Talk:Chiropractic

Physician Status

In the lead, should we mention that even though they are not considered physicians or medical doctors, they graduate with a D.C. degree and that many governments, either state or federal recognize them as physicians? I feel that this would clarify this a bit. I'm not saying they are medical doctors, but I feel that this should at least be mentioned as well as the validity of the D.C. degree. Even reliable sources that debunk chiropractics practices mention the programs and recognition.2603:8081:160A:BE2A:6460:EB74:4175:FD5C (talk) 20:56, 3 December 2020 (UTC)

It's discussed later in the article and is not necessary for the lead. Read WP:LEAD. Sundayclose (talk) 20:58, 3 December 2020 (UTC)

Re the 'governments recognize' stuff, terms are definied in laws and government regulations with respect to those laws. The fact that social security reimburses care by Chiropractors does not mean that the government recognizes them as physicians - you would need a source that actually says that. They still can't write prescriptions or treat infectious diseases or most of the other things physicians are qualified to do. - MrOllie (talk) 21:59, 3 December 2020 (UTC)

I can see that. Wouldn't physician be essentially synonymous with medical doctor?2603:8081:160A:BE2A:6460:EB74:4175:FD5C (talk) 22:20, 3 December 2020 (UTC)

The statement regarding physician status is not a matter of opinion. Two government websites (Federal, and the State of Illinois) are cited and clearly indicate that chiropractors are recognized as physicians. These citations are irrefutable and the government agencies clearly state that they are recognized as physicians. https://www.ssa.gov/OP_Home/ssact/title18/1861.htm and https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1309&ChapterID=24%7Curl-status=live%7Carchive-url=%7Carchive-date=%7Caccess-date=%7Cwebsite=Illinois%20General%20Assembly}}%3C/ref — Preceding unsigned comment added by Malcolm217 (talk • contribs) 19:15, 4 December 2020 (UTC)

Those are primary sources, not secondary, and neither of them establishes what you're claiming they establish. PepperBeast (talk) 19:26, 4 December 2020 (UTC)

pepperbeast Meanwhile, a blog post remains the source in the article for the "chiropractors are not physicians" claim. You can't be serious about rejecting government sources in favor of a blog post. Esoteric10 (talk) 21:32, 27 January 2021 (UTC)

"For purposes of this Act, the following definitions shall have the following meanings" - the laws you're citing are deliberately limited in scope, they do not apply in other contexts. I agree with pepperbeast - secondary sources are required here. - MrOllie (talk) 19:45, 4 December 2020 (UTC)

Sundayclose Why is it ok to put the misleading verbiage in an opening paragraph, only to correct it later in the article? Many jurisdictions do recognize chiropractors as physicians. The statement that "chiropractors are not physicians" is objectively false, as it implies to the reader that they are not considered physicians by any widely accepted definition or by any governmental body. The citations for the claim that they are "not physicians" are two opinion articles from the same blog, one of which is now a broken link. However, here is a source I found in 30 seconds of a state government listing "physician" among "legally accepted terms for chiropractor": https://directory.fclb.org/LicensingBoards/US/Idaho.aspx. Come on guys, I'm all for fighting against pseudoscience, but this is way over the line. Esoteric10 (talk) 06:38, 23 January 2021 (UTC)

Let's not entangle the issues of pseudoscience and use of the term physician. There are a number of healthcare occupations that are not physicians, but that doesn't make them a pseudoscience. Those issues should be determined separately. As for the issue of using the term physician, please provide reliable sources that "Many jurisdictions do recognize chiropractors as physicians", not just the website of one regulatory board. Additional issue: do most jurisdictions allow prescription privileges for chiropractors as does every jurisdiction (in the USA anyway; I'm not sure about other countries) for physicians? I can't claim to know the answer for every jurisdiction, but I do know that many do not. By "prescription", I am not including OTC meds. That is an important distinction. Sundayclose (talk) 18:21, 23 January 2021 (UTC)

Esoteric10's SSA source clearly defines chiropractors as physicians, and is certainly a more reliable source than some blogs. Yes, it says "for the purposes of this title"—but I'd say that the definition of a physician for the purposes of administering Social Security is certainly general enough to refute the absolute claim in the article. BalinKingOfMoria (talk) 19:59, 28 April 2021 (UTC)

I've edited the article to make it clear that "some governmental definitions" include chiropractors as physicians, which is self-obviously true from the SSA source... and also doesn't define them as physicians in any absolute sense. There's no NPOV conflict here that I can see, because there's no ambiguity in the SSA's definition (i.e. that a very important part of the US federal government considers chiropractors physicians) even if that's not true everywhere. BalinKingOfMoria (talk) 20:05, 28 April 2021 (UTC)

BalinKingOfMoria, As I noted above, these laws are deliberately limited in scope. It is not appropriate to apply these definitions in other contexts, especially without secondary sourcing. MrOllie (talk) 20:31, 28 April 2021 (UTC)

MrOllie The previous source for the absolute "not physicians" claim was a single blog post. For some reason I didn't see anyone asking for better sources for that claim, yet here we are disputing definitions codified in federal and state law. I think BalinKingOfMoria's verbiage is appropriate, and I think anyone observing through a neutral lens would agree.Esoteric10 (talk) 10:36, 11 July 2021 (UTC)

Science based medicine enjoys wide consensus as a reliable source on Wikipedia, it is disingenuous to refer to it as 'a single blog post'. But I suspect you already knew that. MrOllie (talk) 12:28, 11 July 2021 (UTC)

"Science based medicine" isn't the issue here—one can believe chiropracty is ineffective, while also believing that chiropractors are legally physicians in the United States. BalinKingOfMoria (talk) 14:04, 11 July 2021 (UTC)

I don't believe you're intentionally conflating the two, but the fact that you're doing so *and* being rude about it certainly doesn't help your argument. BalinKingOfMoria (talk) 14:07, 11 July 2021 (UTC)

Clearly, some chiropractors practice using the title "chiropractic physician" and are allowed to use that term. Some people might not consider them physicians, but that doesn't mean that no one does and it does not mean that Wikipedia can conclude and say in its own voice that they are not physicians. Some people might not think they are physicians, but some other people clearly do, and there are laws that allow chiropractors to use that term when offering services to patients. It is simply and very clearly false to just state that they are not physicians as some sort of undisputed fact. If a law uses the term, then I'm pretty sure that others can use the term too without being considered deceptive. I am sure that you can find thousands of people using that title and explicit allowance to advertise as such in laws. That is not allowed everywhere (e.g., it seems to be prohibited in Texas), but it is allowed in some places, so we cannot just say it is wrong to use the term. The term "chiropractic physician" is

• Used in Connecticut, where "The terms 'chiropractic', 'doctor of chiropractic', 'chiropractor' and 'chiropractic physician' are synonymous, and mean a practitioner of chiropractic".
• Used in Florida, which has an application form if you want to become a certified assistant of a "chiropractic physician". Here are some quotes from Florida law that use the term. The discussion in that article says that "Chiropractic physicians are required to maintain a certain minimum level of professional liability insurance, just as other types of physicians are".
• Used in Illinois, where you can find some guidelines for avoiding Covid infections at the offices of "chiropractic physicians".
• Used in Nevada, where "A license to practice chiropractic authorizes the licensee to use the term 'chiropractic physician'."
• It is used in New Jersey, where "A chiropractor licensed by the State Board of Chiropractic Examiners may use the title doctor, or its abbreviation in the practice of chiropractic, however, it must be qualified by the words doctor of chiropractic, chiropractor or chiropractic physician or its abbreviation D.C., which may be used interchangeably."
• It is also used in New Mexico, which has continuing education requirements for "chiropractic physicians".
• It is also used in Rhode Island, where "'chiropractic physician' means an individual licensed to practice chiropractic medicine".
• The term is used in Utah, where 'chiropractic physician' means a person who has been licensed ... to practice chiropractic."
• It is used in the state of Washington, where "On all cards, books, papers, signs or other written or printed means of giving information to the public, used by those licensed ... to practice chiropractic, the practitioner shall use after or below his or her name the term chiropractor, chiropractic physician, D.C., or D.C.Ph.C."

If someone used a disallowed term to offer services to the public, that would be considered false advertising. Clearly, the term is allowed and commonly used.

