Talk:Craniosacral therapy

From Wikipedia, the free encyclopedia
Jump to: navigation, search
          This article is of interest to the following WikiProjects:
WikiProject Skepticism (Rated B-class)
WikiProject icon This article is within the scope of WikiProject Skepticism, a collaborative effort to improve the coverage of science, pseudoscience, pseudohistory and skepticism related articles on Wikipedia. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.
B-Class article B  This article has been rated as B-Class on the project's quality scale.
 ???  This article has not yet received a rating on the project's importance scale.
Note icon
This article has been marked as needing immediate attention.
WikiProject Alternative medicine (Rated C-class)
WikiProject icon This article is within the scope of WikiProject Alternative medicine, a collaborative effort to improve the coverage of Alternative medicine related articles on Wikipedia. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.
C-Class article C  This article has been rated as C-Class on the quality scale.
WikiProject Medicine (Rated C-class, Low-importance)
WikiProject icon This article is within the scope of WikiProject Medicine, which recommends that this article follow the Manual of Style for medicine-related articles and use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine.
C-Class article C  This article has been rated as C-Class on the project's quality scale.
 Low  This article has been rated as Low-importance on the project's importance scale.


The sentence, "They point to a recent trend of opinion that regards clinical trials as unsuitable to measure the benefits obtainable from therapies such as craniosacral therapy; and that the use of other outcome measures is preferable" is clear WP:OR, as the sources do not mention craniosacral therapy. It is baffling to me how we can use these sources, in the lead no less, when they don't mention craniosacral therapy. Yobol (talk) 12:30, 15 July 2013 (UTC)

The sources refer to papers published in well-respected sources discussing the fact that standard research models may not be correct to assess the efficacy of alternative or complementary therapies. Certainly we can agree without calling it OR that CST is an alternative or complementary therapy. Therefore, I don't believe the sources need to mention CST explictly to validly verify the statement at hand. The sources are offered as examples of the research that CST proponents point to to defend their case. Whether or not the research actually intended to include CST in its scope, the CST proponents rely on that research to bolster their case. Whether or not such research actually does bolster their case is a point for argument, but not that the proponents rely on said research. WikiDan61ChatMe!ReadMe!! 12:43, 15 July 2013 (UTC)
"Alternative medicine" is far too large a field to allow any mention of it to also refer specifically to CST. Also the sourcing appears to have problems with compliance with WP:MEDRS (WP:MEDDATE issue?) and uses the same individual twice under two different sources (is that an undue problem?). Also where the content is located is a problem with WP:LEAD, the content and sourcing are used only in the lead and are not developed in the body, the lead needs to summarize the content developed in the body and should not have new sources in it that aren't in the body. Zad68 12:55, 15 July 2013 (UTC)
The sources listed a published text, a medical journal, and an article by Carol M. Black, a noted figure in British public health issues. How much more reliable do you need? And CST is defined as an alternative therapy in the first sentence of the article. I don't argue that the CST proponents are correct in asserting that these papers validate their claims, but the CST people do point to these papers in their arguments. Whether or not such arguments are valid is not the point, the point is that the CST proponents point to them. WikiDan61ChatMe!ReadMe!! 12:59, 15 July 2013 (UTC)
PS: The content is listed in the lead because that's where the paragraph that defines CST as pseudo-science and quackery is located. In order to provide proper balance and neutrality, the proponents' view should be given at least the same visibility as the skeptics' view. WikiDan61ChatMe!ReadMe!! 13:00, 15 July 2013 (UTC)
Black is a well-connected FRCP and it's reasonable to expect her views will hold more weight than others' but where do we have anything showing Black has commented on CST specifically? If we don't it's textbook WP:SYNTH, if we can't hammer it out here we can take it to the WP:NORN. Even if she does talk about CST we'd have to attribute it to her specifically, as per WP:MEDRS her view would fall under expert opinion. As for where this is mentioned (in lead and not in body), per WP:LEAD, this needs to be fixed. It needs to be developed in the body first, and then the lead will summarize the body. We can't have three sources used in the lead and not in the body. Zad68 13:09, 15 July 2013 (UTC)
I've edited to note their source talks about CAM therapies in general, not CST specifically - David Gerard (talk) 13:54, 15 July 2013 (UTC)
This is a small step in the right direction but doesn't get us all the way there. To support the current article content "They claim a recent trend of opinion..." we need a source that specifically shows that CST proponents state this. We have what they article says they use, we don't have a source that actually states they do use it, this is still a WP:OR problem, and as mentioned above, still a WP:LEAD problem. Zad68 14:00, 15 July 2013 (UTC)

