you can claim that it's WP:SYN simply boggles the mind.


 * In addition, you still have not addressed my statements that leaving my text out doesn't meet the requirements of WP:UNDUE as doing so gives undue weight to a minority, pseudoscientific view. Never once have you even tried to counter this argument. So I may yet take this to RfC or some other means of dispute resolution.


 * That said, even though I don't agree at all with what you're saying, I will comply with your request to reference a study that directly addresses acupuncture and IC treatment. That, at least, will get some of the actual science addressed in the short term. My edits are going in now. Please note that, after these edits, I still don't consider the section to be acceptable - it's just a step in the right direction. -- Transity  ( talk &bull; contribs ) 03:40, 11 April 2009 (UTC)


 * Undue weight does not apply here. It would apply here if there were studies criticising acupuncture in relation to IC/PBS, and I were trying to exclude them and only allow studies that support the use of acupuncture for IC/PBS. But I'm not doing that. I see you managed to find a negative study about acu. and IC/PBS. Now that's the way to go. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 06:28, 11 April 2009 (UTC)


 * Actually you're still wrong. The section still gives undue weight to pseudoscience because right now it gives equal weight to each side. That is undue weight. Not allowing a consensus view that contradicts the referenced fringe view is in violation of WP:UNDUE.


 * Also it's frustrating for you to delete my references that criticize acu, then delete my further reading link to the same thing by saying that it references something that isn't discussed because you deleted it. Of course it is discussed because one of your refs supports the existence of qi, so you're wrong about that, too.


 * Either put back the further reading link or remove the questionable ref that refers to yin and yang. In fact if you remove that ref, I'd agree that the section is doing right by WP:UNDUE and call it acceptable because that way it presents two studies with conflicting results with no mention of any mystical forces. No consensus view needed, no further reading link needed - just a section stating that tests of acu for IC have been conflicting.


 * What do you say? -- Transity  ( talk &bull; contribs ) 13:42, 11 April 2009 (UTC)


 * I say you should make your arguments on the acupuncture page where they belong. The word acupuncture is wikilinked and readers can read the various arguments, pro and con, on that page, where they logically belong. Otherwise you will end up doing something illogical and invalid (and against the WP rules), which is to edit every single page acupuncture is mentioned on wikipedia to insert your warnings. I am not going to debate this further with you. Please ask for 3rd opinions or RfC. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 15:06, 11 April 2009 (UTC)

Request for Opinions: Acupuncture and IC
Please note, Ratel, that I don't expect a reply from you as I am aware of your position and your statement that you are not going to discuss this further.

Quite honestly, I don't have the time to take this through formal dispute resolution. I've been hoping (and I continue to hope) that another editor (or editors) will see this and weigh in on the talk page. I will restate my position here to make it easier for someone to do so. If this doesn't garner any more commentary, I may move to WP:3O or WP:RFC at some point when I have more time.

To be clear, if it wasn't for the reference that pushes the pseudoscientific fringe theory of qi and meridians, I don't think the problem would be so severe. I would still think that the NIH consensus view and the review that concluded that acupuncture doesn't seem to have any effect in general would be good additions, but they wouldn't be critical. That's why I suggested removing what I see as a bad reference. After all, it is a link to an article in which the Pelvic Floor Center who performs acupuncture states a psuedoscientific view about how the procedure works without providing any evidence to backup that claim. Here is that quote:

"Acupuncture is over 5000 years old. Neuromodulation through acupuncture occurs by re-establishing a balanced flow of energy, termed Yin and Yang, throughout the body through 12 meridians and 1000 acupoints. A rebalance of energy flow is thought to occur by increasing endorphin production and pain ablation by stimulating A delta, large-diameter, myelinated sensory nerve fibers with the inhibition of unmyelinated sensory C-fibers. Rapkin and Kames reported the results of a study of 14 patients with pelvic pain who had 6–8 weeks of acupuncture therapy twice a week. Eleven patients had a >50% reduction in pain. Our experience at the Pelvic Floor Institute shows that IC patients need 10–20 acupuncture treatment sessions in order to achieve symptom relief. Further studies are needed to determine the efficacy of acupuncture therapy in patients with IC."

This source is clearly stating that acupuncture points and meridians and chi (yin and yang here) are behind the success of acupuncture, in general and hence for IC. Belief in the existence of chi falls under the header of "generally considered pseudoscience", and it is clearly a minority point of view (WP:UNDUE). From the NPOV policy concerning pseudoscience and minority points of view:

"Please be clear on one thing: the Wikipedia neutrality policy certainly does not state, or imply, that we must 'give equal validity' to minority views. It does state that we must not take a stand on them as encyclopedia writers; but that does not stop us from describing the majority views as such; from fairly explaining the strong arguments against the pseudoscientific theory; from describing the strong moral repugnance that many people feel toward some morally repugnant views; and so forth."

Having a source that asserts the existence of yin, yang, acupoints and meridians without balancing that with the scientific consensus that none of these things exist and with a recent review conducted on studies across many conditions which concludes that acupuncture isn't effective in general (and hence, not effective for IC either) violates WP:UNDUE by giving undue weight to a pseudoscientific fringe theory. That's why I want to take action on this article but not on every article that mentions acupuncture (each article should be looked at on a case-by-case basis, of course).

In order to restore proper balance, I believe that at least one of the following has to happen (I'd prefer a combination of these):

1) Remove the questionable reference that Ratel added. It is itself an unsourced statement by a potentially biased group (they make money in part by performing acupuncture) espousing the validity of a pseudoscientific theory. It should not be included as a reliable source in a medical article.

2) Add back the text that Ratel deleted which shows the scientific consensus on acupuncture. This includes a reference to the National Institutes of Health consensus statement on acupuncture, and a reference to a recent (2009) review which concluded that the evidence for acupuncture in general was lacking. Here is that text:
 * In addition, the consensus view is that there is no known scientific basis for the existence of qi, acupuncture points or meridians, and a February 2009 review of acupuncture studies found the data in favor of acupuncture lacking.

3) Add back the further reading link that Ratel deleted which links to a specific section of the WP article on acupuncture. At least this allows a reader to follow the link to read about the consensus view that there is no evidence supporting the theory behind acupuncture (chi, etc.). Here is that link:

I floated all three of these ideas in an attempt to reach a compromise, but ultimately no compromise was possible as each of these suggestions were either reverted or refused (see long discussion above). Ideally, I'd like to see a combination of these added, but at least one of these is necessary in order to satisfy WP:UNDUE, in my opinion.

