Talk:Chiropractic

NPOV language towards end of Philosophy intro

The following text at the end of the Chiropractic #Philosophy intro has multiple WP:NPOV issues:

This "straight" philosophy, taught to generations of chiropractors, rejected the inferential reasoning of the scientific method, and relied on deductions from vitalistic principles rather than on the materialism of science.

As chiropractic has matured, most practitioners accept the importance of scientific research into chiropractic. Balancing the dualism between the metaphysics of their predecessors and the materialistic reductionism of science, their belief systems blend experience, conviction, critical thinking, open-mindedness, and appreciation of the natural order. They emphasize the testable principle that structure affects function, and the untestable metaphor that life is self-sustaining. Their goal is to establish and maintain an organism-environment dynamic conducive to functional well-being of the whole person.

Here are some of the POV issues:

• The first sentence uses past tense "rejected"/"relied", which implies that straight philosophy is obsolete. It should use present tense.
• The second sentence uses "matured", which implies that mixer chiropractic is better than straight.
• The "Balancing" sentence contains many POV words and phrases, including "balancing", "blend", "experience", "conviction", "critical thinking", "open-mindedness", "appreciation of the natural order".
• The "They emphasize" sentence gives the impression that Wikipedia editors agree with chiropractic theories that there is a "testable principle that structure affects function" and an "untestable metaphor that life is self-sustaining".
• The "Their goal" sentence gives the impression that Wikipedia editors agree with the theory that chiropractors "establish and maintain an organism-environment dynamic conducive to functional well-being of the whole person".

Also, the last three sentences are uncomfortably close to plagiarism, in the sense that they quote too directly from the source without using quote marks. There is no legal problem with this (the source is public-domain), but still there is an ethical problem. Here's what the source says:

Contemporary chiropractic belief systems embrace a blend of experience, conviction, critical thinking, open-mindedness, and appreciation of the natural order of things. Emphasis is on the tangible, testable principle that structure affects function, and, the untestable, metaphorical recognition that life is self-sustaining and the doctor’s aim is to foster the establishment and maintenance of an organism-environment dynamic that is the most conducive to functional well-being.

Furthermore, aside from introducing POV, the last three sentences overall don't say much that is not said elsewhere in Chiropractic #Philosophy. What they do is add a sales pitch, which is not Wikipedia's function.

To fix the above problems, I propose replacing the above text with the following:

This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic principles rather than on the materialism of science. However, most practitioners currently accept the importance of scientific research into chiropractic, and attempt to "mix" the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness.

Eubulides (talk) 22:48, 20 August 2008 (UTC)

You need a period before "However". That second sentence also needs a qualifier to contrast it with the first sentence about "straight" philosophy. -- Fyslee / talk 05:28, 21 August 2008 (UTC)

Thanks, fixed the period. What sort of qualifier did you have in mind? The 2nd sentence uses "mix"; would you prefer "mixer", as a better contrast from "straight"? Eubulides (talk) 09:05, 21 August 2008 (UTC)

Yes, that sounds like a possibility. Let's see how it looks:

This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic principles rather than on the materialism of science. However, most mixers currently accept the importance of scientific research into chiropractic, and attempt to "mix" the materialistic reductionism of science with the metaphysics of their predecessors, as well as with the holistic paradigm of wellness.

How's that? I replaced "practitioners" with "mixers" and "and" with "as well as". -- Fyslee / talk 02:52, 22 August 2008 (UTC)

Unfortunately I think the source says most practitioners, not most mixers. Eubulides (talk) 08:58, 22 August 2008 (UTC)

Good point. We could clarify that "most practitioners - who also happen to be mixers - currently accept ..." without doing any OR. That's a documented fact. Somehow that can be tweaked to make it clear. -- Fyslee / talk 14:22, 22 August 2008 (UTC)

I dunno, it's pretty close to OR to combine the "most practitioners are OR" and "most practitioners accept scientific research" into "most practitioners, who also happen to be mixers, accept scientific research". One can easily construct scenarios where the first two facts are true but the rewritten combination is false. For example, the currently-cited sources do not exclude the (admittedly bizarre) possibility that 60% of DCs are mixers, 60% of DCs accept scientific research, but only 33% of DC mixers accept scientific research. Come to think of it, my proposal suffers from this problem as well. How about the following tweak instead?

This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic principles rather than on the materialism of science. However, most practitioners currently accept the importance of scientific research into chiropractic, and most practioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness.

Eubulides (talk) 22:05, 25 August 2008 (UTC)

Sounds like a good solution, without the problems. -- Fyslee / talk 05:15, 26 August 2008 (UTC)

No further comment, so I installed that change. Eubulides (talk) 01:35, 2 September 2008 (UTC)

Busse et al. 2008

The following text was added to Chiropractic #Vaccination without discussion:

At two majors complementary and alternative medicine colleges in Canada, a minority of students were anti-vaccination and the majority of students were supportive of vaccination.

There are some problems with this addition:

• The word "majors" doesn't make sense to me.
• Those results are too vague; they report only "minority" and "majority".
• The study covered a chiropractic college and a naturopathic college, and it separated out the two colleges' results; there's no reason to report the combined results when results specific to chiropractic are available. The naturopathic college need not even be mentioned.

If that study is mentioned, which is not clear to me that it should be, here is some other information that's relevant:

• The study reported that, for the chiropractic-college students, "the proportion of respondents who stated that they were against vaccination in general increased along with year of study: 4.5% (5/112) first year students, 8.3% (10/121) second year students, 13.9% (16/115) third-year students, and 29.4% (35/119) fourth year students."
• Students said that their most important source of vaccine information was informal, and that this tendency was far more pronounced as the class-year went up. First-years said 2% of their vaccination information came from formal and 0% from informal sources; fourth-years said 7% of their vaccination information came from formal and 46% from informal.
• The study was longitudinal; that is, it was all done the same year, and did not follow single students from one year to the next.

I propose that that the text be removed, as I don't think it adds much to the section; but if it is kept it really needs improvement. For now I've given it a vague tag. Eubulides (talk) 02:09, 21 August 2008 (UTC)

The more important question is whether the students were being taught anything about vaccination as part of their chiropractic studies. How is a survey about vaccination any more notable than a survey about Britney Spears? --Surturz (talk) 05:25, 21 August 2008 (UTC)

Vaccination is a health topic; Britney Spears is not. Some chiropractors aim to be primary health care providers; they do not typically aim to be Britney Spears fans (at least, they don't write papers about it :-). Eubulides (talk) 09:05, 21 August 2008 (UTC)

Eubulides, I agree with you. The addition is poorly worded and needs improving. The study is significant, especially since it shows that anti-vaccination sentiments increased among students, IOW future chiropractors, IOW the profession of the future. The mention of students should be included in a properly worded manner. I suggest it be included and merged with the following:

• Historically, chiropractic strongly opposed vaccination based on its belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines; Daniel D. Palmer, the founder of chiropractic, wrote, "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison." Vaccination remains controversial within chiropractic. The American Chiropractic Association and the International Chiropractic Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; however, surveys in Canada in 2000 and 2002 found that only 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children. Although most chiropractic writings on vaccination focus on its negative aspects, antivaccination sentiment is espoused by what appears to be a minority of chiropractors.

This content is from the Vaccine controversy article and has already passed muster as properly written and reliably sourced content. -- Fyslee / talk

• That material all used to be in Chiropractic, if memory serves, but got edited down using the argument that all that detail wasn't needed here.
• Actually, the study doesn't demonstrate that antivaccination sentiment increased in any particular student, since it took a cross-section of students.
• More recently, the text in question has been altered to make it even less coherent, here. I attempted to fix the immediate problem with this change. I am still not convinced this material about CMCC students needs to be in Chiropractic though; it's a bit marginal. Perhaps it should be moved to Vaccine controversy?

Eubulides (talk) 09:05, 21 August 2008 (UTC)

It should be somewhere. If here, then in a shortened version. -- Fyslee / talk 03:05, 22 August 2008 (UTC)

No it shouldn't be used anywhere. It is a badly constructed, politically motivated opinion poll and should not be considered a WP:RS. --Surturz (talk) 05:27, 26 August 2008 (UTC)

The study is published in a peer-reviewed journal by experienced authors. No evidence has been presented that it is politically motivated or badly constructed. Surveys are an important part of research, when the subject, as in this case, is opinion. Eubulides (talk) 08:43, 26 August 2008 (UTC)

At the moment I don't think I have access to the full-article. Is the 2008 study really publishing data obtained back in 1999-2000? Wasn't this data published back in 2002 by Busse & Injeyan? - DigitalC (talk) 00:37, 28 August 2008 (UTC)

Yes, it's studying data gathered in 1999-2000. I don't know of a 2002 study by Busse & Injeyan; do you have a citation for that? Eubulides (talk) 02:38, 28 August 2008 (UTC)

Here is a link. Looks like the same data to me. cmaj.ca. - DigitalC (talk) 05:52, 28 August 2008 (UTC)

In #Vaccination draft below I am proposing to remove the (updated) version of this sentence. Eubulides (talk) 01:37, 2 September 2008 (UTC)

I prefer we keep the updated sentence in the article. The student bit is an important point. Students are being taught by chiropractic authors about antivaccination in chiropractic circles. QuackGuru 02:39, 2 September 2008 (UTC)

OK; could you please raise this point in #Vaccination draft? That will make it easier to keep track. Note that the study did not conclude that students are being taught by chiropractic authors; it wasn't sure where the influence was. Eubulides (talk) 07:31, 2 September 2008 (UTC)

Flaws, Weight and Bias Widespread throughout article

Upon review, Chiropratic has many small, but significant flaws which has introduced bias in several areas:

• The focus and undue weight on the perceived deficiencies of 'straight' chiropractic at the expense of the rest of the article. Criticisms and controversies should be dealt with in one section rather than being littered throughout the article
• Even though the lead and the article suggests that the 'mixer' brand of chiropractic forms the majority it is not accorded such status in terms of weight in the article itself nor it is represented robustly in its own section
• The lead refers to 'traditional' chiropractic without contrasting it against 'modern' chiropractic. It's preferable to have a sentence which represents all chiropractic belief systems not just one vs. another
• The evidence basis section needs a complete rewrite; older sources are being used to dispute newer ones
• Minority held viewpoints are being unjustly weighted and spread throughout the article rather than having self-contained sections that deal with the scientific and mainstream criticism of chiropractic
• A lack of global viewpoint is apparent; controversies and status issues in North America may not be present in other parts of the world, in particular in Europe
• Lack of adequate coverage of non-controversial chiropractic-related subjects in particular formal integration in various governmental and public community based health care delivery systems

There are more, however a piecemeal approach would be best to address these deficiencies; the most obvious is the non-reliable use of scholarly sources. Given that Wikipedia suffers from credibility and reliability issues, it's of fundamental importance that information be portrayed in the most objective neutral manner. Tone of articles should reflect the tone of major, credible, reliable organizations so that bias, in either direction is not used directly or indirectly to advance editorial agendas. There are a lot of comments to read through, but it seems as though there are clearly 2 camps here and the gap must be bridged. Soyuz113 (talk) 16:27, 23 August 2008 (UTC)

Just to address one point: A lack of global viewpoint is apparent; controversies and status issues in North America may not be present in other parts of the world, in particular in Europe North America birthed the profession and has the lion's share of chiropractors, thus the emphasis. That said, it would be interesting to have a section about chiropractors in the rest of the world. --—CynRN ^(Talk) 05:11, 24 August 2008 (UTC)

Suggested improvements are always welcome - and there is certainly always room for improvement! Try making them here (functioning refs and all) and we can discuss and refine them, then include them when we have a consensus. That way we can avoid disruptions and edit wars. WP:BRD is a bad idea here. Let's hammer it out and make this article better. I have always hoped to see this article become the best article on the subject ever written. Most articles on chiropractic are written from one or another POV, for or against, etc., which is fine and legitimate on other websites, but here we aspire to do much more, including all significant POV and historical points of interest. So far we're moving forward and any good suggestions are appreciated. We are all sitting at the same editing table, so to speak, so welcome to the table! -- Fyslee / talk 05:23, 24 August 2008 (UTC)

• What Fyslee said. :-)
• Criticisms and controversies should not all be put into one section. Chiropractic has many controversial aspects. It is not a good style to have one ghetto section with critical comments, with the rest of the article containing only supportive comments. The article should attempt to fairly and neutrally summarize all facets of chiropractic, and the topic order should be whatever is needed to cover the subject.
• Mixers should indeed be covered better, but there is a good reason to weight straight chiropractic somewhat more heavily than the modern percentage of straight chiropractors would suggest. Straights have an influence on their profession that is larger than their numbers. Part of this is for historical, legal, and philosophical reasons, but those are important reasons that should be covered.
• The sentence in the lead before the "Traditionally" sentence talks about modern chiropractic; perhaps this could be stated more clearly?
• Which "older sources are being used to dispute newer ones"? Examples, please.
• I agree with CynRN; the vast majority of chiropractors are in North America and the article should reflect this.
• "formal integration in various governmental and public community based health care delivery systems" is not "non-controversial". On the contrary, like many aspects of chiropractic, formal integration is highly controversial. That is not to say that the topic shouldn't be covered better, of course.
• What "non-reliable use of scholarly sources"? Examples, please.

Eubulides (talk) 09:33, 24 August 2008 (UTC)

• Controversies SHOULD be put into one section as there are certainly accepted mainstream elements of chiropractic (treating musculoskeletal) and non-mainstream (treating non musculoskeletal). To have criticisms spread throughout every section is fairly dubious. Who suggested the other sections would have "supportive comments"? Commentary should be kept to a minimum on either side. Currently the article does not reflect that and this needs to change.
• Straights have more influence according to whom and where exactly? There is a lot of conjecture here without supporting facts that highlight these alleged are important to anyone but a group of editors here who seem to be literally re-writing history
• According to my research there are more schools of chiropractic operating outside continental United States than within it. As such the American viewpoint should not supercede a global one, especially if reliable information is available on other programs and models of chiropractic.
• Formal integration is highly controversial with whom? To chiropractors? Medical doctors? It's not our job as editors to "spin" facts; rather we are here to report them. For example, there's no mention of any kind of department of veterans affairs formal chiropractic program, no mention of hospital-based chiropractors
• Sources, in particular in the evidence basis section have not been used reliably, in fact, they are misleading the reader as to the 'effectiveness' of modalities used by bodyworkers including chiropractors. When a 2008 review declares "manual therapy to be effective for neck pain" that should not be superceded by a 2007 review that declares it to be "unknown". Especially when the 2008 review covered the 2007 paper. Instances like these are littererd the article.
• I fail to see how come it is appropriate to insert words into cited text; the "hypothesized" word was re-introduced despite it not being in the cited source with an edit summary suggesting "it's in the article". The cited source is being, pardon the pun, "manipulated" and which is not how scholarly articles are written. Soyuz113 (talk) 16:38, 24 August 2008 (UTC)

• I agree that commentary should be kept to a minimum. But it should not be put into a ghetto; comments should be made where appropriate.
• Straights clearly have more influence than their numbers might indicate. Here's one example reliable source to this effect (there are many others): "Since the 1930s, straights have been a very distinct minority in the profession. Nonetheless, they have been able to transform their status as purists and heirs of the lineage into influence dramatically out of proportion to their numbers." (Kaptchuk & Eisenberg 1998, PMID 9818801).
• There are far more chiropractors inside North America than outside; the center of the profession is clearly in North America, its history began in North America, and it's clearly appropriate to emphasize North America in the article.
• Formal integration is controversial both among chiropractors and among physicians, yes.
• When reliable sources conflict with each other, we should not automatically pick the most recent one; that would be recentism and goes against WP:RECENT and WP:MEDRS. We should instead use good judgment and in many cases simply report the conflict. For example, an older Cochrane review might well be more reliable than a more recent review published in the Seychelles Medical and Dental Journal.
• The word "hypothesized" is supported by the cited source (Nelson et al. 2005, PMID 16000175), which emphasizes the point that the idea in question is a hpothesis: it says "hypothesis" 9 times by my count, and has a section entitled "What is the Chiropractic Hypothesis?".

Eubulides (talk) 08:26, 25 August 2008 (UTC)

I see that Surturz removed "hypothesized" without further discussion. This is distressing, as "hypothesized" is quite well-justified by the previous comment, and nobody has made any further comment since then. Also please see Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead for the discussion and justification that originally motivated and eventually inserted "hypothesized", without dissent, after a 6-day wait for comments. Eubulides (talk) 02:19, 26 August 2008 (UTC)

'Hypothesized' may have previously had consensus for inclusion. However, I am now disputing the inclusion of the term. It is a POV word in that it is making a judgement on the efficacy of chiro treatments. It is a weasel word; *who* is 'hypothesizing'? I would like someone to either qualify the term with a subject, or remove the term entirely. --Surturz (talk) 03:59, 26 August 2008 (UTC)

• The word "hypothesis" is not used in the lead to judge the efficacy of treatments: it is used, as in the cited source, to describe the core chiropractic set of beliefs.
• It is not necessary, and would bloat the text, to say explicitly "'who' is doing the hypothesizing". It is obvious from the context that chiropractors are responsible for the chiropractic hypothesis.
• "Hypothesis" and "hypothesized" are not weasel words, either in the lead, or in the cited source. As mentioned, in Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead it is important that Chiropractic not appear to endorse the chiropractic hypothesis.
• Again, your comments have not addressed the point that the word is well-supported by the cited source (Nelson et al. 2005, PMID 16000175), which repeatedly uses the word "hypothesis" to talk about the chiropractic belief that there is an important relationship between the spine and health, mediated by the nervous system.