— BarrelProof (talk) 23:07, 29 April 2021 (UTC)

From all of the above it would appear that Chiropracters are allowed to call themselves "Chiropractic physicians" in some places in the US. It should be noted that there does not seem to be any sources that support that they are called simply "physicians." In these cases, the word "physician" must be qualified with the word "chiropractic" so that there is no doubt that they are not real physicians, but chiros. This point is clearly and properly made in the lead. -Roxy the grumpy dog. wooF 12:10, 30 April 2021 (UTC)

I agree, although I find the phrase "not real physicians" a bit judgmental. — BarrelProof (talk) 13:58, 30 April 2021 (UTC)

Seriously, we cannot have quacks masquerading as physicians, it's just not right. -Roxy the grumpy dog. wooF 14:31, 30 April 2021 (UTC)

My personal impression is that most of them are more rational and knowledgeable and less interested in pretending to be medical doctors than you might think after reading this article. Of course, I'm not a reliable source on the subject and have based that impression on a very small sample size. And even a small minority of complete nut cases could be a big problem. — BarrelProof (talk) 15:31, 30 April 2021 (UTC)

Roxy the dog Thanks for your unbiased opinion on the matter. We should surely be using your opinion about chiropractors as the basis for making editorial decisions, while ignoring the facts staring us in the face. ♫true colors♫. Thanks for taking an objective look at this, BarrelProof. The article is a NPOV nightmare because it's being overrun by a cartel of dogmatic editors.Esoteric10 (talk) 08:54, 11 July 2021 (UTC)

@Roxy the dog AFAIK Wikipedia's goal is to present facts, not to try to cure perceived social ills via intentional misinformation. Why isn't it possible to, one the one hand, believe chiropractics are quacks, and on the other, concede that certain governments define "physician" to include them? It's not an endorsement of the validity of chiropracty, so much as a statement about the current state of American regulations. BalinKingOfMoria (talk) 14:10, 11 July 2021 (UTC)

The term is apparently officially not allowed to be used in Kentucky, at least as of 2005, when the Kentucky Board of Chiropractic Examiners called its use "a technical violation". However, it is easy to find chiropractors in Kentucky who appear to be using it anyway. — BarrelProof (talk) 00:02, 1 May 2021 (UTC)

Comparing the osteopathy article to the chiropractic article.

The article on chiropractic and the article on osteopathy are written surprisingly differently (especially the lead), despite them having very similar historical philosophies and modern-day applications. They are both considered pseduoscience, yet the osteopathy page is written with NPOV, and the chiropractic page is not. To cite a specific example, pseudoscience is the 4th word in the chiropractic article, but is not mentioned until the second sentence of the second paragraph in the osteopathy article. The article on osteopathy reads like an encyclopedia article, while the chiropractic one reads more like a tabloid article pushing an agenda.

The lead for the chiropractic page needs serious revision in how it is written. The agenda is apparent when reading it, but when compared to the osteopathy article, it is glaring. Jmg873 (talk) 13:58, 7 April 2021 (UTC)

Seems to me that we need to put the word "pseudoscience" into the first sentence of the osteopathy article, Yes? -Roxy the sycamore. wooF 14:09, 7 April 2021 (UTC)

I think it's quite an overstatement that all of osteopathy is generally considered a pseudoscience, and its article supports that. Parts of osteopathy have historically been considered pseudoscience, but currently much of osteopathic training and practice has moved into the mainstream, being regulated by the same medical boards and being practiced alongside other physicians. It's not uncommon for osteopaths to be in the same practice and performing the same tasks as other physicians; that's not the case for chiropractic. I'm not denying the historical issues with osteopathy, but considering the current level of training and acceptance in the medical field, comparison with chiropractic as a profession or comparison of how equivalent the two article should be is not well-founded. Any changes need more extensive discussion and consensus on the talk pages of both articles. Sundayclose (talk) 14:26, 7 April 2021 (UTC)

Comment. Osteopaths are not physicians. -Roxy the sycamore. wooF 14:29, 7 April 2021 (UTC)

Osteopaths are physicians. Chiropractors are not physicians. Let's move on from sweeping conclusions about titles and focus on the actual nuts and bolts of the professions. So far I've seen very little discussion of that. Sundayclose (talk) 17:43, 7 April 2021 (UTC)

Sundayclose, you are conflating osteopaths in the rest of the world with osteopathic physicians in the US. Wikipedia makes this distinction by having an article on each topic. The osteopathy discussed in the article strongly parallels chiropractic. I encourage you to read more about osteopathy (rather than US DOs), you might be surprised how similar chiropractic and osteopathy are. Roxy the dog, changing the osteopathy article may be the right solution, but I believe it reads far more NPOV than the chiro article does; it still distinguishes that OMTs application is largely pseudoscientific, but in a far more appropriate way. Like I said, it reads more as an encyclopedia article (as it should), where the chiropractic article's lead does not.Jmg873 (talk) 15:34, 7 April 2021 (UTC)

I am familiar with osteopathy outside the U.S., and I disagree that I have inflated osteopathy. Most healthcare professions vary by country, including physicians of the traditional Doctor of Medicine and Bachelor of Medicine, Bachelor of Surgery varieties. Additionally, the Osteopathy article is not confined to discussion of the topic outside of the U.S., so it applies worldwide. This needs a clear consensus for either article that is changed. That's the way things work on Wikipedia. Sundayclose (talk) 17:35, 7 April 2021 (UTC)

I am familiar with Osteopathy outside the US, and you have inflated these quacks hugely. This needs a clear consensus for either article that is changed. That's the way things work on Wikipedia. -Roxy the sycamore. wooF 17:54, 7 April 2021 (UTC)

I'm glad you agree that clear consensus is needed for either article. Now please. Move on from name-calling the professions and discuss the actual issues at hand. Sundayclose (talk) 18:02, 7 April 2021 (UTC)

WP:OTHERSTUFFEXISTS -Roxy the sycamore. wooF 18:05, 7 April 2021 (UTC)

Randomly linking guidelines accomplishes nothing. Please stop wasting our time with empty non sequiturs. It is WP:DISRUPTIVE. At this point, you have presented nothing of any real substance in terms of the issues. Until you or someone else does, I'm finished here. Sundayclose (talk) 18:11, 7 April 2021 (UTC)

Jmg873, yes., In the US, DO's split off from chiropractic and took on a reality-based medical education. Not so true of osteopaths in other countries, though. Guy (help! - typo?) 20:13, 7 April 2021 (UTC)

This is the point I am making. That article is about the osteopaths in other countries, which practice similarly and have similar beliefs to chiropractors. However, the article reads with a markedly different tone. Jmg873 (talk) 13:18, 10 April 2021 (UTC)

Jmg873This article is indeed riddled with NPOV violations because there is a cartel of anti-pseudoscience activists controlling the article. They think they're doing the flying spaghetti monster's work by inserting their bias into any article tangentially related to pseudoscience, and then spending way too much of their free time gatekeeping the article in the talk section. I won't mention any names, but a few of them can be seen posting here quite frequently. In a few cases, they have revealed themselves to be unfit to edit this article by asserting their subjective bias in the face of an overwhelming amount of evidence to the contrary (see the "physician status" discussion above). Thankfully, it seems that neutrality won the day on that issue, but every sentence I read in this article makes me cringe. It's like watching fox news in the daytime, but worse. Esoteric10 (talk) 09:20, 11 July 2021 (UTC)

Yes, yes, we get it. You want the article to be more friendly towards pseudoscience, and you think you can scare away editors who oppose that by telling them that you have found them out and noticed that they are anti-pseudoscience, as if there were anything wrong with that. Well, that will not work. The rules agree with us: WP:FRINGE.

To succeed, you must first overturn the rules. When you have succeeded in making opposition to pseudoscience illegal, then your reasoning will work. Until then, you will need to switch to a different tactic. But I suspect that one will not work either. --Hob Gadling (talk) 19:42, 13 July 2021 (UTC)

Hob Gadling Two problems with what you've said here. First is the subjective standard used to lump things into "fringe theories". The topic at hand, Chiropractic, has both fringe elements and evidence-based elements that are widely accepted as legitimate within the broad medical community. To lump the entirety of "Chiropractic" into this category is lazy and disingenuous at best, and malicious at worst. For example, if you seek chiropractic care for a torn rotator cuff, you will likely undergo orthopedic shoulder testing, possibly be sent for an MRI, and receive an accurate diagnosis. Similarly, if you seek care for radiating arm pain due to a herniated cervical disc, you'll likely receive ortho testing, an x-ray, and cervical distraction - all of which are accepted by the broad medical community as part of the standard of care for this condition. After reading this article, you would have absolutely no idea that this is part of chiropractic practice. On the other hand, yes, you will have chiropractors who crack your neck to 'treat' your migraines. This also needs to be treated appropriately as fringe. The second issue with what you've said is addressed in the third paragraph of WP:FRINGE. Even if we were to lump the entirety of chiropractic into the "fringe theory" category doesn't give free reign to ignore NPOV, which you're apparently endorsing.Esoteric10 (talk) 00:38, 15 July 2021 (UTC)

Although you claimed there were "problems" with what I said, you completely ignored what I said. I talked about your attempts of scaring away people who disagree with you, and changed the subject completely. Alright. But you are wrong about the other subject too.

Fringe is not subjective. Not if you make a difference between reliable and unreliable sources.

"Fringe" does not mean always being wrong. Every fringe promoter also says things that are based in reality. Otherwise they would fail to attract followers.