If anyone would like to comment, please do so. -- Transity  ( talk &bull; contribs ) 19:52, 14 April 2009 (UTC)


 * That is not how you ask for comments. Go to Help, then type in rfc. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 23:07, 14 April 2009 (UTC)


 * Yes, thanks, I know that. That's why I started my comment with a statement that I don't have time for a formal RfC or 3O right now . I'm well aware of the formal process, and in fact I even linked to WP:RFC and WP:3O above, but there's nothing wrong with trying something less formal first. -- Transity  ( talk &bull; contribs ) 00:12, 15 April 2009 (UTC)


 * Hmmm, fine, I suppose, but if you check the edit history of the IC/PBS page you'll see that you are unlikely to get comments that way (low traffic). <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 00:58, 15 April 2009 (UTC)


 * Unlikely, perhaps, though there are readers (like myself) who came here seeking information, and instead found this remarkable discussion. Ratel, in your Wiki expertise, you seem to have ignored WP:NPA, and I apologize for having to do so myself in order to point out that you've done it. The majority of the first half of your collection of responses to Transity were snide, smug remarks that entirely ignored the topic of discussion, and despite a few salient responses, that tendency has not abated. Please stay on track. You can safely assume that those who take the time to edit here are as easily able to keep abreast of the WP policies and features as you are.


 * I agree with Transity's contentions. If you are to have a source referenced on a page that claims any sort of pseudoscience as true, then a contradicting reference is quite called for, in keeping with the true spirit of WP:NPOV and WP:UNDUE.


 * Further, the assertion that a general debunking of any field of pseudoscience does not qualify as a counterpoint to a specific claim within that field of pseudoscience is nonsensical. Transity's Santa Claus example, while perhaps difficult to relate to this discussion, is a decent analogy. For a more direct comparison, please hypothesize that a WP entry states (or links to sources that state) that iron disintegrates when subjected to water, at room temperature, that has been dyed blue. A source that indicates that metals have never been shown to disintegrate when subjected to water at any temperature would be both appropriate and valuable to a reader attempting to learn from an article on the properties of iron, whether or not it mentions blue-dyed water or the specific metal, iron. Bringing such a claim into the article in the first place opens the door to a general debunking of the basis of the claim. If the original claim which cites pseudoscience is included, then a citation that debunks such claims in general is not only appropriate, but necessary.


 * Your discussion of readers v. editors is an odd one (and more evidence of your tendency toward defying WP:NPA), but brings up the point: making things directly accessible (not necessarily "easy" or "simple") for casual (and non-savvy) readers should be one of the major goals of a repository of information like WP. There was misleading information on this page, and an effort was made to help casual readers find further information on the subject. Remember WP:BURO and WP:IAR, and, contradictorily, stop quoting policy and focus more on the discussion at hand. Obviously, I (and other readers) came to this page for specific reasons, and readers may or may not have the time, resources, or savvy to trawl through twenty WP entries to find out everything we're attempting to learn. Just as obviously, I (and other editors - your apparent misrepresentation of the readers/editors dichotomy seemed to be purely an attack on Transity, and I would like to think you have a better understanding of it than that) would like to make sure that any entry is comprehensive enough to counter baseless claims within the context of the entry itself, so that readers can easily find accurate information.


 * Finally, and preemptively, please refrain from lobbing WP:SPA at me. I came to this entry for my personal reasons as a reader, and joined WP and this discussion as an editor when I saw your behavior in this discussion; if my contribution results in any well-written and/or formatted copy, that would be due to my particular professional skills. I joined this discussion specifically because, as I read it, I felt that you were not staying on topic, were not exhibiting an interest in improving the entry, and were not following etiquette in your interactions; simultaneously, I was swayed by Transity's arguments. So keep the WP:SPA shots to a minimum. You've already tried it (just as pointlessly) on one user in this discussion, and I find it to be counter to the whole point of Wikipedia. Wikipedia's entire purpose is to collect accurate and documented information; no one user can know all information; plenty of individual users can know quite a lot about one specific topic or field of interest. I would posit that the "single-purpose account" you sneer at should be valued as a specialist, providing insight and information regarding a particular specialty (as theorized on WP:SPA itself). I'd rather have a neurosurgeon taking part in my brain surgery than some guy who likes to read neurology books in his spare time, and I'd certainly prefer the neurosurgeon to a casual trepanation enthusiast. Unless you have evidence of an "agenda" that runs counter to the purpose of collecting and presenting accurate information, jabbing at another editor with WP:SPA is irrelevant and, once again, off-topic (WP:TPG). The point of this discussion should be how to improve the content of the page it pertains to; not to argue policy or take on another editor's agenda (again, WP:TPG).


 * In that light, I would second Transity's suggestions; at the very least, if any citation is made which includes, in its content, baseless and unproven pseudoscience, I, as both a reader and editor of WP, believe that a citation debunking that pseudoscience, either in the specified context or across the board, is both appropriate and required. My apologies for having to quote policy in order to make this point, but try to refrain from WP:BITE-ing me. Scramblecase (talk) 04:14, 15 April 2009 (UTC)


 * Ooooh, I've been mugged by a SPA who opened a new account to make this comment. Checkuser may be in order, so we can "collect" the required data. Gnome-face-laugh.svg <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 04:46, 15 April 2009 (UTC)


 * "Mugged"? Ah, of course. Because you apparently think this is about you, rather than about the information that will find its way onto WP.


 * I don't know who you are, Ratel, and I couldn't care less - this may come as a shock to you, but I'm not interested in finding out. Your existence is inconsequential to me - you may be a wonderful, intelligent person, with scintillating wit and extraordinary conversational ability...but that doesn't enter into my reasons for creating an account or joining this discussion. I don't know you, and don't pretend to (though you seem to have no problem facilely and incorrectly assuming knowledge about me). I came here to read the information, saw the edits going back and forth, saw your incredibly off-topic, rude, and non-constructive comments about the issue, and was interested in adding my voice to the debate - which is one of the fundamental purposes of WP in the first place, for a community to collectively arrive at consensus...not for Ratel to run roughshod over other members of the community with false accusations, plaintive references to policy (which you ignore yourself, when necessary), and a complete disregard for the legitimacy and usability of the information that the community is trying to put together.


 * Your reaction, of course, was eminently predictable, but I gave you a chance to surprise me. (In case you missed it: you didn't.) Unlike Transity, I may, indeed, have some spare time to pursue this further and escalate the issue to users who are not blinded by whatever it is that blinds you (I am not, of course, ascribing your motivations - they remain a mystery to me - but it's quite evident that you are, in fact, blinded, willfully or not, to any actual, topical discussion of this issue). Clearly, Ratel, you are not interested in improving and expanding WP, despite your inexhaustible tendency to quote policy, but rather you seem interested in arguing (quite ineffectively) and defending "turf" (which, as you may or may not be aware, isn't yours - that would be another one of the fundamental purposes of WP). "Checkuser" indeed - go right ahead. I have nothing to hide, whatever your quite predictable and quite inaccurate implications may be.


