Talk:Chiropractic

Diagnose with spinal manipulation?? Definition of SMT incorrect

The lede opens with attempts to diagnose and treat patients through manipulation of their musculoskeletal system

This is fundamentally an incorrect definition of manipulation and diagnosis. Spinal manipulation is a therapeutic intervention performed on spinal articulations which are synovial joints. Not a diagnostic procedure. Tharyanp ! 07:07, 2 March 2014 (UTC)

Can we please discuss this definition. Tharyanp ! 10:54, 3 March 2014 (UTC)

I have brought this up on many occasions. I have previously discussed this at length at [[1]].. seems like general consensus agreed upon "The American Cancer Society has: "Chiropractic is a health care system that focuses on the relationship between the body's skeletal and muscular structure and its functions. Treatment often involves manipulating (moving) the bones of the spine to correct medical problems. Other methods may also be used". MedlinePlus has: "Chiropractic is an alternative medical system. Chiropractors perform adjustments (manipulations) to the spine or other parts of the body. The goal is to correct alignment problems, ease pain, and support the body's natural ability to heal itself. They may also use other treatments"DJFryzy (talk) 03:23, 12 March 2014 (UTC)

It has now been 9 days. I take this as consensus to change the definition. DJFryzy (talk) 04:05, 13 March 2014 (UTC)

To what? - - MrBill3 (talk) 04:24, 13 March 2014 (UTC)

Since DJFryzy has failed to reply, how about we use the definition from previous discussions. "A health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation" or ""the diagnosis of neuromusculoskeletal disorders or disorders arising from the structures or function of the spine...and joints of the extremities" ??Tharyanp ! 11:18, 20 March 2014 (UTC)

Why was this removed?

Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain remain inconsistent between countries.Murphy AY, van Teijlingen ER, Gobbi MO (September 2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther. 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948.{{cite journal}}: CS1 maint: multiple names: authors list (link) in this edit? [2] Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:11, 5 March 2014 (UTC)

That was me, in this edit[3] because the source was old in comparison to what we had, and seemed irrelevant to effectiveness (covered by more recent sources). Alexbrn ^{talk|contribs|COI} 06:32, 5 March 2014 (UTC)

It seems to me that inconsistency in treatment protocols is very relevant to the topic of general effectiveness of a treatment. jps (talk) 12:18, 5 March 2014 (UTC)

So, wouldn't juxtaposing it with recent recent Cochrane conclusions imply there was "more to it" than Cochrane was saying, though? And again, there is this question of when SMT "is" chiropractic. Alexbrn ^{talk|contribs|COI} 13:00, 5 March 2014 (UTC)

I'm not sure I understand. The fact that there is inconsistency could just mean that there was lots of confusion which is certainly what one would expect if there was no efficacy. jps (talk) 13:14, 5 March 2014 (UTC)

I suppose it's useful since, although it's a bit old, it discusses nonspecific LBP, which is not otherwise mentioned by us. In general I think this section could be slimmed down and the evidence for nonspecific, chronic and acute back pain teased out. Alexbrn ^{talk|contribs|COI} 13:27, 5 March 2014 (UTC)

hang on

Actually, looking more closely, this content seems to have been in the article all long. It's the last sentence of the "lower back pain" list item, and so what I removed was duplicate info. Alexbrn ^{talk|contribs|COI} 13:35, 5 March 2014 (UTC)

Should we maybe try to consolidate these sections? I think it makes more sense int he efficacy area. jps (talk) 13:36, 5 March 2014 (UTC)

It is in the "Effectiveness" section (where it discusses LBP). This section definitely needs some work and could be much simplified I think. Alexbrn ^{talk|contribs|COI} 13:41, 5 March 2014 (UTC)

I see. Yes, we need to reorganize that. jps (talk) 14:10, 5 March 2014 (UTC)

Ah great thanks. Yes Cochrane discusses the best available evidence. What national guidelines do is more variable but still notable. It is similar with breast cancer. Cochrane states the evidence is not good. The US recommends mammography q 2 years. We mention both positions. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:30, 8 March 2014 (UTC)

