Chiropractic/Archive 17

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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. Eubulides17:18, 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.DigitalC00:49, 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. Eubulides09:12, 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. DigitalC23:16, 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. Eubulides23:42, 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. DigitalC23:48, 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. Eubulides05:57, 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? DigitalC22:07, 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). Eubulides23:38, 12 March 2008 (UTC)

http://www.ccgpp.org/lowbackliterature.pdf DigitalC00:07, 13 March 2008 (UTC)

Thanks; I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=197903204oldid=197902257 added that. Eubulides05:51, 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? EBDCM15:37, 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. Eubulides08:33, 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. Eubulides08:42, 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 (ChiropracticVaccination 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. EBDCM23:30, 18 March 2008 (UTC)

Eubulides

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.

cite journal |journal= J Pain Symptom Manage |date=2008 |title= Chiropractic: a critical evaluation |author= Ernst E |doi=10.1016/j.jpainsymman.2007.07.004 |pmid=18280103

Spinal manipulation

cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=6 |pages=429–42 |title= High-velocity low-amplitude spinal manipulation for symptomatic lumbar disk disease: a systematic review of the literature |author= Lisi AJ, Holmes EJ, Ammendolia C |doi=10.1016/j.jmpt.2005.06.013 |pmid=16096043

cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=4 |pages=266–73 |title= Distraction manipulation of the lumbar spine: a review of the literature |author= Gay RE, Bronfort G, Evans RL |doi=10.1016/j.jmpt.2005.03.012 |pmid=15883580

cite journal |journal= J R Soc Med |date=2006 |volume=99 |issue=4 |pages=192–6 |title= A systematic review of systematic reviews of spinal manipulation |author= Ernst E, Canter PH |pmid=16574972 |url=http://www.jrsm.org/cgi/content/full/99/4/192

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.

cite journal |journal= Clin Orthop Relat Res |date=2006 |volume=444 |pages=236–42 |title= Chiropractic: history and overview of theories and methods |author= Homola S |doi=10.1097/01.blo.0000200258.95865.87 |pmid=16446588

cite journal |journal= Clin Orthop Relat Res |date=2006 |volume=444 |pages=243–9 |title= History and overview of theories and methods of chiropractic: a counterpoint |author= DeVocht JW |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

cite journal |journal=Spine |date=2008 |volume=33 |issue= 4 Suppl |pages=S5–7 |title= The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: executive summary |author= Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å |doi=10.1097/BRS.0b013e3181643f40 |pmid=18204400 |url=http://www.spinejournal.com/pt/re/spine/fulltext.00007632-200802151-00004.htm This is an executive summary (which briefly talks about effectiveness) of a series of studies and reviews.

cite journal |journal=Spine |date=2008 |volume=33 |issue= 4 Suppl |pages=S123–52 |title= Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders |author= Hurwitz EL, Carragee EJ, van der Velde G |doi=10.1097/BRS.0b013e3181644b1d |pmid=18204386 This is a review of interventions, which contains more detail on effectiveness. It is briefly summarized in the executive summary noted above.

cite journal |journal= Eura Medicophys |date=2007 |volume=43 |issue=1 |pages=91–118 |title= Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews |author= Vernon H, Humphreys BK |pmid=17369783 |url=http://www.minervamedica.it/pdf/R33Y2007/R33Y2007N01A0091.pdf |format=PDF

cite journal |journal= Cochrane Database Syst Rev |date=2005 |issue=3 |pages=CD004250 |title= Exercises for mechanical neck disorders |author= Kay TM, Gross A, Goldsmith C "et al." |doi=10.1002/14651858.CD004250.pub3 |pmid=16034925

cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=7 |pages=520–5 |title= Chiropractic manipulation and acute neck pain: a review of the evidence |author= Haneline MT |doi=10.1016/j.jmpt.2005.07.010 |pmid=16182027

Other musculoskeletal problems

Arm/neck/shoulder: cite journal |journal= Cochrane Database Syst Rev |date=2006 |issue=3 |pages=CD003471 |title= Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults |author= Verhagen AP, Karels C, Bierma-Zeinstra SM "et al." |doi=10.1002/14651858.CD003471.pub3 |pmid=16856010

Upper extremities: cite journal |journal= J Manipulative Physiol Ther |date=2008 |volume=31 |issue=2 |pages=146–59 |title= Chiropractic treatment of upper extremity conditions: a systematic review |author= McHardy A, Hoskins W, Pollard H, Onley R, Windsham R |doi=10.1016/j.jmpt.2007.12.004 |pmid=18328941

Whiplash: cite journal |journal= Pain Res Manag |date=2005 |volume=10 |issue=1 |pages=21–32 |title= Treatment of whiplash-associated disorders—part I: non-invasive interventions |author= Conlin A, Bhogal S, Sequeira K, Teasell R |pmid=15782244

Chronic low back pain: cite journal |journal= Spine J |date=2008 |volume=8 |issue=1 |pages=213–25 |title= Evidence-informed management of chronic low back pain with spinal manipulation and mobilization |author= Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S |pmid=18164469

Low back pain and related leg: cite web |title= Chiropractic management of low back pain and low back related leg complaints |author= Meeker W, Branson R, Bronfort G "et al." |url=http://ccgpp.org/lowbackliterature.pdf |format=PDF |date=2007 |accessdate=2008-03-13 |publisher= Council on Chiropractic Guidelines and Practice Parameters

Lower extremities: cite journal |journal= J Manipulative Physiol Ther |date=2006 |volume=29 |issue=8 |pages=658–71 |title= Chiropractic treatment of lower extremity conditions: a literature review |author= Hoskins W, McHardy A, Pollard H, Windsham R, Onley R |doi=10.1016/j.jmpt.2006.08.004 |pmid=17045100

Adult scoliosis: cite journal |journal=Spine |date=2007 |volume=32 |issue= 19 Suppl |pages=S130–4 |title= A systematic literature review of nonsurgical treatment in adult scoliosis |author= Everett CR, Patel RK |doi=10.1097/BRS.0b013e318134ea88 |pmid=17728680

Adolescent idiopathic scoliosis: cite journal |journal=Scoliosis |date=2008 |volume=3 |pages=2 |title= Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review |author= Romano M, Negrini S |doi=10.1186/1748-7161-3-2 |pmid=18211702 |url=http://scoliosisjournal.com/content/3/1/2

Headache

cite journal |journal=Headache |date=2005 |volume=45 |issue=6 |pages=738–46 |title= Physical treatments for headache: a structured review |doi=10.1111/j.1526-4610.2005.05141.x |author= Biondi DM |pmid=15953306

cite journal |journal= Clin J Pain |date=2006 |volume=22 |issue=3 |pages=278–85 |title= Are manual therapies effective in reducing pain from tension-type headache?: a systematic review |author= Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA |doi=10.1097/01.ajp.0000173017.64741.86 |pmid=16514329

Other problems

Baby colic: cite journal |journal= Paediatr Nurs |date=2007 |volume=19 |issue=8 |pages=26 |title= Effectiveness of chiropractic treatment for infantile colic |author= Kingston H |pmid=17970361

Fibromyalgia: cite journal |journal= Curr Pharm Des |date=2006 |volume=12 |issue=1 |pages=47–57 |title= Complementary and alternative medical therapies in fibromyalgia |author= Sarac AJ, Gur A |pmid=16454724

Bedwetting: cite journal |journal= Cochrane Database Syst Rev |date=2005 |issue=2 |pages=CD005230 |title= Complementary and miscellaneous interventions for nocturnal enuresis in children |author= Glazener CM, Evans JH, Cheuk DK |doi=10.1002/14651858.CD005230 |pmid=15846744

Menstrual cramps: cite journal |journal= Cochrane Database Syst Rev |date=2006 |issue=3 |pages=CD002119 |title= Spinal manipulation for primary and secondary dysmenorrhoea |author= Proctor ML, Hing W, Johnson TC, Murphy PA |doi=10.1002/14651858.CD002119.pub3 |pmid=16855988

Nonmusculoskeletal conditions: cite journal |journal= J Altern Complement Med |date=2007 |volume=13 |issue=5 |pages=491–512 |title= Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research |author= Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW |doi=10.1089/acm.2007.7088 |pmid=17604553