 * I "opened a new account to make this comment" - how droll and pointless a statement, Ratel. I would expect that every new user creates an account when they decide they have something to add to WP - to a specific entry, discussion, or other feature of WP. Why go through the bother of simply "creating an account" and then waiting to see if you eventually find any space you feel you can help improve? Your insinuations are, yet again, preposterous and nonsensical. Do you run amok opening bank accounts at every bank you can find, on the off chance that you may eventually want to deposit money there?


 * As a note, you have once again contributed precisely zero to the topic of discussion (but I already expect that from you after reading this single Talk page), and are once again in violation of WP:TPG, not to mention WP:BITE (how incredibly impolite, not to mention inaccurate and non-constructive). Your incorruptible obstinacy in the face of Others Actually Trying To Arrive At Some Kind Of Consensus has not diminished - it's like your superpower. I'd be very interested in what other users have to say about it. Scramblecase (talk) 17:15, 15 April 2009 (UTC)

Ratel,

I am considering filing an RfC regarding this discussion, as both Transity and I have attempted to discuss the topic of the entry with you, been rebuked with nothing more than false accusations and poor etiquette, and you have yet to make any substantive contribution to the discussion, choosing instead to lob insults and innuendo with no particularly evident provocation.

If Transity would like to confirm his own attempts to pursue the actual discussion with you, and his own encounters with the same lack of cooperation or politic behavior, that will serve to start the process, in that:


 * ...at least two editors must have contacted the user on their talk page, or the talk pages involved in the dispute, and tried but failed to resolve the problem.

I am requesting that you, Ratel, attempt in some way to stay on topic, deliver some actual, substantive arguments that have not already been countered (you may expand on them to counter the counterpoint, of course, but simply reiterating them does not further the discussion). I urge Transity to do likewise, here in this discussion, in order to fulfill the guideline quoted above from WP:RFC.

I am currently filing a Wikiquette alert regarding your behavior, and will notify you, as per the guidelines, on your own Talk page. If you are not interested in coming to some sort of civil conclusion regarding both your behavior and the topic of discussion that instigated it, I'll be happy to file an official RfC afterward. I will, of course, give you a notification of that intention before doing so. Scramblecase (talk) 17:53, 15 April 2009 (UTC)


 * This article is not the place to make general criticisms of acupuncture. Readers come to this article expecting information about this bladder condition and, per WP:COATRACK, we should stick to this topic and not digress. Colonel Warden (talk) 18:41, 15 April 2009 (UTC)


 * I agree that this article is not the place to make general criticisms of acupuncture. However, in the same way, it is also not the place for supporting the existence of chi and other pseudoscientific beliefs. Two sources are provided to backup the claim that acupuncture has been shown to be effective for IC. One is perfectly fine. The other is a potentially biased statement made by practitioners of acupuncture stating that acupoints, meridians, and yin/yang are real despite clear scientific consensus that they are not (see above). If such a reference is used (improperly, IMO), then WP:UNDUE would seem to indicate that adding a notation that the statements made in that reference do not reflect the scientific consensus is required. In addition, the source itself would seem to violate WP:MEDRS, which gives even more reason for its removal.


 * To that end, please note that, a while back, I suggested simply removing this reference and leaving the other one as a means of compromise. That suggestion was declined by Ratel. I'm still okay with that approach, and would absolutely agree to such a compromise. With that questionable reference removed, the article would be left with the fact that some studies support acupuncture's efficacy for IC, while others do not, with no mention of mystical energies - no serious problems with WP:UNDUE.


 * Finally, I don't think WP:COATRACK would apply (IMO) if the information in question is necessary to rectify WP:UNDUE. I've made the case for WP:UNDUE above so I won't repeat it here.


 * Regarding the Wikiquette alert, I agree that it has been very difficult getting substantive comments from Ratel on this article. Mostly, in my opinion, he has fallen back on immediate reversions and insults rather than actual debate, and what little debate has taken place did so after his reversions (without exception, I believe). I would be remiss if I didn't acknowledge that, out of frustration, my own behavior was not always completely cordial on this thread (my comment that I would avoid the temptation to be impolite in response to one of Ratel's insults was, in and of itself, impolite), but I've attempted to remain civil, and I believe that I've always remained on topic in my comments, and I've always tried to engage in a substantive discussion as opposed to what I see as Ratel's one-liners, non-answers, off-base accusations and name-calling. Based on these observations, I feel that Ratel has a sense of ownership of this article, and that he would rather cite policies (whether they apply or not) and engage in personal attacks (particularly against those who are, relative to him, newcomers) than discuss substance. It is clear to me that a compromise between the two of us isn't possible (Ratel stated as much above), which is why I asked for more comments.


 * With the Wikiquette alert and the additional editors, let's see if we can build consensus on this issue and make an edit that is acceptable to all. If we are still locked up after further discussion, we can look at next steps at that time. Thanks, Scramble and Colonel, for your comments. Please do continue in the discussion. -- Transity  ( talk &bull; contribs ) 19:46, 15 April 2009 (UTC)


 * The alternative source for the point in question is not "perfectly fine" because it is in German and its source does not seem to be readily available. The disputed source is in English, it can be read online and it seems to be in a reputable journal and written by an MD practising in the field.  I have consulted another source which indicates that acupuncture is well accepted as a treatment modality.  We should therefore move on.  The source I introduced mentions TENS too but our article says little of this.  Likewise the disputed source covers a variety of alternative treaments.  It seems to me that we would be spending our time better to update the article to cover the full range of treatments which are in use, attending to any omissions.  With the full spectrum of treatments laid out, the meagre mention of acupuncture will seem inconsequential. Colonel Warden (talk) 15:33, 16 April 2009 (UTC)


 * Here's an idea. Look at the full article for the citation in question. If you take out the pseudoscience at the beginning, and the self-serving bit at the end, you are left with:


 * "Rapkin and Kames reported the results of a study of 14 patients with pelvic pain who had 6–8 weeks of acupuncture therapy twice a week. Eleven patients had a >50% reduction in pain."


 * The study by Rapkin and Kames is referenced there. It is a study published in the Journal of Reproductive Medicine (PMID: 2439689). That, it seems, is the "good information" from the questionable source. So why not replace the questionable source with a direct reference to the study it cites? That way we cut out the bad (pseudoscience and potentially biased opinions), and keep the good.


