Wikipedia:Conflict of interest/Noticeboard/Archive 139

2nd RfC: Do alternative medicine practitioners have a conflict of interest?
Do practitioners of alternative medicine (Acupuncture, Coin rubbing, Ear candling, Homeopathy, Phrenology, Urine therapy, Vaginal steaming, etc.) have a conflict of interest with regard to content describing their field of practice? --Guy Macon (talk) 19:01, 30 December 2018 (UTC)

Related:
 * First RfC (2015)
 * Alternative medicine
 * List of forms of alternative medicine
 * Quackery

Please !vote in the yes and no sections, and discuss in the threaded discussion section. Any editor may move comments placed in the yes and no sections into the threaded discussion section. --Guy Macon (talk) 19:01, 30 December 2018 (UTC)

Yes

 * Yes. Smallbones( smalltalk ) 21:02, 30 December 2018 (UTC)
 * Yes: seems self-evident. --K.e.coffman (talk) 21:20, 30 December 2018 (UTC)
 * Yes: Someone who gets paid for practicing acupuncture has a clear COI concerning our acupuncture article. Someone who makes their living selling homeopathic medicines has a clear COI concerning our homeopathy article. --Guy Macon (talk) 21:24, 30 December 2018 (UTC)
 * Yes - their income depends on promoting nonsense. --mfb (talk) 21:40, 30 December 2018 (UTC)
 * Yes with qualification Anyone who gets paid or receives money in relation to a subject they are editing has a potential conflict of interest (the potential conflict is that they will edit the subject in a non-neutral manner in order to increase their personal gain). Most medical professionals have a potential conflict if they edit medical articles for example. For the vast vast majority of these editors the potential conflict never arises because they edit perfectly normally without attempting to push any agenda or the potential conflict is very remote. The problem with editors who receive money related to pseudoscience/alt-med etc is that it is almost always in their interest to not present a balanced article, which is why we have so many who edit non-neutrally. But its still only a potential COI. An actual COI needs a much stronger relationship than merely being financially linked through their job. OR a demonstrated pattern of COI editing in the subject area. Its certainly possible for an acupuncturist to edit neutrally on acupuncture articles when describing the process. But this is not the same as a paid editor who is being directly paid to edit an article - their financial conflict is directly linked and pretty much depends on a favorable article. Only in death does duty end (talk) 21:50, 30 December 2018 (UTC)
 * Yes they do, because their business is dependent on the pulic acceptance of the legitimacy of the quackery they sell. A medical doctor can use any valid therapy, they have no COI in respect of a specific drug unless they are a spokesperson or involved in trials, but an acupuncturist, homeopathist or whatever, gains tangible financial benefit when Wikipedia validates the false beliefs that underpin their business. A doctor who prescribes statins will change to another treatment if statins are shown to be ineffective. An acupuncturist has no obvious option other than acupuncture. It's like any other cult. An agnostic has no COI in respect of cults, neither does an atheist, but a member of the cult, does.
 * Consider, for example, knee arthroscopy for arthritis. This was tested in well controlled experiments and found to be no better than placebo. The professional community recognised that this means it does not work, so they stopped doing it. Surgeons who performed knee arthroscopy did not have a problem with that, they were still qualified surgeons and did other work. Now consider what happened when evidence came in that acupuncture is no better than placebo. Acupuncturists can't change their practice - there is no practice of sticking things other than needles into people, they have invested a lot of time and money learning the medical equivalent of Klingon, so they cannot work unless they obscure the evidence that it does not matter where you stick the needles or even whether you put them in. They engage in political agitation and policy-based evidence making to support their business and their quasi-religious beliefs. The number of conditions for which acupuncture still has a positive evidence base is shrinking, and all of them are self-reported subjective symptoms. There is a huge incentive to change Wikipedia to reflect the world as they wish it to be, rather than as science finds it.
 * It's like the difference between a 4-3-3 formation trainer, who has a vested interest in that formation, and a supporter of football, who won't care over much about the formation, only about the game itself. Guy (Help!) 01:26, 1 January 2019 (UTC)


 * Yes almost as a matter of definition. And that also applies to !voting on the RFC Andyjsmith (talk) 08:51, 1 January 2019 (UTC)
 * Yes by definition. The no !vote claims that acupuncture is no different than other legitimate medical professions with regard to COI are required to be dismissed by the closer as direct violations of WP:FRINGE and especially WP:PSCI policy. Such comments have no place on Wikipedia and this RfC cannot be used to override policies and guidelines on the subject.
 * Medical professionals, academics, etc. generally do not have COI with respect to their area of research, specialty, etc, and that's pretty layered too. That is because they are typically not selling products, but instead knowledge or treatments they do not have a vested interest in recommending over another treatment barring isolated cases of someone inventing a surgical technique, patents, etc. More importantly, those medical professionals, even if advocating for mainstream science, do not have a COI in part because representing mainstream science is not contrary to Wikipedia's WP:NPOV policy; it's instead completely in line and enshrined in that policy. There just isn't a lot of room for legitimate medical professionals to be out of line with COI since their role in educating the public is generally the same as an editor's primary role to further the interests of the encyclopedia.


 * It's disingenuous and superficial to claim acupuncturists are the same though. They are actively selling something outside of mainstream science. They have a vested interest in making it appear legitimate if they are trying to sell it and by definition cannot fall in the same group as the medical professionals mentioned above that satisfies WP:COINOTBIAS rather than simple advocacy alone. Such an editor would have an inherent conflict with the expected primary role of furthering the interests of the encyclopedia mentioned within the COI guidance. More similar examples would be someone editing Multi-level marketing that sells for such a group or is collecting at the top of the pyramid. Such a person has a vested interest tied directly to their checkbook in making MLM's appear more legitimate than they are. Someone who does sales in general with no connection a MLM group wouldn't have a COI writing about sales frameworks though (barring isolated instances again), which would make them fairly parallel to mainstream medical professionals (that hurt a little bit to write). CAM practitioners fall more in line with that MLM degree of COI. There's just too much with their profession conflicting with the goals of Wikipedia to not call it a strong COI compared to other medical professionals. Kingofaces43 (talk) 17:30, 1 January 2019 (UTC)


 * Yes, very obviously. Their very livelihoods depend on potential patients's views of their treatments, and Wikipedia is an obvious place for patients to look things up. --Calton | Talk 18:42, 1 January 2019 (UTC)
 * Yes, obviously, but so does a conventional MD supporting the practices of orthodox medicine. They are indeed selling a product: their services. And they are doing so against competition, including competition from the practitioners of other disciplines. In my opinion, and the majority opinion here, and the great majority opinion of scientists in general univovled with medical practice, one of these approaches has a great advantage over the others--the advantage of being at least approximately correct. . But both  regular and alt practitioners have the same goals: to help individuals with their physical and mental problems, to improve society by bringing about a heathier world, and to make money. For any given individual, the relative strengths of the three vary.  But the practice of either form of medicine, whether real or fake,  is a business enterprise, with one of its primary intentions to make money.  DGG ( talk ) 20:10, 1 January 2019 (UTC)
 * I have to disagree with this, not only because of the obvious false-equivalence fallacy, but also because it's fundamentally wrong. Let's suppose I'm a physician (or, as you put it, a "conventional MD" practicing "orthodox medicine"), and I treat breast cancer. The rate of usage and acceptance of alternative medicine has no impact on the need for my "services", or on my financial bottom line. If more people utilize alt-med in place of medical therapy for breast cancer, then I will end up seeing a larger proportion of women whose breast cancer has gone without appropriate treatment and potentially become incurable. But there won't be fewer cases of breast cancer, nor will there be less need for accepted medical care. (Arguably, with greater use of alt-med, there will be more demand for extensive medical therapy, because more women will present with advanced breast cancer, having foregone "conventional" treatment at a time when it would have been curative and minimally invasive). When you see "conventional MD's" here arguing against alt-med practices, they're not motivated by a need to "sell their services"&mdash;sadly, those services will remain in demand no matter how much alt-med is used. Rather, they're motivated by the patients they've seen who have delayed or avoided effective medical treatment in favor of alt-med, and then come to them with advanced and potentially incurable disease. Frankly, if a physician's goal was to maximize his or her income, then the last thing they'd do would be to edit Wikipedia for free, since there are so many reimbursable ways to spend that time instead. MastCell Talk 17:52, 29 January 2019 (UTC)
 * Yes. Roxy, the dog . wooF 00:38, 2 January 2019 (UTC)
 * Yes A conventionally trained doctor does not have a COI when writing about conventional medicine because they should be following WP:MEDRS and reporting what evidence currently shows—the income and status of the doctor do not depend on what treatments are recommended by reliable sources. By contrast, the income and status of an acupuncturist depend on whether a sufficiently large proportion of the public think spending money on acupuncture is worthwhile. Anything positive an acupuncturist might add to acupuncture potentially boosts their income and status, while anything negative would do the opposite. That is the definition of a COI. Johnuniq (talk) 08:57, 2 January 2019 (UTC)
 * What the evidence currently shows is often equivocal. A MDs income certainly does depend on what patients think is most effective. to take two example, There are MEDRSs for the greater effectiveness of treating some mental conditions with drugs, and equally good ones showing no greater effectiveness. Some psychiatrists do primarily one, some the other. A  MD when writing about therapy for these conditions will have a bias in favor of the evidence for the method they use.  Which one the patient chooses directly affects their income.    That is the definition of a COI.  I don't want to stand on any particular example, but there are similar disagreements everywhere within medicine. (and all the other really interesting parts of science, and the rest of the world also. This is an encyclopedia for the general reader, but still we shouldn't oversimplify things.)  DGG ( talk ) 19:34, 2 January 2019 (UTC)
 * Sure, and anyone might benefit if sales of a particular product were boosted and so could have a COI on some articles (and here is a plastic surgeon indeffed for COI spam). However, there is no reason to think a doctor is more susceptible to a COI problem than anyone else engaged in business, and in principle there is plenty a doctor could write about that was neutral and properly sourced. An alt-med practitioner believes in selling products with no (or dubious) evidence of benefit and in principle brings an anti-reliable source view to alt-med articles. Johnuniq (talk) 00:10, 3 January 2019 (UTC)
 * Not all of us. Anti-MEDRS is as anti-MEDRS does. --Middle 8 (t • c | privacy • acupuncture COI?) 01:09, 3 January 2019 (UTC)
 * Yes "While editing Wikipedia, an editor's primary role is to further the interests of the encyclopedia. When an external role or relationship could reasonably be said to undermine that primary role, the editor has a conflict of interest. " Because alt-med practitioners' work and worldview is anti-science or pseudoscience, they have great difficulties furthering the interests of the encyclopedia over their livelihood and worldview. It is a false equivalence to assert alt-med practioners are similar to medical professionals in their approaches, but especially in the body of knowledge draw from and the system for expanding and testing that body of knowledge. --Ronz (talk) 23:39, 2 January 2019 (UTC)
 * Yes We do not set the fox to guard the henhouse. Tgeorgescu (talk) 22:15, 3 January 2019 (UTC)
 * Yes but the COI can be disclosed and managed; for example, I am an internal medicine and infectious diseases practitioner who is also a faculty member at Johns Hopkins - an institution disproportionately invoked (because the page linked does not represent a general institutional endorsement of acupuncture) by one of the respondents to this RFC. My user page acknowledges some conflicts of interest that I manage by disclosure and caution. Some of the comments here could be construed to suggest that I have a direct conflict of interest with all medical topics - which seems too simplistic. Most editors have some conflicts of interest (their own interests versus those of the encyclopedia) but I would argue that a disclosed COI is manageable (with some exceptions); an important caveat is that editor restraint is an important aspect of managing COI. — soupvector (talk) 14:59, 6 January 2019 (UTC)
 * Yes, but only regarding effectiveness and scientific veracity, not necessarily on questions of history, techniques, etc. Questions of effectiveness and science are literally questions about the validity of their own job, that's absolutely a conflict of interest. ApLundell (talk) 19:13, 7 January 2019 (UTC)
 * Yes, I think it is fairly self-evident that they do. I also believe that some individuals with a COI are able to edit in a neutral fashion - the COI must be disclosed, though, and the first step is determining that it exists. --bonadea contributions talk 09:17, 8 January 2019 (UTC)
 * A meaningless "yes" The way it's written, about 98% of all editors have a COI. North8000 (talk) 13:38, 9 January 2019 (UTC)
 * Yes for articles on their specific practice. A Reiki healer should not contribute to the Reiki article as they have a pecuniary interest in the sale of the Reiki "product". However, they could contribute to an article on acupuncture. In the same vein, a conventionally trained cosmetic surgeon who did nothing but C02 laser skin resurfacing should not contribute to the corresponding article on that as they have a pecuniary interest in it as a commoditized service. An obstetrician, however, should be able to contribute to the article caesarean section as they don't have a direct pecuniary interest in the marketing or sale of that procedure. Their livelihood is not dependent on the number of C-sections they perform or, indeed, even public belief in C-sections as an effective method to remove one human from another (though, if there's an obstetrician out there who does nothing but C-sections, and maybe has a private practice, the Caesarean Emporium or Caesarean R Us or whatever, then they should be restrained from contributing to the article caesarean section as the C-section for them is a product and not an area of expertise). Chetsford (talk) 10:21, 11 January 2019 (UTC)
 * Yes Practitioners whose business is tied to a particular treatment have a COI with respect to that modality, in a way that regular medicine, which can abandon particular treatments if they are found to be ineffective, and which routinely introduces novel treatments, doesn’t. Brunton (talk) 11:09, 13 January 2019 (UTC)
 * Yes Well, it’s obvious that they have a COI. But, so what? There has to be a follow up to this. O3000 (talk) 00:54, 21 January 2019 (UTC)
 * Yes - Almost certainly. Of course, having a conflict of interest isn't necessarily an obstacle to contributing to an article, but practitioners in fields which are completely contradicted by the credible evidence (homeopathy, Reiki, etc.) have such a vested interest in portraying their chosen field positively that it seems less than likely that they'd contribute positively. And most other practices are similar, even those with limited evidence. --tronvillain (talk) 16:57, 22 January 2019 (UTC)
 * Yes, ApLundell has already put my opinion quite nicely. They clearly have a COI regarding the "effectiveness and scientific veracity" of their work, because it directly impacts their livelihood. Even if they have definitive evidence of ineffectiveness of their treatment, their publishing of such ineffectiveness would be reducing their customer base. Clear COI.-- D Big X ray ᗙ  09:02, 28 January 2019 (UTC)
 * Yes A lot of the counter arguments seem to be based on a false equivalence. A medical doctor does not have a COI with regard to conventional medicine - their interest is in using whatever treatment works best to heal their patient (and they could be sued if they don't), so they have a duty to stay abreast of prevailing mainstream consensus on what does, and does not, work. Alternative practitioners use treatments that have never been shown to work - their livelihood depends upon convincing people that their treatments will be effective despite the prevailing consensus of mainstream clinicians. Girth Summit  (blether)  10:15, 29 January 2019 (UTC)
 * Yes We have blocked alternative medicine practitioners in the past for persistently disrupting articles. Of course someone whose income depends on homoeopathy, acupuncture etc. is going to have a COI on the article about their "practice" which basically says, quite rightly, that it is unscientific nonsense which doesn't work.  This isn't even a difficult argument, and I am gazing with incredulity at some of the "No" comments here. Black Kite (talk) 15:51, 31 January 2019 (UTC)
 * We have blocked alternative medicine practitioners in the past for persistently disrupting articles Exactly, we block them for disrupting articles, this is nothing to do with COI, since we didn't block them just for being an alt med practitioner editing alt med articles. We can block POV-pushers just fine without using the COI guideline. Also, the effectiveness of the thing someone has an alleged interest in is irrelevant to WP:COI, but quite relevant to NPOV. Tornado chaser (talk) 17:19, 31 January 2019 (UTC)

No

 * No. Acupuncture Program - Johns Hopkins Medicine. I, for one, welcome our expert editors from Johns Hopkins School of Medicine one of the topped ranked medical schools in the world. Please provide real examples where this has been a problem so we can come up with a proposal more precise and less sweeping.  Green  C  19:59, 30 December 2018 (UTC)
 * No The editing may be unbalanced, but unless they are writing about themselves, their own business or paid to write, it is not a "conflict". If we say this is a COI, we would have to ban all experts on writing about their own expertise. That would be no doctors writing on medical topics, no historians writing on history etc. For any of these things it can result in imbalance, but it is not COI. So we need multiple points of view, and this includes alternative medicine practitioners. Graeme Bartlett (talk) 22:54, 30 December 2018 (UTC)
 * No Conflict of interest (COI) editing "involves contributing to Wikipedia about yourself, family, friends, clients, employers, or your financial and other relationships." Unless an editor is involved in an article about their practice, it is not COI, per the guideline. Nor is it COI for a conventional physician to edit articles about medicine. TFD (talk) 17:05, 31 December 2018 (UTC)
 * (as CAM professional) Not enough of one to trigger Wikipedia's COIADVICE, same as my !vote in the first RfC.  COI isn't like being pregnant:  you can have it a little bit, or some, or a lot.  (See my signature link.)  My preference is to disclose, proceed with care, and -- hopefully -- let my edits be judged solely on their merits.  More:  Also, per TFD.  Spot on.  That's what WP:COI is saying.  A CAM professional does not reap the specific benefit from puffery as a specifically-connected contributor (say, Smith editing the article on Smith's Bed & Breakfast).  A CAM professional is far closer to a non-CAM specialist than to someone like Smith, whose puffery benefits only Smith, not an entire profession. --Middle 8 (t • c | privacy • acupuncture COI?) 21:41, 31 December 2018 (UTC); added "More" 12:15, 2 January 2019 (UTC); more on "More" 16:42, 6 January 2019 (UTC); rm redundant sentence 22:19, 6 January 2019 (UTC).
 * Striking incorrect spa. A minority of user's edits are to CAM areas.  Per xtools.wmflabs tool.  — Middle 8 (talk • contribs) has made few or no other edits outside this topic.
 * You did, however, "forget" to disclose that you make money selling acupuncture, so your vote that you have no COI is... a COI. Guy (Help!) 09:39, 1 January 2019 (UTC)
 * I don't know the reason for this misrepresentation of my comment and misuse of the spa tag, but please avoid it. --Middle 8 (t • c | privacy • acupuncture COI?) 06:42, 2 January 2019 (UTC)


 * No - See below. Robert McClenon (talk) 22:13, 31 December 2018 (UTC)
 * No No more than an MD has a conflict of interest writing about medicine. This is yet another attempt to silence anyone who doesn't tow the skeptical line about complimentary medicine and in particular a witch hunt against User:Middle 8... 4,3,2,1 "But acupuncture is pseudoscience and its evil!" See Talk:Acupuncture for background on this. Morgan Leigh | Talk 22:56, 31 December 2018 (UTC)
 * Striking incorrect spa. A minority of user's edits are to CAM areas.  Per xtools.wmflabs tool.  — Morgan Leigh (talk • contribs) has made few or no other edits outside this topic.
 * No Not inherently so. I think nailed it.  Specialists have specialist knowledge and this is not a COI.  Certainly, people in the field of alternative medicine are no more COI than an MD writing about their specialty or a PhD writing about the topic where they teach. I favor balance and NPOV, but the MEDRS and SCIRS gang need to remember that not all "alternative" medicine consists of quack remedies promoted by hucksters. It's all about balance and accuracy.  Montanabw (talk) 00:18, 1 January 2019 (UTC)
 * No and  has have good points. Saying an editor has a COI just because of their profession is a mistake, by this logic MDs should not be able to edit articles about energy healing, because if energy healing was real(which it's not) it would be a threat to doctor's livelihoods. Do we really we want to go down the road of restricting editors from editing the topics they know the best? This proposal appears to be an attempt to stop POV pushing by twisting WP:COI. Given that we have a policy against POV pushing, and discretionary sanctions that can be enforced against POV pushers editing alternative medicine, this proposal is completely unnecessary. Question for closer I have noticed that some of the Yes voters are saying that alternative medicine practitioners who vote No are conflicted votes, yet it seems to me they are only conflicted if the RfC is closed in favor of the Yes voters, it's like having a referendum about whose votes count in referendums, and I don't know what the right way to deal with this is, but please explain how you addressed this issue when you close this. Tornado chaser (talk) 14:07, 1 January 2019 (UTC)
 * No - Sometimes they do, but count me as No. Surgeons have a point of view in favor of surgery, acupuncturists in favor of accupuncture. COI in the sense it is being used here, implies a financial interest making it impossible to edit Wikipedia on related topics in a NPOV manner. And that may or may not be the case, depending on the individual and the topic. This is regulatory creep. No. Carrite (talk) 03:45, 1 January 2019 (UTC)
 * No They have a COI when writing about their specific practice, i.e. their clinic if it's notable, not when writing about their field of study. Besides which, having the kind of people who advocate for fake medicine disclose COI, is not going to make it any harder for them to do what they do now, which is cherry pick sources and barrage the talk pages with wiki-lawyering and nonsense in order to influence article content. Our articles already benefit from policy based mechanisms, which support the removal of bunk. Our policy on COI necessarily states A COI can exist in the absence of bias, and bias regularly exists in the absence of a COI. Beliefs and desires may lead to biased editing, but they do not constitute a COI. Voting yes to this policy, would be avocation of a change to this fundamental policy and risks propagating further changes based on the result of this discussion. Experts in a field have the potential to contribute positively to articles in their specialist field and should not be prevented (or limited) by policy from making contributions, even if they are specialists in powdered unicorn horn or similar. In short the significance of the potential change to wiki-policy is not warranted by the relatively minor benefits this proposal would have on troll sniping on alt med articles. Edaham (talk) 04:57, 1 January 2019 (UTC)
 * Acupuncture is their specific practice. Every edit that makes acupuncture look good, is financially beneficial. Guy (Help!) 09:48, 1 January 2019 (UTC)
 * thanks for taking the time to comment. As I’m sure you are aware I am very much against having quacks creeping around promoting witchcraft, but my point, which I’ll clarify is that unless they are writing an article about their “specific clinic” then their views on a subject amount to a strong bias, not a COI. That’s how I feel about the current policy as it’s written and for the encyclopedia to thrive and maintain inclusivity I think it should stay that way. Edaham (talk) 10:19, 1 January 2019 (UTC)
 * Even the strong bias isn't a rule, at least as long as editors put the interests of WP above their own interests/biases. There have been and still are some pretty clear-eyed and consensus-respecting CAM professionals on WP who have been here awhile (Herbxue for example) and they wouldn't have lasted this long if they were really misbehaving. --Middle 8 (t • c | privacy • acupuncture COI?) 14:12, 6 January 2019 (UTC)
 * Rarely. So far as I know a conflict of interest refers to a direct personal connection.  It should not be a conflict of interest for a registered Democrat to edit an article on Hillary Clinton, nor even for a Democratic state Senator to edit an article on Hillary Clinton, but it would be a conflict of interest for one of Hillary Clinton's employees, drawing a paycheck she signs, to edit that article.  Similarly, it is not a conflict of interest for a plastic surgeon to write about a plastic surgery technique, even if he disagrees with my "unbiased" (supposedly) eye that tells me silicone lips are ugly.  COI is not about having a Wikipedia free of bias, because that is exceedingly difficult.  Ideally, we should use our biases to inspire us and provide us with the depth of background knowledge to add useful sources to articles, while restraining our biases from tempting us to remove any conflicting point of view.  That said, if one person holds the patent for putting leeches up a rectum, and he edits Wikipedia articles saying that's the greatest thing ever, then that would be a COI.  The same situation could exist for a more conventional medical procedure. Wnt (talk) 05:08, 1 January 2019 (UTC)
 * A Democrat is not directly vested in a single candidate. If the party chooses a different candidate, they can change allegiance to the other candidate or support their original candidate as an independent. When evidence shows that a form of quackery is invalid - acupuncture, say, or homeopathy - the practitioner community cannot adopt a different practice. They are vested in one single thing, which science says is wrong. You can't stop acupuncture and start doing chiropractic, there's a long training period in each. Read up on Britt Marie Hermes, who invested several years and many tens of thousands of dollars training as a naturopath, only to realise that naturopathy is bogus. That's a seriously difficult thing for anyone to do, and cognitive dissonance mitigates heavily against it. The acupuncture article has a years-long history of practitioners and True Believers trying to rewrite Wikipedia to reflect the fictional world in which meridians and qi exist. The homeopathy article was, for years, dominated by quacks such as Dana Ullman.
 * An acupuncturist or homeopathist editing those articles has a direct financial vested interest in the content they are editing. If they leave content that says their practice is bogus, they suffer financially If they insert content that obscures that fact, they gain financially. It is really pretty simple. Guy (Help!) 09:47, 1 January 2019 (UTC)
 * Your example is its own disproof. Hermes now has her own Wikipedia article due to her success as a "naturopathy apostate".  She is not homeless or working the cart return machine at Walmart.  Moreover, your assumption is that a Wikipedia editor will take a thoroughly altruistic position about being selfish.  Why can't a qigong practitioner pitch to the suckers by day to pay the bills, then post damning evidence against the practice to Wikipedia by night, under a pseudonym if need be?  He knows no one person saying the truth is going to make his bread and butter go away, or it already would have.  So no -- your argument is completely unsupportable.  And if it were supportable, then we would have to ban plastic surgeons writing about plastic surgery for all the same reasons. Wnt (talk) 16:33, 1 January 2019 (UTC)
 * No - no more so than an art historian writing about art, a chef writing about food, or a mainstream medical practitioner writing about mainstream medicine. Also, why is this RfC pointless straw poll clogging up a noticeboard? Andy Mabbett ( Pigsonthewing ); Talk to Andy; Andy's edits 13:30, 1 January 2019 (UTC)
 * Why yes, it's exactly the same. I mean, it's quite true that chefs, for example, could have a conflict of interest in whether food is an effective treatment for hunger, skewing the question of "Is food necessary?" NPOV demands that we don't let Big Food dominate that question. --Calton | Talk 11:17, 2 January 2019 (UTC)


