Talk:Chiropractic

Proposal: Philosophy: Straight and Mixer (2013 update) Version 2.001 (beta)

The philosophy of Chiropractic merges both elements of vitalism and materialism. Chiropractors emphasizes manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders The relationship between structure, especially the spine, and function, as modulated by the nervous system, is central to chiropractic and its approach to the restoration and preservation of health. Chiropractors examine the biomechanics of the spine and other joints of the neuromusculoskeletal system and examines its role in health and disease. It is hypothesized that clinically significant neurophysiological consequences may occur as a result of spinal dysfunction/subluxation, described by chiropractors as the vertebral subluxation complex Most practitioners currently accept the importance of scientific research into chiropractic. Foundational concepts of the philosophy of chiropractic includes the following principles:

• Vitalism accepts that all living organisms are sustained by a vital force that is both different from, and greater than, physical and chemical forces. Contemporary is it is referred to as "vis medicatrix naturae" (the healing power of nature).
• Holism postulates that health is related to the balanced integration of the individual in all aspects and levels of being: body, mind and spirit, including interpersonal relationships and the interplay between lifestyle, environment, and health.
• Naturalism states a preference for natural remedies. This is bound up with a set of philosophical principles which may be expressed as the body is built on nature’s order, it has natural ability to heal itself, that this is reinforced by the use of natural remedies, that it should not be tampered with unnecessarily through the use of drugs or surgery
• Humanism is based on the postulate that individuals have immutable rights, for example the right to dignity. In CAM there is extensive concern about dehumanizing procedures and the dehumanizing institutions that have been created for the ill. Partly it is recognition of the personal, social and spiritual aspects of health and a move away from simply the biology of health.
• Therapeutic Conservatism is the use therapies that have a low level of side effects and it tends to accept that the least care is the best care. This in some ways is derived from earlier principles. if the body is capable of healing itself, the role of the therapy is simply to initiate the process.

Upon its founding 1895, chiropractic's early philosophy was rooted in vitalism, magnetism, spiritualism and other constructs that were not amenable to the scientific method. A self taught healer, D.D. Palmer, attempted to merge science and metaphysics. In 1896, D.D. Palmer's first descriptions and underlying philosophy of chiropractic was strikingly similar to Andrew Still's principles of osteopathy established a decade earlier. Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction/subluxation to improve health. Palmer drew further distinctions by noting that he was the first to use short-lever HVLA manipulative techniques using the spinous process and transverse processes as mechanical levers. Additionally he described the effects of chiropractic spinal manipulation was mediated by the nervous system in contrast to osteopathy who believed the effects were attributed to the supremacy of the circulatory system. Palmer initially denied being trained by osteopathic medicine founder A.T. Still but later acknowledged osteopathy wrote that the "the underlying philosophy of chiropractic is the same as osteopathy... Chiropractic is osteopathy gone to seed."' By embracing both vitalism and materialism the philosophy of chiropractic has produced a diverse and eclectic mix of chiropractors which despite their emphasis of manual therapy they may vary on their perceived scope of practice, interventions and their role in the health care system.

"Straight" chiropractic

Also known as 'subluxation-based' and 'principled chiropractic', chiropractors educated from this paradigm espouse traditional Palmer principles and philosophy. Historically straight chiropractors regarded spinal joint dsyfunction/subluxation as the primary cause of "dis-ease" and could be corrected via specific chiropractic adjustments. This monocausal view of disease has been abandoned by the profession preferring a holistic view of subluxation that is viewed as theoretical construct in a "web of causation" along with other determinants of health. Palmerian philosophy focused on metaphysical constructs such as Innate Intelligence and Universal Intelligence to explain the effects of the chiropractic adjustment, whose intent was the reduce/correct spinal subluxations and improving the functioning of the nervous system. The subluxation was said to be "the cause of 95 percent of all diseases... the other five percent is caused by displaced joints other than those of the vertebral column." Misalignment of the vertebrae was believed to be cause impingement of the nerve root, a theory which has long been debunked Subluxation-based chiropractors view traditional chiropractic lexicon such as "analysis" and "adjustment" and as a critical distinction of chiropractic despite lack of prevalence of these terms in the chiropractic literature Subluxation-based chiropractors have been criticized both internally and externally for far-reaching claims of "killer" subluxations, pseudoscientific reasoning, dogmatic approaches unethical business practices that invoke religious themes and high-volume treatments for a variety of conditions that lack supportive scientific evidence. This metaphysical and dogmatic and singular approach to chiropractic care has been criticized for failing to engage in critical and rational thinking and embracing evidence-based medicine. Straight chiropractors use a subluxation-based model as opposed to the patient-centered model now favored in health care. Although they are the minority within the profession, they are considered to have a disproportionate influence as "purists".

"Mixer" chiropractic

Mixers form the majority of chiropractors and attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness; While D.D. Palmer considered vertebral misalignment to be the hallmark feature of subluxation, mixer pioneer Solon Langworthy asserted that intervertebral hypomobility, not misalignment, was subluxation’s cardinal biomechanical feature. This contrasting mechanistic emphasis, intervertebral misalignment vs. hypomobility, formed one the basis for a heated polemic in the profession. Although both misalignment and hypomobility are currently recognized as biomechanical features of subluxation, hypomobility has garnered much more attention in recent years. Mixers were disdained by the Palmers who disapproved of their use of instrumentation and mixing chiropractic diagnostic and treatment approaches with osteopathic, naturopathic and medical viewpoints.. MIxers combine both vitalistic and mechanistic viewpoints that has led to scientific investigation of chiropractic principles. Mechanistic underpinnings have led to testable hypotheses that structure affects function via the nervous system by the scientific study of joint dysfunction and the biological mechanisms underlying manipulative therapies Scientific chiropractors suggest that dropping "subluxation dogma" and similar hypotheses without evidence will allow chiropractic care to become integrated into the wider health care community. In contrast to subluxation-based chiropractors, evidence-based chiropractors favor and incorporate mainstream medical diagnostic and treatment approaches such as exercise, nutritional supplementation, self-care, physiotherapeutic modalities, and other natural approaches. A majority of mixers retain belief that spinal dysfunction/subluxation may be involved in somato-visceral disorders. This group may represent the 'silent majority' of centrists who embrace evidence-based medicine but feel comfortable retaining elements of the subluxation complex that have not been validated through empirical evidence.