 * This approach seems to adequately address the problems raised above by the Colonel, and it certainly meets my needs. I haven't seen anything from Ratel indicating that this approach won't work for him, and based on what I've read from Scramblecase, it seems he would accept this as well. What do we all say? Do we have a workable solution? If so, feel free to ignore the rest of my comment and reply below. If not, then please read the rest so you understand my position.




 * Hopefully you aren't reading this, but if you are, I agree that this is a relatively minor issue in a larger article. It should have been resolved days ago, and forgotten. But the fact that it's a small part of the article doesn't mean that it should stand as it is, which in my opinion is in violation of WP:UNDUE.


 * So if I understand your view, Colonel, it is that the statement "acupuncture occurs by re-establishing a balanced flow of energy, termed Yin and Yang, throughout the body through 12 meridians and 1000 acupoints" is okay in a source cited in a medical article? Assuming that you recognize that this flies in the face of scientific consensus (please correct me if I'm wrong in this assumption), can you explain why you feel that this doesn't constitute giving undue weight to a pseudoscientific theory, especially when it's possible to cite the study behind this pseudoscience without also including the pseudoscience. Remember that not everything written in a reputable journal is automatically an acceptable source, and this, I would say, is not acceptable since it qualifies as pseudoscience. The statement made by the MD practicing acupuncture is, itself, not sourced in the source material. It is an unsupported statement, from a potentially biased source, that represents a pseudoscientific view that contradicts the scientific consensus. How is that a "good" source for a medical article? I'm just not seeing it, especially when we can distill it down to the "good" source and avoid the problematic stuff surrounding it.


 * Please note that I have no problem with the statement that some studies have shown that acupuncture is effective at reducing pain associated with IC. That's fine. Some have done so, others have shown no effect. So noted, so stated in the article. My problem is purely with the statement that this effect is a result of chi and meridians. That is the pseduoscience, not acupuncture in general (which may well have other physiological effects on the body besides the placebo effect). So if you want to replace the source in question with another source that simply states "good" results for acupuncture for IC (which was my suggestion above), that's fine with me. I just don't think the source in question belongs here. -- Transity  ( talk &bull; contribs ) 20:10, 16 April 2009 (UTC)
 * Transity, I removed the German source that you say has unscientific language and replaced it with the data you supplied. Hopefully this will settle the issue. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 23:58, 16 April 2009 (UTC)

Excellent! However, you removed the wrong reference and left the problematic one. I'm going to assume it was a simple mistake, and make the correction. Thanks. -- Transity  ( talk &bull; contribs ) 00:59, 17 April 2009 (UTC)


 * Whatever. I'm surprised the Whitmore one has unscientific language. She's a big name in IC/PBS. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄


 * I have reverted as a German language source is not as good for our purposes as an English language one. Colonel Warden (talk) 01:33, 17 April 2009 (UTC)


 * Having now read the full actual study Transity wants excluded, I am reversing myself and adding it back in. While Whitmore does mention the ancient Chinese way of explaining how acu. works, she goes on to give a more scientific understanding, and also extra details of her own experience at her clinic with acu, which should not be excluded. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 01:36, 17 April 2009 (UTC)

Unreal. If you want that study in, and you will not remove it, then we have to balance the pseudoscience with the scientific consensus. I have also read the full study. It is, exactly as I said, unsourced pseudoscience and potentially biased opinions, other than the cited reference within the article. Are we back to an impasse? It sure sounds like it. -- Transity  ( talk &bull; contribs ) 02:19, 17 April 2009 (UTC)

I'd also add that a good German source is better than a questionable English source any day. Thanks for reverting without discussing further, by the way. -- Transity  ( talk &bull; contribs ) 02:26, 17 April 2009 (UTC)

Regarding Colonel's comment below:
 * I agree that, in general, an English source is better than a German one.
 * I agree that, in general, a Secondary source is better than a Primary one.
 * I do not agree that the article in question is a good source.

Per WP:MEDRS:

The fact that a statement is published in a refereed journal does not make it true. Even a well-designed experiment or study can produce flawed results or fall victim to deliberate fraud. (See the Retracted article on neurotoxicity of ecstasy and the Schön affair.)

Neutrality and no original research policies demand that we present the prevailing medical or scientific consensus, which can be found in recent, authoritative review articles or textbooks and some forms of monographs. Although significant-minority views are welcome in Wikipedia, such views must be presented in the context of their acceptance by experts in the field. The views of tiny minorities need not be reported. (See Neutral Point of View.)

If we can make the same point without using the questionable reference, then why not do so? -- Transity  ( talk &bull; contribs ) 12:44, 17 April 2009 (UTC)


 * The source in question provides a good general survey of CAM treatments for this condition and so is useful to us for more than just its acupuncture reference. It is helpful to editors and readers that it is so accessible.  It should therefore be retained unless or until a better secondary source for such treatments is found. Colonel Warden (talk) 14:00, 17 April 2009 (UTC)

And if it's retained, you don't see any need to balance its pseduoscientific statements with something showing that the scientific consensus doesn't agree with this article? That seems like we're placing undue weight on this fringe theory. Please - in all sincerity - help me understand why you don't agree with my view here.

And if it's a questionable source, then its ability to apply to other treatments isn't a good thing, it's a bad thing. I get that it has wide application, and I get that it's more accessible than a primary source available only as an abstract. I don't get how a bad source is any good to begin with, though. -- Transity  ( talk &bull; contribs ) 14:27, 17 April 2009 (UTC)


 * Reviews in Urology does not seem to be a questionable source as we define it. Your concern about a single sentence in that article is a matter that you should take up with the editor of that journal.  We do not report it nor make reference to it and so it is irrelevant to our proceedings here. Colonel Warden (talk) 19:31, 17 April 2009 (UTC)

I think you're missing the point here. I have no problem with the journal. But as I quoted from WP:MEDRS above:

"The fact that a statement is published in a refereed journal does not make it true. Even a well-designed experiment or study can produce flawed results or fall victim to deliberate fraud."

Just because this statement is published in a reputable journal, it doesn't mean it is a true statement. In fact, it is clear pseudoscience. If we agree with the statement from WP:MEDRS and we agree that this is a pseudoscientific statement (I haven't heard your stance on these two issues), then how does it follow that WP should simply parrot a demonstrably improper assertion just because it appears in a reputable journal? That logic just isn't holding together at all for me, and it would seem to fly in the face of policy as well.

To be clear, I understand each of your arguments - the source is in a reputable journal, it's a free full-text article, it's in English, and it contains a lot of other potentially useful information. I concur on each point, not just on a factual basis, but also on the usefulness of such a source. I just don't think that all of that overrides the clear pseudoscientific content, and I think it renders the source highly questionable, and worthy of removal (or statements making the scientific consensus clear).

