Chiropractic/Archive 36

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Recent controversial edits - profession vs. approach

The verifiable fact that chiropractic is a profession has been removed in http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=552384156oldid=551691262 this edit by John Snow 2 and again http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=552558092oldid=552476433 here by Alexbrn. This proposed change is against policy for a number of reasons. First, there is no consensus to remove the description of chiropractic as a profession (the current, stable, consensus version states that chiropractic is a profession) and the editors have chosen not to bring it to the talk page despite my sourced and policy based objections. Second, no source at all has been provided that suggests that chiropractic is not a profession, it has been the editors opinion that the word profession is ‘debatable’, but Wikipedia doesn’t care if John Snow can debate this term, we need reliable sources that could suggest that chiropractic is not a profession. Third, there are multiple reliable sources that verify the fact that chiropractic is indeed a profession:

From http://nccam.nih.gov/health/chiropractic/introduction.htm NIH/NCCAM: ""Chiropractic is a health care profession that focuses on...""

From a peer-reviewed source in http://archinte.jamanetwork.com/article.aspx?articleid=210354 Archives of Internal Medicine: ""Chiropractic, the medical profession that specializes in...""

From a peer-reviewed source in http://www.ncbi.nlm.nih.gov/pubmed/12669653 The Milbank Quarterly: ""Chiropractic is the best established of the alternative health care professions.""

From a peer-reviewed source in http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392833/ Arthritis Research Therapy: ""many patients seek care directly from health-care professionals other than their family doctor; for example, at least one third of back pain patients in Denmark now choose to see a chiropractor as their...""

From the chiropractic health care section of the http://www.apha.org/membergroups/sections/aphasections/chc/about/ American Public Health Association says that the ""CHC Mission - To promote collaboration between chiropractic and other health care professions""

From the http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf World Health Organization: ""Chiropractic - A health care profession concerned with.....""

In Brazil a http://connection.ebscohost.com/c/articles/40221510/brazil-federal-judge-rules-favor-chiropractic-profession Federal Judge has ruledthat: ""chiropractic is a profession and not a technique""

In Canadian provinces, Chiropractic is regulated under the Health Professions Act. Here is verification for http://www.qp.alberta.ca/documents/Acts/h07.pdf Alberta, http://www.health.gov.bc.ca/professional-regulation/notice/chiropractic.html British Columbia, etc.

American state legislatures describe chiropractic as a health profession; For example http://vtprofessionals.org/opr1/chiropractors/ Vermont, http://health.state.tn.us/boards/chiropractic/ Tennessee, http://www.colorado.gov/cs/Satellite?c=Pagechildpagename=DORA%2FDORALayoutcid=1251628238000p=1251628238000pagename=CBONWrapper Colorado, etc.

Puhlaa

15:06, 28 April 2013 (UTC)

It may be a profession, but it's not the principal defining characteristic of Chiropractic, so it shouldn't be ultra-prominent in the lede. Lots of things can be professionally pursued (e.g. photography), but these are not described, front and centre, as "professions" - that would be silly! |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 16:26, 28 April 2013 (UTC)

Alexbrn, this is an article about the chiropractic profession. You have http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=552585612oldid=552574354 restored a controversial change to the lead by John Snow that I challenged; I reverted the change by John Snow according to BRD, what policy are you relying on to support your revert of my challenge? You have provided no sources, no policy, just your opinion? I did not think you were new to wikipedia, but perhaps you need to read V and NPOV? Did you read any of the reliable sources I provided above that verify the fact that chiropractic is a profession; there is even one where a federal judge ruled that chiropractic is indeed a profession and not a 'technique'. Are you suggesting that your opinion deserves more weight than those sources? Puhlaa16:44, 28 April 2013 (UTC)

This has already been settled a month ago with an RfC. John Snow and Alexbrn I suggested you read up. DVMt16:52, 28 April 2013 (UTC)

Personal opinions aside, it's a profession by all definitions, while its methods are the "approaches". That BJ Palmer exploited it for commercial purposes has nothing to do with the matter, but does have current and historical interest if one is to understand the profession: "Chiropractic has had a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school was founded on '…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it.'" -- BullRangifer Brangifer 17:38, 28 April 2013 (UTC)

Puhlaa mdash; your reply is irrelevant: read my response again. This is not a controversial edit, just a common sense improvement. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 19:36, 28 April 2013 (UTC)

Your response is irrelevant Alexbrn, wikipedia requires sources and consensus to get a change, not your opinion that it is an improvement. Seems to me that you dont have sources to support your preferred edit, which is evident by the fact that you have presented none. Seems to me that you dont have consensus either, this is evident by the fact that that editors have challenged the edit. As such, the edit need to be discussed here at the talk page and get consensus before it is pushed through. Are you familiar with wikipedia policy? Did you read any of those that I linked?Puhlaa19:51, 28 April 2013 (UTC)

No Alex, it is a very controversial edit. Even I, an arch chiroskeptic (my life has been threatened after I was officially declared Chiropractic Enemy Number One), recognize it as an unsourced, negative, POV put down. You'd have to have RS for that, and also have them trump myriad RS which describe chiropractic as a profession. Its methods are what we normally think of as its approaches. Of course, to run with your absurd idea, we could say that there is a Chiropractic "approach" to how chiropractors use manipulation, just as there is an Orthopedic "approach" to how MDs use manipulation, an Osteopathic "approach" to how Osteopaths use manipulation, and a Physical Therapy "approach" to how PTs use manipulation. Should they all be claimed to be "approaches", rather than "professions"? Really, get serious. Don't disrupt Wikipedia to make your point, because we all have our opinions on the matter, and we get your point. I'm a skeptic, but even I don't try to edit "pseudoscience", "religion", "scam", or "unscientific" profession into the article (without sources), although those are widely held opinions among scientists, more so among MDs, and universally held among scientific skeptics (it's a defining meme among them). No, your edit will not survive. -- BullRangifer Brangifer 19:59, 28 April 2013 (UTC)

Guys, I am not disputing that Chiropractic may be a profession (which you seem to think I am, hence your irrelevant replies). That is covered in the article body. But this article is on "Chiropractic", "not" "The Chiropractic Profession": hence it is undue to characterize it as first-and-foremost a profession when in truth it is first and foremost a "a "'practice"' which 'emphasizes the conservative management of the neuromusculoskeletal system, without the use of medicines and surgery'" (to quote from the article body). Ledes must summarize the body. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 20:09, 28 April 2013 (UTC)

I am glad that you are not disputing that chiropractic is a profession Alexbrn, because that would be silly considering the volume of sources that say otherwise. Since the article is about the chiropractic profession (ie: its scope of practice, legistlation and licensing, etc.) the lead is accurately summarizing the article by initially describing it as a CAM health profession - as does so many reliable sources that are found in this article and elsewhere.Puhlaa20:34, 28 April 2013 (UTC)

Alexbrn, we've been down this road with you already before regarding the wording of profession. Please refrain from disruptive editing. I agree (for once) with Brangifer and Puhlaa. You should list all your concerns or grievances here so we can tackle them together. DVMt20:46, 28 April 2013 (UTC)

Come off it. Describing Chiropractic primarily as a profession is undue. Let's see what really neutral sources have ... Britannica says: "A system of healing ..."; and Websters: "a system of therapy ...". Instead Wikipedia is now mirroring the definition of a chiropractic advocacy group, the http://www.wfc.org/website/index.php?option=com_contentview=articleid=90Itemid=110 World Federation of Chiropractic: "A health care profession concerned with the diagnosis, treatment and prevention ...". And this text is being reverted to (over 3RR now?) by an editor with a COI. Hmmmm. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 20:51, 28 April 2013 (UTC)

I agree that describing chiropractic as a profession is undue. The material in the article is primarily about the therapy, not about the profession. "Approach" is a more accurate term abd consistent with the reliable sources.Dominus Vobisdu21:29, 28 April 2013 (UTC)

The article is not primarily about the therapy, that would be the article Chiropractic treatment techniques or manual therapy or spinal adjustment. This particular article is about the chiropractic profession. The article has a sub-section for the http://en.wikipedia.org/wiki/ChiropracticTreatment_techniques treatment techniques used by members of the profession, as well as for the professions http://en.wikipedia.org/wiki/ChiropracticHistory history and the professions http://en.wikipedia.org/wiki/ChiropracticEducation.2C_licensing.2C_regulation licensing and regulation and for the professions http://en.wikipedia.org/wiki/ChiropracticConceptual_basis conceptual basis, etc. Perhaps the theme of Alexbrn's idea is better suited to the sub-section on http://en.wikipedia.org/wiki/ChiropracticConceptual_basis conceptual basis? I believe that DVMt was trying to create a new article of chiropractic philosophy or the chiropractic approach, this would be an appropriate place to open the article with a discussion of an 'approach'.Puhlaa21:46, 28 April 2013 (UTC)

Yes, it's primarily about the profession. Where else would that article reside here at Wikipedia?

Here's what our second source, the World Health Organization, says in its glossary:

"Chiropractic: A health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on subluxations." p. 3 (10/51) http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf

That's a pretty good definition, and we use part of it in the opening. We don't have to use the whole quote, but it's quite good, and "profession" is an appropriate word. It's been a very long-standing part of this article until recent (yesterday!), undiscussed, edits. We should keep the long-standing status quo until a consensus is reached to change it. Let it stay that way until we are agreed on a change. -- BullRangifer Brangifer 23:11, 28 April 2013 (UTC)

Except it's cherrying a definition out of a subsection in the middle of that document, rather than using the opening definition given in the Introduction, which is: "Chiropractic is one of the most popularly used forms of manual therapy." And besides, as had been discussed before, this is less-than-good source ... it is a non-peer-reviewed guidelines document offering a view of what Chiropractic "should be" and the consultation participants behind it are mostly chiropractors and CAM lobbyists (including the CEO of the |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 06:06, 29 April 2013 (UTC)

Well, do you have myriad RS that refute that it's a profession? You'll need to provide good sources for any change. Please define "profession". To take this to the absurd, even nonsense can become professionalized! So, what's a "profession"? Define it, then tell us in what ways chiropractic fails the definition. -- BullRangifer Brangifer 07:29, 29 April 2013 (UTC)

To repeat, whether it's a profession or not is not the issue AFAIAC. The issue is whether it's the "first thing that is mentioned" (as though this is it principal attribute). It's undue, and out of line with serious sources. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:37, 29 April 2013 (UTC)

Well, that's a matter of opinion. I agree with B. J. Palmer that it's a "business", but that's my opinion and not a RS. What RS are you going to use to justify a change? You're going to have to convince other editors, because a collaborative change is the only thing that will work. Otherwise it'll just get reverted back, and if you edit war over it, you'll just get blocked. Then an RfC will run its course, and you can be sure than a majority of editors will vote against your position. You'll have to make a very strong case, using impeccable sources that contradict all other sources that call it a profession. -- BullRangifer Brangifer 15:05, 29 April 2013 (UTC)

I don't think that "profession" should be emphasised. Lots of activities can also be professions, but our article is about "Chiropractic" not about "Doing chiropractic as your day job". TO pick some random counterexamples; our article on Weaving says that it's a "method of fabric production", our article on poetry says it's a form of literary art; Quality assurance says that it's "engineering activities". Even though there are assuredly reliable sources which talk about professional poets, weavers, and quality-assurers, Bobrayner bobrayner 16:03, 29 April 2013 (UTC)

A lede must faithfully summarize the article. Currently the lede contains the word "profession" 4 times and it is the first characteristic given. However, in the article body, the strongest RS on this topic supports the rather more nuanced statement "Chiropractic is viewed as a marginal healthcare profession"; most of the article body is describing other characteristics of chiropractic than its professional status, chiefly its biomedical aspects. As I said above this edit (not mine originally, N.B.) seems to me to be "just a common sense improvement". Although it has been incorrectly dramatized as an attempt to remove the description of chiropractic as a profession, it is simply to balance the lede so that is accurately reflects the content of the article, rather than unduly promoting one aspect. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 16:04, 29 April 2013 (UTC)

I would have though chiropractic as the approach makes most sense here. Purely for reasons of the article not making a lot of sense otherwise. For example, when the article talks about the efficacy of chiropractic we are assessing the approach, not of the profession. IRWolfie-23:16, 29 April 2013 (UTC)

Alexbrn, your argument is weak. The lead already summarizes the body because the article as a whole is about the chiropractic profession. The article includes subsections that discuss professional scope of practice, licensing, etc. One of those subsections is probably appropriate to emphasize the chiropractic approach, but the article as a whole is about the profession, which has a lot of diversity. The extensive diversity within the profession is evidenced by the fact that there is an article just for this topic Chiropractic treatment techniques; hundreds of 'approaches' make up the chiropractic profession - hence an article just for that. This article is about a profession with a controversial history and a great deal of diversity in it's curent state.

Bobraynor uses the example of weaving, but this is ridiculous, does weaving have a section on professional scope of practice or licensing? Weaving would be a good analogy for an article like manual therapy, as they are both practices. However, as ruled by a http://connection.ebscohost.com/c/articles/40221510/brazil-federal-judge-rules-favor-chiropractic-profession Brazilian Federal judge, Chiropractic is a profession, not a technique - thus, a better analogy for this chiropractic article would be physical therapy, which also accurately describes it as a profession in the first sentence of the lead.Puhlaa23:23, 29 April 2013 (UTC)

IRwolfie, this article has one subsection that discusses the efficacy of only spine manipulation - which is just one of the more commonly studied techniques used by chiropractors. We chose to include this subsection because spine manipulation has a lot of research, compared to the rest of the manual therapies, and is most commonly associated with chiropractors; however, the 150 some unique chiropractic approaches make it very difficult to discuss them all in an article that is really supposed to be about the profession (ie: this article). Thus, the 'approaches' used have their own article Chiropractic treatment techniques where discussions of the efficacy of different chiropractic approaches could be discussed.Puhlaa23:28, 29 April 2013 (UTC)

Puhlaa mdash; you assert "the article as a whole is about the chiropractic profession". But you only need to look at the section headings to see this is not so; the content of the article covers chiropractic "as a whole". |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 03:38, 30 April 2013 (UTC)

But then we agree Alexbrn, the article is about chiropractic as a whole. As I have pointed out, you and others have agreed and reliable sources have verified, chiropractic as a whole http://connection.ebscohost.com/c/articles/40221510/brazil-federal-judge-rules-favor-chiropractic-profession is a profession not a technique! This article is a great discussion of the profession - including it's conceptual basis, it's history, how it's members are licensed and regulated, the efficacy of the most common form of therapy used by it's members, etc. As I have already indicated, your idea would be best suited for a subsection on the 'approaches used' by chiropractors or an article in itself about the approaches used by chiropractors. This article is about the profession as a whole, not just the approaches/rationale used by members of the profession. 04:03, 30 April 2013 (UTC)

Have a look at this RS all about chiropractic - "http://archinte.jamanetwork.com/article.aspx?articleid=210354 Chiropractic: origins, controversies, and contributions" The first sentence of the abstract says ""...the largest alternative medical profession"", it does not say 'the largest alternative medicine approach'. http://www.ncbi.nlm.nih.gov/pubmed/12669653 Here is another RS that is also all about chiropractic, the first sentence of it's abstract also is a description of the profession. Puhlaa

I'm afraid I don't agree that "chiropractic as a whole is a profession not a technique" (if that opposition even makes sense). The "'article content we have"' tells us it's a whole bunch of things: a belief system, a technique, a profession, a fraud, a culture, etc. The lede must reflect that content, and not unduly over-promote one aspect. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 04:27, 30 April 2013 (UTC)

A thought from a random passer-by:

Why not state both? E.g. "Chiropractic is a health care profession and an approach to healing concerned with..."

This way those who feel that naysayers are trying to slight chiropractic by not explicitly stating the obvious - that it is a health care profession - will be satisfied. And those who feel strongly that the reader will benefit from knowing that it is also an approach to healing will also be satisfied. 04:33, 30 April 2013 (UTC)

I would be satisfied with this suggestion. It is funny how the obvious solution is right there but can be missed by us involved editors even while we discuss the issue :) Puhlaa04:41, 30 April 2013 (UTC)

like

I saw this conversation developing earlier today and was just stopping by here to suggest the same thing: include both. Zad68 "'Zad"'"68" 04:43, 30 April 2013 (UTC)

Yes, that works :-) |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 04:48, 30 April 2013 (UTC)

Done! Thank you everyone :) TippyGoomba04:52, 30 April 2013 (UTC)

Excellent solution! -- BullRangifer Brangifer 07:22, 30 April 2013 (UTC)

Recent edit

http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=552884918oldid=552884073 This edit does a better job a giving a historical perspective to data offered in the dated reference. However, it also introduces information about safety that seems like a non sequitur to the subtopic: International reception. Whereas, a discussion of chiropractic's usage in the United States makes sense under such heading, the material about the serious complications seems out of place and frankly, argumentative there. I'd recommend removing that bit and reserving it for a more relevant section. 03:36, 7 May 2013 (UTC)

Agree with the IP user. The historical info is relevant, but the added discussion on risks should be in the safety section or in the spine manipulation article. Also, the source is not attributing the risk to chiropractic, but to spine manipulation in general. Puhlaa15:03, 7 May 2013 (UTC)

Edit request on 7 May 2013

I have found a reference for the ""manipulative lesion"" which says is in need of a citation.

The manipulative lesion, also known as a spinal biomechanical lesion is deifined as "a pathological condition involving discontinuity (loss of cohesion) of tissue, and loss of normal vertebral joint function (kinesio-pathology) that often has injury as its cause"

Reference: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56115

Thanks

DJFryzy

08:58, 7 May 2013 (UTC)

DJFryzy

08:58, 7 May 2013 (UTC)

DJFryzy, Thank you for trying to find a source for the article. Unfortunately, the source you provided is not appropriate because it is a chiropractic trade magazine. For information about what makes a good source, please read MEDRS.Puhlaa14:58, 7 May 2013 (UTC)

Thanks for your reply Puhlaa

I have done some further investigation to find a citation for this ""manipulative lesion"" which I feel as though I have found a higher level of evidence. It appears more commonly in the literature as ""manipulable lesion"" or ""functional spinal lesion"". The reference is attached.

Biomechanics of spinal manipulative therapy John J Triano, DC, PhD The Spine Journal Volume 1, Issue 2, March–April 2001, Pages 121–130http://www.sciencedirect.com/science/article/pii/S1529943001000079 http://dx.doi.org/10.1016/S1529-9430(01)00007-9,

This is a much better source, thanks DJFryzy. Why don't you go ahead and make the required edit (insert the reference), then we can see if any other editors take any issue. Let me know if you have any problems and I am happy to help.Puhlaa02:26, 8 May 2013 (UTC)

Unfortunately I am unable to edit this page. Possibly due to the semi-restricted nature. Are you able to insert the reference? Or if there is some "back door" route that I'm not able to see could you point me in the right direction? Thanks. DJFryzy05:33, 8 May 2013 (UTC)

You should be able to edit this article by now....This article is semi-protected, meaning only autoconfirmed users can edit it; see http://en.wikipedia.org/wiki/Wikipedia:User_access_levelsAutoconfirmed_users here for an explanation. By making more than 10 edits on wikipedia, you are now an autoconfirmed user.Puhlaa06:00, 8 May 2013 (UTC)

You should be able to edit this article yourself now. -Nathan Johnson15:32, 9 May 2013 (UTC)

Thanks for the heads up. Just about to add the reference in and the appropriate term.

Update of evidence in regards to safety of Chiropractic

"A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is routinely associated with considerable harm and no compelling evidence exists to indicate that it adequately prevents symptoms or diseases, thus the risk-benefit is not evidently favorable.183"

-does sometone have a copy of this journal article they could look over. where is he citing evidence from that "spinal manipulation is routinely associated with considerable harm"...? thanks. — Preceding 18:43, 6 June 2013 (UTC)

I would like to discuss proposed changes in relation to a section within the introduction as well as the safety section within this article.

Currently the introduction contains "and some evidence of severe adverse effects from cervical vertebral manipulation.10 ". I feel this would be better represented within the "Safety" section. In addition to this, a more appropriate source is warranted to verify this.

Furthermore, the safety article is lacking the most up to date studies in regards to the more serious complications that have previously been reported in relation to spinal manipulative therapy (SMT) and vertebral artery dissection (VAD).

Below I have added areas which I would like to see looked at either adding to the current safety section, or changing dated and bias statments.

The most recent in-depth review, published in the Feb 15, 2008 Spine Journal cite journal|last=Cassidy|first=JD|coauthors=Boyle, He, Hogg-Johnson, Silver, Bondy|title=Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a population-based Case-control and Case-crossover study|journal=Spine|date=Feb 15 2008|year=2008|month=February|volume=33|series=4 Suppl|page=176-183 was completed by members of the Spine Decade Task Force. These researchers reviewed 10 years worth of hospital records, involving 100 million person-years. These clinical records revealed no increase in vertebral artery dissection risk with chiropractic, compared with medical management, and further stated that “increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection (already in progress) seeking care before their (eventual) stroke.”

It is now apparent that chiropractors prematurely accepted the notion that cervical adjusting/manipulation could be a “causative” event for VAD. That was a reasonable and professional response to case-studies and reports in the peer-reviewed medical literature, which was often based on a pattern of medical mis-reporting, as was later documented by Terrett. cite journal|last=Terrett|first=AG|title=Misue of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy Injury|journal=Journal of Manipulative Physiol Ther|date=May 1995|year=1995|month=May|volume=18|series=4|page=203-210

The recently published “Current Concepts: Spinal Manipulation and Cervical Arterial Incidents 2005” (NCMIC) cite book|last=Triano Kawchuck, Gudavalli, Haneline, Hil, Wynd|title=Current Concepts: Spinal Manipulation and Cervical Arterial Incidents|year=2005|publisher=NCIMC|page=1-6|url=http://www.chiro.org/LINKS/FULL/Current_Concepts.pdf concludes in it's Executive Summary: “Unfortunately, opinion rather than fact has tended to dominate discussions regarding CVAs and chiropractic, even though there has been no definitive evidence that chiropractic adjustments (actually) cause strokes. This monograph notes that a causative relationship between chiropractic manipulation and stroke is unlikely. There is an associative relationship between the two because people may go to chiropractors for relief of stroke-related symptoms”.

DJFryzy 04:32, 14 May 2013 (UTC) Thanks for your time and looking forward to editing with you.

You may be interested in following the pattern outlined at BRD. Essentially, you make any change you want, anyone who disagrees will revert, and then we discuss until there's a consensus. Of course, if you think the changes will be controversial, it's wise to discuss them first. TippyGoomba04:40, 14 May 2013 (UTC)

Thanks x TippyGoomba. I feel as though BRD may be a way, however I feel that interested parties may be wanting to discuss this before we go through the BRD process. DJFryzy07:34, 14 May 2013 (UTC)

Split

I have just removed a split tag, again. If you think there should be a split then please explain why here so that it may be discussed. Op4722:25, 16 May 2013 (UTC)

Chiropractics - not a medical field

As far as i know, a medial diagnosis is generally given only by Doctors of Medicine and at more specific occasions, Psychologists. a Chiropractic, on the other hand, is not a medical adviser, nor a medical pathologist. he treats. not more. correct me if I'm wrong. Ben-Natan07:17, 17 May 2013 (UTC)

Ben-Natan, it may be that only 'medical doctors' can provide a 'medical diagnosis', but our article does not claim that chiropractic is a 'medical' profession, nor that they make 'medical' diagnoses. The general act of making or communicating a diagnosis is within the scope of practice of many doctored health professions. I am most familiar with the Canadian laws, for example, in Canada one of the authorized acts that chiropractors can perform is ""Communicating a diagnosis identifying, as the cause of a person's symptoms, a disorder arising from the structures or functions of the spine or of the joints of the extremities.http://www.cco.on.ca/site_documents/S-001.pdf"" Another example is Optometrists in Canada, who can http://www.collegeoptom.on.ca/governance/scopeofpractice.asp make a diagnosis related to the eyes. Dentists in Canada can http://www.health.gov.bc.ca/professional-regulation/hpc/review/part-i/scope-dentist.html diagnose conditions related to the teeth or jaw. Even some non-doctored professions, such as http://thehealthprofessional.ca/physiotherapy-scope-of-practice-evolves-two-perspectives/ physiotherapists have now been given the privilege to ""Communicating a diagnosis identifying a disease"". That said, I am not aware of any Canadian provinces that allow chiropractors to make diagnoses that are not related to the musculoskeletal system, for example they cannot communicate a diagnosis of cancer or diabetes. The same could be said for dentists, who are restricted to only making diagnoses related to the teeth and jaw; Optometrists restricted to the eyes, etc. Puhlaa08:19, 17 May 2013 (UTC)

I find reason in what you wrote, and hence suggests that the article will mention the specific type of the not-medical diagnosis that chiropractors can make. you said "musculoskeletal", if this is how exactly it's named, than i believe it should be emphasized at the beginning of the article. Ben-Natan10:44, 17 May 2013 (UTC)

I am glad that you find my comment reasonable Ben-Natan. With regard to your suggestion, the article already emphasizes the fact that chiropractic is CAM (not Medicine) and that those in the profession make neuromusculoskeletal diagnoses; as per the WHO sources, the article says in the first sentence: ""Chiropractic is a complementary and alternative medicine health care profession and an approach to healing concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system...""Puhlaa15:56, 17 May 2013 (UTC)

Your pardon, i missed the word "neuromusculoskeletal", i completely agree with the current wording. regards. Ben-Natan02:37, 18 May 2013 (UTC)

Lillard

This article has just copy-pasted some paragraphs from the article "Chiropractic history", on Harvey Lillard. It is completely taken out of context, it makes absolutely no sense as it stands, and it seems at first to be connected to the words before. I see no reason why it has been added.

