Talk:Chiropractic

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Mediation in progress at Talk:Chiropractic/Mediation

Criticism

As discussed a while ago, I think there needs to be some sort of criticism section in the article. Currently it appears to be overly positive towards chiropractic, even though there is significant criticism within the medical and scientific community which the article doesn't give sufficient weight to.

To start with, I would suggest just adding a paragraph to the end of the lead summarising the main criticisms that are discussed within the article, something along these lines:

Chiropractic remains controversial, with critics pointing out that it is not based on solid science and it's effectiveness has not been demonstrated for any medical condition with the possible exception of lower back pain. The American Medical Association's Committee on Quackery labeled chiropractic an "unscientific cult" until they lost a lawsuit against the chiropractors in 1987 for restraint of trade.

sciencewatcher (talk) 22:20, 8 December 2008 (UTC)

• Oppose. Criticism sections (aka POV sections!) are awful and unencyclopedic. If we add one it will be an excuse for every nutcase and his dog to push in unsubstantiated [[wp:weasel|weaselly] anti-chiro rubbish. Half the article already argues against the profession on scientific grounds and accusations such as "prescribing endless treatments" etc. Your opinion that the article is overly positive towards chiro is just that - your opinion. I for one think it is overly negative. Trying to insert phrases such as "unscientific cult" into the article is clearly POV --Surturz (talk) 23:30, 8 December 2008 (UTC)
• Oppose. I agree with Surturz that a criticism section is not the way to go about it, as it is giving one POV an entire section. In addition, anything about the AMA Committee on Quackery belongs in the history section, not in the lead. DigitalC (talk) 00:24, 9 December 2008 (UTC)

Sometimes a criticism section is the best way to go. Have a look at the articles on naturopathy, homeopathy, acupuncture and you'll see they all either have a criticism section, or at least have a criticism paragraph in the lead, or sometimes both. And if the largest medical organisation representing doctors in the USA says that chiropractic is an "unscientific cult", that carries great weight (more than your opinion or mine). Hell, even the AMA article has a criticism section! However as Eubulides says below, I am just proposing to change the lead section for now. --sciencewatcher (talk) 00:25, 9 December 2008 (UTC)

The "largest medical organisation representing doctors in the USA" DOESN"T say that chiropractic is an "unscientific cult", it DID say that over 20 years ago. As such, that information is relevant in the history section. It is not an important enough fact to belong in the lead, as a summary of the history section. DigitalC (talk) 01:11, 9 December 2008 (UTC)

• Please see #Balancing lead's 3rd paragraph better below. Eubulides (talk) 00:22, 9 December 2008 (UTC)

Balancing lead's 3rd paragraph better

• There must be some confusion here. Sciencewatcher isn't proposing adding a Criticism section; he is proposing adding text to the lead that better summarizes the body. The text he's proposing (including the "unscientific cult") is already in the body; "unscientific cult" is clearly attributed to the AMA.
• Sciencewatcher is correct in that the lead's balance currently errs somewhat in support of chiropractic; it would be helpful for the lead to summarize the body with appropriate weight.
• Here are some more-detailed comments on Sciencewatcher's proposal:

• That last sentence doesn't sound right: the lawsuit was against the AMA, not against chiropractors.
• The statement "chiropractic remains controversial" is not directly supported by the cited source (Ernst 2008, PMID 18280103). That source is a critical evaluation of chiropractic, but it never says chiropractic is controversial.

That statement is supported by the chirobase article (title: "why chiropractic is controversial"). --sciencewatcher (talk) 03:52, 9 December 2008 (UTC)

Sorry, that wasn't clear from the citation given. I now see it was intended to cite this source: Jarvis WT (1990). "Chiropractic: controversial health care" (PDF). Ministry. 63 (5): 25–9. But this is a low-quality source. We prefer peer-reviewed medical journals, not non-peer-reviewed religious magazines. Also, we should not cite sources in the lead that are not also sourced in the body.

