Talk:Chiropractic

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(This section is a stub, and attempts to keep the RFC bot happy so that multiple RFCs can be listed. Please see #Request for Comment: Excluding treatment reviews below for the discussion thread.) Eubulides (talk) 09:17, 24 September 2008 (UTC)

Request for Comment, Possible OR violation at Chiropractic Effectiveness

Template:RFCsci There has been a dispute regarding the possibility of an WP:OR violation at Chiropractic#Effectiveness spanning a few months now. Essentially, this is a debate about whether or not we are able to use research not specifically about chiropractic in the article Chiropractic.

Chiropractors perform a high-percentage of spinal manipulation in the world. Other professions which perform spinal manipulations include Osteopathy and Physical therapy, among others. Chiropractic spinal manipulation (often times differentiated as spinal adjustment) differs from these other profession's version of spinal manipulation in intent, diagnosis, and technique.

There is research which studies the efficacy of chiropractic spinal manipulation. There is also research which studies non-chiropractic spinal manipulation. The latter kind of research is with what this RfC is concerned.

Some of the research currently being used at Chiropractic#Efficacy makes no mention of chiropractic at all; or only mentions chiropractic in passing but the research does not make any conclusions specifically about chiropractic spinal manipulation. This research is either about spinal manipulation in general or about spinal manipulation as performed by non-chiropractors. For instance, this study is cited twice in the "Low Back Pain" section but the conclusions in the full-text makes absolutely no mention of chiropractic specifically, only spinal manipulation (SMT) in general.

Some nominal amount researchers have used some of these non-chiropractic studies to draw conclusions about chiropractic. This RfC is not concerned with those few cases. The RfC is concerned with non-chiropractic spinal manipulation research which neither draws any conclusions about chiropractic specifically nor is there any other research out there drawing conclusions about chiropractic from these non-chiropractic studies.

Since spinal manipulation is closely related to chiropractic and since a marginal amount of researchers have drawn conclusions about chiropractic efficacy from certain non-chiropractic studies, some editors have interpreted this to mean that we have free license at Wikipedia to cite any non-chiropractic spinal manipulation study as evidence for or against chiropractic effectiveness. Further, some editors feel that it is okay to include non-chiropractic spinal manipulation research at Chiropractic#Effectiveness if we make a clear distinction in the article that we are not necessarily talking about chiropractic efficacy but rather the efficacy spinal manipulation in general.

On the other side, editors claim that this violates WP:OR in that editors are setting the reader up to draw conclusions (positive or negative) about chiropractic effectiveness by presenting non-chiropractic evidence which itself makes no conclusions about chiropractic effectiveness. Further, editors on this side of the dispute claim that this may also specifically be a WP:SYN violation as the other editors (those in favor of inclusion of non-chiropractic studies) explain that since some marginal amount of researchers have made conclusions about chiropractic from other non-chiropractic studies then that gives us at Wikipedia free license to do the same with all non-chiropractic spinal manipulation research. Editors who feel that there is an WP:OR violation are in favor of preserving the non-chiropractic information by moving it into the more apropos Spinal manipulation article (which covers spinal manipulation as performed by any kind of practitioner including chiropractors, osteopaths and physical therapists).

Please note that it is not standard practice in the scientific community to use studies about non-chiropractic spinal manipulation to make conclusions about chiropractic spinal manipulation effectiveness. In fact, the chiropractic profession has been rebuked by some members of the scientific community for using positive non-chiropractic spinal manipulation research as evidence of the effectiveness of chiropractic spinal manipulation.

Okay. That may have been a lot of information for someone outside this subject to ingest. I apologize, but I sincerely hope that I was explicit and clear in my description of the dispute. In essence, what we are looking for in terms of comments from outside editors is whether or not the current version of Chiropractic#Effectiveness violates WP:OR/WP:SYN by presenting conclusions from research not specifically about chiropractic, but rather spinal manipulation in general. Would we be better off moving the non-chiropractic spinal manipulation research to the Spinal manipulation article? 01:25, 10 September 2008 (UTC)

Comments from the uninvolved:

You say "Some of the research currently being used at Chiropractic#Efficacy makes no mention of chiropractic at all; or only mentions chiropractic in passing but the research does not make any conclusions specifically about chiropractic spinal manipulation. This research is either about spinal manipulation in general or about spinal manipulation as performed by non-chiropractors."

If this is true, then the case here is cut-and-dried. WP:OR says

Any material that is challenged or likely to be challenged must be supported by a reliable source. "Original research" is material for which no reliable source can be found. The only way you can show that your edit is not original research is to produce a reliable published source that contains that same material. Even with well-sourced material, however, if you use it out of context or to advance a position that is not directly and explicitly supported by the source used, you as an editor are engaging in original research; see below

The bolded part seems relevant here. I don't know which sources specifically don't refer to Chiro, but sources used here ought to refer to it, and in more than just in passing. FWIW, it looks like there is a SM article, and I see no reason not to just refer the reader to that. There is no call to talk about SM in the Chiro article, as that information should be covered in the SM article. Sources which explicitly compare SM in general to Chiro should be used if they are RS, but taking an article on SM in general that doesn't mention Chiro and talking about the differences is OR and SYNTH:

"If the sources cited do not explicitly reach the same conclusion, or if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research."[1]

I write responses in stages, as I go along. I wrote the above before reading your paragraph starting "On the other side, editors claim that this violates WP:OR in that editors are..."

So:

"Would we be better off moving the non-chiropractic spinal manipulation research to the Spinal manipulation article?"

Yes.

I have not digested the section in question. However, if the facts are properly presented above, the conclusion is very clear. ——Martin^phi ☎ Ψ Φ—— 04:02, 10 September 2008 (UTC)

I have not been involved in this particular discussion, I even posted my comment in the wrong place (below). I think it should be moved to the spinal manipulation article. MaxPont (talk) 06:56, 13 September 2008 (UTC)

Martin nails it. . . This violates "original research". . . the example given does not mention chiropractic in any meaningful way. . . sources should be explicitly about chiropractic. . . not just general research on spinal manipulation.TheDoctorIsIn (talk) 23:49, 29 September 2008 (UTC)

Comments:

References to past discussion threads

This topic has been going on for some time; for previous discussions, please see Syn tag, SYN and implicit conclusions, Proposed wording for NOR/N, Chiropractic section on evidence basis, and A starting point for a look at the effectiveness section and introduction. Eubulides (talk) 05:21, 10 September 2008 (UTC)

Examples needed

The RfC gives no specific examples of WP:OR in Chiropractic #Effectiveness, and this vagueness makes the RfC difficult to follow. As far as I can see, every claim in Chiropractic #Effectiveness cites a reliable source that directly and explicitly supports the claim. If this is incorrect, then please list the specific claims that aren't directly supported by their sources. Eubulides (talk) 05:21, 10 September 2008 (UTC)

How about we start in the beginning with the first ref given in the "Low back pain" section which is used to support two statements:

1. There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain; methods for formulating treatment guidelines differ significantly between countries, casting some doubt on the guidelines' reliability.
2. ...whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level.

Neither of there statements say anything about chiropractic specifically but rather SMT in general. The conclusions given in this reference make no statements about chiropractic specifically: Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence. I agree that this would be a nice source for the Spinal manipulation article, but is out of context and misleading at the Chiropractic article, creating an WP:OR violation. -- Levine2112 ^discuss 05:53, 10 September 2008 (UTC)

It is WP:OR without V,RS references that show the effort to deliver identical treatments. I am repeatedly seeing poor research or distant data in a general category, that is off by a factor of 10 to 100 in *several* variables, being touted as relevant to competing CAM categories. WP:OR and highly erroneous pushing a POV.--I'clast (talk) 06:56, 10 September 2008 (UTC)

• Murphy et al. 2006 (PMID 16949948) is not the first reference in Chiropractic #Effectiveness. It is the 12th reference. Are the first eleven references OK? That would be good news.
• Murphy et al. directly supports the two statements that cite it, so there is no WP:OR here. Here are quotes from Murphy et al., one for each of the two statements that you listed above. Each quote directly supports the corresponding statement:

1. "Inconsistencies in the evidence suggest that there is continuing conflict of opinion regarding: efficacy of SMT for treatment of nonspecific or uncomplicated LBP; optimal time in which to introduce this treatment approach; whether SMT is useful for treatment of chronic LBP; and finally, whether subacute LBP actually exists as a separate category requiring a specific treatment approach in its own right. ... The most surprising finding, and a factor that casts some doubt on the reliability of the recommendations made, was that the levels of evidence and/or grades of recommendation used for formulating treatment recommendations varied so significantly between countries." (page 579)
2. "The Swedish guideline, which had been updated since the earlier review by Koes et al, proposed the biggest change for the application of SMT in the treatment of LBP. The earlier version (2000) stated that SMT should be considered within the first 6 weeks (acute period) for patients who need additional help with pain relief or who are failing to return to normal activities. In contrast, the more recently updated guideline (2002) made no recommendation to use SMT as a treatment intervention for the acute phase of LBP, possibly because the guideline developers based their treatment recommendations on grade of recommendation 'A,' which represents the highest level of evidence." (page 579)

• Murphy et al. is not cited out of context. The context is the evidence basis for the effectiveness of spinal manipulative therapy for low back pain, and this context is clearly stated in Chiropractic #Effectiveness. This topic is highly relevant to chiropractic. Murphy et al. base their conclusions on their analysis of systematic reviews and randomized controlled trials that use both chiropractic and non-chiropractic data, which is standard practice in recent reviews; Chiropractic #Effectiveness characterizes their conclusions accurately; it does not claim that their conclusions are specific to chiropractic.
• Your suggestion that this material is relevant to Spinal manipulation is of course reasonable. However, putting the material there would be excluded by the overly-restrictive rule that is assumed by this RfC, because the material is not specifically about spinal manipulation; it is about spinal manipulative therapy, which is not the same thing. Of course, it would be silly to exclude this material from Spinal manipulation on WP:OR grounds, just as it would be silly to exclude this material from Chiropractic on WP:OR grounds.

Eubulides (talk) 07:02, 10 September 2008 (UTC)

• Murphy is currently the first ref given in the "Low back pain" section. Are you really disputing that? In terms of this RfC, does it really matter?
• We are not discussing whether or not Murphy accurately supports the statements it is referencing. We are discussing whether it is appropriate to cite Murphy at all given that it is not making any conclusions about chiropractic spinal manipulation specifically but rather spinal manipulation therapy in general (as performed by a mixed bag of professions).
• You say this topic is highly relevant to chiropractic. But if you look at WP:OR, you will read: ...if you use it out of context or to advance a position that is not directly and explicitly supported by the source used, you as an editor are engaging in original research... Murphy does not directly and explicitly make any conclusions about the effectiveness of chiropractic spinal manipulation specifically; however, you are using it in a section Chiropractic#Effectiveness. Regardless of how clearly you explain it to the reader, you are still engaged in original research because this text is being used to advance a position about the effectiveness of chiropractic which the source does not directly and explicitly support.

-- Levine2112 ^discuss 17:22, 10 September 2008 (UTC)

• I did not dispute that Murphy was the first ref given in some subsection. My question was whether earlier references are OK. This will help give us the rest of us the idea whether the hypothesized problem is systemic, or relatively limited to a few citations.
• WP:OR talks about using a source to support a claim that is not directly and explicitly supported by the source used. And that is what I was talking about as well. Murphy directly and explicitly supports the claim in question.

Eubulides (talk) 23:48, 10 September 2008 (UTC)

• The earlier references are not necessarily "OK". I had access to the full-text of Murphy, it was the first one given in the Headache section, it had been discussed before, and it is a perfect example of the research in question: ones that rely on a mixed bag of professions performing spinal manipulation and one which makes no conclusions specifically about chiropractic.
• Murphy does not support that it has any correlation to any conclusions about the effectiveness of chiropractic. However, by including it in Chiropractic#Effectiveness, you are making such a correlation. Hence, the WP:OR.

-- Levine2112 ^discuss 02:34, 11 September 2008 (UTC)

• So we don't have an idea of how many references are being challenged here? And we don't know which references (other than Murphy et al. 2006, PMID 16949948) are being challenged?
• The statement "Murphy does not support that it has any correlation" doesn't seem to have anything to do with WP:OR. WP:OR says nothing about "correlation".
• Again, WP:OR talks about using a source to support a claim that is not directly and explicitly supported by the source used. The claim in question is directly and explicitly supported by Murphy et al. So there is no OR here, using WP:OR's definition.

Eubulides (talk) 08:14, 11 September 2008 (UTC)

• Any reference that doesn't specifically mention chiropractic, or the claim made is not directly relevant to chiropractic SMT is challenged. If you would like to go through them and count them, feel free. It is a fairly general concept, and we do not need to be specific about exactly which references this relates to at this point in time.
• The claim that Murphy et al's conclusions have anything to do with Chiropractic#Effectiveness is WP:OR. This has been made blatantly clear above. Is this WP:IDHT?
• If this isn't an example of IDHT, I will rephrase what Levine stated above to make it crystal clear. Murphy does not advance a position on Chiropractic effectiveness. It is being used out of context, and to advance a position "that is not directly and explicitly supported by the source..."

DigitalC (talk) 09:33, 11 September 2008 (UTC)

• We will need to be specific, if we want to make specific changes to the article. So far the only specific change requested in this thread is to not cite Murphy et al.
• I understand (and obviously disagree with) the argument that Murphy et al. has nothing to do with Chiropractic. But that argument is not an WP:OR argument. WP:OR says that claims must be directly supported by the citation. And it is not disputed that the claim in question, namely "There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain" is directly supported by the citation in question (Murphy et al.).
• Clearly there is a content dispute here. But it is not an WP:OR dispute.

Eubulides (talk) 16:59, 11 September 2008 (UTC)

• We will be specific if and when it is deemed that there is a general problem with confounding non-chiropractic efficacy research with a section that is supposed to be about chiropractic efficacy. Murphy is just a prime example of such non-chiropractic research for respondents to this RfC to analyze when considering their commentary here.
• I understand (and obviously disagree with) your argument that this is not an OR dispute. This RfC will help us determine if it is or if it isn't an OR issue.
• Yes, there is a content dispute. But whether or not it is an OR dispute is something which this RfC will help us determine. Be patient. -- Levine2112 ^discuss 17:07, 11 September 2008 (UTC)

Well, we do have a spinal manipulation article. Maybe it is better to include stuff in that article instead.MaxPont (talk) 17:23, 11 September 2008 (UTC)

• remove SM material: it seems clear that a distinction is made in reliable sources between chiropractic procedures and spinal manipulation. therefore it seems obvious that you can not generalize from one to the other without violating OR. I can't even see why there's an argument about this. --Ludwigs2 17:01, 16 September 2008 (UTC)

• These more-recent comments still do not address the question of what specific changes are needed. I have followed up in #Request for Comment: Excluding treatment reviews below, to ask for some more-specific advice. Eubulides (talk) 21:39, 16 September 2008 (UTC)

• As a general rule in research articles, the terminology (spinal manipulation and spinal adjustment) is used interchangeably and synonymously by chiropractic and non-chiropractic researchers for HVLA-type manipulations/adjustments, regardless of the performer, or what the performer calls them, with all researchers using only the term "manipulation" when writing in mainstream journals to a non-chiropractic audience. Note that chiropractic researcers do that even when the bulk or all of the "manipulations" were performed by chiropractors, who in real life would likely call them "adjustments". Why? Because there is no proven physical, anatomical, or mechanical difference.

• Exceptions to the general rule will be found in ultra-straight literature. That's the only place where there is any consistency, since they make it a point of pride to identify themselves by the "purity" of their adherance to traditional chiropractic dogma. They are known as "principled" chiropractors. If your belief and point is about "who" performs it, then you will likely concede that a "manipulation", if performed by a chiropractor, is an "adjustment", and as clarified above, an "adjustment" performed by a chiropractor will be termed a "manipulation" by chiropractic authors in research designed for an audience that includes non-DCs.

• The place to make an exception is when research (it matters little who performed it) that explicitly mentions that none or only a small minority of the performers of the spinal manipulation were chiropractors (such studies exist), should be excluded. If such a statement is made in the research, then we could leave it out. -- Fyslee / talk 03:07, 17 September 2008 (UTC)

• I made a new set of comments in the section below Talk:Chiropractic#Request_for_Comment:_Excluding_treatment_reviews before I saw this. if it's true (and verifiable) that Spinal Manipulation is synonymous with Chiropractic, then I think the Ernst and Cantor review can be used (carefully, noting the following objection), but I still oppose the Cochrane review. both seems biased to me - the Cochrane particularly - mostly in how they say there's no evidence that SM is superior to conventional approaches when the evidence they have suggests that SM is roughly equivalent to conventional approaches. I can't understand why they gave chiropractic the higher bar of having to be better than conventional approaches, except that they might have been poisoning-the-well a bit. --Ludwigs2 06:25, 17 September 2008 (UTC)

• No one is saying that "Spinal Manipulation is synonymous with Chiropractic." "Chiropractic" is a profession, while SM is a technique. I'm not even saying that spinal manipulation is identical to spinal adjustment, only that in serious peer reviewed research the two terms are oftened used as synonyms since such research nearly always deals with HVLA type manipulations, not the myriad variations also included under the spinal adjustments umbrella. Since most such research includes mostly chiropractor performed "adjustments" (DCs perform about 90% of all manipulations), and those "adjustments" are termed "manipulation" in that research, even when the researchers are chiriopractors, then we are dealing with a chiropractic research POV that says they are identical enough to be termed the same thing. Serious chiropractic researchers are smart enough to avoid using esoteric straight chiropractic terminology when talking to other researchers and the public. When identical techniques, performed in an identical manner, are performed by two different persons from two different professions, there is basically no physical difference, and lots of HVLA "adjustments" are identical to HVLA "manipulations". Where any real differences show up is in the myriad "adjustment" techniques using devices, hand waving (without even touching the body), etc.. I don't recall any serious peer reviewed research (IOW not Journal of Vertebral Subluxation Research (JVSR) junk) that compares such widely different non-HVLA techniques with HVLA spinal manipulation performed by anyone in any profession. -- Fyslee / talk 14:23, 17 September 2008 (UTC)

The bottom line is that without the source stating that they were studying chiropractic or chiropractic specific spinal manipulations, then we cannot conclude that the results are applicable to chiropractic directly. As you said, spinal manipulation is not synonymous with chiropractic. Chiropractors have their own version of spinal manipulation, wholly different in diagnosis, technique and philosophy. We are not making a judgment call on whether or not the few researchers who have confounded the two are right or wrong. That is not our place a Wikipedia. If a researcher has confounded the two, then we should present their research in context. However, we should not take research which was not specifically saying anything about chiropractic but rather spinal manipulation in general (as performed by a mixed bag of practitioners) and do the confounding ourselves. That would be violating WP:NOR. And if we base our confounding of the two on the notion that "a few researchers have done it themselves with their research, so we should be able to do the same with some other research", then we are violating WP:SYN. So, in conclusion: yes, we can use research that makes conclusions specifically about chiropractic, but research which only discusses spinal manipulation in general should be saved for the Spinal manipulation article. -- Levine2112 ^discuss 17:18, 17 September 2008 (UTC)

Once again you make a claim ("Chiropractors have their own version of spinal manipulation, wholly different in diagnosis, technique and philosophy.") that ignores reality. Yes, chiropractors have all kinds of their own versions which they call "adjustments", but which are wholly different from HVLA type adjustments/manipulations, which is what we are talking about here. We aren't talking about chiropractic brandname techniques that have little to do with HVLA adjustment/manipulation. Those are not the subject of the research we are using. If you find that some of the references we are using are referring to such techniques and confounding them with HVLA adjustment/manipulation, then please help us by pointing them out. The ball is in your court. Your statement would be more true (although wholly inapplicable here) if you used more plurals: "Chiropractors have their own versions of spinal manipulation, wholly different in diagnoses, techniques and philosophy." Yes, they have myriad nonsensical and fantasiful ways of correcting their unique and fictional diagnosis, the chiropractic vertebral subluxation, sometimes using methods that can't affect spinal biomechanics at all.