If there are chiropractors out there who don't use any of the crazy stuff, then why do they call themselves chiropractors? Shouldn't they invent a new word meaning "chiropractor without the crazy stuff"? Then we could have an article about that. Since they don't do that, well, it's their problem if they want to be part of a discredited group, not ours. If you want to mention those people, you need reliable sources which mention them. --Hob Gadling (talk) 08:11, 15 July 2021 (UTC)

No Hob Gadling, it's not "their problem", it's your problem for wanting to squeeze them into the same box as homeopaths and reiki healers when they clearly don't belong there. A significant portion of what chiropractors learn and do is evidence-based, and readers need an accurate portrayal, not a slant one way or the other.Esoteric10 (talk) 06:04, 19 July 2021 (UTC)

Hob Gadling, your comment seems to contradict itself on exactly the topic we are discussing: If there are chiropractors out there who don't use any of the crazy stuff, then why do they call themselves chiropractors? Shouldn't they invent a new word meaning "chiropractor without the crazy stuff"? Then we could have an article about that. Shouldn't osteopaths in the US come up with a different word? They aren't even remotely related to osteopaths in other countries. Despite having the same name, they have separate articles; Osteopathy which is primarily focused on the fringe theory and Osteopathic medicine in the United States, which is very mainstream. Both are osteopaths; this distinction seems to contradict your point. I bring that up because it feeds directly to the point I was making here in the first place. We do not treat the chiropractic article like other similar articles. This is the problem. Jmg873 (talk) 23:24, 9 October 2021 (UTC)

I just tried to think back to what was this about, back then, but actually, I don't see any connection with improving the article. Please go on tangents like that on another site. A Wikipedia Talk page is not a forum. Again: find reliable sources that say what you want the article to say, and the article can say it. Don't find them, and it cannot. --Hob Gadling (talk) 15:34, 10 October 2021 (UTC)

I thought I was clear; it's about making the page more NPOV. Let's start with section 1.4 "Pseudoscience Versus spinal manipulation therapy". Section 1 is supposed to be on Conceptual Basis of chiropractic. Sections 1.1, 1.2, 1.3 are all fine and flow very well, but 1.4 feels very forced and out of place. It is a section entirely dedicated to "here is why you should not see a chiropractor". It is inappropriate as written and certainly not appropriate where it is located. If anything, it would be better to be rewritten and to have it in its own "controversy" or "criticism" section. Jmg873 (talk) 18:48, 11 October 2021 (UTC)

WP:IDONTLIKEIT is not a reason to remove something. These are sourced facts, and you will not succeed in swiping them under the rug. What you are trying to do is the opposite of WP:NPOV. It does not say what you think it says.

You are a WP:SPA whose only purpose seems to be to remove unconvenient facts from articles about chiropractic. This a pretty common phenomenon: purging criticism from articles about pseudoscience only leads to the accounts being banned because they are WP:NOTHERE to build an encyclopedia. --Hob Gadling (talk) 07:00, 12 October 2021 (UTC)

I said move, not remove. Please try not to misconstrue my words. I am not trying to sweep anything under the rug. The criticisms in that section are appropriate for the article and should be included; I never said anything to the contrary. What I said was that I feel that they are out of place in their current location. When I mentioned rewriting them, I am speaking of, for example, the title. What does "Pseudoscience versus spinal manipulative therapy" mean? There is no discussion of the similarity/differences of anything, so why is "versus" being used? More importantly, we have a section for controversy or criticism in most other articles, why do you feel it would be bad to re-title that section as such? At no point in your most recent response have you addressed the point I made, you only addressed me. Please argue the content not the editor.Jmg873 (talk) 14:50, 12 October 2021 (UTC)

Disputing allegation of total absence of studies attesting to chiropractic benefit

While I agree that much of what many chiropractors allege to fix is pseudoscientific and ridiculous, I contest that there exist no scientific studies which demonstrate any link between chiropractic and any tangible benefit beyond alleviated back pain. Here's a small study showing it helps with kyphosis. Here's a case study demonstrating success of chiropractic in treating kyphosis in an adolescent. In any case, I feel that the problem is that, (perhaps due to the grandiose claims made by many chiropractors,) the lack of evidence attesting to possible benefits of chiropractic can in some cases be attributed to a disinclination to investigate some of its simpler claims at all. What I mean by this is that upon searching for research on the effects of chiropractic on kyphosis, while I didn't find very many articles outside of the examples I have given directly showing a possible benefit to chiropractic, I didn't find any which disproved the benefit, nor did I find any which were inconclusive. I didn't find many studies investigating it at all. And I personally feel that kyphosis seems well within a chiropractor's professional territory to treat (unlike the immune system and irritable bowel syndrome and the like.) After all, from a physical perspective, kyphosis is the result of the muscles and tissue around your upper vertebrae forcing your spine into an exaggerated curve. It makes sense that loosening that tissue with adjustments would make it more possible for the spine to extend more in the other direction. And while I don't believe chiropractic can likely cure most spinal injuries, its potential effectiveness in at least helping with any condition which is a consequence of stiff muscles along the spine seems to me to be intuitively reasonable, as intuitively reasonable as the effectiveness of a massage in alleviating myofascial trigger points (in spite of ambiguous scientific understanding as to the direct effect of massages in treating muscle knots.) — Preceding unsigned comment added by HiggsBozo (talk • contribs) 05:09, 16 April 2021 (UTC)

• These are in-universe sources. What's missing is objective evidence from people who are not financially vested in the outcome. Guy (help! - typo?) 20:05, 28 April 2021 (UTC)

I cannot find the policy that suggests sources must come from "out of universe"; could you point me to the relevant policy? It would seem odd if this were an actual policy and not something made-up by a pseudo-skeptic, as who else would research a topic besides those in the "universe" of the topic? Does research on pharmacological therapy need to come from non-medical researchers? Where does dental research come from besides dental researchers? What a joke.2001:56A:75CE:1700:CF8:9C9B:6B5B:B4BF (talk) 20:14, 4 June 2021 (UTC)

HiggsBozo, Guy- no need to only rely on in-universe sources, because there are plenty of 'out-of-universe' sources pointing to the efficacy of many techniques employed by chiropractors (yes, even spinal manipulation) which are proven to be effective for more than low back pain. The treatment of cervical radiculopathy with manual spinal traction comes to mind. Here is one 'out of universe' study showing this: . Here is a meta-analysis showing the same: . Good luck getting this edit in, though. As you can see, there are some people who spend a lot of time here making sure this article remains as biased as can be. Esoteric10 (talk) 09:43, 11 July 2021 (UTC)

See WP:MEDRS (this is the important one here) and secondly WP:FRIND. - MrOllie (talk) 20:19, 4 June 2021 (UTC)

I can not find any suggestion within MEDRS that suggests in Universe sources are excluded, if I missed it I am happy to be corrected. FRIND could definitely be used to counter in-universe sources, but attempts to use FRIND broadly here is problematic, as it is pseudoskepticism to suggest that chiropractic is entirely fringe (High utilization, available in many hospitals, covered by insurance, regulated profession Internationally, evidence of efficacy for some MSK, etc). FRIND definitely would not apply to a discussion of chiropractic and back pain, or other msk conditions. I would agree with the use of FRIND with regard to a discussion specifically about chiropractors treating non-msk, or discussions around subluxation pseudoscience. 2001:56A:75CE:1700:CF8:9C9B:6B5B:B4BF (talk) 20:49, 4 June 2021 (UTC)

pseudoskepticism perfectly describes what's happening here. Thanks for introducing me to the term. I agree with your take on sourcing and WP:FRIND, but if the pseudoskeptics are going to put up a stink, there are indeed some orthopaedic and physical therapy journals that publish studies related to spinal manipulation and manual therapy techniques employed by chiropractors. I did a quick search and found two studies that demonstrate the efficacy of spinal manipulation in treating cervical radiculopathy (ref 3 and 4).Esoteric10 (talk) 10:14, 11 July 2021 (UTC)

WP:MEDRS specifically requires high quality sources, not primary in-bubble sources such as those suggested in the OP. So no. -Roxy . wooF 05:18, 5 June 2021 (UTC)

Roxy the dog Would you consider the two out-of-bubble sources (references 3 and 4) to be low quality? Or are you not going to be happy until you see a JAMA or Lancet article, while apparently being ok with the garbage citations currently being used in this article that support your bias?Esoteric10 (talk) 09:51, 11 July 2021 (UTC)

Ref 3 isn't WP:MEDRS and ref 4 isn't about chiropractic. -Roxy the grumpy dog. wooF 12:03, 11 July 2021 (UTC)

Roxy the dog It's a spinal manipulation modality commonly employed by chiropractors, and it's been proven effective in randomized controlled trials for the treatment of cervical radiculopathy. It's obviously not called "chiropractic" in the articles because it's referring to the specific modality of cervical traction, which is also employed by other disciplines. Remember, apparently we now aren't allowed to cite any "in-universe" literature, regardless of rigor, so I've provided out-of-universe sources. The source for the current claim in the entry is also pretty dated (2007). The current entry reads "Systematic reviews of controlled clinical studies of treatments used by chiropractors have not found evidence that chiropractic manipulation is effective, with the possible exception of treatment for back pain". If we're talking about treatments used by chiropractors, this (and many other modalities used by chiropractors) have mountains of evidence supporting their efficacy. The sentence does a little bait-and-switch, because while it starts by mentioning "treatments used by chiropractors", it goes on to only speak to the efficacy of chiropractic manipulation and not other (evidence-based) modalities used by chiropractors. However, even if we're just talking about "chiropractic manipulation", I've showed you a controlled clinical trial and review showing that a treatment used by chiropractors, which can be considered a 'chiropractic manipulation' is effective at treating cervical radiculopathy. The fact that these articles didn't explicitly use the term "chiropractic manipulation" shouldn't matter, especially since we're not ok with in-universe sources. Cervical traction is a well-documented spinal manipulation modality that is considered under the umbrella of "chiropractic manipulation". The entire paragraph needs to be re-addressed.Esoteric10 (talk) 23:14, 11 July 2021 (UTC)