If it is important, one should include the rest from the article "Chiropractic history" (or an edited version). As it stands now, the opening words (“However, this version was disputed by Lillard's daughter”) seems to be related to the closing words of the paragraph before (“One student, his son Bartlett Joshua (B.J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment”). We must either include the whole (or at least an edited) paragraph on Harvey Lillard, or just delete the two paragraphs (and mention/link to the part on Harvey Lillard from the the article "Chiropractic history"). Carissimi13:48, 21 July 2013 (UTC)

Removing these two paragraphs seems to address the problem for now.

However, this version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make something of it, then they both would share. But, it didn't happen."cite journal |author= Westbrooks B |year=1982 |title= The troubled legacy of Harvey Lillard: the black experience in chiropractic |journal= Chiropr Hist |volume=2 |issue=1 |pages=47–53 |pmid=11611211

In spite of the fact that Lillard could hear well enough to tell jokes, B.J. Palmer claimed under sworn testimony that Lillard had been "thoroughly deaf".http://www.chirobase.org/05RB/BCC/07.html B.J. Palmer's testimony in State of Wisconsin vs. S. R. Jansheski, December, 1910 Since 1895, the story of Palmer's curing a man of deafness has been a part of chiropractic tradition. Palmer's account differs significantly from what actually happened, in that, according to Lillard's daughter, his improved hearing was likely caused by an accidentally fortuitous jarring of Lillard's body and not, as claimed by D.D. Palmer, caused by a "specific" adjustment. It was after this event that Palmer began to experiment with manipulation. He also claimed that his second patient, a man with heart disease, was also cured by spinal manipulation.

The first paragraph is already in the Chiropractic history article. The second is not. Should we incorporate the second back into the Chiropractic history article? Should we summarize the paragraphs in this article? I would suggest answers yes and no. TippyGoomba18:25, 21 July 2013 (UTC)

It's an important fact about Palmer's megalomania and deceptive historical revisionism, especially important since it's the myth upon which the profession is built. We need to keep it in some manner, even if revised. Go for it. -- BullRangifer Brangifer 19:27, 21 July 2013 (UTC)

Effectiveness: grammar correction

Wanted to suggest a quick correction for a confirmed user to tackle - the 6th paragraph under the "Evidence" section reads "There is a wide range of ways to measure treatment outcomes.", which I believe should be "There "'are"' a wide range of ways to measure treatment outcomes.". Luke83104:28, 23 July 2013 (UTC)

"range" is singular, so "is" is right. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 05:27, 23 July 2013 (UTC)

I Don't Understand

I just don't get it. This page has the feel that it was written in 1950's. Chiropractic has never before been as widely accepted as it is now. I know that is not saying much but this is just sad. Its a step backward and I feel that the "medical" people posting on this site are more truely unaware of chiropractic and only have E.Ernst's view of what we do. Is there much evidence for chiropractic? nope. But it does help plenty of people. and this site just steers others who could be helped away. This is a page about COMPLAMENTARY AND ALTERNATIVE MEDICINE and should be moderated as such not Medicines view of Chiropractic and its voodoo old farty unchanging ways and crazy ideas about subluxation and innate intelligence. All I as is that the lines pertaining to Objections to Chiropractic be put in a Controversy secetion. Because the way it reads now I would have no idea what chiropractic is other than a scary psuedo-science made up by some old guy who thought he knew how to heal people and only did it for money. Seriously thats the impression I get. How about adding a section on what some of the names of Chiropractic techniques are. There is Diversified, Logan Basic Technique, Webster, Applied Keniesiology, Graston, Cox flexion distraction, Gonstead, Activator, Upper cervical, Thompson. Ect. Please let me know what I need to do to make some of this happen. Thank you for your time and I apologize for the spelling grammar errors (Airport edit). — Preceding 06:40, 26 July 2013 (UTC)

What you need to do to make this happen is "'edit the page"'. If your edits present an unencyclopedic view of chiropractic, someone will change them if they can be fixed easily or revert them if not. 06:53, 26 July 2013 (UTC)

The article must contain information covering history, controversies, diverse POV, etc.. That's why you see some negative information here. We don't write sales brochures. Since long and detailed content on each aspect would overwhelm the article and make it needlessly long, we have created subarticles, such as History of chiropractic and Chiropractic education. If you look at the category link at the bottom of the article, you'll see a link to :Category:Chiropractic. Check it out.

We try not to use controversy sections here. While not forbidden, they are strongly frowned upon. That's why you'll find it spread out throughout the article. Since the profession has been extremely controversial since its beginning, there is a section which touches on the subject and links to the full article about Chiropractic controversy and criticism.

This article also links to a separate article about Chiropractic treatment techniques. -- BullRangifer Brangifer 15:01, 26 July 2013 (UTC)

Feedback on the article

As a long-time recipient of chiropractic care, I found this article to be very informative on the subject. However, for purely semantic reasons, I think the article puts chiropractic care in an excessively bad light by overemphasizing perspectives of 'straight' chiropractors, who are overwhelmingly in the minority if I'm not mistaken, and using unintentionally negative phrasing such as "chiropractic is only beneficial in dealing with back-pain." (Generally, non-chiropractors don't view it as accomplishing anything else, though I understand this belief's proliferation in the chiropractic community.) I may attempt to fix these issues soon, but I thought it'd be good to list these concerns here.

-- 01:39, 24 August 2013 (UTC)

Thank you for expressing your concerns, and we welcome attempts to improve the article. If you have specific wordings which you believe are not supported by their sources, or if you have reliable sources we could use, please discuss them here on the talk page and we can work towards improving the article. Thanks again. -- BullRangifer Brangifer 02:02, 24 August 2013 (UTC)

Like it or not, the "straights" are a major source of public danger. I don't know if http://www.theage.com.au/national/health/call-for-age-limit-after-chiropractor-breaks-babys-neck-20130928-2ul6e.html this case was straight or mixer, but the fact is that any chiro who has an ethical bone in their body should drop the idea of "maintenance" adjustments, abandon subluixations altogether and that will make them a physiotherapist not a chiropractor. (JzG/help Help!) 16:57, 28 September 2013 (UTC)

&quot;as the sole cause of disease&quot;

This deceptive phrasing implies that the controversy is over whether the spinal dysfunction causes all disease or only some of it, and conceals the actual controversy over whether chiropractic is a working therapy or merely "total snake-oil quackery with dangerous disregard for objective reality".

It should be rephrased to something like "as a possible cause of disease". 16:46, 15 October 2013 (UTC)

I agree DJFryzy02:35, 20 October 2013 (UTC)

No, we base our content on RS, not personal POV. I have fixed the problem, just for you. See:

https://en.wikipedia.org/wiki/Chiropracticcite_note-Chiropractors_Adjuster_2-8

Palmer is a RS for this content. He believed in one cause, one cure.

Done

-- BullRangifer Brangifer 03:13, 20 October 2013 (UTC)

Scope of practice/article photos

I was reading this article and it the images seemed to be appear outdated and look shabby. First and foremost I would propose adding an image of a chiropractor working with a patient receiving a manipulation as this is probably what people associate most strongly with chiropractic. Secondly the caption below the picture of the outdated x-ray machine lacks citation about controversy. I would suggest that radiology usage is an issue within all health professions (not unique to chiropractors). Recent evidence in Australia would put most chiropractors referring for an average of 18.667 x-rays per year. http://www.australiandoctor.com.au/news/latest-news/chiropractors-defend-referral-rates/ Compared to Australian medical usage rates of 10% of patients being sent for radiological studies. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442472723

Whilst I do agree chiropractic deserves its fair share (if not more) of criticism it does not need be littered throughout the article. I propose controversial/skeptic/pseudoscience arguments be neatly explored in the Controversy/Criticism section which is already present. Whether you the use of radiology is excessive or not (Australian data seems to paint a different picture) this is not related to scope of practice and in my opinion should be altered to a more neutral statement. May I suggest- "Many chiropractors are licensed to take their own X-rays although this practice is usually confined to the spine as per regulations". http://www.arpansa.gov.au/Publications/Codes/rps19.cfm

As I see many edits are often revised quickly and changing images is quite a big edit I decided to post here before making the edit.

To summarize I would like to:

1.) Add a picture of a chiropractor treating with a chiropractic patient with spinal manipulation

2.) Change picture of X-ray machine to something more modern looking and the quote below it to reflect that chiropractors are licensed and regulated by the same body as radiographers to take x-rays. (more neutral wording)

3.) Change pictures of chairs and tables to be more aesthetically pleasing/modern

Thanks for your consideration, I eagerly await feedback. — Preceding ) 10:12, 20 May 2013 (UTC)

I think that would be good

A modern x ray machine would be good. Caption not happy -- should be balanced and include mention of the controversy surrounding the use of x-rays in chiropractic. Many feel they are unnecessary exposures.

sounds non controversial change, I think that would be fine. Lesion "'Lesion"' 12:47, 5 June 2013 (UTC)

I have begun the process of undertaking your desired changes. I have also updated the transclusion to bring together information into a more appropriate box (and avoid doubling up the information). As always, new sources or changes have been appropriately referenced. DJFryzy10:48, 17 August 2013 (UTC)

in relation to "'lesion"'s point 2. I have included the latest data in the safety section where there is already mention of xray utilisation DJFryzy11:49, 17 August 2013 (UTC)

It didn't take long, but all the edits have been undone. I think this would be the appropriate forum to talk about this, as the consensus has been for some time that

1.) Add a picture of a chiropractor treating with a chiropractic patient with spinal manipulation

2.) Change picture of X-ray machine to something more modern looking and the quote below it to reflect that chiropractors are licensed and regulated by the same body as radiographers to take x-rays. (more neutral wording)

3.) Change pictures of chairs and tables to be more aesthetically pleasing/modern

DJFryzy

12:01, 17 August 2013 (UTC)

The images you have added appear to be copyright violations. · email) (if I write on your page reply on mine) 12:06, 17 August 2013 (UTC)

thumb|Chiropractic Thoracic Adjustment

thumb|Xray Radiography

thumb|Chiropractic students learning anatomy

In light of the previous issues with editing this page, I thought that I would place the reviews here prior to adding them. Please review and critique these as you feel suitable. All photos have been copyright approved.

1)Add a picture of a chiropractor treating with a chiropractic patient with spinal manipulation

2)Change picture of X-ray machine to something more modern looking and the quote below it to reflect that chiropractors are licensed and regulated by the same body as radiographers to take x-rays. (more neutral wording)

3)Change pictures of chairs and tables to be more aesthetically pleasing/modern. "I thought it may be more relevant to delete the chairs and add in a picture into the education category" DJFryzy05:55, 19 August 2013 (UTC)

You took these yourself I take it? TippyGoomba06:58, 19 August 2013 (UTC)

I think it would be a shame to get rid of the chairs. They convey an old fashioned torture "modern therapeutic" approach to the whole article, which is ideal for the subject matter. Roxy the dog09:37, 19 August 2013 (UTC)

Your bias is obviousx Roxy the dog. Wikipedia is not a place for bias such as this.DJFryzy02:59, 20 August 2013 (UTC)

Back on to the pictures, the license says they're your property. How did you come by them. Did you take them yourself? TippyGoomba03:33, 20 August 2013 (UTC)

Yes, as per the copyright via wiki commons pertains DJFryzy04:06, 20 August 2013 (UTC)

od

That's great! Please add them to the article as you see fit. x Roxy the dog will let us know if he misses the chairs too much. We can tweak the info boxes as needed. TippyGoomba04:44, 20 August 2013 (UTC)

Thank you x TippyGoomba. Please feel free to edit the position of the pictures as you see fit DJFryzy05:08, 20 August 2013 (UTC)

DJFryzy, did you edit with another account before you started using the DJFryzy account? Bobrayner bobrayner 22:49, 13 October 2013 (UTC)

Did you edit with another account before you started using the DJFryzy account? Bobrayner bobrayner 02:01, 21 October 2013 (UTC)

Unethical behaviour by Aussie and UK Chiropractic

Something to consider in this article - http://www.theage.com.au/national/health/call-for-age-limit-after-chiropractor-breaks-babys-neck-20130928-2ul6e.html from The Age in Australia - and a blog post with a http://reasonablehank.com/2013/09/28/australian-chiropractors-sneaking-into-hospital-wards-to-manipulate-patients/ great deal of detail.

I'm not suggesting that this goes into the article yet, as I'm uncertain of "The Age" as an RS, but this appears to be totally despicable behaviour by chiroquacks, sneakily treating hospital patients behind the hospitals back. Not good. --Roxy the dog13:17, 30 September 2013 (UTC)

The blog is useless but news article should be fine. I'd put something in Chiropractic controversy and criticism, if anywhere. TippyGoomba03:32, 1 October 2013 (UTC)

Here is another blog, http://theconversation.com/the-chiropractic-war-with-reality-rages-on-19357 again not a suitable source, but a good analysis of what went on. --Roxy the dog08:44, 21 October 2013 (UTC)

Is there much coverage outside the "The Age" and "The Australian"? I see the ABC is investigating. It might take a "4 Corners" report to turn it into a notable controversy. -- · email) 11:33, 21 October 2013 (UTC)

It seems like we may never find the truth? There were a number of media outlets that reported on a baby having their neck broken, but so far I have only found one article in the Australian that has reported on the findings of the AHPRA: http://www.theaustralian.com.au/news/nation/chiropractor-cleared-over-break/story-e6frg6nf-1226740575036; however the 'blog' that Roxy posted above seems to question what was presented in the Australian's article. Seems like this will be another correlation/causation debate, nothing new.Puhlaa15:11, 21 October 2013 (UTC)

Treatment, Safety (Proposed revision, March 2013) Part 1 of 2

Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include:

manual procedures, particularly spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques;

exercise, rehabilitative programmes and other forms of active care;

psychosocial aspects of patient management;

patient education on spinal health, posture, nutrition and other lifestyle modifications;

emergency treatment and acute pain management procedures as indicated;

other supportive measures, which may include the use of back supports and orthotics;

recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.

Manual and manipulative therapy

right|450px|thumb|Lumbar spine|Lumbar, cervical and thoracic chiropractic spinal manipulation.

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniquescite conference |url=http://www.hom.ucalgary.ca/Dayspapers2002.pdf |format=PDF |booktitle= Proc 11th Annual History of Medicine Days |editor= Whitelaw WA (ed.) |title= The historical development of chiropractic |publisher= Faculty of Medicine, The University of Calgary |pages= 55–58 |author= Swedlo DC |date=2002 |accessdate=2008-05-14 as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.cite journal |journal= J Manipulative Physiol Ther |date=2003 |volume=26 |issue=5 |pages=300–21 |title= Several pathways in the evolution of chiropractic manipulation |author= Keating JC Jr |doi=10.1016/S0161-4754(02)54125-7 |pmid=12819626 Spinal manipulation gained mainstream recognition during the 1980s.cite web |url=http://muaphysicians.com/historical.html |publisher= International MUA Academy of Physicians |title= Manipulation under anesthesia: historical considerations |author= Francis RS |date=2005 |accessdate=2008-07-06 Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.cite web |url=http://acatoday.org/pdf/spinal_manipulation_policy.pdf |format=PDF |title= Spinal manipulation policy statement |author= Winkler K, Hegetschweiler-Goertz C, Jackson PS "et al." |accessdate=2008-05-24 |date=2003 |publisher= American Chiropractic Association It is the most common and primary intervention used in chiropractic care;cite book|title= Job Analysis of Chiropractic|chapter= Professional functions and treatment procedures|year=2005|pages=121–38|author= Christensen MG, Kollasch MW|location= Greeley, CO|publisher= National Board of Chiropractic Examiners|chapterurl=http://nbce.org/pdfs/job-analysis/chapter_10.pdf|format=PDF|accessdate=2008-08-25|isbn=1-884457-05-3dead link|date=June 2012 In North America, chiropractors perform over 90% of all manipulative treatmentscite web |url=http://nccam.nih.gov/health/chiropractic/chiropractic05.pdf |format=PDF |title= About chiropractic and its use in treating low-back pain |accessdate=2008-03-24 |date=2005 |publisher=NCCAM |archiveurl = http://web.archive.org/web/20080227113930/http://nccam.nih.gov/health/chiropractic/chiropractic05.pdf |archivedate = 2008-02-27 with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=7 |pages=526–33 |title= Manipulation under anesthesia: a report of four cases |author= Cremata E, Collins S, Clauson W, Solinger AB, Roberts ES |doi=10.1016/j.jmpt.2005.07.011 |pmid=16182028 Typically, it is performed on patients who have failed to respond to other forms of treatment.cite journal |journal=J Manipulative Physiol Ther |date=2000 |volume=23 |issue=2 |pages=127–9 |title=Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin |author=Michaelsen MR |doi=10.1016/S0161-4754(00)90082-4 |pmid=10714542 |url=http://www.jmptonline.org/article/S0161-4754(00)90082-4/abstractThere has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.cite journal |pmid=17606755 |doi=10.1258/jrsm.100.7.330 |laysummary=http://www.medicalnewstoday.com/articles/75754.php |laysource=Med News Today |laydate=2 July 2007 |year=2007 |month=Jul |last1=Ernst |first1=E |title=Adverse effects of spinal manipulation: a systematic review |volume=100 |issue=7 |pages=330–8 |issn=0141-0768 |journal=Journal of the Royal Society of Medicine |pmc=1905885 Although serious injuries and fatal consequences can occur and may be under-reported,cite journal |journal= Int J Clinical Practice |year=2010 |volume=64 |issue= 8 |pages=1162–1165 |title= Deaths after chiropractic: a review of published cases |author= E Ernst |pmid=20642715 |doi=10.1111/j.1742-1241.2010.02352.x these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.

Definitions

High-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as "adjustment", "thrust manipulation", and "Grade V mobilisation" Maitland, G.D. "Peripheral Manipulation" 2nd ed. Butterworths, London, 1977.

Maitland, G.D. "Vertebral Manipulation" 5th ed. Butterworths, London, 1986. It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques.

Categories

Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety.http://www.ccachiro.org/client/cca/cca.nsf/web/Chapter+10+-+Modes+Of+Care+And+Management!OpenDocument Chapter 10 - Modes Of Care And Management. Canadian Chiropractic Association Manual and mechanically-assisted articular manipulative procedures can include:

HVLA manipulation

HVLA manipulation with recoil

LVLA manipulation (mobilization)

Drop tables and terminal point manipulative thrust

Flexion-distraction and traction-type tables

Pelvic blocks

Instrument assisted manipulative devices

Manual non-articular manipulative procedures can include:

Reflex and muscle relaxation procedures

Muscle energy techniques

Myofascial ischemic compression procedures

Myofascial, and soft tissue manipulative techniques

Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include:

manual procedures, particularly spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques;

exercise, rehabilitative programmes and other forms of active care;

psychosocial aspects of patient management;

patient education on spinal health, posture, nutrition and other lifestyle modifications;

emergency treatment and acute pain management procedures as indicated;

other supportive measures, which may include the use of back supports and orthotics;

recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.

Manual and manipulative therapy

right|450px|thumb|Lumbar spine|Lumbar, cervical and thoracic chiropractic spinal manipulation.

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniquescite conference |url=http://www.hom.ucalgary.ca/Dayspapers2002.pdf |format=PDF |booktitle= Proc 11th Annual History of Medicine Days |editor= Whitelaw WA (ed.) |title= The historical development of chiropractic |publisher= Faculty of Medicine, The University of Calgary |pages= 55–58 |author= Swedlo DC |date=2002 |accessdate=2008-05-14 as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine.cite journal |journal= J Manipulative Physiol Ther |date=2003 |volume=26 |issue=5 |pages=300–21 |title= Several pathways in the evolution of chiropractic manipulation |author= Keating JC Jr |doi=10.1016/S0161-4754(02)54125-7 |pmid=12819626 Spinal manipulation gained mainstream recognition during the 1980s.cite web |url=http://muaphysicians.com/historical.html |publisher= International MUA Academy of Physicians |title= Manipulation under anesthesia: historical considerations |author= Francis RS |date=2005 |accessdate=2008-07-06 Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues.cite web |url=http://acatoday.org/pdf/spinal_manipulation_policy.pdf |format=PDF |title= Spinal manipulation policy statement |author= Winkler K, Hegetschweiler-Goertz C, Jackson PS "et al." |accessdate=2008-05-24 |date=2003 |publisher= American Chiropractic Association It is the most common and primary intervention used in chiropractic care;cite book|title= Job Analysis of Chiropractic|chapter= Professional functions and treatment procedures|year=2005|pages=121–38|author= Christensen MG, Kollasch MW|location= Greeley, CO|publisher= National Board of Chiropractic Examiners|chapterurl=http://nbce.org/pdfs/job-analysis/chapter_10.pdf|format=PDF|accessdate=2008-08-25|isbn=1-884457-05-3dead link|date=June 2012 In North America, chiropractors perform over 90% of all manipulative treatmentscite web |url=http://nccam.nih.gov/health/chiropractic/chiropractic05.pdf |format=PDF |title= About chiropractic and its use in treating low-back pain |accessdate=2008-03-24 |date=2005 |publisher=NCCAM |archiveurl = http://web.archive.org/web/20080227113930/http://nccam.nih.gov/health/chiropractic/chiropractic05.pdf |archivedate = 2008-02-27 with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia.cite journal |journal= J Manipulative Physiol Ther |date=2005 |volume=28 |issue=7 |pages=526–33 |title= Manipulation under anesthesia: a report of four cases |author= Cremata E, Collins S, Clauson W, Solinger AB, Roberts ES |doi=10.1016/j.jmpt.2005.07.011 |pmid=16182028 Typically, it is performed on patients who have failed to respond to other forms of treatment.cite journal |journal=J Manipulative Physiol Ther |date=2000 |volume=23 |issue=2 |pages=127–9 |title=Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin |author=Michaelsen MR |doi=10.1016/S0161-4754(00)90082-4 |pmid=10714542 |url=http://www.jmptonline.org/article/S0161-4754(00)90082-4/abstractThere has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine.cite journal |pmid=17606755 |doi=10.1258/jrsm.100.7.330 |laysummary=http://www.medicalnewstoday.com/articles/75754.php |laysource=Med News Today |laydate=2 July 2007 |year=2007 |month=Jul |last1=Ernst |first1=E |title=Adverse effects of spinal manipulation: a systematic review |volume=100 |issue=7 |pages=330–8 |issn=0141-0768 |journal=Journal of the Royal Society of Medicine |pmc=1905885 Although serious injuries and fatal consequences can occur and may be under-reported,cite journal |journal= Int J Clinical Practice |year=2010 |volume=64 |issue= 8 |pages=1162–1165 |title= Deaths after chiropractic: a review of published cases |author= E Ernst |pmid=20642715 |doi=10.1111/j.1742-1241.2010.02352.x these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.

Definitions

High-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as "adjustment", "thrust manipulation", and "Grade V mobilisation" Maitland, G.D. "Peripheral Manipulation" 2nd ed. Butterworths, London, 1977.

Maitland, G.D. "Vertebral Manipulation" 5th ed. Butterworths, London, 1986. It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques.

Categories

thumb|Flexion distraction|A chiropractor using a flexion-distraction table and manual therapy to the lumbo-sacral spine for low back pain

Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety.http://www.ccachiro.org/client/cca/cca.nsf/web/Chapter+10+-+Modes+Of+Care+And+Management!OpenDocument Chapter 10 - Modes Of Care And Management. Canadian Chiropractic Association Manual and mechanically-assisted articular manipulative procedures can include:

HVLA manipulation

HVLA manipulation with recoil

LVLA manipulation (mobilization)

Drop tables and terminal point manipulative thrust

Flexion-distraction and traction-type tables

Pelvic blocks

Instrument assisted manipulative devices

Manual non-articular manipulative procedures can include:

Reflex and muscle relaxation procedures

Muscle energy techniques

Myofascial ischemic compression procedures

Myofascial, and soft tissue manipulative techniques

Neuromusculoskeletal and somatovisceral disorders

Manual and manipulative therapies is a common intervention used primarily by manual medicine practitioners for the treatment of neuromusculoskeletal disorders. Spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain. However the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial.cite journal|coauthors=Bolton PS, Budgell B.|title=Visceral responses to spinal manipulation|journal=J Electromyogr Kinesiol.|year=2012|month=Oct|volume=22|issue=5|pages=777-84.|pmid=22440554|accessdate=10 February 2013

Research status

"'Acute low back pain:"' It is not known if chiropractic care improves clinical outcomes in those with lower back pain more or less than other treatments. A 2012 Cochrane review found that spinal manipulation was no more effective than standard medical care, sham manipulation, physiotherapy or exercises therapy or inert intenventions. cite journal|last=Rubinstein|first=SM|coauthors=Terwee, CB; Assendelft, WJ; de Boer, MR; van Tulder, MW|title=Spinal manipulative therapy for acute low-back pain.|journal=Cochrane database of systematic reviews (Online)|date=2012 Sep 12|volume=9|pages=CD008880|pmid=22972127 A 2010 systematic review found that most studies suggest SM achieves equal or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. In 2007 the American College of Physicians and the American Pain Society jointly recommended that spinal manipulation be considered for people who do not improve with self care options.