 * No - for this to be legitimate, we'd have to say that less-legitimate fields of work generate COI for its practioniers - but (for example) conventional medicine doesn't rule doctors out. While I could be sympathetic towards this viewpoint, it topples us down a massive rabbithole and would remove any ability for Wikipedia to claim to neutrally discuss issues - we'd have sacrificed NPOV before even starting. Nosebagbear (talk) 15:50, 1 January 2019 (UTC)
 * No - not inherently. Being in favour of something is not necessarily COI. The medical and political examples given above apply. Llwyld (talk) 00:08, 2 January 2019 (UTC)
 * No, except to the extent of pages about their specific organizations from which they derive income. I get it, that alt med practitioners differ from other professionals in having a fringe-based perspective, but that's a matter of POV-pushing in which there is no need to worry about the COI guideline. POV-pushing is POV-pushing, regardless of the motive. --Tryptofish (talk) 00:34, 2 January 2019 (UTC)
 * No: I agree with everything wrote, but I think that it leads to the conclusion "no" rather than "yes".  Articles touching on alt-med subjects are constrained by our policies on reliable sourcing and deserve to be tightly policed, but COI is not a good lens through which to view the problem.  --JBL (talk) 03:57, 2 January 2019 (UTC)
 * No. They have a lack of neutrality and as such their edits should be assessed in the same way we'd treat the edits of a political activist editing the articles on their party or their opponent, but when it comes to something like homeopathy or acupuncture the number of practitioners is so high, any COI is minimal. If someone is advertising a particular firm or a technique only provided by a small number of practitioners of which they're one, there's a COI, but otherwise provided their edits adhere to NPOV I wouldn't consider it any more problematic than an employee of General Motors editing Internal combustion engine. ‑ Iridescent 20:33, 2 January 2019 (UTC)
 * Also adding that for once I agree entirely with Pigsonthewing on something; this proposal can essentially be summarised as "someone who works in a field is automatically unqualified to write about that topic in Wikipedia terms", which is a precedent we not only shouldn't be setting, it's a precedent an RFC on a relatively unwatched board like COIN probably set since it would have implications so far-reaching the board would probably need to sign off on it. ‑ Iridescent 20:40, 2 January 2019 (UTC)
 * No. As per Iri above, although Guy makes a very good point. Experts in Vaginal steaming might be better employed at Goldfinger, of course. Martinevans123 (talk) 20:51, 2 January 2019 (UTC)
 * No. Doctors don't have COI in medicine, nor do lawyers in law. Neither should astrologists in astrology or acupuncturists in acupuncture. COI should apply to their organization, or themselves, but not to the entire field. Levivich (talk) 02:31, 3 January 2019 (UTC)
 * Oppose I concur with who says that this seems like a proposal to change WP:COI. COI is a good policy which exists outside of Wikimedia projects and has a certain definition to mean bias because of money. COI is a problem, and promotionalism for alt med and other passionate topics is a problem, but these are not the same problems. I support efforts to protect Wikipedia from COI and from alt med, but I disagree that the path to resolution is in combining these topics. Anyone can feel free to take protection schemes which work for one model and apply them to others, or even make a general protection scheme which applies to all. COI is not the generic term and concept to describe all problems. Wikimedia projects do not define COI - they adopt this term from much broader, much more developed practice elsewhere.   Blue Rasberry   (talk)  15:30, 3 January 2019 (UTC)
 * No - that is just an all around questionable proposal. Would personal trainers have COI about fitness and physical exercise topics? After all it is in their financial interest to have the most positive coverage possible, encouraging more people to use their services. Taxi drivers livelihood can be negatively impacted by popularity of ride-sharing services, do they have automatic COI on that topic? Etc.--Staberinde (talk) 16:54, 3 January 2019 (UTC)
 * No -- per above arguments. --David Tornheim (talk) 13:30, 4 January 2019 (UTC)
 * No, per discussion and comments. Randy Kryn (talk) 16:45, 4 January 2019 (UTC)
 * no per all of the above editors--Ozzie10aaaa (talk) 18:04, 4 January 2019 (UTC)
 * No per Iridescent and the concern that this will form a precedent/slippery slope for stretching the COI definition further and further. We work/get inspired by precedents quite frequently on Wikipedia. Jo-Jo Eumerus (talk, contributions) 19:22, 4 January 2019 (UTC)
 * No Per Edaham. Yes, we should avoid allowing quacks to use Wikipedia as a forum to promote their quackery, but it is even more important (to the Encyclopedia, if not necessarily to the real world) to distinguish between "bias" and "conflict of interest". I once had an editor accuse me of having a "conflict of interest" in the Rodrigo Duterte article because I stated on-wiki that I disapproved of death squads; having community consensus that a bias is the same as a COI in this one case sets a very dangerous precedent, and leaves the path open for advocates of a particular point of view to write things like this to attempt to silence those with an opposing point of view, which is clearly the opposite of the effect intended by those !voting "yes". (Ironically, both the sender and recipient of the above bogus notice are !voting the same way here, though clearly for opposite reasons.) Hijiri 88 ( 聖やや ) 02:10, 5 January 2019 (UTC)
 * BTW, I think there is a "bright line" between cases like this, where a large number of people would indirectly receive financial benefit by promoting something on Wikipedia to the point where a large portion of the public who rely on Wikipedia for their information accepted it, and cases like what, and  were trying to pull, where the fringe content they were promoting (and directly advertising on Wikipedia by posting them in the EL sections and citing them as sources for articles) was being pushed by a very, very small number of people in the real world, to the point that it could reasonably be assumed that any Wikipedia editor pushing it had a direct personal connection to the real-world people pushing it; granted, if I could go back in time and deal with those editors again, I might do so differently, but I didn't want anyone calling me a hypocrite, since I suspect I accused those editors of "conflict of interest", using those words, way back when. Hijiri 88 ( 聖やや ) 06:24, 6 January 2019 (UTC)


 * No as per . Bondegezou (talk) 16:54, 5 January 2019 (UTC)
 * No, not exactly. An altmed practitioner who is editing about altmed subjects, has no more conflict of interest than a conventional healthcare provider who is editing about cough syrup (which doesn't work) or whatever surgery s/he gets paid to do.  They might be equally biased, but it's not a COI.  For actual COI, see, e.g., employees of a pharmaceutical company editing articles about their own products, employees of hospitals writing articles about their hospitals, cosmetic surgeons creating pages about themselves or techniques they've invented/trademarked/patented, etc.  WhatamIdoing (talk) 20:57, 5 January 2019 (UTC)
 * No as for the most part, they genuinely believe it works and that is the primary driver. And as long as they are not paid, or in some relationship under soft coercion or following an agenda.  scope_creep Talk  22:37, 6 January 2019 (UTC)
 * No, per Whatamioing. We let cosmetic surgeons write about cosmetic surgery procedures, which is equally problematic and equally not against policy. Clayoquot (talk | contribs) 22:17, 7 January 2019 (UTC)
 * No - not as a class of editors. Not unless you think lawyers have a COI editing law articles or doctors in general have a COI editing medical articles. FOARP (talk) 12:10, 8 January 2019 (UTC)
 * Not in any meaningful way - To rephrase this "do people who hold a job have a conflict of interest when writing about their field of study?" Replace any of the above jobs, and see if it affects Wikipedia policy "Do road engineers have a conflict of interest when writing about road construction techniques?"  "Do farmers have a conflict of interest when writing about agricultural practices?"  Not really, in general we don't treat such relationships as a COI.  That does not mean we don't reflect existing, mainstream, scientific assessments of quackery as quackery.  It just means we don't treat people who hold jobs as somehow under any kind of cloud of suspicion when they write about their field of expertise.  Just like we wouldn't treat a professional chemist as somehow under suspicion when they write in our articles about chemistry, we should treat other professions any differently .  -- Jayron 32 14:03, 9 January 2019 (UTC)
 * Are you familiar with cold fusion? Or Dana Ullman? Guy (Help!) 11:02, 12 January 2019 (UTC)


 * No Herbxue (talk) 21:41, 11 January 2019 (UTC)
 * No. A practitioner of alternative medicine has no more of a COI on content describing their field of practice than a religious leader has a COI on content relating to theology. Otherwise, Carrite and Jayron32 said what I wanted to say. feminist (talk) 09:48, 12 January 2019 (UTC)
 * No, not per se, unless we recast WP:COI policy to define practice in any field as a COI when writing about that field. As @Jayron32 notes, if we did that, we would anyone with practical experience of a field: exclude all clergy and theologians from writing about religion, all doctors from writing about medicine, all political activists from writing about politics etc. As FOARP notes, that would even exclude lawyers from writing about law.  It's a recipe for having an encyclopedia written by people with minimal knowledge of the topic.  It's pretty much saying that Randy in Boise is the only editor allowed to write about anything, on account of him being untainted by an expertise.
 * However, an alternative medicine practitioner does have a COI when writing about their own colleagues or their own practice, just as a doctor or engineer or priest or businessperson has. -- Brown HairedGirl (talk) • (contribs) 02:28, 13 January 2019 (UTC)


 * No, with all of the caveats others have brought up (COI when writing about something specific from which they could benefit). Schazjmd (talk) 00:51, 21 January 2019 (UTC)
 * No, not necessarily. VQuakr (talk) 04:07, 22 January 2019 (UTC)
 * Mostly No per FOARP, Graeme Bartlett and BrownHairedGirl. One of the 'yes' voters suggested no votes should be discounted per WP:Fringe. In fact, in line with the great arguments from WhatAmIDoing & Colin below, the more informed view would be that it's the extreme yes arguments that are incompatible with impartial mainstream science. To save clogging up this section with a long post, I'll elaborate in the "This is just weird section" below. FeydHuxtable (talk) 21:02, 27 January 2019 (UTC)
 * No, not inherently. A person employed to sell herbal medicine has no more and no less of a conflict of interest than a person employed to sell conventional medicines or a person employed to sell fruit. A practitioner of reflexology has no more or less conflict of interest than a practitioner of physiotherapy or a practitioner of law. Thryduulf (talk) 09:45, 29 January 2019 (UTC)
 * No practitioners in any field do not necessarily have a WP:COI. It is case by case and the edits they make, as with anyone on Wikipedia. A rule singling out a profession is not appropriate. PackMecEng (talk) 17:11, 29 January 2019 (UTC)

Sometimes

 * Sometimes. I'm boldly adding a third option as I don't believe a blanket judgment is useful here. If someone is here to promote a particular point of view, and has a real-life connection to that subject, then they have a COI. However, contributors considered experts in their field should always be welcome, provided they edit according to policies and community norms. The difference between these two is governed by common sense. Brad  v  🍁 20:57, 31 December 2018 (UTC)
 * Difficult question. I'm sympathetic to the idea that there's an inverse correlation between the legitimacy of a field and the likelihood that a practitioner in that field will edit such articles in a way incompatible with Wikipedia content policies and guidelines. Ultimately, however, I'm not in the "yes" section because I think it largely overlaps with WP:EXTERNALREL. I have no problem with an acupuncturist writing about the history of acupuncture (generally speaking), for example. That said, I'm not in the "no" section because I do think there's one aspect of this that we can say there's an inherently problematic COI: the matter of its legitimacy itself. In other words, I would be a "yes" if the question were phrased "...with regard to the [legitimacy/scientific accuracy/similar] of their field of practice." — Rhododendrites  talk \\ 01:22, 1 January 2019 (UTC)
 * Often, not always. This is a slippery slope - do we want to view legitimate doctors as having a COI in relation to regular medicine? Other fields? Cutting down on medical quackery on Wikipedia is a sound goal, but a blanket assertion of COI is not the way forward.Icewhiz (talk) 18:51, 3 January 2019 (UTC)
 * They have a potential COI, but they are fine - as far as their editing does not cause significant objections from others or conflicts. BTW, editing in this specific subject area is not really different from editing in any other subject areas. We edit pages about fairy tales, whatever. It does not matter if a subject belongs to science.My very best wishes (talk) 16:31, 4 January 2019 (UTC)
 * Put me down here, I guess. I agree that there is a real concern that practitioners of specific alt-med approaches can promote them on Wikipedia in ways that violate any rational understanding of WP:COI. (Dana Ullman comes to mind, as does the Transcendental-Meditation brigade). But I don't agree that alt-med practitioners inherently have a disqualifying COI. My view is based in part on my experiences here&mdash;I've had the pleasure of co-editing with chiropractors and acupuncturists who were scrupulous and fair in representing their professions on Wikipedia, and I think the site would have been poorer for it if we'd dogmatically excluded them. I guess I would argue that COI is a concern for alt-med practitioners editing in their professional topic area, and that we should have a heightened awareness of the potential for conflicts and a lower threshold for acting on them. But I also think we can benefit from an inclusive approach to alt-med practitioners who understand this site's goals and policies and are willing to work within them, and I know that such people exist because I've worked with some of them. MastCell Talk 18:01, 29 January 2019 (UTC)

Threaded discussion

 * Note to closer The result of the previous RfC was no consensus. As we have seen, some editors took that as meaning "practitioners of alternative medicine never have a conflict of interest and have no restrictions with regard to content describing their field of practice" while others took that as meaning "practitioners of alternative medicine always have a conflict of interest and have severe restrictions with regard to content describing their field of practice." I would request that the closing summary be made crystal clear as to what is and is not allowed, and which existing policies apply and how to apply them. A clear explanation will help to avoid re-litigating the meaning of this RfC on multiple pages. --Guy Macon (talk) 04:40, 1 January 2019 (UTC)
 * I'm not sure if we need this in addition to WP:FRINGE, WP:MEDRS, etc., but a lot of No voters seem to be genuinely unaware of how shady alternative medicine is and are AGFing that the typical public presentation of alternative medicine practices is even vaguely sincere and not a result of well-crafted PR work. The majority of alternative medicine consists of treatments that were proven ineffective in controlled trials, and whose existence in the field relies on false marketing, misrepresentation, and acts that would in a reasonable society be widely recognised as blatant hoaxes. It's only PR that keeps presenting decades old tried-and-failed practices as up-and-coming that allows most parts of this industry to thrive, and get grouped together with legitimate but controversial serious controlled medical experiments. I'd recommend everyone to watch a couple of episodes of Penn & Teller's Bullshit!, which while sensationalist and not altogether accurate, shows a few good examples of shameless abuse of facts perpetrated in the course of converting people to alternative medicine.  Daß    Wölf  18:18, 1 January 2019 (UTC)
 *  Another note to closer I have grave reservations about Guy Macon's request, because that's not (at all) what the RfC asks, and many have not attempted to answer.  It's a straight yes/no (with a "sometimes" added after eight !votes).


 * Nor is this the proper way to change WP:COI, which this is an attempt to do in all but name (although opener Guy Macon acts in good faith). That guideline is clear that simply having a profession is not a COI (see talk archive).  Guidelines are to be taken with "common sense and the occasional exception".  This RfC contemplates neither ("CAM professionals" is a broad exception, and here "common sense" is common only to a plurality minority).  There is either consensus to change the guideline or there isn't.  There's our clarity.  --Middle 8 (t • c | privacy • acupuncture COI?) 08:24, 2 January 2019 (UTC); revised 09:03, 2 January 2019 (UTC); plurality --> minority 22:25, 6 January 2019 (UTC)
 * Middle 8 (Who I believe as a person who is an acupuncturist has a COI, and who believes that he does not have a COI -- thus this RfC) Makes the claim that "WP:COI is clear that a simply having a profession is not a COI", but that language was removed years ago, The current consensus wording of the policy is at WP:EXTERNALREL, which says "While editing Wikipedia, an editor's primary role is to further the interests of the encyclopedia. When an external role or relationship could reasonably be said to undermine that primary role, the editor has a conflict of interest... Any external relationship -- personal, religious, political, academic, legal, or financial (including holding a cryptocurrency) -- can trigger a COI. How close the relationship needs to be before it becomes a concern on Wikipedia is governed by common sense. For example, an article about a band should not be written by the band's manager..." This is a direct contradiction to Middle 8's claim. If your profession is band manager for The Ventures, then simply having that profession is a clear COI which applies to editing our article on the Ventures. In my opinion (and of course Middle 8 disagrees; see User:Middle 8/COI for his argument) the fact that his profession is "acupuncturist" gives him a COI concerning our acupuncture article, same as the band manager. --Guy Macon (talk) 09:14, 2 January 2019 (UTC)
 * False equivalence. Your argument is akin to saying that the manager of the Ventures has a conflict of interest regarding the article "talent manager". That's tosh. Andy Mabbett ( Pigsonthewing ); Talk to Andy; Andy's edits 09:23, 2 January 2019 (UTC)
 * So you agree that the band managers profession alone gives him a conflict of interest on some pages (the policy does say "For example, an article about a band should not be written by the band's manager") but are simply pointing out that he doesn't have a COI on some other pages? Sounds like you are agreeing that the claim "On Wikipedia, simply having a profession is not generally considered a COI" is a false statement if the profession is "band manager" and the page is about the band he manages. --Guy Macon (talk) 12:32, 2 January 2019 (UTC)
 * I don't recall asking you to speak for me. Andy Mabbett ( Pigsonthewing ); Talk to Andy; Andy's edits 17:21, 2 January 2019 (UTC)
 * We have a couple of pages that may help you to understand what other editors write: Question mark and Question. I hope this helps. --Guy Macon (talk) 03:55, 3 January 2019 (UTC)
 * Surely it follows then Guy that you, being an electrical engineer, couldn't edit any articles that are in any way related to electrical engineering and should disclose your COI in that respect? Morgan Leigh | Talk 03:19, 3 January 2019 (UTC)
 * That's actually a very good question. If, as is the case with acupuncture, Wikipedia's pages on electronics were based upon multiple reliable sources that say that electricity and electronics don't work, that the results that you get from a high-end laptop computer are indistinguishable from the results from a clay tablet, and that hiring an electronics engineer is a waste of time, then I would have a clear COI and should never edit those pages to imply that electronics actually work.`In fact pretty much any edit I made in that area would be prohibited because of my COI. Why? because the mere existence of those pages and those sources would hurt me financially, just as the mere existence of our acupuncture page hurts Middle 8 financially. As it is, I don't edit anything having to do with electrohydraulic actuators, for example, because is does affect me financially when someone chooses a hydraulic actuator over an electrohydraulic actuator. So if I ever felt a need to edit on that topic, I would disclose my COI, make suggestions on the talk page rather than editing the page directly, and everything else listed at Best practices for editors with close associations. --Guy Macon (talk) 03:55, 3 January 2019 (UTC)
 * That's awfully specific. It's like saying that an acupuncturist who only uses copper needles is ok to edit other stuff about acupuncture that is done with steel needles. I'm guessing you wouldn't agree with that. The thing is the evidence about acupuncture doesn't show its a waste of time. As people who read the article would be able to know if you'd let us add any studies that show this, like these seven Cochrane reviews. But you never do. Morgan Leigh | Talk 04:31, 3 January 2019 (UTC)
 * No it's not. The example was sound: if the two schools of thought were that electricity is a real thing versus electricity is witchcraft, and the scientific consensus was that electricity is witchcraft, then an electrical engineer would have a COI.
 * Remember: we know that it doesn't matter where you put the needles (both from studies and from mutually incompatible schools of acupuncture), we know it doesn't matter if you put the needles in or not (so acupuncturists claim it is so magical that even fake acupuncture works), and significant effects are only found in self-reported outcomes for subjective effects. In science, that means it doesn't work. There's nothing left to explain, the results are fully consistent with the null hypothesis.
 * An acupuncturist cannot adapt their practice in line with this evidence. The only ethical course is to stop sticking needles into people, and they have both a quasi-religious imperative and a financial imperative for continuing to stick needles in people. They have invested a lot of time and money in becoming an expert in something, and part of that is indoctrination into the cult that absolutely believes it to be true. So they come here to bring The Truth™, a version of the universe where their beliefs are correct. But Wikipedia is a reality-based project and we can't have fiction presented as fact by people with a vested interest. Guy (Help!) 08:52, 3 January 2019 (UTC)
 * Hello, hello, (taps microphone). Is this thing on? The evidence does not show that. The Wikipedia article says that because you work super hard to stop evidence being added.Morgan Leigh | Talk 10:24, 3 January 2019 (UTC)
 * Thank you for an excellent example of the problem. Sure, for the True Believer, the evidence does not show that. But for the reality-based community (and remember Wikipedia is a reality-based project) it absolutely does.
 * There are numerous studies that show the location of needling makes no difference, and none that show the opposite (otherwise there could not be competing schools of acupuncture). In fact this resistance to empirical fact is common to many forms of SCAM. Homeopathy also has competing schools of thought that are mutually exclusive, but members of all of these jointly agree that all studies that appear to validate any school, validate all schools. That's why SCAM is widely understood to be quasi-religious, not scientific, in nature.
 * Comparing needling with non-needling is more difficult due to the issue of blinding, and double-blinding is close to impossible. One of the better experiments is Ernst's stage dagger needle trial. A number of well designed studies show to a high degree of certainty that inserting the needles or not, makes no difference. And this is taken by the acupuncturists as validation of acupuncture, because "fake acupuncture works as well as the real thing". That is literally the argument they make.
 * And yes, the article says this mainly because it has been watched by a number of reality-based editors who have met and addressed an endless stream of True Believers wanting to reshape reality in the image of their own beliefs by editing Wikipedia, in much the same way that quacks use "legislative alchemy" to mandate by legal fiat that dangerous bullshit is legitimate. Guy (Help!) 11:32, 3 January 2019 (UTC)