This is a difficult topic indeed, but it's worth noting that the US government healthcare provider Medicare provides coverage for "manual manipulation of the spine provided by a chiropractor or other qualified provider if medically necessary to correct a subluxation." On its face, this would suggest some subset of chiropractic has been deemed a safe and effective treatment. However, a cursory reading of this article lends the distinct impression the field is wholely pseudoscientific. Being wholly unfamiliar with the topic, I'm not yet certain how to best rectify this, as it most certainly IS a field beset with unscrupulous pseudoscience, so it's a fine line to walk. Benetti & MacPhail, 2003 looks useful. Feoffer (talk) 23:43, 11 July 2021 (UTC)

Feoffer It would be nice if this article actually walked the line, but there is a giant elephant on one side of the scale. The article seems to be functionally gate-kept by some vocal anti-pseudoscience crusaders who are trying to cure a perceived social ill via intentional misinformation and brazen NPOV violations. We need to get more unbiased eyes on this article, because as it reads in the first few paragraphs, a casual reader will deduce that chiropractors are murderous snake-oil salesmen.Esoteric10 (talk) 07:11, 12 July 2021 (UTC)

Quacks in other words, indeed. Sources support the article. You may want to start commenting on the article content, rather than constantly moaning about other editors, as sooner or later, they'll decide to do something about your behaviours. -Roxy the grumpy dog. wooF 07:35, 12 July 2021 (UTC)

Roxy the dog The source for the text in question here is dated 2007, predating the sources I've provided. Just parroting "sources support the article" because you like the current slant of the article isn't productive. I've provided plenty of substance here, but it seems you're choosing to not pay attention to things that cause you cognitive dissonance. All I've seen from you here is calling chiropractors quacks and demanding unreasonable amounts of evidence when the evidence presented doesn't fit your bias. It is clear that you are not operating in good faith. Esoteric10 (talk) 19:28, 13 July 2021 (UTC)

That's a nasty accusation. You should try to address the message and not the messenger I suggest you stop trying (badly) to analyse me, and start bringing reliable sources to improve the article. -Roxy the grumpy dog. wooF 10:06, 14 July 2021 (UTC)

Roxy the dog You're joking, right? I literally provided two high quality sources related to this topic, and you responded by calling chiropractors quacks and providing nothing of substance. Projecting much? And it's not a nasty accusation. You've basically admitted this in your own words. Esoteric10 (talk) 00:50, 15 July 2021 (UTC)

Read WP:NPA. I'll request sanctions against you if you continue to attack me, or any other editors. Thanks. -Roxy the grumpy dog. wooF 07:51, 15 July 2021 (UTC)

Esoteric10, the so-called "gate-keepers" do a great job keeping this article free of FRINGE, and it's a tiring, thankless job. If we think the article needs improvements, it's up to us to help advocate for those improvements, not use ad hominem arguments that are utterly unproductive. Feoffer (talk) 00:54, 15 July 2021 (UTC)

References

Lede should define Chiropractor & expand pseudoscience to a full 2nd paragraph

Some simple changes we should incorporate into the lede.

• We need to explicitly define the term "chiropractor" as a practitioner of chiropractic rather than just assuming the reader know that. I absolutely loathe to compare our article with Osteopathy, such analogies are wholly inappropriate, but on the lone point of defining terms, we should follow that article in explicitly defining the term for its practitioner rather than simply introducing it. Our article should be comprehensible to children or new speakers of english, not just people who already know what a chiropractor is.
• After the first paragraph conveys the absolute basics, the very next thing our readers should know is that the field is beset with pseudoscience and quackery. We should devote a full paragraph to warning our readers of the dangers of chiropractic by reminding them it was founded by a spiritualistic channeling, falsely claims cure for general disease, promotes the long-discredited theory of vitalism, and most dangerously opposes vaccinations. All this information is contained various places in the current lede, but it would be more effective as a coherent paragraph providing our readers with a clear warning.

Thoughts? Feoffer (talk) 20:35, 14 July 2021 (UTC)

• Disagree The first paragraph already explains what a chiropractor is/does: "The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine, other joints, and soft tissues, but may also include exercises and health and lifestyle counseling."

The wikilinks provide even further information to the reader.

The second paragraph extensively covers spinal manipulation, which is the dominant feature of chiropractic treatment.

I looked at your changes before you self-reverted and unfortunately did not view them as an improvement. -- Somedifferentstuff (talk) 23:55, 14 July 2021 (UTC)

"first paragraph already explains what a chiropractor is/does" But it doesn't explain what the word "Chiropractor" means. Our second sentence begins "Chiropractors, especially those in the field's early history...", just assuming our readers will know or infer that a Chiropractor is a practitioner of Chiropractic. We're skipping over 8 necessary words: "Practitioners of chiropractic are referred to as chiropractors." Comparable sentences exist in the ledes of Homeopathy, Dentistry, Osteopathy. Feoffer (talk) 00:16, 15 July 2021 (UTC)

I found this part of your suggested edits to be fairly unobjectionable and went ahead and added a brief explanation. Firefangledfeathers (talk) 01:49, 15 July 2021 (UTC)

That looks good 👍 -- Somedifferentstuff (talk) 02:08, 15 July 2021 (UTC)

• Agree Feoffer I agree with most of what you've said and proposed. The first paragraph should be dedicated to the definition, and not editorialized as it currently is. I can 100% get behind your proposed second sentence. "Practitioners of chiropractic are referred to as chiropractors." is totally appropriate and comparable to similar articles. Regarding the second paragraph serving as a 'warning', I think the paragraph as proposed is a bit heavy-handed and not exactly kosher toward NPOV, however I think overall your proposed changes are preferable to the current state of the article. Esoteric10 (talk) 01:01, 15 July 2021 (UTC)

* Disagree. I wholeheartedly disagree with what you are proposing here, and the language you use to propose "warning our readers of the dangers of chiropractic" would certainly not align with the necessary neutral point of view. DigitalC (talk) 02:15, 15 July 2021 (UTC)

Reply with follow-up: It should be obvious that I have no objection to language that defines a chiropractor as a practitioner of chiropractic. As you stated, this is done on other pages, and as Firefangledfeathers mentioned, that is fairly unobjectionable. Creating a second paragraph devoted to "warning our readers of the dangers of chiropractic" still sounds like it may not meet NPOV, and risks future bloat of these "dangers". However, the actual edit you proposed seems reasonable and I withdraw my previous objection. DigitalC (talk) 02:53, 15 July 2021 (UTC)

It's not "bloat", the material is all in the lede already, we just should form it into a single paragraph that's very early in the lede. We allude to chiropractic pseudoscience in the first sentence, but we don't actually show it to the reader in a coherent fashion. When you have a single paragraph connecting spiritualism to antivax, the reader instantly knows why the field in controversial, why they're not medical doctors, etc Feoffer (talk) 02:59, 15 July 2021 (UTC)

Sorry if I wasn't clear. I was not stating that it is currently bloat, but that it creates a risk of future bloat as pseudoskeptics try to jam more "dangers" in. As above, the edit you proposed seems reasonable. DigitalC (talk) 03:10, 15 July 2021 (UTC)

The term pseudoskeptic is just a bugbear invented by a sociologist who believed in psi, for those who disagreed with him on that item. And it is still used by fringe proponents as a label for those who do not agree with them. You using it does nothing except screaming "look at me! I believe in stuff without evidence and I look down on those who dare think differently!" Good job. --Hob Gadling (talk) 08:22, 15 July 2021 (UTC)

Concerns about future direction of the article is no reason to oppose a good change. Wikivoice already characterizes chiropractic as being pseudoscience. Rather than just asserting it, we should devote a full 2nd or 3rd paragraph to making readers take a good, hard look at something borne of Spiritualism that currently espouses Antivax. It's only after that warning that we can, with a clear conscience, brief readers on whatever SMT benefits exist. Feoffer (talk) 09:08, 15 July 2021 (UTC)

I don't know how I can be more clear - I do not oppose your proposed edit. I have stated twice previously that "the edit your proposed seems reasonable". DigitalC (talk) 14:08, 15 July 2021 (UTC)

User:Firefangledfeathers has already implemented the change by adding, "Practitioners of chiropractic are called chiropractors." But Feoffer, if want to drastically change the lede (2nd paragraph or whatever) of this relatively stable article (that is semi-protected until 2026 for a reason) you should definitely post your draft version of suggested lede changes to this talk page and let editors comment on them. -- Somedifferentstuff (talk) 16:28, 15 July 2021 (UTC)

He linked to the proposed changes. I think they're quite good, and the lede changes basically just rearrange things to make the structure more in line with similar articles. The sentence added by Firefangledfeathers was added without the other changes proposed by Feoffer, so it has created a grammatical issue. The sentence following the newly added sentence references the sentence preceding the newly added sentence. I'm in favor of adopting Feoffer's changes in full. I haven't seen any significant opposition, and they seem quite reasonable to me. Esoteric10 (talk) 01:20, 16 July 2021 (UTC)