Have adjusted the wording. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:34, 8 March 2014 (UTC)

User:Harizotoh9 why did you change "Specific guidelines concerning the treatment of nonspecific (i.e., unknown cause) low back pain are inconsistent between countries" back to "Methods for formulating treatment guidelines for low back pain differ significantly between countries, casting some doubt on their reliability". This article is not about "formulating treatment guidelines" and I am unsure what text supports that it casts doubt on their reliability? Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:49, 13 March 2014 (UTC)

I did? I did a few reverts. Did it also make those changes? The reverts were to also remove some text additions. --Harizotoh9 (talk) 20:58, 13 March 2014 (UTC)

Lede again

I think the lede has swung a little too much the other way again. Before I think it was a little too pro-Chiro or not having enough criticism and now it is a little too anti. So it needs some tweaking.

Also it does need citations. See: WP:LEADCITE

...and innate intelligence, a notion that brings criticism from mainstream health care.

That needs a citation. Who said that, where? Was it an individual or a professional group? Also the original wording was "ridicule". I've changed it to a more neutral "criticism".

Much of the 3rd and entire 4th paragraphs need citations.

Studies of chiropractic have found it to be an ineffective treatment, except for certain cases of lower back pain.

This definitely needs to rephrased. It sounds overly negative. An alternative:

Studies of chiropractic have found it to be effective for certain kinds of lower back pain, but ineffective for other things

.

Additionally, Jarvis should not be quoted in the lede. His personal website does not pass WP:MEDRS. And certainly shouldn't be mentioned in the lede. Ernst should not be cited in the lede. It would be WP:Undue to put such an emphasis on his views in the lede. --Harizotoh9 (talk) 18:27, 8 March 2014 (UTC)

Each of these is cited in the body.

1. This is cited in "Concept". Per WP:YESPOV, we should not attribute facts as though they are opinions, and it is not an opinion that mainstream health care is critical of vitalism.
2. This is cited in "Effectiveness"

Your proposed wording places emphasis on chiropractic being effective, with exceptions, when in reality our sources indicate it is ineffective, with exceptions.   — Jess· Δ♥ 18:39, 8 March 2014 (UTC)

In general, ledes should contain citations. It's unfair to expect readers or editors to start hunting through the article itself, and digging through the citations. The article is pretty big. I'm scanning it now and I can't find the citations you reference. It's much easier to have the article have citations in both the lede and the body of the article. It is commonplace on Wikipedia for this (eg. Syrian Civil War among many others). I can't see why this can't be used in this article as well. --Harizotoh9 (talk) 19:08, 8 March 2014 (UTC)

No. In general, leads shouldn't contain citations. There are exceptions for particularly controversial subjects (especially in the case of BLPs), I don't see how mainstream health care rejecting vitalism is in any way controversial. The lead is supposed to be a summary of a well sourced body, which it is.   — Jess· Δ♥ 19:14, 8 March 2014 (UTC)

I think the lede should contain citations for this controversial topic and summarise the body well. The current lede is engaging in original research and is a poor summary. QuackGuru (talk) 19:19, 8 March 2014 (UTC)

Hmm. What's the original research?   — Jess· Δ♥ 19:21, 8 March 2014 (UTC)

Some modern chiropractors now incorporate... There is also original research in the body too. QuackGuru (talk) 19:25, 8 March 2014 (UTC)

That sentence is a summary of the whole "Straights and mixers" section. It has a few sources, including this one. See "The "Straight-Mixer" Schism" section. If there's OR in the body, we should of course fix that, but we shouldn't modify the lead on that basis until we've tracked down and corrected the body's OR.   — Jess· Δ♥ 19:30, 8 March 2014 (UTC)

No. In general, leads shouldn't contain citations. There are exceptions for particularly controversial subjects (especially in the case of BLPs),

Then I am going to have to say that I 100% disagree with you on this issue. It is commonplace on Wikipedia to cite in both the lede and body. It is significantly clearer. A reader/editor knows exactly what source is being used to cite which claim. That I am even having any difficulty finding a citation is all the evidence that is needed that cites should be in the lede.

