Talk:Chiropractic/Archive 9

message: This is now the fifth time I've asked for the ref in the lead from Cooperstein. The ref given doesn't support the claim. The ref is a ref to a ref. Circular reasoning and circular refs don't belong in WP. Can someone show me the Cooperstein? And on the Harrison which kept getting reverted. Unless someone can say why it shouldn't go back in ....Mccready 23:10, 2 June 2006 (UTC)
replies: text: I didn't make the reference, so I don't know. You insist however that this research is disputed. By whom? Levine2112 23:49, 2 June 2006 (UTC)

text: If it helps you McCready, here is a page linking to a lot of research, clinical and case studies and reviews that provide more supportive evidence for chiropractic's claims to help with headaches. Levine2112 23:54, 2 June 2006 (UTC)

text: And here is another page providing more research supportive of this claim by chiropractic. Levine2112 23:56, 2 June 2006 (UTC)

text: And here's yet another page of scientific studies citing chiropractic's effectiveness with headaches... Levine2112 00:03, 3 June 2006 (UTC)

text: I don't know if this helps but I found this. Ontario Ministry of Health, stated emphatically that: "On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain...There would be highly significant cost savings if more management of low back pain was transferred from physician to chiropractors." Levine2112 00:00, 3 June 2006 (UTC)

text: Here's a page full of supportive scientific research of chiropractic's effectiveness with neck pain. Oh, and here's another page chocked full of more research supporting chiropractic's claim to be effective at relieving neck pain. Levine2112 00:06, 3 June 2006 (UTC)

text: I think he is referring to this in the intro: Although disputed research suggests short term pain relief for tension headache and low back pain, there is no scientific consensus for chiropractic's effectiveness for other conditions. Given the 100+ pieces of research that I have just pointed us to (and that even skeptic-extrordinairre James Randi accepts chiropractic's effectiveness for headaches and low-back pain), will the anti-chiro lobby here at least now afford us to remove the word "disputed"? Levine2112 00:22, 3 June 2006 (UTC)
replies: text: I am curious as well.  Who says their disputed, other than Mccready?--Hughgr 00:35, 3 June 2006 (UTC)

text: All of the research I have cited support chiropractic's (not my) claim that chiropractic helps with headaches, back and neck pain individually. Collectively they show some kind of consensus. Your claim is that that this is disputed. Please provide us with reference that support YOUR contention. Levine2112 02:31, 3 June 2006 (UTC)
replies: text: Oh dear, oh dear, oh dear Levine2112, all I'm asking is for ONE study. You CLAIM all support you. Well, please, pretty please, give one. One would be enough, only one, not ten, not twenty, not a hundred, not hundreds. Just one. Why is that hard for you? And also, the problem with the Cooperstein link remains (this is the seventh time now - has anybody got a copy of the study - if that is indeed THE one that Levine2112 wants to rely on. I might add that even the category listing for it in pubmed is erroneous – it is not randomized or controlled. Meantime I'm placing disputed in or perhpaps a big big tag at the top might be more appropriate? We've come a long way here, dear Levine2112. Don't blow it.Mccready 04:12, 3 June 2006 (UTC)
replies: text: Your behavior is completely inappropriate, McCready. I feel incredibly embarrassed for you. Levine2112 06:50, 3 June 2006 (UTC)

text: I concur with Mccready.  Chiropractic has little efficacy outside of fixing certain types of back problems.  Of course, I'll concede that I'm biased since one of my relatives is a physician who sees the occasional refugee from chiropractic about twice a year.  These patients are sick and tired of being overdiagnosed with all kinds of bizarre diseases that don't exist by losers who entered chiropractic because they didn't get good grades in chemistry and biology and failed the MCAT and couldn't get into a decent medical school (even one of those third-rate ones down in the Caribbean), osteopathic school, or veterinary school.  --Coolcaesar 04:49, 3 June 2006 (UTC)
replies: text: WOW Coolcaesar, calling chiropractors "losers" who couldn't get into med school...and your a lawyer as well.  Did you pass the ethics class?  Please try and keep a "cool head" Coolcaesar.  You say your biased b/c a relative see's TWO "refugee's" per year????  OMG, I see that many in a week coming from the medical realm.  The developer of chiropractic once said, "If medicine wants to get rid of chiropractic, all it has to do is get sick people well."  Cheers--Hughgr 06:17, 3 June 2006 (UTC)
replies: text: Well, I did pass the required professional responsibility course and the MPRE, but my professional ethical obligations have nothing to do with how I express my personal views about the relative efficacy of different approaches to healthcare.  I have a lot more respect for osteopaths, who unlike chiropractors are well-trained in conventional, scientific medicine and actually understand gross anatomy, biochemistry, and cell biology; they have purged almost all of the hocus-pocus from their field.  Plus the minimum GPA to get into chiropractic school is simply hilarious.  --Coolcaesar 17:47, 4 June 2006 (UTC)