Quality of clinical trials

Headache: cite journal |journal= J Orthop Sports Phys Ther |date=2006 |volume=36 |issue=3 |pages=160–9 |title= Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache |author= Fernández-de-las-Peñas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC |pmid=16596892

Low back pain: cite journal |journal= J Manipulative Physiol Ther |date=2006 |volume=29 |issue=7 |pages=576–81, 581.e1–2 |title= Inconsistent grading of evidence across countries: a review of low back pain guidelines |author= Murphy AY, van Teijlingen ER, Gobbi MO |doi=10.1016/j.jmpt.2006.07.005 |pmid=16949948

Patient satisfaction

cite journal |journal= J Manipulative Physiol Ther |date=2006 |volume=29 |issue=6 |pages=455–62 |title= Factors associated with patient satisfaction with chiropractic care: survey and review of the literature |author= Gaumer G |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 MEDRS should not be relied on as heavily as secondary stories.

cite journal |journal= J Manipulative Physiol Ther |date=2007 |volume=30 |issue=6 |pages=408–18 |title= The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study |author= Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW |doi=10.1016/j.jmpt.2007.04.013 |pmid=17693331 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. Eubulides22:04, 10 March 2008 (UTC)

cite journal |journal=Spine |date=1998 |volume=23 |issue=17 |pages=1875–83 |title= 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 |author= Skargren EI, Carlsson PG, Öberg BE |pmid=9762745

cite journal |journal=Phys Ther |year=1999 |volume=79 |issue=1 |pages=50-65 |title= Manipulation of the Cervical Spine Risks and Benefits |author= Di Fabio RP |pmid=9920191 |url=http://www.ptjournal.org/cgi/content/full/79/1/50

cite journal |journal=Stroke |year=2001 |volume=32 |issue=5 |pages=1054–60 |title= Chiropractic manipulation and stroke: a population-based case-control study |author= Rothwell DM, Bondy SJ, Williams JI |pmid=11340209 |url=http://stroke.ahajournals.org/cgi/content/full/32/5/1054

cite journal |journal= Ann Intern Med |date=2003 |volume=138 |issue=11 |pages=871–81 |title= Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies |author= Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG |pmid=12779297 |url=http://annals.org/cgi/content/full/138/11/871

cite journal |journal= Ann Intern Med |date=June 3, 2003 |volume= 138 |issue= 11 |pages= 898-906 |title= A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain |author= Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. |pmid= 12779300 |url= http://www.annals.org/cgi/reprint/138/11/898.pdf |format=PDF

Newer cost-effectiveness sources

cite journal |journal= Best Pract Res Clin Rheumatol |date=2005 |volume=19 |issue=4 |pages=671–84 |title= What is the most cost-effective treatment for patients with low back pain? A systematic review |author= van der Roer N, Goossens ME, Evers SM, van Tulder MW |doi=10.1016/j.berh.2005.03.007 |pmid=15949783

cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=8 |pages=555-63 |title= Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain |author= Haas M, Sharma R, Stano M |doi=10.1016/j.jmpt.2005.08.006 |pmid=16226622

cite journal |journal= Evid Based Complement Alternat Med |date=2006 |volume=3 |issue=4 |pages=425–32 |title= Cost-effectiveness of complementary therapies in the United kingdom—a systematic review |author= Canter PH, Coon JT, Ernst E |doi=10.1093/ecam/nel044 |pmid=17173105 |url=http://ecam.oxfordjournals.org/cgi/content/full/3/4/425

cite journal |journal= J R Soc Med |date=2006 |volume=99 |issue=4 |pages=192–6 |title= A systematic review of systematic reviews of spinal manipulation |author= Ernst E, Canter PH |pmid=16574972 |url=http://www.jrsm.org/cgi/content/full/99/4/192

cite journal |journal= J Pain Symptom Manage |date=2008 |title= Chiropractic: a critical evaluation |author= Ernst E |doi=10.1016/j.jpainsymman.2007.07.004 |pmid=18280103

Newer risk-benefit sources

cite journal |journal= J Manipulative Physiol Ther |date=2007 |volume=30 |issue=6 |pages=408–18 |title= The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study |author= Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW |doi=10.1016/j.jmpt.2007.04.013 |pmid=17693331 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 http://en.wikipedia.org/w/index.php?title=Chiropracticoldid=196249919 now. Fixing these problems would suffice to remove the NPOV tag. Comments welcome.

I have struck out items that are done. Eubulides22:07, 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. -- Dematt Dēmatt 03:41, 13 March 2008 (UTC)

Thanks. I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=197988479oldid=197956701 put it in. Eubulides16:29, 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. (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198368946oldid=198367146 fixed; see Revision to "Practice styles" below)

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

OK, please see Revision to "Practice styles" below. Eubulides20:18, 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. (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198368946oldid=198367146 fixed by removing the sources; see Revision to "Practice styles" below)

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

OK, please see Revision to "Practice styles" below. Eubulides20:18, 13 March 2008 (UTC)

Chiropractic Utilization and satisfaction rates has an unsourced claim that needs sourcing. (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198351690oldid=198350723 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. -- Dematt Dēmatt 03:41, 13 March 2008 (UTC)

That sentence was re-added http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=194888137oldid=194864839 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. Eubulides05:58, 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". (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199198890oldid=199189097 fixed)

Agree, though the second is not a complete sentence. Perhaps "..the debate "continues" about.." -- Dematt Dēmatt 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. Eubulides06:00, 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" (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198289539oldid=198240185 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 http://www.chiroweb.com/columnist/rosner/ link that no longer works. The text of the citation says ""Dynamic Chiropractic" Aug. 2006", but the http://www.chiroweb.com/archives/24/17/index.html table of contents for the 2006-08-15 issue, the only issue published in August, does not mention Rosner. For now I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198291729oldid=198289539 removed the quote which had the side effect of removing the peacock phrase.

*"Joseph Janse, DC, ND," (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198293089oldid=198291729 fixed)

*"Judge Susan Getzendanner, who presided over the Wilk case, opined" (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198296274oldid=198293089 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" (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198321909oldid=198319950 fixed)

*The following issues were http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198573735oldid=198570123 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" (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198574839oldid=198574595 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. -- Dematt Dēmatt 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. Eubulides06:05, 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. -- Dematt Dēmatt 03:41, 13 March 2008 (UTC)

Agreed; the summary of the dispute should be both neutral and accurate. Eubulides06:06, 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. (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198573735oldid=198570123 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. Eubulides06:09, 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. -- Dematt Dēmatt 03:41, 13 March 2008 (UTC)

OK, http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198039522oldid=198031883 done. Eubulides20:32, 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. -- Dematt Dēmatt 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 LINKS What should be linked. Let's just remove them all: Wikipedia is not a link farm. (http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198500475oldid=198428751 fixed)

This is a POV issue. -- Dematt Dēmatt 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. Eubulides20:46, 13 March 2008 (UTC)

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

OK, thanks, I took the easy way out by http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198500475oldid=198428751 replacing the section with a single pointer to the Open Directory linkfarm. Eubulides22:34, 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. EBDCM03:32, 17 March 2008 (UTC)

That issue can be resolved by following Dematt's suggestion to finish the body first. Eubulides05:21, 17 March 2008 (UTC)

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

That order sounds reasonable, yes. Eubulides06:10, 13 March 2008 (UTC)

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

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

Eubulides

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.TheDoctorIsIn00:58, 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. DigitalC02:47, 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.CynRNCynRN04:31, 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. DigitalC05:46, 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: http://www.painfree.ca/flueld.html. Eubulides06:24, 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 CynRNCynRN20:12, 14 March 2008 (UTC)

That speech and that outbreak predated the rule change that prevented Ontario chiropractors from discussing vaccination.http://www.planetc1.com/search/chiropractic-awareness-council-discussion-of-vaccination.html?PHPSESSID=2407dc7d3696272e66d76c56da9a5d2a The examples given above were more recent. Eubulides22:02, 14 March 2008 (UTC)

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

The http://www.painfree.ca/flueld.html 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. Eubulides07:25, 15 March 2008 (UTC)

Hehe, the skeletons are part of the background. It's even on the http://www.painfree.ca/fitness.htm 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. -- Dematt Dēmatt 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? Eubulides23:58, 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: http://vaccineinfo.net/immunization/vaccine/influenza/flu_vaccine_facts.shtml.