 * - Really? At the time, you wanted to restore that wording and agreed that SlimVirgin's rewording (which SV made without discussion or controversy, and which SV told you retained the meaning) was an improvement!  (All this is in that talk archive.)  And you quoted most of EXTERNALREL (re which Andy Mabbett is correct) EXCEPT the relevant paragraph about subject matter experts (with SV's wording).
 * Also (and I'm not trying to pick a fight), could you please refrain from putting words in my mouth? I do say I have a COI, just the kind that all subject matter experts have -- itself a spectrum, and I agree CAM is on the far (more conflicted) end, but not uniquely so.  This is pretty clearly implied in my !vote and explicitly stated below.  Thanks, GM.  --Middle 8 (t • c | privacy • acupuncture COI?) 11:55, 2 January 2019 (UTC)
 * [EC] Please edit User:Middle 8/COI to clearly disclose that you have a COI. Right now it says "Do practicing acupuncturists have a conflict of interest (COI) when editing acupuncture-related articles? ... On Wikipedia, opinion on the matter is divided..." and "On Wikipedia, simply having a profession is not generally considered a COI" (quoting wording that was removed from the policy years ago). Until I see a clear declaration on your user page that you have a COI (adding an argument that you should be allowed to edit pages about your profession anyway is fine) I stand by my assertion. --Guy Macon (talk) 12:32, 2 January 2019 (UTC)
 * No, I'm happy with it as is, although I'd prefer that you avoid a tone or other implication that I'm somehow doing something improper (given that my reading of WP:COI is shared by many, if not most, who have commented).
 * I also think it's a bit disingenuous for you to imply that the change in wording necessarily changed the meaning when you yourself wanted the original wording to remain, and were satisfied when SV explained that that the meaning remained. You have every right to change your mind, of course.  I'm curious why, and it might help move the debate along if you explained.  (In any case, I'll do you the courtesy of not repeating that Guy Macon "denies" that he once agreed with my, and the author's intended, reading of the guideline). --Middle 8 (t • c | privacy • acupuncture COI?) 14:23, 2 January 2019 (UTC); minor revision 15:06, 2 January 2019 (UTC)
 * And that is why we have to codify it at a policy level, because people like you who have a direct vested interest in portraying an archaic alternative to medicine as valid, refuse to acknowledge that this is a conflict with the potential to bias your editing. Guy (Help!) 21:52, 2 January 2019 (UTC)
 * "just the kind that all subject matter experts have" ← this exemplifies a problem here. Somebody who is a "subject matter expert" on (say) the history of their local town does not have a confict of interest in "just the same way" as somebody who sells a product for money, particularly if they are heavily invested in that product (through training, reputation and client-base e.g.). The COI becomes acute when the very credibility of that product is in question on Wikipedia, and edits are made which bear directly on that question of the product's credibility. This is just as true for altmed offerings (like acupuncture) as it is for "conventional" medical devices (like the DizzyFIX), or non-medical products (like Amsoil). What you are basically arguing - and I supect fooling yourself into the bargain - is that the potential effect on your wallet is not importanrt. As Upton Sinclair wrote: "It is difficult to get a man to understand something when his salary depends upon his not understanding it". I have to LOL at some of the votes here from editors who would go ballistic if a Monsanto researcher claimed they were free to edit the Glyphosate article because they were merely a "subject matter expert"! Alexbrn (talk) 12:20, 2 January 2019 (UTC)
 * As you know, Alex, Cochrane treats CAM professionals' no differently from other specialists, COI-wise. If your argument is obviously correct, why is that so? --Middle 8 (t • c | privacy • acupuncture COI?) 13:11, 2 January 2019 (UTC)
 * Cochrane (whose policy you are misappropriating anyway) is not Wikipedia, most importantly because it is not a consensus-based collaborative project (for which COI is ruinous): its work is professionally reviewed, and it does of course require transparency from its contributors who are held to ethical standards. On wikipedia most fringe POV-pushers hide behind a pseudonym. Alexbrn (talk) 13:17, 2 January 2019 (UTC)
 * Misappropriating Cochrane how?
 * Your argument strikes me as special pleading, and as I've shown, this supposed problem is uncommon. The worst POV-pushing isn't coming from declared CAM practitioners.  As you noted, it's coming from pseudonymous editors, most of whom declare nothing (I wonder why?). (I am pseudonymous only because of harassment concerns, btw, and was the target of an outing attempt "justified" by COI.)  --Middle 8 (t • c | privacy • acupuncture COI?) 14:53, 2 January 2019 (UTC)
 * You implied somehow an altmed practitioner would not have a COI according to Cochrane - but in fact they would be required to disclose any related income sources (and any other relevant associated interest, very broadly drawn: "... relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote ...") on the COI form, and would be assessed. As for anonymity you can't have it both ways: Cochrane has its rules and they include transparency and peer review (itself subject to COI vetting) prior to publication. How you edit here is nothing like that: you are anonymous editor with power to insta-change content. So really the parallel is irrelevant - the "special pleading" is coming from you. We have a lot of trouble with anonymous fringe POV-pushers; in fact non-anonymous ones are more rare, I'd say. Alexbrn (talk) 15:19, 2 January 2019 (UTC)
 * Anons/pseudons who don't declare, yes. Re Cochrane:  if they treat CAMmers differently, please show me.  Generally: Just revert me if I make a bad edit, but do so because of the content, not the contributor (otherwise be ready to defend it to AE).  Your attempt to change the guideline (which is what this is; see my thread-opener & talk archive linked there) obviously isn't going anywhere, so I suggest putting down the stick and leaving the ex- parrot horse be. --Middle 8 (t • c | privacy • acupuncture COI?) 16:18, 2 January 2019 (UTC)
 * I'm not attempting to change anything, but I do want to counter the implication that somehow altmedists don't have a COI here "because Cochrane". Ultimately it's problematic behaviour and editing which will get problem editors in this space sanctioned - and that's a path you've already started on, as came out at your last AE outing ... and that's what we know just from this account you've used. Alexbrn (talk) 16:53, 2 January 2019 (UTC)
 * Yes, your position represents a change, just read that talk page. Cochrane: You misunderstand my argument.  Read my sig link on COI (I have one for acu under Cochrane but not WP).  In fact, please read the privacy link too.  No, the only warning is on this account, and I do regret bringing that AE.  That was a bad day, bad week, adverse drug reaction to a prescription acting on the CNS.  We're all allowed occasional mistakes, no?  --Middle 8 (t • c | privacy • acupuncture COI?) 17:38, 2 January 2019 (UTC)
 * My dear fellow, we can all make mistakes certainly. But a pattern of mistakes all tending to a certain end could be strong evidence of a COI powering them, even if unconsciously. Alexbrn (talk) 18:31, 2 January 2019 (UTC)
 * Yes, H. sapiens is a brilliant pattern-recognizer. Go for it, but I don't think anyone cares about what happened 4, 5+ years ago.  Call it the price of good judgement (scroll to Rita Mae Brown).  Even old farts like me do learn, you know. --Middle 8 (t • c | privacy • acupuncture COI?) 19:03, 2 January 2019 (UTC)
 * Cochrane is not Wikipedia, but even if it were, they have published some seriously bad analysis by people whose own crappy work dominated the sources they were using. Argumentum ad Cochrane is a fallacious appeal to authority.
 * But the issue of "subject matter experts" is a serious point here. A subject matter expert on acupuncture looks like Edzard Ernst or Steve Novella. These are people who critically examine the research looking for overt and covert bias, with a view to finding out if it's real or not. Anyone who makes their living promoting or practicing acupuncture, homeopathy or whatever, is not a subject matter expert. Their status in respect of alt-med is that of theologists in respect of evolutionary biology. They are experts on what true believers believe, but not on the empirical truth of those beliefs. And the unwillingness or inability to accept hat is why a COI exists. Guy (Help!) 11:44, 3 January 2019 (UTC)
 * @ Guy Regarding what you/anybody thinks about what alt-meders/anybody else believes, I have to periodically remind you of this exchange. At the very least be wary of generalizing about people, as well as overgeneralizing COI into something broader and not commonly accepted (see Bluerasberry's !vote ). --Middle 8 (t • c | privacy • acupuncture COI?) 19:14, 3 January 2019 (UTC)


 * Comment: Not sure this question should be limited to altmed. We already have WP:MEDCOI. Surely anybody who has a financial interest in sellling something specific, has a COI, whether it is in "conventional" medicine (say, specialising in a plastic surgery procedure) or altmed (say, being a rolfer™). Why do we need to have any kind of special treatment for altmed specialists? - they're already covered. Alexbrn (talk) 19:12, 30 December 2018 (UTC)


 * As a wise person going by the name of Alexbrn once wrote:


 * "It is a false equivalence between (most) altmed practitioners and 'western-medicine MDs'. The latter operate in a wide field and if certain therapies and products are found useless they simply adjust to new ones. In altmed the therapy is usually one specific intervention and so there is no 'off ramp' - the practitioner's livelihood is thus strongly bound to assessments of that therapy's worth. So, an advocate of crystal therapy does not operate in a way which responds to evidence. Of course in conventional medicine too editors here have COIs when they have close links to particular medical products or therapies; problems like that happen here often too." (Posted by Alexbrn to Wikipedia talk:Conflict of interest on 11 May 2015 UTC)


 * I'm just saying. :)  --Guy Macon (talk) 19:26, 30 December 2018 (UTC)
 * Acupuncture Program - Johns Hopkins Medicine. I, for one, welcome our expert editors from Johns Hopkins School of Medicine one of the topped ranked medical schools in the world. Please provide real examples where this has been a problem so we can come up with a proposal more precise and less sweeping. -- Green  C  19:59, 30 December 2018 (UTC)
 * User:Middle 8 has consistently refused to admit he has a COI with respect to acupuncture. jps (talk) 20:30, 30 December 2018 (UTC)
 * It's not possible to have a COI with respect to acupuncture. Unless he is editing in favor of his products, services or institution. It is looking like this RfC is really about a single user, User:Middle 8. -- Green  C  01:05, 31 December 2018 (UTC)
 * It's ludicrous to claim it is impossible to have a COI with respect to acupuncture when people make money off of it in spite of the lack of evidence for its efficacy. jps (talk) 21:10, 31 December 2018 (UTC)
 * Yes, this is one of the more ridiculous assertions I've seen here yet? "Not possible"? If someone's income depends on whether potential patients are willing to pay for treatment they believe to be effective -- or at least not snake oil -- then damned right that that someone has a blindingly obvious COI. You asked for an example, and you got one, so don't make sweeping unsupported statements of your own. --Calton | Talk 18:55, 1 January 2019 (UTC)
 * wrote: User:Middle 8 has consistently refused to admit he has a COI with respect to acupuncture -- Actually, I have so admitted, just not in the way you would've preferred. --Middle 8 (t • c | privacy • acupuncture COI?) 21:54, 31 December 2018 (UTC)
 * That you are an unethical, conflicted editor who has used Wikipedia to make money for your various alternative medicine ventures is something with which I can agree, certainly. jps (talk) 21:59, 31 December 2018 (UTC)
 * Climb down off that high horse, the weather's nicer down here. I've been on long-term leave and haven't made money from my "alt-med venture" in quite awhile.  I used to talk to my patients about the evidence base for acu (once I understood it) and the Wikipedia article (partly out of curiosity, partly a sense of ethical obligation).  Most hadn't read it.  The very few who had invariably thought the acu article so ridiculously skeptic-POV'd that they discounted it and even had a boomerang reaction.  (The alternative medicine article today is almost hilariously bad in that way, btw.)  So, you'll be glad to hear that if anything my efforts probably hurt my bottom line.  Back when I had one from acu.  --Middle 8 (t • c | privacy • acupuncture COI?) 00:26, 1 January 2019 (UTC)
 * Why, what a brilliant young man I was back then! I think my view is is still essentially the same - whether altmed or not, people financially interested in something have a COI. Alexbrn (talk) 20:38, 30 December 2018 (UTC)
 * The "off ramp" is the same as for any non-CAM specialist: "I can't help you, let me refer you elsewhere". "--CHORTLE!" -- I know, that's the response; "how could any alt-meder be ethical that way".  Well, it happens, just as non-CAM specialists fail to dismiss patients when they should.  That's another reason the difference between CAM and regular medical COI is more about degree than kind, and why Cochrane doesn't distinguish between the two. --Middle 8 (t • c | privacy • acupuncture COI?) 02:40, 1 January 2019 (UTC)


 * Re: Johns Hopins, see Medicine with a side of mysticism: Top hospitals promote unproven therapies. Key quote:
 * "They’re among the nation’s premier medical centers, at the leading edge of scientific research. Yet hospitals affiliated with Yale, Duke, Johns Hopkins, and other top medical research centers also aggressively promote alternative therapies with little or no scientific backing. They offer 'energy healing' to help treat multiple sclerosis, acupuncture for infertility, and homeopathic bee venom for fibromyalgia. A public forum hosted by the University of Florida’s hospital even promises to explain how herbal therapy can reverse Alzheimer’s. (It can’t.)... Some hospitals have built luxurious, spa-like wellness centers to draw patients for spiritual healing, homeopathy, and more. And they’re promoting such treatments for a wide array of conditions, including depression, heart disease, cancer, and chronic pain. Duke even markets a pediatric program that suggests on its website that alternative medicine, including 'detoxification programs' and 'botanical medicines,' can help children with conditions ranging from autism to asthma to ADHD.  'We’ve become witch doctors,'  said Dr. Steven Novella, a professor of neurology at the Yale School of Medicine and a longtime critic of alternative medicine."
 * As our article on Alternative medicine says, "The scientific consensus is that alternative therapies either do not, or cannot, work. In some cases laws of nature are violated by their basic claims; in others the treatment is so much worse that its use is unethical. Alternative practices, products, and therapies range from only ineffective to having known harmful and toxic effects." --Guy Macon (talk) 21:21, 30 December 2018 (UTC)


 * The claim of "scientific consensus" is unsourced. Sounds about right. How can you source consensus when major scientific medical institutions like Johns Hopkins are using alt medicine. Evidently there is no consensus. Unless you believe these institutions are "witch doctors" says Dr. Steven Novella. Reminds me of Elizabeth Holmes who called the WSJ a "tabloid" when they published something she didn't like. -- Green  C  01:32, 31 December 2018 (UTC)
 * MOS:LEADCITE, that is sourced in the body. Determination of scientific consensus is not through whether reputed medical institutions use alt medicine but through what high-quality WP:MEDRS sources say. Galobtter (pingó mió) 12:39, 31 December 2018 (UTC)
 * Ok found it. Four sources dated 1995,1997,2002,2004 nearly a generation old.. It's also asserting a strong statement of broad consensus which would be difficult to demonstrate in four sources, unless those sources are directly asserting the statement. JH is to medical scientific research, as Stanford is to computer science and MIT is to engineering. They are the establishment, and publishers of reliable sources. There is a Johns Hopkins book in the Bibliography, though not chosen as a source. It looks like core establishment has been changing over the past generation, and Wikipedia is still fighting the altmed battles I recall from the early 2000s. At the very least, a re-examination of what the consensus is these days would be a useful exercise. I suspect there would be such conflicting opinion no clear consensus would emerge, or least not the unqualified one currently claimed with those 4 old sources. -- Green  C  16:31, 31 December 2018 (UTC)
 * Comments like this are prima facie evidence of intellectual vapidity. The year 2004 is described as being "nearly a generation old", entire institutions are held up as paragons of research as though there is no possibility for problems to occur among individuals or groups when they're employed by such a beast, and then further absurdities are entertained that somehow the scientific consensus doesn't exist that acupuncture has no evidence for its efficacy. If we took WP:CIR seriously, this would be grounds for topic banning. jps (talk) 21:57, 31 December 2018 (UTC)
 * The average of those 4 dates centers around 2000 which is about 19 years ago, 20 years is a generation. And you don't need to threaten me with banning. I am not intellectually vapid, are you intellectually vapid? You've got a problem, it's not me, it's time. Consensus changes and a lot has happened since GWB took office. Marijuana is becoming more legal etc., there is a broad trend in health care encompassing alternative therapies that reflects generational changes in the population at large who are more accepting than previous. As the contradictions between Wikipedia and the real world continue to build you will become increasingly embattled. The right action is to keep Wikipedia up to date. -- Green  C  23:12, 31 December 2018 (UTC)
 * You think a generation is 20 years, eh, buster? "Marijuana is becoming legal, etc." WOW! SUCH GREAT arguments! Keep trying, though. You continue to make a wonderful case that you lack the intellectual heft necessary to render an informed opinion on this subject. jps (talk)
 * @jps, Galobtter, Guy Macon, GreenC, Alexbrn Well, we do have the hefty consensus (yes, it says consensus) of the US National Academies of Sciences, Engineering, and Medicine that "Nonpharmacologic interventions for pain treatment, including acupuncture, physical therapy and exercise, cognitive-behavioral therapy, and mindfulness meditation, also are powerful tools in the management of chronic pain." Yes, I am quoting accurately and in context -- the NAM looked at several nonpharmacologic pain treatments and found favorably for a few of them including acu. (Source: NAM consensus report Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use[self-published source?? we'd better find something wrong with it and fast or the sky's going to fall.  someone alert the bloggers!])
 * To be clear: this is the sci consensus (or at least the large majority view, given the source, and others) about acupuncture's clinical value. That is not to be confused with the sci consensus about its efficacy compared to sham acupuncture (perhaps a small analgesic effect).  Pretty impressive example of how researchers and clinicians think differently, I'd say.  After all, it's perverse to { use a treatment that's (mostly) a placebo | not use a treatment that helps certain difficult-to-treat pain patients }.
 * If only we had editors able to hold these two seemingly opposed ideas in mind at the same time and still retain the ability to function. --Middle 8 (t • c | privacy • acupuncture COI?) 00:01, 1 January 2019 (UTC)
 * jps, your personal attacks, YELLING, insults, name calling and threats mark you as someone not worth responding to, it is misdirection. Middle 8 those are good sources. How might we incorporate this? -- Green  C  01:10, 1 January 2019 (UTC)
 * @GreenC - Methodically and patiently. ;-) More than a few skeptical heads are going to spin in disbelief that this source can possibly say what it says (it's just one source, various parts linked to), and contortions to exclude it will ensue.  But the source is crystal clear, so it can't be excluded for long, as long as we stick close to it when citing.  I'll post something soon at acu & other pertinent articles.  Cheers --Middle 8 (t • c | privacy • acupuncture COI?) 03:36, 1 January 2019 (UTC)

The source is not commenting on alternative medicine. It is commenting on pain management and the opioid crisis. It is reminiscent of problems we have always had with POV-pushers like yourself cherry-picking sources that made them feel better about their pet pseudosciences. Also, this source is off-topic for this discussion of COI, of course. A better question might be, do you possibly have a COI with respect to alternative medicine? jps (talk) 01:15, 1 January 2019 (UTC)
 * POV-pushers like yourself cherry-picking sources that made them feel better about their pet pseudosciences. looks like part of a pattern of you making personal comments about editors you disagree with on this thread. Tornado chaser (talk) 02:29, 1 January 2019 (UTC)
 * . fix ping. Tornado chaser (talk) 02:43, 1 January 2019 (UTC)
 * @jps And the contortions begin. --Middle 8 (t • c | privacy • acupuncture COI?) 02:47, 1 January 2019 (UTC)
 * ..looks like part of a pattern of you making personal comments about editors you disagree with...
 * Actually, it looks like an accurate description of a particular phenomenon. --Calton | Talk 18:55, 1 January 2019 (UTC)


 * WP:MEDCOI seems to be fine for this. It says that folks with a COI need to declare it.  Absolutely nothing wrong with that.  I don't mean to say that western medical knowledge is the end-all and be-all of health related articles.  If traditional or other alt-med procedures are used and notable they should be reported, but that doesn't mean they get a pass on reporting scientific studies, or reporting when there have been no scientific studies.  That is the domain of western medicine.  Anybody, alt-med or otherwise, who has a COI and doesn't declare it is walking on thin ice, especially if they don't accurately report the scientific evidence. Smallbones( smalltalk ) 21:34, 30 December 2018 (UTC)
 * At least one user (See User talk:Roxy the dog and User:Middle 8/COI) has declared that it is perfectly OK for a practicing acupuncturist to edit our acupuncture article, and he quotes the 2015 RfC listed above as support for that assertion. So here we are, revisiting the question with a new RfC to see whether the community wants to uphold or overturn the previous RfC. I would assume that if you were to try to invoke WP:MEDCOI he would point to the same RfC as allowing him to edit despite having a clear COI. --Guy Macon (talk) 21:46, 30 December 2018 (UTC)
 * Hmmm. The previous RfC doesn't need to be "overturned" because it was inconclusive (no consensus). But we do need clarity. It's a bit naughty for any altmed specialist to claim that "no consensus" result gave a green light for them to freely edit an article on their specialism. Alexbrn (talk) 21:52, 30 December 2018 (UTC)
 * Well frankly it does. No consensus means exactly that. There is no consensus that those particular workers are inherantly conflicted and should be prohibited from editing articles directly in the topic area in which they are employed (which was the obvious goal of the RFC). I suspect if the question was phrased more generically it would gain clearer consensus. "Do you have a COI in the topic area in which you are employed or otherwise recieve financial renumeration" would either be no or yes. As it stands, singling out one specific industry will end up with 'yeah sometimes'. But no one wants to ask that question because it would prevent all sorts of editors editing their favored topics, or it would prevent none. Only in death does duty end (talk) 22:05, 30 December 2018 (UTC)
 * There was no consensus that that they are, and no consensus that they aren't. Are you familiar with the scottish verdict? But okay, if we're saying anything but an unequivocal finding of "yes" here shall be interpreted as granting altmed folk free reign to edit on their own specialisms, then that at least clarifies how - in community terms - the result will be taken. Alexbrn (talk) 22:09, 30 December 2018 (UTC)
 * Yes [cynic] its what allows people in Scotland to have a 2nd bite in the civil courts when they dont get the result they want in the criminal ones [/cynic]. But that is a very different kettle of fish from an ENWP no consensus result. ENWP is fundementally 'we cant agree'. A not proven verdict is most often deployed in Scotland where the Jury think the person is guilty but the evidence isnt there, or cannot be corroborated. Its not a lack of agreement, its a lack of supporting evidence. Personally I would be more than happy to ban all Altmed practitioners from their relevant topic areas, but thats a thin end of the wedge which is what I suspect led to the original result. If we are going to contemplate going that route, just directly do a proposal for it rather than using the roundabout COI for it (which by policy doesnt actually prohibit them even if it is declared they have a conflict). Only in death does duty end (talk) 22:19, 30 December 2018 (UTC)
 * I think the problem is that editors (well one anyway) are using the previous RfC to claim an exemption from our general COI provisions in a kind of "Wikipedia has cleared me" way. As WP:MEDCOI states "Editing on topics where one is involved or closely related, especially when there is potential financial gain, is discouraged". I think that should be applied to altmed just as it is to conventional medicine. I sort of agree with your general point though, because ultimately all these things are gameable by conflicted editors, and it's POV editing and associated behaviour which will get them in the end. Alexbrn (talk) 22:27, 30 December 2018 (UTC)
 * Acupuncturists are not bound by MEDCOI since acupuncture isnt medicine *Pigeon Cat Pigeon*. Only in death does duty end (talk) 22:31, 30 December 2018 (UTC)
 * The vaunted Johns Hopkins Integrative Medicine Acupuncture Program as described on their own website:
 * "Acupuncture and massage appointments are now available at our downtown campus for cancer patients and their caregivers (family and all healthcare providers) at the Hackerman-Patz Pavilion, located just across the street from the Sidney Kimmel Cancer Center. Massage therapy includes deep tissue, oncology massage, and other types. Acupuncture and massage therapy make excellent gifts! Please call [phone number redacted] to make an appointment or obtain a gift certificate."  Spintendo   12:24, 31 December 2018 (UTC)
 * In shock news, product of US for-profit health system sells useless procedures to vulnerable people... News at 11. Only in death does duty end (talk) 13:17, 31 December 2018 (UTC)
 * (acknowledging my COI as a physician and faculty member at Johns Hopkins, and also that I don't speak for JH here) Johns Hopkins is a not-for-profit entity (it's inaccurate to describe it as for-profit). Also, I personally believe that they (the integrative medicine group) should disclaim acupuncture as a placebo (and there is some evidence that placebos work for self-reported conditions, even when the placebo is labeled as such). — soupvector (talk) 15:50, 6 January 2019 (UTC)
 * I had a quick look at Talk:Acupuncture and see quite a few people quoting MEDRS. It seems to me if "" is held to apply to acupuncture, then the whole of Identifying reliable sources/Medicine applies. In any case, I don't see that MEDCOI places any restrictions or limits that COI doesn't already. Nil Einne (talk) 12:50, 31 December 2018 (UTC)
 * Actually what surprised me was that editors took the "no consensus" to mean "yes, let's call an editor's profession a COI and use it as a reason to revert". But you're putting the conclusion-cart before the premise-horse when you say that by not immediately stopping editing I'm "claim[ing] an exemption from our general COI provisions".  The question is whether (or to what extent) those provisions even apply.  It sounds like you want the "no consensus" closing to be taken the same way we'd take a "Yes (there's a COI)" closing (i.e. CAMmers stop editing in their area) -- right?  If not, then what's the difference?
 * What I gleaned from the first RfC's (non-)result was something I knew anyway: "disclose my profession and edit with care" (basically the way the grownups at Cochrane handle it both for CAM and non-CAM specialties).  I didn't feel I was "given a green light"; I felt always had a flashing yellow one.  The difference between a "no consensus" and a "No (no COI)" is the difference between a flashing yellow and a conservative green.  A "no" doesn't say "be too bold", but it does mean these debates, and attendant comments that are way lower on Graham's Hierarchy than should be tolerated on a talk page, finally wind down.
 * BTW, the problem this RfC seeks to solve is demonstrably minuscule. (See comment "How big is the problem really?" below) --Middle 8 (t • c | privacy • acupuncture COI?) 02:37, 1 January 2019 (UTC)


