Talk:Chiropractic

Edit warning

I am not pleased with the shift from reasoned discussion at this article over the past many months to the petty edit warring of late. Consider this a heads up. My next step is to fully protect the page for a week if necessary, to encourage that happening (or get another admin to do so as I used to edit this article). After that, if individual editors can't resist the urge to make and repeat making changes without consensus, there may be blocks (or bans) as needed. The key here is to have reasoned discussion, and you know what that looks like. If you're getting frustrated or making knee-jerk reverts, you are probably not in a good position to be reasonable so step back and ask for help from others. If you are trying to shape the page so that it looks the way it looked before months of discussion helped it evolve, you are probably not being reasonable. For formality's sake, this page is already under ArbCom Discretionary Sanctions, which means sanctions can be more swift or broad than usual. I'm not threatening action or any one person... just shift the path towards reasoned discussion with reasonable editors and take the extra time to do it right. Cheers, Ocaasi ^{t | c} 02:16, 24 January 2014 (UTC)

Thanks for the reminder Ocaasi!Puhlaa (talk) 02:42, 24 January 2014 (UTC)

Yes, thanks. Discussion should take priority over solo, bold, editing. Any edits which are controversial should be reverted on sight per BRD, and the slightest deviation from BRD (it's not BRBRD, or BRRRRRD) should call forth an immediate block (even if only for one day). There is no need to go all the way to 4RR in such a situation, nor should we have to waste time with a report at the editwarring noticeboard. -- Brangifer (talk) 05:43, 24 January 2014 (UTC)

You knew something happened to the article. Do you see the summary of the body in 2011 when you were editing. Now look at the lead today. Do you think the current version summarises the body properly or the previous version before the article was hacked. QuackGuru (talk) 20:26, 24 January 2014 (UTC)

I completely support this. Puhlaa is an advocate of chiropractic, and an adherent of a school which rejects some of chiropractic's wildr claims. For a long time, Puhlaa has been trying to reshape the article in terms that represent chiropractic as this subgroup wishes it to be, rather than as it actually is - most chiropractors in most countries are simply quacks, promoting their non-existent spinal subluxaitons as the cause of many forms of disease, claiming to treat colic and asthma, engaging in anti-vaccine advocacy, and causing the occasional stroke along the way. I'd be very happy is chiro was as Puhlaa wishes it to be, but that day is a long way off yet. Guy (Help!) 09:23, 25 January 2014 (UTC)

While I agree with your assessment that Puhlaa supports evidence-based chiropractic, I also want to point out that the Discretionary Sanctions specifically suggest we "Avoid discussing other editors, discuss the article instead." Ocaasi ^{t | c} 12:33, 25 January 2014 (UTC)

Take a look at the lede in 2011 and the rest of the article. Currently the lead does not summarise the body properly but how can I or any editor fix the problems when there is much resist to improving the article for far too long. We need to identify what is causing these problems and stop this from happening again. If we don't stop this now it will only continue in the future again. QuackGuru (talk) 18:00, 25 January 2014 (UTC)

Yu can't discuss the issue without addressing the source of the issue. If Puhlaa does not materially change approach, then Puhlaa will end up with a topic ban. It's not a problem of an article needing to be brought under discretionary sanctions (it already is), but a problem of a specific editor consistently making edits that are not in line with policy. My preference is for Puhlaa to start proposing changes on talk instead of editing the article directly, because I do not want Puhlaa to be slapped down; it's much easier to maintain NPOV on articles about quackery if at least some believers take part in debates about content. That doesn't mean we should compromise our standards, but we are here to document, not to debunk, and the involvement of believers halps us to stay honest. That said, if a specific editor cannot restrain themselves form making problematic edits then eventually we have to take action. Guy (Help!) 11:17, 26 January 2014 (UTC)

Hey JzG, I think Puhlaa is about as 'pro-chiropractic' as the couple of 'anti-quack' editors here are anti-chiropractic. There is more than one Chiropractic and some of it is 'woo' as some might call it and other parts of it are 'evidence-based', or 'evidence-supported'. This article should reflect that duality proportionately. To that end, editors who specifically target CAM treatments don't strike me as any less biased than those who practice them; either could be considered to have an agenda and be encouraged to stick to the talk page. But fundamentally, it's not about the background of the editor as much as the sources they use and the arguments they make and policies they cite. I've seen Puhlaa be pretty level-headed here and willing to discuss issues. So in general, I agree that this article would benefit greatly from more talk page discussion all around, but I don't see a single editor as the problem here. Cheers, Ocaasi ^{t | c} 14:22, 30 January 2014 (UTC)

The problem here is the first sentence is SYN because it is putting two different sources to come to a new conclusion and the current article has been undermined. Puhlaa is against restoring what I think is well written summary to the lede. I can combine parts of the well written lede with the updated parts of the new lead to have a proper summary of the body. QuackGuru (talk) 18:17, 26 January 2014 (UTC)

QG, I have already explained that there have been lots of discussion/editing since 2011, to both the article body and lede. Also, an administrator mentioned at the start of this thread that "If you are trying to shape the page so that it looks the way it looked before months of discussion helped it evolve, you are probably not being reasonable". QG, why do you keep suggesting that we should restore a 2011 version of the lede when the article has evolved a lot since then? Your most recent criticism is that the lede combines 2 sources; there was a good discussion and a consensus developed to combine the first two sentences almost 2 years ago! I find it counterproductive to a reasonable discussion, and even insulting, when you suggest that ~3 years of editing and discussion has resulted in an article that is "hacked" or "undermined".Puhlaa (talk) 20:44, 26 January 2014 (UTC)

Discussion did not help improve this article months ago or years ago because the current lede is much shorter and not a good summary. The lede previously had a lot more information in it that was deleted without discussion or reasonable discussion. Where was the discussion to chop in the lede in half. You have ignored there is SYN in the lede sentence and copyright problems. I think chiropractors over the last few years have deteriorated this article. It counterproductive to continue a discussion with an editor who does not understand there is SYN and other problems with the lede. QuackGuru (talk) 22:04, 26 January 2014 (UTC)

@Ocaasi: I am very familiar with the subject. There are actually numerous sects within chiropractic (e.g. McTimoney in the UK), but they broadly separate, like Catholic and Protestant, into Straight and Mixer. Straights are out-and-out quacks, holding to an entirely discredited model of physiology. Mixers occupy a spectrum. At oen end are the quacks, who promote anti-vaccinaiton nosnense, concern themselves primarily with "practice building" and aggressively sell "maintenance adjustments", especially to children. At the other end are those who practise based on evidence, with Sam Homola being the best known example to skeptics. The problem is that most chiros incorporate at least some pseudoscientific practices, virtually all will treat children, which is completely unsupportable, most will claim to treat colic and other diseases entirely unrelated to the musculoskeletal system, and virtually all depend for their livelihood on conducting unnecessary and occasionally dangerous (e.g. manipulation of the neck, wholespine x-rays) procedures and treatments. Puhlaa in particular wants to document an idealised form of chiro that does not do these things, but the evidence shows that the majority of chiros do it all the time.

Skeptics are perfectly content to include the valid indications for chiro: treatment of pain in the musculoskeletal system, where serious underlying disease has been ruled out. Skeptics also want inclusion of the documented adverse events, the lack of any systematic recording of adverse events by chiros, the side-order of pseudoscientific practices and so on. A warts-and-all portrait, in other words. WP:FRINGE entirely supports that. In fact, it mandates it. Guy (Help!) 15:09, 30 January 2014 (UTC)

Indeed JzG, and we have the task of separating unfounded claims (but reporting that Chiropractors sometimes make them) from supported claims. On that point, I agree that adverse events are incredibly relevant to evaluating efficacy and also highlighting the distinction between promise and effect. Puhlaa, I assume is 'documenting' (with reliable sources) the form of chiropractic that s/he actually learned and knows exists, wishes there were more of, and is looking for quality evidence that does support that view. We all bring some bias to articles and I think Puhlaa's evidence-based chiropractic bias is something that will ultimately contribute to a decent article because it bolsters the discussion not to ignore efficacy or overstate risks. In general I want to take the heat down a bit at this article because I don't think we're actually that far off; we're just haggling on the usual issues of WP:WEIGHT and WP:MEDRS and WP:FRINGE. Ocaasi ^{t | c} 15:28, 30 January 2014 (UTC)

Discussion of Alexbrn reverting Puhlaa edit

Alexbrn, you just reverted the addition of a secondary source that I had added to the article body. Your edit summary claim 2 concerns:

1. You said that the source is not in print or finalized, only published online? Can you please show me the policy that says only printed sources are valid - the source says it was finalized in Oct. 2013. It is clearly a valid secondary source.
2. You ask what relevance the conclusions have for the chiropractic profession? Only 36 hours ago you added some text to the article - it said "Chiropractors generally emphasize spinal manipulation but sometimes offer more varied services". Does this fact not make a RS about spine manipulation relevant here?