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. EBDCM01:51, 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" http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htmCynRNCynRN02:21, 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!CynRNCynRN19:08, 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.CynRNCynRN02:21, 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. EBDCM02:30, 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. Eubulides02:50, 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. EBDCM19:09, 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 ChiropracticVaccination 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

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. EBDCM03:36, 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. Eubulides05:31, 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). EBDCM23:45, 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. Eubulides08:47, 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. EBDCM03:23, 17 March 2008 (UTC)

The ICA opposes fluoridation of municipal drinking water as a matter of policy http://www.chiropractic.org/ica/policy.htm. The ACA takes no position now, but a quick check on the web found claims that it formerly supported fluoridation and stopped doing so.http://www.noforcedfluoride.org/ 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. Eubulides05:55, 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! EBDCM23:45, 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. Eubulides08:53, 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. EBDCM23:45, 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. Eubulides08:55, 19 March 2008 (UTC)

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

Eubulides

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. EBDCM23:45, 18 March 2008 (UTC)

Sorry about the above..wrong dates. Some still have or had anti-vax material on websites, see April 2005http://www.painfree.ca/newsletter.htm Have any practitioners been fined for going against the prohibition?CynRNCynRN07:05, 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. Eubulides06:43, 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. DigitalC05:46, 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. Eubulides05:59, 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. ;-) -- Dematt Dēmatt 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. EBDCM01:25, 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

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. EBDCM02:02, 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

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. EBDCM18:21, 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 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. ChiropracticSafety 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. Eubulides00:46, 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.65A recent, multidisciplinary study concluded that there was no evidence of excess risk of VBA stroke associated with chiropractic care."'CynRNCynRN18:58, 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 MEDRS reasons discussed above (this discussion was added after your comment). Eubulides00:46, 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. ---- Dematt Dēmatt 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 ChiropracticSafety. We should not be second-guessing the Task Force's own reviews of its own study. Eubulides06:00, 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 ChiropracticSafety. 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? Eubulides16:55, 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. Eubulides06:15, 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: http://www.spinejournal.com/pt/re/spine/abstract.00007632-200802151-00019.htm;jsessionid=HdfLnKPmJLn2J6n2Bbcvg0nrhRc0QdwPzbJF016bj1wHWhvBWGRH!-1013551081!181195628!8091!-1

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. EBDCM03:16, 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 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 MEDRS guidelines and would raise significant POV issues. Eubulides17:02, 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. EBDCM00:23, 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 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. Eubulides09:05, 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

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. EBDCM00:23, 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. Eubulides09:10, 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. Eubulides03:16, 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. EBDCM03:30, 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. Eubulides03:52, 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. EBDCM04:04, 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. Eubulides04:10, 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. EBDCM05:19, 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. Eubulides05:29, 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. EBDCM05:39, 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. Eubulides06:00, 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. EBDCM06:12, 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. Eubulides06:31, 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 http://books.google.ca/books?hl=enid=xRGhUSdwCgQCdq=the+chiropractic+theoriesprintsec=frontcoversource=webots=lEvlizOB34sig=JM_plMwH86ZiYFWZggpfvonGnIo 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? EBDCM00:23, 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 ChiropracticSafety now. Eubulides09:15, 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. EBDCM23:49, 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. Eubulides03:20, 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. EBDCM03:30, 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. Eubulides03:57, 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. EBDCM05:19, 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

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. EBDCM05:56, 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. Eubulides06:16, 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. EBDCM06:36, 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. Eubulides06:52, 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. EBDCM00:23, 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. Eubulides09:20, 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. EBDCM23:49, 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. Eubulides03:23, 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. EBDCM03:46, 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. Eubulides05:05, 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. EBDCM05:19, 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. Eubulides09:22, 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. EBDCM23:49, 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. Eubulides03:27, 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. EBDCM03:46, 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. Eubulides05:11, 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 ChiropracticSafety.

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

17:27, 17 March 2008 (UTC)

Suppose ChiropracticSafety 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

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. EBDCM00:23, 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 ChiropracticSafety does now. Eubulides09:24, 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. EBDCM23:49, 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. Eubulides03:32, 20 March 2008 (UTC)

It pales in comparison to the Task Force in depth, breadth and quality. EBDCM05:39, 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. Eubulides06:03, 20 March 2008 (UTC)

Eubulides

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)CynRNCynRN06:25, 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.cite journal |journal= Clin Orthop Relat Res |date=2006 |volume=444 |pages=243–9 |title= History and overview of theories and methods of chiropractic: a counterpoint |author= DeVocht JW |doi=10.1097/01.blo.0000203460.89887.8d |pmid=16523145

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. EBDCM15:44, 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.... EBDCM00:23, 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. Eubulides09:36, 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. EBDCM23:49, 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 MEDRS, and there are good reasons for those guidelines. Eubulides03:36, 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. EBDCM04:21, 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

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. EBDCM05:09, 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. Eubulides05:21, 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. EBDCM05:30, 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. Eubulides05:50, 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? EBDCM06:02, 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. Eubulides06:24, 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. EBDCM06:31, 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. Eubulides06:41, 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. EBDCM06:44, 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. Eubulides06:55, 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. EBDCM00:23, 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. Eubulides09:39, 19 March 2008 (UTC)

I think this was a misunderstanding. EBDCM23:49, 19 March 2008 (UTC)

Providing context for both sides in the main text would weaken the article. Among other things, it would lengthen ChiropracticSafety 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

17:46, 17 March 2008 (UTC)

If we have to sacrifice brevity for clarity than so be it. EBDCM00:23, 19 March 2008 (UTC)

There is nothing unclear about putting authorship material in footnotes. That's the standard style, and is expected in Wikipedia. Eubulides09:41, 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. Eubulides06:58, 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. EBDCM15:44, 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

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.CynRNCynRN17:56, 17 March 2008 (UTC)

More on vaccine issue

"'More on vaccine issue"'I 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.CynRNCynRN06:36, 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. EBDCM15:44, 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. Eubulides18:02, 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." http://www.worldchiropracticalliance.org/tcj/2000/jun/jun2000a.htmThis is recent and reflects what is published on the web and on Youtube by chiropractors.CynRNCynRN18:51, 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. Eubulides19:15, 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.CynRNCynRN20:04, 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 —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. DigitalC00:44, 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.CynRNCynRN15:46, 21 March 2008 (UTC)

Just Ontario, as far as has been said here. Eubulides18:08, 21 March 2008 (UTC)

Expanding vaccination section

The Vaccination section is short. Maybe it could be expanded to include more in depth detail. QuackGuru18:12, 21 March 2008 (UTC)

I put an expand tag in the section. -WarthogDemon "'Warthog"'"'Demon"' 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. Eubulides18:46, 21 March 2008 (UTC)

I http://en.wikipedia.org/w/index.php?title=User_talk%3AWarthogDemondiff=200012346oldid=200005118 asked WarthogDemon about this but haven't had a response yet. I'm inclined to remove the tag, unless there's an objection here. Eubulides01:42, 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.TheDoctorIsIn20:45, 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. QuackGuru01:45, 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 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? Eubulides02:12, 22 March 2008 (UTC)

The two refs have abstracts readers can read. The current ref has http://www.ncbi.nlm.nih.gov/pubmed/15965414 no abstract and I was unable to read the article. QuackGuru02:55, 22 March 2008 (UTC)

Thanks for mentioning it; I hadn't noticed that. I made http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=200001241oldid=199874273 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. Eubulides04:35, 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.CynRNCynRN19:09, 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 ChiropracticVaccination'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? Eubulides00:48, 23 March 2008 (UTC)

I don't agree with http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=200001241oldid=199874273 this change. The text about how really effective vaccination is has been erased. QuackGuru20:16, 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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=200192144oldid=200145824 did that. I hope this answers the objection. Eubulides00:39, 23 March 2008 (UTC)

Perfect! QuackGuru00:41, 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!CynRNCynRN03:37, 23 March 2008 (UTC)

I second that. Good addition. --DavidD4scnrt06:10, 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. Mccready12:58, 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. Eubulides16:32, 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?CynRNCynRN18:59, 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. Eubulides19:46, 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.TheDoctorIsIn01:02, 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. Eubulides06:49, 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.TheDoctorIsIn01:04, 13 March 2008 (UTC)