It seems clear we will have to wait for the RfC to move this forward. I thank you, Colonel, for your willingness to actually engage in discussion, I fear we just don't see eye-to-eye. -- Transity  ( talk &bull; contribs ) 19:57, 17 April 2009 (UTC)


 * Your difficulty seems to be a misunderstanding of the purpose and nature of a citation. We are not parroting the article in question because that would be a breach of copyright.  That journal is responsible for their content while we are responsible for ours.  Our content is the statements made in our article and these seem uncontroversial.  The citation exists to verify our statements and it seems satisfactory for this purpose.  Examining sources for all the other extraneous statements which they make is outside our scope and would lead to absurd overreach when many sources are huge books and encyclopedias themselves. Colonel Warden (talk) 21:34, 17 April 2009 (UTC)

I agree, to an extent. But I also feel that we are responsible to an extent for the sources we link to. WP takes great pains to ensure that reliable sources are used, and they do so for a reason. In addition, this source has literally one paragraph on acupuncture. And of that paragraph (roughly) 1/3 is an unsupported pseudoscientific statement, 1/3 is potentially biased promotion of a treatment performed for profit by the author of the article, and the remaining 1/3 refers to an actual study. We aren't talking about reading a 1,000 page book here - we're talking about reading the single relevant paragraph, which anyone clicking on the link will surely do. And if we can just use the study it cites and eschew the problems with the other 2/3s of that paragraph, why not do so? Why not take the "good" from this questionable source and distill it down to just that good bit by using the completely uncontroversial study? I do see your point, though. In your brief time here, you've addressed the substance of this debate about 100 times more than Ratel ever has, and I do appreciate it. I still believe it should be replaced, but the chance to talk this out rationally has been highly beneficial. -- Transity  ( talk &bull; contribs ) 22:28, 17 April 2009 (UTC)


 * Since you've made another personal attack on me in this statement above, let me respond in kind by saying that you may find "the chance to talk" your obession with CAM "out rationally" with a professional person "highly beneficial". [[File:Ras.gif]] Over and out. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 00:32, 18 April 2009 (UTC)


 * I would say that, when a Wikiquette Alert has been opened on you, discussing your behavior is fair game. But maybe you have a different read of WQA. I'm sorry if you thought the above was a personal attack. It was merely a statement of fact - no more, no less. You haven't addressed the content of this discussion, and I've said that about dozen times in the thread above. That's been the crux of my complaint about you - that you seem intent on tossing around insults instead of having a serious discussion on the issue at hand. So this certainly can't be a surprise to you. If you don't like hearing things like this, I would suggest that you stop behaving in the way you've behaved here (and, apparently, elsewhere). We can discuss your behavior at the Wikiquette Alert concerning you. As for this topic, we'll see what the RfC yields. At this point, on this article, I have nothing more to say to you - I've wasted more than enough on with you already. I'm sure you feel the same, so why don't we both just stop addressing one another here? -- Transity  ( talk &bull; contribs ) 01:21, 18 April 2009 (UTC)

Consensus on Whitmore study
POLL MOVED TO NEXT SECTON - PLEASE SEE BELOW TO ADD INPUT -- Transity  ( talk &bull; contribs ) 16:33, 18 April 2009 (UTC)
 * Include without pseudoscience warnings. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 02:23, 17 April 2009 (UTC)


 * Remove and replace with actual study (see above). If this isn't agreeable, then we can keep the reference but only with pseudoscience warnings to ensure compliance with WP:UNDUE. -- Transity  ( talk &bull; contribs ) 02:26, 17 April 2009 (UTC)


 * Include - The Whitmore source is fine and needs no embellishment to address issues which our article does not cover. Note that it is a general review by an expert in the field and so, as a secondary source, is better for our purposes than the study paper which is a primary source per WP:MEDRS. Colonel Warden (talk) 12:24, 17 April 2009 (UTC) (see my comments on this user's vote, just above this section header -- Transity  ( talk &bull;  contribs ) 16:11, 17 April 2009 (UTC))

It looks like this has been suggested for RfC (see above). Let's see where it goes from there and suspend our voting for now. -- Transity  ( talk &bull; contribs ) 16:11, 17 April 2009 (UTC)


 * No need to suspend the straw poll. All the Rfc will do is invite interested editors to add their twopenceworth to the discussion above, and it might also be helpful if they were to add a short indication of their opinion to this poll as well. Unfortunately, the supposedly automatic addition of a pointer to this discussion to the science Rfc page doesn't seem to have taken place&mdash;possibly because I added the Rfc template to an existing talk page section, rather than adding a new one at the bottom.  If my recent tweak to the template doesn't fix the problem, I'll try adding a new section for the Rfc discussion.
 * &mdash;David Wilson (talk · cont) 02:42, 18 April 2009 (UTC)


 * I had similar trouble with an RfC recently - the process seems over-engineered with bots and such. It was sorted out eventually but this perhaps required manual intervention. Colonel Warden (talk) 08:10, 18 April 2009 (UTC)

Rfc: Acupuncture and IC
See the discussion in the sections Request for Opinions: Acupuncture and IC and Consensus on Whitmore study above. I have tried to capture what appear to me to be the points at issue with the questions:
 * RFC closed
 * Should the article say that acupuncture has been reported as having relieved pain in sufferers of IC/PBS? and if so;
 * which sources should be cited to support that statement? and;
 * should the article also include a (properly sourced) disclaimer that other studies have found the effects of acupuncture in general to be indistinguishable from those of a placebo.

Please note, this is an article Rfc and not an Rfc on any editor's conduct, so please avoid commenting on other editors' behaviour or motivations. Even if you think you have overwhelming evidence that another contributor is a sock puppet, single-purpose account, has a conflict of interest, or is guilty of any other Wikisins, please don't clog up this discussion by raising it here. Either take it to the talk page of the user in question, or to the appropriate Wikipedia forum. &mdash;David Wilson (talk · cont) 06:51, 18 April 2009 (UTC)

''Manually adding this RfC as the bot doesn't seem to be picking it up. -- Transity  ( talk &bull; contribs ) 22:05, 18 April 2009 (UTC)''


 * Strong Include - given that western medicine is now starting to support the scientific basis for acupuncture (see the latest study, March 2009 ), it would be foolish in the extreme to insert disclaimers as to its efficacy. This is a fluid area of medicine. Do we really want to retrace our steps to remove unwarranted warnings of pseudoscience from every page mentioning acupuncture somewhere down the track? Obviously not. In addition, the OR and SYN rules prohibit us warning about the use of acupuncture for IC/PBS unless there is a published study concerning acupuncture and IC/PBS that we can cite to that effect. If any user wants to insert data about the supposedly bogus nature of acupuncture, then that belongs on the page: Acupuncture. As regards the Whitmore paper: Whitmore is an acknowledged expert in the field of IC/PBS with ~41 published papers on IC/PBS. Excluding her review paper would be in direct contravention of WP:MEDRS. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 10:35, 18 April 2009 (UTC)


