Talk:Chiropractic

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)

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)

I'm not sure that Ernst is the best place to look for neutrality of information in regards to chiropractic. The following article may be of benefit for this article

"Current literature shows that minor discomfort or soreness following spinal manipulation typically fades within 24 hours." 1. Senstad O, et al. Frequency and characteristics of side effects of spinal manipulative therapy. Spine 1997 Feb 15;435-440.

"Neck manipulation is a remarkably safe procedure. While some reports have associated upper high-velocity neck manipulation with a certain kind of stroke, or vertebral artery dissection, recent evidence suggests that this type of arterial injury often takes place spontaneously, or following everyday activities such as turning the head while driving, swimming, or having a shampoo in a hair salon." 2. Cassidy D, et al. Risk of Vertebrobasilar Stroke and Chiropractic Care. Spine 2008; 33:S176–S183.

"The best evidence indicates that the incidence of artery injuries associated with high-velocity upper neck manipulation is extremely rare – about 1 case in 5.85 million manipulations" 3. Haldeman S, et al. Arterial dissection following cervical manipulation: a chiropractic experience. Can Med Assoc J 2001;165(7):905-06.

DJFryzy (talk) 05:51, 12 February 2014 (UTC)

The problem is that those are chiropractors denying the problem, and they have exactly the same issue that all other chiropractic claims of safety have: there is no systematic reporting of adverse events. What we do know for sure is that victims of VBAs under age 45 are substantially more likely to have recently visited a chiropractor {[1], [2]). Any paper by a chiro that does not address this head on, is by definition not a rebuttal to the point. The reason Ernst is a more reliable source than chiros, evidentially, is that he is not financially dependent on chiropractic. He's also more reliable scientifically in that his research does not start from an assumption of validity, which is the core problem that leads research in fields such as chiropractic to be characterised as pseudoscience. Guy (Help!) 13:27, 12 February 2014 (UTC)

Chiro's are not alone in not having a systematic reporting system. You will need to extend that criticism to physical therapists, osteopaths, exercise physiologists etc. In Australia at least, Chiropractors are the ones heading up the push for systematic reporting.

Ernst not making money off chiropractic? All you need to do is buy a few books that he sites his own research in and he's making money. Sorry, but that is not a good argument. Ernst has invested interest in his research. The largest study, that i'm sure you would like to rebut is the Cassidy study in regards to stroke and primary health care interaction. This would also suggest that you have an increased risk of stoke seeing your MD. DJFryzy (talk) 00:22, 13 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)

You deleted the sources that are reliable.[3][4][5] It happened again with another source. See Talk:Chiropractic#Fringe journal or MEDRS compliant.3F. QuackGuru (talk) 02:39, 10 February 2014 (UTC)

For fringe journals it's not authorship that's the problem, it's the non-independence of the source. Alexbrn ^{talk|contribs|COI} 12:25, 10 February 2014 (UTC)

"Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions." according to WP:MEDASSESS.

Peer-reviewed journals are not fringe journals. Reliable sources can't be deleted based on authorship or where it was published. This was previously explained with the WHO source. You can't reject a source based on being published in a chiropractic "peer-reviewed" journal. User:WhatamIdoing wrote in part: That doesn't sound like a true "fringe" belief to me. It was previously explained that fringe does not apply. See Wikipedia talk:WikiProject Medicine#Is WHO guideline a MEDRS. QuackGuru (talk) 17:11, 10 February 2014 (UTC)

So, you'd use the Flat Earth Journal for flat earth topics would you? ;-) For fringe topics we must use independent sources: that is enshrined in WP:FRINGE. If we start using dedicated periodicals that exist to promote fringe interests, we risk not presenting the mainstream scientific view, as is required by NPOV - one of the central pillars of Wikipedia. Alexbrn ^{talk|contribs|COI} 17:19, 10 February 2014 (UTC)

QuackGuru: You are showing distinct signs of trying to WP:OWN the article. Statements such as "Reliable sources must not be deleted again" are classic ownership. We are not bound to install every source, however reliable; that is a matter of editorial judgment. Guy (Help!) 13:43, 12 February 2014 (UTC)

There was a discussion at Wikipedia talk:WikiProject Medicine#Is WHO guideline a MEDRS. The WHO source is reliable according to other editors but you disagreed. I am not the only editor who wanted to keep the WHO source in the article? See comments by User:RexxS, User:Jmh649, User:Bluerasberry, and User:WhatamIdoing. QuackGuru (talk) 18:52, 12 February 2014 (UTC)

• Hello! Is there anyone here who feels that the latest official statement endorsed by the WHO either should not be used, or is being used improperly? If so please concisely state the problem. Blue Rasberry (talk) 18:55, 12 February 2014 (UTC)