"'Chronic low back pain:"' The effectiveness of spinal manipulation appears to be the same as other commonly prescribed treatment for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy.cite journal|journal= Cochrane Database Syst Rev|year=2011|issue=2|pages=CD008112|title= Spinal manipulative therapy for chronic low-back pain|author= Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW|doi=10.1002/14651858.CD008112.pub2|pmid=21328304|url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008112.pub2/abstract|volume=|editor1-last= Rubinstein|editor1-first= Sidney M Some national guidelines consider its use optional, some do not recommend and others suggest a short course in those who do not improve with other measures.cite journal|last=Koes|first=BW|coauthors=van Tulder, M; Lin, CW; Macedo, LG; McAuley, J; Maher, C|title=An updated overview of clinical guidelines for the management of non-specific low back pain in primary care.|journal=European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society|date=2010 Dec|volume=19|issue=12|pages=2075-94|pmid=20602122 Manipulation under anaesthesia, or medically-assisted manipulation, currently has insufficient evidence to make any strong recommendations.

"'Radiculopathy:"' There is moderate quality evidence to support the use of spinal manipulation for the treatment of acute lumbar radiculopathy and acute lumbar disc herniation with associated radiculopathy. The evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low and no evidence exists for the treatment of thoracic radiculopathy.

"'Neck pain:"' The effectiveness of spine manipulation for the treatment of neck pain is controversial.cite journal|journal=Pain Med. |year=2012 |volume=13|issue=6|pages=754-761|title=Is spinal manipulation effective for pain? An overview of systematic reviews |author=Posadzki P |pmid=22621391|doi= Cervical spine manipulation and mobilisation may provide immediate- or short-term improvements for mechanical neck pain; neither manipulation nor mobilisation have been found to be superior to one another and no long-term data are available.cite journal|journal=Cochrane Database Syst Rev. |year= 2010|volume=|issue=|pages=CD004249|title=Manipulation or mobilisation for neck pain. |author=Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL |pmid=20091561|doi=10.1002/14651858.CD004249.pub3 Thoracic spinal manipulation has a therapeutic benefit to some patients with neck pain and therefore it may also be a suitable intervention to use in combination with other interventions in the treatment of non-specific neck pain.cite journal|coauthors=Huisman PA, Speksnijder CM, de Wijer A.|title=The effect of thoracic spine manipulation on pain and disability in patients with non-specific neck pain: a systematic review.|journal=Disabil Rehabil.|year=2013|month=Jan|pmid=23339721|accessdate=26 January 2013cite journal|journal=J Orthop Sports Phys Ther|year=2011|volume=41|issue=9|pages=633–642|title=Thoracic spine thrust manipulation improves pain, range of motion, and self-reported function in patients with mechanical neck pain: a systematic review|author= Cross KM, Kuenze C, Grindstaff TL, Hertel J.|pmid=21885904|doi=10.2519/jospt.2011.3670 Other manual therapies such as massage have also been found to be effective for mechanical neck pain.cite journal|journal= Chiropractic Osteopathy|year=2010|volume=18|issue=3|title= Effectiveness of manual therapies: the UK evidence report|author= Bronfort G, Haas M, Evans R, Leininger B, Triano J|doi=10.1186/1746-1340-18-3|pmid=20184717|url=http://chiromt.com/content/18/1/3|pmc=2841070|page= 3cite journal|coauthors=Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Côté P, Hogg-Johnson S, Cassidy JD, Haldeman S; Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.|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.|journal=Spine| year=2008| month=|volume=33 |issue=4|pages=123-152| pmid=18204386|accessdate=cite journal|journal= Eura Medicophys|year=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/en/getfreepdf.php?cod=R33Y2007N01A0091|format=PDF

"'Extremity conditions"': Manual and manipulative therapy added to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs.cite journal|author= Jansen MJ, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA|title= Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review|journal= J Physiother|volume=57|issue=1|pages=11–20|year=2011|pmid=21402325|doi=10.1016/S1836-9553(11)70002-9 There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.cite journal|journal= Man Ther|year=2011|volume=16|issue=2|pages=109–117|title= Manual therapy for osteoarthritis of the hip or knee - a systematic review|author= French HP, Brennan A, White B, Cusack T|doi= 10.1016/j.math.2010.10.011|pmid=21146444 The addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) result in significantly better pain relief and functional improvements in both the short and long-term.cite journal|journal= Journal of Manual Manipulative Therapy|year=2008|volume=16|issue=4|pages=225–37|title= A Systematic Review of the Effectiveness of Manipulative Therapy in Treating Lateral Epicondylalgia|author= Herd CR, Meserve BB.|doi= 10.1179/106698108790818288|pmid=19771195|pmc= 2716156 There is a small amount of research into the efficacy of chiropractic treatment for upper limbs,cite journal|journal= J Manipulative Physiol Ther|year=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 limited to low level evidence supporting chiropractic management of shoulder pain and limited or fair evidence supporting chiropractic management of leg conditions.

"'Headache:"' Spinal manipulation may improve migraine and cervicogenic headaches but cautioned type, frequency, dosage, and duration of treatments should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal.cite journal|coauthors=Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E.|title=Evidence-based guidelines for the chiropractic treatment of adults with headache.|journal=J Manipulative Physiol Ther.|year=2011|month=June|volume=34(5)|issue=5|pages=274-89|pmid=21640251|accessdate=9 February 2013 SM might be as effective as propranolol or topiramate in the prevention of migraine headaches,cite journal|last=Posadzki|first=P|coauthors=Ernst, E|title=Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials.|journal=Cephalalgia : an international journal of headache|date=2011 Jun|volume=31|issue=8|pages=964–70|pmid=21511952 as well as other types of headaches. cite journal|journal= Manual Therapy|year= 2010|volume=15|issue=4|pages=315–333|title= Manipulation or mobilisation for neck pain: a Cochrane Review|author= Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL|pmid=20510644|doi= 10.1016/j.math.2010.04.002 cite journal|journal= J Headache Pain|year=2011|volume= 12|issue= 2|pages= 127–33|title= Manual therapies for migraine: a systematic review|author= Chaibi A, Tuchin PJ, Russell MB|pmid=21298314|doi=10.1007/s10194-011-0296-6|pmc=3072494cite journal|journal= Cochrane Database Syst Rev|year=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|editor1-last= Brønfort|editor1-first= Gert

"'Cervicogenic dizziness"': There is moderate evidence to support the use of manual therapy for cervicogenic dizziness.cite journal|journal=Chiropractic and Manual Therapies|year=2011|volume=19|issue= 1|page=21|title= Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: a systematic review|author= Lystad RP, Bell G, Bonnevie-Svendsen M, Carter CV|url=http://chiromt.com/content/19/1/21/abstract|doi=10.1186/2045-709X-19-21|pmid=21923933|pmc=3182131

"'Pediatrics"': The use of manual therapy for pediatric health conditions is supported by only low levels of evidencecite journal|journal= Chiropr Osteopat|year=2008|volume=16|page=11|title= Chiropractic manipulation in pediatric health conditions – an updated systematic review|author= Gotlib A, Rupert R|url=http://chiroandosteo.com/content/16/1/11|doi=10.1186/1746-1340-16-11|pmid=18789139|pmc= 2553791|issue=1cite journal|author=Ernst E|title=Chiropractic manipulation, with a deliberate 'double entendre'|journal=Arch Dis Child|volume=94|issue=6|page=411|year=2009|pmid=19460920|doi=10.1136/adc.2009.158170

"'Mental health"': There is evidence that spinal manipulation improves psychological outcomes compared to verbal interventions.cite journal |author=Williams NH, Hendry M, Lewis R, Russell I, Westmoreland A, Wilkinson C |title=Psychological response in spinal manipulation (PRISM): a systematic review of psychological outcomes in randomised controlled trials |journal=Complement Ther Med |volume=15 |issue=4 |pages=271–83 |year=2007 |month=December |pmid=18054729 |doi=10.1016/j.ctim.2007.01.008 |url=

"'Other"': A 2013 Cochrane reviews found some effectiveness of manipulative therapy as an complementary intervention for pneumonia in adults. Current evidence suggests manipulative therapy reduces the duration of hospital stay, duration of intravenous antibiotic use, and total antibiotic use, but did not improve primary patient outcomes including fever, improvement on X-ray, cure rate, or mortality.cite journal |doi=10.1002/14651858.CD006338.pub3 |title=Chest physiotherapy for pneumonia in adults |journal=Cochrane Database of Systematic Reviews |year=2013 |last1=Yang |first1=Ming |last2=Yan |first2=Yuping |last3=Yin |first3=Xiangli |last4=Wang |first4=Bin Y |last5=Wu |first5=Taixiang |last6=Liu |first6=Guan J |last7=Dong |first7=Bi Rong |editor1-last=Dong |editor1-first=Bi Rong |pmid=20166082 |issue=2 |pages=CD006338 In 2013, a systematic review and meta-analysis of five randomized controlled trials concluded that existing evidence suggests that SMT may improve lower urinary tract symptoms in adult women such as urinary incontinence (involuntary leakage of urine), nocturia (waking up at night to urinate), and urinary hesitancy, but called for further study with additional large, rigorous randomized controlled trials.cite journal |doi=10.1016/j.jbmt.2012.05.001 |title=Osteopathic manipulative treatment (OMT) for lower urinary tract symptoms (LUTS) in women |year=2013 |last1=Franke |first1=Helge |last2=Hoesele |first2=Klaus |journal=Journal of Bodywork and Movement Therapies |volume=17 |pages=11–8 |pmid=23294678 |issue=1 There is insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension.cite journal|journal=J Manipulative Physiol Ther|year=2012|volume=35|issue=3 |pages=235–43|title=Spinal manipulation for the treatment of hypertension: a systematic qualitative literature review|author=Mangum K, Partna L, Vavrek D|url=|doi= 10.1016/j.jmpt.2012.01.005|pmid=22341795|pmc= There is very low evidence for spinal manipulation for adult scoliosis (curved or rotated spine)cite journal|journal=Spine|year=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|year=2008|volume=3|page=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|pmc=2262872|issue=1 There is insufficient evidence from reviews to draw definitive conclusions for a wide variety of other non-neuromusculoskeletal conditions, including ADHD/learning disabilities, vision and other conditions.cite journal|journal= J Altern Complement Med|year=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 significant benefit for asthma,Asthma:

cite journal|author=Ernst E|title=Spinal manipulation for asthma: a systematic review of randomised clinical trials|journal=Respir Med|volume=103|issue=12|pages=1791–5|year=2009|pmid=19646855|doi=10.1016/j.rmed.2009.06.017

cite journal|author=Hondras MA, Linde K, Jones AP|title=Manual therapy for asthma|journal=Cochrane Database Syst Rev|issue=2|pages=CD001002|year=2005|pmid=15846609|doi=10.1002/14651858.CD001002.pub2|editor1-last=Hondras|editor1-first=Maria A

cite journal|author=Kaminskyj A, Frazier M, Johnstone K, Gleberzon BJ|title=Chiropractic care for patients with asthma: A systematic review of the literature|journal=J Can Chiropr Assoc|volume=54|issue=1|pages=24–32|year=2010|pmid=20195423|pmc=2829683|doi=|url=http://www.jcca-online.org/ecms.ashx/PDF/2010/2010-1/jcca-v54-1-024indd.pdf|format=PDF

baby colic,Baby colic:

cite journal|author=Ernst E|title=Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials|journal=Int J Clin Pract|volume=63|issue=9|pages=1351–3|year=2009|pmid=19691620|doi=10.1111/j.1742-1241.2009.02133.x

cite book|author=Husereau D, Clifford T, Aker P, Leduc D, Mensinkai S|title=Spinal Manipulation for Infantile Colic|isbn=1-894978-11-0|url=http://cadth.ca/media/pdf/177_spinal_manipulation_tr_e.pdf|format=PDF|accessdate=2008-10-06|location=Ottawa|publisher=Canadian Coordinating Office for Health Technology Assessment|year=2003|series=Technology report no. 42

bedwetting,cite journal|journal=Cochrane Database Syst Rev|year=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|editor1-last=Glazener|editor1-first=Cathryn MA carpal tunnel syndrome,cite journal|author=O'Connor D, Marshall S, Massy-Westropp N|title=Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome|journal=Cochrane Database Syst Rev|issue=1|pages=CD003219|year=2003|pmid=12535461|doi=10.1002/14651858.CD003219|editor1-last=O'Connor|editor1-first=Denise fibromyalgia,Fibromyalgia:

cite journal|journal= Curr Pharm Des|year=2006|volume=12|issue=1|pages=47–57|title= Complementary and alternative medical therapies in fibromyalgia|author= Sarac AJ, Gur A|pmid=16454724|doi= 10.2174/138161206775193262

cite journal|author= Schneider M, Vernon H, Ko G, Lawson G, Perera J|title= Chiropractic management of fibromyalgia syndrome: a systematic review of the literature|journal= J Manipulative Physiol Ther|volume=32|issue=1|pages=25–40|year=2009|pmid=19121462|doi=10.1016/j.jmpt.2008.08.012

cite journal|author=Ernst E|title=Chiropractic treatment for fibromyalgia: a systematic review|journal=Clin Rheumatol|volume= 28|issue= 10|pages= 1175–8|year=2009|pmid=19544042|doi=10.1007/s10067-009-1217-9

gastrointestinal disorders,cite journal|journal= Can J Gastroenterol|year=2011|volume=25|issue=1|pages=39–49|title= Chiropractic treatment for gastrointestinal problems: A systematic review of clinical trials|author= Ernst E|pmid=21258667|pmc= 3027333 kinetic imbalance due to suboccipital strain (KISS) in infants,cite journal|author= Brand PL, Engelbert RH, Helders PJ, Offringa M|title= Systematic review of the effects of therapy in infants with the KISS-syndrome (kinetic imbalance due to suboccipital strain)|language=Dutch|journal= Ned Tijdschr Geneeskd|volume=149|issue=13|pages=703–7|year=2005|pmid=15819137 menstrual cramps,cite journal|journal= Cochrane Database Syst Rev|year=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|volume= 3|editor1-last= Proctor|editor1-first= Michelle or pelvic and back pain during pregnancy.cite journal|author= Pennick VE, Young G|title= Interventions for preventing and treating pelvic and back pain in pregnancy|journal= Cochrane Database Syst Rev|issue=2|pages=CD001139|year=2007|pmid=17443503|doi=10.1002/14651858.CD001139.pub2|editor1-last= Pennick|editor1-first= Victoria

Safety

The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manual medicine practitioners, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindications apply only to the manipulation of the affected region.cite journal|journal=J Can Chiropr Assoc|year=2005|volume=49|issue=3|pages=158–209|title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash|author= Anderson-Peacock E, Blouin JS, Bryans R "et al."|url=http://jcca-online.org/ecms.ashx/PDF/2005/2005-3/Chiropracticclinicalpracticeguideline-evidence-basedtreatmentofadultneckpainnotduetowhiplash.pdf|format=PDF|pmid=17549134|pmc=1839918 • cite journal|journal=J Can Chiropr Assoc|year=2008|volume=52|issue=1|pages=7–8|title=A Clinical Practice Guideline Update from The CCA•CFCREAB-CPG|author= Anderson-Peacock E, Bryans B, Descarreaux M "et al."|url=http://jcca-online.org/ecms.ashx/PDF/2008/2008-1/ClinicalPracticeGuidelineUpdatefromTheCCACFCREABCPG.pdf|format=PDF|pmid=18327295|pmc=2258235

Adverse events in spinal manipulation studies appear to be under-reported cite journal|journal=N Z Med J|year=2012|volume=125|issue=1353|pages=87–140|title= Reporting of adverse effects in randomised clinical trials of chiropractic manipulations: a systematic review|author= Ernst E, Posadzki P|pmid=22522273|url=|pmc= and appear to be more common following HVLA manipulation than mobilization.cite journal|author=Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM|title=Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study|journal=Spine|volume=30|issue=13|pages=1477–84|year=2005|month=July|pmid=15990659|doi= 10.1097/01.brs.0000167821.39373.c1|url=

Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness. These events typically dissipates within 24–48 hours cite journal|author= Gouveia LO, Castanho P, Ferreira JJ|title= Safety of chiropractic interventions: a systematic review|journal=Spine|volume=34|issue=11|pages=E405–13|year=2009|pmid=19444054|doi=10.1097/BRS.0b013e3181a16d63 Serious injuries and fatal consequences can occur, and are believed to result from upper cervical rotatory manipulation.cite journal|journal=Spine|year=2007|volume=32|issue=21|pages=2375–8|title= Safety of chiropractic manipulation of the cervical spine: a prospective national survey|author= Thiel HW, Bolton JE, Docherty S, Portlock JC|doi=10.1097/BRS.0b013e3181557bb1|pmid=17906581 but are regarded as rare when spinal manipulation is employed skillfully and appropriately.cite journal|journal=J Can Chiropr Assoc|year=2005|volume=49|issue=3|pages=158–209|title= Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash|author= Anderson-Peacock E, Blouin JS, Bryans R "et al."|url=http://jcca-online.org/ecms.ashx/PDF/2005/2005-3/Chiropracticclinicalpracticeguideline-evidence-basedtreatmentofadultneckpainnotduetowhiplash.pdf|format=PDF|pmid=17549134|pmc=1839918 • cite journal|journal=J Can Chiropr Assoc|year=2008|volume=52|issue=1|pages=7–8|title=A Clinical Practice Guideline Update from The CCA•CFCREAB-CPG|author= Anderson-Peacock E, Bryans B, Descarreaux M "et al."|url=http://jcca-online.org/ecms.ashx/PDF/2008/2008-1/ClinicalPracticeGuidelineUpdatefromTheCCACFCREABCPG.pdf|format=PDF|pmid=18327295|pmc=2258235

There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions.cite journal|journal=Spine|year=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 "et al."|doi=10.1097/BRS.0b013e3181644b1d|pmid=18204386cite journal|author= Paciaroni M, Bogousslavsky J|title= Cerebrovascular complications of neck manipulation|journal= Eur Neurol|volume=61|issue=2|pages=112–8|year=2009|pmid=19065058|doi=10.1159/000180314|url=http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltextArtikelNr=180314ProduktNr=223840cite journal|last=Cassidy|first=JD|coauthors=Boyle, E; Côté, P; He, Y; Hogg-Johnson, S; Silver, FL; Bondy, SJ|title=Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study.|journal=Spine|date=15|year=2008|month=Feb|volume=33|issue=4 Suppl|pages=S176-83|pmid=18204390|accessdate=2 December 2012 Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.cite journal|journal=Neurologist|year=2008|volume=14|issue=1|pages=66–73|title= Does cervical manipulative therapy cause vertebral artery dissection and stroke?|author= Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM|doi=10.1097/NRL.0b013e318164e53d|pmid=18195663 A 2012 systematic review determined that there is insufficient evidence to support any association between cervical manipulation and stroke.cite journal|journal=International Journal of Clinical Practice|year=2012|volume=66|issue=10|pages=940–947|title= Assessing the risk of stroke from neck manipulation: a systematic review|author= Haynes MJ, Vincent K, Fischhoff C, Bremner AP, Lanlo O, Hankey GJ.|doi=10.1111/j.1742-1241.2012.03004.x|pmid=22994328|url=http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2012.03004.x/full

Cost-effectiveness

Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches.cite journal|journal= J Electromyogr Kinesiol|year=2012|volume=|issue=|pages=|title=Spinal manipulation epidemiology: Systematic review of cost effectiveness studies|author= Michaleff ZA, Lin CW, Maher CG, van Tulder MW|doi= 10.1016/j.jelekin.2012.02.011|pmid=22429823|pmc= Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent.cite journal|journal= European Spine Journal|year=2011|volume=20|issue=7|pages=1024–1038|title=Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review|author= Lin CW, Haas M, Maher CG, Machado LA, van Tulder MW|doi=10.1007/s00586-010-1676-3|pmid=21229367|pmc= 3176706

placing a signed comment at the end of this section to place timestamp for archiving. - - MrBill323:32, 21 October 2013 (UTC)

Education and stress

I propose https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=582755288oldid=582753605 this change. QuackGuru01:16, 22 November 2013 (UTC)

It is indeed a secondary source

The lead need to be updated with the relevant information. It is indeed a https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=582757709oldid=582755756 secondary source. QuackGuru01:44, 22 November 2013 (UTC)

Outdated and wrong

17:57, 23 November 2013 (UTC) The information on here is not only biased but is outdated and needs updating. For your knowledge, yes there are HUNDREDS if not thousands of medical research on chiropractic. So to say, there is no research supporting chiropractic is not true. People use wikipedia all the time so the information on here needs to be correct.

please change:

"Collectively, spinal manipulation failed to show it is effective for any condition.14 The scientific consensus is that chiropractic may be on a par with other manual therapies for some musculoskeletal conditions such as lower back pain, but that there is no credible evidence or mechanism for effects on other conditions, and some evidence of severe adverse effects from cervical vertebral manipulation."

to:

There is research supporting spinal manipulation and it has been shown to be effective for most conditions (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563165/) also, (http://www.ncbi.nlm.nih.gov/m/pubmed/24262386/?i=1from=Is%20chiropractic;

"Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Neck Pain."

AuthorsBryans R, et al. Show all Journal

J Manipulative Physiol Ther. 2013 Nov 19. pii: S0161-4754(13)00237-6. doi: 10.1016/j.jmpt.2013.08.010. Epub ahead of print

Affiliation

Guidelines Development Committee (GDC) Chairman; Chiropractor, Clarenville, Newfoundland, Canada."

The scientific consensus is that chiropractic may be on a par with other manual therapies for some musculoskeletal conditions such as lower back pain, and there is credible evidence for effects on other conditions (ex. treating hypertension with chiropractic has been shown to be successful)

"Spinal manipulation for the treatment of hypertension: a systematic qualitative literature review."

AuthorsMangum K, et al. Show all Journal

J Manipulative Physiol Ther. 2012 Mar-Apr;35(3):235-43. doi: 10.1016/j.jmpt.2012.01.005. Epub 2012 Feb 17.

Affiliation

Private Practice, Riverside, CA, USA.

And please change this line:

"...and some evidence of severe adverse effects from cervical vertebral manipulation."

to:

No research has been found to be specifically correlated with severe adverse effects. The research claiming this failed to state the preexisting conditions of the patient.

or just leave that sentence out because you cannot claim something that isn't completely true. Oh and it only happened a few times in history and it's not relevant to the profession at hand.