──────────────────────────────────────────────────────────────────────────────────────────────────── I think this discussion is missing the point. The point isn't whether the sources actually mention CST. The point is that the CST proponents use these sources to bolster their argument. So, perhaps the citation needs not to be to the sources themselves, but to the CST proponent position paper that cites these sources. WikiDan61ChatMe!ReadMe!! 14:17, 15 July 2013 (UTC)

the citation needs not to be to the sources themselves, but to the CST proponent position paper that cites these sources - Yes please... honestly I think the article already covers that well enough in the sentence before the one we're discussing, the sentence reading "Proponents of craniosacral therapy (notably the Craniosacral Therapy Association of the United Kingdom) disagree with this depiction and point to a number of small studies which, taken together, they claim indicate beneficial changes for participants in the studies." Doesn't that cover their view? Zad68 14:23, 15 July 2013 (UTC)
No, I don't think that does cover their view sufficiently. Their view is twofold:
  1. There are a number of small studies that demonstrate some advantage to CST; AND
  2. Several major voices in the medical field advocate for a change in the way alternative therapies are evaluated, such that these numerous small studies might validate their claim in the same manner that one large study would.
I don't say that I agree with their claim, but that is their claim. WikiDan61ChatMe!ReadMe!! 14:34, 15 July 2013 (UTC)
Yes, got it... So view #2 isn't clearly subsumed (if that's the right word) into view #1? I'd think you'd have to assume view #2 to be true to hold view #1. Are we in agreement now that the sourcing provided for the sentence covering view #2 isn't sufficient? If so, can we either remove or tag the sentence for view #2 until proper sourcing is found for it? Zad68 14:37, 15 July 2013 (UTC)
No, view #2 is not subsumed into view #1. #1 states the record, and #2 states that perhaps this record is sufficient. Without #2, #1 would be a pointless statement. Yes, one must accept #2 in order for #1 to be a valid argument, but one must explicitly state #2 in order to provide the validation of #1. Since #2 is a non-standard point of view, it can't just be assumed, it must be explicitly stated.
Since the statement reflects the CSTA's claims, I propose the following:
They claim a recent trend of opinion, such as Evans (2003)[1] and Black (2009)[2], that regards clinical trials as unsuitable to measure the benefits obtainable from some complementary and alternative therapies, and which regard the use of other outcome measures as preferable.[citation needed].
  1. ^ Evans, D (2003). "Hierarchy of evidence: a framework for ranking evidence evaluating healthcare". Journal of Clinical Nursing 12: 77–84. 
  2. ^ Black, Carol (10 August 2009). "Assessing complementary practice: Building consensus on appropriate research methods". The King's Fund. 
In this proposed change, I have removed Reason and Rowan, New Paradigms of Research, because I can find no listing of such a book in either Google books or Google scholar, and have my doubts as to its existence or legitimacy. I also list the statement as "citation needed" because I can find no such statement on the CSTA website. However, I would prefer not to delete the statement yet until Peoplemapsdavid (talk · contribs) can weigh in on the topic (he is the user who introduced the section in the first place and may have more insight into these sources). WikiDan61ChatMe!ReadMe!! 15:02, 15 July 2013 (UTC)
I'm OK with waiting for more input, from Peoplemapsdavid and others. From my past experience I've had difficulty in convincing those professionally involved with a movement like this to abide by Wikipedia's content guidelines, but hoping it won't be a problem here. Fundamentally I'm very uncomfortable with using an unsourced statement based on advocacy organization's views in the lead like this, especially without attribution. Even with attribution, using the viewpoint of the Craniosacral Therapy Association of the United Kingdom sourced directly to them would probably be an improper use of a primary source. The more we talk about this the more it's becoming clear (to me) that the statement needs to be removed from the lead certainly and from the article altogether probably. Zad68 15:18, 15 July 2013 (UTC)
They're likely as citable as we're going to get for a proponent's view, which is IMO relevant to the topic. WikiDan61's suggested text is fine by me, fwiw - David Gerard (talk) 16:32, 15 July 2013 (UTC)
I disagree with Dan's proposed content change per WP:CHALLENGE as we'd be supporting the placement of challenged unsourced content into the article. It needs to be sourced or come out until it's sourced. Zad68 17:02, 15 July 2013 (UTC)

