Talk:Chiropractic

Do not use the plus sign above to start a new section. Keep the references list at the bottom.

Sources for effectiveness

Here are some sources for the efficacy and/or effectiveness of chiropractic; the idea is that a companion section to Chiropractic #Safety should be written, that talks about effectiveness. A cost-benefit discussion is also needed and can be done later; these citations are aimed just at effectiveness.

I started looking for sources by using the Pubmed query "chiropractic effectiveness" and looking for reviews published 2005 or later, and added effectivess-related sources mentioned in the safety discussion above. Obviously this is not complete; more searching needs to be done. It's only a start. Eubulides (talk) 17:18, 10 March 2008 (UTC)

Commentary on sources for effectiveness

• PMID: 16320031, Van Tudlder et al. [Eur Spine J] 2006 Jan; Vol. 15 Suppl 1, pp. S64-81.
• PMID: 14673408, Ferriera et al. [J Manipulative Physiol Ther] 2003 Nov-Dec; Vol. 26 (9), pp. 593-601.

I don't have access to the Eur Spine J, but that looks like it may be a good source for effectiveness of various treatment modalities. I don't think we have included Ferriera et al.DigitalC (talk) 00:49, 15 April 2008 (UTC)

Both van Tulder and Ferriera are old enough that they are cited and summarized by Bronfort et al. 2008 (PMID 18164469), a source that we already refer to. Ferreira is also old enough that it is cited by Ernst & Canter 2006 (PMID 16574972), another source we already refer to. It's not clear to me what value we'd get by referring to these older sources directly. Eubulides (talk) 09:12, 15 April 2008 (UTC)

I hope you don't mind adding straight to the list. Hopefully I didn't mess it up, I've never cited before, and find it a little confusing. DigitalC (talk) 23:16, 10 March 2008 (UTC)

Not at all. And thanks. The main thing is to get a PMID or a DOI or a stable URL; we can worry about the details later. Eubulides (talk) 23:42, 10 March 2008 (UTC)

DOI: 10.1016/j.jmpt.2007.01.009 looks useful for benefit (even though it is a primary source), as well as for integrated-medicine. Another 2 primary sources DOI: 10.1016/j.jmpt.2006.12.011 & DOI: 10.1016/j.jmpt.2006.06.022. Will try to look for more reviews. DigitalC (talk) 23:48, 10 March 2008 (UTC)

I dunno, those all look fairly run-of-the-mill; I may be missing something, but I don't detect anything that would overrule the secondary sources we already have. Generally speaking, a primary source in a crowded area like this should be used only when it's too new to be reviewed and is obviously of high quality and says something new and important. Eubulides (talk) 05:57, 11 March 2008 (UTC)

Is there a reason the literature synthesis by the CCGPP on management of low back pain and related leg complaints has not been included? DigitalC (talk) 22:07, 12 March 2008 (UTC)

No; do you have a citation of the latest version? That would save me the work of tracking it down (which I had to do for ther practice guideline, updated this year, for neck pain). Eubulides (talk) 23:38, 12 March 2008 (UTC)

http://www.ccgpp.org/lowbackliterature.pdf DigitalC (talk) 00:07, 13 March 2008 (UTC)

Thanks; I added that. Eubulides (talk) 05:51, 13 March 2008 (UTC)

Asking Ernst to provide an objective assessment on efficacy on chiropractic is like asking Ted Koren or Terry Rondberg to provide an objective assessment on vaccination. Eubulides, out of curiosity, have you read the paper in question? EBDCM (talk) 15:37, 18 March 2008 (UTC)

• Ernst 2008 (PMID 18280103) is a critical evaluation, and is labeled as such. There is value in citing critical evaluations, so long as they're balanced by pro-chiropractic sources.

I think that you're caught a bit with the use of the false dichotomy fallacy. Things are need not always be labelled as "pro" or "anti" chiropractic, or that's not how I select appropriate citations. I would suggest that you do the same.

The labels can be changed to "critical of chiropractic" and "supportive of chiropractic", but the point remains the same: sources should be cited from both sides of the aisle. Eubulides (talk) 08:33, 19 March 2008 (UTC)

• A nice thing about Ernst 2008 is that it's quite recent and has a concise summary of reviews of chiropractic efficacy in all categories. The other sources listed in this talk section are more specialized.

The Ernst paper is riddled with logical fallacies, unfounded conclusions, severely biased interpretations and focuses almost exclusively on straight chiropractic and chiropractors.

It is a critical review. It is not likely to be to the liking of defenders of chiropractic. But that's OK; we can still cite it. I disagree with most of the above comment. For example, many of the paper's paragraphs talk about mixers as well as straights. Eubulides (talk) 08:42, 19 March 2008 (UTC)

• I have read Ernst's "Efficacy" section carefully; that's all that's needed here.

So have I and we can do MUCH better.

• I am not familiar with Ted Koren or Terry Rondberg's work, but if they write about vaccination I suspect that they are more relevant for some other area (Chiropractic#Vaccination perhaps?) rather than the subject of this section.

They are ultra-straight DCs who follow Palmers principles closely. They are extremists and should not be given the time of day, much like Ernst. EBDCM (talk) 23:30, 18 March 2008 (UTC)

Eubulides (talk) 21:28, 18 March 2008 (UTC)

Efficacy in general

This source is a general criticism of chiropractic; it has a section "Efficacy" which is a useful summary of critical evaluations of the effectiveness of chiropractic care.

• Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.

Spinal manipulation

• Lisi AJ, Holmes EJ, Ammendolia C (2005). "High-velocity low-amplitude spinal manipulation for symptomatic lumbar disk disease: a systematic review of the literature". J Manipulative Physiol Ther. 28 (6): 429–42. doi:10.1016/j.jmpt.2005.06.013. PMID 16096043.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Gay RE, Bronfort G, Evans RL (2005). "Distraction manipulation of the lumbar spine: a review of the literature". J Manipulative Physiol Ther. 28 (4): 266–73. doi:10.1016/j.jmpt.2005.03.012. PMID 15883580.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. PMID 16574972.

• The following reviews are a pair; the first is more critical of chiropractic and the second more supportive. They cover more than just effectiveness, but they have effectiveness sections.

• Homola S (2006). "Chiropractic: history and overview of theories and methods". Clin Orthop Relat Res. 444: 236–42. doi:10.1097/01.blo.0000200258.95865.87. PMID 16446588.
• DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.

Specific conditions

These reviews are from the point of view of the condition, not the treatment; they typically cover chiropractic along with several other treatments. As such, they'd be appropriate only for very brief mentions in Chiropractic.

Neck pain and disorders

• Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å (2008). "The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: executive summary". Spine. 33 (4 Suppl): S5–7. doi:10.1097/BRS.0b013e3181643f40. PMID 18204400.{{cite journal}}: CS1 maint: multiple names: authors list (link) This is an executive summary (which briefly talks about effectiveness) of a series of studies and reviews.

• Hurwitz EL, Carragee EJ, van der Velde G (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386.{{cite journal}}: CS1 maint: multiple names: authors list (link) This is a review of interventions, which contains more detail on effectiveness. It is briefly summarized in the executive summary noted above.

• Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews" (PDF). Eura Medicophys. 43 (1): 91–118. PMID 17369783.

• Kay TM, Gross A, Goldsmith C; et al. (2005). "Exercises for mechanical neck disorders". Cochrane Database Syst Rev (3): CD004250. doi:10.1002/14651858.CD004250.pub3. PMID 16034925. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

• Haneline MT (2005). "Chiropractic manipulation and acute neck pain: a review of the evidence". J Manipulative Physiol Ther. 28 (7): 520–5. doi:10.1016/j.jmpt.2005.07.010. PMID 16182027.

Other musculoskeletal problems

• Arm/neck/shoulder: Verhagen AP, Karels C, Bierma-Zeinstra SM; et al. (2006). "Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults". Cochrane Database Syst Rev (3): CD003471. doi:10.1002/14651858.CD003471.pub3. PMID 16856010. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

• Upper extremities: McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (2008). "Chiropractic treatment of upper extremity conditions: a systematic review". J Manipulative Physiol Ther. 31 (2): 146–59. doi:10.1016/j.jmpt.2007.12.004. PMID 18328941.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Whiplash: Conlin A, Bhogal S, Sequeira K, Teasell R (2005). "Treatment of whiplash-associated disorders—part I: non-invasive interventions". Pain Res Manag. 10 (1): 21–32. PMID 15782244.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Chronic low back pain: Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S (2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J. 8 (1): 213–25. PMID 18164469.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Low back pain and related leg: Meeker W, Branson R, Bronfort G; et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. Retrieved 2008-03-13. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

• Lower extremities: Hoskins W, McHardy A, Pollard H, Windsham R, Onley R (2006). "Chiropractic treatment of lower extremity conditions: a literature review". J Manipulative Physiol Ther. 29 (8): 658–71. doi:10.1016/j.jmpt.2006.08.004. PMID 17045100.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Adult scoliosis: Everett CR, Patel RK (2007). "A systematic literature review of nonsurgical treatment in adult scoliosis". Spine. 32 (19 Suppl): S130–4. doi:10.1097/BRS.0b013e318134ea88. PMID 17728680.

• Adolescent idiopathic scoliosis: Romano M, Negrini S (2008). "Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review". Scoliosis. 3: 2. doi:10.1186/1748-7161-3-2. PMID 18211702.{{cite journal}}: CS1 maint: unflagged free DOI (link)

Headache

• Biondi DM (2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
• Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". Clin J Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Other problems

• Baby colic: Kingston H (2007). "Effectiveness of chiropractic treatment for infantile colic". Paediatr Nurs. 19 (8): 26. PMID 17970361.
• Fibromyalgia: Sarac AJ, Gur A (2006). "Complementary and alternative medical therapies in fibromyalgia". Curr Pharm Des. 12 (1): 47–57. PMID 16454724.
• Bedwetting: Glazener CM, Evans JH, Cheuk DK (2005). "Complementary and miscellaneous interventions for nocturnal enuresis in children". Cochrane Database Syst Rev (2): CD005230. doi:10.1002/14651858.CD005230. PMID 15846744.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Menstrual cramps: Proctor ML, Hing W, Johnson TC, Murphy PA (2006). "Spinal manipulation for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev (3): CD002119. doi:10.1002/14651858.CD002119.pub3. PMID 16855988.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Nonmusculoskeletal conditions: Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW (2007). "Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research". J Altern Complement Med. 13 (5): 491–512. doi:10.1089/acm.2007.7088. PMID 17604553.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Quality of clinical trials

• Headache: Fernández-de-las-Peñas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC (2006). "Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache". J Orthop Sports Phys Ther. 36 (3): 160–9. PMID 16596892.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Low back pain: Murphy AY, van Teijlingen ER, Gobbi MO (2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther. 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Patient satisfaction

• Gaumer G (2006). "Factors associated with patient satisfaction with chiropractic care: survey and review of the literature". J Manipulative Physiol Ther. 29 (6): 455–62. doi:10.1016/j.jmpt.2006.06.013. PMID 16904491. This source is already used in Chiropractic but would seem appropriate for an Effectiveness section too.

Primary studies

These are primary studies, and as per WP:MEDRS should not be relied on as heavily as secondary stories.

• Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW (2007). "The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study". J Manipulative Physiol Ther. 30 (6): 408–18. doi:10.1016/j.jmpt.2007.04.013. PMID 17693331.{{cite journal}}: CS1 maint: multiple names: authors list (link) This is probably more useful for a risk-benefit section (which would be some new section after "Effectiveness").

Sources for risk-benefit and cost-effectiveness

These sources attempt to review the risks of chiropractic as compared to its benefits, and/or the cost-effectiveness of chiropractic.

Older sources

These citations predate 2005 and are getting a bit long in the tooth. It'd be better to use newer citations if available, if ones of similar quality can be found. Eubulides (talk) 22:04, 10 March 2008 (UTC)

• Skargren EI, Carlsson PG, Öberg BE (1998). "One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain: subgroup analysis, recurrence, and additional health care utilization". Spine. 23 (17): 1875–83. PMID 9762745.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Di Fabio RP (1999). "Manipulation of the Cervical Spine Risks and Benefits". Phys Ther. 79 (1): 50–65. PMID 9920191.

• Rothwell DM, Bondy SJ, Williams JI (2001). "Chiropractic manipulation and stroke: a population-based case-control study". Stroke. 32 (5): 1054–60. PMID 11340209.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2003). "Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies". Ann Intern Med. 138 (11): 871–81. PMID 12779297.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. (June 3, 2003). "A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain" (PDF). Ann Intern Med. 138 (11): 898–906. PMID 12779300.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Newer cost-effectiveness sources

• van der Roer N, Goossens ME, Evers SM, van Tulder MW (2005). "What is the most cost-effective treatment for patients with low back pain? A systematic review". Best Pract Res Clin Rheumatol. 19 (4): 671–84. doi:10.1016/j.berh.2005.03.007. PMID 15949783.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Haas M, Sharma R, Stano M (2005). "Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain". J Manipulative Physiol Ther. 28 (8): 555–63. doi:10.1016/j.jmpt.2005.08.006. PMID 16226622.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Canter PH, Coon JT, Ernst E (2006). "Cost-effectiveness of complementary therapies in the United kingdom—a systematic review". Evid Based Complement Alternat Med. 3 (4): 425–32. doi:10.1093/ecam/nel044. PMID 17173105.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. PMID 16574972.

• Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.

Newer risk-benefit sources

• Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW (2007). "The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study". J Manipulative Physiol Ther. 30 (6): 408–18. doi:10.1016/j.jmpt.2007.04.013. PMID 17693331.{{cite journal}}: CS1 maint: multiple names: authors list (link) This is just a single study.

POV issues as of 2008-03-12

2008-03-12 issues list

Here is a list of POV problem areas that I see with Chiropractic as it stands now. Fixing these problems would suffice to remove the NPOV tag. Comments welcome.

I have struck out items that are done. Eubulides (talk) 22:07, 14 March 2008 (UTC)

• Chiropractic #Safety devotes too little to criticism and too much to rebuttal of criticism. #Safety 3 is a draft of a replacement, which should fix the problem. This draft has gone through a lot of edits and is ready to go in.

Agree that #Safety 3 is an improvement that is close to NPOV. I notice a lot of good hard work there. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

Thanks. I put it in. Eubulides (talk) 16:29, 13 March 2008 (UTC)

• Chiropractic #Practice styles and schools of thought spends too much time talking about objective straights and reformers, splinter groups that do not seem to exist any more as organized groups. No citations are given for the discussion of these groups (there is one citation for reformers, but it's a dangling link). The simplest fix is to remove this discussion. (fixed; see #Revision to "Practice styles" below)

Agree. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

OK, please see #Revision to "Practice styles" below. Eubulides (talk) 20:18, 13 March 2008 (UTC)

• Chiropractic #Practice styles and schools of thought's last paragraph, which advocates a D.C.M. degree, cites six sources, none of which talk about D.C.M. This paragraph should be removed, or should be properly sourced and rewritten to remove its advocacy. The existing sources should be removed, or moved to appropriate parts of the article. (fixed by removing the sources; see #Revision to "Practice styles" below)

Agree needs appropriate verifiable clarification. -- Dēmatt (chat) 03:46, 13 March 2008 (UTC)

OK, please see #Revision to "Practice styles" below. Eubulides (talk) 20:18, 13 March 2008 (UTC)

• Chiropractic #Utilization and satisfaction rates has an unsourced claim that needs sourcing. (fixed by removing the claim)

Off the top of my head can't remember that sentence, though anything we had did have sources, just might have to dig it out. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

That sentence was re-added here, on 2008-02-29, with a change log entry "restored well known fact; will provide reference". As far as I know the claim has never been sourced. Eubulides (talk) 05:58, 13 March 2008 (UTC)

• Chiropractic #History has the following non-neutral statements that need rewording: (fixed as shown in the following sub-bullets)
  • *"Palmer had discovered that manual manipulation of the spine could result in improved neurological function." It is controversial whether Palmer's treatment actually improved neurological function.
  • The wording "Nevertheless, the debate about the need to remove the concept of subluxation from the chiropractic paradigm" is slightly biased, and would be more-neutrally phrased as "Nevertheless, the debate about whether to keep the concept of subluxation in the chiropractic paradigm". (fixed)

Agree, though the second is not a complete sentence. Perhaps "..the debate continues about.." -- Dēmatt (chat) 03:46, 13 March 2008 (UTC)

The second quote is taken from the complete sentence "Nevertheless, the debate about the need to remove the concept of subluxation from the chiropractic paradigm has been ongoing since the mid 1960s." The end of the sentence would remain unchanged. Eubulides (talk) 06:00, 13 March 2008 (UTC)

• Many phrases are inserted to strengthen the argument for chiropractic by giving the qualifications of sources when they are favorable to chiropractic. Sources should be mentioned in the citation, not in the main text; there is no need to puff up the main text. The following quotes can be removed (with some rewording necessary to fill the gaps):
  • "the World Health Organization defined" (fixed)
  • "Anthony Rosner PhD, director of education and research at the Foundation for Chiropractic Education and Research (FCER)" Here I discovered that the citation was to a link that no longer works. The text of the citation says "Dynamic Chiropractic Aug. 2006", but the table of contents for the 2006-08-15 issue, the only issue published in August, does not mention Rosner. For now I removed the quote which had the side effect of removing the peacock phrase.
  • "Joseph Janse, DC, ND," (fixed)
  • "Judge Susan Getzendanner, who presided over the Wilk case, opined" (fixed; this fix also addresses some citation and temporal problems)
  • "In 1975, the National Institutes of Health brought chiropractors, osteopaths, medical doctors and Ph.D. scientists together" (fixed)
  • The following issues were fixed by citing DeBoer's paper and quoting it directly rather than including all that POV commentary about it. The same fix addresses the "rallying cry" problems noted below.
    • "Joseph Keating dates"
    • "Kenneth F. DeBoer, then an instructor in basic science at Palmer College in Iowa, revealed"
    • "DeBoer's opinion piece demonstrated"
  • "Chiropractic researchers Robert Mootz and Reed Phillips suggest that" (fixed)
  • "the Ontario Ministry of Health and conducted by three health economists led by Professor Pran Manga"
  • "by Steve Wolk"
  • "by Cherkin et al."
  • "The British Medical Association notes that"

Most of these were placed during a phase of POV wars that required that we attribute statements to particular POV sources. Agree that if we can agree to a NPOV statement without them, I would be much more satisfied. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

The attribution requirement is satisfied by proper citations; there is rarely a need to mention the sources directly in the text, and in the above-mentioned cases the need isn't there. Mentioning the sources and their qualifications in the main text tends to puff up what they say; the puffery isn't needed and when done as often as it's done in Chiropractic it constitutes POV. Mentioning the sources in footnotes is fine and is expected. Eubulides (talk) 06:05, 13 March 2008 (UTC)

• Chiropractic #Medical opposition describes the feud between conventional medicine and chiropractors in a heavily biased way. For example, chiropractors are described by a lengthy quote as having "progressive minds" whereas conventional doctors are said to "have failed to realize exactly what is meant by disease processes". Both sides have attacked and have victories and losses, but the current discussion focuses almost exclusively on attacks by the medical profession, on chiropractic victories, and on areas where chiropractic is said to be superior to conventional medicine. The dispute should be covered neutrally. There is no need for a separate section Chiropractic #Wilk et al. vs. American Medical Association with a lot of detail, for example, unless there is also similar detail devoted to the other side.

Have to look at this closer, but we cannot rewrite history. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

Agreed; the summary of the dispute should be both neutral and accurate. Eubulides (talk) 06:06, 13 March 2008 (UTC)

• Chiropractic #Movement toward science contains language like "empower faculty", "demonstrated the faculty's authority to challenge the status quo, to publicly address relevant, albeit sensitive, issues related to research, training and skepticism at chiropractic colleges, and to produce "cultural change" within the chiropractic schools so as to increase research and professional standards", and "It was a rallying call for chiropractic scientists and scholars." that clearly advocates a viewpoint favorable to the movement toward science. This wording should be reworded or removed. (fixed by removing the POV language and by citing DeBoer directly)

These are words used by V and RS's. Though we could add sentences from WCA suggesting that "science will never be able to capture the essence of subluxation."

Whatever it takes to give a reasonable-neutral summary of that part of history. The current summary is clearly biased toward one side. Eubulides (talk) 06:09, 13 March 2008 (UTC)

• There is no need to mention twice that JMPT is included in Index Medicus, particularly since Index Medicus is no longer published.

Once is enough. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

OK, done. Eubulides (talk) 20:32, 13 March 2008 (UTC)

• The sections Chiropractic #The Manga Report, Chiropractic #Workers' Compensation studies, Chiropractic #American Medical Association (AMA), and Chiropractic #British Medical Association are merely a laundry list of endorsements of chiropractic. These sections should be removed, with their useful content moved to appropriate sections, as citations.

Merge them. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

• Chiropractic #External links should be removed. It contains pointers to a whole bunch of anti-chiropractic web sites with approving words surrounding the citations. It also contains many pointers to pro-chiropractic web sites, without comment. This is POV. Besides, none of the external references meet the criteria set forth in WP:LINKS #What should be linked. Let's just remove them all: Wikipedia is not a link farm. (fixed)

This is a POV issue. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

Yes, it's a POV issue. Does the proposed fix (of removing the section) sound reasonable? At first glance that might seem drastic, but many high-quality articles (such as Hippocrates and Sequence alignment) have no External links sections at all. Eubulides (talk) 20:46, 13 March 2008 (UTC)

I am not married to anything is this article as long as we handle all the issues NPOV. ---- Dēmatt (chat) 15:05, 15 March 2008 (UTC)

OK, thanks, I took the easy way out by replacing the section with a single pointer to the Open Directory linkfarm. Eubulides (talk) 22:34, 15 March 2008 (UTC)

• The lead should reflect the body of the article. The lead currently lacks summaries for some entire sections, including Safety, Scientific inquiries, Vaccination. The overall effect is to minimize the controversial parts of the body.

This could be construed as undue weight violations as the safety section and vaccination section are too big or slanted in terms of giving excess weight to minority held positions and a very rare risk of serious injury with SMT. EBDCM (talk) 03:32, 17 March 2008 (UTC)

That issue can be resolved by following Dematt's suggestion to finish the body first. Eubulides (talk) 05:21, 17 March 2008 (UTC)

Finish the body, then look back at the lead. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

That order sounds reasonable, yes. Eubulides (talk) 06:10, 13 March 2008 (UTC)

• The lead also has a POV phrase that needs rewording: "Today, the progressive view".

See above. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

Eubulides (talk) 06:20, 12 March 2008 (UTC)

Comments on assessment

I disagree with much of this assesssment. . . For instance, the Workman's Comp studies were landmark studies and appropriately mentioned. . . hardly mere laundry lists. And "Many phrases are inserted to strengthen the argument for chiropractic by giving the qualifications of sources when they are favorable to chiropractic". . . that seems to be an opinion share by those who would prefer this to be an article which presents arguments against chiropractic. Vaccinations should not have its own section in this article. . . it is a minor point which the opposition tries to play up to be some kind of big deal.TheDoctorIsIn (talk) 00:58, 13 March 2008 (UTC)

I would have to agree here, and say the same about the Manga report. It was a landmark study and derserves to be mentioned. DigitalC (talk) 02:47, 13 March 2008 (UTC)

To "mainstream medicine" folks, the controversy about vaccination among chiropractors is a big deal. It's notable when a significant percentage of group of health professionals recommend against vaccines, or vociferously oppose them, as many do.CynRNCynRN (talk) 04:31, 14 March 2008 (UTC)

FWIW, a chiropractor in Ontario (and I believe the rest of Canada) cannot even comment on vaccines, as they are outside the scope of practice of chiropractic. DigitalC (talk) 05:46, 14 March 2008 (UTC)

I doubt whether it's true of the rest of Canada. See, for example, Injeyan et al. 2006 (PMID 17045098), which asked Alberta chiropractors about their ability to give immunization advice to their patients. And even if it's supposed to be true in Ontario in principle, it's not true in practice; one can easily find websites of chiropractors in Ontario containing advice about vaccination. Here's one example: [12]. Eubulides (talk) 06:24, 14 March 2008 (UTC)

Here's another example from 2004, anti-vax Ted Koren was invited to speak at CMCC, and an outbreak of pertussis was perhaps linked to a chiropractor's advice, http://www.cbc.ca/consumers/market/files/health/vaccines/pg_two.html CynRNCynRN (talk) 20:12, 14 March 2008 (UTC)

That speech and that outbreak predated the rule change that prevented Ontario chiropractors from discussing vaccination.[13] The examples given above were more recent. Eubulides (talk) 22:02, 14 March 2008 (UTC)

The link above (painfree) was not giving advice about vaccination, it was entirely from an educational perspective. 202.161.71.161 (talk) 06:42, 15 March 2008 (UTC)

The link is anti-vaccination propaganda with pictures of skeletons all over it. It's sort of like handing out a pamphlet saying "All doctors are quacks!" with pictures of skulls and crossbones on it, and then afterwards saying "Oh, no, I wasn't giving you advice about medicine, it was entirely from an educational perspective." Perhaps that sort of behavior is technically legal under Ontario's guidelines, but from a practical point of view it means that chiropractors in Ontario can and do advise their patients not to vaccinate. Eubulides (talk) 07:25, 15 March 2008 (UTC)

Hehe, the skeletons are part of the background. It's even on the fitness page. To DCs skeletons are good things ;-) This illustrates the issue about the different types of vaccines (flu vs polio, etc.) There are medical groups opposed to flu vaccine. We need to be careful here. -- Dēmatt (chat) 15:25, 15 March 2008 (UTC)

I guess I overreacted to the skeletons. Still, the text of the page is plenty antivax. Which medical groups are opposed to the flu vaccine? Eubulides (talk) 23:58, 15 March 2008 (UTC)

Perhaps the better question is, what is the efficacy of the flu vaccine? A quick look would suggest that it's not as clear cut as implied by some: [14].

I dunno, that's just a random antivax web site. One can easily find web sites opposing any form of treatment, including chiropractic treatment. Is there a reliable source indicating that flu vaccine is not efficacious? Something like Tosh et al. 2008 (PMID 18174020) or Jefferson et al. 2007 (PMID 17443504)?

I would suggest that it's not necessarily an "anti-vax" site as suggested, and it does cite sources within the body if was read. Nonetheless, it raises interesting points (such as efficacy being related to age and to a particular strain)and does present the other side of the argument. With respect to purported anti-vax statements on websites, this is against the standard of practice in most Canadian provinces and the CCO has fined members up to 25K for those shenanigans. Nonetheless, we should not pick one example and make attributions, for I can go to MD websites and show them endorsing questionable methods such as homeopathy. We need to be careful with giving fringe POVs too much weight here which seems to be an increasing concern. EBDCM (talk) 01:51, 16 March 2008 (UTC)

The site did look very questionable to me, refs or not. The flu shot is not overwhelmingly effective,as any medical person would admit, but probably worthwhile:"Two randomized controlled trials (in long term care facilities) have evaluated the impact of influenza vaccination of HCP on the outcomes of residents in nursing homes. In one study, staff vaccination was associated with a 43% decrease in incidence of (flu)... In another study crude mortality rates were 42% lower among residents in facilities with higher staff vaccination coverage than those in control facilities. Randomized trials assessing the impact of staff vaccination on patient outcomes in acute care facilities have not been conducted, but low staff vaccination coverage has been correlated with influenza outbreaks in hospitals" CynRNCynRN (talk) 02:21, 16 March 2008 (UTC)

(outdent)BTW, the vaccineinfo.net site is full of false and questionable information! Just do a little digging. For instance, writers question the effectiveness of the rabies vaccine in several articles "the vaccinated person dies anyway". Worldwide, at least 55,000 deaths are still caused by rabies. The post exposure prophylaxis has been 100% effective in the US.It's difficult to find reliable info on vaccines on the net with pages and pages of fear-mongering sites!CynRNCynRN (talk) 19:08, 16 March 2008 (UTC)

About your other point, EBDCM, it is notable that a significant % of DCs are anti-vax, especially when some want to be integrated with mainstream. I am glad that another 'significant percent' of chiropractors are pro-vax....but it is an important controversy in the profession.CynRNCynRN (talk) 02:21, 16 March 2008 (UTC)

Cyn, I agree it's notable, it's just a weight issue. When does 20% constitute a significant %? Remember, that chiropractic is really a two (or 4 depending who you ask) headed monster. No "mainstream" DC is opposed to vax, the lit says it's mostly worthwhile. I'm pro-vax but cannot comment on it professionally due to it's outside my scope of expertise. I just don't want to the many level headed DCs who are either pro or neutral have the "guilt by association" fallacy applied to them. We need to be balanced on this issue. The trend suggests that the anti-vax wing is shrinking from generation to generation and this is important to note, IMO. EBDCM (talk) 02:30, 16 March 2008 (UTC)

It's more than just 20%. Busse et al. 2005 (PMID 15965414) reported surveys of Canadian chiropractors with 40% supporting and 31% unsure and 29% opposed. These were recent (year-2000) graduates of CMCC. The level of opposition reported in the U.S. is even higher; see Campbell et al. 2000 (PMID 10742364). This high level of opposition to an enormously successful public-health strategy remains a significant problem. Eubulides (talk) 02:50, 16 March 2008 (UTC)

Well, that's your interpretation of it. As well, as Dematt suggested while some DCs may oppose a PARTICULAR vaccine, they get labelled as anti-vax. Some vax are more effective and better than others. So again, unless we provide some kind of clarification, the current material is misleading and again does not acknowledge the historical trend that this sentinent is at the very least, softening over the last 100+ years. Also, the current edit fails to acknowledge that part of the opposition is towards MANDATORY vaccination and should let the patients decide. Lastly, DCs approach health care differently (philo) from mainstream med and this is not even acknowledged either in the current text. So, it's either a) undue weight or b) does not adequately explain where oppostion comes from. In any case, in politics if 71% (those not anti-vax) would be considered a landslide. I think this section plays up the anti-vax sentiment too much and is undue weight on straights. Vax is not within the scope of practice of DCs anyways and this isn't even mentioned. EBDCM (talk) 19:09, 16 March 2008 (UTC)

• The abovementioned surveys were not about particular vaccines, or about mandatory vaccination; they were about vaccination in general.
• Adding something about the motivation would make sense. Earlier versions of Chiropractic#Vaccination attempted to explain the motivation, with a quote from D.D. Palmer, but this was removed. Perhaps a better explanation could be supplied.
• The level of opposition to vaccination is extraordinary in chiropractic, compared to conventional medicine; this is notable, even if a substantial minority of chiropractors favor vaccination.
• It might make sense to move "Vaccination" into an "Opposition to medicine" section, as vaccination is an area where chiropractic criticizes conventional medicine. Fluoridation might be another topic to cover in that neighborhood.

Eubulides (talk) 00:27, 17 March 2008 (UTC)

straight chiropractic may criticize vax but contemporary does not. Being neutral on a subject is not a bad thing, necessarily. Ask Switzerland. EBDCM (talk) 03:36, 17 March 2008 (UTC)

It's not that simple. I don't know of any reliable source supporting the claim that contemporary chiropractic (which I assume means mixers) does not criticize vaccination. It's quite plausible that many mixers do criticize vaccination in practice. The ACA (a mostly-mixer organization) used to be more in favor of vaccination than it is now; it is now slightly negative, by favoring exemptions to vaccination laws. Eubulides (talk) 05:31, 17 March 2008 (UTC)

You're reaching here by speculating what individuals MAY think in practice. Also, being neutral on a subject is not a negative thing, it's neutral. Exemptions from mandatory laws is a more libertarian way of thinking than anything else. Also, we should not only focus on the USA; it would be worthwhile to investigate other national positions (i.e. Europe). EBDCM (talk) 23:45, 18 March 2008 (UTC)

Speculation is OK on talk pages. The ACA is not entirely neutral on vaccination; it supports exemptions to mandatory vaccination laws, which is a mildly anti-vaccination position. (The ACA does not support exemptions to quarantine laws, which would be just as consistent with libertarianism; so this is not simply a matter of chiropractors being libertarians, and it has something to do with vaccination per se.) If we can find a reliable source to summarize all the international organizations' positions on vaccination, that would be a good thing, yes. Eubulides (talk) 08:47, 19 March 2008 (UTC)

[outdent]. Fluoridation now? Another condemnation topic? The Doctorisin is perhaps right in his assessment... The use of puff adjectives "opposition to vax is extraordinary" and "substantial minority" is neither necessary nor necessarily true. Also, as a separate and distinct profession with a separate and distinct approach and philosophy it really shouldn't be a matter of "passing judgement" as the tone and weight of the vaccination section does. Also, my point that there has been a historical softening of the anti-vax stance. This section is 8 lines for 2 studies that could easily be edited into 1-2 lines as had previously been done that would acknowledge all the points you are trying to make without getting into puff details that stretch it out and give too much weight to one side of the prof vs. the other. EBDCM (talk) 03:23, 17 March 2008 (UTC)

• The ICA opposes fluoridation of municipal drinking water as a matter of policy [15]. The ACA takes no position now, but a quick check on the web found claims that it formerly supported fluoridation and stopped doing so.[16] Fluoridation is not as important as vaccination for public health, but it still might be worth a brief mention as an example of chiropractic's disagreements with mainstream public health. Eubulides (talk) 05:55, 17 March 2008 (UTC)

This is needlessly inflammatory and the ICA hardly speaks for anywhere near the majority of the profession. We should not consistently give so much weight to fringe groups and their fringe opinions. Chiropractic is free to have different opinions than mainstream med without any condemnation from editors who disagree with this view. Also, you will be setting up a (dangerous) precedent by constantly wanting to include mainstream meds 2c on these issues in this article. I'm tempted to apply the same standards here to medicine and see how far I'd get. Probably reverted within 30s! EBDCM (talk) 23:45, 18 March 2008 (UTC)

I don't see what's inflammatory about summarizing chiropractic organizations' positions on matters of public health. Chiropractic is certainly free to differ from mainstream medicine, but that does not mean the differences should be ignored in a Wikipedia article. Eubulides (talk) 08:53, 19 March 2008 (UTC)

• The "puff adjectives" in question are not in Chiropractic and no proposals have been made to put them in.
• Currently chiropractic is less opposed to vaccination than D.D. Palmer was, but it appears to be more opposed than it was in the early 1990s. Any discussion of historical trends should mention both of these changes.

This is nit-picking. Is it more or less anti-vax now than it historically has been? Unquestionably, yes. IMO does it need to go further (USA I'm looking at you), yes. EBDCM (talk) 23:45, 18 March 2008 (UTC)

It is far less anti-vax now than it was 100 years ago. It is a bit more anti-vax now than it was in the early 1990s. Eubulides (talk) 08:55, 19 March 2008 (UTC)

• Specific suggestions for improving the tone, weight, and brevity of the vaccination section are welcome.

Eubulides (talk) 05:55, 17 March 2008 (UTC)

I hope that once we are done with the editing here on all topics that we can maybe get a well deserved beer (or protein shake if you like). When it feels right hopefully most of us will know it; but for now I'm working on other sections first. EBDCM (talk) 23:45, 18 March 2008 (UTC)

Sorry about the above..wrong dates. Some still have or had anti-vax material on websites, see April 2005 Have any practitioners been fined for going against the prohibition?CynRNCynRN (talk) 07:05, 15 March 2008 (UTC)

The proposal is not to remove the discussion of Workman's Comp studies and Manga report. If they are historically important reports, they should be mentioned. However, they do not each deserve an entire section of their own. That's way overkill. And it raises a POV issue: why do old pro-chiropractic studies get entire sections of their own, whereas old anti-chiropractic studies get no mention at all? The Manga report is 10 years old (and the citation to it is now a dangling link! what's up with that?). The Workman's comp studies are nearly as dated. These are historical references, and as history they are not nearly as important or interesting as dozens of other points about the history of chiropractic. The AMA and BMA sections are also weird; they look like testimonials trotted out at the end of an informercial. If it's important that conventional medicine recognized chiropractic around 1990, the article should just say that and give a citation; there's no need to copy long and boring quotes about it. Eubulides (talk) 06:43, 13 March 2008 (UTC)

Which old anti-chiropractic studies are you referring to? The Manga report and WOrkmen's comp studies could go in the history section, AFAIC, because they are historically important. DigitalC (talk) 05:46, 14 March 2008 (UTC)

I wasn't referring to any old anti-chiropractic studies in particular. The point is that there are some, from reliable sources, and it's NPOV to ignore them while giving entire sections to the pro-chiropractic studies. Please see #Manga report notes below on historical coverage of the Manga report. Eubulides (talk) 05:59, 14 March 2008 (UTC)

Safety section

I see that everyone has put a lot of work into the safety section and with relatively good results over the original version. I note that it took all of you to combine your intellects and POVs t come to something that is reasonable and makes sense. EBDCM, keep your nose clean and collaborate with civility. You are important to this process. ;-) -- Dēmatt (chat) 03:46, 13 March 2008 (UTC)

I would like to note that I also have a few POV issues (or perhaps weight) that should be rectified: the safety section and the very little it dedicates to the Neck Pain Task Force findings (in contrast to Ernst) and the vaccination section. Both are too big and should be shortened. Also, the safety section that is in current place seems not to differentiate between chiropractic and SMT, a frequent problem in conventional medical literature. EBDCM (talk) 01:25, 16 March 2008 (UTC)

• The Task Force source says only this about chiropractic safety:

"There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke."

Chiropractic #Safety summarizes it this way:

"Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions."

How does this omit anything that the Task Force source said?

• Chiropractic #Safety is now half as long as it was when the POV issue was originally raised, so the article is much significantly now in that area, if by "better" one means "spends less time talking about safety".
• Specific suggestions for shortening the wording are welcome. Brevity is a good thing.

Eubulides (talk) 01:50, 16 March 2008 (UTC)

Well, for example, why should we care about the Task Force, or Ernst, for that matter? What makes THEIR research notable and worthy of inclusion? Context should be provided. For example, the Task Force included a consensus of the top experts in the world whose findings were collated using a best-evidence synthesis, which addresses risk, prevention, diagnosis, prognosis and treatment risks and benefits.[70] Can you say the same about Ernst? Why should they be given the same weight if not? Furthermore,with respect to the association of VBA stroke and cervical manipulation the study concluded 1)Vertebrobasilar artery stroke is a rare event in the population. 2)There is an association between vertebrobasilar artery stroke and chiropractic visits in those under 45 years of age. 3) There is also an association between vertebrobasilar artery stroke and use of primary care physician visits in all age groups. 4)no evidence of excess risk of VBA stroke associated chiropractic care. 5) The increased risks of vertebrobasilar artery stroke associated with chiropractic and physician visits is likely explained by patients with vertebrobasilar dissection-related neck pain and headache consulting both chiropractors and primary care physicians before their VBA stroke."[71] Do you not think that the bolded text is a pretty big omission? If not, why? Isn't the bolded text the "bottom line"? The major conclusions/findings should be presented in full, not just a quick one liner. EBDCM (talk) 02:02, 16 March 2008 (UTC)

• The task force's report covers many issues; Ernst focuses on just safety, which is the issue at hand. The task force's broad expertise is of value, but focusing on the issue is also of value.
• Ernst is not the only researcher raising these issues. This is not a one-guy-versus-the-consensus situation.
• The results Chiropractic reports from the Task Force do not disagree with the results it reports from Ernst. This is not a battle between two sources only one of which can be right.
• The cited source for the Task Force, which is the executive summary, omitted the bolded text, indicating that they did not consider that text to be part of the bottom line.

Eubulides (talk) 03:11, 16 March 2008 (UTC)

Then we shall use Cassidy et al. if you feel the Task Force is not appropriate. Either way, Ernst is undue weight now whereas the findings of the report should be stated in their full context. Again, you have not addressed my concern which is a severe underplaying of the research done by the multi-disciplinary panel of researchers, not merely an anti-chiro MD in Ernst. We should restore the full findings re: stroke issue. I'm all for brevity as well, but just like Doctorisin is mentioned; the safety section seems have the appeal to fear fallacy. EBDCM (talk) 18:21, 16 March 2008 (UTC)

Cassidy et al. (PMID 18204390) is just a primary study. It is reviewed not only by the Task Force executive summary (PMID 18204400) but also by the Task Force neck-pain review (PMID 18204386). Neither of these reviews mention, much less highlight, the point under dispute. The current summary already covers every point mentioned in both of these reviews. We should not second-guess them and highlight a point in a primary study that they did not think was worth highlighting. The general rule in WP:MEDRS, and it is a good one, is that Wikipedia articles should not use primary studies to dispute reliable reviews. There are sometimes exceptions to these rules (e.g., primary studies newer than any review) but these exceptions do not apply here. Chiropractic#Safety already says that the increased risk of vertebrobasilar artery stroke due to spinal manipulation is small and has not been measured; this point does not need to be repeated. Eubulides (talk) 00:46, 17 March 2008 (UTC)

(outdent)Just a suggestion. Add the Task Force phrase "no excess risk" at the end, although doing that makes one want to "puff if up" by saying it's from a notable study...The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern.[62] Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[65]A recent, multidisciplinary study concluded that there was no evidence of excess risk of VBA stroke associated with chiropractic care.CynRNCynRN (talk) 18:58, 16 March 2008 (UTC)

I'd prefer to stick to what the reviews say about this subject, rather than to dip down into the primary studies, for the WP:MEDRS reasons discussed above (this discussion was added after your comment). Eubulides (talk) 00:46, 17 March 2008 (UTC)

The Task Force is an awfully difficult thing to wish away. It is more recent than the reviews. CynRN's suggestion is reasonable. I suppose I could try to write something up. ---- Dēmatt (chat) 03:28, 17 March 2008 (UTC)

Nobody is saying that the Task Force should be wished away. And the Task Force study is not more recent than the Task Force reviews mentioned above. The Task Force's executive summary summarizes the primary source in question, and is cited, heavily, in Chiropractic#Safety. We should not be second-guessing the Task Force's own reviews of its own study. Eubulides (talk) 06:00, 17 March 2008 (UTC)

We are not second guessing the TaskForce's findings, we are just not omitting the full findings and conclusions which has been done in the current revision of safety. Cited heavily? I disagree on that, where in the body of the text is it cited heavily?

Here is all that the main Task Force review (PMID 18204400) says about chiropractic safety:

"There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke."

Chiropractic #Safety restates that as follows:

"Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions."

How could the Task Force review be cited any more heavily than that? Every point that the review makes about safety is also made by Chiropractic#Safety. The intent here is only minor editing for brevity; it isn't supposed to omit any of the points of the original. But if something is missing, what is it? Eubulides (talk) 16:55, 17 March 2008 (UTC)

We either attribute it to the 2 primary sources in full or from the Task Force findings in full.

It's OK for us to attribute something to the Task Force reviews of its own work. I disagree that we should reach down directly into the primary studies. There is no need to use primary studies when we have reliable reviews of those studies. We should use the reviews, and not second-guess the reviewers' opinions. Eubulides (talk) 06:15, 17 March 2008 (UTC)

There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke.

Conclusion. VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care. Source: [17]

Results The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period.

Conclusion In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization. Source: http://www.springerlink.com/content/wj7161058u5q1211/

A further point, is that both studies cited here contain a multi-disciplinary research team (DC, MD, PhD, DDS) and was years in the making whereas Ernst is a solo MD who is an anti-chiropractic researcher. So, this "technicality" of preferring secondary sources is kind of bogus here in that the primary study in this case is "preferred" based on its multi-disciplinary panel, breadth, depth, and length of study. EBDCM (talk) 03:16, 17 March 2008 (UTC)

• I very much disagree with the approach of overriding the Task Force's own reviews of its own primary studies, and reaching down into these primary studies and bringing out selected parts to favor one particular pro-chiropractic viewpoint. That is not how reliable articles are written, and completely contradicts the sage advice in WP:MEDRS #Some definitions and basics about not using primary sources to argue with secondary ones. We should respect the judgment of the reliable reviews we have on this subject.
• All of the emboldened text above is taken from primary studies, not reviews. We should be using the reviewer's summary of the work, not the primary studies. Standards for reviewers are higher.

I am not suggesting we override anything, I am for clarity however and making sure that its conclusions and findings are cited in full. The current draft does not do this.

Chiropractic #Safety fully cites every conclusion made by the Task Force reviews. None of those conclusions are omitted. The items in dispute here (bolded above) are taken from primary studies, not from reviews. Highlighting particular statements from particular primary studies, out of the proportion given by the Task Force's own reviews of its own studies, does not follow the WP:MEDRS guidelines and would raise significant POV issues. Eubulides (talk) 17:02, 17 March 2008 (UTC)

How does it raise POV issues when we are citing a multidisciplinary study? MDs are on the list of authors, not so in Ernst. Besides, this is a technicality card you are playing and playing it on a vital issue such as SMT and stroke is not appropriate in this context. This continual objection to Cassidy et al. and Haldeman et al. (studies which are far more robust in depth, breadth, referencing, consensus, and notability) while Ernst gets a free ride is really not the best way to be trying to achieve any consensus here. Let's go with the most robust research available, not a hardline interpretation of MEDRS guidelines. EBDCM (talk) 00:23, 19 March 2008 (UTC)

It doesn't matter how many disciplines were involved in the primary study. What matters is that it is a primary study, whose main points are summarized in a reliable Task Force review. We should rely on that review and not substitute our own opinion about what the main results of the primary study are. This is not simply a matter of WP:MEDRS; it's only common sense. One can easily find many high-quality primary studies to support a wide range of opinions about chiropractic. We need to rely on reviews to help us find the way. It is not reliable to search for primary studies whose results look right to us; that is a procedure that clearly has POV issues. And this is not an issue of giving Ernst a free ride: Ernst cites lots of primary studies too, and those primary studies are not cited in Chiropractic #Safety either. The two supportive-of-chiropractic primary studies do not have far more more depth, breadth, etc., than the studies and reviews that Ernst cites. Eubulides (talk) 09:05, 19 March 2008 (UTC)

• I continue to object to the characterization of Ernst as a "solo MD". Ernst is not alone in criticizing the safety of chiropractic.

Noted, but Ernst's review pales in comparison to the depth, breadth and length of safety put into either the task force report or the individual papers. I read the Ernst paper yesterday and I was pretty shocked at how many fallacies were used in that "review". If that is what passes for MEDRS standards, than it is very poor. For example, Ernst cites chiropractic "core concepts" and cites an alt-med text written by MDs that describes chiropractic philosophy which was very, very one sided and was about 50 years behind the times. Also, a lot of the "critical" analysis is on straight chiropractic and I would suggest it mischaracterizes it as well

• Ernst's review (PMID 17606755) is all about safety; the Task Force reviews are about many subjects and devote only a small fraction to safety. Ernst's review contains far more material about safety than the Task Force reviews do.
• Ernst's review does not contain the phrase "core concepts" and does not mention straight chiropractic. Are you sure you were reading the right paper?

Eubulides (talk) 17:13, 17 March 2008 (UTC)

When Ernst describes chiropractic the way he does, he is describing straight chiropractic. You don't need to be a rocket scientist to figure this one out. Also, the "books" and "papers" cited by Ernst is chiropractic "research" done by MDs (who have historically tried to squash chiropractic and chiropractors, see Wilk vs. AMA and you can figure out the rest yourself. Just to note; I have gotten by membership back at University of Toronto libraries so I can now fact check the articles you are citing. So, I would be careful of including studies that do not have adequate multidisciplinary representation. EBDCM (talk) 00:23, 19 March 2008 (UTC)

Ernst's review (PMID 17606755) is generic to spinal manipulation; it does not push straight chiropractic (it does not discuss subluxations, or innate intelligence, or anything like that). There is no rule that primary studies or reviews must be multidisciplinary. Extremely high-quality work can be done by teams within a single discipline. It would be inappropriate to reject a review simply because it didn't have (say) a chiropractor coauthor. Eubulides (talk) 09:10, 19 March 2008 (UTC)

Extremely high work was not done by the author in this discipline. We are not rejecting it; just giving the weight it is due.