I fail to understand your concerns Alexbrn, can you clarify these concerns for me? Puhlaa (talk) 19:54, 29 January 2014 (UTC)

Puhlaa, will you please step away from this for a while. No-one doubts your good intentions but repeatedly pushing your chosen occupation into the lede is not appropriate, and correcting for this is inevitably taking up other people's time unnecessarily now. With respect, an argument about whether a source is primary or secondary isn't moving us on here. John Snow II (talk) 23:17, 29 January 2014 (UTC)

I agree with the above from John Snow II. As I have stated before I think it is a violation of WP:Fringe and WP:DUE to represent chiropractic as a "healthcare profession" in the lede. The lede should summarize and present the mainstream consensus, not present the subject in a manner inconsistent with the mainstream consensus. Repeated edits and reverts by a single editor on this article could be seen as WP:POVPUSH. There seems to be IDHT going on. A break might provide an opportunity for development of a considered suggestion, highly preferable to the virtual WP:EW going on now. - - MrBill3 (talk) 03:05, 30 January 2014 (UTC)

On the specific ref in question, something is RS when it is published; we shouldn't link to proofs. If the only relevance to chiropractic is that it mentions SM, and Puhlaa has reasoned on this basis that it can be used as a source for chiropractic, then that is OR/SYN - which we mustn't do. I wonder now if there are other sources which have been thus incorrectly used in this article. Alexbrn ^{talk|contribs|COI} 08:51, 30 January 2014 (UTC)

Continued lede problems

Not a good summary

Chiropractic theory on spinal joint dysfunction and its putative role in non-musculoskeletal disease has been a source of controversy since its inception in 1895. The controversy is due in part to chiropractic's vitalistic and metaphysical origins, and use of terminology that is not always amenable to scientific investigation.[7] Far-reaching claims and lack of scientific evidence supporting spinal dysfunction/subluxation as the sole cause of disease[8][9] has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system.[10] Although there is external and internal debate within the chiropractic profession regarding the clinical significance of joint dysfunction/vertebral subluxation complex,[11] the manipulable lesion/functional spinal lesion[12] remains inextricably linked to the profession as the basis for spinal manipulation.[13]

There is definitely a POVPUSH in the lede. This is poorly written text. It can be improved. QuackGuru (talk) 07:01, 30 January 2014 (UTC)

Conceptual basis problems

For most of its existence, chiropractic has been sustained by pseudoscientific ideas such as subluxation and innate intelligence[16] which are not based on solid science.[9] Some chiropractors have been criticized for having an anti-immunization stance, despite the consensus of public health professionals on the benefits of vaccination,[17] which has led to negative impacts on both public vaccination and mainstream acceptance of chiropractic.[18] The American Medical Association called chiropractic an "unscientific cult"[19] and boycotted it until losing an antitrust case in 1987.[20] Chiropractic is said to have developed a strong political base and to have sustained demand for services; researchers Cooper and McKee report that it has gained more legitimacy and greater acceptance among physicians and health plans in the U.S. for the treatment of some musculoskeletal conditions[20] and the principles of evidence-based medicine have been used to review research studies and generate practice guidelines.[21] Traditional (or straight) chiropractic still assumes that a vertebral subluxation interferes with the body's "innate intelligence",[22] a vitalistic notion ridiculed by the scientific and healthcare communities.[23] Other chiropractors want to separate themselves from the traditional vitalistic concept of innate intelligence[24] – John W Reggars wrote in 2011 that chiropractic was at a crossroads, and that in order to progress it would need to embrace science; in his view, the promotion of chiropractic as a cure-all was both "misguided and irrational".[25]

See Chiropractic#Conceptual basis.

None of this text belongs in the Conceptual basis/Philosophy section. The first section is about philosophy. The above text is misplaced and not relevant to the section. Most of this text was originally in the lede. See paragraph three in the well written lede. Why was the lede summary moved to Conceptual basis? QuackGuru (talk) 07:01, 30 January 2014 (UTC)

Information that was not about conceptual basis was restored to the section. Also the lede should summarise the body. The text that summarize the body should never have been moved to another section.

https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=prev&oldid=529303776 A section was spun off from the lede into a "background" section.

https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=prev&oldid=529645465 A section was spun off from the lede into a "background" section.

https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=next&oldid=530067980 A section was spun off from the lede into a "background" section.

https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=next&oldid=530492360 A section was spun off from the lede into a "background" section.

These changes did not improve the article. Moving the text to a background section that is a summary of the body is not appropriate. QuackGuru (talk) 23:26, 1 February 2014 (UTC)

No single profession owns spinal manipulation

No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors.

Deleting this text does not improve the article. This is very relevant text. QuackGuru (talk) 05:03, 30 January 2014 (UTC)

The part, as these are the only areas where evidence supports its use. is not about the scope of practice section and no rationale for deleting No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors. has been given. QuackGuru (talk) 03:01, 2 February 2014 (UTC)

Despite this finding?

See Chiropractic#Straights and mixers. "Despite this finding, a 2008 survey of 6000 American chiropractors demonstrated that most chiropractors seem to believe that a subluxation-based clinical approach may be of limited utility for addressing visceral disorders, and greatly favored non-subluxation-based clinical approaches for such conditions.[11][not in citation given][33]"

"The data reported in Figure 1 suggest a more complex picture regarding how chiropractors specifically apply the concept of subluxation in actual clinical practice. Most chiropractors typically reported that over 75% of their clinical approach to addressing musculoskeletal or biomechanical disorders such as back pain was “subluxation-based”.' Conversely, most chiropractors also reported that less than 20% of their clinical approach was “subluxation-based” for patient complaints deemed to be principally problems with circulation, digestion, or similarly “visceral” in nature."page 3

The text follows the source accurately but did not include the part "Most chiropractors typically reported that over 75% of their clinical approach to addressing musculoskeletal or biomechanical disorders such as back pain was “subluxation-based”". Reference 11 is misplaced. QuackGuru (talk) 06:05, 30 January 2014 (UTC)

I fixed the lopsided view but it was reverted. QuackGuru (talk) 23:34, 1 February 2014 (UTC)

The new wording in this case is hard to understand, suggest rephrase. Agree with the other 3 examples of the edits QuackGuru gave on WTMED. Therefore, I think we should AFG and not state that these edits are non NPOV since the edits appear to me to be improvements to the article, such as making sure the figures in the article are the same as the cited sources. Lesion (talk) 18:08, 2 February 2014 (UTC)

Reliability of Chiropr and Osteopat

I'd like to have some discussion about the appropriateness of this source.

Lawrence DJ, Meeker WC (2007). "Chiropractic and CAM utilization: a descriptive review". Chiropr Osteopat. 15: 2. doi:10.1186/1746-1340-15-2. PMC 1784103. PMID 17241465.{{cite journal}}: CS1 maint: unflagged free DOI (link)

• see: http://www.ncbi.nlm.nih.gov/pmc/journals/429/

Cheers, Ocaasi ^{t | c} 14:28, 30 January 2014 (UTC)

I think the first thing to be said is that as things were (in your restore), the source was subtly misrepresented with nonsense. "Practitioners such as chiropractors are often used as a complementary form of care" makes no sense. And the implication that chiro is "often used" is not what the source says, it says: "CAM is itself used by people suffering from a variety of conditions, though it is often used not as a primary intervention, but rather as an additional form of care." (So, notice this is a statement about CAM in general, so I'm still not sure it supports what we say!)