──────────────────────────────────────────────────────────────────────────────────────────────────── I'd be OK with removing the proponents' view from the lead if we also remove the skeptics' view, so as to avoid giving undue weight to one side or the other. I would recommend moving both views to a "Criticism" section. WikiDan61ChatMe!ReadMe!! 16:09, 15 July 2013 (UTC)

That would be balance fallacy, not neutrality - David Gerard (talk) 16:32, 15 July 2013 (UTC)
Explain please. What is "balance fallacy"? WikiDan61ChatMe!ReadMe!! 16:41, 15 July 2013 (UTC)
He'll have to confirm but I'm pretty sure he's talking about WP:GEVAL. Zad68 17:16, 15 July 2013 (UTC)
If this were an article on medicine in general, or even on alternative medicine in general, I'd say that providing the proponents' view on CST would be giving CST undue weight. But this is an article specifically on the topic of CST: the skeptics' view and the proponents' view should be given equal weight when describing this specific alternative medicine modality. WikiDan61ChatMe!ReadMe!! 17:27, 15 July 2013 (UTC)
I'm afraid this approach you're describing is really not in line with WP:WEIGHT. We give emphasis to viewpoints in proportion to the prominence found in reliable sources. If there are 10 good-quality independent reliable secondary sources that all say "CST has not been shown to be effective" and none state otherwise, the article needs to express that scientific consensus clearly. We must not give equal validity to poorly-sourced viewpoints, per WP:NPOV. Zad68 17:37, 15 July 2013 (UTC)
I disagree - I think stating the views of proponents (and a national peak industry body would certainly count) and their justifications would do the reader a service. Needs that last bit cited, though - David Gerard (talk) 17:42, 15 July 2013 (UTC)
The heart of the issue is the assertion the skeptics' view and the proponents' view should be given equal weight as that's clearly not found in content policy. If there's overwhelming evidence against the efficacy of CST and there is only the non-peer-reviewed statements from an advocacy group in support of it, the article must not give the two views equal weight. The article can provide the proponents' views but also indicate clearly that the proponents' views are not in line with scientific consensus (if that's indeed what the sources say). Zad68 17:54, 15 July 2013 (UTC)
Fine by me, I think the article will be better for having the group's view (which I think is laughably unjustified, but anyway), but am not wedded to it being any particular place in the article - David Gerard (talk) 19:17, 15 July 2013 (UTC)
Ok... the next question is if we're going to go ahead and pull a statement (as a primary source) from an organization that promotes CST, which organization's statement are we going to use? There's a suggestion to use a statement from the Craniosacral Therapy Association of the United Kingdom but why not the Biodynamic Craniosacral Therapy Association of North America? The New England Center for CranioSacral Therapy? This place in Nepal? Barbara De Vito? Gloria Flores? Is there such a thing as an authoritative international body that speaks for CST globally? Without a secondary source to identify the most important pro-CST message from among all the proponents, how do we know which organization's statement to choose as the best, most representative view? Zad68 19:36, 15 July 2013 (UTC)
I'd say start with something as an improvement over nothing (avoid the Nirvana fallacy). This is something, start here, improve later. This isn't a BLP, eventualism is actually OK - David Gerard (talk) 20:41, 15 July 2013 (UTC)
"Nirvana fallacy" sounds like a Kurt Cobain cover band...Face-tongue.svg A few steps down from Nirvana is Sufficient, and I'm hoping we also avoid the "Something is better than nothing" fallacy (because it often isn't). But I'm willing to let this go... Zad68 03:47, 16 July 2013 (UTC)
Agree with Zad68; notable advocates and their theories should be published in independent sources, per WP:FRINGE#Independent sources. I have moved the discussion of the UK group down to the body of the article, but am requesting 3rd party sourcing to show that this group is notable within the the craniosacral community and that this particular view is a notable view in that community. Yobol (talk) 12:21, 24 July 2013 (UTC)