Which suggestions are those? Please provide details. Eubulides06:49, 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. EBDCM00:32, 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. Eubulides02:14, 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. EBDCM02:39, 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. Eubulides04:55, 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. EBDCM18:52, 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. Eubulides00:50, 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 http://www.cochrane.org/reviews/en/ab002119.html, breast cancer (chrissakes). The reader needs to know this and know what the science says. 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

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. Eubulides02:36, 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). EBDCM18:48, 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. EBDCM01:04, 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 ;-) -- Dematt Dēmatt 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.CynRNCynRN04:19, 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 http://www.telfer.uottawa.ca/component/listing,Manga,%20Pran/option,com_directory/page,viewListing/lid,136/Itemid,116/lang,en/ Pran Manga directly. It should be noted that the report was controversial when it came out; see, for example:

cite journal |journal=CMAJ |date=1994 |volume=150 |issue=11 |pages=1878–81 |title= Orthopedists have bone to pick with economist over report on chiropractic |author= Lowry F |pmid=7802764 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=7802764

cite journal |journal=CMAJ |date=1994 |volume=151 |issue=8 |pages=1107–8 |title= Report on chiropractic |author= Manga P, Angus D |pmid=7922936 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=7922936

cite journal |journal=CMAJ |date=1994 |volume=151 |issue=8 |pages=1108 |title= Report on chiropractic |author= Chapman-Smith DA |pmid=7802806 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=7802806

cite journal |journal=CMAJ |date=1994 |volume=151 |issue=8 |pages=1110 |title= Report on chiropractic |author= Hoaken PC |pmid=7922937 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=7922937

cite journal |journal=CMAJ |date=1994 |volume=151 |issue=9 |pages=1247–9 |title= Is the chiropractic management of low-back pain the solution? What can physicians learn from the Manga report? |author= Tardif GS |pmid=7954171 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=7954171

cite journal |journal=CMAJ |date=1994 |volume=151 |issue=9 |pages=1250–1 |title= Defending the Manga report on the chiropractic management of low-back pain |author= Manga P |pmid=7954172 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=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. Eubulides05:59, 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.CynRNCynRN17:49, 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!)CynRNCynRN02:32, 16 March 2008 (UTC)

I forgot to say, the report is $20, postage included.CynRNCynRN03:13, 16 March 2008 (UTC)

Revision to &quot;Practice styles&quot;

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. Eubulides20:18, 13 March 2008 (UTC)

This revision uses the following citations which are already present in other sections of Chiropractic:cite book |chapterurl=http://chiroweb.com/archives/ahcpr/chapter2.htm |chapter= Chiropractic belief systems |author= Mootz RD, Phillips RB |date=1997 |title= Chiropractic in the United States: Training, Practice, and Research |pages=9–16 |editor= Cherkin DC, Mootz RD (eds.) |accessdate=2008-02-14 |version= AHCPR Pub No. 98-N002 |location= Rockville, MD |publisher= Agency for Health Care Policy and Research |oclc=39856366cite web |url=http://cce-usa.org/uploads/File/2007%20January%20STANDARDS.pdf |format=PDF |title= Standards for Doctor of Chiropractic programs and requirements for institutional status |author= Council on Chiropractic Education |date=2007 |accessdate=2008-02-14

(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.cite web |url=http://findarticles.com/p/articles/mi_qa3987/is_200309/ai_n9291884/pg_3+ |title=Surveys now and then | Dynamic Chiropractic | Find Articles at BNET.com |accessdate=2008-03-24 |format= |work= Still, significant differences exist amongst the practice styles, claims and beliefs between various chiropractors.cite web |url=http://www.chiroweb.com/archives/08/21/13.html |title=It's Where You Put the Period |date=October 10, 1990 |volume=08 |issue=21 |accessdate=2008-03-24 |author= James W. Healey, DC |authorlink= |coauthors= |format= |work= |publisher=Dynamic Chiropractic |pages= |language= |archiveurl= |archivedate= |quote= 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.cite web |url=http://www.f-a-c-e.com/positionpaper1.htm |title=Position Paper One — What is Objective Straight Chiropractic? |accessdate=2008-03-24 |author= |authorlink= |coauthors= |date= |format= |work= |publisher=Foundation for the Advancement of Chiropractic Education (F.A.C.E.)|pages= |language= |archiveurl= |archivedate= |quote=

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.cite journal |journal= Arch Intern Med |date=1998 |volume=158 |issue=20 |pages=2215–24 |title= Chiropractic: origins, controversies, and contributions |author= Kaptchuk TJ, Eisenberg DM |pmid=9818801 |url=http://archinte.ama-assn.org/cgi/content/full/158/20/2215 In contrast to straight chiropractors, mixers generally want to be integrated into mainstream health care via integrative medicine.Fact|date=April 2008 "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.

cite news

|last=Berrett

|first=Stephen

|title=NCAHF Position Paper on Chiropractic — The Reformers

|url=http://www.ncahf.org/pp/chirop.htmlreformers

|date=

|work=

|publisher=The National Council Against Health Fraud

|accessdate=2008-02-02

|quote=

(end of proposed revision to ChiropracticSchools of thought and practice styles.

Comments on proposed revision to &quot;Practice styles&quot;

(Please put comments here.) Eubulides20:18, 13 March 2008 (UTC)

I made http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=198139747oldid=198139199 these changes to Scope of practice so that its text more-closely reflected the cited sources. Eubulides06:36, 14 March 2008 (UTC)

No further comment so I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198368946oldid=198367146 made that change. Eubulides07:32, 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. EBDCM02:42, 16 March 2008 (UTC)

Sorry, I'm a bit lost: I don't know what is meant by Coppertwigs edit; the http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=193855788oldid=193837981 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? Eubulides05:05, 16 March 2008 (UTC)

The edit that listed the common themes amongst all practice styles. EBDCM18:36, 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 ChiropracticPhilosophy. 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". Eubulides00:55, 17 March 2008 (UTC)

The new subsection Minority added http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=198680241oldid=198679733 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). Eubulides01:04, 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. Eubulides06:05, 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. QuackGuru06:10, 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. Eubulides06:27, 20 March 2008 (UTC)

I will update the article based on theses new comments. I will aslo remove the COPYVIO and massive content changes made without consensus. Please review. QuackGuru01:56, 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? Eubulides07:34, 21 March 2008 (UTC)

I made minor changes when I added it to the article. QuackGuru07:39, 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? Eubulides08:12, 21 March 2008 (UTC)

Lose the Minority section per the Minority View portion of NPOV policy.TheDoctorIsIn07:51, 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. Eubulides08:12, 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, QuackGuru08:39, 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. Eubulides08:42, 21 March 2008 (UTC)

I explained both minority groups are very small. I have no doubts. QuackGuru08:47, 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. Eubulides08:56, 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.http://en.wikipedia.org/w/index.php?title=Chiropracticoldid=181317239Practice_styles_and_schools_of_thought Per WEIGHT, minority groups can have a short paragraph. QuackGuru09:05, 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. Eubulides18:11, 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. QuackGuru18:16, 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. Eubulides18:40, 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 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. QuackGuru01:39, 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. Eubulides02:20, 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. QuackGuru02:42, 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. Eubulides04:43, 22 March 2008 (UTC)

The refs discuss both minority groups. I do not see any reference saying these groups are history. QuackGuru06:03, 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. Eubulides07:01, 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. QuackGuru20:22, 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? Eubulides00:55, 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. QuackGuru01:11, 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. Eubulides01:23, 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. QuackGuru01:27, 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. Eubulides01:35, 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. QuackGuru01:47, 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. Eubulides01:54, 23 March 2008 (UTC)

It was non-controversial until the recent edit wars. There was long term consensus for four unique paragraphs.http://en.wikipedia.org/w/index.php?title=Chiropracticoldid=181317239Practice_styles_and_schools_of_thought 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. QuackGuru02:08, 23 March 2008 (UTC)

Please see 2008-03-23 practice style changes lack consensus below. Eubulides07:04, 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 / 06:46, 23 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=200211230oldid=200192144 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 ChiropracticSchools 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 http://en.wikipedia.org/w/index.php?title=Chiropracticoldid=181317239Practice_styles_and_schools_of_thought 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 ChiropracticSchools 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. Eubulides07:04, 23 March 2008 (UTC)