User:Bluerasberry, I started a new thread about the safety information in the lede regarding the WHO source and another source for the lede. Please see "Although"? and "published by practitioners". QuackGuru (talk) 07:15, 13 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."[6] 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)

SMT is a modality of chiropractic (and in fact the primary one), and it's not OR to cite such sources when a modality is already uncontroversially part of a profession. But (cf. Ernst) to the extent different professions use variants of SMT, we'd have to use editorial discretion as to including a given source here. But it wouldn't be a blanket yes or no. Risks of stroke from SMT are discussed; do we or would we demand that every source specifically mention chiro? --Middle 8 (leave me alone • talk to me) 18:43, 12 February 2014 (UTC)

Yes, otherwise we are interpreting research, which we have no business doing. (And yes, there are lots of problems in this article). The wording of WP:OR is definite. Alexbrn ^{talk|contribs|COI} 18:46, 12 February 2014 (UTC)

Please see my more detailed comment[7] at NORN; we get to use discretion. A blanket "no" defies common sense (see my example there... I have podiatry on the brain lately, if you'll pardon an awkward expression).

Ethics section deleted

If another article is kept this section stills requires a summary. See WP:SUMMARY. I suggest an AFD or redirect for Chiropractic professional ethics. Or maybe the new article could be kept. QuackGuru (talk) 20:48, 9 February 2014 (UTC)

Fine.. so let's just add "See also: Chiropractic professional ethics. ^Д-р_{СДжП,ДС}

I added a link to the new article. QuackGuru (talk) 21:00, 9 February 2014 (UTC)

The part "According to one controversial source is OR and the text is sourced.[8] QuackGuru (talk) 21:14, 9 February 2014 (UTC)

The American Chiropractic Association (ACA) has a Code of Ethics "based upon the acknowledgement that the social contract dictates the profession’s responsibilities to the patient, the public, and the profession; and upholds the fundamental principle that the paramount purpose of the chiropractic doctor's professional services shall be to benefit the patient." The International Chiropractor's Association (ICA) also has a detailed set of professional canons.

This can be discussed in this article. QuackGuru (talk) 02:22, 10 February 2014 (UTC)

I recommend an AFD for Chiropractic professional ethics. I don't see a reason to have a separate article for duplicate information. QuackGuru (talk) 04:58, 11 February 2014 (UTC)

Fringe journal or MEDRS compliant?

• 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)
• See Wikipedia talk:WikiProject Medicine/Archive 22#MEDRS complaint source.
• See Talk:Chiropractic/Archive 33#Changes needed in the LEAD.

There was a previous discussion about this source. QuackGuru (talk) 02:11, 10 February 2014 (UTC)

We follow guidelines and policy, not ad hoc decisions wrongly taken by past editors. For a WP:FRINGE topic we need to use independent sources, and not fringe journals. Otherwise we risk including crappy content in the article: which is precisely what happened here. To find out more read more about this "notorious" Bronfort paper here. Alexbrn ^{talk|contribs|COI} 06:39, 10 February 2014 (UTC)

It's a fringe journal and there is also a financial conflict of interest. Unsuitable. WP:REDFLAG. IRWolfie- (talk) 00:42, 11 February 2014 (UTC)

Let's review Chiropr Osteopat.

"Peer-review policies

Peer review in Chiropractic & Manual Therapies is designed to ensure that published articles are scientifically sound.

The submitted manuscript will be sent to two external experts for evaluation of scientific significance and validity.

Peer reviewers will have three possible options for each manuscript: accept, accept with revision, and reject. Peer reviewers are asked to justify their decision.

Based on the critiques of the reviewers, the authors may choose to revise their manuscript and resubmit it for an additional review. Chiropractic & Manual Therapies allows authors a maximum of two revisions of a manuscript."[9]

You cannot reject it based on funding sources or authorship. See WP:MEDASSESS. QuackGuru (talk) 01:21, 11 February 2014 (UTC)

Yes, most fringe journals claim peer review. It does not make it reliable. I'm not rejecting the source based on my own personal criteria but due to WP:REDFLAG. IRWolfie- (talk) 22:34, 13 February 2014 (UTC)

User:Alexbrn, we can also include this response from Ernst.

This worked for the acupuncture article: "A 2012 meta-analysis conducted by the Acupuncture Trialists' Collaboration found "relatively modest" efficiency of acupuncture (in comparison to sham) for the treatment of four different types of chronic pain, and on that basis concluded it "is more than a placebo" and a reasonable referral option.[107] Commenting on this meta-analysis both Edzard Ernst and David Colquhoun said the results were of negligible clinical significance.[108][100]"

We can do the same for this article to maintain NPOV. QuackGuru (talk) 01:32, 11 February 2014 (UTC)

I included both the 2010 report and the response from Ernst: Commenting on this study, Edzard Ernst stated that it was a notorious example of a pseudo-systematic review that omitted evidence, for instance, of negative primary studies.[134] QuackGuru (talk) 04:25, 11 February 2014 (UTC)