Nonsense. These changes are not acceptable. --Roxy the dog19:19, 23 November 2013 (UTC)

The evidence on chiropractic's is mixed. · email) (if I write on your page reply on mine) 22:23, 23 November 2013 (UTC)

The evidence based on a critical evaluation of a https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=583031455oldid=582850090 systematic review of systematic reviews is clear. This is an authoritative source. I changed the sentence. "A critical evaluation found that collectively, spinal manipulation failed to show it is effective for any condition." This was according to a critical evaluation of a systematic review of systematic reviews. QuackGuru02:03, 24 November 2013 (UTC)

I would expect changes be made to the description of chiropractic. The main authors are people who believe the chiropractic profession are quacks. If they researched medical studies done on chiropractic instead of finding articles that they believe should be displayed. Actually more people are realizing that chiropractic does wonders. Read the medical studies and get up to date on chiropractic instead of picking and choosing what articles fit your description of chiropractic. Ya there is controversy but how many great medical studies are successful on chiropractic? How many are against it? Successful out weigh the non successful. The research your claiming about serious adverse affects like stroke from chiropractic was already a pre existing condition and I would expect you mention that. This whole description of the profession is a joke. The evidence IS out there that the benefits FAR out weigh the adverse effects. I've personally seen hundreds of people be healed from their neuromusculoskeletal disorders by utilizing chiropractic. chronic pain gone just from seeing a chiropractor. Clinical case studies are far better than any other study done because it's with the patients not overseeing and speculating from a review. Hear it from the people. —nbsp;Preceding ) 22:48, 26 November 2013 (UTC)

Please link these studies and we'll be glad to read them. Your own research and assorted testimonies won't hold any weight here by the way. Samwalton922:54, 26 November 2013 (UTC)

Not pseudoscience

There may be some aspects of chiropractic which are considered pseudoscientific . . . but as a whole the majority of the profession . . . yes it is a profession . . . is evidence-based and scientific. TheDoctorIsIn21:18, 21 January 2014 (UTC)

Per FRINGE/PS, Chiropractic is not generally considered a pseudoscience and therefore should not be categorized as such. TheDoctorIsIn22:20, 21 January 2014 (UTC)

That sounds like the curate's egg. Oh, "some parts" of chiropractic are evidence-based! The "profession", I can live with; there is no doubt that some make a career out of it. Bobrayner bobrayner 23:09, 21 January 2014 (UTC)

Regardless of your personal feelings about chiropractic . . . the scientific community does not generally consider chiropractic to be pseudoscience . . . therefore categorizing this article as pseudoscience is a violation of FRINGE/PS. This article (ChiropracticEffectiveness) alone shows that there is a reasonable amount of academic debate still existing about chiropractic. Show me that the scientific community does generally consider chiropractic to be a pseudoscience . . . otherwise there is nothing to talk about here. TheDoctorIsIn00:14, 22 January 2014 (UTC)

The ideas of innate intelligence and the chiropractic subluxation are regarded as "'pseudoscience"'.9 This is in the lead. QuackGuru02:43, 22 January 2014 (UTC)

QG is correct, so that part is settled. The next issue is whether we can categorize the whole profession as pseudoscience. No, we can't, for many reasons. It's too complex to label the whole profession in that way, especially since there is a move away from previously held positions. We would also violate the PSI Arbcom decision by doing that, so we should simply keep the content we have which mentions the pseudoscientific elements still held by some chiropractors, but the template and category have got to go. In fact, chiropractic should be removed from the template, as that too is a violation of the Arbcom decision. I'm doing that right now. -- BullRangifer Brangifer 05:39, 22 January 2014 (UTC)

Hmmm. Not sure about that; that it's a profession is unrelated to its scientific soundness (there are, after all, professional homeopathy practitioners). And insofar as it deals with science, its theories are pseudoscientific are they not? Before such a major change as this it would be wise to get a wider view, perhaps at |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 06:06, 22 January 2014 (UTC)

Way to early for BullRangifer to charge in changing things without proper discussion and consensus. I agree with Alexbrn - any change to the Wiki voioce on this needs much wider discussion. I oppose btw. Chiropractic is pseudoscience to the core. --Roxy the dog12:28, 22 January 2014 (UTC)

Just to chip in, the majority of sources I can find refer to chiropractic as either pseudoscience or in one case "struggling to throw off the shackles of the pseudoscience it was born from". It definitely deserves the category tag.SPACKlick13:01, 22 January 2014 (UTC)

The only arguments being made here to keep the incorrect categorization are mostly based on personal opinion . . . "I feel that chiropractic is pseudoscience therefore is should be categorized as such" . . . if you are saying that the majority of the "reliable scientific sources" are calling chiropractic a pseudoscience, then please show us those sources . . . this article shows that there is a lot of fair to high quality research out there with conflicting conclusions about the effectiveness of chiropractic for this or that ailment . . . Vertebral subluxation and innate intelligence are very much pseudoscientific and those articles should be categorized as such . . . nobody is arguing otherwise . . . however, modern chiropractic is making all attempts to leave those concepts in the past . . . condemning all of chiropractic as pseudoscience for these historical theoretical concepts would be "to some degree" similar to calling medical science a pseudoscience based on the practices of bloodletting and leeching. TheDoctorIsIn05:49, 23 January 2014 (UTC)

For most of its existence, chiropractic has been sustained by pseudoscientific ideas such as subluxation and innate intelligence16 which are not based on solid science.9 See ChiropracticConceptual basis. If a chiropractor would leave their history in the past they would be called a physical therapist. QuackGuru06:33, 23 January 2014 (UTC)

The operative word here is "history" . . . Chiropractic is not currently generally considered pseudoscience. Please provide a reliable scientific source stating otherwise . . . this article shows that there is a lot of fair to high quality research out there with conflicting conclusions about the effectiveness of chiropractic for this or that ailment . . . this means that the scientific status of chiropractic is inconclusive at this point . . . seemingly there is some scientific evidence to support it while there is also scientific evidence to refute it. TheDoctorIsIn18:31, 23 January 2014 (UTC)

Verging into NOTAFORUM.

What specific improvements to the article are being suggested? If none are, then this topic should be closed. --Harizotoh907:16, 23 January 2014 (UTC)

The improvement is to fix the miscategorization of this topic as a pseudoscience . . . as it stands now this article is in violation of FRINGE/PS . . . removing the miscategorization would therefore be an improvement. TheDoctorIsIn18:31, 23 January 2014 (UTC)

"this article is in violation of |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 19:18, 23 January 2014 (UTC)

"3. Questionable science: Hypotheses which have a substantial following but which critics describe as pseudoscience, may contain information to that effect; however it should not be described as unambiguously pseudoscientific while a reasonable amount of academic debate still exists on this point."

Given all of the fair to high quality research out there with conflicting conclusions about the effectiveness of chiropractic for this or that ailment . . . clearly there is a reasonable amount of academic debate about the scientific aspects of chiropractic . . . however the article is currently categorizing (an unambiguous description) as pseudoscience . . . therefore the article is currently in violation of FRINGE/PS. TheDoctorIsIn23:34, 23 January 2014 (UTC)

I agree with what TheDoctorIsIn has just said and agree that it violates FRINGE to try and characterize the entire profession as pseudoscience. I believe that BullRangifer also mentioned that it violates some ArbCom decision to label the profession as pseudoscience outright; perhaps he could ellaborate on that? Moreover, a http://archinte.jamanetwork.com/article.aspx?articleid=210354 RS in JAMA Int Med suggests that ""Today, a substantial number of chiropractors are anxious to sever all remaining ties to the vitalism of innate intelligence. For these practitioners, the notion of the innate serves only to maintain chiropractic as a fringe profession and to delay its "transition into legitimate professional education, with serious scholarship, research, and service."" And the body of our wiki article mentions that traditional straights are the minority. Thus, while it is great to mention the pseudoscientific heritage, traditions, etc., it is equally, perhaps even more important to indicate that a significant shift has/is occurring for 'a substantial part of the profession'. Puhlaa02:08, 24 January 2014 (UTC)

There are two questions, 1) Should :Category:Pseudoscience be removed from the article; 2) Should Chiropractic be removed from the

Pseudoscience

template and therefore have that template not appear at this article. I really think they're two separate questions and need to be considered individually. Categories are more broad and not as selective as a template. The Pseudoscience category has 280 pages in it and 28 subcategories, each with their own pages; the template lists only 30 specific examples.I think there's a decent case for keeping the category, if there's reliable sourcing that indicates that some fundamental aspects of the topic are generally considered pseudoscience. I haven't reviewed the sourcing well enough to know for sure, but I do see a few sources supporting it in the article. I don't think it's a requirement for inclusion in a category that the article topic falls 100% within it. For example, there are plenty of biographies for people involved in more than one discipline that have multiple categories, like Michelangelo is in categories for both painters and sculptors.I think the case for keeping chiropractic in the template is weaker, because it's more selective. Does the authoritative reliable sourcing consider chiropractic to be a foremost example of pseudoscience? I am genuinely unsure. Zad68 "'Zad"'"68" 03:00, 24 January 2014 (UTC)

I think it is worth noting that if you remove the pseudoscience from chiropractic, what you have left is massage. --Roxy the dog05:36, 24 January 2014 (UTC)

The aspects which are pseudoscientific can be labelled as such in this article, and they are. They can also, per the PSI ArbCom, be categorized as such in their own articles. To label a whole profession is problematic. This isn't homeopathy, a classic example of pseudoscience. That's why I think we should remove chiropractic from the template, remove the template, and remove the category. That way we won't be in conflict with the PSI ArbCom decision, while still labeling the pseudoscientific elements as such, which the PSI ArbCom allows. This is a simple solution which does not remove our properly sourced obligation to label the PSI elements for what they are. -- BullRangifer Brangifer 05:38, 24 January 2014 (UTC)

The main point I think is that (as we say in the very opening sentence) Chiropractic is "both" an approach and a profession, and because it has this dual aspect the categorizations we use will apply apply to either those aspects. So some categories (such as "Physical exercise") apply to the "approach" rather than the "profession" aspect of chiropractic. So it is with "pseudoscience". The fact that "Chiropractic" has its own entry in Shermer's encyclopedia of pseudoscience gives us a central RS-based reason why this category applies. I'm not bothered about the template. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 06:37, 25 January 2014 (UTC)

Brangifer's analysis is precisely correct . . . If we follow the guidelines of Wikipedia and the reality of Chiropractic today there is really no other way to interpret the way forward here. Alexbrn . . . do you recognize that science does support chiropractic spinal manipulation as a benefit for some limited conditions and there are a variety of other conditions where there is weak to moderate evidence supporting it? And there are conditions for which science positively refutes chiropractic manipulation as a treatment. This is not just about physical exercise, nutritional counseling . . . This is about the scientific door not being closed on chiropractic spinal manipulation . . . it's very much open as research continues. The scientific debate continues . . . Therefore per FRINGE categorizing chiropractic as pseudoscience is a Wikipedia rule violation and worse . . . it is factually incorrect. TheDoctorIsIn06:55, 25 January 2014 (UTC)

There is no scientific debate: the question of whether the precepts underlying chiropractic are pseudoscientific is settled: they are. Separately to that, some parts of the chiropractic movement are trying to de-emphasize those aspects or make a land-grab to "own" generic spinal manipulation, as we relate in our article here. What is the difference between "spinal manipulation" in general and what you call "chiropractic spinal manipulation"? According to reliable sources that consider the matter, it is pseudoscience - chiropractic's defining differentiatior. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:06, 25 January 2014 (UTC)

Spinal manipulation is chiropractic. Other professions may do it, but manipulation of the spine is chiropractic . . . The land-grab goes the other way . . . as spinal manipulation is found to be scientifically effective for a variety of ailments other healthcare professions are co-opting the techniques. Chiropractic has gotten results in some cases . . . The original hypothesis as to why these results were occurring has been falsified . . . However the techniques remain and science is now finding out the actual why and how these manipulation cause these benefits for some ailments. TheDoctorIsIn07:23, 25 January 2014 (UTC)

Non-chiropractors have long performed spinal manipulation in the limited number of scenarios where it is merited. According to RAND, even in 1991, 6% of the spinal manipulations in the US were performed by non-chiropractors. The fact that chiropractic is being investigated (and found wanting) does not bear on the question of whether it is pseudoscience. Homeopathy is still being "investigated". But in the end, we need to avoid original research and go by reliable sources on pseudoscience which consider the question of whether or not chiropractic should be so categorized. As I say, it's got an entry in Shermer's volumes. What other sources "directly" address this question? |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:40, 25 January 2014 (UTC)

Chiropractic is linked with "pseudoscience". When it is no longer linked with pseudoscience they would be called a physical therapist and the word "chiropractor" would no longer be used. On the contrary, you have not established consensus to https://en.wikipedia.org/w/index.php?title=Template%3APseudosciencediff=592289667oldid=592288506 delete it from the template. It was in the template for a long time. QuackGuru07:11, 25 January 2014 (UTC)

Statement by an admin re. ArbCom sanctions

I think there is a strong case to be made for Puhlaa being excluded from directly editing this article. The lengthy history of non-consensus edits advocating an idealised form of chiropractic whihc is at odds with common practice, places Puhlaa firmly on the wrong side of FRINGE. Puhlaa, for the next month, I suggest you propose all changes on talk first, with existing text, suggested replacement, reasons for the change, and sources. I suggest you do this one small change at a time. If you do not, then I think you will find that arbitration enforcement sanctions will be requested, whihc will likely exclude you form the article altogether. Consider this a free drink at the Last Chance Saloon; the next one will not be free. (JzG/help Help!) 09:28, 25 January 2014 (UTC)

Some concerns from a bunch of numbers

Hi all, I've got some problems with the sections I've posted below (from the SAFETY section):

""Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints.2"

"Sustained chiropractic care is promoted as a preventative tool, but unnecessary manipulation could present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made.9""

First I'm not sure chiropractic care is seen as generally safe anymore (http://www.theguardian.com/lifeandstyle/2012/may/14/dangers-chiropractic-treatment-under-reported eg.). What is the general consensus to changing this statement to be a little less sure of itself?

Secondly what is meant by "when employed skillfully and appropriately"? This seems, to me, like a way of saying "When chiropractic care is administered safely it is safe" a subtly worded case of begging the question.

Thirdly the second sentence contradicts the first - if Chiropractic treatment is safe why would anyone be concerned with ongoing treatment?

Fourthly the reference in this sentence (from Edzard Ernst) implies that it is Chiropractors that are concerned by their own claims - the article written by Ernst doesn't mention that it is Chiropractors who are concerned specifically with the claims, and is highly critical of the efficacy of the whole field.

I'd also like to get rid of the weasel words throughout; perhaps this is a start:

"'Due to a lack of rigorous research and systematic under-reporting of negative affects it is difficult to gauge the safety of Chiropractic therapy http://www.theguardian.com/lifeandstyle/2012/may/14/dangers-chiropractic-treatment-under-reported 1. Most chiropractic practitioners report high levels of safety with their therapies (another ref) As with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications."'

I feel this is more in line with research, and also with the rest of the section which goes into detail about some of the risks associated with Chiropractic therapy. 05:30, 28 January 2014 (UTC)

"Chiropractic care in general is safe when employed skillfully and appropriately" is a meh kind of statement. We might as well say "Chiropractic care in general is safe when done safely". What source is behind this spin? |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 06:58, 28 January 2014 (UTC)

That is the text straight out of the current article. I'm not sure if you are asking me to source it? If so you might want to read my post above (where you are almost paraphrasing me funnily enough). 07:21, 28 January 2014 (UTC)

It's that 2005 "WHO" document behind it (again). This is not a reliable source and needs filleting out of the article I think. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:27, 28 January 2014 (UTC)

Are you saying the first sentence came out of a WHO article? There is no reference provided in text so I thought it was just unnecessary verbiage (at best). 07:31, 28 January 2014 (UTC)

Well, the whole para is sourced to that document (which is actually a document by chiropractors painting an idealized vision of what they should be doing). I didn't verify the precise text though. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:35, 28 January 2014 (UTC)

Well the statement is straight out of the sourced document (slightly paraphrased). I'm not sure of the provenance of the WHO document (although it's references are very out of date), regardless I feel that we could find reliable sources that confirm both points of view. I think the current statement that it is "generally safe" is over-confident given sources positing the opposite and pointing out the lack of quality research on the issue. That's why my proposed new text is kind of 'on the fence'. 07:44, 28 January 2014 (UTC)

Well, the BBC source is not strong enough for biomedical information (see |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 08:18, 28 January 2014 (UTC)

(EC) Ok, the article I provided points back to http://www.jpsmjournal.com/article/S0885-3924(07)00783-X/fulltext this study which paints a different picture to the one above. Both articles note that the research into the issue has used less rigorous methodologies and findings are not clear:

My feeling is that the similarity across articles is that the research is poor and this should be noted in the article, but I'm not sure if this is original research or contravenes whatever other WP policies I'm ignorant of. 08:27, 28 January 2014 (UTC)

Furthermore these two studies are not the only ones to come to this conclusion, so do http://www.researchgate.net/publication/24429097_Safety_of_chiropractic_interventions_a_systematic_review/file/9fcfd5121302fa3487.pdf this one, http://www.researchgate.net/publication/5937541_Safety_of_chiropractic_manipulation_of_the_cervical_spine_a_prospective_national_survey/file/3deec516c0a85bdcaa.pdf this one and http://www.biomedcentral.com/content/pdf/1745-6215-12-235.pdf this article has a useful summary in its introduction. 08:40, 28 January 2014 (UTC)

Just as a note, if no-one objects soon, I will go ahead and rewrite the relevant section to emphasise the low quality of research into the safety of Chiropractic therapy and variable estimates of harm. 09:55, 29 January 2014 (UTC)

Massive deletion and manipulation of text throughout the article

Previous lead sentence. "Chiropractic is a form of alternative medicine1 that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.2 It is generally categorized as complementary and alternative medicine (CAM),1 a characterization that many chiropractors reject.3"

https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=442127826

Check the edit history. The lead is currently a mess and the body of the article was severely hacked.

All over the article text is missing. For example, this was in the history section: "Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine." QuackGuru19:34, 23 January 2014 (UTC)

You are introducing redundancy into the lead with https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592060284oldid=592055083 this edit. Why have you added a second reference to Chapman-smith in the first paragraph of the lede? Before your edit it said: "Chiropractic is a complementary and alternative health profession... (1)." and now you have also added "Chiropractic is generally classified as CAM...(1)" These are saying the same thing, why do you feel they are both needed? One of the two needs to be removed, I have removed the one you added.Puhlaa20:08, 23 January 2014 (UTC)

QG, it seems that https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592060284oldid=592055083 with this edit you may have also removed the text that Alexbrn had included following https://en.wikipedia.org/wiki/Talk:Chiropractic/Archive_35Spine_or_not.3B_a_reverted_edit this discussion. He was editor who wanted text that represented the Villanueva-Russell included in the scope section, you should probably read the archived talk. I think your edit has removed that source? You were banned from editing for a year and a lot changed while you were banned, perhaps just restoring the article to what it looked like before you were banned is not the best idea? Some of the changes were agreed to be improvements.Puhlaa20:18, 23 January 2014 (UTC)

Villanueva-Russell is a good source. The point here is that the "WHO" document is produced by chiroporactors and paints an idealized picture of chiro (TL;DR "we just do spines, sensible us"); Villanueva-Russell's more up-to-date material suggests many chiros are still ploughing the systemic health claim furrow. I would junk the WHO document entirely; it's a non-independent out-of-date source. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 21:19, 23 January 2014 (UTC)

The 2011 research by Yvonne Villanueva-Russell is in the article now.

Editors at the time thought the lead https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=461702631 should not be changed. This edit changed the https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=461708045 lead using the "WHO" document produced by chiropractors.

The Villanueva-Russell source and other sources are https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592081321oldid=592079770 better sources. The text must be written to match the source or sources now. QuackGuru21:41, 23 January 2014 (UTC)

There was no consensus to remove the WHO source from the lede, previous discussion I linked found consensus to include the V-R source in the 'scope' section. The WHO source is the best descriptive source we have for an article that is meant to represent a world view. I have restored the WHO source to the lede, will need to discuss (again) if you want such a good source removed in favour of sources that are US-centric. Puhlaa22:06, 23 January 2014 (UTC)

I don't see consensus to remove the "https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=461708045 Nelson" source from the lead. Most of this article was hacked. Show me where was the consensus that the Nelson source was a bad source. The https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592084565oldid=592081321 Villanueva-Russell source is recent source. Do you believe the Who is a non-independent and out-of-date source or do you think is it an independent and recent source. QuackGuru00:52, 24 January 2014 (UTC)

QG, you pointed to a https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=461708045 2011 edit that removed Nelson from the lede and asked me to show you the consensus for that change? This is irrelevant, the article has come a long way over 3 years. The consensus now is that Nelson is not in the lede, if you think Nelson should be added back into the lede (as you did in https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592081125oldid=592079770 this edit today ), I think you will need consensus. I am not saying it cannot be added to the lede, but it seems like a fairly US-centric source and it is regarding a specific topic (scope of practice in the US), thus it is not helpful as a source for the generic definition of chiropractic in the lede. The Villanueva-Russell source is also about scope of practice of US chiropractors, thus, while it could have it's place in the lede, it is not a good source for a general definition of the global profession, where you had placed it. The WHO source is vetted by an internationally recognized, mainstream medical organization (The World Health Organization) and it is an attempt to standardize the terminology/training/safety/etc of the chiropractic profession internationally. Moreover, the source says that the:

""WHO took every precaution to verify the information contained in this publication"" and

""WHO acknowledges its indebtedness to over 160 reviewers, including experts and national authorities and professional and nongovernmental organizations, in over 54 countries who provided comments and advice on the draft text."".

I think it is a great and authoritative and impartial source for a general definition of chiropractic and a general discussion of the training standards and licensing for the profession internationally. Are you aware of another source on the topic by an international medical body that could be used to introduce a topic of international significance instead of the WHO source? Puhlaa02:38, 24 January 2014 (UTC)

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592069004oldid=592060284 Many chiropractors reject with the characterization that chiropractor is considered CAM. This text should be restored.

"No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors.16"

The lead already says profession enough times with this sentence above.

"The other great divide within chiropractic concerns the question of whether or not chiropractic is a primary care profession. Unfortunately, just as the word "philosophy" is routinely misused, so is the concept of "primary care." Paradoxically, even the extremes of the profession on the philosophy question (e.g., Sherman College and National University) both endorse the notion of chiropractic as a primary care profession. This agreement does not suggest that chiropractic, as primary care is a valid and compelling concept. Rather, it suggests that the concept has been unexamined and hastily adopted. This section will examine the meaning of primary care as it applies to chiropractic."https://www.ncbi.nlm.nih.gov/pubmed/16000175

The Nelson source is a good independent source that explains the controversy. It is relevant the Nelson source was https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=461708045 deleted without consensus. An https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=461714689 editor knew something happened to the article. The lead should not say it is a profession in the first sentence in WP's voice when there is disagreement. Do you think we should assert it as an objective fact in the first sentence when there is disagreement. QuackGuru20:17, 24 January 2014 (UTC)

As I said above, I am not against Nelson or V-H sources being used, but it is not helpful to point to 2011 edits for discussions of 2014 content; please keep the discussion geared towards a current, specific proposal(s). If you make a clear proposal for the addition of Nelson and V-H to the lede then we can discuss the merits of that proposal. I have mentioned already that they are not good sources for the first sentence, which is a general definition of the international profession.

With regard to restoring old text to the lede that discussed the controversy over the term CAM (ie: many DCs surveyed rejected the term); RS seem to agree that chiropractic is considered a CAM profession; I think that the disagreement by DCs over the CAM characterization is not really noteworthy for the lede. Similarly, the debate over primary care is purely academic and dependent on what definition of primary care is used (the term is often mis-used). I dont think we should use this term in the lede at all. Puhlaa22:03, 24 January 2014 (UTC)

See the lede https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=442127826 here. It summarises the body. The current lede does not summarise the body at all. Would you like me to summarise the body in the LEAD. It would only take a couple of minutes to update the lede. Chiropractic is a "form" of alternative medicine. We can't assert it as alternative medicine or CAM in the lede when it is "generally" considered CAM. These differences are noteworthy. "Chiropractic is an alternative medicine1" is OR. The source does not assert it as alternative medicine. https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=461702631 Chiropractic is a form of alternative medicine. This is neutrally written and passes V policy. Larry Sanger created simply policies for editors to adhere to but Wikipedia administrators do not enforce V or NPOV policy. So now the very first sentence in the article is OR. It is very helpful to point to 2011 edits when the problems happened. I asked you to show where was the consensus to https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=461708045 delete the Nelson source but you failed to show there ever was consensus. For what seems link a number of years, you have been arguing against many editors against improving the lede sentence when editors know sources disagree. For example, you accused User:JzG in 2011 of https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=465993481 vandalising the lede sentence when all along you are the editor who violated NPOV. I already explained we can't say it in WP's voice. See ASSERT. Editors have previously pointed out the problems with using the Who source in the lede. When "chiropractic is viewed as a marginal healthcare profession"40, we can't assert it in the lede sentence that chiropractic "is" a healthcare profession. You are beating a dead horse over this for a very long time now. Please move on. QuackGuru06:20, 25 January 2014 (UTC)

QG, I have tried my best to adress each of your points:

"'1)"' You said ""The current lede does not summarise the body at all. Would you like me to summarise the body in the LEAD?""

Response: I think the lede is a mostly good summary of the body, but there is always room for improvement. For example, I think the last paragraph of the lede is innacurate and OR. I am working on making a specific proposal for changes there.

"'2)"' You said: ""Chiropractic is a "form" of alternative medicine. We can't assert it as alternative medicine or CAM in the lede when it is "generally" considered CAM. These differences are noteworthy. ""

Response: I do not see the notable difference between 'CAM' and 'a form of CAM' and 'generally considered CAM' that you suggest.

"'3)"' You said: ""Chiropractic is an alternative medicine1" is OR. The source does not assert it as alternative medicine.""

Response: You state in point (2) that the source says it is "is a form of alternative medicine". As I said above, I do not really see the notable difference between 'CAM' and 'form of CAM' and 'generally considered CAM'.

"'4)"' You pointed to ASSERT and said: “"When chiropractic is viewed as a marginal healthcare profession40, we can't assert it in the lede sentence that chiropractic is a healthcare profession.""

Response: The lede sentence does not assert what you claim; the lede sentence says it ""is an alternative medicine healthcare profession"". Chiropractic is considered a 'marginal' healthcare profession because it is generally considered 'CAM' and 'CAM' is not part of the mainstream - Please see http://www.ncbi.nlm.nih.gov/pubmed/12669653 This recent mainstream source which says in the first 2 sentences of the abstract ""Chiropractic is the best established of the alternative health care professions. Although marginalized for much of the 20th century, it has entered the mainstream of health care, gaining both legitimacy and access to third-party payers."" Our lede does not try to say that it is a mainstream profession, our lede maintains that it is a "CAM healthcare profession", as such, I do not think that our lede is asserting anything that is inconsistent with the RS. Our lede sentence is a good summary of current RS. Puhlaa02:18, 26 January 2014 (UTC)

The lede says it is a "alternative medicine healthcare profession" but a newer 2011 source say it is https://www.ncbi.nlm.nih.gov/pubmed/21531061 tied to a marginal professional status. When there is disagreement you can't assert it as fact in the lede that it is an alternative medicine healthcare profession. It is https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592069004oldid=592060284 generally considered CAM but not CAM or alternative medicine. The OR should be removed from the lede. The source you stated is http://www.ncbi.nlm.nih.gov/pubmed/12669653 from 2003. It is not used in the lede sentence and it is not a recent source. The first part of the lede sentence is still OR and there is a disagreement among sources. You haven't given a reason to assert it as fact in the first sentence when there is a disagreement. The part "alternative medicine1 health care profession" is putting two sources together that to come to a new conclusion. It is SYN. Chiropractic is an alternative medicine1" is OR but your response did not address the OR. It is not about you don't see the notable difference. It is about OR and sources disagree. The https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=442127826 previous lede summarised the body. The current lede is poorly writing and does not summarise the body well at all. The WHO source is not consistent with newer sources. For example, it says under Chiropractic: "A health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health." Now we are going to have to replace it. QuackGuru04:42, 26 January 2014 (UTC)

"concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health." This is what the WHO source says.

"concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health." This is what the current article says. This is a COPYRIGHT violation. QuackGuru18:24, 26 January 2014 (UTC)

"'QG, you said"': ""The lede says it is a "alternative medicine healthcare profession" but a newer 2011 source say it is tied to a marginal professional status. When there is disagreement you can't assert it as fact in the lede that it is an alternative medicine healthcare profession.""

"'Response"': Did you read the newer source? The newer source you refer to is https://www.ncbi.nlm.nih.gov/pubmed/21531061 Yvonne_VRussell. You keep suggesting the phrase "The dilemma of remaining tied to a marginal professional status must be balanced against considerations of integration." is inconsistent with our lede. However, I dont think you have read the full text? I tried to explain this concept to you in my last response, perhaps I wasn't clear. In the full text of Yvonne_VRussell’s source, she explains what she means by 'marginal':

""In health care, orthodox medicine has “professional dominance” and possesses the largest jurisdiction , although much discussion of the decline of this hegemonic power has also occurred in the literature. Complementary and Alternative Medicine (CAM) has established itself as a “marginal profession” in relation to this framework.""https://www.ncbi.nlm.nih.gov/pubmed/21531061 Yvonne_VRussell

Yvonne_VRussell is clearly using ‘marginal’ to describe a CAM professions placement relative to the mainstream and in this source she is specifically discussing the CAM health profession 'chiropractic'. This description of chiropractic is perfectly consistent with other sources, like http://nccam.nih.gov/health/chiropractic/introduction.htm,http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf,http://www.ncbi.nlm.nih.gov/pubmed/12669653,http://archinte.jamanetwork.com/article.aspx?articleid=210354, which have been presented to you previously.

"'Bottom line"', there are good reliable sources that call chiropractic a "health profession" http://nccam.nih.gov/health/chiropractic/introduction.htm http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf ; an "alternative healthcare profession" http://www.ncbi.nlm.nih.gov/pubmed/12669653; a "marginal (CAM) healthcare profession" https://www.ncbi.nlm.nih.gov/pubmed/2153106; and even a "medical profession" http://archinte.jamanetwork.com/article.aspx?articleid=210354. In the year https://en.wikipedia.org/w/index.php?title=User_talk%3AQuackGurudiff=441111231oldid=438700979 you were blocked from editing chiropractic there were editors who wanted the CAM designation included in the first sentence, there were also editors who wanted the profession status included in the first sentence. You can see that the consensus version that currently exists was able to achieve both, while staying consistent with the sources available. I think that future discussion would be more fruitful if you just made specific proposals based on RS that we can reasonably discuss. Puhlaa20:08, 26 January 2014 (UTC)

You are not collaborating at this talk page because you ignored my concerns about the https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592539555oldid=592528799 SYN and copyright violations. Editors cannot have a reasonable discussion with you here. The WHO source did not verify the claim "alternative medicine healthcare profession". As I said before putting two sources together to come to a new conclusion is SYN. Do you agree it was SYN and copyright violations in the lede sentence. If we use the Yvonne VRussell source it could start by saying "Chiropractic is a marginal heath care profession in the field of complementary and alternative medicine whose practitioners emphasize..." QuackGuru18:43, 28 January 2014 (UTC)

;Proposal

Current lede sentence: Chiropractic is a health care profession in the field of complementary and alternative medicine whose practitioners emphasize manual manipulation of the spine, sometimes with the unevidenced claim this can treat a wide variety of human ailments.1

Proposal to replace lede sentence. "'Chiropractic"' is a form of alternative medicine that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system. It is a marginal complementary and alternative medicine health care profession. QuackGuru05:34, 29 January 2014 (UTC)

As author of that current lede sentence, let me just explain a couple of the thoughts behind it:

By saying what chiros "do" right after mentioning "profession", I hopes to make clear that chiropractic is both a method and a profession while avoiding the mouthful of explicitly saying so

I think the "sometimes unevidenced" wording is useful as it lets readers know we have something suspect here. I think it's important for this to be apparent early so this doesn't look like a legitimate form of medicine until we arrive at the criticism paragraph. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 05:46, 29 January 2014 (UTC)

The part "sometimes with the unevidenced claim this can treat a wide variety of human ailments.1 is too vague. There is also a lot of stuff missing from the https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=442127826 first paragraph and entire lede that is more specific and better written. The part "It is a marginal complementary and alternative medicine health care profession." can be expanded using the Yvonne VRussell’s source. QuackGuru06:26, 29 January 2014 (UTC)

There are a lot of proposals and discussion now in this one thread, perhaps some new threads with clear proposals could be started? I am replying here to QG comment at 18:43 on Jan 28.Puhlaa06:44, 29 January 2014 (UTC)

QG, I have already explained to you that I do not think our lede sentence has any synthesis! Our lede says: “’’ Chiropractic is an alternative medicine health care profession’’” We have http://www.ncbi.nlm.nih.gov/pubmed/12669653 RS source that says”’’ Chiropractic is the best established of the alternative health care professions’’”. You claim that the WHO source does not support that chiropractic is an alternative healthcare profession, but the WHO starts it’s chiropractic guidelines with a foreword all about traditional/alternative/complementary medicine. Remember I pointed you to https://en.wikipedia.org/wiki/Talk:Chiropractic/Archive_34Suggest_combine_first_two_sentences this consensus-building discussion that generated the current lede sentence; you will see that editors pointed-out this fact then as well.

You want to add the term 'marginal' to the first sentence of the lede along with the alternative medicine description. I have already shown you that Yvonne_VRussell explains in her source what she means by 'marginal' – alternative medicine professions are 'marginal' to mainstream medicine, just as they are also 'alternative' to mainstream medicine. There is no need to describe chiropractic as 'marginal' AND 'alternative' in the lede sentence, as you propose, when they are referring to the same characteristic – their position relative to mainstream medicine.

With regard to you newest concern; I dont think we are violating any copyright policy by using a half-sentence from the WHO guidelines source. However, if you feel strongly that this is a big problem, perhaps you could show good intent and start a thread for a clear proposal for how to address your copyright concerns without also trying to change all the other components of the lede sentence where there are no problems and where we have good consensus. For example, there is no reason, based on copyright to remove the WHO source, or to remove the general description of chiropractic the WHO gives us; but perhaps we can re-word the general description so that you are confident we are not copying the WHO too closely. Puhlaa06:44, 29 January 2014 (UTC)

I would say a new consensus needs to be developed for the lede, this is appropriate as new RS is available. The WHO source is not appropriate MEDRS as it is biased as discussed by Alexbrn above. I agree with the editors who have expressed concern that chiro being described as a healthcare profession early in the lede can create an improper impression, "healthcare profession" is suggestive of mainstream healthcare. - - MrBill306:57, 29 January 2014 (UTC)

You stated "We have http://www.ncbi.nlm.nih.gov/pubmed/12669653 RS source that says”’’ Chiropractic is the best established of the alternative health care professions’’”." That is not the WHO source. The WHO source does not explicitly say it is an "alternative medicine health care profession". A cut and paste copy of the WHO source is a https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592922204oldid=592922069 copyright violation. But that is not the main issue here. We have better independent sources. QuackGuru07:05, 29 January 2014 (UTC)

QG, the source used in the article, from http://www.amazon.com/Principles-Practices-Chiropractic-Scott-Haldeman/dp/0071375341 "Principles and Practice" also verifies the text in the lede; chiropractic as a CAM profession. If you are struggling with the lack of sources used in the lede, we could discuss adding some of the many sources that have been discussed that support the current lede. The V-H source and the source from http://www.ncbi.nlm.nih.gov/pubmed/12669653 Milbank Quarterly, which is a very respectable medical journal, could simply be added to the lede with the current source and it would be consistent with our current text. However, each of these sources is all about US chiropractic. Chiropractic is an international profession and this article is supposed to represent a world view. The current sources, http://www.amazon.com/Principles-Practices-Chiropractic-Scott-Haldeman/dp/0071375341 Chapter:International status, standards, and education of the chiropractic profession and the http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf WHO guidleines are of international relevance and consistent with the text. As such, while I am open to adding US-centric sources, I am not open to deleting internationally relevant sources until new internationally relevant sources are available. Puhlaa07:43, 29 January 2014 (UTC)

MrBill, you only need to look at the threads above to see the list of international sources that all support the description of chiropractic as a profession and the vast majority of editors have acknowledged this fact. Also, the WHO source is definitely not biased, but I agree that this is Alexbrn's view. I have suggested we take the WHO source to the RS noticeboard in previous discussions on this same topic...perhaps this is the time to get a good consensus on the value of this document for it's use here? I think it is the best source we have for this article, with regard to international education and safety standards for the chiropractic profession. Puhlaa07:43, 29 January 2014 (UTC)

QG, I am not sure why you decided to split this discussion https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592926111oldid=592924945 with this edit now into "Proposal", when it is a continuous discussion with the thread above. Now my replies to your comments are split between two threads. Perhaps you could start a new thread each time BEFORE you start a new proposal or discussion, instead of changing topics within a thread quickly before other editors have time to reply to your original topic and then splitting the thread? It gets hard for other editors to follow when discussion are split and then no one will join in the discussion. Puhlaa07:47, 29 January 2014 (UTC)

The WHO source can't be used to verify the text because it is SYN. It must be deleted. We can't add a source. We can replace the source with another source. The http://www.ncbi.nlm.nih.gov/pubmed/12669653 Milbank Quarterly is from 2003. The V-H source is more recent. QuackGuru07:55, 29 January 2014 (UTC)

The WHO source verifies the second part of the sentence and is also consistent with the first part of the sentence. I have explained repeatedly that there is no Synthesis violation in the lede sentence and your repeatedly listing those policies without any rationale does not add credibility to your argument. With regard to the 'newness' of V-H, it would be against MEDDATE to automatically give preference to V-H just because it is a few years newer when there is no disagreement with the other sources we use; since the Milbank Q. and the V-H sources both agree that chiropractic is an alternative medicine health profession there is no disagreement. However, as I said already, I don't really care which, or if any, of these US-centric sources we agree to add to the lede, as long as the internationally relevant sources stay - unless you have newer internationally relevant sources that we can discuss? Puhlaa08:11, 29 January 2014 (UTC)

The WHO source verifies the second part of the sentence because it is a direct cut and paste copyright violation. The first part uses another source for the alternative medicine. This is the definition of SYN when you need two sources to verify "alternative medicine1 health care profession". Because the WHO source did not verify "alternative medicine health care profession" you added the another source at the end of https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592922204oldid=592922069 alternative medicine. The Milbank Q. fails verification for "It is a "marginal" complementary and alternative medicine health care profession." It does not verify the whole sentence and the Milbank Q. is too old. You claim it is a few years newer. I disagree. 2011 versus 2003 is more than a few years difference. QuackGuru19:10, 29 January 2014 (UTC)

Puhlaa discusses recent edits by Alexbrn

Alexbrn, I would like to discuss https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592770393oldid=592300438 this series of recent edits you made. Improvements to the article, in my opinion, were the addition of the sceptical source to the ‘further reading’ section, done with https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592766294oldid=592300438 these 2 edits and the addition of criticism to the ‘Conceptual basis’ section done with https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592767748oldid=592766294 this edit. I did not modify these edits in any way. I did find some edits controversial and I have reverted them, per BRD. I have tried to clearly explain what I reverted and why. Puhlaa06:55, 29 January 2014 (UTC)

Deletion of 2 reliable sources and associated text

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592770393oldid=592768717 These edits removed text from the body of the “Scope of Practice” section and replaced it with text using a different source.

I have reverted these edits because there is no consensus to remove the WHO and Nelson sources from this section at this time, nor the text that was associated with the sources. However, I believe that there is merit to the additions. I suggest we add the ad your new text back into the article without removing the existing text.

My suggestion: “Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery,http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf with special emphasis on the spine. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1185558/ They generally emphasize spinal manipulation but sometimes offer other treatments, such as advice on diet and lifestyle, provide exercises, or perform acupuncture.http://www.nhs.uk/conditions/chiropractic/Pages/Introduction.aspx" Puhlaa06:55, 29 January 2014 (UTC)

The trouble with your revert is that as well as using the problematic WHO source, it fails to present a key controversial aspect of chiropractic: that all kinds of quack claims are made for its systemic effects on human health; your edit presents chiro like some kind of regular medical "modality". It's not neutral. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 08:26, 29 January 2014 (UTC)

I can "kind of" see what you are saying with regard to 'presenting like a medical modality', especially for the text associated with the Nelson source. What if we removed the reference to Nelson source there and the text "special emphasis on the spine", but kept the WHO source and the description from that source: "emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery", which is consistent with all the descriptions I have seen, birth inside and outside the profession - see your NHS source. We could still include your addition after the general statement. Puhlaa08:38, 29 January 2014 (UTC)

Re-write of the lede sentence

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592768717oldid=592767748 These edits removed the http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf WHO guidelines and the general description/definition of chiropractic from the lede and replaced it with text about unsupported claims of efficacy and a source from http://www.nhs.uk/conditions/chiropractic/Pages/Introduction.aspx The National Health Service – chiropractic.

My concerns:

The http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf WHO guidelines that were removed is the best source we have for this article. It is the only source we have that is vetted by an international medical organization. Key features of the WHO source: ""WHO took every precaution to verify the information contained in this publication"" AND ""WHO acknowledges its indebtedness to over 160 reviewers, including experts and national authorities and professional and nongovernmental organizations, in over 54 countries who provided comments and advice on the draft text"". The general description/definition the WHO guidelines provides is impartial and relevant for the profession in every country where it is licensed.

I cannot seem to Verify the text that was added to replce the general description of chiropractic from the http://www.nhs.uk/conditions/chiropractic/Pages/Introduction.aspx NHS source. I cannot find anything that says ""sometimes with the unevidenced claim this can treat a wide variety of human ailments"".

The added text gives considerable weight to controversy about claims of efficacy by placing this controversy in the first sentence of the lede. However, the http://www.nhs.uk/conditions/chiropractic/Pages/Introduction.aspx NHS source that was added gives the most weight - it starts it article with - the same general definition/description of chiropractic that these controversial edits removed from our lede sentence – that used by the WHO guidelines (and apparently by the GCC in the UK).Puhlaa06:55, 29 January 2014 (UTC)

In answer,

The chiropactors' guidelines published by the WHO document are old (2005) and partial; there are later stronger sources so that document should not be used so prominently here.

The NHS text has "Some chiropractors, however, treat a wider range of conditions, including asthma, infant colic, irritable bowel syndrome and many others" and "There is no evidence that treatments offered by chiropractors are effective for other conditions than musculoskeletal ones".

Yes, we need to include controversy per |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 08:08, 29 January 2014 (UTC)

Hey Alexbrn, thanks for your response. I have continued to organize my comments numerically,

I agree that the WHO guidelines are from 2005, but no newer source of equal quality exists yet and I think that probably the WHO hasn't changed their mind on the contents yet, or they would publish a new version. I suggest we go to the RS noticeboard and get a consensus on this source! We have had this debate so many times and it would be so much easier if we just got an impartial consensus and abide by it until the next round of RS shows up. Do you want to draft an impartial request that could be posted there?

Thank you for verifying the text you added. I trust it is there; but can you tell me what section you see that content? Is it the first paragraph of the NHS source? Is it the first page? I suggest that we rely on RS like this one for guidance on how much weight to give each topic. If RS like this one put the controversy at the top then I definitely think we should as well. I think I saw the WHO definition at the top of the NHS source :)

We have a discussion of this controversy over efficacy in the second paragrah of our lede: ""Far-reaching claims and lack of scientific evidence supporting spinal dysfunction/subluxation as the sole cause of disease89 has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system""10 We could certainly discuss expanding that section if you think it is not sufficient. Puhlaa08:25, 29 January 2014 (UTC)

It's not a question of reliability, the document is a reliable source for what a panel of altmed people wrote in 2005, which was then published by the WHO. That's not in question. The question is over the weight that such a source can have, and the consequent neutrality effects.

It's right there on the page (use your browser's find function to help). Yes you "did" see the WHO definition there, carefully framed as "what chiropractors say about themselves" - a model of neutrality your edits fall short of. (BTW you can't deduce the importance of part of a document from its location.)

We need to have chiropractic's dubious nature front and centre from the outset, and avoid sanitized and partial descriptions. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 08:44, 29 January 2014 (UTC)

For what it's worth I agree on Alexbrn in this issue - the WHO report is written as an idealised version of how Chiropractic therapy should be used, rather than how it is used. I also note that many of the references are out of date - a particularly problematic issue when the methodological quality of studies into Chiropractic therapy are only starting to achieve the minimum required level of rigour in the last decade or less. 09:59, 29 January 2014 (UTC)

I guess we disagree on how much weight the WHO source deserves. I think that when the WHO puts it's stamp on a source and says "they did everything they could to verify the source and ensure it's accuracy", it becomes the voice of the WHO. It is the WHO verifying and acknowledging the accuracy of the document that gives it it's weight. We have had this discussion before - If you strongly feel that the WHO source is less valuable for the lede than other sources we have, then lets go the the RS noticeboard.

I see that the first mention of controversy appears in the 6th paragraph of the http://www.nhs.uk/conditions/chiropractic/Pages/Introduction.aspx NHS source. If you claim that location in the document does not imply relevance, why are you so concerned about the location of the controversy in our wikipedia article? Personally, I think that the NHS started their article with the general definition of chiropractic because it is a good way to start a good article about the profession.

Why do you think our article should "have chiropractic's dubious nature front and centre from the outset" when the NHS think it is more important to put the general definition of chiropractic "front and centre" and the first mention of a "dubious nature" in paragraph 6? You thought the NHS source was good enough for the 1st sentence of our lede, but will not acknowledge it's value for organizational/weighting decisions? Puhlaa16:42, 29 January 2014 (UTC)

Reply:

The document is not peer reviewed; it is a decade old; it's written by altmed people (so, lacks independence); it sets out "guidelines". We should not use it for anything other than a statement of what Chiropractors wanted to say about themselves in 2004. We have better sources now.

and 3. The NHS no doubt have their own style for document writing, we have ours. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 16:55, 29 January 2014 (UTC)

Response to Alexbrn,

The WHO source was peer-reviewed; the WHO tells us that ""WHO acknowledges its indebtedness to over 160 reviewers, including experts and national authorities and professional and nongovernmental organizations, in over 54 countries who provided comments and advice on the draft text.""

Do you think we are not explicit about the controversy in our lede when we say that ""Far-reaching claims and lack of scientific evidence supporting spinal dysfunction/subluxation as the sole cause of disease89 has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system""10? You point to PSCI, but we also have NPOV and Weight that guide us - one of these is a pillar of wikipedia! What sources do you think we should use to determine the relative weight of each topic for our article? I think we use other sources that have described chiropractic; like http://nccam.nih.gov/health/chiropractic/introduction.htm NIH, http://archinte.jamanetwork.com/article.aspx?articleid=210354 Archives of Internal Med, http://www.ncbi.nlm.nih.gov/pubmed/12669653 Milbank Quarterly, etc. None of these seem to highlight controversy in the first sentence; the worst I see in the first sentence of any of these sources is that chiropractic is 'alternative', or 'marginal', to mainstream medicine! We already say that in our lede sentence. In fact, our current lede sentence is nearly identical to the first sentence of all of these sources: ""Chiropractic is an alternative medicine health care profession"" Puhlaa17:48, 29 January 2014 (UTC)

"The WHO source was peer-reviewed" ← Ah! You're saying it "was" peer-reviewed (in the normal sense of the term we use on WP when discussing RS)? I missed that. Your source for this? |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 18:46, 29 January 2014 (UTC)

Yes, I am saying that the WHO source was peer-reviewed; I provided a quote of the WHO that verifies that they had over 160 reviewers internationally before they were willing to put their stamp of approval on it. I do understand your point Alexbrn, 'it is not a peer-reviewed medical journal article'. Don't get me wrong, if we have a medical journal article that gives a definition of chiropractic that is in disagreement with the WHO, I think that policy would require us to note the controversy. However, I have not seen this disagreement in the literature. All sources we use seem to agree on what chiropractic is. Your concern with the WHO definition (and the GCC definition and what the NHS uses in it's information source) is that it focuses on musculoskeletal treatment and you think that this ignores the controversy surrounding the treatment of non-MSK conditions - am I correct in my interpretation of your concern? I want to point out that RS say that, in North America, ""patients seek chiropractic care almost exclusively for musculoskeletal symptoms""http://www.ncbi.nlm.nih.gov/pubmed/11805694. Also, ""A range of conditions are managed by chiropractors in Victoria, Australia, but most commonly these conditions are musculoskeletal-related.""http://www.ncbi.nlm.nih.gov/pubmed/24237100. In the UK, chiropractors have been described as ""private musculoskeletal practitioners""http://www.ncbi.nlm.nih.gov/pubmed/22078065 and the National Health Service starts it's http://www.nhs.uk/conditions/chiropractic/Pages/Introduction.aspx chiropractic information page with the same general definition we use from the WHO. It seems that all sources agree that chiropractic is primarily concerned with the musculoskeletal system. The discussion of controversy over non-msk conditions is 'Sixth paragraph type information according to NHS' - of much less importance than the musculoskeletal stuff. Puhlaa19:34, 29 January 2014 (UTC)

Conversation about clarifying the lede

I have reverted 2 edits that are attempting to remove the verified fact that chiropractic is a profession; first https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=591148884oldid=591117854 here, then https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=591574552oldid=591549311 here. The first time I reverted I referred to previous consensus in the edit summary of my revert; now this second time I will point editors directly to the previous consensus so that we can hopefully avoid an edit war. You will note that the recent discussion https://en.wikipedia.org/wiki/Talk:Chiropractic/Archive_36Recent_controversial_edits_-_profession_vs._approach Recent_controversial_edits_-_profession_vs._approach resulted in a clear consensus for the current version; there has been no discussion to change the consensus version.Puhlaa16:03, 20 January 2014 (UTC)

That isn't quite the point Puhlaa, with respect. It's verifiably the case that some people, including you, earn their living as chiropractors, and that's not in dispute. But levering it into the lede of an article about chiropractic "as a concept" does not make for great readability. I'll edit this to restore the consensus view, as I understand it, and I then recommend that you and I both step back once more, so that your POV doesn't become an issue and I don't engage you in an edit war. Thanks.John Snow II17:08, 20 January 2014 (UTC)

John Snow, the point is that you are removing the consensus version in favour of your own preferred version, despite your preferred version going against verified facts and consensus. Please read the link I provided above, where all involved editors agreed to include the version that you don't like... which states that chiropractic is a profession and an approach. Now that I have provided a link to the discussion which achieved the current consensus (that you are arguing against), your continued removal of the adjective "profession" is starting to appear tendentious. I have reverted your POV edit again and I would ask that you leave the consensus version alone until there has been new consensus achieved.Puhlaa17:32, 20 January 2014 (UTC)

Somebody's COI is showing, and really shouldn't be on this page at all. --Roxy the dog18:01, 20 January 2014 (UTC)

Roxy and John, wikipedia is meant to represent verifiable sources that give the mainstream view. I would ask of you both, please explain why you feel that the verifiable fact that chiropractic is a profession should not be included here. In addition, please explain why the consensus version (reached previously https://en.wikipedia.org/wiki/Talk:Chiropractic/Archive_36Recent_controversial_edits_-_profession_vs._approach Recent_controversial_edits_-_profession_vs._approach ) should no longer apply? Do you feel that any of the sources provided previously are not valid? Did you read https://en.wikipedia.org/wiki/Talk:Chiropractic/Archive_36Recent_controversial_edits_-_profession_vs._approach Recent_controversial_edits_-_profession_vs._approach before you reverted away from the consensus version? Puhlaa18:54, 20 January 2014 (UTC)

There is probably https://books.google.com/ngrams/graph?content=chiropractic+technique%2Cchiropractic+approach%2Cchiropractic+professionyear_start=1800year_end=2000corpus=15smoothing=3share=direct_url=t1%3B%2Cchiropractic%20technique%3B%2Cc0%3B.t1%3B%2Cchiropractic%20approach%3B%2Cc0%3B.t1%3B%2Cchiropractic%20profession%3B%2Cc0 a good basis for calling chiropractic a "profession". Making money from the punters is, after all, one of its chief "raisons d'être". |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 19:07, 20 January 2014 (UTC)

Yep, I don't have a problem with people calling themselves chiropractic professionals if they are appropriately trained and (where applicable) registered. The point of the edit, yet again, was to improve clarity, which a lede should have in any WP article, shouldn't it? Repeatedly levering this apparent advertorialising back in looks like it reflects a personal conflict of interest, rather than the consensus. Further input from editors without such a COI would be welcome. John Snow II19:52, 20 January 2014 (UTC)

Well I guess the key here is, John, it doesn't matter what you, or I, do or do not have a problem with; wikipedia follows reliable, mainstream sources, not my opinion or yours. Reliable sources say that chiropractic is a profession; do you have any sources to present that suggest chiropractic is not a profession? The most recent consensus, which I have already pointed to repeatedly https://en.wikipedia.org/wiki/Talk:Chiropractic/Archive_36Recent_controversial_edits_-_profession_vs._approach here, was to include the ideas that it is a profession and an 'approach'. The onus is on you, John, who wants to change the lede away from the consensus version to provide sources and seek consensus. Here is what supports the term profession in the lede:

From http://nccam.nih.gov/health/chiropractic/introduction.htm NIH/NCCAM: "Chiropractic is a health care profession that focuses on..."