In light of the above discussion I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=200253592oldid=200234668 reverted the controversial part of the change. Eubulides07:07, 23 March 2008 (UTC)

QuackGuru http://en.wikipedia.org/w/index.php?title=User_talk%3AEubulidesdiff=200254256oldid=200203726 pointed out on my talk page that the reversion also contains http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=200016452oldid=200001241 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. Eubulides07:24, 23 March 2008 (UTC)

As QuackGuru http://en.wikipedia.org/w/index.php?title=User_talk:Eubulidescurid=9530555diff=200256478oldid=200256035 pointed out, I confused his addition to ChiropracticMixers with the text that Fyslee removed. They are not the same thing. Sorry about my mistake. I repaired it by http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=200257523oldid=200253592 restoring that part of QuackGuru's change. I then made a further http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=200257718oldid=200257523 change to remove the need to cite Kaptchuk Eisenberg 1998 twice, along with requesting a citation for newly added unsourced material. Eubulides07:50, 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 http://archinte.ama-assn.org/cgi/content/full/158/20/2215 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 / 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).CynRN 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

Comments on 2nd proposed revision to &quot;Practice styles&quot;

Here are some comments on the http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticoldid=200468863Schools_of_thought_and_practice_styles 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 (cite book |author= Keating JC Jr |chapter= A brief history of the chiropractic profession |pages=23–64 |title= Principles and Practice of Chiropractic |edition= 3rd ed. |editor= Haldeman S, Dagenais S, Budgell B "et al." (eds.) |publisher=McGraw-Hill |date=2005 |isbn=0-07-137534-1). 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.

cite news |title=How Do I Choose a Chiropractor? |url=http://www.healthprofs.com/cam/content/chiropractic_choose.html |date=2008 |publisher=The Health Professionals Directory |accessdate=2008-02-02 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 Mirtz TA, Long P, Dinehart A. Slaughter RL, DuVall Jr., CE, Bryson R, Kourmadas F. Campo J. http://www.accessmylibrary.com/coms2/summary_0286-25525357_ITM NACM and its argument with mainstream chiropractic health care. "Journal of Controversial Medical Claims", 2002;9(1):11-25. (Article summary) 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. Eubulides06:27, 24 March 2008 (UTC)

Agreed. The less reliable sources should be removed and we need to see the bigger picture and edit. QuackGuru23:48, 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. http://www.chiroweb.com/archives/21/12/19.htmlCynRN 02:19, 26 March 2008 (UTC)

cite journal |journal= Arch Intern Med |date=1998 |volume=158 |issue=20 |pages=2215–24 |title= Chiropractic: origins, controversies, and contributions |author= Kaptchuk TJ, Eisenberg DM |pmid=9818801 |url=http://archinte.ama-assn.org/cgi/content/full/158/20/2215 This ref () verifies that fact that "mixers believe subluxation is one of the many causes of disease." QuackGuru00:08, 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. QuackGuru00:30, 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. Eubulides01:30, 23 March 2008 (UTC)

I have restored the Scope of practice to its original location after the Schools of thought. QuackGuru05:04, 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.TheDoctorIsIn08:05, 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 methodshttp://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198149560oldid=198141253. 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 Kelvin08:25, 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. Eubulides19:19, 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. ---- Dematt Dēmatt 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 Kelvin01:08, 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. EBDCM01:14, 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. Eubulides01:20, 17 March 2008 (UTC)

I reverted massive edits.http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199479081oldid=199474559 We need to talk this over. QuackGuru00:30, 20 March 2008 (UTC)

The substantial and massive changes without consensus to the article has continued.http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=199489688 QuackGuru01:27, 20 March 2008 (UTC)

I agree with this edit anyhow.http://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=199491190oldid=199490653 QuackGuru01:30, 20 March 2008 (UTC)

I also concur with this edit.http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199494291oldid=199493504 QuackGuru01:52, 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 01:57, 20 March 2008 (UTC)

I agree with this NPOV edit.http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199505793oldid=199505721 QuackGuru02:45, 20 March 2008 (UTC)

I concur with this edit.http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199506345oldid=199506203 QuackGuru02:48, 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.TheDoctorIsIn03:03, 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 http://en.wikipedia.org/wiki/User_talk:Orangemarlinreverting_referenced_text_from_chiro_.28again.29 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. EBDCM03:13, 20 March 2008 (UTC)

This edit was made without consensus.http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199509467oldid=199506345 QuackGuru04:06, 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?CynRNCynRN01:49, 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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198345901oldid=198321909 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. Eubulides04:02, 15 March 2008 (UTC)

Thanks, I'll see if I can look it up in Vear.CynRNCynRN16:25, 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.cite journal |journal=Spine |date=2007 |volume=32 |issue=21 |pages=2375–8 |title= Safety of chiropractic manipulation of the cervical spine: a prospective national survey |author= Thiel HW, Bolton JE, Docherty S, Portlock JC |pmid=17906581 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 adultscite journal |journal= J R Soc Med |date=2007 |volume=100 |issue=7 |pages=330–8 |title= Adverse effects of spinal manipulation: a systematic review |author= Ernst E |pmid=17606755 |url=http://www.jrsm.org/cgi/content/full/100/7/330 and children.cite journal |journal=Pediatrics |date=2007 |volume=119 |issue=1 |pages=e275–83 |title= Adverse events associated with pediatric spinal manipulation: a systematic review |author= Vohra S, Johnston BC, Cramer K, Humphreys K |doi=10.1542/peds.2006-1392 |pmid=17178922 |url=http://pediatrics.aappublications.org/cgi/content/full/119/1/e275 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.cite journal |journal=Spine |date=2008 |volume=33 |issue= 4 Suppl |pages=S5–7 |title= The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: executive summary |author= Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å |doi=10.1097/BRS.0b013e3181643f40 |pmid=18204400 |url=http://www.spinejournal.com/pt/re/spine/fulltext.00007632-200802151-00004.htm

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.cite journal |journal= J Can Chiropr Assoc |date=2005 |volume=49 |issue=3 |pages=158–209 |title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash |author= Anderson-Peacock E, Blouin JS, Bryans R "et al." |url=http://www.jcca-online.org/Client/cca/jcca.nsf/objects/jcca-v49-3-158/$file/jcca-v49-3-158.pdf |format=PDF cite journal |journal= J Can Chiropr Assoc |date=2008 |volume=52 |issue=1 |pages=7–8 |title= A clinical practice guideline update from The CCA•CFCREAB-CPG |author= Anderson-Peacock E, Bryans B, Descarreaux M "et al." |url=http://www.jcca-online.org/Client/cca/JCCA.nsf/objects/JCCA_March_2008_52_1/$file/jcca-v52-1-007.pdf |format=PDF

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.cite paper |author= World Health Organization |date=2005 |title= WHO guidelines on basic training and safety in chiropractic |url=http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf |format=PDF |accessdate=2008-03-03

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.cite journal |journal= J Can Chiropr Assoc |date=2005 |volume=49 |issue=3 |pages=158–209 |title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash |author= Anderson-Peacock E, Blouin JS, Bryans R "et al." |url=http://www.jcca-online.org/Client/cca/jcca.nsf/objects/jcca-v49-3-158/$file/jcca-v49-3-158.pdf |format=PDF cite journal |journal= J Can Chiropr Assoc |date=2008 |volume=52 |issue=1 |pages=7–8 |title= A clinical practice guideline update from The CCA•CFCREAB-CPG |author= Anderson-Peacock E, Bryans B, Descarreaux M "et al." |url=http://www.jcca-online.org/Client/cca/JCCA.nsf/objects/JCCA_March_2008_52_1/$file/jcca-v52-1-007.pdf |format=PDF

Risks can reasonably be considered slight when compared to all forms of medical treatment.cite journal |journal= Clin Orthop Relat Res |date=2006 |volume=444 |pages=243–9 |title= History and overview of theories and methods of chiropractic: a counterpoint |author= DeVocht JW |doi=10.1097/01.blo.0000203460.89887.8d |pmid=16523145

