Chiropractic/Archive 18

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Draft effectiveness section

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

Remove the following paragraph from ChiropracticScientific investigation, as it is obsoleted by the proposed new "Effectiveness" section below:

While there is still debate about the effectiveness of manipulation for the many conditions in which it is applied, it seems to be most effective for acute low back pain and tension headaches.McCrory DC, et al. (2001) "Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache". Duke University Evidence-Based Practice Center, Durham, North Carolina http://www.fcer.org/html/Research/DukeEvidenceReport.htm available online (PDF format) One small pilot study has shown that upper cervical spinal manipulation may be beneficial for certain types of hypertension.Bakris, G "http://www.nature.com/jhh/journal/v21/n5/abs/1002133a.html Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study" "Journal of Human Hypertension" (2007) 21, 347–352. doi:10.1038/sj.jhh.1002133; published online 2 March 2007 http://www.ucrf.org/themes/nuccra/images_new/pdf/Hypertension2007.pdf Complete article

Move the subsections ChiropracticThe Manga Report, ChiropracticWorkers' compensation studies, ChiropracticAmerican Medical Association (AMA), and ChiropracticBritish Medical Association from ChiropracticScientific investigation to ChiropracticHistory. These subsections talk about old reports that may be of historical interest but are no longer current with respect to scientific investigation or effectiveness.

Add the following section (here called Effectivness 1) as a new "Effectiveness" section, immediately after ChiropracticSafety.

Comments are welcome; please see Effectiveness 1 comments. Eubulides23:37, 1 April 2008 (UTC)

Effectiveness 1

The effectiveness of chiropractic treatment depends on the type of chiropractic treatment used and on the problem the treatment is intended to address. Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective.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 Many scientific studies focus on spinal manipulation therapy (SMT), chiropractic's characteristic treatment; they typically cover SMT as used in chiropractic and other disciplines, and this article uses "SMT" in this more general sense. Many controlled clinical studies of SMT are available, but their results disagree,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 and they are typically of low quality.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=17604553cite 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 Available evidence covers the following conditions:

"'Low back pain"'. Opinions differ on the efficacy of SMT for nonspecific or uncomplicated 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 A 2008 review found that SMT with exercise is as effective as medical care with exercise.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 A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain.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 Of four systematic reviews published between 2000 and May 2005, only one recommended SMT, and the most authoritative (cite journal |journal= Cochrane Database Syst Rev |date=2004 |issue=1 |pages=CD000447 |title= Spinal manipulative therapy for low back pain |author= Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG |doi=10.1002/14651858.CD000447.pub2 |pmid=14973958) stated that SMT or mobilization is no more or less effective than other interventions for back pain.

"'Whiplash and other neck pain"'. There is no overall consensus on manual therapies for neck pain.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 A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis.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 A 2007 review found that SMT and mobilization are effective for neck pain. Of three systematic reviews of SMT published between 2000 and May 2005, one reached a positive conclusion, but the most authoritative (cite journal |journal= Cochrane Database Syst Rev |date=2004 |issue=1 |pages=CD004249 |title= Manipulation and mobilisation for mechanical neck disorders |author= Gross AR, Hoving JL, Haines TA "et al." |doi=10.1002/14651858.CD004249.pub2 |pmid=14974063) stated that SMT/mobilization is effective only when combined with other interventions such as exercise. A 2005 review found limited evidence supporting SMT for whiplash.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

"'Headache"'. A 2006 review found no rigorous evidence supporting SMT or other manual therapies for tension headache.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 A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.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 A 2004 review found that SMT may be effective for migraine and tension headache, and SMT and neck exercises may be effective for cervicogenic headache.cite journal |journal= Cochrane Database Syst Rev |date=2004 |issue=3 |pages=CD001878 |title= Non-invasive physical treatments for chronic/recurrent headache |author= Bronfort G, Nilsson N, Haas M "et al." |doi=10.1002/14651858.CD001878.pub2 |pmid=15266458 Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of SMT.

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

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

"'Other"'. A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that there is promising evidence for SMT for children with middle ear infection. The evidence from reviews is negative, or too weak to draw conclusions, for ADHD/learning disabilities, asthma, baby colic,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 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 cancer pain, chronic pelvic pain, constipation, digestive system disorders including irritable bowel syndrome and peptic disorders, dizziness, dysfunctional nursing, 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 hypertension, infertility/amenorrhea, jet lag, 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 premenstrual syndrome, respiratory conditions such as COPD, skin disease,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 urinary tract infection, vision conditions, and many other nonmusculoskeletal conditions. club foot, hip dysplasia, mechanical syndromes? Geriatric (orthopedic, functional?) - public education, fall prevention programs, satisfaction rates, VA results, mobilization/manipulation for mechanical spinal syndromes, etc... Other? --

Effectiveness 1 comments

(Please put comments here.) Eubulides23:37, 1 April 2008 (UTC)

I will work through this over the next few days - I definitely have comments, but I will work with you here before striking anything out. It at least gives us a framework to start fromDigitalC01:13, 2 April 2008 (UTC)

Thank you. This is the sort of clear descriptive information that will make the article easier to read. To be fair though I think we do need to add information from chiropractic sourcebooks or manuals. I will have a look through the library to see how chiropractic sources match up with the above. Delvin Kelvin01:24, 2 April 2008 (UTC)

You're welcome. It took some time to read the references in Sources for effectiveness. I also looked at "Principles and Practice of Chiropractic" (3rd ed.), but its main chapters on effectiveness (Bronfort G, Haas M, Evans R, "The clinical effectiveness of spinal manipulation for musculoskeletal disorders", pages 147–166; Vernon H, "The treatment of headache, neurologic, and non-musculoskeletal disorders by spinal manipulation", pages 167–183) appear to be superseded by Bronfort "et al." 2008 (PMID|18164469) and Hawk "et al." 2007 (PMID|17604553). That isn't to say there isn't something of value in the older citations, but generally speaking the more-recent ones are better and textbooks tend to lag behind. Eubulides05:13, 2 April 2008 (UTC)

Ok, here goes...

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

The cited source (Murphy "et al." 2006, PMID|16949948) says they are inconclusive about quite a few things, including effectiveness. Here's a quote from the discussion section of the cited source: "Inconsistencies in the evidence suggest that there is continuing conflict of opinion regarding: efficacy of SMT for treatment of nonspecific or uncomplicated LBP; optimal time in which to introduce this treatment approach; whether SMT is useful for treatment of chronic LBP; and finally, whether subacute LBP actually exists as a separate category requiring a specific treatment approach in its own right." The "inconclusive" bit comes from the abstract of the cited source. Eubulides06:02, 2 April 2008 (UTC)

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

OK, thanks, I made http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=202747619oldid=202746784 this change to reword along the lines that you suggested. This rewording uses a shorter paraphrase rather than a direct quote, for brevity. Eubulides07:02, 2 April 2008 (UTC)

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

The phrase "most authoritative" is describing Assendelft "et al." 2004 (PMID|14973958); it is not describing any paper by Ernst. To answer your question "Most authoritative according to who?", it's most authoritative according to Ernst Canter 2006 (PMID|16574972). The Cochrane reviews are widely considered to be authoritative and this judgment by Ernst Canter seems reasonable. Eubulides06:14, 2 April 2008 (UTC)

Basically, I misread the citations. I was believing that the citation was for the most authoritative paper, not for who was claiming it was the most authoritative paper. I will try to take a look at Assendelft et al. and Gross et al. this week. I have for now struck my previous comments. I also retract my claim that you were pushing a POV, and apologize for it. However, I still think it is POV to be using Ernst (a known bias) to editorialize what is or is not the most authoritative paper.DigitalC04:25, 3 April 2008 (UTC)

Ernst and bias

I agree with DigitalC. Ernst does have a known bias. -- Levine211218:06, 7 April 2008 (UTC)

Every source in the draft has bias. That includes (for example) Ernst Canter 2006 (PMID|16574972), which is critical of chiropractic; it also includes (for example) http://ccgpp.org/lowbackliterature.pdf Meeker "et al." 2007, which supports chiropractic. It would not be neutral to exclude Ernst simply because he is critical, retaining only sources that support chiropractic. On this particular point, moreover, there's little point in arguing against Ernst. Surely nobody is seriously contending that the Cochrane review is not the most authoritative of the bunch. Eubulides00:27, 8 April 2008 (UTC)

Please provided your evidence of so-called known bias. No evidence has been presented. QuackGuru18:46, 7 April 2008 (UTC)

The research cited by Ernst is not specifically about chiropractic's efficacy but SMT in general provided by various practitioners in addition to chiropractors; however it is being used here to discuss chiropractic's efficacy. A review of SMT efficacy in general is too general for an article specifically about chiropractic. It would be more appropriate at spinal manipulation. -- Levine211219:13, 7 April 2008 (UTC)

Much of the research that supports chiropractic is not specific to chiropractic. Please see Specific to chiropractic? below. It would not be reasonable to exclude Ernst's reviews because he mentions the broader research, while including reviews supportive of chiropractic that also mention the broader research. Eubulides00:37, 8 April 2008 (UTC)

We should exclude conclusions which Ernst (or any other reviewer) makes which doesn't specifically discern chiropractic care from general SMT. An extreme analogy: Let's that Ernst's review of literature researching SMT's effectiveness in aiding foo disease included ten chiropractor but 90 osteopaths and other practitioners performing SMT. Let's say that Ernst's conclusion was that SMT does not seem to be effective for aiding foo disease. What would be the value of saying that SMT does not seem to be effective for aiding foo disease at the Chiropractic article? Not much. However, if in Ernst's review he discerned that the ten chiropractor he reviewed was not effective, then perhaps yes. But the reviews which I have seen don't make this distinction. IOW, if the reviewer doesn't discern chiropractic from the rest of the SMT, then we should't use it here to make a general statement about SMT which the reader would likely mistake as the equivalent to chiropractic SMT. -- Levine211207:03, 8 April 2008 (UTC)

Again, excluding studies containing non-chiropractic data is not the approach being taken by the reliable reviews in this area. Reviewers both supportive and critical of chiropractic are focusing on therapies, not on the hats being worn by the therapist, and there are good reasons for doing so. The reviewers in question are published experts in the field and they are saying the studies are relevant, even if the studies contain some data generated by non-chiropractic therapists; there is no good reason to override this expert opinion. Eubulides21:04, 8 April 2008 (UTC)

The research presented by Ernst is NPOV and related to this article. Again, please provide your evidence of "a known bias." QuackGuru19:21, 7 April 2008 (UTC)

The research presented is perhaps somewhat related to this article but it is too general to use as we are doing here as it studies research of SMT as performed by not only chiropractors, but osteopaths and other practitioners as well (and doesn't distinguish amongst these in its conclusions). Using its general SMT conclusions here to describe the efficacy of chiropractic specifically would be intellectually dishonest, IMHO. -- Levine211220:24, 7 April 2008 (UTC)

It's not intellectually dishonest to base results on reviews of techniques performed by non-chiropractors. That sort of thing is regularly done by reviews that support chiropractic, reviews that are cited in the draft. See Specific to chiropractic? below. Eubulides00:37, 8 April 2008 (UTC)

That's not what I am saying. I am not saying that the reviewers are being intellectually dishonest. I am saying that we would be intellectually dishonest if we to try and pass off general SMT research to support conclusions (for or against) the efficacy of chiropractic care. This works both ways, I assure you. Chiropractors, for instance, came under heavy criticism when they used positive SMT research by the RAND corporation on the efficacy/safety/appropriateness of SMT for low back pain. Because the research was generally about SMT and not chiropractic specifically, chiropractors who were using this research as "proof" that chiropractic works or is safe came under heavy fire and were accused of being intellectually dishonest. Make sense? -- Levine211207:07, 8 April 2008 (UTC)

It might make sense if that's what chiropractic reviewers themselves do, when they are summarizing research in their own literature syntheses. But that's not what they are doing. The CCGPP uses results from studies of treatment by non-chiropractors in order to assess the effectiveness of a treatment. From their point of view, it doesn't matter that the treatments were done by non-chiropractors; what matters is whether the treatments worked. We should follow their lead in this matter; they are the published experts, and we are not. Eubulides07:34, 8 April 2008 (UTC)

Whose lead are we following? The CCGPP? Because if so, there is plenty of research in their "Chiropractic Clinical Compass" which should be included in our efficacy discussion. As I said, chiropractic organizations and individuals who used the Rand study "http://rand.org/pubs/reports/R4025.3/ The Appropriateness of Spinal Manipulation for Low-Back Pain" to declare that chiropractic is safe all came under heavy fire because opponents felt that since the RAND study didn't limit or discern chiropractic adjustments from other practitioners' spinal manipulation, that using this study to declare chiropractic safe is intellectually dishonest. In the same regard, us using a study of general SMT (where chiropractic is not discernible) in our article about chiropractic can also be seen as intellectually dishonest (whether the study is positive or negative). Now then, if you wish for me to make specific edits to the draft above, please know that they will be rather significant as I would be axing anything about general SMT. This includes much of the opening discussion and a lot of the conclusions for the various conditions. I know it will seem harsh, but if we then replace all that was excised with chiropractic specific studies and conclusions, we will have a better, more focused and honest article. Shall I proceed? -- Levine211217:23, 8 April 2008 (UTC)

We are following the lead of the reliable sources listed in Sources for effectivness. As a general rule, all the sources, including the CCGPP, focus on therapies, not on whether the therapies are done by chiropractors or non-chiropractors.

If there are other reliable sources not listed, please mention them.

The RAND study is too old to be considered a reliable source now. The same is true for the old reactions to it which you mention. Chiropractic effectiveness has moved beyond that, chiropractic researchers no longer waste a lot of their time worrying about whether a treatment is "chiropractic" or not, and Chiropractic should reflect the current state of the art.

Any substantial changes to Effectiveness 1 should be discussed first. If it's a complete rewrite, I suggest drafting a new section ("Effectivness 2" perhaps?) that reflects the alternate goal of omitting all research that mentions non-chiropractic treatment. I still think this alternate goal is mistaken, as it is not reflecting the current state of the art accurately.

Eubulides

20:30, 8 April 2008 (UTC)

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

I got that information by reading the recent sources in Sources for effectiveness. The world has changed from the bad old days when chiropractors refused to look at evidence generated by non-chiropractors. The current wording reflects recent reliable sources; that's better than going back into older, less-reliable sources. Eubulides22:04, 8 April 2008 (UTC)

"The RAND study is too old to be considered a reliable source now" - Really? According to who? What is the statute of limitation on research before it is considered unreliable? 5 years? 10 years? 15 years? Please be specific and let us know upon what you rationale is based. -- Levine211221:44, 8 April 2008 (UTC)

As a general rule, recent sources, which look at a lot more evidence and better-quality evidence, are better than older studies, which (by definition) don't have as much evidence to look at. Also, more-recent sources can refer to older sources and bring up what's good about them, so there's no need to refer to the older sources directly. \The sources in Sources for effectiveness are dated 2005 or later; to some extent this date was arbitrary but the further you go back, the more work there is, and the fewer reliable sources you get; when I gathered the data I stopped at 2005 since there was plenty of sources. One cannot use just 2008 sources since there are publication delays, and 2008 sources won't always have 2007 (or even 2006) sources available when they were written. Eubulides22:04, 8 April 2008 (UTC)

Come on QG, the research by Ernst is absolutely not NPOV. DigitalC00:24, 8 April 2008 (UTC)

Again, Ernst is critical, but that does not mean his reviews should be excluded, any more than reviews by (say) Meeker should be excluded because he supports chiropractic. Eubulides00:40, 8 April 2008 (UTC)

Agreed. However, we seem to be giving way too much credence to Ernst's review, citing him several times (I count 6x... WEIGHT violation anyone?) and referring to his work as the "most authoritative". Hence, I made http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=204368823oldid=204368563 this edit to remove this editorializing - that is, unless we have some way of know that Ernst is the most authoritative. -- Levine211202:53, 9 April 2008 (UTC)

The current draft cites Ernst's critical reviews 5 times. But many supportive-of-chiropractic authors are cited far more often. For example, Hawk is cited 11 times. If anything, the weight violation is in favor of reviews that support chiropractic.

The text is not referring to Ernst's work as "most authoritative". It is referring to Cochrane reviews as "most authoritative". They are widely considered to be the gold standard in health-care reviews. However, this isn't the only time I've seen some confusion here, so I made http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204393154oldid=204389194 this edit to cite the Cochrane reviews directly, to try to make the point more clearly.

Eubulides

05:52, 9 April 2008 (UTC)

It is still editorializing to call it the "most authoritative". We have no source proclaiming it to be so. I have http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=204520228oldid=204512468 edited accordingly. If a source is found which proclaims these studies in particular to be the "most authoritative", then we can discuss reinsertion, but until then it would seem to be editorializing. -- Levine211217:10, 9 April 2008 (UTC)

The most recent, most comprehensive and most authoritative review (9Assendelft WJJ, Morton SC, Yu Emily I, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low-backpain. Cochrane Database Syst Rev 2004; Issue 1:CD000447) states that SM or mobilization is superior to sham treatment and to detrimental or ineffective treatments but not better than other interventions for back pain. The most authoritative of the three reviews (12Gross AR, Hoving JL, Haines TA, et al. Manipulation and mobilisation for mechanical neck disorders. Cochrane Database Syst Rev 2004; 3:CD004249) stated that SM/mobilization is effective only when combined with other interventions such as exercise and as a sole treatment for neck pain, it is not of demonstrable effectiveness. http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204523161oldid=204520900 I read the refs. QuackGuru20:16, 9 April 2008 (UTC)

Perfect. I was still looking at the wrong ref for that. Thanks. -- Levine211222:00, 9 April 2008 (UTC)

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

Again, the phrase is describing a Cochrane review, not a paper by Ernst; in this case, the paper in question is Gross "et al." 2004 (PMID|14974063). Eubulides06:14, 2 April 2008 (UTC)

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

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

"There is a large number of case studies (level 4 evidence) documenting the use of chiropractic management of peripheral lower extremity conditions."

"There is a lack of higher-quality publications (level 1–3 evidence)."

"Management has been documented for a broad array of different lower extremity conditions."

"Chiropractic lower extremity management appears to be characteristically multimodal in nature incorporating various manual therapy approaches, rehabilitation, therapeutic exercise, and/or other modalities directed at local and nonlocal kinetic and kinematic considerations."

The only part of the conclusion that talks about benefit is the phrase "Of the limited literature produced, it would appear that chiropractic management may be beneficial in certain cases", which is a very weak claim of benefit, one that neither the bullet points nor the abstract summarizes, so I'd be a bit leery of highlighting that weak claim in Chiropractic; I think the existing wording is a fairer summary of that paper's results (which is, basically, that the published evidence is lacking). Eubulides06:31, 2 April 2008 (UTC)

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

The abstract of that paper (McHardy "et al." 2008) says "There is a small amount of chiropractic research into upper limb conditions that is comprised mostly of case studies (level 4 evidence) and a small number of higher-level publications (level 1-3 evidence)." You are correct that this should not be summarized as "there is little evidence"; instead, it should be summarized as "there is a small amount of research", so I http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticcurid=197022diff=202749266oldid=202748059 did that. I am leery, though, of adding a claim that there is "strong low-level" evidence, since the other bullets of this section consider this sort of level 4 evidence to be relatively weak. Eubulides07:21, 2 April 2008 (UTC)

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

The current text does use the words in the source, no? It's a question of which words; currently it's using the words in the abstract, which are the words the source's authors wanted to highlight. I'd welcome further opinions. Most of all, I'd welcome more sources. The hard work about writing this sort of thing is finding and reading sources. Eubulides16:10, 2 April 2008 (UTC)

Thats my start, now to follow some of the sources. DigitalC10:22, 2 April 2008 (UTC)

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

Lower back pain is a nice easy to visualize condition. We also need easy to visualize descriptive terms for all the claimed treatments that chiropractic has no support for, and especially for those that chiropractic failed to show an effect after testing. I'm emphasizing the scientific support here as that is the medical scientific view. I understand that if a treatment has no support then it is wrong to apply it in medicine. Fortunately in Chiropractic's case, there is support for the lower back pain treatment. The larger set does need presenting though. Delvin Kelvin01:16, 3 April 2008 (UTC)

In general I tried to use common terms rather than medical terms. Which terms do you think could still use rephrasing? I took a quick look and discovered "otitis media", which I just now http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=202991381oldid=202975698 replaced with "middle ear infection". I don't offhand see another rephrasing that would be as simple: there is "cervicogenic dizziness" but I don't know what to replace that with. Eubulides06:51, 3 April 2008 (UTC)

You are misinformed if you believe that every medical treatment has research supporting its use. In fact, it has been reported (I believe in BMJ) that chiropractic has MORE evidence behind its procedures than allopathic medicine. DigitalC04:02, 3 April 2008 (UTC)

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

Good point, thanks. I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=202996782oldid=202991809 added a mention of all the items where that source gave fair evidence or better. Eubulides07:44, 3 April 2008 (UTC)

DigitalC

04:32, 3 April 2008 (UTC)

Any further comments? I'd like to get this one out the door so that we can go back to striking out items from POV issues as of 2008-03-12. Going once, going twice … Eubulides05:24, 5 April 2008 (UTC)

Specific to chiropractic?

Yes. Perhaps a can of worms. But unless the SMT being studied is specifically a chiropractic adjustment then I would be against using it to support/discredit the efficacy or chiropractic. SMT is broad and can be done by a host of practitioners. Further, spinal manipulation has its own article where these general studies would be better placed. This article should deal with studies of chiropractic efficacy only. That said, the http://www.chiroweb.com/archives/19/06/02.html Duke study on chiropractic's effectiveness on tension headaches should be included in the article. -- Levine211206:27, 5 April 2008 (UTC)

It is a can of worms, yes. The CCGPP literature synthesis on low back pain, which is written by a team of chiropractors, regularly uses studies of non-chiropractic spinal manipulation as evidence to support chiropractic. For example, it cites Aure "et al." 2003 (PMID|12642755) to support manual therapy with low back pain, even though that study specifically disallowed chiropractic manipulation. If even published chiropractic researchers do this sort of thing, who are we to overrule them? In Effectiveness 1 I did attempt to point out which studies were about chiropractic and which studies were about SMT, as obviously these are not the same thing. Eubulides05:34, 6 April 2008 (UTC)

Additionally, sources of research for a variety of conditions have been compiled http://www.chiro.org/research/ABSTRACTS/Conditions.shtml here and http://www.icpa4kids.org/research/chiropractic.htm here. Most of the research I have seen here is high quality and some are specifically about chiropractic. There are some instances of general SMT research which I think we should disregard for this article, but may be of use at article spinal manipulation. I would also disregard the case studies. -- Levine211208:14, 5 April 2008 (UTC)

Those two web pages are not reliable sources in an of themselves, though they may point to reliable sources. To be honest I just looked at one or two and wasn't that impressed, but if you have the patience to wade through them and find better sources than what's in Chiropractic now, please bring them to our attention. Eubulides05:38, 6 April 2008 (UTC)

Levine. . . good point as usual. . . though we will be hardpressed to find just chiro specific research, at the end of the day we will have a better article for it.TheDoctorIsIn02:04, 6 April 2008 (UTC)

The res provided by Levine are from pro chiro advocacy groups. When we have better refs available as in this case we will use the better refs. The article should deal with effectiveness and efficacy too. This is the main chiro article and it should be complete. Now then, I think it is time to update the article with the Effectiveness section. QuackGuru02:46, 6 April 2008 (UTC)

Thats strange, I still see quite a bit of discussion going on here within the last day. There is no RUSH to get this into the article as soon as possible. DigitalC04:57, 7 April 2008 (UTC)

None of the comments http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=203919497oldid=203664712 made within the last day have proposed specific changes or made specific criticisms of the proposed change. They are limited to vague comments along the lines of "there may be other sources elsewhere". It's true that there is no rush, but on the other hand there is little recent progress and the proposal has been available for several days now and it is clearly much better than what is in the article now. What further improvements can be made to it before it goes in? Eubulides05:19, 7 April 2008 (UTC)

I have suggested a very specific change; that we remove all of the studies (for or against) that aren't specifically about chiropractic. Studies about SMT in general (which can be performed by a number of kinds of practitioners) should not be used to discuss chiropractic's effectiveness. For instance, a study such as http://www.ncbi.nlm.nih.gov/pubmed/17252032?dopt=AbstractPlus this one is specifically about chiropractic care. These are the kinds of studies we should include in this article. Whereas, a study such as http://www.ncbi.nlm.nih.gov/pubmed/16514329 this one which we are using about doesn't seem to be specifically about studying chiropractic's effectiveness but rather "manual therapies" in general. So use this study to support "A 2006 review found no rigorous evidence supporting SMT for tension headache" in a section about chiropractic effectiveness seems to me to be intellectually dishonest. The same goes for http://www.ncbi.nlm.nih.gov/pubmed/16574972 this study which we use to say "Of three systematic reviews published between 2000 and May 2005, one found that SMT is as effective as other interventions, but others did not find conclusive evidence in favor of SMT." This review even expressly says: "The search Chiropract* OR spinal manipul* OR manual therap* OR osteopath* AND systematic ADJ review was carried out in the following electronic databases: Medline, Embase, AMED, Cochrane Database." So that means that it was reviewing literature not just about chiropractic's efficacy but spinal manipulation in general as performed by wholly different practitioners including osteopaths. Again, it is intellectually dishonest to use this review to support such phrasing in a portion of chiropractic article specifically about chiropractic's efficacy. It would be better suited for the spinal manipulation article which deals with the efficacy of SMT in general. -- Levine211217:54, 7 April 2008 (UTC)

By "specific change" I meant a complete wording proposal: which words would be taken out? and which would be substituted, exactly? A change that specific has not been proposed.

Reliable reviews on both the supportive-of and critical side disagree with you. They cite chiropractic-only studies; they cite mixed studies; and in some cases they even cite studies that excluded chiropractors. Why should we second-guess the reviewers? They are published experts in the field; we are not. It is not "intellectually dishonest" to use the same terminology and techniques that these reviewers themselves use.

Eubulides

00:50, 8 April 2008 (UTC)

My specific change is to remove any reference (supportive or critical) which is not specifically about chiropractic, and remove its associated text (if a chiropractic specific study cannot be substituted). I am not second-guessing the reviewers in any way. Their review may be fine. But if their review was about a mix of SMT as performed by chiropractors, osteopaths, and others, and if they don't discern amongst the practitioners in their conclusions - if they are only lumping them all together to make some general statement about the efficacy of SMT rather than commenting specifically on the efficacy of chiropractic treatment - then it is intellectually dishonest of us to use such a review to comment on the efficacy of chiropractic treatment specifically. That's a mouthful, but I believe it should make sense. Let me know if I am not being clear. If it helps here is an extreme analogy: Imagine a study on the safety of hypodermic needles. Now imagine we had a review of literature which included but did not distinguish between the following uses in its materials and conclusions - inoculations as performed by MDs, steroid injections as performed by personal trainers, and shooting up heroin as performed by addicts. Now let's say that the review generalized a conclusion which said that usage of hypodermic needles is not safe and now let's say that we were using such a reference in the Medical Doctor article to say that MDs practice an unsafe technique in their use of hypodermic needles... I hope you see the equivalence here. So if you would like, I can go through each reference and strike the ones which aren't specifically about chiropractic care or specifically discern chiropractic care in their conclusions. Sound like a reasonable way to proceed here? -- Levine211206:55, 8 April 2008 (UTC)

That's a general description of what a change might be, but it's not a specific proposal for a change (which would include the exact wording being proposed).

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

Eubulides

07:10, 8 April 2008 (UTC)

When a chiropractor employs SMT, it is very different from when a non-chiropractor employs SMT. Chiropractors have hundreds of specifc MST techniques which non-chiropractors do not employ. Get manipulated by a chiropractor, an osteopath, and a physical therapist - I have been. They are very different. So to cite a study which is only about osteopaths or about a mix of chiropractors and osteopaths but doesn't distinguish between the two in the conclusions lends itself to us using a generality to support a statement which may be true at the specific level. It's simple really; find source which are solely about chiropractic care or discerns chiropractic care in its conclusions. Make sense? -- Levine211207:18, 8 April 2008 (UTC)

Again, it would make sense if that's what chiropractic reviewers themselves were doing, but they're not. They are using the studies you are objecting to, using their best expert opinion. They are not excluding studies merely because the studies contain data generated by non-chiropractors. On the contrary, in some cases, they are including studies whose data was generated "entirely" by non-chiropractors. Who are we to override the opinion of the published experts? This is not a question of being supportive or critical of chiropractic, as the same approach is used by both sides. Eubulides21:08, 8 April 2008 (UTC)

We are not overriding the opinions of experts. Their opinions are completely valid for an article about spinal manipulation. Here we have an article about chiropractic and a sub-section about the efficacy of chiropractic. It is plainly illogical and wrong to confound efficacy results of osteopathic and physical therapy manipulation with the efficacy of chiropractic. -- Levine211221:51, 8 April 2008 (UTC)

But the articles in question are about chiropractic treatments, not just SMT. For example, Meeker "et al." 2007 is written by the Council on "Chiropractic" Guidelines and Practice Parameters. Its title is ""Chiropractic" management of low back pain and low back related leg complaints". It is an article written by and for chiropractors. It is a high-quality and recent article, and is typical of the recent literature. And it uses research data partly generated by non-chiropractors to come to its conclusions. That is the way chiropractic research works nowadays. We should not override the opinions of the recently published experts in the field. Eubulides22:11, 8 April 2008 (UTC)

Precisely. Even chiropractic organizations confound evidence for general SMT as evidence for chiropractic adjustment. I can understand why too. They are similar; however there are differences. That said and recognized, I went ahead and made http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=204367436oldid=204330221 this edit which alerts the reader that the evidence presented is not necessarily specifically about chiropractic but about SMT in general as performed by any number of practitioners including but not limited to chiropractors. While this edit will clarify it for the reader, I still feel we are making a mistake by including general SMT research in an article specifically about chiropractic. However, at least with this qualifier in the beginning, we are not being intellectually dishonest (but perhaps a tad misleading). -- Levine211202:47, 9 April 2008 (UTC)

Thanks, good point, and I agree a qualifier is appropriate. But that's not quite the right place for it, since that clause introduces a bullet list that is not all about SMT. A better place is the previous sentence, which "is" about SMT, so I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204388772oldid=204369568 moved the "(not necessarily performed by a chiropractor)" qualifier to the previous sentence. Eubulides05:10, 9 April 2008 (UTC)

As I said though, I think we would still be pretty deceptive leaving to include results of SMT in general as evidence of the efficacy of chiropractic adjustments specifically. I understand your point that the researchers aren't excluded data from non-chiropractors and then chiropractic groups go ahead and use this data to discuss chiropractic. However, some of these reviews do not draw conclusions about chiropractic specifically, yet here we are using it to describe the efficacy of chiropractic. To me, this seems to be a OR violation. We have data "A" about SMT and we have a conclusion "C" about chiropractic adjustments; however, we don't seem to have data "B" which links SMT data from "A" to the chiropractic adjustment conclusion "C". It's a bit hazy, but I think it falls under SYN. (I know that in some case we actually do have data "B" linking "A" and "C" - so this isn't meant for those cases.) -- Levine211217:19, 9 April 2008 (UTC)

The reviews in question are about chiropractic and yet they are sometimes giving conclusions about SMT. It is not SYN when the reviews we're citing are doing the synthesis, which is the case here. As long as we are careful to state when the conclusions are about SMT and when they are about something else (as the reviews do), we are simply reporting what the reviews say. I don't see how we could do better than that. The reviews typically do not use the phrase "chiropractic adjustments"; they use "SMT", and the draft text sticks to their terminology. Eubulides22:41, 9 April 2008 (UTC)

I fail to see how we can include conclusions specifically about chiropractic from http://jrsm.rsmjournals.com/cgi/content/full/99/4/192 this review for instance, when this review makes no conclusions about chiropractic specifcally. It takes into account SMT done by other kinds of practitioners (as well as chiropractors) and it does not make any distinction in its conclusions. Sure, it is about chiropractic as you say. But it is also about osteopathy and many other disciplines which use forms of SMT. The results section doesn't mention chiropractic specifically at all. So how can we use these results of this review in our article about chiropractic specifically without violating SYN? -- Levine211202:09, 10 April 2008 (UTC)

(outdent)

Effectiveness 1 says "SMT" when it is talking about SMT, and "chiropractic" when it is talking about chiropractic, so we're making every attempt to clearly identify which studies address which topic.

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

Eubulides

07:03, 10 April 2008 (UTC)

I still think the distinction between SMT and chiropractic would be unclear to the reader of our article. Perhaps if we added "(not necessarily performed by a chiropractor) in each mention. Regardless, I maintain that using reviews of the effectiveness of SMT rather than chiropractic specifically in an article specifically about chiropractic is inappropriate. -- Levine211216:38, 10 April 2008 (UTC)

The whole point of the abbreviation SMT is to avoid article bloat, and to replace each use with "SMT (not necessarily performed by a chiropractor)" would seriously bloat the article. Instead, let's just carefully define SMT to make this point clear; I made http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204727716oldid=204724379 this change to try to do this clearly. Eubulides16:59, 10 April 2008 (UTC)

That's fine except that "spinal manipulation" is not precisely chiropractic's characteristic treatment. Rather, spinal adjustments are chiropractic's characteristic treatment. Spinal adjustments are merely a subset - a specific kind - of spinal manipulation. Whereas, many practitioners do spinal manipulation (that which is being reviewed in some of those studies), only chiropractors do (or should be doing) spinal adjustments. I think this needs to be made abundantly clear for the reader so that when they read our article and read about a review of "SMT", they will know that SMT is not chiropractic's characteristic treatment, but merely an umbrella term which includes chiropractic's characteristic treatment but also the treatments of other practitioners as well. I hope this is making sense (and I am sorry if I am being such a stickler about this, but I feel it is of paramount importance, lest we write an article which is intellectually misleading). -- Levine211217:25, 10 April 2008 (UTC)

Again, I'm afraid that reliable sources disagree with you. For example, the CCGPP literature synthesis on chronic low back pain uses the two terms interchangeably. For some purposes it may be useful to distinguish between spinal adjustment and spinal manipulation, and that topic sounds like it would be a good one for Chiropractic to take up somewhere, but for the purposes of Effectiveness 1 reliable sources are saying that the distinction is not important enough to worry about. We should follow the lead of reliable sources in this area. Eubulides21:00, 10 April 2008 (UTC)

I will try and make this very plain: Where in http://jrsm.rsmjournals.com/cgi/content/full/99/4/192 this review does it say that the results of studying spinal manipulations performed by osteopaths, chiropractors and other practitioners can be singularly applied to just measure the efficacy of chiropractic? -- Levine211222:15, 10 April 2008 (UTC)

The review in question is about SMT, just as other reviews cited in Effectiveness 1 are about SMT. These reviews are focusing on SMT in order to get insight about chiropractic's principal treatment modality. Some of these reviews are written by and for chiropractors. It is unreasonable to exclude them: they are entirely on the point of the effectiveness of chiropractic treatment. We should not override the opinions of published experts in the field. Eubulides06:56, 11 April 2008 (UTC)

You haven't answered my question. You did say, "These reviews are focusing on SMT in order to get insight about chiropractic's principal treatment modality." How do you know this? It appears to me that the insight is on SMT and not on chiropractic. (Remember, I am asking you specifically about http://jrsm.rsmjournals.com/cgi/content/full/99/4/192 this review.) SMT is not chiropractic's principal treatment modality; rather spinal adjustments are. While not wholly different, there are important differences. Too important for us to synthesize conclusions on chiropractic's efficacy from a general study on SMT. What we have written above is fine, but the most of it would be better suited for the spinal manipulation article, not this one. -- Levine211207:06, 11 April 2008 (UTC)

We know that Ernst Canter 2006 is relevant to getting insight about chiropractic because we have another reliable source, namely Bronfort "et al." 2007 (PMID|18164469), a review article written by and for chiropractors, which says it's a relevant source.

As far as effectiveness is concerned, "SMT" and "spinal adjustments" are interchangeable terms. We know that because we have a reliable source that says so, namely the CCGPP literature synthesis on low back pain. It is not synthesis to rely on reliable sources that use the two terms interchangeably.

Eubulides

08:19, 11 April 2008 (UTC)

I can't see the full text for Bronfort et al. as I didn't shell out the $30+ for it. Did you? Or do you have some other means by which we can all view the full-text. I am really looking for a reliable source which specifically states that the conclusions of Ernst/Canter 2006 general review of SMT efficacy literature is directly applicable for making a 1:1 statements about the efficacy of chiropractic specifically. Remember, this is not the article on "spinal manipulation" or "spinal adjustments". So relying on one source (Meeker) to make another source (Ernst) relevant to the chiropractic article create a SYN violation, according to my understanding of this policy. -- Levine211217:41, 11 April 2008 (UTC)

That article is copyrighted and is not freely readable, I'm afraid. That review does not say anything specific like "It's OK to cite Ernst Canter 2006 in a Wikipedia article about chiropractic." However, it does attempt to be a comprehensive review of its subject, and it is written by chiropractors and for chiropractors, and it cites Ernst Canter at length (mostly in a critical way, obviously, as Bronfort "et al." are supportive of chiropractic treatments). If it thought Ernst Canter were irrelevant it would not have cited it. But it is quite relevant. It is not synthesis to use reliable sources that are on topic; clearly the effectiveness of SMT is a vital part of the story of the effectiveness of chiropractic, and Bronfort "et al." and Ernst Canter are not the only examples of this. Eubulides18:04, 11 April 2008 (UTC)

I'm sorry, I just don't think that it is clear that the effectiveness of SMT as performed by practitioners other than chiropractor is a vital part of the story of the effectiveness of chiropractic. It seems tangential to main circle of this section of the article - Chiropractic's efficacy; and I don't believe that we have the sources to redirect this tangent back to the circle. That said, I think we are each guilty of going in circles here. We both understand each other's viewpoints on the matter, but we are just not seeing eye-to-eye. So perhaps it is better to just agree to disagree, and let us see if there is a consensus with the other editors either way. If that doesn't prove to be satisfactory, we can follow the other methods for dispute resolution. Sound reasonable? -- Levine211220:03, 11 April 2008 (UTC)

We are not here to second-guess the reviewers or reliable references. We are following there lead. Everything is relevant to this article. Thanks for your concerns anyhow. QuackGuru20:20, 11 April 2008 (UTC)

We are not here to draw our own conclusions from two disparate pieces of research. That is by definition a SYN violation, my oh my. -- Levine211220:26, 11 April 2008 (UTC)

It is inaccurate to say that Effectiveness 1 is drawing its own conclusions from two disparate pieces of research. The research in question is summarized separately for each article. No conclusions are drawn by the Wikipedia editors. The summaries of the reviews are accurate, and the reliable sources themselves are making the association between chiropractic and SMT. The only question is whether this association should also be described in Chiropractic. There is a legitimate weight issue (how much discussion should be give to effectiveness and to SMT?), but there is no real SYN issue here. Eubulides20:31, 11 April 2008 (UTC)

We have been following the references faithfully. This is the definition of NPOV. QuackGuru20:34, 11 April 2008 (UTC)

No, that is not the definition of NPOV. Yes, we are following the references faithfully, but we are using some of them on the wrong article. Research about SMT should be on the SMT article. There maybe reliable sources making an association between chiropractic and SMT, but no reliable sources have been presented which state that the findings of Ernst general SMT review can be applied directly to measure chiropractic's effectiveness. Yet, this is what the current draft is doing. -- Levine211221:47, 11 April 2008 (UTC)

Bronfort "et al." 2007 (PMID|18164469), a reliable source, does exactly that: it applies Ernst's general SMT review to the problem of measuring chiropractic's effectiveness. Eubulides22:44, 11 April 2008 (UTC)

Can you please provide the quote(s) from Bronfort which state that the findings of Ernst general SMT review can be applied directly to measure chiropractic's effectiveness? Thanks. -- Levine211218:00, 14 April 2008 (UTC)

They don't state "it can be applied directly". They just apply it directly. It's part of a rather long discussion. Even the section that talks about Ernst and related sources is about 350 words, and you'd need more of the context to see the application. I'm afraid that even those 350 words is a bit much to just copy here, from that copyrighted source. Eubulides09:12, 15 April 2008 (UTC)

How about you email it to me? It still feels like a SYN violation to me. -- Levine211217:17, 15 April 2008 (UTC)

That would also violate the copyright terms of that paper, I'm afraid. Eubulides19:08, 18 April 2008 (UTC)

I'm stuck on this issue of perceived SYN. Further, I tend to agree with the others below who feel that this section should be divvied up and placed on each modality's page. With that in mind, and not wanted you to violate any copyright agreement, I think we are at an impasse in terms of adding this section to this article. Again, I don't want our hard work here to be in vain; adding this information to each modalities page makes sense - spinal manipulation, spinal adjustment (when specified), etc. -- Levine211219:24, 18 April 2008 (UTC)

The source in question (PMID|18164469) is not obscure: it was published in the January-February issue of a reliable and widely available journal ("The Spine Journal"). It is unreasonable to reject material merely because it cites a verifiable and reliable source that is not in one's own library; if that were standard practice in Wikipedia, it would justify deleting almost anything from the encyclopedia. Effectiveness 1 is not organized by treatment modality: it is about chiropractic care in general, and is organized by conditions being treated because that is how the reliable sources are organized. It is entirely appropriate to summarize the effectiveness of chiropractic here, even if there is more-detailed information elsewhere. Eubulides20:11, 18 April 2008 (UTC)

Rather than going in circles, suffice it to say that I disagree with your assessment of the issues here. No one is calling the source obscure and no one is rejecting the source for the reason you enumerate above. My contention remains that some of the sources being used are not about chiropractic specifically but rather studies of SMT as performed by practitioners other than chiropractors. Despite these studies being about SMT as performed by practitioners other than chiropractors, we are trying to use them to discuss the efficacy of SMT when performed by a chiropractor. This seems to be a SYN violation as it requires us to synthesize that a conclusion about SMT in general can be applied to SMT specifically performed by a chiropractor. This is my position and I have yet to been shown something to change my mind. So either show me something, or accept my position. Repeating the same point over and over again to try and convince me or trying to turn my objection into something which it is not will not aide in swaying my opinion. Furthermore, please also consider the opinions of several other editors here who feel the section is inappropriate on this article for a host of other reasons. Again, I don't want all of our hard work on this to be for naught; that is why I feel placing these findings on the pages of the appropriate modality is a fine compromise (and the compromise closest to consensus). -- Levine211221:12, 18 April 2008 (UTC)

(outdent)

Effectiveness 1 does not summarizes reviews for each "appropriate modality"; it summarizes reviews for each condition. That is because the reviews are written that way: we have one review for low back pain, another for headache, and so forth. Moving this material to articles of the appropriate modality would make no more sense than put in Chiropractic. For example, an editor of Spinal manipulation could object to the material on exactly the same grounds, saying "Why put this review here? It's a review of low back pain, not spinal manipulation." Such an objection would be no more reasonable there than it would be here: allowing that sort of objection would be a recipe for omitting scientific evidence from both Chiropractic and Spinal manipulation (as well as from many other articles).

It's standard practice in reliable sources to use studies of SMT in exactly the way being objected to in this thread. It's not SYN to refer to these sources and summarize what they say.

It's regrettable that you lack access to the source I've mentioned, but that is not a fatal objection to including this material. I mentioned "obscure" because it would be different if the material were truly obscure (say, a technical report sitting in only one or two libraries worldwide). But this source (PMID|18164469) is widely available.