Chiropractic & Osteopathy is an open-access CAM journal. The article is written by two chirporactors at the Palmer College of Chiropractic. So, not an independent source: it's a community speaking to itself. However, the claim is not very exceptional (especially now it is represented correctly). But more worryingly, this is now seven years old and based on older data, yet Wikipedia is asserting the sourced statement, in its own voice, as if it were contemporary fact. Alexbrn ^{talk|contribs|COI} 15:01, 30 January 2014 (UTC)

Thanks for that explanation. I think the source was reasonably represented as "often used not as a primary intervention, but rather as an additional form of care" is tantamount to "often used as complimentary care [rather than a primary form]". I can't see much of a difference there, honestly, though I could skeptically read it from a different perspective. In any case, your tweaks make sense and avoiding ambiguity is always good.

I'm more generally concerned with the notion that no chiropractors writing about chiropractic could never be independent, in the sense that doctors writing about medicine are presumed to be unbiased. I'm not drawing a false equivalence here, but raising a point and a question: if published in a decent journal at the appropriate level of evidence-review, aren't chiropractors reliable for claims about their own profession. Explicitly medical claims about efficacy I can see needing to be from higher quality reviews, but claims that 'chiropractic is often complimentary rather than primary' is just the sort of claim that published chiropractors could reliably make. In an established journal--and I admit I'm not familiar with Chiropr and Osteopat--I'm not sure I agree that they are automatically excluded from reliability solely on the basis of their profession.

As for age, we do prefer articles within 5 years, and this is 7 years old, so it could be better. Still, the plainness of the claim seems unproblematic to me in that time-frame. Thanks again for explaining your view. Cheers, Ocaasi ^{t | c} 15:10, 30 January 2014 (UTC)

As it was originally, I think the problem was it wasn't a claim about the profession, but a more general claim about how chiro is "often used" (implying, used in general), which is problematic. Anyhow, that issue is moot with the re-write we have. I am a bit concerned that where the source is talking about CAM, we've changed the meaning to make it specific to chiro only.

I do think there is the danger of a false equivalence between doctors and chiropractors. Medicine is a broad field in which doctors tend to use what is best (when they behave correctly); techniques change over time and so practice and options change. A chiropractor believes in and delivers a single product, chiropractic, and is financially interested in selling as much of it as they can. A better equivalence would be between a Doctor who is sponsored by a drug company writing about those drugs, and a chiropractor writing about chiropractic (which, for the doctor, would be unethical without a COI declaration). WP:FRINGE guides us to use independent sources for fringe topics, and states: "Points that are not discussed in independent sources should not be given any space in articles". The article we're citing is like an advertisement in parts, with some very dubious statements: I mean, "CAM and chiropractic often offer lower costs for comparable results compared to conventional medicine" ... that's just garbage as stated, isn't it? We should be very wary of fringe journals. Alexbrn ^{talk|contribs|COI} 15:34, 30 January 2014 (UTC)

"When chiropractic is used, it is often as a complementary therapy rather than as primary treatment.[113]" This is a non-controversial statement. We can't wipe out all sources we don't like from this article. QuackGuru (talk) 05:26, 4 February 2014 (UTC)

Actually it's a VERY controversial statement, because it is simply untrue. The source doesn't even back it up. Some wording there has been misinterpreted:

• "CAM is itself used by people suffering from a variety of conditions, though it is often used not as a primary intervention, but rather as an additional form of care. CAM and chiropractic often offer lower costs for comparable results compared to conventional medicine."

That quote is about CAM in general, not specifically chiropractic. In practice, chiropractors rarely work together with mainstream health care, but in their own private clinics, where chiropractic care is indeed the "primary intervention". It is only if the patient also happens to be getting some other form of care that one could discuss other possible descriptions, but it's often not happening with the good will or wishes of the chiropractor, since they often seek to advise against MDs, drugs, surgery, etc., and try to convince patients and their families to use them as their primary care physician.

So, we have some wording that needs to be removed as it is a misunderstanding and unintentional SYNTH violation. -- Brangifer (talk) 06:05, 4 February 2014 (UTC)

I replaced it with another source. See (PMID 23171540). QuackGuru (talk) 06:43, 4 February 2014 (UTC)

I don't think that really solves the problem, even though you have changed the wording somewhat. This reference, unless I'm misreading it, actually surprises me. I had thought that chiropractors had succeeded in deliberately (according to their discussed plans) placing their practices more in areas where coverage by MDs and DOs was low or nonexistent, but this source indicates that this hasn't happened to the degree I had expected. It indicates that they practice the same places where MDs and DOs practice, and thus are not "an alternative point of access", IOW not an "only" point of access. They are one of many points of access, because their patients can use them, and MDs, and DOs, simply because they are all in the same geographical area. "Complementary" doesn't refer to geographical proximity, but to deliberate cooperation between practitioners. This source doesn't mean they are cooperating, which is the implication of "complementary" care. If we stretch the meaning of "complementary medicine" to include every situation where patients receive treatment from multiple providers, some of whom are alternative medicine practitioners, and who may not even be talking to each other or coordinating their efforts, then the term "complementary medicine" just became meaningless. I don't think we should do that. It would be best to leave this source and wording out, and I see that it has happened.

Let's not try to get this type of wording into the article by stretching to reach it. Let's find examples where these practitioners are actually working together, cooperating, and complementing each other. That does happen, but it's rare, and the examples we can find are the exception which proves the rule. When it becomes the norm, rather than the exception, then we can talk about the profession as a complementary profession. Right now it's still offered as an alternative (in direct competition, with enmity), and thus comes under the CAM umbrella, but usually only the "A" (alternative) part. -- Brangifer (talk) 16:00, 4 February 2014 (UTC)

We should stick to what the sources say. An uninvolved editor made this comment. User:WhatamIdoing is right. See Wikipedia talk:WikiProject Medicine#Is WHO guideline a MEDRS. QuackGuru (talk) 02:59, 5 February 2014 (UTC)

This is getting a bit out of hand. Please see Talk:Chiropractic#Reliable sources must not be deleted again. QuackGuru (talk) 18:44, 5 February 2014 (UTC)

• Bronfort G, Haas M, Evans R, Leininger B, Triano J (2010). "Effectiveness of manual therapies: the UK evidence report". Chiropr Osteopat. 18: 3. doi:10.1186/1746-1340-18-3. PMC 2841070. PMID 20184717.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link) The article may need updating because we have a lot more independent sources available at this time. QuackGuru (talk) 19:42, 30 January 2014 (UTC)

Still useless, as it's in a journal devoted to promoting chiropractic. How about Cochrane? That would be considered reliable.

• http://www.ncbi.nlm.nih.gov/pubmed/21248591: "Combined chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions."
• http://www.ncbi.nlm.nih.gov/pubmed/22972127 "SMT is no more effective in participants with acute low-back pain than inert interventions, sham SMT, or when added to another intervention. SMT also appears to be no better than other recommended therapies. Our evaluation is limited by the small number of studies per comparison, outcome, and time interval. Therefore, future research is likely to have an important impact on these estimates. The decision to refer patients for SMT should be based upon costs, preferences of the patients and providers, and relative safety of SMT compared to other treatment options. Future RCTs should examine specific subgroups and include an economic evaluation."

Seems like a fair summary to me. Guy (Help!) 20:45, 30 January 2014 (UTC)

The source I mentioned that might be "useless" is in the article. QuackGuru (talk) 03:58, 31 January 2014 (UTC)

Request newer source

Most people who seek chiropractic care do so for low back pain.[6] QuackGuru (talk) 18:41, 30 January 2014 (UTC)

Might be true. That doesn't stop chiropractors seeking new patients who have no low back pain, and trying to sell them a never ending course of treatment. Where and why do you think your statement is relevant? Guy (Help!) 20:54, 30 January 2014 (UTC)

We can keep this source until a newer source is found. It is relevant because people seek chiropractic care for back pain but not dogma care. QuackGuru (talk) 01:29, 31 January 2014 (UTC)

Effectiveness

Manual therapies commonly used by chiropractors are as effective as other manual therapies for the treatment of low back pain,[122][123] and might also be effective for the treatment of lumbar disc herniation with radiculopathy,[124][125] neck pain,[126] some forms of headache,[127][128] and some extremity joint conditions.[129][130] While guidelines issued by the WHO state that chiropractic care may be considered safe when employed skillfully and appropriately,[2] chiropractic spinal manipulation is frequently associated with mild to moderate adverse effects, and with serious or fatal complications in rare cases.[131][132][133]

There is a POVPUSH in the introduction of effectiveness. QuackGuru (talk) 19:53, 30 January 2014 (UTC)

In what way? That does not seem overly promotional of chiropractic to me. Guy (Help!) 20:42, 30 January 2014 (UTC)

"While guidelines issued by the WHO state that chiropractic care may be considered safe when employed skillfully and appropriately,[2] chiropractic spinal manipulation is frequently associated with mild to moderate adverse effects, and with serious or fatal complications in rare cases.[131][132][133]" This is information about safety. It is duplicate from safety.