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.cite journal |journal=Spine |date=2007 |volume=32 |issue=21 |pages=2375–8 |title= Safety of chiropractic manipulation of the cervical spine: a prospective national survey |author= Thiel HW, Bolton JE, Docherty S, Portlock JC |pmid=17906581

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 adultscite journal |journal= J R Soc Med |date=2007 |volume=100 |issue=7 |pages=330–8 |title= Adverse effects of spinal manipulation: a systematic review |author= Ernst E |pmid=17606755 |url=http://www.jrsm.org/cgi/content/full/100/7/330 and children.cite journal |journal=Pediatrics |date=2007 |volume=119 |issue=1 |pages=e275–83 |title= Adverse events associated with pediatric spinal manipulation: a systematic review |author= Vohra S, Johnston BC, Cramer K, Humphreys K |doi=10.1542/peds.2006-1392 |pmid=17178922 |url=http://pediatrics.aappublications.org/cgi/content/full/119/1/e275 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.cite journal |journal=Spine |date=2008 |volume=33 |issue= 4 Suppl |pages=S5–7 |title= The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: executive summary |author= Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å |doi=10.1097/BRS.0b013e3181643f40 |pmid=18204400 |url=http://www.spinejournal.com/pt/re/spine/fulltext.00007632-200802151-00004.htm

-- Dematt Dēmatt 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? ---- Dematt Dēmatt 06:01, 15 March 2008 (UTC)

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

Thanks, I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198367146oldid=198364636 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. Eubulides07:15, 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". CynRNCynRN06:36, 15 March 2008 (UTC)

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

Good suggestion, particularly since the source says "chiropractic care is safe" without the confusing addition. I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198364636oldid=198359841 made the suggested change. Eubulides06:45, 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. -- Dematt Dēmatt 16:31, 15 March 2008 (UTC)

Thanks. I made http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=198522500oldid=198505401 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. Eubulides00:33, 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.

---- Dematt Dēmatt 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? Eubulides06:20, 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...CynRNCynRN18:33, 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. Eubulides18:46, 17 March 2008 (UTC)

Yeah, oops. "Side effect, some of which may be considered adverse...."CynRNCynRN07:33, 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. EBDCM01:33, 16 March 2008 (UTC)

This article was under probation. Someone removed the probation tag. QuackGuru01:38, 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 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. 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? —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. EBDCM18:40, 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. -- Dematt Dēmatt 03:01, 17 March 2008 (UTC)

&quot;Contemporary&quot;

The word "Contemporary" is used twice in ChiropracticPhilosophy, 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 ChiropracticPhilosophy 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. Eubulides01:13, 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. EBDCM01:54, 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.

-- Dematt Dēmatt 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, http://chiroweb.com/archives/ahcpr/chapter2.htm Mootz Phillips (1997) write:

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

whereas ChiropracticPhilosophy 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. Eubulides06:38, 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. EBDCM16:11, 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'?CynRNCynRN17:40, 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. EBDCM21:40, 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? Eubulides22:54, 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? EBDCM00:32, 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". Eubulides10:12, 19 March 2008 (UTC)

"Contemporary" is POVish. We can do better than that. QuackGuru19:28, 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. EBDCM23:36, 19 March 2008 (UTC)

(undent). I see no issue with using either the word contempoary or evidence-based. DigitalC06:47, 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 Kelvin05:01, 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.CynRNCynRN06:38, 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. Eubulides06:44, 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. EBDCM15:52, 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. Eubulides18:07, 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... EBDCM22:24, 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 Kelvin06:33, 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. Eubulides06:57, 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 Kelvin07:10, 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. Eubulides07:19, 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 Kelvin07:49, 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". DigitalC06:33, 20 March 2008 (UTC)

Good point. EBDCM06:39, 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 Kelvin03:54, 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. 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. WhatamIdoing17:44, 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 / 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. WhatamIdoing06:07, 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.""http://www.jcca-online.org/client/cca/JCCA.nsf/objects/Commentary:+Subluxation-the+silent+killer/$file/2-commentary.pdf Read the spinal adjustment article. To get the "pure" explanation, visit the ICA website and read about "http://www.chiropractic.org/guidelines/ChapterThree.pdf subluxation correction". Here is one of their http://www.chiropractic.org/index.php?p=news/veterans press releases. This ultra-straight message about what is sometimes termed the "http://www.jcca-online.org/client/cca/JCCA.nsf/objects/Commentary:+Subluxation-the+silent+killer/$file/2-commentary.pdf 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 / 06:59, 30 March 2008 (UTC)

) 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 / 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.DigitalC06:49, 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 / 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. DigitalC22:14, 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 / 05:21, 2 April 2008 (UTC)

Following the anaology about the American procedure, can a Canadian follow the American Dream?DigitalC05:34, 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 Kelvin07:29, 1 April 2008 (UTC)

Subluxation debate

In going through the 2008-03-12 issues list, I found a problem in ChiropracticVertebral 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 http://www.cmcc.ca/PDF/2006/CMCC_Calendar06to07.pdf 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:

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. Eubulides06:52, 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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199189097oldid=199185579 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. Eubulides21:49, 18 March 2008 (UTC)

Following up on my own suggestion, I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199198890oldid=199189097 added the citation suggested above and modified the text somewhat to match the citation better.

We should use http://books.google.ca/books?hl=enid=xRGhUSdwCgQCdq=the+chiropractic+theoriesprintsec=frontcoversource=webots=lEvlizPIa1sig=RKsl1IxFbS0d-3xaSlPeEq3iEsA Chiropractic Theories as the scientific source to investigate the chiropractic theories, including those on subluxation. EBDCM00:34, 19 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=199198890 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.http://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=199212750oldid=199198890_note-19 It was confusing for me. There is a big difference between clarity and brevity. QuackGuru01:20, 19 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=199256479oldid=199246202 This edit was not an improvement. The controversial edit deleted cited text. QuackGuru03:04, 19 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=199257526oldid=199256479 I agree with this edit. QuackGuru03:07, 19 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=199257526 I disagree with this edit. Cited text got deleted again. QuackGuru03:15, 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. EBDCM05:07, 19 March 2008 (UTC)

I made http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199309131oldid=199308898 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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199308898oldid=199307815 this edit to more clearly match the text to the citations. Hope this helps. Eubulides10:11, 19 March 2008 (UTC)

This helps. The idea is to follow the source carefully and not delete cited text that briefy describes subluxation. QuackGuru19:19, 19 March 2008 (UTC)

Hmmm, are you two trying to 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" — http://chiroandosteo.com/content/13/1/17 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. Eubulides03:46, 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. EBDCM03:51, 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 Kelvin08:20, 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!CynRNCynRN15:41, 21 March 2008 (UTC)

Merge from &quot;Scientific investigation of chiropractic&quot;

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199129770oldid=199072241 This change was made without discussion.

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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199185579oldid=199185160 removed the template; it can be re-added once there's a serious proposal on the table. Eubulides21:34, 18 March 2008 (UTC)

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

Agreeing that it was a disingenuous edit. . . I removed it from the other article as well.TheDoctorIsIn01:57, 19 March 2008 (UTC)

However, according to x TheDoctorIsIn, http://en.wikipedia.org/w/index.php?title=Wikipedia:Articles_for_deletion/Chiropractic_care:_Research_and_Criticismdiff=nextoldid=191000400 Let's get it the fork out of here! QuackGuru02:10, 19 March 2008 (UTC)

My personal opinion of the forked article withstanding. . . Quackguru was still doing it wrong.TheDoctorIsIn02:18, 19 March 2008 (UTC)

Agreed. I would like to know why Fyslee reverted my edit which removed this. EBDCM05:04, 19 March 2008 (UTC)

As long as there is a main article it is normal practice to link to the main article. QuackGuru19:14, 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. QuackGuru19:22, 28 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=202398802oldid=201754971 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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=202419475oldid=202398802 undid the change. Eubulides23:38, 31 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=202398802oldid=201754971 This change was made http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=nextoldid=201642093 with discussion. There was no specific opinion against merging and http://en.wikipedia.org/w/index.php?title=Wikipedia:Articles_for_deletion/Chiropractic_care:_Research_and_Criticismdiff=nextoldid=191000400 TheDoctorIsIn supported the merge but disagreed on how I was http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=nextoldid=199247978 initially proposing the merge. QuackGuru00:47, 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. QuackGuru01:01, 1 April 2008 (UTC)

That http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=nextoldid=201642093 discussion does not propose a specific change. A specific proposal needs to be discussed.

http://en.wikipedia.org/w/index.php?title=Wikipedia:Articles_for_deletion/Chiropractic_care:_Research_and_Criticismdiff=nextoldid=191000400 TheDoctorIsIn's comment is in favor of speedily deleting the other article, but that is not the same thing as favoring a merge.