Eubulides (talk) 05:00, 26 August 2008 (UTC)

I disagree, as previously described. The word is quoted out of context. You no longer have consensus for the use of the word 'hypothesized' --Surturz (talk) 05:23, 26 August 2008 (UTC)

The use of the word (or a similar one) is definitely justified by NPOV, which requires that Wikipedia not appear to endorse a POV. Since that POV is a chiropractic POV/opinion and belief system that is disputed by mainstream science, it is especially important that readers not get the impression that the chiropractic POV is undisputed by stating it as fact when it isn't a fact. NPOV and the source allow use of "hypothesized".

Surturz, you have no consensus to edit war. If you can't collaborate and get a consensus before you change things, please go somewhere else. So far your presence here is very reminiscent of an indef banned editor who wreaked similar havoc on this subject. I'd hate to see you reported and an RfCU run on you, but that may be necessary. -- Fyslee / talk 05:32, 26 August 2008 (UTC)

Please stop threatening me with administration whenever I make an edit. All my edits so far have been in good faith, and all of them have been instantly reverted. I am merely stating that I do not agree with the inclusion of the word 'hypothesize' and that you cannot now claim consensus for its inclusion. I have not edit-warred over the word, contrary to your accusation. --Surturz (talk) 05:41, 26 August 2008 (UTC)

Okay, I'll AGF. To avoid starting edit wars in the future, please don't make any edits that might be controversial. Start here and discuss them, IOW, you basically need to ask permission. I know that sounds awful, but this article is a minefield and WP:BRD (which is a poor idea at controversial articles) doesn't work very well here. If someone reverts your edit, don't restore it. Discuss until there's a solid consensus. -- Fyslee / talk 06:14, 26 August 2008 (UTC)

In this case, the consensus is no longer universal, since Surturz is disagreeing with it; however, that does not mean that we no longer have a working consensus. I'd like to hear other editors' opinion on the subject (other than via edit war :-). Certainly the text without "hypothesis" has a POV problem, as described in Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead above. Something needs to be done about it. "Hypothesize" is well-supported by the source. If there's no better alternative, we should use "hypothesize". Eubulides (talk) 08:43, 26 August 2008 (UTC)

Section break

I agree that hypothesized should not be placed in the lead. It should go.

• the reference quoted (Eisenburg, 1998) that discusses the "straights out of proportion" argument is obsolete and is a directly an American POV from 1998. Currently there are more chiropractic schools outside the US than within in; accordingly a global POV must predominate not simply America and everything else.
• It would be wise to firmly delineate all controversial (medical aspects) of chiropractic care. Currently editors are sniping that this is or isn't controversial mixing in conjecture with fact. Clearly not all aspects of modern chiropractic practice are controversial; and the article appears to be needlessly 'political'.
• Although I agree that not all recent papers are necessarily the best, there does appear to be obvious (to academics at least) no-no's in the way evidence-basis and other sections have been handled. I see the section is under dispute and it is quite wordy. It needs to be trimmed down considerably. Also, while on the topic, I am skeptical that the evidence is 'conflicting' for chiropractic treatment for low back pain. Also, the opening statement for neck pain (no consensus for manual therapy, Vernon, 2007) contradicts the more recent 2008 study that demonstrates equivocally that manual therapy is effective for neck pain. Given that the 2007 paper was reviewed in the 2008 one, why lead the topic with a) an older study that b) contradicts the newer research? Is this a mistake? Judgment calls of this nature are clearly wrong (academically, at least) and if Wikipedia strives to be a reliable source editors should reliably uses the sources and promote any POV or agenda they may have.
• Formal integration is occurring regardless of what individual chiropractors and medical doctors think. Wikipedia is not a battleground for idealistic priciples, but is here to neutrally and accurately represent the facts, as you are aware. This article currently seems to want to include all controversial aspects at the expense of minimising the non-controversial aspects, portray the majority as a minority and cover the minority as if it were the majority, include CAM=chiropractic and manipulative medicine=chiropractic and other troublesome confabulations.
• This article would be far better off if it were to use neutral language as found here. The National Institute of Health is a reliable source; furthermore it gives us a good template to work around. Conclusions drawn here should not deviate significantly from major governmental health agencies. Soyuz113 (talk) 23:45, 26 August 2008 (UTC)

I think Souz113's assessment is spot on. I think we all have been dealing with this article for so long that it is hard for us to step back and look at it objectively. Soyuz comes to us with fresh eyes and I tend to agree with his description of various issues plaguing this article. -- Levine2112 ^discuss 23:57, 26 August 2008 (UTC)

Levine2112, while you're right about our need for stepping back occasionally, we aren't dealing with an inexperienced or new user who has "fresh" eyes. We've read these same arguments before from an indef banned user.

Soyuz113, you seem to be ignoring Eubulides post above, so I'll copy from it, since his points are highly relevant:

• "Certainly the text without "hypothesis" has a POV problem, as described in Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead above. Something needs to be done about it. "Hypothesize" is well-supported by the source. If there's no better alternative, we should use "hypothesize"."

The issue isn't just about the source, which abundantly supports use of "hypothesize", but of NPOV, which requires that we not endorse the chiropractic hypothesis as if it weren't a hypothesis, as explained by Eubulides in the "Simon says" section above:

• "In reviewing Talk:Chiropractic/Archive 25 #Simon-says in 2nd sentence, I noticed a similar problem in the lead's summary of that sentence. The first sentence in the lead appears to endorse the chiropractic theory that mechanical disorders of the musculoskeletal system have a leading role in general health. The cited source talks about this theory in its section "What is the Chiropractic Hypothesis", so I propose the following simple solution, supported by the source, which is to add the word "hypothesized" to the lead sentence, as follows ..."

His arguments are far more compelling than yours. It is clearly a hypothesis that is uniquely chiropractic and not supported by the evidence or mainstream medical sources. While musculoskeletal disorders are certainly significant health problems, the chiropractic hypothesis that spinal subluxations are connected with nearly every dis-ease, and that correcting them will somehow heal them (or directly aid in their healing), is very fringe. Such hypothetical chiropractic statements must be neutralized by abiding by NPOV. We do that by adding words like "hypothesize", which in this case is supported by a good source.

Your proposition of using the NIH source as a model for this article isn't new..... You know that we've been over this before.... Such a model for editing would violate policies here and the intention of Wikipedia to be different, more, and better, than other sources. NPOV forces unique deviations from the NIH article, and we edit by Wikipedia policies, not NIH editorial guidelines. -- Fyslee / talk 05:03, 27 August 2008 (UTC)

• Fyslee, I think we need to abide by WP:AGF & WP:BITE, unless you are going to invoke WP:DUCK, and if so you should formally do so elsewhere.
• I don't see any POV problems with removing "hypothesized". While the source does use the term, in the wording that is used, there cannot be any reasonable disagreement. Is there any evidence that people disagree with the fact that musculoskeletal disorders affect the nervous system? Isn't PAIN a clear sign that the nervous system is affected? If health is the absence of disease (WHO def), then having a (neuro)musculoskeletal disorder is obviously also affecting health.

DigitalC (talk) 10:32, 27 August 2008 (UTC)

Of course musculoskeletal disorders can affect the nervous system; there's no real disagreement about that. But the chiropractic hypothesis goes beyond that: it postulates a special role of the spine on general health, a postulate that goes beyond the mainstream consensus. This postulate is a core part of the chiropractic philosophy, which is why it's mentioned in the lead; but the lead should not give the mistaken impression that the postulate is widely accepted outside chiropractic. There is certainly evidence that this postulate is disputed; if necessary (which I don't think is the case here), we can supply citations to this effect from reliable sources. Eubulides (talk) 16:54, 27 August 2008 (UTC)

The wording is:

• "Chiropractic is a health care profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and their hypothesized effects on the nervous system and general health, with special emphasis on the spine".(emphasis mine)

This to me doesn't mention anything about a special role of the spine, it states that "Chiropractic is a health care profession... ...with special emphasis on the spine". I don't think that is hypothesized. What this sentence does imply, is that effects from mechanical disorders are only hypothesized. The postulate that you mention is well described by:

• "Traditionally, it assumes that a vertebral subluxation or spinal joint dysfunction can interfere with the body's function and its innate ability to heal itself".(emphasis mine).

The word 'assumes' here is appropriate to prevent the impression that this is accepted outside (straight) chiropractic. DigitalC (talk) 01:16, 28 August 2008 (UTC)

• The chiropractic hypothesis, which is not shared by mainstream medicine and science, includes the postulated effects of mechanical disorders on general health, as mediated by the nervous system. This is what is described in the phrase "effects on the nervous system and general health", and this is the phrase needs some sort of qualification, so that it doesn't appear that Wikipedia endorses the chiropractic hypothesis.
• Another way to reword the sentence would be as follows:

Chiropractic is a health care profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, with special emphasis on the spine, under the hypothesis that these disorders affect general health via the nervous system.

Would that be clearer?

Eubulides (talk) 02:38, 28 August 2008 (UTC)

It is certainly clearer, but what source are we using for it? It certainly isn't NPOV, because it then doesn't include the reform POV which rejects the hypothesis that the disorders affect general health "via the nervous system". - DigitalC (talk) 22:58, 28 August 2008 (UTC)

The source we are using is the source we are already citing there, namely Nelson et al. 2005 (PMID 16000175). That source is freely available, please see its section "What is the Chiropractic Hypothesis?" Eubulides (talk) 01:18, 29 August 2008 (UTC)

• Chiropractic does not say "the evidence is 'conflicting'"; it says "There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain", which is a different claim. This claim is supported by the cited source (Murphy et al. 2006, PMID 16949948).
• The 2008 paper (Hurwitz et al., PMID 18204386) does not review or cite the 2007 paper (Vernon & Humphreys, PMID 17369783). When reviews disagree, and neither clearly trumps the other, the article should mention both results as fairly and neutrally as possible.
• Formal integration remains controversial, and should not be reported as if it were noncontroversial; that would not be accurate.
• As far as I can see, Chiropractic does not claim that CAM=chiropractic, nor that manipulative medicine=chiropractic.
• What is the source for the claim "there are more chiropractic schools outside the US than within"? Chiropractic #Education, licensing, and regulation says that there are 18 accredited D.C. programs in the U.S., 2 in Canada, and 4 in Europe. Even if the "outside the US" claim were true, it would not overcome the facts that chiropractic is based in the U.S., and that U.S. chiropractors outnumber the rest of the world.
• The word "hypothesized" is well-supported by the cited source. It was put in for good reasons, summarized in Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead. These reasons need to be addressed. Arguments against it that merely say "it must go" are not persuasive. Without "hypothesized", or something similar, the sentence appears to endorse the chiropractic hypothesis, which is not what Wikipedia should do.
• No evidence has been presented that the "straights out of proportion" point is obsolete. We have a reliable source making that claim, and no reliable sources disputing it. It is unlikely that chiropractic has seen a revolution in the past decade that have made straights obsolete.
• It would be wise to firmly delineate all controversial (medical aspects) of chiropractic care." Controversies in chiropractic are not limited to medical aspects. They go through all parts of the field, from philosophy to history to scope of practice to billing. There is an old joke about chiropractors: ask five of them a question and they'll respond with a dozen vehemently disagreeing answers.
• Every section in Chiropractic is under some sort of dispute or another. That's the way this article is, I'm afraid.
• I agree that the material in the section could be shortened by moving it into a subarticle, and have mentioned this more than once. This has been lower priority than the other problems with the article. The length of the section is not excessive; a similar length was in effect for many months, in a section that was hopelessly out-of-date and hopelessly POV in favor of chiropractic (it cited no critical sources whatsoever), and there were no complaints about the length back then. The complaints about length came only when the section came closer to balance.
• Chiropractic is supposed to be an encyclopedia article; as such its audience and goals differ considerably from those of a government agency set up to support and promote complementary and alternative medicine.

Eubulides (talk) 09:05, 27 August 2008 (UTC)

• "*Formal integration remains controversial, and should not be reported as if it were noncontroversial; that would not be accurate." It is POV to NOT discuss integration because "it is controversial". Remember, Wikipedia doesn't care about accuracy, it cares about verifiability. If we have reliable sources that discuss the controversy, then we should include those too.
• Where is the source for the claim that "chiropractic is based in the U.S."? A quick look at List of chiropractic schools 19 Chiropractic schools outside the US. Again, per NPOV we should strive to obtain a world-wide view. Wikipedia's readers and editors are not all American.
• "It is unlikely that chiropractic has seen a revolution in the past decade that have made straights obsolete.". Strange, because I happen to think that such a revolution has been occuring. I believe it was Corticospinal that mentioned that back in 1999? CMCC switched to an evidence-based curriculum. I have certainly read that evidenced based chiropractic has been increasing in Europe as well. However, once again, we go back to WP:V, and the fact that WP strives for verifiability, not accuracy—you win this one!

DigitalC (talk) 10:32, 27 August 2008 (UTC)

• I agree that Chiropractic should discuss integration. Currently it does that only in minor snippets under Philosophy and Scope of practice; it would be nice to expand on that a bit. My point was merely that coverage of integration should not give the mistaken impression that it is noncontroversial. I think we're pretty much in violent agreement on this point.
• Many of the schools in that list are not accredited according to the CCE-I standards. If one counts just as-per-CCE-I accredited programs, as I understand that Chiropractic #Education, licensing, and regulation does, the vast majority (18 of 24) of accredited D.C. programs are in the U.S. Also, if you count D.C. chiropractors, the estimates in Chiropractic #Education, licensing, and regulation are that the vast majority of chiropractors are in the U.S.
• I agree with you that straights have lost some influence over the profession in the past twenty years. However, I think they still retain notable and considerable influence. Of course, these are just my opinions; we would need reliable sources about any changes of influence before we could put text like that into the article.

Eubulides (talk) 16:54, 27 August 2008 (UTC)

• Why would we only count schools that are accredited per CCE-I? For the record, there are schools accredited to CCE-I standards not included in Chiropractic #Education, licensing, and regulation such as the schools in [edit: New Zealand, Australia and] Japan. DigitalC (talk) 00:49, 28 August 2008 (UTC)

source for accrediation of Australasian programs - perhaps that SHOULD be added to the article? - DigitalC (talk) 00:55, 28 August 2008 (UTC)

Good catch, thanks! I added that. That should cover Australia, New Zealand, and Japan. Non-accredited schools should probably not be mentioned in that section, though; anybody could start one. And the existence of non-accredited schools in some other countries wouldn't undermine the basic point that chiropractic is heavily dominated by the U.S., far more than (say) surgery is. Eubulides (talk) 02:38, 28 August 2008 (UTC)

• The cited (Nelson) text does not include the word hypothesis in the passage. It's inclusion is hardly a violation of WP:NPOV. I don't see the logic behind the Simon-says argument.
• No one suggested straights were obsolete. What is being questioned is how the reference is being used and interpreted and the predominence of straight chiropractic within the US and globally.
• I would appreciate if you could produce evidence that suggests chiropractic philosophy, billing and other things are controversial. Alas, I'm afraid you my question has not been answered. What justifies treating the minority like the majority and listing all controversies at the expense of non-controversies?
• With respect to the reviews, if neither review trumps the other, as you suggest, why make the claim there is no consensus for manual (manipulative?) medicine on neck pain? Also, a quick look at the sources suggests that the Vernon 2007 study is an inferior one, academically speaking, to the Hurwitz 2008 study. Another example of non-reliable use of a source occurs in the lead itself using a 2006 commentary on chiropractic as "proof" that chiropractic treatment is not effective. This needs to be fixed. The lead also fails to include other sections in the article such as utilization/satisfaction.
• The "old joke" analogy is rather distasteful; it again, is conjecture and it would be best to leave speculation at the door so to speak. The issue here isn't the opinions of chiropractors, it's about finding agreement on important topics.
• To suggest a reliable agency such as the NIH is somehow complicit in perpetuating anything other than research into CAM is surprising. Wikipedia is already considered by most scholars to be non-reliable; we can do better. Soyuz113 (talk) 17:28, 27 August 2008 (UTC)

• I don't like the Simon-says style either, but there was consensus that it should be used to avoid giving readers the impression that Wikipedia endorses a position that editors find controversial. Please see Talk:Chiropractic/Archive 25 #Antiscientific reasoning along with the next few talk-page sections after that.
• The cited (Nelson) text mentions the chiropractic "hypothesis" about 10 times.
• I lack the time right now to produce citations suggesting that the philosophy etc. of chiropractic are controversial. Surely this is a given? The mainstream rejects many elements of chiropractic philosophy, and the mixers and the straights argue about it. Whether chiropractors should be able to bill insurance companies is a constant sore spot. Controversies abound in chiropractic.
• I don't see how Chiropractic treats "the minority like the majority".
• The claim that there is no consensus is supported by a reliable source, and the claim is quite relevant to the evidence basis issue. Too often, both skeptics and supporters generate accounts that make it sound like chiropractic care doesn't work at all, or is well supported for many conditions; but in reality this is a controversial area and it's important to make that point.
• Hurwitz et al. 2008 (PMID 18204386) is given substantially more space in Chiropractic than Vernon & Humphreys (PMID 17369783), and the latter source is used only to support points that are not controversial. Vernon & Humphreys (PMID 17369783) is a reliable source, and there's no reason to shut it out.
• The lead does not say or imply that chiropractic treatment is not effective. It merely says that opinions differ on the subject; this at least is not controversial among reliable sources.
• Currently the lead sentence "Chiropractic is well established in the U.S., Canada and Australia." is intended to (very briefly) summarize the utilization and satisfaction section, along with the last paragraph of the "Scope of practice" section (these to some extent overlap). The structure of both the article and the lead could be improved here; suggestions are welcome.
• Sorry you didn't like the joke. The point of it was not that there is controversy on this talk page, but that there is controversy among chiropractors. This controversy should be covered fairly and neutrally.
• The NCCAM (the alt-med part of NIH) was set up by Congress, not by scientists. It is a reliable source about some aspects of chiropractic (e.g., federal research funding), but it is not a good source for others. Its main web page on chiropractic, for example, is entirely silent about the effectiveness of chiropractic care; that is a huge omission.