The article is also published on the National Council Against Health Fraud's website. There is also a peer reviewed article PMID 10573757 ("Quackery: the National Council Against Health Fraud perspective.") which discusses chiropractic, but I don't have access to the full-text. --sciencewatcher (talk) 16:09, 9 December 2008 (UTC)

• Please don't get me wrong: I agree with you that the current lead has weight problems, and that they should get fixed. However, any fixes should be supported by high-quality sources as per WP:MEDRS, and these sources should be used in the body as well as the lead, so that (as per WP:LEAD) the lead summarizes the body.
• The body of Chiropractic already cites some high-quality sources in this area. Can't we use those? That is, can't we summarize the existing body in the lead, rather than introduce new (and lower-quality) sources into the lead?
• The NCAHF website is better than nothing, but it's not peer-reviewed, and it doesn't stand up well in the company of the peer-reviewed journal articles that Chiropractic is already sourcing.
• I do have access to Jarvis 1999 (PMID 10573757). It is about quackery in general, not about chiropractic in particular. It has only two quotes about chiropractic:

• "Chiropractic and naturopathy claim to be natural and drug-free ways to health but lack proof of safety and efficacy." (no citation)
• "Patients of chiropractors were three times as likely as patients of family physicians to report that they were "very satisfied" with the care they received for low back pain. Satisfaction was linked to practice style rather than to factors related to safety or efficacy." (citing Cherkin & MacCornack 1989, PMID 2525303).

• In both cases, Chiropractic cites more up-to-date and more-relevant sources on the same points. Perhaps we can use those sources instead, and summarize the corresponding text in the lead? Here are the quotes I'm thinking of, taken from Chiropractic:

• "Spinal manipulation is associated with frequent, mild and temporary adverse effects, including new or worsening pain or stiffness in the affected region. They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours. Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children."
• "Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness. Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree, and they are typically of low quality.
• "Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of persons satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors."

• For my attempt at doing this sort of thing, please see #Alternative idea for 3rd paragraph below. Comments and suggestions for further improvements are welcome. For example, perhaps we could add summaries of the above well-sourced statements into the lead. Another possibility is that we could find more high-quality sources, and add them to both the body and the lead.
• Here's one other source that might be helpful, to be added to the body and the lead.

• Winnick TA (2005). "From quackery to 'complementary' medicine: the American medical profession confronts alternative therapies". Soc Probl. 52 (1): 38–61. doi:10.1525/sp.2005.52.1.38.

Eubulides (talk) 20:19, 9 December 2008 (UTC)

• The word "critics" is also not supported by that source: Ernst doesn't talk about critics of chiropractic.

Again, see the Jarvis article. --sciencewatcher (talk) 03:52, 9 December 2008 (UTC)

• Ernst doesn't say that chiropractic is not based on solid science; he says its concepts are not based on solid science. The distinction is a fine one, but one that we should preserve.
• Ernst doesn't make a claim about the "effectiveness" of chiropractic in general; his claim is about the effectiveness of "chiropractic spinal manipulation".
• Ernst doesn't say "possible exception of lower back pain"; he says "possible exception of back pain" without the "lower".
• There's no source for the "Committee on Quackery" sentence.

Jarvis --sciencewatcher (talk) 03:52, 9 December 2008 (UTC)

• The 3rd paragraph of Chiropractic's lead already talks about the controversy; it seems odd to add a 4th paragraph that duplicates some of the points. It'd be better to integrate the new points into the 3rd paragraph, no?