Good point about the reference issue. I made a clarifying edit and would be fine with further tweaks to "my" addition (really, credit to Feoffer), but I do oppose at least part of Feoffer's overall proposed lead change. I think that it has so far been presented as a reorganization. In fact, it removes 'pseudoscience' from the first sentence—where it describes chiropractic—and shifts it to the second paragraph, applying it only to "Parts of chiropractic". I think we can have a discussion on the merits of such a change, but we should be clear about it being a significant change in content, meaning, and presentation. Firefangledfeathers (talk) 01:52, 16 July 2021 (UTC)

"Parts of chiropractic" Thank you for that catch!! I think I copied some of that text from Osteopathy and failed to properly adapt it. Clearly, "parts of" is inappropriate here -- it's all pseudoscience! I share your ambivalence about the loss of pseudoocience from the first sentence, but it seemed like it would be more effective in a second paragraph devoted exclusively to that aspect. I could certainly live with either placement. The crux of my remaing suggestion is to move the spiritualism, vitalism, and antivax into a second or third paragraph.Feoffer (talk) 05:34, 16 July 2021 (UTC)

Lots of Primary/OR/Synth here

Having now closely read over the current lede and its sources, we definitely have some issues with sourcing. I've tagged for now, as I suspect much of it can be properly sourced with time. Does anyone have a good recent book-length secondary source they like for this topic? Feoffer (talk) 00:49, 15 July 2021 (UTC)

You placed an "awkward" tag in the second paragraph on a sentence that isn't awkward and a "better source needed" tag on a reliable source. What is your aim here? -- Somedifferentstuff (talk) 02:06, 15 July 2021 (UTC)

My aim?? To remind myself to improve the sourcing and verbiage, and to invite others to do so in the interim.

Double negatives are indeed awkward: "chiropractic is not effective for pain, with the possible exception of treatment for back pain". We need one thought that says Chiropractic is not effective for non-back pain, we need one thought that describes its effectiveness for back pain (whatever that may be), and we ultimately need them sourced to a reliable mainstream secondary source reflecting the entire medical field's assessment, not a lone article we found in a pain management journal. Feoffer (talk) 02:27, 15 July 2021 (UTC)

Feoffer It seems to have been intentionally written this way to frame it in the most damning way possible. The source for this is also dated and not very good. One of the studies quoted in the NYT article you linked to below is much better source. It's a more recent and more comprehensive systematic review of the efficacy of spinal manipulation on low back pain. I think it's fair to use "spinal manipulation therapy" studies, even though they're not specifically referring to "chiropractic manipulation", especially since we can only rely on out-of-universe sources. These sources will tend to use the general term (Spinal manipulation therapy) vs. the in-universe term (Chiropractic manipulation therapy). I've added the reference here. I believe the reference and verbiage should be changed in the article. The evidence for its efficacy with regard to low back pain is pretty conclusive. "Systematic reviews of controlled clinical studies of treatments used by chiropractors have found some treatments to be effective, while others have been found to be no more effective than placebo. Spinal manipulation therapy has been found to be effective in treating low back pain, however there is little evidence to support its efficacy in treating other conditions." Esoteric10 (talk) 07:19, 15 July 2021 (UTC)

I welcome your support for recent edits, but I can't concur with your assertion that SMT -vs- CMT is just a matter of terminology (out-of-universe vs in-universe). The latter seems to expose a patient to risk of becoming a victim of pseudo-scientific quacks. BUT, RSes do seem to agree that chiropractors can be an effective, if problematic, deliverer of SMT. Feoffer (talk) 07:43, 15 July 2021 (UTC)

Let me again reiterate, comments about editor motivations are a dead end. It seems to have been intentionally written this way to frame it in the most damning way possible. Wikipedia is 20 years old, the people who wrote this might be long dead. Address the content, not the editors. Even if you're correct, its a conversation stopper. Let's assume we're all on the same team and trying to help our readers understand this topic. Feoffer (talk) 09:53, 15 July 2021 (UTC)

There's an excellent chapter on Chiropractic in a book edited by noted FRINGE-fighter Michael Shermer that looks promising in helping us get out of the synth/primary sandtrap. Feoffer (talk) 03:35, 15 July 2021 (UTC)

This 2017 quote from Skeptical Inquirer is very effective: "Spinal manipulation therapy (SMT) is a reasonable option for patients to try if they like the hands-on approach, don’t mind multiple visits to the provider, and prefer not to take pills. ... But I could not in good conscience refer a patient to a chiropractor. ... When chiropractic is effective, what is effective is not “chiropractic”: it is SMT. SMT is also offered by physical therapists, DOs, and others. These are science-based providers. If I thought a patient might benefit from manipulation, I would rather refer him or her to a science-based provider." Feoffer (talk) 03:53, 15 July 2021 (UTC)

NYTs that will be useful for summarizing the effectiveness studies, but let's not trust its conclusions over Skeptical Inquirer which explicitly disagrees with them. Feoffer (talk) 05:15, 15 July 2021 (UTC) Additional NYT summation of recent developments, along with firsthand account of negative experience. Feoffer (talk) 00:26, 16 July 2021 (UTC)

With respect, the book by Shermer, the article from skeptical inquirer, and the NYT article all very clearly fail WP:MEDRS. Generally, we prefer high-level peer-reviewed sources on this page. DigitalC (talk) 00:57, 16 July 2021 (UTC)

What's up with the moving goalpost here? If a primary source is provided, I see calls for secondary sources. If a high quality secondary source is provided (NYT article), there are calls for primary sources. If a high-quality out-of-universe primary source that meets WP:MEDRS is provided, it's challenged for not using in-universe terminology (SMT vs. CMT). If a high quality in-universe source is provided, it's rejected outright regardless of rigor because it's "in-universe". Meanwhile, as I browse the article, there are entire sections sourced from a single quackwatch opinion piece. There is a glaring double-standard here. Esoteric10 (talk) 02:11, 16 July 2021 (UTC)

The New York Times cites the systemic review articles in its text, so by all means we could supplement the sourcing with explicit references to the journals. I don't think anyone would seriously doubt Skeptical Inquirer is a RS on this topic unless we also thought another more-reputable source disagreed with its conclusions - since it warns against chiropractic treatment, I don't anticipate reputable contradictions of SI's conclusions.

Again, I'm not a source stickler, you can't get six sentences into the article before it's clear the sourcing and verbiage is problematic. We cite a study and claim "critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition." The cited study says absolutely no such thing! I understand how the error was made, but it just demonstrates why technical literature can be a poor foundation for an article when reliable mainstream sourcing can help guide us. Feoffer (talk) 05:27, 16 July 2021 (UTC)

That last contribution is an outright lie. The following bit between the exclamation points, is a quote, "these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition" -Roxy the grumpy dog. wooF 05:34, 16 July 2021 (UTC)

Are you suggesting I'm in error, that the source is deceptive, or are you calling me a liar? Those are all three very different replies. Feoffer (talk) 05:37, 16 July 2021 (UTC)

The source isn't in error. -Roxy the grumpy dog. wooF 05:41, 16 July 2021 (UTC)

Roxy the dog, my instinct here is that there is a difference between failure to demonstrate effectiveness and evaluation/finding of ineffectiveness. Is there more to the NZ Med J source to support the stronger claim? Firefangledfeathers (talk) 05:44, 16 July 2021 (UTC)

Precisely. And mind you, I'm not saying it IS effective, I'm just saying we need a better source, cause the source we have don't say that, not that I see. Feoffer (talk) 05:46, 16 July 2021 (UTC)

Which bit of these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition' are you guys not getting? I find this disturbing. -Roxy the grumpy dog. wooF 05:50, 16 July 2021 (UTC)

It shouldn't disturb you. These sources are written for a very specific audience. Like English or Mandarin or Differential Calculus nobody is born knowing how to speak this language. But this just cinches the importance of using reliable sources written for a general audience, insofar as they aren't contradicted by more reputable sources. Feoffer (talk) 05:54, 16 July 2021 (UTC)

Quick side issue, I am taking "collectively" out of our article's summary of the review study. In the study's conclusion, "collectively" serves to describe the aggregation of data from multiple papers. Our article doesn't get into the details enough, and it's unclear what "collectively" is referring to.

Roxy the dog, I don't want to be pedantic, and I am genuinely unsure if the distinction applies here. Here's a potentially re-framing question: would you be equally happy with our article saying "critical evaluation did not find that spinal manipulation was effective at treating any condition"? Firefangledfeathers (talk) 06:00, 16 July 2021 (UTC)

I believe that he quote that User:Roxy the dog is providing comes from the conclusion of the abstract. It is clearly and simply worded. I do not believe that is provides any evidence that we should be using sources written for a general audience rather than scientific journal articles. DigitalC (talk) 14:17, 16 July 2021 (UTC)

People who understand how medical science works (such as Roxy) know that if you make a good, strong, meaningful, carefully designed study to find out whether some treatment is effective against a specific thing, and there is no good reason why the treatment should be effective, and the study finds no evidence, then you can conclude that the treatment is ineffective. This is because if it were effective, the study would very likely have found it.