 * What a silly RFC. It's like asking "Are scientific journals reliable source?". There is no yes/no answer. Seems to me some editors are just looking for hammer with which to hit editors they disagree with and a way of deciding who is "one of us" (Horray!) vs "one of them" (Oh No!). I encourage folks to read the !votes by MastCell and WhatAmIDoing in the previous RFC. As noted, while some AltMed requires such a degree of impossibleness as to be unreasonable (homeopathy) others are more complicated (when does a diet become mainstream?). And WhatAmIDoing points out that COI is not the issue, but POV pushing may be. And quite possible for a practitioner in WM to push their POV and even to earn from one specific treatment from which they have invested money on equipment, training and promotion. Where I disagree with some is that I think there is a fair amount of inertia in WM towards shifting treatment in the face of new evidence (or of continuing to use and promote a treatment that never had much or any evidence). Recent scandals with surgical implants demonstrate that quite amply. I'd rather we were focussing more on whether someone was making helpful edits (or not) than who they are. -- Colin°Talk 15:36, 31 December 2018 (UTC)
 * Comment It certainly is not COI per the existing guideline (WP:COI). If you wish to change the guideline, it should be taken to the village pump where changes to guidelines are made. TFD (talk) 17:10, 31 December 2018 (UTC)
 * That's odd. The very first sentence of Conflict_of_interest reads, "Conflict of interest (COI) editing involves contributing to Wikipedia about yourself, family, friends, clients, employers, or your financial and other relationships." Given that whether the public accepts the efficacy of acupuncture or other "alternative medicine" has a direct effect on the customer base and finances of acupuncturists and other alt-med practitioners, it applies. How did you miss that?
 * Or how did you miss this bit from WP:ACTUALCOI?: "An actual COI exists when an editor has a COI with respect to a certain judgment and is in a position where the judgment must be exercised." Like, for example, whether acupuncture is efficacious or just bunk, which certainly affects sales.
 * I mean, it's right there in the guideline. If you wish to change the guideline, it should be taken to the village pump where changes to guidelines are made. --Calton | Talk 11:14, 2 January 2019 (UTC)


 * The problem is when there are subjects like transcendental meditation where you have a well-documented conflict of interest, and acupuncture where others are so-documemented, the self-proclaimed "expertise" is little more than a smokescreen for charlatanism and promotionalism. It is fine to have the input from true believers, like yourself, into the content of an article on Wikipedia, but to pretend that they are somehow needed to write a good article on a subject that is total woo is irresponsible. In fact, the best people to write such articles are those with the technical knowledge in related fields (medicine, science) who haven't been brainwashed in the way you have been. jps (talk) 22:04, 31 December 2018 (UTC)
 * Really? jps. There 's nothing I could say that condemns you more than the way you have condemned yourself by attacking editors who in good faith are commenting here.Littleolive oil (talk) 22:10, 31 December 2018 (UTC)
 * That you see this as an attack is exactly the problem here. You have not been forthcoming or honest about your own conflicted associations and beliefs when contributing here and have been given a pass for this in spite of a well-documented history of problems. I am not attacking you, I am pointing out the problem with your position and the position of others who are similarly conflicted. I think you can be a value to Wikipedia, but the problem is that you have been a gatekeeper yourself which has caused the quality of content in areas where you have a conflict of interest to deteriorate. jps (talk) 22:14, 31 December 2018 (UTC)
 * Actually I wasn't referring so much to your attack on me. Its old news. I was referring to your personal insults to GreenC and Middle 8 which changed the tenor of this page and discussion. Littleolive oil (talk) 00:02, 1 January 2019 (UTC)
 * I just warned Jps on their talk page for making 4 PAs against 3 editors in this discussion. Tornado chaser (talk) 00:25, 1 January 2019 (UTC)
 * This is absolutely an unproductive conversation with a lot of old history and implicit personal attacks dredging up old news, long settled. Stop. Now. Best we have someone hat this as off-topic. In fact, I will. Montanabw (talk) 00:31, 1 January 2019 (UTC)


 * We don't need to use the conflict of interest policy to deal with POV-pushing editors in complementary and alternative medicine, because ArbCom discretionary sanctions are a satisfactory draconian remedy. (We sometimes need draconian remedies, and this one is sufficiently draconian.)  Robert McClenon (talk) 22:13, 31 December 2018 (UTC)
 * I have to agree with on this.  Alternative medicine is one of those topics like politics and Gibralter where emotions run high and ARBCOM remedies are in place. They do the job.  I also agree with  that even mainstream medical sources can sometimes have biases exposed and are not to be taken as perfect gospel. As always, our alphabet soup of policies (WP:V, WP:NPOV, and even most of the time WP:MEDRS and SCIRS) usually provide the guidance needed.  Time to stop beating this dead horse.  Montanabw (talk) 00:33, 1 January 2019 (UTC)
 * Comment: This RfC is part of an ongoing attempt to vilify anyone who adds information that speaks to the effectiveness of any kind of alternative medicine, or any other topic the pseudoskeptics have declared to be pseudoscience. The things listed in the RfC are chosen to make it look as kooky as possible and they betray the poster's biases. What they are really talking about is acupuncture and Chinese Traditional Medicine, which they repeatedly claim are pseudoscience. Such a claim reveals a fundamental misunderstanding of what science is. As I have said before here "Science is a method, not a list of things that are right and things that are wrong. The scientific study of any phenomena is not pseudoscience. Pseudoscience is bad science. Science not done right. If the method is followed it is ipso facto science, no matter what it is studying." and "Science is about examining the evidence. Suppressing information about whole subject areas because one has decided are dodgy is not science. There is a name for it though. It is a witch hunt." See here "Yes, stop your COI editing, it’s disgusting that you have the bare-faced gall to involve yourself in this article. You already know this.  Roxy, the dog. wooF 15:13, 30 December 2018 (UTC)".


 * Moreover this is a content dispute disguised as an RfC. At AcupunctureUser:Middle 8 made this edit:

"The Joint Commission requires the organizations it accredits to provide complementary, non-pharmacologic pain treatments (e.g. acupuncture) for patients who may benefit from them, such use potentially reducing the need for opioids. The Joint Commission allows organizations to choose which type(s) of complementary treatment to provide — it mandates none in particular because the evidence base for these treatments varies widely and is incomplete."


 * This text is cited to this page. See Joint Commission for info on this body.


 * User:Roxy the dog reverted it claiming it was a COI edit. I reverted it back as it is accurate, well sourced information and I have no COI. User:JzG now seems to be claiming the source is not reliable "Neither is a self-sourced statement on the website of a trade body that has clearly been the subject of industry lobbying." I contend that his source is reliable, especially for statements about their own policies, which is what this is. These same editors have been removing well sourced information from the Acupuncture page for some time. See for example here where these same editors argue that an IPD meta review, the gold standard of systematic review, is not a reliable source. Morgan Leigh | Talk 00:35, 1 January 2019 (UTC)
 * That may be your view, but it's an assumption of bad faith. It's not about vilifying people who add information that speaks to the effectiveness of any kind of alternative medicine, it's about recognising that someone who is a practitioner of alternative medicine is not neutral when promoting the validity of that form of alternative medicine. Wikipedia is a reality-based encyclopaedia, and content that promotes fantastical nonsense like reiki, homeopathy, acupuncture and so on as if it were valid, has no place here. Practitioners and believers can help us by explaining their beliefs and views on things, just as creationists can help us to describe the creationist mindset, but as soon as they start trying to assert that their beliefs are correct, when objectively they are not, we have a problem. This is usually seen as a COI for the simple and obvious reason that a quack's business depends on the quackery being treated as legitimate, so describing the quackery as legitimate on Wikipedia, whether motivated by greed or by quasi-religious belief, has the effect of boosting their business. As long as practitioners stick to the talk page and accept consensus, Wikipedia doesn't have a problem. And if they don't, well, we have the example of . Guy (Help!) 10:05, 1 January 2019 (UTC)


 * How big is the problem really? Obviously we're headed for another "no consensus", but has anyone wondered? Which articles/editors are afflicted, and how much trouble could've been saved if the last RfC had closed with a "Yes"?


 * To answer this, I looked at the most common CAM's, checking article talk for any mention of "COI" or "Conflict of interest" regarding specific editors editing in their profession. Here's the last time anyone raised a concern:


 * Biofeedback, Herbalism, Massage, Nutrition/Nutritionist, Therapeutic Touch, Tai Chi - never
 * Yoga - December 2006 (only instance)
 * Osteopathy - January 2007 (only instance)
 * Meditation - April 2007 (only instance)
 * Reiki - February 2008 (only instance; editor self-disclosing)
 * Hypnosis - June 2013 (only instance)
 * Homeopathy - September 2013
 * Chiropractic - January 2014
 * Qigong - February 2014 (only instance)
 * Traditional Chinese Medicine - May 2014, then October 2013 (two instances)
 * Naturopathy - August 2015 and Feburary 2008 (two instances)
 * Ayurveda - May 2016 (only instance; user with zero mainspace edits and two talk page edits)
 * Dietary supplement - January 2018 (only instance; editor self-disclosing)
 * Acupuncture - Just a couple weeks ago (whenever I or one of the other 2-3 acu'ist editors use the talk page, a couple of other editors find it necessary to make it into a thing, repeatedly. I guess it's understandable -- I only disclose my profession once per signature)
 * Obviously.... an urgent problem.
 * In the last three years, I've edited acupuncture a total of eight times, btw. --Middle 8 (t • c | privacy • acupuncture COI?) 01:20, 1 January 2019 (UTC); minor rearr of table chronologically 01:37, 3 January 2019 (UTC)
 * It's probably better if you don't try to set yourself up as an arbiter of fact on this, given that you have a vested interest in acupuncture.Guy (Help!) 09:57, 1 January 2019 (UTC)
 * Not arbiting, reporting. Anyone may verify.  I may have missed a couple things, but I think we both realize that if it's grossly wrong, that's likely to be taken as bad faith.  --Middle 8 (t • c | privacy • acupuncture COI?) 06:50, 2 January 2019 (UTC)


 * And what happens if research shows (as in fact it does) that acupuncture is invalid? A research programme made up of acupuncturists has a seriously hard time adapting its practices to exclude the refuted parts of acupuncture, such as meridians and qi, so will have a close to impossible task accepting evidence that "real" acupuncture is no better than fake, as science shows. Instead they say, literally, that acupuncture is so powerful that even fake acupuncture works. Yes, really. Guy (Help!) 01:30, 1 January 2019 (UTC) This comment was in response to 's !vote, I have moved it into the discussion section for the sake of organizationTornado chaser (talk) 02:24, 1 January 2019 (UTC)
 * Oddly enough there is a whole bunch of evidence cited to support the argument that acupuncture doesn't work already in the article. That's what we do, we include whatever evidence there is, except unless of course it supports acupuncture. Then it must be killed with fire because it's bad. You seem to be saying, as you often do, that your opinion about the quality of research is more important than citing reliable sources and that some people just can't be trusted because they hold an opinion you don't and so they must be excluded. Morgan Leigh | Talk 04:54, 1 January 2019 (UTC)
 * Yes, and you and Middle 8 are devoting most of your on-wiki time to obscuring it. It's almost as if your business benefits from obscuring the reality-based view, isn't it? Guy (Help!) 09:57, 1 January 2019 (UTC)
 * (Has Morgan Leigh disclosed their profession?) FWIW, Guy, pls see my comment above. addendum: Also, ML and I aren't arguing against "negative" content (heck, I'll be adding some, from Harrison's, which says acu's no good for a lot more than they say it's good for).  You, however, are plainly trying to suppress anything favorable (my favorite example being that you refuse to include NICE guidelines because Wikipedia is not is so a crystal ball).  But this demolishes your contention that the sci consensus is that acu is "bollocks" (it's obviously more complicated). --Middle 8 (t • c | privacy • acupuncture COI?) 16:39, 2 January 2019 (UTC) addendum 17:13, 2 January 2019 (UTC) ; abridged 17:59, 2 January 2019 (UTC)


 * Guy is mischarachterising the edits Middle 8 and I are attempting to make while trying to red herring about potential COIs. Strangely they haven’t divulged their profession.


 * A perusal of the history will show that Middle 8 and I are not trying to remove anything. We are trying to add high quality sources to the article. See here for examples. However our actions are being continually blocked.


 * JzG referred to these sources, including an IPD meta review, the gold standard of systematic review as the "optimistic findings of True Believers".


 * I suggested no less than seven Cochrane reviews that provided evidence for acupuncture however, according to the personal opinions, and no other evidence, despite repeated requests for some, of Alexbrn, Roxy the dog, MrBill3 and JzG, these sources are either too old or pro fringe and none of them are good enough to be cited. Which is super odd, because in other places on Wikipedia these same editors can be seen lauding Cochrane Reviews... Morgan Leigh | Talk 02:59, 3 January 2019 (UTC)
 * Alternative hypothesis: I am one of the group of reality-based editors resisting the endless POV-pushing of true believers, at least some of whom (specifically including Middle 8) have a direct financial incentive to portray acupuncture as more valid than it is. Guy (Help!) 11:21, 3 January 2019 (UTC)


 * There's a critical difference between medical doctors and quacks in respect of specific treatments. A doctor would only have a COI in respect of drug treatments if the question is whether drugs work at all, not whether a specific drug works. A quack is typically only able to practice a specific quackery - a homeopathist cannot switch to some other quackery when the evidence shows that homeopathy does not work. Guy (Help!) 10:37, 2 January 2019 (UTC)
 * To use different examples than I used before, there is equivocal evidence about whether medical or surgical therapy is best for many spine problems. A non-surgical neurologist can't switch to doing surgery, if that turns out to actually have the best evidence.  A surgeon can switch to not doing surgery, if that has the best evidence, but it would cut his income in half.  And if the best evidence turns out to be that neither is better than placebo, and patients can be convinced to actually go by the evidence, they're both out of business in this field.   If people were convinced by the current recommendation against routine PSA screening, many urologists would similarly lose most of their income.  There are similar disputes about the indications for surgery in many other fields, and in many surgical fields about which specialty should do it.   DGG ( talk ) 19:55, 2 January 2019 (UTC)
 * Yes, in those edge cases a COI would exist. Ditto for a psychotherapist where there is a question over drugs v. psychotherapy for a mental illness - but not for a psychiatrist, who could use either without any particular problem.
 * I suspect we might both agree with Edzard Ernst here:
 * If someone published evidence to show that a new drug is ineffective, most GPs would simply use another one. If, however, someone demonstrates that acupuncture is a placebo, acupuncturists would automatically fear for their cash flow.
 * In other words, in alternative medicine, such conflicts of interest tend to be very acute, powerful and personal. Consequently, enthusiasts of alternative medicine are often incapable or unwilling to look upon criticism as anything other than an attack on their income, their beliefs, their status, or their person.
 * That is absolutely consistent with what we have seen on articles on homeopathy, acupuncture, reiki and dozens of other SCAM topics. Guy (Help!) 08:41, 3 January 2019 (UTC)

Arbitrary break 1
I'd like to point out that a No vote is a vote for Quackery and Medical Fraud. -Roxy, the dog . wooF 13:06, 2 January 2019 (UTC)
 * That may be your opinion, but that does not make it true. Please argue using logic and evidence. · · · Peter Southwood (talk): 16:16, 2 January 2019 (UTC)
 * Acupuncturists charge their victims real money, for doing nothing helpful. This is fraudulent. A fraudulent doctor is struck off. Why should we allow frauds to edit fraudulently? -Roxy, the dog . wooF 16:22, 2 January 2019 (UTC) QED. -Roxy, the dog . wooF 16:20, 2 January 2019 (UTC)
 * Acupuncture was endorsed by the NAM for pain treatment. I'm sure they consider it quackery, pseudoscience, fraud etc.[sarcasm] --Middle 8 (t • c | privacy • acupuncture COI?) 16:32, 2 January 2019 (UTC)
 * Taking a single statement from a 456 page book that is unrelated to evaluating the claims of acupuncture as your new standard bearer is sadly typical of your horrible and misleading propaganda in favor of sticking needles in people because you believe in magic. jps (talk) 06:01, 3 January 2019 (UTC)
 * This is the fifth time you have made a personal attack on this thread, I will seriously consider reporting you if you do it again. Tornado chaser (talk) 06:14, 3 January 2019 (UTC)
 * Once again you ignore the substance of what jps wrote and choose to back the quack. By all means chide jps (and me) for being blunt or report us to ANI, but don't skip evaluating the substance. Was it a single statement? From a 456 page book? Was the book unrelated to evaluating the claims of acupuncture? If so, wouldn't you think that is a pretty serious charge? Johnuniq (talk) 09:13, 3 January 2019 (UTC)
 * Robust criticism of your terrible arguments is not a personal attack, however often you assert otherwise. Guy (Help!) 10:13, 3 January 2019 (UTC)

(OD for sake of formatting below) @ jps, Johnuniq - I try to at least peruse sources before commenting on them. NAM's endorsement of acupuncture is not an incidental observation -- they devote a chapter section to a half-dozen non-pharma treatments for pain, endorsing four of them including acu. There are two paragraphs on acu, plus a summary paragraph for all modalities endorsed. Whether that strikes one as adequate or not, they're the NAM and don't need to "show their work".

In order to prevent selective quoting, I'm pasting all three para's below in a nifty box. NAM's endorsement is not unqualified: they correctly note the RCT findings showing sham acu very nearly or as good as real acu, and although they conclude that it's a "powerful tool", they also say it "may" help, not that it "does". But it is still an endorsement -- of acu's clinical value, which (like the rest of the report) represents the position of the National Academies.

I cite NAM here not to say "acu is awesome,!!", but simply to refute stuff like this -- because the late great Jytdog was spot-on about research vs. clinical practice.

PAIN MANAGEMENT AND THE OPIOID EPIDEMIC > Chapter 2: Pain Management and the Intersection of Pain and Opioid Use Disorder p.49 Section: Nonpharmacologic Treatments p.84

The use of acupuncture for the treatment of pain has become widespread in recent decades. Acupuncture is a key component of traditional Chinese medicine that involves insertion of needles through the skin to acupuncture points. Pressure, heat, electrical current, laser light, and other means also may be used to stimulate these points. Investigations have demonstrated that the nervous system, neurotransmitters, and other endogenous substances respond to the needling stimulation to induce analgesia (Foster and Sweeney, 1987). It has been shown that acupuncture analgesia is mediated by opioids produced in the periaqueductal gray and can be reversed by naloxone, an opioid antagonist (Cheng and Pomeranz, 1980). Recent studies also suggest activation of cannabinoid receptors as a possible mechanism of action (Gondim et al., 2012).
 * Acupuncture pp 84-85

Systematic reviews evaluating the effect of acupuncture in treating pain have revealed mixed results. Some reviews have found minimal or no effect (Lee et al., 2008; Madsen et al., 2009), while others have found acupuncture to be superior to sham acupuncture and placebo (Berman et al., 1999; White et al., 2007), and still others have concluded that data are insufficient to support a recommendation (Furlan et al., 2005; Paley et al., 2015; Smith et al., 2016a; van Tulder et al., 1999). Recent reviews and meta-analyses examining the effect of acupuncture on musculoskeletal pain (neck and back pain, osteoarthritis, chronic headache and shoulder pain, fibromyalgia) have found that overall, acupuncture is superior to sham and no acupuncture, but with relatively modest differences between true and sham acupuncture (Vickers et al., 2012; Yuan et al., 2016). Although it has been suggested that acupuncture is an effective treatment for pain, additional factors, such as potent placebo and context effects, may play a role in its observed effect as well (Linde et al., 2010a,b; Vickers et al., 2012). It also has been suggested that acupuncture may have value in the treatment of chronic and tension headaches (Linde et al., 2009b; Vickers et al., 2012), as well as in prophylactic treatment for migraine (Linde et al., 2009a). Additional RCTs are needed to determine the effect of acupuncture on neuropathic and postsurgical pain.

(goes on to discuss other non-pharm treatments)....