To say that these brandname techniques are "their own version of spinal manipulation" is misleading, since the HVLA type adjustments have little to do with them and are already well known to and used by Osteopaths, Physical Therapists, and MDs. Many of the HVLA type techniques are not unique to chiropractic, even predating Palmer. Remember that Palmer learned from A.T. Still and bonesetters. He did develop some new variations, but those have long since become public property, are used by other professions, and are a part of what is being researched in the studies we are citing. Chiropractors have been sharing "their" techniques for years. It is only the "different diagnosis" (vertebral subluxation (VS)) and "philosophy" (VS as a cause of "dis-ease") that remains unique, very fringe, and quackery.

The HVLA techniques are the same by any name or any practitioner. There is no physical/mechanical/biomechanical/physiological difference, only a difference in intent. -- Fyslee / talk 04:20, 18 September 2008 (UTC)

Mainstream research does not consider spinal manipulation to be significantly different from spinal adjustment (the term preferred by straight chiropractors) from the point of view of effectiveness studies. We should not let WP:FRINGE theories about the distinction between "spinal adjustment" and "spinal manipulation" override mainstream views in this area. Eubulides (talk) 17:42, 17 September 2008 (UTC)

Very true. -- Fyslee / talk 04:20, 18 September 2008 (UTC)

"Mainstream research does not consider spinal manipulation to be significantly different from spinal adjustment" - How do you know this? Remember, I have provided sources which contradict this. -- Levine2112 ^discuss 22:03, 17 September 2008 (UTC)

We haven't seen any sources that directly contradict this, without backward OR inferences related to effectiveness. No evidence has been provided that there is a physical difference between them. Even major chiropractic researchers (university presidents, professors, etc.) make no difference between the two. They are not "just anyone" who doesn't understand the issues. They are not confused or confounding anything. They know more about this than you do. You need to bow to their expertise and learn from them.

I will make some remarks about the "Futility of "effectiveness" discussions" in a new section below. -- Fyslee / talk 04:20, 18 September 2008 (UTC)

Sure we have seen remarks that contradict this. Shekelle contradicts it and so does Ernst (on Haldeman & Meeker: The authors also claim that 43 randomized, controlled trials of spinal manipulation for back pain have been published, but they fail to mention that most of them do not relate to chiropractic spinal manipulation. -- Levine2112 ^discuss 23:13, 18 September 2008 (UTC)

Neither Shekelle nore Ernst contradicts this. Shekelle is talking about confusing SM with chiropractic, which is a different issue. Ernst is criticizing Haldeman & Meeker for not clearly identifying sources. Ernst later does exactly what Haldeman & Meeker do, except that he clearly identifies the sources (see Ernst 2008, PMID 18280103). It is the identification of the sources that Ernst is concerned with, not the sources themselves. Eubulides (talk) 19:27, 19 September 2008 (UTC)

Note. Specific examples of OR are needed. Which sentence is OR and why. I do not see any WP:OR or WP:SYN. QuackGuru 17:39, 18 September 2008 (UTC)

At the beginning of this very sub-thread, a clear example is given. Let me know if you need further explanation of how that piece of non-chiropractic specific spinal manipulation research which makes no specific conclusions about the effectiveness chiropractic creates an OR violation at our article about Chiropractic because we are using it in the context of discussing the effectiveness of chiropractic. That said, I don't believe I can be any clearer than I have already been. -- Levine2112 ^discuss 23:22, 18 September 2008 (UTC)

The example at the top of this thread is accurately supported with references from reliable sources. QuackGuru 00:21, 19 September 2008 (UTC)

And yet the source makes no mention of chiropractic specifically in its conclusions. From WP:OR: Citing sources and avoiding original research are inextricably linked: to demonstrate that you are not presenting original research, you must cite reliable sources that refer directly to the topic of the article, and that directly support the information as it is presented. The example source for the text is supports doesn't refer directly to Chiropractic, thus it is an OR violation. -- Levine2112 ^discuss 00:33, 19 September 2008 (UTC)

(outdent)Clear case of OR if the reference does not specifically state it is relevant to Chiropractic. Surely a study that actually studies chiropractic can be found instead? --Surturz (talk) 00:39, 19 September 2008 (UTC)

Citing references that are directly related to chiropractic using reliable references is relevant. QuackGuru 00:56, 19 September 2008 (UTC)

Non-chiropractic spinal manipulation may be related to chiropractic spinal manipulation. But it isn't directly related. Heroin addicts' usage of hypodermic needles are related to medical doctor's usage of hypodermic needles, but you would not want to confound research about the two. -- Levine2112 ^discuss 01:01, 19 September 2008 (UTC)

When spinal manipulation is related to chiropractic there is no OR violation. QuackGuru 01:11, 19 September 2008 (UTC)

When the scientific community agrees that all non-chiro SM research is directly related to chiro SM, then there is no OR violation. Until that day comes, however, we have an OR violation. -- Levine2112 ^discuss 01:25, 19 September 2008 (UTC)

Editors decide what is related such as the outside view at the NOR noticeboard. QuackGuru 01:32, 19 September 2008 (UTC)

Not necessarily true. Especially when such a decision violates WP:OR as is the case here. Keep using the fact that you found one newbie editor to support you position; it's a really strong point. Especially when considering that two other outside views from more experienced editors supported my position at the very same NOR noticeboard posting. :-) -- Levine2112 ^discuss 01:43, 19 September 2008 (UTC)

There was only one outside view, from Calamitybrook, which clearly stated that it was not OR. All the other views were from editors who had previously expressed opinions here. Almost all of the the NOR discussion was merely a repeat of the discussion here; only Calamitybrook supplied a fresh viewpoint. Eubulides (talk) 19:27, 19 September 2008 (UTC)

Specific examples of OR is requested. The views who agree with Levine2112 are unable to provide any specific examples. QuackGuru 01:47, 19 September 2008 (UTC)

Murphy is a specific example of a piece of research which doesn't make any sort of direct reference to chiropractic in any of its conclusions, and yet we are using it to discuss the effectiveness of chiropractic. There is your example. I have provided an example. Insisting that I haven't is only the characteristic of the utterly ridiculous. -- Levine2112 ^discuss 01:53, 19 September 2008 (UTC)

The claim that cites Murphy is directly suppported by Murphy. Murphy refers to data derived from chiropractic. No OR is involved here. Eubulides (talk) 19:27, 19 September 2008 (UTC)

That is not a specific example of OR. I have explained before that spinal manipulation is related to chiropractic. QuackGuru 01:59, 19 September 2008 (UTC)

Okay, until you are ready to accept the possibility that your opinions are wrong, there is nothing really further to discuss with you. -- Levine2112 ^discuss 02:33, 19 September 2008 (UTC)

That also wasn't a specific example of OR. QuackGuru 04:33, 24 September 2008 (UTC)

Futility of "effectiveness" discussions

What is troubling and bothersome about all of this is that misleading accusations of OR and SYNTH are being thrown around, and are functioning as straw men diversions because they are largely untrue, while another pressing issue is still unsettled. If we had settled that issue a long time ago, we would have avoided months of these discussions and have moved far ahead in our editing.

That issue is the inappropriateness of devoting so much space and energy to "effectiveness" in this article. These matters belong in the specific articles, and the only ones that relate to chiropractic are the articles related to Chiropractic treatment techniques, Spinal manipulation and Joint manipulation. Instead of devoting space to their effectiveness or lack thereof here, we should just mention them and wikilink them, for example: "The effectiveness of spinal adjustment/spinal manipulation is discussed in their own articles."

We need to get this matter settled once and for all and get on with editing other matters. An RfC would be appropriate and I will support a drastically pared down version (mostly removal to other articles) of anything related to "effectiveness", if the RfC is worded properly without the OR and SYNTH nonsense, which is unnecessary in such an RfC. If anyone revives these false accusations in that discussion, I will withdraw my support. Such accusations will only sidetrack the RfC. -- Fyslee / talk 04:20, 18 September 2008 (UTC)

Several times I have said that it'd be OK to trim Chiropractic #Evidence basis and put it into a subarticle, with a summary here. But I don't see why doing that would affect these misleading accusations.

• If we put discussion of the evidence-basis into Chiropractic treatment techniques, the exact same accusations would apply there; supporters of chiropractic would say that mainstream studies are about spinal manipulation, not chiropractic treatments, so it's WP:OR to cite those studies in Chiropractic treatment techniques.
• If we put the material into Spinal adjustment, supporters of chirorpractic would say that the mainstream studies use the term "spinal manipulation", not "spinal adjustment", so it's WP:OR to cite those studies in Spinal adjustment.
• Even Spinal manipulation wouldn't work. In #Examples needed Levine2112 gives just one example, Murphy et al. 2006 (PMID 16949948). Supporters of chiropractic would object to moving the material supported by Murphy et al. to Spinal manipulation, because Murphy et al. use the term spinal manipulative therapy, not spinal manipulation, and the two are not exactly the same thing.
• Last and not least, any summary of the evidence basis should include at least a brief mention of Ernst & Canter 2006 (PMID 16574972), the only systematic review of systematic reviews of the evidence basis, but supporters of chiropractic would object to this on the same grounds.

In short, these accusations of WP:OR are a device for removing discussion of the evidence basis from all articles about chiropractic, and for splintering the discussion in related articles so that the inexpert reader cannot follow what's going on. Eubulides (talk) 08:07, 18 September 2008 (UTC)

I see a lot of lack of good faith here. Please considered restating this so as not to accuse all who recognize the OR/SYN violations as supporters of chiropractic. It might just be that they are supporters of Wikipedia. Fyslee has claimed that there is no evidence contradicting Meeker & Haldeman's reasoning for directly applying non-chiropractic spinal manipulation research to make conclusions about the efficacy/safety of chiropractic. To the contrary, I and others have pointed out several researchers who disagree with Meeker & Haldeman's rationale including Edzard Ernst: The authors also claim that 43 randomized, controlled trials of spinal manipulation for back pain have been published, but they fail to mention that most of them do not relate to chiropractic spinal manipulation. -- Levine2112 ^discuss 23:19, 18 September 2008 (UTC)

The first part of that comment does not disagree with the substance of what I said. The only substantive point was about Ernst's comment. But Ernst's comment does not disagree with Meeker & Haldeman's rationale; on the contrary Ernst uses the same sort of reasoning in Ernst 2008 (PMID 18280103). What Ernst was saying is that M & H should have clearly identified the sources of their data. Which is what Ernst does in Ernst 2008. Eubulides (talk) 19:27, 19 September 2008 (UTC)

Request for Comment: Excluding treatment reviews

Should a Cochrane review on spinal manipulation be excluded from Chiropractic on WP:OR grounds? Similarly, should other reviews of treatments used by chiropractors be excluded from Chiropractic?

• Example of what's in the article now. Chiropractic #Effectiveness's coverage of chiropractic treatments talks about spinal manipulation (SM), and says "a 2004 Cochrane review () stated that SM or mobilization is no more or less effective than other standard interventions for back pain." This passage cites the current Cochrane review on SM therapy for low back pain, along with a systematic review of systematic reviews of SM. Chiropractic #Effectiveness also cites several other reviews of treatments used by chiropractors, e.g., Bronfort et al. 2008 (PMID 18164469), Chou et al. 2007 (PMID 17909210), and Gross et al. 2004 (PMID 14974063).

• Some background on the dispute. Some Wikipedia editors are objecting to citing mainstream reviews such as these, arguing that only sources specifically devoted to chiropractic should be cited by Chiropractic. This dispute has gone on for months; for previous discussions, please see Syn tag, SYN and implicit conclusions, Proposed wording for NOR/N, Chiropractic section on evidence basis, and A starting point for a look at the effectiveness section and introduction. A previous RfC on this issue (see Request for Comment, Possible OR violation at Chiropractic Effectiveness) does not specifically ask whether the abovementioned reviews should be excluded. This followup asks for clear advice on the core of the dispute.

Statements by editors previously involved in dispute

• Mainstream reviews of treatments commonly used by chiropractors should not be excluded from Chiropractic on WP:OR grounds. Such exclusion would be contrary to WP:WEIGHT, a fundamental Wikipedia principle. Eubulides (talk) 21:39, 16 September 2008 (UTC)

Comments

View by Ludwigs2

• Remove Cochrane Review. reading the review (as provided here), the review really says little, much less anything useful about chiropractic, and what it does say it says in a mildly biased fashion. summarizing the results, the review uses the following categories: 'sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful'. SHAM appears to be a placebo control, but chiropractic is not mentioned in the list, and it is not obviously clear where it would fall. even if we assume that chiropractic is considered to be a form of spinal manipulation, the review concludes that "There is no evidence that spinal manipulative therapy is superior to other standard treatments", which is simply a well poisoning way of saying that spinal manipulation is roughly equal in effectiveness to conventional treatments. since we don't know the relationship between Ch and SM, and SM is roughly equivalent to conventional treatments, this review tells us absolutely nothing about Ch. --Ludwigs2 00:53, 17 September 2008 (UTC)

The abstract says that SM comparably effective to some other standard treatments. I'm not sure why you think that is negative. Your point about chiropractic is relevant, though. Do we have any sources discussing the relationship between SM and chiropractic? Chou's review states that heat is moderately effective, and I know some chiropractors use heat. II | (t - c) 07:02, 17 September 2008 (UTC)

• Yes, we have sources describing the relationship between SM and chiropractic, and Chiropractic cites them. For example, Meeker & Haldeman (2002) wrote in the Annals of Internal Medicine 137 (8), p. 702, "We agree that many of the randomized trials we described were on spinal manipulation rather than specifically on chiropractic manipulation itself, but we believe that this is not a significant point. Chiropractors use all forms of manipulation. In the United States, more than 90% of all spinal manipulation services are provided by chiropractors, and research on spinal manipulation, like that on any other treatment method, is equally of value regardless of the practitioner providing it." The course of recent mainstream research has followed this principle, without dissent by any reliable source that I know of.
• Ludwigs2's comment seems to be primarily about WP:NPOV, not WP:OR. NPOV is of course an important issue, but the RfC is about WP:OR, not WP:NPOV.

Eubulides (talk) 17:42, 17 September 2008 (UTC)

• Include SM reviews.I find it strange that you didn't mention that Ernst raised the exact point we have at issue here, saying that these SM studies are not relevant to chiropractic necessarily. And we have separate articles with the two -- and my attempt to connect the two was reverted. Until this relationship has been clarified more extensively, it's hard to say whether general SM research is really completely relevant to chiropractic. Are the providers who are being tested in the RCTs chiropractors? Anyway, I still want to keep the SM research summarized in the article, and I think its relationship to chiropractic is decently presented. However, Ernst's point that general SM research may not apply to chiropractic SM should be noted. II | (t - c) 07:42, 18 September 2008 (UTC)

• It would be appropriate to note that point and cite Ernst. Could you refresh our memories with a cited quote from Ernst about this? I don't recall his writing about it. Thanks. Eubulides (talk) 08:07, 18 September 2008 (UTC)

• I see that II made an edit along these lines, but it has problems. I have started a thread about this in #Ernst, Meeker, Haldeman below. Eubulides (talk) 22:13, 18 September 2008 (UTC)

• Remove Ernst and Cantor review. (subject to consideration). this review shares the same problems as the above review - it does not clearly speak to chiropractic, and its conclusion is oddly biased. if it can be demonstrated that SM and Ch are equivalent terms, this review would be useful for for pointing out the number of conditions that SM doesn't seem to work on; however, its general conclusions do not follow from its conclusions about back pain (e.g., they assert that SM is better than sham but not better than conventional treatments for back pain, but then they assert that "these data do not demonstrate that spinal manipulation is an effective intervention for any condition", which is patently false given their earlier statement. why use a source that can't be consistent over the space of three lines? --Ludwigs2 01:03, 17 September 2008 (UTC)

Would appreciate you linking these reviews as you kindly did the other one. II | (t - c)

sorry - I just took them from the links given above. but here you go. --Ludwigs2 07:45, 17 September 2008 (UTC)

• Here, Ludwigs2's comment seems to be primarily about WP:RS, not WP:OR. That is, Ludwigs2 seems to be primarily arguing that Ernst & Canter are contradictory and are not reliable.
• The results from Ernst & Canter 2006 (PMID 16574972) are consistent. They say that some reviews (e.g., Assendelft et al., Bronfort) say that SM is superior to sham for back pain, and that some reviews (e.g., Gross et al., Ferreira) say it's not. Their remark "Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition" says that the overall evidence is contradictory and that SM overall has not been demonstrated to be effective. This is a consistent position.