Yes, if you can. But I think we need a link to chirobase or similar to point out the significant criticisms. --sciencewatcher (talk) 03:52, 9 December 2008 (UTC)

We can and should do better than chirobase. We can cite peer-reviewed scientific or medical journals. Please see #Alternative idea for 3rd paragraph below for one way to do it; there are others. Eubulides (talk) 07:32, 9 December 2008 (UTC)

Alternative idea for 3rd paragraph

• How about this idea instead? Change the 3rd paragraph of Chiropractic as follows (deleted text struck out, inserted text in italics):

For most of its existence, chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are considered significant barriers to scientific progress within chiropractic that are not based on solid science. Vaccination remains controversial among chiropractors. The American Medical Association called chiropractic an "unscientific cult" and boycotted it until losing a 1987 restraint-of-trade court decision. In recent decades chiropractic has gained more legitimacy and greater acceptance among medical physicians and health plans and has had a strong political base and sustained demand for services, and evidence-based medicine has been used to review research studies and generate practice guidelines. Opinions differ as to the efficacy of chiropractic treatment; Chiropractic spinal manipulation has not been shown to be effective for any medical condition with the possible exception of back pain; the efficacy and cost-effectiveness of maintenance chiropractic care are unknown. Although spinal manipulation can have serious complications in rare cases, chiropractic care is generally safe when employed skillfully and appropriately.

Eubulides (talk) 00:22, 9 December 2008 (UTC)

• Look, trying to insert "unscientific cult" into the lead is clearly POV. It's a 30 year old accusation and not relevant to current chiropractic. I dislike the phrase 'solid science' too - what is unsolid science? --Surturz (talk) 00:51, 9 December 2008 (UTC)

• The phrase is quoted and properly attributed in the text as being part of the past. There's nothing inherently POV about that. "Solid science" is a common phrase meaning science that is firmly grounded on facts and the scientific method; see, for example, Black & Corcitto 1998 (PMID 9717854). An advantage of the "solid science" phrase is that it's clearer and shorter than the phrase it replaces. Eubulides (talk) 07:32, 9 December 2008 (UTC)

• It still fails WP:LEAD & WP:UNDUE. Why are we introducing something into the lead, when it doesn't deserve that much weight? It isn't a good summary of the history section, where such information belongs. DigitalC (talk) 04:42, 12 December 2008 (UTC)

• Per WP:LEAD: "The lead serves both as an introduction to the article below and as a short, independent summary of the important aspects of the article's topic". Do you really feel that this information about the AMA serves as an adequate summary of the History section? Do you believe that as proposed, it meets WP:NPOV, without the balancing statement that "in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy"? DigitalC (talk) 01:07, 9 December 2008 (UTC)

• The proposed sentence already contains that balancing statement. It says that the AMA lost the restraint-of-trade case. Eubulides (talk) 07:32, 9 December 2008 (UTC)

I respectfully submit that it is dishonest to state that the proposed sentence already contains that balancing statement, when it clearly doesn't. The proposed text didn't say anything about conspiracy, and the article text was changed to not even mention restraint of trade. DigitalC (talk) 03:16, 15 December 2008 (UTC)

I did not remove the restraint-of-trade part; another editor did that, and I do not agree with that removal. The word "conspiracy" is a legalism that is invariably attached to restraint-of-trade cases; it doesn't need to appear in the lead. The basic point is that the AMA lost an antitrust court case; in fact, "antitrust" would be even better than "restraint of trade" since it's shorter. Eubulides (talk) 08:30, 15 December 2008 (UTC)

• I also feel that the statement "Opinions differ as to the efficacy of chiropractic treatment" is a better summary of the effectiveness section than "Chiropractic spinal manipulation has not been shown to be effective for any medical condition with the possible exception of back pain". DigitalC (talk) 01:09, 9 December 2008 (UTC)

• "Opinions differ" make it sound like opinions are all over the map. They're not that far apart, actually, among reliable sources. The proposed statement more accurately summarizes what reliable sources currently say. Eubulides (talk) 07:32, 9 December 2008 (UTC)

I disagree, I think that the older text (also based on what reliable sources say) is a more accurate summary. In addition, the proposed text disagrees with text in the article about headaches (which are not back pain), which suggests that SM may be effective for migraine, cervicogenic and tension headache. DigitalC (talk) 04:42, 12 December 2008 (UTC)

