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• The first sentence uses past tense "rejected"/"relied", which implies that straight philosophy is obsolete.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)

Vague tag on "hampered by chiropractic philosophy"

This edit added a {{vague}} tag after "Serious research to test chiropractic theories did not begin until the 1970s, and was hampered by the chiropractic philosophy" and before "that sustained the profession in its long battle with organized medicine." One way to remove the vague tag would be to replace the phrase "chiropractic philosophy" with the same phrase used by the source, namely "anti-scientific and pseudo-scientific ideas". This would run afoul of other editors' desire to avoid saying "antiscientific" more than once. The word "pseudoscientfic" doesn't occur in Chiropractic, but just saying "pseudoscientific ideas" wouldn't accurately summarize the source. Any other suggestions for fixing the vagueness? Eubulides (talk) 21:32, 21 August 2008 (UTC)

Perhaps "vitalistic" or "holistic" would provide an adequate descriptor. -- Levine2112 ^discuss 22:26, 21 August 2008 (UTC)

"Holistic" would be an anachronism; "vitalistic" would be better but is still not right, as initially many medical doctors had vitalistic beliefs as well. As I understand it the essential point is that chiropractors obtained legal defense by saying that they had their own philosophy, which was not the same as the philosophy of medicine, and therefore they were not practicing medicine. Eubulides (talk) 22:42, 21 August 2008 (UTC)

The word "vitalistic" or "holistic" makes no sense. The current wording "chiropractic philosophy" is vague and also makes no sense. The words "anti-scientific and pseudo-scientific ideas" is NPOV and is faithful to the source. QuackGuru 00:26, 22 August 2008 (UTC)

"anti-scientific and pseudo-scientific ideas" is more vague. Which ideas are these referring to? Read the source. -- Levine2112 ^discuss 02:19, 22 August 2008 (UTC)

While it's "true" that vitalism is part of what has held the profession back, that would be OR and not following the source. There is really no good argument for not following the source. Just quote it. It's up to the readers to read the source and figure it out if they can. The source names one example, which we have also named, but beyond that we mustn't engage in OR. Just quote it accurately as the opinion of chiropractic researchers (who include university presidents, professors, etc.). We can't go wrong by following the source. -- Fyslee / talk 19:53, 22 August 2008 (UTC)

The words "anti-scientific and pseudo-scientific ideas" is a more detailed descriptor. QuackGuru 23:20, 24 August 2008 (UTC)

I fixed the vagueness and removed the tag. QuackGuru 01:49, 26 August 2008 (UTC)

It is non-controversial to fix vagueness in the article. QuackGuru 04:19, 26 August 2008 (UTC)

I agree that following the source is the safest way, but don't go making the edit and claim "consensus". Wait for more comments. If they aren't forthcoming in the next couple days, then do it. All this edit warring needs to stop. -- Fyslee / talk 05:18, 26 August 2008 (UTC)

Wait a second. This information was in the article for a while but Levine2112 removed it about a month ago. I restored the consensus version and Levine2112's suggestion does not follow the source. QuackGuru 05:22, 26 August 2008 (UTC)

QuackGuru's summary here is essentially correct, I'm afraid. That being said, it's OK to wait a bit for more comments. Eubulides (talk) 08:43, 26 August 2008 (UTC)

90% part of general SM research

I'm wondering how we can tweak this:

Most research has focused on spinal manipulation (SM) in general, rather than solely on chiropractic SM; chiropractors perform over 90% of all manipulative treatments in the U.S.

so it's clear that most SM research includes 90 or so percent chiropractic SM. My previous parenthesis wasn't the best way, although grammatically correct. Can we do it in a better manner?

Here's a suggestion:

Most research has focused on spinal manipulation (SM) in general, rather than solely on chiropractic SM. Since chiropractors perform over 90% of all manipulative treatments in the U.S., this research normally includes mostly chiropractic SM.

What think ye? -- Fyslee / talk 14:16, 22 August 2008 (UTC)

The claim is probably true, but it's not supported by the cited sources, so we can't word it that way. We would need a cited source that says 90% of SM research is on chiropractic SM and I doubt whether anyone has done a formal or informal study on that particular statistic. Eubulides (talk) 18:46, 22 August 2008 (UTC)

Maybe I'm missing your point, but don't we have descriptions of the available studies? As I recall, they specifically mention that chiropractors are major participants in those studies. Unless a study has specifically made it clear that this isn't the case (a large Dutch study used only PTs), then it's nearly always mostly chiropractic SM that makes up the bulk of the statistics in those studies. -- Fyslee / talk 20:13, 22 August 2008 (UTC)