 * Summary p.91 (duplicated in introductory material )

Nonpharmacologic interventions for pain treatment, including acupuncture, physical therapy and exercise, CBT, and mindfulness meditation, represent powerful tools in the management of chronic pain. Many are components of successful self-management. While further research is needed to better understand the mechanism of action and the appropriate dosage and delivery for some nonpharmacologic approaches, they may provide effective pain relief for many patients in place of or in combination with pharmacologic approaches. ....end of post about NAM --Middle 8 (t • c | privacy • acupuncture COI?) 14:43, 3 January 2019 (UTC)
 * And when you look up the studies they cite, you find things like: This review includes trials in which some of the reviewers were involved, as follows: Allais 2002 ‐ Gianni Allais; Jena 2008 ‐ Benno Brinkhaus; Linde K 2005 ‐ Benno Brinkhaus and Klaus Linde; Streng 2006 ‐ Klaus Linde; and Vickers 2004 ‐ Andrew Vickers. These trials were reviewed by at least two other members of the review team. Gianni Allais, Benno Brinkhaus, Yutong Fei, and Michael Mehring use acupuncture in their clinical work. Adrian White has used acupuncture in the past but has retired from clinical practice. Within the last three years (June 2013 to May 2016): Gianni Allais received fees for teaching acupuncture in private schools; Klaus Linde once received a fee from the German Medical Acupuncture Society for speaking about research at a conference; Benno Brinkhaus has received fees for presenting research findings at meetings of acupuncture societies in various countries; Adrian White is employed by the British Medical Acupuncture Society as a journal editor and has received fees for lecturing on acupuncture on several occasions.
 * Absolutely classic SCAM research, conducted by True Believers, with the most positive results in the worst studies and the least positive results in the most robust studies.
 * Linde does not seem to have learned anything from the fiasco of his reviews arguing that homeopathy works. But that's as nothing compared to practitoners - for example Dana Ullman, who insisted on citing superseded work by Linde even after Linde himself had pointed out that the conclusions were no longer tenable. Guy (Help!) 19:11, 3 January 2019 (UTC)
 * Well, better exclude this source too.[sarcasm] See WP:TE, 2.6 and 2.16.  We can't assume that their deliberations were limited to the sources you impeach. As I said, they're the NAM and are not obliged to "show (all) their work".  --Middle 8 (t • c | privacy • acupuncture COI?) 19:24, 3 January 2019 (UTC); added sentence 19:33, 3 January 2019 (UTC)
 * Otherwise excellent sources do make mistakes and it isn't hard to see where NAM went wrong in their 1.5 paragraphs out of 1500. Of course, those who LOVE acupuncture will want to see reference to this afterthought reflected in Wikipedia immediately just so that people who are struggling with pain and opoid addiction get the real deal. *rolleyes* jps (talk) 21:02, 3 January 2019 (UTC)
 * The very first sentence in the chapter says it discusses two broad areas, the second of which is the effectiveness of pain treatments, including non-pharm ones -- so not exactly an afterthought.  If a sufficiently strong source thinks NAM made a mistake, then naturally we include that too.  --Middle 8 (t • c | privacy • acupuncture COI?) 19:43, 4 January 2019 (UTC)
 * All this would be so much easier if there were some remotely plausible mechanism by which acupuncture might work, a single set of acupoints arrived at by multiple traditions through independent experimentation, and robust evidence of objective effect. In the absence of these things we have a lot of ideologically motivated pseudoscience, which will work for a while but not indefinitely (hence the death of homeopathy on the NHS in the UK). Guy (Help!) 23:27, 4 January 2019 (UTC)

I think part of the problem is demonstrated by Guy Macon's comment: "I would request that the closing summary be made crystal clear as to what is and is not allowed, and which existing policies apply and how to apply them. A clear explanation will help to avoid re-litigating the meaning of this RfC on multiple pages." He re-opened this RFC without really appreciating the diverse comments on the previous one would simply be repeated, and believing somehow that a consensus would develop simply by opening a poll with two choices. He also believes some divine closing admin is going to have greater wisdom than the community and be able to provide "crystal clear" advice that applies in all situations and with whatever Guy Macon believes is "Alt Med". It seems there are a bunch of editors who have a fundamental difficulty with people who hold different beliefs than them, and simply want rid of them, and who hold a frankly religious and naively overconfident belief in Western Medicine. Just for the record: I think homeopathy is nonsense, think Western medicine is generally great. But, a few examples: I like the comment by User:Rhododendrites: "I'm sympathetic to the idea that there's an inverse correlation between the legitimacy of a field and the likelihood that a practitioner in that field will edit such articles in a way incompatible with Wikipedia content policies and guidelines." But I don't think we can be much more specific than that, and not hard to find examples of terrible editing behaviour and terrible edits among editors who claim to practice WM or align themselves with those who do. -- Colin°Talk 18:47, 2 January 2019 (UTC)
 * When surgery is just a stitch-up: "If evidence is the line that separates robust science from squishy pseudoscience, and if that evidence is missing in many cases of surgery, what is the difference between a homeopath and a surgeon? You’d hope that it is the way they react if they find out their treatments don’t work." There's a difference between "hope" and some of the assured statements above that they do change, stop and make efforts to prevent a recurrence. Sometimes a class-action lawsuit seems to be required.
 * Doctors write 10m needless antibiotics prescriptions a year, says Nice This is still going on. According to the CDC "At least 30% of antibiotic courses prescribed in the outpatient setting are unnecessary, meaning no antibiotic was needed at all." and "Antibiotic resistance is one of the most urgent threats to the public’s health." Damn there's a weird discontinuity there between doctors being held up as rational and evidence based, and able to change their minds, and yet still prescribing not just sugar pills but sugar pills that cause antibiotic resistance. Makes homeopathy look tame. The vets are even worse.
 * No evidence cough medicines work, with one in seven patients experiencing negative side effects, study finds Yet another dangerous "sugar pill" prescribed by those whacky doctors of Western medicine. When I visited my GP a few years ago, with a persistent cough after a bad cold, I was advised to buy a well known cough medicine brand and take twice the recommended dose.
 * At the risk of disrupting things with an outside opinion, I think some contributors here might be interested in what Edzard Ernst (who has actually spent his career first providing then researching altmed) has to say on the topic: link. Alexbrn (talk) 19:44, 2 January 2019 (UTC)
 * Thanks, Alex. I would point out that Ernst's evaluation closely mirrors mine, but for some reason is considered inflammatory by many at Wikipedia (including those who claim, in private, to agree with my general argument). Sigh. jps (talk) 20:02, 2 January 2019 (UTC)
 * I think some contributors here might be interested to know that Ernst was pushed out of his academic position and the journal he started was closed down after he broke "every professional code of scientific behaviour". Note that this is not my opinion but that of Richard Horton the editor of The Lancet. Here's a source (The Times, Monday 29 August 2005) Strangely he is still oft cited in articles... Morgan Leigh | Talk 23:07, 2 January 2019 (UTC)
 * I think you should be honest that Ernst was criticized by Horton for publishing details of a study that had been commandeered by alternative medicine propaganda. He whistle-blew and The Lancet was caught with egg on their face. This is why he continues to be upheld as a great source for information here and elsewhere. It's nice to have Prince Charles on your side, I guess. jps (talk) 06:05, 3 January 2019 (UTC)
 * Ernst's concept (here) of an "idealogical COI" (which I'd simply call "fanaticism") is one of the best examples yet of a type of bias non-unique to CAMmers. Plus he deprecates the money side relative to the idealogy.  Thus not much of an argument for a "Yes" here. Just FWIW. --Middle 8 (t • c | privacy • acupuncture COI?) ; edited first sentence to make it clear I'm talking about Ernst's concept of COI and not a COI he himself has: 20:18, 3 January 2019 (UTC)
 * Your COI, to be clear (which I'd simply call "intellectual bankruptcy") is a devotion to a belief in the ideas to which you've dedicated your life. The problem comes when such ideas are demonstrably pseudoscientific as they are in the choices you have made. I am somewhat sympathetic to the argument that COI doesn't really do justice to this as a description of the ideological problem (WP:POV Push isn't quite right either). It's an issue we've had on Wikipedia since it was founded. We need experts to help us make content and I think your experience as a practitioner of acupuncture is valuable for us so that you can help contextualize how people who engage in this particular brand of pseudomedicine actually do the dirty work and justify their beliefs. That's useful information. What you are singularly unable to do is offer decent analysis of the scientific evidence. This is mostly because you are committed to a false belief so dramatically that you are simply unwilling to make a disinterested accounting of the subject. That's not exactly a "COI", but Wikipedia does not afford us very many tools to describe problem editors like yourself, so we will continue to revisit it until you get the message. jps (talk) 18:18, 3 January 2019 (UTC)
 * Does Wikipedia hold an operating thetan as having a COI for edititing Scientology articles? (genuine question). I'd see this as roughly parallel to the altmed question. Alexbrn (talk) 20:17, 2 January 2019 (UTC)
 * @Alexbrn, there have certainly been cases in the past of our holding eminent theologians as having a COI when it comes to religion. (Don't ask me where to find the cases, although digging through the archives of Historicity of Jesus should turn up a few.) Where one draws the line between "non-neutral" and "COI" is a matter of semantics, but "true believers in something are the best qualified to explain the beliefs but the worst qualified to explain whether the beliefs are true" is a well-established principle both regarding Wikipedia and regarding writing in general. ‑ Iridescent 20:25, 2 January 2019 (UTC)
 * Pretty much, yes. CoS IPs are blocked and CoS cultists are essentially banned from those articles. Guy (Help!) 08:23, 3 January 2019 (UTC)
 * Ernst was pushed out because he did not follow the party line. There was interference from Prince Charles, a well-known supporter of woo. His "crime" was to publish studies that honestly investigate the claims of alternative medicine rather than promote it, as most alt-med studies do. The main function of alt-med journals is to publish pseudoscience and give an appearance of legitimacy - that's why we generally exclude them per WP:MEDRS. They are a marketing tool not a scientific enterprise.
 * Ernst's Law: if you are studying alternative medicine and quacks do not hate you, you are not doing your job. Guy (Help!) 08:24, 3 January 2019 (UTC)
 * Alexbrn, my problem is the arguments, although strong against Alt Med, are also damning of some in WM. I fully accept there are big differences, and plenty good evidence-based medicine occurs and lives saved, people made healthier. But several people have claimed assuredly that WM doctors happily shift to alternative treatments when demonstrated to be superior or ineffective. And all such a claim needs are a few big counter examples, as I have given above. For heart-sink problems like a persistent cough or a patient at the GP surgery with a viral infection, doctors can be just as stupid and irrational as a homeopath, giving out medicines they should know are ineffective, have side effects and can cause long term problems. My dentist recommends a particular kind of crown, not because it is currently the "Which Best Buy" in some medical journal, but because a few years ago he spent a fortune buying a machine that makes it in his surgery, rather than using a lab. In an epilepsy journal I read some years ago, there was an advert for Keppra (Levetiracetam) that showed a young attractive violinist. Clearly the impression was that this drug did not impair one's intellectual or coordination abilities. They didn't quote some figure from a scientific study, but used exactly the same technique that BMW use to sell cars or Channel to sell perfume. They wouldn't do that if it didn't work. We are all just humans. Irrationality and stupidity is part of human nature. I know that in 20 years time, when some relative of mine dies from a bacterial infection that previously was treatable, I won't be cursing and swearing at the homeopaths. I thought Wikipedians were supposed to judge the edits, not the editor? -- Colin°Talk 09:39, 3 January 2019 (UTC)
 * Good points but we know that some medical staff kill patients through malice or incompetence. The issue is not whether some doctors are bad, but whether a doctor has an inherent COI when editing a medical article using MEDRS. The answer is no—some doctors are bad but most aren't. By contrast, an alt-med practioner believes in their work (although some might not believe and merely be unethical) and that belief is maintained against scientific evidence. Such people have a COI when editing alt-med topics. Dealing with enthusiasts at alt-med articles is hard enough without a pretence that no COI exists. Johnuniq (talk) 09:59, 3 January 2019 (UTC)
 * I think you are confusing two issues. There's no suggestion that antibiotics don't work, and the leading critics of overuse of antimicrobials are reality-based doctors (e.g. Prof. Dame Sally Davies, author of The Drugs Don't Work). Educating the public to stop demanding ABs for viral infections is seen as a significant problem in the medical fraternity. The DeHavilland Comet had a widely publicised series of crashes due to explosive decompression caused by fatigue at the corners of the windows. Aeronautical engineers worked this out and solved the problem. At no point did magic carpets become a realistic alternative.
 * The issue is not that the "antiobiotic apocalypse" may result in the resurgence of microbial infections as a cause of mass death. Antibiotics have, to date, saved billions of lives and a huge burden of suffering. Prescribing practices may indeed undermine that, and it would be terrible, but the total number of lives provably saved by homeopathy is zero, in all of history, and the total number of people who have died from relying on quack remedies instead of reality-based medicine is non-zero.
 * Our article on antibiotics should and does reference overuse and resistance. That is an important part of our message to inform. In the same way, our articles on homeopathy, acupuncture and so on should and do point out that they have no objective effect. The correct alternative to ABs for a viral infection is water and sleep, not acupuncture or homeopathy. Guy (Help!) 10:29, 3 January 2019 (UTC)


 * In recent years a better understanding of the placebo effect has led to new insights about how certain alternative medicine treatments can work, even if they don't work better than a placebo. So, I think the best way forward to deal with this subject is to simply edit these new insights published in leading peer reviewed journals into these articles. There are a large number of such results, just a few weeks ago it was reported that the old debunked idea that eating dairy products causes mucus formation to increase is actually true for people who believe in this, but they'll also have that reaction when they eat soy based products when they are told that it is dairy. If they eat dairy and are told that it is 100% soy based, then they don't get any reaction. This sort of information should be edited into the articles. Count Iblis (talk) 04:30, 3 January 2019 (UTC)
 * Le sigh. That is their narrative, sure, because they now have to acknowledge that homeopathy, acupuncture and the rest are indistinguishable from placebo, but the "placebo effect" is not a thing. The myth of the placebo stems from a 1955 study titles The Powerful Placebo, but subsequent reanalysis has shown that not one of its conclusions is supportable from the actual data. The leading proponent of the "placebo effect" right now is Ted Kaptchuk - an acupuncture proponent. In the reality based community it is accepted that "works no better than placebo" means "doesn't work", because placebo is a proxy for cognitive biases, observational errors, natural course of disease and so on. The "placebo effect" is visible only in self-reported outcomes for subjective effects. What it actually means is not that anyone gets better, but that if you tell them confidently that they feel better, they will agree. That's all. Guy (Help!) 08:38, 3 January 2019 (UTC)
 * That's a "somewhat narrow" description of the placebo effect. Martinevans123 (talk) 09:38, 3 January 2019 (UTC)
 * It's accurate. The role of placebo in clinical trials is not to compare with a "placebo effect", but to eliminate bias. If a treatment is indistinguishable from placebo, it is, by definition, indistinguishable from experimental error, and it doesn't work. Even if the placebo effect were real, that would be a terrible reason for supporting people who pretend that inert treatments are something other than inert, because the cult of alt-med does not recognise limitations on scope of practice and even when they publicly admit their treatments are placebos they say something else in private. Guy (Help!) 10:03, 3 January 2019 (UTC)
 * If people feel they are getting a treatment that works for them then even if they are actually being fooled by all sorts of psychological processes here, they will tend to change their behavior which can have real health effects. E.g., a placebo treatment for pain may make people start to exercise again and that can cause them to sleep better, eat better etc. etc. A study done on elderly people in a nursing home found that if you reduce the care people get there by forcing people to do more for themselves, their health tends to improve dramatically. So, there may even be a placebo cure for old age. As mentioned here:


 * "And while retiring early is generally thought to be better for your health, in some circumstances giving up work might achieve the opposite. One study of blue collar workers in Austria found that men who retired three and a half years early were 13% more likely to die by the age of 67 – particularly if they were single, lonely and used it as an opportunity to reduce their physical activity. South-west of Japan’s main islands, in the East China Sea, is a tropical outpost that seems to back this up. Okinawa is famed for its high proportion of centenarians; it’s been estimated that roughly one in every 2,000 people there are over the age of 100.


 * Over the years, researchers studying this remarkable place have noticed several aspects of the Okinawan lifestyle that might explain their longevity. These include eating lots of vegetables and fewer calories overall than the average American – but also their attitude to work. There is no word for “retirement” in the Okinawan language; the locals, many of whom grew up as farmers and fisherpeople, may carry on working until they die. Elderly residents live by the principle of “ikigai”, which is loosely translated as “having a reason to get up in the morning”. " Count Iblis (talk) 19:35, 3 January 2019 (UTC)
 * Yes, good mental health is a positive indicator for good physical health, though positive attitude has no impact once an organic disease exists and in some cases, e.g. cancer, actually turns out to correlate with worse outcomes. That is, obviously, not a reason to support charlatans and their bogus claims. It doesn't matter if sticking needles in peopel and lying to them makes them feel a bit better, there are less risky ways of obtaining identical benefit which do not rely on deceit. Guy (Help!) 23:24, 4 January 2019 (UTC)


 * There is no such thing as "Western medicine". There's just medicine. Nothing about antibiotics makes them Western. Eastern "medicine" is not medicine, it's superstition - TCM is largely a creation of Mao (see barefoot doctor). The whole industry of traditional/herbal/Chinese/alternative medicine is simply an organised effort by practitioners of refuted therapies to retain their business. Guy (Help!) 10:16, 3 January 2019 (UTC)
 * Semantics. It's stylistically awkward to talk about "Chinese medicine" (which is what it's called) vs. "medicine", just as talking about "Jones" vs. "John Jones" is awkward.  I call it "biomedicine" in such contexts. --Middle 8 (t • c | privacy • acupuncture COI?) 14:57, 3 January 2019 (UTC)
 * Semantics. I call it "real medicine" and what you do is called "quackery." I'm curious as to how you M8 resolve the ethical dilemma of treating your victims with quackery? It seems wrong for you to take their money for nothing somehow. -Roxy, the dog . wooF 16:49, 3 January 2019 (UTC)
 * No, not semantics. By definition, alternative medicine either hasn't been proven to work, or has been proven not to. The term for alternative medicine that has been proven to work is: medicine. There is no Western medicine or Eastern medicine. There is medicine that works, and superstition. Practitioners of superstition use terms like Western medicine or allopathy to give the false impression of equivalence between their beliefs and the scientific practice of medicine. I will acknowledge that the near-impossibility of proper blinding has led a significant minority in the medical world to believe that acupuncture has something to it, but the trajectory of findings by Copchrane, MHRA, NICE and other bodies is clear: more sophisticated ways of blinding have show the claims of acupuncture to be as illusory as its purported mechanisms. Guy (Help!) 18:50, 3 January 2019 (UTC)
 * Moved to Wikipedia talk:Conflict of interest/Noticeboard Restored. --Calton | Talk 13:57, 3 January 2019 (UTC)
 * JzG apologies if I'm not using the rational sceptic approved vocabulary. I was using the term that AlexBrn used in the sentence I disagreed with: "It is a false equivalence between (most) altmed practitioners and 'western-medicine MDs'. The latter operate in a wide field and if certain therapies and products are found useless they simply adjust to new ones.". So, please don't lecture me on vocab. I'm really really very aware of all the nonsense in AltMed. You and he have both claimed that conventional medicine practitioners are evidence based and swiftly shift with new evidence.
 * You gave one example of knee surgery: "Consider, for example, knee arthroscopy for arthritis. This was tested in well controlled experiments and found to be no better than placebo. The professional community recognised that this means it does not work, so they stopped doing it. Surgeons who performed knee arthroscopy did not have a problem with that". But your story doesn't fit the facts. The guidance in 2017 was made when "1 million knee arthroscopies are performed each year in the United States, at a cost of more than $3 billion". The linked article says the American Academy of Orthopaedic Surgeons complained that "the recommendations are too stringent and don’t take into account the needs of individual patients" (AAOS make no mention of lack-of-evidence here). The article also says that "several studies in the past 15 years that have raised questions about knee arthroscopy. At least four studies in The New England Journal of Medicine found that arthroscopy wasn’t effective for arthritis pain in older adults." The BJM recommendation says  "Arthroscopic knee surgery for degenerative knee disease is the most common orthopaedic procedure in countries with available data and on a global scale is performed more than two million times each year" Hmm so we have a $3 billion a year (US alone) industry performing pointless operations that (typical for surgery) probably had no strong evidence to begin with, and for which studies over 15 years have been saying are pointless. I haven't found a source to backup your claim "they stopped doing it". They went from two million operations globally to zero overnight? Really?
 * This isn't just about doctors that are so bad they should be struck off. A colleague went to their GP with occasionally sore hands. Possibly arthritis the doctor said. What should I do? Well we don't have anything that will prevent it. If it gets really bad, there are some pain killers. You could try taking cod liver oil or glucosamine tablets. He said there isn't good evidence they work, but some patients swear they help. So worth a try perhaps. And that was it. That's all he could suggest.
 * Or consider tonsillectomy... oh, look that one up yourself.
 * My point is that conventional medicine, where we have effective treatments, is often evidence based and goes with best practice. But where we lack effective treatments (coughs, common viral infections, preventing arthritis, painful knees) the doctors don't go with the evidence. They naturally want too help, they naturally don't want to look incompetent and useless, so they suggest and prescribe rubbish that doesn't work or worse, book you in for surgery that doesn't work, or give you pills that kill off the good bacteria in your gut. The key thing is that the AltMed folk deal with incurable conditions too. Nobody goes to the homeopath with a broken bone or visits a herbalist for sepsis. There's plenty evidence that for these areas without effective treatment, conventional medicine lets patients down too. And $3 billion a year for a sham knee operation sounds like a recipe for COI to me. Should we ban surgeons from articles too? -- Colin°Talk 17:02, 3 January 2019 (UTC)
 * The entire field of medicine is a work in progress, and even cherished long-standing practices can be and are discarded when found to be ineffective or harmful. But in all of science it has al;ways been true that some ideas die only with the last of their proponents. Nonetheless, evidence is absolutely the key to this discussion. When the evidence shows a specific drug, or even a class of drugs, to be ineffective or harmful, doctors will stop using them. Yes, it may take longer than it should, but practice will change. When the evidence shows a class of woo to be ineffective, the practitioners have nowhere to go. They fight tooth and nail to preserve their business and their practice. Just look at the years-long rearguard action fought by homeopathists in the UK, which is only now coming to a close with the last Clinical Commissioning Group dropping NHS funding of homeopathy. Even now there are a small number of doctors who will hand out private prescriptions for magic sugar, and Scotland still has at least one homeopathic hospital. We have known since 1842 that homeopathy is a crock of shit, but believers have sustained it by a combination of politicking, propaganda and pseudoscience. Exactly the same for acupuncture.
 * And there's the point: someone who is a practitioner of one of these forms of woo cannot edit neutrally, because their worldview is not anchored in reality. Their livelihood depends on promoting the view that the scientific community is wrong - in the case of homeopathy, spectacularly wrong about everything.
 * When your business depends on the reflection of falsehood as fact, that is a material conflict of interest on Wikipedia. Our rules on COI are about vested interests that drive people to advance a non-neutral POV. Guy (Help!) 19:02, 3 January 2019 (UTC)
 * Thousands of American orthopaedic surgeons paid for their golf memberships and audi sports cars by performing useless operations on millions of people, many no doubt performing that one operation day in day out, with goodness knows how many millions of lost days of work and pay, not to mention the bills, for those with the bad knees. If they'd gone to a homeopath instead, they'd have been better off. Yes homeopathy is bunk and no I don't advocate NHS paying for it. It is rather hard, morally, to choose between a deluded homeopath and a sham surgeon. Keep repeating "doctors will stop using them" all you like, it simply isn't true. Go look into neuropathic pain and tell me how many millions of prescriptions are being written for drugs we know don't work. They prescribe them, because we haven't found drugs that do reliably work. You say "evidence is key to this discussion" but the evidence is that you were not truthful about the knee surgery -- the doctors did not stop doing it when trials found it didn't work. I doubt they ever had good trials in the first place. It was all just some blokes with knives and a knowledge of anatomy and a hunch. So, if you can't be truthful in your facts, you aren't any better than the folk you are trying to block and I'm done arguing. -- Colin°Talk 21:29, 3 January 2019 (UTC)
 * I am about 35% sympathetic with your point, Colin, but I think there is a big difference here and that is that we have documented issues with altmed proponents and sympathizers making a mess of content at Wikipedia while simultaneously carrying on about how it is those who are opposed to their whitewashing who are the real villains. Have you seen much evidence that there are orthopedic surgeons asserting ownership over the articles about the subjects you would like to properly characterize? I guess the strong argument here is that there is a parallel issue with so-called "bad medicine" (to coin a Ben Goldacre phrase) that Wikipedia should be aware of. But when it comes to actual editors and their actions, where is the group of surgeons and their comrades-in-arms who are pushing content that is dubious at best and misleading at worst? jps (talk) 22:03, 3 January 2019 (UTC)
 * jps Ok, now your argument is about editors POV pushing and making bad edits, which we have policy and guidelines about. Any complaints and actions will be due to what they have done and written on wiki. This proposal is about topic banning (from article space) a set of editors because of who they are, and their profession. I think we need to be vary wary of crossing that line, because it is in conflict with our basic principles of allowing anyone to edit and of judging the edits not the editor. Arguments proposed here are that we should ban these people because they believe in treatments that have no evidence and who carry on performing and believing in that treatment even after the treatment has been repeatedly shown to be ineffective. This apparently makes them so irrational that we shouldn't allow them to edit the topic at all. But I have demonstrated that the same irrationality occurs with ineffective areas of conventional medicine.
 * I'm well aware there are a large bunch of editors who are here as a hobby to combat "woo" or whatever they want to call it. They like bashing the nutcases on "the other side" of the battle, and spend their evenings going through their watchlists reverting nearly everything. They get very upset with anyone who appears to give "them" an inch, and are so polarised that it is unthinkable for them to admit their "own side" has flaws. You'll be aware of confirmation bias. If one's life on Wikipedia is to do battle with AltMed then that's where you'll see problems, and you won't really pick up on any COI editing from "your side". Further, if all you read are medical journals, then you'll get a rather biased viewpoint. Much as medical editors hate journalists, it took a journalist to expose the MMR fraud, and there's been recent journalism in The Guardian about surgical implants. What the NEJM/BMJ won't tend to say is how much a treatment is used/performed and plot that over time. It was rather unusual for the BMJ to give figures for the knee surgery. They note that existing guidelines "generally discourage arthroscopy for ...." but still note that it is "the most common orthopaedic procedure". What they don't do is add any journalistic outrage at those conflicting facts, or desire to find out why and how that could be prevented in future.
 * I don't think Guy is a bad chap, but his story was as crap and madey-uppy as a Daily Mail article. He took a bit of truth "A big study has concluded this surgery is pointless" and mixed in his world-view about how rational and evidence-based doctors are compared to AltMed, and wanted desperately for it to fit his argument that AltMed was fixed doing the same procedure whereas conventional medical doctors would switch to alternatives. Well the alternative for knee surgery is exercise, according to the BMJ, and exercise doesn't pay for the Audi. The truth is these surgeons have been ignoring the facts for 15 years, and I'm doubtful they have all stopped. I'll guess many in the AAOS are conveniently finding that their patients have exceptional circumstances that indicate the procedure.
 * I'd be very very surprised if there wasn't POV pushing from industry/conventional medicine. There are some barriers to financial COI (e.g. a UK GP doesn't earn from the drug they write a prescription for) but there are other motivators than money. I don't disagree there is a lot of POV pushing for AltMed, and that it is a problem for Wikipedia. But any argument has to be rooted in honesty rather than stories made up that support your pre-existing world view. -- Colin°Talk 10:02, 4 January 2019 (UTC)
 * I am a little confused by why you went into such a protracted response. Is your goal here to help us come to a mutual understanding or just to brow beat? It's absolutely the case that COI is a haphazard justification (I agreed with you on that!), but the POV pushing WP:PAGs do not quite address the problem as witnessed by us. I cannot decide whether you think NuclearWarfare is on the take or not from your comments below, but while I can point to dozens of problematic instances of AltMed POV-pushers who I think represent something more than just POV-pushing (there are vested IRL interests present here that are not present in the motivations for those who are fans of Star Wars versus Star Trek, for example), I find your examples to be less than convincing just considering the volume of problems I've witnessed. Your single edit below and a reference to certain removals seem to be your evidence of something rotten in the state of Wikipedia medical articles. Let's put it out there: Is there a conspiracy of Audi-driving surgeons campaigning this way? If so, I'm not seeing it. I DO see the campaign of the alt med. They publish of-wiki articles, write petitions (www change org/p/jimmy-wales-founder-of-wikipedia-create-and-enforce-new-policies-that-allow-for-true-scientific-discourse-about-holistic-approaches-to-healing) on the subject and have even set up kickstarter pages ! jps (talk) 16:58, 5 January 2019 (UTC)
 * jps confirmation bias is all about what you don't "witness". The Arthroscopy page used to say it was "ineffective for treating osteoarthritis" then was changed by a well known editor to say "it is not clear whether it is a more effective treatment for treating osteoarthritis" along with other misrepresentations of our sources and an unsourced personal conclusion. It took two years for the article to be fixed and that removed, by some IP. Consider if someone had modified an AltMed article from "ineffective" to "not clear" and from "no benefit" to "small benefit"? How long would that last? Minutes? Seconds? For two years, Wikipedia helped ensure that anyone reading our article on the surgery was left confused and would then probably choose to believe what their surgeon said instead. If looking by chance at one conventional medicine page turns up two years of misinformation in promotion of a treatment that had been debunked a decade before, I'm not at all confident the rest of our pages are in a good shape, or free from POV pushing edits. As for your links, those are like stupid burglars boasting down the pub. I don't seriously think any professional level editing of Wikipedia would be advertised at all. Indeed, Wikipedia is no longer as important as it was when the web was young. Plenty competing sites for medical information. -- Colin°Talk 18:37, 5 January 2019 (UTC)
 * I feel like your argument is hitting up close to one that is non-falsifiable in the sense that you do not find it surprising there is no evidence that there are surgeons manipulating the content on Wikipedia since they will be better organized and perhaps more stealthy than the stupid burglars. You are absolutely right that I am operating under confirmation bias since my experience is as a contributor to Wikipedia rather than a researcher. I honestly do not know if there is evidence that your concern is equal to or greater than my concern. All I can say is what my evidence for it is (which I posted) and can compare it to your evidence (a diff by NW that lasted a year). Your evidence may convince others and perhaps I am compromised by my confirmation bias, but I think we can let our comparison of the problems speak for themselves. NW is a much more competent intellectual than the people I've linked to, I would argue, so I will concede that point at least! jps (talk) 19:31, 7 January 2019 (UTC)
 * jps well yes I agree it is difficult to prove that argument: at least I'm straight wrt what I'm speculating about rather than just telling made-up Daily Mail-level stories about knee doctors, that turn out to be a textbook example of the opposite. I don't know if anyone has seriously investigated, and its fairly clear everyone is more focused on the AltMed errors than the knee surgery errors in articles. Consider for example, the illegal off-label promotion of Neurontin, which resulted in a $430 million fine for Pfizer. It is a well documented story and a large number of techniques were used to promote the drug for several conditions without all the hassle of RCTs and regulatory approval. Why would Wikipedia be exempt from this kind of underhand promotion activity today? Clearly the cost of being caught can be huge, hence why you won't see those silly websites and fundraisers. There is a well known concern with some patient charities and fake "grassroots" campaigns, encouraging NICE or NHS funding to approve/pay for extremely expensive and doubtfully effective drugs, particularly with cancer. I wouldn't be at all surprised if there were some "well meaning" POV edits in that area. I see below WhatAmIDoing has some examples of plastic surgery and makes the argument for all elective procedures.
 * Guy repeatedly makes the well known claim that there isn't "X medicine" or "Y medicine" but only "medicine that works and superstition". This sounds great, but is not only a gross and naive oversimplification of reality but ignores practice. Medicine, throughout the ages, as been about the practice of trying to make people/oneself better and healthier. It is medicine whether that practice is grounded in modern evidence-based science, or the hunch of a surgeon with the latest untested implant, or the dad buying cough syrup for their child, or some eastern religion. It is medicine whether that practice is effective or not. Cancer doctors are practising medicine even if sometimes their treatment involves crossing one's fingers and hoping for the best, knowing the best is unlikely but they have nothing better yet. I don't think the problem with AltMed is comparable to conventional med -- for a start conventional med does have plenty drugs and operations and treatments that do work, so no need to make up stuff about that. The area is more of an issue for those areas where medicine is ineffective. And then, I wonder if the distinction between the two is as large as some would like to think it is. -- Colin°Talk 09:05, 8 January 2019 (UTC)
 * You are comparing the worst possible scenario for doctors (that it is likely a doctor would, for example, boost knee surgery in articles to improve their income) with the best possible scenario for those who profit from anti-science (that, for example, an acupuncturist might do something other than boost the idea that acupuncture is great). Johnuniq (talk) 10:44, 4 January 2019 (UTC)