Eubulides (talk) 07:19, 30 August 2008 (UTC)

Lack of Controversy?

I just happened to browse this article and was shocked (shocked I tell you!) to find that it was lacking a section on Controversies. I cannot think of any other Wikipedia article of such weight that lacks such a section. In addition, the controversies surrounding this field are numerous, significant, and persistent. I haven't started any research yet, but anecdotally, my experience is that a large percentage (but perhaps still a minority) of chiropractors are quacks (yes, that's a technical term). Before doing any such research, can any of the regulars here tell me:

Why is this section lacking? (Was there some nuclear edit war in the past?)

Is someone already doing or working on this section?

I believe I can save a lot of time if someone were to answer these questions. Thanks! 99th Percentile (talk) 03:12, 3 September 2008 (UTC)

Many Wikipedia articles of similar weight, or even greater weight, lack controversy sections. As a general rule, controversy sections are a sign of editing problems. I just now checked Wikipedia:Featured articles #Health and medicine, and none of the 36 articles listed there have a section with the word "controversy" in its name. Eubulides (talk) 04:08, 3 September 2008 (UTC)

Obviously, I meant topics that are inherently controversial, as this one is. I would expect articles on vaccinations, crash diets, and homeopathy to also have such sections. Comparing this to mainstream medicine as a citation for why the section is lacking is kind of missing my point. 99th Percentile (talk) 04:04, 4 September 2008 (UTC)

Vaccination does not have a Controversy section. Nor does Crash diet. Nor does Homeopathy. Generally speaking having a Controversy section is contrary to the goal of writing an encyclopedic article, as it attempts to migrate disputed material into a Controversy ghetto, instead of having the article be organized according to topic. Eubulides (talk) 16:18, 4 September 2008 (UTC)

Vaccination draft

Although vaccination is one of the most cost-effective forms of prevention against infectious disease, it (Vaccination) remains (is) controversial within the chiropractic community. Most chiropractic writings on vaccination focus on its negative aspects,[10] claiming that it is hazardous or ineffective.[107] Additionally, a segment of chiropractors support freedom of choice as opposed to compulsory vaccination. (Principles and Practice of Chiropractic, pg 197) Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease.[59] The Canadian Chiropractic Association supports vaccination; surveys in Canada in 2000 and 2002 found that 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children.[10] A survey of Canadian Memorial Chiropractic College students in 1999–2000 reported that more-senior students opposed vaccination more strongly, with 29.4% of fourth-year students opposing vaccination.[108]--—CynRN ^(Talk) 06:34, 28 August 2008 (UTC)

---

If vaccination is taken out as a section and put in somewhere else, I am not sure where it would fit? As has been pointed out, the anti-vac stance is not limited to straight chiropractors. The large minority of chiropractors who are 'anti' or neutral is notable and deserves some 'weight' in the article. The wording can be tweaked, as I did above with the strikeouts, to soften the tone. The sentence "evidence-based chiros....disease cannot be affected by vaccines" could theoretically be thrown out, for further brevity, and the section would still make it's point...--—CynRN ^(Talk) 06:28, 29 August 2008 (UTC)

• As for location, I proposed in Talk:Chiropractic/Archive 26 #Attacks on vaccination section (this edit) to put it in Chiropractic #Schools of thought and practic styles, but nobody has agreed with that so I'm loath to do it.
• Striking out the last sentence is reasonable, as it's not that notable. However, the first sentence is supported by the source and is an important part of the dispute. I agree that the idea could be worded less contentiously. How about starting with "Vaccination is controversial" and then putting the cost-effective bit later? The "support freedom of choice" wording repeats what is already in the phrase "support individual exemptions to compulsory vaccination laws", but is far more POV; I would omit it as redundant and POV. Here is a proposed revision that reflects the above proposals:

Vaccination is controversial within the chiropractic community. Although it is one of the most cost-effective forms of prevention against infectious disease, most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective. Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; surveys in Canada in 2000 and 2002 found that 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children.

Eubulides (talk) 07:19, 30 August 2008 (UTC)

I like the lead-in better in your draft. Less POV, maybe. I think the vaccine controversy deserves it's own section here in the article. Potential or current chiropractic patients should have this information. I see someone's taken out the 'Evidenced-based' sentence. I didn't mean for that to happen without discussion. Everything in your draft is sourced and sounds pretty neutral. I don't really understand all the objections.--—CynRN ^(Talk) 17:24, 30 August 2008 (UTC)

version by Soyuz is much better. I don't think it deserves any mention at all, but at least Soyuz' version is NPOV and not attempting to paint the entire chiropractic discipline with the anti-vaccination brush. --Surturz (talk) 22:35, 30 August 2008 (UTC)

Please see the followup in #Vaccination redux below. Eubulides (talk) 22:36, 1 September 2008 (UTC)

The version starting with Vaccination is controversial within the chiropractic community. is good except it is missing the additional improvements at the end of the section. QuackGuru 02:33, 2 September 2008 (UTC)

• There are two sentences at the end of Chiropractic #Vaccination that I assume you are referring to as improvements.
• "A survey of Canadian Memorial Chiropractic College students in 1999–2000 reported that seniors opposed vaccination more strongly than freshmen, with 29.4% of fourth-year students opposing vaccination." I don't have a strong opinion about this sentence one way or another; it's OK, but it isn't that important. Perhaps other editors can opine about it.
• "There appears to be a small group of chiropractic authors who promote antivaccination citing questionable research." This sentence is almost entirely duplicative of earlier material in the same paragraph: "it remains controversial within the chiropractic community, with most chiropractic writings on vaccination focusing on its negative aspects, claiming that it is hazardous or ineffective." There is no need to say the same thing twice, surely. If there's something new in the "small group" sentence, perhaps it should be mreged into the "it remains controversial" phrase?

Eubulides (talk) 07:31, 2 September 2008 (UTC)

There is a difference with the last sentence. It explains about chiropractic authors promote antivaccination. The last sentence could be merged into the chriopractic writings and the first sentence broken into two sentences as I proposed before. The first sentence in vaccination is too long. QuackGuru 17:17, 2 September 2008 (UTC)

Thanks, could you please identify the "as I proposed before" wording? Or copy it here? There are a lot of wordings being proposed and I'm not sure which one you mean. Eubulides (talk) 18:01, 2 September 2008 (UTC)

Vaccination is controversial within the chiropractic community. Although it is one of the most cost-effective forms of prevention against infectious disease, most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective.

My proposal before was to split the first sentence in two sentences. But now we can merge the last sentence into the second proposed sentence.

"There appears to be a small group of chiropractic authors who promote antivaccination citing questionable research."

This is the last sentence in vaccination that can be merged and shortened into another sentence. The point being made is that antivaccination is being promoted. QuackGuru 18:17, 2 September 2008 (UTC)

I propose to delete this section and maybe give this vaccination discussion a brief mention elsewhere in the article. This is really overblown nonsense. I suspect it deserves maybe a one-sentence mention in the article - if that. -- Levine2112 ^discuss 01:28, 3 September 2008 (UTC)

It is not "overblown nonsense" to summarize a notable departure by a substantial number of chiropractors from a widely accepted and important public health practice. Several peer-reviewed papers have been written on the subject, and it is well worth summarizing in a brief paragraph; one sentence wouldn't do it justice (unless it was a very long sentence :-). Eubulides (talk) 01:50, 3 September 2008 (UTC)

(outdent) OK, thanks to QuackGuru for the clarification. Here is a proposed rewording that tries to take QuackGuru's comments into account:

Vaccination is controversial within the chiropractic community. Although it is one of the most cost-effective forms of prevention against infectious disease, what appears to be a relatively small number of authors generate most chiropractic writings on vaccination, focusing on its negative aspects and claiming that it is hazardous or ineffective. Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; surveys in Canada in 2000 and 2002 found that 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children. A survey of Canadian Memorial Chiropractic College students in 1999–2000 reported that seniors opposed vaccination more strongly than freshmen, with 29.4% of fourth-year students opposing vaccination.

Eubulides (talk) 01:50, 3 September 2008 (UTC)

The second sentence is confusing to me. I'm not sure how to merge this short sentence into the second sentence. A relatively small number of authors continue to promote an antivaccination philosophy. QuackGuru 02:49, 3 September 2008 (UTC)

The short sentence is already merged into the 2nd sentence of this latest draft. Obviously there is some confusion here though; can you please explain the confusion you see in the 2nd sentence there? Eubulides (talk) 04:08, 3 September 2008 (UTC)

The 2nd sentence in the latest draft does not flow well and is hard to follow. QuackGuru 04:20, 3 September 2008 (UTC)

Too long and too overblown. This would be better suited at Vaccine controversy. Here it is just a minor subtopic, too tangential to go into such detail on. -- Levine2112 ^discuss 05:38, 3 September 2008 (UTC)

• OK, how about replacing the first two sentences with the following instead?

Vaccination is controversial within the chiropractic community. A relatively small number of authors generate most chiropractic writings on vaccination, one of the most cost-effective forms of prevention against infectious disease; these authors focus on vaccination's negative aspects and claim that it is hazardous or ineffective.

• The proposed rewording would slightly shorten the section in question (by my count, it's 5 words shorter), so it should be a slight improvement from Levine2112's viewpoint, even if it obviously does not accomplish everything Levine2112 wants.

Eubulides (talk) 20:40, 3 September 2008 (UTC)

We can keep the sentence as is or simply delete it. I prefer to delete it instead of the proposed merge because the original meaning is lost. Or we can readd the short sentence at the end. QuackGuru 00:27, 4 September 2008 (UTC)

Adding the words However, only to the beginning of the sentence is unnecessary. QuackGuru 00:34, 4 September 2008 (UTC)

Law suit against Simon Singh and broader issues of controversy

British Chiropractic Association has issued a lawsuit against Simon Singh.

http://en.wikipedia.org/wiki/Simon_Singh

This lawsuit is part of broader controversy about Chiropractic in the UK and NZ which this article doesn't really imply.

Ben Goldacre for example criticises the Association for resorting to legal methods over scientific ones: http://www.badscience.net/2008/08/silence-dissent/

"While chiropractors struggle to manifest to their customers an air of academic rigour, their actions in this letter demonstrate more than anything else how little they understand the simple day to day business of academic journals, journal clubs, work in progress seminars and indeed the entirety of medicine: we take the piss out of each others ideas. We criticise them. We tear them apart, mercilessly. When we criticise survival stats, or the interpretation and analysis of data, make no mistake: we are accusing each other of killing patients unnecessarily. This is the bread and butter of academia and medicine. Only very occasionally does anyone take personal offense."

The impression I get is that in Britain at least Chiropractic is viewed in much the same light as Homoepathy. This article I think should reflect more that there is a substantial voice that view Chiropractic as totally ineffective. Macgruder (talk) 10:55, 28 August 2008 (UTC)

I don't think that the BCA lawsuit against Singh deserves much attention here. It is much more relevant to Simon Singh than it is to Chiropractic. As for the article reflecting a "substantial voice", we need to keep a neutral point of view. If there were reliable sources that described this "substantial voice that [views] Chiropractic as totally ineffective", it might warrant inclusion. - DigitalC (talk) 23:25, 28 August 2008 (UTC)

I agree with DigitalC; it's not worth mentioning in the top-level Chiropractic article. It might be worth mentioning in some subarticle, though I don't offhand know what that would be. Eubulides (talk) 01:18, 29 August 2008 (UTC)

Chiropractors Try to Silence Simon Singh, Beware the spinal trap, and Trick or Treatment: The Undeniable Facts about Alternative Medicine Simon Singh is an expert on chiropractic. We can use the reference. I think it is relevant. A book called Trick or Treatment written by Simon Singh may also be relevant for this article. QuackGuru 02:00, 29 August 2008 (UTC)

These sorts of highly partisan topics are best avoided here as they are needlessly inflammatory and highly political. For example, where is the proof that Sighn is a "expert on chiropractic". To let in a book of that nature (skeptical) we would also have to let in pro-partisan books as well which would quickly escalate a battle between POV. This article needs to better separate the "beliefs" and the "theories" from what the public, governments, health-care agencies, insurers and scientists accepts as "mainstream". Based on another thread somewhere here, it says that chiropractic therapy for muscle and joint problems is OK, but for asthma, ear infections and similar complaints it is quackery? Why not make a distinction clear? —Preceding unsigned comment added by Soyuz113 (talk • contribs) 03:31, 29 August 2008 (UTC)

You're missing the point here. You don't need to be an expect in Chiropractic to talk about scientific method and comment on the fact a law suit is happening. I think it is relevant because I know of no other health body in the UK at least, or scientific body for the matter, that has resorted to a legal challenge to their methods over a scientific one. (Where is the proof that sociologist Dr. Yvonne Villanueva-Russell is an expert either.) Macgruder (talk) 05:22, 29 August 2008 (UTC)

• Villanueva-Russell is not an expert on biomechanics or anything like that, but she is an expert on the sociology of chiropractic, e.g., issues such as the politics of evidence-based guidelines.
• As WP:MEDRS suggests, it's better to cite sources in peer-reviewed medical journals than to cite popular books, when talking about biomedical topics. Trick or Treat is coauthored by Ernst, and I expect that anything interesting it has to say about the evidence basis has already appeared in some peer-reviewed medical journal article by Ernst, which we can cite. Perhaps I'm wrong; if so, please enlighten us.

Eubulides (talk) 07:19, 30 August 2008 (UTC)

Integrative medicine in the lead

This edit introduced changes that were not supported by the source. The cited source (Redwood et al. 2008, PMID 18435599) does not demonstrate a "preference for integrative medicine"; it shows that only 27% of the surveyed chiropractors preferred the term "integrative medicine". Nor does the cited source say that chiropractic "shares elements of mainstream medicine"; it talks about exhibiting characteristics of "mainstream health care", which is quite a different thing. As the top of this talk page suggests, "Please read this page and discuss substantial changes here before making them." Perhaps some change to the lead is needed, but let's discuss it here first, please. I undid the change for now. Eubulides (talk) 20:51, 28 August 2008 (UTC)

The words were taken from the source. Please self-revert, for it seems as though WP:OWN is beginning to be an issue here. The change itself was not substantial, it was done as the current text "many chiropractors dispute" is misleading. Soyuz113 (talk) 21:04, 28 August 2008 (UTC)

• The words were not taken from the source. The source never says "shares elements of mainstream medicine". Nor does the source say "demonstrating a preference for the term integrative medicine"; it says "The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%)." It is substantially misleading to turn 27% into "demonstrating a preference for the term integrative medicine".
• How is the phrase "many chiropractors dispute" misleading? Would you prefer "reject" to "dispute"? That would be a well-supported change, which I would support.

Eubulides (talk) 21:21, 28 August 2008 (UTC)

Whether or not it is a plurality, is it still a fact that the source explicitly stated that a majority of surveyed chiropractors said they preferred the term integrative medicine. Indeed the words were taken from the source, but the current text was not. Perhaps we can add "demonstrate a preference for the term integrative medicine. I would also favor removing it altogether from the lead and letting the classification of CAM stand for now as no major health organization classifies chiropractic care other than CAM. My problem was the sense that, again, a needless WP:POINT was being made and attempting (perhaps inadvertently) to drum of controversy. Another phrasing such as "a majority of surveyed DCs in the United States favor the term of integrative medicine". —Preceding unsigned comment added by Soyuz113 (talk • contribs) 22:47, 28 August 2008 (UTC)

• No, the survey did not say a "majority" preferred the term IM. It explicitly stated exactly the opposite: it said that more chiropractors preferred the term "CAM" (31%), than the term "IM" (27%). Please see Table 2 (page 364) of the source, which is briefly summarized in the 1st paragraph of Chiropractic #Scope of practice.
• "demonstrate a preference for the term integrative medicine" is not right either, since it implies to the unwary reader that most chiropractors prefer the term IM, which isn't correct.
• "a majority of surveyed DCs in the United States favor the term of integrative medicine" isn't right either, since only 27% of those surveyed preferred the term IM.
• All of the above suggestions are needless wordy. The lead should not go into details here; it should be short. The body of the article talks about this subject at more length, and that is were any longer explanation should go.
• Omitting the point entirely from the lead wouldn't be right, as gives the mistaken impression that Wikipedia endorses the view that chiropractic is CAM; see Talk:Chiropractic/Archive 25 #Fix for CAM claim for why something needs to be said here.
• I repeat my suggestion of going back to the old version, substituting "reject" for "dispute". Here's what the resulting sentence would look like:

Chiropractic is generally considered to be complementary and alternative medicine, a characterization many chiropractors reject.