Naysayers could claim OR in the claim that studies of SM include mostly chiropractors, but I am leaning toward Common Knowledge, so a study would not be needed. Some editors are going to say, however, that there are too many studies or reviews of same with PTs, MDs and osteopaths in the mix. Hmmm. --—CynRN ^(Talk) 22:08, 22 August 2008 (UTC)

Yes, naysayers and obstructionists will always pop up, but - to the best of my knowledge - there aren't many studies of SM that don't include mostly chiropractic SM and are exclusively performed by PTs, MDs, and DOs. That would usually give too small a base for a good study, of course depending on the study design. -- Fyslee / talk 01:35, 23 August 2008 (UTC)

Ugh... it will take me a long time to dig up the source on the internet if someone wants it, but IIRC, a large proportion of SM research is done by PTs, not DCs. There has been disucssion about this by Chiropractors in that (paraphrased)"PTs are owning the research field". I recall listening to a discussion between the authors of a paper that came out in Australia last year and authors of a clinical prediction rule, and I think that may be where this was discussed. Either way, without a source, I would say that it is definitely OR to say that most studies of SM include Chiropractors. Sorry to be the "naysayer" that CynRN predicted. I certainly wouldn't say that it is common knowledge, because I don't think it is even true. - DigitalC (talk) 06:36, 23 August 2008 (UTC)

You may be right about newer research produced by a mainstream profession. I'm referring to most of the research we have been citing, and to most of the previous research, but things are changing. If I'm wrong, I'm sure someone will correct me and we'll all be the wiser for it! -- Fyslee / talk 07:52, 23 August 2008 (UTC)

The research cited in Chiropractic #Evidence basis relies in large proportion on chiropractic data, but I agree with DigitalC that it would be OR to say that most studies of SM include chiropractors. Eubulides (talk) 09:33, 24 August 2008 (UTC)

I surrender. I guess we can't take the time to actually examine each single study here and actually quote the facts. That would take a huge amount of time that I'm not willing to invest in this subjec. Maybe my memory is tricking me, or the changing nature of the subject caused by the addition of some very recent and newer research I haven't noticed is making such a statement borderline and tipping the balance, but I don't think it's OR. Whatever the case, it's not worth fighting about. Let's move on. -- Fyslee / talk 17:41, 24 August 2008 (UTC)

The part about "chiropractors perform over 90% of all manipulative treatments in the U.S" is duplication and should be removed from the Evidence basis section. QuackGuru 22:41, 25 August 2008 (UTC)

I agree; it's redundant to give that fact twice. I suppose I could be talked into removing either copy, though I think it was fine the way it was, in Chiropractic #Treatment techniques. Eubulides (talk) 02:55, 26 August 2008 (UTC)

I removed the duplication but it got reverted without explanation. QuackGuru 04:21, 26 August 2008 (UTC)

I'm not sure, but maybe it got reverted because you made too many changes at one time (several times at that!), and the only way to save lots of grief and wasted time was for several editors to just revert your mass edits. Do your edits one at a time, and only when you are sure you have a solid consensus. The edit warring needs to stop, which is why I restored the last consensus version.-- Fyslee / talk 05:22, 26 August 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 #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)

Attacks on vaccination section

We seem to be having a number of recent attacks on this section, not only by newbies or supposed newbies, but by regular editors as well. Unfortunately (since edit histories aren't accepted as RS) we can't use this documented abuse of the article as proof of continued anti-vax sentiments in the profession and in its supporters here, it is an interesting form of proof they are providing right here. It's amazing the weak excuses for straw man arguments being used. Instead of seeking improvement, deletion seems to be the name of the game. How about looking for more and better sources to strengthen this fact about the profession, instead of trying to whitewash and delete? Okay? -- Fyslee / talk 08:54, 24 August 2008 (UTC)

I dunno, I find the edits you made (after making the above comments) to not be an improvement. They make the vaccination section longer by inserting some Simon-says quotes, but the quotes don't say anything that the section didn't already say, and the section has grown considerably, from 170 words to 276 words, raising WP:WEIGHT issues. The Simon-says style is also unfortunate: it makes the section more argumentative (which is like adding oxygen to a fire). I did some relatively minor tweaks to fix some obvious gotchas in this edit, but all in all it'd be better to go back to the way this section was before the recent flurry of edits. Eubulides (talk) 10:12, 24 August 2008 (UTC)

Weight is not a matter of words but a matter of tone as well. The section based on a quick review of the history has always been disputed in some form and I agree with Surtuz that it smacks WP:POINT. Also, the omission of naturopathic college students who share the same attitude as DCs is significant; for it shows that it is moreso CAM than specifically chiropractic that has reservations of blanket immunisations. We can't simply cherry pick the information within a source that appeals to us personally, the message of the paper needs to be conveyed. That goes for both sides. Soyuz113 (talk) 16:43, 24 August 2008 (UTC)