(outdent) Johnuniq I'm not comparing two scenarios at all. I'm concentrating only on the repeated claim by several users that an important difference between AltMed and Conventional medicine is that doctors are evidence based and switch treatments when better evidence arises, whereas AltMed practitioners are not and therefore should not be allowed to edit. Let's be honest, the "worse possible scenario" is performing millions of operations on knees for decades, and Wikipedia is not really important in the grand scheme of things. jps and yourself both seem sceptical that someone might alter the knee article to make it seem less bad, so I looked at the history.


 * On July 2014 User:NuclearWarfare whitewashed the knee part of the Arthroscopy article. The existing text "current evidence is that surgery is ineffective for treating osteoarthritis" was replaced with "it is not clear whether it is a more effective treatment for treating osteoarthritis than more conservative therapies." In a new subsection the conclusion shifts from negative "no benefit" to positive "patients undergoing APM recover at high rates" and "differences [between trial groups] are small". The "are small" claim is scientific nonsense. The paper says "did not differ significantly" which is all that matters. The second source cited by NW says "not superior". The fifth source (from 2013) cited by NW concludes "The the results of this randomized, sham-controlled trial show that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. These results argue against the current practice of performing arthroscopic partial meniscectomy in patients with a degenerative meniscal tear". Following a bunch of 5 citations is the unsourced conclusion by NW: "It is unclear which treatment is most clinically- or cost-effective."
 * Another feature of the history is that although article text about landmark notable and interesting trials have been added (from as far back as 2008 by WhatAmIDoing and others), they keep getting removed in favour of citing meta-analysis or reviews per MEDRS. While these reviews are stronger sources, the background and history of research, not to mention the 15 years of trying to demonstrate how useless this op is, is lost. The reader no longer gets an explanation of why the treatment has been found ineffective but is just told it is. The famous placebo surgery pioneered by the Moseley study from 2002, which is highly cited and even mentioned on popular medical TV documentaries, no longer gets mentioned here, though is briefly noted in Sham surgery.

So, hmm, I'm a bit concerned about the iffy edit by NuclearWarfare to be honest. Trying to make the very clear science appear "unclear" is classic disinformation used over the years from smoking to global warming conspiracy theorists. -- Colin°Talk 22:12, 4 January 2019 (UTC)


 * Alternative medicine is certainly not free of problems also w.r.t. editing Wikipedia here. However unlike real medicine it isn't responsible for millions of premature deaths per year. A quarter the population in Western nations will die prematurely as a result of bad medical advice about their diets. We're told in official sources that a healthy diet must contain dairy, meat or fish, refined oils and fats, whole grains, vegetables and fruits. The latter 3 items are indeed healthy to include, but the overall makeup of this sort of a diet is extremely unhealthy, it leads to atherosclerosis in almost 100% of the population, which then causes heart attacks and strokes in about 25% of the population.
 * Populations that eat a mostly plant-based diet are almost free of cardiovascular disease. Many studies have been done some recently, and quite a few many years ago confirming this using many different methods. But, such results are overwhelmed by the much larger number of studies looking into variations of our own diet looking for correlations between things like fat intake, carb intake, salt intake and cardiovascular disease. The latter type of studies are then included in review articles, they involve large numbers of unhealthy Western people, the highly statistically significant results make them more valuable in the eyes of the medical profession and they then form the basis of official medical advice and guidelines. Cardiologist are educated based on the results of such studies.
 * Very occasionally the propaganda we're fed about our own diet is interrupted by news items like this read this: "Cardiologists are generally convinced that blood pressure inevitably increases with age. Now a new study calls this belief into question." As a result of such mistakes, we're exposed to a risk of cardiovascular disease that is about 100 times larger than the natural risk we would be exposed to if we all stuck to a mainly planted-base, whole food diet, supplemented by small amounts of meat and fish. We're only told that we can lower our risk by 30% by switching to the Mediterranean diet. So, we're only told about a healthier option that gives us a 70 times higher risk instead of the usual 100 times higher risk.
 * Why are the results from statistical studies on Western populations wrong? As pointed out here, a healthy diet that reduces cardiovascular disease risk to almost zero is a mainly planted-based diet that provides less than 20% of the calories from fat. This means that you need to eat a massive amount of whole grain carbs, you should also eat a large amount of fruits and vegetables. On such a diet, you'll get your proteins from plant sources, you only need to eat small amounts of meat and fish to obtain vitamin B12. So, the fundamental flaw of the Western diet is the high fat content. This would cause massive nutritional deficiencies that are only averted by eating lots of meat and dairy. So, the shortage of protein is made up for by eating meat and dairy, the shortage of calcium is made up for by eating dairy. However, by plugging holes in our diet this way that prevents malnutrition on the short run, we may leave holes open that cause diseases on the very long run. E.g. meat and dairy don't contain fiber which we now know is good for cardiovascular health. Fat itself can be neutral or even slightly heart healthy for our diet to still cause cardiovascular problems down the line. It's impossible to see this problem when doing research on a population that is almost 100% sticking to the same sort of diet. Count Iblis (talk) 01:34, 4 January 2019 (UTC)


 * How do you know that? MDs have little training in nutrition science. And bona fide nutrition experts, e.g. prof. dr. Martijn B. Katan, a highly cited scientist, do no deal in such alarmism. Tgeorgescu (talk) 03:00, 4 January 2019 (UTC)
 * Let's study populations who get almost all their nutrients from planted-based foods. Example 1, example 2, example 3, example 4, example 5. And note this debunking of the story that Eskimos don't get heart disease.


 * Now the bona fide nutrition experts are aware of all this, but they have taken the view that since most people are not going to eat a mainly plant-based diet that it's a waste of time and resources to do a lot of research into this. Their main focus is to do research on small variants of the diet we already eat, they think that it's going to be difficult enough to get people to eat just a bit more vegetables. They fear that if they're told to eat a lot more vegetables, then they'll give up completely on trying to eat healthier. We can read here: "Dr Aune said the findings did not mean the five-a-day message needed to change.He told the BBC: "There are many different considerations if changing policy, it's not just the health effects - is it feasible? "But our findings are quite clear in that they do support five a day, but there are even some further benefits for higher intakes." Dr Alison Tedstone, chief nutritionist at Public Health England, said: "The five-a-day target is the foundation of a healthy balanced diet and is an achievable way to help prevent a number of diseases. "Whilst consuming more than five portions of fruit and vegetables a day may be desirable... adding pressure to consume more fruit and vegetables creates an unrealistic expectation."" Count Iblis (talk) 04:31, 4 January 2019 (UTC)


 * I see that Count Iblis has once again deigned to grace Wikipedia with his usual contrarian schtick/performance art. Meantime, in the real world, the actual dangers, costs, and financial incentives for letting charlatans skew Wikipedia coverage are outline here --Calton | Talk 03:02, 4 January 2019 (UTC)
 * Stop drinking the Kool-Aid before it is too late. Count Iblis (talk) 04:36, 4 January 2019 (UTC)
 * Actually says it rather well why Wikipedia differs from a free, democratic society: we're more like a company with strict management principles than like a country. Tgeorgescu (talk) 05:22, 4 January 2019 (UTC)

Arbitrary break 2
As can be clearly seen from this edit, ("is it OK for others editors to act like he must follow COIADVICE?"), is committed to his claim that he is exempt from WP:COIADVICE. For those of you who have voted no on this RfC, do you agree with Middle 8's assertion? Should I ask Middle 8 to follow COIADVICE, or should I ask the authors of the edits Middle 8 cites (Roxy the dog and Guy) to stop acting as if he is required to follow COIADVICE? Somebody is right and somebody is wrong. Which is it? --Guy Macon (talk) 16:27, 7 January 2019 (UTC)


 * If there is a consensus that being an acupuncturist is not inherently a COI when editing acupuncture related articles, then you should only ask Middle 8 to follow COIADVICE if you are aware of some more direct conflict of interest such as being paid to edit, or editing related to their specific acupuncture practice, but just being an acupuncturist is fine. Tornado chaser (talk) 23:44, 7 January 2019 (UTC)


 * I'm no more or less "exempt from COIADVICE" than anyone without a finding of COI, and the diff Guy Macon selectively quotes in no way implies otherwise. --Middle 8 (t • c | privacy • acupuncture COI?) 07:08, 8 January 2019 (UTC)
 * Your COI leads to your relentless advocacy. A topic ban would solve that pretty simply and remove the drama. Guy (Help!) 07:19, 8 January 2019 (UTC)
 * What COI? I take no position on a topic ban, but a TBAN should only be used if Middle 8 is POV-pushing, there is no consensus that acupuncturists have a COI on acupuncture articles, so such questionable accusations should not be used to sanction(or threaten to sanction) anyone. Tornado chaser (talk) 15:55, 8 January 2019 (UTC)

Plastic surgeons
So I've been thinking about this a bit more. I think the RFC is poorly framed, and I do wonder about the motivation (what exactly triggered this?), but let's see if we can get some good out of this discussion.

Let's talk about practical reality: We have had a huge amount of trouble with a few altmed folks. (A few, including a long-time homeopathy promoter, have actually helped us achieve NPOV.)

Do you know who else we have ongoing trouble with? Plastic surgeons. Specifically, the ambitious cosmetic sort. The "plastic surgeons" that specialize in functional repairs to hands or deal with major medical problems, like reconstruction after trauma or cancer, don't seem to bother us much, but the ones who do optional aesthetic work, like face lifts and breast augmentation, have been serious and sometimes subtle pests for years. The old hands will remember when we suddenly sprouted a huge number of articles about plastic surgeons in Alaska (possibly all of them – it seemed to be a project by some medical association there). Self-citations to trivial publications happen all the time. It seems like every other one plastic surgeon has trademarked something, and everyone with a trademark wants it in the English Wikipedia. We really need before-and-after photos for some of these surgeries, and we get them ...but not realistic or typical ones. We only get the wildly successful cases, usually involving gorgeous women, and you can click through on the picture to get contact information for the doctor's office. Find the photo you like on Wikipedia, and click through to schedule your own.

When I read the question at top of this RFC, it feels like we're being asked to treat an everyday altmed practitioner as being materially different from these "conventional, science-based medicine" physicians who make money by advertising their skills and products to women who want to look younger than they are. Given the long history of personal self-promotion by surgeons who earn their money through purely optional medical procedures, I'm really not sure why we would welcome the cosmetic surgeon but reject the massage therapist.

Also, in setting this up as an either-or, what do we do with dual-licensed healthcare professionals? A huge proportion of American physicians refer pain patients for chiropractic, acupuncture, and massage therapy. AIUI, MDs are legally able to perform any medical procedure and prescribe any treatment in the US, and I'm aware of one MD who does both conventional medicine and acupuncture. Is it logical say that the doctor has no COI if she writes that medically supervised treatments for acne are more effective than over-the-counter remedies, but she has a COI if she adds the name of a traditional acupuncture pattern, or adds a source that says it's useless for cancer, or removes overly favorable information? That doesn't seem logical to me. I think what we are really struggling with here is the problem of POV pushing, not COI. We have our pro-science POV pushers, and we have anti-science POV pushers on the altmed articles. When I look at this RFC, I wonder whether one of our steadfast anti-woo warriors is just seeking another tool to stymie the altmed POV pushers, rather than dealing with an actual problem of COI. Because, if – as he says above – any pro-acupuncture edit is a financial COI for a person who earns a living through acupuncture, then presumably any pro-optional-aesthetic-surgery edit is also a financial COI for a person who earns a living through optional aesthetic surgeries. And if that's true, then the question shouldn't be about altmed practitioners; it should be about all healthcare providers that provide elective treatment. WhatamIdoing (talk) 13:59, 6 January 2019 (UTC)
 * Strongly agree! COI is manageable through disclosure; POV-pushing is the main problem, not addressed by the RFC as formed. — soupvector (talk) 15:58, 6 January 2019 (UTC)
 * That's self-promotion, not POV-pushing, though. And yes it's a problem. I agree with soupvector up to a point, but with proponents of quackery it is extremely rare to find any proposed content that does not serve to suggest spurious legitimacy., which homeopathist helped to achieve NPOV? Guy (Help!) 07:23, 8 January 2019 (UTC)
 * I think there is a difference between an elective medical treatment, and ineffective Alt-Med fraud. They are not providing health care. -Roxy, the dog . wooF 08:29, 8 January 2019 (UTC)


 * What makes you think that common cosmetic procedures, such as laser hair removal and botox injections, should usually count as "providing health care"? There's no healthcare payer in the world that thinks botox to hide wrinkles is "health care".  WhatamIdoing (talk) 10:41, 8 January 2019 (UTC)
 * I think it depends on the content. Declaring that your invented procedure is better than the next guy's is self-promotion and POV pushing.  (I don't remember the name of the old homeopathy editor, who is doubtless inactive by now.  I do remember someone talking about the situation a few years ago, contrasting the one proponent, who worked within the rules to create descriptions that were recognizable both to the pro-homeopathy minority and the anti-homeopathy majority, vs the typical proponent.)  WhatamIdoing (talk) 10:54, 8 January 2019 (UTC)
 * Sure, the inventor of a procedure would have a COI as well as likely POV / PROMO issues. But the example is illuminating. The proponent of a specific surgical procedure has a COI for that procedure but probably not for surgery per se, whereas in the case of, say, acupuncture, there is only sticking needles in people - it's a single homogeneous suject and someone who earns their living selling it can't really separate out any edit from their immediate financial stake in it. Guy (Help!) 11:56, 8 January 2019 (UTC)
 * But in practice there is more to acupuncture than sticking needles in people (precisely because sticking needles in people doesn't do anything useful). So, the people who have been able to make a living out of such a practice, tend to do things that their patients are satisfied about (which is mostly talking to them about their personal lives). While they could abuse Wikipedia to get more customers, they obviously can't advertise their specific practice, they need to write something that fits into the generic topic area and there is nothing specifically about sticking needles in people specifically that makes their business successful. So, they would not be able to write down on a Wiki page about acupuncture why everyone needs to visit their business and not their competitor's business. Count Iblis (talk) 12:18, 8 January 2019 (UTC)
 * The claim "acupuncture ... is only sticking needles in people - it's a single homogeneous subject " isn't considered useful by researchers, who clearly have been wasting their time investigating it for all sorts of specific conditions. I guess they should just have poked themselves in the thumb with a needle, noticed their back pain was just as bad as ever, and written off that entire subject. It really doesn't help to drag this down to political-campaign level of over-simplification and polarisation. Plenty doctors are prescribing medicines or treatments that have no evidence of effect, or evidence of no effect, often off-label, and typically in areas where we lack effective medicine or treatment alternatives.. Some of them may be doing so out of desperate care for their acutely ill cancer patients, and others may just be stringing along someone with untreatable pain who has already tried all the approved treatments, and has a fat wallet. As one gets older, one comes across an increasing number of ailments that aren't effectively treatable. AltMed is not alone in exploiting this situation. -- Colin°Talk 13:27, 8 January 2019 (UTC)
 * Indeed, but I would say that there does exist a treatment that has its roots in alternative medicine that does work well here, namely exercise. It's not prescribed all that much by doctors because patients tend not to like do do this. As we can read here: "If exercise was a pill, everyone would be taking it". Count Iblis (talk) 13:55, 8 January 2019 (UTC)
 * The idea that diet, exercise or anything else was ever alternative is incorrect. The entire point of the rebranding of alt-med to CAM was to bundle in legitimate complementary therapies that were already in use to give a halo effect to obscure the lack of legitimacy of the alternative bullshit. Homeopathy is bollocks. Homeopathy plus exercise works! Therefore it's the homeopathy. That was their entire game. Guy (Help!) 11:22, 12 January 2019 (UTC)
 * Also, how would Wikipedia, had it existed in the 1930s, have covered health and fitness clubs? We can read here: "In 1936, he opened the nation's first health and fitness club in Oakland, California,[12] where he offered supervised weight and exercise training and gave nutritional advice. His primary goal was to encourage and motivate his clients to improve their overall health. Doctors, however, advised their patients to stay away from his health club, a business totally unheard of at the time, and warned their patients that "LaLanne was an exercise 'nut,' whose programs would make them 'muscle-bound' and cause severe medical problems."[12] LaLanne recalls the initial reaction of doctors to his promotion of weight-lifting:


 * “People thought I was a charlatan and a nut. The doctors were against me‍—‌they said that working out with weights would give people heart attacks and they would lose their sex drive.[5]"". Count Iblis (talk) 13:49, 8 January 2019 (UTC)
 * Do plastic surgeons have a code of practice? a regulatory body? LASIK eye surgeons who spam the project? Are those bodies effective? how about alt-medists? What happens to alt meddlers whose victims end up dead after an alt med procedure? What do alt-med governing bodies do to rogue practitioners? Differences between how real medicine regulates itself, and quackery, are very telling. Foxes, chickens and chicken coups. Roxy, the dog . wooF 16:06, 8 January 2019 (UTC)
 * Regulation of alternative medicine. Count Iblis (talk) 16:35, 8 January 2019 (UTC)
 * Some slash and burn needed there!! Roxy, the dog . wooF 17:30, 8 January 2019 (UTC)
 * And the difference in regulation between what you call "real medicine" and what you call "quackery" is what exactly? Your foxes/chickens comment seems to imply conventional medicine is policed by independent third parties? Instead it relies rather a lot of doctors making formal complaints about each other, which they are understandably loathe to do. Sometimes it relies on class action lawsuits against companies making unsafe implants. Harold Shipman probably murdered 250 of his patients, and regulation failed in many ways. I suggest that, compared with homeopathy and acupuncture, ear candling and yoga, conventional doctors and nurses have many more "victims end [who] up dead", whether though malice, malpractice, incompetence or ignorance. They have many more grateful patients who thank them for being alive and well, though, it has to be said. I'm not entirely sure why regulation is relevant to whether we let people edit, but once again, the differences people claim aren't nearly as significant as they make out. We all have our human weaknesses. -- Colin°Talk 19:42, 8 January 2019 (UTC)
 * Similarly, I'm not sure of the relevance of Plastic surgeons to ALT-MED. It's chalk and cheese. Is the professional ability of a surgeon being compared to the professional capability of a Reikist for example. -Roxy, the dog . wooF 20:35, 8 January 2019 (UTC)
 * I think you've forgotten the purpose of this RFC. Which is to decide that those who practice one a group of medical therapies called "Alt Med" should be topic banned from medical articles, whereas presumably those who practice conventional medicine should be encouraged to edit such articles. And specifically that the Alt Med practitioners may have a COI, and are particularly unsuitable for MEDRS topics due to the lack of evidence (or evidence of lack). The problem is there are areas of conventional medicine where the same is true, particularly for elective treatments and where medicine is mostly ineffective. Let's not forget Andrew Wakefield was a conventionally trained doctor, fellow of the Royal College of Surgeons, and the child of a neurologist and a GP. -- Colin°Talk 21:14, 8 January 2019 (UTC)
 * Colin is correct: The RFC seems to be focused on a difference that doesn't seem to matter.  The financial benefits to polishing up LASIK articles for a person who does LASIK eye surgery may even be greater than the financial benefits that a massage therapist gets from polishing up massage articles.  But this RFC question is "Let's all say that altmed folks are bad", instead of sticking with something closer to a universal truth:  "If changing this article could significantly change your paycheck or your work, then stay away – and that includes all of you in that situation, not just some of you".  WhatamIdoing (talk) 21:24, 10 January 2019 (UTC)
 * That is a very good point: the closer your financial interests are tied to what an article says about them, the more of a problem we have. Unfortunately alt-medders are arguing pretty much the exact opposite - that their practice is not in any way benefited by whether Wikipedia says it's legit or not. A lot of the No votes above should actually be "Yes, but not just them". Guy (Help!) 11:18, 12 January 2019 (UTC)
 * Additionally, said "No" !votes may well mean "No to this RfC, but maybe Yes to a different one". But I'd be careful about assumptions.
 * Anyway: WhatamIdoing's argument is spot-on.  Why not open a new RfC, or better just try to change the COI guideline, accordingly?  --Middle 8 (t • c | privacy • acupuncture COI?) 01:25, 13 January 2019 (UTC); more, 11:03, 13 January 2019 (UTC)


 * Am I the only one to think it a little wrong this whole discussion has received such an extreme amount of attention but there seems to have been zero (whether here, in our articles, or the editors talk pages) given to where the person for who concerns were expressed seems to be named in at least source used in one of our articles? Nil Einne (talk) 09:28, 9 January 2019 (UTC)

This is just weird
We have pretty solid consensus that people who sell X have a COI in respect of the article on X. Does this change when X is a service? I doubt anyone would say it does. Yet here we seem to be saying that it does change in the specific case where X is a pseudomedical treatment. Basically we are saying here that someone who sells widgets has a COI in respect of the widget article, but someone who markets magical fake cancer cures does not have a COI in respect of the article on their magical fake cancer cure.

There are solid arguments above that being a practitioner of most things could give you a COI, but there seems to be a widespread belief that this does not apply if the thing of which you are a practitioner is fraudulent. That's... odd. Guy (Help!) 11:30, 12 January 2019 (UTC)


 * To further confuse the issue, nobody seems to have a problem with, say, a person who does conventional knee surgery and who competes with people doing arthroscopic knee surgery not being allowed to edit a page that contains claims that arthroscopic is better, but if the person is an acupuncturist many here think that he should be allowed to freely edit a page that says that acupuncture is ineffective (which it clearly is).


 * I fear that this might end up being something that Arbcom has to deal with with the usual heavy hand. Didn't they already have an alt-med case? Anyone have a link? I didn't find it when I searched. --Guy Macon (talk) 16:46, 12 January 2019 (UTC)


 * It's usually not selling X and editing an article on X, as having an article on X will then be problem in the first place. So, when an article on X is created, the article will end up on AFD. Usually the problem with COI editing will manifest itself when someone edits something about X in an article about a large class C if products to which X belongs. Selling X is a problem as you may not be impartial about all the items that belong to C. But it's not a problem for someone who professionally deals with the entire set C. As long as C is a large class of different items and editors who professionally deal with C are not particularly invested in any specific elements of C, there is not going to be a problem with editing C. And if someone is invested in a particular element of C, then it's not a problem either as long as such specific elements of C are not mentioned in the article about C.


 * Editors who practice acupuncture are therefore not going to pose problems as the subject "acupuncture" is a similarly generic topic area. The editors who may be professional acupuncturists compete with each other within this generic field. It would require edits about certain special practices within acupuncure that only a particular acupuncturists offers for COI to be an issue. Count Iblis (talk) 21:14, 12 January 2019 (UTC)
 * That is the core error. There are hundreds of different types of surgery, but only really one acupuncture. Showing that knee arthroscopy is ineffective has no significant effect on the income of a surgeon who performs knee arthroscopy, as there is a mountain of other work to do. Showing that acupuncture is ineffective is fatal to the acupuncturist's business. The analogue would be if all surgery were shown to be ineffective. That is unlikely, to say the least. Guy (Help!) 21:26, 12 January 2019 (UTC)
 * @Guy, step back from the specifics and generalise your proposition.
 * What it amounts to is "A person providing X service has a COI unless their training is broad enough to allow them to maintain their livelihood if their current work was curtailed".
 * Do i really need to spell out how many thousands of occupations would be caught within that net? -- Brown HairedGirl (talk) • (contribs) 02:36, 13 January 2019 (UTC)
 * To put it another way, if homeopathy was found to be real, it could cause doctors to lose business, so by Guy's logic, User:Doc James can't edit any articles about homeopathy. This proposal will lead to a reduction in the expertise of editors. Tornado chaser (talk) 02:51, 13 January 2019 (UTC)
 * Or to put it another way, if homeopathy was found to be real, it would be added to the armoury of real medicine. The idea that doctors suppress novel treatments belongs with conspiracy theories. I don’t recall ever seeing any evidence that suggests that doctors opposed the introduction of, say, antibiotics for fear of losing business. Brunton (talk) 10:52, 13 January 2019 (UTC)
 * Given that there are already practitioners of homeopathy, if homeopathy way found to be real, It could lead more people to go to the homeopath and less to the doctor. Antibiotics are different, as for I know there weren't fringe practitioners giving people antibiotics back before antibiotics were found to work, so there was no one to go to instead of the doctor. Tornado chaser (talk) 15:17, 13 January 2019 (UTC)
 * Not unless the core claim of homeopathy - that theirs is the only valid form of medicine - were validated. If homeopathy worked it would be a part of medicine in the same way as antibiotics. I don't think there was ever a time when antibioticists were a separate an distinct thing, and homeopaths are only a distinct thing because real doctors stopped using it. Guy (Help!) 19:05, 13 January 2019 (UTC)
 * I don't think that's true. Homeopaths declared themselves to be a completely distinct thing from the very beginning, because denigrating the group that eventually because mainstream physicians was their original marketing strategy.
 * Also, it's worth remembering that before antibiotics, there were sulfa drugs, and before sulfa drugs there was, well, all those tinctures at the herbal store, which used to be formally prescribed as drugs by mainstream, science-oriented physicians – and during our lifetimes (for some of us), not just way back in the dark ages. WhatamIdoing (talk) 02:09, 20 January 2019 (UTC)
 * Well, kind of. Hahnemann was a doctor, and his opposition was not to medicine as currently practiced bt to heroic medicine, which he termed allopathy. There are a small number of medical homeopaths, MDs with a sideline in homeopathy. But it is true that most homeopaths have no medical training (though NDs fondly believe they do). Guy (Help!) 14:41, 24 January 2019 (UTC)
 * William Douglass (physician) covers a case from 1721 in which physicians in Boston at first opposed the use of innoculation against smallpox. However, the physician William Douglass changed his mind a year later, an instance of evidence-based medicine at work. - Donald Albury 16:39, 13 January 2019 (UTC)
 * Exactly. The COI comes in part from the fact that the article subject is the thing and the whole of the thing, in a way that is not true of antibiotics, which is a tiny subset of medicine even for someone specialising in acute care, and in part form the fact that the vested interest is in opposition to reality. Doc James doesn't have a COI in respect to homeopathy not only because he could use it if it worked, but also because he has no vested interest in preventing the scientific consensus from being accurately reflected on Wikipedia. Guy (Help!) 19:03, 13 January 2019 (UTC)

I absolutely agree. Step back and generalise. Here is my thinking, tell me where I am wrong.
 * An oncologist edits articles on cancer: Normally fine. Oncology as a profession depends ont he existence of cancer, but this has always existed and probably always will, and the practice of oncology is evidence-based and changes as treatments are devised or refuted.
 * A surgical oncologist edits articles on cancer: Normally fine. There's no real controversy about the nature of surgical oncology, as long as the views being reflected are mainstream and well supported by MEDRS.
 * A surgical oncologist edits articles on a specific form of cancer surgery in which they specialise: Proceed with caution, declare possible COI. If you only do a specific form of surgery then you will have a problem if it is refuted, and that can put you in conflict with the evidence base when editing Wikipedia.
 * A surgical oncologist edits articles on a specific form of cancer surgery of which they are a lead proponent: Definite COI, don't edit the article directly. This would apply, say, to Bill Heald at the article on total mesorectal excision.

Do we agree on this? The COI is dependent on the degree of overlap of my vested interest (financial or reputational) and the article content. I hope this is not an especially controversial view of COI practice.

The fundamental test for COI, beyond obvious spamming, seems to me to be: what would be the consequences for me if this article completely invalidated everything I believe on the subject? If TME were shown to be worthless or harmful, it would be devastating for Bill Heald, would be a major blow for several groups around the world who have invested heavily in training, but would be of minimal importance to anyone for whom that specific surgery was just part of their job. The same patients would present with the same cancer, they would simply need a different surgery.

Now let's try to switch surgical oncology for acupuncture.
 * An acupuncturist editing an article on pain, not mentioning acupuncture: Normally fine.
 * An acupuncturist editing an article on pain, mentioning acupuncture: Problematic. The question of whether acupuncture works for pain is not settled, the evidence suggests it is increasingly unlikely, and an acupuncturist definitely has a dog in the fight. An acupuncturist gains direct financial benefit if our article on pain says that acupuncture is effective for pain, and direct financial harm if we acknowledge that it is not.
 * An acupuncturist editing an article on acupuncture: Definite COI. If an acupuncturist wakes to the news that final clinching proof is in that acupuncture is bollocks (some would argue this already happened, of course) they are stuck. There is no other use for the skill of sticking needles in people, the skills are not transferable and they are not trained in any other treatment for the same conditions.
 * There is no real analogy for the case of the major proponent of a specific surgery. You don't have specialists in knee acupuncture.

Real doctors exist within a framework of evidence-based medicine where practices change in response to science. They have broad and transferable skills. If our surgical oncologist wakes up one morning and finds that the illuminati have finally released the cure for all cancers that they have been suppressing for a century, she is still a surgeon and can do other work. And even then, doctors can persist with well known false beliefs long after they should have stopped (e.g. some forms of breast cancer surgery). The more closely someone's reputation and income is tied to a specific treatment (and remember that surgery is a family of treatments but acupuncture is basically just one), and the more equivocal and contentious the evidence is for that treatment, the more important their COI is for Wikipedia. Conversely, the smaller the overlap between their practice and the topic, and the more mainstream and settled the science is, the less important the COI becomes. Former medical students are certainly not infallible, but virtually all of them are wedded to the idea of evidence based practice, whereas alt-med practitioners have massive cognitive dissonance when science contradicts their claims. Homeopaths have fought tooth and nail for decades to preserve their practices in the UK in the face of incontrovertible evidence that they are wrong. There is no other use for the skills of a homeopath other than homeopathy, they have spent decades training, they have no other option than to resist the march of evidence.

Finally, and most importantly, COI is strongest when money, reputation and belief are all in play. Naturopaths, for example, have a strong vested interest in expanding their scope of practice and promoting naturopathy as a primary care practice. Most of what they learned at their expensive naturopathy schools is false, misleading or only accidentally true - but they believe they are more qualified than reality-based doctors "because holistic". There is no practical difference between an alternative medicine school and a seminary, but when a seminarian emerges they do not (usually) claim to cure disease. A big part of the COI comes from the fact that there is an inherent conflict between belief-based alternatives to medicine, and the scientific method, because science has this terrible tendency to prove the beliefs wrong. Guy (Help!) 17:49, 13 January 2019 (UTC)
 * I agree, as an internist and infectious diseases specialist who has focused clinically and scientifically on hepatitis C; I comment here because the latter - "scientifically" - is the greater challenge for me as an academic. I edit medicine-related content without much concern about COI, but have approached the biomedical topic of hepatitis C with caution, recognizing a "third rail" when the editing involves consideration of citing my own work (peer-reviewed primary and secondary sources, including reviews and book chapters). In an academic world where citation impact is the coin of the realm, the COI associated with self-citation should be a major consideration. This is similar to what and others have said above, just an additional layer that might not be captured by assessment of clinical motivations (and applies to the topic of acupuncture specifically, for academics who write about that). 18:06, 13 January 2019 (UTC)
 * Yes. And let's not forget the definitional issue: alternative medicines are alternative because they do not have good evidence. If there was robust evidence, they would not be alternative. Alt-med practitioners have a deep resentment and suspicion of science and evidence based medicine and have their own litany of pejoratives to delegitimise it even while adopting its mannerisms - hence the term pseudoscience to describe much alt med research. Guy (Help!) 18:55, 13 January 2019 (UTC)
 * Indeed, but this has been the case for a very long time. So, alt-med practitioners today have set up their practices, have build up their client base in a setting where the science is clear cut about the lack of evidence and also in many cases about evidence against any of the claims they are making about the efficacy of the treatments offered. This means that whatever science has to say is irrelevant to their business. If the way a practitioner were to recruit clients would make what science has to say be important, then his/her business would go bust. Most successful businesses are good at exploiting whatever the current situation is. So, alt-med businesses will end up exploiting the fact that part of the population thinks negatively of what science has to say, perhaps because of negative experiences with conventional medicine. So, if science says X then they can get away with argueing for the opposite of X to get their clients recruited.


 * The real competitor of an alt-med business are therefore other alt-med businesses, not conventional medicine. It's just like religion being quite immune to scientific arguments. The competitor of a particular religion will be another religion. Showing that Jesus could not have walked on water is not going to cause people to cancel their church memberships. Count Iblis (talk) 19:35, 13 January 2019 (UTC)
 * You would hope so, but in fact that does not seem to eb the case. Al-medders happily nod and smile at each other's bullshit, they don't try to take patients away, they try to sell their bullshit as well.
 * This is in stark contrast to the alt med rhetoric about reality-based medicine, which they denigrate relentlessly. A substantial proportion of alt-medders are antivax, most will denounce chemotherapy, radiotherapy and surgery for cancer (the "cut poison burn" narrative), all talk about "big pharma" and the supposed huge sums paid to doctors to promote drugs and vaccines. Read Natural News, for example, or GreenMedInfo, or any of the other insane alt-med websites. Or the entirely reputable-looking glossy supermarket crunchy-mummy lifestyle magazine "What Doctors Don't Tell You", which contains disinformation and fraudulent advertising on a truly epic scale. Guy (Help!) 00:05, 14 January 2019 (UTC)


 * I Strongly agree with the post by "the other Guy" starting with "Here is my thinking, tell me where I am wrong". I would like to see it turned into an essay (I will be glad to do this with attribution if nobody else has the time). --Guy Macon (talk) 23:00, 13 January 2019 (UTC)


 * The real competitor of an alt-med business are therefore... The real competitor is reality (evidence-based medicine, and the science it is based upon). Comparing a medical professional to an alt-med practioner is a false equivalency. Comparing a medical professional to someone pretending to be a medical professional is much closer. Alt med practitioners are people who want to be compared favorably to medical professionals, without going too far over the line of practicing medicine without a license, of making health claims without evidence, or other health fraud that will result in major legal action. --Ronz (talk) 23:52, 13 January 2019 (UTC)


 * It's a mistake to call it "Alternative medicine", which means "some other medicine." A better name is Pseudo-medicine, which clarifies that it is a pseudoscience, not medicine at all.  Any treatment that is scientifically shown to work is called evidence based medicine, or more succinctly, medicine.  Any treatment that plausibly might work and can be studied scientifically is experimental medicine.  Everything else is pseudo-medicine.  There is also traditional medicine which overlaps some of each. I think we need to start a discussion somewhere to clean up the terminology.  Then, the issue of COI is that those who promote pseudoscience have a conflict of interest editing Wikipedia in any topic related to their promotion.  Wikipedia has a firm policy not to represent fringe views, including pseudoscience, at all. Medical professionals represent an evidence-based practice and have no conflict of interest with Wikipedia by virtue of their professions. Jehochman Talk 02:28, 14 January 2019 (UTC)
 * Both Jehochman and User:JzG are making claims that oversimplify the problem and certainly Guy has made several claims that are in contradiction to all evidence. It is all very well repeating the mantra that there is only one "medicine" (evidence based) or repeating claims that "Real doctors exist within a framework of evidence-based medicine where practices change in response to science". But this is, to be quite frank, bollocks. Many "real doctors" prescribe as many non-evidence based pills before their morning coffee than some homeopaths. Many "real doctors" use surgical implants with no randomised controlled trials. Many "real doctors" take 15 years before the evidence that their surgery is no better than placebo forces them to find something else to do. Many "real doctors", selling fertility treatments, offer "add-ons" at extra cost and with little or no evidence of effectiveness or safety. All these "real doctors" are practising medicine, but not apparently according to the fairy-tale definition you would like to use. Some of this behaviour is scandalous and unethical, much of it is very routine and current practice, and many times done because there is nothing better and a genuine desire to help. But some in this unnecessarily polarised "vote" choose to ignore it. The difference is that conventional doctors do also prescribe pills with evidence of efficacy and safety, they do perform surgery that cures, and they do help infertile people conceive. But they also do the other stuff that you think should get Alt Med folk topic banned. It really isn't as simple as you claim. -- Colin°Talk 08:56, 17 January 2019 (UTC)
 * Medicine certainly operates on a continuum of validity, but you are missing the essential point that in order to be alternative medicine, something has to be outside of that continuum. This is a fundamental truth that years of rebranding have been designed to obscure. Alt-Med became CAM (i.e. legitimate complementary therapies plus bullshit) and that became Integrative Medicine (integrating legitimate complementary therapies and bullshit into legitimate practice). No amount of rebranding, though, can ever make homeopathy, reiki, acupuncture and the like anything other than bullshit.
 * Problems with real medicine validate pseudomedicine in exactly the same way that plane crashes validate magic carpets. Guy (Help!) 09:48, 17 January 2019 (UTC)
 * No, you are trying to oversimplify a complicated issue and neatly compartmentalise "good guys" and "bad guys" so you can topic ban people. I don't accept alternative medicine is outside that continuum, just at one end. Plenty of conventional medicine operates at the same end, and plenty doctors do things throughout their day that are at all parts of that continuum. Here's Cochrane: "Many transvaginal polypropylene meshes have been voluntarily removed from the market, and newer light‐weight transvaginal meshes that are available have not been assessed by RCTs. Clinicans and women should be cautious when utilising these products, as their safety and efficacy have not been established." So surgeons were and are implanting plastic meshes into women, with no evidence of safety or efficacy, and with mounting evidence of real harm. They were only "voluntarily removed from the market" when the class action lawsuits arrived. Those surgeons are just the same as the herbalist prescribing some herb because some old textbook recommends it. Neither knew nor cared about evidence, only their own confidence and ego and misplaced trust in another authority. Nobody died on a magic carpet. -- Colin°Talk 13:07, 17 January 2019 (UTC)
 * Come on Colin, there are good examples of magic carpet rides leading to death for the rider. -Roxy, the dog . wooF 13:15, 17 January 2019 (UTC)


 * I also think one has to consider the "fake-news meme" that people are sensitive to. People who are into alt-med whether they are pratitioners or clients will put aside what the media that is based on rigorous scientific research has to say. This is why the statement by JzG: "An acupuncturist editing an article on acupuncture: Definite COI. If an acupuncturist wakes to the news that final clinching proof is in that acupuncture is bollocks (some would argue this already happened, of course) they are stuck. There is no other use for the skill of sticking needles in people, the skills are not transferable and they are not trained in any other treatment for the same conditions." is not true. The "this already happened" is the dominating fact tat makes this so, as I pointed out above, this defines the climate they operate in. They cannot achieve anything by attempting to get their POV across in the media that is based on real science, that would amount to tilting at windmills. Instead they have done for decades what Donald Trump is doing to keep his support base happy. Fake news is nothing new, the way it works is by polarizing things which creates sharp divisions in the media, you can then get your point across in the "friendly media". Each side then accuses the other side of being the "fake media". Now, Wikipedia is a reliable member of the scientific camp, alt-med practitioners editing here know that here they are in the lion's cave and need to behave accordingly.