From the http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf World Health Organization: "Chiropractic - A health care profession concerned with....."

From a peer-reviewed source in http://archinte.jamanetwork.com/article.aspx?articleid=210354 Archives of Internal Medicine: "Chiropractic, the medical profession that specializes in..."

From a peer-reviewed source in http://www.ncbi.nlm.nih.gov/pubmed/12669653 The Milbank Quarterly: "Chiropractic is the best established of the alternative health care professions."

In Brazil a http://connection.ebscohost.com/c/articles/40221510/brazil-federal-judge-rules-favor-chiropractic-profession Federal Judge has ruled that: "chiropractic is a profession and not a technique"

In Canadian provinces, Chiropractic is regulated under the Health Professions Act. Here is verification for http://www.qp.alberta.ca/documents/Acts/h07.pdf Alberta, http://www.health.gov.bc.ca/professional-regulation/notice/chiropractic.html British Columbia, etc.

American state legislatures describe chiropractic as a health profession; For example http://vtprofessionals.org/opr1/chiropractors/ Vermont, http://health.state.tn.us/boards/chiropractic/ Tennessee, http://health.state.tn.us/boards/chiropractic/ Colorado, etc.

Puhlaa

20:35, 20 January 2014 (UTC)

As x Puhlaa is at 4RR I have invited him/her to self revert and issued a final warning. Roxy the dog20:26, 20 January 2014 (UTC)

Not going to self-revert to a non-consensus POV version Roxy, even if it is your preferred version, sorry. However, you are welcome to report me to 3RR noticeboard and explain why you think that the consensus version should be removed without discussion first? I have simply restored the consensus version, which satisfies V and NPOV, until there is consensus for a change I think that maintaining the consensus version is consistent with policy.Puhlaa20:35, 20 January 2014 (UTC)

Last chance. It is self-evident that the consensus has changed. Roxy the dog20:41, 20 January 2014 (UTC)

I don't see any evidence of change to consensus; I only see you and John trying to push through a change to the lede that goes against consensus and against reliable sources. I have reverted your change per BRD and now I expect that there will be a discussion here (per BRD) before you try to push your preferred version through again. Puhlaa20:54, 20 January 2014 (UTC)

No change of consensus, just support for an edit warring attempt to revert the long standing consensus version. There are abundant sources which describe chiropractic as a profession and approach. One's personal POV about chiropractic is another matter, and I'm definitely a skeptic, but we should follow the sources. -- BullRangifer Brangifer 03:42, 21 January 2014 (UTC)

We've maybe got off the piste here. The point was never to get into one of those endless tennis matches about sources - it was about making the lede clear enough to be readable and informative. I'm not an anti-chiro campaigner and I do not question the relevance of material about how chiros are trained, licensed and employed, so I do not have a vested-interest POV to push here. But squeezing every possible point into the intro does not look like a sensible approach and my feeling is that the consensus has in fact evolved. Thanks. John Snow II12:10, 21 January 2014 (UTC)

It reads just fine. We have discussed this quite thoroughly and you'll need to come up with some policy based arguments for making such a change. The consensus hasn't changed just because you came out of the blue, without any discussion, and attempted to forcefully remove long standing content, and one person supported your edit war. I suggest you read the archives. -- BullRangifer Brangifer 16:07, 21 January 2014 (UTC)

No, it doesn't read "just fine." It's pedantic, "busy," and awkward as hell. With all sorts of terms readers are unlikely to be familiar with thrown at them in the lead, they are likely to turn away. We write for the readers not ourselves. John Snow is spot-on when he advises against "squeezing every possible point into the intro." By the way, I've never heard of a medical field described as a "complementary medicine." Sounds like something the doctor would hand out to you before you have to get a prescription filled. Badmintonhist16:57, 21 January 2014 (UTC)

The archives are pretty clear, sources appear to win out this time. It is a great shame that these con-men, quacks and snake oil salesmen have to be lumped in with worthwhile professionals like doctors, nurses, physiotherapists. It does the real health care professionals a disservice to be compared to chiropracters. It helps to think of them with others of their ilk, professional thieves, or professional Real Estate Salesman, or Bankers, and people of no moral standards who con their customers. --Roxy the dog18:17, 21 January 2014 (UTC)

I can certainly agree "The archives are pretty clear, sources appear to win out" but it's not necessary to get into our personal feelings regarding the subject and I'm hoping we don't use the article Talk page for any more of that. Let's just look at what the sources say and reflect those accurately in the article. The article itself devotes a non-trivial amount of space to discussing it as a profession, and nine months ago in this discussion, authoritative reliable sources were brought that discuss chiropractic as a profession. Both those sympathetic to and skeptical of chiropractic came to a compromise agreement to mention both in the lead and that part of the article has been stable since. I don't see any significant change in the circumstances since that time. Zad68 "'Zad"'"68" 18:34, 21 January 2014 (UTC)

That is all very well, but to say, "in Wikipedia's voice", that these people are "Health Care Professionals" really sticks in my craw. --Roxy the dog18:52, 21 January 2014 (UTC)

I hear ya, but as you surely know, the argument you need to have is with the likes of the WHO and NIH/NCCAM. Zad68 "'Zad"'"68" 18:56, 21 January 2014 (UTC)

I too am sympathetic, but "professional" is a problematic word. I take it just to mean "you make your money from it", but it has also somehow taken on meanings associating it with some kind of "excellence". |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 19:03, 21 January 2014 (UTC)

I don't have a strong opinion about chiropractors one way or the other. My point was about the clumsy style of the lead. Badmintonhist19:24, 21 January 2014 (UTC)

x Alexbrn, the discussion isn't about the word "professional", but about "profession". -- BullRangifer Brangifer 04:06, 23 January 2014 (UTC)

For sure, but the connotations ("pro") are shared. To be clear, I'm not objecting to the word - simply saying it's much misunderstood. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:48, 23 January 2014 (UTC)

"It is generally categorized as complementary and alternative medicine (CAM),1 a characterization that many chiropractors reject.3"

If you check the edit history a lot of text from the lead and the entire article has been deleted or rewritten over without explanation. QuackGuru19:12, 23 January 2014 (UTC)

Proposal for new wording

There appears to be some interest in removing the word "profession" from the opening sentence of the lead. I think the word "profession" is supported by the sourcing and the article, but understand the existing sentence is a bit of a mouthful. Can new wording be proposed that addresses the issues raised above, so we can come to consensus on what to include and how to word it? Zad68 "'Zad"'"68" 21:45, 21 January 2014 (UTC)

Nothing wrong with the current wording . . . Those who seem to disagree have only made a personal argument . . . they do not like that doctors make money as chiropractors. Personal feelings of editors do not outweigh what the sources say. TheDoctorIsIn22:22, 21 January 2014 (UTC)

"'Proposal"': Chiropractic is a complementary and alternative medicine1 ""'health care approach"'" to healing concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health.2 QuackGuru02:48, 22 January 2014 (UTC)

I oppose QG's proposal based on everything just discussed above and the previous consensus-building discussion https://en.wikipedia.org/wiki/Talk:Chiropractic/Archive_36Recent_controversial_edits_-_profession_vs._approach here. I don't have a problem with the first sentence as it currently stands, but it seems that some editors feel it to be a run-on sentence? If the consensus becomes that the first sentence is cumbersome, I propose simply splitting it into two sentences, without removing any of the current content.Puhlaa04:31, 22 January 2014 (UTC)

I agree with Puhlaa and oppose QG's proposal. It's not "new" at all. OTOH, Zad's and Puhlaa's suggestions may be worth considering. By rewording, without removing any of the content, we could make the wording less awkward. I don't see it as awkward, but some do, so let's work on another way of constructing it. If it means splitting it, so be it. -- BullRangifer Brangifer 05:32, 22 January 2014 (UTC)

I do not object to the term "profession" in the lede. According to our own Wikipedia page on the term:

A profession is a vocation founded upon specialized educational training, the purpose of which is to supply objective counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain.

It does not imply scientific validity. It is often confused by the public as meaning that, but we should not let the public misunderstandings of terms dictate how we use words on WP. So, I am okay with the term, as long as the article discusses in depth some of the disproven or controversial aspects of Chiropractic. --Harizotoh907:29, 23 January 2014 (UTC)

It appears the word "profession" was select sourcing. The lead must summarise the body properly. QuackGuru19:12, 23 January 2014 (UTC)

My evaluation (as an involved editor) of the consensus regarding this is that "profession" should remain in the lead, although it's still an open question as how best to word it. There are several clear policy- and source-based supports for keeping it; most of those who have been supporting its removal were doing so in the interest of clarity, and didn't really question its applicability to the article topic. This can be addressed with copyediting as opposed to removal. So we should be looking for proposals to improve the clarity of the existing wording, while retaining "profession". Suggestions from those who think the wording could stand improvement? Zad68 "'Zad"'"68" 02:34, 24 January 2014 (UTC)

QG's proposal looks right to me. The debate about whether there are sources to back a description of chiropractic as a professions is irrelevant; the question is simply whether including this in the lede adds to or detracts from clarity. The article which the lede introduces is about chiropractic as a "concept", a "method", an "approach", not just as an occupation/profession. Picking out one aspect of the article for special treatment in the first line is indeed arguably SYN; imagine how it would look if we started with "chiropractic is a source of controversy" or even "chiropractic is a form of alternative medicine often described as pseudoscience" - both true, and supported by ample evidence, but starting the article that way would hardly be neutral. I'll go ahead and make the edit as discussed. John Snow II23:30, 29 January 2014 (UTC)

Discussion of Alexbrn reverting Puhlaa edit

Alexbrn, you https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592998776oldid=592996602 just reverted the addition of a secondary source that I had added to the article body. Your edit summary claim 2 concerns:

You said that the http://www.ncbi.nlm.nih.gov/pubmed/24412033 source is not in print or finalized, only published online? Can you please show me the policy that says only printed sources are valid - the source says it was finalized in Oct. 2013. It is clearly a valid secondary source.

You ask what relevance the conclusions have for the chiropractic profession? Only 36 hours ago https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592769788oldid=592768717 you added some text to the article - it said ""Chiropractors generally emphasize spinal manipulation but sometimes offer more varied services"". Does this fact not make a RS about spine manipulation relevant here?

I fail to understand your concerns Alexbrn, can you clarify these concerns for me? Puhlaa19:54, 29 January 2014 (UTC)

Puhlaa, will you please step away from this for a while. No-one doubts your good intentions but repeatedly pushing your chosen occupation into the lede is not appropriate, and correcting for this is inevitably taking up other people's time unnecessarily now. With respect, an argument about whether a source is primary or secondary isn't moving us on here. John Snow II23:17, 29 January 2014 (UTC)

I agree with the above from John Snow II. As I have stated before I think it is a violation of Fringe and DUE to represent chiropractic as a "healthcare profession" in the lede. The lede should summarize and present the mainstream consensus, not present the subject in a manner inconsistent with the mainstream consensus. Repeated edits and reverts by a single editor on this article could be seen as POVPUSH. There seems to be IDHT going on. A break might provide an opportunity for development of a considered suggestion, highly preferable to the virtual EW going on now. - - MrBill303:05, 30 January 2014 (UTC)

On the specific ref in question, something is RS when it is "published"; we shouldn't link to proofs. If the only relevance to chiropractic is that it mentions SM, and Puhlaa has reasoned on this basis that it can be used as a source for chiropractic, then that is OR/SYN - which we mustn't do. I wonder now if there are other sources which have been thus incorrectly used in this article. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 08:51, 30 January 2014 (UTC)

Edit warning

I am not pleased with the shift from reasoned discussion at this article over the past many months to the petty edit warring of late. Consider this a heads up. My next step is to fully protect the page for a week if necessary, to encourage that happening (or get another admin to do so as I used to edit this article). After that, if individual editors can't resist the urge to make and repeat making changes without consensus, there may be blocks (or bans) as needed. The key here is to have "reasoned discussion", and you know what that looks like. If you're getting frustrated or making knee-jerk reverts, you are probably not in a good position to be reasonable so step back and ask for help from others. If you are trying to shape the page so that it looks the way it looked before months of discussion helped it evolve, you are probably not being reasonable. For formality's sake, this page is already under ArbCom Discretionary Sanctions, which means 02:16, 24 January 2014 (UTC)

Thanks for the reminder Ocaasi!Puhlaa02:42, 24 January 2014 (UTC)

Yes, thanks. Discussion should take priority over solo, bold, editing. Any edits which are controversial should be reverted on sight per BRD, and the slightest deviation from BRD (it's not BRBRD, or BRRRRRD) should call forth an immediate block (even if only for one day). There is no need to go all the way to 4RR in such a situation, nor should we have to waste time with a report at the editwarring noticeboard. -- BullRangifer Brangifer 05:43, 24 January 2014 (UTC)

You https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=461714689 knew something happened to the article. Do you see the summary of the body in 2011 when https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=461714689 you were editing. Now look at the lead today. Do you think the current version summarises the body properly or the previous version before the article was hacked. QuackGuru20:26, 24 January 2014 (UTC)

I completely support this. Puhlaa is an advocate of chiropractic, and an adherent of a school which rejects some of chiropractic's wildr claims. For a long time, Puhlaa has been trying to reshape the article in terms that represent chiropractic as this subgroup wishes it to be, rather than as it actually is - most chiropractors in most countries are simply quacks, promoting their non-existent spinal subluxaitons as the cause of many forms of disease, claiming to treat colic and asthma, engaging in anti-vaccine advocacy, and causing the occasional stroke along the way. I'd be very happy is chiro was as Puhlaa wishes it to be, but that day is a long way off yet. (JzG/help Help!) 09:23, 25 January 2014 (UTC)

While I agree with your assessment that Puhlaa supports evidence-based chiropractic, I also want to point out that the Discretionary Sanctions specifically suggest we " 12:33, 25 January 2014 (UTC)

Take a look at the https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=442127826 lede in 2011 and the rest of the article. Currently the lead does not summarise the body properly but how can I or any editor fix the problems when there is much resist to improving the article for https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=465993481 far too long. We need to identify what is causing these problems and stop this from happening again. If we don't stop this now it will only continue in the future again. QuackGuru18:00, 25 January 2014 (UTC)

Yu can't discuss the issue without addressing the source of the issue. If Puhlaa does not materially change approach, then Puhlaa will end up with a topic ban. It's not a problem of an article needing to be brought under discretionary sanctions (it already is), but a problem of a specific editor consistently making edits that are not in line with policy. My preference is for Puhlaa to start proposing changes on talk instead of editing the article directly, because I do not want Puhlaa to be slapped down; it's much easier to maintain NPOV on articles about quackery if at least some believers take part in debates about content. That doesn't mean we should compromise our standards, but we are here to document, not to debunk, and the involvement of believers halps us to stay honest. That said, if a specific editor cannot restrain themselves form making problematic edits then eventually we have to take action. (JzG/help Help!) 11:17, 26 January 2014 (UTC)

Hey JzG, I think Puhlaa is about as 'pro-chiropractic' as the couple of 'anti-quack' editors here are anti-chiropractic. There is more than one Chiropractic and some of it is 'woo' as some might call it and other parts of it are 'evidence-based', or 'evidence-supported'. This article should reflect that duality proportionately. To that end, editors who specifically target CAM treatments don't strike me as any less biased than those who practice them; either could be considered to have an agenda and be encouraged to stick to the talk page. But fundamentally, it's not about the background of the editor as much as the sources they use and the arguments they make and policies they cite. I've seen Puhlaa be pretty level-headed here and willing to discuss issues. So in general, I agree that this article would benefit greatly from more talk page discussion all around, but I don't see a single editor as the problem here. Cheers, 14:22, 30 January 2014 (UTC)

The problem here is the first sentence is SYN because it is putting two different sources to come to a https://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=prevoldid=592429960 new conclusion and the https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592063865oldid=592061869 current article has been undermined. https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592416163oldid=592353331 Puhlaa is against restoring what I think is well written summary to the lede. I can combine parts of the https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=442127826 well written lede with the updated parts of the new lead to have a proper summary of the body. QuackGuru18:17, 26 January 2014 (UTC)

QG, I have already explained that https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592072343oldid=592063865 there have been lots of discussion/editing since 2011, to both the article body and lede. Also, an administrator mentioned at the start of this thread that https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592112356oldid=592111340 "If you are trying to shape the page so that it looks the way it looked before months of discussion helped it evolve, you are probably not being reasonable". QG, why do you keep suggesting that we should restore a 2011 version of the lede when the article has evolved a lot since then? Your most recent criticism is that the lede combines 2 sources; there was a good discussion and a consensus developed to https://en.wikipedia.org/wiki/Talk:Chiropractic/Archive_34Suggest_combine_first_two_sentences combine the first two sentences almost 2 years ago! I find it counterproductive to a reasonable discussion, and even insulting, when you suggest that ~3 years of editing and discussion has resulted in an article that is https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592223834oldid=592222641 "hacked" or https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592508799oldid=592462604 "undermined".Puhlaa20:44, 26 January 2014 (UTC)

Discussion did not help improve this article months ago or years ago because the current lede is much shorter and not a good summary. The lede previously had a lot more information in it that was deleted without discussion or reasonable discussion. Where was the discussion to chop in the lede in half. You have https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592523651oldid=592509766 ignored there is https://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=prevoldid=592429960 SYN in the lede sentence and https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=592509766oldid=592462604 copyright problems. I think chiropractors over the last few years have deteriorated this article. It counterproductive to continue a discussion with an editor who does not understand there is SYN and other problems with the lede. QuackGuru22:04, 26 January 2014 (UTC)

@Ocaasi: I am very familiar with the subject. There are actually numerous sects within chiropractic (e.g. McTimoney in the UK), but they broadly separate, like Catholic and Protestant, into Straight and Mixer. Straights are out-and-out quacks, holding to an entirely discredited model of physiology. Mixers occupy a spectrum. At oen end are the quacks, who promote anti-vaccinaiton nosnense, concern themselves primarily with "practice building" and aggressively sell "maintenance adjustments", especially to children. At the other end are those who practise based on evidence, with Sam Homola being the best known example to skeptics. The problem is that most chiros incorporate at least some pseudoscientific practices, virtually all will treat children, which is completely unsupportable, most will claim to treat colic and other diseases entirely unrelated to the musculoskeletal system, and virtually all depend for their livelihood on conducting unnecessary and occasionally dangerous (e.g. manipulation of the neck, wholespine x-rays) procedures and treatments. Puhlaa in particular wants to document an idealised form of chiro that does not do these things, but the evidence shows that the majority of chiros do it all the time.

Skeptics are perfectly content to include the valid indications for chiro: treatment of pain in the musculoskeletal system, where serious underlying disease has been ruled out. Skeptics also want inclusion of the documented adverse events, the lack of any systematic recording of adverse events by chiros, the side-order of pseudoscientific practices and so on. A warts-and-all portrait, in other words. FRINGE entirely supports that. In fact, it mandates it. (JzG/help Help!) 15:09, 30 January 2014 (UTC)

Indeed JzG, and we have the task of separating unfounded claims (but reporting that Chiropractors sometimes make them) from supported claims. On that point, I agree that adverse events are incredibly relevant to evaluating efficacy and also highlighting the distinction between promise and effect. Puhlaa, I assume is 'documenting' (with reliable sources) the form of chiropractic that s/he actually learned and knows exists, wishes there were more of, and is looking for quality evidence that does support that view. We all bring some bias to articles and I think Puhlaa's evidence-based chiropractic bias is something that will ultimately contribute to a decent article because it bolsters the discussion not to ignore efficacy or overstate risks. In general I want to take the heat down a bit at this article because I don't think we're actually "that" far off; we're just haggling on the usual issues of 15:28, 30 January 2014 (UTC)

Effectiveness

Manual therapies commonly used by chiropractors are as effective as other manual therapies for the treatment of low back pain,122123 and might also be effective for the treatment of lumbar disc herniation with radiculopathy,124125 neck pain,126 some forms of headache,127128 and some extremity joint conditions.129130 While guidelines issued by the WHO state that chiropractic care may be considered safe when employed skillfully and appropriately,2 chiropractic spinal manipulation is frequently associated with mild to moderate adverse effects, and with serious or fatal complications in rare cases.131132133

There is a POVPUSH in the introduction of effectiveness. QuackGuru19:53, 30 January 2014 (UTC)

In what way? That does not seem overly promotional of chiropractic to me. (JzG/help Help!) 20:42, 30 January 2014 (UTC)

"While guidelines issued by the WHO state that chiropractic care may be considered safe when employed skillfully and appropriately,2 chiropractic spinal manipulation is frequently associated with mild to moderate adverse effects, and with serious or fatal complications in rare cases.131132133" This is information about safety. It is duplicate from safety.

The first section is supposed to be about effectiveness in general. The specific details are in the specific sections. QuackGuru01:19, 31 January 2014 (UTC)

Entire section is missing?

What happened to the https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=442127826Utilization.2C_satisfaction_rates.2C_and_third_party_coverage Utilization, satisfaction rates, and third party coverage section? A lot text was deleted when the section was split into two separate sections. QuackGuru20:30, 30 January 2014 (UTC)

I suspect someone decided that we should not succumb to fallacious appeals to popularity. (JzG/help Help!) 20:52, 30 January 2014 (UTC)

I think some of the information can be restored. QuackGuru01:25, 31 January 2014 (UTC)

Request newer source

Most people who seek chiropractic care do so for low back pain.6 QuackGuru18:41, 30 January 2014 (UTC)

Might be true. That doesn't stop chiropractors seeking new patients who have no low back pain, and trying to sell them a never ending course of treatment. Where and why do you think your statement is relevant? (JzG/help Help!) 20:54, 30 January 2014 (UTC)

We can keep this source until a newer source is found. It is relevant because people seek chiropractic care for back pain but not dogma care. QuackGuru01:29, 31 January 2014 (UTC)

Continued lede problems

Not a good summary

Chiropractic theory on spinal joint dysfunction and its putative role in non-musculoskeletal disease has been a source of controversy since its inception in 1895. The controversy is due in part to chiropractic's vitalistic and metaphysical origins, and use of terminology that is not always amenable to scientific investigation.7 Far-reaching claims and lack of scientific evidence supporting spinal dysfunction/subluxation as the sole cause of disease89 has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system.10 Although there is external and internal debate within the chiropractic profession regarding the clinical significance of joint dysfunction/vertebral subluxation complex,11 the manipulable lesion/functional spinal lesion12 remains inextricably linked to the profession as the basis for spinal manipulation.13

There is definitely a POVPUSH in the lede. This is poorly written text. It can be improved. QuackGuru07:01, 30 January 2014 (UTC)

Conceptual basis problems

For most of its existence, chiropractic has been sustained by pseudoscientific ideas such as subluxation and innate intelligence16 which are not based on solid science.9 Some chiropractors have been criticized for having an anti-immunization stance, despite the consensus of public health professionals on the benefits of vaccination,17 which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic.18 The American Medical Association called chiropractic an "unscientific cult"19 and boycotted it until losing an antitrust case in 1987.20 Chiropractic is said to have developed a strong political base and to have sustained demand for services; researchers Cooper and McKee report that it has gained more legitimacy and greater acceptance among physicians and health plans in the U.S. for the treatment of some musculoskeletal conditions20 and the principles of evidence-based medicine have been used to review research studies and generate practice guidelines.21 Traditional (or straight) chiropractic still assumes that a vertebral subluxation interferes with the body's "innate intelligence",22 a vitalistic notion ridiculed by the scientific and healthcare communities.23 Other chiropractors want to separate themselves from the traditional vitalistic concept of innate intelligence24 – John W Reggars wrote in 2011 that chiropractic was at a crossroads, and that in order to progress it would need to embrace science; in his view, the promotion of chiropractic as a cure-all was both "misguided and irrational".25

See ChiropracticConceptual basis.

None of this text belongs in the Conceptual basis/Philosophy section. The first section is about philosophy. The above text is misplaced and not relevant to the section. Most of this text was https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=442127826 originally in the lede. See https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=442127826 paragraph three in the well written lede. Why was the lede summary moved to Conceptual basis? QuackGuru07:01, 30 January 2014 (UTC)

Information that was not about https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593501863oldid=593500305 conceptual basis was restored to the section. Also the lede should summarise the body. The text that summarize the body should never have been moved to another section.

