Talk:Chiropractic

Wording in WP:LEDE

See "This agreement does not suggest that chiropractic, as primary care is a valid and compelling concept. Rather, it suggests that the concept has been unexamined and hastily adopted. This section will examine the meaning of primary care as it applies to chiropractic."[1]

"Many chiropractors describe themselves as primary care providers" is verifiable to only one source. Both sources do not make the same claim. The Nelson source does not verify the claim "Many" and the part "this is not a valid concept.[2]" is not what the source stated. QuackGuru (talk) 05:25, 19 September 2016 (UTC)

Full paragraph says: "The other great divide within chiropractic concerns the question of whether or not chiropractic is a primary care profession. Unfortunately, just as the word "philosophy" is routinely misused, so is the concept of "primary care." Paradoxically, even the extremes of the profession on the philosophy question (e.g., Sherman College and National University) both endorse the notion of chiropractic as a primary care profession. This agreement does not suggest that chiropractic, as primary care is a valid and compelling concept. Rather, it suggests that the concept has been unexamined and hastily adopted. This section will examine the meaning of primary care as it applies to chiropractic."[2]

Also, we can read in the same ref: "There is a lack of uniformity and consensus within the profession about the proper role of chiropractic.  ... A number of models are impractical, implausible or even indefensible from a purely scientific point of view (e.g., subluxation-based healthcare), from a professional practice perspective (e.g., the primary care model), or simply from common sense (e.g. Innate Intelligence as an operational system for influencing health)."[3]

Adjusted and added a new ref, wich supports the sentence "Many chiropractors describe themselves as primary care providers""Although most chiropractors consider themselves to be specialists in NMS conditions, many also view chiropractic as a form of primary care." and the doubt regarding their role in primary care.

Best regards. --BallenaBlanca (talk) 11:23, 19 September 2016 (UTC)

The word "valid" is referring to the paragraph I cited that does not verify the claim in the lede.

The part "A number of models are impractical, implausible..."[4] is also referring to the primary care model. That part can be summarized. To avoid confusion the word valid can be adjusted. QuackGuru (talk) 17:42, 19 September 2016 (UTC)

Adjusted. [5] Best regards. --BallenaBlanca (talk) 07:43, 20 September 2016 (UTC)

Misplaced article?

"Moreover, this review is aimed at evaluating the AEs of an intervention (massage) and not that of a profession (massage therapist/chiropractic)."[6] QuackGuru (talk) 20:28, 19 September 2016 (UTC)

This article reviews "Spinal manipulation in massage", wich "has repeatedly been associated with serious AEs especially. But the incidence of such events is probably low." "Clearly, we should differentiate between various approaches. The above cases suggest that massage by nonprofessional and forceful techniques is often associated with AEs. In 8 cases the practitioners are massage therapists (5.8% of total) and 33 are chiropractors (23.9%), while in the other cases (70.3%) they are unregistered or even healthcare professionals only. So it might be unfair to assess the AEs of spinal manipulation as practiced by well-trained chiropractors alongside that associated with the untrained. Obviously from above, a variety of different care providers like physiotherapists, massage therapists, physicians, and osteopaths may perform a manipulation as part of their practice, but it should be most frequently performed by chiropractors [67]. Certainly skill and experience are important, and it is relevant to differentiate between different professions. But on the other hand, skill is a quality not easily controlled and some therapists are more skilled than others. Moreover, this review is aimed at evaluating the AEs of an intervention (massage) and not that of a profession (massage therapist/chiropractic). That is why in this review we show the implicated practitioners are not only chiropractors but also physicians, physiotherapists, “bonesetters,” and general medical practitioners."

But to illustrate that the rate of serious adverse effects is probably low, we may also use the NHS Choices source. I do not put any objections to remove the other source [7] and replace it with this other [8].

Best regards. --BallenaBlanca (talk) 20:57, 19 September 2016 (UTC)

I do object to replacing a review with a source that is not a review or adding another source that makes a different claim. You replaced sourced to a review with text that FV to the review and added a source that does not belong in this article. See "The survey data indicated that even serious adverse effects are rarely reported in the medical literature."[9] That confirms the part "probably low.[14][16]" is not supported by the review and the other source is related to massage. The part "but this does not seem to be a valid concept.[2]" is also misleading. QuackGuru (talk) 21:40, 19 September 2016 (UTC)

Yes, the systematic review concludes "The survey data indicated that even serious adverse effects are rarely reported in the medical literature." [10] This does not reflect the "incidence", but the incidence is unknown because adverse effects are not being reported. If we continue to read, we see at Conclusions of the abstract: "Currently, the incidence of such events is not known." and in the full text "Consequently the frequency of serious adverse effects is currently unknown. Estimates by chiropractors vary (e.g. 6.4 per 10 million manipulations of the upper spine and 1 per 100 million manipulations of the lower spine).53 These figures, however, may be over-optimistic. Retrospective investigations have repeatedly shown that under-reporting is close to 100%.13,52 This level of under-reporting would render such estimates nonsensical. At present, there is no sufficiently large and rigorous prospective study to generate reliable incidence figures; previous studies have failed to investigate those patients which were lost at follow-up. This could be the subgroup which has been harmed. It is therefore essential that future studies follow up close to 100% of the initial patient sample."