References

Comments (Proposal: Straight and Mixer)

Are you proposing adding this to an article that is already >100k? (last edit made it 118,063 bytes). Per WP:TOOBIG the article is already WAY to big and ALMOST DEFINITELY needs divided and chopped up. Articles shouldn't exceed 50k, it's already over TWICE that. So obviously, no for adding this text to the article without serious cuts to it's content. — raekyt 05:21, 21 February 2013 (UTC)

It will be replacing the current version and has taken several sources from other parts of the article and incorporated them in the appropriate way. Prior to Doc James reversion, the article stood at a lean 91k down 30 over all and reflects all the sources accurately. We're going to go over them one by one. Unless you oppose specific sources, this material is essential to the article. Please specifically cite what changes you would like to see and what sources you are challenging. DVMt (talk) 05:52, 21 February 2013 (UTC)

The reason why you had half a dozen editors revert your changes was that we do not think your changes "reflected all the sources accurately." Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:54, 21 February 2013 (UTC)

I haven't even looked at the sources, but the existing History section is 2.6k this is 4.4k, almost twice the size. So it's headed in the wrong direction if we're trying to bring this article to a manageable size. Like 40k needs to be cut. Would a History of Chiropractic article be unreasonable, if something like it doesn't already exist, and WP:SPLIT out the history, and maybe split out other parts as well? — raekyt 05:58, 21 February 2013 (UTC)

That's incorrect Doc. Only you reverted the article in its entirety. Prior to that it stood for 10 days without any reversion. You assumed that sources were being misused despite not even having read the content in question. If you're not reading it and checking the sources directly, than how is it possible to make any accurate judgment on the material? DVMt (talk) 06:22, 21 February 2013 (UTC)

No, we have Yobol in this edit [1] and RexxS in this edit [2] who reverted all of it as well. We have other reverts of your changes by Raeky in this edit [3] and Alexbrn in this edit [4] plus me which brings us to 6 different editors who disagree with your changes.

Vote stacking doesn't count and they agreed with the admin in question. How could they have read all the material in 1 min? Not likely. Raeky thinks spinal manipulation is as effective as crystal healers so that covers that. You're also being misleading because Raeky and Alexbrn did not revert the whole article, only you did and had the troops on stand by. Regardless, that's water under the bridge. Feel free to stick around for the long haul and oversee the 2013 update. I wouldn't have it any other way. DVMt (talk) 01:06, 22 February 2013 (UTC)

"Vote stacking" "troops on stand by" Seriously.... Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:54, 22 February 2013 (UTC)

I did read the content and changes in question which is how I determined that the sources were being missed. And than I noticed that high quality sources that reflected less than positively on chiropractics had gone missing. So I restored said sources to the last stable version of the article per WP:BRD

With respect to it standing for 10 days with NO changes, uh, you made a 15 edits the day before and 4 edits the day before that and 8 edits the day before that? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:38, 21 February 2013 (UTC)

It's not called chiropractics. There is no 's'. Also, you're again taking thing out of context. The article had been revised for a total on 10 days without any reversions from Raeky, Alexbrn, TippyGoomba, Bobrayner or any other potential dogmatic skeptic. Primary sources went missing, replaced by secondary sources. But I suppose, as TippyGoomba suggested, that I'm being too focused on the science and should focus more on the magic. As for deleting sources, for your revert kiled 60 additional references a good chunk which were secondary and tertiary sources. DVMt (talk) 01:06, 22 February 2013 (UTC)

The old version has 179 refs your "update" has 139. I pointed out some recent (in the last 2 years) reviews that disappeared in your changes. But anyway it is up to you to convince the community that these where improvements. This has not been done. While return when I see a concrete proposal / RfC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:53, 22 February 2013 (UTC)

Primary studies were replaced with secondary sources which is why the count went down. You still deleted 60 additional sources. DVMt (talk) 16:01, 23 February 2013 (UTC)

Raeky I'm not opposed to the idea of a split once the proposed revision gets a hard look. Like I mentioned you said that 40k needed to go 30k is achieved with the 2013 revision. I think we could pare it down even more and if we can't a split is perfectly reasonable. DVMt (talk) 06:27, 21 February 2013 (UTC)

10 days? How about WP:NORUSH? Also, notice how only a single WP:SPA came to your defense when your massive white-wash was reverted. Anyway... back to the purposed edit... I actually think that this distinction between straight and mixer isn't adequately covered in the article. This relates to DVMt's white-washing efforts, he wants the article to be more about the science and less about the magic. But imagine if someone tried to edit the mystical bullshit out of the Yoga article. TippyGoomba (talk) 06:33, 21 February 2013 (UTC)

So Tiippy, you want the article to be less scientific then? DVMt (talk) 01:06, 22 February 2013 (UTC)

You have a version in your head and the reality is less scientific. The article should reflect reality. Put up some stats on how Chiropractors view innate intelligence and vaccinations which reflect reality and I will instantly change my view of how the article should be presented. TippyGoomba (talk) 02:27, 22 February 2013 (UTC)

There's a major difference between 'having a version in your head' and having reliable sources that supports the claims made. By adding 60 new references from 2005-2013 the tone did shift, moreso because there was scientific evidence thats now exists on given topics that didn't previously. As DigitalC mentioned somewhere at talk, the last major revision was in 2008. Five years have passed and now in 2013 there's a lot more sources that updates the "story" of chiropractic. It was being edited from a straight viewpoint (20%) as opposed to a straight and mixer (80%) viewpoints. Don't forget, globally there are virtually no straight schools. This decreases their numbers even further. As straight chiros get 'diluted' there will be socio-cultural change not only within the profession itself but also how collaborates with mainstream scientists. In 2018 the story will continue to evolve and change. But we must tell the whole story, history and present. Ok, to your other question. Innate intelligence is a weird term; cause it has different meanings apparently. Vis medicatrix naturae (healing power of nature) is a synonym and its also represents homeostasis. To straight chiropractors it's a separate philosophy tied in with subluxation this is about 20% of the chiros in the States. So, definitely a minority. Their views run counter to the chiropractic mainstream. The anti-vax is roughly the same 20-25%) because, again, the straights seem dogmatic with their views which fall are out of the mainstream in both chiropractic and medicine. DVMt (talk) 04:33, 22 February 2013 (UTC)