I strongly disagree with the current vague lead. The lead needs to summarize the history section. The current version about "opinions differ" is vague. There are obvious problems that we should fix. I prefer the new proposal to resolve the mainspace problems with the lead. QuackGuru 05:29, 12 December 2008 (UTC)

The vague tag leads to MOS#Unnecessary_vagueness, which has to do with accuracy of measurements. It certainly doesn't apply here. If there are obvious (non-controversial) problems, then fix them. There is nothing vague about "opinions differ", and it is further clarified within the body of the article. DigitalC (talk) 03:12, 15 December 2008 (UTC)

The part about "opinions differ" is clearly vague and deleting the sentence about history in the lead was controversial. Please see Talk:Chiropractic#WP:LEAD violation. QuackGuru 03:50, 15 December 2008 (UTC)

I disagree that there is anything vague about "opinions differ". It is clear to me. There is nothing controversial about WP:BRD, especially when you fail to obtain consensus for your edits on the talk page first. DigitalC (talk) 05:47, 15 December 2008 (UTC)

Adding vagueness to the lead is extremely controversial. It was a clear cut case of violating WP:LEAD. QuackGuru 06:19, 15 December 2008 (UTC)

There is nothing "extremely controversial" about reverting back to a version that had consensus. There is nothing here violating WP:LEAD, and there is nothing vague about "opinions differ" (which is also reliably sourced). DigitalC (talk) 06:40, 15 December 2008 (UTC)

The LEAD violation is very serious. Blocking improvements is not helpful. The article should continue to improve from edit ot edit. The LEAD violation alone would cause this article to fail WP:GA. QuackGuru 06:56, 15 December 2008 (UTC)

Template:Vague #Usage says that {{vague}} "should be used in articles where a sentence may be vague, ambiguous, or unspecific", which does apply here. The template's wikilink to Wikipedia:Manual of Style #Unnecessary vagueness gives one example of vagueness, but that's not the only example. Another possible template would be {{clarifyme}}, but either way, the text in question is too vague to accurately summarize Chiropractic #Effectiveness and Chiropractic #Cost-effectiveness. Eubulides (talk) 08:30, 15 December 2008 (UTC)

In recent decades

• No comment as to content, but I noticed that the sentence that starts "In recent decades" seems to be a run-on or reads somewhat like several sentences were glued together. Shell ^babelfish 08:04, 12 December 2008 (UTC)

• Thanks for pointing it out. I tried to fix that run-on sentence this way, along with fixing some suboptimal phrasing that recently crept into the lead. Eubulides (talk) 17:35, 12 December 2008 (UTC)

Style of writing

Emphasizes

The word "emphasizes" is used twice in the lead paragraph. I think we should not use the same word twice. I'm sure we can focus on an alternative word. QuackGuru 19:00, 12 December 2008 (UTC)

I changed the 2nd instance to "focuses on"; hope this helps. Eubulides (talk) 20:57, 12 December 2008 (UTC)

Rarely

In the safety section a sentence begins with the word "Rarely". I have rarely seen writing like this before. This is a bit odd to me. QuackGuru 19:15, 12 December 2008 (UTC)

It's that way so that the word "rarely" can be cited separately. It's not that unusual. See, for example this webpage by the American Pediatric Surgical Association, which says "Rarely, multiple esophageal duplication cysts have been observed." and "Rarely, they may arise primarily within the chest." This usage emphasizes the "rarely", which is appropriate here. Eubulides (talk) 20:57, 12 December 2008 (UTC)

Opinions differ

This edit planted a {{vague}} tag after this phrase:

"Opinions differ as to the efficacy of chiropractic treatment".