Eubulides

22:08, 18 April 2008 (UTC)

Other therapies

outdentIf we are going to include effectiveness of 'chiropractic' then it would be chiropractic care which is more than SMT. So, that would include other therapies utilized in clinical practice such as exercise, mobilization, soft tissue massage, modalities (laser, IFC, TENS, US), patient education and other commonly used things in clinical practice. I believe the CCGPP and various clinical practice guidelines have already done a lit review and synthesis, so it could be as simple as listing their findings. Thoughts? EBDCM17:21, 9 April 2008 (UTC)

Can you point us to research on the effectiveness of these therapies? -- Levine211217:23, 9 April 2008 (UTC)

The current draft does cover mobilization, laser, and education. It does not spend much time on things like TENS (as there's little reliable evidence, and what little there is argues against TENS), but if there's consensus to mention TENS etc. then we can do that as well. Hurwitz "et al." 2008 (PMID|18204386) would be a source for that for TENS and neck pain, for example. Eubulides22:50, 9 April 2008 (UTC)

That is a good example. We need to format this section better, however, and by the time we're done it will likely stand on it's own and we'll have to summarize it for Chiropractic mainly for brevity purposes. I think I nice way to organize the section would be to have subsection headers (Low Back/Neck, Upper Extremity, Lower Extremity, and Non-NMS or Special Populations (geriatrics, pediatrics, etc...) I also suggest that we develop a consensus that the "chiropractic care" of these conditions is not only limited to SMT/manip/mob/adjustment. For example, in a rotator cuff tear manipulation is not the main form of treatment but it is something encountered in clinical practice. CorticoSpinal03:57, 10 April 2008 (UTC)

There is certainly enough material for a subarticle here, but that is a different (and larger) project. Currently, there's not enough material to justify stubby little sections, one per paragraph. There would be justifications for subsections if the material were expanded in a subarticle. Effectiveness 1 cover treatments other than mobilization and manipulation, where reliable sources were found. If other sources can be found that coverage could be expanded. Eubulides07:08, 10 April 2008 (UTC)

2008-04-08 changes to Effectiveness 1

I have made some changes and reference suggestions to the opening paragraph per our discussion here. My edits http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=nextoldid=204290122 begin here and go for about 5 edits. I have added comments to help understand why the reference either seems not to be specific to chiropractic or if it doesn't seems to support the text it is attached to. Let me know how this works for you and I will begin to do the same with the rest of the text. -- Levine211220:31, 8 April 2008 (UTC)

Thanks, I'll take a look at them one by one. Eubulides21:18, 8 April 2008 (UTC)

(outdenting)

http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204290637oldid=204290122 This change replaced "Spinal manipulation therapy (SMT)" with "Spinal adjustment". But the sources in this section almost invariably use the term "spinal manipulation". This is merely a terminological dispute, as the two phrases mean the same thing in practice (see Meeker Haldeman 2002, PMID|11827498). In cases such as this it's better to use the term that the sources use, plus there's a conciseness advantage of the abbreviation "SMT", so I http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=prevoldid=204304960 went back to "SMT", and added a wikilink to Spinal manipulation in case there's any confusion. If the topic of "spinal manipulation" versus "spinal adjustment" is important to Chiropractic, I suggest that it be put into a new "Terminology" section; that would be a better place for the issue than "Effectiveness". Eubulides21:29, 8 April 2008 (UTC)

Please compare spinal manipulation with spinal adjustment. There is a difference between the two concepts and thus often confused. In essence, spinal adjustment is a subset of spinal manipulation. The techniques, equipment and reasoning behind spinal adjustments is wholly different from say the spinal manipulation an osteopath administers. Chiropractors perform spinal adjustments which are alway spinal manipulation. However, spinal manipulation isn't always spinal adjustment. Therefore, we are doing a disservice by referring to chiropractic methodology as "spinal manipulation" and including research which is about the general spinal manipulation rather than the specific spinal adjustment. I will thus change it back above. -- Levine211221:38, 8 April 2008 (UTC)

What I took away from Spinal adjustment and Spinal manipulation is what Meeker Haldeman 2002 (PMID|11827498) say, which is that it's merely a dispute about which term to use. Let's put it this way: if the two terms mean the same thing, then it doesn't matter (in terms of correctness) which Chiropractic uses; and if (contrary to Meeker Haldeman 2002) the two terms differ, then we should use "spinal manipulation" in Effectiveness 1 because that's what its sources are using. Eubulides21:52, 8 April 2008 (UTC)

If they are the same, then why the two distinct articles? As I said, the techniques, equipment, and rationale used by chiropractors are wholly different from any other practitioner (osteopath, physical therapist, craniosacral therapist, etc.) Confound the efficacy of general spinal manipulation as performed by a host of other practitioners with the efficacy of chiropractic specifically would be tantamount to presenting our readers with intellectual dishonesty. -- Levine211221:58, 8 April 2008 (UTC)

I don't know why there are two distinct articles, but that doesn't matter here. Chiropractic should depend on reliable sources outside of Wikipedia; it should not use other Wikipedia articles as sources. The reliable sources mentioned in this discussion, including Meeker Haldeman 2002 (PMID|11827498), say that there's no important difference between the terms. But even if there is a difference (which is dubious), that's even "more" of an argument that Effectiveness 1 should be using the term "manipulation" rather than "adjustment", because Effectiveness 1's sources say "manipulation" and not adjustment. It is inconsistent to argue that "manipulation" ≠ "adjustment", and then to substitute "adjustment" for "manipulation" when the sources say "manipulation". Eubulides22:17, 8 April 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204291701oldid=204290637 This change asked for a verification that the cited source supports the claim "Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective." The cited source (DeVocht 2006, PMID|16523145) says:

"Although by far most chiropractic treatment is given for back pain, it seems able to affect a broader range of conditions as shown in the following few examples. Second to back pain, chiropractors probably are best known for treatment of chronic headaches. Although not rigorously documented in large-scale, well-designed randomized control trials, as of 2001, there had been at least nine trials of various degrees of quality and size involving 683 patients with chronic headaches with reported clinical improvement.… Nevertheless, there are different views concerning the efficacy of chiropractic treatment, which is not surprising. Unfortunately, it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts despite the millions of papers that have been written about presumably scientifically sound studies. Because of this difficulty, numerous medical procedures have not been rigorously proven to be effective either."

Hope this suffices. I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204307344oldid=204306627 removed the request. Eubulides21:41, 8 April 2008 (UTC)

Yes, this suffices. Thank you. That said, the wording can be improved, as now it is a bit confusing. I will work on it, when I return later. -- Levine211222:01, 8 April 2008 (UTC)

OK, I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204318504oldid=204316487 removed the fact tag. This change also brought back "SMT", as per the discussion above (it was changed back to "adjustment" without comment, perhaps inadvertently?) Further suggestions for improving the wording are welcome. Eubulides22:28, 8 April 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204291966oldid=204291701 This change asked for a citation for the "Many controlled studies" sentence, noting "citation doesn't discern chiropractic adjustment from osteopathic manipulation, etc." Thanks for catching that; it was an editing error as the sentence was previously after an SMT sentence where the context was SMT. I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204320496oldid=204318965 fixed the problem by adding an explicit "of SMT" to the sentence. Eubulides22:38, 8 April 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204292802oldid=204291966 This change planted a fact tag on the citation to Fernández-de-las-Peñas "et al." 2006 (PMID|16596892) with the comment "doesn't discern chiropractic adjustment from spinal manipulation". The http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204320496oldid=204318965 fix for the previous problem also fixed this problem, since it made it clear that the sentence is about SMT and not chiropractic treatment in general or chiropractic adjustment in particular. So I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204322612oldid=204321347 removed the tag. Eubulides22:48, 8 April 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204292802oldid=204291966 The same change planted a fact tag on the citation to Hawk "et al." 2007 (PMID|17604553) with the comment "does this support this statement?". Hawk "et al." say "First, the number of studies on chiropractic care and/or SMT and other manual therapies for patients with nonmusculoskeletal conditions is relatively small, and the quality of the studies is generally not high.". Also, the other citation for that sentence (Fernández-de-las-Peñas "et al." 2006, PMID|16596892) says "There are few published randomized controlled trials analyzing the effectiveness of spinal manipulation and/or mobilization for TTH tension-type headache, CeH cervicogenic headache, and M migraine in the last decade. In addition, the methodological quality of these papers is typically low." Hope this helps. Eubulides23:23, 8 April 2008 (UTC)

References in chiro.org

The references are gathered on pro-chiro sites. . .yes. . .however the references themselves are good. . . let us use them.TheDoctorIsIn17:38, 6 April 2008 (UTC)

Some of those references may be good, but many are not. I happen to know a bit about Autism and that http://www.chiro.org/research/ABSTRACTS/Autism.shtml autism page was full of old and unreliable material touting dubious remedies and theories; this is exactly the sort of thing that Chiropractic should not be relying on. If there are any good references in there, as good as what is in Sources for effectiveness, by all means let us know, but I quickly gave up looking for any wheat in all that chaff. Eubulides04:37, 7 April 2008 (UTC)

Whiplash and other neck pain

Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. and Combined interventions involving mobilization and exercises or supervised training and rehabilitation demonstrated short-term effectiveness when compared with conventional medical care or care involving physical modalities, collars, or simple advice or referral to exercise. and For other neck disorders without radicular signs or symptoms (Grades I and II), the evidence suggests that manual (manipulation or mobilization) and exercise interventions, LLLT, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of these treatments is clearly superior to any other in either the short- or long-term. and For both WAD and neck disorders without trauma, the evidence favors supervised exercise sessions with or without manual therapy over usual or no care. Of the manual therapies, manipulation and mobilization yield comparable clinical outcomes... the choice between mobilization or manipulation should depend on patient preference and There is evidence from one nonrandomized intervention study that a coordinated multidisciplinary management approach with active interventions were less costly than “usual care” for patients with acute WAD and There is consistent evidence from 3 RCTs that a neck exercise program alone or in combination with spinal manipulation was positively associated with reduced pain and disability in the short-term (6 to 13 weeks) in persons with subacute or chronic or recurrent neck pain when compared to spinal manipulation alone, TENS, or usual GP care. and There is consistent evidence from 4 RCTs that cervical spine manipulation alone or with advice and home exercises was not associated with greater pain or disability reduction in the short- or long-term in persons with subacute or chronic neck pain when compared with mobilization with or without traction, to strengthening exercises, or to instrumental manipulation.77,106,110,126,137

12. There is consistent evidence from 4 RCTs that mobilization or exercise sessions alone or in combination with medication was positively associated with better pain and functional outcomes in the short-term (4–13 weeks) in people with subacute or chronic neck pain when compared to usual GP care, pain medications, or advice to stay active. and There is consistent evidence from 4 double-blind placebo-controlled RCTs that LLLT laser was associated with improvements in pain and function in the short-term (10 days to 12 weeks) in persons with subacute or chronic neck or shoulder pain.

For WAD, (a) mobilization and exercises appear more beneficial than usual care or physical modalities

There is evidence from one RCT that therapeutic exercise with or without manipulation or mobilization was associated with fewer headaches and a better global outcome after 1 year in patients with cervicogenic headache when compared with no treatment.

Slightly summed up. For WAD, educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities; for other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions. However, none of the active treatments is clearly superior to any other in the short- or long-term.

A lot of evidence here for neckpain, WAD, cervicogenic headache, etc. that should be added to the effectiveness section. That was all from Treatment of Neck Pain: Noninvasive Interventions, Results of the Bone and Joint Decade 2000-2010 Task Force, by Hurwitz et al. DigitalC05:31, 7 April 2008 (UTC)

Currently, Effectiveness 1 (under "Neck pain") sums up that source (Hurwitz "et al." 2008, PMID|18204386) with this sentence: "A 2008 review found that many studies reported no significant difference in outcomes between patients using chiropractic manipulation and other therapies, such as mobilization or exercise." There are several other neck pain reviews to summarize, and although this one is high quality and the most recent, the other reviews should be summarized too. Plus, there are several other conditions to cover besides neck pain. Putting all the above text, or even just the "slightly summed up" version, would be overkill; ChiropracticEffectiveness needn't discuss things like acupuncture and laser therapy. Can you suggest a replacement for that sentence that isn't quite as lengthy, but still addresses the concerns you raise? Thanks. Eubulides06:13, 7 April 2008 (UTC)

You lost me. We are we not discussing things like acupuncture and laser therapy? Chiropractors use acupuncture and laser therapy as part of their treatment, as they do with mobilization and manipulation. This section is not supposed to be Spinal ManipulationEffectiveness. The way it is worded above, ""A 2008 review found that many studies reported no significant difference in outcomes between patients using chiropractic manipulation and other therapies, such as mobilization or exercise." doesn't at all mention that manipulation, mobilization, and exercise are all more effective than usual GP care, medication, or advice to stay active. DigitalC06:32, 7 April 2008 (UTC)

Sorry, I guess I got lost because Chiropractic doesn't mention laser therapy anywhere, and mentions acupuncture only offhand. Clearly ChiropracticTreatment procedures needs a lot of work. But that's a different subject. In the meantime I made http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=203936345oldid=203931330 this change to Effectiveness 1 to try to address the above-mentioned points. It seemed better to combine the neck pain and whiplash sections to accomplish this, so I did that too. Suggestions for further improvements are welcome (my own feeling is that the neck/whiplash bullet is now a bit long …). Eubulides07:33, 7 April 2008 (UTC)

"For other neck disorders without radicular signs or symptoms (Grades I and II), the evidence suggests that manual (manipulation or mobilization) and exercise interventions, LLLT, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions". Somehow we left out manipulation/mobilization. DigitalC07:57, 7 April 2008 (UTC)

I summarized "manual (manipulation or mobilization) and exercise interventions" as "manual and exercise interventions" in the http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticoldid=203936886Effectiveness_1 2008-04-07T07:33:34 UTC version of the proposed text, but perhaps that was too cryptic. I see now that QuackGuru later http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204052442oldid=204049739 removed that bit entirely, perhaps confused by my rewording. I'll follow up under QuackGuru's "whiplash and neck pain section is too long" comment below. Eubulides05:19, 8 April 2008 (UTC)

Currently, the whiplash and neck pain section is too long and is formatted a bit differently than the other sections. I will reformat and shorten the text. This will make it more focused and NPOV per WEIGHT. So, http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticcurid=197022diff=204052442oldid=204049739 I made this change. QuackGuru19:34, 7 April 2008 (UTC)

The reformatting is fine, but alas, the shortening ran afoul of DigitalC's desire to include the results for non-whiplash neck pain. I attempted to work around the problem with http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204162814oldid=204157120 this change; it lengthens the text a bit but I don't see an easy alternative if we want to mention those non-whiplash neck pain results. Eubulides06:12, 8 April 2008 (UTC)

We also have still left out manipulation, and only included mobilization. Manual therapy is the term that the article uses to include both (even though manipulation is just a grade of mobilization). DigitalC00:59, 10 April 2008 (UTC)

The text says "…SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives…". The "SMT" is manipulation, so the text has not left out manipulation. Eubulides01:10, 10 April 2008 (UTC)

Apparently I need to read better! DigitalC01:18, 10 April 2008 (UTC)

Scoliosis

http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204851660oldid=204845136 This change inserted a reference to a low-quality pilot study whose conclusion does not match the inserted text. Let's stick with high-quality reviews rather than primary studies or pilot studies. I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204863820oldid=204862873 removed the text. Eubulides05:53, 11 April 2008 (UTC)

Here are a couple of studies to review.http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmedpubmedid=18211702http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmedpubmedid=18211702 QuackGuru06:10, 11 April 2008 (UTC)

Those are two references to the same study, no? But anyway, thanks, it's a much better source for the claim, so I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204871322oldid=204870318 reinstated the claim with this new source, with the claim reworded to match the source. Eubulides07:09, 11 April 2008 (UTC)

The claim was DIRECTLY from the source Eubulides. We do not NEED to have high-quality reviews for things that are properly referenced, unless it is a contentious claim. However, thank you to QuackGuru for digging up a higher quality source. DigitalC07:42, 11 April 2008 (UTC)

Sorry, I missed the claim in the source (it was in its background section, not the conclusion). Anyway, the point is moot now. Eubulides08:22, 11 April 2008 (UTC)

Here is a study to review.http://www.jmptonline.org/article/S0161-4754(01)03269-9/abstract This study covers young scoliosis. QuackGuru20:08, 11 April 2008 (UTC)

Thanks, but we needn't refer to that primary study, as the review we're already using (Romano Negrini 2008, PMID|18211702) covers it. Eubulides20:26, 11 April 2008 (UTC)

Currently, we have no mention of scoliosis in the young. QuackGuru20:30, 11 April 2008 (UTC)

I think we'll just have to live with "adolescent" since that's what the review says. Referring to a primary study just to say the word "young" is a bit much. Eubulides20:33, 11 April 2008 (UTC)

Okay. We will stick to the wording the latest review says and not the primary study. QuackGuru20:41, 11 April 2008 (UTC)

Headaches

From Bronfort G, Nilsson N, Haas M, Evans R, Goldsmith CH, Assendelft WJJ, Bouter LM. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001878. DOI: 10.1002/14651858.CD001878.pub2.. For the prophylactic treatment of migraine headache, there is evidence that spinal manipulation may be an effective treatment option with a short-term effect similar to that of a commonly used, effective drug (amitriptyline). for migraine,... ...There were fewer side effects associated with spinal manipulation. For the prophylactic treatment of chronic tension-type headache, amitriptyline is more effective than spinal manipulation during treatment. However, spinal manipulation is superior in the short term after cessation of both treatments. for TTH, and for cervicogenic headache we have For the prophylactic treatment of cervicogenic headache, there is evidence that both neck exercise (low-intensity endurance training) and spinal manipulation are effective in the short and long term when compared to no treatment. There is also evidence that spinal manipulation is effective in the short term when compared to massage or placebo spinal manipulation, and weaker evidence when compared to spinal mobilization.. Currently we don't mention cervicogenic headache at all in Effectiveness 1. DigitalC01:43, 10 April 2008 (UTC)

Interesting. Can you please provide a link to this research? Or is it something which we already have? If so, maybe draft up a sentence to include. -- Levine211202:12, 10 April 2008 (UTC)

http://www.cochrane.org/reviews/en/ab001878.htm Link. It is a cochrane systematic review. I wish I had saved that tool that turns any citation into a WP reference. DigitalC03:54, 10 April 2008 (UTC)

This citation is currently summarized in Effectiveness 1 under "Headache" as "Of three systematic reviews published between 2000 and May 2005, one found that SMT is as effective as other interventions, but others did not find conclusive evidence in favor of SMT." This summarizes the following text in the cited source: "Similarly, there are three systematic reviews of SM for headache. While Bronfort "et al." concluded that SM is as effective as other interventions, the other two teams of reviewers did not find conclusive evidence in favour of SM." Eubulides06:42, 10 April 2008 (UTC)

Given that the source article breaks it up into different types of headaches, I think this article should to. There is a big difference between a tension type headache and a cervicogenic headache.DigitalC07:26, 10 April 2008 (UTC)

OK, I http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204645112oldid=204644176 did that by adding a sentence summarizing Bronfort "et al." 2004 separately. Eubulides07:51, 10 April 2008 (UTC)

Problems with current Effectiveness draft

Too much weight on SMT; not on other Tx done in practice

* The weight roughly corresponds to the weight given by the sources. It is true that sources focus more on the effectiveness on SMT. But this is understandable, given that SMT is the characteristic treatment of chiropractic, and has generated the most research. Eubulides22:49, 10 April 2008 (UTC)

**We have already in the treatment section a the most common treatment methods used in clinical chiropractic practice. We should do a much better job of representing the whole picture than isolating to SMT. CorticoSpinal23:29, 10 April 2008 (UTC)

**:* As ChiropracticTreatment procedures makes clear, SMT is the most common treatment in chiropractic care and it is the characteristic chiropractic treatment. It is entirely appropriate for an effectiveness section to spend considerable time on SMT. Effectiveness 1 does not isolate to SMT; it covers other treatment forms. Eubulides06:03, 11 April 2008 (UTC)

*** This basically ties into my chief complaint; that studies not specific to chiropractic are being used her to make specific statements about chiropractic efficacy. For instance, where in http://jrsm.rsmjournals.com/cgi/content/full/99/4/192 this review does it say that the results of studying spinal manipulations performed by osteopaths, chiropractors and other practitioners can be singularly applied to just measure the efficacy of chiropractic? I don't believe it does. Yet we are currently applying it in such a way. IMHO, this is a SYN violation. -- Levine211201:02, 11 April 2008 (UTC)

**** Effectiveness 1 is following the lead of high-quality reviewers (both critical and supportive of chiropractic) in using results of studies from other practitioners to gain insight into the effectiveness of SMT for chiropractic care. It is not synthesis if we are saying what the experts themselves say. On the contrary, we should not exclude their reviews, as that would be substituting our judgment for that of the experts. Eubulides06:05, 11 April 2008 (UTC)

******QFE "into the oeffectiveness of SMT for chiropractic care". This should really be effectiveness of SMT, in the SMT article. DigitalC07:25, 11 April 2008 (UTC)

******* Sorry, I don't know what "QFE" means. It's entirely appropriate to have a summary of the effectiveness of chiropractic's main and characteristic treatment modality here. A longer treatment would be appropriate for the SMT article. Eubulides07:36, 11 April 2008 (UTC)

******** QFE = quoted for emphasis. Chiropractic's main and characteristic modality is spinal adjustments, not SMT. There are differences in technique, philosophy, instrumentation, procedure, etc. Unless the reviewers are stating that their studies of general SMT is directly applicable to chiropractic spinal adjustment specifically, we cannot synthesize that it is. -- Levine211217:48, 11 April 2008 (UTC)

********* We have a reliable source on effectiveness saying it's merely a difference in terminology and does not matter for effectiveness. We have no reliable sources on effectiveness saying otherwise. The difference may matter for other purposes (e.g., for chiropractic philosophy), but it does not matter here. It is not synthesis to use what reliable sources say. Eubulides18:07, 11 April 2008 (UTC)

********** Without the individual reviews or studies stating that their conclusions about general SMT directly corresponds with the efficacy of chiropractic, then I don't see how we can say it does without violation SYN. It seems pretty textbook to me. We have source A drawing a conclusion about SMT as performed by practitioners other than chiropractors. Then we have one source B saying that SMT and chiropractic's spinal adjustment are the same thing. So then we conclude that the conclusions from A about SMT must be the same conclusion about spinal adjustments as per source B saying that SMT and spinal adjustments are the same. Off that we write our statement C in this Wikipedia article specifically about chiropractic. (A + B = C) = SYN violation. I think I have explained this before and I think I understand (but don't agree) with Eubilides rationale why it isn't a SYN violation. Thus, I recommend we see what others have to say or we move forward with some other form of dispute resolution. -- Levine211220:11, 11 April 2008 (UTC)

***********Source B does not merely say that SMT and spinal adjustment are the same thing. Source B goes on to give lots of advice to chiropractors about SMT/spinal adjustment, using the assumption that they're the same thing, and using data taken from both chiropractors and non-chiropractors. This is not an unusual thing. It is standard practice in the recent literature, and it's done by more than one study (these are just two examples). What recent reliable sources are saying is that the distinction between "spinal adjustment" and "spinal manipulation" is no longer relevant for effectiveness studies. It is not synthesis to report what these sources are saying, which is all that Effectiveness 1 is doing. It does not report anything that is not in the sources. Eubulides20:39, 11 April 2008 (UTC)

************ Source B does not state that the specific findings of Source A can be applied to chiropractic. (Source A doesn't even state that its specific findings can be applied to chiropractic.) Source B may give us some general information which could allow us to make the leap that the conclusions of Source A can be applied to directly chiropractic, but therein lies the SYN issue. By presenting the findings of Source A here at chiropractic, we are effectively saying that they are directly applicable to chiropractic even though we don't have a source stating that the conclusions of Source A are directly applicable. Look, I understand your position. And I think by now you must understand mine. Let's agree to disagree and wait for others' input, or let's proceed with some other dispute resolution method. -- Levine211221:40, 11 April 2008 (UTC)

************* Source B (Bronfort "et al." 2007, PMID|18164469) "applies" the specific findings of Source A to chiropractic. They don't make a big deal about it (they don't say, "Look! We are referring to a study that talks about SMT, even though we are chiropractors and are giving advice to chiropractors!"). They just "do" it. They do state that Source A is about SMT, but that's it. This is standard practice in reliable sources (it happens a lot more than with just Source A and Source B), and we can and should do likewise. Eubulides22:22, 11 April 2008 (UTC)

Most "reviews" listed are from mainstream med rather than preferably from chiropractic researchers (the experts in chiropractic care and related conservative therapies)

* It is a Wikipedia requirement to fairly represent all majority (mainstream med) and significant minority (chiropractic and CAM) viewpoints, roughly in proportion to the prominence of each view. Every effort was made to find recent reliable reviews from both supportive and critical sources. It would be contrary to Wikipedia policy to suppress mainstream opinion on this subject. Eubulides22:49, 10 April 2008 (UTC)

** The article in question is Chiropractic. The majority viewpoint Medicine should not dictate or overrule the minority viewpoint. According to this policy, any mainstream med viewpoint would squash any CAM viewpoint. Also, we are talking about a profession here, one that has a long, complicated and often contentious history with allopathic medicine. The number of "reviews" in medicine will clearly outweigh the number of reviews published by chiropractors which is easily explained by the discrepancy in the numbers of schools, practitioners and funding opportunities. We should use evidence-based syntheses that have been provided by the CCGPP, CCA-CFCRB and other documents that have direct expertise in the area of chiropractic. As it stands right now, this has not occured. CorticoSpinal23:29, 10 April 2008 (UTC)

*** That analysis is backwards. Articles that talk about a minority viewpoint (to take an extreme example: Flat Earth) are not supposed to push that minority viewpoint. That is why Flat Earth emphasizes the majority viewpoint that the earth is round: this is standard Wikipedia policy. Chiropractic is about a minority health-care viewpoint. Chiropractic is a much more significant viewpoint than flat-earthers are, of course, but it's still clearly a minority. By standard Wikipedia policy, chiropractic should be presented as a minority viewpoint, fairly and neutrally, with the mainstream medical viewpoint also being covered with appropriate weight. Effectiveness 1 attempts to do that: if anything, it gives critics of chiropractic too little weight. Eubulides06:16, 11 April 2008 (UTC)

**** I disagree. An article on 20:47, 11 April 2008 (UTC)

***** Obviously Chiropractic is supposed to be about chiropractic; that's not the issue here. The issue is whether the effectiveness of chiropractic should be covered from the mainstream point of view. And NPOV is quite clear here: the mainstream viewpoint is the preferred one for Wikipedia. Flat Earth came from NPOV: it's not intended to mean any disrespect to chiropractic, it's merely the standard example for discussing POV issues like this. Eubulides 20:57, 11 April 2008 (UTC)

******The effectiveness of chiropractic should represent the mainstream view of CHIROPRACTIC not mainstream medicine. Globally, the "mainstream" in chiropractic are "mixers". We have the literature base now to "stand on our own" and we don't need to push the mainstream med POV because we have the appropriate sources and literature now on our own. Not to see mainstream can't have it's 2c, of course it should, but to be given so much weight here... that's the heart of the issue. Perhaps the issue is too big for Chiropractic Talk and there might be a better venue for it. CorticoSpinal22:17, 11 April 2008 (UTC)

*******This proposal is contrary to Wikipedia policy, which is to present mainstream viewpoint fairly and in proportion to its overall weight. Flat Earth does not present flat-earth theories primarily from the viewpoint of dominant flat-earth society; it presents them from the mainstream viewpoint that the earth is round. Chiropractic should be similar. Eubulides23:21, 11 April 2008 (UTC)

********This comparison is completely invalid. Evidence-based, peer reviewed research by chiropractic PhDs is not even remotely similar to Flat Earth in any way shape or form. This is a red herring argument. Please provide justification that evidence based mainstream medicine POV trumps evidence based chiropractic POV in Chiropractic. Furthermore it is not contrary to any wikipedia policy. If anything this is a form of scientific opression of the one medical culture over another. That's not right, fair, just or warranted. Also, who is to say the mainstream view fairly and accurately portrays chiropractic? In other words, why does mainstream medical expert opinion/research TRUMP expert chiropractic opinion/research in Chiropractic. Are you suggesting that medical professions are the experts of chiropractic now? CorticoSpinal

********* Wikipedia policy is that minority views, such as chiropractic, can be spelled out in great detail in articles specifically devoted to these views, but these articles must make appropriate reference to the majority viewpoint. This is not "scientific oppression": it's merely reporting mainstream scientific and medical opinion with the appropriate weight. Saying that only chiropractors can be expert on chiropractic is like saying only flat-earthers can be expert on Flat Earth; it is a recipe for not giving proper weight to the majority viewpoint, which is contrary to Wikipedia policy. Eubulides08:34, 13 April 2008 (UTC)

********** First of all, Chiropractic is not a minority view, it is a profession. The majoirty viewpoint here is not medicine, it is science. However, that is a moot point, since it has not been demonstrated what the majority viewpoint is WITHIN medicine. Ernst is not the majority viewpoint within medicine, he is a minority view critic. DigitalC00:13, 14 April 2008 (UTC)

************* I don't know of anyone in the literature who claims that Ernst is a minority-view critic. By "chiropractic views" I meant sources about chiropractic effectiveness that are written by and for chiropractors; these generally are more favorable towards chiropractic. I agree that the majority viewpoint here is mainstream science; for health care this includes mainstream medicine. The sources for Effectiveness 1 were chosen without regard to whether they came from chiropractic or other sources, using standard scientific search techniques such as Google Scholar. Using these techniques, Ernst ranks quite highly: for example, Google Scholar reports that Ernst Canter 2006 (PMID|16574972) is cited 29 times, whereas (for example) Hoskins "et al." 2006 (PMID|17045100), the only supportive-of-chiropractic source cited in Effectiveness 1 that also happens to be published in 2006, is cited only 3 times. Eubulides08:00, 14 April 2008 (UTC)

************That was possibly the most brilliant statement that summarizes this case! Checkmate, Eubulides. Science shall have the floor. Now that the chiropractic profession has nicely developed its evidence base over the past 25 years, we will use scientific chiropractic literature, first and foremost in chiropractic. Allopathic scientic POV will and must be represented but not the the extend where a) it trumps and outweighs scientific chiropractic POV b)a credible chiropractic source shall be given at a MINIMUM the same weight a credible allopathic source and c)no allopathic source(s) should be used to determine the professional identity of the autonomous profession of chiropractic that is self-regulated and is licensed in over 60 countries. 02:35, 14 April 2008 (UTC)

************* Credible sources should be given similar weight, of course. However, sources should not be emphasized or preferred simply because their authors happen to be chiropractors. I'm not sure what is meant by "determine the professional identity" here; this thread is about effectiveness, not about scope of practice. Eubulides 08:00, 14 April 2008 (UTC)

Ernst POV pushing

* Ernst's critical reviews should not be suppressed; they should be fairly represented. The current draft does not push Ernst's POV; only a small amount of the text relies on Ernst, and most of this text is not controversial. If anything, Ernst's viewpoints are underrepresented in the current draft. Eubulides22:49, 10 April 2008 (UTC)

** Ernst is a very polarizing figure and I certainly disagree that his views are under-represented (in fact I'd say the opposite). Nevertheless, it's not very "fair" to have Ernst studies be included and not have studies which refutes his "conclusions".

* But Effectiveness 1 does cite studies that claim to refute Ernst's conclusions. For example, it cites Bronfort "et al." 2007 (PMID|18164469), which explicitly claims to refute Ernst Canter 2006 (PMID|16574972). Perhaps you haven't followed the citations in the existing draft carefully enough? Eubulides06:22, 11 April 2008 (UTC)

* In the current draft, Ernst's opinions are cited 12 times! I think we should draw from a wider breadth of researchers to avoid at least the appearance of lending too much weight to anyone. -- Levine211201:11, 11 April 2008 (UTC)

* Hawk "et al." 2007 is cited 20 times, far more than Ernst's 10. But both of those figures are inflated because most of those citations are to individual phrases like "bedwetting" in the last bullet item. A fairer measure is the amount of text supported by Ernst. By my count, 113 of the 614 words in the current Effectiveness 1 are supported only by Ernst. It's not at all out of line to give 18% of the space to the leading mainstream medical critic of chiropractic. If anything, mainstream medicine, being the majority viewpoint, should get more space than that.

* Additional sources are welcome, if they are as high-quality as the existing ones.

Eubulides

06:39, 11 April 2008 (UTC)

*This is sort of misleading. a) Hawk talks about a variety of different conditions in her review whereas Ernst focuses only on SMT. Fairer measure? According to whom? We can't go by words; we can have 200 words saying DCs effective and then 3 to negate it "DCs are quacks". This is not a good measure to use. Furthermore, this reinterates my point that there seems to be Ernst POV pushing as he has now cropped up in safety many times and now effectiveness. How many times are we going to quote the same individual saying the same thing in different sections? 20:52, 11 April 2008 (UTC)

* Ernst 2008 does not "focus only on SMT". He does focus primarily on SMT, true (as does Hawk "et al."), but that's appropriate for chiropractic. Perhaps you're confusing Ernst 2008 with a different Ernst study? Anyway, there's nothing in Effectiveness 1 that says DCs are quacks: it's merely reporting what reliable reviews say, and it neither says nor implies anything about quackery. It is certainly not unreasonable to give the critical side here; it "would" be unreasonable to completely ignore critical reviews. Eubulides 21:27, 11 April 2008 (UTC)

* I was using "DCs are quacks" as an example how 3 words could undermine 300 words before it. So, using a count (118 words) and percentages (18%) to describe the "effect" of mainstream meds opinions (which can be very harsh and very misleading which is my main beef with all Ernst articles) does not accurately represent the true "weight" of the words. CorticoSpinal22:17, 11 April 2008 (UTC)

* Fair enough, but none of the words in question are anything like "DCs are quacks". They're all fairly bland, just like the words used elsewhere in the section. A word count is a rough measure, but it's a reasonable one in this case. Eubulides23:23, 11 April 2008 (UTC)

* We don't know that Ernst is the leading mainstream medical critic of chiropractic nor to we know if his criticisms reflect the mainstream opinion of the efficacy chiropractic. For instance, the esteemed http://www.umm.edu/altmed/articles/chiropractic-000350.htm University of Maryland Medical Center states: "Chiropractic has been shown to be effective for acute and chronic low back pain, neck pain, headaches (including migraines), frozen shoulder, tennis elbow and other sports injuries, and carpal tunnel syndrome, and may be helpful for otitis media (ear infection), digestive problems, menstrual and premenstrual pain, and asthma." We can find similar text published by the http://pennhealth.com/health_info/lowbackpain/lowbackpain_chiropractic.html University of Pennsylvania and on other various prestigious medical sites on the web. How are we not to know that this is more in line with the mainstream medical opinion of chiropractic's efficacy? Why are we relying so heavily on one critic? -- Levine211217:56, 11 April 2008 (UTC)

* Those two sources, as esteemed as they are, are merely information web pages. They are not as reliable as peer-reviewed journal articles. One is dated 2003 and cites no sources; the other is dated 2002 and cites sources ranging from 1993 to 2002, mostly primary studies. These are far inferior to the sources used in Effectiveness 1, which are newer, are reviews, are published in peer-reviewed articles, and are far more comprehensive. If we were to rely on just information web pages like that in Effectiveness 1, there would be thousands of sources available, whose conclusions would range all over the map. This is not a good way to produce a high-quality article. As per MEDRS, we should prefer recent peer-reviewed journal articles, primarily secondary sources like reviews. Relying on obsolescent information web pages is a big step down in quality from that. And when we look at recent high-quality reviews, we see Ernst mentioned often. (We don't see the authors of those information web pages.) Eubulides18:19, 11 April 2008 (UTC)

** Completely disagree here, and again, it precisely illustrates my point: an editor who decides unilaterally what is acceptable for inclusion, the argument being primary studies. Well, if it's a good study, it's a good study, period. I sense a bit of righteousness here in the argumentation. Obsolescent? From 2002? Common. More Ernst again? This is more ammunition that supports claims of an Ernst POV push. Ernst is only notable to allopaths, there is not much respect there from chiropractic academics (DC/PhDs) who seriously question the intellectual honesty of his work. It's also a gross misrepresentation of mainstream chiropractic and focuses on the more overzealous subluxation-based DCs and their belief system which forms the minority viewpoint. I would hope that you listen a source who has a bit more insight into this issue. CorticoSpinal22:17, 11 April 2008 (UTC)

* The criteria are not mine; they are taken from MEDRS, guidelines that represent a consensus that is good for Wikipedia and produces better articles. 2002 is pretty old; it's older than any of the sources used in Effectiveness 1. It's quite clear that Ernst is controversial among chiropractors, but that does not mean his work should be ignored: it's published in high-quality journals and gets cited often. Eubulides23:27, 11 April 2008 (UTC)

*2002 is old? According to who? 2002 is still a fairly recent study. DigitalC02:13, 13 April 2008 (UTC)

* The item dated 2002 is not a study; it's just a web page. And yes, a web page that hasn't been updated for six years is pretty old. Anyway, I don't think anybody is seriously arguing that that web page is as good a source as what's in Effectivness 1, so this point is not relevant to what sources should be in Effectiveness 1. Eubulides08:34, 13 April 2008 (UTC)

* We are sidestepping the point here. "We don't know that Ernst is the leading mainstream medical critic of chiropractic nor to we know if his criticisms reflect the mainstream opinion of the efficacy chiropractic." - Those sources may not be RS for effectiveness, they are reliable in talking about themselves. DigitalC00:19, 14 April 2008 (UTC)

* It's easy to see that Ernst is the leading mainstream medical critic; just do a Google Scholar search; he writes a lot of papers and his papers get cited a lot. And he is certainly not alone in his criticisms; it's easy to find other medical authors who agree with him (many who use stronger criticisms than he does). But we don't have to decide whether Ernst is the leading critic in order to write this section. All we need to do is to consult reliable sources using standard techniques. Ernst's name pops out (along with other sources), so we use him. We certainly shouldn't "avoid" him merely because he is so vehemently opposed by chiropractors. Eubulides08:00, 14 April 2008 (UTC)

Listing of conditions such "infectious disease" "parasistic disease" and "cancer" treatments is highly inappropriate as they are not even in the top 1% of conditions treated by DCs. Dedicating this much space and (misleading the public) that these are somehow routinely treated in practice should be rectified (by suggesting Type O or using another word to replace all those conditions listed which does not accurately reflect the state of practice circa 2008)

* The text does not state that these conditions are routinely treated in practice. The list of conditions included cancer pain, not cancer itself. This list was taken from a reliable source. I just now checked, and a different source (Hawk "et al." 2007) also mentions cancer pain, so it does appear that cancer pain is worth mentioning. Hawk "et al." 2007 do not mention infectious or parasitic disease, though, so let's drop that. I noticed several other conditions (e.g., vision problems) mentioned by several papers cited by Hawk "et al." 2007; when there were 5 or more papers I added a mention of those conditions. Here's the resulting http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204792057oldid=204778272 change I installed. Eubulides22:49, 10 April 2008 (UTC)

** Treating pain syndromes as a palliative measure is appropriate but it should be described as such. Otherwise readers are left to assume that SMT is being applied to treat parasitic diseases and that's not right. We don't need the whole list, we certainly don't list the more common conditions treated in chiropractors offices' in the effectiveness part, so why dedicate a list to something that less than 1% treat? CorticoSpinal23:29, 10 April 2008 (UTC)

* Effectiveness 1 says "cancer pain" not "cancer". That's pretty clear, but if someone can suggest something clearer that doesn't require a lot of words, that would be helpful.

* Effectiveness 1 no longer mentions parasitic disease; that's been taken out in response to earlier comments.

* Generally speaking, the conditions mentioned in Effectiveness 1's "Other" bullet have five or more research papers published recently, as counted in Hawk "et al."'s review, or they have at least one high-quality paper (e.g., a RCT). This represents notable interest in chiropractic treatment of that condition. Even if it were true that only 1% of chiropractors treat (say) middle ear infection, there is significant interest in that treatment when there are so many papers published about it, making it a legitimate topic here.

Eubulides

06:50, 11 April 2008 (UTC)

* CorticoSpinal has made an excellent point here. This also ties back into my chief complaint with the safety issue - How is it that we give so much space to a risk which is only estimated to be 0.000002%? That's seems like a WEIGHT violation. Similarly, dedicating space to discuss the effectiveness of chiropractic in treating something only a fraction percent of chiropractors claim to treat seems like another WEIGHT issue. -- Levine211201:06, 11 April 2008 (UTC)

* Safety is a different matter, which was discussed at length earlier; I'd rather not reopen that can of worms in this thread. Let's start a new thread for it, please, if the topic is worth reopening.

* The weight given to (say) middle ear infection is appropriate, I think: it's only 3 words representing (by Hawk "et al."'s count) 8 research articles including 1 RCT which (according to Hawk "et al.") was "promising for the potential benefit of manual procedures for children with otitis media". Eubulides07:17, 11 April 2008 (UTC)

* So long as its discussed properly I don't have a problem with listing the 3-5 common non NMS conditions treated by a minority of DCs. CorticoSpinal22:38, 11 April 2008 (UTC)

Sources selected and used are without consensus; this has been a topic of debate before and perhaps we can take this to the appropriate venue to get clarification. We should not have only 1 editor deciding unilaterally what is "good" and "inclusion worthy" research. To truly move forward we should get to the bottom of the issue via arbitration if necessary.

* This greatly mischaracterizes the process used to select the sources. A http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=197262340oldid=197200029 call for sources with an initial cut went out a month ago. Significant discussion followed, and resulted in substantial additions to the list. This process took quite some time. The text of the proposed section itself was not drafted until three weeks later.

*The standards used for selecting sources were the same as with any other high-quality medical article, as per the Wikipedia guidelines in MEDRS.

*It is premature to talk about arbitration, as we are still making progress in coming up with a consensus.

Eubulides

22:49, 10 April 2008 (UTC)

* I was suggesting a neutral discussion forum where we can get input from non DCs and MDs. Also, your reply doesn't address my concern that high quality articles are routinely passed over. When discussing Chiropractic we should not dismiss high quality literature because it is not a secondary source. The literature base by DCs does not have the same funding as MDs consequently we are left with primarily an allopathic viewpoint. Also, I had mentioned before that guidelines are just that guidelines, and not strict rules and we allows for interpretation. For example, it has been written before that the Cassidy et. al study on SMT and stroke should not be included because it is a primary source whereas Ernst should be included because it is a secondary source. Looking at the 2 papers though we can clearly see that Cassidy et al. has much more depth, breadth and covers 7 years of data compared to Ernst which does not and could easily be suggested as cherry picking strictly allopathic journals. If we cannot resolve this disagreement here, then we should go to an arbitration site where we can lay down our case and get an outside opinion. CorticoSpinal23:29, 10 April 2008 (UTC)

* The previous comment suggested "arbitration". I was hoping we could avoid it by coming to a consensus here. If we can't do that, then I suppose we can go through the usual Wikipedia procedures when editors cannot come to a consensus. I'd far rather come to a consensus, though.