The first section is supposed to be about effectiveness in general. The specific details are in the specific sections. QuackGuru (talk) 01:19, 31 January 2014 (UTC)

Entire section is missing?

What happened to the Utilization, satisfaction rates, and third party coverage section? A lot text was deleted when the section was split into two separate sections. QuackGuru (talk) 20:30, 30 January 2014 (UTC)

• I suspect someone decided that we should not succumb to fallacious appeals to popularity. Guy (Help!) 20:52, 30 January 2014 (UTC)

I think some of the information can be restored. QuackGuru (talk) 01:25, 31 January 2014 (UTC)

Over 100 countries

Chiropractors practice in over 100 countries in all regions of the world, but they are most prevalent in North America, Australia and parts of Europe.[2][5]

There is a POVPUSH in the lead. Chiropractors practice in over 100 countries in all regions of the world?

For the lede: Chiropractic is established in the U.S., Canada, and Australia.

For the body: Chiropractic is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries.

• Tetrault M (2004). "Global professional strategy for chiropractic" (PDF). Chiropractic Diplomatic Corps.

The text in the lede must be improved. QuackGuru (talk) 03:50, 31 January 2014 (UTC)

I support these proposed edits based on the reasoning given. - - MrBill3 (talk) 18:45, 31 January 2014 (UTC)

I added it to the body and lede but is was reverted. Not sure why yet. QuackGuru (talk) 23:33, 1 February 2014 (UTC)

History

There is too much information on Palmer and Palmer's son. See Chiropractic#History. Similar sentences is duplication:

Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease.

According to D.D. Palmer, subluxation was the sole cause of disease and manipulation was the cure for all diseases. See Chiropractic#History. QuackGuru (talk) 18:49, 31 January 2014 (UTC)

"Chiropractic has had a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school was founded on "…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it".[120] D.D. Palmer established a magnetic healing facility in Davenport, Iowa, styling himself ‘doctor’. Not everyone was convinced, as a local paper in 1894 wrote about him: "A crank on magnetism has a crazy notion hat he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method…he has certainly profited by the ignorance of his victims…His increase in business shows what can be done in Davenport, even by a quack."[120] D.D. Palmer remarked that "Give me a simple mind that thinks along single tracts, give me 30 days to instruct him, and that individual can go forth on the highways and byways and get more sick people well than the best, most complete, all around, unlimited medical education of any medical man who ever lived."[9]"

I deleted this text above because it is not a good summary. A long run on quote is not a well written summary. I improved the section that accurately explained about the history of chiropractic. See here. QuackGuru (talk) 02:54, 2 February 2014 (UTC)

Concerted campaign

There have been a very substantial number of edits by QuackGuru, plus additional advocacy by others, I have seen OTRS requests relating to the "imbalance" of the chiropractic article; months of stability have been replaced by a rapid push towards a more flattering portrayal of chiro, and (purely by coincidence) my sinister agents tell me that chiros are once again angling for money under Obamacare and for primary care provider status. Very singular... Guy (Help!) 21:11, 1 February 2014 (UTC)

I rewrote the safety information for the lede. QuackGuru (talk) 22:43, 1 February 2014 (UTC)

You also reverted my removal of the questionable claim that it is safe when practiced correctly. This is unsupportable; it is a claim made by the industry in the report they wrote for the WHO, but there is no systematic recording of adverse events and no consensus definition of what correct might be. This has no place in the lede, and definitely no place in discussing the consensus view of chiro. Guy (Help!) 23:06, 1 February 2014 (UTC)

The text you deleted said "Spinal manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications."

It did not say it is safe "when practiced correctly".

Your edit deleted text from the lede that summarised the body. The article should be balanced and not one-sided. You also deleted a recent 2013 systematic review (PMID 23787298) from the safety section. QuackGuru (talk) 23:18, 1 February 2014 (UTC)

I'm sorry, Guy, but you cannot dismiss WHO guidelines merely on the grounds of authorship. Such guidelines are well-established as reliable in WP:MEDRS #Medical and scientific organizations and carry the weight of the body and its review procedures to establish its authority. "WHO acknowledges its indebtedness to over 160 reviewers, including experts and national authorities and professional and nongovernmental organizations, in over 54 countries who provided comments and advice on the draft text." I'm not willing to accept that you're a better judge of the quality of the guidelines than they. The WHO guidelines contain this introduction to safety of chiropractic on page 19 "When employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems. There are, however, known risks and contraindications to manual and other treatment protocols used in chiropractic practice." Now unless you can find an equally strong MEDRS-compliant source that contradicts that (hint: Ernst will have done so), it needs to be in the article - and it's so much a central point that it needs to be in the lead. If you can't come up with a source and a wording that describes a disagreement between MEDRS sources, I'm going to have to insist that QG's wording goes back in.

Now if you want to argue each of QG's edits point-by-point, then let's get on with it, but you need to have good quality MEDRS-compliant sources to back up your version. My first impression is that you've reverted as a gut reaction, rather than from the basis of best sources. Let's hope you prove my impression wrong. Cheers --RexxS (talk) 01:26, 2 February 2014 (UTC)

WP:FRINGE also applies, and guides us to use independent sources. The WHO guidelines go on to say the guidelines were finalized by their panel (of chiropractors and CAM advocates), which suggests this is not such an independent text. However, even in purely MEDRS terms this is rather an old document; we should do better.

In 2008 Ernst wrote about chiropractic safety in the review, PMID 18280103. First (of relevance to the above) he notes statements such as "chiropractic is safe" "can be found abundantly" in "chiropractic literature". Based on poor available evidence he then goes on to say that "it seems highly doubtful whether reliable incidence figures can presently be calculated". Alexbrn ^{talk|contribs|COI} 07:26, 2 February 2014 (UTC)

This is what is in the body: "Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints.[2]"

This edit to the lede is only summarising what is already in the body. The lede should summarise major points in the body. The World Health Organization (WHO) is listed under Wikipedia:Identifying reliable sources (medicine)#Medical and scientific organizations. QuackGuru (talk) 07:33, 2 February 2014 (UTC)

The WHO may be reliable in general, but the document in question is not a statement of the WHO. Granted, it is published by their publishing arm and so has something of the WHO imprimatur, but it was authored and finalized by chiropractors and CAM activists and we know nothing of the fact-checking process that was used. But this is moot anyway: even if the source was good for sure, we should not be using a 2005 document to make statements in Wikipedia's own voice when later (and certainly reliable) sources paint a different, more complicated picture. This goes right to the heart of a requirement for NPOV. Alexbrn ^{talk|contribs|COI} 07:56, 2 February 2014 (UTC)

You haven't shown later sources paint a different picture about the safety information and the safety information is still in the body. QuackGuru (talk) 08:09, 2 February 2014 (UTC)

As the Ernst abstract has it, "Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence". That is different from the bromide offered by the "WHO" document. As to synchronizing the lede and body, I see that as a housekeeping exercise that can be done once we know what the neutral point of view is which WP should be taking. Alexbrn ^{talk|contribs|COI} 08:20, 2 February 2014 (UTC)

The "housekeeping exercise" can be done any time and there is no reason to exclude a summary of a key point of the body because there may be changes to it in future. The WHO guidelines were produced by the WHO and you can't dismiss them just because some of the contributors were part of the chiropractic industry. There is a lengthy list of attendees at the conference which shows a spread of backgrounds - most of the non-chiropractors seem to be experts in traditional medicine or representatives of local or regional health authorities. Anyway, that's not relevant; we either trust WHO to produce accurate, neutral guidelines or we don't. We can't have it both ways where we accept WHO as MEDRS only when we like what they say. None of us are qualified to criticise individual WHO guidelines.