I agree that the phrase is way too vague. I proposed a replacement in #Alternative idea for 3rd paragraph; DigitalC objected to the replacement on the grounds that the text says that SM may be effective for headache. The text I proposed does not disagree with that point, as it says that chiropractic treatment has not been "shown to be effective" for conditions other than back pain, and this is consistent with the idea that chiropractic treatment may be effective for other conditions. However, it is a good idea to mention that there's been a lot of research, with conflicting results; this is stated several times in the body and should be mentioned in the lead. To take this into account, I propose the following replacement instead:

"Treatments used by chiropractors have been heavily researched, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain. These reviews usually cover treatments independent of profession, and thus do not evaluate chiropractic in isolation."

This replacement text summarizes Chiropractic #Evidence basis fairly well, and is well-supported by the cited source, which says this on page 8:

"Numerous controlled clinical studies of chiropractic are now available, but their results are far from uniform. Rather than selecting single studies according to their findings, it is therefore preferable to consider the totality of this evidence. Table 3 gives an overview of the most up-to-date systematic reviews by indication. These systematic reviews usually include trials of spinal manipulation regardless of who administered it. Thus, they are not exclusively an evaluation of chiropractic. Collectively, their results fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain. For this condition, manipulation may be as effective (or ineffective) as standard therapy."

Eubulides (talk) 20:57, 12 December 2008 (UTC)

I made this change to fix the vagueness in the lead. QuackGuru 22:20, 14 December 2008 (UTC)

That change is close to what was proposed in #Alternative idea for 3rd paragraph above, except it removed "restraint-of-trade" from "restraint-of-trade court decision". DigitalC objected to several of the components of that change; in response, I proposed the above further wording improvements in this section, which were not included in that change. Perhaps some more thought is needed in this area before installing this change? Eubulides (talk) 08:30, 15 December 2008 (UTC)

WP:LEAD violation

This controversial change deleted a sentence about chiropractic history and added vagueness to the lead. We are supposed to summarize the article in the lead. Information about history belongs in the lead. Opinions differ is very vague. Opinions are not all over the map. The lead should be able to stand on its own. QuackGuru 03:46, 15 December 2008 (UTC)

I made this change in accordance with WP:LEAD. The lead should be able to stand alone as a concise overview of the article. QuackGuru 04:04, 15 December 2008 (UTC)

By doing so, you are edit-warring the information into the article. Please stop. Consensus does not exist to ADD the information about the AMA to the lead, and it was reverted per WP:BRD (which is not bold-revert-editwar). It was reverted to the last consensus version, unlike your recent edit-warring edit. There is nothing controversial about reverting a change that does not have consensus. Please self-revert unless/until consensus is established. DigitalC (talk) 05:44, 15 December 2008 (UTC)

Blocking clear improvements by stating no consensus is not a valid reason for the edits made by DigitalC. Continuing to violate WP:LEAD is not productive and it should stop. Violating the lead guideline is a serious matter. It is vague to add "opinions differ" and no valid explanation has been made to delete the summary of the chiropractic history from the lead too. QuackGuru 06:00, 15 December 2008 (UTC)

It is a misrepresentation of facts to state that I am "adding" "opinions differ". I merely reverted back to the last consensus version. (Yes, it had consensus, so you are also violating WP:CON). There is nothing vague about "opinions differ". A valid explanation for reverting the addition of trivial historical information to the lead was given above, or is this another of QuackGuru's many WP:IDHT violations? There is no consensus to add the information (thats 1 valid explanation for the revert), and it does not (per WP:LEAD) act as a "short, independent summary" of the history section of the article. The only historical information that should be in the lead should act as a short summary of the history section (thats the 2nd valid explanation for the revert). You seem to feel that violating WP:LEAD is a serious matter, so you should abide by it. DigitalC (talk) 06:37, 15 December 2008 (UTC)

DigitalC has been informed to comply with WP:LEAD. Continuing to violate WP:LEAD is not helpful. The lead should properly summarize chiropractic history and opinions ("opinions differ") are not all over the map. Why have vagueness in the lead and delete a summary of the history from the lead. QuackGuru 06:50, 15 December 2008 (UTC)