Surely if you think Bronfot's article is unable to be used, then how can Ernst's be used??? DJFryzy (talk) 04:07, 12 February 2014 (UTC)

I did not delete the source. Another editor claimed it was a fringe journal but that is not the case. QuackGuru (talk) 04:33, 13 February 2014 (UTC)

It is not an objectively reliable source, obviously, since its existence is dependent on promoting the validity of chiropractic, its editorial board are all ideologically committed to chiropractice, its authors are all chiropractors, and thus is follows the pseudoscientific method (seeking confirmation) rather than the scientific method (testing truth). It is a reliable source for what chiropractors believe, but not for truth. A bit like Acupuncture and Meridian studies or Homeopathy - we can use such junk journals to describe the views of practitioners, but not to assert that these views are in any way connected with reality. Guy (Help!) 07:20, 12 February 2014 (UTC)

I provided evidence the source is peer-reviewed. How does your personal opinion of the source trump MEDRS. QuackGuru (talk) 04:33, 13 February 2014 (UTC)

You provided evidence that they claim peer review. You haven't shown that their peer review is any good or that they have any sort of reputation for fact checking; i.e that they aren't fringe. IRWolfie- (talk) 22:35, 13 February 2014 (UTC)

I could NOT provide evidence it is peer reviewed. QuackGuru (talk) 05:33, 14 February 2014 (UTC)

Weight issue

Students attending the chiropractic program at Canadian Memorial Chiropractic College during 2011-12 had a positive outlook toward vaccination.[213][undue weight? – discuss]

The source (PMID 23997247) is reliable but it is a weight issue. QuackGuru (talk) 16:14, 11 February 2014 (UTC)

A primary source from an industry-specific altmed journal, commenting on that industry? Really? It's undue too. (Add: and to top it off, it was misused - the source says: "it can not be said with any certainly if this represents a trend toward a more favorable attitude with respect to vaccination among chiropractic students at CMCC" while we implied otherwise by including it. Sheesh.) Alexbrn ^{talk|contribs|COI} 16:17, 11 February 2014 (UTC)

Radical changes to article

The recent additions and subtractions from this article have shown blatant bias to the topic. This is meant to resemble an encyclopaedia, not propaganda for ones own agenda. QuackGuru has continued to use articles from the likes of Edward Ernst, in preference to peer reviewed literature such as Cochrane and guidlines from some of the most prominent medical societies.

This page has been the subject of much vandalism in the past and it is not appropriate that we continue to allow this to happen to this page.

DJFryzy (talk) 04:04, 12 February 2014 (UTC)

You will find it much more productive to refrain from accusing contributors of 'vandalism', and instead provide specific details of what exactly the problem is. AndyTheGrump (talk) 04:08, 12 February 2014 (UTC)

thankyou for your concern AndyTheGrump, however no such accusation was made, just an observation of the many previous additions of autoconfirmed status for the protection of the page Protection statusDJFryzy (talk) 05:06, 12 February 2014 (UTC)

How about we start with reference 3. The reference never mentions the profession is marginal, however that some members remain tied to a marginal professional status..i.e. a "minority" are tying themselves to a marginal group, no longer supported by the broader profession.DJFryzy (talk) 05:06, 12 February 2014 (UTC)

Looks fine to me (though we could say it "has been called a marginal profession"). You're quoting from the abstract? "The potential movement of chiropractic from a marginal to a limited status" is one of the strands of the article. Alexbrn ^{talk|contribs|COI} 06:53, 12 February 2014 (UTC)

Adding a "'Simon-says' style" like "has been called" a marginal profession raises a serious dispute as to the wording of "marginal profession".

The existence of featured articles on controversial subjects like Evolution, articles that do not use the "Simon-says" style, shows that we need not use the "Simon-says" style here. The "Simon-says" style is certainly not required for NPOV. It is merely a style; other, better styles are available.

The proposed style change, which is to insert "has been called" when the current wording has a significantly NPOV tone, raises the question of how one determines whether a word or phrase has a significantly non-NPOV tone. I think WP:ASSERT is a good way to follow when there is no serious dispute. QuackGuru (talk) 20:59, 12 February 2014 (UTC)

Evolution isn't controversial -Roxy the dog (resonate) 21:17, 12 February 2014 (UTC)

Evolution ranks at the 10th percentile for readability on Wikipedia. Not exactly a mark of excellence. Collect (talk) 21:18, 12 February 2014 (UTC)

Bravo, point taken. Doesn't make your point though, if the article was good enough for a featured article according to whoever makes those choices, perhaps your metric isn't as good as you think it is? Anyway, that isn't what I meant, as you probably realise. -Roxy the dog (resonate) 21:27, 12 February 2014 (UTC)