We need to find some consensus on what sources are best for describing the safety of chiropractic. A Pubmed search on "chiropractic safety" limited to reviews from the last 5 years produces eight results - six if we ignore the two relating to small animals and horses. Three are Cochrane reviews, but are specific to infantile colic (PMID 23235617), acute low-back pain (PMID 22972127), and carpal tunnel syndrome (PMID 22696387), respectively. None of these say anything about safety beyond there's no evidence to come to any conclusion. The same is true of PMID 2164025 (treatment of adults with headache). That leaves us with PMID 19712793 which is an attempt "to develop an evidence-focused and work-based model framework for patient safety training" and is "how-to" guidance for chiropractors on safety - not what we're actually looking for. So that leaves PMID 19444054 (Gouveia LO, Castanho P, Ferreira JJ, 2009) that looks good to me. The only problem is that it concludes "There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic." I'm failing to find anything solid to put up against WHO's 2005 guidelines. We do need to be cognisant of the dangers of WP:RECENT and it would be a mistake to dismiss that nine-year-old source purely on the grounds of age, when we don't have anything new to replace it with.

Now it may be that I've missed some recent reviews - Pubmed isn't infallible and Professor Ernst will probably have something relevant. Please feel free to adduce some sources and perhaps some better wording than that taken from WHO 2005, but right now I'm not seeing any convincing reason to alter what is in the body - and hence what should be in the lead. --RexxS (talk) 15:49, 2 February 2014 (UTC)

Most topics the WHO treats are not fringe ones, so the independence question does not come into play: it's not a question of being qualified to criticize the guidelines, but of being able to recognize an independent source. MEDRS is an important guideline built on an important guideline, but it mustn't be used to erode one of the central pillars of Wikipedia which is neutrality (and WP:FRINGE expands on WP:PSCI, part of the NPOV policy). In the context of a "guidelines" document the statement that chiropractic is "safe and effective [when employed skillfully and appropriately]" is not an assessment of the situation, but a statement of reassurance of what will happen if the guidelines are followed. If it's used (as we use it) to imply that this is an evidenced description then that is misleading; it contradicts later, better, sources which tell us there is no evidence to support such a general safety claim. Alexbrn ^{talk|contribs|COI} 16:22, 2 February 2014 (UTC)

That's probably because chiropractic is considered CAM, not fringe in the mainstream view. I don't think you'll find WHO guidelines on homeopathy, for example. I agree that we shouldn't be eroding NPOV, but that means we need to be open-minded about topics. I find the stuff about "subluxations" to be complete hogwash, but I'm open to hear sources say that SMT can have some effect - even if nobody can suggest a mechanism beyond placebo - and I'm prepared to believe a reliable source that tells me that the manipulations can be performed relatively safely, even if 5 out of 100,000 result in arterial dissection. To be honest, I'm sick of hearing entrenched view on one side or another battling it out time and again on the same issues in this article. If you want to know what the consensus here is - and that is really aimed at you, Guy - then take the time to read the archives. You can see in Talk:Chiropractic/Archive 31, Talk:Chiropractic/Archive 32, Talk:Chiropractic/Archive 33, from September 2010 to August 2011 where I argued exactly the same issues of MEDRS and NPOV, but that time I was arguing with editors who thought we couldn't use Ernst because he's anti-chiropractic. I really don't want to repeat the same ordeal with editors who want to reject WHO because they think it is pro-chiropractic. Let me make my position clear: There are editors who think chiropractic is a great cure-all and the best thing since sliced bread; there are editors who think chiropractic is utter nonsense, both ineffective and highly dangerous. Both are wrong - and the sources will show that if we're open-minded enough to read them. --RexxS (talk) 17:15, 2 February 2014 (UTC)

A very arrogant and wrong statement Rexx, which deserves to be ignored. "Hardcore" chiropractic is total claptrap, despite what you claim. If you remove the unevidenced parts of chiropractic, what remains isn't chiropractic, and might do some good for backache. --Roxy the dog (resonate) 17:31, 2 February 2014 (UTC)

Complete bollocks, Roxy. I make no claims about "hardcore" chiropractic, whatever that is - although I agree that there is a lot of clap-trap around subluxations that ought to be treated as the nonsense it is. If you'd bothered to read the archives where I spent a year of my wiki-life trying to keep the clap-trap out of this article, you'd know how far off the mark you are. For what it's worth, your arguments about the efficacy of chiropractic echo my position, but you're three years late in quoting me. The above is my concern about how we represent the safety of chiropractic, which if you get your brain around it, is a different issue. --RexxS (talk) 17:46, 2 February 2014 (UTC)

Do you think we should maintain NPOV in the lead and body? QuackGuru (talk) 17:56, 2 February 2014 (UTC)

I'm not sure WHO should be rejected necessarily, but neither do I think it should be a kind of ace-of-trumps source. Taking a step back ... Wikipedia, to be neutral, needs to be in line with respected scientific opinion. Do we really get that by having Wikipedia relay a source which says "When employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems." Effective for the prevention of a number of health problems? really? Are we really saying this is fine? Alexbrn ^{talk|contribs|COI} 17:43, 2 February 2014 (UTC)

The WHO source is not contradicted by later, better, sources. You have not given a better source that can be used to update the safety section. If that were true the safety section in the body would of been updated. Editors should not delete the information in the body without replacing it with updated information about safety. I previously explained we should summarise the body in the lede. You were asked to provide better or updated sources and you were unable to do that. You say that stating it is "safe and effective [when employed skillfully and appropriately]" is misleading. That is not the proposal. The source also said: "There are, however, known risks and contraindications to manual and other treatment protocols used in chiropractic practice". This is the proposal I previous explained in this thread: "Spinal manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications." This edit to the lede is a proper summary of the body according to WP:LEAD. We are eroding NPOV when we don't include it in the lede. QuackGuru (talk) 17:56, 2 February 2014 (UTC)

(edit conflict) Well, Alex, it's deja vu again for me. Ernst has a 2008 review that accepts efficacy for just lower back pain; Bronfort G, Haas M, et al, "Effectiveness of manual therapies: the UK evidence report", Chiropr Osteopat. 2010; 18: 3. February 25. doi: 10.1186/1746-1340-18-3. PMCID: PMC2841070, which found efficacy in a few other areas, gained consensus here three years ago - Talk:Chiropractic/Archive 33 #Changes needed in the LEAD et seq. refers. And so on for the efficacy question. Risks are covered by WHO 2005 who found chiropractic relatively safe, but Ernst reviewed fatalities and concluded "the risks outweigh the benefits". Do you really want the article to say "chiropractic is dangerous and offers no benefits as a treatment"? Because, as skeptic as I am personally, my reading of the sources just doesn't support that. --RexxS (talk) 18:03, 2 February 2014 (UTC)

Well as a (relative) newbie to this article I thank you for indulging me :-) No, I don't think we should say "chiropractic is dangerous and offers no benefits as a treatment" - the sources don't support that and there are degrees here. I am simply concerned about following the "WHO" source too closely particularly in regards of its "safe and effective" line. I will reserve further judgement until its settled what exactly this article will say (and hunt around to see if there are some sources we've missed) ... Alexbrn ^{talk|contribs|COI} 18:20, 2 February 2014 (UTC)

My edit did not state its "safe and effective". I suggest you look at the specific edit again and explain what is the issue. You have not made a reasonable argument for excluding it from the lede. Why are you so hesitant to improving the lede? After reviewing my edits and concerns, do you support this version? QuackGuru (talk) 19:13, 2 February 2014 (UTC)

TBH I wasn't thinking about the lede it particular, but the WHO sourcing and POV more generally. Is the idea that we pick the safety info from the WHO source and disregard other things it says in the same sentence? Alexbrn ^{talk|contribs|COI} 20:06, 2 February 2014 (UTC)