Ernst's review is of high quality, and cites several other high-quality reviews. It should be cited appropriately and neutrally, and Chiropractic should not attempt to drown it out by surrounding it with a sea of disagreeing studies. Eubulides (talk) 03:16, 20 March 2008 (UTC)

It's rather low quality paper by an extremist author; but we are keeping it because you want us to. That's fine. However, please spare the theatrics of claiming anything about "drowning" it out; when this is clearly not the case. Other high quality papers completely disagree with his claims and assessments; and unlike Ernsts papers who are written by an MD/PhD, the papers we're citing contains MDs, DCs, PhDs, DrSc, DDS, PTs and other health professionals and researchers. Remember, it has to be NPOV and safety must reflect this with proper weight. It's getting closer now; but we're not there yet. EBDCM (talk) 03:30, 20 March 2008 (UTC)

It's a high-quality review by a serious mainstream researcher. Its results should not be drowned out by surrounding it with lots of pro-chiropractic sources. None of the recent edits to "Safety" have been discussed on the talk page, which is contrary to standard procedure in a controversial article like this. It would not be hard to bring up dozens of sources written by lots of people with initials on either side of this controversy; just adding papers devoted to one side is clear POV. Eubulides (talk) 03:52, 20 March 2008 (UTC)

Seriously extremist and flawed. No one is drowning anything out, we are simply balancing it out so its is NPOV. First, chiropractic is more than manipulation, yet soft tissue and low force and reflex techniques aren't mentioned; now they are. I added stuff primarily from the World Health Organization. Safety still is adequate and is still keeping Ernst and other mainstream critics. We are merely fleshing it out and covering the various aspects of chiropractic safety, manipulation. EBDCM (talk) 04:04, 20 March 2008 (UTC)

There is nothing extremist or flawed about Ernst 2007. Adding multiple pro-chiropractic sources, when there were already more pro- than anti-chiropractic sources, is not neutral. These repeated edits to the main page, adding controversial material without any discussion on the talk page, is not a constructive way to work. Eubulides (talk) 04:10, 20 March 2008 (UTC)

Disagree, and so would many physical medicine researchers. You are using the false dichotomy fallacy against suggesting sources are either pro or con. They are not. Also, the sources included discuss SMT and not necessarily chiropractic. The material added presents a more well rounded version and removes the condemning tone of the previous version. We are much closer to neutral now that we have been before. EBDCM (talk) 05:19, 20 March 2008 (UTC)

I am not aware of any physical medicine researchers saying that Ernst 2007 is "seriously extremist and flawed". It is true that not all sources are pro or con but the sources added today, without discussion or consensus, support chiropractic. Any changes of this sort, whether to "tone" or to add controversial material, ought to be discussed on the talk page. That was not done here, and this is regrettable. Eubulides (talk) 05:29, 20 March 2008 (UTC)

Incorrect, Eubulides. They do not support chiropractic they suggest that the incidence of SMT is low. Why do you continuously misrepresent edits? Sources such as the WHO were also used which validates the points made as well. Why do you object to including soft tissue treatments in the text? The way it was written insinuated that DCs always cracked necks with HVLA thrusts. This was a gross mischaracterization again. EBDCM (talk) 05:39, 20 March 2008 (UTC)

Chiropractic #Safety did not mention HVLA thrusts or cracking necks. The recent edits add several old sources (ages 15-25 years) from chiropractic sources saying that chiropractic is safe. This repeats later material supported by recent, evidence-based sources that say the same thing. Why cite the older and less-reliable material, to say the same thing over again? I do not object to mentioning soft tissue treatments, but including lots of older and less-reliable material that all supports the safety of chiropractic is not good for the article's quality. Eubulides (talk) 06:00, 20 March 2008 (UTC)

The sources included were evidence based. Please do not mischaracterize the cited works. Also, this consistent behaviour of whereby you seemingly are the judge and jury for inclusion of high papers must stop. It is getting very repetitive now and I have asked you previously to respect the inclusion criteria. It seems there is a habit of calling papers "weak or low" quality or citing MEDRS guidelines whenever an editor presents a paper that contradicts one's that support your argument. EBDCM (talk) 06:12, 20 March 2008 (UTC)

I did not mischaracterize the newly added sources. I said they were old, which they are. Some are more than 25 years old. Research in this area has come a long way since way back then, and sources that old are not that reliable any more. Eubulides (talk) 06:31, 20 March 2008 (UTC)

• There are several high-quality studies on both sides of this issue. Why push two pro-chiropractic ones?

Ernst is not a high quality paper. It focuses almost exclusively the vitalistic, metaphysical and straight viewpoint of chiropractic (the minority nonetheless). In describing chiropractic theory is refers to dated Palmer concepts which Palmer himself repudiated and does not even take into account modern theories. It failed to include the most recent definition of subluxation (WHO 2005) despite the fact it cited definitions from 1996-2002. Considering it was published in 08, this seems like a deliberate attempt to omit anything that would make chiropractic look like a reasonable profession. Also, a "critical" evaluation requires an objective look at the both sides of the picture and Ernst has clearly not done that. Even his conclusions are highly suspect, suggesting that SMT is not grounded in science and that all of a sudden chiropractic needs a higher standard that other professions in that it has not been proven beyond a shadow of a doubt. What is the success of surgery for LBP? Why is Ernst applying a double standard and moreso, why do you endorse it? EBDCM (talk) 00:23, 19 March 2008 (UTC)

Again, this seems to be an attack on the wrong paper. Ernst 2007 (PMID 17606755), which is the paper Chiropractic #Safety cites, does not match the above description. I disagree with the attack, but regardless of whether one agrees or disagrees with it, the attack is irrelevant to what's in Chiropractic#Safety now. Eubulides (talk) 09:15, 19 March 2008 (UTC)

I'm not "attacking" the wrong paper, I'm critiquing it. Please use better language, you said that word 3x in 2 sentences. EBDCM (talk) 23:49, 19 March 2008 (UTC)

A phrase like "seems like a deliberate attempt to omit anything that would make chiropractic look like a reasonable profession" sounds very much like an accusation of lack of good faith; in short, an attack on the author of the review. Plus, the critique or attack (or whatever one wants to call it) was against some paper other than Ernst 2007 (PMID 17606755), which is the paper Chiropractic #Safety cites. Eubulides (talk) 03:20, 20 March 2008 (UTC)

I'm not making any attacks on Ernst personally; to insinuate so is being disingenious. I'm stating that his papers are clearly biased and have been severely rebutted many times over to the point know where Ernst could easily be regarded as an extremist. It's actually quite ironic; since the people his critiques the most are equally dogmatic in their belief system. The best available paper on safety is put out by the CCA and its the neck pain guidelines. Unlike Ernst; it cites mainstream medical literature and chiropractic and alternative lit as well for an comprehensive evidence based review. EBDCM (talk) 03:30, 20 March 2008 (UTC)

Ernst's work is controversial, but it has not been "severely rebutted" except in the eyes of his detractors. His work is not an extremist viewpoint; it's a mainstream viewpoint. The CCA neck pain guidelines are not the best available work on chiropractic safety in general; they focus only on neck pain, and they spread their attention to many other forms of treatment. Ernst's review cites both mainstream medical and chiropractic literature as well. Eubulides (talk) 03:57, 20 March 2008 (UTC)

Actually, Ernst's work has been criticized by DCs, PTs, DOs, MDs, ATCs and other professions who choose to use manipulation. Ernst's review did not even look at the ICL nor provide a comprehensive literature and transparent editing process like the CCA guidelines. The mainstream point is noted many times throughout safety. To insist it isn't is not factual. Let's use multidiscipinary sources which are preferred. EBDCM (talk) 05:19, 20 March 2008 (UTC)

• Ernst's work is critical of CAM, and he gets criticized back; there is nothing surprising about this.
• Ernst 2007 used AMED, and that covers refereed chiropractic literature; there is no need to use ICL as well.
• The recent edits to Chiropractic #Safety, which were done without discussion or consensus, have reduced mainstream criticism down to well under 25% of the section. Wikipedia policy is that all articles must fairly represent all majority and significant-minority viewpoints; giving mainstream medical critics a small fraction of this section is contrary to that policy.

Eubulides (talk) 05:46, 20 March 2008 (UTC)

Criticism based on an objective review is fine. Ernst has failed this repeatedly. Mainstream med does not get to decide what is acceptable chiropractic literature. AMED is no a substitute for nor replaces ICL. ICL is the THE definitive chiropractic literature index. The claims made that critcism is not adequately covered is without merit nor is is factual. The article is about safety, not about mainstream meds take on safety. Also, the edits made are factual and even common knowledge and the objections here are seem more to be about ownership issues than anything else. No wikipedia policy are being violated; to insinuate this again is a gross misrepresentation of the facts. EBDCM (talk) 05:56, 20 March 2008 (UTC)

I completely agree that mainstream medical opinion should not be the only opinion cited. However, it should be given due weight; giving mainstream opinion a small fraction of the section, and overwhelming it by surrounding pro-chiropractic opinion, is not proper. AMED suffices for finding high-quality recent alternative-medicine reviews of SMT safety, which was Ernst's goal. Ernst's review is critical, but it is a reasonable mainstream opinion and is by no means extremist or unfair. Adding lots of material to the pro-chiropractic side of Chiropractic #Safety, to bolster that side of the argument, is POV even if the material itself is factual, because it gives undue weight to one side. Eubulides (talk) 06:16, 20 March 2008 (UTC)

You are misrepresenting the section and the edits, yet again. I will ask you nicely one more time, do not this any more, please. The majority of the material added was not "pro" or "con" it provided operational definitions of common knowledge and included non-thrust techniques. Your continuous objections to these inclusions are perplexing. Please assume good faith. EBDCM (talk) 06:36, 20 March 2008 (UTC)

Much of the newly added material was duplicative, or irrelevant to safety. For example, the list of chiropractic treatments belongs in Chiropractic #Treatment procedures, not Chiropractic #Safety. The material that was relevant to safety was supportive of chiropractic. Some of new newly added material directly disputes the text supported by reliable reviews. The entire effect was to skew the section greatly in the pro-chiropractic direction. Without discussion. This is not a good way to operate. Eubulides (talk) 06:52, 20 March 2008 (UTC)

The studies aren't pro-chiropractic, they address the topic at hand, namely manipulation and VBA. And, after careful analysis of the data, they've (a PANEL of professionals not just DCs or MDs, but BOTH along with PhDs and MANY notable institutions) concluded that there is no excess risk. The Ernst study is not of this caliber, or is it even close. It's a condemnation piece which is hardly objective. It is written by one person, with an agenda, namely to discredit chiropractic at seemingly any cost. At first I had not read the study in question, but after reading it is such a gross misrepresentation of the overall chiropractic picture (its biggest fallacies include of the biased sample and appeal to fear and ridicule). Ernst goes to say how the straights are the minority then dedicates almost the whole paper critiquing them and condemning the majority of the profession who do not share those values or practice styles. It also suggests that many of the critiicisms are directed towards US DCs and mentions in several instances how Canada and Europe "buck the trends". There was at least 3-4 separate mentions of this in the paper yet no mention in safety? Common, Eubulides. Now that I have read the paper in question, you're going to have to justify a lot of the garbage in there that is included in safety and why you chose certain passages and not others that provide a more balanced, objective view.

• The primary studies in question have pro-chiropractic results. Other primary studies have results that go the other way. Why emphasize detailed claims from two pro-chiropractic studies, when even the Task Force reviews do not mention those claims? Why emphasize pro-chiropractic primary studies, while ignoring the other side?

Pro-chiropractic results? Why the false dichotomy again? It could have been inconclusive or negative. I'm not saying we ignore Ernst, let's just give him the weight he deserves until his paper(s) are as good as Cassidy's and Haldemans. At least they INCLUDED MDs as part of the review whereas Ernst does not include DCs to be part of his research. EBDCM (talk) 00:23, 19 March 2008 (UTC)

The edits being proposed in bold above are attempting to highlight words in these primary studies that support chiropractic, even though reliable reviews by the Task Force do not mention the words at all. Highlighting these words would substitute Wikipedia editors' POV for the viewpoint of published experts in the field. That is not a wise thing to do. It doesn't matter whether DCs appear on the author list; what matters is whether the reviews are reliable sources. Ernst's reviews clearly fill that bill, as do the Task Force reviews. Eubulides (talk) 09:20, 19 March 2008 (UTC)

Those aren't my words Eubulides those are the verbatim conclusions of the authors. Reliable sources also include Haldeman et al. and Cassidy et al. These don't "support" chiropractic (the profession, remember, Eubulides) rather it merely states that the risk of SMT to the cervical spine does not result in an increase in relative risk. Surely you know better than to confuse the two. EBDCM (talk) 23:49, 19 March 2008 (UTC)

The emboldened words are taken from primary studies, which report results that support chiropractic. They are not taken from reviews that the Task Force made of its own studies. We should not reach down into primary studies to grab bits and pieces merely because we disagree with the reviewers' opinions of what was important about those studies. Eubulides (talk) 03:23, 20 March 2008 (UTC)

Incorrect. The results of the study support that spinal manipulation (particularly to the upper cervical spine) is not associated with increased risk for VBA. These are high quality papers and we shall not omit them. Bits and pieces? We are grabbing conclusions from a historical paper that debunks a lot of long held beliefs. They cannot be swept away, as Dematt has said already. EBDCM (talk) 03:46, 20 March 2008 (UTC)

There is nothing incorrect about the above comment. The studies in question are primary studies. The emboldened words are taken from primary studies, not from the Task Force's own reviews of their own studies. The papers are high quality but they are just primary studies; their main results, as determined by the Task Force itself, are already in Chiropractic #Safety. There is no good reason to reach down into these primary studies and grab more words, overriding the expert opinion of the Task Force itself. Their results (and the Tasks Force's summary of their results) do not contradict what's cited from Ernst's review. It would be POV to highlight these supportive-of-chiropractic primary studies, while not highlighting similar studies whose results are critical of chiropractic. Eubulides (talk) 05:05, 20 March 2008 (UTC)

Yes, you are equating studies that study SMT as "supporting chiropractic". Your argument is noted; considered and rejected. No one is overriding anything, you are again misrepresenting my argument using a straw man fallacy. The main results aren't in safety; if they were we would not be having this discussion. The section is about safety, Eubulides not about supportive and critical studies of chiropractic. It's a profession, not a modality. Please get this straight. EBDCM (talk) 05:19, 20 March 2008 (UTC)

• The Task Force's careful analysis of the data was published in its reviews. The primary sources are just single studies, and do not represent the opinion of the entire Task Force. Let's stick with the reviews.

Primary studies are sometimes better and more robust academically and in notability than secondary studies. This is the case here. It's also has MD co-authors. Does Ernst have another discipline as part of his review?

The Task Force's primary studies are not stronger than its reviews. Its reviews are much stronger and they rely on far more sources. This is not an issue of Ernst or MD co-authors or anything like that. Ernst isn't even involved at all. This is an issue of the Task Force's own reviews of its own work. Eubulides (talk) 09:22, 19 March 2008 (UTC)

Sorry, disagree. We wouldn't be here if your safety edit had provided OK weight, but it did not and was a fear mongering edit that needlessly plays up a small risk. EBDCM (talk) 23:49, 19 March 2008 (UTC)

The edit is not fear mongering, and it cites reliable sources and gives adequate weight to both sides. It gives more weight to sources that support chiropractic than those that don't. It says that the risk is small, and does not play it up. Eubulides (talk) 03:27, 20 March 2008 (UTC)

Well, I disagree with you, so does the DoctorisIn and so does DigitalC. No reliable sources are going to be removed; on the contrary we will add high quality papers by Cassidy and Haldeman to balance things out. Don't forget the section in question is about "safety" not about "support of chiropractic". You seem to be a bit confused here. If the risks were small, as you describe, then why do we proceed to try and list medullary signs and specific neurological trivia bits. For something that is so small, there sure is a big amount of text describing it; especially the puff emergency medical servicess wikilink. EBDCM (talk) 03:46, 20 March 2008 (UTC)

Please ask Dematt about the scary stuff you're referring to; that discussion was added by him. The original version had something simpler and more easily understood by non-experts, and did not mention emergency medical services or medullary signs, and that was fine with me. Again, there is no need to bulk up the section by reaching down into primary sources on only one side of this controversial area; that would be adding POV. Eubulides (talk) 05:11, 20 March 2008 (UTC)

• The Ernst review does not talk about straights and does not contain the phrase "buck the trends". Apparently there is some confusion here, and the wrong paper was being read. Please follow the reference to Ernst 2007 given in Chiropractic#Safety.

I was reading the 2008 paper, I will read the 2007 one tonight although I doubt it will cut from a different cloth than his previous "reviews" on chiropractic, SMT and safety.

Eubulides (talk) 17:27, 17 March 2008 (UTC)

• Suppose Chiropractic#Safety reached down into some of the primary studies cited by Ernst and heightened their individual results more than Ernst himself does. Would that seem like neutral coverage of the issue?

Garbage in, garbage out. We have enough editors here versed in literature reviews and we can discuss the papers and their merits/validity or lack thereof. We should do and review the individual papers if need be; but the stuff cited by Ernst and his entire article is nothing more than anti-chiropractic propaganda and the fact that you're vouching for it is, IMO, lamentable.

• When we have reliable reviews of individual primary studies, we should prefer those reviews. The opinions of Wikipedia editors should not override the opinions of published expert reviewers. (If we were really that good at reviewing, we should be publishing those papers!…)
• Ernst's review represents serious criticism that should not be ignored by any neutral summary of chiropractic safety issues.

Eubulides (talk) 17:34, 17 March 2008 (UTC)

I'm not suggesting we ignore Ernst. We should state his concerns briefly and succintly. As long as it catches the "spririt" of his message. We don't need to get into a stats pissing match here. The safety, as currently written does not adequately capture the weight, importance and spirit of the conclusions. This issue and study has been in the making for 6+ years now and your edit reduces it to 1 line. 1 million patient years of data was studied. Can Ernst say the same, or any other paper for that matter? Common. EBDCM (talk) 00:23, 19 March 2008 (UTC)

The Ernst review, like the Task Force review, relies on many, many primary sources. I agree that we need not get into a stats match here; we can simply report what both reviews say, and move on. That is what Chiropractic#Safety does now. Eubulides (talk) 09:24, 19 March 2008 (UTC)

The Ernst review, unlike the Task Force review, only cites mainstream med lit. Hence, it egregiously misses tons of literature done by chiropractic researchers. It's invalided based on this. At least Task Force used a full review all ALL the relevant literature then got a MULTIDISCIPLINARY panel to review it. Not so with Ernst. EBDCM (talk) 23:49, 19 March 2008 (UTC)

This completely mischaracterizes the Enrst review. It cites several chiropractic sources, including J Am Chiropr Assoc, Chiropr J, J Vertebral Subluxation Res, and others. Ernst is a valid and high-quality review. Eubulides (talk) 03:32, 20 March 2008 (UTC)

It pales in comparison to the Task Force in depth, breadth and quality. EBDCM (talk) 05:39, 20 March 2008 (UTC)

Ernst's review (PMID 17606755) is all about safety; the Task Force reviews are about many subjects and devote only a small fraction to safety. So yes, it is narrower in scope. It is not lower-quality, though. It covers its narrow topic more thoroughly than the Task Force reviews do. Eubulides (talk) 06:03, 20 March 2008 (UTC)

Eubulides (talk) 06:15, 17 March 2008 (UTC)

Eubulides makes good points. I would only support adding one additional sentence to support the Task Force, as it was a notable study and...more or less as a peace offering and to underscore the impression of "safety". (Not very scientific, I know)CynRNCynRN (talk) 06:25, 17 March 2008 (UTC)

We shouldn't reach down into the primary studies. Nor should we add puffery about how great the Task Force is (any more than we should add puffery about how great Ernst etc. are). However, I would favor adding another sentence about safety, taken from a review. How about adding this sentence?

Risks can reasonably be considered slight when compared to all forms of medical treatment.

Eubulides, please do not continue down this path. We have heard it before and many of us disagree. The primary studies in this case are much higher quality papers than Ernst and anyone with any degree of scientific and lit background who read the papers in question would agree. Nor is anyone adding any puffery. We are providing suffiicient context as WHY it should be notable and WHY readers would care of who or is concluding. There are major omissions in the current version and they need to be rectified ASAP. EBDCM (talk) 15:44, 17 March 2008 (UTC)

• The primary studies are not "much higher quality" than Ernst 2007. First, they are primary studies and not reviews, so they are not directly comparable. Second, both sets of papers are high quality; it is not at all clear that one is higher quality than the other. It appears from the discussion above that you were reading some paper other than Ernst 2007; perhaps that explains our difference in opinion here.

Again, a technicality. The studies are much better than Ernst 07 for several reasons: 1)multidisciplinary input 2)associated with WHO and 100+ universities and public health institutions, 3) has provided a much more intense and competitive lit review process for citations inclusion 4) has studied 1 million years of patient data, 5) has compared stroke rates with other health professionals 6) has some of the best authorities in the world on VBA stroke as authors 7) is part of of international task force 8) etc.... EBDCM (talk) 00:23, 19 March 2008 (UTC)

The primary studies do not review nearly as many sources as Ernst 2007 does. The primary studies were not done by the WHO, nor by 100+ universities, etc., etc.; they were just primary studies. Ernst 2007 is published in a high-quality journal. It is not fringe opinion, or anything like that. Chiropractic should not ignore Ernst's criticism, nor should it argue with it by going to the lengths of citing primary studies that disagree with it. Eubulides (talk) 09:36, 19 March 2008 (UTC)

You're making this needlessly personal. Ernst is cited in the safety. His points are noted. You are misrepresenting my argument (again) by stating that we are "ignoring it" and that I'm resorting to citing a "primary" study. Please do not do this again. This is the third time I've asked. EBDCM (talk) 23:49, 19 March 2008 (UTC)

There was nothing personal in the above remark. Ernst should not be ignored or shouted down in Chiropractic; his review represents a respectable mainstream opinion and should be given due weight as per standard Wikipedia policy. Using primary studies to dispute secondary reviews of those studies violates the guidelines in WP:MEDRS, and there are good reasons for those guidelines. Eubulides (talk) 03:36, 20 March 2008 (UTC)

I cannot understand why you continue to misrepresent my statement; I do not want to ignore and shout down Ernst. I am simply providing references that state different conclusions. Ernst is already cited 3 times SEPARATELY in safety. He has his weight. What does not, is the opposing view. There is no violation of MEDRS; that insinuation is disingenious. According to your guidelines nothing can contradict Ernst. Guidelines are guidelines, Eubudlies and had Ernst's study not been so blatantly one sided and weak (as the "systematic review" only "systematic reviewed conv med literature and omitted chirorpractic and cam studies on the subject) we have high quality papers by a multidisciplinary panel that openly contradicts Ernst. Besides, the research by Cassidy et al and Haldeman is more current and provided a more transparent and better lit review and included a multi-displinary lit review. EBDCM (talk) 04:21, 20 March 2008 (UTC)

• Critical sources had only 25% of Safety before today's edits began bulking up the pro-chiropractic side. These edits were done without discussion and without consensus, and by loading up the section with additional and redundant pro-chiropractic discussion their effect is to drown out the criticism. Obviously one can come up with dozens of papers on both sides and justify adding extensive discussion on both sides; but continuing to add just to one side constitutes POV.
• Ernst's review did not limit itself to conventional medical literature, His search used AMED (which covers chiropractic literature) and his review mentions several chiropractic sources.
• The primary studies by Cassidy et al. and Haldeman et al. are just that, primary studies; they are covered by the Task Force reviews, which are written by expert reviewers, and we should rely on those reviews rather than override them with our own opinions.

Eubulides (talk) 04:56, 20 March 2008 (UTC)

Please do not mischaraterize editors arguments again, Eubulides. There is no drowning out. Please do not repeat this any more. It's special pleading fallacy. Also, Cassidy et al. and Haldeman et al. are high quality papers whose conclusions need to be cited for an accurate portrayal of the evidence. Otherwise we are left with Ernst having a disproportionate say which he still does. No one is overrding anything, we are citing conclusions verbatim. Also, no one is swaying any POV; the safety section is now more complete, more factual, more robust and better overall. There were scandalous omissions on the previous version and it lacked any discussion regarding other treatment modalities which was included. Please stop refering to pro-chiropractic side; the high quality papers discuss spinal manipulation, risks, safety, etc. The criticism is still there and Ernst is still cited 3 times. Both sides are almost adequately covered now. We're getting close to a NPOV safety, no small feat. EBDCM (talk) 05:09, 20 March 2008 (UTC)

Safety edits made without discussion or consensus

(outdent)I don't know what a "special pleading fallacy" is, but it is not right to add substantial and controversial pro-chiropractic material to Chiropractic #Safety without discussion. This is contrary to the usual practice in controversial pages, and there is no good reason to depart from that practice here. Much of the new material is redundant with what was already in the section, and this redundancy serves no good purpose other than to lessen the apparent importance of the criticism, thus introducing POV. And some of the new material is unsourced; this is lowering the quality of the section. I realize that part of this problem is due to today's revert war, but nevertheless this is not good editing practice. Eubulides (talk) 05:21, 20 March 2008 (UTC)

It's also called a red herring fallacy too. The addition resolved what many editors felt was undue weight issues and negative tone. It is now closer to neutral. No critical citations were removed and supposed "pro" chiropractic material such as mentioning the fact that DCs also use light force, soft tissue and reflex techniques are further examples of glarring deficiencies in the text. Editors should not be canvassing for votes here but rather discuss specifics edits and the problems. Also, I object to your editorializing here and taken conversations out of context and omitting other parts of the conversation. This is beginning to be a bad habit. EBDCM (talk) 05:30, 20 March 2008 (UTC)

Chiropractic #Safety was discussed at length, over a period of weeks, by many editors. These recent changes were not discussed at all. There is no evidence on this talk page that "many editors" feel these undiscussed changes have improved the section. The resulting section is less neutral than before. It is not right to make substantial, controversial changes to Chiropractic without discussion. I have not attempted to take anything out of context, but if I have inadvertently done so, I apologize; that was not my intent. Eubulides (talk) 05:50, 20 March 2008 (UTC)

I was part of this conversation, so please don't pretend like I was not here. The resulting section is FAR more neutral than before. The changes have resolved weight issues and tone issues and lack of proper breadth issues as well. What specific changes are you objecting to? The fact that DCs don't always use HLVA thrust techniques? For describing what HVLA was? For adding there are serious neurological complications and vascular accidents? EBDCM (talk) 06:02, 20 March 2008 (UTC)

The resulting section is far more supportive of chiropractic than before, and is less neutral. I will take up specific objections later. I continue to object to the practice of making controversial changes to the article without discussion; that is really not a good way to proceed. Eubulides (talk) 06:24, 20 March 2008 (UTC)

No, it's far more informative. All sources were cited properly and no content was taken out, stuff was added in as per policy. EBDCM (talk) 06:31, 20 March 2008 (UTC)

It is not right to add controversial material to the article without discussion. The resulting section is longer and the information content of the newly-added material is relatively low. It is supported by lower-quality (very old) sources which are not readily available online. Some of the newly added material is not supported at all. Overall, this was a low-quality and biased edit. Eubulides (talk) 06:41, 20 March 2008 (UTC)

Nope. It's all from the WHO document, Eubulides. Who cares if its longer if its more accurate? Every added material is supported. The edit was hardly biased; at least no more than any of yours have been. Do not forget, Eubulides, several editors have complained of your edits including the condemning tone and overplay of Ernst. EBDCM (talk) 06:44, 20 March 2008 (UTC)

Much of the new material was taken from dusty chiropractic sources dating as far back as 1982. This is not the WHO 2005; it's much older and less-reliable. This material is duplicative and is supported by less-reliable sources. And it was added without discussion. That's not right. Eubulides (talk) 06:55, 20 March 2008 (UTC)

• Providing the context for pro-chiropractic results, while failing to provide similar context for the other side, is not neutral.

You are misrepresenting my argument. Please do not do it again. EBDCM (talk) 00:23, 19 March 2008 (UTC)

I understood "We are providing suffiicient context as WHY it should be notable and WHY readers would care of who or is concluding" to stand for a proposal to include results from the primary studies, and to give information that might include who did the primary studies, what their affiliations and degrees were, how these primary studies were multidisciplinary, and so forth. If that was not the proposal, I apologize for misinterpreting it. Eubulides (talk) 09:39, 19 March 2008 (UTC)

I think this was a misunderstanding. EBDCM (talk) 23:49, 19 March 2008 (UTC)

• Providing context for both sides in the main text would weaken the article. Among other things, it would lengthen Chiropractic#Safety and make it appear to be a more-serious issue than it really is. The typical reader wants to know about safety, not about the various researchers involved who are working on safety issues.
• It is not a major omission to put authorship material in footnotes; that's where authors belong.

Eubulides (talk) 17:46, 17 March 2008 (UTC)

If we have to sacrifice brevity for clarity than so be it. EBDCM (talk) 00:23, 19 March 2008 (UTC)

There is nothing unclear about putting authorship material in footnotes. That's the standard style, and is expected in Wikipedia. Eubulides (talk) 09:41, 19 March 2008 (UTC)

This could be appended to the 1st paragraph of Chiropractic #Safety. This sentence was in the "Safety 3" draft and got put into Chiropractic #Safety, but Dematt removed it a couple of days ago; I don't know why (there wasn't anything in this talk page about it). The advantage of this sentence is that it's a new point; the stuff we're talking about from the primary studies is merely emphasizing points that are already in Chiropractic #Safety. Eubulides (talk) 06:58, 17 March 2008 (UTC)

If risks are slight/minimal why is it described in 10 sentences? If the risks of SMT for neck pain are less that NSAIDS or surgery why isn't this mentioned? The current edit is too close to an appeal to fear fallacy and is undue weight. EBDCM (talk) 15:44, 17 March 2008 (UTC)

• Risks are also slight for vaccines but Wikipedia has thousands of words about vaccine safety in articles like Vaccine court, Vaccine injury, Vaccine Adverse Event Reporting System, Vaccine Safety Datalink, MMR vaccine controversy, Thiomersal controversy, Vaccine controversy, and many others. There is genuine public concern about safety, and this concern is stimulated by a few real problems. The situation for chiropractic is similar. Wikipedia should cover the issue: even though the risk is small, it is real.
• The sentence proposed above ("Risks can reasonably be considered slight when compared to all forms of medical treatment") makes the point you mentioned and cites a review. Do you like the proposed text? If not, what text and citation would you prefer instead?

Eubulides (talk) 18:02, 17 March 2008 (UTC)

I like this addendum:"Risks can reasonably be considered slight when compared to all forms of medical treatment" That alludes to the risk of NSAIDs, etc. The reason some editors want this topic mentioned is that it is currently very controversial and commonly written about in medical journals. I think it's been presented quite neutrally and not fear-mongeringly.CynRNCynRN (talk) 17:56, 17 March 2008 (UTC)

More on vaccine issue

More on vaccine issueI am afraid the anti-vax question needs to be covered. Why not explain this interesting and notable quirk in chiropractic? The range of objection to vaccines goes from the libertarian stance to a anti-vax religious zeal, as Craig Nelson points out. It's a vital public health issue.CynRNCynRN (talk) 06:36, 17 March 2008 (UTC)

I agree. It's not as cut and dry as an issue, and the fact that there is a vaccine controversy page suggests this as well. It should be handled better than it currently is here and we should not have excess weight of it either. I also object to not acknowledging a historical softening towards vax and that being neutral on a given subject that falls outside the scope of practice is not a horrendous thing. EBDCM (talk) 15:44, 17 March 2008 (UTC)

I also would not object to expanding the coverage of vaccination to include changes in attitude with time. Both longer-term trends (since the days of D.D. Palmer\) and shorter term trends (slight hardening of position against vaccination since the early 1990s) should be covered. Eubulides (talk) 18:02, 17 March 2008 (UTC)

From the WCA in 2000 in response to the Campbell article in Pediatrics: "Ms. Fisher(who wrote anti-vax book A Shot in the Dark) sees this as the start of a serious confrontation between the two professions. "The battle lines are drawn and are clear," she states. "They are going to go after chiropractors who treat children and especially go after any chiropractor who does not recommend vaccination...Our message is getting increasingly favorable treatment in the media -- the other side knows we are gaining ground and they know we have been able to stay the course in large part because of chiropractic support in the past five years," she observes.

After publication of the pediatrics articles, The World Chiropractic Alliance sent a special Action Alert to its members and others on its special e-mail list. Dr. Terry Rondberg, WCA President, (stated) ... "the key in this instance is for all the major chiropractic organizations to work together to present a solid front to the medical profession and to the public," he stated. "We are only as strong as our weakest link and if the medical and drug industries can find even one organization to back down on this position(anti-vax), they will use it against us." This is recent and reflects what is published on the web and on Youtube by chiropractors.CynRNCynRN (talk) 18:51, 17 March 2008 (UTC)

I dunno, I'm not sure what this stuff about the WCA would add to the article. Obviously a vocal minority of chiropractors oppose vaccination, but the current article already says that. If peer-reviewed journal articles cover the topic, I'd rather use them than citing partisan web sites. Eubulides (talk) 19:15, 17 March 2008 (UTC)

I am not suggesting adding this to the article. I am making the point that chiropractic hasn't 'softened' that much toward vaccination, at least in the media and that this was a 'call to arms' regarding the issue. Obviously, it doesn't prove that the profession responded to the call.CynRNCynRN (talk) 20:04, 17 March 2008 (UTC)

(outdent)Being neutral on a public health measure like vaccine is a dicey position. When chiropractors are primary care providers and commonly treat children, any hedging about the effectiveness of vaccines may sway the parent against them. High percentages of vaccination are imperative to keep several common childhood diseases at bay and protect the immunocompromised individuals in our society (for whom vaccines may be contraindicated). It's not that the rare adverse effects need to be covered up, but the evident advantages should be presented, as well. Although vaccine is not scope of practice for chiropractors, who says they can't be promoters of them as a preventive measure? (I'll jump off my soap-box, now) Anyway, I think the article presents the situation pretty acurately without besmirching the 'evidence-based' rational chiropractors. We could go on and on about 'germ theory' vs 'individual liberty' as reasons for anti-vax positions vs 'anti-establishment', etc, but that would just enlarge the section needlessly.CynRNCynRN (talk) —Preceding comment was added at 00:00, 19 March 2008 (UTC)

"Although vaccine is not scope of practice for chiropractors, who says they can't be promoters of them as a preventive measure?". The regulatory colllege says so. They are not allowed to talk about vaccines at all, as any discussion on that front should be done with their medical doctor. DigitalC (talk) 00:44, 19 March 2008 (UTC)

I'm not clear, is that all of Canada, or just Ontario? As a rule, I think gag-orders for medical professionals are horrible, but in this case public healh officials must have perceived a big problem.CynRNCynRN (talk) 15:46, 21 March 2008 (UTC)

Just Ontario, as far as has been said here. Eubulides (talk) 18:08, 21 March 2008 (UTC)

Expanding vaccination section

The Vaccination section is short. Maybe it could be expanded to include more in depth detail. QuackGuru (talk) 18:12, 21 March 2008 (UTC)

I put an expand tag in the section. -WarthogDemon 18:14, 21 March 2008 (UTC)

Nobody has proposed any detail that could be added. What's the point of an expand tag if no specific suggestion has been made? There is a question of weight here; Chiropractic is a big topic, and vaccination is just one piece of it. If there's no specific suggestion then I suggest removing the expand tag. Eubulides (talk) 18:46, 21 March 2008 (UTC)

I asked WarthogDemon about this but haven't had a response yet. I'm inclined to remove the tag, unless there's an objection here. Eubulides (talk) 01:42, 23 March 2008 (UTC)

I agree. The vaccination section is already a violation of NPOV undue weight because this is such a minor non-issue which we are unfairly giving its own section. This section should be removed entirely and put into the practice styles section possibly.TheDoctorIsIn (talk) 20:45, 21 March 2008 (UTC)

I have an idea. The better way to expand the section is to include the missing two references that best verified a sentence. QuackGuru (talk) 01:45, 22 March 2008 (UTC)

An expand tag means that more text is needed for the section. If all that was being asked for was more citations, some other tag would have been used, surely. Does "missing two references" mean Orenstein et al. 2007 (PMID 17971821) and Ernst 2001 (PMID 11587822)? If so, then I disagree that these new citations are helpful. The former doesn't mention chiropracticl, and is to some extent a WP:COATRACK citation. The latter is better, but it's dated, and it is general to CAM rather than being specific to chiropractic, and it doesn't support anything that the existing, newer citation doesn't also support; so what is the point of adding it? Eubulides (talk) 02:12, 22 March 2008 (UTC)

The two refs have abstracts readers can read. The current ref has no abstract and I was unable to read the article. QuackGuru (talk) 02:55, 22 March 2008 (UTC)

Thanks for mentioning it; I hadn't noticed that. I made this change so that the 1st sentence is supported by the source where both the abstract and the entire paper are freely readable, which should fix that source-readability problem. Eubulides (talk) 04:35, 22 March 2008 (UTC)

Perhaps one reason this section is disliked so much by chiropractors is this sentence:"Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as traditional chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines."[68] My feeling is that many chiropractors believe that the "evidence" of harm from vaccines outweighs the benefit. IOW, it's not the simplistic "all disease affected by the spine" thing, but, for them, something more significant, as the Ernst ref. implies. Can this viewpoint be given a voice without causing a POV problem? I don't think it's as simple as straights vs mixers, either. There is a real focus on the negative studies on vaccination on chiropractic websites. They believe they are being scientific about the issue.CynRNCynRN (talk) 19:09, 22 March 2008 (UTC)

Good point. Ernst says the chiropractic literature "repeatedly stresses that immunisation is hazardous and ineffective" and "The risks of immunisation are often exaggerated." How about if we change Chiropractic#Vaccination's "Most chiropractic writings on vaccination focus on its negative aspects." to "Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective." and use Ernst to support the newly added clause? Eubulides (talk) 00:48, 23 March 2008 (UTC)

I don't agree with this change. The text about how really effective vaccination is has been erased. QuackGuru (talk) 20:16, 22 March 2008 (UTC)

I looked a bit more on the net, and found a freely readable copy of Busse et al. 2005. This lets us restore the previous text and cite Busse et al. so I did that. I hope this answers the objection. Eubulides (talk) 00:39, 23 March 2008 (UTC)

Perfect! QuackGuru (talk) 00:41, 23 March 2008 (UTC)

"Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective." I like the addition...good!CynRNCynRN (talk) 03:37, 23 March 2008 (UTC)

I second that. Good addition. --DavidD4scnrt (talk) 06:10, 8 April 2008 (UTC)

Science section needs a rewrite

Agree. Also the "science" section needs a complete rewrite. The bulk of scientific reports in Cochrane and elsewhere show chiro has no effect on a range of conditions. The article needs to reflect this. The philosophy of science lecture is superfluous. Mccready (talk) 12:58, 12 March 2008 (UTC)

Here is a suggestion for improving Chiropractic #Scientific inquiries. Looking at Scientific investigation of chiropractic, its main article, it appears that the main scientific topics are (1) safety, (2), effectiveness, (3) risk-benefit and/or cost-benefit, (4) philosophical issues, and (5) history (that is, history of the interaction between science and chiropractic). I suggest the following disposition of this material:

• Expand Chiropractic #Safety into a new section Safety, effectiveness, and cost-benefit that includes topics 1 through 3 as subsections.
  • The safety subsection could start with the text in #Safety 3.
  • The effectiveness subsection could be written from the sources in #Sources for effectiveness.
  • The risk-benefit / cost-effectivness subsection could be written from the sources in #Sources for risk-benefit and cost-effectiveness.
• Move philosophical discussion (topic 4) into Chiropractic #Philosophy. Some discussion of the philosophy of straight chiropractic versus the philosophy of science is appropriate there; perhaps the existing discussion is enough, or perhaps it can be improved.
• Move historical discussion (topic 5) into Chiropractic #History.

Once this is done, there will be no need for a "Scientific inquiries" section, and no need to rewrite it; though there will be a need to rewrite the moved material. Eubulides (talk) 16:32, 12 March 2008 (UTC)

Very ambitious! Your plan sounds logical. Are you going to tackle it yourself, or do you want to divvy it up?CynRNCynRN (talk) 18:59, 12 March 2008 (UTC)

Help would be very much appreciated. The first subtask (safety) is done I hope. Would you like to volunteer for one or more of the remaining tasks? I think subtask 3 (cost-benefit) will be hardest, as #Sources for risk-benefit and cost-effectiveness is still incomplete; a more-extensive search needs to be done. Subtask 2 (effectiveness) involves reading the sources in #Sources for effectiveness and distilling them down to something short and sweet; this is easier but is still a nontrivial task that requires access to sources. The remaining tasks are the easiest, I hope, since no access to sources is required. Eubulides (talk) 19:46, 12 March 2008 (UTC)

The safety section does not need to be expanded. . . to the contrary, it should be much shorter. Why? Because there is no real big safety issue with chiropractic. . . It is actually remarkably safe. . . I do not even think "safety" warrants its own section. Again, the safety issue is only notable because chiro-opponents play up the infinitessimal risks. Giving this much room to their minority-opinion agenda is a violation of NPOV.TheDoctorIsIn (talk) 01:02, 13 March 2008 (UTC)

There must be some confusion here. The idea is to shrink the safety section, not grow it. The plan is to replace the current Chiropractic #Safety (505 words, by my count) with #Safety 3 (250 words). That's a more-than-50% reduction. Eubulides (talk) 06:49, 13 March 2008 (UTC)

More and more it seems like this article would be turning into a condemnation of chiropractic rather than a neutral discussion of it if we were to follow many of the suggestions above.TheDoctorIsIn (talk) 01:04, 13 March 2008 (UTC)

Which suggestions are those? Please provide details. Eubulides (talk) 06:49, 13 March 2008 (UTC)

Doctorisin, I too share your sentiments and have raised this issue as well. Regarding science rewrite I too agree a rewrite is in order and we should use the CCGPP sources as it provides the most comprehensive, evidence based review of scientific literature as it pertains to chiropractic clinical practice on UE, spinal, LE and non-NMS conditions.

http://www.ccgpp.org/lowbackliterature.pdf http://www.ccgpp.org/upperextremity.pdf http://www.ccgpp.org/2.pdf http://www.ccgpp.org/softtissue.pdf

If someone can find a more comprehensive source and a review of chiropractic literature they should present it, otherwise these documents should suffice as the work has already been done for us. EBDCM (talk) 00:32, 16 March 2008 (UTC)

The first source (lowbackliterature.pdf) is already listed in #Other musculoskeletal problems. The 3rd source (2.pdf) is already listed in #Other problems. The other two sources are still in draft form, and shouldn't be cited in Wikipedia until their final versions are available. #Sources for effectiveness contains many other high-quality reviews of the effectivness of chiropractic. Eubulides (talk) 02:14, 16 March 2008 (UTC)

They're still V and RS and should be included. It's the most comprehensive review available and gives the complete picture, not merely a medical one like the sources from exclusively mainstream med. journals. It meets inclusion criteria and will suffice until the final draft comes in. EBDCM (talk) 02:39, 16 March 2008 (UTC)

They are not for attribution, while in draft status. One of them explicitly says this; the other is in the same category. That review is intended only to express the opinion of CCGPP; it is not the complete picture. Eubulides (talk) 04:55, 16 March 2008 (UTC)

The literature review has been done and we can grab the studies and appropriate conclusions. The review is a lit synthesis and provides us with all the necessary sources and references to make adequate conclusions. Otherwise we are left with mainstream med speaking on behalf of chiropractic and that is not appropriate given the fact we have an evidence-based lit review that is more pertinent to the topic at hand. EBDCM (talk) 18:52, 16 March 2008 (UTC)

It would be OK to refer to studies that these drafts refer to, so long as we don't cite the drafts themselves. More generally, mainstream medical sources and chiropractic sources should both be used. This is not an area where one set of sources completely dominates the other. Eubulides (talk) 00:50, 17 March 2008 (UTC)

Cochrane. Bandolier. I did a lot of work on the science section before the 'defend chiro at all costs lobby' bulldozed along. The article needs to list up front the diseases chiros treat then list the evidence for whether chiro works for these diseases or not. It's that simple. Chiros claim efficacy for all sorts of things. You name it they treat it: asthma, rheumatoid arthritis, infantile colic, urinary incontinence, dysmenorrhoea [18], breast cancer (chrissakes). The reader needs to know this and know what the science says. 125.168.45.230 (talk) 00:38, 16 March 2008 (UTC)

#Sources for effectiveness lists four Cochrane sources, including the dysmenorrhea citation you mention. The Cochrane sources are quite reliable and their results are worth referring to. Are there other good sources aside from those already listed in #Sources for effectiveness? Eubulides (talk)

Thanks anonymous, but those aren't articles per say. DCs treat between 85-95% neuromusculoskeletal conditions, and the article will reflect this otherwise it's an undue weight issue. Regarding your statement that DCs claim to treat various conditions, do you have any evidence of this or is this hearsay? Hawk et al. provides a comprehensive review of all non NMS conditions which will suffice.

There is plenty of evidence that chiropractors claim benefits for asthma etc. See, for example, Pollentier & Langworthy 2007 (doi:10.1016/j.clch.2007.02.001), which reported that more than half of the surveyed chiropractors thought chiropractic intervention benefits gastrointestinal complaints, pre-menstural syndrome, infantile colic, middle ear infection, and asthma; and that significant minorities thought it benefited osteoporosis, obesity, hypertension, and infertility. Eubulides (talk) 02:36, 16 March 2008 (UTC)

Hawk et al. adequately covers this topic. Regardless, 85-95% of DCs treat NMS complaints. The evidence is inconclusive; not enough to suggest it is effective, not enough evidence to suggest it is not. After all, there are many case studies and over 100 years of claims that spinal manipulation could help alleviate symptoms not related to strictly NMS. Also, see my comment below regarding the HOW and WHY of non-NMS care. A lot of eat is to provide symptomatic relief. We need to be careful here with weight issues again. History is already riddled with vert sub stuff as though it was the only thing in chiropractic history (undue weight). EBDCM (talk) 18:48, 16 March 2008 (UTC)

Also, perhaps you are confused regarding HOW and WHY DCs treat non-NMS conditions. From the OCA: Chiropractic care may also be used to provide symptomatic relief for patients with chronic conditions. According to patient surveys, by treating the neuromusculoskeletal elements of such disorders, chiropractic treatment has been shown to improve the general well-being of the patient. This falls in line with the philosophy of chiropractic in treating in a holistic manner, which this is an example of. EBDCM (talk) 01:04, 16 March 2008 (UTC)

It is difficult to try and decide what an entire profession believes. That would take a really long article. McCreedy, don't forget to sign in ;-) -- Dēmatt (chat) 03:46, 17 March 2008 (UTC)

Manga report notes

I too, think the Manga report and worker's comp reports should be merged with the other cost-effectiveness studies. I would like to see a full text copy of the Manga report. I have read that the conclusions are not supported by the research. For instance, manipulation was studied, not chiropractic manipulation, and that most of the studies reviewed were not chiropractic studies, but some other type of practitioner. If this is true, I don't understand why the Manga is such a big deal? Try as I might, I could not find a full text, just the summary.CynRNCynRN (talk) 04:19, 14 March 2008 (UTC)

I could not find a copy of the original Manga report online. You may be able to get a copy by writing Pran Manga directly. It should be noted that the report was controversial when it came out; see, for example:

• Lowry F (1994). "Orthopedists have bone to pick with economist over report on chiropractic". CMAJ. 150 (11): 1878–81. PMID 7802764.
• Manga P, Angus D (1994). "Report on chiropractic". CMAJ. 151 (8): 1107–8. PMID 7922936.
• Chapman-Smith DA (1994). "Report on chiropractic". CMAJ. 151 (8): 1108. PMID 7802806.
• Hoaken PC (1994). "Report on chiropractic". CMAJ. 151 (8): 1110. PMID 7922937.
• Tardif GS (1994). "Is the chiropractic management of low-back pain the solution? What can physicians learn from the Manga report?". CMAJ. 151 (9): 1247–9. PMID 7954171.
• Manga P (1994). "Defending the Manga report on the chiropractic management of low-back pain". CMAJ. 151 (9): 1250–1. PMID 7954172.