Would you happen to have sources for those numbers? Because that would change everything in my mind. TippyGoomba (talk) 04:51, 22 February 2013 (UTC)

I'm looking for secondary or tertiary sources that would be better than a primary study. Also most of the literature focuses on the US. When I find it I'll post it here. Any specific comments regarding the proposed straight vs mixer revision? DVMt (talk) 15:58, 23 February 2013 (UTC)

Since the material presented has not been challenged for several days, I will move into the main article to enhance the current 'straight vs.mixer' section. Regards, DVMt (talk) 02:09, 28 February 2013 (UTC)

Tippy has failed to discuss his controversial edit that removed non-challenged material. I will revert per BRD: and Tippy must discuss, specifically, his/her concern. DVMt (talk) 04:26, 28 February 2013 (UTC)

I do not see consensus here for the change DVMt? It is the person trying to make the change that needs the consensus not the other way around. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:40, 28 February 2013 (UTC)

Doc James, without discussion (again) [5] has reverted material that had been proposed and had 0 opposition until it's insertion tonight. Could both Tippy and Doc James specifically state what material they find controversial. DVMt (talk) 04:42, 28 February 2013 (UTC)

Consensus can be changed. You called the edit controversial, please explain what specifically you found offensive. DVMt (talk) 04:52, 28 February 2013 (UTC)

Ah just because there is not active opposition dose not mean there is support. All of a sudden these two section ended up under history? Yet they are still active concepts not just historical concepts. Thus disagree with them being subheadings. 05:05, 28 February 2013 (UTC) — Preceding unsigned comment added by Jmh649 (talk • contribs)

It wasn't exactly obvious what your changes were, but I looked through them. There were some good things, and some suboptimal things:

• On the good side, I like that you 'translated' the large box under Conceptual basis to prose, which Wikipedia prefers.
• Also good, you also translated the list of philosophy bullet points and the "Straights and mixers" table to prose.
• Also good was the separation of the "straight" and "mixer" concepts
• Not so good: You broke off some content from Conceptual basis and created a new History section, but there is already another History section, so you made a second one.
• You added a bullet point "Therapeutic Conservatism" as a part of Conceptual basis but it was just floating there by itself, and had some extraneous close-braces.
• Under your new History you added a large quote from Palmer in support of an argument as to whether Palmer got the idea from Still. Big quotes like that are not preferred, it'd be better to just state the point being made.
• Under "'Straight' chiropractic" you added a bunch of "scare quotes", that is not a preferred style.
• In general a lot of new content was added to this article which was already tagged as too large.

So I think the reverts were justified, there's some stuff to work on here. Zad68 05:09, 28 February 2013 (UTC)

Ok, these are great, insightful comments. The history was not meant to replace the current history section, but as a means of introducing the philosophy (ies) underlying chiropractors to it would read better. Removing the history subsection there would clarify it. It was also not the intent to make the straight vs. mixer distinction appear as a historical fact, indeed I recognize this is present currently. Regarding Palmer and Still, Palmer in fact did acknowledge that philosophically, the underpinnings of chiropractic are osteopathic which makes sense given their affinity for manipulation. The bullet point was a CE that can easily be undone. I will do this. The scare quotes are an actual article I believe, if I find it I can support the "killer" subluxations claim. The article is large, but my proposed revision was 30k less than this and this is a section at a time breakdown. These are good suggestions and interestingly, things I had not even considered controversial (such as the accidental classification of straight and mixer as "historical" were brought to attention. This is good because I believe there is a lot of common ground here. Thanks for your input Zad68. DVMt (talk) 05:20, 28 February 2013 (UTC)

Comments (Proposal: Straight and Mixer, Version 2.001 (beta))

As per the recommendations of Zad68 and Doc James, a revised proposal has been made (see the proposal 2.001b). Open for discussion and comments. DVMt (talk) 00:46, 1 March 2013 (UTC)

Note that the revised content is at the top of the section; named :Proposal: Philo of Straight and Mixer, 2013 DVMt (talk) 02:45, 1 March 2013 (UTC)

My comments on "Version 2.001 (beta)": In general, in parts, the tone is too "in-universe", meaning that it is written not as an academic, outside commentary or review of chiropractic philosophy, but rather it is written on top of the assumption that the philosphy or principles have an evidence base or are grounded in fact. Some of the terms used don't have any meaning to a non-specialist, and require in-line explaining or a Wikilink. Also, some of the words chosen are promotional rather than informative. Specific examples:

• Chiropractic medicine embraces naturalistic principles that suggest decreased "host resistance" of the body facilitates the disease process. - "Embraces" is too flowery; "naturalistic principles" isn't defined or wikilinked; "host resistance" likewise

• these terms where in the cited source. We can change them however. "Chiropractic medicine is part of the natural healing arts. Chiropractic theory suggests that decreased host-resistance of the body facilitates the disease process DVMt (talk) 04:48, 1 March 2013 (UTC)

• Chiropractors propose manual, conservative and natural interventions are preferable towards optimizing health and functional well-being. - Preferable to what? Is "conservative" here the same "conservative" as in "conservative treatment", the term found in medicine? "optimizing health and functional well-being" sounds purely like brochure-speak and isn't imparting actual encyclopedic information.

• Agreed this sentence is problematic. Chiropractors propose manual and manipulative interventions as part of a conservative treatment approach for neuromusculoskeletal disorders. DVMt (talk) 04:48, 1 March 2013 (UTC)

• Chiropractors emphasizes manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders. - This sounds "in-universe" because it's written on the assumption that chiropractic has been shown to be in general an equally valid alternative to medications and surgery.

• I disagree, for two reasons. One, there is proof of equivalency for LBP (thereby reducing meds and surgery) and the tertiary source, by Dr. Haldeman (MD, DC, PhD) et al. is a well regarded textbook amongst manual medicine practitioners and it's WP:MEDRS compliant. I acknowledge a source outside the profession would be nice but it would have to directly challenge the claim being made. DVMt (talk) 04:48, 1 March 2013 (UTC)

• The relationship between structure, especially the spine, and function as modulated by the nervous system, is central to chiropractic and its approach to the restoration and preservation of health. - Again "in-universe" written on the assumption that chiropractic has been shown to restore and preserve health.