Also your opinion does not appear in WP:LEDECITE. It does not say that citations should not be in the lede as a firm rule.

The lead must conform to verifiability and other policies. The verifiability policy advises that material that is challenged or likely to be challenged, and quotations, should be supported by an inline citation. Because the lead will usually repeat information that is in the body, editors should balance the desire to avoid redundant citations in the lead with the desire to aid readers in locating sources for challengeable material.

I don't see how mainstream health care rejecting vitalism is in any way controversial

It's the way it is phrased:

...and innate intelligence, a notion that brings criticism from mainstream health care.

That is a very specific claim. It claims specific people or organizations within mainstream medicine have criticized or ridiculed (using the original phrasing) innate intelligence. It would be WP:Synth to merely assume that criticism of vitalism infers criticism of Innate intelligence. The source has to discuss Chiropractic and innate intelligence. --Harizotoh9 (talk) 19:35, 8 March 2014 (UTC)

Harizotoh, can you please use conventional indenting on your posts? Weird indenting combined with tons of blockquotes makes this whole section nearly impossible to parse. My summary above was of WP:LEDECITE, and our conventions on featured articles; I don't see any discrepancy. Your last claim just swaps "vitalism" for "innate intelligence". I'll reiterate, I don't see how mainstream health care rejecting innate intelligence is in any way controversial.   — Jess· Δ♥ 19:41, 8 March 2014 (UTC)

I agree with QuackGuru. I think this is a significantly better written lede. I would tweak some of the language. --Harizotoh9 (talk) 20:25, 8 March 2014 (UTC)

I strongly disagree that's better written. The current lead was discussed quite a bit before being implemented; the goal was to reduce clutter, while leaving all the same information. IIRC, there's no information missing from the current lead that was there before, and it's considerably shorter and easier to understand. QG left some notes on my talk, which I'm hoping to address, but in the meantime, going back to an older, wordier version does not strike me as an improvement.   — Jess· Δ♥ 22:14, 8 March 2014 (UTC)

Changes to Education, licensing, and regulation

I could not verify the changes in accordance with V. QuackGuru (talk) 16:32, 15 March 2014 (UTC)

Quality & neutrality of the article

Hello. It is my opinion that this article is biased in favour of chiropractic. I find that the article minimises the risks of chiropractic. Here are some examples of what I find to be non-neutral sectiosn:

• Chiropractic curricula in the U.S. have been criticized for failing to meet generally accepted standards of evidence-based medicine. However as the profession evolves there is a greater push for more evidence based and evidence informed clinical application.
• Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications.

Also, I find that the article isn't of great quality. Take for instance the following sections:

• Throughout its history, chiropractic has been controversial, battling with mainstream medicine and sustained by pseudoscientific ideas. Despite the general consensus of public health professionals regarding the benefits of vaccination, there are significant disagreements among chiropractors, which has led to negative impacts on public vaccination and acceptance of chiropractic.
• Taken overall, spinal manipulation is not effective for the treatment of any condition.[123] A 2008 critical review found that with the possible exception of back pain, chiropractic manipulation has not been shown to be effective for any medical condition.

As well, why was the description of the Bruce Hyer study removed? (The study can be found at http://www.csicop.org/si/show/skeptical_consumers_look_at_chiropractic_claims/ ).

In general, I think that this page needs a major review and it would probably be a good idea to add some tags to notify other editors and readers of the issues surrounding the page. Thanks! NHCLS (talk) 15:37, 17 March 2014 (UTC)

The changes were reverted because the changes to the text were not supported by the source in safety and the sources were deleted because they were not WP:MEDRS compliant. I made changes to the article where I agreed with you about your concerns. However, I do agree with you about the text in the lede. I think there should be sources in the lede. QuackGuru (talk) 20:15, 17 March 2014 (UTC)