WP:OR - Sources[edit]

One of the sources is given as "Reason and Rowan (ed.). New Paradigms of Research" This isn't enough for me to identify a particular document. Can a URL, PMID or ISBN be provided please? Zad68 13:18, 15 July 2013 (UTC) Adding: Is it this? Zad68 13:19, 15 July 2013 (UTC)

Re your 15 July comment about overwhelming evidence against the efficacy of CST, Zad, there isn't any! The negative evidence is mostly about the description of how CST works; whereas Professor Ernst's separate comments express his opinion of the poor quality of 5 of the 6 clinical trials carried out on CST - not on whether CST works. That's why we're not comparing like with like. The small studies mentioned previously show an overall trend towards participants experiencing health and other improvements, whereas the negative sources quoted to justify calling CST quackery are wholly about the description of how it works; not on whether it works. As a general observation on some of the other recent comments on this page, the clinical trial discussion is not about CST as such but whether clinical trials are the right research vehicle for complementary medicine.

There are a number of internet references to Reason and Rowan papers and also an extract from their book Human Inquiry in Action: developments in new paradigm research. Please bear in mind that the discussion is about the suitability of clinical trials for complementary medicine and therapy; not particularly about their use in testing the efficacy of CST. Peoplemapsdavid (talk) 16:52, 16 July 2013 (UTC)

Here's the justification for replacing the 'quackery' comment with something more balanced and in tune with client experience. (Suggested wording to follow my comments):

1. Craniosacral therapists don't diagnose, do not deal with symptoms and nor do they either prescribe or discuss medication. CST is not medical and is a subset of what is usually described as Energy medicine. The science behind energy medicine usually starts with what is described as the living matrix which is a continuously interconnected system comprising virtually all the molecules of the body linked together in an intricate network: the skin, the connective tissue and the cellular structure together act as a semi-conductor providing a communication system and one also capable of storing information such as emotional or traumatic experience. Touching the skin provides contact with the whole of the living matrix.

A detailed explanation of the science behind energy medicine is provided by Dr James Oschmann in two books: 'Energy Medicine: The Scientific Basis'; and 'Energy Medicine in Therapeutics and Human Performance'. I find this science much more satisfactory than the hypothesis put forward by the originators of craniosacral therapy, the science of which has rightly been criticised; and which made me decide not to challenge the assertion that CST is pseudoscience.

We haven't carried out any research on how CST works, preferring to concentrate on showing that it does work. Research is very expensive and beyond our means. A large clinical trial costs upwards of £1million and can only really be afforded by pharmaceutical companies who have absolutely no reason at all to want to help find a scientific basis for CST. Available funds have been used to set-up a building block approach to providing evidence that CST works. This will take time but there are now about 50 worldwide small studies (not ours - just carried out independently of each other by interested groups). Taken together, these show that clients receive quantifiable benefit from receiving CST treatments; and that it would be worthwhile setting up much bigger trials. This is where the lack of funding prevents us from doing this; but the collection of small trials and my own and other therapist/client experience is the primary reason I object to the quackery description. It isn't quackery. I've seen too many people helped!

CST takes two year's training in the technique plus a further one year's study of foundation anatomy, so 3 years in all. It's a touch therapy. Clients remain fully clothed; and we use a number of hand holds on various parts of the body to sense where the body is holding tensions. These may arise either from pain, from injury, or from emotional or traumatic experience. There is evidence that 'intent' plays a part in a healing process i.e. the intent to help the client to heal; and placing the hands on the body results in the held tensions relaxing. This is why I find the living matrix science so fascinating because it possibly explains why touching the body can lead to changes within it.

Craniosacral therapists do not manipulate or use any kind of manipulation technique - it's all touch and touch only. It's thought that the internal tensions inhibit the flow of energy and fluids through the body; and prevent whatever healing mechanisms the body has from working. These are primarily the flow of peptides from their source of origin within the body to the receptors for which they're intended. The body manufactures a little over 50 chemicals which jointly enable health and the effective running of the organs and other mechanisms within the body.