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=529303776 A section was spun off from the lede into a "background" section.

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=529645465 A section was spun off from the lede into a "background" section.

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=530067980 A section was spun off from the lede into a "background" section.

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=530492360 A section was spun off from the lede into a "background" section.

These changes did not improve the article. Moving the text to a background section that is a summary of the body is not appropriate. QuackGuru23:26, 1 February 2014 (UTC)

Over 100 countries

Chiropractors practice in over 100 countries in all regions of the world, but they are most prevalent in North America, Australia and parts of Europe.25

There is a POVPUSH in the lead. Chiropractors practice in over 100 countries in all regions of the world?

For the lede: Chiropractic is established in the U.S., Canada, and Australia.

For the body: Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.

cite web |url=http://chiropracticdiplomatic.com/strategies/global_strategy.pdf |format=PDF |title=Global professional strategy for chiropractic |author=Tetrault M |publisher=Chiropractic Diplomatic Corps |year=2004 |accessdate=

The text in the lede must be improved. QuackGuru03:50, 31 January 2014 (UTC)

I support these proposed edits based on the reasoning given. - - MrBill318:45, 31 January 2014 (UTC)

I added it to the body and lede but is was reverted. Not sure why yet. QuackGuru23:33, 1 February 2014 (UTC)

History

There is too much information on Palmer and Palmer's son. See ChiropracticHistory. Similar sentences is duplication:

Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease.

According to D.D. Palmer, subluxation was the sole cause of disease and manipulation was the cure for all diseases. See ChiropracticHistory. QuackGuru18:49, 31 January 2014 (UTC)

"Chiropractic has had a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school was founded on "…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it".120 D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself ‘doctor’. Not everyone was convinced, as a local paper in 1894 wrote about him: "A crank on magnetism has a crazy notion hat he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…His increase in business shows what can be done in Davenport, even by a quack."120 D.D. Palmer remarked that "Give me a simple mind that thinks along single tracts, give me 30 days to instruct him, and that individual can go forth on the highways and byways and get more sick people well than the best, most complete, all around, unlimited medical education of any medical man who ever lived."9"

I deleted this text above because it is not a good summary. A long run on quote is not a well written summary. I improved the section that accurately explained about the history of chiropractic. See https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=593497515History here. QuackGuru02:54, 2 February 2014 (UTC)

No single profession owns spinal manipulation

No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors.

Deleting this text does https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592300438oldid=592299998 not improve the article. This is very relevant text. QuackGuru05:03, 30 January 2014 (UTC)

The part, "https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=592300438oldid=592299998 as these are the only areas where evidence supports its use". is not about the scope of practice section and no rationale for deleting "No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors." has been given. QuackGuru03:01, 2 February 2014 (UTC)

Despite this finding?

See ChiropracticStraights and mixers.

"Despite this finding, a 2008 survey of 6000 American chiropractors demonstrated that most chiropractors seem to believe that a subluxation-based clinical approach may be of limited utility for addressing visceral disorders, and greatly favored non-subluxation-based clinical approaches for such conditions.11not in citation given33"

"The data reported in Figure 1 suggest a more complex picture regarding how chiropractors specifically apply the concept of subluxation in actual clinical practice. "'Most chiropractors typically reported that over 75% of their clinical approach to addressing musculoskeletal or biomechanical disorders such as back pain was “subluxation-based”."" Conversely, most chiropractors also reported that less than 20% of their clinical approach was “subluxation-based” for patient complaints deemed to be principally problems with circulation, digestion, or similarly “visceral” in nature."http://archive.journalchirohumanities.com/Vol%2015/JChiroprHumanit2008v15-19-26.pdf page 3

The text follows the source accurately but did not include the part "Most chiropractors typically reported that over 75% of their clinical approach to addressing musculoskeletal or biomechanical disorders such as back pain was “subluxation-based”". Reference 11 is https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=593075046oldid=593072684 misplaced. QuackGuru06:05, 30 January 2014 (UTC)

I https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593382689oldid=593379421 fixed the lopsided view but it was reverted. QuackGuru23:34, 1 February 2014 (UTC)

The new wording in this case is hard to understand, suggest rephrase. Agree with the other 3 examples of the edits QuackGuru gave on WTMED. Therefore, I think we should AFG and not state that these edits are non NPOV since the edits appear to me to be improvements to the article, such as making sure the figures in the article are the same as the cited sources. Lesion "'Lesion"' 18:08, 2 February 2014 (UTC)

Concerted campaign

There have been a very substantial number of edits by QuackGuru, plus additional advocacy by others, I have seen OTRS requests relating to the "imbalance" of the chiropractic article; months of stability have been replaced by a rapid push towards a more flattering portrayal of chiro, and (purely by coincidence) my sinister agents tell me that chiros are once again angling for money under Obamacare and for primary care provider status. Very singular... (JzG/help Help!) 21:11, 1 February 2014 (UTC)

I https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=593497515oldid=593486342 rewrote the safety information for the lede. QuackGuru22:43, 1 February 2014 (UTC)

You also reverted my removal of the questionable claim that it is safe when practiced correctly. This is unsupportable; it is a claim made by the industry in the report they wrote for the WHO, but there is no systematic recording of adverse events and no consensus definition of what correct might be. This has no place in the lede, and "definitely" no place in discussing the consensus view of chiro. (JzG/help Help!) 23:06, 1 February 2014 (UTC)

The text you deleted said "https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=593500305oldid=593497515 Spinal manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications."

It did "not" say it is safe "when practiced correctly".

Your https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=593500305oldid=593497515 edit deleted text from the lede that summarised the body. The article should be balanced and not one-sided. You also deleted a recent 2013 systematic review (PMID|23787298) from the https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=593500305oldid=593497515 safety section. QuackGuru23:18, 1 February 2014 (UTC)

I'm sorry, Guy, but you cannot dismiss WHO guidelines merely on the grounds of authorship. Such guidelines are well-established as reliable in MEDRS Medical and scientific organizations and carry the weight of the body and its review procedures to establish its authority. "WHO acknowledges its indebtedness to over 160 reviewers, including experts and national authorities and professional and nongovernmental organizations, in over 54 countries who provided comments and advice on the draft text." I'm not willing to accept that you're a better judge of the quality of the guidelines than they. The WHO guidelines contain this introduction to safety of chiropractic on page 19

"When employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems. There are, however, known risks and contraindications to manual and other treatment protocols used in chiropractic practice."

Now unless you can find an equally strong MEDRS-compliant source that contradicts that (hint: Ernst will have done so), it needs to be in the article - and it's so much a central point that it needs to be in the lead. If you can't come up with a source and a wording that describes a disagreement between MEDRS sources, I'm going to have to insist that QG's wording goes back in.

Now if you want to argue each of QG's edits point-by-point, then let's get on with it, but you need to have good quality MEDRS-compliant sources to back up your version. My first impression is that you've reverted as a gut reaction, rather than from the basis of best sources. Let's hope you prove my impression wrong. Cheers --RexxS01:26, 2 February 2014 (UTC)

|RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:26, 2 February 2014 (UTC)

This is what is in the body: "Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints.2"

This https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593497515oldid=593486342 edit to the lede is only summarising what is already in the body. The lede should summarise major points in the body. The World Health Organization (WHO) is listed under Wikipedia:Identifying reliable sources (medicine)Medical and scientific organizations. QuackGuru07:33, 2 February 2014 (UTC)

The WHO may be reliable in general, but the document in question is not a statement of the WHO. Granted, it is published by their publishing arm and so has something of the WHO imprimatur, but it was authored and finalized by chiropractors and CAM activists and we know nothing of the fact-checking process that was used. But this is moot anyway: even if the source was good for sure, we should not be using a 2005 document to make statements in Wikipedia's own voice when later (and certainly reliable) sources paint a different, more complicated picture. This goes right to the heart of a requirement for NPOV. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:56, 2 February 2014 (UTC)

You haven't shown later sources paint a different picture about the safety information and the https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=593550145oldid=593548605 safety information is still in the body. QuackGuru08:09, 2 February 2014 (UTC)

As the Ernst abstract has it, "Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence". That is different from the bromide offered by the "WHO" document. As to synchronizing the lede and body, I see that as a housekeeping exercise that can be done once we know what the neutral point of view is which WP should be taking. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 08:20, 2 February 2014 (UTC)

The "housekeeping exercise" can be done any time and there is no reason to exclude a summary of a key point of the body because there may be changes to it in future. The WHO guidelines were produced by the WHO and you can't dismiss them just because some of the contributors were part of the chiropractic industry. There is a lengthy list of attendees at the conference which shows a spread of backgrounds - most of the non-chiropractors seem to be experts in traditional medicine or representatives of local or regional health authorities. Anyway, that's not relevant; we either trust WHO to produce accurate, neutral guidelines or we don't. We can't have it both ways where we accept WHO as MEDRS only when we like what they say. None of us are qualified to criticise individual WHO guidelines.

We need to find some consensus on what sources are best for describing the safety of chiropractic. A Pubmed search on "chiropractic safety" limited to reviews from the last 5 years produces eight results - six if we ignore the two relating to small animals and horses. Three are Cochrane reviews, but are specific to infantile colic (PMID|23235617), acute low-back pain (PMID|22972127), and carpal tunnel syndrome (PMID|22696387), respectively. None of these say anything about safety beyond there's no evidence to come to any conclusion. The same is true of PMID|2164025 (treatment of adults with headache). That leaves us with PMID|19712793 which is an attempt "to develop an evidence-focused and work-based model framework for patient safety training" and is "how-to" guidance for chiropractors on safety - not what we're actually looking for. So that leaves PMID|19444054 (Gouveia LO, Castanho P, Ferreira JJ, 2009) that looks good to me. The only problem is that it concludes "There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic." I'm failing to find anything solid to put up against WHO's 2005 guidelines. We do need to be cognisant of the dangers of RECENT and it would be a mistake to dismiss that nine-year-old source purely on the grounds of age, when we don't have anything new to replace it with.

Now it may be that I've missed some recent reviews - Pubmed isn't infallible and Professor Ernst will probably have something relevant. Please feel free to adduce some sources and perhaps some better wording than that taken from WHO 2005, but right now I'm not seeing any convincing reason to alter what is in the body - and hence what should be in the lead. --RexxS15:49, 2 February 2014 (UTC)

Most topics the WHO treats are not fringe ones, so the independence question does not come into play: it's not a question of being qualified to criticize the guidelines, but of being able to recognize an independent source. MEDRS is an important guideline built on an important guideline, but it mustn't be used to erode one of the central pillars of Wikipedia which is neutrality (and RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 16:22, 2 February 2014 (UTC)

That's probably because chiropractic is considered CAM, not fringe in the mainstream view. I don't think you'll find WHO guidelines on homeopathy, for example. I agree that we shouldn't be eroding NPOV, but that means we need to be open-minded about topics. I find the stuff about "subluxations" to be complete hogwash, but I'm open to hear sources say that SMT can have some effect - even if nobody can suggest a mechanism beyond placebo - and I'm prepared to believe a reliable source that tells me that the manipulations can be performed relatively safely, even if 5 out of 100,000 result in arterial dissection. To be honest, I'm sick of hearing entrenched view on one side or another battling it out time and again on the same issues in this article. If you want to know what the consensus here is - and that is really aimed at you, Guy - then take the time to read the archives. You can see in Talk:Chiropractic/Archive 31, Talk:Chiropractic/Archive 32, Talk:Chiropractic/Archive 33, from September 2010 to August 2011 where I argued exactly the same issues of MEDRS and NPOV, but that time I was arguing with editors who thought we couldn't use Ernst because he's anti-chiropractic. I really don't want to repeat the same ordeal with editors who want to reject WHO because they think it is pro-chiropractic. Let me make my position clear: There are editors who think chiropractic is a great cure-all and the best thing since sliced bread; there are editors who think chiropractic is utter nonsense, both ineffective and highly dangerous. Both are wrong - and the sources will show that if we're open-minded enough to read them. --RexxS17:15, 2 February 2014 (UTC)

A very arrogant and wrong statement Rexx, which deserves to be ignored. "Hardcore" chiropractic is total claptrap, despite what you claim. If you remove the unevidenced parts of chiropractic, what remains isn't chiropractic, and might do some good for backache. --Roxy the dog17:31, 2 February 2014 (UTC)

Complete bollocks, Roxy. I make no claims about "hardcore" chiropractic, whatever that is - although I agree that there is a lot of clap-trap around subluxations that ought to be treated as the nonsense it is. If you'd bothered to read the archives where I spent a year of my wiki-life trying to keep the clap-trap out of this article, you'd know how far off the mark you are. For what it's worth, your arguments about the "'efficacy"' of chiropractic echo my position, but you're three years late in quoting me. The above is my concern about how we represent the "'safety"' of chiropractic, which if you get your brain around it, is a "different" issue. --RexxS17:46, 2 February 2014 (UTC)

Do you think we should https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=593497515 maintain NPOV in the lead and body? QuackGuru17:56, 2 February 2014 (UTC)

I'm not sure WHO should be "rejected" necessarily, but neither do I think it should be a kind of ace-of-trumps source. Taking a step back ... Wikipedia, to be neutral, needs to be in line with respected scientific opinion. Do we really get that by having Wikipedia relay a source which says

"When employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems."

Effective for the prevention of a number of health problems? really? Are we really saying this is fine? |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 17:43, 2 February 2014 (UTC)

The WHO source is "'not"' contradicted by later, better, sources. You have not given a better source that can be used to update the safety section. If that were true the safety section in the body would of been updated. Editors should not delete the information in the body without replacing it with updated information about safety. I previously explained we should https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=593552703oldid=593551648 summarise the body in the lede. You were https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=593594003oldid=593562626 asked to provide better or updated sources and you were unable to do that. You say that stating it is "safe and effective when employed skillfully and appropriately" is misleading. That is not the proposal. The source also said: "There are, however, known risks and contraindications to manual and other treatment protocols used in chiropractic practice". This is the proposal I previous explained in this thread: "https://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=prevoldid=593501997 Spinal manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications." This edit to the lede is a https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=593497515 proper summary of the body according to LEAD. We "are" eroding NPOV when we don't include it in the lede. QuackGuru17:56, 2 February 2014 (UTC)

ec

Well, Alex, it's deja vu again for me. Ernst has a 2008 review that accepts efficacy for just lower back pain; Bronfort G, Haas M, et al, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841070/ "Effectiveness of manual therapies: the UK evidence report", Chiropr Osteopat. 2010; 18: 3. February 25. doi: 10.1186/1746-1340-18-3. PMC|2841070, which found efficacy in a few other areas, gained consensus here three years ago - Talk:Chiropractic/Archive 33 Changes needed in the LEAD "et seq." refers. And so on for the efficacy question. Risks are covered by WHO 2005 who found chiropractic relatively safe, but Ernst reviewed fatalities and concluded "the risks outweigh the benefits". Do you really want the article to say "chiropractic is dangerous and offers no benefits as a treatment"? Because, as skeptic as I am personally, my reading of the sources just doesn't support that. --RexxS18:03, 2 February 2014 (UTC)

Well as a (relative) newbie to this article I thank you for indulging me :-) No, I don't think we should say "chiropractic is dangerous and offers no benefits as a treatment" - the sources don't support that and there are degrees here. I am simply concerned about following the "WHO" source too closely particularly in regards of its "safe and effective" line. I will reserve further judgement until its settled what exactly this article "will" say (and hunt around to see if there are some sources we've missed) ... |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 18:20, 2 February 2014 (UTC)

My edit did not state its "safe and effective". I suggest you look at the https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593497515oldid=593486342 specific edit again and explain what is the issue. You have not made a reasonable argument for excluding it from the lede. Why are you so hesitant to improving the lede? After reviewing my edits and concerns, do you support https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=593497515 this version? QuackGuru19:13, 2 February 2014 (UTC)

TBH I wasn't thinking about the lede it particular, but the WHO sourcing and POV more generally. Is the idea that we pick the safety info from the WHO source and disregard other things it says in the same sentence? |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 20:06, 2 February 2014 (UTC)

I'm sorry I was patronising, Alex, and I promise I'll try harder not to let my weariness with the endless arguments here tire me out. It's not fair to take it out on you. I think QG's wording was tq|"Spinal manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Spinal manipulation is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases." which looked like a good summary to me of both the WHO general view and Ernst's investigations of particular, but thankfully rare, serious adverse effects. Whereas Guy prefers tq|"there is ... some evidence of severe adverse effects from cervical vertebral manipulation.cite book |pages=145–90 |chapter=The truth about chiropractic therapy |title=Trick or Treatment: The Undeniable Facts about Alternative Medicine |author=Singh S, Ernst E |year=2008 |publisher=W.W. Norton |isbn=978-0-393-06661-6 " to be the sole comment about chiropractic safety in the lead. I think that we could (and should) have more to say about safety than that. Please understand, I'm only talking about what the lead says about "safety" - not effectiveness, nor risk/benefit that always get confused here. So, the question should be "does including a summary in the lead of what the WHO has to say about safety improve the article or not?" I would remind everyone that simply dismissing a source as "written by pro-chiropractic authors" makes it very hard for us to counter the chiropractor advocates when they want to dismiss Ernst "because he's an anti-chiropractic author". And believe me, I know how hard that is. --RexxS22:11, 2 February 2014 (UTC)

Demarcation

There are a couple of sources from Michael Shermer:

http://books.google.com/books?id=KCanmmIb8QUCpg=PA23dq=chiropractic+shermer+borderlandshl=ensa=Xei=Ek3vUvqNI4XYyQHU2YCgDgved=0CDwQ6AEwAAv=onepageq=chiropractic%20shermer%20borderlandsf=false The Borderlands of Science : Where Sense Meets Nonsense: Where Sense Meets Pseudoscience (2001)

http://books.google.com/books?id=Pc4OAAAAQBAJpg=PA206dq=chiropractic+shermer+borderlandshl=ensa=Xei=Ek3vUvqNI4XYyQHU2YCgDgved=0CEgQ6AEwAgv=onepageq=chiropractic%20shermer%20borderlandsf=false Philosophy of Pseudoscience: Reconsidering the Demarcation Problem (book chapter; ed. Massimo Pigliucci Maarten Boudry) (2013)

In both, Shermer places chiropractic in what he calls "borderlands science", i.e. a gray area between science and pseudoscience. He also says (in the second source) that demarcation depends on multiple factors -- including efficacy, btw -- which ties into Brangifer's point about chiro being a mixed bag. Unlike the question of whether to eat the Curate's egg, demarcation is frequently considered fuzzy (particularly among scholarly sources), and this view appears to be a significant one with respect to chiro specifically. Shermer and similar sources turn up with a Google books search for chiro and terms like "demarcation" and "gray area". (If you just google for chiro and pseudoscience you're more likely to find the sources that take a bright line approach call it pseudo outright.) --x Middle 8 (Middle 8/Privacy leave me alone • 08:56, 3 February 2014 (UTC)

This is a point we make well in the lede. Chiro is plausible for back pain, massively implausible for colic or asthma. However, the Australian situation is illustrative of the problem. CBA has a robust stance against anti-vax advocacy and predatory practices, CAA is run by antivaxers. CAA has more members.

In chiropractic, the charlatan majority is giving the responsible minority a bad name. (JzG/help Help!) 10:55, 3 February 2014 (UTC)

2010 report

Current text: "A 2010 report found that manual therapies commonly used by chiropractors are effective for the treatment of low back pain, neck pain, some kinds of headaches and a number of extremity joint conditions.133" See ChiropracticEffectiveness.

Proposal: "A report found that spinal manipulation therapies are effective for the treatment of low back pain, neck pain, migraine and cervicogenic headache and a number of extremity joint conditions." Read the conclusion for ref https://www.ncbi.nlm.nih.gov/pubmed/20184717 133 The part "commonly used by chiropractors" is not part of the conclusion. The part "some kinds of headaches" might be OR. QuackGuru02:15, 5 February 2014 (UTC)

Reliability of Chiropr and Osteopat

I'd like to have some discussion about the appropriateness of this source.

cite journal |author=Lawrence DJ, Meeker WC |title=Chiropractic and CAM utilization: a descriptive review |journal=Chiropr Osteopat |volume=15 |issue= |pages=2 |year=2007 |pmid=17241465 |pmc=1784103 |doi=10.1186/1746-1340-15-2

see: http://www.ncbi.nlm.nih.gov/pmc/journals/429/

Cheers, 14:28, 30 January 2014 (UTC)

I think the first thing to be said is that as things "were" (in your http://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593118500oldid=593093994 restore), the source was subtly misrepresented with nonsense. "Practitioners such as chiropractors are often used as a complementary form of care" makes no sense. And the implication that chiro is "often used" is not what the source says, it says: "CAM is itself used by people suffering from a variety of conditions, though it is often used not as a primary intervention, but rather as an additional form of care." (So, notice this is a statement about CAM in general, so I'm still not sure it supports what we say!)

Chiropractic Osteopathy is an open-access CAM journal. The article is written by two chirporactors at the Palmer College of Chiropractic. So, not an independent source: it's a community speaking to itself. However, the claim is not very exceptional (especially now it is represented correctly). But more worryingly, this is now seven years old and based on older data, yet Wikipedia is asserting the sourced statement, in its own voice, as if it were contemporary fact. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 15:01, 30 January 2014 (UTC)

Thanks for that explanation. I think the source was reasonably represented as "often used not as a primary intervention, but rather as an additional form of care" is tantamount to "often used as complimentary care rather than a primary form". I can't see much of a difference there, honestly, though I could skeptically read it from a different perspective. In any case, your tweaks make sense and avoiding ambiguity is always good.

I'm more generally concerned with the notion that no chiropractors writing about chiropractic could never be independent, in the sense that doctors writing about medicine are presumed to be unbiased. I'm not drawing a false equivalence here, but raising a point and a question: if published in a decent journal at the appropriate level of evidence-review, aren't chiropractors reliable for claims about their own profession. Explicitly medical claims about efficacy I can see needing to be from higher quality reviews, but claims that 'chiropractic is often complimentary rather than primary' is just the sort of claim that published chiropractors could reliably make. In an established journal--and I admit I'm not familiar with Chiropr and Osteopat--I'm not sure I agree that they are automatically excluded from reliability solely on the basis of their profession.

As for age, we do prefer articles within 5 years, and this is 7 years old, so it could be better. Still, the plainness of the claim seems unproblematic to me in that time-frame. Thanks again for explaining your view. Cheers, 15:10, 30 January 2014 (UTC)

As it was originally, I think the problem was it wasn't a claim about the profession, but a more general claim about how chiro is "often used" (implying, used in general), which is problematic. Anyhow, that issue is moot with the re-write we have. I am a bit concerned that where the source is talking about CAM, we've changed the meaning to make it specific to chiro only.

I do think there is the danger of a false equivalence between doctors and chiropractors. Medicine is a broad field in which doctors tend to use what is best (when they behave correctly); techniques change over time and so practice and options change. A chiropractor believes in and delivers a single product, chiropractic, and is financially interested in selling as much of it as they can. A better equivalence would be between a Doctor "who is sponsored by a drug company" writing about those drugs, and a chiropractor writing about chiropractic (which, for the doctor, would be unethical without a COI declaration). |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 15:34, 30 January 2014 (UTC)

"When chiropractic is used, it is often as a complementary therapy rather than as primary treatment.113" This is a non-controversial statement. We can't wipe out all sources we don't like from this article. QuackGuru05:26, 4 February 2014 (UTC)

Actually it's a VERY controversial statement, because it is simply untrue. The source doesn't even back it up. Some wording there has been misinterpreted:

"CAM is itself used by people suffering from a variety of conditions, though it is often used not as a primary intervention, but rather as an additional form of care. CAM and chiropractic often offer lower costs for comparable results compared to conventional medicine."

That quote is about CAM in general, not specifically chiropractic. In practice, chiropractors rarely work together with mainstream health care, but in their own private clinics, where chiropractic care is indeed the "primary intervention". It is only if the patient also happens to be getting some other form of care that one could discuss other possible descriptions, but it's often not happening with the good will or wishes of the chiropractor, since they often seek to advise against MDs, drugs, surgery, etc., and try to convince patients and their families to use them as their primary care physician.

So, we have some wording that needs to be removed as it is a misunderstanding and unintentional SYNTH violation. -- BullRangifer Brangifer 06:05, 4 February 2014 (UTC)

I replaced it with https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593850690oldid=593847475 another source. See (PMID|23171540). QuackGuru06:43, 4 February 2014 (UTC)

I don't think that really solves the problem, even though you have changed the wording somewhat. This reference, unless I'm misreading it, actually surprises me. I had thought that chiropractors had succeeded in deliberately (according to their discussed plans) placing their practices more in areas where coverage by MDs and DOs was low or nonexistent, but this source indicates that this hasn't happened to the degree I had expected. It indicates that they practice the same places where MDs and DOs practice, and thus are not "an alternative point of access", IOW not an "only" point of access. They are one of many points of access, because their patients can use them, and MDs, and DOs, simply because they are all in the same geographical area. "Complementary" doesn't refer to geographical proximity, but to deliberate cooperation between practitioners. This source doesn't mean they are cooperating, which is the implication of "complementary" care. If we stretch the meaning of "complementary medicine" to include every situation where patients receive treatment from multiple providers, some of whom are alternative medicine practitioners, and who may not even be talking to each other or coordinating their efforts, then the term "complementary medicine" just became meaningless. I don't think we should do that. It would be best to leave this source and wording out, and I see that it https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=593850690 has happened.