We are going off topic a little here... back to the profession being labelled "marginal".. A study from the RAND corporation state, Today, chiropractors are the third largest group of health care providers, after physicians and dentists, who treat patients directly. In the last decade of the 20th century, chiropractic has begun to shed its status as a marginal or deviant approach to care and is becoming more mainstream. DJFryzy (talk) 22:20, 12 February 2014 (UTC)

User:DJFryzy, you may be right. This proposal is for section Chiropractic#International reception: "In the U.S., chiropractic is the largest alternative medical profession.<ref name=Kaptchuk-Eisenberg/>

This is reference 8 that is in the article and it is a reliable source.[10] QuackGuru (talk) 03:54, 13 February 2014 (UTC)

How should we go about editing the article? I suggest either removing "marginal profession" and changing to either "It is a profession moving from a marginal to mainstream health profession" ... or ... "it is a profession maturing towards mainstream healthcare profession"...or any other thoughts?DJFryzy (talk) 10:04, 13 February 2014 (UTC)

User:DJFryzy, this might work: It is a health care profession maturing towards integration.[3]

OR: It is a health care profession moving towards integration.[3] QuackGuru (talk) 19:34, 13 February 2014 (UTC)

You have hit the nail on the head with the first one. I support you on the edit. Would you like to or should I. DJFryzy (talk) 07:02, 14 February 2014 (UTC)

You can go ahead an edit. I am taking a break from editing this article. QuackGuru (talk) 07:03, 14 February 2014 (UTC)

We can't say "maturing towards integration" in Wikipedia's voice based on old sources. Sounds like a brochure. Alexbrn ^{talk|contribs|COI} 07:59, 14 February 2014 (UTC)

What would you suggest Alexbrn? Please keep in mind the previous references, in particular the most recent RAND study. DJFryzy (talk) 08:08, 14 February 2014 (UTC)

The quickest fix is probably to delete that sentence (how can a profession be based on vitalism anyway?) until the definition is nailed down better, as you are proposing below. The RAND document is not a great source - something out of an American think-tank? We can do much better. Alexbrn ^{talk|contribs|COI} 08:35, 14 February 2014 (UTC)

I'm not sure I understand. Why couldn't a profession be based on vitalism? It is, isn't it? [11], [12], [13], [14], [15] Shouldn't we document this clearly in the lead, since it's such a large part of the traditional (and even current) underpinnings of the topic?   — Jess· Δ♥ 14:51, 14 February 2014 (UTC)

I'm probably just being pedantic/weird (hey, I'm British - that's my excuse anyway) and seeing "based on" as implying an "is a" rather than "has a" type of relationship. I think one could say the beliefs in chiropractic are based on vitalism, or that the chiropractic profession is based around the sales of services which contain elements of vitalism. Alexbrn ^{talk|contribs|COI} 14:57, 14 February 2014 (UTC)

I see. So you'd prefer not saying "a profession based on vitalism". Would "chiropractic is based on vitalism" be ok? We're defining chiropractic as "a form of alt med", so that seems to sidestep the issue AFAICT. I tried incorporating that into the lead. Let me know if it addresses your concerns!   — Jess· Δ♥ 15:10, 14 February 2014 (UTC)

Or we could say Traditional chiropractic, with beliefs based on vitalism..., but that seems a little wordy for me.   — Jess· Δ♥ 15:12, 14 February 2014 (UTC)

Yup - something like that :-) (Though I'm not sure how exclusively central vitalism is ... but that's another question!) Alexbrn ^{talk|contribs|COI} 15:14, 14 February 2014 (UTC)

Seems way too wordy... the RAND doc was a non chiropractic think tank out of the US and Canada. The two largest providers of chiropractic services. Thus probably a fitting group to define a profession. How about we make a few changes here... delete: *marginal* as we have decided that this is not the case..Second change appears to be around *vitalism*. According all the sources that have been mentioned above, vitalism is a part of the philosophy of chiropractic, not necessarily the basis of the clinical aspect of practice. Would it be more appropriate to have a sentence such as Chiropractic philosophy is based on vitalism... or Vitalism is the core of chiropractic philosophy...DJFryzy (talk) 04:34, 15 February 2014 (UTC)

That's wordier. The current approach was just to add the words , based on vitalism, to the article.   — Jess· Δ♥ 04:38, 15 February 2014 (UTC)

It is necessary to have vitalism in context though, otherwise it is not relevant. DJFryzy (talk) 04:48, 15 February 2014 (UTC)

Not sure what you mean. What's the "context"? Your recent edit changed it to be only a historical connection, is that what you mean? As far as the sources I've seen indicate, the connection is not only historical, but also current. "Straights" embrace the traditional vitalistic underpinnings of the profession, and "mixers" still incorporate vitalism with bits and pieces of modern medicine. Do we have sources indicating the connection to vitalism is only in the past?   — Jess· Δ♥ 05:08, 15 February 2014 (UTC)

Mann_jess and DJFryzy, here is a reliable source that discusses the topic of vitalism and may help you. Puhlaa (talk) 05:57, 15 February 2014 (UTC)

Congratulations!