text: CoolCaesar, you contributions here thus far are not helping further this article. I encourage you to participate here, but please keep is useful for editing this article. Please no ad hominem attacks. Go Bruins! Levine2112 18:02, 4 June 2006 (UTC)
thread_title: Top dispute

message: I've copied this here for reference of editors from Anecdotal evidence:
Miller and Miller (2005) list five standards of proof, by level of evidence Miller, DW Jr, Miller, CG. On evidence, medical and legal. Journal of American Physicians and Surgeons Volume 10 Number 3, Fall 2005, 70-75.:
 
Kind             	Level of Evidence	Standard
Regulatory, Legal	                 	Precautionary Principle
Legal - Civil    	*                	More likely than not
Legal - Civil    	**               	Clear and convincing
Legal - Criminal 	***              	Beyond a reasonable doubt
Scientific       	****             	Irrefutable
Citing situations involving adverse drug reactions, Miller and Miller outline three events related to administration of the drug which can prove specific causation: 
*challenge: the reaction occurs after the drug is given
*de-challenge: it resolves when the drug is discontinued
*re-challenge: the adverse event recurs when the drug is given a second time. (Cook County 2005)
Altman and Bland argue that the case report or statistical outlier cannot be dismissed as having no weight: "With rare and uncommonly occurring diseases, a nonsignificant finding in a randomized trial does not necessarily mean that there is no causal association between the agent in question and the disease." Altman DG, Bland M. Absence of evidence is not evidence of absence. British Medical Journal, 1995;311:485 
Miller and Miller conclude: "Most medical evidence does not meet the scientific standard of proof; and, as in law, it should be judged by a standard of proof appropriate to the fact or point in question. An 'anecdotal' case report can provide evidence of probative value, just like eyewitness testimony in a murder trial. And it can be similarly tested, by second opinions, re-examination, laboratory tests, and follow-up."
:Give me something that is irrefutable. I don't think such a thing truly exists. Therefore, Miller and Miller's denotation is not helpful at all with our work on any scientific subjects. There are no absolutes except that there are no absolutes. Levine2112 02:57, 6 June 2006 (UTC)
thread_title:  Miller and Miller 