I agree, your continued violations of WP:LEAD are not helpful. The lead should stand as a summary of the article. The trivial AMA information is not an adequate summary of Chiropractic#History, and the AMA lawsuit is not even mentioned in Chiropractic history, nor is "unscientific cult". 0.1% of articles on Google scholar mention Chiropractic also use the term "unscientific cult", and only 1.2% of the articles discussing Chiropractic also mention both "AMA" and "lawsuit". To put this into the lead of the article is clearly violating WP:UNDUE. DigitalC (talk) 23:17, 15 December 2008 (UTC)

It is a violation of WP:LEAD to not properly summarize the article. Problems have been identified and proposals have been made to fix the problems. QuackGuru 00:43, 16 December 2008 (UTC)

I agree wtih DigitalC here. The lead currently in place does a far better job of accurately summarizing the main tenets of the articles than the one suggested below at Talk:Chiropractic#Lead improvements, which overblows the AMA historical stance in a effort to denigrate the subject. More than a WP:LEAD violation, the proposed version below is also a WP:POVPUSH violation. Keep it neutral, folks. Keep it accurate. Keep it proportional. The current lead does just that. I see no need to change it at this time. -- Levine2112 ^discuss 01:08, 16 December 2008 (UTC)

This antagonism isn't helping things. Anyway, here are my suggestions for changes to the lead: [1] add the AMA info somewhere between "For most of its existence, chiropractic has battled with" and "in recent decades, it has gained more legitimacy". It is important historical info and should go in the lead. [2] remove the vague "Opinions differ" and put in the conclusions of the Cochrane reviews with regard to effectiveness. I would also suggest removing the efficacy studies done by chiropractors themselves and just leaving the independent reviews, such as Cochrane. This should be done in the Effectiveness section as well as in the lead. --sciencewatcher (talk) 20:04, 15 December 2008 (UTC)

The latest proposal just got completed at Talk:Chiropractic#Lead improvements. Please have a look. QuackGuru 20:41, 15 December 2008 (UTC)

Vague tag

The {{vague}} tag stems from the vagueness objection to the "opinions differ" phrase in the lead. This objection is that the article itself gives much more detail about the effectiveness of chiropractic, and summarizing that down to just "Opinions differ as to the efficacy of chiropractic treatment" is too much reduction/condensation, so much so that the summary is vague. Please see the start of this (top-level) section for a proposed fix. Eubulides (talk) 08:30, 15 December 2008 (UTC)

The vague tag is used inappropriately here. As noted previously, it leads to a section of the MOS dealing with accuracy of measurements. Further, I respectfully submit that there is nothing vague about the statement "opinions differ". DigitalC (talk) 22:53, 15 December 2008 (UTC)

The statement needs clarification. It is an entirely inadequate summary of Chiropractic #Effectiveness, which contains a large quantity of solid reviews that should not be summarized merely by an "opinions differ" statement. The reviews should be summarized as a whole in the lead. As things stand, the lead gives way too little weight to the issue of effectiveness. As there seems to be some confusion here about accuracy of measurements, which is just one form of vagueness (there are others), I substituted a {{clarifyme}} tag instead. Regardless of what the tag is, the problem needs to be fixed. Eubulides (talk) 01:44, 16 December 2008 (UTC)

As I stated below, "opinions differ" appears to be concise and accurate wording. The efficacy section includes reviews with a wide range of opinions about the efficacy of spinal manipulation. Some research says it is effective for such-and-such while other research says it is not effective for such-and-such; hence "opinions differ" seems to be concise and entirely accurate. -- Levine2112 ^discuss 02:02, 16 December 2008 (UTC)

Opinions differ is vague. I don't see how the current version is be more accurate than the new proposal. The new proposal accurately summarizes the article. QuackGuru 02:07, 16 December 2008 (UTC)