Only 11% of Wikipedia articles are less readable, ensuring that no one can understand this article as it sits. [16]. I would award it the "barbstar of unreadability" but that page seems quite difficult to find ... Collect (talk) 15:30, 12 February 2014 (UTC)

This isn't simple wikipedia. This is an article about a medical topic. According to that site, academic works usually score less than 30, this one scoring 26. The score is based on sentence and word length. The word "chiropractic" is 4 syllables, and we need to discuss even longer words like the musculoskeletal system. There are undoubtedly ways that this article can be improved for readability, but your summary that "no one can understand it" seems unjustified, especially without any concrete proposals for change. If you want the article cleaned up, then what's one area, such as a section, paragraph or sentence, that you think we could improve?   — Jess· Δ♥ 16:11, 12 February 2014 (UTC)

Collect has a point though. Even ignoring any metrics, this article is a pretty gnarly read - and if the various sub-articles are taken into account their collective force is even gnarlier. As for many controversial topics, the battlefield scars are apparent. (P.S. I love the idea of a "barbstar"!) Alexbrn ^{talk|contribs|COI} 16:33, 12 February 2014 (UTC)

The subpages for this article are not immune -- Vertebral subluxation is at the 9% level, Chiropractic treatment techniques is at the 3% level, Spinal adjustment is at the 14% level, and so on. And this is not a requirement for medical topics, by the way. We can make articles with some readability if we try. Even on "technical stuff." Cancer is just as difficult a topic -- but is at the 23% level -- not great, but miles better than these articles. IRS instructions tend to be well over the 50% mark, really. Collect (talk) 16:54, 12 February 2014 (UTC)

I'd say that Collect has a point. I suspect that much of the unreadability may be down to the contentiousness of the article, and the tendency for contributors to argue endlessly about every last word, rather than looking at the broader picture. A little more consideration for the readership is clearly needed. AndyTheGrump (talk) 20:19, 12 February 2014 (UTC)

It owuld be interesting to check the version before QuackGuru's hundreds of edits over the last few weeks, which have bloated the lede and introduced much obfuscation elsewhere. Guy (Help!) 23:22, 12 February 2014 (UTC)

User:Mann jess is right. This is an encyclopedia, not a simple Wikipedia. If you look back in the edit history such as in 2011 when User:BullRangifer was improving the article the lede and the body of the article is similar to the current version. QuackGuru (talk) 04:04, 13 February 2014 (UTC)

I think everyone misunderstood me, which is undoubtedly my own fault. Let me clarify. The article should be cleaned up, but the metric above doesn't tell us how. I wanted a concrete proposal, which Collect provided. I'm obviously not opposed to making the article easier to understand. My longer explanation was here   — Jess· Δ♥ 13:49, 13 February 2014 (UTC)

See Chiropractic treatment techniques for a quick improvement from a 3% WP rating up to 17& by using pretty straightforward editing. Collect (talk) 14:54, 13 February 2014 (UTC)

First paragraph

Chiropractic is a form of alternative medicine[1] that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.[2] It is a marginal health care profession.[3] Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry.[4] The main chiropractic treatment technique involves manual therapy, including manipulation of the spine, other joints, and soft tissues; treatment also includes exercises and health and lifestyle counseling.[5] Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body's function and its innate intelligence,[6] a vitalistic notion that brings ridicule from mainstream health care.[7] A large number of chiropractors want to separate themselves from the traditional vitalistic concept of innate intelligence.[8] has horrid readability -- only 5% of Wikipedia articles are less readable.

Chiropractic is an alternative medicine[1] which says that mechanical problems of the spine affect general health. While chiropractors have many attributes of primary care providers, chiropractic is considered more of a specialty such as dentistry or podiatry.[4] It uses manual therapy, including manipulation of the spine, other joints, and soft tissues as well as exercises and health and lifestyle counseling.[5] It used to assume that spine problems interfere with the body's general functions and Innate intelligence. It has been ridiculed by practitioners of mainstream health care.[7] Many chiropractors now do not follow the old belief of "innate intelligence".[8]

I suggest no important bits are missing -- but the readability is now more than 26% of Wikipedia articles. Collect (talk) 17:05, 12 February 2014 (UTC)

May I suggest that replacing "it is a marginal health care profession" with a something a little more factual and less emotive, like "It is the third largest health profession and has begun to shed its status as a marginal approach to more mainstream" This reference is from the RAND Corporation which is a nonprofit research organization providing objective analysis for the public and private sectors around the world.DJFryzy (talk) 22:27, 12 February 2014 (UTC)