• The source was quoted verbatim but I don't see why we couldn't change to "Chiropractic theory suggests the relationship between structure (primarily the spine) and function (modulated by the nervous system) is central to chiropractic and its approach towards the restoration and preservation of health.

Many more examples like this follow.

Some good things:

• It is hypothesized that clinically significant neurophysiological consequences may occur as a result of spinal dysfunction/subluxation, described by chiropractors as the vertebral subluxation complex. - This is good, the kind of tone we're looking for in a Wikipedia article, it's written from the point of view of an outsider critically examining chiropractic philosphy.
• Discussions of history seem good.

Sourcing: I think part of the issue of the tone of the prose is the choice of sourcing, not because it isn't authoritative or reliable - after Googling "Scott Haldeman", I can't imagine anyone more authoritative on chiropractic - but because it is mostly "in-universe" sourcing, meaning sources written by chiropractors and those involved in the promotion or management of chiropractic as a profession, and published in journals like Chiropractic and Osteopathy and Chiropractic and Manual Therapies. The WHO document was discussed earlier. I'm not saying not to use such sourcing, but rather when writing the article content you have to step outside the world of chiropractic and describe it as what "they" (chiropractors) think. This is done in some places but it has to be done everywhere.

• I understand your concern of the insourcing, but realistically, who knows more about the chiropractic profession then their own scholars? The sources all meet WP:MEDRS reliable sourcecs and are published in mainstream academic publishing houses. The same applies to any profession, medicine knowing the most about medicine, lawyers about law etc. The claims also aren't bold are controversial, their simply ones from better sources that are more current. CMT is now what CO was. It's indexed by pubmed, and the article in question is written by Gert Bronfort who co-authored Cochrane reviews. It's examples like these that we must have an outside source, such as yourself, to review the source in question and be educated, to a degree, on the main authors. A good discussion for later I'm sure!. DVMt (talk) 04:48, 1 March 2013 (UTC)

Grammar: There are a number of small things to clean up like subject/verb agreement, singular/plural errors, missing punctuation, etc.

• Yeah, that's for sure. DVMt (talk) 04:48, 1 March 2013 (UTC)

Zad68 03:48, 1 March 2013 (UTC)

Zad,I cleaned up the proposal for this section as per your suggestions. Can you give it a peek and give comments prior to insertion? DVMt (talk) 16:55, 2 March 2013 (UTC)

Might not be a bad idea to get a RfC and greater community attention than just the couple of us. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:35, 2 March 2013 (UTC)

At this point I think the collaborative version addresses the major concerns . Zads analysis was great and there's input from MDs a DC and a DVM. It couldn't have been done without all of us. Since the material isn't challenged it's pretty close being ready to go :). DVMt (talk) 19:08, 2 March 2013 (UTC)

I see you've made some changes, took out the jargon-y sentence. I'm not sure what "natural healing arts" means. Regarding words like "embrace", this is where you, as a Wikipedia article editor, need to look at the wording and context used in the source, which is a chiropractor talking to chiropractors, and translate it into a general Wikipedia article talking to nonspecialist readers. This often involves intentionally using less florid prose than the sources. I see there is a separate Philosophy of Chiropractic article, so this article should give only a brief introduction to the most important points and link to the main article. This might be a case where the content will go in and will get toned down by other editors or at a GA review. Zad68 04:23, 3 March 2013 (UTC)

What you must do is get a formal support that this new version is better than the previous. And what you plan to replace with it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:26, 3 March 2013 (UTC)

Ok. Will look at the proposal again and refine the language. Great tips again! I really appreciate your help Zad. I see you as a mentor figure. DVMt (talk) 04:34, 3 March 2013 (UTC)

Zad I'm not going to include the arts thing. It's wordy. Let me know if you find other issues you want to iron out, or just go ahead of change it yourself above. DVMt (talk) 05:09, 3 March 2013 (UTC)

Does anyone oppose the proposed text (which will replace the current philo/straight/mixer) section)? If not, I will insert it. DVMt (talk) 18:57, 5 March 2013 (UTC)

• By incorrectly saying science necessariy is is a materialistic and reductionist philosophy in your proposals you appear to be putting up a straw man that medicine does not take a holistic approach (which is not the case as the article holistic article and citations within make clear). From reading [6], which is written "in universe" I doubt its reliability for statements about science or medicine in general. Also, drop the use of the allopathic terminology, nothing says written by a quack louder than using the word allopathic to describe medicine. I'm not saying this is what you intended, just that this is the impression it would give off if added to an article, IRWolfie- (talk) 22:51, 5 March 2013 (UTC)

Thanks for chipping in IRWolfie. I didn't realize allopathic was pejorative, it just flowed with the chiropractic, osteopathic, allopathic. I believe I saw this terminology used at the Osteopathic Medicine page. It was not my intent though for it do come off as a judgemental, quack sounding term. Regarding the statement of materialsim, I have to look and see where it is. THe source said it incorporate both vitalistic and materialistic philosophies. But again, it's not aimed as a criticism of science. I do see more medicine using a holistic approach, but holism is predominantly associated with CAM. I will revise the proposal and feel free to comment again. DVMt (talk) 00:54, 6 March 2013 (UTC) Edit: Allopathic medicine is apparently a common term; the American Medical Student Association uses the term presently here [7]. Learn something new everyday! DVMt (talk) 01:38, 6 March 2013 (UTC)

It's common within alt med communities (who invented the term) like the one you just linked. It is not used in the mainstream medical community. As [8] makes clear, allopathy in its original use referred to pre-evidence based medicine. IRWolfie- (talk) 12:55, 6 March 2013 (UTC)

Yeah it seems definitions, over time, change to reflect the times and evidence. it's not a big deal to me, and it goes beyond the scope of this article. I replaced the word allopathic with medical, are there any other issues that need addressing? DVMt (talk) 17:37, 6 March 2013 (UTC)