People who do not understand medical science do not know this. Instead, they usually think, "oh, they didn't find the evidence for it yet. It's inconclusive! Let's try again! Oh, it's still inconclusive! Let's try again! Oh, it's still inconclusive! Let's try again! Oh, it's still inconclusive! Let's try again!" This is what is happening with pretty much all alternative medicine. Heaps of money is wasted on unpromising crap instead of actually promising candidates because deciders don't get it.

So, for knowledgeable people, "spinal manipulation was ineffective" is just a minor rewording, but for others, it is a distortion. Let's use WP:CIR, alright? --Hob Gadling (talk) 06:32, 16 July 2021 (UTC)

Oof, that smarts a bit. I would be more convinced (and to be clear, I am a little convinced) if the authors of the systematic review weren't clear about ineffectiveness in some contexts. Some of the systematic reviews included tests against sham treatment or a similar placebo option and are described with language like "This review demonstrates rather convincingly that SM is an ineffective option in the management of some types of pain such as neck pain; and the risks outweigh the benefits." (from this source). Yet, they hold off from saying so about all conditions.

I am with you on "science never proves anything", or similar constructions, often being the flaccid flailing of the pro-pseudoscience folk. For this case, I still think close adherence to the prudence of the published experts will do us better than interpreting more liberally because we're knowledgeable people. Firefangledfeathers (talk) 06:54, 16 July 2021 (UTC)

To those who believe that this 2011 review has somehow definitively "proven" that SMT is "ineffective" at treating any condition, let me point you to this 2018 review that pretty conclusively shows that a form of SMT (cervical traction) is effective at treating cervical radiculopathy, with significant improvements in short and intermediate-term pain and disability.. Yes, cervical traction is a form of Spinal Manipulation Therapy used by chiropractors. Here's a reputable secondary source that lists traction among the SMT techniques used by chiropractors. Not only is the current 2011 review dated and unable to support the current language, but the statement that "spinal manipulation is ineffective at treating any condition" is false. I think we need to come to terms with the fact that chiropractors do some things that aren't complete quackery, and trying to squeeze them into the same box as homeopaths and reiki healers is a pseudoskeptic's errand. Pinging Feoffer, Hob Gadling, DigitalC, Firefangledfeathers, Roxy the dog. Esoteric10 (talk) 06:28, 18 July 2021 (UTC)

Feoffer, I don't think the wording issue we're working out here is a reason to prefer "mainstream sourcing" over high-quality MEDRS, however technical. Since this talk page section is about Primary/OR/Synth, are we at least on the same page about this source being reliable and secondary? Firefangledfeathers (talk) 06:21, 16 July 2021 (UTC)

Definitely reliable, definitely secondary in the sense it's a systematic review. WP:PRIMARY is relevant to the extent that it's a source we should use "only with care, because it is easy to misuse". The biggest priority for me is to sculpt text that a vulnerable lay audience can quickly and effortlessly understand and verify. That doesn't mean excluding technical sources, it just means supplementing them with sources anyone can understand, and making sure the two jibe. Feoffer (talk) 07:15, 16 July 2021 (UTC)

Neither the NY Times nor Skeptical Inquirer would meet WP:MEDRS. Peer-reviewed secondary sources such as systematic reviews are the preferred sources. With that said, no QuackWatch shouldn't be being used to support the article either. DigitalC (talk) 14:13, 16 July 2021 (UTC)

DigitalCThe review I cited here does meet WP:MEDRS, and shows that cervical traction, a form of spinal manipulation therapy, is effective in treating cervical radiculopathy. The current verbiage in the article needs to be revised. The statement that "critical evaluation found that collectively, spinal manipulation was ineffective at treating any condition" is demonstrably false. Esoteric10 (talk) 18:28, 21 July 2021 (UTC)

The source you are citing doesn't mention spinal manipulation or chiropractic. Firefangledfeathers (talk) 04:31, 22 July 2021 (UTC)

FirefangledfeathersThe source is about cervical traction, which is a type of spinal manipulation therapy. At least two of the studies included in the review were involving cervical traction performed by chiropractors. If this isn't a good source, I really don't know what is. There seems to be a bit of a catch-22 happening here with regard to sourcing. In-universe sources can't be used, but when a high quality out-of-universe source is provided, it's not considered kosher because it's not in-universe.Esoteric10 (talk) 16:22, 22 July 2021 (UTC)

Out-of-universe sources are fine! We were discussing one just above. I am not sure what exactly you're advocating for when it comes to use of this particular source, but your comments above suggest that you're proposing changing well-sourced language based on some WP:OR using the 2018 source. Firefangledfeathers (talk) 19:14, 22 July 2021 (UTC)

FirefangledfeathersThe current language is based on a dated source and is demonstrably false. The current language asserts that SMT is not effective at "treating any condition", which itself is misleading language, given that it's citing the findings of one review, which only means that it was not deemed effective at treating the conditions that were within the scope of that particular review. The source I provided was a more recent review for a particular condition which a form of SMT is absolutely effective at treating. How is this not in line with WP:OR?Esoteric10 (talk) 03:04, 23 July 2021 (UTC)

I prefer not to be pinged into conversations I'm already actively involved in. The 2018 source derives its reliability from being a systematic review; the individual studies do not obtain reliability by inclusion. It's reasonable to assume that the review authors are equating chiropractic traction with physical therapist traction by including both types in their review without comment. It's reasonable to assume that the review's conclusion applies to all traction, regardless of who provides it, or they likely would have excluded the chiro studies or qualified their results. But those are assumptions not verified in the text of the source. They're original research. Firefangledfeathers (talk) 04:03, 23 July 2021 (UTC)

References

Cost effectiveness in lede?

What would we think about excising/shortening/delaying the sentences about cost-effectiveness. While it's true cost-effectiveness lacks evidence, debates about "cost-effectiveness" in the lede tend to distract from the more-important discussion of effectiveness (and lack-thereof). To a vulnerable lay audience, debates about "cost-effectiveness" in the lede will imply "effectiveness". Let's relegate that discussion to the body of the article and use the precious lede-space to help readers understand the pseudoscientific nature of chiropractic, not debate the "cost-effectiveness" of something that likely is not even effective, at least as compared with science-based practitioners. Feoffer (talk) 08:43, 16 July 2021 (UTC)

Disagree, and disagree with your assertion that somehow SMT provided from another practitioner would be more effective than if provided by a chiropractor. Now that is a strong [citation needed] claim!. DigitalC (talk) 14:19, 16 July 2021 (UTC)

It's not my assertion, I don't come here with any particular point of view. Are you telling me the SMT that's offered by DOs and PTs isn't effective? My current understanding is that those are both science-based providers who are part of mainstream medicine, but I'm completely open-minded. Feoffer (talk) 19:32, 16 July 2021 (UTC)

I haven't seen any evidence SMT provided by any practitioner is more effective than when provided by any other practitioner. If you want to provide that evidence, I'd be happy to look at it. DigitalC (talk) 18:57, 19 July 2021 (UTC)

Disagree, per DigitalC.Esoteric10 (talk) 11:08, 18 July 2021 (UTC)

Risks: Stroke, Death

The infobox currently lists death and stroke as risks.

• Death: From the information I've gathered, the risk of death from a chiropractic manipulation is extremely low, with causality not established. There were 26 reported cases of fatalities associated with a chiropractic visit globally between 1934 and 2009, (0.35 deaths per year).. Let's put causality aside and assume they were all a direct result of actions taken by the chiropractor. In the United States, about 35 million people visit a chiropractor each year with an average number of visits of 6.7. This amounts to approximately 235 Million chiropractic visits per year just in the United States. If we are extremely generous and assume the number of actual deaths are 30x greater than the number of reported cases, and assuming all cases occurred in the united states as opposed to globally, this would bring us to about a 1 in 23.5 million chance of death, which is the same risk of death as driving an automobile about 4 miles. Based on the number of actual reported cases, that gives us a 1 in 670 million risk, about the same as driving a car 1/8th of a mile. I think it's our job to give the reader an accurate portrayal of risks. Listing "death" in the infobox at the top of the page gives the impression that it's much more than a 1 in 670 million risk, and that causality has been thoroughly established. A good rule might be that when an adverse event is more likely to occur while driving to see a chiropractor than while in the chiropractor's office, it shouldn't be listed as a "risk" in the infobox.

• Stroke: Quality sources point to no increased risk of stroke when visiting a chiropractor when compared to visiting a PCP. "We found no excess risk of carotid artery stroke after chiropractic care. Associations between chiropractic and PCP visits and stroke were similar and likely due to patients with early dissection-related symptoms seeking care prior to developing their strokes.". There is a source that points to the nominal number of stroke cases, but when it comes to causality, there is no consensus. Signs point to there being no causality, at least based on the sources I've found and referenced here (4 and 5 in the reflist), both high quality out-of-universe sources. It certainly doesn't meet the burden of proof required to be confidently listed as a "risk". This is aside from the fact that it is also extremely rare (about 1 in 4 million, based on what I've seen).

More broadly, I think the whole infobox needs to be re-addressed, as it is extremely misleading, however I would like to have a discussion regarding these two claims, since I think they're the most glaring issues. Esoteric10 (talk) 10:07, 18 July 2021 (UTC)

Are you saying we should sweep those deaths under the carpet because there are not enough of them?