 * Include - The Whitmore source is fine and needs no embellishment to address issues which our article does not cover. Note that it is a general review by an expert in the field and so, as a secondary source, is better for our purposes than the study paper which is a primary source per WP:MEDRS. Colonel Warden (talk) 10:46, 18 April 2009 (UTC)


 * Remove - I have no problem with Whitmore in general. I have no problem with this journal in general. I have no problem with acupuncture in general. And I prefer a secondary source to a primary one in general (as per WP:MEDRS). All that said, I have a problem using this source to backup the efficacy of acupuncture for IC. Since we're looking at WP:MEDRS, we should note that it also says that just because something is written in a peer-reviewed journal it doesn't mean it's an acceptable reference, and I believe that's the case with this article. I also don't want to include a pseudoscience warning - I just feel that if this source is left as a reference, then a properly cited statement about the scientific consensus on the existence of chi is needed to satisfy WP:UNDUE (I have provided such a properly sourced statement above, if we need it). But I'd prefer to simply remove this source and avoid the warning entirely.


 * Here is the totality of what this source has to say about acupuncture and IC:


 * "Acupuncture is over 5000 years old. Neuromodulation through acupuncture occurs by re-establishing a balanced flow of energy, termed Yin and Yang, throughout the body through 12 meridians and 1000 acupoints. A rebalance of energy flow is thought to occur by increasing endorphin production and pain ablation by stimulating A delta, large-diameter, myelinated sensory nerve fibers with the inhibition of unmyelinated sensory C-fibers. Rapkin and Kames reported the results of a study of 14 patients with pelvic pain who had 6–8 weeks of acupuncture therapy twice a week. Eleven patients had a >50% reduction in pain. Our experience at the Pelvic Floor Institute shows that IC patients need 10–20 acupuncture treatment sessions in order to achieve symptom relief. Further studies are needed to determine the efficacy of acupuncture therapy in patients with IC."


 * The first sentence is inconsequential. The second is unsupported pseudoscience that contradicts the scientific consensus on the existence of chi, etc. The third is an unsupported hypothesis about how actual medical knowledge affects chi - still pseudoscience since it assumes the existence of chi as a basis of the hypothesis. The fifth sentence is a statement made by someone who performs acupuncture for profit, and not a statement about a formal study conducted - that seems like a potentially biased statement, and also purely anecdotal evidence. The sixth sentence just says that further study is needed to determined if acupuncture has an effect on patients with IC.


 * That leaves sentences three and four which, quite simply, refer to a study by Rapkin and Kames. Out of the entire source, there are only six sentences about acupuncture, and of those six sentences, only two are truly useful, good information. And those two simply refer to another single study (not a meta-analysis of multiple studies).


 * So why not replace this mostly off-topic, potentially problematic source with the study to which it refers? That way, we keep the good part from the source, and set aside the rest. If someone wants to keep this in the External Links section as a good overview of various treatments of IC, that's fine with me (those links, in my opinion, are held to a less stringent standard than the ones used in the body as references). -- Transity  ( talk &bull; contribs ) 16:31, 18 April 2009 (UTC)


 * The fact that Whitmore, one of the —most well known IC/PBS experts in the world— uses acupuncture with success in her clinic is of seminal importance to readers of this topic, your aspersions about "for profit" notwithstanding (you want she should work for nothing?). <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 01:08, 19 April 2009 (UTC)
 * No, you are missing the point. She can do whatever she wants in her clinic. That's great for her. But her experience is anecdotal - it doesn't carry the weight of a clinical trial. Your assertion is nothing but a textbook example of an argument from authority. In fact, I'm guessing that Whitemore understands that her statement is only anecdotal, hence her wording was "our experience at the institute" and not "based on the result of X clinical trials" or "the evidence shows." Her position as an expert in her field is great, but it doesn't magically turn her anecdotal evidence into the equivalent of a clinical trial. I'm not sure how much more simply I can explain this - you seem either unable or unwilling to acknowledge what I'm saying. You also didn't address the pseudoscience in the first part of the article text - in fact, in all the lines of text above, you have never once addressed that and provided an adequate reason why it should be overlooked. You speak in generalities about how acupuncture is being researched and accepted, and I agree, but you never once addressed the blatantly pseudoscientific statement in Whitemore's paper. You are apparently willing to ignore it, though it constitutes approximately a full third of the entire write up on acupuncture and IC. I am not willing to overlook it, which is at the heart of our disagreement. So when you say I'm still not getting your point, rest assured that I've heard it. And I've responded to it, over and over again. So I "get" your point, I just don't think it's even remotely valid. There's a big difference. So if this is all you have to say, I've heard it already, and I disagree. -- Transity  ( talk &bull;  contribs ) 02:45, 19 April 2009 (UTC)


 * You are showing a basic lack of understanding of our purpose and authority as editors. We cannot make the sort of judgements about review studies that you are making. This is a secondary source from an acknowledged, much-published expert in the field, published in a pre-eminent journal Reviews in Urology. This has passed peer review. IT IS NOT OUR PLACE TO PEER REVIEW sources, or to second-guess the peer review process. We are not medical experts. And even if we were experts, we have no capacity in our roles as anonymous editors of this project to insert caveats to studies of this caliber. Can you understand this point? Please stay within the ambit of your authority as an editor. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 03:42, 19 April 2009 (UTC)


 * Let me try quoting WP:MEDRS one more time here (this is the third or fourth time I've quoted this exact phrase, by the way), in a continued hope that you will read it : "The fact that a statement is published in a refereed journal does not make it true. Even a well-designed experiment or study can produce flawed results or fall victim to deliberate fraud." If it isn't our job to actually check the sources we use as references as you imply, then why does this statement exist at all? You would seem to be saying that if something appears in a peer-reviewed journal, we should simply include it as true, even if it is recognized as being 100% false. That's absurd. Also, I'd be remiss if I didn't once again point out that the source in question is not a study as you've referred to it above, but rather an article that references one acupuncture study (the very source I would like in place of this one).  And I'm not trying to insert a caveat - I'm trying to replace this flawed source with a better one. Not a contradictory one, not a biased one, but the very source referenced in the Whitemore article itself. My position is that, if this source is kept, then WP:UNDUE and WP:MEDRS tell us we have to balance out the pseudoscience with a properly sourced statement about the scientific consensus. In the future, I'd appreciate it if you'd let me explain my own position rather than attempting to do that for me (and failing). -- Transity  ( talk &bull;  contribs ) 13:05, 19 April 2009 (UTC)


 * You are cherry-picking sentences about primary sources from MEDRS, an inappropriate strategy since we are dealing with a secondary source here. The part of MEDRS you seem to be missing is the Respect secondary sources paragraph wherein you are told Individual primary sources should not be cited or juxtaposed so as to "debunk" or contradict the conclusions of reliable secondary sources. And you cannot replace a secondary with a primary source; that is contrary to MEDRS, no matter how you feel about the quality of the different papers. Your understanding of UNDUE is also flawed. It has nothing to do with the situation at hand. I won't waste time explaining why to you, maybe someone else has no life and can do it.