You have: "By embracing mechanistic viewpoint, mixers balance the vitalistic notions with critical reasoning skills that led to legitimate scientific investigation of chiropractic principles." This violates NPOV. Firstly it implies that science is just one viewpoint equal to any other. Secondly, it implies that vitalism is its equal, and not an outdated concept which is rejected. The main issue really is that most of your sources aren't reliable for discussing the connection to standard medical practice (which are the majority of reliable sources). You need to extend your secondary sources outside of the chiropractic "in universe" sources if you want to do that. Essentially, it's still evident from the text that it is written by a chiropractor, using the chiropractic sources. Don't forget, wikipedia categorically does not aim to balance opposing views as equal. If the majority of scientific sources disagree with some notion like vitalism, then wikipedia should reflect that. Giving weight to viewpoints based on how the sources give weight is a summary of what NPOV is. Chiropractic sources can be used for stating their own views, but not for saying things about science or greater medical practice. IRWolfie- (talk) 11:36, 7 March 2013 (UTC)

I think it's just us interpreting the sentence differently. I don't read it as science as one POV equal to vitalism (i.e. healing power of nature). I see it rather as a mixer chiropractors combining elements of both vitalism and materialism, as opposed to them being equivalent. With respect to vitalism specifically, it's not my intent to push vitalism or to knock it down, merely just reporting the facts. We agree that chiropractic sources shouldn't be used to comment specifically on issues that pertain outside their scope. How about some different wording though to address your concerns: MIxers combine both vitalistic and mechanistic viewpoints that has led to scientific investigation of chiropractic principles." I think that reads better as well. DVMt (talk) 15:43, 7 March 2013 (UTC)

That you are talking about materialism (which you seem to use interchangeably with science) tells me you have missed the issue again. Science is not the same as materialism, and it isn't necessarily materialistic. Use of the word "Mechanistic" is alt med type terminology for biomed again.

On your proposed suggestion; Vitalism is not scientific, so combining it with standard viewpoints does not led to a scientific investigation. Looking at it purely from a biomedical perspective would be scientific i.e in this case purely in terms of looking at the efficacy and establishing there is something to look for, before positing theories (much like this guy suggested: http://www.chiromt.com/content/13/1/17 ). You need to get mainstream sources as they are the ones that would clarify the issue (look to MEDRS for good sources) . IRWolfie- (talk) 17:20, 7 March 2013 (UTC)

I'd suggest dumping it into the article now and we can tweak further from there. I think it needs a lot of work, but it's easier to do it from this stage in article. IRWolfie- (talk) 17:34, 7 March 2013 (UTC)

Ok. The gist of the source (my interpretation) is that chiro combines reductionistic (materialism/mechanistic) and vitalistic (vis medicatrix naturae, sum is greater than the whole of its parts). Mechanistic, as I understood it, was meant as a contrast to vitalism and one that could be investigated by the scientific method (as opposed to vitalism). I will proceed to dump it into the article as per your suggestion. Thanks for your comments again, they are insightful. Regards, DVMt (talk) 17:50, 7 March 2013 (UTC)

RfC proceedings

There is a discussion here [9] regarding the the effectiveness of SMT for LBP. DVMt (talk) 19:22, 24 February 2013 (UTC)

Why did you label this section "RfC proceedings" since there is still no open RfC? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:57, 24 February 2013 (UTC)

Because it breaks up the page and the discussions for sectional revisions. I was trying to organize the page a bit for readability but if you want it kept, no biggie. DVMt (talk) 02:11, 4 March 2013 (UTC)

It will archive. Typically one never removed others comments from a talk page. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:28, 4 March 2013 (UTC)

Ok. The section seemed out of sorts was all. Didn't the discussion was critical for the page. But, if those are the rules, then so be it. DVMt (talk) 02:39, 4 March 2013 (UTC)

retract proposal DVMt (talk) 04:15, 8 March 2013 (UTC)

Comments (On hold:Ethics and medicolegal issues)

DVMt, is the text you have 'proposed' above meant to replace current article text? If so, which text and where? If not, where do you propose adding this text? More information will be help editors make insightful comments about your proposal.Puhlaa (talk) 05:29, 28 February 2013 (UTC)

It would condense the main arguments and controversies around chiropractic clearly, distinctly on all the topics. It would also cover the ethical questions surrounding chiropractors and the paradox of high patient satisfaction and the straight segment that really goes against the mainstream of chiropractors identified more clearly. Primary care definitions, etc. could also be done. It shortens the article somewhat but covers the pertinent topics in an objective manner. DVMt (talk) 06:06, 28 February 2013 (UTC)

• Oppose this version Concerns about chiropractics are more than just from SMT. There is also the concern that they will miss other diagnosis or treat conditions for which chiro is not effective resulting in overall harm to the patient. The current text sort of mentions these concerns however the above bit does not. So I do not see this as an improvement Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:32, 2 March 2013 (UTC)
  • What part of the current text are you referring to? Do you have a source regarding misdiagnosis, or treat conditions resulting in overall harm? These are bold claims that need evidence. DVMt (talk) 18:36, 2 March 2013 (UTC)

Given that no sources have been presented, the concerns appear more of conjecture than based on fact verifiable by the evidence. Please provide sources to support the claims. DVMt (talk) 00:34, 3 March 2013 (UTC)

There are sources. They are the ones you where hoping to delete such as this one [10].Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:35, 3 March 2013 (UTC)

I did not propose removing the Ernst critical review. More conjecture. It is used extensively in the page. Do you have other sources outside Ernst/Posadzki? DVMt (talk) 00:47, 3 March 2013 (UTC)

Yes I see it is still there however some of its conclusions have been removed. I do not see this bit "The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations." support by this 2009 review [11] Seems to have been replaced by a ref to an older review in the journal "Chiropractic Osteopathic" Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:32, 3 March 2013 (UTC)

This is the direct conclusion from the study you mentioned : There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic. Why don't we stick to what the source says? DVMt (talk) 01:37, 3 March 2013 (UTC)