If a reader wants to know if there are any risks, reads "no", and gets killed by a chiropractor, her death is on our hands if we agree to that. (I say "her" because young women never ever die of a stroke, except shortly after they had their neck vertebrae manhandled - you know, the ones where that vulnerable artery runs, which causes strokes if demolished. Isn't that very weird if there is no causal connection?)

If a reader wants to find a line of work where there is no danger of damaging people, reads "Risks: None", becomes a chiropractor and starts recklessly killing people because there is, after all, no risk, those deaths are again on our hands.

To avoid WP:RGW, I will add that those deaths are only the ones we know of. Read the writings of Edzard Ernst to find out more. The three studies you quote are WP:PRIMARY sources, all by the same chiropractor, J David Cassidy. Not very useful as evidence.

So, no. Fuck off. --Hob Gadling (talk) 12:54, 18 July 2021 (UTC)

Hob Gadling Sounds like an emotional response for what should be a discussion about the facts of the matter. You didn't address any of the major points I made. The data literally shows about a 1 in 1 billion chance of death, and we have absolutely nothing pointing to causality. What is the standard by which you'd feel comfortable calling something a risk? Do you have blood on your hands for not putting "stroke" or "death" as a risk of visiting a PCP in the infobox on top of the page? Provide some good sources. Show me a source that shows that deaths are associated with visiting a chiropractor at a higher rate than someone visiting a PCP. Further, show me something that points to causality. The studies I cited are in high quality peer-reviewed journals. Your response was to attack one of the authors? Show me a study that tells a different story. Claiming that something causes death is a pretty serious accusation. Should we slap that label on every wikipedia article about something with > 1 in 500 million chance of death, with no evidence suggesting causality? We are so far from reaching any burden of proof to confidently make this claim that I can't believe you can simultaneously claim to respect the scientific method while also holding this position. The only thing that seems to explain this is that you wish to portray chiropractors in a negative light. The hypothesis that pre-stroke symptoms prompt the visits seems perfectly plausible, and would make sense given the data showing stroke rates being very similar to PCP visits. The reality of the situation is far from what you're trying to portray, which seems to be the idea that chiropractors are out there doing mortal combat finishers on their patients. Also, WP:WQ you, too. Esoteric10 (talk) 04:02, 19 July 2021 (UTC)

we have absolutely nothing pointing to causality. This is a lie. I just told you a thing we have. I did not read beyond the lie because there is very likely nothing worthwhile in it. We are finished here. --Hob Gadling (talk) 06:21, 19 July 2021 (UTC)

Hob Gadling You wanted a non-primary source, I encourage you to take a look at this review . I noticed this has not been included in the article. It is the most recent and comprehensive analysis of the subject to date. I would like to highlight a particular part

The assumption that the cervical manual-therapy intervention triggers CAD in rare cases has been dominated by single-case reports and retrospective case series or surveys from neurologists who naturally lack substantial methodological quality to establish definitive causality [87]. These neurological case reports have probably contributed to an over-reporting of serious and catastrophic AEs compared to minor and moderate AEs, which are likely to occur more frequently [55,88]. In light of the evidence provided in this comprehensive review, the reality is (a) that there is no firm scientific basis for direct causality between cervical SMT and CAD...

I agree with Esoteric10 about removing death and stroke from the box. Based on the current scientific evidence, having those risks written there massively exaggerates the actual risk. That is to say, there is no evidence whatsoever demonstrating causation. Ernst's article that are cited here does not even attempt to demonstrate causation, as that cannot be done with case studies. If you have a specific article that demonstrate causation, please link it. I am extremely familiar with Ernst's work and I have never seen an article of his which demonstrates that spinal manipulation causes stroke. Your argument that those are the only deaths we know of is fallacious; that is an argument of ignorance. Trying to use the idea that there are deaths we don't know about as a matter of proof literally demonstrates that you do not have evidence to support your point. It is the same argument used by the seditionists in the US to claim that fraudulent votes overturned the 2020 election, despite having no evidence to support that belief. Jmg873 (talk) 06:06, 23 September 2021 (UTC)

Not being super-familiar with the subject, there's a lot of room for improvement here in conveying to the reader the risks. Text is sort of all over the place... Feoffer (talk) 08:26, 23 September 2021‎ (UTC)

Absolutely on board with you, Jmg873 and Esoteric10. Stating stroke and death in the infobox is misleading. This article definitely has a lot of room for improvement. Jebbles (talk) 10:48, 23 September 2021 (UTC)

Oh, look! Another review from another chiropractor claiming that there is no risk. Quelle surprise. I don't think this counts for anything.VdSV9•♫ 12:27, 29 September 2021 (UTC)

VdSV9, I think that your criticism of the clinical training of what appears to be a full-time researcher is not really meaningful here. First, the review is published in a peer-reviewed medical journal that meets MEDRS. Secondly, the claims make in the chiropractic researcher's review are consistent with all recent reviews on the topic, many of which published by researchers who have clinical training in medicine. E.G.: "There is no convincing evidence to support a causal link between chiropractic manipulation and CAD."[1] and "Conclusive evidence is lacking for a strong association between neck manipulation and stroke, but is also absent for no association." [2]

VdSV9, It is an in-universe researcher (therefore, an expert on the subject), publishing in a peer-reviewed medical journal that is out of universe (therefore, objective and unbiased). The journal would have looked for evidence of bias when reviewing the study. Your response implies that we should ignore it because it came from a chiropractor, but you ignore that this is published in a peer-reviewed medical journal. You seem to believe that an impact-rated journal with an all-medical review board would blindly publish a study without adequate review.

We have no studies which demonstrate causation. We have reviews (such as listed above) which have evaluated multiple different types of studies, including on mechanism, cohort studies, case-control studies, and found a minimal association, or no association. The injury itself is at most exceptionally rare (per the other research listed here). In fact, part of the reason it is so difficult to prove despite some fairly sizable studies is because of its extreme rarity. If anyone has a study demonstrating otherwise, please link it, otherwise we need to remove stroke and death from the infobox.Jmg873 (talk) 00:24, 8 October 2021 (UTC)

How would studying causation work? Rip at a lot of people's necks and see how many get strokes and how many die? That would not be allowed for ethical reasons. We already know, from basic anatomy, that there is a blood vessel at a place that makes it vulnerable to specific violent movements such as chiropractic manipulation of atlas and axis. We know that young women never get strokes except shortly after chiropractic manipulation of the neck. We have means, motive and opportunity. Any person who looks at this and is honest and unbiased can see that there is an obvious causal connection between chiropractic and stroke. "Causal" studies on this are neither needed nor ethical.

Medical doctors already know and accept that what they do can have negative effects. There are mechanisms in place that handle this. It is part of their professionalism. Chiropractics need to start going in this direction, and the first step is going out of denial regarding this. At the moment, they refuse that sort of professionalism, and there are journals who help them by publishing their denialism. For Wikipedia, that does not matter. Chiropractics are WP:FRINGE, and what they write is in-universe, colored by a fantasy worldview, and unreliable. --Hob Gadling (talk) 07:59, 8 October 2021 (UTC)

Hob Gadling, You have been here long enough to know that your personal opinions do not matter and this is not a forum for you to share your perspective. There have ben multiple secondary sources presented that suggest no causational relationship and a questionable association. Feel free to provide some recent secondary sources that support your claims, otherwise take your own advice from your first comment and f*** off.2001:56A:70E6:DB00:EC21:DA54:FA25:1647 (talk) 16:09, 8 October 2021 (UTC)

Hob, your argument is fallacious; it's an argument from incredulity. Your statement that Any person who looks at this and is honest and unbiased can see that there is an obvious causal connection between chiropractic and stroke." is OR. If you have a legitimate MEDRS source please share it. Otherwise, please refrain from OR. Jmg873 (talk) 05:59, 9 October 2021 (UTC)

Instead of asking for sources, you and the IP should just have a look at the sources already linked in the article in the Stroke-Death section, especially those by Edzard Ernst, arguably the foremost expert on alternative quackery in the world. He can explain to you what I wrote above: yes, there is a very plausible causal explanation. See [3]: The most serious problems, which some experts now describe as ‘well-recognized’, are vertebral artery dissections due to intimal tearing as a result of over-stretching the artery during rotational manipulation. This seems to occur most commonly at the level of the atlantoaxial joint.

The sources you have are, as I said, in-universe. They are biased towards a fringe idea and therefore much weaker than the non-fringe ones. Why don't you just read WP:FRINGE and accept that Wikipedia is not the right place for quackery PR? --Hob Gadling (talk) 06:21, 11 October 2021 (UTC)

We seem to be having difficult agreeing on the reliability of the source, so I have made a posting at the NPOV noticeboard. https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_view/Noticeboard#RfC:_Neutrality_of_a_secondary_research_paper_written_by_a_chiropractor,_but_published_in_a_medical_journal. Jmg873 (talk) 21:00, 11 October 2021 (UTC)

Not only that, we also seem to have difficulties agreeing on whether what I said is an argument from incredulity and OR or rather comes directly from a MEDRS source quoted in the article. Maybe you want to acknowledge that I do have a legitimate MEDRS source which you could have found by clicking on a link in the article?