Well, I will remove the new source, I will use the review you propose (which was already present in previous versions), and I'll adjust the content to this review.

Best regards. --BallenaBlanca (talk) 06:23, 20 September 2016 (UTC)

I think adding this review we can support that the incidence is "probably low". [11] Best regards. --BallenaBlanca (talk) 06:37, 20 September 2016 (UTC)

You added duplication and the review does not verify the claim. QuackGuru (talk) 13:09, 20 September 2016 (UTC)

The part "but this does not seem to be a valid concept.[2]" is also misleading --> Adjusted. [12] Best regards. --BallenaBlanca (talk) 07:44, 20 September 2016 (UTC)

I do not understand what "clinical training does not support the requirements" means. QuackGuru (talk) 03:49, 21 September 2016 (UTC)

It is paraphrased from: "The length, breadth, and depth of chiropractic clinical training do not support the claim of broad diagnostic competency required of a PCP." [13]. Best regards. --BallenaBlanca (talk) 09:00, 22 September 2016 (UTC)

There is still original research in the lede. Both sources support that it is rare. The part "probably low.[11][12]" is original research and we should not add or replace reviews with others sources that are not reviews. QuackGuru (talk) 16:06, 22 September 2016 (UTC)

I propose replacing the original research with sourced text such as "rare" or "likely rare". QuackGuru (talk) 01:08, 25 September 2016 (UTC)

There is not any "original research". NHS is a major governmental body and this NHS Choices is a statement by them, which says: "These more serious complications of spinal manipulation are probably rare." I will adjust, as it has been done at spinal manipulation [14] [15]. Best regards. --BallenaBlanca (talk) 09:08, 25 September 2016 (UTC)

Duplication

See "but this idea is not supported by any scientific evidence.[7]" We are have a similar claim sourced to a review. QuackGuru (talk) 13:09, 20 September 2016 (UTC)

Fixed [16]. Best regards. --BallenaBlanca (talk) 10:35, 22 September 2016 (UTC)

Text in the lede that was not duplication was deleted

"Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its innate intelligence," QuackGuru (talk) 16:02, 22 September 2016 (UTC)

It seemed duplicated because there is this explanation below: "Chiropractic has two main groups: "straights", now the minority, emphasize vitalism, "innate intelligence" and spinal adjustments, and consider vertebral subluxations to be the cause of all disease; "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[21] D. D. Palmer founded chiropractic in the 1890s, and his son B. J. Palmer helped to expand it in the early 20th century.[22] Throughout its history, chiropractic has been controversial.[23][24] Its foundation is at odds with mainstream medicine, and has been sustained by pseudoscientific ideas such as subluxation and innate intelligence[25][26]..."

Best regards. --BallenaBlanca (talk) 00:27, 25 September 2016 (UTC)

This is specifically about the traditional chiropractic beliefs regarding vertebral subluxation and innate intelligence. This specific belief about spinal joint dysfunction is not explained in the lede. Explaining what is their beliefs is differ than stating what they believe in. QuackGuru (talk) 00:37, 25 September 2016 (UTC)

Quotes

Too many quotes were recently added to the refs in the ref section. QuackGuru (talk) 03:47, 21 September 2016 (UTC)

"Too many"? Exactly, two: [17] And in total, currently there are four quotes in the page [18]. It is perfectly valid per WP:QUOTE.

Best regards. --BallenaBlanca (talk) 08:59, 22 September 2016 (UTC)

The new quotes added are not clarifying anything that needs to be clarified. QuackGuru (talk) 16:02, 22 September 2016 (UTC)

Duplication and misplaced text

"These concepts of subluxation and spinal manipulation are not based on sound science.[5][6]" This is not supposed to be in the first paragraph. Later on we do explain in the correct paragraph. See "...that are not based on sound science." QuackGuru (talk) 00:56, 25 September 2016 (UTC)

New review about vaccination

A review has recently been published in the journal 'Vaccine' that examines the evidence in relation to complementary medicine practitioner attitudes to childhood vaccination: [19]

I notice that the public health section of the chiropractic article here at wikipedia relies on sources from before 2010 and as early as 2000. This new review can be used to update the article and also fill holes in the current article knowledge; for example, the wikipedia article says: "The extent to which anti-vaccination views perpetuate the current chiropractic profession is uncertain" and this new review offers this information. I have included some relevant text that might be useful here:

• "Most studies have focused on chiropractor attitudes on vaccination, and found significant disparity within this practitioner group."

• "Heterogeneity appears to exist even within discrete complementary medicine practitioner groups such as chiropractors, whose attitudes to vaccination appear to be influenced by philosophical beliefs (i.e. ‘straight’ versus ‘mixer’ chiropractic). ‘Straight’ chiropractors (those who believe vertebral subluxation is the primary origin of all disease; approximately one-fifth of the chiropractic population) are significantly more vaccine hesitant than ‘mixer’ chiropractors [13,15,17,18] (those who focus on musculoskeletal conditions and interpret diagnosis and treatment in a biomedical model). Personal experiences were reported by vaccine opposing chiropractors as being more influential in determining opposition than professional norms [19]."

• "In many instances, anti-vaccination attitudes are not pervasive through complementary medicine communities, but may be limited to significant subgroups within those communities. For example, anti-vaccination sentiment amongst chiropractors largely centres on graduates of ‘conservative’ (i.e. ‘straight’) chiropractic schools, and it is not known if these views/beliefs are also representative of the beliefs of other complementary medicine professionals with anti-vaccination sentiments."

2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 05:25, 25 September 2016 (UTC)

This statement is from the wikipedia article "a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.[210]"

I cannot read your proposed source because I do not have access to it. Does the Review clearly quantify the Number of chiropractors against or for vaccination in a manner like this? Sassmouth (talk) 06:42, 25 September 2016 (UTC)

The new systematic review discusses multiple primary sources, including the one from Alberta that you mention in your quote above, and each primary source offers specific numbers based on their specific methodology (location, setting, questions asked, etc). As one would expect from a secondary source, the new review takes all the specific numbers from the available primary studies and makes some general conclusions based on the entirety of the research.

Some relevant text from this current review is: "attitudes to vaccination appear to be influenced by philosophical beliefs" and "‘Straight’ chiropractors (those who believe vertebral subluxation is the primary origin of all disease; approximately one-fifth of the chiropractic population) are significantly more vaccine hesitant than ‘mixer’ chiropractors [13,15,17,18] (those who focus on musculoskeletal conditions and interpret diagnosis and treatment in a biomedical model). and "anti-vaccination attitudes are not pervasive through complementary medicine communities, but may be limited to significant subgroups within those communities." 2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 07:20, 25 September 2016 (UTC)

• I don't have a copy of this paper. I do have McMurtry, A., Wilson, K., Clarkin, C., Walji, R., Kilian, B., Kilian, C., Lohfeld, L., Alolabi, B., Hagino, C., & Busse, J. (2015). The development of vaccination perspectives among chiropractic, naturopathic and medical students: a case study of professional enculturation. Advances in Health Sciences Education, 20(5), 1291-1302. That shows considerable influence of education in vaccine views. Ernst (http://edzardernst.com/2014/07/why-so-many-chiropractors-advise-against-immunisation/) and Bellamy (https://www.sciencebasedmedicine.org/chiropractic-pediatrics-firmly-in-the-anti-vaccination-camp/) discuss some worrying influences. So yes, there is heterogeneity. My reading of the informal literature leads me to conclude that "straight" chiros are very likely to be anti-vaccine, with a lot of discussion in Australia especially about conflicts between the chiropractic associations and their members. That's not a surprise: if you believe disease is caused by disturbance of the flow of innate caused by spinal subluxations, then it would be illogical to support vaccination, based on an entirely different theory of disease. The problem, of course, is that the germ theory of disease is correct, and the subluxation theory is not.

The relevance of the fake medical education system here is that author affiliation for at least one author is listed as "Endeavour College of Natural Health" - in other words, they have a strong ideological motvation to minimise criticism of SCAM practices. Looking at the other authors, Wardle is a naturopath, Frawley is editor of the Australian Journal of Herbal Medicine. Sullivan appears to be the only one who is not associated with selling SCAM. Guy (Help!) 08:26, 25 September 2016 (UTC)

We are discussing a systematic review published in a mainstream medical journal Guy, I am pretty sure that we can trust 'Vaccine' and it's peer-review and editorial staff to have guarded against SCAM sales. I am not certain what the case study by McMurtry and the blog posts by Ernst really offer here as per wikipedia sourcing policy? 2001:56A:75B7:9B00:441:A41B:9784:50F1 (talk) 15:24, 25 September 2016 (UTC)