* No high-quality articles have been passed over in the drafting of Effectiveness 1, as far as I know. Editors have suggested further articles, and the good ones have gone in. Just in the past few hours, for example, a lower quality pilot study on adolescent scoliosis (Rowe "et al." 2006, PMID|16923185) was inserted http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204851660oldid=204845136 here), and it was soon replaced with a much higher quality review (Romano Negrini 2008, PMID|18211702), suggested http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204865874oldid=204865391 here. Further high-quality articles are welcome, of course. Eubulides07:32, 11 April 2008 (UTC)

* Again, I think no harm can come from at least considering a wider breadth of sources. This way we can fairly represent all significant POVs. -- Levine211201:12, 11 April 2008 (UTC)

* Further high-quality sources are welcome, of course. Eubulides07:32, 11 April 2008 (UTC)

Effectiveness section is not present in Medicine Osteopathic Medicine Naturopathic Medicine. Remember we are discussing a profession and not just a modality. For example, what is the "effectiveness" of "medicine"? It's a very broad topic and trying to condense it and limit it to SMT does not represent NPOV. We must have some kind of consistent standard across all alt med/conventional med articles and professions. Chiropractic is too hazardous to be experimenting with highly contentious issues without proper precedents. Comments are welcome. CorticoSpinal17:51, 10 April 2008 (UTC)

* Effectiveness is an important and legitimate topic for Chiropractic. The current draft does not limit the topic to SMT. It is true that some other Wikipedia articles lack proper coverage of effectiveness, but others (e.g., Homeopathy) do a better job, and at any rate we should not let shortcomings in other articles dictate a shortcoming in this one. Eubulides22:49, 10 April 2008 (UTC)

** Again, we are discussing the effectiveness of a profession as the title currently stands. We should either change the title to SMT and accordingly move this discussion to the SMT talk page or we broaden it to accurately reflect what conditions are treated by what modalities in clinical practice. I would hesitate to use the word shortcoming; the article would still be highly informative without this section in the main article per se. CorticoSpinal23:29, 10 April 2008 (UTC)

**** Effectiveness 1 spends considerable time on treatment modalities other than SMT. It gives primary place to SMT, which is appropriate, but it covers all chiropractic treatment forms for which we have reliable sources. It would be entirely inappropriate to move Effectiveness 1 to the SMT page; its topic is the effectiveness of chiropractic care, and it is entirely appropriate for Chiropractic. Eubulides07:50, 11 April 2008 (UTC)

*** I basically agree with CorticoSpinal on this one. We are spinning our wheels by attempting to discuss the "effectiveness" of a whole profession, when only individual techniques and methods can properly be the subject of an "effectiveness" discussion. It would save a whole lot of effort and avoid alot of unpleasant discussions if effectiveness was only dealt with on the article devoted to each technique. Then we can simply state that chiropractors use this, that, and another technique, and wikilink each one. Then readers can hop over to those articles and find an "effectiveness" section in each one. By simply dropping the whole line of discussion on this matter here, we can sidestep an issue that shouldn't be under discussion here. Save such discussions for each of those articles. -- Fyslee / 01:11, 11 April 2008 (UTC)

***** Effectivness 1 does not talk about the effectiveness of a profession; it talks about the effectiveness of the treatments used by that profession. It is entirely appropriate to discuss effectiveness in this area, which is controversial largely because mainstream medical opinion is that chiropractic treatment is ineffective in many cases. Obviously it would "simplify" things for editors if we bypassed this contentious subject, that that's not the right way to write an encyclopedia: the subject should be discussed here, where it's highly relevant. Eubulides07:50, 11 April 2008 (UTC)

******Disagree, and so do many other editors now. So now we're finally getting at the heart of the issue which is "mainstream medicine" finds chiropractic treatment (what, SMT?) ineffective. So, why does manipulation appear in the allopathic physicians http://www.medscape.com/viewarticle/563639clinical practice guidelines? It seems like there's increasingly an attempt to disproportionately cite mainstream opinion and bypass expert chiropractic research; mainly on the grounds of "primary studies" Interestingly enough, article like Cassidy et al get omitted whereas Ernst gets to stay based on this very rigid interpretation of MEDRS (does it apply to CAM?) guidelines rather than using discretion which many editors here favour. CorticoSpinal21:14, 11 April 2008 (UTC)

******* It's not clear what you're disagreeing with here, exactly. No attempt has been made to "disproportionately cite mainstream opinion". Mainstream opinion is what it is, and Wikipedia policy is that it should be given greater weight. Cassidy "et al." (PMID|18204390) is not about effectiveness, so it's not relevant to this part of the discussion. Chiropractic should be using the highest-quality sources available; we should not switch to lower-quality sources to override parts of higher-quality sources that we disagree with. Eubulides21:45, 11 April 2008 (UTC)

*********Just so I get this right: It is wikipedia policy that suggests that mainstream allopathic medicine (i.e. Western/conventional/mainstream medicine) gets a bigger say in all CAM articles because it is the dominant POV? So, in the Chinese version of wikipedia, does this still count, that Chinese Medicine is the minority POV? Also, Cassidy et al. was used to provide a useful example how a defining study is passed over and described as "lower quality" whereas Ernst is described as "higher quality". So, now, not only is there more POV pushing in the sense of a gross omission, but the situation would never be rectified as the sheer number of allopathic schools and practitioners will always dominate the number of DC schools and DC practitioners. That's not right; it's a form of supression and censorship. I could see if I was bringing a web page to the table, but to pass over and exclude such an important article like Cassidy et al is to the chiropractic community and providers of manipulative therapy? Hmmmm... CorticoSpinal22:38, 11 April 2008 (UTC)

********** Yes, you have it right: articles are supposed to be written with the mainstream viewpoint in mind, obviously with alternative viewpoints fairly represented. Cassidy "et al." was omitted from the safety section for good reason, which was discussed earlier: it's a primary study that had a high-quality review and citing the review sufficed. It is a bit of a stretch to call the standard Wikipedia NPOV policy a form of censorship. Eubulides23:33, 11 April 2008 (UTC)

***********Actually I didn't say that the standard NPOV policy was a form of censorship. Please do not misrepresent my statements in the future; I have asked you twice already within the last few days. Nevertheless, the censorship in question has to do with the deliberate omission of high quality research by experts in VBA and manipulation, namely Cassidy et al. (2008) and Haldeman (2008) et al. Their expertise is excluded in any meaningful manner in Chiropractic:Safety whereas a non-expert in chiropractic such as Ernst gets included? I'm not even suggesting we remove Ernst, I suggest we INCLUDE Haldeman and Cassidy. This is proper wikietiquette and your outright refusal to include these articles is puzzling and precludes any meaninful collaboration between editors here. CorticoSpinal06:23, 13 April 2008 (UTC)

************* What you wrote was "the sheer number of allopathic schools and practitioners will always dominate the number of DC schools and DC practitioners. That's not right; it's a form of supression and censorship." This appears to be arguing that mainstream opinion has an unfair advantage because it's, well, mainstream. But that's Wikipedia policy: it is supposed to reflect mainstream opinion.

************* There is no need to refer to a primary study if it has been summarized by a high-quality review, which was the case here. Reaching down and grabbing primary studies that one likes is a recipe for introducing bias, and for good reason is recommended against in MEDRS. But to repeat, these safety studies have nothing to do with effectiveness, this thread's topic. Eubulides08:34, 13 April 2008 (UTC)

**************Then it is agreed that we shall present in full the summaries findings. Because as currently written, we're reporting 1 of the 5 conclusions. The reason why this stuff in being repeated in different threads is of because 02:25, 14 April 2008 (UTC)

*************** Without knowing what specific change is being proposed here, it's hard to indicate agreement or disagreement. I suggest that the change, whatever it is, be proposed in a different section in the talk page. This thread is about effectiveness, not safety. Eubulides 08:00, 14 April 2008 (UTC)

**** I tend to agree that this may be the best route to go; discuss efficacy per each article of each technique. Chiropractic is too broad of a profession perhaps to discuss the efficacy of it on the whole. As I mentioned before, much of the SMT data we have collected would probably be better suited for the spinal manipulation article anyway. In turn, some of the specific chiropractic research would be better suited for the spinal adjustment article. -- Levine211201:17, 11 April 2008 (UTC)

******I disagree that chiropractic is too broad a profession to discuss the efficacy of its treatments. Effectiveness 1 is a counterexample to that claim. Eubulides07:50, 11 April 2008 (UTC)

*******I disagree with your assessment. What is the efficacy of Physical Therapy for example? I mean, DCs and PTs treat MSK conditions (there's a lot of them) and let's take anterior shoulder pain for example. DDx can include tendonapathy/osis, paratendonitis, bursitis, instability, capsulitis, bursistis, inflammatory conditions/OA, strain, sprain, impingement syndromes, periostitis, referral from cervical spine or myocardial infarction, disc herniation, cholecystitis, pancoast tumour, subclavian steele syndrome, etc... This is what we're dealing with in clinical practice. All these DDx have their own prognosis and plan of management attached. POM can include, but not limited to, myofascial release/soft tissue work, reflex inhibition techniques, mobilization/manipulation, physiotherapeutic modalities, acupuncture, ergonomic advice, nutritional advice, functional rehab exercises, etc... This is just for anterior shoulder pain. So, clearly there's a problem in reasoning that suggests that chiropractic is "not too broad" to judge the efficacy of Tx. If we're genuinely interested in doing this let's include the findings of the CCGPP since they've already done all the work in terms of appraising the evidence and making specific recommendations re: which treatments are the most effective. After all, they are clinical practice guidelines. CorticoSpinal21:04, 11 April 2008 (UTC)

********Effectiveness 1 already cites the CCGPP findings at length and gives their effectiveness results all the way down to the "fair" level. What more is needed? Eubulides21:32, 11 April 2008 (UTC)

*********We must not be reading the same document then. Perhaps I could take a stab at it? CorticoSpinal22:38, 11 April 2008 (UTC)

**********Effectiveness 1 is above. It's citing Ernst 2008, which is here: Eubulides23:36, 11 April 2008 (UTC)

*****I agree as well, and I think the same could be said about the safety section. DigitalC03:01, 11 April 2008 (UTC)

******* It's completely unreasonable to move important sections away from this article under the guise that chiropractic is a "profession". The important thing about chiropractic is that it treats people. Do the treatments work? This is a basic question that should not be sidestepped here. Eubulides07:50, 11 April 2008 (UTC)

******** Precisely. If we were discussing "do chiropractic treatments work?", sure, that may be fine. But the current efficacy draft is wrapped to much in discussing if general SMT (as performed by a whole host of other practitioners other than chiropractic) works. It is inappropriate for this article. Studies which would be more appropriate here are those measuring the results of patients going through the entire chiropractic experience (such as the Manga and Workmen's Comp studies). No one is doing anything under any guises nor are we sidestepping; rather we are wanting to have that question (Does chiropractic work?) discussed fairly here. Relying on studies which do not discern an osteopathic procedure from a chiropractic adjustment is simply inappropriate. -- Levine211218:03, 11 April 2008 (UTC)

********* SMT is the characteristic and main mode of treatment of chiropractic; it is entirely appropriate for an effectiveness section to focus on its effectiveness; that's what the sources do. The current draft spends about a third of the text specifically on SMT; this is not out of line for the main treatment modality. The Manga and Workmen's Comp studies are old and have serious problems and are superseded by these more recent reviews, which are of much higher quality. It is not inappropriate to use evidence from various disciplines; that's what our reliable sources are doing. Eubulides18:29, 11 April 2008 (UTC)

********** Manga and Workmen's Comp studies have serious problems? I buy that they may be older, but what are the serious problems? It is inappropriate to use evidence from various disciplines' use of SMT to make statements about chiropractic's efficacy specifically if the sources themselves are not making statements about chiropractic's efficacy specifically but rather just SMT in general as performed by various disciplines. -- Levine211220:16, 11 April 2008 (UTC)

*********** They rely on old data. Really old data. That's enough. That is a serious problem, and it's enough to exclude them from the section on effectiveness, regardless of the other problems they have. At this point they are purely of historical interest. Let's put it this way: they are not cited by the 2007 CCGPP literature synthesis on low back pain. Or by the Bone and Joint Decade 2000–2010 review of neck pain treatments. These reviews cover hundreds of sources, but those two old sources don't make the cut. They shouldn't make the cut in Chiropractic either, for the same reason, unless they're of historical interest, in which case they're fodder for ChiropracticHistory. Eubulides20:50, 11 April 2008 (UTC)

************I can concede this point, but there are 2004 studies and an updated report than could be mentioned that will supplement the "really old data". CorticoSpinal22:38, 11 April 2008 (UTC)

****** Spinal manipulation already has a safety section which is more than redundant compared to what is in this article. And again, it begs to question why are we discussing the safety of a procedure used by many general kinds of practitioners using studies that encompass many general kinds of practitioners in an article about the chiropractic profession specifically? -- Levine211203:23, 11 April 2008 (UTC)

******* ChiropracticSafety is a brief summary of safety issues; Spinal manipulationSafety is a much longer section. It is normal and usual to have briefer summaries in a more-general article; it would be unreasonable to remove the brief summary entirely from the more-general article. Eubulides07:50, 11 April 2008 (UTC)

******** It is not as brief as it ought to be. Two are three paragraphs is too long. One paragraph would be enough. -- Levine211218:15, 11 April 2008 (UTC)

********* It started out being shorter. I agree it could be shortened somewhat compared to what it is now. But we are starting to stray from the topic, which is effectiveness. Eubulides18:32, 11 April 2008 (UTC)

I agree mostly with all of these comments in terms of problems we need to address before taking this section "live". In terms of 6, it is also worthy of noting that Medicine Osteopathic Medicine and Naturopathic Medicine don't have a safety section either. -- Levine211222:18, 10 April 2008 (UTC)

Which is why I bring my concerns here. It seems like Chiropractic is getting some kind of double standard. How Medicine has no safety section is completely beyond me. However I can imagine the protests if I were to want to add that section there. All I would like to see is a degree of consistency being applied including WEIGHT issues. I feel that safety still has weight issues but it's getting better. I'd like to see some relative risk added; specifically comparing SMT (for mechanical pain syndromes) to say, NSAIDs which are commonly used for pain control as well. When you start comparing the numbers, I think the weight issue will become painfully (no pun intended) obvious. CorticoSpinal22:28, 10 April 2008 (UTC)

Again, shortcomings in other articles should not mean that Chiropractic should have similar shortcomings. Many medical articles have effectiveness sections: for example, Homeopathy, Vaccine, and Vision therapy have effectiveness sections. And many other articles (for example, Treatment of Tourette syndrome) may not have a separate effectiveness section but they do discuss effectiveness at length under several treatment modalities.

Coverage of effectiveness is more appropriate when there is significant interest in effectiveness, which is certainly the case in chiropractic.

Eubulides

22:57, 10 April 2008 (UTC)

I disagree that there are shortcomings in chiropractic. The examples listed above are types of therapy, not professions. Where is the effectiveness in Physical Therapy, Osteopathic Medicine, Medicine, Veterinary Medicine? They are also all professions and are more representative and accurately reflect the argument being made. That is, one should not reduce a profession to a modality and secondly, one cannot measure the effectiveness of a profession. Hence the comparison of Chiropractic to Vision Therapy is not a logical one. CorticoSpinal23:29, 10 April 2008 (UTC)

Homeopathy is not a profession? That claim would be surprise to many homeopaths. It is entirely appropriate for Homeopathy to talk about effectiveness, just as it is entirely appropriate for Chiropractic to do so. Eubulides07:53, 11 April 2008 (UTC)

Point noted on homeopaths; but that's still a red herring. The main questions are can we judge the effectiveness of an profession, and no other profession has an effectiveness section attached to it, probably because you can't judge effectiveness of a profession. For example, what is the effectiveness of Medicine or Physical Therapy? The wrong question is being asked and it's being approached in the wrong manner. Significant interest from whom? 3rd party payers? You? Mainstream medicine? CorticoSpinal21:20, 11 April 2008 (UTC)

Homeopathy is not a red herring; it's an illustration of why an effectiveness section is more important for controversial treatment philosophies. As far as mainstream medicine is concerned, homeopathic treatments must be ineffective, as they're just water. So it's right and proper for Homeopathy to have a huge section on effectiveness, written mostly from the mainstream viewpoint. Chiropractic has a lot more mainstream credibility than homeopathy does, but it still has a serious and significant issues with effectiveness, so it deserves a good-sized section—not as long as Homeopathy, but long enough to do the controversial topic justice. The significant interest comes not only from me, but (more importantly) from readers. Chiropractic's effectiveness is an important issue here, and should not be swept under the rug. Eubulides21:54, 11 April 2008 (UTC)

Yeah it is, Homeopathy is the exception to the rule and homeopaths aren't even regulated in North America so the comparison is unfair and moot. So, how may I assume that you know the readers wishes? What the readers want, is a fair, accurate, balanced and professional article. No one is suggesting we sweep it under the rug; rather we're (many editors) that we move the discussion to the appropriate page and not under the guise of "chiropractic" effectiveness. Perhaps a limited blurb on effectiveness could be included with safety and then contrasted with NSAIDs as to not mislead the readers and imply that manipulation in general and chiropractic care overall is not as safe as conventional treatment. Because that's simply not the case according to the research. Also, in order to gain a FULL perspective on something we need to contrast it at times with other approaches. Accordingly, we should look at what common medical management is as well for common conditions treated by chiropractors so that the readers know their options and where the evidence lies. Shall we go this route? CorticoSpinal22:38, 11 April 2008 (UTC)

I don't see any problems with the current Effectiveness. This article has many shortcomings, including lack of Effectiveness, Cost-benefit, Minority groups, an updated lead to respresent the body of the article, and more missing things that make this article below Wikipedia's standard for a good article (GA). QuackGuru02:35, 11 April 2008 (UTC)

From GACR:

It is broad in its coverage. In this respect, it:

(a) addresses the major aspects of the topic;3 and

(b) stays focused on the topic without going into unnecessary details (see summary style).

So why do you think we need more unnecessary details (such as nonexistent minority groups) taking away from the focus to qualify for GA? -- Levine211203:16, 11 April 2008 (UTC)

The minority viewpoint (reformers and objective straights) "is" necessary in order to qualify for a GA per WEIGHT. QuackGuru05:37, 11 April 2008 (UTC)

Of course "nonexistent" is still OR. Why keep repeating it? Even if they were nonexistent, their viewpoints are still very much alive, and one of these days the "reform" POV may become the mainstream chiro POV. It happened in osteopathy. -- Fyslee / 05:56, 11 April 2008 (UTC)

Perhaps, but Wikipedia is not a crystal ball. -- Levine211207:09, 11 April 2008 (UTC)

Perhaps indeed. Wikipedia is not a crystal ball to determine that the known minority groups no longer exist. They do exist, just in small numbers. That's why they are called minority groups. Agreed? QuackGuru20:13, 11 April 2008 (UTC)

I don't agree. Either does WEIGHT: "Articles that compare views should not give minority views as much or as detailed a description as more popular views, and "'will generally not include tiny-minority views at all"'." -- Levine211220:18, 11 April 2008 (UTC)

I expressed my opinion on this a while ago, but in case people have forgotten, I agree with Levine2112 that the two groups in question are not currently notable enough to be included. We have some reason (not reliable sources, admittedly) to think the groups are no longer active, and we have no reliable sources saying they are active. Nonexistent groups are "tiny-minority" by anybody's standard.... Eubulides21:01, 11 April 2008 (UTC)

Are we there yet?

No additional specific changes have been made. Therefore, we can add the Effectiveness section to the article now. QuackGuru Mr.Guru 19:30, 8 April 2008 (UTC)

No. There is still much discussion going on above in which you are welcome to participate. Please don't insert the Effectiveness section until these discussions have been resolved. Thanks! -- Levine211220:14, 8 April 2008 (UTC)

I think were are there now. Consensus has been http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=nextoldid=204543096 achieved. QuackGuru00:21, 10 April 2008 (UTC)

Consensus has been achieved? People have been posting about alterations to this section within the last few hours. DEADLINE - There is no rush to have this inserted, we are not trying to beat another publisher to a deadline, so why don't we work to make this a section that everyone is happy with? DigitalC01:10, 10 April 2008 (UTC)

Are you http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticcurid=197022diff=204591703oldid=204591363 happy now? QuackGuru01:22, 10 April 2008 (UTC)

No consensus yet. I am getting closer to approving it, but I still have some unanswered questions and issues above. I concur with DigitalC; there's no rush. -- Levine211202:02, 10 April 2008 (UTC)

I have tried to catch up (whew!) and provide answers for those questions. If I missed any questions please let me know. Eubulides07:10, 10 April 2008 (UTC)

Getting there. I have a suggestion above in SMT vs. Chiropractic. -- Levine211216:41, 10 April 2008 (UTC)

Thanks, I responded to that suggestion http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=204728179oldid=204727716 here, and I think that improved the Effectiveness 1 draft. Eubulides07:57, 11 April 2008 (UTC)

There are many questions unanswered and concerns above. I don't see a resolution in the near future which will please everyone. However, there does seem to be a growing consensus to move our work on efficacy to article more directly related such as spinal manipulation or spinal adjustment. -- Levine211218:06, 11 April 2008 (UTC)

I have attempted to answer all the questions inline above. What have I missed? I disagree that there is a growing consensus to move the effectiveness work to other articles. Effectiveness is core issue of chiropractic, it's the main reason the subject is so controversial, and the existing material on effectiveness in Chiropractic is much lower quality and is blatantly pro-chiropractic in its POV. This problem needs to be addressed here, not ignored here. Eubulides18:35, 11 April 2008 (UTC)

When I say that there is a growing consensus, I am merely referring to the fact that there are now four of the six regular editors who are in support of moving the effectiveness content to the various technique articles, rather than keep it at this article. Perhaps we can do as we have done with ChiropracticSafety; provide a summary of efficacy and link out to the various technique articles. -- Levine211220:21, 11 April 2008 (UTC)

There are far more than six regular editors, and (given the recent edit wars) there are clearly more than two editors who favor Effectiveness 1 in its current form, or something very close to it. I would support trimming the effectiveness section somewhat, but it would not work to move it all to various technique articles; that would make Chiropractic far less useful to the casual reader who wants to know whether chiropractic is effective. Effectiveness 1 was written at the suggestion of just such a reader, who later http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=202494439oldid=202489759 commented that Effectiveness 1 is the sort of thing he was looking for. We should be striving to make the article useful for readers, even if that requires more work for editors. Sweeping controversial bits under the rug into other articles, where they'll be much harder to find, is not the right way to help the reader. Eubulides21:13, 11 April 2008 (UTC)

"Effectiveness is core issue of chiropractic, it's the main reason the subject is so controversial". However, you cannot determine the effectiveness of a profession. SMT is not chiropractic, and although I don't have the sources to back it up, I would believe that soft tissue therapy is used as much by chiropractors as SMT is. Now, if you want to determine the effectiveness of each treatment procedure used by chiropractors (SMT, STT, LLLT, US, IFC, Vibration therapy, etc. etc. etc.), for each condition they are used for (IE - is SMT effective for low back pain? is STT effective for lateral epicondylitis, is ultrasound effective for plantar fasciitis) then that would work, however those effectiveness sections really belong on the article for the respective treatment.DigitalC02:24, 13 April 2008 (UTC)

That's precisely the point I'm trying to make in the http://en.wikipedia.org/wiki/Talk:ChiropracticAn_appeal:_Drop_the_.22effectiveness.22_discussion section below. Please comment there (preferably duplicate your excellent comment). -- Fyslee / 03:02, 13 April 2008 (UTC)

"'Agreed. "' This is getting rather redundant and it look like there is a fundamental problem here. That is, we have a misunderstanding that we can judge effectiveness of professions. It's not done; and we've already provided examples that it's not done in any other mainstream medical profession and most of CAM. There's really no need to keep going this route; since the arrival of our resident medical expert we have had to endure controversial section after section after section (vaccination, safety, effectiveness) which was exposed to be to get the allopathic/medical POV in here which has more of less fanned the flames at chiropractic. We're making this article evidence-informed but the evidence if there, should come from Chiropractic experts and research first and foremost so long that it meets inclusion guidelines. Mainstream med can have it's say too; but not override or overrule but this trend of omitting high quality citations unilaterally determined by an editor when there are more scientific POV editors in agreement is not right. It's time for our medical editors to understand the concept of cultural relativism in a professional medical sense. A mainstream, evidence-based med POV should NEVER overrule or have more weight/influence than mainstream evidence-based chiropractic POV. That is exactly what is occuring right now and it's a terrible precedent to be setting up that somehow mainstream western medicine can impose it's majority status and concepts of health to other professions especially if that profession has a peer reviewed research base to draw from. CorticoSpinal03:22, 13 April 2008 (UTC)

I agree there is repetition here. I'll follow up in An appeal: Drop the "effectiveness" discussion below. Eubulides08:34, 13 April 2008 (UTC)

Effectiveness is a main issue of chiropractic and all the relevant text is core to this article. Partisan refs from chiro advocates has "no" place in this article "when" higher quality peer-reviewed journals exist. QuackGuru06:33, 13 April 2008 (UTC)

Nah, this argument is bunk. Editors are presenting peer-reviewed journals just not only allopathic ones. This point is moot anyways as there is majority consensus amongst the regular editors here that the section should be either suspended and moved to the more appropriate venue (namely SMT and/or respective modality articles). Thanks for your input though. CorticoSpinal06:43, 13 April 2008 (UTC)

Again, I'll follow up in An appeal: Drop the "effectiveness" discussion below. Eubulides08:34, 13 April 2008 (UTC)

Efficacy and cost-benefit

A 1999 study stated, "Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements)."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

A 2001 study states, "Ultimately, the acceptable level of risk associated with a therapeutic intervention also must be balanced against evidence of therapeutic efficacy. Therefore, further research is indicated into both the benefits and harms associated with cervical spine manipulation. Practitioners of this technique should be called on to demonstrate the evidenced-based benefit of this procedure and to define the specific indications for which the benefits of intervention outweigh the risk."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

A 2003 study concluded, "Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy."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

A 2006 study states, "the risk-benefit balance does not favour SM over other treatment options such as physiotherapeutic exercise."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

A 2006 study concluded, "Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful, although chiropractic may result in a greater likelihood of perceived improvement, perhaps reflecting satisfaction or lack of blinding. Physical therapy may be more effective than medical care alone for some patients, while physical modalities appear to have no benefit in chiropractic care."cite journal |journal=Spine |date=2006 |volume=31 |issue=6 |pages=611–21 |title= A randomized trial of chiropractic and medical care for patients with low back pain: eighteen-month follow-up outcomes from the UCLA low back pain study |author= Hurwitz EL, Morgenstern H, Kominski GF, Yu F, Chiang LM |doi=10.1097/01.brs.0000202559.41193.b2 |pmid=16540862

A 2007 study concluded, "Adverse events may be common, but are rarely severe in intensity. Most of the patients report recovery, particularly in the long term. Therefore, the benefits of chiropractic care for neck pain seem to outweigh the potential risks."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

Spinal manipulation for the lower back appears to be relatively cost-effective.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=16226622cite 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

Future studies are needed to properly evaluate spinal manipulation's efficacy.

cite news

|last=

|first=

|title=Chiropractic manipulation: reasons for concern?

|url=http://www.ncbi.nlm.nih.gov/pubmed/17904731?ordinalpos=2itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

|date=December 2007

|work=

|publisher=Clinical neurology and neurosurgery

|accessdate=2008-03-03

|quote=

cite journal

|journal=J Pain Symptom Manage

|date=2008

|title=Chiropractic: a critical evaluation

|author= Ernst E

|pmid=18280103 Chiropractors believe spinal manipulation is an effective procedure when compared to conventional medical approaches.

cite news

|last=Fillon

|first=Mike

|title=Stroke Risks From Spinal Manipulation Unknown

|url=http://www.webmd.com/news/20000522/stroke-risks-from-spinal-manipulation-unknown

|date=May 22, 2000

|work=

|publisher=WebMD Medical News

|accessdate=2008-03-03

|quote=

Efficacy and cost-benefit comments

Here is some info to review for a future section. This can be summarized and improved. According to Levine we should have info about http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=203479835oldid=203459521 efficacy. I agree. QuackGuru03:16, 6 April 2008 (UTC)

As it stands that section needs a lot of work. It's just a string of quotes; it should be a section written by Wikipedia editors. It cites some older sources and some primary studies; it should focus on recent reviews. Perhaps the first thing to do for that section is to come up with a good list of sources. Please see Sources for risk-benefit and cost-effectiveness for a first cut at a list of sources. Eubulides05:41, 6 April 2008 (UTC)

Animal/Veterinary Chiropractic

Perhaps we can work on a less contentious subject; namely the application of spinal manipulation to pets. DCs and DVMs, with the appropriate training are licensed to do this (depending on various state/provincial legislations) and it seems to be getting more popular and mainstream nowadays. If there's no objections, I can start to compile a list of sources and relevant sites/materials. I just think that it would be best to take a log off the fire and work together on something a less controversial. EBDCM17:36, 9 April 2008 (UTC)

I wouldn't normaly describe what could be argued to be animal curealty to be less controversial.17:55, 9 April 2008 (UTC)

That sounds interesting and I would love to see some source describing the nature of such work, the state of affairs in regulating/practicing, and any research available. Depending on the breadth of information available, this could even warrant its own article (Veterinary Chiropractic perhaps). -- Levine2112 17:57, 9 April 2008 (UTC)

I think a small section here would be appropriate and if it mushroomed we can make it into its own article. I think it's noteworthy as the are more and more DCs and DVMs getting certified in providing manual therapy to animals. —Preceding )

Cool. Let's see what you find in terms of sources. -- Levine211218:24, 9 April 2008 (UTC)

Sources for veterinary chiropractic

Older sources

cite journal |journal= Can Vet J |date=1995 |volume=36 |issue=9 |pages=559 |title= The American Veterinary Chiropractic Association |author= Taylor L |pmid=7497418 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmedpubmedid=7497418

Newer sources

cite journal |journal= Equine Vet J |date=2008 |volume=40 |issue=1 |pages=14-20 |title= The effects of chiropractic, massage and phenylbutazone on spinal mechanical nociceptive thresholds in horses without clinical signs |author= Sullivan KA, Hill AE, Haussler KK |pmid=18083655 |url=

Links &amp; Misc

http://www.cmcc.ca/CE/AnimalChiropractic.htm

http://www.cco.on.ca/standard_of_practice_s-009.htm

http://www.veterinarychiropractic.ca/programs.htm

http://72.14.205.104/search?q=cache:slYHk-Azr38J:www.dora.state.co.us/OPR/archive/2002AnimalChiropractorsSunrise.pdf+animal+chiropractic+regulationhl=enct=clnkcd=10gl=ca

http://www.ncbi.nlm.nih.gov/pubmed/12516938?ordinalpos=2itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

http://131.170.40.30/browse;ID=MC030;STATUS=A?QRY=path%3D%22Study%3Bat%3BRMIT%2FTypes%3Bof%3Bstudy%2FPostgraduate%3BPrograms%22%20INTEREST%3D%22SCIENCE%22STYPE=PROGRAMS

Commentary on sources for veterinary chiropractic

Here is a new section to get things started. Happy editing! QuackGuru18:56, 9 April 2008 (UTC)

Not so much research yet, but more resources... more to come after work. CorticoSpinal 21:17, 9 April 2008

(UTC)

Would it be more appropriate to have a small section devoted to this growing field or should it suffice under scope of practice? CorticoSpinal19:31, 15 April 2008 (UTC)

Probably a brief mention under Scope of Practice with a link to stubbed article Veterinary chiropractic. -- Levine211219:52, 15 April 2008 (UTC)

Done, I started Veterinary chiropractic perhaps you can peruse it and suggest essential elements that should appear in the main chiropractic article. CorticoSpinal00:31, 16 April 2008 (UTC)

Tremendous work! I would presume that the lead of that article (or some tightened version of it) would fit nicely in this article. -- Levine211203:07, 16 April 2008 (UTC)

Veterinary chiropractic also known as Animal chiropractic, is an emerging specialization which consists of the medical application of spinal manipulation, primarily used for common neuromusculoskeletal conditions.cite web|url=http://www.veterinarychiropractic.ca/index.html|title=CACCP|language=English|accessdate=2008-04-15 Here is a sentence. QuackGuru03:19, 16 April 2008 (UTC)

I think that's nearly perfect, except I would like to see a minor mention of the specific credentials a Veterinarian chiropractor must for accreditation and/or licensure. Assuming I was a casual reader of the chiropractic article (kind of hard for me to assume, but I'm trying) that nugget of information abut the licensure would be most helpful as that's all I'd basically want to know on the surface about Veterinary chiropractors while reading the Chiropractic article in its entirety. -- Levine211203:52, 16 April 2008 (UTC)

POV issues: April 11/08

We have about 4 days before the article becomes unlocked and seem to spinning our wheels on effectiveness right now. I suggest the more pressing concern is identifying significant POV issues that were raised previously and dealing with these first. As the article stands right now, are there any remaining holes that we could come to a consensus on first? I'd like to see

Education include a passage that reflects the various degrees obtained from various countries, not only the DC (DCM) from North America. It might be also worth mentioning a quick note about the various specializations (neurology, orthopedics, rehab, clinical sciences, etc..)

Scope of Practice to include common areas of clinical practice and controlled acts permitted to DCs (diagnosis, imaging/lab rights, assessment techniques, etc CorticoSpinal04:26, 11 April 2008 (UTC)

A pressing issue would be to end the discussion of "effectiveness" of chiropractic, as you (and I, and Levine2112) suggested above. That would free up everyone's minds to deal with other things. -- Fyslee / 04:41, 11 April 2008 (UTC)

I suggest we create a "things to do list" in order for Wikipedia editors to focus on what they believe or understand is missing from this article. QuackGuru05:15, 11 April 2008 (UTC)

Agreed with Fyslee on this. Let's cut bait on effectiveness, finish up outstanding POV issues that had been brought up before then revisit effectiveness later on if there's still a strong demand that it be included here.

Here's a quick draft of a to-do list:

Chiropractic's current coverage of effectiveness is extremely poor. The topic of effectiveness is important, but it is addressed only in ChiropracticHistory, which refers to a bunch of outdated reports that give only the pro-chiropractic viewpoint. Effectiveness 1 is a high-quality proposal for fixing this. We should not give up on covering effectiveness in Chiropractic: it's a central issue.

Disagree, again it's preferable if we do not consistently use false dichotomies in describing material as "pro" or "against" chiropractic. It seems to be a central issue for some allopathic practitioners. We should either do effectiveness well (i.e. give the appropriate weight to chiropractic experts, i.e. DC/PhDs) or we desist from spinning our wheels trying to count words and justify an unusually heavy push to including the "majority" allopathic viewpoint which, given it's long, tumultuois, complicated and at times down right nasty history with chiropractic, more undue weight. By this logic, CAM viewpoints should be represented in mainstream medicine, but it is not. CorticoSpinal21:43, 11 April 2008 (UTC)

No false dichotomies have been presented. Some reviews are more favorable to chiropractic, and some are less. Effectiveness is one of the central issues for chiropractic, not just for "some allopathic practitioners", but for anybody who's seriously considering chiropractic treatment or who wants to know more about how chiropractic works. The current Effectiveness 1 draft gives significant weight to reviews by DCs. It is not reasonable to exclude mainstream opinion, or even to diminish it: it should be given its proper weight as per standard Wikipedia guidelines. Eubulides21:58, 11 April 2008 (UTC)

I would please ask that my argument is not misrepresented. I have never, not once advocated to exclude mainstream medical opinion. I have suggested that it's POV should not be the dominant POV in Chiropractic just as it would be inappropriate to make Chiropractic or CAM in general a dominant viewpoint in Medicine. Also, I'm curious if we are misunderstanding what guidelines are. It's my understanding that they allow for a degree of flexibility and discretion, unlike a protocol for example. So, given that we are talking about guidelines, we have the editorial flexibility and responsibility to use our judgment when including articles. I'm afraid that citing MEDRS and "secondary sources" does not address the fundamental issue here and I hope that it's not being used to omit valid sources that add much needed content to the article. CorticoSpinal23:16, 11 April 2008 (UTC)

2008-03-12 issues list contains several important problems with the POV in the current article. Many of these have been fixed and are struck out, but some of the biggest ones still remain. ChiropracticHistory, in particular, is a highly partisan section that will need considerable change in order to become neutral.

We cannot rewrite history. Whether our allopathic editors like it or not, there was an active campaign to discredit, supress, contain and eliminate chiropractic by the allopathic community. The two have been at odds since the beginning. There is still some lingering resentment despite a nice thawing over the last 15-20 years. I don't know how we could possibly sugar coat medicine's historical involvement with chiropractic and make it look neutral, let alone a "good guy". Facts are facts. We should however, clean up Manga, BMA, AMA and stuff so that it's clearer, more concise and reflects a historical stance as opposed to something more current. What about VA programs, limited hospital integration, etc? The sources for integrative medicine could be included in a "Present" section that contrasts history and we could give many examples of collaboration between the 2 professions which would bring us to modern times that reflects a thawing in relations. CorticoSpinal21:43, 11 April 2008 (UTC)

There is no suggestion to rewrite history, and the active campaign should be described. However, the current description of that campaign is entirely from the chiropractic viewpoint, and that is clearly POV and should get fixed. It is needed possible to cover heated battles in a relatively neutral way; this is regularly done in other parts of Wikipedia. Eubulides22:01, 11 April 2008 (UTC)

So I'm clear, are you suggesting that the current version is not accurately describing the historical "battle" between chiropractic and medicine? Because I see a quote there that suggests that DCs were an unscientific cult which seems to describe pretty much the thought of the day from mainstream med. CorticoSpinal23:16, 11 April 2008 (UTC)

There should also be a risk-benefit / cost-benefit section.

This not a vaccine here, it's a profession. Where are these sections in Medicine, Physical Therapy, Osteopathic Medicine, Naturopathic Medicine, Chinese medicine? We should not use Chiropractic as an experiment; it's too contentious of an article to be "trying out stuff". CorticoSpinal21:43, 11 April 2008 (UTC)

Eubulides

08:08, 11 April 2008 (UTC)

We have some reliable sources on risk-benefit and cost-benefit of chiropractic treatment; we can use them. We should be striving for what's best for this article. Settling for a substandard article simply because the subject is contentious, or because other articles have similar problems, is a recipe for continued mediocrity. Eubulides22:04, 11 April 2008 (UTC)

You mean the mediocre Chiropractic the A class article or do you mean the more mediocre B class Medicine? What's best for this article is to let chiropractic experts have their full say and not squash their literature because it does not meet an arbirtrary guideline that is being rigidly interpreted. CorticoSpinal23:16, 11 April 2008 (UTC)

ChiropracticSafety is far too bloated to essentially say that chiropractic is safe (or that it has a 0.000002% chance of fatality. In my book, it is just easier to say it is extremely safe and move on with it.

Serious adverse effects are rare, but their incidence rate is not known; the 0.000002% figure is not reliable. The existing text does say that chiropractic treatment is generally safe. It could be shortened somewhat, but just saying "chiropractic is extremely safe" is too short and does not address the real concerns that people have. Eubulides18:41, 11 April 2008 (UTC)

How are the Ernst stats more reliable, especially moreso than Haldeman et al. and Cassidy et al? It seems like you're arbitrarily choosing to cite a "preferred" allopathic source which has come under disrepute rather than a solid epidemiological paper that is Cassidy et al. What are the real concerns people have and your comment presumes that myself and other editors don't seem to care the concerns of the people. Who would know more about chiropractic concerns than a chiropractic academic who has researched the topic for 15 years? Ernst isn't the authoritative source here, it's Cassidy and or Haldeman. CorticoSpinal22:56, 11 April 2008 (UTC)

Not reliable according to whom? Ernst? Why does my malpractice insurance quote me 1 in 5.85? Why do most sources suggest 1 in 1 million? If safety is going to nitpick like this, then we best contrast it with NSAIDs and examine the relative risk for both which are primarily used to treat pain.

Ernst is certainly one of the sources saying it's not reliable, but there are others, and he has good reasons for saying that the 1-in-a-million estimates are dubious due to underreporting. Malpractice insurance counts legal liability, not medical risk; these are not the same thing. I thought that one of the criticisms of ChiropracticSafety was that it was too long? But if additional comparisons are needed, I suppose they could be added. Eubulides22:11, 11 April 2008 (UTC)

So what we have here is a crystalization of opinion. Ernst who has 0 expertise in manipulative therapy and 0 expertise in VBA dissection epidemiology says strokes are happening at a far greater rate than the expert opinion of Drs. Haldeman (MD, DC, PhD) and Cassidy (DC, DrSc) who have the expertise in manipulation, VBA dissection epidemiology and the other plethora of manipulative researchers who cite the 1-5.85 to 1-1 million. And, in this article, Ernsts 'review' is given full green light whereas the true experts sit on the sidelines? That's not right. CorticoSpinal23:16, 11 April 2008 (UTC)

Ernst is a vocal critic of chiropractic and has already been lambasted by DCs for his misleading "reviews". Underreporting, is this speculative or proven? Is it a possibility, sure, is it a probability, doubtful. Malpractice insurance is also based on actuarial statistics which is how insurance companies make money. If SMT was as risky and unsafe as implied the insurance rates would be significantly higher. CorticoSpinal22:56, 11 April 2008 (UTC)

The underreporting of practically 100% is well-proven:

"'"http://www.cmaj.ca/cgi/content/full/166/1/40 Spinal manipulation: Its safety is uncertain""'

"One gets the impression that the risks of spinal manipulation are being played down, particularly by chiropractors. Perhaps the best indication that this is true are estimates of incidence rates based on assumptions, which are unproven at best and unrealistic at worse. One such assumption, for instance, is that 10% of actual complications will be reported. Our recent survey, however, demonstrated an under-reporting rate of 100%. This extreme level of underreporting obviously renders estimates nonsensical." - Edzard Ernst

-- Fyslee / 04:46, 12 April 2008 (UTC)

ChiropracticHistory is perhaps one of the finest written sections in this article. My only suggestion would be to move the Manga and Workmen's Comp sections out of here and back into the scientific investigation section as that is where they are most appropriate.

Some of the writing in ChiropracticHistory is good, but some of it is blatantly POV, and the POV stuff must be fixed. The Manga and Workmen's Comp sections are partisan and are much lower quality (and dated) than what is in Effectiveness 1; they can be briefly summarized in "History" to shorten it. Eubulides18:40, 11 April 2008 (UTC)

Out of curiosity, you suggest that workmans comp and Manga are partisan, yet I see these as being independent authors/agencies who made their own conclusions. Perhaps http://www.wsib.on.ca/wsib/wsibsite.nsf/LookupFiles/DownloadableFileALBIEvaluationReport/$File/ALBIReport.pdf this 2004 workmans comp study is partisan as well? These are independent agencies who are making independent conclusions. Conclusion? Chiropractic care is effective at getting people out of pain and back to work. I suggest that the link be included and added to the old Workmans comp or replace it since it's 2004. CorticoSpinal21:43, 11 April 2008 (UTC)

Can you elaborate on "blatant POV" or perhaps for brevity just give an example or two? I can't see how Manga and Workmen's Comp are partisan. Just because they are positive? These are studies done by gov't agencies and by scientific researchers. -- Levine211220:23, 11 April 2008 (UTC)

Sure: Manga and Workmen's Comp are old results favorable to chiropractic. There are old results not favorable to chiropractic, but Chiropractic does not mention them. Presenting just one side, and ignoring the other, is blatant POV. Effectiveness 1, which is intended to be an up-to-date summary of effectiveness issues in chiropractic, also attempts to avoid this sort of blatant POV. Eubulides21:37, 11 April 2008 (UTC)

I would like to see some diffs or evidence of this; and I also suggest we use Australian, New Zealand, Canadian, American and European clinical practice guidelines which recommend manipulation as a safe and effective form of treatment for mechanical disorders. CorticoSpinal21:50, 11 April 2008 (UTC)

Not sure what is meant by "diffs" but there are many old studies saying there's no convincing evidence that chiropractic is effective. Assendelft "et al." 1996 (PMID|8902660) and Assendelft "et al." 1993 (PMID|8492059) are two examples. Both of these are more-reliable than the Manga report and the workmen's comp studies, but their results are not presented in Chiropractic. This is all water under the bridge now: we have far-better studies available. But the continuing emphasis on the Manga and workmen's compensation studies, which are obsolete and no longer used by serious researchers, and the exclusion of any serious countepoint, is a serious case of POV in the current article. Eubulides22:38, 11 April 2008 (UTC)

I'm sorry those references are obsolescent. CorticoSpinal23:16, 11 April 2008 (UTC)

Of course they're obsolescent! They are in support of the earlier claim "There are old results not favorable to chiropractic, but Chiropractic does not mention them." The point is that the current writeup in Chiropractic about effectiveness is massively biased even if one restricts one's attention to obsolescent sources. Eubulides08:00, 14 April 2008 (UTC)

What bias in particular are you referring to, specifically? I have not yet seen any specific points being raised. CorticoSpinal19:36, 15 April 2008 (UTC)

I plan to prepare a new version of POV issues as of 2008-03-12 to clarify this point. Eubulides19:08, 18 April 2008 (UTC)

I too would like to see that the Education section includes a passage that reflects the various degrees obtained from various countries, not only the DC (DCM) from North America. And that a Scope of Practice is added to include common areas of clinical practice and controlled acts permitted to DCs (diagnosis, imaging/lab rights, assessment techniques, etc.