Eubulides

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. DigitalC06:44, 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.McCrory DC, et al. "Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache". Duke University Evidence-Based Practice Center, Durham, North Carolina, January 2001 http://www.fcer.org/html/Research/DukeEvidenceReport.htm available online (PDF format) A systematic review of systematic reviews in 2006 by Edzard Ernst and P.H. Canter concluded that no data "demonstrates 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."Ernst E (2006) A systematic review of systematic reviews of spinal manipulation" J R Soc Med" 99:192-6 http://www.jrsm.org/cgi/content/full/99/4/192 Available on-line 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."E Ernst http://www.jrsm.org/cgi/content/full/100/7/330?maxtoshow=HITS=10hits=10RESULTFORMAT=author1=ernst,+edzardsearchid=1FIRSTINDEX=0resourcetype=HWCIT "Adverse effects of spinal manipulation: a systematic review." "J R Soc Med" 2007;100:330-338 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."G Bronfort, M Haas, "Review conclusions by Ernst and Canter regarding spinal manipulation refuted", Chiropr Osteopat. 2006; 14: 14. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1563471

One controlled trial showed a lowering of blood pressure in hypertensive patients similar to taking two blood-pressure lowering drugs at onceBakris, G. (2007) Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. "Journal of Human Hypertension 2007 (May);21 (5):347–352 http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmedcmd=Retrievedopt=AbstractPluslist_uids=17252032query_hl=1itool=pubmed_docsum available online 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".Biggs L (2002) "Measuring philosophy:

"a philosophy index"" http://www.jcca-online.org/client/cca/JCCA.nsf/objects/Issue+46_3/$file/Pages173-184.pdf JCCA

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?"cite journal | author = French S, Green S | title = The Cochrane Collaboration: is it relevant for doctors of chiropractic? | journal = J Manip Physiol Ther | volume = 28 | pages = 641-2 | year = | id = PMID|16326231 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 http://www.cochrane.org/reviews/en/ab001002.html asthma. http://www.cochrane.org/reviews/en/ab003219.html 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

http://www.cochrane.org/reviews/en/ab002119.html 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 http://www.jr2.ox.ac.uk/bandolier/booth/Migraine/Chiromig.html 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 findingshttp://www.jr2.ox.ac.uk/bandolier/booth/painpag/Chronrev/muscskel/CP092.html Chiropractic for low back pain but there might be some short-term pain relief, especially in patients with acute pain.cite journal | author = Assendelft WJJ "et al."| title = The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling| journal = J Manip Physiol Ther | volume = 19 | pages = 499-507 | year = 1996| id = PMID|16326231 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."cite journal | author = Meade "et al."| title = The effectiveness of chiropractic for treatment of low back pain: an update and attempt at statistical pooling| journal = Brit Med J | volume = | pages = | year = 1995| id = PMID|16326231

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....Shekelle PM (1993) RAND misquoted. "ACA J Chir" 30:59–63

There is conflict in the results of chiropractic research. For instance, many DCs claim to treat http://www.chiroweb.com/find/tellmeabout/colic.html infantile colic. According to a 1999 survey, 46% of chiropractors in Ontario treated children for colic.Verhoef MJ, Costa Papadopoulos C. "Survey of Canadian chiropractors’ involvement in the treatment of patients under the age of 18". http://www.ccachiro.org/client/cca/JCCA.nsf/objects/Survey+-March+1999/$file/Pages050-057.pdf In 1999 a Danish randomized controlled clinical trial with a blinded observer suggested that there is evidence that spinal manipulation might help infantile colic.Wiberg JMM "et al." (1999) The short-term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. "J Manip Physiol Ther" 22:517-22http://www.journals.elsevierhealth.com/periodicals/ymmt/article/PIIS0161475499700035/abstract However, in 2001, a Norwegian blinded study concluded that chiropractic spinal manipulation was no more effective than placebo for treating infantile colic.Olafsdottir E "et al." (2001) Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation." Arch Dis Child" 84:138-141. http://adc.bmjjournals.com/cgi/content/abstract/84/2/138

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."cite journal | author = Keating J "et al." | title = A descriptive analysis of the Journal of Manipulative and Physiological Therapeutics, 1989-1996 | journal = J Manip Physiol Ther | volume = 21 | pages = 539-52 | year = 1998 | id = PMID|9798183

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."http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1208927 Subluxation: dogma or science?

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."http://www.acsh.org/healthissues/newsID.656/healthissue_detail.asp ACSH Health Issues

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.Web MD, http://www.webmd.com/pain-management/news/20041012/chiropractic-care-may-reduce-surgeries-x-rays

Commentary on &quot;Scientific investigation&quot; 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. Eubulides22:53, 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. DigitalC23:01, 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. Eubulides23:07, 1 April 2008 (UTC)

I have drafted something shorter; please see Draft effectiveness section below. Eubulides23:38, 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? QuackGuru05:00, 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. Eubulides08:34, 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? 02:33, 20 March 2008 (UTC)

I do not agree with this controversial edit.http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=199503917 QuackGuru02:37, 20 March 2008 (UTC)

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

I have signed in. EBDCM06:28, 20 March 2008 (UTC)

I have noticed, but you are now evading a block. That's not right. -- Fyslee / 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 )

So you are clearly denying that you have been editing using the now-blocked IP? Is that correct? -- Fyslee / 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 / 17:23, 20 March 2008 (UTC)

Problems with 2008-03-19/20 edits

The recent edit war made several controversial changes to Chiropractic (summarized http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199539351oldid=199309131 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. Eubulides08:19, 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. EBDCM17:07, 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 COPYRIGHT and COPYVIO.

Eubulides

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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199758184oldid=199713310 reverting one set of changes and perhaps inadvertently reverting the other set, or http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199781546oldid=199758184 vice versa, without any clear indication that they knew that that's what they were getting. For now, I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199790052oldid=199786983 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. Eubulides08:51, 21 March 2008 (UTC)

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

A 60-word passage was taken without permission from the http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf 2005 WHO guidelines and prepended to this section. This is a copyright violation and needs to be reverted ASAP as per COPYVIO. Eubulides08:19, 20 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199550703oldid=199550047 fixed. Eubulides08:24, 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. EBDCM12:45, 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. Eubulides04:13, 21 March 2008 (UTC)

The following sentence was inserted:

Common themes to chiropractic care include holistic, conservative and non-medication approaches via manual therapy.http://findarticles.com/p/articles/mi_qa3987/is_200309/ai_n9291884/pg_3

It's not a big deal, but this is somewhat redundant with Chiropractic Philosophy. Perhaps a simple "See 'Philosophy'" would be simpler. Eubulides08:19, 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. Eubulides04:16, 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. Eubulides08:19, 20 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199551121oldid=199550703 Fixed. Eubulides08:26, 20 March 2008 (UTC)

Considering that is is educational guidelines document that applies worldwide, we will use it as an appropriate source. EBDCM12:42, 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. Eubulides04:19, 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. Eubulides08:19, 20 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199551321oldid=199551121 Fixed. Eubulides08:28, 20 March 2008 (UTC)

WHO is the most appropriate source; these are educational guidelines and scope of practice is accurately portrayed across all regions. EBDCM12:41, 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. Eubulides04:22, 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. Eubulides08:19, 20 March 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199551674oldid=199551321 Fixed by reverting to the text that the 160-word passage replaced. Eubulides08:31, 20 March 2008 (UTC)

The text was cited appropriately.EBDCM12:39, 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. Eubulides04:24, 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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199552242oldid=199551674 fixed this by putting the source directly after the text, rather than a sentence or two later. Eubulides08:36, 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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199552582oldid=199552457 requested a citation for this addition. Eubulides08:39, 20 March 2008 (UTC)

Eubulides

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. Eubulides08:19, 20 March 2008 (UTC)

I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199553005oldid=199552765 replaced it with a request for a citation. Eubulides08:43, 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. Eubulides08:19, 20 March 2008 (UTC)

Everything is properly cited.