Chiropractic #The Manga Report does not cover this controversy; it gives only Manga's side. At this point the Manga report is a historical curiosity (we have later and better studies in #Newer cost-effectiveness sources). If the report is important for historical reasons, it could be briefly mentioned in Chiropractic #History, along with a brief summary of the controversy it engendered, and perhaps (to avoid bias) similar treatment of a vintage anti-chiropractic study. We can use them as examples of the historical feud between chiropractic and conventional medicine. Eubulides (talk) 05:59, 14 March 2008 (UTC)

Thanks for the links. Manga is still on a many chiropractor's websites, on casual perusal, to prove cost-effectiveness. It would be interesting to include some of the criticisms.CynRNCynRN (talk) 17:49, 14 March 2008 (UTC)

I just got a email reply from Professor Manga himself! His full report is available in book form (5 copies left) postage included. He says it is not online. I think I'll pass, I have too many books in the house.:-) His email is above for those who want it.(Nice guy, I didn't think he'd take the time!)CynRNCynRN (talk) 02:32, 16 March 2008 (UTC)

I forgot to say, the report is $20, postage included.CynRNCynRN (talk) 03:13, 16 March 2008 (UTC)

Revision to "Practice styles"

Here is a modified version of Chiropractic #Practice styles and schools of thought that attempts to address issues described in #POV issues as of 2008-03-12 above, along with improving some wording. One change I'd like to make is to shorten the section header, as per the usual Wikipedia dictum that section headers should be short. Eubulides (talk) 20:18, 13 March 2008 (UTC)

This revision uses the following citations which are already present in other sections of Chiropractic:

(start of proposed revision to Chiropractic #Practice styles and schools of thought)

---

Schools of thought and practice styles

Common themes to chiropractic care include holistic, conservative and non-medication approaches via manual therapy. Still, significant differences exist amongst the practice styles, claims and beliefs between various chiropractors. Those differences are reflected in the varied viewpoints of multiple national practice associations. This has led to internal conflicts.

Straight

Straight chiropractors are the oldest movement. They adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities. Straight chiropractors believe that vertebral subluxation leads to interference with an Innate intelligence within the human nervous system and is a primary underlying risk factor for almost any disease. Straights view the medical diagnosis of patient complaints (which they consider to be the "secondary effects" of subluxations) to be unnecessary for treatment. Thus, straight chiropractors are concerned primarily with the detection and correction of vertebral subluxation via adjustment and do not "mix" other types of therapies. Their philosophy and explanations are metaphysical in nature and prefer to use traditional chiropractic lexicon (i.e. perform spinal analysis, detect subluxation, correct with adjustment, etc.). They prefer to remain separate and distinct from mainstream health care. Objective Straight chiropractors differentiate from traditional straights mainly by the claims. While traditional straights claimed that chiropractic adjustments are a plausible treatment for a wide range of diseases, objectives only focus on the correction of chiropractic vertebral subluxations.

Mixer

Mixer chiropractors are an early offshoot of the straight movement. This branch "mixes" diagnostic and treatment approaches from naturopathic, osteopathic, medical, and chiropractic viewpoints. Unlike straight chiropractors, mixers believe subluxation is one of the many causes of disease, and they incorporate mainstream medical diagnostics and employ myriad treatments including joint and soft tissue manipulation, electromodalities, physical therapy, exercise-rehabilitation and other complementary and alternative approaches such as acupuncture. In contrast to straight chiropractors, mixers generally want to be integrated into mainstream health care via integrative medicine. Reform chiropractors are a recent evidence-based off-shoot of mixers who use scientifically-oriented methods and protocols in the treatment of neuromusculoskeletal disorders. Reform minded chiropractors have rejected traditional Palmer philosophy and tend not to use alternative medicine methods.

---

(end of proposed revision to Chiropractic#Schools of thought and practice styles.

Comments on proposed revision to "Practice styles"

(Please put comments here.) Eubulides (talk) 20:18, 13 March 2008 (UTC)

I made these changes to #Scope of practice so that its text more-closely reflected the cited sources. Eubulides (talk) 06:36, 14 March 2008 (UTC)

No further comment so I made that change. Eubulides (talk) 07:32, 15 March 2008 (UTC)

I would ask that you please allow more time for the users to properly reply. There's no rush to move these to the main article, and there is a significant omission on what all DCs agree on in practice styles (Coppertwigs) edit. Despite differences, there are basic agreements and unity on the issues you've left out. EBDCM (talk) 02:42, 16 March 2008 (UTC)

Sorry, I'm a bit lost: I don't know what is meant by Coppertwigs edit; the most recent edit by Coppertwig didn't affect the contents of the section in question (just some minor formatting thing). How much time is needed to review a draft section? Eubulides (talk) 05:05, 16 March 2008 (UTC)

The edit that listed the common themes amongst all practice styles. EBDCM (talk) 18:36, 16 March 2008 (UTC)

It's not clear that the common themes need to be listed again, as they were covered in great detail in Chiropractic#Philosophy. If they are mentioned, it should be just a brief reference to "Philosophy". But wouldn't it be simpler just to interchange "Practice styles" with "Treatment procedures"? That way, "Practice styles" would be right after "Philosophy", and we wouldn't need to reprise "Philosophy" at the start of "Practice styles". Eubulides (talk) 00:55, 17 March 2008 (UTC)

The new subsection #Minority added here seems way too long. The citations are weak, and do not indicate that these splinter groups are viable today. Please see Talk:Chiropractic/Archive 16 #Lead for some reliable sources that suggest the groups are not viable today; search for the strings "PSC approach to chiropractic" and "two much smaller groups". Perhaps if this section were abbreviated and moved to Chiropractic #History? At any rate, the citations need to be better, and PPC is a good place to start (as EBDCM suggested on my talk page). Eubulides (talk) 01:04, 17 March 2008 (UTC)

I could be persuaded to add it if it is well written, does not violate weight issues and has some kind of acceptable reference. I actually don;t mind QGs recent edit; I think it was good (re: Minority).

None of the recent edits address the points made in Talk:Chiropractic/Archive 16 #Lead that these two groups do not seem to be viable today. If #Minority were modified to make it clear that the groups are no longer active, that would address this objection. Eubulides (talk) 06:05, 20 March 2008 (UTC)

I do not have a reference that states the minority groups are no longer active. Please provide a reference I can read. Thanks. QuackGuru (talk) 06:10, 20 March 2008 (UTC)

Please see the extended quote of PPC in Talk:Chiropractic/Archive 16 #Lead, which shows that the SCSC (the chief institutional proponent of objective-straights) no longer observes it in practice. That book is available on Google Books in limited view (enough to let you read a bit more on the subject if you like). The NACM seems long-dead; I don't have a reliable source saying "it's dead" but it hasn't been mentioned by reliable sources for several years, and it would be odd for Chiropractic to talk them up in anything but the "History" section. Eubulides (talk) 06:27, 20 March 2008 (UTC)

I will update the article based on theses new comments. I will aslo remove the WP:COPYVIO and massive content changes made without consensus. Please review. QuackGuru (talk) 01:56, 21 March 2008 (UTC)

I just now read #Minority and it doesn't appear to reflect the comments yet; perhaps you modified some other copy? Eubulides (talk) 07:34, 21 March 2008 (UTC)

I made minor changes when I added it to the article. QuackGuru (talk) 07:39, 21 March 2008 (UTC)

I don't see how those minor changes reflected the comments in question. They said nothing about the apparent demise of the objective straights and of the reformer group. Also, it was a bit jumping the gun to change the draft and install it all at one go. I see now that editors are reverting and unreverting this change, and in some cases are inadvertently restoring copyright violations. It would have been better to get the change right first, before installing it. How about if we undo that change, get the above comments addressed here on the talk page, and then install it? Eubulides (talk) 08:12, 21 March 2008 (UTC)

Lose the #Minority section per the Minority View portion of NPOV policy.TheDoctorIsIn (talk) 07:51, 21 March 2008 (UTC)

From the evidence shown so far, I'd guess the minority-group coverage should be put in the history section, if it's put anywhere, as the groups don't appear to be viable now. Eubulides (talk) 08:12, 21 March 2008 (UTC)

Me thinks it it best in the section where it explains the different schools of thought and practice styles. It is clear for the reader the minority groups are very small. I explained that (very small) based on the new comments and my understanding. Demise seems to be original research. Thanks, QuackGuru (talk) 08:39, 21 March 2008 (UTC)

PPC is not original research, and it indeed says that the principal organization behind the objective straights no longer follows their principles. But even without that, there are serious doubts that these groups still exist, much less have influence, so why mention them so prominently at all? The general rule in Wikipedia is that when in doubt, say nothing. We don't have a strong source saying these groups are influential, so the simplest thing is to say nothing about them. Eubulides (talk) 08:42, 21 March 2008 (UTC)

I explained both minority groups are very small. I have no doubts. QuackGuru (talk) 08:47, 21 March 2008 (UTC)

There's no doubt that they are, or were, small. The doubt is over whether they even exist as organized groups any more. No evidence has been cited of any real activity by either group in the past 5 years. And even if they do exist as groups, which is doubtful, if they were that small then they wouldn't pass the notability and weight tests. They wouldn't deserve being discussed in a section that is bristling with citations and that is as long as the mixer section. Eubulides (talk) 08:56, 21 March 2008 (UTC)

FYI, there is long term consensus for all four groups having each there own unique paragraph before the recent edit wars.[19] Per WP:WEIGHT, minority groups can have a short paragraph. QuackGuru (talk) 09:05, 21 March 2008 (UTC)

That consensus may have been appropriate long ago, if those minority groups were still active. But if they're not active any more, they shouldn't be described as if they were active. It would be OK to briefly mention them under "History", since we have clear evidence that the groups were active in the 1990s. Even then, though, the proposed paragraph is too long and cites too many not-that-relevant sources. One source per no-longer-active tiny minority should be plenty. Eubulides (talk) 18:11, 21 March 2008 (UTC)

That consensus was a short time ago this year and it is original research to claim the groups are no longer active. The proposed paragraph is already very short and to the point. QuackGuru (talk) 18:16, 21 March 2008 (UTC)

The consensus among Wikipedia editors may have been earlier this year, but if it was based on outdated evidence then it still is out-of-date. If the Wikipedia article is to contain claims that significant minority groups exist, these claims need to be supported by reliable sources. PPC is not original research, but even if it was, it is not necessary to justify excluding the material by supplying reliable sources showing that the groups no longer exist; that sort of reasoning is backwards, and would justify putting in all sorts of incorrect material (as it is typically quite hard to prove a negative). To put this material in here (as opposed to the History section), we need reliable sources from which one can reasonably conclude that the groups still exist and are still active. No such sources have been supplied. Eubulides (talk) 18:40, 21 March 2008 (UTC)

I have supplied the references. I understand they are a bit dated. When newer sources become available we can revisit this. Per WP:WEIGHT, we can include a blurp about the minority school of thought. I will add it to the article. Feel free to tweak or rewrite the text. QuackGuru (talk) 01:39, 22 March 2008 (UTC)

The material has been credibly challenged as being so out-of-date as to be irrelevant for a section on current practice styles. Sources need to be supplied to meet that challenge. It is not right to add text to the article in the hope that sources will be supplied later. That is a recipe for allowing in all sorts of questionable material. Please find reliable sources before adding the material; in the process of doing that, you may well discover that the groups are indeed no longer active. Eubulides (talk) 02:20, 22 March 2008 (UTC)

It is not right to leave out or delete text that meets the include criteria and has references. When newer references are found we can use newer refs. For now we should use what we have available. I do not see any Wikipedia policy saying we can't use references that are not very new when newer references can't be found. I can't find newer refs. Therefore we should use what is available now. QuackGuru (talk) 02:42, 22 March 2008 (UTC)

The text as proposed fails to meet Wikipedia inclusion criteria, because the cited sources do not support the claim that these groups still exist and are significant. Multiple Wikipedia editors have searched for reliable sources to support such a claim, but none have been found. It would be OK to mention these splinter groups under "History", as we do have sources showing that the groups existed some time ago, and had some effect back then. Eubulides (talk) 04:43, 22 March 2008 (UTC)

The refs discuss both minority groups. I do not see any reference saying these groups are history. QuackGuru (talk) 06:03, 22 March 2008 (UTC)

It is not necessary to rebut the proposed text with a reference saying the groups are history. The burden of proof is on the text in a Wikipedia article, not on any rebuttal. And the proposed text's citations don't support its claim that the groups exist and are significant. If the text were changed to add qualifiers like "back in 1992" (or whatever), then the claims would support the text; but the text would then belong in Chiropractic #History. Eubulides (talk) 07:01, 22 March 2008 (UTC)

It is necessary to provide a reference saying the minority groups are history or otherwise they should remain in the Schools of thought section under Minority. No qualifiers are needed. The references support the text and explain about the splinter groups. QuackGuru (talk) 20:22, 22 March 2008 (UTC)

The proposed text clearly implies that the groups are significant and current. This is not supported by the sources. This needs to be fixed regardless of which section the material is put in. Either sources need to be supplied to support the claims, or the text needs to be rewritten to match the sources. I expect that the former can't be done, so the latter is the only real possibility (e.g., add dates when the groups were known to be active). Once that's done, we can discuss which section the rewritten text should be put into. I expect this to be Chiropractic #History but that's jumping the gun. How about if we see the rewritten claims and then decide? Eubulides (talk) 00:55, 23 March 2008 (UTC)

The text will be simple. I will clearly indicate the minor groups are very small and it is speculation to say the minority groups are history. QuackGuru (talk) 01:11, 23 March 2008 (UTC)

Your are correct that the article should not contain speculation that the minority groups are history. However, the article should clearly state that these groups were active during the 1990s (or whatever period we have reliable evidence for). Whatever the draft text happens to be, please put it on the talk page so that we can discuss it here. Eubulides (talk) 01:23, 23 March 2008 (UTC)

I'm not sure about the 1990s. We would have to have a reference to show that the groups were more active then and then less active now. I am ready to edit the article anyhow. QuackGuru (talk) 01:27, 23 March 2008 (UTC)

(outdent) We do not need a reference saying that they are less active now. All we need is a reference saying that they were active in (say) the 1990s, and the article can say that. You have read the sources: what do they say? Also, please put the revised proposal in the talk page first. This is a controversial area and the wording should be discussed and reviewed before going in. Eubulides (talk) 01:35, 23 March 2008 (UTC)

This is a non-controversial area and the article can be updated right now. This should be easy. I will update the article based on everything I have read on the talk page, inlcuding all proposed drafts and suggestions. Please review. QuackGuru (talk) 01:47, 23 March 2008 (UTC)

No, the area is controversial. #Massive edits against consensus suggests that it is indeed controversial, and that multiple editors disagreed with the earlier wording. Please put revised wording on the talk page; this article is controversial and standard practice is to propose controversial changes on the talk page rather than putting them directly into the article. Eubulides (talk) 01:54, 23 March 2008 (UTC)

It was non-controversial until the recent edit wars. There was long term consensus for four unique paragraphs.[20] I have compromised and shortened the text and have listened. The Mixers section is a bit short at the moment. I will add some more info to it. I will remove extra spaces from the lead. I will put quotes in the proper place, update the Safety section, add a bit of suggested material to the Vaccination section, and NPOV the article. I will also update the article with the suggestions on the talk page. Thanks for your concerns. I appreciate it. QuackGuru (talk) 02:08, 23 March 2008 (UTC)

Please see #2008-03-23 practice style changes lack consensus below. Eubulides (talk) 07:04, 23 March 2008 (UTC)

2008-03-23 practice style changes lack consensus

QuackGuru, I see that you have barged ahead ("I will add...."), totally ignoring Eubulides advice above ("No, the area is controversial...."). Such an uncollaborative style makes you no better than our recently departed other uncollaborative user. We don't need a bull in this china closet. Don't think that you now have license to edit unhindered. Get your act together and work together with others. Acknowledging what they say and then ignoring it is crap editing. Make your suggestions and edits here. Get consensus, then - and only then - make any changes that could be considered controversial. -- Fyslee / talk 06:46, 23 March 2008 (UTC)

That edit introduced several unrelated changes, not all of which have reached consensus. In the future, please try to make unrelated changes in separate edits; that will make it easier to follow what's going on. This is particularly important when doing controversial edits.

In particular, the edit introduced changes to Chiropractic#Schools of thought and practice styles that are controversial and have not reached anything like consensus. Commentary in #Comments on proposed revision to "Practice styles" says that there was an old consensus, but since that old version was written new evidence has been produced on this talk page casting reasonable doubt on the existence and significance of the minority groups in question, and all editors who have an expressed an opinion on this change (other than the editor who made the change) have expressed a negative opinion (see #Comments on proposed revision to "Practice styles", #Massive edits against consensus, and Talk:Chiropractic/Archive 16 #Lead). Challengable material like what is in the new Chiropractic#Schools of thought and practice styles cannot be kept in Wikipedia without reliable sources, and no reliable sources for the groups' current existence and significance have been given. Eubulides (talk) 07:04, 23 March 2008 (UTC)

In light of the above discussion I reverted the controversial part of the change. Eubulides (talk) 07:07, 23 March 2008 (UTC)

QuackGuru pointed out on my talk page that the reversion also contains this recent change by Fyslee which removed the following unsourced text: "They tend to focus more on the neuromusculoskeletal system but also treat non-neuromusculoskeletal conditions as well. Mixers tend to use more mainstream scientific methods and descriptions as opposed to metaphysical ones.". Fyslee's comment was "that doesn't apply strictly to mixers, but describes reformers". However this particular issue gets resolved, the resulting text should cite a reliable source (that is the main reason I didn't object to Fyslee's change: it removed challengeable and unsourced material). I see no problem adding those two sentences back in if they can be sourced reliably. Eubulides (talk) 07:24, 23 March 2008 (UTC)

As QuackGuru pointed out, I confused his addition to Chiropractic#Mixers with the text that Fyslee removed. They are not the same thing. Sorry about my mistake. I repaired it by restoring that part of QuackGuru's change. I then made a further change to remove the need to cite Kaptchuk & Eisenberg 1998 twice, along with requesting a citation for newly added unsourced material. Eubulides (talk) 07:50, 23 March 2008 (UTC)

My reasoning (only partially explained in that edit summary) was that many mistakenly believe that mixers are somehow less believers in Vertebral Subluxations than straights. That's not necessarily true. It's a matter of definitions, and the basic difference lies in their names. "Straights" only use adjustments, while "mixers" use more, while still believing in VS. Yet it is from mixers that you will also find reformers. In this case the difference lies in their total disbelief in VS. There is simply a continuous spectrum from straights, to mixers, to reformers (who are mixers). The two minority groups on each end are defined by their total belief or disbelif in VS.

Their influence is disproportional to their actual numbers. By numbers I am not referring to actual membership in organizations. In this section we aren't dealing with them, but dealing with "schools of thought" which is not dependent on membership in formal organizations, though sympathies are shared. We already use a reference which contains these significant sentences:

• "Since the 1930s, straights have been a very distinct minority in the profession.43 Nonetheless, they have been able to transform their status as purists and heirs of the lineage into influence dramatically out of proportion to their numbers.44"

I would dispute the first sentence, but that's another matter. I wish the influence of the reformers were as great, but they haven't had as much success because straights are nearly totally accepted, while reformers threaten the very foundations of the profession. They have had significant influence through professors and researchers, and especially played the key role in the VA committee, being responsible for getting chiropractic access to VA hospitals for all DCs.

Any statement that implies a total "for or against VS" position, is describing straights or reformers, not the great majority in between. That is the significant difference in the end points of the schools of thought. -- Fyslee / talk 08:14, 23 March 2008 (UTC)

"There is simply a continuous spectrum from straights, to mixers, to reformers (who are mixers). The two minority groups on each end are defined by their total belief or disbelief in VS." Well said. I think the article should make the point that it's more complex than two main groups(or four main groups).CynRN24.4.129.58 (talk) 06:23, 26 March 2008 (UTC)

It would be worthy to include the dominant national associations in the US (since oddly there are more than 1) in order of prominence (i.e. membership). I'd also like to add the blurb that Fyslee found about straights having an undue influence despite their numbers so long as the reference is reliable and not a med hit piece article. Even if it was, I know there is a chiropractic paper equivalent which would be better to cite anyways since editors couldn't use the argument that it was "planted" there by mainstream advocates. Mixer, as the dominant mainstream POV in global chiropractic (even in the US too) needs more attention, weight and prominence. We can drop the reform bit by mentioning that mixers have moved towards evidence-based practices and favour certain reforms in both educational, professional and regulatory processes to increase it's cultural legitimacy. I believe the article by Keating, Grod et al. touches on this subject and we can cite it. CorticoSpinal (talk)

Comments on 2nd proposed revision to "Practice styles"

Here are some comments on the 2nd proposed revision:

• It removes a "Fact" tag after "In contrast to straight chiropractors, mixers generally want to be integrated into mainstream health care via integrative medicine." without supplying a citation in its place. If that claim is present, it should be sourced; the fact tag shouldn't simply be removed.

• It adds the sentence "There are two main groups as well as minor splinter groups." and cites History-PPC (). But History-PPC does not support the claim that the two splinter groups currently exist; on the contrary, it only offhand mentions straights and mixers, and doesn't mention any splinter groups.

• It proposes several minor changes to Chiropractic #Scope of practice which I assume are no longer intended, as that section has evolved.

• The new "Minority" section starts off by citing History-PPC again, which (again) doesn't support the claim.

• The new "Minority" section is written in a confusing combination of present and past tense. It needs to tell a coherent story that is supported by citations.

• Many of the sources for the new "Minority" section are low quality and are not needed. They can be removed:

• is a polemic that says things like "Many mixers have brain damage."
• is about referrals, and is irrelevant here.
• is a random website and is not a reliable source; it looks like it was derived from an old version of Wikipedia.
• is less reliable than and doesn't say anything useful than the more-reliable source says. One source for the NACM is enough.

• More generally, the "Minority" section doesn't present the big picture, which is that chiropractic has always been riven by internal disputes, and that simplifying it to "straight" versus "mixer" is a bit like simplifying the history of American politics to "Republicans" versus "Democrats". There are always subgroups with their own agendas, the two examples given are just recent examples of this, and it's missing the bigger picture to mention only those two examples. Eubulides (talk) 06:27, 24 March 2008 (UTC)

Agreed. The less reliable sources should be removed and we need to see the bigger picture and edit. QuackGuru (talk) 23:48, 24 March 2008 (UTC)

Perhaps "How chiropractors think and practice" from 2003 by McDonald can be used to explain how eclectic chiropractors are in practice....not stereotypically 'straight' or 'mixer' Dr. McDonald says,"Chiropractors, as a whole, strongly endorse two things: the subluxation and its somatovisceral implications, and the use of numerous conservative treatments. While the subluxation is championed by the focused-scope camp (straight) and the spectrum of services is championed by the broad-scope practitioners(mixer), the typical chiropractor is eclectic. This type of contemporary practitioner values the adjustment, yet sees no contradiction in working to gain hospital privileges." This reference is used already, #32?, just the abstract is shown, though. There is a lot more info in this survey on what chiropractors do or think is appropriate to do in practice. CynRN24.4.129.58 (talk) 02:19, 26 March 2008 (UTC)

• Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. PMID 9818801. This ref () verifies that fact that "mixers believe subluxation is one of the many causes of disease." QuackGuru (talk) 00:08, 12 April 2008 (UTC)

Section order

The Scope of practice section should be after the Schools of thought and practice styles section. Someone changed the place where it was in the article. QuackGuru (talk) 00:30, 23 March 2008 (UTC)

There's a lot not to like about the section order in the article. But why should scope of practice come after practice styles? Typically, scope of practice comes early, and even first, no? See, for example, Nurse practitioner, Primary care physician, Kinesiology, Optometry, and Speech therapy. There are counterexamples, but it seems to me that scope of practice delineates a practice's boundaries, and should come quite early in an article about a profession, just as Classification should be the first section for an article about a disease. Eubulides (talk) 01:30, 23 March 2008 (UTC)

I have restored the Scope of practice to its original location after the Schools of thought. QuackGuru (talk) 05:04, 24 March 2008 (UTC)

Massive edits against consensus

II reverted Quackguru's massive controversial edits against consensus. . . there are two main groups of chiropractors. . . the other two are off-shoots. . . his version includes poor references as well.TheDoctorIsIn (talk) 08:05, 14 March 2008 (UTC)

Hello. I am interested in getting to the root of the matter here. It seems to me that the main difference between your and Quackguru's edits is the statement about the minority still using dubious methods[21]. From what I understand of science, it is not just about devices and techniques, but theory also. So what we really need to discuss is about chiropractic theory (which is always the basis) and the minority. I don't know minorities from majorities myself, but it would be constructive to get some sort of consensus on what science considers about chiropractic theory. Please don't refer me back to past discussions as this point is definitely something that needs clarification now. Delvin Kelvin (talk) 08:25, 14 March 2008 (UTC)

Part of the discussion is also about changes to the lead. Please see Talk:Chiropractic/Archive 16 #Lead for details. That section also talks about sources for the claims about objective straights and reform chiropractors; so far the evidence is fairly weak that these groups still exist as viable groups, which suggest sthat discussion of these groups should be moved to Chiropractic #History, and be made briefer. Eubulides (talk) 19:19, 14 March 2008 (UTC)

I agree with Eubulides assessment here. No matter how we try to accomodate QuackGurus wording, it just is not supportable by the sources. ---- Dēmatt (chat) 05:48, 15 March 2008 (UTC)

You haven't handled the question at all. What does the scientific community think of the main chiropractic theory? Also, you state that the evidence is weak. Which evidence? I don't think its a matter of accommodation any particular editor's wording. Its a question of answering simple questions that the reader will have in mind. Delvin Kelvin (talk) 01:08, 17 March 2008 (UTC)

There is no "main" chiropractic theory. There is a chiropractic philosophy though which approaches care in a different manner than allopathic medicine. You're also misunderstanding the evidence remark; it was made with respect to the off shoot chiropractic groups, the reformers and the objective straights. EBDCM (talk) 01:14, 17 March 2008 (UTC)

I think part of the problem is that the Wikilink to Talk:Chiropractic/Archive 16 #Lead was broken; I fixed that in my comment above. I agree that there should be a brief summary of the scientific criticism of subluxation; currently that is missing. However, this thread is about a different topic, namely the importance/existence of the reform and objective-straight splinter groups. Eubulides (talk) 01:20, 17 March 2008 (UTC)

I reverted massive edits.[22] We need to talk this over. QuackGuru (talk) 00:30, 20 March 2008 (UTC)

The substantial and massive changes without consensus to the article has continued.[23] QuackGuru (talk) 01:27, 20 March 2008 (UTC)

I agree with this edit anyhow.[24] QuackGuru (talk) 01:30, 20 March 2008 (UTC)

I also concur with this edit.[25] QuackGuru (talk) 01:52, 20 March 2008 (UTC)

I agree with all edits made that was supported by newtral references. Education is taken directly from world health chiro education guidelines, may need proper citation? —Preceding unsigned comment added by 64.25.184.27 (talk) 01:57, 20 March 2008 (UTC)

I agree with this NPOV edit.[26] QuackGuru (talk) 02:45, 20 March 2008 (UTC)

I concur with this edit.[27] QuackGuru (talk) 02:48, 20 March 2008 (UTC)

I made a revert to the article rich with battle wounds from the recent edit war. . . the version I reverted to was the last stable version.TheDoctorIsIn (talk) 03:03, 20 March 2008 (UTC)

WTF is going on around here? It's like the chiropractic twilight zone! An anonymous user makes perfectly valid points yet somehow gets away with 10 reverts defending him/herself against 3-4 editors who themselves go well beyond 3RR. Quack, you agreed with the edits and now you change your 2 seconds later? What exactly do you object to, all my edits were done in sections (look at the history) used chiropractic texts and WHO Chiropractic guidelines as a source. I'm confused as to why this is such a big debate; these are facts that have no editorializing whatsoever. Also, I'd like to know why are how Arthur Rubin, OrangeMarlin (who anon makes a very good case against here Quack Guru, Red Rocket all blantantly cite vandalism when it obviously wasn't. I'm not trying to start a conspiracy theory or anything, but I hadn't even heard of all these users let them all come here at once and try to disrupt the perfectly good edits I made earlier this evening. EBDCM (talk) 03:13, 20 March 2008 (UTC)

This edit was made without consensus.[28] QuackGuru (talk) 04:06, 20 March 2008 (UTC)

Prevent subsequent deterioration

I was just rereading the article and came across:"The objective is early identification of mechanical dysfunctions to prevent subsequent deterioration which would result in permanent pathological changes.[24]" in the last paragraph of the philosophy section. Is there any evidence that "subsequent deterioration" can be affected by chiropractic treatment? The reference only gives me the name of the textbook. Is there an accessable ref. for this assertion?CynRNCynRN (talk) 01:49, 15 March 2008 (UTC)

That textbook is not online and is hard to find nowadays. It's better to use a citation that's online. I made this change to cite Vear (readable on Google Books) instead of Strang. This change also rewords for brevity and makes the additional point that prophylaxis is intended to delay (as well as prevent) permanent damage. Eubulides (talk) 04:02, 15 March 2008 (UTC)

Thanks, I'll see if I can look it up in Vear.CynRNCynRN (talk) 16:25, 15 March 2008 (UTC)

Safety again

I started just doing some minor copyediting, but when I got to the Safety section I noticed we had said some things two times and then the order seemed backwards. I ended up making a lot of changes, but I don't think it has changed the meaning, other than being more succinct. I'll put the new one here along with Safety 3. Hopefully it still works for everybody.

Chiropractic care in general, and chiropractic manipulation in particular, are safe when employed skilfully and appropriately. As with all treatments, complications can arise and there are known contraindications and risks.

Spinal manipulation is statistically associated with minor side effects. These include frequent, mild and temporary new or worsening pain in the head, neck, arm or upper back; and stiffness of the neck, shoulder or arm. They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours. Rarely, upper cervical (neck) manipulation can also result in complications that can lead to permanent disability or death; these can occur in adults and children. The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects. Vertebrobasilar artery stroke, the most commonly reported serious complication, is associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.

Absolute contraindications to any form of manipulation (conditions that should not be manipulated) include conditions that are known to result in unstable joints, such as rheumatoid arthritis. Relative complications mean the increased risk is acceptable under some conditions, such as osteoporosis. Although most contraindications apply only to manipulation of the affected region, some neurological signs such as unilateral facial paresthesia, objective cerebellar signs, lateral medullary signs, and visual field defects are indications for emergency referral.

---

Chiropractic care in general, and chiropractic manipulation in particular, are safe when employed skilfully and appropriately. As with all treatments, complications can arise and there are known contraindications and risks.

Absolute contraindications, such as rheumatoid arthritis, prohibit employing manipulation. Relative complications, such as osteoporosis, mean the increased risk is acceptable under some conditions. Although most contraindications apply only to manipulation of the affected region, a few emergency conditions, such as visual field defects, absolutely contraindicate all chiropractic treatment.

Risks can reasonably be considered slight when compared to all forms of medical treatment. Spinal manipulation is statistically associated with frequent, mild and temporary adverse effects; they have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours. The most common minor side effects reported in a 2007 study of cervical spine manipulation were new or worsening pain in the head, neck, arm or upper back; and stiffness of the neck, shoulder or arm. Spinal manipulation, particularly on the upper spine, can also result in rare complications that can lead to permanent disability or death; these can occur in adults and children. The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects. Vertebrobasilar artery stroke, the most commonly reported serious complication, is associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.

-- Dēmatt (chat) 05:49, 15 March 2008 (UTC)

I have a problem with the first sentence, though, and for the life of me I can't figure out a better way to say it:

• Chiropractic care in general, and chiropractic manipulation in particular, are safe when employed skilfully and appropriately.

This tends to make me feel that chiropractic manipulation is safer that chiropractic care? ---- Dēmatt (chat) 06:01, 15 March 2008 (UTC)

BTW, Eubulides, I think your changes were warranted. ---- Dēmatt (chat) 06:01, 15 March 2008 (UTC)

Thanks, I made a few more changes to the contraindication paragraph. It's still too abstruse (how many ordinary readers are going to know what "objective cerebellar signs" are, even with the wikilink?) but it's better than before. Eubulides (talk) 07:15, 15 March 2008 (UTC)

Great job rewording the Safety section. It reads much easier now and is nice and short. No easy task. I suggest making the first sentence "Chiropractic care is (considered)safe when employed skillfully and appropriately". The next paragraph goes on to talk about manipulation, so no need to say it in the first sentence. Then it's not implying that manipulation is "especially safe". CynRNCynRN (talk) 06:36, 15 March 2008 (UTC)

Thanks! And perfect solution to my dilemma! -- Dēmatt (chat) 15:28, 15 March 2008 (UTC)

Good suggestion, particularly since the source says "chiropractic care is safe" without the confusing addition. I made the suggested change. Eubulides (talk) 06:45, 15 March 2008 (UTC)

I ended up making one more change to try and differentiate that spinal manipuation is only one part of chiropractic care as the source tries to point out.

• Chiropractic care in general is safe when employed skillfully and appropriately. There are known side effects, risks and contraindications for it's primary treatment modality, spinal manipulation.

I also switched back the defintion of Absolute contraindications in front of RA, etc. I just think it is better to define the term first then give examples. -- Dēmatt (chat) 16:31, 15 March 2008 (UTC)

Thanks. I made a few more changes which I hope are improvements. I didn't see why Thiel et al. 2007 needed to be cited twice in the same sentence. The contraindications wording confused me; I tried to fix the confusion while preserving the order you preferred. It bugs me a bit to call adverse effects "side effects" (not all side effects are adverse) but I guess it's common enough usage that it's OK. Eubulides (talk) 00:33, 16 March 2008 (UTC)

Looks good, though I took out disc herniations. A little more complicated than that I'm afraid.

(not all side effects are adverse) Exactly. Most of those 'adverse effects' are soreness that you would expect after an hour of exercise. I don't think physical therapists consider those adverse effects either.

---- Dēmatt (chat) 02:54, 17 March 2008 (UTC)

But the cited sources all say "adverse effects" whereas Chiropractic #Safety says "side effects". Shouldn't the article respect its sources here? Why substitute a different term, which means something different? Eubulides (talk) 06:20, 17 March 2008 (UTC)

Is it too awkward to say 'adverse effects or side effects'? Some of the described side effects sound adverse to me...CynRNCynRN (talk) 18:33, 17 March 2008 (UTC)

All adverse effects are side effects, so saying 'adverse effects or side effects' would be a bit like saying 'mammals or animals', which would be even more confusing. The reverse is not true: some side effects are beneficial. The sources talk only about adverse effects, and it's not clear why the article should use the broader term. Eubulides (talk) 18:46, 17 March 2008 (UTC)

Yeah, oops. "Side effect, some of which may be considered adverse...."CynRNCynRN (talk) 07:33, 19 March 2008 (UTC)

The summary

A user has altered my edit to the summary. He wants to say chiros only treat muscular stuff. But the article says that Straights say subluxation is a "primary underlying risk factor for almost any disease" and mixers "treat non-neuromusculoskeletal conditions". Who is right? Me or that other user?

Your edit to the lead put words in that was not attributed to the source. Also, given the fact that this article is under probation and was recently locked; major edits, especially to the lead need to be discussed. Also, you are mis-representing my words, I never said that DCs only treat MSK "stuff" but rather PRIMARILY treat neuromusculoskeletal disorders. 85-95% in fact. It seems that there is potentially some confusion with anonymous and his/her understanding of the topic at hand. EBDCM (talk) 01:33, 16 March 2008 (UTC)

This article was under probation. Someone removed the probation tag. QuackGuru (talk) 01:38, 16 March 2008 (UTC)

The article says Straights say subluxation is "primary underlying risk factor for almost any disease" and Mixers "treat non-neuromusculoskeletal conditions". So what's wrong with saying chiropractic treats human diseases in the summary? —Preceding unsigned comment added by 125.168.45.230 (talk) 03:07, 16 March 2008 (UTC)

The Lead will be undergoing reconstruction and rewording after the rest of the article has been rehashed anyway, so you may as well just leave it be. I don't think it belongs in the lead per se. 202.161.71.161 (talk) 10:08, 16 March 2008 (UTC)

So you are saying I'm right but leave it till later? That doesn't make sense to me. If it's right it can go in now? 125.168.45.230 (talk) —Preceding comment was added at 13:51, 16 March 2008 (UTC)

The section practice styles section needs proper referencing (including the "primarily risk factor for any disease bit". I don't think straights are suggesting that much, the one cause one cure mentality isn't that bad. Perhaps Dematt can shed some light on that issue. Also, I don't see any reference, citation, educational curriculum or anything that suggest that "chiropractic treats human diseases". This type of editing uses the bias sample fallacy and a straw man fallacy. EBDCM (talk) 18:40, 16 March 2008 (UTC)

I don't think straights use the word 'treat' for anything, do they? They adjust subluxations, period. I think back then they would have been jailed if they said they 'treated' anything. But I agree we would need something that references a statement like that. -- Dēmatt (chat) 03:01, 17 March 2008 (UTC)

"Contemporary"

The word "Contemporary" is used twice in Chiropractic#Philosophy, but both times the word is redundant and should be removed. None of the points made are unique to today's chiropractic belief systems; they belong to historical ones as well. Mootz & Phillips goes out of its way to say "Traditional and contemporary chiropractic philosophies both display the dualism of testable principle (materialism) and untestable metaphor (holism)." so it's odd that Chiropractic#Philosophy emphasizes "contemporary" here, with the implication that traditional chiropractic does not have the same dualism. Let's remove the two uses of "Contemporary" in Chiropractic #Philosophy. If there is a need to distinguish contemporary from traditional, it should follow that of the cited source. Eubulides (talk) 01:13, 17 March 2008 (UTC)

Why do you want to squash a word that has vital importance in that it reflects the maturation of the profession? Traditionalists/Straights/Palmerists/Subluxation-based/Principled-based chiropractors are not contemporary chiropractors if they did not attend a progressive school and adopt the contemporary viewpoint (primarily NMS specialists). Mootz and Phillips use this word deliberately. So do departments of chiropractic education (http://www.cmcc.ca/undergrad/Dept_Prof_Ed/Chiropractic_Principles_and_Practice.htm). Contemporary is also used to describe the medical approach to acupuncture which is described in western biomedical terminology (neuroanatomy, neuroscience, anatomy, physiology, etc...) http://fhs.mcmaster.ca/anaesthesia/acupuncturecourses/#who. There is already too much weight given on the minority straight DCs and their views and not enough mention of the contemporary aka reform/evidence-based/mixer view. It's equally as influential as has assumed a defacto leadership role in setting standards of practice guidelines, is geting its research published in mainstream medical journals, chiropractic journals are now beginning to be indexed on mainstream med sites (PubMed) etc. This isn't even counting the ever growing body of chiropractic literature found here http://www.chiroindex.org/. We need to be very, very careful that we do not omit quality chiropractic research that is not indexed in mainstream med. search engines. Chiropractic and Allopathic medicine are separate professions with separate philosophies and separate approaches and separate emphases. My concern again, as stated many times now and that has support of many regular editors here is that there seems to be a push for playing up controversies (i.e. vaccination and safety) and making undue weight for these while small, yet important words that reflect profound paradigms seem to get the boot. EBDCM (talk) 01:54, 17 March 2008 (UTC)

Our problem here is not that there is a medical POV and a chiropractic POV. There is a traditional straight chiropractic POV and a modern/reform/contemporary chiropractic POV that since the 1950s has worked to divorce itself from protectionist vitalistic constructs of straight chiropractic - a construct that was created by BJ Palmer to keep the profession out of the hands of the 'Medical Machine'. BJ died in 1963 and the 'Committee on Quackery' about the same time. Chiropractic made significant changes in the decades since and medicine has had bigger problems than chiropractic. Unfortunately, they also haven't kept up with the changes. EBDCM is a fresh contemporary chiropractor and has no idea why Eubulides keeps combining traditional and contemporary concepts into one, because his concept of chiropractic is totally different. It is the same comparison as traditional medicine - that may use modalities that have no basis in science and scientific medicine - to call a scientific physician a traditional physician would be 'fighting words', while a traditional physician might be flattered to be called scientific. I think it would behoove us to keep that in mind.

The way the article was written before both of you began here was an attempt to present chiropractic as a single entity - only presenting beliefs the two POVS had in common. The reality is that both POVs exist and they are diametrically opposed to each other. So we are slowly changing the article to improve it. We will now need to elucidate the differences as well as the similarities between the two POVs. If we write our article correctly, we inform the public of both POVs without denigrating either. For this reason, it might be better to use the word contemporary when comparing to traditional - and it is reasonable to use the words as we compare the things that make them different and the things that they have in common. It is quite probable that the new jargon will be 'contemporary' as the reform movement tries to divorce itself from the NACM.

-- Dēmatt (chat) 02:36, 17 March 2008 (UTC)

Dematt and EBDCM make some good points. The problem I have is that the sources disagree with them. So, for example, Mootz & Phillips (1997) write:

Traditional and contemporary chiropractic philosophies both display the dualism of testable principle (materialism) and untestable metaphor (holism).

whereas Chiropractic#Philosophy says:

Contemporary chiropractic belief systems vary along a philosophical spectrum ranging from vitalism to materialism

Not only is that "Contemporary" not needed, it's implying that traditional chiropractic is simplistic and not dualistic; this is not supported by the source. Similarly, the second "contemporary" is not supported either.

There's more to this than simply matching the source, though. "Contemporary" is classic newism: it appeals to the assumption that newer is better, which has a whiff of POVism. (Those contemporary chiropractors must be so much better than those old-fashioned chiropractors—that sort of thing.) And part of my worry is that by using advertising words like "contemporary" when they're not needed or even apropos, Chiropractic sounds too much like an advertisement, thus hurting its credibility. Eubulides (talk) 06:38, 17 March 2008 (UTC)

I wouldn't suggest that contemporary is better, it's just a different approach or interpretation, that's all. I don't claim that practicing contemporary chiropractic and contemporary acupuncture is any better than traditional chiropractic and acupuncture although I'm sure it's much more palatable to the scientific and mainstream med communities because the language that describes it's purported effects are based on Western scientific principles and terminology. I disagree that it's an advertisement, but it is a fact that there is shift occuring not only in the US but globally as well. Most of all DC programs outside the US are in universities and offer at least a BSc in chiropractic. They're teaching a contemporary view of chiropractic (aka scientific as opposed to metaphysical, integrated/mixer rather than straight). I don't think the article's credibility is in jeopardy by adding these words but it's credibility is affected by leaving them out and not recognizing this paradigm. EBDCM (talk) 16:11, 17 March 2008 (UTC)

Contemporary feels like 'new and improved' and it's vague... Maybe scientific or evidence-based would be a more accurate descriptive term. What professional would not think that he or she is 'contemporary'?CynRNCynRN (talk) 17:40, 17 March 2008 (UTC)

It's unfortunate that I have to "convince" and "sway" our fellow mainstream editors regarding the word contemporary. It's a synonym for "modern" is a perfectly acceptable contrast and word to the word "traditional" which has been used interchangeably with "straight" chiropractic approaches. If scientific or evidence-based is a consensus preferred term I can go along with it; but know that the term contemporary is being increasingly used by both practicing chiropractors and some articles to describe the modern chiropractic approach that is not subluxation based and is on consistent with EBM principles. EBDCM (talk) 21:40, 17 March 2008 (UTC)

It's not a question of which word is being used to describe modern. It's a question of whether it's appropriate to use "contemporary" to describe a dualism that has been present in chiropractic from the beginning. The source (Mootz & Phillips) says traditional and modern chiropractic philosophies both display this dualism. So why does Chiropractic #Philosophy say only that contemporary philosophy has it? Eubulides (talk) 22:54, 17 March 2008 (UTC)

You're right. What the bigger issue is, should we and can we use the word contemporary to describe the evidence-based approach elsewhere in the article to contrast it with the traditional approach? EBDCM (talk) 00:32, 19 March 2008 (UTC)

"Evidence-based" is much better than "contemporary": it's more specific and it is more commonly used to describe the approach. Let's use "evidence-based". Eubulides (talk) 10:12, 19 March 2008 (UTC)

"Contemporary" is POVish. We can do better than that. QuackGuru (talk) 19:28, 19 March 2008 (UTC)

I find it bizarre to the opposition to the word contemporary. It's no more POVish than the word traditional, quack guru. We'll keep evidence based for now until we hear what the rest of the regular brigade says. EBDCM (talk) 23:36, 19 March 2008 (UTC)

(undent). I see no issue with using either the word contempoary or evidence-based. DigitalC (talk) 06:47, 20 March 2008 (UTC)

Readable encyclopedic writing

This article needs to be made more understandable to the average reader. Its pretty clear from the links and archives that I have been directed to that there are differences of view between chiropractic theory and practice. The science says that spinal manipulation can be one way of reducing back pain, with a few risks included (as with any internal intervention). Science says that any other use of chiropractic is considered to be what? Dangerous? Pseudoscience? Unethical? Wrong headed?

Clearly chiropractic has some sort of benefit according to science. But as with all science views they use limitations, delineations and they are critical. Please lets have that information presented so it is clear for the reader, both in the lead and in the main body of the article. Delvin Kelvin (talk) 05:01, 17 March 2008 (UTC)

Yes, the terminology is very dense. Can you point out some specific parts that need clarifying? New eyes can be helpful.CynRNCynRN (talk) 06:38, 17 March 2008 (UTC)

I agree with Delvin Kelvin's criticism. Chiropractic is very weak on answering these obvious questions on the subject. Fixing the problem will be tricky, though, as the area is quite controversial. Concrete wording suggestions are welcome. In the meantime you can consult the sources listed in #Sources for effectiveness and #Sources for risk-benefit and cost-effectiveness. Eubulides (talk) 06:44, 17 March 2008 (UTC)

Disagree on a few fronts. First, chirorpractic is not a modality, it's a profession. Next, the CCGPP answers all the scientific questions posed by Delvin Kelvin; we just have to present the findings of the lit review in clear, understandable terms. Otherwise, if it was up to a few editors here the entire article would be a critical condemnation of chiropractic which is mostly directed towards the minority of the professionals most of whom are in the US. The writing in most of the article is pretty easy to understand and the science section is the last one that has not been touched yet for a rewrite. As for your insinuations what science says about chiropractic, we should let the experts on chiropractic (DC/PhDs) care, epidemiology, safety, efficacy have their say. Othewise we our mainstream med editors here will always cite mainstream med "take" on chiropractic which has a pretty big lack of understanding on the modern day chiropractic which was also alluded to by Dematt. EBDCM (talk) 15:52, 17 March 2008 (UTC)

I agree with most of this, except for the implication that the section should be rewritten based on one source or on side's view of the evidence. Mainstream opinion should also be cited and should be given due weight. Eubulides (talk) 18:07, 17 March 2008 (UTC)

Weight is always a sensitive issue around here... just as long as the same standard is applied and enforced over at the medicine article, say if we wanted to present the chiropractic or CAM viewpoint on medical science... EBDCM (talk) 22:24, 17 March 2008 (UTC)

OK, good start. Science gets priority then. I don't see anyone disagreeing with my own recent discovery that chiropractic back manipulations are one scientifically supported method of reducing back pain (with specific science based medical reservations as always). So then we need the science oriented view on all the other applications of chiropractic (some sort of categorized list (or just categories) that have not been supported by science. That will cover the main science findings. Written nice and clear, the reader will be able to get to the core of chiropractic.

Chiropractors/groups themselves are another story, and a complex sociological one by the looks of it. I think we can possibly contain all argument within their own section.

So we know chiropractic has some effectiveness regarding some forms of back pain. What are the main categories of other treatments that they have shown no effect for? I guess a handful of categories would be sufficient. Delvin Kelvin (talk) 06:33, 18 March 2008 (UTC)

See #Specific conditions for some sources and categories. No one has yet had the time to write this section up for Wikipedia; there's rather a lot to read. Eubulides (talk) 06:57, 18 March 2008 (UTC)

Thanks Eubulides, thats helpful. Something more along the lines of a review of research may be more useful than detailed studies though. I think thats the encyclopedic preference. Are there any independent papers that are general reviews? Delvin Kelvin (talk) 07:10, 18 March 2008 (UTC)

#Efficacy in general cites a critical review that has an "Efficacy" section. We don't currently have any cites to a similarly-short overview on the pro-chiropractic side. Eubulides (talk) 07:19, 18 March 2008 (UTC)

Thanks Eubulides. That seems to be a well published science oriented view.

In response to the above request for some ideas on readability; one problem with the article is its main intro to the reader - the lead section. Specifically, the lead section is seems to be more about chiropractors and not enough about chiropractic. This article is supposed to be about chiropractic, and not only chiropractors do chiropractic. Basically in the intro it would make it a lot easier to understand what the subject is if it gave some more condensed information about chiropractic. So as before, if the science results are given a bit more airing there it would help. I am sure this would be acceptable to any pro editors here as the results basically show that there is a positive result for lower back pain. Equally, the science results are scientific and naturally will be critical, as they are of all subjects they investigate. So criticism can be made clearer there also.