"Reject" is better than "dispute" here, since it avoids some POV and it is what the source actually says.

• Again, it would have been better to propose a controversial change like this on the talk page, instead of just installing it. Lots of things in Chiropractic are controversial and the choice of words can be tricky. Proposing the change first here can avoid the addition of misleading text.

Eubulides (talk) 01:18, 29 August 2008 (UTC)

I agree with Eubulides here. The source says 27% thought that chiropractors should be classified as IM, not a majority. ☺ Coppertwig (talk) 02:13, 29 August 2008 (UTC)

• • I'm sorry if you find it controversial that the text added was almost a direct quote from the conclusion of the article, but it does provide the accurate representation of the paper.
  • What is known is that 69% of chiropractors rejected the term compared to 31% approved. Hence a majority of those surveyed rejected the categorization as CAM. The study does not state that the majority of those surveyed rejected the categorization of IM. To assume so is a violation of WP:OR.
  • Redwood concludes: The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%). The added text to the lead was "but a majority of surveyed American chiropractors rejected being characterized as CAM practitioners, showing some preference for the term integrative medicine." Again I fail to see how the added text was in anyway controversial. If anything perhaps slight quotation marks could be placed!
  • It was said that chiropractic did not share elements of mainstream medicine, however a source cited here (Cooper 2003) stipulates "Although marginalized for much of the 20th century, it has entered the mainstream of health care, gaining both legitimacy and access to third-party payers.
  • Surely it cannot be argued that chiropractic therapy is not legitimate in some, if limited form. If so the article should explicit state what the mainstream characteristics of chiropractic therapy are, what elements are not, and for both to which degree.
  • "Omitting the point entirely from the lead wouldn't be right, as gives the mistaken impression that Wikipedia endorses the view that chiropractic is CAM; see Talk:Chiropractic/Archive 25 #Fix for CAM claim for why something needs to be said here.". This is a rather weak argument, Chiropractic is already classified as CAM on Wikipedia. If we are suggesting that chiropractic isn't CAM (are at least not completely) then it should be placed under the Wikipedia Medicine banner. In fact, since the article is being edited under WP:MEDRS and we have reliable sources suggesting it is, at least partially, part of mainstream health care, why not re-classify Chiropractic into Wikiproject Medicine which would cut down on a lot of BS WP:POINT. WP:OR, WP:WEIGHT, WP:OWN and other misgivings that weigh this article and editors down. Soyuz113 (talk) 03:09, 29 August 2008 (UTC)

• The study uses uses "rejected" to mean the opposite of "accepted"; its saying that 69% of the chiropractors rejected being characterized as CAM is entirely equivalent to its saying that 31% of the chiropractors accepted the CAM label (the study says both things, obviously).
• The total figures, by the way, were as follows: 31% CAM, 27% IM, 14% not CAM, but no alternative suggested, 12% mainstream medicine, 7% any, depending on practitioner, 5% its own category, 2% primary care providers, 2% categorize by level of education, and 2% no opinion. Responses may not total to 100% due to missing values and rounding.
• The mainstream view of chiropractic is indeed that it is CAM, so it is appropriate for Wikipedia to use that categorization in Wikipedia's own organization.
• Though the lead should emphasize the mainstream view, it should not exclude the significant minority opinion among chiropractors themselves. A large majority of chiropractors rejects the CAM label, even though the CAM label has the plurality among chiropractors (31%). The IM label is 2nd among chiropractors (27%). The lead should not misrepresent this situation with confusing wording like "showing some preference for the term integrative medicine", without bothering to mention that CAM was a more popular label than IM.
• Again, there is a WP:WEIGHT violation in this addition. With this addition, the mainstream view is given only 10 words ("Chiropractic is generally considered to be complementary and alternative medicine") but the minority view is given 21 words. The lead had only 286 words total, before this change bloated it; it is too valuable a resource to waste it on the minutiae of what is just a single survey. The 5 words "a characterization many chiropractors reject" is much more appropriate weight to summarize the minority view.

Eubulides (talk) 03:48, 29 August 2008 (UTC)

• I'm sorry; I don't understand what is being disputed here, the study clearly demonstrated that chiropracty as labelled CAM was rejected; and there was a slight preference for IM. I have not misquoted the paper, in fact it is almost verbatim.
• "The lead should not misrepresent this situation with confusing wording like "showing some preference for the term integrative medicine", without bothering to mention that CAM was a more popular label than IM." How is the lead misrepresenting the conclusions of the paper? Also, the point may have been lost but I will repeat it again: a majority of those surveyed rejected the term CAM. They did not reject the term IM. To suggest otherwise I'm afraid is extrapolation and is WP:OR.
• The lead is bloated, but not with this minor addition. The entire straight vs. mixer description is beyond the scope of the lead anyways, the evidence for and against chiropractic therapy could be presented in a much clearer fashion. Conclusions regarding the characteristic treatment, manipulative medicine should be presented as to what it is and is not useful, currently the cited source is not the appropriate one to determine the efficacy of spinal manipulation.
• WP:WEIGHT is not violated in this addition, what is a problem, that has not yet been addressed despite my repeated queries, is how come the minority segment of chiropractic seems to be the "target" of undue weight at the expense of the article as a whole.
• "The mainstream view of chiropractic is indeed that it is CAM, so it is appropriate for Wikipedia to use that categorization in Wikipedia's own organization." I'm afraid that is not what the cited source says. The source (Cooper 2003) said that chiropractic was part of mainstream health care. The author appears to hold the M.D. designation as well which should rule out some considerable cries of COI. Unless a specific source says that "CAM cannot be mainstream at any point" if evidence suggests that Chiropractic therapy (or parts of it) are now considered mainstream medicine then the it would be wise to re-classify the article. It is a tough call; the passage in the article said it shares elements of both alternative and mainstream medicine. To tie it back into integrative medicine, it would be worthwhile to see what elements of chiropractic are being integrated, what ones are being rejected and that should help us decipher what is the accepted view of chiropractic care and what is not accepted (i.e. quackery, pseudoscientific elements).

Soyuz113 (talk) 04:51, 29 August 2008 (UTC)

Soyuz, I think the meaning gets lost without the preceding discussion from the source that enumerates the different results. 69% say ‘not CAM’, so 31% say they are CAM. Yes, 27% say they prefer “IM” but when the stats are left out of that sentence it seems to mean “a majority show a slight preference for IM” which is not the case at all. It's trivial at first glance but the source doesn't show a huge preference for 'IM' and we shouldn't imply this. --—CynRN ^(Talk) 01:45, 30 August 2008 (UTC)

• What CynRN said. It is misleading to summarize that paper's data to make it sound like chiropractors prefer IM to CAM in that study. They didn't. More preferred CAM than preferred IM.
• With that longwinded addition, about 10% of the lead was given over to the CAM-vs-IM dispute. Less than 1% of the body is given to the same dispute. The expanded lead was clearly overweighting this dispute heavily.
• The cited source about CAM is not Cooper; it is Chapman-Smith & Cleveland, in Principles and Practice of Chiropractic. However, Soyuz113 did mention Cooper, so let's check: the first sentence of Cooper & McKee's abstract (PMID 12669653) says "Chiropractic is the best established of the alternative health care professions." i.e., it falls under the CAM umbrella.
• The claim I objected to was calling chiropractic "mainstream medicine", not "mainstream health care". Cooper & McKee do not call chiropractic "mainstream medicine".
• Other specific suggestions for improving the lead are welcome, but this thread is focusing on the CAM vs IM issue. The other points in Soyuz's comment seem to address issues that are outside the scope of this talk-page section.

Eubulides (talk) 07:19, 30 August 2008 (UTC)

Actually, this is OR in your part. The conclusion of the article specifically states ". CONCLUSIONS: The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%)." We should not "spin" studies to suit our own agendas, otherwise reliable sources are not being used reliably. I am not misleading I am representing the conclusions of the study. That is a major problem with this current incarnation of Chiropractic. It's a problem that needs to be fixed and I hope we can co-operate and get it done together!

The addition that was made should have said "mainstream health care" and not mainstream medicine. I erred, and apologize for that mistake

I have removed the "dispute" claim primarily because it's not being said what is disputed. Also, if you suggest that it represents less than 1% of the body of the article why include it in the lead? Soyuz113 (talk) 16:32, 30 August 2008 (UTC)

The "dispute" claim is attached to the sentence saying that chiropractic is characterized as CAM; that is what is being disputed. It is not OR to quote the body of the study in question, which is what I have done. We should not selecting isolated phrases from the abstract, without accurately presenting their context. Please see Talk:Chiropractic/Archive 25 #Fix for CAM claim for why a phrase like "a characterization most chiropractors dispute" is needed. Eubulides (talk) 22:36, 1 September 2008 (UTC)

Mainstream elements of chiropracty; pseudoscientific elements of chiropracty

My interpretation thus far (please correct me if I'm wrong) is that the sceptical editors here see everything related to chiropracty as controversial. However, sources in the article suggest it is far more "mainstream" than critics suggest. Also, the use of the literature in this article is quite distressing and yet regular editors here seems to be avoiding my concerns. I'll WP:AGF for now but here are the major problems once again

1. Undue weight on the minority aspect of chiropracty in relation to the majority
2. Vagueness of controversial aspects of chiropracty in relation to accepted aspects
3. Misuse of scientific literature by editors in the evidence-basis section
4. Debate whether or not Chiropractic should be moved into Wikimedicine project
5. Apparent case of WP:OWN

I understand that it is difficult to edit and create an scholarly article based (especially when editing anonymously) but great care is required, especially so, when we are discussing a medically related topic and a whole profession. Browsing through the archives (and there are plenty!) I see a constant back and forth between partisans. We need to clearly establish what is quackery and what isn't and more importantly differentiate between chiropractic theory and the effectiveness of their methods. Soyuz113 (talk) 16:32, 30 August 2008 (UTC)

What does being anonymous have to do with editing? We should not worry about whether the other editors are chiropractors, doctors or laymen. It's the content and verifiability of the edit that matters. Also, in an article as contentious as this one, it's imperative (and extremely tedious!) to read the backstory in the archives and tread very carefully. Propose, discuss, get consensus...then make changes.

I'm not at all sure that the majority of chiropractors are 'uncontroversial'. I've seen the stats on belief in subluxation (by major chiropractic organisations and schools), the belief in the far-reaching ramifications of said subluxation, the use of activators, the use of homeopathy, AK, and the like. Some of this has been left out, perhaps suppressed, from the article. If anything, many 'fringe' aspects of chiropractic have been de-emphasized. That said, the article should give the science-minded chiropractors their due weight. We should get the feel of both ends of the spectrum and perhaps try to explain how most fit into the middle. --—CynRN ^(Talk) 20:41, 30 August 2008 (UTC)

Well, the anonymity here is actually a bad, thing, IMHO. For example, a 12 year old with no background in medical sciences can freely edit, rewrite, delete factual material put in my a medical doctor. Same thing can be occuring here. There is quite a disparity between finding a source and using it appropriately. This, I'm afraid, is what is occuring at evidence basis and other sections. I noticed that some can edit this article with impugnity (look at the the recent history) whereas others are reverted on the spot. The rules need to go both ways.

I agree that chiropracty has both mainstream and fringe elements. This is what is making this article so hard to edit properly. It seems to straddle that middle ground but what objective criteria here are being used to label aspects of chiropracty fringe? I very much like your proposal, however I noticed that subluxation is something that seems to be quite weighty in this article as opposed to say, something more significant such as the long road to professional licensure. What elements of subluxation are fringe, what elements are mainstream? Perhaps we can start there! I have removed puffery from the subluxation section and vaccination section for now, but we can propose better wordings here. Soyuz113 (talk) 21:04, 30 August 2008 (UTC)

I agree that chiropractic has both mainstream and fringe elements, and that this makes editing this article applies. Sometimes WP:FRINGE applies; sometimes it doesn't. What is "puffery" to one editor is an important part of the explanation to another. Discussing the problem at this high level is unlikely to make much progress; specific proposals for wording changes would be better. Eubulides (talk) 22:36, 1 September 2008 (UTC)

Chiropractors in Finland

A new survey:

• Chiropractors in Finland - a demographic survey, Chiropractic & Osteopathy 2008, 16:9 doi:10.1186/1746-1340-16-9

-- Fyslee / talk 00:28, 29 August 2008 (UTC)

My kneejerk reaction is that it looks a bit specialized for here, but might be suitable for a subarticle. Eubulides (talk) 01:18, 29 August 2008 (UTC)

There might be some usable information for schools of though/practice styles, when it states: "The vast majority described their scope of practice to be based on a musculoskeletal approach" or "Most reported to have a musculoskeletal approach, using mainly Diversified Manipulation Technique, Soft Tissue Techniques and Activator Instrument. These are methods previously reported frequently to be used in Europe" or "Finnish chiropractic profession is relatively young, these chiropractors appeared to have a traditional practice profile: solo practice, a musculoskeletal approach, allowing good time for examination and treatment". - DigitalC (talk) 23:59, 29 August 2008 (UTC)

Well, I'm not entirely opposed, depending on the detailed wording that would be proposed. But surely the stuff that is not specific to Finland (e.g., musculoskeletal preference) can be sourced more globally? Diversified is #1 in the U.S. too, no? And the stuff that are specific to Finland (e.g., young profession) isn't notable enough for this article, unless I'm missing something. Eubulides (talk) 07:19, 30 August 2008 (UTC)

If we had a source that stated that "the vast majority describes their scope of practice to be based on a msuculoskeletal approach" that was sources globally, I think it would fix at lot of the issues here. I also haven't seen much mention in the article of soft tissue therapy, which is used extensively by Chiropractors. - DigitalC (talk) 02:04, 1 September 2008 (UTC)

Opening Paragraph contains weasel words, and other issues.

"In recent decades chiropractic has gained more legitimacy(who?) and greater acceptance among physicians(who?) and health plans(who?) and has had a strong political base(?) and sustained demand(by who?) for services,[11] and evidence-based medicine has been used to review research studies and generate practice guidelines.[12]"

The source given certainly cannot make all these claims. It should be balanced with a recent study

From the Journal of The Royal Society of Medicine http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

Collectively, these data suggest that spinal manipulation is associated with frequent, mild and transient adverse effects as well as with serious complications which can lead to permanent disability or death [...]. In conclusion, spinal manipulation, particularly when performed on the upper spine, has repeatedly been associated with serious adverse events. Currently the incidence of such events is unknown. Adherence to informed consent, which currently seems less than rigorous,75 should therefore be mandatory to all therapists using this treatment. Considering that spinal manipulation is used mostly for self-limiting conditions and that its effectiveness is not well established, we should adopt a cautious attitude towards using it in routine health care.

The does not imply 'more legitimacy', 'greater acceptance' but rather totally the opposite. I think the Medical Journal contains substantially more weight here than a paper Dr. Yvonne Villanueva-Russell who is a sociologist. Certainly the above sentence strongly implies a broad support of the effective of chiropractic which top medical journals don't seem to support. Macgruder (talk) 05:24, 29 August 2008 (UTC)

This kind of problem runs through the whole article. Take a typical sentence like this:

Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness.[13]

This kind of sentence has no place in an encyclopedia. Qualifying that chiropractic may not work but some other stuff, which we won't mention, doesn't work either seems to me to be a sign of desperation to hide the fact that chiropractic simply does not have any weight of evidence behind its effectiveness, and as the above citation shows may be in fact the opposite. Macgruder (talk) 09:06, 29 August 2008 (UTC)

• There are undoubtedly some biases in the article. It would be helpful to propose detailed solutions, in form of the exact textual changes that should be made, along with why they need to be made. I suggest starting with one or two small change proposals.
• "gained more legitimacy" comes from the cited source, Cooper & McKee 2003 (PMID 12669653), which says in its 1st sentence, "From its origins as an unconventional therapy in the late 19th century through decades of marginalization during the 20th century, chiropractic has acquired legitimacy and prominence"
• "greater acceptance", "physicians", "health plans", and "sustained demand" comes from the same source, which says the following in its 2nd and 3rd sentences: "Signs of its success abound. They include a broadening of the laws and regulations affecting its licensure, scope of practice, and reimbursement; greater acceptance by both physicians and health plans; and a sustained demand for its services."
• "strong political base" comes from its 4th sentence: "Chiropractic's political base is strong, and it enjoys a high degree of patient satisfaction."
• The balancing source you suggest, namely Ernst 2007 (PMID 17606755), is already cited in Chiropractic. It is cited four times, more often than Cooper & McKee, so in that sense the article is already balanced.
• The claims supported by Cooper & McKee do not conflict with the quoted claims made by Ernst 2007. For example, it is quite conceivable for a profession to gain legitimacy even if the profession espouses a risky treatment.
• The "Opinions differ" quote is supported directly by the cited source, namely DeVocht 2006 (PMID 16523145). The quote makes what on the surface is a reasonable point, which is that many medical fields lack strict proof of effectivenes (e.g., randomized controlled trials). Heart transplants are one example, I expect: I'd hate to be the patient receiving the placebo!

Eubulides (talk) 07:19, 30 August 2008 (UTC)

Unfortunately, here we're talking about the introduction to Chiropractic, so although there may be balance later on in the article, this balance needs to occur in the introduction itself. Furthermore, the paper you are citing at great length within this introduction is simply one paper referring to chiropractic in the States (the fact that C was developed in the States is irrelevant to the need for a world viewpoint). It needs to be balanced with the fact that in the UK at least Chiropractic is more regarded as quack medicine.