The purpose of the exercise was to demonstrate that content and readability are not enemies - and that we can, and ought, dramatically improve the usability of the article by people less learned that Stephen Hawking. It was not intended to be "non-improvable" at all. Collect (talk) 22:49, 12 February 2014 (UTC)

The RAND source is clearly referring to the United States and Canada - where the research it cites was carried out. It can't be cited for a general statement regarding the status of chiropractic worldwide. AndyTheGrump (talk) 22:47, 12 February 2014 (UTC)

The size does not affect the fact that it's marginal. In many cases it is a "health care profession" only in the imagination of practitioners: there's precious little evidence of any effect other than accidental benefits which would be conferred just as well or better by reality-based therapists, and plenty of evidence of noxious practice (e.g. completely unnecessary "maintenance" adjustments, unnecessary X-rays, treating children, bollocks like cranio-sacral therapy, and of course the vile antivaccination propaganda). Guy (Help!) 23:20, 12 February 2014 (UTC)

The current reference is not adequate in giving any general information regarding the profession. As per AndyTheGrump, RAND only covers US and Canada... however the current Reference 4 only covers USA.. quote from the methodology " I have chosen to analyze the debate occurring amongst chiropractors in the United States as they struggle to create their own sense of identity and project that onto a larger environment of health care providers." It therefore should be replaced by the RAND article, or be deleted as is not accurate of the general population. DJFryzy (talk) 23:33, 12 February 2014 (UTC)

Note that the second example paragraph -- which is the "Readable one" seems not to affront your position. Cheers. Collect (talk) 00:42, 13 February 2014 (UTC)

What is the purpose of having it in the first paragraph then? DJFryzy (talk) 01:48, 13 February 2014 (UTC)

The first one is the current state of the article used to show how poorly it is written, Collect (talk) 12:54, 13 February 2014 (UTC)

Please read my previous comment. Simple wording for a medical article does not improve the lede. QuackGuru (talk) 04:33, 13 February 2014 (UTC)

See WP:Lead the lead should be written in a clear, accessible style with a neutral point of view; it should ideally contain no more than four paragraphs and be carefully sourced as appropriate., Editors should avoid lengthy paragraphs and over-specific descriptions, since greater detail is saved for the body of the article. In short, the lead should be clear and readable, even if you feel that abstruseness is a virtue. Cheers. Collect (talk) 13:29, 13 February 2014 (UTC)

I'd like to propose this for the lead. It is based largely on Collect's copyedits, with some additional changes (integrations from the current lead, additional removal of some redundant content, etc). I also propose migrating all the refs out of the lead and into the body, which is good practice anyway. Let me know what everyone thinks.   — Jess· Δ♥ 15:00, 13 February 2014 (UTC)

Definitely an improvement, though I would likely remove the "internal stuff" about different groups of chiropractors, and the iteration of such terms as "vitalism" which may be historically interesting, but are unlikely to be relevant to most readers now. Also such material as crossroads as being opinion as such. I think the lead can be brought up to the 25% WP mark without too much effort overall. Collect (talk) 15:09, 13 February 2014 (UTC)

I agree that the "straights vs mixers" bit seems overly detailed, but I do think it's important to distinguish between the two groups. I wouldn't want the lead to imply that all chiropractors fall into just one of those groups. The terminology is probably insignificant in the lead. I also have a problem with the crossroads bit, but for a different reason. The 2nd half of that paragraph seems to conflict with the final sentence (and the rest of the lead). Is it increasingly accepted by mainstream physicians, or not? That whole paragraph (after vaccinations) looks like its the result of years of editing and compromises, as opposed to being the best reflection of the sources.   — Jess· Δ♥ 15:21, 13 February 2014 (UTC)

@Collect:, how is draft 2? I removed the antitrust campaign (figuring coverage in the body was more useful), the "crossroads" sentence, the "straights and mixers" terminology, and and then combined some ideas. It's a bit shorter.   — Jess· Δ♥ 15:52, 13 February 2014 (UTC)

Better -- but can we lose the "laundry list" of groups not directly related to the topic, and the "vitalism" bit which may fit in the body but is likely to confuse readers looking for a clear exposition of the article. And the "controversial ... battling" bit could be changed to "conflicted with mainstream medicine" and remove the superfluous "pseudoscientific" bit as that is rather implicit in the prior clause, and does not need further exposition in the lead AFAICT. Collect (talk) 16:05, 13 February 2014 (UTC) Cheers. Collect (talk) 16:05, 13 February 2014 (UTC)

I think this is where we disagree. IMO, that shortens it too much. I'm not sure which unrelated groups you're referring to, so I might support that if you could clarify. However, I think mentioning the underpinnings of pseudoscience is important and not implicit, and I think in addition to chiropractic's traditional [vitalism] is significant, since removing it would imply some chiropractic is composed of entirely conventional techniques. Does that make sense? I'm open to seeing what other editors think, though. If you want to add another section called "Collect's draft", go for it.   — Jess· Δ♥ 16:30, 13 February 2014 (UTC)