 * Tell you what — come up with a good quality, published review study that outright calls acupuncture "pseudoscience", and we'll insert a caveat. How's that? No, not a NIH consensus position from 1999, not a paper that shows needles inserted anywhere ease pain, but an outright condemnation of acupuncture. Can you do it? <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 16:11, 19 April 2009 (UTC)


 * Again, I don't think the issue is whether "acupuncture works," here, whatever any one editor's position is one way or the other. The pseudoscience that the citation provides regards the mechanism behind acupuncture, and you yourself, Ratel, have provided a condemnation of that mechanism ( - see below).  The cited source claims, unequivocally, that acupuncture works through yin, yang, qi, and so forth.  Your link claims that modern researchers in acupuncture do not believe that.  Leaving in a source that claims, unequivocally, something which is no longer the majority consensus view...well, by definition, that gives too much weight to the fringe view. Scramblecase (talk) 16:49, 19 April 2009 (UTC) (Who is such an incredible SPA that he should likely have a tag right here.  Somebody, please, provide that.  I've heard that WP's editing toolkit is so complex that I couldn't possibly look several lines down to copy the technique from Colonel Warden.  End sarcasm.)


 * Well, I disagree with Ratel's out-of-hand dismissal of the NIH Consensus on acupuncture, but since Scramblecase has provided (actually, Ratel has provided, and Scramblecase merely pointed out) a reference, let's go ahead and insert that caveat, as you offered, Ratel. I suggest the following:


 * Acupuncture has been reported to alleviate pain associated with IC/PBS as part of multimodal treatment . However, the consensus view is that there is no known scientific basis for the existence of qi, acupuncture points or meridians, and modern practitioners of acupuncture have largely set aside concepts such as Yin/Yang and qi. The result of studies on the effect of modern acupuncture on IC are mixed. While one study showed that 11/14 (78%) patients had a >50% reduction in pain, another study found no beneficial effect.


 * So was your offer sincere, Ratel, or was it just a dare that you assumed couldn't be won (despite the fact that you had already provided the link to meet your own demands) ? I think I'd still prefer to just remove the questionable source, but I'm happy to accept your olive branch, whether it was genuine or not . I await your reply (and, though I'm not psychic, I have a premonition of what it will be) . -- Transity  ( talk &bull; contribs ) 19:20, 19 April 2009 (UTC)


 * (de-indent)
 * 1) You have not provided the debunking study I sought from you, because there is in fact no study that backs your dogmatic "pseudoscience" position. The paper Western medical acupuncture: a definition  does not call acupuncture pseudoscience, quite the contrary.
 * 2) As recent studies like this one  show, acupuncture, and needling generally, are effective in chronic pain conditions, so any caveat on the basis of obscure terminology would be both unwise, misleading and potentially harmful.
 * 3) IC/PBS patients have zero interest in your hangups about the words chi, ying/yang, meridians etc. That is an arcane argument best reserved for the acupuncture page, because it has no effect on the outcomes of the treatments. It is certainly not an argument that should be added to every mention of acupuncture all over wikipedia, to satisfy the whims of someone who dislikes the Chinese origins of the modality.
 * 4) The NIH consensus paper you are trying to use as a source  is both out of date (see warning prominently displayed at the top) and pre-dates many positive studies that would have precluded the findings.
 * 5) The Whitmore study does not endorse the traditional Chinese view of how acupuncture works. She simply mentions the Chinese theory of meridians, etc, saying that these theories go back 5000 years. In that context, her words are understandable, a nod to the sources, and I for one do not come away with the impression that she is claiming validity for the ancient, non-Western theory, merely for its effects.
 * 6) From a practical point of view, I would only support someone trying to do what you are doing if the CAM treatment was actually harmful, like the use of silver ions, which leads to argyria. But in this case the treatment is actually effective at best, and placebo at worst, never harmful, so caveats to patients about esoteric arguments concerning ancient Chinese vs. modern Western terminology are completely out of place. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄  23:14, 19 April 2009 (UTC)
 * Hear, hear - User:Ratel explains the matter well and I fully endorse these comments. Colonel Warden (talk) 23:31, 19 April 2009 (UTC)


 * So in other words, it was a "dare" that was never meant as an actual form of compromise. Got it. I'll note once again that the caveat idea you just spent a paragraph shooting down was your idea, and not mine, so calling it a flawed approach (which is the bulk of your most recent comment) is really just calling your own suggestion flawed. But then again, since it wasn't a good-faith suggestion, you probably see nothing wrong with what you've done. As anyone can see, I clearly said above that I'd still prefer to remove the bad source, but that I'd agree to accept your olive branch, if it was real. It was not. So we're right back to where we were, unsurprisingly - replace the source or leave it where it is.


 * As it's clear that you are not the least bit interested in a compromise, why don't you simply stop wasting everyone's time with further comments here and just let the RfC take place? Really, Ratel, I'd think you'd be fine with that since your immediate reversions to anything contrary to your own position has ensured that your version is what is in place today. Hey, the longer the RfC takes, the longer your text is in use, right?


 * And I see that the unproductive name calling continues. However, my "dogmatic" view of what constitutes pseudoscience is directly informed by various WP policies (like WP:NPOV, WP:NPOV/FAQ, and WP:UNDUE). In addition, I don't agree with your characterization of the NIH Consensus statement as useless. The very fact that your own March 2009 source reiterates what the 1999 NIH statement says - that acupuncture may have some benefit, but that modern practitioners are not leaning on the outdated and silly concepts of qi (et al) that acupuncture grew from - tells me that their ten-year-old statement has yet to be significantly challenged to this day.