Whiplash and other neck pain

Are editors happy with the length of the Whiplash and other neck pain paragraph or do editors want to shorten it a bit. QuackGuru 22:38, 14 December 2008 (UTC)

I wouldn't mind shortening it a bit. It shouldn't be much longer than the low-back-pain paragraph, surely. We could try doing that in the mediation talk page, as the procedure worked fairly well for the low-back-pain para. Eubulides (talk) 08:30, 15 December 2008 (UTC)

I started a new section at the mediation page. QuackGuru 19:40, 15 December 2008 (UTC)

Mysterious yellow image

In the Chiropractic#History section the picture to the right seems to have a yellow lining on three sides of the picture. Am I seeing things? QuackGuru 22:46, 14 December 2008 (UTC)

No, it's there. No doubt we should get a better image anyway; that one is pretty low-resolution. Eubulides (talk) 08:30, 15 December 2008 (UTC)

I found a better image in Commons, and changed the article to use it. I also changed the portraits to not override user preferences on image sizes; overriding shouldn't be done except in unusual cases, which these portraits are not. 208.127.71.78 (talk) 17:21, 15 December 2008 (UTC)

Unnecessary citation to Ontario Chiro Assn

I don't see the need for this edit, which added a citation to an old web page (a primary source) put out by the Ontario Chiropractic Association that is not refereed. The same point is supported by a recent refereed journal article (Garner et al. 2008, PMID 18194787). Why cite an older lower-quality source when we have a recent higher-quality source on the same point? Eubulides (talk) 08:30, 15 December 2008 (UTC)

Lead improvements

For most of its existence, chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are not based on solid science. Vaccination remains controversial among chiropractors. The American Medical Association called chiropractic an "unscientific cult" and boycotted it until losing a 1987 antitrust case. Chiropractic has had a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among medical physicians and health plans, and evidence-based medicine has been used to review research studies and generate practice guidelines. Many studies of treatments used by chiropractors have been conducted, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain. The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. Although spinal manipulation can have serious complications in rare cases, chiropractic care is generally safe when employed skillfully and appropriately.

Comments on lead improvements

In order to reach WP:GA status we should improve the lead. This is mandated under WP:LEAD which says: The lead should be able to stand alone as a concise overview of the article. QuackGuru 19:14, 15 December 2008 (UTC)

I agree the lead needs improving, particularly the vague part. However, the above text is identical to the text proposed in #Alternative idea for 3rd paragraph. I don't see the point of repeating the same proposal here: that would merely lead to duplication of comments. Let's continue the discussion above instead of restarting it here. Eubulides (talk) 19:41, 15 December 2008 (UTC)

The talk page is too long. I think we should archive all the other discussions about the lead and put a summary of the discussion here. We can also provide links to the archive of the old discussions if they were archived. This proposal is slightly different. It uses the word antitrust instead of the phrase that is hard to understand. It is better to be concise. QuackGuru 19:48, 15 December 2008 (UTC)

Sorry, I didn't see that wording change. I suggest replacing "antitrust court decision" with "antitrust case"; that's shorter and to the point, and the wikilink to United States antitrust law will help explain things. As described in #Opinions differ above, I also suggest expanding "Chiropractic spinal manipulation has not been shown to be effective for any medical condition with the possible exception of back pain;". Here's a suggested rewording: "Many studies of treatments used by chiropractors have been conducted, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain. These reviews usually cover treatments independent of profession, and thus do not evaluate chiropractic in isolation." Eubulides (talk) 20:09, 15 December 2008 (UTC)

I made this initial change to the proposed text. The second part of the proposal seems a bit long but it is accurate. QuackGuru 20:21, 15 December 2008 (UTC)

I made this change to the proposed text. This is concise and in accordance with WP:LEAD. QuackGuru 20:35, 15 December 2008 (UTC)

I don't think that this version is an improvement of the current lead in place in the article. This does a worse job at accurately summarizing the body of the article and seems to be focusing only on the negative POV. I'd say that this lead fails WP:LEAD, WP:POVPUSH and most notably WP:NPOV. What is wrong with the current lead? It seems to do a fine job of accurately summarizing the article in a more neutral way than the version suggested above. The current lead is able to stand alone as a concise overview of the article. So, what's the issue. Can the current lead not stand alone right now? If you think so, please specify why. Is the current lead not a concise overview of the article? If you think so, again please specify why. Please be SPECIFIC. For instance, I've read the efficacy section - and "opinions differ" seems to be a very concise and accurate way to describe the efficacy of chiropractic for various conditions. I see some research which says it is effective for such-and-such and I see some research which says it is not effective for such-and-such; hence, "opinions differ". -- Levine2112 ^discuss 01:11, 16 December 2008 (UTC)

What is wrong with the current lead? The vaguenss of "opinions differ" and not properly summarizing chiropractic history. QuackGuru 01:19, 16 December 2008 (UTC)

The problems are not fixed. QuackGuru 01:26, 16 December 2008 (UTC)

More on criticism/effectiveness/independence

In PMID 16574972 Ernst says "Our previous work has shown that the conclusions of reviews of SM for back pain appear to be influenced by authorship and methodological quality such that authorship by osteopaths or chiropractors and low methodological quality are associated with a positive conclusion. It is perhaps relevant to note that all three of the overtly positive recommendations for SM in the indications back pain, neck pain and headache originate from the same chiropractor". Can we include this somewhere?

One issue is blinding: do the studies in the reviews for back pain actually show that the patients are properly blinded? I don't have access to the full-text, so I can't check. I did find a small study (PMID 15750369) which looked into chiropractic blinding and they found that patients were not properly blinded. This would, of course, lead to an erroneously positive result in any study comparing chiropractic to sham treatment. This small study was done by chiropractors from the Parker Institute, so even the chirporactors are admitting that patients are not properly blinded in the studies! I think this should be mentioned in the article somewhere, perhaps where it currently discusses the placebo effect in the second paragraph of the effectiveness section. --sciencewatcher (talk) 20:50, 15 December 2008 (UTC)

• Bronfort et al. 2008 (PMID 18164469), pp. 217–9, have this to say about those claims in Ernst & Canter 2006 (PMID 16574972):

"The Ernst review is severely limited in its approach because of an incomplete quality assessment, lack of prespecified rules to evaluate the evidence, and several erroneous assumptions [PMID 16887028]. Ernst goes further to conclude that bias exists in systematic reviews performed by chiropractors, particularly members of our group. We refuted this assertion [PMID 16887028], and have attempted to be as transparent as possible in our methodology, which details a priori defined standard and acceptable methods for conducting systematic reviews [PMID 7933399, PMID 12829562]. Table 7 summarizes the conclusions from the latest systematic reviews. The conclusion of this review, which includes the results of the latest published RCTs, is consistent with the latest high-quality evidence-based systematic reviews [PMID 14973958, PMID 16320031]."

In the light of this disagreement among high-quality sources, I don't think we can mention just one side of the story. It might be OK to mention both sides (but not in the lead, I think); a specific wording proposal would be helpful.

• Blinding is rare, because it's difficult; see Ernst & Harkness 2001 (PMID 11576805) and Hancock et al. 2006 (PMID 16764551). The reviews we're citing do not exclude studies merely because they're not double-blinded. This seems to be standard practice in the mainstream scientific and medical literature. On the subject of blinding, Chiropractic #Effectiveness currently says "It is hard to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect." Specific suggestions for improving this wording and/or coverage would be welcome.

Eubulides (talk) 21:22, 15 December 2008 (UTC)

Violation of multiple Wikipedia policies

This controversial edit added a lot of text that is in violation of a number of policies including WP:MEDRS, WP:NPOV, and WP:WEIGHT. QuackGuru 01:49, 16 December 2008 (UTC)

References

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