-- Levine211218:13, 11 April 2008 (UTC)

Agreed, we need to represent a more global POV in this article and the fact that chiropractors have a different educational system in Europe and Australasia should be reflected. We can use http://www.kiropraktiikka.org/media/Final_Chiro-guidelines_03-11-2005.pdf this source which deftly and accurately reflects the various degrees and educational processes. Maybe this time we can put quotation marks? CorticoSpinal21:43, 11 April 2008 (UTC)

Sure. Quotation marks or more preferably faithful summary. -- Levine211221:51, 11 April 2008 (UTC)

The article should not degenerate into a list of quotations. A faithful summary is to be preferred. Preferably something shorter than the original. Eubulides22:24, 11 April 2008 (UTC)

I object to this mischaracterization that suggests by including a vital piece of educational curriculum material would degenerate the article into a "list of quotations". This is not the truth. Also, if we as editors cannot write the passage better than the original source than it should be quoted. Besides, this is NPOV, we're simply listing the various academic degrees obtained by chiropractors outside North America. CorticoSpinal23:16, 11 April 2008 (UTC)

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Disruptive editing by OrangeMarlin on April 17/08

I'm very upset at the tactics used by OrangeMarlin who has not once participated in any meaningful discussion at this article and begins to blindly reverts. Since I'm voluntarily restricting myself to 3R I won't revert; but I will be taking this to ANI as it seems this editor has a history of making questionable reverts to the article without any discussion whatsoever. This user has no context to the situation here and has many, many times has either flat out said or insinuated supporters of CAM therapies as "anti-science". This type of behaviour is absolutely against good wikipedia etiquette and OM can't play the newbie card; he's been here for years now and knows better. CorticoSpinal19:48, 17 April 2008 (UTC)

You may also want to note in any report that you may file that OM is using Twinkle to make such reversion, even though they don't constitute as reversions to vandalism. Be that as it may, I think we should hold off a day or two to gather some comments on the Scope of Practice section before re-inserting. -- Levine211219:53, 17 April 2008 (UTC)

If the edits aren't perfectly clear in the article, why would I come here to read thousands upon thousands of lines of commentary that constitutes, if I may sum it up, "yes", "no", "maybe", "you're wrong", "I'm right", yada yada yada. Take it to AN/I. You'll get nowhere, I assure you. Your edits are unsupported by the wealth of science. And my analysis stays in the edit summary. When and if someone here cares to bullet point your reasons for your edits, without long tendentious commentary, that would be helpful to me. But I am not reading this excessively boring and repetitive discussion section. And yes, CAM supporters are anti-science, hence the use of the term "pseudoscience" to cover such therapies. To Levine, Twinkle use does not, de facto, imply vandalism, unless the "rollback vandalism" button is used. I never once called yours or CorticoSpinal's edits as vandalism, nor do I think they're vandalism. So ping me if there's a 5 or less bullet point comment that supports your edits. 20:25, 17 April 2008 (UTC)

You have absolutely no idea what you're talking about, OM. Your edit was not in the least justified, nor constructive, nor was your comment here helpful or clarified your position. You have no expertise in physical medicine, so I suggest you let the professionals deal with this. Actually, I'm a bit surprised that a physician, such as yourself, a purported "evidence-based" practitioner does follow the evidence or science. My edits are supported by the wealth of science? Did you even read the scope of practice, section, OrangeMarlin? What claim was not made by a fully referenced citation? This is more smoke and mirrors, courtesy of a fish out of water. Take two valium and call me in the morning. CorticoSpinal21:18, 17 April 2008 (UTC)

"Your edits are unsupported by the wealth of science." - How can a section on scope of practice be supported or unsupported by science? DigitalC01:19, 18 April 2008 (UTC)

You have a conflict of interest in this subject Cortico, so I would advice against making sniping comments. Now, you are making a major change to a controversial article, so it should not be surprising that you were reverted initially. If you would be so good as to discuss each of your proposed sections individually, and talk out the issues that science based editors have with them then there is a good chance we can make headway. Jefffire21:31, 17 April 2008 (UTC)

I have already acknowledged any conflict of interest, but so do medical doctors who edit allopathic medicine and doctor of medicine such as User:Antelan and User:OrangeMarlin, for example. So I'm not quite sure why a DC couldn't provide expertise on Scope of Practice of Chiropractic Medicine that is fully referenced. Also, I would note that I had indeed discussed the proposed section for quite awhile and let it sit there for days for comments. I inserted it because the references are sound and supports the claims made. I don't need to wait for Eubulides to give his OK; especially given the fact the content is not disputed. He could have fact checked for himself first but instead triggered another edit war for really no justified reason. I also warned Eubulides that I did not appreciate his misleading statements that "citations were changed" and "nontrivial stuff was added" when there was clearly none. To me, it's just another example of more allopathic disruption and a lack of insight into my profession. Nonetheless, I'll heed Levine2112's advice and will voluntary not revert; but User:Eubulides and User:OrangeMarlin both medical doctors I will point out, case is pretty thin at best. CorticoSpinal21:51, 17 April 2008 (UTC)

The citations that went in did not work and therefore did not constitute reliable sources that could be fact checked. Nontrivial additions were made just before the section went in (see http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=206353719oldid=206348344), without enough time to review, even if the citations had been working. Eubulides22:42, 17 April 2008 (UTC)

Rubbish. Curiously enough, you're the only editor for whom the citations did not work. Hmmmmm. That's rather odd. Furthermore, I made NO nontrivial additions, you are mischacterizating my edit again. That's 13, now. Regardless, I see a definite pattern now; you're making my case regarding your edits here at chiropractic much easier to bring forward, so I do appreciate that. I will ask you one final time and I will be perfectly clear: please do not embellish, mischaracterize or make misleading statements either here or on your edit summaries. Any more misleading statements or mischaracterization of my, or other editors quote will be taken to ANI. I have asked you no less than a dozen time and you have yet to acknowledge my requests. It's quite impolite not to do so, especially after being asked repeatedly to stop or clarify yourself. CorticoSpinal22:56, 17 April 2008 (UTC)

I posted this in comments above, but the citations work fine. OrangeMarlin, please stop using the anti-science personal attacks, and AGF. I am really suprised to see an edit war over this section, as it doesn't seem to be controversial to me. DigitalC01:09, 18 April 2008 (UTC)

Might I suggest discussing the references and why you consider them reliable as a better approach than throwing a hissy fit? Jefffire07:24, 18 April 2008 (UTC)

Jefffire, please no personal attacks. Next,it seems to only be controversial to Eubulides who reverted the insertion of scope of practice citing he had no "time" to look at it, meanwhile a quick look at his contributions shows he's actively editing elsewhere on wikipedia. This is just more of the same obstructionist type of tactics that are used by allopaths to dispute, challenge and make everything here controversial. He even argued that DCs aren't PCPs and the first sentence was NPOV. Surprising it took 7 days for him to raise that point despite comments were available for posting for a week. Grasping at straws it seems now. CorticoSpinal23:50, 18 April 2008 (UTC)

I agree with Jefffire: it would be better to focus our attention on the material, such as the POV problem in the first sentence. This is discussed further in Scope of practice comments on primary care above. Eubulides07:44, 19 April 2008 (UTC)

OrangeMarlin, perhaps you might care to explain exactly what was POV about which elements of the content you removed (reverted)? That might help people understand what the problem is. Sambc SamBC 01:22, 19 April 2008 (UTC)

I can't speak for OrangeMarlin, but certainly there was a POV issue with the first sentence of that content: it presented only one side of the primary-care versus specialist dispute (see Scope of practice comments on primary care for details). Eubulides07:44, 19 April 2008 (UTC)

Archival, indexing, general cleanup of talk page

As a new uninvolved editor the the size, pace, and organization of this talk page make it very difficult to get up to speed here. Some of the current arguments for not reading these talk pages tend towards Wikipedia:Too long; didn't read, and I tend to agree, especially after waiting for a two month old, 600kb talkpage to load.Would anyone object to:

Moving Talk:Chiropractic medicine/Archive 1 → Talk:Chiropractic/Archive 1

Changing the archive box to use the automatic parameter to track archives

Setting up archive indexing using the User:HBC Archive Indexerbot

Splitting the references out onto their own talk sub-page (Talk:Chiropractic/References) with an alpha sorted list of references.

Reference all sources discussed on this talk page using (Author, Date) style citation. For example the first current reference (McCrory, DC et al., 2001).

Setting up autoarchival of the talk page using MiszaBot/Archive_HowTo MiszaBot with a setting of 30 days old.

I know this will switch from one complex talk page setup to another, but the current setup doesn't appear to be working. For an example of a basic setup of autoarchival and indexing see my talk page. -Optigan1303:08, 19 April 2008 (UTC)

Chiropractic uses reference styles like this: cite journal|…. It would be inconvenient to use one reference style for the article and a different style for the talk page, since we often use the talk page to prototype text for the article. That's why we have references at the end of the talk page: it's so that the references are readable and visible and easily clickable to, on the talk page. I don't see how that would work with a separate talk sub-page: perhaps you could explain? I don't have any objection to the other four proposals (not that I understand the details). I expect that we can try them and back out to the current way of doing things if we run into trouble with them. Eubulides05:21, 19 April 2008 (UTC)

I was thinking of a switch of the citation style on the article from the ref tags and specific cite templates(Cite journal, etc.) to tl|Harv and tl|Citation. This matches a lot of the discussion on this page already, for example when you mentioned earlier Harv|Meeker|Haldeman|2002. You could write the drafts on this page using the harvard template, add a citation on the sub-page if it doesn't exist already, and when adding to the article add the citation to the article's references list. I was thinking of the sub-page as a literature being discussed, and not necessarily having valid links from this talk page, but maybe transcluding on the page with a collapsed box. In the meantime maybe start using the general citation template instead of the specific ones, but keep using ref tags, and maybe switch later. I recently setup Paradise Lost using harv/citation templates, also CITET has a useful table for examples. In the meantime, I've set up everything except the sub-page, so remove the configuration messages up top if something misfires. -Optigan1306:07, 20 April 2008 (UTC)

The usual style in medical articles on Wikipedia is to use cite journal|… and I'd be a bit loath to change that here. Harvard style tends to work better for literary articles like Paradise Lost where one often has many different citations to the same poem (the citations differ only as to line number), or many different citations to the same book (the citations differ only as to page). Harvard style doesn't work as well for medical articles where one has a jillion citations, each to a separate medical article, and where the text would get really cluttered with Harvard-style citations. (See Autism for an example of this.) Chiropractic's use of citations is much closer to that of medical articles than it is to literary ones. I realize many medical journals do use Harvard style, but most don't, and there's a good reason they don't.

Much of the discussion in this section uses Harvard-style when talking "about" the citation, but it uses medical style when "using" the citation. It's OK to use one notation for the text and the other for the metatext. Perhaps I'm missing something, but I don't see a great need to use templates to formalize the metatext on the talk page. Eubulides06:37, 20 April 2008 (UTC)

Leaving the references the current style is fine. I was just throwing that out there, and then trying to explain my logic. Unfortunately the need to be reference dense, writing for a general audience, and the setup of this talk page make for a somewhat odd setup. After having stepped back and watched this page for a couple days, the talk page is somewhat unapproachable for the same reasons many of the big ones are, which are the speed, size, and controversial nature of the discussion. I'll just wait and see if the autoarchival and indexing help things. -Optigan1309:22, 20 April 2008 (UTC)

Straight v. mixer

State laws to regulate and protect chiropractic practice were eventually introduced in all fifty states in the US, but it was a hard-fought struggle. Medical Examining Boards worked to keep all healthcare practices under their legal control, but an internal struggle among DCs on how to structure the laws significantly complicated the process. Initially, the UCA, led by BJ Palmer and armed with his philosophy, opposed state licensure altogether. Palmer feared that such regulation would lead to allopathic control of the profession.Phillips R (1998), http://www.chiroweb.com/archives/16/07/23.html "Education and the Chiropractic Profession", Dynamic Chiropractic The UCA eventually caved in, but BJ remained strong in the opinion that examining boards should be composed exclusively of chiropractors (not those who mixed chiropractic with other remedies). Mixers campaigned to alter education standards toward those of medical schools and consistent with the tenets of the medical profession while Palmer resisted any alteration in standards away from his conceptualization of the chiropractic profession.

Comments for Straight v. mixer

Here is some old info. Is this too old for the history section? QuackGuru04:16, 25 April 2008 (UTC)

This is the kind of quality that is fitting of encyclopaedic content. Annals of Int Med has a few reliable and verifiable statements about the straight vs. mixer debate. Interestingly enough, I've been reading some of the research activities of the straight wing. The most notable thing is that they're not even really straight anymore because most of them do counseling, exercise prescription and ergo/postural correction as well. The sophistication of the research designs using a qualitative, whole system research yields compelling preliminary evidence in a few notable non-nms conditions, including recently a study on chiropractic care and addiction which showed demonstrable increases in quality of life and function as well as a pretty plausible theoretical model. In short, there is beginning to be the buds of decent subluxation-based (i.e. mechanical joint dysfunction as described by Gatterman) research which comes from better clinical questions from DCs and DC/PhDs. I'm going to check out some of the non-chiropractic peer-reviewed journals that apparently published subluxation-based chiropractic care interventions. The abstract was good but I'll try reading the article and see if it's worthy of consideration for inclusion. With big claims requires big evidence. We shall see. CorticoSpinal05:05, 25 April 2008 (UTC)

If we want to cover history encyclopaedically we need to bring more Keating (PhD) and Coulter (PhD) are considered chiropractic history and sociology experts, respectively. This is going to be a damn fine article when we get done with it. Featured article material, fo shizzle!

The "straight v. mixer" proposal needs a lot of work. First of all, it needs a lot more refs to verifiy the facts. Or maybe we can IAR. QuackGuru17:15, 25 April 2008 (UTC)

If you keep up the same good work as demonstrated above, I see no problem with you running with the ball. Important stuff does need to be noted 1) straights are the minority 2)straights are evolving to include more than just adjustment for vert sub correction (use their terms) 3) mixers are the majority 4)mixers and the EBM movement. Those are 4 key things which jumped out right off the bat. The Annals of Int Med piece (i forget the author) has some good points which I can personally attest to being truthful and correct (even though wikipedia isn't about truth it's always easier if it takes that into strong consideration). So, if it's OK, and you have the time, tighten up straight vs. mixer, but please be fair, use references from both sides of the fence (MD, DC) and make the tone right. Give it a shot and hopefully you can continue to surprise like above. CorticoSpinal17:22, 25 April 2008 (UTC)

Proposed section rewrites

Scope of practice

Although chiropractors have many attributes of primary care providers, they also have more of the attributes of a medical specialty like dentistry. Chiropractors are considered primary contact providers who emphasize the conservative management of the neuromusculoskeletal systems without the use of medicines or surgery. The practice of chiropractic medicine involves the restricted acts of diagnosis and spinal manipulationnote-type-WikipediaModel_fact_noteand involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests, as well as other specialized tests as required.cite 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 A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. Common patient management involves:

spinal manipulation and other manual therapies to the joints and soft tissues

rehabilitative exercises

health promotion

electrical modalities

conservative and complementary procedures.

health and lifestyle counseling

cite book|last=Haldeman |first=Scott|coauthors=Chapman-Smith, David, Petersen, Donald, Jr.|title=Guidelines for Chiropractic Quality and Practice Parameters|publisher=Jones and Bartlett|location=Sudbury, MA|pages=111-113|isbn=0-7437-2921-3|url=http://books.google.ca/books?id=MHqo1ngXtkoCpg=PA111lpg=PA111dq=source=webots=lPUzIAEwfMsig=2JZUNBxP4KNjwSuz_EvqIP5gzoYhl=enPPA111,M1|accessdate=2008-04-16|language=English

Chiropractors generally cannot write medical (pharmaceutical) prescriptions; however there has been a shift within the profession with a slight majority of North American DCs favouring an expansion of scope of practice to include limited prescription rights.cite book |author= McDonald WP, Durkin KF, Pfefer M "et al." |date=2003 |title= How Chiropractors Think and Practice: The Survey of North American Chiropractors |location= Ada, OH |publisher= Institute for Social Research, Ohio Northern University |isbn=0972805559cite journal |journal= Semin Integr Med |date=2004 |volume=2 |issue=3 |pages=92–8 |title= How chiropractors think and practice: the survey of North American chiropractors |author= McDonald WP, Durkin KF, Pfefer M |doi=10.1016/j.sigm.2004.07.002 |laydate=2003-06-02 |laysummary=http://www.chiroweb.com/archives/21/12/19.html |laysource= Dynamic Chiropractic A notable exception is the state of Oregon which is considered to have an "expansive" scope of practice of chiropractic, which allows chiropractors with additional qualifications to prescribe over-the-counter drugs. With additional training and certification licensed chiropractors (DCs) and veterinarians (DVMs) can expand their scope of practice and practice veterinary/animal chiropractic which includes assessment, diagnosis and treatment of biomechanical disorders of animals that may be amenable to manual therapy. cite web|url=http://www.veterinarychiropractic.ca/|title=Canadian Animal Chiropractic Certification Program|language=English|accessdate=2008-04-17cite web|url=http://www.animalchiropractic.org/animal_chiropractic_certification.htm|title=Animal Veterinary Chiropractic Association|language=English|accessdate=2008-04-17 Chiropractors are also generally permitted to use adjunctive therapeutic modalities such as acupuncture and manipulation under anesthesia with additional training from accredited universities/colleges.

Currently, chiropractic is a regulated health care profession with licensure requirements in over 50 countries globally although chiropractic medicine is most established in North America, Australia as well as a few European countries. cite web |url=http://www.chiropracticdiplomatic.com/strategies/global_strategy.pdf |title=Chiropractic Global Professional Strategy|author=Tetrault, Michael |publisher=Chiropractic Diplomatic Corps |accessdate=2008-04-18 Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic. cite book|last=Pybus|first=Beverly, E.|coauthors=Cairns, Carol, S.|others=C|title=A Guide to AHP Credentialing |publisher=hcPro |pages=241-243 |isbn=1-57839-478-3 |accessdate=2008-04-16cite web|url=http://www.chiroweb.com/archives/ahcpr/chapter3.htm|title=CHIROPRACTIC TRAINING|coauthors=Ian D. Coulter, PhD Alan H. Adams, DC; Ruth Sandefur, DC, PhD|publisher=AHCPR|language=English|accessdate=2008-04-17cite journal|coauthors=Michael A. Mestan DC, John A.M. Taylor DC, G. Lansing Blackshaw PhD, and J. Clay McDonald JD, DC|date=June 2006|title=Establishing an Accredited Master of Science in Diagnostic Imaging Degree at a Chiropractic College |journal=Journal of Manipulative and Physiological Therapeutics|volume=29, |issue=5|pages=410-413 |url=http://www.sciencedirect.com/science?_ob=ArticleURL_udi=B6WK1-4K4DFWG-K_user=10_rdoc=1_fmt=_orig=search_sort=dview=c_acct=C000050221_version=1_urlVersion=0_userid=10md5=2f2a8802530a8e3ae4d8de4a3feaee80|accessdate=2008-04-16

CorticoSpinal

04:55, 13 April 2008 (UTC)

CorticoSpinal 16:47, 13 April 2008 (UTC)

CorticoSpinal

Strikeouts. DigitalC00:55, 15 April 2008 (UTC)

CorticoSpinal

19:20, 18 April 2008 (UTC)

Comments Scope of Practice

Please put any notable stuff that may be missing from scope of practice below.

animal chiropractic (i.e. non human practice) (expanded scope of practice with additional training/certification):* prescription of ergonomic devices (orthotics) and assistive devices, disability evaluations, IMEs, etc..

practice of other regulated therapies (acupuncture (i.e does it require some kind of license to practice or is considered to be within the 'public domain'

clinical specialities (most common only, i.e. sports sciences, rehabilitation sciences, neurology, radiology, etc...):* Practice demographics (solo, vs. multidiscipinary, integrative medicine (i.e. public health/governmental)

Anything else? CorticoSpinal05:41, 13 April 2008 (UTC)

This section is long and boring: it's a huge paragraph with no breaks and I suspect that nobody has read it. Does there really need to be this level of coverage here? It's too long by at least a factor of two, maybe three. Also, there's some duplication with the proposed Education and Licensing section (see below). Eubulides08:15, 14 April 2008 (UTC)

It doesn't seem too long or boring to me. Changes may have been made to increase readability, but I think it reads well and is not too long. Any duplication should be taken care of. DigitalC00:57, 15 April 2008 (UTC)

Several of the citations do not work for me. The Google Books citations don't work. Some of the citations are simply numbers in brackets; they don't work either. Please use proper citation templates ("cite journal", "cite book", etc.) As things stand the citations are too hard to follow. I fixed a couple of them but there are many more that need fixing, and it's hard to review the proposed text properly without seeing the citations. Eubulides08:15, 14 April 2008 (UTC)

The section fully covers the scope of practice of chiropractic and represents the subtle ins and outs of scope of practice globally and within North America. Yes, there needs to be a full and appropriate coverage of chiropractic scope of practice in Chiropractic. This is done fully and completely in other regulated health profession in articles here. Duplication of material can be deleted.

Google Books citations work fine for me; where do I find citation templates? The citations are there; they take you to the relevant citations; are there any specifically that you dispute? If so, why? We can easily change formatting to increase readability and I will break the paragraph into 2. We could always add bullet points to highlight some of the major restricted acts or common treatment modalities in scope of practice as well. Thanks for your comments. CorticoSpinal15:43, 14 April 2008 (UTC)

The Google Book citations don't work for me; I click on them and get a message "page unavailable for viewing". So I don't know what's being cited. You can find citation templates by looking at how books and journals are cited in Effectiveness 1. Eubulides09:12, 15 April 2008 (UTC)

This is reading well. IMHO, this is the kind of professional information perfectly suited for an article about Chiropractic. Nice work! -- Levine211219:36, 14 April 2008 (UTC)

As per Eubulides request, I will attempt to introduce good citation formatting; if it's not up to snuff, I apologize I'm still trying to learn how to use the various tools here at Wikipedia. Nonetheless, if there aren't significant objections, I propose we roll out scope of practice today.

It's not just the formatting (although that clearly needs to be fixed). The bigger problem is that some of the citations don't work at all, and I can't follow them to check them, and therefore cannot do what I feel would be a proper review. Please fix the citations first, so that people can have a day or two to review the whole thing. Eubulides16:46, 16 April 2008 (UTC)

I can assure you that when I checked the citations they were functional and working but I'll make doubly sure they're still there. With all due respect I was pretty thorough in writing the section and made sure the citations met inclusion criteria. After all, I do have expertise in this field and know the salient points probably a bit better than other health professionals. CorticoSpinal18:55, 16 April 2008 (UTC)

Thanks, but even if they work for you, they may not work for other readers. Google Books is notorious for this, since it may give a page to one reader but refuse access to others; please avoid URLs to it. Also, some of the references (e.g., ".30.") cannot possibly work for anybody; these clearly need fixing. Eubulides19:11, 16 April 2008 (UTC)

Citations were done using the cite button (that's pretty handy!) as to conform to proper citation formatting. Section was added today as there appeared to be no significant objections for inclusion. Scope of practice section was moved to conform with other health professional articles and to increase readibility. Education section will be dealt with next; comments for that section are welcome there. CorticoSpinal14:56, 17 April 2008 (UTC)

I asked "Please fix the citations first, so that people can have a day or two to review the whole thing." But that's not what happened. Some citations were changed, and the material was put into Chiropractic in a matter of hours. Worse, nontrivial changes were made the non-citation part of the material just before it was put in, without any review. For now, I am reverting the change, and propagating its fixes into Scope of practice above. Please give us a day or two to review this revised proposal. (I don't have time right now to do a careful review, but I did notice that the Google Books URLs were not fixed, so at least that problem remains.) Eubulides16:42, 17 April 2008 (UTC)

This section has been proposed already for a week, all the citations were there and looking at your contribs list I saw that you had been editing regularly over the past few days with little to no input on scope of practice of chiropractic. It's OK if it's not really a priority to you, but others shouldn't have to wait for one editor to give the final approval. Consensus doesn't work that way. If you have any specific objections than feel free to list them, otherwise I found your revert to be in poor taste. CorticoSpinal17:58, 17 April 2008 (UTC) Actually on further review, I see you have misrepresented your statement once again. Nontrivial changes? Where, what, when? None were made, the citations were not changed this incorrect. Please be more careful in the future. x CorticoSpinal 18:01, 17 April 2008 (UTC)

Significant changes to the text were made a few hours before it went in, with no time for anybody to reasonably comment. The citations that went in could not be followed (at least, not by me: Google Books URLs are not reliable, for reasons I've already stated). About four hours ago most of the citations in the draft were fixed well enough so that they can now be followed so I will take a look at them and then use them to review the proposed text. This will take a bit of time, since it requires reading not only the proposed text, but also the supporting sources. Please give the other editors a day or two to do that. Eubulides22:08, 17 April 2008 (UTC)

One other comment about the citations (and then I really must run): the last two are so badly formatted that I cannot read them. Nothing happens when I click on the last citation, and the 2nd-to-the-last ends up with a weird long section of text that starts "cite web|url=http://www.chiroweb.com/…". Can you please fix this? And please check the other citations too: the Google Books URLs must go, for example. The idea here is to fix the proposal to have proper citations, and then give editors a day or two to review the proposal and check that it is adequately supported. Thanks. Eubulides16:50, 17 April 2008 (UTC)

I have tried my best to format the citations for wikipedia but it's something I'm learning still. Regardless, the content is reliable, verifiable, accurate and notable and all the info is there. CorticoSpinal17:58, 17 April 2008 (UTC)

"Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic.929394" This part seems a bit long and is not focused on Scope of practice. QuackGuru17:37, 17 April 2008 (UTC)

Similar to other professions, chiropractors can specialize in certain disciplines and increase their breadth of scope of practice. Do you feel it would be better elsewhere? CorticoSpinal17:58, 17 April 2008 (UTC)

I have made a concerted effort to repair the ref code. Let me know if I have overlooked anything though. -- Levine211218:08, 17 April 2008 (UTC)

There is a Chiropractice education article. Some of this material could be split up and put there. Currently, it is too long and needs more focus. QuackGuru18:11, 17 April 2008 (UTC)

This doesn't seem to be about Chiropractic Education though, but rather about Scope of Practice. Are there any passages in particular which you think are more appropriate for Education? Can you specify please? Thanks. -- Levine211218:16, 17 April 2008 (UTC)

outdent Exactly. Thanks Levine2112. Eubulides, I strongly object to these stall tactics; the majority of editors here won't wait for your exclusive approval. Judging by your contribs history you seem to be quite active, so if this is not a priority for you then please be so kind as to say so; otherwise we will implement this section tomorrow. One final note: please do not making misleading or false allegations in your edit summaries. To say that I made "non-trivial" changes is completely untrue and easily verifiable by the diffs. I would like to note that the last week or so here I have your contributions and collaborative style to be less than ideal as seen from a tendentious editing in the "appeal to drop effectiveness". There seems to be an issue with respecting the consensus of a majority of editors. So, in summary, I would please ask that you refrain from making misleading statements, mischaracterizing other editors comments. You're approaching a dozen times now. CorticoSpinal19:58, 17 April 2008 (UTC)

It is not "stall tactics" to ask for a day or two to review a new section before it goes in. Without proper citations, it wasn't really reviewiable.

http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=206276213oldid=206171438 The difference between the last stable draft on the talk page and what was installed into the article shows that changes were made other than adding citations or trivial formatting changes. For example, the last stable draft talked about training for acupuncture, but the version that went into Chiropractic had a more-general claim about training for several "adjunctive therapeutic modalities".

Eubulides

22:31, 17 April 2008 (UTC)

Actually, the citations worked fine for everyone else. This section had been here for a week and you had no specific objections until, of course, it was time to put the section in the body. Acupuncture is an example of adjuctive therapeutic modality that requires extra training. So is manipulation under anaesthesia. What's your point? That DCs don't take courses to get certified in adjunctive therapeutics? You're kidding, right? PS: Please check my comment left at Dispuritive edits by OrangeMarlin section, regarding your complete refusal to acknowledge my concerns of your habitual tendency to mischaracterize and mislead. I'm simply giving you the heads up as I'm going to be taking this ANI if it happens again, if this were baseball you would have struck out 4 separate times. You're at 13 now. That's more than enough "notices". CorticoSpinal23:03, 17 April 2008 (UTC)

All the citations worked fine for me. However, I cleaned one up using the Citation templates, and removed the link to Google Books from another, as no preview was available for that book. If anyone wants to follow the source, they'll have to go to the book. DigitalC01:01, 18 April 2008 (UTC)

Thanks for the cleanup. So far, the revised citations are working for me, with only minor formatting issues. I will try to do further cleanup as I review the text more carefully. Eubulides19:08, 18 April 2008 (UTC)

Scope of practice comments

Here are some detailed comments about Scope of practice. These comments are incomplete, as I'm still working on it.

Scope of practice quality of sources

First, the quality of sources could be improved. As per MEDRS it's better to use articles published in refereed journals, preferably secondary sources. Here is a are several higher-quality sources that are the sort of thing that should be used in the section. I hope to add more sources later as I find them.

Meeker Haldeman 2002 ("MH2002" below)cite journal |journal= Ann Intern Med |date=2002 |volume=136 |issue=3 |pages=216–27 |title= Chiropractic: a profession at the crossroads of mainstream and alternative medicine |author= Meeker WC, Haldeman S |pmid=11827498 |url=http://www.annals.org/cgi/reprint/136/3/216.pdf |format=PDF

Cooper McKee 2003 ("CM2003" below)cite journal |journal= Milbank Q |date=2003 |volume=81 |issue=1 |pages=107 –38 |title= Chiropractic in the United States: trends and issues |author= Cooper RA, McKee HJ |doi=10.1111/1468-0009.00040 |pmid=12669653

Eisenberg "et al." 2002 ("E2002" below)cite journal |journal= Ann Intern Med |date=2002 |volume=137 |issue=12 |pages=965–73 |title= Credentialing complementary and alternative medical providers |author= Eisenberg DM, Cohen MH, Hrbek A, Grayzel J, Van Rompay MI, Cooper RA |pmid=12484712 |url=http://www.annals.org/cgi/reprint/137/12/965.pdf |format=PDF

Pollentier Langworthy 2007 ("PL2007" below)cite journal |journal= Clin Chiropr |date=2007 |volume=10 |issue=3 |pages=147–55 |title= The scope of chiropractic practice: a survey of chiropractors in the UK |author= Pollentier A, Langworthy JM |doi=10.1016/j.clch.2007.02.001

Eubulides

19:08, 18 April 2008 (UTC)

It doesn't work that way, Eubulides. We don't get to formulate an "opinion" on scope of practice, because opinion doesn't matter. What we are doing is defining the "'legal"' boundaries of a profession. And, the WHO document, a tertiary source no less, representing the global POV reflects this legal fact. I'm not saying the sources aren't good to discuss the issue elsewhere, say, practice styles and schools of thought, but again, it's the validity of your argument, not the content that is fallacious. DCs are PCPs for NMS (this is specific) and the point is moot. Orthodox medical opinion has no place in the legal arena of scope of practice. It's that simple. CorticoSpinal03:49, 21 April 2008 (UTC)

The sources in question (WHO, etc.) do not define the legal boundaries of chiropractic. They do not set the legal boundaries, they do not cite the legal boundaries, and they are not even particularly trying to summarize the legal boundaries. They are merely introducing the subject of chiropractic in order to get on with their main topics, which are education, safety, and accreditation. If they were really attempting to summarize the legal boundaries (which they are not), they would be talking about the wide diversity of scope of practice among the various jurisdictions. But they aren't doing that. Eubulides08:19, 21 April 2008 (UTC)

The WHO sets up a global POV. The WHO is a tertiary source which amalgamated various sources from peer-reviewed literature. The WHO clearly spells out common scope of practice for DCs based on training. There is more confabulation occuring here; and I'm really getting tired of continuously getting involved in nominal arguments with an editor who has no expertise on the subject. Do you dispute, that legally, yes or no, that DCs are PCPs for NMS? Because we're getting off track here. CorticoSpinal14:45, 21 April 2008 (UTC)

The WHO document is about basic training and safety. It does not mention scope of practice anywhere. In contrast, MH2002 mention scope of practice more than once. MH2002 is on point (and is published in a high quality peer-reviewed journal); the WHO document is not. Chiropractic should prefer higher-quality, relevant sources when they are available, as is the case here. I do not dispute that DCs are PCPs for NMS in some jurisdictions; however, I do dispute that this is the whole story. MH2002 explain why it's not the whole story. Eubulides09:41, 22 April 2008 (UTC)

"It does not mention scope of practice anywhere". Page 19, paragraph 4. Moving on, shall we? There is no scope of practice "story". The "story" is commentary; we don't comment about legal scope of practice boundaries. It's our responsibility to present to readers what practice parameters are in place; i.e. what the health professional can and cannot do. That's it. "'That's also the way the scope of practice section written at every other health profession article"' on Wikipedia. Not disputing the papers (they're good) disputing the validity of your argument (it's not). PS -Don't come back with a comparison to Homeopathy or Flat Earth (which you've already done "'several times "'. That tune is overplayed. CorticoSpinal04:17, 23 April 2008 (UTC)

Page 19, paragraph 4, is a vague, high-level description of chiropractic practice. It says that practice "involves" this and "emphasizes" that. But it doesn't ever say what the boundaries are, which is the essence of what scope is. Tellingly, the paragraph never uses the word "scope". It certainly doesn't talk about any legal aspects. In short, this is a low-quality source for scope of practice. It's far better to use a source whose main topic is scope of practice (the WHO document's main topic is something else). A source like MH2002, for example. Eubulides08:41, 23 April 2008 (UTC)

The sources are fine. This is just another attempt to get more allopathic sources in there to dispute chiropractic scope of practice. You won't find a RCT on this, Eubulides.

CorticoSpinal

13:40, 18 April 2008 (UTC)

I agree with Eubulides, lets use the best sources AVAILABLE. Oh wait, I think we already are. We are talking about scope of practice, which is a legal entity. I have found a peer-reviewed article on scope of practice within the US, however it was old and outdated. DigitalC07:24, 21 April 2008 (UTC)

I think, DigitalC, you are noticing a trend and pattern with Eubulides' editing style here at Chiropractic. IMO, it's gone overboard as of late, with this whole debate re: SOP as a perfect example of a case of civil POV pushing and disruption. There have been many instances of wikilawyering, violations of IDIDNTHEARTHAT, NPOV, POINT, SYN, gaming the system amongst others. My patience is now beginning to wear thin with these needlessly long debates that sap productive editing not only here, but elsewhere on the project. CorticoSpinal16:06, 21 April 2008 (UTC)

I agree that this discussion has been needlessly long, and I think it's probably time we took it to dispute resolution. Eubulides09:41, 22 April 2008 (UTC)

There wouldn't have been a need if you ceded the way to CynRN who has demonstrated an excellent ability to collaborate productively yet firmly represent the orthodox med POV. She would be my nominee to be the lead editor in mediation talks; she is a strong representative of the mainstream POV but is fluid and adapts her arguments based on knowledge, rather than dogma. What do you think Cyndy? :) CorticoSpinal04:17, 23 April 2008 (UTC)

The only higher-quality source proposed so far is Meeker Haldeman 2002 (MH2002). Are you disputing that it is a higher-quality source? If so, please explain the concerns with this source. Eubulides19:08, 18 April 2008 (UTC)

The source is good, it's just in the wrong section. It also editorializes. CorticoSpinal23:07, 18 April 2008 (UTC)

The source is more on point than the sources currently being cited for the first few sentences of this section. The source is a reliable one written by acknowledged experts in the field and published in a high-quality peer-reviewed journal. One could just as easily say that the WHO source "editorializes" as arguing that MH2002 "editorializes". That's what reliable sources are "for": to give us their expert opinions. Eubulides07:44, 19 April 2008 (UTC)

Addition: When discussing scope of practice; we don't need refereed journals per say, nor would they be appropriate. This could introduce heavy bias, for example an allopathic 'opinion' in a "secondary study" from a 'critic' like Ernst. We have already listed 2 excellent books which cover this aspect extremely well and they are thorough.

^ Haldeman, Scott; Chapman-Smith, David, Petersen, Donald, Jr.. Guidelines for Chiropractic Quality and Practice Parameters (in English). Sudbury, MA: Jones and Bartlett, 111-113. ISBN|0-7437-2921-3. Retrieved on 2008-04-16.

Pybus, Beverly, E.; Cairns, Carol, S. A Guide to AHP Credentialing, C, hcPro, 241-243. ISBN|1-57839-478-3.

So, I don't see any justification for concerns regarding the quality of the sources but if other good ones can be found that's obviously OK too. CorticoSpinal13:54, 18 April 2008 (UTC)

So far, I have reviewed only the first part of the proposed section, which does not use the sources you mention. The sources that it does use are lower-quality than MH2002, because they are principally on different topics (education, safety) and only briefly discuss scope of practice by way of introduction. Also, they are not published in peer-reviewed journals. In contrast, MH2002 focuses heavily on scope of practice and it was published in a very high quality peer-reviewed journal. Eubulides19:08, 18 April 2008 (UTC)

This is the legal arena, Eubulides. Secondary sources for scope of practice aren't necessary not are they at all valid. I guess you are disputing now the notability of the World Health Organization. Interesting. CorticoSpinal23:07, 18 April 2008 (UTC)

The WHO and CCE sources are no more apropos for the legal arena than MH2002 is. In none of these sources is the law the primary topic. I am not disputing the notability of the WHO. I am merely saying that for the topic of scope of practice, MH2002 is a more-reliable source than that WHO source is. The WHO source is primarily about education and safety, not about scope of practice. Similarly, the CCE source is primarily about education and accreditation, not about scope of practice. Eubulides07:44, 19 April 2008 (UTC)

Actually they are. They describing the medical-legal realm of scope of practice. You're also confusing reliability with validity again, as I mentioned several times through this needlessly overdrawn debate. Next time, I'd ask that rather than reverting the entirely of scope of practice, like you did http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=206276476oldid=206253718here instead of either a) discussing your concern or b) editing the line you were concerned with would have been far more constructive and productive. I'd like for you to note, so I'm being clear, that I found that move to be a perfect example of a civilly disruptive move, ditto with your professional colleague Orangemarlin's incredibly convenient and timed reverts where he essentially deleted the whole scope of practice section without any comment whatsoever. And as of now, he still hasn't bothered to come here and explain his actions which was already cited as vandalism by admin Swatjester. CorticoSpinal03:59, 21 April 2008 (UTC)

The sources do not discuss the legal scope of practice. I discussed concerns about the lack of proper sourcing well before the changes went in. Once citations were supplied (which happened only after the revert), problems were found with sources not matching the text. It's better to supply a complete proposal for a change, including proper citations, to avoid problems like these. Eubulides08:19, 21 April 2008 (UTC)

You're the only editor concerned with the sources and the claims are well founded and well known. When a neutral, 3rd party observer, like admin Swatjester even calls it NPOV and well sourced, it should become readily apparent that your case is weak and are engaged in civil disruption. CorticoSpinal14:45, 21 April 2008 (UTC)

Swatjester's assessment of the situation predates the criticisms raised here, and did not address them. I disagree that I am the only editor concerned with the sources. Eubulides09:41, 22 April 2008 (UTC)

Where did Swatjester call it "vandalism"? Swatjester got reverted. Keep in mind you have a 1RR parole, which you just violated, so be careful. -- Fyslee / 04:47, 21 April 2008 (UTC)

Thanks for your concern Fyslee. Not only did Swatjester call say it http://en.wikipedia.org/w/index.php?title=User_talk:Vassyanadiff=prevoldid=206522835 once he actually said again http://en.wikipedia.org/w/index.php?title=Wikipedia:Administrators%27_noticeboard/Incidentsdiff=prevoldid=206557895 here and also suggested it was disruptive http://en.wikipedia.org/w/index.php?title=User_talk:Swatjesterdiff=prevoldid=206546492 here and again http://en.wikipedia.org/w/index.php?title=Wikipedia:Administrators%27_noticeboard/Incidentsdiff=prevoldid=206596375 here. Seems like a pretty clear case of vandalism to me. CorticoSpinal05:01, 21 April 2008 (UTC)

Thanks for those diffs. I wasn't aware of those conversations and thought you were referring to edit summaries in this article. -- Fyslee / 05:17, 21 April 2008 (UTC)

No problem. It seems documentation matters here, as much as real life. I'm glad I'm getting the hang of it; the concept of a digital footprint. I might trademark that before DigitalC does. ;) G'night. CorticoSpinal05:32, 21 April 2008 (UTC)

Now, comments on specific sentences in Scope of practice:

Scope of practice comments on primary care

"Chiropractors are considered primary care providers who emphasize the conservative management of the neuromusculoskeletal systems without the use of drugs or surgery."

I would ask that you do not delete striked out material. This issue was not fixed, in fact it completely ignored by previous concern about using a qualifying statement to open scope of practice. I had also removed portal of entry, so I don't know what your objection is. CorticoSpinal23:13, 18 April 2008 (UTC)

Could you please explain the concern about a "qualifying statement"? Is it the form of the first sentence that is the cause of concern? As for "portal of entry", the objection was written before the phrase was removed; now that the phrase is removed that objection is moot and struck out. Eubulides07:44, 19 April 2008 (UTC)

The concern is that rather than stating DCs current scope of practice in the legal arena, we are using the opinion of a paper which there is debate whether or not DCs are moreso PCPs or med specialists. The current text, which says DCs are PCPs primarily for NMS is accurate. They are the first point of contact for a very common medical ailment, i.e. back pain, do not require any referrals and are entitled to communicate a Dx and carry out a Tx plan. That is what PCPs do. So, to open the scope of practice already with a sentence which suggests a debate or controversy, is needless, and under the current context here, needlessly disruptive. This is really splitting hairs here and ultimately dragging this out when we could be more productive and finishing off education, licensing and regulation for example. Let's get those 2 done, then we can focus on Safety, Vaccination and get those sections back on track with the appropriate weight and tone. CorticoSpinal04:31, 21 April 2008 (UTC)

The current proposed text states one viewpoint (DCs are PCPs primarily for NMS). This may be the majority viewpoint within chiropractic, but there is a significant minority viewpoint that says that DCs are PCPs without being restricted to NMS. Furthermore, there is a widespread viewpoint in mainstream medicine that DCs are better thought of as specialists, not PCPs. It does not suffice to merely summarize one of these viewpoints accurately; they must all be summarized, fairly and neutrally. Eubulides08:19, 21 April 2008 (UTC)

It's not that simple. PCP is not entirely synonymous with "portal of entry." DCs are portal of entry practitioners, but are hardly qualified or legally allowed to deal with all healthcare issues, as PCPs do. If they are seen as PCPs in any sense, then it is in a limited sense, like dentists or podiatrists. "Portal of entry" is not a controversial description, while PCP would need some qualifying. This qualifying would be especially embarrassing for the many DCs who actually claim to be unlimited PCPs, encouraging their patients to come to them for all their family's healthcare needs, which is a dangerous situation. This is unfortunately a widespread holdover of the ultra-straight, original philosophy, which a number of DCs still follow and advertise as a part of their "wellness" paradigm propaganda. This is in contrast to some of the more modern, science-based DCs who know how to appropriately limit their practice and cooperate with the rest of the medical system's players. -- Fyslee / 04:58,

21 April 2008 (UTC)

The initial version that got vandalized and reverted included PCP and portal of entry but this was objected by Eubulides. I think that portal of entry should go in that why I wrote it that way intially. PCP but for NMS or general health/lifestyle. Also, straights aren't the majority but they get the majority of the attention here. Time to represent the less contentious mainstream a bit more but obviously retain the notable and at times, questionable, practices of the straight wing. CorticoSpinal05:10, 21 April 2008 (UTC)

I objected to "portal of entry" primarily because the sources did not say "portal of entry". If reliable sources can be used to justify "portal of entry" that would be fine. However, my impression is that the reliable sources generally talk about primary care, not about portal of entry, and that our emphasis should be similar. Eubulides08:19, 21 April 2008 (UTC)

The cited source does not use the phrase "portal-of-entry", which in any event is redundant with "primary care".

Portal of entry is specifically different than exclusively primary care, but if you want to omit portal of entry, I don't think it's that big of a deal but the CCE source I think mentioned it. CorticoSpinal13:40, 18 April 2008 (UTC)

The source calls chiropractors "primary-contact health care practitioners"; "primary care practitioners" is a more-accurate paraphrase of the source than "primary care, "portal-of-entry" providers".

The source says "chiropractic practice emphasizes the conservative management", but the current wording implies that chiropractic practice is limited to conservative management.

Emphasizes is a good word to add. No objections.

The cited source says "medicines", not "drugs".

This is OK too and is probably more professionally sounding. CorticoSpinal13:40, 18 April 2008 (UTC)

I changed it to "medicines"; somebody changed it back to "drugs". Was that intended by you? The above comment suggests no. Eubulides07:44, 19 April 2008 (UTC)

It should read medicines. CorticoSpinal04:07, 21 April 2008 (UTC)

MH2002 says "Chiropractors have many of the attributes of primary care providers and often describe themselves as such. Others point out that chiropractic has more of the attributes of a limited medical profession or specialty, akin to dentistry or podiatry. This is an ongoing internal and external debate affected by dynamic health industry forces." This is a better summary of both sides of a dispute about scope of practice.