Leads are supposed to be summaries -- when entire sections get incorporated into the lead, it is no longer compliant with the MOS standards. Collect (talk) 22:34, 13 February 2014 (UTC)

Sure, but I'm not clear how that applies. Mentioning the words "pseudoscience" and "vitalism" in the lead isn't "incorporating entire sections". The lead includes a summary of chiropractic's pseudoscience and vitalistic underpinnings, which are both fairly integral to the topic.   — Jess· Δ♥ 00:26, 14 February 2014 (UTC)

I made the change, hoping for additional input. So far, it seemed to be relatively positive reception on talk. I know Collect has some other ideas for changes. I'm hoping for some additional input from others, since it's a pretty big change on a top level article.   — Jess· Δ♥ 00:39, 14 February 2014 (UTC)

I would like the references to stay in the lede. This will benefit the reader, especially on this controversial topic.

I think this sentence can be improved: "Some modern chiropractors now incorporate conventional medical techniques, such as exercise, massage, and ice therapy, in addition to chiropractic's traditional vitalistic underpinnings."

Previous sentence: "It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider vertebral subluxations to be the cause of all disease; "mixers", the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.[8]"

I think the text would improve if you explain the difference between "straights" and "mixers". Stating "Some modern chiropractors"... is too vague. QuackGuru (talk) 01:09, 14 February 2014 (UTC)

paragraph 4

Many studies of treatments used by chiropractors have been conducted, with conflicting results.[14] A critical evaluation found that collectively, spinal manipulation failed to show it is effective for any condition.[23] A Cochrane review found good evidence that spinal manipulation therapy was no more effective than inert interventions, sham SMT or as an adjunct therapy for acute low back pain.[24] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[25] Although evidence published by practitioners suggests that spinal manipulation therapy is safe,[26] the actual prevalence of adverse events is unknown[27] as there is no systematic reporting;[28] it is frequently associated with mild to moderate adverse effects, with serious or fatal complications in rare cases.[27][29] ranks at the 12% level for readability.

Studies about chiropractic have conflicting results. One found spinal manipulation was not shown effective for any condition. A Cochrane review found it ineffective for low back pain. The cost-effectiveness of chiropractic is unknown. Evidence published by practitioners show the therapy is safe, although the number of adverse results is not known, and there are reports of mild to serious adverse effects.

gets us up to a rating of 36% (an improvement of 24%), while only sacrificing the added bit about deaths in rare cases. Collect (talk) 20:40, 12 February 2014 (UTC)

seems fair to me. I seem to recall spending a fair bit of time getting the lede down to manageable proportions, now it's back to being War And Peace, so adding concision without losing precision is a clear win. Guy (Help!) 23:16, 12 February 2014 (UTC)

Please read my previous comment. Simple wording is not encyclopedic. QuackGuru (talk) 04:33, 13 February 2014 (UTC)

In short -- if an article is actually readable, it is no good? I find that remarkably incomprehensible as an argument. Cheers. Collect (talk) 12:53, 13 February 2014 (UTC)

Dated 2005 Canadian Chiropractic Association source

Gleberzon et al. identify "deliberate fraud" as a notably harmful element of the chiropractic profession, finding that dubious practice techniques can translate into "outlandish billing and utilization rates". Those at the "fringe of ethical behavior" present the profession with a challenge, they believe, and must be weeded out.[210] Alexbrn claims chiropractic peer-reviewed journals are fringe journals but look what Alexbrn added to the article. See Chiropractic#Cost-effectiveness. Should we keep this dated source or delete it? QuackGuru (talk) 04:45, 13 February 2014 (UTC)

Their opinion is neither extraordinary nor out-of-sync with the mainstream. Is there more recent material on this topic? How is the weeding-out going? Alexbrn ^{talk|contribs|COI} 07:20, 13 February 2014 (UTC)

Might as well add to articles on Bankers and Lawyers then. Collect (talk) 13:23, 13 February 2014 (UTC)

I agree Collect..is this actually necessary?DJFryzy (talk) 07:24, 14 February 2014 (UTC)

Unless the source states that such behaviour is peculiar to chiropractic, I think it may easily hit undue weight. "Outlandish billing" has been noted recently for many medical areas, including hospitals in general. Collect (talk) 13:24, 14 February 2014 (UTC)

"Although"? and "published by practitioners"

The safety information using the WHO source was previously deleted from the lede.[17]

• "Chiropractic care and public health: answering difficult questions about safety, care through the lifespan, and community action". J Manipulative Physiol Ther. 35 (7): 493–513. 2012. doi:10.1016/j.jmpt.2012.09.001. PMID 23069244.

