Talk:Chiropractic

This article should be titled 'Chiropracty'

'Chiropractic', as the article is currently named, is an adjective. The practice, and therefore the noun is 'chiropracty'. Because of this, the title of this page should be altered to 'chiropracty', as should any points in the text where 'chiropractic' is used as a noun.

eg 'chiropractic medicine' is grammatically fine, but the first line should begin 'chiropracty is a form of alternate medicine...' Revobear (talk) 19:02, 18 December 2016 (UTC)

This...actually seems really obvious when pointed out. TimothyJosephWood 19:05, 18 December 2016 (UTC)

Amusingly I had the same reaction. 'Chiropathy' would be another, imo better candidate. However, the fact is that 'chiropractic' is extremely widely used as a noun, probably by abbreviation of the phrase '... medicine'. An argument can be made that it is both an adjective and a noun (some dictionaries list it as both, and some actually only list it as a noun). In a nutshell, it sound odd as it is, but that's how the word is used, and that's that. Since WP's job is not to act as the vanguard of language prescriptivism, no renaming is warranted. — Gamall Wednesday Ida (t · c) 16:37, 22 December 2016 (UTC)

Roxy the dog reversion

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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I appreciate that you make many edits in a day, and that Wikipedia benefits. However, "not an improvement" and wholesale reversion isn't a cooperative manner to show in a collective project. If you disagree with edits, then you should constructively explain why. Bluehotel (talk) 20:29, 8 February 2017 (UTC)

If something is simply "not an improvement" means simply that it's not to your taste, then I's suggest you should pay at least some respect to other people's positions. For example, I changed "believe" to "maintain" because, as a point of fact, it isn't possible to divine the beliefs of others. Also, I amended a sentence construction because it was appallingly written. Indeed, much of this article is very poorly written, and is filled with opinion, masquerading as fact, and animus towards matters that need to be handled in a neutral tone. Bluehotel (talk) 20:33, 8 February 2017 (UTC)

Please see WP:BRD. Reverting does not mean that the editor doesn't "pay [..] respect to other people's positions", it means the changes are disputed and need to be discussed. Which can be done here. Then whatever changes are agreed on can be implemented. — Gamall Wednesday Ida (t · c) 21:02, 8 February 2017 (UTC)

I suppose I could have put "better before". -Roxy the dog. bark 22:38, 8 February 2017 (UTC)

@Bluehotel: We don't have to divine what the beliefs of others are: we only have to report what reliable sources state those beliefs to be. If you don't believe that that the sources used in the article are the best available, please feel free to suggest the sources that you believe are better. This article is not "filled with opinion, masquerading as fact, and animus towards matters that need to be handled in a neutral tone", and its present state is much better than whitewashing a treatment that has little or no evidence of effectiveness, and is based on thoroughly unscientific theories of "vertebral subluxations" and "innate intelligence". --RexxS (talk) 12:30, 9 February 2017 (UTC)

I agree with bluehotel that several things in this article are written with Animus. I think some of that carries over from some of the sources, but some of it is inappropriately sourced from the editors. For example the caption:

"Chiropractors use x-ray radiography to examine the bone structure of a patient. This exposes patients to harmful ionizing radiation for no evidentially supported reason." Saying "no evidentially supported reason" is inappropriate. That implies chiropractors take x-rays solely for the purpose of seeing "subluxations", which is patently false. Chiropractors also take x-rays for the same reasons as other medical professionals; to detect injury and pathology.

@RexxS you are saying its present state is better than whitewashing; writing with a neutral tone is not whitewashing. That's what bluehotel is asking for. Jmg873 (talk) 14:08, 9 February 2017 (UTC)

On the contrary, you are very much mistaken, and I already know what Bluehotel is asking for. The article has been written by presenting information from the best sources found so far, giving differing points of view the same weight as they receive in mainstream sources. WP:WEIGHT is the guideline you're looking for, and "vertebral subluxations" has about as much currency in mainstream literature as the Flat Earth Theory has. As for the use of ionising radiation to detect injury and pathology: why would anyone be visiting a chiropractor to seek treatment for suspected broken bones or other genuine bone damage? That's the job of an MD, and chiropractic has no effectiveness in treating such conditions. Are you telling me that the claim Although there is no clear evidence for the practice, some chiropractors may still X-ray a patient several times a year is false? or that it's untrue that there seems to be a disparity between some schools and available evidence regarding the aspect of radiography for patients with acute low back pain without an indication of a serious disease, which may contribute to chiropractic overuse of radiography for low back pain? Because the sources say otherwise:

• Singh S, Ernst E (2008). "The truth about chiropractic therapy". Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. pp. 145–90. ISBN 978-0-393-06661-6.
• Ammendolia C, Taylor JA, Pennick V, Côté P, Hogg-Johnson S, Bombardier C (2008). "Adherence to radiography guidelines for low back pain: A survey of chiropractic schools worldwide". Journal of Manipulative and Physiological Therapeutics. 31 (6): 412–8. doi:10.1016/j.jmpt.2008.06.010. PMID 18722195.