We really shouldn't be making editorial contents on what the is going on behind the scenes although I don't object to mention that it is shifting towards a specialty is you want that it in there. CorticoSpinal13:40, 18 April 2008 (UTC)

MH2002 is a reliable source: we are not making editorial comments (I assume that's what you meant) simply by summarizing it and citing it. Eubulides19:08, 18 April 2008 (UTC)

MH2002 is not a valid source for this section and does not conform with global POV and is being used as a red herring tool, i.e to distract that legislatively DCs are PCPs for NMS. CorticoSpinal23:13, 18 April 2008 (UTC)

MH2002 is a better source than the sources currently being used: it is published in a peer-reviewed journal of high quality, and its subject is on point (rather than being education or safety). The current draft, by presenting only one side of this dispute, is POV; this needs to get fixed. Eubulides07:44, 19 April 2008 (UTC)

There is no dispute Eubulides. A scope of practice is pretty straight forward. It's an act of legislation what a health profession can and cannot do as it forms the basis of regulation and licensure. To repeat, MH2002 is a good source, it's more apropos at practice styles/schools of thought and then we could give orthodox med its 2c there. Also, you're forgetting that the WHO is a tertiary document that is far more robust and valid here than MH2002. CorticoSpinal04:07, 21 April 2008 (UTC)

The WHO document is neither far more robust nor more valid than MH2002 on this particular topic. The WHO document is not about scope of practice; MH2002 is. The WHO document is not published in a high-quality peer-reviewed journal; MH2002 is. Eubulides08:19, 21 April 2008 (UTC)

You are questioning the validity and notability of a document that is produced by the leading health organization in the whole world, right Eubulides? A document that itself is well sourced. This is just a clear cut example of using a paper (MH2002) to undermine what common legal fact that DCs are considered PCPs "'for NMS"'. How can you possibly dispute this fact? CorticoSpinal15:03, 21 April 2008 (UTC)

I am not questioning the validity or notability of the WHO document for the subject that it addresses (namely, basic training and safety). I am questioning whether it's appropriate to pick bits and pieces out of that document for a different topic (scope of practice), a topic that the WHO document does not mention. It is far better to use a source that is directly aimed at scope of practice. Eubulides09:41, 22 April 2008 (UTC)

To summarize, let's replace the above quote with:

Although chiropractors have many attributes of primary care providers, they also have more of the attributes of a medical specialty like dentistry. They emphasize conservative management of the neuromusculoskeletal system without medicines or surgery.

This can go in a different section other than scope of practice as should the below reference. Let's work together here. CorticoSpinal04:07, 21 April 2008 (UTC)

If the "scope of practice" section is only going to be about legal issues, then it should use legal citations. My impression from the existing text and sources, though, was that it was not merely or even primarily about legal scope of practice, but about de facto scope of practice. I prefer having the article talk about practical issues rather than legal ones; I think that's more helpful to the average reader. Eubulides08:19, 21 April 2008 (UTC)

It's not a matter of individual preferences, its a matter of accurately reflecting the state of the profession. And, when we are discussing a section, such as Scope of Practice, a legal arena, we musn't use more SYN to mention potential debates in scope of practice. I could easily find a paper by MDs who dispute the expanded scope of practice of Nurse practitioner but I won't because a) a paper should mined and used to advance an agenda that way and b) it is not valid. Hopefully you catch the drift. CorticoSpinal15:03, 21 April 2008 (UTC)

Sorry, I don't catch your drift. Surely you are not saying that Meeker Haldeman are MDs who dispute the expanded scope of practice of chiropractors, or that they wrote a "mined" paper (sorry, I don't know what that is). Eubulides09:41, 22 April 2008 (UTC)

CM2003 say "Although most chiropractors consider themselves to be specialists in NMS conditions, many also view chiropractic as a form of primary care. For some, this means 'primary contact' for NMS conditions, but for most it is seen in its larger context....". This nicely encapsulates the 3-way controversy about chiropractic and primary care; the current draft covers only one of the three points of view. Eubulides08:28, 20 April 2008 (UTC)

Does the source say 'more attributes'? Chiropractors have many attributes of primary care providers but are also being increasingly seen as specialists, like dentistry.

Yes, as mentioned above, the source says "chiropractic has more of the attributes of a limited medical profession or specialty". Since there seems to be no objection to this suggestion, I've put it in. Eubulides19:08, 18 April 2008 (UTC)

Actually I have objected to it, 2x now, but someone keeps on deleting my comments here on talk. That is in very, very poor taste. CorticoSpinal23:13, 18 April 2008 (UTC)

Are the comments deleted now? If not, where are they? Eubulides07:44, 19 April 2008 (UTC)

This change http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=206549648oldid=206548343 struck out the suggestion with the comment "the very first sentence should not be a qualifier. The source would be more apropos in practice styles or potentially education". Is the first part of the comment about English style, or something else? As for the source, it contains a lot of material about scope of practice and is highly relevant here; I don't see why it should be excluded. More important, the change fixes a real POV problem in the first sentence. It is controversial whether chiropractors are primary care (i.e., they are valid substitutes for primary care physicians) or specialists (i.e., they're somebody like a podiatrist that you go for specific problems). Chiropractic should cover this controversy neutrally: it should not just report the primary-care side. For now, I'm restoring that particular change; if there is an English-language issue let's fix it. Eubulides20:11, 18 April 2008 (UTC)

outdent, a POV problem in the first sentence? DCs are LEGISLATED as PCPs. You're going to have to argue with your state representative for that one. Furthermore, you have a nasty habit of "restoring" stuff on the spot that you seem to like and drag out and stall stuff which you don't. That's not good editing style. So, to be clear you dispute that DCs are PCP despite the evidence presented to the contrary? CorticoSpinal23:13, 18 April 2008 (UTC)

Yes, there is a POV problem in the first sentence. I am not disputing that some people say that chiropractors are primary care providers, or that chiropractors are legally primary care providers in many jurisdictions. I am disputing that this is the only viewpoint. The article should be encyclopedic and present all significant viewpoints. The other viewpoint, which is that chiropractors have more of the attributes of a medical specialty, should also be presented. Eubulides07:44, 19 April 2008 (UTC)

I have added more sources on this point: PL2007, E2002, CM2003. They are in agreement that the current Scope of practice draft oversimplifies the primary-care versus specialist issue. Eubulides08:28, 20 April 2008 (UTC)

So I'm clear, you are disputing the suggestion that DCs are legally PCPs? Is that the fundamental issue here? CorticoSpinal04:07, 21 April 2008 (UTC)

I am not disputing that chiropractors are legally primary care providers in many jurisdictions. I am disputing that this is the only thing that should be said about scope of practice. The other viewpoints should be given. And the controversy about whether chiropractors are PCPs just for NMS, or for all medical conditions, should also be covered. Eubulides08:19, 21 April 2008 (UTC)

To make it perfectly clear, I don't know of any jurisdiction where DCs are not legislated as PCPs for NMS. The claim is not that they are PCPs for all medical conditions. Yet another mispresentation of the the discussion or my comments specifically. I'd also like to note that I feel that you're being disruptive now trying to make a point. So, you don't dispute that DCs are legally PCPs for NMS. So why are we having this conversation again? CorticoSpinal15:03, 21 April 2008 (UTC)

DCs are not legislated as PCPs in New York; see http://www.ins.state.ny.us/ogco2005/rg050718.htm (dated 2005). I'm sure there are other examples. The point is that the rules vary quite a bit from one jurisdiction to another, and the assertion "DCs are legally PCPs for NMS" is not correct in general. Eubulides09:41, 22 April 2008 (UTC)

"I am not disputing that chiropractors are legally primary care providers in many jurisdictions. I am disputing that this is the only thing that should be said about scope of practice. The other viewpoints should be given." - We should not be adding controversy here. Lets stay to the FACTS, shall we? Not what some people think about the facts? DigitalC00:08, 22 April 2008 (UTC)

The other viewpoints are just as much "facts" as the viewpoint that chiropractors are just primary care practitioners for the the neuromusculoskeletal system. Eubulides09:41, 22 April 2008 (UTC)

The first sentence should say "primary "contact"". The way it is written sounds like DCs all offer primary care, only with an emphasis on MSK. The differences pointed out by Fyslee between DCs in how they practice, i.e. 'self-limited to MSK' vs offering to treat nearly everything (some straights) are important. WHO says 'primary contact'. 'Primary care' sounds like my family doctor, to whom I bring toenail fungus, rectal bleeding, abd pain and the like.CynRNCynRN18:11, 23 April 2008 (UTC)

Primary care and specialty

http://en.wikipedia.org/w/index.php?title=Chiropracticaction=history This change moved the text "chiropractic has more of the attributes of a medical specialty like dentistry" from ChiropracticScope of practice to the paragraph on the British Medical Association, with the comment "restore cited previously cited version, place opinion in medical opposition". There are several problems with this change:

The change log is confusing, as it describes a change that does not restore any citations; the change moves text (plus a citation) from one section to another.

The text in question has nothing to do with the British Medical Association, and does not belong where it was moved to.

This is not an example of opposition from traditional medicine, and the text does not belong in the medical-opposition section. The text in question is supported by a citation by Meeker Haldeman, two DCs who are widely respected and highly supportive of chiropractic.

The revised text contains the new claim "There is some debate in the medical community regarding the status of chiropractors as primary care providers." but the cited source says the debate is both internal and external to chiropractic. Again, this is not a medical-opposition issue.

The text in question is supported by a highly reliable source on scope of practice, appearing in a high-quality refereed journal; it should not be diminished or deprecated by moving it to a "controversy" section.

Without the text in question, ChiropracticScope of practice is heavily biased in favor of the point of view of chiropractic as primary care, and against the point of view of chiropractic as specialty. The section should be written with a neutral point of view.

The change clearly has many problems. For now, I attempted to work around the problem by http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=210534530oldid=210530877 moving the text back. Let's discuss how to improve matters further here. Eubulides09:58, 6 May 2008 (UTC)

You are ignoring the compromise that was proposed by CynRN which changed primary care to primary contact. The difference is subtle, but important. There is no diminishing as implied, to the contrary, it meets inclusion criteria however, it was agreed by the majority of editors that scope of practice would reflect the legal status and not opinions on the legal status. If you would like to put it in a proposed conflicts and criticisms section, that would be apropos as well. We've gone circles around this and quite simply a majority of regular editors (not the occasional meat puppet gallery who seem to randomly chirp in) disagree with your stance. I also find it lamentable that you disagree with CynRN who suggested primary contact as a neutral way of resolving your concerns. Please avoid conflating primary care and primary contact. You have moved text back that was not agreed on by anyone but yourself. Don't forget, Admin Swatjester, a neutral 3rd party had already deemed the section NPOV as well. You need to stop turning everything into a controversy. CorticoSpinal14:35, 6 May 2008 (UTC)

It's fine to say "primary contact", but merely saying "primary contact" does not resolve the concerns. There is a genuine dispute both within and without chiropractic as to whether (1) chiropractors should be the first point of contact, and (2) whether they should (one extreme) specialize in neck and back pain, or (the other extreme) treat a wide variety of other conditions such as baby colic and menstrual cramps, or perhaps take some position between the extremes (specialize in neuromusculoskeletal disorders, say). The text should not present just POV of this dispute, as if almost everybody agreed that chiropractors should be primary contact and should focus or specialize in neuromusculoskeletal disorders. The text should present all sides of this dispute fairly.

It is not the case that the majority of editors agree that Meeker Haldeman is not a suitable source here, or that the issues are so cut-and-dried. On the contrary, the sentiment seems to be more the other way: there is genuine disagreement in the real world about scope of practice, and this issue should be mentioned.

Please see 2008-05-06 changes below for more.

Eubulides

09:25, 7 May 2008 (UTC)

Scope of practice comments on therapy and diagnosis

"The practice of chiropractic medicine involves the restricted acts of diagnosis and spinal manipulation and involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests, as well as other specialized tests as required."

The cited source does not use the phrase "chiropractic medicine".

This is commonly used. CorticoSpinal13:40, 18 April 2008 (UTC)

The phrase may be commonly used, but it is also somewhat controversial, and the cited source doesn't use it. Let's stick with what the source says. Eubulides19:08, 18 April 2008 (UTC)

The source does not say that diagnosis is a "restricted act". Nor does it say that spinal manipulation is a "restricted act".

Are you disputing that diagnosis and the application of SMT are not regulated, restricted acts? CorticoSpinal13:40, 18 April 2008 (UTC)

Yes. Diagnosis in general is not a restricted act. And SMT's restrictions vary from one jurisdiction to another: in many countries it is not regulated at all. Regardless of the truth of the claim, though, it must be sourced; currently it's not. Eubulides19:08, 18 April 2008 (UTC)

So you claim that the act of communicating a diagnosis is in the public domain? CorticoSpinal23:18, 18 April 2008 (UTC)

No, I did not claim that; and anyway it's not important what I claim. What is important is that the material must be sourced. Eubulides07:44, 19 April 2008 (UTC)

The source says "Spinal manipulative therapy is the primary therapeutic procedure used by chiropractors"; this point is important and should be mentioned. (To underscore this point, Meeker Haldeman 2002 have an entire subsection "Spinal manipulation: the chiropractic adjustment" in their practice-characteristics section.) The source also mentions "other manual therapies, rehabilitative exercises, supportive and adjunctive measures, patient education and counselling." That complete list is a bit long but some therapies other than spinal manipulation should be mentioned.

The source does not mention nutritional counselling, just "counselling".

This in the sources listed; it's there. CorticoSpinal13:40, 18 April 2008 (UTC)

It may be somewhere in some listed somewhere in the section, but it is not in the cited source. Claims must be supported directly by cited sources. Eubulides19:08, 18 April 2008 (UTC)

Good grief Eubulides, its already mentioned elsewhere in the article several times and you know it's there. Why not collaborate and add it rather than drawing this out and making needless drama out of it? CorticoSpinal23:18, 18 April 2008 (UTC)

The point is now moot, since nutritional counseling was removed from the claim.

The current wording characterizes nutritional counseling as a diagnostic method, which is surely not intended.

Agreed, it's a management. CorticoSpinal13:40, 18 April 2008 (UTC)

The source does not mention "specialized tests as required".

This is in the CCE standards. CorticoSpinal13:40, 18 April 2008 (UTC)

That is not the cited source. Eubulides19:08, 18 April 2008 (UTC)

Yes, take a look. CorticoSpinal23:18, 18 April 2008 (UTC)

The CCE standards were added as a source, after the above comment was made. That fixed the problem; thanks. Eubulides07:44, 19 April 2008 (UTC)

To summarize, let's replace the above quote with:

Chiropractic diagnosis methods include skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests, and other specialized tests.

Nah, this is a very watered down version of the above. The current draft is better. CorticoSpinal13:40, 18 April 2008 (UTC)

The only parts that are "watered down" are the parts that were unsourced. Without proper sourcing, they can't go in. For now, I've added a "Failed verification" tag to remind us to fix this. Eubulides19:08, 18 April 2008 (UTC)

All the unsourced stuff is common knowledge and don't need citations. Look at Nurse practitioner SOP as an example and come back here and tell us our section is not stronger sourced (by far). CorticoSpinal23:18, 18 April 2008 (UTC)

It may be common knowledge to experts, but it isn't common knowledge to the average Wikipedia reader. Sources need to be added for it, even if every expert would know it. Eubulides07:44, 19 April 2008 (UTC)

Eubulides, when I say it's common knowledge it should automatically be implied that is common knowledge, i.e. most people know it, not amongst experts. Again, as I've mentioned numerous times now, where was all these concerns when the proposed draft sat there for 5 days without you making a comment? DigitalC, myself, Levine2112 and even admin Swatjester already found this section to be NPOV. Even if, for example, you were seriously concerned about a particular claim, then still assume good faith that I have done my homework when I wrote the section. We have similar goals, to make this article is scientifically, yet accurate as possible, but where we disagree, is the fact that you routinely dismiss high quality, peer-reviewed literature by DC/PhDs. And, the fact that you're doing this over the stroke issue to me is the biggest slap in the face of all. The tone of the safety section is hardly NPOV, and you're using orthodox lit to dictate the POV while vehemently lobbying to keep up notable "'experts on manipulation and stroke"' Haldeman and Cassidy out. It's this tendentious behaviour and civil POV push (to disproportionately increase mainstreams weight (which is not measured in words, I might add, but in tone) so that it not only dictates overall tone, but that the word of MD/PhDs gets the final say over DC/PhDs on chiropractic topics and ultimately at Chiropractic. That's not right, nor fair and you won't be able to wikilawyer your way out it. The precedent it sets for established (i.e. they could be considered mainstream and have their own, high quality literature base) CAM professions. Sometimes, we need to invoke IAR and in order to strengthen the project and I'm doing it now. CorticoSpinal04:48, 21 April 2008 (UTC)

I disagree that the unsourced stuff was common knowledge. But if it becomes properly sourced then there isn't a problem.

The scope-of-practice section had some serious POV issues, which were pointed out only after the section was given proper citations that everybody could follow. The editors you mention have not weighed in on these issues.

Let's focus on scope-of-practice here; safety issues are best discussed in a thread devoted to safety.

Eubulides

08:19, 21 April 2008 (UTC)

outdent This is getting ridiculous. So far, I think that you're *the* classic example of a civil POV pusher; and the more this section gets dragged through the mud needlessly the more it becames apparent. I also note that you conveniently ducked my question yet again which is itself disruptive, considering I've ask this in some form, for close to 2 months now, without a response from you. Classic example of IDIDNTHEARTHAT. You've also violated, in some form, most of http://en.wikipedia.org/wiki/Wikipedia:POINTGaming_the_system these points already. I want to give you a clear heads up, that the longer you drag this out and stonewall it in effect; the stronger you make my case. The same editing tactics have been used elsewhere, particularly at Safety and Vaccination and even Philosophy. So, it's been 3 months of this nonsense; you've almost made me quit the project because your continued civil obstruction and trying to disproportionately affect tone (so that it reads negative) and continued insistence to reject perfectly good papers which I am now invoking IAR since your wikilawyering of this issue has already caused enough stress and aggravation that was entirely preventable. CorticoSpinal15:15, 21 April 2008 (UTC)

I am not aware of any "mud" or "negative tone" related to scope of practice. I am trying to get the best sources on scope of practice, and to have the draft section reflect those sources as accurately and neutrally as possible. That is how Wikipedia is supposed to work; it is in no way "gaming the system". If you wish to discuss safety again, please start a new thread on that topic (as the old threads are archived) and I'll be happy to discuss it in that thread. Eubulides09:41, 22 April 2008 (UTC)

I think we might need to talk about this http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=210199046oldid=210197976 edit. QuackGuru03:49, 5 May 2008 (UTC)

That edit, I think, refers to comments below which talked about a later draft. Or at least, it was a draft put later on this page; it appears to be earlier work. It is quite confusing. Anyway, under the assumption it was talking about the later draft, the first and last strikeouts are OK (those problems are fixed) but the middle one (about restricted acts) is not, so I removed that strikeout. Eubulides08:15, 5 May 2008 (UTC)

Scope of practice comments on referral

"When indicated, the doctor of chiropractic consults with, co-manages with, or refers to other health care providers." (http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=206547500oldid=206540441 fixed)

This is a direct quote from the last line of page 15 of the cited source. I'm uncomfortable with taking an entire sentence from the source without using quote marks. Also, MH2002 cover the same point (they say "Essentially, patients may receive a trial of chiropractic care, be referred for co-management, or be referred to an appropriate specialist.") and are a refereed source that is more on-point; let's use them

To summarize, let's replace the above quote with:

A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.

No objections there. CorticoSpinal13:40, 18 April 2008 (UTC)

OK, done. Eubulides19:08, 18 April 2008 (UTC)

That's it for now; more later. Eubulides07:33, 18 April 2008 (UTC)

What does "emphasize conservative management" mean? I think I understand the gist of it, but could a clearer wording be given? Jefffire07:52, 18 April 2008 (UTC)

We could list examples "such as..." conservative pretty much means the opposite of surgery of invasive procedures. CorticoSpinal13:40, 18 April 2008 (UTC)

Anti-surgery? I presume you mean to say the absence. It would be vastly less pretentious to say "non-invasive" rather than conservative. Jefffire14:08, 18 April 2008 (UTC)

Simpler would be to omit "conservative" entirely, since the very next phrase says "without medicines or surgery", which neatly summarizes "conservative" and makes the "conservative"/"non-invasive" bit redundant. Also, "conservative" is already discussed at length under ChiropracticPhilosophy and doesn't need to be repeated here. I've removed "conservative" in the draft above. Eubulides19:08, 18 April 2008 (UTC)

It would simpler to remove it, except it's pretty much the core of clinical practice. Also, conservative also implies the treatments selected and holistic and natural preferences of those methods. To object to using the word conservative in the scope of practice section, is, IMO, preposterous. Also, to clarify for Jefffire who seems to not understand what conservative means, it doesn't mean anti-surgery (?!) it means trying to resolve things without surgery first. CorticoSpinal00:25, 19 April 2008 (UTC)

OK, then let's keep "conservative". Eubulides07:44, 19 April 2008 (UTC)

Scope of practice comments on common patient management

OK, starting up with some more review of quotes from the Scope of practice draft.

"Common patient management involves:

spinal manipulation and/or other manual and/or soft tissue therapies

rehabilitative exercises

health promotion

physiological therapeutic modalities

conservative and complementary procedures.cite book|last=Haldeman |first=Scott|coauthors=Chapman-Smith, David, Petersen, Donald, Jr.|title=Guidelines for Chiropractic Quality and Practice Parameters|publisher=Jones and Bartlett|location=Sudbury, MA|pages=111-113|isbn=0-7437-2921-3|url=http://books.google.ca/books?id=MHqo1ngXtkoCpg=PA111lpg=PA111dq=source=webots=lPUzIAEwfMsig=2JZUNBxP4KNjwSuz_EvqIP5gzoYhl=enPPA111,M1|accessdate=2008-04-16|language=English"

This sentence duplicates material in the 2nd ("spinal manipulation") sentence. We shouldn't have two sentences that talk about spinal manipulation. It's better to have one phrase on diagnostics, and another on therapy, as Scope of practice comments on therapy and diagnosis proposes.

The list of treatments is redundant with the list a

"conservative" is redundant for reasons discussed above.

important hallmark of clinical practice, used in nearly all sources provided CorticoSpinal00:33, 19 April 2008 (UTC)

OK, let's keep "conservative". Eubulides07:44, 19 April 2008 (UTC)

"complementary procedures" nearly content-free; it can go.

we can make a list, it's not content free, to suggest so is allopathic arrogance. CorticoSpinal00:33, 19 April 2008 (UTC)

An example or two would be helpful, yes. Without examples, the non-expert reader won't know what it's talking about. Eubulides07:44, 19 April 2008 (UTC)

"physiological therapeutic modalities" is jargon that the average Wikipedia reader won't follow. It should be replaced by non-jargon.

It seems that any common medical language is deemed "jargon" at Chiropractic, but kosher for other articles about health professions. What's next, calling it "buzzing machines?" CorticoSpinal00:33, 19 April 2008 (UTC)

The Wikipedia audience is the general reader, not medical experts. Few general readers will know what "physiological therapeutic modalities" are. Eubulides07:44, 19 April 2008 (UTC)

The Google Books URL should go: it is not reliable. Google Books puts a quota on each reader and if you go over quota it won't show the citation to you. Quota enforcement is erratic, and works for some users but not others under an algorithm that Google does not publicize but which I suspect depends at least in part on reader location. Also, the URL gives more-detailed information to Google about the editor who originally read the book, and allows Google to determine extra information about people who read Wikipedia; it would be better not to go into those privacy issues.

You've advocated using Google Books in the past, now I find a great source and it suddenly has to go. No thanks, Eubulides. This is sinking to unheard of depths now, citing a red herring privacy concern.

Google Books is a good way to "read" books. It's not a good way to "cite" books. I am not saying the source has to go: the citation can stay, obviously. It's the the URL that should go. Eubulides07:44, 19 April 2008 (UTC)

There is no need for "language=English" in an English-language article. By default, citations are to English-language sources.

The bullet list is undesirable. The list items aren't long enough to deserve bullets. The original draft lacked bullets, and was better that way.

Nah, it's fine there, and it improves readibility which you were concerned about before. So far you claimed to not to have liked it without bullets, then not with bullets and now without bullets again. Look at Nurse practitioner. Bullets galore. We can add a few if there's not enough, I was holding back. CorticoSpinal00:33, 19 April 2008 (UTC)

Perhaps you're confusing me with someone else? I don't recall giving a different opinion about these bullets. Sometimes bullets are good, sometimes not; this is one of the places where they're not needed. Eubulides07:44, 19 April 2008 (UTC)

To summarize, this sentence should be removed; it is no longer needed once the change in Scope of practice comments on therapy and diagnosis is made. Eubulides20:11, 18 April 2008 (UTC)

Anything to water it down, eh, Eubulides? CorticoSpinal00:33, 19 April 2008 (UTC)

Scope of practice comments on medical prescriptions

"Chiropractors generally cannot write medical (pharmaceutical) prescriptions; however there has been a gradual shift within the profession with a slight majority of North American DCs favouring an expansion of scope of practice to include limited prescription rights.cite book |author= McDonald WP, Durkin KF, Pfefer M "et al." |date=2003 |title= How Chiropractors Think and Practice: The Survey of North American Chiropractors |location= Ada, OH |publisher= Institute for Social Research, Ohio Northern University |isbn=0972805559cite journal |journal= Semin Integr Med |date=2004 |volume=2 |issue=3 |pages=92–8 |title= How chiropractors think and practice: the survey of North American chiropractors |author= McDonald WP, Durkin KF, Pfefer M |doi=10.1016/j.sigm.2004.07.002 |laydate=2003-06-02 |laysummary=http://www.chiroweb.com/archives/21/12/19.html |laysource= Dynamic Chiropractic"

The cited source does not support the claim that there has been a "gradual shift" within the profession; that is, the source does not exclude the possibility that there was a sudden shift, or that the popularity of prescription rights goes up and down.

Historically DCs opposed meds. Now a small majority are in favour. What do you call that? Is it not a shift? CorticoSpinal00:39, 19 April 2008 (UTC)

The objection is to ""gradual" shift", not to "shift". The cited source does not say "gradual". Eubulides07:44, 19 April 2008 (UTC)

Since it's just one survey, it'd be better to say that, and give its date.

It was OK in the beginning, as you had no objections (this was in the article for 6 months) and now it's suddenly an issue. Bunk. CorticoSpinal00:39, 19 April 2008 (UTC)

When it was in the article, it said that this was just one survey, and it gave the year. I'm asking that this be retained. Eubulides07:44, 19 April 2008 (UTC)

There's no need for the "(pharmaceutical)". The standard phrase in Wikipedia is Medical prescription and we can use that.

The text should wikilink to Medical prescription.

Good idea. CorticoSpinal00:39, 19 April 2008 (UTC)

The phrase "however there has been a gradual shift" makes little sense here. The gradual shift was from opposition to drugs to a slight majority favoring the right to prescribe drugs. But the current text doesn't mention the opposition to drugs.

Common knowledge, Eubulides. It's stated also in Philosophy and the lead. Why dispute something so obvious?

It is not common knowledge to the average reader. Neither Philosophy nor the lead mention opposition to drugs. Eubulides07:44, 19 April 2008 (UTC)

There is no need to repeat "scope of practice" here; this is the "Scope of practice" section.

The two citations at the end should be combined to one, to avoid the 1011 syndrome. They are essentially the same source anyway.

If they're separate sources, keep them separate. What's essentially mean? Is that your call? CorticoSpinal00:39, 19 April 2008 (UTC)

One is just a brief summary of the other. They are written by the same authors on the same subject. They resemble the Anderson-Peacock sources in Chiropractic, which are also combined into a single reference. Eubulides07:44, 19 April 2008 (UTC)

Typically, "A; however B" is better rewritten "Although A, B" so that the reader has a heads-up that a contrary clause is coming up.

To summarize, let's replace the above sentence with:

Although chiropractors traditionally opposed prescription drugs and generally cannot write medical prescriptions, a 2003 survey of North American chiropractors found that a slight majority favored limited prescription rights.cite book |author= McDonald WP, Durkin KF, Pfefer M "et al." |date=2003 |title= How Chiropractors Think and Practice: The Survey of North American Chiropractors |location= Ada, OH |publisher= Institute for Social Research, Ohio Northern University |isbn=0972805559 Summarized in: cite journal |journal= Semin Integr Med |date=2004 |volume=2 |issue=3 |pages=92–8 |title= How chiropractors think and practice: the survey of North American chiropractors |author= McDonald WP, Durkin KF, Pfefer M |doi=10.1016/j.sigm.2004.07.002 |laydate=2003-06-02 |laysummary=http://www.chiroweb.com/archives/21/12/19.html |laysource= Dynamic Chiropractic

Eubulides

23:46, 18 April 2008 (UTC)

I'll propose an alternate version a bit later, though this one is not too bad; though it needs to be mentioned that there has been a shift in thought. To say there hasn't is inaccurate and the section needs to acknowledge this. CorticoSpinal00:39, 19 April 2008 (UTC)

Scope of practice comments on Oregon

"A notable exception is the state of Oregon which is considered to have an "expansive" scope of practice of chiropractic, which allows chiropractors with additional qualifications to prescribe over-the-counter drugs."

This claim is unsourced, and was marked with a Fact template last month. It's still unsourced now, but somehow the Fact template got removed in the draft. The claim should be either sourced or removed. I suggest removing it. For now, I've restored the Fact template.

Eubulides

23:46, 18 April 2008 (UTC)

I'm surprised there has been a reference for that; that is common knowledge amongst DCs about the Oregon situation. Minor surgery too. Definitely not average scope of practice, and it's notable. I'll track it down, it shouldn't be too hard. CorticoSpinal00:40, 19 April 2008 (UTC)

http://licenseinfo.oregon.gov/index.cfm?fuseaction=license_senglink_item_id=14154 Licenseinfo.orgon.gov states that for surgery/proctology, they must have "36 hours of undergraduate or postgraduate education in minor surgery/proctology", as well as rotation under licensed "physicians (including, but not limited to DCs, MDs, or NDs)". According to this source, http://www.fclb.org/directory/oregon.pdf, Chiropractors in Oregon can NOT write prescrptions for "drugs", where drugs does NOT include over-the-counter non-prescription medicine. That is, they can write prescriptions for over-the-counter non-prescription medicine.DigitalC05:47, 21 April 2008 (UTC)

Scope of practice comments on veterinary chiropractic

"With additional training and certification licensed chiropractors (DCs) and veterinarians (DVMs) can expand their scope of practice and practice veterinary/animal chiropractic which includes assessment, diagnosis and treatment of biomechanical disorders of animals that may be amenable to manual therapy. cite web|url=http://www.veterinarychiropractic.ca/|title=Canadian Animal Chiropractic Certification Program|accessdate=2008-04-17cite web|url=http://www.animalchiropractic.org/animal_chiropractic_certification.htm|title=Animal Veterinary Chiropractic Association|accessdate=2008-04-17"

These citations are weak: the first is the home page for the CACCP, and says almost nothing about scope of practice. The second is about certification, not about scope of practice. For example, neither source says anything about DVMs, or biomechanical disorders of animals, or manual therapy.

I suggest removing this sentence; it's not key to scope of practice. For now, I've added a "Failed verification" template for each source.

Eubulides

23:46, 18 April 2008 (UTC)

Eubulides, it's not up to you to suggest it failed verification. The site clearly proves, beyond a shadow of a doubt the claims made. Again, the obvious: DCs and DVMs can practice veterinary chiropractic (they're trained together), manual therapy is what veterinary chiropractic is mostly about at this point in time, third in order to practice veterinary chiropractic you need additional training and certification for DCs and DVMs. This is directly a scope of practice issue. This type of nit-picking is a complete waste of time and energy. Also, another effort by you to water down the scope of practice. It's time to let the experts on chiropractic (i.e. chiropractors and chiropractic scientists). I cannot believe you honestly don't think that veterinary chiropractic is a) notable and b) a scope of practice issue. To make the point more clear; I'm a DC but cannot practice veterinary chiropractic. It's not within my scope and I don't have my accreditation. CorticoSpinal00:48, 19 April 2008 (UTC)

I read the sources and they do not support the claims. The claims may well be true, but "Failed verification" is appropriate when the sources do not support the claims. I disagree that the claims are obvious to the average Wikipedia reader; so they need to be sourced. I think it's reasonable to discuss veterinary chiropractic briefly; what's not clear is whether it needs to be discussed in this section. Eubulides07:44, 19 April 2008 (UTC)

None of the peer-reviewed sources on chiropractic scope of practice (MH2002, CM2003, E2002) mention veterinary chiropractic. It sounds like veterinary chiropractic is not notable within the scope-of-practice arena. Veterinary chiropractic may be suitable for other sections of Chiropractic, but it doesn't sound suitable for this one. Eubulides08:28, 20 April 2008 (UTC)

It's already been discussed ad nauseum re: the validity of those sources for scope of practice, and again, the legal right to treat animals, which was historically ONLY done by DVMs has now been expanded to include DCs. It's a scope of practice issue plain and simple. Name me another profession besides DCs and DVMs who can treat animals. Not even MDs can do it. CorticoSpinal05:59, 21 April 2008 (UTC)

Yes, it's a scope-of-practice issue; but there are lots of scope-of-practice issues that are more important than this one. Again, none of the peer-reviewed sources mention it, which suggests it's not notable here. Eubulides08:19, 21 April 2008 (UTC)

Again, this section is about Scope of Practice - something that is NOT generally covered by peer reviewed sources. Just because they do not mention it does NOT suggest it isn't notable. DigitalC00:45, 22 April 2008 (UTC)

Scope of practice quality of sources lists four peer-reviewed sources on scope of practice, which should be enough to address this sort of question. And if it's not enough, I'm sure more such sources exist. Eubulides09:41, 22 April 2008 (UTC)

When peer reviewed sources do not generally cover Veterinary chiropractic, it means it is not notable. AFD anyone? QuackGuru01:30, 22 April 2008 (UTC)

Scope of practice comments on sports chiropractic

cite journal |journal=Chiropr Osteopat |date=2007 |volume=19 |issue=15 |pages=14 |title= Australian chiropractic sports medicine: half way there or living on a prayer? |author= Pollard H, Hoskins W, McHardy A, Bonello R, Garbutt P, Swain M, Dragasevic G, Pribicevic M, Vitiello A |pmid=17880724 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmedpubmedid=17880724

Can we include a brief mention about sports chiropractic. QuackGuru19:52, 19 April 2008 (UTC)

MH2002 and E2002 both briefly mention sports chiropractic (just the phrase, nothing more), and we could do likewise, citing them. Eubulides08:28, 20 April 2008 (UTC)

First as above, QuackGuru wants a mention of sports chiropractic in the main article and cites a paper. Today he proposes to delete the article at an AfD. Something smells fishy here... there wouldn't have been any canvassing going on here would there? I mean, surely there's a more rational explanation than that. It's all so very strange, yet oddly familiar... CorticoSpinal05:31, 22 April 2008 (UTC)

Scope of practice comments on acupuncture and MUA

"Chiropractors are also generally permitted to use adjunctive therapeutic modalities such as acupuncture and manipulation under anesthesia with additional training from accredited universities/colleges."

This sentence is not sourced. CM2003 says "... chiropractors have obtained the licensed authority to administer acupuncture in 30 states,..." which suggests the "generally permitted" is a bit much: "permitted in most U.S. states" would be more accurate, at least for acupuncture. Unless the number of states has grown recently? Either way, we need a source.

this is more splitting hairs. There are 50 US states. 30/50 (60%) permit it currently, hence "generally permitted". Also, more States are changing the laws to permit DCs, MDs, DOs to practice acu which will increase the total from 30. No need to mention the US, it the same situation in Canada. The article needs to reflect a global POV, remember? CorticoSpinal15:25, 21 April 2008 (UTC)

I disagree that "generally permitted" means 60%. It would be better to simply say "30 states". If we were to use a global perspective, the vast majority of the world's population lives in countries which don't have such laws at all. Eubulides09:41, 22 April 2008 (UTC)

CM2003 also says "some chiropractors are attempting to elevate SMT to a new level by administering it under short-term general anesthesia, but most are moving in the opposite direction by incorporating other manual techniques in combination with exercise and various physical modalities". It's not clear from this whether MUA is "generally permitted"; we need a better source for that.

MUA is definitely a scope of practice issue and we can find a source, it's easy.

The simplest fix is to remove the sentence. Or it could be sourced and rewritten to match the sources. Eubulides08:28, 20 April 2008 (UTC)

All your proposed "simple fixes" involve removing material that is relevant and notable to chiropractic scope of practice. I've already mentioned to you several times that your attempts to water down scope of practice that it conforms with *your* personal POV, is not what the project is about. Stop inserting your subjective opinions here and accept the fact that scope of practice, as currently written is indeed factual. CorticoSpinal15:25, 21 April 2008 (UTC)

It's fine if the material is properly sourced and rewritten to match the sources, which was the alternate (and more-complicated) suggestion. Eubulides09:41, 22 April 2008 (UTC)

http://www.ncbi.nlm.nih.gov/pubmed/14589481?ordinalpos=11itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumThis might come in handy. CorticoSpinal05:38, 22 April 2008 (UTC)

Scope of practice comments on global scope

"Currently, chiropractic is a regulated health care profession with licensure requirements in over 50 countries globally although chiropractic medicine is most established in North America, Australia as well as a few European countries. cite web |url=http://www.chiropracticdiplomatic.com/strategies/global_strategy.pdf |title=Chiropractic Global Professional Strategy|author=Tetrault, Michael |publisher=Chiropractic Diplomatic Corps |accessdate=2008-04-18"

The cited source never says "50 countries". It says "there are only three countries where the profession is fully established with legal protection and can practice the full measure of the training. These are: the USA, Canada and Australia." It says there are "20 or so countries" where "there is yet much to be done before the profession can claim to be fully established".

The simplest fix is to rewrite the sentence to match the quotes from the source.

Eubulides

08:28, 20 April 2008 (UTC)

Cherry picking, again, eh? Let's go to the WFC and get those stats for you. CorticoSpinal05:40, 22 April 2008 (UTC)

Scope of practice comments on specialties

"Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic. cite book|last=Pybus|first=Beverly, E.|coauthors=Cairns, Carol, S.|others=C|title=A Guide to AHP Credentialing |publisher=hcPro |pages=241-243 |isbn=1-57839-478-3 |accessdate=2008-04-16cite web|url=http://www.chiroweb.com/archives/ahcpr/chapter3.htm|title=CHIROPRACTIC TRAINING|coauthors=Ian D. Coulter, PhD Alan H. Adams, DC; Ruth Sandefur, DC, PhD|publisher=AHCPR|language=English|accessdate=2008-04-17cite journal|coauthors=Michael A. Mestan DC, John A.M. Taylor DC, G. Lansing Blackshaw PhD, and J. Clay McDonald JD, DC|date=June 2006|title=Establishing an Accredited Master of Science in Diagnostic Imaging Degree at a Chiropractic College |journal=Journal of Manipulative and Physiological Therapeutics|volume=29, |issue=5|pages=410-413 |url=http://www.sciencedirect.com/science?_ob=ArticleURL_udi=B6WK1-4K4DFWG-K_user=10_rdoc=1_fmt=_orig=search_sort=dview=c_acct=C000050221_version=1_urlVersion=0_userid=10md5=2f2a8802530a8e3ae4d8de4a3feaee80|accessdate=2008-04-16"

"Similar to other primary contact health providers" is redundant and can be removed. It's also similar to medical specialists, no? And to electrical engineers?

"in different areas of chiropractic medicine" is also redundant.

Which of the sources say that the given list is the most common, and where?

The phrase "which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic" is not that important and can be removed. It's also hard to parse; most of it is about getting a license, but it's in a section that talks about continuing education?

In short, these two sentences should be trimmed way down. There's no need for 3 citations; one should do.

Eubulides

08:28, 20 April 2008 (UTC)

If its hard to parse, perhaps a suggestion to rephrase it? The section is not talking about continuing education, it is talking about specialization. It is within the scope of practice to become a specialist, which requires further education and subsequent licensing exams. DigitalC06:56, 21 April 2008 (UTC)

OK, here's a proposed rephrasing:

"Chiropractors can gain accreditation in radiology, orthopedics, neurology and other specialties by taking 2– to 3–year postgraduate programs and passing competency examinations."

Eubulides

08:19, 21 April 2008 (UTC)

"Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of additional post graduate study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic and passing competency examinations. cite book|last=Pybus|first=Beverly, E.|coauthors=Cairns, Carol, S.|others=C|title=A Guide to AHP Credentialing |publisher=hcPro |pages=241-243 |isbn=1-57839-478-3 |accessdate=2008-04-16cite web|url=http://www.chiroweb.com/archives/ahcpr/chapter3.htm|title=CHIROPRACTIC TRAINING|coauthors=Ian D. Coulter, PhD Alan H. Adams, DC; Ruth Sandefur, DC, PhD|publisher=AHCPR|language=English|accessdate=2008-04-17cite journal|coauthors=Michael A. Mestan DC, John A.M. Taylor DC, G. Lansing Blackshaw PhD, and J. Clay McDonald JD, DC|date=June 2006|title=Establishing an Accredited Master of Science in Diagnostic Imaging Degree at a Chiropractic College |journal=Journal of Manipulative and Physiological Therapeutics|volume=29, |issue=5|pages=410-413 |url=http://www.sciencedirect.com/science?_ob=ArticleURL_udi=B6WK1-4K4DFWG-K_user=10_rdoc=1_fmt=_orig=search_sort=dview=c_acct=C000050221_version=1_urlVersion=0_userid=10md5=2f2a8802530a8e3ae4d8de4a3feaee80|accessdate=2008-04-16"

The refs should be kept; Pybus is a independent 3rd party textbook on credentialing although we can add Meeker. The refs support the claims made, and it makes it harder for a skeptic to parade through and vandalize the section by taking out one ref. If there's a few there, its harder to "ignore". CorticoSpinal15:30, 21 April 2008 (UTC)

"Similar to other primary contact health providers," is not needed and can be removed.

Disagree, other health care professionals have subspecialties. It should stay.

A wide variety of topics in Chiropractic are in common with other health care professionals. But we don't have a phrase "Similar to other health care professionals" in front of all those other sentences. Why have that sentence here? Also, is this sentence sourced? Eubulides08:41, 23 April 2008 (UTC)

"of chiropractic medicine" is also redundant and can be removed.

It should stay.

Is it not redundant? If not, what does it add? It is already in a sentence that makes it clear that it's talking about chiropractic. Eubulides08:41, 23 April 2008 (UTC)

In "The most common post-graduate diplomate programs include" "The most common" is not necessary and reads weirdly when connected with "include"; let's remove "The most common". Also, please add veterinary chiropractic here; that should suffice to cover that subject (assuming the sources mention it).

It doesn't read weird; the sentence is perfectly fine. Veterinary chiropractic is a scope of practice issue. No minimizing it, Eubulides. It's also completely outside your scope of expertise and you should recuse yourself to the experts who know of this issue much more than yourself. CorticoSpinal22:58, 22 April 2008 (UTC)

Briefly mentioning it, with a wikilink to the article on veterinary chiropractic, should suffice, just as a brief metion of sports medicine should suffice. My personal expertise is irrelevant here. Eubulides08:41, 23 April 2008 (UTC)

"neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology" is too many subjects. Please trim it down to three or so.

Why not list the whole sha-bang then? It's already done in Medicine. I wanted to list the most common, feeling that there wouldn't be any objections or insinuations of puff. Now you want to pair down the most common. It's not going to happen; they are all important. More attempts to minimize noted. CorticoSpinal22:58, 22 April 2008 (UTC)

I think it weakens Chiropractic to include that list, because it makes Chiropractic look a bit like a sales pitch; but if you feel strongly about the current list, let's keep it. Eubulides08:41, 23 April 2008 (UTC)

"2-3 additional years of additional post graduate study" is way redundant. Remove both "additional"s; the "post graduate" implies "additional".

Extra sources should be added only if they are needed to have a good encyclopedia; they should not be added merely as cannon fodder for edit wars (wars that they would have no effect on, at any rate). MH2002 is a good source here, since it's high quality and freely readable; I don't see what the other sources add here.

