User:Transity/Altmed

=Helpful Links on Pseudoscience=  Guidelines on Pseudoscience 
 * WP:PSCI: Policy: What should be classified as pseudoscience and what should not
 * WP:NPOVFAQ: Policy: When not to give equal validity to opposing views
 * WP:UNDUE: Policy: How to properly weight minority views vs. majority views
 * WP:BURDEN: Policy: Burden of Proof and what to do with unsourced pseudo information
 * WP:REDFLAG: Policy: Exceptional claims require exceptional sources
 * WP:MEDRS: Guideline: Reliable sources for medicine-related articles
 * WP:FTN: Advice: Fringe Theory Notice Board
 * WP:SCICON: Essay: Scientific Consensus
 * WP:FLAT: Essay: Dealing with Dedicated Fringe Advocates

=Links, Issues, and Edits concerning the IC Article=

Acupuncture
While a 1987 study showed that 11 of 14 (78%) PBS/IC patients had a >50% reduction in pain when treated with acupuncture, another study (published in 1993) found no beneficial effect. A 2008 review found that although there are hardly any controlled studies on alternative medicine and BPS/IC, "rather good results have been obtained" when acupuncture is combined with other treatments.

Acupuncture
I have removed a source and the associated text. The source I removed, a review from 2002, contains almost nothing on the use of acupuncture for this condition. The entirety of its contents on this subject are as follows:


 * 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 only relevant information I can see is the reference to the Rapkin and Kames study, which is the source for the very next statement in the WP article. The rest of the information in the paragraph above seems to be irrelevant. As such, I have removed the less-useful of the two sources in question and left the better source (the Rapkin and Kames study) to make the claim.

Links associated with the IC discussion

 * WP:OWN - Nobody Owns an Article
 * WP:NVC - No Vested Contributors
 * WP:BULLY - No Bullying
 * WP:BITE - Don't Bite the Newcomers

Diffs Documenting Threat of Wikihounding
As I've been advised (informally) to try to ignore User:Ratel, I will refrain from replying to his comment on either the Talk:IC/PBS page or on his User Talk Page. Instead, I will document the threat he made here, in case he follows through on it. If he drops the issue, I will not pursue any administrative intervention.

In Ratel's latest comment on the Talk:IC/PBS page, he threatens to follow me to other pages I've edited with the intent of reverting my changes (diff). He said:

"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."

Compare this to what he said about User:Collect's similar behavior on his own talk page (diff):

"As regards Collect — I shall try to ignore him from now on as advised, but I find it a pity that wp cannot slough off editors like this, who make sport of pursuing other editors to pages they habitually edit in order to provoke unpleasantness. He's done it before to me. My prediction: he'll go through any page I've recently edited and pick as many holes in the sources as he can, not to improve the page, but to irritate me."

As stated in WP:HOUND:

"Threatening another person is considered harassment. This may include threats to harm another person, to disrupt their work on Wikipedia, or to otherwise hurt them."

Also:

"The term 'wiki-hounding' has been coined to describe singling out one or more specific editor(s), and joining discussions on pages or topics they may edit (often unrelated), or debates where they contribute, in order to repeatedly confront or inhibit their work, with an apparent aim of creating irritation, annoyance or distress to the other editor. ... The important component of wiki-hounding is disruption to another user's own enjoyment of editing, or to the project generally, for no overriding reason. If 'following another user around' is accompanied by tendentiousness, personal attacks, or other disruptive behavior, it may become a very serious matter and could result in blocks and other editing restrictions."

Clearly, this is a threat of retribution if I comment again (even though my previous comment was 100% civil and sought merely to clarify the outcome of the RFC), which clearly constitutes harassment. In addition, what Ratel has threatened is further harassment in the form of Wikihounding. My edits on IC/PBS were clearly not vandalism, and I never engaged in edit warring. Further, Ratel had no support for stating that my changes were clearly contrary to policies. I had as much of a case for that argument against his text as he did in his argument against mine. So there is no viable reason for threatening to revert my edits on other articles other than to intimidate me, and to inhibit my work.

I considered posting a version of this comment on Ratel's user talk page, but there would be no point in doing so as he routinely deletes any criticism he receives there, no matter the accuracy, the tone, or the source. In addition, doing so would almost certainly incite Ratel to Wikihound me, per his threat. While I'm confident that my edits would stand up to scrutiny, and while I'm sure that his Wikihounding would be easy to prove (given his clear, open threat to do so), I have no desire to waste time engaged in dispute resolution with Ratel.

So while I disagree that "two experienced editors" can trump any two other editors (as he stated on the IC/PBS talk page), and while I disagree with the entire premise of a SPA, and while I would submit that, even if I agreed with the premise of a SPA, I am no more a SPA than Ratel is at this point, and while I still believe that my edits to IC/PBS are justified and beneficial, I have no desire to continue to engage with him at any level. As I said on the Talk:IC/PBS page, I consider the RFC and the issue closed, and I have no intention of commenting on the acupuncture issue on IC/PBS any further at this time. I will do my best to ignore Ratel from this point on. If Ratel does follow through on his threats, I will append any relevant evidence here to aid in my request for administrative intervention. Hopefully, though, this will be the end of it. -- Transity  ( talk &bull; contribs ) 15:58, 22 May 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.

Acupuncture
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."

...or...

Although acupuncture has been reported to alleviate pain associated with IC/PBS in several cases. , 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.

...or...

While acupuncture has been reported to alleviate pain associated with IC/PBS as part of multimodal treatment in several cases, other studies have found no beneficial effect at all.

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.

Talk Page
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.

Pain control
Pain control is usually necessary in the IC treatment plan. The pain of IC has been rated equivalent to cancer pain and should not be ignored to avoid central sensitization. The use of a variety of traditional pain medications, including opiates, is often necessary to treat the varying degrees of pain. Even children with IC should be appropriately addressed regarding pelvic pain, and receive necessary treatment to manage it.

Drug Treatment
Amitriptyline can reduce pain symptoms according to the visual analogue scale among patients with interstitial cystitis according to a randomized controlled trial. The relative benefit was 236.0%. For control patients given placebo (12.5% had reduced pain symptoms), this leads to an absolute benefit of 29.5%. Therefore, 3.4 patients must be treated for one patient to benefit from amitriptyline therapy.

Physical Therapy
Transvaginal manual therapy of the pelvic floor musculature (Thiele massage) has shown promise in relieving the pain associated with Interstitial cystitis in at least one open, clinical pilot study.

Electronic pain-killing options include TENS (a machine connected to sticky pads which one places on their body at certain pressure points; the TENS machine sends electrical impulses to the skin, using the human body as an 'earth'). PTNS stimulators have also been used, with varying degrees of success. This is similar to a TENS treatment, except a needle is used rather than sticky pads. Neurostimulation techniques are not FDA approved for IC.

Complementary and Alternative Treatments
Acupuncture has been reported to alleviate pain associated with IC 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.

Biofeedback, a relaxation technique aimed at helping people control functions of the autonomous nervous system, has shown some benefit in controlling pain associated with IC as part of a multimodal approach that may also include medication or hydrodistention of the bladder.

Thiele massage study details