I'm sorry I was patronising, Alex, and I promise I'll try harder not to let my weariness with the endless arguments here tire me out. It's not fair to take it out on you. I think QG's wording was "Spinal manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications.<ref name=WHO-guidelines/> Spinal manipulation is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.<ref name=Ernst-adverse/><ref name=CCA-CFCREAB-CPG/>" which looked like a good summary to me of both the WHO general view and Ernst's investigations of particular, but thankfully rare, serious adverse effects. Whereas Guy prefers "there is ... some evidence of severe adverse effects from cervical vertebral manipulation.<ref name=Trick-or-Treatment>{{cite book |pages=145–90 |chapter=The truth about chiropractic therapy |title=[[Trick or Treatment: The Undeniable Facts about Alternative Medicine]] |author=Singh S, Ernst E |year=2008 |publisher=W.W. Norton |isbn=978-0-393-06661-6 }}</ref>" to be the sole comment about chiropractic safety in the lead. I think that we could (and should) have more to say about safety than that. Please understand, I'm only talking about what the lead says about safety - not effectiveness, nor risk/benefit that always get confused here. So, the question should be "does including a summary in the lead of what the WHO has to say about safety improve the article or not?" I would remind everyone that simply dismissing a source as "written by pro-chiropractic authors" makes it very hard for us to counter the chiropractor advocates when they want to dismiss Ernst "because he's an anti-chiropractic author". And believe me, I know how hard that is. --RexxS (talk) 22:11, 2 February 2014 (UTC)

Enough boldness already

There are an immense number of edits, restoring much content that had previously been discussed and rejected, and introducing other questionable content. It is time to stop the rapid-fire edits and start discussing them.

For example, the section "conceptual basis" is written entirely in-universe, and fails to reflect the fact that "innate" is (a) rnonsense and (b) still believed by some; it does not reflect the fact that vertebral subluxation does not exist; it presents descriptions of straights and mixers direct from the manual and not accordding to a reality-based perspective.

There are far too many edits over too short a time to properly assess, and any attempt at discussion is steamrollered bere by "I changed that" without in any way taking on board the comments made. QuackGuru, this article is covered by the WP:FRINGE arbitration. I am rolling back to the point before your mass edit spree, per WP:BRD, you must now achieve consensus for the changes you wish to make. Guy (Help!) 23:16, 1 February 2014 (UTC)

https://en.wikipedia.org/w/index.php?title=Chiropractic&oldid=593497515 This version is neutrally written.

https://en.wikipedia.org/w/index.php?title=Chiropractic&oldid=593501863 This version does not summarise the body and is poorly written.

I summarised the body in the lede and I made a lot of good improvements. There was text in the conceptual basis section that was misplaced. A major part of the summary of the article was added to conceptual basis. See Talk:Chiropractic#Conceptual basis problems. QuackGuru (talk) 23:44, 1 February 2014 (UTC)

You are engaging in argument by assertion. You made many edits in a short space of time, replacing the version thrashed out over months with a version favourable to an idealised view of chiropractic and reverting changes made to try to restore long-standing consensus wording. You falsely perceive your own biases as neutrality. The article falls under the ambit of the arbitration ruling on pseudoscience, that kind of behaviour is not going to do you any favours.

This is against a background where I know that external collusion is going on, and where the trade is desperate to refactor the Wikipedia article to follow the idealised view they like to present to legislators rather than the real-world view. Chiropractors are widely viewed as charlatans due to their practice of endless courses of wholly unnecessary "maintenance" treatment, adverse events about which they are in flat-out denial, claims of safety in the absence of any systematic adverse event reporting (and some thing that dizziness and blackouts are not significant), implausible claims to cure colic and asthma, blatantly pseudoscientific side-practices like quack nutritional therapies and cranial osteopathy, and widespread anti-vaccination activism. As your own version acknowledges, chiro needs to ditch a lot of baggage to become a reputable health profession. Until it has done that, we don't represent it as a reputable health profession.

So: propose changes, in bite-size chunks that can be assessed by others, and don't execute them until you have achieved consensus. Guy (Help!) 09:37, 2 February 2014 (UTC)

The thing is, Guy, that QG isn't pro-chiropractic; he isn't part of a grand conspiracy to promote pseudoscience; and he certainly isn't a trade-insider, looking to get rich by promoting his business in a flattering light. I don't know of an editor more skeptical of chiropractic's claims than QG. You're claiming "consensus" for the wording and sources, yet you haven't read the archives. Try 31 to 33 where even a cursory glance will show you that you've got him wrong. Your problem at present is that you're on a crusade to get chiropractic re-classified as fringe/pseudoscience, but it isn't. It is a serious discipline in the CAM field and does have good quality, reliable sources that have studied it. You'll find the jury's still out on most of the claims of effectiveness - even Ernst's 2008 review admitted some results in treating lower-back pain - and I still find Ernst's conclusion that the "risks outweigh the benefits" to be convincing. But that's not the same as feeling it necessary to paint a wholly negative picture when the best sources don't agree with that. Your extremism at one end is as misguided as those chiropractic advocates who were so relentless 3 years ago. It does us no favours to try to turn "CAM" into "Fringe", because when we fail to understand the difference, we weaken our ability to reject wholly non-scientific pseudoscience like homeopathy - and that only benefits the snake-oil salesmen in the long run.

I agree most heartily with your advice to QG (and I've already suggested the same to him, at WT:WikiProject Medicine. Let's do our best to cooperate in improving this article and genuinely seek some consensus. --RexxS (talk) 17:36, 2 February 2014 (UTC)

But in this case, CAM and Fringe (and Pseudoscience) are one and the same thing. --Roxy the dog (resonate) 17:40, 2 February 2014 (UTC)

That is not the point. The point is if editors edited according to NPOV this article would improve. QuackGuru (talk) 17:56, 2 February 2014 (UTC)

You did not directly response to my comment in this thread. See Talk:Chiropractic#Conceptual basis problems. You have not given a reason based on Wikipedia policy why this article should not have a good summary of the body in the lede and you have not made any legitimate objection to my edits based on any policy on Wikipedia. Your statement of chiropractic such as "Chiropractors are widely viewed as charlatans" should not get in the way of improving this article even if it is the truth. QuackGuru (talk) 17:56, 2 February 2014 (UTC)

I'm judging by the tone of the edits, many of which are functionally identical to proposals in the past by Puhlaa, who is not only pro-chiropractic but a practising chiropractor. But actually the principal point is that this is a mature article and it was extensively refactored over a rapid series of dozens of edits, with absolutely no meaningful response to any reservations raised other than to assert, basically, that QG rewrote that (as if that necessarily fixed the problem). The WHO example is a case in point. That does not belong in the lede because it makes a claim that is unsupportable (how would they know if it;s safe, every independent assessment shows that there is no systematic adverse event reporting) and it certainly doesn't belong in the block devoted to the reality-based perspective, because it's a report written by industry insiders. The WHO has fallen down in this way many times, with reports on homeopathy and acupuncture also written by insiders, at least one of which they have had to publicly distance themselves from. Developing the article is fine, change is good, but please achieve consensus first, and don't use a blunderbuss. Guy (Help!) 20:36, 2 February 2014 (UTC)

The WHO guideline belongs in the lead in the absence of any MEDRS-compliant source that contradicts it. Your personal opinion on the flaws of the WHO are worthless in the absence of reliable sources that confirm your opinion. The WHO guidelines had consensus from three years ago and it's you who are editing in defiance of that consensus. I'm happy to discuss CCC, but you need to bring sources that support your view. Or better yet, you need to amend your view to match what the best sources say and not let your personal bias cause you to reject good sources where their conclusions are inconvenient to your preconceptions.