Eubulides (talk) 17:42, 17 September 2008 (UTC)

Keep the reviews. It's not us to decide whether or not they apply to SM, chiropractic, or both. If the authors state that they apply, we do not as editors contradict that. Ernst & Canter have clearly stated that in the reports themselves and in other writings ( a whole chapter in Ernst & Singh's book Trick or Treatment ) that these reviews apply to the effectiveness of chiropractic. We defer to the experts. Macgruder (talk) 14:28, 18 September 2008 (UTC)

If it can be demonstrated that Ernst's non-chiropractic studies have been applied to chiropractic by Ernst (or other researchers in published research), then I agree with you, MacGruder. If the researchers apply specific non-chiropractic research to chiropractic, then we can use the research (with the context explaining who said it was applicable). I'm am definitely not arguing against the inclusion of those cases. However, do you agree that we should not use other non-chiropractic SM research where no researcher has applied its conclusions directly to chiropractic? -- Levine2112 ^discuss 19:49, 18 September 2008 (UTC)

• It can indeed be demonstrated that Ernst & Canter 2006 (PMID 16574972) (which you call "non-chiropractic") is applied to chiropractic by published researchers. One example is the following source on chiropractic pain management, which discusses the evidence basis for spinal manipulative therapy (SMT) and uses Ernst & Canter as one of the citations supporting the claim "Recent systematic reviews have been contradictory and unable to clarify the role of SMT in spinal pain management." Here's the source: Kettner NW (2008). "Chiropractic pain management". In Audette JF, Bailey A (ed.). Contemporary Pain Medicine: Integrative Pain Medicine: The Science and Practice of Complementary and Alternative Medicine in Pain Management. Totowa, NJ: Humana. pp. 333–51. doi:10.1007/978-1-59745-344-8_16. ISBN 978-1-58829-786-0.
• This is one example, of course. More generally, though, we need not supply examples like this to support every use of a relevant source. That would simply be a recipe for excluding sources. It would tend to exclude recent sources, which are more up-to-date and therefore tend to be more-reliable, but are less-likely to be cited because they are so new. We need not wait for others to cite recent high-quality sources before citing them ourselves.

Eubulides (talk) 20:48, 18 September 2008 (UTC)

I am honestly undecided about Ernst. But just because Ernst cites a chiropractic specific study, doesn't mean that his non-chiropractic conclusion can be applied to chiropractic. What I want to see is that for every statement which we attribute to some source, that the statement can be shown to be referring to chiropractic specifically. From WP:OR: ...to demonstrate that you are not presenting original research, you must cite reliable sources that refer directly to the topic of the article, and that directly support the information as it is presented. This means that the statements we included must be cite in direct reference to chiropractic. If we have to infer that they are about chiropractic, we have created an OR violation. If we are inferring that the research could be applied to chiropractic based on an opinion given in some other wholly different research, then we have created an SYN violation. -- Levine2112 ^discuss 23:36, 18 September 2008 (UTC)

• What would help you decide about Ernst? Would another citation help? It should not be too hard to show from the literature that Ernst & Canter 2006 is an influential work in the study of the effectiveness of chiropractic care.
• The WP:OR part of your comment is outdated. WP:OR was recently changed to say that you must cite sources that are directly related to the topic of the article, not that refer directly. (This change was by editors I had never heard of, and I had no idea that it would happen until I just now checked WP:OR.) The change was to alter WP:OR to be more internally consistent, as WP:SYN already said "directly related". Clearly spinal manipulation is directly related to chiropractic: it's the core treatment of chiropractic, and is the reason for chiropractic's existence. There is no SYN here.

Eubulides (talk) 19:27, 19 September 2008 (UTC)

• I would like to see that Ernst is directly refering to chiropractic in the conclusions which we are using in our article. That's all really.

• I don't see much of a difference in the changed wording in terms of meaning. Ernst has stated that not all spinal manipulation studies are related to chiropractic. Thus, we cannot make the determination of which ones are related and which ones aren't related (though I would certainly like to read some insight into Ernst rationale). If we were to make the determination of which spinal manipulation research is directly related to chiropractic and which ones are not, then we would be engaged in original research. -- Levine2112 ^discuss 00:10, 24 September 2008 (UTC)

Outside view by WhatamIdoing

The Cochrane reviews should be included. Chiropractors in general accept studies on spinal manipulation as being directly relevant for the major technique of chiropractic manipulation. The ongoing assertion at this page that Wikipedia should exclude normal scientific information from highly reputable sources simply because a given paper wasn't written by a chiropractor is absurd. WP:WEIGHT prevents the exclusion of mainstream sources. However, if you want to follow up on that theme, it might be interesting to include a point published by Ernst: whether or not a given clinical study determines that chiropractic care is effective depends significantly on whether there's a DC writing the paper (not just doing the spinal manipulation).

The Ernst and Cantor review should be included. Editors with an opposing POV may want to make a case for including this editorial about it, although I found several of the complaints to be particularly weak. They will also want to carefully consider their position: if you accept this critical commentary, then you must also accept the fact that the Ernst and Cantor review is considered, by relevant experts in chiropractic itself, to have direct connections to chiropractic.

About the difference between "same effectiveness" (for one condition) and "not effective" in general: Increasingly, the standard for effectiveness is "better than what we've already got". However, the general reader isn't going to know that, and thus the conclusions should be presented in somewhat more detail: "no more or less effective than other standard interventions for back pain." In other words, exactly like it's currently in the article. I also don't understand why this is seen as disparaging information.

In short, the inclusion of these reviews does not violate WP:OR and they do provide necessary balance under WP:WEIGHT. WhatamIdoing (talk) 22:50, 17 September 2008 (UTC)

Your argument for inclusion hinges on this statement: Chiropractors in general accept studies on spinal manipulation as being directly relevant for the major technique of chiropractic manipulation. How do you know this? Plus, is this about what chiropractors accept or what the mainstream scientific community accepts? For instance, there was a case where chiropractors were using positive conclusions from a general spinal manipulation study to state things such as "Chiropractic works!" However, the researchers involved with the study were very critical of chiropractors doing so because their research was about spinal manipulation and not about chiropractic. Dr. Paul Shekelle of RAND released this statement:

"...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....RAND's studies were about spinal manipulation, not chiropractic... Comparative efficacy of chiropractic and other treatments was not explicitly dealt with."

-- Levine2112 ^discuss 23:51, 17 September 2008 (UTC)

You are again confounding "spinal manipulation" (a technique) with "chiropractic" (the profession), which is the same error made by the original chiropractors mentioned above, and scolded by Shekelle for doing so. They were trying to claim that spinal manipulation research that was positive was a green card for claiming that everything the profession did "works", which is far from the truth. Much in chiropractic is rejected as fringe, unscientific quackery, and Shekelle wasn't about to allow such misuse of the RAND study. The conclusions of the study only had relevance to the major technique performed by the profession, and upon which the profession is based. Chiropractic is not equal to spinal adjustment/manipulation (SM), but "no SM, no chiropractic". Chiropractic without SM would be like a nail without a hammer. They belong together.

We aren't discussing the RAND conflict here. We are discussing whether the subject of "spinal manipulation" is relevant to the chiropractic profession, and it is very relevant, as noted by their strong objections in the commentary mentioned above. If it were irrelevant, they would have been silent. BUT keep in mind, it is only relevant as regards the effectiveness of manipulation/adjustments, which are performed by chiropractors and thus such research is very relevant to them, even when it is about SM performed solely by non-DCs (a few such studies exist), or including a few non-DCs (usually the case). -- Fyslee / talk 04:50, 18 September 2008 (UTC)

I totally agree with this point. Macgruder (talk) 14:36, 18 September 2008 (UTC)

The fact that notable chiropractors and researchers consider general research about spinal manipulation relevant for the profession is explained quite clearly by Meeker and Haldeman, as noted above by Eubulides:

• Yes, we have sources describing the relationship between SM and chiropractic, and Chiropractic cites them. For example, Meeker & Haldeman (2002) wrote in the Annals of Internal Medicine 137 (8), p. 702, "We agree that many of the randomized trials we described were on spinal manipulation rather than specifically on chiropractic manipulation itself, but we believe that this is not a significant point. Chiropractors use all forms of manipulation. In the United States, more than 90% of all spinal manipulation services are provided by chiropractors, and research on spinal manipulation, like that on any other treatment method, is equally of value regardless of the practitioner providing it." The course of recent mainstream research has followed this principle, without dissent by any reliable source that I know of.

Neither Eubulides nor myself know of any dissenting voices in reliable sources, and I think we should follow the sources, rather than Levine2112's (or other's) personal opinion. This is not a case of OR or SYNTH. -- Fyslee / talk 06:09, 18 September 2008 (UTC)

Your explanation illustrates the WP:SYN violation beautifully. You are wanting to use Meeker's explanation to justify the inclusion of research which Meeker didn't specifically analyze. Thus you are justifying Source A by using an explanation in Source B to create an Original Statement C (that the conclusions of non-chiropractic Source A is directly applicable to chiropractic). Please note that I have no problem including Meeker or the non-chiropractic research which they analyzed and directly applied to chiropractic. This issue here is with the other non-chiropractic research which has not been directly applied to chiropractic by any researchers. Merely following the lead of Meeker here with these other non-chiropractic studies creates original research and we cannot have that. -- Levine2112 ^discuss 07:58, 18 September 2008 (UTC)

There is no "original statement C" in Chiropractic #Evidence basis, so there is no WP:OR there. As you note, there are original statements on this talk page; but that's OK. A talk page is allowed to contain original research, and talk pages routinely contain OR; it's only the article itself that should not contain OR. Eubulides (talk) 08:07, 18 September 2008 (UTC)

Stating or implying that conclusions from non-chiropractic spinal manipulation efficacy or safety research is directly applicable to conclusion about the efficacy or safety of chiropractic is original research. This is what we are referring to as "Original Statement C". That you are justifying such an application on the notion that Meeker & Haldeman have done it in their research is why this is a synthesis violation. -- Levine2112 ^discuss 17:00, 18 September 2008 (UTC)

That is not a Statement C. SM research is relevant to chiropractic. QuackGuru 17:08, 18 September 2008 (UTC)

I agree with QuackGuru. The only "Original Statement C" is on the talk page. It is not WP:OR when the only occurrence of "Original Statement C" is on the talk page. Eubulides (talk) 17:29, 18 September 2008 (UTC)

Non-chiropractic SM efficacy/safety research is directly relevant to chiropractic efficacy/safety" is an implied statement we are making in the article by basing so many conclusion in the Chiropractic article on non-chiropractic SM efficacy/safety research; whereas commenting on chiropractic was not the expressed intention of the researchers. -- Levine2112 ^discuss 19:39, 18 September 2008 (UTC)

WP:OR governs what is put into Chiropractic. It does not govern the myriads of inferences that a reader might make from Chiropractic. As a trivial example, a reader might infer from Chiropractic that the profession is normally called "chiropractic" and not "chiropracty", because Chiropractic consistently uses the word "chiropractic" and never uses the word "chiropracty". But this does not mean that Chiropractic is guilty of WP:OR because it does not cite a source saying that "chiropractic" is a more common term than "chiropracty". Eubulides (talk) 20:48, 18 September 2008 (UTC)

I believe that after all this time you are still missing something major at WP:OR: ...to demonstrate that you are not presenting original research, you must cite reliable sources that refer directly to the topic of the article, and that directly support the information as it is presented. So if the non-chiropractic spinal manipulation research you want to include never mentions chiropractic , then you must concede that it is a source which doesn't refer directly to the topic of the article (namely, Chiropractic). Thus you have not demonstrated that you are not presenting original research. -- Levine2112 ^discuss 23:30, 18 September 2008 (UTC)

Again, the WP:OR part of this comment is outdated. WP:OR's lead was recently changed to say that you must cite sources that are directly related to the topic of the article, not that refer directly. This change was for consistency, as the body said "directly related". Eubulides (talk) 19:27, 19 September 2008 (UTC)

WP:OR: or if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research.

Spinal manipulation is directly related to chiropractic. QuackGuru 00:31, 19 September 2008 (UTC)

Related? Yes. Directly related? Well that's the topic of this debate. Meeker & Haldeman said it was okay for them to confound non-chiropractic SM research to draw conclusions about chiropractic; however, Ernst disagrees with them. So, according to the sources, it is questionable whether non-chiropractic spinal manipulation is directly related to chiropractic spinal manipulation. Let's look at the whole quote form WP:OR which you have mentioned: If the sources cited do not explicitly reach the same conclusion, or if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research. Well, if a source is about non-chiropractic spinal manipulation and we are using it to draw conclusions about chiropractic spinal manipulation, then you have to admit that the source cited does not explicitly reach the same conclusion as that which we are presenting in the article. -- Levine2112 ^discuss 00:39, 19 September 2008 (UTC)

Ernst does not disagree with Meeker & Haldeman. He merely notes that they should state where their data came from. In a later work, Ernst 2008 (PMID 18280103), Ernst does what Meeker & Haldeman do, except he says where his data came from. Eubulides (talk) 19:27, 19 September 2008 (UTC)

I have explained it before that spinal manipulation is directly related to chiropractic and therefore it is reasonable to include it in this article. QuackGuru 00:46, 19 September 2008 (UTC)

Just because you explained it, does not make it true. I have show that several leading researchers disagree with you. So once again: Related? Yes. Directly related? That is a matter of debate. We can refer to the debate in our article, but we cannot perform original research based on the opinions of one side in the debate. Sorry. -- Levine2112 ^discuss 00:58, 19 September 2008 (UTC)

Again, it is not the case that "several leading researchers" are disagreeing with QuackGuru's point. QuackGuru's point agrees with the positions taken by Meeker, Haldeman, and Ernst. Eubulides (talk) 19:27, 19 September 2008 (UTC)

I do not see several researchers disagreeing with OR guidelines. It is reasonable to include related research. QuackGuru 01:07, 19 September 2008 (UTC)

Several researchers disagree with your position that non-chiro SM research is directly related to chiro SM research. Thus inclusion of non-chiro SM research in a section about Chiropractic effectiveness is a violation of WP:OR. -- Levine2112 ^discuss 01:22, 19 September 2008 (UTC)

Again, it is not the case that "several leading researchers" are disagreeing with QuackGuru's point. Meeker, Haldeman, and (later) Ernst are agreeing on this point. Eubulides (talk) 19:27, 19 September 2008 (UTC)

I know spinal manipulation is related to chiropractic. It is obvious that SM research is related to chiropractic. And the outside view at the NOR noticeboard supports the inclusion of the related text. QuackGuru 01:35, 19 September 2008 (UTC)

I'm sorry but you opinion means very little in terms of if non-chiro SM research is directly related to chiro SM. We must rely on the sources. Currently the sources show that there is disagreement on whether or not it is directly related. And yes, one outside view (from a newbie editor) at NOR agreed with your position. However, two outside views from more experienced editors agreed with my position. That's kind of a weak point on your point. Especially in the face of the current RfC which show majority support of my position. Sorry again. -- Levine2112 ^discuss 01:39, 19 September 2008 (UTC)

Again, it is not the case that "the sources show there is disagreement". On the contrary, Meeker & Haldeman agree with Ernst. Eubulides (talk) 19:27, 19 September 2008 (UTC)

The views from editors who agreed with Levine2112's position never provided any specific examples of OR. Specific examples are needed. QuackGuru 01:43, 19 September 2008 (UTC)

Yes, keep insisting that no examples were given, even though it is plainly obvious to everyone else that specific example were given and are even now currently being discussed (Murphy, Ernst, Cochrance, Haldeman & Meeker). Despite flying in the face of reality, you are doing a tremendous job of holding firmly to your position. -- Levine2112 ^discuss 01:49, 19 September 2008 (UTC)

Those researchers are not specific examples of OR. The views who claim there is OR have not demonstrated any OR. I request specific examples. Exactly which sentence is OR and why. QuackGuru 01:55, 19 September 2008 (UTC)

Until you are ready to accept the possibility that your opinions on the specific example which I have provided may be wrong, then there is really nothing further to discuss with you here. -- Levine2112 ^discuss 02:36, 19 September 2008 (UTC)

I request a specific example of OR and how it is OR. This is a simple request. A specific example of OR would be a specific sentence that is not verfified. Please explain exactly which sentence is OR and why. I hope this was helpful. QuackGuru 16:10, 19 September 2008 (UTC)

I have provided you with an example above. That you don't think it is a good example is beyond my power. Regardless, I have provided an example. Every outside commentator in this RfC agrees that there is an OR violation. Please respect their opinions. -- Levine2112 ^discuss 17:31, 19 September 2008 (UTC)

(outdent) QuackGuru is correct here. We need a specific example of wording in the article that contains OR which is not supported by the cited source. So far, no such examples have been supplied. Also, it is not correct that "Every outside commentator in this RfC agrees that there is an OR violation." So far, we've seen two outside commentators, Ludwigs2 and WhatamIdoing. WhatamIdoing clearly supports the material in question. Ludwigs2 opposes inclusion, but mostly on WP:NPOV and WP:WEIGHT grounds; those are different issues than the question raised by the RfC. Eubulides (talk) 19:27, 19 September 2008 (UTC)

Sorry. I got my RfC confused. The RfC above this one - which deals in generalities of OR existing in this specific section of the article - received comments from several outsiders, all of whom agreed that the section contains OR. There, in that RfC, the Murphy et al example was provided. This RfC deals with specific examples and doesn't strike at the core of the dispute - that in general, since there is no agreement in the scientific community that non-chiro SM research is directly relevant to chiro SM conclusions, by including such conclusions from non-chiro SM research in our Wikipedia article on Chiropractic violates WP:NOR. You will also note that the majority of respondents to the first RfC were in favor of moving the non-chiro SM research supported statements to the more apropos Spinal manipulation article. Please at least acknowledge these results from the first RfC. -- Levine2112 ^discuss 19:55, 19 September 2008 (UTC)

• OK, so we agree that the current RfC does not currently support the WP:OR claim.
• The previous RfC has comments from two uninvolved editors. One (MaxPont) supports moving SM material to the SM article, but does not say why; this is not agreement that the section contains WP:OR. The other (Martinphi) conditioned his response on whether the facts are properly presented in the RfC; this fairly slender reed would be stronger if Martinphi had read the section in question, but Martinphi unfortunately has not have the time to digest it.
• I myself have proposed trimming down Chiropractic #Evidence basis and moving some of its details to a subarticle. I am not opposed to that, nor is this RfC about that. This RfC is about whether it's OR to discuss spinal manipulation in Chiropractic, and to support the discussion with reliable sources on spinal manipulation.
• The Murphy et al. example was not part of the previous RfC. It is part of later commentary on the RfC, and no outsider has commented on Murphy et al.
• The specific examples in this RfC are the sources that are at the core of the dispute. It is better for RfCs to be specific, e.g., by proposing specific wording changes; otherwise, their conclusions are less useful.

Eubulides (talk) 20:58, 19 September 2008 (UTC)

• No. The current RfC neither supports or refutes the OR claim. Some commentators don't recognizethe OR violation while some commentators do.
• While I too wish MaxPont elaborated in his two responses, I believe it is clear that he feels that there is an OR problems here and that the material would be better located at the more general spinal manipulation article. MartinPhi's response is thorough. I don't think it is fair of you to assess that he didn't read the section in question. He may not have fact-checked every source, but his response accounts for that by stating that if what the RfC says about the sources in question is true, then he recognizes that there is an OR issue.
• Trimming is fine, especially if you are cutting out the non-chiropractic SM studies which currently may be in violation of OR. The ideal article to move them to is spinal manipulation as these are studies about spinal manipulation in general and not as performed by any specific kind of practitioner. Moving them to an article specifically about chiropractic adjustments or to a newly created article about chiropractic effectiveness, would essentially be moving the same OR problem to a different article.
• The Murphy example was added to that RfC just after you requested of me to provide a specific example.
• That RfC did propose a specific solution and that was moving the information sourced to general spinal manipulation research to the more apropos spinal manipulation article. I believe that every respondent was in favor of this proposal.

-- Levine2112 ^discuss 23:48, 19 September 2008 (UTC)

• Martinphi wrote "I have not digested the section in question. However, if the facts are properly presented above"; it's quite clear that this opinion is based on the wording in the RfC, and not on any careful reading of what's in Chiropractic.
• MaxPont's comment says nothing about OR; it does not support the claim that there is OR here.
• The Murphy example is not part of the RfC. It is part of later commentary on the RfC.
• The RfC did not specifically identify which sources were "general spinal manipulation research", and as such, it does not propose a specific solution.
• Trimming should use the WP:SUMMARY style, which should summarize everything of interest in this section.

Eubulides (talk) 07:11, 22 September 2008 (UTC)

When I say I didn't digest the section, that is because in order for my response to be incorrect, the RfC would have to be basically very wrong in its presentation of the facts. There is no reason I should read all the sources to respond here. I did read enough of the section to see that articles which are not really about chiro are being used. If there aren't sources specifically saying "this study of SM would apply equally to chiro," we have no business using them to draw conclusions about chiro. this has sub-sections which are clearly about SM, and at the very least to the extent they are being presented at the Chiropratic article, but may or may not be relevant, they are SYNTH/OR. The material is for a SM article, not Chiro. So, I think my comments relevant, unless you have specific reasons for saying they are not.

Thus, I think that you should simply cut the material, not summarize. You should only keep what is actually sourced to documents which discuss Chrio. But there should be a link to the SM article. The issue is a simple one of policy, not a content dispute in which I would have had to understand the sources and the way they are being used. If you're using sources which aren't about chrio, but about SM, then keep it for the SM article. Keep and use any good sources which talk about the relationship of Chrio to SM in general. But discuss SM only in another article when it is not directly about Chiro SM. ——Martin^phi ☎ Ψ Φ—— 02:38, 24 September 2008 (UTC)

Do I really have to repeat the arguments. If I support a certain position it is because I find the other editors arguments in favour of that position convincing. MaxPont (talk) 13:09, 24 September 2008 (UTC)

I would help if specific examples of OR were presented. Please show there is OR rather than just asserting it would be helpful. If no OR is specifically presented we can reasonably conclude there is no OR in this article. QuackGuru 16:11, 24 September 2008 (UTC)

Of course you (MaxPont) don't have to repeat the arguments. It is sufficient to say that you agree or disagree. It is a request for comments from uninvolved editors. How much you wish to comment is up to you. Certainly the more you contribute, the better, but a simple "agree" or "disagree" is completely valid as well. Thank you for taking the time to respond.

Martinphi, also thank you for taking the time to respond to the RfC as an uninvolved editor. Hopefully, yours and MaxPont's (and Ludwig2's) (and I'clast) comments will not continue to be discounted by the opposition. -- Levine2112 ^discuss 17:38, 24 September 2008 (UTC)

It is not sufficient to claim there is OR when no evidence of OR has been presented. QuackGuru 17:45, 24 September 2008 (UTC)

Well I for one disagree with you. As does Martinphi, MaxPont, Ludwig2, and I'clast. I think I can speak for DigitalC, Surturz, Hughgr and Dematt who have also agreed that evidence of OR have been presented. I would even venture to guess that the "opposition" (such as Eubulides) will agree that evidence has been presented, even if they disagree with the evidence. I think you're on your own with this line of argumentation. -- Levine2112 ^discuss 17:56, 24 September 2008 (UTC)

Hughgr has commented on this RfC? Dematt has commented on this RfC? Where? Eubulides (talk) 07:36, 25 September 2008 (UTC)

You disagree with: It is not sufficient to claim there is OR when no evidence of OR has been presented.

You claim it is sufficient to assert there is OR without presenting evidence of OR. That's not a valid reason to delete research related to chiropractic. QuackGuru 18:02, 24 September 2008 (UTC)

Please just stop it. Accept that evidence has been provided but you simply don't agree with the evidence. To continue on like this with your head buried in the sand is just childish at this point (Sorry for the mixed metaphor). -- Levine2112 ^discuss 18:04, 24 September 2008 (UTC)

Please show me the evidence of OR rather than asserting it would be more helpful. QuackGuru 18:15, 24 September 2008 (UTC)

Evidence: 1) Murphy makes no mention of chiropractic specifically in any of its conclusions about spinal manipulation. 2) Edzard Ernst tells us that not all spinal manipulation studies are related to chiropractic. 3) WP:OR states that if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research.

There is your evidence. I have presented it. Please don't ever claim that I have not presented it because that would be a fabrication at this point. Whether or not you agree with the evidence is another matter. It is evidence and it has been presented. End of story. -- Levine2112 ^discuss 18:40, 24 September 2008 (UTC)

You have not explained specifically which if any spinal manipulation is not directly related to chiropractic. Based on your many comment you believe you do not have to give any specific examples of OR. I believe if anyone claims there is OR it is that editor's responsibility to present such evidence. Please explain specifically which sentence is OR and how it is OR. SM is performed by chiropractors, thus it is directly related to chiropractic. QuackGuru 18:52, 24 September 2008 (UTC)

It is OR to have SM which is not about Chiro in the Chiro article. You have SM which is not about Chiro in the Chiro article (evidence in this section). Therefore, you haven OR/SYNTH in the Chiro article. ——Martin^phi ☎ Ψ Φ—— 22:40, 24 September 2008 (UTC)

(outdent) The source in question, Murphy et al. 2006 (PMID 16949948), refers directly to chiropractic. It would be inaccurate to call this source "SM which is not about chiro". Eubulides (talk) 07:36, 25 September 2008 (UTC)

I see only an abstract. The whole point is that we should indeed say what it says about Chiro, or about the relationship between Chiro and SM. But not assume that SM applies to Chiro. I can't review the source to say more than this. If you have it you could send it to me? ——Martin^phi ☎ Ψ Φ—— 23:20, 25 September 2008 (UTC)

Sorry, I don't have the rights to send you a copy. WP:OR does not have the restriction that you mention, though. Eubulides (talk) 07:12, 26 September 2008 (UTC)

Then I would have to say that merely referring directly to Chrio is not enough: he could have been referring to the fact that SM is not the same as Chiro. ——Martin^phi ☎ Ψ Φ—— 22:41, 26 September 2008 (UTC)

You can see the full text of Murphy here. Note that chiropractic is only mentioned in data collection and that the data is mixed with osteopathic data. In the conclusion (which is what we are citing in the article), chiropractic is never referred to. The conclusion is about spinal manipulation in general and not about chiropractic spinal manipulation specifically. There is no clear way for us to know which general spinal manipulation research can relate to chiropractic spinal manipulation and which ones cannot. Of the 43 published spinal manipulation RCTs, Edzard Ernst has said that the majority do not relate to chiropractic. For us to relate Murphy to chiropractic (when there is no other source out there doing so) qualifies as original research, because the authors of Murphy are not relating their studies to chiropractic. Nor is any other researcher relating Murphy to chiropractic. For us to present this relationship is original research. -- Levine2112 ^discuss 00:06, 27 September 2008 (UTC)

Murphy does directly refer to chiropractic, so WP:OR is satisfied. Most of the studies in its Table 2 are chiropractic studies, so Ernst's criticism does not apply to Murphy. Eubulides (talk) 03:32, 27 September 2008 (UTC)

Maybe the lay public does not understand this. . . but there is spinal manipulation and then there is chiropractic spinal manipulation. . . which we call spinal adjustments. There is a difference between the two as Levine212, Martin and DigitalC have rightly pointed out. . . the difference as far as research goes has been pointed out by Edward Enrst. . . as noted above. . . and others. It is without question that spinal manipulation research not about chiropractic spinal manipulation should not be used in your article about spinal manipulation. This is a violation of "OR" as it is written now and is rightly labeled.TheDoctorIsIn (talk) 23:56, 29 September 2008 (UTC)

Ernst, Meeker, Haldeman

Back to Murphy et al.

(outdent) Again, Murphy et al. 2006 (PMID 16949948) refers directly to chiropractic, and it therefore satisfies the requirements of WP:OR. Eubulides (talk) 09:17, 24 September 2008 (UTC)

That's not good enough. The onus is on you to demonstrate that you are not presenting original research by showing us that you are citing reliable sources that are directly related to the topic and directly support the information as it is presented. This is how and we are presented from Murphy:

• There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain; methods for formulating treatment guidelines differ significantly between countries, casting some doubt on the guidelines' reliability.

• ...the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level.

So please demonstrate that the source is directly related to chiropractic and that the source directly supports these two usages direct relation to chiropractic. Otherwise you have no demonstrated that you are not presenting original research. -- Levine2112 ^discuss 15:38, 25 September 2008 (UTC)

The above comment has not demonstrated original research exists in the chiropractic article.

The responsibility is on the editor who claims there is OR. Editors have already demonstrated SM is directly related to chiropractic. If an editor thinks a specific sentence and reference is OR then present the evidence. QuackGuru 17:51, 25 September 2008 (UTC)

QuackGuru, you state that Editors have already demonstrated SM is directly related to chiropractic." Levine has shown that reliable sources disagree. A blanket statement that "SM is directly related to chiropractic" is FALSE. For you to be repeating it is disruptive editing. Further, in relation to disruptive editing and IDHT, please DO go back and answer the questions that Levine posed to you. DigitalC (talk) 11:17, 26 September 2008 (UTC)

Sure it does. The policy clearly states that the onus is on those presenting the content to demonstrate that they are not presenting original research. So far, that has not been demonstrated. Please answer my three questions above. I have numbered them for you so it is really simply for you to respond. -- Levine2112 ^discuss 00:34, 26 September 2008 (UTC)

Again, Murphy refers directly to chiropractic, which is what WP:OR requires. And Murphy directly supports the two claims in question. Both of these points have been discussed before, in threads you were involved in, with quotes from the source in question; there's little point to repeating that discussion here. Eubulides (talk) 07:12, 26 September 2008 (UTC)

And again, the claims from murphy are NOT directly related to chiropractic, and as such should not be used. DigitalC (talk) 11:05, 26 September 2008 (UTC)

Murphy refers directly to chiropractic but some editors claim this is false. This has been explained before. Murphy is directly related to chiropractic and this satisfies OR. QuackGuru 17:57, 26 September 2008 (UTC)

I am not claiming that Murphy doesn't refer to chiropractic in its text. However, just because a subject is referred to in the source, doesn't mean that the source is directly related to that subject (especially in the context which that source is being used in the article). Read WP:OR. Context is largely the issue here. The conclusions of Murphy say nothing about chiropractic effectiveness. Yet, we are using these non-chiropractic conclusions in the context of discussing chiropractic effectiveness in our article. Hence we are using the source out of context (in an original way, not intended by the authors). Hence the WP:NOR violation. It's that simple. Again, the onus is on those in favor of inclusion to show that the there is no violation. Otherwise, this source and its corresponding content should be removed. -- Levine2112 ^discuss 20:40, 26 September 2008 (UTC)

Please see #Understanding the argument correctly? below. (I inserted the header to avoid an overly long subsection). Eubulides (talk) 05:39, 27 September 2008 (UTC)

Understanding the argument correctly?

(outdent) As I understand it, the above comment argues Murphy et al. 2006 (PMID 16949948), a source that specifically mentions chiropractic, does not qualify as one of the "sources that are directly related to chiropractic" in the sense of WP:OR. Am I understanding the argument correctly? If so, it would be absurd; so I must be missing something. Eubulides (talk) 03:32, 27 September 2008 (UTC)

Here is what we are source to Murphy:

There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain; methods for formulating treatment guidelines differ significantly between countries, casting some doubt on the guidelines' reliability.

...whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level.

Both of these statements are drawn from the conclusions of Murphy. The conclusions of Murphy which state nothing about chiropractic whatsoever (directly or even inferred). The word chiropractic is never even mentioned in the context of either of these conclusions. So the fact that we are using both of the conclusions about general spinal manipulation to make statements about iropractic effectiveness is clearly original research. These statements are fine in the spinal manipulation article, but not in chiropractic. Please don't refer to my argument as absurd. That is really weak and unexpected on your part. -- Levine2112 ^discuss 05:25, 27 September 2008 (UTC)

That long answer to a yes-or-no question seems to be saying "Yes" (that is, it seems to be saying that I understood the argument correctly) but it doesn't come right out and say "Yes". Was it a "Yes"? It's of course fine if that answer was "No"; then we can find out where I went astray. Eubulides (talk) 05:39, 27 September 2008 (UTC)

The short answer is: "No, you are either not fully grasping or are not fully summarizing the position. Yes, Murphy might factor in chiropractic data into its research, but it also factors in data from other professions (osteopaths, acupuncturists, et cetera). And regardless of this, the conclusions that Murphy reaches (the very conclusions which we are citing in this article) say nothing about chiropractic specifically. Yet we are using these conclusions to discuss the effectiveness of chiropractic. That means that we are using the sources to further a position which the source itself does not make. And that means that we are creating original research. -- Levine2112 ^discuss 05:54, 27 September 2008 (UTC)

• Chiropractic does not use Murphy et al. 2006 to further "a position which the source itself does not make". Every claim that cites that source is clearly supported by the source.
• But getting back to the yes-or-no question, I'm afraid the comment doesn't say what's incorrect about my understanding of the argument, which is too bad. Let me try to ask a more specific question. Which part of my understanding is incorrect? (a) the part that says Murphy et al. 'specifically mentions chiropractic', or (b) the part that says Murphy et al. 'does not qualify as one of the "sources that are directly related to chiropractic" in the sense of [[WP:OR]'? (Those are the only two parts.)

Eubulides (talk) 06:54, 27 September 2008 (UTC)

• Regardless of whether every claim that cited to Murphy is clearly supported by Murphy, do you feel that the claims from Murphy currently used in our article are being used to discuss the effectiveness of chiropractic?
• I will answer this below, but please be sure to answer my question in the above bullet point. Thanks. This is a really fascinating discussion! Actually here's a good place to answer as any. I guess the main thing that I objected to is your calling my position absurd. My response is that just because a subject is mentioned in a source, doesn not mean that everything contained within that source is directly related to that subject. Is that so absurd of a position to hold? -- Levine2112 ^discuss 08:16, 27 September 2008 (UTC)

• The claims from Murphy are currently used in Chiropractic #Effectiveness, and in that sense they "are being used to discuss the effectiveness of chiropractic?". That is a subsection of Chiropractic #Evidence basis, so in the same sense these claims are being used to discuss the evidence basis for chiropractic. And Chiropractic #Evidence basis is in turn a section of chiropractic, so in the same sense these claims are being used to discuss chiropractic. However, the claims themselves are much more specific than chiropractic, or the evidence basis for chiropractic, or the evidence basis for chiropractic's effectiveness. For example, one of these claims says that there is a conflict of opinion about the efficacy of spinal manipulative therapy for nonspecific low back pain. This claim is obviously directly relevant to chiropractic, as most people who seek chiropractic care do so for low back pain.
• I did not say that your position is absurd. I said "Am I understanding the argument correctly? If so, it would be absurd". You responded "No, you are either not fully grasping or are not fully summarizing the position." Which is fine, it's only my (incorrect) understanding of your position that is absurd.
• But then the question remains: what is your position, particularly with respect to points (a) and (b) above? You wrote "I will answer this below", but I don't see an answer below.

Eubulides (talk) 07:19, 28 September 2008 (UTC)

• Follow up question - Since you agree that the claims of Murphy are not directly discussing chiropractic effectiveness but rather the efficacy of spinal manipulative therapy in general ("the claims themselves are much more specific than chiropractic, or the evidence basis for chiropractic, or the evidence basis for chiropractic's effectiveness"), but you also agree that the claims of Murphy are currently used in our article to discuss the effectiveness of chiropractic, then wouldn't you have to agree that we are using the claims of Murphy to discuss something more specific than what Murphy intended?

• Further, I would refute that general claims about spinal manipulation therapy as performed by a mixed bag of practitioners are "more specific" then claims about chiropractic spinal manipulation. I would say that it is just the opposite. A discussion about chiropractic spinal manipulation is more specific than a discussion about spinal manipulation in general. The claims of Murphy are not discussing the more specific chiropractic spinal manipulation, but rather the more general spinal manipulation therapy. Murphy is making no claims about chiropractic, yet we are using Murphy to make such claims. That is a WP:OR violation.

• Your understanding is correct, so in effect you were calling my position absurd. I felt that was a tactic beneath you.

• I wrote that I would answer it below, but then in the same breath, I decided to answer it there. Please reread.

-- Levine2112 ^discuss 18:35, 28 September 2008 (UTC)

• I did not write, nor do I agree, that the claims supported by Murphy et al. 2006 (PMID 16949948) discuss the efficacy of SMT in general. The claims are much more specific than that.
• The claims supported by Murphy et al. are part of a larger discussion of the effectiveness of chiropractic care, yes. This sort of thing is normal in Wikipedia: a larger discussion is broken down into sentences or phrases, each of which is supported by a reliable source.
• If my understanding was correct (this is news; earlier I was led to believe that my understanding was incorrect), then the argument is indeed absurd. As I understand it, the argument is that Murphy et al., a source that specifically mentions chiropractic, does not qualify as one of the "sources that are directly related to chiropractic" in the sense of WP:OR. How can a source that directly mentions a topic not be directly related to that topic?

Eubulides (talk) 07:26, 29 September 2008 (UTC)

• Okay, then what are the claims about specifically? Please quote.

• SMT is the larger discussion when discussing chiropractic SM specifically. Chiropractic SM is just on form of SMT. Clearly, SMT is the larger discussion. It is therefore improper to include a discussion of material outside the scope of this article, especially in a manner which is deceptive to the reader. The way we are currently breaking down this discussion is to include material not necessarily directly related to the subject and therefore it violated WP:OR. So says I and so says the majority of respondents to all of our third-opinion queries.

• Please stop calling my argument absurd. Insults are the last bastion of those grasping for straws. How can a source that directly mentions a topic not be directly related to that topic? Well let's see. First of all, we are discussing the claims (conclusions) of Murphy, as that is what we are including in the article. The conclusions of Murphy say nothing about chiropractic specifically. Sure, they mention SMT, but not chiropractic. Murphy, in fact, never mentions chiropractic in any of the body text of the entire paper, only in a table where it cites two other pieces of research that looked at chiropractic with a mixed bag of professions. So other than Murphy citing to other studies in one of Murphy's tables, the word chiropractic is never mentioned in the Murphy research. Directly related? I don't think so. Murphy also says the word "bibliographic" it the text, does that mean that Murphy is directly related to the subject of bibliography? Would it be proper to state the following at bibliography: ...the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level? No? But I don't understand. Murphy mentions the word "bibliographic" in its text, therefore Murphy must be directly related to the subject of bibliography. Really? That's your argument now? -- Levine2112 ^discuss 16:24, 29 September 2008 (UTC)

(outdent)

• SMT is not "the larger discussion". Chiropractic is bigger than SMT: it includes treatments that are not SMT, and it even includes concepts that are not treatments. Neither SMT nor chiropractic is a superset of the other.
• However, SMT is clearly highly relevant to chiropractic: it is chiropractic's core treatment technique, and chiropractic would not exist without it.
• I was not discussing the claims or conclusions of the source (Murphy et al. 2006, PMID 16949948). I was discussing the source itself.
• Table 2 of Murphy et al. mentions 4 studies, of which 3 are from chiropractic data and 1 is not. This by itself establishes that Murphy et al. is directly related to chiropractic. It's not the only connection, but it's enough.
• Whether this source could be used on other Wikipedia articles like Bibliographic without violating WP:OR would depend on how it's used there.

Eubulides (talk) 20:38, 29 September 2008 (UTC)

• Do you agree with mainstream researchers such as Edzard Ernst that there is a difference between SMT and chiropractic spinal manipulation?

• What are we using from Murphy if not the conclusions?

• Unless I am reading it incorrect, Chiropractic is only mentioned in 2 of the 4 studies in that particular table. It is mentioned nowhere else in the research. Murphy references 21 studies total.

• Since we are probably dispassionate about "bibliographic", could you explain how Murphy could possibly be used as a source at Bibliographic.

-- Levine2112 ^discuss 21:32, 29 September 2008 (UTC)

Three questions for those in favor of inclusion

1. Do you agree that Ernst has stated that not all spinal manipulation trials are related to chiropractic spinal manipulation?

• To make sure we are on the same page, please provide the Ernst ref (link) and a quote from it which you deem is relevant. -- Fyslee / talk 02:31, 27 September 2008 (UTC)

• Sure. I'm happy to provide the quote and link again. In Ernst's response to Haldeman and Meeker's research, Ernst had this to say:

The authors also claim that 43 randomized, controlled trials of spinal manipulation for back pain have been published, but they fail to mention that most of them do not relate to chiropractic spinal manipulation.

So of the 43 RCTs of spinal manipulation for back pain, it is Edzard Ernst's opinion that most of them do not relate to chiropractic spinal manipulation. Edzard Ernst (whether I like it or not) is a voice of mainstream science. Certainly representational to some degree. (Fyslee, I am sure that you think he is even more representational that I am willing to admit.) WP:OR tells us that in order to not present original research, we must cite reliable sources that are directly related to the topic (chiropractic... or more specifically, the effectiveness of chiropractic spinal manipulation). Now given that Edzard Friggin' Ernst states that the majority of the published spinal manipulation RCTs for back pain is NOT related to chiropractic, is it really okay for us to cite twice in our discussion of chiropractic's effectiveness on back pain research such as Murphy et al. which never mentions chiropractic at all in its conclusions about the effectiveness of spinal manipulation for back pain? Certainly, I recognize that Murphy bases some of its opinions on studies specifically about chiropractic, but it is also based on other professions treatment of back pain, including osteopathic spinal manipulation. But in the end, the conclusions of Murphy state nothing about chiropractic specifically, only spinal manipulation in general. So in effect, Murphy tells us nothing specifically about chiropractic. Given Ernst's feeling that the majority of spinal mannipulation RCTs are not related to chiropractic, how are we - as Wikipedians - to conclude that Murphy's general conclusions about spinal manipulations are directly related to chiropractic? Remember, WP:OR states that that in order to demonstrate that you are not presenting original research, you must cite reliable sources that are directly related to the topic and directly support the information as it is presented. Ernst tell us that most spinal manipulation RCTs are not related to chiropractic, so how can we assume that Murphy is directly related to chiropractic? Better question: How can we assume that the conclusions we are using from Murphy are directly related to chiropractic given that Murphy looked at a mixed bag of professions performing spinal manipulation, states nothing specifically about chiropractic in its conclusions, and that mainstream researchers such as Ernst has stated that most spinal manipulation RCTs are not related to chiropractic? -- Levine2112 ^discuss 05:44, 27 September 2008 (UTC)

• Just as I suspected. You have misquoted Ernst when you wrote above: "Do you agree that Ernst has stated that not all spinal manipulation trials are related to chiropractic?" To answer that, I would say "No, he did not". He wrote about "chiropractic spinal manipulation", not about "chiropractic". You left out those last two words, and that changes things quite a bit. You have been - possibly carelessly - using two different expressions on this talk page, and that is confusing and sometimes makes your questions seem like trick questions, hence my reticence to answer directly with a Yes or No. "Related to chiropractic" and "related to chiropractic spinal manipulations" are the two different expressions you have been using, or some slight variation of them. They mean different things, as the subjects are different.

• Please rephrase your questions and you'll get better answers. Your trick question skips a step and subtly goes directly into asking us to reply "Yes, we are engaging in OR." I don't think you are doing this deliberately, but that's what is happening. I would suggest that Eubulides retract his answers until this is cleared up. -- Fyslee / talk 06:16, 27 September 2008 (UTC)

• If Spinal Manipulation is not directly related to Chiropractic Spinal Manipulation, how can it be directly related to Spinal Manipulation? DigitalC

• Reprashed. Sorry, no tricks intended. If you look at my previous discussions, I do in fact include the quote in it's entirity. Regardless, I think the version where I left off the last two words weakens my positions because if a spinal manipulation RCT is not related to chiropractic spinal manipulation then it certainly is not directly related to chiropractic. Thank you for pointing this out to me, Fyslee. (P.S. Please note that in my verbose explanation just above, I state: ...or more specifically, the effectiveness of chiropractic spinal manipulation. Again, not tricks intended. Just shorthand.) -- Levine2112 ^discuss 06:21, 27 September 2008 (UTC)

• Thanks for fixing it. I had noticed that you used both expressions and wanted to be sure of your meaning. I wouldn't want to give an answer to the "wrong question". -- Fyslee / talk 07:13, 27 September 2008 (UTC)

2. Do you agree that if something is not related, then it certainly is not directly related?

3. Do you agree that in order to demonstrate that you are not presenting original research, you must cite reliable sources that are directly related to the topic and directly support the information as it is presented?

Please answer these questions above. Feel free to inter-leave underneath each question. Just sign each response. -- Levine2112 ^discuss 20:42, 26 September 2008 (UTC)

• These are duplicates of questions asked in the previous section. Please see the discussion in the previous section for my thoughts. Eubulides (talk) 03:32, 27 September 2008 (UTC)

• I apologize if I am wrong, but I don't feel that you ever gave me a direct answer to any of these three questions. A simple yes or no would suffice for any of these. Thanks. -- Levine2112 ^discuss 05:46, 27 September 2008 (UTC)

• I say "yes" to all 3. Sorry if that wasn't clear. Eubulides (talk) 05:51, 27 September 2008 (UTC)

• Be careful. You may want to retract that and wait to answer. See my comment above. -- Fyslee / talk 06:16, 27 September 2008 (UTC)

• Thank you for your clarity. Now, given that we are using conclusions from Murphy which say nothing specifically about chiropractic but rather spinal manipulation in general, given that you agree that Ernst has stated that not all spinal manipulation research (such as Murphy) are related to chiropractic, given that you agree that if something is not related then it certainly is not directly related and given that you agree that in order to demonstrate that you are not presenting original research, you must cite reliable sources that are directly related to the topic and directly support the information as it is presented, then will you please go with me to the next step and agree that since Murphy concludes nothing specifically about chiropractic's effectiveness for low back pain and that no other researcher has published studies which cite Murphy to discus chiropractic effectivness for low back pain, that us - as Wikipedians - using Murphy to discuss chiropractic's effectiveness for low back pain creates an orignal argument and uses Murphy to further a position which Murphy does not explicitly state and thus violates WP:OR? (Forgive the run-on, but I believe it strings together our entire discussion into a poignantm singular question for you to weigh. :-) -- Levine2112 ^discuss 06:06, 27 September 2008 (UTC)

• Just as I suspected, this was a trick setup, and not necessarily a deliberate one at that! Scrap everything above and start all over with correctly worded questions. -- Fyslee / talk 06:22, 27 September 2008 (UTC)

• No trick intended and I have rephrased (added the two words) to the question above. Regardless, I think the version where I left off the last two words weakens my positions because if a spinal manipulation RCT is not related to chiropractic spinal manipulation then it certainly is not directly related to chiropractic. Thank you for pointing this out to me, Fyslee. (P.S. Please note that in my verbose explanation above, I state: ...or more specifically, the effectiveness of chiropractic spinal manipulation. Again, not tricks intended. Just shorthand.) Much appreciated. Good faith and all that. :-) -- Levine2112 ^discuss 06:26, 27 September 2008 (UTC)

The real issue here: A <-> B

1. Is HVLA spinal manipulation related to chiropractic? Yes. It is the basis for the existence of the profession, the most commonly used treatment method, and the one (and only?) thing all chiropractors have in common. Beyond that there are wide differences between chiropractors.

2. Do chiropractors consider any peer reviewed research on spinal manipulation, regardless of performer, as important to the profession? Yes, they do. They read it, quote it, discuss it, internalize it, use it to make their own treatment guidelines, criticize it, praise it, etc.. If it didn't relate to them, they would ignore it.

3. In their peer reviewed research, do chiropractic researchers commonly refer to HVLA spinal manipulation performed by non-chiropractors as spinal "manipulation", and to HVLA spinal manipulation performed by chiropractors as spinal "manipulation" rather than spinal "adjustment"? Yes, they do on both counts. They do so because there is no physical or biomechanical difference between the two. They also do it because there is no desire to bring attention to the odd esoteric philosophical and biotheological beliefs and terminologies in the profession. This would poison the atmosphere between them and mainstream researchers with whom they cooperate in doing their research. Even if their reasoning for doing it may be different, what is done is the same, regardless of performer, so the focus on what is physically done.

4. SYNTH involves A, B, and C. We are only dealing with A and B. A = spinal manipulation, and B = the chiropractic profession. The connection is direct: A <-> B

5. This is why it is not an OR or SYNTH violation to logically relate research on spinal manipulation, regardless of performer, to the profession of chiropractic. It is highly relevant to the profession. Maybe not in every aspect, but in many, many ways, because there is a clear relation between the two made by chiropractors and chiropractic researchers themselves. They do it, and that's why we can do what they do and it's not OR or SYNTH. We have learned by observing them and are just doing what they do.

-- Fyslee / talk 07:08, 27 September 2008 (UTC)

1) It depends on who is performing it. Is HVLA manipulation performed by an osteopath, physician, physiotherapist, or myotherapist related to Chiropractic? No.

2) This is a straw-man argument that is irrelevant to this discussion.

3) Researchers can do things that Wikipedia editors can't. We need valid, reliable sources.

4) The connection is not direct. If A was chiropractic spinal manipulation, then yes, the connection would be direct.

5) While it isn't a logical violation, it IS an OR violation, because it is using the sources to advance a position that the source did not advance. Again, as Wikipedia editors, we are bound by Wikipedia's policies - which means we can't do things that researchers do, such as perform original research.

DigitalC (talk) 07:57, 27 September 2008 (UTC)

None of the claims in Chiropractic #Evidence basis advances a position that the cited sources do not themselves advance. The criticism of that section is based on a different theory of OR, a theory that is independent of whether each claim is directly supported by the cited source. Eubulides (talk) 07:19, 28 September 2008 (UTC)

Eubulides states: None of the claims in Chiropractic #Evidence basis advances a position that the cited sources do not themselves advance. What about the claim that the included sources themselves are directly related to chiropractic? -- Levine2112 ^discuss 21:46, 28 September 2008 (UTC)

No such claim appears in Chiropractic #Evidence basis. Eubulides (talk) 07:26, 29 September 2008 (UTC)

Such as claim in implied, based on the fact that it is in a section called Chiropractic #Evidence basis. DigitalC (talk) 08:52, 29 September 2008 (UTC)

There are a lot of implied claims in Chiropractic. For example, there is the implied claim that "chiropractic" is the commonly accepted term, not "chiropracty"; we can infer this from the fact that the term "chiropractic" is used throughout, and that "chiropracty" is not used anywhere. There must be thousands of such implied claims for the article. But WP:V does not require a reliable source for all inferences that one can make for an article. It requires a reliable source only for claims that the article actually makes. There is no need for Chiropractic to cite a source saying that "chiropracty" is not commonly accepted and that "chiropractic" is. Similarly for other implied claims. If well-sourced material could be removed from an article simply because an implied claim is not sourced, then Chiropractic would become empty. Eubulides (talk) 20:38, 29 September 2008 (UTC)

Firstly, I'm glad at least there is a new argument presented. You are right... to a point. Yes, there are a lot of hidden assumptions in the article. No, we don't need references for all of them (e.g. chiropractic vs chiropracty). But we do need references for the material that is contentious. Common-sense would indicate that if there is not consensus for a particular use of a reference, either its use or the reference itself must change. If the point you are trying to illustrate in the article is widely accepted, surely another reference that makes similar conclusions, but makes conclusions specifically about chiropractic, can be found? --Surturz (talk) 00:07, 30 September 2008 (UTC)

Time to give it up?

I have spent much time reading all the discussion on this topic, and IMHO User:Fyslee, User:Eubulides and User:Levine2112 are going around in circles, reiterating the same points over and over. Rather than all this legalistic argument, would it not be better to find a better source that draws direct conclusions about chiropractic, rather than using a source that is obviously having trouble obtaining consensus for inclusion? The argument "Chiropractors use Spinal Manipulation, Spinal Manipulation is bad, therefore chiropractic is bad" is a logically flawed (and WP:OR) argument just as the argument "Doctors prescribe Thalidomide. Thalidomide is bad. Therefore the whole medical profession is bad" is flawed. I feel Thalidomide is a good analogy with Spinal Manipulation because you really need to distinguish between the 'bad' use of it as a morning sickness medication vs. its other uses when discussing it. --Surturz (talk) 01:54, 28 September 2008 (UTC)

You're right about the "going around in circles" part ;-) Personally I'd like to see this discussion disappear, and it could if we didn't deal with effectiveness in this article, and left it to the specific articles on the subjects of various techniques and methodologies, like Spinal manipulation and Spinal adjustment, but that's another issue. I have mentioned this several times before, but no one is taking action on it in the form of an RfC. If they will, I'll support that we move the efficacy discussions to their respective articles.

Your comparative analogy stands on all four legs as a comparison goes, except for the pretty major details that spinal manipulation isn't "bad", and chiropractic isn't "bad". Okay, yes, I'll concede that there are some "bad" uses of SM, and there are some "bad" elements of chiropractic, but we are separating them and dealing with the good and the bad in this article. That's what NPOV requires of us. -- Fyslee / talk 06:01, 28 September 2008 (UTC)

Removing all discussion of effectiveness from Chiropractic would go way too far. The effectiveness issue is central to the controversy about chiropractic, and it cannot be ignored in an encyclopedic article. Moving some discussion to other articles would be OK, so long as what's left accurately summarizes what was removed. Eubulides (talk) 07:19, 28 September 2008 (UTC)

I don't think I have ever called for a removal of "all" discussion of effectiveness from this article, only that it be severely cut down from what is currently being proposed by yourself. We could be doing actual improvements to this article in MANY different ways if we weren't being kept bogged down now for months on this ONE issue about including detailed effectiveness matters here, instead of moving them to their respective articles where they could be dealt with in depth. Now if you want to discuss the wild claims related to effectiveness, that would fit into a section on dubious aspects of the profession. There are plenty of sources dealing with such claims, but that's another subject. -- Fyslee / talk 14:48, 28 September 2008 (UTC)

• We have made several improvements to this article in other areas while the effectiveness discussion has been going on, which undercuts the argument that the effectiveness dispute is preventing improvements in other area.
• I doubt whether the effectiveness discussion will ever go away, no matter what happens to this article. If we wait for it to go away before making further improvements, we'll wait forever.
• The article has treated effectiveness ever since its very first version in 2002 (which had only one sentence of content, almost all of it about effectiveness!). Effectiveness is clearly a core and significant area of chiropractic; discussion of it could certainly be trimmed, even trimmed significantly, but "severely cut down" goes too far.
• It sounds like you'd like a section on wild claims to be added. Can you propose one? That would improve the article, and it would give us a better idea for how it could shrink some of the existing sections.

Eubulides (talk) 16:39, 28 September 2008 (UTC)

I am all for pairing the effectiveness section down, but mianly to eliminate the barage of WP:OR violating content. We cannot take sources which make no claims about chiropractic specifically, and then use them to refute/support claims of chiropractic just because we feel that they are related. I feel that this "problem" doesn't go away because there is a constant push to include weakly sourced or deceptively written material by those wishing to denigrate the subject. That POV push was evidenced by the very first version of the article in 2002 (a wildly false and POV claim... even in 2002). Certainly a section on "wild claims" will do nothing more than push this article further down the POV rabbit hole. I don't understand why we can't write an article which discusses the profession respectfully and doesn't rely on original research and synthesis to push a POV. And I mean this both ways - POV pushing for and against the subject. Remember the laws of Newton - equal and opposite reaction. My honest opinion here is that the POV pushing against chiropractic is causing the POV pushing for chiropractic to push back; this way moreso than the other way around. So everyone just stop pushing and treat this article as if you were writing something you were dispassionate about. Image this article was about harmonicas. Or if you're a harmonica enthusiast, imagine this article was about lanyards or moulding or accordian files. Then just include well-sourced, directly related content in an NPOV fashion and we should be all right. Deal? -- Levine2112 ^discuss 18:48, 28 September 2008 (UTC)

Three questions for those in favor of exclusion

Do you agree that spinal manipulation research is relevant to chiropractic when chiropractors employ SM? If no, then give specific examples.

Do you agree when research is related to a topic it is does not have to cite the topic when the research is directly related.

If we remove all of spinal manipulation studies then what will be used instead of the most relevant studies per WP:MEDRS.

Here are a few questions for all us to better understand the debate. QuackGuru 18:59, 28 September 2008 (UTC)

1. Whether or not I agree (or any of us agree) is not the issue. I happen to disagree though. What is the issue is that researchers don't agree that all spinal manipulation research is relevant (related) to chiropractic. Mainstream researcher Edzard Ernst has stated that of the 43 RCTs for spinal manipulation effectivenss for back pain, that the majority are NOT related to chiropractic.
2. No, I don't necessarily agree with that. However, if research is directly related to a topic, then the research doesn't necessarily have to mention the topic in order to satisfy WP:OR. At this point, all we know is that there is disagreement in the scientific community about whether or not general spinal manipulation RCTs are even related to chiropractic - much less directly related.
3. If we remove all of spinal manipulation studies which do not draw conclusions specifically about chiropractic spinal manipulation, then aside from just better satisfying WP:OR, we would also be left with all of the research which is specifically about chiropractic and chiropractic spinal manipulation. If we feel then that there is not enough content, then we can certainly find more studies to cite, provided that they are specifically about chiropractic and chiropractic spinal manipulation.

-- Levine2112 ^discuss 19:11, 28 September 2008 (UTC)

If researchers don't agree that all spinal manipulation research is relevant then what spinal manipulation do they agree is related?

Exactly what type of spinal manipulation research researchers claim is not related to chiropractic? Please be specific.

We can't assume what a researcher meant or can we? QuackGuru 19:46, 28 September 2008 (UTC)

The plain answer to this is, "I don't know". Unless specified, I don't know which spinal manipulation research is related to chiropractic and I don't know which ones are not related. Neither do you. All we can know - especially in terms of our content at Wikipedia - is what the sources tells us. If a piece of spinal manipulation research states that it is related to chiropractic effectiveness (by specifically discussing chiropractic effectiveness in its conclusions), then by all means we can use it in our article to discuss chiropractic effectiveness. However, if a piece a research discusses nothing in terms of chiropractic effectiveness in its conclusions, then we cannot presume that it is directly related to chiropractic effectiveness and thus we cannot use it in our article without violating WP:NOR.

So yes, we cannot assume what researcher meant. That assumption on our part is exactly what causes WP:NOR violations. When we assume that the researcher must have meant for his/her conclusions about general spinal manipulation therapy to be applied to chiropractic effectiveness even though the researcher has not specified such an application, then we are violating WP:NOR.

Whether or not you agree, do you at least understand my position? -- Levine2112 ^discuss 21:35, 28 September 2008 (UTC)

It is to my understanding that your position is it a violation of WP:NOR if the source does not say it is related to chiropractic. That would be an incorrect interpretation of WP:NOR. We can cite SM research that is directly related to chiropractic. We know there would be not enough content, and no additional studies have been cited to replace the current references. No specific suggestions have been made. QuackGuru 01:41, 29 September 2008 (UTC)

How is that an incorrect interpretation of WP:OR considering that the policy reads: to demonstrate that you are not presenting original research, you must cite reliable sources that are directly related to the topic and directly support the information as it is presented. Given that Ernst tells us that most of the spinal manipulation RCTs are not related to chiropractic, in order to include a spinal manipulation study in our article, you must show that it is one of those few that are not only related, but moreover directly related to chiropractic. So either the source should demonstrate that its conclusions are directly related to chiropractic by discussing chiropractic's relationship to the conclusions, or you must find some other source which directly relates chiropractic to the results of that particular piece of research.

In terms of content, there is no minimum content requirement that we must meet, so we shouldn't keep WP:OR-violating material in this article just to fill up space. "There would be not enough content" is not valid argument. So far, we have only discussed a small handful of the sources used int he Effectiveness section, so I think it is premature for you to assume that there won't be "enough content". I am not suggesting replacement content at this point, because that is another conversation. However, the agreement we reach in this conversation will help guide us in the inclusion criteria for future research. Of course, my main inclusion criteria at this point would be that the content is cited to a reliable source which is demonstrated to be directly related to chiropractic and directly supports the information as it is presented. In that way, my criteria is 100% directly aligned with WP:OR policy. What would be your inclusion criteria if not what I have outlined? -- Levine2112 ^discuss 03:49, 29 September 2008 (UTC)

We are citing research that is directly related to chiropractic. Spinal manipulation is employed by chiropractors. The source does not need to cite chiropractic. We can use related research. The research cited in this article is directly supported by the information as it is presented. I have conlcuded there is no violation of OR because SM is directly related. QuackGuru 04:27, 29 September 2008 (UTC)

You are citing research that is not directly related to chiropractic. Chiropractors do not call their technique Spinal Manipulation. The source does need to cite chiropractic. We cannot use unrelated research. The information presented in this article must be supported by the cited research, not the other way around. I have concluded that there is a violation of OR because it is not for us as editors to assert that all SM studies are directly related to chiropractic. --Surturz (talk) 04:35, 29 September 2008 (UTC)

• Certainly chiropractors do call their technique "spinal manipulation". One example is "The core clinical action that all chiropractors agree upon is spinal manipulation", a statement taken from Meeker & Haldeman 2002 (PMID 11827498). These are highly respected chiropractor researchers.
• Chiropractic does not assert that all SM studies are directly related to chiropractic.

Eubulides (talk) 07:26, 29 September 2008 (UTC)

I can't quite parse the grammar of these questions.

1) Not all spinal manipulation research is relevant to chiropractic, only research of chiropractic spinal manipulation, or research that has conclusions that mention chiropractic.

2) If there are reliable sources that show that it is directly related, it might make sense to use a source that does not directly reference the article topic. However, no broad statement can be made.

3) We will use any appropriate study that has conclusions directly related to chiropractic.

DigitalC (talk) 09:05, 29 September 2008 (UTC)

understanding of WP:NOR policy

Can we cite references that are directly related or directly connected to a topic of an article?

The above question is a simple question. I want to know where editors stand on their interpretation of Wikipedia's Original Research. QuackGuru 05:00, 29 September 2008 (UTC)

That's a "still beating your wife?" question. No blanket answer could cover all the possible cases, and interpretations of "directly connected" are of the "your milage may vary" variety. - brenneman 05:10, 29 September 2008 (UTC)

At this point, from reading the comments over the last few months, editors have a different interpretation of OR. My impression is that some editors claim we can only use references that say they are related to chiropractic and some editors say it is acceptable to cite references that are directly related. But where do we go from here? QuackGuru 05:19, 29 September 2008 (UTC)

The relevant editors finding alternate references that draw conclusions about chiropractic adjustments, rather than fighting for references that talk about spinal manipulation (which may or may not be chiropractic adjustments) would be a good place to go from here. --Surturz (talk) 05:23, 29 September 2008 (UTC)

No references have been presented. QuackGuru 05:24, 29 September 2008 (UTC)

Exactly! --Surturz (talk) 06:12, 29 September 2008 (UTC)

Mass edits

I have reverted QuackGuru's mass edits which were not only done without consensus, but fly in the face of on-going discussions. I advise QuackGuru to be patient and not get frustrated by long discussions. We are working on establishing a consensual version of the content of this article. This is a delicate procedure as each side has strong opinions. The fragility of this proceedings are disrupted every time you launch into these kinds of mass edits done against our agreement here: to talk first, establish consensus second, and edit last. Please abide and help create a better functioning edit environment. Thank you. -- Levine2112 ^discuss 18:30, 22 September 2008 (UTC)

Some of QuackGuru's edits reflect what so far seems to be consensus; others were not, and revert changes that were introduced here without consensus. It's better to make edits like these one at a time, rather than all at once; that makes it easier for editors who disagree with some edits, but not with others, to revert only the edits they disagree with. Of course this strategy relies on having other editors be selective about what they revert, which has not always been the case recently, unfortunately. Eubulides (talk) 23:49, 23 September 2008 (UTC)

Consensus is growing for QuackGuru's improvements when editors do not have a valid reason for deleting content that is referenced and more accurate. For example, there were improvements to the vaccination section. Levine2112 did not provide any specfic objection to QuackGuru's mass improvements. How many references did Levine2112 delete without explanation? Hmmm. QuackGuru 05:10, 24 September 2008 (UTC)

Folks, for best results, please try to comment on content instead of contributors, hmm? --Elonka 05:12, 24 September 2008 (UTC)

I am yet to see an explanation by the editor who reverted my mass NPOV improvements. For example, I made improvements to the vaccination section. No explanation for reverting the improvements were made. Please explain what were your objections to the edit. What specifically did you disagree with. QuackGuru 17:44, 25 September 2008 (UTC)

See the past vaccination discussion in which those specific edits were not agreed to. You were attempting to "slow edit war" them into the article, but that tactic failed. Please desist your campaign of gaming the system and whining about how no objections have been presented when everyone else here knows that such objections have been presented in separate discussions. Thanks. -- Levine2112 ^discuss 00:31, 26 September 2008 (UTC)

Please provide specfic objections to the mass NPOV improvements and please stop accusing me of gaming the system. That was an WP:AGF violation. QuackGuru 01:02, 26 September 2008 (UTC)

(outdent) Can we please keep the discussion to the article? The side-comments aren't helpful. Cheers, guys. lifebaka++ 01:07, 26 September 2008 (UTC)

What would be helpful is any specific objection to my mass NPOV improvements. I do not see any specific objections. QuackGuru 01:23, 26 September 2008 (UTC)

See past discussions. I agree with Eubulides: "...revert changes that were introduced here without consensus." and "It's better to make edits like these one at a time, rather than all at once..." -- Levine2112 ^discuss 20:00, 29 September 2008 (UTC)

Just as a point of clarification: the "revert changes that were introduced here without consensus" is talking about part of QuackGuru's changes that I agree with, namely the part that reverts changes that were introduced here without consensus. I still think, though, that the changes should be proposed and discussed here one by one. Preferably in a new section for each change. Eubulides (talk) 20:38, 29 September 2008 (UTC)

I replied to the non-argument. I request specifics about content. No specifc objections to content have been made about my edit. QuackGuru 20:11, 29 September 2008 (UTC)

Specific objections have been made to the majority of your mass edits. You are either forgetting about or ignoring past conversations. If you would like to break down your edits one-by-one here, it may be easier to reply. Otherwise, I agree with Eubulides that you introduced revert changes without consensus and that it would be better to make edits like these one at a time, rather than all at once. -- Levine2112 ^discuss 20:15, 29 September 2008 (UTC)

Levine2112 wrote in part: Specific objections have been made to the majority of your mass edits. I don't see any specific objections to the content of my edit.

Please explain specifically what you disagreed with or are you unable to provide a valid reason for your revert. QuackGuru 20:20, 29 September 2008 (UTC)

Please refer to past discussions for specific objections. I have neither the time nor inclination to rehash all of the past objections without you first putting in the legwork to review those objections. Then, if you'd like, you can list out those past objections versus the content you wish to change. This way, we can all be on the same page and see if those objections still hold water. Otherwise, I'm done with this conversation and you can keep typing that "no objections have been presented" until your fingers are blue; it still won't make it true. -- Levine2112 ^discuss 20:32, 29 September 2008 (UTC)

Past discussions do not explain you reverts. You reverted without explaining your specific objections to the content of my edit. No objections have been presented to the content. Please be specific. What did you specifically disagree with. QuackGuru 20:41, 29 September 2008 (UTC)

Levine2112 wrote in part: Please refer to past discussions for specific objections.

Where in past discussions does it explain your specific objection to adding a ref citation and a ref style. Please explain your specific objection. I would like the article to be referenced. Why did you revert adding a reference citation. Please provide a link to past discussions for specific objections to the ref citation and ref style. QuackGuru 00:04, 30 September 2008 (UTC)

Gallup poll 2

I judge the consensus of editors to be that including the Gallup poll is right. Although some editors made fatuous arguments like "opinion polls are ephemeral", this is beside the point for the fact that Gallup is a recognized polling firm. We quote Gallup across Wikipedia to get readers the idea for what various populations' opinions of controversial matters are. Since chiropractic is obviously controversial, quoting Gallup is right to do.

I judge the obstructionist editors who are continually removing reference to the Gallup poll to be acting highly inappropriately.

ScienceApologist (talk) 01:25, 24 September 2008 (UTC)

You call my comment fatuous? A "Science Apologist" that relies on opinion polling rather than science to push his POV? What delicious irony. You want to argue the science, argue the science. Don't push a POV with opinion polls. Majority agreement is not the same as consensus. And the gallup poll does not have consensus for inclusion. --Surturz (talk) 02:18, 24 September 2008 (UTC)

It is reasonable to include information from a Gallop poll. Please provide a specific objection based on Wikipedia policy. QuackGuru 05:02, 24 September 2008 (UTC)

I agree with Surturz here. Describing someone's arguments as "fatuous" and editors as "obstructionist" is highly uncivil. ScienceApologist, please refrain from personal attacks. I also agree with Surturz in that there is no such things as a "consensus of editors". Majority agreement is not the same as consensus. -- Levine2112 ^discuss 02:47, 24 September 2008 (UTC)

Levine2112 agrees with Surturz who was unable to provide a valid reason to delete the Gallop poll. QuackGuru 05:02, 24 September 2008 (UTC)

Establishing consensus per WP:CON:

Consensus develops from agreement of the parties involved. This can happen through discussion, editing, or more often, a combination of the two. Consensus can only work among reasonable editors who make a good faith effort to work together in a civil manner. Developing consensus requires special attention to neutrality - remaining neutral in our actions in an effort to reach a compromise that everyone can agree on.

Someone edits a page, and then viewers of the page have three options: accept the edit, change the edit, or revert the edit. Articles go through many iterations of consensus to achieve a neutral and readable product. If other editors do not immediately accept your ideas, think of a reasonable change that might integrate your ideas with others and make an edit, or discuss those ideas. You can do this at the talk page, as an edit summary, or as a note to others at a user talk page or other widely read pages, such as the Village pump.

Edit summaries are useful, and should contain a summary of the change made to the article by the edit, or an explanation of why the editor made the change. A short summary is better than no summary. If the reason for an edit is not clear, editors are more likely to revert it, especially when someone inserts or deletes material. To give longer explanations, use the Talk page and put in the edit summary "see Talk".

Edit wars lead to page protection rather than improvements to the article.

Editors only excuse is that we do not have consensus. That is not a valid reason to delete well sourced text that meets Wikipedia's inclusion criteria. Consensus can only work among reasonable editors who make a good faith effort to work together in a civil manner. When editors or an editor continues to revert in the presence of bad faith, we have established WP:CON. QuackGuru 06:47, 24 September 2008 (UTC)

Rubbish, I have said repeatedly that inclusion of the gallup poll violates WP:SYNTH and WP:NPOV, and I think Levine agrees with me. Consensus means that all, or very nearly all, editors accept the inclusion of a particular piece of text. If other editors do not immediately accept your ideas, think of a reasonable change that might integrate your ideas with others is the bit you seem to be ignoring. Attempting to discredit the views of other editors is not the way to build consensus, changing your proposed text to incorporate their concerns is. --Surturz (talk) 07:05, 24 September 2008 (UTC)

No specific proposal was made by the above comment.

The gallup poll violates WP:SYNTH and WP:NPOV? Tha't news to me. How does it violate any Wikipedia policy.

Note: In the presence of bad faith, we have established WP:CON. QuackGuru 07:09, 24 September 2008 (UTC)

My understanding of the current status is that Fyslee, QuackGuru, ScienceApologist and I favor inclusion of the currently proposed text. Levine2112 and Surturz opposed an earlier version, on the grounds that opinion polls are ephemeral and political. The most recently proposed wording attempts to address the ephemerality issue by mentioning the similar results in 1999 and 2003. (It's not clear what the "political" issue refers to; the poll was not a political poll.) Coppertwig wanted changes to the wording of an earlier version, and the most recently-proposed wording contains changes that try to address the issues Coppertwig raised, but Coppertwig has not discussed the most recently-proposed wording. It would help to get further comments on the latest wording in #Gallup poll. Eubulides (talk) 09:17, 24 September 2008 (UTC)

I too agree that it should be included. --CrohnieGal^Talk 13:07, 24 September 2008 (UTC)

We have consensus for the Gallop poll and I agree with including it. QuackGuru 18:22, 24 September 2008 (UTC)

Great! So we have five editors saying we should include the Gallup poll, one editor who would like to reword how it is phrased (which I think we should accommodate) and two editors who argue that they don't want to see the Gallup poll included. My ability to feel out consensus tells me that the Gallup poll should be included above the objections of Surturz and Levine2112. If people would like to reword that sentence, please try: but keep the reference intact, please. ScienceApologist (talk) 18:23, 24 September 2008 (UTC)

I would prefer if we had a more neutral observer "feel out" the consensus. Also, we should work out and agree on the rewording before implementation. -- Levine2112 ^discuss 18:28, 24 September 2008 (UTC)

Third opinion is thataway. ScienceApologist (talk) 20:06, 24 September 2008 (UTC)

The text is different from the original version and there is no specific proposal to reword. A rewording was only a suggestion. QuackGuru 18:32, 24 September 2008 (UTC)

I'm curious, what do you mean Levine by "I would prefer if we had a more neutral observer "feel out" the consensus." There are 6 editors who have said to leave it in with one of the 6 stating some rewording would be needed. Who do you consider to be more neutral to "feel out" the consensus? I don't really understand this myself, thanks, --CrohnieGal^Talk 21:07, 24 September 2008 (UTC)

It was in response to ScienceApologist above touting his abilities to feel out consensus. I think that ScienceApologist is confused by consensus in that he believes it to mean "majority rules". That is not the case. I beleive that we are a critical point in a delicate conversation, and that forcing the inclusion of this information is breaking down all of our efforts to acheive such a consensus. -- Levine2112 ^discuss 21:53, 24 September 2008 (UTC)

I think we've achieved consensus beautifully and have successfully bypassed the obstructionism of the feet-draggers. I'd like to congratulate all those who helped! ScienceApologist (talk) 23:22, 24 September 2008 (UTC)

This is the problem with the editors on this article. Consensus is seen as the majority overruling the minority. Real consensus is where all editors work towards a version of the text that all editors can tolerate (or even better, all are happy with). If the majority are going overrule the minority, at least have the decency to say that is what is happening. Don't call it 'consensus' when it clearly isn't. How can you call it consensus when you are installing a version of the text "above the objections of Surturz and Levine2112"? If the editors forcing in the gallup poll would like to extend an olive branch, I would like the "rated last" text removed. It is only fair to use "rated last" if all health related professions (including things like iridology etc) are included. If Apologist, Fyslee, QuackGuru or Eubulides changed the text to "rated seventh" it would indicate that this group of allied editors are not simply running roughshod over the minority dissenting editors of this article. --Surturz (talk) 23:54, 24 September 2008 (UTC)

The latest draft does not merely say "rated last"; it says "rated last among seven health care professions", and mentions dentistry and nursing as two other professions rated. This makes it clear that the poll covered only major health care professions and excluded relatively minor players like iridology. The cited source says "rated dead last"; changing this to "rated seventh" would not summarize the source well. Eubulides (talk) 07:36, 25 September 2008 (UTC)

This is a question of good faith. You are 'spinning' the text just like you have with the lead sentence in the vaccination section. Why not just quote the percentage? Why not just say seventh, instead of 'last'? You won't even allow the smallest compromises in text. --Surturz (talk) 10:50, 25 September 2008 (UTC)

The latest draft does quote percentages, and it follows the cited source in saying "last" rather than "seventh". Eubulides (talk) 07:12, 26 September 2008 (UTC)

You claimed it violates WP:SYNTH and WP:NPOV. How so? Please tell us. What is your specific objection to the Gallop poll. QuackGuru 00:10, 25 September 2008 (UTC)

You have already asked this question and I have already answered it. QG, your habit of asking a question, ignoring the answer, then asking the same question again is becoming tiresome. I will say this once more. The reference is POV and SYNTH because the only reason you want it in there is to imply that chiropractors are untrustworthy - which is not a correct conclusion, because the people surveyed were the general public, not chiropractic patients. In other words, the poll says more about the people being surveyed than the subject they were surveyed about. --Surturz (talk) 04:44, 25 September 2008 (UTC)

If you think the ref is POV and SYNTH then what part WP:RS supports your position. QuackGuru 04:49, 25 September 2008 (UTC)

Who said anything about WP:RS? My objections were never on RS grounds. If you can't refute the NPOV and SYNTH arguments, then say so... don't try and shift the argument to RS. --Surturz (talk) 05:22, 25 September 2008 (UTC)

The current draft summarizes the source accurately; it does not introduce any POV terms, and it does not SYNTHesize any conclusions that are not in the source. Eubulides (talk) 07:36, 25 September 2008 (UTC)

I disagree. And yet again my concerns are dismissed without refutation. --Surturz (talk) 10:50, 25 September 2008 (UTC)

(outdent) The ref states "The profession still finds itself in a situation in which it is rated dead last amongst healthcare professions with regard to ethics and honesty [2], and in which only 7.5% of the population utilizes its services [3], this percentage having dwindled from 10% only a short time ago [3,4]." I don't think that the article is misrepresenting anything here. --CrohnieGal^Talk 13:08, 25 September 2008 (UTC)

in which only 7.5% of the population utilizes its services is the key here. Most people that were surveyed hadn't even used chiropractic. I'll add the 7.5% stat, which would satisfy some of my concerns. --Surturz (talk) 00:00, 26 September 2008 (UTC)

It's time to ignore tendentiousness. If you disagree, Surturz, WP:RfC, WP:TO, and WP:DR can be consulted. Also note that consensus is not unanimity. I'm comfortable with the fact that you cannot seem to understand that while only one person agrees with you everyone else disagrees with you and that does make a consensus. Good luck! ScienceApologist (talk) 16:38, 25 September 2008 (UTC)

Actually the real issue is that the Gallup poll appears in a section called "Utilization, satisfaction rates, and third party coverage" and the Gallup poll is actually measuring the general public's perception of chiropractic, not any of the three subjects in the heading. --Surturz (talk) 00:08, 26 September 2008 (UTC)

I always thought that was the main point. Anyhow, that's my understanding. It doesn't seem to belong in the section it is in. Also, it is deceptive because the vast majority of those surveyedhad never used chiropractic. Sure, they may have perceptions, but without experience, those perceptions are reduced to stereotypes and heuristics. -- Levine2112 ^discuss 00:29, 26 September 2008 (UTC)

The section title "Utilization, satisfaction rates, and third party coverage" is a dog's breakfast, and indicates that the contents of the section contain topics that are not that closely related. Specific suggestions for fixing this are welcome. I don't think anything in that section should be deleted, but it sure wouldn't hurt to move it around to be more logical. Eubulides (talk) 07:12, 26 September 2008 (UTC)

An editor claims the Gallop poll violates NPOV and SYNTH. What part of SYN and NPOV does it violate? Please explain how is violates any Wikipedia policy. QuackGuru 17:38, 25 September 2008 (UTC)

• • The current text says: Satisfaction rates are typically higher for chiropractic care compared to medical care, with quality of communication seeming to be a consistent predictor of patient satisfaction with chiropractors. In contrast, in a 2006 Gallup Poll of U.S. adults, chiropractors rated last among seven health care professions (emphasis mine). I allege that 'In contrast' violates WP:SYNTH. Contrasting the two is comparing apples with oranges - the first statistic is measuring patient satisfaction, while the gallup poll is measuring community perception. As such, I am removing the words 'in contrast'. --Surturz (talk) 03:59, 26 September 2008 (UTC)

True enough. "In contrast" is being used to create an original argument and hence is a WP:OR violation. -- Levine2112 ^discuss 04:23, 26 September 2008 (UTC)

I agree that the "In contrast" should have been removed; thanks for catching that problem. The following phrase was put in its place: "The perception of chiropractic among the general community compares unfavourably with mainstream medicine". But the cited source doesn't talk about perception in general; only about perception with regard to ethics and honesty. Also, "Among the general community" can be phrased more concisely as "public". I made this change to try to fix this (also, to standardize on American spelling). Eubulides (talk) 07:12, 26 September 2008 (UTC)

I am still not particularly happy with the inclusion of the gallup poll at all, but I can tolerate your revision. I have removed quotation of previous gallup polls under the same logic you insisted on at #Recent_undiscussed_addition_of_Sawyer_et_al._1993 --Surturz (talk) 07:52, 26 September 2008 (UTC)

I prefer the removal as well. The removed text was not part of the original proposal; see Talk:Chiropractic/Archive 27 #Gallup poll. Eubulides (talk) 08:06, 26 September 2008 (UTC)

(outdent) After this further edit which was not discussed but was logged "If the gallup line can quote numbers, so can this one." and which added the 83% satisfaction figure from the 1998 Gaumer survey, I made this further minor cleanup which identified the year and location of the survey (which is typical for Chiropractic), and correcting a minor grammar glitch. Eubulides (talk) 03:45, 27 September 2008 (UTC)

I've found this reference which may be a candidate to replace the 1998 "83%" survey. It measures satisfaction as a secondary interest, however. It does say that chiropractic compares favourably with medicine in terms of outcome and satisfaction. --Surturz (talk) 05:14, 28 September 2008 (UTC)

That study (Nyiendo et al. 2001), based on 1994–1996 data, is (as you mention) not a study of satisfaction, and it doesn't report patient satisfaction as a single number. Gaumer 2006 (PMID 16904491) reviewed the Nyiendo et al. work; as per WP:MEDRS it would be better to rely on Gaumer's review of the Nyiendo et al. primary studies than to do the reviewing ourselves. Eubulides (talk) 07:19, 28 September 2008 (UTC)

Is chiropractic pseudoscience?

See Wikipedia:Administrators' noticeboard#Chiropractic. QuackGuru 07:27, 24 September 2008 (UTC)

To clarify, it's not a question of whether Chiropractic is pseudoscience, but instead whether the dispute at the Chiropractic article, might fall within the scope of Wikipedia:Requests for arbitration/Pseudoscience. This article has been in a state of dispute for a long time, so it'd be nice to figure out a way to help stabilize things. Based on the data I've been accumulating (see my draft page at /Admin log), the majority of the dispute here is the same couple dozen editors, who keep going 'round in circles with each other. And it's also a concern to note that there are a few editors who just pop up to revert, but without actually participating at the talkpage. So having an admin presence here to deal with some of the more questionable tactics, could be helpful. --Elonka 07:36, 24 September 2008 (UTC)

I'd like to know how you can be listed in the log as both an uninvolved administrator and other frequent editor? That doesn't seem to be consistent. Also, for the record, I have used this talk page in the past, just not my last revert which I used the summary to explain my revert. This sounds hokey to me, sorry. I don't feel this is fair in the way you are describing events. --CrohnieGal^Talk 13:01, 24 September 2008 (UTC)

To clarify, Elonka originally generated this list of users, I presume by hand. I then made this change to incorporate the list of all users who contributed to the last 1000 edits to Chiropractic, with users contributing five or more edits counting as Other frequent editors. Crohnie contributed only one of the past 1000 edits, so I moved Crohnie to the Other infrequent editors section (similarly for ImperfectlyInformed, Orangemarlin, and SqueakBox). Elonka contributed nine edits, so I added Elonka to the Other frequent editors section (similarly for Dematt and Arthur Rubin). I did not examine edits to the talk page, and the "(not participating at talk)" comments were all hand-generated from my (and presumably Elonka's) faulty memories and no doubt are erroneous in some cases. Elonka's edits were all to citation formats and tags to citations, so Elonka has been uninvolved with disputes about chiropractic pseudoscience per se. Eubulides (talk) 17:08, 24 September 2008 (UTC)

User:Elonka is listed as an uninvolved admin but this is false. This should be fixed at Talk:Chiropractic/Admin log#Uninvolved admins. Elonka has been involved in a content dispute at Chiropractic. See Talk:Chiropractic/Archive 25 #Speedy deletion of former red link for example. During the discussion here, Elonka made allegations of WP:CIVIL[2], WP:POINT[3], and WP:OWN[4] violations. These statements were uneccesary to the discussion at Chiropractic, and Elonka should not claim to be an uninvolved admin. Elonka is editing as an involved at this article and the admin log page at chiropractic should reflect that. QuackGuru 17:30, 24 September 2008 (UTC)

I satisfy the requirements of WP:UNINVOLVED, as I am able to use admin tools from a position of neutrality, and any edits that I made to the article were extremely minor. I was mainly doing some source-checking a couple months ago (on this and other articles). Here at Chiropractic I added some "[" and "]" links,[5][6][7] removed some unnecessary/redundant links,[8] and improved some citations.[9][10][11] I also tagged one source as potentially unreliable.[12] I never engaged in any substantive editing of the article, and have no preference on the content of the article either way. As an admin here, my only goal is to help reduce disruption to the project. --Elonka 19:44, 24 September 2008 (UTC)

Elonka, you misunderstand what neutrality is really all about. There is no such thing as someone who is "purely neutral". We all come to Wikipedia with viewpoints, biases, prejudices, etc. Yours happens to be that you think that you are somehow "more neutral" than the rest of us. Know that this opinion is not something that anyone needs to accept and, indeed, many (including myself) rightly object to it. Acknowledging when other users feel that you have been involved goes a long way toward calming them down. Also, getting outside help from other administrators rather than taking a heavy-handed approach to imposing your administrative will is also helpful. A little humility would go a long way. Just a bit of advice. ScienceApologist (talk) 20:09, 24 September 2008 (UTC)

WP:POT seems suddenly appropriate. -- Levine2112 ^discuss 20:13, 24 September 2008 (UTC)

Eubulides, thanks for the changes, I did notice. I changed the part where it said I wasn't active on the talk page. Elonka, I'm not sure if with what you did do constitutes uninvolved. It seems you have done more than I have here but that is just my opinion of course. I appreciate the explanations though, thank you, --CrohnieGal^Talk 20:44, 24 September 2008 (UTC)

Per WP:UNINVOLVED: Uninvolved admins An administrator is considered "uninvolved" if it is clear that they are able to exercise their tools from a position of neutrality. If they have been involved in a content dispute, were a significant editor of an article in question, were involved in revert wars, or are under their own sanctions for that topic area, they do not qualify as uninvolved.

Elonka has been involved in a content dispute with significant editor of this article.[13][14][15]. Special:Contributions/Elonka is not qualified as uninvolved. QuackGuru 23:13, 24 September 2008 (UTC)

Elonka has participated in edit war.[16][17] QuackGuru 19:04, 25 September 2008 (UTC)

QG, I really wish you were joking when I read stuff like this. Elonka was not involved in a "content dispute", as there was no "content" being disputed, only formatting style of references. Please provide evidence that Elonka is not uninvolved. DigitalC (talk) 10:04, 26 September 2008 (UTC)

I have already provided evidence Elonka has been involved in a content dispute and therefore is not qualified as uninvolved. QuackGuru 18:18, 26 September 2008 (UTC)

No. . . Chiropractic is not pseudoscience.TheDoctorIsIn (talk) 23:58, 29 September 2008 (UTC)

Recent undiscussed changes to Effectiveness

This edit, which was installed without discussion, has some good ideas but it also has some problems:

• It changes Chiropractic #Effectiveness to lead with a discussion of chiropractic spinal manipulation, without making it clear that SM (though it is the main form) is not the only form of chiropractic treatment.
• It summarizes Ernst & Canter 2006 (PMID 16574972) by saying "Many controlled clinical studies of SM are also available, but while they, too, conclude that SM has not been shown to be an effective treatment for any condition, they also have been criticized for using questionable methodology." This is an inaccurate summary. The controlled clinical studies do not all "conclude that SM has not been shown to be an effective treatment for any condition". That is a conclusion of Ernst & Canter, not of the studies that they review. Also, Ernst & Canter do not criticize all the controlled clinical studies for "questionable methodology"; they merely say "Our previous work has shown that the conclusions of reviews of SM for back pain appear to be influenced by authorship and methodological quality such that authorship by osteopaths or chiropractors and low methodological quality are associated with a positive conclusion" which is not the same thing. The old text summarizes the source better: "Many controlled clinical studies of SM are available, but their results disagree, and they are typically of low quality."
• It summarizes Kaptchuk 2002 (PMID 12044130) with "What effectiveness Chiropractic care might have is often attributed to the placebo response." But Kaptchuk does not make that point, or anything like that point: Kaptchuk does not cast dobut on the effectiveness of chiropractic with words like "might have". Kaptchuk's main point is far more accurately summarized by the old text "Chiropractic care, like all medical treatment, benefits from the placebo response."
• It removes a large quantity of well-sourced text without discussion. This includes the following:

• 'There is a wide range of ways to measure treatment outcomes. Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness.'
• 'Most research has focused on spinal manipulation (SM) in general, rather than solely on chiropractic SM. Some of this research has been criticized as being misleading for failing to mention incorporation of data derived from studies of SM that do not relate to chiropractic SM; defenders have replied that SM research is equally of value regardless of practitioner. There is little consensus as to who should administer the SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors; the focus on SM has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.'

There are some improvements in this change, such as some of its ideas to reorder the text, but the improvements are mixed in with so many problems that it's hard to separate them out. I suggest that we revert the change and discuss the improvements here as needed. Eubulides (talk) 19:32, 24 September 2008 (UTC)

I think this comes from us by the same IP address who made similar edits yesterday. I recommend reverting and then continuing this discussion. -- Levine2112 ^discuss 19:54, 24 September 2008 (UTC)

• Hi all. I made those edits. It's weird cause I couldn't find a history of yesterday's edits so I made them again today. I agree with lots of responses to my edits but not all. Go ahead and revert as I realize now I should've put my proposals in the discussion page before actually making changes. I disagree with that text that precedes several citations in that version. I tried to fix it. Some of the text did not correctly capture what the cited authors were saying, or used biased language. Other text did capture what the author said but left a bias or misleading angle in the article. I deleted the whole "stealing SM procedures" bit because that has nothing to do with efficacy and shouldn't be in the article, or if it should, it should be elsewhere. Most importantly, I prefer my ordering of the info to the previous version's ordering. I think the most important point under efficacy is something along the lines that controlled studies indicate no clear medical benefit for SM for any condition, even though those studies are questionable. Jordan 21:19, 24 September 2008 (UTC)

OK, thanks, that sketch seems reasonable; can you please propose a complete set of changes here, including exactly where to move the "stealing" text to? That would help us move forward incorporating those ideas. In the meantime I reverted the first version of the edit. Eubulides (talk) 07:36, 25 September 2008 (UTC)

Most research has focused on spinal manipulation (SM) in general,[85] rather than solely on chiropractic SM.[12] Some of this research has been criticized as being misleading for failing to mention incorporation of data derived from studies of SM that do not relate to chiropractic SM;[86] defenders have replied that SM research is equally of value regardless of practitioner.[85] There is little consensus as to who should administer the SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors; the focus on SM has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.[12]

Me thinks the above information would be more relevant for Chiropractic#Treatment techniques. We can move the text without any change to content. QuackGuru 18:22, 28 September 2008 (UTC)

I am not sure about the location, but the material is more or less acceptible. However, we cannot use the material to justify the inclusion of non-specific SM research in the article. -- Levine2112 ^discuss 18:54, 28 September 2008 (UTC)

If that is your position, then we should not also use the material to justify the exclusion of SM research in this article. QuackGuru 19:08, 28 September 2008 (UTC)

Agreed. That's why I keep pointing out that the call for exclusion is justified by Wikipedia policy. WP:OR calls for sources which are directly related to the subject, not arguably related. That said, we can present the argument (as we do in the passage above), however we cannot "take sides" in the argument by basing our inclusion/exclusion criteria on the sides of the argument. All we know is policy and what the sources say. If the sources don't say that they are about chiropractic, then we cannot assume that they are. The onus to show otherwise lays with those wishing for inclusion. This is clearly spelled out in WP:OR. -- Levine2112 ^discuss 03:37, 29 September 2008 (UTC)