This is another WP:MEDRS compliant source: "So, do the risks outweigh the benefits? The best evidence suggests that SMT, whether it be for neck or low back pain, is a safe and effective therapy. At a population level, the benefits still outweigh the risks."[18]

I don't see a serious dispute to the text. What is the point to adding "published by practitioners". Is there evidence that specifically says it is not safe. "Although" is unnecessary grammar and suggests there is a dispute when none is being presented. These are different sources that make different distinct points in the lede. The part "published by practitioners" is not what the source says anyhow. QuackGuru (talk) 07:09, 13 February 2014 (UTC)

I don't see the point either QuackGuru I would agree "although" is unnecessary and that the WHO reversion would be appropriate.. my only concern is that the Lede is becoming an article in itself. Is there any way we can reduce it to a paragraph with all the most important information and relegate the rest to the subtitles? DJFryzy (talk) 11:16, 13 February 2014 (UTC)

User:DJFryzy, you are correct about the "although" but since I made changes to this article editors are trying to get me banned. QuackGuru (talk) 18:50, 13 February 2014 (UTC)

Definition of Chiropractic

I would like to review the definition of chiropractic. This has previously been discussed [[Talk:Chiropractic/Archive_35#MerWP:MEDMOS [WP:MEDMOS]] e|here]]. Currently it is without references and is poorly defined, poorly worded and difficult to read. I would suggest a more appropriate and referenced definition for the opening definition in the article.DJFryzy (talk) 08:20, 14 February 2014 (UTC)

What definition did you have in mind? The majority or sources I have come across say something along the lines of "A health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation." Found at the world federation of chiropractic.. " health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches." found at the ACA.. plenty of references .. which one do you want to utilize? Brosurf (talk) 09:18, 14 February 2014 (UTC)

What about an independent definition? Alexbrn ^{talk|contribs|COI} 09:26, 14 February 2014 (UTC)

From a secondary source; "the diagnosis of neuromusculoskeletal disorders or disorders arising from the structures or function of the spine...and joints of the extremities" Chapter 21 Statues of Ontario, 1991, Sections 3 and 4. Can be found hereBrosurf (talk) 09:31, 14 February 2014 (UTC)

This last reference is from a legal paper in reference to the scope of practice and legislation governing chiropractic practice around the world. Brosurf (talk) 09:33, 14 February 2014 (UTC)

That from a chiropractic journal, so not independent. The American Cancer Society has: "Chiropractic is a health care system that focuses on the relationship between the body's skeletal and muscular structure and its functions. Treatment often involves manipulating (moving) the bones of the spine to correct medical problems. Other methods may also be used".[19] MedlinePlus has: "Chiropractic is an alternative medical system. Chiropractors perform adjustments (manipulations) to the spine or other parts of the body. The goal is to correct alignment problems, ease pain, and support the body's natural ability to heal itself. They may also use other treatments [...]".[20] This is more the sort of thing we'd use, I think. Alexbrn ^{talk|contribs|COI} 09:37, 14 February 2014 (UTC)

Probably our best source is Edzard Ernst's PMID 18280103. He specifically addresses the topic of definition - unfortunately it does not make our life easy as he says it has many definitions and devotes an entire table to 12 of them: "Chiropractic is a popular form of health care for which many definitions can be found^{1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12} (Table 1).". Ho hum. Alexbrn ^{talk|contribs|COI} 09:51, 14 February 2014 (UTC)

I see the difficulty. Unfortunately those that Ernst uses are primary sources as well.. Thus we are back at square one. Where does WHO fit on this scale? If we were to look at this differenlty.. say defining what dentistry, medicine, veterinary science etc is.. why would someone outside that profession need to define their own profession for them? Brosurf (talk) 10:37, 14 February 2014 (UTC)

What a strange thing to say. We use Ernst as a secondary source, it does not matter if he cites primary sources so long as we don't. Secondary sources are expected to cite primary research and interpret it for us. Do you not see the distinction? IRWolfie- (talk) 10:41, 14 February 2014 (UTC)

I agree IRWolfie-, however the point I am aiming to make is why are there double standards when an independent secondary source such as the statues which is put into affect by government, not the profession itself, are not as good as a reference as a primary reference, put into a lit review, then published... I struggle to see why Brosurf (talk) 10:47, 14 February 2014 (UTC)

I would argue that this is in fact a better definition to use, due to its impartiality. Please refer to WP:MEDMOS Brosurf (talk) 10:48, 14 February 2014 (UTC)

The material you used was from an in universe source which would provide a favourable definition, Ernst is independent of Chiropractic and is a well known expert on AM, IRWolfie- (talk) 11:01, 14 February 2014 (UTC)

Incorrect. It is not an "in universe" source. It is an external, neutral and unbiased source completely separate from the published article. Please read WP:MEDMOS and re read the aforementioned article. Brosurf (talk) 11:53, 14 February 2014 (UTC)