A few comments on each point:

• The tone should clearly emphasize the controversial nature of the subject. If it wasn't controversial, the subject wouldn't be mentioned at all. It would be a non-issue. One way to improve any concerns about tone and weight would be to tweak the heading to make it clear this is about "Resistance to vaccination" and make it a subheading as follows: If the pro-vaccination POV in chiropractic is developed here, and I see no legitimate reason to hide it, it would be rather small, and then we would have a "Vaccination" heading, with "Support" and "Resistance" as subheadings. Maybe that would balance things better? Improvement and balance are always welcome. Deletionism is definitely not welcome.
• I don't see what POINT has to do with this. If you share Surturz understanding of POINT, then we have a problem regarding understanding of policies and guidelines here. I notice that you have the same POV and mirror each other in many ways.
• Precisely because the section is disputed, it needs to be strengthened. That's the way Wikipedia works. That can be done by enlarging it, providing better references, and/or providing better attribution, among other things. It should definitely not be weakened or eliminated as that would give the objectors an undeserved victory in their attempts to whitewash the article and violate NPOV. The subject (Chiropractic resistance to vaccination) is actually large enough in a historical context, its notable controversiality, its currently widespread presence on the internet, its documentation in V & RS, and in its current impact on the real world (we're talking about large numbers of unnecessarily dead children here), that it could/should be an independent article with lots of V & RS. It could be large or small, but it could be done. If that happens, then we could eliminate the current section's content here and replace it with a "main" article link and use that article's LEAD as the content here.
• I do agree that the placement of the section could be better, but where.... While there is no prohibition about collecting criticisms in one section, it is generally better to place them where applicable, IOW throughout the article. One downside to this is that it serves the purpose of whitewashers by hiding the criticisms where only readers of the finer details will discover them. That tactic has been used many times here at Wikipedia. Sometimes certain items just don't fit in in that manner, and thus a "criticisms/controversies/diverse POV" (use the appropriate label) section could still be legitimate for those items.
• I hadn't noticed that the naturopathic students weren't mentioned anymore, but maybe that's because it's off-topic here in the chiropractic article? That would be legitimate stuff for the Vaccine controversy article, but not here.

I hope I have addressed each of your concerns. Improvements are indeed welcomed. -- Fyslee / talk 18:55, 24 August 2008 (UTC)

• I'm afraid the point is being lost. First, the placement of the text, at the very end of the article, is problematic. Very much like the LEAD, good format would somehow enclose a neutral or non-controversial subsection.
• I see no shortage of criticisms of chiropractic whatsoever, I do however, see a lack of objectivity when editors suggest that having a controversy section dedicated to all aspects of chiropractic would somehow be "ghetto". I suppose it would be "ghetto" as "evidence basis" "schools of thought" and every other subsection.
• Vaccination, along with elements of straight chiropractic, such as subluxation and its role in internal health should be dealt with its own criticisms section. It could easily be written and include the current references.
• Other concerns still abound, but since vaccination seems to be the current hot topic perhaps we can deal with it first before to moving onto other major concerns. Soyuz113 (talk) 22:15, 24 August 2008 (UTC)

The controversy/criticism section was rejected on more than one occasion. CorticoSpinal wanted a criticism section but that never materialized.

The current vaccination version is too long and hard to follow. Let's restore the shorter version and work from there. QuackGuru 23:19, 24 August 2008 (UTC)

[ec] Okay Soyuz113. Let's read your proposed improvements right here. This is the right thread, or you can start a new one.

Personally I would write the article using main sections dealing with all major aspects of the subject, and more-or-less mandatory subsections in each one dealing with the relevant controversies and criticisms for that section, but that's just my opinion as regards formatting. To my way of thinking that would make for a very easily understood article and would ensure that each section contained all relevant POV, as per NPOV. Another great advantage is that it undermines the efforts of whitewashers, and ensures that no matter what section a reader happens to read, they get "the whole story," which is an ideal of Wikipedia. It would take a firm consensus of most major editors to put that kind of formatting in effect, although it seems we already do it to some degree, but in a hidden way. -- Fyslee / talk 23:35, 24 August 2008 (UTC)

I agree, the vaccine section was pretty good before the changes. Perhaps, it would have a better 'tone' if Haldeman's viewpoint from Principles and Practice of Chiropractic(pg 197) was worked in: "the objection (to vaccination) centers on two areas: freedom of choice and lack of true efficacy of vaccination". Both points are in there to a degree, but maybe they could be strengthened.