The sources back the claims. There's no need to remove them. CorticoSpinal22:58, 22 April 2008 (UTC)

It's not a huge deal, but redundant citations do add up, and in the end they'll need to be trimmed; we can't have an article with a thousand citations. Eubulides08:41, 23 April 2008 (UTC)

Eubulides

09:41, 22 April 2008 (UTC)

Forget it, Eubulides. I tried to compromise. It's clear to me now that your intent is to stall as much as possible, to insert as much controversy as possible, to blow up minor controversies as much as possible and to civilly push your POV as much as possible. A great recipe to drive certain editors batshiat crazy. I've been fallen for these tricks once already. Not again. CorticoSpinal22:58, 22 April 2008 (UTC)

The intent is to have a neutral section on scope of practice that is solidly based on reliable sources. The draft isn't so very far from that; it has only a few major problems (most of them are minor). Please don't assume the worst of honest criticism. Eubulides08:41, 23 April 2008 (UTC)

Watering Down Scope of Practice: Tendentious editing

What turned out to be a pretty straight forward, NPOV section has resulted in a needless edit war and an attempt to essentially castrate the section. Amongst proposed changes made by Eubulides include

suggesting that a qualifying statement be made in the very first line of SOP "Although..."

suggesting that DCs are not PCPs

suggesting that veterinary chiropractic is not a scope of practice issue

suggesting that conservative care should be taken out

suggesting that DCs performing minor surgery and writing medical prescription in the state of Oregon is not notable

suggesting that common knowledge stuff like restricted acts of diagnosis and SMT are not restricted and are fall within the public domain

suggesting to take out a Google Book source which supports claims being made citing privacy issues and some kind of bandwith problem (talk about grasping for straws)

suggesting that DCs opinions of wanting limited Rx rights does not represent a shift from the historical "without drugs or surgery" approach

more

These types of objections are completely trivial and represent more stall and delay tactics and disruptive editing practices. Note, that NO objections were raised by Eubulides et al. for a whole week until I suggested we include the SOP section. Then suddenly, objections started flying out left and right, first with apparent citations problems (that no one else had) then pleading for more time to review (while actively editing other articles on wikipedia the whole time).

I raised one objection early: the citations were missing or busted. This problem remained until a day or two ago. Once usable citations went in, I started to review. Most of the comments are minor, but that's how reviews work. Some of the comments are definitely nontrivial, though. In particular, the dispute about whether chiropractors are better thought of as primary care practitioners or as specialists is an important one, one that the current draft presents only one side of; this is a serious POV issue. The review is not done yet, alas, as I have other responsibilities (plus this discussion to attend to :-) and have found more problems than I expected. I hope to finish it soon, though. Eubulides07:44, 19 April 2008 (UTC)

There 2 key points here that should be highlighted. 1) no other user but yourself claimed the citations were busted and not working for them. 2) more importantly, you have a penchant for making small things turn into very big things, i.e. blowing of a controversy out of proportion. Also your language (...and have found more problems than I expected) is a classic example how you continuously insert little shots here and there that don't necessarily cross a civility line but taken altogether over the past 2 months suggests a bigger problem. Also, a whole sections titled "Scope of Practice: Comments by Eubulides" is a bit much, no? CorticoSpinal05:42, 22 April 2008 (UTC)

What can I say? I had problems following the citations. Clearly http://en.wikipedia.org/w/index.php?title=Chiropracticoldid=206253718References the citations that went in were busted, independetly of whether an editor mentioned that fact.

POV issues are not little things; they are a major problem with Chiropractic.

I've changed the subsection title, and I'm sorry if its name offended anybody. That was not its intent.

Eubulides

09:41, 22 April 2008 (UTC)

Regardless of POV issue that YOU think the article may have, the bigger problem is your editing style which perfectly reflects that of a civil-POV pusher. When you factor this with the fact that you have grossly obstructed the SOP section, an area where you have 0 expertise in becomes even a bigger issue. Then, lastly, and most importantly, your refusal to include indexed, peer-review literature that I present that clearly refutes your argument, you engage in more tendentious wikilawyering. You have disrupted this article so make a point. I'm offering you one final chance: please collaborate productively with the chiropractic experts. There is absolutely no reason why this cannot be sorted out in a fair, just manner. But you're going to have to change your approach here and start treating this article as a profession and not some medication that can be picked apart, reduced, quantified, etc. This line of exclusive thinking, reductionism, is not always valid nor the best approach. CorticoSpinal22:50, 22 April 2008 (UTC)

It is not obstruction to present detailed and useful criticism of the draft section. Most of the points raised were minor, but (when fixed) will improve the quality. There is a significant POV issue that does need fixing, and some other stuff that needs to be better sourced and/or rewritten to match the existing sources. Eubulides08:41, 23 April 2008 (UTC)

I've finished the review of Scope of practice. The section has mutated while I was reviewing it so there are some rough edges no doubt. But it's a reasonable first cut. Eubulides08:33, 20 April 2008 (UTC)

Education, Licensing, Regulation

Chiropractic medicine is currently formally regulated in approximately 60 countries although chiropractors are also practicing in several other countries where there is no formal legal recognition of the profession at this time Fact|date=April 2008. To help standardize and ensure quality of chiropractic education and patient safety, in 2005 the World Health Organization published the official guidelines for basic training and safety in chiropractic http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf Most commonly, chiropractors obtain a doctoral-level "second entry", first professional degree in Chiropractic medicine. The degrees obtained include Doctor of Chiropractic (Medicine) (DC or DCM) in North America whereas a Bachelors or Masters degree in Chiropractic Sciences (BChiro, MChiro, BAppSc) degrees are granted in Australia and selected countries in Europe, Asia and Africa. Fact|date=April 2008 Typically a 3 year university undergraduate education is required to apply for the chiropractic degree.http://www.ac-fpeh.com/PDF/academic/Chiropractic.pdfhttp://www.ccachiro.org/Client/cca/cca.nsf/web/Chiropractic%20Education?OpenDocument In general, the World Health Organization lists three major educational paths involving full‐time chiropractic education across the globe:

A four‐year full‐time programme within specifically designated colleges or universities, with suitable pre-requisite training in basic sciences at university level;

A five‐year bachelor integrated chiropractic degree programme offered within a public or private university

A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree.

Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training. 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=2008-03-03insert CCE, CCEC, ICCEC Health professionals with advanced clinical degrees, such as medical doctors, can can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy. http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed.

All Chiropractic Examining Board requires all candidates to complete a 12 month clinical intership to obtain licensure. Candidates must successfully pass a written cognitive skills examination to be eligible for the clinical skills examination. http://cceb.ca/english/exam/index.htm Licensure is granted following successful completion of all state/provincial and national board exams so long as the DC maintains malpractice insurance. Nonetheless, there still some variations in educational standards internationally depending on admission and graduation requirements. For example, Canadian chiropractic accrediting standards are higher than the United States, and it's admission requirements into the Doctorate of Chiropractic Degree programme are the strictest in North America. http://72.14.205.104/search?q=cache:T3ZpTWx44MYJ:www.ontla.on.ca/hansard/37_parl/session1/Committees/gengov/g037.htm+jean+moss+meet+and+exceed+standards+chiropractichl=enct=clnkcd=2gl=ca Chiropractic medicine is regulated in North America by state/provincial statute. The regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency.http://www.ccachiro.org/Client/cca/cca.nsf/web/Facts%20%26%20FAQs?OpenDocument Facts FAQs Each state or province has a regulatory college established by legislation in the same manner, and with the same structure and similar regulations, as the regulatory bodies for other health care professions.

Comments about Education, Licensing Regulation

Stuff to be added could include

self-regulation status

continuing education requirements

sub-specialities, (common ones)

differentiation between straight and mixer schools (this difference is noted in the US Dept of Edu; but this problem is not so much an issue in the rest of the world)

regulatotry status globally, where it is, is not, and the in between

more? CorticoSpinal18:57, 13 April 2008 (UTC)

Again, this is waaaay too long. I suspect nobody has read it other than its author; it's a guaranteed put-you-to-sleep text. There is duplication of material between this section and the Scope of Practice draft (both talk about licensing). How about combining the two sections and shortening the result? Also, I have similar problems with citations here. For example, there is a URL to an IP address that appears to be some sort of cache; this didn't work for me. Please use proper citation format; it's hard to review stuff that isn't properly cited. Thanks. Eubulides08:15, 14 April 2008 (UTC)

Nah, if there's overlap with scope of pratice we can chop out duplication. We need to cover the section adequately and it is being done so now, remember, we're talking about the profession globally and need to represent, at best, a global POV. Regardless of the length, it's the content that is most important. Do you dispute any of the content there? If so, which ones? What citations do not work? What is the proper citation format and how is it done? CorticoSpinal15:37, 14 April 2008 (UTC)

I think a lot of this may be found (or should be found) at Chiropractic education. Perhaps we should have a brief summary of the information above and then link to Chiropractic education from this main article (pretty much as we do now, but with a more solid detailed summary - perhaps just a short paragraph or two in length). Then let's strive to make sure that Chiropractic education matches the excellence on the draft above. -- Levine211219:39, 14 April 2008 (UTC)

We definitely could move some stuff to chiropractic education; but think we should keep the types of degrees granted, self-regulation and licensure stuff here because some stuff we missing from the body but mentioned a bit in the lead. Details re: the types of common courses taken I was going to add here but would be better suited at chiropractic education and/or chiropractic school. Still, we need to add stuff about CE (it's required to maintain licensure in almost every state/province/jurisdiction. Again, we need to make sure that a global POV is respected here which is why some editors have quite rightly said it's not always a doctoral level degree (outside NA) where the term first professional degree is better used to adequately reflect the status of the degree outside the US and Canada. CorticoSpinal19:51, 14 April 2008 (UTC)

That sounds perfectly reasonable. Perhaps start with updating Chiropractic education with all of this information? -- Levine211219:53, 14 April 2008 (UTC)

That makes sense to me too. I still have having trouble following the citations, though, as per above discussion. Eubulides09:12, 15 April 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=210437698oldid=210435771 This change ignored the above suggestion to start with updating Chiropractic education, and instead installed the proposed change directly into Chiropractic. I did not review this material carefully because I assumed that it would go into Chiropractic education first, and then a shorter version would be proposed for Chiropractic. There are several problems with the proposed change: for example, it's highly duplicative with, and even to some extent contradicts, ChiropracticScope of practice. So it shouldn't go in unchanged. Let's stick with the original plan to put the material into Chiropractic education and put a shorter version here. For now, until the matter is resolved, I http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=210528328oldid=210526675 went back to the previous version of this section. Eubulides09:07, 6 May 2008 (UTC)

The material has been there Eubulides since April 13/08. It is now May 6/08. To say that I've been patiently waiting is an understatement. I've already pruned down the version slightly, but the meat and potatoes are there. I should note that besides yourself (as always it seems) and your trustworthy sidekick below, no one else has objected to the contents of this draft. Given the fact that education is currently shorter than safety and vaccination, both topics that have undue weight (i.e. they're too big/long) we should probably address those first now since violations of WEIGHT and TONE have been there since you first installed them in February 08. Safety could easily be rectified by including the conclusions of Boyle and Cassidy so it's more neutral and balanced. Vaccination, while definitely notable, is undue weight on the Cdn DCs and I suggest we prune the sentences, not the sources (to be clear). CorticoSpinal17:11, 6 May 2008 (UTC)

A suggestion was made by Levine2112 on April 14 to start by updating Chiropractic education and then to propose a shorter version for Chiropractic. I seconded that suggestion on April 15. There was no need to patiently wait for a suggestion; the suggestion was made several weeks ago.

It is standard practice to briefly summarize a topic that has a subarticle. Such a summary should be brief; it does not need to be longer than another section lacking a subarticle, simply because the summarized topic is an important one.

So far no other editor has supported the addition of the section in anything like its current form.

Please see 2008-05-06 changes below for more.

Safety and vaccination are different topics, best discussed elsewhere. Again, please see 2008-05-06 changes below for more.

Eubulides

09:25, 7 May 2008 (UTC)

I agree with http://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=210528328oldid=210526675 this edit. The section (recently added text) requires a lot of clean up and references too. QuackGuru09:03, 6 May 2008 (UTC)

Perhaps your efforts would be better off focusing on beginning a draft for history as you had deep concerns about it. We have a good list of sources to start it off. I'm going to begin working on the science of chiropractic 1895-2008. I'll highlight the major events in each decade or something like that. What do you think? CorticoSpinal20:36, 6 May 2008 (UTC)

That would be an amazing step forward. Thanks Cortico! -- Levine211220:39, 6 May 2008 (UTC)

An appeal: Drop the &quot;effectiveness&quot; discussion

Please, please, please!! Drop this extremely divisive and contentious discussion. It is causing an awful waste of time here, right where it doesn't belong. I repeat my previous comments and would like a response from all concerned parties:

I basically agree with CorticoSpinal on this one. We are spinning our wheels by attempting to discuss the "effectiveness" of a whole profession, when only individual techniques and methods can properly be the subject of an "effectiveness" discussion. It would save a whole lot of effort and avoid alot of unpleasant discussions if effectiveness was only dealt with on the article devoted to each technique. Then we can simply state that chiropractors use this, that, and another technique, and wikilink each one. Then readers can hop over to those articles and find an "effectiveness" section in each one. By simply dropping the whole line of discussion on this matter here, we can sidestep an issue that shouldn't be under discussion here. Save such discussions for each of those articles. http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=prevoldid=204824940

A pressing issue would be to end the discussion of "effectiveness" of chiropractic, as you (and I, and Levine2112) suggested above. That would free up everyone's minds to deal with other things. http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=prevoldid=204856172

A whole profession can't be dealt with in this way. It's unheard of (except for things like homeopathy and acupuncture, where the profession is synonymous with the method). Only individual techniques and methods can be dealt with in this manner. The only place where chiropractic can be dealt with in this manner is on any one of the various Chiropractic treatment techniques articles, especially Spinal adjustment. It can legitimately happen there, since that is the only thing unique about chiropractic, and where it's claims are significantly differently from those made for spinal manipulation. -- Fyslee / 05:23, 12 April 2008 (UTC)

It is not at all unheard of. It's done all the time. It's done on the web (see, for example http://chirospinecenter.com/effect.htm The Austin Chiropractic Center's web page on chiropractic effectiveness. It's done in peer-reviewed journals (see, for example, Kingston 2007, PMID|17970361). It's done by Chiropractic right now, which cites sources on this subject at length (the Manga report was titled "A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain").

A summary of the effectiveness of chiropractic care is sorely needed in Chiropractic. The current summary (currently found in ChiropracticMovement toward science) is obsolescent and highly biased. This does not mean it should be removed: effectiveness is a core topic! It means it should be fixed. Eubulides08:34, 13 April 2008 (UTC)

I will concede that a short section dealing with the few sources that - as DigitalC mentions below - "compare the entire clinical encounter of one profession to another", might be in order. But this detailed analysis of many different techniques and methods is improper here. It should be dealt with, but is better dealt with elsewhere. -- font

color="004000"Fyslee / 05:32, 14 April 2008 (UTC)

That is too selective. Most of our reviews on effectiveness refer to some studies like that, but they're relatively rare and tend to be less reliable. The reviews spend more time talking about effectiveness studies of particular treatments, because that's where most of the research has been (including most of the higher-quality research). We should not be ignoring all this research; we should be summarizing it briefly, as it's quite relevant. Eubulides09:15, 14 April 2008 (UTC)

"'Agree"'. Cost-effectiveness of care could be a fair play; and 3rd party sources should also be considered (such as Workman Compensation, integrative medicine models and recently completed and active demonstration projects. I need the sources to back me up but I'm almost positive that chiropractic care is usually significantly cheaper (20%) and gets similar if not better results than conventional medicine for neuromusculoskeletal complaints. This is not surprising, naturally, as chiropractors are on one hand specialists in neuromusculoskeletal medicine yet offer a distinct form of health care due to their holistic heritage that relies on conservative and complementary therapies most of which are natural as DCs cannot prescribe nor perform surgery. CorticoSpinal06:16, 14 April 2008 (UTC)

Cost-effectiveness is another section that should get written, and we have collected in Sources for risk-benefit and cost-effectiveness a list of sources for such a section. But we should not limit Chiropractic's discussion to "just" cost-effectiveness. Effectiveness is an important topic in its own right, and has been studied a lot more and has more to report. Eubulides09:15, 14 April 2008 (UTC)

Actually the reasoning and application is completely invalid. Validity, as a refresher refers to the degree to which a study accurately reflects or assesses the specific concept that the researcher is attempting to measure. How can you attempt to measure the effectiveness, risk/benefit, safety, cost-effectiveness, etc. of a profession? We're not studying a technique, a modality or a drug here where the aforementioned apply. This argument is further reinforced as even Medicine does not have sections on "effectiveness" "cost-effectiveness" "safety" and "risk/benefit". It's not that Medicine as an article has shortcomings (as incorrectly suggested) but rather that these sections cannot be applied readily or measured reliably to WHOLE professions. It's invalid to think so. Majority of editors agree. Please respect and accept the consensus of the majority of your fellow editors, many of whom who have far more experience editing this topic that yourself and myself combined. Thanks. CorticoSpinal04:41, 15 April 2008 (UTC)

Nobody is proposing that we measure the effectiveness etc. of a "profession"; we are just proposing that it covers effectivenss of common treatments for which research exists. The effectiveness of those techniques is a core issue of chiropractic: it's the main reason it has been controversial for so many years. The current version of Chiropractic talks about cost-effectiveness of chiropractic care at length with blatant pro-chiropractic POV; why didn't this objection that "We're not studying a technique" apply to what's in Chiropractic now? Eubulides09:12, 15 April 2008 (UTC)

Do you have a reference that backs up your statement that effectiveness of, presumably, manipulation is the reason why "it has been controversial for so many years". Because I would disagree with that statement; and so does American Pain Society and American College of Physicians who recommend spinal manipulation in their clinical practice guidelines. In fact, I quote "The expert panel noted that physicians should consider the following noninvasive, nonpharmacologic therapies that have been proven effective in evidence-based trials: exercise therapy, "'spinal manipulation"', acupuncture, yoga, intensive interdisciplinary rehabilitation, cognitive-behavioral therapy, and progressive relaxation". A summary can be found http://www.physweekly.com/article.asp?issueid=528articleid=4910 here. So, to be clear; is your argument that allopathic medicine is concerned about manipulation (which it now recommends) or is allopathic medicine concerned by manipulation performed by chiropractors? CorticoSpinal15:15, 15 April 2008 (UTC)

I don't quite follow the question, but I'll try to answer it anyway. Mainstream medicine (which you call "allopathic") is concerned both about the safety of SMT, and about its effectiveness against the wide variety of conditions that it is promoted for. Although this concern is independent of whether SMT is performed by chiropractors, it is highly relevant to chiropractic, because chiropractic is so strongly identified with SMT. I think even the harshest mainstream critics of chiropractic would concede that there's some evidence that chiropractic SMT is as effective for low back pain as anything else is (which they would say is "not much"). Of course there is a big gap between what the critics say and what most chiropractors say, and we shouldn't report only what the critics say. However, the issue should be fairly and neutrally covered in Chiropractic. Eubulides19:08, 18 April 2008 (UTC)

This is getting quite tendentious, Eubulides. A majority of editors disagree with you, and for one reason or another the argument that a reductionistic model (which I argued was core to medicine) cannot be done to analyze professions' 'effectiveness' no matter what you claim. Many editors here have already sought to compromise with you and have made alternative suggestions and wish to collaborate however it seems increasingly apparent that this feeling is not being reciprocated. Anyways, the point is moot, there is agreement by the majority of regular editors that we're not going to go down your suggested route and Fyslees recommendation is a sensible one. CorticoSpinal15:27, 13 April 2008 (UTC)

I agree that the discussion has been divisive and contentious. But the subject of effectiveness is an important one, and the current coverage of it in Chiropractic is biased and misleading: we cannot simply ignore the problem. Eubulides08:34, 13 April 2008 (UTC)

It should not be ignored, but for the most part (all the details) it should be dealt with elsewhere. -- Fyslee / 05:44, 14 April 2008 (UTC)

One could write hundreds of pages of details, and I agree for the most part these should be elsewhere. However, Chiropractic should have a reasonable summary of the issue of chiropractic effectiveness, as that is a core question about the field. Currently Chiropractic has a highly-biased and obsolescent summary of effectiveness that should be replaced by something better. Effectiveness 1 has been drafted and is miles better than the effectiveness discussion in Chiropractic now. Plus, it's shorter. So what's not to like? Eubulides09:15, 14 April 2008 (UTC)

See above comment. Invalid application. CorticoSpinal04:41, 15 April 2008 (UTC)

Replied to above. Eubulides09:12, 15 April 2008 (UTC)

Fyslee, myself, DigitalC, Levine2112, the DoctorIsIn and others have never suggested 'ignoring' the problem. Please, this is the 4th time I've asked you now, do not mispresent or mischaracterize other editors statements or at least ask for clarification if you're confused. We have offerred alternative solutions to compromise and collaborate whereas your position seems to be crystallized. CorticoSpinal15:44, 13 April 2008 (UTC)

If we leave Chiropractic alone, and keep its current blatantly-biased treatment of effectiveness, then we are ignoring the problem of bias. Merging Effectiveness 1 into a subarticle (the alternative solution proposed) does not solve this problem. Eubulides09:15, 14 April 2008 (UTC)

It's incorrect to say that only individual techniques can be studied for effectiveness. A research study, for example, can compare patients in chiropractic care to patients using traditional medical care. Studies like that have been done, and are cited (via reviews) in Effectiveness 1. Furthermore, reviewers themselves can (and do) synthesize practice guidelines and effectiveness surveys out of primary studies investigating individual techniques, and we can cite those reviews.

It certainly makes sense to do detailed discussion of effectiveness of chiropractic care into the respective detailed articles, but effectiveness of important techniques (notably, SMT) should be summarized in Chiropractic itself, and should not be ignored there. It would be extremely awkward for readers to have to go to each subarticle to see "any" discussion of effectiveness. Effectiveness 1 was written partly in response to a reader's natural request to see good coverage of effectiveness here, and the reader indicated that an earlier draft was the sort of thing being sought. Wikipedia, in the end, is supposed to be for readers, not for editors. Eubulides08:34, 13 April 2008 (UTC)

It's those types of comparisons that can be mentioned here, since there are sources that do it, but the detailed descriptions for each method should be dealt with in their own respective articles. If you want to examine chiropractic's special relationship to SMT, then do it in the spinal adjustment article, where there is place for detailed descriptions of that very special and unusual relationship, an analysis and description that would be inappropriate in the SMT article. -- Fyslee / 05:44, 14 April 2008 (UTC)

Effectivness 1 does not contain "detailed descriptions for each method". It doesn't describe the methods at all. It merely gives known effectiveness results. This draft could be pruned, but why? I don't understand an objection based on length. Effectiveness 1 is "shorter" than the text it would replace. Why object to its length, when there is no similar objection to the longer and much-lower-quality material on effectiveness that is in Chiropractic now? Eubulides09:15, 14 April 2008 (UTC)

Disagreed. It's a violation of SYN as argued by Levine2112 above when you insist on choosing SMT studies done by various professions (DO, PT, MD) and cite it as effective for/against the chiropratic profession. Invalid application again. CorticoSpinal04:41, 15 April 2008 (UTC)

I didn't choose the SMT studies: a reliable review by and for chiropractors chose those studies, and for good reasons, which has been explained by the experts. We should not substitute our own judgment for that of published experts in the field. Eubulides09:12, 15 April 2008 (UTC)

You did not address my argument: regardless of who chose the studies it is a SYN violation to take studies on manipulation performed by physical therapists, osteopathic and allopathic physicians and pass it off as effectiveness of "'chiropractic"'. I would also note that you're using the same, tired argument (substitute judgement) that has already been addressed several times on several threads here on Talk. CorticoSpinal15:15, 15 April 2008 (UTC)

It is not synthesis to report what reliable reviewers say. Published expert reviewers are "supposed" to do synthesis. That's their "job". SYN says Wikipedia editors are not supposed to do synthesis on their own. SYN does not say that Wikipedia articles cannot report the results of reliable expert reviews simply because those reviews happened to do some syntheses. Eubulides19:08, 18 April 2008 (UTC)

Please, Eubulides, it's time to drop this now. How many times can ask you to please step back from this? It's not necessarily about length; it's about content, validity and the generalizability of the studies back to the effectiveness of 'chiropractic'. Fyslee, myself, DigitalC, Levine2112 and DoctorIsIn disagree with your stance and approach. This doesn't even take into account that no health care profession has an effectiveness section within it here at wikipedia (besides from acupuncture/homeopathy which was already discussed earlier) Also, it omits major findings from the CCGPP clinical practice guidelines and gives disproportionate amount of weight to allopathic sources. Nowithstanding, a lot of editors, myself included dispute the authoritativeness (which seems to be arbitrary). Regardless, this point is moot there is majority agreement that this section will not continue as currently planned and consensus is that we talk about various modalities/treatment in their respective pages. 19:21, 14 April 2008 (UTC)

First, I disagree that there is consensus. The recent edit war is evidence that there is not consensus. Second, and more important, Chiropractic currently has blatant pro-chiropractic POV in its treatment of effectiveness. I have pointed this out several times; none of the replies have addressed this issue. Blatant POV is a violation of Wikipedia policy and must be fixed. Third, there is a reason that CAM fields such as homeopathy require an effectiveness section more than non-CAM fields such as (say) brain surgery: their effectiveness is far more a topic of interest and dispute. Eubulides09:12, 15 April 2008 (UTC)

First, look at the thread. You're the ONLY editor here who consistently opposes the consensus of the majority minus a few words occasionally from QG. The edit war in question has no bearing of what has occurred subsequently over the past 10 days where we have discussed this issue at length and have come to a conclusion. Second, where does Chiropractic have blantant POV in its treatment of effectiveness? Do you have any specific examples? Also, perhaps you can tell me why according to the "'panel of experts"' American College of Physicians "'physicians should consider the following noninvasive, nonpharmacologic therapies that have been proven effective in evidence-based trials"': exercise therapy, "'spinal manipulation"', acupuncture, yoga, intensive interdisciplinary rehabilitation, cognitive-behavioral therapy, and progressive relaxation. Remember, according to your very own words "We should not substitute our own judgment for that of published experts in the field." I would also like to note that the majority of the above nonpharmacologic therapies can and are provided by DCs and fall within its scope of practice. These should be noted as well.

I am not the only editor who thinks Effectiveness 1 is a real improvement over the blatant POV in the current article. There is a big difference between considering chiropractic SMT for low back pain (which I suspect most physicians would agree with) and considering it for (say) vision problems (which I suspect they wouldn't). I plan to address the POV again later; it's still a major problem, and it still needs to be fixed. Eubulides19:08, 18 April 2008 (UTC)

Third, comparing homeopathy to brain surgery is ridiculous. To suggest that the effectiveness of homeopathic tinctures is of a greater concern or relevant in the medicine than brain surgery is laughable. Furthermore, it's hard to measure the effectiveness of brain surgery as there are different prognoses for different brain conditions. More appropriate would be the effectiveness of back or neck surgery where I last read the were less than 50% including many unncessary surgeries which is why the recent Neck Pain Task Force clearly made note of this and made a classification system (1-4) to prevent excessive surgery or invasive measures.

The reason effectiveness is of more concern to Homeopathy is that the mainstream opinion is that it has no effect at all. That's not the case for brain surgery. The effectiveness of chiropractic is under dispute: not as much dispute as homeopathy of course, but still, it's under serious dispute, for many conditions that it is promoted for. It's entirely appropriate to cover that dispute in Chiropractic. Eubulides19:08, 18 April 2008 (UTC)

In general, it seems to be like you're making up policy on the spot "there is a reason that CAM fields require an effectiveness section more than non-CAM fields their effectiveness is far more a topic of interest and dispute". First, where is the policy that states the above? Did you make it up or is there something you can quote for us? Second, CAM therapies can indeed be studied and a relative effectiveness determined, CAM professions cannot. Third, Chiropratic should not follow the exception to the rule of Homeopathy which is a non player in terms of regulation in North America and most of Europe and Australia. So, it's not comparable. CorticoSpinal15:15, 15 April 2008 (UTC)

It's blatant POV that violates Wikipedia policy, which is all that I said about policy. Effectiveness 1 is about the effectiveness of chiropractic care, which is a notable topic of considerable interest, one that Chiropractic currently covers in a way that's blatant POV. The regulation (or absence thereof) of chiropractic is a different issue, one that is appropriate for a licensing section and inappropriate for a discussion of effectiveness. Eubulides19:08, 18 April 2008 (UTC)

Fyslee is right here. The most interesting and perplexing thing of it all, is I believe that adjustment belongs in the SMT article. I can tell why later; but it can be done tastefully that covers both straight and mixer interpretations. I happen to excel in this particular chiropractic legal arena and we must carefully consider as well the weight of "'mainstream chiropractic"' vs. the minority (but vocal) straight DCs who retain Palmer Philosophy and Practice Principles. For example, straight DCs would always, always, (always!) refer to manipulation as "spinal adjustment". The intent; and purpose is distinct; the correct dysfunctional vertebral segments (dubbed vertebral subluxation which is to be differentiated from VS COMPLEX) to improve neurological function (or the inverse; "remove nerve interference" (i.e. the chiropractic boogie man). In contrast, mixer DCs and all evidence-based practitioners use spinal manipulation and adjustment INTERCHANGEABLY. The focus in not necessarily the "intent" but rather than biomechanical kinematics that are involved in a HVLA manipulative protocol. Subtle, but EXTREMELY IMPORTANT, and understanding these 2 viewpoints within the profession is crucial. They're both very real, both notable but from here on in, mainstream (mixer) chiropractic view gets more weight but we're cognizant that straight chiropractic needs to be represented NPOV as well, despite the fact that we may have serious reservations about some elements of their style of practice CorticoSpinal06:16, 14 April 2008 (UTC)

These points are reasonable ones but are appropriate more for the straight-vs-mixer section than for the effectiveness section. Eubulides09:15, 14 April 2008 (UTC)

You're missing the point. We're not going to have an effectiveness section; at least not the way it's currently in place or drafted. Why are you not collaborating with your fellow editors here? 19:21, 14 April 2008 (UTC)

The topic of this thread is effectiveness. Certainly changes could be made to Effectiveness 1 before it goes in; it's not cast in stone. But the current Chiropractic is severely biased and must get fixed; Effectiveness 1 is a vast improvement on what is there now. Eubulides09:12, 15 April 2008 (UTC)

No, the topic of this thread is an APPEAL TO DROP EFFECTIVENESS. An appeal which the majority of the editors here and heeding with yourself being a notable exception. CorticoSpinal15:15, 15 April 2008 (UTC)

We cannot simply drop the matter, due to blatant POV in the current treatment of effectiveness. I plan to take up the issue further in a later section. Eubulides19:08, 18 April 2008 (UTC)

It's incorrect to try and impose the same argument time after time despite the fact it has been rejected by a majority of editors. It's incorrect to say allopathic sources are preferred and should be weighed more than chiropractic sources especially given the fact we're talking about evidence-based literature. It's incorrect to include a section here which is not present in other health professions (for good reason, you can't measure the effectiveness of the 'medical profession' or the 'osteopathic profession' or the 'physical therapy' profession or the veterinary profession. It's incorrect to give such prominence to a chiropratic critic who has 0 expertise in the subject and not at least give equal weight to a source that refutes (soundly) Ernst's claims. It's incorrect to not use expert sources such as Haldeman and Cassidy et al when they're right there and published in Feb 2008. It's incorrect to incorrect to assume that regular editors here don't know that Wikipedia is for the readers not for the editors. It's incorrect to keep pursuing this and comparing the profession to a modality which is a fundamental flaw in reasoning by a few choice editors new to Chiropractic and who lack the expertise in this field. CorticoSpinal15:44, 13 April 2008 (UTC)

I disagree that the idea of an effectiveness section has been rejected by a majority of editors.

4 editors have pleaded with you and have even made an appeal section to voice their concerns. You're the only editor who disagrees with our consensus. CorticoSpinal05:04, 15 April 2008 (UTC)

The recent edit war indicates that there is no consensus. I agree that some editors would rather not have an effectiveness section in Chiropractic right now. However, the POV concerns that have been expressed are real, and a violation of Wikipedia policy of this magnitude cannot be simply ignored. Effectiveness 1 is a good way to address these issues and is a proposal on the table. No other proposal has been made. Eubulides09:12, 15 April 2008 (UTC)

This argument has been debunked above. You have not listed any examples of violation of wikipedia policy. Also, you continue to misrepresent the opinion of other editors. The frequency at which this has been occuring is problematic. I have asked you no more than half a dozen times already to not do this or to ask for clarification. Several counter proposals have been made; which is another misrepresentation of editors arguments. This penchant is getting to be quite problematic and irritating. The argument is that there should not be an effectiveness section in chiropractic PERIOD, not right now. As DigitalC mentioned already, any profession that uses a given modality that is being listed here should have that listed on their page as well. CorticoSpinal15:15, 15 April 2008 (UTC)

None of the counterproposals have addressed the fundamental issue here, which is the blatant POV in favor of chiropractic with respect to effectiveness. I plan to write a further section about this, as this thread is getting pretty long. Eubulides19:08, 18 April 2008 (UTC)

Sources should be given appropriate weight according to Wikipedia policy; as there still seems to be some dispute about what that means here, I will look into asking the experts on those policies.

No need, I'm already on that as well. I'm sure we'll have an interesting conversation about this. CorticoSpinal05:07, 15 April 2008 (UTC)

An effectiveness section "is" present for some professions, like homeopathy, and it would not be out of place for others; we should not let weaker articles prevent us from making Chiropractic better.

Nah, red herring argument. The application of it is invalid; and no mainstream med profession has this because it's not valid to measure the effective of a profession. This is simply a double standard being pushed on CAM articles. Besides, no health profession article lists these sections. Homeopathy is not the standard; it's the exception to the rule. CorticoSpinal05:07, 15 April 2008 (UTC)

Homeopathy is not an exception: it's an example of how to do things well. It is far higher quality than Chiropractic is. Coverage of effectiveness and safety would be quite apropos for Medicine as well. But our focus in this thread is Chiropractic, not Medicine. Eubulides09:12, 15 April 2008 (UTC)

Effectiveness 1 gives plenty of weight to sources that disagree vehemently with Ernst, and does not give undue prominence to Ernst.

It does not read that way. Besides, Ernst has no expertise in safety of SMT nor does he have expertise in effectiveness; he's just a mainstream critic. Experts on safety on SMT are the researchers who study it. I'd give Flynn and Childs, both PT/PhDs far more weight on expertise on SMT since they're actively studying the topic. Also, Herzog, Kawchuck et al. should be mentioned in safety. CorticoSpinal05:04, 15 April 2008 (UTC)

In what specific way can Effectiveness 1 be improved so that it satisfies your concerns about weight? A specific suggestion, with specific citations, could help us improve it. Eubulides09:12, 15 April 2008 (UTC)

Cassidy "et al." (PMID|18204390) is about safety and is irrelevant to effectiveness; I'm not sure what you mean by "Haldeman" (PMID|18204400, perhaps? but that wouldn't add anything to Effectiveness 1 that isn't there already).

It's about the same topic, i.e. an editor who claims superiority of allopathic sources and prevents the inclusion of notable, verifiable, high quality chiropractic sources. It's the principle being applied on this aborted section, safety and vaccination. CorticoSpinal05:04, 15 April 2008 (UTC)

Again, this sounds like a different thread, one about safety. Eubulides09:12, 15 April 2008 (UTC)

I have never assumed "regular editors here don't know that Wikipedia is for the readers not for the editors"; on the contrary, I have based some of my arguments on the assumption that editors know Wikipedia is for readers.

Thanks for the clarification. But you have also insinuated that other editors don't know what they're doing which will result in a "mediocre" article. That kind of language is regretable under rather tense conditions. CorticoSpinal05:04, 15 April 2008 (UTC)

Again, my assumption has always been that editors know that the goal is to write encyclopedic articles even about controversial subjects, and to summarize those subjects, controversies and all, in a neutral way. My arguments have been based on the understanding that editors know that articles which avoid important controversies are lower-quality than articles that cover them. That is what I intended when I wrote "We should be striving for what's best for this article. Settling for a substandard article simply because the subject is contentious, or because other articles have similar problems, is a recipe for continued mediocrity." If this comment was interpreted in some other way, which hurt your feelings, then I apologize for that; it really wasn't intended. Eubulides09:12, 15 April 2008 (UTC)

Effectiveness 1 does not compare the profession to a modality: it talks about the effectiveness of chiropractic treatments, which is a core issue in chiropractic.

Eubulides

09:15, 14 April 2008 (UTC)

No it does not. It talks about the effectiveness of SMT; as performed by chiropractors, physical therapists, osteopathic doctors and medical doctors. And the section tries to pass it off under the guise of "'"chiropractic""' effectiveness. PTs use ultrasound in clinical practice, should we generalize the effectiveness of PT based on the effectiveness of the ultrasound modality? Because that's essentially what you're suggesting here. It's an invalid application to the article and that's why it's getting the boot. CorticoSpinal05:04, 15 April 2008 (UTC)

The section talks about all forms of chiropractic care for which we have scientific evidence. A large fraction of this is SMT because that's where the evidence is. The section does not try to "pass off" anything: it clearly states when it's talking about SMT versus other treatments. For better or for worse, chiropractic is strongly associated with its characteristic treatment, SMT, and it's entirely appropriate for the effectiveness section to focus on SMT, just as it's entirely appropriate for the safety section to do so, or for the treatment section to list an SMT treatment first. Eubulides09:12, 15 April 2008 (UTC)

repost from aboveYou cannot determine the effectiveness of a profession. SMT is not chiropractic, and although I don't have the sources to back it up, I would believe that soft tissue therapy is used as much by chiropractors as SMT is. Now, if you want to determine the effectiveness of each treatment procedure used by chiropractors (SMT, STT, LLLT, US, IFC, Vibration therapy, etc. etc. etc.), for each condition they are used for (IE - is SMT effective for low back pain? is STT effective for lateral epicondylitis, is ultrasound effective for plantar fasciitis) then that would work, however those effectiveness sections really belong on the article for the respective treatment. That said however, the entire clinical encounter may be more effective than the sum of its parts - however, we do not have enough sources to compare the entire clinical encounter of one profession to another (although I have seen articles advocating for research encompassing the clinal encounter). DigitalC23:55, 13 April 2008 (UTC)

Again, Effectiveness 1 talks about effectiveness of treatments, not about effectiveness of a profession. ChiropracticTreatment procedures says that the most popular treatment, in terms of % of patients receiving it, is diversified (full-spine manipulation), not soft tissue therapy. http://www.annals.org/cgi/content/full/137/8/702-a Meeker Haldeman 2002 says "In the United States, more than 90% of all spinal manipulation services are provided by chiropractors, and research on spinal manipulation, like that on any other treatment method, is equally of value regardless of the practitioner providing it." Effectiveness 1 already talks about the entire clinical encounter, but reliable sources say that's just part of the picture; we shouldn't limit ourselves to just one corner of it. Eubulides09:15, 14 April 2008 (UTC)

"Again, Effectiveness 1 talks about effectiveness of treatments, not about effectiveness of a profession.". That is exactly the point. Chiropractic is a profession, and Effectiveness 1 talks about effectiveness of treatments. The effectivenss of those treatments belongs on the articles for those treatments, not on Chiropractic. DigitalC23:58, 14 April 2008 (UTC)

These treatments, and their effectiveness, are fundamental to chiropractic. One of the most natural questions about chiropractic, given its history and controversy, is "When does it work?" Any encyclopedic article on chiropractic must seriously address this issue. The current Chiropractic article spends a considerable time on this, using blatantly POV sources (and obsolescent ones to boot). What is the justification for excluding a high-quality and relatively unbiased discussion of effectiveness from Chiropractic, while keeping a low-quality and blatantly biased discussion? Eubulides09:12, 15 April 2008 (UTC)

FTR, the source used for ChiropracticTreatment Procedures doesn't mention soft tissue therapy, but does suggest that trigger point therapy (a subset of soft tissue therapy) is used in 45% of patients. Electrical stimulation is used in 46% of patients, ultrasound in 30%, and LLLT not included. DigitalC00:30, 15 April 2008 (UTC)

Now we're getting somewhere. Indeed, it is the whole clinical counter that is "chiropractic care" not merely the application of spinal manipulation (whereby DCs are the expert provider) whch can also be done in limited amount by osteopaths, medical doctors, physical therapists and selected other naturopaths. The reference that DigitalC has mentioned is PMID|17604553, the Hawk et al found in JACM, whereby Hawk is a leading pioneer in WSR (whole systems research). This bodes well for designing better observational studies looking at the whole (holistic) clinical encounter in chiropractic medicine and should lead to good answers (and good questions) on the validity of manipulative therapy and chiropractic care for nonmusculoskeletal disorders (visceral). Incidentally, it is worth noting that the WSR approach is in direct contrast to the typical, allopathic reductionistic model that has stagnated and is only now begining to understand the merits of holistic and integrative medicine. CorticoSpinal05:42, 14 April 2008 (UTC)

Effectiveness 1 cites Hawk "et al." 2007 (PMID|17604553) more often than any other source. It's a good source, but it is not the whole story, and other reliable sources should be used as well. Eubulides09:15, 14 April 2008 (UTC)

I tend to agree with this argumentation that chiropractic is a career and thus cannot be measured for its effectiveness any more than we can measure the effectiveness of a dentist or veterinarian or a surgeon. We are just going in circles here discussing information which really has no place in this article. -- Levine211218:03, 14 April 2008 (UTC)

Chiropractic is more than just a career, and this article is not just about professional qualifications and certifications. Eubulides09:12, 15 April 2008 (UTC)

This is getting repetitive very fast. Besides being tendentious continuing this discussion doesn't make much sense; where past the point of diminishing returns. It's been a week, the majority of editors disagree with the position taken by Eubulides and that's basically as cut and dry as we can have it. I also strong recommend AGAINST doing any risk/benefit section right now; that's another contentious and heated one ready to come, especially if the trend continues were allopathic sources routinely gets to trump chiropractic sources which are being incorrectly omitted and described at times as low quality and inappropriate and misleading suggestions as "reaching down". I'm gonna take the rest of the day off from Chiropractic to sit back and unplug; I just see so many unfair and unjust standards trying to be applied here which fly in the face of precedent setting pages of other health professions. I'm also going to make sure that somewhere on Chiropractic a blurb about it being a profession and not a modality gets put it; there's far too much confusion about this still and it's at the heart we're even having this debate. CorticoSpinal19:32, 14 April 2008 (UTC)

Chiropractic "already" has multiple risk/benefit sections. The problem is that they are blatantly POV. This must get fixed, and Effectiveness 1 fixes them. This has nothing to do with whether chiropractic is a profession; it has everything to do with a core question on the subject, which is when and whether chiropractic care works. Eubulides09:12, 15 April 2008 (UTC)

Effectiveness 1 talks about effectiveness of chiropractic treatments, which is about effectiveness of a chriopractor's profession. This is exactly the point. Chiropractic is a profession, and Effectiveness 1 talks about effectiveness of chiropractic treatments. The effectiveness of those treatments belongs on the chiropractic article. Chiropractors perform those treatments and therfore it is relevant to have the material about Chiropractic's effectiveness. QuackGuru00:46, 15 April 2008 (UTC)

Medical doctors, Osteopaths, Naturopaths and physical therapists can perform many of the treatments as well. Is it relevant to have the same material copied to those various pages? DigitalC01:15, 15 April 2008 (UTC)

Agree with DigitalC here. Dentistry is a profession which uses fluoride as a treatment; yet the article for dentistry makes no mention of the effectiveness of fluoride treatments. How come? Maybe it is because the wise souls who edit these articles know that discussion about the effectiveness of specific treatments belong in articles about those specific treatments and not in the articles of the various professions that use such treatments. -- Levine211201:23, 15 April 2008 (UTC)

Again -- Effectiveness 1 talks about effectiveness of chiropractic treatments, which is about effectiveness of a chriopractor's profession. This is exactly the point. Chiropractic is a profession, and Effectiveness 1 talks about effectiveness of chiropractic treatments. The effectiveness of those treatments belongs on the chiropractic article. Chiropractors perform those treatments and therfore it is relevant to have the material about Chiropractic's effectiveness. Another article's format or inclusion or lack of inclusion of information is irrelavant to NPOVing this article. It is a strawman argument to say another article's info does not contain effectiveness so therefore we should exclude it here. Homeopathy contains effectiveness info anyhow. Readers want to know it's effectiveness. We can discuss chiropractic's effectiveness when the references discuss it's effectiveness. We are following the lead of the reviewers such as Ernst. So far I do not see any valid reason for excluding relevant chiropractic's effectiveness material. Thank you. QuackGuru05:38, 15 April 2008 (UTC)

outdent Agree with DigitalC above as well. The application of effectiveness to Homeopathy is also invalid. That article is the exception not the rule. The current standard one would presume would be Medicine and no sections are found there regarding safety, effectiveness, risk/benefit or any other proposed ones that are suitable to study a drug or a therapy/modality, but not valid to be studying a profession. Ernst is but one critic, in fact to say he represents the opinion of mainstream opinion would be highly debatable, especially when the US Surgeon General, an MD, supports Chiropractic and spoke at a recent ACA conference.