Yes and the above was from the results section "Most of the adverse events reported were benign and transitory, however, there are reports of complications that were life threatening, such as arterial dissection, myelopathy, vertebral disc extrusion, and epidural hematoma. The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations." Additionally the full paper adds as key points "Complications associated with chiropractic procedures are frequent. Most of the adverse events reported are benign and transitory, however, some can be life threatening." The discussion section also states "The remarkable popularity of spinal manipulation is contrasted by a disappointing lack of well-conducted studies to assess efficacy."Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:48, 3 March 2013 (UTC)

Ok. So you are claiming there is a serious safety with spinal manipulation and that the studies to investigate efficacy are poor. Is that correct? DVMt (talk) 01:59, 3 March 2013 (UTC)

I don't think he is claiming anything, rather it is the paper that is, IRWolfie- (talk) 21:51, 11 March 2013 (UTC)

DVMt, I also have some concerns regarding sources. IMO, this 2012 systematic review currently represents the best source available on the association between spine manipulation and stroke. It is in the current article, but I do not see it in your proposal. Notable findings in this review are 1) the lack of quality evidence either supporting or refuting a strong association; and 2) the lack of any accurate risk-benefit analysis available to date. Any discussion of stroke, again IMO, should be qualified with the fact that any evidence for or against the association is weak at best and any claims for or against the relative safety of the procedure are still based on conjecture. With regard to Doc James comments and in consideration of the best sources available, lets be careful not to give too much weight to any one author or source that seems to make too bold of claims about safety.Puhlaa (talk) 01:55, 3 March 2013 (UTC)

Treatment, Safety (Proposed revision, March 2013) Part 1 of 2

Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include:

• manual procedures, particularly spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques;
• exercise, rehabilitative programmes and other forms of active care;
• psychosocial aspects of patient management;
• patient education on spinal health, posture, nutrition and other lifestyle modifications;
• emergency treatment and acute pain management procedures as indicated;
• other supportive measures, which may include the use of back supports and orthotics;
• recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.

Manual and manipulative therapy

Lumbar, cervical and thoracic chiropractic spinal manipulation.

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniques as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine. Spinal manipulation gained mainstream recognition during the 1980s. Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. It is the most common and primary intervention used in chiropractic care; In North America, chiropractors perform over 90% of all manipulative treatments with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment.There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.

Definitions

High-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as adjustment, thrust manipulation, and Grade V mobilisation It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques.

Categories

File:Flexion distraction.jpg

A chiropractor using a flexion-distraction table and manual therapy to the lumbo-sacral spine for low back pain

Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety. Manual and mechanically-assisted articular manipulative procedures can include:

• HVLA manipulation
• HVLA manipulation with recoil
• LVLA manipulation (mobilization)
• Drop tables and terminal point manipulative thrust
• Flexion-distraction and traction-type tables
• Pelvic blocks
• Instrument assisted manipulative devices

Manual non-articular manipulative procedures can include:

• Reflex and muscle relaxation procedures
• Muscle energy techniques
• Myofascial ischemic compression procedures
• Myofascial, and soft tissue manipulative techniques

show full draft

Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include: manual procedures, particularly spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques; exercise, rehabilitative programmes and other forms of active care; psychosocial aspects of patient management; patient education on spinal health, posture, nutrition and other lifestyle modifications; emergency treatment and acute pain management procedures as indicated; other supportive measures, which may include the use of back supports and orthotics; recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals. Manual and manipulative therapy Lumbar, cervical and thoracic chiropractic spinal manipulation. The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniques as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine. Spinal manipulation gained mainstream recognition during the 1980s. Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. It is the most common and primary intervention used in chiropractic care; In North America, chiropractors perform over 90% of all manipulative treatments with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment.There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately. Definitions High-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as adjustment, thrust manipulation, and Grade V mobilisation It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques. Categories File:Flexion distraction.jpg A chiropractor using a flexion-distraction table and manual therapy to the lumbo-sacral spine for low back pain Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety. Manual and mechanically-assisted articular manipulative procedures can include: HVLA manipulation HVLA manipulation with recoil LVLA manipulation (mobilization) Drop tables and terminal point manipulative thrust Flexion-distraction and traction-type tables Pelvic blocks Instrument assisted manipulative devices Manual non-articular manipulative procedures can include: Reflex and muscle relaxation procedures Muscle energy techniques Myofascial ischemic compression procedures Myofascial, and soft tissue manipulative techniques Neuromusculoskeletal and somatovisceral disorders Manual and manipulative therapies is a common intervention used primarily by manual medicine practitioners for the treatment of neuromusculoskeletal disorders. Spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain. However the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. Research status Acute low back pain: It is not known if chiropractic care improves clinical outcomes in those with lower back pain more or less than other treatments. A 2012 Cochrane review found that spinal manipulation was no more effective than standard medical care, sham manipulation, physiotherapy or exercises therapy or inert intenventions. A 2010 systematic review found that most studies suggest SM achieves equal or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. In 2007 the American College of Physicians and the American Pain Society jointly recommended that spinal manipulation be considered for people who do not improve with self care options. Chronic low back pain: The effectiveness of spinal manipulation appears to be the same as other commonly prescribed treatment for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy. Some national guidelines consider its use optional, some do not recommend and others suggest a short course in those who do not improve with other measures. Manipulation under anaesthesia, or medically-assisted manipulation, currently has insufficient evidence to make any strong recommendations. Radiculopathy: There is moderate quality evidence to support the use of spinal manipulation for the treatment of acute lumbar radiculopathy and acute lumbar disc herniation with associated radiculopathy. The evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low and no evidence exists for the treatment of thoracic radiculopathy. Neck pain: The effectiveness of spine manipulation for the treatment of neck pain is controversial. Cervical spine manipulation and mobilisation may provide immediate- or short-term improvements for mechanical neck pain; neither manipulation nor mobilisation have been found to be superior to one another and no long-term data are available. Thoracic spinal manipulation has a therapeutic benefit to some patients with neck pain and therefore it may also be a suitable intervention to use in combination with other interventions in the treatment of non-specific neck pain. Other manual therapies such as massage have also been found to be effective for mechanical neck pain. Extremity conditions: Manual and manipulative therapy added to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs. There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive. The addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) result in significantly better pain relief and functional improvements in both the short and long-term. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, limited to low level evidence supporting chiropractic management of shoulder pain and limited or fair evidence supporting chiropractic management of leg conditions. Headache: Spinal manipulation may improve migraine and cervicogenic headaches but cautioned type, frequency, dosage, and duration of treatments should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal. SM might be as effective as propranolol or topiramate in the prevention of migraine headaches, as well as other types of headaches. Cervicogenic dizziness: There is moderate evidence to support the use of manual therapy for cervicogenic dizziness. Pediatrics: The use of manual therapy for pediatric health conditions is supported by only low levels of evidence Mental health: There is evidence that spinal manipulation improves psychological outcomes compared to verbal interventions. Other: A 2013 Cochrane reviews found some effectiveness of manipulative therapy as an complementary intervention for pneumonia in adults. Current evidence suggests manipulative therapy reduces the duration of hospital stay, duration of intravenous antibiotic use, and total antibiotic use, but did not improve primary patient outcomes including fever, improvement on X-ray, cure rate, or mortality. In 2013, a systematic review and meta-analysis of five randomized controlled trials concluded that existing evidence suggests that SMT may improve lower urinary tract symptoms in adult women such as urinary incontinence (involuntary leakage of urine), nocturia (waking up at night to urinate), and urinary hesitancy, but called for further study with additional large, rigorous randomized controlled trials. There is insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension. There is very low evidence for spinal manipulation for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. There is insufficient evidence from reviews to draw definitive conclusions for a wide variety of other non-neuromusculoskeletal conditions, including ADHD/learning disabilities, vision and other conditions. Other reviews have found no evidence of significant benefit for asthma, baby colic, bedwetting, carpal tunnel syndrome, fibromyalgia, gastrointestinal disorders, kinetic imbalance due to suboccipital strain (KISS) in infants, menstrual cramps, or pelvic and back pain during pregnancy. Safety The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manual medicine practitioners, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindications apply only to the manipulation of the affected region. Adverse events in spinal manipulation studies appear to be under-reported and appear to be more common following HVLA manipulation than mobilization. Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness. These events typically dissipates within 24–48 hours Serious injuries and fatal consequences can occur, and are believed to result from upper cervical rotatory manipulation. but are regarded as rare when spinal manipulation is employed skillfully and appropriately. There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke. A 2012 systematic review determined that there is insufficient evidence to support any association between cervical manipulation and stroke. Cost-effectiveness Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches. Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent. References