ArbCom restrictions

FYI, according to discussions at the administrators' noticeboard, there appears to be a rough consensus among uninvolved editors and admins that the Chiropractic article falls within the scope of the Pseudoscience arbitration case. This means that uninvolved administrators could be empowered to use discretionary sanctions to reduce the disruption to this article. The exact scope of these potential sanctions is listed on the case page. There has not yet been any move to actively place any restrictions on the editing here, though discussion about the best way to proceed is ongoing at the noticeboard thread. No restrictions may end up needed, either, depending how it goes... At this time, what is needed is for everyone to be aware of the case, and to work together to edit as carefully and congenially as possible. Thanks, --Elonka 00:43, 26 September 2008 (UTC)

I can't understand all the wikilegalese from those links? What does this mean for us editing the article? We are now under 1RR? --Surturz (talk) 00:55, 26 September 2008 (UTC)

Hopefully, no. Basically, it means that officially "uninvolved admins", some of whom have helpfully listed themselves on /Admin log (such as myself), are able to impose editing sanctions such as blocks, 1RR restrictions, etc. to editors in order to generally keep the peace and make sure most people can edit the article in peace. Hopefully we won't have to do anything, though. Cheers. lifebaka++ 01:05, 26 September 2008 (UTC)

What Lifebaka said. :) There are no current restrictions, though 1RR is being discussed at WP:AN#Chiropractic. To try and put the discussion into context: It's been recognized that there's been a dispute here at Chiropractic for some time. Sometimes longrunning disputes like these can be handled through normal dispute resolution procedures, but others are more complex. In some areas of Wikipedia that are subject to frequent disputes, the arbitration committee has authorized administrators to take stronger action than they might at other articles (normally admins are just janitors, but sometimes they have more authority). The debate at the admin noticeboard, was whether or not the Chiropractic article fell into the scope of one of those "increased supervision" areas. The general consensus appears to be "yes", so that's the first step. The next step is figuring out if any further action is needed. If the dispute resolves itself and everyone manages to figure out a way to work together, then no other restrictions will probably be needed. If the dispute continues or escalates, then further restrictions may be put in place. But right now, there are no restrictions. That help?  :) --Elonka 01:08, 26 September 2008 (UTC)

The Wikipedia community has been notified of Elonka's involvement in edit war and a content dispute regarding this article. QuackGuru 02:00, 26 September 2008 (UTC)

Thanks that clears things up for me. If we're good, bad things won't happen to us. Check. :-) --Surturz (talk) 03:53, 26 September 2008 (UTC)

Excellent! This will hopefully keep edit wars to a minimum and stop them quickly. When controversial edits are made by regulars, they should be discussed here first. If they are made anyway without discussion, that is grounds for a serious warning or worse. BOLD, Revert, Discuss (BRD) will apply as always for simple, uncomplex, uncontroversial edits. IOW, if an edit is reversed, discussion is the next step, not reinstatement of that edit. (Reinstatement would be edit warring.) Complex edits with many changes may be reverted as the simplest way to ensure consensual agreement of each edit. It's best to avoid them. Make an edit, save it, make a new edit, save it, etc.. New editors who happen by and treat this article as if it was just any uncontroversial article and get into edit wars can be warned quickly and made aware that this is not the place for BRD.

Having several admins who function as a referee committee will be good. Let's give this a chance, and I'd appreciate it if QG would lay off Elonka. Give her a chance. I suspect that she is wise enough to discuss possible sanctions with the other admins before acting single-handedly. -- Fyslee / talk 01:13, 27 September 2008 (UTC)

I note QG has been cautioned on his talkpage on this issue, although he has since deleted the text. --Surturz (talk) 03:55, 30 September 2008 (UTC)

Uninvolved adminstrators willing to serve

I'm happy to serve as a back-up admin in the event that there are any difficulties, either with normal editing or (probably more importantly) with the application of the discretionary sanctions. In that capacity I'm happy to receive notifications on my talk page with a ten-word précis linking to a discussion here. - brenneman 01:06, 29 September 2008 (UTC)

Welcome to the party pal! Uninvolved adminstrators can sign up at Talk:Chiropractic/Admin log. QuackGuru 01:11, 29 September 2008 (UTC)

Thank you for that link. However, since I like to start from first principles, what purpose are we (collectivly) anticipating that page to serve? It looks like paperwork to me. - brenneman 01:17, 29 September 2008 (UTC)

More info is at User talk:Elonka#Notification, which explains the philosophy behind it. If you don't want to use it though, that's fine. Each admin has their own style.  :) As it is, since the editing of the article has calmed down quite a bit, it looks like no restrictions may be required after all, which is a Good Thing. :) --Elonka 01:34, 29 September 2008 (UTC)

Nice to have more eyes on this. So far nothing's needed to be done, which with luck will continue to be the case. Elonka put some links up at the top of /Admin log, which may be useful. Cheers! lifebaka++ 01:14, 29 September 2008 (UTC)

Recent undiscussed changes to Vaccination

This edit by an IP address had some good ideas, but it had some problems as well:

• It inserted the claim that most chiropractic writings on vaccination claim that vaccination is "unnecessary". But the cited source (Ernst 2001, PMID 11587822) does not make this claim. It says the chiropractic literature "repeatedly stresses that immunisation is hazardous and ineffective", but it doesn't mention "unnecessary". We do have a reliable source that supports all 3 of the points (hazardous, ineffective, and unnecessary), namely Campbell et al. 2000 (PMID 10742364), so that source can be substituted for Ernst 2001.
• It removed the claim that vaccination is "one of the most cost-effective forms of prevention against infectious disease", but this claim is supported by the cited source (Busse et al. 2005, PMID 15965414) and is an important part of that source's point.
• It changed "original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines" to "original chiropractic philosophy traces disease to barriers to the optimal functioning of the nervous system, which controls immune-system function". The cited source does not support the revised claim: it says "The basis seems to lie in early chiropractic philosophy, which, eschewing both the germ theory of infectious disease and vaccination, considered disease the result of spinal nerve dysfunction caused by misplaced (subluxated) vertebrae.", "Although B. J. did not dispute the existence of germs, he rejected the proposition that they were the causes of infectious disease.", and "Another tenet of early chiropractic was that drugs were poisons that interfered with the natural healing mechanisms of the body. Vaccines were anathema, because chiropractic adjustments were considered to be all that were necessary to correct most disease conditions." but there's nothing there about immune function. In reviewing the source, it does appear that it does not directly support the claim that "diseases cannot be affected by vaccines" either, so this should be changed to something that is supported, such as "vaccines interfere with healing".

I made this further edit to try to address the points mentioned above. Eubulides (talk) 03:32, 27 September 2008 (UTC)

Please provide a quote from Busse that supports the statement "one of the most cost-effective forms of prevention against infectious disease" as you claim it does. DigitalC (talk) 07:49, 27 September 2008 (UTC)

The quote is found in the full text version:

• "Although most public health authorities would agree that vaccination constitutes one of the most cost-effective infectious disease control measures of the last century, few, if any, would argue that there are no problems associated with their use."

It's partially a direct quote. -- Fyslee / talk 15:30, 27 September 2008 (UTC)

"Partial" is correct. In its partiality, the content is taken out of context to create an original argument; one which the source does not assert. The "although" refers to second clause that most health authorites agree that there are problems associated with vaccines. However, we are taking the first clause out of context by setting the "although" against the focus of chiropractic writings on the negative aspects of vaccine. This is a WP:NOR violation. -- Levine2112 ^discuss 21:52, 28 September 2008 (UTC)

I don't agree that there is a WP:OR violation, but it's easy enough to fix the perceived WP:OR violation by removing the "Although" and do minor rewording to fix up afterwards. I made this change to do that. Eubulides (talk) 07:26, 29 September 2008 (UTC)

"most public health authorities would agree..." means that some public health authorities would NOT agree, which puts it into the realm of opinion. Again, we should not be stating opinions as fact. DigitalC (talk) 09:09, 29 September 2008 (UTC)

I'd like to see one who doesn't agree. Vaccination happens to be one of the greatest advances in medical history, and that is undisputed in mainstream circles. Only fringe elements would dispute that. The "most" is the chiropractic author's careful way of writing (after all, nothing is absolute), whereas public health authorities wouldn't write so cautiously. We could just as well choose to quote from the same source: “The CCA accepts vaccination as a cost-effective and clinically efficient public health preventive procedure for certain viral and microbial diseases, as demonstrated by the scientific community” (Policy Manual; Motion 2139/93)., although that just says "a" cost-effective, and suffers from the lack of the word "most" cost-effective, leaving it up to straight chiros to treat it like just any other medical procedure, instead of like the amazing thing it is. It's right up there with hand washing, penicillin, and clean water. -- Fyslee / talk 13:31, 29 September 2008 (UTC)

(outdent) "Most" chiropractors support vaccination, too. It's funny how you are not quite so strenuous in defending that concept. --Surturz (talk) 01:56, 30 September 2008 (UTC)

I sure hope you are right, but that is not an established fact. Significant minorities both oppose and support vaccination, with a third group who is somewhere in between, without us knowing for sure if they are opposed or supportive. I would think they are most likely somewhat oppositional, since their education and the history of the profession will have trained them to be so, but we just don't know. If I'm right, then a majority of the profession opposes vaccinations. The ACA has taken a step backwards from nearly positive to noncommital in a way that aids those who oppose vaccination, and the ICA and WCA are of course against. -- Fyslee / talk 04:34, 30 September 2008 (UTC)

Recent undiscussed changes to Safety

This edit by an IP deleted a sentence that was difficult to understand but supported by the reference. The average reader is not going to understand this sentence but we should leave it in the article for now. QuackGuru 18:29, 28 September 2008 (UTC)

I agree that the wording in that sentence is a bit hard to follow. Suggestions for making it clearer are of course welcome. Eubulides (talk) 07:26, 29 September 2008 (UTC)

This controversial edit deleted well sourced text that made a very important point. No explanation has been made for this edit. QuackGuru 00:59, 29 September 2008 (UTC)

The original reference (a literature review of hundreds of chiro patients) drew no conclusions about frequency of serious adverse events. The replacement reference (which already has consensus for inclusion, as it is used elsewhere) was a study of thousands of chiro patients and concluded that the incidence of serious events is low or very low. This matches the preceeding sentence which says such events are "Rare". The two references are contemporary (the replacement ref being slightly more recent). I don't think anyone here would put forth the argument that chiropractors are causing death or disability in a large number of their patients, underreporting or no. --Surturz (talk) 01:58, 29 September 2008 (UTC)

It matches the preceeding sentence which explains such events are Rare. That means it was duplication to add this edit. The important conclusions were deleted and then replaced with duplication. QuackGuru 02:04, 29 September 2008 (UTC)

So are you saying the entire sentence should be deleted, or would you prefer it trimmed to mention underreporting only? --Surturz (talk) 03:49, 29 September 2008 (UTC)

I prefer the entire sentence be expanded. Your edit added duplication and deleted an important point without any valid reason. Do you agree you added duplication anyhow. QuackGuru 04:15, 29 September 2008 (UTC)

Underreporting

I agree that the edit was controversial. It's better to discuss edits that delete well-sourced material here first. The replacement reference (Thiel et al. 2007, PMID 17906581) is a primary study, and as per WP:MEDRS the original source Ernst 2007 (PMID 17606755), which is a review, should be preferred. Furthermore, Thiel et al. do not contradict Ernst's claims that underreporting is a very real possibility and a potential source of bias in their results: on the contrary, they explicitly agree with Ernst on this point. With this in mind, we should not remove the text or the citation to Ernst 2007. Eubulides (talk) 07:26, 29 September 2008 (UTC)

Theil et al however DO contract Ernst in saying that the risk is unknown. Instead, they state that it is low to very low. DigitalC (talk) 09:13, 29 September 2008 (UTC)

To a degree the risk is unknown in part because of the unreporting and the rarity of some of the incidences. This information is giving context to the reader. Low to very low is duplication. Please explain why you want duplication. QuackGuru 18:10, 29 September 2008 (UTC)

Thiel et al. do not contradict's Ernst's point that the risk is unknown due to underreporting. Their results apply only to reported cases. They make this point abundantly clear in their paper. Eubulides (talk) 20:38, 29 September 2008 (UTC)

The risk is unkown because of the underreproting bit is a valid point and adding duplication has not been explained. QuackGuru 00:11, 30 September 2008 (UTC)

'Underreporting' is just an opinion and a weak theory at that. . . we should not present thoughts like that as though they were statements of facts. . . we do know that incidence is incredibly low making chiropractic one of the safest health professions around according to all major insurers. The risk is known. . . but it may be too small to pinpoint. . . we are talking fractions of percentages here.TheDoctorIsIn (talk) 00:13, 30 September 2008 (UTC)

This is not correct. First, the fact that underreporting is an issue is agreed by multiple reliable sources. For example, Thiel et al. write that underreporting is a very real possibility and a potential source of bias in their results. Second, the underreporting mentioned by Ernst 2007 (PMID 17606755) is not merely an "opinion": that source is a reliable review that cites several primary studies, which agree that underreporting is at very high levels (approaching 100%). No reliable sources disagree with these studies. It's not right to delete well-sourced material with weak justification like it's "one guys opinion". We need reliable sources for changes like this. I restored the deleted text and citation. Eubulides (talk) 00:30, 30 September 2008 (UTC)

Following up on my own comment: the text already says that serious adverse effects are rare. The (now-reverted) text would alter this to say that it's not only rare, the incidence of these complications is low to very low. It would be OK to mention "low to very low" in addition to rare. But it's not OK to omit all discussion of the well-sourced and important issue of underreporting. Eubulides (talk) 00:35, 30 September 2008 (UTC)

I see underreporting as a separate issue to the incidence of severe adverse effects. Removing the underreporting part was probably a mistake on my part. However, quoting Ernst to say that the incidence is 'unknown' is misleading; really all it means is that Ernst didn't do enough research to give the incidence a number. I don't think Ernst was trying to say that chiropractors might be killing or injuring large numbers of people without any of us knowing about it. All of us know that chiropractic cervical adjustments can and have killed a small number of patients in the past; I am sure you don't need to look very hard to find chiropractors that don't perform cervical adjustments because of this risk. You and Fyslee's reversion of the change (rather than the more sensible course of re-adding the underreporting text) just shows that you prefer the POV-pushing hatchet job version of the Safety section, just as you both prefer the POV-pushing hatchet job version of the vaccination section. Ernst says that to enable informed consent for chiropractic, a large prospective study should be done. Thiel et al is such a study, and it is indicative of your POV-pushing that you don't want it included, when it clearly represents what everyone knows about the incidence of death or disability caused by chiropractic; that the incidence is low or very low. --Surturz (talk) 01:47, 30 September 2008 (UTC)

When there is underreporting the incidence will be unknown to a degree. Both are related. QuackGuru 03:36, 30 September 2008 (UTC)

I'd estimate that what is in there now. . . what my edit was reverted to by an editor claiming ownership of this article. . . is more misleading and untruthful. . . it promotes an opinion as though it was a fact. . . which is unacceptable. Surturz's estimation about POV-pushing is frighteningly close to accurate.TheDoctorIsIn (talk) 04:15, 30 September 2008 (UTC)

This edit added attribution against WP:ASF. For example: "some researchers" gives an impression there is serious disagreement among reliable sources when no evdience has been presented. QuackGuru 05:09, 30 September 2008 (UTC)

At the crossroads

There are still improvements to be made. The crossroads bit has to do more with a historical perspective and can be added to the history section and the combines aspects bit is an accurate description for the scope of practice section. There is also a discussion at the NPOV board about all the unecessary attribution added to this article. See Crossroads of Chiropractic. An archived discussion about asserting facts can be found here. QuackGuru 19:19, 28 September 2008 (UTC)

On this page you have people arguing that it is pseudoscience. . . I don't think the crossroads statement is a fact. . . I like it though because it is a far nicer description than the this place typically gives to chiropractic.TheDoctorIsIn (talk) 00:00, 30 September 2008 (UTC)

A serious misquoting problem

Levine2112 has been misquoting Edzard Ernst many times here and elsewhere, and it needs to stop. I am copying a bit of an exchange from my talk page where it happened yet again:

I replied to Levine2112:

Just as I suspected, you once again misquote Ernst when you write:

• "In the face of Edzard Ernst stating that the majority of spinal manipulation RCTs for lower back pain are in fact not related to chiropractic, ..." - Levine2112

You have been doing this time and time again on Talk:Chiropractic by leaving out the last two words - "spinal manipulation". You even know the exact quote because you occasionally quote it right, but insert your own opinion and OR when you misquote him by leaving out the SM part. Let's compare the real quote and your misquote:

• "... do not relate to chiropractic spinal manipulation.- Edzard Ernst
• "... Edzard Ernst stating ... not related to chiropractic." - Levine2112

You are making a talk page OR violation when you do that, because you interpret him as meaning chiropractic, when he says and means chiropractic "spinal manipulation". Now please stop doing this not so subtle manipulation of his quote for your own purposes.

This has been going on for far too long. I don't believe that Ernst would say that spinal manipulation was not related to chiropractic. It is extremely relevant to chiropractic, and Levine2112 knows it. This manipulation of Ernst needs to stop. Whenever Levine2112 does this, he needs to be confronted with it. -- Fyslee / talk 04:18, 30 September 2008 (UTC)

You don't believe Enrst would. . . or you don't know? More conjecture doesn't help here. It seems this debate is about a section dealing with the effectiveness of chiropractic. . . chiropractic spinal manipulation is the chief therapy chiropractors prescribe to our patients. . . not spinal manipulation but chiropractic spinal manipulation. . . a.k.a. spinal manipulation. So if Enrst says that not all spinal manipulation studies are related to chiropractic spinal manipulation then why the hell would they be related to chiropractic?TheDoctorIsIn (talk) 04:22, 30 September 2008 (UTC)

I just looked at your talk page, and Levine2112 quotes Ernst fully, including "spinal manipulation"? I fail to see any 'serious misquoting problem'... Ernst's letter says that studies of non-chiro SM should not be used to draw conclusions about chiropractic SM... which is what Levine2112 (and I) have been saying all along. --Surturz (talk) 04:33, 30 September 2008 (UTC) P.S. Unless you are trying to say studies of non-chiro SM should not be used to draw conclusions about chiro SM but those same studies of non-chiro SM *can* be used to draw conclusions about chiropractic in general?? I don't understand your complaint. --Surturz (talk) 04:35, 30 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: )