Talk:Chiropractic

History

The history section is way too long and covers effectiveness using outdated studies. We need to discuss the WP:WEIGHT problems with the huge and oudated history section. QuackGuru 17:46, 24 April 2008 (UTC)

Um, how can history be outdated? -- Levine2112 ^discuss 17:51, 24 April 2008 (UTC)

Because the studies are too old. We have newer studies available. QuackGuru 17:59, 24 April 2008 (UTC)

They are too old for history? Sorry, this doesn't seem to compute. -- Levine2112 ^discuss 18:00, 24 April 2008 (UTC)

Isn't it discussing effectiveness that's the problem? Jefffire (talk) 18:15, 24 April 2008 (UTC)

I don't see any problem with talking about historically important research. My issue there would be that the study should be discussed for its historical importances. Manga, for instance, was landmark research in helping to establish the scientific legitimacy of the profession. I read that somewhere. I'm sure we can dig up the source. -- Levine2112 ^discuss 18:20, 24 April 2008 (UTC)

If studies are presented for their historical impact then there is no issue. If they are presented as "establishing scientific legitimacy", then there is an issue since that's PoV. Jefffire (talk) 18:25, 24 April 2008 (UTC)

Historically, establishing chiropractic scientific legitimacy for treating low back pain is exactly what the Manga Report (and the second Manga Report) did. It also showed the cost-effectiveness of such treatments. -- Levine2112 ^discuss 18:29, 24 April 2008 (UTC)

That's PoV. Providing evidence for it would be a more neutral wording. Also, nudge you again on this - published =/= truth. Jefffire (talk) 18:32, 24 April 2008 (UTC)

Oh, sure. I see your point. Manga was one of the first of a few big scientific studies (such as the AHCPR) to come out after the Wilks case ended (and the AMA had been found guilty of suppressing supportive chiropractic research). Certainly Manga provided evidence which has helped to establish a growing trend towards scientific acceptance. Nudge to you... Wikipedia isn't about truth, it is about verifiability. Published information helps to establish verifiability. I encourage you to read WP:V when you have a moment. -- Levine2112 ^discuss 18:40, 24 April 2008 (UTC)

OK, since you agree with, we can work toward a neutral phrasing. Also, I think you've misinterprated my comment about published material. It's a common misconception that a published study must be true "true", which is not neccasery correct. Your wording missed that subtle point. Offtopic-Science isn't decided by trials. Jefffire (talk) 18:50, 24 April 2008 (UTC)

I would love to help work on that. I am heading out for the night right now, but if you draft something up, I will be back in the morning to review. I don't think that published studies are necessarily true. Science isn't a decision, but rather a process by which a decision can be made. -- Levine2112 ^discuss 18:54, 24 April 2008 (UTC)

I actually consider that current wording section on the Manga report to be presented in a generally neutral manner. Jefffire (talk) 19:58, 24 April 2008 (UTC)

The history section can definitely be tweaked; for example it neglects to cover important topics like the straight vs mixer evolution, the fight for licensure/regulation, the important steps in getting reimbursement under Medicaid/Medicare (US) and the expansion of the profession globally (what about history of the profession in Canada, Europe, and elsewhere?)

That's for another day though and we do not to resolve Scope of Practice first. CorticoSpinal (talk) 22:31, 24 April 2008 (UTC)

The history section has outdated effectiveness studies. When newer studies are available we can easily replace them with the newer studies. The oudated studies are mostly about effectiveness. Our goal is to replace the oudated studies with the newer studies. Makes sense? QuackGuru 03:57, 25 April 2008 (UTC)

New studies of effectiveness are irrelevant unless they comment on the impact of the Manga report. DigitalC (talk) 04:19, 25 April 2008 (UTC)

Recent effectiveness reviews do not cite the Manga report because it is of such low quality that it is not worth citing. The most recent mention I found of the Manga report in peer-reviewed literature is Grod et al. 2001 (PMID 11677551), and they dismiss it as an example of a low-quality study that they found cited in unreliable patient brochures. Any mention that Chiropractic makes of the Manga report should also describe its sad fate. Eubulides (talk) 08:16, 25 April 2008 (UTC)

I do not see any impact of the Manga report. QuackGuru 04:25, 25 April 2008 (UTC)

Hmm, yes, that's an important factor I missed. A reference from a medical textbook or something authoritative on it's impact on American medicine would be nice. Jefffire (talk) 07:29, 25 April 2008 (UTC)

If any editor wants to include the Manga report it must be rewritten using a newer ref (PMID 11677551) and also it should be explained why the need to keep the report in this or any article. This has not been done yet. Please propose a draft with your explanation and we can review it. Agreed? QuackGuru 17:11, 25 April 2008 (UTC)

Not agreed, why are you making demands that the Manga report(s) are suddenly crap and need to be taken out? The report is notable because professor Pran Manga (PhD) in economics, I believe, has made a strong and notable argument that chiropractic services should be integrated into mainstream health care, specifically in the public system. Are you disputing the verifiability of the report? It has stood the test of time here and no one has proposed at removing it until yourself. CorticoSpinal (talk) 17:15, 25 April 2008 (UTC)

The Manga report is not "suddenly crap". It was always low quality; see for example, Grod et al. 2001 (PMID 11677551), which says "The Manga report was not a controlled clinical trial but a review of the literature that offered an opinion that has not been experimentally established." Regardless of its initial quality, though, it is long obsolete and no longer deserves much (if any) coverage in Chiropractic. Eubulides (talk) 21:53, 25 April 2008 (UTC)

The report is outdated. We have much newer studies available. QuackGuru 17:20, 25 April 2008 (UTC)

If the Manga report is notable in the history of chiropractic then its place in the history section should be assured. I ask that material in the history section be explicitly dated so that the reader can understand the timeline offered. SmithBlue (talk) 07:32, 26 April 2008 (UTC)

The Manga report has zero historical impact and is an obsolete study. QuackGuru 07:38, 26 April 2008 (UTC)

The history section can easily be improved and could use a bit of expansion. The movement towards science section is very short and lacks a lot of information. Studies that describe Manga in historical terms would fit well in that section. QuackGuru 12:19, 14 May 2008 (UTC)

out with the old and in with the new (duplication)

There is a lot of oudated studies and sections that have very little or no impact on Chiropractic history. This includes The Manga Report, Workers' compensation studies, American Medical Association (AMA), and the British Medical Association.

The best approach is to delete the old studies and replace them with the newer studies. The old studies discuss mainly effectiveness. We are essentially removing duplication. QuackGuru 07:50, 26 April 2008 (UTC)

I would greatly appreciate it if you would show us how these studies and positions (which I have found in nearly every historical account of chiropractic) have had - as you say - little or no impact on the history of the Chiropractic profession. I personally don't see it and further think we should also include a mention of the AHCPR, which has been described as a "landmark" study. [1]. -- Levine2112 ^discuss 08:24, 26 April 2008 (UTC)

The dc doctor is an unreliable source. No evidence has been presented that the old studies had any "landmark" impact. QuackGuru 08:31, 26 April 2008 (UTC)

I do want to make explicit that a "History" section will usually refer to events and material that is dated. Hopefully QuackGuru will cite some RS sources on Chiropractic history that neglect to mention Manga. And at the same time some RS chiropractic histories that do include it would bolster its continued inclusion. SmithBlue (talk) 11:23, 26 April 2008 (UTC)

Some mainstream medical sources would be pretty welcome. History of medicine textbooks, medical textbook etc. Jefffire (talk) 11:50, 26 April 2008 (UTC)

Hopefully History of chiropractic articles, chiropractic textbooks, perhaps health policy articles such as "Chiropractic in the United States: Trends and Issues" as well. Doubtless there will be multiple POVs on chiro history. SmithBlue (talk) 12:28, 26 April 2008 (UTC)

There are indeed a plethora of chiropractic history sources, most notably Dr. Joseph Keating, PhD. He is "the" chiropractic historian. The article is about chiropractic, so let's talk about chiropractic, shall we? Mainstream, of course, can have their 2c, but let's tell the story of the art, science and philosophy of chiropractic. CorticoSpinal (talk) 17:35, 26 April 2008 (UTC)

A useful source, but one must bear in mind not a neutral one. Jefffire (talk) 18:25, 26 April 2008 (UTC)

When these studies and sections have no impact to Chiropractic history they should be deleted. We have newer studies available such as the proposed Effectiveness section. QuackGuru 17:42, 26 April 2008 (UTC)

For chiropractic history, we can include studies that are specifically about chiropractic history and not old or obsolete studies. QuackGuru 18:15, 26 April 2008 (UTC)

Precisely, and these studies (Manga, etc.) are important to chiropractic history as per their mention in many chiropractic history sources (Keating, etc.). -- Levine2112 ^discuss 22:46, 26 April 2008 (UTC)

Unlike science, history is of necessity subjective, POV based, filtered information producing a story. And not surprisingly who is telling the story and who is listening makes a great deal of difference in what is considred relevant. Unlike medical research, which (we hope) reduces human failings to a minimum, the medical view of chiropractic history can only be just another POV on chiro history. In the "History" section we will of necessity be presenting multiple POVs given the disparate views that exist on chiro history - if in one POV Manga is not important that does not in any way reduce its notability in another POV. SmithBlue (talk) 03:14, 27 April 2008 (UTC)

Levine, if a reference exists that discussed the Manga report in a historical context then provide the reference. We would use the reference that discusses the Manga report and not the Manga report itself anyhow. The Manga report itself does not qualify for the history section. If another source mentions older studies (Manga, etc.) then provide all those references to replace the older and obsolete studies. QuackGuru 04:00, 27 April 2008 (UTC)

No specific references have been provided to show that any of the older or obselete studies have any historical impact. If references are provided, we would use those references and not the original older studies. QuackGuru 04:13, 27 April 2008 (UTC)

Man I remember learning Manga in school. . . it represents a critical piece of research in chiropractic history. I am sure there are dozens of references out there discussing chiropractic history which detail the significance of Manga.TheDoctorIsIn (talk) 04:59, 27 April 2008 (UTC)

It represents a critical piece of research in chiropractic history? Please provide a reference discussing chiropractic history which details the significance of Manga. At the moment, no reference has been provided. These studies (Manga, etc.) have no impact to chiropractic history unless a reference is provided. QuackGuru 07:26, 27 April 2008 (UTC)

Levine wrote: Precisely, and these studies (Manga, etc.) are important to chiropractic history as per their mention in many chiropractic history sources (Keating, etc.).[2] <-- This comment implies Keating mentions the Manga report in a historical perspective. I do not see any evidence of that. Please provide a reference to support this claim. Got it? QuackGuru 18:00, 27 April 2008 (UTC)

For starters, how about this one from Keating? Get it? -- Levine2112 ^discuss 16:58, 28 April 2008 (UTC)

Thank you for the ref. The ref by Keating mentions the Manga report. We can replace the Manga report with the Keating ref. The Manga report itself is not specifically about chiropractic history but Keating seems to have some historical context. We can add the Keating ref and text. QuackGuru 18:48, 28 April 2008 (UTC)

I also added this ref which discusses Manga in terms of history. -- Levine2112 ^discuss 19:00, 28 April 2008 (UTC)

Oh, and this article describes Manga historically as having "caused ripples throughout the traditional medical community when it concluded that chiropractic management of low-back pain is both more effective and cost-effective than traditional medical treatment." -- Levine2112 ^discuss 19:03, 28 April 2008 (UTC)

As previously explained here all of the obsolete and outdated studies will be deleted. No argument has been made to keep these dated studies. The Manga Report, Workers' compensation studies, American Medical Association (AMA), and the British Medical Association are clearly obsolete when newer sources are available. For the Manga report there are newer studies that describe the report. We can use these newer studies as long as they have historical impact. We will remove the older studies and replace them with the newer effectiveness studies. This is essentially removing duplication and will make this article one step closer to a GA status. QuackGuru 20:34, 29 April 2008 (UTC)

You do not get to determine what has had historical impact on the chiropractic profession. Chiropractic historians do. Keating and others have mentioned it numerous times. You don't delete history QG because it doesn't conform to our personal POV. Effectiveness is not even on the horizon given that there is a clear lack of consensus (with majority opposed, I might add). Scope of Practice is sitting there ready to go in (despite a tendentious and stonewalling attempt by a certain editor to drag the process out over trivial points) CorticoSpinal (talk) 20:50, 29 April 2008 (UTC)

No evidence or reason has been provided to keep the obsolete studies. Removing outdated studies and replacing them with newer studies is common sense. We can add the Keating reference about the Manga report if it has historical impact. QuackGuru 20:56, 29 April 2008 (UTC)

For example, the Workers' compensation studies are outdated. Newer studies are available. Anyone can search PUBMED and retrieve newer studies (). I hope this answered this question. QuackGuru 17:43, 30 April 2008 (UTC)

In this case, I disagree. This newer study isn't nearly as comprehensive. I would perhaps use both, but not remove the older, more comprehensive ones. -- Levine2112 ^discuss 17:47, 30 April 2008 (UTC)

The newer study is recent. I think it would be best to delete obsolete studies. If you want to find and and add more recent studies that is fine. QuackGuru 17:52, 30 April 2008 (UTC)

I still disagree. You are providing no new argument to change my position. I don't think that one newer but less comprehensive study trumps all the studies before it. This review for instance, provides excellent summaries of much of the research at hand, and perhaps would serve as the best source we currently have on the matter. It is a review of the literature and serves as the most comprehensive study we have found too date, in my opinion. Take a look and let me know your thoughts. -- Levine2112 ^discuss 17:56, 30 April 2008 (UTC)

I agree that we should be referring to recent reviews instead of to primary studies. Expert reviewers should be able to let us know which primary studies are with summarizing. We shouldn't be doing the reviewing ourselves, if reviews are available. Eubulides (talk) 18:06, 30 April 2008 (UTC)

No specific argument has been made to keep the outdated studies. If anything is worth keeping it should be put in the proper section. The obsolete studies have no historical impact. QuackGuru 22:23, 30 April 2008 (UTC)

You said the same thing about Manga, and that proved to be incorrect. Let's just cool down and discuss rationally before we go and remove/add anything to the article. -- Levine2112 ^discuss 22:30, 30 April 2008 (UTC)

The Manga report itself is not a historical reference and the section should be deleted. If editors prefer, they can use the references that describe the Manga report if those references are reliable and show historical impact. I said the Manga report should be deleted and I was correct. No argument has been presented for keeping the Manga report. We should not use the Manga report in the history section when the report is not a historical reference. There may be historical references decribing the Manga report and that is a different matter. We have newer references that discuss effectiveness that can replace the Manga report. The history section is about chiropractic history and not a place for outdated studies. Agreed? QuackGuru 22:46, 30 April 2008 (UTC)

older references are obsolete when newer references are currently available (common sense)

[outdent] No specific argument has been made for keeping outdated and obsolete studies in the history section. The studies are not about chiropractic history and the studies themselves have no historical impact. We have newer effectiveness/cost-benefit studies anyhow. In any event, it would be best to delete all the obsolte studies.

http://en.wikipedia.org/wiki/Chiropractic#The_Manga_Report

http://en.wikipedia.org/wiki/Chiropractic#Workers.27_compensation_studies

http://en.wikipedia.org/wiki/Chiropractic#American_Medical_Association_.28AMA.29

http://en.wikipedia.org/wiki/Chiropractic#British_Medical_Association

All the above sections contain old studies. They are obsolete. This has been discussed long enough. Going once... going twice... and it will be deleted if no specific objections are made. Please provide a specific reason if you disagree. Agreed? QuackGuru 06:38, 2 May 2008 (UTC)

Specific objections have been made, including "old does not equal obsolete". Further, don't remove anything without consensus. This conversation spans several area. Let's start a new section in which we propose specific revisions. -- Levine2112 ^discuss 06:48, 2 May 2008 (UTC)

P.S. As far as I know, the policies of the AMA and BMA with regards to chiropractic have not changed. Thus, those sections are clearly not obsolete. -- Levine2112 ^discuss 06:50, 2 May 2008 (UTC)

P.S.S. Where is the Wikipedia policy which supports: "older references are obsolete when newer references are currently available"? -- Levine2112 ^discuss 06:57, 2 May 2008 (UTC)

When newer references are available the older ones are obsolete. We have newer references that discuss the same or similar topics as the AMA and BMA does (examples,). P.S., it is common sense to delete older studies and replace them when newer studies are available. Currently, the history section contains unrelated information that is not specifically about chiropractic history. Why should we keep older studies when newer studies are current and up to date? QuackGuru 07:18, 2 May 2008 (UTC)

Two things here Quack Guru -

1. I support your push for the re-writing of the History section. At present Manga and the WC studies can too easily be read as providing information on effectiveness. We need RS sources naming the important events/studies/laws/milestones - (these will be Chiro and Medical and other sources). I have no doubt that Manga and WC studies will feature in the future History section but they will be described in terms of their effects in relation to Chiropractic with only a brief description of their actual findings. A fuller explanation of the findings and and effects would probably be better placed in a separate article on the Manga report if sufficient material is available.
2. I find your claim that these sources cover similar territory as the current History/AMA or History/BMA sub-sections incomprehensible. Please explain your claim. SmithBlue (talk) 08:40, 2 May 2008 (UTC)

These recent studies () cover a similar topic that AMA and BMA covers. AMA is about efficacy. We have newer source available. The BMA is is about referring patients to practitioners which we have newer sources available. These studies (AMA and BMA) are not about history. That is a separate issue. We have newer sources available for efficacy/benefit and references for historical content (). The more recent studies about effectiveness/cost-benefit can replace the older studies. For the history section, the older obsolete studies should be deleted. The content is unrelated to history. There is no need to replace those obsolete studies in the history. We can replace those obsolete studies in new sections such as cost-benefit. The first step is to delete all the unrelated content to chiropractic history. I reviewed each and every source that is unrelated to chiropractic history. Those old sources are absolete. Newer sources covering similar topics exist. The unrelated content to history should be deleted. If editors find specific references for the history section then those can be used but not the obsolete studies. If anyone thinks any of the obsolete studies are still current I would like that explained or we can delete the obsolete studies. There are a lot of newer sources available that cover effectiveness / cost-benefit that can replace AMA[3] and BMA[4] among other things [5][6] with newer sections such as Effectiveness and Cost-benefit. Anyone is free to rewrite the history section but that is not the point of this discussion. If no rewrite happens then I still think we should delete the unrelated content. It is important for editors to realize there is unrelated content in chiropractic history section. Those older studies are obsolete when we have plenty of newer studies available. I am saying we can delete the unrelated content to chiropractic history and to also use newer sources for new sections. I could update the history section with information about the Manga report from a historical perspective. But I think some editors want to take it slow or reject a rewrite. They want to keep the most if not all of the outdated studies and reject the newer studies. BTY, I have already rewritten part of the history section and finished the effectiveness section and started a new cost-benefit section. The newer sources about effectiveness are current and the older references on the same topic are obsolete. It's time to move the article forward. Adding the new information will be an improvement IMHO. QuackGuru 18:10, 2 May 2008 (UTC)

For what it's worth, I agree with SmithBlue and QuackGuru that Chiropractic#History needs to be rewritten, and that the Manga and WC studies should be supported by reliable sources on chiropractic history rather than by the studies themselves. I have not had time to read all those sources that QuackGuru mentions, but if QuackGuru has read them all then I suggest that QuackGuru draft a new History section based on them. I encourange the draft to cover the entire sweep of chiropractic history, not just on a few events. Eubulides (talk) 19:30, 2 May 2008 (UTC)

Quack Guru your appreciation of Chiropractic history, like mine, needs to expand, Chiropractic is a profession which we show, in Wilks etc, has been ostracised and conspired against by a very powerful profession (the medical profession) The AMS and BMA subsections address steps in Chiropractic gaining professional recognition. Removing them makes as much sense as removing a section on the Magna Carta from a "History of English law".

The single reference you supply for chiropractic history (Cooper 2003) is fine as far it goes. However it is just one POV - in history we are dealing with multiple POVs. We need to present all notable ones WP:NPOV. We need to present the Chiropractic profession's view of its own history as well as other views. We are dealing with the history of a profession here - professional recognition is rather central. SmithBlue (talk) 02:01, 3 May 2008 (UTC)

On further surfing I find Chiropractic history. So a detailed presentation of Chiro/History is not required here. Which leaves us to reach concensus on what is better included here. Have started new section below for this dicussion. (The layout of this page at present makes it very difficult to use.) SmithBlue (talk) 02:22, 3 May 2008 (UTC)

It would be best to use references that describe the AMA () and BMA () in a historical perspective instead of the references themselves.

The Manga Report as well as Workers' compensation studies sections are unrelated to chiropractic history and no specific reason has been given for keeping them. We have newer sources describing the Manga report () and newer sources on Workers' compensation (). QuackGuru 04:30, 3 May 2008 (UTC)

The obsolete sources are old and newer sources exist. For the time being, we can delete the Manga report section and the Workers' coompensation studies section. Theses dated studies are unrelated to chiropractic history. We can use newer studies available that have historical interest. For example, we have newer sources availble that discuss the Manga report. And we have newer sources available for the workers' compensation studies for a new section under cost-benefit. My specific revision is to delete both of obsolete sections (Manga and WC studies) and editors can improve the article where appropriate. Going one... going twice... QuackGuru 20:30, 4 May 2008 (UTC)

We explained very clearly that the obsolete studies are not current. But no good reason has been given for keeping POV material in the article. This misleads the reader to readd obsolete studies to mainspace. The controversial edit did not benefit the project. Please provide evidence if any of the obsolete studies should be reworked in a rewrite. If no evidence is provided to rework any of the oudated studies it will be deleted again. Going once... going twice... QuackGuru 23:39, 5 May 2008 (UTC)

There are several sources already given on this talk page (such as this one) which discuss the historical significance of the studies such as Manga. I don't understand why you keep ignoring these. Further, there is no consensus to remove any of the content discussing these studies until a rewrite of the history section which incorporates these studies meets consensual agreement. -- Levine2112 ^discuss 23:52, 5 May 2008 (UTC)

The sources on the talk page (such as this one) differ from the sources in the article. I added many of the sources to the talk page. The claim of me ignoring them is false. There is no consensus for keeping a misrepresention of chiropractic information (misleading to the reader) in mainspace. No evidence has been provided for keeping any of the POV material or the obsolete sources in the article. Please provide any evidence that these outdated sources should be worked into a rewrite. QuackGuru 00:06, 6 May 2008 (UTC)

This edit added unsourced POV material to the article and added unrelated content to the history section. The Manga report failed verification and the Workers' compensation studies contains obsolete studies. We have newer sources available on both topics. For the Manga report, we have references that describe the Manga report. For the workers' compensation studies, we have newer sources available. Both sections should be deleted. This POV change should be reverted. The oudated workers' compensation studies are not current and the Manga report is not properly sourced. QuackGuru 04:07, 6 May 2008 (UTC)

This controversial change added a link to a promotional advocacy group called The Chiropractic Resource Organization. The link fails WP:RS. QuackGuru 08:57, 6 May 2008 (UTC)

The report is a reliable source. That is is hosted by the Chiropractic Resource Organization in it's entirely doesn't turn it unreliable. Oh, here's another source which discusses the historical impact of Manga. -- Levine2112 ^discuss 17:34, 6 May 2008 (UTC)

The report is unreliable and has no historical impact. Other sources should be used and not the Manga report itself. This is common sense. Further, according to this conversation here, Levine2112 acknowledged the current Manga text has no historical relevancy by stating in part:Historical context is currently not being mentioned, so for the way we are using it currently... No clear explanation has been provided for keeping oudated studies in the history section. Sources that describe the Manga report in a historical manner should be used rather than the sources themselves. As for the workers' comp studies we have newer sources available for a cost-benefit section. The workers' comp studies have no historical relevancy. QuackGuru 23:34, 6 May 2008 (UTC)

The obsolete studies are not written in a historical context. They are unrelated to the history section. Historical context is currently not being mentioned, so for the way we are using it currently... I agree. QuackGuru 17:12, 10 May 2008 (UTC)

As discussed in this section, the obsolete studies are unrelated to history. So, I made this edit. Unrelated content to history does not belong in the history section. There are plenty of references that discuss history and those refs can be used. The obsolete studies currently being used have no historical relevancy. Newer references covering the same topic currently exist. For history, it would be best to use references that discuss any history from a historical perspective. QuackGuru 22:09, 10 May 2008 (UTC)

There are two sections[7][8] in the history section that are unrelated to history. These two sections offer no historical context. So why keep it in the history section. There are newer sources available discussing history (from a historical perspective), Manga report (newer sources are available to expand the movement towards science section), and workers' comp studies (for a new cost-benefit section). QuackGuru 01:28, 11 May 2008 (UTC)

There was prior notification of the unrelated to history content.[9][10] There sections are not written in a historical context and newer studies are available. Levine2112 acknowledged: Historical context is currently not being mentioned, so for the way we are using it currently... but he has improperly restored unrelated content to history. There are references that describe and cover history and those references can be used. The original study of the Manga report has no historical context. There are references that discuss the historical impact of Manga. The dated studies (including the original Manga report) had no historical impact. There are newer sources on the talk page which differ from the older, obsolete sources in the article. This edit do not fix the source. The source is unreliable from a POV chiropractic research and advocacy group. The workers' comp studies are very old. In short, when newer references are available the older, dated studies can be deleted. Newer studies are current and exist. Why add unrelated content to history. QuackGuru 18:11, 11 May 2008 (UTC)

There is a need for a rewrite. In short, the obsolete studies are highly POV and we have numerous newer studies available. QuackGuru 12:16, 14 May 2008 (UTC)

Medical opposition

The AMA and BMA information (along with a possible rewrite of AMA and BMA) should be under the Chiropractic#Medical opposition section and not its own sections. QuackGuru 18:04, 3 May 2008 (UTC)

My specific revision is to merge AMA and BMA sections into the medical opposition section. Going one... going twice... QuackGuru 20:33, 4 May 2008 (UTC)

Merge it and find other notable medical associations (i.e. Australia) and get their take on intedisciplinary collaboration with DCs. Not sure if it's appropriate under "opposition" per se; but we can always move the merged material later on if need be. CorticoSpinal (talk) 20:48, 4 May 2008 (UTC)

I prefer peer reviewed journals if available. Here is AMA's position statement on complementary medicine as of 2002. QuackGuru 21:04, 4 May 2008 (UTC)

Glad to see you prefer peer-reviewed sources, as do I. It would be preferred to get the official stance on 'chiropractic care/medicine' as CAM is large umbrella. CorticoSpinal (talk) 21:13, 4 May 2008 (UTC)

I prefer peer reviewed but if we can't find any peer reviewed sources we can always use the sources that are presently available. QuackGuru 21:25, 4 May 2008 (UTC)

We will go ahead and merge the content into the appropriate section. QuackGuru 04:31, 5 May 2008 (UTC)

sources for chiropractic history

• Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. PMID 9818801.

• Keating JC Jr (2008). "William D. Harper, Jr, MS, DC: Anything Can Cause Anything". JCCA J Can Chiropr Assoc. 52 (1): 38–66. PMID 18327301.

• Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther. 26 (5): 300–21. doi:10.1016/S0161-4754(02)54125-7. PMID 12819626.

• Homola S (2006). "Chiropractic: history and overview of theories and methods". Clin Orthop Relat Res. 444: 236–42. doi:10.1097/01.blo.0000200258.95865.87. PMID 16446588.
• DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.

• Martin SC (1994). "'The only truly scientific method of healing'. Chiropractic and American science, 1895–1990". Isis. 85 (2): 206–27. doi:10.1086/356807. PMID 8071054.

• Martin SC (1993). "Chiropractic and the social context of medical technology, 1895–1925". Technol Cult. 34 (4): 808–34. PMID 11623404.

• Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med. 136 (3): 216–27. PMID 11827498.

• Chiropractic: An Illustrative History. Mosby. 1994. pp. 528 pages. ISBN 0801677351. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help) correct title: Chiropractic: An Illustrated History

• McDonald WP, Durkin KF, Pfefer M; et al. (2003). How Chiropractors Think and Practice: The Survey of North American Chiropractors. Ada, OH: Institute for Social Research, Ohio Northern University. ISBN 0972805559. {{cite book}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) Summarized in: McDonald WP, Durkin KF, Pfefer M (2004). "How chiropractors think and practice: the survey of North American chiropractors". Semin Integr Med. 2 (3): 92–8. doi:10.1016/j.sigm.2004.07.002. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)CS1 maint: multiple names: authors list (link)

• Chiropractic in the United States: Training, Practice, and Research Chapter I: A Brief History of Chiropractic by Reed B. Phillips, DC, PhD
• History of Chiropractic Care ACA

• Keating, Joseph C. (2004). "Chiropractic History: a Primer" (PDF). Association For The History Of Chiropractic. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Martin, S. (1993). "The Limits of Medicine: A Social History of Chiropractic, 1893--1930". Chiropractic History. 13 (1): 43. (Yes, there is a journal, Chiropractic History)
• THE EVOLUTION OF CHIROPRACTIC — SCIENCE & THEORY Haldeman 2000 evolution of Chiro theory

• Keating JC Jr (1997). "Faulty logic & non-skeptical arguments in chiropractic" (PDF). Retrieved 2008-03-15. {{cite journal}}: Cite journal requires |journal= (help)

• Grod JP, Sikorski D, Keating JC Jr (2001). "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". J Manipulative Physiol Ther. 24 (8): 514–9. doi:10.1067/mmt.2001.118205. PMID 11677551.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• "Canada Celebrates 100 Years of Chiropractic". Dynamic Chiropractic. July 17, 1995. Retrieved 2008-05-01. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)

• Lowry F (1994). "Orthopedists have bone to pick with economist over report on chiropractic". CMAJ. 150 (11): 1878–81. PMID 7802764.

• Manga P, Angus D (1994). "Report on chiropractic". CMAJ. 151 (8): 1107–8. PMID 7922936.

• Chapman-Smith DA (1994). "Report on chiropractic". CMAJ. 151 (8): 1108. PMID 7802806.

• Hoaken PC (1994). "Report on chiropractic". CMAJ. 151 (8): 1110. PMID 7922937.

• Tardif GS (1994). "Is the chiropractic management of low-back pain the solution? What can physicians learn from the Manga report?". CMAJ. 151 (9): 1247–9. PMID 7954171.

• Manga P (1994). "Defending the Manga report on the chiropractic management of low-back pain". CMAJ. 151 (9): 1250–1. PMID 7954172.

commentary on sources for chiropractic history

:Quack Guru, let's discuss one of the sources you have given to show that Manga is not a notable part of the history of chiropractic; "Anything Can Cause Anything" by Keating. This appears to me to be a biography/memoriam of an individual who died in 1990. Not surprisingly the only sources includued for material after that date are directly connected to historical material on Harper himself.

The Manga reports you seek to remove from the History section was released in 1998.

Please explain how you see the absence of Manga from this article[[11]] on some-one deceased in 1990 as bearing on the importance of Manga (1998) to chiropractic history. SmithBlue (talk) 02:38, 27 April 2008 (UTC)

If you'll do the same for another source you give "Chiropractic: An Illustrated History isbn=0801677351" cause again I'll need you to explain how a book published in 1994 could reflect on the Manga(1998) report. Am now hoping these references are adressing Chiro history in a far broader way and are not adressing Manga inclusion/exclusion. SmithBlue (talk) 03:34, 27 April 2008 (UTC)

We can add relevant studies and articles and chiropractic history. The most notable chiropractic historian is Keating. QuackGuru 18:15, 26 April 2008 (UTC)

I'm not sure I get the point of the chiropractic history sources section. Is it about a rewrite for Chiropractic#History? If so, that's a big project; there's a lot wrong with that section (for one thing, it has serious bias problems aside from its presentation of the Manga and other obsolete reports). But if this is just about the Manga reports, then that's a different story. For example, Meeker & Haldeman 2002 cites multiple sources on cost but does not cite Manga; it cites more-recent sources that are far more reliable than Manga. Perhaps there is a reliable source somewhere that Manga is an important part of chiropractic history, but so far we haven't seen it cited here. Eubulides (talk) 08:46, 27 April 2008 (UTC)

The chiropractic history needs a bit more information. The older studies (including the Manga report) that have no impact to chiropractic history will be deleted. If editors are willing, they can add new information using references that are specifically about chiropractic history. This is not a rewrite proposal. This is a suggestion for anyone to work on to add more info to the history section if anyone is interested. QuackGuru 09:10, 27 April 2008 (UTC)

In a research paper from 1997 criticizing the unscientific and uncritical culture of chiropractic, Keating mentions the Manga study approvingly as a recent (at the time) study on cost-effectiveness.

“A cost-effectiveness study of chiropractic services commissioned by the Ministry of Health for the Canadian province of Ontario strongly endorsed chiropractic management of low back pain (Manga et al., 1993)” Manga is part of history and should be in this article. However, Manga has problems and these should be mentioned, as well. Look at how many DC websites still use The Manga Report as advertising.[12]CynRNCynRN (talk) 15:57, 28 April 2008 (UTC)

I have added 2 more sources to the list above. I highly recommend the book Chiropractic History - a Primer to anyone editing this page. (It does not mention Manga, but would also be a good source for integrative medicine, wouldn't it?) DigitalC (talk) 11:30, 3 May 2008 (UTC)

The Manga report has been rewritten using newer sources. This includes the usage of the Keating ref. QuackGuru 13:01, 14 May 2008 (UTC)

Safety sources again

This is a response to the question "Why is Haldeman et al and Cassidy et al. (who are the experts in manipulation and stroke) not be given equal weight (at the very least) to Ernst?" in Talk:Chiropractic/Archive 18 #Comments on claim of bias and proposal for fix above. As I understand it, the question is why Chiropractic#Safety does not give Cassidy et al. (PMID 18204390) and Haldeman et al. (PMID 18204400) at least equal weight as Ernst 2007 (PMID 17606755). This topic was previously discussed in #Talk:Chiropractic/Archive 17#Safety section and this section continues that old thread.

To summarize the issue: in Chiropractic#Safety, Haldeman et al. is used to support the claim "Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions". Ernst is used to support the claim "The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern", which I believe is the point of controversy here.

Cassidy et al. is a primary study that is reviewed by Hurwitz et al. (PMID 18204386). Hurwitz et al. have this to say on the subject:

"There are, however, a number of case reports and case series which show temporal associations between interventions and potentially serious complications (e.g., Martienssen and Nilsson, 1989; Haldeman, 1999). These temporal relationships do raise the question about the potential of side effects from most noninvasive interventions. This is a field that deserves considerable further study and, as part of its mandate, the Neck Pain Task Force studied the relationship between chiropractic treatment and vertebrobasilar artery (VBA) strokes (these findings are summarized below).

"In a population-based case-control study, Rothwell et al showed an increased risk of VBA dissection within a week of a chiropractic visit among persons under age 45 years (odds ratio = 5.03, 95% CI = 1.32, 43.87). As part of the Neck Pain Task Force mandate, Cassidy et al extended these findings using both a case-control and case-crossover research design (a research design in which cases serve as their own controls until the event). This study confirmed an increased risk of VBA, but found a similar increase in risk of this form of stroke after visiting a primary care physician for neck pain. These findings suggest that the increased risk of VBA stroke associated with chiropractic and primary care physician visits is likely due to patients with headache and neck pain from VBA dissection (in the prodromal stage) seeking care before their stroke. Thus, although cervical spine manipulation cannot be ruled out as a potential cause of some VBA strokes, any potential risk is very small."

As per WP:MEDRS it is better to use a reliable review when one is available, as is the case here. I think the Wikipedia summary of the situation matches the union of Hurwitz et al. and Haldeman et al. and Ernst fairly closely. However, if you'd like to propose better wording based on Hurwitz et al.'s review, please feel free. For example, it would be fine to say "risk is very small" instead of "rare". Eubulides (talk) 21:53, 25 April 2008 (UTC)

Suggested change re stroke wording

Suggest change to "Vertebrobasilar artery stroke has similar statistical associations with both chiropractic services in persons under 45 years of age, and with general practitioner services, suggesting that these associations are likely explained by preexisting conditions." I see no reason for us to be contrasting the safety of DC and GP services by using "but" when the reference says that in this mmeasure they are similar.

I also note that the sentence whichs follows "Vertebrobasilar artery stroke is statistically associated..." appears to be a non sequitur - "These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation." - appears to refer to the strokes that have in the previous sentence described as likely due to "pre-existing conditions". If we are presenting a separate view/model of VBA with this latter sentence we need to let the reader know this. SmithBlue (talk) 06:52, 26 April 2008 (UTC)

• The cited source uses "but"; it says:

"There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke." (Haldeman et al. 2008, PMID 18204400)

Given that the cited source is contrasting the two services, shouldn't we be doing something similar?

• Thanks for noticing and mentioning the confusion with the "These strokes" sentence. We can fix that by replacing this:

"These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation."

with this:

"Strokes after cervical spine manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication."

which should clear up the confusion (and is shorter to boot).

Eubulides (talk) 08:46, 27 April 2008 (UTC)

I am unconvinced that we benefit the reader by continuing the "surprise of similar risk" of GP and chiro services here. What do you wish to communicate to the reader by using "but" instead of "and"? If you think communicating "surprise!" here is helpful I can live with that.

The "but" is there for the same reason it's there in the source. There's a finding that manipulation of the cervical spine is slightly risky, but there's a similar risk in GP care for the same sorts of problems, suggesting that the risk is caused by the underlying problems and not by the care. Eubulides (talk) 06:58, 28 April 2008 (UTC)

The problem with the juxtaposition of the sentences remains, whether as they are at present, or as you suggest.

1. "Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[63] Strokes after cervical spine manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication.[64}"

They take the form:

1. "A is similarly associated with B and C, likely that A is related to pre-existing D. A is caused by E."

2nd sentence contradicts 1st sentence. If we are shifting explanation/model/source then we must make explicit that these statements are reflecting differing explanations/models/sources.

The serious problem with these sentences is that they reflect works by the same researcher; Haldeman - the first source is published in 2008, the second is published in 2002. Normally in such situations the older source might be presented 1st as history and then the new source presented as the current understanding. Why is this development being presented as a contradiction? SmithBlue (talk) 11:11, 27 April 2008 (UTC)

There is no contradiction between these two sentences. The first sentence talks about a statistical association. The second sentence talks about causation. They are not the same thing. It is possible for A to cause B even though A is not statistically associated with B; this can happen if B is also caused by other factors with much greater statistical association, which swamps the statistical association between A and B so that we cannot measure it. If you would prefer putting the second sentence first, to reflect the historical order of the sources, that would be fine. Also, since this subject seems likely to come up again, it would help to mention the distinction between association and causation. In other words, how about if we replace this:

"Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation."

with this:

"Strokes after cervical spine manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, 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."

? Eubulides (talk) 06:58, 28 April 2008 (UTC)

1. Haldeman (2002) says its inherent.
2. Haldeman(2008) says evidence suggests the likely explanation is common pre-existing condition.

These are contradictions. Given that both are Haldeman, presenting them as a development of understanding of VA stroke would be common practice. To present them as you suggest (or as at present) is misleading and confusing. SmithBlue (talk) 08:16, 28 April 2008 (UTC)

They are not contradictions, for the reasons explained: the first is about causation, the second is about statistical association. The third reference (Miley et al. 2008) cited in the proposed rewrite is also about causation. This is not a case of "development of understanding": Miley et al. is the most recent citation. It is a case of the difference between statistical association and causation. Eubulides (talk) 16:35, 28 April 2008 (UTC)

Haldeman 2002 is a study on 64 cases of cerebrovascular accidents temporally associated with cervical spine manipulation. Haldemans suggested explanation of risk to patients, for these temporal associations, was, "It is, however, possible to inform the patient of this risk, to discuss the relative risk ..., and to explain that according to the current understanding of this problem, cerebrovascular symptoms are unpredictable, inherent, and rare complications of cervical manipulation."

Haldeman 2008 clearly states that the most likely explanation for the associations is a pre-existing conditions. Associations here refers to the statistically significant temporal assocition between either GP or DC service and VA stroke.

Haldeman 2002 is no more relevant to causation than Haldeman 2008. Haldeman 2002 did not research the mechanism of the stroke - only statistical correlates such as putative risk factors, symptoms after stroke, treatment, outcome etc. To cherry pick the presently used quote from an outdated 2002 study on statistical associations is misleading. The presently used 2002 quote was expressedly "the current understanding" for patient education. The other expression of this point stated in the article "These complications appear to be unpredictable, and should be considered as inherent and idiosyncratic" is in far less definite language. ANd is superceded by Haldeman 2008 as his view of the current understanding. The material we include about this supercession will need to clearly tell the reader that we are discussing a changing view. SmithBlue (talk) 01:14, 29 April 2008 (UTC)

That's a good point. Chiropractic#Safety is about the current understanding, not about history (that's for Chiropractic#History), so let's drop Haldeman 2002 entirely, then, since it's superseded by more-recent material. Also, as noted below, the current text somewhat-confusingly refers to the executive summary of the review, rather than the review itself; it'd be better to just cite the review and summarize what it says. Combining all these suggestions, how about if we replace this:

"Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation."

with this:

"Several case reports show temporal associations between interventions and potentially serious complications. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, 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." (*)

? Eubulides (talk) 06:58, 28 April 2008 (UTC)

Unfortunately I do not have online journal access and am unable to read more than the abstract which precludes me giving a useful reply at present. SmithBlue (talk) 08:56, 30 April 2008 (UTC)

Excellent point, SmithBlue. I also question why the full findings of the Task Force, which has been described as the "one of the most important research and policy documents ever published for the chiropractic profession" here gets exactly 1 sentence. Undue weight? Surely. Time to fix this. CorticoSpinal (talk) 22:54, 27 April 2008 (UTC)

SmithBlue's point is discussed above. The safety findings of the Task Force on Neck Pain, as expressed in its executive summary (Haldeman et al. 2008, PMID 18204400), are fully summarized in Chiropractic#Safety. Eubulides (talk) 06:58, 28 April 2008 (UTC)

I think working from full documents, not summaries, allows for a better distillation of the source. Who's got access? SmithBlue (talk) 08:16, 28 April 2008 (UTC)

When there are a reliable review sources, as is the case here, it is not our job to reach down into primary studies and distill them ourselves. There are thousands of primary studies, and it would be all too easy for us to introduce bias by distilling studies, or parts of studies, whose results we happen to prefer. In cases like this, as per WP:MEDRS, we should be relying on reliable secondary reviews to do the distillation for us: we should not substitute our judgment for the judgment of experts in the field. Eubulides (talk) 16:35, 28 April 2008 (UTC)

If Eubulides would be kind enough to show a cite stating that exectutive summaries of reports are considered reliable review sources? SmithBlue (talk) 01:14, 29 April 2008 (UTC)

The executive summary summarizes the review in Hurwitz et al. (PMID 18204386), whose findings about the primary study in question are quoted in #Safety sources again above. The primary study, the review, and the executive summary are all by the Task Force on Neck Pain. Chiropractic#Safety says everything about the primary study that the review and the executive summary says. Eubulides (talk) 08:29, 29 April 2008 (UTC)

And if that source could also state that the existence of an executive summ absolutely preludes the use of the full paper? SmithBlue (talk) 01:24, 29 April 2008 (UTC)

WP:MEDRS does not absolutely preclude anything. It is guideline, not policy. However, it is a guideline that works well and makes a lot of sense. Without that guideline, it's all too tempting for Wikipedia editors to reach down into primary studies to pick out tidbits that agree with their personal opinions. It's far better to rely on the opinions of published experts in the field instead, and to use the experts' reviews when available. Eubulides (talk) 08:29, 29 April 2008 (UTC)

If such sources are not to be found I will ask Eubulides to remember that we are here to further develop WP and that seeking to prevent even the exploration on the talk page of the full document, as Eubulides has done above, is not congruent with our purpose (or the primary WP:IAR). SmithBlue (talk) 02:31, 29 April 2008 (UTC)

First, there seems to be some confusion here about the executive summary and the review it summarizes, which I have attempted to fix in the latest draft wording. Second, I have not attempted to prevent the exploration on the talk page of the full document. Please feel free to talk about the full document here. Eubulides (talk) 08:29, 29 April 2008 (UTC)

For the record, this is the same kind of argument and wikilawyering Eubulides has used to prevent the inclusion of high quality "primary studies" whilst keeping weak "secondary" studies. It's always "reaching down" and "substituting judgment". This is the tactic used to keep out high quality, peer-reviewed, scientific chiropractic research by DC/PhDs out of chiropractic and, especially, out of safety. There is a huge weight violation by neutering and spaying the WHO Joint Task Force Neck Pain report conclusions and mentioning one tiny line that Eubulides' later rebuts with a dated study. Not cool. CorticoSpinal (talk) 23:51, 28 April 2008 (UTC)

All of the the executive summary's and the corresponding review's conclusions about chiropractic safety have been presented in the revised wording. It would not be right to override these experts by reaching down into primary studies that they have reviewed, and to present our own, differing opinions of those studies. Eubulides (talk) 08:29, 29 April 2008 (UTC)

Thank you for your detailed reply. On reviews - my understanding is that reviews are conducted to draw out specific and relevant finding for a specific purpose. The purposes of a reviewer may or may not accord with WP needs for documenting evidence on a specific topic. If we need to reach down into these reviewed studies, which may well have been conducted for purposes not wholely aligned with our article topic, there is nothing in WP:RS or WP:MEDRS that prevents us doing so. If we do reach down we will need to excercise far greater caution than usual to ensure that we are not presenting WP:OR. Hopefully all editors here would contribute to that caution. SmithBlue (talk) 09:03, 29 April 2008 (UTC)

The presentation of these safety studies does not attain WP:NPOV "representing significant views fairly, proportionately and without bias." SmithBlue (talk) 02:31, 29 April 2008 (UTC)

I have proposed a change in wording, marked (*) above, that attempts to address the issues you raised. Eubulides (talk) 08:29, 29 April 2008 (UTC)

No objection was made to the proposed change marked (*), so I installed that change. Eubulides (talk) 19:38, 2 May 2008 (UTC)

What does SmithBlue's objection just above refer to: "The presentation of these safety studies does not attain WP:NPOV 'representing significant views fairly, proportionately and without bias'"? Further, I think that any of the studies which confound general SMT with that performed by a chiropractor specifically should be removed. This is the chiropractic article and thus if safety is to be discussed, it should be discussed as the "Safety of Chiropractic" and not as the "Safety of SMT". -- Levine2112 ^discuss 19:44, 2 May 2008 (UTC)

I believe SmithBlue's objection refers to the old wording, which was replaced by the change. The change did not address the other issue that you mention, as the old and the new versions both cite studies which talk about SMT (as opposed to chiropractic care). So that issue is orthogonal to this change, though obviously it is an issue that might be a subject of future changes. Eubulides (talk) 19:54, 2 May 2008 (UTC)

These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation. This sentence was deleted. I think it added something to the article. Or was it duplication. QuackGuru 21:46, 3 May 2008 (UTC)

That was removed because SmithBlue objected that the cited source (Haldeman et al. 2002, PMID 11805635) was to some extent obsoleted by the more-recent source (Hurwitz et al. 2008, PMID 18204386; Haldeman was part of the same Task Force as Hurwitz). To some extent the removed text was duplicative of the newly added sentence that is supported by Miley et al. 2008 (PMID 18195663). Eubulides (talk) 06:58, 4 May 2008 (UTC)

Significant (Deliberate?) Omissions from Safety

Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces.

Spine. 33(4S) Supplement:S170-S175, February 15, 2008. Boyle, Eleanor PhD *+; Cote, Pierre DC, PhD *+++[S][P]; Grier, Alexander R. DC, MBA [//]; Cassidy, J David DC, PhD, DrMedSc *+++[S]

Abstract: Study Design. Ecological study.

Objectives. To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization.

Summary of Background Data. Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level.

Methods. All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates.

Results. The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period.

Conclusion. In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study.

Spine. 33(4S) Supplement:S176-S183, February 15, 2008. Cassidy, J David DC, PhD, DrMedSc *+++; Boyle, Eleanor PhD *; Cote, Pierre DC, PhD *+++[S]; He, Yaohua MD, PhD *; Hogg-Johnson, Sheilah PhD +[S]; Silver, Frank L. MD, FRCPC [P][//]; Bondy, Susan J. PhD + Abstract: Study Design. Population-based, case-control and case-crossover study.

Objective. To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke.

Summary of Background Data. Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke.

Methods. Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls.

Results. There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke.

Conclusion. VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

Treatment of Neck Pain: Noninvasive Interventions: Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

Best Evidence on Assessment and Intervention for Neck Pain

Spine. 33(4S) Supplement:S123-S152, February 15, 2008. Hurwitz, Eric L. DC, PhD *; Carragee, Eugene J. MD, FACS +++; van der Velde, Gabrielle DC [S][P][//]**; Carroll, Linda J. PhD ++; Nordin, Margareta PT, DrMedSc ++++[S][S]; Guzman, Jaime MD, MSc, FRCP(C) [P][P][//][//]; Peloso, Paul M. MD, MSc, FRCP(C) ***; Holm, Lena W. DrMedSc +++; Cote, Pierre DC, PhD [P][//]**[S][S][S]; Hogg-Johnson, Sheilah PhD [P][P][P][P]; Cassidy, J David DC, PhD, DrMedSc [//]**[S][S][S]; Haldeman, Scott DC, MD, PhD [//][//][//]**** Abstract: Study Design. Best evidence synthesis.

Objective. To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders.

Summary of Background Data. No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade.

Methods. We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis.

Results. Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.

Conclusion. Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.

These omissions don't even take into account the negative tone as implied by Eubulides' drafts (going on 4 now). A casual reader will leave with the impression that manual therapy (predominantly manipulation) is riddled with "minor and adverse side effects" and listed tons of contraindications. Safety ignores that manual therapy has been proven to be effective in grades I, II non-traumatic neck pain. There are other major omissions but I'd like to get feedback first. For the record, SB, I now have full access to journals once again, so if you ever need me to reproduce a certain subsection I can do so, as long as I'm not violating some kind of copyright. CorticoSpinal (talk) 20:34, 29 April 2008 (UTC)

• Of the three sources mentioned, the review (Hurwitz et al. 2008, PMID 18204386) is already cited by the most-recent proposed safety rewrite. The other two sources are primary studies and we don't need to mention them directly. There are dozens of primary studies on all sides of the safety issue: reaching down and citing just the ones we like, which is what seems to be proposed here (it's not exactly clear), is a recipe for introducing editorial bias.
• Minor adverse side effects are common and are worth mentioning briefly.
• Effectiveness is a different issue; this is the safety section, not the effectiveness section.

Eubulides (talk) 18:06, 30 April 2008 (UTC)

Please propose a suggestion (such a written sentence) for review using a ref (). QuackGuru 19:24, 29 April 2008 (UTC)

Use a direct quote from the conclusion "At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.". Simple, consise, clear, relevant and factual. CorticoSpinal (talk) 20:34, 29 April 2008 (UTC)

That primary source (Boyle et al. 2008, PMID 18204389) was reviewed by Hurwitz et al. 2008 (PMID 18204386), which is already cited in the proposed safety text. It would not be right to reach down and highlight a primary source that reliable reviewers have already deemed not worth notice. If that were allowed, skeptics of chiropractic would rightly ask why they couldn't also add "simple, concise, clear, relevant, and factual" statements like these: "Chiropractic by not being a drug nor a medical device has not been submitted to formal evaluation by the medicinal agencies. Similarly, its safety profile escapes to the pharmacovigilance networks." and "The described serious adverse events promptly recommend the implementation of a risk alert system." These are quotes from a primary source, namely Gouveia et al. 2007 (PMID 17904731), which is an example of dozens of critical primary sources that one could easily add to Chiropractic if standards were so low as to include that quote from Boyle et al. 2008. Eubulides (talk) 18:06, 30 April 2008 (UTC)

That sound simple and reasonable. -- Levine2112 ^discuss 20:57, 29 April 2008 (UTC)

It is a bad idea. Per WP:COPYVIO. QuackGuru 04:39, 30 April 2008 (UTC)

A single line quoted from an article is NOT a copyright violation. It is covered by fair use. DigitalC (talk) 05:56, 30 April 2008 (UTC)

I agree it's not a copyright issue. An entire sentence taken unchanged should be quoted and attributed, or (better) paraphrased carefully; either way, it would not be a copyright violation. The problem with the proposed addition is not copyright violation, it is that it highlights a primary study that our expert reviewers cite but do not highlight. We should not override the opinion of the published expert reviewers. Eubulides (talk) 18:06, 30 April 2008 (UTC)

Quack Guru, you seem to be working with a very unusual interpretation of WP policy. Unfortunately your interpretation, at least in this instance, could have the effect of disrupting editing. Quoting sentences, and paragraphs, is accepted and standard practice on WP. WP:MOSQUOTE gives details on how to quote multiple paragraphs. I suggest you retract your above comment suggesting that quotes are copyright violations. SmithBlue (talk) 06:09, 30 April 2008 (UTC)

I have rewritten the sentence hours ago without using any quotes. QuackGuru 07:56, 30 April 2008 (UTC)

With increased chiropractic utilization, the increase in VBA stroke does not seem to be associated. This is a primary study. QuackGuru 17:41, 1 May 2008 (UTC)

Relevant papers

I will the relevant passages from relevant papers to help bring the tone to more NPOV. We simply cannot pass over high quality lit by stroke and manipulation experts because of an arbitrary interpretation of a guideline. Invoking WP:IAR on this one. CorticoSpinal (talk) 17:38, 26 April 2008 (UTC)

I do not understand what arbitrary interpretation of a guideline should be avoided in order to invoke WP:IAR. QuackGuru 18:09, 26 April 2008 (UTC)

Well, here is the issue, as I understand it, from the orthodox med perspective on SMT and safety: 1) DCs and stroke are related and potentially causative 2) SMT is inherently dangerous with serious safety risks which results, at worst, in death 3) SMT is not a proven treatment for neck pain. So, when I find and present literature that tackles these 3 subjects and very soundly refutes it, it is argued that the studies don't belong. Well, I'm sorry, but I completely disagree and in order to preserve the reliablity of the project, I need to invoke WP:IAR so that the whole story is presented. Because as it stands, we don't even have 1 peep from the experts in stroke and manipulation, namely, Haldeman, Cassidy and Cote. CorticoSpinal (talk) 18:47, 26 April 2008 (UTC)

Please provide the references along with proposed text on the talk page for review. Keep in mind that when newer studies review older studies, we should use the newer studies. Makes sense? QuackGuru 19:18, 26 April 2008 (UTC)

QG, it's getting very tiring of hearing your demands and condescending tone. No, it doesn't make sense; the quality of the study, not the "recentness" matters in advacing the evidence in either direction. Clearly your knowledge of research and evidence-based methods is tenuous, at best, right now, but you can improve by reading up on Sacketts levels of evidence here; it will help you better appraise the quality, notability, reliability, validity and applicability of the sources you bring to the table. We are in the evidence-based era now (should be evidence-informed, but that's a separate matter) and research is the currency when staking claims. I hope you keep this in mind when you are editing other chiropractic medicine related articles; there's no point in having the same discussion 5+ times elsewhere. Cheers. CorticoSpinal (talk) 01:19, 27 April 2008 (UTC)

The quality of a study is obvious. For example, a primary study is weaker than a more recent review of the primary study. That said, a recent review study is much stronger and holds more weight. Sacketts lack of evidence here; is outdated and very old. It is clearly obsolete (unreliable). For example, Sacketts mostly uses references that are older than a decade. We have higher quality sources that are already in this article. QuackGuru 03:46, 27 April 2008 (UTC)

That simply isn't true. WP:MEDRS would have us believe that a review is higher quality than a primary study, but that is not the truth. A poorly designed systematic review, or a biased editorial review, should not hold more weight than a high quality, well designed primary study. DigitalC (talk) 22:53, 27 April 2008 (UTC)

It is true that a high-quality primary study is a better source than a bad review. But that is not what is happening here. The review in question (Haldeman et al. 2008, PMID 18204400) is high quality and is put out by the same group (the Task Force on Neck Pain) that sponsored the primary study in question (Cassidy et al. 2008, PMID 18204390). It would make little sense to reject the Task Force's own review of its own study. Eubulides (talk) 06:58, 28 April 2008 (UTC)

This doesn't appear to be a review, it appears to be an executive summary of the findings. DigitalC (talk) 22:46, 28 April 2008 (UTC)

The review is Hurwitz et al. (PMID 18204386). The executive summary summarizes this review. The review's coverage of this issue is quoted above, in #Safety sources again. As far as I am concerned, either the review or the executive summary could be cited in Chiropractic; the main reason the executive summary is cited in Chiropractic#Safety is that it's freely readable (the review is not). However, given the resulting confusion the latest draft (marked (*) above) cites the review instead. Eubulides (talk) 08:29, 29 April 2008 (UTC)

I've already mentioned this to him and it seemed to more of the same with his editing here WP:IDIDNTHEARTHAT. He also completely refuses to include the results of Cote et al. (2008) here published in Spine. Coincidence? I don't think so anymore, it's his attempt to not only to get allopathic med POV here, but it's to treat chiropractic like [[WP:FRINGE|fringe] and marginalize the profession (just like the whole "dispute" over chiropractic scope of practice. The trend is unmistakingly clear now... CorticoSpinal (talk) 00:05, 29 April 2008 (UTC)

This is the first I recall hearing of Cote et al., although so many studies have been mentioned in this thread over the past couple of months that it's quite possible I forgot it. Shouldn't that be Boyle et al. 2008 (PMID 18204389), not Cote et al.? Anyway, that is a primary study that doesn't add much. Hurwitz et al. briefly mention Boyle et al. as being one of the task force studies, but they seem to think little of it, and do not mention it anywhere else that I can see. Unlike Cassidy et al., they mention it neither in their discussion of chiropractic safety nor in their conclusion. Let's stick with what the review (Hurwitz et al.) has to say here, since they already reviewed this primary study. Eubulides (talk) 08:29, 29 April 2008 (UTC)

[outdent]. It's this type of editorial arrogance (Anyway, that is a primary study that doesn't add much) that prolongs this dispute. How many editors is it now that disagree with your stance? 5-6? This is a violation of WP:POINT, WP:IDIDNTHEARTHAT and a violation of WP:NPOV. This is getting out of hand. CorticoSpinal (talk) 20:39, 29 April 2008 (UTC)

Hurwitz et al. (PMID 18204386) review the source in question (Boyle et al. 2008, PMID 18204389), and don't think much of it. In contrast, they highlight the results of Cassidy et al. 2008 (PMID 18204390). We should follow the lead of the reliable reviewers and highlight Cassidy et al.'s result; we should n not substitute our own judgment for that of published experts in the field. It is not "arrogance" to prefer summaries of the opinion of expert reviewers; on the contrary, it is humility to avoid one's own opinion as much as possible, and to instead simply summarize the opinions of published experts. Eubulides (talk) 18:06, 30 April 2008 (UTC)

I have heard this same, tired argument time and time again and the majority of editors disagree with you here. I'm going to add the conclusions of the Boyle study as it is appropriate. CorticoSpinal (talk) 16:58, 4 May 2008 (UTC)

This is an incorrect summary of what the other editors have said on this subject. On the contrary, there is considerable sentiment that we should defer to reliable reviews in the area. Eubulides (talk) 08:15, 5 May 2008 (UTC)

This controversial change added text from a primary study. We should not second-geuss the reviewers. QuackGuru 17:35, 6 May 2008 (UTC)

This edit added text to the article. Where in the source does it say that. Hmm. QuackGuru 17:57, 6 May 2008 (UTC)

Just adding clarity for the review, lest the readers think that the reviewers were only discussing CMT as performed by chiropractors. They were not. The reason why clarification is needed, because in an article about chiropractic, a reader might assume that CMT refers to a procedure only performed by chiropractors. This is not the case in this review. The alternative to clarifying this would be to remove mention of the study entirely. Take you pick. -- Levine2112 ^discuss 18:01, 6 May 2008 (UTC)

Your edit failed verification. Again, where in the source did it say that. QuackGuru 18:10, 6 May 2008 (UTC)

Where in the source does it say that the researchers were specifically studying CMT as only performed by chiropractors? If it doesn't say that, technically it shouldn't be in this article. -- Levine2112 ^discuss 18:12, 6 May 2008 (UTC)

Please address my comments instead of ignoring them.

We should not second geuss the latest state of the art reviews. QuackGuru 18:25, 6 May 2008 (UTC)

I have addressed your comment in the form of a counter-question. Please feel free to respond to it if you would like to continue this conversation. -- Levine2112 ^discuss 18:28, 6 May 2008 (UTC)

Please provide a reference or the unreferenced text will be deleted. Irrespective of the tag deletion it is still unreferenced. QuackGuru 19:55, 6 May 2008 (UTC)

As the whole text doesn't seem to be specific to the subject at hand - cheifly, Chiropractic - the {{nonspecific}} is more appropriate. And I agree in that if the entire reference cannot be shown to be specific to chiropractic, it should be deleted. If it is just about CMT in general (as performed by any number of practitioners and non-practitioners), it would be better suited for the spinal manipulation article. -- Levine2112 ^discuss 20:06, 6 May 2008 (UTC)

Do you think this edit is referenced? If so, where in the source does it say that. QuackGuru 20:12, 6 May 2008 (UTC)

You have asked this before and once again, I address your comment in the form of the same counter-question which you haven't answered: Where in the source does it say that the researchers were specifically studying CMT as only performed by chiropractors? -- Levine2112 ^discuss 20:18, 6 May 2008 (UTC)

This is about safety issues. The unreferenced text has been challenged. Please provide a reference or delete it. QuackGuru 20:29, 6 May 2008 (UTC)

Yes, this is about safety issues and chiropractic. The text which we are currently discussing doesn't seem to be about chiropractic specifically. Please provide a reference which shows it does or delete it. Essentially, why discuss a minor parenthetical portion when we should be discussing the relevance of the whole statement? -- Levine2112 ^discuss 20:33, 6 May 2008 (UTC)

(outdent) Miley et al. 2008 (PMID 18195663) covers evidence from both chiropractic and non-chiropractic sources. Briefly reviewing it, the strongest evidence comes either from chiropractic data (e.g., Rothewell et al. 2001) or from criteria that are independent of whether the data was generated from chiropractic or non-chiropractic care (e.g., our understanding of the mechanism of disease). It is standard practice nowadays, in both chiropractic and non-chiropractic reviews, to consider sources from both chiropractors (the main source of data for spinal manipulation) and non-chiropractors (a relatively minor source) when evaluating safety and effectiveness of SMT. Please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

Problem with worker's compensation section

The last paragraph in the worker's comp section doesn't relate to the title of the section, as it is about patient satisfaction. Furthermore, the reference given, the Cherkin survey, doesn't support patient satisfaction. It talks about chiropractor's and physician's attitudes toward treatment of back pain: "Random samples of 605 family physicians and 299 chiropractors in Washington were surveyed to determine their beliefs about back pain and how they would respond to three hypothetic patients with back pain". This disconnect has been bothering me. Someone fix it please!CynRNCynRN (talk) 02:40, 30 April 2008 (UTC)

CynRN, there are a lot more problems with the Workers's compensation studies. For example, The text says in "1998" when the reference says "1988." A 1988 study is way too old when newer sources are available. QuackGuru 23:51, 1 May 2008 (UTC)

I explained about it in this thread. It contains obsolete studies. It will be deleted. That's my fix. QuackGuru 04:35, 30 April 2008 (UTC)

OK, sounds good. Will there be an updated summary of worker's comp studies?CynRNCynRN (talk) 16:07, 30 April 2008 (UTC)

I already did that hours ago. I will add an update to the article when it becomes unprotected. QuackGuru 17:19, 30 April 2008 (UTC)

Can you point me to where the updated summary of worker's comp studies are? It doesn't appear to me to be any consensus to delete this material. But perhaps I am overlooking it on this rather huge discussion page. Thanks. -- Levine2112 ^discuss 17:23, 30 April 2008 (UTC)

Got it? QuackGuru 17:46, 30 April 2008 (UTC)

So despite you adding that just after my request here, there still doesn't seem to be a consensus nor an updated summary as you suggest just above. All that is there is your opinion on the matter and much disagreement with your opinion. Thus, if you were to "add an update to the article when it becomes unprotected", it would be considered a tendentious edit. Please strive to work out a consensus version first, lest we find ourselves with a blocked article for another week or more. Make sense? -- Levine2112 ^discuss 18:00, 30 April 2008 (UTC)

Also, let's carefully consider this source which provides a comprehensive review of the literature. I think this may very well qualify as the best source we have. -- Levine2112 ^discuss 18:02, 30 April 2008 (UTC)

(outdent) As I understand it, the intent is to write a new cost-effectiveness/risk-benefit/etc. section based on the latest reviews of the subject. (A draft of sources for this section can be found in Talk:Chiropractic/Archive 17#Sources for risk-benefit and cost-effectiveness.) If these reviews refer to those old worker's compensation studies the new section should summarize them; if not, it won't. Either way, the new section will summarize higher-quality stuff that has come out more recently; that should suffice to cover the topic. This new section should be drafted and discussed on the talk page before going in. Eubulides (talk) 18:06, 30 April 2008 (UTC)

We also have from 2004 an updated Workmans Comp (WSIB)study performed by an independent 3rd party consulting firm. Conclusion? Go see for yourself! This should be included in any revision. I'm also a bit leary of any intent to do a risk/benefit section for the exact same reasons as described by the majority of editors when the proposed effectiveness went thud. CorticoSpinal (talk) 18:09, 30 April 2008 (UTC)

The proposed effectiveness section is still under discussion. Like any substantial change in a controversial article, we can expect a lot of discussion. Even in the unlikely event that the discussion results in no changes to Chiropractic's coverage of effectiveness, a failure to improve one part of the article does not mean we should give up trying to improve another part. Eubulides (talk) 18:37, 30 April 2008 (UTC)

Please point me to the specific policy where Wikipedians cannot start a stub section in mainspace. I will use newer, high quality studies and delete the obolete studies. Starting a stub section in mainspace is done everyday on Wikipedia. QuackGuru 18:29, 30 April 2008 (UTC)

For controversial articles like this one, it is common practice (and a good idea) to propose specific changes on the talk page first, so that they can be discussed. Please try that in this case. For non-controversial articles things are quite a bit easier, but this article is controversial. Eubulides (talk) 18:37, 30 April 2008 (UTC)

There was an edit conflict here, but Eubulides essentially took the words right out of my mouth. QG, please work to form a a consensus here first before inserting anything into the article. This article is too delicate to risk anything which might appear to be tendentious editing. Make sense? -- Levine2112 ^discuss 18:42, 30 April 2008 (UTC)

My question was not answered. Again. Please point me to the specific policy where Wikipedians cannot start a stub section in mainspace. QuackGuru 19:08, 30 April 2008 (UTC)

Agreed with Eubulides and Levine2112 on this one. Sure some studies like the old workmans comp can be pruned, but should be amalgamated with newer workmans comp stuff. So long as the studies are in the proper historical context and have the proper significance (Manga was a landmark study for the profession regardless of the controversy it may have generated afterwards) and that's important to note. I trust the judgment of chiropractic historians, such as Keating, PhD to determine the appropriate impact and weight rather than a skeptical editor who seems to abide by a deletionist policy rather than the favoured inclusionist one. Also, if there is no (majority) consensus for a stub, there's no stub. That's one of the important tenets of wikipedia per WP:CON. Your efforts and edits will be much better if you approach it that way, methinks. CorticoSpinal (talk) 19:12, 30 April 2008 (UTC)

Again QG, please consider WP:CON. While it doesn't prohibit you from making article edits on articles, it certainly recommends discusses edits first on talk. Given the contentious nature of this article and all of the recent article blocks, I and the other editors all agree to abide to talking out edits first. I hope you can see to it to abide by this too as bold edits to the article at this point may be viewed as disruptive. Further, please consider WP:DE as well as it may answer your question above even more directly. -- Levine2112 ^discuss 19:34, 30 April 2008 (UTC)

I do not see any harm for starting a new stub section in mainspace. This is done every single day on Wikipedia and this is normal practice. QuackGuru 20:08, 30 April 2008 (UTC)

The harm is that all the other editors who have spoken about this here would prefer if you didn't because it would be perceived as disruptive. Instead of posting your new stub section article space, all we are asking is that you post it here first so we can discuss. The block which the article is currently in was in effect started by you performing a similar action (installing the efficacy section before it had achieved consensus). The result was that was an edit war, the article was locked, morale fell, and civility and the spirit of cooperation dropped. So, you ask us now what's the harm in doing it once again when I should think it is plainly obvious from last time what the harm is. -- Levine2112 ^discuss 21:26, 30 April 2008 (UTC)

The article is currently locked up because a certain editor added original research and POV material to the article.[13][14] How is it preceived as disruptive to start a new stub in mainspace when this is normal practice. Improving the article is not harmful. If someone disagrees based on POV issues like the Scope of practice, that is a different matter. It is up to the editor who disagrees to provide a reason why it does not meet Wikipedia's standard. If it does meets Wikipedia's standard, it is harmful to the project to blatantly delete NPOV written text, especially when using the newest available sources. The worker's compensation studies do not belong in the history section. It belongs in a new section titled cost-benefit. Most if not all of those studies are outdated anyhow. If there is anything worth keeping it should be put in the proper section under cost-benefit. QuackGuru 21:57, 30 April 2008 (UTC)

And the time before that, it was you adding the not-ready Efficacy section [15] which lead to an edit war and the eventual block. See the pattern? See what happens when contentious material is added without consensus? Just be cool and let's discuss it first. That is the consensual wishes of everyone here. If anyone disagrees with me (anyone aside from QuackGuru) and rather thinks we should not discuss major edits first, please speak up now. Otherwise, this is the consensus on how we are going to move forward. We will discuss edits such as adding new sections/stubs to the article, work out a consensus version and then (and only then) insert in the article. -- Levine2112 ^discuss 22:06, 30 April 2008 (UTC)

Adding a new stub section is not a major edit. The obsolete studies have no place in the history section. And the Effectiveness seems ready now. QuackGuru 22:13, 30 April 2008 (UTC)

I am sorry, but I disagree. And so do others. You are going to have to wait. -- Levine2112 ^discuss 22:14, 30 April 2008 (UTC)

QG, you would be wise to heed Levine2112s and Eubulides advice. You're also ignoring the points we've mentioned above already; we're not suggesting we keep the obsolete studies, we suggest in making sure they're relevant and put in the proper context. Unilaterally deciding what stays, what goes is not the right way to go about this. CorticoSpinal (talk) 22:38, 30 April 2008 (UTC)

It makes sense to delete the obsolete studies that are unrelated to history. The proper context is to replace the outdated studies with the newer effectiveness studies. A stub section is not a major edit. Agreed? QuackGuru 22:59, 30 April 2008 (UTC)

We're going in circles here. Round and round. QuackGuru, you know everyone's position here. -- Levine2112 ^discuss 00:11, 1 May 2008 (UTC)

We can reach and strive for a better article and not the status quo. Just around the corner is a great improvement and thus a better article because of our efforts. It can be done easily, especially when arguments such as this makes sense. Please provide a reason for your desire to keep oudated studies and ignore newer effectiveness studies. Small improvements such as starting a new stub section (cost-benefit) will encourage thought and development to reach that elusive GA status. We can do this. Trust me, okay. QuackGuru 02:18, 1 May 2008 (UTC)

Disagreeing with isn't a lack of |good faith, QG. What perplexes me is how you do not seem to understand what we are proposing. Just because Manga is an old study does not mean it's not relevant to the profession. Keating says so many times as well. I don't know why you want this study gone so badly. We agree that we must use the best, recent and relevant sources for an update. I appreciate your efforts in attempting to bring this article to FA (featured article) not GA (I thought it was a typo, the f and g key are side by side!) status and we'll get there if we can avoid disruptive conversations on the Talk page of all places. 208.101.118.196 (talk) 04:21, 1 May 2008 (UTC)

I think we can reach common ground with the Manga report. The Manga report is out and it can be replaced with historical refs such as Keating. We can do the same with the other obsolete studies. They are also out and the newer studies are in. Sounds reasonable? QuackGuru 04:43, 1 May 2008 (UTC)

So I take it that you don't stand by this comment anymore? That you at least agree that Manga is of historical significance to Chiropractic? Yes? -- Levine2112 ^discuss 05:16, 1 May 2008 (UTC)

The Manga report itself is an obsolete study and no argument has been made to keep it. The Manga report itself has no historical impact. The Keating reference might be used as a historical reference. There are also more obsolete studies that should also be deleted. Agreed? QuackGuru 16:58, 1 May 2008 (UTC)

I sincerely apologize but continue to disagree with the same argument you keep repeating over and over again. Additionally I find it hard to understand that you maintain that the Manga Report has zero historical impact considering not just the Keating source, but the others I and others have provided above. Consider, for instance, this source. My feeling remains that Manga (and a few other of the landmark studies following Wilk) should be discussed for their historical context in our article. -- Levine2112 ^discuss 17:20, 1 May 2008 (UTC)

References that decribe the Manga report might be used if they are reliable and have historical impact. But the original Manga report is obsolete and should be deleted. The same goes for the other obsolete studies. Agreed? QuackGuru 17:29, 1 May 2008 (UTC)

Instead of talking about it like this, let's draft it up on this page. That way our discussions can be more tangible. -- Levine2112 ^discuss 17:53, 1 May 2008 (UTC)

The draft for the obsolete studies would be blank. QuackGuru 18:08, 1 May 2008 (UTC)

Why? I have already provided at least three sources above which show some of their significance in terms of chiropractic history. -- Levine2112 ^discuss 18:32, 1 May 2008 (UTC)

The obsolete studies would be blanked because we have newer studies available such as the ready effectiveness section. If you want to add new information using historical references about history that is a different issue. Feel free to edit the article and add historical information according to the sources. QuackGuru 19:10, 1 May 2008 (UTC)

All I am saying is don't blank, add, edit, remove, or delete anything from the article without a consensus to do so. This article is too volatile at the moment. Let's just take it slow. -- Levine2112 ^discuss 19:16, 1 May 2008 (UTC)

Please provide a reason for keeping obsolete studies and completely rejecting newer and ready effectiveness studies. Anyone is free to update the history section with references that discuss history. QuackGuru 19:23, 1 May 2008 (UTC)

No one is completely rejecting the newer studies. I just don't agree that they necessarily render the older studies obsolete. The older studies are seemingly much more comprehensive. Let's start first by drafting up a version which we can all live with before we make any further edits to the article. I think we have all agreed to abide by this except for you. This is out of interest of stopping any future edit wars and subsequent locking of the article. I think we all want to know that you will at least agree to abide by this. -- Levine2112 ^discuss 19:27, 1 May 2008 (UTC)

The obsolete studies have no place in the history section. The history section is specifically for chiropractic history and not a place for outdated studies. If there is anything worth keeping it should be added to the appropriate section. Newer studies on the same specific topic renders the older studies obsolete. A draft of obsolete studies? That would not be an improvement for this article. QuackGuru 19:59, 1 May 2008 (UTC)

[outdent]. This has hit a new low. GQ, you are misrepresenting Levine2112's point. The fact that 3 sources (so far) has mentioned Manga as an important study illustrates the point that it's a notable. Next, there is confabulation with other topics which prevents this discussion from moving forward in a productive manner. CorticoSpinal (talk) 19:47, 1 May 2008 (UTC)

Anyone is free to update the article using historical references that mention the Manga report. But the Manga report itself is an obsolete study when we have newer effectiveness studies available. QuackGuru 19:59, 1 May 2008 (UTC)

Perhaps, but I just want your assurance that you will abide by the consensus here to discuss all changes (including removing, add, amending content) first and to arrive at some agreement before making changes to article space. Once you agree, I would very much be interested in moving forward discussing this matter with you and drafting up new versions of the content. -- Levine2112 ^discuss 20:02, 1 May 2008 (UTC)

I am not interested in drafting up new versions of outdated studies. QuackGuru 20:09, 1 May 2008 (UTC)

That's not what I am asking. I am asking you if you are willing to abide to our agreement not to edit the article without a consensual agreement here first. Are you willing to abide by this? -- Levine2112 ^discuss 20:11, 1 May 2008 (UTC)

If it's any consolation. . . I will abide by this too. . . Are we unanimous now (save Quackguru)?TheDoctorIsIn (talk) 04:17, 2 May 2008 (UTC)

Yes, as far as I can tell. Thanks, Doc. -- Levine2112 ^discuss 05:57, 2 May 2008 (UTC)

Me too. (for getting consensus on this before editing article) SmithBlue (talk) 06:21, 2 May 2008 (UTC)

How does Wikipedia work? An experienced administrator explained it best: CBM wrote in part: "we encourage people to edit the page first." Got in? QuackGuru 03:43, 5 May 2008 (UTC)

And a follow up reply from the same thread. - "Only newbies are expected to edit controversial articles as if talk pages do not exist. An experienced editor coming to a controversial article is expected to read the talk page history." DigitalC (talk) 03:00, 6 May 2008 (UTC)

That "experienced administrator" was foolishly encouraging grief. Here is my comment that immediately preceded the one quoted by QG:

• Generally any potentially controversial edit, especially on a controversial article, should be discussed on the talk page before even attempting the edit. Discuss it there, reach a consensus, and then make (or not make) the edit. It will then have a much better chance of surviving and edit wars will be avoided. -- Fyslee

the reply was:

• That isn't the way wikipedia is set up: we encourage people to edit the page first. -- CBM

Well, the typical BOLD, REVERT, DISCUSS editing pattern causes an awful lot of grief and edit wars on controversial articles, and I think that consensus is also an important part of policy, hence my comment. It would be nice if we could get a couple sentences echoing what I've written above included in policy here. We sorely need a whole paragraph or more dealing with how to edit controversial articles, because they definitely aren't like other articles, and editing them as if they were only leads to grief. If this could somehow cut down on the edit wars and bold, solo editing by various editors, it would sure make editing here a more pleasurable experience. -- Fyslee / talk 03:53, 6 May 2008 (UTC)

Reading this whole thread is quite an experience! One thing stands out, and it's QG's failure to seek to edit collaboratively. His continual insistance that bold, solo editing is OK is getting very tiring. Einstein stated that "Insanity is doing the same thing over and over again and expecting different results." QuackGuru, wake up and smell the flowers. They are over there, about 8 million light years away from Wikipedia. Go pick some and enjoy them......there. -- Fyslee / talk 04:02, 6 May 2008 (UTC)

This thread is about the problems with worker's compensation studies. The workers' compensation studies are misleading because they are very old. Newer sources are available. Currently, we have a NPOV failure. Editors talk about a socalled consensus but ignore NPOV. But NPOV is the key. I would appreciate it if editors would make an attempt to collaborate on this discussion. CynRN commented that there is a survey that needs to be fixed. A study is in 1988 and not 1998. Insanity is when editors continue to post repeated comments that would make reasonable improvements and editors continue to ignore them. QuackGuru 07:02, 6 May 2008 (UTC)

Agreed with Fyslee, QG. It's your approach that is drawing criticism and detracting away from the point you're (trying) to make. Considering you narrowly escaped an ANI meeting last week and after seeing what happened to your buddy User:Mccready you'd think you'd lie low a bit and not push too much. We shall see how it all plays out, but other users have given you wise counsel and I strongly suggest you abide by it. CorticoSpinal (talk) 17:23, 6 May 2008 (UTC)

When both me and CorticoSpinal are agreeing with Fyslee, it is certainly time to pay attention, QuackGuru. Abide. -- Levine2112 ^discuss 17:37, 6 May 2008 (UTC)

Please consider addressing the POV issues mentioned above instead of ignoring them. Agreed? QuackGuru 17:44, 6 May 2008 (UTC)

For the one millionth time, please suggest rewording at talk and I will be happy to discuss it with you. -- Levine2112 ^discuss 17:48, 6 May 2008 (UTC)

I already explained what we should do with the dated studies but I was ignored. We should delete the dated studies. QuackGuru 14:04, 8 May 2008 (UTC)

The 1988 study says 1998 but it is 1988. My specific revision is to fix the date. QuackGuru 18:54, 9 May 2008 (UTC)

I fixed that. Stuff like this is minor and noncontroversial and doesn't really need to be discussed on the talk page before fixing. Thanks for noticing it. Sorry, I didn't see your earlier comments (this talk page is quite large and I expect that no single person has read it all). Eubulides (talk) 21:06, 9 May 2008 (UTC)

Section Chiro/History

As noted above article Chiropractic history already exists. Now we just need to reach concensus on what is better included in Chiropractic/History. I suggest we find a few references from each notable POV and work from there? Other's ideas? SmithBlue (talk) 03:18, 3 May 2008 (UTC)

Finding sources is good. Please see #sources for chiropractic history for a draft list. Eubulides (talk) 07:48, 3 May 2008 (UTC)

At this article we need a v brief overview of Chiro history. Very brief descript of sources found and history content in point form

• New Study Finds Unity in Chiropractic

no obvious relav

• How Chiropractors Think and Practice: The Survey of North American Chiropractors

no obvious relav

• Canada Celebrates 100 Years of Chiropractic Dynamic Chiropractic July 17, 1995

no relevant material: Canada postage stamp?

• Chiropractic: history and overview of theories and methods. Homola (abstract only sighted)

Palmer DD 1st adj, Palmer BJ dev prof (more in article?)

• History of Chiropractic Care ACA

2 relv para; 1895 founded profession, legal recognition 50 states, report: Chiropractic in New Zealand 1979, 1993 Manga study.

• Chapter I: A Brief History of Chiropractic by Reed B. Phillips, DC, PhD

~14 relav short para; 1st adj 1895, early 20th allopathic greater cultural authority - chiro lexicon, adversity economic/political/legal nnec clinical, State Board Licensing Exams 1925, Council on Chiropractic Education 1974, allopathic attacks, Research was neglected early, Foundation for Chiropractic Education and Research 1977? 4 Fed research grants 1996, increased collab (Mootz 1995), LBPain(Shekelle, 1992), recommended treatment in the Federal guidelines for the treatment of acute low back pain (Bigos, 1994). (research emphasis in this history)

• Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine, Meeker & Haldeman

3 para (+1 events timelist): 1st adj, Palmer innate, professional self-regulation and independent legal status were crucial to survival, 1923 Alberta, 1923 Zurich, now most countries, (Timelist: 1905 license Minnesota, 1922 license California, USCSCE 1933 (now FCLB), FCER 1944, NBCE 1963, Louisiana last license 1974, USCCE recog by US Dep Ed 1974, Journal of Manipulative and Physiological Therapeutics 1976 indexd NLM, US Supreme Court uphold Wilks 1987, U.S. Agency for Health Care Policy and Research findings 1994, Consortial Center for Chiropractic Research est by NIH grant 1997. (emphasis: education and research dev, legislation)

SmithBlue (talk) 09:31, 3 May 2008 (UTC)

Please review this [restrospective] of the FCER, which was made in 1944, however it had a predecessor the NCA as well. Skeptics do not realize that the chiropractic sciences had been in development for many years but strigent opposition from the allopathic community severely hampered the ability to get funds and make partnerships for research. CorticoSpinal (talk) 04:47, 6 May 2008 (UTC)

I added some more sources to #sources for chiropractic history. One is freely readable and worth looking at: Kaptchuk & Eisenberg 1998 (PMID 9818801). Eubulides (talk) 10:25, 3 May 2008 (UTC)

Factors so far: beginnings, relationship with medical mainstream developments, legislative developments, educational developments, international spread, scientific research development, research outcomes, effectiveness study developments SmithBlue (talk) 10:34, 3 May 2008 (UTC)

POV issues as of 2008-05-03

Here is a list of POV problem areas that I see with Chiropractic as it stands now. Fixing these problems would suffice to remove the articles POV tag. This list is updated from Talk:Chiropractic/Archive 17 #POV issues as of 2008-03-12, and reflects changes made to the article since 2008-03-12 as well as discussion since then and some other POV problems I noticed recently. Comments welcome; please make them in #Comments on 2008-05-03 issues list below. I plan to strike out items as they are addressed. Thanks. Eubulides (talk) 07:48, 3 May 2008 (UTC)

2008-05-03 issues list

• The sections Chiropractic #Movement toward science through Chiropractic #Scientific investigation are heavily biased on the subject of effectiveness. They present only old sources that promote the effectiveness and cost-effectiveness of chiropractic treatment, and discuss neither the mainstream viewpoint that disputed these old sources, nor more modern sources on the subject that present a more-balanced approach. One simple way to fix the problem would be to replace these sections with a new section for which we have a draft #Scientific investigation 2. This draft was inspired by a reader who wanted clear information on whether chiropractic treatment is effective [16] and who thought that an earlier version of the draft "is the sort of clear descriptive information that will make the article easier to read."[17] We rarely get comments from readers, so the few we do get should be listened to when at all possible.

• Chiropractic #Medical opposition describes the feud between conventional medicine and chiropractors in a heavily biased way. For example, chiropractors are described by a lengthy quote as having "progressive minds" whereas conventional doctors are said to "have failed to realize exactly what is meant by disease processes". Both sides (traditional medical and chiropractic) have attacked and have victories and losses, but the current discussion focuses almost exclusively on attacks by the medical profession, on chiropractic victories, and on areas where chiropractic is said to be superior to conventional medicine. The dispute should be covered neutrally. There is no need for a separate section Chiropractic #Wilk et al. vs. American Medical Association with a lot of detail, for example, unless there is also similar detail devoted to the other side.

• The sections Chiropractic #The Manga Report, Chiropractic #Workers' Compensation studies, Chiropractic #American Medical Association (AMA), and Chiropractic #British Medical Association are merely a laundry list of endorsements of chiropractic. These sections should be removed, with their useful content moved to appropriate sections, as citations.

Merge them. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

• Several phrases are inserted to strengthen the argument for chiropractic by giving the qualifications of sources when they are favorable to chiropractic. Sources should be mentioned in the citation, not in the main text; there is no need to puff up the main text. The following quotes can be removed (with some rewording necessary to fill the gaps):
  • "the Ontario Ministry of Health and conducted by three health economists led by Professor Pran Manga"
  • "by Steve Wolk"
  • "by Cherkin et al."
  • "The British Medical Association notes that"

• Several places, including the lead, characterize chiropractic as complementary and alternative medicine. This characterization is controversial and alternative views should be given. See, for example, Redwood et al. 2008 (PMID 18435599), in which 69% of surveyed DC faculty disagreed with the proposition that chiropractic is CAM.

• Chiropractic #Philosophy claims "Evidence-based chiropractic balances this dualism by emphasizing both the tangible, testable principle that structure affects function, and the untestable, metaphorical recognition that life is self-sustaining." but the cited source does not talk about evidence-based chiropractic. Removing "Evidence-based" would fix this problem.

• Need I remind you of the conversation which it was requested BY YOURSELF to change it from contemporary to evidence-based because YOU felt the word contemporary was too PEACOCKISH? Please decide on a term, evidence-based or contemporary. CorticoSpinal (talk) 16:42, 4 May 2008 (UTC)

• Evidence-based is not in the source, and it's inaccurate to boot in this context, so it should go. "Contemporary" is peacockish, so it should go too. Let's just say "Chiropractic" without the adjective. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• Disagreed. You can't have it both ways, Eubulides. We had contemporary you said EB. Now you want EB gone and not cite contemporary which is in the source. Just accept the fact that contemporary chiropractors exist, they're EB and we go with it. Stop constantly trying to minimize any hint of the maturation of the profession. Lastly, I'll point out that your POV re: chiropractic is in direct conflict with the trend and literature demonstrating the efficacy and importance of integrative medicine. Speaking of which, what ever happened to that proposed section? I'll go dig it out of the archives, that was another section squashed by the skeptics for no good reason. CorticoSpinal (talk) 04:31, 6 May 2008 (UTC)

• I don't recall the earlier discussion. What I do see now is text that is not supported by its source. This needs to be fixed. Please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

• The lead also has several POV problems, which can get fixed once the body gets fixed:
  • The lead should reflect the body of the article. The lead currently lacks summaries for some entire sections, including Safety, Scientific inquiries, Vaccination. The overall effect is to minimize the controversial parts of the body.
  • The lead has a POV phrase that needs rewording: "Today, the progressive view".

• • Need I remind you of the conversation already had earlier which the the progressive view is a directly taken from the US Department of Education who divides the Chiropractic programmes into straight and progressive?

• The usual terms for this division, and the one used elsewhere in the article, is "straight" and "mixer"; let's stick with that rather than "traditional" and "progressive". Eubulides (talk) 08:15, 5 May 2008 (UTC)

• The cited source does not say "straight" or "mixer" it refers to the educational paradigns as "traditonal" and "progressive". Why the constant nit-picking of trivial stuff, Eubulides? You play with the rules; when it suits YOUR POV it's pliable, when it doesn't it's rigid. This example is case and point of this. CorticoSpinal (talk) 04:31, 6 May 2008 (UTC)

• None of the three cited sources ([18], [19], [20]) say either "traditional" or "progressive". I just now checked. This is a mismatch between the lead and its sources, which needs to be fixed. I will add a "failed verification" tag; please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

Eubulides (talk) 07:48, 3 May 2008 (UTC)

The "progressive view" is unverified. QuackGuru 12:11, 14 May 2008 (UTC)

Comments on 2008-05-03 issues list

• Safety The safety section omits valuable resources from DC/PhDs that contest the findings of Ernst and give more appropriate context to the article at hand. Considering the February 2008 issue of Spine dedicated a whole issue to the WHO Task Force, surely the 1 sentence currently at Safety is undue weight, no?

• 1 sentence might be undue weight, yes. But Chiropractic#Safety currently devotes 5 sentences to the WHO safety guidelines and 2 sentences to the February 2008 issue of Spine, so this doesn't appear to be a problem. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• The tone of the article is fear mongering. SMT is a relatively safe procedure. The section reads as though there is no real benefit to it; instead it relies heavily on Ersnt that side effects are very common (implied risk is great that benefit) that there are catastrophic consequence (permanent neurological impairment and even DEATH (insert scary music here). You have no problem with adding Miley et al, a study which contradicts the majority of the safety literature, yet Boyle, Cassidy and Haldeman cannot be included who are expert researchers in SMT and stroke. Anyways, the tone of the section is uneven and comes off as harsh. It reads like it's written by someone who is against manips rather than neutral. Again, I need to make my point clear: it's not the amount of sentences or references (lack thereof of the best ones available that are relevant), it the WORDS BEING USED TO DESCRIBE THEM. This needs to be fixed asap. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

• Chiropractic#Safety is not fear mongering: it starts off saying "Chiropractic care in general is safe when employed skillfully and appropriately."

• ...which subsequently degenerates into an oratory that SMT is dangerous and hurts. Gimme a break. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

• If there is a problem with the tone, please make a specific suggestion for improving the wording. The suggestion should be supported by reliable sources, as is usual for this section. Eubulides (talk) 09:25, 7 May 2008 (UTC)

• The section is about safety, not effectiveness, and so a discussion of benefits would be irrelevant; #Effectivness 2 is a draft for benefits.
• There is no serious dispute that mild side effects are very common.

• There is no mention what the benefits are. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

• Benefits are for the Effectiveness or Cost-effectiveness sections, not the Safety section. #Effectiveness 2 is a draft for the first of these. We should have the second one too. Eubulides (talk) 09:25, 7 May 2008 (UTC)

• There is no serious dispute that in rare cases there are very serious complications.

• Occurs infrequently and unpredictably enough to not warrant the the spotlight as you've done. This is more allopathic arrogance and bias. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

• It occurs often enough to be highlighted by reliable reviews in the area; it's a notable topic that deserves coverage. Eubulides (talk) 09:25, 7 May 2008 (UTC)

• Miley et al. 2008 (PMID 18195663) is a structured evidenced-based clinical neurologic practice review; it is not a primary study. As per WP:MEDRS, secondary sources like Miley et al. are preferable to primary studies.
• The sources you refer to are primary studies that are reviewed in Hurwitz et al. 2008 (PMID 18204386), which Chiropractic#Safety cites heavily in this area, and which do not mention the parts of the primary studies that you wish to emphasize. Reaching down into primary studies to select points that reliable reviewers do not mention is something we should avoid, as it is too easily a source of bias.

• Why do you fail to understand that your argument has been debunked by myself, Levine2112, DigitalC and most recently by SmithBlue? For the very last time, stop saying reaching down into primary studies. This is not the case. You have been stonewalling this issue for close to 3 months. I'm getting fairly annoyed now. Stop it. I have been gracious is debating this with you for the amount of time and have let other editor chime in. You are wrong. I'm going to include the relevant passages. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

• Please do not argue with reliable secondary reviews by highlighting results of primary studies that have been reviewed. This is contrary to the WP:MEDRS guidelines and there is good reason for this: it is too prone to editor bias. We need good reasons to disregard expert opinion in this area, and no good reasons have been supplied. Please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

• Miley et al. 2008 does not contradict the majority of the safety literature. On the contrary, it agrees with the mainstream opinion, which is that cervical manipulative therapy causes stroke in rare cases.

Actually, this is patently false. Mainstream opinion, as evidenced by the Spine articles suggests the opposite conclusion. You are trying to portray the WHO Task Force as a DC source when it's clearly not. It's a multidisciplinary panel which gives it more credibility. You are cherry picking data to support your case while wikilawyering from preventing a rebuttal. This is a very tendentious, and highly unethical approach. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

The Spine articles do not dispute a causative relationship between SMT and stroke. They merely state that there's good reason to believe that the statistical association is explained by other causes. Statistical association is not the same as causation, so the two sources do not disagree here. The mainstream opinion (not just Miley et al., but also Haldeman and others; these are DCs as well as MDs) is that causation occurs in some cases. Eubulides (talk) 09:25, 7 May 2008 (UTC)

• Specific suggestions about wording changes to correct tone are welcome; obviously any such changes must respect the sources and should follow WP:MEDRS guidelines.

Eubulides (talk) 21:24, 5 May 2008 (UTC)

• Vaccination. There is undue weight on the Canadian chiropractors who hold an anti-vaccination stance. These DCs form an estimated 0.02% of the world chiropractic tally. So much space is dedicated to them and not enough to those who aren't against or neutral towards vaccination.

• "0.02%"? Really? I thought it was more like 5%. Anyway, sources on the rest of the world would be welcome, but in the meantime we have to rely on the sources we have. Eubulides (talk) 08:15, 5 May 2008 (UTC)

I don't know how many chiropractors there are in the world, but if you figure 80,000 then the Canadians are about 3%, but 5% may be more accurate. But, the point from the reference regarding the Canadian DCs was that, given the scientific emphasis in the Canadian Chiropractic College, Canadian chiropractors should be more likely to embrace vaccination than not, and their opposition/neutrality was surprising.--—CynRN ^(Talk) 16:49, 5 May 2008 (UTC)

Nice new font Cyn! Looks good. There are a few caveats that need to be illustrated. First, the data was collected in 2000. The new integrative curriculum began in 1999. Hence, the cohort studied was significantly different than those who have graduated since. This brings up the reliability of these stats. Secondly, the CCA unmistakeably favours vaccination as a cost-effective and effective method of public health. Also, the 3-5% you are quoting asssumes that all 60000 (at the time, it's closer to 7k now) were all anti-vaccination; which was not the case. Regardless, Eubulides continues to ignore my point that it's a weight issue, not a notability issue. I've mentioned this now for close to 3 months. Please justify the undue weight you have put on the fringe element of the profession (anti-vaccination) whilst ignoring the stance of the majority (neutral -> pro). Thanks. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

• More recent data would be welcome, if we can find a reliable source for it. Particularly for the U.S., which has far more chiropractors, and which appears to be more anti-vaccination than Canada does.
• Obviously it's not the case that the Canadian statistics mean 0.02% or 3% or 5% (or whatever) of chiropractors are against vaccination. It was a small sample, and in that sample, 25% opposed vaccination. A larger 1995 sample of U.S. chiropractors found that a larger fraction (about 1/3) did not believe that there was proof that immunization prevents disease. Based on all this, it'd be reasonable to guess that about 30% of chiropractors worldwide oppose vaccination. Of course this is just a guess, and cannot be reported in the article. But the point is that there is a significant opposition to vaccination among chiropractors. It's not "0.02%"; it's more than 20%.
• The CCA supports vaccination, but they represent a much smaller fraction of the world's chiropractors than the ACA, which supports exemptions to compulsory vaccination laws. It is certainly notable that the leading chiropractic association is so ambivalent about vaccination. The ACA is not the fringe; it's mainstream chiropractic.

Eubulides (talk) 21:24, 5 May 2008 (UTC)

From the Kansas survey of American chiropractors, 2005: "Immunizations are effective in the prevention of disease." strongly agree 12.0%, agree 30.7%, neutral 12.1%, disagree 19.3%, strongly disagree 19.9%.

"Encouraged patients to be immunized." yes 16.3%, no 54.2%, under certain circumstances 29.5%"

So as recently as 2005, 40% say vaccinations are 'ineffective'. So the article really should emphasize the belief (by 30-40% of chiropractors) that vaccines are 'ineffective'.--—CynRN ^(Talk) 04:25, 6 May 2008 (UTC)

• Effectiveness/Science The proposals are grossly inappropriate, especially the into to science which has exactly 0 DC sources. This article is about Chiropractic and chiropractors. The science of chiropractic medicine, goes far beyond simple manips. Also, there is 0 mention of the evidence-based clinical practice guidelines the foundings of the CRF/FCRE the development of university-based masters programs in chiropractic SCIENCE, etc. This is simply another vehicle for the allopathic physician editing here to marginalize chiropractic

• It is not necessary for a source to be written by a DC for it to be reliable. The sections in question go far beyond simple manipulation. #Scientific investigation 2 explicitly mentions practice guidelines. The source for #Scientific investigation 2 was not written by an "allopathic physician", not that that matters. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• I never said that. I said that there was 0 sources from chiropractic scientists and chiropractic historians or chiropractic experts. The article is about chiropractic, the section on the science of chiropractic. Hence it is not valid when you omit all relevant, reliable and valid DC sources. I have mentioned this time and time again, but you have insisted that my sources does not meet inclusion criteria despite the fact that several other editors agree including independent 3rd parties. Anyways, it's a poor intro and does not even come close to tackling the fundamental issues as noted already by SmithBlue in a separate thread. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

• You wrote "0 DC sources". The introduction is backed by a recent reliable source in a peer-reviewed journal. It is far better than what is in Chiropractic#Scientific investigation now, most of which is entirely unsourced (and the only source is lower quality). No doubt it could be improved further, but it's far better than what's there now, and unless specific further improvements are suggestion there's no reason it can't go in now. Eubulides (talk) 21:24, 5 May 2008 (UTC)

• The lead does not accurately reflect the body of the article which is missing vital importances from Scope of Practice, to Education, to History-(PRESENT) to Integrative Medicine, to subspecialities, etc. We all know that our resident MD wants to include every controversy under the sun in the lead; however this would be a serious violation of WP:WEIGHT

Yes, the lead should accurately reflect the body of the article. Eubulides (talk) 08:15, 5 May 2008 (UTC)

Then we agree it's the last thing to be changed. Finish the body, then we can touch-up the lead. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

I used to think that, but it's becoming clear now that the body will never be "finished", and we should strive to keep the lead in sync with the body. Eubulides (talk) 21:24, 5 May 2008 (UTC)

• Treating the fringe elements of chiropractic as mainstream and the mainstream as fringe. This is by far the biggest violation of the approach by certain skeptical editors. This needs to change.

Yes, this should be fixed. What specific instances of this are there? Eubulides (talk) 08:15, 5 May 2008 (UTC)

Practice Styles and schools of thought, Vaccination, safety, science, history, subluxation, etc. Take your pick. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

That's a bit vague. Please suggest specific wording changes. Eubulides (talk) 21:24, 5 May 2008 (UTC)

Scope of Practice: Sources dispute

If Arthur Rubin would like to explain his concerns regarding the scope of practice section which according regarding the "relevance or reliability of the sources presented that would be helpful. I do believe they all meet our inclusion criteria per WP:RS, WP:V and thensome. Also, if you would please abide by WP:NPA and WP:CIVIL and not make attacks [21] in your edit summaries that would be appreciated as well. I've gone ahead and brought an highlighted some of the sources you dispute

• Council on Chiropractic Education which is accredited by the US Department of Education
• You've got to be kidding, right?
• Since when is Dr. Haldeman not credible, nor a respected publishing house?

This journal is credible. Are you seriously disputing this?

• The credibility Ian Coulter sir, is not in doubt.

However, with tendentious edits like this that seem to raise a point are not helpful in the least. I would hope that good faith would be extended to me however you seem to be making a habit of contesting a lot of my edits on some questionable grounds. Nonetheless, if you would participate in talk perhaps you would be familiarized on some of the salient points raised over the last few months. There's a lot of material to go over, but seeing as you have a long history with this article you might as well invest the time like the regulars have since January 08. Cheers. CorticoSpinal (talk) 02:37, 6 May 2008 (UTC)

There we go? What in the world is that supposed to mean? I don't know.

This controversial edit changed the entire meaning of the text. Now it is POV again. The reference formatting does not work properly. QuackGuru 16:26, 6 May 2008 (UTC)

QG, the addition by Eubulides is a poor one but I won't revert it today. Whether you agree with it or not, DCs are at the very LEAST primary CONTACT and most are legislated as primary CARE. I've conceded the primary CARE, as per CynRN's suggestion so stop crying wolf. These constant cries of NPOV for the scope of practice section are definitely misleading and not as warranted as you make it seem to be. CorticoSpinal (talk) 17:03, 6 May 2008 (UTC)

Please adrress the issue at hand and help fix the POV problems. Two refs need to be fixed. They are not properly working after your recent edit. QuackGuru 17:14, 6 May 2008 (UTC)

So, to be clear, you are disputing that chiropractors are primary contact providers for conservative care of the neuromusculoskeletal system? That's the POV? Please provide clarification so I can be address your concern. CorticoSpinal (talk) 17:18, 6 May 2008 (UTC)

When I added the templates:

Re verify-source templates: The versions I saw, at the time I added the tags, did not support the statements made. Quite simple. Some of them might have been broken, and some google books references are automatically broken for most people. Please refer DIRECTLY to the book using {{cite book}}. If google books works, you can get there through the links, or add a google books reference in the URL field.

Re verify-reliability templates: The use of a chiropractic source for legal information as to scope of practice is self-serving. Because of the history of dispute between medical doctors and chiropractic doctors, we would need sources from both for inclusion, as well you should know.

Specifics.

1. I'd never heard of Jones & Bartlett. Are they primarily a medical publishing house? A chiropractic publishing house?
2. Chiroweb and "Dynamic Chiropractic" are not credible sources except as to the opinions of chiropractors. "Semin Integr Med" (by the way, there was a discussion elsewhere, which suggests journal abbreviations should NEVER be used, as there isn't a one to one correspondance between abbreviations and names), might be, and the doi: link doesn't list the actual name of the journal for me.
3. The credibility of Ian Coulter is not seriously in doubt, but he's only one of the co-authors of the source, and we don't know he had final editorial control, that his reputation has sufficient standing that it is considered implausible he would assist a friend or colleage in supporting something that he doubted the accuracy of, or that AHCPR (which, again, shouldn't have been abbreviated -- I can think of at least 2 relevant organizations known by those initials, and you didn't list the journal or book title) isn't a chiropractic organization.

The sources and text have been significantly changed since I added the tags, so I'm not sure that the tags would still be correct. — Arthur Rubin (talk) 18:47, 6 May 2008 (UTC)

You are either misleading the readers and other editors, are mispeaking but the sources have stayed the same as they did when I originally put them in and when Eubulides checked them out. In fact, since you are an administrator, I find your conduct to be very unbecoming of someone who is to be a voice of reason and a calming influence. Rather, it seems that your last change here is more of the same as I written above. Also, if you could be so kind as to point out policy that chiropractic sources cannot be used as you have alluded to above would move this discussion further. Thanks. CorticoSpinal (talk) 19:45, 6 May 2008 (UTC)

Weasel wording attribution was added here. QuackGuru 23:08, 6 May 2008 (UTC)

QG, you are crossing the line making false allegations. Jefffire routinely does the exact same thing (but much worse) at Sports Chiropractic and he gets a free pass, I mention that it's a research paper (weasel?) and you cry foul. A bit of consistency from you would be nice. Thanks. CorticoSpinal (talk) 00:03, 7 May 2008 (UTC)

The source is from a high quality journal () and not a chiropractic POV source. We need more medical journal representation on Wikipedia. Attribution is weaseling in this particular case. QuackGuru 00:17, 7 May 2008 (UTC)

Please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

image/table

The image in the scientific investigation section is about philosophy and not scientific investigation. Possibly, it can be placed in the philosophy section. QuackGuru 21:54, 3 May 2008 (UTC)

Yes, that image clearly belongs under Chiropractic#Philosophy. Eubulides (talk) 06:58, 4 May 2008 (UTC)

My specific revisions is to delete the unrelated content in the scientific investgation section and move the image to the appropriate philosophy section. Going once... going twice... QuackGuru 20:37, 4 May 2008 (UTC)

No, "clearly" that image does not belong in philosophy. If the image in question is BJ, the "developer" he is a historical figure (now dead) and belongs in history. We don't put pictures of random individuals in Philosophy, Eubulides and QG. If you want to kill the image altogether, go ahead I'm cool with that. CorticoSpinal (talk) 20:44, 4 May 2008 (UTC)

This is not a picture of a person. The image is in the scientific investigation section. And it is clearly about philosophy. Unrelated content remains in the scientific investigation section. QuackGuru 20:47, 4 May 2008 (UTC)

This table was not an improved on Dematts. If we can find Dematt's table (better aesthetically by far) I see no problem moving this to Practice Styles/Schools of Thoughts where it was ORIGINALLY. CorticoSpinal (talk) 21:16, 4 May 2008 (UTC)

There already is a table in the Schools of thought and practice styles section. See at the end of the Chiropractic#Mixer's section. QuackGuru 21:30, 4 May 2008 (UTC)

Can we move the table to the philosophy section and delete the unrelated content in scientific investigation now? QuackGuru 00:09, 5 May 2008 (UTC)

This comment was made over a day ago. No objections have been raised. The table in the scientific investigation section is about philosophy. It can be moved to a more appropriate place. QuackGuru 04:00, 5 May 2008 (UTC)

keep or delete table

We added the table to the philosophy section. Should we keep the table or delete it. Please discuss. QuackGuru 04:22, 5 May 2008 (UTC)

The table is kind of corny, but it's better than nothing. In general, having a few illustrations is nicer than just having plain text. If we can find a better illustration for Chiropractic#Philosophy, let's use it; but in the meantime let's keep the table. Eubulides (talk) 08:15, 5 May 2008 (UTC)

The table was deleted. Why did this happen. QuackGuru 15:56, 7 May 2008 (UTC)

The change log says it was deleted because CorticoSpinal thinks that as an illustration it is redundant and ugly. On both counts CorticoSpinal is correct: it is redundant, and it is ugly. However, it is still useful in an encyclopedia to give a diagram or illustration, as this can help new readers follow the exposition. A more-beautiful diagram would be nicer, but in the meantime it's what we have; there's little point to deleting a useful diagram from an article that is begging for decent illustrations. It's no big deal, but I would support restoring the diagram (or a more-beautiful version, if someone cared to write it). Eubulides (talk) 09:36, 8 May 2008 (UTC)

I prefer the useful table restored. QuackGuru 14:06, 8 May 2008 (UTC)

Is Chiropractic Fringe?

It seems like a lot of the endless debate, POV wars, edit wars, disruption, bans, blocks, etc could be attributed to a fundamental differences that proponents and skeptics view the chiropractic profession.

I have been told by skeptics that DCs and chiropractic care is fringe, and, in effect is no different than Homeopathy and Flat Earth. Skeptics also suggest that chiropractic medicine is a pseudoscience. Let's have an open debate about these points and we shall see the strength of the arguments on both sides. The floor is open. CorticoSpinal (talk) 18:58, 4 May 2008 (UTC)

To begin with, statements by chiropractors that chiropractic is not fringe can and should be disregarded by all, unless backed up by evidence not generated by chiropractors. That's just self-serving, even if published in (chiropractic)-peer-reviewed journals.

My feeling is that the evidence supports chiropractic working for some muscular-skeletal conditions, there is marginal evidence for some not-obviously muscular-skeletal conditions, such as headaches, and no evidence that it works for any conditions considered "diseases" by the medical community. There is no scientific support of chiropractic theory, even to the extent of whether:

1. Vertebral subluxations cause disease (illness, or whatever non-standard term for such that chiropractors claim to cure).
2. Chiropractic adjustments correct vertebral subluxations.

So, in summary, chiropractic theory is WP:FRINGE, but, chiropractic, itself, is marginal. — Arthur Rubin (talk) 19:27, 4 May 2008 (UTC)

Thanks for starting the conversation, Arthur. So, to summarize, chiropractic is "marginal" hence not "mainstream" and chiropractic "theory" is fringe. Also, chiropractic sources, regardless of their reliability and validity are to be disregarded, correct? Are there particular elements of the theory that is fringe and what is your understanding of vertebral subluxation (complex) and adjustments (just to specify so I clearly understand). Cheers. CorticoSpinal (talk) 19:52, 4 May 2008 (UTC)

There appears to be no definition of chiropractic adjustments which distinguishes them from other spinal manipulations, as we seem to have agreed in Talk:spinal manipulation, even if we allow ourselves to consider definitions supplied by chiropractors. (That should have been an additional point above in the "clearly fringe" list. My bad.)

And we cannot use statements supplied by chiropractors or published in chiropractic journals as WP:RS as to the efficacy of chiropractic, but we can use them toward definitions as understood by chiropractors, provided it's made clear. Even under WP:FRINGE, statements by practitioners as to what they (think they're) do(ing) are allowable. — Arthur Rubin (talk) 21:35, 4 May 2008 (UTC)

Thanks for the reply but you didn't really address my questions above. Also, you've raised another point which I need to clarify; namely that we cannot use chiropractic sources, as per WP:RS to discuss the effectiveness of chiropractic care. Is that correct? I think before we proceed I do need you to address the questions I've raised above so I clearly understand your position. Many thanks in advance. CorticoSpinal (talk) 21:49, 4 May 2008 (UTC)

Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13: 17. doi:10.1186/1746-1340-13-17.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link) Here is a comprehensive ref about subluxation. QuackGuru 21:42, 4 May 2008 (UTC)

What about Gatterman, Leach and Haldeman? The Keating et al. paper talks primarily about the fringe (but vocal) viewpoint of vert sub. What about what the majority of the profession and vert sub? CorticoSpinal (talk) 21:49, 4 May 2008 (UTC)

What questions haven't I answered? And, in your opinion, what is the mainstream chiropractic theory? I'm just looking for opinions at this point, not requesting that they be backed up with sources. — Arthur Rubin (talk) 21:59, 4 May 2008 (UTC)

Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med. 136 (3): 216–27. PMID 11827498. I think this insightful ref can be used to improve this article. This ref answers a lot of questions. QuackGuru 22:07, 4 May 2008 (UTC)

[outdent] I just want to confirm a few things before I answer your question. To summarize, chiropractic is "marginal" is not "mainstream" and chiropractic "theory" is fringe. Also, chiropractic sources, regardless of their reliability and validity are to be disregarded, correct? Lastly, that we cannot use chiropractic sources, as per WP:RS to discuss the effectiveness of chiropractic care. I want to make sure I understand your position clearly so we can have more effective communication. CorticoSpinal (talk) 22:11, 4 May 2008 (UTC)

Almost. Because of obvious conflicts of interest, chirpractic sources as to the effectiveness of chiropractic cannot be reliable. Chiropractic sources as to the definition of chiropractic, and as to what the chiropractic theories are, can be appropriate. Chiropractic sources as to the history of chiropractic can usually be used if noted. Chiropractic sources as to other aspects can be considered separately, keeping in mind obvious conflicts of interest. — Arthur Rubin (talk) 22:17, 4 May 2008 (UTC)

Some sources are RS and some are SPS for example. There are a lot of different types of sources. We should use the best sources available. If that means using less than reliable sources than RS then that is fine in some circumstances. Some sources are okay as long as proper attribution is given. It all depends on the specific circumstance. Blogs are sometimes considered reliable when written by a notable expert on the topic. QuackGuru 22:20, 4 May 2008 (UTC)

“ Right now chiropractors can go before any audience and say that there is sufficient science to discuss the neurological and clinical effects of the adjustment. It is no longer credible for anyone to state that "there is no scientific basis for spinal manipulation or the chiropractic adjustment." It is, however, essential that any proponent of chiropractic be very careful not to include leaps of faith and dogma when interpreting the research that is available. ”

Does this accurately sum of the state of affairs today, NPOV? CorticoSpinal (talk) 05:11, 5 May 2008 (UTC)

This seems like a COI source from a chiropractic advocacy group. POV? Surely. QuackGuru 05:20, 5 May 2008 (UTC)

Quack, could you please elaborate on your concerns that a statement on chiropactic science and theory by Dr. Haldeman is not fair game? He is THE leading chiropractic scientist, IMO. YOu should also note that the FCER merely reproduced the transcript. I also think you don't understand the purpose, notability, relevance and signifance of the FCRE in both historical and modern contexts. To not have this at science of chiropractic is a serious error that needs to be corrected. As soon as I can roll out SOP and education, (which has been waiting patiently since April 13/08) I'd be more than happy to invest time and effort to help rewrite the scientific section. CorticoSpinal (talk) 19:40, 5 May 2008 (UTC)

There is no purpose in evaluating this source when we can't use this unreliable source. More reliable sources are currently available. QuackGuru 19:52, 5 May 2008 (UTC)

Scott Haldeman is an unreliable source on chiropractic science? Is this what you are suggesting? CorticoSpinal (talk) 20:25, 5 May 2008 (UTC)

[ec] Good question. That statement may not be very precise, and therefore risks being labelled a (unintentional) straw man argument, since it may miss it's mark ever so slightly, and lead to lots of wasted time on futile discussions. Who says it, and what is the setting? That might make a difference. It might be advisable to refine it. There are even chiropractic sources that admit nearly the same thing and therefore urge caution in making claims. It would be the claims themselves that often lack scientific evidence. -- Fyslee / talk 05:23, 5 May 2008 (UTC)

Feel free to tweak the sentence(s) as you see fit so long as it can be backed up with a source, if need be. Don't forget that was also said in 2000. There's been significant scientific developments since that time. CorticoSpinal (talk) 19:40, 5 May 2008 (UTC)

The International Classification of Diseases is the gold-standard diagnostic text for classifying, billing and coding. Look at the list of signatories. Fringe company?

Your point? Chiropractic uses standard billing codes and this has nothing to do with any questions of fringe or not fringe. All organizations that use those codes are of course signers. Keep in mind that many instances where chiropractic is mentioned in various places are in fact proof that chiropractic is still on the fringes and not in the center (as yet). Those mentions of exceptional occurrences (which is why they are noticeable!) where chiropractors are seen involved with or cooperating with mainstream practitioners or in mainstream institutions are examples of "the exception and not the rule," and such exceptional "fringe" mentions should not be use to make a case for "not fringe". Examples of this have been (mis)use of the fact that a chiropractor here or there has ER privileges or teaches in some medical school as proof that chiropractic is now mainstream. (Often those chiros are also MDs, which is why they are where they are.) No, those are exceptional cases. BTW, please sign above.-- Fyslee / talk 06:01, 8 May 2008 (UTC)

tags

There is a content dispute tag at the top of the article. There is no need to additionally add tags to the Safety and Vaccination sections. It looks spammy. QuackGuru 23:04, 4 May 2008 (UTC)

I thought content dispute tags were added to the article. The tags are relevancy tags. I think Safety and Vaccination topics are relevant for this article and are in the appropriate section. QuackGuru 23:26, 4 May 2008 (UTC)

Someone felt obliged to add the same 'spam' to effectiveness and history. Skeptics aren't the only ones who have NPOV issues with the article. To note, Eubulides' recent change of safety with the inclusion of Miley but not Boyle made it that much worse. At least stuff like that makes my case that a double standard is being used that much easier to prove. It's unfortunate that an otherwise good editors would get snagged in something like this; but their edits are out of my control. Edit conflict: since you have more experience at Wikipedia, please put a NPOV tag or a weight tag. That would be more appropriate but I don't know how to do it CorticoSpinal (talk) 23:28, 4 May 2008 (UTC)

I thought the recent addition to the safety section was an improvement. NPOV as ever. QuackGuru 23:40, 4 May 2008 (UTC)

First of all, the wrong tags were added to the Safety and Vaccination sections. It should of been specifically the content dispute tags. However, at the top of the page is a content dispute tag for the whole article. It would be duplication to add more content dispute tags. QuackGuru 23:36, 4 May 2008 (UTC)

Thanks for clarifying that for me, QG. You definitely know your dispute tags well, for whatever reason. Anyways, let's take down the main dispute tag and leave it for the sections that are disputed. How does that sound? CorticoSpinal (talk) 23:39, 4 May 2008 (UTC)

There are too many sections under dispute. Even improving references (formatting) is under dispute. QuackGuru 23:42, 4 May 2008 (UTC)

Generally speaking when there are this many disputes it's better just to have one tag at the start rather than litter the article with tags. I made this change to coalesce the tags that way. Eubulides (talk) 08:15, 5 May 2008 (UTC)

I made this change to reflect that the unrelated content has been removed. Now we can get to work on the rewrite. QuackGuru 08:33, 5 May 2008 (UTC)

QG, you have removed content that we, as editors, had asked you to please not remove until we got consensus (Manga report). I'm going to give you the opportunity to restore that, otherwise it will look like a disruptive edit. We don't want to page to be locked down again, so let's co-operate here. Thanks. CorticoSpinal (talk) 19:31, 5 May 2008 (UTC)

I explained my reasons for removing the obsolete studies. We have consensus for a rewrite anyhow. QuackGuru 19:58, 5 May 2008 (UTC)

I think you are mistaken, QG. Please reinsert Manga as per our discussion above. Thank you. CorticoSpinal (talk) 20:20, 5 May 2008 (UTC)

I agree with Cortico here. There is no consensus to remove, though there is one to rework them into the history section. Let's rework them first and then remove. Not having these important studies included in the interim is egregiously not including topical information from the article. -- Levine2112 ^discuss 20:24, 5 May 2008 (UTC)

We have newer sources available that decribe the Manga report. QuackGuru 20:11, 5 May 2008 (UTC)

There is consensus for a rewrite. We can use the latest sources available and not the obsolete studies. QuackGuru 01:06, 7 May 2008 (UTC)

unsourced material in scientific investigation

When testing the efficacy of health treatments, double blind studies are considered acceptable scientific rigor. These are designed so that neither the patient nor the doctor knows whether they are using the actual treatment or a placebo (or "sham") treatment. However, chiropractic treatment involves a manipulation; "sham" procedures cannot be easily devised for this, and even if the patient is unaware whether the treatment is a real or sham procedure, the doctor cannot be unaware. Thus there may be "observer bias" - the tendency to see what you expect to see, and the potential for the patient to wish to report benefits to "please" the doctor. Similarly, it is often difficult to devise a sham procedure for surgical procedures, but it is not impossible. It is also a problem in evaluating treatments; even when there are objective outcome measures, the placebo effect can be very substantial. Thus, DCs have historically relied mostly on their own clinical experience and the shared experience of their colleagues, as reported in case studies, to direct their treatment methods. Consequently there has been a call to increase qualitative research studies that can better examine the whole chiropractic clinical encounter.

Please provided a quality reference or in accordance with Wikipedia policy the unreferenced material should be deleted. QuackGuru 01:57, 7 May 2008 (UTC)

The proposal on the table is to replace that material with #Scientific investigation 2. Eubulides (talk) 09:25, 7 May 2008 (UTC)

This unsourced text will be deleted if no references are provided. QuackGuru 15:17, 7 May 2008 (UTC)

Does anyone prefer we delete this material or should we keep it? QuackGuru 18:43, 9 May 2008 (UTC)

I prefer deleting the outdated material and replacing it with the new material. That change is controversial, though; please see Wikipedia:Mediation Cabal/Cases/2008-05-05 Chiropractic. Are you suggesting that while trying to gain consensus on a new Scientific investigation we delete the sections Chiropractic #The Manga Report through the lead two pargraphs of Chiropractic #Scientific investigation? That sounds a bit drastic. Perhaps a smaller deletion? If so, exactly what would it be? We need a specific proposal here. Eubulides (talk) 21:06, 9 May 2008 (UTC)

That change is controversial or drastic? I did not know improving on NPOV is controversial. BTY, the scientific investigation 2 is highly bias. It is missing information from Effectiveness 1. It looks like the effectiveness has been chopped in half. Some Wikipedians believe we should not have an effectiveness section though. Maybe Levine2112 has some specific ideas we can work on. QuackGuru 02:25, 10 May 2008 (UTC)

It wasn't chopped in half, but some material was removed in the interests of brevity. Perhaps too much was removed. I plan to draft an #Effectiveness 3 to try to address this (and other) issues. Eubulides (talk) 07:04, 10 May 2008 (UTC)

I'd prefer to hash it out at the Med Cabal page and in the interim all agree not to make any controversial edits to the article. -- Levine2112 ^discuss 02:45, 10 May 2008 (UTC)

Improvinng an article is non-controversial. It was never controversial to begin with (NPOVing). But some feel even improving a reference is controversial. Hmm. QuackGuru 03:11, 10 May 2008 (UTC)

Suffice it to say that your version of "improving" and "NPOV" is different from mine and that of most every other editor here. Hence, mediation may be the best place to handle this at the moment. -- Levine2112 ^discuss 03:21, 10 May 2008 (UTC)

We don't need to wait to make article improvements. QuackGuru 17:04, 10 May 2008 (UTC)

I removed the unsourced material from mainspace. No references was provided and plenty of time has been given. QuackGuru 05:39, 12 May 2008 (UTC)

outdated POV material in scientific investigation

In 1994 and 1995, half of all grant funding to chiropractic researchers was from the US Health Resources and Services Administration (7 grants totaling $2.3 million). The Foundation for Chiropractic Education and Research (11 grants, $881,000) and the Consortium for Chiropractic Research (4 grants, $519,000) accounted for most of the rest. By 1997, there were 14 peer-reviewed chiropractic journals in English that encouraged the publication of chiropractic research, including The Journal of Manipulative and Physiological Therapeutics (JMPT), Topics in Clinical Chiropractic, and the Journal of Chiropractic Humanities. However, of these, only JMPT is indexed in MEDLINE. Research into chiropractic, whether from Universities or chiropractic colleges, is however often published in many other scientific journals.

Here is more oudated stuff in the article. Time for a cleanup. QuackGuru 01:57, 7 May 2008 (UTC)

The notion that historical information can be outdated is rather ironic. I think this information is well-cited, relevant and important to chiropractic history. It should stay. -- Levine2112 ^discuss 07:52, 7 May 2008 (UTC)

This information is not part of the history section. It is in the scientific investigation section. The notion that you believe it is historical information is not the point. Even if the information is historical it has no historical impact. The text is highly one-sided from a less than a reliable website. Get it? QuackGuru 15:10, 7 May 2008 (UTC)

Certainly historical material can become outdated. The information in question is highly biased: it does not present the other side of the argument, which was available contemporaneously in high-quality sources. This must get fixed. Again, the proposal is to replace that material with #Scientific investigation 2. Details about these obsolete studies can go into the history subarticle; they are not that relevant here. Eubulides (talk) 09:25, 7 May 2008 (UTC)

Scientitic investigation, as it stands, is about investigation of SMT and not of the profession of chiropractic or any of the significant scientific milestones of the profession (Palmer clinic circa 1920's, FCER foundation 1944, CCE accrediation (funding for scientific investigations was a directed consequence of accreditation) conference on manipulation 1975 USA (they could not call it chiropractic for fear of a boycott (Petersen/Wiese 1994), the New Zealand commission 1979, Index Medicus JMPT 1983, major medical publishing houses publishing chiropractic textbooks 80s, 90s, WHO recognition (90s), integrative medicine (2000s). Also, scientific investigation as proposed by Eubulides violates WP:NPOV, WP:OR,WP:SYN and applies questionable WP:COATRACK tactics. Seeing as there may be an impasse here I'll make a quick draft that is more relevant and valid to the topic at hand, namely the science of chiropractic. CorticoSpinal (talk) 15:39, 7 May 2008 (UTC)

• #Scientific investigation 2 dicusses forms of treatment other than SMT.
• People who are reading about scientific studies of effectiveness and safety want to know today's best results, not about old stuff. Historical material should be put into Chiropractic history with a brief summary in Chiropractic #History.
• The effectiveness of chiropractic care is a core issue; the scientific bureaucracy behind the scenes is not.
• #Scientific investigation 2 relies on high-quality recent reviews, from both chiropractic and non-chiropractic sources, and is far superior to what's in Chiropractic now, both in terms of quality of sources and lack of bias.

Eubulides (talk) 09:36, 8 May 2008 (UTC)

According to Levin2112 the information should stay. But the information is in the scientific investigation section and has no historical value. QuackGuru 18:21, 7 May 2008 (UTC)

That's your opinion (which is nowhere in line with any consensus). -- Levine2112 ^discuss 03:23, 10 May 2008 (UTC)

Accordinng to this comment the text is relevant and important to chiropractic history This dated information is in the scientific investigation section and not the history. The highly bias text has no historical impact. Going once... twice... QuackGuru 03:09, 9 May 2008 (UTC)

This too is just your opinion. -- Levine2112 ^discuss 03:23, 10 May 2008 (UTC)

This too is just your opinion? I am referring to Levine2112's opinion too which claims the text is related to history. Then why is it still in the scientific investigation section. QuackGuru 21:48, 11 May 2008 (UTC)

That is your opinion that the text is related to history but it is in the scientific investigation section. QuackGuru 17:04, 10 May 2008 (UTC)

This is outdated POV material and newer higher quality studies exist. QuackGuru 12:07, 14 May 2008 (UTC)

2008-05-06 changes

Reviewing these changes made to Chiropractic since 2008-05-06 noon UTC, along with the comments made above:

• The lead talks about "progressive view" but none of the three cited sources ([22], [23], [24]) say "progressive". This is a mismatch between the lead and its sources, which needs to be fixed. For now, let's add a "failed verification" tag.
  • It's clearly in the US Dept. of Education, Eubulides. Why you seem to dispute everything here is beyond me. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)
    • Text must be directly supported by cited sources. Surely this is not controversial. The current text is not supported by the sources this cites. This is not controversial either. So the tag is appropriate. Eubulides (talk) 09:36, 8 May 2008 (UTC)
• The wording in Chiropractic#Scope of practice has strayed to include material like "legislated as" that is not supported by the source, and the phrase "according to a research paper" which is out of place in a Wikipedia article (it is attempting to undercut the source). It's better to stick to what the sources say. The simplest approach is to keep the first sentence "primary contact providers" as-is, citing the WHO, and to have the second sentence use "primary care providers" and cite Meeker & Haldeman. That way, the text matches the sources, and it more accurately reflects the underlying controversy without getting bogged down in the dispute. Rewording it this way lets us avoid the "failed verification" tag.

• You have included that piece which was absolutely no bearing on the actual scope of practice of chiropractors. It shall be moved to the appropriate section, opinions of any kind, do not belong SOP. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

• Every source used in Chiropractic gives an opinion. If a source could be excluded merely because it expresses an "opinion" that would give license to exclude any source whatsoever, which is surely not intended. The source in question (Meeker & Haldeman 2002) is high-quality and discusses scope-of-practice issues in a relatively neutral way, giving adequate weight to the wide variety of opinions on this subject. Eubulides (talk) 09:36, 8 May 2008 (UTC)

• The discussion of veterinary chiropractic is still supported by dubious citations. The discussion says DCs and DVMs "can practice veterinary chiropractic" but neither source says that. For now let's add "Failed verification" tags to these sources.

• Sorry that you find anything less than a double blind RCT "dubious" but had you actually read the sources, it says it clearly. I'm going to remove the tags, they are unneccessary and are a further example of questionable editing practices. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

• It's not a question of whether the sources are reliable. It's a question of whether the sources support the claim.

• Neither of the two source cited ([25], [26]) support the claim that veterinary chiropractic "includes assessment, diagnosis and treatment of biomechanical disorders of animals that may be amenable to manual therapy"; neither of talk about assessment, or about diagnosis, or about biomechanical disorders, or about amenability to manual therapy.
• Neither source says that DCs and DVMs "can practice veterinary chiropractic". The first source is an advertisement for a training course; it says nothing about practice or scope of practice. The second source talks about the examination process for getting an ACCC certification. It does say "examinations are designed to evaluate the suitability for practice in the international animal chiropractic environment" but that's too vague. Does it mean passing the test lets one practice veterinary chiropractic in (say) Mongolia? But one doesn't need a certificate to do that; one can just go ahead and do it; the Mongolian authorities won't care one way or another.

• Let's find a source that directly supports the claim that this is a genuine scope of practice issue, as opposed to a meaningless and unenforced certificate that one can hang on the wall. And let's find a source that supports the other stuff about biomechanical disorders and diagnosis and so forth.

In short, I am not saying the text is incorrect; it's just that it's unsourced. Claims need to be sourced. Eubulides (talk) 09:36, 8 May 2008 (UTC)

• The ACA, the leading chiropractic association, opposes veterinary chiropractic as a matter of official policy. This should be mentioned briefly, as the existing text gives only the positive POV of veterinary chiropractic. I propose adding the text "However, the official position of the American Chiropractic Association is that applying manipulative techniques to animals does not constitute chiropractic and that veterinary chiropractic is a misnomer." and citing the abovementioned source. Eubulides (talk) 09:25, 7 May 2008 (UTC)

• • This has no bearing to scope of practice and it completely ignores the subsequent survey which demonstrated de-facto support. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

• Sure it has bearing on the scope of practice. The leading chiropractic organization opposes the very existence of "veterinary chiropractic". Subsequent surveys do not change the fact that the topic is a controversial one, and all sides should be fairly covered. Eubulides (talk) 09:36, 8 May 2008 (UTC)

• No further comment, so I made that change. Eubulides (talk) 07:27, 12 May 2008 (UTC)

• The cited source for where chiropractic medicine is more established[27] lists (on page 23, under "Thinking things through") that the U.S., Canada, and Australia are "established" but that other countries such as England, Denmark, South Africa, and New Zealand are merely "advancing". This does not support Chiropractic's claim that chiropractic medicine is "most established" in North America (North America includes Mexico, which is surely not intended) or the U.K. Let's fix this problem by rewording it to "Chiropractic medicine is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries."

  It's a big player in UK and they are producing good research and have a good journal as well. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

The cited source says that chiropractic is not established in the UK. Claims made in Chiropractic should match their cited sources. Eubulides (talk) 09:36, 8 May 2008 (UTC)

• The expansion to Chiropractic#Education, licensing, and regulation was added not only without consensus, but with an undisputed outstanding suggestion in its review to put the new text in Chiropractic education first, and to propose a briefer version here. I'll move the expansion to Chiropractic education as a first step to implement that suggestion. Eubulides (talk) 09:25, 7 May 2008 (UTC)

  The section is NPOV and this is yet another attempt by yourself to supress any information that you personally disagree with. I have restored the version as it is well cited, factual amd all significant claims are sourced. Please desist from deleting cited material that is directly applicable to chiropractic. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

The material is duplicative of material that is already in Chiropractic. When the material reviewed two editors expressed their opinions; both suggested putting it in Chiropractic education and drafting a shorter version here. Nobody expressed a different opinion. The suggestions should not have been silently ignored. Eubulides (talk) 09:36, 8 May 2008 (UTC)

• The phrase "(not necessarily performed by a chiropractor)" was inserted. A clarification is useful as the sentence appears right after a sentence talking about chiropractic care, but the parenthetical remark could be worded a bit more briefly. I suggest "(whether chiropractic or not)". I verified that the source, although it does not limit itself to chiropractic care, does emphasize chiropractic studies and/or arguments that apply equally well to chiropractic versus non-chiropractic care for its stronger results, so the "nonspecific" tag can be removed.
• A citation was added to a primary study (Boyle et al. 2008, PMID 18204389) in order to argue with secondary reviews. This is not in accordance with the WP:MEDRS guidelines, which states that Wikipedia should not use primary studies to argue with secondary reviews due to the possibility of introducing our bias. In this particular case arguing with the secondary review is particularly inappropriate:

• We have discussed already this many times and Boyle et al. can be added in accordance with WP:IAR (at worst) and the guidelines does not preclude us from using high impact, quality, peer-reviewed articles. Unlike say, Miley et al. which does not mention chiropractic, and is rather about cervical manipulation (thus should not really be in the article, but rather SMT) Boyle is about chiropractic safety and utilization CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

• WP:IAR is not a good basis for writing a reliable encyclopedic article in a controversial area. It is a recipe for generating low-quality material that endlessly mutates. The Boyle citation is lower-quality for reasons already mentioned, none of which have been disputed; it was reviewed by Hurwitz et al. 2008 (PMID 18204386), and all of its results mentioned by Hurwitz (that is, the empty set) were already covered. Citing Boyle et al. is disagreeing with a reliablye high-quality review by reaching down into a primary study to obtain material used to dispute another high-quality review. This sort of behavior is a recipe for building ureliable and tendentious material. You are incorrect about Miley et al. 2008 (PMID 18195663); that study mentions chiropractic heavily and relies on chiropractic studies for some of their strongest results. Eubulides (talk) 09:36, 8 May 2008 (UTC)

• • One of the cited reviews (Hurwitz et al. 2008, PMID 18204386) covers the primary study in question and did not highlight the result in question.
  • The Hurwitz et al. review is by the same task force as the primary study, so this is not a hostile or critical review we're talking about here; they would be expected to summarize the primary study with some sympathy.

It would be best not to speculate, Eubulides. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

The point is that there's no reason to expect Hurwitz to review Boyle unfairly. They are on friendly terms. Even a friendly review found nothing worth summarizing about this study. Eubulides (talk) 09:36, 8 May 2008 (UTC)

• • The measurement technique used by the primary study (an "ecologic" one) is crude, so it's not surprising that the study reports no significant results.

• • Please abide by WP:AGF and don't doubt the experts. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

• I am assuming good faith of the experts. The experts here (Hurwitz et al. 2008, PMID 18204386) do not think the report's results are worth mentioning. As per WP:MEDRS, their opinions should take precedence over primary studies. We need a good reason to refuse to follow guidelines. No good reason has been presented, other than WP:IAR, and "ignore all rules" is not a reason. Eubulides (talk) 09:36, 8 May 2008 (UTC)

• • Other primary studies, using different techniques, have measured a statistical association between chiropractic services and stroke.
  • Nobody is seriously disputing that this statistical association exists. The Task Force review acknowledges it, among other reviews.
  • The text claims that the weak Boyle et al. result "is in contrast" to the Miley et al. review. But this is not the case. The Boyle et al. result (i.e., their crude technique could not detect a statistical association that other techniques can detect) does not disagree with or contrast with the Miley et al. review (i.e., there is weak to strong evidence of causation).
  • A Wikipedia article should not mislead the leader into thinking that Boyle et al.'s weak result casts any doubt on the other results.
    • Where does it mention that the results are 'weak'? Are you injecting your personal commentary and inuendo or is there a source which suggests Boyle et al is weak? Please clarify. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

• The experts in this case (Hurwitz et al. 2008, PMID 18204386) have reviewed the study do not think its results are worth mentioning. We should not override their opinion in an effort to undercut the results of another reliable review. Eubulides (talk) 09:36, 8 May 2008 (UTC)

For now, I'll remove the citation and the text. If there is real sentiment that Wikipedia should cover Boyle et al.'s primary study, I suggest putting it into a subarticle on scientific investigation, along with coverage of dozens of other primary studies. 09:25, 7 May 2008 (UTC)

For now, I'll restore the citation and the text. It's a study that directly investigates chiropractic care and stroke. It's published in a high-impact journal. It's a study funded by the WHO. It's part of an international task force. Weak? Hardly. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

It's a study that has been reviewed by the same group that produced the study (Hurwitz et al. 2008, PMID 18204386) and they did not think its results worth mentioning. We should not override published expert opinion. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

I made this change to implement the above suggestions. All in all, though this has been a lot of work and obviously there is some disagreeement here, I think we're making some real progress. Thanks to everyone who has contributed. Eubulides (talk) 09:25, 7 May 2008 (UTC)

This controversial change added the POV wording of significance of subluxation. What happened to the 2002 survey?

If we are going to use a primary source we should use something that adds value to the article. I find this sentence to be both comprehensive and informative. --> These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation.

That sentence was removed after comments by SmithBlue in the #Suggested change re stroke wording thread. His feeling was that the sentence is to some extent superseded by the 2008 reviews and executive summary by Haldeman et al. published in Spine. I don't feel strongly about it either way, but SmithBlue did, so I removed it. Please review the above thread before re-adding that sentence. The citation is not a primary source, by the way; it is a review, which is a secondary source. Eubulides (talk) 09:36, 8 May 2008 (UTC)

This recently added sentence, is written biasly. It starts off by saying "This is contrast to the conclusions that suggest..." This is POV and should be deleted. The cherry picked source does not add much to the article. It is saying that the risk does not increase with additional chiropractic care. The reviews did not think much of this too. This sentence seems misleading too. It is giving me the impression there is no risk with more chiropractic care. Please fix it. I think the text flowed better with the previous version. This change does not flow well. QuackGuru 15:49, 7 May 2008 (UTC)

The "biasly" text and "cherry picked source" was added by CorticoSpinal for no stated reason other than WP:IAR. No other editor supports it, and due to its serious problems it should be removed. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

Chiropractors are primary contact providers who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery. <-- This sentence is POV. The next sentence explains about the primary contact providers debate. QuackGuru 16:04, 7 May 2008 (UTC)

This quote was not what I had in mind. Fixing the previous sentence about the primary contact providers issue is easy. Just remove the primary contact providers words. QuackGuru 16:19, 7 May 2008 (UTC)

Given the controversy I thought it would avoid the whole mess by removing possibly PoV paraphrasing and go for a direct quote. I thought it worked rather well, but I would be happy to discuss this if you would elaborate on your objection. Jefffire (talk) 17:00, 7 May 2008 (UTC)

Quotes are a good starting point. But when we have an original Wikipedia sentence it is better to use our own writings. Quotes are fine is some circumstances. QuackGuru 17:07, 7 May 2008 (UTC)

I agree that it isn't ideal. I viewed it as a compromise until an elegant NPoV wording could be found. Jefffire (talk) 17:34, 7 May 2008 (UTC)

Asking for elegance is probably asking for too much here. It should suffice if the wording is accurate and not overly clumsy. Accuracy is more importance than elegance. But I attempted to supply more-elegant wording; please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

There was NPOV wording before but someone added the POV wording (primary contact providers). QuackGuru 17:46, 7 May 2008 (UTC)

The cited source says "primary-contact health care practitioners", so let's use that phrase. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

This is a misleading edit summary and the POV wording has returned. QuackGuru 18:13, 7 May 2008 (UTC)

QuackGuru, everywhere that DCs are legislated and regulated (hence scope of practice) they are considered PRIMARY CARE. I have compromised and took CynRNs suggestion to replace care with contact. Now skeptics won't even allow the disemination of information that DCs are PCPs for neuromusculoskeletal. Give me a break. CorticoSpinal (talk) 18:25, 7 May 2008 (UTC)

Given the controversy I thought it would avoid the whole mess by removing possibly PoV paraphrasing and go for a direct quote. I thought it worked rather well, but I would be happy to discuss this if you would elaborate on your objection. Jefffire (talk) 17:00, 7 May 2008 (UTC)

Except in doing so, you disregarded the consensus on compromise that was achieved by myself, Eubulides and CynRN who felt that setence was appropriate. You have an increasingly worrisome habit of popping by the article, making an edit/reverting without even being part of the discussion that proceeded it. CorticoSpinal (talk) 18:25, 7 May 2008 (UTC)

Quotes are a good starting point. But when we have an original Wikipedia sentence it is better to use our own writings. Quotes are fine is some circumstances. QuackGuru 17:07, 7 May 2008 (UTC)

I agree that it isn't ideal. I viewed it as a compromise until an elegant NPoV wording could be found. Jefffire (talk) 17:34, 7 May 2008

I attempted to supply some more-elegant wording. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

It is a NPOV sentence. It's only POV to chiropractic skeptics who seem to have a warped sense of what constitutes POV. CorticoSpinal (talk) 18:25, 7 May 2008 (UTC)

That has ALWAYS been part of the draft, QG, there are many, many diffs to prove this. If I might give you some friendly advice, if you are going to cast stones, make sure you don't live in a glass house. Your attitude here lately is unbecoming of an experienced editor and you have failed to agree to consensus as demonstrated above. I will remind you, yet again, that you narrowly escaped an ANI investigation into your disruptive tendencies on chiropractic and related articles and the diffs are accumulating since that time. For the good of the project, fellow editors and the article, please desist from inflammatory statements and false accusations. Consider this a gentle nudge! Take care, CorticoSpinal (talk) 18:25, 7 May 2008 (UTC)

I must say that this was an unexpectedly hostile reaction to providing a quote from the world health organization. Jefffire (talk) 19:00, 7 May 2008 (UTC)

I'm not going to take your bait, Jefffire ("unexpectedly hostile". You have not participated here through building of the draft so naturally, you have no context to the situation. Go fish elsewhere. CorticoSpinal (talk) 20:26, 7 May 2008 (UTC)

This controversial edit is in direct contradiction to the next sentence. The first sentence declares chiropractors as "primary contact providers" but the next sentence explains the primary contact providers controversy. The sentences appear to be contradictory. QuackGuru 18:42, 7 May 2008 (UTC)

That's because Eubulides went against consensus and inserted an opinion of Haldeman and Meeker. It was struck out in the original draft and several editors felt it belonged ELSEWHERE. There was agreement however on the first sentence (primary CONTACT) and if anything the second sentence should be moved into the practice styles section or where OPINIONS belong.

I did not go "against consensus"; I went against only your opposition to including the relevant points from Haldeman & Meeker. It is not the case that "several editors felt it belonged ELSEWHERE". Eubulides (talk) 09:36, 8 May 2008 (UTC)

Here is another controversial edit. Please fix it. QuackGuru 19:51, 7 May 2008 (UTC)

Here is another controversial change that declares chiropractors as "primary contact providers" but the next sentence explains the primary contact providers controversy. QuackGuru 07:31, 8 May 2008 (UTC)

If there is a legitimate controversy about the status, then I think the appropriate thing to do would be to cut the "primary" stuff from the first sentence, and then explain the controversy in the second. Jefffire (talk) 07:55, 8 May 2008 (UTC)

Removing the POV material (primary contact providers) from the first sentence works for me. QuackGuru 07:58, 8 May 2008 (UTC)

Apparently I have missed something. How is it POV to say that DCs are primary contact when they are? If someone can demonstrate a reason why it should be changed (ie - how is it POV?), then it should be changed BACK to primary care. DigitalC (talk) 08:15, 8 May 2008 (UTC)

The next sentence explains the controversy. It should be changed back where there was no mention of primary contact providers or primary care. QuackGuru 08:24, 8 May 2008 (UTC)

(outdent) I gave a shot at rewording it in the light of the above comments. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

QG, the next sentence does not explain the controversy. In fact, the second sentence could be deleted completely imho. Chiropractors are primary care/primary contact health care providers. That is a fact. It is not POV. Eubulides, I don't think that edit is acceptable, because now it seems like they aren't primary care/contact, they only have "many" attributes of primary care/contact, and then goes on to qualify it. Why the watering down of the fact that chiropractors ARE primary care/contact?DigitalC (talk) 11:46, 8 May 2008 (UTC)

It is not a universal "fact" that DCs are PCPs. They are PCPs in some jurisdictions, but not in others. For example, DCs are not legislated as PCPs in New York; see [28] (dated 2005). I'm sure there are other examples. The point is that the rules vary quite a bit from one jurisdiction to another, and the assertion "DCs are legally PCPs for NMS" is not correct in general. Eubulides (talk) 09:41, 22 April 2008 (UTC)

Thank you for that source. It has been my experience up to this point that legally, Primary Care has met the defintion of [29], in that there is no need for referral. Obviously, I was mistaken, and an agreed upon definition does not necessarily exist. I still fail to see the controversy about the first sentence calling chiropractors primary contact health care providers.DigitalC (talk) 00:33, 9 May 2008 (UTC)

I think the controversy is because the first sentence ("Chiropractors are primary-contact health care practitioners who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery.") seems to conflict with the second sentence ("Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry.") A naive reader will see that and say, "OK, which is it? Primary care or specialty?" Opinions differ, the rules are different in different jurisdictions, and it is hard to summarize this confusing state in a non-confusing way. We may have to settle with what we've got now, unless someone can come up with a reliable source that explains things better. Eubulides (talk) 16:29, 9 May 2008 (UTC)

The next sentence clearly explains the controversy in a neutral way. The next sentence explains it accurately. QuackGuru 16:20, 8 May 2008 (UTC)

Disruptive editing by Jefffire

I would ask that Jefffire please refrain from editing agreed upon material with respect to scope of practice. The first sentence, which you have reverted twice, adequately and NEUTRALLY describes by and large the scope of chiropractic practice. Several discussions took place over this sentence and a neutral, agreed upon version claiming primary CONTACT (rather than care) was AGREED TO by the REGULAR editors here, including Eubulides, CynRN and myself. I would ask that you please desist from making any more reversions to agreed upon material or I will have to ask an uninvolved admin to lock the page if your disruptive and bogus edit summaries (POV) continue. Thank you. CorticoSpinal (talk) 20:26, 7 May 2008 (UTC)

Calm down a sec. There is no problem with making changes to an article. If adding a quote from the world health organisation which gives their view on chiropractic is so unbearably PoV then the other regular editors will chip in on it. Jefffire (talk) 21:40, 7 May 2008 (UTC)

You replaced an agreed sentence which has been under review for 2 months and replaced with a non-sequitur that is a duplication of the lead from the WFC. You replaced a statement by the WHO that was cited and attributed and agreed upon with something that was not. Then you ignored my reversion which stated the statement was agreed upon. Then, by divine right, Arthur Rubin comes down and reverts it again. You two are beginning to look awfully suspicious in the way you edit this article. You have not participated in the discussions so you have no moral right to come here and disrupt the progress being made. It's the same garbage wherever you edit chiropractic-related articles. Then you slag me on QGs talk page. How can you come across as credible and I'm to AGF when you constantly disrupt chiropractic-related pages? CorticoSpinal (talk) 21:46, 7 May 2008 (UTC)

Here was the consensus version for SCOPE OF PRACTICE. This had the input of all regular editors.

CONSENSUS VERSION

Chiropractors are primary contact providers who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery.

JEFFFIREs CHANGE

The World Health Organisation described Chiropractic as "A health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on subluxations"

Jefffire's needlessly disruptive edit. Thanks for proving your [[WP:POINT}point]] but that change is not for the better and not valid. We are discussing the primary contact provider (or primary care). The sentence was succint and clear. It was relevant to the section. He reverted me twice and then Arthur Rubin came and and ignored the consensus version (that guy is an admin?)and reverted the consensus version. So, technically, Jefffire escapes 3RR but the spirit of the rule was still violated. Skeptics have gone too far. Uninvolved Admin Swatjester has already said that the section had been NPOV and properly referenced. Since I included it has been the target of persistent attacks and stonewalling tactics by both Jefffire and Arthur Rubin. What makes this even worse is that neither of those 2 were present for the discussions. So, they're essentially undoing the hard work it took to achieve consensus on the major points resulting in a low grade edit reversion. I apologize for going up to 2RR and I'm going to desist for tonight but Jefffires edits and Arthur Rubin's approval just go to show at what lengths skeptics will go to challenge anything that challenges their personal POV. CorticoSpinal (talk) 22:42, 7 May 2008 (UTC)

• I share CorticoSpinal's distress at the way these reverts and reverts-of-reverts have been done. It would be better to discuss changes like this on the talk page first.
• The existing text is not carved in stone; if there is a good reason to change it to include the other points, let's please hear about it on the talk page first: why is it a worthwhile improvement over the existing version?
• Swatjester did not have the benefit of subsequent remarks explaining POV concerns about the text, and Swatjester has not weighed in on the discussion since then. It is not clear what Swatjester's opinion would be now, about either the original or the revised text.

For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

draft for lead changes

Traditionally, it is based on the premise that a vertebral subluxation or spinal joint dysfunction can interfere with the nervous system and result in many different conditions of diminished health. Today, the progressive view examines the relationship between structure and function and its impact on neurological mechanisms in both health and disease.

Chiropractic medicine focuses on the body's structure (primarily the spine) and its function (as coordinated by the nervous system) are closely related, and suggests this relationship affects health. Chiropractic care is given with the goals of normalizing this relationship between structure and function and assisting the body as it heals.

commentary on draft for lead changes

There has been two differnent versions to the lead. Please discuss. QuackGuru 21:43, 7 May 2008 (UTC)

It's easy. The sources deleted by Arthur Rubin were authorative texts that specifically go over this issue and that UNIFIES all the theories into some basic premises that straights, mixers and anything in between agrees upon. It was NPOV, it was factual, it was relevant it was cited. Arthur Rubin, for an adminstrator, is displaying incredibly poor judgment and has been reverting me in some way for the last 2 weeks and all the reversions he made went back to the original version? Why? Because he does not familiarize himself with the salient points before jumping it. He's letting his chiro-skepticism get the best of him. The fact that there seems to be an unofficial alliance between Jefffire and Arthur Rubin is even more disconcerting, it's a way of going around 3RR by getting someone else to revert AGREED UPON MATERIAL. The scope of practice section will be THE downfall of the skeptical editors, you guys have clearly crossed the line with the billion stonewalls, reverts, tags, disputes, verifications and other BS to discredit, obstruct and marginalize the profession which you clearly view fringe. This is my last warning: continued disruptive and disingenious reversions to scope of practice, particularly the first sentence, will go to ANI. We now have Orangemarlin, Arthur Rubin, Jeffire all reverting consensus material without warning/discussion despite pleas from involved editors; Eubulides has the distinction of being lumped in with those guys. You already know where I stand with respect to your editing practices. — Preceding unsigned comment added by CorticoSpinal (talk • contribs)

If you're being reverted by 5 editors, and the edits are not being restored by any, doesn't that tell you something about consensus? — Arthur Rubin (talk) 23:28, 7 May 2008 (UTC)

5 editors? Sure. If you mean randoms like you and Jefffire disrupting and leaving like you have a history of doing. You have completely ignored and disregarded any of the talks discussion and you have been proven wrong in every single instance you have tried to stonewall Scope of Practice? How are those verification failed tags doing you put up at Scope of Practice? Every single one of them you put up has been taking down (by Eubulides no less!). You simply do not have a grasp of the salient issues here because unlike the regular who have spent the last 2 months trying to fix things, you're simply trying to disrupt them. You won't be able to get away with this crap, forever. You should be stripped of your admin status; rather than build bridges and consensus you seek to delete and destroy. You have also failed again to address any of the points I raised above before using a red herring fallacy to try and cover up your significant errorS in judgment. CorticoSpinal (talk) 23:44, 7 May 2008 (UTC)

I've been editing Chiropractic longer than you have, unless you have another account before your last change. And there is no evidence that there was consensus on what you call "the consensus version". I think you and possibly Levine just outshouted the other editors. And all of my {{verification failed}} tags were clearly supported (i.e., the text was clearly not supported by the reference).

And you've reverted 7 times in 72 hours. How is that in keeping with your 1RR parole? — Arthur Rubin (talk) 00:06, 8 May 2008 (UTC)

This controversial change added text to the lead (are closely related) that DigitalC previously striked out as makes no sense. QuackGuru 06:28, 8 May 2008 (UTC)

Chiropractic is "assisting the body as it heals." Is this true? QuackGuru 07:52, 8 May 2008 (UTC)

Changes like these should be discussed on the talk page before installing. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

Sorry, I don't follow what those two paragraphs in #draft for lead changes are intended to mean. What are they supposed to replace in the lead? Why is the replacement important? I agree the lead has real problems but I don't understand this as a concrete proposal for improving it. Perhaps it would be clearer and simpler to put a draft replacement for the entire lead as a subsection of this section? Eubulides (talk) 09:36, 8 May 2008 (UTC)

Let me explain. There was a recent edit war over the two different versions above. I thought discussion would be helpful. QuackGuru 12:38, 8 May 2008 (UTC)

lead improvements

The lead currently does not reflect the body of the article. We should not wait to finish the body. It may takes years that way things are going. I suggest the lead be improved where possible. QuackGuru 04:09, 8 May 2008 (UTC)

Yes, the lead should reflect the body today; we can't go on for months editing the body without fixing the lead to reflect the body. Eubulides (talk) 09:36, 8 May 2008 (UTC)

I recommend we start with Safety first per WP:LEAD. QuackGuru 16:25, 8 May 2008 (UTC)

2008-05-07 changes

Reviewing these edits made from 2008-05-07 11:00 through 2008-05-08 08:00 UTC, I see the following problems:

• As discussed above there is considerable dispute over the phrase "primary contact". The cited source (the WHO guidelines) uses the phrase "primary-contact health care practitioners" and I suggest we stick to the source's wording.
• As discussed above, there's some confusion about the seeming contradiction between the 1st two sentences in Scope of practice re primary contact etc. I tried to reword it to avoid confusion.

• This edit undid the change with this comment that "Eubulides, I don't think that edit is acceptable, because now it seems like they aren't primary care/contact, they only have "many" attributes of primary care/contact, and then goes on to qualify it. Why the watering down of the fact that chiropractors ARE primary care/contact?" The problem is that chiropractors are primary care in some jurisdictions, but not in others. For example, they are not legislated as PCPs in New York; see [30]. We need to briefly summarize, somehow, that there are important diverging views on this subject; the article cannot simply state that chiropractors are primary-care or primary-contact without also covering alternate views with proper weight. I will try another way to phrase it, since this way obviously didn't work for you. Here's what I'll try: "Chiropractors are primary-contact health care practitioners who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery." citing the WHO, followed by "Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry." citing Meeker & Haldeman.

• This edit introduced substantial and controversial changes to the lead (for example, it removed the notion of vertbral subluxation) without any advance discussion or comment. Please don't do that; it understandably caused a mini-revert war. Let's please go back to the old lead and discuss the changes first here on the talk page.

Why is it important to have vertebral subluxation in the lead? DigitalC (talk) 11:55, 8 May 2008 (UTC)

Certainly vertebral subluxation is important in the historical development in chiropractic. But the point here is not to argue about what should be in the lead; the point is that there should be discussion about controversial changes like this before installing them. That was not done in this case: the lead was fairly stable for weeks, and then all of a sudden a substantial change was made to it without advance discussion. That is contrary to the proper practice for this controversial article. Eubulides (talk) 16:35, 8 May 2008 (UTC)

• This edit removed a diagram from Chiropractic#Philosophy. The diagram is indeed ugly, but it's functional and it illustrates some of the relationships in Philosophy. Let's keep it until we get a better illustration. Illustrations are good; Chiropractic needs more of them.
• This edit added a citation for Oregon and adjusted the text to match the citation. Thanks, that is an improvement. A couple of minor points: there's no need for the phrase "with no additional qualifications" here; also the cited source says "substances" rather than "drugs" so we should use the more-general "substances" term.

• I changed it from "with additional training", because they DON'T need additional training. I feel that it is notable that they DON'T need additional training to prescribe OTC "substances", but maybe it isn't, and I certainly don't have a source that says its notable. Feedback from others?DigitalC (talk) 11:37, 8 May 2008 (UTC)

• The cited source doesn't say that they don't need additional training; why should Chiropractic highlight something that's not in the cited source. Eubulides (talk) 16:35, 8 May 2008 (UTC)

• This edit removed a couple of failed-verification tags, and reworded the text at the same time (presumably to make the text match the cited sources better). But I just now went to the two cited sources, and I can't see anything like that text there. The two cited web pages do not mention anything being "in accordance with state or provincial licensing boards". They do not mention "assessment" or "diagnosis" or "treatment" or "biomechanical disorders" or "amenable" or "manual therapy". The first web page does not mention "practice". The second web page does say "The examinations are designed to evaluate the suitability for practice in the international animal chiropractic environment" but it is not clear that this "practice" is recognized by any legal authority. Please rewrite the claims to match the sources, or find better sources. I'll add a comment to that effect to the text, along with a "Failed verification".

• I did have some problems with this, as I tried to add another source that stated that veterinarians and chiropractors could perform animal chiropractic with additional training and licensure, but WP has blacklisted that URL.
• However, if we change (or add?) the first reference to [31], it is stated there that"Qualified Doctors of Chiropractic or Veterinary Medicine can practice Animal Chiropractic in accordance with the standards set forth by their respective provincial or state licensing boards."

• Thanks for that URL. This addresses the concern that none of the cited sources talk about "accordance with state or provincial licensing boards" or "practice". However, the other concerns remain: none of the cited sources talk about "assessment" or "diagnosis" or "treatment" or "biomechanical disorders" or "amenable" or "manual therapy". Please find a source that talks about these things, and add that; in the meantime I'll use the adjusted URL and restore the "failed verification" tag with the smaller remaining set of concerns. Eubulides (talk) 16:35, 8 May 2008 (UTC)

• Again, please comment on "RMIT - Animal Chiropractic – Master of Chiropractic Science incorporating Graduate Diploma". www.rmit.edu.au. Retrieved 2008-05-08.. It is not a cited reference yet, but rather than insert it and get in an edit war, I'd like opinions on it first. DigitalC (talk) 23:16, 8 May 2008 (UTC)

• Sorry, I missed that comment the first time around. (This page is too big!) That URL says RMIT offers a postgraduate animal chiropractic program that covers diagnosis and management. This would address the concerns about mentioning "diagnosis", and if "treatment" is changed to "management" it would address those concerns as well. The remaining words not covered would be "assessment", "biomechanical disorders", "amenable", and "manual therapy". A couple of thoughts: first those remaining words could simply be dropped, surely. Second, I'm a bit uncomfortable with gluing together bits and pieces from various universities etc., and would prefer rewording it so that there's one phrase supported by each source if possible.
• I did a bit more Googling and found this source, for Nevada: [32] (PDF). Note that it says any vet can practice veterinary chiropractic, but DCs can practice it only after jumping through hoops and only under the direction of a vet. Of course Nevada is just one state, but this is a worrisome datum, since it suggests that in Nevada at least chiropractors aren't really independent actors, and the summary currently presented in Chiropractic doesn't correctly state the relationship between DVMs and DCs (at least in Nevada). Here is one other source, in a journal: doi:10.2460/javma.2003.222.1679. It pretty much is in line with the Nevada source. If these are right, it looks like the current text has some real problems.

Eubulides (talk) 00:00, 9 May 2008 (UTC)

• That was part of the reason for the inclusion of the "in accordance with...". Perhaps this could be changed to "In some locations..."?. Given that health care regulations vary from state to state, province to province, and that we want a global POV, I would assert that it would be NPOV to use "In some locations". ?DigitalC (talk) 01:04, 9 May 2008 (UTC)

• Yes, "In some locations" sounds better. I made that change. Eubulides (talk) 16:29, 9 May 2008 (UTC)

• As for "diagnosis", and "treatment", would this be a RS? Not every word needs a citation. This source backs up claims that treatment includes "injuries" (ie - of the biomechanical kind, not lacerations), and we are allowed to paraphrase. "RMIT - Animal Chiropractic – Master of Chiropractic Science incorporating Graduate Diploma". www.rmit.edu.au. Retrieved 2008-05-08.DigitalC (talk) 11:26, 8 May 2008 (UTC)

• Yes, please see above. (I missed this comment at first.) Eubulides (talk) 00:00, 9 May 2008 (UTC)

As for NEEDING additional trainig, this is Australia-centric, but I just chanced across it while looking for the proper RMIT url above, [33] DigitalC (talk) 12:02, 8 May 2008 (UTC)

Yes, that source means there's a legal scope of practice in Victoria for animal chiropractic. Again, please see above. (I missed this comment at first.) Eubulides (talk) 00:00, 9 May 2008 (UTC)

• This edit replaced a brief summary of Chiropractic education with a copy of that article's lead section. So far, three editors' comments in #Comments about Education, Licensing Regulation have disagreed with putting this lengthy discussion here rather than in the subpage. Please address the concerns by adding to the discussion there; it's not constructive to silently ignore other editors' concerns and revert their changes. I will attempt to address the concerns myself, by drafting a brief summary; no doubt there will be problems with this draft but at least it should be a step forward.
• The same edit created a broken citation to the CCE-USA web site.
• The same edit lost the hyperlinks to Chiropractic education and List of chiropractic schools; surely this wasn't intended.
• This edit's log said "moving contraindications to top where it flows better." but it did far more than that: it made significant changes to the wording without discussion. It's OK to move the contraindications, but it's not OK to make significant changes like that without discussion and with a misleading change log entry. Perhaps the wording can be improved, but this needs to be discussed first. For now, I'll restore the old wording.
• The same edit changed "high levels of underreporting" to "potential high levels of underreporting". The cited source does not say "potential". Again, this is a significant change in wording with a misleading change log entry. For now, I'll restore the old wording.
• The same edit changed "is similarly associated with general practitioner services" to "is similarly associated with general practitioner services for all ages". The cited source (Hurwitz et al. 2008, PMID 18204386) does not mention the "all ages" detail; it merely says "This study confirmed an increased risk of VBA, but found a similar increase in risk of this form of stroke after visiting a primary care physician for neck pain." Since the cited source does not mention this detail we should not reach down into the (uncited) primary study and highlight it. Again, this is a significant change in wording with a misleading change log entry. For now, I'll restore the old wording.
• The same edit added a "content" tag but there's nothing in the log entry saying why. Since the entire article has a "content" tag it's redundant to put it on this section.
• This edit inserted a controversial citation to Boyle et al. 2008, reaching down into a primary study, and supplying linking text "This is in contrast to" that is WP:OR. This change has not reached consensus; on the contrary, two editors have opposed the change, and no one (other than the editor who made the change) has supported it. The change violates WP:MEDRS guidelines, and the only argument made for it seems to be WP:IAR, which is not a good policy for a controversial article like this. Also please see the discussion in #2008-05-06 changes above. Please discuss further options for this change on the talk page first. If we start adding primary sources because we disagree with what reliable reviews say, there will be no end to problems with editors adding marginal sources; hundreds if not thousands of primary sources would be available as ammunition for this sort of thing. For now, I'm reverting the change.
• One other detail: there was a "nonspecific" tag that I said can be removed in #2008-05-06 changes, but due to a typographical error I forgot to remove it. There's been no discussion since then so I assume it's OK.

I made this change to implement the above suggestions. Eubulides (talk) 09:36, 8 May 2008 (UTC)

Not acceptable change regarding primary care/contact

I saw this controversial change and now I am shaking my head. The controversial changes have continued. This edit reverted a reference improvement among other things. The primary study was reverted back in the safety section. The table was deleted. QuackGuru 13:41, 8 May 2008 (UTC)

Yes, that edit undid many changes without explanation. The change log entry did say "Not acceptable change regarding primary care/contact" with this further comment. I attempted to addressed these concerns, and the few other concerns that were explained and installed a change to try to accommodate them, while restoring the changes that were not commented upon. Here is the set of changes that result from the combination of these edits. Eubulides (talk) 16:35, 8 May 2008 (UTC)

I'm willing to admit I may have made a mistake here. Is there a way to undo one part of a large edit without undoing the rest? DigitalC (talk) 23:11, 8 May 2008 (UTC)

No automated that I know of, alas; one must simply create the desired page by hand. (Nor do I know of a good way to edit giant talk pages like this one. Ouch, it's large!) Eubulides (talk) 00:00, 9 May 2008 (UTC)

Make small edits, save them, and continue. Any single edit that might be controversial (in this article that's just about anything other than spelling changes..;-) should be aired here first and only added after a consensus has been reached. -- Fyslee / talk 03:32, 9 May 2008 (UTC)

deletion of cited text in medical opposition

This controversial change change deleted cited text. Hmmm. QuackGuru 17:10, 8 May 2008 (UTC)

To be specific, that change removed the text 'According to a 2002 survey, 68% of chiropractors believed that "most diseases are caused by spinal malalignment," although only 30% agreed that "subluxation was the cause of many diseases."' with a citation to Biggs et al. 2002. The log comment for the change said "this is not in the proper chronological order (at the very least)". A few thoughts:

• I assume the log comment is referring to the problem in citing a 2002 survey after a discussion of events in 2005 and 2006. This criticism makes sense, and can be addressed by moving survey results earlier in the text, so that it's clear the survey results are talking about chiropractic attitudes a few years ago rather than chiropractic attitudes today.
• Isn't McDonald et al. 2003 a better survey? Larger, more comprehensive, better questions, etc.? It's already cited by Chiropractic and it would make sense to cite it instead of Biggs 2002 unless there's some reason to cite Biggs 2002.
• I understand there's been a long-running dispute as to how much Chiropractic should emphasize survey results, but to be honest I don't recall all the details. Is there a short summary of the dispute that would make sense to people who haven't been following it all that carefully?

Eubulides (talk) 19:24, 8 May 2008 (UTC)

The 2002 survey is very clear and concise. If something similar is written from the 2003 survey it can replace the 2002 survey or we can add both surveys. For now I think we should restore the 2002 survey. We would have to write something in order to replace the 2002 survey. I don't see any proposal. If you are sure you have something good in mind then by all meaans add the 2003 survey to the article at any time. QuackGuru 02:54, 9 May 2008 (UTC)

OK, how about the following change instead?

• Change "The significance of subluxation" to "The concept of subluxation".
• Before "This is still a continuing source of debate", insert "A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex, and that when asked to estimate the percent of visceral ailments that subluxation significantly contributes to, the mean response was 62%." and cite McDonald et al. 2003 (already cited elsewhere in Chiropractic).

Eubulides (talk) 16:29, 9 May 2008 (UTC)

Sounds good. Insert the survey there.--—CynRN ^(Talk) 18:03, 9 May 2008 (UTC)

Both surveys are a bit different. Why not both. "The concept of subluxation" is correct. "The significance of subluxation" is POV wording. QuackGuru 05:42, 10 May 2008 (UTC)

If one survey is clearly better than the other (more recent, more surveyed) then let's not bother with the redundant one. The reader's patience is limited, even if ours isn't. Eubulides (talk) 07:04, 10 May 2008 (UTC)

After review, the 2003 survey is fine. Before "As of 2005, the chiropractic subluxation was defined by the World Health Organization as" insert the 2003 survey. This would problably be the best placement. "The concept of subluxation" can be restored. QuackGuru 12:01, 14 May 2008 (UTC)

philosophy

recognizes the centrality of the nervous system and its intimate relationship with both the structural and regulatory capacities of the body

The word intimate seems like a WP:PEACOCK term. QuackGuru 13:32, 8 May 2008 (UTC)

I will remove the peacock term. Going once... going twice... QuackGuru 02:58, 9 May 2008 (UTC)

Is it peacock or descriptive? Hmmm... Is there another word you'd prefer?--Hughgr (talk) 03:57, 9 May 2008 (UTC)

Is it peacock or descriptive? I think it is a peacock term. Is there a reference that verifies the word intimate? I could not find any reference. I could not think of another word. I recommend we delete the peacock term. QuackGuru 16:23, 9 May 2008 (UTC)

The cited source (Mootz & Phillips 1997) says "intimate". This source is dated but unless we find a better one I'd leave the word alone. Eubulides (talk) 16:29, 9 May 2008 (UTC)

Irrespective of what any source says it is still a peacock term. We can tone down the sentence by removing the WP:PEACOCK word. QuackGuru 05:39, 10 May 2008 (UTC)

I'm not sure I agree that it is peacock. When Prescher 2000 (PMID 10963915) says "an intimate relationship exists to the tendon of the long bicipital head and in about 55% of cases", is that a peacock term too? If not, why is a similar use of "intimate" peacock here? Eubulides (talk) 07:04, 10 May 2008 (UTC)

About 55% of cases? That is not a large majority. Irrespective of sourcing I believe the word itself as it is currently being used is a peacock word. QuackGuru 17:17, 10 May 2008 (UTC)

The "55%" quote was not taken from a chiropractic article. The quote was given to illustrate the point that "intimate" is commonly used in a medical sense that has nothing to do with emotional intimacy. Eubulides (talk) 21:31, 10 May 2008 (UTC)

Its a word commonly used in anatomy and physiology. I think your out in left field on this one.--Hughgr (talk) 18:07, 10 May 2008 (UTC)

Agreed. Not a peacock term. Let's move on. -- Levine2112 ^discuss 18:31, 10 May 2008 (UTC)

reference improvements

Does anyone have any objection if I improve a few references. I know some editors continue to blindly bulk reverts quality NPOV edits (heavily cited text) and that is not right. Please do not blindly revert. We hope the reference tampering stops. QuackGuru 13:47, 8 May 2008 (UTC)

I will improve references. Again, please do not revert reference improvements. Formatting references is an improvement. Blindly reverting ref improvements is unproductive. QuackGuru 03:02, 9 May 2008 (UTC)

You have proposed some changes which you admit might be controversial enough that someone might revert them. Then why do you do it? When are you going to learn? Try it out HERE first. If it flies, then, and ONLY then, do it. This advice applies to your editing in general, not just your proposed improvement of references. -- Fyslee / talk 03:39, 9 May 2008 (UTC)

Improving a ref is not controversial in any way. How is it controversial to improve a ref? It is not. I never said it might be controversial. Reverting a formatted ref is controversial. Claiming it might be controversial to format a ref is unproductive. Why improve a ref? Why would I do it? Formatting a ref is an improvement. A formatted ref will offer consistancy with the other formatted refs. QuackGuru 16:05, 9 May 2008 (UTC)

This comment does not address the issue at hand. A ref improvement is normal practice. QuackGuru 16:19, 9 May 2008 (UTC)

I propose I improve reference number 55 using a ref template. QuackGuru 08:18, 9 May 2008 (UTC)

The reference is in the Chiropractic#Vertebral subluxation section. QuackGuru 08:22, 9 May 2008 (UTC)

There is nothing controversial about this sort of change. The current citation is poorly done. Please improve its quality if you have a mind. I sense that there is some sort of misunderstanding here: others thought that the changes you were proposing were controversial (because you made them on the talk page). The proposals were vague enough that others couldn't see that they are not controversial. Eubulides (talk) 16:29, 9 May 2008 (UTC)

I do not see any misunderstanding. My comments were clear. I am specifically referring to ref improvements. This comment claims it is controversial to improve refs. QuackGuru 16:37, 9 May 2008 (UTC)

I don't understand the reasons behind the conflict here (I sense there's some Wikipedia history behind it) but for this particular case surely the reasons don't matter. The citation has a low-quality format and there should be no controversy in improving it. Sometimes it's easier to fix things than to argue about procedure and I hope this is one of those times. To help move things along, I made this change to improve the citation. Please feel free to make similar improvements to citation format; they should not be controversial. Eubulides (talk) 21:06, 9 May 2008 (UTC)

I could be wrong, but perhaps the issue is if the reference formatting is done at the same time as a more controversial edit, and the edit is reverted at the same time.DigitalC (talk) 02:07, 10 May 2008 (UTC)

We have proposed a non-controversial improvement. Changing a citation from a low quality to a high quality format is to be respected. Am I wrong? QuackGuru 05:57, 10 May 2008 (UTC)

No, you're not wrong. Let's move on to another topic, please. Eubulides (talk) 07:04, 10 May 2008 (UTC)

This change was not a ref improvement. It was an old obsolete version. QuackGuru 18:37, 15 May 2008 (UTC)

I thought it was the other way around. Feel free to revert that particular edit. -- Levine2112 ^discuss 18:40, 15 May 2008 (UTC)

The word "summary" was added. The word summary is the not part of the title of the article. --> (summary) <-- A "work" was added. --> work 671 F. Supp. 1465 (N.D. Ill. 1987) <-- The work refers to a court case. The ref is not a court case. QuackGuru 18:56, 15 May 2008 (UTC)

ref names

We have references that have ref names and some without ref names. For this article do we want all the refs to have ref names or do we want the refs with additional inline citations to only have ref names. QuackGuru 08:08, 9 May 2008 (UTC)

I think it would be nice to have the names.--—CynRN ^(Talk) 16:17, 9 May 2008 (UTC)

The style I prefer is to names only those references that are cited in two or more locations (so that you have to have ref names). That way, there's a clear indication to the editor that a reference is cited multiple times. This is low priority, but let's remove unused ref names from the text. Eubulides (talk) 16:29, 9 May 2008 (UTC)

I prefer every ref have a name. Is there specific policy on this. If not, there should be. QuackGuru 18:56, 9 May 2008 (UTC)

There is no policy on this, not even a guideline as far as I know. It is a style issue. It is not that important. All that being said, what is the advantage of giving every ref a name? It clutters up the article for editors. Eubulides (talk) 21:06, 9 May 2008 (UTC)

I try to add names to references, especially if I think the reference MAY be used again. I have seen editors removing cited text on controversial articles BECAUSE the reference was used twice, not named, and hence in the reference list twice. My $0.02 (completely off topic, but if the penny gets eliminated, will that phrase be eliminated?). Will have some references named and some un-named be a hinderance to GA status somewhere down the road?DigitalC (talk) 00:14, 10 May 2008 (UTC)

There is really no harm in always using ref names and the benefit is that you don't have to create one every time you want to dupe a ref. -- Levine2112 ^discuss 03:25, 10 May 2008 (UTC)

This is about having the same consistancy from ref to ref when using ref names. We need new specific policy on this. QuackGuru 03:31, 10 May 2008 (UTC)

Why is this an issue? Why do we need consistenancy from ref to ref? If you want a policy, here I'll create one. 1) If the reference is a journal, name it according to the authors name, then add a digit if the name is used more than once -ie: name="Keating1". 2) If the reference is a website, and no author is know, name it according to the first 4 letters of the website URL, and add a digit. Eg: name="CCE-1", "NCCA1" etc.". Happy? DigitalC (talk) 03:50, 10 May 2008 (UTC)

I thought discussion is important to resolve this issue because editors are doing different things to the refs. Some are adding ref names. Others think it clutters the article. I think the best place to have discussion on the ref names is at a policy page. Having an official detailed policy on this issue is a good idea. QuackGuru 04:09, 10 May 2008 (UTC)

Thanks QG for your explanation of what the issue is. I don't see it really cluttering up the page, but clearly others disagree (see Eubulides comment above). I think taking it to a policy page for discussion is a good idea, and is a better location for the discussion than here. Cheers, DigitalC (talk) 04:33, 10 May 2008 (UTC)

I'm not sure under which policy page is the best place to start a new dicussion on this trivial but important to resolve issue. QuackGuru 04:41, 10 May 2008 (UTC)

Check out WP:CITE#HOW. Your questions may already be answered, in a sense: Any style or system is acceptable on Wikipedia so long as articles are internally consistent. You should follow the style already established in an article, if it has one; where there is disagreement, the style or system used by the first editor to use one should be respected. -- Levine2112 ^discuss 04:45, 10 May 2008 (UTC)

That policy makes very little sense and does not mention ref names specifically. So much for policy. Oh well. QuackGuru 04:53, 10 May 2008 (UTC)

Prefer single-line inline citations

While we're on the subject of references styles, I prefer keeping a citation all on one line when possible, in the source (this issue doesn't affect what article readers see). Multiline citations make it harder to see differences when people insert citations. For example, this change simply added a citation, but because the citation is multiline the diff listing makes it hard to see that; it looks like it may have also changed some text, which is a bigger deal. In contrast, this change, which added to a citation, is clearly marked out in the diff as only changing that citation; had we used the multiline style that would have been much harder to see.

This is just a style issue; I don't know of any policy or guideline in this area. But I thought I'd mention it since we're talking about style. Eubulides (talk) 21:06, 9 May 2008 (UTC)

I can see what you mean about it being harder to see on diffs. However, I use Wickipedia CITE to automatically format most of my web references, and it formats them into multiline. I guess it would be less of a hassle to turn them into single line format than to create them by hand, but then... the whole reason I use Wickipedia CITE is to reduce the hassle. (See User:Jehochman for link to the tool).DigitalC (talk) 00:31, 10 May 2008 (UTC)

Ah, I see. I format them by hand. Others I know use Diberri's tool for journal citations, which defaults to uniline. I take it you wouldn't object to someone else reformatting to uniline? It's no big deal either way, of course. Eubulides (talk) 07:04, 10 May 2008 (UTC)

Thank you, this was posted before and I didn't bookmark, and it makes it so much easier. I have no objecting to reformatting to uniline, and will try to remember to re-format multiline citations to uniline instead. I had seen objections raised before, but didn't understand why it mattered. When looking at a diff though, I can understand. In fact, Diberr's tool can create URL citations, so I can use that tool. While not quite as easy to use as WP:CITE (where you right click any page and then click WP:CITE), its still easy enough. DigitalC (talk) 07:34, 10 May 2008 (UTC)

court case refs

At this time, court case refs should not be formatted using any template. These changes seems to have formatted two court case refs using a template. Here is the relevant link: Template:Cite court. Thanks. QuackGuru 06:14, 12 May 2008 (UTC)

Hi QG, I have self reverted for now. I see that we shouldn't use {cite court} as it is experimental, but does Wikipedia:Citing_sources#Say_where_you_found_the_material apply? DigitalC (talk) 06:25, 12 May 2008 (UTC)

Not sure. QuackGuru 06:30, 12 May 2008 (UTC)

I'd say that it's not needed for citing judicial opinions, unless there's serious doubt as to whether the web page is an accurate copy of the judicial opinion. The usual style in legal papers is to just cite the opinion and let the reader (who is presumed to have access to a law library) look it up. Wikipedia is not a legal paper, but the same basic idea would apply here, I think: the citation is to the actual judicial opinion, and the URL is for convenience. There's no need to say who's hosting the URL in the printed copy of Wikipedia. Eubulides (talk) 07:27, 12 May 2008 (UTC)

I think one of the court citations is still formatted using a template. QuackGuru 12:04, 12 May 2008 (UTC)

One of the court citations is still improperly formatted using a template. QuackGuru 19:41, 12 May 2008 (UTC)

That reference is not to a court case, it is to a summary of the court case at a website.DigitalC (talk) 00:05, 13 May 2008 (UTC)

The ref is a summary of a court case and should not be formatted using a regular template IMHO. For now, it can be typed without a template. In the near future, the cite court template can be used when it is ready for mainspace. There was prior discussion about these refs.QuackGuru 03:04, 13 May 2008 (UTC)

IMHO, we should reference the summary as a website, or not reference the summary at all. It is fine to just reference the court case, but if we are referencing the summary, than we need to cite it as such.DigitalC (talk) 04:20, 13 May 2008 (UTC)

I agree that we should keep judicial opinions separate from summaries. This particular summary was generated by one of the sides of the suit, and therefore we should warn the reader about that, since it's likely to be partisan. Eubulides (talk) 07:35, 13 May 2008 (UTC)

The ref is formatted using a template. The court cite template is not ready. What should we do for in this particular case. Should we format the ref using a template or hand type it. QuackGuru 09:14, 13 May 2008 (UTC)

This particular reference is not to a judicial opinion; it's to a web page generated by a chiropractic organization, which summarizes the case. For this case Template:Cite web is appropriate. Eubulides (talk) 19:59, 13 May 2008 (UTC)

I expanded the summary of the court case ref. Any thoughts. QuackGuru 13:23, 14 May 2008 (UTC)

file not found ref

A ref linked to a file not found. So I fixed it. Here is the improved ref added to the Medical opposition section. QuackGuru 13:33, 14 May 2008 (UTC)

to quote or not to quote (ref names)

Some ref names have "quotes" and some ref names do not have any quotes. For ref name consistancy it may be best to remove the quotations. QuackGuru 18:25, 14 May 2008 (UTC)

I prefer omitting the quotes unless they are needed (e.g., with names containing spaces). I also prefer names that lack spaces. All other things being equal, names should be short and easy for editors to work with. Eubulides (talk) 19:32, 14 May 2008 (UTC)

Learning curve! I thought they had to have quotes. I will take note for future changes.DigitalC (talk) 23:39, 14 May 2008 (UTC)

They have to have quotes with XHTML 1.0, but they do not have to have quotes in Wiki markup. The Wiki software adds the quotes automatically when generating the XHTML 1.0 article that gets sent to the user. Eubulides (talk) 23:47, 14 May 2008 (UTC)

DOI

This reference in the Teatment procedures section seems to have a DOI glitch.

Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther. 26 (5): 300–21. doi:10.1016/S0161-4754(02)54125-7. PMID 12819626.

Thoughts? QuackGuru 21:12, 19 May 2008 (UTC)

The DOI code was recently changed because of a problem with parsing special characters like "(" (which is in the DOI in question). This DOI still "works", albeit not as well, as the DOI itself is not blue but is simply followed by the hyperlink. Presumably they will improve this at some point. In the meantime I would leave Chiropractic alone and continue to use doi= as before. Please see Template talk:Cite journal #new #urlencode parserfunction and doilabel parameter for details. Eubulides (talk) 21:30, 19 May 2008 (UTC)

Failed verification tag - SOP

With the addition of the RMIT reference (and rewording to match the source), are we prepared to remove the respective failed verification tag? The tag was included with the following comment, which I think has been cleared up: 'The two cited web pages do not mention "assessment" or "diagnosis" or "treatment" or "biomechanical disorders" or "amenable" or "manual therapy". Please rewrite the claims to match the sources, or find better sources'.DigitalC (talk) 00:46, 10 May 2008 (UTC)

Yes, thanks; I removed the tag. Eubulides (talk) 07:04, 10 May 2008 (UTC)

Should all three citations remain, or should at least one of them be removed? I will look for sources for acupuncture next. I already know that it will be similar in that some areas allow Chiropractors to practice acupuncture, and others don't.DigitalC (talk) 07:41, 10 May 2008 (UTC)

Let's please remove sources that are not needed to support the article. There's little sense sending readers on wild goose chases. Thanks. Eubulides (talk) 21:31, 10 May 2008 (UTC)

Cost-benefit draft

The following draft was added to Chiropractic (not by me) without discussion, and then reverted (not by me). The article does need a cost-benefit section, so I've copied the draft here for further comments. Please put comments in #Cost-benefit 0 comments. Eubulides (talk) 21:31, 10 May 2008 (UTC)

Cost-benefit 0

The Manga Report was an outcomes-study funded by the Ontario Ministry of Health and conducted by three health economists led by Professor Pran Manga. The Report supported the scientific validity, safety, efficacy, and cost-effectiveness of chiropractic for low-back pain, and found that chiropractic care had higher patient satisfaction levels than conventional alternatives. The report states that "The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability."

In 1988, a study of 10,652 Florida workers' compensation cases was conducted by Steve Wolk. He concluded that "a claimant with a back-related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors." Similarly, a 1991 study of Oregon Workers' Compensation Claims examined 201 randomly selected workers' compensation cases that involved disabling low-back injuries: when individuals with similar injuries were compared, those who visited DCs generally missed fewer days of work than those who visited MDs.

A 1989 study analyzed data on Iowa state records from individuals who filed claims for back or neck injuries. The study compared benefits and the cost of care from MDs, DCs and DOs, focusing on individuals who had missed days of work and who had received compensation for their injuries. Individuals who visited DCs missed on average 2.3 fewer days than those who visited MDs, and 3.8 fewer days than those who saw DOs, and accordingly, less money was dispersed as employment compensation on average for individuals who visited DCs.

In 1989, a survey by Cherkin et al. concluded that patients receiving care from health maintenance organizations in the state of Washington were three times as likely to report satisfaction with care from DCs as they were with care from other physicians. The patients were also more likely to believe that their chiropractor was concerned about them.

Cost-benefit 0 comments

I don't think a cost-benefit section needs to refer to the Manga report, or to 20-year-old workers' compensation studies. That material should be moved to Chiropractic history with a one- or two-sentence summary in Chiropractic #History. A cost-benefit section should be written based on current sources. Please see Talk:Chiropractic/Archive 17 #Newer cost-effectiveness sources and Talk:Chiropractic/Archive 17 #Newer risk-benefit sources. So, pretty much, I think a complete rewrite of this draft will be needed. Eubulides (talk) 21:31, 10 May 2008 (UTC)

Manga DID have a huge impact on the profession, so hopefully we can find a source that describes this, and put it in Chiropractic History. I agree that a cost-benefit section should be based on current sources, where the sources are focused on the cost-benefit of chiropractic care (ie - not somehow reductionistic).DigitalC ([[User

talk:DigitalC|talk]]) 00:12, 11 May 2008 (UTC)

By reductionistic, do you mean studies that focus on manipulation? I think the reviews of literature don't always distinguish between studies: is the study on the 'total encounter' of chiropractic or manipulation only. Anyway, I agree with Eubulides that Manga and the old worker's comp studies need to be moved to history. Manga is something of an icon but has huge problems (as was pointed out in refs that Eubulides provided a while ago.)

I found a site that collects studies on CAM, effectiveness, cost-effectiveness which may be of interest in finding more material. "National Knowledge Week on CAM for Low Back Pain

Evidence Update on CAM for Low Back Pain - October 2007

The following relevant studies on this topic have been published since 1 October 2002.

These studies have met our selection criteria."

--—CynRN ^(Talk) 19:00, 11 May 2008 (UTC)

There are some good studies there, CynRN; however, many of them are about spinal manipulation in general and not chiropractic specifically. We just have to weed through and find the chiropractic specific studies. Eubulides, perhaps a good place to start would be to suggest the wording for Manga in terms of history. I think it should be 3-4 sentences, encompass the studies findings in general and why the findings were significant to chiropractic history. -- Levine2112 ^discuss 19:45, 11 May 2008 (UTC)

I see a consensus for a rewrite. This would include a new cost-benefit section and sources the describe Manga and not the original Manga report itself. QuackGuru 11:58, 14 May 2008 (UTC)

Table needs moving to right

I just tweaked a table to make it look better, but it needs to be at the right, and I'm unsure how to do it. [34] -- Fyslee / talk 15:20, 11 May 2008 (UTC)

Does adding all those lines to the diagram really make it work better? Or does it distract the reader by suggesting relationships that aren't really there, such as the relationship between "operational definitions possible" and "origin of holism in chiropractic"? One of Edward Tufte's design principles is to prefer white space to ink unless the ink is really needed. The original source (see page 10) doesn't have the lines, and I suspect the inferior HTML version has lines only because the HTML transcriber didn't bother to remove them (the lines are the defaults with tables in HTML). Anyway, for now I moved the table to the right and went back to the style used in the original PDF source. Eubulides (talk) 16:21, 11 May 2008 (UTC)

The lines aren't essential. It was more the background color I was after, and the wikitable format does that. If you can just color the background, that would do it. -- Fyslee / talk 16:37, 11 May 2008 (UTC)

Is Lerner a reliable source?

This change cites the Lerner manuscript, which was repudiated by its sponsoring organization and was never published by it. Is Lerner a reliable source? If so, shouldn't we also be citing it with respect to other parts of early chiropractic history? For example, Lerner says the Lillard story is "more than doubtful" and compares the story to the Tales of the Arabian Nights. Eubulides (talk) 01:41, 12 May 2008 (UTC)

Chiropractic sources and historians all treat it as very reliable. -- Fyslee / talk 02:03, 12 May 2008 (UTC)

Here is an interesting article (in the ultra straight WCA's journal) that discusses it:

• Chiropractic's secret history by Simon A. Senzon, MA, DC

-- Fyslee / talk 02:14, 12 May 2008 (UTC)

Thanks, then I propose that in Chiropractic#History, after "D.D. Palmer gave the first spinal adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895, reportedly resulting in a restoration of the man's hearing." we add the following text, citing Lerner:

"The story of Lillard's adjustment is at least partly apocryphal, as Palmer gave spinal adjustments before 1895; it may be that the story was concocted in order to give chiropractic a particular date of invention."

Eubulides (talk) 07:27, 12 May 2008 (UTC)

We have two contradictory statements. Per WP:NPOV, neither should be presented as fact. I see the first is referenced to Palmer's textbook, so the wording might be something like "D.D. Palmer reports having given the first ..." The second might be something like "According to Lerner, the story of Lillard's adjustment is at least partly apocryphal..." ☺ Coppertwig (talk) 10:29, 12 May 2008 (UTC)

Lillard's own daughter also had something to say. You can read it here. -- Fyslee / talk 06:27, 13 May 2008 (UTC)

OK, in the light of the above, how about if we change Chiropractic#History's first two sentences from this:

Chiropractic (also known as Chiropractic Medicine) was founded in 1895 by Canadian-American Daniel David Palmer in Davenport, Iowa, USA. D.D. Palmer gave the first spinal adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895, reportedly resulting in a restoration of the man's hearing.

to this:

Chiropractic (also known as Chiropractic Medicine) was founded in the 1890s by Canadian-American Daniel David Palmer in Davenport, Iowa, USA. Palmer and his son B.J. Palmer later wrote that the elder Palmer gave the first chiropractic adjustment to a deaf man, Harvey Lillard, on September 18, 1895, restoring the man's hearing. Lillard's daughter disputed the account, saying that Palmer had merely slapped Lillard on the back after hearing a joke. Investigator Cyrus Lerner found in 1952 that the Lillard story disagreed with other evidence published about the same time, speculated that B.J. concocted the date of the first adjustment in order to establish priority for chiropractic, and compared the Lillard story to the Tales of the Arabian Nights..)

That's certainly much better than the previous version. While we probably can't outright call the Palmers liars (although they undoubtedly were), this at least reveals that things were not as the profession has generally been taught to believe. -- Fyslee / talk 14:17, 14 May 2008 (UTC)

I have learned a lot here about early chiropractic history. This is a great improvement. QuackGuru 14:27, 14 May 2008 (UTC)

I made this change to improve the section. QuackGuru 15:02, 14 May 2008 (UTC)

Thanks for editing that in, QuackGuru. I would delete the part about the tales of the Arabian nights. It seems unnecessary here. We don't need to repeat every colourful criticism or compliment of chiropractic.☺ Coppertwig (talk) 02:48, 16 May 2008 (UTC)

RfC: Effectiveness of chiropractic care

This is an updated version of Talk:Chiropractic/Archive 18 #RfC: Effectiveness of chiropractic care. It attempts to address some of the comments brought up in that discussion. There seems to be no serious dispute that there is a serious POV problem in the current coverage of effectiveness in Chiropractic, so I won't repeat Talk:Chiropractic/Archive 18 #POV in existing coverage. Again, this is a controversial issue that may require some work to resolve; please bear with the following exposition as it covers many issues. Eubulides (talk) 08:50, 12 May 2008 (UTC)

To help other editors follow this discussion better, please place comments below, after the the proposal.

Criticisms of earlier proposed fix

Earlier I proposed Scientific investigation 2, a draft that relies on recent high-quality scientific sources, along with a proposal to remove the obsolescent material. This draft has been discussed extensively in Talk:Chiropractic/Archive 18 #Comments on Scientific investigation 3, so far with no consensus. To help move matters forward I have drafted a new section below, #Scientific investigation 3, which attempts to respond to some (but not all) the concerns expressed. These concerns (italicized below) included the following:

• Effectiveness of treatments should not be discussed in chiropractic; it should be discussed under each form of treatment. Most of the literature cited in #Scientific investigation 3 focuses on effectiveness of chiropractic treatment, not simply treatment by any practitioner. It is therefore inappropriate to move it to treatment pages per se. The few counterexamples are highly relevant to chiropractic; if there is a specific complaint about any of them, please mention it. To help underscore the relevance I have added a citation to Meeker & Haldeman 2002 about the relationship between chiropractic and research into SMT effectiveness.

• Undue weight given to spinal manipulation. The weight given is appropriate: spinal manipulation is the core treatment modality of chiropractic, and is naturally heavily empahsized in reviews of the effectiveness of chiropractic care.

• Clinical practice guidelines are omitted. They were present in the 1st draft, and were omitted from the 2nd draft in the interest of brevity. I have restored them in the 3rd draft.

• Ernst is fringe. No, he's a mainstream researcher who gets cited a lot.

• More sources are needed. None were suggested. I did turn up some more sources on my own, which are included in #Scientific investigation 3.

(Again, please place further comments below.)

Revised proposal for fix

The revised proposed fix is to replace the sections Chiropractic #The Manga Report through Chiropractic #Scientific investigation with the following text (between the horizontal lines), to keep Chiropractic #Safety unchanged, and to replace the "===Vaccination===" with "==Vaccination==" (as that section has nothing to do with scientific investigation).

(Again, please place further comments below.)

---

Scientific investigation 3

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs pseudoscientific and antiscientific reasoning and makes unsubstantiated claims.

Effectiveness 3

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment. Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective. Chiropractic care, like all medical treatment, benefits from the placebo response. The efficacy and cost-effectiveness of maintenance care in chiropractic is unknown.

Research has focused on spinal manipulation therapy (SMT) rather than specifically on chiropractic SMT, but the distinction is not significant: chiropractors use all forms of SMT, more than 90% of SMT in the U.S. is done by chiropractors, and SMT research is equally of value regardless of practitioner type. There is little consensus as to who should administer the SMT, raising concerns by chiropractors that orthodox medical physicians could "steal" SMT procedures from chiropractors; the focus on SMT has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Many controlled clinical studies of SMT are available, but their results disagree, and they are typically of low quality. It is hard to construct a trustworthy placebo for clinical trials of SMT, as experts often disagree whether a proposed placebo actually has no effect. Although a 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference, a 2008 supportive review found serious flaws in the critical approach, and found that SMT and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments.

Available evidence covers the following conditions:

• Low back pain. Opinions differ on the efficacy of SMT for nonspecific or uncomplicated low back pain. An authoritative 2004 review found that SMT or mobilization is no more or less effective than other interventions. A 2008 review found strong evidence that SMT is similar in effect to medical care with exercise, and moderate evidence that SMT is similar to physical therapy and other forms of conventional care. A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain.

• Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain. An authoritative 2004 review found that SMT/mobilization is effective only when combined with other interventions such as exercise. A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis. A 2007 review found that SMT and mobilization are effective for neck pain. A 2005 review found little investigative research into chiropractic manipulative therapy for acute neck pain.

• Headache. An authoritative 2004 review found that SMT may be effective for migraine and tension headache, and SMT and neck exercises may be effective for cervicogenic headache. A 2006 review found no rigorous evidence supporting SMT or other manual therapies for tension headache. A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.

• Other. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions. Other reviews have found no evidence of benefit for baby colic, bedwetting, fibromyalgia, or menstrual cramps.

---

(End of proposed replacement text.)

(Please place further comments below.)

Comments on Scientific investigation 3

(Please put comments here.)

I was editing this article in February, and have been meaning to return when I have time. I've heard that there are difficult disputes here and thought I might at least see what's happening and maybe even help resolve some disputes, as well as participating in editing. For now, I'm offering my opinion for this RfC.

The proposed text above is, in my opinion, a vast improvement over that section of the current article, in terms of being organized in a logical and relevant way. The current article gives undue prominence to the name of a particular study and to funding issues, which are not of fundamental importance and which will become dated. Focussing on effectiveness for various parts of the body is a relevant way to organize the information. It's readable, and I didn't see any problems with it.

Re "Effectiveness of treatments should not be discussed in chiropractic; it should be discussed under each form of treatment." Different articles can have some overlap of content; see WP:SUMMARY. If any particular section forms too long a stretch of text which overlaps between two articles, one of them can be shortened to a summary, with a {{main}} hatnote directing the reader to a section-link of the other article for more information. I don't think any one of the above short sections about each condition or body part is long enough to merit such summarizing. In my opinion, effectiveness is of fundamental relevance to this subject and belongs in this article (though it can also occur in other articles too).

Re "Undue weight given to spinal manipulation": I agree that spinal manipulation is fundamental to chiropractic; it's hard to imagine how it could be given undue weight in this article. I'd have to see specific arguments about what else needs to be mentioned. ☺ Coppertwig (talk) 10:20, 12 May 2008 (UTC)

Thank you Coppertwig, for coming back to weigh in on this edit! Please stick around as long as you can. I agree with your points. Spinal manipulation is fundamental and needs to be here in this article. Another objection often made is that studies of non-chiropractic manipulation are not relevant in considering effectiveness of SMT. Even Dr. Meeker, a prominent chiropractic researcher says that "research on spinal manipulation, like that of any other treatment method is equally of value regardless of the practitioner"(from #111, above)--—CynRN ^(Talk) 16:24, 12 May 2008 (UTC)

While I do feel that this version is better than the previous versions, I am unsure about two things:

1. That even though one researcher is saying it is okay to correlate general SMT studies with the effectiveness of chiropractic, our following this researcher's advice still may cause a WP:SYN violation. Even though we are spelling it out for the reader that these studies are about SMT and not chiropractic specifically, we are also implying (or rather now directly stating) that the conclusions of these general SMT studies can be applied to the effectiveness of chiropractic.
2. DigitalC, CorticoSpinal, and several others have raised objections that Chiropractic is an occupation which employs many services and modalities and not any one specific modality. As such, the inclusion of the above material would be like the inclusion of an effectiveness section at the Dentistry article based on the effectiveness of Fluoride as administered by dentists, hygienists, the gov't via tap water, etc.

Levine2112 ^discuss 17:26, 12 May 2008 (UTC)

I hear the argument (re #2), but the fact is that SMT is the centerpiece of chiropractic. Is there much controversy about the effectiveness of a dentist removing caries from teeth? Is there a long, involved holistic philosophy connected with dentistry? Apples and oranges. There is controversy surrounding chiropractic, in part because of the whole subluxation paradigm. As long as the section explains again that chiropractors do a range of treatments besides SMT, the effectiveness of SMT really belongs here.There are plenty of studies, and reviews of same, regarding the effectiveness of SMT.--—CynRN ^(Talk) 18:37, 12 May 2008 (UTC)

Actually, yes there is much controversy surrounding dental caries: Dental amalgam controversy. And holistic dentistry has been around for at least 30 years; specifically founded by the anti-mercury/amalgam movement. So you see, it's not apples to oranges after all. -- Levine2112 ^discuss 18:51, 12 May 2008 (UTC)

Of course, I figured you'd bring that up! How many holistic dentists are there as a percentage of all, vs 'holistic chiropractors'? Are there any non-holistic chiropractors? What is non-controversial, I would think, is 'treatment of dental decay'. Whether we choose composite fillings or amalgam is a different issue.--—CynRN ^(Talk) 23:00, 12 May 2008 (UTC)

Holistic dentistry is quite different from Dentistry, just as Chiropractic is quite different from mainstream Medicine. If there were an article on Holistic dentistry (there isn't, yet), I'd expect it to cover effectiveness in some detail, as that's an important part of the controversy about holistic dentistry. Eubulides (talk) 07:35, 13 May 2008 (UTC)

"There are plenty of studies, and reviews of same, regarding the effectiveness of SMT". Agreed. There are pleny of sources discussing the effectiveness of SMT. However, SMT is not chiropractic, and the effectiveness of SMT belongs over at the SMT article. DigitalC (talk) 00:03, 13 May 2008 (UTC)

The cited sources in #Scientific investigation 3 are by and large not talking just about SMT. They are mostly talking about chiropractic care. Is there any particular source being objected to here? Eubulides (talk) 07:35, 13 May 2008 (UTC)

• Re Levine2112's #1, it's not just "one researcher"; Meeker & Haldeman are two of the very top chiropractic researchers. For example, Haldeman is the editor in chief of PPC, the leading chiropractic textbook. These reliable sources say there's no significant distinction between chiropractic and non-chiropractic SMT. There doesn't seem to be any real controversy over this issue among reliable sources. It is not WP:SYN to report what these sources say. That being said, if there is a specific source being objected to on the grounds that it talks about SMT and not chiropractic SMT, which source is it and why? If this is just a matter of a few sources and how they're characterized perhaps we can come up with compromise wording that will address this concern.
• Re Levine2112's #2:

• Chiropractic is not just a profession: it is also a philosophy, and a way of doing treatment.
• As far as Wikipedia goes, the Chiropractic article is much closer to the Traditional Chinese medicine article than it is to the Dentistry article. Chiropractic and Traditional Chinese medicine are both somewhat out of (but also somewhat in) the mainstream, and there are serious questions about effectiveness of the main forms of treatment for both Chiropractic and Traditional Chinese medicine. Criticisms of dental care (as in the amalgam controversy) are not in the same ballpark: they do not seriously question the effectiveness of core dental care methods.
• There is ample precedent in Wikipedia for covering effectiveness and safety of treatment for professions that are not entirely mainstream. This includes not just Chiropractic and Traditional Chinese medicine, but others such as Ayurveda, Naprapathy, and Osteopathy.
• Chiropractic #The Manga Report and Chiropractic #Worker's compensation studies contain extensive discussion of effectiveness and cost-effectiveness of chiropractic care, and this coverage has been in Chiropractic for quite some time. It seems very odd to raise the objection "chiropractic is a profession" now. The proposal is not to add discussion of effectiveness; it is to replace the existing obsolete and biased coverage.

More generally, the question is not whether #Scientific investigation 3 is perfect; it's not. The question is whether it's better than what's in Chiropractic now. It is. It's way better. It fixes serious POV problems, among other things. We should not let the relatively minor problems of the current proposal blind us to the fact that it's a real improvement and it therefore should go in. We can always improve it later. Eubulides (talk) 07:35, 13 May 2008 (UTC)

Well, I guess that's your opinion - that chiropractic is closer to Traditional Chinese medicine than it is to Dentistry. I don't share that opinion; not do I think that either of our personal opinions should dictate what kind of information we include in this article. -- Levine2112 ^discuss 16:15, 13 May 2008 (UTC)

• All I meant was that chiropractic is neither fully mainstream (like dentistry) nor fully fringe science (like homeopathy). It has elements of both, as does traditional Chinese medicine. Even a cursory treatment of chiropractic needs to address the issue of whether it is effective, because this is a serious question as to commonly-practiced parts of chiropractic care. In this sense, chiropractic is more like traditional Chinese medicine than it is like dentistry.
• One doesn't have to take my word for this. Just type "fringe chiropractic" into Google Scholar and you'll find lots of papers about chiropractic vis-a-vis fringe medicine. Type "fringe dentistry" and you'll find lots of papers about fringe benefits and fringe patterns, and precious little about fringe medicine. Or, please see Keating 1997, where it's explicitly stated that chiropractic uses scientific, antiscientific, and pseudoscientific rhetoric. One doesn't find similar articles about dentistry.

Eubulides (talk) 19:59, 13 May 2008 (UTC)

Again, I find that this section fails to mention the many other treatments provided by Chiropractors, and the efficacy of such other treatments. There is no mention of Ultrasound, Laser, IFC, Orthotics, Prescribed Exercises, or even soft tissue therapy.DigitalC (talk) 23:59, 12 May 2008 (UTC)

Actually, #Effectiveness 3 mentions laser, and supervised / customized exercise. It also mentions many other non-SMT treatments provided by chiropractors, including mobilization, assurance and advice to stay active, educational videos, acupuncture, and the entire clinical encounter of chiropractic care. It does not cover the other treatments you mention (ultrasound, IFC, orthotics, soft tissue therapy) because as far as I know the cited sources don't say anything definitive about those forms of treatment. If someone can dig up reliable sources for those treatment forms, that would be nice; in the meantime, the #Effectiveness 3 is much better than the effectiveness material that is in Chiropractic now. Eubulides (talk) 07:35, 13 May 2008 (UTC)

We should certainly think carefully about the WP:SYN issue raised by Levine2112. Note that the Meeker et al. (2007) study uses the word "chiropractic" as well as the phrase "spinal manipulation", so I see no SYN problem in citing it. For the other studies, I think it would be an improvement if we simply cited the studies, implying but not stating outright that SMT studies shed light on chiropractic effectiveness. I would delete the sentence "Research has focused on spinal manipulation therapy (SMT) rather than specifically on chiropractic SMT,[18] but the distinction is not significant: chiropractors use all forms of SMT, more than 90% of SMT in the U.S. is done by chiropractors, and SMT research is equally of value regardless of practitioner type." I think this is good information for us to use here on the talk page while deciding whether the SMT studies can be used, but that including it in the article perhaps contributes to a SYN violation. If that sentence is deleted, the rest of the paragraph may need to be reorganized to flow smoothly.

Thanks, Eubulides, by the way, for your patience and diligence in coming up with yet another draft version.☺ Coppertwig (talk) 09:29, 13 May 2008 (UTC)

You're welcome. I removed that sentence from the draft in #Scientific investigation 3C. I agree that it's better to leave it out in future drafts as well; the citation was there only because of Levine2112's continuing concerns about generic SMT research versus research specifically on chiropractic care. Eubulides (talk) 20:55, 13 May 2008 (UTC)

I think that sentence was added to avoid any synthesis and to make it clearer to the reader. QuackGuru 09:36, 13 May 2008 (UTC)

I think that sentence is an attempt to justify the synthesis. Essentially, it may be the opinion of one researcheer (or one team of two researchers), but we can't then go ahead and apply it to the SMT research across the board. That is where the WP:SYN violation happens. That said, I maintain that we should remove all studies which are about SMT in general and do not make distinct conclusions about chiropractic specifically. These general SMT studies would be perfect for the spinal manipulation article. -- Levine2112 ^discuss 16:09, 13 May 2008 (UTC)

Spinal manipulation is inherent to chiropractic as its most commonly performed modality and we should not second-geuss the reviewers. QuackGuru 18:06, 13 May 2008 (UTC)

(outdent) I strongly disagree that generic SMT research should be excluded from Chiropractic. It's standard practice in high-quality chiropractic sources to include such research, we have a high-quality chiropractic source saying that there's no significant difference between chiropractic and non-chiropractic research data in SMT, and we have no high-quality sources disagreeing. However, to help move the discussion ahead I propose a new version #Scientific investigation 3C below, which excludes generic SMT research. That is, all the sources #Scientific investigation 3C talk explicitly about chiropractic care, not just about SMT (or mobilization or whatever) in general. Eubulides (talk) 19:59, 13 May 2008 (UTC)

Researchers commonly apply regular SMT research and sources indicate there is no sigificant difference among the high quality studies. This version is a bit short and could use a slight expansion. QuackGuru 11:50, 14 May 2008 (UTC)

Here is what the scientific investigation (now renamed scientific research) section of the article was at the beginning of year. The current version includes newer peer-reviewed references and is very concise. QuackGuru 13:11, 14 May 2008 (UTC)

Proposal for fix 3C

I view this "3C" draft as being far inferior to #Scientific investigation 3 due to 3C's weaker sourcing, but 3C is still much better than what's in Chiropractic now. I offer 3C as an attempt to fix Chiropractic's obvious datedness and POV problems now, and to continue the discussion here about what to do about the generic SMT studies.

The revised proposed fix is to replace the sections Chiropractic #The Manga Report through Chiropractic #Scientific investigation with the following text (between the horizontal lines), to keep Chiropractic #Safety unchanged, and to replace the "===Vaccination===" with "==Vaccination==" (as that section has nothing to do with scientific investigation).

(Please place further comments below.) Eubulides (talk) 19:59, 13 May 2008 (UTC)

Scientific investigation 3C

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs pseudoscientific and antiscientific reasoning and makes unsubstantiated claims.

Effectiveness 3C

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment. Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective. Chiropractic care, like all medical treatment, benefits from the placebo response. Many studies of chiropractic care are available, but they are typically of low quality. The efficacy and cost-effectiveness of maintenance care in chiropractic is unknown.

Research has focused on spinal manipulation therapy (SMT) in general, rather than specifically on chiropractic SMT. There is little consensus as to who should administer the SMT, raising concerns by chiropractors that orthodox medical physicians could "steal" SMT procedures from chiropractors; the focus on SMT has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. A 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition.

Available evidence covers the following conditions:

• Low back pain. A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain. A 2008 critical review found that chiropractic SMT is possibly effective for back pain, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference.

• Other musculoskeletal conditions. A 2005 review found little investigative research into chiropractic manipulative therapy for acute neck pain. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine).

• Nonmusculoskeletal conditions. A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine. A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions. Other reviews have found no evidence of benefit for baby colic, bedwetting, or fibromyalgia.

---

(End of proposed replacement text.)

(Please place further comments below.) Eubulides (talk) 19:59, 13 May 2008 (UTC)

Comments on Scientific investigation 3C

(Please put comments here.)

I agree that if the premier chiropractic researchers use generic SMT studies in their reviews, we should be able to use them too. However, Sci Inv 3C is far better than what's in the article now, so let's replace Manga and Worker's Comp with it.--—CynRN ^(Talk) 04:41, 14 May 2008 (UTC)

This extremely short version runs afowl with NPOV. More importantly, the reader deserves to read a comprehensive version. A comprehensive version is more imformative for the reader. This lack of information version is not it. It is way to short and is below Wikipedia's standard. QuackGuru 11:45, 14 May 2008 (UTC)

Where does it run afowl with NPOV?DigitalC (talk) 23:43, 14 May 2008 (UTC)

I am happy with 3C.DigitalC (talk) 06:08, 15 May 2008 (UTC)

I'm guessing maybe QuackGuru means that by being too short, it's not giving due weight to effectiveness of SMT to reflect how much that's discussed in the sources. I apologize in advance if I got that wrong, QuackGuru. ☺ Coppertwig (talk) 02:57, 16 May 2008 (UTC)

I think this version gives far too much wait to this opinion: "A 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition." This comes from a major chiropractic critic often accused of bias and not necessarily a neutral researcher. As such it should be balanced or removed. That said, I am all for keeping this section brief if we have it at all. This is an article about Chiropractic and not about SMT. All of the details about every study ever conducted about SMT should be saved for spinal manipulation. -- Levine2112 ^discuss 03:10, 16 May 2008 (UTC)

A major chiropractic critic often accused of bias and not necessarily a neutral researcher? Please provide your evidence. Ernst is peer-reviewed and meets the inclusion criteria for this article. We should edit based on NPOV and exclude any personal opinion. Thus, we can include Ernst. QuackGuru 03:20, 16 May 2008 (UTC)

Yes, but this version gives his opinion far too much prominence. -- Levine2112 ^discuss 03:26, 16 May 2008 (UTC)

That's your opinion. Please provide evidence of any bias by Ernst. QuackGuru 03:33, 16 May 2008 (UTC)

Not even mainstream medicine listens to Ernst re: his views on the safety and effectiveness of spinal manipulation for back pain. His view is fringe. It can be proved. To repeat: Ernsts (MD) views on spinal manipulation is the FRINGE viewpoint within respect to mainstream medicine. It will be weighed as such. He is not an expert on SMT nor chiropractic, but is simply a vocal critic who is coming off as increasingly righteous and pig-headed despite the mounting evidence which negates his POV. CorticoSpinal (talk) 05:33, 16 May 2008 (UTC)

Ernst is not fringe. His works are often cited by his peers. I just now visited Google Scholar and typed the query "chiropractic Ernst". This returned about 2390 citations. In the first page, one source by Ernst (the 2001 desktop guide) was cited 280 times. Another by Ernst (the 2000 BBC survey) was cited 170 times. All of these numbers beat the query "chiropractic Haldeman" (1230 citations, top two sources on the 1st page cited 107 and 97 times). By this measure, or any other reasonably neutral measure, Ernst is one of the top current sources in the area. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Citations does not necessarily translate into positive remarks on his work. It has also generated significant controversy and those same papers would have to cite his work in order to talk about it. Since it is the most vocal anti-SMT voice, both chiropractic researchers and healthcare researchers reference it as the most extreme, which I would assume would be considered the "fringe" of science.. but you know what assuming does. But, regardless, we can't just assume that citations translates into quality or mainstream. -- Dēmatt (chat) 11:51, 19 May 2008 (UTC)

I tested the theory that citations to Ernst are to cover the controversy by taking the most-cited work of Ernst mentioned above (the desktop guide), going to Google Scholar, finding which works cite it, looking at the first page of results, and reading each of the papers that cite it. I skipped the papers cowritten by Ernst himself for obvious reasons. None of the citations mentioned any controversy; they all simply cited Ernst as an authority. The papers I examined were Marty 2002 {{doi:10.1089/107555302317371523}}, Mason et al. 2002 (PMID 12376448), Bair et al. 2002 (PMID 12406817), Cohen & Eisenberg 2002 (PMID 11955028), and Cherkin et al. 2003 (PMID 12779300). These papers are all highly-cited (all have at least 45 citations). Of course this is just a spot-check, but it suggests that Ernst is not considered to be fringe by mainstream researchers. Eubulides (talk) 20:47, 19 May 2008 (UTC)

Evidence of bias by Ernst:

• Evans, W. (2003). "Chiropractic Care: Attempting A Risk-benefit Analysis". American Journal of Public Health. 93 (4): 522. Retrieved 2008-05-20.
• Bronfort, G. (2006). "Review conclusions by Ernst and Canter regarding spinal manipulation refuted". Chiropractic & Osteopathy. 14 (1): 14. doi:10.1186/1746-1340-14-14. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
• Hurwitz, E.L. (2002). "Chiropractic care: a flawed risk-benefit analysis?". Am J Public Health. 92 (10): 1603–4. Retrieved 2008-05-20. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Morley, J. (2001). "Ernst Fails to Address Key Charges". The Journal of Alternative & Complementary Medicine. 7 (2): 127–128. doi:10.1089/107555301750164145. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• "Profession Responds Quickly to Negative U.K. Study on Spinal Manipulation". Retrieved 2008-05-20.
• SPINAL MANIPULATION DOES WORK: THE FACTS FROM THE BCA
• A balanced review of evidence?

DigitalC (talk) 06:40, 20 May 2008 (UTC)

Yes, Ernst is strongly opposed by many in the chiropractic profession, and those citations illustrate this opposition. However, this does not undercut the claim that citations to Ernst by high-quality mainstream publications are, by and large, positive. Eubulides (talk) 07:20, 20 May 2008 (UTC)

Being opposed by many in the chiropractic profession doesn't have anything to do with research. Research doesn't oppose anything, it is what it is; it either supports or it doesn't. DigitalC's information does show that at least some of those 2390 citations are not positive, which, of course, was my point above. I would suggest that no-one has disagreed with Haldeman's research because he is a neurologist/chiropractor. Maybe that is why he has only half the citations :-) Anyway, I think this shows that Ernst is Ernst and we use his information just as we would Haldemans's or anyone else's. -- Dēmatt (chat) 13:23, 20 May 2008 (UTC)

Obviously some of the citations are negative. But my spot-check from Google Scholar suggests that most of them are positive. (It doesn't prove this, of course; it was only a spot-check.) And it is not true that nobody has disagreed with Haldeman; I can easily cite sources strongly criticizing Haldeman's work. I agree that we should cite Haldeman as well as Ernst; both are leading and reliable sources. Eubulides (talk) 22:16, 20 May 2008 (UTC)

A mischaracterization of what was posted above. In some of the papers there is no way to know what degrees/professions the authors have. For example, in the Bronfort et al. paper, we get these associated groups, but no degrees. (Chalmers Research Group, Evidence-based Practice Center, Departments of Pediatrics, Epidemiology and Community Medicine, University of Ottawa, 401 Smyth, Ottawa ON, K1H8L1, Canada; 4Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, The Netherlands; 5Texas Back Institute, 6300 W. Parker Road, Plano Texas 75093, USA; 6Department of General Practice and Nursing Home Medicine, LUMC Medical Centre, Leiden, The Netherlands). In addition, one of the Authors, Assendelft, is a prior co-author with Ernst, and an MD, NOT a Chiropractor. He's also writes cochrane reviews, so he probably knows how to assess evidence.DigitalC (talk) 07:56, 20 May 2008 (UTC)

It is not a mischaracterization. The Bronfort et al. paper has 10 authors, of which 5 have DCs (including Bronfort, the lead author) and 1 (Assendelft) has an MD. So it's strongly dominated by chiropractors. The other sources are even more strongly dominated by chiropractors. Ernst has cowritten more than a dozen Cochrane reviews so I daresay he knows how to assess evidence as well. What we have here is a difference of opinion among experts, a difference that should be reported fairly and neutrally; Ernst is not at all on the fringe here. Eubulides (talk) 09:17, 20 May 2008 (UTC)

It IS a misrepresentation of the sources to state as a summy that "Ernst is strongly opposed by many in the chiropractic profession", when the sources are not solely Chiropractors.DigitalC (talk) 11:20, 20 May 2008 (UTC)

It is not a misrepresentation. The sources given were:

• A letter by a DC (Evans).
• A paper with 5 DC and 1 MD coauthors, the lead being a DC (Bronfort et al.; 4 coauthors were neither DCs nor MDs)
• A letter signed by 3 DCs and zero MDs (Hurwitz et al.).
• A letter signed by 2 DCs and zero MDs (Morley et al.; 1 coauthor was neither DC nor MD).
• An article about chiropractors lobbying against Ernst (Dynamic Chiropractic).
• A position paper by the British Chiropractic Association.
• A letter signed by 2 DCs and zero MDs (Breen et al.; 3 coauthors were neither DC nor MD).

It's true that there are some non-chiropractors there, but these sources are heavily dominated by chiropractors. They may represent the mainstream of opinion within chiropractic, but they do not represent mainstream opinion generally. They do not at all demonstrate that Ernst is a fringe researcher. Eubulides (talk) 22:16, 20 May 2008 (UTC)

(Undent) Here is the rift here. If we were to accept that chiropractic researchers are biased, then that acknowledges that medical research is biased. I personally think they are equally biased, but that is just my experience. Therefore, we have two choices, use them both as equal, or consider them POV and attribute the findings to the different sources. One method requires a littel more writing, but either can be productive and get toward the end product. -- Dēmatt (chat) 13:01, 20 May 2008 (UTC)

Once again Dematt comes up with the Solomonic solution - inclusion of all POV using good sources. I also agree with most of his comments. We are all biased, controversies occur, and those biases and controversies need to be documented here. We just need to do it properly. -- Fyslee / talk 14:38, 20 May 2008 (UTC)

That is the goal of #Scientific investigation 3. It includes both supportive and critical sources and cites them appropriately, with due weight given to all sides. Eubulides (talk) 22:16, 20 May 2008 (UTC)

Improved version RfC

Template:RFCsci It is my opinion that this change was for the better. Please give your opinion on the matter. ScienceApologist (talk) 15:01, 14 May 2008 (UTC)

The majority of these edits were contentious, still being discussed on this page, and still lack consensus. Accordingly, I have reverted. There were some decent housekeeping edits in the mix, but the bad outweighed the good in my opinion. -- Levine2112 ^discuss 17:45, 14 May 2008 (UTC)

I would not have made these edits at this time. That being said, the discussion in #Comments on Scientific investigation 3 seems to have petered out, with questions remaining for the dissenting editors but no replies from them recently. The edits that were already discussed are a big improvement over what was in Chiropractic. Surely they can be further improved, and we can discuss that here. Many edits were not previously discussed, though, and they are more problematic; please see #Several important changes were never discussed below for more about them. Eubulides (talk) 23:44, 14 May 2008 (UTC)

It has been discussed on this talk page previously that any contentious edits should be discussed on the page before being implented. In addition, rather than grouping large housekeeping edits and reference formatting with contentious edits, it is better to make a larger number of smaller changes.DigitalC (talk) 23:53, 14 May 2008 (UTC)

We are not bound by what has happened on this page in the past (see e.g. WP:BOLD, WP:IAR). The question is whether the edits were good. There is consensus that they are. ScienceApologist (talk) 19:34, 19 May 2008 (UTC)

• It is true that we are not bound; still, standard practice, as noted at the top of this talk page, is to discuss controversial changes before making them, which was (alas) not done here.
• Even if there was consensus that the big edit improved the article overall, that would not imply that consensus for each part of the big edit. None of the commenters backing the consensus have commented on detailed criticisms of the previously-undiscussed parts of the big edit. (These criticisms were not available to the commenters, precisely because the big edit was sprung on the regular editors without discussion.) So there is no real evidence for consensus for the previously-undiscussed parts of the big edit that have been criticized after the big edit was made.

Eubulides (talk) 20:47, 19 May 2008 (UTC)

• Agree with ScienceApologist: Surveying these changes, they appear to be quite reasonable and backed by reliable sources. I agree with SA that these changes constitute an excellent start at reform of this page, which is sorely needed to create something encyclopedic that conforms to WP:NPOV.--Filll (talk) 18:04, 14 May 2008 (UTC)

• It looks good, adds balance, especially to the section on the Manga report. The additions appear to be well-supported. Guettarda (talk) 18:26, 14 May 2008 (UTC)

• I think it's better, more NPOV. I'm not sure that adding back practice styles is worthwhile (this article is way long already!) and I believe it's hard to pigeon-hole any individual chiropractor, but I approve of most changes, esp. re. Manga and worker's comp studies.--—CynRN ^(Talk) 19:07, 14 May 2008 (UTC)

• I will take a look at the edits one by one and add the ones that haven't been disputed; I'll then come back here and summarize what's remaining. Eubulides (talk) 19:32, 14 May 2008 (UTC)

• After I wrote the above comment, someone else added all the edits. So now I'm looking at them one by one and plan to take out the ones with the most problems. (If someone else doesn't revert again first.…). So far I've found mostly just citation problems, but I haven't got to the controversial stuff yet. Eubulides (talk) 20:13, 14 May 2008 (UTC)

• I found a serious problem with the edits: many of them have never been discussed on this page, even though they are potentially controversial. For now I have reverted them; please see [[#[edit] Several important changes were never discussed]] below. Eubulides (talk) 23:44, 14 May 2008 (UTC)

• I agree that the changes meet NPOV, are well sourced and helps the article to be able to go forward. My comment is from an outside opinion who watches the article and the talk page. --CrohnieGal^Talk 19:39, 14 May 2008 (UTC)

• There is growing consensus for the recent changes that are being discussed in this RFC. However, a couple of edits deleted some information that was part of the recent changes discussed in this RFC. Any minor tweaks can be made in mainspace. QuackGuru 01:07, 15 May 2008 (UTC)

• This severely controversial change went against broad consensus. QuackGuru 01:12, 15 May 2008 (UTC)

• I've restored the content under discussion. It appears fairly well-sourced. It deserves to be discussed rather than removed on a whim without properly addressing the quality of the references and their use. Let's all follow WP:TALK and WP:CON here. Thanks. --Ronz (talk) 01:42, 15 May 2008 (UTC)

There are serious problems with many parts of the edit. This should have been discussed before insertion, as per consensus above that any contentious edit would be previewed on the talk page before being taken to mainspace.DigitalC (talk) 04:16, 15 May 2008 (UTC)

I do not see any serious problems. I see a very thoughtfully written improved version. My recent edits were discussed in this RFC. Please respect the external advise. QuackGuru 04:38, 15 May 2008 (UTC)

There is broad consensus among external observers in this new RFC discussing the recent changes I made. These edits went against the advise from external third-party input of this RFC. QuackGuru 04:38, 15 May 2008 (UTC)

That edit had two parts. First, it installed the changes proposed in #Scientific investigation 3 and discussed extensively earlier. Second, as mentioned below, that edit installed several changes that were never discussed before installation. None of the external observers have commented specifically on the second (previously-undiscussed) class of changes. It is not clear that they approve of the previously-undiscussed changes. It is not even clear that the observers even noticed the previously-undiscussed changes. I didn't notice them without doing a line-by-line analysis of the edit, which took quite some time. Eubulides (talk) 06:09, 15 May 2008 (UTC)

The external observers are commenting at this RFC about this recent change. QuackGuru 06:25, 15 May 2008 (UTC)

The discussion here has been fruitful in this RFC for this recent change but this edit went against established third-party consensus. QuackGuru 06:39, 15 May 2008 (UTC)

I will follow up at #Several important changes were never discussed below. Eubulides (talk) 06:48, 15 May 2008 (UTC)

I saw this dispute while reading Vassayana's talk page. I don't know the subject, but I can see two things: first, probably many of the changes are good. Second, that while bold edits are good, they were subsequently edit warred in, [35](these for example) which is against the processes of WP. Therefore, there is a need for obtaining consensus on the changes before they are considered more than suggestions. ——Martin^phi ☎ Ψ Φ—— 02:07, 16 May 2008 (UTC)

There was growing consensus for the recent changes but it appeared a certain editor attempted to flout consensus by edit warring.[36][37][38][39] QuackGuru 22:19, 19 May 2008 (UTC)

Martin, do you believe that the agreement seen by so many outside reviewers of the RfC that the content is good is not enough to establish that the content should be added? ScienceApologist (talk) 19:34, 19 May 2008 (UTC)

• Concerned Comment The biggest problem I have with this version is that it is being billed as a consensus from the community, but they have not shared in the conversation or the work that has been put in to improve upon the very version they are looking at. There is more work to do, but if you call this a consensus version, it will be virtually impossible to make any more edits - even minor ones - as a particularly eccentric editor will likely take it as his duty to defend the "consensus view from outside editors". So while I can work with anything, nobody can work with the constant reversions to "the RfC version that many outside members have agreed to". So, unless you really like this version, I would rather you suggest that we continue to work together in the manner that WP was meant to work - where anyone can edit anytime and collaboration is the preferred method to accomplish consensus. Let the ones that are working this article decide what the 'best version' is. -- Dēmatt (chat) 00:58, 20 May 2008 (UTC)

Objective straights and reforms

Part of the change added material about objective straight and reform chiropractors, two groups which it's not clear still exist (we don't have good evidence that they exist, and we have weak evidence that they don't). As I recall this was last discussed at the end of the long section Talk:Chiropractic/Archive 18 #Problems with current Effectiveness draft, without a consensus about including the material in Chiropractic#Schools of thought and practice styles. I suggest moving this material to Chiropractic history or perhaps Chiropractic #History; I don't think it'd be controversial there. I removed this material for now, pending further discussion. Eubulides (talk) 20:54, 14 May 2008 (UTC)

I don't think the article needs the material about reform and objective straights, maybe not even in history. I don't think it's very notable.--—CynRN ^(Talk) 21:20, 14 May 2008 (UTC)

I'm not sure that removing the material was altogether appropriate. I agree that the issue may be one of historical relevance rather than modern day relevance, but I found the material to be informative, interesting, and well-sourced. ScienceApologist (talk) 22:09, 14 May 2008 (UTC)

I don't feel strongly either way. The subject of the reform group especially got discussed ad nauseum on the talk pages a few months ago with no real consensus. History would be the place if it is to be included.--—CynRN ^(Talk) 22:16, 14 May 2008 (UTC)

OK, for now I moved it to Chiropractic #History. Eubulides (talk) 22:25, 14 May 2008 (UTC)

I prefer the information under Internal conflicts be put at the end of the Schools of thought and practice styles section. QuackGuru 01:07, 15 May 2008 (UTC)

The internal conflicts section is relevant to the schools of thought and practice styles section. The internal conflicts has discussion about the varying thoughts, practices, and beliefs. QuackGuru 08:12, 15 May 2008 (UTC)

Sure, but almost everything in Chiropractic #History is relevant to some other section, and could be moved there. The point is that Chiropractic, by and large, is a discussion of chiropractic as it is today. Stuff that's no longer relevant should be put in Chiropractic #History to avoid cluttering up the rest of the sections with material that used to be true but is no longer true. That's how other historical material is treated, and this particular historical material should be no exception.

Unless something has changed since previous consensus existed that there was not sources to believe these groups still exist, they should ONLY be placed in the history section. I for one believe that reform chiropractors DO exist, they just don't use the name "reform chiropractors" - but alas, without the name, it is hard to find sources that back that up. In that sense, I guess they are just at the end of the ideological spectrum of mixers.DigitalC (talk) 00:21, 16 May 2008 (UTC)

Effectiveness and Cost-benefit sections

Both of these section were added without a consensus. They are still a lot of discussion about the wording and even about whether or not to add these sections at all. To me, this (and the addition of the Objective straight and Reform) were the most egregious of the mass edits and most in need of being removed. -- Levine2112 ^discuss 21:42, 14 May 2008 (UTC)

There's an RfC currently in the works. Most of the people commenting seem to think that the edits including these bits were good. You are free to explain exactly what your objections are, but I don't think removal at this time is appropriate. ScienceApologist (talk) 22:10, 14 May 2008 (UTC)

The RfC was about effectiveness, not about cost-benefit. The cost-benefit section was added without any discussion, which is not a good idea for a controversial article like this. Also, the effectiveness section that was added was not the effectiveness section that was proposed. For now, I reverted to what was proposed and copied the undiscussed stuff to the next subsection. Eubulides (talk) 23:44, 14 May 2008 (UTC)

The new RFC was linked to the recent edits. I see growing consensus to include the information from the comments in the new RFC. QuackGuru 01:07, 15 May 2008 (UTC)

Calling a consensus again when there is no such consensus?DigitalC (talk) 04:18, 15 May 2008 (UTC)

There is broad consensus among external observers in the new RFC which is to be respected. QuackGuru 04:26, 15 May 2008 (UTC)

Again, I disagree that the external observers have a consensus about (or even noticed) the previously-undiscussed changes in that edit. Eubulides (talk) 06:09, 15 May 2008 (UTC)

Several important changes were never discussed

The edit contains several important changes that were never discussed on the talk page. Some of them are quite likely controversial. Please discuss changes like these before putting them in. For now I removed the undiscussed changes and list them below for further comment. Eubulides (talk) 23:33, 14 May 2008 (UTC)

• The following text was added to the discussion of the British Medical Association:

'In 1997, the BMA has identified chiropractic health care that can be regarded as "discrete clinical disciplines" because it has "established foundations of training and have the potential for greatest use alongside orthodox medical care."'

• The version of Scientific investigation that was installed had serious discrepancies from what was proposed in #Scientific investigation 3. It appears to be some mixture of #Scientific investigation 3 and the older Talk:Chiropractic/Archive 18 #Scientific investigation 2. For now, I have changed it to the #Scientific investigation 3, as that seemed to have more consensus. Further edits will no doubt be needed, but this sort of thing should be discussed first.

• The new Cost-benefit section was never discussed. I enclose it below, for further discussion. Please put comments in #Comments on Cost-benefit 1 below.

Eubulides (talk) 23:33, 14 May 2008 (UTC)

The RFC was about all of my recent edits. QuackGuru 01:07, 15 May 2008 (UTC)

The external observers commented about the overall edit, most of which had been discussed earlier. There's no evidence that the observers noticed, much less approved of, the changes that were slipped into that edit without any previous discussion. The only comments they made were about the changes that had been discussed earlier. It is contrary to common practice on this page to install major, potentially-controversial changes without any discussion on the talk page. Please discuss these changes in the relevant sections of this talk page, now that the sections have been created. Eubulides (talk) 06:48, 15 May 2008 (UTC)

The external observers were commenting on this recent change. We have discussion from third-party input. Uninvolved Wikipedians did discuss my recent change in the new RFC. QuackGuru 07:08, 15 May 2008 (UTC)

Most of what you are calling "my recent change" consisted of material that had been previously discussed. The uninvolved Wikipedians commented on the entire edit, and could easily have been fooled (by the way earlier discussion occurred) into thinking that the edit was installing what had been discussed. None of the comments by the uninvolved Wikipedians indicate that they read, understood, or agreed with the not-previously-discussed part of the change. It is poor practice to take a proposed edit which has had a lot of discussion, to make unannounced and important changes to it, and to install the changed edit without bothering to notify people that the edit involves undiscussed changes. I cannot emphasize this enough. Major changes need to be discussed first, before installing them; that is the standard procedure on this page, and it's standard procedure for good reason. Eubulides (talk) 09:15, 15 May 2008 (UTC)

There is absolutely NO indication that any of the RfC respondents were fooled. This is pure obstructionism. I will assume good faith and simply ask you to abide by the new consensus that the additions are good and needed in the article. There is no policy or guideline that says someone has to discuss first. One can discuss after the changes are made. That is being done here. The current consensus is to keep the changes. Please also stop making up rules for editing. Your cooperation is appreciated. Thanks. ScienceApologist (talk) 14:39, 15 May 2008 (UTC)

• There is no evidence that the RfC respondents read or understood the not-previously-discussed changes. None of the RfC respondents have responded to the substance of the subsequent criticism of the not-previously-discussed changes; this appears in many sections on the talk page, including #Comments on Cost-benefit 1, #Sorry to stop by in the middle of a POV war, and #Objective straights and reforms.
• So it is not true that "the current consensus is to keep the changes"; there may have been a consensus at the point the previously-undiscussed changes were made, but now that problems have been pointed out with those changes, the consensus, if there was one, is no longer present.
• Your revert to an old state ignored discussion that occurred after the "new consensus" (see, for example, #Sorry to stop by in the middle of a POV war). This discussion resulted in several improvements in wording in citation to the material, improvements that have not been disputed, and thus your revert lost this useful information. Please do not ignore later discussion, and please do not blindly revert and inadvertently remove later improvements.

Eubulides (talk) 16:14, 15 May 2008 (UTC)

• One other thing: I am not "making up rules for editing". The top of this talk page says "This is a controversial topic that may be under dispute. Please read this page and discuss substantial changes here before making them." This is a good rule, and should in general be followed. It was not followed for the previously-undiscussed changes. It is bad procedure to install changes into a controversial article without discussing them first. Eubulides (talk) 16:17, 15 May 2008 (UTC)

One thing is for sure, there is clearly no consensus to add these edits. It is truly a mystery why these editors are claiming that there is a consensus when so many editors disagree with these edits. -- Levine2112 ^discuss 19:32, 15 May 2008 (UTC)

Consensus is established above. ScienceApologist (talk) 17:11, 18 May 2008 (UTC)

I don't think so, SA. The question of validity still has not been addressed; i.e. why are Eubulides et QuackGuru trying to push an WP:SYN of SMT and pass it off as effectiveness of chiropractic. What is the effectiveness of medicine, dentistry and maybe more appropriately, physical therapy? If you can provide a sound rationale that would be helpful. CorticoSpinal (talk) 19:21, 18 May 2008 (UTC)

You are confused about what consensus is. Please read up on Wikipedia policies and guidelines. ScienceApologist (talk) 19:25, 19 May 2008 (UTC)

• Concerned Comment The biggest problem I have with this version is that it is being billed as a consensus from the community, but they have not shared in the conversation or the work that has been put in to improve upon the very version they are looking at. There is more work to do, but if you call this a consensus version, it will be virtually impossible to make any more edits - even minor ones - as a particularly eccentric editor will likely take it as his duty to defend the "consensus view from outside editors". So while I can work with anything, nobody can work with the constant reversions to "the RfC version that many outside members have agreed to". So, unless you really like that version, I would rather you suggest that we continue to work together in the manner that WP was meant to work - where anyone can edit anytime and collaboration is the preferred method to accomplish consensus. Let the ones that are working this article decide what the 'best version' is. -- Dēmatt (chat) 00:58, 20 May 2008 (UTC)
  • Here, here. Well said. -- Levine2112 ^discuss 22:29, 20 May 2008 (UTC)

Cost-benefit 1

The benefits of chiropractic care seem to outweigh the involved risk. The cost-effectiveness of SMT has not been demonstrated beyond a reasonable doubt. However, spinal manipulation for the lower back appears to be relatively cost-effective. Of the various interventions available, the most cost-effectiveness treatment for lower back pain could not be determined from the limited research available. The data indicates that SM therapy typically represents an additional cost to conventional treatment. Due to SM's popularity, higher quality research into the risk-benefit is recommended. Preliminary evidence suggests that massage but not spinal manipulation may reduce the costs of care after an initial therapy. When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SM. The small risk associated with manipulation of the cervical spine could be avoided with the use of nonthrust passive mobilization movements. There is no evidence that SM is superior to other treatment options available for patients with low back pain. In occupational low back pain, shorter chiropractor care had a benefit for reducing work-disability recurrence and longer chiropractic care did not show a benefit for preventing work-disability recurrence when analyzing tha data from workers' compensation claims data. SM helps to reduce time lost due to workplace back pain, and thus employer savings.

Comments on Cost-benefit 1

(Please put comments here.) Eubulides (talk) 23:33, 14 May 2008 (UTC)

• First comment is that any SM should be changed to SMT. I changed the first thinking it was a typo. This is going to run into similar problems as effectiveness, where the sources are talking about the cost-effectiveness of SMT, not the cost-effectiveness of chiropractic.DigitalC (talk) 00:02, 15 May 2008 (UTC)
• If There is no evidence that SM is superior to other treatment options available for patients with low back pain.is to be included, it should be changed to There is no evidence that SMT is either superior or inferior to other treatment options available for patients with low back pain. In accordance with the following quote from the conclusion of the article "Neither did we find evidence that these therapies are superior to spinal manipulative therapy.". However, this source is not EVEN on cost effectiveness of SMT, it is on effectiveness of SMT, and as such should not be in this section.
• after an initial therapy. is grammatically incorrect. After initial therapy, or after an intiial treatment would be grammatically correct.
• When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SM. Again, this falls into the trap of assuming that this is Cost-benefit of SMT, and not Cost-benefit of Chiropractic. Chiropractors use physiotherapeutic exercise as a treatment.
• The small risk associated with manipulation of the cervical spine could be avoided with the use of nonthrust passive mobilization movements. This one is a POV statement, and I will have to search for a source the backs that it is POV. From my understanding the risk is the same for any grade of mobilization. DigitalC (talk) 00:49, 15 May 2008 (UTC)

Actually, the research suggests that manipulation and mobilization carry the same risk. In fact, the same risk as performing a cervical range of motion exam. So not only is it POV, it's not accurate. Is there a reference for it? -- Dēmatt (chat) 03:43, 15 May 2008 (UTC)

Yes, it is referenced, but I agree with you that research suggests that any movement of the cervical spine carries the same risk.DigitalC (talk) 04:10, 15 May 2008 (UTC)

I am pretty much against the majority of the content which Quackguru added. . . moreover I am petrubed by the manner in which it was added. Discussion about Reformers should be removed. . . along with the contentious efficacy and research section.TheDoctorIsIn (talk) 01:03, 15 May 2008 (UTC)

I feel there are severe limitation still in this version although there is undoubtedly some good to it too. We can work with this and make it much better and more relevant, however. The validity some of the information presented here is highly suspect and there are major omissions still. For example, scientific research into chiropractic has been done by chiropractors, believe it or not, since the 1920's. I thought we are supposed to be discussing scientific investigation of chiropractic care, not SMT. They're not the same. What about the NIH study? That was a landmark one in 1976. The New Zealand study in 1979? The Meade study, the Rand study, etc? These are all SPECIFIC to CHIROPRACTIC CARE. Just because they're old doesn't mean that their invalid. The Crick and Watson paper (1955) after all, is holding up well. Also, there has been some pretty bad cherry picking that is either a violation of WP:POINT or WP:COATRACK. If our allopathic editors want to play that game, we can have a tit for tat war with inserting trivial facts that present the OTHER POV. For example, the addition of the "Canadian DCs don't know how to research" is a bit over the top. This study was done in the province of ALBERTA representing less than 15% of Cdn DCs most of whom graduated when the EBM era hadn't arrived. There are more examples, but I must go back to work. Too bad these edits had been railroaded in, and supported blindly by the usual suspects. Also, Fill -- your comment was in poor taste. If you think the Citizendium article with it's lead (with a direct quote taken from 1966) applies here, you're not up with the times. Also, the medical community here is editing against the evidence which I find distressing. Lastly, Ernst is being used throughout this article to negate, trump or override the sound opinion of EXPERTS in SMT and EFFECTIVE and CHIROPRACTIC CARE. This practice must stop. CorticoSpinal (talk) 16:58, 15 May 2008 (UTC)

• The current version emphasizes scientific investigation of chiropractic care. This inevitably means heavy coverage of SMT, since SMT is a core component of that care.
• If an old study is truly landmark it can be expected to affect current reviews. If not, then we shouldn't be mentioning it ourselves. We should rely on expert opinion as to what is important and what is not. We should not be making those calls ourselves, when the expert opinion is already available.

• No, and SmithBlue told you this already. If the purpose of the review is not congruent with the given topic, the review is not valid and should not be used. DCs would consider Manga to be landmark, MDs not so much. So we are to rely on MD reviews? CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)

• SmithBlue's argument, while valid, is not a get-out-of-jail-free card that will let an editor ignore a review whenever they please. It requires a good reason that the review is not congruent with the given topic. No reason has been advanced for any of the reviews cited in Chiropractic, so in no case has there been any justification for ignoring expert reviews and reaching down into the reviewed sources. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• I agree that reaching down and inserting trivial facts from primary studies is not the way to go. If that exists in Chiropractic now, we should fix it.
• The "Canadian DCs" stuff has been removed (for now; until someone reverts it again, I suppose). That stuff is contentious and was not discussed before inserting. I agree that it is potentially controversial and deserves careful review first.

• It was an attribution problem; and the Grod citation should have been used to demonstrate the opposing POV to make it NPOV. CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)

• Sorry, I don't follow this remark. Anyway, I don't see "Canadian DCs" in the current version, so perhaps this point is moot now? Eubulides (talk) 07:35, 19 May 2008 (UTC)

• Many (most?) cites to Ernst are not to things that override expert chiropractors. The exceptions are marked as such (e.g., "a critical review"). At least, that's the intent; if there are problems in this area then let's please discuss fixes.

19:18, 15 May 2008 (UTC)

• Ernst is pushed on every single CAM article and although his opinion is certainly notable (that's NEVER been debated) the weight, tone and influence of his words, especially in chiropractic has been a huge problem since he was pushed onto the scene in Feb 08. Mainstream doesn't even agree with his views on SMT, this is illustrated with the American College of Physicians recommending SMT for LBP whereas Ernst still says its "dangerous" with "no proven beyond a resonable doubt" and "adds costs". Essentially, all his statements are in direct conflict with bulk the mainstream literature. His star is fading as he continues his witch hunt and if he's reading this I think he's a massive douche bag and the quality of his papers re: chiropractic care are by far the most biased, unbalanced, unobjective and misleading ones out there. He should take a cue from Kaptchuk (1998) who can raise concerns but present both sides. CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)

• There is certainly a difference of opinion in mainstream medicine about the effectiveness of SMT. The American College of Physicians does not "recommend" SMT for LBP; it lists it as a "likely effective" therapy, along with massage therapy, acupuncture, willow bark extract, and devil's claw.[40] There is substantial disagreement among low back pain guidelines, with some of them agreeing more with Ernst and some agreeing more with chiropractors (see Murphy et al. 2006, PMID 16949948). It is highly misleading to cite just one group in this area and to pretend that it is the final word, and Chiropractic should fairly represent all sides, including both the skeptics and the proponents of chiropractic. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Manipulation of the cervical spine (MCS) is used in the treatment of people with neck pain and muscle-tension headache. The purposes of this article are to review previously reported cases in which injuries were attributed to MCS, to identify cases of injury involving treatment by physical therapists, and to describe the risks and benefits of MCS. One hundred seventy-seven published cases of injury reported in 116 articles were reviewed. The cases were published between 1925 and 1997. The most frequently reported injuries involved arterial dissection or spasm, and lesions of the brain stem. Death occurred in 32 (18%) of the cases. Physical therapists were involved in less than 2% of the cases, and no deaths have been attributed to MCS provided by physical therapists. Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements). The literature does not demonstrate that the benefits of MCS outweigh the risks. Several recommendations for future studies and for the practice of MCS are discussed.

Here is the abstract from the Di Fabio RP ref. The risk can be avoided with the use of mobilization (nonthrust passive movements). Thanks. QuackGuru 04:23, 15 May 2008 (UTC)

As above, yes you have a source for it. However, it is POV, in that other sources state that the risk is the same for manipulation, mobilzation, range of motion examination, and shoulder-checking while driving.DigitalC (talk) 05:15, 15 May 2008 (UTC)

Please provide a list of other sources. QuackGuru 05:21, 15 May 2008 (UTC)

Please see Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
 • we deem that where it is the mere movement of neck tissues that causes a risk factor to be an absolute contraindication to an HVLA thrust, manipulation that is not HVLA or mobilization are equally contraindicated by this factor, see also Rome P.L. “Perspectives: An Overview of Comparative Considerations of Cerebrovascular Accidents”, Chiropractic Journal of Australia 1999; 29(3): 87-102, as well as Terrett A.G. Current Concepts in Vertebrobasilar Complications following Spinal Manipulation. Des Moines, Iowa: National Chiropractic Mutual Insurance Company, 2001. DigitalC (talk) 05:38, 15 May 2008 (UTC)

The word however was added to a sentence. I do not see any reason for this. QuackGuru 07:52, 15 May 2008 (UTC)

"However" is a connecting adverb meaning "nevertheless, in spite of that, etc". "However" used correctly in a sentence will suggest that that sentence disagrees in sense somewhat with the preceeding sentence(s). In this case, it was used to tie two sentences together to improve flow, so that it wasn't so choppy.DigitalC (talk) 00:39, 19 May 2008 (UTC)

I have not yet had time for a detailed review of #Cost-benefit 1 (I've been tied up with the aftermath of the recent Effectiveness changes) but here is a quick first reaction:

• It's much improved from #Cost-benefit 0, but still needs quite a bit of work.
• It refers directly to many primary studies. It should focus instead on what recent reviews say, e.g., van der Roer et al. 2005 (PMID 15949783), Canter et al. 2006 (PMID 17173105), Cherkin et al. 2003 (PMID 12779300). Primary sources should be used only with good reason (e.g., if they're too new to be reviewed and are obviously important). Eubulides (talk) 09:00, 15 May 2008 (UTC)
• Isn't Assendelft et al. 2003 (PMID 12779297) superseded by Assendelft et al. 2004 (PMID 14973958). Why cite the obsolescent source?
• Let's stay away sources older than 5 years old. They're too dated. If a subject hasn't been reviewed in the past 5 years, then it's probably not worth summarizing here.

This makes no sense. Historically chiropractic care has been shown to be cost effective, why ignore the data? There's a reason why DCs SPECIFICALLY have been invited to participate in integrative models of care. Result? Less costs again. CorticoSpinal (talk) 17:03, 15 May 2008 (UTC)

Again, there is no intent to ignore old data. If old data is still important, it should appear in a recent review. If it doesn't appear, that's good evidence that it wasn't that important after all, at least according to published expert reviewers. Eubulides (talk) 19:18, 15 May 2008 (UTC)

Again, you are missing the point regarding the validity of some of the reviews. Let me paraphrase, again, what SmithBlue and myself have been telling you for quite some time now: if the purpose of the review is not congruent with the topic at hand, then it is not valid. There are severe logical flaws in your reasoning and you've used the same excuse for 4 months to keep out extremely reliable and valid "primary" studies that are far more valid and academically robust than some of the reviews supported by yourself. A refusal to include studies which meets WP:RS, WP:V and are from indexed peer-reviewed journals will forever prevent from making this article NPOV. CorticoSpinal (talk) 23:18, 16 May 2008 (UTC)

No argument has been put forth that the reviews in question are incongruent with the topic at hand. On the contrary, the reviews are quite congruent with the topic of effectiveness. There is no good reason to disregard reliable reviews and to substitute our own opinion about the the reviewed studies. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• The text flows poorly. Contradictory sentences are run together without any explanation. The text needs to tell a consistent story and hang together; currently it doesn't do that well at all.

Eubulides (talk) 09:00, 15 May 2008 (UTC)

And yet, attempts to make it flow better are met with objection.DigitalC (talk) 00:02, 16 May 2008 (UTC)

• Minor grammatical point: "the most cost-effectiveness treatment" Please delete "ness" from end of word. ☺ Coppertwig (talk) 03:08, 16 May 2008 (UTC)

Cost-Benefit of Chiropractic Care 2a: Work in Progress

The benefits of chiropractic care seem to outweigh the involved risk. A 2007 retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs . This effect was greater on a per-episode basis than on a per-patient basis. Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain. A 4-year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399). The authors concluded: "Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care." In occupational low back pain, shorter chiropractor care had a benefit for reducing work-disability recurrence and longer chiropractic care did not show a benefit for preventing work-disability recurrence when analyzing tha data from workers' compensation claims data.

Comments of Cost-effectiveness 2a

Before I get hounded, this is a very quick draft; it is by no means complete and I will integrate the best of QGs draft into when I have a bit more time. There are tons of workmans comp studies to include but the bulk of them say chiropractic care (for NMS disorders) is cost effective and patients prefer it to standard medical care (don't know if PT is included in this or not, we should find out so we don't lump in PT care with med if appropriate). The preliminary results of the just completed Chiropractic Medicare Demonstration project in the US shows this trend continues, but I'm willing to simply state there's been a cost-effectiveness and effectiveness project done by the DoD, Medicare and DVA in the US to determine the merits of integrating chiropractic care into managed, governmental programs. St-Mikes deserves a mention too; I think its the first hospital in North America to have permanent inclusion of DCs on staff who are fully integrated (i.e. full time employee status). I'm not quite sure of the situation in the US; although I do know there is a small, but increasing # of DCs who have hospital privileges. The trend is that this is increasing too. CorticoSpinal (talk) 22:53, 16 May 2008 (UTC)

This draft relies on primary studies when it should rely on reliable reviews. For cost-effectiveness we have enough high-quality reviews that there's no need to reach down into primary studies ourselves. Chiropractic's current cost-benefit section is bad enough, but at least it cites some reviews relatively fairly; this proposed 2a replacement is far worse in that regard. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Well, it certainly appears thorough. I'll have to check the sources as Eubilides suggests, but it's a start. BTW, I haven't quite found my way around this talk page, so if there is something that is no longer of any use, how about archiving it so I don't strike up another conversation about something that is already settled. -- Dēmatt (chat) 19:41, 20 May 2008 (UTC)

• It's the "appears thorough" that worries me. By citing primary sources in addition to the secondary reviews, it's making the evidence appear stronger than it is, or it is arguing with the reviews (I don't know which, as I haven't had time to read all that stuff). Either way, it should be fixed, preferably by dropping citations to the primary sources (I don't see why they're needed, but again I haven't read the sources yet).
• Currently we're relying on auto-archiving; the page is getting a tad big to navigate through (or archive) by hand.

Eubulides (talk) 22:16, 20 May 2008 (UTC)

Biomechanics and obsesity

In an overweight patient lower extremity biomechanics are very different . When walking, obese people tend to take shorter wider steps and walk slower. The Q-angles are increased at the knee and significantly more abducted foot angles. Hyperpronation is greatly increased, with more eversion of the foot and more flat-footed weight acceptance. There is also greater ankle dorsiflexion, but less plantar flexion.Lvs2bAdjstd (talk) 18:14, 14 May 2008 (UTC)

Sorry to stop by in the middle of a POV war

This talk page is too long for me to follow with the limited time that I have available, so basically I have to read the article and make edits as I see them. Hope you don't mind. You can always revert anything I may be misunderstanding.

I did remove this as it seems unsupported by the citation:

• Opinions differ on the efficacy of SMT for nonspecific or uncomplicated low back pain.

-- Dēmatt (chat) 02:01, 15 May 2008 (UTC)

The cited source (Murphy et al. 2006, PMID 16949948) says, "Inconsistencies in the evidence suggest that there is continuing conflict of opinion regarding: efficacy of SMT for treatment of nonspecific or uncomplicated LBP; optimal time in which to introduce this treatment approach; whether SMT is useful for treatment of chronic LBP; and finally, whether subacute LBP actually exists as a separate category requiring a specific treatment approach in its own right." Its conclusion says, "In conclusion, this study showed that the treatment of LBP remains as ambiguous as before and that the way best evidence is being interpreted could play a large role in this." I made this change to reword the statement to be closer to the cited source. Eubulides (talk) 02:20, 15 May 2008 (UTC)

The article is about guidelines for the treatment of nonspecific LBP. The cited source actually says:

• RESULTS: According to best evidence from review of the Cochrane database of systematic reviews, there remains a lack of consensus regarding reported efficacy of spinal manipulative therapy for the treatment of nonspecific LBP. Furthermore, the guidelines reviewed in the present study have not changed significantly with respect to treatment recommendations for nonspecific LBP since the original review, and there is inconsistency between the guidelines regarding optimal time to introduce spinal manipulation to treat nonspecific LBP. CONCLUSION: Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence.

The source was actually about guidelines for the treatment nonspecific LBP. In my opinion, to cherry pick the SMT sentence from the results section when it is not mentioned under the authors conclusions, makes this statement very weak. We should be able to find better. I will make an attempt myself to make it less POV. Wish me luck. -- Dēmatt (chat) 02:41, 15 May 2008 (UTC)

Here was my attempt to clarify. -- Dēmatt (chat) 03:03, 15 May 2008 (UTC)

The "continuing conflict" quote is from the lead (2nd sentence) of the discussion section, not from the results section. The "the way best evidence is being interpreted" quote is from the conclusion. It is true that the source is primarily about nonspecific low back pain, and thanks for catching that: I was misled because the source does review a RCT for uncomplicated LBP and mentions this in the discussion section. The attempt-to-clarify replaced discussion of efficacy with discussion of recommended treatment, but this section of Chiropractic is the Effectiveness section, not the Treatment section, so this section should focus on what the source says about effectiveness, not on what the source recommends for treatment. And what the source says about effectiveness (and underlines in its conclusion) is that opinions differ widely and that experts are interpreting the best evidence quite differently. I made this change to bring the wording back to effectiveness, noting (as mentioned above) that the review is about nonspecific LBP and not about LBP in general. Eubulides (talk) 07:27, 15 May 2008 (UTC)

This doesn't seem suppported by the reference either:

• An authoritative 2004 review found that SMT/mobilization is effective only when combined with other interventions such as exercise.

-- Dēmatt (chat) 02:13, 15 May 2008 (UTC)

The cited source (Gross et al. 2004, PMID ) says in its conclusion, "Multimodal care, including mobilisation and/or manipulation plus exercise, is beneficial for pain relief, functional improvement and global perceived effect for subacute/chronic mechanical neck disorder with or without headache. The evidence did not favour manipulation and/or mobilisation done alone or in combination with various other types of treatments for pain, function, and global perceived effect." I made this change to reword the statement to be closer to the cited source. Eubulides (talk) 02:41, 15 May 2008 (UTC)

I added the details. Funny how they both say the same thing, but they feel so different? -- Dēmatt (chat) 03:13, 15 May 2008 (UTC)

That edit removed the very important detail that the evidence did not favor SMT and/or mobilization done alone. I made this change to restore that detail. The "with or without headache" didn't seem that important so I omitted it; please restore that phrase if you disagree. Eubulides (talk) 07:42, 15 May 2008 (UTC)

Ok with deleting headache. My impression is that my wording was as accurate as yours, but you chose the negative while mine chose the positive. Is there a middle ground? ---- Dēmatt (chat) 04:52, 16 May 2008 (UTC)

I disagree that your wording was as accurate, because it omitted the important detail that the evidence did not favor SMT and/or mobilization unless they were combined with exercise. That is, the original source did not merely look at SMT/mobilization + exercise and say "that's good"; it looked at SMT/mobilization + exercise and said "that's good" and it also looked at SMT/mobilization without exercise and said "that's no good". The second part of these results also needs to be mentioned. The exact wording I'm not that hung up on. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Good point, let's try to make it a little more neutral by taking out "authorative" and rearranging it some while adding in the "not without exercise".

• A 2004 review found that SMT and mobilization for the cervical spine are beneficial for pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder when combined with exercise. Without exercise, or with other modalites, SMT did not fair as well.

Or something like that.

-- Dēmatt (chat) 15:06, 19 May 2008 (UTC)

It's OK to remove "authoritative" (Chiropractic currently says "comprehensive") but "Without exercise, or with other modalites, SMT did not fair as well." is too vague; that could mean that SMT is still known to be effective without exercise, just not as effective as with exercise. It should say that the evidence does not favor SMT done without exercise. Is the current wording not neutral? It says "Of three systematic reviews of SMT published between 2000 and May 2005, one reached a positive conclusion, and a comprehensive 2004 review () found that SMT and mobilization are beneficial only when combined with exercise, the benefits being pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder." Eubulides (talk) 20:47, 19 May 2008 (UTC)

It's unfortunate that certain editors here try spin something that is neutral in the conclusions that ends up with a bad tone. For the record, Dematt, I have told Eubulides this since he first began editing at chiropractic in February 2008. Isn't it part of WP:AGF that we extend good faith to the article we're writing? You know, assume the best? We can't be skeptical at all parts at all times, this article and profession are treated like ultimate fringe when the reality is, it's practically mainstream. A serious POV shift needs to be take place for the skeptics. CorticoSpinal (talk) 23:36, 16 May 2008 (UTC)

This is not about spin; it is about summarizing the source accurately. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Again, this source says nothing about 'prognosis':

• A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that manual therapies and supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis. A 2007 review found that SMT and mobilization are effective for neck pain.

The source says:

• For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.

• The cited source (Hurwitz et al., PMID 18204386) talks about prognosis in a "Key Points" box on page S149. There are 4 key points. The 3rd one is: "There is (1) no evidence that a particular course of care with any intervention improves the prognosis for whiplash or other neck disorders; (2) some evidence that high rates of health-care use may slow recovery from whiplash; and (3) little data on cost effectiveness." I noticed that your quote from Hurwitz says "there is evidence that X" rather than X, which is worth mentioning, so I put that in this change which restored the Hurwitz citation but mentioned the "evidence" bit.

My problem seems to be that I don't have access to something that you are looking at (the box). All I have is the pubmed abstract. Do you have the actual link to the article that you are looking at? ---- Dēmatt (chat) 04:44, 16 May 2008 (UTC)

I have the actual article from here. Unfortunately it is copyrighted and I cannot redistribute it. Perhaps your local library can get you a copy. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Understandable. How about we ditch the "prognosis" part then. It makes it hard to verify. I will entertain other source though. -- Dēmatt (chat) 15:18, 19 May 2008 (UTC)

Most of Chiropractic's sources are copyrighted and are not freely readable; why discriminate against this one? This source is a recent high-quality review and is widely available (even if it's not free). We have verified the point in question by quoting one of the article's key points. Eubulides (talk) 20:47, 19 May 2008 (UTC)

• There were actually two sources here. That same edit removed the sentence "A 2007 review found that SMT and mobilization are effective for neck pain." citing Vernon & Humphreys 2007 (PMID 17369783). But you didn't discuss that part of the change. Was it intended? If so, why? If not, then let's please restore that sentence and citation.

Eubulides (talk) 08:07, 15 May 2008 (UTC)

That was purely accidental - slip of the mouse! ---- Dēmatt (chat) 04:52, 16 May 2008 (UTC)

This change to a sentence does not seem to focus on the topic at hand (effectiveness). QuackGuru 03:00, 15 May 2008 (UTC)

Yes, that problem is further discussed above (sorry, I am working my way through the comments and didn't see yours until just now). As discussed above, I fixed that problem here. Eubulides (talk) 08:14, 15 May 2008 (UTC)

Mainspace may not be the place to ask questions.[41] QuackGuru 03:00, 15 May 2008 (UTC)

The reason it says "or mobilization" is because the source says it. Is mobilization irrelevant here? Chiropractors use mobilization, right? I don't see why the "or mobilization" was removed in that edit. Perhaps Dematt can explain? Eubulides (talk) 08:14, 15 May 2008 (UTC)

I've run out of time tonight. I only made it to the whiplash section. I haven't been able to make it through everything, but it looks close. I do agree with Eubilides that some of this was probably just added a little prematurely. I like the way you've been working it through on the talk page first. -- Dēmatt (chat) 03:38, 15 May 2008 (UTC)

I disagree with this edit. The reference is a 2004 ref. There is a 2006 Canter review of the 2004 ref. We should use the newer ref that says the 2004 ref as an authoritative source. The 2006 ref does not say all of this when I looked at it. We should use the newer 2006 ref that is currently available. The 2004 ref does not say it is an authoritative review. Thus, it fails verification. QuackGuru 04:05, 15 May 2008 (UTC)

As discussed above I made this change to change that wording to match the 2004 source (Gross et al.) better. The 2006 source (Ernst & Canter) is not as authoritative as the 2004 source, and it's not clear what the 2006 source brings to the table, other than saying that the 2004 source is "authoritative". Is there a serious challenge here as to whether Cochrane reviews are authoritative? I don't know of anybody seriously disputing that. If it's a real issue, perhaps the simplest thing is to remove the word "authoritative"; it hardly seems worth the trouble to plant a footnote after every use of that adjective. Eubulides (talk) 08:24, 15 May 2008 (UTC)

Yes Cochrane reports are authoritative, but it's preferable to avoid peacock terms. WP:PEACOCK lists authoritative in it's list of "Words and phrases to watch for". Jefffire (talk) 08:36, 15 May 2008 (UTC)

One undiscussed minor change made in the above run was to change "SMT is no more or less effective than other interventions" to "SMT is no more or less effective than standard interventions" when summarizing Assendelft et al. 2004 (PMID 14973958). However, the cited source actually says "There is no evidence that spinal manipulative therapy is superior to other standard treatments", which implies (contrary to what Chiropractic currently says) that SMT is a standard treatment. To match the source better I changed "standard" to "other standard". Eubulides (talk) 08:42, 15 May 2008 (UTC)

After the "massive edit", most of the above seems moot now, but for future reference, I think your overall edits brought the article too far back toward the "other POV", but I am pretty sure we would have gotten there eventually. Maybe we'll get another chance? It was fun working with you! ---- Dēmatt (chat) 04:39, 16 May 2008 (UTC)

I hope we do get another chance. I do appreciate working with you. With the big stampede of partisan edits (by both sides) this may be difficult, though. Eubulides (talk) 07:35, 19 May 2008 (UTC)

First, Eubulides fails to realize that Cochrane reviews are generally only good for 2 years. This is the length of time that they usually update their lit synthesis and modify the content. So, a 2004 "authoritative" Cochrane review is outdated 2 fold. It's these types of edits and wikilawyering that it's a "reliable review" to omit more recent evidence (i.e. 2007 American College of Physicians clinical practice guidelines for LBP) and more comprehensive studies (WHO Bone and Joint Decade 2000-2010 Neck Pain Task Force) which presents a vastly different conclusion (i.e. manual therapy is effective for grade 1,2 neck pain) but claiming that manual therapy is not effective for neck pain. I think Eubulides forgets he's dealing with other health care professionals and scientists who know how to appraise the literature and know the difference between what's generally right and what's generally BS. Eubulides edits promotes a fringe viewpoint of mainstream medicine while exploiting the fringe elements of chiropractic at the expense of the mainstream majority of the profession. CorticoSpinal (talk) 04:55, 16 May 2008 (UTC)

• All of the Cochrane reviews currently cited by Chiropractic have "2008" on them when you visit them, which means Cochrane thinks they're up-to-date. They are periodically reviewed and can be kept unchanged, or unchanged with comments.
• There are certainly other opinions out there, but the Cochrane reviews are very high quality, and are more authoritative than the alternatives mentioned.

Eubulides (talk) 07:35, 19 May 2008 (UTC)

Personally, I have no problem including as many studies as we need to fully discuss the issues. The net result is that, while the jury is out on the use of spinal manipulation for Type O (organ related) conditions, its use for low back pain, neck pain and headaches is at least as good as any other medical intervention and, regardless of opinion, it is relatively safe. Now, we can either say this in the two sentences that I have written above, or we can cite every source possible and I am quite sure the net result will be the same for spinal manipulation. Now for the issue of spinal adjustment - we have wiped the article pretty much clean of the fact that chiropractors do other things besides spinal manipulation. IOWs, chiropractic <> SMT, as Cortico and Digital suggest. -- Dēmatt (chat) 14:11, 16 May 2008 (UTC)

I don't think the evidence is quite as strong as that. For low back pain and relative safety I agree with you. But for whiplash, neck pain, and headache there is not a strong consensus that SMT is at least as good as any other medical intervention. And by "jury is out" do you mean "the evidence is weak" for organ-related conditions? Eubulides (talk) 07:35, 19 May 2008 (UTC)

Well, I would start with what we do agree with then:

• Generally, the research supports the use of spinal manipulation for the treatment of low back pain as effective and relatively safe.(refs) For neck pain, whiplash and headaches, some evidence supports its use and yet some does not. So-and-so says blah blah blah(ref), while Yoman says blah, blah(ref). For the treatmetnt of type O, or organ related problems, there is a lack of research to make any determination either way (ref).

Of course, that is just a start. You could come up with the not so good research and I'll let Cortico come up with the other stuff :-) -- Dēmatt (chat) 18:42, 19 May 2008 (UTC)

Isn't that what this version did? Albeit at somewhat more length. (This is the version suggested in #Version suggestion below.) Eubulides (talk) 20:47, 19 May 2008 (UTC)

“ While the jury is out on the use of spinal manipulation for Type O (organ related) conditions, its use for low back pain, neck pain and headaches is at least as good as any other medical intervention and, regardless of opinion, it is relatively safe. Now, we can either say this in the two sentences that I have written above, or we can cite every source possible ”

I have been saying the same for the last 2 months yet the skeptical editors wanted to cherry pick the evidence and drum up a 'false consensus' that there was real doubt re: the effectiveness of SMT for mechanical spinal syndromes and certain HAs and completely negate the possible' validity of SMT for certain Type O conditions. I've always said that DCs will live and die by the research sword and that science will drive practice and philosophy (as per Triano) and not vice-versa. Publish or perish. It's that simple. If there really was no connection between SMT and visceral dysfunction clearly the notion of SMT as a Tx for this would have died. Yet its somehow survived for 113 years. Interestingly, as Hawk et al suggest reducing chiropractic to SMT and studying that instead of the whole clinical enccounter (which averages 18 min, its takes 10-30s for to deliver an adjustment) might have been the critical flaw in the research designs when looking at chiropractic care for Type 0 conditions. Also, with the increasing prevalent model of health promotion/wellness coming into play, it would be foolish to assume that this type of intervention doesn't not play a positive role in improving the quality of life of patients. Orthodox medicine fails miserably in really looking at all the determinants of health and want to find some kind of reductionistic measure. Qualitative research designs are much better suited for the type of research required to truly understand the value (if any) of DC care for Type O.

[outdent] Yetmore evidence demonstrating that mainstream medicine is embracing manual medicine. Who are the expert providers of manual therapy (done by hand)? Hint, it's in their name (done by hand). Skeptics focus so much on the outdated fringe chiropractic philosophy at the expense of the inclusion of the cold hard facts: philosophically, allopathic and chiropractic medicine at the opposite spectrum; but that doesn't mean the main methods used by chiropractors aren't valid. Manual medicine is a real, its a traditional form of medicine and we shall present this piece of the chiropractic story. Also, we really should the science of chiropractic; i.e. science of manual therapy and holistic, conservative health care. Scientific investigation right now is a sham; it's a SYN of SMT (which is great for the SMT article) and the generalizable points must be covered here at the main article; nonetheless, this is article is the story of chiropractic medicine. I shall begin a proposal after the long weekend. It will be a historical-to-present account of the major scientific developments within the profession which will surely raise eyebrows (because why would skeptics really want to get that out). To be perfectly fair, I also propose a Criticisms section where we can roll the main concerns/criticisms in a nice, tidy section and avoid dumb WP:POINT violations. For example, a criticsm of chiropractic care is a perceived lack of professionalism and ethics, improper advertising/marketing, the clinical value and weight of subluxation (note that mixers and straights give the VSC different weight, this is fundamental to understand), debates regarding safety, cost-effectivness of SMT and others I'm sure that QuackGuru will dig up. It's all fair game and must be treated fairly. So, I'm also proposing a Integration into the Mainstream section, with reviews, studies, sociological lit, government docs that demonstrate a move towards the mainstream with chiropractic at crossroads (a la Meeker and Haldeman) and the paradox of continued opposition from POLITICAL medicine despite the successess of integrative (MD-DC) models of care. The story of chiropractic is so interesting yet wacky, we can cover it NPOV but it will require a significant paradigm shift from skeptics who edit. Yes, there are fringe elements of the profession. We can highlight these but not at the expense of soiling the views and credibility of the mainstream (non-fringe) chiropractic. Mixers, for better or worse, are going to determine the eventual fate of mainstream integration (it won't be the straights for obvious reasons, the least being they don't want to integrate) and their story needs more focus here. Thoughts?

Recent edits made without discussion

After this huge change was installed, containing many components that were installed without discussion, other editors have now felt that it's OK to install major changes to Chiropractic without discussion, despite a notice at the top of this talk page saying "Please read this page and discuss substantial changes here before making them." I view this new practice with great dismay: it's a recipe for an edit war. To document what's going on a bit better, here is a list of controversial edits made recently without any discussion.

• This edit reverted a revert of a revert etc.; basically, it reinstalls a large number of controversial edits which were installed without any prior discussion, as discussed in #Several important changes were never discussed.

I agree. We need to avoid reverting all the way back to older versions. You guys have been working hard to fine tune and when someone just wipes them all out, well, that is just frustrating for everyone, I think. -- Dēmatt (chat) 14:25, 16 May 2008 (UTC)

• This edit hoists material here, out of Chiropractic education, without discussion or consensus.

I think the chiropractic education section was inadequate as it was. I have no problem with returning some content from the Chiropractic education article. -- Dēmatt (chat) 14:28, 16 May 2008 (UTC)

Actually this material was "hoisted" AWAY for no real good reason and it essentially omitted the meat and potatoes of education namely, what are the various degrees earned internationally and what are the common elements of all chiropractic education? Considering how lengthy of a topic this could be and the length of the education article, this size is absolutely fair game for the main article. It's well referenced, it's relevant, it's valid and it's NPOV. CorticoSpinal (talk) 16:25, 16 May 2008 (UTC)

Chiropractic currently spends far too much time on the WHO model for how chiropractic education ought to be, and too little time on how chiropractic education actually is. The text also does not clearly state when it's talking about the ideal, as opposed to the reality. Certainly the WHO model is not followed "across the globe", despite what Chiropractic seems to claim. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• This edit inserts an older primary source to argue with a recent reliable review. The review in question already covers the older primary source in question, and this edit attempts to overturn the review, in a clear violation of WP:MEDRS guidelines. The edit also mischaracterizes the recent reliable review as a "study".

I think that the concept of maintenance care needs to be fully discussed and Cortico's edit was a good start. WP:MEDRS are guidelines, we might not be able to follow them to the T. -- Dēmatt (chat) 14:32, 16 May 2008 (UTC)

It is certainly reasonable to talk about maintenance care, and Chiropractic#Philosophy already does that. It is not reasonable to argue with a review by emphasizing one of the primary source's reviews. It is not our job to argue with reviews. We should be presenting their results as neutrally as possible. Eubulides (talk) 07:35, 19 May 2008 (UTC)

I have made the same plea to Eubulides to stop wikilawyering about his very, very rigid interpretation of MEDRS guidelines. Guidelines. Not policy, guidelines. Guidelines, which have been used thus far to omit valid, reliable sources. Case and point are the American College of Physicians clinical practice guidelines which recommends many non-pharmacologic options for LBP which SMT is one of many EFFECTIVE alternatives to standard medical care (pills).

There is no good reason in this particular case to argue with the review. Let's stick with what the review says. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Actually there is. You suggest that Ernst view of SMT represents the mainstream. That clearly cannot be the case for the American College of Physicians own clinical practice guidelines includes SMT as safe, effective alternative for LBP. So, when the most influential college of physicians in the world (the US) endorses SMT, that is the mainstream position. It shall stay, it more than meets WP inclusion criteria and the practice guideline itself is an expert review. CorticoSpinal (talk) 16:21, 20 May 2008 (UTC)

• The ACoP has not "endorsed" SMT. Its current recommendation strongly advises advice to remain active and self-care, with medications as needed. For patients who do not improve with self-care, it weakly suggests adding other therapies, one of which is SMT, which it says has small to moderate short-term benefits (for acute LBP) and moderate benefits (for chronic LBP; this is among 8 possible alternative treatments). These recommendations do not apply to children, adolescents, pregnant women, or to nonspinal LBP. See Chou et al. (PMID 17909209). It is misleading to collapse these recomendations into a statement of "endorses" or (as Chiropractic does to say that SMT was "recommended" by the ACoP.
• It would be reasonable to mention the ACoP position, as long as this was done accurately and neutrally, which is not the case now, as shown above. I suggest replacing ", although it was recommended in the 2007 clinical practice guidelines of the American College of Physicians " with ". For example, a 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail, whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help.".

• This edit removed material about who should administer SMT, without discussion or consensus. It also broke a citation (turning it into a dangling red link).

This was probably more appropriate in the Spinal manipulation (wow, what happened to that link?) article anyway. -- Dēmatt (chat) 14:59, 16 May 2008 (UTC)

I could be talked into moving the material, yes. It was a great shame that the edit broke the citation. If it had been reviewed ahead of time that problem could have been reverted.

This is a huge problem with Eubulides' drafts (all 3) is that is synthesizes all SMT research and then attempts to pass it off as "effectiveness" of chiropractic. Much more specific and relevant to effectiveness of chiropractic care would be the NIH, New Zealand studies, Meade, Rand, Manga studies, the integrative models which demonstrated that DC care is effective and cost effective as well as the ongoing MEDICARE DEMONSTRATION PROJECTS occuring at the DoD, DVA and other major governmental agencies. What about the Kapansky-Giles article which talks about the effectiveness of chiropractic care at St-Mikes hospital in Toronto? This is SPECIFIC to chiropractic and it was a demo project that was made PERMANENT because it was such a rousing success in both clinical and financial terms. There's many more sources that adequately discuss the effectiveness of chiropractic care (i.e. the whole clinical encounter not just SMT some editors don't seem to understand). CorticoSpinal (talk) 16:25, 16 May 2008 (UTC)

None of these comments seem to have anything to do with the edit in quesiton. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• [http://en.wikipedia.org/w/index.php?

title=Chiropractic&diff=212703876&oldid=212702655 This edit] also removed material without discussion. (I agree with the removal, not that that matters as far as procedure is concerned.)

It was probably fluff anyway. Could just take out the "Samual Homala" part. Save energy for issues that count. -- Dēmatt (chat) 15:02, 16 May 2008 (UTC)

• This edit, without discussion or consensus, removed important sourced material about scientific versus antiscientific reasoning among chiropractors.
• This edit, without discussion or consensus, attempts to undermine a reliable review of practice guidelines by citing just one guideline, on one side of the dispute. Again, this sort of tactic is contrary to the spirit of WP:MEDRS as it is attempting to overturn a review.
• This edit, without discussion or consensus, again attempts to undermine a review-of-reviews by citing a review. It also uses unsourced peacock terms like "the most comprehensive study to date" and disparaging terms like "opined".
• This edit, without discussion or consensus, attempts to undercut a source by characterizing it as being by a "vocal critic of chiropractic". It does not balance this by mentioning the many other sources that are by vocal supporters of chiropractic.
• This edit, without discussion or consensus, removed sourced material.

Eubulides (talk) 22:33, 15 May 2008 (UTC)

Disagreed, Eubulides. All edits are supported by the sources. It's making the sections, which have been aded WITHOUT consensus relatively more NPOV. There's a lot of work to be done but we can get there. Since when is opined "giving an opinion" disparaging? Humphreys and Vernon were my PROFESSORS. I'm not going to slag them. And, do you disagree that the Neck Pain Task Force is the most comprehensive study on neck pain? Maybe this might shed more light on the topic. If we're to rush in edits without consensus then, inevitably, there will be much editing to try and present opposing views. Also, note that you're being completely redundant and trying to make a point with your repetitive use of discussion/consensus. The edits installed previously were very faulty and cherry picked evidence and did not fully attribute the information. CorticoSpinal (talk) 23:16, 15 May 2008 (UTC)

• It's not true that all those edits are supported by the sources. Many edits removed sources. Some edits broke sources, leaving red links.
• Using "opined" to talk about opinions favoring one side, while in contrast using words like "most comprehensive study" to talk about opinions favoring the other, is clear POV.
• It's not a question of whether I think the study is the most-comprehensive. It's a question of WP:PEACOCK. The words "authoritative" were recently struck for the same reason, even though the reviews in question were indeed authoritative (and we have reliable sources saying so).
• We should not rush in edits without consensus.
• It is not right for a Wikipedia article to attempt to undermine a reliable review by highlighting results of a reviewed primary source that disagrees with the review. Wikipedia should defer to published expert reviewers, and not attempt to override them.

Eubulides (talk) 23:30, 15 May 2008 (UTC)

I think you both made some good edits and some not so good edits. We can't help our biases; we can only hope to keep them in check. Keep working on it. ---- Dēmatt (chat) 04:57, 16 May 2008 (UTC)

[outdent]. Eubulides still using the same tired arguments as the past 4 months. The problem is that this extremely controversial section, which has NO VALIDITY in that it looking at the effectiveness of SPINAL MANIPULATION and passing it off as "chiropractic care" and selectively cherry picked the literature to marginalize, minimize the effectiveness of SMT and pass it off as chiropractic. Lastly, yet, all edits were supported by the sources. There is one thing I want to note: you have a habit of selectively highliting negative points and not providing the full context or the major findings when you cite "supportive" sources of chiropractic care. You actually cited the CCAs Clinical Practice Guidelines of Neck Pain proving that "the are adverse effects" of neck manipulation while not mentioning a peep that evidence-based document actually supports the use of MANUAL THERAPY (not just SMT, please understand this point) and the benefits far outweight the risks. So, the edit goes in that essentially states that there are adverse effects to neck SMT and cites the CCA guidelines and doesn't cover the whole conclusion. Cherry picking. Dematt has said the same. CorticoSpinal (talk) 05:25, 16 May 2008 (UTC)

Most of the citations are to sources that talk about chiropractic care, not merely SMT. The other comment you make seems to be about safety, not effectiveness. The safety section talks about safety, not cost-benefit. Perhaps there should be a change to the cost-benefit section along the lines you suggest; could you propose a change? Eubulides (talk) 07:35, 19 May 2008 (UTC)

Please see Cost effectiveness 2a. CorticoSpinal (talk) 16:21, 20 May 2008 (UTC)

It may have been helpful if you had also done what I did - revert QuackGuru's this huge change. I know that you were against the huge change and you made that known somewhat on this page, but perhaps if you also reverted the huge change just once, it would have made your feelings that much stronger. Instead, I was left to revert it two or three times, and then accused of edit warring by the very editor who started the war; chiefly QuackGuru. The end result was QuackGuru and pals trying to make it appear that I was the only editor in support of reverting the huge change and that I was somehow ignoring a mysterious "broad consensus". Unfortunately, the truth of what was being ignored was that there were/are a large number of editors against QuackGuru's huge change, including me, you (Eubulides), CorticoSpinal, Dematt, DigitalC, TheDoctorIsIn, etc. I am typically against edit warring and I wouldn't ask you to participate in one, but I felt like QuackGuru was allowed to steamroll his version through, emboldened by supposedly "outside" editors (the usual gang of editors ready to do anything to bash CAM topics such as Chiropractic). I applaud CorticoSpinal for rising above myself, taking the higher ground, not edit warring, and instead effectively improving gross NPOV negligence on the part of QuackGuru. We have two paths we can take now. We can revert back to how the article read before QuackGuru's unfortunate and huge edit or we can move forward and pound away at his additions to try and make it comply with NPOV, RS and V. The former puts us back to discussing all major edits, hashing everything out, striving for a consensus before implementation; whereas the latter places us in a spot where we all just edit the article directly (because the content is live and we want it to be the best it can be immediately). Either way, I still encourage much discussion here to foster a better article and more cooperative spirit. -- Levine2112 ^discuss 00:33, 16 May 2008 (UTC)

I do not like to do revert wars, and did not understand the etiquette of reverting (such as at it is). Apparently I did not stay out of the war successfully; I was warned for 3RR, as my understanding of a revert did not agree with the official version. Sorry for being such a novice at this. Eubulides (talk) 07:35, 19 May 2008 (UTC)

All of these edits are highly POV and should be greeted with a revert. This article should not be turned into a POV promotional piece. Hopefully, we can get back on the right NPOV track. QuackGuru 01:32, 16 May 2008 (UTC)

See and I would say that all of these edits are highly POV and should have been greeted with a revert. This is why we need to discuss things first here before making such bold edits. Remember when you asked what's the harm in being bold with this article. Well, you were bold and a tad reckless IMHO and that led to edit warring, general incivility and now the article is locked. See the harm now? -- Levine2112 ^discuss 01:41, 16 May 2008 (UTC)

Well said Levine... what say ye'all. How do we want to do this? ---- Dēmatt (chat) 04:35, 16 May 2008 (UTC)

For what it's worth, lets "move forward and pound away at his additions to try and make it comply with NPOV, RS and V". That would be more productive and definitely more interesting!--—CynRN ^(Talk) 06:35, 16 May 2008 (UTC)

Hey, I vote for interesting every time! But we really can't be reverting.... that takes the fun out of it. We should agree to only add/fine tune? -- Dēmatt (chat) 15:06, 16 May 2008 (UTC)

I do have one question for CorticoSpinal - when you type, are you yelling in your head, or do you always talk that way :-D (just picking:-) -- Dēmatt (chat) 15:10, 16 May 2008 (UTC)

Lol, is that because of the CAPS? I'm too lazy to scroll up the page for bolding or italics, so if I want a word to get NOTICED I just hold down the shift key! In all seriousness though there are still major flaws with the validity of effectiveness of the chiropractic profession as the section (after 3 attempts you would have figured the author would have gotten the point that this was a no go) despite the fact that a compromise by CynRN (to include the highlights of SMT) was agreed upon by the majority of the editors. We're essentially here because many believe (as I do) that (1) QG and Eubulides want to pass off SMT as chiropractic care and (2)ignoring documents that are specific to the effectiveness of chiropractic care; i.e. the evidence-based CPGs of the profession. Not even one peep of soft tissue therapy in all 3 drafts? I think DigitalC has mentioned this 10 times (and I concurred) and yet a certain editor feels its not inclusion worthy. When a profession develops an evidence-based clinical practice guideline SPECIFICALLY for this, it's inclusion worthy, period. This gong show has gone on long enough and its time we cut bait: SMT goes into SMT article, a blurb can stay in chiro, we draft a specific to chiropractic care effectiveness section that is valid to chiropractic care, not a synthesis of DC, MD, PT, DO and other manipulative using profs. CorticoSpinal (talk) 02:37, 17 May 2008 (UTC)

Version suggestion

I suggest that this version be reinstated after protection is up. This is the best version with the most consensus per the RfC above. ScienceApologist (talk) 17:09, 18 May 2008 (UTC)

I agree that the version you mention is higher-quality and less-biased than the currently-protected version, and would support reinstating it over keeping the currently-protected version. The second and later bullets of #Recent edits made without discussion explain why I think so. However, I don't see the consensus that you mention; there is a lot of controversy over the big edit incorporated in that version (alluded to in the first bullet of #Recent edits made without discussion). Eubulides (talk) 07:35, 19 May 2008 (UTC)

If you look through the RfC comments, I think you'll see that most of the outsiders who commented support the addition of that content. ScienceApologist (talk) 19:36, 19 May 2008 (UTC)

I am concerned about the attempted railroading of the discussion by known alt med proponents and chiropractors. I have filed a Third opinion request to get outsider help:

As a practicing chiropractor, if there is a problem with my participation on this page, I will certainly leave it to you, but I suppose that would mean that SA shouldn't edit science and physics articles either, right? I think as long as we edit NPOV as best we can, that is what we are looking for, some expert guidance, I would hope. I wouldn't begrudge SA from working on Relativity or Eubilides from working on medicine or even Vaccination, so why would you point at me? -- Dēmatt (chat) 20:33, 19 May 2008 (UTC)

There is no problem with your participation on this page, and frankly, I have less of an issue with you than I do with other editors. I absolutely have issue with others using you as a shill to pretend that there is some legitimate controversy over text. I read you as saying you don't like edit wars. Fine. However, there are others who are implying that your position is in-line with some of the more stridently opposed. Note that below we have a particularly strident editor making a laundry list of all the people who agree/disagree with a proposal without so much as a qualification. It is that sort of lumping-and-running that I'm getting tired of. If we could limit chiropractic-supporting editors to just Dematt, I don't think we would have a problem. You are a very good editor who is aware of his own POV enough to be honest about it. However, when discussions happen where you find yourself surrounded by "the usual suspects" it might be better if you didn't entertain the more egregious game-playing. Just a suggestion. ScienceApologist (talk) 21:50, 19 May 2008 (UTC)

SA, thanks for clarifying. I appreciate your confidence, but I do want you to know that, at least as far as the edits that I see here on this page, CorticoSpinal has not improperly used my name. If he had, I would not have hesitated to set the record straight. Having said that, I do not hold any animosity for any editors here as they are all doing a very good job trying to get things right - from their POV. Quite the opposite, I appreciate all the work everyone is putting in trying to get it right. The problem is that we all come with preconceived ideas of what chiropractic is - even different chiropractors have a different understandings of what chiropractic is. As a result, there are no sides here; no-one agree with each other 100%. The version that was here previously that was stable for at least a year ignored reformed chiropractors mostly because the editors that were here didn't know any. Fyslee fought hard to make sure they were included, but the article talked mostly about straights. Well, then CorticoSpinal showed up. Apparently there are reformed chiropractors. The problem is that he rewrote the article from his POV, then Eubilides stopped in when he noticed that straight chiros preached against vaccination. He took that to heart and set out to rewrite the article from his POV. Well, there you have the fuel and the match. What I want you to notice, however, is that now we have no straight chiropractor representation, so the article is in a little bit of a disarray right now, but as Eubilides and CorticoSpinal struggle through their research, I'll do my best to represent those pesky straights. Otherwise, I really don't think that picking a particular version of anything in this transition phase is a good representation of NPOV for chiropractic. I hope you understand. If I thought that accepting that version would stop the bleeding at this article, I would be thanking you from the bottom of my heart, but I am afraid we will only make it harder to improve. Let's let them get it right first, then 'freeze it'. -- Dēmatt (chat) 01:39, 20 May 2008 (UTC)

1. Talk:Chiropractic#Version suggestion. There was an RfC where uninvolved editors determined that a particular set of edits was an improvement. Now, many editors who are actively known to be chiropractic supporters are advocating for the removal of the edits in seeming defiance of the consensus achieved above. We need a neutral party unfamiliar with the disputes to review the discussion for bias in the editors remarks. Note that User:CorticoSpinal, User:Levine2112, User:Dematt, User:TheDoctorIsIn, User:SmithBlue, and User:DigitalC are all either practicing chiropractors or are alternative medicine promoters. ScienceApologist (talk) 19:23, 19 May 2008 (UTC)

---

Disagree. Dematt, myself, DigitalC, Levine2112, Doctorisin and SmithBlue have serious reservations about the draft. Perhaps it would be best if you did not embellish or claim a consensus where there is none. CorticoSpinal (talk) 19:24, 18 May 2008 (UTC)

That is funny :-) Wasn't that the version that started the edit war. I don't think Eubilides even liked that one. -- Dēmatt (chat) 22:17, 18 May 2008 (UTC)

I think that (generally) the version right before this edit was the version that was closest to a consensus. The article was pretty stable back then. Things changed after that edit. -- Fyslee / talk 22:35, 18 May 2008 (UTC)

Ha! That would be this guys first edit on chiropractic :) ---- Dēmatt (chat) 23:56, 18 May 2008 (UTC)

It's unfortunate that Fyslee seems to have it out for me. I cannot believe that he thinks that the pre Jan/08 version is superior to what we have now. I guess we will have to agree to disagree on this. How about comments on the images, new proposed cost-benefit and discussing the validity of calling effectiveness of SMT and passing it off as the effectiveness of chiropractic? CorticoSpinal (talk) 00:25, 19 May 2008 (UTC)

Ah, don't take it so tough. You dish it out pretty good yourself! We really shouldn't take stuff so seriously. I do like the images and , no, the effectiveness of SMT is not the same thing as effectiveness of chiropractic. There are other factors in the chiropractic encounter that need to be included, such as; time spent with the patient, touch, accessability, etc.. and of course there is that placebo effect thing. You know... is it true, or is it just in the imagination of weak minded people (just being facetious of course!) ---- Dēmatt (chat) 01:00, 19 May 2008 (UTC)

During your sabbatical a I went through a lot of BS including a few witch hunts and continued character assassination attempts. Essentially, skeptics are trying to portray me an as "anti-science" "POV warrior" who "cannot collaborate". Now that you are back on the scene I am confident that we will be able to better navigate these turbulent waters with you at the helm. I'd much rather find literature and revise existing weak sections and not have to be, at times, a defacto spokesperson for contemporary chiropractic. I hate coming on here and dealing with all the BS; but I'm not going to let dogmatic skeptics railroad changes in, claiming "NPOV" when it's clearly marginalizing, not valid or has an undue harsh tone. Then I have to deal with a certain editor who seems to have an unhealthy fixation on me and makes grandiose soliloquoys to admins that I'm pretty much exclusively responsible for the state of affairs here at chiropractic.

Your tone is likely going to be more diplomatic that mine, however, since your return you have pretty much raised the same concerns (validity of effectiveness of SMT and passing it off as chiro), cherry picking evidence and not fully attributing it, having a harsh/negative tone of something that should be neutral, suggestions that the effectiveness of SMT for LBP is in doubt, suggestions that manual therapy for neck pain is useless, etc. There are far more, but I'm heading out for the night so we can continue this discussion tomorrow if you'd like. CorticoSpinal (talk) 01:18, 19 May 2008 (UTC)

Well, as Fyslee and Levine can tell you, this page has been a lot hotter and a lot worse at times. I write better when there are two editors with two different POVs as I like to work toward a compromise. However, sometimes compromise is not the best solution, so it has to be grappled out in two balanced POV elements using verifiable sources with the right amount of weight for each. For that, we need people like you and Eubilides to see both sides, but each of you have to realize that you won't always end up with what You want, but it should be better than what would have been there without You. I think you're getting there. It took us two years to get to where we were before, but it was stable for more than a year after that. Hopefully we'll get back to that - and it will be a better article. ---- Dēmatt (chat) 03:37, 19 May 2008 (UTC)

That stability and collaboration is what I miss. I too think that the best articles are produced when editors with opposing POV collaborate and ensure that each other's POV is represented using good sources. That way no one is totally satisfied with the article, which may actually mean that NPOV has been reached...;-) -- Fyslee / talk 05:32, 19 May 2008 (UTC)

I think that there is too much well-poisoning going on here. I'm not pleased that the only person who is commenting on this issue who is not firmly aligned as a chiropractor or alt med proponent is Fyslee. I'm going to ask for a third opinion. ScienceApologist (talk) 19:17, 19 May 2008 (UTC)

Would it be considered well-poisoning to suggest there is a consensus where there clearly is none? -- Levine2112 ^discuss 18:28, 20 May 2008 (UTC)

typos

I'd like to change intial to initial but the page is edit protected. Can someone fix this when you come to a concensus on the disputed bits? Jonathan Cardy (talk) 18:37, 16 May 2008 (UTC)

Images

I propose we use the chiropractic emblem in this article. It was adopted in 1934 in Pittsburgh, USA and is more than relevant and valid. It should be free license too. The article should make better use of images that enhance the understanding of the material. We should have a picture of a chiropractic spinal manipulation. I'd be curious to see if this image really is OMM, CSMT, SMT, OMPT, etc. Thoughts? CorticoSpinal (talk) 01:12, 17 May 2008 (UTC)

I really like the images. That Caduceus is awesome. That cervical view is obviously an osteopathic manipulation as it includes too much head rotation. That would be a general cervical move. However, it is appropriate as a manipulation picture. I would add them for sure as long as they aren't copyrighted. -- Dēmatt (chat) 00:37, 19 May 2008 (UTC)

Thanks. Eubulides suggested the article needs more images and I would agree so long as they're relevant and obviously don't violate copyright. I think an SMT and the Caduceus are a great start and if there's no major objections I think we should include them. As for the SMT pic(s) I'd like to present a single pic that would include a cervical, thoracic and lumbar manipulation using the Diversified technique (the most common chiropractic manipulative technique). Thoughts? CorticoSpinal (talk) 00:41, 19 May 2008 (UTC)

article improvements in the works

chiropractic schools tidbit

This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic (for example, Palmer School of Chiropractic) still teaching the traditional/straight subluxation-based chiropractic, while others (for example, Canadian Memorial Chiropractic College) have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions but retains a holistic approach and an emphasis on manual therapy.

commentary on chiropractic schools tidbit

This sentence seems a bit long. Any suggestions? QuackGuru 21:37, 18 May 2008 (UTC)

Make a proposal, QG. Never write down in 10 words what you can say in 5. That's the tough part about writing and editing. Anything to explain the apparent dichotomy that exists. CorticoSpinal (talk) 00:15, 19 May 2008 (UTC)

I think making a statement that Palmer still teaches the traditional metaphysical approach is not really accurate. That same website says this. If their first reference had said Innate Intelligence (Uppercase) rather than innate intelligence (lowercase), I might buy the argument, but Innate Intelligence is the metaphysical equivalent to the untestable vitalistic "spark of Life" while innate intelligence is the inborn intelligence that science embraces as reductionist to a point then emergent through the potentially millions of combinations that can occur. Fyslee understandsthis. IOWs, there is nothing metaphysical about innate intelligence, only Innate Intellingence. It's like placing all the intricacies of life in a metaphor called mother nature rather than calling what we don't quite understand, God. Nobody actually believes there is a Mother Nature, it's just a metaphor used to lump it all into one 'easy to communicate concept' so we don't have to describe everything in scientific terms. For instance, the birds and the bees. Once everyone knows what birds and bees means, we don't have to keep explaining about the spermatozoa and ovums, etc., etc.. You see what I mean? ---- Dēmatt (chat) 03:23, 19 May 2008 (UTC)

Innate Intelligence (Uppercase) and innate intelligence (lowercase) has been used both ways in the same article. QuackGuru 05:25, 19 May 2008 (UTC)

Excellent article QG, everyone should read it. Now compare that with Keating's Innate. Remember Keating was a psychologist that worked and taught in chiropractic colleges, in fact I think maybe both Palmer and Canadian Memorial, but don't hold me to it. Anyway, notice that he talks about "innate" as homeostasis, etc. initially, but then in 1906 the metaphysical Innate Intelligence starts - remember DD went to jail in 1906 for practicing medicine without a license. Your article shows how chiropractic cohorts at the time were against the change, it mentions Carver (who started several schools that are still around today) and John Howard of National Chiropractic College. These were major players in the mixer movement that denounced Innate Intelligence early in 1900s. There is so much more, but we better fo with one piece at a time. ---- Dēmatt (chat) 13:09, 19 May 2008 (UTC)

Lon Morgan (1998). "Innate intelligence: its origins and problems". 42 (1): 35–41. {{cite journal}}: Cite journal requires |journal= (help) Here is an article on innate. Any suggestions. QuackGuru 05:37, 19 May 2008 (UTC)

The differences between II and ii, as explained by Dematt, are very real, but usage of the words, regardless of capitalization differences, is still problematic. In the real world, including chiropractic writings, there is lack of consistency (except in ultra straight writings), and the words often have the same metaphysical connotations. If chiropractic and chiropractors wish to avoid being misunderstood when they are referring to non-metaphysical concepts, they should stop using those antiquated esoteric terms that historically have only had metaphysical meanings. They should simply call the natural healing processes, the immune system, and the self-limited nature of many diseases, what they are and with those words, just like everyone else does. There are various common terms that could be used, instead of continuing to use the "innate intelligence" words. It would save the profession from many misunderstandings and make the "chiropractic bull's eye" a smaller target for skeptics to hit. I'd favor that. -- Fyslee / talk 06:10, 19 May 2008 (UTC)

I entirely agree, but we're verging into discussion forum territory here. Back to work ;) Jefffire (talk) 14:54, 20 May 2008 (UTC)

You know what's absolutely amazing about the aforementioned discussion? I had no clue about the difference in capitalization, about the meanings etc of II vs ii, etc... The integrative curriculum at CMCC really did not emphasize/teach traditional philosophy. As if even the spelling means something different. CorticoSpinal (talk) 16:07, 20 May 2008 (UTC)

I didn't know it either till Fyslee turned me on to the chiropractic history archives that Keating donated to Chiro.org. We didn't learn it at Logan (a mixer school) in the early 1980s, only that DD discovered it and BJ developed it. The rest was sort of passed off as "you really don't want to know ;-)". Keep an open mind and you will learn a lot more, too. Especially that those darned straights aren't as bad as we make them sound :-) But, don't tell Fyslee I told you that, now, okay, I'll try to get back to work... remember I'm trying to present the straight POV. Where's Hugher when we need him? Levine? ---- Dēmatt (chat) 18:59, 20 May 2008 (UTC)

Oh I'm here. I just don't have much to comment on this. I always understood innate intelligence as the body's inclination toward homeostasis. A body typically "wants" to be healthy. A body "knows" how to be healthy. I know there is a vitalistic history to the concept, but how does materialism define the body's inborn ability to heal itself? Is there a mainstream term for this? If you cut me, I bleed - but my body will also form a scab, send out anti-bodies, cells will repair, and in time I will heel. My body just "knows" how to do this. Chiropractically speaking, the theory goes that only the body heals. Only the body cures. No medicine cures. No adjustment/manipulation heels. However, just as a band-aid may help the healing process of a would, alignment of the spine may help the body cure itself. That's my knowledge of innate intelligence in a nutshell. -- Levine2112 ^discuss 19:22, 20 May 2008 (UTC)

Exactly... there does not have to be anything vitalistic about innate intelligence (ii), no untestable force that can't be explained or measured, it accepts the same reductionist view that studies all the way down to DNA and evolution and whatever other science we can call it, then it falls into that same abyss that all complex systems fall into - some just call it emergence, others call it Mother Nature and still others call it innate intelligence. Sure, some believe that there is something vitalistic/untestable, but then there are scientists that believe in Creationism, too. Their are fringe people everywhere. That doesn't mean we call all scientists fringe, we try to differentiate them from the rest. Okay, I promise, I will stop! Dangit. -- Dēmatt (chat) 20:31, 20 May 2008 (UTC)

chiropractic professional tidbit

Most commonly, chiropractors obtain a first professional, second entry, degree in Chiropractic medicine.[42][43] Typically a 3 year university undergraduate education is required to apply for the chiropractic degree.[44][45]

commentary on chiropractic professional tidbit

Here is a bit information that can be improved. Thoughts? QuackGuru 21:37, 18 May 2008 (UTC)

Citation 80

{{editprotected}}

As I am restricted from editing this page, I am unable to fix the blatant problem with citation 80. If someone could fix the problem, it would be greatly appreciated. Alan.ca (talk) 20:35, 18 May 2008 (UTC)

Here is the whole ref: -- Fyslee / talk 22:20, 18 May 2008 (UTC)

The whole ref with a sentence was removed which caused the broken citation. I recommend all of these edits be reverted to the last broader consensus version. QuackGuru 23:12, 18 May 2008 (UTC)

There is no consensus, Quack. Alan, what specifically is wrong with citation #80 and what is it's relevance to the purported effectiveness of chiropractic? CorticoSpinal (talk) 23:31, 18 May 2008 (UTC)

The problem with the ref is that it's red. It needs fixing. -- Fyslee / talk 05:50, 19 May 2008 (UTC)

Agreed. There is no consensus for these edits. QuackGuru 02:22, 19 May 2008 (UTC)

 Done reference fixed, as a temporary measure. You need to establish whether or not the edits which broke it in the first place had consensus. And the |doi= parameter looks a bit wierd... Happy‑melon 09:39, 19 May 2008 (UTC)

• What's wrong with the DOI parameter? it works for me.
• There was not consensus for the edits which broke it; please see #Recent edits made without discussion.

Eubulides (talk) 20:47, 19 May 2008 (UTC)

red link

Low-level laser therapy is now a red link. Is there another link that might be helpful or should we unlink it. QuackGuru 04:20, 19 May 2008 (UTC)

Sorry, I don't see the red link. In Chiropractic, "low-level laser therapy" is not wikilinked at at all, so how could it be a red link? I recall that there was a draft that wikilinked to LLLT (the page was Photobiomodulation) but that page was removed recently. Until/unless something like it gets added again, I suggest leaving the term alone, i.e., no wikilink. Eubulides (talk) 20:47, 19 May 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropractic&oldid=212672736 I am specifically referring to this version just before CorticoSpinal's recent edits. I recommend removing the red link when the broader consensus version is restored. QuackGuru 20:58, 19 May 2008 (UTC)

Yes, that makes sense. Thanks for clarifying. Eubulides (talk) 21:10, 19 May 2008 (UTC)

Is there another wikilink we might use as an alternative that also covers low-level laser therapy. QuackGuru 21:17, 19 May 2008 (UTC)

I looked for another wikilink but did not find anything plausible. Eubulides (talk) 21:30, 19 May 2008 (UTC)

stable version

Here is a stable version from earlier this year. Is there anything worh merging with the newer version we are working on. We need to take a hard look and see if there was anything deleted that should be restored. QuackGuru 21:36, 19 May 2008 (UTC)

efficacy tidbit

The efficacy and cost-effectiveness of maintenance care in chiropractic is unknown. Original sentence.

The efficacy of maintenance care in chiropractic is unknown. Change to this sentence.

Now that we have a cost-benefit section the discussion about cost-effectiveness would be better in that section. QuackGuru 17:35, 20 May 2008 (UTC)

cost-benefit tidbit

The inclusion of chiropractic for low back and neck pain treatment had a reduction in the rate of advanced imaging, surgery, and plain-film radiographs, and inpatient care.

Having access to chiropractic managed care is associated with a reduction in health care costs, having a clinical benefit, and may reduce overall health care expenditures.

Here is some information I have been working on. Are these two studies useful or are there better references available? QuackGuru 18:12, 20 May 2008 (UTC)

I like these two studies a lot because they are specifically about "chiropractic care" and not SMT in general. I think they can be used in cost-effectiveness and quite possibly in efficacy as well. -- Levine2112 ^discuss 18:32, 20 May 2008 (UTC)

Are these two studies useful or are there better or newer references that generaly cover cost-benefit? We have a lot of references to choose from including reviews. QuackGuru 20:20, 20 May 2008 (UTC)

I think they are useful and are better (for our purposes at this article) than the references which discuss SMT in general. -- Levine2112 ^discuss 21:11, 20 May 2008 (UTC)

I like them and would like to see others as well. Good point about the "chiropractic care" and not only SMT. -- Dēmatt (chat) 21:50, 20 May 2008 (UTC)