 * So please - stop wasting time with insincere offers to compromise, stop reiterating your position over and over without adding anything new, stop bandying about insults, stop assigning me strawman positions and then gleefully knocking them down, and just let the process run its course. If you are so sure you are right, then why not just await your destined vindication? Hey, I have no idea if my ideas will be upheld or not, and even I'm fine sitting and waiting right now. Everything that can be said between the four parties involved has already been said. Just chill. M'kay? -- Transity  ( talk &bull; contribs ) 23:58, 19 April 2009 (UTC)


 * I made an offer, you were unable to meet the conditions of the offer, there is no suggestion of bad faith except from you, who cannot meet the required standard of proof.
 * Your suggestion that I am gaming the system to keep "my" edit in place as long as possible contravenes AGF and insults Colonel Warden too.
 * "Name calling continues" — my edit above calls you no names at all. Stop lying please.
 * Our wikipedia text does not contain the words "qi", "ying/yang", and "meridians". That text is in a cited paper in a passing comment on ancient sources. So for you to insert a warning or clarification about your interpretation of a footnoted source into the main text would be absurd. UTTERLY ABSURD. I have never seen it done anywhere else, ever. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 00:13, 20 April 2009 (UTC)


 * Ah, no, you can't just let the RfC run its course. Got it. I won't respond to you except to say that your latest response is just more of the same nonsense. I'll let the arguments speak for themselves. -- Transity  ( talk &bull; contribs ) 01:05, 20 April 2009 (UTC)


 * Remove - Ratel's point regarding further scientific advancement of the study of acupuncture is thoroughly valid; however, the citation he links in his vote demonstrates why the disputed content should be removed (or qualified/altered in a manner similar to Transity's suggestions). As Transity quotes the disputed source:


 * Neuromodulation through acupuncture occurs by  [note the unequivocal claim] re-establishing a balanced flow of energy, termed Yin and Yang, throughout the body through 12 meridians and 1000 acupoints.


 * Quoting Ratel's source cited above :


 * While Western medical acupuncture has evolved from Chinese acupuncture, its practitioners no longer adhere to concepts such as Yin/Yang and circulation of qi...


 * Therefore, the disputed source is in conflict with the material Ratel cites as a reason for leaving it in. The dispute does not, to me, seem to rest on the efficacy of acupuncture itself (in my opinion, the jury is still way, way out on that one), but the source's blatantly pseudoscientific claims as to the mechanism behind it.  On this basis alone, it seems on shaky grounds; add to that the pseudoscientific nature of "classical" acupuncture which is referenced in the source, and I vote firmly to remove, absent any consensus on qualifying remarks surrounding the citation. Scramblecase (talk) 18:31, 18 April 2009 (UTC) — Scramblecase (talk&#32;• contribs) has made few or no other edits outside this topic.


 * Yes, let's leave your tag in there, Colonel. Again: I believe David Wilson correctly pointed out that that references to WP:SPA or any other irrelevant issue do not belong here, Colonel Warden. If you have responses to my points, feel free to make them.  If you do not, then perhaps your position is not as solid as you make it out to be.  Please stay on topic.  Do not remove this note; it is relevant so long as you insist on tagging my signature. Scramblecase (talk) 19:40, 18 April 2009 (UTC)

Summary
Summary of the above by : Acupuncture is occasionally used in the treatment of IC/PBS. How should this information be presented?


 * 1) Cite it, but include a cited caveat regarding the pseudoscientific basis of traditional acupuncture and/or the general non-mainstreamness of dry needling (counter: WP:COATRACK).
 * 2) Cite the couple of studies and reviews that have mentioned acupuncture and IC/PBS (counter: WP:PROMINENCE and FRINGE).
 * 3) Avoid citing the Whitmore review Complementary and Alternative Therapies as Treatment Approaches for Interstitial Cystitis, but do cite Rapkin and Kames, which is the only relevant study in the non-systematic literature review.

Comments on summary
Seems on point to me. Based on my read, it's possible to use the three options on their own or in some combination (of two or of all three approaches). If that was your intent, then I think you've covered the relevant possibilities. Thanks. -- Transity  ( talk &bull; contribs ) 22:10, 21 April 2009 (UTC)


 * Clearly, Colonel Warden and I opt for #2 above. UNDUE is not called into play (2 sentences on the page). This is also not a fringe theory or practice, with numerous clinical trials on the go: . It is also listed in the Masters in Urology series as a recognised intervention: <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄  06:55, 22 April 2009 (UTC)

Outside comments
Note: I added this discussion to the Fringe theories/Noticeboard. - Eldereft (cont.) 22:03, 21 April 2009 (UTC)

AUA 2009 Meeting abstract on acupuncture
An extremely positive view of acupuncture will be presented at the American Urological Association's 2009 Meeting. If published, I'll be sure to include it on the page. I'll quote the conclusion here:

"Conclusions: Acupuncture was successful in 100% of patients in terms of improving symptoms and 86% felt an improvement in quality of life. The success rate is particularly important as it occurred after failure of cystodistension and both oral and intravesical therapy in this group."

Hope this helps. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 00:22, 25 April 2009 (UTC)


 * here is a direct link to the entire abstract of the relevant presentation.
 * &mdash;David Wilson (talk · cont) 08:57, 25 April 2009 (UTC)

Outcome of this RFC
The outcome of the RFC was to keep the text on acupuncture as is, without warnings or caveats. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 00:23, 22 May 2009 (UTC)


 * Actually, that's not entirely accurate. The outcome was that no one other than the original two editors and the additional two who joined the discussion prior to the RFC ever weighed in. This ensured that the 2-2 deadlock remained in place. That doesn't mean the same thing as saying that the outcome was a decision to keep the current text &mdash; it wasn't.


 * I do agree, however, with the decision to close the RFC as it has been open long enough, and I also agree that it's up to me (or Scramblecase) to take this to the next stage (mediation, I imagine) which I have no desire to do. So yes, the text will remain as is, without warnings or caveats, but that result actually has nothing to do with the outcome of the RFC, which was a tie vote. -- Transity  ( talk &bull; contribs ) 03:57, 22 May 2009 (UTC)


 * An RFC is not a vote. Only you and, like yourself an WP:SPA, (who has since ceased editing) stood against me and Colonel Warden, two longtime, experienced editors. The consensus, and the science, is therefore clearly on our side. I consider this case closed in our favour and will not reply to any further comments you append to this section. And if you insist on getting the last word, I'll take the time to check your history to see if you've gotten away with appending CAM warnings elsewhere, and reverse them. <span style="color:#333; font-weight:bold; font-size:9px; border:2px solid #FFCC33;background-color:#CEE1DD; padding: 2px 10px; letter-spacing: 6px;">► RATEL ◄ 04:14, 22 May 2009 (UTC)

MiszaBot
Any issues with me setting up automated archiving on this talk page? I suggest archiving anything older than 6 months. -- <font color="800080" face="Verdana"> Transity (talk &bull; contribs) 17:24, 20 June 2010 (UTC)
 * Done. -- <font color="800080" face="Verdana"> Transity (talk &bull; contribs) 02:12, 10 July 2010 (UTC)