Futhermore, the introduction reads like original research to me in that although the citations themselves are obviously not original research, the selection and presentation of them is. Commentators like Ben Goldacre are relevant to the introduction because he is Guardian journalist/physician who specializes in writing about the scientific method. The objection 'Ben Goldacre is not an expert in Chiropractic' is mistaken: His writings contain the necessary citations and by using a respected commentator you are not falling into the trap of original research by inappropriate synthesis. (Of course, this can be balanced by a respected source with an opposite viewpoint if one exists).

I think the whole intro should be rewritten to be honest to reflect the fact that in other countries Chiropractic like Homeopathy is not very highly regarded. On top of which I think the efficacy issue should be given bigger weight. These are just my thoughts. Macgruder (talk) 08:58, 31 August 2008 (UTC)

Just goes to show how the UK remains backwards :) Chiropractic in Australia is well respected, the courses are taught in major universities, our health funds cover chiro treatment, and the government subsidises chiropractic treatments when referred by a GP. There are chiropractors in most suburbs of Sydney. I am not saying the Aus medical profession don't generally disdain chiro - they do - but no more than they disdain everything else by non-doctor health providers (dietitians, physio, nursing etc etc). --Surturz (talk) 12:14, 31 August 2008 (UTC)

• Specific suggestions for wording improvement would be helpful; it's hard to respond to vague "selection and presentation" criticisms.
• Most chiropractors are in the U.S., so a U.S.-centric viewpoint is appropriate here. Of course the rest of the world should not be neglected.
• Ben Goldacre is a reliable source for many things; I haven't seen any arguments here against him.

Eubulides (talk) 22:36, 1 September 2008 (UTC)

• Cool. Sometime, I'll see if I can up with something.
• However, "Most chiropractors are in the U.S., so a U.S.-centric viewpoint is appropriate here." is certainly not Wikipedia policy WP:BIAS and of course it breaks the pillar of Wikipedia WP:NPOV ( and here WP:SUBSTANTIATE that I brought up). Most English speakers are in the U.S. too, but that doesn't mean that the English article should be U.S.-centric.

Macgruder (talk) 07:32, 2 September 2008 (UTC)

• Thanks; we appreciate whatever effort you can provide.
• This is a bit off the subject, but List of countries by English-speaking population disagrees with the claim that most English speakers are in the U.S.; it says there are more outside the U.S. than in. In contrast, according to Chiropractic #Education, licensing, and regulation, the vast majority of licensed chiropractors are in the U.S.

Eubulides (talk) 07:41, 2 September 2008 (UTC)

Only if you include 2nd language speakers :-) It's beside the point. It doesn't matter what percentage. Because if you think about it by definition societies that have deemed Chiropractic ineffective won't have many practitioners, but it wouldn't make their viewpoint any less significant. Macgruder (talk) 09:05, 2 September 2008 (UTC)

I hadn't thought of that. Do you have a reliable source that makes that point? If so, we could write up some wording to that effect. Eubulides (talk) 18:01, 2 September 2008 (UTC)

Controversial edits made without discussion

This edit by MaxPont (soon reverted) was made without any discussion on the talk page.

This edit by Soyuz113 says the wording "the characterization many chiropractors dispute" does not have consensus (because Soyuz113 opposes it), and installs wording "although there is also some preference for the term integrative medicine" that has already been rejected as misleading by the consensus in #Integrative medicine in the lead. Chiropractors mildly preferred complementary and alternative medicine to integrative medicine in that survey.

This edit by TheDoctorIsIn, made without discussion, removed substantial text from the vaccination section, text that is directly supported by the cited sources. It also removed citations, causing the resulting text to be incorrectly attributed.

Again, I urge editors to discuss changes first, on this talk page, before installing controversial edits like that, which disrupt the article and introduce errors. Eubulides (talk) 16:34, 30 August 2008 (UTC)

I can't see why my edit was controversial. It is not obvious that vaccination is the most effective method (compared to e.g. antibiotics). And we dont have direct refs to support that claim. I only changed the wording slightly and made it more neutral. MaxPont (talk) 18:46, 30 August 2008 (UTC)

I agree. Relatively minor changes I've made that follow the source to a 'T' has been called 'controversial' when they're really not so. I won't suggest that it's crying wolf, but I could easily call into question several of a similar regard and label them controversial as well. There's definitely instances of puffery here, vaccination being one of them. I favor your change as well, but would also like it conform to a more global view. Soyuz113 (talk) 19:35, 30 August 2008 (UTC)

Soyuz113, may I call you CorticoSpinal? These two controversial edits were not minor, was not NPOV, and turned ref citations red. A lot of text was deleted. QuackGuru 01:25, 31 August 2008 (UTC)

Please self revert, Soyuz. There was no consensus for your sweeping changes.--—CynRN ^(Talk) 06:14, 31 August 2008 (UTC)

Yes, CS, please self-revert. Your heavy handed tendencies toward ownership are all too familiar and recognizable. -- Fyslee / talk 06:28, 31 August 2008 (UTC)

Again, we need to abide by WP:AGF and WP:BITE here. Assuming this new user is CS is NOT assuming good faith. DigitalC (talk) 02:41, 1 September 2008 (UTC)

BITE applies to truly new users, and we're not dealing with a new user, just a new username. This one knows these discussions and their history pretty well. Note. -- Fyslee / talk 19:36, 1 September 2008 (UTC)

Here is another attempt to chop up the vaccination section. A ref citation is now red. This was an extremely controversial edit. QuackGuru 03:13, 2 September 2008 (UTC)

I am not sure why a ref name was added to a ref. There is consensus to have a ref name only when necessary for this article. It better to have consistancy throughout this article. QuackGuru 17:08, 2 September 2008 (UTC)

This is minor point, but I agree with QuackGuru that there is no need to give names to refs that are used just once. Eubulides (talk) 18:01, 2 September 2008 (UTC)

Vaccination redux

It is already reverted. I changed the text slightly and removed the references to vaccination as cost-effective. We only need to state that it is widely accepted - or a similar wording.MaxPont (talk) 18:32, 31 August 2008 (UTC)

It is relevant that it is cost-effective. The claim that it is not relevant is not true because chiropractors claim vaccination is ineffective. QuackGuru 18:36, 31 August 2008 (UTC)

I have tweaked it to include both of your edits, since you both made good contributions. I have left out the word "cost", since actual "effectiveness" (no matter in which manner) is the most important point, regardless of cost. By including the word "cost" we are limiting and lessening the point. Can you both accept that solution as an improvement? -- Fyslee / talk 19:24, 31 August 2008 (UTC)

Indeed, the source only says this about cost-effectiveness: "Although most public health authorities would agree that vaccination constitutes one of the most cost-effective infectious disease control measures of the last century" (would some disagree? sounds like opinion that needs attribution, not fact) , but does state "In the face of now overwhelming evidence to show that vaccination is an effective public health procedure." In light of this, I made this change, which follows the source closely. - DigitalC (talk) 02:55, 1 September 2008 (UTC)

Well, you did follow the source ;-) at least part of it. It's accurate enough. Including more would have highlighted the contrast and thus more clearly revealed the controversial nature of the resistance to vaccination. But at least you followed the source. -- Fyslee / talk 05:41, 1 September 2008 (UTC)

Including more would have given more weight than this section deserves, which some editors here feel is none. - DigitalC (talk) 06:14, 1 September 2008 (UTC)

I think the first sentence it too long. We can start with: Vaccination is controversial within the chiropractic community. and then include the rest of the information in a second sentence. A quick adjustment will fix it. QuackGuru 19:05, 1 September 2008 (UTC)

This comment makes no sense. It is not about including more or less information. The current text is inaccurate and does not follow the source close enough for the important point of the sentence. We can keep it short and follow the source more closely at the same time. QuackGuru 19:15, 1 September 2008 (UTC)

You're welcome to propose a new version here. -- Fyslee / talk 19:39, 1 September 2008 (UTC)

Vaccination is controversial within the chiropractic community. Although it is one of the most cost-effective forms of prevention against infectious disease, most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective. QuackGuru 20:11, 1 September 2008 (UTC)

That version was already proposed in #Vaccination draft above, where two editors favored it and one opposed. This makes three to one on this particular change. I expect further improvements can be made, but this does appear to be an improvement over what's in there now. Eubulides (talk) 22:36, 1 September 2008 (UTC)

As stated previously, I don't think there should be a vaccination section at all. But if certain editors insist on its inclusion, the section should not imply that anything more than a (vocal) minority of the chiropractic profession are anti-vaccination, and it certainly should not imply that anti-vaccination is taught as part of chiropractic qualifications. This is my proposed rewrite:

A minority of chiropractors oppose vaccination. Several prominent chiropractors have written articles claiming that vaccination is hazardous or ineffective.[107] Additionally, a segment of chiropractors support freedom of choice as opposed to compulsory vaccination. (Principles and Practice of Chiropractic, pg 197) Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, while the Canadian Chiropractic Association supports vaccination.[10]

Anti-vaccination is a crusade by a minority of chiropractors, it is NOT taught as part of the profession, and it is NOT a majority view. The text should reflect that, rather than the 'spin' use of terms such as 'most writings' and implying that vaccination is controversial among the whole chiropractic community when it is a minority view. --Surturz (talk) 01:53, 2 September 2008 (UTC)

You think we should not have a vaccination section and your proposal chopped up the vaccination section almost in half. Chripractors are learning from chiropractic authors to have an antivaccination philosophy. QuackGuru 02:47, 2 September 2008 (UTC)

This proposed rewrite has several problems:

• The phrase "A minority of chiropractors oppose vaccination" doesn't convey to the reader how large and significant that minority is. A minority of MDs oppose vaccination too, but it's a tiny and insignificant minority. In contrast, many chiropractors oppose vaccination, and less than a majority supports it; this fact should be noted clearly.
• Another way to put it is that antivaccination is not simply "a crusade by a minority". Only a minority of the profession favors vaccination; this lack of support for a widely-accepted and important public-health measure would be remarkable for any health-care profession.
• Using the phrase "freedom of choice" without qualification promotes the antivaccination POV. The freedom-of-choice business is subsidiary to the main argument, which is that vaccination is hazardous or ineffective.
• Percentages of chiropractors that support or oppose vaccination should be given, so that readers can see for themselves how important this issue is.
• There is redundancy in the paragraph about how a minority of the profession rejects vaccination.

Eubulides (talk) 07:31, 2 September 2008 (UTC)

I agree with Surturz. . . We are letting a vocal minority misrepresent the views of the majority. . . The text ought to reflect that.TheDoctorIsIn (talk) 03:09, 2 September 2008 (UTC)

I think you might have a hard time understanding NPOV. The section is now a stub and in need of serious expansion. Please explain why you turned a ref citation red. QuackGuru 03:23, 2 September 2008 (UTC)

::I find it amusing that you are accusing me of POV, and refer everyone to an archive of your talk page, and particularly the "medicare website unreliable?" section. Enjoy your 'semi-retirement' --Surturz (talk) 03:44, 2 September 2008 (UTC)

Surturz wrote in part: I find it amusing that you are accusing me of POV I do not see any evidence of an accusation towards Surturz.

I was asking a question to TheDoctorIsIn but Surturz replied. Hmm. I still would like an answer to the red ref problem. I will get to work on the Insurance and subsidies section soon enough. QuackGuru 03:57, 2 September 2008 (UTC)

My apologies, I didn't see TheDoctorIsIn's comment, I thought it was directed at me. Although I think TDII's change was un-reverting mine (which in turn was restoring Soyuz' superior text). --Surturz (talk) 04:13, 2 September 2008 (UTC)

And neither was instituted as a result of any consensus agreement here, so I have restored the existing version. Let's work on it and improve it HERE. -- Fyslee / talk 05:31, 2 September 2008 (UTC)

I agree with this restoration for now. I have a draft for an improved version in #Vaccination draft above. Eubulides (talk) 07:31, 2 September 2008 (UTC)

"Significant" minority

The third paragraph in the LEAD contains this phrase:

• "Vaccination remains controversial among a minority of chiropractors."

Since it's far from a small minority, and includes two major organizations, I think inclusion of the word "significant" is warranted as being more accurate. The existing wording could easily be interpreted as if it was a tiny minority of fringe chiropractors with no influence, when this is far from the case. The new wording would look like this:

• "Vaccination remains controversial among a significant minority of chiropractors."

What think ye? -- Fyslee / talk 05:36, 2 September 2008 (UTC)

Disagree. Significant to whom? 'Minority' is factual. 'Significant minority' is an opinion. Why don't we stay factual? IMO we should rely on facts and science, not opinions and opinion polls. Bludgeoning the reader of this article with vaccination arguments just gives the impression that the anti-vaccination chiropractors have credibility or are speaking for the entire profession. I am of too generous a nature to presume that other editors of this article would use the anti-vaccination minority as a means of damning the entire profession. --Surturz (talk) 07:01, 2 September 2008 (UTC)

• Before today's changes, the text read "Vaccination remains controversial among chiropractors." This was more accurate than either of the wordings above. The wordings above imply that, among the minority, vaccination is controversial, i.e., that some of the minority oppose vaccination and some favor it. But that's not the case: the minority in question opposes vaccination.
• If we're going to say something about a significant minority, it should say "A significant minority of chiropractors opposes vaccination." That's nearly as short, and is just as accurate as the older text.
• However, let's go back to the more-accurate text before today's changes: it's shorter and is thus more appropriate for the lead. Also, it answers Surturz's objections.

Eubulides (talk) 07:31, 2 September 2008 (UTC)

"A significant minority of chiropractors opposes vaccination." is very accurate, and was the whole point of my suggestion. The sources back up such a description, as it is not a small minority, and is an important opinion that is directly supported or not opposed ("unsure") by a majority of the 2000 graduating class at CMCC, as born out by the research:

• "One might presume, therefore, that the Canadian chiropractic profession maintains a similar perspective on vaccination. Nevertheless, a recent survey of 621 students (75.2% response rate) attending the Canadian Memorial Chiropractic College (CMCC), the only English-language chiropractic college in Canada, found that approximately 29% of students graduated in the year 2000 with antivaccination attitudes, 40% being supportive of vaccination, with 31% unsure.5 Further, a 2002 survey of Alberta (Canada) chiropractors, many of whom will have graduated from CMCC, found that 27.2% advised patients against vaccinating themselves or their children.6" [1]

Here's the math: 29% oppose vaccination + 31% unsure = 60%, as opposed to only 40% who support vaccination.

While this is OR (although research and historical sources would probably back this up), it would be quite reasonable to assume that adding the older generation of DCs to this mix, IOW the majority of practicing DCs who have even stronger anti-vaccination POV, would bring this percentage even higher than 60%. So "significant" minority is putting it very lightly. "Majority" would be more accurate.... I can understand why Surturz would feel uncomfortable with this, but he's in the minority of the profession who supports vaccination, even if he might be among a majority within his circle of DC friends, thus giving him a feeling that his is a majority position, when it isn't.

Your wording sounds good. Go for it. -- Fyslee / talk 19:53, 2 September 2008 (UTC)

While it's OK to speculate, it's not OK to synthesize and extrapolate.

Since when does unsure=opposed?

Using a survey done in 1999 at one school to "paint" as Surturz said the profession? Unacceptable. There is already a WP:WEIGHT and WP:POINT violations, there are editors actively involved here who want the section gone and this is how the response is? Adding fuel to the fire?

Please cease with the accusations and insinuations, I am here to help. WP:OWN is moreso a concern of mine, I see that only certain editors can edit Chiropractic, only those of the sceptical kind. Soyuz113 (talk) 21:28, 2 September 2008 (UTC)

• The proposed text does not assume "unsure=opposed". It says merely that a significant minority of chiropractors opposes vaccination, which is what reliable sources say. Chiropractic #Vaccination is not merely using "a survey done in 1999"; it also mentions a 1995 survey of US chiropractors which found that about 1/3 of them think that immunizations cause more disease than they prevent, and a 2002 survey of Alberta chiropractors which found that 27.2% advised patients against vaccinating themselves or their children. These are all significant minorities, and we have found no reliable source that disagrees with these sorts of numbers.
• Changes that are installed with discussion and consensus have a greater chance of surviving. For more on this, please see #Moving CAM issue to Schools of thought below.

Eubulides (talk) 01:50, 3 September 2008 (UTC)

According to that study, it would seem that the largest percentage of chiropractors actually support vaccination. Hence, all of the space we are dedicating to "vaccination" is just trumped up controversy in violation of WEIGHT. -- Levine2112 ^discuss 01:25, 3 September 2008 (UTC)

It is highly notable that only a minority of chiropractors support one of the two most important public-health procedures of the last two centuries (the other being clean water supplies). This controversy is not "trumped up"; it is an important one, that is cited often in the peer-reviewed literature. Eubulides (talk) 01:50, 3 September 2008 (UTC)

"spiritual inspiration"

The Philosophy section contains this wording:

• "Chiropractic's early philosophy was rooted in spiritual inspiration and rationalism."

I suggest that the words "magnetic healing" and "vitalism" be included. This is pretty fundamental to chiropractic history.