message: First off, Thanks to everyone, and straight away let me say that I don't consider anything written above as remotely a personal attack on me; I take it all as honest and interesting critiques of a position. On the lead, as I said any follow up statement will need care and agreement and I don't want to get into that now because I'm not ready, and the resolution of a statement so clearly controversial would have to be on the basis of accepted V RS. I think I have found some V RS, but others might disagree. Either way I'd like to take the heat out of this by setting it aside for later.
Broadly I know the science section needs a rewrite, so let any further addition to the lead await the outcme of consensus on that. 
"the evidence is inconclusive" etc. Well this is the V RS statement from Cochrane etc so on WP rules, I don't see any alterntive; it's not our job to interpret but to report in cases like this. 
Am I saying this because it's my POV? Well if it is it's an acquired POV through what I've read while being interested in this, and I guess none of us can escape our POVs though we all try to exclude them from the article. My POV is SPOV. I'm happy to declare my personal conclusions, just so everyone is aware of my POV and can help me to exclude it if it intrudes despite my best efforts.
I have been particularly impressed by the House of Lords select committee report. To clarify its status, because mostly you won't know anything about this select committee. The Lords
is the upper house of Parliament- but very different to the Senate. The Lords are unelected, and largely apolitical. It had very many members, but miost active members are honorary, life appointments, for exceptional contributions in their fields of activity. They are unpaid, mostly retired, and the scientists there are very distinguished, and those that I've known I have very great respect for. The Lords has been notably awkward, comprising independent minded people with talent but little to lose or gain personally, who take pride in their consciences. The Select Committee report is certainly not a "political" document; the phrasing is reasonable and polite, but the underlying message is nonetheless clear, to the point, and frankly critical where this seems to be merited. Chiropractic comes off relatively well, but the grounds for that are clearly explained - in the UK it has strong independent regulation of training and practice, works well with conventional medicine in some areas, has gained respect and understanding in many quarters, takes the imporance of evidence based research into its effectiveness seriously etc etc. Some other alternative approaches come off very badly indeed.
The interesting part of the report to me does seem to apply to chiropractic as I've come to appreciate it and understand it. To summarise briefly the conclusions that I've reached, influenced by the conclusions of this committee as I understand them.
1) The committee accepted that there was strong evidence that chiropractic was beneficial for some patients with some conditions.
2) Why chiropractic treatment is beneficial is far from clear.
3) The scientific basis is (arguably) plausible, but lacks validation
4) Placebo controlled trials are inappropriate because the intervention is a physical intervention
5) There is strong evidence of patient reported benefits
6) Chiropractors tend to spend much longer with their patients than conventional practioners, are more sympathetic, explain things in a way that are more clearly understood by the patient - build up a stronger climate of trust
7) Such a climate of trust, and the physical nature of the intervention are both likely to both predispose the patient to favourable reporting of outcomes - but also are likely to aid healing in themselves - the placebo effect is a real effect and a strong effect
8) Thus there is a possibility, perhaps a strong possibility, that the benefits of chiropractic have at least as much to do with this climate of trust and confidence as with the specific manipulation
9) Accordingly it is at present undecideable whther chiropractic is beneficial because of the specific nature of interventions
10) Thus it is important to extend efforts to investigate the scientific basis of interventions.
11) The scientific basis is plausible, in that spinal nerves do affect virtually all internal organs and can influence their regenerative activity and their physiological function. However what is lacking is objective diagnosis of appropriate conditions for intervention, and objective defined outcomes for specific conditions and interventions, and independent validation of the propsed mechanisms.
12) However, it is likely that some conditions might be caused by dysfunction of the spinal nerves, and that others might be ameliorated by altering nerve activity - if we knew how to diagnose these particular cases and who to intervene rationally.
13) As patients come to chiropractic often after other treatments have failed, it is possible that this subset comprises patients for whom conventional diagnosis has failed - i.e. known possible explanations of their conditions have been excluded already. This subset might well be enriched in examples where the aetiology is indeed nerve malfunction.
14) So it is open. Maybe those patients who go to chiropractic do include a proportion who will benefit specifically from spinal manipulation above and beyond any placebo effect.
I have read a fair amount beyond this report. In fact I've read every review in PubMed retrieved as (review chiropractic trial) since 2003, though mostly I wish I hadn't. Anyway all above is my acquired POV, though I think I could justify it mostly through V RS.
I know it seems like I'm "taking the chiropractors side" here. I don't see it that way, I call things as I see them, and in many respects it's because of the grounds we're choosing to fight on. It is an unconfortable fact, or so my medical friends advise me, that for very many conditions, patients who come to conventional medicine, have objectively demonstrable illness for which no diagnosis can be validated - indeed for many conditions, typically about a third of patients have no clear diagnosis. i.e. there is no objectively determined cause for their symptoms, and they do not respond to treatment. 
Effectiveness of treatments depends on selection of patient group. The patients that come to chropractic are often patients for whom other treatments have already been tried and have failed. How therefore can we even compare treatments for this preselected subgroup?
If we therefore judge chiropractic solely on evidence of efficacy, given the circumstances as we know them, it is difficult to be less than at leaast open about its value, and I think it is honest to accept its efficacy in some cases for whatever reasons.
However, had we chosen different grounds to argue the case, my stance would have been very different. My personal POV is that for conventional treatments, trials are also generally pretty inconclusive annd often weak and unconvincing. I put a much greater value on scientific validation - demonstration of the mechanism of action as a way of objectively validating interventions. On these grounds you would find me a strong sceptic of chiropractic because of lack of evidence. In this respect, I might support statements stating that "there is no evidence for the claims" - where we are specifically talking about the claimed explanations. For efficacy however, there is plenty of evidence, often indistinguishable from the evidence that is considered as acceptable for conventional treatments. Compare as an extreme example, the evidence for ECT (which is another controversial article I've been looking at in part to find some path through our troubles here).
So are scientists struggling in their povish way to say that chiropractic is crap? Well when we think we can show that something is crap, we do say it. In fact, in my own field I have a particular reputation for saying such things, I hope politely, but quite directly, I suspect my colleagues generally would smile wryly at the notion that I'm a paragon of tact. We cannot infer opinions, and if we try maybe we'll be right but maybe we'll be wrong. Here we can only go by what people say - this is the discipline of V RS; we have to accept that people say what they mean and mean what they say, and that's all we can do. 
I'm sorry this is long. I'll leave this up briefly and then remove it to my Chirpractic Talk page so it doesn't disturb the thread here. This is all an account of POV mine particularly, and is of no consequence to the article.  :) (Feel free to be as abusive of my opinions as you like, I won't take that personally, and I might even change my mind - we all have the right to do that). Gleng 11:15, 4 June 2006 (UTC)
replies: text: Thanks Gleng, well stated.  I look forward to your future assessments. --Dematt 14:32, 4 June 2006 (UTC)
replies: text: Well put, Gleng. Levine2112 17:46, 4 June 2006 (UTC)
replies: text: That was well put, thanks Gleng.  I've wondered how some of the "detractors" here can have such strong opinions without any experience, either in healthcare or science.--Hughgr 02:28, 5 June 2006 (UTC)
thread_title: Responses