2. The handful of examples that purport to show the danger of using CST are not in fact based on craniosacral therapy treatments. They're some kind of cranial intervention used by other modality practitioners who are not craniosacral therapists; and using techniques that are not part of CST training. CSTs never use manipulation; everything is based on touch and only on touch. This so-called negative evidence is used to claim that CST does not work; but none of it is a CST treatment. It can't therefore be said that medical research has concluded that there is no evidence for the therapy's effectiveness.

3. The only research carried out into the effectiveness of CST (which is not the same as research carried out into the scientific explanations put forward by the pioneers of CST - and which I agree doesn't stand-up) shows a trend of improvement either in health and/or in the way in which clients feel about themselves.

4. Craniosacral therapy is not the only therapy for which the underlying science doesn't stack up but from which clients receive definable benefits. Freud's work didn't have a rigorous scientific basis but his theories ruled the psychological world for decades; and is still regarded as a 'useful fiction' in assessing how best to help clients. A particular psychological technique in frequent use with sports 'superstars' is known as the chimp model. Its pioneer, Dr Peters, is the first to admit that the underlying science is suspect but the technique still works. Critics of acupuncture question its underlying science but any number of research studies have been carried out that show it works for specific conditions.

5. Craniosacral Therapy is a complementary therapy (CAM) and while (to answer one earlier critic on this page) no work has been done to show that RCTs are not a suitable research method for CST it seems self-evident that it can only be classified as a complementary therapy. Work has been done to demonstrate that RCTs are not a suitable research instrument for CAM. In fact, some researchers question whether they're entirely suitable for mainstream medicine! For example, have a look at Ben A Williams 'Perils of evidence-based medicine' and also Timmermans S,Berg M: 'The gold standard: The challenge of evidence-based medicine and standardization in health care'. Philadelphia/; /Temple University Press, 2003. As far as CST is concerned, it is impossible to blind the treatment; impossible to 'factor out' the 'non-specific' elements such as the therapeutic relationship and listening skills of the therapist, as these are inherently part of the treatment; and the sessions themselves cannot be standardised.

6. Coming back to the edit of the pseudoscience and quackery section, the words used can't be claimed to be measured; or really provide a sufficient balance between opponents and proponents of the therapy. I suggest something more balanced along the following lines to replace the section that reads: 'The settled scientific consensus...........the therapy's effectiveness' with: 'A number of studies carried out into the scientific explanation of how craniosacral therapy works concluded that important elements of the claimed underlying science do not work. This suggests that the therapy also does not work. [References to be added once the edit is agreed].

Proponents of craniosacral therapy (notably the Craniosacral Therapy Association of the United Kingdom) disagree with this depiction and point to a number of small studies which, taken together, they claim indicate beneficial changes for participants in the studies.[2] They point to a recent trend of opinion that regards clinical trials as unsuitable to measure the benefits obtainable from therapies such as craniosacral therapy; and that the use of other outcome measures is preferable.[3][4][5][Note to wiki editors: not part of the suggested edit: this is wording that WikiDan61 suggested in the last exchange of views on this section's wording. It's been removed from the CST page and needs to be re-inserted as part of the overall edit - once the whole edit is agreed]. Peoplemapsdavid (talk) 13:12, 6 August 2013 (UTC)

Experts on craniosacral therapy[edit]

Hi folks,

I just noticed that IP user wrote in defense of their removal of sourced content that they are a physician that uses craniosacral therapy often, and has adequate expertise to vouch for its effectiveness and that it is therefore NOT pseudoscience. Unfortunately, a user's status as an expert in any field does not afford them any special privileges in editing on wikipedia. It still all comes down to reliable sources. See WP:EXPERT, the section on "warning to expert editors", specifically #4. Perhaps experts are better equipped to prove their statements and contributions, but it is still necessary for them to do so. Rytyho usa (talk) 20:43, 16 February 2014 (UTC)

Recent edits[edit]

An IP hacked away the critical section of the article, leaving a pile of dangling references, and adding an ill-formatted bit of what appears to be original research. I reverted to the last stable version for now, but before going back we should probably talk about what bits of the cut section may warrant cutting and if any of the new stuff doesn't qualify as synthesis and OR - David Gerard (talk) 09:15, 20 July 2014 (UTC)