If the phrase "spiritual inspiration" is referring to "spiritualistic inspiration" (which would be very true and logical, since Palmer claimed to have received chiropractic "from the other world", and was an active spiritualist), then the phrase should be wikilinked as "spiritual inspiration". The suggested version would look like this:

• "Chiropractic's early philosophy was rooted in spiritual inspiration, magnetic healing, vitalism, and rationalism." ^{Vitalism is already wikilinked.}

While it looks like alot with all the coding, the only real differences are wikilinking the phrase, adding "magnetic healing" and "vitalism", and the refs. What think ye? -- Fyslee / talk 06:25, 2 September 2008 (UTC)

Unnecessary This is already covered in the History section. Actually, IMHO the philosophy section should only cover current Chiro philosophies (a lot of the historical stuff in the philosophy section could be moved to 'History'). A comparison with the coverage of barber surgeons in the surgery article is useful. --Surturz (talk) 07:14, 2 September 2008 (UTC)

• The cited source (Keating 2005, in PPC) says "spiritual inspiration" many times; it talks about "spiritualism" only once, and in a context that wouldn't support claims that chiropractic was derived from spiritualism. It defines "spiritual inspiration" as "insight from ethereal sources", if that helps; but I think "spiritual inspiration" is pretty clear by itself. I think it does mean something different from "spiritism", and should not be wikilinked to "spiritism".
• If it helps, Keating's summary says "Chiropractors have employed a wide range of epistomologies (ways of knowing) to defend their art and professional autonomy. This diversity has included critical and uncritical rationalism (e.g., so-called deductive science), spiritual inspiration, and the scientific method."
• Keating mentions magnetic healing and vitalism on several occasions; he even points out that D.D. originally called chiropractic "magnetic manipulation", a point that should perhaps be made. I don't see the need to cite Beck 1991 or the religion cite as well, given that we have a far-more-recent and more-respected source on the same topic, which integrates it for us. So I suggest simply adding "magnetic healing, vitalism" without adding any more citations.

Eubulides (talk) 07:31, 2 September 2008 (UTC)

Disagree as well. This is again promoting a minority and old viewpoint which is another WP:WEIGHT violation. Soyuz113 (talk) 21:31, 2 September 2008 (UTC)

Eubulides, There is a huge difference between including 'Spiritualism', which is still part of some chiropractor's philosophy and "magnetic healing", which is not. 'Spiritualism' does not open the door for 'magnetic healing'. 'Magnetic healing' deserves the same weight as 'barber surgeon' in 'surgery' i.e. not much. You and will Fyslee will have an easier time gaining consensus if you restrict historical chiropractic practice to the history section, rather than attempting to equate current day chiropractic with the chiropractic of a hundred years ago. --Surturz (talk) 00:37, 3 September 2008 (UTC)

Agreed. -- Levine2112 ^discuss 01:23, 3 September 2008 (UTC)

What part of "Chiropractic's early philosophy was rooted in.." don't you all understand? "...was rooted in..." is past tense, ergo, we are talking about history and making no statement about current practice in that sentence. What's the big deal? Are you all questioning the accuracy of the terminology or of the history? The addition of these terms should be totally uncontroversial, unless one is uncomfortable with admitting the origins of the profession.

Now Surturz thinks this should be in the history section, which is another matter. Right now let's get the wording down, and then discuss its proper placement, which is a legitimate concern. -- Fyslee / talk 13:58, 3 September 2008 (UTC)

Whatever the literal reading of the text, if 'magnetic healing' appears in the 'philosophy' section, it will give the impression that magnetic healing is relevant to modern chiropractic, and I think you know that this is the impression it will give. It is not possible to discuss the wording divorced from the placement. Why are you so keen to mention magnetic healing a second time in the article, anyway? Your suggested text does not improve the article - it does not provide new information, nor does it improve the clarity of the text. --Surturz (talk) 01:33, 4 September 2008 (UTC)

No it won't "give the impression that magnetic healing is relevant to modern chiropractic," and you are assuming very bad faith when you accuse me: "and I think you know that this is the impression it will give." I have absolutely no desire to give such an impression. I only want to provide the accurate facts about the historical aspects of the chiropractic philosophy. Keep in mind that I did concede your point about placement.

Right now we can easily resolve this problem, since the Chiropractic #Philosophy section is already divided into two parts, an "early philosophy was rooted in" section (at the end), and an "Although a wide diversity of ideas exists among chiropractors" section (at the beginning), but unfortunately they are in the wrong order, and this can be fixed. I suggest we reverse their order, so there is a logical historical progression, and make the distinction clearer by adding one little word - "currently":

• "early philosophy was rooted in .... Although a wide diversity of ideas CURRENTLY exists among chiropractors"

I would like to try that edit as an experiment below Eubulides' comment below. -- Fyslee / talk 03:40, 4 September 2008 (UTC)

I'll comment below that edit. Eubulides (talk) 16:18, 4 September 2008 (UTC)

• I agree that "vitalism" should appear somewhere in the body of Chiropractic. Currently "vitalism" appears only in the lead, which is a no-no; the lead should summarize the body.
• I also agree that Chiropractic #Philosophy is an appropriate place to talk about vitalism. That section currently talks about holism, conservatism, rationalism, and spiritual inspiration; vitalism is just as important as these if not more so, and should be mentioned in Chiropractic #Philosophy. No editor has opposed adding "vitalism" here. I suggest the wording "Chiropractic's early philosophy was rooted in vitalism, spiritual inspiration and rationalism." (italics mark the new word).
• Magnetic healing is a different matter. Unlike vitalism, it is not a significant part of modern chiropractic philosophly. Chiropractic #History already talks about magnetic healing; I don't see what additional mention would be useful there. Perhaps you could propose specific wording within the context of History?

Eubulides (talk) 20:40, 3 September 2008 (UTC)

I fear you are making the same mistaken assumption that Surturz did above. "Magnetic healing" (IOW Mesmerism, or animal magnetism) relates to original chiropractic philosophy, IOW its history, and has little to do with modern chiropractic. Therefore it deserves just as much mention in that one sentence. Palmer didn't suddenly stop believing and practicing his magnetic healing when he started manipulating people's joints. He continued to manipulate their minds just as much as before, but now along with a physical method to boot. BJ Palmer developed this even further with his circus background in trickery, illusion and deception, and later his expert salesmanship and pioneering mass marketing of chiropractic:

• ^{"D.D. Palmer’s son, B.J. Palmer, became involved in the chiropractic movement early on, during the formative years. B.J shared his father’s metaphysical bent (prior to chiropractic, he worked with a mesmerist and worked in the circus), his tendency to make sweeping statements about health without justification, and his ignorance of contemporary scientific knowledge. He was reported to state, for example, “When I saw there was no use for a sympathetic nervous system, I threw it out, and then just had to put something better in its place, so I discovered Direct Mental Impulse.” B.J. also discovered a non-existent “Duct of Palmer” connecting the spleen to the stomach. In 1907 B.J. engineered a hostile take over of his father’s school of chiropractic." [2]}

The two words can be included as I proposed - as a part of that one sentence. This shouldn't be controversial. It's a highly recognized part of chiropractic history. It's about who Palmer was and how he thought, and that's what produced chiropractic. -- Fyslee / talk 04:06, 4 September 2008 (UTC)

Experimental version

... with reversed order, as proposed above:

Chiropractic's early philosophy was rooted in vitalism, spiritual inspiration and rationalism. A philosophy based on deduction from irrefutable doctrine helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic principles rather than on the materialism of science. However, most practitioners currently accept the importance of scientific research into chiropractic, and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness.

Although a wide diversity of ideas CURRENTLY exists among chiropractors, they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system. Chiropractors study the biomechanics, structure and function of the spine, along with what they say are its effects on the musculoskeletal and nervous systems and its role in health and disease.

Chiropractic philosophy includes the following perspectives:

• Holism assumes that health is affected by everything in people's complex environments; some sources also include a spiritual or existential dimension.

• Conservativism considers the risks of clinical interventions when balancing them against their benefits. It emphasizes noninvasive treatment to minimize risk, and avoids surgery and medication.

• Homeostasis emphasizes the body's inherent self-healing abilities. Chiropractic's early notion of innate intelligence can be thought of as a metaphor for homeostasis.

• A patient-centered approach focuses on the patient rather than the disease, preventing unnecessary barriers in the doctor-patient encounter. The patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health.

Now that is the original text (without the diagram), but with a reversed order of the first and last paragraphs, and the addition of one word - "currently". Doesn't that make it clear who believed what and when, and doesn't it now read with a logical historical progression, as good writing should do? -- Fyslee / talk 03:40, 4 September 2008 (UTC)

That change to the text makes sense to me. But is removing the diagram part of the proposal? It's not clear from the text whether you're proposing to remove the diagram as well. Eubulides (talk) 16:18, 4 September 2008 (UTC)

No, I am not proposing removing the diagram. I only left it out to save space here. (Whether we think the diagram is appropriate, pretty, etc., is another topic for another time. I think it is well made, but creates a cluttered appearance due to varying monitor sizes, etc.)

If no one objects, then the change can be made shortly, so go for it when you feel the time is right. -- Fyslee / talk 06:06, 5 September 2008 (UTC)

Only a legal defense?

I have long questioned the idea that the religious/metaphysical beliefs of Palmer were only invented as a legal defense. Palmer was a spiritualist, vitalist, and magnetic healer long before "inventing" chiropractic. His religous ideas weren't new ones invented to serve as a legal defense, although they were certainly used for that purpose

While he wasn't above historical revisionism, exaggeration, and deception (the twisted version of the Lillard story, with BJ Palmer perpetuating the myth), I think the following article has a point. It is in Today's Chiropractic Lifestyle, a RS as far as chiropractic opinion is concerned:

There is a revisionist trend in the history of chiropractic today, which claims that the philosophy of chiropractic was only developed to win legal battles. And now that the profession is established, the philosophy should be abandoned. This trend is partially true; the philosophy was indeed used to legalize chiropractic. The first landmark court case to establish chiropractic’s legitimacy was in 1907, Wisconsin vs. Morikubo. In the case it was shown that chiropractic had a distinct philosophy. After this case, B.J. Palmer had the faculty grant him a Ph.C., he re-titled his 1906 book to include philosophy in the title, and then in 1910 D.D. Palmer’s book was published and it, too, addressed philosophy. According to this revisionist approach to history, the philosophy of chiropractic was a legal ploy. Chiropractic became a distinct profession in the courts because it had a distinct philosophy and approach to health.

The revisionists would have us believe the surface only. The fact is, there were about 3,300 court cases against chiropractors won on these grounds. B.J. was an expert witness in many of the trials. Are we to leave it at that or go deeper? I wish chiropractic school had prepared me to discuss these questions. This revisionist argument implies that D.D. Palmer used his final years to create a fictitious philosophical legal defense (that, by the way, was a clear descendent from his Mesmeric, and Spiritualist roots). Are we also to believe that his son B.J. was to spend the next 54 years espousing and evolving a philosophical system of life, health and spirit just for legal reasons? [3]

Should this be added as a qualifying source to balance what we already have in the article? -- Fyslee / talk 06:59, 2 September 2008 (UTC)

I don't see any claim in Chiropractic that its philosophy was developed only to win legal battles. It's not clear to me what this somewhat-speculative article would add to Chiropractic. Perhaps a (presumably brief?) wording-change proposal would clear up my confusion? Eubulides (talk) 07:31, 2 September 2008 (UTC)

Other procedures lack rigorous proof

I disagree with this recent edit, which removed the phrase "many other medical procedures also lack rigorous proof of effectiveness". That phrase is there because of a common theme in many sources that although chiropractic care has not been rigorously proven, in this respect it's in the same boat as many other forms of medical treatment. That's an important point, which should be made. All too often, chiropractic critics say "the science isn't there" without noting that the science isn't there for many other forms of medical treatment, too. We had a long discussion about this in Talk:Chiropractic/Archive 22 #"Rigorously proven" and the current wording is the result of quite a bit of consensus-searching. Let's keep it. Eubulides (talk) 07:48, 2 September 2008 (UTC)

Well, there are lots of problems with the statement.

• The scientific method is unconcerned with whether other perhaps unrelated disciplines are 'proven' or not. Being 'guilty of not working' is not mitigated by the fact that other procedures may not work.(This is the section about efficacy after all)
• The science is not there for other procedures. The doesn't mean anything scientifically. Science and medicine is not relative to other results - burden of proof is independent. Medicine is required to show that a procedure works better that the placebo. If it doesn't it's not medicine. If chiropractic shares this lack of efficacy with other procedures then all you can say is 'Chiropractic has not been proved to work beyond the placebo effect'. No doubt not working is shared with many other procedures: prayer, applying leeches, etc. What doesn't work 'medically' (after being subjected to the scientific method) is by definition not medicine. Of course, new procedures are tried all the time, and they are subjected to trials. If after being subjected to these trials they are not shown to be effective they tend to be discarded or modified and tested again.
• It is for this reason that some scientific/medical commentators (such as Richard Dawkins) call the term 'alternative medicine' misleading. 'If a medicine is shown to work it is simply medicine.' If it cannot be shown to work it isn't. (Obviously new procedures and treatment in the midst of trials may in future be shown to work).
• Saying 'many other medical procedures' fails Wikipedia policy for a number of reasons. First it's weasel words, and to paraphrase Wikipedia policy itself is easily countered with a statement such as 'so what if leeching and homeopathy lack rigorous proof'. See here: WP:SUBSTANTIATE and here: WP:WEASEL which says "This page in a nutshell: Avoid using fuzzy, estimated statistics..."
• This whole idea that the 'science isn't there for other things' is really just an excuse in the scientific world for when something doesn't work. If the science is not there for 'these other things' (weasel words!) then 'those other things' don't work either. That's all there is to it. Scientifically, if that is the case, this and those other things get consigned to the trash can equally. Now, if there is an issue with the Wikipedia articles about 'those other things', then go to those pages and make the appropriate edits there.

As an aside, it's a myth that science/medicine is somehow not open to new ideas. Quite the opposite. Medicine simply requires something to work (beyond placebo). I'll stand on my head and listen to Abba backwards to cure an ailment if it passes scientific rigour. And doctors will equally prescribe it as treatment.

Macgruder (talk) 08:41, 2 September 2008 (UTC)

I am sympathetic to many of these points, but I disagree with the blanket statement "Medicine is required to show that a procedure works better that the placebo." Medicine is not science, and physicians must sometimes act even when they don't have a course of action that has been scientifically proven. In some cases these actions turn out to be wrong when science has its say, but that doesn't mean that they weren't best medical practices at the time. Assessing Medical Technologies (ISBN 030903583X, page 562) gives the examples of gastric freezing in the treatment of peptic ulcer disease, and internal mammary artery ligation for coronary artery disease; these were widely accepted medical practices that lacked scientific evidence. I expect that many current practices are in the same boat. Eubulides (talk) 18:01, 2 September 2008 (UTC)

Well, you seem to contradicting yourself here:

"Medicine is not science, and physicians must sometimes act even when they don't have a course of action that has been scientifically proven. In some cases these actions turn out to be wrong when science has its say, but that doesn't mean that they weren't best medical practices at the time."

This action is precisely the scientific method (you are confusing 'proven with science' with 'science' itself: i.e. the scientific method) . If the result of an action is unknown, you can still carry it out. But to decide whether it works the scientific method is required. Besides take a look at the medicine article itself where it clearly states that medicine is a science; at least what cannot be under ANY dispute is when talking about the efficacy of a medical approach then that is science. My edit was in the efficacy section. (It is probably for this very reason that 'medical' procedures such as 'homeopathy', 'chiropractic' command little respect amongst the scientific community: if you are not prepared go by results subjected to the rigor of science then it's no more than anecdotal evidence.) A well-known example is Einstein's Laws of Relativity. When he proposed them, they had not yet been subjected to testing, but it was still science. The first step of the procedure: the proposal of a theory. Then they were subjected to the scientific method, and the theory matched the observation, then the theory is accepted.

Obviously there is a grey area. Here we are not talking about a particular treatment like a new drug. We are talking about a whole branch of treatment that has been around for over 100 years. If correctly carried out testing has not shown any statistically efficacy of the treatment then there becomes a point where it is rejected as medicine (like applying leeches). Unfortunately, the paper in your introduction that talks about the testing is written by a practitioner from Palmer College of Chiropractic which has a vested interest in saying that Chiropractic works (and besides which it is not a scientific review paper) . More recent papers doing scientific analysis (a scientific review paper) on previous studies say : ' "no convincing evidence from systematic reviews to suggest that [spinal manipulation] is a recommendable treatment option for any medical condition."'

For the efficacy section, you must just stick to the science.

Obviously, much of this 'science' discussion is moot regarding the edit. The way it stands breaks Wikipedia policy as I have written above anyway (and regards the science - there is no avoiding it when talking about efficacy )

The short version as quoted by Ben Goldacre: "Evidence based medicine is the applied science (that has probably saved more lives in the last 50 years than any other)" .

Macgruder (talk) 08:52, 3 September 2008 (UTC)

• Again, I am sympathetic with most of what you're writing. Still, the grey area you mention is larger than we'd like, even in well-accepted areas of medicine. Most available evidence in surgery comes from non-scientific studies: surgeons routinely consult narrative or qualitative reviews, or cohort studies, but rarely consult randomized controlled trials or meta-analyses. Part of this is due to the difficulty of doing evidence-based surgery: it is hard, for example, to construct a good placebo that resembles open-heart surgery! For more on this subject, please see Slim 2005 (PMID 15827835).
• DeVocht 2006 (PMID 16523145) is pretty recent. As far as I can see, none of the more-recent reviews that you allude to are relevant to the "many other medical procedures also lack rigorous proof of effectiveness" wording. They talk about evidence of effectiveness of procedures that chiropractors use; that is a different subject. So I don't see why they are relevant to this particular wording change.