message: These are the studies that we have referenced in this chiropractic article.  I put them here for easy reference.  I think there are many better studies both pro and con out there.  We need to find them.
*asthma,Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma
*carpal tunnel syndrome, Oral steroids, splinting, ultrasound, yoga and wrist mobilisation provide short-term relief from carpal tunnel syndrome, but other non-surgical methods have not been shown to help. ..Trials of magnet therapy, laser acupuncture, exercise or chiropractic care did not demonstrate symptom benefit when compared to placebo or control.
*painful menstrual periodsNot enough evidence to show the effects of spinal manipulation for painful period cramps 
*migraine,There is limited evidence that spinal manipulative therapy may reduce the frequency and intensity of migraine attacks, but the evidence that spinal manipulation is better than amitriptyline, or adds to the effects of amitriptyline, is insubstantial.
*chronic low back painClinical bottom line: Based on a small, poor quality set of trials, there is no convincing evidence for long-term benefits of chiropractic interventions for acute or chronic low back pain. There may be some short-term pain relief, especially in patients with acute pain. Better quality evidence is required before the question of efficacy can be answered adequately.
*menopausal symptoms For all but one remedy there was no convincing evidence, or no evidence at all. Those for which there was no evidence in the form of randomised placebo-controlled studies included any herbal remedy, homeopathy, chiropractic, massage, exercise, acupuncture or relaxation techniques. Food supplements like vitamin E and evening primrose oil were found to have no benefit over placebo. 
*http://www.journals.elsevierhealth.com/periodicals/ymmt/article/PIIS0161475499700035/abstract 1999 Wiberg RCT infantile colic] Spinal manipulation is effective in relieving infantile colic. (J Manipulative Physiol Ther 1999;22:517–22)
*and Norwegian RCT on Infantile colicChiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic.
--Dematt 15:36, 6 June 2006 (UTC)
thread_title:  Cochrane and Bandolier 