As a matter of principle, I've restored the last-known good version of the article, because you have twice evaded my reasonable request to state which version of the article you restored. If anyone wishes to restore an earlier version, then I have no objection as long as you have the courtesy to indicate which version of the article you are restoring. --RexxS (talk) 20:55, 2 February 2014 (UTC)

If the decision is to roll back, I think that the article should be restored to oldid 592998776. This version existed just after Alexbrn reverted my edit per BRD and we started discussion about his revert. The next edit after Alexbrn's revert was JohnSnow's controversial edit to the first sentence that was against the consensus that was established here and recently discussed again here. It was after JohnSnow's controversial edit against consensus that QG began mass editing without consensus and where discussion should probably resume. Puhlaa (talk) 03:16, 3 February 2014 (UTC)

The WHO source may be the most reliable source for safety information in general. No other source directly contradicts it. QuackGuru (talk) 04:06, 3 February 2014 (UTC)

Apart from the ones noting serious adverse events, anti-vaccinationism and so on, of course. The problem is that the WHO report refers to an idealised "safely practiced" chiropractic, assuming that the lack of adverse events is because there are none rather than because of the well known absence of any systematic recording of them, and begs the question of what is correct practice - something on which chiros themselves show no agreement. It's a document written by the industry to try to legitimise itself, and should not be viewed as any kind of authoritative statement on the actual safety of chiropractic as practiced. It needs to be viewed in the context of commentaries like this, which note: " In patients <45 years old, those with VBA [vertebrobasilar accidents] were 5 times as likely as controls to have visited a chiropractor in the previous week, and 5 times more likely to have made more than 3 visits for cervical treatment in the preceding month." See also this: "As they have no systematic method of compiling adverse events, they simply aren’t looking for them." And remember that the neck twist is a singularly dramatic intervention, and one that many chiros regard as a signature move. It is potentially lethal and has no proven beneficial effect. We have to be extremely careful in taking any kind of assessment of risk at face value, because as the Nerology study showed, they are normally found only by reverse engineering admissions data. You cannot survey chiropractors and ask them for adverse event data, they don't have it, and many of them are in denial about the mere possibility they might exist. And as I said before, the WHO previously published a report on hmeopathy, also written by industry insiders; it was junk. They have since distanced themselves from this. In alternative medicine the WHO is acting in a political role: it is vulnerable to lobbying by interest groups and that can and does skew output. Guy (Help!) 10:41, 3 February 2014 (UTC)

I am trying to find a better source specifically for the "safety" information. Eventually Ernst or another researcher will explain the current safety of chiropractic. QuackGuru (talk) 05:16, 4 February 2014 (UTC)

Demarcation

There are a couple of sources from Michael Shermer:

• The Borderlands of Science : Where Sense Meets Nonsense: Where Sense Meets Pseudoscience (2001)
• Philosophy of Pseudoscience: Reconsidering the Demarcation Problem (book chapter; ed. Massimo Pigliucci & Maarten Boudry) (2013)

In both, Shermer places chiropractic in what he calls "borderlands science", i.e. a gray area between science and pseudoscience. He also says (in the second source) that demarcation depends on multiple factors -- including efficacy, btw -- which ties into Brangifer's point about chiro being a mixed bag. Unlike the question of whether to eat the Curate's egg, demarcation is frequently considered fuzzy (particularly among scholarly sources), and this view appears to be a significant one with respect to chiro specifically. Shermer and similar sources turn up with a Google books search for chiro and terms like "demarcation" and "gray area". (If you just google for chiro and pseudoscience you're more likely to find the sources that take a bright line approach & call it pseudo outright.) --Middle 8 (leave me alone • talk to me) 08:56, 3 February 2014 (UTC)

This is a point we make well in the lede. Chiro is plausible for back pain, massively implausible for colic or asthma. However, the Australian situation is illustrative of the problem. CBA has a robust stance against anti-vax advocacy and predatory practices, CAA is run by antivaxers. CAA has more members.

In chiropractic, the charlatan majority is giving the responsible minority a bad name. Guy (Help!) 10:55, 3 February 2014 (UTC)

Duplication

UK chiropractic organizations and their members make numerous claims which are not supported by scientific evidence. Many chiropractors adhere to ideas which are against science and most seemingly violate important principles of ethical behaviour on a regular basis. The advice chiropractors gave to their patients is often misleading and dangerous.[106] This situation, coupled with a backlash to the libel suit filed against Simon Singh, has inspired the filing of formal complaints of false advertising against more than 500 individual chiropractors within one 24 hour period,[107][108] prompting the McTimoney Chiropractic Association to write to its members advising them to remove leaflets that make claims about whiplash and colic from their practice, to be wary of new patients and telephone inquiries, and telling their members: "If you have a website, take it down NOW." and "Finally, we strongly suggest you do NOT discuss this with others, especially patients."[107] See Chiropractic#Ethics.

In 2008 and 2009, chiropractors, including the British Chiropractic Association, used libel lawsuits and threats of lawsuits against their critics.[124] Science writer Simon Singh was sued for libel by the British Chiropractic Association (BCA) for criticizing their activities in a column in The Guardian.[125] A preliminary hearing took place at the Royal Courts of Justice in front of Justice David Eady. The judge held that merely using the phrase "happily promotes bogus treatments" meant that he was stating, as a matter of fact, that the British Chiropractic Association was being consciously dishonest in promoting chiropractic for treating the children's ailments in question.[126] An editorial in Nature has suggested that the BCA may be trying to suppress debate and that this use of British libel law is a burden on the right to freedom of expression, which is protected by the European Convention on Human Rights.[127] The libel case ended with the BCA withdrawing its suit in 2010.[128][129] See Chiropractic#History.

In two different sections we have similar, almost duplicate text. I think for the history section it should be shortened or deleted. QuackGuru (talk) 19:32, 4 February 2014 (UTC)

It may look worse than it is. Although both para's mention the Singh case, they discuss different ramifications of it. In fact I'm having a hard time finding a single sentence, or clause, that is redundant. --Middle 8 (leave me alone • talk to me) 20:57, 7 February 2014 (UTC)

User:Middle 8, I made this change and merged some of the deleted text. QuackGuru (talk) 08:03, 8 February 2014 (UTC)

2010 report

Current text: "A 2010 report found that manual therapies commonly used by chiropractors are effective for the treatment of low back pain, neck pain, some kinds of headaches and a number of extremity joint conditions.[133]" See Chiropractic#Effectiveness.

Proposal: "A report found that spinal manipulation therapies are effective for the treatment of low back pain, neck pain, migraine and cervicogenic headache and a number of extremity joint conditions." Read the conclusion for ref 133 The part "commonly used by chiropractors" is not part of the conclusion. The part "some kinds of headaches" might be WP:OR. QuackGuru (talk) 02:15, 5 February 2014 (UTC)

Reliable sources must not be deleted again

https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=next&oldid=592768717

https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=next&oldid=593089869

https://en.wikipedia.org/w/index.php?title=Chiropractic&diff=593850971&oldid=593850690

"A 2012 study suggests that chiropractors may be used in a more complementary role to primary medical intervention." See (PMID 23171540).

Per NPOV, we must include opposing POV. All the journals are reliable. Move on. QuackGuru (talk) 18:41, 5 February 2014 (UTC)

To quote WP:FRINGE: "Points that are not discussed in independent sources should not be given any space in articles". So, any points worth inclusion will be easy to source in independent sources, right? Find me those sources. Alexbrn ^{talk|contribs|COI} 19:00, 5 February 2014 (UTC)

The sentence is relevant to the section. There is no basis for deleting it based on fringe because chiropractic is not fringe. QuackGuru (talk) 03:34, 6 February 2014 (UTC)

I think this is a fringe topic: we have the PS discretionary sanctions applying here. If you want to think about this another way, your source is a primary source from an industry publication venturing a speculative claim about how others (i.e. mainstream medicine) interact. Yet our policy requires that when we use primary sources only for "straightforward, descriptive statements of facts". Is there really no better source? Alexbrn ^{talk|contribs|COI} 06:58, 6 February 2014 (UTC)

Here is another source. This source is already used in this article. It says a lot. Maybe we can include both sources. Here is the ref citation.<ref name=Cooper/> I made this change. QuackGuru (talk) 22:54, 6 February 2014 (UTC)

Alexbrn, do you agree it was a mistake to try to delete chiropractic reliable sources solely based on authorship. QuackGuru (talk) 18:02, 7 February 2014 (UTC)

When did that happen? who did it? Alexbrn ^{talk|contribs|COI} 18:04, 7 February 2014 (UTC)

Misplaced and irrelevant text

On the NHS Choices website, they make patients aware that there is "no scientific evidence to support the idea that most illness is caused by misalignment of the spine."[111] This is not about international reception. See Chiropractic#International reception. QuackGuru (talk) 03:24, 6 February 2014 (UTC)

Duplication again

A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).[94] The same sentence is found in another section. See Chiropractic#Ethics. QuackGuru (talk) 05:30, 6 February 2014 (UTC)

Not neutrally written

A 2010 analysis of chiropractic websites found the majority of chiropractors and their associations made claims of effectiveness not supported by scientific evidence, including claims about the treatment of asthma, ear infection, earache, otitis media, and neck pain.[103] Read the conclusion. See Chiropractic#Ethics. QuackGuru (talk) 05:30, 6 February 2014 (UTC)

Recent 2012 source for safety

I found a more recent source for the safety information. I made this change to summarise the body. QuackGuru (talk) 07:04, 7 February 2014 (UTC)

In general, your citations need to be formatted to follow WP:MEDREF. The easiest way to achieve this is to use this tool. Alexbrn ^{talk|contribs|COI} 07:08, 7 February 2014 (UTC)

A 2013 systematic review and meta-analysis

A 2013 systematic review and meta-analysis found a statistically significant improvement in overall recovery from sciatica following spinal manipulation, when compared to usual care, and suggested that spine manipulation may be considered.