Where are your sources that contradict those? Or am I supposed to just take your word for it? --RexxS (talk) 16:40, 9 February 2017 (UTC)

You asked, "Why would a patient seek a chiropractor for treatment of broken bones or other genuine bone damage?" You assume that a patient knows they have bone damage. If someone falls and has back pain, they may visit a chiropractor rather than a PCP. Clinical guidelines warrant an X-ray. If the patient has a fracture, the chiropractor refers to a PCP. In regard to pathology: if a patient has cancer or metastasis and develops a pathologic fracture (in the absence of trauma), they may again visit a chiropractor thinking the pain is benign. The chiropractor will refer that case as well. So in short, the patient wouldn't seek chiropractic treatment for broken bones or pathology, they would seek chiropractic care not knowing they have those things. Your PCP (an MD or DO) will likely diagnose your cancer even though an oncologist will be the person treating it; the same thing applies to a chiropractor in that respect.

Regarding your quotes: I'm not saying that some chiropractors don't overuse x-rays. Those sources are correct, some chiropractors and schools use x-rays for non-evidentially supported uses. However, the statement "This exposes patients to harmful ionizing radiation for no evidentially supported reason" does not say that some chiropractors overuse x-ray, it implies that all chiropractors have no legitimate use for them. The implication that all (or even most) chiropractors take x-rays for non-evidentially supported reasons is an example of the Animus bluehotel and I were referring to. Your quotes also seemed to neglect this: "Research suggests that radiology instruction given at chiropractic schools worldwide seem to be evidence-based." Jmg873 (talk) 23:17, 9 February 2017 (UTC)

Chiros use X-rays, and they absolutely should not. Nobody should go to a chiro first if they might have a fractured spine, and it would be fantastical to claim that this is the reason chiropractic offices have X-rays. Legislative alchemy notwithstanding, chiropractors do not have the training or experience necessary to diagnose most (some might legitimately argue any) health problems or injuries. Anybody with an injury requiring X-ray should not be at a chiropractor's office, period, and that is not why they have the X-ray machines. You know it, I know it. The machines are used for full-spine X-rays to diagnose the fictional "subluxations" they love to pretend to treat. Guy (Help!) 00:21, 10 February 2017 (UTC)

Chiros use X-rays, and they absolutely should not This is strictly your opinion. However, when it pertains to seeking "subluxations" I agree with you. Nobody should go to a chiro first if they might have a fractured spine, and it would be fantastical to claim that this is the reason chiropractic offices have X-rays. Patient's don't know what they may or may not have, and seeking legitimate injury is the reason most chiropractors have it. Legislative alchemy notwithstanding, chiropractors do not have the training or experience necessary to diagnose most (some might legitimately argue any) health problems or injuries Any evidence to support that? because the evidence I linked in my previous post speaks to the contrary. Anybody with an injury requiring X-ray should not be at a chiropractor's office, period, and that is not why they have the X-ray machines. You know it, I know it. You are holding to the belief that subluxations are what most chiropractors are looking for with X-rays, that they aren't trained to diagnose real problems with X-rays, when in reality this is not the case for the majority of chiropractors. The machines are used for full-spine X-rays to diagnose the fictional "subluxations" they love to pretend to treat. Again, most chiropractors don't use full-spine x-rays. You seem to have taken a slight understanding of a Gonstead chiropractor (or someone practicing similarly) and erroneously applied it to all chiropractors. Again, I'm not trying to make the argument that there aren't chiropractors that are using X-ray equipment in the way you are suggesting, I'm saying that your statements do not represent the majority of chiropractors or the majority of chiropractic institutions.Jmg873 (talk) 01:53, 10 February 2017 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Removal of 'cauda equina syndrome' from risks

This shouldn't be listed as a risk. It is a next to non-existent relationship with only a single published 'observed' case. Jmg873 (talk) 11:40, 10 February 2017 (UTC)

Removal of X-ray radiology caption

Chiropractors use x-ray radiography to examine the bone structure of a patient. This exposes patients to harmful ionizing radiation for no evidentially supported reason. As previously discussed The caption for X-ray radiology needs to be modified or removed. To imply that chiropractors are using x-ray solely for non-evidentially supported reasons is false. To respond to a previous editor regarding full spine x-rays: The source I cited before noted that 29 of the 33 chiropractic schools worldwide disagree with the use of full-spine x-rays.

As previously discussed, the caption needs to remain. There is no implication that chiropractors are using x-rays solely for non-evidentially supported reasons: that's just your construction. The caption does not specifically refer to full-spine x-rays, and even a small area x-ray exposes a patient to ionising radiation. The source also supports our text stating that there seems to be a disparity between some schools and available evidence regarding the aspect of radiography for patients with acute low back pain without an indication of a serious disease, which may contribute to chiropractic overuse of radiography for low back pain, so the schools teach one thing but something else happens in practice. You seem to be under a misapprehension about the extent to which chiropractors subscribe to the theory of vertebral subluxations. The World Federation of Chiropractic, representing almost every national chiropractic association in the world, maintains the existence of these subluxations. The National Board of Chiropractic Examiners made a statement in 2014 placing chiropractic subluxation as the "specific focus of chiropractic practice". Your stance that the majority of chiropractors are not looking for subluxations is not founded in reality. --RexxS (talk) 14:37, 10 February 2017 (UTC)

There is no implication that chiropractors are using x-rays solely for non-evidentially supported reasons: that's just your construction. That is absolutely the implication. The way that is phrased leaves no ambiguity about its meaning; it ascribes certainty. The source also supports our text stating that... You seem to misunderstand what that means, and what they are talking about. the phrase there seems to be a disparity between some schools and available evidence regarding the aspect of radiography for patients with acute low back pain without an indication of a serious disease, which may contribute to chiropractic overuse of radiography for low back pain refers to the phrase in the results section However, only 14 (44%) respondents concurred with the guidelines and disagreed with the statement that there "is a role for radiography in acute low back pain in the absence of 'red flags' for serious disease." Which basically states, only 14 of the schools believe taking x-rays should be withheld if the patient has no red flags; that does not support your caption. so the schools teach one thing but something else happens in practice. unsupported by your quote. You seem to be under a misapprehension about the extent to which chiropractors subscribe to the theory of vertebral subluxations. I'm very well educated, and very well aware on the extent to which chiropractors subscribe to this belief. I'm a chiropractic student about to graduate. I've conversed with hundreds of different chiropractors and chiropractic students, from a variety of schools. I have no misapprehension about the frequency subluxation theory is or is not applied. I am also very clear on what is taught radiologically; taking X-rays for subluxations is not. In fact, merely the word "Subluxation" is very taboo where I attend to school. You cited the National Board of Chiropractic Examiners and the World Federation of Chiropractic. The NBCE has that on their page, but you have taken it out of context. As for the WFC, you are misquoting them; if you look closer you'll see they are in fact quoting the World Health Organization. The definition the WFC uses is 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. Regardless, how these organizations define subluxation is not the point. The point is how radiology is taught and used. The phrasing used in this caption inappropriate and incorrect.Jmg873 (talk) 15:52, 10 February 2017 (UTC)

What exactly would be the problem with adding "some" to the beginning of the caption? --tronvillain (talk) 16:46, 10 February 2017 (UTC)

@Jmg873: "That is absolutely the implication" - no, it isn't, other than in your mind. There is indeed no ambiguity in "Chiropractors use x-ray radiography to examine the bone structure of a patient. This exposes patients to harmful ionizing radiation for no evidentially supported reason", but you're drawing an erroneous conclusion from that. Is it not true that "Chiropractors use x-ray radiography to examine the bone structure of a patient"? Is it not true that "This exposes patients to harmful ionizing radiation for no evidentially supported reason"?

"You seem to misunderstand what that means, and what they are talking about". No. I understand exactly. Your argument proves my point about what is taught in the schools not being what occurs in practice. Less than half of the respondents agreed with the guidelines.

Who cares if you're very well educated? You're not as well educated as I am, if you want to make a pissing contest out of it. Your opinion and anecdotes are worth precisely nothing on Wikipedia. When you've finished being a chiropractic student, and have some papers published in respected journals, then you can start to lecture me about the value of what you know.

The NBCE has that on their page, but you have taken it out of context. Nonsense. Anyone can check http://www.nbce.org/about/about_chiropractic/ and read the prominent section titled "Subluxation": "The specific focus of chiropractic practice is known as the chiropractic subluxation or joint dysfunction. A subluxation is a health concern that manifests in the skeletal joints, and, through complex anatomical and physiological relationships, affects the nervous system and may lead to reduced function, disability or illness." That's complete garbage without a shred of scientific evidence to back it up. Nothing taken "out of context" there.

This is the consensus statement from the Association of Chiropractic Colleges in 1996:

• "Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health. A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence." ref: Robert Cooperstein, Brian J. Gleberzon. Technique systems in chiropractic. Elsevier Health Sciences, 2004, ISBN 0-443-07413-5, ISBN 978-0-443-07413-4.

It was adopted by the World Federation of Chiropractic in 2001. ref: Donald M. Petersen Jr. WFC Lays Foundation for Worldwide Chiropractic Unity. Dynamic Chiropractic, July 2, 2001, Vol. 19, Issue 14.

So it seems it is the WFC that "focuses particular attention on the subluxation [sic]". You need to read the sources before you start to tell me to look closer, right? --RexxS (talk) 18:34, 10 February 2017 (UTC)

• per PMID 27713818 (2016) about half of Australian chiropractors are unaware of the guideline for medical imaging in their field. Jytdog (talk) 19:30, 10 February 2017 (UTC)

@RexxS: Is it not true that "Chiropractors use x-ray radiography to examine the bone structure of a patient"? This is true. Is it not true that "This exposes patients to harmful ionizing radiation for no evidentially supported reason"? In cases where the chiropractor is seeking a subluxation, this is true. However, that doesn't represent most chiropractic X-rays.

Your argument proves my point about what is taught in the schools not being what occurs in practice. Less than half of the respondents agreed with the guidelines. The respondents were chiropractic schools. So this reflects what is taught in the schools rather than what is done in practice. 14 of 32 respondants believe that imaging should be done even when there are no red flags. Again, that is less than half that believed that. So most of the schools are teaching radiology consistent with evidence-based guidelines.

You continue to associate subluxations with radiology. Again, most chiropractors do not use radiology in this way. Chiropractors who believe in subluxations do not require X-rays to find them. As I said previously, practitioners practicing "Gonstead", or similar methodology (a very small minority of chiropractors) use x-rays to find subluxations. The vast majority of chiropractors find subluxations by palpation alone; with X-rays used when red flags are present, or to rule out contraindications to spinal manipulation.

The Talk page is NOT a forum for you or anybody else to make generalizations about this field or anything else, unsupported by citations. If you continuing doing that I will close this thread. The purpose of this page is discuss specific changes to the associated article. That is all it is for. Jytdog (talk) 20:15, 10 February 2017 (UTC)

OK. Let's get to the meat and potatoes then of the argument then: The source I cited earlier, cited here as a full-text [1] explains in greater detail what I said regarding chiropractic radiology. Note that Australia is not among the respondants. The study you posted from 2016 is more recent, but also represents only Australia. In your study it said 50% did not follow guidelines, that also doesn't make the caption currently posted valid. you want to modify the statement to be relative to Australia that is fine, otherwise it should state "Chiropractors use x-ray radiography to examine the bone structure of a patient", and nothing else. I think the most appropriate compromise would be "Some chiropractors use X-ray radiography to look for subluxations, a practice that exposes patients to ionizing radiation for no evidentially supported reason", and I think that would be fine.Jmg873 (talk) 22:14, 10 February 2017 (UTC)

I forgot to mention, the generalization you're talking about, is exactly what I'm trying to correct. The caption as it is, is a generalization. I'm trying to make it specific.Jmg873 (talk) 22:17, 10 February 2017 (UTC)

Thanks for getting on point. The caption as I edited it says "Chiropractors overuse x-ray radiography to examine the bone structure of a patient, despite professional guidelines advising restrained use. This exposes patients to harmful ionizing radiation for no evidentially supported reason" The source you provided is a survey of schools. We would expect high compliance at schools - higher than in the field, and yet 22% of schools did not agree with the guideline. The field has a problem, still. It is not alone in that. Please note that I added that the guidelines teach away from the practice. Jytdog (talk) 23:30, 10 February 2017 (UTC)

I appreciate some of the contents of the edit, but my initial issue with it still remains. Without using a quantifier (as both of our sources do), it's still generalizing. It still implies chiropractors as a whole, rather than some chiropractors.Jmg873 (talk) 04:01, 11 February 2017 (UTC)

• Here is a complete list of all the possible valid uses for X-rays in chiropractic:

I did not miss any. Guy (Help!) 17:11, 12 February 2017 (UTC)

I understand your stance on chiropractic, as you've made it quite clear; that doesn't address the point I brought up. Both sources reference some amount of chiropractors using evidence based guidelines for radiology, shouldn't the caption reflect that rather than generalizing?Jmg873 (talk) 20:15, 13 February 2017 (UTC)

Sources are irrelevant to this discussion. See WP:CAPTION. Please do not discuss sources. Please focus on the image. That goes for all editors. See WP:CIR. QuackGuru (talk) 20:18, 13 February 2017 (UTC)

What caption do you propose, based only on the image itself, QG? Jytdog (talk) 20:25, 13 February 2017 (UTC)

I propose following Sanger's rules. I do not have a specific proposal in mind for the wording. QuackGuru (talk) 20:37, 13 February 2017 (UTC)

Per Wikipedia:Manual_of_Style/Captions#Establishing_relevance_to_the_article, the caption discusses the relevance of an X-ray image to the subject of this article. I will not respond further to general comments from you and I reckon others will do the same Jytdog (talk) 20:47, 13 February 2017 (UTC)

Jytdog, I put "some chiropractors", you changed it to "in the field of chiropractic". You commented earlier that you opposed generalization, but you're removing something to quantify the caption; creating a generalization. The phrase "X-ray radiography is overused in the field of chiropractic" conveys the message of the whole field, a generalization unsupported by the sources. Why the change?Jmg873 (talk) 22:57, 13 February 2017 (UTC)

You misunderstood what I wrote above which was The field has a problem'. (what I wrote about generalizations was you and others making general statements not based on sources here on the talk page). "Some" just begs the question of "how many" and we don't know -- we have two data points. From those two data points there is a nontrivial amount and that is a problem for the field. QG will tell you at length about the problems with "some". Jytdog (talk) 23:14, 13 February 2017 (UTC)

A source must explicitly use the word "some" or it is most likely original research. QuackGuru (talk) 01:03, 14 February 2017 (UTC)

Awk! Original research! Awk! Guy (Help!) 10:33, 14 February 2017 (UTC)

No, that's not a "stance on chiropractic", it's an evidence-based statement of the valid uses of X-rays in chiropractic practice. X-rays have only one legitimate use n this context: diagnosis of fracture. Chiros have no expertise int he treatment of fracture. Most chiros who use X-rays, use them to "diagnose" the non-existent subluxation complex. That is evidentially and ethically unsupportable. Anybody with a reality-based disorder requiring X-rays, should be in the hands of a real physician. This is not a remotely controversial view. If you want respect, stop pretending to treat non-existent conditions, stop claiming to treat conditions not related to musculoskeletal pain, stop using bogus diagnostics, stop selling indefinite courses of "maintenance" treatment, and stop twisting people's necks. Guy (Help!) 00:28, 14 February 2017 (UTC)

I think things would mover faster if the wording was simplified. One sentence is plenty to describe the image and how it related to chiropractic. QuackGuru (talk) 01:03, 14 February 2017 (UTC)

Simplified to what? Guy (Help!) 10:32, 14 February 2017 (UTC)

@JzG:No, that's not a "stance on chiropractic", it's an evidence-based statement of the valid uses of X-rays in chiropractic practice. I didn't see a citation with those statements. I'll cite some evidence to the contrary below.

X-rays have only one legitimate use n this context: diagnosis of fracture. by "this context" do you mean a muscluskeletal context? If so, this is statement is extremely incorrect. In the context of low-back pain for example: X-ray may be used to see Arthritic conditons: Enteropathic, psoriatic, or osteo- arthritides; arthritic changes such as spondylophyte formation, disc degeneration or joint ossification; Genetic abnormalities which can be a pain generator, such as DISH, or Ankylosing spondylitis; Cardiovascular issues, most notably Abdominal Aortic Aneurysm; Space Occupying Lesion (this in and of itself is a huge category); Diseases affecting bone density like Paget's, or osteopetrosis; Other issues affecting bone density such as prostatic or other metastasis, Osteomyelitis, or generalized osteoporosis; degenerative bony changes such as degenerative spondylolisthesis. X-ray might be used to search for things like these depending on the patient's comprehensive medical history, and history of present illness. That list is only for low-back complaints, that doesn't include any peripheral areas or other parts of the spine. I've intentionally left out all of the different types of fractures that can happen in the spine, because you already recognized fracture as a legitimate use of x-ray in this context. There are a lot more things visible on plain-film X-ray that can cause low back pain, but I think that's a good start. X-rays have a legitimate use for a lot of things in that context.

Most chiros who use X-rays, use them to "diagnose" the non-existent subluxation complex. Actually, the most recent study that Jytdog posted said that 37.5% used it to seek out subluxation (listed in the study as "biomechanical analysis"), 37.5% isn't most chiropractors.

Anybody with a reality-based disorder requiring X-rays, should be in the hands of a real physician. You also said that the only legitimate use of x-rays in this context is fracture; there are reality based disorders requiring x-rays that your comment didn't demonstrate an awareness of. It's also worth noting, part of knowing a patient needs a referral to someone else is by making a diagnosis; which sometimes requires X-rays.

If you want respect... When did this become about respect? I thought it was about changing a caption regarding X-rays. I'm unclear about what specific article changes your comment was proposing, but lets stay on topic. I'll repeat my question: If we're avoiding unsupported generalization, why remove quantifiers from the caption?

@QuackGuru: I agree, one sentence would be sufficient. Maybe as simple as "Chiropractors sometimes use x-ray radiography equipment to examine a patient's skeletal structure". It's simple, accurate, applies no bias, makes no generalizations or speculations, and relevant to both the article and picture.

References

--Jmg873 (talk) 12:17, 14 February 2017 (UTC)

It doesn't need a citation. Chiropractors are not trained in orthopaedic fracture care (whereas DOs might be, in the US, at least), and the chiropractic subluxation does not exist. Those are the only two plausible uses of an X-ray machine in a chiropractor's office.

It is true that "Chiropractors sometimes use x-ray radiography equipment to examine a patient's skeletal structure". It is also true that hoemopaths sometimes treat cancer patients. The fact that it is true absolutely does not make it defensible, still less a good idea. The use of X-rays by chiropractors exposes patients to ionising radiation for no evidentially supportable reason. That is the critical point. The X-ray machines are just props for the theatre of "straight" chiropraxy, but they are dangerous props. Guy (Help!) 16:26, 14 February 2017 (UTC)

Guy, the content dispute can be resolved very quickly if editors follow WP:CAPTION and agree to keep the wording down to one sentence. QuackGuru (talk) 16:28, 14 February 2017 (UTC)

Jmg873, if you want to use the word "sometimes" I suggest you find a source to back up the claim. See WP:WEASEL. Simple wording for the image description will work for me. QuackGuru (talk) 16:28, 14 February 2017 (UTC)

A single-sentence version would be: x-ray radiography is overused in chiropractic, exposing patients to harmful ionizing radiation for no evidentially supported reason (with the two existing sources). I have no problem with brevity, only with misleading incompleteness. Guy (Help!) 16:46, 14 February 2017 (UTC)

"x-ray radiography is overused in chiropractic,..." does not follow WP:CAPTION. Does the image show it being overused? Nope. QuackGuru (talk) 17:42, 14 February 2017 (UTC)

Frankly I have no idea why we even include the bloody picture anyway. Guy (Help!) 21:22, 14 February 2017 (UTC)

@JzG: Your quote is the professional opinion from a former chiropractor, which doesn't provide quantification. It has value, but not more than published research. With that said, a comment like "Chiropractors use x-ray radiography to examine the bone structure of a patient" is not incomplete or misleading.Jmg873 (talk) 21:13, 14 February 2017 (UTC)

It is a qualified opinion from someone who investigates billing fraud claims against chiropractors. It would qualify as expert evidence in court, I think. Guy (Help!) 21:25, 14 February 2017 (UTC)

There are two main reasons why chiropractors take more x-rays than are medically necessary. One is easy money. It costs about 35¢ to buy an 8- x 10-inch film, for which they typically charge $40. In chiropractic, the spine encompasses five areas: the neck, mid-back, low-back, pelvic, and sacral regions. That means five separate regions to bill for—typically three to seven views of the neck, two to six for the low back, and two for each of the rest. So eleven x-ray films would net the chiropractor over $400 for just few minutes of work. In many accident cases I have reviewed, the fact that patients had adequate x-ray examinations in a hospital emergency department to rule out fractures did not deter the chiropractor from unnecessarily repeating these exams.

Chiropractors also use x-ray examinations inappropriately for marketing purposes. Chiropractors who do this point to various things on the films that they interpret as (a) subluxations, (b) not enough spinal curvature, (c) too much spinal curvature, and/or (d) “spinal decay,” all of which supposedly call for long courses of adjustments with periodic x-ray re-checks to supposedly assess progress. In addition to wasting money, unnecessary x-rays entail unnecessary exposure to the risks of ionizing radiation.

— Preston H. Long, chiropractor [2]

Simply removing the picture

I support removing the picture as was done here by guy, which was reverted by User:Harizotoh9 here, and again removed by Guy here. Adds no real value to understanding chiropractic and is probably misleading, since chiros don't use them much. Jytdog (talk) 23:14, 14 February 2017 (UTC)

• The image does not need to be removed because editors have a difficult time following WP:CAPTION or simplifying the wording. QuackGuru (talk) 23:17, 14 February 2017 (UTC)

That has nothing to do with the reason given in the edit note rationale for removing it, nor my rationale for supporting the removal. Jytdog (talk) 23:29, 14 February 2017 (UTC)

The image is relevant. Chiropractic use such equipment. I think straight chiropractors use it more often. Unless a better image is used we can keep this one. QuackGuru (talk) 23:32, 14 February 2017 (UTC)

In your opinion. Mine is that it's not relevant, and Jytdog agrees. Guy (Help!) 14:40, 15 February 2017 (UTC)

In my humble opinion, the picture is a bit of a "double-edged coat-rack". It gives the chiropractors a chance to show how they use shiny new equipment that make them look like MDs; optionally, it gives those of us with a rather more sceptical attitude an opportunity to explain how chiropractors misuse such equipment. On the plus side, it's a nice picture, but that's about all you can say. On balance, I'd have thought the article would be better off without it. --RexxS (talk) 15:48, 15 February 2017 (UTC)

"In your opinion. Mine is that it's not relevant, and Jytdog agrees." But chiropractors do use this equipment. That makes it relevant. It cannot be irrelevant when they use it. QuackGuru (talk) 16:13, 15 February 2017 (UTC)

chiropractors do use this equipment - true. That makes it relevant - in your opinion. Chiropractors wear white coats in order to look doctorey. Does that mean we need a picture of a white coat? Some chiropractors wear spectacles. Do we need a picture of a pair of spectacles? The issue of X-rays is covered in the article, that does not mean we need a random picture of an X-ray machine. Most of the things discussed in the article are not, in fact, pictured. Guy (Help!) 22:29, 15 February 2017 (UTC)

case study, yikes

PMID 16769516 is the kind of thing people talk about with regard to the dangers of alt med: "We report a 44-year-old man suffering complete paraplegia due to paraspinal and epidural abscess, following chiropractic therapy for severe back pain and whose diagnosis was delayed." just yikes. Jytdog (talk) 19:36, 10 February 2017 (UTC)

Headache

The first review mentioned in the headache section isn't "good evidence" that chiropractic SMT is effective for treating migraines. Their conclusion was "Current RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally efficient as propranolol and topiramate in the prophylactic management of migraine. However, a firm conclusion requires, in future, well-conducted RCTs without the many methodological shortcomings of the evaluated RCTs on manual therapies." None of that is a justification for removing the opening line of that section, "There is no good evidence that chiropractic is effective for the treatment of any medical condition, except perhaps for certain kinds of back pain." --tronvillain (talk) 14:17, 14 February 2017 (UTC)

I adjusted it (see what I did there?). Guy (Help!) 21:20, 14 February 2017 (UTC)

Recent removal of secondary source

A secondary source was recently removed from the article under the misinformed idea that chiropractors do not treat knees. Is there a source that can be provided to verify that chiropractors do not treat knees? Or is this just the opinion of the editor who made the edit? peer-reviewed source that examined why people see chiropractors found that 30% of visits were for musculoskeletal problems besides the neck and back [3]. Moreover, the NCCIH says "Many people who seek chiropractic care have low-back pain. People also commonly seek chiropractic care for other kinds of musculoskeletal pain (e.g., neck, shoulder), headaches, and extremity (e.g., hand or foot) problems."[4] 75.152.109.249 (talk) 18:54, 14 February 2017 (UTC)

I am of the view that the relevance of this is questionable. Chiros are back-crackers. That's what they do. The relevance of manipulative therapy on knees is not clear, and the evidence is weak anyway. We're better off without that para if only on the principle of minimum astonishment. People looking up back-crackers on Wikipedia are not really looking to see if there's crappy evidence that some kinds of manual therapy might work as well as other treatments (which is to say: not worth a damn) for knees. Nothing works for knee arthritis. I wish this were not true, for selfish reasons if nothing else, but it is. Guy (Help!) 21:20, 14 February 2017 (UTC)

It was two secondary sources that editor removed, not one. They are and I can also provide another source explaining that chiropractors treat knees. NHS says: Chiropractic treatments are often used for musculoskeletal conditions (which affect the muscles, bones and joints). These conditions include: [...] pain or problems with hip, knee, ankle and foot joints [5]

@JzG: Chiropractors are not merely "back-crackers" spinal manipulation is a key treatment method of chiropractic, but chiropractors use a variety of different treatments for different problems. This includes manipulation of areas other than the spine. From NCCIH Chiropractors may combine the use of spinal adjustments and other manual therapies with several other treatments and approaches such as:, Heat and ice, Electrical stimulation, Relaxation techniques, Rehabilitative and general exercise, Counseling about diet, weight loss, and other lifestyle factors, Dietary supplements. [6], From NHS Some chiropractors can make other treatments available, as well as manual therapy. These can include advice on exercise, diet and nutrition, which is intended to help improve, manage or avoid the recurrence of your health condition, and to improve your general health. They can also include rehabilitation programmes in which you are taught exercises that are intended to help you recover from your health condition, and prevent it recurring. [[7]] They are also do not limit themselves to manipulation of the spine, as listed above.

References

-- Jmg873 (talk) 21:38, 14 February 2017 (UTC)

Some chiropractors may have branched out into other areas, but the chiropractic trade is defined by back-cracking, and this weak evidence cited to primary sources neither of which mention chiropractic in their abstracts or categorisations, has no obvious relevance. Guy (Help!) 22:18, 14 February 2017 (UTC)

Guy/JzG, you are making claims that you are not verifying and that apparently cannot be verified. You removed this source, and claim that it says nothing about chiropractic and is thus not relevant. It is a review on manual therapy for knee arthritis and the first paragraphs of the intro state: "Management aims to control pain and reduce disability. Non-pharmacologic measures such as education, weight loss, physical therapies, and exercise should be tried first, with adjunctive pharmacologic intervention. Manual therapy is a physical treatment used by physiotherapists, chiropractors, osteopaths and other practitioners to treat musculoskeletal pain and disability, and includes massage therapy, joint mobilisation and manipulation.".75.152.109.249 (talk) 23:28, 14 February 2017 (UTC)

And another source, cochrane: For this review, chiropractic was defined as encompassing a combination of therapies such as spinal manipulation, massage, heat and cold therapies, electrotherapies, the use of mechanical devices, exercise programs, nutritional advice, orthotics, lifestyle modification and patient education. The review did not look at studies where chiropractic was defined as spinal manipulation alone as this has been reviewed elsewhere and is not necessarily reflective of actual clinical practice.[emphasis mine] [[8]] More than just back crackers.Jmg873 (talk) 21:52, 14 February 2017 (UTC)

You are a single purpose account, every word you have written on Wikipedia, as far as I can see, is promoting chiropractic, so I understand your limited exposure to our policies and guidance. That does not excuse your constant use of bait-and-switch. The fact that chiros are known as back-crackers not as general musculoskeletal therapists is context for the fact that inclusion of studies on knees is going to be puzzling for the reader. That context is combined with the substantive point that (a) the studies are weak and (b) neither the abstracts nor the categories even mention chiropractic. The relevance of these studies is not established. Guy (Help!) 23:46, 14 February 2017 (UTC)

I am promoting a neutrally written chiropractic article. It appears these sources that were deleted might be MEDRS compliant. QuackGuru (talk) 00:17, 15 February 2017 (UTC)

So they might be, but, if you'd like to go back and read what I wrote, you'll note that neither the abstract nor the categorisation mentions chiropractic, so while there may be sources identifying non-spinal manipulation as a practice within at least a subset of chiropractors, to use that to justify inclusion of two papers that do not appear, on the face of it, to relate to chiropractic sufficiently to mention it in the categories or abstracts, would be WP:SYN. And we don't do that. Add the fact that the evidence is weak and equivocal, and I see no good reaosn to include it. Guy (Help!) 14:39, 15 February 2017 (UTC)

I don't really care if it's included in the article or not, the statements and source aren't very significant. The part that concerns me is your reason for removing them. You removed it with the explanation "Chiros don't do knees", which you've yet to support with evidence; a problem with WP:V. The counter-point has been cited.

Aside from that, I also have a concern that you believe because I oppose your views of chiropractic, that I am POV pushing. As I said before, if you think I've done a bait and switch, please let me know what you're referring to so I can be more cognizant of that in the future.Jmg873 (talk) 16:14, 15 February 2017 (UTC)

No, I believe you are POV-pushing because you have no interest on Wikipedia other than promoting chiropractic.

I have already expanded at length on what lay behind the necessary brevity of my edit summary. Guy (Help!) 19:08, 15 February 2017 (UTC)

I understand your criticism of my edits. While they are primarily on one topic, they are not designed to push any agenda. My goal is not for the promotion of chiropractic, or to modify the article in a biased way. My goal is a neutrally written article, that is all. You and I seem to differ in what we think that is. You're right though, I am new to the policies and procedures. I am trying to learn them, and I fully intend on branching out to other articles of interest. For example, what do you suggest I am "bait and switching"? Help me learn so I can be a better editor. Jmg873 (talk) 01:28, 15 February 2017 (UTC)

Jmg873, please do not be concerned, you have done nothing wrong. There is no policy against being an SPA and that JzG/GUy has used this argument shows that they are running out of, or lacking altogether, any policy or source based argument. Further, this article is under 'discretionary sanctions', so discussing you (as an SPA) rather than staying focused on content and sources, could be seen as a violation. The sources that guy removed are very relevant to chiropractic in that they are regarding manual therapy (something chiropractors do according to reliable sources ) for a musculoskeletal condition (that chiropractors treat according to reliable sources). One of the 2 sources that JzG deleted even explicitly states chiropractic as one of the professions that uses manual therapy to treat conditions such as knee OA: "Manual therapy is a physical treatment used by physiotherapists, chiropractors, osteopaths and other practitioners to treat musculoskeletal pain and disability, and includes massage therapy, joint mobilisation and manipulation." I would think that continuing to argue against inclusion of these sources is ridiculous.2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 02:08, 15 February 2017 (UTC)

There is also no policy against deleting positive reviews. QuackGuru (talk) 03:08, 15 February 2017 (UTC)

I love it when grudge-bearers come along to give terrible advice to POV-pushers. Sure, there's no rule against being an SPA. However, when an SPA is pushing a POV, as is the case here, their status as an SPA is taken into account, and the result is much more likely to be an editing restriction or outright ban. And in the last ten years and more as an admin here, I have seen the community's tolerance for such accounts steadily reduce, and its willingness to impose restrictions has increased along with that. So advising a POV-pushing SPA to keep on keeping on, is about the worst advice you could give. Guy (Help!) 14:11, 15 February 2017 (UTC)

Do you still support your reason for removing it? QuackGuru (talk) 16:17, 15 February 2017 (UTC)

That is great Guy, as a 10+ year admin then you know better and you know that JmG873 is not pushing a POV. JmG is arguing in support of inclusion of a MEDRS compliant source that itself describes manual therapy as relevant to chiropractors. You, on the other hand, are arguing against inclusion of an policy-compliant source, based on a reasoning that the high-quality source itself contradicts and that multiple other sources tell us is incorrect. If you continue to argue against inclusion of the source in the face of policy and source based reasons for inclusion, and when you yourself have provided no policy or source based arguments, then you are the one pushing a POV.2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 17:45, 15 February 2017 (UTC)

On the contrary: it is my firm view that JmG873 is pushing a POV, since every action he makes is weighted towards chiropractic. As noted above, the issue here is not reliability, it's relevance. Being a S does not confer relevance. Please also log in, because you clearly have been here before and probably have an account and there are enough topic-banned editors that you don't want to be shut out on suspicion of being one of them. Guy (Help!) 19:05, 15 February 2017 (UTC)

Guy, so far I have seen every position taken by JmG supported by sources that he/she provides (so I do not care what their POV is), whereas, you have provided no sources or policy and you continue to steer the discussion towards being about editors rather than sources and content (thus your POV is still unsupported). Rather than focusing on other editors, please recall that this article is under discretionary sanctions and everyone should please keep your discussion relevant to the content and sources related to this article. Any further comment about other editors and not regarding sources and content is going to result in reports to ANI so that discussion here can stay focused appropriately. If you have a concern, please report it to the appropriate noticeboard and avoid discussing other editors here at this talk page. I prefer to maintain no account and this is allowed, just as being an SPA is allowed. If you are concerned that I am a topic banned editor then feel free to ask me at my talk page, or report me to the appropriate places (checkuser I think), otherwise, lets stay focused on content and sources, please. You have still not provided any source or policy that supports your position that these 2 secondary sources are not relevant for this article. Sources have been presented by JmG that supports the idea that chiropractors use manual therapy and treat knee OA? Moreover, I have quoted text from one of the sources in question that supports that they are relevant to chiropractic. Do you still feel the sources are not relevant? Can you please support your position with source or policy (no more unsubstantiated opinion please).2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 20:45, 15 February 2017 (UTC)

There is no inconsistency between use of sources and POV-pushing. Acupuncturists have been doing it for years, so have homeopaths. My mind is conjuring up a picture of Nicolas Cage with a bird on his head.

I do not know if you are a topic-banned editor, but you are very obviously not a passing randon anonymous user. It is highly likely that you have an account and are deliberately not using it.

I already stated clearly several times why the sources are not relevant. They relate to the puzzling (to the reader) knee, they are weak evidence and not in any way compelling, and the sources themselves don't even mention chiropractic in the abstract or categories. It gives the storng impression of a standard SCAM tactic of using a positive study on a closely related practice, to imply validity.

If JmG873 wants to include the claim that chiropractic is effective for knee pain, then we need reliable independent secondary sources that say chiropractic, (not arbitrary manipulation therapy) has a significant effect on knees that is clearly not down to bias. These studies fail on more than one criterion there.

The core issue here is that A union B is not the same as A intersect B, but SCAM proponents have a very great tendency to imply that it is the same. Guy (Help!) 22:26, 15 February 2017 (UTC)

I have to agree with Guy here, and would like to point out that not any of the arguments given here by you (IP-editor) or JmG873 have even bordered on being coherent. You can't restate falsehoods over and over again and press minor sources to include any potential benefit for chiropractic. The major sources such as meta-analyses and systematic reviews from the biggest and most widely recognized independent sources do not corroborate the "weak evidence" found in fringy chiropractic journals. Carl Fredrik 💌 📧 22:59, 15 February 2017 (UTC) 

CFCF, please provide specific examples of where "falsehoods have been restated over and over" so that we can make sure not to repeat them again. I will offer an example, Guy has suggested repeatedly that these secondary sources, which are examining manual therapies for musculoskeletal conditions, are not relevant to chiropractors. This is a falsehood that has been clearly shown, repeatedly, with reliable sources in this discussion, yet Guy keep repeating this falsehood. Guy, you suggest that "we need reliable independent secondary sources that say chiropractic, (not arbitrary manipulation therapy) has a significant effect on knees", but this is ridiculous, based on no policy, and you have clearly not read single source that has been provided here. Chiropractic is a profession that applies treatment modalities, such as those categorized under 'manual therapies'. Please read the quote from the secondary source you are saying is not relevant again: "Manual therapy is a physical treatment used by physiotherapists, chiropractors, osteopaths and other practitioners to treat musculoskeletal pain and disability, and includes massage therapy, joint mobilisation and manipulation." No credible researcher publishes a conclusion that "X profession is effective for Y condition"; Research examines specific modalities and in this case, modalities that are specifically related to chiropractors. 2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 00:41, 16 February 2017 (UTC)

Rather than repeating ourselves any further, I have posted at the project medicine page for additional perspectives here. 2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 01:11, 16 February 2017 (UTC)

In the news

Chiropractor who claimed he could cure cancer convicted of false advertising is covered in a large number of news sources today. Several sources are quoted who state that this is a common issue. Guy (Help!) 19:10, 15 February 2017 (UTC)