message: Alright, I put the updated history in.  It is definitely longer, but it is hard to understand the issues without the history so maybe everybody here will be able to be on the same page when we discuss science, etc.... Some parts are controversial, so feel free to comment.--Dematt 20:36, 14 June 2006 (UTC)
replies: text: I am so impressed and grateful. Thank you. Levine2112 00:40, 15 June 2006 (UTC)
replies: text: Yes, this new intro looks great.  Great job, Dematt! Drdr1989 01:18, 15 June 2006 (UTC)
thread_title:  New and (hopefully) improved History 

message: Currently reads: Chiropractic is a complementary and alternative health care profession whose aims are to diagnose, treat, and prevent mechanical disorders of the musculoskeletal system and their effects on the nervous system and general health.
My feeling is that "whose" is out of place grammatically. "Whose" (as with its root "who") refers to a person. Chiropractic - the subject of the sentence - is not a person. It would be more proper to use "which" rather than "whose". However, I note that Steth added "whose" in an attempt to make the sentence read - as he put it - less hillbilly. I think "aims" is the source of the "hillbilliness". I am going to update the word "aims" with its near synonym "focuses". Levine2112 17:11, 15 June 2006 (UTC)
replies: text: Looks like a good change. Jefffire 17:29, 15 June 2006 (UTC)

text: Looks good to me.--Hughgr 17:40, 15 June 2006 (UTC)

text: I like it Levine!  Y'all come back now, y'hear?  Steth 11:19, 16 June 2006 (UTC)

text: I likes it alaught:) --Dematt 13:10, 16 June 2006 (UTC)
thread_title:  Very first sentence 

message: I've done some editing of the first paragraph under vertebral subluxation.  Let me know if this is inaccurate or incomplete.--Hughgr 01:07, 16 June 2006 (UTC)
replies: text: Looking good. Levine2112 01:32, 16 June 2006 (UTC)
replies: text: I have no problem with the explanation.  If we had a reference for it, that would be even better.  Did DD actually say it?--Dematt 02:43, 16 June 2006 (UTC)
thread_title:  Vertebral subluxation 

message: While we welcome all contributors to this article, please desist in adding the link to the ChiroTalk proboards forum. It is Wikipedia policy that forums generally don't make for good encyclopedic external links. Please review Wikipedia policy. I understand that you are a Senior Member of the Chirotalk site and it is frustrating that you cannot link to your own site. If you are looking to publicize your site, might I suggest submitting it to search engines. Levine2112 21:14, 16 June 2006 (UTC)
replies: text: Just like to confirm that forums aren't accpetable as external sources. I'm happy to have another editer helping, but please read Wikipedia's rules on verifiability, which state that all content has to be confirmed from reliable sources. Jefffire 21:19, 16 June 2006 (UTC)

text: You know, technically, you (Levine2112) have violated 3RR if those aren't overt vandalism.  (Although I agree with you, you should let other editors, such as Jefffire and me get in on the fun...). — Arthur Rubin |  (talk) 21:53, 16 June 2006 (UTC)
replies: text: I didn't think of it that way. I guess I was thinking that I was enforcing a policy. Hmm. Who am I to enforce policy? You make a great point. Please feel free to help us explain the rules to Randalllord and get it on the reverting fun. Thank you. Levine2112 21:57, 16 June 2006 (UTC)

text: I'll try to help out too. TheDoctorIsIn 23:49, 16 June 2006 (UTC)
thread_title:  New user, [[User:Randalllord|Randalllord]] 

message: Hey Dematt, I like what you've done in the lower definition section, took the words right out of my mouth. :)  What do you (and others here) think about merging the intro definitions into that section, while expanding a little on the paragraph in the into...without getting into too much detail, which would then be in the lower part.
There are two main groups of chiropractors, known within the field as "straights" and "mixers". Both groups treat patients using a subluxation based treatment system. Differences are based on the reasons for giving adjustments, claims made about the effects of those adjustments, and various additional treatments or sub-specialities provided.--Hughgr 18:57, 21 June 2006 (UTC)
replies: text: Seems like a solid idea to me. Levine2112 19:31, 21 June 2006 (UTC)
replies: text: I thought you would like that:]  I think we have to try.  If it doesn't work, we can always put it back.  One thing for sure, we will end up with something better.  Everytime we work on something together, it seems to end up good.--Dematt 00:54, 22 June 2006 (UTC)
thread_title:  Merging definitions... 

message: Jefffire, I noticed that you replaced while objective evidence from controlled trials is lacking. with does not meet the standards of evidence based medicine.  I'm not sure I understand what the "standards" of evidence based medicine are.  Is there a better way to say it that is more clear?  Otherwise, I like Gleng's version better: while objective evidence from controlled trials is lacking.--Dematt 13:48, 22 June 2006 (UTC)
replies: text: Basically I'm trying to make it clear that some of the wilder claims (healing cancer, and the like), which I hasten to add I don't believe most chiropracters believe in, aren't based on scientific evidence like evidence based medicine is. My objection to the previous wording is that that feels slightly ungainly. Essentially they say the same thing, so my arguement is chiefly an aesthetic one. Jefffire 16:21, 22 June 2006 (UTC)
replies: text: Why does there need to be citations for those statements?--Hughgr 18:20, 22 June 2006 (UTC)
replies: text: Umm...because they are important claims from both sides. I think I may be missing something from your question. Jefffire 18:27, 22 June 2006 (UTC)

text: Oh, I guess I did leave out a bit:)  I was thinking that the wording had been agreed upon as a generalization which was covered in the article, and it reads better without a citation after every sentence.  I realize what what your saying though, and it looks like dematt covered your problem.  Cheers. --Hughgr 18:44, 22 June 2006 (UTC)

text: Dematt, I agree with what you've said above, but I wouldn't say the objective straights "don't want the resposibility" per se, I think they want it to be made clear that the art of diagnosis is best made by the profession who makes it their entire forte.  They see that their job is to solely find and adjust subluxations,(like going to a dentist for a cavity) because they see a subluxation as a detriment to health,  so regardless of disease condition, they should be adjusted, as long as the adjustment can be safely delivered.  Thus they wouldn't be "treating" any disease, rather the condition of "subluxation".  From what I've read about their frame of thinking, if something unusual is seen/discovered, they inform the patient but do not make a recommendation as to whom to see (specialist) but rather tell the patient see a GP, who would then make a referral.  It looks like they (objective straights) don't want to be seen as primary care physicians, and encourage their patients to have a "family physician" (GP/MD) to take care of thier "medical needs".--Hughgr 20:31, 22 June 2006 (UTC)

text: This is going beyong my realm of knowledge, so I'll respectfully bow out till it returns. In the mean time I'd just like to congratulate all contributing editors on a good natured cooperation despite differences of opinion. Truely an excellent example of Wiki editting. Jefffire 21:13, 22 June 2006 (UTC)
replies: text: No Dematt, I don't know of any school nor chiropractors who claim that and adjustment is a cure for cancer.  Although, there are always those within every profession who don't know their limitations or get overzealous in what they do, hence make exagerated claims.  And thanks for the compliment Jefffire.--Hughgr 00:21, 23 June 2006 (UTC)
thread_title:  does not meet the standards of EBM 

message: Hey Dematt, here is a quote from DD's 1910 book (pg 20) to justify my edit earlier on subluxation paragraph:
:Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations which are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionating—too much or not enough action—which is disease.
If you could add the necessary reference, I be grateful.  Cheers.--Hughgr 00:57, 23 June 2006 (UTC)
replies: text: Awesome!  I think we should use the entire quote somewhere. I'll put the reference in for now, but lets see if we can find a place to put it.  If that was the 1910 book, then that was before the God reference in his 1914 book.  Maybe I can work it into the end of the history. --Dematt 11:58, 23 June 2006 (UTC)
replies: text: That'd by fine, thanks for the assistance!  --Hughgr 17:57, 23 June 2006 (UTC)
thread_title:  Found quote 

message: I've moved and edited the "groups" from the intro to the lower part.  If you see I've missed something or 'gasp' made an error in my editing, please correct or add.  Thank you for your support. :)--Hughgr 19:17, 29 June 2006 (UTC)
replies: text: Well done!  I like it.  It consolidates all the relevant information into one section and makes the intro less confusing as well.  Kills two birds with one big rock:) --Dematt 20:31, 29 June 2006 (UTC)
thread_title:  moved and combined