 * If an acupuncture practitioner were to edit in something unreliable in Wikipedia, it could just as well be something that thrashes acupuncture (in a way that's not supported by reliable sources) as they use the fact that from their POV there exist a "hostile media" that makes exaggerated and in their eyes unreliable statements. Count Iblis (talk) 20:00, 17 January 2019 (UTC)
 * Yes there are plenty studies that show that for people who have strong views on contentious issues that are based on ideology rather than evidence, that presenting good evidence to the contrary doesn't make them change their minds: they just dig their heals in further. Examples above with the two Guys! But yes, it is also true that all the "Alt Med is bollocks and here's why" writing on Wikipedia does not impact on certain groups at all, who now get their information from other sources. That doesn't mean we should give up, and that message will be heard by those receptive who may otherwise be led astray. I shudder to think if Wikipedia had adopted a "BBC TV" approach to contentious subjects, where opposing views are given equal weight and time. Any interview with a proper scientist has to be balanced with someone in a tin-foil hat who thinks lizards control the earth. (I should note that the BBC seem to be finally waking up to this, after some proper scientists refuse to be interviewed like that any more). I'm glad WP takes the view that on some issues the science/evidence is overwhelming and documents the consensus of experts. But "the encyclopaedia anyone can edit" is a fundamental and we should be very cautious about restrictions. -- Colin°Talk 08:48, 18 January 2019 (UTC)
 * I don't ever want to us to head towards a false balance on matters of fact, but the other half of writing is a matter of tone. If we want to educate people (e.g., to tell them that ____ won't help their painful knee, regardless of whether ____ is alternative medicine or bad medicine), there are known ways to do that.  Unfortunately, most of our anti-altmed editors don't seem to be using those effective techniques.  Their approach has been more effective at social signaling ("Wikipedia editors hate altmed just as much as you and all the other cool science kids!") than at changing the minds that could be changed.  WhatamIdoing (talk) 02:24, 20 January 2019 (UTC)
 * WhatamIdoing's comment makes an excellent point about a major problem in this area of wikipedia, although I don't know that it is directly relevant to this RfC. Tornado chaser (talk) 13:59, 20 January 2019 (UTC)
 * We are not here to persuade, we are here to document. The fact that alt med is fraudulent may well be unwelcome to some, and cause cognitive dissonance, but that really is not our problem to fix. Wikipedia is not improved by being more sympathetic to bullshit, quacks, cranks and charlatans. If anything it is more important to avoid weaselly descriptions of non-agricultural manual earth-turning implements in this area, as the entire modus operandi of the anti-vax, anti-medicine, anti-science crowd is to exploit the natural tendency of science to cautious language. The opening paragraph of the homeopathy article is a good example of how we should write about medical frauds. The potential harm to patients from using SCAM instead of medicine is much greater than the damage inflicted to true believers' feels by telling it like it is. Guy (Help!) 14:07, 20 January 2019 (UTC)
 * We are not here to persuade, we are here to document. Yes, this is also an important point, and JzG is right wikipedia is certainly not improved by accepting BS. The point I thought was trying make was that we must be carful not to write in a tone that leads the reader to question our objectivity, not that statements of fact should be watered down (they absolutely shouldn't). The potential harm to patients from using SCAM instead of medicine is much greater than the damage inflicted to true believers' feels by telling it like it is Absolutely true, my point is that it can be easily it start editorializing without even realizing it, and that this may lead the reader to question our objectivity, making the reader more likely to consider using SCAM. Tornado chaser (talk) 14:18, 20 January 2019 (UTC)
 * Yes, as I mentioned above, I observed such a boomerang effect among patients. --Middle 8 (t • c | privacy • acupuncture COI?) 14:28, 20 January 2019 (UTC)


 * It's not that simple; ask the US National Academies. JzG/Guy's argument under this subheader would be fairly persuasive if it weren't oversimplified.  First, the CAM definition that it relies on is not generally accepted; a different definition (based on sphere of use rather than evidence) is supported by better MEDRS including the US National Academies (see Alternative Medicine § Definitions and terminology ).  Determined editors have simply insisted on keeping their preferred one in the lede (edit: i.e. to the exclusion of others).  Second, as noted above, the US National Academies' position on pain management includes a qualified endorsement of acupuncture, including their comment that it is a "powerful [tool] in the management of chronic pain" (summary, discussion).  Obviously not all CAM's are equally bullshit, which is why this RfC's attempt to single out CAM is misguided.  Finally (also noted above), as a practical matter -- unless I missed something in my search of CAM article talk pages -- the problem that this RfC seeks to address is in fact minuscule. --Middle 8 (t • c | privacy • acupuncture COI?) 14:40, 20 January 2019 (UTC) added (edit:...) 20:17, 20 January 2019 (UTC)
 * This is not really surprising given the millions of dollars of lobbying by the SCAM industry notably focused on getting SCAM covered by the VA. Entire laws have been written to favour the SCAM industry, and the closer you get to politics and policy, and the further from the scientific literature, the stronger the statements in favour of SCAM will be. The fact that this source states confidently that acupuncture can be a "powerful" intervention, when the scientific literature says pretty close tot he exact opposite (that it is weak and only affects self-reported symptoms) is a sure sign of exactly the industry influence and COI I'm talking about here. The tell is "further research is needed for some nonpharmacologic interventions to better understand their mechanism of action and optimal frequency and intensity" - all quackery papers close with "more research needed", this is functionally equivalent to "give us more money", but NCCIM has spend around $3bn investigating SCAM treatments without validating a single one and there is in fact no open scientific question over mechanism for acupuncture - there's no reason to think it works, so no need to explain how it works. All the research points in exactly the same direction: observed effects are consistent with the null hypothesis, but blinding is especially tricky for acupuncture because it is invasive. The only thing that distinguishes sources is how honest they are about it. Ernst says exactly this, while Kaptchuk claims that the fact fake acupuncture works as well as "real" acupuncture means acupuncture is so stupendously powerful that even faking it has an effect. Guy (Help!) 15:34, 20 January 2019 (UTC)
 * Yes, acupuncture "only affects self-reported symptoms... like Pain, to name one salient example.
 * What you keep refusing to grapple with in these endless acupuncture debate is that its made-up story about energy is completely irrelevant to the question of whether some patients actually have fewer symptoms. If you've got (some kinds of) pain, then you have a (small) chance of having less if you do acupuncture.  The more you "believe in" it, the better your chance of success.  The more you like your practitioner, the better your chance of success.  The more you pay for it, the better your chance of success.  And, sure, it may not do anything for some people, and it won't do much directly for anyone, but the direct medical risks are quite low.
 * So for years now, this discussion has run like this:
 * You: Acupuncture doesn't work!
 * Everyone else: Well, actually, a few patients do actually feel better, compared to doing nothing.
 * You: But you could do made-up acupuncture with no training and just poking the guy with toothpicks and saying nice things!  You'll get the same results!
 * Doctors: Great!  Buy me some toothpicks!  Find me someone with good social skills, who can afford to stand here and empathize with this patient while gently jabbing them in beautifully made-up spots!  Rejoice, because my pain patient might get better!
 * You: But even if the patient feels better, the theory is absolutely, utterly despicable, irrational, anti-scientific balderdash that you should be ashamed to even be associated with it!  An effective treatment with such a stupid story can't possibly be called "effective" even if all the patients were instantly cured!
 * Mainstream medicine: Um, yeah, but when you're in the clinic, and you're talking to a guy who can't pick up his little kid, and you've already failed to fix his problems by recommending the options that fit certain people's personal values for being sufficiently scientific, then who actually cares about having a tidy little scientific story?  Putting scientific purity above my patient's actual needs is a luxury afforded only to armchair quarterbacks.  We're those empirical dogs that the homeopaths railed against for doing whatever seemed to work best.  If a pain patient becomes more functional, even if it's only partly more functional or only sometimes more functional, we are going to do more of that.  As far as we're concerned, a pain patient being more functional is the only definition of an effective treatment for pain that actually matters.  I don't really care whether what caused the improvement is the needles, or lying face down on a table for half an hour, or the receptionist's encouraging smile, or the sense of being unconventional, or thinking that he was supposed to be getting better, so he finally got up out of his recliner and moved around more.  Maybe that whole thing was the package that this guy needed.  I just care that he gets better in the ways that matter to him.  This may only give him a 5% chance compared to doing nothing, but the "science-approved" options are either mostly ineffective (e.g., surgery), potentially deadly (e.g., opiates), or ultimately refused by the patients (e.g., long-term exercise), so it's not like we're not working with a lot of good options here.  If someone poking this guy with toothpicks means that I'm not filling out a death certificate or getting hounded by the disability insurance paperwork people, then I. Do. Not. Care. About. The. Theories.
 * Can you see the other (multiple) points of view here? Can you imagine a world in which other people aren't wrong when they disagree with you about what constitutes "efficacy", or when they disagree with you about whether "theoretical scientific plausibility" is the most important factor in choosing a medical treatment in tough cases?  WhatamIdoing (talk) 22:49, 20 January 2019 (UTC)
 * Yes, I am good at visualising alternate universes, I read a lot of sci-fi. But Wikipedia documents the real world, and in the real world the evidence clearly shows that sticking needles in people doesn't make them better, even though it sometimes fools them into thinking they feel better for a short while. Do you understand what mainstream means? Mainstream economists say Ponzi schemes are a fraud, but Bernie Madoff would tell you otherwise. Guy (Help!) 00:33, 21 January 2019 (UTC)
 * This kind of reply makes me think that you're not very familiar with the problem of intractable chronic pain. For that kind of case, "fooling" the patient into feeling better for a short while is actually identical to solving the problem (albeit temporarily).  That's what half of anesthesiology does, after all:  less perceived pain, temporarily.  Fooling patients into feeling better is a fine old tradition in mainstream medicine.  WhatamIdoing (talk) 00:50, 21 January 2019 (UTC)
 * Why are we debating the effectiveness of acupuncture? How is this relevant to the COI question the RfC was made to address? Tornado chaser (talk) 00:06, 21 January 2019 (UTC)
 * Because the acupuncturist thinks that will somehow obscure his obvious COI, I guess. Guy (Help!) 00:31, 21 January 2019 (UTC)
 * (belated) Because the argument JzG is making assumes that all CAM's are by definition ineffective, fraudulant etc. --Middle 8 (t • c &#124; privacy • acupuncture COI?) 09:33, 30 January 2019 (UTC)
 * It appears (to me) that the main point of this RFC is to request a rule that excludes all acupuncturists from editing about acupuncture, regardless of the (de)merits of their edits, without imposing identical rules on healthcare providers in similar situations but whom editors categorize as "mainstream medicine". WhatamIdoing (talk) 00:39, 21 January 2019 (UTC)
 * Concur. Also, whether someone has a COI does not depend on the effectiveness of the service they sell, but how closely connected they are to the article being edited. Tornado chaser (talk) 00:57, 21 January 2019 (UTC)
 * I've reworded your false equivalency message: "It appears (to me) that the main point of this RFC is to request a rule that excludes all snake oil salesmen from editing about snake oil, regardless of the (de)merits of their edits, without imposing identical rules on actual healthcare providers (whose over-riding purpose is in making people healthy, not selling bullshit) whom the rest of the scientific world categorize as "mainstream medicine"." Only in death does duty end (talk) 02:47, 21 January 2019 (UTC)
 * Sounds to me like you're saying that as long as what you sell is effective you don't have a COI when editing content related to it, a healthcare provider has a COI in regards to a technique or drug that they have some specific financial stake in, or when writing about there own practice, but not the field in general(unless it is some really specialized field they invented, ect). The same for acupuncturists. To be clear I am not advocating for false equivalency, our articles do need to be based on the evidence, but NPOV covers that, COI only deals with how close to the subject of the article the editor is. Tornado chaser (talk) 18:42, 21 January 2019 (UTC)
 * If you can find an acupuncturist who is dedicated to saying what the reliable sources say -- that acupuncture doesn't work -- your might have an argument. Or if you can find an actual healthcare provider who practices a treatment that the reliable sources say does not work. But is the real world, actual healthcare providers have a financial interest in making it so that Wikipedia says what the reliable sources say, and an acupuncturist has a financial interest in making it so that Wikipedia says something other than what the reliable sources say. That's a significant difference. --Guy Macon (talk) 06:00, 22 January 2019 (UTC)
 * WP:COI is about whether someone has a vested interest in something, not whether their vested interest is in something that RS support or not, this is what WP:RS and WP:FRINGE are for. This proposal looks to me like an attempt to drive a nail with a saw, despite the fact that we have a hammer, we have policies to prevent FRINGE pushing or addition of erroneous or poorly sourced content, and we have policies to deal with editors who have a vested interest in what they write about, I don't understand why are people trying to twist the policies regarding vested interests to use them against FRINGE-pushers, when we already have other policies in place to stop the fringe pushers. Tornado chaser (talk) 15:10, 24 January 2019 (UTC)
 * Right. And a medical practitioner usually has no direct vested interest in any specific treatment, whereas a SCAM practitioner does have a vested interest in a specific treatment. If antibiotics, SSRIs or any other class of drug were shown not to work, practice would change, but homeopathy cannot change to not use the refuted parts of homeopathy because the entire category is refuted. A homeopath generally has no medical training. Any SCAM practitioner has a concrete and tangible vested interest in what Wikipedia says about their form of SCAM. Guy (Help!) 15:15, 24 January 2019 (UTC)
 * A MD has an interest in saying homeopathy is wrong, because if homeopathy were right then all of what the MD does must be wrong, just like a homeopath has an interest in trying to disprove all real medicine. This leaves us with 3 imperfect options 1: We could restrict both MDs and alternative practitioners from editing medical articles, this might stop some POV pushing, but will reduce the competence of the editors on any given article, and is therefor a bad idea. 2: we could restrict alternative practitioners from editing certain topics without putting any restrictions on MDs, this would reduce POV pushing without reducing editor competence, but would constitute a shift from restricting editors with an interest in the topic, to restricting editors based on which side they have an interest in, this is counter to policy and creates an appearance of bias that would damage Wikipedia's credibility. 3: The option I support, we could allow both MDs and alternative practitioners to edit articles related to their fields, avoiding both the bias and competence issues raised by the other options, while this doesn't do anything to actively counter POV pushing, we have other policies(NPOV, DS, ect) that are plenty effective at stopping POV pushers when applied correctly. Tornado chaser (talk) 05:29, 28 January 2019 (UTC)
 * Belatedly, replying to Guy re NAM: The National Academies are about as far from politics & policy, and close to science, as one gets.  That's why their position statements are so esteemed, e.g. in educating people about climate change.  If they've been lobbied, and compromised, then that's a big deal, a big claim that (cf. PARITY ) requires a big source.  They aren't stupid -- they can read the acu literature, "and yet" they call it a powerful tool, almost as if they grok the dichotomy between RCT results and clinical practice that WAID illustrated above.  --Middle 8 (t • c &#124; privacy • acupuncture COI?) 10:35, 30 January 2019 (UTC)

@User:JzG - "We have pretty solid consensus that people who sell X have a COI in respect of the article on X." - Since when? Are you really saying that used car sales men have a COI when editing articles related to automobiles? That farmers have a COI in relation to topics about agricultural produce? Or that even software engineers have a COI in relation to the general topic of computers? The solid consensus is that there must actually be a plausible interest that conflicts with the specific editing that they are doing. Me being a patent attorney does not mean I have to declare a COI every time before I edit anything to do with the law, or even the topic of patents, because there isn't really a plausible interest - some way in which I might gain personally - from doing so in every case. Where COIs obviously arise is when editing an article where you might plausibly gain by doing so - for example by editing articles about their employers, or about their own company or its specific products, or about competitors (i.e., a Microsoft employee need not repeatedly declare interests in everything related to software/computers in general, but might if the topic is an Apple computer). The alternative is a world in which everyone has declare where/how they are employed at every turn. FOARP (talk) 13:49, 24 January 2019 (UTC)
 * When the Venn diagram of X they sell and X the article is about is close to a single circle, yes. So a Ford salesman would have a COI writing about Ford or its direct competitors. They have a vested interest in the content. Guy (Help!) 14:36, 24 January 2019 (UTC)

TLDR: this post is to develop the argument that it's not the "no" vote, but the more extreme "yes" arguments, that could be discounted per WP:Fringe.

To start with a balancing view, while it's well known that Biotech is largely responsible for the endemic corruption in conventional med & associated science, it's also the case that Biotech are a key reason why humanity has enjoyed the massive increases in life expectancies over the last 70 or so years. Nothing in this post is meant to say they're the bad guys. And none can deny that harmful alt meds quacks are a thing. The work Guy Macon and other more reasonable yes voters do against them is of great value. But every virtue becomes a vice when taken to the extreme. As is well explained above, some of the less sophisticated yes voters seem to have an almost fundamentalist religious faith in conventional medicine, wanting to see things as a simplistic divide, with con-med being 100% good and alt-med 100% bad. JzG's self description of his side as the "reality-based" community is revealing. JzG – other than in tiny circles like Randian atheists, it's a totally Fringe view to think its possible to directly apprehend reality. No serious scientist would describe themselves as "reality-based". The phrase to describe good mainstream scientists is "evidence based". WhatAmIDoing and others have made eloquent posts showing examples of Alt-med sometimes being good & conventional med being bad. To give an example from a field where I've consulted in recently, mental health, CBT is as mainstream as it gets as an option to treat the global rise in anxiety and depression. Yet the fraudulent behaviour from parts of the CBT community is well documented. Low grade psychiatrists, either out of corruption or a commitment to nonsensical materialistic ideologies, will often repeatedly advise drugs & CBT, never trying anything else, thus prolonging the psychic torment for patients who don't positively respond to such things. The more successful psychiatrists might try CBT first, but then if it doesn't work, and assuming good IPT therapists aren't locally available, they'll refer patients to treatments often described as alt-med, like the well respected Music therapy, or spiritual therapy. And these often get good outcomes for the patients.

It had long appeared our MEDS coverage was a lost cause. The ungodly alliance between biotech accounts and extreme sceptics seemed unbreakable. While the biotech accounts are obvious to anyone whos spent much time with PR execs, even editors with a good enough social antenna to become Arbs don't seem to be able to recognise them. So pointless to ever expect the extreme sceptics to recognise who their apparent scientist friends really are.

In a sense this doesn't much matter. No senior official in public health policy would trust our science articles any more than they'd believe the nonsense published in most med related systematic reviews. (Other than when they're from a known good source, like Cochrane before they took down Gøtzsche. Back in the 90s systematic reviews and meta studies really were among the best sources to summarise scientific knowledge. Since then biotech spent billions corrupting the scientists who write them and the staff who admin applicable journals. There's hundreds of sources about this, the best one being by John Ioannidis, arguably the world's most respected authority on public health policy: The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses Everyone in PHP circles knows about this, but not apparently most of the editors over at Meds. Similarly, as good Middle 8 puts it, our "ridiculously skeptic-POV'd" often causes a boomerang reaction among much of the general public. So it's mostly just a few junior journalist and academics who are going to taken in by our biased coverage.

Having seem how the community are responding to this RfC though, with even some of the more thoughtful MEDS editors like Tryptofish voting no, perhaps there is hope for impartial mainstream scientists after all. If the community continues to reject the arguments of the "reality based" crowd, perhaps editors like User:SandyGeorgia and User:Colin can resume their rightful place as leading lights on the MEDS project. Then we return to having articles in that topic class that are both beautifully styled, and reflective of the latest evidence based science. FeydHuxtable (talk) 21:02, 27 January 2019 (UTC)
 * Thanks for pinging me, but I am unsure what this is about. If Colin is involved, Colin is right :) :)  He analyzes issues thoroughly, logically and objectively, and operates ethically without engaging in the tribalism that has overtaken MEDRS and COI discussions. No chance I want to tangle again with the utter mess that the Medicine Project has become, in the misguided name of supporting some of Wikipedia's nastiest and thankfully now gone editors (as did one of the editors you mention above), swarming to ANI as a mob to defend indefensible behavior by their own, and wielding MEDRS and COI as blunt instruments of power.  Gone are the days of the kind and knowledgeable gentlepeople who were behind the founding and successful days of the Wikipedia medicine project.  Sandy Georgia  (Talk)  21:27, 27 January 2019 (UTC)
 * Youre welcome. That was exactly my impression of Colin, and I agree certain wiki projects don't deserve your time right now. Hopefully things might change for the better for once, and the successful days of old can return. If you have time to read this whole discussion, it's most encouraging how the logical views of folk like Colin seem to be carrying the majority. FeydHuxtable (talk) 21:41, 27 January 2019 (UTC)
 * Thank you again for the kind words,, but I will refrain from reading this very long discussion, because medical misinformation on Wikipedia still angers me too much. And I question my decision to resign as FAC delegate so I could fulfill a promise to Colin to return to medical editing:  in hindsight, I was more useful at FAC, which has now deteriorated also.  I will take your word for it that Colin seems to be carrying the majority:  he is always a force for logical, policy-based, and ethical reasoning.  Sandy Georgia  (Talk)  20:51, 30 January 2019 (UTC)

Do alternative medicine practitioners have a conflict of interest?

 * Comments: So what are we attempting here? I am sorry but I got lost, confused, and maybe both. The subtitle above "appeared" to be the question and that has evolved to "other world" type discussions. Yes, most "specialist" can have a particular point of view or bias. Over 40 years ago I was in a horrible accident and was told I "had to have surgery" or end up a cripple by two doctors. Someone suggested I go to a Chiropractor and since I had a 50-50 chance of a successful surgery I went. I didn't know they were considered (at the time and even to an extent today) quacks. They are not "true" doctors, certainly not medical doctors, but receive extensive training. I never had back surgery and worked over 40 years in a physically demanding profession. I have went to some since and found what I considered "quacks" though. From some points of views above this could be considered Pseudo-medicine, pseudoscience or "Alternative medicine". Now we may get the "Chiropractor" supporters and opponents involved but that is not the point. My sister had, and died, from a rare form of cancer. She went to the very prestigious MD Anderson Cancer Center in Houston, Texas. They not only support "homeopathic" medicine they research and promote it as what they describe as Integrative medicine. Dr. Moshe Frenkel, associate professor at the University of Texas, Houston (considered an authority), uses the term as well as "homeopathy" and "complementary alternative medicine" (CAM) treatments.
 * While "Comparing a medical professional to an alt-med practitioner is a false equivalency", would be true I do not think we should try to hamstring Wikipedia or attempt to add unnecessary micromanaging to "anything not a medical degree" type articles. The COI policies and guidelines give enough to "battle it out" on individual articles without trying to go some rogue route detrimental to Wikipedia.
 * I recently survived a Widow maker heart attack. The "cardiologist" gave me a list of foods for a special diet and stated that some of them has had known homeopathic properties for decades. It just so happens that I arrived where the doctor is a member of a top 100 cardiac program in the country. A heart specialist and a cancer center that recognizes the term so again, what are we attempting here? Does anyone need a list (it can be found via Google) on articles by medical institutions, researchers, and physicians, concerning homeopathy. That article states in the lead "Homeopathic preparations are not effective for treating any condition". Not a quote but a "fact" that NO homeopathic preparations are effective in treating "any condition". "If that were true, and a fact" why do some in the medical profession in fact refer to it? That statement is not a "the sky is blue" statement but a bias opinion.
 * If someone is considered an "expert" in their field (medical or homeopathic), we can argue that on an individual article basis. If there is (or appears to be) advertising on an article, mark it as such, and lets get rid of it. We do have AFD. If something is "known worldwide" our discussions should be if it deserves an article on Wikipedia. IF we want "expert advice" we ask those considered to be an "expert" even if we don't like that particular area. If "anyone" advances that Homeopathy, or any holistic healing, is a replacement for medical help, they likely have brain damage and we should be concerned about that coverage on Wikipedia. One may believe in prayer and healing but even a Disciple was a physician. A "conventional MD supporting the practices of orthodox medicine", considered an expert, could be biased so we back up these things with "multiple" reliable sources. There have been debates and controversy for years. Anyone ever hear of Constantine Hering? Arizona, Nevada and Connecticut offer licenses in homeopathic medicine to physicians. Some colleges offer "Homeopathic Medicine and Surgery" as an undergraduate degree. How about Heroic medicine that was consider "orthodox" at one point? Anyone here think sweating or bleeding will cure cancer?
 * We need to be careful in attempting to correct one "wrong" with another equally "wrong" solution. Otr500 (talk) 19:31, 28 January 2019 (UTC)