Lewis RA, Williams NH, Sutton AJ; et al. (2013). "Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses". Spine Journal. doi:10.1016/j.spinee.2013.08.049. PMID 24412033. {{cite journal}}: Cite has empty unknown parameter: |month= (help); Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) We are using numerous sources about spinal manipulation in this article. I don't understand why this particular source was deleted. QuackGuru (talk) 08:17, 7 February 2014 (UTC)

Does it mention chiropractic ? Alexbrn ^{talk|contribs|COI} 08:29, 7 February 2014 (UTC)

We have numerous sources in this article that do not mention chiropractic specifically. It was decided to include them in the article. QuackGuru (talk) 08:31, 7 February 2014 (UTC)

Who "decided" OR/SYN was okay? Alexbrn ^{talk|contribs|COI} 08:35, 7 February 2014 (UTC)

There is no SYN or OR when the text is sourced. Check the archives. Editors already decided to keep this type of information. Almost all the effectiveness section is spinal manipulation in general. QuackGuru (talk) 08:40, 7 February 2014 (UTC)

Standards have risen then. We shouldn't be concluding things about chiropractic from sources that don't even mention it! That is kind of a basic expectation. Alexbrn ^{talk|contribs|COI} 08:47, 7 February 2014 (UTC)

You haven't shown what is OR. There was a RfC on this. See Talk:Chiropractic/Archive 27#Request for Comment: Excluding treatment reviews. And there were uninvolved editors who commented on this including User:WhatamIdoing. See Talk:Chiropractic/Archive 27#Outside view by WhatamIdoing. QuackGuru (talk) 08:57, 7 February 2014 (UTC)

An inconclusive RfC from 6 years ago doesn't overturn community consensus as embodied now in one of our chief guidelines, WP:OR. It states: "To demonstrate that you are not adding OR, you must be able to cite reliable, published sources that are directly related to the topic of the article, and directly support the material being presented." (bolding in original). That is perfectly clear. Alexbrn ^{talk|contribs|COI} 09:11, 7 February 2014 (UTC)

This was previously explained in the RfC the sources are directly related to the topic at hand and directly support the material being presented. QuackGuru (talk) 17:05, 7 February 2014 (UTC)

(e/c) @ Alexbrn -- "Embodied now", as opposed to six years ago? OR has been around for a lot longer than that. And it pertains to explicit syntheses that advance a position, not inclusion of relevant material in articles. Chiropractors' main modality is spinal manipulation (SM), so discussing SM in the article is natural and not OR. An example of OR/SYN might be, e.g., "30% of American primary healthcare providers referred for SM in 2012, so that same 30% endorses chiropractic care." Ask at WP:OR/N? --Middle 8 (leave me alone • talk to me) 17:20, 7 February 2014 (UTC)

The sources do not "directly" refer to chiropractic. You might try and argue that SMT and chiropractic are synonymous - but there are sources in the article which say that it's just not that simple: "ownership" of SMT is controversial. Maybe try WP:NORN ? Alexbrn ^{talk|contribs|COI} 17:23, 7 February 2014 (UTC)

The sources "directly relate" to chiropractic. This was explained many many times. QuackGuru (talk) 17:53, 7 February 2014 (UTC)

Wrongly. You cannot override community consensus guidelines with specious local arguments. As I say: try WP:NORN if wider input is needed. Alexbrn ^{talk|contribs|COI} 17:55, 7 February 2014 (UTC)

Please read this comment. In short, the NOR/N discussion supported removing the SYN tag. Levine2112 disagreed with that removal, and initiated an RfC here to reverse it. This was discussed at length. QuackGuru (talk) 18:20, 7 February 2014 (UTC)

Looks inconclusive to me (like the RfC), and is six years old. Let us return to WP:NORN. I will raise this here tomorrow morning (GMT), unless somebody beats me to it ... Alexbrn ^{talk|contribs|COI} 18:32, 7 February 2014 (UTC)

See Talk:Chiropractic/Archive 27#Request for Comment.2C Possible OR violation at Chiropractic Effectiveness.

See Talk:Chiropractic/Archive 27#Futility of .22effectiveness.22 discussions.

See Talk:Chiropractic/Archive 27#Request for Comment: Excluding treatment reviews.

There were 2 RfC. There are convincing arguments the text is not OR at all. QuackGuru (talk) 18:47, 7 February 2014 (UTC)

• This commentary is directly relevant: you cannot judge me by my signature therapy. That's precisely what is going on with these studies. Things chiros do that are accidentally effective are being used to assert the validity of a core concept that is wholly bogus, namely the diagnosis, treatment and prevention of non-existent spinal subluxations. And although that is a blog, the source is Britain's first professor of complementary and alternative medicine, so as a statement of his considered professional judgement it is perfectly usable. Guy (Help!) 10:54, 8 February 2014 (UTC)
  • Yes, saw that too - a good read. Incidentally, I have opened a thread at WP:NORN. Alexbrn ^{talk|contribs|COI} 11:07, 8 February 2014 (UTC)
  • (Add) And, speaking of Ernst, this blog post makes it clear why we can't just say that SMT=chiropractic if the source doesn't say so. Different professions offer SMT with different levels of supporting evidence and different outcomes. Alexbrn ^{talk|contribs|COI} 11:23, 8 February 2014 (UTC)

"If we ask how effective spinal manipulation is as a treatment of back pain, we get all sorts of answers. Therapists who earn their money with it – mostly chiropractors, osteopaths and physiotherapists - are obviously convinced that it is effective. But if we consult more objective sources, the picture changes dramatically. The current Cochrane review, for instance, arrives at this conclusion: SMT is no more effective in participants with acute low-back pain than inert interventions, sham SMT, or when added to another intervention. SMT also appears to be no better than other recommended therapies."[1] Ernst is using an objective source to compare the different professions. He also said we cannot draw firm conclusions from comparing the systematic reviews. QuackGuru (talk) 19:49, 8 February 2014 (UTC)

Exactly. If different types of SMT are not comparable, we can't just take SMT in general and say it "is" Chiropractic SMT. Alexbrn ^{talk|contribs|COI} 07:37, 9 February 2014 (UTC)

We are not comparing different types of SMT the way Ernst is doing. The text does not say it is Chiropractic SMT. The text says it is SMT. QuackGuru (talk) 19:14, 9 February 2014 (UTC)

Again, exactly. We can't take it upon ourselves to equate SMT in general to "chiropractic SMT", if the source is silent on that matter. Alexbrn ^{talk|contribs|COI} 19:27, 9 February 2014 (UTC)

There's also the issue that chiros tend to assert some type of ownership over SMT, even though it is basically only accidental that the pseudoscientific theory on which chiro is based, leads to manipulation of the spine in an attempt at therapy. Guy (Help!) 19:29, 9 February 2014 (UTC)

Chiropractors do tend to claim ownership over SMT but that does not mean the text about spinal manipulation is OR. We are not saying SMT is chiropractic SMT in the text. QuackGuru (talk) 19:42, 9 February 2014 (UTC)

So if SMT in general is not chiropractic per se, and the source doesn't mention chiropractic, then why include it? What possible reason could there be? Alexbrn ^{talk|contribs|COI} 19:47, 9 February 2014 (UTC)