Homeopathy is a method and therefore it's perfectly proper to have an effectiveness section in that article. -- Fyslee / 05:33, 15 April 2008 (UTC)

Homeopathy is not the exception or the rule. The standard is not a Medicine article. The standard are the reviewers. We are here to follow their lead. Ernst represents a mainstream view. Thanks again. QuackGuru05:38, 15 April 2008 (UTC)

No thanks. QuackGuru, please stop talking down to us. If you're going to disagree, just do it without the "Thanks again" and such like tacked on at the end. It's insulting. BTW, I don't buy your argument. -- Fyslee / 05:52, 15 April 2008 (UTC)

It's not insulting to say thanks to someone. It is being polite. By the way, this chiropractic article has a section on chiropractic's methods. It is called ChiropracticTreatment_procedures. For example, spinal manipulation is the most common modality in chiropractic care. We can discuss the treatment procedures as well as it's effectiveness. Thanks for listening. QuackGuru08:15, 15 April 2008 (UTC)

Sure we can mention which modalities chiropractors use in this article, but then to go into each modality's effectiveness gets a tad tangential and tedious. We have an electronic encyclopdia with fancy-schmancy Wikilinks. Let's take advantage of the exciting technology and write this article in the Wonderful Wiki Way. (BTW, unless someone here is utilizing a text-to-voice reader, it is inappropriate to say, "Thanks for "listening"." Rather, "Thanks for "reading"," would be the more correct way to express your obviously sincere gratitude.) -- Levine211217:23, 15 April 2008 (UTC)

When we can mention which modalities chiropractors use in this article, it is equally relevant to include the modaliy's effectiveness. It does not get tangential or tedious, because we have followed the sources and respected NPOV. We can take advantage of wiki technology by including the relevant effectiveness info in this article. The same can be done for the Veterinary chiropractic‎ article. QuackGuru19:13, 16 April 2008 (UTC)

This argument is well-worn territory which has been refuted in many previous exchanges. Rather than going in circles, please review the responses above and know that I still haven't changed my mind despite your repetition. If you wish to continue repeating yourself, please know that I may not respond. If you wish to move forward with some other form of dispute resolution, I am happy to fascilitate. Thank you. -- Levine211221:38, 16 April 2008 (UTC)

A noticeboard may be another option per DR. http://en.wikipedia.org/wiki/Wikipedia:DRAsk_for_help_at_a_relevant_noticeboard QuackGuru02:10, 17 April 2008 (UTC)

Sure but I am unsure which noticeboard would be applicable here. -- Levine211217:44, 17 April 2008 (UTC)

[[WP:NPOV|relevancy]] (a central issue) &amp; [[WP:IDONTLIKEIT|strawman arguments]] (oh my)

The effectiveness of chiropractic is relevant. The main reason why chiropractic is controversial is because of it's effectiveness. Chiropractic is a specific career. This is the same as Veterinary chiropractic‎ is a specific career. The references discuss the resulting effectiveness of chiropractor treatments. There is no SYN because we are following the sources faithfully in a measured, rationale way. We should not ignore the relevant references. We are using peer-reviewed journals. A core issue to Chiropractic is it's Effectiveness. Some Wikipedians claim the information is not relevant to chiropractic profession or it would be better left to add to other articles. That is a strawman argument. In some matter, effectiveness can be discussed in this article. The reviewers (refs) think it is relevant. They are discussing the chiropractic profession. For example, the researchers are discussing the effectiveness of chiropractic treatments. We can do the same here. The best we can do is to continue to follow the lead of the references. Saying Ernst is bias is POV-pushing. Ernst is neutral and notable and meets the inclusion criteria. It seems a few editors may not be thrilled with what the effectiveness says. However, this would benefit the project when we include and not suspend the effectiveness bit. The argument/claim that this information is not relevant doesn't fly with me. They want to permanently suspend the section. Nah. The effectiveness is a central issue and would be an improvement for this article. I think this is a case of IDONTLIKEIT and nothing more. One of the goals of the project is to provide the most appropriate information available on each topic. The Effectiveness 1 accomplished this goal at least with respect to chiropractic's effectiveness. We can have further success/improvements by including the Effectiveness 1 which would benefit the reader and also meets the inclusion criteria.

Of course we can mention which modalities chiropractors use in this article, and then we can go into each modality's effectiveness. This is easy because we simply follow the sources. This can be done. Wait a second. This has been already done. The Effectiveness section seems to be completed now. It is clearly NPOV. We have an online encyclopedia, with the vision of its founders (or at least Jimbo's vision). Consistant with that vision, we can create the sum of all knowledge about chiropractic. This article should not be the wild, wild west of wiks. Yes, the subject matter is contentious but that is not the point. The point is we have written something the meets the inclusion criteria and now we can improve this article. The modalities of chiropractic, controversy since its inception and effectiveness are all linked together. Rather than making it difficult for the reader by splitting up the well sourced text, it would be easiest and best (at least for the reader) if we included the Effectiveness 1 in this article. Irrespective of the chiropractic controversy surrounding it's effectiveness, it is reasonable to include neutrally written material (NPOV) which is a core issue about the field, in the main chiropractic article. Respectively, QuackGuru19:13, 16 April 2008 (UTC)

I disagree with this rationale and maintain that the efficacy section should be split off under each modalities article. I think that is well aligned with the vision of Jimbo, the founder of Wikipedia. I actually think the efficacy section as written comes off very favourable for chiropractic; however as we can't distinguish SMT research from chiropractic specific research without a deadly SYN and since chiropractic is an occupation and not any singular modality with an efficacy that can be measured overall, the inclusion of an efficacy section here seems inappropriate. -- Levine211219:40, 16 April 2008 (UTC)

We have neutrally written SMT research and we should not second-geuss the reviewers. There is no SYN of words. Only well sourced facts. The text is relevant to chiropractic. For example, the most common modality is chiropractic spinal manipulation. When we can discuss the chiropractic's modalities we can discuss chiropractic's effectiveness in the same article as well. They are intimately related. Readers are curious about this kind of stuff. This is part of the mission of the project to improve this article (the sum of all human knowledge). ☺ QuackGuru02:46, 17 April 2008 (UTC)

And the Oscar goes to... ;) That's a bit rich, Quack. You have not addressed any of the points made by myself, Levine2112, DigitalC and Fyslee. We, however have heard the argument and have addressed it in so many ways. I agree with Levine2112 that this is getting repetitive and tendentious. I'm not going to talk about it anymore, it's been 7 days. CorticoSpinal03:35, 17 April 2008 (UTC)

QuackGuru is essentially correct in the argument that effectiveness is a high-importance topic for chiropractic and needs to be discussed in this article. Chiropractic currently expends a significant amount of text on effectiveness, more than the proposed text (Effectiveness 1) that would replace it. This alone casts serious doubt on any claim that effectiveness is not a proper subject for Chiropractic. Eubulides19:08, 18 April 2008 (UTC)

I find it a little surprising that some editors want to completely drop "Effectiveness", when this topic, ie, the effectiveness of SMT has been studied extensively. Since approx 90% of patients of chiropractors receive SMT , I don't see why the effectiveness of this modality can't be presented. The only suggestion might be that the section could address the two or three main things chiropractors treat, low back and neck pain, or perhaps headaches, and leave off the other conditions. As for the point about some studies including PT or osteopath studies, so they are not relevant, well, doesn't Manga include those also? I haven't popped the $20 to buy the full 1993 Manga report and I can't find those details in other sources. But plenty of reviews used by chiropractors use studies of SMT not exclusively performed by chiropractors. I would say, the Effectiveness section could be shortened but not eliminated!CynRNCynRN21:24, 18 April 2008 (UTC)

Clearly, a discussion about the effectiveness of SMT belongs in the article about spinal manipulation|SMT. I tend to agree with the logic that the effectiveness of chiropractic can no more easily be discussed that the effectiveness of dentistry, medicine or veterinarians. I don't feel that either of these points have been addressed and refuted in such a way to merit my changing opinions on this matter. Again, some other form of DR may be a better solution than just rehashing ineffective arguments over and over again. -- Levine211221:45, 18 April 2008 (UTC)

I have tried hard to resolve this issue here, and have resisted bringing in dispute resolution, but I am coming to the reluctant conclusion that you may be right, and we are not getting much closer to consensus here. Eubulides22:08, 18 April 2008 (UTC)

Trying hard to resolve an issue is not to tendentious push the same point over and over again like you've done in the Appeal section. Fyslee, myself, DigitalC, Levine2112 and DoctorisIn have at all one time or another made numerous suggestions on how to overcome this impasse whereas your proposed suggestion of keeping the status quo and violating SYN in doing so is, in part, to blame why we're at this point. At least CynRN compromises and make good counter-suggestions. CorticoSpinal23:45, 18 April 2008 (UTC)

I would not object to shortening Effectiveness 1 somewhat, which was CynRN's countersuggestion. However, several of those editors have objected to any discussion of the effectiveness of chiropractic care, on the grounds that chiropractic is a profession and one cannot measure the effectiveness of a profession. These objections wouldn't be overcome by shortening the section. Eubulides07:44, 19 April 2008 (UTC)

I agree that the Effectiveness of medicine or nursing cannot be measured because these are way too diverse. I understand that chiropractors use many modalities, as well. However, the "key" thing that they do is manipulate backs for back pain. This is their unique specialty. The effectiveness of this subset of their treatment should be included in the article and if readers want to know about the effectiveness of manipulation of, say, asthma, they can go to the SMT article via a link. Sorry about beating this poor, dead horse!CynRNCynRN18:41, 19 April 2008 (UTC)

Speaking as a DC with a spouse who is an RN. . . your assessment could not be further from the truth. . . The key thing I do is no more "manipulate for back pain" than my wife's is checking for blood pressure. . . We can no more assess the effectiveness of a DC than we can a RN. . . an MD. . . a PT. . . a DO. . . a DDS. . .TheDoctorIsIn21:45, 19 April 2008 (UTC)

Reliable sources tend to agree with CynRN. For example, "The core clinical action that all chiropractors agree upon is spinal manipulation." I can't imagine anyone seriously saying "The core clinical action that all RNs agree upon is checking for blood pressure." Chiropractic is heavily identified with SMT, and SMT with chiropractic; in this respect DCs differ greatly from RNs. Eubulides22:22, 19 April 2008 (UTC)

Well I do not agree. . . there are lots of professions practicing spinal manipulation. . . and I check blood pressure during my Dx. . . is that factored into my career's effectiveness? Besides. . . your explanation requires us piecing together information from various sources. . . something which is a no-no here.TheDoctorIsIn07:49, 20 April 2008 (UTC)

Lots of professions may practice spinal manipulation, but only chiropractic is strongly identified with it, and more than 90% of the spinal manipulations in the U.S. are done by chiropractors. Reliable review papers are doing the piecing together for us: they are combining results from various professions to issue recommendations for chiropractic spinal manipulation. It is not SYN to report what these sources say. Eubulides08:28, 20 April 2008 (UTC)

Piecing together neutrally written and highly relevant information from various sources in known as NPOV. Vague comments of a "http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=nextoldid=206840420 no-no here" is unhelpful. So that makes your argument moot. When we follow the lead of the latest state of the art sources, we are keeping the faith with the expert reviewers. We will keep the faith with the vision of "Wikipedia". QuackGuru08:45, 20 April 2008 (UTC)

Other than this statement, I will ignore Quackguru's silly statements. Eubilides. . . only DDS are strongly identified with filling cavities. . . what does that mean for the dentist wiki and its descriptions of effectiveness?TheDoctorIsIn17:28, 20 April 2008 (UTC)

It means that it would be appropriate for Dentistry to discuss effectiveness and safety of filling cavities and similar treatments. For example, a brief discussion of Dental amalgam controversy would be entirely appropriate. Currently, Dentistry is in pretty sad shape (it's marked for expert attention) but if it were in good shape I would expect a short discussion of the topic. Mainstream opinion is more skeptical of the effectiveness of chiropractic than it is of the safety and effectiveness of dental care, so it's even more appropriate for Chiropractic to discuss effectiveness. Eubulides18:40, 20 April 2008 (UTC)

Get a stable version of Effectiveness inserted at Dentistry. . . then we will talk.TheDoctorIsIn22:34, 20 April 2008 (UTC)

Done. Now we can talk. QuackGuru07:16, 4 May 2008 (UTC)

That sort of change is a really bad idea. First, it's not right that a dispute about chiropractic, which gives Dentistry as an example, ends up in somewhat-random edits being made to Dentistry. Second, that particular edit is low quality: it cites just a review of one relatively-minor dental treatment (ozone), which hardly constitutes a proper section on effectiveness. Third, it's not a stable edit (and I suspect it will be reverted, though I'm not the right person to do that) and Dentistry itself is not a high-quality article. All in all, please reconsider that change; I suggest you do the right thing and self-revert. Eubulides07:33, 4 May 2008 (UTC)

This discussion is about Chiropractic, not Dentistry. The fact that Dentistry is weak (and is marked as being weak) does not mean that Chiropractic should be weak. Eubulides08:19, 21 April 2008 (UTC)

Chiropractic is not weak, and to suggest it is another misrepresentation of the truth. Chiropractic, the article is rated higher than either Medicine or Dentistry and have far citations to back up claims made. You are being needlessly argumentative, you're essentially arguing with every regular editor here except for QG (no surprise) and a mild endorsement from CynRN who has displayed far greater wikiquette than yourself by making reasonable compromises and making a decent effort to break the impasse. On the other hand, you're simply stonewalling the SOP section and trying to insert (again) allopathic opinions on chiropractic scope of practice. At least you're facilitating my case.

The weakness comment was about Dentistry, and was intended to suggest that Chiropractic should not mimic a weak article like Dentistry (which would tend to make Chiropractic weak). I apologize if the comment was misinterpreted. The comment about "allopathic opinions" is a bit unclear: do you mean asking for the scope-of-care section to mention the dispute over whether chiropractors are primary-care providers? What problem would there be with mentioning an important mainstream opinion on the dispute, in a neutral way? Eubulides08:41, 23 April 2008 (UTC)

TDII has a good idea for a test. Try inserting an "Efficacy" section at a "mainstream" health profession article such as Dentistry and let's see how it is received. Perhaps on an article which is less controversial than Chiropractic, we can better assess what to do in a situation such as this. -- Levine211218:18, 21 April 2008 (UTC)

Okay. See DentistryEffectiveness. QuackGuru07:16, 4 May 2008 (UTC)

That's already been tried, with Homeopathy, an article that is far more controversial than Dentistry, and it seems to work there. Eubulides09:41, 22 April 2008 (UTC)

Stop comparing homeopathy to chiropractic, they're not even in the same ballpark. CorticoSpinal22:40, 22 April 2008 (UTC)

It's not just Homeopathy. It's also Acupuncture. In general, CAM professions like these have (and deserve) a large section on effectiveness. Chiropractic currently devotes considerable space to effectiveness too (the Manga report, etc.); it's just that it's done in a biased way, and without an explicit "Effectiveness" section. Eubulides08:41, 23 April 2008 (UTC)

There is consensus that the effectiveness (or lack thereof) of chiropractic medicine is of relevance to this article. Any attempt to delete it on the part of editors whose positive-inclinations toward chiropractic medicine are known should be seen for for what it is. ScienceApologist19:46, 20 April 2008 (UTC)

I disagree about such a consensus. I am definitely a chiroskeptic as far as the widespread continued support and promotion of quackery, the common false claims for spinal adjustments, and the tendencies to be anti-medical and anti-science, "ad libitum", but I still think that a discussion of the effect of "chiropractic" should be very limited here. It should mostly occur on the spinal adjustment article, since that is the modality we all can agree is uniquely chiropractic, and which involves numerous controversial claims. It is the sacred cow that is intimately tied to the non-existent vertebral subluxation, not to be confused with real, objectively verifiable, orthopedic subluxations. Do it there, not here. Keep anything here to a minimum, according to the sources. Keep in mind that very, very, very!! often sources mention "effectiveness" and "chiropractic" in the same breath, when they are obviously referring to the "effectiveness" of chiropractic's use of "spinal adjustments", and aren't referring to some general effectiveness of the whole profession. Try to understand what is written, instead of getting stuck with the actual words. This only takes a bit of common sense. It's an extremely common phenomenon, and smart people shouldn't be so careless as to get caught doing superficial reading of sources that are careless with their wording. -- Fyslee / 20:08, 20 April 2008 (UTC)

The newer updated text is shorter than the http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=202398802 previous outdated text. The Effectiveness 1 is written according to the sources in a very neutral way. QuackGuru20:38, 20 April 2008 (UTC)

It isn't much shorter at all really. I think we can do better. We should begin by excluding any research which isn't specifically studying the efficacy of chiropractic techniques as performed by - and only by - chiropractors. Everything else is inapplicable here other than by SYN. -- Levine211201:07, 21 April 2008 (UTC)

How can someone come here a declare that there is a consensus when there is obviously none?TheDoctorIsIn22:34, 20 April 2008 (UTC)

It's shorter than what is there now, which means we can put it in now (to shorten things), and then improve it later as time permits. It would not be right, though, to exclude research that chiropractors themselves include when reviewing effectiveness of chiropractic care. Eubulides08:19, 21 April 2008 (UTC)

This could be solved by changing the section title to "Research" The profession has accumulated enough evidence and research over the last 25 years now that it can stand on it's own. The shift towards evidence-based practices is definitely apparent, one needs to only look at the the quality, depth, breath of clinical practice guidelines which is *by far* the best source for "effectiveness" of "'conditions"' treated by chiropractors. Also, I'd like to know why this is such an issue as mainstream medicine now recommends spinal manipulation in their very own clinical practice guidelines. Isn't that what readers ultimately want to know? What treatments the experts recommend (and for what)?

ScienceApologist, it would be good for you to acclimatize yourself to the conversation first before making patently false declarations. CorticoSpinal04:17, 21 April 2008 (UTC)

I agree with ScienceApologist that readers want to know the strength of the scientific evidence for chiropractic treatment. It was a comment by such a reader that prompted the drafting of Effectiveness 1, and that reader liked an earlier draft of Effectiveness 1 precisely because it covered a topic of real concern. Eubulides08:19, 21 April 2008 (UTC)

While I think that may be a decent assumption you are making, I don't see why the reader wouldn't be opposed to clicking on the corresponding article of each modality used by the core of the chiropractic profession to learn about their relative effectiveness. Effectiveness 1 still includes studies which include other professions performing SMT and thus are not appropriate for this article specifically about chiropractic. -- Levine211218:21, 21 April 2008 (UTC)

First, readers wouldn't know that clicking on the links would give them the effectiveness information they're looking for. Second, it would be quite inconvenient for readers to keep doing the clicky-clicky even if they knew it would give them the information they're looking for. A summary of effectiveness information here is a far better way to present the information to the average reader. Eubulides09:41, 22 April 2008 (UTC)

Stop assuming what readers can and cannot do and the click argument has got to be one of the most ridiculous things I've heard since this discussion began. Eubulides, you're grasping for straws and your arguments while being completely repetitive and tendentious have grown incredibly weak as late. You also have failed to address, for over 2 weeks, any of the concerns raised by myself, Levine2112, DigitalC, Fyslee and DoctorIsIn. A classic case of IDIDNTHEARTHAT. CorticoSpinal22:40, 22 April 2008 (UTC)

I have answered the comments as best I can. We have several remaining disagreements, true. The click argument is a valid one; we want things to be easy to find on Wikipedia. Eubulides08:41, 23 April 2008 (UTC)

While I commend our allopathic editors here for trying to get to the bottom of this, there is a fundamental flaw in their reasoning which is why that a majority of "'regular"' editors rejected the effectiveness proposal outright. The flaw is, chiropractic treatment, is not limited to a single modality, and the effectiveness of a treatment is specific to a given diagnosis. Lastly, research done by MDs, PTs and DOs is being passed off as effectiveness of "'chiropractic"' is a non-starter. We've also omitted the majority important documents in clinical chiropractic history (directly valid) which is somewhat of a problem. CorticoSpinal19:26, 21 April 2008 (UTC)

Nothing is being passed off; Effectiveness 1 clearly states when it's talking about SMT as opposed to chiropractic care. ChiropracticHistory can talk about history; "Effectiveness" should stick with what's known now. Eubulides09:41, 22 April 2008 (UTC)

"clearly states when it's talking about SMT as opposed to chiropractic care." Thank you for proving our point, i.e. this is better off in SMT article. Also, by passing off 99% of the most thorough evidence-based review of chiropractic care, it completely invalidates the section, in its current form. CorticoSpinal22:40, 22 April 2008 (UTC)

A longer discussion of SMT effectiveness would be appropriate for the SMT article, but given the heavy identification of chiropractic care with SMT, a brief summary is appropriate here. Sorry, I don't know what the "passing off 99%" refers to. Eubulides08:41, 23 April 2008 (UTC)

I have to agree that a brief summary of 'Effectiveness of SMT' should be inserted. SMT is the 'core procedure' and one of the 'most studied forms of conservative tx for spinal pain'.(Meeker?) Why should the reader have to dig to see a summary of the effectiveness of the treatment with SMT of back pain?CynRNCynRN18:17, 23 April 2008 (UTC)

Efficacy of SMT belongs in the SMT article. Efficacy of SMT with back pain belongs in the SMT and the back pain article. If there are studies specifically about chiropractic care (and not SMT as performed by other professions) then perhaps there is an argument to include that in this article. I feel like we are going in circles here with our argumentation and the net result is that we are not getting anywhere. Meanwhile, I don't see any disagreement that the efficacy of SMT should not be in the SMT article. Perhaps, in the meantime, someone should just take the SMT efficacy material and place it in the SMT article. (And take the efficacy material of the other modalities and place them in their respective modality's article.) Is that a reasonable way to at least take a step forward out of this circular quagmire that we are in? -- Levine211218:44, 23 April 2008 (UTC)

There are a lot of old and obsolete studies that have no historical impact. We will be adding the newer studies and then we can delete the older studies. We are essentially removing duplication. See here. -- out with the old and in with the new (duplication). QuackGuru07:56, 27 April 2008 (UTC)

It would be reasonable to add effectiveness sections to those other articles too. That'd be a lot of work, though. There are a lot of other articles. I quail at editing them all (just as I would quail at reading them all, if I were a reader interested in the topic of the effectiveness of chiropractic care). If somebody wants to volunteer to do that, though, all power to them. Eubulides08:46, 27 April 2008 (UTC)

There is more discussion below. See older references are obsolete when newer references are currently available (common sense). QuackGuru16:40, 7 May 2008 (UTC)

CfI: Scope of Practice

Chiropractors are considered primary contact providers who emphasize the conservative management of the neuromusculoskeletal systems without the use of medicines or surgery. The practice of chiropractic medicine involves the restricted acts of diagnosis and spinal manipulation and involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests, as well as other specialized tests as required.cite 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 A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. Common patient management involves:

spinal manipulation and/or other manual and/or soft tissue therapies

rehabilitative exercises

health promotion

physiological therapeutic modalities

conservative and complementary procedures.

health and lifestyle counseling

cite book|last=Haldeman |first=Scott|coauthors=Chapman-Smith, David, Petersen, Donald, Jr.|title=Guidelines for Chiropractic Quality and Practice Parameters|publisher=Jones and Bartlett|location=Sudbury, MA|pages=111-113|isbn=0-7437-2921-3|url=http://books.google.ca/books?id=MHqo1ngXtkoCpg=PA111lpg=PA111dq=source=webots=lPUzIAEwfMsig=2JZUNBxP4KNjwSuz_EvqIP5gzoYhl=enPPA111,M1|accessdate=2008-04-16|language=English

Chiropractors generally cannot write medical (pharmaceutical) prescriptions; however there has been a gradual shift within the profession with a slight majority of North American DCs favouring an expansion of scope of practice to include limited prescription rights.cite book |author= McDonald WP, Durkin KF, Pfefer M "et al." |date=2003 |title= How Chiropractors Think and Practice: The Survey of North American Chiropractors |location= Ada, OH |publisher= Institute for Social Research, Ohio Northern University |isbn=0972805559cite journal |journal= Semin Integr Med |date=2004 |volume=2 |issue=3 |pages=92–8 |title= How chiropractors think and practice: the survey of North American chiropractors |author= McDonald WP, Durkin KF, Pfefer M |doi=10.1016/j.sigm.2004.07.002 |laydate=2003-06-02 |laysummary=http://www.chiroweb.com/archives/21/12/19.html |laysource= Dynamic Chiropractic A notable exception is the state of Oregon which is considered to have an "expansive" scope of practice of chiropractic, which allows chiropractors with additional qualifications to prescribe over-the-counter drugs. With additional training and certification licensed chiropractors (DCs) and veterinarians (DVMs) can expand their scope of practice and practice veterinary/animal chiropractic which includes assessment, diagnosis and treatment of biomechanical disorders of animals that may be amenable to manual therapy. cite web|url=http://www.veterinarychiropractic.ca/|title=Canadian Animal Chiropractic Certification Program|language=English|accessdate=2008-04-17cite web|url=http://www.animalchiropractic.org/animal_chiropractic_certification.htm|title=Animal Veterinary Chiropractic Association|language=English|accessdate=2008-04-17 Chiropractors are also generally permitted to use adjunctive therapeutic modalities such as acupuncture and manipulation under anesthesia with additional training from accredited universities/colleges.

Currently, chiropractic is a regulated health care profession with licensure requirements in over 50 countries globally although chiropractic medicine is most established in North America, Australia as well as a few European countries. cite web |url=http://www.chiropracticdiplomatic.com/strategies/global_strategy.pdf |title=Chiropractic Global Professional Strategy|author=Tetrault, Michael |publisher=Chiropractic Diplomatic Corps |accessdate=2008-04-18 Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic. cite book|last=Pybus|first=Beverly, E.|coauthors=Cairns, Carol, S.|others=C|title=A Guide to AHP Credentialing |publisher=hcPro |pages=241-243 |isbn=1-57839-478-3 |accessdate=2008-04-16cite web|url=http://www.chiroweb.com/archives/ahcpr/chapter3.htm|title=CHIROPRACTIC TRAINING|coauthors=Ian D. Coulter, PhD Alan H. Adams, DC; Ruth Sandefur, DC, PhD|publisher=AHCPR|language=English|accessdate=2008-04-17cite journal|coauthors=Michael A. Mestan DC, John A.M. Taylor DC, G. Lansing Blackshaw PhD, and J. Clay McDonald JD, DC|date=June 2006|title=Establishing an Accredited Master of Science in Diagnostic Imaging Degree at a Chiropractic College |journal=Journal of Manipulative and Physiological Therapeutics|volume=29, |issue=5|pages=410-413 |url=http://www.sciencedirect.com/science?_ob=ArticleURL_udi=B6WK1-4K4DFWG-K_user=10_rdoc=1_fmt=_orig=search_sort=dview=c_acct=C000050221_version=1_urlVersion=0_userid=10md5=2f2a8802530a8e3ae4d8de4a3feaee80|accessdate=2008-04-16

Final thoughts? CorticoSpinal23:13, 24 April 2008 (UTC)

Sorry, what does "Cfl" mean?

The first sentence contains a serious POV problem, discussed in Scope of practice comments on primary care, which has not been addressed.

The first two sentences are incoherent; the first says chiropractors have more of the attributes of a specialty, whereas the second says they are primary care providers. This is an important point. The current draft seems to contain leftover text from the POV problem discussed in Scope of practice comments on primary care. Let's fix the problem by changing ". Chiropractors are considered primary care providers who" to "; they". The alternative approach of removing the first sentence would not fix the POV problem.

The cited sources do not support the 3rd 2nd sentence's claim that diagnosis and spinal manipulation are restricted acts. Nor do they use the phrase "chiropractic medicine". On the other hand, they do say that SMT is the primary therapeutic procedure, an important point that should be mentioned. These issues were raised in Scope of practice comments on therapy and diagnosis but have not been followed up on. They need to be fixed.

Legal and or peer-reviewed sources will be found to verify that DCs, where regulated, are legally allowed to diagnose and adjust (perform spinal manipulative therapy). CorticoSpinal06:38, 26 April 2008 (UTC)

There should be no problem finding such sources. However, that is not what the text currently says. The text currently says that diagnosis and spinal manipulation are restricted acts. Restricted to whom? And in what jurisdictions is it restricted, and where isn't it restricted? The article needs a reliable source on this subject if it is to cover the issue. Eubulides08:46, 27 April 2008 (UTC)

The bullet list contains the jargon "physiological therapeutic modalities" that should be rephrased using words that ordinary readers will understand. The Google Books URL should go, as it's not reliable. The bullets themselves are not needed; an inline list should suffice. These topics were discussed in Scope of practice comments on common patient management but have not been followed up on.

Therapeutic modalities and adjunctive therapies/techniques is another section we shall add. I insist on the bullets for aesthetic purposes, improved readibility and syle. If you would like Scope of Practice in Medicine not to have bullets then I respect your professional judgment. CorticoSpinal06:38, 26 April 2008 (UTC)

There is already a section ChiropracticTreatment procedures on that subject. The section is very weak, though (most of its text is about history!) and can be greatly improved. Eubulides08:46, 27 April 2008 (UTC)

The cited source does not support the claim that there has been a "gradual shift". The shift was from opposition to drugs, but the text doesn't say that. Since it's just one survey, it'd be better to say that, and give its date. There's no need for the (pharmaceutical) and the text should wikilink to Medical prescription. There is no need to repeat the phrase "scope of practice" here. The two citations about surveys are really just the same citation, and should be combined. All these problems would be fixed by the wording proposed in Scope of practice comments on medical prescriptions, which has not been followed up on.

::*If the term 'shift' is preferred to 'gradual shift' as noted above; then that's fine but no need to mention the survey but should look for another source to help strengthen the claim. Agree it should link to medical prescription, pharmaceutical can go. If you feel the article is better if the citation is combined then so be it. CorticoSpinal06:38, 26 April 2008 (UTC)

:::* http://en.wikipedia.org/w/index.php?title=Chiropracticoldid=206011789Scope_of_practice The previous version of the article (just before the edit war) mentioned the survey and its date. It is standard practice when there's just a single survey (as opposed to a review) to give the date and mention that it's just a survey. It took only 4 words in the article "in a 2003 survey" and that's a small price to pay. Eubulides08:46, 27 April 2008 (UTC)

The claim about Oregon is unsourced and requires a source. See Scope of practice comments on Oregon.

The material on veterinary chiropractic is poorly sourced and is not notable. It'd be OK to mention it in one phrase, but it's way overkill to go on and on about it. This was discussed in Scope of practice comments on veterinary chiropractic.

The claim about acupuncture and MUA is unsourced and its "generally permitted" is misleading. See Scope of practice comments on acupuncture and MUA.

I suggest you take a look at Veterinary chiropractic for notability purposes. If anything, we will be adding more due to the fact its virtually mainstream (according to the AVMA), it provides a new method of assessment, treatment and diagnosis (according to DVMs), the fact the only legal providers of animal/veterinary chiropractor are licensed DCs and DVMsinterprofessional collaboration between chiropractors and veterinarians, amazingly practical and good research by DCs, DVMs, PhDs, DVM/DC/PhD (it's true!). We can add a qualifying statement if you wish for acupuncture (in the Scope of 60% and rising in the US alone...) and we can get better sources on MUA. I do know its use is increasing too and it's DCs and MDs "collaborating".

Veterinary chiropractic is notable at the level of the Veterinary chiropractic article. It's not notable here to be worth spending 40 words and two citations on. That's more than the 18 words Chiropractic currently expends on explaining spinal manipulation ("involves directed thrust to move a joint past its physiological range of motion without exceeding the anatomical limit" is all it says)! A brief wikilinked phrase ("veterinary chiropractic") should suffice. The topic is controversial, as the http://www.amerchiro.org/level2_css.cfm?T1ID=10T2ID=117107 official policy of the American Chiropractic Association Eubulides08:46, 27 April 2008 (UTC)

The claim about "50 countries" disagrees with the cited source, which says there are only 3 countries with a fully established profession. See Scope of practice comments on global scope.

Surely you don't suggest that there are "'far"' more than 3 countries where the profession is regulated and/or that have accredited schools of chiropractic medicine? If you would like a list of the "chiropractic top 10" we can do that as well, but I would insist, again, on bullets. CorticoSpinal06:38, 26 April 2008 (UTC)

The text should accurately reflect the source. Currently it does not. This must be fixed. I am not objecting to the source, just the draft's incorrect characterization of what the source says. It would not be appropriate to list the "20 or so" countries where "there is yet much to be done before the profession can claim to be fully established"; for one thing, the "20 or so" means the list isn't precise. Eubulides08:46, 27 April 2008 (UTC)

The section on specialties contains way too many words. A first cut at fixing this is in Scope of practice comments on specialties.

The wording is appropriate given the weight, notability and verifiability of the subject. CorticoSpinal06:38, 26 April 2008 (UTC)

The wording contains much duplication, which can be improved regardless of the notability of the subsection. Eubulides08:46, 27 April 2008 (UTC)

The quality of sources can be improved, as suggested in Scope of practice quality of sources.

Overall, almost none of the comments made in Scope of practice comments have been addressed; even most of the undisputed comments remain unaddressed. Most important, the draft takes a particular POV on the scope-of-practice controversy described in Scope of practice comments on primary care; it should cover the controversy neutrally. Eubulides08:16, 25 April 2008 (UTC)

The quality of the sources are not in dispute nor necessarily is the content (until closer examination) what is disputed is the appropriateness of inserting opinion and making comment on legal matters. It's a precedent that it would set across all article's This is kinda like cherry picking the sources to support or refute a given POV and an example of malfeasant source mining. Let's go with AGF here that my intent, the tone, the notability and factuality have been adequately captured of the profession, in a global POV. CorticoSpinal06:38, 26 April 2008 (UTC)

The quality of sources are indeed in dispute. That is what "The quality of sources can be improved" means. It is not "cherry-picking" to supply higher-quality sources and ask that the text reflect their contents. Eubulides08:46, 27 April 2008 (UTC)

The sources suggested will be used for the criticisms and controversy section. Please do not take advantage of my good faith here. Criticisms and controversies must be NPOV and carry the right weight. Perhaps you can make a list of the controversies and then we can collect citations. CorticoSpinal23:29, 5 May 2008 (UTC)

It would not be right for ChiropracticScope of practice to take one side of the controversy, and to banish alternative viewpoints to a new "Controversy" section. That would give the "Scope of practice" reader the mistaken impression that there's a unified mainstream opinion about scope of practice, and that this opinion is that chiropractors are and should be primary contact providers for neuromusculoskeletal conditions. The topic is not so cut-and-dried, with debate both within and without chiropractic, and the various viewpoints should be mentioned when this topic comes up in ChiropracticScope of practice. Eubulides09:25, 7 May 2008 (UTC)

The first sentence was struck out. CynRN suggested primary contact. That is fair. Scope of practice is a legal right; editorial comments from allopaths can be placed in another section, perhaps medical opposition. Ironically enough, the proposed edits in question further support the conclusions by Theberge (2008) which orthodox medicine continuously tries to marginalize chiropractic. This is in action here. There was no "opposition" to drugs as implied; I know, I'm a DC. They were not favoured. There is a difference. The bullets stay; it improves readability and you even suggested it. More nitpicking. 50 countries is accurately according to the WFC, moreso the article goes out of its way to say it's primarily established in a in a CONTINENT (North America) as well as Australia and selected Euro counties. This is factual and it stays. Chiropractic medicine as a phrase is routinely used in both the literature and routinely in public. It stays as well; more stalling over trivial stuff noted though. The specialties is fine as is, in fact you are the only editor who has disputed any of the aforementioned. Time to cut bait, Eubulides. DigitalC provided a source for Oregon. The act of communicating a diagnosis and utilizing spinal manipulation are not within the public domain (i.e. anyone can do them) unlike say, exercise-prescription or soft tissue therapy. This is common knowledge. You are being extremely tendentious with this section and everyone involved has tried to appease you in some form. So, please bring better arguments because the regular editors have already addressed these concerns. Thanks. CorticoSpinal15:58, 25 April 2008 (UTC)

Sorry (again); what does "Cfl" mean?

A Wikipedia article cannot cite an editor's expertise. It must cite reliable sources. "I know, I'm a DC" does not suffice.

It is not common knowledge that "The act of communicating a diagnosis and utilizing spinal manipulation are not within the public domain". (Walk up to the average person on the street and say that sentence, and see what happens....)

Not that this should matter, but the main source I suggested (MH2002) is by DCs. It is not "editorial comment by allopaths". And (again) it is more reliable than the sources given above.

I did not suggest these bullets.

The cited source does not say 50 countries; it says 3 for fully established profession, and 20 where much work needs to be done. Again, claims must be sourced; this claim "disagrees" with its source.

::* I will concede the "chiropractic medicine" point, though I still prefer using the terminology of the source.

There is no source for Oregon in the text. If one gets added, that would remove that objection.

There is a serious POV issue about scope of practice, which has not been addressed.

Several other minor points remain unaddressed in the list above. I have struck out the addressed points.

No other editor has addressed the concerns mentioned above.

Eubulides

21:53, 25 April 2008 (UTC)

CfI=candidate for insertion. So, to be clear, you want me to track down a reference that supports that DCs can diagnose and manipulate? This would be a legal document, as it is a legal matter. I know the Meeker is a DC and Haldeman a dual registrant. Their paper could easily go in medical opposition or a controversy section that I'm pondering of writing up but fear will be abused and gamed by a certain few editors thereby resulting is severe WEIGHT or POV issues. It's a question of trust; I would be inclined to nominate CynRN to objectively oversee my writing of that section to make sure that it's adequate and represents orthodox concerns but doesn't come off as a condemnation hit piece. Controversial elements of safety and vaccination could be rolled into there as well. I shall provide the WFC document which lists 60 countries where there is some kind of regulation and perhaps include a blurb about it being practiced in an additional 40 with no formal regulation as of yet although that's probably not relevant to scope of practice necessarily but could be used in a practice demographics section I've working on offline. Thank you for the concession on chiropractic medicine. If DigitalC could supply the Oregon ref that would be helpful, I think it got carted away in the archive. How do you propose we resolve the purported serious POV issue? I argue that SOP should reflect the legal common scope of practice whereas you'd like to include some lit regarding some discussion re: scope of practice which I feel belongs in a separate section, even below scope if you'd like. Unfortunately I'm rather tied up this weekend and won't be able to contribute much and a breather would probably be OK anyways. I hope to chip away at these concerns; and if we achieve a consensus version, we can always ask an admin to add that section whilst keeping the article locked until we have resolved the other sections that need rewrites (education, safety, research (aka effectiveness) contemporary (to contrast with history), practice styles/schools of thought, etc. If we can continue what seems to be a slight thawing of relations here, it should bode well for the article. Please to realize that I don't want chiropractic to read as a promo piece, but I don't want it to read as a controversial allopathic criticism piece either. If it would be OK, I propose that I take a bit of the lead and draft some proposals and your discerning eye can pick apart the MAJOR content disputes and we can iron out the details in the future. Thoughts? —Preceding 22:14, 25 April 2008 (UTC)

Yes, please track down a reference. I suspect there's no single legal document, as each state/province has its own legal definition. The ideal reference, if one exists, would be a reliable summary of the legal statuses in the U.S., Canada, and Australia, along with the other countries with less-well-developed, all published in high quality a peer-reviewed journal. Most likely there won't be anything matching that ideal, but let's see what can be found. I suspect that it will be appropriate to briefly cite MH2002 on this, as it is a high-quality source of what the status is in practice (as opposed to what it is in law), but again, let's see what other sources say. Haldeman is a DC/MD yes, but he's the lead editor of a leading textbook on chiropractic, and is a source friendly to chiropractic.

The Oregon reference and the other asked-for references (WFC? it's not clear to me what they would be) also need to be tracked down and checked against the text.

The evidence-based section ("Scientific investigation", which by the way I wouldn't mind retitling to "Evidence-based medicine" or "Evidence-based health care") should focus on evidence, not controversy. To some extent it's impossible to ignore the controversy entirely, of course, but it would not do to put all controversial material off into a "Controversy" section, because then almost all of Chiropractic would go into the "Controversy" section. Instead, the controversy section should be reserved for political issues (AMA opposition, etc), leaving the technical issues (effectiveness, etc) for the technical sections.

Similarly, a brief mention (one sentence, say) of the various possibilities for scope of practice should be mentioned in the scope of practice section, reserving any heavy-duty political stuff for the controversy section. Perhaps the legal review source will have this, or perhaps we can just use MH2002.

I like your proposal for taking time to chip away at the various sections that are needed. There is no rush. I suggest doing one section at a time rather than trying to do them all at once. I do ask for progress on drafting "Effectiveness" first, as it was proposed a while ago (April 1) and it attempts to fix a serious POV problem in the existing text. As you know, my concerns are high-quality supporting citations (even for stuff that is obvious to practitioners), along with a careful (that is, neither dismissive nor subservient) coverage of skeptical sources.

Thanks, and good luck. Eubulides23:09, 25 April 2008 (UTC)

There are still POV problems with this Scope of practice. The problems may seem trivial but they are still problems. When it is up to Wikipedia's standard it can be restored. Until then, it is a no go. I want to see the Scope of practice section in the article as soon as the POV issues are fixed. QuackGuru02:46, 1 May 2008 (UTC)

This recent http://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=210435654oldid=210432145 controversial change added unsourced material to the article. QuackGuru22:50, 5 May 2008 (UTC)

Another http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=210435771 controversial change added unsourced material to the article. QuackGuru22:55, 5 May 2008 (UTC)

You are calling the scope of practice section unsourced? CorticoSpinal23:29, 5 May 2008 (UTC)

No, he is saying that both changes added unsourced material. And that is correct: both changes added material with "citation needed" fact tags, indicating that the added material has verifiability issues. It reasonable to ask that material be properly sourced before it goes in. Eubulides09:25, 7 May 2008 (UTC)

RfC: Effectiveness of chiropractic care

Is Chiropractic's discussion of effectiveness biased, and if so, what should it be replaced with?

Claim of bias and proposal for fix

This subsection addresses a serious POV problem with the http://en.wikipedia.org/w/index.php?title=Chiropracticaction=history current version of Chiropractic, namely, heavy bias in its discussion of the effectiveness of chiropractic care. Much of the problem has been discussed extensively on this talk page for weeks, so far with no consensus. This subsection is an attempt to gather the issues together in one spot and propose a solution. This is a controversial issue that may require some work to resolve; please bear with the following exposition as it covers many issues. Eubulides08:36, 24 April 2008 (UTC)

"To help other editors follow this discussion better, please place comments below, after the the proposal."

POV in existing coverage

There is conflicting evidence about the effectiveness of chiropractic care, and Chiropractic should present the evidence fairly without giving undue weight to minority views. Unfortunately Chiropractic currently falls seriously short of this goal. Here is a summary of POV problems in Chiropractic's treatment of effectiveness:

Chiropractic gives a section to the Manga report, a 1993 effectiveness paper highly favorable to chiropractic that was not published in a peer-reviewed journal. Chiropractic does not mention the widespread peer-reviewed criticism of the Manga report (for example, "The Manga report was not a controlled clinical trial but a review of the literature that offered an opinion that has not been experimentally established." in Grod "et al." 2001, PMID|11677551). In any event, the Manga report was long ago superseded by higher-quality work and is not now a reliable source for effectiveness.

Chiropractic gives a section to worker's compensation studies that, like the Manga report, are old, disputed, and strongly pro-chiropractic. Contrary evidence is widely available in peer-reviewed journals, e.g., Hess Mootz 1999 (PMID|10395430), http://www.jstor.org/stable/253608 Johnson "et al." 1999, but Chiropractic does not mention it. Again, this material is obsolescent and low quality by today's standards, and is not now a reliable source.

Chiropractic gives two sections (ChiropracticAmerican Medical Association (AMA) and ChiropracticBritish Medical Association) that mention old endorsements about effectiveness and referrals. This material might be worth putting into the Chiropractic history subpage here, but it is way too much detail here, and it gives the mistaken impression that the old AMA statement reflects the best current science on effectiveness.

ChiropracticScientific investigation repeats material from ChiropracticPhilosophy that (aside from being redundant) has little to do with scientific investigation: it approvingly describes some antiscientific components of chiropractic philosophy, which is POV. The section's second paragraph is highly dated (it talks about grant funding in 1994 and 1995, which again is material suitable for Chiropractic history but not here) and talks with almost entirely approving note about chiropractic research (again, POV coverage of a controversial subject). The section's third paragraph is entirely unsourced; that is not POV in itself, but it is a worrisome sign.