As for the section being at the end of "chiropractic"...you are assuming that more than a hardy handful of folks would be able to have the attention span to read it all the way through to the end! :).--—CynRN ^(Talk) 00:14, 25 August 2008 (UTC)

It's looking like most editors commenting on the topic agree that the vaccine section was better without the lengthy quotes. Any other comments? If not, I'm inclined to change it back. Eubulides (talk) 08:26, 25 August 2008 (UTC)

I think this version was the last consensus version. QuackGuru 22:10, 25 August 2008 (UTC)

Either version is still to WEIGHTy. The section should be removed. -- Levine2112 ^discuss 01:41, 26 August 2008 (UTC)

I restored the shorter version but I was reverted. QuackGuru 01:44, 26 August 2008 (UTC)

You were reverted because you included a lot of other non-consensual edits into your reversion. -- Levine2112 ^discuss 02:23, 26 August 2008 (UTC)

I agree with Levine2112 that this change contained a mixture of relatively uncontroversial changes (such as restoring the shorter version) along with some other more-controversial changes, that require more time to give others a chance to respond to the edit proposals. Eubulides (talk) 02:52, 26 August 2008 (UTC)

I agree. There were far too many edits made at one time (as I have commented above), so I reverted to the last consensus version. Too many edits at one time are a bad idea and often lead to edit/revert wars.-- Fyslee / talk 05:35, 26 August 2008 (UTC)

I agree with Levine2112 that the section should be removed and I suggest relevant info moved into a controversy section. As far as I can tell, so far, controversy (at least perceived one's here) seem to be everything related to straight chiropractic, vaccination, subluxation, classification of chiropractic, history of chiropractic, pediatric chiropractic and non-musculoskeletal approaches. Does that pretty much summarize the biggest "controversies" that currently face the profession today? Also, threats should be kept to a minimum, we're all here to make the article a true representation of the real thing. The weight of vaccination here is in question (not the notability) and the amount of detail given to this. Soyuz113 (talk) 00:02, 27 August 2008 (UTC)

Here's a thought. Remove the vaccination section completely, but then in the Schools of Thought/Practice Styles section, mention that a minority of the profession rejects vaccination. -- Levine2112 ^discuss 00:10, 27 August 2008 (UTC)

There is no evidence that opposition to vaccination is limited to straight chiropractors; on the contrary, the survey was at a mixer school. I agree that a separate section for the vaccination material is not necessary; it would be OK to move the text into Schools of thought and practice styles (but banishing it to a controversy ghetto would not be a good idea). However, the text should not be cut down substantially; chiropractic has an important role in opposition to vaccination. Eubulides (talk) 09:05, 27 August 2008 (UTC)

Sure, chiropractic may be important to vaccination opposition. But is vaccination opposition important to chiropractic? My point being that chiropractic should and is mentioned in Vaccine controversy but should it be the other way around. That said, I think the first step here which we can all agree to is to minimize "vaccine opposition" discussion in this article. A sentence or two in "Schools of thought" may be just what the doctor ordered. -- Levine2112 ^discuss 17:53, 27 August 2008 (UTC)

• I did a quick Google Scholar search to try to address this question. (Obviously this is just a rough estimate, but it's better than nothing). The query "chiropractic vaccine OR vaccination" found 502 recent articles (less than five years old). The query "chiropractic" found 10,800 recent articles. So, 4.6% of recent articles that mention chiropractic also mention vaccines or vaccination. The previous version of this section (which there seems to be consensus to revert to) is 170 words, which is about 3.2% of the article's length of 5194 words. So, once we trim, we'll be in a plausible ballpark.
• In contrast, Google Scholar reports 190,000 recent articles for "vaccine OR vaccination". So it appears that, relatively speaking, the topic of vaccination is far more important to chiropractic, than chiropractic is to vaccination.
• I realize that Google Scholar counts are not at all authoritative, and that these numbers are not a scientific test or anything like that; still, it's undeniable that recent scholarly papers do mention vaccination quite a bit when the subject is chiropractic.