Comments on Treatment/Safety Proposal, March 2013

The proposed draft, for practical purposes, can be subdivided into 2 sections. Section 1 would include treatment, definitions, categories. Section 2 is the research status of manual therapy (effectiveness, safety, cost-effectiveness).

Let the discussion begin! DVMt (talk) 20:55, 7 March 2013 (UTC)

If no opposition, I will insert section 1 of 2. This is a descriptive section involving definitions, manual and manipulative therapy, categories of manipulative therapy. It's better organized and referenced than the current section. Regards, DVMt (talk) 01:13, 10 March 2013 (UTC)

Far too much at one time. Do a little at a time so we can see if any existing content will be deleted, and what will be added. Tweaking is a better procedure than blanket substitution. In case you hadn't noticed, that content has not been developed through collaboration. You are the sole creator. Try copying one paragraph from the article and placing it here. Then place your proposed changes right under it. Then we can see what's going on. Right now it's far too difficult to analyze. -- Brangifer (talk) 02:05, 10 March 2013 (UTC)

I'd second that. If you can go paragraph by paragraph it might be best. Despite your sincere efforts it's challenging to review large rewrites unless there's a section by section comparison. Ocaasi ^{t | c} 02:22, 10 March 2013 (UTC)

Ok, I've broken it down into 2 sections. The citations are far heavier in the research section. Thanks for the suggestions. DVMt (talk) 16:35, 10 March 2013 (UTC)

Comments on good looking women with good complexion some of whom are subject to copyright.

Sorry but what is with the pictures of the sexy women with the perfect completion? It makes the changes look like a promotional pamphlet. Also we seem to have some copyright infringe going on as this image is exactly the same as this one for sale here [12] Also what is with the two people looking at an Xray together. This also looks suspect. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:47, 10 March 2013 (UTC)

I'm not going to comment regarding the sexiness of the women, in case my wife is watching. Their complexion falls outside my expertise ;) The rationale behind the image insertion was a) women are more prevalent than men to use manual therapy 2) VBA stroke issue seems to be more prevalent in women and c) the debate is mostly concerning upper neck manipulation safety. Hence the palpation of the neck. We can always find a different image if required though. The image with the manipulations and the X-ray is being used at the osteopathic page (manual medicine or the OM page). DVMt (talk) 17:28, 10 March 2013 (UTC)

You marked the images as being your "own work". What exactly do you think that means? The "(c) Science Photo Library" was a very odd choice for you to have put in the metadata. TippyGoomba (talk) 18:01, 10 March 2013 (UTC)

Looks like a copyvio, IRWolfie- (talk) 18:17, 10 March 2013 (UTC)

Other images uploaded by DVMt seem to have been copied from a third party but claimed as own work. I've flagged them for deletion on Commons. I'm not going to embed images here because we shouldn't compound the copyvio problem. At this point it would be inappropriate to trust any image uploaded by DVMt. bobrayner (talk) 19:18, 10 March 2013 (UTC)

If only the content were to get as much as a look as the images... Ok, so the last image doesn't meet criteria, the first two do. Any comments about the written material itself? DVMt (talk) 19:55, 10 March 2013 (UTC)

Copyright violation, reverts, and lies ignorance

I removed another image which appeared to be copyvio; it's identical to this which is "© 2004-2013 All rights reserved - Bigstock®". DVMt reverted it with the edit summary "not copyvio". DVMt, can you explain? Perhaps you also own the stock photo business? bobrayner (talk) 21:30, 10 March 2013 (UTC)

Sure. This image was produced in the 1920s and is the official chiropractic symbol (cauduceus). It's part of the public domain. I don't see how any company can "own" an emblem that belongs to a profession. Just like the snake and staff, that is used as the symbol/image of medicine. DVMt (talk) 21:49, 10 March 2013 (UTC)