Any information on chiropractors and their behaviour should be given a seperate smaller para in the lead. That would help reduce argument there. Of course it can be given larger airing in a large section in the article main body if need be. I'll take a deeper look throughout the article. Delvin Kelvin (talk) 07:49, 19 March 2008 (UTC)

Only chiropractors perform chiropractic by definition, and by law. Other qualified practitioners can provide spinal manipulation, one treatment technique used by chiropractors, however they cannot claim to "do chiropractic". DigitalC (talk) 06:33, 20 March 2008 (UTC)

Good point. EBDCM (talk) 06:39, 20 March 2008 (UTC)

I can do a Chiropractic procedure for a specific purpose if I follow the instructions given on a Chiropractic course even though I am not a chiropractor. That is Chiropractic and that is what the reader wants to know. The article would benefit a huge amount if the reader could be shown nice and clear what is generally involved, and for what purposes. Otherwise, we could have a straightforward definition; Chiropractic = being a DC.

The article gives some notion that twisting the spine can do some specific set of things according to chiropractic manuals. So what are those things that Chiropractic is supposed to do according to the manuals? The reader could seriously do with some sort of brief or organized list, and a similar sentence in the lead. Delvin Kelvin (talk) 03:54, 25 March 2008 (UTC)

You cannot do a Chiropractic procedure if you are not a Chiropractor, as it would therefore not be a Chiropractic procedure. Lets take 2 treatments that Chiropractors use, such as Spinal Manipulation Therapy and Therapeutic Ultrasound. A Physical Therapist or Medical Doctor could (depending on local regulations) use these same treatments. They would not be performing chiropractic procedures. 202.161.71.161 (talk) 04:14, 29 March 2008 (UTC)

(Undent) This doesn't make sense. Let's say that giving someone a drink of water was a common chiropractic procedure. So the chiropractor fills a glass with water and hands it to the client. You're saying that if someone else fills the same kind of glass with the same kind of water, and hands it to the client in the same way, that it's suddenly not the same procedure? Or do you interpret "chiropractic procedure" as meaning "any procedure, so long as it's done by a chiropractor"? Using that logic, "American procedure" means "any procedure performed by a person from America. I do not think that the average reader will understand these phrases that way. WhatamIdoing (talk) 17:44, 29 March 2008 (UTC)

It may be confusing, but one thing is certain - the chiropractic spinal adjustment is uniquely chiropractic, as it is not totally identical to spinal manipulation. -- Fyslee / talk 05:24, 30 March 2008 (UTC)

Can you explain the differences in this article? I would think that substantive differences (assuming that any exist, for any given type of technique) would be of particular interest to readers. A summary of how it's different from Osteopathic manipulative medicine is also in order, I think. WhatamIdoing (talk) 06:07, 30 March 2008 (UTC)

The difference has to do with intentions, and thus is a philosophical and metaphysical question: "Ironically since 1895 the only concept that all chiropractors agree on is the need to adjust the spine."[29] Read the spinal adjustment article. To get the "pure" explanation, visit the ICA website and read about "subluxation correction". Here is one of their press releases. This ultra-straight message about what is sometimes termed the "Silent killer" nearly closed the door for chiropractic at the VA, but the NACM presented a more scientific version of chiropractic, which was the deciding factor and caused the committee to give DCs access to VA hospitals. If you read the links in this comment of mine, you will understand this matter much better. BTW, I don't think such details are suited for this article. -- Fyslee / talk 06:59, 30 March 2008 (UTC)

TL;DR - but I would disagree with you on that there is necessarily a difference in intentions. What about PT DC - what would their intentions be? In some jurisdictions, nurse practicioners or pharmacists can prescribe pharmaceuticals. They are not practicing medicine. Chiropractic is what is done by chiropractors. —Preceding unsigned comment added by DigitalC (talk • contribs) 05:31, 31 March 2008 (UTC)

I'm not sure what TL;DR means. The chiropractic intention is the correction of vertebral subluxations, something which is not believed or intended by others than chiropractors. PTs, DOs, and MDs who manipulate, do it for other reasons. -- Fyslee / talk 05:52, 31 March 2008 (UTC)

This is where wikipedia breaks down. Yes, that is probably verifiable, but completely false. For example, EBDCM who does not consider himself a reform chiropractor, would likely disagree with you on that statement. Reform chiropractors would definitely disagree with you on that point. Further demonstrating that point, according to the article, reform chiropractors don't exist, only straights and mixers.DigitalC (talk) 06:49, 1 April 2008 (UTC)

??? I think we're talking "past" each other, IOW not understanding each other. Let's leave EBDCM out of this. I know many reform chiros (including members of the NACM), and they would definitely agree with me about the "intentions" difference. There exist plenty of "reform" chiros, it just depends on how you define them. I am defining them loosely based on their disbelief in vertebral subluxations, not on any memberships or other things. -- Fyslee / talk 14:26, 1 April 2008 (UTC)

My point is that you are saying only reform chiropractors disbelieve subluxations. However, that is not the truth, in that many mixers do as well. DigitalC (talk) 22:14, 1 April 2008 (UTC)

Well, all reformers are mixers, but not all mixers are reformers, and no straights are reformers. Disbelief in subluxations is not the defining difference between straights and mixers, since most mixers still believe in them, but it is the defining difference between reformers and all others. It is so fundamental and radical a departure from original and fundamental chiropractic beliefs that straights often state that any chiropractor who doesn't believe in subluxations is not a real chiropractor. In fact, since correction of subluxations is the legal basis for the profession in the USA (incorporated into Medicare reimbursement rules in 1972), it is still what defines the profession. It is the only truly unique thing about chiropractic. The Department of Health and Human Services specifies chiropractic reimbursement for this service:

• “manipulation of the spine to correct a subluxation”.

I hope that makes things more clear. Reformers are attacking the very foundation of the profession. Now if you are defining reformers in other terms, then you're the first one I've ever seen attempting to do so. -- Fyslee / talk 05:21, 2 April 2008 (UTC)

Following the anaology about the American procedure, can a Canadian follow the American Dream?DigitalC (talk) 05:34, 31 March 2008 (UTC)

OK thats all fine. Put simply though, Chiropractic treatments should be described concisely and simply for the reader, and the expected recoveries/expected improvements should also be listed nice and clear according to the various significant chiropractic sources. That will be the most useful thing to do in the lead and main body to help make this article at least halfway readable. Delvin Kelvin (talk) 07:29, 1 April 2008 (UTC)

Subluxation debate

In going through the #2008-03-12 issues list, I found a problem in Chiropractic#Vertebral subluxation. It says "certain chiropractic schools still teaching the straight/traditional metaphysical model of subluxation while others have moved towards a contemporary scientific and evidence-based model emphasizing the relationship of structure and function on health" and cites the CMCC 2006–07 course catalog. But this catalog does not say some schools teach straight and others have moved towards evidence-based; it merely says that CMCC's 2006–07 catalog is more evidence-based than before. That's just one college, and it says nothing about straight colleges.

I looked for a better source on the subluxation debate, and found the following:

Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13: 17. doi:10.1186/1746-1340-13-17.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)

I propose that the paragraph cite this source instead of a course catalog, and that the contents be modified to reflect this source more accurately. As a side effect, this will fix the POV problem that got me looking at this paragraph in the first place. Eubulides (talk) 06:52, 18 March 2008 (UTC)

After I asked for a citation on the college, the request for a citation was reverted with the change log "it's in there". However, the citation does not support the claim that "others have moved" towards an evidence-based curriculum. All it supports is the claim that one college moved. To work around the problem temporarily, I made this change to insert a sentence that corresponded more closely to what the source actually says, and to request a source for the other part of the paragraph. Keating et al. 2005 looks like a good source but has to be checked against the Wikipedia text. Eubulides (talk) 21:49, 18 March 2008 (UTC)

Following up on my own suggestion, I added the citation suggested above and modified the text somewhat to match the citation better.

We should use Chiropractic Theories as the scientific source to investigate the chiropractic theories, including those on subluxation. EBDCM (talk) 00:34, 19 March 2008 (UTC)

[30] I disagree with this edit. A lot of the cited text was deleted, it introduced vagueness and lost the meaning of the text, and one of the refs seems to be improperly formatted now.[31] It was confusing for me. There is a big difference between clarity and brevity. QuackGuru (talk) 01:20, 19 March 2008 (UTC)

[32] This edit was not an improvement. The controversial edit deleted cited text. QuackGuru (talk) 03:04, 19 March 2008 (UTC)

[33] I agree with this edit. QuackGuru (talk) 03:07, 19 March 2008 (UTC)

[34] I disagree with this edit. Cited text got deleted again. QuackGuru (talk) 03:15, 19 March 2008 (UTC)

I restored the omitted 2005 WHO definition. I don't actually mind the other edits, it actually nicely illustrates the 2 main viewpoints in the profession and this information is presented in the lead anyways but was not mentioned specifically in the rest of the article. It looks pretty NPOV as well. EBDCM (talk) 05:07, 19 March 2008 (UTC)

I made this edit to restore the cited text that I think is what QuackGuru was referring to; basically, the idea is to briefly explain why subluxation is controversial (otherwise the lengthy summary of who's on what side won't be motivated for the average reader). I also made this edit to more clearly match the text to the citations. Hope this helps. Eubulides (talk) 10:11, 19 March 2008 (UTC)

This helps. The idea is to follow the source carefully and not delete cited text that briefy describes subluxation. QuackGuru (talk) 19:19, 19 March 2008 (UTC)

Hmmm, are you two trying to tag team whis section and hole article so it gives chiropractics a negative slant? The tone written is bad, it makes it sound like some kind of disaproval in many sections here including subluxation, vaccination and especialy safety. I am reading that it is a small risk so why is there so much info? Also, chiropractics does more than adjusting, they do other hands on stuff like muscle work and use physiotherapy machines. —Preceding unsigned comment added by 64.25.184.27 (talk) 01:18, 20 March 2008 (UTC)

The text in question ("The concept of subluxation remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.") is derived from text in a reliable source ("More than twenty years ago Donald K. Moon, D.C. wrote of a 'flight from the subluxation' among chiropractors. Dr. Moon, a firm believer in the validity of the traditional chiropractic lesion, bemoaned the dearth of scientific data to substantiate the construct, and warned of the possibility that medical researchers would step in to fill the void created by chiropractors' indolence. He decried the tendency among many chiropractors to pit diagnosis against spinal analysis (i.e., subluxation-detection), as though the two were mutually exclusive.… Despite these accomplishments, many chiropractors' preeminent theoretical construct remains unsubstantiated, and largely untested" — Keating et al. 2005). Vaccination and safety are controversial in chiropractic, but that doesn't mean the article should skip the subjects; on the contrary. I agree that the list of treatments is woefully inadequate, and improvements to that section would be welcome. Eubulides (talk) 03:46, 20 March 2008 (UTC)

I think you are mischaracterization a lot editors here when you suggest that they want to skip subjects. Rather, proper weight, tone and sectioning is important and currently the vaccination and safety sections have an unbalanced representation of facts (i.e. weight issues) and uses language that is not impartial; but rather critical which is NPOV. Like the DoctorIsIn suggested, it reads like a condemnation. This needs to improve. EBDCM (talk) 03:51, 20 March 2008 (UTC)

I read the vaccination section and it seems to be a very direct statement from sources. I don't see any condemnation coming from editors or editing. I will check the accuracy of the sourced statements though. Delvin Kelvin (talk) 08:20, 20 March 2008 (UTC)

The vaccination section is about as short as it can be and neutrally explain that there is controversy within the profession. Someone coming to wikipedia may have noticed that there is opposition and want to learn about it. Just relying on DC's websites, one would think a lsrge majority oppose vaccination. I cannot see how it is a condemnation!CynRNCynRN (talk) 15:41, 21 March 2008 (UTC)

Merge from "Scientific investigation of chiropractic"

This change was made without discussion. Template:Mergefrom is supposed to be used with a pointer to a section on the talk page that justifies and explains the proposed merge. That wasn't done here, so it's not at all clear what's being proposed. For now, I removed the template; it can be re-added once there's a serious proposal on the table. Eubulides (talk) 21:34, 18 March 2008 (UTC)

Thank-you for this. I was thinking the same. 208.101.89.150 (talk) 22:41, 18 March 2008 (UTC)

Agreeing that it was a disingenuous edit. . . I removed it from the other article as well.TheDoctorIsIn (talk) 01:57, 19 March 2008 (UTC)

However, according to TheDoctorIsIn, Let's get it the fork out of here! QuackGuru (talk) 02:10, 19 March 2008 (UTC)

My personal opinion of the forked article withstanding. . . Quackguru was still doing it wrong.TheDoctorIsIn (talk) 02:18, 19 March 2008 (UTC)

Agreed. I would like to know why Fyslee reverted my edit which removed this. EBDCM (talk) 05:04, 19 March 2008 (UTC)

As long as there is a main article it is normal practice to link to the main article. QuackGuru (talk) 19:14, 19 March 2008 (UTC)

About 40% of the Scientific investigation of chiropractic is duplication. The other around 60% can be condensed for brevity when returned to this article. QuackGuru (talk) 19:22, 28 March 2008 (UTC)

This change merged the contents of Scientific investigation of chiropractic without discussion. The above comments seems lean against such a change. I agree that Chiropractic needs better discussion of scientific evidence, but making controversial changes without real discussion and against the opinion of the other editors involved is not the right way to do it. I suggest drafting a replacement section instead, here on the talk page, before installing it. In the meantime I undid the change. Eubulides (talk) 23:38, 31 March 2008 (UTC)

This change was made with discussion. There was no specific opinion against merging and TheDoctorIsIn supported the merge but disagreed on how I was initially proposing the merge. QuackGuru (talk) 00:47, 1 April 2008 (UTC)

I am not interested in drafting an entirely new replacement section. I want to know if anyone specifically supports or rejects the merge. Or prefers a draft be proposed on the talk page first. QuackGuru (talk) 01:01, 1 April 2008 (UTC)

• That discussion does not propose a specific change. A specific proposal needs to be discussed.
• TheDoctorIsIn's comment is in favor of speedily deleting the other article, but that is not the same thing as favoring a merge.

Eubulides (talk) 01:07, 1 April 2008 (UTC)

I'm not sure on the protocol for this, but after reviewing the material, it seemed highly POV, and I would plead to NOT incorporate it into the main article. If there is something missing from the main article that needs to be added, lets DISCUSS that instead. DigitalC (talk) 06:44, 1 April 2008 (UTC)

Scientific investigation of chiropractic (draft/merge)

There is evidence that spinal manipulation is effective for the treatment of acute low back pain, tension headaches and some musculoskeletal issues, but not all studies support this conclusion. A systematic review of systematic reviews in 2006 by Edzard Ernst and P.H. Canter concluded that no data "demonstrate[s] that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment." In 2007, Ernst performed another review, drawing similar findings which concluded: "Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation." A commentary from a chiropractic and osteopathic journal disputed Ernst and Canter's conclusion as, "..definitely not based on an acceptable quality review of systematic reviews and should be interpreted very critically by the scientific community, clinicians, patients, and health policy makers. Their conclusions are certainly not valid enough to discredit the large body of professionals utilizing spinal manipulation."

One controlled trial showed a lowering of blood pressure in hypertensive patients similar to taking two blood-pressure lowering drugs at once after alignment of the atlas vertebra.

Sociologist Leslie Biggs interviewed 600 Canadian DCs in 1997: while 86% felt that chiropractic methods needed to be validated, 74% did not believe that controlled clinical trials were the best way to evaluate chiropractic. Moreover, 68% believed that "most diseases are caused by spinal malalignment", although only 30% agreed that "subluxation was the cause of many diseases".

Even when a valid mechanism of action is not determined, it is generally thought sufficient to present evidence showing benefit for the claims made. There is wide agreement that, where applicable, an evidence based medicine framework should be used to assess health outcomes, and that systematic reviews with strict protocols are important for objectively evaluating treatments. Where evidence from such reviews is lacking, this does not necessarily mean that the treatment is ineffective, only that the case for a benefit of treatment may not have been rigorously established.

A 2005 editorial in JMPT, "The Cochrane Collaboration: is it relevant for doctors of chiropractic?" proposed that involvement in Cochrane collaboration would be a way for chiropractic to gain greater acceptance within medicine. The collaboration has 11,500 contributors from more than 90 countries organized in 50 review groups. For chiropractic, relevant review groups include the Back Group; the Bone, Joint, and Muscle Trauma Group; the Musculoskeletal Group; and the Neuromuscular Disease Group. The editorial states that, for example, "a chiropractor may provide conservative care supported by a Cochrane review to a patient with carpal tunnel syndrome. If the patient's symptoms become progressive, the doctor may consider referring the patient for surgery using a recent Cochrane review that examined new surgical techniques compared with traditional open surgery..."

The Cochrane Collaboration did not find enough evidence to support or refute the claim that manual therapy (including, but not limited to, chiropractic) is beneficial for asthma. Carpal tunnel syndrome trials have not shown benefit from diuretics, non-steroidal anti-inflammatory drugs, magnets, laser acupuncture, exercise or chiropractic and there is not enough evidence to show the effects of spinal manipulation (including, but not limited to, chiropractic) for painful menstrual periods. Bandolier found limited evidence that spinal manipulative therapy (including, but not limited to, chiropractic) might reduce the frequency and intensity of migraine attacks, but the evidence that spinal manipulation is better than amitriptyline, or adds to the effects of amitriptyline, is insubstantial for the treatment of migraine, although "spinal manipulative therapy might be worth trying for some patients with migraine or tension headaches."

According to Bandolier, a systematic review of a small, poor quality set of trials provided no convincing evidence for long-term benefits of chiropractic interventions for acute or chronic low back pain, despite some positive overall findings but there might be some short-term pain relief, especially in patients with acute pain. However, the BMJ noted in a study on long-term low-back problems "...improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear." A 1994 study by the U.S. Agency for Health Care Policy and Research (AHCPR) and the U.S. Department of Health and Human Services endorses spinal manipulation for acute low back pain in adults in its Clinical Practice Guideline.

The first significant recognition of the appropriateness of spinal manipulation for low back pain was performed by the RAND Corporation. This meta-analysis concluded that some forms of spinal manipulation were successful in treating certain types of lower back pain. Some chiropractors claimed these results as proof of chiropractic hypotheses, but RAND's studies were about spinal manipulation, not chiropractic specifically, and dealt with appropriateness, which is a measure of net benefit and harms; the efficacy of chiropractic and other treatments were not explicitly compared. In 1993, Dr Shekelle rebuked some DCs for their exaggerated claims: ...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....

There is conflict in the results of chiropractic research. For instance, many DCs claim to treat infantile colic. According to a 1999 survey, 46% of chiropractors in Ontario treated children for colic. In 1999 a Danish randomized controlled clinical trial with a blinded observer suggested that there is evidence that spinal manipulation might help infantile colic. However, in 2001, a Norwegian blinded study concluded that chiropractic spinal manipulation was no more effective than placebo for treating infantile colic.

In 1997, historian Joseph Keating Jr described chiropractic as a "science, antiscience and pseudoscience", and said "Although available scientific data support chiropractic's principle intervention method (the manipulation of patients with lower back pain), the doubting, skeptical attitudes of science do not predominate in chiropractic education or among practitioners". He argued that chiropractic's culture has nurtured antiscientific attitudes and activities, and that "a combination of uncritical rationalism and uncritical empiricism has been bolstered by the proliferation of pseudoscience journals of chiropractic wherein poor quality research and exuberant over-interpretation of results masquerade as science and provide false confidence about the value of various chiropractic techniques". However, in 1998, after reviewing the articles published in the JMPT from 1989-1996, he concluded,

"substantial increases in scholarly activities within the chiropractic profession are suggested by the growth in scholarly products published in the discipline's most distinguished periodical (JMPT). Increases in controlled outcome studies, collaboration among chiropractic institutions, contributions from nonchiropractors, contributions from nonchiropractic institutions and funding for research suggest a degree of professional maturation and growing interest in the content of the discipline."

Joseph C. Keating, Jr. and researchers argued: "The dogma of subluxation is perhaps the greatest single barrier to professional development for chiropractors. It skews the practice of the art in directions that bring ridicule from the scientific community and uncertainty among the public. Failure to challenge subluxation dogma perpetuates a marketing tradition that inevitably prompts charges of quackery. Subluxation dogma leads to legal and political strategies that may amount to a house of cards and warp the profession's sense of self and of mission. Commitment to this dogma undermines the motivation for scientific investigation of subluxation as hypothesis, and so perpetuates the cycle."

Dr. Craig F. Nelson states, "The chiropractic profession has crusaded against one of the most effective public health measures of all time¬vaccination¬and many of its members publicly scoff at the germ theory of disease. Even today some chiropractors are openly opposed to vaccination. Some practice "muscle testing"¬for example, manually, subjectively appraising the muscle strength of a patient with a vitamin pill in his or her hand as a means of diagnosing nutritional deficiencies."

WebMD

WebMD has published several studies regarding chiropractic adjustments. The first of these, published on October 11, 2004 in the Archives of Internal Medicine, concluded that chiropractic cut the cost of treating back pain by 28%, reduced hospitilizations by 41%, back surgeries by 32%, and the cost of medical imaging, such as X-rays or MRIs, by 37%. Researchers did not look at patient satisfaction in this study, but study co-leader Douglas Metz says company studies show that 95% of chiropractic care patients are satisfied with the care they receive.

Commentary on "Scientific investigation" draft

This is way too long for Chiropractic, it contains many older and or lower-quality citations, and it has too many quotes. It's too much work to edit; I will try to draft a better version from scratch shortly. Eubulides (talk) 22:53, 1 April 2008 (UTC)

Why does this have to be so hard. 2 lines in, and I'm already coming across known biased-POV Ernst. This is not off to a good start to make a NPOV section. I definitely agree with Eubulides that this is WAY too long. DigitalC (talk) 23:01, 1 April 2008 (UTC)

I'll try to draft something shorter. See #Commentary on sources for effectiveness above for discussion of Ernst. Ernst's reviews are of high quality, and although they are critical, it is OK to cite them so long as it's done in a balanced way. Eubulides (talk) 23:07, 1 April 2008 (UTC)

I have drafted something shorter; please see #Draft effectiveness section below. Eubulides (talk) 23:38, 1 April 2008 (UTC)

I understand the Effectiveness section is a replacement for this section with newer and more reliable refs. But is there anything or any refs we can use from this section? QuackGuru (talk) 05:00, 12 April 2008 (UTC)

Of those refs, French & Green 2005 (PMID 16326231) is an alternative source for the claim that the Cochrane Collaboration is a reliable source for chiropractic, a topic that seemed to be in some dispute but that dispute seems to have died down. Other than that, nothing jumped out at me. Eubulides (talk) 08:34, 13 April 2008 (UTC)

Deleting Newtral material by world health organization

Why does quack guru insist on deleting cited world health material this is newtral view, verifiable and improves the article? These are facts if not truths. Please discuss.

Orangemarlin and Arthur rubin are tag teaming and abusing wikipedia tools (twinkle) claiming that the reverted edits were vandalism when they were clearly not. How to I report these 2 guys to admins for disruptive editing and false statements in there summaries? 64.25.184.27 (talk) 02:33, 20 March 2008 (UTC)

I do not agree with this controversial edit.[35] QuackGuru (talk) 02:37, 20 March 2008 (UTC)

EBDCM, please sign in instead of using yet another IP, (that is now blocked). -- Fyslee / talk 06:17, 20 March 2008 (UTC)

I have signed in. EBDCM (talk) 06:28, 20 March 2008 (UTC)

I have noticed, but you are now evading a block. That's not right. -- Fyslee / talk 06:35, 20 March 2008 (UTC)

You are making unfounded accusations, Fyslee. If you are insinuating that I'm anon; I am stating flatly that I am not. — Preceding unsigned comment added by EBDCM (talk • contribs)

So you are clearly denying that you have been editing using the now-blocked 64.25.184.27 IP? Is that correct? -- Fyslee / talk 06:44, 20 March 2008 (UTC)

May I assume that your failure to reaffirm your denial is because you know that a check user might place you in the same location (possibly even street) as that IP? -- Fyslee / talk 17:23, 20 March 2008 (UTC)

Problems with 2008-03-19/20 edits

The recent edit war made several controversial changes to Chiropractic (summarized here) without discussion. This is lamentable. This is a controversial article, and it's not right to make changes without even bothering to discuss them. This section attempts to list the recent changes that are problematic. Eubulides (talk) 08:19, 20 March 2008 (UTC)

The recent edit were was a disgraceful attempt to claim that the edits I had made earlier that day was vandalism. Also, how exactly is citing a passage from the WHO constitute a copyvio? The guideline is a public document and we've already cited other bits of it elsewhere in Chiropractic without claiming a copyright violation. EBDCM (talk) 17:07, 20 March 2008 (UTC)

• I reviewed the changes noted above by looking at the old and new versions; I made no attempt to ferret out which editor made which contribution. A brief glance at the edit history shows that it was quite a mess.
• It is certainly OK to cite documents, and to summarize what they say, at times using their choices of particular words in order to be accurate. But it is not OK to pull entire extracts out of copyrighted material; that is a clear copyright violation. It is certainly wrong to pull sections from a copyrighted document without making it clear to the reader that word-for-word quotes are being used.
• For more information about copyright and Wikipedia, please see WP:COPYRIGHT and WP:COPYVIO.

Eubulides (talk) 02:38, 21 March 2008 (UTC)

I see that somehow this set of changes got bundled together with the changes currently being discussed in #Comments on proposed revision to "Practice styles", and editors were reverting one set of changes and perhaps inadvertently reverting the other set, or vice versa, without any clear indication that they knew that that's what they were getting. For now, I took both sections back to the states that they were before the revert wars of the last 48 hours or so; there are active discussions on the talk pages about both sets of edits, and I suggest continuing these discussions here before further edits are made to the article. One thing I hope we can all agree on, though, is that we can't put copyright violations into the article. Eubulides (talk) 08:51, 21 March 2008 (UTC)

2008-03-19/20 changes to Schools of thought

A 60-word passage was taken without permission from the 2005 WHO guidelines and prepended to this section. This is a copyright violation and needs to be reverted ASAP as per WP:COPYVIO. Eubulides (talk) 08:19, 20 March 2008 (UTC)

fixed. Eubulides (talk) 08:24, 20 March 2008 (UTC)

The cited source was referenced properly and there is no violation. This appears to be an attempt to muzzle an editor and to omit valuable information. EBDCM (talk) 12:45, 20 March 2008 (UTC)

The source was cited, but an extended word-for-word extract from the source was inserted into the article without quote marks, which means that it was plagiarism. Simply inserting quote marks would fix this particular plagiarism issue, but this article should not consist of snippets of quotes taken from various sources; it should be an article that stands on its own, in its own words. Besides, this article cannot contain lots and lots of quotes from a copyrighted source on the same topic; that raises copyright issues in its own right, quite aside from the issue of giving proper credit. Eubulides (talk) 04:13, 21 March 2008 (UTC)

The following sentence was inserted:

Common themes to chiropractic care include holistic, conservative and non-medication approaches via manual therapy.

It's not a big deal, but this is somewhat redundant with Chiropractic #Philosophy. Perhaps a simple "See 'Philosophy'" would be simpler. Eubulides (talk) 08:19, 20 March 2008 (UTC)

If it's not a big deal why are you turning it into one? There is a trend of glaring omissions in your edits which provides an incomplete picture of the profession and clinical practice.

A brief comment in the talk page is not a big deal. This is merely a redundant sentence in the article, that's all. In the light of the much-bigger problems the article has, a redundant sentence not a big deal. Eubulides (talk) 04:16, 21 March 2008 (UTC)

2008-03-19/20 changes to Education

A 150-word passage was taken without permission from the 2005 WHO guidelines and inserted into this section. This also needs to be reverted. Eubulides (talk) 08:19, 20 March 2008 (UTC)

Fixed. Eubulides (talk) 08:26, 20 March 2008 (UTC)

Considering that is is educational guidelines document that applies worldwide, we will use it as an appropriate source. EBDCM (talk) 12:42, 20 March 2008 (UTC)

There is no problem with using the WHO guidelines as a source; the article already does that. But the article can't contain extended chunks of the source, without quotation marks; that is a no-no. Even with quote marks, it wouldn't be right to contain quote after quote from one source. Eubulides (talk) 04:19, 21 March 2008 (UTC)

2008-03-19/20 changes to Scope of practice

A 60-word passage was taken without permission from the 2005 WHO guidelines and inserted into this section. This also needs to be reverted. Eubulides (talk) 08:19, 20 March 2008 (UTC)

Fixed. Eubulides (talk) 08:28, 20 March 2008 (UTC)

WHO is the most appropriate source; these are educational guidelines and scope of practice is accurately portrayed across all regions. EBDCM (talk) 12:41, 20 March 2008 (UTC)

The inserted material was duplicative (how many times is the article going to say chiropractic doesn't use medicines or surgery) and somewhat out of place; most of it was about diagnosis and treatment rather than scope of practice. But regardless of the merits of the content, the article cannot take big chunks of text from a copyrighted source without quote marks; that's not right. Eubulides (talk) 04:22, 21 March 2008 (UTC)

2008-03-19/20 changes to History

A 160-word passage was taken without permission from the 2005 WHO guidelines and prepended to this section. This also needs to be reverted. Eubulides (talk) 08:19, 20 March 2008 (UTC)

Fixed by reverting to the text that the 160-word passage replaced. Eubulides (talk) 08:31, 20 March 2008 (UTC)

The text was cited appropriately.EBDCM (talk) 12:39, 20 March 2008 (UTC)

A citation was provided, but no quote marks were given for this extended extract. That is not right. Quotes must be quoted. Plus, the article should not be merely a succession of 3rd-party quotes. Eubulides (talk) 04:24, 21 March 2008 (UTC)

2008-03-19/20 changes to Vertebral subluxation

The following text was removed without discussion. The text is well supported by the cited source.

The concept of subluxation remains unsubstantiated and largely untested, and a debate about whether to keep it in the chiropractic paradigm has been ongoing for decades.

I fixed this by putting the source directly after the text, rather than a sentence or two later. Eubulides (talk) 08:36, 20 March 2008 (UTC)

The following text was added, without a source:

limits itself to primarily neuromusculoskeletal conditions but retains a holistic approach and an emphasis on manual therapy.

I requested a citation for this addition. Eubulides (talk) 08:39, 20 March 2008 (UTC)

Eubulides (talk) 08:19, 20 March 2008 (UTC)

2008-03-19/20 changes to Wilk et al. vs. American Medical Association

A citation was made to support the claim that the AMA lost its appeal to the Supreme Court. But the citation doesn't say anything about the AMA's appeal to the Supreme Court. It is merely an appeals court decision. Eubulides (talk) 08:19, 20 March 2008 (UTC)

I replaced it with a request for a citation. Eubulides (talk) 08:43, 20 March 2008 (UTC)

2008-03-19/20 changes to Safety

A 40-word passage was taken without permission from the 2005 WHO guidelines and inserted to this section. This also needs to be reverted. Eubulides (talk) 08:19, 20 March 2008 (UTC)

Everything is properly cited.

Verbatim quotes need quote marks, as described above. Eubulides (talk) 04:55, 21 March 2008 (UTC)

The following material was added without discussion. This material is duplicative and is based on sources that, because of their age, are less-reliable than the sources already used. By repeating the fact that manipulation is generally regarded as safe and complications are rare, it introduces a weight issue into the section. Eubulides (talk) 08:19, 20 March 2008 (UTC)

Spinal manipulative therapy is the primary therapeutic procedure used by chiropractors, and because spinal manipulation involves the forceful passive movement of the joint beyond its active limit of motion, chiropractors must identify the risk factors that contraindicate manipulation or mobilization Manipulation is regarded as a relatively safe, effective and conservative means of providing pain relief and structural improvement of biomechanical problems of the spine. As with all therapeutic interventions, however, complications can arise. Serious neurological complications and vascular accidents have been reported, although both are rare.

These are factual statements, which are V and RS. It also provides necessary context. EBDCM (talk) 12:37, 20 March 2008 (UTC)

The article itself provides necessary context. It should not be necessary to define spinal manipulation in the "Safety" section. Definitions like that should be in the "Treatment" section. The citations are old and less reliable; surely it can't be too much trouble to cite the current edition of PPC, for example, rather than the old 1992 edition. Eubulides (talk) 04:55, 21 March 2008 (UTC)

The phrase "Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death" was changed to "Rarely, the administration of spinal manipulation, particularly on to the upper cervical spine, can also result in serious neurological complications though this appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach". The source says "upper spine", not "upper cervical spine". It doesn't talk about "administration". The source says "permanent disability or death"; this phrase was removed. The use of "though" makes it sound like unpredictability is in opposition to seriousness; this is not the case. The citation placement is such that it's now hard to see which source supports which part of the text. Eubulides (talk) 08:19, 20 March 2008 (UTC)

I added a source which mentions upper cervical spine specifically. We cannot only rely on Ernst for his opinion. EBDCM (talk) 12:37, 20 March 2008 (UTC)

First, the added source, Haldeman et al. 2002 (PMID 11805635) is about the cervical spine: its text never mentions "upper cervical spine" specifically. Second, even if Haldeman et al. were about the upper cervical spine, which it isn't, its conclusions couldn't be shoehorned into Ernst's that way. It's clearer to state Haldeman et al.'s main point separately, as is done in #Safety 4, rather than to try to jumble the conclusions together. Eubulides (talk) 06:25, 21 March 2008 (UTC)

The sentence "Furthermore, no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care" was added, but the cited source does not support this claim. Eubulides (talk) 08:19, 20 March 2008 (UTC)

This was in Haldeman et al. Removing a cited reference is not proper etiquette.

Proper etiquette is to discuss controversial changes on the talk page, which is what is being done here; that is better than making changes without discussion. The #Safety 4 proposal (below) includes the Haldeman et al. 2002 (PMID 11805635) citation. That citation is a bit dated, but is acceptable if no better source can be found. Eubulides (talk) 04:59, 21 March 2008 (UTC)

The contraindication paragraph was appended to the safety paragraph; these are two subjects and it is useful to have two paragraphs. Eubulides (talk) 08:19, 20 March 2008 (UTC)

Contraindications is getting to be undue weight and needs to be either shortened or provided with adequate context for readers. EBDCM (talk) 12:37, 20 March 2008 (UTC)

Chiropractic #Safety has (by my quick count) 76 words on contraindications. The undiscussed rewrite had 103 words. #Safety 4 has 76 words (not the same 76 words as before). So it appears that both Chiropractic #Safety and #Safety 4 do better on undue weight than the controversial rewrite did. Eubulides (talk) 05:11, 21 March 2008 (UTC)

"visual field defects" was changed to "visual disturbances" but the source says "visual field defects". Eubulides (talk) 08:19, 20 March 2008 (UTC)

All discussion of relative contraindications was removed without discussion. This is an important aspect of contraindications and is discussed at some length in the reliable sources. The example of rheumatoid arthritis as an absolute contraindication was removed without discussion; this is a useful example that illustrates (1) absolute contraindications are not necessarily life-threatening, and (2) they typically apply just to the manipulated regions, not to all chiropractic treatment. Some other absolute contraindications were also removed (certain types of loss of balance, lateral medullary signs); this is fine with me but that stuff was put in by other editors. Eubulides (talk) 08:19, 20 March 2008 (UTC)

We cannot have an editor who decides everything unilaterally like is the case here. DoctorIsIn agreed with the edits as well. We do not need to go into excess detail about contraindicatons, doing so is a weight violation and a puff issue. EBDCM (talk) 12:37, 20 March 2008 (UTC)

Absolutely: one editor should not decide everything unilaterally. That is why controversial changes should be discussed in the talk pages; it is not right to make changes to the article without discussion. I don't recall DoctorIsIn agreeing with the undiscussed edits (after all, they weren't discussed; how could DoctorIsIn agree with them?). And those undiscussed edits added verbiage about contraindications, so if there is concern about weight the edits made things worse. Eubulides (talk) 05:15, 21 March 2008 (UTC)

Following up my own comment; I see now by reading the discussion in #Current Safety below that TheDoctorIsIn did write, after the undiscussed version was made, that it was more NPOV than Chiropractic #Safety, so I struck out that part of my comment. TheDoctorIsIn also wrote that shorter is better; #Safety 4 is shorter than the undiscussed version, so perhaps it'll be more to TheDoctorIsIn's liking. Eubulides (talk) 06:50, 21 March 2008 (UTC)

The text:

Chiropractic care in general is safe when employed skillfully and appropriately

was changed to:

Chiropractic care in general is safe when employed skillfully and appropriately in comparison to surgical and medication approaches for mechanical pain syndromes.

No source was given for this addition. Eubulides (talk) 08:19, 20 March 2008 (UTC)

There are enough problems here that the simplest way to proceed is to start with the previous version and move forward, so I started by going to that. Eubulides (talk) 09:02, 20 March 2008 (UTC)

No, this is not the simplest way to proceed. Your objections is in the minority and the claims made are unfounded.

Objections to these changes are not in the minority. A proposal has been made in #Safety 4 to incorporate the useful parts of the changes; this is a good way to proceed. Eubulides (talk) 05:41, 21 March 2008 (UTC)

The next section is a draft of a new version of "Safety" with some of the above changes in mind. Comments are welcome; please put them in #Safety 4 comments. Eubulides (talk) 09:37, 20 March 2008 (UTC)

Safety 4

Chiropractic care in general is safe when employed skillfully and appropriately. Its primary therapeutic procedure, spinal manipulation, involves directed thrust to move a joint past its physiological range of motion without exceeding the anatomical limit. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications.

Spinal manipulation is associated with frequent, mild and temporary adverse effects, including new or worsening pain or stiffness in the affected region. They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours. Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children. The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation.

Absolute contraindications to spinal manipulation are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints. Relative contraindications are conditions where increased risk is acceptable in some situations and where low-force and soft-tissue techniques are treatments of choice; these contraindications include osteoporosis. Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.

Safety 4 comments

The above draft started with Chiropractic #Safety before yesterday's long series of edits, and attempted to merge the changes suggested by those edits, with the above comments in mind. Comments are welcome. Eubulides (talk) 09:37, 20 March 2008 (UTC)

How about letting other editors have a say and write for a change? One editor should not dictate to the rest what are acceptable sources and acceptable writing.

Yes, that's what this section is for: discussing and improving the draft in #Safety 4. Comments and (especially) improvements are welcome. Eubulides (talk) 05:44, 21 March 2008 (UTC)

Here is an example of questionable editing: the source says cerebrovascular accidents. The editor replaces the word with strokes. This editor has chimed many for not following words verbatim when quoting a piece yet goes on to do the opposite. This type of double standard does need to stop and one editor cannot be the judge, jury and executioner of all the material provided. Why is there so much protectionism over a section and why can no editor write about it in their own words? EBDCM (talk) 12:58, 20 March 2008 (UTC)

Cerebrovascular accident is a synonym for stroke. If you follow the wikilinks in the previous sentence, you'll see that they both end up at the same page, which begins "Stroke or cerebrovascular accident (CVA) is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain." It is standard practice in Wikipedia articles to use plain English when possible, to make articles accessible to a wider readership; see WP:JARGON and WP:MEDMOS#Audience. If a word change introduces an important change in meaning that is another thing; that should be avoided. But that's not what happened here. It is not protectionism to ask for high-quality edits and to discuss controversial changes. Eubulides (talk) 05:52, 21 March 2008 (UTC)

So your attitude is to attack one of the better medical editors on Wikipedia? I'm not sure that's wise. Other editors happen to agree with his edits, you don't. So, why don't you suggest some edits that are neutral and supported by verified and reliable sources? OrangeMarlin ^{Talk• Contributions} 17:16, 20 March 2008 (UTC)

That's not correct at all OrangeMarlin. If you didn't notice, chiropractic is not medicine. Many editors disagreed with his edits as well. The edits I have suggested are indeed V:RS. Attempts to demoninize me are not constructive. Unlike others, often I write for the enemy and have done so numerous times. Lastly, our medical editor seems to have a tendency to omit good papers and chooses language that many edits have found to be inflammatory and condemning. EBDCM (talk) 17:21, 20 March 2008 (UTC)

EBDCM [b]has[/b] suggested edits that are neutral and supported by VS & RS. Your suggestion otherwise is inflammatory and unnecessary, as is your suggestion that only EBDCM disagrees with Eubulides edits. DigitalC (talk) 02:32, 27 March 2008 (UTC)

EBDCM, there was support for E's version among several editors, including me. As for absolute contraindications, I think "sudden severe neck ache, or headache" should be mentioned along with visual defects, from the ref: "neck or occipital pain with a sharp quality and severe intensity that is sudden and unlike any previously experienced pain(even when it is suspected the pain is of a musculoskeletalor neuralgic origin); and 3) severe and persistent headache that is sudden and unlike any previously experienced headache (even when it is suspected the pain is of a musculoskeletal or neuralgic origin) {L-5}.GDC These are absolute contraindications to all treatment modalities"CynRNCynRN (talk) 18:22, 20 March 2008 (UTC)

These (visual defect, h/a, neck ache) were a triad of contraindications and obviously the above would need to be condensed....CynRNCynRN (talk) 23:03, 20 March 2008 (UTC)

Thanks for the suggestion. Each contraindication category has just one or two examples, so we need not list them all. But I like the idea of mentioning sudden, severe, novel headache or back pain, as that is much easier for the average reader to understand than "visual field defects" which are a bit abstruse. Also, on this topic the source cites Saeed et al. 2000 (PMID 11097518), which says that headache and/or neck pain was the prominent feature in 88% of patients whereas visual field defects were clinical features in only 15% of patients. Typically it's better to use the more-common feature as an example. I made this change to the #Safety 4 draft to implement the suggestion. Eubulides (talk) 06:11, 21 March 2008 (UTC)

This is still too long. . . we should just say that Chiropractic care in general is safe when employed skillfully and appropriately. Its primary therapeutic procedure, spinal manipulation, involves directed thrust to move a joint past its physiological range of motion without exceeding the anatomical limit that is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, though any serious complication are extremely rare. That says it all. . . rather than cherrypicked source. . . and giving an extremely fringe minority viewpoint (that chiropractic is somehow "dangerous") far too much weight. . . see the minority Viewpoint section of NPOV policy.TheDoctorIsIn (talk) 07:55, 21 March 2008 (UTC)

Some real discussion of common, minor complications is in order (what sort of complications? how common?), as is a discussion of the rare, serious complications (again, what sort of complications? how common? how severe?). It is not extremist or fringe to cover chiropractic safety issues; these issues come up even if serious adverse effects are rare, and people are curious about them, just as they are curious about other rare but serious adverse effects like Vaccine injury. The sources are not cherrypicked; they are taken from recent high-quality reviews published in reputable journals, and 5 of the 7 sources are supportive of chiropractic. Eubulides (talk) 08:20, 21 March 2008 (UTC)

I disagree for reasons mentioned above.TheDoctorIsIn (talk) 06:44, 27 March 2008 (UTC)

Please see followup in #Adverse effects discussion below. Eubulides (talk) 07:40, 27 March 2008 (UTC)

Current Safety

pinal manipulative therapy is the primary therapeutic procedure used by chiropractors, and because spinal manipulation involves the forceful passive movement of the joint beyond its active limit of motion, chiropractors must identify the risk factors that contraindicate manipulation or mobilization[66][67][68] Manipulation is regarded as a relatively safe, effective and conservative means of providing pain relief and structural improvement of biomechanical problems of the spine.[69] As with all therapeutic interventions, however, complications can arise. Serious neurological complications and vascular accidents have been reported, although both are rare.

Spinal manipulation is associated with frequent, mild and temporary side effects,[70][71] including new or worsening pain or stiffness in the affected region.[72] They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours.[70] Rarely, the administration of spinal manipulation, particularly on to the upper cervical spine, can also result in serious neurological complications though this appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach [73] which can occur in both adults[71] and children.[74] The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern.[71] Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. Furthermore, no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care[75] Contraindications to spinal manipulation include non-indication where mobilization or manipulation may do no good or do no harm to absolute contraindications where manipulation or mobilization could be life threatening. [48] In many instances mobilization or manipulation may be contraindicated in one area of the spine but beneficial in another [76] Also in relative contraindications, low‐force and soft‐tissue techniques are the treatments of choice, as both may be performed safely in most situations where a relative contraindication is present.[48] Nevertheless, some neurological signs, such as visual disturbances indicate referral to emergency medical services.[70][70] The chiropractor’s scope in manual therapy extends beyond the use of manipulation or mobilization and includes manual traction, passive stretching, massage, ischaemic compression of trigger points and reflex techniques designed to reduce pain and muscle spasm. Chiropractic care in general is safe when employed skillfully and appropriately [48] in comparison to surgical and medication approaches for mechanical pain syndromes.

What are exactly your objections, Eubulides? This version is as close to NPOV as we've been. EBDCM (talk) 16:30, 20 March 2008 (UTC)

That proposal is hard to follow since it has lost its references, but objections to some of its problems can be found in #2008-03-19/20 changes to Safety, and its improvements have been incorporated into the draft in #Safety 4. Eubulides (talk) 06:15, 21 March 2008 (UTC)

I agree with EBDCM. . . this is the most NPOV version yet. . . Still I think this section should be shorter. . . Safety is minor issue because the risks associated with adjustments are so minimal. . . tiny tiny fractional percentages. . . why dedicate this much article space to such a nontopic?TheDoctorIsIn (talk) 19:17, 20 March 2008 (UTC)

Many editors disagree and have reverted this nonsensical version. This version has been rejected. I recommend archiving this thread. QuackGuru (talk) 02:00, 21 March 2008 (UTC)

Quackguru has mention a copyvio issue. . . cannot we just rewrite so there is no issue (rather than delete). . . the material is good.TheDoctorIsIn (talk) 08:08, 21 March 2008 (UTC)

The copyright violation issue is discussed at length in #Problems with 2008-03-19/20 edits, and it addresses your question. The material is high-quality but some of it was redundant or was put in inappropriate parts of the article; I didn't think much about that, though, since copyright violations trump the other concerns. Eubulides (talk) 08:25, 21 March 2008 (UTC)

lead suggestions

Spinal manipulation is a hallmark treatment of chiropractors and is associated with common mild adverse effects as well as an unknown risk of serious complications. <-- Here is a suggestion for the lead. The article is expanding and the WP:LEAD should represent the body of the article. QuackGuru (talk) 05:30, 24 March 2008 (UTC)

Not a good idea. -- Fyslee / talk 06:12, 24 March 2008 (UTC)

Let's finish with the POV problems in the body first, before worrying about the lead. The lead is not seriously out of whack now, and there's no rush to adjust it. Eubulides (talk) 06:48, 24 March 2008 (UTC)

Hello QuackGuru. Thanks for the suggestion. What you have written seems to me to be quite accurate, though I would place other facts in priority. Spinal manipulation, I think we can all agree upon. What it is a treatment for is something that seems to have largely been left out and it is important that it needs to be stated clearly to help the reader in the lead.

The possibility of averse effects can be mentioned within the broader ambit of scientific findings, as with any other measured treatment in existence. I understand that the adverse effects information needs to he thought through and summarized carefully, but the information on treatment and illnesses it is for can go in pretty easily now. I believe it should also be stated very clearly in the main body somewhere, together with an appropriate heading that the reader can find easily. Then later we can add any tricky information to the lead after reasonable discussion.Delvin Kelvin (talk) 04:20, 25 March 2008 (UTC)

Absolutely terrible idea, due to NPOV and WEIGHT. DigitalC (talk) 02:56, 27 March 2008 (UTC)

How about: "Spinal manipulation is a hallmark treatment of chiropractors and is generally considered safe." for the WP:LEAD. QuackGuru (talk) 19:13, 28 March 2008 (UTC)

That sounds like a portmanteau sentence, i.e., one that glues together unrelated topics. Why not wait until the body has been fixed before worrying about the lead? Eubulides (talk) 04:00, 29 March 2008 (UTC)

Treatment procedures suggestions

There is a Chiropractic#Treatment procedures section in the article. We can expand on what is spinal manipulation in that section. Currently, the article explains very little on what exactly is spinal manipulation. QuackGuru (talk) 05:56, 27 March 2008 (UTC)

This is a good suggestion. Any volunteers on writing the proposed addition to the treatment section? Eubulides (talk) 06:25, 27 March 2008 (UTC)

It is undue weight to be mentioning adverse effects in the lead. In fact, many of us believe that it shouldn't be mentioned in the article at all, due to undue weight. DigitalC (talk) 06:18, 27 March 2008 (UTC)

This most recent suggestion is about the body, not the lead. This is all a bit confusing, since this talk section is titled "lead suggestions". I added a subsection header here "Treatment procedures suggestions" to try to help clarify this a bit. Eubulides (talk) 06:25, 27 March 2008 (UTC)

Adverse effects discussion

I agree with DigitalC. . . it is undue weight mentioning adverse effects to the extent we are even mentioning it now. . . the adverse effects are so miniscule. . . yet we dedicate so much space to this topic. . . I have seen it argued here that in other articles about topics which are much more risky the adverse effects section are much briefer. The amount we dedicate to adverse effects here throws this article way out of the NPOV balance and is more in line with POV pushing.TheDoctorIsIn (talk) 06:43, 27 March 2008 (UTC)

Chiropractic#Safety's coverage of adverse effects is just one paragraph and is not too large. Go to scholar.google.com and type "chiropractic safety" as the query, and look at many of the resulting papers: there is a real concern among the thousands of papers found there. Summarizing these papers neutrally in one paragraph is not way out of balance for weight. Let's put it this way: homeopathy is safer than chiropractic and yet Homeopathy devotes more space to safety issues than Chiropractic does; this also suggests that the space that Chiropractic devotes to safety is not way out of balance. Eubulides (talk) 07:00, 27 March 2008 (UTC)

I did the search on Google. . . the first result it [36]. . . how come we are not citing anything from this resource? This one has the data of the most comprehensive study which shows that the actual incidence of stroke or VAD following cervical manipulation was found to be one per 5.85 million cervical adjustments. That means that the average chiropractor could work for 1430 years (or practice 48 full chiropractic careers!) Also it puts WHO into context and compares the virtual nonrisk of chiropractic to the extremely high risks of surgery and drugs. . . all things which should be discussed in this article if we are to devote so much space to safety. I just read homeopathy and found it to be an article riddled with great NPOV problems as well so I do not think it makes a good comparison.TheDoctorIsIn (talk) 18:44, 27 March 2008 (UTC)

The suggestion was to use scholar.google.com, not the less-reliable www.google.com. Of course, even with scholar.google.com, one must use good judgment; being indexed on scholar.google.com does not mean the paper is reliable. The source you found on google.com is a partisan website and is less reliable than the refereed review articles that Chiropractic #Safety is currently using. The one per 5.85 million figure is not reliable and is not mentioned in the higher-quality reviews being cited now. Please see WP:MEDRS for what constitutes reliable sources in articles like this. Eubulides (talk) 06:27, 28 March 2008 (UTC)

I have already debunked the use of google scholar to determine whether something is notable or not. DigitalC (talk) 06:51, 28 March 2008 (UTC)

Nobody is claiming that raw Google Scholar counts are definitive. Google Scholar searches need to be assessed by following up links. In this particular case, links have been followed, chiropractic safety is definitely a matter of concern in the scholarly literature, and nothing has been debunked. Eubulides (talk) 03:58, 29 March 2008 (UTC)

Vertebral artery dissection from any cause is extremely rare and the article needs to reflect that. The one in 5.85 mill figure is from malpractice claims and not very reliable since not everyone would be aware that a VAD could be from a manipulation and also, a small percentage of patients actually file a malpractice claim.CynRN24.4.129.58 (talk) 23:51, 1 April 2008 (UTC)

I agree that specific figures are unreliable, and Chiropractic #Safety currently gives none, which seems the right thing to do. It says that serious complications like VAD are rare (twice). The sources don't say "extremely rare", as far as I know, but they do say "rare". Eubulides (talk) 00:29, 2 April 2008 (UTC)

Schievink, 2001, estimates 1 to 1.5 per 100,000 so called 'spontaneous' dissections. Of course, you are right that the figures are unreliable as it is still a difficult thing to diagnose and not something most clinicians will think of right away. IMO the risks need to be in the article. Risk of SMT is notable in the medical literature and popular press and it would be kind of strange to eliminate the Risk section.CynRN24.4.129.58 (talk) —Preceding comment was added at 18:58, 2 April 2008 (UTC)

1/100,000 is on the high end compared to other estimates that I have seen, and I think that is the problem. As Eubulides stated, specific figures are unreliable at this point in time, because the events are so rare. We have definitely mentioned the risk of adverse events already in the safety section. DigitalC (talk) 22:32, 2 April 2008 (UTC)

Sorry, I meant "safety" section not "risk" (and yes, it's already mentioned) and the 1-3 in 100,000 is the risk from all causes, not just manipulation...The actual risk from SMT or other causes is very difficult to determine.CynRN24.4.129.58 (talk) 05:48, 4 April 2008 (UTC)

Clean up

I did some general clean up and a lot of ref formatting today. I hope that it was helpful. In the future, Dave Iberri has this very convenient automagic ref making webpage that might be useful for you. It can turn most websites, ISBNs, or PubMed ID numbers (and other stuff) into a beautiful little ref in the click of a button. WhatamIdoing (talk) 04:56, 25 March 2008 (UTC)

Thanks for the cleanup! I did notice one glitch in all that work: one of the newly added citations didn't really support the claim being made. I made this change to identify the citation and ask for better citations in this area. Thanks again. Eubulides (talk) 05:27, 26 March 2008 (UTC)

I had assumed, actually (and perhaps wrongly), that the sole point behind that fact-tag was an objection to the existence of "chiropractic physician," as in the American Academy of Chiropractic Physicians, not the American Academy of Chiropractors, because it's both the least common title in use by clients and the most likely to be irritating to MDs (who have an obvious interest in guarding the title physician from alternative medicine uses). Therefore any reliable source that proves the actual existence of the term is sufficient. A quick Google search of "chiropractic physicians" site:.gov turns up several thousands references to that exact phrase on government websites, including NV ID, UT state boards using only chiropractic physician as their formal title for the profession. Many states have laws referring to chiropractic physicians.

But if you want a general statement including the three most common titles, perhaps the US Bureau of Labor Statistics will suit your purpose? WhatamIdoing (talk) 18:41, 26 March 2008 (UTC)

Thanks for following up. The fact tag was intended to apply to everything in that paragraph other than the first phrase (which is supported by a citation). The BLS source supports part of what's claimed in the last sentence, but it does not support all of it, since it doesn't support the claim that doctors of chiropractic and chiropractic physicians are common terms, or that these terms used both in the USA and Canada, or the implication that the terms are limited to or are always used by licensed individuals. How about rewording the claim to match the BLS source, as follows: "Chiropractors are also known as doctors of chiropractic (DCs) or chiropractic physicians." and then citing the BLS source instead of the Oregon source? That would suffice to remove the "failed verification" tag. Eubulides (talk) 05:38, 27 March 2008 (UTC)

Agreed. QuackGuru (talk) 05:48, 27 March 2008 (UTC)

Would either of you like to make these changes? (I have a vague memory that this issue might turn up twice in the article.) WhatamIdoing (talk) 18:16, 27 March 2008 (UTC)

OK, done. Eubulides (talk) 06:36, 28 March 2008 (UTC)

Draft effectiveness section

Currently Chiropractic's coverage of effectiveness is extremely weak. It cites very old reports or primary studies, mostly of low quality, and it puts them in a section Chiropractic#Scientific investigation where they are not all that appropriate. Here is a proposal to improve things:

• Remove the following paragraph from Chiropractic#Scientific investigation, as it is obsoleted by the proposed new Effectiveness section below:

While there is still debate about the effectiveness of manipulation for the many conditions in which it is applied, it seems to be most effective for acute low back pain and tension headaches. One small pilot study has shown that upper cervical spinal manipulation may be beneficial for certain types of hypertension.

• Move the subsections Chiropractic#The Manga Report, Chiropractic#Workers' compensation studies, Chiropractic#American Medical Association (AMA), and Chiropractic#British Medical Association from Chiropractic#Scientific investigation to Chiropractic#History. These subsections talk about old reports that may be of historical interest but are no longer current with respect to scientific investigation or effectiveness.

• Add the following section (here called #Effectivness 1) as a new Effectiveness section, immediately after Chiropractic#Safety.

Comments are welcome; please see #Effectiveness 1 comments. Eubulides (talk) 23:37, 1 April 2008 (UTC)

Effectiveness 1

The effectiveness of chiropractic treatment depends on the type of chiropractic treatment used and on the problem the treatment is intended to address. Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective. Many scientific studies focus on spinal manipulation therapy (SMT), chiropractic's characteristic treatment; they typically cover SMT as used in chiropractic and other disciplines, and this article uses SMT in this more general sense. Many controlled clinical studies of SMT are available, but their results disagree, and they are typically of low quality. Available evidence covers the following conditions:

• Low back pain. Opinions differ on the efficacy of SMT for nonspecific or uncomplicated low back pain. A 2008 review found that SMT with exercise is as effective as medical care with exercise. A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain. Of four systematic reviews published between 2000 and May 2005, only one recommended SMT, and the most authoritative () stated that SMT or mobilization is no more or less effective than other interventions for back pain.

• Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain. A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis. A 2007 review found that SMT and mobilization are effective for neck pain. Of three systematic reviews of SMT published between 2000 and May 2005, one reached a positive conclusion, but the most authoritative () stated that SMT/mobilization is effective only when combined with other interventions such as exercise. A 2005 review found limited evidence supporting SMT for whiplash.

• Headache. A 2006 review found no rigorous evidence supporting SMT or other manual therapies for tension headache. A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine. A 2004 review found that SMT may be effective for migraine and tension headache, and SMT and neck exercises may be effective for cervicogenic headache. Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of SMT.

• Extremities (arms and legs). There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg.

• Scoliosis (curved or rotated spine). There is very weak evidence for chiropractic care for adult scoliosis and no scientific data for idiopathic adolescent scoliosis.

• Other. A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that there is promising evidence for SMT for children with middle ear infection. The evidence from reviews is negative, or too weak to draw conclusions, for ADHD/learning disabilities, asthma, baby colic, bedwetting, cancer pain, chronic pelvic pain, constipation, digestive system disorders including irritable bowel syndrome and peptic disorders, dizziness, dysfunctional nursing, fibromyalgia, hypertension, infertility/amenorrhea, jet lag, menstrual cramps, premenstrual syndrome, respiratory conditions such as COPD, skin disease, urinary tract infection, vision conditions, and many other nonmusculoskeletal conditions.

Effectiveness 1 comments

(Please put comments here.) Eubulides (talk) 23:37, 1 April 2008 (UTC)

I will work through this over the next few days - I definitely have comments, but I will work with you here before striking anything out. It at least gives us a framework to start fromDigitalC (talk) 01:13, 2 April 2008 (UTC)

Thank you. This is the sort of clear descriptive information that will make the article easier to read. To be fair though I think we do need to add information from chiropractic sourcebooks or manuals. I will have a look through the library to see how chiropractic sources match up with the above. Delvin Kelvin (talk) 01:24, 2 April 2008 (UTC)

You're welcome. It took some time to read the references in #Sources for effectiveness. I also looked at Principles and Practice of Chiropractic (3rd ed.), but its main chapters on effectiveness (Bronfort G, Haas M, Evans R, "The clinical effectiveness of spinal manipulation for musculoskeletal disorders", pages 147–166; Vernon H, "The treatment of headache, neurologic, and non-musculoskeletal disorders by spinal manipulation", pages 167–183) appear to be superseded by Bronfort et al. 2008 (PMID 18164469) and Hawk et al. 2007 (PMID 17604553). That isn't to say there isn't something of value in the older citations, but generally speaking the more-recent ones are better and textbooks tend to lag behind. Eubulides (talk) 05:13, 2 April 2008 (UTC)

Ok, here goes...

• "Guidelines for SMT and nonspecific low back pain remain inconclusive.". What do they remain inconclusive about? How does this relate to effectiveness? For brevity, for we need to have this in the section of effectiveness?

• The cited source (Murphy et al. 2006, PMID 16949948) says they are inconclusive about quite a few things, including effectiveness. Here's a quote from the discussion section of the cited source: "Inconsistencies in the evidence suggest that there is continuing conflict of opinion regarding: efficacy of SMT for treatment of nonspecific or uncomplicated LBP; optimal time in which to introduce this treatment approach; whether SMT is useful for treatment of chronic LBP; and finally, whether subacute LBP actually exists as a separate category requiring a specific treatment approach in its own right." The "inconclusive" bit comes from the abstract of the cited source. Eubulides (talk) 06:02, 2 April 2008 (UTC)

Thanks for the explanation Eubulides. My comment would be that it really doesn't add to the readability of that subsection. I'm not attempting to debate the content here, in fact I think putting in that "inconsistencies in the evidence suggest that there is continuing conflict of opinion regarding efficacy of SMT for treatment of nonspecific or uncomplicated LBP"". I would find that more clear than that guidelines are inconclusive.

OK, thanks, I made this change to reword along the lines that you suggested. This rewording uses a shorter paraphrase rather than a direct quote, for brevity. Eubulides (talk) 07:02, 2 April 2008 (UTC)

• the most authoritative stated that it is no better than other interventions for back pain.. Given the noted bias of Ernst, I think we should not editorialize towards his paper and call it the most authoritative. Most authoritative according to who? If it is no better than other inerventions for back pain, could that not be reworded in a less POV way to state that it is AS GOOD AS other interventions for back pain?

• The phrase "most authoritative" is describing Assendelft et al. 2004 (PMID 14973958); it is not describing any paper by Ernst. To answer your question "Most authoritative according to who?", it's most authoritative according to Ernst & Canter 2006 (PMID 16574972). The Cochrane reviews are widely considered to be authoritative and this judgment by Ernst & Canter seems reasonable. Eubulides (talk) 06:14, 2 April 2008 (UTC)

Basically, I misread the citations. I was believing that the citation was for the most authoritative paper, not for who was claiming it was the most authoritative paper. I will try to take a look at Assendelft et al. and Gross et al. this week. I have for now struck my previous comments. I also retract my claim that you were pushing a POV, and apologize for it. However, I still think it is POV to be using Ernst (a known bias) to editorialize what is or is not the most authoritative paper.DigitalC (talk) 04:25, 3 April 2008 (UTC)

Ernst and bias

I agree with DigitalC. Ernst does have a known bias. -- Levine2112 ^discuss 18:06, 7 April 2008 (UTC)

Every source in the draft has bias. That includes (for example) Ernst & Canter 2006 (PMID 16574972), which is critical of chiropractic; it also includes (for example) Meeker et al. 2007, which supports chiropractic. It would not be neutral to exclude Ernst simply because he is critical, retaining only sources that support chiropractic. On this particular point, moreover, there's little point in arguing against Ernst. Surely nobody is seriously contending that the Cochrane review is not the most authoritative of the bunch. Eubulides (talk) 00:27, 8 April 2008 (UTC)

Please provided your evidence of so-called known bias. No evidence has been presented. QuackGuru (talk) 18:46, 7 April 2008 (UTC)

The research cited by Ernst is not specifically about chiropractic's efficacy but SMT in general provided by various practitioners in addition to chiropractors; however it is being used here to discuss chiropractic's efficacy. A review of SMT efficacy in general is too general for an article specifically about chiropractic. It would be more appropriate at spinal manipulation. -- Levine2112 ^discuss 19:13, 7 April 2008 (UTC)

Much of the research that supports chiropractic is not specific to chiropractic. Please see #Specific to chiropractic? below. It would not be reasonable to exclude Ernst's reviews because he mentions the broader research, while including reviews supportive of chiropractic that also mention the broader research. Eubulides (talk) 00:37, 8 April 2008 (UTC)

We should exclude conclusions which Ernst (or any other reviewer) makes which doesn't specifically discern chiropractic care from general SMT. An extreme analogy: Let's that Ernst's review of literature researching SMT's effectiveness in aiding foo disease included ten chiropractor but 90 osteopaths and other practitioners performing SMT. Let's say that Ernst's conclusion was that SMT does not seem to be effective for aiding foo disease. What would be the value of saying that SMT does not seem to be effective for aiding foo disease at the Chiropractic article? Not much. However, if in Ernst's review he discerned that the ten chiropractor he reviewed was not effective, then perhaps yes. But the reviews which I have seen don't make this distinction. IOW, if the reviewer doesn't discern chiropractic from the rest of the SMT, then we should't use it here to make a general statement about SMT which the reader would likely mistake as the equivalent to chiropractic SMT. -- Levine2112 ^discuss 07:03, 8 April 2008 (UTC)

Again, excluding studies containing non-chiropractic data is not the approach being taken by the reliable reviews in this area. Reviewers both supportive and critical of chiropractic are focusing on therapies, not on the hats being worn by the therapist, and there are good reasons for doing so. The reviewers in question are published experts in the field and they are saying the studies are relevant, even if the studies contain some data generated by non-chiropractic therapists; there is no good reason to override this expert opinion. Eubulides (talk) 21:04, 8 April 2008 (UTC)

The research presented by Ernst is NPOV and related to this article. Again, please provide your evidence of "a known bias." QuackGuru (talk) 19:21, 7 April 2008 (UTC)

The research presented is perhaps somewhat related to this article but it is too general to use as we are doing here as it studies research of SMT as performed by not only chiropractors, but osteopaths and other practitioners as well (and doesn't distinguish amongst these in its conclusions). Using its general SMT conclusions here to describe the efficacy of chiropractic specifically would be intellectually dishonest, IMHO. -- Levine2112 ^discuss 20:24, 7 April 2008 (UTC)

It's not intellectually dishonest to base results on reviews of techniques performed by non-chiropractors. That sort of thing is regularly done by reviews that support chiropractic, reviews that are cited in the draft. See #Specific to chiropractic? below. Eubulides(talk) 00:37, 8 April 2008 (UTC)

That's not what I am saying. I am not saying that the reviewers are being intellectually dishonest. I am saying that we would be intellectually dishonest if we to try and pass off general SMT research to support conclusions (for or against) the efficacy of chiropractic care. This works both ways, I assure you. Chiropractors, for instance, came under heavy criticism when they used positive SMT research by the RAND corporation on the efficacy/safety/appropriateness of SMT for low back pain. Because the research was generally about SMT and not chiropractic specifically, chiropractors who were using this research as "proof" that chiropractic works or is safe came under heavy fire and were accused of being intellectually dishonest. Make sense? -- Levine2112 ^discuss 07:07, 8 April 2008 (UTC)

It might make sense if that's what chiropractic reviewers themselves do, when they are summarizing research in their own literature syntheses. But that's not what they are doing. The CCGPP uses results from studies of treatment by non-chiropractors in order to assess the effectiveness of a treatment. From their point of view, it doesn't matter that the treatments were done by non-chiropractors; what matters is whether the treatments worked. We should follow their lead in this matter; they are the published experts, and we are not. Eubulides (talk) 07:34, 8 April 2008 (UTC)

Whose lead are we following? The CCGPP? Because if so, there is plenty of research in their "Chiropractic Clinical Compass" which should be included in our efficacy discussion. As I said, chiropractic organizations and individuals who used the Rand study "The Appropriateness of Spinal Manipulation for Low-Back Pain" to declare that chiropractic is safe all came under heavy fire because opponents felt that since the RAND study didn't limit or discern chiropractic adjustments from other practitioners' spinal manipulation, that using this study to declare chiropractic safe is intellectually dishonest. In the same regard, us using a study of general SMT (where chiropractic is not discernible) in our article about chiropractic can also be seen as intellectually dishonest (whether the study is positive or negative). Now then, if you wish for me to make specific edits to the draft above, please know that they will be rather significant as I would be axing anything about general SMT. This includes much of the opening discussion and a lot of the conclusions for the various conditions. I know it will seem harsh, but if we then replace all that was excised with chiropractic specific studies and conclusions, we will have a better, more focused and honest article. Shall I proceed? -- Levine2112 ^discuss 17:23, 8 April 2008 (UTC)

• We are following the lead of the reliable sources listed in #Sources for effectivness. As a general rule, all the sources, including the CCGPP, focus on therapies, not on whether the therapies are done by chiropractors or non-chiropractors.
• If there are other reliable sources not listed, please mention them.
• The RAND study is too old to be considered a reliable source now. The same is true for the old reactions to it which you mention. Chiropractic effectiveness has moved beyond that, chiropractic researchers no longer waste a lot of their time worrying about whether a treatment is "chiropractic" or not, and Chiropractic should reflect the current state of the art.
• Any substantial changes to #Effectiveness 1 should be discussed first. If it's a complete rewrite, I suggest drafting a new section (Effectivness 2 perhaps?) that reflects the alternate goal of omitting all research that mentions non-chiropractic treatment. I still think this alternate goal is mistaken, as it is not reflecting the current state of the art accurately.

Eubulides (talk) 20:30, 8 April 2008 (UTC)

"Chiropractic researchers no longer waste a lot of their time worrying about whether a treatment is 'chiropractic' or not" - Really? Where do you get this information from? Can you verify this? Otherwise, there is a distinction between the chiropractic spinal adjustment and the general spinal manipulation which can be performed by a host of practitioners and non-practitioners, and thus unless a study/review discerns chiropractic from the rest, it cannot be a reliable source on the effectiveness of chiropractic. The current wording does a disservice to the reader by confounding the two.

I got that information by reading the recent sources in #Sources for effectiveness. The world has changed from the bad old days when chiropractors refused to look at evidence generated by non-chiropractors. The current wording reflects recent reliable sources; that's better than going back into older, less-reliable sources. Eubulides (talk) 22:04, 8 April 2008 (UTC)

"The RAND study is too old to be considered a reliable source now" - Really? According to who? What is the statute of limitation on research before it is considered unreliable? 5 years? 10 years? 15 years? Please be specific and let us know upon what you rationale is based. -- Levine2112 ^discuss 21:44, 8 April 2008 (UTC)

As a general rule, recent sources, which look at a lot more evidence and better-quality evidence, are better than older studies, which (by definition) don't have as much evidence to look at. Also, more-recent sources can refer to older sources and bring up what's good about them, so there's no need to refer to the older sources directly. \The sources in #Sources for effectiveness are dated 2005 or later; to some extent this date was arbitrary but the further you go back, the more work there is, and the fewer reliable sources you get; when I gathered the data I stopped at 2005 since there was plenty of sources. One cannot use just 2008 sources since there are publication delays, and 2008 sources won't always have 2007 (or even 2006) sources available when they were written. Eubulides (talk) 22:04, 8 April 2008 (UTC)

Come on QG, the research by Ernst is absolutely not NPOV. DigitalC (talk) 00:24, 8 April 2008 (UTC)

Again, Ernst is critical, but that does not mean his reviews should be excluded, any more than reviews by (say) Meeker should be excluded because he supports chiropractic. Eubulides (talk) 00:40, 8 April 2008 (UTC)

Agreed. However, we seem to be giving way too much credence to Ernst's review, citing him several times (I count 6x... WP:WEIGHT violation anyone?) and referring to his work as the "most authoritative". Hence, I made this edit to remove this editorializing - that is, unless we have some way of know that Ernst is the most authoritative. -- Levine2112 ^discuss 02:53, 9 April 2008 (UTC)

• The current draft cites Ernst's critical reviews 5 times. But many supportive-of-chiropractic authors are cited far more often. For example, Hawk is cited 11 times. If anything, the weight violation is in favor of reviews that support chiropractic.
• The text is not referring to Ernst's work as "most authoritative". It is referring to Cochrane reviews as "most authoritative". They are widely considered to be the gold standard in health-care reviews. However, this isn't the only time I've seen some confusion here, so I made this edit to cite the Cochrane reviews directly, to try to make the point more clearly.

Eubulides (talk) 05:52, 9 April 2008 (UTC)

It is still editorializing to call it the "most authoritative". We have no source proclaiming it to be so. I have edited accordingly. If a source is found which proclaims these studies in particular to be the "most authoritative", then we can discuss reinsertion, but until then it would seem to be editorializing. -- Levine2112 ^discuss 17:10, 9 April 2008 (UTC)

The most recent, most comprehensive and most authoritative review (9) states that SM or mobilization is superior to sham treatment and to detrimental or ineffective treatments but not better than other interventions for back pain. The most authoritative of the three reviews (12) stated that SM/mobilization is effective only when combined with other interventions such as exercise and as a sole treatment for neck pain, it is not of demonstrable effectiveness. I read the refs. QuackGuru (talk) 20:16, 9 April 2008 (UTC)

Perfect. I was still looking at the wrong ref for that. Thanks. -- Levine2112 ^discuss 22:00, 9 April 2008 (UTC)

• but the most authoritative stated Again, we have Ernst's paper being labeled as the most authoritative. This is NOT NPOV, and seems to be pushing a POV.

• Again, the phrase is describing a Cochrane review, not a paper by Ernst; in this case, the paper in question is Gross et al. 2004 (PMID 14974063). Eubulides (talk) 06:14, 2 April 2008 (UTC)

• lack of higher-quality publications supporting chiropractic management of leg conditions. However, the same paper states that the trials that are available were generally favorable for the treatment modalities employed, and stated that on a whole, the quality of such research is good in nature and has been performed on small to mderate subject numbers. The take home point I got from the paper was that although there may be a liack of higher-quality publications, the publications available are favourable and that multimodal tratment may be beneficial.

• The conclusion of that paper (Hoskins et al. 2006, PMID 17045100) has a somewhat different take-home point. Here are all its bullet points:

• "There is a large number of case studies (level 4 evidence) documenting the use of chiropractic management of peripheral lower extremity conditions."
• "There is a lack of higher-quality publications (level 1–3 evidence)."
• "Management has been documented for a broad array of different lower extremity conditions."
• "Chiropractic lower extremity management appears to be characteristically multimodal in nature incorporating various manual therapy approaches, rehabilitation, therapeutic exercise, and/or other modalities directed at local and nonlocal kinetic and kinematic considerations."

The only part of the conclusion that talks about benefit is the phrase "Of the limited literature produced, it would appear that chiropractic management may be beneficial in certain cases", which is a very weak claim of benefit, one that neither the bullet points nor the abstract summarizes, so I'd be a bit leery of highlighting that weak claim in Chiropractic; I think the existing wording is a fairer summary of that paper's results (which is, basically, that the published evidence is lacking). Eubulides (talk) 06:31, 2 April 2008 (UTC)

• There is little evidence for the efficacy of chiropractic treatment for upper limbs,[64] - indeed This review of the literature concludes that there is strong low-level evidence to support the chiropractic care of a large number of upper extremity conditions. I think it shows a strong editorializing to state that there is little evidence, and then cite a paper that states that there is STRONG low-level evidence

• The abstract of that paper (McHardy et al. 2008) says "There is a small amount of chiropractic research into upper limb conditions that is comprised mostly of case studies (level 4 evidence) and a small number of higher-level publications (level 1-3 evidence)." You are correct that this should not be summarized as "there is little evidence"; instead, it should be summarized as "there is a small amount of research", so I did that. I am leery, though, of adding a claim that there is "strong low-level" evidence, since the other bullets of this section consider this sort of level 4 evidence to be relatively weak. Eubulides (talk) 07:21, 2 April 2008 (UTC)

I would lean towards using the words in the source, but why don't we both defer to another opinion?

The current text does use the words in the source, no? It's a question of which words; currently it's using the words in the abstract, which are the words the source's authors wanted to highlight. I'd welcome further opinions. Most of all, I'd welcome more sources. The hard work about writing this sort of thing is finding and reading sources. Eubulides (talk) 16:10, 2 April 2008 (UTC)

Thats my start, now to follow some of the sources. DigitalC (talk) 10:22, 2 April 2008 (UTC)

Ok, back to readability. The reviews of research (rather than individual studies) I have seen, and that you posted above, do their own research on these studies and tend to conclude that chiropractic was more or less successful in showing an effect for lower back pain (with conditionals). I believe being an encyclopedia we need to prioritize to the reviews of research, and be specific about what they are saying.

Lower back pain is a nice easy to visualize condition. We also need easy to visualize descriptive terms for all the claimed treatments that chiropractic has no support for, and especially for those that chiropractic failed to show an effect after testing. I'm emphasizing the scientific support here as that is the medical scientific view. I understand that if a treatment has no support then it is wrong to apply it in medicine. Fortunately in Chiropractic's case, there is support for the lower back pain treatment. The larger set does need presenting though. Delvin Kelvin (talk) 01:16, 3 April 2008 (UTC)

In general I tried to use common terms rather than medical terms. Which terms do you think could still use rephrasing? I took a quick look and discovered "otitis media", which I just now replaced with "middle ear infection". I don't offhand see another rephrasing that would be as simple: there is "cervicogenic dizziness" but I don't know what to replace that with. Eubulides (talk) 06:51, 3 April 2008 (UTC)

You are misinformed if you believe that every medical treatment has research supporting its use. In fact, it has been reported (I believe in BMJ) that chiropractic has MORE evidence behind its procedures than allopathic medicine. DigitalC (talk) 04:02, 3 April 2008 (UTC)

• One of the things I noticed about the low back section is that it seems to focus on SMT. According to the best source we have (Literature Synthesis by CCGPP), Manipulation is supported by good evidence from relevant studies for acute low back pain, subacute low back pain, and chronic low back pain. Assurance and advice (an important part of treatment) to stay active in activities of daily living is supported by fair evidence. Exercise for chronic low back pain is supported by good evidence, and fair evidence supports exercise for subacute low back pain. However, there is insufficient evidence to support exercise as a treatment for acute low back pain.

• Good point, thanks. I added a mention of all the items where that source gave fair evidence or better. Eubulides (talk) 07:44, 3 April 2008 (UTC)

DigitalC (talk) 04:32, 3 April 2008 (UTC)

Any further comments? I'd like to get this one out the door so that we can go back to striking out items from #POV issues as of 2008-03-12. Going once, going twice … Eubulides (talk) 05:24, 5 April 2008 (UTC)

Specific to chiropractic?

Yes. Perhaps a can of worms. But unless the SMT being studied is specifically a chiropractic adjustment then I would be against using it to support/discredit the efficacy or chiropractic. SMT is broad and can be done by a host of practitioners. Further, spinal manipulation has its own article where these general studies would be better placed. This article should deal with studies of chiropractic efficacy only. That said, the Duke study on chiropractic's effectiveness on tension headaches should be included in the article. -- Levine2112 ^discuss 06:27, 5 April 2008 (UTC)

It is a can of worms, yes. The CCGPP literature synthesis on low back pain, which is written by a team of chiropractors, regularly uses studies of non-chiropractic spinal manipulation as evidence to support chiropractic. For example, it cites Aure et al. 2003 (PMID 12642755) to support manual therapy with low back pain, even though that study specifically disallowed chiropractic manipulation. If even published chiropractic researchers do this sort of thing, who are we to overrule them? In #Effectiveness 1 I did attempt to point out which studies were about chiropractic and which studies were about SMT, as obviously these are not the same thing. Eubulides (talk) 05:34, 6 April 2008 (UTC)

Additionally, sources of research for a variety of conditions have been compiled here and here. Most of the research I have seen here is high quality and some are specifically about chiropractic. There are some instances of general SMT research which I think we should disregard for this article, but may be of use at article spinal manipulation. I would also disregard the case studies. -- Levine2112 ^discuss 08:14, 5 April 2008 (UTC)

Those two web pages are not reliable sources in an of themselves, though they may point to reliable sources. To be honest I just looked at one or two and wasn't that impressed, but if you have the patience to wade through them and find better sources than what's in Chiropractic now, please bring them to our attention. Eubulides (talk) 05:38, 6 April 2008 (UTC)

Levine. . . good point as usual. . . though we will be hardpressed to find just chiro specific research, at the end of the day we will have a better article for it.TheDoctorIsIn (talk) 02:04, 6 April 2008 (UTC)

The res provided by Levine are from pro chiro advocacy groups. When we have better refs available as in this case we will use the better refs. The article should deal with effectiveness and efficacy too. This is the main chiro article and it should be complete. Now then, I think it is time to update the article with the Effectiveness section. QuackGuru (talk) 02:46, 6 April 2008 (UTC)

Thats strange, I still see quite a bit of discussion going on here within the last day. There is no RUSH to get this into the article as soon as possible. DigitalC (talk) 04:57, 7 April 2008 (UTC)

None of the comments made within the last day have proposed specific changes or made specific criticisms of the proposed change. They are limited to vague comments along the lines of "there may be other sources elsewhere". It's true that there is no rush, but on the other hand there is little recent progress and the proposal has been available for several days now and it is clearly much better than what is in the article now. What further improvements can be made to it before it goes in? Eubulides (talk) 05:19, 7 April 2008 (UTC)

I have suggested a very specific change; that we remove all of the studies (for or against) that aren't specifically about chiropractic. Studies about SMT in general (which can be performed by a number of kinds of practitioners) should not be used to discuss chiropractic's effectiveness. For instance, a study such as this one is specifically about chiropractic care. These are the kinds of studies we should include in this article. Whereas, a study such as this one which we are using about doesn't seem to be specifically about studying chiropractic's effectiveness but rather "manual therapies" in general. So use this study to support "A 2006 review found no rigorous evidence supporting SMT for tension headache" in a section about chiropractic effectiveness seems to me to be intellectually dishonest. The same goes for this study which we use to say "Of three systematic reviews published between 2000 and May 2005, one found that SMT is as effective as other interventions, but others did not find conclusive evidence in favor of SMT." This review even expressly says: "The search [Chiropract* OR spinal manipul* OR manual therap* OR osteopath*] AND [systematic ADJ review] was carried out in the following electronic databases: Medline, Embase, AMED, Cochrane Database." So that means that it was reviewing literature not just about chiropractic's efficacy but spinal manipulation in general as performed by wholly different practitioners including osteopaths. Again, it is intellectually dishonest to use this review to support such phrasing in a portion of chiropractic article specifically about chiropractic's efficacy. It would be better suited for the spinal manipulation article which deals with the efficacy of SMT in general. -- Levine2112 ^discuss 17:54, 7 April 2008 (UTC)

• By "specific change" I meant a complete wording proposal: which words would be taken out? and which would be substituted, exactly? A change that specific has not been proposed.
• Reliable reviews on both the supportive-of and critical side disagree with you. They cite chiropractic-only studies; they cite mixed studies; and in some cases they even cite studies that excluded chiropractors. Why should we second-guess the reviewers? They are published experts in the field; we are not. It is not "intellectually dishonest" to use the same terminology and techniques that these reviewers themselves use.

Eubulides (talk) 00:50, 8 April 2008 (UTC)

My specific change is to remove any reference (supportive or critical) which is not specifically about chiropractic, and remove its associated text (if a chiropractic specific study cannot be substituted). I am not second-guessing the reviewers in any way. Their review may be fine. But if their review was about a mix of SMT as performed by chiropractors, osteopaths, and others, and if they don't discern amongst the practitioners in their conclusions - if they are only lumping them all together to make some general statement about the efficacy of SMT rather than commenting specifically on the efficacy of chiropractic treatment - then it is intellectually dishonest of us to use such a review to comment on the efficacy of chiropractic treatment specifically. That's a mouthful, but I believe it should make sense. Let me know if I am not being clear. If it helps here is an extreme analogy: Imagine a study on the safety of hypodermic needles. Now imagine we had a review of literature which included but did not distinguish between the following uses in its materials and conclusions - inoculations as performed by MDs, steroid injections as performed by personal trainers, and shooting up heroin as performed by addicts. Now let's say that the review generalized a conclusion which said that usage of hypodermic needles is not safe and now let's say that we were using such a reference in the Medical Doctor article to say that MDs practice an unsafe technique in their use of hypodermic needles... I hope you see the equivalence here. So if you would like, I can go through each reference and strike the ones which aren't specifically about chiropractic care or specifically discern chiropractic care in their conclusions. Sound like a reasonable way to proceed here? -- Levine2112 ^discuss 06:55, 8 April 2008 (UTC)

• That's a general description of what a change might be, but it's not a specific proposal for a change (which would include the exact wording being proposed).
• If a reliable review finds that (say) low-level laser therapy is more effective than usual care for non-whiplash neck pain, and if LLLT is a standard chiropractic treatment, it's quite relevant to cite that review, even if the review covers LLLT treatment by non-chiropractors. Again, the CCGPP is doing this sort of thing in its literature synthesis on low back pain: we should not override and/or suppress results from the CCGPP because we think their literature is not "pure" enough. They are the published experts; we are not.

Eubulides (talk) 07:10, 8 April 2008 (UTC)

When a chiropractor employs SMT, it is very different from when a non-chiropractor employs SMT. Chiropractors have hundreds of specifc MST techniques which non-chiropractors do not employ. Get manipulated by a chiropractor, an osteopath, and a physical therapist - I have been. They are very different. So to cite a study which is only about osteopaths or about a mix of chiropractors and osteopaths but doesn't distinguish between the two in the conclusions lends itself to us using a generality to support a statement which may be true at the specific level. It's simple really; find source which are solely about chiropractic care or discerns chiropractic care in its conclusions. Make sense? -- Levine2112 ^discuss 07:18, 8 April 2008 (UTC)

Again, it would make sense if that's what chiropractic reviewers themselves were doing, but they're not. They are using the studies you are objecting to, using their best expert opinion. They are not excluding studies merely because the studies contain data generated by non-chiropractors. On the contrary, in some cases, they are including studies whose data was generated entirely by non-chiropractors. Who are we to override the opinion of the published experts? This is not a question of being supportive or critical of chiropractic, as the same approach is used by both sides. Eubulides (talk) 21:08, 8 April 2008 (UTC)

We are not overriding the opinions of experts. Their opinions are completely valid for an article about spinal manipulation. Here we have an article about chiropractic and a sub-section about the efficacy of chiropractic. It is plainly illogical and wrong to confound efficacy results of osteopathic and physical therapy manipulation with the efficacy of chiropractic. -- Levine2112 ^discuss 21:51, 8 April 2008 (UTC)

But the articles in question are about chiropractic treatments, not just SMT. For example, Meeker et al. 2007 is written by the Council on Chiropractic Guidelines and Practice Parameters. Its title is "Chiropractic management of low back pain and low back related leg complaints". It is an article written by and for chiropractors. It is a high-quality and recent article, and is typical of the recent literature. And it uses research data partly generated by non-chiropractors to come to its conclusions. That is the way chiropractic research works nowadays. We should not override the opinions of the recently published experts in the field. Eubulides (talk) 22:11, 8 April 2008 (UTC)

Precisely. Even chiropractic organizations confound evidence for general SMT as evidence for chiropractic adjustment. I can understand why too. They are similar; however there are differences. That said and recognized, I went ahead and made this edit which alerts the reader that the evidence presented is not necessarily specifically about chiropractic but about SMT in general as performed by any number of practitioners including but not limited to chiropractors. While this edit will clarify it for the reader, I still feel we are making a mistake by including general SMT research in an article specifically about chiropractic. However, at least with this qualifier in the beginning, we are not being intellectually dishonest (but perhaps a tad misleading). -- Levine2112 ^discuss 02:47, 9 April 2008 (UTC)

Thanks, good point, and I agree a qualifier is appropriate. But that's not quite the right place for it, since that clause introduces a bullet list that is not all about SMT. A better place is the previous sentence, which is about SMT, so I moved the "(not necessarily performed by a chiropractor)" qualifier to the previous sentence. Eubulides (talk) 05:10, 9 April 2008 (UTC)

As I said though, I think we would still be pretty deceptive leaving to include results of SMT in general as evidence of the efficacy of chiropractic adjustments specifically. I understand your point that the researchers aren't excluded data from non-chiropractors and then chiropractic groups go ahead and use this data to discuss chiropractic. However, some of these reviews do not draw conclusions about chiropractic specifically, yet here we are using it to describe the efficacy of chiropractic. To me, this seems to be a WP:OR violation. We have data "A" about SMT and we have a conclusion "C" about chiropractic adjustments; however, we don't seem to have data "B" which links SMT data from "A" to the chiropractic adjustment conclusion "C". It's a bit hazy, but I think it falls under WP:SYN. (I know that in some case we actually do have data "B" linking "A" and "C" - so this isn't meant for those cases.) -- Levine2112 ^discuss 17:19, 9 April 2008 (UTC)

The reviews in question are about chiropractic and yet they are sometimes giving conclusions about SMT. It is not SYN when the reviews we're citing are doing the synthesis, which is the case here. As long as we are careful to state when the conclusions are about SMT and when they are about something else (as the reviews do), we are simply reporting what the reviews say. I don't see how we could do better than that. The reviews typically do not use the phrase "chiropractic adjustments"; they use "SMT", and the draft text sticks to their terminology. Eubulides (talk) 22:41, 9 April 2008 (UTC)

I fail to see how we can include conclusions specifically about chiropractic from this review for instance, when this review makes no conclusions about chiropractic specifcally. It takes into account SMT done by other kinds of practitioners (as well as chiropractors) and it does not make any distinction in its conclusions. Sure, it is about chiropractic as you say. But it is also about osteopathy and many other disciplines which use forms of SMT. The results section doesn't mention chiropractic specifically at all. So how can we use these results of this review in our article about chiropractic specifically without violating WP:SYN? -- Levine2112 ^discuss 02:09, 10 April 2008 (UTC)

(outdent)

• #Effectiveness 1 says "SMT" when it is talking about SMT, and "chiropractic" when it is talking about chiropractic, so we're making every attempt to clearly identify which studies address which topic.
• It is not SYN to discuss the effectiveness of SMT when discussing the effectiveness of chiropractic: we are merely doing what chiropractic researchers themselves are doing. For example, Bronfort et al. 2007 (PMID 18164469) takes exactly the same approach: even though it focuses on SMT as opposed to chiropractic adjustment (for example, it cites Ernst & Canter 2006, the review we're talking about), it's extremely relevant to #Effectiveness 1, and it's written by and for chiropractors. #Effectiveness 1 cites Bronfort et al. 2007, and rightly so; that review should not be excluded merely because it focuses on SMT. Similarly for Ernst & Canter 2006.

Eubulides (talk) 07:03, 10 April 2008 (UTC)

I still think the distinction between SMT and chiropractic would be unclear to the reader of our article. Perhaps if we added "(not necessarily performed by a chiropractor) in each mention. Regardless, I maintain that using reviews of the effectiveness of SMT rather than chiropractic specifically in an article specifically about chiropractic is inappropriate. -- Levine2112 ^discuss 16:38, 10 April 2008 (UTC)

The whole point of the abbreviation SMT is to avoid article bloat, and to replace each use with "SMT (not necessarily performed by a chiropractor)" would seriously bloat the article. Instead, let's just carefully define SMT to make this point clear; I made this change to try to do this clearly. Eubulides (talk) 16:59, 10 April 2008 (UTC)

That's fine except that "spinal manipulation" is not precisely chiropractic's characteristic treatment. Rather, spinal adjustments are chiropractic's characteristic treatment. Spinal adjustments are merely a subset - a specific kind - of spinal manipulation. Whereas, many practitioners do spinal manipulation (that which is being reviewed in some of those studies), only chiropractors do (or should be doing) spinal adjustments. I think this needs to be made abundantly clear for the reader so that when they read our article and read about a review of "SMT", they will know that SMT is not chiropractic's characteristic treatment, but merely an umbrella term which includes chiropractic's characteristic treatment but also the treatments of other practitioners as well. I hope this is making sense (and I am sorry if I am being such a stickler about this, but I feel it is of paramount importance, lest we write an article which is intellectually misleading). -- Levine2112 ^discuss 17:25, 10 April 2008 (UTC)

Again, I'm afraid that reliable sources disagree with you. For example, the CCGPP literature synthesis on chronic low back pain uses the two terms interchangeably. For some purposes it may be useful to distinguish between spinal adjustment and spinal manipulation, and that topic sounds like it would be a good one for Chiropractic to take up somewhere, but for the purposes of #Effectiveness 1 reliable sources are saying that the distinction is not important enough to worry about. We should follow the lead of reliable sources in this area. Eubulides (talk) 21:00, 10 April 2008 (UTC)

I will try and make this very plain: Where in this review does it say that the results of studying spinal manipulations performed by osteopaths, chiropractors and other practitioners can be singularly applied to just measure the efficacy of chiropractic? -- Levine2112 ^discuss 22:15, 10 April 2008 (UTC)

The review in question is about SMT, just as other reviews cited in #Effectiveness 1 are about SMT. These reviews are focusing on SMT in order to get insight about chiropractic's principal treatment modality. Some of these reviews are written by and for chiropractors. It is unreasonable to exclude them: they are entirely on the point of the effectiveness of chiropractic treatment. We should not override the opinions of published experts in the field. Eubulides (talk) 06:56, 11 April 2008 (UTC)

You haven't answered my question. You did say, "These reviews are focusing on SMT in order to get insight about chiropractic's principal treatment modality." How do you know this? It appears to me that the insight is on SMT and not on chiropractic. (Remember, I am asking you specifically about this review.) SMT is not chiropractic's principal treatment modality; rather spinal adjustments are. While not wholly different, there are important differences. Too important for us to synthesize conclusions on chiropractic's efficacy from a general study on SMT. What we have written above is fine, but the most of it would be better suited for the spinal manipulation article, not this one. -- Levine2112 ^discuss 07:06, 11 April 2008 (UTC)

• We know that Ernst & Canter 2006 is relevant to getting insight about chiropractic because we have another reliable source, namely Bronfort et al. 2007 (PMID 18164469), a review article written by and for chiropractors, which says it's a relevant source.
• As far as effectiveness is concerned, "SMT" and "spinal adjustments" are interchangeable terms. We know that because we have a reliable source that says so, namely the CCGPP literature synthesis on low back pain. It is not synthesis to rely on reliable sources that use the two terms interchangeably.

Eubulides (talk) 08:19, 11 April 2008 (UTC)

I can't see the full text for Bronfort et al. as I didn't shell out the $30+ for it. Did you? Or do you have some other means by which we can all view the full-text. I am really looking for a reliable source which specifically states that the conclusions of Ernst/Canter 2006 general review of SMT efficacy literature is directly applicable for making a 1:1 statements about the efficacy of chiropractic specifically. Remember, this is not the article on "spinal manipulation" or "spinal adjustments". So relying on one source (Meeker) to make another source (Ernst) relevant to the chiropractic article create a WP:SYN violation, according to my understanding of this policy. -- Levine2112 ^discuss 17:41, 11 April 2008 (UTC)

That article is copyrighted and is not freely readable, I'm afraid. That review does not say anything specific like "It's OK to cite Ernst & Canter 2006 in a Wikipedia article about chiropractic." However, it does attempt to be a comprehensive review of its subject, and it is written by chiropractors and for chiropractors, and it cites Ernst & Canter at length (mostly in a critical way, obviously, as Bronfort et al. are supportive of chiropractic treatments). If it thought Ernst & Canter were irrelevant it would not have cited it. But it is quite relevant. It is not synthesis to use reliable sources that are on topic; clearly the effectiveness of SMT is a vital part of the story of the effectiveness of chiropractic, and Bronfort et al. and Ernst & Canter are not the only examples of this. Eubulides (talk) 18:04, 11 April 2008 (UTC)

I'm sorry, I just don't think that it is clear that the effectiveness of SMT as performed by practitioners other than chiropractor is a vital part of the story of the effectiveness of chiropractic. It seems tangential to main circle of this section of the article - Chiropractic's efficacy; and I don't believe that we have the sources to redirect this tangent back to the circle. That said, I think we are each guilty of going in circles here. We both understand each other's viewpoints on the matter, but we are just not seeing eye-to-eye. So perhaps it is better to just agree to disagree, and let us see if there is a consensus with the other editors either way. If that doesn't prove to be satisfactory, we can follow the other methods for dispute resolution. Sound reasonable? -- Levine2112 ^discuss 20:03, 11 April 2008 (UTC)

We are not here to second-guess the reviewers or reliable references. We are following there lead. Everything is relevant to this article. Thanks for your concerns anyhow. QuackGuru (talk) 20:20, 11 April 2008 (UTC)

We are not here to draw our own conclusions from two disparate pieces of research. That is by definition a WP:SYN violation, my oh my. -- Levine2112 ^discuss 20:26, 11 April 2008 (UTC)

It is inaccurate to say that #Effectiveness 1 is drawing its own conclusions from two disparate pieces of research. The research in question is summarized separately for each article. No conclusions are drawn by the Wikipedia editors. The summaries of the reviews are accurate, and the reliable sources themselves are making the association between chiropractic and SMT. The only question is whether this association should also be described in Chiropractic. There is a legitimate weight issue (how much discussion should be give to effectiveness and to SMT?), but there is no real SYN issue here. Eubulides (talk) 20:31, 11 April 2008 (UTC)

We have been following the references faithfully. This is the definition of NPOV. QuackGuru (talk) 20:34, 11 April 2008 (UTC)

No, that is not the definition of NPOV. Yes, we are following the references faithfully, but we are using some of them on the wrong article. Research about SMT should be on the SMT article. There maybe reliable sources making an association between chiropractic and SMT, but no reliable sources have been presented which state that the findings of Ernst general SMT review can be applied directly to measure chiropractic's effectiveness. Yet, this is what the current draft is doing. -- Levine2112 ^discuss 21:47, 11 April 2008 (UTC)

Bronfort et al. 2007 (PMID 18164469), a reliable source, does exactly that: it applies Ernst's general SMT review to the problem of measuring chiropractic's effectiveness. Eubulides (talk) 22:44, 11 April 2008 (UTC)

Can you please provide the quote(s) from Bronfort which state that the findings of Ernst general SMT review can be applied directly to measure chiropractic's effectiveness? Thanks. -- Levine2112 ^discuss 18:00, 14 April 2008 (UTC)

They don't state "it can be applied directly". They just apply it directly. It's part of a rather long discussion. Even the section that talks about Ernst and related sources is about 350 words, and you'd need more of the context to see the application. I'm afraid that even those 350 words is a bit much to just copy here, from that copyrighted source. Eubulides (talk) 09:12, 15 April 2008 (UTC)

How about you email it to me? It still feels like a WP:SYN violation to me. -- Levine2112 ^discuss 17:17, 15 April 2008 (UTC)

Other therapies

[outdent]If we are going to include effectiveness of 'chiropractic' then it would be chiropractic care which is more than SMT. So, that would include other therapies utilized in clinical practice such as exercise, mobilization, soft tissue massage, modalities (laser, IFC, TENS, US), patient education and other commonly used things in clinical practice. I believe the CCGPP and various clinical practice guidelines have already done a lit review and synthesis, so it could be as simple as listing their findings. Thoughts? EBDCM (talk) 17:21, 9 April 2008 (UTC)

Can you point us to research on the effectiveness of these therapies? -- Levine2112 ^discuss 17:23, 9 April 2008 (UTC)

The current draft does cover mobilization, laser, and education. It does not spend much time on things like TENS (as there's little reliable evidence, and what little there is argues against TENS), but if there's consensus to mention TENS etc. then we can do that as well. Hurwitz et al. 2008 (PMID 18204386) would be a source for that for TENS and neck pain, for example. Eubulides (talk) 22:50, 9 April 2008 (UTC)

That is a good example. We need to format this section better, however, and by the time we're done it will likely stand on it's own and we'll have to summarize it for Chiropractic mainly for brevity purposes. I think I nice way to organize the section would be to have subsection headers (Low Back/Neck, Upper Extremity, Lower Extremity, and Non-NMS or Special Populations (geriatrics, pediatrics, etc...) I also suggest that we develop a consensus that the "chiropractic care" of these conditions is not only limited to SMT/manip/mob/adjustment. For example, in a rotator cuff tear manipulation is not the main form of treatment but it is something encountered in clinical practice. CorticoSpinal (talk) 03:57, 10 April 2008 (UTC)

There is certainly enough material for a subarticle here, but that is a different (and larger) project. Currently, there's not enough material to justify stubby little sections, one per paragraph. There would be justifications for subsections if the material were expanded in a subarticle. #Effectiveness 1 cover treatments other than mobilization and manipulation, where reliable sources were found. If other sources can be found that coverage could be expanded. Eubulides (talk) 07:08, 10 April 2008 (UTC)

2008-04-08 changes to Effectiveness 1

I have made some changes and reference suggestions to the opening paragraph per our discussion here. My edits begin here and go for about 5 edits. I have added comments to help understand why the reference either seems not to be specific to chiropractic or if it doesn't seems to support the text it is attached to. Let me know how this works for you and I will begin to do the same with the rest of the text. -- Levine2112 ^discuss 20:31, 8 April 2008 (UTC)

Thanks, I'll take a look at them one by one. Eubulides (talk) 21:18, 8 April 2008 (UTC)

(outdenting)

This change replaced "Spinal manipulation therapy (SMT)" with "Spinal adjustment". But the sources in this section almost invariably use the term "spinal manipulation". This is merely a terminological dispute, as the two phrases mean the same thing in practice (see Meeker & Haldeman 2002, PMID 11827498). In cases such as this it's better to use the term that the sources use, plus there's a conciseness advantage of the abbreviation "SMT", so I went back to "SMT", and added a wikilink to Spinal manipulation in case there's any confusion. If the topic of "spinal manipulation" versus "spinal adjustment" is important to Chiropractic, I suggest that it be put into a new Terminology section; that would be a better place for the issue than Effectiveness. Eubulides (talk) 21:29, 8 April 2008 (UTC)

Please compare spinal manipulation with spinal adjustment. There is a difference between the two concepts and thus often confused. In essence, spinal adjustment is a subset of spinal manipulation. The techniques, equipment and reasoning behind spinal adjustments is wholly different from say the spinal manipulation an osteopath administers. Chiropractors perform spinal adjustments which are alway spinal manipulation. However, spinal manipulation isn't always spinal adjustment. Therefore, we are doing a disservice by referring to chiropractic methodology as "spinal manipulation" and including research which is about the general spinal manipulation rather than the specific spinal adjustment. I will thus change it back above. -- Levine2112 ^discuss 21:38, 8 April 2008 (UTC)

What I took away from Spinal adjustment and Spinal manipulation is what Meeker & Haldeman 2002 (PMID 11827498) say, which is that it's merely a dispute about which term to use. Let's put it this way: if the two terms mean the same thing, then it doesn't matter (in terms of correctness) which Chiropractic uses; and if (contrary to Meeker & Haldeman 2002) the two terms differ, then we should use "spinal manipulation" in #Effectiveness 1 because that's what its sources are using. Eubulides (talk) 21:52, 8 April 2008 (UTC)

If they are the same, then why the two distinct articles? As I said, the techniques, equipment, and rationale used by chiropractors are wholly different from any other practitioner (osteopath, physical therapist, craniosacral therapist, etc.) Confound the efficacy of general spinal manipulation as performed by a host of other practitioners with the efficacy of chiropractic specifically would be tantamount to presenting our readers with intellectual dishonesty. -- Levine2112 ^discuss 21:58, 8 April 2008 (UTC)

I don't know why there are two distinct articles, but that doesn't matter here. Chiropractic should depend on reliable sources outside of Wikipedia; it should not use other Wikipedia articles as sources. The reliable sources mentioned in this discussion, including Meeker & Haldeman 2002 (PMID 11827498), say that there's no important difference between the terms. But even if there is a difference (which is dubious), that's even more of an argument that #Effectiveness 1 should be using the term "manipulation" rather than "adjustment", because #Effectiveness 1's sources say "manipulation" and not adjustment. It is inconsistent to argue that "manipulation" ≠ "adjustment", and then to substitute "adjustment" for "manipulation" when the sources say "manipulation". Eubulides (talk) 22:17, 8 April 2008 (UTC)

This change asked for a verification that the cited source supports the claim "Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective." The cited source (DeVocht 2006, PMID 16523145) says:

"Although by far most chiropractic treatment is given for back pain, it seems able to affect a broader range of conditions as shown in the following few examples. Second to back pain, chiropractors probably are best known for treatment of chronic headaches. Although not rigorously documented in large-scale, well-designed randomized control trials, as of 2001, there had been at least nine trials of various degrees of quality and size involving 683 patients with chronic headaches with reported clinical improvement.… Nevertheless, there are different views concerning the efficacy of chiropractic treatment, which is not surprising. Unfortunately, it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts despite the millions of papers that have been written about presumably scientifically sound studies. Because of this difficulty, numerous medical procedures have not been rigorously proven to be effective either."

Hope this suffices. I removed the request. Eubulides (talk) 21:41, 8 April 2008 (UTC)

Yes, this suffices. Thank you. That said, the wording can be improved, as now it is a bit confusing. I will work on it, when I return later. -- Levine2112 ^discuss 22:01, 8 April 2008 (UTC)

OK, I removed the fact tag. This change also brought back "SMT", as per the discussion above (it was changed back to "adjustment" without comment, perhaps inadvertently?) Further suggestions for improving the wording are welcome. Eubulides (talk) 22:28, 8 April 2008 (UTC)

This change asked for a citation for the "Many controlled studies" sentence, noting "citation doesn't discern chiropractic adjustment from osteopathic manipulation, etc." Thanks for catching that; it was an editing error as the sentence was previously after an SMT sentence where the context was SMT. I fixed the problem by adding an explicit "of SMT" to the sentence. Eubulides (talk) 22:38, 8 April 2008 (UTC)

This change planted a fact tag on the citation to Fernández-de-las-Peñas et al. 2006 (PMID 16596892) with the comment "doesn't discern chiropractic adjustment from spinal manipulation". The fix for the previous problem also fixed this problem, since it made it clear that the sentence is about SMT and not chiropractic treatment in general or chiropractic adjustment in particular. So I removed the tag. Eubulides (talk) 22:48, 8 April 2008 (UTC)

The same change planted a fact tag on the citation to Hawk et al. 2007 (PMID 17604553) with the comment "does this support this statement?". Hawk et al. say "First, the number of studies on chiropractic care and/or SMT and other manual therapies for patients with nonmusculoskeletal conditions is relatively small, and the quality of the studies is generally not high.". Also, the other citation for that sentence (Fernández-de-las-Peñas et al. 2006, PMID 16596892) says "There are few published randomized controlled trials analyzing the effectiveness of spinal manipulation and/or mobilization for TTH [tension-type headache], CeH [cervicogenic headache], and M [migraine] in the last decade. In addition, the methodological quality of these papers is typically low." Hope this helps. Eubulides (talk) 23:23, 8 April 2008 (UTC)

References in chiro.org

The references are gathered on pro-chiro sites. . .yes. . .however the references themselves are good. . . let us use them.TheDoctorIsIn (talk) 17:38, 6 April 2008 (UTC)

Some of those references may be good, but many are not. I happen to know a bit about Autism and that autism page was full of old and unreliable material touting dubious remedies and theories; this is exactly the sort of thing that Chiropractic should not be relying on. If there are any good references in there, as good as what is in #Sources for effectiveness, by all means let us know, but I quickly gave up looking for any wheat in all that chaff. Eubulides (talk) 04:37, 7 April 2008 (UTC)

Whiplash and other neck pain

• Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. and Combined interventions involving mobilization and exercises or supervised training and rehabilitation demonstrated short-term effectiveness when compared with conventional medical care or care involving physical modalities, collars, or simple advice or referral to exercise. and For other neck disorders without radicular signs or symptoms (Grades I and II), the evidence suggests that manual (manipulation or mobilization) and exercise interventions, LLLT, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of these treatments is clearly superior to any other in either the short- or long-term. and For both WAD and neck disorders without trauma, the evidence favors supervised exercise sessions with or without manual therapy over usual or no care. Of the manual therapies, manipulation and mobilization yield comparable clinical outcomes... the choice between mobilization or manipulation should depend on patient preference and There is evidence from one nonrandomized intervention study that a coordinated multidisciplinary management approach with active interventions were less costly than “usual care” for patients with acute WAD and There is consistent evidence from 3 RCTs that a neck exercise program alone or in combination with spinal manipulation was positively associated with reduced pain and disability in the short-term (6 to 13 weeks) in persons with subacute or chronic or recurrent neck pain when compared to spinal manipulation alone, TENS, or usual GP care. and There is consistent evidence from 4 RCTs that cervical spine manipulation alone or with advice and home exercises was not associated with greater pain or disability reduction in the short- or long-term in persons with subacute or chronic neck pain when compared with mobilization with or without traction, to strengthening exercises, or to instrumental manipulation.77,106,110,126,137

12. There is consistent evidence from 4 RCTs that mobilization or exercise sessions alone or in combination with medication was positively associated with better pain and functional outcomes in the short-term (4–13 weeks) in people with subacute or chronic neck pain when compared to usual GP care, pain medications, or advice to stay active. and There is consistent evidence from 4 double-blind placebo-controlled RCTs that LLLT [laser] was associated with improvements in pain and function in the short-term (10 days to 12 weeks) in persons with subacute or chronic neck or shoulder pain.

• For WAD, (a) mobilization and exercises appear more beneficial than usual care or physical modalities
• There is evidence from one RCT that therapeutic exercise with or without manipulation or mobilization was associated with fewer headaches and a better global outcome after 1 year in patients with cervicogenic headache when compared with no treatment.

• Slightly summed up. For WAD, educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities; for other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions. However, none of the active treatments is clearly superior to any other in the short- or long-term.

A lot of evidence here for neckpain, WAD, cervicogenic headache, etc. that should be added to the effectiveness section. That was all from Treatment of Neck Pain: Noninvasive Interventions, Results of the Bone and Joint Decade 2000-2010 Task Force, by Hurwitz et al. DigitalC (talk) 05:31, 7 April 2008 (UTC)

Currently, #Effectiveness 1 (under "Neck pain") sums up that source (Hurwitz et al. 2008, PMID 18204386) with this sentence: "A 2008 review found that many studies reported no significant difference in outcomes between patients using chiropractic manipulation and other therapies, such as mobilization or exercise." There are several other neck pain reviews to summarize, and although this one is high quality and the most recent, the other reviews should be summarized too. Plus, there are several other conditions to cover besides neck pain. Putting all the above text, or even just the "slightly summed up" version, would be overkill; Chiropractic#Effectiveness needn't discuss things like acupuncture and laser therapy. Can you suggest a replacement for that sentence that isn't quite as lengthy, but still addresses the concerns you raise? Thanks. Eubulides (talk) 06:13, 7 April 2008 (UTC)

You lost me. We are we not discussing things like acupuncture and laser therapy? Chiropractors use acupuncture and laser therapy as part of their treatment, as they do with mobilization and manipulation. This section is not supposed to be Spinal Manipulation#Effectiveness. The way it is worded above, ""A 2008 review found that many studies reported no significant difference in outcomes between patients using chiropractic manipulation and other therapies, such as mobilization or exercise." doesn't at all mention that manipulation, mobilization, and exercise are all more effective than usual GP care, medication, or advice to stay active. DigitalC (talk) 06:32, 7 April 2008 (UTC)

Sorry, I guess I got lost because Chiropractic doesn't mention laser therapy anywhere, and mentions acupuncture only offhand. Clearly Chiropractic#Treatment procedures needs a lot of work. But that's a different subject. In the meantime I made this change to #Effectiveness 1 to try to address the above-mentioned points. It seemed better to combine the neck pain and whiplash sections to accomplish this, so I did that too. Suggestions for further improvements are welcome (my own feeling is that the neck/whiplash bullet is now a bit long …). Eubulides (talk) 07:33, 7 April 2008 (UTC)

"For other neck disorders without radicular signs or symptoms (Grades I and II), the evidence suggests that manual (manipulation or mobilization) and exercise interventions, LLLT, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions". Somehow we left out manipulation/mobilization. DigitalC (talk) 07:57, 7 April 2008 (UTC)

I summarized "manual (manipulation or mobilization) and exercise interventions" as "manual and exercise interventions" in the 2008-04-07T07:33:34 UTC version of the proposed text, but perhaps that was too cryptic. I see now that QuackGuru later removed that bit entirely, perhaps confused by my rewording. I'll follow up under QuackGuru's "whiplash and neck pain section is too long" comment below. Eubulides (talk) 05:19, 8 April 2008 (UTC)

Currently, the whiplash and neck pain section is too long and is formatted a bit differently than the other sections. I will reformat and shorten the text. This will make it more focused and NPOV per WP:WEIGHT. So, I made this change. QuackGuru (talk) 19:34, 7 April 2008 (UTC)

The reformatting is fine, but alas, the shortening ran afoul of DigitalC's desire to include the results for non-whiplash neck pain. I attempted to work around the problem with this change; it lengthens the text a bit but I don't see an easy alternative if we want to mention those non-whiplash neck pain results. Eubulides (talk) 06:12, 8 April 2008 (UTC)

We also have still left out manipulation, and only included mobilization. Manual therapy is the term that the article uses to include both (even though manipulation is just a grade of mobilization). DigitalC (talk) 00:59, 10 April 2008 (UTC)

The text says "…SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives…". The "SMT" is manipulation, so the text has not left out manipulation. Eubulides (talk) 01:10, 10 April 2008 (UTC)

Apparently I need to read better! DigitalC (talk) 01:18, 10 April 2008 (UTC)

Scoliosis

This change inserted a reference to a low-quality pilot study whose conclusion does not match the inserted text. Let's stick with high-quality reviews rather than primary studies or pilot studies. I removed the text. Eubulides (talk) 05:53, 11 April 2008 (UTC)

Here are a couple of studies to review.[37][38] QuackGuru (talk) 06:10, 11 April 2008 (UTC)

Those are two references to the same study, no? But anyway, thanks, it's a much better source for the claim, so I reinstated the claim with this new source, with the claim reworded to match the source. Eubulides (talk) 07:09, 11 April 2008 (UTC)

The claim was DIRECTLY from the source Eubulides. We do not NEED to have high-quality reviews for things that are properly referenced, unless it is a contentious claim. However, thank you to QuackGuru for digging up a higher quality source. DigitalC (talk) 07:42, 11 April 2008 (UTC)

Sorry, I missed the claim in the source (it was in its background section, not the conclusion). Anyway, the point is moot now. Eubulides (talk) 08:22, 11 April 2008 (UTC)

Here is a study to review.[39] This study covers young scoliosis. QuackGuru (talk) 20:08, 11 April 2008 (UTC)

Thanks, but we needn't refer to that primary study, as the review we're already using (Romano & Negrini 2008, PMID 18211702) covers it. Eubulides (talk) 20:26, 11 April 2008 (UTC)

Currently, we have no mention of scoliosis in the young. QuackGuru (talk) 20:30, 11 April 2008 (UTC)

I think we'll just have to live with "adolescent" since that's what the review says. Referring to a primary study just to say the word "young" is a bit much. Eubulides (talk) 20:33, 11 April 2008 (UTC)

Okay. We will stick to the wording the latest review says and not the primary study. QuackGuru (talk) 20:41, 11 April 2008 (UTC)

Headaches

From Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJJ, Bouter LM. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001878. DOI: 10.1002/14651858.CD001878.pub2.. For the prophylactic treatment of migraine headache, there is evidence that spinal manipulation may be an effective treatment option with a short-term effect similar to that of a commonly used, effective drug (amitriptyline). for migraine,... & ...There were fewer side effects associated with spinal manipulation. For the prophylactic treatment of chronic tension-type headache, amitriptyline is more effective than spinal manipulation during treatment. However, spinal manipulation is superior in the short term after cessation of both treatments. for TTH, and for cervicogenic headache we have For the prophylactic treatment of cervicogenic headache, there is evidence that both neck exercise (low-intensity endurance training) and spinal manipulation are effective in the short and long term when compared to no treatment. There is also evidence that spinal manipulation is effective in the short term when compared to massage or placebo spinal manipulation, and weaker evidence when compared to spinal mobilization.. Currently we don't mention cervicogenic headache at all in Effectiveness 1. DigitalC (talk) 01:43, 10 April 2008 (UTC)

Interesting. Can you please provide a link to this research? Or is it something which we already have? If so, maybe draft up a sentence to include. -- Levine2112 ^discuss 02:12, 10 April 2008 (UTC)

Link. It is a cochrane systematic review. I wish I had saved that tool that turns any citation into a WP reference. DigitalC (talk) 03:54, 10 April 2008 (UTC)

This citation is currently summarized in #Effectiveness 1 under Headache as "Of three systematic reviews published between 2000 and May 2005, one found that SMT is as effective as other interventions, but others did not find conclusive evidence in favor of SMT." This summarizes the following text in the cited source: "Similarly, there are three systematic reviews of SM for headache. While Bronfort et al. concluded that SM is as effective as other interventions, the other two teams of reviewers did not find conclusive evidence in favour of SM." Eubulides (talk) 06:42, 10 April 2008 (UTC)

Given that the source article breaks it up into different types of headaches, I think this article should to. There is a big difference between a tension type headache and a cervicogenic headache.DigitalC (talk) 07:26, 10 April 2008 (UTC)

OK, I did that by adding a sentence summarizing Bronfort et al. 2004 separately. Eubulides (talk) 07:51, 10 April 2008 (UTC)

Problems with current Effectiveness draft

1. Too much weight on SMT; not on other Tx done in practice
   • The weight roughly corresponds to the weight given by the sources. It is true that sources focus more on the effectiveness on SMT. But this is understandable, given that SMT is the characteristic treatment of chiropractic, and has generated the most research. Eubulides (talk) 22:49, 10 April 2008 (UTC)
     • We have already in the treatment section a the most common treatment methods used in clinical chiropractic practice. We should do a much better job of representing the whole picture than isolating to SMT. CorticoSpinal (talk) 23:29, 10 April 2008 (UTC)

       • As Chiropractic#Treatment procedures makes clear, SMT is the most common treatment in chiropractic care and it is the characteristic chiropractic treatment. It is entirely appropriate for an effectiveness section to spend considerable time on SMT. #Effectiveness 1 does not isolate to SMT; it covers other treatment forms. Eubulides (talk) 06:03, 11 April 2008 (UTC)

       • This basically ties into my chief complaint; that studies not specific to chiropractic are being used her to make specific statements about chiropractic efficacy. For instance, where in this review does it say that the results of studying spinal manipulations performed by osteopaths, chiropractors and other practitioners can be singularly applied to just measure the efficacy of chiropractic? I don't believe it does. Yet we are currently applying it in such a way. IMHO, this is a WP:SYN violation. -- Levine2112 ^discuss 01:02, 11 April 2008 (UTC)
         • #Effectiveness 1 is following the lead of high-quality reviewers (both critical and supportive of chiropractic) in using results of studies from other practitioners to gain insight into the effectiveness of SMT for chiropractic care. It is not synthesis if we are saying what the experts themselves say. On the contrary, we should not exclude their reviews, as that would be substituting our judgment for that of the experts. Eubulides (talk) 06:05, 11 April 2008 (UTC)
           • • QFE "into the oeffectiveness of SMT for chiropractic care". This should really be effectiveness of SMT, in the SMT article. DigitalC (talk) 07:25, 11 April 2008 (UTC)
               • Sorry, I don't know what "QFE" means. It's entirely appropriate to have a summary of the effectiveness of chiropractic's main and characteristic treatment modality here. A longer treatment would be appropriate for the SMT article. Eubulides (talk) 07:36, 11 April 2008 (UTC)
                 • QFE = quoted for emphasis. Chiropractic's main and characteristic modality is spinal adjustments, not SMT. There are differences in technique, philosophy, instrumentation, procedure, etc. Unless the reviewers are stating that their studies of general SMT is directly applicable to chiropractic spinal adjustment specifically, we cannot synthesize that it is. -- Levine2112 ^discuss 17:48, 11 April 2008 (UTC)
                   • We have a reliable source on effectiveness saying it's merely a difference in terminology and does not matter for effectiveness. We have no reliable sources on effectiveness saying otherwise. The difference may matter for other purposes (e.g., for chiropractic philosophy), but it does not matter here. It is not synthesis to use what reliable sources say. Eubulides (talk) 18:07, 11 April 2008 (UTC)
                     • Without the individual reviews or studies stating that their conclusions about general SMT directly corresponds with the efficacy of chiropractic, then I don't see how we can say it does without violation WP:SYN. It seems pretty textbook to me. We have source A drawing a conclusion about SMT as performed by practitioners other than chiropractors. Then we have one source B saying that SMT and chiropractic's spinal adjustment are the same thing. So then we conclude that the conclusions from A about SMT must be the same conclusion about spinal adjustments as per source B saying that SMT and spinal adjustments are the same. Off that we write our statement C in this Wikipedia article specifically about chiropractic. (A + B = C) = WP:SYN violation. I think I have explained this before and I think I understand (but don't agree) with Eubilides rationale why it isn't a WP:SYN violation. Thus, I recommend we see what others have to say or we move forward with some other form of dispute resolution. -- Levine2112 ^discuss 20:11, 11 April 2008 (UTC)
                       • Source B does not merely say that SMT and spinal adjustment are the same thing. Source B goes on to give lots of advice to chiropractors about SMT/spinal adjustment, using the assumption that they're the same thing, and using data taken from both chiropractors and non-chiropractors. This is not an unusual thing. It is standard practice in the recent literature, and it's done by more than one study (these are just two examples). What recent reliable sources are saying is that the distinction between "spinal adjustment" and "spinal manipulation" is no longer relevant for effectiveness studies. It is not synthesis to report what these sources are saying, which is all that #Effectiveness 1 is doing. It does not report anything that is not in the sources. Eubulides (talk) 20:39, 11 April 2008 (UTC)
                         • Source B does not state that the specific findings of Source A can be applied to chiropractic. (Source A doesn't even state that its specific findings can be applied to chiropractic.) Source B may give us some general information which could allow us to make the leap that the conclusions of Source A can be applied to directly chiropractic, but therein lies the WP:SYN issue. By presenting the findings of Source A here at chiropractic, we are effectively saying that they are directly applicable to chiropractic even though we don't have a source stating that the conclusions of Source A are directly applicable. Look, I understand your position. And I think by now you must understand mine. Let's agree to disagree and wait for others' input, or let's proceed with some other dispute resolution method. -- Levine2112 ^discuss 21:40, 11 April 2008 (UTC)
                           • Source B (Bronfort et al. 2007, PMID 18164469) applies the specific findings of Source A to chiropractic. They don't make a big deal about it (they don't say, "Look! We are referring to a study that talks about SMT, even though we are chiropractors and are giving advice to chiropractors!"). They just do it. They do state that Source A is about SMT, but that's it. This is standard practice in reliable sources (it happens a lot more than with just Source A and Source B), and we can and should do likewise. Eubulides (talk) 22:22, 11 April 2008 (UTC)
2. Most "reviews" listed are from mainstream med rather than preferably from chiropractic researchers (the experts in chiropractic care and related conservative therapies)
   • It is a Wikipedia requirement to fairly represent all majority (mainstream med) and significant minority (chiropractic and CAM) viewpoints, roughly in proportion to the prominence of each view. Every effort was made to find recent reliable reviews from both supportive and critical sources. It would be contrary to Wikipedia policy to suppress mainstream opinion on this subject. Eubulides (talk) 22:49, 10 April 2008 (UTC)
     • The article in question is Chiropractic. The majority viewpoint Medicine should not dictate or overrule the minority viewpoint. According to this policy, any mainstream med viewpoint would squash any CAM viewpoint. Also, we are talking about a profession here, one that has a long, complicated and often contentious history with allopathic medicine. The number of "reviews" in medicine will clearly outweigh the number of reviews published by chiropractors which is easily explained by the discrepancy in the numbers of schools, practitioners and funding opportunities. We should use evidence-based syntheses that have been provided by the CCGPP, CCA-CFCRB and other documents that have direct expertise in the area of chiropractic. As it stands right now, this has not occured. CorticoSpinal (talk) 23:29, 10 April 2008 (UTC)
       • That analysis is backwards. Articles that talk about a minority viewpoint (to take an extreme example: Flat Earth) are not supposed to push that minority viewpoint. That is why Flat Earth emphasizes the majority viewpoint that the earth is round: this is standard Wikipedia policy. Chiropractic is about a minority health-care viewpoint. Chiropractic is a much more significant viewpoint than flat-earthers are, of course, but it's still clearly a minority. By standard Wikipedia policy, chiropractic should be presented as a minority viewpoint, fairly and neutrally, with the mainstream medical viewpoint also being covered with appropriate weight. #Effectiveness 1 attempts to do that: if anything, it gives critics of chiropractic too little weight. Eubulides (talk) 06:16, 11 April 2008 (UTC)
         • I disagree. An article on Chiropratic should and must have greater emphasis on chiropractic. Chiropractic should not be a "minority" viewpoint on it's own article and allopathic medicine's POV should definitely not "overrule" or have equal weight. The insinuations that "mainstream med" has too little weight is not factual; in fact that same argument has already been raised at safety and vaccination which are already NPOV in terms of weight issues. Also, comparing Chiropractic to Flat Earth, I mean, really? 208.101.118.196 (talk) 20:47, 11 April 2008 (UTC)
           • Obviously Chiropractic is supposed to be about chiropractic; that's not the issue here. The issue is whether the effectiveness of chiropractic should be covered from the mainstream point of view. And WP:NPOV is quite clear here: the mainstream viewpoint is the preferred one for Wikipedia. Flat Earth came from WP:NPOV: it's not intended to mean any disrespect to chiropractic, it's merely the standard example for discussing POV issues like this. Eubulides (talk) 20:57, 11 April 2008 (UTC)
             • The effectiveness of chiropractic should represent the mainstream view of CHIROPRACTIC not mainstream medicine. Globally, the "mainstream" in chiropractic are "mixers". We have the literature base now to "stand on our own" and we don't need to push the mainstream med POV because we have the appropriate sources and literature now on our own. Not to see mainstream can't have it's 2c, of course it should, but to be given so much weight here... that's the heart of the issue. Perhaps the issue is too big for Chiropractic Talk and there might be a better venue for it. CorticoSpinal (talk) 22:17, 11 April 2008 (UTC)
               • This proposal is contrary to Wikipedia policy, which is to present mainstream viewpoint fairly and in proportion to its overall weight. Flat Earth does not present flat-earth theories primarily from the viewpoint of dominant flat-earth society; it presents them from the mainstream viewpoint that the earth is round. Chiropractic should be similar. Eubulides (talk) 23:21, 11 April 2008 (UTC)
                 • This comparison is completely invalid. Evidence-based, peer reviewed research by chiropractic PhDs is not even remotely similar to Flat Earth in any way shape or form. This is a red herring argument. Please provide justification that evidence based mainstream medicine POV trumps evidence based chiropractic POV in Chiropractic. Furthermore it is not contrary to any wikipedia policy. If anything this is a form of scientific opression of the one medical culture over another. That's not right, fair, just or warranted. Also, who is to say the mainstream view fairly and accurately portrays chiropractic? In other words, why does mainstream medical expert opinion/research TRUMP expert chiropractic opinion/research in Chiropractic. Are you suggesting that medical professions are the experts of chiropractic now? CorticoSpinal (talk)
                   • Wikipedia policy is that minority views, such as chiropractic, can be spelled out in great detail in articles specifically devoted to these views, but these articles must make appropriate reference to the majority viewpoint. This is not "scientific oppression": it's merely reporting mainstream scientific and medical opinion with the appropriate weight. Saying that only chiropractors can be expert on chiropractic is like saying only flat-earthers can be expert on Flat Earth; it is a recipe for not giving proper weight to the majority viewpoint, which is contrary to Wikipedia policy. Eubulides (talk) 08:34, 13 April 2008 (UTC)
                     • First of all, Chiropractic is not a minority view, it is a profession. The majoirty viewpoint here is not medicine, it is science. However, that is a moot point, since it has not been demonstrated what the majority viewpoint is WITHIN medicine. Ernst is not the majority viewpoint within medicine, he is a minority view critic. DigitalC (talk) 00:13, 14 April 2008 (UTC)
                       • • • I don't know of anyone in the literature who claims that Ernst is a minority-view critic. By "chiropractic views" I meant sources about chiropractic effectiveness that are written by and for chiropractors; these generally are more favorable towards chiropractic. I agree that the majority viewpoint here is mainstream science; for health care this includes mainstream medicine. The sources for #Effectiveness 1 were chosen without regard to whether they came from chiropractic or other sources, using standard scientific search techniques such as Google Scholar. Using these techniques, Ernst ranks quite highly: for example, Google Scholar reports that Ernst & Canter 2006 (PMID 16574972) is cited 29 times, whereas (for example) Hoskins et al. 2006 (PMID 17045100), the only supportive-of-chiropractic source cited in #Effectiveness 1 that also happens to be published in 2006, is cited only 3 times. Eubulides (talk) 08:00, 14 April 2008 (UTC)
                         • That was possibly the most brilliant statement that summarizes this case! Checkmate, Eubulides. Science shall have the floor. Now that the chiropractic profession has nicely developed its evidence base over the past 25 years, we will use scientific chiropractic literature, first and foremost in chiropractic. Allopathic scientic POV will and must be represented but not the the extend where a) it trumps and outweighs scientific chiropractic POV b)a credible chiropractic source shall be given at a MINIMUM the same weight a credible allopathic source and c)no allopathic source(s) should be used to determine the professional identity of the autonomous profession of chiropractic that is self-regulated and is licensed in over 60 countries. 208.101.118.196 (talk) 02:35, 14 April 2008 (UTC)
                           • Credible sources should be given similar weight, of course. However, sources should not be emphasized or preferred simply because their authors happen to be chiropractors. I'm not sure what is meant by "determine the professional identity" here; this thread is about effectiveness, not about scope of practice. Eubulides (talk) 08:00, 14 April 2008 (UTC)
3. Ernst POV pushing
   • Ernst's critical reviews should not be suppressed; they should be fairly represented. The current draft does not push Ernst's POV; only a small amount of the text relies on Ernst, and most of this text is not controversial. If anything, Ernst's viewpoints are underrepresented in the current draft. Eubulides (talk) 22:49, 10 April 2008 (UTC)
     • Ernst is a very polarizing figure and I certainly disagree that his views are under-represented (in fact I'd say the opposite). Nevertheless, it's not very "fair" to have Ernst studies be included and not have studies which refutes his "conclusions".

   • But #Effectiveness 1 does cite studies that claim to refute Ernst's conclusions. For example, it cites Bronfort et al. 2007 (PMID 18164469), which explicitly claims to refute Ernst & Canter 2006 (PMID 16574972). Perhaps you haven't followed the citations in the existing draft carefully enough? Eubulides (talk) 06:22, 11 April 2008 (UTC)
   • In the current draft, Ernst's opinions are cited 12 times! I think we should draw from a wider breadth of researchers to avoid at least the appearance of lending too much weight to anyone. -- Levine2112 ^discuss 01:11, 11 April 2008 (UTC)

   • Hawk et al. 2007 is cited 20 times, far more than Ernst's 10. But both of those figures are inflated because most of those citations are to individual phrases like "bedwetting" in the last bullet item. A fairer measure is the amount of text supported by Ernst. By my count, 113 of the 614 words in the current #Effectiveness 1 are supported only by Ernst. It's not at all out of line to give 18% of the space to the leading mainstream medical critic of chiropractic. If anything, mainstream medicine, being the majority viewpoint, should get more space than that.
   • Additional sources are welcome, if they are as high-quality as the existing ones.

   Eubulides (talk) 06:39, 11 April 2008 (UTC)

   • This is sort of misleading. a) Hawk talks about a variety of different conditions in her review whereas Ernst focuses only on SMT. Fairer measure? According to whom? We can't go by words; we can have 200 words saying DCs effective and then 3 to negate it "DCs are quacks". This is not a good measure to use. Furthermore, this reinterates my point that there seems to be Ernst POV pushing as he has now cropped up in safety many times and now effectiveness. How many times are we going to quote the same individual saying the same thing in different sections? 208.101.118.196 (talk) 20:52, 11 April 2008 (UTC)

   • Ernst 2008 does not "focus only on SMT". He does focus primarily on SMT, true (as does Hawk et al.), but that's appropriate for chiropractic. Perhaps you're confusing Ernst 2008 with a different Ernst study? Anyway, there's nothing in #Effectiveness 1 that says DCs are quacks: it's merely reporting what reliable reviews say, and it neither says nor implies anything about quackery. It is certainly not unreasonable to give the critical side here; it would be unreasonable to completely ignore critical reviews. Eubulides (talk) 21:27, 11 April 2008 (UTC)

   • I was using "DCs are quacks" as an example how 3 words could undermine 300 words before it. So, using a count (118 words) and percentages (18%) to describe the "effect" of mainstream meds opinions (which can be very harsh and very misleading which is my main beef with all Ernst articles) does not accurately represent the true "weight" of the words. CorticoSpinal (talk) 22:17, 11 April 2008 (UTC)

   • Fair enough, but none of the words in question are anything like "DCs are quacks". They're all fairly bland, just like the words used elsewhere in the section. A word count is a rough measure, but it's a reasonable one in this case. Eubulides (talk) 23:23, 11 April 2008 (UTC)

   • We don't know that Ernst is the leading mainstream medical critic of chiropractic nor to we know if his criticisms reflect the mainstream opinion of the efficacy chiropractic. For instance, the esteemed University of Maryland Medical Center states: Chiropractic has been shown to be effective for acute and chronic low back pain, neck pain, headaches (including migraines), frozen shoulder, tennis elbow and other sports injuries, and carpal tunnel syndrome, and may be helpful for otitis media (ear infection), digestive problems, menstrual and premenstrual pain, and asthma. We can find similar text published by the University of Pennsylvania and on other various prestigious medical sites on the web. How are we not to know that this is more in line with the mainstream medical opinion of chiropractic's efficacy? Why are we relying so heavily on one critic? -- Levine2112 ^discuss 17:56, 11 April 2008 (UTC)

   • Those two sources, as esteemed as they are, are merely information web pages. They are not as reliable as peer-reviewed journal articles. One is dated 2003 and cites no sources; the other is dated 2002 and cites sources ranging from 1993 to 2002, mostly primary studies. These are far inferior to the sources used in #Effectiveness 1, which are newer, are reviews, are published in peer-reviewed articles, and are far more comprehensive. If we were to rely on just information web pages like that in #Effectiveness 1, there would be thousands of sources available, whose conclusions would range all over the map. This is not a good way to produce a high-quality article. As per WP:MEDRS, we should prefer recent peer-reviewed journal articles, primarily secondary sources like reviews. Relying on obsolescent information web pages is a big step down in quality from that. And when we look at recent high-quality reviews, we see Ernst mentioned often. (We don't see the authors of those information web pages.) Eubulides (talk) 18:19, 11 April 2008 (UTC)

   • • Completely disagree here, and again, it precisely illustrates my point: an editor who decides unilaterally what is acceptable for inclusion, the argument being primary studies. Well, if it's a good study, it's a good study, period. I sense a bit of righteousness here in the argumentation. Obsolescent? From 2002? Common. More Ernst again? This is more ammunition that supports claims of an Ernst POV push. Ernst is only notable to allopaths, there is not much respect there from chiropractic academics (DC/PhDs) who seriously question the intellectual honesty of his work. It's also a gross misrepresentation of mainstream chiropractic and focuses on the more overzealous subluxation-based DCs and their belief system which forms the minority viewpoint. I would hope that you listen a source who has a bit more insight into this issue. CorticoSpinal (talk) 22:17, 11 April 2008 (UTC)

   • The criteria are not mine; they are taken from WP:MEDRS, guidelines that represent a consensus that is good for Wikipedia and produces better articles. 2002 is pretty old; it's older than any of the sources used in #Effectiveness 1. It's quite clear that Ernst is controversial among chiropractors, but that does not mean his work should be ignored: it's published in high-quality journals and gets cited often. Eubulides (talk) 23:27, 11 April 2008 (UTC)

   • 2002 is old? According to who? 2002 is still a fairly recent study. DigitalC (talk) 02:13, 13 April 2008 (UTC)

   • The item dated 2002 is not a study; it's just a web page. And yes, a web page that hasn't been updated for six years is pretty old. Anyway, I don't think anybody is seriously arguing that that web page is as good a source as what's in #Effectivness 1, so this point is not relevant to what sources should be in #Effectiveness 1. Eubulides (talk) 08:34, 13 April 2008 (UTC)

   • We are sidestepping the point here. "We don't know that Ernst is the leading mainstream medical critic of chiropractic nor to we know if his criticisms reflect the mainstream opinion of the efficacy chiropractic." - Those sources may not be RS for effectiveness, they are reliable in talking about themselves. DigitalC (talk) 00:19, 14 April 2008 (UTC)

   • It's easy to see that Ernst is the leading mainstream medical critic; just do a Google Scholar search; he writes a lot of papers and his papers get cited a lot. And he is certainly not alone in his criticisms; it's easy to find other medical authors who agree with him (many who use stronger criticisms than he does). But we don't have to decide whether Ernst is the leading critic in order to write this section. All we need to do is to consult reliable sources using standard techniques. Ernst's name pops out (along with other sources), so we use him. We certainly shouldn't avoid him merely because he is so vehemently opposed by chiropractors. Eubulides (talk) 08:00, 14 April 2008 (UTC)

4. Listing of conditions such "infectious disease" "parasistic disease" and "cancer" treatments is highly inappropriate as they are not even in the top 1% of conditions treated by DCs. Dedicating this much space and (misleading the public) that these are somehow routinely treated in practice should be rectified (by suggesting Type O or using another word to replace all those conditions listed which does not accurately reflect the state of practice circa 2008)
   • The text does not state that these conditions are routinely treated in practice. The list of conditions included cancer pain, not cancer itself. This list was taken from a reliable source. I just now checked, and a different source (Hawk et al. 2007) also mentions cancer pain, so it does appear that cancer pain is worth mentioning. Hawk et al. 2007 do not mention infectious or parasitic disease, though, so let's drop that. I noticed several other conditions (e.g., vision problems) mentioned by several papers cited by Hawk et al. 2007; when there were 5 or more papers I added a mention of those conditions. Here's the resulting change I installed. Eubulides (talk) 22:49, 10 April 2008 (UTC)
     • Treating pain syndromes as a palliative measure is appropriate but it should be described as such. Otherwise readers are left to assume that SMT is being applied to treat parasitic diseases and that's not right. We don't need the whole list, we certainly don't list the more common conditions treated in chiropractors offices' in the effectiveness part, so why dedicate a list to something that less than 1% treat? CorticoSpinal (talk) 23:29, 10 April 2008 (UTC)

   • #Effectiveness 1 says "cancer pain" not "cancer". That's pretty clear, but if someone can suggest something clearer that doesn't require a lot of words, that would be helpful.
   • #Effectiveness 1 no longer mentions parasitic disease; that's been taken out in response to earlier comments.
   • Generally speaking, the conditions mentioned in #Effectiveness 1's Other bullet have five or more research papers published recently, as counted in Hawk et al.'s review, or they have at least one high-quality paper (e.g., a RCT). This represents notable interest in chiropractic treatment of that condition. Even if it were true that only 1% of chiropractors treat (say) middle ear infection, there is significant interest in that treatment when there are so many papers published about it, making it a legitimate topic here.

   Eubulides (talk) 06:50, 11 April 2008 (UTC)

   • CorticoSpinal has made an excellent point here. This also ties back into my chief complaint with the safety issue - How is it that we give so much space to a risk which is only estimated to be 0.000002%? That's seems like a WP:WEIGHT violation. Similarly, dedicating space to discuss the effectiveness of chiropractic in treating something only a fraction percent of chiropractors claim to treat seems like another WP:WEIGHT issue. -- Levine2112 ^discuss 01:06, 11 April 2008 (UTC)

   • Safety is a different matter, which was discussed at length earlier; I'd rather not reopen that can of worms in this thread. Let's start a new thread for it, please, if the topic is worth reopening.
   • The weight given to (say) middle ear infection is appropriate, I think: it's only 3 words representing (by Hawk et al.'s count) 8 research articles including 1 RCT which (according to Hawk et al.) was "promising for the potential benefit of manual procedures for children with otitis media". Eubulides (talk) 07:17, 11 April 2008 (UTC)

   • So long as its discussed properly I don't have a problem with listing the 3-5 common non NMS conditions treated by a minority of DCs. CorticoSpinal (talk) 22:38, 11 April 2008 (UTC)

5. Sources selected and used are without consensus; this has been a topic of debate before and perhaps we can take this to the appropriate venue to get clarification. We should not have only 1 editor deciding unilaterally what is "good" and "inclusion worthy" research. To truly move forward we should get to the bottom of the issue via arbitration if necessary.

   • This greatly mischaracterizes the process used to select the sources. A call for sources with an initial cut went out a month ago. Significant discussion followed, and resulted in substantial additions to the list. This process took quite some time. The text of the proposed section itself was not drafted until three weeks later.
   • The standards used for selecting sources were the same as with any other high-quality medical article, as per the Wikipedia guidelines in WP:MEDRS.
   • It is premature to talk about arbitration, as we are still making progress in coming up with a consensus.

   Eubulides (talk) 22:49, 10 April 2008 (UTC)

   • I was suggesting a neutral discussion forum where we can get input from non DCs and MDs. Also, your reply doesn't address my concern that high quality articles are routinely passed over. When discussing Chiropractic we should not dismiss high quality literature because it is not a secondary source. The literature base by DCs does not have the same funding as MDs consequently we are left with primarily an allopathic viewpoint. Also, I had mentioned before that guidelines are just that guidelines, and not strict rules and we allows for interpretation. For example, it has been written before that the Cassidy et. al study on SMT and stroke should not be included because it is a primary source whereas Ernst should be included because it is a secondary source. Looking at the 2 papers though we can clearly see that Cassidy et al. has much more depth, breadth and covers 7 years of data compared to Ernst which does not and could easily be suggested as cherry picking strictly allopathic journals. If we cannot resolve this disagreement here, then we should go to an arbitration site where we can lay down our case and get an outside opinion. CorticoSpinal (talk) 23:29, 10 April 2008 (UTC)

   • The previous comment suggested "arbitration". I was hoping we could avoid it by coming to a consensus here. If we can't do that, then I suppose we can go through the usual Wikipedia procedures when editors cannot come to a consensus. I'd far rather come to a consensus, though.
   • No high-quality articles have been passed over in the drafting of #Effectiveness 1, as far as I know. Editors have suggested further articles, and the good ones have gone in. Just in the past few hours, for example, a lower quality pilot study on adolescent scoliosis (Rowe et al. 2006, PMID 16923185) was inserted here), and it was soon replaced with a much higher quality review (Romano & Negrini 2008, PMID 18211702), suggested here. Further high-quality articles are welcome, of course. Eubulides (talk) 07:32, 11 April 2008 (UTC)

   • Again, I think no harm can come from at least considering a wider breadth of sources. This way we can fairly represent all significant POVs. -- Levine2112 ^discuss 01:12, 11 April 2008 (UTC)

   • Further high-quality sources are welcome, of course. Eubulides (talk) 07:32, 11 April 2008 (UTC)

6. Effectiveness section is not present in Medicine Osteopathic Medicine Naturopathic Medicine. Remember we are discussing a profession and not just a modality. For example, what is the "effectiveness" of "medicine"? It's a very broad topic and trying to condense it and limit it to SMT does not represent WP:NPOV. We must have some kind of consistent standard across all alt med/conventional med articles and professions. Chiropractic is too hazardous to be experimenting with highly contentious issues without proper precedents. Comments are welcome. CorticoSpinal (talk) 17:51, 10 April 2008 (UTC)
   • Effectiveness is an important and legitimate topic for Chiropractic. The current draft does not limit the topic to SMT. It is true that some other Wikipedia articles lack proper coverage of effectiveness, but others (e.g., Homeopathy) do a better job, and at any rate we should not let shortcomings in other articles dictate a shortcoming in this one. Eubulides (talk) 22:49, 10 April 2008 (UTC)
     • Again, we are discussing the effectiveness of a profession as the title currently stands. We should either change the title to SMT and accordingly move this discussion to the SMT talk page or we broaden it to accurately reflect what conditions are treated by what modalities in clinical practice. I would hesitate to use the word shortcoming; the article would still be highly informative without this section in the main article per se. CorticoSpinal (talk) 23:29, 10 April 2008 (UTC)
       • • #Effectiveness 1 spends considerable time on treatment modalities other than SMT. It gives primary place to SMT, which is appropriate, but it covers all chiropractic treatment forms for which we have reliable sources. It would be entirely inappropriate to move #Effectiveness 1 to the SMT page; its topic is the effectiveness of chiropractic care, and it is entirely appropriate for Chiropractic. Eubulides (talk) 07:50, 11 April 2008 (UTC)
       • I basically agree with CorticoSpinal on this one. We are spinning our wheels by attempting to discuss the "effectiveness" of a whole profession, when only individual techniques and methods can properly be the subject of an "effectiveness" discussion. It would save a whole lot of effort and avoid alot of unpleasant discussions if effectiveness was only dealt with on the article devoted to each technique. Then we can simply state that chiropractors use this, that, and another technique, and wikilink each one. Then readers can hop over to those articles and find an "effectiveness" section in each one. By simply dropping the whole line of discussion on this matter here, we can sidestep an issue that shouldn't be under discussion here. Save such discussions for each of those articles. -- Fyslee / talk 01:11, 11 April 2008 (UTC)
         • • #Effectivness 1 does not talk about the effectiveness of a profession; it talks about the effectiveness of the treatments used by that profession. It is entirely appropriate to discuss effectiveness in this area, which is controversial largely because mainstream medical opinion is that chiropractic treatment is ineffective in many cases. Obviously it would "simplify" things for editors if we bypassed this contentious subject, that that's not the right way to write an encyclopedia: the subject should be discussed here, where it's highly relevant. Eubulides (talk) 07:50, 11 April 2008 (UTC)
             • Disagree, and so do many other editors now. So now we're finally getting at the heart of the issue which is "mainstream medicine" finds chiropractic treatment (what, SMT?) ineffective. So, why does manipulation appear in the allopathic physicians practice guidelines? It seems like there's increasingly an attempt to disproportionately cite mainstream opinion and bypass expert chiropractic research; mainly on the grounds of "primary studies" Interestingly enough, article like Cassidy et al get omitted whereas Ernst gets to stay based on this very rigid interpretation of WP:MEDRS (does it apply to CAM?) guidelines rather than using discretion which many editors here favour. CorticoSpinal (talk) 21:14, 11 April 2008 (UTC)
               • It's not clear what you're disagreeing with here, exactly. No attempt has been made to "disproportionately cite mainstream opinion". Mainstream opinion is what it is, and Wikipedia policy is that it should be given greater weight. Cassidy et al. (PMID 18204390) is not about effectiveness, so it's not relevant to this part of the discussion. Chiropractic should be using the highest-quality sources available; we should not switch to lower-quality sources to override parts of higher-quality sources that we disagree with. Eubulides (talk) 21:45, 11 April 2008 (UTC)
                 • • Just so I get this right: It is wikipedia policy that suggests that mainstream allopathic medicine (i.e. Western/conventional/mainstream medicine) gets a bigger say in all CAM articles because it is the dominant POV? So, in the Chinese version of wikipedia, does this still count, that Chinese Medicine is the minority POV? Also, Cassidy et al. was used to provide a useful example how a defining study is passed over and described as "lower quality" whereas Ernst is described as "higher quality". So, now, not only is there more POV pushing in the sense of a gross omission, but the situation would never be rectified as the sheer number of allopathic schools and practitioners will always dominate the number of DC schools and DC practitioners. That's not right; it's a form of supression and censorship. I could see if I was bringing a web page to the table, but to pass over and exclude such an important article like Cassidy et al is to the chiropractic community and providers of manipulative therapy? Hmmmm... CorticoSpinal (talk) 22:38, 11 April 2008 (UTC)
                     • Yes, you have it right: articles are supposed to be written with the mainstream viewpoint in mind, obviously with alternative viewpoints fairly represented. Cassidy et al. was omitted from the safety section for good reason, which was discussed earlier: it's a primary study that had a high-quality review and citing the review sufficed. It is a bit of a stretch to call the standard Wikipedia NPOV policy a form of censorship. Eubulides (talk) 23:33, 11 April 2008 (UTC)
                       • Actually I didn't say that the standard NPOV policy was a form of censorship. Please do not misrepresent my statements in the future; I have asked you twice already within the last few days. Nevertheless, the censorship in question has to do with the deliberate omission of high quality research by experts in VBA and manipulation, namely Cassidy et al. (2008) and Haldeman (2008) et al. Their expertise is excluded in any meaningful manner in Chiropractic:Safety whereas a non-expert in chiropractic such as Ernst gets included? I'm not even suggesting we remove Ernst, I suggest we INCLUDE Haldeman and Cassidy. This is proper wikietiquette and your outright refusal to include these articles is puzzling and precludes any meaninful collaboration between editors here. CorticoSpinal (talk) 06:23, 13 April 2008 (UTC)
                         • • What you wrote was "the sheer number of allopathic schools and practitioners will always dominate the number of DC schools and DC practitioners. That's not right; it's a form of supression and censorship." This appears to be arguing that mainstream opinion has an unfair advantage because it's, well, mainstream. But that's Wikipedia policy: it is supposed to reflect mainstream opinion.
                           • There is no need to refer to a primary study if it has been summarized by a high-quality review, which was the case here. Reaching down and grabbing primary studies that one likes is a recipe for introducing bias, and for good reason is recommended against in WP:MEDRS. But to repeat, these safety studies have nothing to do with effectiveness, this thread's topic. Eubulides (talk) 08:34, 13 April 2008 (UTC)
                             • Then it is agreed that we shall present in full the summaries findings. Because as currently written, we're reporting 1 of the 5 conclusions. The reason why this stuff in being repeated in different threads is of because WP:TEND tendentious editing practices from the mainstream POV. It's been happening for 2 months now, and has occurred with vaccination, safety and now this aborted section. To be clear, the mainstream opinion will and has always been presented, but we will accurately and fairly describe the papers of leading chiropractic researchers. So, the science will have the majority view, and the argument that medicine's majority status trumps chiropractic minority status is moot. The science value and quality of research from of Cassidy et al. and Haldeman et al., the 2 leading experts in manipulation and VBA dissection epidemiology will have their views fully and completely represented because they represent the chiropractic profession. CorticoSpinal 208.101.118.196 (talk) 02:25, 14 April 2008 (UTC)
                               • Without knowing what specific change is being proposed here, it's hard to indicate agreement or disagreement. I suggest that the change, whatever it is, be proposed in a different section in the talk page. This thread is about effectiveness, not safety. Eubulides (talk) 08:00, 14 April 2008 (UTC)
         • I tend to agree that this may be the best route to go; discuss efficacy per each article of each technique. Chiropractic is too broad of a profession perhaps to discuss the efficacy of it on the whole. As I mentioned before, much of the SMT data we have collected would probably be better suited for the spinal manipulation article anyway. In turn, some of the specific chiropractic research would be better suited for the spinal adjustment article. -- Levine2112 ^discuss 01:17, 11 April 2008 (UTC)
           • • I disagree that chiropractic is too broad a profession to discuss the efficacy of its treatments. #Effectiveness 1 is a counterexample to that claim. Eubulides (talk) 07:50, 11 April 2008 (UTC)
               • I disagree with your assessment. What is the efficacy of Physical Therapy for example? I mean, DCs and PTs treat MSK conditions (there's a lot of them) and let's take anterior shoulder pain for example. DDx can include tendonapathy/osis, paratendonitis, bursitis, instability, capsulitis, bursistis, inflammatory conditions/OA, strain, sprain, impingement syndromes, periostitis, referral from cervical spine or myocardial infarction, disc herniation, cholecystitis, pancoast tumour, subclavian steele syndrome, etc... This is what we're dealing with in clinical practice. All these DDx have their own prognosis and plan of management attached. POM can include, but not limited to, myofascial release/soft tissue work, reflex inhibition techniques, mobilization/manipulation, physiotherapeutic modalities, acupuncture, ergonomic advice, nutritional advice, functional rehab exercises, etc... This is just for anterior shoulder pain. So, clearly there's a problem in reasoning that suggests that chiropractic is "not too broad" to judge the efficacy of Tx. If we're genuinely interested in doing this let's include the findings of the CCGPP since they've already done all the work in terms of appraising the evidence and making specific recommendations re: which treatments are the most effective. After all, they are clinical practice guidelines. CorticoSpinal (talk) 21:04, 11 April 2008 (UTC)
                 • #Effectiveness 1 already cites the CCGPP findings at length and gives their effectiveness results all the way down to the "fair" level. What more is needed? Eubulides (talk) 21:32, 11 April 2008 (UTC)
                   • We must not be reading the same document then. Perhaps I could take a stab at it? CorticoSpinal (talk) 22:38, 11 April 2008 (UTC)
                     • #Effectiveness 1 is above. It's citing Ernst 2008, which is here: Eubulides (talk) 23:36, 11 April 2008 (UTC)
           • I agree as well, and I think the same could be said about the safety section. DigitalC (talk) 03:01, 11 April 2008 (UTC)
             • • It's completely unreasonable to move important sections away from this article under the guise that chiropractic is a "profession". The important thing about chiropractic is that it treats people. Do the treatments work? This is a basic question that should not be sidestepped here. Eubulides (talk) 07:50, 11 April 2008 (UTC)
                 • Precisely. If we were discussing "do chiropractic treatments work?", sure, that may be fine. But the current efficacy draft is wrapped to much in discussing if general SMT (as performed by a whole host of other practitioners other than chiropractic) works. It is inappropriate for this article. Studies which would be more appropriate here are those measuring the results of patients going through the entire chiropractic experience (such as the Manga and Workmen's Comp studies). No one is doing anything under any guises nor are we sidestepping; rather we are wanting to have that question (Does chiropractic work?) discussed fairly here. Relying on studies which do not discern an osteopathic procedure from a chiropractic adjustment is simply inappropriate. -- Levine2112 ^discuss 18:03, 11 April 2008 (UTC)
                   • SMT is the characteristic and main mode of treatment of chiropractic; it is entirely appropriate for an effectiveness section to focus on its effectiveness; that's what the sources do. The current draft spends about a third of the text specifically on SMT; this is not out of line for the main treatment modality. The Manga and Workmen's Comp studies are old and have serious problems and are superseded by these more recent reviews, which are of much higher quality. It is not inappropriate to use evidence from various disciplines; that's what our reliable sources are doing. Eubulides (talk) 18:29, 11 April 2008 (UTC)
                     • Manga and Workmen's Comp studies have serious problems? I buy that they may be older, but what are the serious problems? It is inappropriate to use evidence from various disciplines' use of SMT to make statements about chiropractic's efficacy specifically if the sources themselves are not making statements about chiropractic's efficacy specifically but rather just SMT in general as performed by various disciplines. -- Levine2112 ^discuss 20:16, 11 April 2008 (UTC)
                       • They rely on old data. Really old data. That's enough. That is a serious problem, and it's enough to exclude them from the section on effectiveness, regardless of the other problems they have. At this point they are purely of historical interest. Let's put it this way: they are not cited by the 2007 CCGPP literature synthesis on low back pain. Or by the Bone and Joint Decade 2000–2010 review of neck pain treatments. These reviews cover hundreds of sources, but those two old sources don't make the cut. They shouldn't make the cut in Chiropractic either, for the same reason, unless they're of historical interest, in which case they're fodder for Chiropractic#History. Eubulides (talk) 20:50, 11 April 2008 (UTC)
                         • I can concede this point, but there are 2004 studies and an updated report than could be mentioned that will supplement the "really old data". CorticoSpinal (talk) 22:38, 11 April 2008 (UTC)
             • Spinal manipulation already has a safety section which is more than redundant compared to what is in this article. And again, it begs to question why are we discussing the safety of a procedure used by many general kinds of practitioners using studies that encompass many general kinds of practitioners in an article about the chiropractic profession specifically? -- Levine2112 ^discuss 03:23, 11 April 2008 (UTC)
               • Chiropractic#Safety is a brief summary of safety issues; Spinal manipulation#Safety is a much longer section. It is normal and usual to have briefer summaries in a more-general article; it would be unreasonable to remove the brief summary entirely from the more-general article. Eubulides (talk) 07:50, 11 April 2008 (UTC)
                 • It is not as brief as it ought to be. Two are three paragraphs is too long. One paragraph would be enough. -- Levine2112 ^discuss 18:15, 11 April 2008 (UTC)
                   • It started out being shorter. I agree it could be shortened somewhat compared to what it is now. But we are starting to stray from the topic, which is effectiveness. Eubulides (talk) 18:32, 11 April 2008 (UTC)

I agree mostly with all of these comments in terms of problems we need to address before taking this section "live". In terms of 6, it is also worthy of noting that Medicine Osteopathic Medicine and Naturopathic Medicine don't have a safety section either. -- Levine2112 ^discuss 22:18, 10 April 2008 (UTC)

Which is why I bring my concerns here. It seems like Chiropractic is getting some kind of double standard. How Medicine has no safety section is completely beyond me. However I can imagine the protests if I were to want to add that section there. All I would like to see is a degree of consistency being applied including WP:WEIGHT issues. I feel that safety still has weight issues but it's getting better. I'd like to see some relative risk added; specifically comparing SMT (for mechanical pain syndromes) to say, NSAIDs which are commonly used for pain control as well. When you start comparing the numbers, I think the weight issue will become painfully (no pun intended) obvious. CorticoSpinal (talk) 22:28, 10 April 2008 (UTC)

• Again, shortcomings in other articles should not mean that Chiropractic should have similar shortcomings. Many medical articles have effectiveness sections: for example, Homeopathy, Vaccine, and Vision therapy have effectiveness sections. And many other articles (for example, Treatment of Tourette syndrome) may not have a separate effectiveness section but they do discuss effectiveness at length under several treatment modalities.
• Coverage of effectiveness is more appropriate when there is significant interest in effectiveness, which is certainly the case in chiropractic.

Eubulides (talk) 22:57, 10 April 2008 (UTC)

• I disagree that there are shortcomings in chiropractic. The examples listed above are types of therapy, not professions. Where is the effectiveness in Physical Therapy, Osteopathic Medicine, Medicine, Veterinary Medicine? They are also all professions and are more representative and accurately reflect the argument being made. That is, one should not reduce a profession to a modality and secondly, one cannot measure the effectiveness of a profession. Hence the comparison of Chiropractic to Vision Therapy is not a logical one. CorticoSpinal (talk) 23:29, 10 April 2008 (UTC)

• Homeopathy is not a profession? That claim would be surprise to many homeopaths. It is entirely appropriate for Homeopathy to talk about effectiveness, just as it is entirely appropriate for Chiropractic to do so. Eubulides (talk) 07:53, 11 April 2008 (UTC)

• Point noted on homeopaths; but that's still a red herring. The main questions are can we judge the effectiveness of an profession, and no other profession has an effectiveness section attached to it, probably because you can't judge effectiveness of a profession. For example, what is the effectiveness of Medicine or Physical Therapy? The wrong question is being asked and it's being approached in the wrong manner. Significant interest from whom? 3rd party payers? You? Mainstream medicine? CorticoSpinal (talk) 21:20, 11 April 2008 (UTC)

• Homeopathy is not a red herring; it's an illustration of why an effectiveness section is more important for controversial treatment philosophies. As far as mainstream medicine is concerned, homeopathic treatments must be ineffective, as they're just water. So it's right and proper for Homeopathy to have a huge section on effectiveness, written mostly from the mainstream viewpoint. Chiropractic has a lot more mainstream credibility than homeopathy does, but it still has a serious and significant issues with effectiveness, so it deserves a good-sized section—not as long as Homeopathy, but long enough to do the controversial topic justice. The significant interest comes not only from me, but (more importantly) from readers. Chiropractic's effectiveness is an important issue here, and should not be swept under the rug. Eubulides (talk) 21:54, 11 April 2008 (UTC)

• Yeah it is, Homeopathy is the exception to the rule and homeopaths aren't even regulated in North America so the comparison is unfair and moot. So, how may I assume that you know the readers wishes? What the readers want, is a fair, accurate, balanced and professional article. No one is suggesting we sweep it under the rug; rather we're (many editors) that we move the discussion to the appropriate page and not under the guise of "chiropractic" effectiveness. Perhaps a limited blurb on effectiveness could be included with safety and then contrasted with NSAIDs as to not mislead the readers and imply that manipulation in general and chiropractic care overall is not as safe as conventional treatment. Because that's simply not the case according to the research. Also, in order to gain a FULL perspective on something we need to contrast it at times with other approaches. Accordingly, we should look at what common medical management is as well for common conditions treated by chiropractors so that the readers know their options and where the evidence lies. Shall we go this route? CorticoSpinal (talk) 22:38, 11 April 2008 (UTC)

• I don't see any problems with the current Effectiveness. This article has many shortcomings, including lack of Effectiveness, Cost-benefit, Minority groups, an updated lead to respresent the body of the article, and more missing things that make this article below Wikipedia's standard for a good article (GA). QuackGuru (talk) 02:35, 11 April 2008 (UTC)

From WP:GACR:

It is broad in its coverage. In this respect, it:

(a) addresses the major aspects of the topic;[3] and

(b) stays focused on the topic without going into unnecessary details (see summary style).

So why do you think we need more unnecessary details (such as nonexistent minority groups) taking away from the focus to qualify for GA? -- Levine2112 ^discuss 03:16, 11 April 2008 (UTC)

The minority viewpoint (reformers and objective straights) is necessary in order to qualify for a GA per WP:WEIGHT. QuackGuru (talk) 05:37, 11 April 2008 (UTC)

Of course "nonexistent" is still OR. Why keep repeating it? Even if they were nonexistent, their viewpoints are still very much alive, and one of these days the "reform" POV may become the mainstream chiro POV. It happened in osteopathy. -- Fyslee / talk 05:56, 11 April 2008 (UTC)

Perhaps, but Wikipedia is not a crystal ball. -- Levine2112 ^discuss 07:09, 11 April 2008 (UTC)

Perhaps indeed. Wikipedia is not a crystal ball to determine that the known minority groups no longer exist. They do exist, just in small numbers. That's why they are called minority groups. Agreed? QuackGuru (talk) 20:13, 11 April 2008 (UTC)

I don't agree. Either does WP:WEIGHT: Articles that compare views should not give minority views as much or as detailed a description as more popular views, and will generally not include tiny-minority views at all. -- Levine2112 ^discuss 20:18, 11 April 2008 (UTC)

I expressed my opinion on this a while ago, but in case people have forgotten, I agree with Levine2112 that the two groups in question are not currently notable enough to be included. We have some reason (not reliable sources, admittedly) to think the groups are no longer active, and we have no reliable sources saying they are active. Nonexistent groups are "tiny-minority" by anybody's standard.... Eubulides (talk) 21:01, 11 April 2008 (UTC)

Are we there yet?

No additional specific changes have been made. Therefore, we can add the Effectiveness section to the article now. Mr.Guru^Speak! 19:30, 8 April 2008 (UTC)

No. There is still much discussion going on above in which you are welcome to participate. Please don't insert the Effectiveness section until these discussions have been resolved. Thanks! -- Levine2112 ^discuss 20:14, 8 April 2008 (UTC)

I think were are there now. Consensus has been achieved. QuackGuru (talk) 00:21, 10 April 2008 (UTC)

Consensus has been achieved? People have been posting about alterations to this section within the last few hours. WP:DEADLINE - There is no rush to have this inserted, we are not trying to beat another publisher to a deadline, so why don't we work to make this a section that everyone is happy with? DigitalC (talk) 01:10, 10 April 2008 (UTC)

Are you happy now? QuackGuru (talk) 01:22, 10 April 2008 (UTC)

No consensus yet. I am getting closer to approving it, but I still have some unanswered questions and issues above. I concur with DigitalC; there's no rush. -- Levine2112 ^discuss 02:02, 10 April 2008 (UTC)

I have tried to catch up (whew!) and provide answers for those questions. If I missed any questions please let me know. Eubulides (talk) 07:10, 10 April 2008 (UTC)

Getting there. I have a suggestion above in SMT vs. Chiropractic. -- Levine2112 ^discuss 16:41, 10 April 2008 (UTC)

Thanks, I responded to that suggestion here, and I think that improved the #Effectiveness 1 draft. Eubulides (talk) 07:57, 11 April 2008 (UTC)

There are many questions unanswered and concerns above. I don't see a resolution in the near future which will please everyone. However, there does seem to be a growing consensus to move our work on efficacy to article more directly related such as spinal manipulation or spinal adjustment. -- Levine2112 ^discuss 18:06, 11 April 2008 (UTC)

I have attempted to answer all the questions inline above. What have I missed? I disagree that there is a growing consensus to move the effectiveness work to other articles. Effectiveness is core issue of chiropractic, it's the main reason the subject is so controversial, and the existing material on effectiveness in Chiropractic is much lower quality and is blatantly pro-chiropractic in its POV. This problem needs to be addressed here, not ignored here. Eubulides (talk) 18:35, 11 April 2008 (UTC)

When I say that there is a growing consensus, I am merely referring to the fact that there are now four of the six regular editors who are in support of moving the effectiveness content to the various technique articles, rather than keep it at this article. Perhaps we can do as we have done with Chiropractic#Safety; provide a summary of efficacy and link out to the various technique articles. -- Levine2112 ^discuss 20:21, 11 April 2008 (UTC)

There are far more than six regular editors, and (given the recent edit wars) there are clearly more than two editors who favor #Effectiveness 1 in its current form, or something very close to it. I would support trimming the effectiveness section somewhat, but it would not work to move it all to various technique articles; that would make Chiropractic far less useful to the casual reader who wants to know whether chiropractic is effective. #Effectiveness 1 was written at the suggestion of just such a reader, who later commented that #Effectiveness 1 is the sort of thing he was looking for. We should be striving to make the article useful for readers, even if that requires more work for editors. Sweeping controversial bits under the rug into other articles, where they'll be much harder to find, is not the right way to help the reader. Eubulides (talk) 21:13, 11 April 2008 (UTC)

• "Effectiveness is core issue of chiropractic, it's the main reason the subject is so controversial". However, you cannot determine the effectiveness of a profession. SMT is not chiropractic, and although I don't have the sources to back it up, I would believe that soft tissue therapy is used as much by chiropractors as SMT is. Now, if you want to determine the effectiveness of each treatment procedure used by chiropractors (SMT, STT, LLLT, US, IFC, Vibration therapy, etc. etc. etc.), for each condition they are used for (IE - is SMT effective for low back pain? is STT effective for lateral epicondylitis, is ultrasound effective for plantar fasciitis) then that would work, however those effectiveness sections really belong on the article for the respective treatment.DigitalC (talk) 02:24, 13 April 2008 (UTC)

• That's precisely the point I'm trying to make in the section below. Please comment there (preferably duplicate your excellent comment). -- Fyslee / talk 03:02, 13 April 2008 (UTC)

• Agreed. This is getting rather redundant and it look like there is a fundamental problem here. That is, we have a misunderstanding that we can judge effectiveness of professions. It's not done; and we've already provided examples that it's not done in any other mainstream medical profession and most of CAM. There's really no need to keep going this route; since the arrival of our resident medical expert we have had to endure controversial section after section after section (vaccination, safety, effectiveness) which was exposed to be to get the allopathic/medical POV in here which has more of less fanned the flames at chiropractic. We're making this article evidence-informed but the evidence if there, should come from Chiropractic experts and research first and foremost so long that it meets inclusion guidelines. Mainstream med can have it's say too; but not override or overrule but this trend of omitting high quality citations unilaterally determined by an editor when there are more scientific POV editors in agreement is not right. It's time for our medical editors to understand the concept of cultural relativism in a professional medical sense. A mainstream, evidence-based med POV should NEVER overrule or have more weight/influence than mainstream evidence-based chiropractic POV. That is exactly what is occuring right now and it's a terrible precedent to be setting up that somehow mainstream western medicine can impose it's majority status and concepts of health to other professions especially if that profession has a peer reviewed research base to draw from. CorticoSpinal (talk) 03:22, 13 April 2008 (UTC)

• I agree there is repetition here. I'll follow up in #An appeal: Drop the "effectiveness" discussion below. Eubulides (talk) 08:34, 13 April 2008 (UTC)

Effectiveness is a main issue of chiropractic and all the relevant text is core to this article. Partisan refs from chiro advocates has no place in this article when higher quality peer-reviewed journals exist. QuackGuru (talk) 06:33, 13 April 2008 (UTC)

Nah, this argument is bunk. Editors are presenting [WP:RS|peer-reviewed journals]] just not only allopathic ones. This point is moot anyways as there is majority consensus amongst the regular editors here that the section should be either suspended and moved to the more appropriate venue (namely SMT and/or respective modality articles). Thanks for your input though. CorticoSpinal (talk) 06:43, 13 April 2008 (UTC)

Again, I'll follow up in #An appeal: Drop the "effectiveness" discussion below. Eubulides (talk) 08:34, 13 April 2008 (UTC)

Efficacy and cost-benefit

A 1999 study stated, "Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements)."

A 2001 study states, "Ultimately, the acceptable level of risk associated with a therapeutic intervention also must be balanced against evidence of therapeutic efficacy. Therefore, further research is indicated into both the benefits and harms associated with cervical spine manipulation. Practitioners of this technique should be called on to demonstrate the evidenced-based benefit of this procedure and to define the specific indications for which the benefits of intervention outweigh the risk."

A 2003 study concluded, "Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy."

A 2006 study states, "the risk-benefit balance does not favour SM over other treatment options such as physiotherapeutic exercise."

A 2006 study concluded, "Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful, although chiropractic may result in a greater likelihood of perceived improvement, perhaps reflecting satisfaction or lack of blinding. Physical therapy may be more effective than medical care alone for some patients, while physical modalities appear to have no benefit in chiropractic care."

A 2007 study concluded, "Adverse events may be common, but are rarely severe in intensity. Most of the patients report recovery, particularly in the long term. Therefore, the benefits of chiropractic care for neck pain seem to outweigh the potential risks."

Spinal manipulation for the lower back appears to be relatively cost-effective.

Future studies are needed to properly evaluate spinal manipulation's efficacy. Chiropractors believe spinal manipulation is an effective procedure when compared to conventional medical approaches.

Efficacy and cost-benefit comments

Here is some info to review for a future section. This can be summarized and improved. According to Levine we should have info about efficacy. I agree. QuackGuru (talk) 03:16, 6 April 2008 (UTC)

As it stands that section needs a lot of work. It's just a string of quotes; it should be a section written by Wikipedia editors. It cites some older sources and some primary studies; it should focus on recent reviews. Perhaps the first thing to do for that section is to come up with a good list of sources. Please see #Sources for risk-benefit and cost-effectiveness for a first cut at a list of sources. Eubulides (talk) 05:41, 6 April 2008 (UTC)

Animal/Veterinary Chiropractic

Perhaps we can work on a less contentious subject; namely the application of spinal manipulation to pets. DCs and DVMs, with the appropriate training are licensed to do this (depending on various state/provincial legislations) and it seems to be getting more popular and mainstream nowadays. If there's no objections, I can start to compile a list of sources and relevant sites/materials. I just think that it would be best to take a log off the fire and work together on something a less controversial. EBDCM (talk) 17:36, 9 April 2008 (UTC)

I wouldn't normaly describe what could be argued to be animal curealty to be less controversial.17:55, 9 April 2008 (UTC)

That sounds interesting and I would love to see some source describing the nature of such work, the state of affairs in regulating/practicing, and any research available. Depending on the breadth of information available, this could even warrant its own article (Veterinary Chiropractic perhaps). -- Levine2112 ^discuss 17:57, 9 April 2008 (UTC)

I think a small section here would be appropriate and if it mushroomed we can make it into its own article. I think it's noteworthy as the are more and more DCs and DVMs getting certified in providing manual therapy to animals. — Preceding unsigned comment added by EBDCM (talk • contribs)

Cool. Let's see what you find in terms of sources. -- Levine2112 ^discuss 18:24, 9 April 2008 (UTC)

Sources for veterinary chiropractic

Older sources

• Taylor L (1995). "The American Veterinary Chiropractic Association". Can Vet J. 36 (9): 559. PMID 7497418.

Newer sources

• Sullivan KA, Hill AE, Haussler KK (2008). "The effects of chiropractic, massage and phenylbutazone on spinal mechanical nociceptive thresholds in horses without clinical signs". Equine Vet J. 40 (1): 14–20. PMID 18083655.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Links & Misc

• http://www.cmcc.ca/CE/AnimalChiropractic.htm
• http://www.cco.on.ca/standard_of_practice_s-009.htm
• http://www.veterinarychiropractic.ca/programs.htm
• http://72.14.205.104/search?q=cache:slYHk-Azr38J:www.dora.state.co.us/OPR/archive/2002AnimalChiropractorsSunrise.pdf+animal+chiropractic+regulation&hl=en&ct=clnk&cd=10&gl=ca
• http://www.ncbi.nlm.nih.gov/pubmed/12516938?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
• http://131.170.40.30/browse;ID=MC030;STATUS=A?QRY=path%3D%22Study%3Bat%3BRMIT%2FTypes%3Bof%3Bstudy%2FPostgraduate%3BPrograms%22%20INTEREST%3D%22SCIENCE%22&STYPE=PROGRAMS

Commentary on sources for veterinary chiropractic

Here is a new section to get things started. Happy editing! QuackGuru (talk) 18:56, 9 April 2008 (UTC)

Not so much research yet, but more resources... more to come after work. CorticoSpinal (talk) 21:17, 9 April 2008 (UTC)

Would it be more appropriate to have a small section devoted to this growing field or should it suffice under scope of practice? CorticoSpinal (talk) 19:31, 15 April 2008 (UTC)

Probably a brief mention under Scope of Practice with a link to stubbed article Veterinary chiropractic. -- Levine2112 ^discuss 19:52, 15 April 2008 (UTC)

Done, I started Veterinary chiropractic perhaps you can peruse it and suggest essential elements that should appear in the main chiropractic article. CorticoSpinal (talk) 00:31, 16 April 2008 (UTC)

Tremendous work! I would presume that the lead of that article (or some tightened version of it) would fit nicely in this article. -- Levine2112 ^discuss 03:07, 16 April 2008 (UTC)

Veterinary chiropractic also known as Animal chiropractic, is an emerging specialization which consists of the medical application of spinal manipulation, primarily used for common neuromusculoskeletal conditions. Here is a sentence. QuackGuru (talk) 03:19, 16 April 2008 (UTC)

I think that's nearly perfect, except I would like to see a minor mention of the specific credentials a Veterinarian chiropractor must for accreditation and/or licensure. Assuming I was a casual reader of the chiropractic article (kind of hard for me to assume, but I'm trying) that nugget of information abut the licensure would be most helpful as that's all I'd basically want to know on the surface about Veterinary chiropractors while reading the Chiropractic article in its entirety. -- Levine2112 ^discuss 03:52, 16 April 2008 (UTC)

POV issues: April 11/08

We have about 4 days before the article becomes unlocked and seem to spinning our wheels on effectiveness right now. I suggest the more pressing concern is identifying significant POV issues that were raised previously and dealing with these first. As the article stands right now, are there any remaining holes that we could come to a consensus on first? I'd like to see

• Education include a passage that reflects the various degrees obtained from various countries, not only the DC (DCM) from North America. It might be also worth mentioning a quick note about the various specializations (neurology, orthopedics, rehab, clinical sciences, etc..)
• Scope of Practice to include common areas of clinical practice and controlled acts permitted to DCs (diagnosis, imaging/lab rights, assessment techniques, etc CorticoSpinal (talk) 04:26, 11 April 2008 (UTC)

A pressing issue would be to end the discussion of "effectiveness" of chiropractic, as you (and I, and Levine2112) suggested above. That would free up everyone's minds to deal with other things. -- Fyslee / talk 04:41, 11 April 2008 (UTC)

I suggest we create a "things to do list" in order for Wikipedia editors to focus on what they believe or understand is missing from this article. QuackGuru (talk) 05:15, 11 April 2008 (UTC)

Agreed with Fyslee on this. Let's cut bait on effectiveness, finish up outstanding POV issues that had been brought up before then revisit effectiveness later on if there's still a strong demand that it be included here.

Here's a quick draft of a to-do list:

• Chiropractic's current coverage of effectiveness is extremely poor. The topic of effectiveness is important, but it is addressed only in Chiropractic#History, which refers to a bunch of outdated reports that give only the pro-chiropractic viewpoint. #Effectiveness 1 is a high-quality proposal for fixing this. We should not give up on covering effectiveness in Chiropractic: it's a central issue.

• Disagree, again it's preferable if we do not consistently use false dichotomies in describing material as "pro" or "against" chiropractic. It seems to be a central issue for some allopathic practitioners. We should either do effectiveness well (i.e. give the appropriate weight to chiropractic experts, i.e. DC/PhDs) or we desist from spinning our wheels trying to count words and justify an unusually heavy push to including the "majority" allopathic viewpoint which, given it's long, tumultuois, complicated and at times down right nasty history with chiropractic, more undue weight. By this logic, CAM viewpoints should be represented in mainstream medicine, but it is not. CorticoSpinal (talk) 21:43, 11 April 2008 (UTC)

• No false dichotomies have been presented. Some reviews are more favorable to chiropractic, and some are less. Effectiveness is one of the central issues for chiropractic, not just for "some allopathic practitioners", but for anybody who's seriously considering chiropractic treatment or who wants to know more about how chiropractic works. The current #Effectiveness 1 draft gives significant weight to reviews by DCs. It is not reasonable to exclude mainstream opinion, or even to diminish it: it should be given its proper weight as per standard Wikipedia guidelines. Eubulides (talk) 21:58, 11 April 2008 (UTC)

• I would please ask that my argument is not misrepresented. I have never, not once advocated to exclude mainstream medical opinion. I have suggested that it's POV should not be the dominant POV in Chiropractic just as it would be inappropriate to make Chiropractic or CAM in general a dominant viewpoint in Medicine. Also, I'm curious if we are misunderstanding what guidelines are. It's my understanding that they allow for a degree of flexibility and discretion, unlike a protocol for example. So, given that we are talking about guidelines, we have the editorial flexibility and responsibility to use our judgment when including articles. I'm afraid that citing WP:MEDRS and "secondary sources" does not address the fundamental issue here and I hope that it's not being used to omit valid sources that add much needed content to the article. CorticoSpinal (talk) 23:16, 11 April 2008 (UTC)

• #2008-03-12 issues list contains several important problems with the POV in the current article. Many of these have been fixed and are struck out, but some of the biggest ones still remain. Chiropractic#History, in particular, is a highly partisan section that will need considerable change in order to become neutral.

• We cannot rewrite history. Whether our allopathic editors like it or not, there was an active campaign to discredit, supress, contain and eliminate chiropractic by the allopathic community. The two have been at odds since the beginning. There is still some lingering resentment despite a nice thawing over the last 15-20 years. I don't know how we could possibly sugar coat medicine's historical involvement with chiropractic and make it look neutral, let alone a "good guy". Facts are facts. We should however, clean up Manga, BMA, AMA and stuff so that it's clearer, more concise and reflects a historical stance as opposed to something more current. What about VA programs, limited hospital integration, etc? The sources for integrative medicine could be included in a "Present" section that contrasts history and we could give many examples of collaboration between the 2 professions which would bring us to modern times that reflects a thawing in relations. CorticoSpinal (talk) 21:43, 11 April 2008 (UTC)

• There is no suggestion to rewrite history, and the active campaign should be described. However, the current description of that campaign is entirely from the chiropractic viewpoint, and that is clearly POV and should get fixed. It is needed possible to cover heated battles in a relatively neutral way; this is regularly done in other parts of Wikipedia. Eubulides (talk) 22:01, 11 April 2008 (UTC)

• So I'm clear, are you suggesting that the current version is not accurately describing the historical "battle" between chiropractic and medicine? Because I see a quote there that suggests that DCs were an unscientific cult which seems to describe pretty much the thought of the day from mainstream med. CorticoSpinal (talk) 23:16, 11 April 2008 (UTC)

• There should also be a risk-benefit / cost-benefit section.

• This not a vaccine here, it's a profession. Where are these sections in Medicine, Physical Therapy, Osteopathic Medicine, Naturopathic Medicine, Chinese medicine? We should not use Chiropractic as an experiment; it's too contentious of an article to be "trying out stuff". CorticoSpinal (talk) 21:43, 11 April 2008 (UTC)

Eubulides (talk) 08:08, 11 April 2008 (UTC)

• We have some reliable sources on risk-benefit and cost-benefit of chiropractic treatment; we can use them. We should be striving for what's best for this article. Settling for a substandard article simply because the subject is contentious, or because other articles have similar problems, is a recipe for continued mediocrity. Eubulides (talk) 22:04, 11 April 2008 (UTC)

• You mean the mediocre Chiropractic the A class article or do you mean the more mediocre B class Medicine? What's best for this article is to let chiropractic experts have their full say and not squash their literature because it does not meet an arbirtrary guideline that is being rigidly interpreted. CorticoSpinal (talk) 23:16, 11 April 2008 (UTC)

• Chiropractic#Safety is far too bloated to essentially say that chiropractic is safe (or that it has a 0.000002% chance of fatality. In my book, it is just easier to say it is extremely safe and move on with it.

• Serious adverse effects are rare, but their incidence rate is not known; the 0.000002% figure is not reliable. The existing text does say that chiropractic treatment is generally safe. It could be shortened somewhat, but just saying "chiropractic is extremely safe" is too short and does not address the real concerns that people have. Eubulides (talk) 18:41, 11 April 2008 (UTC)
• How are the Ernst stats more reliable, especially moreso than Haldeman et al. and Cassidy et al? It seems like you're arbitrarily choosing to cite a "preferred" allopathic source which has come under disrepute rather than a solid epidemiological paper that is Cassidy et al. What are the real concerns people have and your comment presumes that myself and other editors don't seem to care the concerns of the people. Who would know more about chiropractic concerns than a chiropractic academic who has researched the topic for 15 years? Ernst isn't the authoritative source here, it's Cassidy and or Haldeman. CorticoSpinal (talk) 22:56, 11 April 2008 (UTC)

• Not reliable according to whom? Ernst? Why does my malpractice insurance quote me 1 in 5.85? Why do most sources suggest 1 in 1 million? If safety is going to nitpick like this, then we best contrast it with NSAIDs and examine the relative risk for both which are primarily used to treat pain.

• Ernst is certainly one of the sources saying it's not reliable, but there are others, and he has good reasons for saying that the 1-in-a-million estimates are dubious due to underreporting. Malpractice insurance counts legal liability, not medical risk; these are not the same thing. I thought that one of the criticisms of Chiropractic#Safety was that it was too long? But if additional comparisons are needed, I suppose they could be added. Eubulides (talk) 22:11, 11 April 2008 (UTC)

So what we have here is a crystalization of opinion. Ernst who has 0 expertise in manipulative therapy and 0 expertise in VBA dissection epidemiology says strokes are happening at a far greater rate than the expert opinion of Drs. Haldeman (MD, DC, PhD) and Cassidy (DC, DrSc) who have the expertise in manipulation, VBA dissection epidemiology and the other plethora of manipulative researchers who cite the 1-5.85 to 1-1 million. And, in this article, Ernsts 'review' is given full green light whereas the true experts sit on the sidelines? That's not right. CorticoSpinal (talk) 23:16, 11 April 2008 (UTC)

• Ernst is a vocal critic of chiropractic and has already been lambasted by DCs for his misleading "reviews". Underreporting, is this speculative or proven? Is it a possibility, sure, is it a probability, doubtful. Malpractice insurance is also based on actuarial statistics which is how insurance companies make money. If SMT was as risky and unsafe as implied the insurance rates would be significantly higher. CorticoSpinal (talk) 22:56, 11 April 2008 (UTC)

• The underreporting of practically 100% is well-proven:

• "Spinal manipulation: Its safety is uncertain"
• "One gets the impression that the risks of spinal manipulation are being played down, particularly by chiropractors. Perhaps the best indication that this is true are estimates of incidence rates based on assumptions, which are unproven at best and unrealistic at worse. One such assumption, for instance, is that 10% of actual complications will be reported. Our recent survey, however, demonstrated an under-reporting rate of 100%. This extreme level of underreporting obviously renders estimates nonsensical." - Edzard Ernst

• -- Fyslee / talk 04:46, 12 April 2008 (UTC)

• Chiropractic#History is perhaps one of the finest written sections in this article. My only suggestion would be to move the Manga and Workmen's Comp sections out of here and back into the scientific investigation section as that is where they are most appropriate.

• Some of the writing in Chiropractic#History is good, but some of it is blatantly POV, and the POV stuff must be fixed. The Manga and Workmen's Comp sections are partisan and are much lower quality (and dated) than what is in #Effectiveness 1; they can be briefly summarized in History to shorten it. Eubulides (talk) 18:40, 11 April 2008 (UTC)

• Out of curiosity, you suggest that workmans comp and Manga are partisan, yet I see these as being independent authors/agencies who made their own conclusions. Perhaps this 2004 workmans comp study is partisan as well? These are independent agencies who are making independent conclusions. Conclusion? Chiropractic care is effective at getting people out of pain and back to work. I suggest that the link be included and added to the old Workmans comp or replace it since it's 2004. CorticoSpinal (talk) 21:43, 11 April 2008 (UTC)
• Can you elaborate on "blatant POV" or perhaps for brevity just give an example or two? I can't see how Manga and Workmen's Comp are partisan. Just because they are positive? These are studies done by gov't agencies and by scientific researchers. -- Levine2112 ^discuss 20:23, 11 April 2008 (UTC)

• Sure: Manga and Workmen's Comp are old results favorable to chiropractic. There are old results not favorable to chiropractic, but Chiropractic does not mention them. Presenting just one side, and ignoring the other, is blatant POV. #Effectiveness 1, which is intended to be an up-to-date summary of effectiveness issues in chiropractic, also attempts to avoid this sort of blatant POV. Eubulides (talk) 21:37, 11 April 2008 (UTC)

• I would like to see some diffs or evidence of this; and I also suggest we use Australian, New Zealand, Canadian, American and European clinical practice guidelines which recommend manipulation as a safe and effective form of treatment for mechanical disorders. CorticoSpinal (talk) 21:50, 11 April 2008 (UTC)

• Not sure what is meant by "diffs" but there are many old studies saying there's no convincing evidence that chiropractic is effective. Assendelft et al. 1996 (PMID 8902660) and Assendelft et al. 1993 (PMID 8492059) are two examples. Both of these are more-reliable than the Manga report and the workmen's comp studies, but their results are not presented in Chiropractic. This is all water under the bridge now: we have far-better studies available. But the continuing emphasis on the Manga and workmen's compensation studies, which are obsolete and no longer used by serious researchers, and the exclusion of any serious countepoint, is a serious case of POV in the current article. Eubulides (talk) 22:38, 11 April 2008 (UTC)

I'm sorry those references are obsolescent. CorticoSpinal (talk) 23:16, 11 April 2008 (UTC)

Of course they're obsolescent! They are in support of the earlier claim "There are old results not favorable to chiropractic, but Chiropractic does not mention them." The point is that the current writeup in Chiropractic about effectiveness is massively biased even if one restricts one's attention to obsolescent sources. Eubulides (talk) 08:00, 14 April 2008 (UTC)

What bias in particular are you referring to, specifically? I have not yet seen any specific points being raised. CorticoSpinal (talk) 19:36, 15 April 2008 (UTC)

• I too would like to see that the Education section includes a passage that reflects the various degrees obtained from various countries, not only the DC (DCM) from North America. And that a Scope of Practice is added to include common areas of clinical practice and controlled acts permitted to DCs (diagnosis, imaging/lab rights, assessment techniques, etc.

-- Levine2112 ^discuss 18:13, 11 April 2008 (UTC)

• Agreed, we need to represent a more global POV in this article and the fact that chiropractors have a different educational system in Europe and Australasia should be reflected. We can use [40] this source which deftly and accurately reflects the various degrees and educational processes. Maybe this time we can put quotation marks? CorticoSpinal (talk) 21:43, 11 April 2008 (UTC)

Sure. Quotation marks or more preferably faithful summary. -- Levine2112 ^discuss 21:51, 11 April 2008 (UTC)

The article should not degenerate into a list of quotations. A faithful summary is to be preferred. Preferably something shorter than the original. Eubulides (talk) 22:24, 11 April 2008 (UTC)

I object to this mischaracterization that suggests by including a vital piece of educational curriculum material would degenerate the article into a "list of quotations". This is not the truth. Also, if we as editors cannot write the passage better than the original source than it should be quoted. Besides, this is NPOV, we're simply listing the various academic degrees obtained by chiropractors outside North America. CorticoSpinal (talk) 23:16, 11 April 2008 (UTC)

Proposed section rewrites

Scope of practice

Chiropractors are considered primary care, portal-of-entry providers for conservative management of the neuromusculoskeletal systems without the use of drugs or surgery. The practice of chiropractic medicine involves the restricted acts of diagnosis and spinal manipulation and involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests, nutritional counseling as well as other specialized tests as required. When indicated, the doctor of chiropractic consults with, co-manages with, or refers to other health care providers. Common patient management involves:

• spinal manipulation and/or other manual and/or soft tissue therapies
• rehabilitative exercises
• health promotion
• physiological therapeutic modalities
• conservative and complementary procedures.

Chiropractors generally cannot write medical (pharmaceutical) prescriptions; however there has been a gradual shift within the profession with a slight majority of North American DCs favouring an expansion of scope of practice to include in limited prescription rights. A notable exception is the state of Oregon which is considered to have an "expansive" scope of practice of chiropractic, which allows chiropractors with additional qualifications to prescribe over-the-counter drugs. With additional training and certification licensed chiropractors (DCs) and veterinarians (DVMs) can expand their scope of practice and practice veterinary/animal chiropractic which includes assessment, diagnosis and treatment of biomechanical disorders of animals that may be amenable to manual therapy. Chiropractors are also generally permitted to use adjunctive therapeutic modalities such as acupuncture with additional training from accredited universities/colleges and schools of acupuncture.

Currently, chiropractic is a regulated health care profession with licensure requirements in over 50 countries globally although chiropractic medicine is most established in North America, Australia as well as a few European countries. Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic.

CorticoSpinal (talk) 04:55, 13 April 2008 (UTC) CorticoSpinal (talk) 16:47, 13 April 2008 (UTC) CorticoSpinal (talk) Strikeouts. DigitalC (talk) 00:55, 15 April 2008 (UTC)

Comments Scope of Practice

Please put any notable stuff that may be missing from scope of practice below.

• animal chiropractic (i.e. non human practice) (expanded scope of practice with additional training/certification):* prescription of ergonomic devices (orthotics) and assistive devices, disability evaluations, IMEs, etc..
• practice of other regulated therapies (acupuncture (i.e does it require some kind of license to practice or is considered to be within the 'public domain'
• clinical specialities (most common only, i.e. sports sciences, rehabilitation sciences, neurology, radiology, etc...):* Practice demographics (solo, vs. multidiscipinary, integrative medicine (i.e. public health/governmental)
• Anything else? CorticoSpinal (talk) 05:41, 13 April 2008 (UTC)

This section is long and boring: it's a huge paragraph with no breaks and I suspect that nobody has read it. Does there really need to be this level of coverage here? It's too long by at least a factor of two, maybe three. Also, there's some duplication with the proposed Education and Licensing section (see below). Eubulides (talk) 08:15, 14 April 2008 (UTC)

It doesn't seem too long or boring to me. Changes may have been made to increase readability, but I think it reads well and is not too long. Any duplication should be taken care of. DigitalC (talk) 00:57, 15 April 2008 (UTC)

Several of the citations do not work for me. The Google Books citations don't work. Some of the citations are simply numbers in brackets; they don't work either. Please use proper citation templates ("cite journal", "cite book", etc.) As things stand the citations are too hard to follow. I fixed a couple of them but there are many more that need fixing, and it's hard to review the proposed text properly without seeing the citations. Eubulides (talk) 08:15, 14 April 2008 (UTC)

The section fully covers the scope of practice of chiropractic and represents the subtle ins and outs of scope of practice globally and within North America. Yes, there needs to be a full and appropriate coverage of chiropractic scope of practice in Chiropractic. This is done fully and completely in other regulated health profession in articles here. Duplication of material can be deleted.

Google Books citations work fine for me; where do I find citation templates? The citations are there; they take you to the relevant citations; are there any specifically that you dispute? If so, why? We can easily change formatting to increase readability and I will break the paragraph into 2. We could always add bullet points to highlight some of the major restricted acts or common treatment modalities in scope of practice as well. Thanks for your comments. CorticoSpinal (talk) 15:43, 14 April 2008 (UTC)

The Google Book citations don't work for me; I click on them and get a message "page unavailable for viewing". So I don't know what's being cited. You can find citation templates by looking at how books and journals are cited in #Effectiveness 1. Eubulides (talk) 09:12, 15 April 2008 (UTC)

This is reading well. IMHO, this is the kind of professional information perfectly suited for an article about Chiropractic. Nice work! -- Levine2112 ^discuss 19:36, 14 April 2008 (UTC)

As per Eubulides request, I will attempt to introduce good citation formatting; if it's not up to snuff, I apologize I'm still trying to learn how to use the various tools here at Wikipedia. Nonetheless, if there aren't significant objections, I propose we roll out scope of practice today.