If one MEDRS source actually gives a causal explanation and another source (whether MEDRS or not) claims there isn't any causal explanation, then there is no way the article will say there isn't any causal explanation. --Hob Gadling (talk) 07:20, 13 October 2021 (UTC)

"Giving a causal explanation" is not the same as demonstrating causation scientifically and you know that; being able to explain how something could occur, is not the same as proving that it does. Jmg873 (talk) 12:54, 13 October 2021 (UTC)

And you know (if only because I told you) that it would be unethical to do a study demonstrating causation scientifically. You demand evidence that cannot be collected except by people with a moral compass similar to that of Josef Mengele. So, that objection is at least worthless and at most ghoulish. --Hob Gadling (talk) 13:46, 13 October 2021 (UTC)

References

Post-NPV Noticeboard Section Break

I noticed this from the NPOV noticeboard. First, far too much space is being used by the anti-fringe editor here arguing from their personal beliefs, using ad-hominems against the researchers, ignoring the fact that the source has been peer-reviewed by a reliable journal, arguing from emotion and in one case telling an editor to "fuck off". I am inclined to pursue a tendentious editing charge against editors who behave in this manner. MarshallKe (talk) 13:08, 12 October 2021 (UTC)

Moving on, if we determine that the RS is on the same level as the other sources used in this article, and I as an insofar uninvolved editor believe it probably is, we should, at the very least, include its major claims in this article, even if they contradict the other sources used. I recommend something of the format A YEAR systematic review found CLAIM. I suggest separating the edit discussion from the source discussion, as the edit discussion WILL be messy and full of petty obstructionism. MarshallKe (talk) 13:08, 12 October 2021 (UTC)

When editor Esoteric10 wants Wikipedia to delete information about a deadly risk from an article about a technique (which, BTW, has neither a theoretical basis in reality nor empirical evidence in favor of it), then that editor must be told very clearly that No, We Will Not Do That. If you don't care about people dying after Wikipedia has ensured them that there is no danger - because bah, it's just 26 dead bodies we know of, that's peanuts, let's ignore them and pretend that chiropractic has a clean slate - and call people who think that 26 is bigger than zero "emotional", well, that is your problem. --Hob Gadling (talk) 14:57, 12 October 2021 (UTC)

Indeed. -Roxy the sceptical dog. wooF 15:00, 12 October 2021 (UTC)

Clearly the article improvements suggested by Jmg873 above are supported by plenty of recent, MEDRS-compliant sources ([4], [5], [6]). Seasoned editors like Hob and Roxy know full well that their opinions have no value here, so surely they would not resort to logical fallacies and unsupported opinions if there were actually sources or a policy-based rational that supported their preferred version of the article. Jmg873, I would suggest that you just go ahead and make the bold change. If Hob and Roxy want to push the issue then they will revert, but at some point their unsupported assertions will fail to be enough to prevent article improvements; just stay persistent and within the rules.2001:56A:70E6:DB00:850B:18B4:52A7:892D (talk) 02:27, 13 October 2021 (UTC)

Yeah I'm pretty sure it wouldn't be staying "persistent and within the rules" to make clearly contentious bold edits during an ongoing discussion (WP:CAUTIOUS WP:TALKDONTREVERT WP:DISCUSSCONSENSUS). Not really in the spirit of consensus to decide it's not worth establishing. --Xurizuri (talk) 06:15, 13 October 2021 (UTC)

Xurizuri, you suggest that being bold would be contentious, can you clarify why you feel this way? Despite months of 'discussion', no editors have brought any sources or policy-based reasons to suggest that the changes suggested are not appropriate. How long do you think editors should be able to block improvements without providing any sources or policy-based reasoning? 2001:56A:70E6:DB00:850B:18B4:52A7:892D (talk) 08:27, 13 October 2021 (UTC)

Another one who is unable to click on the source links in the article. --Hob Gadling (talk) 07:20, 13 October 2021 (UTC)

Hob, I have looked though the article and I cannot find anything newer than a couple 2010 sources by Ernst - a list of cases and a narrative review - that suggests anything with regard to spine manipulation and serious risks; however, higher-quality work has been done in the decade since. While no one has suggested removing the older works, the articles infobox currently makes a bold claim about safety based only on outdated and low quality sources. Surely you do not think that the infobox should rely exclusively on information from decade old sources that have since been contradicted by newer secondary sources? As a reminder, here are the 3 newest secondary sources (2 systematic reviews and a comprehensive review), that encompass at least 2 review cycles:

• Haynes et al 2012: "Conclusive evidence is lacking for a strong association between neck manipulation and stroke, but is also absent for no association."
• Church et al 2016: "There is no convincing evidence to support a causal link between chiropractic manipulation and CAD"
• Chaibi & Russel 2019: "In light of the evidence provided in this comprehensive review, the reality is that there is no firm scientific basis for direct causality between cervical SMT and CAD..."

2001:56A:70E6:DB00:850B:18B4:52A7:892D (talk) 08:27, 13 October 2021 (UTC)

• User:MarshallKe - I think the source actually is the only thing that does matter, and whether to include pro-chiropractor is simple: WP:MEDRS and WP:RS/MC state it is a matter of published in reputable journals. All these Diversions into who wrote it it or spats among WP editors will not change whether a medical journal published the content. After that, the claim of risk of death is a matter of NPOV prominence by WEIGHT, and to fairly describe both sides - and please include numbers. The claim of risk seems fairly exceptional to me, but if the position is 26 deaths per zillion is something to worry about and countering positions exist, then edits should just state it. Cheers Markbassett (talk) 08:33, 13 October 2021 (UTC)

  If you set the deaths in relation to the clinical benefit, the quotient becomes quite large. See division by zero. I know from your creationist editing history that you do not care much about WP:FRINGE, but is still a guideline, and it says, When discussing topics that reliable sources say are pseudoscientific or fringe theories, editors should be careful not to present the pseudoscientific fringe views alongside the scientific or academic consensus as though they are opposing but still equal views. Have those sources received any reception, positive or negative? Remember, it has been established by a court that chiropractors "happily promote bogus treatments". --Hob Gadling (talk) 13:46, 13 October 2021 (UTC)

  This is a discussion about risk, and whether or not stroke/dissection/death should be included. Benefit/efficacy is a different discussion. Whether or not there is a benefit, does not change the risk. on a separate note, please argue the content not the editors. Jmg873 (talk) 14:41, 13 October 2021 (UTC)

  You forgot to answer the question "Have those sources received any reception, positive or negative?" and to comment on the fringe guideline. --Hob Gadling (talk) 15:14, 13 October 2021 (UTC)

  I am unclear on the point you are making about their reception. Are you suggesting that the scientific community has received these studies poorly? Admittedly, I am a relatively inexperienced editor. Perhaps I am ignorant to the relevance of this, if so, please educate me.

  Regarding the fringe guideline cited: If these were studies published exclusively in chiropractic journals and there were no similar studies in out of universe journals, I could see your point. However, the studies cited here are the three most recent reviews on the topic and are all in medical journals. As such, these are not pseudoscientific fringe views, these represent the current scientific consensus. This is evidenced by their publication in three different medical journal over 10 years of time. Different authors, different review boards, different journals; same conclusion. There seems to be consensus that these sources are MEDRS compliant, both here and on the noticeboard. Do you have any studies to present demonstrating that this is not the current scientific consensus? Jmg873 (talk) 15:42, 13 October 2021 (UTC)

  There are many thousands of scientific studies. Most of them are unimportant enough to be pretty much ignored by the scientific community at large. Wikipedia needs to select the most relevant ones. Relevance increases with reception and with the importance of the journal. If nobody has ever cited that study, then why should Wikipedia? See WP:UBO.

  WP:MEDRS is not a yes-no thing. It is a hierarchy. As jps pointed out in Wikipedia:Neutral point of view/Noticeboard, The source is still relatively new and so its reliability is suspect until other sources indicate that its conclusions are warranted. This is closely related to the reception thing. Studies are not the end product of science - after they are written and published, peers still review them and use their results or not.

  Strictly spoken, the NPOV board is not the right place for that kind of question. There is Wikipedia:WikiProject Medicine and Wikipedia:Reliable sources/Noticeboard. --Hob Gadling (talk) 06:33, 14 October 2021 (UTC)

As Xurizuri pointed out on the NPOV noticeboard section, why are we even including a "risks" section in the infobox at all? I took a look at several other fringe articles, including osteopathy (a nearly identical therapy) and did not any that include risks in the infobox. Why are we including these risks in a section that is too small to explain the nuance of the research that exists on it? Jmg873 (talk) 03:23, 14 October 2021 (UTC)

That question is based on the false assumption that the risk is not solidly established. Actually, The stroke risk been known for a while, based on several studies, and has been quoted a lot. In pseudosciences, we often have the situation that established facts are called into question by new studies, but then the new studies are found to contain fatal mistakes. Then there is a new study doing the same thing, and then it is found to faulty too. It would be wise to wait until the new studies have been evaluated thoroughly. --Hob Gadling (talk) 06:41, 14 October 2021 (UTC)