Let's not try to get this type of wording into the article by stretching to reach it. Let's find examples where these practitioners are actually working together, cooperating, and complementing each other. That does happen, but it's rare, and the examples we can find are the exception which proves the rule. When it becomes the norm, rather than the exception, then we can talk about the profession as a complementary profession. Right now it's still offered as an alternative (in direct competition, with enmity), and thus comes under the CAM umbrella, but usually only the "A" (alternative) part. -- BullRangifer Brangifer 16:00, 4 February 2014 (UTC)

We should stick to what the sources say. An uninvolved editor made https://en.wikipedia.org/w/index.php?title=Wikipedia_talk%3AWikiProject_Medicinediff=593939285oldid=593939085 this comment. User:WhatamIdoing is right. See Wikipedia talk:WikiProject MedicineIs WHO guideline a MEDRS. QuackGuru02:59, 5 February 2014 (UTC)

This is getting a bit out of hand. Please see Talk:ChiropracticReliable sources must not be deleted again. QuackGuru18:44, 5 February 2014 (UTC)

cite journal |author=Bronfort G, Haas M, Evans R, Leininger B, Triano J |title=Effectiveness of manual therapies: the UK evidence report |journal=Chiropr Osteopat |volume=18 |issue= |pages=3 |year=2010 |pmid=20184717 |pmc=2841070 |doi=10.1186/1746-1340-18-3 The article may need updating because we have a lot more independent sources available at this time. QuackGuru19:42, 30 January 2014 (UTC)

Still useless, as it's in a journal devoted to promoting chiropractic. How about Cochrane? That would be considered reliable.

http://www.ncbi.nlm.nih.gov/pubmed/21248591: "Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions."

http://www.ncbi.nlm.nih.gov/pubmed/22972127 "SMT is no more effective in participants with acute low-back pain than inert interventions, sham SMT, or when added to another intervention. SMT also appears to be no better than other recommended therapies. Our evaluation is limited by the small number of studies per comparison, outcome, and time interval. Therefore, future research is likely to have an important impact on these estimates. The decision to refer patients for SMT should be based upon costs, preferences of the patients and providers, and relative safety of SMT compared to other treatment options. Future RCTs should examine specific subgroups and include an economic evaluation."

Seems like a fair summary to me. (JzG/help Help!) 20:45, 30 January 2014 (UTC)

The source I mentioned that might be "useless" is in the https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593164409oldid=593156853cite_note-Bronfort-Haas-121 article. QuackGuru03:58, 31 January 2014 (UTC)

Misplaced and irrelevant text

On the NHS Choices website, they make patients aware that there is "no scientific evidence to support the idea that most illness is caused by misalignment of the spine."111 This is not about international reception. See ChiropracticInternational reception. QuackGuru03:24, 6 February 2014 (UTC)

Duplication again

A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).94 The same sentence is found in another section. See ChiropracticEthics. QuackGuru05:30, 6 February 2014 (UTC)

Not neutrally written

A 2010 analysis of chiropractic websites found the majority of chiropractors and their associations made claims of effectiveness not supported by scientific evidence, including claims about the treatment of asthma, ear infection, earache, otitis media, and neck pain.103 Read the https://www.ncbi.nlm.nih.gov/pubmed/20389316 conclusion. See ChiropracticEthics. QuackGuru05:30, 6 February 2014 (UTC)

Recent 2012 source for safety

I found a http://www.jmptonline.org/article/S0161-4754%2812%2900152-2/fulltexts0005 more recent source for the safety information. I made https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=594332887oldid=594331992 this change to summarise the body. QuackGuru07:04, 7 February 2014 (UTC)

In general, your citations need to be formatted to follow |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:08, 7 February 2014 (UTC)

Duplication

UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behaviour on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous.106 This situation, coupled with a backlash to the libel suit filed against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24 hour period,107108 prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients."107 See ChiropracticEthics.

In 2008 and 2009, chiropractors, including the British Chiropractic Association, used libel lawsuits and threats of lawsuits against their critics.124 Science writer Simon Singh was sued for libel by the British Chiropractic Association (BCA) for criticizing their activities in a column in The Guardian.125 A preliminary hearing took place at the Royal Courts of Justice in front of Justice David Eady. The judge held that merely using the phrase "happily promotes bogus treatments" meant that he was stating, as a matter of fact, that the British Chiropractic Association was being consciously dishonest in promoting chiropractic for treating the children's ailments in question.126 An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights.127 The libel case ended with the BCA withdrawing its suit in 2010.128129 See ChiropracticHistory.

In two different sections we have similar, almost duplicate text. I think for the history section it should be shortened or deleted. QuackGuru19:32, 4 February 2014 (UTC)

It may look worse than it is. Although both para's mention the Singh case, they discuss different ramifications of it. In fact I'm having a hard time finding a single sentence, or clause, that is redundant. --x Middle 8 (Middle 8/Privacy leave me alone • 20:57, 7 February 2014 (UTC)

User:Middle 8, I made https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=594485038oldid=594334064 this change and merged some of the deleted text. QuackGuru08:03, 8 February 2014 (UTC)

Ethics section deleted

If another article is kept this section stills requires a https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=594720871oldid=594720698 summary. See SUMMARY. I suggest an AFD or redirect for Chiropractic professional ethics. Or maybe the new article could be kept. QuackGuru20:48, 9 February 2014 (UTC)

Fine.. so let's just add "See also: Chiropractic professional ethics.

I added a https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=594722803oldid=594721629 link to the new article. QuackGuru21:00, 9 February 2014 (UTC)

The part "https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=594724342oldid=594722803 According to one controversial source is OR and the text is sourced.https://www.ncbi.nlm.nih.gov/pubmed/19541879 QuackGuru21:14, 9 February 2014 (UTC)

The American Chiropractic Association (ACA) has a Code of Ethics "based upon the acknowledgement that the social contract dictates the profession’s responsibilities to the patient, the public, and the profession; and upholds the fundamental principle that the paramount purpose of the chiropractic doctor's professional services shall be to benefit the patient."Cite web|author=Staff|title=Code of Ethics|publisher=American Chiropractic Association|url=http://www.acatoday.org/content_css.cfm?CID=719 The International Chiropractor's Association (ICA) also has a detailed set of professional canons.Cite web|author=Staff|title=ICA code of Ethics|publisher=International Chiropractor's Association|url=http://www.chiropractic.org/ica/ethics.htm

This can be discussed in this article. QuackGuru02:22, 10 February 2014 (UTC)

I recommend an AFD for Chiropractic professional ethics. I don't see a reason to have a separate article for duplicate information. QuackGuru04:58, 11 February 2014 (UTC)

Weight issue

Students attending the chiropractic program at Canadian Memorial Chiropractic College during 2011-12 had a positive outlook toward vaccination.213undue weight? – discuss

The source (PMID|23997247) is reliable but it is a weight issue. QuackGuru16:14, 11 February 2014 (UTC)

A primary source from an industry-specific altmed journal, commenting on that industry? Really? It's undue too. (Add: and to top it off, it was misused - the source says: "it can not be said with any certainly if this represents a trend toward a more favorable attitude with respect to vaccination among chiropractic students at CMCC" while we implied otherwise by including it. Sheesh.) |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 16:17, 11 February 2014 (UTC)

A 2013 systematic review and meta-analysis

A 2013 systematic review and meta-analysis found a statistically significant improvement in overall recovery from sciatica following spinal manipulation, when compared to usual care, and suggested that spine manipulation may be considered.

cite journal |author=Lewis RA, Williams NH, Sutton AJ, "et al." |title=Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. |journal=Spine Journal |volume= |issue= |pages= |year=2013 |month= |pmid= 24412033 |url= |doi=10.1016/j.spinee.2013.08.049 We are using numerous sources about spinal manipulation in this article. I don't understand why this particular source was deleted. QuackGuru08:17, 7 February 2014 (UTC)

Does it mention chiropractic ? |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 08:29, 7 February 2014 (UTC)

We have numerous sources in this article that do not mention chiropractic specifically. It was decided to include them in the article. QuackGuru08:31, 7 February 2014 (UTC)

Who "decided" OR/SYN was okay? |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 08:35, 7 February 2014 (UTC)

There is no SYN or OR when the text is sourced. Check the archives. Editors already decided to keep this type of information. Almost all the effectiveness section is spinal manipulation in general. QuackGuru08:40, 7 February 2014 (UTC)

Standards have risen then. We shouldn't be concluding things about chiropractic from sources that don't even mention it! That is |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 08:47, 7 February 2014 (UTC)

You haven't shown what is OR. There was a RfC on this. See Talk:Chiropractic/Archive 27Request for Comment: Excluding treatment reviews. And there were uninvolved editors who commented on this including User:WhatamIdoing. See Talk:Chiropractic/Archive 27Outside view by WhatamIdoing. QuackGuru08:57, 7 February 2014 (UTC)

An inconclusive RfC from 6 years ago doesn't overturn community consensus as embodied now in one of our chief guidelines, |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 09:11, 7 February 2014 (UTC)

This was previously explained in the RfC the sources are directly related to the topic at hand "and" directly support the material being presented. QuackGuru17:05, 7 February 2014 (UTC)

(e/c) @ Alexbrn -- "Embodied now", as opposed to six years ago? OR has been around for a lot longer than that. And it pertains to explicit syntheses that advance a position, not inclusion of relevant material in articles. Chiropractors' main modality is spinal manipulation (SM), so discussing SM in the article is natural and not OR. An example of OR/SYN might be, e.g., "30% of American primary healthcare providers referred for SM in 2012, so that same 30% endorses chiropractic care." Ask at OR/N? --x Middle 8 (Middle 8/Privacy leave me alone • 17:20, 7 February 2014 (UTC)

The sources do not "directly" refer to chiropractic. You might try and argue that SMT and chiropractic are synonymous - but there are sources in the article which say that it's just not that simple: "ownership" of SMT is controversial. Maybe try |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 17:23, 7 February 2014 (UTC)

The sources "directly relate" to chiropractic. This was explained many many times. QuackGuru17:53, 7 February 2014 (UTC)

Wrongly. You cannot override community consensus guidelines with specious local arguments. As I say: try |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 17:55, 7 February 2014 (UTC)

Please read https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=239220482oldid=239219785 this comment. https://en.wikipedia.org/w/index.php?title=Talk%3AChiropracticdiff=239220482oldid=239219785 In short, the NOR/N discussion supported removing the SYN tag. Levine2112 disagreed with that removal, and initiated an RfC here to reverse it. This was discussed at length. QuackGuru18:20, 7 February 2014 (UTC)

Looks inconclusive to me (like the RfC), and is six years old. Let us return to |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 18:32, 7 February 2014 (UTC)

See Talk:Chiropractic/Archive 27Request for Comment.2C Possible OR violation at Chiropractic Effectiveness.

See Talk:Chiropractic/Archive 27Futility of .22effectiveness.22 discussions.

See Talk:Chiropractic/Archive 27Request for Comment: Excluding treatment reviews.

There were "'2 RfC"'. There are convincing arguments the text is "'not"' OR at all. QuackGuru18:47, 7 February 2014 (UTC)

This commentary is directly relevant: http://edzardernst.com/2014/02/the-alchemists-of-alternative-medicine-part-4-you-cannot-judge-me-by-my-signature-therapy/ you cannot judge me by my signature therapy. That's precisely what is going on with these studies. Things chiros do that are accidentally effective are being used to assert the validity of a core concept that is wholly bogus, namely the diagnosis, treatment and prevention of non-existent spinal subluxations. And although that is a blog, the source is Britain's first professor of complementary and alternative medicine, so as a statement of his considered professional judgement it is perfectly usable. (JzG/help Help!) 10:54, 8 February 2014 (UTC)

* Yes, saw that too - a good read. Incidentally, I have opened a thread at |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 11:07, 8 February 2014 (UTC)

* (Add) And, speaking of Ernst, http://edzardernst.com/2013/11/spinal-manipulation-for-back-pain-who-does-it-best-chiros-physios-or-osteos/ this blog post makes it clear why we can't just say that SMT=chiropractic if the source doesn't say so. Different professions offer SMT with different levels of supporting evidence and different outcomes. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 11:23, 8 February 2014 (UTC)

"If we ask how effective spinal manipulation is as a treatment of back pain, we get all sorts of answers. Therapists who earn their money with it – mostly chiropractors, osteopaths and physiotherapists - are obviously convinced that it is effective. But if we consult more objective sources, the picture changes dramatically. The current http://www.ncbi.nlm.nih.gov/pubmed/22972127 Cochrane review, for instance, arrives at this conclusion: "SMT is no more effective in participants with acute low-back pain than inert interventions, sham SMT, or when added to another intervention. SMT also appears to be no better than other recommended therapies.""http://edzardernst.com/2013/11/spinal-manipulation-for-back-pain-who-does-it-best-chiros-physios-or-osteos/ Ernst is using an objective source to compare the different professions. He also said we cannot draw firm conclusions from comparing the systematic reviews. QuackGuru19:49, 8 February 2014 (UTC)

Exactly. If different types of SMT are not comparable, we can't just take SMT in general and say it "is" Chiropractic SMT. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 07:37, 9 February 2014 (UTC)

We are not comparing different types of SMT the way Ernst is doing. The text does not say it is Chiropractic SMT. The text says it is SMT. QuackGuru19:14, 9 February 2014 (UTC)

Again, exactly. We can't take it upon ourselves to equate SMT in general to "chiropractic SMT", if the source is silent on that matter. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 19:27, 9 February 2014 (UTC)

There's also the issue that chiros tend to assert some type of ownership over SMT, even though it is basically only accidental that the pseudoscientific theory on which chiro is based, leads to manipulation of the spine in an attempt at therapy. (JzG/help Help!) 19:29, 9 February 2014 (UTC)

Chiropractors do tend to claim ownership over SMT but that does not mean the text about spinal manipulation is OR. We are not saying SMT is chiropractic SMT in the text. QuackGuru19:42, 9 February 2014 (UTC)

So if SMT in general is not chiropractic "per se", and the source doesn't mention chiropractic, then why include it? What possible reason could there be? |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 19:47, 9 February 2014 (UTC)

SMT is a modality of chiropractic (and in fact the primary one), and it's not OR to cite such sources when a modality is already uncontroversially part of a profession. But (cf. Ernst) to the extent different professions use variants of SMT, we'd have to use editorial discretion as to including a given source here. But it wouldn't be a blanket yes or no. Risks of stroke from SMT are discussed; do we or would we demand that every source specifically mention chiro? --x Middle 8 (Middle 8/Privacy leave me alone • 18:43, 12 February 2014 (UTC)

Yes, otherwise we are interpreting research, which we have no business doing. (And yes, there are lots of problems in this article). The wording of |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 18:46, 12 February 2014 (UTC)

Please see my more detailed commenthttps://en.wikipedia.org/w/index.php?title=Wikipedia:No_original_research/Noticeboarddiff=595180012oldid=594868786 at NORN; we get to use discretion. A blanket "no" defies common sense (see my example there... I have podiatry on the brain lately, if you'll pardon an awkward expression).

Reliable sources must not be deleted again

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=592768717

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=593089869

https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593850971oldid=593850690

"A 2012 study suggests that chiropractors may be used in a more complementary role to primary medical intervention." See (PMID|23171540).

Per NPOV, we must include https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593850971oldid=593850690 opposing POV. All the journals are reliable. Move on. QuackGuru18:41, 5 February 2014 (UTC)

To quote |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 19:00, 5 February 2014 (UTC)

The sentence is https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=prevoldid=593850690 relevant to the section. There is no basis for deleting it based on https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593850971oldid=593850690 fringe because chiropractic is https://en.wikipedia.org/w/index.php?title=Wikipedia_talk%3AWikiProject_Medicinediff=594131484oldid=594097485 not fringe. QuackGuru03:34, 6 February 2014 (UTC)

I think this is a fringe topic: we have the PS discretionary sanctions applying here. If you want to think about this another way, your source is a primary source from an industry publication venturing a speculative claim about how others (i.e. mainstream medicine) interact. Yet our |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 06:58, 6 February 2014 (UTC)

Here is http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690192/ another source. This source is https://en.wikipedia.org/wiki/Chiropracticcite_note-Cooper-20 already used in this article. It says a lot. Maybe we can include https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593850971oldid=593850690 both sources. Here is the ref citation. I made https://en.wikipedia.org/w/index.php?title=Chiropracticcurid=7738diff=594281940oldid=594278133 this change. QuackGuru22:54, 6 February 2014 (UTC)

x Alexbrn, do you agree it was a mistake to try to delete chiropractic reliable sources solely based on authorship. QuackGuru18:02, 7 February 2014 (UTC)

When did that happen? who did it? |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 18:04, 7 February 2014 (UTC)

You deleted the sources that are reliable.https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=592768717https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=nextoldid=593089869https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593850971oldid=593850690 It happened again with https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=594728975oldid=594726402 another source. See Talk:ChiropracticFringe journal or MEDRS compliant.3F. QuackGuru02:39, 10 February 2014 (UTC)

For fringe journals it's not "authorship" that's the problem, it's the non-independence of the source. |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 12:25, 10 February 2014 (UTC)

""Do not reject a high-quality "type" of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions."" according to MEDASSESS.

Peer-reviewed journals are not fringe journals. Reliable sources can't be deleted based on authorship or where it was published. This was previously explained with the WHO source. You can't reject a source based on being published in a chiropractic "peer-reviewed" journal. User:WhatamIdoing wrote in part: https://en.wikipedia.org/w/index.php?title=Wikipedia_talk:WikiProject_Medicinediff=prevoldid=593939285 That doesn't sound like a true "fringe" belief to me. It was previously explained that fringe does not apply. See Wikipedia talk:WikiProject MedicineIs WHO guideline a MEDRS. QuackGuru17:11, 10 February 2014 (UTC)

So, you'd use the "|RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 17:19, 10 February 2014 (UTC)

QuackGuru: You are showing distinct signs of trying to OWN the article. Statements such as "Reliable sources must not be deleted again" are classic ownership. We are not bound to install every source, however reliable; that is a matter of editorial judgment. (JzG/help Help!) 13:43, 12 February 2014 (UTC)

There was a discussion at Wikipedia talk:WikiProject MedicineIs WHO guideline a MEDRS. The WHO source is reliable according to other editors but you disagreed. I am not the only editor who wanted to keep the WHO source in the article? See comments by User:RexxS, User:Jmh649, User:Bluerasberry, and User:WhatamIdoing. QuackGuru18:52, 12 February 2014 (UTC)

Hello! Is there anyone here who feels that the latest official statement endorsed by the WHO either should not be used, or is being used improperly? If so please concisely state the problem. Bluerasberry "' Blue Rasberry "' 18:55, 12 February 2014 (UTC)

User:Bluerasberry, I started a new thread about the safety information in the lede regarding the WHO source and another source for the lede. Please see "Although"? and "published by practitioners". QuackGuru07:15, 13 February 2014 (UTC)

paragraph 4

"Many studies of treatments used by chiropractors have been conducted, with conflicting results.14 A critical evaluation found that collectively, spinal manipulation failed to show it is effective for any condition.23 A Cochrane review found good evidence that spinal manipulation therapy was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain.24 The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.25 Although evidence published by practitioners suggests that spinal manipulation therapy is safe,26 the actual prevalence of adverse events is unknown27 as there is no systematic reporting;28 it is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.2729" ranks at the 12% level for readability.

"Studies about chiropractic have conflicting results. One found spinal manipulation was not shown effective for any condition. A Cochrane review found it ineffective for low back pain. The cost-effectiveness of chiropractic is unknown. Evidence published by practitioners show the therapy is safe, although the number of adverse results is not known, and there are reports of mild to serious adverse effects. "

gets us up to a rating of 36% (an improvement of 24%), while only sacrificing the added bit about deaths in rare cases. Collect20:40, 12 February 2014 (UTC)

seems fair to me. I seem to recall spending a fair bit of time getting the lede down to manageable proportions, now it's back to being War And Peace, so adding concision without losing precision is a clear win. (JzG/help Help!) 23:16, 12 February 2014 (UTC)

Please read my https://en.wikipedia.org/w/index.php?title=Talk:Chiropracticcurid=197022diff=595247038oldid=595245077 previous comment. Simple wording is not encyclopedic. QuackGuru04:33, 13 February 2014 (UTC)

In short -- if an article is actually readable, it is no good? I find that remarkably incomprehensible as an argument. Cheers. Collect12:53, 13 February 2014 (UTC)

Congratulations!

Only 11% of Wikipedia articles are less readable, ensuring that no one can understand this article as it sits. http://www.readabilityofwikipedia.com/check/Chiropractic. I would award it the "barbstar of unreadability" but that page seems quite difficult to find ... Collect15:30, 12 February 2014 (UTC)

This isn't simple wikipedia. This is an article about a medical topic. According to that site, academic works usually score less than 30, this one scoring 26. The score is based on sentence and word length. The word "chiropractic" is 4 syllables, and we need to discuss even longer words like the hearts; 16:11, 12 February 2014 (UTC)

Collect has a point though. Even ignoring any metrics, this article is a pretty gnarly read - and if the various sub-articles are taken into account their collective force is even gnarlier. As for many controversial topics, the battlefield scars are apparent. (P.S. I love the idea of a "barbstar"!) |RRR_User:AlexbrnConflict_of_interest_declaration_RRR COI 16:33, 12 February 2014 (UTC)

The subpages for this article are not immune -- Vertebral subluxation is at the 9% level, Chiropractic treatment techniques is at the 3% level, Spinal adjustment is at the 14% level, and so on. And this is "not" a requirement for medical topics, by the way. We "can" make articles with some readability if we try. Even on "technical stuff." Cancer is just as difficult a topic -- but is at the 23% level -- not great, but miles better than these articles. IRS instructions tend to be well over the 50% mark, really. Collect16:54, 12 February 2014 (UTC)

I'd say that Collect has a point. I suspect that much of the unreadability may be down to the contentiousness of the article, and the tendency for contributors to argue endlessly about every last word, rather than looking at the broader picture. A little more consideration for the readership is clearly needed. AndyTheGrump20:19, 12 February 2014 (UTC)

It owuld be interesting to check the version before QuackGuru's hundreds of edits over the last few weeks, which have bloated the lede and introduced much obfuscation elsewhere. (JzG/help Help!) 23:22, 12 February 2014 (UTC)

User:Mann jess is right. This is an encyclopedia, not a simple Wikipedia. If you look back in the edit history such as in https://en.wikipedia.org/w/index.php?title=Chiropracticoldid=463009794 2011 when User:BullRangifer was improving the article the lede and the body of the article is similar to the current version. QuackGuru04:04, 13 February 2014 (UTC)

I think everyone misunderstood me, which is undoubtedly my own fault. Let me clarify. The article should be cleaned up, but the metric above doesn't tell us how. I wanted a concrete proposal, which Collect provided. I'm "obviously" not opposed to making the article easier to understand. My longer explanation was https://en.wikipedia.org/w/index.php?title=Talk:Chiropracticdiff=595297121oldid=595294894 here nbsp; mdash; hearts; 13:49, 13 February 2014 (UTC)

See Chiropractic treatment techniques for a quick improvement from a 3% WP rating up to 17 by using pretty straightforward editing. Collect14:54, 13 February 2014 (UTC)

&quot;Although&quot;? and &quot;published by practitioners&quot;

The safety information using the WHO source was https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593710145oldid=593708803 previously deleted from the lede.https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=593486006oldid=593484296

cite journal|journal= J Manipulative Physiol Ther |year=2012|volume=35|issue=7|pages=493–513|title=Chiropractic care and public health: answering difficult questions about safety, care through the lifespan, and community action|pmid=23069244|doi=10.1016/j.jmpt.2012.09.001

This is another MEDRS compliant source: "So, do the risks outweigh the benefits? The best evidence suggests that SMT, whether it be for neck or low back pain, is a safe and effective therapy. At a population level, the benefits still outweigh the risks."http://www.jmptonline.org/article/S0161-4754%2812%2900152-2/fulltext

I don't see a serious dispute to the text. What is the point to adding "https://en.wikipedia.org/w/index.php?title=Chiropracticdiff=595139628oldid=595084507 published by practitioners". Is there evidence that specifically says it is not safe. "Although" is unnecessary grammar and suggests there is a dispute when none is being presented. These are different sources that make different distinct points in the lede. The part "published by practitioners" is not what the source says anyhow. QuackGuru07:09, 13 February 2014 (UTC)

I don't see the point either QuackGuru I would agree "although" is unnecessary and that the WHO reversion would be appropriate.. my only concern is that the Lede is becoming an article in itself. Is there any way we can reduce it to a paragraph with all the most important information and relegate the rest to the subtitles? DJFryzy11:16, 13 February 2014 (UTC)

User:DJFryzy, you are correct about the "although" but since I made changes to this article editors are trying to get me banned. QuackGuru18:50, 13 February 2014 (UTC)