It's not just the formatting (although that clearly needs to be fixed). The bigger problem is that some of the citations don't work at all, and I can't follow them to check them, and therefore cannot do what I feel would be a proper review. Please fix the citations first, so that people can have a day or two to review the whole thing. Eubulides (talk) 16:46, 16 April 2008 (UTC)

I can assure you that when I checked the citations they were functional and working but I'll make doubly sure they're still there. With all due respect I was pretty thorough in writing the section and made sure the citations met inclusion criteria. After all, I do have expertise in this field and know the salient points probably a bit better than other health professionals. CorticoSpinal (talk) 18:55, 16 April 2008 (UTC)

Thanks, but even if they work for you, they may not work for other readers. Google Books is notorious for this, since it may give a page to one reader but refuse access to others; please avoid URLs to it. Also, some of the references (e.g., ".[30].") cannot possibly work for anybody; these clearly need fixing. Eubulides (talk) 19:11, 16 April 2008 (UTC)

Citations were done using the cite button (that's pretty handy!) as to conform to proper citation formatting. Section was added today as there appeared to be no significant objections for inclusion. Scope of practice section was moved to conform with other health professional articles and to increase readibility. Education section will be dealt with next; comments for that section are welcome there. CorticoSpinal (talk) 14:56, 17 April 2008 (UTC)

I asked "Please fix the citations first, so that people can have a day or two to review the whole thing." But that's not what happened. Some citations were changed, and the material was put into Chiropractic in a matter of hours. Worse, nontrivial changes were made the non-citation part of the material just before it was put in, without any review. For now, I am reverting the change, and propagating its fixes into #Scope of practice above. Please give us a day or two to review this revised proposal. (I don't have time right now to do a careful review, but I did notice that the Google Books URLs were not fixed, so at least that problem remains.) Eubulides (talk) 16:42, 17 April 2008 (UTC)

This section has been proposed already for a week, all the citations were there and looking at your contribs list I saw that you had been editing regularly over the past few days with little to no input on scope of practice of chiropractic. It's OK if it's not really a priority to you, but others shouldn't have to wait for one editor to give the final approval. Consensus doesn't work that way. If you have any specific objections than feel free to list them, otherwise I found your revert to be in poor taste. CorticoSpinal (talk) 17:58, 17 April 2008 (UTC) Actually on further review, I see you have misrepresented your statement once again. Nontrivial changes? Where, what, when? None were made, the citations were not changed this incorrect. Please be more careful in the future. CorticoSpinal (talk) 18:01, 17 April 2008 (UTC)

One other comment about the citations (and then I really must run): the last two are so badly formatted that I cannot read them. Nothing happens when I click on the last citation, and the 2nd-to-the-last ends up with a weird long section of text that starts "{{<ref>{{cite web|url=http://www.chiroweb.com/…". Can you please fix this? And please check the other citations too: the Google Books URLs must go, for example. The idea here is to fix the proposal to have proper citations, and then give editors a day or two to review the proposal and check that it is adequately supported. Thanks. Eubulides (talk) 16:50, 17 April 2008 (UTC)

I have tried my best to format the citations for wikipedia but it's something I'm learning still. Regardless, the content is reliable, verifiable, accurate and notable and all the info is there. CorticoSpinal (talk) 17:58, 17 April 2008 (UTC)

Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic.[92][93][94] This part seems a bit long and is not focused on Scope of practice. QuackGuru (talk) 17:37, 17 April 2008 (UTC)

Similar to other professions, chiropractors can specialize in certain disciplines and increase their breadth of scope of practice. Do you feel it would be better elsewhere? CorticoSpinal (talk) 17:58, 17 April 2008 (UTC)

I have made a concerted effort to repair the ref code. Let me know if I have overlooked anything though. -- Levine2112 ^discuss 18:08, 17 April 2008 (UTC)

There is a Chiropractice education article. Some of this material could be split up and put there. Currently, it is too long and needs more focus. QuackGuru (talk) 18:11, 17 April 2008 (UTC)

This doesn't seem to be about Chiropractic Education though, but rather about Scope of Practice. Are there any passages in particular which you think are more appropriate for Education? Can you specify please? Thanks. -- Levine2112 ^discuss 18:16, 17 April 2008 (UTC)

[outdent] Exactly. Thanks Levine2112. Eubulides, I strongly object to these stall tactics; the majority of editors here won't wait for your exclusive approval. Judging by your contribs history you seem to be quite active, so if this is not a priority for you then please be so kind as to say so; otherwise we will implement this section tomorrow. One final note: please do not making misleading or false allegations in your edit summaries. To say that I made "non-trivial" changes is completely untrue and easily verifiable by the diffs. I would like to note that the last week or so here I have your contributions and collaborative style to be less than ideal as seen from a tendentious editing in the "appeal to drop effectiveness". There seems to be an issue with respecting the consensus of a majority of editors. So, in summary, I would please ask that you refrain from making misleading statements, mischaracterizing other editors comments. You're approaching a dozen times now. CorticoSpinal (talk) 19:58, 17 April 2008 (UTC)

Education, Licensing, Regulation

Chiropractic medicine is currently formally regulated in approximately 60 countries although chiropractors are also practicing in several other countries where there is no formal legal recognition of the profession at this time . To help standardize and ensure quality of chiropractic education and patient safety, in 2005 the World Health Organization published the official guidelines for basic training and safety in chiropractic Most commonly, chiropractors obtain a doctoral-level second entry, first professional degree in Chiropractic medicine. The degrees obtained include Doctor of Chiropractic (Medicine) (DC or DCM) in North America whereas a Bachelors or Masters degree in Chiropractic Sciences (BChiro, MChiro, BAppSc) degrees are granted in Australia and selected countries in Europe, Asia and Africa. Typically a 3 year university undergraduate education is required to apply for the chiropractic degree. In general, the World Health Organization lists three major educational paths involving full‐time chiropractic education across the globe:

• A four‐year full‐time programme within specifically designated colleges or universities, with suitable pre-requisite training in basic sciences at university level;
• A five‐year bachelor integrated chiropractic degree programme offered within a public or private university
• A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree.

Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training. Health professionals with advanced clinical degrees, such as medical doctors, can can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy. Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed.

All Chiropractic Examining Board requires all candidates to complete a 12 month clinical intership to obtain licensure. Candidates must successfully pass a written cognitive skills examination to be eligible for the clinical skills examination. Licensure is granted following successful completion of all state/provincial and national board exams so long as the DC maintains malpractice insurance. Nonetheless, there still some variations in educational standards internationally depending on admission and graduation requirements. For example, Canadian chiropractic accrediting standards are higher than the United States, and it's admission requirements into the Doctorate of Chiropractic Degree programme are the strictest in North America. Chiropractic medicine is regulated in North America by state/provincial statute. The regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Each state or province has a regulatory college established by legislation in the same manner, and with the same structure and similar regulations, as the regulatory bodies for other health care professions.

Comments about Education, Licensing Regulation

Stuff to be added could include

1. self-regulation status
2. continuing education requirements
3. sub-specialities, (common ones)
4. differentiation between straight and mixer schools (this difference is noted in the US Dept of Edu; but this problem is not so much an issue in the rest of the world)

# regulatotry status globally, where it is, is not, and the in between

1. more? CorticoSpinal (talk) 18:57, 13 April 2008 (UTC)

Again, this is waaaay too long. I suspect nobody has read it other than its author; it's a guaranteed put-you-to-sleep text. There is duplication of material between this section and the Scope of Practice draft (both talk about licensing). How about combining the two sections and shortening the result? Also, I have similar problems with citations here. For example, there is a URL to an IP address that appears to be some sort of cache; this didn't work for me. Please use proper citation format; it's hard to review stuff that isn't properly cited. Thanks. Eubulides (talk) 08:15, 14 April 2008 (UTC)

Nah, if there's overlap with scope of pratice we can chop out duplication. We need to cover the section adequately and it is being done so now, remember, we're talking about the profession globally and need to represent, at best, a global POV. Regardless of the length, it's the content that is most important. Do you dispute any of the content there? If so, which ones? What citations do not work? What is the proper citation format and how is it done? CorticoSpinal (talk) 15:37, 14 April 2008 (UTC)

I think a lot of this may be found (or should be found) at Chiropractic education. Perhaps we should have a brief summary of the information above and then link to Chiropractic education from this main article (pretty much as we do now, but with a more solid detailed summary - perhaps just a short paragraph or two in length). Then let's strive to make sure that Chiropractic education matches the excellence on the draft above. -- Levine2112 ^discuss 19:39, 14 April 2008 (UTC)

We definitely could move some stuff to chiropractic education; but think we should keep the types of degrees granted, self-regulation and licensure stuff here because some stuff we missing from the body but mentioned a bit in the lead. Details re: the types of common courses taken I was going to add here but would be better suited at chiropractic education and/or chiropractic school. Still, we need to add stuff about CE (it's required to maintain licensure in almost every state/province/jurisdiction. Again, we need to make sure that a global POV is respected here which is why some editors have quite rightly said it's not always a doctoral level degree (outside NA) where the term first professional degree is better used to adequately reflect the status of the degree outside the US and Canada. CorticoSpinal (talk) 19:51, 14 April 2008 (UTC)

That sounds perfectly reasonable. Perhaps start with updating Chiropractic education with all of this information? -- Levine2112 ^discuss 19:53, 14 April 2008 (UTC)

That makes sense to me too. I still have having trouble following the citations, though, as per above discussion. Eubulides (talk) 09:12, 15 April 2008 (UTC)

An appeal: Drop the "effectiveness" discussion

Please, please, please!! Drop this extremely divisive and contentious discussion. It is causing an awful waste of time here, right where it doesn't belong. I repeat my previous comments and would like a response from all concerned parties:

• I basically agree with CorticoSpinal on this one. We are spinning our wheels by attempting to discuss the "effectiveness" of a whole profession, when only individual techniques and methods can properly be the subject of an "effectiveness" discussion. It would save a whole lot of effort and avoid alot of unpleasant discussions if effectiveness was only dealt with on the article devoted to each technique. Then we can simply state that chiropractors use this, that, and another technique, and wikilink each one. Then readers can hop over to those articles and find an "effectiveness" section in each one. By simply dropping the whole line of discussion on this matter here, we can sidestep an issue that shouldn't be under discussion here. Save such discussions for each of those articles. [41]

• A pressing issue would be to end the discussion of "effectiveness" of chiropractic, as you (and I, and Levine2112) suggested above. That would free up everyone's minds to deal with other things. [42]

A whole profession can't be dealt with in this way. It's unheard of (except for things like homeopathy and acupuncture, where the profession is synonymous with the method). Only individual techniques and methods can be dealt with in this manner. The only place where chiropractic can be dealt with in this manner is on any one of the various Chiropractic treatment techniques articles, especially Spinal adjustment. It can legitimately happen there, since that is the only thing unique about chiropractic, and where it's claims are significantly differently from those made for spinal manipulation. -- Fyslee / talk 05:23, 12 April 2008 (UTC)

It is not at all unheard of. It's done all the time. It's done on the web (see, for example The Austin Chiropractic Center's web page on chiropractic effectiveness. It's done in peer-reviewed journals (see, for example, Kingston 2007, PMID 17970361). It's done by Chiropractic right now, which cites sources on this subject at length (the Manga report was titled "A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain").

A summary of the effectiveness of chiropractic care is sorely needed in Chiropractic. The current summary (currently found in Chiropractic#Movement toward science) is obsolescent and highly biased. This does not mean it should be removed: effectiveness is a core topic! It means it should be fixed. Eubulides (talk) 08:34, 13 April 2008 (UTC)

I will concede that a short section dealing with the few sources that - as DigitalC mentions below - "compare the entire clinical encounter of one profession to another", might be in order. But this detailed analysis of many different techniques and methods is improper here. It should be dealt with, but is better dealt with elsewhere. -- Fyslee / talk 05:32, 14 April 2008 (UTC)

That is too selective. Most of our reviews on effectiveness refer to some studies like that, but they're relatively rare and tend to be less reliable. The reviews spend more time talking about effectiveness studies of particular treatments, because that's where most of the research has been (including most of the higher-quality research). We should not be ignoring all this research; we should be summarizing it briefly, as it's quite relevant. Eubulides (talk) 09:15, 14 April 2008 (UTC)

Agree. Cost-effectiveness of care could be a fair play; and 3rd party sources should also be considered (such as Workman Compensation, integrative medicine models and recently completed and active demonstration projects. I need the sources to back me up but I'm almost positive that chiropractic care is usually significantly cheaper (>20%) and gets similar if not better results than conventional medicine for neuromusculoskeletal complaints. This is not surprising, naturally, as chiropractors are on one hand specialists in neuromusculoskeletal medicine yet offer a distinct form of health care due to their holistic heritage that relies on conservative and complementary therapies most of which are natural as DCs cannot prescribe nor perform surgery. CorticoSpinal (talk) 06:16, 14 April 2008 (UTC)

Cost-effectiveness is another section that should get written, and we have collected in #Sources for risk-benefit and cost-effectiveness a list of sources for such a section. But we should not limit Chiropractic's discussion to just cost-effectiveness. Effectiveness is an important topic in its own right, and has been studied a lot more and has more to report. Eubulides (talk) 09:15, 14 April 2008 (UTC)

Actually the reasoning and application is completely invalid. Validity, as a refresher refers to the degree to which a study accurately reflects or assesses the specific concept that the researcher is attempting to measure. How can you attempt to measure the effectiveness, risk/benefit, safety, cost-effectiveness, etc. of a profession? We're not studying a technique, a modality or a drug here where the aforementioned apply. This argument is further reinforced as even Medicine does not have sections on "effectiveness" "cost-effectiveness" "safety" and "risk/benefit". It's not that Medicine as an article has shortcomings (as incorrectly suggested) but rather that these sections cannot be applied readily or measured reliably to WHOLE professions. It's invalid to think so. Majority of editors agree. Please respect and accept the consensus of the majority of your fellow editors, many of whom who have far more experience editing this topic that yourself and myself combined. Thanks. CorticoSpinal (talk) 04:41, 15 April 2008 (UTC)

Nobody is proposing that we measure the effectiveness etc. of a profession; we are just proposing that it covers effectivenss of common treatments for which research exists. The effectiveness of those techniques is a core issue of chiropractic: it's the main reason it has been controversial for so many years. The current version of Chiropractic talks about cost-effectiveness of chiropractic care at length with blatant pro-chiropractic POV; why didn't this objection that "We're not studying a technique" apply to what's in Chiropractic now? Eubulides (talk) 09:12, 15 April 2008 (UTC)

Do you have a reference that backs up your statement that effectiveness of, presumably, manipulation is the reason why "it has been controversial for so many years". Because I would disagree with that statement; and so does American Pain Society and American College of Physicians who recommend spinal manipulation in their clinical practice guidelines. In fact, I quote "The expert panel noted that physicians should consider the following noninvasive, nonpharmacologic therapies that have been proven effective in evidence-based trials: exercise therapy, spinal manipulation, acupuncture, yoga, intensive interdisciplinary rehabilitation, cognitive-behavioral therapy, and progressive relaxation". A summary can be found here. So, to be clear; is your argument that allopathic medicine is concerned about manipulation (which it now recommends) or is allopathic medicine concerned by manipulation performed by chiropractors? CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

This is getting quite tendentious, Eubulides. A majority of editors disagree with you, and for one reason or another the argument that a reductionistic model (which I argued was core to medicine) cannot be done to analyze professions' 'effectiveness' no matter what you claim. Many editors here have already sought to compromise with you and have made alternative suggestions and wish to collaborate however it seems increasingly apparent that this feeling is not being reciprocated. Anyways, the point is moot, there is agreement by the majority of regular editors that we're not going to go down your suggested route and Fyslees recommendation is a sensible one. CorticoSpinal (talk) 15:27, 13 April 2008 (UTC)

I agree that the discussion has been divisive and contentious. But the subject of effectiveness is an important one, and the current coverage of it in Chiropractic is biased and misleading: we cannot simply ignore the problem. Eubulides (talk) 08:34, 13 April 2008 (UTC)

It should not be ignored, but for the most part (all the details) it should be dealt with elsewhere. -- Fyslee / talk 05:44, 14 April 2008 (UTC)

One could write hundreds of pages of details, and I agree for the most part these should be elsewhere. However, Chiropractic should have a reasonable summary of the issue of chiropractic effectiveness, as that is a core question about the field. Currently Chiropractic has a highly-biased and obsolescent summary of effectiveness that should be replaced by something better. #Effectiveness 1 has been drafted and is miles better than the effectiveness discussion in Chiropractic now. Plus, it's shorter. So what's not to like? Eubulides (talk) 09:15, 14 April 2008 (UTC)

See above comment. Invalid application. CorticoSpinal (talk) 04:41, 15 April 2008 (UTC)

Replied to above. Eubulides (talk) 09:12, 15 April 2008 (UTC)

Fyslee, myself, DigitalC, Levine2112, the DoctorIsIn and others have never suggested 'ignoring' the problem. Please, this is the 4th time I've asked you now, do not mispresent or mischaracterize other editors statements or at least ask for clarification if you're confused. We have offerred alternative solutions to compromise and collaborate whereas your position seems to be crystallized. CorticoSpinal (talk) 15:44, 13 April 2008 (UTC)

If we leave Chiropractic alone, and keep its current blatantly-biased treatment of effectiveness, then we are ignoring the problem of bias. Merging #Effectiveness 1 into a subarticle (the alternative solution proposed) does not solve this problem. Eubulides (talk) 09:15, 14 April 2008 (UTC)

It's incorrect to say that only individual techniques can be studied for effectiveness. A research study, for example, can compare patients in chiropractic care to patients using traditional medical care. Studies like that have been done, and are cited (via reviews) in #Effectiveness 1. Furthermore, reviewers themselves can (and do) synthesize practice guidelines and effectiveness surveys out of primary studies investigating individual techniques, and we can cite those reviews.

It certainly makes sense to do detailed discussion of effectiveness of chiropractic care into the respective detailed articles, but effectiveness of important techniques (notably, SMT) should be summarized in Chiropractic itself, and should not be ignored there. It would be extremely awkward for readers to have to go to each subarticle to see any discussion of effectiveness. #Effectiveness 1 was written partly in response to a reader's natural request to see good coverage of effectiveness here, and the reader indicated that an earlier draft was the sort of thing being sought. Wikipedia, in the end, is supposed to be for readers, not for editors. Eubulides (talk) 08:34, 13 April 2008 (UTC)

It's those types of comparisons that can be mentioned here, since there are sources that do it, but the detailed descriptions for each method should be dealt with in their own respective articles. If you want to examine chiropractic's special relationship to SMT, then do it in the spinal adjustment article, where there is place for detailed descriptions of that very special and unusual relationship, an analysis and description that would be inappropriate in the SMT article. -- Fyslee / talk 05:44, 14 April 2008 (UTC)

#Effectivness 1 does not contain "detailed descriptions for each method". It doesn't describe the methods at all. It merely gives known effectiveness results. This draft could be pruned, but why? I don't understand an objection based on length. #Effectiveness 1 is shorter than the text it would replace. Why object to its length, when there is no similar objection to the longer and much-lower-quality material on effectiveness that is in Chiropractic now? Eubulides (talk) 09:15, 14 April 2008 (UTC)

Disagreed. It's a violation of WP:SYN as argued by Levine2112 above when you insist on choosing SMT studies done by various professions (DO, PT, MD) and cite it as effective for/against the chiropratic profession. Invalid application again. CorticoSpinal (talk) 04:41, 15 April 2008 (UTC)

I didn't choose the SMT studies: a reliable review by and for chiropractors chose those studies, and for good reasons, which has been explained by the experts. We should not substitute our own judgment for that of published experts in the field. Eubulides (talk) 09:12, 15 April 2008 (UTC)

You did not address my argument: regardless of who chose the studies it is a WP:SYN violation to take studies on manipulation performed by physical therapists, osteopathic and allopathic physicians and pass it off as effectiveness of chiropractic. I would also note that you're using the same, tired argument (substitute judgement) that has already been addressed several times on several threads here on Talk. CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

Please, Eubulides, it's time to drop this now. How many times can ask you to please step back from this? It's not necessarily about length; it's about content, validity and the generalizability of the studies back to the effectiveness of 'chiropractic'. Fyslee, myself, DigitalC, Levine2112 and DoctorIsIn disagree with your stance and approach. This doesn't even take into account that no health care profession has an effectiveness section within it here at wikipedia (besides from acupuncture/homeopathy which was already discussed earlier) Also, it omits major findings from the CCGPP clinical practice guidelines and gives disproportionate amount of weight to allopathic sources. Nowithstanding, a lot of editors, myself included dispute the authoritativeness (which seems to be arbitrary). Regardless, this point is moot there is majority agreement that this section will not continue as currently planned and consensus is that we talk about various modalities/treatment in their respective pages. 208.101.118.196 (talk) 19:21, 14 April 2008 (UTC)

First, I disagree that there is consensus. The recent edit war is evidence that there is not consensus. Second, and more important, Chiropractic currently has blatant pro-chiropractic POV in its treatment of effectiveness. I have pointed this out several times; none of the replies have addressed this issue. Blatant POV is a violation of Wikipedia policy and must be fixed. Third, there is a reason that CAM fields such as homeopathy require an effectiveness section more than non-CAM fields such as (say) brain surgery: their effectiveness is far more a topic of interest and dispute. Eubulides (talk) 09:12, 15 April 2008 (UTC)

First, look at the thread. You're the ONLY editor here who consistently opposes the consensus of the majority minus a few words occasionally from QG. The edit war in question has no bearing of what has occurred subsequently over the past 10 days where we have discussed this issue at length and have come to a conclusion. Second, where does Chiropractic have blantant POV in its treatment of effectiveness? Do you have any specific examples? Also, perhaps you can tell me why according to the panel of experts American College of Physicians physicians should consider the following noninvasive, nonpharmacologic therapies that have been proven effective in evidence-based trials: exercise therapy, spinal manipulation, acupuncture, yoga, intensive interdisciplinary rehabilitation, cognitive-behavioral therapy, and progressive relaxation. Remember, according to your very own words "We should not substitute our own judgment for that of published experts in the field." I would also like to note that the majority of the above nonpharmacologic therapies can and are provided by DCs and fall within its scope of practice. These should be noted as well.

Third, comparing homeopathy to brain surgery is ridiculous. To suggest that the effectiveness of homeopathic tinctures is of a greater concern or relevant in the medicine than brain surgery is laughable. Furthermore, it's hard to measure the effectiveness of brain surgery as there are different prognoses for different brain conditions. More appropriate would be the effectiveness of back or neck surgery where I last read the were less than 50% including many unncessary surgeries which is why the recent Neck Pain Task Force clearly made note of this and made a classification system (1-4) to prevent excessive surgery or invasive measures.

In general, it seems to be like you're making up policy on the spot "there is a reason that CAM fields require an effectiveness section more than non-CAM fields their effectiveness is far more a topic of interest and dispute". First, where is the policy that states the above? Did you make it up or is there something you can quote for us? Second, CAM therapies can indeed be studied and a relative effectiveness determined, CAM professions cannot. Third, Chiropratic should not follow the exception to the rule of Homeopathy which is a non player in terms of regulation in North America and most of Europe and Australia. So, it's not comparable. CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

Fyslee is right here. The most interesting and perplexing thing of it all, is I believe that adjustment belongs in the SMT article. I can tell why later; but it can be done tastefully that covers both straight and mixer interpretations. I happen to excel in this particular chiropractic legal arena and we must carefully consider as well the weight of mainstream chiropractic vs. the minority (but vocal) straight DCs who retain Palmer Philosophy and Practice Principles. For example, straight DCs would always, always, (always!) refer to manipulation as "spinal adjustment". The intent; and purpose is distinct; the correct dysfunctional vertebral segments (dubbed vertebral subluxation which is to be differentiated from VS COMPLEX) to improve neurological function (or the inverse; "remove nerve interference" (i.e. the chiropractic boogie man). In contrast, mixer DCs and all evidence-based practitioners use spinal manipulation and adjustment INTERCHANGEABLY. The focus in not necessarily the "intent" but rather than biomechanical kinematics that are involved in a HVLA manipulative protocol. Subtle, but EXTREMELY IMPORTANT, and understanding these 2 viewpoints within the profession is crucial. They're both very real, both notable but from here on in, mainstream (mixer) chiropractic view gets more weight but we're cognizant that straight chiropractic needs to be represented NPOV as well, despite the fact that we may have serious reservations about some elements of their style of practice CorticoSpinal (talk) 06:16, 14 April 2008 (UTC)

These points are reasonable ones but are appropriate more for the straight-vs-mixer section than for the effectiveness section. Eubulides (talk) 09:15, 14 April 2008 (UTC)

You're missing the point. We're not going to have an effectiveness section; at least not the way it's currently in place or drafted. Why are you not collaborating with your fellow editors here? 208.101.118.196 (talk) 19:21, 14 April 2008 (UTC)

The topic of this thread is effectiveness. Certainly changes could be made to #Effectiveness 1 before it goes in; it's not cast in stone. But the current Chiropractic is severely biased and must get fixed; #Effectiveness 1 is a vast improvement on what is there now. Eubulides (talk) 09:12, 15 April 2008 (UTC)

No, the topic of this thread is an APPEAL TO DROP EFFECTIVENESS. An appeal which the majority of the editors here and heeding with yourself being a notable exception. CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

It's incorrect to try and impose the same argument time after time despite the fact it has been rejected by a majority of editors. It's incorrect to say allopathic sources are preferred and should be weighed more than chiropractic sources especially given the fact we're talking about evidence-based literature. It's incorrect to include a section here which is not present in other health professions (for good reason, you can't measure the effectiveness of the 'medical profession' or the 'osteopathic profession' or the 'physical therapy' profession or the veterinary profession. It's incorrect to give such prominence to a chiropratic critic who has 0 expertise in the subject and not at least give equal weight to a source that refutes (soundly) Ernst's claims. It's incorrect to not use expert sources such as Haldeman and Cassidy et al when they're right there and published in Feb 2008. It's incorrect to incorrect to assume that regular editors here don't know that Wikipedia is for the readers not for the editors. It's incorrect to keep pursuing this and comparing the profession to a modality which is a fundamental flaw in reasoning by a few choice editors new to Chiropractic and who lack the expertise in this field. CorticoSpinal (talk) 15:44, 13 April 2008 (UTC)

• I disagree that the idea of an effectiveness section has been rejected by a majority of editors.

• 4 editors have pleaded with you and have even made an appeal section to voice their concerns. You're the only editor who disagrees with our consensus. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• The recent edit war indicates that there is no consensus. I agree that some editors would rather not have an effectiveness section in Chiropractic right now. However, the POV concerns that have been expressed are real, and a violation of Wikipedia policy of this magnitude cannot be simply ignored. #Effectiveness 1 is a good way to address these issues and is a proposal on the table. No other proposal has been made. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• This argument has been debunked above. You have not listed any examples of violation of wikipedia policy. Also, you continue to misrepresent the opinion of other editors. The frequency at which this has been occuring is problematic. I have asked you no more than half a dozen times already to not do this or to ask for clarification. Several counter proposals have been made; which is another misrepresentation of editors arguments. This penchant is getting to be quite problematic and irritating. The argument is that there should not be an effectiveness section in chiropractic PERIOD, not right now. As DigitalC mentioned already, any profession that uses a given modality that is being listed here should have that listed on their page as well. CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

• Sources should be given appropriate weight according to Wikipedia policy; as there still seems to be some dispute about what that means here, I will look into asking the experts on those policies.

• No need, I'm already on that as well. I'm sure we'll have an interesting conversation about this. CorticoSpinal (talk) 05:07, 15 April 2008 (UTC)

• An effectiveness section is present for some professions, like homeopathy, and it would not be out of place for others; we should not let weaker articles prevent us from making Chiropractic better]].

• Nah, red herring argument. The application of it is invalid; and no mainstream med profession has this because it's not valid to measure the effective of a profession. This is simply a double standard being pushed on CAM articles. Besides, no health profession article lists these sections. Homeopathy is not the standard; it's the exception to the rule. CorticoSpinal (talk) 05:07, 15 April 2008 (UTC)

• Homeopathy is not an exception: it's an example of how to do things well. It is far higher quality than Chiropractic is. Coverage of effectiveness and safety would be quite apropos for Medicine as well. But our focus in this thread is Chiropractic, not Medicine. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• #Effectiveness 1 gives plenty of weight to sources that disagree vehemently with Ernst, and does not give undue prominence to Ernst.

• It does not read that way. Besides, Ernst has no expertise in safety of SMT nor does he have expertise in effectiveness; he's just a mainstream critic. Experts on safety on SMT are the researchers who study it. I'd give Flynn and Childs, both PT/PhDs far more weight on expertise on SMT since they're actively studying the topic. Also, Herzog, Kawchuck et al. should be mentioned in safety. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• In what specific way can #Effectiveness 1 be improved so that it satisfies your concerns about weight? A specific suggestion, with specific citations, could help us improve it. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• Cassidy et al. (PMID 18204390) is about safety and is irrelevant to effectiveness; I'm not sure what you mean by "Haldeman" (PMID 18204400, perhaps? but that wouldn't add anything to #Effectiveness 1 that isn't there already).

• It's about the same topic, i.e. an editor who claims superiority of allopathic sources and prevents the inclusion of notable, verifiable, high quality chiropractic sources. It's the principle being applied on this aborted section, safety and vaccination. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• Again, this sounds like a different thread, one about safety. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• I have never assumed "regular editors here don't know that Wikipedia is for the readers not for the editors"; on the contrary, I have based some of my arguments on the assumption that editors know Wikipedia is for readers.

• Thanks for the clarification. But you have also insinuated that other editors don't know what they're doing which will result in a "mediocre" article. That kind of language is regretable under rather tense conditions. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• Again, my assumption has always been that editors know that the goal is to write encyclopedic articles even about controversial subjects, and to summarize those subjects, controversies and all, in a neutral way. My arguments have been based on the understanding that editors know that articles which avoid important controversies are lower-quality than articles that cover them. That is what I intended when I wrote "We should be striving for what's best for this article. Settling for a substandard article simply because the subject is contentious, or because other articles have similar problems, is a recipe for continued mediocrity." If this comment was interpreted in some other way, which hurt your feelings, then I apologize for that; it really wasn't intended. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• #Effectiveness 1 does not compare the profession to a modality: it talks about the effectiveness of chiropractic treatments, which is a core issue in chiropractic.

Eubulides (talk) 09:15, 14 April 2008 (UTC)

• No it does not. It talks about the effectiveness of SMT; as performed by chiropractors, physical therapists, osteopathic doctors and medical doctors. And the section tries to pass it off under the guise of "chiropractic" effectiveness. PTs use ultrasound in clinical practice, should we generalize the effectiveness of PT based on the effectiveness of the ultrasound modality? Because that's essentially what you're suggesting here. It's an invalid application to the article and that's why it's getting the boot. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• The section talks about all forms of chiropractic care for which we have scientific evidence. A large fraction of this is SMT because that's where the evidence is. The section does not try to "pass off" anything: it clearly states when it's talking about SMT versus other treatments. For better or for worse, chiropractic is strongly associated with its characteristic treatment, SMT, and it's entirely appropriate for the effectiveness section to focus on SMT, just as it's entirely appropriate for the safety section to do so, or for the treatment section to list an SMT treatment first. Eubulides (talk) 09:12, 15 April 2008 (UTC)

[repost from above]You cannot determine the effectiveness of a profession. SMT is not chiropractic, and although I don't have the sources to back it up, I would believe that soft tissue therapy is used as much by chiropractors as SMT is. Now, if you want to determine the effectiveness of each treatment procedure used by chiropractors (SMT, STT, LLLT, US, IFC, Vibration therapy, etc. etc. etc.), for each condition they are used for (IE - is SMT effective for low back pain? is STT effective for lateral epicondylitis, is ultrasound effective for plantar fasciitis) then that would work, however those effectiveness sections really belong on the article for the respective treatment. That said however, the entire clinical encounter may be more effective than the sum of its parts - however, we do not have enough sources to compare the entire clinical encounter of one profession to another (although I have seen articles advocating for research encompassing the clinal encounter). DigitalC (talk) 23:55, 13 April 2008 (UTC)

Again, #Effectiveness 1 talks about effectiveness of treatments, not about effectiveness of a profession. Chiropractic#Treatment procedures says that the most popular treatment, in terms of % of patients receiving it, is diversified (full-spine manipulation), not soft tissue therapy. Meeker & Haldeman 2002 says "In the United States, more than 90% of all spinal manipulation services are provided by chiropractors, and research on spinal manipulation, like that on any other treatment method, is equally of value regardless of the practitioner providing it." #Effectiveness 1 already talks about the entire clinical encounter, but reliable sources say that's just part of the picture; we shouldn't limit ourselves to just one corner of it. Eubulides (talk) 09:15, 14 April 2008 (UTC)

"Again, #Effectiveness 1 talks about effectiveness of treatments, not about effectiveness of a profession.". That is exactly the point. Chiropractic is a profession, and Effectiveness 1 talks about effectiveness of treatments. The effectivenss of those treatments belongs on the articles for those treatments, not on Chiropractic. DigitalC (talk) 23:58, 14 April 2008 (UTC)

These treatments, and their effectiveness, are fundamental to chiropractic. One of the most natural questions about chiropractic, given its history and controversy, is "When does it work?" Any encyclopedic article on chiropractic must seriously address this issue. The current Chiropractic article spends a considerable time on this, using blatantly POV sources (and obsolescent ones to boot). What is the justification for excluding a high-quality and relatively unbiased discussion of effectiveness from Chiropractic, while keeping a low-quality and blatantly biased discussion? Eubulides (talk) 09:12, 15 April 2008 (UTC)

FTR, the source used for Chiropractic#Treatment Procedures doesn't mention soft tissue therapy, but does suggest that trigger point therapy (a subset of soft tissue therapy) is used in 45% of patients. Electrical stimulation is used in 46% of patients, ultrasound in 30%, and LLLT not included. DigitalC (talk) 00:30, 15 April 2008 (UTC)

Now we're getting somewhere. Indeed, it is the whole clinical counter that is "chiropractic care" not merely the application of spinal manipulation (whereby DCs are the expert provider) whch can also be done in limited amount by osteopaths, medical doctors, [physical therapists]] and selected other naturopaths. The reference that DigitalC has mentioned is PMID: 17604553, the Hawk et al found in JACM, whereby Hawk is a leading pioneer in WSR (whole systems research). This bodes well for designing better observational studies looking at the whole (holistic) clinical encounter in chiropractic medicine and should lead to good answers (and good questions) on the validity of manipulative therapy and chiropractic care for nonmusculoskeletal disorders (visceral). Incidentally, it is worth noting that the WSR approach is in direct contrast to the typical, allopathic reductionistic model that has stagnated and is only now begining to understand the merits of holistic and integrative medicine. CorticoSpinal (talk) 05:42, 14 April 2008 (UTC)

#Effectiveness 1 cites Hawk et al. 2007 (PMID 17604553) more often than any other source. It's a good source, but it is not the whole story, and other reliable sources should be used as well. Eubulides (talk) 09:15, 14 April 2008 (UTC)

I tend to agree with this argumentation that chiropractic is a career and thus cannot be measured for its effectiveness any more than we can measure the effectiveness of a dentist or veterinarian or a surgeon. We are just going in circles here discussing information which really has no place in this article. -- Levine2112 ^discuss 18:03, 14 April 2008 (UTC)

Chiropractic is more than just a career, and this article is not just about professional qualifications and certifications. Eubulides (talk) 09:12, 15 April 2008 (UTC)

This is getting repetitive very fast. Besides being tendentious continuing this discussion doesn't make much sense; where past the point of diminishing returns. It's been a week, the majority of editors disagree with the position taken by Eubulides and that's basically as cut and dry as we can have it. I also strong recommend AGAINST doing any risk/benefit section right now; that's another contentious and heated one ready to come, especially if the trend continues were allopathic sources routinely gets to trump chiropractic sources which are being incorrectly omitted and described at times as low quality and inappropriate and misleading suggestions as "reaching down". I'm gonna take the rest of the day off from Chiropractic to sit back and unplug; I just see so many unfair and unjust standards trying to be applied here which fly in the face of precedent setting pages of other health professions. I'm also going to make sure that somewhere on Chiropractic a blurb about it being a profession and not a modality gets put it; there's far too much confusion about this still and it's at the heart we're even having this debate. CorticoSpinal (talk) 19:32, 14 April 2008 (UTC)

Chiropractic already has multiple risk/benefit sections. The problem is that they are blatantly POV. This must get fixed, and #Effectiveness 1 fixes them. This has nothing to do with whether chiropractic is a profession; it has everything to do with a core question on the subject, which is when and whether chiropractic care works. Eubulides (talk) 09:12, 15 April 2008 (UTC)

Effectiveness 1 talks about effectiveness of chiropractic treatments, which is about effectiveness of a chriopractor's profession. This is exactly the point. Chiropractic is a profession, and Effectiveness 1 talks about effectiveness of chiropractic treatments. The effectiveness of those treatments belongs on the chiropractic article. Chiropractors perform those treatments and therfore it is relevant to have the material about Chiropractic's effectiveness. QuackGuru (talk) 00:46, 15 April 2008 (UTC)

Medical doctors, Osteopaths, Naturopaths and physical therapists can perform many of the treatments as well. Is it relevant to have the same material copied to those various pages? DigitalC (talk) 01:15, 15 April 2008 (UTC)

Agree with DigitalC here. Dentistry is a profession which uses fluoride as a treatment; yet the article for dentistry makes no mention of the effectiveness of fluoride treatments. How come? Maybe it is because the wise souls who edit these articles know that discussion about the effectiveness of specific treatments belong in articles about those specific treatments and not in the articles of the various professions that use such treatments. -- Levine2112 ^discuss 01:23, 15 April 2008 (UTC)

Again --> Effectiveness 1 talks about effectiveness of chiropractic treatments, which is about effectiveness of a chriopractor's profession. This is exactly the point. Chiropractic is a profession, and Effectiveness 1 talks about effectiveness of chiropractic treatments. The effectiveness of those treatments belongs on the chiropractic article. Chiropractors perform those treatments and therfore it is relevant to have the material about Chiropractic's effectiveness. Another article's format or inclusion or lack of inclusion of information is irrelavant to NPOVing this article. It is a strawman argument to say another article's info does not contain effectiveness so therefore we should exclude it here. Homeopathy contains effectiveness info anyhow. Readers want to know it's effectiveness. We can discuss chiropractic's effectiveness when the references discuss it's effectiveness. We are following the lead of the reviewers such as Ernst. So far I do not see any valid reason for excluding relevant chiropractic's effectiveness material. Thank you. QuackGuru (talk) 05:38, 15 April 2008 (UTC)

[outdent] Agree with DigitalC above as well. The application of effectiveness to Homeopathy is also invalid. That article is the exception not the rule. The current standard one would presume would be Medicine and no sections are found there regarding safety, effectiveness, risk/benefit or any other proposed ones that are suitable to study a drug or a therapy/modality, but not valid to be studying a profession. Ernst is but one critic, in fact to say he represents the opinion of mainstream opinion would be highly debatable, especially when the US Surgeon General, an MD, supports Chiropractic and spoke at a recent ACA conference.

Homeopathy is a method and therefore it's perfectly proper to have an effectiveness section in that article. -- Fyslee / talk 05:33, 15 April 2008 (UTC)

Homeopathy is not the exception or the rule. The standard is not a Medicine article. The standard are the reviewers. We are here to follow their lead. Ernst represents a mainstream view. Thanks again. QuackGuru (talk) 05:38, 15 April 2008 (UTC)

No thanks. QuackGuru, please stop talking down to us. If you're going to disagree, just do it without the "Thanks again" and such like tacked on at the end. It's insulting. BTW, I don't buy your argument. -- Fyslee / talk 05:52, 15 April 2008 (UTC)

It's not insulting to say thanks to someone. It is being polite. By the way, this chiropractic article has a section on chiropractic's methods. It is called Chiropractic#Treatment_procedures. For example, spinal manipulation is the most common modality in chiropractic care. We can discuss the treatment procedures as well as it's effectiveness. Thanks for listening. QuackGuru (talk) 08:15, 15 April 2008 (UTC)

Sure we can mention which modalities chiropractors use in this article, but then to go into each modality's effectiveness gets a tad tangential and tedious. We have an electronic encyclopdia with fancy-schmancy Wikilinks. Let's take advantage of the exciting technology and write this article in the Wonderful Wiki Way. (BTW, unless someone here is utilizing a text-to-voice reader, it is inappropriate to say, "Thanks for listening." Rather, "Thanks for reading," would be the more correct way to express your obviously sincere gratitude.) -- Levine2112 ^discuss 17:23, 15 April 2008 (UTC)

When we can mention which modalities chiropractors use in this article, it is equally relevant to include the modaliy's effectiveness. It does not get tangential or tedious, because we have followed the sources and respected NPOV. We can take advantage of wiki technology by including the relevant effectiveness info in this article. The same can be done for the Veterinary chiropractic‎ article. QuackGuru (talk) 19:13, 16 April 2008 (UTC)

This argument is well-worn territory which has been refuted in many previous exchanges. Rather than going in circles, please review the responses above and know that I still haven't changed my mind despite your repetition. If you wish to continue repeating yourself, please know that I may not respond. If you wish to move forward with some other form of dispute resolution, I am happy to fascilitate. Thank you. -- Levine2112 ^discuss 21:38, 16 April 2008 (UTC)

A noticeboard may be another option per WP:DR. http://en.wikipedia.org/wiki/Wikipedia:DR#Ask_for_help_at_a_relevant_noticeboard QuackGuru (talk) 02:10, 17 April 2008 (UTC)

Sure but I am unsure which noticeboard would be applicable here. -- Levine2112 ^discuss 17:44, 17 April 2008 (UTC)

relevancy (a central issue) & strawman arguments (oh my)

The effectiveness of chiropractic is relevant. The main reason why chiropractic is controversial is because of it's effectiveness. Chiropractic is a specific career. This is the same as Veterinary chiropractic‎ is a specific career. The references discuss the resulting effectiveness of chiropractor treatments. There is no SYN because we are following the sources faithfully in a measured, rationale way. We should not ignore the relevant references. We are using peer-reviewed journals. A core issue to Chiropractic is it's Effectiveness. Some Wikipedians claim the information is not relevant to chiropractic profession or it would be better left to add to other articles. That is a strawman argument. In some matter, effectiveness can be discussed in this article. The reviewers (refs) think it is relevant. They are discussing the chiropractic profession. For example, the researchers are discussing the effectiveness of chiropractic treatments. We can do the same here. The best we can do is to continue to follow the lead of the references. Saying Ernst is bias is POV-pushing. Ernst is neutral and notable and meets the inclusion criteria. It seems a few editors may not be thrilled with what the effectiveness says. However, this would benefit the project when we include and not suspend the effectiveness bit. The argument/claim that this information is not relevant doesn't fly with me. They want to permanently suspend the section. Nah. The effectiveness is a central issue and would be an improvement for this article. I think this is a case of WP:IDONTLIKEIT and nothing more. One of the goals of the project is to provide the most appropriate information available on each topic. The Effectiveness 1 accomplished this goal at least with respect to chiropractic's effectiveness. We can have further success/improvements by including the Effectiveness 1 which would benefit the reader and also meets the inclusion criteria.

Of course we can mention which modalities chiropractors use in this article, and then we can go into each modality's effectiveness. This is easy because we simply follow the sources. This can be done. Wait a second. This has been already done. The Effectiveness section seems to be completed now. It is clearly WP:NPOV. We have an online encyclopedia, with the vision of its founders (or at least Jimbo's vision). Consistant with that vision, we can create the sum of all knowledge about chiropractic. This article should not be the wild, wild west of wiks. Yes, the subject matter is contentious but that is not the point. The point is we have written something the meets the inclusion criteria and now we can improve this article. The modalities of chiropractic, controversy since its inception and effectiveness are all linked together. Rather than making it difficult for the reader by splitting up the well sourced text, it would be easiest and best (at least for the reader) if we included the Effectiveness 1 in this article. Irrespective of the chiropractic controversy surrounding it's effectiveness, it is reasonable to include neutrally written material (NPOV) which is a core issue about the field, in the main chiropractic article. Respectively, QuackGuru (talk) 19:13, 16 April 2008 (UTC)

I disagree with this rationale and maintain that the efficacy section should be split off under each modalities article. I think that is well aligned with the vision of Jimbo, the founder of Wikipedia. I actually think the efficacy section as written comes off very favourable for chiropractic; however as we can't distinguish SMT research from chiropractic specific research without a deadly SYN and since chiropractic is an occupation and not any singular modality with an efficacy that can be measured overall, the inclusion of an efficacy section here seems inappropriate. -- Levine2112 ^discuss 19:40, 16 April 2008 (UTC)

We have neutrally written SMT research and we should not second-geuss the reviewers. There is no SYN of words. Only well sourced facts. The text is relevant to chiropractic. For example, the most common modality is chiropractic spinal manipulation. When we can discuss the chiropractic's modalities we can discuss chiropractic's effectiveness in the same article as well. They are intimately related. Readers are curious about this kind of stuff. This is part of the mission of the project to improve this article (the sum of all human knowledge). ☺ QuackGuru (talk) 02:46, 17 April 2008 (UTC)

And the Oscar goes to... ;) That's a bit rich, Quack. You have not addressed any of the points made by myself, Levine2112, DigitalC and Fyslee. We, however have heard the argument and have addressed it in so many ways. I agree with Levine2112 that this is getting repetitive and tendentious. I'm not going to talk about it anymore, it's been 7 days. CorticoSpinal (talk) 03:35, 17 April 2008 (UTC)

Disruptive editing by OrangeMarlin on April 17/08

I'm very upset at the tactics used by OrangeMarlin who has not once participated in any meaningful discussion at this article and begins to blindly reverts. Since I'm voluntarily restricting myself to < 3R I won't revert; but I will be taking this to ANI as it seems this editor has a history of making questionable reverts to the article without any discussion whatsoever. This user has no context to the situation here and has many, many times has either flat out said or insinuated supporters of CAM therapies as "anti-science". This type of behaviour is absolutely against good wikipedia etiquette and OM can't play the newbie card; he's been here for years now and knows better. CorticoSpinal (talk) 19:48, 17 April 2008 (UTC)

You may also want to note in any report that you may file that OM is using Twinkle to make such reversion, even though they don't constitute as reversions to vandalism. Be that as it may, I think we should hold off a day or two to gather some comments on the Scope of Practice section before re-inserting. -- Levine2112 ^discuss 19:53, 17 April 2008 (UTC)

If the edits aren't perfectly clear in the article, why would I come here to read thousands upon thousands of lines of commentary that constitutes, if I may sum it up, "yes", "no", "maybe", "you're wrong", "I'm right", yada yada yada. Take it to AN/I. You'll get nowhere, I assure you. Your edits are unsupported by the wealth of science. And my analysis stays in the edit summary. When and if someone here cares to bullet point your reasons for your edits, without long tendentious commentary, that would be helpful to me. But I am not reading this excessively boring and repetitive discussion section. And yes, CAM supporters are anti-science, hence the use of the term "pseudoscience" to cover such therapies. To Levine, Twinkle use does not, de facto, imply vandalism, unless the "rollback vandalism" button is used. I never once called yours or CorticoSpinal's edits as vandalism, nor do I think they're vandalism. So ping me if there's a 5 or less bullet point comment that supports your edits. OrangeMarlin ^{Talk• Contributions} 20:25, 17 April 2008 (UTC)

You have absolutely no idea what you're talking about, OM. Your edit was not in the least justified, nor constructive, nor was your comment here helpful or clarified your position. You have no expertise in physical medicine, so I suggest you let the professionals deal with this. Actually, I'm a bit surprised that a physician, such as yourself, a purported "evidence-based" practitioner does follow the evidence or science. My edits are supported by the wealth of science? Did you even read the scope of practice, section, OrangeMarlin? What claim was not made by a fully referenced citation? This is more smoke and mirrors, courtesy of a fish out of water. Take two valium and call me in the morning. 208.101.118.196 (talk) 21:17, 17 April 2008 (UTC)

References