Eubulides (talk) 20:40, 3 September 2008 (UTC)

• You're giving DeVocht undue weight WP:UNDUE. DeVocht is an assistant professor at the Palmer College of Chiropractic (i.e. a college that promotes the effectiveness of the treatment) . A single paper by an assistant professor that is giving just an overview as part of an introduction cannot be compared to a scientifically controlled review study or a systematic review of Cochrane. DeVocht paper is not attempting to be a review paper, the focus is totally different. My new section adds what I feel is an appropriate source: Ernst.
• 'Still, the grey area you mention is larger than we'd like, even in well-accepted areas of medicine. Most available evidence in surgery comes from non-scientific studies: surgeons...' Perhaps this is true, but it's original research to apply it here unless any of your sources directly allude to it. The difficulty of constructing a placebo is irrelevant to this article beyond what is in sources themselves. Those issues belong in the research based medicine article. Good luck with that!
• Let end this discussion here, and move it to below. Macgruder (talk) 05:17, 5 September 2008 (UTC)

Moving CAM issue from Scope of practice

This recent change was installed with neither discussion nor consensus; this is not a good procedure. A fairly recent thread, Talk:Chiropractic/Archive 25 #Fix for CAM claim contained a discussion of that very point. It was proposed on July 29 to move the text in question to Chiropractic #Scope and practice; a bit of discussion ensued, and on August 25 the change was finally made (please see Talk:Chiropractic/Archive 26 #Chiropractic-as-CAM out of utilization and satisfaction for the announcement). This is in sharp contrast with today's change. I don't see why today's change is for the better, as the matter seems more relevant to scope of practice (where does chiropractic fit into the rest of the world?) rather than schools of thought (what distinguishes straights from mixers?); but regardless of my opinion, changes like these should be discussed first. Eubulides (talk) 01:50, 3 September 2008 (UTC)

As a controversial undiscussed change, it should be restored to its original consensus location. -- Fyslee / talk 04:06, 3 September 2008 (UTC)

Done, including other undiscussed edits, and even one by CorticoSpinal himself, using an IP. -- Fyslee / talk 05:42, 3 September 2008 (UTC)

A starting point for a look at the effectiveness section and introduction

I've been having an interesting discussion with User:Eubulides (thank-you!) about Chiropractic and the scientific basis of its effectiveness / efficacy (I prefer the word effectiveness for the lay reader). A number of issues strike me.

• It's not sufficient to simply link to published studies. Not all studies stand the test of time: they may be later discredited or have other problems such as methology, bias, etc etc. This issue is one of synthesis, and is outlined here WP:SYNTH. This is an issue of Wikipedia policy.
• A good starting point is the Cochrane Collaboration. In the words of Edzard Ernst:

Virtually all experts agree that the best available evidence in any area of health care is that provided by Cochrane reviews. The Cochrane Collaboration is a worldwide network of independent scientists dedicated to systematically summarising the totality of the evidence related to specific medical subjects in a rigorous and transparently impartial fashion.

• Given that the Effectiveness section at present has a 'Synthesis problem' box, I'm going to try to use Cochrane to get a start on the evidence as it stands in the scientific community today.

Comments, objections etc welcome. Cheers, Macgruder (talk) 12:58, 3 September 2008 (UTC)

Both Cochrane Collaboration and Edzard Ernst is already cited in the effectiveness section and I do not have any idea what in the world you are proposing. QuackGuru 13:10, 3 September 2008 (UTC)

• I agree with Macgruder that it doesn't suffice merely to link to published studies. Chiropractic #Evidence basis attempts to follow the advice given in WP:MEDRS about reliable sources in this area; these guidelines agree with you about using up-to-date studies.
• Macgruder came to this discussion recently, so here's a bit of catch-up for his benefit. Obviously we should be avoiding synthesis. The WP:SYN tag was placed by supporters of chiropractic, who I expect would say that citing the Cochrane collection would constitute synthesis. For more on this, please see Talk:Chiropractic/Archive 24 #Syn tag, Talk:Chiropractic/Archive 24 #SYN and implicit conclusions, and Talk:Chiropractic/Archive 25 #Proposed wording for NOR/N, and Wikipedia:No original research/noticeboard #Chiropractic section on evidence basis.
• If it helps, here is a list of works in the Cochrane database that are currently cited in Chiropractic: Assendelft et al. 2004 (PMID 14973958), Hayden et al. 2005 (PMID 16034851), Gross et al. 2004 (PMID 14974063), Bronfort et al. 2004 (PMID 15266458), Glazener et al. 2005 (PMID 15846744), Proctor et al. 2006 (PMID 16855988).
• I agree with QuackGuru that it would be helpful to have specific proposals for wording changes.

Eubulides (talk) 20:40, 3 September 2008 (UTC)

Eubulides is grossly misrepresenting the SYN issue again. This is not a matter of chiropractic supporters versus chiropractic critics. This is a matter of editorial SYN. As I have said in the past, any study which isn't specifically about chiropractic should not be used (regardless of whether the conclusions would favorable or not if interpreted and applied to chiropractic). This is a pretty basic and real complaint about this section. No research should be used unless it is specifically commenting on chiropractic efficacy. If it is merely commenting on the effectiveness of spinal manipulation as performed by practitioners other than chiropractors, then it should not be used here in this article (but rather at Spinal manipulation. This is an article about chiropractic. Chiropractors employ a specific form of spinal manipulation wholly unique in application and technique tot he chiropractic profession. Using studies of other practitioners performing different spinal manipulation techniques creates an OR violation (regardless of whether the research is favorable to spinal manipulation or not). Essentially what we are doing now would be tantamount to describing the effectiveness of Dentistry using research studying the efficacy of dental care as performed by heart surgeons. Cochrane is a very reliable resource and should be used at this article if the researchers have something specific to say about the efficacy of chiropractic, but should not be used if they are only discussing spinal manipulation as performed by non-chiropractors. -- Levine2112 ^discuss 20:57, 3 September 2008 (UTC)

I expect that all the Cochrane reviews include some data from non-chiropractic sources, and I expect that the editors who placed that SYN tag would therefore exclude all Cochrane reviews from Chiropractic. If there are any counterexamples to this expectation, it would be good to hear about them. I don't see what is being misrepresented here; I've tried to be clear that these are merely my expectations, which of course may be incorrect. Eubulides (talk) 23:49, 3 September 2008 (UTC)

Levine2112, you are twisting things again, just like at the NOR noticeboard, where I replied to you, and you evaded without providing evidence yet. You are creating a straw man diversion when you write above "Using studies of other practitioners performing different spinal manipulation techniques..." ^{my emphasis} We are talking about the same HVLA techniques by different names (non-DC researchers and DC researchers call them "spinal manipulations" (regardless of practitioner), and DCs call them "adjustments" and "spinal manipulations"). -- Fyslee / talk 04:47, 4 September 2008 (UTC)

Talk about strawman. You have actually been the one evading my question which remains: How do you know that they are the exact same techniques? I'm still waiting for an answer. -- Levine2112 ^discuss 05:59, 5 September 2008 (UTC)

I don't recall that question and will defer until you answer my requests for evidence backing up your unusual claim. You made the claim that they were "mechanically" different, but haven't provided any proof of such a difference without resorting to OR and personal opinion inferences. While that is interesting and I'd like to see your evidence, that isn't the discussion here. We are talking about the terminology used. Do you deny that non-DC researchers and DC researchers call them "spinal manipulations" (regardless of practitioner), and DCs call them "adjustments" and "spinal manipulations"? I really doubt that in these cases (the cited research) they are including esoteric and odd brand name chiro techniques like Activator, and comparing it to real HVLA manipulations/adjustments. -- Fyslee / talk 06:37, 5 September 2008 (UTC)

I've read all the above and rather than trying to comment individually to everyone. I'll try to give an overrall summary of my feelings:

• Wikipedia policy is very clear on the idea of original research. You do not synthesize different viewpoints combined with a knowledge of other articles (such as the placebo effect, difficulties in constructing a double-blind study) and so forth. You simply look for a respected source and summarize it. However, this has to be done carefully due to the issue of due weight, and defining what is a respected source;
• This means that you need to be careful not to simply choose to summarize a published paper, or a single paragraph from it. The paper itself may not have been studying the summary you are inferring from it (the problem with the deVocht) paper; it may have been funded by an interested group (Atkins diets also have this problem); it may later on closer inspection by experts in the field be dismissed for the way it was carried out etc. , it may not be challenged by other scientists because the assertions it makes are not the main focus of the paper. This last is an important point. A paper about the social and historical issues of Chiropractic may make assertions about the results of research but since this is not the primary focus of the paper, it will not be necessarily looked at by other researchers. etc.
• Thus the best approach is to let the experts do this work for you, and summarize that. Sometimes this can be hard to find, but it's not too difficult in this case:

Focus Altern Complement Ther 2005; 10: 87–8 http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm

This is a summary by Edzard Ernst (who has impeccable credentials on the issue of evidence-based medicine ) on Chiropractic using Cochrane.

Now, you could object to this writing on the grounds of something like "it also includes spinal manipulation as performed by non-..." (this is just an example), but that is irrelevant to Wikipedia because it's original research. Your objection needs to be reliably sourced, and if it is sourced it can be included (see policy quote below). Ernst says his article is about Chiropractic thus we summarize it. Ernst article obviously corresponds with his published paper too.

Obviously, here Ernst's conclusion is something you may not agree with that but that is besides the point. If you can find a paper/writing with the other viewpoint then that can be included too, but note the Undue weight issue. Wikipedia policy says:

NPOV weights viewpoints in proportion to their prominence. However, when reputable sources contradict one another and are relatively equal in prominence, the core of the NPOV policy is to let competing approaches exist on the same page: work for balance, that is: describe the opposing viewpoints according to reputability of the sources, and give precedence to those sources that are most reliable and verifiable.

At the moment, we have in the introduction as a summary a single paper by DeVocht. ( ... giving DeVocht undue weight WP:UNDUE. DeVocht is an assistant professor at the Palmer College of Chiropractic (i.e. a college that promotes the effectiveness of the treatment) . A single paper that is giving just an overview as part of an introduction to a paper on a different subject (i.e. not efficacy) cannot be compared to a scientifically controlled review study or a systematic review of Cochrane by Edzard Ernst. ), and it is patently WP:UNDUE to include only this paper in the introduction. At a stretch you can summarize Ernst and add a sentence alluding to this paper.

(The use of Ernst plus Cochrane works well in Acupuncture where it concludes that acupuncture may be effective for a particular subset of treatments.)

Another suggestion is to also put individual research results into their own article like http://en.wikipedia.org/wiki/Low-carbohydrate_diet .

Anyway, I'm going to take a stab at updates the introduction paragraph of the article (effectiveness area) based on the above. If you have objection to the use of Ernst and Cochrane that's fine - but to save time just link to the objection that you have found in a reputable source. (A quote in a newspaper is not sufficient - Flat Earthers are quoted in newpapers all the time :-) Obviously, an opposite summary viewpoint would be important. I'd like to see links for that. Macgruder (talk) 06:43, 5 September 2008 (UTC)

• We agree about WP:OR and WP:SYN and summaries.
• A proposal for improving the text would be welcome, but perhaps first I should mention a few problems that you might want to be aware of.
• The editorial that you cite (Ernst 2005) is obsoleted by Ernst 2008 (PMID 18280103). Ernst's 2008 paper is peer-reviewed and covers the same ground in a lot more detail than Ernst 2005, and is more up-to-date. I see no value in citing an older, less-detailed, non-peer-reviewed, duplicative source by the same author. I suggest citing Ernst 2008 instead of Ernst 2005 for any new text you'd like to propose.
• Ernst is a reliable source, but he is definitely not the only reliable source in this controversial area, and Chiropractic should not be rewritten to promote Ernst's views at the expense of other reliable sources. Other sources for the evidence basis of chiropractic that deserve attention, in addition to Ernst 2008 and to Ernst & Canter 2006 (PMID 16574972), include Villanueva-Russell 2005 (PMID 15550303), Johnston et al. 2008 (PMID 18404113), Bronfort et al. 2008 (PMID 18164469), Chou et al. 2007 (PMID 17909210), Meeker et al. 2007, Vernon & Humphreys 2007 (PMID 17369783), Hurwitz et al. 2008 (PMID 18204386), and Hawk et al. 2007 (PMID 17604553). There are others, but that's enough for starters. Each of these sources are highly reliable and summarize chiropractic's evidence basis just as well as Ernst 2005 does, and in many ways better. But they don't agree with each other. (That would be too easy. :-)
• For an "opposite summary viewpoint" please read Chiropractic #Evidence basis. It cites all the papers I've mentioned above (including Ernst's of course), and cites many more to boot. It gives both the supportive-of-chiropractic side and the critical-of-chiropractic side, and for both sides it cites high-quality sources in peer-reviewed journals. This is not flat-earth or newspaper stuff.
• Getting back to the "many other medical procedures also lack rigorous proof of effectiveness" point: nothing in Ernst or any Cochrane review contradicts this comment by DeVocht. More generally, I am unaware of any reliable source disagreeing with this point by DeVocht. DeVocht's comment is a meta-comment about whether scientific evidence is required before a medical treatment can be undertaken, and as such it is highly relevant to this section. I still don't see why it should be removed. Given that we have one editor for removal of this stable text, and one editor against, I suggest keeping it in for now. (Or perhaps another editor can chime in on this subject.)

Eubulides (talk) 07:27, 5 September 2008 (UTC)

• This is good stuff. One brief point before I take a look at those links in detail: a number of the links you give me are papers from Chiropractic colleges: i.e. summaries published by people whose professions depends on the positive outcome of these trials. A problem Ernst alludes to.
• It'll take time to see whether these are 'highly reliable', but thanks for listing them.
• "nothing in Ernst or any Cochrane review contradicts this comment by DeVocht" - this doesn't mean they agree with it. More likely they don't think it's worth addressing. I don't see any evidence that DeVocht carries anything near the weight of Ernst regarding evidence-based medicine. I myself have had a scientific paper published (about another topic), but I'd be shocked if anyone in Wikipedia used it! It's a question of undue-weight. Make the point when referring to the paper but that point cannot be synthesized to the intro.
• A very pertinent issue is here. A paper published by Chiropractors themselves:

http://www.chiroandosteo.com/content/16/1/10

Macgruder (talk) 10:25, 5 September 2008 (UTC)

• I agree that Chiropractic #Evidence basis is good stuff. Some of the good stuff is written by chiropractors, and some of it is written by non-chiropractors. High-quality sources should not be excluded merely because chiropractors wrote them.
• I'm glad you agree that the Cochrane reviews and Ernst do not disagree with DeVocht's comment about other medical fields not having rigorous scientific evidence. As I understand it, your concern now is not that DeVocht's comment is incorrect, but that it's not notable. But this concern is misplaced. It is common knowledge in medical circles that many medical procedures are not supported by rigorous scientific proof. Here are two examples:

• Vincent 2004 (PMID 15302748) writes about randomized controlled trials (RCTs) in other fields of medicine and then says, "However, in intensive care medicine the situation is a little different, with RCT evidence frequently lacking....".
• Jeppsson & Thorlacius 2005 (PMID 18333189) write about RCTs and evidence-based medicine (EBM) and say, "There are several reasons for this lack of RCTs in surgery. One important reason is the reliance on RCTs as the cornerstone of EBM. The value of RCT is however limited in surgery. There are four main reasons limiting the value of RCTs in surgery.... 1. Experimentation may be unnecessary.... 2. Experimentation may be inappropriate.... 3. Experimentation may be impossible.... 4. Experimentation may be inadequate."

Many more examples of this can be cited. The point that many medical techniques are not well-supported scientifically is not controversial, is relevant to Chiropractic #Evidence basis, and is mentioned in a reliable source. I still see no reason for omitting it. Eubulides (talk) 16:26, 5 September 2008 (UTC)

MacGruder, I have no problem using reliable research which make specific conclusions about chiropractic (regardless of whether or not they are favorable to chiropractic). I do object to us using research which does not make any conclusions about chiropractic specifically (whereas the research may have studied spinal manipulations as performed by non-chiropractors and then made conclusions about spinal manipulations in general). For us to take this general non-chiropractic spinal manipulation research conclusion and apply it to make a conclusion about chiropractic at this article is - in my mind - a violation of WP:OR. Again, essentially what we are doing now would be tantamount to describing the effectiveness of Dentistry using research studying the efficacy of dental care as performed by heart surgeons. I am not speaking about DeVocht or Ernst or Cochrane specifically at this point. I am only trying to reach an agreement of generalities (i.e. At this article, we should not cite research on non-chiropractic spinal manipulation which makes no conclusion specifically about chiropractic.) Does that sound reasonable to you? -- Levine2112 ^discuss 18:21, 5 September 2008 (UTC)

• This comment on "generalities" takes a position that would exclude all use of the Cochrane reviews in question. Again, for more about this topic, please see Syn tag, SYN and implicit conclusions, Proposed wording for NOR/N, and Chiropractic section on evidence basis.
• Going back to Macgruder's comment on "a very pertinent paper". I agree that the paper is pertinent. For more, please see #Murphy et al. 2008 below.