Eubulides (talk) 18:11, 27 August 2008 (UTC)

You are correct. Those Google searches mean absolutely nothing at all in terms of our discussion here. -- Levine2112 ^discuss 06:54, 28 August 2008 (UTC)

Levine2112 agreed with Eubulides by stating: "You are correct." but then changed his view by claiming the Google searches "mean absolutely nothing..." Levine2112's comment makes no sense. Google scholarly demonstrates there is a lot of coverage on vaccination and thus it is relevant. QuackGuru 16:03, 28 August 2008 (UTC)

I think this section is currently well written and well sourced. Verbal chat 10:49, 27 August 2008 (UTC)

It's in poor taste to refer to a proposed section as 'ghetto'. I favor CynRNs approach, i.e. making it much more cut and dry and getting rid of the excess fluff. Essentially what the paper is saying is that chiropractic and naturopathic students circa 1999 in Toronto develop anti-vaccination attitudes outside the classroom. Shouldn't this be stated as such? Also, I have yet to hear a compelling argument regarding the weight of this section. We are in agreement that it should be moved. Soyuz113 (talk) 17:08, 27 August 2008 (UTC)

As I understand it CynRN is proposing adding text to a previous (shorter) version of the section. CynRN's proposal seemed to be a reasonable one. Perhaps CynRN (or someone else) could put a draft new version here, so that we can discuss something concrete? I agree that the section needs trimming, and proposed a trim here about 3 days ago, which simply reverts to the previous (shorter) version. Most of the commentary since then has agreed with the trim but I'm waiting for another day for further comments, before making that change. Perhaps a new draft could be proposed assuming the trim has been made? You can start with this version, which was the consensus version before the recent additions. Eubulides (talk) 17:37, 27 August 2008 (UTC)

Sorry, forgot to reply to the "shouldn't this be stated as such?" question. The paper does say that CMCC does not formally teach anti-vaccination views, but points out that lecturers may discuss the topic on their own. It goes on to say that students may get anti-vaccination information from the Internet, from chiropractic magazines, and from informal settings such as student clubs. Much of this sort of detail comes from the discussion section of the paper, and is somewhat speculative; I don't think it needs to be discussed in Chiropractic (as I mentioned before, I'm not even convinced the survey needs mentioning at all). However, please feel free to draft new text and discuss it here; that's what the talk page is for. Eubulides (talk) 17:54, 27 August 2008 (UTC)

I support the vaccine section as it was previously, for the most part. It could be tweaked a bit. I am sorry that the scientific chiropractors don't like it or think it reflects negatively, but a big chunk of their fellows oppose this important public health measure. It's notable since chiropractors want to be primary care providers and see infants and children. Here are my two cents for a version, adding more about freedom of choice and striking out a few words for brevity and in a spirit of compromise:

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 #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)

Safety: di Fabio metaanalysis

The Safety section would be more complete if it included the results of the di Fabio metaanalysis. As far as safety studies go, it is the most thorough study of its type ever done. It specifically revealed that chiropractors are implicated in far more injuries and deaths than other professions:

• "Manipulation of the Cervical Spine: Risks and Benefits", by Richard P Di Fabio, Physical Therapy, Vol. 79, No. 1, January 1999, pp. 50-65.

• Figure 2 is relevant to this article.

It was a very thorough analysis, and none since has topped it. It is thus remarkable that we aren't using it. -- Fyslee / talk 04:03, 25 August 2008 (UTC)

When we worked through the safety section, it was proposed that we only use sources 3 years old or newer. This source definitely fails this, and in terms of age of research, this is ancient. Other sources have been removed from the article because they were too old—I don't think we should start adding more old sources in. - DigitalC (talk) 06:57, 25 August 2008 (UTC)

Old facts that are still facts are still facts and thus relevant. No later research has undone or changed the results of the di Fabio study. Homegrown rules don't trump Wikipedia policies or guidelines regarding sourcing. -- Fyslee / talk 05:37, 26 August 2008 (UTC)

That's just what I was thinking. There is not always a 'fresh, 3 year or less' study to be found on the specific subject at hand. Sometimes you need the older studies.--—CynRN ^(Talk) 07:03, 26 August 2008 (UTC)

The dangers of cervical spine adjustments by chiropractors is adequately described with the current references. Hard to see what additional text is needed on the subject. Inclusion of the 1999 study as an additional reference wouldn't take up much space, though. --Surturz (talk) 07:30, 26 August 2008 (UTC)

(outdent)

• It's not "homegrown rules" to prefer relatively-recent reviews to older material; it's in WP:MEDRS #Use up-to-date evidence (disclaimer: I contributed to that section).
• The claim that di Fabio is a "metaanalysis" is dubious. That paper does not claim to be a meta-analysis, or even a systematic review. It claims merely to be a review.
• The assertion "none has since topped" di Fabio is dubious as well. It's certainly a high-quality review, one of the best, if not the best, for its time; but lots of data has been gathered since then, and better reviews have come out since then, for example, Gross et al. 2004 (PMID 14974063), Assendelft et al. 2004 (PMID 14973958), Hurwitz et al. 2008 (PMID 18204386).
• Sometimes one may need older reviews, but that's not the case for cervical manipulation! I'd guess probably two reviews a year are published. The problem isn't finding a recent one; it's summarizing the recent ones fairly (there are several).

Eubulides (talk) 08:43, 26 August 2008 (UTC)

I'm not disputing that it's generally a good idea to use newer sources, but am agreeing with what you wrote above:

• "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."

Even when there is not a conflict, older and newer studies can supplement and complement each other, so let's just examine each source and see if it is worth using. -- Fyslee / talk 14:20, 26 August 2008 (UTC)

OK, then let's discuss the substantive points raised above: we do have newer and higher-quality reviews, which cite di Fabio in a larger context with more-recent data. There's no need to cite an old study directly unless it is historically compelling, which I don't yet see here. Eubulides (talk) 14:45, 26 August 2008 (UTC)

Okay, what studies are you thinking of? -- Fyslee / talk 19:55, 26 August 2008 (UTC)

For starters, the reviews I mentioned just above: Gross et al. 2004 (PMID 14974063), Assendelft et al. 2004 (PMID 14973958), Hurwitz et al. 2008 (PMID 18204386). There are others; this is just off the top of my head. Eubulides (talk) 20:42, 26 August 2008 (UTC)

The study itself is by scholarly accounts, obsolete, it has been supplanted by newer research on the subject and furthermore its not even specific to chiropractic care. I tend to agree here that the inclusion on this particular "meta-analysis" is a step backwards and there are frankly more pressing needs. Soyuz113 (talk) 16:45, 26 August 2008 (UTC)

Data that is still accurate is never "obsolete". The results that applied to chiropractic injuries and deaths is obviously very much "specific to chiropractic care." Is this more denialism, akin to the oft heard "rebuttals" from some chiropractors and editors here who claim that chiropractic high cervical adjustments have never killed anyone, and/or that's its not possible (per a flawed Canadian experiment on cadavers)? No, that part certainly applies and these objections just show how important that study is, since chiropractors want to bury it so much. It even took into account Terrett's findings of (two?) misattributions!

Now if we have better studies that include this data, then fine. I'm going to wait for Eubulides to provide the cites and URLs to them. -- Fyslee / talk 19:55, 26 August 2008 (UTC)

• I mentioned some above. Also, Miley et al. 2008 (PMID 18195663), which Chiropractic cites, mentions di Fabio and cites it multiple times. Miley et al. searched for all sources from 1950 until about September 15, 2007; they mentioned di Fabio (which is a sign it's a good source). Of the 28 sources they cite, only 6 are older than di Fabio. However, they use di Fabio only to support relatively noncontroversial things such as the fact that CMT has been used to treat neck pain; this suggests that di Fabio's results were not that useful, compared to the other studies they cite, for the core of the question whether CMT causes VAD and stroke. Certainly di Fabio's Figure 2, by itself, is not that useful: chiropractors perform the vast majority (90%?) of CMT, so if they're responsible for only 60 to 70% of cases then it could be argued (albeit via WP:OR) that they are safer than MDs for CMT.
• In briefly eyeballing Google Scholar, it appears that di Fabio was cited quite a bit, with cite counts high in the late 1990s and early 2000s, dropping off since then. That sounds about right; it's a good study for its time but somewhat dated now.

Eubulides (talk) 20:42, 26 August 2008 (UTC)

Your last comment doesn't take into account that we are referring to reported incidents. The fact that underreporting is a huge problem (Ernst uncovered a 100% rate in England) isn't discussed, but needs to be factored into this. With such huge degrees of underreporting, the percentages could be vastly larger.

I think I get your first point. We don't need more text. That jibes with what Surturz said above:

• "Hard to see what additional text is needed on the subject. Inclusion of the 1999 study as an additional reference wouldn't take up much space, though." --Surturz

How about I just add the link and we can move on. It's inclusion certainly won't hurt anything and will be a good additional source for readers to study. Can we do that as a compromise? -- Fyslee / talk 05:20, 27 August 2008 (UTC)

I expect underreporting is a huge problem in all fields; but we are straying into OR here. To get back to the point: sorry, I still don't see the point of adding that citation. The text does not rely on it. It would be like citing the Manga report, no? Eubulides (talk) 09:05, 27 August 2008 (UTC)

Underreporting is documented in V & RS, but extrapolating is OR. We just need to be aware of it when making OR statements ourselves, like your statement above "it could be argued", which you recognize. I just engaged in a bit of OR to counter your OR ;-) Nothing for the article. The comparison to Manga is an apple vs. oranges comparison. The di Fabio study just reports some actual injury and death statistics that never will change. It is thus still relevant as a source. -- Fyslee / talk 14:08, 27 August 2008 (UTC)

A defender of the Manga report could also say that it just reports some cost-benefit statistics that will never change, no? Let's put it this way: I am only slightly opposed to citing di Fabio per se (on the grounds that it's obsolete), and I wouldn't revert an edit that simply adds that source; my main worry is that adding it would become a justification or precedent for adding all sorts of obsolescent sources even when we've got plenty of up-to-date sources on a particular point, which would lead to undesirable citation bloat. Eubulides (talk) 16:54, 27 August 2008 (UTC)

MANIPULATION AND COMPLICATIONS (CHIROPRACTORS/OSTEOPATHS/PT)

Here's an interesting source list I found here:

• Assendelft WJJ, Bouter LM, Knipschild PG 1996 Complications of spinal manipulation: A comprehensive review of the literature. J Family Practice 42: 475-480.
• DiFabio RP 1999 Manipulation of the cervical spine: risks and benefits. Phys Therapy 79: 50-65.
• Dvorak J, Orelli FV 1985 How dangerous is manipulation to the cervical spine? Case report and results of a survey. Manual Medicine 2: 1-4.
• Dvorak J, Valach L, Schmid S 1987 Injuries of the cervical spine in Switzerland. Orthopade 16: 2-12.
• Johnson K, Pasquarello G 2003 Position paper on osteopathic manipulation of the cervical spine. AAO Newsletter; http://www.academyofosteopathy.org
• Malone DG, Baldwin NG, Tomecek FJ, Boxell CM, Gaede SE, Covington CG, Kugler KK 2002 Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice. Neurosurg Focus 13(6)
• Patijn J 1991 Complications in manual medicine: a review of the literature. J Manual Med 6: 89-92
• Powell FC, Hanigan WC, Olivero SC 1993 A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery 33: 73-79
• Rothwell DM, Bondy SJ, Williams JI 2001 Chiropractic manipulation and stroke: a population-based case control study. Stroke 32: 1054-1060
• Rydell N, Raf L 1999 Spinal manipulation--treatment associated with a high risk of complications. Lakartidningen 96: 3536-3540.
• Shekelle PH, Phillips RB, Cherkin DC, Meeker WC 2001 Benefits and risks of spinal manipulation. Chapter XI (www.chiroweb.com/archives)
• Vick DA, McKay C, Zengerle CR 1996 The safety of manipulative treatment: a review of the literature from 1925-1993. JAOA 96: 113-115

Maybe we can use some of these. -- Fyslee / talk 04:03, 25 August 2008 (UTC)

Again, lets look at the age of these papers. Not one passes the cut-off proposed by Eubulides back when we were building the safety section. - DigitalC (talk) 07:22, 25 August 2008 (UTC)

I agree that these sources are too old, as is the di Fabio meta-analysis. The di Fabio work is cited by recent reviews that Chiropractic does cite (e.g., Miley et al. 2008), and that should suffice. Unless there's some reason to cite di Fabio in Chiropractic #History? But to do that we'd need a source commenting on di Fabio's historical importance. Eubulides (talk) 08:26, 25 August 2008 (UTC)

Have we inadvertently made a homegrown rule here, like Elonka's rules that have gotten her in such trouble? Each source should be examined and its useability be judged on an individual basis, regardless of age. It all depends on the topic matter. Old studies and results that are still legitimate are valid sources. Only when older studies have been superceded by newer studies that study and include the same statistics, and add to them, would it be legitimate to use the newer in lieu of the older. Lacking that, older studies can be added to newer ones which carry on from the older ones, but don't include them. Sources must be evaluated on their own merits, not some arbitrary rule made here that has no wiki-authority. That's the way in works in the research world and many scientific sources. -- Fyslee / talk 05:46, 26 August 2008 (UTC)

Again, it's not "homegrown rules"; it's in WP:MEDRS, which discusses this subject in some detail. Eubulides (talk) 08:43, 26 August 2008 (UTC)

As I wrote above, I'm not disputing that it's generally a good idea to use newer sources, but am agreeing with what you wrote above:

• "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."

Even when there is not a conflict, older and newer studies can supplement and complement each other, so let's just examine each source and see if it is worth using. -- Fyslee / talk 14:20, 26 August 2008 (UTC)

Please see my followup comment in #Safety: di Fabio metaanalysis above. Eubulides (talk) 14:45, 26 August 2008 (UTC)

Chiropractic-as-CAM out of utilization and satisfaction

On July 29 (now archived in Talk:Chiropractic/Archive 25 #Fix for CAM claim) I proposed moving text about chiropractic-as-CAM from the end of Chiropractic #Utilization and satisfaction rates, where it does not really belong, to the beginning of Chiropractic #Scope of practice. Nobody objected, but I see now that I didn't act on that proposal. I just now made the edit, updated as best I could for the changes made since then. Eubulides (talk) 08:26, 25 August 2008 (UTC)

Good job. It's good to collect similar stuff together. -- Fyslee / talk 05:47, 26 August 2008 (UTC)

three unreliable refs

New text was added to the Effectiveness section but the refs are not reliable.[1] QuackGuru 04:47, 26 August 2008 (UTC)

The first ref, perhaps fair enough, but since when have .gov.au sites been unreliable? Did you actually click on the links and check them?? --Surturz (talk) 05:00, 26 August 2008 (UTC)

Thanks for providing a better ref. I have formatted them. -- Fyslee / talk 06:07, 26 August 2008 (UTC)

Insurance and subsidies

The edits adding a paragraph on insurance and subsidies is the start of an important topic (yay!), but the edit itself has some problems:

• Insurance and subsidies are important, but they are a distinct issue from cost-effectiveness. This material should not be in Chiropractic #cost-effectiveness, nor in its parent section Chiropractic #Evidence basis.
• The edit talks only about Australia. Chiropractic should have a global view; most chiropractors are in the U.S.
• The Medicare Benefits Schedule - Item 10964 and Medicare Item 10964 processed from July 2007 to June 2008 are primary sources of relatively low quality. Readers should not have to wade through statistics spreadsheets from funding agencies. It verges on original research to be citing primary data directly like this.
• Also, as a rule, Wikipedia should not use "https:" URLs.
• Normally I'd just move the text in question (which was added without any previous discussion; not good practice) to the talk page, but given that an edit war is in progress for now I'll instead note that this text needs work.
• For now I have made an edit to add tags to the new paragraph and put it in a new section "Insurance and subsidies" (suggestions for better names are welcome); but it would have been far better to discuss this controversial change on the talk page first, which was not done in this case.
• For starters, I propose that the new section be moved to just after Education, licensing, and regulation, where it's more at home.

Eubulides (talk) 08:43, 26 August 2008 (UTC)

• I have never heard of this "rule" that Wikipedia should not use links that use a secure connection (that is what https: means). Do you have a link to this rule?
• I think a better name for the section would be "Third party coverage", as this seems to be a more commonly used term.

DigitalC (talk) 04:53, 27 August 2008 (UTC)

I see no problems with the sources. They are V & RS. "Third party coverage" sounds fine, too. -- Fyslee / talk 06:32, 27 August 2008 (UTC)

I don't have a link to this rule. I do have a browser (Lynx) that complains about the https: link. The browser says the https: link is to a site that has botched its credentials. I don't think it's worth worrying about the https: all that much here, since the source is of such a low quality. We should not be citing detailed spreadsheet items in government websites. Surely there are better sources (ones not limited to Australia), and once we include them the problem will fix itself. Eubulides (talk) 09:05, 27 August 2008 (UTC)

This has useful data on insurance coverage in U.S., percentage of private insurance, Medicare, etc.: --—CynRN ^(Talk) 16:49, 28 August 2008 (UTC)

Chiropractic physicians

This edit did a blanket substitution which is not appropriate (the common term is chiropractors, not chiropractic physicians), but still it raises the point that the phrase chiropractic physician should be present somewhere. I propose putting it at the start of Chiropractic #Scope of practice, so that it starts off "Chiropractors, also known as doctors of chiropractic or chiropractic physicians,...". Eubulides (talk) 14:45, 26 August 2008 (UTC)

I agree. That edit should be reverted and your suggested entry should do the trick. We've already had that wording here in the past. It will need to be qualified that it is only in the USA (and possibly Canada) that this applies, since chiropractors are not recognized as "physicians" in other countries, partially because their education isn't sufficient, and partially on legal grounds, depending on the country. In fact the designation is rather meaningless in the USA, since literally anyone, even a child, can legally call themselves a "physician" in most states. It isn't a protected title. -- Fyslee / talk 19:34, 26 August 2008 (UTC)

OK, let's change it to "Chiropractors, also known as doctors of chiropractic or chiropractic physicians in many jurisdictions,...." This would use Cooper et al. 1998 (PMID 9729991), a source we haven't used before, which says "Chiropractors are permitted to use titles such as doctor of chiropractic (DC) or chiropractic physician (CP) in most states, although 5 states restrict their title to chiropractor." Eubulides (talk) 20:01, 26 August 2008 (UTC)

Excellent solution. Go for it. -- Fyslee / talk 05:21, 27 August 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)

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)

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)

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)

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: )