In short, Chiropractic's coverage of effectiveness (a core topic) is currently weak and is heavily biased in favor of chiropractic. Eubulides08:36, 24 April 2008 (UTC)

"(Again, please place further comments below.)"

Criticisms of earlier proposed fix

To help fix this I proposed Effectiveness 1, a draft section on effectiveness that relies on recent high-quality scientific sources, along with a proposal to remove the obsolescent material. This draft has been discussed extensively in Draft effectiveness section and An appeal: Drop the "effectiveness" discussion, so far with no consensus. To help move matters forward I have drafted a new section below, Effectiveness 2, which attempts to respond to some (but not all) the concerns expressed about Effectiveness 1. These concerns ("italicized" below) included the following:

"Ernst is biased." (Edzard Ernst is a prominent critic of chiropractic, cited by Effectiveness 1.) However, all the sources for Chiropractic are biased to some extent. This includes Ernst (an MD/PhD/FRCP/FRCPEd who is critical of chiropractic) along with (say) Cheryl Hawk (a DC/PhD who is supportive). Wikipedia should not omit critics of chiropractic, any more than it should omit supporters. Ernst's work is well known and widely cited; for example, Google Scholar lists Ernst as one of the five key authors for the search "chiropractic effectiveness". The work of critics like Ernst should be summarized fairly and with due weight.

"The draft cites Ernst too often." To help address this problem, Effectiveness 2 cites Ernst just twice.

"The draft is too long." It's shorter than what is in there now. By my count the entire proposed change, including removal of obsolescent material, would replace 928 words of text with 621 words, a 33% savings.

"Chiropractic is a profession, not a treatment, so this material should be moved to articles about each particular treatment."

*This objection has not been raised against longstanding effectiveness-related text in the current article (ChiropracticThe Manga Report through ChiropracticScientific investigation), text which is heavily biased in favor of chiropractic. Why raise the objection now that a much-better-sourced and much-less-biased alternative has become available?

*The effectiveness of chiropractic care is a core question of controversy in chiropractic, and should be summarized in Chiropractic even if the details are so voluminous that they need to be in a subpage.

*The effectiveness question is already raised in ChiropracticHistory, for example, which discusses allegations that chiropractic is "an unscientific cult". The answer to this charge should be addressed in Chiropractic, not in some subpage.

*There is a reader-expressed need for coverage of effectiveness here. Effectiveness 2 is derived from material written in response to a reader request for effectiveness, and the reader approved of an earlier draft.

"Other articles (Dentistry, for example), don't have effectiveness sections." Effectiveness is a core issue in Chiropractic because of the profession's controversial history. The fallout from that history is still with us, so the topic needs coverage in Chiropractic far more than in Dentistry. The text of Effectiveness 2 is considerably shorter than (for example) Acupuncture Scientific research into efficacy, Homeopathy Research on medical effectiveness, and Traditional Chinese medicine Efficacy, so the size of Effectiveness 2 is not at all out of line for this sort of complementary and alternative medicine article. Again, Chiropractic has had substantial material about effectiveness for quite some time, so why raise this criticism now?

"The draft includes research on spinal manipulation performed by non-chiropractors, which is not relevant." It is standard practice include such research in high-quality reviews and practice guidelines, written by and for chiropractors (for example, http://ccgpp.org/lowbackliterature.pdf Meeker "et al." 2007; or Bronfort "et al." 2008, PMID|18164469). We should not use a more-selective research standard than the published experts in the field; instead, we should defer to the experts' judgment. To help assuage concerns on this point, the revised draft (in Scientific investigation 2 below discusses the issue, citing Villanueva-Russell 2005 (PMID|15550303).

"The draft should emphasize sources written by chiropractic researchers, as they are the experts on chiropractic." Wikipedia should give the most-detailed coverage to reliable mainstream scientific and medical views on effectiveness of chiropractic care, while of course also fairly representing minority viewpoints. This is as per the usual WEIGHT policy.

Eubulides

08:36, 24 April 2008 (UTC)

"(Again, please place further comments below.)"

Revised proposal for fix

The revised proposed fix is to replace the sections Chiropractic The Manga Report through Chiropractic Scientific investigation with the following text (between the horizontal lines), and to change Chiropractic Safety from a section (with two "=="s) to a subsection (with three "==="s), so that it becomes a subsection of the new Chiropractic Scientific investigation section. Please see http://en.wikipedia.org/w/index.php?title=User:Eubulides/Sandboxdiff=prevoldid=207809531 this listing of changes for details.

"(Again, please place further comments below.)"

Scientific investigation 2

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care. This work has focused on spinal manipulation therapy (SMT) independently from the underlying philosophy of chiropractic, with little consensus as to who should administer the SMT, raising concerns by chiropractors that orthodox medical physicians could "steal" SMT procedures from chiropractors; the focus on SMT has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.cite journal |journal= Soc Sci Med |date=2005 |volume=60 |issue=3 |pages=545–61 |title= Evidence-based medicine and its implications for the profession of chiropractic |author= Villanueva-Russell Y |doi=10.1016/j.socscimed.2004.05.017 |pmid=15550303

Effectiveness 2

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment. Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective.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 Chiropractic care, like all medical treatment, benefits from the placebo response,cite journal |journal= Ann Intern Med |date=2002 |volume=136 |issue=11 |pages=817–25 |title= The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance? |author= Kaptchuk TJ |pmid=12044130 |url=http://annals.org/cgi/reprint/136/11/817.pdf |format=PDF and it is hard to construct a trustworthy placebo for clinical trials of SMT, as experts often disagree whether a proposed placebo actually has no effect.cite journal |journal= Aust J Physiother |date=2006 |volume=52 |issue=2 |pages=135–8 |title= Selecting an appropriate placebo for a trial of spinal manipulative therapy |author= Hancock MJ, Maher CG, Latimer J, McAuley JH |pmid=16764551 |url=http://www.physiotherapy.asn.au/AJP/52-2/AustJPhysiotherv52i2Hancock.pdf |format=PDF Many controlled clinical studies of SMT are available, but their results disagree,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 |doi=10.1258/jrsm.99.4.192 |pmid=16574972 |url=http://www.jrsm.org/cgi/content/full/99/4/192 and they are typically of low quality.

Quality of SMT studies:

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

cite journal |journal=Spine |date=2008 |volume=33 |issue=8 |pages=914–8 |title= The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review |author= Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW; Expertise-Based RCT Working Group |doi=10.1097/BRS.0b013e31816b4be4 |pmid=18404113

Although a 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference,cite journal |journal= J Pain Symptom Manage |date=2008 |volume=35 |issue=5 |pages=544–62 |title= Chiropractic: a critical evaluation |author= Ernst E |doi=10.1016/j.jpainsymman.2007.07.004 |pmid=18280103 a 2008 supportive review found serious flaws in the critical approach, and found that SMT and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments.

Available evidence covers the following conditions:

"'Low back pain"'. Opinions differ on the efficacy of SMT for nonspecific or uncomplicated 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 An authoritative 2004 review found that SMT or mobilization is no more or less effective than other interventions.cite journal |journal= Cochrane Database Syst Rev |date=2004 |issue=1 |pages=CD000447 |title= Spinal manipulative therapy for low back pain |author= Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG |doi=10.1002/14651858.CD000447.pub2 |pmid=14973958 A 2008 review found strong evidence that SMT is similar in effect to medical care with exercise, and moderate evidence that SMT is similar to physical therapy and other forms of conventional care.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 |doi=10.1016/j.spinee.2007.10.023 |pmid=18164469

"'Whiplash and other neck pain"'. There is no overall consensus on manual therapies for neck pain.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 An authoritative 2004 review found that SMT/mobilization is effective only when combined with other interventions such as exercise.cite journal |journal= Cochrane Database Syst Rev |date=2004 |issue=1 |pages=CD004249 |title= Manipulation and mobilisation for mechanical neck disorders |author= Gross AR, Hoving JL, Haines TA "et al." |doi=10.1002/14651858.CD004249.pub2 |pmid=14974063 A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis.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 A 2007 review found that SMT and mobilization are effective for neck pain.

"'Headache"'. An authoritative 2004 review found that SMT may be effective for migraine and tension headache, and SMT and neck exercises may be effective for cervicogenic headache.cite journal |journal= Cochrane Database Syst Rev |date=2004 |issue=3 |pages=CD001878 |title= Non-invasive physical treatments for chronic/recurrent headache |author= Bronfort G, Nilsson N, Haas M "et al." |doi=10.1002/14651858.CD001878.pub2 |pmid=15266458 A 2006 review found no rigorous evidence supporting SMT or other manual therapies for tension headache.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"'. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,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 and a lack of higher-quality publications supporting chiropractic management of leg conditions.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 There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine)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 and no scientific data for idiopathic adolescent 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 A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision 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 Other reviews have found no evidence of benefit for 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 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 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 or 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

"(End of proposed replacement text.)"

"(Please place further comments below.)"

Comments on claim of bias and proposal for fix

"(Please put comments here.)"

Thank you for starting the RfC Eubulides, there was no consensus to proceed and this was the best step forward. However, in my opinion, Effectivenes 2 suffers the same problems that were raised with Effectiveness 1. That is, undue weight is given to SMT. SMT and Chiropractic are not the same. Effectiveness of a particular procedure belongs on the article for that procedure. Chiropractic care consists of much more than SMT. For example, from the Chiropractic article, trigger point therapy is used in 45% of patients; Electrical stimulation is used in 46% of patients; Ultrasound is used in 30% of patients. None of these therapies are mentioned in effectivess 2. The problem with addressing the question of "What is the effectiveness of Chiropractic" is that it is too broad. Chiropractic is a profession, and not a treatment modality. As such, the question should be "What is the effectiveness of TREATMENT X". However, even that is too broad. We need to know what condition we are determining the effectiveness of the treatment for - for example, Therapeutic ultrasound may be effective in treating plantar fasciitis, but not in the treatment of symptomatic lumbar disc disease. So, the question must be "What is the effectiveness of TREATMENT X for condition Y". Effectiveness 2 spends the majority of the time talking about SMT (a treatment procedure that is performed by Physical Therapists, Osteopathic Doctors, Naturopathic Doctors, and some Medical Doctors), without giving due weight to other treatment modalities. The entire clinical encounter of a Chiropractic visit is more than just SMT, and therefore unless there are enough sources that discuss the effectiveness of CHIROPRACTIC, then the effectiveness of SMT belongs on the article for SMT.DigitalC09:31, 24 April 2008 (UTC)

Interesting, but I think that there is very good cause to discuss the effectiveness of principal treatments. Certainly these should not go into great depths (expect in their individual articles). But a sentence or two on what evidence there is, or lack therof, would not go amiss, especially if they are primarily associated with the proffession. Jefffire09:46, 24 April 2008 (UTC)

I agree, there is good cause to discuss the effectiveness of treatments. However, that belongs on the page for the treatment (whatever treatment modality that may be).DigitalC11:06, 24 April 2008 (UTC)

I argue for nothing more than a sentence or two giving the positive and/or negative reviews for a few of the major treatments. There's no reason why even the briefest of discussions have to be entirely banished to the specialised articles. Jefffire12:05, 24 April 2008 (UTC)

DigitalC has summed up my thoughts perfectly, so no need to repeat them. Suffice it to say that the research we include in this article about chiropractic should be research specifically about chiropractic and not research about DOs and PTs performing SMT which we can only apply to chiropractic by means of a OR/SYN violation. -- Levine211217:36, 24 April 2008 (UTC)

As far as I see it, there are 2 main issues. 1) the validity of PT, MD, DO research on SMT to determine the effectiveness of "'chiropractic care"' and b) the omission of expert, evidence-based clinical practice guidelines findings (such as the CCCGPP, for example). I myself have no objection to having a quick discussion of effectiveness of x treatment for y condition, as per DigitalC's recommendations and CynRNs suggestion. CorticoSpinal15:55, 24 April 2008 (UTC)

The above remarks essentially repeat comments in Criticisms of earlier proposed fix. Eubulides08:16, 25 April 2008 (UTC)

Exactly, criticisms and concerns that YOU have not addressed since YOU insist in being the primary author of the science of chiropractic. Perhaps if chiropractors would be allowed to include research about chiropractic science and the development of chiropractic research things would flow better, no?

These comments are addressed in Criticisms of earlier proposed fix. I have never insisted on being the primary author. Effectiveness 2 contains extensive references to research reviews written by chiropractors. Eubulides21:53, 25 April 2008 (UTC)

Agreed that that information is dated, could be pared and moved to history. I don't think that was really ever the issue; and as far as I can remember no one disputed that the info was dated. For example, that info was already moved to History without any peep from any regular editor here. CorticoSpinal15:55, 24 April 2008 (UTC)

Clearly it (coverage of the Manga report etc.) should be pruned back severely. The current suggestion is to simply remove it. However, it addresses an important issue (namely effectiveness), which should be covered. Eubulides08:16, 25 April 2008 (UTC)

There is absolutely no reason why Manga, which even Jefffire acknowledged read neutral needs to be pruned from 4 lines. It's already been moved to history. What's next, suggesting to remove Manga altogether? CorticoSpinal16:29, 25 April 2008 (UTC)

Yes, the current proposal is to remove Manga altogether. The Manga report is not neutral, and the coverage of it in Chiropractic is heavily biased. This is discussed in POV in existing coverage. I would not object to replacing it with neutral coverage, but that would be more work. The simplest thing is to remove it. That obsolete report is not that relevant now anyway. Eubulides21:53, 25 April 2008 (UTC)

No one had ever suggested of omitting Ernst. How an MD/PhD can be "'more"' "expert" in chiropractic effectiveness than a DC/PhD is beyond me, and the effectiveness, along with safety has omitted key papers that soundly refute Ernst. I am not proposing to delete Ernst, I am proposing to include strong DC/PhD papers. This is a reasonable suggestion, no?

http://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=207884301oldid=207883778 One of the first suggestions made for Effectiveness 2 was to remove the sentence supported by Ernst 2008. Clearly there is some sentiment to omit Ernst's criticisms; but we can't really do that and remain NPOV.

Ernst represents the fringe of mainstream medicine, first and foremost. It is up to you to provide proof that he represents mainstream opinion on the subject, because mainstream medicine has pretty much acknowledged that a)chiropractic medicine is mainstream and b)chiropractic manipulation is safe. Ernst, IMO is a garbage POV pusher who blantantly mispresents large segments of the profession in an attempt to marginalize the profession. Looking at all CAM articles, it seems the good professor has a disproportionate amount of say. Good thing that his "conclusions" have been rebuked. We shall include this to remain NPOV. CorticoSpinal16:29, 25 April 2008 (UTC)

Ernst is a mainstream medical researcher. I just typed the query "effective of chiropractic" into Google Scholar, and it responded with a page that contained "Key authors: E Ernst - W Assendelft - E Skargren - L Bouter - D Cherkin". He's first on the list. He's been a coauthor with Assendelft. It is true that he is critical of chiropractic, but he is a mainstream researcher and his work gets cited a lot. In no way is Ernst a "fringe" researcher. Eubulides21:53, 25 April 2008 (UTC)

Effectiveness 2 already follows the suggestion of including strong DC/PhD papers. For example, it immediately follows the Ernst-2008 sentence with a sentence citing a strong DC/PhD paper that "found serious flaws" with Ernst's approach, and which gives that paper's conclusions as the final word in that paragraph. This is being pretty hard on Ernst already; it verges on being unfair to him. And this is not the only strong DC/PhD paper mentioned; there are lots of others, many more than there are citations to Ernst. I don't offhand see how the text could be any harder on Ernst without becoming POV.

Eubulides

08:16, 25 April 2008 (UTC)

When we are discussing the science of chiropractic, naturally DC/PhDs and those engaged in high quality research get highlited. It just happens that most, if not all disagree with Ernst. CorticoSpinal16:29, 25 April 2008 (UTC)

Ernst gets highlighted. The other guys get highlighted too. Both sides deserve coverage. Ernst should not be ignored. Eubulides21:53, 25 April 2008 (UTC)

length is irrelevant to me so long as it covers all the salient points, provides proper context and is written in NPOV and has neutral tone. CorticoSpinal15:55, 24 April 2008 (UTC)

Yes, I agree. I have tried hard to keep Effectiveness 2 short, while satisfying those other constraints. It is not an easy task. Eubulides08:16, 25 April 2008 (UTC)

And I appreciate your efforts. There is some good research done here, definitely, but there are major topic omissions if we're going to do this section properly. I shall attempt a rewrite over the weekend which we can pick apart vociferously next week. CorticoSpinal16:29, 25 April 2008 (UTC)

Thank you. Eubulides21:53, 25 April 2008 (UTC)

It seems to me obvious that medical doctors are the most authoritative source on medical matters. They killed smallpox after all. One would not consider a homeopath an authoritative source on the effectiveness of his speciality, or a Ted Haggard on the age of the Earth.

Or to put it another way; there is no such thing as an authority on something that does not exist--Kenneth Cooke04:07, 26 April 2008 (UTC)

I don't for a second doubt the authoritativeness of MDs on medical matters. But, the research has shown that MDs routinely a) do poorly at MSK medicine and b) DCs perform superiorly to MDs in MSK medicine; which is not surprising since it is their core focus. Which brings us to the argument at hand. Who is the authoratitive source on chiropratic matters? Traditionally, prior to the establishment of a literature base, it was MDs by default who at least had scientific research. That is no longer the case. The profession, really since 1983, or 25 years (who's counting?) has seen it's literature base grow to the point where we no longer need to rely on "medical" research from MDs to define the profession.

DC/PhDs, or chiropractic scientists are very real, have been integrated in various aspects in mainstream health care and research agencies, etc. So, let's cut to the chase. Why is Haldeman et al and Cassidy et al. (who are the experts in manipulation and stroke) not be given equal weight (at the very least) to Ernst? This argument is important to resolve because the same tactics have been applied to vaccination and now effectiveness. That is, treating Chiropractic as FRINGE. Let's get to the bottom of this and then everything else will proceed a lot smoother. Thoughts? CorticoSpinal22:28, 24 April 2008 (UTC)

Cassidy "et al." (PMID|18204390) is about safety, not effectiveness; it's irrelevant here. Haldeman "et al." (PMID|18204400) says nothing about effectiveness that is not already reported in Effectiveness 2 (it cites the underlying review that Haldeman "et al." cite). Eubulides08:16, 25 April 2008 (UTC)

IDIDNTHEARTHAT. Please read my statement above and address my concerns; they're the same one in effectiveness, safety and vaccination. CorticoSpinal16:29, 25 April 2008 (UTC)

I started a new thread (Safety sources again below) to address those concerns. Eubulides21:53, 25 April 2008 (UTC)

Jefffire

18:08, 24 April 2008 (UTC)

Perhaps one should mindful that the "effectiveness" controversy is kinda overblown and dated based on the various endorsements of SMT from mainstream practitioners. For example, SMT is now part of the American Physicians clinical practice guidelines for low back pain. So, I'm a bit confused how come the editor is citing a "effectiveness" controversy when an "'expert panel"' has recommended SMT as an effective, conservative approach to NMS problems and spinal issues specifically. CorticoSpinal15:55, 24 April 2008 (UTC)

Nah, not really, there was one bypasser (DelvinKelvin) who want some clarification, but other than that it's been moreso hardcore skeptics and orthodox practitioners. It should be noted than no other health care profession has an effectiveness section; and the orthodox practitioners here are treating chiropractic care like FRINGE when it's practically mainstream for all intents and purposes. Even the literature (orthodox sources to boot) say this. This is a fundamental flaw in the approach of certain editors here; treating Chiropractic more like homeopathy rather than Dentistry, Physical Therapy or even Osteopathic Medicine. CorticoSpinal15:55, 24 April 2008 (UTC)

Almost all of the comments on this talk page are by editors, but editors are not the best sources for what readers need, because editors know too much. It is quite valuable when a reader stops by and makes a helpful comment as to material that may be obvious to editors but is not obvious to the typical reader.

An admin once said "If you struggled with passing calculus, don't go mucking about with the taylor series article." That seems to be occuring here, to a large extent. You have not addressed my fringe concerns. Please do so. CorticoSpinal16:29, 25 April 2008 (UTC)

Chiropractic is closer to Acupuncture or to Traditional Chinese medicine than it is to Homeopathy. Like chiropractic (and unlike homeopathy), acupuncture and traditional Chinese medicine have plausible scientific mechanisms. I would not call acupuncture fringe medicine, any more than I would call chiropractic fringe medicine. That being said, all three professions have serious questions about effectiveness, questions that need to be addressed in their respective articles. Eubulides21:53, 25 April 2008 (UTC)

Other health care professions have effectiveness sections, as noted in Criticisms of earlier proposed fix. One example is Traditional Chinese medicine Efficacy.

Chiropractic should not be treated just like Homeopathy (it is not nearly as fringe as homeopathy is) but it does have aspects that require careful coverage. A closer (albeit still imperfect) analogy would be Acupuncture.

Eubulides

08:16, 25 April 2008 (UTC)

Acupuncture is a modality. Chiropractic is a profession. The comparison ends there unless you can point to me that acupuncturists are licensed and regulated in all 50 states and are indeed a profession. CorticoSpinal16:29, 25 April 2008 (UTC)

Acupuncture is also a profession. It is one of the four largest CAM professions in the U.S. (the others are chiropractic, massage therapy, and naturopathy; my source is Cherkin "et al.' 2002, PMID|12463292). Eubulides21:53, 25 April 2008 (UTC)

It should go then, if that would solve issues. CorticoSpinal15:55, 24 April 2008 (UTC)

Vehemently disagree on 2 fronts. 1) It still treats chiropractic as FRINGE when it's clearly not, 2)given allopathic views greater weight even within Chiropractic's own article which is a separate, distinct and autonomous branch of health care and 3)is used as a tactic to subvert the inclusion of research by DC/PhDs on chiropractic in chiropractic's own article! CorticoSpinal15:55, 24 April 2008 (UTC)

Effectiveness 2 is scholarly and comprehensive. It addresses the fact that SMT is not the only treatment modality, but is an important one; as well as acknowledging the fact that other professions practice it. The 'total patient encounter' is also discussed. I agree that Manga and the worker's comp stuff must be taken out for the reasons given.Perhaps some stuff from CCCGPP can be worked in? I hope we can agree on the new Effectiveness, but I'm not optimistic!CynRNCynRN17:05, 24 April 2008 (UTC)

When commenting, please don't insert comments into a draft. Copy a phrase and take it down here to comment on it. Chopping up a draft with commments makes things very confusing.CynRN —Preceding ) 17:08, 24 April 2008 (UTC)

I think I did that and I apologize. Effectiveness 2 is a step in the right direction, if can narrow the focus to the big 3, (back pain, neck pain, HA) that would be helpful. I'm going to include and track down clinical practice guidelines recommendations; after all that is directly related to practice. CorticoSpinal22:16, 24 April 2008 (UTC)

Where effectiveness 2 and its predecessor fails is looking at the effectiveness of the various types of treatments used by DCs. The most common ones would be soft tissue tx, exercise-rehab, ergo advice/ and some kind of education/counseling/reassurance. Let's broaden it a bit and not make contemporary practice and the mainstream of chiropractic (i.e. mixers) look like one trick ponies. A good ref would also be Theberge(2008) that is used at the sports chiropractic article as well as the conclusions from the CCCGPP CorticoSpinal22:16, 24 April 2008 (UTC)

I agree that the reader should know that DCs do a lot of different things. The article already goes into these quite a bit, however. I don't think there is the volume of studies on the other treatments that there is on SMT. Maybe a qualifier in Effectiveness 2 that chiropractors use many other modalities?CynRNCynRN02:50, 25 April 2008 (UTC)

(outdent) I like the suggestion of mentioning other modalities; even if the evidence is lacking, we can just say it's lacking. Also, I could put the CCGPP stuff back in (it was in Effectiveness 1 but I took it out in the interests of brevity). Do these suggestions sound OK? Eubulides08:16, 25 April 2008 (UTC)

We're moving in the right direction at least. I will attempt to make a hybrid proposal this weekend that addresses the main concerns raised by myself and other editors. Productive dialogue is good; but a qualifying statement hardly does justice to the various other common clinical things DCs do. Remember, the whole clinical encounter, not just a reductionistic approach that focuses on SMT. An analogy is sorta like sex; you just don't go "in there" and start thrusting away! The adjustment takes 10s to deliver; yet the average appointment runs 18 min. There is a beautiful example in Theberge (2008) where a DC illustrates this point when a PT attempted to marginalize the DCs role (they can't assess core dysfunction). Misunderstandings and miseducation are common in dealing with chiropractic medicine. I'm here to help clean that up, clear the air and foster better inteprofessional relations, just like I'm doing IRL. CorticoSpinal16:29, 25 April 2008 (UTC)

The Effectiveness 2 compromises NPOV. A lot of NPOV text has been removed. The lead to the scientific investigation is an improvement and can easily be expanded. QuackGuru05:51, 10 May 2008 (UTC)

I plan to draft an Effectiveness 3 to try to address the above issues. Eubulides07:04, 10 May 2008 (UTC)

Comments on scientific investigaton

Highly inappropriate to base scientific investigation on 1 source, even more is the "fear" tone implied by it. "Steal SMT procedures" "raise concerns that scope would be reduced"; I mean; it's this kind of writing, tone and source selection that has turned off a majority of regular editors here. Where are sources from Coulter? He's THE expert in sociological development in chiropractic. Also, where any mention of the scientific journals in chiropractic that are at least indexed? Where is the mention of the FCRE, the establishment of DCconsult (evidence-based resource), mention of the ICL (index to chiropractic literature), the development of evidence-based clinical practice guidelines? I mean, this article is about chiropractic and this is about the science of chiropractic. To skeptics, they will say this in an oxymoron or patently untrue; but anybody who is objective and moral will see that the science of the profession is very real, and it's not limited to just SMT. But, outsiders, and orthodox practitioners wouldn't know (or possibly care to know) about these things. So, let's fix this massive oversight right now. CorticoSpinal22:41, 24 April 2008 (UTC)

More sources would be welcome. This was by far the best peer-reviewed source I found on the sociology of evidence-based medicine and chiropractic. I am unaware of any recent work that Coulter has published on the subject. I do know of Mootz, Coulter Hansen 1997 (PMID|9127258) but it's pretty dated; it's an old proposal of what to do, not a description of what's been done. The text does briefly mention the development of evidence-based guidelines. The other evidence-based stuff would be worth a brief mention, though that'd need a reliable source (preferably a peer-reviewed paper; not ICL or DCconsult itself). Eubulides08:16, 25 April 2008 (UTC)

I know of much more recent lit that Coulter has done; it's just not on PubMed. The humanities must have their own lit base indexed somewhere, anybody know what it's called? ICL and DCconsult are important in the fact that they are clear cut examples of the movement towards science and developing and implementing evidence-based practice. They're both very notable; in particular the ICL. I haven't even attempted to bring a source from there yet; but I won't be overlooking it much longer; the allopathic database is predominantly allopathic; and ICL focuses predominantly on chiropractic. DC/PhDs are also writing article in journals such as Journal of Chiropractic Education. We need to include those as well to get a full picture. CorticoSpinal16:29, 25 April 2008 (UTC)

Please cite the more recent literature; that would be helpful. Eubulides21:53, 25 April 2008 (UTC)

Dammit Eubulides, please stop reverting the struck out text. We've been doing this now for 3 months, just look above at Education as an example. I'll give you time to respond before reinseting my edit, but I do find you 2 reversions to be in bad taste and you haven't even bothered to respond to any of my concerns. To be clear: don't delete struck out material; those are points being contested. Thanks. CorticoSpinal23:05, 24 April 2008 (UTC)

The intent of that long comment was to provide a single, complete summary of the problem and proposed solution. Jefffire had earlier expressed frustration when trying to follow commentary inserted within other commentary, so with that in mind the long comment asked for followups to come after, rather than being interspersed within it. If this idea doesn't work well we can go back to doing things the old way, but for this particular comment let's try it the way Jefffire suggested. If we want to come up with an improved draft, I suggest starting a new section for it, Scientific investigation 3 say. I will respond to followup comments soon, but would like to wait a few hours to give things a chance to settle down. Eubulides00:41, 25 April 2008 (UTC)

The best approach is to combine the best of effectiveness 1 and 2. QuackGuru22:19, 30 April 2008 (UTC)

Let's give that a try on the talk page and see how it looks. I just want to make sure that the following concerns are addressed in the newest draft:

Chiropractic is a profession. And like Dentistry, measuring the overall effectiveness of a profession is difficult or at least seemingly odd. If there are studies/reviews which discuss the efficacy of the entire clinical encounter with a chiropractor, I feel that would be best.

Therefore, if we are limiting ourselves to discussion about the effectiveness of certain chiropractic techniques, then the studies/reviews cited should be measuring chiropractic techniques as performed by chiropractors specifically and not include similar techniques performed by other practitioners (unless the results of each profession is kept separate somehow).

Detailed discussion about specific modalities should be saved for the corresponding modality's article and not be included in this article.

That's really my only concerns. As long as they are addressed, I'll be satisfied. -- Levine211222:28, 30 April 2008 (UTC)

Chiropractic is not just about the profession; it is also about chiropractic care, just as Traditional Chinese medicine is not just about the profession but is also about the techniques used. Large chunks of Chiropractic are about chiropractic care, not about the profession; this includes ChiropracticTreatment procedures, ChiropracticUtilization and satisfaction rates, ChiropracticThe Manga Report, ChiropracticWorkers' compensation studies, ChiropracticScientific investigation, and ChiropracticSafety. And there's good reason for this: when people think "chiropractic"; they are typically thinking of the care, not just of the profession. It would be odd to rip all these sections out of Chiropractic on the grounds that Chiropractic should only be about the profession. It would be very odd to exclude from Wikipedia common usage such as is found in the ACA's web page http://www.amerchiro.org/content_css.cfm?CID=2205 Chiropractic: A Safe Treatment Option.

We should follow our reliable sources, which include data from studies of spinal manipulation performed by non-chiropractors. This is standard practice now. It's not controversial among recent reliable reviews. We should not second-guess the expert reviewers in the field.

I agree that detailed discussion about particular spinal manipulation techniques, or other techniques used in chiropractic care, belong in their respective articles. However, an overall discussion belongs in Chiropractic, due to its strong association with particular treatments, notably spinal manipulation.

Chiropractic has long discussed the effectiveness of chiropractic care at quite some length; why stop now?

Eubulides

09:27, 1 May 2008 (UTC)

It is easy to write about chiropractic. The controversial nature of chiropractic does not make it difficult to write about it when we follow the sources in a neutral way. This has been done already. Minor adjustments can be done in mainspace. Taking the best from each effectiveness draft will create something wonderful called NPOV. QuackGuru02:40, 1 May 2008 (UTC)

Chiropractic is a healthcare profession like Dentistry. ChiropracticTreatment procedures describes some of the procedures chiropractors use. ChiropracticUtilization and satisfaction rates, ChiropracticThe Manga Report, and ChiropracticWorkers' compensation studies describe studies specifically about chiropractic. ChiropracticScientific investigation and ChiropracticSafety are two disputed sections of this article and should not be used as cause to move forward on something with similar problems. It remains intellectually disingenuous to use studies involving other kinds of practitioners to make an assessment about the efficacy of chiropractic care. Sure, you can use these studies to assess the efficacy of spinal manipulation in general and that would be good info for the spinal manipulation article. But unless a study makes conclusions about chiropractic specifically, we shouldn't be using it on this article because it would create a SYN violation. So let's create some version 3 of the efficacy section which addresses these concerns and let's see what we have. Perhaps it will be a version which we can all live with -- the very definition of consensus. -- Levine211218:03, 1 May 2008 (UTC)

There is no SYN when the text is written according to the sources in a neutral way. This is the definition of NPOV. QuackGuru18:14, 1 May 2008 (UTC)

The problem here is that we have sources which study SMT as performed by a host of practitioners and don't conclude anything specific about chiropractic. Then we are taking these sources and we are making a conclusion about chiropractic specifically (if only by including these non-chiropractic specific studies in our article about chiropractic). That's the definition of a SYN violation. As it stands, a host of editors here are against including this section for this very reason. Remove all of the source which do this, and then we can continue discussing this topic. Otherwise, we are stuck and can't move forward. -- Levine211218:30, 1 May 2008 (UTC)

The proposed rewrite is severely biased in the representation of research. This is typical of Eubulides' drafts. Notwithstanding; it seems like the edits go out of their way to drum up more fear or controversy

afraid they might steal

limit their scope

the most authoritative (2004 Cochrane?) sorry, it's the 2008 WHO Neck Pain Task Force

no benefit of manual therapy for neck pain (false)

no mention of any additional treatments provided by DCs

Does not consider recent WSIB stats

Does not reference the effectiveness of SMT which has been included in allopathic physicians' clinical practice guidelines

Violations of SYN, OR, POINT, NPOV, CON amongst others. This is old new. Until we get representation from the chiropractic profession, this is just a blantant marginalization and subversion of DC/PhD research. It's the same old, same old "shouldn't reach down argument" which SmithBlue has debunked. As I mentioned before, I think it's time to apply IAR and get past this stalemate. Scope of practice needs to be finished and education is dangling. Those are by far less contentious than this and we need to make progress. Once we can include the needed DC/PhD research to attain NPOV we can tweak safety and move onto the science of chiropractic. That means science of manual therapies and conservative care; in case someone out there needs a translation.

(outdent)

The quotes are supported by reliable sources.

*Every single source ever brought here is a condemnation of chiropractic. There is a severe lack of balance in the sources brought to the table here and major omissions (Coulter is THE expert in sociology and chiropractic).

Not true. Scientific investigation cites many sources that are quite supportive of chiropractic. Examples include DeVocht 2006 (PMID|16523145), Bronfort "et al." 2008 (PMID|18164469), Hurwitz "et al." 2008 (PMID|18204386), and Hawk "et al." 2007 (PMID|17604553). There are other examples. Coulter is certainly a leading expert on the sociology of chiropractic, and recent citations from his work would certainly be welcome if someone can dig up some; in the meantime the current draft cites reliable sources (just one example: one of the coauthors of Hawk "et al." is Rahelah Khorsan, one of Coulter's colleagues at the Samueli Institute) and there is no reason to reject it simply because it does not cite Coulter. Eubulides08:15, 5 May 2008 (UTC)

"raising concerns by chiropractors that orthodox medical physicians could 'steal' SMT procedures from chiropractors" is supported by the following paragraph:

"Anderson (2002) noted that the ‘‘Fugelli Tactic,’’ or the idea that ‘‘if you can’t beat ‘em, join ‘em’’ ideology, might very well apply to orthodox medical physicians faced with mounting evidence that manipulation primarily performed by alternative medical practitioners had proved a valuable and effective treatment (p. 197). The Fugelli Tactic might better be described as ‘‘if you can’t beat ‘em, steal from ‘em,’’ instead, as the practice involved the dominant actor learning and becoming proficient in the practice so that they could better compete and maintain their monopoly share of the market. Anderson discussed the possibility that manipulation might become permanently ‘‘borrowed’’ by orthodox medical physicians if they saw it as beneficial and easily learned at continuing education weekend seminars. (Villanueva-Russell 2005, PMID|15550303; this is citing Anderson 2002, PMID|12006128)

Relevance to the science of chiropractic (besides it being needlessly inflammatory)? CorticoSpinal17:07, 4 May 2008 (UTC)

It's not inflammatory. It's highly relevant to concerns about evidence-based chiropractic. Eubulides08:15, 5 May 2008 (UTC)

Please provide link to this much discussed draft. Material quoted ("Anderson (2002) noted...) will need a source saying its relavant to "concerns about evidence-based chiropractic". Out of context it appears OR, in context? SmithBlue11:15, 5 May 2008 (UTC)

The draft is in Scientific investigation 2. The above quotation about Anderson (2002) is taken from Villanueva-Russell 2005 (PMID|15550303), a reliable source cited by the draft. This source's subject is evidence-based medicine and its implications for chiropractic, which is directly on-topic. Eubulides21:24, 5 May 2008 (UTC)

"the focus on SMT has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks" is supported by the following paragraph:

"If positivistic science was the means to achieve an ‘‘established’’ rating for a technique and if the only scientific studies evaluated for the rating were done by non-chiropractors on ‘‘manipulation’’ for lower back pain, the result was an overly narrow standard of care that reinforced the neuromusculoskeletal, limited professional status of chiropractic. Clinical practice guidelines would serve to further institutionalize chiropractic’s marginal structural position and circumscribe the scope and range of practice to lower back pain doctors, or those that addressed ‘‘sprains and strains.’’" (Villanueva-Russell 2005, PMID|15550303) There are two more paragraphs in the same vein, which I am loath to copy for concerns of copyright violation, but the last paragraph ends, "Had chiropractic become a victim of its own rhetoric—trapped as a limited-scope back and neck doctor?".

We should not milk the same source to prove a point. Where is the DC POV on this, incidentally? I thought so. CorticoSpinal17:07, 4 May 2008 (UTC)

Other highly-reliable sources are welcome. For now, the draft is based on a reliable source. Eubulides08:15, 5 May 2008 (UTC)

Cochrane reviews are widely regarded as the gold standard in evidence-based medicine. We have a reliable source (Ernst 2006, PMID|16574972) which says that the two Cochrane reviews in question are authoritative. No reliable source has been presented to the contrary. The proposed draft in Effectiveness 2 does not say "most authoritative" (even though Ernst does); it merely says "authoritative", which is inarguable.

This is supplanted by the Feb 2008 issue of Spine and the WHO Task Force report. CorticoSpinal17:07, 4 May 2008 (UTC)

It's not supplanted. We have no reliable saying it's supplanted. The Cochrane reviews are very high quality. Eubulides08:15, 5 May 2008 (UTC)

The proposed draft in Effectiveness 2 does not say "no benefit of manual therapy for neck pain".

It omits the proven benefit as highlighted by the task force report. CorticoSpinal17:07, 4 May 2008 (UTC)

No, it doesn't omit that. It says "SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives". Eubulides08:15, 5 May 2008 (UTC)

Effectiveness 2 does mention other treatments provided by DCs, including educational videos, mobilization, and exercises.

One sentence on all the other "mixes" is insufficient to be NPOV. CorticoSpinal17:07, 4 May 2008 (UTC)

There is more than one sentence on that. Multiple sentences talk about mobilization. Multiple sentences talk about exercise. If there is something missing, please suggest some additions that are based on reliable sources. Eubulides08:15, 5 May 2008 (UTC)

Every attempt has been made to use the best sources published in peer-reviewed journals. If those sources base their results on WSIB stats, they have been used. If not, they haven't. Given the amount of reviews in this area, it is not really our job to dive down into the WSIB stats ourselves.

IAR. You have used this argument to keep good literature and findings out. CorticoSpinal17:07, 4 May 2008 (UTC)

Generally speaking, we should rely on high-quality reviews to decide whether literature and findings are good. This is standard practice in medical articles, as per MEDRS, and is quite helpful in avoiding bias. Eubulides08:15, 5 May 2008 (UTC)

The criticism that allopathic physicians' clinical practice guidelines have been ignored is a curious one. On the one side, we're supposed to ignore traditional medical sources when they publish extensive critical reviews about effectiveness in refereed high-quality journals; on the other hand, we're supposed to pull out short sentences that appear in clinical practice guidelines on some other subject? I'm not opposed to all citation of practice guidelines, but let's not put the cart before the horse: the section on effectiveness should primarily use sources on effectiveness, not little bits taken from sources that are primarily about other things and for which effectiveness of chiropractic care is not a central concern.

This is another misrepresentation of my argument (16 now). CorticoSpinal17:07, 4 May 2008 (UTC)

The argument you made was "Does not reference the effectiveness of SMT which has been included in allopathic physicians' clinical practice guidelines". The comment directly responded to that argument. Eubulides08:15, 5 May 2008 (UTC)

It is not right to omit all controversial material, simply because it is controversial. The controversial side of chiropractic must be covered, as well as the not-so-controversial side. Omitting the central points of controversy results in the strongly-biased article that we have today.

19:30, 2 May 2008 (UTC)

(17). No one has ever said to omit controversial material. The article is not as biased as you think; however your attempts to keep out scope of practice and education (both relatively non-controversial) sections is duly noted. It would be nice if your edits and proposals were not always controversial and you stopped arguing with the majority of the regular editors here. CorticoSpinal17:07, 4 May 2008 (UTC)

Certainly there have been attempts to strike out controversial material from critics of chiropractic, and arguments that we should focus on "less contentious" sections. This would continue leave important gaping holes in the article and (more important) would leave the article strongly biased. Bias like that is contrary to Wikipedia policy. I'm sorry that it is so controversial, but violations of policy need to get fixed. Eubulides08:15, 5 May 2008 (UTC)

What does "http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticcurid=197022diff=209610774oldid=209581343 representation from the chiropractic profession" mean? QuackGuru02:38, 2 May 2008 (UTC)

"In chiropractic's early years, influences from both straight and mixer concepts were incorporated into its construct. Chiropractic has both materialistic qualities that lend themselves to scientific investigation and vitalistic qualities that do not."16 This info is about philosophy and not scientific investigation. It is duplication and should be deleted. QuackGuru21:13, 3 May 2008 (UTC)

Asking for informal mediation

Discussion seems to have died down in this thread without consensus. The bias in the current article continues to be a problem, so I am asking for informal mediation. Eubulides21:24, 5 May 2008 (UTC)

Wilks v. AMA

Is there a reason that this section in the Chiropractic article doesn't link to the main article, http://en.wikipedia.org/wiki/Wilk_v._American_Medical_Association here? DigitalC01:57, 29 April 2008 (UTC)

I think it does link there. However, since it may be lost in the Wikilink, we may consider adding a "Main article" link such as the one at the top of the "Treatment procedures" section. -- Levine211202:23, 29 April 2008 (UTC)

Chester A. Wilk, DC from Chicago initiated an antitrust suit against the AMA and other medical associations in 1976 - Wilk "et al." vs AMA "et al." Here is the current sentence with the wikilink and it clearly works. QuackGuru18:55, 29 April 2008 (UTC)

Totally. I think in addition to that we should add a "Main article" link such as the one at the top of the "Treatment procedures" section. -- Levine211218:59, 29 April 2008 (UTC)

What would be the purpose for having duplicate links. QuackGuru19:07, 29 April 2008 (UTC)

The same as the History section does with vertebral subluxation. Making sure that the main article is easy to find for the casual reader. -- Levine211219:09, 29 April 2008 (UTC)

The section is too short to have a main article link. I can easily spot the main article link in that short section. QuackGuru19:27, 29 April 2008 (UTC)

Disagree. It's a vital landmark in the profession. Another article which needs definite attention is verterbral subluxation. Skeptics have had field day with this and regular use it as a straw man to marginalize the profession and destabilize the main chiropractic article. Rightly or wrongly (I'm in the latter) the profession has chosen to retain this term. Hence it needs to be given the scientific treatment; as per the texts by Gatterman, Leach, Haldeman, Beck and Lederman. That will cool off the jets of more edit wars, reliable sources citing the experts in the field. CorticoSpinal20:45, 29 April 2008 (UTC)

I don't think it is a big deal either way in terms of adding the Wilk main article link. But even DigitalC - a frequent contributor - overlooked the Wikilink and that is significant. As adding the main article link doesn't advance or detract from any specific viewpoint, I don't see the harm in adding it per DigitalC's request. -- Levine211221:08, 29 April 2008 (UTC)

I think the 1st sentence of this section could be re-written to be clearer which could well make the link more obvious too. SmithBlue08:28, 30 April 2008 (UTC)

That should work. Any suggestions? -- Levine211217:24, 30 April 2008 (UTC)

If http://en.wikipedia.org/w/index.php?title=Talk:Chiropracticcurid=197022diff=209267193oldid=209267029 that works does it mean the main article link should be avoided now. QuackGuru17:30, 30 April 2008 (UTC)

Let's see what the rewrite looks like and it that satisfies DigitalC's concern. -- Levine211217:42, 30 April 2008 (UTC)

I guess we should rewrite that first sentence either way, but I don't understand reasoning for NOT having a main article link. —Preceding ) 23:13, 30 April 2008 (UTC)

There really isn't any reasoning against it. I don't mind adding it if only to make Wikipedian research easier. -- Levine211200:13, 1 May 2008 (UTC)

References

reflist