Eubulides (talk) 19:11, 5 September 2008 (UTC)

Why would it exclude the use of Cochrane? -- Levine2112 ^discuss 19:14, 5 September 2008 (UTC)

Please see #Cochrane reviews below for a followup. Eubulides (talk) 20:34, 5 September 2008 (UTC)

Cochrane reviews

Following up on Levine2112's proposal in the above section to remove citations to sources "using research which does not make any conclusions about chiropractic specifically": this proposal would not exclude the use of Cochrane reviews in general, just the reviews mentioned in the above section.

Come to think of it, it would be helpful to do a sweep of Cochrane reviews that specifically mention chiropractic; I'll take a look at that. Cochrane reviews are a generally-recognized high quality source. Even if their official publish date is older, they are regularly updated and reviewed, so the are more-recent sources than their pub-date would otherwise indicate. Eubulides (talk) 20:34, 5 September 2008 (UTC)

I believe that Cochrane is a high quality source. If Cochrane makes conclusions specifically about chiropractic, then we should feel free to use it as a source (regardless of whether the conclusions are positive or negative for chiropractic). However, we should not include Cochrane reviews which are only making conclusions about spinal manipulation in general (not specifically about chiropractic). Such reviews are best suited for the Spinal manipulation article.

I am in the process of creating a detailed but clear RfC to address this matter in general, but if the editors here can generally agree to the proposal Eubulides describes here as: "to remove citations to sources 'using research which does not make any conclusions about chiropractic specifically'", then I see no need to open the RfC can of worms. -- Levine2112 ^discuss 21:10, 5 September 2008 (UTC)

• That proposal runs contrary to modern scientific practice, in which systematic reviews focus on treatments, not professions. When a treatment is so strongly identified with a profession, as spinal manipulation is with chiropractic, it is entirely proper to cite high-quality systematic reviews on that treatment. Similarly, it is entirely proper for Traditional Chinese medicine to cite studies on acupuncture and on Chinese herbal medicine.
• I searched for Cochrane reviews mentioning chiropractic, and propose to add the following words to the list at the end of Chiropractic #Effectiveness, preserving the alphabetic order that is already in that list.

asthma

carpal tunnel syndrome

pelvic and back pain during pregnancy

Each citation is to a Cochrane review that mentions chiropractic. None of the reviews found evidence of benefit. Generally speaking, what the reviews did was look for evidence supporting the use of treatments for these conditions, and included searches for treatments done by chiropractors, without finding supporting evidence.

Eubulides (talk) 21:22, 5 September 2008 (UTC)

Murphy et al. 2008

A new commentary paper has been published comparing chiropractic to podiatry, as professions (Murphy et al. 2008, PMID 18759966). It contains several interesting points, which deserve better attention in Chiropractic. Here are some proposed changes to Chiropractic in the light of this new paper: Eubulides (talk) 23:49, 3 September 2008 (UTC)

"How can chiropractic become a respected mainstream profession? The example of podiatry", Donald R Murphy , Michael J Schneider , David R Seaman , Stephen M Perle and Craig F Nelson, Chiropractic & Osteopathy 2008, 16:10doi:10.1186/1746-1340-16-10 -- Fyslee / talk 14:06, 4 September 2008 (UTC)

Gallup poll

The Utilization and satisfaction section does not address the common patient concern about the ethics of practitioners. To address this, insert the following text after the "Satisfaction rates are typically higher for chiropractic care" sentence.

In contrast, a 2006 Gallup Poll found that chiropractors ranked last among health care professions for honesty and ethics, with 36% of poll respondents ranking chiropractors as very high or high; other rankings ranged from 62% for dentists to 84% for nurses.

Eubulides (talk) 23:49, 3 September 2008 (UTC)

Yeah, nurses!--—CynRN ^(Talk) 04:42, 4 September 2008 (UTC)

Nurses have consistently finished at the top of that poll for years. If memory serves, among all professions they were briefly topped by firefighters after 9/11, but then resumed being #1. Eubulides (talk) 16:18, 4 September 2008 (UTC)

I just can't help adding my vote here. My mother was a nurse, and this most caring of all professions deserves all the support and credit it deserves. -- Fyslee / talk 06:10, 5 September 2008 (UTC)

I have a suggested tweak of the wording:

• In contrast, a 2006 Gallup Poll found that chiropractors ranked lowest among health care professions for honesty and ethics, with 36% of poll respondents ranking the honesty and ethics of chiropractors as "high" or "very high" as compared to the rankings of 62% for dentists and 84% for nurses.

I have indicated the changes in italics. The added wording, although a repetition, makes it clearer what the statistics refer to, as well as make the large contrast clearer. -- Fyslee / talk 05:05, 4 September 2008 (UTC)

More opinion polls!!! Arrgh!!! WHY OH WHY ARE YOU EDITORS SO FASCINATED WITH OPINION POLLS AND WHY DO YOU THINK OPINION POLLS ARE ENCYCLOPEDIC????. Opinion polls are ephemeral and political. They have no place in this article. --Surturz (talk) 12:47, 4 September 2008 (UTC)

Industrial Strength Oppose to the gallup poll, if you didn't work that out. --Surturz (talk) 12:49, 4 September 2008 (UTC)

Do I sense frustration with the way Wikipedia works and its all inclusive policies, as regards information? NPOV requires the inclusion of opposing and controversial POV, and if a Reliable Source has published something, it's fair game. You really don't need to shout at us. Just calm down and get used to how things work here and you'll survive, otherwise you're headed for trouble. -- Fyslee / talk 14:15, 4 September 2008 (UTC)

No, you sense my frustration that certain editors seem to want to show chiropractic as an unscientific and non-medical profession, yet use non-scientific (i.e. opinion poll) sources to do it. If you want to argue the science, then argue the science. Using opinion polls like the gallup poll or the poll of student opinions on vaccination is completely unscientific and cheapens wikipedia, and turns this article into a political battleground. Newsworthy is not the same as noteworthy. --Surturz (talk) 00:25, 5 September 2008 (UTC)

The modified proposal (mentioned below) attempts to address the "argue the science" issue somewhat by also citing the paper by Murphy et al. in Chiropractic & Osteopathy, a peer-reviewed medical journal. Of course by itself this does not establish scientifically that chiropractors are less-trusted than dentists, nurses, etc. However, the topic is clearly a notable one, and this is a reliable source published in a scientific journal, and is the best source we've found on the subject. Eubulides (talk) 02:28, 5 September 2008 (UTC)

I dispute the 'clearly notable' contention. Patient satisfaction rates could be notable, but the general public's opinion of chiropractic is hardly notable in this place. I imagine that many of the respondents hadn't ever gone to a chiropractor, or may not even know what chiropractic is. In other forums the poll would be of interest - among chiropractors, who would have an interest in improving the perception of chiros, for example - but this is not the forum website <-- talk about nitpicky! --> for such political issues. Phrasing the poll results as "chiro came last" also misrepresents reality since there would be many "health" professions not even represented in the poll. e.g. if faith healers, or water diet advocates were put in the poll, would chiros still come last? --Surturz (talk) 04:14, 5 September 2008 (UTC)

• We have a reliable source to the effect that the poll is notable.
• Patient satisfaction rates are also notable, and are also cited by reliable sources, just as the Gallup Poll is. Patient satisfaction rates are currently mentioned prominently in Chiropractic: they are mentioned in a section header, and the body of that section discusses them and cites two reliable sources.
• Chiropractic is not a "forum"; it is an encyclopedic article about chiropractic, and the topic of public opinion about chiropractic is highly relevant, just as the topic of patient satisfaction is highly relevant.

Eubulides (talk) 04:26, 5 September 2008 (UTC)

• (outdent)It may be newsworthy but it is not notable. Nowhere in the Medicine article does this sort of opinion poll rubbish appear, nor should it do so in this article. --Surturz (talk) 08:05, 5 September 2008 (UTC)

• The topic is mentioned with emphasis in a reliable source published in a peer-reviewed medical journal, indicating that it is indeed notable and not merely newsworthy. Whether Medicine includes this or other polls is not that relevant to Chiropractic; Medicine is a much broader topic, with dozens of subarticles, whereas Chiropractic has just a few, none on this particular topic. Eubulides (talk) 16:26, 5 September 2008 (UTC)

• I don't understand the comment "More opinion polls". Chiropractic currently does not cite any mass opinion polls. It does cite surveys, but that's something else.
• I agree with Fyslee; this poll is notable and is cited by a recent reliable source.
• The rewording proposed by Fyslee has some problems. Most important, it omits the point that chiropractic's number is way out of the range for other healthcare professions (the earlier text established that dentists were 2nd lowest and nurses highest; the rewording doesn't). Also, the rewording unnecessarily duplicates the phrase "honesty and ethics". How about the following wording instead? It attempts to address Fyslee's points. The new words are in italics.

In contrast, a 2006 Gallup Poll found that chiropractors ranked last lowest among health care professions for honesty and ethics, with 36% of poll respondents ranking chiropractors as very high or high; by the same measure other professions' rankings ranged from 62% for dentists to 84% for nurses.

Eubulides (talk) 16:18, 4 September 2008 (UTC)

Following up on my own comment; I missed that you'd changed "last" to "lowest". That change is fine of course. I updated the above rewording accordingly. Eubulides (talk) 06:16, 5 September 2008 (UTC)

I didn't leave out dentists and nurses, but made the contrast between their high position and chiropractic's low position more clear. The current use of the words "very high or high" doesn't clearly refer to anything. I tried to make it clear by repeating the words. -- Fyslee / talk 06:28, 5 September 2008 (UTC)

Your draft mentions dentists and nurses, but omits the important point that dentists finished 2nd from the bottom in the healthcare professions, and that despite finishing 2nd from the bottom, dentists still finished way above chiropractors. This point is captured in the "ranged from" wording, but it's missing in the wording you propose, where a reader might think that dentists and nurses were picked at random from the set of healthcare professions (which is not the case), and that perhaps some other profession finished nearly as lowly as chiropractic did (which is also not the case). Eubulides (talk) 07:27, 5 September 2008 (UTC)

• (outdent) I oppose the current suggested text. --Surturz (talk) 08:05, 5 September 2008 (UTC)

• Can you suggest any improvements? Eubulides (talk) 16:26, 5 September 2008 (UTC)

I agree with Surturz. Opinion polls are ephemeral and political and have no place in this article. -- Levine2112 ^discuss 19:16, 5 September 2008 (UTC)

The 2006 poll is just one year, of course, but these results are not ephemeral: Gallup did the same poll in 1999 and 2003 and got similar results. Politics very much has a place in this article: this article is encyclopedic and should not exclude a topic merely because it is political. However, as far as I can see the Gallup Poll topic is about public opinion, not politics per se. Given the "ephemeral" contention, perhaps the previous results should be mentioned as well? We could do something like the following text:

In contrast, a 2006 Gallup Poll found that chiropractors ranked lowest among health care professions for honesty and ethics, with 36% of poll respondents ranking chiropractors as very high or high; other professions' rankings ranged from 62% for dentists to 84% for nurses. Chiropractors received rankings of 26% in 1999 and 31% in 2003 using the same measure.

Eubulides (talk) 20:34, 5 September 2008 (UTC)

The ref is WP:RS and meets the inclusion criteria. This may be a case of I don't like it. QuackGuru 19:27, 5 September 2008 (UTC)

Fraud and abuse

Murphy et al. write that "fraud, abuse, and quackery ... are more rampant in our profession than in other healthcare professions", citing Foreman & Stahl 2004 (PMID 15389179). This is an important point, of course; it should be mentioned somewhere. I propose appending the following text to Chiropractic #Education, licensing, and regulation:

Abuse, fraud, and quackery are more prevalent in chiropractic than in other health care professions. A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).

Eubulides (talk) 23:49, 3 September 2008 (UTC)

These are the same concerns and criticisms that skeptics have and write about in skeptical writings and books, but which chiropractors often attempt to claim are based on turf wars and attempts to suppress the profession. If there is any attempt to suppress, that's why! (This was very clearly the issue in the failed attempt to get a chiropractic school established at Florida State Univ. The medical and science professors screamed "quackery and unscientific" pretty loudly, and threatened to resign.) The concerns are about rampant quackery and health fraud, and even Keating openly scolded the president of the ACA for claiming that such accusations were about a "myth". No, they were and are problems, and need coverage. -- Fyslee / talk 05:05, 4 September 2008 (UTC)

Murphy also mentions the "shrinking market share", and we haven't discussed this at all. Instead we have seemed to imply that things are looking better. There are other sources that document a shrinking market share and very slow growth. -- Fyslee / talk 05:13, 4 September 2008 (UTC)

Well, it looks like you have already found and used the good source I was thinking of! Good going. -- Fyslee / talk 05:46, 4 September 2008 (UTC)

Holism

Murphy et al. note that holism is "a drastic departure from the reductionistic subluxation-only approach, which 'reduces' the cause and care of health problems to a spinal subluxation." This important point is not made in Chiropractic's discussion of holism. To fix this, append the following to the Holism bullet in Chiropractic #Philosophy:

In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation.

Eubulides (talk) 23:49, 3 September 2008 (UTC)

Analogy to podiatry

Murphy et al. have a very useful analogy on page 21, which is basically this:

podiatry : foot reflexology :: "chiropractic medicine" : straight chiropractic

where "chiropractic medicine" is their term for science-based chiropractic. Perhaps this point should be made in Chiropractic somehow? But I don't have a specific suggestion here yet. Eubulides (talk) 23:49, 3 September 2008 (UTC)

WP is not a political platform in which to attempt to divide the chiropractic profession. I see no evidence that the term 'chiropractic medicine' is in common parlance. Just because an editor might like the term does not mean it should be included. --Surturz (talk) 12:54, 4 September 2008 (UTC)

This isn't about an editor's opinion. You're missing the point the very prominent chiropractic authors are seeking to make. They are pointing out well-known existing differences and divisions already present in the profession, and Wikipedia's job is to report what the sources say. Maybe you should read it for yourself:

6. Podiatrists and Foot Reflexologists

We feel it is important here to briefly contrast and compare podiatry and foot reflexology. While the two professions have always been distinct, there is commonality in that each focuses its treatment efforts on the foot; however, this is where any resemblance between the two professions ends. Podiatric medicine is a science-based profession dedicated to the diagnosis and treatment of foot disorders. Foot reflexology is a metaphysically-based group consisting of non-physicians who believe that many physical disorders arise from the foot. Podiatrists have rejected foot reflexology as an unproven and unscientific practice, and do not consider it part of mainstream podiatric practice. Thus, it would be quite unreasonable to think that podiatry and foot reflexology could ever exist under one professional roof.

Yet, this is the very untenable situation in which we find ourselves in the chiropractic profession. Chiropractic has frequently been described as being two professions masquerading as one, and those two professions have attempted to live under one roof. One profession, the “subluxation-based” profession, occupies the same metaphysical and pseudoscientific space as foot reflexology. The other chiropractic profession -- call it “chiropractic medicine” as we do in this commentary -- has attempted to occupy the same scientific space as the podiatric profession. Alas, the marriage of convenience between these two chiropractic professions living under one roof has not worked. We find science-based practitioners and organizations alongside quasi-metaphysical, pseudoreligious, pseudoscientific practitioners and organizations. The result is continual battling with a huge waste of energy and resources, while professional growth stagnates.

"How can chiropractic become a respected mainstream profession? The example of podiatry", Donald R Murphy , Michael J Schneider , David R Seaman , Stephen M Perle and Craig F Nelson, Chiropractic & Osteopathy 2008, 16:10doi:10.1186/1746-1340-16-10 Source

Their and other's use of the term "chiropractic medicine" is another issue and should be discussed elsewhere. -- Fyslee / talk 13:51, 4 September 2008 (UTC)

• It is clear from the text you have quoted that the author is not using a common term, but is attempting to establish a new one viz. 'chiropractic medicine'. As such it should not appear in the article. --Surturz (talk) 08:11, 5 September 2008 (UTC)

• I agree that their use of "chiropractic medicine" is not that common and shouldn't be adopted uncritically in Chiropractic. Eubulides (talk) 16:26, 5 September 2008 (UTC)

Public health

Murphy et al. has a section "Public Health" that talks not only about vaccination, but about the broader issue of opposition to "many public health measures such as vaccination and water fluoridation". Perhaps Chiropractic #Vaccination should be renamed to Public health, with some treatment of other issues. A good source for ideas would be Johnson et al. 2008 (PMID 18722194). I don't have a specific proposal in this area now, though. Eubulides (talk) 23:49, 3 September 2008 (UTC)

Nugent

Murphy et al. cite the work of John J. Nugent DC in improving the quality of chiropractic education. Perhaps a sentence should be added to Chiropractic #History? I don't have a specific proposal here. Eubulides (talk) 23:49, 3 September 2008 (UTC)

Maintenance

Here's one more quote, about maintenance:

"We are concerned that the common perception (which is well supported, in our experience) that chiropractors are only interested in 'selling' a lifetime of chiropractic visits may be one of the primary factors behind our low standing in the minds of members of the public." (page 8)

I'm not sure how this would be worked in, though. Eubulides (talk) 23:49, 3 September 2008 (UTC)

References

Please keep this section at the bottom. TO ADD A NEW SECTION, just click the EDIT link at the right and add the new section ABOVE this one. Then copy the heading into the edit summary box.

(The following resolve otherwise-dangling references: )