Talk:Chiropractic

History

The history section is way too long and covers effectiveness using outdated studies. We need to discuss the WP:WEIGHT problems with the huge and oudated history section. QuackGuru 17:46, 24 April 2008 (UTC)

Um, how can history be outdated? -- Levine2112 ^discuss 17:51, 24 April 2008 (UTC)

Because the studies are too old. We have newer studies available. QuackGuru 17:59, 24 April 2008 (UTC)

They are too old for history? Sorry, this doesn't seem to compute. -- Levine2112 ^discuss 18:00, 24 April 2008 (UTC)

Isn't it discussing effectiveness that's the problem? Jefffire (talk) 18:15, 24 April 2008 (UTC)

I don't see any problem with talking about historically important research. My issue there would be that the study should be discussed for its historical importances. Manga, for instance, was landmark research in helping to establish the scientific legitimacy of the profession. I read that somewhere. I'm sure we can dig up the source. -- Levine2112 ^discuss 18:20, 24 April 2008 (UTC)

If studies are presented for their historical impact then there is no issue. If they are presented as "establishing scientific legitimacy", then there is an issue since that's PoV. Jefffire (talk) 18:25, 24 April 2008 (UTC)

Historically, establishing chiropractic scientific legitimacy for treating low back pain is exactly what the Manga Report (and the second Manga Report) did. It also showed the cost-effectiveness of such treatments. -- Levine2112 ^discuss 18:29, 24 April 2008 (UTC)

That's PoV. Providing evidence for it would be a more neutral wording. Also, nudge you again on this - published =/= truth. Jefffire (talk) 18:32, 24 April 2008 (UTC)

Oh, sure. I see your point. Manga was one of the first of a few big scientific studies (such as the AHCPR) to come out after the Wilks case ended (and the AMA had been found guilty of suppressing supportive chiropractic research). Certainly Manga provided evidence which has helped to establish a growing trend towards scientific acceptance. Nudge to you... Wikipedia isn't about truth, it is about verifiability. Published information helps to establish verifiability. I encourage you to read WP:V when you have a moment. -- Levine2112 ^discuss 18:40, 24 April 2008 (UTC)

OK, since you agree with, we can work toward a neutral phrasing. Also, I think you've misinterprated my comment about published material. It's a common misconception that a published study must be true "true", which is not neccasery correct. Your wording missed that subtle point. Offtopic-Science isn't decided by trials. Jefffire (talk) 18:50, 24 April 2008 (UTC)

I would love to help work on that. I am heading out for the night right now, but if you draft something up, I will be back in the morning to review. I don't think that published studies are necessarily true. Science isn't a decision, but rather a process by which a decision can be made. -- Levine2112 ^discuss 18:54, 24 April 2008 (UTC)

I actually consider that current wording section on the Manga report to be presented in a generally neutral manner. Jefffire (talk) 19:58, 24 April 2008 (UTC)

The history section can definitely be tweaked; for example it neglects to cover important topics like the straight vs mixer evolution, the fight for licensure/regulation, the important steps in getting reimbursement under Medicaid/Medicare (US) and the expansion of the profession globally (what about history of the profession in Canada, Europe, and elsewhere?)

That's for another day though and we do not to resolve Scope of Practice first. CorticoSpinal (talk) 22:31, 24 April 2008 (UTC)

The history section has outdated effectiveness studies. When newer studies are available we can easily replace them with the newer studies. The oudated studies are mostly about effectiveness. Our goal is to replace the oudated studies with the newer studies. Makes sense? QuackGuru 03:57, 25 April 2008 (UTC)

New studies of effectiveness are irrelevant unless they comment on the impact of the Manga report. DigitalC (talk) 04:19, 25 April 2008 (UTC)

Recent effectiveness reviews do not cite the Manga report because it is of such low quality that it is not worth citing. The most recent mention I found of the Manga report in peer-reviewed literature is Grod et al. 2001 (PMID 11677551), and they dismiss it as an example of a low-quality study that they found cited in unreliable patient brochures. Any mention that Chiropractic makes of the Manga report should also describe its sad fate. Eubulides (talk) 08:16, 25 April 2008 (UTC)

I do not see any impact of the Manga report. QuackGuru 04:25, 25 April 2008 (UTC)

Hmm, yes, that's an important factor I missed. A reference from a medical textbook or something authoritative on it's impact on American medicine would be nice. Jefffire (talk) 07:29, 25 April 2008 (UTC)

If any editor wants to include the Manga report it must be rewritten using a newer ref (PMID 11677551) and also it should be explained why the need to keep the report in this or any article. This has not been done yet. Please propose a draft with your explanation and we can review it. Agreed? QuackGuru 17:11, 25 April 2008 (UTC)

Not agreed, why are you making demands that the Manga report(s) are suddenly crap and need to be taken out? The report is notable because professor Pran Manga (PhD) in economics, I believe, has made a strong and notable argument that chiropractic services should be integrated into mainstream health care, specifically in the public system. Are you disputing the verifiability of the report? It has stood the test of time here and no one has proposed at removing it until yourself. CorticoSpinal (talk) 17:15, 25 April 2008 (UTC)

The Manga report is not "suddenly crap". It was always low quality; see for example, Grod et al. 2001 (PMID 11677551), which says "The Manga report was not a controlled clinical trial but a review of the literature that offered an opinion that has not been experimentally established." Regardless of its initial quality, though, it is long obsolete and no longer deserves much (if any) coverage in Chiropractic. Eubulides (talk) 21:53, 25 April 2008 (UTC)

The report is outdated. We have much newer studies available. QuackGuru 17:20, 25 April 2008 (UTC)

If the Manga report is notable in the history of chiropractic then its place in the history section should be assured. I ask that material in the history section be explicitly dated so that the reader can understand the timeline offered. SmithBlue (talk) 07:32, 26 April 2008 (UTC)

The Manga report has zero historical impact and is an obsolete study. QuackGuru 07:38, 26 April 2008 (UTC)

The history section can easily be improved and could use a bit of expansion. The movement towards science section is very short and lacks a lot of information. Studies that describe Manga in historical terms would fit well in that section. QuackGuru 12:19, 14 May 2008 (UTC)

out with the old and in with the new (duplication)

There is a lot of oudated studies and sections that have very little or no impact on Chiropractic history. This includes The Manga Report, Workers' compensation studies, American Medical Association (AMA), and the British Medical Association.

The best approach is to delete the old studies and replace them with the newer studies. The old studies discuss mainly effectiveness. We are essentially removing duplication. QuackGuru 07:50, 26 April 2008 (UTC)

I would greatly appreciate it if you would show us how these studies and positions (which I have found in nearly every historical account of chiropractic) have had - as you say - little or no impact on the history of the Chiropractic profession. I personally don't see it and further think we should also include a mention of the AHCPR, which has been described as a "landmark" study. [14]. -- Levine2112 ^discuss 08:24, 26 April 2008 (UTC)

The dc doctor is an unreliable source. No evidence has been presented that the old studies had any "landmark" impact. QuackGuru 08:31, 26 April 2008 (UTC)

I do want to make explicit that a "History" section will usually refer to events and material that is dated. Hopefully QuackGuru will cite some RS sources on Chiropractic history that neglect to mention Manga. And at the same time some RS chiropractic histories that do include it would bolster its continued inclusion. SmithBlue (talk) 11:23, 26 April 2008 (UTC)

Some mainstream medical sources would be pretty welcome. History of medicine textbooks, medical textbook etc. Jefffire (talk) 11:50, 26 April 2008 (UTC)

Hopefully History of chiropractic articles, chiropractic textbooks, perhaps health policy articles such as "Chiropractic in the United States: Trends and Issues" as well. Doubtless there will be multiple POVs on chiro history. SmithBlue (talk) 12:28, 26 April 2008 (UTC)

There are indeed a plethora of chiropractic history sources, most notably Dr. Joseph Keating, PhD. He is "the" chiropractic historian. The article is about chiropractic, so let's talk about chiropractic, shall we? Mainstream, of course, can have their 2c, but let's tell the story of the art, science and philosophy of chiropractic. CorticoSpinal (talk) 17:35, 26 April 2008 (UTC)

A useful source, but one must bear in mind not a neutral one. Jefffire (talk) 18:25, 26 April 2008 (UTC)

When these studies and sections have no impact to Chiropractic history they should be deleted. We have newer studies available such as the proposed Effectiveness section. QuackGuru 17:42, 26 April 2008 (UTC)

For chiropractic history, we can include studies that are specifically about chiropractic history and not old or obsolete studies. QuackGuru 18:15, 26 April 2008 (UTC)

Precisely, and these studies (Manga, etc.) are important to chiropractic history as per their mention in many chiropractic history sources (Keating, etc.). -- Levine2112 ^discuss 22:46, 26 April 2008 (UTC)

Unlike science, history is of necessity subjective, POV based, filtered information producing a story. And not surprisingly who is telling the story and who is listening makes a great deal of difference in what is considred relevant. Unlike medical research, which (we hope) reduces human failings to a minimum, the medical view of chiropractic history can only be just another POV on chiro history. In the "History" section we will of necessity be presenting multiple POVs given the disparate views that exist on chiro history - if in one POV Manga is not important that does not in any way reduce its notability in another POV. SmithBlue (talk) 03:14, 27 April 2008 (UTC)

Levine, if a reference exists that discussed the Manga report in a historical context then provide the reference. We would use the reference that discusses the Manga report and not the Manga report itself anyhow. The Manga report itself does not qualify for the history section. If another source mentions older studies (Manga, etc.) then provide all those references to replace the older and obsolete studies. QuackGuru 04:00, 27 April 2008 (UTC)

No specific references have been provided to show that any of the older or obselete studies have any historical impact. If references are provided, we would use those references and not the original older studies. QuackGuru 04:13, 27 April 2008 (UTC)

Man I remember learning Manga in school. . . it represents a critical piece of research in chiropractic history. I am sure there are dozens of references out there discussing chiropractic history which detail the significance of Manga.TheDoctorIsIn (talk) 04:59, 27 April 2008 (UTC)

It represents a critical piece of research in chiropractic history? Please provide a reference discussing chiropractic history which details the significance of Manga. At the moment, no reference has been provided. These studies (Manga, etc.) have no impact to chiropractic history unless a reference is provided. QuackGuru 07:26, 27 April 2008 (UTC)

Levine wrote: Precisely, and these studies (Manga, etc.) are important to chiropractic history as per their mention in many chiropractic history sources (Keating, etc.).[15] <-- This comment implies Keating mentions the Manga report in a historical perspective. I do not see any evidence of that. Please provide a reference to support this claim. Got it? QuackGuru 18:00, 27 April 2008 (UTC)

For starters, how about this one from Keating? Get it? -- Levine2112 ^discuss 16:58, 28 April 2008 (UTC)

Thank you for the ref. The ref by Keating mentions the Manga report. We can replace the Manga report with the Keating ref. The Manga report itself is not specifically about chiropractic history but Keating seems to have some historical context. We can add the Keating ref and text. QuackGuru 18:48, 28 April 2008 (UTC)

I also added this ref which discusses Manga in terms of history. -- Levine2112 ^discuss 19:00, 28 April 2008 (UTC)

Oh, and this article describes Manga historically as having "caused ripples throughout the traditional medical community when it concluded that chiropractic management of low-back pain is both more effective and cost-effective than traditional medical treatment." -- Levine2112 ^discuss 19:03, 28 April 2008 (UTC)

As previously explained here all of the obsolete and outdated studies will be deleted. No argument has been made to keep these dated studies. The Manga Report, Workers' compensation studies, American Medical Association (AMA), and the British Medical Association are clearly obsolete when newer sources are available. For the Manga report there are newer studies that describe the report. We can use these newer studies as long as they have historical impact. We will remove the older studies and replace them with the newer effectiveness studies. This is essentially removing duplication and will make this article one step closer to a GA status. QuackGuru 20:34, 29 April 2008 (UTC)

You do not get to determine what has had historical impact on the chiropractic profession. Chiropractic historians do. Keating and others have mentioned it numerous times. You don't delete history QG because it doesn't conform to our personal POV. Effectiveness is not even on the horizon given that there is a clear lack of consensus (with majority opposed, I might add). Scope of Practice is sitting there ready to go in (despite a tendentious and stonewalling attempt by a certain editor to drag the process out over trivial points) CorticoSpinal (talk) 20:50, 29 April 2008 (UTC)

No evidence or reason has been provided to keep the obsolete studies. Removing outdated studies and replacing them with newer studies is common sense. We can add the Keating reference about the Manga report if it has historical impact. QuackGuru 20:56, 29 April 2008 (UTC)

For example, the Workers' compensation studies are outdated. Newer studies are available. Anyone can search PUBMED and retrieve newer studies (). I hope this answered this question. QuackGuru 17:43, 30 April 2008 (UTC)

In this case, I disagree. This newer study isn't nearly as comprehensive. I would perhaps use both, but not remove the older, more comprehensive ones. -- Levine2112 ^discuss 17:47, 30 April 2008 (UTC)

The newer study is recent. I think it would be best to delete obsolete studies. If you want to find and and add more recent studies that is fine. QuackGuru 17:52, 30 April 2008 (UTC)

I still disagree. You are providing no new argument to change my position. I don't think that one newer but less comprehensive study trumps all the studies before it. This review for instance, provides excellent summaries of much of the research at hand, and perhaps would serve as the best source we currently have on the matter. It is a review of the literature and serves as the most comprehensive study we have found too date, in my opinion. Take a look and let me know your thoughts. -- Levine2112 ^discuss 17:56, 30 April 2008 (UTC)

I agree that we should be referring to recent reviews instead of to primary studies. Expert reviewers should be able to let us know which primary studies are with summarizing. We shouldn't be doing the reviewing ourselves, if reviews are available. Eubulides (talk) 18:06, 30 April 2008 (UTC)

No specific argument has been made to keep the outdated studies. If anything is worth keeping it should be put in the proper section. The obsolete studies have no historical impact. QuackGuru 22:23, 30 April 2008 (UTC)

You said the same thing about Manga, and that proved to be incorrect. Let's just cool down and discuss rationally before we go and remove/add anything to the article. -- Levine2112 ^discuss 22:30, 30 April 2008 (UTC)

The Manga report itself is not a historical reference and the section should be deleted. If editors prefer, they can use the references that describe the Manga report if those references are reliable and show historical impact. I said the Manga report should be deleted and I was correct. No argument has been presented for keeping the Manga report. We should not use the Manga report in the history section when the report is not a historical reference. There may be historical references decribing the Manga report and that is a different matter. We have newer references that discuss effectiveness that can replace the Manga report. The history section is about chiropractic history and not a place for outdated studies. Agreed? QuackGuru 22:46, 30 April 2008 (UTC)

older references are obsolete when newer references are currently available (common sense)

[outdent] No specific argument has been made for keeping outdated and obsolete studies in the history section. The studies are not about chiropractic history and the studies themselves have no historical impact. We have newer effectiveness/cost-benefit studies anyhow. In any event, it would be best to delete all the obsolte studies.

http://en.wikipedia.org/wiki/Chiropractic#The_Manga_Report

http://en.wikipedia.org/wiki/Chiropractic#Workers.27_compensation_studies

http://en.wikipedia.org/wiki/Chiropractic#American_Medical_Association_.28AMA.29

http://en.wikipedia.org/wiki/Chiropractic#British_Medical_Association

All the above sections contain old studies. They are obsolete. This has been discussed long enough. Going once... going twice... and it will be deleted if no specific objections are made. Please provide a specific reason if you disagree. Agreed? QuackGuru 06:38, 2 May 2008 (UTC)

Specific objections have been made, including "old does not equal obsolete". Further, don't remove anything without consensus. This conversation spans several area. Let's start a new section in which we propose specific revisions. -- Levine2112 ^discuss 06:48, 2 May 2008 (UTC)

P.S. As far as I know, the policies of the AMA and BMA with regards to chiropractic have not changed. Thus, those sections are clearly not obsolete. -- Levine2112 ^discuss 06:50, 2 May 2008 (UTC)

P.S.S. Where is the Wikipedia policy which supports: "older references are obsolete when newer references are currently available"? -- Levine2112 ^discuss 06:57, 2 May 2008 (UTC)

When newer references are available the older ones are obsolete. We have newer references that discuss the same or similar topics as the AMA and BMA does (examples,). P.S., it is common sense to delete older studies and replace them when newer studies are available. Currently, the history section contains unrelated information that is not specifically about chiropractic history. Why should we keep older studies when newer studies are current and up to date? QuackGuru 07:18, 2 May 2008 (UTC)

Two things here Quack Guru -

1. I support your push for the re-writing of the History section. At present Manga and the WC studies can too easily be read as providing information on effectiveness. We need RS sources naming the important events/studies/laws/milestones - (these will be Chiro and Medical and other sources). I have no doubt that Manga and WC studies will feature in the future History section but they will be described in terms of their effects in relation to Chiropractic with only a brief description of their actual findings. A fuller explanation of the findings and and effects would probably be better placed in a separate article on the Manga report if sufficient material is available.
2. I find your claim that these sources cover similar territory as the current History/AMA or History/BMA sub-sections incomprehensible. Please explain your claim. SmithBlue (talk) 08:40, 2 May 2008 (UTC)

These recent studies () cover a similar topic that AMA and BMA covers. AMA is about efficacy. We have newer source available. The BMA is is about referring patients to practitioners which we have newer sources available. These studies (AMA and BMA) are not about history. That is a separate issue. We have newer sources available for efficacy/benefit and references for historical content (). The more recent studies about effectiveness/cost-benefit can replace the older studies. For the history section, the older obsolete studies should be deleted. The content is unrelated to history. There is no need to replace those obsolete studies in the history. We can replace those obsolete studies in new sections such as cost-benefit. The first step is to delete all the unrelated content to chiropractic history. I reviewed each and every source that is unrelated to chiropractic history. Those old sources are absolete. Newer sources covering similar topics exist. The unrelated content to history should be deleted. If editors find specific references for the history section then those can be used but not the obsolete studies. If anyone thinks any of the obsolete studies are still current I would like that explained or we can delete the obsolete studies. There are a lot of newer sources available that cover effectiveness / cost-benefit that can replace AMA[16] and BMA[17] among other things [18][19] with newer sections such as Effectiveness and Cost-benefit. Anyone is free to rewrite the history section but that is not the point of this discussion. If no rewrite happens then I still think we should delete the unrelated content. It is important for editors to realize there is unrelated content in chiropractic history section. Those older studies are obsolete when we have plenty of newer studies available. I am saying we can delete the unrelated content to chiropractic history and to also use newer sources for new sections. I could update the history section with information about the Manga report from a historical perspective. But I think some editors want to take it slow or reject a rewrite. They want to keep the most if not all of the outdated studies and reject the newer studies. BTY, I have already rewritten part of the history section and finished the effectiveness section and started a new cost-benefit section. The newer sources about effectiveness are current and the older references on the same topic are obsolete. It's time to move the article forward. Adding the new information will be an improvement IMHO. QuackGuru 18:10, 2 May 2008 (UTC)

For what it's worth, I agree with SmithBlue and QuackGuru that Chiropractic#History needs to be rewritten, and that the Manga and WC studies should be supported by reliable sources on chiropractic history rather than by the studies themselves. I have not had time to read all those sources that QuackGuru mentions, but if QuackGuru has read them all then I suggest that QuackGuru draft a new History section based on them. I encourange the draft to cover the entire sweep of chiropractic history, not just on a few events. Eubulides (talk) 19:30, 2 May 2008 (UTC)

Quack Guru your appreciation of Chiropractic history, like mine, needs to expand, Chiropractic is a profession which we show, in Wilks etc, has been ostracised and conspired against by a very powerful profession (the medical profession) The AMS and BMA subsections address steps in Chiropractic gaining professional recognition. Removing them makes as much sense as removing a section on the Magna Carta from a "History of English law".

The single reference you supply for chiropractic history (Cooper 2003) is fine as far it goes. However it is just one POV - in history we are dealing with multiple POVs. We need to present all notable ones WP:NPOV. We need to present the Chiropractic profession's view of its own history as well as other views. We are dealing with the history of a profession here - professional recognition is rather central. SmithBlue (talk) 02:01, 3 May 2008 (UTC)

On further surfing I find Chiropractic history. So a detailed presentation of Chiro/History is not required here. Which leaves us to reach concensus on what is better included here. Have started new section below for this dicussion. (The layout of this page at present makes it very difficult to use.) SmithBlue (talk) 02:22, 3 May 2008 (UTC)

It would be best to use references that describe the AMA () and BMA () in a historical perspective instead of the references themselves.

The Manga Report as well as Workers' compensation studies sections are unrelated to chiropractic history and no specific reason has been given for keeping them. We have newer sources describing the Manga report () and newer sources on Workers' compensation (). QuackGuru 04:30, 3 May 2008 (UTC)

The obsolete sources are old and newer sources exist. For the time being, we can delete the Manga report section and the Workers' coompensation studies section. Theses dated studies are unrelated to chiropractic history. We can use newer studies available that have historical interest. For example, we have newer sources availble that discuss the Manga report. And we have newer sources available for the workers' compensation studies for a new section under cost-benefit. My specific revision is to delete both of obsolete sections (Manga and WC studies) and editors can improve the article where appropriate. Going one... going twice... QuackGuru 20:30, 4 May 2008 (UTC)

We explained very clearly that the obsolete studies are not current. But no good reason has been given for keeping POV material in the article. This misleads the reader to readd obsolete studies to mainspace. The controversial edit did not benefit the project. Please provide evidence if any of the obsolete studies should be reworked in a rewrite. If no evidence is provided to rework any of the oudated studies it will be deleted again. Going once... going twice... QuackGuru 23:39, 5 May 2008 (UTC)

There are several sources already given on this talk page (such as this one) which discuss the historical significance of the studies such as Manga. I don't understand why you keep ignoring these. Further, there is no consensus to remove any of the content discussing these studies until a rewrite of the history section which incorporates these studies meets consensual agreement. -- Levine2112 ^discuss 23:52, 5 May 2008 (UTC)

The sources on the talk page (such as this one) differ from the sources in the article. I added many of the sources to the talk page. The claim of me ignoring them is false. There is no consensus for keeping a misrepresention of chiropractic information (misleading to the reader) in mainspace. No evidence has been provided for keeping any of the POV material or the obsolete sources in the article. Please provide any evidence that these outdated sources should be worked into a rewrite. QuackGuru 00:06, 6 May 2008 (UTC)

This edit added unsourced POV material to the article and added unrelated content to the history section. The Manga report failed verification and the Workers' compensation studies contains obsolete studies. We have newer sources available on both topics. For the Manga report, we have references that describe the Manga report. For the workers' compensation studies, we have newer sources available. Both sections should be deleted. This POV change should be reverted. The oudated workers' compensation studies are not current and the Manga report is not properly sourced. QuackGuru 04:07, 6 May 2008 (UTC)

This controversial change added a link to a promotional advocacy group called The Chiropractic Resource Organization. The link fails WP:RS. QuackGuru 08:57, 6 May 2008 (UTC)

The report is a reliable source. That is is hosted by the Chiropractic Resource Organization in it's entirely doesn't turn it unreliable. Oh, here's another source which discusses the historical impact of Manga. -- Levine2112 ^discuss 17:34, 6 May 2008 (UTC)

The report is unreliable and has no historical impact. Other sources should be used and not the Manga report itself. This is common sense. Further, according to this conversation here, Levine2112 acknowledged the current Manga text has no historical relevancy by stating in part:Historical context is currently not being mentioned, so for the way we are using it currently... No clear explanation has been provided for keeping oudated studies in the history section. Sources that describe the Manga report in a historical manner should be used rather than the sources themselves. As for the workers' comp studies we have newer sources available for a cost-benefit section. The workers' comp studies have no historical relevancy. QuackGuru 23:34, 6 May 2008 (UTC)

The obsolete studies are not written in a historical context. They are unrelated to the history section. Historical context is currently not being mentioned, so for the way we are using it currently... I agree. QuackGuru 17:12, 10 May 2008 (UTC)

As discussed in this section, the obsolete studies are unrelated to history. So, I made this edit. Unrelated content to history does not belong in the history section. There are plenty of references that discuss history and those refs can be used. The obsolete studies currently being used have no historical relevancy. Newer references covering the same topic currently exist. For history, it would be best to use references that discuss any history from a historical perspective. QuackGuru 22:09, 10 May 2008 (UTC)

There are two sections[20][21] in the history section that are unrelated to history. These two sections offer no historical context. So why keep it in the history section. There are newer sources available discussing history (from a historical perspective), Manga report (newer sources are available to expand the movement towards science section), and workers' comp studies (for a new cost-benefit section). QuackGuru 01:28, 11 May 2008 (UTC)

There was prior notification of the unrelated to history content.[22][23] There sections are not written in a historical context and newer studies are available. Levine2112 acknowledged: Historical context is currently not being mentioned, so for the way we are using it currently... but he has improperly restored unrelated content to history. There are references that describe and cover history and those references can be used. The original study of the Manga report has no historical context. There are references that discuss the historical impact of Manga. The dated studies (including the original Manga report) had no historical impact. There are newer sources on the talk page which differ from the older, obsolete sources in the article. This edit do not fix the source. The source is unreliable from a POV chiropractic research and advocacy group. The workers' comp studies are very old. In short, when newer references are available the older, dated studies can be deleted. Newer studies are current and exist. Why add unrelated content to history. QuackGuru 18:11, 11 May 2008 (UTC)

There is a need for a rewrite. In short, the obsolete studies are highly POV and we have numerous newer studies available. QuackGuru 12:16, 14 May 2008 (UTC)

The rewrite and NPOVing has begun. Newer sources are available and the dated sources are obsolete. See WP:MEDRS. QuackGuru 17:19, 23 May 2008 (UTC)

Medical opposition

The AMA and BMA information (along with a possible rewrite of AMA and BMA) should be under the Chiropractic#Medical opposition section and not its own sections. QuackGuru 18:04, 3 May 2008 (UTC)

My specific revision is to merge AMA and BMA sections into the medical opposition section. Going one... going twice... QuackGuru 20:33, 4 May 2008 (UTC)

Merge it and find other notable medical associations (i.e. Australia) and get their take on intedisciplinary collaboration with DCs. Not sure if it's appropriate under "opposition" per se; but we can always move the merged material later on if need be. CorticoSpinal (talk) 20:48, 4 May 2008 (UTC)

I prefer peer reviewed journals if available. Here is AMA's position statement on complementary medicine as of 2002. QuackGuru 21:04, 4 May 2008 (UTC)

Glad to see you prefer peer-reviewed sources, as do I. It would be preferred to get the official stance on 'chiropractic care/medicine' as CAM is large umbrella. CorticoSpinal (talk) 21:13, 4 May 2008 (UTC)

I prefer peer reviewed but if we can't find any peer reviewed sources we can always use the sources that are presently available. QuackGuru 21:25, 4 May 2008 (UTC)

We will go ahead and merge the content into the appropriate section. QuackGuru 04:31, 5 May 2008 (UTC)

sources for chiropractic history

• Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. PMID 9818801.

• Keating JC Jr (2008). "William D. Harper, Jr, MS, DC: Anything Can Cause Anything". JCCA J Can Chiropr Assoc. 52 (1): 38–66. PMID 18327301.

• Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther. 26 (5): 300–21. doi:10.1016/S0161-4754(02)54125-7. PMID 12819626.

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

• Martin SC (1994). "'The only truly scientific method of healing'. Chiropractic and American science, 1895–1990". Isis. 85 (2): 206–27. doi:10.1086/356807. PMID 8071054.

• Martin SC (1993). "Chiropractic and the social context of medical technology, 1895–1925". Technol Cult. 34 (4): 808–34. PMID 11623404.

• Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med. 136 (3): 216–27. PMID 11827498.

• Chiropractic: An Illustrative History. Mosby. 1994. pp. 528 pages. ISBN 0801677351. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help) correct title: Chiropractic: An Illustrated History

• McDonald WP, Durkin KF, Pfefer M; et al. (2003). How Chiropractors Think and Practice: The Survey of North American Chiropractors. Ada, OH: Institute for Social Research, Ohio Northern University. ISBN 0972805559. {{cite book}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) Summarized in: McDonald WP, Durkin KF, Pfefer M (2004). "How chiropractors think and practice: the survey of North American chiropractors". Semin Integr Med. 2 (3): 92–8. doi:10.1016/j.sigm.2004.07.002. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)CS1 maint: multiple names: authors list (link)

• Chiropractic in the United States: Training, Practice, and Research Chapter I: A Brief History of Chiropractic by Reed B. Phillips, DC, PhD
• History of Chiropractic Care ACA

• Keating, Joseph C. (2004). "Chiropractic History: a Primer" (PDF). Association For The History Of Chiropractic. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Martin, S. (1993). "The Limits of Medicine: A Social History of Chiropractic, 1893--1930". Chiropractic History. 13 (1): 43. (Yes, there is a journal, Chiropractic History)
• THE EVOLUTION OF CHIROPRACTIC — SCIENCE & THEORY Haldeman 2000 evolution of Chiro theory

• Keating JC Jr (1997). "Faulty logic & non-skeptical arguments in chiropractic" (PDF). Retrieved 2008-03-15. {{cite journal}}: Cite journal requires |journal= (help)

• Grod JP, Sikorski D, Keating JC Jr (2001). "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". J Manipulative Physiol Ther. 24 (8): 514–9. doi:10.1067/mmt.2001.118205. PMID 11677551.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• "Canada Celebrates 100 Years of Chiropractic". Dynamic Chiropractic. July 17, 1995. Retrieved 2008-05-01. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)

• Lowry F (1994). "Orthopedists have bone to pick with economist over report on chiropractic". CMAJ. 150 (11): 1878–81. PMID 7802764.

• Manga P, Angus D (1994). "Report on chiropractic". CMAJ. 151 (8): 1107–8. PMID 7922936.

• Chapman-Smith DA (1994). "Report on chiropractic". CMAJ. 151 (8): 1108. PMID 7802806.

• Hoaken PC (1994). "Report on chiropractic". CMAJ. 151 (8): 1110. PMID 7922937.

• Tardif GS (1994). "Is the chiropractic management of low-back pain the solution? What can physicians learn from the Manga report?". CMAJ. 151 (9): 1247–9. PMID 7954171.

• Manga P (1994). "Defending the Manga report on the chiropractic management of low-back pain". CMAJ. 151 (9): 1250–1. PMID 7954172.

commentary on sources for chiropractic history

:Quack Guru, let's discuss one of the sources you have given to show that Manga is not a notable part of the history of chiropractic; "Anything Can Cause Anything" by Keating. This appears to me to be a biography/memoriam of an individual who died in 1990. Not surprisingly the only sources includued for material after that date are directly connected to historical material on Harper himself.

The Manga reports you seek to remove from the History section was released in 1998.

Please explain how you see the absence of Manga from this article[[24]] on some-one deceased in 1990 as bearing on the importance of Manga (1998) to chiropractic history. SmithBlue (talk) 02:38, 27 April 2008 (UTC)

If you'll do the same for another source you give "Chiropractic: An Illustrated History isbn=0801677351" cause again I'll need you to explain how a book published in 1994 could reflect on the Manga(1998) report. Am now hoping these references are adressing Chiro history in a far broader way and are not adressing Manga inclusion/exclusion. SmithBlue (talk) 03:34, 27 April 2008 (UTC)

We can add relevant studies and articles and chiropractic history. The most notable chiropractic historian is Keating. QuackGuru 18:15, 26 April 2008 (UTC)

I'm not sure I get the point of the chiropractic history sources section. Is it about a rewrite for Chiropractic#History? If so, that's a big project; there's a lot wrong with that section (for one thing, it has serious bias problems aside from its presentation of the Manga and other obsolete reports). But if this is just about the Manga reports, then that's a different story. For example, Meeker & Haldeman 2002 cites multiple sources on cost but does not cite Manga; it cites more-recent sources that are far more reliable than Manga. Perhaps there is a reliable source somewhere that Manga is an important part of chiropractic history, but so far we haven't seen it cited here. Eubulides (talk) 08:46, 27 April 2008 (UTC)

The chiropractic history needs a bit more information. The older studies (including the Manga report) that have no impact to chiropractic history will be deleted. If editors are willing, they can add new information using references that are specifically about chiropractic history. This is not a rewrite proposal. This is a suggestion for anyone to work on to add more info to the history section if anyone is interested. QuackGuru 09:10, 27 April 2008 (UTC)

In a research paper from 1997 criticizing the unscientific and uncritical culture of chiropractic, Keating mentions the Manga study approvingly as a recent (at the time) study on cost-effectiveness.

“A cost-effectiveness study of chiropractic services commissioned by the Ministry of Health for the Canadian province of Ontario strongly endorsed chiropractic management of low back pain (Manga et al., 1993)” Manga is part of history and should be in this article. However, Manga has problems and these should be mentioned, as well. Look at how many DC websites still use The Manga Report as advertising.[25]CynRNCynRN (talk) 15:57, 28 April 2008 (UTC)

I have added 2 more sources to the list above. I highly recommend the book Chiropractic History - a Primer to anyone editing this page. (It does not mention Manga, but would also be a good source for integrative medicine, wouldn't it?) DigitalC (talk) 11:30, 3 May 2008 (UTC)

The Manga report has been rewritten using newer sources. This includes the usage of the Keating ref. QuackGuru 13:01, 14 May 2008 (UTC)

reference improvements

Does anyone have any objection if I improve a few references. I know some editors continue to blindly bulk reverts quality NPOV edits (heavily cited text) and that is not right. Please do not blindly revert. We hope the reference tampering stops. QuackGuru 13:47, 8 May 2008 (UTC)

I will improve references. Again, please do not revert reference improvements. Formatting references is an improvement. Blindly reverting ref improvements is unproductive. QuackGuru 03:02, 9 May 2008 (UTC)

You have proposed some changes which you admit might be controversial enough that someone might revert them. Then why do you do it? When are you going to learn? Try it out HERE first. If it flies, then, and ONLY then, do it. This advice applies to your editing in general, not just your proposed improvement of references. -- Fyslee / talk 03:39, 9 May 2008 (UTC)

Improving a ref is not controversial in any way. How is it controversial to improve a ref? It is not. I never said it might be controversial. Reverting a formatted ref is controversial. Claiming it might be controversial to format a ref is unproductive. Why improve a ref? Why would I do it? Formatting a ref is an improvement. A formatted ref will offer consistancy with the other formatted refs. QuackGuru 16:05, 9 May 2008 (UTC)

This comment does not address the issue at hand. A ref improvement is normal practice. QuackGuru 16:19, 9 May 2008 (UTC)

I propose I improve reference number 55 using a ref template. QuackGuru 08:18, 9 May 2008 (UTC)

The reference is in the Chiropractic#Vertebral subluxation section. QuackGuru 08:22, 9 May 2008 (UTC)

There is nothing controversial about this sort of change. The current citation is poorly done. Please improve its quality if you have a mind. I sense that there is some sort of misunderstanding here: others thought that the changes you were proposing were controversial (because you made them on the talk page). The proposals were vague enough that others couldn't see that they are not controversial. Eubulides (talk) 16:29, 9 May 2008 (UTC)

I do not see any misunderstanding. My comments were clear. I am specifically referring to ref improvements. This comment claims it is controversial to improve refs. QuackGuru 16:37, 9 May 2008 (UTC)

I don't understand the reasons behind the conflict here (I sense there's some Wikipedia history behind it) but for this particular case surely the reasons don't matter. The citation has a low-quality format and there should be no controversy in improving it. Sometimes it's easier to fix things than to argue about procedure and I hope this is one of those times. To help move things along, I made this change to improve the citation. Please feel free to make similar improvements to citation format; they should not be controversial. Eubulides (talk) 21:06, 9 May 2008 (UTC)

I could be wrong, but perhaps the issue is if the reference formatting is done at the same time as a more controversial edit, and the edit is reverted at the same time.DigitalC (talk) 02:07, 10 May 2008 (UTC)

We have proposed a non-controversial improvement. Changing a citation from a low quality to a high quality format is to be respected. Am I wrong? QuackGuru 05:57, 10 May 2008 (UTC)

No, you're not wrong. Let's move on to another topic, please. Eubulides (talk) 07:04, 10 May 2008 (UTC)

This change was not a ref improvement. It was an old obsolete version. QuackGuru 18:37, 15 May 2008 (UTC)

I thought it was the other way around. Feel free to revert that particular edit. -- Levine2112 ^discuss 18:40, 15 May 2008 (UTC)

The word "summary" was added. The word summary is the not part of the title of the article. --> (summary) <-- A "work" was added. --> work 671 F. Supp. 1465 (N.D. Ill. 1987) <-- The work refers to a court case. The ref is not a court case. QuackGuru 18:56, 15 May 2008 (UTC)

I recently improved a few refs and added a few refs where needed. QuackGuru 15:40, 23 May 2008 (UTC)

ref names

We have references that have ref names and some without ref names. For this article do we want all the refs to have ref names or do we want the refs with additional inline citations to only have ref names. QuackGuru 08:08, 9 May 2008 (UTC)

I think it would be nice to have the names.--—CynRN ^(Talk) 16:17, 9 May 2008 (UTC)

The style I prefer is to names only those references that are cited in two or more locations (so that you have to have ref names). That way, there's a clear indication to the editor that a reference is cited multiple times. This is low priority, but let's remove unused ref names from the text. Eubulides (talk) 16:29, 9 May 2008 (UTC)

I prefer every ref have a name. Is there specific policy on this. If not, there should be. QuackGuru 18:56, 9 May 2008 (UTC)

There is no policy on this, not even a guideline as far as I know. It is a style issue. It is not that important. All that being said, what is the advantage of giving every ref a name? It clutters up the article for editors. Eubulides (talk) 21:06, 9 May 2008 (UTC)

I try to add names to references, especially if I think the reference MAY be used again. I have seen editors removing cited text on controversial articles BECAUSE the reference was used twice, not named, and hence in the reference list twice. My $0.02 (completely off topic, but if the penny gets eliminated, will that phrase be eliminated?). Will have some references named and some un-named be a hinderance to GA status somewhere down the road?DigitalC (talk) 00:14, 10 May 2008 (UTC)

There is really no harm in always using ref names and the benefit is that you don't have to create one every time you want to dupe a ref. -- Levine2112 ^discuss 03:25, 10 May 2008 (UTC)

This is about having the same consistancy from ref to ref when using ref names. We need new specific policy on this. QuackGuru 03:31, 10 May 2008 (UTC)

Why is this an issue? Why do we need consistenancy from ref to ref? If you want a policy, here I'll create one. 1) If the reference is a journal, name it according to the authors name, then add a digit if the name is used more than once -ie: name="Keating1". 2) If the reference is a website, and no author is know, name it according to the first 4 letters of the website URL, and add a digit. Eg: name="CCE-1", "NCCA1" etc.". Happy? DigitalC (talk) 03:50, 10 May 2008 (UTC)

I thought discussion is important to resolve this issue because editors are doing different things to the refs. Some are adding ref names. Others think it clutters the article. I think the best place to have discussion on the ref names is at a policy page. Having an official detailed policy on this issue is a good idea. QuackGuru 04:09, 10 May 2008 (UTC)

Thanks QG for your explanation of what the issue is. I don't see it really cluttering up the page, but clearly others disagree (see Eubulides comment above). I think taking it to a policy page for discussion is a good idea, and is a better location for the discussion than here. Cheers, DigitalC (talk) 04:33, 10 May 2008 (UTC)

I'm not sure under which policy page is the best place to start a new dicussion on this trivial but important to resolve issue. QuackGuru 04:41, 10 May 2008 (UTC)

Check out WP:CITE#HOW. Your questions may already be answered, in a sense: Any style or system is acceptable on Wikipedia so long as articles are internally consistent. You should follow the style already established in an article, if it has one; where there is disagreement, the style or system used by the first editor to use one should be respected. -- Levine2112 ^discuss 04:45, 10 May 2008 (UTC)

That policy makes very little sense and does not mention ref names specifically. So much for policy. Oh well. QuackGuru 04:53, 10 May 2008 (UTC)

Prefer single-line inline citations

While we're on the subject of references styles, I prefer keeping a citation all on one line when possible, in the source (this issue doesn't affect what article readers see). Multiline citations make it harder to see differences when people insert citations. For example, this change simply added a citation, but because the citation is multiline the diff listing makes it hard to see that; it looks like it may have also changed some text, which is a bigger deal. In contrast, this change, which added to a citation, is clearly marked out in the diff as only changing that citation; had we used the multiline style that would have been much harder to see.

This is just a style issue; I don't know of any policy or guideline in this area. But I thought I'd mention it since we're talking about style. Eubulides (talk) 21:06, 9 May 2008 (UTC)

I can see what you mean about it being harder to see on diffs. However, I use Wickipedia CITE to automatically format most of my web references, and it formats them into multiline. I guess it would be less of a hassle to turn them into single line format than to create them by hand, but then... the whole reason I use Wickipedia CITE is to reduce the hassle. (See User:Jehochman for link to the tool).DigitalC (talk) 00:31, 10 May 2008 (UTC)

Ah, I see. I format them by hand. Others I know use Diberri's tool for journal citations, which defaults to uniline. I take it you wouldn't object to someone else reformatting to uniline? It's no big deal either way, of course. Eubulides (talk) 07:04, 10 May 2008 (UTC)

Thank you, this was posted before and I didn't bookmark, and it makes it so much easier. I have no objecting to reformatting to uniline, and will try to remember to re-format multiline citations to uniline instead. I had seen objections raised before, but didn't understand why it mattered. When looking at a diff though, I can understand. In fact, Diberr's tool can create URL citations, so I can use that tool. While not quite as easy to use as WP:CITE (where you right click any page and then click WP:CITE), its still easy enough. DigitalC (talk) 07:34, 10 May 2008 (UTC)

court case refs

At this time, court case refs should not be formatted using any template. These changes seems to have formatted two court case refs using a template. Here is the relevant link: Template:Cite court. Thanks. QuackGuru 06:14, 12 May 2008 (UTC)

Hi QG, I have self reverted for now. I see that we shouldn't use {cite court} as it is experimental, but does Wikipedia:Citing_sources#Say_where_you_found_the_material apply? DigitalC (talk) 06:25, 12 May 2008 (UTC)

Not sure. QuackGuru 06:30, 12 May 2008 (UTC)

I'd say that it's not needed for citing judicial opinions, unless there's serious doubt as to whether the web page is an accurate copy of the judicial opinion. The usual style in legal papers is to just cite the opinion and let the reader (who is presumed to have access to a law library) look it up. Wikipedia is not a legal paper, but the same basic idea would apply here, I think: the citation is to the actual judicial opinion, and the URL is for convenience. There's no need to say who's hosting the URL in the printed copy of Wikipedia. Eubulides (talk) 07:27, 12 May 2008 (UTC)

I think one of the court citations is still formatted using a template. QuackGuru 12:04, 12 May 2008 (UTC)

One of the court citations is still improperly formatted using a template. QuackGuru 19:41, 12 May 2008 (UTC)

That reference is not to a court case, it is to a summary of the court case at a website.DigitalC (talk) 00:05, 13 May 2008 (UTC)

The ref is a summary of a court case and should not be formatted using a regular template IMHO. For now, it can be typed without a template. In the near future, the cite court template can be used when it is ready for mainspace. There was prior discussion about these refs.QuackGuru 03:04, 13 May 2008 (UTC)

IMHO, we should reference the summary as a website, or not reference the summary at all. It is fine to just reference the court case, but if we are referencing the summary, than we need to cite it as such.DigitalC (talk) 04:20, 13 May 2008 (UTC)

I agree that we should keep judicial opinions separate from summaries. This particular summary was generated by one of the sides of the suit, and therefore we should warn the reader about that, since it's likely to be partisan. Eubulides (talk) 07:35, 13 May 2008 (UTC)

The ref is formatted using a template. The court cite template is not ready. What should we do for in this particular case. Should we format the ref using a template or hand type it. QuackGuru 09:14, 13 May 2008 (UTC)

This particular reference is not to a judicial opinion; it's to a web page generated by a chiropractic organization, which summarizes the case. For this case Template:Cite web is appropriate. Eubulides (talk) 19:59, 13 May 2008 (UTC)

I expanded the summary of the court case ref. Any thoughts. QuackGuru 13:23, 14 May 2008 (UTC)

file not found ref

A ref linked to a file not found. So I fixed it. Here is the improved ref added to the Medical opposition section. QuackGuru 13:33, 14 May 2008 (UTC)

to quote or not to quote (ref names)

Some ref names have "quotes" and some ref names do not have any quotes. For ref name consistancy it may be best to remove the quotations. QuackGuru 18:25, 14 May 2008 (UTC)

I prefer omitting the quotes unless they are needed (e.g., with names containing spaces). I also prefer names that lack spaces. All other things being equal, names should be short and easy for editors to work with. Eubulides (talk) 19:32, 14 May 2008 (UTC)

Learning curve! I thought they had to have quotes. I will take note for future changes.DigitalC (talk) 23:39, 14 May 2008 (UTC)

They have to have quotes with XHTML 1.0, but they do not have to have quotes in Wiki markup. The Wiki software adds the quotes automatically when generating the XHTML 1.0 article that gets sent to the user. Eubulides (talk) 23:47, 14 May 2008 (UTC)

DOI

This reference in the Teatment procedures section seems to have a DOI glitch.

Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther. 26 (5): 300–21. doi:10.1016/S0161-4754(02)54125-7. PMID 12819626.

Thoughts? QuackGuru 21:12, 19 May 2008 (UTC)

The DOI code was recently changed because of a problem with parsing special characters like "(" (which is in the DOI in question). This DOI still "works", albeit not as well, as the DOI itself is not blue but is simply followed by the hyperlink. Presumably they will improve this at some point. In the meantime I would leave Chiropractic alone and continue to use doi= as before. Please see Template talk:Cite journal #new #urlencode parserfunction and doilabel parameter for details. Eubulides (talk) 21:30, 19 May 2008 (UTC)

Is Lerner a reliable source?

This change cites the Lerner manuscript, which was repudiated by its sponsoring organization and was never published by it. Is Lerner a reliable source? If so, shouldn't we also be citing it with respect to other parts of early chiropractic history? For example, Lerner says the Lillard story is "more than doubtful" and compares the story to the Tales of the Arabian Nights. Eubulides (talk) 01:41, 12 May 2008 (UTC)

Chiropractic sources and historians all treat it as very reliable. -- Fyslee / talk 02:03, 12 May 2008 (UTC)

Here is an interesting article (in the ultra straight WCA's journal) that discusses it:

• Chiropractic's secret history by Simon A. Senzon, MA, DC

-- Fyslee / talk 02:14, 12 May 2008 (UTC)

Thanks, then I propose that in Chiropractic#History, after "D.D. Palmer gave the first spinal adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895, reportedly resulting in a restoration of the man's hearing." we add the following text, citing Lerner:

"The story of Lillard's adjustment is at least partly apocryphal, as Palmer gave spinal adjustments before 1895; it may be that the story was concocted in order to give chiropractic a particular date of invention."

Eubulides (talk) 07:27, 12 May 2008 (UTC)

We have two contradictory statements. Per WP:NPOV, neither should be presented as fact. I see the first is referenced to Palmer's textbook, so the wording might be something like "D.D. Palmer reports having given the first ..." The second might be something like "According to Lerner, the story of Lillard's adjustment is at least partly apocryphal..." ☺ Coppertwig (talk) 10:29, 12 May 2008 (UTC)

Lillard's own daughter also had something to say. You can read it here. -- Fyslee / talk 06:27, 13 May 2008 (UTC)

OK, in the light of the above, how about if we change Chiropractic#History's first two sentences from this:

Chiropractic (also known as Chiropractic Medicine) was founded in 1895 by Canadian-American Daniel David Palmer in Davenport, Iowa, USA. D.D. Palmer gave the first spinal adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895, reportedly resulting in a restoration of the man's hearing.

to this:

Chiropractic (also known as Chiropractic Medicine) was founded in the 1890s by Canadian-American Daniel David Palmer in Davenport, Iowa, USA. Palmer and his son B.J. Palmer later wrote that the elder Palmer gave the first chiropractic adjustment to a deaf man, Harvey Lillard, on September 18, 1895, restoring the man's hearing. Lillard's daughter disputed the account, saying that Palmer had merely slapped Lillard on the back after hearing a joke. Investigator Cyrus Lerner found in 1952 that the Lillard story disagreed with other evidence published about the same time, speculated that B.J. concocted the date of the first adjustment in order to establish priority for chiropractic, and compared the Lillard story to the Tales of the Arabian Nights..)

That's certainly much better than the previous version. While we probably can't outright call the Palmers liars (although they undoubtedly were), this at least reveals that things were not as the profession has generally been taught to believe. -- Fyslee / talk 14:17, 14 May 2008 (UTC)

I have learned a lot here about early chiropractic history. This is a great improvement. QuackGuru 14:27, 14 May 2008 (UTC)

I made this change to improve the section. QuackGuru 15:02, 14 May 2008 (UTC)

Thanks for editing that in, QuackGuru. I would delete the part about the tales of the Arabian nights. It seems unnecessary here. We don't need to repeat every colourful criticism or compliment of chiropractic.☺ Coppertwig (talk) 02:48, 16 May 2008 (UTC)

The part about the tales of the Arabian nights was interesting. It grabs the reader. In fact, it pulled me in and I enjoyed reading the Arabian nights article. After reading the Arabian nights tidbit, I wanted to continue reading. It was spicey. QuackGuru 03:13, 26 May 2008 (UTC)

OK, I restored it, since I don't feel strongly about it. Adding spice is OK, I guess. (I retained my addition of the word "had" for the pluperfect tense.) It's OK as is. One problem I have with it is that it doesn't specify in what way the story was like the Arabian Nights, and the wikilink provides no clue about that. Maybe it's supposed to be obvious. Possibly adding a few words would clarify – or maybe that would be digressing too much. ☺ Coppertwig (talk) 22:52, 26 May 2008 (UTC)

RfC: Effectiveness of chiropractic care

This is an updated version of Talk:Chiropractic/Archive 18 #RfC: Effectiveness of chiropractic care. It attempts to address some of the comments brought up in that discussion. There seems to be no serious dispute that there is a serious POV problem in the current coverage of effectiveness in Chiropractic, so I won't repeat Talk:Chiropractic/Archive 18 #POV in existing coverage. Again, this is a controversial issue that may require some work to resolve; please bear with the following exposition as it covers many issues. Eubulides (talk) 08:50, 12 May 2008 (UTC)

To help other editors follow this discussion better, please place comments below, after the the proposal.

Criticisms of earlier proposed fix

Earlier I proposed Scientific investigation 2, a draft that relies on recent high-quality scientific sources, along with a proposal to remove the obsolescent material. This draft has been discussed extensively in Talk:Chiropractic/Archive 18 #Comments on Scientific investigation 3, so far with no consensus. To help move matters forward I have drafted a new section below, #Scientific investigation 3, which attempts to respond to some (but not all) the concerns expressed. These concerns (italicized below) included the following:

• Effectiveness of treatments should not be discussed in chiropractic; it should be discussed under each form of treatment. Most of the literature cited in #Scientific investigation 3 focuses on effectiveness of chiropractic treatment, not simply treatment by any practitioner. It is therefore inappropriate to move it to treatment pages per se. The few counterexamples are highly relevant to chiropractic; if there is a specific complaint about any of them, please mention it. To help underscore the relevance I have added a citation to Meeker & Haldeman 2002 about the relationship between chiropractic and research into SMT effectiveness.

• Undue weight given to spinal manipulation. The weight given is appropriate: spinal manipulation is the core treatment modality of chiropractic, and is naturally heavily empahsized in reviews of the effectiveness of chiropractic care.

• Clinical practice guidelines are omitted. They were present in the 1st draft, and were omitted from the 2nd draft in the interest of brevity. I have restored them in the 3rd draft.

• Ernst is fringe. No, he's a mainstream researcher who gets cited a lot.

• More sources are needed. None were suggested. I did turn up some more sources on my own, which are included in #Scientific investigation 3.

(Again, please place further comments below.)

Revised proposal for fix

The revised proposed fix is to replace the sections Chiropractic #The Manga Report through Chiropractic #Scientific investigation with the following text (between the horizontal lines), to keep Chiropractic #Safety unchanged, and to replace the "===Vaccination===" with "==Vaccination==" (as that section has nothing to do with scientific investigation).

(Again, please place further comments below.)

---

Scientific investigation 3

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs pseudoscientific and antiscientific reasoning and makes unsubstantiated claims.

Effectiveness 3

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment. Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective. Chiropractic care, like all medical treatment, benefits from the placebo response. The efficacy and cost-effectiveness of maintenance care in chiropractic is unknown.

Research has focused on spinal manipulation therapy (SMT) rather than specifically on chiropractic SMT, but the distinction is not significant: chiropractors use all forms of SMT, more than 90% of SMT in the U.S. is done by chiropractors, and SMT research is equally of value regardless of practitioner type. There is little consensus as to who should administer the SMT, raising concerns by chiropractors that orthodox medical physicians could "steal" SMT procedures from chiropractors; the focus on SMT has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Many controlled clinical studies of SMT are available, but their results disagree, and they are typically of low quality. It is hard to construct a trustworthy placebo for clinical trials of SMT, as experts often disagree whether a proposed placebo actually has no effect. Although a 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference, a 2008 supportive review found serious flaws in the critical approach, and found that SMT and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments.

Available evidence covers the following conditions:

• Low back pain. Opinions differ on the efficacy of SMT for nonspecific or uncomplicated low back pain. An authoritative 2004 review found that SMT or mobilization is no more or less effective than other interventions. A 2008 review found strong evidence that SMT is similar in effect to medical care with exercise, and moderate evidence that SMT is similar to physical therapy and other forms of conventional care. A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain.

• Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain. An authoritative 2004 review found that SMT/mobilization is effective only when combined with other interventions such as exercise. A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis. A 2007 review found that SMT and mobilization are effective for neck pain. A 2005 review found little investigative research into chiropractic manipulative therapy for acute neck pain.

• Headache. An authoritative 2004 review found that SMT may be effective for migraine and tension headache, and SMT and neck exercises may be effective for cervicogenic headache. A 2006 review found no rigorous evidence supporting SMT or other manual therapies for tension headache. A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.

• Other. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions. Other reviews have found no evidence of benefit for baby colic, bedwetting, fibromyalgia, or menstrual cramps.

---

(End of proposed replacement text.)

(Please place further comments below.)

Comments on Scientific investigation 3

(Please put comments here.)

I was editing this article in February, and have been meaning to return when I have time. I've heard that there are difficult disputes here and thought I might at least see what's happening and maybe even help resolve some disputes, as well as participating in editing. For now, I'm offering my opinion for this RfC.

The proposed text above is, in my opinion, a vast improvement over that section of the current article, in terms of being organized in a logical and relevant way. The current article gives undue prominence to the name of a particular study and to funding issues, which are not of fundamental importance and which will become dated. Focussing on effectiveness for various parts of the body is a relevant way to organize the information. It's readable, and I didn't see any problems with it.

Re "Effectiveness of treatments should not be discussed in chiropractic; it should be discussed under each form of treatment." Different articles can have some overlap of content; see WP:SUMMARY. If any particular section forms too long a stretch of text which overlaps between two articles, one of them can be shortened to a summary, with a {{main}} hatnote directing the reader to a section-link of the other article for more information. I don't think any one of the above short sections about each condition or body part is long enough to merit such summarizing. In my opinion, effectiveness is of fundamental relevance to this subject and belongs in this article (though it can also occur in other articles too).

Re "Undue weight given to spinal manipulation": I agree that spinal manipulation is fundamental to chiropractic; it's hard to imagine how it could be given undue weight in this article. I'd have to see specific arguments about what else needs to be mentioned. ☺ Coppertwig (talk) 10:20, 12 May 2008 (UTC)

Thank you Coppertwig, for coming back to weigh in on this edit! Please stick around as long as you can. I agree with your points. Spinal manipulation is fundamental and needs to be here in this article. Another objection often made is that studies of non-chiropractic manipulation are not relevant in considering effectiveness of SMT. Even Dr. Meeker, a prominent chiropractic researcher says that "research on spinal manipulation, like that of any other treatment method is equally of value regardless of the practitioner"(from #111, above)--—CynRN ^(Talk) 16:24, 12 May 2008 (UTC)

While I do feel that this version is better than the previous versions, I am unsure about two things:

1. That even though one researcher is saying it is okay to correlate general SMT studies with the effectiveness of chiropractic, our following this researcher's advice still may cause a WP:SYN violation. Even though we are spelling it out for the reader that these studies are about SMT and not chiropractic specifically, we are also implying (or rather now directly stating) that the conclusions of these general SMT studies can be applied to the effectiveness of chiropractic.
2. DigitalC, CorticoSpinal, and several others have raised objections that Chiropractic is an occupation which employs many services and modalities and not any one specific modality. As such, the inclusion of the above material would be like the inclusion of an effectiveness section at the Dentistry article based on the effectiveness of Fluoride as administered by dentists, hygienists, the gov't via tap water, etc.

Levine2112 ^discuss 17:26, 12 May 2008 (UTC)

I hear the argument (re #2), but the fact is that SMT is the centerpiece of chiropractic. Is there much controversy about the effectiveness of a dentist removing caries from teeth? Is there a long, involved holistic philosophy connected with dentistry? Apples and oranges. There is controversy surrounding chiropractic, in part because of the whole subluxation paradigm. As long as the section explains again that chiropractors do a range of treatments besides SMT, the effectiveness of SMT really belongs here.There are plenty of studies, and reviews of same, regarding the effectiveness of SMT.--—CynRN ^(Talk) 18:37, 12 May 2008 (UTC)

Actually, yes there is much controversy surrounding dental caries: Dental amalgam controversy. And holistic dentistry has been around for at least 30 years; specifically founded by the anti-mercury/amalgam movement. So you see, it's not apples to oranges after all. -- Levine2112 ^discuss 18:51, 12 May 2008 (UTC)

Of course, I figured you'd bring that up! How many holistic dentists are there as a percentage of all, vs 'holistic chiropractors'? Are there any non-holistic chiropractors? What is non-controversial, I would think, is 'treatment of dental decay'. Whether we choose composite fillings or amalgam is a different issue.--—CynRN ^(Talk) 23:00, 12 May 2008 (UTC)

Holistic dentistry is quite different from Dentistry, just as Chiropractic is quite different from mainstream Medicine. If there were an article on Holistic dentistry (there isn't, yet), I'd expect it to cover effectiveness in some detail, as that's an important part of the controversy about holistic dentistry. Eubulides (talk) 07:35, 13 May 2008 (UTC)

"There are plenty of studies, and reviews of same, regarding the effectiveness of SMT". Agreed. There are pleny of sources discussing the effectiveness of SMT. However, SMT is not chiropractic, and the effectiveness of SMT belongs over at the SMT article. DigitalC (talk) 00:03, 13 May 2008 (UTC)

The cited sources in #Scientific investigation 3 are by and large not talking just about SMT. They are mostly talking about chiropractic care. Is there any particular source being objected to here? Eubulides (talk) 07:35, 13 May 2008 (UTC)

• Re Levine2112's #1, it's not just "one researcher"; Meeker & Haldeman are two of the very top chiropractic researchers. For example, Haldeman is the editor in chief of PPC, the leading chiropractic textbook. These reliable sources say there's no significant distinction between chiropractic and non-chiropractic SMT. There doesn't seem to be any real controversy over this issue among reliable sources. It is not WP:SYN to report what these sources say. That being said, if there is a specific source being objected to on the grounds that it talks about SMT and not chiropractic SMT, which source is it and why? If this is just a matter of a few sources and how they're characterized perhaps we can come up with compromise wording that will address this concern.
• Re Levine2112's #2:

• Chiropractic is not just a profession: it is also a philosophy, and a way of doing treatment.
• As far as Wikipedia goes, the Chiropractic article is much closer to the Traditional Chinese medicine article than it is to the Dentistry article. Chiropractic and Traditional Chinese medicine are both somewhat out of (but also somewhat in) the mainstream, and there are serious questions about effectiveness of the main forms of treatment for both Chiropractic and Traditional Chinese medicine. Criticisms of dental care (as in the amalgam controversy) are not in the same ballpark: they do not seriously question the effectiveness of core dental care methods.
• There is ample precedent in Wikipedia for covering effectiveness and safety of treatment for professions that are not entirely mainstream. This includes not just Chiropractic and Traditional Chinese medicine, but others such as Ayurveda, Naprapathy, and Osteopathy.
• Chiropractic #The Manga Report and Chiropractic #Worker's compensation studies contain extensive discussion of effectiveness and cost-effectiveness of chiropractic care, and this coverage has been in Chiropractic for quite some time. It seems very odd to raise the objection "chiropractic is a profession" now. The proposal is not to add discussion of effectiveness; it is to replace the existing obsolete and biased coverage.

More generally, the question is not whether #Scientific investigation 3 is perfect; it's not. The question is whether it's better than what's in Chiropractic now. It is. It's way better. It fixes serious POV problems, among other things. We should not let the relatively minor problems of the current proposal blind us to the fact that it's a real improvement and it therefore should go in. We can always improve it later. Eubulides (talk) 07:35, 13 May 2008 (UTC)

Well, I guess that's your opinion - that chiropractic is closer to Traditional Chinese medicine than it is to Dentistry. I don't share that opinion; not do I think that either of our personal opinions should dictate what kind of information we include in this article. -- Levine2112 ^discuss 16:15, 13 May 2008 (UTC)

• All I meant was that chiropractic is neither fully mainstream (like dentistry) nor fully fringe science (like homeopathy). It has elements of both, as does traditional Chinese medicine. Even a cursory treatment of chiropractic needs to address the issue of whether it is effective, because this is a serious question as to commonly-practiced parts of chiropractic care. In this sense, chiropractic is more like traditional Chinese medicine than it is like dentistry.
• One doesn't have to take my word for this. Just type "fringe chiropractic" into Google Scholar and you'll find lots of papers about chiropractic vis-a-vis fringe medicine. Type "fringe dentistry" and you'll find lots of papers about fringe benefits and fringe patterns, and precious little about fringe medicine. Or, please see Keating 1997, where it's explicitly stated that chiropractic uses scientific, antiscientific, and pseudoscientific rhetoric. One doesn't find similar articles about dentistry.

Eubulides (talk) 19:59, 13 May 2008 (UTC)

Again, I find that this section fails to mention the many other treatments provided by Chiropractors, and the efficacy of such other treatments. There is no mention of Ultrasound, Laser, IFC, Orthotics, Prescribed Exercises, or even soft tissue therapy.DigitalC (talk) 23:59, 12 May 2008 (UTC)

Actually, #Effectiveness 3 mentions laser, and supervised / customized exercise. It also mentions many other non-SMT treatments provided by chiropractors, including mobilization, assurance and advice to stay active, educational videos, acupuncture, and the entire clinical encounter of chiropractic care. It does not cover the other treatments you mention (ultrasound, IFC, orthotics, soft tissue therapy) because as far as I know the cited sources don't say anything definitive about those forms of treatment. If someone can dig up reliable sources for those treatment forms, that would be nice; in the meantime, the #Effectiveness 3 is much better than the effectiveness material that is in Chiropractic now. Eubulides (talk) 07:35, 13 May 2008 (UTC)

We should certainly think carefully about the WP:SYN issue raised by Levine2112. Note that the Meeker et al. (2007) study uses the word "chiropractic" as well as the phrase "spinal manipulation", so I see no SYN problem in citing it. For the other studies, I think it would be an improvement if we simply cited the studies, implying but not stating outright that SMT studies shed light on chiropractic effectiveness. I would delete the sentence "Research has focused on spinal manipulation therapy (SMT) rather than specifically on chiropractic SMT,[18] but the distinction is not significant: chiropractors use all forms of SMT, more than 90% of SMT in the U.S. is done by chiropractors, and SMT research is equally of value regardless of practitioner type." I think this is good information for us to use here on the talk page while deciding whether the SMT studies can be used, but that including it in the article perhaps contributes to a SYN violation. If that sentence is deleted, the rest of the paragraph may need to be reorganized to flow smoothly.

Thanks, Eubulides, by the way, for your patience and diligence in coming up with yet another draft version.☺ Coppertwig (talk) 09:29, 13 May 2008 (UTC)

You're welcome. I removed that sentence from the draft in #Scientific investigation 3C. I agree that it's better to leave it out in future drafts as well; the citation was there only because of Levine2112's continuing concerns about generic SMT research versus research specifically on chiropractic care. Eubulides (talk) 20:55, 13 May 2008 (UTC)

I think that sentence was added to avoid any synthesis and to make it clearer to the reader. QuackGuru 09:36, 13 May 2008 (UTC)

I think that sentence is an attempt to justify the synthesis. Essentially, it may be the opinion of one researcheer (or one team of two researchers), but we can't then go ahead and apply it to the SMT research across the board. That is where the WP:SYN violation happens. That said, I maintain that we should remove all studies which are about SMT in general and do not make distinct conclusions about chiropractic specifically. These general SMT studies would be perfect for the spinal manipulation article. -- Levine2112 ^discuss 16:09, 13 May 2008 (UTC)

Spinal manipulation is inherent to chiropractic as its most commonly performed modality and we should not second-geuss the reviewers. QuackGuru 18:06, 13 May 2008 (UTC)

(outdent) I strongly disagree that generic SMT research should be excluded from Chiropractic. It's standard practice in high-quality chiropractic sources to include such research, we have a high-quality chiropractic source saying that there's no significant difference between chiropractic and non-chiropractic research data in SMT, and we have no high-quality sources disagreeing. However, to help move the discussion ahead I propose a new version #Scientific investigation 3C below, which excludes generic SMT research. That is, all the sources #Scientific investigation 3C talk explicitly about chiropractic care, not just about SMT (or mobilization or whatever) in general. Eubulides (talk) 19:59, 13 May 2008 (UTC)

Researchers commonly apply regular SMT research and sources indicate there is no sigificant difference among the high quality studies. This version is a bit short and could use a slight expansion. QuackGuru 11:50, 14 May 2008 (UTC)

Here is what the scientific investigation (now renamed scientific research) section of the article was at the beginning of year. The current version includes newer peer-reviewed references and is very concise. QuackGuru 13:11, 14 May 2008 (UTC)

Proposal for fix 3C

I view this "3C" draft as being far inferior to #Scientific investigation 3 due to 3C's weaker sourcing, but 3C is still much better than what's in Chiropractic now. I offer 3C as an attempt to fix Chiropractic's obvious datedness and POV problems now, and to continue the discussion here about what to do about the generic SMT studies.

The revised proposed fix is to replace the sections Chiropractic #The Manga Report through Chiropractic #Scientific investigation with the following text (between the horizontal lines), to keep Chiropractic #Safety unchanged, and to replace the "===Vaccination===" with "==Vaccination==" (as that section has nothing to do with scientific investigation).

(Please place further comments below.) Eubulides (talk) 19:59, 13 May 2008 (UTC)

Scientific investigation 3C

In the current healthcare environment, The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which treatments are legitimate and perhaps reimbursable under managed care. Chiropractic treatments are evaluated using those same standards. Evidence-based guidelines are supported by many chiropractors while others remain pseudoscientific and antiscientific and make unsubstantiated claims. Research has focused specifically on spinal manipulation therapy (SMT) rather than on the whole chiropractic visit and all that is involved in the patient encounter, some of which may be the result, as with all healthcare encounters, of the placebo effect, The distinction is not significant regarding who performs SMT for musculoskelatal conditions.

Effectiveness 3C

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment. Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective. As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective. Chiropractic care, like all medical treatment, benefits from the placebo response. Few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality. The efficacy and cost-effectiveness of maintenance care in chiropractic is unknown.

Research has focused on spinal manipulation therapy (SMT) in general, rather than specifically on chiropractic SMT. There is little consensus as to who should administer the SMT, raising concerns by chiropractors that orthodox medical physicians could "steal" SMT procedures from chiropractors; the focus on SMT has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. A 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition.

Available evidence covers the following conditions:

• Low back pain. A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain. A 2008 critical review found that chiropractic SMT is possibly effective for back pain, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference.

• Other musculoskeletal conditions. A 2005 review found little investigative research into chiropractic manipulative therapy for acute neck pain. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine).

• Nonmusculoskeletal conditions. A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine. A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions. Other reviews have found no evidence of benefit for baby colic, bedwetting, or fibromyalgia.

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(End of proposed replacement text.)

(Please place further comments below.) Eubulides (talk) 19:59, 13 May 2008 (UTC)

Comments on Scientific investigation 3C

(Please put comments here.)

I agree that if the premier chiropractic researchers use generic SMT studies in their reviews, we should be able to use them too. However, Sci Inv 3C is far better than what's in the article now, so let's replace Manga and Worker's Comp with it.--—CynRN ^(Talk) 04:41, 14 May 2008 (UTC)

This extremely short version runs afowl with NPOV. More importantly, the reader deserves to read a comprehensive version. A comprehensive version is more imformative for the reader. This lack of information version is not it. It is way to short and is below Wikipedia's standard. QuackGuru 11:45, 14 May 2008 (UTC)

Where does it run afowl with NPOV?DigitalC (talk) 23:43, 14 May 2008 (UTC)

I am happy with 3C.DigitalC (talk) 06:08, 15 May 2008 (UTC)

I'm guessing maybe QuackGuru means that by being too short, it's not giving due weight to effectiveness of SMT to reflect how much that's discussed in the sources. I apologize in advance if I got that wrong, QuackGuru. ☺ Coppertwig (talk) 02:57, 16 May 2008 (UTC)

I think this version gives far too much wait to this opinion: "A 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition." This comes from a major chiropractic critic often accused of bias and not necessarily a neutral researcher. As such it should be balanced or removed. That said, I am all for keeping this section brief if we have it at all. This is an article about Chiropractic and not about SMT. All of the details about every study ever conducted about SMT should be saved for spinal manipulation. -- Levine2112 ^discuss 03:10, 16 May 2008 (UTC)

A major chiropractic critic often accused of bias and not necessarily a neutral researcher? Please provide your evidence. Ernst is peer-reviewed and meets the inclusion criteria for this article. We should edit based on NPOV and exclude any personal opinion. Thus, we can include Ernst. QuackGuru 03:20, 16 May 2008 (UTC)

Yes, but this version gives his opinion far too much prominence. -- Levine2112 ^discuss 03:26, 16 May 2008 (UTC)

That's your opinion. Please provide evidence of any bias by Ernst. QuackGuru 03:33, 16 May 2008 (UTC)

Not even mainstream medicine listens to Ernst re: his views on the safety and effectiveness of spinal manipulation for back pain. His view is fringe. It can be proved. To repeat: Ernsts (MD) views on spinal manipulation is the FRINGE viewpoint within respect to mainstream medicine. It will be weighed as such. He is not an expert on SMT nor chiropractic, but is simply a vocal critic who is coming off as increasingly righteous and pig-headed despite the mounting evidence which negates his POV. CorticoSpinal (talk) 05:33, 16 May 2008 (UTC)

Ernst is not fringe. His works are often cited by his peers. I just now visited Google Scholar and typed the query "chiropractic Ernst". This returned about 2390 citations. In the first page, one source by Ernst (the 2001 desktop guide) was cited 280 times. Another by Ernst (the 2000 BBC survey) was cited 170 times. All of these numbers beat the query "chiropractic Haldeman" (1230 citations, top two sources on the 1st page cited 107 and 97 times). By this measure, or any other reasonably neutral measure, Ernst is one of the top current sources in the area. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Citations does not necessarily translate into positive remarks on his work. It has also generated significant controversy and those same papers would have to cite his work in order to talk about it. Since it is the most vocal anti-SMT voice, both chiropractic researchers and healthcare researchers reference it as the most extreme, which I would assume would be considered the "fringe" of science.. but you know what assuming does. But, regardless, we can't just assume that citations translates into quality or mainstream. -- Dēmatt (chat) 11:51, 19 May 2008 (UTC)

I tested the theory that citations to Ernst are to cover the controversy by taking the most-cited work of Ernst mentioned above (the desktop guide), going to Google Scholar, finding which works cite it, looking at the first page of results, and reading each of the papers that cite it. I skipped the papers cowritten by Ernst himself for obvious reasons. None of the citations mentioned any controversy; they all simply cited Ernst as an authority. The papers I examined were Marty 2002 {{doi:10.1089/107555302317371523}}, Mason et al. 2002 (PMID 12376448), Bair et al. 2002 (PMID 12406817), Cohen & Eisenberg 2002 (PMID 11955028), and Cherkin et al. 2003 (PMID 12779300). These papers are all highly-cited (all have at least 45 citations). Of course this is just a spot-check, but it suggests that Ernst is not considered to be fringe by mainstream researchers. Eubulides (talk) 20:47, 19 May 2008 (UTC)

Evidence of bias by Ernst:

• Evans, W. (2003). "Chiropractic Care: Attempting A Risk-benefit Analysis". American Journal of Public Health. 93 (4): 522. Retrieved 2008-05-20.
• Bronfort, G. (2006). "Review conclusions by Ernst and Canter regarding spinal manipulation refuted". Chiropractic & Osteopathy. 14 (1): 14. doi:10.1186/1746-1340-14-14. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
• Hurwitz, E.L. (2002). "Chiropractic care: a flawed risk-benefit analysis?". Am J Public Health. 92 (10): 1603–4. Retrieved 2008-05-20. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Morley, J. (2001). "Ernst Fails to Address Key Charges". The Journal of Alternative & Complementary Medicine. 7 (2): 127–128. doi:10.1089/107555301750164145. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• "Profession Responds Quickly to Negative U.K. Study on Spinal Manipulation". Retrieved 2008-05-20.
• SPINAL MANIPULATION DOES WORK: THE FACTS FROM THE BCA
• A balanced review of evidence?

DigitalC (talk) 06:40, 20 May 2008 (UTC)

Yes, Ernst is strongly opposed by many in the chiropractic profession, and those citations illustrate this opposition. However, this does not undercut the claim that citations to Ernst by high-quality mainstream publications are, by and large, positive. Eubulides (talk) 07:20, 20 May 2008 (UTC)

Being opposed by many in the chiropractic profession doesn't have anything to do with research. Research doesn't oppose anything, it is what it is; it either supports or it doesn't. DigitalC's information does show that at least some of those 2390 citations are not positive, which, of course, was my point above. I would suggest that no-one has disagreed with Haldeman's research because he is a neurologist/chiropractor. Maybe that is why he has only half the citations :-) Anyway, I think this shows that Ernst is Ernst and we use his information just as we would Haldemans's or anyone else's. -- Dēmatt (chat) 13:23, 20 May 2008 (UTC)

Obviously some of the citations are negative. But my spot-check from Google Scholar suggests that most of them are positive. (It doesn't prove this, of course; it was only a spot-check.) And it is not true that nobody has disagreed with Haldeman; I can easily cite sources strongly criticizing Haldeman's work. I agree that we should cite Haldeman as well as Ernst; both are leading and reliable sources. Eubulides (talk) 22:16, 20 May 2008 (UTC)

If most of them are positive, then why is more weight being given to the negative ones in the version above? Featuring this - "chiropractic SMT has not been shown to be effective for any medical condition" - so prominently in the lead of this section seems to violate WP:WEIGHT - especially in the context given. I believe enough concern has been raised about Ernst's lack of objectivity, that giving his opinions so much weight seem unjust to the article. -- Levine2112 ^discuss 22:38, 20 May 2008 (UTC)

That quote is preceded by "Although a 2008 critical review found that with the possible exception of back pain" so it is not as strong as that out-of-context snipped would make it appear. Furthermore, the sentence containing quote also says "a 2008 supportive review found serious flaws in the critical approach, and found that SMT and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments" (citing Bronfort et al. 2008, PMID 18164469). This is a strong criticism that immediately undercuts Ernst's claims. If anything, this is being unfair to Ernst; it's not the sort of treatment that any other source is being given here. Given all this context, it's not out of line to let Ernst briefly have his say. Eubulides (talk) 02:16, 21 May 2008 (UTC)

A mischaracterization of what was posted above. In some of the papers there is no way to know what degrees/professions the authors have. For example, in the Bronfort et al. paper, we get these associated groups, but no degrees. (Chalmers Research Group, Evidence-based Practice Center, Departments of Pediatrics, Epidemiology and Community Medicine, University of Ottawa, 401 Smyth, Ottawa ON, K1H8L1, Canada; 4Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, The Netherlands; 5Texas Back Institute, 6300 W. Parker Road, Plano Texas 75093, USA; 6Department of General Practice and Nursing Home Medicine, LUMC Medical Centre, Leiden, The Netherlands). In addition, one of the Authors, Assendelft, is a prior co-author with Ernst, and an MD, NOT a Chiropractor. He's also writes cochrane reviews, so he probably knows how to assess evidence.DigitalC (talk) 07:56, 20 May 2008 (UTC)

It is not a mischaracterization. The Bronfort et al. paper has 10 authors, of which 5 have DCs (including Bronfort, the lead author) and 1 (Assendelft) has an MD. So it's strongly dominated by chiropractors. The other sources are even more strongly dominated by chiropractors. Ernst has cowritten more than a dozen Cochrane reviews so I daresay he knows how to assess evidence as well. What we have here is a difference of opinion among experts, a difference that should be reported fairly and neutrally; Ernst is not at all on the fringe here. Eubulides (talk) 09:17, 20 May 2008 (UTC)

It IS a misrepresentation of the sources to state as a summy that "Ernst is strongly opposed by many in the chiropractic profession", when the sources are not solely Chiropractors.DigitalC (talk) 11:20, 20 May 2008 (UTC)

It is not a misrepresentation. The sources given were:

• A letter by a DC (Evans).
• A paper with 5 DC and 1 MD coauthors, the lead being a DC (Bronfort et al.; 4 coauthors were neither DCs nor MDs)
• A letter signed by 3 DCs and zero MDs (Hurwitz et al.).
• A letter signed by 2 DCs and zero MDs (Morley et al.; 1 coauthor was neither DC nor MD).
• An article about chiropractors lobbying against Ernst (Dynamic Chiropractic).
• A position paper by the British Chiropractic Association.
• A letter signed by 2 DCs and zero MDs (Breen et al.; 3 coauthors were neither DC nor MD).

It's true that there are some non-chiropractors there, but these sources are heavily dominated by chiropractors. They may represent the mainstream of opinion within chiropractic, but they do not represent mainstream opinion generally. They do not at all demonstrate that Ernst is a fringe researcher. Eubulides (talk) 22:16, 20 May 2008 (UTC)

I was responding to QG's request for evidence of claims of bias towards Ernst. That is what I provided.

Ernst's conclusions are fringe and so are his opinions on the subject. His work on SMT and Chiropractic care has been terrible. He's represents the extreme on one end; the WCA represents the fringe on the other end. Both views should be discarded because they are just that, extremist. Ernst has been used to 'bomb' CAM related articles with his 'reviews' which he essentially reviews himself. CorticoSpinal (talk) 12:50, 21 May 2008 (UTC)

We appreciate that's your belief, but just restating it isn't convincing. If an author is heavily cited then it's pretty clear that people are listening to him. Regardless of ones personal beliefs on his work that makes him a notable party. Jefffire (talk) 13:00, 21 May 2008 (UTC)

(Undent) Here is the rift here. If we were to accept that chiropractic researchers are biased, then that acknowledges that medical research is biased. I personally think they are equally biased, but that is just my experience. Therefore, we have two choices, use them both as equal, or consider them POV and attribute the findings to the different sources. One method requires a littel more writing, but either can be productive and get toward the end product. -- Dēmatt (chat) 13:01, 20 May 2008 (UTC)

Once again Dematt comes up with the Solomonic solution - inclusion of all POV using good sources. I also agree with most of his comments. We are all biased, controversies occur, and those biases and controversies need to be documented here. We just need to do it properly. -- Fyslee / talk 14:38, 20 May 2008 (UTC)

That is the goal of #Scientific investigation 3. It includes both supportive and critical sources and cites them appropriately, with due weight given to all sides. Eubulides (talk) 22:16, 20 May 2008 (UTC)

Unfortunately it does not seem like your interpretation of Scientific Investigation 3 is shared by the majority of editors nor does it generally represent the conclusions of the scientific community (due to cherry picking of sources). CorticoSpinal (talk) 12:50, 21 May 2008 (UTC)

Looks quite sound to me. Could you give specific advice for how to improve it, rather than baseless sniping, thanks. Jefffire (talk) 13:00, 21 May 2008 (UTC)

Is there a reason that effectiveness 3C has been struck out entirely, and that multiple editors comments are struck out as well? I seem to have missed something. DigitalC (talk) 06:42, 31 May 2008 (UTC)

The talk page is now archived automatically by a bot. Sections that haven't been changed for 14 days get archived. If you want the section back, you can resurrect it by hand from the archive. Eubulides (talk) 07:56, 31 May 2008 (UTC)

Continued discussion of Scientific investigation 3C

Okay, back to work on SCI 3C. I've sticken through:

• Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs pseudoscientific and antiscientific reasoning and makes unsubstantiated claims.

Evidence based medicine does not care what your philosophy is, if it works it works. It doesn't matter which side of any arbitrary line you are on. This just seems like an opportunity to use the word pseudoscience, but it doesn't really fit. -- Dēmatt (chat) 13:55, 21 May 2008 (UTC)

It's true that evidence-based medicine is independent of philosophy. However, the point is that some chiropractors accept the principles of evidence-based medicine, and others don't. This is quite relevant to the subject of scientific investigation, because the entire philosophical basis of scientific investigation is questioned by a significant minority of chiropractors. For the purpose of this section, I agree "pseudoscience" isn't needed so I struck that instead. Eubulides (talk) 16:43, 21 May 2008 (UTC)

I'm not sure I'm buying that one, Eubilides. Let's put the groups scientific orientation in the sections that address their scope and leave this for the science - which doesn't care what race, creed, or color you are. -- Dēmatt (chat) 19:36, 21 May 2008 (UTC)

Other sections (notably Chiropractic#Philosophy already discuss this issue at some length. However, it's useful to put in a brief mention of the problem here. We can't expect every reader of this section to have read the whole article. Eubulides (talk) 20:13, 21 May 2008 (UTC)

Absence of adherence to EBM does not automatically imply pseudoscience. I wouldn't even go that far characterizing the straight wing. As on the Physical therapy page, a significant chunk of PTs don't use the evidence (thus far) but I would not call them pseudoscientific. Even the MDs who use outdated methods (antibiotics for sinus infections) for the last 40 years which was found to be of 0 benefit. I'm actually beginning to see some quality research designs by straight-leaning chiropractic schools in the US. I think they're getting it. Publish or perish (or lose market share to professions who will fill the gap). CorticoSpinal (talk) 18:06, 21 May 2008 (UTC)

The current 3C draft omits "pseudoscience", which should address the concerns mentioned here. Eubulides (talk) 20:13, 21 May 2008 (UTC)

because the entire philosophical basis of scientific investigation is questioned by a significant minority of chiropractors - Then what we would have to do is explain why, i.e. this is where Keating ref would come in with antiscience - it's not that they don't believe science or rational thinking, it is not trusting the scientist that is doing the research, i.e. drug companies performing the research on drugs, MDs evaluating chiropractic methods. It is more a distrust than a true antiscience. -- Dēmatt (chat) 18:29, 21 May 2008 (UTC)

It might be helpful to add a discussion of this point. However, the source (Keating 1997) does not address the trust issue, so we'd need a reliable source to justify the discussion. Eubulides (talk) 20:13, 21 May 2008 (UTC)

This statement does not match the source. I changed it as shown, it still needs work, but just to get it on paper disk.

• Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective. As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective.

-- Dēmatt (chat) 14:37, 21 May 2008 (UTC)

• • It does match the source. The source says "Nevertheless, there are different views concerning the efficacy of chiropractic treatment, which is not surprising. Unfortunately, it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts despite the millions of papers that have been written about presumably scientifically sound studies. Because of this difficulty, numerous medical procedures have not been rigorously proven to be effective either." The sentence in question is an abridged version of this quote. The stuff about "as of 2002" is obsolete and should not appear here. Also, in general it's not a good idea merely to quote the source; we should use the ideas and not degenerate into a list of quotes. Eubulides (talk) 16:43, 21 May 2008 (UTC)
    • While attempting to be constructive, Eubulides, the tone of your message to Dematt comes off rather condescending and paternalistic to a highly respected editor. I'm sure that was not the intent, but I had mentioned this concern before and hope you realize that Dematt's editorial skills are appreciated by both proponents and skeptics. CorticoSpinal (talk) 18:06, 21 May 2008 (UTC) I can tell he was smiling when he said that ;-) It's okay, really, down doggie, down :-)

I'm reading the Pubmed version and don't see your sentence there. The doi link is not working for me. -- Dēmatt (chat) 18:42, 21 May 2008 (UTC)

The source is copyrighted and only the abstract is freely readable. The above quote is from the "Efficacy and Patient Satisfaction" section of the source. Eubulides (talk) 20:13, 21 May 2008 (UTC)

Nevertheless, I think we can write it more neutrally and fit the source better if we say it this way:

• Because it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts, most medical procedures have not been rigorously proven to be effective. Chiropractic fits this category as well.

-- Dēmatt (chat) 19:31, 21 May 2008 (UTC)

That's less neutral than the current summary, because the cited source does not say "most medical procedures"; it merely says "numerous". Also, I don't see how adding all that other verbiage makes the summary more neutral. What's not neutral about the much-shorter "Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective."? Eubulides (talk) 20:13, 21 May 2008 (UTC)

I merged the second sentence to make it shorter, but don't want to lose the qualifying section of the sentence that explains to our readers who have no idea what 'rigorously proven' means. They need something to compare it to. All the reader sees is, "chiropractic treatment has not been proven to be effective" and of course that is not NPOV. We have to qualify it and still keep it along the lines of what the author was intending to say (which in the abstract was actually positive towards chiropractic), otherwise we are creating and SYN error, or OR. The other option is number three, where we use the information from the abstract itself:

• "Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective."?

• "Because it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts; numerous medical procedures, including chiropractic care, have not been rigorously proven to be effective."

-- Dēmatt (chat) 20:50, 21 May 2008 (UTC)

It's not the case that 'All the reader sees is, "chiropractic treatment has not been proven to be effective"'. The reader also sees "Like many other medical procedures" at the start of the sentence. This places the claim in context. The wording also uses the word "rigorously" to make it clear that we're talking about proofs with a high degree of confidence. The quote from the source is wordy and the extra verbiage adds little; plus, we shouldn't just be stringing together quotes. I take it that the objection is that the summary does not mention the point that it's hard to establish definitive findings? Then how about rewording it to "It is hard to make definitive findings about much of medicine, and like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective." Eubulides (talk) 08:35, 22 May 2008 (UTC)

The placebo source is excellent, but the sentence is misplaced. I just struck it out for now.

• Chiropractic care, like all medical treatment, benefits from the placebo response.

-- Dēmatt (chat) 14:58, 21 May 2008 (UTC)

Thanks. But let's find a better home for it rather than just removing it. I unstruck it for now. Eubulides (talk) 16:43, 21 May 2008 (UTC)

I found one!, but you know that, it is below. I won't delete the other one until we're all happy with the new placement. -- Dēmatt (chat) 19:16, 21 May 2008 (UTC)

This sentence has problems with the source, too. It's about chiropractic care with Type O problems. It's giving suggestions about how to improve studies. It's not making any judgements about 'low quality"?

• Many studies of chiropractic care are available, but they are typically of low quality.

-- Dēmatt (chat) 15:30, 21 May 2008 (UTC) Thanks for catching that. The source says "the number of studies on chiropractic care and/or SMT and other manual therapies for patients with nonmusculoskeletal conditions is relatively small, and the quality of the studies is generally not high.". I think there was a similar source for MS that said "many studies" that got removed by later editing; I'll take a look for it but for now I reworded the claim. Eubulides (talk) 16:43, 21 May 2008 (UTC)

Again, I hope thatis the source that is not listed, or am I missing something with the doi ref? -- Dēmatt (chat) 19:19, 21 May 2008 (UTC)

Sorry, I don't follow. Many of the sources for Chiropractic are not free; Hawk et al. is one of them. That's life in the big research city, I'm afraid. All other things being equal we prefer free sources, but high-quality nonfree sources are fine when equal-quality free sources are not available. Eubulides (talk) 20:13, 21 May 2008 (UTC)

I'll take a break now. I feel like this version (3C) so far still does not follow the sources well enough to represent what they are saying. I think we might be trying to fit things into our "Efficacy", but we're having to use sources that aren't really addressing that. We're still not there. We may have to go to some primary sources as well. Perhaps a combination of this and that other version that CS brought us and call it something different. -- Dēmatt (chat) 15:37, 21 May 2008 (UTC)

Okay, so much for the break, but I saw SC investigation 3 above and saw this sentence:

• Research has focused on spinal manipulation therapy (SMT) rather than specifically on chiropractic SMT, but the distinction is not significant: chiropractors use all forms of SMT, more than 90% of SMT in the U.S. is done by chiropractors, and SMT research is equally of value regardless of practitioner type.

We could add the placebo reference here, like this:

• Research has focused specifically on spinal manipulation therapy (SMT) rather than on the whole chiropractic visit and all that is involved in the patient encounter, some of which may be the result, as with all healthcare encounters, of the placebo effect, The distinction is not significant regarding who performs SMT for musculoskelatal conditions.

Still needs work, but you get the idea. -- Dēmatt (chat) 16:10, 21 May 2008 (UTC)

I don't see why we'd want to move the placebo sentence from the generic paragraph to the SMT paragraph. The placebo effect applies to all treatments, not just to SMT. Eubulides (talk) 16:43, 21 May 2008 (UTC)

If placebo applies equally to all Tx (which it does) why redundantly mention it? CorticoSpinal (talk) 18:06, 21 May 2008 (UTC)

I'm okay with putting it in the generic paragraph, I'll do it now to see what it looks like. -- Dēmatt (chat) 18:48, 21 May 2008 (UTC)

By "generic" I meant "generic to effectiveness", not "generic to all research". Safety studies generally don't use placebos. How about moving it back to where it was, which was in the generic-to-effectiveness paragraph? Eubulides (talk) 20:13, 21 May 2008 (UTC)

I see that more material was added here, but I confess I don't see the point. I thought that the idea behind the 3C draft was to avoid all mention of sources unless they specifically talk about chiropractic care. And yet now a lot of material has been added that talks about SMT irrespective of chiropractic. But that's what Chiropractic#Effectiveness does. Why not start with that version, rather than the old 3C version whose goal in excluding all but specifically chiropractic sources was different (and by the way, was a goal I didn't agree with)? Eubulides (talk) 08:35, 22 May 2008 (UTC)

I agree with Dematt that the bit about "rigourously proven" is not a good abridgement of that source: it strikes me as implying much more strongly than the source does that chiropractic is unproven. I think a better abridgement of that source is the following direct quote from the source: "There are different views concerning the efficacy of chiropractic treatment." ☺ Coppertwig (talk) 00:10, 26 May 2008 (UTC)

And actually, I agree with Dematt that the quote about 30 of 43 studies is better. Eubulides, the quote you give from the source above does not actually state that the efficacy of chiropractic has not been rigorously proven. It leaves open the possibility, for example, that some people believe it to have been rigorously proven while others do not. Perhaps it implies that it has been rigorously proven and perhaps it does not, but it doesn't state it, so we shouldn't state it right out either based on that source. ☺ Coppertwig (talk) 01:31, 27 May 2008 (UTC)

• Sorry, I don't know what you mean by "the quote about 30 of 43 studies"; there's no string "30 of 43" anywhere else on this talk page.
• I don't see how to read the source in the way that you say. Nobody seriously argues that the efficacy of chiropractic care has been rigorously proven.
• That quote is there because of a common theme in many sources that although chiropractic care has not been rigorously proven, in this respect it's in the same boat as many other forms of medical treatment. That's an important point, which should be made. All too often, chiropractic critics say "the science isn't there" without noting that the science isn't there for many other forms of medical treatment, too. Perhaps DeVocht is not the ideal source to make this point, but it will do until we find a better one.
• We don't need DeVocht to support the claim that there are differing views of the subject; that claim is already stated elsewhere in the section, and is well-supported already (by better sources than DeVocht).

Eubulides (talk) 08:08, 27 May 2008 (UTC)

Improved version RfC

It is my opinion that this change was for the better. Please give your opinion on the matter. ScienceApologist (talk) 15:01, 14 May 2008 (UTC)

The majority of these edits were contentious, still being discussed on this page, and still lack consensus. Accordingly, I have reverted. There were some decent housekeeping edits in the mix, but the bad outweighed the good in my opinion. -- Levine2112 ^discuss 17:45, 14 May 2008 (UTC)

I would not have made these edits at this time. That being said, the discussion in #Comments on Scientific investigation 3 seems to have petered out, with questions remaining for the dissenting editors but no replies from them recently. The edits that were already discussed are a big improvement over what was in Chiropractic. Surely they can be further improved, and we can discuss that here. Many edits were not previously discussed, though, and they are more problematic; please see #Several important changes were never discussed below for more about them. Eubulides (talk) 23:44, 14 May 2008 (UTC)

It has been discussed on this talk page previously that any contentious edits should be discussed on the page before being implented. In addition, rather than grouping large housekeeping edits and reference formatting with contentious edits, it is better to make a larger number of smaller changes.DigitalC (talk) 23:53, 14 May 2008 (UTC)

We are not bound by what has happened on this page in the past (see e.g. WP:BOLD, WP:IAR). The question is whether the edits were good. There is consensus that they are. ScienceApologist (talk) 19:34, 19 May 2008 (UTC)

• It is true that we are not bound; still, standard practice, as noted at the top of this talk page, is to discuss controversial changes before making them, which was (alas) not done here.
• Even if there was consensus that the big edit improved the article overall, that would not imply that consensus for each part of the big edit. None of the commenters backing the consensus have commented on detailed criticisms of the previously-undiscussed parts of the big edit. (These criticisms were not available to the commenters, precisely because the big edit was sprung on the regular editors without discussion.) So there is no real evidence for consensus for the previously-undiscussed parts of the big edit that have been criticized after the big edit was made.

Eubulides (talk) 20:47, 19 May 2008 (UTC)

• Agree with ScienceApologist: Surveying these changes, they appear to be quite reasonable and backed by reliable sources. I agree with SA that these changes constitute an excellent start at reform of this page, which is sorely needed to create something encyclopedic that conforms to WP:NPOV.--Filll (talk) 18:04, 14 May 2008 (UTC)

• It looks good, adds balance, especially to the section on the Manga report. The additions appear to be well-supported. Guettarda (talk) 18:26, 14 May 2008 (UTC)

• I think it's better, more NPOV. I'm not sure that adding back practice styles is worthwhile (this article is way long already!) and I believe it's hard to pigeon-hole any individual chiropractor, but I approve of most changes, esp. re. Manga and worker's comp studies.--—CynRN ^(Talk) 19:07, 14 May 2008 (UTC)

• I will take a look at the edits one by one and add the ones that haven't been disputed; I'll then come back here and summarize what's remaining. Eubulides (talk) 19:32, 14 May 2008 (UTC)

• After I wrote the above comment, someone else added all the edits. So now I'm looking at them one by one and plan to take out the ones with the most problems. (If someone else doesn't revert again first.…). So far I've found mostly just citation problems, but I haven't got to the controversial stuff yet. Eubulides (talk) 20:13, 14 May 2008 (UTC)

• I found a serious problem with the edits: many of them have never been discussed on this page, even though they are potentially controversial. For now I have reverted them; please see [[#[edit] Several important changes were never discussed]] below. Eubulides (talk) 23:44, 14 May 2008 (UTC)

• I agree that the changes meet NPOV, are well sourced and helps the article to be able to go forward. My comment is from an outside opinion who watches the article and the talk page. --CrohnieGal^Talk 19:39, 14 May 2008 (UTC)

• There is growing consensus for the recent changes that are being discussed in this RFC. However, a couple of edits deleted some information that was part of the recent changes discussed in this RFC. Any minor tweaks can be made in mainspace. QuackGuru 01:07, 15 May 2008 (UTC)

• This severely controversial change went against broad consensus. QuackGuru 01:12, 15 May 2008 (UTC)

• I've restored the content under discussion. It appears fairly well-sourced. It deserves to be discussed rather than removed on a whim without properly addressing the quality of the references and their use. Let's all follow WP:TALK and WP:CON here. Thanks. --Ronz (talk) 01:42, 15 May 2008 (UTC)

There are serious problems with many parts of the edit. This should have been discussed before insertion, as per consensus above that any contentious edit would be previewed on the talk page before being taken to mainspace.DigitalC (talk) 04:16, 15 May 2008 (UTC)

I do not see any serious problems. I see a very thoughtfully written improved version. My recent edits were discussed in this RFC. Please respect the external advise. QuackGuru 04:38, 15 May 2008 (UTC)

There is broad consensus among external observers in this new RFC discussing the recent changes I made. These edits went against the advise from external third-party input of this RFC. QuackGuru 04:38, 15 May 2008 (UTC)

That edit had two parts. First, it installed the changes proposed in #Scientific investigation 3 and discussed extensively earlier. Second, as mentioned below, that edit installed several changes that were never discussed before installation. None of the external observers have commented specifically on the second (previously-undiscussed) class of changes. It is not clear that they approve of the previously-undiscussed changes. It is not even clear that the observers even noticed the previously-undiscussed changes. I didn't notice them without doing a line-by-line analysis of the edit, which took quite some time. Eubulides (talk) 06:09, 15 May 2008 (UTC)

The external observers are commenting at this RFC about this recent change. QuackGuru 06:25, 15 May 2008 (UTC)

The discussion here has been fruitful in this RFC for this recent change but this edit went against established third-party consensus. QuackGuru 06:39, 15 May 2008 (UTC)

I will follow up at #Several important changes were never discussed below. Eubulides (talk) 06:48, 15 May 2008 (UTC)

I saw this dispute while reading Vassayana's talk page. I don't know the subject, but I can see two things: first, probably many of the changes are good. Second, that while bold edits are good, they were subsequently edit warred in, [26](these for example) which is against the processes of WP. Therefore, there is a need for obtaining consensus on the changes before they are considered more than suggestions. ——Martin^phi ☎ Ψ Φ—— 02:07, 16 May 2008 (UTC)

There was growing consensus for the recent changes but it appeared a certain editor attempted to flout consensus by edit warring.[27][28][29][30] QuackGuru 22:19, 19 May 2008 (UTC)

Or rather that certain editor was flouting the lack of consensus despite another certain editor touting that there was one. -- Levine2112 ^discuss 22:32, 20 May 2008 (UTC)

Martin, do you believe that the agreement seen by so many outside reviewers of the RfC that the content is good is not enough to establish that the content should be added? ScienceApologist (talk) 19:34, 19 May 2008 (UTC)

• Concerned Comment The biggest problem I have with this version is that it is being billed as a consensus from the community, but they have not shared in the conversation or the work that has been put in to improve upon the very version they are looking at. There is more work to do, but if you call this a consensus version, it will be virtually impossible to make any more edits - even minor ones - as a particularly eccentric editor will likely take it as his duty to defend the "consensus view from outside editors". So while I can work with anything, nobody can work with the constant reversions to "the RfC version that many outside members have agreed to". So, unless you really like this version, I would rather you suggest that we continue to work together in the manner that WP was meant to work - where anyone can edit anytime and collaboration is the preferred method to accomplish consensus. Let the ones that are working this article decide what the 'best version' is. -- Dēmatt (chat) 00:58, 20 May 2008 (UTC)
  • Again, well said. -- Levine2112 ^discuss 22:32, 20 May 2008 (UTC)
    • I agree. The "consensus version" has real flaws and can use further improvement. Eubulides (talk) 02:16, 21 May 2008 (UTC)
      • I have made further improvements. Please review. QuackGuru 15:31, 23 May 2008 (UTC)

Objective straights and reforms

Part of the change added material about objective straight and reform chiropractors, two groups which it's not clear still exist (we don't have good evidence that they exist, and we have weak evidence that they don't). As I recall this was last discussed at the end of the long section Talk:Chiropractic/Archive 18 #Problems with current Effectiveness draft, without a consensus about including the material in Chiropractic#Schools of thought and practice styles. I suggest moving this material to Chiropractic history or perhaps Chiropractic #History; I don't think it'd be controversial there. I removed this material for now, pending further discussion. Eubulides (talk) 20:54, 14 May 2008 (UTC)

I don't think the article needs the material about reform and objective straights, maybe not even in history. I don't think it's very notable.--—CynRN ^(Talk) 21:20, 14 May 2008 (UTC)

I'm not sure that removing the material was altogether appropriate. I agree that the issue may be one of historical relevance rather than modern day relevance, but I found the material to be informative, interesting, and well-sourced. ScienceApologist (talk) 22:09, 14 May 2008 (UTC)

I don't feel strongly either way. The subject of the reform group especially got discussed ad nauseum on the talk pages a few months ago with no real consensus. History would be the place if it is to be included.--—CynRN ^(Talk) 22:16, 14 May 2008 (UTC)

OK, for now I moved it to Chiropractic #History. Eubulides (talk) 22:25, 14 May 2008 (UTC)

I prefer the information under Internal conflicts be put at the end of the Schools of thought and practice styles section. QuackGuru 01:07, 15 May 2008 (UTC)

The internal conflicts section is relevant to the schools of thought and practice styles section. The internal conflicts has discussion about the varying thoughts, practices, and beliefs. QuackGuru 08:12, 15 May 2008 (UTC)

Sure, but almost everything in Chiropractic #History is relevant to some other section, and could be moved there. The point is that Chiropractic, by and large, is a discussion of chiropractic as it is today. Stuff that's no longer relevant should be put in Chiropractic #History to avoid cluttering up the rest of the sections with material that used to be true but is no longer true. That's how other historical material is treated, and this particular historical material should be no exception. Eubulides (talk) 02:06, May 15, 2008 (UTC)

I fear that statement reveals a misunderstanding (at least on this point) of Wikipedia. While I agree that purely historical and dated events (IOW no longer, unquestionably, and impossibly current in any manner) should be placed in the history section IF our sources also do so, this happens to be a different matter. Wikipedia articles should NOT limit themselves to the present picture of the subject. It would take alot of OR to achieve this with some things about chiropractic, since many DCs in practice TODAY believe, think, and act as described by what you term "historical" or what CorticoSpinal terms "progressive". Chiropractic today is a very broad spectrum of beliefs and practices, and we shouldn't limit mention of something we believe (or wish) is purely historical to the history section, since it is ALL current practice and belief many places. Ultra straight subluxationism and anti-subluxationism are all very current within the profession. They are all part of "progressive" chiropractic, depending upon one's own personal POV. The struggle for domination is far from over.

There is also a straw man at work here, which you (Eubulides) many not be aware of. Straw men can effectively be used to shoot down unpopular ideas. When this section was first written and later being developed further, the strawman of existence or nonexistence of groups and organizations was constantly being brought up as if it was an issue to this section. It is NOT an issue in this section. This section is about "schools of thought and practice styles". Let me illustrate. Luther is long since dead, but his "school of thought" still exists and is present in Protestantism, and we mention him, his thoughts, and the work of various protestant groups and denominations. Just so here. Even if the only organization that has been officially reform (the NACM) were to cease to exist (it happens to live a quiet existence, as always), it's school of thought is expressed by many chiropractors whose utterances reveal that they share "reform" thoughts and their practices as well. In this context it is OR to engage in speculations about the existence of an organization which is so unlike ordinary organizations that it has usually been relatively quiet and whose membership has been relatively secret. That question is totally irrelevant to this section.

What we need to focus on is: (1) Did that school of thought exist and (2) was it officially the position of one organization? Yes. Unquestionably. (3) Does that school of thought still exist? Unquestionably. That's all we need to know to include mention of the organization, its school of thought, and its role in the profession, past and present. In fact, a substantial portion of the proof of its influence and notability has been provided by its opposition. Notoriety is a pretty powerful form of notability which Wikipedia recognizes. If you want the strongest proof of something, get its enemies to provide it. The testimony of friends can't always be trusted, but the opposition of enemies can certainly be used as evidence. FYI, chiropractors wouldn't have access to VA hospitals today if it hadn't been for the influence of the representative of the NACM on the work committee where access was granted. That's a pretty powerful influence exerted by one little, minority, relatively secret, organization that has been very notably and vocally opposed by the whole profession. [31][32] Although that representative was initially attacked[33] quite viciously, that representative was actually thanked later for his role. Ultra straight organizations had actually opposed the idea. -- Fyslee / talk 04:38, 22 May 2008 (UTC)

Luther is dead, but the Lutheran church is very much alive: I can still call up the Lutheran church and someone will answer the phone. This is not the case for the NACM, by all reports. Let me take that analogy and run with it: Lutheranism only briefly mentions Pietism (in Lutheranism#See also), and this is appropriate. Pietism was formerly a very active branch of Lutheranism, but it's now dead as an organized group: you can't call any Pietist churches on the phone (the Pietists have an indisputable effect on current teachings of some Lutherans, but they're no longer active). In contrast, Lutheranism does mention the differences between reformism and confessionalism, an important and active distinction among Lutherans: one can currently call up the reformists and someone will answer the phone, and likewise for the confessionalists, and it's entirely appropriate to cover that as a current issue.

In that sense, I don't see any reliable evidence cited showing that reformers are still active. Their work may have influenced current thought (just as Pietists influenced current Lutheran thought), but outside the History section Chiropractic should cover current thought, not the historical influences. Eubulides (talk) 08:35, 22 May 2008 (UTC)

You're missing the point, which is that it doesn't make any difference if the organization is active or not. The school of thought and practice style (anti-subluxation) is very much alive. Those who express such views are reform chiropractors. -- Fyslee / talk 14:16, 22 May 2008 (UTC)

I agree with this. -- Dēmatt (chat) 13:10, 23 May 2008 (UTC)

If we can find reliable sources showing that anti-subluxation is very much alive now, then I agree that should be included in the school-of-thought section. But it should be called "anti-subluxation", not "reform", no? Eubulides (talk) 16:58, 22 May 2008 (UTC)

It's not anti-subluxation per se, but pro-mainstreaming (which means they think chiropractors must drop their garb). -- Dēmatt (chat) 13:12, 23 May 2008 (UTC)

OMG is "garb" not just the perfect word for it! We should write for living! -- Dēmatt (chat) 13:16, 23 May 2008 (UTC)

Unless something has changed since previous consensus existed that there was not sources to believe these groups still exist, they should ONLY be placed in the history section. I for one believe that reform chiropractors DO exist, they just don't use the name "reform chiropractors" - but alas, without the name, it is hard to find sources that back that up. In that sense, I guess they are just at the end of the ideological spectrum of mixers.DigitalC (talk) 00:21, 16 May 2008 (UTC)

Effectiveness and Cost-benefit sections

Both of these section were added without a consensus. They are still a lot of discussion about the wording and even about whether or not to add these sections at all. To me, this (and the addition of the Objective straight and Reform) were the most egregious of the mass edits and most in need of being removed. -- Levine2112 ^discuss 21:42, 14 May 2008 (UTC)

There's an RfC currently in the works. Most of the people commenting seem to think that the edits including these bits were good. You are free to explain exactly what your objections are, but I don't think removal at this time is appropriate. ScienceApologist (talk) 22:10, 14 May 2008 (UTC)

The RfC was about effectiveness, not about cost-benefit. The cost-benefit section was added without any discussion, which is not a good idea for a controversial article like this. Also, the effectiveness section that was added was not the effectiveness section that was proposed. For now, I reverted to what was proposed and copied the undiscussed stuff to the next subsection. Eubulides (talk) 23:44, 14 May 2008 (UTC)

The new RFC was linked to the recent edits. I see growing consensus to include the information from the comments in the new RFC. QuackGuru 01:07, 15 May 2008 (UTC)

Calling a consensus again when there is no such consensus?DigitalC (talk) 04:18, 15 May 2008 (UTC)

There is broad consensus among external observers in the new RFC which is to be respected. QuackGuru 04:26, 15 May 2008 (UTC)

Again, I disagree that the external observers have a consensus about (or even noticed) the previously-undiscussed changes in that edit. Eubulides (talk) 06:09, 15 May 2008 (UTC)

Several important changes were never discussed

The edit contains several important changes that were never discussed on the talk page. Some of them are quite likely controversial. Please discuss changes like these before putting them in. For now I removed the undiscussed changes and list them below for further comment. Eubulides (talk) 23:33, 14 May 2008 (UTC)

• The following text was added to the discussion of the British Medical Association:

'In 1997, the BMA has identified chiropractic health care that can be regarded as "discrete clinical disciplines" because it has "established foundations of training and have the potential for greatest use alongside orthodox medical care."'

• The version of Scientific investigation that was installed had serious discrepancies from what was proposed in #Scientific investigation 3. It appears to be some mixture of #Scientific investigation 3 and the older Talk:Chiropractic/Archive 18 #Scientific investigation 2. For now, I have changed it to the #Scientific investigation 3, as that seemed to have more consensus. Further edits will no doubt be needed, but this sort of thing should be discussed first.

• The new Cost-benefit section was never discussed. I enclose it below, for further discussion. Please put comments in #Comments on Cost-benefit 1 below.

Eubulides (talk) 23:33, 14 May 2008 (UTC)

The RFC was about all of my recent edits. QuackGuru 01:07, 15 May 2008 (UTC)

The external observers commented about the overall edit, most of which had been discussed earlier. There's no evidence that the observers noticed, much less approved of, the changes that were slipped into that edit without any previous discussion. The only comments they made were about the changes that had been discussed earlier. It is contrary to common practice on this page to install major, potentially-controversial changes without any discussion on the talk page. Please discuss these changes in the relevant sections of this talk page, now that the sections have been created. Eubulides (talk) 06:48, 15 May 2008 (UTC)

The external observers were commenting on this recent change. We have discussion from third-party input. Uninvolved Wikipedians did discuss my recent change in the new RFC. QuackGuru 07:08, 15 May 2008 (UTC)

Most of what you are calling "my recent change" consisted of material that had been previously discussed. The uninvolved Wikipedians commented on the entire edit, and could easily have been fooled (by the way earlier discussion occurred) into thinking that the edit was installing what had been discussed. None of the comments by the uninvolved Wikipedians indicate that they read, understood, or agreed with the not-previously-discussed part of the change. It is poor practice to take a proposed edit which has had a lot of discussion, to make unannounced and important changes to it, and to install the changed edit without bothering to notify people that the edit involves undiscussed changes. I cannot emphasize this enough. Major changes need to be discussed first, before installing them; that is the standard procedure on this page, and it's standard procedure for good reason. Eubulides (talk) 09:15, 15 May 2008 (UTC)

There is absolutely NO indication that any of the RfC respondents were fooled. This is pure obstructionism. I will assume good faith and simply ask you to abide by the new consensus that the additions are good and needed in the article. There is no policy or guideline that says someone has to discuss first. One can discuss after the changes are made. That is being done here. The current consensus is to keep the changes. Please also stop making up rules for editing. Your cooperation is appreciated. Thanks. ScienceApologist (talk) 14:39, 15 May 2008 (UTC)

• There is no evidence that the RfC respondents read or understood the not-previously-discussed changes. None of the RfC respondents have responded to the substance of the subsequent criticism of the not-previously-discussed changes; this appears in many sections on the talk page, including #Comments on Cost-benefit 1, #Sorry to stop by in the middle of a POV war, and #Objective straights and reforms.
• So it is not true that "the current consensus is to keep the changes"; there may have been a consensus at the point the previously-undiscussed changes were made, but now that problems have been pointed out with those changes, the consensus, if there was one, is no longer present.
• Your revert to an old state ignored discussion that occurred after the "new consensus" (see, for example, #Sorry to stop by in the middle of a POV war). This discussion resulted in several improvements in wording in citation to the material, improvements that have not been disputed, and thus your revert lost this useful information. Please do not ignore later discussion, and please do not blindly revert and inadvertently remove later improvements.

Eubulides (talk) 16:14, 15 May 2008 (UTC)

• One other thing: I am not "making up rules for editing". The top of this talk page says "This is a controversial topic that may be under dispute. Please read this page and discuss substantial changes here before making them." This is a good rule, and should in general be followed. It was not followed for the previously-undiscussed changes. It is bad procedure to install changes into a controversial article without discussing them first. Eubulides (talk) 16:17, 15 May 2008 (UTC)

One thing is for sure, there is clearly no consensus to add these edits. It is truly a mystery why these editors are claiming that there is a consensus when so many editors disagree with these edits. -- Levine2112 ^discuss 19:32, 15 May 2008 (UTC)

Consensus is established above. ScienceApologist (talk) 17:11, 18 May 2008 (UTC)

I don't think so, SA. The question of validity still has not been addressed; i.e. why are Eubulides et QuackGuru trying to push an WP:SYN of SMT and pass it off as effectiveness of chiropractic. What is the effectiveness of medicine, dentistry and maybe more appropriately, physical therapy? If you can provide a sound rationale that would be helpful. CorticoSpinal (talk) 19:21, 18 May 2008 (UTC)

You are confused about what consensus is. Please read up on Wikipedia policies and guidelines. ScienceApologist (talk) 19:25, 19 May 2008 (UTC)

• Concerned Comment The biggest problem I have with this version is that it is being billed as a consensus from the community, but they have not shared in the conversation or the work that has been put in to improve upon the very version they are looking at. There is more work to do, but if you call this a consensus version, it will be virtually impossible to make any more edits - even minor ones - as a particularly eccentric editor will likely take it as his duty to defend the "consensus view from outside editors". So while I can work with anything, nobody can work with the constant reversions to "the RfC version that many outside members have agreed to". So, unless you really like that version, I would rather you suggest that we continue to work together in the manner that WP was meant to work - where anyone can edit anytime and collaboration is the preferred method to accomplish consensus. Let the ones that are working this article decide what the 'best version' is. -- Dēmatt (chat) 00:58, 20 May 2008 (UTC)
  • Here, here. Well said. -- Levine2112 ^discuss 22:29, 20 May 2008 (UTC)

Cost-benefit 1

The benefits of chiropractic care seem to outweigh the involved risk. The cost-effectiveness of SMT has not been demonstrated beyond a reasonable doubt. However, spinal manipulation for the lower back appears to be relatively cost-effective. Of the various interventions available, the most cost-effectiveness treatment for lower back pain could not be determined from the limited research available. The data indicates that SM therapy typically represents an additional cost to conventional treatment. Due to SM's popularity, higher quality research into the risk-benefit is recommended. Preliminary evidence suggests that massage but not spinal manipulation may reduce the costs of care after an initial therapy. When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SM. The small risk associated with manipulation of the cervical spine could be avoided with the use of nonthrust passive mobilization movements. There is no evidence that SM is superior to other treatment options available for patients with low back pain. In occupational low back pain, shorter chiropractor care had a benefit for reducing work-disability recurrence and longer chiropractic care did not show a benefit for preventing work-disability recurrence when analyzing tha data from workers' compensation claims data. SM helps to reduce time lost due to workplace back pain, and thus employer savings.

Comments on Cost-benefit 1

(Please put comments here.) Eubulides (talk) 23:33, 14 May 2008 (UTC)

• First comment is that any SM should be changed to SMT. I changed the first thinking it was a typo. This is going to run into similar problems as effectiveness, where the sources are talking about the cost-effectiveness of SMT, not the cost-effectiveness of chiropractic.DigitalC (talk) 00:02, 15 May 2008 (UTC)
• If There is no evidence that SM is superior to other treatment options available for patients with low back pain.is to be included, it should be changed to There is no evidence that SMT is either superior or inferior to other treatment options available for patients with low back pain. In accordance with the following quote from the conclusion of the article "Neither did we find evidence that these therapies are superior to spinal manipulative therapy.". However, this source is not EVEN on cost effectiveness of SMT, it is on effectiveness of SMT, and as such should not be in this section.
• after an initial therapy. is grammatically incorrect. After initial therapy, or after an intiial treatment would be grammatically correct.
• When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SM. Again, this falls into the trap of assuming that this is Cost-benefit of SMT, and not Cost-benefit of Chiropractic. Chiropractors use physiotherapeutic exercise as a treatment.
• The small risk associated with manipulation of the cervical spine could be avoided with the use of nonthrust passive mobilization movements. This one is a POV statement, and I will have to search for a source the backs that it is POV. From my understanding the risk is the same for any grade of mobilization. DigitalC (talk) 00:49, 15 May 2008 (UTC)

Actually, the research suggests that manipulation and mobilization carry the same risk. In fact, the same risk as performing a cervical range of motion exam. So not only is it POV, it's not accurate. Is there a reference for it? -- Dēmatt (chat) 03:43, 15 May 2008 (UTC)

Yes, it is referenced, but I agree with you that research suggests that any movement of the cervical spine carries the same risk.DigitalC (talk) 04:10, 15 May 2008 (UTC)

I am pretty much against the majority of the content which Quackguru added. . . moreover I am petrubed by the manner in which it was added. Discussion about Reformers should be removed. . . along with the contentious efficacy and research section.TheDoctorIsIn (talk) 01:03, 15 May 2008 (UTC)

I feel there are severe limitation still in this version although there is undoubtedly some good to it too. We can work with this and make it much better and more relevant, however. The validity some of the information presented here is highly suspect and there are major omissions still. For example, scientific research into chiropractic has been done by chiropractors, believe it or not, since the 1920's. I thought we are supposed to be discussing scientific investigation of chiropractic care, not SMT. They're not the same. What about the NIH study? That was a landmark one in 1976. The New Zealand study in 1979? The Meade study, the Rand study, etc? These are all SPECIFIC to CHIROPRACTIC CARE. Just because they're old doesn't mean that their invalid. The Crick and Watson paper (1955) after all, is holding up well. Also, there has been some pretty bad cherry picking that is either a violation of WP:POINT or WP:COATRACK. If our allopathic editors want to play that game, we can have a tit for tat war with inserting trivial facts that present the OTHER POV. For example, the addition of the "Canadian DCs don't know how to research" is a bit over the top. This study was done in the province of ALBERTA representing less than 15% of Cdn DCs most of whom graduated when the EBM era hadn't arrived. There are more examples, but I must go back to work. Too bad these edits had been railroaded in, and supported blindly by the usual suspects. Also, Fill -- your comment was in poor taste. If you think the Citizendium article with it's lead (with a direct quote taken from 1966) applies here, you're not up with the times. Also, the medical community here is editing against the evidence which I find distressing. Lastly, Ernst is being used throughout this article to negate, trump or override the sound opinion of EXPERTS in SMT and EFFECTIVE and CHIROPRACTIC CARE. This practice must stop. CorticoSpinal (talk) 16:58, 15 May 2008 (UTC)

• The current version emphasizes scientific investigation of chiropractic care. This inevitably means heavy coverage of SMT, since SMT is a core component of that care.
• If an old study is truly landmark it can be expected to affect current reviews. If not, then we shouldn't be mentioning it ourselves. We should rely on expert opinion as to what is important and what is not. We should not be making those calls ourselves, when the expert opinion is already available.

• No, and SmithBlue told you this already. If the purpose of the review is not congruent with the given topic, the review is not valid and should not be used. DCs would consider Manga to be landmark, MDs not so much. So we are to rely on MD reviews? CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)

• SmithBlue's argument, while valid, is not a get-out-of-jail-free card that will let an editor ignore a review whenever they please. It requires a good reason that the review is not congruent with the given topic. No reason has been advanced for any of the reviews cited in Chiropractic, so in no case has there been any justification for ignoring expert reviews and reaching down into the reviewed sources. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• I agree that reaching down and inserting trivial facts from primary studies is not the way to go. If that exists in Chiropractic now, we should fix it.
• The "Canadian DCs" stuff has been removed (for now; until someone reverts it again, I suppose). That stuff is contentious and was not discussed before inserting. I agree that it is potentially controversial and deserves careful review first.

• It was an attribution problem; and the Grod citation should have been used to demonstrate the opposing POV to make it NPOV. CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)

• Sorry, I don't follow this remark. Anyway, I don't see "Canadian DCs" in the current version, so perhaps this point is moot now? Eubulides (talk) 07:35, 19 May 2008 (UTC)

• Many (most?) cites to Ernst are not to things that override expert chiropractors. The exceptions are marked as such (e.g., "a critical review"). At least, that's the intent; if there are problems in this area then let's please discuss fixes.

19:18, 15 May 2008 (UTC)

• Ernst is pushed on every single CAM article and although his opinion is certainly notable (that's NEVER been debated) the weight, tone and influence of his words, especially in chiropractic has been a huge problem since he was pushed onto the scene in Feb 08. Mainstream doesn't even agree with his views on SMT, this is illustrated with the American College of Physicians recommending SMT for LBP whereas Ernst still says its "dangerous" with "no proven beyond a resonable doubt" and "adds costs". Essentially, all his statements are in direct conflict with bulk the mainstream literature. His star is fading as he continues his witch hunt and if he's reading this I think he's a massive douche bag and the quality of his papers re: chiropractic care are by far the most biased, unbalanced, unobjective and misleading ones out there. He should take a cue from Kaptchuk (1998) who can raise concerns but present both sides. CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)

• There is certainly a difference of opinion in mainstream medicine about the effectiveness of SMT. The American College of Physicians does not "recommend" SMT for LBP; it lists it as a "likely effective" therapy, along with massage therapy, acupuncture, willow bark extract, and devil's claw.[34] There is substantial disagreement among low back pain guidelines, with some of them agreeing more with Ernst and some agreeing more with chiropractors (see Murphy et al. 2006, PMID 16949948). It is highly misleading to cite just one group in this area and to pretend that it is the final word, and Chiropractic should fairly represent all sides, including both the skeptics and the proponents of chiropractic. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Manipulation of the cervical spine (MCS) is used in the treatment of people with neck pain and muscle-tension headache. The purposes of this article are to review previously reported cases in which injuries were attributed to MCS, to identify cases of injury involving treatment by physical therapists, and to describe the risks and benefits of MCS. One hundred seventy-seven published cases of injury reported in 116 articles were reviewed. The cases were published between 1925 and 1997. The most frequently reported injuries involved arterial dissection or spasm, and lesions of the brain stem. Death occurred in 32 (18%) of the cases. Physical therapists were involved in less than 2% of the cases, and no deaths have been attributed to MCS provided by physical therapists. Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements). The literature does not demonstrate that the benefits of MCS outweigh the risks. Several recommendations for future studies and for the practice of MCS are discussed.

Here is the abstract from the Di Fabio RP ref. The risk can be avoided with the use of mobilization (nonthrust passive movements). Thanks. QuackGuru 04:23, 15 May 2008 (UTC)

As above, yes you have a source for it. However, it is POV, in that other sources state that the risk is the same for manipulation, mobilzation, range of motion examination, and shoulder-checking while driving.DigitalC (talk) 05:15, 15 May 2008 (UTC)

Please provide a list of other sources. QuackGuru 05:21, 15 May 2008 (UTC)

Please see Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
 • we deem that where it is the mere movement of neck tissues that causes a risk factor to be an absolute contraindication to an HVLA thrust, manipulation that is not HVLA or mobilization are equally contraindicated by this factor, see also Rome P.L. “Perspectives: An Overview of Comparative Considerations of Cerebrovascular Accidents”, Chiropractic Journal of Australia 1999; 29(3): 87-102, as well as Terrett A.G. Current Concepts in Vertebrobasilar Complications following Spinal Manipulation. Des Moines, Iowa: National Chiropractic Mutual Insurance Company, 2001. DigitalC (talk) 05:38, 15 May 2008 (UTC)

The word however was added to a sentence. I do not see any reason for this. QuackGuru 07:52, 15 May 2008 (UTC)

"However" is a connecting adverb meaning "nevertheless, in spite of that, etc". "However" used correctly in a sentence will suggest that that sentence disagrees in sense somewhat with the preceeding sentence(s). In this case, it was used to tie two sentences together to improve flow, so that it wasn't so choppy.DigitalC (talk) 00:39, 19 May 2008 (UTC)

I have not yet had time for a detailed review of #Cost-benefit 1 (I've been tied up with the aftermath of the recent Effectiveness changes) but here is a quick first reaction:

• It's much improved from #Cost-benefit 0, but still needs quite a bit of work.
• It refers directly to many primary studies. It should focus instead on what recent reviews say, e.g., van der Roer et al. 2005 (PMID 15949783), Canter et al. 2006 (PMID 17173105), Cherkin et al. 2003 (PMID 12779300). Primary sources should be used only with good reason (e.g., if they're too new to be reviewed and are obviously important). Eubulides (talk) 09:00, 15 May 2008 (UTC)
• Isn't Assendelft et al. 2003 (PMID 12779297) superseded by Assendelft et al. 2004 (PMID 14973958). Why cite the obsolescent source?
• Let's stay away sources older than 5 years old. They're too dated. If a subject hasn't been reviewed in the past 5 years, then it's probably not worth summarizing here.

This makes no sense. Historically chiropractic care has been shown to be cost effective, why ignore the data? There's a reason why DCs SPECIFICALLY have been invited to participate in integrative models of care. Result? Less costs again. CorticoSpinal (talk) 17:03, 15 May 2008 (UTC)

Again, there is no intent to ignore old data. If old data is still important, it should appear in a recent review. If it doesn't appear, that's good evidence that it wasn't that important after all, at least according to published expert reviewers. Eubulides (talk) 19:18, 15 May 2008 (UTC)

Again, you are missing the point regarding the validity of some of the reviews. Let me paraphrase, again, what SmithBlue and myself have been telling you for quite some time now: if the purpose of the review is not congruent with the topic at hand, then it is not valid. There are severe logical flaws in your reasoning and you've used the same excuse for 4 months to keep out extremely reliable and valid "primary" studies that are far more valid and academically robust than some of the reviews supported by yourself. A refusal to include studies which meets WP:RS, WP:V and are from indexed peer-reviewed journals will forever prevent from making this article NPOV. CorticoSpinal (talk) 23:18, 16 May 2008 (UTC)

No argument has been put forth that the reviews in question are incongruent with the topic at hand. On the contrary, the reviews are quite congruent with the topic of effectiveness. There is no good reason to disregard reliable reviews and to substitute our own opinion about the the reviewed studies. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• The text flows poorly. Contradictory sentences are run together without any explanation. The text needs to tell a consistent story and hang together; currently it doesn't do that well at all.

Eubulides (talk) 09:00, 15 May 2008 (UTC)

And yet, attempts to make it flow better are met with objection.DigitalC (talk) 00:02, 16 May 2008 (UTC)

• Minor grammatical point: "the most cost-effectiveness treatment" Please delete "ness" from end of word. ☺ Coppertwig (talk) 03:08, 16 May 2008 (UTC)

I have updated the cost-benefit section. It flows very well now. QuackGuru 15:43, 23 May 2008 (UTC)

Cost-Benefit of Chiropractic Care 2a: Work in Progress

The benefits of chiropractic care seem to outweigh the involved risk. A 2007 retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs . This effect was greater on a per-episode basis than on a per-patient basis. Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain. A 4-year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399). The authors concluded: "Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care." In occupational low back pain, shorter chiropractor care had a benefit for reducing work-disability recurrence and longer chiropractic care did not show a benefit for preventing work-disability recurrence when analyzing tha data from workers' compensation claims data. In 2004, Workmans Compensation evaluated the effectiveness and cost-effectiveness of chiropractic care for acute low back injuries and demonstrated that chiropractic care was superior to physical therapy in reducing pain, inproving perceived disability, and lost work time (9 days for chiropractic care in comparison to 20 days for physiotherapy). . This is in general agreement with previous Workmans Compensation analyses' which chiropractic care is equal or superior to standard medical care. A 1999 Medicare study revealed that "The results strongly suggest that chiropractic care significantly reduces per beneficiary costs to the Medicare program. The results also suggest that Chiropractic services could play a role in reducing costs of Medicare reform and/or a new prescription drug benefit." A demonstration project regarding an expansion of coverage of chiropractic services was launched in 2005. Under this demonstration project, chiropractors will be allowed to bill medical, radiology, clinical lab and certain therapy services related to the treatment of neuromusculoskeletal conditions.

Comments of Cost-effectiveness 2a

Before I get hounded, this is a very quick draft; it is by no means complete and I will integrate the best of QGs draft into when I have a bit more time. There are tons of workmans comp studies to include but the bulk of them say chiropractic care (for NMS disorders) is cost effective and patients prefer it to standard medical care (don't know if PT is included in this or not, we should find out so we don't lump in PT care with med if appropriate). The preliminary results of the just completed Chiropractic Medicare Demonstration project in the US shows this trend continues, but I'm willing to simply state there's been a cost-effectiveness and effectiveness project done by the DoD, Medicare and DVA in the US to determine the merits of integrating chiropractic care into managed, governmental programs. St-Mikes deserves a mention too; I think its the first hospital in North America to have permanent inclusion of DCs on staff who are fully integrated (i.e. full time employee status). I'm not quite sure of the situation in the US; although I do know there is a small, but increasing # of DCs who have hospital privileges. The trend is that this is increasing too. CorticoSpinal (talk) 22:53, 16 May 2008 (UTC)

This draft relies on primary studies when it should rely on reliable reviews. For cost-effectiveness we have enough high-quality reviews that there's no need to reach down into primary studies ourselves. Chiropractic's current cost-benefit section is bad enough, but at least it cites some reviews relatively fairly; this proposed 2a replacement is far worse in that regard. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Well, it certainly appears thorough. I'll have to check the sources as Eubilides suggests, but it's a start. BTW, I haven't quite found my way around this talk page, so if there is something that is no longer of any use, how about archiving it so I don't strike up another conversation about something that is already settled. -- Dēmatt (chat) 19:41, 20 May 2008 (UTC)

• It's the "appears thorough" that worries me. By citing primary sources in addition to the secondary reviews, it's making the evidence appear stronger than it is, or it is arguing with the reviews (I don't know which, as I haven't had time to read all that stuff). Either way, it should be fixed, preferably by dropping citations to the primary sources (I don't see why they're needed, but again I haven't read the sources yet).
• Currently we're relying on auto-archiving; the page is getting a tad big to navigate through (or archive) by hand.

Eubulides (talk) 22:16, 20 May 2008 (UTC)

So, you haven't investigated the sources but object to them? Stop trying to omit valid studies that aren't covered by reviews. Geez, how many times in 4 months can you use the same argument, over and over again with many different editors disagreeing with the way you interpret MEDRS? CorticoSpinal (talk) 18:28, 21 May 2008 (UTC)

Has anybody actually read the sources? So far, I see no evidence that anybody has. As far as I can tell, this cost-effectiveness draft was generated by someone who read only the abstracts. Someone (and it will probably be me, sigh) will have to actually read the sources. I am skeptical that there will be any need to cite the primary sources, because I expect that review will cover the material in question. Eubulides (talk) 20:13, 21 May 2008 (UTC)

I've read the sources used in the draft. The claims are supported by the literature. Many of the papers are interdisciplinary collaboration, between DCs and MDs. So, a lot of bias goes out the window there. If we can find reviews that addresses all the points made above then obviously we can choose a review, however I doubt that one review will cover all the specific points. Tertiary sources such as governmental studies could be used as well. CorticoSpinal (talk) 23:23, 21 May 2008 (UTC)

By "reading the sources" I do not mean just reading the abstracts. I mean reading the entire papers. I still don't see any evidence that anybody has actually read the sources. Eubulides (talk) 08:35, 22 May 2008 (UTC)

I haven't read all the sources either, but I have now read the draft, and it is far inferior to what's in Chiropractic#Cost-benefit, a section that itself is not that strong. We'd be better off starting from the existing section than from this draft. Here are some specific comments. Some of these comments also apply to Chiropractic#Cost-benefit (as some of the text is in common).

• The most important complaint is that this section consists entirely of cites to primary studies. It should rely on reliable reviews where these are available. It should lead with the results from reviews, and should fill in with primary studies only when necessary. Currently it does just the opposite: it leads with primary studies, and emphasizes their results, and doesn't report reviews. This is backwards from what WP:MEDRS recommends, and means that there is all-too-great opportunity for our bias to leak into the text.

• "The benefits of chiropractic care seem to outweigh the involved risk." This is just a primary study, and should not be the lead sentence in the section. Also, the cited source does not talk about chiropractic care in general, just about chiropractic care for neck pain. Also, this relies on a single primary study and should say so. A better summary would be "A 2007 Dutch study found that the benefits of chiropractic care for neck pain seems to outweigh the involved risk." but this summary should not be used to lead the section. Eubulides (talk) 08:35, 22 May 2008 (UTC)
• "A 2007 retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone." Again, this is a primary study and should not be emphasized so strongly, at the start. The second "clearly demonstrates" sentence is POV and is not supported by the source. The source's conclusion makes it clear that these results are for one IPA and may or may not generalize to others. The first sentence is way too long, given that it's summarizing just one primary study. The study is just about costs, not cost-benefit, and as such is of limited use in this section. I suggest creating a new section Cost for material like this.
• "For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs . This effect was greater on a per-episode basis than on a per-patient basis." Again, this is just one primary study. This is a direct and extended quote from the abstract, without quote marks, and as such is too close to being a copyright violation for comfort. The study is just about cost, not cost-benefit, so it'd be more appropriate for a Cost section.
• "Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain." Again, this is simply quoting the abstract from a single primary study; we can't do that. Somehow the quote managed to skip around the fact that this study found that chiropractic care costs were higher. This study is rarely cited elsewhere (I checked Google Scholar) and is suspect for that reason.
• "A 4-year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399). The authors concluded: "Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care." This is a higher-quality primary study, but there's way too much here for Chiropractic. Again, this is a copyright violation. Again, this is just a primary study; we should be focusing on the reviews.
• "In occupational low back pain, shorter chiropractor care had a benefit for reducing work-disability recurrence and longer chiropractic care did not show a benefit for preventing work-disability recurrence when analyzing tha data from workers' compensation claims data." Again, this is just citing a single primary study; here there is a bit more excuse for citing it (it's too recent to be reviewed) but the wording could be shortened quite a bit without harming this dicussion.
• The remaining text is supported by lower quality studies (some not peer-reviewed, some older) and I won't bother to review it here now.
• In short, this is a real step down in quality from what is in Chiropractic now. At least the current version cites three reviews and summarizes their results. This draft ignores the reviews. There is a great deal of possible bias inherent in going out and reviewing primary sources ourselves. We should resist that temptation by relying on reliable reviews whenever possible, as is largely the case here.

Eubulides (talk) 08:35, 22 May 2008 (UTC)

Your concerns of bias do not ring true. It is YOUR source, a secondary source nonetheless that has been demonstrated to be very biased and have severe design flaws. None of the primary studies cited have this deficiency. In other words, the review that is currently included is not valid and has been refuted but it being given a free ride despite the fact it's been rebutted. It's not a quality paper. You should resist the temptation of citing crap reviews that conform to your personal POV and goes against mainstream consensus. Yes, that's correct, Ernst's conclusions on SMT and chiropractic care goes against mainstream consensus. Which makes his opinion fringe. And his studies are flawed, so now we are citing flawed, fringe material as fact with 0 qualifiers. Is this the kind of "NPOVing" you want to bring to the article? CorticoSpinal (talk) 23:43, 26 May 2008 (UTC)

Wikipedia is not the place to conduct research reviews on our own, overriding reviews already published by experts in the field. Multiple reviews are cited in Chiropractic #Cost-benefit; they are not all by Ernst. Other reliable review sources are welcome, as per the usual WP:MEDRS guidelines. Reaching down into primary studies is dubious; Chiropractic #Cost-benefit already does way too much of this (and this should be fixed). Rewriting it to remove all mention of reviews, which is what is being proposed here, would be a step that is way, way in the wrong direction. Eubulides (talk) 08:08, 27 May 2008 (UTC)

Sorry to stop by in the middle of a POV war

This talk page is too long for me to follow with the limited time that I have available, so basically I have to read the article and make edits as I see them. Hope you don't mind. You can always revert anything I may be misunderstanding.

I did remove this as it seems unsupported by the citation:

• Opinions differ on the efficacy of SMT for nonspecific or uncomplicated low back pain.

-- Dēmatt (chat) 02:01, 15 May 2008 (UTC)

The cited source (Murphy et al. 2006, PMID 16949948) says, "Inconsistencies in the evidence suggest that there is continuing conflict of opinion regarding: efficacy of SMT for treatment of nonspecific or uncomplicated LBP; optimal time in which to introduce this treatment approach; whether SMT is useful for treatment of chronic LBP; and finally, whether subacute LBP actually exists as a separate category requiring a specific treatment approach in its own right." Its conclusion says, "In conclusion, this study showed that the treatment of LBP remains as ambiguous as before and that the way best evidence is being interpreted could play a large role in this." I made this change to reword the statement to be closer to the cited source. Eubulides (talk) 02:20, 15 May 2008 (UTC)

The article is about guidelines for the treatment of nonspecific LBP. The cited source actually says:

• RESULTS: According to best evidence from review of the Cochrane database of systematic reviews, there remains a lack of consensus regarding reported efficacy of spinal manipulative therapy for the treatment of nonspecific LBP. Furthermore, the guidelines reviewed in the present study have not changed significantly with respect to treatment recommendations for nonspecific LBP since the original review, and there is inconsistency between the guidelines regarding optimal time to introduce spinal manipulation to treat nonspecific LBP. CONCLUSION: Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence.

The source was actually about guidelines for the treatment nonspecific LBP. In my opinion, to cherry pick the SMT sentence from the results section when it is not mentioned under the authors conclusions, makes this statement very weak. We should be able to find better. I will make an attempt myself to make it less POV. Wish me luck. -- Dēmatt (chat) 02:41, 15 May 2008 (UTC)

Here was my attempt to clarify. -- Dēmatt (chat) 03:03, 15 May 2008 (UTC)

The "continuing conflict" quote is from the lead (2nd sentence) of the discussion section, not from the results section. The "the way best evidence is being interpreted" quote is from the conclusion. It is true that the source is primarily about nonspecific low back pain, and thanks for catching that: I was misled because the source does review a RCT for uncomplicated LBP and mentions this in the discussion section. The attempt-to-clarify replaced discussion of efficacy with discussion of recommended treatment, but this section of Chiropractic is the Effectiveness section, not the Treatment section, so this section should focus on what the source says about effectiveness, not on what the source recommends for treatment. And what the source says about effectiveness (and underlines in its conclusion) is that opinions differ widely and that experts are interpreting the best evidence quite differently. I made this change to bring the wording back to effectiveness, noting (as mentioned above) that the review is about nonspecific LBP and not about LBP in general. Eubulides (talk) 07:27, 15 May 2008 (UTC)

This doesn't seem suppported by the reference either:

• An authoritative 2004 review found that SMT/mobilization is effective only when combined with other interventions such as exercise.

-- Dēmatt (chat) 02:13, 15 May 2008 (UTC)

The cited source (Gross et al. 2004, PMID ) says in its conclusion, "Multimodal care, including mobilisation and/or manipulation plus exercise, is beneficial for pain relief, functional improvement and global perceived effect for subacute/chronic mechanical neck disorder with or without headache. The evidence did not favour manipulation and/or mobilisation done alone or in combination with various other types of treatments for pain, function, and global perceived effect." I made this change to reword the statement to be closer to the cited source. Eubulides (talk) 02:41, 15 May 2008 (UTC)

I added the details. Funny how they both say the same thing, but they feel so different? -- Dēmatt (chat) 03:13, 15 May 2008 (UTC)

That edit removed the very important detail that the evidence did not favor SMT and/or mobilization done alone. I made this change to restore that detail. The "with or without headache" didn't seem that important so I omitted it; please restore that phrase if you disagree. Eubulides (talk) 07:42, 15 May 2008 (UTC)

Ok with deleting headache. My impression is that my wording was as accurate as yours, but you chose the negative while mine chose the positive. Is there a middle ground? ---- Dēmatt (chat) 04:52, 16 May 2008 (UTC)

I disagree that your wording was as accurate, because it omitted the important detail that the evidence did not favor SMT and/or mobilization unless they were combined with exercise. That is, the original source did not merely look at SMT/mobilization + exercise and say "that's good"; it looked at SMT/mobilization + exercise and said "that's good" and it also looked at SMT/mobilization without exercise and said "that's no good". The second part of these results also needs to be mentioned. The exact wording I'm not that hung up on. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Good point, let's try to make it a little more neutral by taking out "authorative" and rearranging it some while adding in the "not without exercise".

• A 2004 review found that SMT and mobilization for the cervical spine are beneficial for pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder when combined with exercise. Without exercise, or with other modalites, SMT did not fair as well.

Or something like that.

-- Dēmatt (chat) 15:06, 19 May 2008 (UTC)

It's OK to remove "authoritative" (Chiropractic currently says "comprehensive") but "Without exercise, or with other modalites, SMT did not fair as well." is too vague; that could mean that SMT is still known to be effective without exercise, just not as effective as with exercise. It should say that the evidence does not favor SMT done without exercise. Is the current wording not neutral? It says "Of three systematic reviews of SMT published between 2000 and May 2005, one reached a positive conclusion, and a comprehensive 2004 review () found that SMT and mobilization are beneficial only when combined with exercise, the benefits being pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder." Eubulides (talk) 20:47, 19 May 2008 (UTC)

It's unfortunate that certain editors here try spin something that is neutral in the conclusions that ends up with a bad tone. For the record, Dematt, I have told Eubulides this since he first began editing at chiropractic in February 2008. Isn't it part of WP:AGF that we extend good faith to the article we're writing? You know, assume the best? We can't be skeptical at all parts at all times, this article and profession are treated like ultimate fringe when the reality is, it's practically mainstream. A serious POV shift needs to be take place for the skeptics. CorticoSpinal (talk) 23:36, 16 May 2008 (UTC)

This is not about spin; it is about summarizing the source accurately. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Again, this source says nothing about 'prognosis':

• A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that manual therapies and supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis. A 2007 review found that SMT and mobilization are effective for neck pain.

The source says:

• For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.

• The cited source (Hurwitz et al., PMID 18204386) talks about prognosis in a "Key Points" box on page S149. There are 4 key points. The 3rd one is: "There is (1) no evidence that a particular course of care with any intervention improves the prognosis for whiplash or other neck disorders; (2) some evidence that high rates of health-care use may slow recovery from whiplash; and (3) little data on cost effectiveness." I noticed that your quote from Hurwitz says "there is evidence that X" rather than X, which is worth mentioning, so I put that in this change which restored the Hurwitz citation but mentioned the "evidence" bit.

My problem seems to be that I don't have access to something that you are looking at (the box). All I have is the pubmed abstract. Do you have the actual link to the article that you are looking at? ---- Dēmatt (chat) 04:44, 16 May 2008 (UTC)

I have the actual article from here. Unfortunately it is copyrighted and I cannot redistribute it. Perhaps your local library can get you a copy. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Understandable. How about we ditch the "prognosis" part then. It makes it hard to verify. I will entertain other source though. -- Dēmatt (chat) 15:18, 19 May 2008 (UTC)

Most of Chiropractic's sources are copyrighted and are not freely readable; why discriminate against this one? This source is a recent high-quality review and is widely available (even if it's not free). We have verified the point in question by quoting one of the article's key points. Eubulides (talk) 20:47, 19 May 2008 (UTC)

• There were actually two sources here. That same edit removed the sentence "A 2007 review found that SMT and mobilization are effective for neck pain." citing Vernon & Humphreys 2007 (PMID 17369783). But you didn't discuss that part of the change. Was it intended? If so, why? If not, then let's please restore that sentence and citation.

Eubulides (talk) 08:07, 15 May 2008 (UTC)

That was purely accidental - slip of the mouse! ---- Dēmatt (chat) 04:52, 16 May 2008 (UTC)

This change to a sentence does not seem to focus on the topic at hand (effectiveness). QuackGuru 03:00, 15 May 2008 (UTC)

Yes, that problem is further discussed above (sorry, I am working my way through the comments and didn't see yours until just now). As discussed above, I fixed that problem here. Eubulides (talk) 08:14, 15 May 2008 (UTC)

Mainspace may not be the place to ask questions.[35] QuackGuru 03:00, 15 May 2008 (UTC)

The reason it says "or mobilization" is because the source says it. Is mobilization irrelevant here? Chiropractors use mobilization, right? I don't see why the "or mobilization" was removed in that edit. Perhaps Dematt can explain? Eubulides (talk) 08:14, 15 May 2008 (UTC)

I've run out of time tonight. I only made it to the whiplash section. I haven't been able to make it through everything, but it looks close. I do agree with Eubilides that some of this was probably just added a little prematurely. I like the way you've been working it through on the talk page first. -- Dēmatt (chat) 03:38, 15 May 2008 (UTC)

I disagree with this edit. The reference is a 2004 ref. There is a 2006 Canter review of the 2004 ref. We should use the newer ref that says the 2004 ref as an authoritative source. The 2006 ref does not say all of this when I looked at it. We should use the newer 2006 ref that is currently available. The 2004 ref does not say it is an authoritative review. Thus, it fails verification. QuackGuru 04:05, 15 May 2008 (UTC)

As discussed above I made this change to change that wording to match the 2004 source (Gross et al.) better. The 2006 source (Ernst & Canter) is not as authoritative as the 2004 source, and it's not clear what the 2006 source brings to the table, other than saying that the 2004 source is "authoritative". Is there a serious challenge here as to whether Cochrane reviews are authoritative? I don't know of anybody seriously disputing that. If it's a real issue, perhaps the simplest thing is to remove the word "authoritative"; it hardly seems worth the trouble to plant a footnote after every use of that adjective. Eubulides (talk) 08:24, 15 May 2008 (UTC)

Yes Cochrane reports are authoritative, but it's preferable to avoid peacock terms. WP:PEACOCK lists authoritative in it's list of "Words and phrases to watch for". Jefffire (talk) 08:36, 15 May 2008 (UTC)

One undiscussed minor change made in the above run was to change "SMT is no more or less effective than other interventions" to "SMT is no more or less effective than standard interventions" when summarizing Assendelft et al. 2004 (PMID 14973958). However, the cited source actually says "There is no evidence that spinal manipulative therapy is superior to other standard treatments", which implies (contrary to what Chiropractic currently says) that SMT is a standard treatment. To match the source better I changed "standard" to "other standard". Eubulides (talk) 08:42, 15 May 2008 (UTC)

After the "massive edit", most of the above seems moot now, but for future reference, I think your overall edits brought the article too far back toward the "other POV", but I am pretty sure we would have gotten there eventually. Maybe we'll get another chance? It was fun working with you! ---- Dēmatt (chat) 04:39, 16 May 2008 (UTC)

I hope we do get another chance. I do appreciate working with you. With the big stampede of partisan edits (by both sides) this may be difficult, though. Eubulides (talk) 07:35, 19 May 2008 (UTC)

First, Eubulides fails to realize that Cochrane reviews are generally only good for 2 years. This is the length of time that they usually update their lit synthesis and modify the content. So, a 2004 "authoritative" Cochrane review is outdated 2 fold. It's these types of edits and wikilawyering that it's a "reliable review" to omit more recent evidence (i.e. 2007 American College of Physicians clinical practice guidelines for LBP) and more comprehensive studies (WHO Bone and Joint Decade 2000-2010 Neck Pain Task Force) which presents a vastly different conclusion (i.e. manual therapy is effective for grade 1,2 neck pain) but claiming that manual therapy is not effective for neck pain. I think Eubulides forgets he's dealing with other health care professionals and scientists who know how to appraise the literature and know the difference between what's generally right and what's generally BS. Eubulides edits promotes a fringe viewpoint of mainstream medicine while exploiting the fringe elements of chiropractic at the expense of the mainstream majority of the profession. CorticoSpinal (talk) 04:55, 16 May 2008 (UTC)

• All of the Cochrane reviews currently cited by Chiropractic have "2008" on them when you visit them, which means Cochrane thinks they're up-to-date. They are periodically reviewed and can be kept unchanged, or unchanged with comments.
• There are certainly other opinions out there, but the Cochrane reviews are very high quality, and are more authoritative than the alternatives mentioned.

Eubulides (talk) 07:35, 19 May 2008 (UTC)

Personally, I have no problem including as many studies as we need to fully discuss the issues. The net result is that, while the jury is out on the use of spinal manipulation for Type O (organ related) conditions, its use for low back pain, neck pain and headaches is at least as good as any other medical intervention and, regardless of opinion, it is relatively safe. Now, we can either say this in the two sentences that I have written above, or we can cite every source possible and I am quite sure the net result will be the same for spinal manipulation. Now for the issue of spinal adjustment - we have wiped the article pretty much clean of the fact that chiropractors do other things besides spinal manipulation. IOWs, chiropractic <> SMT, as Cortico and Digital suggest. -- Dēmatt (chat) 14:11, 16 May 2008 (UTC)

I don't think the evidence is quite as strong as that. For low back pain and relative safety I agree with you. But for whiplash, neck pain, and headache there is not a strong consensus that SMT is at least as good as any other medical intervention. And by "jury is out" do you mean "the evidence is weak" for organ-related conditions? Eubulides (talk) 07:35, 19 May 2008 (UTC)

Well, I would start with what we do agree with then:

• Generally, the research supports the use of spinal manipulation for the treatment of low back pain as effective and relatively safe.(refs) For neck pain, whiplash and headaches, some evidence supports its use and yet some does not. So-and-so says blah blah blah(ref), while Yoman says blah, blah(ref). For the treatmetnt of type O, or organ related problems, there is a lack of research to make any determination either way (ref).

Of course, that is just a start. You could come up with the not so good research and I'll let Cortico come up with the other stuff :-) -- Dēmatt (chat) 18:42, 19 May 2008 (UTC)

Isn't that what this version did? Albeit at somewhat more length. (This is the version suggested in #Version suggestion below.) Eubulides (talk) 20:47, 19 May 2008 (UTC)

“ While the jury is out on the use of spinal manipulation for Type O (organ related) conditions, its use for low back pain, neck pain and headaches is at least as good as any other medical intervention and, regardless of opinion, it is relatively safe. Now, we can either say this in the two sentences that I have written above, or we can cite every source possible ”

I have been saying the same for the last 2 months yet the skeptical editors wanted to cherry pick the evidence and drum up a 'false consensus' that there was real doubt re: the effectiveness of SMT for mechanical spinal syndromes and certain HAs and completely negate the possible' validity of SMT for certain Type O conditions. I've always said that DCs will live and die by the research sword and that science will drive practice and philosophy (as per Triano) and not vice-versa. Publish or perish. It's that simple. If there really was no connection between SMT and visceral dysfunction clearly the notion of SMT as a Tx for this would have died. Yet its somehow survived for 113 years. Interestingly, as Hawk et al suggest reducing chiropractic to SMT and studying that instead of the whole clinical enccounter (which averages 18 min, its takes 10-30s for to deliver an adjustment) might have been the critical flaw in the research designs when looking at chiropractic care for Type 0 conditions. Also, with the increasing prevalent model of health promotion/wellness coming into play, it would be foolish to assume that this type of intervention doesn't not play a positive role in improving the quality of life of patients. Orthodox medicine fails miserably in really looking at all the determinants of health and want to find some kind of reductionistic measure. Qualitative research designs are much better suited for the type of research required to truly understand the value (if any) of DC care for Type O.

[outdent] Yetmore evidence demonstrating that mainstream medicine is embracing manual medicine. Who are the expert providers of manual therapy (done by hand)? Hint, it's in their name (done by hand). Skeptics focus so much on the outdated fringe chiropractic philosophy at the expense of the inclusion of the cold hard facts: philosophically, allopathic and chiropractic medicine at the opposite spectrum; but that doesn't mean the main methods used by chiropractors aren't valid. Manual medicine is a real, its a traditional form of medicine and we shall present this piece of the chiropractic story. Also, we really should the science of chiropractic; i.e. science of manual therapy and holistic, conservative health care. Scientific investigation right now is a sham; it's a SYN of SMT (which is great for the SMT article) and the generalizable points must be covered here at the main article; nonetheless, this is article is the story of chiropractic medicine. I shall begin a proposal after the long weekend. It will be a historical-to-present account of the major scientific developments within the profession which will surely raise eyebrows (because why would skeptics really want to get that out). To be perfectly fair, I also propose a Criticisms section where we can roll the main concerns/criticisms in a nice, tidy section and avoid dumb WP:POINT violations. For example, a criticsm of chiropractic care is a perceived lack of professionalism and ethics, improper advertising/marketing, the clinical value and weight of subluxation (note that mixers and straights give the VSC different weight, this is fundamental to understand), debates regarding safety, cost-effectivness of SMT and others I'm sure that QuackGuru will dig up. It's all fair game and must be treated fairly. So, I'm also proposing a Integration into the Mainstream section, with reviews, studies, sociological lit, government docs that demonstrate a move towards the mainstream with chiropractic at crossroads (a la Meeker and Haldeman) and the paradox of continued opposition from POLITICAL medicine despite the successess of integrative (MD-DC) models of care. The story of chiropractic is so interesting yet wacky, we can cover it NPOV but it will require a significant paradigm shift from skeptics who edit. Yes, there are fringe elements of the profession. We can highlight these but not at the expense of soiling the views and credibility of the mainstream (non-fringe) chiropractic. Mixers, for better or worse, are going to determine the eventual fate of mainstream integration (it won't be the straights for obvious reasons, the least being they don't want to integrate) and their story needs more focus here. Thoughts?

Recent edits made without discussion

After this huge change was installed, containing many components that were installed without discussion, other editors have now felt that it's OK to install major changes to Chiropractic without discussion, despite a notice at the top of this talk page saying "Please read this page and discuss substantial changes here before making them." I view this new practice with great dismay: it's a recipe for an edit war. To document what's going on a bit better, here is a list of controversial edits made recently without any discussion.

• This edit reverted a revert of a revert etc.; basically, it reinstalls a large number of controversial edits which were installed without any prior discussion, as discussed in #Several important changes were never discussed.

I agree. We need to avoid reverting all the way back to older versions. You guys have been working hard to fine tune and when someone just wipes them all out, well, that is just frustrating for everyone, I think. -- Dēmatt (chat) 14:25, 16 May 2008 (UTC)

• This edit hoists material here, out of Chiropractic education, without discussion or consensus.

I think the chiropractic education section was inadequate as it was. I have no problem with returning some content from the Chiropractic education article. -- Dēmatt (chat) 14:28, 16 May 2008 (UTC)

Actually this material was "hoisted" AWAY for no real good reason and it essentially omitted the meat and potatoes of education namely, what are the various degrees earned internationally and what are the common elements of all chiropractic education? Considering how lengthy of a topic this could be and the length of the education article, this size is absolutely fair game for the main article. It's well referenced, it's relevant, it's valid and it's NPOV. CorticoSpinal (talk) 16:25, 16 May 2008 (UTC)

Chiropractic currently spends far too much time on the WHO model for how chiropractic education ought to be, and too little time on how chiropractic education actually is. The text also does not clearly state when it's talking about the ideal, as opposed to the reality. Certainly the WHO model is not followed "across the globe", despite what Chiropractic seems to claim. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• This edit inserts an older primary source to argue with a recent reliable review. The review in question already covers the older primary source in question, and this edit attempts to overturn the review, in a clear violation of WP:MEDRS guidelines. The edit also mischaracterizes the recent reliable review as a "study".

I think that the concept of maintenance care needs to be fully discussed and Cortico's edit was a good start. WP:MEDRS are guidelines, we might not be able to follow them to the T. -- Dēmatt (chat) 14:32, 16 May 2008 (UTC)

It is certainly reasonable to talk about maintenance care, and Chiropractic#Philosophy already does that. It is not reasonable to argue with a review by emphasizing one of the primary source's reviews. It is not our job to argue with reviews. We should be presenting their results as neutrally as possible. Eubulides (talk) 07:35, 19 May 2008 (UTC)

I have made the same plea to Eubulides to stop wikilawyering about his very, very rigid interpretation of MEDRS guidelines. Guidelines. Not policy, guidelines. Guidelines, which have been used thus far to omit valid, reliable sources. Case and point are the American College of Physicians clinical practice guidelines which recommends many non-pharmacologic options for LBP which SMT is one of many EFFECTIVE alternatives to standard medical care (pills).

There is no good reason in this particular case to argue with the review. Let's stick with what the review says. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Actually there is. You suggest that Ernst view of SMT represents the mainstream. That clearly cannot be the case for the American College of Physicians own clinical practice guidelines includes SMT as safe, effective alternative for LBP. So, when the most influential college of physicians in the world (the US) endorses SMT, that is the mainstream position. It shall stay, it more than meets WP inclusion criteria and the practice guideline itself is an expert review. CorticoSpinal (talk) 16:21, 20 May 2008 (UTC)

• The ACoP has not "endorsed" SMT. Its current recommendation strongly advises advice to remain active and self-care, with medications as needed. For patients who do not improve with self-care, it weakly suggests adding other therapies, one of which is SMT, which it says has small to moderate short-term benefits (for acute LBP) and moderate benefits (for chronic LBP; this is among 8 possible alternative treatments). These recommendations do not apply to children, adolescents, pregnant women, or to nonspinal LBP. See Chou et al. (PMID 17909209). It is misleading to collapse these recomendations into a statement of "endorses" or (as Chiropractic does to say that SMT was "recommended" by the ACoP.

• Did I use the word "endorse" or did you just misrepresent my statement yet again (18 and counting). Here's what I wrote: American College of Physicians own clinical practice guidelines includes SMT as safe, effective alternative for LBP. You should stop misrepresenting my words to strengthen your argument. That is a straw man tactic. Anything to mimize the effectiveness of SMT for LBP, eh? CorticoSpinal (talk) 18:59, 21 May 2008 (UTC)

• Yes, you used the word "endorse". You wrote "when the most influential college of physicians in the world (the US) endorses SMT". Please don't be so quick to assume misrepresentation. Eubulides (talk) 20:13, 21 May 2008 (UTC)

Here's what I wrote in the article "[SMT was]recommended in the 2007 clinical practice guidelines of the American College of Physicians"[95]. I did not use the word endorse. I'm not being quick to assume any misrepresentation, however DigitalC also said you misrepresented evidence as well and Dematt (and myself) has suggested you may be cherry picking the evidence. These are serious concerns which you have ducked, dipped, dove and dodged over the past 4 months with discussions with various editors. Now, if we were playing dodgeball I would commend your skills, however, we are trying to collaborate and write an encyclopaedic article. Please do heed our concerns and address them. CorticoSpinal (talk) 15:22, 22 May 2008 (UTC)

You wrote "endorses" here, in the talk page. My comment objecting to "endorse" was immediate response to the claim that the ACoP "endorses SMT". As mentioned above, the ACoP has not endorsed SMT. It has weakly recommended SMT as one of several alternatives after standard treatments fail. Chiropractic currently describes this weak recommendation inaccurately, and this needs to get fixed, independently of whether Chiropractic uses the word "endorse". Eubulides (talk) 16:58, 22 May 2008 (UTC)

• It would be reasonable to mention the ACoP position, as long as this was done accurately and neutrally, which is not the case now, as shown above. I suggest replacing ", although it was recommended in the 2007 clinical practice guidelines of the American College of Physicians " with ". For example, a 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail, whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help.".

Weakly? Lol, sure... anything to continue the marginization of SMT... good thing the consensus is that it's effective for mechanical LBP. CorticoSpinal (talk) 18:59, 21 May 2008 (UTC)

The cited source says the recommendation is weak. Eubulides (talk) 20:13, 21 May 2008 (UTC)

Did you dig down to find that or is it in the abstract that is freely readable? So exercise and manipulation are weakly recommend by the ACoP? Just out of curiosity what does the ACoP strongly recommend for back pain? CorticoSpinal (talk) 15:22, 22 May 2008 (UTC)

Both the abstract and the body of that article are freely readable. Both the abstract and the body of the article say that the recommendation for SMT is "weak". The recommentation for exercise is also "weak". The ACoP has six strong recommendations, which you can find by reading the citation. Eubulides (talk) 16:58, 22 May 2008 (UTC)

• This edit removed material about who should administer SMT, without discussion or consensus. It also broke a citation (turning it into a dangling red link).

This was probably more appropriate in the Spinal manipulation (wow, what happened to that link?) article anyway. -- Dēmatt (chat) 14:59, 16 May 2008 (UTC)

I could be talked into moving the material, yes. It was a great shame that the edit broke the citation. If it had been reviewed ahead of time that problem could have been reverted.

This is a huge problem with Eubulides' drafts (all 3) is that is synthesizes all SMT research and then attempts to pass it off as "effectiveness" of chiropractic. Much more specific and relevant to effectiveness of chiropractic care would be the NIH, New Zealand studies, Meade, Rand, Manga studies, the integrative models which demonstrated that DC care is effective and cost effective as well as the ongoing MEDICARE DEMONSTRATION PROJECTS occuring at the DoD, DVA and other major governmental agencies. What about the Kapansky-Giles article which talks about the effectiveness of chiropractic care at St-Mikes hospital in Toronto? This is SPECIFIC to chiropractic and it was a demo project that was made PERMANENT because it was such a rousing success in both clinical and financial terms. There's many more sources that adequately discuss the effectiveness of chiropractic care (i.e. the whole clinical encounter not just SMT some editors don't seem to understand). CorticoSpinal (talk) 16:25, 16 May 2008 (UTC)

None of these comments seem to have anything to do with the edit in quesiton. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• This edit also removed material without discussion. (I agree with the removal, not that that matters as far as procedure is concerned.)

It was probably fluff anyway. Could just take out the "Samual Homala" part. Save energy for issues that count. -- Dēmatt (chat) 15:02, 16 May 2008 (UTC)

• This edit, without discussion or consensus, removed important sourced material about scientific versus antiscientific reasoning among chiropractors.
• This edit, without discussion or consensus, attempts to undermine a reliable review of practice guidelines by citing just one guideline, on one side of the dispute. Again, this sort of tactic is contrary to the spirit of WP:MEDRS as it is attempting to overturn a review.
• This edit, without discussion or consensus, again attempts to undermine a review-of-reviews by citing a review. It also uses unsourced peacock terms like "the most comprehensive study to date" and disparaging terms like "opined".
• This edit, without discussion or consensus, attempts to undercut a source by characterizing it as being by a "vocal critic of chiropractic". It does not balance this by mentioning the many other sources that are by vocal supporters of chiropractic.
• This edit, without discussion or consensus, removed sourced material.

Eubulides (talk) 22:33, 15 May 2008 (UTC)

Disagreed, Eubulides. All edits are supported by the sources. It's making the sections, which have been aded WITHOUT consensus relatively more NPOV. There's a lot of work to be done but we can get there. Since when is opined "giving an opinion" disparaging? Humphreys and Vernon were my PROFESSORS. I'm not going to slag them. And, do you disagree that the Neck Pain Task Force is the most comprehensive study on neck pain? Maybe this might shed more light on the topic. If we're to rush in edits without consensus then, inevitably, there will be much editing to try and present opposing views. Also, note that you're being completely redundant and trying to make a point with your repetitive use of discussion/consensus. The edits installed previously were very faulty and cherry picked evidence and did not fully attribute the information. CorticoSpinal (talk) 23:16, 15 May 2008 (UTC)

• It's not true that all those edits are supported by the sources. Many edits removed sources. Some edits broke sources, leaving red links.
• Using "opined" to talk about opinions favoring one side, while in contrast using words like "most comprehensive study" to talk about opinions favoring the other, is clear POV.
• It's not a question of whether I think the study is the most-comprehensive. It's a question of WP:PEACOCK. The words "authoritative" were recently struck for the same reason, even though the reviews in question were indeed authoritative (and we have reliable sources saying so).
• We should not rush in edits without consensus.
• It is not right for a Wikipedia article to attempt to undermine a reliable review by highlighting results of a reviewed primary source that disagrees with the review. Wikipedia should defer to published expert reviewers, and not attempt to override them.

Eubulides (talk) 23:30, 15 May 2008 (UTC)

I think you both made some good edits and some not so good edits. We can't help our biases; we can only hope to keep them in check. Keep working on it. ---- Dēmatt (chat) 04:57, 16 May 2008 (UTC)

[outdent]. Eubulides still using the same tired arguments as the past 4 months. The problem is that this extremely controversial section, which has NO VALIDITY in that it looking at the effectiveness of SPINAL MANIPULATION and passing it off as "chiropractic care" and selectively cherry picked the literature to marginalize, minimize the effectiveness of SMT and pass it off as chiropractic. Lastly, yet, all edits were supported by the sources. There is one thing I want to note: you have a habit of selectively highliting negative points and not providing the full context or the major findings when you cite "supportive" sources of chiropractic care. You actually cited the CCAs Clinical Practice Guidelines of Neck Pain proving that "the are adverse effects" of neck manipulation while not mentioning a peep that evidence-based document actually supports the use of MANUAL THERAPY (not just SMT, please understand this point) and the benefits far outweight the risks. So, the edit goes in that essentially states that there are adverse effects to neck SMT and cites the CCA guidelines and doesn't cover the whole conclusion. Cherry picking. Dematt has said the same. CorticoSpinal (talk) 05:25, 16 May 2008 (UTC)

Most of the citations are to sources that talk about chiropractic care, not merely SMT. The other comment you make seems to be about safety, not effectiveness. The safety section talks about safety, not cost-benefit. Perhaps there should be a change to the cost-benefit section along the lines you suggest; could you propose a change? Eubulides (talk) 07:35, 19 May 2008 (UTC)

Please see Cost effectiveness 2a. CorticoSpinal (talk) 16:21, 20 May 2008 (UTC)

It may have been helpful if you had also done what I did - revert QuackGuru's this huge change. I know that you were against the huge change and you made that known somewhat on this page, but perhaps if you also reverted the huge change just once, it would have made your feelings that much stronger. Instead, I was left to revert it two or three times, and then accused of edit warring by the very editor who started the war; chiefly QuackGuru. The end result was QuackGuru and pals trying to make it appear that I was the only editor in support of reverting the huge change and that I was somehow ignoring a mysterious "broad consensus". Unfortunately, the truth of what was being ignored was that there were/are a large number of editors against QuackGuru's huge change, including me, you (Eubulides), CorticoSpinal, Dematt, DigitalC, TheDoctorIsIn, etc. I am typically against edit warring and I wouldn't ask you to participate in one, but I felt like QuackGuru was allowed to steamroll his version through, emboldened by supposedly "outside" editors (the usual gang of editors ready to do anything to bash CAM topics such as Chiropractic). I applaud CorticoSpinal for rising above myself, taking the higher ground, not edit warring, and instead effectively improving gross NPOV negligence on the part of QuackGuru. We have two paths we can take now. We can revert back to how the article read before QuackGuru's unfortunate and huge edit or we can move forward and pound away at his additions to try and make it comply with NPOV, RS and V. The former puts us back to discussing all major edits, hashing everything out, striving for a consensus before implementation; whereas the latter places us in a spot where we all just edit the article directly (because the content is live and we want it to be the best it can be immediately). Either way, I still encourage much discussion here to foster a better article and more cooperative spirit. -- Levine2112 ^discuss 00:33, 16 May 2008 (UTC)

I do not like to do revert wars, and did not understand the etiquette of reverting (such as at it is). Apparently I did not stay out of the war successfully; I was warned for 3RR, as my understanding of a revert did not agree with the official version. Sorry for being such a novice at this. Eubulides (talk) 07:35, 19 May 2008 (UTC)

All of these edits are highly POV and should be greeted with a revert. This article should not be turned into a POV promotional piece. Hopefully, we can get back on the right NPOV track. QuackGuru 01:32, 16 May 2008 (UTC)

See and I would say that all of these edits are highly POV and should have been greeted with a revert. This is why we need to discuss things first here before making such bold edits. Remember when you asked what's the harm in being bold with this article. Well, you were bold and a tad reckless IMHO and that led to edit warring, general incivility and now the article is locked. See the harm now? -- Levine2112 ^discuss 01:41, 16 May 2008 (UTC)

Well said Levine... what say ye'all. How do we want to do this? ---- Dēmatt (chat) 04:35, 16 May 2008 (UTC)

For what it's worth, lets "move forward and pound away at his additions to try and make it comply with NPOV, RS and V". That would be more productive and definitely more interesting!--—CynRN ^(Talk) 06:35, 16 May 2008 (UTC)

Hey, I vote for interesting every time! But we really can't be reverting.... that takes the fun out of it. We should agree to only add/fine tune? -- Dēmatt (chat) 15:06, 16 May 2008 (UTC)

I do have one question for CorticoSpinal - when you type, are you yelling in your head, or do you always talk that way :-D (just picking:-) -- Dēmatt (chat) 15:10, 16 May 2008 (UTC)

Lol, is that because of the CAPS? I'm too lazy to scroll up the page for bolding or italics, so if I want a word to get NOTICED I just hold down the shift key! In all seriousness though there are still major flaws with the validity of effectiveness of the chiropractic profession as the section (after 3 attempts you would have figured the author would have gotten the point that this was a no go) despite the fact that a compromise by CynRN (to include the highlights of SMT) was agreed upon by the majority of the editors. We're essentially here because many believe (as I do) that (1) QG and Eubulides want to pass off SMT as chiropractic care and (2)ignoring documents that are specific to the effectiveness of chiropractic care; i.e. the evidence-based CPGs of the profession. Not even one peep of soft tissue therapy in all 3 drafts? I think DigitalC has mentioned this 10 times (and I concurred) and yet a certain editor feels its not inclusion worthy. When a profession develops an evidence-based clinical practice guideline SPECIFICALLY for this, it's inclusion worthy, period. This gong show has gone on long enough and its time we cut bait: SMT goes into SMT article, a blurb can stay in chiro, we draft a specific to chiropractic care effectiveness section that is valid to chiropractic care, not a synthesis of DC, MD, PT, DO and other manipulative using profs. CorticoSpinal (talk) 02:37, 17 May 2008 (UTC)

Version suggestion

I suggest that this version be reinstated after protection is up. This is the best version with the most consensus per the RfC above. ScienceApologist (talk) 17:09, 18 May 2008 (UTC)

I agree that the version you mention is higher-quality and less-biased than the currently-protected version, and would support reinstating it over keeping the currently-protected version. The second and later bullets of #Recent edits made without discussion explain why I think so. However, I don't see the consensus that you mention; there is a lot of controversy over the big edit incorporated in that version (alluded to in the first bullet of #Recent edits made without discussion). Eubulides (talk) 07:35, 19 May 2008 (UTC)

If you look through the RfC comments, I think you'll see that most of the outsiders who commented support the addition of that content. ScienceApologist (talk) 19:36, 19 May 2008 (UTC)

I am concerned about the attempted railroading of the discussion by known alt med proponents and chiropractors. I have filed a Third opinion request to get outsider help:

As a practicing chiropractor, if there is a problem with my participation on this page, I will certainly leave it to you, but I suppose that would mean that SA shouldn't edit science and physics articles either, right? I think as long as we edit NPOV as best we can, that is what we are looking for, some expert guidance, I would hope. I wouldn't begrudge SA from working on Relativity or Eubilides from working on medicine or even Vaccination, so why would you point at me? -- Dēmatt (chat) 20:33, 19 May 2008 (UTC)

There is no problem with your participation on this page, and frankly, I have less of an issue with you than I do with other editors. I absolutely have issue with others using you as a shill to pretend that there is some legitimate controversy over text. I read you as saying you don't like edit wars. Fine. However, there are others who are implying that your position is in-line with some of the more stridently opposed. Note that below we have a particularly strident editor making a laundry list of all the people who agree/disagree with a proposal without so much as a qualification. It is that sort of lumping-and-running that I'm getting tired of. If we could limit chiropractic-supporting editors to just Dematt, I don't think we would have a problem. You are a very good editor who is aware of his own POV enough to be honest about it. However, when discussions happen where you find yourself surrounded by "the usual suspects" it might be better if you didn't entertain the more egregious game-playing. Just a suggestion. ScienceApologist (talk) 21:50, 19 May 2008 (UTC)

SA, thanks for clarifying. I appreciate your confidence, but I do want you to know that, at least as far as the edits that I see here on this page, CorticoSpinal has not improperly used my name. If he had, I would not have hesitated to set the record straight. Having said that, I do not hold any animosity for any editors here as they are all doing a very good job trying to get things right - from their POV. Quite the opposite, I appreciate all the work everyone is putting in trying to get it right. The problem is that we all come with preconceived ideas of what chiropractic is - even different chiropractors have a different understandings of what chiropractic is. As a result, there are no sides here; no-one agree with each other 100%. The version that was here previously that was stable for at least a year ignored reformed chiropractors mostly because the editors that were here didn't know any. Fyslee fought hard to make sure they were included, but the article talked mostly about straights. Well, then CorticoSpinal showed up. Apparently there are reformed chiropractors. The problem is that he rewrote the article from his POV, then Eubilides stopped in when he noticed that straight chiros preached against vaccination. He took that to heart and set out to rewrite the article from his POV. Well, there you have the fuel and the match. What I want you to notice, however, is that now we have no straight chiropractor representation, so the article is in a little bit of a disarray right now, but as Eubilides and CorticoSpinal struggle through their research, I'll do my best to represent those pesky straights. Otherwise, I really don't think that picking a particular version of anything in this transition phase is a good representation of NPOV for chiropractic. I hope you understand. If I thought that accepting that version would stop the bleeding at this article, I would be thanking you from the bottom of my heart, but I am afraid we will only make it harder to improve. Let's let them get it right first, then 'freeze it'. -- Dēmatt (chat) 01:39, 20 May 2008 (UTC)

1. Talk:Chiropractic#Version suggestion. There was an RfC where uninvolved editors determined that a particular set of edits was an improvement. Now, many editors who are actively known to be chiropractic supporters are advocating for the removal of the edits in seeming defiance of the consensus achieved above. We need a neutral party unfamiliar with the disputes to review the discussion for bias in the editors remarks. Note that User:CorticoSpinal, User:Levine2112, User:Dematt, User:TheDoctorIsIn, User:SmithBlue, and User:DigitalC are all either practicing chiropractors or are alternative medicine promoters. ScienceApologist (talk) 19:23, 19 May 2008 (UTC)

---

Disagree. Dematt, myself, DigitalC, Levine2112, Doctorisin and SmithBlue have serious reservations about the draft. Perhaps it would be best if you did not embellish or claim a consensus where there is none. CorticoSpinal (talk) 19:24, 18 May 2008 (UTC)

That is funny :-) Wasn't that the version that started the edit war. I don't think Eubilides even liked that one. -- Dēmatt (chat) 22:17, 18 May 2008 (UTC)

I think that (generally) the version right before this edit was the version that was closest to a consensus. The article was pretty stable back then. Things changed after that edit. -- Fyslee / talk 22:35, 18 May 2008 (UTC)

Ha! That would be this guys first edit on chiropractic :) ---- Dēmatt (chat) 23:56, 18 May 2008 (UTC)

It's unfortunate that Fyslee seems to have it out for me. I cannot believe that he thinks that the pre Jan/08 version is superior to what we have now. I guess we will have to agree to disagree on this. How about comments on the images, new proposed cost-benefit and discussing the validity of calling effectiveness of SMT and passing it off as the effectiveness of chiropractic? CorticoSpinal (talk) 00:25, 19 May 2008 (UTC)

Ah, don't take it so tough. You dish it out pretty good yourself! We really shouldn't take stuff so seriously. I do like the images and , no, the effectiveness of SMT is not the same thing as effectiveness of chiropractic. There are other factors in the chiropractic encounter that need to be included, such as; time spent with the patient, touch, accessability, etc.. and of course there is that placebo effect thing. You know... is it true, or is it just in the imagination of weak minded people (just being facetious of course!) ---- Dēmatt (chat) 01:00, 19 May 2008 (UTC)

During your sabbatical a I went through a lot of BS including a few witch hunts and continued character assassination attempts. Essentially, skeptics are trying to portray me an as "anti-science" "POV warrior" who "cannot collaborate". Now that you are back on the scene I am confident that we will be able to better navigate these turbulent waters with you at the helm. I'd much rather find literature and revise existing weak sections and not have to be, at times, a defacto spokesperson for contemporary chiropractic. I hate coming on here and dealing with all the BS; but I'm not going to let dogmatic skeptics railroad changes in, claiming "NPOV" when it's clearly marginalizing, not valid or has an undue harsh tone. Then I have to deal with a certain editor who seems to have an unhealthy fixation on me and makes grandiose soliloquoys to admins that I'm pretty much exclusively responsible for the state of affairs here at chiropractic.

Your tone is likely going to be more diplomatic that mine, however, since your return you have pretty much raised the same concerns (validity of effectiveness of SMT and passing it off as chiro), cherry picking evidence and not fully attributing it, having a harsh/negative tone of something that should be neutral, suggestions that the effectiveness of SMT for LBP is in doubt, suggestions that manual therapy for neck pain is useless, etc. There are far more, but I'm heading out for the night so we can continue this discussion tomorrow if you'd like. CorticoSpinal (talk) 01:18, 19 May 2008 (UTC)

Well, as Fyslee and Levine can tell you, this page has been a lot hotter and a lot worse at times. I write better when there are two editors with two different POVs as I like to work toward a compromise. However, sometimes compromise is not the best solution, so it has to be grappled out in two balanced POV elements using verifiable sources with the right amount of weight for each. For that, we need people like you and Eubilides to see both sides, but each of you have to realize that you won't always end up with what You want, but it should be better than what would have been there without You. I think you're getting there. It took us two years to get to where we were before, but it was stable for more than a year after that. Hopefully we'll get back to that - and it will be a better article. ---- Dēmatt (chat) 03:37, 19 May 2008 (UTC)

That stability and collaboration is what I miss. I too think that the best articles are produced when editors with opposing POV collaborate and ensure that each other's POV is represented using good sources. That way no one is totally satisfied with the article, which may actually mean that NPOV has been reached...;-) -- Fyslee / talk 05:32, 19 May 2008 (UTC)

I think that there is too much well-poisoning going on here. I'm not pleased that the only person who is commenting on this issue who is not firmly aligned as a chiropractor or alt med proponent is Fyslee. I'm going to ask for a third opinion. ScienceApologist (talk) 19:17, 19 May 2008 (UTC)

Would it be considered well-poisoning to suggest there is a consensus where there clearly is none? -- Levine2112 ^discuss 18:28, 20 May 2008 (UTC)

I have 2 diffs that can be used if this point needs to be clarified and verified. I don't understand his sudden need to rock the boat here, last time I checked the waters were already rough. SA needs to stop treating chiropractic like fringe and then we can move ahead. Chiropractic is not fringe, it's mainstream. These words aren't from me. They're from Dr. Kapchuk, MD. When MDs say DCs are more mainstream than alternative (fringe?) I think its time the skeptics listen to the evidence and not some outdated dogmatic belief system. Thoughts? CorticoSpinal (talk) 00:35, 21 May 2008 (UTC)

I don't know what "this point" refers to, or what the "2 diffs" are. However, as mentioned in #2008-05-03 issues list, one of the POV problems in Chiropractic is that it characterizes chiropractic as complementary and alternative medicine, a view that is controversial. Other views should be given fairly. See, for example, Redwood et al. 2008 (PMID 18435599).

typos

I'd like to change intial to initial but the page is edit protected. Can someone fix this when you come to a concensus on the disputed bits? Jonathan Cardy (talk) 18:37, 16 May 2008 (UTC)

Images

I propose we use the chiropractic emblem in this article. It was adopted in 1934 in Pittsburgh, USA and is more than relevant and valid. It should be free license too. The article should make better use of images that enhance the understanding of the material. We should have a picture of a chiropractic spinal manipulation. I'd be curious to see if this image really is OMM, CSMT, SMT, OMPT, etc. Thoughts? CorticoSpinal (talk) 01:12, 17 May 2008 (UTC)

I really like the images. That Caduceus is awesome. That cervical view is obviously an osteopathic manipulation as it includes too much head rotation. That would be a general cervical move. However, it is appropriate as a manipulation picture. I would add them for sure as long as they aren't copyrighted. -- Dēmatt (chat) 00:37, 19 May 2008 (UTC)

Thanks. Eubulides suggested the article needs more images and I would agree so long as they're relevant and obviously don't violate copyright. I think an SMT and the Caduceus are a great start and if there's no major objections I think we should include them. As for the SMT pic(s) I'd like to present a single pic that would include a cervical, thoracic and lumbar manipulation using the Diversified technique (the most common chiropractic manipulative technique). Thoughts? CorticoSpinal (talk) 00:41, 19 May 2008 (UTC)

article improvements in the works

chiropractic schools tidbit

This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic (for example, Palmer School of Chiropractic) still teaching the traditional/straight subluxation-based chiropractic, while others (for example, Canadian Memorial Chiropractic College) have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions but retains a holistic approach and an emphasis on manual therapy.

commentary on chiropractic schools tidbit

This sentence seems a bit long. Any suggestions? QuackGuru 21:37, 18 May 2008 (UTC)

Make a proposal, QG. Never write down in 10 words what you can say in 5. That's the tough part about writing and editing. Anything to explain the apparent dichotomy that exists. CorticoSpinal (talk) 00:15, 19 May 2008 (UTC)

I think making a statement that Palmer still teaches the traditional metaphysical approach is not really accurate. That same website says this. If their first reference had said Innate Intelligence (Uppercase) rather than innate intelligence (lowercase), I might buy the argument, but Innate Intelligence is the metaphysical equivalent to the untestable vitalistic "spark of Life" while innate intelligence is the inborn intelligence that science embraces as reductionist to a point then emergent through the potentially millions of combinations that can occur. Fyslee understandsthis. IOWs, there is nothing metaphysical about innate intelligence, only Innate Intellingence. It's like placing all the intricacies of life in a metaphor called mother nature rather than calling what we don't quite understand, God. Nobody actually believes there is a Mother Nature, it's just a metaphor used to lump it all into one 'easy to communicate concept' so we don't have to describe everything in scientific terms. For instance, the birds and the bees. Once everyone knows what birds and bees means, we don't have to keep explaining about the spermatozoa and ovums, etc., etc.. You see what I mean? ---- Dēmatt (chat) 03:23, 19 May 2008 (UTC)

Innate Intelligence (Uppercase) and innate intelligence (lowercase) has been used both ways in the same article. QuackGuru 05:25, 19 May 2008 (UTC)

Excellent article QG, everyone should read it. Now compare that with Keating's Innate. Remember Keating was a psychologist that worked and taught in chiropractic colleges, in fact I think maybe both Palmer and Canadian Memorial, but don't hold me to it. Anyway, notice that he talks about "innate" as homeostasis, etc. initially, but then in 1906 the metaphysical Innate Intelligence starts - remember DD went to jail in 1906 for practicing medicine without a license. Your article shows how chiropractic cohorts at the time were against the change, it mentions Carver (who started several schools that are still around today) and John Howard of National Chiropractic College. These were major players in the mixer movement that denounced Innate Intelligence early in 1900s. There is so much more, but we better fo with one piece at a time. ---- Dēmatt (chat) 13:09, 19 May 2008 (UTC)

Lon Morgan (1998). "Innate intelligence: its origins and problems". 42 (1): 35–41. {{cite journal}}: Cite journal requires |journal= (help) Here is an article on innate. Any suggestions. QuackGuru 05:37, 19 May 2008 (UTC)

The differences between II and ii, as explained by Dematt, are very real, but usage of the words, regardless of capitalization differences, is still problematic. In the real world, including chiropractic writings, there is lack of consistency (except in ultra straight writings), and the words often have the same metaphysical connotations. If chiropractic and chiropractors wish to avoid being misunderstood when they are referring to non-metaphysical concepts, they should stop using those antiquated esoteric terms that historically have only had metaphysical meanings. They should simply call the natural healing processes, the immune system, and the self-limited nature of many diseases, what they are and with those words, just like everyone else does. There are various common terms that could be used, instead of continuing to use the "innate intelligence" words. It would save the profession from many misunderstandings and make the "chiropractic bull's eye" a smaller target for skeptics to hit. I'd favor that. -- Fyslee / talk 06:10, 19 May 2008 (UTC)

I entirely agree, but we're verging into discussion forum territory here. Back to work ;) Jefffire (talk) 14:54, 20 May 2008 (UTC)

You know what's absolutely amazing about the aforementioned discussion? I had no clue about the difference in capitalization, about the meanings etc of II vs ii, etc... The integrative curriculum at CMCC really did not emphasize/teach traditional philosophy. As if even the spelling means something different. CorticoSpinal (talk) 16:07, 20 May 2008 (UTC)

I didn't know it either till Fyslee turned me on to the chiropractic history archives that Keating donated to Chiro.org. We didn't learn it at Logan (a mixer school) in the early 1980s, only that DD discovered it and BJ developed it. The rest was sort of passed off as "you really don't want to know ;-)". Keep an open mind and you will learn a lot more, too. Especially that those darned straights aren't as bad as we make them sound :-) But, don't tell Fyslee I told you that, now, okay, I'll try to get back to work... remember I'm trying to present the straight POV. Where's Hugher when we need him? Levine? ---- Dēmatt (chat) 18:59, 20 May 2008 (UTC)

Oh I'm here. I just don't have much to comment on this. I always understood innate intelligence as the body's inclination toward homeostasis. A body typically "wants" to be healthy. A body "knows" how to be healthy. I know there is a vitalistic history to the concept, but how does materialism define the body's inborn ability to heal itself? Is there a mainstream term for this? If you cut me, I bleed - but my body will also form a scab, send out anti-bodies, cells will repair, and in time I will heel. My body just "knows" how to do this. Chiropractically speaking, the theory goes that only the body heals. Only the body cures. No medicine cures. No adjustment/manipulation heels. However, just as a band-aid may help the healing process of a would, alignment of the spine may help the body cure itself. That's my knowledge of innate intelligence in a nutshell. -- Levine2112 ^discuss 19:22, 20 May 2008 (UTC)

Exactly... there does not have to be anything vitalistic about innate intelligence (ii), no untestable force that can't be explained or measured, it accepts the same reductionist view that studies all the way down to DNA and evolution and whatever other science we can call it, then it falls into that same abyss that all complex systems fall into - some just call it emergence, others call it Mother Nature and still others call it innate intelligence. Sure, some believe that there is something vitalistic/untestable, but then there are scientists that believe in Creationism, too. Their are fringe people everywhere. That doesn't mean we call all scientists fringe, we try to differentiate them from the rest. Okay, I promise, I will stop! Dangit. -- Dēmatt (chat) 20:31, 20 May 2008 (UTC)

No specific suggestions have been made. I added the refs. QuackGuru 15:46, 23 May 2008 (UTC)

chiropractic professional tidbit

Most commonly, chiropractors obtain a first professional, second entry, degree in Chiropractic medicine.[36][37] Typically a 3 year university undergraduate education is required to apply for the chiropractic degree.[38][39]

commentary on chiropractic professional tidbit

Here is a bit information that can be improved. Thoughts? QuackGuru 21:37, 18 May 2008 (UTC)

No specific suggestions have been made. Therefore, I improved one of the sentences, formatted the refs, and chose the best refs I could find. QuackGuru 15:49, 23 May 2008 (UTC)

Citation 80

{{editprotected}}

As I am restricted from editing this page, I am unable to fix the blatant problem with citation 80. If someone could fix the problem, it would be greatly appreciated. Alan.ca (talk) 20:35, 18 May 2008 (UTC)

Here is the whole ref: -- Fyslee / talk 22:20, 18 May 2008 (UTC)

The whole ref with a sentence was removed which caused the broken citation. I recommend all of these edits be reverted to the last broader consensus version. QuackGuru 23:12, 18 May 2008 (UTC)

There is no consensus, Quack. Alan, what specifically is wrong with citation #80 and what is it's relevance to the purported effectiveness of chiropractic? CorticoSpinal (talk) 23:31, 18 May 2008 (UTC)

The problem with the ref is that it's red. It needs fixing. -- Fyslee / talk 05:50, 19 May 2008 (UTC)

Agreed. There is no consensus for these edits. QuackGuru 02:22, 19 May 2008 (UTC)

 Done reference fixed, as a temporary measure. You need to establish whether or not the edits which broke it in the first place had consensus. And the |doi= parameter looks a bit wierd... Happy‑melon 09:39, 19 May 2008 (UTC)

• What's wrong with the DOI parameter? it works for me.
• There was not consensus for the edits which broke it; please see #Recent edits made without discussion.

Eubulides (talk) 20:47, 19 May 2008 (UTC)

There was no consensus for the edits that preceded it either. Had QG not railroaded in "effectiveness" we wouldn't be here, but that's water under the bridge now. CorticoSpinal (talk) 00:29, 21 May 2008 (UTC)

There was not universal consensus for either set of edits. However, the edits that broke it have far less consensus. Eubulides (talk) 02:16, 21 May 2008 (UTC)

Just so we're clear, no one agrees, save quack guru and yourself that effectiveness 3 is any more VALID that 2, and 1 were. I think it's pretty clear that chiropractic care is not simply SMT. So, effectiveness of chiropractic must be of chiropractic care. We have studies specifically on this. Governments have done some too (tertiary sources) as well as independent 3rd parties (workmans compensation). They are generally point to the same thing: chiropractic care is just as or more effective than standard medical care for musculoskeletal disorders. Jury is out on non-NMS, and even I think they'll be a few systemic dysfunctions that SMT can help out in select individuals. We'll toss in the dissenter (Ernst) but he shall not weigh down the section. Simply put, we'll have a blurb of SMT effectiveness (naturally it's the characteristic modality of chiropractors) as per CynRNs suggestion and the rest of the great research you have synthesized can go into Spinal manipulation with a few tweaks of course to better represent mainstream consesus on the topic, not the selective use sources that skews the reality of the situation. It's tactic Ernst himself used as was throttled for it above in the research by DigitalC on the subject. CorticoSpinal (talk) 05:25, 21 May 2008 (UTC)

That's an inaccurate summary of opinions expressed on this talk page. Many editors (most of them outside) expressed a favorable opinion of QG's big edit, which contained #Effectiveness 3 as a major component. The subject is indeed controversial (for example, I didn't agree with QG's big edit overall), but that does not mean #Effectiveness 3 advocates a minority position. Eubulides (talk) 20:13, 21 May 2008 (UTC)

I have issues with #Effectiveness 3, just haven't gotten there, yet.. I suppose I missed 1 and 2 :-) -- Dēmatt (chat) 03:17, 22 May 2008 (UTC)

We have another broken ref citation. It is citation 17 (Villanueva-Russell) this time. QuackGuru 19:53, 24 May 2008 (UTC)

red link

Low-level laser therapy is now a red link. Is there another link that might be helpful or should we unlink it. QuackGuru 04:20, 19 May 2008 (UTC)

Sorry, I don't see the red link. In Chiropractic, "low-level laser therapy" is not wikilinked at at all, so how could it be a red link? I recall that there was a draft that wikilinked to LLLT (the page was Photobiomodulation) but that page was removed recently. Until/unless something like it gets added again, I suggest leaving the term alone, i.e., no wikilink. Eubulides (talk) 20:47, 19 May 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropractic&oldid=212672736 I am specifically referring to this version just before CorticoSpinal's recent edits. I recommend removing the red link when the broader consensus version is restored. QuackGuru 20:58, 19 May 2008 (UTC)

Yes, that makes sense. Thanks for clarifying. Eubulides (talk) 21:10, 19 May 2008 (UTC)

Is there another wikilink we might use as an alternative that also covers low-level laser therapy. QuackGuru 21:17, 19 May 2008 (UTC)

I looked for another wikilink but did not find anything plausible. Eubulides (talk) 21:30, 19 May 2008 (UTC)

stable version

Here is a stable version from earlier this year. Is there anything worh merging with the newer version we are working on. We need to take a hard look and see if there was anything deleted that should be restored. QuackGuru 21:36, 19 May 2008 (UTC)

Old stable versions are considered controversial. QuackGuru 21:42, 21 May 2008 (UTC)

efficacy tidbit

The efficacy and cost-effectiveness of maintenance care in chiropractic is unknown. Original sentence.

The efficacy of maintenance care in chiropractic is unknown. Change to this sentence.

Now that we have a cost-benefit section the discussion about cost-effectiveness would be better in that section. QuackGuru 17:35, 20 May 2008 (UTC)

I agree with this change, so long as the obvious change is also made to the cost-effectiveness section. The latter section should say "The cost-effectiveness of maintenance care in chiropractic is unknown." and cite the same source. Eubulides (talk) 02:16, 21 May 2008 (UTC)

Not exactly as Descarreaux et al have demonstrated. You cannot ignore evidence, they're 2 different papers. Also, do you think maintenance care is simply an adjustment? Does is specify? A better sentence would be "The efficacy of maintenance spinal manipulation is unknown; preliminary evidence suggests that it may be beneficial in maintaning perceived post-intensive manipulation CorticoSpinal (talk) 05:04, 21 May 2008 (UTC)

Please see my comment immediately below DigitalC's. Eubulides (talk) 08:35, 22 May 2008 (UTC)

Maintenance Care in Chiropractic - what do we know?] Chiropractic & Osteopathy, May 2008. DigitalC (talk) 07:43, 22 May 2008 (UTC)

The review cited in Chiropractic (which DigitalC also cites in his comment) has reviewed the results of Descarreaux et al. and the reviewers have personally communicated with Descarreaux on the subject; it's not like this material is unknown to the reviewers. It is not our place to second-guess published expert reviewers on the subject. We should summarize what the reviewers say, and not reach down into a primary study to pull out details that favor one side. Eubulides (talk) 08:35, 22 May 2008 (UTC)

cost-benefit tidbit

The inclusion of chiropractic for low back and neck pain treatment had a reduction in the rate of advanced imaging, surgery, and plain-film radiographs, and inpatient care.

Having access to chiropractic managed care is associated with a reduction in health care costs, having a clinical benefit, and may reduce overall health care expenditures.

Here is some information I have been working on. Are these two studies useful or are there better references available? QuackGuru 18:12, 20 May 2008 (UTC)

I like these two studies a lot because they are specifically about "chiropractic care" and not SMT in general. I think they can be used in cost-effectiveness and quite possibly in efficacy as well. -- Levine2112 ^discuss 18:32, 20 May 2008 (UTC)

Are these two studies useful or are there better or newer references that generaly cover cost-benefit? We have a lot of references to choose from including reviews. QuackGuru 20:20, 20 May 2008 (UTC)

I think they are useful and are better (for our purposes at this article) than the references which discuss SMT in general. -- Levine2112 ^discuss 21:11, 20 May 2008 (UTC)

I like them and would like to see others as well. Good point about the "chiropractic care" and not only SMT. -- Dēmatt (chat) 21:50, 20 May 2008 (UTC)

Some definitions and basics

• A primary source in medicine is one where the authors participated in research or documented their personal experiences. They examined the patients, injected the rats or filled the test tubes, or at least supervised those who did. Many, but not all, papers published in medical journals are primary sources. Most medical journals have high editorial standards and ensure research papers are peer reviewed.

• A secondary source in medicine summarizes one or more primary or secondary sources, usually to give an overview of the current understanding of a medical topic. Review articles and specialist textbooks are examples of secondary sources. A good secondary source from a reputable publisher will be written by an expert in the field and be editorially or peer reviewed. Journalists writing in the popular press, and marketing departments who issue press releases, tend to write poorer secondary source material; however, such material may be appropriate for inclusion in some contexts.

• A tertiary source usually summarizes secondary sources. Encyclopedias, including Wikipedia, are tertiary sources.

In general, Wikipedia's medical articles should be based upon published, reliable secondary sources whenever possible. Reliable primary sources should be used with great care because of the potential for misuse. For that reason, edits that rely on primary sources should only make descriptive claims that can be checked by anyone without specialist knowledge. Where primary sources are cited, they should be presented in a manner which hews closely to the interpretation given by the authors or by published, reliable secondary sources. Primary sources should not be cited in support of a conclusion which is not clearly adduced by the authors or by reliable secondary sources, as defined above (see Wikipedia:No original research).

Why should we cherry pick primary sources when recent reviews are available. We have good guidelines on Wikipedia (WP:MEDRS). Please provide a specific reason for ignoring them. QuackGuru 22:44, 20 May 2008 (UTC)

Umm, you brought these sources to our attention - so if any one is harvesting cherries, it would be you. That said, per the policy, we can still use these sources provided that we exercise caution and follow the suggestions MEDRS puts forward. -- Levine2112 ^discuss 22:48, 20 May 2008 (UTC)

I did not cherry pick these references for inclusion in this article. I am having a civil discussion here. When we follow the suggestions put forth by MEDRS we will avoid these primary sources when recent reviews are available. Get it? QuackGuru 22:56, 20 May 2008 (UTC)

Was it your intention to lay a trap for us as we tried to be gracious and collaborate with you? You won't mind if I no longer WP:AGF. I wish you well. -- Dēmatt (chat) 00:18, 21 May 2008 (UTC)

I had already mentioned those studies under my Cost Benefit 2a draft. Also, SmithBlue eloquently deconstructed the entire MEDRS debacle that is being used by certain editors here to prevent the inclusion of critical primary studies while using MEDRS as a policy and not as a guideline as suggested. Also, Dematt, I have noticed similar tactics by QG, but as a "valuable contributor" I guess certain editors have a lot more leeway. CorticoSpinal (talk) 00:23, 21 May 2008 (UTC)

Oh, I'm not so sure it is all QG. I think we are looking at something much bigger than QG. Didn't all this start on May 14th? [40]. I might owe QG an apology. -- Dēmatt (chat) 00:42, 21 May 2008 (UTC)

Correct. It was May 14th when the fiddle playing began. -- Levine2112 ^discuss 01:27, 21 May 2008 (UTC)

Oh, oh, my link suddenly dissappeared of QG talk page, good thing it is still in the history. That's the thing about WP, you can run but you can't hide. :-) Shame on you guys. I think you owe Eubilides an apology, too. So who was the target, Levine? CorticoSpinal? -- Dēmatt (chat) 01:36, 21 May 2008 (UTC)

I thought everyone knew that QG kept old versions of chirpractic in his sandbox :-D This is almost funny if it hadn't cuased so many hard feelings. -- Dēmatt (chat) 01:41, 21 May 2008 (UTC)

Just so I'm clear: how is this kind of stuff tolerated? Isn't ScienceApologist on some kind of arbitration/probation? He's also declared 2 false consensus' when there was clearly none (besides the railroad attempt to get QGs sandbox version in). This is surely disruptive, no? So long as blantant attempts to subvert the will of the community by gaming the system occurs true progress won't be made. Most of us here are trying to build bridges; I've tried to make alliances with the GPs here only to be rebuffed and treated like a POS with absolutely no professional courtesy or respect. My point? How can Wikipedia work if its editors don't extend good faith when they know your professional designation. It's absolutely horrid. Also, QuackGuru must be on 9 lives or something. He has ducked and dodged a recent ANI but surely a truly independent group of admins would look at the evidence presented by several editors over a period of time and come to a logical conclusion. He's even deleting incriminating evidence of potential canvassing with SA. CorticoSpinal (talk) 04:58, 21 May 2008 (UTC)

Can we drop the cloak and dagger theatrics? Unless there is something going on that hasn't been linked to, then all I'm seeing is SA and QG talking about gaining consensus. There is no reason that these two editors can't discuss these matters. Jefffire (talk) 16:01, 21 May 2008 (UTC)

Yup, water under the bridge, no harm no foul. Just learned a little lesson, that's all, WP:AGF, after all these years. -- Dēmatt (chat) 16:19, 21 May 2008 (UTC)

I think a brief mention of health care costs might improve this article. Any suggestions? QuackGuru 01:32, 23 May 2008 (UTC)

Ready to Unprotect article

In light of the fact that the edit war that occurred last week was created by outside influence and in reality, the editors were actually working relatively well here before that edit, we should ask that the article be unprotected, we drop the egregious RfC game, and begin to collaborate on this article in the manner in which wikipedia was designed to operate and worked just fine on Chiropractic for the last three years. -- Dēmatt (chat) 01:58, 21 May 2008 (UTC)

If that was "worked just fine" I'd hate to see what you would describe as "worked poorly"! Unfortunately I doubt whether edits will proceed well if the page is unprotected now. I'd rather have a longer cooling-off period. There's no rush. Also, I disagree that RfCs in general are a "game"; that one was poorly done, but they can work well if editors are genuinely trying to cooperate in improving the article. Eubulides (talk) 02:16, 21 May 2008 (UTC)

Well, I can appreciate what you feeling, but this RfC was most definitely a game, and we were the unwitting players. We may have been a little dysfunctional, but at least we can trust each other. This article does not need to be protected because the war was over QuackGuru's sandbox version that ScienceApologist convinced him to put in; a version that should have been reverted (as you did) and never returned (as SA did). The rest were about 50 edits trying to improve it. This was a spillover from something bigger that we do not want to be a part of. -- Dēmatt (chat) 02:48, 21 May 2008 (UTC)

Definitely agree. The RfC was a total sham; and the BS of this page has hit an all-time high. Let's open the page up and tackle 1 section at a time. I suggest we get safety and vaccination done right and roll it into a Criticisms section. The essential/major criticisms can go in the lead. Let's just get down to business; it's what the skeptics want so let get'er done tastefully than those that truly care for the article can begin to tackle other important issues such as chirorpractic and integrative medicine, the science of chiropractic (textbooks, theories, scientific contributions, technology developments, journals, interdisciplinary research, accreditation from the major educational bodies, integration in universities outside North America, etc.) Chiropractic medicine in 2008 is not the same as it was in 1966... CorticoSpinal (talk) 05:13, 21 May 2008 (UTC)

Chiropractic education certainly seems more scientific. Good science should definitely be in the article. Unfortunately, reliable surveys show that significant percentages of chiropractors offer unscientific treatments like applied kinesiology or homeopathy and oppose vaccination. I thought the vaccine section was hammered out with cooperation and consensus? How would you change it?--—CynRN ^(Talk) 16:48, 21 May 2008 (UTC)

Vaccination is fair game to tackle. That's not under dispute. Nor are the practices you've listed above (AK/Homeopathy). I'm not going to cover up for the BS of those practitioners. However, I object to 1) the undue weight put on the Cdn DCs 2) the undue weight given to the views of the majority of the profession (neutral or supportive) and 3) the cherry picking up on "con" sources that doesn't present the views of the mainstream (i.e. pro vax or neutral). My objections is more about the detail it covers that is puff and used to make a point and the harsh tone projects. So, I'd like to see Dematt or someone else considered to be non-partisan work both POVs together and add a few more references both pro and con. You had a Kansas survey that could be included; we would need to know whether or not thats the views of the Kansas State DCs, US DCs, whether or not they're from the ICA (generally not in favour of vax, is that correct Fyslee?). Perhaps it would help if I made a proposal and then we could pick it apart. Another concern of mine is safety; the section starts off by saying its relatively safe then spends 10 lines saying how bad SMT is for you (adverse effects, contraindications and even DEATH!) then there is a cherry picking of the lit which prevents us from discussing the findings of the experts of SMT and stroke, namely Haldeman, Cote and Cassidy. Had Eubulides decided not to play games with sources and prevent editors from including more than relevant and reliable studies we would not be here and have the same problem as we did 3 months ago. Safety is terribly flawed in design and execution and it should be summarized and roled into a Criticisms section. CorticoSpinal (talk) 17:41, 21 May 2008 (UTC)

This project, overall, is pretty overwhelming! I agree that it would be good to keep the page protected for now and discuss strategies to edit productively. I have a feeling it will take a long, long time to come up with a version everyone is comfortable with. We'll get back to vaccines when it comes up again, but I don't understand how the current version of vaccines is 'harsh'.--—CynRN ^(Talk) 19:13, 21 May 2008 (UTC)

Here's that 2005 survey, FYI.[41]--—CynRN ^(Talk) 19:26, 21 May 2008 (UTC)

Okay, if those of you that edit here are okay with it being protected, then that's okay with me. -- Dēmatt (chat) 21:05, 21 May 2008 (UTC)

I'm fine with leaving it protected, considering the editing POV I've just read. Edit wars are so tiring, and this way we can avoid them. BTW, as far as coming up with "a version everyone is comfortable with", I not only doubt that will ever happen, it can only happen if one of two things occur: every editor truly comes to understand NPOV, or NPOV is terriby ignored by editors who make a devil's pagt and compromise to keep the peace by leaving out any details that could offend editors who hold the opposite POV. Fat chance. If the article ends up (which never happens here) with all parties somewhat uncomfortable but willing to stop edit warring and leave well enough alone, then we'll likely have an NPOV article that offends everyone a little bit because it tells the whole story, and that's where we need to arrive. -- Fyslee / talk 04:18, 23 May 2008 (UTC)

My 2c to get beyond the stalemale is to let skeptics raise all controversies surrounding chiropractic, find the best sources to neutrally present the material and roll into into a Criticisms section. Then those who really care about intricacies and details of the chiropractic story can get on with the show and make the article interesting and not some big stats/research battleground. For the record, I completely agree 100% that effectiveness of chiropractic care is well established for low back disorders (just as good if not better) that manual therapy is effectiveness in neck pain (Task Force 2008) that the results seem favourable for certain types of headaches (TTH, migraine, cervicogenic/headache of cervical origin) and inconclusive and controversial for non-musculoskeletal disorders. Part of effectiveness too is patient satisfaction scores which patients routinely display a far greater preference for chiropractic care than medical care for LBP. This is the most succint and precise summary there is. We can toss the reference in and call it a day. A majority of editors agree that the current and past evidence, both in research and 3rd parties (governments) favours chiropractic care. We can't let Ernst' conclusions (which have been rebutted and invalidated) skew what is now generally accepted. Notice the terms too, generally, etc. CorticoSpinal (talk) 04:33, 23 May 2008 (UTC)

The article it unprotected and further improvments have been made. Happy reading. QuackGuru 16:05, 23 May 2008 (UTC)

potential misuse of primary sources

I hope editors will learn a good lesson here. For example, we should not reach down to primary sources to argue with recent reviews. Cherry picking primary sources has a potential for misuse. See WP:MEDRS. Get it? QuackGuru 16:34, 21 May 2008 (UTC)

Stop saying "get it?"! It makes you sound snarky and I'm sure you don't mean it that way.:)--—CynRN ^(Talk) 18:56, 22 May 2008 (UTC)

I agree with CynRN. It does sound snarky. -- Levine2112 ^discuss 19:37, 22 May 2008 (UTC)

Unless you're having a text reader speak these words for you, it doesn't sound like anything. Get it? ScienceApologist (talk) 23:03, 22 May 2008 (UTC)

I also agree with CynRN; it would be better to avoid "Get it?", which has the vague connotation that the reader may not be bright enough to follow what's going on. It's a small thing, but small things add up. Eubulides (talk) 23:16, 22 May 2008 (UTC)

I fully agree. It sounds snarky and condescending. A common one that QG often ends with is "agreed?", when agreement is obviously a few light years away. That's manipulative, condescending, and very insulting. Just say what you mean and leave it at that. -- Fyslee / talk 04:06, 23 May 2008 (UTC)

Agreed. Passive-aggressive editing (wikipedia civility hat) "is unbecoming and detrimentally affects the project" (real life) "blows." QuackGuru this is not the first time this particular issue has been brought up. Considering there are now 5 dissenters and its own special thread, I'd suggest you heed the advice of your co-editors. CorticoSpinal (talk) 04:39, 23 May 2008 (UTC)

Edzard Ernst/Scott Haldeman

Just to get this out of the way so there's no misrepresentation of my views (as frequently done by certain chiro-skeptic editors)

Edzard Ernsts' biased and flawed secondary source reviews on SMT and chiropractic can be used here at Chiropractic That is not in dispute.

Issues

• Breaking the spirit of WP:MEDRS and using it as a tool to:

a)Promote the viewpoint (and conclusions) of vocal critic Edzard Ernst despite serious methodological flaws and strong evidence of bias while b)not promoting the viewpoint (and conclusions) by neurologist/chiropractor Scott Haldeman c) To game the system and misrepresent the argument of dissenting editors in a straw man like manner using "reaching down" as a way to invalidate the views of the opposing party.

There are claims that Ernst POV is not presented in Chiropractic. Here are all the instances and where Ernst is used currently in the article

• SMT is a passive manual maneuver during which a three-joint complex is taken past the normal physiological range of movement without exceeding the anatomical boundary limit.
• The data indicates that SMT typically represents an additional cost to conventional treatment.[121]
• Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[113]
• the incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern.[113]
• After initial therapy, preliminary evidence suggests that massage but not spinal manipulation may reduce the costs of care.[123] When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SMT.[
• SMT being passed off for chiropractic care (its in the safety section): Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[112]

Yet Eubulides insists that the editors here are "not being fair" to Ernst. To wit:

“ If anything, this is being unfair to Ernst; it's not the sort of treatment that any other source is being given here. Given all this context, it's not out of line to let Ernst briefly have his say. ”

Eubulides (talk) 02:16, 21 May 2008 (UTC)

Does it look like Ernst hasn't already had his "brief say" despite the fact that his reviews are from a research methods POV, "pure shit?" Despite all of the above you still want more Ernst inclusions! All the while denying the use of the opinion of the expert in chiropractic care, SMT, SMT/neurological accidents, effectiveness of the experts whose primary study has never been rebuked and invalidated like Ernst.

“ Please do not argue with reliable secondary reviews by highlighting results of primary studies that have been reviewed. This is contrary to the WP:MEDRS guidelines and there is good reason for this: it is too prone to editor bias. We need good reasons to disregard expert opinion in this area, and no good reasons have been supplied. Please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC) ”

Eubulides has argued against the inclusion of Haldeman, Cassidy, Cote and other expert researchers who dispute the conclusions of Ernst simply because "its a primary study" and that would "be reaching down". Actually, I think the case is that Eubulides "reached up" and advocates the use of flawed reviews (invalidates the conclusions) by Ernst all the while preventing the inclusion of robust primary sources that have none of the intrisic weaknesses in research design, but also none of the fringe views that Ernst advocates. His views are clearly fringe (i.e. not mainstream). His POV on safety, efficacy and cost effectiveness go directly against the majority of research that demonstrates SMT and chiropractic care is safe, effective and cost effectiveness. There's no amount of spinning he can do to change this fact. As a reminder, here is a brief inclusion of some sources that openly rebuke Edzard Ernsts studies citing severe bias, poor methodology and invalid conclusions:

Evidence of Bias and Methodological and critical flaws that invalidate the conclusions drawn by Ernst and Ernst-Cantor:

Evidence of bias by Ernst:

1. • Evans, W. (2003). "Chiropractic Care: Attempting A Risk-benefit Analysis". American Journal of Public Health. 93 (4): 522. Retrieved 2008-05-20.
   • Bronfort, G. (2006). "Review conclusions by Ernst and Canter regarding spinal manipulation refuted". Chiropractic & Osteopathy. 14 (1): 14. doi:10.1186/1746-1340-14-14. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
   • Hurwitz, E.L. (2002). "Chiropractic care: a flawed risk-benefit analysis?". Am J Public Health. 92 (10): 1603–4. Retrieved 2008-05-20. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
   • Morley, J. (2001). "Ernst Fails to Address Key Charges". The Journal of Alternative & Complementary Medicine. 7 (2): 127–128. doi:10.1089/107555301750164145. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
   • "Profession Responds Quickly to Negative U.K. Study on Spinal Manipulation". Retrieved 2008-05-20.
   • SPINAL MANIPULATION DOES WORK: THE FACTS FROM THE BCA
   • A balanced review of evidence?

Yet, under WP:MEDRS guideline he insists that the studies on SMT and chiropractic care done by Edzard Ernst are not biased and is a "strong, reliable secondary source". According to Eubulides, we "shouldn't reach down into primary sources". Essentially, Eubulides has argued that (a) Edzard Ernst POV is not represented enough in the article and (b) his reviews cannot be refuted by Scott Haldeman who would represent the proponent of SMT and chiropractic care (despite the fact he's also an MD and a PhD).

So, plainly and simply

(1) Why do we permit the use Edzard Ernst citations which (a) has demonstrable methodological flaws (2) are severely biased (3) are not valid and not afford the same courtesy to the work of Scott Haldeman who is the expert in spinal manipulative therapy research in the topics of safety and effectiveness.

(2)Why is Chiropractic using Edzard Ernsts definition of spinal manipulation which is incorrect characterization of healing art.

• • This definition by Ernst is seriously flawed; in fact it's not even close to the definition of spinal manipulation provided by the World Health Organization "Includes all procedures where the hands or mechanical devices are used to mobilize,

adjust, manipulate, apply traction, massage, stimulate or otherwise influence the spine and paraspinal tissues with the aim of influencing the patient’s health." We could also use Principles and Practice of Chiropractic textbook which provides a good definition as well.

(3)Why does Eubulides refuse to allow scientifically robust, primary sources written by notable experts in the field (i.e. Haldeman, Cote, Cassidy) to counter the claims by Ernst that SMT is "dangerous" "adds additional costs" "risk outweighs the benefit" "has not been proven beyond a reasonable doubt" has "many adverse effects".

(4) Do we not present the view/research of Scott Haldeman DC,MD,PhD more prominently who, unlike Edzard Ernst, is much more respected, credible and truly representative source on the topics of safety and effectiveness

(5) Why are we allowing Ernsts critique of effectiveness of SMT being equated and passed off as effectiveness of chiropractic care? His severely biased view is already springing a leak article at various junctures as though to sink the article. CorticoSpinal (talk) 04:48, 22 May 2008 (UTC)

Comments on Edzard Ernst vs. Scott Haldeman

• Chiropractic contains more citations to Haldeman than to Ernst, so I don't understand the claim that it is somehow "not promoting" Haldeman.
• As mentioned above, the "evidence of bias" consists of sources dominated by chiropractors, who are hardly neutral observers in this controversy.
• WP:MEDRS suggests preferring reliable reviews for good reason. In an area like this, where there are hundreds of primary studies to choose from, it's all too easy to come up with material that is apparently well-sourced (as it cites many primary studies) but still does not present the evidence neutrally as per the usual Wikipedia rules about mainstream consensus. It's much better to rely on reliable reviews, which tend to avoid this problem much better than Wikipedia editors do.
• The context of my "unfair to Ernst" comment was somehow omitted. The point was that particular text (which referred to Ernst) was immediately followed by the summary of a review by Bronfort et al. that directly criticized Ernst. Chiropractic does this to Ernst, but to no other source.
• I am not aware of anyone advocating "more Ernst inclusions" over what is in Chiropractic now. Perhaps I missed a proposal somewhere? It is a large talk page.
• The definition of SMT cites Ernst, but Ernst is merely citing the American Chiropractic Association. Chiropractic should be fixed to point to the ACA's policy statment on SMT directly instead of indirectly via Ernst. The ACA defines manipulation as:

"a passive manual maneuver during which the three-joint complex may be carried beyond the normal voluntary physiological range of movement into the paraphysiological space without exceeding the boundaries of anatomical integrity."

This is pretty much the same wording as Ernst (any slight differences may be due to the fact that the ACA updated their policy statement after Ernst's paper was published). I disagree that this definition is "seriously flawed"; it is the definition in the official policy of the leading chiropractic professional organization.

• The review by Haldeman, Côté, Cassidy and others (Hurwitz et al. 2008, PMID 18204386) is cited twice and at length in Chiropractic#Safety. You disagree with their review and wish to emphasize details about their primary studies that they themselves did not think worth summarizing in their own review. Let's stick with the expert reviewers' opinion of their own work, rather than overriding them and reaching down into their primary studies ourselves. Eubulides (talk) 08:35, 22 May 2008 (UTC)
• I am not aware of any place in Chiropractic where SMT is being "passed off" as chiropractic care. Material about SMT is labeled as being about SMT.
• Text in Chiropractic like "According to a vocal critic of chiropractic, Edzard Ernst, MD" (added during an edit war just before the article got frozen) is designed to discredit a reliable source, is clearly POV, and should be removed as per Wikipedia policy. It would be equally out of place to add text like "According to a committee dominated by chiropractors" to nearby material that is supportive of chiropractic. This kind of partisan edit warring should be avoided.

Eubulides (talk) 08:35, 22 May 2008 (UTC)

• • The citations used by Haldeman do not unduly sway the tone or content of the article. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

Statements used by Haldeman sources with respect to safety, efficacy

• Research has focused on spinal manipulation therapy (SMT) in general,[88]

So, what about this claim that Haldeman contains more citations than Ernst? It sure doesn't seem like Haldemans "sources" have been used to counter the claims by Ernst. Why would that be? Ernst severely biased and flawed reviews are presented yet strong primary studies which disagree with Ernst cannot be used. Strange. CorticoSpinal (talk) 13:48, 22 May 2008 (UTC)

• • The question is the methodological flaws that invalidates the conclusions of Ernst. It's a critique of the research. Stop confabulating. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
  • You have used MEDRS as a tool to promote a weak quality review that is flawed and biased (Ernst) whilst preventing the inclusion of strong primary sources. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
  • The placement of Ernst's opinion (severely flawed review) is used to contradict the mainstream opinion of research. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

The ACA does not determine what SMT is. It's a multidisciplinary consensus at best, or it can come from PPC. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

See above. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

• • A complete misrepresentation of my views (#19). I do not disagree with their review I disagree with the fact that the reviews covers everything that was presented in the Feb 08 issue of Spine. Somehow the most authoritative study ever done on neck pain and manipulation/stroke is getting thumped by a) Ernst and b) Miley et al. You're cherry picking the evidence to present a picture that disagrees with the general scientific consensus. You are deliberately omitting far stronger, valid and reliable primary sources. I'm not asking for Ernst to get deleted (deletionism policy) I'm asking we balance it out by adding the research of the experts (inclusion policy). Regardless, you're wrong in your assessment, 5 separate editors have specifically challenged your assessment of the research and you have violated WP:IDHT now close to 2 dozen times. How can the concern of 5 separate editors regarding your stance keep going unnoticed? Surely an admin must step in now as this is gotten to the point where the system is being gamed (violation of WP:NPOV and the spirit of WP:MEDRS has been broken. It's also an example of tendentious pushing, another violation of wikipedia policy. We have a way around this. It's called WP:IAR. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
  • Actually no. It's under the safety section. Safety section in chiropractic where the majority of the discussion is on the negative effects of SMT. Hardly balanced. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

• • Attribution is not a problem, and considering the source you want included is severely flawed attributing it to Ernst rather than outright deletion of the review. Is Ernst not a vocal critic of chiropractic? We can take out vocal if you'd like. You seem to have a real problem with separating the quality of research and then confabulating it with professional designation. Science doesn't care if you're a DC or and MD. The research stands on its own and the scientific community will pick it apart. Anyways, you have failed to address the concerns raised above and your defiant tone is noted. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

• Haldeman and Ernst both bring their own biases, and they both represent mainstream opinions in their own ways. Both sources should be cited as appropriate; in both cases, we should keep the sources' biases in mind.
• The goal of Chiropractic is not to refute Ernst by citing Haldeman. It is to present encyclopedic coverage of a complicated and controversial topic. It would be unseemly for Chiropractic to follow each citation of Ernst by a countering citation of Haldeman (or vice versa, for that matter). Let's focus on the topic rather than conduct a war.
• The "evidence of bias" is produced by sources that are (understandably) biased themselves. I could easily produce "evidence of bias" on the other side. But what would be the point? This is not supposed to be a debating society; it is supposed to be a discussion of how to produce an encyclopedic article.
• The "strong primary sources" are covered indirectly, by a strong review that summarizes those sources well. This review (Hurwitz et al., 18204386) is not coauthored by Ernst. I don't see what Ernst has to do with that particular dispute.
• Ernst needs to be covered, and the coverage needs to be placed somewhere. No matter where it's placed, it will "contradict" other researchers whose work is more supportive of chiropractic. The other researchers are not the only "mainstream opinion of research"; they are one mainstream view (typically, the mainstream of chiropractic), but there are other mainstream views (notably, mainstream medical opinion), and Ernst's view, which is a mainstream view, should be fairly represented.
• The ACA's definition of SMT is an important one. No doubt other views could also be represented. However, the ACA's definition is not an "incorrect characterization of healing art", as was claimed above.
• The review in question (Hurwitz et al.) also appeared in the February issue of Spine and it summarizes the primary studies appearing in that same issue, along with many other studies. You continue to disagree with the author's review of their own work, which is published in the same issue of Spine. As far as I can see, you are alone in the campaign to reach down into the primary source in question and override the opinions of the expert reviewers (who are reviewing their own work!).
• I am unaware of anything in Chiropractic#Safety which "passes off" research about SMT as if it were research about chiropractic in general, or about chiropractic SMT in particular. Could you please be specific about this "passing off"?
• Are Haldeman et al. not chiropractors? Should we be putting "according to a committee dominated by chiropractors" after every citation to Spine issue? No, that would be attempting to undercut the source, and would represent POV, even though it's the literal truth. It is similarly POV to attempt to undercut claims supported by Ernst by taking time to poison the well in that particular case. The footnote is adequate citation, in both cases.

Eubulides (talk) 16:58, 22 May 2008 (UTC)

• • This is not the point. The point is the quality of the research. Haldemans far surpasses Ernst. Haldemans has interdisciplinary consensus. Ernst does not. Equating Edzard Ernst to Scott Haldeman is grossly inappropriate. One holds a fringe viewpoint and produces low quality research on SMT and chiropractic care (Ernst). Haldeman does the opposite. Haldeman is also a medical doctor, Eubulides and specifically a neurologist. He might know a thing or 2 about SMT, safety, effectiveness of chiropractic care. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • The goal of chiropractic is to present both points of view and selecting the best evidence to do so. The topic is this: you preventing the inclusion of strong primary sources and advocating the use of flawed secondary sources that promotes and given it more weight (verbally) than it deserves. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • No. You are confusing the situation. It's not MDs vs DCs. It's about the quality of the research that Ernst produced with respect to SMT and chiropractic care. The research produced by Ernst has severe flaws. If you can find me severe methodological flaws and evidence of bias in the reviews or studies than that would be helpful. Otherwise you have no argument here and are speculating. We've provided the evidence of bias and flaws in Ernst' research. I'm talking about the quality of his review. Stop ducking the subject. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • Red herring, not on topic. What are you possibly talking about? CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • Ernst is already covered. That is not in debate. I've already said so at the very begining of this thread. Stop ignoring evidence and making misleading statements. You are cherry picking data here and are presenting an academically dishonest view of the literature. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • The ACAs definition is irrelevant to the discussion. The problem was replaced a definition of SMT provided by the WHO. Somewhere along the lines the definition of SMT was changed from the WHO reference to the Ernst reference. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
• No. You are missing the point. I am not disagreeing with Hurwitz. STOP ACCUSING ME OF DOING SO. I have asked you three times. I'm stating that you have ignored the evidence that WAS NOT COVERED IN HURWITZ and (b) The conclusions of the task force have been pruned to such a degree that it does not cover adequately nor in proper context the conclusion. Boyle et al. shall be included as will Cassidy and Haldeman. It's not to 'override' anything its to provide balance to it and they meet inclusion criteria as per MEDRS. If you could be so kind to provide me with specific Wikipedia policy that prevents the inclusion of strong, peer-reviewed primary studies I'd appreciate it. SmithBlue already asked you do this as well, it would be nice to give us an answer to a direct question. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • How convenient. You're unaware that the safety section cites manipulation can cause death (despite the extremely low risk). Safety should be specific to chiropractic care. Lumping it German MDs who practice SMT (2 week course) call themselves "chirotherapists" and kill people with inappropriate use of spinal manipulation and attributing it to "chiropractic manipulation" is a problem. This is the slippery slope you advocate? Terrible! CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • That is not the point. You are missing the point yet again. Let me perfectly clear: it's about the quality of the research. You are disagreeing with the WHO Task Force on Neck pain now. The experts. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)

• There is no evidence that "Haldemans far surpasses Ernst" in quality of research. On the contrary, Google Scholar suggests that Ernst is cited more often than Haldeman is. A spot-check of the citations to Ernst showed only positive citations. Obviously some are negative, but the spot-check suggests they're relatively rare. There is also no evidence that Ernst's viewpoint is "fringe"; this is merely a naked assertion. Obviously we have competing opinions here (Ernst and Haldeman); both expert opinions should be presented fairly and neutrally.
• The secondary source in question (Hurwitz et al., PMID 18204386) is by the same group that produced the "strong" primary source (Boyle et al. 2008, PMID 18204389). No reason has been presented to reach down into the primary source in order to obtain information that the research group in question did not think worth summarizing in its own review of its own research.
• Haldeman, like Ernst, has had serious criticism of his work. A quick web search finds Kapral & Bondy 2001 (PMID 11599330), which criticizes the paper of Haldeman et al. 2001 (PMID 11599329) for its risk analysis of "1:5.85 million cervical manipulations". Kapral & Bondy point out that malpractice claims data used by Haldeman et al. are inaccurate and that the risk of stroke remains unknown, despite the numbers Haldeman et al. report. I am sure there are other criticisms of Haldeman's work, but frankly, I would rather not head in this direction. Anybody whose goal is to dig up dirt about a particular researcher is sure to find something bad to say about their work. That has been done for Ernst, by chiropractic sources who have obvious motivations in going after a strong critic of the profession. It has not been done for Haldeman, because a similar motivation does not exist for going after Haldeman. Heavy criticism of Ernst does not necessarily mean that Haldeman is right and Ernst is wrong; it could just as plausibly mean that Ernst is stepping on people's toes and Haldeman is not.
• I'm not sure what the "red herring" comment refers to.
• Nor do I know what the charge of being "academically dishonest" refers to.
• The ACA's definition is quite relevant to this discussion. This discussion started with a long criticism of Ernst saying, among other things, "Why is Chiropractic using Edzard Ernsts definition of spinal manipulation which is incorrect characterization of healing art. This definition by Ernst is seriously flawed...." But Ernst was merely quoting the ACA. If this is the sort of criticisms Ernst gets, no wonder he has so many critics! Even if Ernst just repeats what the ACA says, a critic will say that Ernst incorrectly characterizes chiropractic. Perhaps some of the other criticisms of Ernst are also misguided?
• The safety-related conclusions of Hurwitz et al. have not been "pruned". They are presented in full in Chiropractic.
• Overriding a published expert review, based only on the naked opinion of a single Wikipedia editor of what constitutes "balance", violates the Wikipedia POV policy. It introduces bias to "balance" a review by reaching down into a primary study done by the very same group that produced the review. Such an action constitutes arguing with expert reviewers about their own work, and is well beyond what responsible Wikipedia editors should do.
• Ernst 2007 (PMID 17606755) cites 22 cases of severe adverse effects of chiropractic SMT with outcomes ranging from full recovery to paraplegia. I would support replacing "death" with "paraplegia" in Chiropractic.
• Chiropractic is not disagreeing with the task force on neck pain. It cites their review fully on the subject of safety.

Eubulides (talk) 23:16, 22 May 2008 (UTC)

• Actually there is, and your tired use of Google Scholar is not valid. Do you understand validity, Eubulides? Because I don't think you do. Google scholar (the instruement) does not assess quality of research. It provides hits. Ernst has been refuted for the last 7 years. His conclusions have been invalidated. His positions such as (SMT adds costs) goes against the majority of the literature describing SMT as cost effective. His conclusions go against the general consensus. His view is an extreme one, just like the World Chiropractic Alliance represents the other extreme. They're both fringe views. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)

• • The study by Boyle is independent of the task force hence it can and will be used. You are not going to get away with omitting evidence that demonstrates chiropractic care is a risk factor for stroke. It's not going to happen. It's too critical of an issue. Your edit on safety is a very, very poor one that cherry picks the evidence exclusively in your favour, that is, suggestive of chiropractic care causing strokes. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)

• This is patently untrue and you have missed the point (yet again) besides not producing a valid argument. The Haldeman article you are referring to is not being used here at chiropractic.((PMID 11599329). So, since you refuse to collaborate I propose we do not use the flawed review of Ernst. Haldeman has not had any 'serious criticism' of his work. That's why he led the International Neck Pain Task Force. He's a bigger player than Ernst. Ernst is a terribly biased researcher who, during the past 7 years, has been rebuked annually for his papers on SMT and chiropractic care. Heavy criticism has nothing to do with 'stepping on toes' it has to do with the quality of the research. Stop dodging the *&*&ing issue. It's about the research, Eubulides. Research, not designations. Ernst' studies here are pure crap and scientists have exposed the flaws in his research that you are pushing on us. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)
• Sigh, whatever.
• More confabulation. Taking the ACA definition and trying to spin it into misguidings of Ernst. When was that definition of the ACA produced, Eubulides and why is it superior to the definition provided by the World Health Organization?
• You not only pruned it, it was chopped in half. I have never met such an intellectually dishonest editor. You use "supportive" sources of chiropractic/SMT to bash chiropractic/SMT, just like you did with the CCA Neck Pain Guidelines. Then you claim "there are far more supportive sources in favour of chiropractic". You're gaming the system. A brief review: SmithBlue has said that your stance on MEDRS was faulty, DigitalC has said that you're misrepresenting views, Dematt has said you may have cherry picked the evidence, and I have told you all the above. What is your response to that, or will you again duck the question?

• • It's not overriding if the review isn't congruent with the subject at hand. POV is already violated because you have a) cherry picked sources b) have not attributed the view properly and have omitted relevant passages which supports the opposing view. You have misrepresent my view yet again. Pathetic. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)

• Chiropractic SMT? You mean, manipulation done by a chiropractor? Not likely. Ernst is a German. Look what his German buddies are doing here. They're killing people with improper neck manips and then attributing it to Chiropractic SMT. Think it's not plausible that Ernst is beefing up his stats with misattribution? Definitely a strong possibility. This is the kind of research you espouse? How can you be serious? Do you not critically appraise the studies which you cite?

• Chiropractic cites an executive summary and it does not cover the 5 main conclusions of the multidisplinary panel of experts, it lists 1. Ernst is a solo MD on a mission. You cannot compare the reputation of Dr. Haldeman to Ernst. One leads international task forces one writes severely biased and flawed reviews on SMT by himself. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)

• Google Scholar is not a perfect indicator of course, but it is better than nothing. It has provided evidence that Ernst is cited more often than Haldeman is, and that the top cites to his work are positive. No evidence has been presented to the contrary. Ernst's conclusions do go against mainstream consensus within chiropractic, but mainstream chiropractic is not the same thing as mainstream opinion overall.
• Boyle et al. 2008 (PMID 18204389) was not "independent of the task force". The task force review (Hurwitz et al. 2008, PMID 18204386) says that Boyle et al. was "original research conducted by the Neck Pain Task Force" and that Boyle et al.'s results "were included in the analysis of these intervention modalities".
• My point was merely that Haldeman's work has been criticized, which it has been. In science, serious criticism is a normal thing. It is not unusual. One can easily find more criticism of Haldeman, but I'm not going to bother. I don't want this to descend into an attempt to cast aspersions on the character of Haldeman; that is certainly not intended. It would be just as silly and counterproductive to do that as to cast aspersions on the character of Ernst.
• Ernst's work is high quality and is often cited, in a positive way, by serious researchers.
• The ACA's definition of manipulation was done in 2003. You can verify this by reading the cited document; it is freely readable. It's a high-quality definition; I don't see why anybody would characterize it as "incorrect characterization of healing art" or "seriously flawed". Certainly there are different definitions of SMT floating around, and the WHO's definition isn't a bad one, but it wouldn't be right to say that the definition in the WHO training/safety guideline is the definitive one.
• Nothing was "chopped in half". All the safety-relevant conclusions of Hurwitz et al. are in Chiropractic.
• I disagree with your characterization of the comments by SmithBlue et al. For example, SmithBlue and I pretty much agree on WP:MEDRS.
• The review in this particular case (Hurwitz et al.) is directly on topic.
• Yes, by "chiropractic SMT" I meant SMT done by a chiropractor. Ernst 2007 (PMID 17606755) cites 22 cases of severe adverse effects of chiropractic SMT.
• I think it implausible that Ernst engaged in scientific misconduct in his review. I don't see any evidence that he did.
• Chiropractic does not cite the task force executive summary.
• Ernst and Haldeman both have good reputations. Both of them write reliable sources on the subject, and both their opinions should be fairly summarized on Chiropractic.

Eubulides (talk) 09:03, 23 May 2008 (UTC)

• • • I don't believe anyone has presented any information demonstrating bias or flaws is Haldeman's research. However, many flaws and bias in Ernst have been demonstrated. My main contention with Ernst is his "A systematic review of systematic reviews of spinal manipulation" study. I don't think that this should be used at all in Chiropractic because it does not study chiropractic specifically but rather SMT in general. I really don't care how clearly we explain to the reader that the SMT studied by Ernst was not necessarily performed by chiropractors, merely including the conclusions from this study on Chiropractic leaves it open to reader confabulation. My other chief contention with Ernst is not only in how much we rely on him as a source, but the prominence his biased and flawed conclusions are given. -- Levine2112 ^discuss 18:16, 22 May 2008 (UTC)
      • See the discussion of Kapral & Bondy 2001 above for one criticism of Haldeman's work. I disagree that readers will be confused by text that clearly distinguishes SMT research from research on chiropractic care. Also, Ernst's latest critical review (PMID 18280103) is about chiropractic, not about SMT; surely there's no objection to citing that. Eubulides (talk) 23:16, 22 May 2008 (UTC)
        • • A disagreement by 2 MDs with the Haldemans method of determining the 1 in 1.85 million risk of dissecting stroke is not even close to the numerous rebuttals and outright bias of Ernst' reviews include a refutation of his methods in his reviews. This has never happened with any Haldeman research. This is why Haldeman was selected by the World Health Organization to lead the Bone and Joint Decade (2000-2010) Neck Pain Task Force. He's got lots of credibility amongst a multitude of disciplines. Ernsts credibility is in doubt and he does not enjoy broad mainstream support. That's where you've got it wrong. There is multidisciplinary consensus in Haldemans work, and none in Ernsts'. CorticoSpinal (talk) 05:50, 23 May 2008 (UTC)
            • It was just one example found by a quick web search. It was not intended to be an indictment of Haldeman, and I do not intend to go down the path of casting aspersions on researchers on one side of this issue or another. Again: in science, serious criticism is a normal thing. It is not unusual. The fact that Haldeman's work is sometimes criticized does not mean his work is unreliable or low quality. Similarly for Ernst. Eubulides (talk) 09:03, 23 May 2008 (UTC)

Expecting too much from scientists

Confabulation, I like that word :) Part of the problem is that we are expecting too much from our scientists. They can only say so much. They seem to pretty much agree that SMT is very well studied and is at least as good as any other standard medical treatment for neck pain and headaches and better than some for the treatment of low back pain. For Type O conditions, there is not enough information to draw any conclusions. We could throw in there that there is risk associated with using smt for the cervical spine, but then we would need to address that the other standard methods have risks as well. Ernst would fit in there somewhere for sure. -- Dēmatt (chat) 21:24, 22 May 2008 (UTC)

I disagree that scientists "pretty much agree" that SMT is "at least as good as any other standard medical treatment for neck pain and headaches and better than some for the treatment of low back pain. For example, the American College of Physicians only weakly recommends SMT as an alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail. Admittedly the ACoP is just one group, but it's an important one, and it disagrees with the contention that SMT is "better than" the ordinary treatments. Eubulides (talk) 23:16, 22 May 2008 (UTC)

Good point, that could go on forever. We should quote our best prochiro POV review (CS chooses) and then our best antichiro POV review (Eubilides chooses) in Chiropractic then link them to Scientific investigation of chiropractic where we can use the entire page to talk about any kind of research on anything we want.... It's an option? -- Dēmatt (chat) 01:02, 23 May 2008 (UTC)

It couldn't hurt to try. A few questions before: does a multi-disciplinary review carry more weight to due less bias than a review by a single profession (i.e. MD or DC?) CorticoSpinal (talk) 05:11, 23 May 2008 (UTC)

It would not be appropriate to break things out now into a subarticle, for reasons discussed in #Scientific investigation subarticle below. Eubulides (talk) 09:03, 23 May 2008 (UTC)

Hey, how do they handle things on the Surgery page? (I just thought of that while typing so I put a link in so I could click on it.) -- Dēmatt (chat) 21:37, 22 May 2008 (UTC)

They don't handle science on the surgery page... I do like the Medicine article, though. They don't handle the science part on the page either. No wonder. Why are we trying to handle science here? Why not on each type of treatment? I know we've discussed it before, and isn't that why we created the Scientific investigation of chiropractic article? -- Dēmatt (chat) 21:49, 22 May 2008 (UTC)

Medicine is a very broad topic. Perhaps a more confabuliciously specific professional article such as Internal medicine would be a more apt comparison to Chiropractic. That said, there are no science or effectiveness section there either. -- Levine2112 ^discuss 22:11, 22 May 2008 (UTC)

Maybe the reason we feellike we are swimming upstream is because we are trying to cram too much into this article. For instance, osteopaths, chiros, and PTs all use SMT - we can explain all the stuff about SMT over there. Only chiropractors use Spinal adjustments so we explain that over there. Here we just do a skeleton article that includes things like the history, scope and education with lots of links to the other articles... That is the way everyone else is doing it. I know we've discussed this before, but not with everyone here. Thoughts (again)-- Dēmatt (chat) 22:29, 22 May 2008 (UTC)

• We try to handle effectiveness and safety here, just as we do in Acupuncture and Traditional Chinese medicine and Homeopathy, because they are legitimate and core issues to the subject. I agree that it would make sense, if Chiropractic#Scientific investigation gets too long, to create a subarticle for it. I disagree that the material should be moved to Spinal manipulation though; most of the material in that section is about chiropractic care, not about SMT in general.Eubulides (talk) 23:16, 22 May 2008 (UTC)

• I haven't read the TCM article, but Acupuncture and Homeopathy are bad analogies, because they use 1 treatment modality.DigitalC (talk) 00:42, 23 May 2008 (UTC)

• No article is a perfect analogy, but these articles do have something important in common with Chiropractic, namely, they all involve treatments for which there are serious questions about efficacy or safety. Ayurveda is another example. Eubulides (talk) 09:03, 23 May 2008 (UTC)

• Are you saying Medicine is less risky and more efficacious? Or are you saying that it is just more mainstream? Anyway, maybe we should look at medical articles that are FA status? -- Dēmatt (chat) 13:53, 23 May 2008 (UTC)

Scientific investigation subarticle

• I disagree that the current section is so long that a subarticle is necessary. It's way shorter than Chiropractic#History, for example. And the current discussion is about the same length as it was back when the coverage of effectiveness was heavily biased in the pro-chiropractic direction. We should be careful not to give the impression that there is an interest in moving this material elsewhere merely because it's less supportive of chiropractic than it used to be.

Eubulides (talk) 23:16, 22 May 2008 (UTC)

• You seem to disagree with every regular editor here except QuackGuru. Perhaps you should re-evaluate your commitment to collaborating with others. Chiropractic is not TCM, it's not homeopathy. You even pushed for an article that suggests is "more of a medical specialization, like Dentistry. So, how can chiropractic be a medical specialization and fringe like you claim it is? Medicine, Optometry, Osteopathic Medicine, Physical Therapy, Dentistry and other professional articles do not have effectiveness, safety, science, cost-effectiveness, etc. For good reason too. You are pushing a CAM double standard used to discredit and marginalize CAM, which incidentally had more visits to their practioners than "mainstream" ones. So, who's mainstream again? Bottom line: stop disagreeing with everybody. Nobody but QG shares your views. SA and then anti-chiro skeptic alliance (ACSA) can randomly drop by here and bomb the article and try to railroad changes, but as Dematt had already mentioned falsifying consensus by uninvolved observers is not good editing. (I meant - to use outside editors to determine what version of an entire article was 'consensus' was not a good idea while it is being developed because it would be too hard to make necessary improvements ~Dematt).CorticoSpinal (talk) 00:36, 23 May 2008 (UTC)

Could we possible hold a discussion without people who disagree with you being part of an evil alliance of villainy, thanks. Comment on edits, not editors. If you have a problem with a users conduct, file a RfC. Jefffire (talk) 13:17, 23 May 2008 (UTC)

• I have not said that chiropractic is fringe. Chiropractic is a complicated beast: it has elements of primary care and elements of specialization; it has elements of science and elements of antiscience (or "fringe" or whatever you want to call it); and so forth. These elements should be covered. Chiropractic should not attempt to present a sanitized version of chiropractic as we wish it might be; it should present chiropractic as it is, warts and all. Eubulides (talk) 09:03, 23 May 2008 (UTC)

• I don't remember saying that? But I could be wrong? -- Dēmatt (chat) 01:17, 23 May 2008 (UTC)
• I am not concerned whether the article is too long, it's too boring. -- Dēmatt (chat) 01:17, 23 May 2008 (UTC)

"Too boring" that gave me a chuckle, Dematt.--—CynRN ^(Talk) 06:31, 23 May 2008 (UTC) It's the talk pages that are really exciting!

I agree the article is too boring. More spice, please! Eubulides (talk) 09:03, 23 May 2008 (UTC)

Hehe, the spice is on the talk page! If we could just transfer that to the article space! :D -- Dēmatt (chat) 12:57, 23 May 2008 (UTC)

I am finding this talk page very hard to follow. However, I wanted to respond to Eubulides statement that "No reason has been presented to reach down into the primary source in order to obtain information that the research group in question did not think worth summarizing in its own review of its own research." The review does not cover the primary study does it? It is OR to decide why it was not covered in the review. If a review does not exist that covers the article in question, then it is totally acceptable to use the primary source.DigitalC (talk) 00:42, 23 May 2008 (UTC)

The review in question (Hurwitz et al. 2008, PMID 18204386) does cover the primary study in question (Boyle et al. 2008, PMID 18204389). Which is understandable, since the review and the primary study were both put out by the same task force. Eubulides (talk) 09:03, 23 May 2008 (UTC)

Hard to follow, indeed!I guess the skeptics are outnumbered!:)"there is an interest in moving this material elsewhere merely because it's less supportive of chiropractic than it used to be." That's how it comes across to me. My apologies if that is not what is going on. So certain medical articles don't have 'safety and effectiveness'? The Chiropractic article can be better than that by including it. I don't see why the effectiveness of SMT can't be summarized succinctly and be included here. Chiropractic researchers have been researching SMT. Chiropractors do about 90% of it(?), so if a PT study gets mixed in somewhere, does that invalidate all the reviews of studies of SMT? Some chiropractors have suggested that chiropractors should redefine themselves as "MSK pain specialists" because that is really what they are in practice. All the philosophy stuff confuses the public. Instead of attacking Eubulides, concrete suggestions should be made for the content of the article.

Actually DigC has made an interesting point... --—CynRN ^(Talk) 00:53, 23 May 2008 (UTC)

Yes, DigitalC's point is a reasonable one, but it doesn't apply here, since the review in question covers the primary study in question. Eubulides (talk) 09:03, 23 May 2008 (UTC)

No apologies needed. I thought we were all skeptics :-) But really, hopefully we are all working toward turning the article that had GA (good article) status to FA (featured article). It won't be possible unless we all are able to pull together and create a NPOV and thorough succinct and interesting article. -- Dēmatt (chat) 01:17, 23 May 2008 (UTC)

For the record, I don't object to having the effectiveness material on this article, please see my support for Effectiveness 3C (although the addition of STT research would be good?), the only version that doesn't have a SYN violation by including SMT provided by non-chiropractors. I also support a similar section being written for the SMT article, without mention of other chiropractic interventions (Laser, IFC, US, Soft tissue, etc. etc.) - and then having a wikilink between the sections. Cyn is correct that Chiropractic researchers have been researching SMT. They may apply that to Chiropractic SMT, but *WE* are bound to follow WP policy such as WP:SYN, WP:OR, and WP:NPOV, policies which DON'T apply to researchers.DigitalC (talk) 01:54, 23 May 2008 (UTC)

my two cents. . . leave out non chiro specific research.TheDoctorIsIn (talk) 01:59, 23 May 2008 (UTC)

DigitalC, I'm not sure I am following what you are suggesting. Can you clarify? What is it that CYN thinks is a good idea? I can't follow this page either. -- Dēmatt (chat) 02:30, 23 May 2008 (UTC)

Is it Scientific Investigation 3C (with all the strike-outs) found above that should be a scaffold for current editing, DigC?--—CynRN ^(Talk) 03:15, 23 May 2008 (UTC)

Effectiveness 3C has no SYN violations because it only uses sources that talk about chiropractic SMT, not SMT in general. I think that current attention should go towards 3C, to gather a consensus version for insertion. This would at least allow us to move forward in SOME direction.DigitalC (talk) 03:54, 23 May 2008 (UTC)

This approach could likely create the odd and untenable situation of producing two antithetical scenarios: (1) chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI), and (2) all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors. What the heck am I saying?! That's already the case, and has been for years! -- Fyslee / talk 04:44, 23 May 2008 (UTC)

I think Chiropractic SMT still includes SMT studies and reviews that are performed by nonchiros. I think he is just saying not to include studies that have others performing SMT, am I right Digital? -- Dēmatt (chat) 14:20, 23 May 2008 (UTC)

Correct. It isn't the source that matters, it is the data. If it is not explicitely stated that it is talking about Chiropractic SMT, it shouldn't be in this section (But SHOULD be in a section of effectiveness over at SMTDigitalC (talk) 04:59, 25 May 2008 (UTC)

The problem with this approach is that it disagrees with the opinion of expert chiropractic researchers, who have said that the distinction between SMT performed by chiropractors and non-chiropractors is not significant as far as effectiveness research goes; see Meeker & Haldeman 2002. I don't see a good reason here to override the opinions of experts in the field. Eubulides (talk) 07:34, 25 May 2008 (UTC)

It doesn't disagree with the opinion of those researchers at all. However, we are in a different realm than the researchers, we are in the realm of wikipedia, with its own policies. For example, from WP:SYN - "if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research". The sources on (generic) SMT effectiveness are NOT directly related to the subject of Chiropractic. However, they ARE directly related to the subject of Spinal Manipulation. Outside of WP, I would totally agree with you that the source of the SMT doesn't necessarily matter. DigitalC (talk) 09:44, 27 May 2008 (UTC)

I dunno about this Fyslee: "chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI)," These researchers are either MS or PhD holding DCs. They're there (nice!) to advance the science of manipulation and its applications (or lack thereof) in primarily musculoskeletal disorders and some select non MS disorders. Your description sounds like they'd fudge the research just to validate chiropractic SMT at any cost. That's not exactly AGF ;)

"all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors." This implies that chiropractic researchers do not care about identifying risk factors. Steering cleer of negative results is a bit rich, no? Anyways, I favour Dematts suggestion of a few sentences with general impressions on LBP, neck pain, headache for SMT. Extremity adjusting is technically not spinal manipulation anyways. I also want to include the research of SMT with respect to animal models in addition to the neurophysiological effects of spinal manipulation (recalibration of the gamma motor system, resting EMG tone, sensorimotor integration at the level of the cortex, the breaking of fibrous adhesions to to immobility (fixation/subluxation), the biomechanical consequences of subluxation(vertebral joint dysfunction), the reduction of inflammatory markers (TNF-alpha, IL 1-6) the mechanical reduction of inflammation in the IVF via spinal manipulation (mechanical movement of the inflammation), the call by Hawk for Whole System Research (WSR) in investigating the whole clinical encounter not just the application of manipulation; etc. Science section is lacking but we should include specific chiropractic spinal manipulation studies since they generally place greater value on manipulation and research it in a different, more specific manner. CorticoSpinal (talk) 05:33, 23 May 2008 (UTC)

"This approach could likely create the odd and untenable situation of producing two antithetical scenarios: (1) chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI), and (2) all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors.". I fully support the development of a "Effectiveness of SMT" section over at SMT as well (which then would not include other chiropractic interventions).DigitalC (talk) 05:41, 23 May 2008 (UTC)

I agree. I still think it is inappropriate to deal with the effectiveness of individual treatment methods here. It needs to be done....at their respective articles. The effectiveness of the clinical encounter can be mentioned here, since that has to do with how the profession relates to the patient encounter. -- Fyslee / talk 06:12, 23 May 2008 (UTC)

Agree. -- Dēmatt (chat) 13:06, 23 May 2008 (UTC)

Likewise. CorticoSpinal (talk) 17:08, 23 May 2008 (UTC)

(outdent)

• Most of Chiropractic#Scientific investigation is about chiropractic treament, not SMT in general (or any other particular treatment outside of chiropractic). It would be inappropriate to move this material to treatment articles, because the material is specific to chiropractic.
• I still find it curious that there's a desire to move effectiveness-related material elsewhere now. Why wasn't there a similar desire during the long period when the effectiveness-related coverage was all strongly pro-chiropractic?

Eubulides (talk) 09:03, 23 May 2008 (UTC)

1)It will still be appropriate in the Scientific investigation of chiropractic article, too. That article would be a lot bigger and be able to include your reviews and CS's 'primary' sources as well as NPOV discussions of all the reason's why somebody's research is better/worse/outdate/orwhateverotherexcusethatcanbeimagined without bagging this page down. This will be the 'portal of entry' for chiropractic. 2) I wasn't here? -- Dēmatt (chat) 12:51, 23 May 2008 (UTC)

As a clarification Dematt, I'm not advocating whatsoever that primary sources trump secondary sources. That's not right. However, when the secondary review is not congruent with the claim being made than primary studies can definitely fill the void. Also, I'd like to get some opinions on how Ernst' reviews are being used here (I last counted 8 separate references to Ernst in "safety" "effectiveness" and "cost effectiveness". This is problematic; his reviews are methodologically unsound and his conclusions go against the bulk of the literature but are being given equal weight. We need to solve Ernst first and foremost then we can tackle other things. We need to set priorities for the page otherwise we're spinning our wheels having 15 different discussions at once. I propose we deal with Ernst fist, then we can move onto Effectiveness of Chiropractic Care making a new draft that incorporates my suggestions with Eubulides draft that specifically deals with chiropractic care. Othewise there's confabuluation happening (gotta love that word). CorticoSpinal (talk) 17:08, 23 May 2008 (UTC)

This approach could likely create the odd and untenable situation of producing two antithetical scenarios: (1) chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI), and (2) all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors. This works both ways.. I'm sure that is what you meant :-) Or are you saying that PhDs, MDs, PTs, DOs have no COIs? Oh wait a minute! Can we say WILKS! (more shock and awesome sarcasm :-D ) -- Dēmatt (chat) 13:06, 23 May 2008 (UTC)

Since this comment is coming from a good friend, I'll accept it in the constructive criticism spirit in which it is intended. Yes Dematt, it's very true that all professions are subject to the natural human foibles and tendencies that make it easy to consciously or unconsciously slip into COI thinking, to ignore personal blindspots, and to cherish tendencies to avoid uncomfortable conclusions. Absolutely true. That applies to mainstream and other professions, my own included.

In this case I was being specific about SMT research, which has an interesting history. This history is interesting to follow because of the changing culture for scientific research in chiropractic. It is only a relatively short time ago that truly scientific research (without chiro philosophy dictating and dominating the research) began in chiropractic. Before that such research was totally untrustworthy. (What can be expected when DC students were told to cross out whole pages in their scientific textbooks of anatomy and other subjects because BJ deemed it untrue?) Now we have more and more chiropractic research that is more trustworthy, but usually because the ones doing it are DC/MD/PhDs, not only DC degreed. This is in contrast to mainstream professions which have much longer and well-established traditions for doing non-philosophy-dominated (there is no real philosophy that dominates modern medicine) scientific research. The specific case of SMT involves THE profession's core foundational treatment method and chiro research has been notoriously unreliable on this point (but that's changing) because the philosophy has dictated that the results must be positive. Call it blindspots, deliberate fudging, carelessness, ignorance of how to do truly objective scientific research, ignoring plenty of medical research on the same subject, or whatever, the COI of chiropractic on this point bears no comparison to research on the same subject performed by medical professionals without that COI. (Older chiropractic research doesn't deserve AGF.) Other medical professionals have been looking at this subject from many more angles than DC research and without the same blinders, and thus have been more open to admitting where the evidence might be weak, or where side effects should be openly discussed. Few chiro researchers (at least previously) literally "dared" to do that. They got attacked as traitors and could lose their jobs. This explains why little chiropractic research pays much attention to potentially serious side effects and why other researchers have actually tried to examine that question. The two groups of researchers approach the subject very differently, which was my point above. Ernst actually did concrete research and found a 100% rate of non-reporting, which makes all talk of actual percentages for risks of cervical manipulation nonsensical. No chiropractic researchers have done that. They have used methods that could easily be distorted because they made extrapolations from incomplete data, while Ernst went directly to the source, asked, and got concrete results from a whole nation. The results were shocking to all, and many chiropractic leaders have been in denial since then. Yes, mainstream professionals could be in danger of doing the same thing in specific areas where they might have a COI, but this isn't one of them. -- Fyslee / talk 23:47, 24 May 2008 (UTC)

I really meant it with a twist of humor rather than criticism, but you're right, it is hard to write in such a way that get's the emotion just right :-), but rest assured, regardless of your skewed politics (I'm pickin'), I do consider you a friend. Your point about 'reporting adverse events' is well taken on these ears and I do respect that this was an important issue. If you remember our 2006 version of this issue, it ended with this statement: 'that any attempt to determine percentages of risk were nonsensical...", because that was the new and important feature of Ernst's research. Well, since that time, the neck task force has taken another important step by trying to determine if he might be right, "that the numbers might actually be higher" and I don't have to tell anyone here what they determined by comparing patients from other primary care doctors and those from chiropractors and determined that the numbers were identical. Their research did not support Ernst's assertion. This does not mean he is wrong, only that he is not supported with this form of evaluation. This should not be a problem to repeat this type test, and there will be more types of evaluation in the future that will either support or negate these findings. If there are enough of these from different sources, this hypothesis will be formally debunked. If not, it will become part of mainstream thought. Now, you can choose not to 'believe' the task force because you 'believe' there is a conflict of interest, but then you would be committing the same fallacious thinking that you attribute to chiropractors, a type of appeal to your authority. All I am asking is that you give 'your' sources the same skeptical assessment that you give 'mine'. I am betting that if you did, you would realize that we were all rational, reliable, and good intentioned people. The problem is not us, but that science has not yet provided us with the knowledge that we all seek. -- Dēmatt (chat) 04:26, 25 May 2008 (UTC)

I agree that the task force work did not support Ernst's assertion. Nor did it argue against Ernst's assertion; it could be, for example, that the risks are so rare that they were not picked up by the techniques used by the task force. There is some (although very small) risk, since we do have a few cases where chiropractic SMT caused severe adverse effects. With that in mind, Chiropractic should mention both the task force work (which it does) and Ernst's assertion (which it does). Eubulides (talk) 07:34, 25 May 2008 (UTC)

Why should the Task Forces report and Ernst' study be given the same weight? CorticoSpinal (talk) 23:53, 26 May 2008 (UTC)

The Task Force report represents the chiropractic mainstream (although the task force has some MD members, it is dominated by chiropractors). Ernst represents critics of chiropractic, which includes much of the medical mainstream, a far bigger group of people than chiropractors. Both sides make good points, and both should be fairly represented. Eubulides (talk) 08:08, 27 May 2008 (UTC)

This is a flawed argument. The Task Force represents the scientific/medical mainstream. It is not a chiropractic document. It is a research document. Done by a multidisciplinary panel of health care scientists reaching a consensus on topics such as efficacy, effectiveness, validity, safety. So, why should Ernsts, one man, severely biased, methodologically flawed' paper a) being presented as majority mainstream opinion and b) should be given the same weight to the World Health Organization Task Force? (which is the far superior document in both depth, breadth, scientific consensus and notable involvement of universities and governments from all over the world). I do expect a reply, Eubulides, so I'll give you advance notice not to use WP:IDIDNTHEARTHAT like you've done so in the past when I've asked you this question in the past. Thanks. CorticoSpinal (talk) 04:48, 28 May 2008 (UTC)

The Task Force is led by a chiropractor and is dominated by chiropractors. It does have MD members but it represents mainstream chiropractic opinion, which is not the same thing as the scientific/medical mainstream. Ernst is just one critic, true, but is a suitable representative for many in science and medicine, some who hold stronger anti-chiropractic opinions than he does. Eubulides (talk) 09:05, 28 May 2008 (UTC)

The Task Force is a World Health Organization sponsored organization of expert scientists (we are talking about research, not professional affilitations, Eubulides, please stop mixing the 2 together). It does not represent mainstream 'chiropractic' opinion. It simply represents the findings of the expert scientists. So, it's a scientific document produce by mainstream scientists. The fact that chiropractors are included in this proves its mainstream; the fact that the lead editor is a neurologist and a chiropractor proves this even moreso. Also, where in the cited source does it say it represents mainstream chiropractic opinion? I didn't think so. Are you disputing the notability of the Task Force report? Your source is disputed. It's been invalidated and this his been verified and proven. Go find another one, according to you they're easy to find. CorticoSpinal (talk) 06:47, 29 May 2008 (UTC)

The task force is not directly sponsored by the WHO. It is a bit amusing to see it continually being cited here as a "World Health Organization sponsored organization". It would be more accurate to describe it as a "World Federation of Chiropractic sponsored organization" (the WFC, unlike the WHO, is a direct sponsor). The task force is dominated by chiropractors. It produces scientific documents reflecting mainstream chiropractic opinion. I am not disputing the notability or reliability of the task force reports within the context of mainstream chiropractic, but I am disputing that it definitively represents mainstream medical and scientific opinion. It does not. Eubulides (talk) 08:47, 29 May 2008 (UTC)

So you are suggesting the WHO is not involved in the BJD Neck Pain Task Force? So, to review: you do not dispute the source, and you acknowledge that it is not fringe? I need a bit of clarification on your stance on that. Next, you dispute the claim that the document represents mainstream scientific opinion? Yes/No? Finally, you claim the BJD Task Force is "dominated by chiropractors" is this correct? I don't want to misrepresent your argument so I'll allow you to clarify before proceeding with a possible rebuttal. Cheers. CorticoSpinal (talk) 15:42, 29 May 2008 (UTC)

I'm sure there is some sort of connection between the WHO and the task force, yes; it's a small world, after all, and undoubtedly some of the people in that large task force have something to do with the WHO at some point. I haven't seen any evidence, though, that it's a WHO-sponsored organization. I do not think that the task force is "fringe". But that does not mean that it is "mainstream" either. It is mainstream chiropractic, I'd say; undoubtedly many straights would disagree with it, but straights are in the minority within chiropractic. It does not represent the definitive mainstream scientific opinion, no. The task force is dominated by chiropractors, yes; this dominance is far out of proportion to their relatively minor influence in mainstream medicine and science. Eubulides (talk) 16:56, 29 May 2008 (UTC)

---

"I really don't care how clearly we explain to the reader that the SMT studied by Ernst was not necessarily performed by chiropractors, merely including the conclusions from this study on Chiropractic leaves it open to reader confabulation." I think this word should be "conflation". Confabulation: "A fantasy that has unconsciously emerged as a factual account in memory, based partly on fact or complete construction of the imagination" Conflation: Treating two distinct concepts as if they were one, i.e. (some would say) SMT and chiropractic treatment. --—CynRN ^(Talk) 19:03, 24 May 2008 (UTC)

I will prove that, as currently being used, Ernst's opinions (fringe) are used to undermine and subvert the mainstream consensus. The placement of Ernst' text within Safety, Efficacy, Cost Effectiveness is done is a manner that is inconsistent with the general consensus. It's being used to open and close paragraphs instead of representing the dissenting opinion on a topic where the majority of the research favours the opposite stance. Not to mention that the reviews by Ernsts are severely flawed from a methodological perspective. So now we're citing flawed, biased research and passing it off as 'mainstream' when it clearly goes against mainstream. Its a violation of WP:OR in that the evidence has been cherry picked to present a different conclusion than is generally agreed upon. Tertiary sources prove this as well. CorticoSpinal (talk) 23:53, 26 May 2008 (UTC)

Mainstream chiropractic opinion clearly opposes Ernst, but that is not at all the same thing as saying that mainstream scientific or medical opinion opposes Ernst. Ernst's work is approvingly cited by a wide variety of non-chiropractic sources. It is not "fringe" work by any reasonable non-chiropractic standard. Eubulides (talk) 08:08, 27 May 2008 (UTC)

Yes, it should be clearly explained to readers that while 95% does apply to chiropractors, certain DC editors wish to make sure everyone knows that 5% might not apply to them, so therefore (because maybe 5% weren't DCs) the whole thing can't be used here, even in the cases where the ones conducting the study were chiropractors who were studying the effects of SMT (the irony of it all ;-) -- Fyslee / talk 23:14, 24 May 2008 (UTC)

Integration: Sources

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2384186 - CorticoSpinal 16:47, May 21, 2008

Independent Studies of Chiropractic

Most commentaries regarding chiropractic (pro and con) come from sources with a distinct bias, and therefore their interpretations of existing data tend to conform to their preexisting opinions. That would be the case with this article, and with the article published with this one by Homola. The most objective evaluations of chiropractic would be expected to come from independent sources if they have no vested interests, but rather simply have a need to know. There have been two such major studies done by the governments of two nations seeking to determine whether it would be in the best interests of their citizens to include chiropractic in their systems of socialized health care.6,28

The first one was done in New Zealand more than 25 years ago.6 After a lengthy, exhaustive inquiry, a comprehensive 377-page report was compiled that listed many findings including the following quotes that were taken from the Summary of Principle Findings: 1. Spinal manual therapy in the hands of a registered chiropractor is safe. 2. The education and training of a registered chiropractor are sufficient to enable him to determine whether there are contra-indications to spinal manual therapy in a particular case, and whether the patient should have medical care instead of or as well as chiropractic care. 3. Spinal manual therapy can be effective in relieving musculoskeletal symptoms such as back pain, and other symptoms known to respond to such therapy, such as migraine. 4. Chiropractors should, in the public interest, be accepted as partners in the general health care system. No other health professional is as well qualified by his general training to carry out a diagnosis for spinal mechanical dysfunction or to perform spinal manual therapy.

The other independent study was done by the government of Ontario for which a group of health economists was commissioned to study chiropractic management of low back pain (LBP).28 The following quotes were taken from the Executive Summary of their findings: 1. 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 LBP. Many medical therapies are of questionable validity or are clearly inadequate. 2. There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low-back pain. 3. There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management. We reviewed numerous studies that range from very persuasive to convincing in support of this conclusion. The lack of any convincing argument or evidence to the contrary must be noted and is significant to us in forming our conclusions and recommendations. The evidence includes studies showing lower chiropractic costs for the same diagnosis and episodic need for care. 4. There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management. Patient satisfaction is an important health outcome indicator and adds further weight to the clinical and health economic results favoring chiropractic management of LBP. 5. Despite official medical disapproval and economic disincentive to patients (higher private out-of-pocket cost), the use of chiropractic has grown steadily over the years. Chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians. CorticoSpinal 21:53, May 22, 2008

Yes, the NZ report is rebutted by the US government! (Reply to edit summary)

• New Zealand report not "trustworthy"
• A review of the New Zealand report prepared by the United States Congress' Office of Technology Assessment found "'serious problems' in the Report's treatment of safety and efficacy issues..... It concluded .... that the New Zealand Report's review of the safety issue was 'unsatisfactory.'...In light of this thorough and well-considered appraisal of the New Zealand Report, with which I agree, I do not find the Report's conclusions trustworthy. The request for admission for the purposes of showing the truth of the matter asserted is therefore denied." [42]

The judge in the Wilks case wasn't happy with the NZ Report. -- Fyslee / talk 05:19, 23 May 2008 (UTC)

• The rebuttal is fair game too, of course. We can either include both or neither. To your knowledge has any government rebutted Manga besides Tardif? CorticoSpinal (talk) 05:37, 23 May 2008 (UTC)

Several independent studies have been done in Europe, as part of national practice guidelines for low back pain. Five of them are reviewed in Murphy et al. 2006 (PMID 16949948). We should be using reliable reviews like this rather than doing the research ourselves. The Manga report is so dated now that we shouldn't be citing it anywhere outside the History section. Eubulides (talk) 09:03, 23 May 2008 (UTC)

I wasn't suggesting we add the text per se; that exerpt is taken from DeVocht, 2006. I was wondering more if anyone found anything useful for any section from that exerpt. If not, we can junk it. Manga could easily fit into cost-effectiveness/effectiveness as well as it was a landmark study. We just need to attribute it to 1994. CorticoSpinal (talk) 16:40, 23 May 2008 (UTC)

The obsolete Manga report has only historical impact and is already mentioned in the history section. See the movement towards science section. We should not add the Manga report to argue with newer references in the cost-benefit section. See WP:MEDRS. QuackGuru 17:10, 23 May 2008 (UTC)

I don't understand why the Manga report is considered obselete when it is still being cited by scientific papers (and yet we can't cite it). [43], [44], [45], [46], [47], [48], [49], [50], [51] ALL cited Manga between 2000 and 2006.DigitalC (talk) 00:58, 25 May 2008 (UTC)

• The first citation you mention (Bronfort et al. 2004) criticises the Manga report, saying its "conclusion is almost exclusively based on analysis of retrospective and nonrandomized studies, which do not allow conclusions about clinical effectiveness."
• The 3rd citation is a URL that does not work for me.
• The 6th citation (Dagenais & Haldeman 2002, doi:10.1016/S0095-4543(01)00005-7) says of Manga and similar reports: "A detailed analysis of this literature by Baldwin et al., however, has revealed many methodologic flaws in this literature and concludes that these studies fail to clarify whether medical or chiropractic care is more cost-effective."
• The 7th citation (Oakley et al. 2005, PMID 17549209) primarily refers to politics, not to effectiveness. It says "Since 1975, the chiropractic profession has enjoyed improved political support in a number of countries due to some published analyses favorable to chiropractic care." and cites Manga among 4 other studies.
• The other citations are all primary studies, not reviews of Manga et al.

Given all the above, it appears that the scientific reviews of the Manga report were unfavorable, and that we should not be relying on its results in the scientific investigation section. It would be reasonable to talk about Manga with respect to the historical politics of chiropractic, though, so coverage in Chiropractic #History would be reasonable (although it should be noted even there that the Manga report does not represent scientific consensus). Eubulides (talk) 07:34, 25 May 2008 (UTC)

The original Manga report is obsolete when newer references discuss the Manga report. We are currently using newer references that describe the Manga report in historical terms in the movement towards science section. QuackGuru 02:28, 25 May 2008 (UTC)

DigitalC makes a good point, but I tend to like to include everything, pro and con. I really feel that if we do, we are more likely to reach a stable GA article status, because every chiro that reads this article is going to ask the same question. -- Dēmatt (chat) 06:28, 25 May 2008 (UTC)

Perhaps chiros would be satisfied if we include some of the citations above, explaining why the Manga report's results have been so questioned? Eubulides (talk) 07:34, 25 May 2008 (UTC)

Manga is flawed and biased. Dr. Manga was a 'satisfied chiropractic patient'. He used ancient studies as old as from 1930. They were not RCTs. He discounted large studies with results he didn't like in favor of small ones with favorable results. Eubulides provided links to critiques of Manga a few thousand words ago.--—CynRN ^(Talk) 03:17, 28 May 2008 (UTC)

Mass edits

The article was just unfrozen and, rather than fall into an edit war, I want to voice my objection to some of these edits. Some of the edits are controversial and have been reverted in earlier versions. I am concerned that they will start an edit war again. Please nobody revert while we consider here on the talk page about what to do with them -- Dēmatt (chat) 16:08, 23 May 2008 (UTC)

I agree with Dematt's appeal to avoid reverts and to do discussions. I continue to object to the practice of installing major changes without discussion. I disagree with some of QuackGuru's edits and agree with others. I have other matters to attend to, and cannot comment in more detail right now. Eubulides (talk) 16:21, 23 May 2008 (UTC)

I too agree with Dematts suggestion and lament QuackGurus large, disruptive edit which was not talked about in the least. Similarly to Eubulides, I agree with some, disagree with others, but its the principle of QG continuing to insert large edits which can trigger edit wars. The page should have remained protected until the May 26th (if not longer) and we could have inserted/revised a section at a time, got consensus then ask an admin to toss it in. Thoughts? CorticoSpinal (talk) 16:30, 23 May 2008 (UTC)

CorticoSpinal agreed with Dematt's suggestion but added a puffery piece to the Education, licensing, and regulation section.[52] Hmm. QuackGuru 16:56, 23 May 2008 (UTC)

I too lament the mass edits by QuackGuru - not necessarily for all of its content but mostly for his reasoning, his tone and his continued uncivil accusations. I think it is high time to start an RfC. Anyone disagree? -- Levine2112 ^discuss 18:16, 23 May 2008 (UTC)

I see now that User:ScienceApologist reverted to an older version that was worse than both (1) the version in place when Dematt issued his appeal, and (2) the version in place just before the revert.. Some of the reverted changes were uncontroversial improvements (e.g., additions of citations), and also some of the changes had been discussed with no disagreement. Again, I ask that editors please stop issuing blind reverts like this. I'll leave a note on ScienceApologist's talk page in case he missed this part of the discussion (quite possible, as it's such a huge talk page), and ask him to self-revert. Eubulides (talk) 20:03, 23 May 2008 (UTC)

Actually - BION - I am more comfortable with QuackGuru's version (plus the few amendments which followed before SA reverted to this controversial version). Again, I lament when editors make such huge edits in the name of some imaginary consensus. I am tempted to revert but will give SA an opportunity to self-revert first. -- Levine2112 ^discuss 22:42, 23 May 2008 (UTC)

A user conduct RfC is way overdue regarding QG. We have repeatedly explained to him that bold, solo editing is disruptive, uncollaborative, and ignores consensus. He is either lacking in intelligence (obviously not) or has some kind of pathology left up to a shrink to determine. While Einstein wasn't a psychiatrist, he did say that "Insanity is doing the same thing over and over again and expecting different results." (The diagnosis for someone who refuses to collaborate by ALWAYS getting consensus BEFORE editing anything other than spelling errors or fixing existing refs is another matter.) In either case this behavior has been going on for far too long and needs to stop. A topic ban (all major articles - and related articles and talk pages - he has ever edited at Wikipedia) would be a proper sanction. Chiropractic, History of Wikipedia, Larry Sanger, and Jimmy Wales would be good places to start. -- Fyslee / talk 04:31, 24 May 2008 (UTC)

I have been avoiding this place due to the editing habits of QG. I have been watching though and his habit of creating a sandbox of the article, making changes in his sandbox that he wants, then adding it wholesale without anyone's input is completely and totally against the idea of a wiki. Watching him shop for people to back his edits should be bad enough. I wonder how many people he's contacted via email looking for support... I don't know if a RfC will have any affect as he's been told many, many times to change to no avail. A topic ban would help but I recall this exact same behaviour at the Essjay Controversy article as well. He also seems blind to other people's input and advice. I originally thought Fyslee's comment above was a little harsh but he keeps doing the same thing over and over expecting a differnt result.... which means... :)--Hughgr (talk) 08:05, 24 May 2008 (UTC)

Yes, Hughgr, I see that your assessment makes sense. He seems to take everything he wants from our discussions (whether we have ruled them out or not) and then inserts them at random times. This in itself is not a problem as we can always discuss the edits, make appropriate changes according to the refs to reach a consensus and NPOV and go from there, but he will re-insert them again, perhaps days, weeks or months later. Mind you, he is not siding with a particular POV; he supports and antagonizes both sides of NPOV. It is that he continues to replace the edits. Maybe if he would only work on the talk page and be forced to abide by consensus. I don't know, though, if he is capable of co-operating, for whatever reason.

Meanwhile, I do see that Eubilides has made some minor changes that appear to be good as well as a couple others by CorticoSPinal and Levine that were reasonable, so let's start with this version. I do see that it has all the sections that we were discussing, but it does not incorporate any of the changes that I suggested, or the agreements that were made above. I think we should start by allowing Eubilides to replace the Science section in the article with one of the above science sections (of his choosing) and then copy it to a section below us where we can begin (again) to work our way through it. This time, though, since there are so many of us, let's go slow and give everyone a chance to chime in. There is no need to make changes in article space until we decide (at various time) to update the *section* - very similar to what we did with the philosophy section. It doesn't have to be perfect, just better each time. Is everyone okay with that?

-- Dēmatt (chat) 15:36, 24 May 2008 (UTC)

Sounds like a reasonable plan to me!--—CynRN ^(Talk) 18:21, 24 May 2008 (UTC)

I have revised my comment above. -- Fyslee / talk 18:29, 24 May 2008 (UTC)

I see a lot of people clamboring for a censorship of QG, but I think that there are other editors here who are working in much more disruptive ways. ScienceApologist (talk) 23:13, 24 May 2008 (UTC)

Not censorship. Just demands that he collaborate in his editing, use the talk page properly, and stop claiming consensus where there is none. Other disruptive influences are another matter. This is about QG. -- Fyslee / talk 23:57, 24 May 2008 (UTC)

If you want to talk about a particular editor's habits, might I suggest you do it elsewhere? This is the page to discuss the problems with the article. To that end, I see far more problems coming from another group of editors than from QG. Please, feel free to discuss your problems with QG at his user talk page. ScienceApologist (talk) 15:36, 25 May 2008 (UTC)

controversial edits

The cost-benefit section is about cost-effectiveness and risk-benefit. This edit moved content about the risk versus benefit for neck pain. The most appropriate section for this material would be the cost-benefit section. The word "potential" is synonamous (a synonym) for the word "possible". QuackGuru 15:20, 24 May 2008 (UTC)

QG, I disagree that the most appropriate place for that was under cost benefit, as the edit concerned relative risk. Do not change it. -- Dēmatt (chat) 15:40, 24 May 2008 (UTC)

The edit concerned risk and the cost-benefit section is also about risk-benefit. QuackGuru 15:45, 24 May 2008 (UTC)

The edit seems to have removed content without discussion and broke ref number 17 (Villanueva-Russell). Hmm. QuackGuru 15:45, 24 May 2008 (UTC)

The controversial edits have continued. Some of the edits mixed up the text and seem very strange. I suggest we revert back to the last edit by Eubulides QuackGuru 16:54, 24 May 2008 (UTC)

There has been more recent edits. The last stable and closest to NPOV version was Eubulides last edit. QuackGuru 21:56, 24 May 2008 (UTC)

the sum of all human knowledge

The last closest to NPOV/consensus version before the last protection was this edit.

I have made some clear improvements for the better. For example, the cost-benefit section has greatly improved.

Moreover, the WP:LEAD should reflect the body of the article. See lead improvements.

Here are the differences between the last NPOV edit before protection and the updated version after protection.[53] Enjoy! _-Mr. ^o G-_ 16:33, 23 May 2008 (UTC)

Note

I reverted "this" because it had be reverted by others plus it's a new account from today. I do not know though if the edit I made is per what everyone here wants so please if I have made a mistake please do not hesitate to revert me (of course I mean other editors other than the IP I reverted. I say this because what I have seen is that this IP is being reverted by regulars here. Again, please feel free to make any corrections, I am just trying to help. --CrohnieGal^Talk 17:10, 24 May 2008 (UTC)

Thanks for your help. I reviewed the recent edits. It seems there is still some text missing and a ref citation is still broken.[54] I recommend we revert to the last edit by Eubulides. QuackGuru 17:16, 24 May 2008 (UTC)

I support this recommendation. I have done so, though there was one citation that was added that was good. I kept it. I'm not sure where discussion happened to in state the edits that were after Eubulides. ScienceApologist (talk) 23:11, 24 May 2008 (UTC)

The citation that you kept was not needed, since it is a duplicate of an existing citation. The wiki software detects the duplicate and acts as if your edit was not made, so there's no change visible to the user (which you can confirm by viewing the article both before and after your edit), but the resulting page is a bit more confusing to edit because it's longer (as it has the duplicate citation in the source). Eubulides (talk) 07:34, 25 May 2008 (UTC)

Sorry, honest mistake. ScienceApologist (talk) 15:37, 25 May 2008 (UTC)

POV issues as of 2008-05-25

Here is a list of POV problem areas that I see with Chiropractic as it stands now. Fixing these problems would suffice to remove the articles POV tag. This list is updated from Talk:Chiropractic/Archive 19 #POV issues as of 2008-05-03, and reflects changes made to the article since 2008-05-03 as well as discussion since then and some other POV problems I noticed recently. Comments welcome; please make them in #Comments on 2008-05-25 issues list below. I would like to strike out items as they are addressed. Thanks. Eubulides (talk) 07:34, 25 May 2008 (UTC)

2008-05-25 issues list

1. Chiropractic #Medical opposition describes the feud between conventional medicine and chiropractors in a heavily biased way. For example, chiropractors are described by a lengthy quote as having "progressive minds" whereas conventional doctors are said to "have failed to realize exactly what is meant by disease processes". Both sides (traditional medical and chiropractic) have attacked and have victories and losses, but the current discussion focuses almost exclusively on attacks by the medical profession, on chiropractic victories, and on areas where chiropractic is said to be superior to conventional medicine. The dispute should be covered neutrally.
2. Several places, including the lead, characterize chiropractic as complementary and alternative medicine. This characterization is controversial and alternative views should be given. See, for example, Redwood et al. 2008 (PMID 18435599), in which 69% of surveyed DC faculty disagreed with the proposition that chiropractic is CAM.
3. Chiropractic #Safety is backed by reliable reviews, except for its concluding sentence "The benefits of chiropractic care for neck pain seems to outweigh the potential risks.", which is backed only by a primary source. The primary source in question is too new to have been reviewed, but the text should highlight that it's a single primary study, e.g., "A 2007 Dutch study found that the the benefits of chiropractic care for neck pain seem to outweigh the potential risks." But there's another problem: this sentence seemingly contradicts the following statement in Chiropractic #Cost-benefit: "When compared with treatment options such as physiotherapeutic exercise (also performed by a chiropractor), the risk-benefit balance does not favor SMT." These two sentences should be placed next to each other (I suggest in Chiropractic #Cost-benefit) and the wording clarified to make this issue clearer. As things stand the reader of Chiropractic #Safety might reasonably conclude that there's no contoversy whether benefits outweigh risks here. (This example illustrates some of the dangers of our mentioning primary studies ourselves.)

Eubulides (talk) 07:34, 25 May 2008 (UTC)

Which editor here removed and censored my edit adding to the list of POV issues]. I propose an immediate block for the editor who has done so, this is completely ridiculous now the downright disruptiveness and dirty tactics used by the anti-chiropractic editors. Again, why were my additions to the POV list deleted without any consent, discussion, explanation. Is this normal editing practices? I mean, can the anti-chiropractic brigade really get away with absolutely everything including deleting talk page comments of other editors? CorticoSpinal (talk) 05:00, 28 May 2008 (UTC)

Nothing was removed or censored. The problem was that your edit moved my signature into a single bullet item, and put your signature at the bottom of the entire list of items; this caused the resulting talk page section to look like you wrote the whole list of items (and that I contributed just one of the items). The usual etiquette in Wikipedia talk pages is to avoid inserting commentary in such a way that the authorship of others' comments becomes unclear. I naturally assumed you did not intend to create any such confusion, so in my next comment I repaired my signature to the way that it looked before, and moved your added commentary into a section of its own; this approach avoided the confusion in question. I suggest that you add comments after other people's comments (where signatures are part of the comments, of course); that will avoid similar confusion in the future. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Comments on 2008-05-25 issues list

I made this change to help organize things. QuackGuru 08:28, 25 May 2008 (UTC)

I agree with the first and the last POV-issues. The middle issue is a bit more confusing. Just because 69% of DC disagree doesn't mean that the categorization of Chiropractic as CAM is controversial. We are under the obligation to describe things as verifiably, neutrally, and reliably as possible. Most health insurance companies consider chiropractic to be CAM. Most mainstream doctors consider chiropractic to be CAM. I'm pretty sure it's fairly straightforward to find sources for these facts. If most reliable, verifiable sources view chiropractic this way, then Wikipedia should not shy from using the designation. After all, Wikipedia is not the place to right great wrongs. ScienceApologist (talk) 15:42, 25 May 2008 (UTC)

I think we can mention it the utilization and satisfaction rates section about CAM versus integrated medicine chiropractic beliefs. Perhaps this would resolve this issue. QuackGuru 17:47, 25 May 2008 (UTC)

An IP made controversial changes in mainspace again. I recommend it be reverted. QuackGuru 17:47, 25 May 2008 (UTC)

I made this change to describe the CAM versus integrated medicine beliefs. QuackGuru 18:40, 25 May 2008 (UTC)

I made this change to focus the conversation on medical opposition. QuackGuru 19:19, 25 May 2008 (UTC)

With regards to Eubulides' issue number 3 above, I agree with noting it as a study and not a review, however, it makes far greater sense to include this information in the "Safety" section as this is a about "Risk vs. Benefit" and has nothing to do with "Cost". -- Levine2112 ^discuss 19:13, 25 May 2008 (UTC)

The "Risk vs. Benefit" and has has to to do with "Cost-Benefit." The section is about costs as well as benefits. QuackGuru 19:19, 25 May 2008 (UTC)

Not sure what the poorly worded response above means, but I think I understand the gist. My question is: What does this study have to do with "Cost"? The answer: Nothing. The Cost-Benefit section is about weighing the financial cost of chiropractic care versus benefit. Whereas the "Safety" section is about safety (aka Risk) and presumably should weigh "Risk vs. Benefit"; hence the study is clearly more properly apropos under "Safety" than "Cost-Benefit". -- Levine2112 ^discuss 19:26, 25 May 2008 (UTC)

We do not have a section called "Cost" or "Risk." The section is titled Cost-benefit. That said, the section is about the cost-effectiveness as well as the risk-benefit. QuackGuru 19:39, 25 May 2008 (UTC)

I think we all would agree that "Risk" is more akin to "Safety" than it is to "Cost". Does anyone disagree? -- Levine2112 ^discuss 21:33, 25 May 2008 (UTC)

I think we do not have a section called "Cost". The cost-benefit section is also about risk-benefit. QuackGuru 03:04, 26 May 2008 (UTC)

No, the cost-benefit section is about cost-benefit, not risk-benefit. The cost-benefit section should be about cost-effectiveness, and the respective text should be in the risk section.DigitalC (talk) 07:12, 26 May 2008 (UTC)

The cost-benefit section covers two topics. Cost-effectiveness as well as risk-benefit (Cost-benefit). QuackGuru 07:24, 26 May 2008 (UTC)

If editors want I could add a small blurp about risk-benefit to the Safety section but we should do this using a higher quality source per WP:MEDRS. I will review all the refs and do my best to address the concerns. QuackGuru 08:35, 26 May 2008 (UTC)

• We could add a brief Risk-benefit section.
• The primary study in question (Rubinstein et al. 2007, PMID 17693331) is a dubious source for the claim that "the benefits of chiropractic care for neck pain seem to outweigh the potential risks". First, the study had no control group, so it did not measure either the benefits or the adverse effects of chiropractic care alone; instead, it was measuring the combination of chiropractic care and natural history. For all we can tell from that study, it could be that chiropractic care has negative benefits (compared to no treatment) and positive risks (again, compared to no treatment). Second, the study had no benefits-risk model, that is, it did not even attempt to quantify the value of the benefits versus the value of the risks; and therefore its data cannot be used to support any claim that benefits "outweigh" risks. The simplest way to fix this problem is to remove the unwarranted claim that the benefits outweigh the risks. (And this illustrates the problems I see with citing primary sources in the absence of reliable reviews.) Eubulides (talk) 08:08, 27 May 2008 (UTC)

This is again flawed logic. You are violating WP:OR as you are making your personal opinion override the stated claim. Remember not to argue with experts? You said that. You should stick to it too. Unless there is a rebuttal in the literature somewhere then your personal interpretation is not valid for disqualifying the study. Thanks. CorticoSpinal (talk) 05:06, 28 May 2008 (UTC)

It is not flawed logic to look at a primary study carefully. After all, primary studies about chiropractic are a dime a dozen, and one can easily find a primary study giving just the opposite impression to this one about risks and benefits. This particular primary study, like many primary studies about chiropractic, is of low quality, because it has no controls and it does not have any measures of the weights of risks versus benefits. For that reason we should be extremely careful about mentioning it in Chiropractic, if we mention it at all; the current mention is obviously not careful enough. Eubulides (talk) 09:05, 28 May 2008 (UTC)

I thought you held the belief that we should not be questioning the researchers? Regardless, this is about placement, and I have not seen a good argument about keeping the statement in the entirely unrelated "Cost-Benefit" section. Certainly we can all agree that "Risk-Benefit" is more akin to "Safety" than to "Cost-Benefit". -- Levine2112 ^discuss 17:38, 27 May 2008 (UTC)

My comments were not about the researchers; they were about the study in question. It is not clear that risk-benefit is closer to safety than to cost-benefit. Chiropractic #Safety does not talk about benefits at all (by design), whereas Chiropractic #Cost-benefit does compare downsides to benefits. It could be that the match to "compares downsides to benefits" is closer than the match between risk and safety. At any rate, putting this stuff in a new Risk-benefit section would address the issue. Eubulides (talk) 20:52, 27 May 2008 (UTC)

This controversial change added an old reference when newer references are available. In fact, the previous sentence has a 2008 ref covering the same topic. Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist. 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.{{cite journal}}: CS1 maint: multiple names: authors list (link) Per WP:MEDRS, the dated 2003 ref should be deleted. QuackGuru 03:33, 26 May 2008 (UTC)

I reverted that good-faith change, as I agree with you that the previous sentence uses a much newer reference covering the same topic.DigitalC (talk) 07:18, 26 May 2008 (UTC)

I agree with the removal of the dated material.[55]. QuackGuru 07:24, 26 May 2008 (UTC)

I started new sections below to help focus the discussion. QuackGuru 22:22, 26 May 2008 (UTC)

Chiropractic#Safety

Editors have expressed some interest in adding a tidbit about risk-benefit to the Safety section. At the moment, I am reviewing all the references in the Safety section. QuackGuru 22:22, 26 May 2008 (UTC)

Croft AC, D'Antoni AV (2008). "Chiropractic manipulation: reasons for concern?". Clin Neurol Neurosurg. 110 (4): 422–3. doi:10.1016/j.clineuro.2007.12.014. PMID 18242824. Has anyone read this 2008 study? Maybe we can use it. QuackGuru 03:05, 27 May 2008 (UTC)

I've read it. It's not a study; it's just a letter to the editor. I don't think it's directly useful for Chiropractic, though some of its citations may be useful. It comments on Gouveia et al. 2007 (PMID 17904731), a primary study which is too new to be the subject of any of our reviews. (I would not favor citing that primary study, unless we start adding other primary studies to the scientific-investigation section, which is something I would not favor either, as we have plenty of reliable reviews). Eubulides (talk) 08:08, 27 May 2008 (UTC)

Chiropractic#Medical opposition

http://en.citizendium.org/wiki/Chiropractic http://en.citizendium.org/wiki/Critical_views_of_chiropractic

Here are related wiki articles that may help give us some ideas on improving the Medical opposition section of this article. Thoughts? QuackGuru 22:22, 26 May 2008 (UTC)

Other POV issues

1. [[Chiropractic #Safety] Innacurately cherry picks the evidence, does not discuss relative risk compared to NSAIDs, surgery or other treatments used for mechanical spinal disorders and strikes a fear mongering tone by not addressing the benefits and effectiveness (clinical and cost)
2. The research and POV of Edzard Ernst has been used in a civil POV push. Ernst'research and conclusions on SMT and chiropractic care, which have been rebuked by his colleagues and other mainstream health professinals, and go against majority consensus in the literature. It's being used to subvert the efficacy, cost-effectiveness and safety of chiropractic care. A misleading argument that "Ernst is not being presented enough" is also being promoted which completely exacerbates the problem.
3. Chiropractic #Efficacy is a synthesis and mixture of SMT and chiropractic care. Chiropractic specific references should be used as already agreed upon by the majority of editors. Ernst is again being used to subvert mainstream opinion (chiropractic care is just as if not more effective, safe and cost-effectiveness for LBP and that patients overwhelmingly prefer chiropractic management for LBP in comparison to standard medical care. This is the most succint way to put it. An editor here has used Ernst to undermine the mainstream consensus and has cherry picked reviews (which is in violation of WP:OR to warp the mainstream scientific and independent 3rd party consensus.
4. Research is not at all specific to chiropractic care, and ignores every major research milestone in the history of the profession.
5. Chiropractic #History seems to want to discredit Palmer from the start, focus all on subluxations and does not make any account to anything other than controversy.

CorticoSpinal (talk) 06:29, 27 May 2008 (UTC)

• It would be helpful to discuss relative risk, if we can find reliable sources on that topic, preferably reliable reviews. We can't discuss the topic without reliable sources.
• Ernst goes against consensus in the chiropractic mainstream, but that's not the same thing as going against mainstream consensus overall. Ernst represents an important part of the medical mainstream. These critical views of chiropractic should be covered fairly and neutrally.
• Chiropractic#Effectiveness relies heavily on reliable reviews published in referred scientific journals. These reviews do synthesize work on chiropractic care and SMT, but that is standard practice in evidence-based reviews of chiropractic these days, and it is not synthesis for Chiropractic to report what the experts are saying.
• The first two sentences of Chiropractic #History are complimentary to Palmer.
• I agree that much of Chiropractic#Vertebral subluxation is misplaced. It does not belong in Chiropractic #History. Most of that section (and all of the long paragraph at the end) has nothing to with history. I suggest moving this subsection to Chiropractic #Philosophy, where it fits much better.
• Chiropractic #History does not overly emphasize controversy. On the contrary: if anything it currently plays the controversy down, and this makes it boring compared to what it could be. Compare Chiropractic history, which devotes a higher percentage of its content to controveries. Chiropractic history has been dominated by controversy.

Eubulides (talk) 08:08, 27 May 2008 (UTC)

A qucik note on #4 on the list above:

• "The benefits of chiropractic care for neck pain seems to outweigh the potential risks.", which is backed only by a primary source. The primary source in question is too new to have been reviewed, but the text should highlight that it's a single primary study, e.g., "A 2007 Dutch study found that the the benefits of chiropractic care for neck pain seem to outweigh the potential risks." But there's another problem: this sentence seemingly contradicts the following statement in Chiropractic #Cost-benefit: "When compared with treatment options such as physiotherapeutic exercise (also performed by a chiropractor), the risk-benefit balance does not favor SMT."

I see no problem; the first sentence says "chiropractic care". The second sentence says "SMT" and even modifies it to be "performed by a chiropractor". This suggests (accurately) that, while chiropractic care sometimes includes SMT, SMT <> chiropractic care. I have no trouble with attributing the source, but the same holds true for the gander.

I am also concerned that while eradicating statments that appeared POV to some, we are left with other unbalanced POV statments. As chiropractic is a complicated POV subject, we will not likely get one NPOV statement. The only solution will be to balance the POV statements. IOWs, criteria for removal of the POV tag for Eubilides may mean return of the tag for CorticoSpinal. The only solution will be to allow each their due balanced in a fair and neutral way. -- Dēmatt (chat) 15:24, 27 May 2008 (UTC)

I assume by "#4 on the list above" you mean #3 in #2008-05-25 issues list? I agree about the distinction between chiropractic care and SMT. However, it's still a problem that the two sentences were planted in different sections with no care taken to clarify the confusion. By the way, I see further problems with that particular primary source, which I don't have time to go into now (I haven't yet had time to read the source carefully, and I indeed that no editor here has actually read the source), but intend to do so later. This is another problem with citing primary sources: it's really much better to rely on reviews! Eubulides (talk) 16:59, 27 May 2008 (UTC)

Wording in lead

This wording doesn't make sense: "Chiropractic's greatest contribution to health care may be its patient-physician relationship which is done by hand" How can a relationship be done by hand? Change to '...patient-physician relationship and hands-on treatment.'--—CynRN ^(Talk) 16:19, 26 May 2008 (UTC)

I made this change to improve the sentence. QuackGuru 16:33, 26 May 2008 (UTC)

Much better, thanks.--—CynRN ^(Talk) 16:40, 26 May 2008 (UTC)

By the way: I was asked to comment on what's going on at this page and have put some comments here: (diff) (talk) (archive). When participating at this page, I don't expect to express my personal views (if any) about chiropractic but will strive to edit according to NPOV based on the sources, even if that sometimes means putting in material I disagree with or removing material I agree with. I've been participating in discussion at User talk:Raul654/Civil POV pushing and have previously participated at pages I arrived at via Mediation Cabal, and a large part of my purpose in participating here is to try to help resolve disputes. (I hope this post is not taking up too much space with meta-discussion.) ☺ Coppertwig (talk) 01:53, 27 May 2008 (UTC)

Coppertwig, I value very much your contributions here at Chiropractic and felt that your previous participation here led to major improvements in the article. I'm looking forward to working with you again here. My biggest concern with the article, at the moment is the civil POV of Edzard Ernst and how his flawed and biased reviews are being used 'neutrally' to subvert the mainstream consensus on critical topics such as effectiveness, safety, cost-effectiveness and scientific research. What is occuring here is misuse of research to advance a fringe viewpoint upon the majority. The difference is, Edzard Ernst, who is being presented as the mainstream viewpoint research goes againt the vast majority of research over the last 25 years. This is despite the fact thatthe Ernst secondary sources have been refuted and invalidated, with severe methodological flaws and heavy bias Then, at a clear gaming of the system, uses WP:MEDRS as a defense to prevent the inclusion of primary studies that are more academically robust, come from multidisciplinary colloboration (hence consensus and no particular bias) under the wikilawyering guise of "reaching down". I propose we investigate the use or rather misuse of Edzard Ernst here at chiropractic in a civil POV push. I believe this at the core of the last 4 months of dysfunction. CorticoSpinal (talk) 03:37, 27 May 2008 (UTC)

The consensus on Wikipedia is that Ernst is WP:NPOV and WP:RS despite the reservations. For example, see the homeopathy article. QuackGuru 03:48, 27 May 2008 (UTC)

I agree. Ernst is an excellent source. I don't know what is "flawed" or "biased" about his reviews of subjects other than the fact that he sticks to reality rather than fantasy. ScienceApologist (talk) 05:08, 27 May 2008 (UTC)

I disagree. Ernst is a biased POV source, and flaws in his methodology have been pointed out via WP:RS on this page. If you "don't know what is 'flawed' or 'biased' about his reviews", then perhaps you may wish to read those sources if you have not already.DigitalC (talk) 05:28, 27 May 2008 (UTC)

Ernst is one of the most NPOV sources available. Ernst reviews are highly relevant and on target. QuackGuru 05:41, 27 May 2008 (UTC)

I await a source that criticizes Ernst who is not themselves being criticized by Ernst. The reliability of Ernst is that he is a third-party who does not derive his profession from the alternative medicine world. Those who criticize Ernst have an obvious incentive to misappropriate and malign him. Attacking the reliability of Ernst is a non-starter. If the alternative medicine fans here disagree, they should take it up on WP:RSN and get a consensus of outside opinion that Ernst is "unreliable". Until such time, this conversation should be tabled as pointless character asssassination and sour grapes. ScienceApologist (talk) 05:52, 27 May 2008 (UTC)

If you're hanging your hat on that rationale this shall be a quick and embarassing exit for the skeptics. You do realize that tertiary sources, leading national health agencies, 3rd party payers, and mainstream opinion disagree with the conclusions of Edzard Ernst re: SMT and chiropractic care don't you? QG, Ernst is NPOV? Please explain. Thanks. CorticoSpinal (talk) 07:07, 27 May 2008 (UTC)

Certainly there are chiropractic sources that explicitly criticize some of Ernst's work. A leading example of this is Bronfort et al. 2008 (PMID 18164469), whose criticism of Ernst's work is discussed and cited in Chiropractic# Effectiveness. However, I am not aware of any "national health agencies, 3rd party payers, and mainstream opinion" that directly criticize Ernst's work. Can you please supply some? It would strengthen Chiropractic if we could cite those sources, instead of merely citing Bronfort et al. Thanks. Eubulides (talk) 08:08, 27 May 2008 (UTC)

The reliability of Ernst' conclusions on SMT and chiropractic are in doubt because they disagree with mainstream consensus on the issue. They don't criticize Ernst per se; but the national health agencies, 3rd party payers, tertiarty sources, the World Health Organization and mainstream research opinion on chiropractic care and smt disagrees with his conclusions. Any attempt to 'cite' these sources have been rebuffed by yourself because of wikilawyering and claiming that if it wasn't expliciity a 'secondary source'. You should not play so coy. You've been doing this for 4 months now, Eubulides. Except, over time your civil POV push for Ernst representing the mainstream opinion has been exposed as a farce. Ernst's specific conclusions on SMT and chiropractic care doesn't represent the mainstream and it is in itself the fringe viewpoint which is being passed off as the majority one. That is so underhanded and I'll called you on it since day 1 but you have ignored every concern brought to you regarding the misuse of Ernst, the cherry picking of sources (aka mining papers) to promote the fringe viewpoint that is Ernst's conclusions at the expense of the mainstream consensus (safe, effective, cost effective). Shame on you. CorticoSpinal (talk) 05:22, 28 May 2008 (UTC)

• Ernst etc.'s conclusions do not disagree with mainstream consensus. They disagree with mainstream chiropractic, which is not the same as mainstream in general.
• Some national health agencies do not recommend chiropractic; others do. There is not a mainstream consensus in this area. And national health agencies' opinions have changed with time, not always in a direction favorable to chiropractic. See, for example, Murphy et al. 2006 (PMID 16949948).
• Chiropractic #Scientific investigation cites both the WHO guidelines and mainstream chiropractic opinion, at some length. This hardly constitutes a "rebuff" of these sources.
• There is nothing underhanded about citing reliable mainstream reviews such as Ernst. Obviously Ernst is a critic of chiropractic, but all citations to his work are fairly balanced by citations to works that are supportive of chiropractic.

Eubulides (talk) 09:05, 28 May 2008 (UTC)

more controversial edits

This controversial change was a complete rewrite of the Education, licensing, and regulation. The first part is historical info and the second part is a text dump from the lead of Chiropractic education article. QuackGuru 05:27, 27 May 2008 (UTC)

It's not controversial QG and the "text dump" is the material I wrote in April on here. QuackGuru is being completely disrupting this page and I'm fed up with his antics. He can dump 3 entire sections (efficacy, cost-effectiveness, research) make major revisions to the lead all the while majority of editors here disagreed strongly on the validity of the content and the cherry picking up sources and the miuse of Ernst to subvert the majority mainstream viewpoint. Your conduct here is becoming very frustrating QG and this is echoed by many editors now. Please refrain from making deliberately misleading statements, thanks. CorticoSpinal (talk) 05:43, 27 May 2008 (UTC)

The info was written way back in April and was rejected (reverted) and now the text dump continues. QuackGuru 05:48, 27 May 2008 (UTC)

Actually no, its Eubulides who doesn't want the different educational paths listed for whatever reason. The draft had consensus all but from yourself in Eubulides. So, no it was not rejected like you say. Another misleading statement. You're on a roll tonight. Regardless, the added text is NPOV, is accurate and is from reliable and valid sources. There's no reason to drum up controversy when there is none. CorticoSpinal (talk) 05:59, 27 May 2008 (UTC)

I don't know what "The draft had consensus all but from yourself in Eubulides" means. The draft did not have consensus. It was put in anyway. Eubulides (talk) 08:08, 27 May 2008 (UTC)

Would you mind taking out the snide remarks and the innuendo? They don't help matters and only make you look bad. ScienceApologist (talk) 06:30, 27 May 2008 (UTC)

I'm sorry that you intepret it that way SA. As a true believer in QuackGuru, it must be difficult at times seeing your friend's approach at editing here being rebuked. I believe the possibility of a RfC was discussed a few days ago. Perhaps it is time to follow through based on tonight's festivities. CorticoSpinal (talk) 06:40, 27 May 2008 (UTC)

Disruptive editing (blind reversion) yet again.

This is at least the 3rd separate time Orangemarlin has disruptively and inaccurately deleted well cited material and has made misleading edit summaries at Chiropractic since mid-March 2008.

Why did you make blind reversion of my edit at practice styles regarding straight/focused scope chiropractors here? You wrote the source was not reliable. However, the same source is already being used elsewhere in the article. So, I'd ask that you please self-revert your edit. A failure to do so will be construed as a deliberate attempt to destabilize and censor relevant, valid, and reliable information. Considering that you have already done so twice already a RfC should be in order. CorticoSpinal (talk) 05:30, 27 May 2008 (UTC)

This controversial change added POV nonsense to the Chiropractic#Straight section. QuackGuru 05:34, 27 May 2008 (UTC)

I tend to agree. The situation is extremely strange because I see no discussion of the wording in this addition and the use of the term "stereotypes" to describe "focused-scope chiropractors" is hugely absurd. Since most people in the world including most people who have interacted with chiropractic have never had any exposure to the distinctions it is hardly reasonable to declare a "stereotype" regardless of how stridently a source puts it. Please workshop appropriate wording here before making this kind of addition. ScienceApologist (talk) 05:47, 27 May 2008 (UTC)

This word is in the cited source. The source is not in dispute, it's already being used elsewhere in the article. So, what's the big deal? Oh right, it debunks a lot of the myths skeptics promote. Well, sorry, SA, you're going to have to suck it up and deal with the fact the profession is maturing and is not fringe like you promote it to be. CorticoSpinal (talk) 05:54, 27 May 2008 (UTC)

I'm fine with a maturing profession. I'm not fine with borrowing the wording from marginal sources just to prove a point. Wikipedia is not the place to right great wrongs. Let the profession actually mature and then we'll talk. Until that time, we have an article to write from the most reliable, neutral, verifiable, and weighted-to-the-mainstream perspective possible. ScienceApologist (talk) 05:57, 27 May 2008 (UTC)

Please elaborate and prove your claim that McDonald (2003) is a marginal source. Chiropractic is mainstream. See Integrative medicine. Get over it. CorticoSpinal (talk) 06:03, 27 May 2008 (UTC)

It's marginal because it is a survey of chiropractors. If I surveyed creationists and then tried to "debunk the myths skeptics promote" from such a survey, that would also be a marginal source. ScienceApologist (talk) 06:29, 27 May 2008 (UTC)

Incredibly weak argument. Red herring with the creationists by the way; non-sequiturs are not useful in advancing your point which has been rebutted. McDonald is legit, the wording is in the source, the source is being used elsewhere in the article. Let me repeat: chiropractic is mainstream. Do you have proof it is fringe? Otherwise I'd suggest you stop treating it as such and making ridiculous comparisons to creationists. You skeptics tend to do that. It also got equated with Flat Earth and Homeopathy. It's much more like a medical specialization, such as Dentistry. Thanks. CorticoSpinal (talk)

I'm beginning to think you should be banned from this article. ScienceApologist (talk) 14:11, 27 May 2008 (UTC)

You're on your 29th life, SA. Banned for what? Exposing the weakness in your arguments and your disruptive editing here? Aren't you already on probation? What have you contributed to chiropractic, SA? You only delete and revert here. At least I attempt to author good material CorticoSpinal (talk) 23:17, 27 May 2008 (UTC)

Focused-scope chiropractors are mixers.

McDonald WP, Durkin KF, Pfefer M; et al. (2003). How Chiropractors Think and Practice: The Survey of North American Chiropractors. Ada, OH: Institute for Social Research, Ohio Northern University. ISBN 0972805559. {{cite book}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) Summarized in: McDonald WP, Durkin KF, Pfefer M (2004). "How chiropractors think and practice: the survey of North American chiropractors". Semin Integr Med. 2 (3): 92–8. doi:10.1016/j.sigm.2004.07.002. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)CS1 maint: multiple names: authors list (link)

"The labels we traditionally use are not always helpful. Most self-reported broad-scope practitioners are 'straight' on the issues of subluxation and adjustment, and most focused-scope chiropractors 'mix' the adjustment with other regimens and therapies," McDonald observed.

The above text is from the marginal survey reference.

This controversial edit added text about mixers to the straight section. I am puzzled. QuackGuru 06:38, 27 May 2008 (UTC)

Focused scope is straight. Broad scope= mixer. This is well established in the literature. Please do not attempt to confuse readers seeing you are confused. The edit is pretty straight forward: even straights now (contemporary) aren't so much straights as they DDx and they recommend adjunctive therapies. There's a blending happening in the US, at least. Outside the USA, there is 1 straight school and 16 mixer ones and all are in or affiliated with public universities. Straights have no choice but the go with the EBM movement otherwise legislation will leave them behind along with the mainstream of chiropractic. CorticoSpinal (talk) 06:49, 27 May 2008 (UTC)

From McDonald "While Life graduates tended to label themselves focused scope and middle scope, National graduates tended to declare themselves broad scope and middle scope." And "While the subluxation is championed by the focused-scope camp and the spectrum of services is championed by the broad-scope practitioners, the typical chiropractor is eclectic. This type of contemporary practitioner values the adjustment, yet sees no contradiction in working to gain hospital privileges." It's pretty clear in the article that McDonald differentiates and knows the difference betweens straights and mixers. CorticoSpinal (talk) 06:54, 27 May 2008 (UTC)

This controversial edit failed verification. The added text is discussing mixers and not straights.

According to the marginal survey reference: "The labels we traditionally use are not always helpful. Most self-reported broad-scope practitioners are 'straight' on the issues of subluxation and adjustment, and most focused-scope chiropractors 'mix' the adjustment with other regimens and therapies," McDonald observed. The reference clearly states focused-scope chiropractors 'mix'... QuackGuru 07:05, 27 May 2008 (UTC)

The recently added text to the straight section is describing mixers according to the reference. QuackGuru 07:20, 27 May 2008 (UTC)

The term "focused scope" (instead of "straight") is not well-established in the literature. In the scholarly literature it is used only by this particular source (McDonald et al. 2003). Chiropractic should stick with standard terminology instead of oddball terminology used only by one source. Also, Chiropractic is not the place to advise straights to go into the evidence-based camp, or to predict which way legislation will go. Eubulides (talk) 08:08, 27 May 2008 (UTC)

I agree that "focused scope" vs. "broad scope" is not a well-established term. However, that does not mean this source should not be used. Further explanation that broad scope = mixer is here"# Broad-scope chiropractors, despite being tagged by their detractors as "medically" oriented, believe the subluxation is a "significant contributing factor" in a majority of visceral ailments.

1. Furthermore, 89% of broad-scope practitioners are opposed to having the adjustment limited to musculoskeletal conditions."DigitalC (talk) 09:25, 27 May 2008 (UTC)

QG, why would you add a failed verification tag in one edit, and then remove the allegedly unsupported text in the next edit? This is not collaborative editing. ([56] & [57]) DigitalC (talk) 09:31, 27 May 2008 (UTC)

Focused and broad scope are used commonly in the chiropractic literature as synonyms for straight and mixer respectively. I removed the failed verification tags as it was a deliberate attempt by QuackGuru to disruptive and subvert the information being presented. CorticoSpinal (talk) 14:01, 27 May 2008 (UTC)

I disagree that they are common terms. Do you have a reliable source saying otherwise? Let's stick with "straight" and "mixer", which at any rate are far more-commonly used than "focused scope" and "broad scope". Eubulides (talk) 16:59, 27 May 2008 (UTC)

Replying to DigitalC's two previous comments: I agree that McDonald et al. 2003 can be used in Chiropractic; it is already used, and is a reliable source about chiropractic opinion in North America. However, I disagree with several elements of the edit in question:

• That edit uses argumentative language like "X is refuted in research" which is not supported by the source.
  • It's in the source.

Regardless of what the source says, "refuted" is completely PoV language. Jefffire (talk) 14:05, 27 May 2008 (UTC)

On which page number is it in the source? I see "refuted" only in the lay summary, which is not the actual source. At any rate I agree with Jefffire that the term is hopelessly POV regardless of source. The source has not "refuted" anything of the sort. Eubulides (talk) 16:59, 27 May 2008 (UTC)

• Also, it is NPOV, since it says that straights endorse many "mixer" principles, but it does not also make the point (which is made quite strongly in the source) that mixers endorse several important "straight" principles. This is unbalanced coverage. The source's main point is that mixers are close to straights and vice versa, a point that goes two ways and not just one.
  • We can add this to mixer as well, in fact I was going to before QG, SA and OM decided to gang up again and try to remove the edit citing WP:RS. CorticoSpinal (talk) 14:01, 27 May 2008 (UTC)
• Regardless, a controversial change like this should be discussed before being installed: but even more important than discussion is that the change should be NPOV and be supported by the cited source, which is not the case here.
  • It's not a controversial change Eubulides because you or QG say it is. The whole section of Safety, Effectiveness, cost-effectiveness and vaccination is far more controversial then adding a blurb about the straights offering up DDx. CorticoSpinal (talk) 14:01, 27 May 2008 (UTC)

Eubulides (talk) 09:48, 27 May 2008 (UTC)

• • • By "controversial" I meant controversial among the editors working on Chiropractic. It is indeed controversial by that measure, as this discussion proves. Eubulides (talk) 16:59, 27 May 2008 (UTC)
      • What this discussion proves that zombie editors and anti-chiropractic skeptics are obstructing anybody who disagrees with them. The zombie editing practices of the anti-chiropractic axis of Jefffire-OrangeMarlin-ScienceApologist with sleeper cell of Filll and Arthur Rubin will be exposed. You don't have all the wikipedia admins in your back pocket. What a fucking joke this place is. CorticoSpinal (talk) 23:14, 27 May 2008 (UTC)

Blind Reversion

The biggest reason why Chiropractic article is dsyfunction is the amount of "drive by" blind reversions done by the skeptics. So far, in 24 hours, ScienceApologist, Jefffire, OrangeMarlin have all made reversions of cited material, branded it as "controversial" and have deleted cited material that is supported by the claims.

How can we ever move forward in this article if admins to not stop these kind of disruptive edits? These guys don't even participate in Talk at all and just revert. This needs to be investigated. It's complete BS. CorticoSpinal (talk) 16:40, 27 May 2008 (UTC)

Dude, when it's only your edits being reverted and they contain blatant PoV violations (eg. "refute"), you should look at your own edits. Jefffire (talk) 16:45, 27 May 2008 (UTC)

"Dude" there was no blantant POV violations if and if had a problem with the word you can change it rather than deleting the cited text. Anyways, you guys are making this quite easy. Keep up the disruptive reversions to all chiropractic related articles. The diffs are piling up. CorticoSpinal (talk) 16:52, 27 May 2008 (UTC)

The reversions were done without comment, which I disagree with. However, the reverted material was inserted without previous discussion and had real problems, as discussed in #Education draft needed work below. Let's work together on the talk page to strengthen the material, instead of getting into install/revert wars. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Agree. Please put any large insertion here and discuss it before installing.--—CynRN ^(Talk) 18:00, 27 May 2008 (UTC)

The section that was in place was a minor tweak that is better worded and had the exact same references. Skeptics just doesn't want the world to know they're handing out Bachelors and Masters degrees of Science to chiropractors. It's good enough for the WHO to mention yet not good enough for anti-chiropractic editors here. CorticoSpinal (talk) 22:46, 27 May 2008 (UTC)

I don't quite follow the previous comment, as the change in question altered quite a bit of text (it was not a "minor tweak"). Perhaps you are talking about some previous version of Chiropractic? If so, which one, exactly?

Education draft needed work

I see a new draft of Chiropractic #Education was published, again without discussion or comment or consensus, and then was reverted by someone else. Again, it's not right to put in changes like this without discussion. Before the section was reverted, I took the time to review it, and to draft an improved version of it, which I enclose below. My own feeling is that even with the improvements, it's inferior to the current version, but perhaps the best features of both versions could be combined. Eubulides (talk) 09:18, 27 May 2008 (UTC)

First, the draft that I installed originally was the consensus version. Only you objected to it. The draft currently in place was not discussed and was disagreed upon by a majority of editors. So, you're spinning this the wrong way. Your version has serious shortcomings, as most of your edits do. Every edit you have made has tried to marginalize the chiropractic profession Think about this. You're always trying to cover up anything that makes the profession sound respectable. Why do you do this? CorticoSpinal (talk) 22:51, 27 May 2008 (UTC)

• No recent version of Education ever reached consensus. Others have objected strongly to the Education rewrite that was abruptly installed, both by reverting the change that installed it and by objecting on the talk page.
• It's not true that every edit I have made "has tried to marginalize the chiropractic profession". Here is a list of my ten most recent edits to Chiropractic:

• This one did not marginalize the chiropractic profession.
• Nor did this one.
• Nor this one.
• Nor this one.
• Nor this one. Amusingly enough, it consists of a removal of a citation to Ernst, the critic of chiropractic that you have voiced vehement objections to.
• Nor this one.
• Nor this one.
• Nor this one.
• Nor this one.
• Nor this one.

Eubulides (talk) 09:05, 28 May 2008 (UTC)

Quite frankly, it's annoying seeing how the skeptics continuously refer to non-controversial edits as controversial. Everything in the section is from a reliable, valid source, it's NPOV and it presents the highlights of the educational paths. This is simply sour grapes. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

The edit is controversial among the editors here. I don't see how one can argue otherwise, given the revert war. The section has material that is not supported by reliable sources and it has POV issues as mentioned below. Eubulides (talk) 16:59, 27 May 2008 (UTC)

The edit is controversial among the meat puppet and the zombie editors. You're pushing a false consensus. Everything in the draft I provided is supported by reliable sources To insist they are not is is untruthful. I ask that you retract your statement which is misleading (yet again, #20). CorticoSpinal (talk) 22:51, 27 May 2008 (UTC)

Perhaps you're talking about a version other than the one that was installed? The version that was installed certainly does have problems with a lack of reliable sources. Its very first sentence, for example, is unsourced, and is inaccurate to boot (it gets the date wrong). This is just one example; that edit has several other real problems with lack of sourcing or with failed verification of sources. Please see #Education draft needed work and #Comments on Education, licensing, and regulation drafts for more info. Eubulides (talk) 09:05, 28 May 2008 (UTC)

The following comments are based on the new draft as it appeared in this version:

• "The first school of chiropractic was opened in 1896 in Davenport, Iowa, USA." This claim is unsourced and belongs in Chiropractic#History after it becomes sourced.

• The claim is appropriately sourced and it is relevant to education.

• There was no citation after the claim. It is more relevant to history. Eubulides (talk) 16:59, 27 May 2008 (UTC)

• I think that it makes a good introduction to the education system, and could easily be sourced in anyone doubts the statement.DigitalC (talk) 04:01, 28 May 2008 (UTC)

• A source is needed. The statement is incorrect, as the year is wrong. The statement does not appear in Chiropractic education, which is an indication that it's not that important here. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Sorry Eubulides, I thought it was 1897 too, but Peterson/Wiese (1994 Chiropractic an Illustrated History) said it was 1896 with the first graduate in 1897. Palmer did not open any school in 1895. Also, that information is not at chiropractic education because the edit was first proposed 2 days ago here on the main page. Information doesn't have to appear on subarticles first, unless you can point a specific policy that says so. So, to be clear, you are disputing the inclusion of the very first chiropractic school in history at chiropractic? Really? CorticoSpinal (talk) 05:22, 29 May 2008 (UTC)

The 189x school was called the "Palmer School of Magnetic Cure"; and it was not strictly a chiropractic college. It would be reasonable to discuss this sort of thing in Chiropractic #History. That is what History is for. The education section should talk about the current state of chiropractic, not history. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "Chiropractic education is unique in the United States that it is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution." The cited source does not support the claim. It does not say the practice is "unique in the United States".
  • The cited source is from the US Department of Education. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

• True, but the cited source does not say the practice is "unique in the United States". Eubulides (talk) 16:59, 27 May 2008 (UTC)

Find me another country that separates the curriculums into progressive and straight and then we'll talk. It is unique in the US. Deal with it CorticoSpinal (talk) 23:01, 27 May 2008 (UTC)

To claim that it is unique would be OR without a RS. However, we can reword this to "Chiropractic education in the US is divided into straight or mixer eduational curriculums, depending on the philosophy of the institution.<ref></ref> And then use a DIFFERENT source to explain that elsewhere in the world, mixer philsophy is taught.DigitalC (talk) 04:07, 28 May 2008 (UTC)

Yes, that rewrite would be fine, as it matches the source. Thanks. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• "In the United States, all but one of the chiropractic colleges are privately funded, but the colleges in Australia, South Africa, Denmark, one in Canada, and two in Great Britain are located in government-sponsored universities and colleges." Details about which countries have which colleges are better left to the subarticle.
  • Actually no, its quite relevant to Chiropractic because skeptics such as yourself promote that Chiropractic is fringe and is pseudoscientific. All schools outside North America save 1 are in government universities. This is notable and its critical it appear in the article. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

• It is relevant that many schools outside the U.S. are supported by the government. It is a minor detail as to where those schools are, a detail that isn't that important here. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Stop trivializing the matter. They're not supported by the government. They're part of mainstream, public universities. You claim chiro is fringe and is like homeopathy. Last time I checked there were no Bachelors and Masters degrees in homeopathic science. CorticoSpinal (talk) 23:01, 27 May 2008 (UTC)

I am not claiming that chiro is fringe, nor that it is "like homeopathy" full stop. My proposal would not affect wording that says that the outside-the-U.S. colleges are government universities. So what's the problem with the proposal? Eubulides (talk) 09:05, 28 May 2008 (UTC)

You have not said Chiropractic is like Homeopathy? Final answer? CorticoSpinal (talk) 05:28, 29 May 2008 (UTC)

Chiropractic is like homeopathy in some respects, and unlike it in others. Surely this is obvious. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "In 1971, National College of Chiropractic (now known as National University of Health Sciences) became the first federally recognized and accredited college by the United States Department of Education. This led the way to important grants in federal funding for research as well as grants and loans to chiropractic schools and prospective chiropractic students." This event does not appear in the NUHS's own web page on accreditation or on the NUHS's own web page on its own history. If even the NUHS itself doesn't think it's notable, it is not notable enough to make the cut for Chiropractic education, much less Chiropractic itself.
  • It doesn't matter if it makes the NUHS website, what matters is that the source supports the claim. It does. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

One can find sources for all sorts of non-notable material. Having one source doesn't prove that something is notable. Wikipedia is about notability as well as verifiability. If the institution in question doesn't think a fact is notable, it's a strong indication that the fact is indeed not notable. Eubulides (talk) 16:59, 27 May 2008 (UTC)

You're so off base here I don't know where to begin. Let's but it plainly: do you have a source that suggests it's not notable? Because National College of Chiropractic being the first chiro institution in the world to be accredited by a federal governent is a notable thing. Dematt your thoughts? CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

I disagree that it is not notable if NUHS doesn't mention it on their website. If there is a reliable source for the claim, then it is notable by the fact that there IS a source for that claim.DigitalC (talk) 04:10, 28 May 2008 (UTC)

• That is a very strange standard for notability. But if that's the standard, shouldn't we add "The chiropractic college at Marycrest International University closed in 2002.", and cite Homola 2006 (PMID 16446588)? After all, this is a claim about education for which we have a reliable source (considerably more reliable, as it is published in a refereed journal).
• I dispute that the NCC was the first "federally recognized and accredited college by the U.S. Dept of Education". The DoE does not do accreditation for chiropractic, and does not recognize chiropractic colleges directly; the CCE does that.

Eubulides (talk) 09:05, 28 May 2008 (UTC)

• The claim is supported by the source Wiese/Peterson (1994). Do you have a source of evidence that disputes this or do we just have to take your word for it? CorticoSpinal (talk) 05:28, 29 May 2008 (UTC)

Well, your dispute would be correct, they were the first chiropractic college to achieve "federally recognized regional accrediation" by the [b]New York State[/b] Department of Education. The CCE wasn't recognized by the US Commissioner on Education until 1974.[58]. As for notability, that doesn't really apply - perhaps you mean that you feel that we are giving undue weight to the issue? Speaking of undue weight, was the Marycrest University a milestone? Was it the first college to close? The last college to close?

The Marycrest University is just as much of a milestone as the 1971 event, if what is required for something to be notable merely that a reliable source supports it. There is nothing particularly notable about the 1971 New York State event, worthy of inclusion here. It might be worth mentioning in Chiropractic education. Eubulides (talk) 08:47, 29 May 2008 (UTC)

Eubulides, please read my statement again, or is this a case of WP:IDHT? Notability doesn't apply here. Perhaps you mean WP:UNDUE? How was Marycrest a milestone? Was it the FIRST of something? Was is the LAST of something? Has it been listed as a milestone in a reference? DigitalC (talk) 05:19, 30 May 2008 (UTC)

Yes, sorry, notability is wrong (that is for article topics, not particular bits of content), and undue weight is the right issue. Just as Marycrest wasn't important enought to be worth citing here, and the 1971 NCC event wasn't that important either. The 1971 NCC event isn't even worth citing on the NCC's own website! Why should we mention it here? Eubulides (talk) 11:39, 30 May 2008 (UTC)

• "Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine." This claim is plausible but is unsourced. A source is needed.
• "In North America, typically a 3 year university undergraduate education is required to apply for the chiropractic degree." The cited source gives the requirements for one university, which does not support the claim that it is a "typical" requirement. In any event, this requirement is not notable enough for Chiropractic. It is suitable for Chiropractic education.

You do not get to determine what is notable for chiropractic. Listing common pre-reqs is fair game. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

Neither of us, individually, gets to determine anything. Prerequisites are low-level and unimportant details. They can be put into the subarticle. Eubulides (talk) 16:59, 27 May 2008 (UTC)

They belong in the main article. Suddenly the fact that DCs need 3 years of sciences pre-reqs low level? Lol, sure, sure  :) CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

This source supports the claim that it is a tyical requirement. "All matriculants must furnish proof of having earned a minimum of 90 semester hour credits of appropriate pre-professional education courses at an institution or institutions accredited by a nationally recognized agency" - [59]. If we can find a source for it, we may as well include that the majority of students have a bachelor's degree or higher. DigitalC (talk) 05:43, 28 May 2008 (UTC)

Yes, thanks, that would support the claim that entrants to accredited U.S. schools must have at least 90 semester hour credits. It does not support the claim about 3 years, though, so the claim would need rewording. I still fail to see, however, why this low-level detail is worth mentioning at the level of Chiropractic. Maybe Chiropractic education, the subarticle; but why Chiropractic?

90 semester hours is typically 3 years of University. However, I support changing the wording to 90 semster hours, because it isn't as vague (for example, you can't take 1 course a year for 3 years and then get in). DigitalC (talk) 05:10, 29 May 2008 (UTC)

It's notable because it is the basic requirement to apply for the chiropractic degree. And, in the section Chiropractic Education (the main article) it's not unreasonable to include this detail. Are you disputing the source? If no, let's move on. As a compromise I support including both 3 years (90 semester hours), DigitalC. CorticoSpinal (talk) 05:42, 29 May 2008 (UTC)

The source says only 90 semester hours, right? Let's not extrapolate beyond what the source actually says. And again, this material is better left to Chiropractic education, the subarticle that is designed for it. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• A direct and lengthy quote is made from the WHO guidelines without quote marks. This is plagiarism and is a copyright violation. Also, there is too much about full-time training programs and not enough about conversion and limited training programs.

It is attributed and I shall put the quotation marks.

It would be better to briefly summarize the material, rather than include long and boring quotes from the source. That is what is done in the draft below. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Your opinion of long and boring differs from many other editors. CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

On the contrary, CynRN, the only other editor who has spoken up on the subject, thinks that the education draft was boring and thought that there should not be a whole lot on education. Eubulides (talk) 09:05, 28 May 2008 (UTC)

There you go again, misrepresenting (#21) and conflating again. CynRN has said the section is boring and does not interest her, she does not dispute the material. There's a difference. CorticoSpinal (talk) 05:17, 29 May 2008 (UTC)

I was responding to the claim "Your opinion of long and boring differs from many other editors." CynRN agrees that the draft is boring, so in that sense my opinion does not differ from hers. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training." This text is misleading, because it's just a guideline, not a requirement. Also, it's longwinded and should be shortened.

• Than we can specify its a guideline. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

• Or, we can include that it is a guideline worldwide, but a requirement in the US. [60] "The DCP must require each student awarded the D.C. degree to have successfully completed not less than 4,200 instructional hours, and must have earned not less than the final 25% of the total credits required for the D.C. degree from the program that confers the degree."DigitalC (talk) 05:47, 28 May 2008 (UTC)

• Yes, thanks, that's a good idea for the 4,200-hours detail. The other details still have the problem, though. And, again, why is it worth mentioning 4,200 hours in Chiropractic? This seems such a low-level detail. We have a subarticle in Chiropractic education; why not use it? Eubulides (talk) 09:05, 28 May 2008 (UTC)

How is it a low level detail? 4200 hours is what it takes to earn the degree. There's people out there who think Chiropractic is a 1 year program after highschool. We are simply providing the readers with reliable, verifiable information that is supported by reliable sources. CorticoSpinal (talk) 05:47, 29 May 2008 (UTC)

The stuff about 4200 hours of this and 1000 hours of that and 25% of this is really boring stuff. Go look at (say) the Wikipedia entry for Harvard; does it talk about how many hours it takes to graduate? Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "Health professionals with advanced clinical degrees, such as medical doctors, can can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy." I don't see anything in the source about this being "most commonly done in countries where the profession is in its infancy". Again, the wording can be trimmed without losing information.
  • This is directly taken from the source. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

Where? What page? I didn't find it. Anyway, the material should be trimmed here. Eubulides (talk) 16:59, 27 May 2008 (UTC)

• "Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted." This sentence is too much detail; it's kind of obvious that one goes to school to get a degree, no? It can be put in Chiropractic education. It needs sourcing, though.

Common knowledge does not need to be sourced. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

If the knowledge is that common, it need not be placed here at all, no? But at any rate it is unimportant detail suitable for the subarticle. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Another logical fallacy in your argumentation. Common knowledge doesn't need to be referenced, Eubulides. CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

The main point is that unimportant detail, whether sourced or not, does not need to be in the article. 09:05, 28 May 2008 (UTC)

• "However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed." This needs a source. In particular, it needs to state which countries where this requirement is in place. It is not true in all countries.
  • In all countries that wish to use the designation chiropractic and chiropractor it is a requirement. Othewise you get stuck with the situation in Germany and Brazil CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)
    • Again, the statement needs a reliable source, and should be rewritten to match the source. Eubulides (talk) 16:59, 27 May 2008 (UTC)
• "Regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency." The cited source supports this claim only for Canada.

Are you really disputing this? That regulatory colleges are NOT responsible for protecting the public? This seems a little pedantic to me. DigitalC (talk) 05:57, 28 May 2008 (UTC)

I am disputing that it is a requirement worldwide, certainly. At any rate the claim needs to be accurately sourced; currently it is not. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Nowhere does it claim to be a requirement worldwide.DigitalC (talk) 05:10, 29 May 2008 (UTC)

The requirement was stated as a blanket one. The default scope in Wikipedia is global. If the requirement is sourced only for Canada, the text should say that. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the U.S. and 2 in Canada," The cited source does not mention Canada.

Here is another source, which lists the 18 locations in the US, the 2 in Canada, as well as Australia and Japan. [61] DigitalC (talk) 05:57, 28 May 2008 (UTC)

Unfortunately that source does not suffice for the claim, as it does not say that the colleges in question are accredited. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Again, this is getting pedantic. Do you doubt that the colleges are accredited? Attribution is only needed if the data is challenged, or likely to be challenged. How about, "There are 15 accredited Doctor of Chiropractic programs in 18 locations in the US, 4 in Europe, 3 in Australia, and 2 in Canada." [62] We lose out on RMIT Japan, but we increase our world view, and have a a reliable source for the content as well. DigitalC (talk) 00:45, 29 May 2008 (UTC)

That is a better source, since it talks about accreditation. However, it disagrees with the numbers in the proposed quote. It lists 13 accredited DC programs in the US, at 19 locations. It lists 2 in Australia. It lists 1 in NZ. The article should match the source. I suggest adding "as of 2003" since it is an old source. It is not pedantic to insist that statements be sourced; it is a core property of Wikipedia. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• " and an estimated 70,000 chiropractors in the USA, 6500 in Canada, 2500 in Australia, 2,381 in the UK, and smaller numbers in about 80 other countries" The cited source does not contain any information about numbers of chiropractors.

• Back Pain Revolution, by Gordon Waddell (page 62). [63] states 70,000 in the US, 6000 in Canada, 1500 in the UK, and 90,000 internationally. For the record, this information has been in the article for ages. You cry foul when others object to information that has been in the article previously, but then turn around and do the same. Now do you understand that while we are discussing something on the talk page, we might as well get it right? DigitalC (talk) 06:51, 28 May 2008 (UTC)

• That URL does not work for me; Google Books responds "You have either reached a page that is unavailable for viewing or reached your viewing limit for this book." The book is dated 2004. The U.S. Bureau of Labor Statistics reports "Chiropractors held about 53,000 jobs in 2006."[64] and I suggest using this figure instead for the U.S., as it is more recent and the BLS gives a date for its estimate, which is better. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• The URL works for me, and I stated above the numbers it gives. I agree that the BLS stats are probably better for the US, but we can use both references. DigitalC (talk) 05:10, 29 May 2008 (UTC)

Here is my attempt at an improved version (which is still not as good as what Chiropractic got reverted to):

Chiropractic education is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution. In the United States, all but one of the chiropractic colleges are privately funded, but in several other countries they are in government-sponsored universities and colleges.

Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine. The World Health Organization guidelines suggest three major educational paths involving full‐time chiropractic education, along with a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic. For full-time education the guidelines suggest at least 4200 student/teacher contact hours, and for conversion they suggest at least 2200 hours; in both cases including at least 1000 hours of clinical experience.

In some jurisdictions chiropractors, like other health care professionals, must be licensed in order to legally practice. In Canada, regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the U.S.,

Eubulides (talk) 09:18, 27 May 2008 (UTC)

Your draft omits critical information (as it usually seems to be the case). My draft is superior and more succint.

I don't follow the "succinct" remark, as my draft is considerably shorter. At any rate, both drafts are considerably inferior to what's in Chiropractic now. Also, #Education, licensing, and regulation draft is better than what's in Chiropractic now. Though it's obviously not perfect, it's a better starting point for future improvements. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Shorter and missing the relevant info. Listen. You seem to think that you're the only editor here who can make drafts. Your draft leaves out key information. You push Ernst on us. Give it a break. CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

We have no shortage of drafts! Four editors, four drafts. I have never said or implied that I am the only editor who can make drafts. On the contrary, I have written none of the four drafts. Eubulides (talk) 09:05, 28 May 2008 (UTC)

This is the first time this has ever occurred that 4 editor had 4 drafts. Nice try though. How many times did you attempt for Safety (4-5?) Effectiveness (4-5?) They're still bogus too. See Chiropractic is fringe for rational. CorticoSpinal (talk) 05:17, 29 May 2008 (UTC)

Sorry, I didn't follow that remark at all. Eubulides (talk) 08:47, 29 May 2008 (UTC)

"Further research is needed"

This change installed the text "Further research is necessary to determine the acceptable level of risk associated with both the benefits and the harms of CMT." Let's remove this sentence. First, it uses "CMT" without defining the acronym. Second, and more important, it basically just says "Further research is needed". That is not notable. Every research paper says "further research is needed". There's no particular reason to make that point here, as opposed to the many dozens of other places in Chiropractic that cite sources saying further research is needed. Eubulides (talk) 09:57, 27 May 2008 (UTC)

Totally agree. I removed the offending text. ScienceApologist (talk) 14:21, 27 May 2008 (UTC)

Here is a copy of the CONCLUSIONS: Weak to moderately strong evidence exists to support causation between CMT and VAD and associated stroke. Ultimately, the acceptable level of risk associated with a therapeutic intervention like CMT must be balanced against evidence of therapeutic efficacy. Further research, employing prospective cohort study designs, is indicated to uncover both the benefits and the harms associated with CMT.

Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist. 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Here is the reference. Some editors expressed an interest in the Safety section weighing in on the risk-benefit. I gave it a try.

Perhaps we can shorten it or tweak it to bring it up to Wikipedia's standard. Any thoughts for improving the Safety section? QuackGuru 15:00, 27 May 2008 (UTC)

Question: How come when a chiropractic skeptic makes want to remove a claim, SA and QG are there to bulldoze it through (with Jeffire and Orangemarlin seemingly on stand by for reversions) without any discussion, yet the same courtesy is not offered to those who disagree with Eubulides? CorticoSpinal (talk) 16:55, 27 May 2008 (UTC)

The sentence "the acceptable level of risk associated with a therapeutic intervention like CMT must be balanced against evidence of therapeutic efficacy" might be useful to source the introduction to a new Risk-benefit section. Otherwise I don't see the use of the other quoted sentences in that source. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Education, licensing, and regulation drafts

Education, licensing, and regulation 1

International training guidelines require that persons without relevant prior health care experience must spend at least 4200 student/teacher contact hours in four years of full‐time education; experienced health professionals need only 2200 hours. Both figures include at least 1000 hours of supervised clinical training. In some countries a license is required in order to practice. To help standardize and ensure quality of chiropractic education and patient safety, in 2005 the World Health Organization published the official guidelines for basic training and safety in chiropractic. The WHO guidelines suggest three major educational paths involving full‐time chiropractic education, along with a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic. For full-time education the guidelines suggest at least 4200 student/teacher contact hours, and for conversion they suggest at least 2200 hours; in both cases including at least 1000 hours of clinical experience. Most commonly, chiropractors obtain a first professional degree in the field of chiropractic medicine. Typically a 3 year university undergraduate education is required to apply for the chiropractic degree.

A Chiropractic Examining Board requires all candidates to complete a twelve-month clinical internship to obtain licensure. Licensure is granted following successful completion of all state/provincial and national board exams so long as the DC maintains malpractice insurance. Nonetheless, there are still some variations in educational standards internationally depending on admission and graduation requirements. Chiropractic medicine is regulated in Canada by provincial statute. Regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the USA and 2 in Canada, and an estimated 70,000 chiropractors in the USA, 6500 in Canada, 2500 in Australia, 2,381 in the UK, and smaller numbers in about 80 other countries. Chiropractic education is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution. In the United States, all but one of the chiropractic colleges are privately funded, but in several other countries they are in government-sponsored universities and colleges.

Education, Licensing, Regulation 2

The first school of chiropractic was opened in 1896 in Davenport, Iowa, USA.[65] Chiropractic education is unique in the United States that it is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution. In the United States, all but one of the chiropractic colleges are privately funded, but the colleges in Australia, South Africa, Denmark, one in Canada, and two in Great Britain are located in government-sponsored universities and colleges.. In 1971, National College of Chiropractic (now known as National University of Health Sciences) became the first federally recognized and accredited college by the United States Department of Education. This led the way to important grants in federal funding for research as well as grants and loans to chiropractic schools and prospective chiropractic students.

Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine. In North America, typically a 3 year university undergraduate education is required to apply for the chiropractic degree. In general, there are 3 major educational paths involving full‐time chiropractic education across the globe:

• A four‐year full‐time programme within specifically designated colleges or universities, with suitable pre-requisite training in basic sciences at university level;
• A five‐year bachelor integrated chiropractic degree programme offered within a public or private university
• A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree.

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

Regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the USA and 2 in Canada, and an estimated 70,000 chiropractors in the USA, 6500 in Canada, 2500 in Australia, 2,381 in the UK, and smaller numbers in about 80 other countries.

Education, Licensing, Regulation 3

Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine (DC or DCM). In North America, a 3 year university undergraduate education (90 semester hours) is required before applying to chiropractic college, followed by no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training. Internationally, the World Health Organization (WHO) suggests 3 major educational paths involving full‐time chiropractic education:

• "A four‐year full‐time programme within specifically designated colleges or universities, with a 1 - 4 year pre-requisite training in basic sciences at university level;
• " A five‐year bachelor integrated chiropractic degree programme offered within a public or private university;
• " A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree."

Health care professionals with advanced clinical degrees can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours. Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. The chiropractor may then be required to pass national, state, or provincial boards before being licensed to practice in a particular jurisdiction. Depending on the state or province, continuing education (CE) may be required to renew these licenses and chiropractors may further specialize in fields such as Chiropractic Orthopedics (DABCO), Chiropractic Radiology (DABCR), and Chiropractic Sports Physician (DABCSP) by completing additional study and passing specified boards that are separate and distinctly different than medical boards.

In the United States, chiropractic schools are accredited through the Council on Chiropractic Education (CCE) and recognized by the US Department of Education with the stated purpose of insuring the quality of chiropractic education by means of accreditation, educational improvement and public information and allowing for grants and loans to chiropractic schools and prospective chiropractic students. All but one of the chiropractic colleges in the United States are privately funded, but in several other countries they are in government-sponsored universities and colleges.In 1971, National College of Chiropractic (now known as National University of Health Sciences) became the first federally recognized and accredited college by the United States Department of Education allowing for grants and loans to chiropractic schools and prospective chiropractic students. Recently, CCE standards were integrated into the English speaking countries of Australia/New Zealand, Canada, and Europe. These councils have since developed CCE - International in an effort to maintain chiropractic education standards globally. Today, there are 18 accredited Doctor of Chiropractic programs in the USA, 2 in Canada, and 4 in Europe and the UK.

Regulatory colleges and chiropractic boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. The Federation of Chiropractic Licensing Boards (FCLB) oversees most of these regulatory bodies. In 2006, there were approximately 53,000 chiropractors in the United States and over 6500 chiropractors licensed in Canada.

Comments on Education 3

• I prefer this draft to the others. However, I think that this line from Eubulides, "but in several other countries they are in government-sponsored universities and colleges" is better than "but the colleges in Australia, South Africa, Denmark, one in Canada, and two in Great Britain are located in government-sponsored universities and colleges". DigitalC (talk) 05:55, 30 May 2008 (UTC)
• I support this draft as well. I removed the strikeouts that QG inserted for the educational paths; his argument that its too much weight is unfounded; moreover, not all degrees conferred to chiropractors are the same. As the section suggests, some are 2-3 years MSc (chiro), some are 4 years BSc(chiro) and in North America, it's 4 years after a minimum of 3 (total of 7). The article needs to reflect this global perspective. The source is not in dispute, the source is not fringe so I don't know where the weight argument comes from. I think it's more WP:IDONTLIKEIT than anything else. CorticoSpinal (talk) 00:30, 31 May 2008 (UTC)
• This draft is still mutating so I hesitate to make comments on it, but on the offchance that people are taking it seriously I will say that the draft is disappointing, as it has essentially ignores many of the comments in #Education draft needed work. For example, I don't see anything in the cited source about the 2200 hours being "most commonly done in countries where the profession is in its infancy", and I am quite skeptical that that 2200-hour claim is true. This is just one example of a comment being ignored; there are others. Dematt, have you had a chance to read the bullets at the start of #Education draft needed work? (Just the top-level bullets; you can ignore all the to-and-fro underneath if you like....) Eubulides (talk) 01:08, 31 May 2008 (UTC)

I took out the infancy part. In my rewrite, I apparently inadvertently addressed some of the bullet points. It looks like I agreed with you on some and with others on others. I am hoping to equally satisfy/dissappoint everyone, yet remain true to the sources. Rather than me reading through all that above again, are there specific issues that you feel strongly enough about that you cannot support it? -- Dēmatt (chat) 02:25, 31 May 2008 (UTC)

Education 3 improvement suggestions

OK, I took the time to review the section completely. Here is the revised set of bullet points.

• "Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine (DC or DCM)." The cited source does not say anything about "Most commonly". It says only that DC or DCM are the recognized first-professional degrees. The source is a U.S. source so this would be for the U.S., which should be stated in the text (or a better source should be found).

• "In North America, a 3 year university undergraduate education (90 semester hours) is required before applying to chiropractic college," The 2nd citation (ccachiro) has nothing to do with the claim; it says nothing about prerequisites. It can be removed. The 1st citation (FPEH) is only about Canada, so the text should be changed from "North America" to "Canada" or better citations should be found. The claim is not true for all of North America (it's not true for Mexico). Neither source says anything about "90 semester hours", so that part should be removed from the text (or a better source found).

• "followed by no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training." The citation is to the WHO guidelines, which are a guideline curriculum for the world, and do not place any requirements per se on Canada (or North America). And yet the text is worded as if the WHO was imposing curriculum rules on North America. The text needs to be reworded to make it clear that this is just a voluntary guideline, not a requirement.

• "Internationally, the World Health Organization (WHO) suggests 3 major educational paths involving full‐time chiropractic education:" This "suggests" bit could perhaps be moved in front of the "4200" bit, to make it clear that the "4200" is part of the suggestion.

• "
  • "A four‐year full‐time programme within specifically designated colleges or universities, with a 1 - 4 year pre-requisite training in basic sciences at university level;
  • " A five‐year bachelor integrated chiropractic degree programme offered within a public or private university;
  • " A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree."

" It's tacky to have such an extensive quote. This should be reworded and trimmed. This sort of yawningly-boring detail is not needed in Chiropractic; it might be suited for Chiropractic education.

• "Health care professionals with advanced clinical degrees can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours." Again, this is part of a international guideline, not strictly a requirement; this is not made clear in the text. Also, it's not made clear that the 2200 hours includes 1000 hours of supervised clinical training.

• "Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted." This sentence is too much detail and is unsourced. At the very least it needs to be sourced.

• "The chiropractor may then be required to pass national, state, or provincial boards before being licensed to practice in a particular jurisdiction. Depending on the state or province, continuing education (CE) may be required to renew these licenses and chiropractors may further specialize in fields such as Chiropractic Orthopedics (DABCO), Chiropractic Radiology (DABCR), and Chiropractic Sports Physician (DABCSP) by completing additional study and passing specified boards that are separate and distinctly different than medical boards." This material is completely unsourced. It needs a source. There is some duplication between this material and the "radiology" and "sports sciences" of Chiropractic #Scope of practice; I suggest trimming the material either here or there, as we don't need it both places.

• "In the United States, chiropractic schools are accredited through the Council on Chiropractic Education (CCE) and recognized by the US Department of Education with the stated purpose of insuring the quality of chiropractic education by means of accreditation, educational improvement and public information and allowing for grants and loans to chiropractic schools and prospective chiropractic students." This material needs to be sourced. Does the DoE really recognize chiropractic schools directly? Also, this stuff is really boring and too much detail and doen't all belong here. "insuring the quality of"? "public information"? "grants and loans"? "prospective chiropractic students"? My goodness but the unnecessary words are really thick here.

• "Recently, CCE standards were integrated into the English speaking countries of Australia/New Zealand, Canada, and Europe. These councils have since developed CCE - International in an effort to maintain chiropractic education standards globally. The cited source says nothing about "recently" or "integrated" or "Australia" or "New Zealand" or "Canada" or "Europe". The text needs to be reworded to match the source, or a better source found.

• "Today, there are 18 accredited Doctor of Chiropractic programs in the USA, 2 in Canada, and 4 in Europe and the UK." The cited sources cover just the U.S. and Canada; they do not mention Europe. Please just copy the sentence and citations from #Education, licensing, and regulation 6.

• "Regulatory colleges and chiropractic boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency." The cited source is just about Canada, and only about regulatory colleges; it does not mention chiropractic boards.

• "The Federation of Chiropractic Licensing Boards (FCLB) oversees most of these regulatory bodies." The cited source does not mention "overseeing"; it's just a list of member bodies. The FCLB is more of a clearinghouse and forum; it does not have a formal oversight role.

• Nothing is said about the distinction between straight and mixer schools. (QuackGuru also raised this point.) The straight/mixer distinction is worth mentioning briefly here, far more than the eye-glazing material about student loans. We do have a source for it, no? Eubulides (talk) 05:13, 31 May 2008 (UTC)

• Have you read #Education, licensing, and regulation 6 carefully? It has some good ideas, some along the above lines, some independent. I think it might help if you tried to read that draft carefully, just as we've tried to read this draft carefully. It does have flaws, but it has one important virtue: it's far better sourced.

Thanks. Eubulides (talk) 05:13, 31 May 2008 (UTC)

Education, licensing, and regulation 4

Most commonly, chiropractors obtain a first professional degree in the field of chiropractic medicine. In North America, typically a 3 year university undergraduate education is required to apply for the chiropractic degree. In Canada a license is required in order to practice. The World Health Organization suggest three major educational paths involving full‐time chiropractic education across the globe, along with a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic. For full-time education the guidelines suggest at least 4200 student/teacher contact hours, and for conversion they suggest at least 2200 hours; in both cases including at least 1000 hours of clinical experience. Health professionals with advanced clinical degrees, such as medical doctors, can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy. A degree in chiropractic medicine is granted upon meeting all clinical and didactic requirements. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed.

A Chiropractic Examining Board requires all candidates to complete a clinical internship to obtain licensure. In Canada, licensure is granted following successful completion of all state/provincial and national board exams so long as the DC maintains malpractice insurance. Nonetheless, there are still some variations in educational standards internationally depending on admission and graduation requirements. Chiropractic medicine is regulated in Canada by provincial statute; regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the USA and 2 in Canada, and an estimated 53,000 - 70,000 chiropractors in the USA, 6000 in Canada, 2500 in Australia, 1,500 in the UK, and about 90,000 in 80 other countries. Chiropractic education is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution. In the United States, all but one of the chiropractic colleges are privately funded, but in several other countries they are in government-sponsored universities and colleges.

Comments on Education, licensing, and regulation 4

I have made some small adjustments. Some of the unnecessary references can be removed. Happy reading. _-Mr. ^o G-_ 03:45, 28 May 2008 (UTC)

First, its a misnomer to call this section 2. Dematt and myself have also already made alternate drafts. Although I do think yours is a good attempt, I still prefer Dematts though we could integrate bits of yours that reads well. It misses the degrees granted and incorrectly ascribes straight vs. mixer programs worldwide (this is primarily a US phenomenon). It also does omits the brief history info which was well sourced and relevant to the section. CorticoSpinal (talk) 04:06, 28 May 2008 (UTC)

I changed it from "2" to "4" to help to avoid confusion with 2 or 3 versions. This draft is the best of the lot so far. Thanks! Undoubtedly it could still use improvements but I will let others comment for now. Eubulides (talk) 09:05, 28 May 2008 (UTC)

I have made a few more improvements. QuackGuru 09:36, 28 May 2008 (UTC)

I changed them all to numbers, and refactored Eubilidies comment above, hopefully you can understand why, so that we can evaluate all of them based on their merits. -- Dēmatt (chat) 13:08, 28 May 2008 (UTC)

Education, licensing, and regulation 5

Most commonly, chiropractors obtain a first professional degree in the field of chiropractic medicine. In North America, typically a 3 year university undergraduate education is required to apply for the chiropractic degree. Internationally, the World Health Organization (WHO) suggest three major educational paths involving full‐time chiropractic education, along with a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic. For full-time education the guidelines suggest at least 4200 student/teacher contact hours, and for conversion they suggest at least 2200 hours; in both cases including at least 1000 hours of clinical experience. Health professionals with advanced clinical degrees, such as medical doctors, can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy. In Canada, licensure is granted following successful completion of all state/provincial and national board exams so long as the DC maintains malpractice insurance. Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, the chiropractor may then be required to pass national, state, or provincial boards before being licensed to practice in a particular jurisdiction.

In the United States, chiropractic schools are accredited through the Council on Chiropractic Education and recognized by the US Department of Education with the stated purpose of insuring the quality of chiropractic education by means of accreditation, educational improvement and public information and allowing for grants and loans to chiropractic schools and prospective chiropractic students. Recently, CCE standards were integrated into the English speaking countries of Australia/New Zealand, Canada, and Europe. These councils have since developed CCE - International in an effort to maintain chiropractic education standards globally. Chiropractic medicine is regulated in Canada by provincial statute; regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the USA and 2 in Canada, and an estimated 53,000 - 70,000 chiropractors in the USA, 6000 in Canada, 2500 in Australia, 1,500 in the UK, and about 90,000 in 80 other countries. Chiropractic education is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution. In the US, all but one of the chiropractic colleges are privately funded, but in several other countries they are in government-sponsored universities and colleges.

Comments on Education, licensing, and regulation 5

Here is another variation for Wikipedians to review. QuackGuru 19:31, 28 May 2008 (UTC)

Which versions are viable candidates now? I see both "5" and "3" in your recent edits. There are a lot of drafts now and I don't want to waste time reviewing ones that are no longer active. Eubulides (talk) 21:19, 28 May 2008 (UTC)

I still think #3 is the best. -- Levine2112 ^discuss 02:00, 29 May 2008 (UTC)

I agree with Levine here. 3# seems to be the best candidate. DigitalC (talk) 05:46, 29 May 2008 (UTC)

Dematts (3) proposal is the best thus far as well. CorticoSpinal (talk) 21:34, 30 May 2008 (UTC)

Education, licensing, and regulation 6

Most commonly, chiropractors obtain a first professional degree in the field of chiropractic medicine. In North America, typically a 3 year university undergraduate education (90 semester hours) is required before applying for a chiropractic college, followed by no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training. Internationally, to help standardize and ensure quality of chiropractic education, in 2005 the World Health Organization (WHO) guidelines suggest three major educational paths involving full‐time chiropractic education, along with a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.

Health professionals with advanced clinical degrees, such as medical doctors, can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours. In Canada, licensure is granted following successful completion of all state/provincial and national board exams so long as the DC maintains malpractice insurance. Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, the chiropractor may then be required to pass national, state, or provincial boards before being licensed to practice in a particular jurisdiction. Depending on the state or province, continuing education (CE) may be required to renew these licenses. Chiropractors may further specialize in fields such as Chiropractic Orthopedics (DABCO), Chiropractic Radiology (DABCR), and Chiropractic Sports Physician (DABCSP) by completing additional study and passing the specified boards that are separate and distinctly different than medical boards.

In the United States, chiropractic schools are accredited through the Council on Chiropractic Education (CCE) and recognized by the US Department of Education with the stated purpose of insuring the quality of chiropractic education by means of accreditation, educational improvement and public information and allowing for grants and loans to chiropractic schools and prospective chiropractic students. Recently, CCE standards were integrated into the English speaking countries of Australia/New Zealand, Canada, and Europe. These councils have since developed CCE - International in an effort to maintain chiropractic education standards globally. In the US, all but one of the chiropractic colleges are privately funded, but in several other countries they are in government-sponsored universities and colleges. Today, there are 18 accredited Doctor of Chiropractic programs in the USA, 2 in Canada, and 4 in Europe.

In Canada, regulatory colleges and chiropractic boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. The Federation of Chiropractic Licensing Boards (FCLB) oversees most of these regulatory bodies. There are an estimated 53,000 - 70,000 chiropractors in the USA, 6000 in Canada, 2500 in Australia, 1,500 in the UK, and about 90,000 in 80 other countries. Chiropractic education is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution.

Comments on Education, licensing, and regulation 6

Here is yet another variation for Wikipedians to review. There may be some low levels details that can be condensed and unnecessary refs can be removed. Thanks. QuackGuru 05:55, 29 May 2008 (UTC)

I commend you on a good attempt QG, and there's some good stuff in your draft that can definitely go into the subarticle Chiropractic education. That being said, I believe Dematts proposal is the best thus far and is more succint. CorticoSpinal (talk) 17:44, 29 May 2008 (UTC)

No specific objections have been made regarding draft six. Dematt's proposal is controversial. QuackGuru 19:09, 29 May 2008 (UTC)

• "In both cases, this includes a minimum of 1000 hours of supervised clinical training." What does in both cases mean? DigitalC (talk) 07:20, 30 May 2008 (UTC)
  • That quote isn't present in the current version of #Education, licensing, and regulation 6, so I assume this comment is obsolete? Eubulides (talk) 11:39, 30 May 2008 (UTC)

Comments concerning all education, licensing and regulation drafts

• They are all missing components such as National Board examinations, State Board examinations, and the accredidation body; Council on Chiropractic Education, and FCER (education and research)and FSLB (state licensing regulation). -- Dēmatt (chat) 13:33, 28 May 2008 (UTC)
• They are missing specialization such as DACBO (chiropractic orthopedist), DACBR (chiropractic radiology), DABCN (chiropractic neurology), etc..
• They are missing the distinction between straight and mixer educational curriculums. It's notable enough for the US Dept of Education to note it's good enough to note for chiropractic. The US is the only jurisdiction in the world that actually separates the chiropractic educational system this way. Every other country in whole world, with the exception of New Zealand is exclusively mixer. This is a significant detail. Practice styles and belief systems are associated with the school matriculation. There's sources that proves this such as McDonald (2003). CorticoSpinal (talk) 06:01, 29 May 2008 (UTC)

Comments on Education, licensing, and regulation drafts

A Chiropractic Examining Board requires all candidates to complete a twelve-month clinical internship to obtain licensure.

http://www.life.edu/Current_Students/licensure.asp http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V47-2-P81-P83/$file/V47-2-P81-P83.pdf

I found a couple of refs that might be useful. I suggest we improve the above draft to replace the current section. Thoughts? QuackGuru 16:31, 27 May 2008 (UTC)

The proposed additions (in #Education, licensing, and regulation 1) to Chiropractic #Education, licensing, and regulation draft are an improvement. Thanks for making the proposal here, and avoiding the temptation to edit directly. Eubulides (talk) 16:59, 27 May 2008 (UTC)

This draft (again) omits the various education degrees granted. Why do you keep on trying to delete this key piece of information? Also, you omitted all the new citations too which are relevant. Chiropractic education, licensing and regulation covers ALL of it, not just present tense. Please include those sections. Thanks. CorticoSpinal (talk) 17:02, 27 May 2008 (UTC)

None of the drafts specifically mentions any degrees. It's not a key piece of information at any rate, to say whether it's DC Flavor A or DC flavor B. It would be relevant and useful to mention DC. I suggest mentioning that. Currently the article uses the acronym "DC" without defining it, which is a real shortcoming, and the Education section is the logical place to define it. Eubulides (talk) 20:52, 27 May 2008 (UTC)

Actually, this proves how you don't get it. Only in North America are they DCs. Overseas they're MSc (Chiro) or BSc (Chiro). Skeptics claim there is no such thing as chiropractic science. I present evidence of the contrary. Not only that, it's a minimum of 7 years of schooling in North America, that's not the case overseas. Anyways, your argument has problems with logical fallacies. CorticoSpinal (talk) 22:43, 27 May 2008 (UTC)

None of the drafts specifically mentions any degrees, wither DC or MSc (Chiro) or BSc (Chiro). This is a shortcoming in all the drafts. This has nothing to do with chiropractic science; it's an issue of which degrees are granted. Eubulides (talk) 09:05, 28 May 2008 (UTC)

I think the point CorticoSpinal is trying to make is that these are 1) Different degrees than the DC/DCM, 2) That they are Bachelors of Science (or B. Appl Sci (Chiro)) or Masters of Science from publicly funded universities. Therefore, when critics say that these Chiropractors are anti-science, they are calling into question the reputability of Science degrees from these institutions. DigitalC (talk) 05:53, 29 May 2008 (UTC)

Bingo Where's Orangemarlin when you need him?  ;) CorticoSpinal (talk) 06:15, 29 May 2008 (UTC)

A sentence asserts the guidelines are official guidelines. Are the guidelines official guidelines or merely suggestions. The next sentence says: The WHO guidelines suggest... This is confusing. QuackGuru 17:30, 27 May 2008 (UTC)

Official guidelines are still just that - guidelines. They are not requirements. DigitalC (talk) 05:53, 29 May 2008 (UTC)

Seeing as Eubulides keeps on deleting cited material and is trying to water down education (as he attempted with scope of practice) I have included a succint draft that introduces the salient points. It is critical to include the different degrees DCs get, not all chiropractors receive the doctorate in chiropractic. Some programs are 4 years, some are 5, some are Masters of Science some are Bachelors of Science. These are important facts to note. Chiroskeptics who claim chiropractic is fringe must deal with the fact that outside the US, chiropractic is integrated in public universities and are receiving Bachelors and Masters degrees OF SCIENCE. These are mixer schools; they're not promoting straight/Palmer chiropractic. The skeptics here only want that side of the story covered (even though they form a minority) and obstruct any attempts to tell the other side and especially a non-US side. CorticoSpinal (talk) 18:58, 27 May 2008 (UTC)

• "Keeps on deleting"? I have not deleted any material from Chiropractic #Education, licensing, and regulation since May 14. We are discussing possible improvements, not any actions I have taken on Chiropractic.
• It is not "watering down" to remove boring and overly detailed material. On the contrary, it strengthens Chiropractic to limit it to highly-useful and relevant material.
  • The boring material you refer is notable enough for the WHO. It's not boring Eubulides if it's not controversial. All your edits here either play up controversy by using poor sources such as Ernst, Ernst-Cantor, or attempt to drum some up out of nowhere. CorticoSpinal (talk) 23:30, 27 May 2008 (UTC)

• The WHO generates reams and reams of boring material. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• None of the drafts mention Masters of Science or Bachelors of Science. Furthermore, it's not at all clear that this level of detail is needed here; it can go in Chiropractic education.

That level of detail doesn't belong here? It's less than 10 words. Why are you fighting so hard to prevent it's inclusion. Even Dematt's draft has included it. CorticoSpinal (talk) 23:30, 27 May 2008 (UTC)

We are talking about far more than 10 words of boring material. Eubulides (talk) 09:05, 28 May 2008 (UTC)

To each their own I suppose. So to clarify, you object to listing the various educational paths for lincensure throughout the globe? CorticoSpinal (talk) 16:52, 28 May 2008 (UTC)

Yes. That is excessive detail here. It should be in Chiropractic education. Eubulides (talk) 21:19, 28 May 2008 (UTC)

You seem to dispute all the details Eubulides. DigitalC has also said you have been pedantic. I would use tendentious, but that's just me. Either way, you might want to look at what admin Vassyana said yesterday, here, about arguing minutiae. Thanks. CorticoSpinal (talk) 06:08, 29 May 2008 (UTC)

• #Education, licensing, and regulation 1 mentions the topic of public universities outside the U.S.

Eubulides (talk) 20:52, 27 May 2008 (UTC)

Dematt's draft is superior to both yours and mine. I endorse his draft. It would be nice if you could compromise too and let Dematt try to work his magic. Thanks. CorticoSpinal (talk) 23:30, 27 May 2008 (UTC)

I am sure we can work together starting with Dematt's draft. But it will need a lot of work, as described elsewhere. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Doubt it needs as much work as you imply, but its agreed that we shall use Dematts draft as the template and starting point. CorticoSpinal (talk) 16:52, 28 May 2008 (UTC)

Well, I'm in Britain and things are pretty much exactly the same here. Jefffire (talk) 19:48, 27 May 2008 (UTC)

It's my understanding that chiropractic in Britain is more integrated into the system than here. But then, the whole system is different isn't it, isn't it harder to be an MD.. and what we call MDs here are what you call Mr.? I may be totally off base here. -- Dēmatt (chat) 20:46, 27 May 2008 (UTC)

I'm not aware of any significant differences between the quality of UK and US MD's, but what I meant is that Chiropractic is not considered mainstream medicine. I wouldn't say it any more integrated than in the US. Jefffire (talk) 21:00, 27 May 2008 (UTC)

Something tells me it is more integrated than the US and that the BCA said chiropractic had the most potential to be integrated in the mainstream. I'll ask my colleague at AACC for materials/sources that can shed more light. CorticoSpinal (talk) 23:30, 27 May 2008 (UTC)

I added my version above as well, it's a compromise version of sorts, though I think it needs building of the regulation section as well as licensing or the title should change. -- Dēmatt (chat) 19:10, 27 May 2008 (UTC)

If Jefffire would be so kind to perhaps tell us a bit about the educational system in the UK that would be helpful. I'm aware of Anglo-European, Welsh Institute and McTimmoney. I believe the first two have formal associations with universities as well. One of the biggest oversights of the article is it's heavy US-centric look without giving the rest of the chiropractic world their due. There is now officially more schools of chiropractic outside the US than within in. Also, all schools except New Zealand are mixer. So, of the 35 schools of chiropractic in the world, I believe only 7-8 are straight with 6-7 coming from the USA. USA is the only jurisdiction in the world whereby the education is divided into straight or progressive (mixer). These details need to be in the article. They're important for various reasons. CorticoSpinal (talk) 20:14, 27 May 2008 (UTC)

Details about things like the Welsh Institute's funding arrangements do not need to be in Chiropractic. They can be in Chiropractic education. Eubulides (talk) 20:52, 27 May 2008 (UTC)

Who mentioned anything about funding arrangements? CorticoSpinal (talk) 23:30, 27 May 2008 (UTC)

The main point, as I understand it, is that the chiropractic colleges outside the U.S. are at government-sponsored universities. Eubulides (talk) 09:05, 28 May 2008 (UTC)

The main point is that, outside the US, chiropractic education is almost exclusively taught in public universities which is in contrast to the US where its almost exclusively private schools (except Bridgeport). CorticoSpinal (talk) 16:52, 28 May 2008 (UTC)

Yes, that's the main point, and it can be made without a long list of countries. Eubulides (talk) 21:19, 28 May 2008 (UTC)

• IMHO, I think Dematt's (#3) version above is the most clear and concisely written. That said, I do like the way that CorticoSpinal's version opens with a brief overview of the history of chiropractic education. I agree that there should be a section (perhaps separate from education) discussing regulation and licensing. -- Levine2112 ^discuss 20:45, 27 May 2008 (UTC)

Dematt's may be clear and concise, but it has serious problems with citations and POV. Please see #I lost track below for more details. Eubulides (talk) 20:52, 27 May 2008 (UTC)

Draft 1 is too much of a mess to work with and suffers from more citation and NPOV issues. Let's start with Dematt's version as a base of this discussion and work out a consensual version from there. See below. -- Levine2112 ^discuss 21:33, 27 May 2008 (UTC)

All the drafts have serious citation problems; Draft 1 has the fewest. NPOV is harder to measure. We can start with any of the versions, of course; Dematt's hasn't addressed more of the bullets in #Education draft needed work, but it may well be that it's easier to fix those bullets one by one in a better-structured draft. Eubulides (talk) 21:56, 27 May 2008 (UTC)

I support Dematt's draft as a compromise. Eubulides' complaints regarding citations are not valid. Your opinion on draft 1 is just that, an opinion. Which I do not share. So, please, stop pushing your views on the rest of of us. Thanks. CorticoSpinal (talk) 22:33, 27 May 2008 (UTC)

Forgive me, but I don't think there should be a whole lot about education. I thought we wanted to make the article less boring!;) —Preceding unsigned comment added by CynRN (talk • contribs) 03:08, 28 May 2008 (UTC)

Dematt, I think it would be preferred that rather than highlighting the US CCE we use the Council on Chiropractic Education International. This is more globally representative and represents the CCE(USA) CCE(Canada) the CCE(Europe) and the CCE(Oz). There might be good tibits in there too. CorticoSpinal (talk) 16:41, 28 May 2008 (UTC)

I continue to be puzzled by which of the drafts is currently worth reviewing. Edits seem to be happening to two sets of drafts at the same time. This makes it very difficult to follow the intent. Can someone please explain what's going on vis-a-vis these drafts? Thanks. Eubulides (talk) 08:47, 29 May 2008 (UTC)

Education, license, regulations: CfI (Candidate for Insertion)? (5/29/2008)

Comments welcome on any of the drafts -- Dēmatt (chat) 14:17, 29 May 2008 (UTC)

Congrats on coming up with a very economical yet succint hybrid draft, Dematt. Though it's not perfect (for example, the DACBO and the like are American designations and other jurisdiction including Canada cannot legally use the term 'physician') but I do a agree that a blurb regarding the specializations is game for education. Perhaps, you can track down the most common specialization designations worldwide (for example, there is no 'pediatrics' designation in Canada, but there is in the US, however both have sport sciences and orthopedics designations. Ditto for Australia. Basically a more global outlook on the specializations would be nice. I also feel its notable to include the different educational paths of the US system (straight/progressive), but these are details we can add later on. So, I support the inclusion of your draft. It's well referenced, the sources aren't in dispute, it covers the requirements for admission and graduation; it mostly has a global perspective. It's thin on licensing and regulation; but those sections can be tackled later. All in all, a good piece of writing and solid, non-controversial addition to Chiropractic. CorticoSpinal (talk) 14:44, 29 May 2008 (UTC)

I left out the (straight/mixer) part because I am not sure what it means and was looking for another reference, but could not find one... don't mind putting it in, but I'm thinking that the jist of whatit means is that the CCE accredits schools based on criteria that is not affected by philosophy. Not sure though. -- Dēmatt (chat) 19:52, 29 May 2008 (UTC)

As CorticoSpinal suggested, the (straight/mixer) part should be in the draft. This is accomplished in draft six. QuackGuru 20:03, 29 May 2008 (UTC)

Draft three is not well referenced. It contains unnecessary quoted text from WHO. That should be summarized the way it is done in draft six. Draft three contains a non-notable 1971 historical tibdbit that was mixed in with reference number 188. Notable information is missing. For example, the different educational paths of the US system (straight/progressive) is not in draft three. That said, the best version is CLEARLY draft #6. No specific objections have been raised against draft six. There are problems with draft three. Draft six is closest to NPOV by far. QuackGuru 19:01, 29 May 2008 (UTC)

I left the 1971 reference in the link because I didn't want to lose it. We can lose it if we want. Nothing wrong with leavig the WHO reference in; it's notable, verifiable, and reliable. It is the only source we have that makes this less US-centric. The question would be why not put it in? -- Dēmatt (chat) 19:52, 29 May 2008 (UTC)

I am not talking about the 1971 ref. I am talking about the sentence mixed in with the ref. I am not talking about the WHO reference. The boring WHO quotes can be summarized. Please delete the boring quotes. QuackGuru 20:03, 29 May 2008 (UTC)

Disagree, Quack. Dematt's version is the better written and, quite frankly, has more respect that you or I around here. I also notice you tend to repeat a lot of the same words as Eubulides. You might want to be careful of not mimicking his approach too much otherwise it begins to look meaty. Cheers. CorticoSpinal (talk) 22:31, 29 May 2008 (UTC)

CorticoSpinal specifically disagreed with parts of Dematt's version. The issue has been resolved with draft 6. QuackGuru is the one of the respected editor here. My edits stick because I edit from a neutral view point. We should begin with the most neutral version. Quite obviously, draft 6 is the BEST. Some of the unimportant details can be deleted from both drafts. QuackGuru 00:18, 30 May 2008 (UTC)

QuackGuru, I'd please ask that you refrain from misrepresenting my views. As I said here, I support Dematt's version for inclusion. Thanks. CorticoSpinal (talk) 00:26, 30 May 2008 (UTC)

There are issues surrounding draft three that have not been fully addressed. I agree with CorticoSpinal's suggestion. The (straight/mixer) part should be in the draft. QuackGuru 00:34, 30 May 2008 (UTC)

You're being vague. What are you disputing specifically? The sources? The tone? The writing? User:CorticoSpinal 03:14, 30 May 2008 (UTC)

I already explained what I am disputing specifically about draft 3. QuackGuru 03:20, 30 May 2008 (UTC)

Sorry, I don't see you explaining much other that your boasting that you're draft is the closest to NPOV by far! and the BEST by far!. That's a surefire, tell-tale sign that it isn't. I really don't think you understand NPOV, QG. You think Edzard Ernst is NPOV. Bluntly, QG your constant objections to non-disputed sources, your continuously disruptive edits which has locked the page 3 straight times in less than 6 weeks, your outright refusal to collaborate and acknowledge consensus, your underhanded tactics (removing users comments, deleting valid concerns of other editors) and your continued civil POV push of Ernsts research on chiropractic and SMT representing the majority viewpoint on the literature when it does not as well as your belief that chiropractic is WP:FRINGE leads me to believe you have not learned any lessons whatsoever with your time editing at Chiropractic. Fyslee and Dematt, whom both have edited together, constructively since 2006, can attest to your sheninigans which have been going on for 2 years. I firmly believe that the 'restrictions/probations' placed on QG aren't working. A topic ban on all chiropractic-related articles (the same nonsense also occurs at Veterinary Chiropractic and Sports chiropractic. I propose a full and transparent inquiry via a RfC/ANI. Is there a 2nd to vote to this motion? CorticoSpinal (talk) 04:35, 30 May 2008 (UTC)

I have already raised specific objections to draft three in this thread. I already explained in this thread about the WHO quotes (boring material and WEIGHT concerns), the lack of the different educational paths of the US system (straight/progressive), and the 1971 sentence is mixed in with the ref. As for Ernst, the peer-reviewed reference is completely reliable. Feel free to take Ernst to the WP:RSN. I understand NPOV very well. QuackGuru 04:52, 30 May 2008 (UTC)

I lost track

Things are happening pretty fast, but I think we are making some headway the old fashioned way (Be bold). I rewrote and re-ordered the education section.. It still needs regulation and licensing info ( or get rid of that in the title). -- Dēmatt (chat) 17:46, 27 May 2008 (UTC)

I read you revised version and found it to be the strongest yet. I agree that it still needs regulation and licensing info. -- Levine2112 ^discuss 17:50, 27 May 2008 (UTC)

Unfortunate, User:Filll has executed another drive-by reversion much akin to that of OrangeMarlin and ScienceApologist. -- Levine2112 ^discuss 17:54, 27 May 2008 (UTC)

There are out-standing issues with the revision as made that are being discussed in a section above. Please comment up there. ScienceApologist (talk) 17:56, 27 May 2008 (UTC)

I think the outstanding issue is that we still have people that want to edit the old fashioned way (be bold) and people who are trying to reach a consensus before editing. This article seems to be eveidence that as long as one person continues to add his own version to the article page and it is edit warred until it is allowed to stick, then we are no longer working on a consensus method. So, I thought we were going back to being bold... in which case, I think I am supposed to offer references, or you are supposed to offer your objection to my references so I can fix it, or you can make minor tweaks to what I did, which is what I did tothe version before that. -- Dēmatt (chat) 18:40, 27 May 2008 (UTC)

Let's focus less on procedure and more on goals. What is it that we want the section to say exactly? That's the discussion that's going on above. ScienceApologist (talk) 18:43, 27 May 2008 (UTC)

Sounds like a plan, maybe we can stick to it this time ;-) -- Dēmatt (chat) 19:18, 27 May 2008 (UTC)

• Neither #Education, Licensing, Regulation: CorticoSpinal Draft nor #Education, Licensing, Regulation: Dematt Draft address the bullets in #Education draft needed work. In particular, both drafts contain several unsourced claims. #Education, licensing, and regulation 1 addresses more of these bullets and is much better for that reason.

Your draft is inferior in both tone, organization and content. Dematt's version fixes this. CorticoSpinal (talk) 00:33, 28 May 2008 (UTC)

Dematt's version may have a nicer tone, but it still has serious sourcing problems which must be fixed before it goes in.

• In rereading #Education, licensing, and regulation 1 I see that it has several problems as well:

• It repeats the 4200 and 2200 and 1000 figures unnecessarily. I suggest removing the 1st two sentences.

More attempts to water down. It's a critical piece of information. It's what's required to earn the chiropractic degree and to be regulated and licensed. It stays. CorticoSpinal (talk) 00:33, 28 May 2008 (UTC)

There is no need to repeat the critical piece of information twice. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• It contains the claim "In some countries a license is required in order to practice." but the source supports this claim only for Canada.

• You cannot call yourself a chiropractor nor practice chiropractic without proper training. The PTs in Brazil and MDs in Germany are trying to get away with this. This is why the WHO developed educational guidelines and this is why we cite them. CorticoSpinal (talk) 00:33, 28 May 2008 (UTC)

• I don't see what this has to do with the problem. The problem is that the claim is unsourced. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• The sentence "To help standardize and ensure quality of chiropractic education and patient safety, in 2005 the World Health Organization published the official guidelines for basic training and safety in chiropractic." is redundant and can be removed.

• It is not redundant and should stay. CorticoSpinal (talk) 00:33, 28 May 2008 (UTC)

• The adjacent sentences contain the relevant information; there's no need to add all that stuff about patient safety, for example. This is the education section, not the safety section. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• The sentence "Typically a 3 year university undergraduate education is required to apply for the chiropractic degree." contains a citation to a source that does not support the claim. The source talks about only one degree program, not about what is "typically" the case.

Typically most students enter the chiropractic programme with an undergrad education. Saying 3 years is the compromise, otherwise I can easily find a source which suggests that 90% are entering with a Bachelors degree. CorticoSpinal (talk) 00:33, 28 May 2008 (UTC)

What is needed is a source that supports the stated claim. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• The sentence "Licensure is granted following successful completion of all state/provincial and national board exams so long as the DC maintains malpractice insurance.", again, is not supported by the source. The source talks only about Canada.

• This is the case for every jurisdiction where chiropractic is regulated. Are you dispute this fact? CorticoSpinal (talk) 00:33, 28 May 2008 (UTC)

• Every country that regulates chiropractic has state/provincial exams? Really? I'm skeptical. The source does not support this claim. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• "Chiropractic medicine is regulated in Canada by provincial statute. Regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency." These two sentences should be separated by ";" not "." to make it clearer that the 2nd sentence is only about Canada as well.
• "Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the USA and 2 in Canada," The cited source does not mention Canada.
• "and an estimated 70,000 chiropractors in the USA, 6500 in Canada, 2500 in Australia, 2,381 in the UK, and smaller numbers in about 80 other countries." The cited web page does not contain these estimates.

• Many of the above problems are shared by the other drafts, but the other drafts have several other issues (see #Education draft needed work) and are inferior to #Education, licensing, and regulation 1 as things stand now.

Eubulides (talk) 20:52, 27 May 2008 (UTC)

To be blunt, your draft has several defiencies as already pointed out by Levine2112 and myself. Why aren't you collaborating with Dematt's draft is a compromise? It's far superior to your draft and reads better too.

I disagree that it's far superior, but I'm willing to help Dematt come up with something better. A lot of work will be needed. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• Draft 1 is poorly constructed and not easy to read, whereas both CorticoSpinal's and Dematt's drafts are well-crafted and organized. I would suggest starting with Dematt's version as a base and working out a consensus version from there. For instance, where as Draft 1 has the problematic statement "Typically a 3 year university...", Dematt's goes a step further and qualifies it to "North America". Make some specific suggestion on Dematt's draft and let's take it from there. -- Levine2112 ^discuss 21:27, 27 May 2008 (UTC)

• Please see the bullets in #Education draft needed work for specific suggestions. Several of those suggestions have not been acted on in Dematt's draft. There is still a serious copyright violation and several serious citation problems, among other things. Eubulides (talk) 21:56, 27 May 2008 (UTC)

Please see bullets to see how Eubulides is attempting to stonewall and obstruct the inclusion relevant cited material. There is no serious copyright violation, stop suggesting there is one. You are dealing with experienced editors here who would know if this was the case. And if there are concerns toss in quotation marks. Not surprisingly the "copyvio" is the various degrees granted. Interesting how that seems to work, eh? Cherry picking again? CorticoSpinal (talk) 00:33, 28 May 2008 (UTC)

I dunno, copying a string of several sentences verbatim without quote marks sure looks like plagiarism to me. There is no need for such an extensive quote, however; the relevant material can be summarized. Eubulides (talk) 09:05, 28 May 2008 (UTC)

I think it's great that chiropractic educational standards are improving. There is still a significant difference when one compares them to standards for a medical education. "Perhaps the best summation of current pre-entrance requirements among professional doctoral degree programs comes from Todd Doxey. In a 1997 study, chiropractic ranked dead last when evaluated on the following four outcome measures: minimum number of semester hours; completion of baccalaureate degree; minimum grade point average; and cumulative grade point average. The study acknowledges that chiropractic colleges require a C average for matriculation, that the average cumulative grade point average at matriculation was 2.90, and that almost all medical school matriculants have a B or better grade point average-on average, 3.56."[66] These facts are notable, but I don't think we want to go there? If we start talking about education, a comparison to other professions might be interesting.--—CynRN ^(Talk) 03:39, 28 May 2008 (UTC)

This may be a slippery slope, but if you want to include the stats we can so long as we atrribute it properly (US?), make sure it hasn't been supplanted by something more recent and we can use the research which demonstrates chiropractic students superior skills at MSK diagnosis and treatment as well as how they fared comparatively well to medical students in other clinical and basic science areas (there is research demonstrating this too). I'd also like note that in Canada a minimum of B is required to enter DC school and the average entering class at the Ontario and Quebec schools is between 3.1-3.5. I won't let inferior model used at some US schools soil it for majority of chiro schools outside it. CorticoSpinal (talk) 05:41, 28 May 2008 (UTC)

Maybe the education stuff should be at the Chiropractic education article? It could be a slippery slope. I don't doubt you on the higher GPA's for Canadian schools. In the U.S., schools only require a 2.5 GPA. "Clearly, most chiropractic students are less academically talented than their medical counterparts. This is an obvious and noncontentious fact."[67]--—CynRN ^(Talk) 08:13, 28 May 2008 (UTC)

I don't think it is a fact that US schools only require a 2.5 GPA. The CCE accreditation requires only a 2.5 GPA, however depending on the quality of students attracted to the school, the school may indeed have more stringent acceptance requirements than the CCE minimum. DigitalC (talk) 04:31, 30 May 2008 (UTC)

These are the actual requirements for matriculation into an accredited program through CCE. I wouldn't mind if we put them in. I did mine through Indiana University (Go Hoosiers!) alongside the premed students. I didn't do too bad, considering that only 30% of the premed students made it through at all ;-) -- Dēmatt (chat) 17:52, 28 May 2008 (UTC)

a. All matriculants must furnish proof of having earned a minimum of 90 semester hour credits of appropriate pre-professional education courses at an institution or institutions accredited by a nationally recognized agency. A national accrediting agency is an agency recognized by the Secretary of the US Department of Education.

Included in these credits must be a minimum of 48 semester hour credits in the course areas noted in Section 2.III.H.1.b (below). In addition, all matriculants must have earned a cumulative grade point average of at least 2.50 on a scale of 4.00 for the courses listed in Section 2.III.H.1.b, and for the required 90 semester hours. Quarter hour credits may be converted to equivalent semester hour credits. In situations in which one or more courses have been repeated with equivalent courses, the most recent grade(s) may be used for grade point average computation and the earlier grade(s) may be disregarded.

b. All matriculants must present a minimum of 48 semester hours' credit (or the quarter-hour credit equivalents), distributed as follows:

• English Language Skills*..............................6 semester hours
• Psychology...................................................3 semester hours
• Social Sciences or Humanities.....................15 semester hours
• Biological Sciences**....................................6 semester hours
• Chemistry***.................................................12 semester hours
• Physics and related studies****....................6 semester hours

In each of the six distribution areas, no grades below 2.00 on a 4.00 scale may be accepted. In each of the six distribution areas, if more than one course is taken to fulfill the requirement, the course contents must be unduplicated.

• English Language Skills requirement includes English composition, Speech, or English literature coursework.
• The Biological Sciences requirement must include pertinent laboratory experiences that cover the range of material presented in the didactic portions of the course(s).
• The chemistry requirement may be met with at least three semester hours of general or inorganic chemistry and at least six hours of organic chemistry and/or biochemistry courses with unduplicated content. At least six semester hours of the chemistry courses must include pertinent related laboratory experiences, which cover the range of material presented in the didactic portions of the courses.
• The physics requirement may be met with either one or more physics courses with unduplicated content (of which one must include a pertinent related laboratory that covers the range of material presented in the didactic portions of the course), or three semester hours in physics (with laboratory) and three semester hours in either biomechanics, kinesiology, statistics, or exercise physiology.

even more controversial edits

This controversial change added controversial material and moved text out of the cost-benefit section. I do not see any consensus for this. QuackGuru 17:56, 27 May 2008 (UTC)

There is no consensus for the version from which it was changed. In essence, the edits that made and continue to restore that version are controversial. At least the logic behind grouping "Risk vs. Benefit" with Safety actually makes sense; whereas putting a statement about Risk vs. Benefit in the Cost-Benefit makes little to no sense. -- Levine2112 ^discuss 18:00, 27 May 2008 (UTC)

It is inappropriate to claim anything has consensus at this point. False claims of consensus should be stopped. We have page protection now, so we can discuss what should and should not be changed after protection is removed on the 30th of May. ScienceApologist (talk) 18:04, 27 May 2008 (UTC)

This controversial change moved material out of the cost-benefit section without any consensus. QuackGuru 18:04, 27 May 2008 (UTC)

QuackGuru, please desist from calling every single edit controversial that does not fit with your POV. Critique the source and stop reverting. Your deletionist editing style and red herring attacks are pushing this over the edge. Please stop. Thanks. CorticoSpinal (talk) 18:44, 27 May 2008 (UTC)

Dispute

Please discuss the edits below this line. Thanks, PeterSymonds (talk) 18:00, 27 May 2008 (UTC)

Driveby Reverts

Since January 08 I have noticed important trends used by the anti-chiropractic editors here. It would be important to list those who have disrupted progression of the article by doing "drive by" or blind reverts. The overwhelming majority of these users do not participate in the Talk discussions. So, in essence, they are reverting blindly. All the aforementioned users revert to material exclusively to drafts by QuackGuru or Eubulides. So, these users are potentially defacto meat puppets or zombie editors at Chiropractic who potentially game the system by engaging in covert edit wars to try and bulldoze edits that fit the anti-chiropractic agenda. These include deleting sourced material that meets inclusion criteria.

For example, I made 5 edits yesterday, all of which were reverted within minutes by either QuackGuru, ScienceApologist or Orangemarlin. Essentially, I cannot edit this article as every one of my edits is being censored despite the fact that I had used reliable sources and had added material that conforms to wikipedia NPOV.

So, we have a situation here whereby the anti-chiropractic editors and the zombie sleeper crew bulldoze edits they favour that are being actively discussed on Talk (i.e. consensus has yet to be achieved) and delete material that they do not like. It's a double standard. It's uncivil. It's got to stop. We need an investigation into this matter. CorticoSpinal (talk) 20:24, 27 May 2008 (UTC)

• I also dislike the widespread use of reverts and have protested against them (see #Several important changes were never discussed and #Mass edits made by QuackGuru, which complain about blind reverts done by skeptics), as has QuackGuru (see #reference improvements, which complains about blind reverts done by proponents of chiropractic). Blind reverts are being done by both sides, and we should strive to avoid them.
• That being said, the edits made yesterday were neither NPOV nor well-sourced. They had problems in both areas, as discussed in #Education draft needed work above. It's much better to draft a new version on the talk page and then discuss it, rather than simply install it without discussion. Doing that will help to avoid revert wars in the future.

Eubulides (talk) 20:52, 27 May 2008 (UTC)

This is patently untrue. Prove to me the edits were NPOV. Even Fyslee agreed with focused scope edit and he's a skeptic. Blind reverts are NOT being done by both sides. Prove to me that this is happening both ways, blindly. Editors who participate at Talk on an ongoing basis are not blindly doing anything. You are misleading others yet again. It might be time for a RfC, I have enough evidence now of your repeated misleading statements and your refusal to acknowledge concerns. This is uncivil. You don't walk on water, Eubulides... CorticoSpinal (talk) 23:10, 27 May 2008 (UTC)

• Fyslee did not agree with the terminology "focused scope". It is nonstandard terminology used in only one source. It is not "well established".
• NPOVness is not something that admits to formal proof. However, there were NPOV problems with the edits: please see #Disruptive editing (blind reversion) by Orangemarlin yet again. and search for "POV".
• Certainly blind reverts were done by both sides.

• Here is one by ScienceApologist (a critic of chiropractic) which removed this harmless reference fix (among other harmless fixes).
• Here is one by Levine2112 (a proponent of chiropractic) which removed the reference improvements from this fix.

Eubulides (talk) 09:05, 28 May 2008 (UTC)

Does anyone have a policy or guideline reference for "blind reverts"? ScienceApologist (talk) 21:34, 27 May 2008 (UTC)

Yes, of course. And also here. Now that you know that these policies/guidelines exist and that we are dealing with a controversial article, will you please abide by our agreement to discuss all major changes first and work to establish a consensus? -- Levine2112 ^discuss 21:40, 27 May 2008 (UTC)

Those policies/guidelines do not discuss blind reverts. They do discuss the problem of making major changes without discussion, saying these can lead to reverts; but that is not the same thing as discussing blind reverts per se. Help:Reverting does suggest to "reword, rather than reverting", which is good advice, but it is neither policy nor guideline. Eubulides (talk) 21:56, 27 May 2008 (UTC)

So you are endorsing the blind reversions by Filll, Orangemarlin and ScienceApologist? CorticoSpinal (talk) 23:06, 27 May 2008 (UTC)

I would say that "the problem of making major changes without discussion" is the very definition of "blind reverting". -- Levine2112 ^discuss 00:19, 28 May 2008 (UTC)

I would encourage those who like to use this terminology to try to get it included in policy/guidelines somewhere before continuing to use it. ScienceApologist (talk) 22:00, 27 May 2008 (UTC)

Either way, its disruptive. SA, you're treading on thin ice. You have conditions on your probation. You've broken several of them already in the last 24 hrs here at Chiropractic including edit warring, blind reverting, harrassing editors with spam on their talk page, claiming false consensus. Either way it's unacceptable. CorticoSpinal (talk) 23:06, 27 May 2008 (UTC)

Note. Arguments about whether or not "blind reverting", as so phrased, is prohibited by policy are besides the point and unhelful. The behavior itself is prohibited by the edit warring policy in the very first sentence of the lede: "Edit warring occurs when individual editors or groups of editors repeatedly revert content edits to a page or subject area." Further disruption of this sort from either "side" will not be tolerated. If you are reverting or be reverted, I strongly recommend taking the advice of WP:BRD. I also strongly recommend that the disputing parties take the time afforded by the protection to focus on discussion and draft building, rather than arguing (somewhat disruptively) about minutiae, exact wording or blame assignment. Vassyana (talk) 07:38, 28 May 2008 (UTC)

The behavior itself is prohibited by the edit warring policy in the very first sentence of the lede: "Edit warring occurs when individual editors or groups of editors repeatedly revert content edits to a page or subject area.": This isn't quite correct: some people have made only one revert and have been accused of "blind reverting". In any case, the gist of what you are saying is fine, but there is a tendency for some people to take certain parts of WP:BRD to heart and not others. For example, they think that they should revert any revert when they disagree with it without talking about it. Others find this behavior distressing and revert the revert of the revert with the excuse that there was no discussion. The point is that if people would simply be less accusatory and more willing to discuss matters, things would settle down almost immediately. So I move to table all mention of specific editing patterns on the article talk pages and simply stick to discussing what content is agreeable and what content isn't. ScienceApologist (talk) 21:57, 28 May 2008 (UTC)

Chiropractic is Fringe

I would like to see the pro-chiropractic editors come to some sort of consensus and resolution with the mainstream editors and proscience editors amd mainstream medicine editors on this page FIRST. Then, if an edit is acceptable to your "adversaries" or those on the other side, then you can have them make it for you. Otherwise, given the disasterous condition that this article became without sufficient mainstream attention, this entire article should be flushed down the toilet and we start from scratch. This is not an advertising venue for pseudoscience and voodoo. Sorry. You can go to other wikis for that. Not here. This is an NPOV resource, which means "in proportion to their prominence". And by any measure that is reasonable among the experts in the field, chiropractic is a very FRINGE treatment.

This does not mean it is right or wrong. Just that it is not widely accepted at the moment among the mainstream experts in the field. And we just reflect the view of the mainstream experts. Sorry.--Filll (talk | wpc) 00:26, 28 May 2008 (UTC)

Filll, your comments are unhelpful. I do think there is some POV guarding here of almost anything negative to the profession. Be that as it may, chiropractic is more complex than 'fringe'. I suspect there are many chiropractors way over the edge on the voodoo scale. More 'quacky', on the whole, than other health professionals. On the other hand, studies and reviews of studies are giving support, if not overwhelmingly, to chiropractic treatment for back pain and some other MSK disorders. I know that a percentage of chiropractors are pro-science and stay away from fringe therapies.

And I agree with you that additions to this article, with it's turbulent history, need to be worked out on the talk page or all Hell will break loose!--—CynRN ^(Talk) 02:51, 28 May 2008 (UTC)

Despite our disagreements; CynRN is the ideal type of editor who objectively looks at the evidence and the context in which it is presented. She makes sensible recommendations is collaborative and can compromise. She too, being a RN is "mainstream". The fact that the MDs here are trying to marginalize chiropractic at every opportunity and trying to subvert the general mainstream consensus on chiropractic care for spinal pain syndromes and other neuromusculoskeletal disorders. This is done by claiming the conclusions of Ernst' reviews (which has been rebuked, invalidated, cited for severe methodological flaws no less) represent the mainstream consensus when it clearly does not. Briefly, Ernsts claims that SMT isn't cost-effective and adds costs goes against the bulk of the research. Ernsts claims that the risks outweighs the benefits for spinal manipulation goes against the bulk of the literature/ Ernst's claims that manipulation is unsafe goes against the bulk of the literature. Ernst' claims that chiropractic care for LBP has not been 'proven beyond a reasonable doubt" goes against the bulk of the literature (not to mention the absolutely bogus-ness of the demand). So, in short, flawed, biased reviews whose conclusions are are directly opposed by the majority of the literature, 3rd parties, tertiary sources, government reviews, is being presented as "mainstream" opinion and is being used to subvert the actually efficacy, effectiveness and safety of SMT as a modality and chiropractic care as whole. I hope some neutral admin comes by and actually see's the Ernst Civil POV push happening here and how a sleeper cell of zombie"mainstream" (aka anti-chiropractic) editors are on call to railroad in these changes (all the while calling all chiropractic fringe instead of delineating the arguably fringe element of chiropractic (using SMT for select systemic disorders). CorticoSpinal (talk) 04:32, 28 May 2008 (UTC)

• I agree that CynRN's remarks have been quite helpful, and are a refreshing alternative to the sort of contentious comments that are all too common on this talk page.
• As for the comments about Ernst, I don't see anything new there. Perhaps we should set up a FAQ for this talk page, to cover points like that which come up repeatedly? That would save us all some work; we could just say "Please see FAQ #12" instead of relaunching a long discussion about Ernst.

Eubulides (talk) 21:19, 28 May 2008 (UTC)

Well, I came here expecting that things would be a little less contentious. Why would I expect this? Well, because before coming over here, I went and looked it up at NIH [68]. It says that 20% of Americans have used it. It's covered by health insurance extensively. It's regulated heavily by the state. Then I come here, and I see "This is not an advertising venue for pseudoscience and voodoo. Sorry. You can go to other wikis for that. Not here..... And by any measure that is reasonable among the experts in the field, chiropractic is a very FRINGE treatment... " But what's fringe about 20% of people having received chiro? Chiro is not fringe by any meaningful definition of the word. A religion which had 20% of the population would not be fringe.

Yet, it isn't fully mainstream either. "The medical establishment has not yet fully accepted chiropractic as a mainstream form of care." [69] Thus, while chiro is nearly mainstream it is not fully there yet. At any rate, comments such as "This is not an advertising venue for pseudoscience and voodoo" are completely unjustified, and edits based on such an extraordinarily strong POV should be resisted .

Now, at Homeopathy I suggested that all editors, or at least the ones whose POV was not too strong, get behind an article which basically took on the general tone and the POV balance of the most mainstream of mainstream sources, the NIH (which is a good source, also, for finding the scientific consensus). This suggestion was of course attacked as some way promoting pseudoscience, but I believe that because no one accepted this general principle Homeopathy went down hill from there. Not that the article is bad, but users are banned. The principle can be formulated as take the most mainstream sources which most reflect the scientific consensus and work from there. Make sure the tone of the article reflects these sources just as much as it's actual factual content. Don't compromise on these principles, because they are the essence of NPOV, and NPOV is the non-negotiable basis of Wikipedia. However, be willing to compromise on issues which don't really matter too much, that is, which don't violate NPOV. Strive to say nice things even about those who have been really nasty to you, if they do something good. Take it to ArbCom if you have to. At all times, remain civil. Never edit war. Use every dispute resolution mechanism available: request a comment, informal mediation, formal mediation, ArbCom. Gather your most mainstream sources, and just keep strictly to them. On chiropractic, you are not going to have any problem with the article sounding terribly negative or positive, I believe. If you do this, you will be treated well by WP. If you don't, if you go the way of Homeopathy, you may as well give up right now.

Comments like these (section below) are not helping the case for an NPOV article "Otherwise, Filll has just discredited himself with a stupid comment that has has no validity whatsoever." and "And you say you represent the mainstream? Lol!" Don't call Filll stupid, and don't laugh at him. Be above all that. Push your mainstream sources instead.

Don't get caught up in endless debates, which I'm guessing this long talk page reflects. Go through the process of dispute resolution. If you follow the principles laid out above, you'll be fine. I'm talking to everyone here. Anyone who doesn't like it is by definition a POV pusher. ——Martin^phi ☎ Ψ Φ—— 19:04, 30 May 2008 (UTC)

Thanks Martinphi. I agree 100% with your assessment and your advice. I would love to invite you to stick around and help us through this little dark time if you have the time! Currently we are working to decide how best to approach the chiropractic education section, without giving you too much information, would you consider giving us some advice on any of the 6 draft versions?-- Dēmatt (chat) 19:25, 30 May 2008 (UTC)

Well, I responded because of the issues of FRINGE and possible POV problems in the article. I read the first two of the sections you mention, and don't see that they are controversial. Are there in fact some sort of POV problems that people see? The second one was much better written than the first. ——Martin^phi ☎ Ψ Φ—— 05:33, 31 May 2008 (UTC)

Alas, it appears now that the two active versions are #Education, Licensing, Regulation 3 and #Comments on Education, licensing, and regulation 6. There aren't that many POV problems with these drafts; it's more just making sure that the claims are sourced, and that that part of the article doesn't get too long (it's supposed to be just a summary of Chiropractic education). Eubulides (talk) 07:56, 31 May 2008 (UTC)

• I agree with most of Martinphi's remarks.
• However, the "20% of people having received chiro" argument is suspect. Many fringe theories are accepted by a sizeable proportion of the population. About 1/4 of Europe uses homeopathy, but homeopathy is nevertheless fringe science by any reasonable standard. About 1/3 of Americans believe in astrology, but astrology is fringe as well. One cannot decide whether something is fringe simply by counting the number of people who believe it.
• We have tried informal mediation, which did not work. I expect formal mediation is next.
• The "6 draft versions" is pretty discouraging. The 6 drafts is greater than the number of editors involved? Can you give Martinphi some advice as to which of those drafts are currently viable? Surely they are not all seriously being considered.

Eubulides (talk) 01:08, 31 May 2008 (UTC)

Chiropractic is Fringe: The rebuttal

Clearly Filll is not up to date on his research nor is applying evidence-based principles. I know that already because Filll endorsed a 1966 disparaging quote on Chiropractic. Filll also makes several misrepresentations here that need to be debunked:

"pro-chiropractic editors come to some sort of consensus and resolution with the mainstream editors and proscience editors amd mainstream medicine editors on this page FIRST."

• Filll implies that "pro" chiropractic editors need to come to resolution with proscience editors. Filll implies that chiropractic and chiropractors are not scientific. Filll is attempting to straw man pro-chiropractic editors claiming they are neither scientific nor mainstream. The literature says otherwise.

"This is not an advertising venue for pseudoscience and voodoo. Sorry."

• If Filll would provide an example that Chiropractic is endorsing pseudoscience or voodoo that would be helpful. Also, if Filll coould provide evidence that mainstream chiropractic is pseudoscientific that would be helpful. Otherwise, Filll has just discredited himself with a stupid comment that has has no validity whatsoever.

"And by any measure that is reasonable among the experts in the field, chiropractic is a very FRINGE treatment."

• If Filll could provide any evidence of any measure that experts in the field suggest that chiropractic (SMT?) is fringe treatment that would be helpful. Because the vast majority of the literature disagrees with you. And you say you represent the mainstream? Lol! CorticoSpinal (talk) 00:45, 28 May 2008 (UTC)

Chiropractic is a FRINGE alternative medical practice by many different measures. First, it is mainly prevalent in the US, and to a lesser extent in Canada and Australia. Although it is present in other countries, it is far less common in these. Even in the US, where it is most common, there are only 53,000 chiropracters [70] compared to 633,000 physicians and surgeons [71]. When considered on a worldwide basis, this is a very very minor treatment option. Even in the US, over their entire lives, only 1/5 of the US population has ever had an encounter with a chiropracter. And this in spite of their much cheaper cost and the problems with US healthcare costs. On a dollar basis, chiropractic is minor indeed.

Looking at the Palmer theory, it is clearly complete nonsense. He claimed that 95% of all disease was due to "subluxations" which have been shown to not even exist. Even using a witch doctor word like "subluxation" in the way we do in this article really tells me this article is in terrible shape.

When you can show me that more than half of the PhDs and MDs who work at the NIH have been fired and replaced by DCs, and more than half of the PhDs and MDs who work at the CDC have been fired and replaced by DCs, then I will agree with you that Chiropractic is mainstream. However, one has to go a ways before that will happen I suspect.

So I am sorry, I have to beg to differ, but the strong impression I have is that chiropractic falls in the category of "FRINGE". I will grant you that there are a couple of studies that show it has some value in very isolated very very very narrow circumstances in lower back pain problems, although whether this is greater than a placebo is debatable.--Filll (talk | wpc) 20:20, 28 May 2008 (UTC)

• Lets play with your numbers to see if they are a valid argument. Do you consider optometry "fringe"? There are roughly 33,000 optometrists in the US (BLS data), and 53,000 Chiropractors (BLS data). There are 15 Optometry schools in the US, 2 in Canada, and 3 in Australia. There are 18 Chiropractic colleges in the US, 2 in Canada, and 3 in Australia. You say that in the "US, over their entire lives only 1/5 of the US population" [sampled] has seen a Chiropractor. In the province of Alberta, 1/5 of the population (sampled) had seen a Chiropractor within the last year. As for Palmer theory, you are now talking about a minority of Chiropractors. As far as I know, subluxation, as a hypothetical construct has not been "shown to not even exist", however I know that many Chiropractors reject the use of the word subluxation. DigitalC (talk) 01:09, 29 May 2008 (UTC)

• If one may offer a more succinct arguement: There is what is called "mainstream medicine". Chiropractic is not a part of it. What is not mainstream, is fringe. QED. Jefffire (talk) 20:28, 28 May 2008 (UTC)

It's not that simple. Some elements of chiropractic are fringe: e.g., using spinal adjustments to treat autism, something for which there is zero scientific evidence). Some elements are not fringe, even if there is controversy about them: e.g., using SMT to treat lower back pain, as even Ernst, a sharp critic, says that this may help in a subgroup of patients (Ernst 2008, PMID 18280103). It is certainly true that the medical establishment has not yet fully accepted chiropractic as mainstream (e.g., see Meeker & Haldeman 2002, PMID 11827498), so in that sense it is not mainstream. But this does not mean that chiropractic is entirely fringe either. It is a bit of a hybrid: a profession at the crossroads, as it were. Eubulides (talk) 21:19, 28 May 2008 (UTC)

Essentially, what Filll and Jefffire have given us are their own fringe ideas. Allow me to demonstrate by us looking at some evidence:

• Once fringe, chiropractic care now gets mainstream acceptance
• Chiropractic Care Moving From Fringe to Mainstream
• chiropractic joins the medical mainstream
• Chiropractic itself can no longer be considered a fringe therapy
• Mainstream Makes Adjustments
• Once on the fringe, chiropractic joins the medical mainstream

Accordingly it does seem that the popular belief nowadays is that chiropractic - though once considered fringe - is not not considered as such by the mainstream based on the growing scientific support. After all, what is fringe? Our own Wikipedia defines fringe as ideas viewed as marginal or extremist by the mainstream. Well, since the mainstream apparently doesn't think chiropractic is fringe, the only thing fringe around here are the ideas of those still maintaining that chiropractic is still fringe! ;-) -- Levine2112 ^discuss 21:39, 28 May 2008 (UTC)

I think that there are some WP:REDFLAG issues with the "evidence" you cite. Many of them are obviously chiropractic websites with the goal of making themselves look more mainstream than they are. Others are mainstream news articles which are notoriously bad for determining what is the opinion of the experts. Why not get some references from the organizations of medical doctors and scientists who are able to best evaluate the subject to back up your claims? ScienceApologist (talk) 22:09, 28 May 2008 (UTC)

Incorrect. And your "one bad apple spoils the bunch" tactics don't fly here. -- Levine2112 ^discuss 00:48, 29 May 2008 (UTC)

How about the only apple in the bunch of lemons is spoiled? ScienceApologist (talk) 08:41, 31 May 2008 (UTC)

Please look closer. We have a medical journal in Australia, mainstream newspapers, magazine. The one chiropractic source is actually just a reprint of the New York Daily News article. No ref flags. Sorry, that argument holds no water. The sources above demonstrate that the mainstream media and science no longer consider chiropractic "fringe". Thus, the belief that chiropractic is fringe is ironically a fringe belief. -- Levine2112 ^discuss 22:30, 28 May 2008 (UTC)

The article in MJA contends that chiropractic is not mainstream medicine, rather it claims that because a large minority uses chiropractic it has to be examined closely. The no longer considered "fringe" comment is a red herring extraordinaire: googled for and ripped from the context of the actual article [72]. You obviously didn't read WP:REDFLAG carefully. Get some better sources and stop misconstruing the ones you do find. ScienceApologist (talk) 22:41, 28 May 2008 (UTC)

Incorrect. And your "one bad apple spoils the bunch" tactics don't fly here. -- Levine2112 ^discuss 00:48, 29 May 2008 (UTC)

No. You've established that chiropractic true believers think that chiropractic is mainstream and not fringe. That's quite different. ScienceApologist (talk) 19:38, 29 May 2008 (UTC)

The 'true believer' label is a red-herring and straw man attack. We could apply the same logic and call ScienceApologist a 'true denier' of chiropractic. It's the same thing. Most importantly, It has nothing to do with the the topic at hand: Namely, there is strong evidence, from high impact mainstream, peer-reviewed journals that supports the claim that chiropractic is not fringe but rather mainstream health care in 2008. (Or far closer to it in a sliding scale context than it is to fringe and comparisons to 'alien abductions Flat Earth, Creationism, AIDS Denialism, and other nonsense. There is also evidence of this in verifiable, reliable and reputable lay sources such as the New York Times and many other distinguished and notable papers. You have presented nothing that supports your claim that chiropractic is fringe, nor have you produced any evidence that disputes the sources presented. In short, you have produced nothing but hot air on this topic. You have, however presented, rather tendentiously I might add, your personal opinion that chiropractic is fringe and a pseudoscience. Given your track record, SA, I'd be careful to how much you civilly push your POV. CorticoSpinal (talk) 03:54, 30 May 2008 (UTC)

Come on now guys. The article, to be NPOV, must contain both the "true believer" POV, and the "true denier" POV. Get over it and get on with including both POV. Be inclusionists (builders of the encyclopedia) rather than deletionists (destroyers of the encyclopedia). Just use good sources that present both POV in a representative manner. Try writing for the enemy for a change, or at least enable the opposing POV's inclusion, rather than preventing its inclusion. -- Fyslee / talk 04:28, 30 May 2008 (UTC)

No one is arguing that we shouldn't report true believer POVs in here: that's what the article is ostensibly about anyway. We are only arguing that we should simply characterize it as such. The claim that "true denier" POV exists can also be attributed to true believers. However, there is a group of people hoping to write the entire article from a true-believer perspective that heralds chiropractic as the new fountain of youth that will invigorate all of medicine. This kind of ridiculous posturing needs to be resisted. ScienceApologist (talk) 08:41, 31 May 2008 (UTC)

Thank-you both for responding. First, Jefffire, your argument is flawed. It is the fallacy of a false dichotomy. Next, onto Filll. Unfortunately, your argument is based on a very narrow synthesis of literature which essentially leads tooriginal research that you are presenting here. Perhaps if we examined Fillls argument a bit closer in detail we can point out the deficits in the arguments being raised.

"First, it is mainly prevalent in the US, and to a lesser extent in Canada and Australia. Although it is present in other countries, it is far less common in these."

So, it is firmly established in North America, including the world's only superpower, is also established firmly in the UK, developing nicely in Europe and is in entrenched in public universities outside North America. Would the World Health Organization bother to develop safety and training guidelines if it were fringe? Also, is your opinion, consistent with the opinion of the expert researchers on the topic? Well, I won't cite a paper written by a DC, but the following passage is from a review by an MD.

“ Even to call chiropractic "alternative" is problematic; in many ways, it is distinctly mainstream. Facts such as the following attest to its status and success: Chiropractic is licensed in all 50 states. An estimated 1 of 3 persons with lower back pain is treated by chiropractors.1 In 1988 (the latest year with reliable statistics), between $2.42 and $4 billion3 was spent on chiropractic care, and in 1990, 160 million office visits were made to chiropractors.4 Since 1972, Medicare has reimbursed patients for chiropractic treatments, and these treatments are covered as well by most major insurance companies. In 1994, the Agency for Health Care Policy and Research removed much of the onus of marginality from chiropractic by declaring that spinal manipulation can alleviate low back pain.5 In addition, the profession is growing: the number of chiropractors in the United States—now at 50,000—is expected to double by 2010 (whereas the number of physicians is expected to increase by only 16%).6 ”

There's more Filll, but I'm not trying to make you look stupid. I'm just seeing if your position is dogmatic skepticism or rational skepticism.

"Even in the US, over their entire lives, only 1/5 of the US population has ever had an encounter with a chiropracter. And this in spite of their much cheaper cost and the problems with US healthcare costs."

Do you think this has to do with the fact that the American Medical Association was found guilty of an anti-trust and anti-competition lawsuit by the United States Supreme Court and that the AMA's policy until 1990 was to "contain and eliminate" chiropractic? and may have resumed its practices again?

"On a dollar basis, chiropractic is minor indeed."

• Thanks for sharing your opinion. Unfortunately, Wikipedia requires reliable sources to support the claims made. Fortunately this has been addressed, in part, by Kaptchuk (1998).

""Looking at the Palmer theory, it is clearly complete nonsense. He claimed that 95% of all disease was due to "subluxations" which have been shown to not even exist. Even using a witch doctor word like "subluxation" in the way we do in this article really tells me this article is in terrible shape.""

Out of curiosity, Filll, could you provide evidence that

1. Palmer Theory is being used today by the mainstream of the profession
2. Subluxations/joint dysfunction (manipulable lesion) has been found not to exist and
3. That the use of the word subluxation proves that the article is in terrible shape.

Here's a bit of facts for you to chew on. First, your assessment is completely invalid, unreliable and dated. First, straights are the minority. Let me repeat. Straight chiropractors represent the minority viewpoint. Every single school outside the USA except 1 (New Zealand) teaches a mixer/integrative/evidence-based curriculum. That's 16 mixers program to 1 straight. Taken as a whole, there are 35 accredited schools of chiropractic globally, only 8 of which teach the straight model, 7 of which are located in the USA. Wikipedia policies are that we represent the majority view and does so in a global manner. Your asinine comments are not congruent with Wikipedia policies in this regard.

So, what exactly is "Palmer Theory". Well, there really is none. The concept of subluxation (joint dysfunction) has been revised and modernized throughout the years. You see, you're basing your views on a 100 year old concept and like most uninformed individuals, perpetuate stereotypes and falsehoods. Let's read an exerpt of the latest of "chiropractic theory" from DeVocht (2006) from Palmer School of Chiropractic:

“ Chiropractic is based on the theory that intervertebral joints can become stabilized in some aberrant situation that may lead to biomechanical and/or neurologic alterations. It originally was thought that it was a simple matter of a vertebra getting out of alignment relative to the adjacent vertebrae and consequently applying pressure on the spinal nerve root as it exited the spine through the intervertebral foramen. The subluxation, as this condition has been termed, was thought to sometimes cause the impediment of action potentials as they passed through that nerve. This “foot on the hose” concept provides an easily visualized explanation as to how subluxations could cause any of a myriad of symptoms in whatever region that nerve happened to supply.

As research began to be done, it became apparent that the mechanisms involved are not as straightforward as originally thought. Nevertheless, the general notion of some sort of deleterious lesion involving the spine and/or adjacent structures with far reaching implications that can be affected by spinal manipulation can be explained by other mechanisms. For example, it has been theorized that edema or inflammation of tissues in or around the inter-vertebral foramen sometimes could cause enough pressure on the spinal nerve roots to interfere with nerve impulses passing through them.26 Some have hypothesized that rotational misalignment of the cervical vertebrae could twist the dura mater causing the dentate ligaments to pull directly on the spinal cord.20 One other theory, of many, is that spinal kinematics can be impaired by localized joint fixations of various etiologies.36 That is why some chiropractic approaches involve manual flexion of the spine- the clinicians are looking for specific areas of restricted motion.

Because the exact mechanisms are not known does not negate the validity and usefulness of the general concept of a subluxation. The term, which is ingrained in the profession, is somewhat of a misnomer because it no longer seems that there is always an abnormal displacement of one vertebra relative to the others. The entire practice of spinal manipulation is based on the concept that there must be some kind of lesion in the spine that responds favorably to manipulation. Therefore, other more accurately descriptive names have been suggested, such as manipulatable lesion. There is no reason to perform spinal manipulation if one is not convinced that there is some kind of lesion present that would respond to manipulation. Although the specific mechanisms involved are not known, it has been empirically shown that there are specific indicators that typically are associated with a spinal lesion that is likely to respond to manipulation (a subluxation) such as joint restriction, muscle spasm, and/or pain.

”

"When you can show me that more than half of the PhDs and MDs who work at the NIH have been fired and replaced by DCs, and more than half of the PhDs and MDs who work at the CDC have been fired and replaced by DCs, then I will agree with you that Chiropractic is mainstream. However, one has to go a ways before that will happen I suspect."

There's a lot wrong with this argument. First, it is an appeal to authority fallacy. In addition to being appeal to belief fallacy as well as an appeal to ridicule. In fact there are so many logical fallacies in your arguments that you really to need to read this. It's hard to have a meaningful and productive conversation with someone when their arguments are so flawed and unsound. The CDC comment is a red-herring. DCs are primarily for MSK disorders. So, that's not a valid comparison nor statement.

"So I am sorry, I have to beg to differ, but the strong impression I have is that chiropractic falls in the category of "FRINGE". I will grant you that there are a couple of studies that show it has some value in very isolated very very very narrow circumstances in lower back pain problems, although whether this is greater than a placebo is debatable.--Filll (talk | wpc) 20:20, 28 May 2008 (UTC)"

Just to be clear, you think chiropractic care for LBP is less effective than placebo? That is your official position on this stance? (drools....)

So, considering that your arguments fail the litmus test, perhaps you can bring new arguments (not riddled with fallacies either) that I can debunk. It's been a pleasure providing you with some (badly needed) continuing education. Also, your opinions are not congruent with the majority on SMT and chiropractic care. Please refrain from continuing this civil POV push which suggests that SMT and chiropractic is fringe (similar to Flat Earth, Creationism and Homeopathy. Last time I checked none of those topics were covered at the World Health Organization. CorticoSpinal (talk) 21:59, 28 May 2008 (UTC)

It is quite clear that close textual analysis of CS's citations that are to actual experts do not argue that Chiropractic is mainstream medicine, just that millions of people use it. Well, millions of people use a lot of fringe things (look at homeopathy, creation science, UFOs, etc.) Whether people use it or not does not determine whether it is fringe or not. Expert evaluation does, and expert evaluation is pretty clear that there isn't much that can be said that chiropractic has been shown to medically benefit. A number of the other sources are obvious WP:REDFLAGs. ScienceApologist (talk) 22:09, 28 May 2008 (UTC)

I think the larger picture here reveals that fringe and mainstream are not an either/or set of demarcation. Rather, is is a sliding scale. Like black and white with all shades of gray in between. That's the problem with labeling based on narrow-thinking and bias - some people want so badly for something to be labeled one thing, that they fail to realize what kind of scale they are dealing with. Currently, based on modern sources, chiropractic slides much more towards mainstream than it does toward fringe. -- Levine2112 ^discuss 22:35, 28 May 2008 (UTC)

You're right about everything but the last sentence. You have yet to provide us with the high-quality sources needed to establish that chiropractic is mainstream medicine. ScienceApologist (talk) 22:44, 28 May 2008 (UTC)

Incorrect. All I set out to do was to show that Chiropractic is not fringe. I have demonstrated that clearly with reliable mainstream sources. -- Levine2112 ^discuss 00:50, 29 May 2008 (UTC)

Yet, you failed to adhere to the standards outlined in WP:REDFLAG. ScienceApologist (talk) 08:41, 31 May 2008 (UTC)

When more than half the healthcare practitioners in the US are chiropracters, and when the surgeon general is replaced by a chiropracter general, then Chiropractic will not be FRINGE. Until then...--Filll (talk | wpc) 22:02, 28 May 2008 (UTC)

Again, is optometry fringe? Is dentistry fringe? Is podiatry fringe? Is chiropody fringe? Where is the optometrist general? The dentist general? The podiatrist general? Why would we want half of the healthcare practitioners in the US to be specialized in focusing on NMS disorders? Your arguments are flawed and do not contribute to enhancing this article, nor to the encyclopedia. DigitalC (talk) 01:40, 29 May 2008 (UTC)

Is it your position that chiropractors are "specialists"? In what anatomical or physiological sense are they specialists? Are they spinal doctors? ScienceApologist (talk) 19:38, 29 May 2008 (UTC)

There ARE problems with the word 'specialist' (for instance, to see many specialists, one needs a referal from an MD ie: to see a dermatologist). However, I would assert that chiropractors focus on NMS issues. Why you ignored that above, and then asked if they are "spinal doctors", I don't know. Again, if you look at the research, aside from asthma, infantile colic, and cervicogenic headache, there isn't adequate evidence for non-musculoskeletal conditions - as such, an evidence based chiropractor would not be treating non-NMS conditions. DigitalC (talk) 01:10, 30 May 2008 (UTC)

Just as a point of information: the evidence for asthma, infantile colic, and cervicogenic headache is about the total package of chiropractic care, including unmeasured qualities such as belief and attention. The evidence does not support any particular treatment. See Hawk et al. 2007 (PMID 17604553).

The official identity of Chiropractic medicine and chiropractors are indeed [the spinal health care experts in the health care system.] Why the anti-chiropractic editors dispute this is beyond me. CorticoSpinal (talk) 04:02, 30 May 2008 (UTC)

That quote is the brand platform promoted by the World Federation of Chiropractic's position. But that doesn't mean it's the mainstream medical position. The WFC's definition is also controversial among chiropractors. One chiropractor criticized the WFC's definition for its failure to place proper limits on chorpractors who treat general health problems, saying that the WFC's definition is "plunging the profession deeper into pseudoscience and away from establishing an identity for chiropractors as back-pain specialists". See: Homola S (2008). "Chiropractic: a profession seeking identity". Skept Inq. 32 (1). Eubulides (talk) 01:08, 31 May 2008 (UTC)

Are you suggesting, Eubulides, that the WFC is a fringe organization that deserves to be doubted? The organization that represents the chiropractic profession globally. The organization that is recognized by the World Health Organization. Bingo. Not fringe anymore. So, given that it is a legitimate (mainstream) organization that represents the chiropractic profession globally with Dr. Haldeman as the lead scientitst in the Research division, we shouldn't argue with the experts, just as you've always said. The opinion of mainstream allopathic (conventional) medicine is irrelevant. Chiropractic defines itself, not the medical profession. This is the critical difference between FRINGE and mainstream. The mainstream gets to define itself. Mainstream medicine has tried to kill chiropractic. So, what are we left with: the opinion of one man, (Samuel Homola who edits at Quackwatch with Stephen Barrett and who's previous papers have been rebuked; this time he writes in a non-indexed, biased, non-peer-reviewed magazine that is trying to trump, subvert and cast doubt on the reputability of the identity agreed by WFC and by extension the WHO? Weren't you the has said close to 150 times (I've counted) that "we shouldn't reach down into primary sources". And you bring a skeptical inquirer article to the table to discredit the WFC? You are falsifying any real controversy, but rather trying to create one by suggesting that the opinion of disputed, critic of chiropractic who has zero weight in the scientific arena somehow should be seriously taken with weight to dispute the obvious? Homola's personal opinion that has zero evidence to support his theory that chiro will go fringe by adopting the Identity Paper has got to be one of the more ridiculous claims I've seen yet since editing here. So now you dispute the official, verifiable and reliably sourced identity of chiropractic by the WFC with a hit-piece article in the skeptical inquirer. I guess to determine the weight and determine which source should be included we need to determine if the Skeptical Inquirer carries more weight than the World Health Organization, for it is the WHO admitted the WFC into the fold 1997 who and has represented the chiropractic profession at WHO since that time.[73]. At least the contrast in our arguments and editing practices at chiropractic has become abundantly clear. CorticoSpinal (talk) 08:29, 31 May 2008 (UTC)

For the record, Samuel Homola has not been a Chiropractor since 2000, as far as I know. DigitalC (talk) 07:32, 31 May 2008 (UTC)

Yes, Homola is a retired chiropractor. Eubulides (talk) 07:56, 31 May 2008 (UTC)

Let the Surgeon general speak for himself. CorticoSpinal (talk) 22:06, 28 May 2008 (UTC)

I removed a personal attack perpetrated by CS above. Also, Filll's point is well-taken. The title itself speaks to the fact that surgery is mainstream while chiropractic is not. Even the video you cite indicates that chiropractic is not part of mainstream medicine. Ergo it is fringe. ScienceApologist (talk) 22:09, 28 May 2008 (UTC)

Chiropractic is Fringe: The rebuttal Section 2

Here is another way to think of it. There are maybe 200 million adults in the US. About 40 million of these will have some contact with chiropractic in their lives. All other countries in the world it is much less prevalent than in the US. Suppose that There are at most another 10 or 20 million people in the world who will have some contact with chiropractic during their lives (and this is being generous, since it really is very minor in the rest of the world compared to the US, especially outside the English speaking world). This means that substantially less than 1 percent of the world's population will use a chiropracter anytime during their entire lives. That is about as close to FRINGE as you can get.

By the way, by many definitions of chiropractic, SMT is not even considered chiropractic at all.--Filll (talk | wpc) 22:12, 28 May 2008 (UTC)

Um, what percentage of the world use artificial hearts? Are artificial hearts "fringe" because less than 1 percent of the world's population will use an artificial hearts anytime during their entire lives? I think your argument has serious flaws, IOW. -- Levine2112 ^discuss 22:26, 28 May 2008 (UTC)

Priors, Levine. Chiropractors claim that most of the population would benefit from chiropractic. Most of the population that has access to chiropractic fail to avail themselves of its use. That's much different than the artificial heart "analogy". A better comparison might be to internal medicine. ScienceApologist (talk) 22:33, 28 May 2008 (UTC)

How about vitamins? Current thinking is that taking vitamins can improve health. The majority of the world has access to vitamins. The majority does not take vitamins. Are vitamins fringe? What about exercise? Sorry, the argument based on population usage is seriously flawed. -- Levine2112 ^discuss 22:38, 28 May 2008 (UTC)

The majority of the world does indeed ingest vitamins. Current thinking is that most people should try to get their balanced nutrition from food sources rather than supplements. ScienceApologist (talk) 22:42, 28 May 2008 (UTC)

I would argue that the world does not ingest sufficient amounts of vitamins from either whole-food or supplement sources despite mainstream science telling us that is the healthy thing to do. But that's neither here nor there. The main thing which I have demonstrated is that the usage logic behind the determination of what is fringe is extremely flawed. You can go off on any tangent which you would like, but you can't evade what the sources are saying... that chiropractic is considered more mainstream than fringe. -- Levine2112 ^discuss 00:54, 29 May 2008 (UTC)

You haven't really established anything because chiropractic makes universalist claims rather than specialist claims. ScienceApologist (talk) 19:38, 29 May 2008 (UTC)

Certainly artificial hearts are on the FRINGE edge of mainstream medicine. For example, people cannot live for an extended period with an artificial heart. This is bleeding edge medical care and we obviously have huge problems with it. It is way too expensive and unreliable and creates blood clots that kill the patient, etc.

Lower back pain, or many of the other ailments that supposedly chiropractic can correct, affect a much much larger fraction of the world's population than a heart ailment for which an artificial heart is judged to be an important part of the treatment. --Filll (talk | wpc) 22:38, 28 May 2008 (UTC)

What? The artificial heart is fringe? Am I reading that right? Okay, go over to artificial heart and edit away over at that article. Hold it up to the WP:Fringe standards and see how that goes for you. Currently, the artificial heart article says nothing about fringe, as far as I know. By the way, isn't heart disease one of the leading causes of death in the world? Can the same be said about lower back pain? Hmm. -- Levine2112 ^discuss 01:20, 29 May 2008 (UTC)

Also a good quarter of the US states do not include chiropractic in their healthcare plans, and medicare and medicaid only partially reimburse for it. Also in the subject of subluxations, can you show me a sequence of papers in say the Lancet or the New England Journal of Medicine verifying their existence, and cause of a range of physical ailments, with later peer-reviewed papers confirming the results of the first set of papers, and another 2 or 3 waves of papers subsequently verifying those results, so that it is clear that the mainstream medical scientific consensus is that they exist and are medically relevant? How about a similar set of papers reporting on double blind experiments where groups of chiropracters are challenged by xrays or patient examinations and then their diagnoses are compared and correlated? How about other kinds of double blind studies? Are you telling me there is effectively no controversy about the value of Chiropractic? The existence of "straights" and "superstraights" and "mixers" and god knows what else, different groups that cannot even agree among themselves what chiropractic is, is prima facie evidence that this is pure horse pucky.--Filll (talk | wpc) 22:38, 28 May 2008 (UTC)

In the US, where it is most popular, many more people believe in alien abduction than believe in chiropractic.--Filll (talk | wpc) 22:41, 28 May 2008 (UTC)

[ http://www.nizkor.org/features/fallacies/appeal-to-belief.html Appeal to belief fallacy]. Unsubstantiated claim. No evidence presented. Red herring and straw man. Maybe you should take your own AGF challenge! CorticoSpinal (talk) 22:58, 28 May 2008 (UTC)

SA, I would please ask that you refrain from censoring my comments on the talk page. So, what we have here is evidence in both the literature and lay sources that chiropractic is mainstream. We have no evidence of the contrary, in fact we have a lot of innuendo and hot air. So, why exactly again are you both arguing with non-controversial experts who say chiropractic is "distinctly mainstream"? CorticoSpinal (talk) 22:58, 28 May 2008 (UTC)

Filll: I'm not suggesting there aren't controversial elements of chiropractic care. 90-95% of DCs practices are for MSK disorders. Is that controversial? No. So, the overwhelming majority of typical chiropractic caseload is being overshadowed and smeared by the 5-10% of visceral cases where the research is inconclusive. That is the controversy. And it's being blown up here and used a straw man to discredit the majority of chiropractic Furthermore, your tidbit on subluxation is actually false. I prefer a different term (too much baggage with subluxation) however there are major medical publishing houses who are publishing textbooks on subluxation. Whether or not its called subluxation (chiro) or somatic lesion (osteopaths) or joint dysfunction (PTs) it's still boils down to a manipulable lesion. CorticoSpinal (talk) 23:18, 28 May 2008 (UTC)

What matters is the WP definition, not the definition of anyone else, for "FRINGE" or mainstream. And the way we normally do it is by the preponderence of reliable sources in the mainstream peer-reviewed academic and scientific journals in the area. Which in this instance, would be something like Nature Medicine, New England Journal of Medicine or the Lancet.--Filll (talk | wpc) 23:05, 28 May 2008 (UTC)

So you are ignoring the non-controversial expert review (Kaptchuk) that cites chiropractic is distinctly mainstream and saying it doesn't matter? Luckily that's what WP:IAR is for, is to correct gross misuse of wikipedia policies to subvert mainstream opinion like you're doing right now. I think you're misinterpretating WP:FRINGE and not applying correctly here at Chiropractic. So now you are pushing your viewpoint which has been demonstrated to be fringe, and pretending it is the majority consensus. Right. Perhaps you should re-read your essay on civil POV push. You're fitting into it quite nicely. Again I repeat: evidence from highly respected journals and reputable lay sources suggests chiropractic is mainstream. You have provided none that it is fringe except random bits about alien abductions, chiropractic care being no better than placebo for LBP, etc. Where's the evidence, Filll?CorticoSpinal (talk) 00:21, 29 May 2008 (UTC)

You can wikilawyer it however you like. I am just putting you on notice how things are actually done on Wikipedia. So you know.--Filll (talk | wpc) 23:43, 28 May 2008 (UTC)

Presenting evidence to support my claim and asking you to present evidence to support yours is Wikilawyering? You do realize that you're endorsing a double standard; a same double standard that is also being applied to other CAM-type pages. I'm starting to see why Wikipedia is so dysfunctional now. So, do you have any evidence to refute/rebuke the claim that chiro is mainstream or are you simply going to quote me your bizarre interpretation of WP:FRINGE?. Thanks. CorticoSpinal (talk) 00:21, 29 May 2008 (UTC)

So you have greater depth of knowledge of Wikipedia and its policies in your 1777 total edits then? More than people with 20,000 edits or 30,000 edits? More than admins and people with 60,000 edits? That is interesting.

I am just telling you how we do things on the rest of Wikipedia instead of in this tiny isolate SPA-fed corner. By consensus. By policy. Just so you know. For future reference. If you don't like it, I am sorry. That is reality.--Filll (talk | wpc) 00:44, 29 May 2008 (UTC)

That's a pretty weak place to go, Filll. Comparing the size of your edit counts? Sounds like a mine-is-bigger-than-your argument. Well I have a lot of edits too and I think your interpretation of WP:Fringe is too extreme and incorrect. Meanwhile, it seems like you are evading CorticoSpinal's simple request. We have presented reliable sources from the mainstream media and mainstream science all stating that chiropractic is no longer considered fringe and leans more towards mainstream. Your POV is that these sources must be wrong because you consider chiropractic fringe. Yet, you are unable/unwilling to provide us with any source more reliable than your own opinion. Again, your belief that chiropractic is fringe is actually and ironically a fringe belief. A true skeptic - a true scientific skeptic - looks at and weighs all of the evidence before making an opinion. And a true skeptic is completely willing to change their mind about something in the face of new evidence. Those who stubbornly hold onto their beliefs and close their eyes to new evidence are known as pseudoskeptics. If that is what you are, that is fine. Just own up to it. I personally don't think you to be a pseudoskeptic. In our prior dealings, you seem to have had an open mind before. I guess I am asking you to step back, take a look at all of the sources presented here, look for and present any sources which contradict these, weigh them all, and then reconsider your opinion on this matter. That is the pathway of a true skeptic. -- Levine2112 ^discuss 01:14, 29 May 2008 (UTC)

Stop being snide. You are no more a guru of the pathway of a true skeptic than anyone else. Your additions to this conversation are entirely unhelpful. ScienceApologist (talk) 19:38, 29 May 2008 (UTC)

Do you not see the irony of your sentence, SA? You request Levine2112 to not be snide (which he wasn't) and make a snide, derogatory comment. Have you found any evidence yet, btw? User:CorticoSpinal 03:04, 30 May 2008 (UTC)

I think Filll needs to learn that WP:FRINGE is based on moreso on extremist ideologies than minority numbers. DigitalC has exposed yet another critical flaw in Fillls (and to be fair, Eubulides, ScienceApologist, QuackGuru, Orangemarlin, Jefffire, Arthur Rubin) reasoning and argumentation that Chiropractic is fringe. Again, there is evidence presented from non-disputed, highly reliable sources that suggest Chiropractic is mainstream. No evidence has been provided to supports that Chiropractic is fringe (circa 2008). What we have so far from the anti-chiropractic skeptics are illogical arguments, wikilawyering threats, red herrings, comparisons to alien abductions and flat earth, character-assasination remarks to discredit proponents of chiropractic care.

The grand the grand-daddy of them all a civil POV push to discredit efficacy, safety, cost-effectiveness and risk/benefit of SMT and chiropractic care by using flawed, biased Edzard Ernst immaculate reviews and cherry picked research (paper mining I believe MastCell called it) that deliberate attempts to portray the conclusions on the research of SMT by Ernst as the majority viewpoint on SMT research and chiropractic care when it has been proven that it is the minority viewpoint. Then, we're supposed to give the flawed, biased research at least equal weight (some skeptics it should be given more weight than the majority viewpoint). All this, of course is occuring while Eubulides single-handedly decides what research is makes the cut for Chiropractic while preventing the inclusion of reliable primary sources that do not suffer the same bias and methodological problems but yet agree as well with the majority of the research. Note: Eubulides is also the editor has brought and has vehemently defended the claim that the Ernst research represents the majority view on the research.

In the end, there is only violations here of WP:NPOV, WP:WEIGHT WP:SYN, WP:OR,WP:MEDRS by dogmatic anti-chiropractic editors but regularly character attacks on select proponents of chiropractic care (such as myself) care in violation of WP:AGF, WP:NPA, WP:CIVIL. Pro-chiropractic editors are treated like 2nd class citizens from a 3rd world country. They are discredited and denigrated, branded as "anti-science", "POV-warriors" who are clearly "fringe" just for believing in the majority of the research (chiropractic care is generally just as safe and effective (if not moreso) for back and neck pain and other musculoskeletal ailments. Then suddenly, Filll, Mr. "AGF" and "I'm evidence-based" (yet refuses to consider the evidence presented that is contrary to his belief system --true denier?--) comes in and completely proves my point to a 'T' with nonsense arguments and absolutely no clue of what the evidence says. The chiropractor schooling the medical doctor in research. You have to appreciate the irony, no? Goodnight. CorticoSpinal (talk) 04:45, 29 May 2008 (UTC)

Good luck with that argument. Also, please stop with the invectives and the personal attacks. ScienceApologist (talk) 19:38, 29 May 2008 (UTC)

Did I claim that I had a greater depth of knowledge or are you misrepresenting my statement to undermine my claim, a classic straw man tactic? Furthermore, you should conflate that # of edits with adherence to and knowledge of policies. If that is the case then you are not faring so well. Bottom line: the number of edits I have is not the point.

And now we're off topic (again). Evidence has been presented that chiropractic is mainstream. Your rebuttals contain 0 evidence but plenty of vacuuous non-sequiturs, comapisons to alien abductions, logical fallacies and attempts to undermine my arguments with straw man attacks and red herrings. Where is the evidence to support your claim, Filll. I shall remind you that we're in 2008, not 1966. Thanks! CorticoSpinal (talk) 01:07, 29 May 2008 (UTC)

Again, this is not a black-and-white issue, and you can find opinions on both side of the subject. Here are two data points: Redwood et al. 2008 (PMID 18435599) surveyed D.C. practitioners and found that 20% of them thought that chiropractic is mainstream medicine, whereas only 9% of surveyed D.C. faculty thought the same. When describing chiropractic, both faculty and practitioners preferred the terms "integrated medicine" and "complementary and alternative medicine" to "mainstream medicine". This survey suggests that the vast majority of chiropractors (particularly the experts) do not think chiropractic is mainstream medicine. (Of course this doesn't mean they'd agree that chiropractic is "fringe"!. "Not mainstream medicine" is not the same thing as "fringe medicine".) Eubulides (talk) 08:47, 29 May 2008 (UTC)

The problem here is the definition of mainstream. While chiropractic has changed considerably (as has medicine) in the last twenty years, 'mainstream' has changed even more. Mainstream is a moving target and at this point in time it is moving in the direction of conservative, noninvasive treatments; those that chiropractic seemed poised to offer, especially for musculoskeletal problems. Surely it is 'fringe' for Type O (organ problems), but 'mainstream' may one day interest itself in conservative, noninvasive treatments there as well. Only time will tell. We aren't supposed to worry about that, though. -- Dēmatt (chat) 13:58, 29 May 2008 (UTC)

Considering the above survey, we have to wonder how alternative medicine is defined (the definition is different depending on who you ask); I would submit that if the person were thinking it meant an "alternative to medicine" then quite a few would answer "yes", it is alternative medicine. But once someone began to attach 'unproven or unscientific" to the term alternative medicine, of course the attitude changes. Suddenly, Integrated medicine is better for those that want to 'mainstream' themselves, but for others, that may be a little too close to 'medicine'. Interesting though. -- Dēmatt (chat) 14:09, 29 May 2008 (UTC)

I quite agree that chiropractic's position is subtle. It is not entirely mainstream; but it's not entirely antiscientific fringe either. It represents a difficult case for WP:FRINGE because the whole field is not fringe but the field certainly does have fringe elements and aspects (e.g., chiropractic treatments for autism). Eubulides (talk) 16:56, 29 May 2008 (UTC)

This is a red-herring ploy. What % of DCs treat austism and any non-NMS disorder? Reliable evidence suggests 90-95% of cases that are being treated are neuromusculoskeletal. So, of the remaining 5-10% is non-NMS. Of that austism isn't even in the top 10. The most common are dysmenorrhea, otitis media, colic and asthma. That is the fringe. 10% So, how you equate this as a 50/50 split is beyond me. BTW, have you found any reliable sources that disputes the evidence presented that chiropractic is oart of mainstream health care? Thats the topic at hand. Evidence. CorticoSpinal (talk) 07:04, 30 May 2008 (UTC)

I said nothing about a 50/50 split. The point is that too many chiropractors engage in treatments that are fringe science. Even if it's only 5-10% of treatments (what is the source for that figure, by the way?) that's too much fringe. And certainly there are reliable sources disputing that chiropractic is mainstream medicine (as opposed to mainstream health care). Eubulides (talk) 01:08, 31 May 2008 (UTC)

That's reasonable. I'm sure we agree on more than we disagree. Even that treating someone with autism is not the same thing as treating autism. -- Dēmatt (chat) 19:20, 29 May 2008 (UTC)

I think we also agree on quite a bit. Unfortunately the treatments I was referring to were treatments for autistic symptoms, not treatments for unrelated musculoskeletal complaints. There is zero scientific evidence supporting such treatments. Eubulides (talk) 01:08, 31 May 2008 (UTC)

A huge amount of nonsense and spew. But it does not take away from the fact that for WP:FRINGE we go by WP definitions, no one else's. Thanks.--Filll (talk | wpc) 14:55, 29 May 2008 (UTC)

So I guess that means it's not WP:FRINGE. -- Dēmatt (chat) 15:19, 29 May 2008 (UTC)

No, WP:FRINGE applies to Chiropractic. You'd be hard-pressed to claim otherwise. ScienceApologist (talk) 19:38, 29 May 2008 (UTC)

Filll, it seems your interpretation of WP:FRINGE is fringe in itself. Eubulides, the survey proves nothing more that DCs see themselves more as integrative than CAM. Also, mainstream health care is different than mainstream allopathic medicine. I have yet to see any rebuttal or source that rebukes the evidence provided that chiropractic is mainstream health care. Still waiting. Meanwhile, Filll might want to learn about how to apply FRINGE. It's about extremist ideologies/positions (or, in another words, far away from the mean, 2 standard deviations away if a stats analogy could be used) not about minority numbers. Also, a controversial subject does not equate to fringe. SmithBlue nicely pointed this out to us before. We musn't conflate controversy for fringe, like the anti-chiropractic editors here regularly do. CorticoSpinal (talk) 15:49, 29 May 2008 (UTC)

The survey question was not about "mainstream allopathic medicine". It was about "mainstream medicine". The vast majority of chiropractors do not view their profession as mainstream medicine. This does not mean they think chiropractic is fringe, far from it! But they don't think it's mainstream medicine either. Also, we must remember that this survey was merely of chiropractors; a survey of mainstream medicine and/or science personnel would yield results that would likely be less supportive of chiropractic as being mainstream. Eubulides (talk) 16:56, 29 May 2008 (UTC)

You're a bit confused. But that's OK, I'll walk you through it. But, promise me to stop conflating things! Points 1) mainstream allopathic medicine (which is not synonymous with mainstream health care) has tried to eliminate, contain and kill off chiropractic. So your survey analogy there is bunk. 2) The source does nothing to disprove the evidence presented that chiropractic is considered mainstream. Do you have reliable, verifiable, high quality sources that rebukes the evidence presented? I can only ask so many times. This is a classic example of WP:IDIDNTHEARTHAT. Not surprisingly, this is a common tactic used by civil POV pushers. CorticoSpinal (talk) 23:56, 29 May 2008 (UTC)

Comments on Chiropractic is Fringe: The rebuttal Section 3

This section seems to be devoted to debating whether "chiropractic" is "fringe". Would someone please explain to me why this is being debated on this talk page? I just re-read WP:FRINGE and don't see what part of it this thread might be concerned with. Feel free to reply on my talk page if this is something everybody else around here already understands. I can see how it may be useful at a page such as Asthma to decide whether the chiropractic theory of treatment of asthma is "fringe" and not notable enough to be mentioned in that article, but I don't see how a decision as to whether "chiropractic" (the profession? a theory of?) is "fringe" or not would have any bearing on the content of this article: either way, the article will be based in a balanced way on the reliable sources.☺ Coppertwig (talk) 01:01, 30 May 2008 (UTC)

• The survey indicates that the vast majority of chiropractors do not consider chiropractic to be mainstream medicine. This is true independently of the old antipathy between the fields. And the survey's results are not contradicted by any other source presented on this talk page.
• I see some quibbling as to whether chiropractic is "mainstream medicine" versus "mainstream health care". But one can easily find sources saying that chiropractic is not mainstream health care as well. For example, Langworthy & Cambron 2007 (PMID 17693332) write, "As the chiropractic profession in the United States (US) and United Kingdom (UK) continues in its efforts for full recognition in mainstream health care,..." indicating that the authors do not believe that chiropractic is mainstream health care yet. Another example: the title of Hirschkorn & Bourgeault 2004 (PMID 15847969), which is "Conceptualizing mainstream health care providers' behaviours in relation to complementary and alternative medicine", indicates that the authors do not consider chiropractic to be mainstream health care. I don't see any evidence that the distinction between "mainstream medicine" and "mainstream health care" is a huge one in practice, in this regard.
• The effectiveness of chiropractic care is a topic under genuine dispute. In some cases (treatment of low back pain, at least for some categories of patients) the evidence is relatively strong, and chiropractic supporters are not fringe, nor are the skeptics fringe (as the evidence is not overwhelming). In other cases (for example, treatment of autism) the scientific evidence is nonexistent, and it's fair to say chiropractic is fringe. And there are some gray areas in between, where some evidence does exist but it's low quality; this is where things get tricky.

Eubulides (talk) 01:08, 31 May 2008 (UTC)

Coppertwig, labelling chiropractic fringe is the core issue namely for two reasons: research (science) and legitimacy. Currently allopathic (medical doctors) research (MD/PhD) by default gets more weight and sets the tone. Research done by and favourable to chiropractic researchers (DC/PhDs) published in mainstream (health care) journals is denied proper weight in the most crucial areas (Safety, Efficacy, Research/Science, Cost-Effectiveness). The majority of the research which demonstrates chiropractic care is just as safe if not more effective than conventional medical management for low back pain, neck pain and other neuromusculoskeletal disorders. Yet, this dominant view, by multi-disciplinary panel of experts worldwide is being deliberately subverted by presenting the disputed, flawed and biased research of one individual: Edzard Ernst, MD, a vocal critic of chiropractic. It is argued then, the extremist critical Ernst should be given at a minimum as much, if not more weight (and tone) than a international majority consensus (whose research has either been a) deliberately marginalized and b) deliberately omitted in a cherry picking of sources and quotes to subvert the majority of the scientific literature (yet again).

Fringe is everything. Its the whole context of the article, the way information is perceived (and delivered) its the rules of the game (less weight, less detail to tone). Filll wants this article flushed down the toilet. Proponents here have invested literally thousands of hours trying to get the Chiropractic story to reflect the current state of affairs (2008) and not an article that is peppered with deliberate "attacks" that play up the fringe element of chiropractic care (treating non-musculoskeletal disorders) and presents it with undue weight that changes the whole tone and context of the material surrounding. It's these covert attacks to the article (and remember, I have proposed a Criticisms section where all the controversies, disputes and challenges can be and should be handled). I'm a fair editor. I haven't been given a fair shake because anti-chiropractic editors have portrayed me as some anti-scientific, POV warrior, mongrel because they believe that I'm a fringe practitioner and thus should be doubted at every turn. It's made editing here constructively virtually impossible. Wake up call to all of WIkipedia editors: being a non-traditional health care provider does not mean they are a) fringe and b) anti-scientific. Au contraire, they merely emphasize and research different therapies and a model/system of health (Holism). Why is different being portrayed as fringe? If you're no different than allopathic medicine you are automatically fringe? Is this the standard and the final say of Wikipedia on this subject? This is what is at stake. This decision will set a precedent for all CAM pages here. If chiropractic is fringe, then every single CAM profession, modality and science is, by extension fringe. If chiropractic is determined to share more attributes of a mainstream, legitimate health care professional than a fringe medical practitioner based on the the quality of the evidence presented alone (as opposed to personal opinion and vote stacking puppet shows) then similar disputes occuring at Acupuncture and other CAM pages has a template to follow and a process of evaluating and judging the strength asking 2 basic questions: (1) Does the evidence demonstrate, by and large, that the topic at hand is WP:FRINGE and (2) Is there reliable evidence/sources that suggests otherwise and to what extent? I hope I have presented the case clearly. Perhaps this discussion belongs someplace bigger and away from the kamakazi tactics of some editors.

Proponents of chiropractic care who make the valid argument that chiropractic is at a minimum much more part of the mainstream (health care) than fringe, if not already part of it. It completely changes the dynamics of editing. Evidence (with much, much more available) from reliable, non-disputed sources have supported the claim the chiropractic medicine is part of mainstream health care (and not to be conflated with mainstream allopathic medicine, the specific profession) and no evidence has been provided that it is still fringe, circa 2008. Contemporary chiropractic is scientific. Bachelors and Masters Degrees in Chiropractic Science are been awarded by public, government-sponsored universities. The fringe argument also applies to the science of chiropractic medicine which insists there is no such thing as 'true' chiropractic science because it is fringe and a pseudoscience. A bit of education on the matter and then a a little applied common sense (rather than dogmatic skepticism that is uninformed) decidedly (and perhaps surprisingly) proves the point made by pro-chiropractic editors. As it stands, the anti-chirorpractic editors are pushing (civilly and uncivlly) that chiropractic medicine is fringe despite evidence presented to the contrary. CorticoSpinal (talk) 05:52, 30 May 2008 (UTC)

Thank you for your reply, CorticoSpinal. I recognize that you're trying to address my question, but I'm sorry: I'm completely missing your point! If there are peer-reviewed scientific publications giving evidence of benefit of chiropractic treatment, then regardless of whether "chiropractic" (some particular theory of?) is labelled "fringe", those publications need to be represented in the article, balanced by other, more critical sources. Surely there are enough reliable sources about chiropractic that we don't need to resort to using self-published websites and such as sources? While labelling something "fringe" allows self-published websites etc. to be used, it doesn't require that they be used, and for this article I don't think it's necessary. So, what would be different about the article depending on whether "chiropractic" is classified as "fringe" or not? ☺ Coppertwig (talk) 12:22, 30 May 2008 (UTC)

I agree that this article should be handled as a mainstream article and we do not lower the bar to dealve into the fringe elements of chiropractic any more than we would lower the bar to dealve into the fringe elements of medicine. Chiropractic is "mainstream enough" to keep our content reliable from peer reviewed sources and be able to say whatever we need to say. We do not need to make any WP:Points to create a FA article. -- Dēmatt (chat) 13:43, 30 May 2008 (UTC)

I agree that the article should only cover the chiropractic fringe the way that any article (Evolution, say) should briefly discuss closely-related fringe theories (such as creationism). The current treatment in Chiropractic#Scientific investigation does that: it is almost entirely about mainstream chiropractic care. Eubulides (talk) 01:08, 31 May 2008 (UTC)

Coppertwig, while I definitely agree with your logic, the problem is that currently chiroskeptic editors are treating Chiropractic by default is fringe. Accordingly the research I try to include in crucial areas of safety, efficacy, cost-effectiveness is being given the fringe treatment, getting less weight, worse tone and less credibility. Basically, MD/PhD research on chiropractic or SMT is being given superior weight than research by DC/PhD at Chiropractic because the chiropractic viewpoint on its own research is interpreted as fringe and automatically at odds with mainstream health care. That's not the case at all. Look at the TaskForce thread. Some major players are DC/PhDs, (but do not dominate the representation of the TaskForce as suggested repetitively by Eubulides despite the evidence to the contrary) and its even led by a DC/MD/PhD. Yet the interpretation is that the document is a mainstream chiropractic one and not a mainstream science one. It's implied that chiropractic and science are at odds despite the obvious fact that its clearly not. CorticoSpinal (talk) 19:46, 30 May 2008 (UTC)

This mischaracterizes the dispute in question. The current article uses high-quality reviews from all sources, including chiropractic sources. The dispute in question was over whether we should ignore the guidelines in WP:MEDRS, override the opinions of published and detailed reliable reviews by experts in the field, and highlight results of primary studies that the reviews did not think worthy of mention. Eubulides (talk) 01:08, 31 May 2008 (UTC)

One question, is Edzard Ernst debunking the fringe elements of chiro, or the stuff that seems to have some effect on back and neck pain? Is this the only source which is extremely critical? If so, then is this being presented as the view of most doctors? If it is, then is there anything backing up the claim that this is the veiw of most doctors? What exactly is said to be wrong with sources like this? I'm sorry to ask all this, but my god, it's a long talk page.

The way it looks to me is that there is solid evidence and mainstream support for the practice of chiro.

"Manipulation has been shown to have a reasonably good degree of efficacy in ameliorating back pain, headache, and similar musculoskeletal complaints,13 and some chiropractors limit their practices to these conditions. While precise statistics are not available, a majority of chiropractors adhere to the method’s original theories, and continue to claim that chiropractic manipulation cures disease rather than simply relieving symptoms."

But, there is theory and claims which have almost no support. If this were merely treated as seperate issues in the article, as it is in the sources, that might solve a problem? ——Martin^phi ☎ Ψ Φ—— 22:50, 30 May 2008 (UTC)

" While precise statistics are not available, a majority of chiropractors adhere to the method’s original theories, and continue to claim that chiropractic manipulation cures disease rather than simply relieving symptoms."

That last statement is patently false quoted here is patently false, but the rest of it is spot on. First, the majority group is the mixers (of the 35 accredited schools world wide only 8 are straight 27 are not). Next, DeVocht (2006) has nicely illustrated the controversy over theory here. It should be noted this is from Palmer College, which is the minority view yet it still has universal elements (manipulable lesion) Next, and most important is that the literature (tertiary source) provided by the World Health Organization in 2005 states explicitly here the basics of chiro theory; none of which mentions anything of disease and adhering to the palmers methods (which is why mixer chiropractic separated and differentiated itself from straight chiropractic). What source made the claim? Who wrote it? Professional designation? Was it an MD? MD&DC and other multidisciplinary collaboration? If not, that's problematic; Medicine has always tried to marginalize chiropractic and was found guilty by the US Supreme Court of anti-competitive practices trying to contain, disrupt and eliminate the chiropratic profession. CorticoSpinal (talk) 23:50, 30 May 2008 (UTC)

Hmmm, so there is a minority of chiropractors who follow the original philosophy and who do say that chiro cures diseases besides back pain related stuff. That's a significant minority, but unless there is disagreement about how much of the profession believes those ideas (from other editors here) the subject could be treated mainly from the mainstream sources which say it works for back and neck. In that case, what we'd have is a section of the article covered by FRINGE, in which case one would describe the ideas, and say also whatever criticisms have been leveled at them, or their influence on practice. However, this section could be isolated pretty well, and treated more as a belief with a potential for harm if the chiropractor acted out of that belief. Treating the whole article as FRINGE because of the beliefs of a minority would be an unfair way of doing things. Unless, of course, there are sources which I'm not yet aware of. I'm not sure here, might want to take some of this back. There is also the issue of our not trying for truth, but for sources, and the above is a pretty good source. Thoughts? ——Martin^phi ☎ Ψ Φ—— 05:48, 31 May 2008 (UTC)

• In "the above is a pretty good source" which source are you referring to?
• Things are more complicated than that, I'm afraid. Mixers also treat for conditions other than back pain.
• Mainstream sources are not in agreement for back and neck. Please see Chiropractic#Effectiveness for details, and look for "Low back pain" and "Whiplash and other neck pain".
• It is not so easy to isolate which part of Chiropractic is "fringe". Some sections (e.g., Chiropractic#Vertebral subluxation are quite "fringish", and some (e.g., Chiropractic#Safety are not, but some (e.g., Chiropractic#Philosophy) cover both the "fringe" and the "non-fringe" parts and separation would be difficult.

Eubulides (talk) 07:56, 31 May 2008 (UTC)

Challenge

Template:RFCsci I claim that WP:FRINGE applies to this article. Who disagrees/agrees and why? ScienceApologist (talk) 19:38, 29 May 2008 (UTC)

You're not giving me a chance to say I agree? OrangeMarlin ^{Talk• Contributions} 19:42, 29 May 2008 (UTC)

What theory are you asserting that WP:FRINGE applies to? DigitalC (talk) 01:18, 30 May 2008 (UTC)

It's not a poopularity contest, SA. It's about evidence. Remember Stephen Colbert and African Elephants? You can easily manipulate and distort "facts" if you are uninformed and don't provide any reliable evidence to support the claims made. Anyone can canvass anyone to get "consensus". You, or any other anti-chiropractic editor has yet to provide any evidence that suggests chiropractic is fringe. There is compelling evidence to the contrary, however. CorticoSpinal (talk) 02:34, 30 May 2008 (UTC)

I would agree that WP:FRINGE applies to this article, but I am starting to think that it is too dangerous to hold that position.--Filll (talk | wpc) 19:31, 30 May 2008 (UTC)

I also agree that WP:FRINGE applies to this article. Chiropractic does have strong fringe elements; a sizeable minority of chiropractors are straights, for example, and are definitely fringe by the standards mainstream science. However, I disagree that every topic in chiropractic is covered by WP:FRINGE. There are areas where chiropractic is merely controversial, and is not fringe; evidence-based treatment of low back pain, for example.

Filll, you have nothing to be afraid of here. If so, I would have been dead a long time ago. -- Dēmatt (chat) 00:42, 31 May 2008 (UTC)

Commenting here as an uninvolved editor, I think that there might be a case both ways. Chiropractic is not yet quite mainstream, but is almost mainstream- see this source. However, I think there should be little argument here, because as I see it, the most mainstream sources such as the NIH give chiro an NPOV treatment, in that they are not overly negative or overly positive. Thus there should be little argument about the best sources. Because of this, saying that chiro is covered by FRINGE would not help to promote either the POV of debunkers or the POV of those who wish to present chiro as completely accepted and scientifically fully established.

This concluding quote from what looks to me like one of the more critical sources should not be any problem:

"Contemporary chiropractic philosophy recognizes its partnership with the greater body of philosophy and science in general. Most contemporary chiropractors and their organizations distinguish between what is known and what is believed. Chiropractic belief systems embrace the holistic paradigm of wellness while incorporating deterministic materialism for the establishment of valid chiropractic principles. Chiropractic’s philosophic foundation serves as the basis for theoretical development, not a substitution for it (Phillips, 1992)." [74]

This is also a mainstream source, and should not be objectionable to those who promote chrio:

"Scientifically rigorous general population-based studies comparing chiropractic with primary-care medical patients within and between countries have not been published."

I doubt anyone wants to say that chiro is completely established. There should not be too much contention here, because I don't think there is much tension between the "chiropractic POV" and the "mainstream POV" as reflected in the sources. Most of the article can probably be written without too much attention to attribution of opinion, because most of it will be agreed upon between the two perspectives, if the mainstream sources are followed.

The CNN article is highly negative, but one of the lesser sources.

It would help to have a summary of the debate, and it would help if you archived this talk page.

If you want to achieve consensus, and avoid sanction in the end, stop the name calling completely. ——Martin^phi ☎ Ψ Φ—— 19:34, 30 May 2008 (UTC)

Thanks for the comments. I agree with their overall thrust; unfortunately the devil is in the details.

• The sources you give are a too old to be included in this article, compared to what's already there, and the sources already included in the article make the same basic points; the problem is that these points are under dispute here.
• This talk page is archived; any topic not touched in 14 days is automatically archived by a bot.
• It would indeed help to have a summary of the debate, but nobody has taken the (considerable) time to write one. It would take a lot of time to write one primarily because editors would argue a lot about what its contents should be. It really is quite dysfunctional, I'm afraid.

Eubulides (talk) 01:08, 31 May 2008 (UTC)

Ok, a question. And please bear in mind I never knew anything about chiro before today.... and basically I'm not sure how effective requesting comments on such a complex issue is going to be. But, what is the mainstream view of chiro? I mean, if it isn't what I see at NIH and the other sources. I know that the mainstream view of the philosophy is that it is not supported- no form of vitalism is supported by mainstream science at least. But the other part, the part where they are doing good to backs- what is the mainstream view of that? What are the sources there? I get the impression that most of the sources say it does good, but one or two question that. So is the mainstream view that it does good, per the NIH, or something else? And, shouldn't the info in "Scope of practice" be above the philosophy section? ——Martin^phi ☎ Ψ Φ—— 02:23, 31 May 2008 (UTC)

• You have to be careful here. The "NIH" source you cite is actually the U.S. National Center for Complementary and Alternative Medicine. Although it falls under the NIH umbrella, it is not a mainstream-medicine organization; it focuses on CAM, which by definition is not mainstream medicine. In the past NCCAM has supported obvious pseudoscience such as remote viewing and distant healing. It has its supporters (enough to get Congressional funding, after all; NCCAM was created for political reasons, not for scientific ones) but it also has sharp critics (for example, [75]).
• The mainstream view of chiropractic is what is being disputed here. On the one side we have proponents of chiropractic who say that the mainstream view is represented by the The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders and that sources critical of chiropractic are fringe. On the other side we have those less supportive of chiropractic, who would point to (say) the American Pain Society/American College of Physicians clinical practice guideline, which only weakly recommends spinal manipulation as one alternative therapy (among many) for spinal low back pain in nonpregnant adults when ordinary treatments fail (see Chou et al. 2007, PMID 17909210), or maybe to the Swedish guideline for low back pain, which removed chiropractic manipulation as a treatment option in 2002 (see Murphy et al. 2006, PMID 16949948).
• That's just the short version. For more details about what mainstream sources say about effectiveness, please see Chiropractic #Effectivness.

Eubulides (talk) 07:56, 31 May 2008 (UTC)

• I doubt given our respective histories on CAM articles that either Martinphi or I may be considered completely uninvolved, but I broadly agree with the above assessment. Clearly, anything involving subluxations is obviously fringe at best, but even Quackwatch agrees that chiropractors can treat neuromusculoskeletal problems. If I recall correctly, the profession is currently debating with itself over whether it should practice specialized physical therapy or abandon itself to mysticism. WP:FRINGE applies to the latter view, but not to the view of chiropractic as a minor health-allied profession. We should make this distinction clear and report on percentages as appropriate. - Eldereft ~(s)talk~ 22:03, 30 May 2008 (UTC)

Yes, exactly, very good analysis. I've had one or two edits to Homeopathy article and just a few on the talk page- that's about all for me on alternative med. ——Martin^phi ☎ Ψ Φ—— 23:20, 30 May 2008 (UTC)

A very interesting comment by Eldereft. I agree with 90% of it. I wouldn't call it a "minor allied health profession" because frankly, the sources don't even come close to saying that but they do some primary contact provider for NMS. The "debate" that you referred to is over, the World Federation of Chiropractic, in 2005 has positioned chiropractic as the spinal health care experts in the health care system. It also states that chiropractic should focus on

• Ability to improve function in the neuromusculoskeletal system, and overall health, wellbeing and quality of life.*
• Specialized approach to examination, diagnosis and treatment, based on best available research and clinical evidence with particular emphasis on the relationship between the spine and the nervous system
• Tradition of effectiveness and patient satisfaction
• Without use of drugs and surgery, enabling patients to avoid these where possible
• Expertly qualified providers of spinal adjustment, manipulation and other manual treatments, exercise instruction and patient education.
• Collaboration with other health professionals
• A patient-centered and biopsychosocial approach, emphasizing the mind/body relationship in health, the self-healing powers of the individual, and individual responsibility for health and encouraging patient independence.

So, it's a done deal. Primarily NMS yet with a overall holistic approach to health and well-being. The percentages are also clear: 90-95% of DCs treat NMS disorders (primarily back and neck pain), 5-10% treat non-NMS. I've been trying to get this crucial point across for months now. CorticoSpinal (talk) 00:01, 31 May 2008 (UTC)

I view with great skepticism any claim that the debate is "over" or that "it's a done deal". Remember, this is chiropractic we're talking about: put 3 chiropractors in the room and ask them a question, and you're bound to get at least 4 strongly held and widely varying answer. Certainly the WFC approach is not universally held by chiropractors: Homola, a chiropractor, argues that the WFC's definition is "plunging the profession deeper into pseudoscience and away from establishing an identity for chiropractors as back-pain specialists". See: Homola S (2008). "Chiropractic: a profession seeking identity". Skept Inq. 32 (1).

Maybe what we need to get from this is that when we talk about Neuromusculoskeletal(90-95%) we can use mainstream editing, but when we talk about the vitalistic (non-materialistic) aspects of subluxation and innate intelligence(5-10%), whether past or present, we need to treat it as a Fringe theory - meaning that we explain it NPOV, but give the mainstream view more weight. I'm okay with that... does that work for others? The trick is that we have to be able to differentiate who uses what concepts, because it is not fair to either side (reform or straight) to burden them with the other's baggage or jargon. -- Dēmatt (chat) 00:35, 31 May 2008 (UTC)

Those percentages do not sound right, as I expect that far more than 5-10% chiropractors are straights. (I have no idea where those percentages came from; can anyone cite a source?) Furthermore, the vitalistic stuff is important when explaining chiropractic history, so it needs to be covered more than just the current percentage of practitioners would suggest, if only in Chiropractic #History. Finally, as the McDonald survey shows, the distance between straights and mixers is not as far as a simple "straights vitalistic, mixers materialistic" discussion would suggest. Eubulides (talk) 01:08, 31 May 2008 (UTC)

Being a straight DC doesn't imply fringe. Straights by and large majority treat MSK issues, they're just more likely to treat non NMS ones. Vitalism was used to differentiate legally and is better represented by holism today. The concept still stands: the whole is greater than the sum of its parts. Was it Aristotle or Plato who said that? Regardless, I support Dematts suggestion its sensible, but lets not bring skeptical inquirer articles and Homola into this: We have DC/PhDs who produce far better articles with better content on the same subject. Homola has direct ties with Stephen Barrett and his views are completely fringe. See his article in 2006 in Clin Ortho which was rebutted by Dr. Hart and throttled by DeVocht's counterpoint which was a far superior piece of research. Bottom line should be, the identity issue is officially put to rest, primarily NMS yet overall health, and the majority of the profession should not be discredited because of the fringe aspects of a minority of practitioners. Good call by MartinPhi as well. We're moving in the right direction; this is positive, productive dialogue for a change. CorticoSpinal (talk) 01:46, 31 May 2008 (UTC)

Not surprisingly I disagree with the characterization of Homola's recent publications: I think they're of higher quality than DeVocht's paper. I also disagree that the identity issue has been put to rest. It's not just Homola who says that chiropractic still suffers from a high degree of internal confusion. See, for example, the WCA's take on the WFC's position.[76] Eubulides (talk) 07:56, 31 May 2008 (UTC)

BJD Neck Pain Task Force: Dominated by Chiropractors?

Claim:

"The Task Force report represents the chiropractic mainstream (although the task force has some MD members, it is dominated by chiropractors). Ernst represents critics of chiropractic, which includes much of the medical mainstream, a far bigger group of people than chiropractors. Both sides make good points, and both should be fairly represented. [77]."

Considering the information below, its clear that this statement is without merit and invalidated. Thus, the argument presented above is debunked. Consequently, TaskForce, as an international, muti-disciplinary source gets more weight than the opinion of Edzard Ernst and we can put this is a FAQ so the next generation of Wikipedians don't have to go through the same dog and pony show. CorticoSpinal (talk) 19:57, 30 May 2008 (UTC)

The information has merit and is not invalidated. Please see below for details. Eubulides (talk) 01:08, 31 May 2008 (UTC)

Common sense dictates that indeed, the argument presented that the TaskForce represents mainstream scientific opinion and not mainstream chiropractic opinion, your personal, yet curious interpretation of the matter. CorticoSpinal (talk) 08:45, 31 May 2008 (UTC)

A frequent argument made is that the Neck Pain Task Force is 'dominated by chiropractors' and is a mainstream chiropractic document. I have argued that no, the TaskForce is a mainstream scientific document. The dispute is not whether or not the Task Force is reputable and represents mainstream scientific opinion. The dispute is the allegation used by Eubulides et al. that the TaskForce is a dominated by chiropractors. This has tendentiously been pushed for now for 3 months. An analysis into the principal investigators (scientific panel) demonstrates clearly the claim is without merit (which was used to discredit and subvert the findings and weighting of the task force at Chiropractic

A quick look into the matter here easily debunks the claim of chiropractors "dominating" the TaskForce. Looking at the advisory, scientific secretariat and admin committees, here is the breakdown, by professional designation of the principal investigators: MD=16, DC=8, DDS=1, PT=1, OT=1, PhD=6. Dual registrants were noted as such. Dominated? No. Debunked? Yes.

PS: This further proves chiropractic medicine is mainstream, btw. The leaders of the admin and scientific committees are DCs and the lead co-ordinator is a DC/MD/PhD. Yet more evidence that supports the argument that chiropractic care is part of mainstream health care. Cheers. CorticoSpinal (talk) 16:22, 30 May 2008 (UTC)

• That source shows that top guys in the task force are chiropractors. The president (Haldeman) is a chiropractor. The head of its scientific secretariat (Cassidy) is a chiropractor. If the #1 admin and #1 technical guys are chiropractors, it's a pretty safe bet that the task force in general will be friendly to chiropractors, regardless of whether they have "D.C." after their name.
• This can be shown in who's writing the reviews. The most important review for Chiropractic #Safety is Hurwitz et al. 2008 (PMID 18204386). Here, the lead author (Hurwitz) is a chiropractor, and 5 of 12 authors are chiropractors. Again, a chiropractor is running the show, and there is a heavy chiropractic component to the reviewers involved.
• I am not at all accusing the task force of being intentionally biased or underhanded or anything like that. It's an extremely strong group and they have done good work. Still, one can't ignore the fact that unintentional biases may well be at work, and that a group with such a heavy chiropractic makeup is less likely to generate a report that is critical of chiropractic.
• There are certainly some elements of mainstream medicine that are supportive of chiropractic, just as some elements of mainstream medicine support acupuncture, homeopathy, etc.; but this is not the same thing as saying that chiropractic is mainstream medicine. As we've seen, very few chiropractors agree with that assessment.

Eubulides (talk) 01:08, 31 May 2008 (UTC)

You can spin all you want but the fact remains you said it was dominated by chiropractors, which is isn't. Also your are using red herrings again ("there are certainly some elements of mainstream medicine that are supportive of chiropractic, just as some elements of mainstream medicine support acupuncture, homeopathy, etc.; but this is not the same thing as saying that chiropractic is mainstream medicine. As we've seen, very few chiropractors agree with that assessment.) I've asked that you not do that, but I guess it's more WP:IDIDNTHEARTHAT. Besides the obvious diversion, do you have any evidence that suggests the TaskForce is produced by a fringe organization? Because if you're saying that there's a heavy chiropractic component, in an international multidisciplinary, health care document, you might have inadvertently proved my point that chiropractic is more part of mainstream health care than fringe. (PS -I'll kindly remind you again that chiropractic is not part of mainstream medicine(the profession) but moreso a part of mainstream health care (the system). It's all in the details. Also, your comment ("...a chiropractor is running the show) proves that the profession is more mainstream than fringe, but it should be noted that Dr. Haldeman a chiropractor, a neurologist (MD), and a scientist (PhD). Bottom line, are you disputing the fact that the Bone and Joint Decade is a mainstream scientific outfit? CorticoSpinal (talk) 02:13, 31 May 2008 (UTC)

It is chaired by a chiropractor, and the primary author of the review in question is a chiropractor. You may not call that "domination", but I do. It's clearly high-quality work and should be cited, but it is not the definitive source in this area; there are other mainstream sources that should be cited as well, and these include Ernst as well as others. Eubulides (talk) 07:56, 31 May 2008 (UTC)

"it's a pretty safe bet that the task force in general will be friendly to chiropractors, regardless of whether they have "D.C." after their name". To be clear here Eubulides, are you calling into question the scientific integrity of the interdisciplinary panelists of the World Health Organizations Bone and Joint Decade 2000–2010 Task Force on Neck Pain? CS is right on this one, this is a mainstream scientific document, not a mainstream chiropractic document. DigitalC (talk) 06:30, 31 May 2008 (UTC)

No, I already said "I am not at all accusing the task force of being intentionally biased or underhanded or anything like that". Their review is consonant with mainstream chiropractic, and I would even agree that it is part of mainstream science. However, I do disagree that they represent the definitive mainstream opinion on chiropractic care: they do not. Their review represents one source among many; it is not "the definitive" source versus a bunch of "fringe" sources. Eubulides (talk) 07:56, 31 May 2008 (UTC)

CS, I'm confused about whcih documents we are talking about. Ernst has several papers. Do you have links to the Task Force document and the Ernst document in question? (The link above does not work, btw). I think if we can see them together, we can better make judgements. -- Dēmatt (chat) 17:21, 30 May 2008 (UTC)

The Task Force document in question is Hurwitz et al. 2008 (PMID 18204386). It is not freely readable, I'm afraid. It's not clear which Ernst document CorticoSpinal is referring to. Eubulides (talk) 01:08, 31 May 2008 (UTC)

I'm talking specifically about the Bone and Joint Decade (2000-2010) Neck Pain Task Force. Links to it can be found here and [here]. I shall save my rebuttal of Ernst for a separate thread, I do not want to conflate the 2 topics. PS -I believe I fixed the link in my previous comment. If you want to open another thread about Ernst (Reliability/Validity of the conclusions of Edzard Ernst regarding spinal manipulation and chiropractic care) I could post the papers and rebuttals there. CorticoSpinal (talk) 17:41, 30 May 2008 (UTC)

Well, I don't think there is any question that that is a RS. I assume you are asking whether Ernst should carry more weight than the Task Force, is that correct? -- Dēmatt (chat) 17:59, 30 May 2008 (UTC)

Ahh, so the whole issue of WP:FRINGE is whether Ernst carries as much weight as the Task Force... Well, if all things are equal, and both are considered mainstream, then I think the Task Force carries more weight just because Ernst is one person vs an entire multidisciplinary body. However, if the Task Force is fringe, then Ernst would become the mainstream opinion at this time and therefore carry more weight... -- Dēmatt (chat) 18:04, 30 May 2008 (UTC)

Yes, that's right. The question is whether the Task Force document (which is largely supportive of chiropractic care) should carry substantially more weight than critical reviews like Ernst's (which are less supportive). As I understand it, CorticoSpinal argues that the Task Force is mainstream and that Ernst etc. are fringe, hence Ernst etc. are unfairly given too much weight right now. CorticoSpinal's position disagrees with more-neutral measures like Google Scholar citation count, but he disputes that the citation counts are significant. Eubulides (talk) 01:08, 31 May 2008 (UTC)

I don't think this is a logically sound argument. Regardless of the conclusions we're looking at the quality of the research document. The quality of the document depends on several things, depth, breath, solo author vs. international multidisciplinary experts, notable institutions involved, where the source is published and obviously methodological quality. The strength of the conclusions and, consequently, the weight of the paper are directly dependent on these factors. For example, one review that is written in say 1 week by one reviewer who comes to conclusion 'x' whereas another review is done over a period of 8 years by a variety of scientific experts representing various mainstream health disciplines who comes to conclusions are polar opposite 'y' should logically be weighed differently no? Thus the argument at hand isn't about citation counts, it's about the reliability, validity and the overall quality of the papers in question. The issue at hand is the Neck Pain Task Force paper a stronger paper than the paper by Edzard Ernst. I would argue that the TaskForce not only trumps the Ernst papers (whose conclusions were openly disputed and refuted) but does so rather handily and that we didn't need to waste 4 months proving this point. Your argument comes down to we should weigh a disputed paper by a known critiic with heavy bias whose conclusions are opposed by the majority of the literature equal weight and a google counter to the BJD 2008 TaskForce on Neck Pain, which according to you is fringe because it is a chiropractic document. Are you serious? CorticoSpinal (talk) 05:43, 31 May 2008 (UTC)

• I have never said that the Task Force review is fringe. On the contrary, I've said it's a mainstream work.
• You are correct that the Task Force review (Hurwitz et al. 2008, PMID 18204386) was done by a lot more people who undoubtedly collectively took a lot more time than Ernst 2007 (PMID 17606755). But Ernst had an advantage too: his review focuses entirely on adverse effects of SMT, whereas Hurwitz et al. is about the much broader topic of the use, effectiveness, and safety of all noninvasive interventions for neck pain etc. If memory serves, Ernst's more-focused review, which is directly on the topic at hand, has more material on SMT safety than Hurwitz's broader review.
• Ernst 2007 is not the only high-quality critical source cited on chiropractic safety; there are others, including Vohra et al. 2007 (PMID 17178922) and Miley et al. 2008 (PMID 18195663). These are also cited by Chiropractic#Safety.
• Ernst 2007 was not "refuted"; it was criticized, which is normal and expected in a contentious scientific area like this.
• Most of the material in Chiropractic #Safety is supported by sources favorable to chiropractic; this includes the WHO guidelines on safety (the single most-heavily cited source), Anderson-Peacock et al. 2005 (PDF), and Thiel et al. 2007 (PMID 17906581).

Eubulides (talk) 07:56, 31 May 2008 (UTC)

Roughly, thats my interpretation of the matters as well. Also, the Ernst papers have been refuted and rebutted (so they're disputed). We're currently giving a disputed source, whose conclusions are opposed by the majority of the literature, equal weight (if not more) with respect to crucial scientific aspects such as Safety, Efficacy, and Cost-Effectiveness. Essentially it's being used to water down scientific consensus which has consistently demonstrated that SMT/manual therapy and chiropractic care as a safe, effective and cost-effective for back pain (at a minimum) neck pain (generally) and neuromusculoskeletal complaints (globally). It's a pretty big deal. The opinion of one man can subvert and circumvent international scientific consensus at Chiropractic. This is the push Eubulides has been making over the last 4 months, the push I've been resisting for 4 months and we're now seeing it crystallize. In Canada, we'd say this issue is the "TSN Turning Point". Eubulides assessment of the TaskForce has been demonstrated to be false. He has tendentiously pursued this point for months. Hit control-F, type "dominated by chiropractors" to see how often he has used this false argument to discredit the task force and its implications for the article as a whole. CorticoSpinal (talk) 18:23, 30 May 2008 (UTC) Addendum: The whole issue of WP:FRINGE is whether or not it applies to the chiropractic profession as a whole, and whether or not chiropractic care is moreso mainstream health care or moreso fringe health care. CorticoSpinal (talk) 18:26, 30 May 2008 (UTC)

The Task Force's work is a mainstream chiropractic document, and should be fairly summarized, but it does not represent "the international scientific consensus" nor does it represent the definitive mainstream scientific opinion. It should not be given undue weight over critical mainstream opinion. All sources in this controversial area are disputed to some extent; that is not an argument for not citing them. Eubulides (talk) 01:08, 31 May 2008 (UTC)

Repeating the same argument does not advance the debate. You have suggested the Task Force was dominated by chiropractors. The evidence has proven this to be incorrect. You have suggested it's a mainstream chiropractic document (despite the fact there is a 2:1 ratio of MD to DC) thats incorrect. It's a "a multidisciplinary, international Task Force led by Prof Scott Haldeman from the University of California in Irvine and in L.A., involved more than 50 researchers based in 9 countries and represented 14 different clinical and scientific disciplines in 8 universities. The group assembled the best international research data on neck pain and related disorders – specifically more than 31,000 research citations with subsequent analysis of over 1,000 studies – making this monumental document one of the most extensive reports on the subject of neck pain ever developed, and offering the most current expert perspective on the evidence related to the treatment of neck pain."[78]. So that's incorrect too. It does indeed represent mainstream scientific opinion because its written by mainstream scientific experts as illustrated above. Next, there really is no controversy in this area, besides the fact that you are disputing the weight of the task force and claiming it is mainstream chiro and not mainstream science which is clearly not the case. So, next unless you can provide a reliable source that disputes the conclusions of the TaskForce then all we are left is your protest vote which is more or less a case of WP:IDONTLIKEIT. We do however have reliable sources that disputes Ernst's reviews. So, given that Ernst' reviews are disputed in the literature which suggests his conclusions are invalid, given that he is a one man show vs. an international panel of experts, given that the TaskForce is a mainstream scientific document, I fail to the merit in your argument that the sources should be presented with the same weight. Also, I'd please ask that you not misrepresent my argument, as you have done. Despite the severe bias, methodological flaws and invalidated conclusions I haven't argued against the inclusion of Ernst. I have argued that his conclusions represent the minority view of the literature, that he is rather extremist in his assessment of SMT and chiropractic care, and that there is quite frankly, far better research that disputes his conclusions. So, please explain to me, logically, why Ernst POV=Task Force in terms of weight. Thanks. CorticoSpinal (talk) 02:04, 31 May 2008 (UTC)

I agree that repeating the same argument does not advance the debate; as this is the only new discussion topic that appears in the above comment, perhaps we can at least agree that the subject is exhausted here? Eubulides (talk) 07:56, 31 May 2008 (UTC)

No, the subject is not exhausted until we've reached a definite, undisputed consensus that settles the matter once and for all. It's been 4 months of back and forth nonsense over things exactly like this. We will sit hit and get it right and then we will codify it in a FAQ or a chiropractic constitution if we will to make sure these types of tendentious, civil pov pushing arguments that is not scientifically credible nor defensible get the prominence it has here on Chiropractic. So, again, I will ask you directly: Please explain to me, logically, why Ernst POV=TaskForce in terms of weighing and impact? To be clear, please explain why you contend the impact of a disputed paper by 1 author who is known critic of SMT and chiropractic is greater than the impact of a international health document by a panel of expert scientists that has been described as the most authoritative and comprehensive, evidence-based investigation on neck pain? Because that's what this is really about. Weighing Ernst as much and more (as you content) than the TaskForce (which you cite as fringe and being a chiropractic document). CorticoSpinal (talk) 08:45, 31 May 2008 (UTC)

Eubulides, you say that "The Task Force's work is a mainstream chiropractic document, and should be fairly summarized, but it does not represent "the international scientific consensus" nor does it represent the definitive mainstream scientific opinion." and "Ernst represents critics of chiropractic, which includes much of the medical mainstream."

I'm not sure how you know either of these sentences. If you have the sources for them, then you have made your case. But they are statements. What I mean is, statements about scientific opinion and about the medical mainstream should be backed up by sources (I mean if we use that to write the article). In this large of a field, the mainstream opinion will be written somewhere, in peer reviewed articles or other RS sources. I'm just wondering how we know this. If we do know it, then this information is highly relevant. I usually edit in the paranormal, and for instance in Astrology, there is a clear and stated scientific consensus that it is wrong.

I assume you're talking about this source. This is NIH, correct? So, it was sponsored by NIH? What exactly does this Joint Decade 2000-2010 Task Force on Neck Pain represent? ——Martin^phi ☎ Ψ Φ—— 02:53, 31 May 2008 (UTC)

Consider where the funding for the Task Force came from: [79]. ScienceApologist (talk) 07:45, 31 May 2008 (UTC)

The web site Martinphi cites (PMID 18204386) is just the entry in the NIH PUBMED database for the abstract of the paper in question. It has nothing to do with whether the task force was sponsored by the NIH. As ScienceApologist mentions, its funding came from places like the Canadian Chiropractic Protective Assn. and like NCMIC, a chiropractic malpractice insurance company. Eubulides (talk) 07:56, 31 May 2008 (UTC)

Request for comment

Education, licensing, and regulation

There are a variety of Education, licensing, and regulation drafts. I suggest we choose the best draft and continue to move the article forward.

Scientific research vs Scientific investigation

Which section name do Wikipedians prefer. Scientific research or Scientific investigation for the section title. QuackGuru 02:00, 31 May 2008 (UTC)

A better name would be "Evidence basis". Not all the material in this section is scientific; some of it is based only on case studies. Eubulides (talk) 07:56, 31 May 2008 (UTC)

Vertebral subluxation

Chiropractic#Vertebral subluxation This section is not about history. I suggest we move the section and perhaps expand on the subluxation theory. Thoughts? QuackGuru 02:00, 31 May 2008 (UTC)

I agree with moving the section; I've already suggested moving it to Chiropractic#Philosophy; see #Other POV issues above. Also, Chiropractic#Schools of thought and practice styles should be made a subsection of Chiropractic#Philosophy, as schools of thought are inevitably tightly bound to philosophy. Eubulides (talk) 07:56, 31 May 2008 (UTC)

My thoughts are that we should focus on forming a consensus on effectiveness and education first, before moving on to other sections. I'm not trying to stonewall here, but there is no rush. Given the amount of talk page space we take up discussing 1 section, I think its better that we don't try to fix every section at once. We ARE making progress. DigitalC (talk) 07:16, 31 May 2008 (UTC)

I disagree. I think that every proposal should be considered as long as editors are willing to entertain them. I, for one, am willing to review QG's proposals. If you aren't, that's fine, but there's no need to prevent others from reviewing them. ScienceApologist (talk) 07:30, 31 May 2008 (UTC)

similar cost-benefit sentences

An initial study found that the benefits of chiropractic care for neck pain seem to outweigh the possible risk. When compared with treatment options such as physiotherapeutic exercise (also performed by a chiropractor), the risk-benefit balance does not favor SMT. These two above sentences are similar and should both be in the cost-benefit section together. QuackGuru 02:00, 31 May 2008 (UTC)

I agree that it makes no sense to separate those two sentences. As discussed in #Comments on 2008-05-25 issues list above, the sentence based on the primary source is dubious and the simplest thing would be to remove it, along with its source. Fancier solutions are also possible, such as summarizing the primary source more carefully, or putting in another primary source to balance the dubious one. Eubulides (talk) 07:56, 31 May 2008 (UTC)

Which paper does that sentence come from? Because the majority of the research suggests the opposite (risk balance does not favour SMT). CorticoSpinal (talk) 02:31, 31 May 2008 (UTC)

Both sentences are referenced. QuackGuru 03:06, 31 May 2008 (UTC)

That wasn't my question. I'm asking you about which paper that it came from and who the author was. CorticoSpinal (talk) 05:15, 31 May 2008 (UTC)

Check the article. ScienceApologist (talk) 07:23, 31 May 2008 (UTC)

I checked the article, and easily found that the two sources in question are Rubinstein et al 2007 (PMID 17693331) and Ernst & Canter 2006 (PMID 16574972). Eubulides (talk) 07:56, 31 May 2008 (UTC)

Medical opposition neutrality

Chiropractic#Medical opposition describes a debate between conventional medicine and chiropractors. The debate can be covered more neutrally. QuackGuru 03:06, 31 May 2008 (UTC)

Yes, I read that, and it was part of my question: Is that the worst it gets? Statements on this talk page lead me to believe there is a resounding rejection of chiropractic by the scientific and medical establishment in general, which could be inserted. I skipped the history, as it doesn't relate to the current debate. ——Martin^phi ☎ Ψ Φ—— 03:24, 31 May 2008 (UTC)

I'm not sure what you mean by "worst it gets", but currently Chiropractic #History, which contains Chiropractic #Medical opposition is the section with the most POV problems in Chiropractic. I wouldn't agree with rewriting Chiropractic to reflect mainly a "resounding rejection of chiropractic by the scientific and medical establishment in general", as that doesn't describe mainstream opinion accurately. It's not that negative. Eubulides (talk) 07:56, 31 May 2008 (UTC)

MartinPhi, that is history and the opposition story has changed, medicine has partially embraced chiropractic care (TaskForce, integrative medicine models) yet a fringe element within it continues to critically attack it, via "research" now such as Ernst'. I could add about 5 references regarding the deliberate misattribution of strokes to chirorpactors despite the fact no chiropractor was involved in the treatment yet received 'chiropractic manipulation'. It's that kind of shadiness that has gone on. The AMA also recently tried to prevent chiropractors from conducting examinations outside the spine in a clearly anti-competitive move that actually breached the US Supreme Court decision ruled against the AMA. Also, one must differentiate between chiropractic integration into mainstream medicine vs. integration into mainstream health care. One is occurring (medicine) where one has already occurred (licensure, regulation, reimbursement, governmental and health agency recognition, use of services, scientific contributions, etc.). More evidence that chiropractic is mainstream as opposed to fringe. Quack we haven't heard your opinion yet, I'm going to assume you believe Chiropractic is fringe but I'd rather you tell the community for yourself your stance on this issue. Cheers. CorticoSpinal (talk) 05:27, 31 May 2008 (UTC)

Again, Ernst's work represents mainstream criticism of chiropractic, published in reputable journals and widely cited. It is not "fringe" by any reasonable measure. Eubulides (talk) 07:56, 31 May 2008 (UTC)

WP:REDFLAG. The TaskForce document is written by chiropractors who are not reliable sources when it comes to whether mainstream medicine has embraced chiropractic care. You can see that the Task Force received its funding mainly from chiropractic organizations here. Small wonder they declared chiropractic to be as effective and safe as they did! We can hardly expect chiropractors to be reliable when they admit to their agenda to make chiropractic a part of the "mainstream". No, we need consistent statements from medical doctors who are not chiropractors to establish this so-called "fact". ScienceApologist (talk) 07:28, 31 May 2008 (UTC)

References