Verbatim quotes need quote marks, as described above. Eubulides04:55, 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. Eubulides08:19, 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 mobilizationGatterman M. Standards for contraindications to spinal manipulative therapy. In

Vear HJ, ed. Chiropractic standards of practice and quality of care. Gaithersburg, MD, Aspen Publishers Inc, 1992Vear HJ. Standards of chiropractic practice. Journal of Manipulative and Physiological Therapeutics, 1985, 8(1):33‐43Gatterman MI. Indications for spinal manipulation in the treatment of back pain. Journal of the American Chiropractic Association, 1982, 19(10):51‐66 Manipulation is regarded as a relatively safe, effective and conservative means of providing pain relief and structural improvement of biomechanical problems of the spine.Kleynhans AM, Terrett AG. Cerebrovascular complications of manipulation. In: Haldeman S, ed. Principles and practice of chiropractic, 2nd ed. East Norwalk, CT, AppletonLang, 1992. 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. EBDCM12:37, 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. Eubulides04:55, 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. Eubulides08:19, 20 March 2008 (UTC)

I added a source which mentions upper cervical spine specifically. We cannot only rely on Ernst for his opinion. EBDCM12:37, 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. Eubulides06:25, 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. Eubulides08:19, 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. Eubulides04:59, 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. Eubulides08:19, 20 March 2008 (UTC)

Contraindications is getting to be undue weight and needs to be either shortened or provided with adequate context for readers. EBDCM12:37, 20 March 2008 (UTC)

Chiropractic Safety has (by my quick count) 76 words on contraindications. The http://en.wikipedia.org/w/index.php?title=Chiropracticoldid=199539351Safety 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. Eubulides05:11, 21 March 2008 (UTC)

"visual field defects" was changed to "visual disturbances" but the source says "visual field defects". Eubulides08:19, 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. Eubulides08:19, 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. EBDCM12:37, 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. Eubulides05:15, 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. Eubulides06:50, 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. Eubulides08:19, 20 March 2008 (UTC)

There are enough problems here that the simplest way to proceed is to start with the http://en.wikipedia.org/w/index.php?title=Chiropracticoldid=199361004Safety previous version and move forward, so I started by http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=199554835oldid=199553298 going to that. Eubulides09:02, 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. Eubulides05:41, 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. Eubulides09:37, 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.cite journal |journal=Spine |date=2007 |volume=32 |issue=21 |pages=2375–8 |title= Safety of chiropractic manipulation of the cervical spine: a prospective national survey |author= Thiel HW, Bolton JE, Docherty S, Portlock JC |pmid=17906581 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 adultscite journal |journal= J R Soc Med |date=2007 |volume=100 |issue=7 |pages=330–8 |title= Adverse effects of spinal manipulation: a systematic review |author= Ernst E |pmid=17606755 |url=http://www.jrsm.org/cgi/content/full/100/7/330 and children.cite journal |journal=Pediatrics |date=2007 |volume=119 |issue=1 |pages=e275–83 |title= Adverse events associated with pediatric spinal manipulation: a systematic review |author= Vohra S, Johnston BC, Cramer K, Humphreys K |doi=10.1542/peds.2006-1392 |pmid=17178922 |url=http://pediatrics.aappublications.org/cgi/content/full/119/1/e275 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.cite journal |journal=Spine |date=2008 |volume=33 |issue= 4 Suppl |pages=S5–7 |title= The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: executive summary |author= Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å |doi=10.1097/BRS.0b013e3181643f40 |pmid=18204400 |url=http://www.spinejournal.com/pt/re/spine/fulltext.00007632-200802151-00004.htm These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation.cite journal |journal=Spine |date=2002 |volume=27 |issue=1 |pages=49–55 |title= Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation |author= Haldeman S, Kohlbeck FJ, McGregor M |pmid=11805635

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.cite journal |journal= J Can Chiropr Assoc |date=2005 |volume=49 |issue=3 |pages=158–209 |title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash |author= Anderson-Peacock E, Blouin JS, Bryans R "et al." |url=http://www.jcca-online.org/Client/cca/jcca.nsf/objects/jcca-v49-3-158/$file/jcca-v49-3-158.pdf |format=PDF cite journal |journal= J Can Chiropr Assoc |date=2008 |volume=52 |issue=1 |pages=7–8 |title= A clinical practice guideline update from The CCA•CFCREAB-CPG |author= Anderson-Peacock E, Bryans B, Descarreaux M "et al." |url=http://www.jcca-online.org/Client/cca/JCCA.nsf/objects/JCCA_March_2008_52_1/$file/jcca-v52-1-007.pdf |format=PDF

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. Eubulides09:37, 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. Eubulides05:44, 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? EBDCM12:58, 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 JARGON and MEDMOSAudience. 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. Eubulides05:52, 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? 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. EBDCM17:21, 20 March 2008 (UTC)

EBDCM bhas/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. DigitalC02:32, 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"CynRNCynRN18:22, 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....CynRNCynRN23:03, 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 http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=prevoldid=199774360 this change to the Safety 4 draft to implement the suggestion. Eubulides06:11, 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.TheDoctorIsIn07:55, 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. Eubulides08:20, 21 March 2008 (UTC)

I disagree for reasons mentioned above.TheDoctorIsIn06:44, 27 March 2008 (UTC)

Please see followup in Adverse effects discussion below. Eubulides07:40, 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 mobilization666768 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,7071 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 adults71 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 care75 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.7070 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. EBDCM16:30, 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. Eubulides06:15, 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?TheDoctorIsIn19:17, 20 March 2008 (UTC)

Many editors disagree and have reverted this nonsensical version. This version has been rejected. I recommend archiving this thread. QuackGuru02:00, 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.TheDoctorIsIn08:08, 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. Eubulides08:25, 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 LEAD should represent the body of the article. QuackGuru05:30, 24 March 2008 (UTC)

Not a good idea. -- Fyslee / 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. Eubulides06:48, 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 Kelvin04:20, 25 March 2008 (UTC)

Absolutely terrible idea, due to NPOV and WEIGHT. DigitalC02:56, 27 March 2008 (UTC)

How about: "Spinal manipulation is a hallmark treatment of chiropractors and is generally considered safe." for the LEAD. QuackGuru19:13, 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? Eubulides04:00, 29 March 2008 (UTC)

Treatment procedures suggestions

There is a ChiropracticTreatment 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. QuackGuru05:56, 27 March 2008 (UTC)

This is a good suggestion. Any volunteers on writing the proposed addition to the treatment section? Eubulides06:25, 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. DigitalC06:18, 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. Eubulides06:25, 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.TheDoctorIsIn06:43, 27 March 2008 (UTC)

ChiropracticSafety'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. Eubulides07:00, 27 March 2008 (UTC)

I did the search on Google. . . the first result it http://www.chiro.org/LINKS/Safety.shtml. . . 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.TheDoctorIsIn18:44, 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 MEDRS for what constitutes reliable sources in articles like this. Eubulides06:27, 28 March 2008 (UTC)

I have already debunked the use of google scholar to determine whether something is notable or not. DigitalC06:51, 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. Eubulides03:58, 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.CynRN 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". Eubulides00:29, 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.CynRN —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. DigitalC22:32, 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.CynRN 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 http://diberri.dyndns.org/wikipedia/templates/ 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. WhatamIdoing04:56, 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 http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=200995435oldid=200725144 this change to identify the citation and ask for better citations in this area. Thanks again. Eubulides05:27, 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 http://www.aacp.net/ American Academy of Chiropractic Physicians, not the American Academy of Chiropract"ors", 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 http://chirobd.nv.gov/ NV http://www.ibol.idaho.gov/chi.htm ID, http://www.dopl.utah.gov/licensing/chiropractic.html 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 http://www.bls.gov/oco/ocos071.htm US Bureau of Labor Statistics will suit your purpose? WhatamIdoing18:41, 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. Eubulides05:38, 27 March 2008 (UTC)

Agreed. QuackGuru05:48, 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.) WhatamIdoing18:16, 27 March 2008 (UTC)

OK, http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=201520328oldid=201482710 done. Eubulides06:36, 28 March 2008 (UTC)

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