Do you have some evidence that that image - and not just a similar-looking one - is in the public domain? The problem is that I found an identical image with a credible copyright claim. Which site did you get that image from? bobrayner (talk) 22:00, 10 March 2013 (UTC)

Bob, I'd ask kindly that you remove the "reverts and lies" part of your section header. That is not assuming any good faith and is a personal attack. I don't recall the site I got it from; but it did not have any copyright on it that I saw. Also, it had no meta-data too. Your tone is rather aggressive, may be cool down a bit. DVMt (talk) 22:08, 10 March 2013 (UTC)

You've written that you are the copyright holder in the license. You need to find a proper license. I think you want to either argue some kind of fair use or find a public domain image. The solution is not to blatantly lie, pretending that you own the copyright. TippyGoomba (talk) 22:16, 10 March 2013 (UTC)

No one owns the copyright, hence the public domain. It's analogous to the medical symbol here [13]. I did in fact stencil the chiropractic caduceus. So does that make me the copyright owner then? DVMt (talk) 22:21, 10 March 2013 (UTC)

It does. Did you write it as an svg? Why did you convert it to jpg? TippyGoomba (talk) 22:30, 10 March 2013 (UTC)

It appears this is the work of John T. Takai and it must be purchased:

• http://www.shutterstock.com/pic.mhtml?id=33965233

Contrary to what is claimed, it is not DVMt's "own work," even if he stenciled it or otherwise copied it. The chiropractic caduceus comes in many variations, and most of them are copyrighted by the creators. We have previously dealt with exactly this same issue, since we wished to use one, but we never found one that wasn't copyrighted, so we haven't used it. -- Brangifer (talk) 06:49, 11 March 2013 (UTC)

Literature synth source

I'm a bit confused with [14]. There conclusions, according to this article, are the opposite of the cochrane review, and they don't seem to declare the conflict of interest that they work for the Council on Chiropractic guidelines and practice parameters [15]. I also can't find text that supports "A 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration" in the conclusions (I don't have access to the full article), but from the conclusion it doesn't look like it supports that text. IRWolfie- (talk) 18:30, 10 March 2013 (UTC)

I'll double check the source. 2008 has likely been supplanted by more recent evidence, so that citation can go. I'll remove the claim. DVMt (talk) 20:11, 10 March 2013 (UTC) Does this pertain to the proposal or to the current text present in the article? DVMt (talk) 20:15, 10 March 2013 (UTC) The effectiveness section itself is dated with old reviews (2004-2005-2006) still here despite being usurped by newer reviews. Take a peek at my proposal which has an updated section on effectiveness (ie. research status). I've been chipping away at it now for over a month. DVMt (talk) 20:41, 10 March 2013 (UTC)

It's in the current article. I think any proposal on the page will just get messy. It's just not the usual approach to editing pages on wikipedia, and it doesn't work well for collaborative editing; we lose the edit history on the article. IRWolfie- (talk) 21:56, 11 March 2013 (UTC)

I never considered we would lose the edit history by collaborating on the talk page. I'll replace the current effectiveness section with the updated version. Yourself, Puhlaa, Doc James or whoever has issues can edit it on the main page. I think it's a pretty accurate summary; but James and I have had disagreements over language. Regardless, I trust that if you have any problems with it you'll edit as you see fit. DVMt (talk) 23:07, 11 March 2013 (UTC)

I must have misunderstood what you meant. I thought you were of the opinion that the current research status was outdated and needed better clarity. Regardless, it should be noted that the proposed content is up-to-date and removes any 'hanging' primary papers that have been reviewed since that point. DVMt (talk) 00:01, 12 March 2013 (UTC)

I don't think I stated anything about research being outdated in this thread. I had an issue with a source verifying text. You dropped 16000 words which were covered with citations, see WP:CAREFUL. IRWolfie- (talk) 00:06, 12 March 2013 (UTC)

If you are concerned about the need for clarity, an easy approach would be to drop all reviews that aren't in the core biomed journals highlighted here Wikipedia:MEDRS. IRWolfie- (talk) 00:11, 12 March 2013 (UTC)

I read into it; the fact that you had found an old 2008 lit synthesis which was outdated and still being used despite a newer review which covers that topic, etc. It's the same thing throughout the section. There's agreement between 2 sources, covering the same topic, and the older review stays in despite its redundancy. Regarding dropping 16 000 words, a lot of that is simply the references which takes a lot of "words" (bytes). The last time this article, according to older editors anyways, had a major lit review (effectiveness) was in 2008. It's the 5 year update (because a lot is out-of date). Regards, DVMt (talk) 00:19, 12 March 2013 (UTC) Edit: I'm familiar with MEDRS (thank you!) and when in doubt, I'll check impact factor, and if still in doubt, I go to WP:MED Talk. DVMt (talk) 00:26, 12 March 2013 (UTC)

Last paragraph lede

Current:

The scientific consensus is that chiropractic may be on a par with other manual therapies for some musculoskeletal conditions such as lower back pain, but that there is no credible evidence or mechanism for effects on other conditions, and some evidence of severe adverse effects from cervical vertebral manipulation. The ideas of innate intelligence and the chiropractic subluxation are regarded as pseudoscience.

Proposed:

Manual and manipulative therapies commonly used by chiropractors other manual medicine practitioners are used primarily to help treat low back pain and other neuromusculoskeletal disorders. Spinal manipulation appears as effective to other commonly prescribed treatments for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy. For acute low back pain, spinal manipulative therapy does not appear better than commonly recommended therapies such as analgesics, acupuncture, back pain education or exercise therapy. National guidelines regarding spinal manipulation vary country to country; some do not recommend, while others recommend a short course of manipulative therapy for those who do not improve with other interventions. Manipulation under anaesthesia, or medically-assisted manipulation, currently has insufficient evidence to make any strong recommendations. Spinal manipulation may be effective for lumbar disc herniation with radiculopathy, as effective as mobilization for neck pain, some forms of headache, and some extremity joint conditions. .There is insufficient evidence regarding the effectiveness of spinal manipulation on non-musculoskeletal conditions.[16]. There is considerable debate regarding the safety of spinal manipulation, particularly with the upper cervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare as spinal manipulation is relatively safe when employed skillfully and appropriately. Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches. Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent.