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serious NPOV issues (oh my)

Lead

There are serious NPOV issues with this article. The lead needs to conform to WP:LEAD and be neutrally written. The word confusion in the lead does not make much sense to me. I don't get it with respect to the word confusion. There needs to be references to verify the text in the lead. For example, a reference to support the inclusion of the four distinct chiropractic groups is necessary. --QuackGuru (talk) 21:55, 22 February 2008 (UTC)

There is still no explanation to the usage of the word confusion in the lead. Please discuss. QuackGuru (talk) 19:53, 26 February 2008 (UTC)

The word "confusion" is somewhat redundant and can easily be removed. The wording that you installed overdid the controversy a bit; I made this change to trim it down. Note that "confusion" is supported by Keating et al. 2005, a cited source; however, I doubt whether it's a big enough deal to be in the lead. Eubulides (talk) 23:23, 26 February 2008 (UTC)

I don't see any citation, either in the old version or the version that you installed, that would indicate that there are four coherent and stable groups. On the contrary, if you look at the end of Talk:Chiropractic/Archive 15 #Elimination of reform chiro, you'll see that PPC indicates that the objective-straights are defunct in practice, and it doesn't even mention a coherent reform group. With this in mind, the lead should just say something noncommittal like "The two main groups of chiropractors are the 'straights' and the 'mixers'.", which is accurate and easy to source. The lead shouldn't bother with relatively-unimportant splinter groups. Eubulides (talk) 23:35, 26 February 2008 (UTC)

Relatively unimportant according to whom, Eubulides? —Preceding unsigned comment added by EBDCM (talk • contribs) 01:34, 27 February 2008 (UTC)

Relatively unimportant to the reliable sources mentioned at the end of Talk:Chiropractic/Archive 15 #Elimination of reform chiro. For reference, here they are again:

• PPC talks only about traditional straight, mixers, and objective-straight (which it calls purpose-straight (PSC) and mentions also the alias super-straight). After characterizing purpose-straight, it has the following to say about the politics:

The PSC approach to chiropractic came into conflict with several constituencies. The nondiagnostic orientation of this perspective stands in contrast to most statutes governing the practice of chiropractic. Some degree of compromise by the chief institutional proponent of PSC, Sherman College of Straight Chiropractic (SCSC), was apparently reached with the CCE circa 1995, when the SCSC was first recognized by the accreditation agency. The CCE's educational standards require training in diagnosis and referral when appropriate to other health care providers. Accordingly, there would seem to be some disconnect between this institution's ideology and its actual instructional practices. It should be noted that several of SCSC's presidents (e.g., Thomas Gelardi, DC, David Koch, DC) have been articulate contributors to philosophical dialogue within the profession (e.g., reference 64).

The source: Keating JC Jr (2005). "Philosophy in chiropractic". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 77–98. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link)

• Ernst talks only about straights and mixers. The source: Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.
• I looked in Google Scholar for any paper mentioning "straight", "mixer", "reform", and "chiropractic". In the summaries I found, there was no mention of "reform chiropractic" or "reform chiropractors" or anything like that.

It seems clear that this reform group is marginal and is currently overemphasized in Chiropractic. The PSC/objective straight group seems to be somewhat overemphasized as well: it seems to be a group that is no longer a major bifurcation from straight. Perhaps discussion of PSC aka objective straights should be moved to the "History" section. Eubulides (talk) 07:47, 27 February 2008 (UTC)

The ACA and whole profession have certainly used an awful lot of ammunition on attacking a "relatively-unimportant splinter groupss." They obviously didn't consider it "unimportant." BTW, they haven't done much to oppose straights, since they are so numerous and dominant in many ways, and are the ones who are defending the philosophical and legal basis for the profession's existence. OTOH, it was the NACM that was instrumental in getting the VA deal passed, since they were the ones seen as representing an acceptable (to mainstream medicine) form of chiropractic. That's a quite ironic fact. -- Fyslee / talk 06:08, 27 February 2008 (UTC)

I looked for mentions of the NACM in reliable sources published in refereed journals or high-quality textbooks in the last five years, using Google Scholar.

• PPC mentions them as one of "two much smaller groups: the National Association of Chiropractic Medicine (which advocates chiropractors' subordination to allopathic diagnosticians) and the World Chiropractic Alliance (propounder of exclusively subluxation-based chiropractic practice)." (p. 56). It also says that the work of the ACA and the ICA "is made more difficult by small organizations of extreme viewpoints that claim democratic authority and seek a profile at the national level, groups such as the National Association of Chiropractic Medicine (limiting chiropractic to the management of musculoskeletal pain syndromes) and the World Chiropractic Alliance (limiting chiropractic to location and correction of vertebral subluxations)." (p. 115).
• Menke 2003 (doi:10.1016/S0161-4754(02)54113-0) writes "Obvious ostracism persists in the guise of 'quack busters,' such as the National Association for Chiropractic Medicine (NACM) and the National Council Against Health Fraud in Loma Linda, California."
• Cates et al. 2003 (doi:10.1016/S0161-4754(03)00010-1) mentions them as part of a long list of organizations that the ICA ignored while developing guidelines.

That's all I found. These brief mentions do not indicate a prominent role for the NACM currently; quite the reverse. Perhaps they are important in chiropractic's history; I did not look back farther than five years. But they do not seem important now. Eubulides (talk) 08:16, 27 February 2008 (UTC)

I am becoming more and more convinced that NACM only exists in name at this point (if at all). I believe Dematt tried calling the number on the NACM website and it was either a recording or disconnected. -- Levine2112 08:25, 27 February 2008 (UTC)

OK, here's a proposed change to address this problem with the lead. Let's change the first sentence in the lead's last paragraph from this:

Chiropractors have historically fallen into two main groups, "straights" and "mixers," though "objective straights" and "reformers," who are minority groups, are recent off-shoots from the straight and mixer models, respectively.

to this:

Chiropractors have historically fallen into two main groups, "straights" and "mixers"; both have had splinter groups.

Eubulides (talk) 21:35, 27 February 2008 (UTC)

No further comment so I installed that change. Eubulides (talk) 09:29, 29 February 2008 (UTC)

Practice styles and schools of thought

The Practice styles and schools of thought secton is cluttered and difficult to read. In its recent form it is hard to follow and does not flow well. For example, mixing the Straight chiropractors and Objective chiropractors in the same paragraph is confusing. Having each group in its own paragraph would be best. Per WP:WEIGHT, we can still incude each group. An off-shoot refers to its origin and not its prominence anyhow. A well writtened introduction to the Practice styles and schools of thought secton is lacking. It is short but can easily be expanded. I think it would be better to move the table to the right. --QuackGuru (talk) 21:55, 22 February 2008 (UTC)

It actually reads quite well. Objective are offshoots of straights and share many similarities as straight and, accordingly, should be talked about in the straight section. Same logic goes for the reform and mixer groups. EBDCM (talk) —Preceding comment was added at 01:55, 23 February 2008 (UTC)

For readability purposes it should be in its own paragraph. The objective straights addition can be limited but also in its own paragraph. QuackGuru (talk) 03:36, 24 February 2008 (UTC)

Common themes in chiropractic care are conservative, non-invasive, non-medication approaches via manual therapy. Nonetheless, there are significant differences amongst the practice styles, claims and beliefs between various practitioners. Those differences are reflected in the varied viewpoints of multiple national practice associations. There are four practice styles and schools of thought among chiropractors. This was in the article and was a nice introduction to the section and well sourced. Please explain the deletion. Thanks. QuackGuru (talk) 03:40, 24 February 2008 (UTC)

I apologize for deleting the citations; they were inadvertently taken out while I reverted your omnibus bill of an edit which spanned almost every section of the article. In the future, if you keep your edits to one section at a time, they're less likely to be mistakenly taken out. Feel free to add those citations again. Thanks. EBDCM (talk) 07:56, 24 February 2008 (UTC)

At times manual therapy is synonymous with"manual medicine". Philosophically, reform chiropractors focus on the structural and functional relationships of the neuromusculoskeletal system in both health and disease. Reform chiropractors support vaccination as a cost-effective and proven preventative health measure.

There have been some calls to differentiate reform or 'contemporary' chiropractors from both straight and mixer chiropractors by establishing a Doctor of Chiropractic Medicine (D.C.M.) degree. It is argued this would distinguish them from previous diplomas, and would allow current DCs to upgrade their education to the DCM degree whivh would permit DCMs to utilize prescription drugs suitable to the limitations of their practices and have a unified scope of practice across all jurisdictions.

These sentences don't add much to the article. The section needs to be cleaned up. The vaccination bit should remain in the vaccination section and not this section. QuackGuru (talk) 20:43, 24 February 2008 (UTC)

It's notable and verifiable re: the DCM and it was written by a skeptic of chiropractic as well. It's important to clearly differentiate the different styles of thoughts and approaches hence the structure and function which is also verifiable from a reliable source. Thanks for your input, QG! EBDCM (talk) 23:58, 24 February 2008 (UTC)

According to what references it's notable and verifiable. Please explain. QuackGuru (talk) 01:15, 25 February 2008 (UTC)

I added back in the citations. QuackGuru (talk) 01:55, 25 February 2008 (UTC)

You apoligized for deleting the citations but you deleted the citations again. Please discuss the deletions. QuackGuru (talk) 05:33, 25 February 2008 (UTC)

• I agree that this section is muddled, but that's not a serious NPOV problem, is it? I thought this talk-page section was about NPOV problems.
• I disagree that each group needs its own paragraph. Mixers and straights yes, but the other groups are splinters and don't need to be discussed at length; the splinters can be folded into the respective main paragraphs.

Eubulides (talk) 00:39, 27 February 2008 (UTC)

I had done this originally but QG seems determined to go against the majority of editors here. Your calls for deletion of cited sources is your own fault; editors have asked you previously to add content one section at a time instead of a mass edit in case stuff gets mistakenly deleted. Feel free (like I mentioned 4 times now) to ADD THE REFERENCES ONLY that way your edit won't get reverted THEN add your input. Thanks for cooperating quack guru we really appreciate your new and improved tone since your block. EBDCM (talk) 01:33, 27 February 2008 (UTC)

I f it is of any worth, Citizendium articles are still not considered a reliable source according for Misplaced Pages's purposes. -- Levine2112 05:17, 27 February 2008 (UTC)

History

The history section can include the survey. It does not fit in the lead but can be included somewhere else in this article such as the history section. The text of the survey is as follows: A 2003 paper showed that 90% of North American chiropractors surveyed believed vertebral subluxation played a significant role in all or most diseases. --QuackGuru (talk) 21:55, 22 February 2008 (UTC)

The survey was selected by Mccready. If editors prefer, we can select another study. That's fine with me. I thought this information would improve this article. We can try using other references such as the Biggs study. We can add the Biggs study instead "that shows that 36% of DCs think vert sub causes disease." I am open to suggestions. --QuackGuru (talk) 04:31, 23 February 2008 (UTC)

Safety

The safetey section is a huge POV probem. There is too much WP:WEIGHT being given to describing The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. It seems pointy to have a lengthy description of The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. It can be shortened. The reference linking to the The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders website and the reference linking to chiropractic advocacy group's news release in the article are not WP:RS. This can easily be fixed by replacing it with the Spine journal reference. The following text in the safety section seems out of place and is not referenced: Patients should be screened and undergo a complete clinical exam including history, physical and at times additional specialized imaging and laboratory diagnostics in order to rule out any of these contraindications before undergoing a treatment regime that includes spinal manipulation. Spinal manipulation is a controlled health act and should not be performed except by licensed health professionals whose scope allows it. There are many references to include in this section that will expand and explain about the safety issues. Deleting well sourced sentences supported by references is a clear NPOV issue. In this regard, my first option would be the Misplaced Pages:WikiProject Neutrality. We need more uninvolved Wikipedians. Agreed? --QuackGuru (talk) 21:55, 22 February 2008 (UTC)

I agree that we should use spine as the main reference. Good suggestion, GQ. Lets get those references (you do agree that there is a clinical examination and diagnosis prior to treatment and SMT, right? You do agree that the practice of SMT is limited by scope of practice and legislated acts, right? What do oyu mean by uninvolved? Uninformed? The community here is very knowlegeable and has a scientific bent to it which, IMO is a huge bonus because the quality of citations, and accordingly, the article, goes up. EBDCM (talk) 08:39, 23 February 2008 (UTC)

I did not say to use the Spine ref as the main ref. It should be the only ref because it is RS and because The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders and the chiropractic advocacy group is not RS. It there a RS ref for "the practice of SMT is limited by scope of practice and legislated acts" you described above? What do I mean by uninvolved? I want more uninvolved editors to help NPOV this article. Please explain your reasons for deleting the new Spine ref, the WHO reference, and the Edzard Ernst ref anyhow. --QuackGuru (talk) 03:33, 24 February 2008 (UTC)

In February 2008, the World Health Organization sponsored Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders, the largest and most comprehensive study on neck pain to date. The task force was comprised of a group of international clinician-scientists and methodologists to undertake a best-evidence synthesis on neck pain and its associated disorder and make recommendations of clinical practice guidelines for the management of neck pain and its associated disorders. This included a consensus of the top experts in the world whose findings will be collated using best-evidence synthesis, which addresses risk and prevention, diagnosis, prognosis and treatment risks and benefits. Please explain your reason to add such a HUGE amount of text to describe The Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders. It smacks WP:POINT. QuackGuru (talk) 03:58, 24 February 2008 (UTC)

The NPOV problems with this section has continued. I will restore the facts and add more information to strengthen WP:NPOV. QuackGuru (talk) 20:59, 24 February 2008 (UTC)

The neck pain study was 6 years in length, comprised over 1 million patient years and was a landmark study which included a various array of health professionals and researchers (i.e. there was a consensus). This helps readers to know that the findings and conclusions are accepted by a wide majority of professional researchers. It also explains to readers why it's an important study whose conclusions are worth including. Thanks. EBDCM (talk) 00:00, 25 February 2008 (UTC)

It is still way too much text. The length of the study does not mean we should add such a huge amount of text. QuackGuru (talk) 01:11, 25 February 2008 (UTC)

Describing The Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders does not need to be so long. QuackGuru (talk) 01:31, 25 February 2008 (UTC)

The WHO report in the 'Safety' section was referenced but the reference was deleted. Please explain this. QuackGuru (talk) 01:17, 26 February 2008 (UTC)

I don't understand this last comment. The first URL does not point at a reference, and the second URL does not point at the deletion of a reference. Eubulides (talk) 01:30, 26 February 2008 (UTC)

In a 2005 report, the World Health Organization states that when "employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems." The WHO report goes on to say, "there are however, known risks and contraindications to manual and therapeutic protocols used in chiropractic practice," and, "Contraindications to spinal manipulative therapy range from a nonindication for such an intervention, where manipulation or mobilization may do no good, but should cause no harm, to an absolute contraindication... where manipulation or mobilization could be life‐threatening." This was referenced but the reference got deleted. QuackGuru (talk) 02:14, 26 February 2008 (UTC)

Sorry, I still can't make heads or tails of that comment. All its URLs point to the same diff listing, which contain zero diffs, so I don't see what changed. I agree with you that the section in question is overly POV. But I still don't understand this specific comment. Eubulides (talk) 08:38, 26 February 2008 (UTC)

A lot of the above text (including the reference) was removed and now it reads: According to the World Health Organization "employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems." I will add the text + reference back. QuackGuru (talk) 08:45, 26 February 2008 (UTC)

Originally the 2005 WHO report was NPOV and referenced. Currently it is POV and unreferenced. QuackGuru (talk) 08:56, 26 February 2008 (UTC)

I have included more text and references to verify the facts but it was deleted without any good explanation. QuackGuru (talk) 19:56, 26 February 2008 (UTC)

I agree the safety section is POV and has too much about the Bone and Joint study. I also object to the 'cherry picking' of the WHO statement, deleting the contraindication part.

"Spinal manipulation, the most common modality in chiropractic care, has been increasingly studied in recent years as critics and proponents debate the merits of its efficacy and safety.

Spinal manipulation has generally regarded is a safe and effective procedure for the treatment of various mechanical low back pain syndromes." These references don't support the second sentence. Refs 74-77 are pretty negative; "not clinically meaningful"74, "not clinically worthwhile in decreasing pain and mobility" 75, "not effective for any condition" 76, "not established as effective" and spinal manipulation "burdened with severe adverse reactions" 77 The last two refs are vaguely positive. The second sentence should say something like "many studies have found spinal manipulation to be only mildly effective or ineffective" Any mention of safety was toward the negative side, but the impression the reader is left with is "safe and effective".CynRNCynRN (talk) 21:17, 28 February 2008 (UTC)

http://en.wikipedia.org/search/?title=Chiropractic&oldid=194269776#_ref-Hurwitz_0 Here is the NPOV version along with the correct reference placement. QuackGuru (talk) 21:27, 28 February 2008 (UTC)

What would be helpful here is to draft a new version of Chiropractic#Safety that addresses the above concerns. I have created a new section #Safety 2 below to do this. The initial version is the version you suggested; I hope we can all edit it into something that addresses the POV problems and approaches consensus. Eubulides (talk) 22:20, 28 February 2008 (UTC)

There is a growing consensus for the well sourced NPOV version and not the blatant POV worded problems. QuackGuru (talk) 22:31, 28 February 2008 (UTC)

Nice job quack guru, you plant crappy references and deceive the editors here because there is much better, stronger and BALANCED refereces for your claims. You might want to start here for a decent lit review on all chiropractic care. http://www.ccgpp.org/ Until then, do us a favour and stop making weak edits with weak citations leading to equally weak claims. I hope you take my words to heart; as a growing # of editors here and becoming frustrated by your 'approach' to editing the chiropractic article. EBDCM (talk) 05:37, 29 February 2008 (UTC)

Vaccination

All the tweaking to this section had diluted the entire section. I will restore the missing well sourced sentences. QuackGuru (talk) 20:47, 24 February 2008 (UTC)

This first sentence is a little wierd."Mandatory vaccination is controversial within the chiropractic community controversial with different schools of thought" Controversial with different schools of thought doesn't make sense. I think it means straights often oppose it and mixers may not, but it could use clearing up. Just a little history of where the opposition came from would be useful; initial opposition to the germ theory, etc.CynRNCynRN (talk) 21:23, 24 February 2008 (UTC)

I liked this lead in from Eubulides:"although vaccination is one of the most cost-effective form of prevention against infectious disease, it remains controversial in chiropractic. Most chiropractic writings on vaccination focus on its negative aspects." This is accurate and referenced.CynRNCynRN (talk) 21:30, 24 February 2008 (UTC)

As long as it differentiates between the varying opinions within the chiropractic profession it's all good by me though we really don't need to go into germ theory, IMO. EBDCM (talk) 00:02, 25 February 2008 (UTC)

Most chiropractic writings on vaccination focus on its negative aspects, despite its being one of the most cost-effective forms of disease prevention. I think this would work too. QuackGuru (talk) 01:21, 25 February 2008 (UTC)

I brought back the wording CynRN liked at about the same time that you suggested the other wording. Either wording is fine with me. Eubulides (talk) 01:29, 25 February 2008 (UTC)

Both ways work for me. QuackGuru (talk) 02:12, 25 February 2008 (UTC)

Education, licensing, and regulation

I will fix the red links and format a ref. QuackGuru (talk) 20:52, 24 February 2008 (UTC)

I fixed the red links and formatted a reference but it was reverted. QuackGuru (talk) 05:36, 25 February 2008 (UTC)

I fixed the red links again and formatted a reference among other things. It was reverted. The edit was partial vandalism to this section. QuackGuru (talk) 19:50, 26 February 2008 (UTC)

Treatment techniques vs. Manipulative treatment techniques

I think the appropriate title for the section should be Chiropractic treatment techniques because there is more than just manipulative techniques. QuackGuru (talk) 21:13, 24 February 2008 (UTC)

The name "Chiropractic treatment techniques" runs afoul of WP:HEAD, which says "Avoid restating or directly referring to the topic." To fix this particular problem I removed the word "Chiropractic" from the section header. Currently the body of the section talks only about manipulative techniques: shouldn't that be fixed too? Eubulides (talk) 02:30, 25 February 2008 (UTC)

Agreed. "Treatment techniques" works in accordance with WP:HEAD. QuackGuru (talk) 02:36, 25 February 2008 (UTC)

Are all techniques manipulative or not all techniques are manipulative. QuackGuru (talk) 05:23, 25 February 2008 (UTC)

http://en.wikipedia.org/search/?title=Chiropractic&diff=next&oldid=194269776 I agree with this edit. QuackGuru (talk) 22:51, 26 February 2008 (UTC)

Holistic and naturopathic approach

This header seems unecessary. I don't see any point to keeping it. QuackGuru (talk) 22:23, 24 February 2008 (UTC)

I agree. The current redrafts of the philosophy section seem to omit it, so it looks like it will go at some point. Eubulides (talk) 02:31, 25 February 2008 (UTC)

Disagree. Why don't you want to readers to know this? EBDCM (talk) 04:52, 25 February 2008 (UTC)

Section headers are supposed to be short and to the point. It's not a question of what I want readers to know; the material in question will be in the body, and doesn't need to be in a section header. Besides, it's strange for the entire contents of a section to consist of a single subsection, with no other text; I don't recall ever seeing that in any featured article in Misplaced Pages. Eubulides (talk) 05:21, 25 February 2008 (UTC)

We will add conservative to the mix. Thanks.EBDCM (talk) 01:29, 27 February 2008 (UTC)

Comments on the 2008-02-22 12:06:18 edit

Here are some comments on the 2008-02-22 12:06:18 edit that QuackGuru just made.

• There are a lot of changes in that one edit, and many of them are no doubt controversial. Surely it'd be better to discuss the changes one by one; that's more likely to achieve a working consensus.

• Wheeler 2006 is not published in a refereed journal. I'd prefer a higher-quality citation.

• I disagree that chiropractors fall into four distinct groups. See the comment "I checked two reliable sources on this subject." in #Elimination of reform chiro above. Reliable sources agree about the two main groups (straights and mixers); the existence of the other two as formal groups is in doubt, and the article should not give greater emphasis to the other groups than reliable sources do. It is OK to mention the two less-well-supported groups, but not in so much detail that they appear to be just as important as the two main groups.

• The cited source does not support the claim that "All groups, except reform, treat patients using a subluxation-based system." It doesn't say that mixers use a subluxation-based system.

• The claim "A 2003 paper showed that 90% of North American chiropractors surveyed believed vertebral subluxation played a significant role in all or most diseases." is supported by McDonald 2003. I don't have easy access to that source, but this summary doesn't mention that figure. The summary mentions a bunch of other numbers, which may well be more notable than the 90% figure; why was the 90% figure selected here? Eubulides (talk) 00:18, 23 February 2008 (UTC)

• I haven't had the time to wade through all the studies on the efficacy and safety of spinal manipulation so I can't comment on the material in the many edits made in that section. However, I suggest using "cite journal" with pmid= instead of "cite news" with URLs in citations to Pubmed-indexed articles. I made that change just for Ernst 2008, to give you a feeling for how it works. Eubulides (talk) 00:18, 23 February 2008 (UTC)

Eubulides (talk) 00:18, 23 February 2008 (UTC)

It appears that quack guru has cherry picked the evidence and neglected to include meta-analyses which have already been performed on this subject and shown SMT for LBP to be both safe and effective. It also demonstrates common reductionistic thinking that still pervades conv med. http://theintegratorblog.com/site/index.php?option=com_content&task=view&id=381&Itemid=1 EBDCM (talk) 02:01, 23 February 2008 (UTC)

I will make the necessary adjustments based on all the comments above. QuackGuru (talk) 21:20, 24 February 2008 (UTC)

I will adhere to NPOV and edit the article. QuackGuru (talk) 10:32, 26 February 2008 (UTC)

I have included a meta-analyses study in the Safety section but it was deleted. QuackGuru (talk) 20:01, 26 February 2008 (UTC)

partial vandalism and NPOV violation

http://en.wikipedia.org/search/?title=Chiropractic&diff=next&oldid=194142433 This edit was in part vandalism. For example, references were removed that cited the text.

Evidence at the trial showed that the defendants took active steps, often covert, to undermine chiropractic educational institutions, conceal evidence of the usefulness of chiropractic care, undercut insurance programs for patients of chiropractors, subvert government inquiries into the efficacy of chiropractic, engage in a massive disinformation campaign to discredit and destabilize the chiropractic profession and engage in numerous other activities to maintain a medical physician monopoly over health care in this country. I provided a reference that verified the above text.

A 2005 World Health Organization report states that when "employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems." The report continued, "there are however, known risks and contraindications to manual and therapeutic protocols used in chiropractic practice," and, "Contraindications to spinal manipulative therapy range from a nonindication for such an intervention, where manipulation or mobilization may do no good, but should cause no harm, to an absolute contraindication... where manipulation or mobilization could be life‐threatening." I provided a reference that verified the above text.

The current text reads: According to the World Health Organization "employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems." This is not the entire story of the 2005 report by WHO. The reference was deleted along with the balance facts. Therefore, it is an NPOV violation.

In February 2008, the World Health Organization sponsored Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders, the largest and most comprehensive study on neck pain to date. The task force was comprised of a group of international clinician-scientists and methodologists to undertake a best-evidence synthesis on neck pain and its associated disorder and make recommendations of clinical practice guidelines for the management of neck pain and its associated disorders. This included a consensus of the top experts in the world whose findings will be collated using best-evidence synthesis, which addresses risk and prevention, diagnosis, prognosis and treatment risks and benefits.

Here is another example of an NPOV violation. The above text is a description of The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders. It also has WEIGHT problems.

In February 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders, comprising a group of experts to evaluate neck pain and its associated disorder, released a manuscript of their findings with recommendations and guidelines, including associated risks and benefits. Here is the shortened text.

http://en.wikipedia.org/search/?title=Chiropractic&diff=prev&oldid=194142433#Safety This edit shortened the text and is NPOV as ever.

Also a Spinal journal reference was added to replace the unreliable reference but it got deleted. The Spinal journal is a reliable reference.

http://en.wikipedia.org/search/?title=Chiropractic&diff=prev&oldid=194142433#Education.2C_licensing.2C_and_regulation The same edit fixed the red links and formatted a reference in the Education, licensing, and regulation section. But the formatted reference and the proper blue links were reverted. It was a clear policy violation (partial vandalism) to remove a formatted reference.

http://en.wikipedia.org/search/?title=Chiropractic&diff=prev&oldid=194142433#_note-Edzard_Ernst formatted reference number 79

http://en.wikipedia.org/search/?title=Chiropractic&diff=next&oldid=194142433#_note-Edzard_Ernst deleted reference number 70 in red

A reference was formatted but the reference was deleted.

Spinal manipulation is a regulated medical intervention and can only be performed by chiropractors and a limited number of physical medicine professionals.

Most patients have no adverse effects from cervical manipulation, though the risk of stroke is not zero.

Here are a couple of more examples. The above text was referenced but the references were deleted.

There are problems with the Practice style and schools of thought section.

The four different groups were in its own paragraph along with a nice introduction but the introduction got shortened and the citation got removed. The current version reads: Common themes in chiropractic care are conservative, non-invasive, non-medication approaches via manual therapy. Nonetheless, there are significant differences amongst the practice styles, claims and beliefs between various practitioners. Notice the missing citations.

Common themes in chiropractic care are conservative, non-invasive, non-medication approaches via manual therapy. Nonetheless, there are significant differences amongst the practice styles, claims and beliefs between various practitioners. Those differences are reflected in the varied viewpoints of multiple national practice associations. There are four practice styles and schools of thought among chiropractors. Now here is a quality introduction to that section along with references. No good explanation has been given to remove a good introduction.

http://en.wikipedia.org/search/?title=Chiropractic&oldid=194142433#Practice_styles_and_schools_of_thought Before and NPOV.

http://en.wikipedia.org/search/?title=Chiropractic&diff=next&oldid=194142433#Practice_styles_and_schools_of_thought After and POV.

It was a WP:POINT violation to undo a quality edit. --QuackGuru (talk) 21:12, 26 February 2008 (UTC)

Eubulides agrees with me that the 'Safety' section in question is overly POV. Any suggestions on NPOVing this article would be helpful. QuackGuru (talk) 21:49, 26 February 2008 (UTC)

Feel free to insert references, but do it one section at a time; otherwise your controversial edits will get reverted including accidental omissions of your sources. With all due respect; Eubulides POV is not the end-all-be all. What specifically do you have a problem with? EBDCM (talk) 01:23, 27 February 2008 (UTC)

It can't be an accidental omission of the sources when editors are fully aware of the additional sources were added to the article that verified the text. It was an intential ommission.

I will insert the references along with the NPOV sentences that went along with the facts. I will follow the references. The sentences must be written in accordance with NPOV policy. WP:NPOV states: Neutral point of view is a fundamental Misplaced Pages principle. NPOV is absolute and non-negotiable. EBDCM asked: What specifically do you have a problem with? I already explained that above. QuackGuru (talk) 21:03, 28 February 2008 (UTC)

Historical material belongs in "History"

The following material in Chiropractic #Treatment techniques is mostly about history, not about techniques. Let's move this material to Chiropractic #History.

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "father of medicine" used manipulative techniques, as did the ancient Egyptians and many other cultures. A modern reemphasis on manipulative therapy occurred in the late 1800s in North America with the emergence of the osteopathic and chiropractic professions. While some manipulative procedures now associated with chiropractic care can be traced back to ancient times, the modern profession of chiropractic was founded by Daniel David Palmer in 1895 in Davenport, Iowa. Spinal manipulative therapy gained recognition by mainstream medicine during the 1980s.

Eubulides (talk) 00:47, 27 February 2008 (UTC)

Vehemently disagree. It seems if editor Eubulides had his/her way the whole article would be flipped upside down according to his/her standard. This section is perfectly referenced and gives readers insight and appropriate context of manipulative therapies the #1 modality used in chiropractic clinical practice. Of course, I cannot wait to add some contrasting material with medicine that Eubulides is so desperately trying to keep out of the page despite appropriate citations and perfectly allowable contrast. Thanks. EBDCM (talk) 01:28, 27 February 2008 (UTC)

Be careful with the contrasting. This article is about chiropractic, not medicine. If you stay on topic, you can avoid problems. -- Fyslee / talk 06:21, 27 February 2008 (UTC)

I am not asking that the material be removed, nor am I saying that the material is poorly sourced. I am merely saying that material about 3000-year-old manipulation is obviously historical, and that it therefore ought to be in Chiropractic #History. I disagree that the historical material provides any real insight into the nature or types of spinal manipulative techniques. All it says is that the techniques go way back, so it's useless for the purpose of a section that describes the main techniques. I do not know what EBDCM means by "contrasting material with medicine that Eubulides is so desperately trying to keep out of the page", and I do not understand why that point (whatever it is) is relevant here. Eubulides (talk) 07:37, 27 February 2008 (UTC)

The material about SMT belongs in the SMT (procedures) section. The history section is more about the political and foundings on the profession and it's subsequent struggles for legitimacy, the AMA blurb, etc. We will leave it here. Thanks. EBDCM (talk) 15:35, 27 February 2008 (UTC)

Chiropractic #History should be about the history of chiropractic. If it's really just about politics, then it should be labeled Politics and we should start a new History section. The first sentence in Chiropractic #History is about spinal adjustment; if it really was the case that every sentence in this article that mentions SMT should be in the Treatment section, then we'd have to move that sentence and many other chunks of the article into Treatment, which would be silly. What matters is what is the best section for a particular point, not what sections that point could conceivably be put in. On balance, the material under dispute is far more about history than it is about SMT (it says nothing about what SMT is). I don't see why it belongs anywhere but the history section. Eubulides (talk) 16:44, 27 February 2008 (UTC)

Another point: WP:SUMMARY says that when a section summarizes a subarticle, as Chiropractic#Treatment procedures summarizes Chiropractic treatment techniques, the section's material should be in sync with the subarticle. And yet in this case we have a section whose text spends most of its time on a topic (history) that is not in the subarticle. This is another indication that the historical material is ill-placed. Eubulides (talk) 16:55, 27 February 2008 (UTC)

Until you made wholesale changes to the entire table, it was all about manipulation, so you comment is disingenious. Please do not refer to me like a special-ed child; I cannot stand being spun wikipedia policy. Clearly a few sentences about the history and re-ermegence of SMT as a modality in a chiropractic article under a treatment methods section is appropriate. EBDCM (talk) 01:48, 29 February 2008 (UTC)

Whether the table mentions only spinal manipulation or other procedures is irrelevant to the question whether "Treatment procedures" should devote most of its text to history. This is not a Misplaced Pages policy issue; it is a guideline issue. It's not necessary to discuss chiropractic's ancient history in Chiropractic #Treatment procedures, and there are strong and obvious arguments for putting the history discussion under Chiropractic #History. Eubulides (talk) 06:39, 29 February 2008 (UTC)

No further comment, so I moved the historical material to Chiropractic #History. Eubulides (talk) 22:48, 3 March 2008 (UTC)

(outdent) That movement was reverted with the log entry "no consensus for this move; see talk page". I don't see a consensus against the move either; perhaps another editor can weigh in? In the meantime I made this change in an attempt to better address the concerns noted above. This change keeps a brief introduction to the history of chiropractic in Chiropractic #Treatment procedures, but puts the bulk of the historical material in Chiropractic #History, a more natural home for historical material. Eubulides (talk) 06:34, 4 March 2008 (UTC)

Integrative Medicine

Proposed amendment. Integrative Model of Care or Integrative medicine or another fitting title. With the rise of popularity of complementary and alternative therapies and the reformation of health care systems internationally integrative models of health care delivery are becoming increasingly prevalent. National Center for Complementary and Alternative Medicine defines integrative medicine as combination of mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness." Consequently, some chiropractors, in particular refom chiropractors, are beginning to become integrated in formal public health settings such as hospitals, interdisciplinary health teams and within governmental institutions to provide their expertise in the management of neuromusculoskeletal disorders.

This was swept away in the archives but we should discuss it here first, as always before incorporating it into the main article. Eubulides, do you have any problems with the language and what section do you think this belongs in? EBDCM (talk) 02:05, 27 February 2008 (UTC)

As I mentioned at the end of Talk:Chiropractic/Archive 15 #Mainstream integration, I can't easily review this proposal because it has has zero citations; it has merely uninformative numbers like "". Without that information, I cannot verify that the claims are well-sourced. Can you please fix this so that I can do a proper review? Thanks. Eubulides (talk) 07:26, 27 February 2008 (UTC)

Thanks Go--- I mean Eubulides, but the sources are well sourced. Personally I think that it's condecending of you to infer that only your eyes and brain can make a call on what is well sourced. I have 8 years of university education, am very familar with EBM and research protocols I think I can tell the difference between a poor source and a good one. Anyways, I was asking you about the language first. EBDCM (talk) 15:38, 27 February 2008 (UTC)

Please provide the sources. I cannot tell whether I have problems the language without seeing the sources. Eubulides (talk) 16:48, 27 February 2008 (UTC)

EBDCM, what Eubulides is saying is that he doesn't know what you mean by or as there is no hyperlinked text. Are you referring to sources already in the article? Sources in the notes section of the talk page? On the other hand, Eubulides, you should not need the sources to decide if you have a problem with the way the text is worded. 121.44.227.79 (talk) 00:24, 28 February 2008 (UTC)

I see some minor problems with the phrasing, but I'd rather not waste everybody's time with those while the major problem of sourcing remains unaddressed. Eubulides (talk) 05:31, 28 February 2008 (UTC)

Why don't you mention those now, because otherwise you are wasting everybody's time. 121.44.227.79 (talk) 05:50, 28 February 2008 (UTC)

Let's go Eubulides, as anonymous suggests. The sources have already been provided in the archives in both the main article and talk page. EBDCM (talk) 15:48, 28 February 2008 (UTC)

I disagree that strong sources have been provided. However, since you asked, here are some problems with the existing text:

• Integration implies being integrated with some other professionals. Who are these other professionals, and how do they interact with chiropractors in an integrated models? Without this information the paragraph isn't saying much, other than "Integration good" (which raises POV issues).
• "With the rise of popularity of complementary and alternative therapies". Lawrence & Meeker also point out that the chiropractic is rising in popularity only modestly.
• "The reformation of health care systems internationally" This doesn't say much. Health care systems are always changing, and people are always reforming them. This phrase can go.
• "integrative models of health care delivery are becoming increasingly prevalent". What is the source for the claim that integrative models are more prevalent? How much more prevalent are they?
• "National Center for Complementary and Alternative Medicine defines" There's no need to mention the NCCAM in the main text; a citation suffices.
• "in particular reform chiropractors" This phrase is not needed (and I suspect is not supported by the sources).

Eubulides (talk) 17:57, 28 February 2008 (UTC)

I fetched some of them though I think I had a more recent revision with better quality references,

Some chiropractors, particularly reform chiropractors, may practice Integrative medicine in hospitals, within interdisciplinary health teams . Chiropractors are also becoming more integrated in scientific research communities and within governmental institutions. —Preceding unsigned comment added by EBDCM (talk • contribs) 05:00, 29 February 2008 (UTC)

• does not support the cited claim. It does not mention reform chiropractors. It is a Norwegian feasibility study.
• is a brochure describing Ontario's payment procedures for interdisciplinary health care. I guess it's being cited to prove that interdisciplinary health care exists? If so, that's not at all obvious; and surely there is a better source.
• is to a list of speakers and publications. I fail to see how it supports the claim that chiropractors are becoming more integrated in scientific research communities. If it's evidence, it's too indirect.
• is to a list of publications relating to health care policy reform in Canada, which does not say "chiropractic" anywhere. I don't see the relevance.
• does not mention chiropractic either.
• is a VA press release saying VA facilities offer chiropractic care. The press release does not talk about integrative medicine, and does not support any claims about integrative medicine.
• does not talk about integrative medicine either.

To summarize: the citations either do not support the claims, or are not relevant, or are exceedingly indirect. Better citations are needed. Have you had a chance to look at Mootz 2007 (PMID 17224347), Barrett 2003 (PMID 12816630), and Meeker & Haldeman 2002 (PMID 11827498)? Eubulides (talk) 07:25, 29 February 2008 (UTC)

Read the citations closer, Eubulides. It's not a feasiibility study and the conclusion clearly states that the DC was fully integrated into the ortho department within the hospital. It's note l a brochure (what poor wording) and it comes directly from the government of Ontario. Furthermore its proof that DCs are members of interdisciplinary teams. Health care reform is happening; the link shows proof and the interdisciplinary teams (CHC and FHT) are evidence of this. What would you call chiropractors working in the VA side by side with MDs, PTs and other professionals? Gimme a break. Your claims are unfounded and the citations support the claims made that DCs are beginning to be incorporated into CHC, FHT, governmental agencies and hospitals. Thanks for your spin though! EBDCM (talk) 13:45, 29 February 2008 (UTC)

• concludes "the inclusion of chiropractors within hospital orthopedic departments is feasible", which indicates the authors were studying feasibility; if they weren't, why would they have made feasibility an important part of their conclusion?
• is some sort of document talking about who is eligible for compensation; whether one calls it a "brochure" or a "handout" or something else, it is an extraordinarily odd choice to support the claim that chiropractors are interdisciplinary health care providers. It's sort of like citing instructions to an I.R.S. tax form to support the claim that businesses have profits and losses. I could not tell from reading the source what claim it was intended to support. A better source is needed. I am not disputing the claim that some chiropractors practice as part of integrative medicine; I'm saying only that the source is inadequate.
• does not say that chiropractors work "side by side" with MDs. It merely says that they work at certain locations. It also makes clear that the program supports outpatient care, which suggests a non-integrated approach. Merely getting funding from the VA, or even setting up shop in a VA hospital, does not necessarily mean integrative medicine. A better source is needed to support the claim.
• None of the other detailed comments have been addressed.
• In drafting a better version, it would be helpful to start by finding reliable sources on the subject, using the criteria suggested in WP:MEDRS, and to summarize their main points in the draft. Doing that will avoid the sort of sourcing problems noted above.

Eubulides (talk) 21:39, 29 February 2008 (UTC)

Revision to "safety"

The following subsection, #Safety 2, contains a proposed draft revision to Chiropractic #Safety. The initial version of this draft was taken from this version; the idea is to edit this into something that addresses the POV problems discussed in #Safety above, in a way that achieves consensus. Eubulides (talk) 22:20, 28 February 2008 (UTC)

Safety 2

Efficacy

The safety of chiropractic has been increasingly studied in recent years as researchers investigate the merits of its effectiveness and risk-benefit balance.

The efficacy of spinal manipulation for the lower back has not been convincingly demonstrated. Nevertheless, there is supportive evidence, indicating some benefits for lower back pain treatment. Researchers in the scientific and medical community believe more studies are needed to properly evaluate its safety and efficacy. Chiropractors have frequently countered that cervical spinal manipulation was a safe and effective procedure compared to conventional medical approaches for mechanical neck pain syndromes.

A 1996 study concluded, "The efficacy of spinal manipulation for patients with acute or chronic low back pain has not been demonstrated with sound randomized clinical trials. There certainly are indications that manipulation might be effective in some subgroups of patients with low back pain. These impressions justify additional research efforts on this topic. Methodologic quality remains a critical aspect that should be dealt with in future studies."

A 2004 study concluded, "Our data synthesis suggests that recommendations can be made with some confidence regarding the use of SMT and/or MOB as a viable option for the treatment of both low back pain and NP. There have been few high-quality trials distinguishing between acute and chronic patients, and most are limited to shorter-term follow-up. Future trials should examine well-defined subgroups of patients, further address the value of SMT and MOB for acute patients, establish optimal number of treatment visits and consider the cost-effectiveness of care."

The 2005 published 'Current Concepts: Spinal Manipulation and Cervical Arterial Incidents' concludes in it's Executive Summary: "What does the evidence reveal about the effectiveness of cSMT? The evidence shows that chiropractic treatment is favorable for most conditions. Research shows a trial of spinal manipulation is advisable for patients with neck pain, neck-related upper extremity pain and headaches—as long as specific contraindications are absent. Treated conditions may include cervical sprain/strain injury, myofascial syndromes, discogenic pain, cervicogenic headache, pseudoradicular and radicular syndromes of the upper extremities."

A 2006 study concluded, "Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful, although chiropractic may result in a greater likelihood of perceived improvement, perhaps reflecting satisfaction or lack of blinding. Physical therapy may be more effective than medical care alone for some patients, while physical modalities appear to have no benefit in chiropractic care."

Safety

Spinal manipulation, the most common modality in chiropractic care. Spinal manipulation is associated with common but mild adverse effects as well as an unknown risk of serious complications. Most patients have no adverse effects from cervical manipulation, though the risk of stroke is not zero. Cervical spine manipulation (upper cervical specifically) has been a source of controversy. Spinal manipulation is a regulated medical intervention and can only be performed by chiropractors and a limited number of physical medicine professionals. Prior to the adminstration of spinal manipulative therapy, patients must be screened out for absolute contraindications and undergo a complete clinical exam including history, physical and at times additional specialized imaging and laboratory diagnostics. These include inflammatory arthritides, fractures, dislocations, instabilities, bone weakening disorders, tumours, infections, acute trauma as well as various circulatory and neurological disorders.

A 2005 World Health Organization report states that when "employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems." The report continued, "there are however, known risks and contraindications to manual and therapeutic protocols used in chiropractic practice," and, "Contraindications to spinal manipulative therapy range from a nonindication for such an intervention, where manipulation or mobilization may do no good, but should cause no harm, to an absolute contraindication... where manipulation or mobilization could be life‐threatening."

A 2007 study of 50,276 chiropractic manipulations of the cervical spine conducted by the Anglo-European College of Chiropractic in the UK turned up no reports of serious adverse effects; the study concluded that the risk of serious adverse effects was, at worst, 6 per 100,000 manipulations. The most common minor side effect was fainting, dizziness, and/or light-headedness, which occurred after, at worst, 16 in 1,000 treatments.

A 2007 study states, "In conclusion, spinal manipulation, particularly when performed on the upper spine, has repeatedly been associated with serious adverse events. Currently the incidence of such events is unknown. Adherence to informed consent, which currently seems less than rigorous, should therefore be mandatory to all therapists using this treatment. Considering that spinal manipulation is used mostly for self-limiting conditions and that its effectiveness is not well established, we should adopt a cautious attitude towards using it in routine health care."

Spinal adjustments on children carry a risk of injury. A 2007 review in Pediatrics concluded, "Spinal manipulation is common among children, and although serious adverse events have been identified, their true incidence remains unknown. Randomized, controlled trials will likely reveal common minor adverse events, and these events must be better reported. Prospective population-based studies are needed to identify the incidence of serious rare adverse events associated with spinal manipulation. Patient safety demands a greater collaboration between the medical community and other health care professionals, particularly chiropractors, such that we can investigate and report harms related to spinal manipulation together. In the interim, clinicians should query parents and children about CAM usage and caution families that although serious adverse events may be rare, a range of adverse events or delay in appropriate treatment may be associated with the use of spinal manipulation in children."

In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders, comprising a group of experts to evaluate neck pain and its associated disorder, released a manuscript of their findings with recommendations and guidelines, including associated risks and benefits. With respect to the association of VBA stroke and cervical manipulation the study concluded, "Vertebrobasilar artery stroke is a rare event in the population. There is an association between vertebrobasilar artery stroke and chiropractic visits in those under 45 years of age. There is also an association between vertebrobasilar artery stroke and use of primary care physician visits in all age groups. No evidence of excess risk of VBA stroke associated chiropractic care. The increased risks of vertebrobasilar artery stroke associated with chiropractic and physician visits is likely explained by patients with vertebrobasilar dissection-related neck pain and headache consulting both chiropractors and primary care physicians before their VBA stroke."

Risk-benefit

Researchers discuss whether the risk versus benefit of spinal manipulation is acceptable.

A 2001 study states, "Ultimately, the acceptable level of risk associated with a therapeutic intervention also must be balanced against evidence of therapeutic efficacy. Therefore, further research is indicated into both the benefits and harms associated with cervical spine manipulation. Practitioners of this technique should be called on to demonstrate the evidenced-based benefit of this procedure and to define the specific indications for which the benefits of intervention outweigh the risk."

A 2003 study concluded, "There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain."

A 2003 study concluded, "Initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy."

A 2006 study states, "the risk-benefit balance does not favour SM over other treatment options such as physiotherapeutic exercise."

A 2007 study concluded, "Adverse events may be common, but are rarely severe in intensity. Most of the patients report recovery, particularly in the long term. Therefore, the benefits of chiropractic care for neck pain seem to outweigh the potential risks."

Spinal manipulation for the lower back appears to be relatively cost-effective.

Comments on safety 2

(Please place comments here.) Eubulides (talk) 22:20, 28 February 2008 (UTC)

• "Stephen Barrett of Quackwatch asserts that there is a risk of stroke associated with neck manipulation, and questions the validity of studies that find very low incidences for serious complications." This has no place in a NPOV article on Safety of SMT/Chiropractic. DigitalC (talk) 00:15, 29 February 2008 (UTC)

I agree. I have not yet had time to review the references (wow, there are tons of them!), but my initial impression is that there are way too many citations, too many of them are primary sources rather than reviews, too many of them are old, and there is no need to cite lower-quality sources like Quackwatch when higher-quality sources are available. One other thing: there's no need to mention the source's name and affiliation in the main text: this is supposed to be an article about chiropractic, not about chiropractic's critics and defenders. Eubulides (talk) 00:33, 29 February 2008 (UTC)

• "Spinal manipulation is a regulated medical intervention and can only be performed by chiropractors and a limited number of physical medicine professionals. Prior to the adminstration of spinal manipulative therapy, patients must be screened out for absolute contraindications and undergo a complete clinical exam including history, physical and at times additional specialized imaging and laboratory diagnostics. These include inflammatory arthritides, fractures, dislocations, instabilities, bone weakening disorders, tumours, infections, acute trauma as well as various circulatory and neurological disorders" This paragraph should be moved to before the bone and joint task force paragraph. DigitalC (talk) 00:34, 29 February 2008 (UTC)

I would also like to see the two statements on contraindications put into one paragraph, rather than have them in two separate paragraphs. The one statement doesn't seem linked to the study which the paragraph seems to be about. DigitalC (talk) 00:38, 29 February 2008 (UTC)

Slowly going through it, working with the most contentious first. Is there a need for the Ernst quote? It is based on a commentary (opinion piece) article. DigitalC (talk) 01:15, 29 February 2008 (UTC)

Please review this edit. Thanks. QuackGuru (talk) 01:42, 29 February 2008 (UTC)

Wow, this proposal by quack guru is off the wall. He chides me on my talk page about being NPOV and proceeds to add references from Quackwatch and a mention of uber-chiropractic basher Stephen Barrett, Also, how many times are we going to use Ernst in this article? We all know where he stands, he has nothing new to say and his statements have come under disrepute from many physical medicine specialists. When you toss in the fact that the majority of GQs citations suck (sorry to be blunt) and this version is not an improvement over the current version I'll leave it at that. EBDCM (talk) 01:52, 29 February 2008 (UTC)

The children thing is not necessary; and you should know that there was a major reversal in the US re: chiropractic care for children (it had previously been "delisted"). The safety section now amounts nothing more to fear mongering my Eubulides and quack guru. How about we quote the 0.0000002% of serious injury just so the public truly knows the risks. This type of editing by these individuals is questionable at best and continues a trend of going against the consensus of many editors here. EBDCM (talk) 01:59, 29 February 2008 (UTC)

There is a serious safety issue for children. If you disagree, please provide the references. QuackGuru (talk) 02:04, 29 February 2008 (UTC)

The reference which you provided does not support that conclusion. If you are going to make a claim, YOU should provide the reference to back it up. DigitalC (talk) 02:23, 29 February 2008 (UTC)

You are still using a commentary (opinion piece) reference when better references are readily available. DigitalC (talk) 02:26, 29 February 2008 (UTC)

(<-- out-dent) I think the source is weak for the fear mongering notion that spinal manipulation of children. Quotes which make me think so include:

• Though researchers found only a handful of serious injuries among 13 published studies, they believe that there's still too little known about the safety of spinal manipulation in children.
  • So despite the lack of evidence that it is dangerous, the researchers are going to go ahead and say it is dangerous. Sounds pretty pseduoskeptical to me.
• Until more is learned, they suggest that parents be cautious about seeking this therapy for their children.
  • Same as above. This is classic fear-mongering.
• Only two were based on clinical trials that tested the effects of spinal manipulation on children; the rest were reports on individual cases of injuries.
  • IOW, this inconclusive review is based on pretty weak studies.
• A chiropractor performed the adjustments in most cases, though other health professionals -- including medical doctors, physical therapists and osteopaths -- sometimes offer the therapy.
  • We have seen this trick in other studies, where the "researchers" confuse (seemingly on purpose) the precision adjustments of chiropractors with those less skilled. (Were there kung-fu practitioners and Indian Barbers thrown into the mix in these "studies" as well?)

Finally, what I find most disheartening here is that despite chiropractic merely having a 0.0000002% hypothetical chance of serious risk, we dedicate so much of this article to the subject. While articles about health treatments with astronomically higher risks don't mention safety issues at all (i.e. See surgery... Iatrogenesis anyone?). My opinion is that this bogus section in Chiropractic needs to be severely shortened and state what WHO has said: According to the World Health Organization "employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems. Anything else is a matter of taking misguided research and hypothetical statistics and blowing them out of proportion. That the chiropractic adjustment has much of any serious risk associated with it is a true minority viewpoint and by giving this much of this article to the discussion of this subject is a clear violation of WP:WEIGHT. -- Levine2112 02:27, 29 February 2008 (UTC)

Everything is referenced. The scientific research and studies verify it is NPOV. QuackGuru (talk) 02:32, 29 February 2008 (UTC)

Weak reference. -- Levine2112 02:34, 29 February 2008 (UTC)

Furthermore, just because something is referenced, doesn't mean it is NPOV. DigitalC (talk) 02:37, 29 February 2008 (UTC)

You don't seem to get it QG, your references, well, they suck. Please review Sackett's levels of evidence if you don't get my drift. Also, I'm in complete agreement with Levine here. What a double standard being applied to the chiropractic article. Nothing like this appears in any medical article, including Eubulides personal baby, vaccination. I added contraindication there as a sign of good faith primarily for CynRN and now Eubulides and QG have taken the ball and ran with it and now it's nothing more than fear mongering. You argument has been thoroughly dismantled, quack guru, so please spare us with more of this nonsense unless you have some high quality research and not op-ed pieces. Thanks for your cooperation! EBDCM (talk) 02:39, 29 February 2008 (UTC)

There is no evidence of weak references. They are high quality references. Thanks for your comments. QuackGuru (talk) 02:57, 29 February 2008 (UTC)

A commentary article is not a high quality reference, and is indeed a weak reference when talking about safety. DigitalC (talk) 03:16, 29 February 2008 (UTC)

I can count 4 editors already here on this comments section that think your references are weak. Denial isn't just a river in Egypt, Quack Guru. Thanks for your efforts to improve the article. PS: Please do read Sackett's levels of evidence so you can better contribute to the article and save us a lot of time. EBDCM (talk) 03:20, 29 February 2008 (UTC)

Commentary articles are very high quality references. There is commentary from chiropractors. For example, Chiropractors have frequently countered that cervical spinal manipulation was a safe and effective procedure compared to conventional medical approaches for mechanical neck pain syndromes. This is in the Safety and is commentary. QuackGuru (talk) 03:30, 29 February 2008 (UTC)

CONCLUSIONS: Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients. QuackGuru (talk) 03:30, 29 February 2008 (UTC)

Commentary article are very LOW quality references. As EBDCM suggested, perhaps you should look at Sackett's level of evidence. Why you then linked the conclusions of a systematic review (not a commentary article) that is already in the draft, I don't know. DigitalC (talk) 03:43, 29 February 2008 (UTC)

Undent. No they are not. I'm familiar with this article, Humphreys is an author. I can easily find tons of references in favour of SMT for children that would cancel out your claim easily. The commentary you described above is a from a review of the literature which suggested that the relative risk of complications of SMT for neck pain, relative to common medical procedures shows that it IS AS or MORE effective than conventional approach. It's not a commentary it's a statement of fact. Another red herring from Quack Guru. You are also using an appeal to fear fallacy as well. EBDCM (talk) 03:44, 29 February 2008 (UTC)

More comments on safety 2

I propose a strikeout of "Spinal adjustments on children carry a risk of injury. Researchers suggest that spinal manipulation is associated with common but mild adverse effects as well as an unknown risk of serious complications." because it is already covered with "there are however, known risks and contraindications to manual and therapeutic protocols used in chiropractic practice" Comments? DigitalC (talk) 06:00, 29 February 2008 (UTC)

Agreed. It would be easier to bring the current edit here and dissect rather than going the QGs proposal which is riddled with holes, WEIGHT issues, NPOV issues, poor citations and fallacies. I also like your idea of combining the contraindications in 1 paragraph rather than 2 before the Task force study so feel free to edit that on the main page. Good job. EBDCM (talk) 06:04, 29 February 2008 (UTC)

Actually, instead of striking that out, maybe we can work it into "Critics have suggested that spinal manipulation is of limited benefit and a risk factor for vertebral basilar stroke." and look into removing the WP:WEASEL word "critic" at the same time (have to look at the sources and see who suggested it). Something along the lines of "WEASEL-removed have suggested that spinal manipulation is a risk factor for vertebral basilar stroke and may carry a risk of injury in children" ??. DigitalC (talk) 06:18, 29 February 2008 (UTC)

Metacomments on safety 2

Obviously there are several disagreements here. In rereading the draft and the above comments, I have some thoughts that are not about POV directly but which I hope can help towards resolving the dispute.

• This section is titled Safety, but the draft and many of the comments have also talked about efficacy and cost-effectiveness. Shouldn't those issues be spun off into different sections? That is, shouldn't this section focus on safety? Or at least limit itself to safety and the risk-benefit ratio (with a previous section talking about efficacy)?

• The section talks only about safety of spinal manipulation. What about the other treatments used in chiropractic?

• Professions other than chiropractors do spinal manipulation. How should this be addressed?

Let's look at this in context shall we. First, DCs were historically ridiculed, jailed, called pseudoscientfic for using SMT and now suddenly SMT is en vogue, PTs are chomping at the bit to manipulate and other professions are claiming to provide adequate manipulative therapy. Hello? 1) This article is about chiropractic and chiropractors and chirorpractic manipulation (i.e. done by a chiropractor or a technique invented by a DC) and that's all the needs to be said. EBDCM (talk) 01:34, 4 March 2008 (UTC)

I agree that Chiropractic #Safety should focus on chiropractic safety. The only question is how to address the issue that other professions also do spinal manipulation. Given the other discussion below, perhaps it's best deferred to a later section that compares chiropractic cost-benefit to that of other professions, which would mean Chiropractic #Safety could ignore the issue. Eubulides (talk) 06:48, 4 March 2008 (UTC)

• It seems that much of the disagreement stems over what the best sources are to use. I looked over all the sources mentioned above, and there are many weak ones. How about if we try to come up with a short list of the best sources of chiropractic safety? By "best" I mean the usual standards: published in refereed journals or in textbooks with equivalent editorial standards; secondary sources preferred; recent sources preferred. Ideally we could come up with a short (five to ten references) list that could be use to support a revised version.

WP:UNDUE WEIGHT for this section now, as Levine2112 mentioned; how many studies will have to be done to demonstrate that SMT is safe? Clearly Ernst et al. will NEVER stop writing anti-chirorpractic and manipulation articles and will we always give him mention? The guy is losing credibility fast with his witch-hunt and is beginning to look more and more stupid as the evidence in favour of the safety of SMT adds up. He has already been severely rebutted before for this less than forthright "review" of SMT and of chiropractors. In short, his yearly anti-chiropractic op-ed pieces are becoming increasingly boring and he really has nothing new to say and is losing credibility with his continued pursuit of trying to discredit DCs and SMT. EBDCM (talk) 01:34, 4 March 2008 (UTC)

This topic of Ernst et al. is addressed under #Comments on sources for safety and risk-benefit below. Eubulides (talk) 06:51, 4 March 2008 (UTC)

Sources for safety

For starters, I thought I'd try to mention four five six of the stronger sources on spinal manipulation safety. Comments? Are there some even-stronger sources I missed?

• World Health Organization (2005). "WHO guidelines on basic training and safety in chiropractic" (PDF). Retrieved 2008-02-29. {{cite journal}}: Cite journal requires |journal= (help)

• The following clinical practice guideline is also available. It focuses on adult neck pain not due to whiplash. Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) Anderson-Peacock E, Bryans B, Descarreaux M; et al. (2008). "A clinical practice guideline update from The CCA•CFCREAB-CPG" (PDF). J Can Chiropr Assoc. 52 (1): 7–8. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

• Triano J (2005). "The theoretical basis for spinal manipulation". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 361–82. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link)

• A more extensive and up-to-date version of this material should be in the following source (we don't have online access to it): Triano JJ, Kawchuck G, Gudavalli MR, Terrett AGJ (2006). Current Concepts: Spinal Manipulation and Cervical Arterial Incidents. Clive, IA: NCMIC. ISBN 1892734141. OCLC 63161672.{{cite book}}: CS1 maint: multiple names: authors list (link)

• Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med. 100 (7): 330–8. PMID 17606755.

• Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å (2008). "The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: executive summary". Spine. 33 (4 Suppl): S5–7. doi:10.1097/BRS.0b013e3181643f40. PMID 18204400.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Vohra S, Johnston BC, Cramer K, Humphreys K (2007). "Adverse events associated with pediatric spinal manipulation: a systematic review". Pediatrics. 119 (1): e275–83. doi:10.1542/peds.2006-1392. PMID 17178922.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• Thiel HW, Bolton JE, Docherty S, Portlock JC (2007). "Safety of chiropractic manipulation of the cervical spine: a prospective national survey". Spine. 32 (21): 2375–8. PMID 17906581.{{cite journal}}: CS1 maint: multiple names: authors list (link) This one is a primary study, not a review, so normally it'd be avoided. However, it is so recent that no reviews cover it. It is high quality (a prospective study of 19,722 patients) and contains notable results, so it is a good case for an exception to the usual rule.

Eubulides (talk) 11:13, 29 February 2008 (UTC)

Sources for risk-benefit

Here is a source that is high-quality, but is not as good for Chiropractic #Safety. It's only a primary study, and it's smaller than the Thiel study, and it's primarily a risk-benefit analysis rather than a safety study. It is probably more useful for a risk-benefit section (which would be some new section other than safety):

• Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW (2007). "The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study". J Manipulative Physiol Ther. 30 (6): 408–18. doi:10.1016/j.jmpt.2007.04.013. PMID 17693331.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Eubulides (talk) 08:18, 1 March 2008 (UTC)

Comments on sources for safety and risk-benefit

Why not:

Or the UCSF, Smith, 2003 study indicating that manipulation is an independent risk factor? Or Reuter, et al, 2005, or Refshauge, et al, 2002.CynRNCynRN (talk) 19:01, 29 February 2008 (UTC)

• Rothwell et al. 2001 (PMID 11340209) is a high-quality study, but it's a primary study. WP:MEDRS suggests the article should prefer secondary sources when they are available, which is true here.
• Likewise for Smith et al. 2003 (PMID 12743225).
• Likewise for Reuter et al. 2006 (PMID 16511634).
• By "Refshauge, et al, 2002" do you mean Pengel et al. 2002 (PMID 12501942)? It lists Refshauge as a coauthor. That is a systematic review, which is much better, but (a) it's a bit dated and more important (b) it's about efficacy, not safety.

Eubulides (talk) 22:33, 29 February 2008 (UTC)

Again, these sources say that the risk is so minuscule that the amount of space we are dedicating to this hypothetical 0.0000002% chance of risk clearly violates WP:UNDUE. At most, mention of the possibility serious risk in the article deserves one sentence (if that). -- Levine2112 19:07, 29 February 2008 (UTC)

I agree that the risk is very small, but it's not zero. The refs say that the full extent of risk is unknown. Rendering the numbers into decimals make any risk look infinitesimal. However, I don't know if the safety section needs to be more than a few sentences. It should summarize the various study's conclusions.CynRNCynRN (talk) 19:50, 29 February 2008 (UTC)

I agree that safety issues need to be discussed. However, I disagree that one sentence is an appropriate length. I just now checked Google Scholar, which estimated 60,000 articles mentioning "chiropractic", and 7,540 mentioning both "chiropractic" and "safety". Obviously this is a very rough measure, but it indicates that safety is a legitimate subtopic of concern with respect to chiropractic, and that one sentence is not nearly enough to do it justice. Eubulides (talk) 22:46, 29 February 2008 (UTC)

Me thinks this children's study is significant. It seems the risk for children is higher than adults. QuackGuru (talk) 22:51, 29 February 2008 (UTC)

Yes, thanks, that's a recent high-quality review. I added that to the list. Eubulides (talk) 23:22, 29 February 2008 (UTC)

No, that's a wildly inconclusive study which amounts to saying nothing. And Google searches are a pretty weak way to make such assessments. I have been learning this recently. For all we know, 99% of the articles mentioning chiropractic and safety are there to tell us that chiropractic is safe. Or maybe "chiropractic" in mentioned on the page but with no context to the word "safety". And , CynRN, rendering the numbers into decimals only makes the risk look infinitesimal because the risks are infinitesimal. I didn't make up that percentage. That is derived from the hypothetical risk calculation based on inconclusive experiments marred by purposeful deception seemingly motivating to be a scare tactic employed by allied competition. See Terrett's study: "Vertebrobasilar stroke following manipulation." where Terrett observed that "manipulations" administered by a Kung Fu practitioner, GPs, osteopaths, physiotherapists, a wife, a blind masseur, and an Indian barber were incorrectly attributed to chiropractors. As Terrett wrote, "The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT injury by medical authors, respected medical journals and medical organizations. In many cases, this is not accidental; the authors had access to original reports that identified the practitioner involved as a non-chiropractor. The true incidence of such reporting cannot be determined. Such reporting adversely affects the reader's opinion of chiropractic and chiropractors." -- Levine2112 23:31, 29 February 2008 (UTC)

• It's OK to use reliable sources even if they draw limited conclusions, as long as Chiropractic reports those conclusions accurately.
• I agree that the Google Scholar search figures are approximate. However, they do suggest a real concern.
• Given the level of controversy and uncertainty in this area, I doubt whether any neutral summary could report just one numeric estimate and leave it at that. More likely it will give a range, or multiple estimates by different sources, or say that reliable estimates are unavailable, or something like that. That's OK. That's how reliable reviews work.

Eubulides (talk) 00:39, 1 March 2008 (UTC)

It must be Sunday again since Eubulides (aka God, the prophet Muhammed) is telling his disciples what to do again like we're morons. First you're all "we need secondary sources" and as soon as he discovers an article that sides with his POV that SMT is unsafe it's suddenly ok to use review pieces. What a joke. Do us a favour and stop patronizing us, stop telling us what's good and not, stop playing politics here and be a little more forthright and hiding behind your INTERPRETATION of various wikipedia policies. EBDCM (talk) 01:40, 4 March 2008 (UTC)

There must be some confusion here. First, reviews are secondary sources; please see WP:MEDRS #Some definitions and basics. Second, I don't understand the comments about politics and forthrightness, but please be assured that I am attempting to improve Chiropractic as best I can. Eubulides (talk) 07:22, 4 March 2008 (UTC)

Thanks for your comments. Nevertheless, we are going to follow the references where thay take us. QuackGuru (talk) 23:38, 29 February 2008 (UTC)

Have you actually read the study? It is impossible to infer that the risk of SMT is higher in children than in adults, as the study does not report on incidence! DigitalC (talk) 23:48, 29 February 2008 (UTC)

Yes, I have read the study. QuackGuru (talk) 01:03, 1 March 2008 (UTC)

"A number of risk factors may predispose a child to an adverse event as a result of spinal manipulative procedures, including immaturity of the spine, rotational manipulation of the cervical spine, and high-velocity spinal manipulations.44–47 We found that all 9 serious adverse events (eg, death resulting from subarachnoid hemorrhage, paraplegia, etc) occurred in children under 13 years of age.30,32,34 In a case series, Ragoet32 presented 3 cases of dislocated atlas as a result of pediatric spinal manipulation. Evidence suggests that there is a strong correlation between severity of injury to the spinal cord and the immaturity of the spine44 and that the atlas (cervical vertebra 1 (C1) and dens of the axis (C2) of children are more vulnerable to trauma than those of adults.45 Although 5 of our serious adverse-event reports did not specify the type of spinal manipulation used, 2 of the 4 that reported serious adverse events specified that the practitioner used rapid and/or strong rotational maneuvers.27,31 The majority of complications attributed to spinal manipulative therapy have occurred as a result of rotational manipulation of the cervical spine.46 In addition, high-velocity manipulations of the spine have the potential for serious complications resulting from diagnostic error/inadequate patient assessment.47 Although the authors did not clearly specify the type of spinal manipulation provided, 2 of the severe adverse-event reports identified underlying risk factors (spinal cord astrocytoma, congenital occipitalization) that may have predisposed the child to the subsequent serious adverse event (ie, quadriplegia, unsteady gait).29,34 An error in the diagnosis of any number of preexisting conditions such as arteritis, arthritic and cardiac conditions, clotting abnormalities, meningitis, or vertebrobasilar insufficiency may predispose children to neurologic and/or vertebrobasilar complications.45,48–50" I have read the facts. QuackGuru (talk) 23:59, 29 February 2008 (UTC)

At this point I'm not yet ready to discuss the contents of the reliable sources. I'm just trying to come up with a short list of reliable sources. Eubulides (talk) 00:39, 1 March 2008 (UTC)

This UK study is reliable and may be significant too. Thoughts. QuackGuru (talk) 01:25, 1 March 2008 (UTC)

It's less good, since it's a primary study, but there are reasonable arguments for including it despite that problem, so I added it to the list. Thanks. Does anyone have other suggestions for other sources, of this quality or better? Eubulides (talk) 07:13, 1 March 2008 (UTC)

From the pediatrics study above, and why it does not support the statement that SMT risk is higher in children than in adults: "Although our search strategy was more comprehensive, we did not feel comfortable creating risk estimates with an uncertain denominator." Without a risk estimate, it CANNOT be compared to the risk of SMT in adults. As with before, this is an acceptable source to say that "there SMT may carry a risk of injury to children". As such, this really isn't a valuable source as it does not contribute much to the section. DigitalC (talk) 07:29, 1 March 2008 (UTC)

I'm not quite ready to discuss technical details; I'm still just trying to identify the best sources. I disagree, however, that Vohra et al. 2007 provides little of value. It is sometimes valuable to point out, as they do, how little is known about an area. Eubulides (talk) 08:29, 1 March 2008 (UTC)

I also suggest using this reference. DigitalC (talk) 08:04, 1 March 2008 (UTC)

Thanks, that one looks more apropos for a (not-yet-written) risk-benefit section. I created a new subsection #Sources for risk-benefit for it; we can add other citations to that section as needed. The source does have some safety data and that might be useful for the safety section, I suppose; but it's not as good for that purpose. Eubulides (talk) 08:18, 1 March 2008 (UTC)

It seems like risk/benefit is all tied up together. If massage works as well as manipulation, why take any risk? Why are physical therapists becoming hesitant to do manipulations, or at least, recommending consent and caution? 'Causes of complications from cervical manipulation', Mann and Refshauge, 2001,CynRNCynRN (talk) 08:31, 1 March 2008 (UTC)

Yes, in the end they're all tied up together. We probably need 3 sections (or at least 3 paragraphs), one for safety (risk), one for efficacy (benefit), and one for risk-benefit. For now I'd like to start with safety, though (primarily because there's an existing section called "Safety"). Safety first, and all that.… Eubulides (talk) 08:42, 1 March 2008 (UTC)

What about citing textbooks on manual tx and chiropractic about safety, as references?CynRNCynRN (talk) 09:16, 1 March 2008 (UTC)

Depends on the textbook and the publisher. Some are quite good. The current list has one source from a textbook, namely Triano 2005. WP:MEDRS has a bit more on textbooks and sources. Eubulides (talk) 09:21, 1 March 2008 (UTC)

If someone has access to a copy (EBDCM?) I suggest the following book as a source. I do not think it is available online. "Current concepts in spinal manipulation and cervical arterial incidents" by Triano and Kawchuk. DigitalC (talk) 11:17, 1 March 2008 (UTC)

Thanks. That source is a little hard-to-find, and sounds like it would mostly just expand on the existing Triano source, but I added it since it should be more extensive and it was published a year later. Eubulides (talk) 19:22, 1 March 2008 (UTC)

It is extensive. There are over 700 references used in it. DigitalC (talk) 10:25, 2 March 2008 (UTC)

I'm sure this has been mentioned before, but CCGPC CCGPC -other-version DigitalC (talk) 11:56, 2 March 2008 (UTC)

That's limited to adult non-whiplash neck pain, which is a bit of a subset; also, it's a clinical practice guideline rather than being a study or review of safety. It's got relevant info, but is it up to the standard of the other references, which attempt to be directly on point? Let's put it another way: does it say something about safety that the WHO report doesn't? Eubulides (talk) 04:53, 3 March 2008 (UTC)

Eubulides, let's put it this way: the most comprehensive, evidence-based literature synthesis and review on ALL aspects of chiropractic treatment is done by the ccgpp. We will use those sources, it's done in 2007-2008. And, for the record, oh great one, if you even bothered to read the Canadian guidelines safety was well mentioned in there for neck manipulation which is really the only real source of controversy. Thanks for coming out! EBDCM (talk) 01:43, 4 March 2008 (UTC)

If the CCGPP work is higher-quality than the WHO's, then we should prefer it to the WHO's. That would be fine with me. Although neck manipulation is the only real source of controversy over safety, I disagree that neck manipulation is the only real source of controversy; Ernst 2007 also cites adverse effects from chiropractic manipulation of the thoracic and lumbar spine. Eubulides (talk) 07:38, 4 March 2008 (UTC)

No further comment, so I added that guideline to the list of sources. It's not clear to me that both the WHO and CCA•CFCREAB-CPG guidelines will be needed, but it can't hurt to list both for now. Eubulides (talk) 21:47, 4 March 2008 (UTC)

:

Here is a rebuttal of this study and outlines many flaws in it: http://www.fcer.org/html/News/pediatrics107.htm EBDCM (talk) 01:12, 3 March 2008 (UTC)

PMID 17178922 contains pointers to rebuttals that address points mentioned in that press release (other than its touting of the effectiveness of spinal manipulation to treat ear infections, which is irrelevant to safety). We can rely on those rebuttals rather than on that press release. Eubulides (talk) 07:26, 3 March 2008 (UTC)

God, I mean, Eubulides, are you ever wrong? I mean, why bother having other editors here when you can a) find all the relevant literature, b)review all the relevant literature c) synthesize and come up with appropriate conclusions of the literature and d) make an edit here using said literature. Gimme a break. Many, many editors here have disagreed with you yet you keep pushing through ignoring their points or concerns. The double standard applies here too; effectiveness has not been established for 85% of medical interventions yet we need a massive section here on chiropractic, eh? What BS. I'm with Levine2112 on this one, more double standards and fear mongering supported by Eubulides and Quack Guru. 208.101.89.150 (talk) 17:02, 3 March 2008 (UTC)

I often make mistakes; for example, I missed some high quality sources, which other editors suggested later (thanks, by the way), and which I added to the list. However, a press release is not a high-quality source. When higher-quality sources are available, as is the case here, we should prefer them. As for your other point: effectiveness is an important topic, and should be addressed, but I'd rather address Chiropractic #Safety's problems first. Eubulides (talk) 17:50, 3 March 2008 (UTC)

We are going to stick with the reliable sources and NOT the chiropractic advocacy press release reference. QuackGuru (talk) 07:43, 3 March 2008 (UTC)

This coming from a guy who brings quackwatch and stephen barrett articles to the table. Nice. Regardless, Rosner a PhD, has waaaaaaaaaaay more research background that barrett and his "press releases" are used here. Sorry, same standards apply; this goes both ways, unless, of course, we take out every single press release from chirobase, quackwatch and stephen barrett. 208.101.89.150 (talk) 17:02, 3 March 2008 (UTC)

The French Society of Orthopedic and Osteopathic Manual Medicine has a paper, well referenced, concluding with 5 cautions regarding cervical thrust manipulations, inluding: "No cervical thrust in rotation in females less than 50 years. No cervical thrust in rotation in males less than 50 years at the first visit (but allowed at the 2nd visit if the first treatment was not efficient). Instead of rotational thrust, it is highly recommended to use mobilisations, MET (muscle energy techniques), soft tissue cervical techniques and upper thoracic spine thrust manipulations (which certainly act on the cervico thoracic muscles)." I think it is worth mentioning that several physiotherapy and osteopathic associations are studying the issue.CynRNCynRN (talk) 00:16, 4 March 2008 (UTC)

What is the reliable source for "several physiotherapy and osteopathic associations are studying the issue"? I'm asking because I'm wondering whether it is that big a deal. All other things being equal, I'd prefer to simply report the results that are in; it's not that useful to say "further studies are underway". (Further studies are always underway.…) Eubulides (talk) 07:09, 4 March 2008 (UTC)

I mispoke. PTs have been studying this issue for a decade or so. 3D223807+american+psysiotherapy+vertebral+dissection&hl=en&ct=clnk&cd=3&gl=us</ref>

ref>http://www.accessmylibrary.com/coms2/summary_0286-12484328_ITM</ref> CynRNCynRN (talk) 08:14, 4 March 2008 (UTC) And Grieve's Modern Manual Tx talks about Grimmer in Australia, Michaeli in South Africa and Rivett in New Zealand with data on cervical manip. pgs 257 on, Google books. CynRNCynRN (talk) 08:26, 4 March 2008 (UTC)

That comment has a few formatting problems, but what appears to be the first source mentions only one chiropractic case, one I imagine our existing sources address. What appears to be the second source does not mention chiropractic. The third source, Grieve's (ISBN 0443071551, OCLC 56659290) looks like it's high quality but (alas) the online version is so redacted that it's hard for me to follow. Eubulides (talk) 09:24, 4 March 2008 (UTC)

I was trying to make the point that PTs, who are licensed to do cervical manipulation, have taken a very cautious approach to it. I guess it's not a point we need to go into here in this article. Yes, too bad the Grieve's ref. is so limited.CynRN17:33, 4 March 2008 (UTC) —Preceding unsigned comment added by CynRN (talk • contribs)

If I took weekend courses and learned how to adjust necks, I'd be cautious too. A PT who practices "orthopedic manual physica therapy" is really practicing chiropractic at its core. EBDCM (talk) 00:26, 5 March 2008 (UTC)

French osteopaths and PTs are not chiropractors and their manipulations are not chiropractic manipulations. More fear mongering. 0.0000002%. Let's put this in. Also, why is everyone here ducking the fact that there's a double standard here; no other med article or profession has such a section on safety or efficacy. Since we have begun the slippery slope I vote we kill this section entirely until there is a fair balance occuring at other articles. Eubulides can start and go back to his vaccination article and start there FIRST before attempting to force upon us his interpretation of the events, ditto for CynRN who does not seem to understand the conclusions of the Neck Pain Task Force and resorts to comparing physio and osteo manipulations and trying to pidgeon toe chiropractic with it. EBDCM (talk) 01:26, 4 March 2008 (UTC)

• I agree that the FSOOMM source is of lower quality than the ones we already have. It's less on point, and I don't think it adds much.
• It's not true that no other medical article has a section on safety. For example, Ozone therapy has a long section "Studies of the toxicity and side effects of blood ozonation". Gene therapy has a long section "Problems and ethics" that covers safety issues and mentions deaths that have occurred with gene therapy. Phage therapy has a "Safety" section. Megavitamin therapy has a long "Criticisms and side effects" section. There are many other examples.

Ozone therapy? Are you kidding me? Lol! Get back to me when we are talking about the same thing, not apples and oranges. What an intellectually dishonest comment. EBDCM (talk) 00:26, 5 March 2008 (UTC)

Who said ozone therapy is the same as chiropractic? It's a completely different form of therapy. It has safety issues, just as chiropractic does. Gene therapy is similar: it's quite different from chiropractic, but it also has safety issues. Similarly for phage therapy and megavitamin therapy. Safety issues are important and relevant for nearly every kind of therapy, chiropractic included. Eubulides (talk) 00:32, 5 March 2008 (UTC)

• Vaccine safety is a topic best raised in Talk:Vaccine and Talk:Vaccination; unless I'm missing something (in which case an explanation would be helpful), it's not that relevant here.
• It is not realistic to remove all discussion of safety from Chiropractic. As mentioned in #Comments on sources for safety and risk-benefit, more than 10% of articles in Google Scholar that mention chiropractic also mention safety. This is just a rough measure, but it indicates that safety is a valid and important subtopic of chiropractic.

Eubulides (talk) 07:09, 4 March 2008 (UTC)

Who cares what google scholar says? Is that your research? That mainstream medicine still doubts SMT its efficacy? That's why there's so many bloody articles its yet another attempt to discredit the chiropractic profession. Don't lecture me about Ernst, he is without credibility anymore and has been rebutted severely in JMPT for his less than thorough review of SMT. EBDCM (talk) 00:26, 5 March 2008 (UTC)

Google Scholar is just a rough measure, but it is better than nothing, and it is an indication of the importance of safety. For example, Google Scholar also indicates that safety is an important issue in surgery (a point made below). Of course, one hardly needs Google Scholar to prove that for surgery; still, it does make the point that the rough measure has some validity. Eubulides (talk) 00:36, 5 March 2008 (UTC)

Actually no, it's a weasel technique and you're using it here on chiropractic. EBDCM (talk) 00:49, 5 March 2008 (UTC)

I understand your frustration, EBDCM, about having a 'safety' section. I realize the risk is very small. The thing is, when a person decides to have surgery, it's a last resort option and the risks are well-known, in general. (I did find risk of death discussed in Misplaced Pages Gastric Bypass.) It seems that a great deal of attention is given to risk of cervical manipulation by conventional medical researchers in the past few years, so maybe countering this or explaining the chiropractic viewpoint in the article is worthwhile?CynRNCynRN (talk) 17:53, 4 March 2008 (UTC)

I will work with CynRN on this one; but suggesting that surgery as a last resort? Yeah right. How many unnecessary back surgeries per year? What about carpal tunnel releases? These are both wayyyyy move amenable to soft tissue and joint manipulation I don't see most MDs recommending manual therapy for this stuff. Again, the most comprehensive, in depth review we've had so far re: neck manips is the Task Force report. It's co-authored by MDs and many various researchers and top-notch universities and notable health organizations. Yet it still gets dismissed summarily by most of allopathic practitioners. EBDCM (talk) 00:26, 5 March 2008 (UTC)

Surgery is not directly related to spinal manipulation. Non-surgical therapies, such as massage is related. By the way, surgery is not always the last resort. Doctors have routinely performed unnecessary surgury to get the insurance money. Doctors do not always inform the patients about the risk of surgury. Moreover, they do not tell the patient to get a second opinion. However, if reliable sources make a direct comparison we can consider using it in this article. QuackGuru (talk) 21:17, 4 March 2008 (UTC)

The point isn't that surgery is realted to manipulation. The point is that it is a violation of WP:UNDUE to mention safety in the chiropractic article. Especially, when looking at other medical articles it is not mentioned. Eubulides, you mention that 10% of chiropractic articles on google scholar mention safety. A comparable search reveals that 13% of surgery articles on google scholar mention safety, yet again it is not listed on the surgery article. As for the risks being well known, the last (minor) surgery that I had, I had to sign a consent form that I had discussed the risks with the attending and resident. However, I had to sign this before I even got to see the attending and the resident. I don't think that risks are well-known in general. 121.44.227.79 (talk) 00:06, 5 March 2008 (UTC)

I fully support adding a safety section to Surgery. That article lacks a safety section now, which greatly weakens it, and helps to explain why Surgery is rated only at the Start-Class (i.e., just barely above stub quality) on the Misplaced Pages:WikiProject Medicine/Assessment #Quality scale. If you have the time and inclination to do so, please improve Surgery. In the meantime, Surgery's shortcomings should not distract from the topic at hand, which is the POV issue with Chiropractic #Safety. Clearly safety is an important subtopic of chiropractic, just as it is an important subtopic of surgery, and Chiropractic should cover it. Eubulides (talk) 00:29, 5 March 2008 (UTC)

Finally someone calls a spade a spade. Eubulides parades around here with his medical hat lecturing evidence-based DCs about the profession through his warped lens. I've already said that there is a massive double standard going on here and Eubulides never addresses this point. He also fails to address the fact that I have asked him to "man up" and including the reference I provided regarding medical safety. Hush hush, it's so quiet now I hear crickets chirping in the background. So, I'll ask Eubulides again: as a sign of good faith collaboration, will you include the references I provided you and address the safety issue (or lack thereof) in the medicine article? If not, then why? Also, why not apply the same standard to the vaccination article? I'm just trying to follow your logic. EBDCM (talk) 00:26, 5 March 2008 (UTC)

As I mentioned, proposed changes to other articles are best discussed on the other articles' talk pages. Please take up those discussions there. I fully support adding safety sections to other medical articles where appropriate. However, right now the topic is Chiropractic. Eubulides (talk) 00:40, 5 March 2008 (UTC)

No, Eubulides, I want you to address my concerns NOW and stop ducking them. You recent safety 3 proposal is possibly the worst fear mongering I've ever seen and I'm no longer inclined to give you any more benefit of the doubt. Your qualifier where appropriate is BS. Your response telling me that ozone therapy also has a safety section is a low point in our discussions. You think I'm retarded or something? Because I'm a DC I can't seem through a weak argument and weak logic. You have shown nothing but contempt for DCs so far in your talk discussions and you keep ducking my questions. Why should the chiropractic article even mention safety when medicine and surgery does not? Which risk is greater, surgery for mechanical neck pain or SMT for mechanical neck pain? Please think carefully before you reply. Thanks. EBDCM (talk) 00:49, 5 March 2008 (UTC)

Safety and Efficacy

As stated above, I do not believe that efficacy belongs in the safety section. IF we are going to have sections for safety and efficacy, they should be dealt with in their own subsections. That is, the other efficacy section should not mention safety, and the safety section should not mention efficacy. In addition, since it seems that the focus is on safety right now, could we hold off on discussing the inclusion of efficacy until we have created a NPOV section for safety? The talk page is confusing enough as it is without adding another completely different conversation to it. DigitalC (talk) 07:59, 1 March 2008 (UTC)

I like the idea of focusing on safety first here. My suggestion for the final order of presentation would be: efficacy; then safety; then risk-benefit and/or cost-benefit. That's a logical order. Eubulides (talk) 09:28, 1 March 2008 (UTC)

Efficacy, Safety, and Risk-benefit are all related. Me thinks it is okay if a bit of overlap occurs among the sections. Now, what is the next step? QuackGuru (talk) 00:46, 2 March 2008 (UTC)

I agree there's overlap but it's a big job to do it all and I'd like to focus on safety first. If there is a reasonable agreement on the sources listed in #Sources for safety, the next step would be to draft a safety section based on them. The current draft in #Safety 2 doesn't do that. (Also, it's way too long for Chiropractic.) If you like, I could give it a stab. Eubulides (talk) 07:38, 2 March 2008 (UTC)

Please edit away. Be very very WP:BOLD. QuackGuru (talk) 07:45, 2 March 2008 (UTC)

OK, but first I'll have to read the sources carefully. That's going to take days rather than hours, I'm afraid, as I have other responsibilities. But you are welcome to draft something yourself, if you've read the sources in question. Eubulides (talk) 09:09, 2 March 2008 (UTC)

I agree with Levine re: undue weight and this is attributed primarily to the medical profession continuing to sandbag the chiropractic profession (i.e. Ernst et al). What other med article has this as well? Does Eubulides own baby, vaccination, have this as well? Again, we are going to compare SMT to other conv. med modalities for similar conditions (i.e. neck pain) and look at the risks, benefits and efficacies of those as well (i.e. surgery for neck pain) so we can put all this into perspective and context. I doubt surgery for mechanical neck pain has a .000002% odds of serious effects. Ten bucks that's not even mentioned in those articles. Double standards again and we're going to make sure that our resident medical editors here are not going push through any spin or fear mongering tone. The evidence is clearly in favour of SMT; if this persistent whining about safety is beyond bogus. Name one other modality that has been studied as extensively for SMT and I'll drop $100 in your bank account tomorrow. EBDCM (talk) 00:41, 3 March 2008 (UTC)

• Sandbagging is something one does to oneself, so I'm not sure what is meant by "the medical profession continuing to sandbag the chiropractic profession".
• The concern about adverse effects is genuine, and Ernst 2007 (PMID 17606755) is a reliable and recent secondary source.
• Comparing SMT's cost-benefits to those of other therapies is a different topic, one that would logically follow the cost-effectiveness topic already mentioned. For now, I'd rather focus on safety, since the POV dispute is over Chiropractic #Safety.
• I agree that Vaccination (or actually Vaccine, which it should be merged into) could have better coverage of safety. I suggest following up this part of the discussion on Talk:Vaccine or Talk:Vaccination or both; they are better venues for that topic.

Eubulides (talk) 02:53, 3 March 2008 (UTC)

Railroading, sandbagging, using straw mans fallacies, surely you've studied up on these since you so cleverly employ these and hide behind policy. At least I can respect Quack Guru and Mccready because they're direct with their positions whereas you constantly take cheap shots at the profession and have purged any contrast to conventional medical treatment because a lot of times chiropractic care is equal to or superior to med care for NMS conditions and some non NMS conditions. Anyways, here's a link to a 2004 WSIB (workmans comp from Ontario contrast DC and PT efficacy. http://www.wsib.on.ca/wsib/wsibsite.nsf/LookupFiles/DownloadableFileALBIEvaluationReport/$File/ALBIReport.pdf. We will include this and get rid of some of the more ancient references are start synthesizing them together to establish accurate trends. EBDCM (talk) 01:48, 4 March 2008 (UTC)

I am unaware of any attempt by any recent editor of this page to use the techniques you describe. Certainly I have not intended to use them. Please assume good faith. Compared to what's in #Sources for safety, the WSIB source is relatively low quality, as it does not mention safety, and it does not appear in a refereed journal. Let's strive for higher-quality sources that are on-topic, using WP:MEDRS as a guide. Eubulides (talk) 07:48, 4 March 2008 (UTC)

It's about efficacy and its notable and reliable. Chiropractic care was 2x as effective as PT care. WSIB is notable and reliable and use evidence-based protocols. If you lecture me one more time about "higher quality sources"..... Anyways, good faith has long gone out the window, in fact I have NEVER seen you backdown from any single point you've ever made here. You're always right and when editors disagree with you, you cite your interpretation of policy. No more MEDRS as a guideline. Chiropractic is not medicine; and it cannot be expected to have the same amount of high quality secondary sources because research culture is relatively new and there are many DC journals that are simply not indexed at PubMed, for example. You know absolutely NOTHING about chiropractic which is why your edits suck. You lack insight and sensitivity to this topic and article, because you're an MD and do not understand chiropractic culture, chiropractic philosophy, chiropractic styles of practice and chiropractic research. You think you "get it" if you read an article or a textbook? Sorry you do not. The best source who would understand the whole chiropractic spectrum from straight to reform is either a chiropractic historian or an actual DC, preferably a reformer who understands research methodology and is strong in clinical and biological sciences.

Hello again, Eubulides. Before we proceed any further we should perhaps take into account the scope of chiropractic (aka SMT) safety vs. mainstream medicine safety.

http://www.ourcivilisation.com/medicine/usamed/deaths.htm Now, you said above that you've made mistakes and I would opine that you would be making a big one by not reviewing and including this in the most appropriate article, you know, as a sign of NPOV editing and a sign of good faith. My experience with you as an editor has been a mixed one; on one hand you are excellent with formatting the citations and coming up with a few good papers; yet on the other, your edits on chiropractic both here and at vaccine controversy have, in my opinion, unneccessarily "biting" language with respect to chiropractic and an editing style here that really does not understand the complexities of the profession itself to appreciate how difficult it will be to really getting the appropriate NPOV, something both Dematt and Fyslee would attest to. Hopefully we can constructively move forward here but I know one thing for sure it would be best to find another team-mate (I'm looking at you, Quack Guru) that is more objective and is more educated with respect to acceptable literature standards and proper writing style. EBDCM (talk) 04:15, 4 March 2008 (UTC)

That web page is not suitable for citing in Chiropractic, as it doesn't mention chiropractic. Are you suggesting that it be cited in some other article? If so, the appropriate venue would be the talk page for that article. Eubulides (talk) 08:00, 4 March 2008 (UTC)

I'm suggesting you look at the WEIGHT of what you are proposing and the double standard you are endorsing. EBDCM (talk) 01:02, 5 March 2008 (UTC)

Where does the .0000002%(or is it .0000002) come from? Is it the 1 in 5 million risk from the malpractice study? Do you maintain that there is zero risk, as the Bone and Joint task force would indicate? That strokes only happen to people that were going to have one anyway? In any case, let's report the 'hypothetical' risks in the usual 1/1000 form instead of mind-numbing decimals. CynRNCynRN (talk) 07:53, 4 March 2008 (UTC)

A better format can be found in phrases like this one, taken from Thiel et al. 2007 (PMID 17906581): "This translates to an estimated risk of a serious adverse event of, at worse ≈1 per 10,000 treatment consultations immediately after cervical spine manipulation, ≈2 per 10,000 treatment consultations up to 7 days after treatment and ≈6 per 100,000 cervical spine manipulations." This sort of presentation is fairly standard in epidemiology. The format "1 per 17,000" is also used, but many readers find it harder to interpret. Eubulides (talk) 08:21, 4 March 2008 (UTC)

I have included all the available info. Now it can be adjusted to fit this specific article as needed. Just edit away. QuackGuru (talk) 08:51, 4 March 2008 (UTC)

Another redraft of "safety"

I read the sources in #Sources for safety. I looked at what's in Chiropractic #Safety now: as already mentioned, it has real POV problems and also it can be shortened. I also looked at what's proposed in the Safety subsection of #Safety 2 now; it's even longer, suffers from a too-many-quotes problem, and has POV problems of its own: for example, it doesn't lead with the point that chiropractic care is regarded as safe. So I propose the following new draft below. It's shorter than the alternatives, it covers the bases of the #Sources for safety, and it attempts to address the POV problems. Comments are welcome (I'm sure there will be some…). Please comment in #Comments on safety 3 below. Eubulides (talk) 00:15, 5 March 2008 (UTC)

Attempts to address POV problems? Your whole proposal is a POV problem. What exactly to you have a problem with? Are contraindications not listed? Is the stroke issue not mentioned even though there is no increased incidence? Is it not mentioned that critics think that SMT is dangerous? Do we not list common side effects? I mean, give me a break Eubulides, This is getting beyond pathetic now. If you thought philosophy was a rough go, buckle up. EBDCM (talk)

Safety 3

Chiropractic care in general, and chiropractic manipulation in particular, are safe treatments when employed skilfully and appropriately. As with all treatments, complications can arise and there are known contraindications and risks.

Absolute contraindications, which prohibit employing manipulation, include rheumatoid arthritis, broken bones resulting from one-time injuries, tumors, hematomas, dislocation of a vertebra, bone or joint infection, and many other factors. Relative complications, which mean the increased risk is acceptable under some conditions, include osteoporosis, double-jointedness, disk herniations, steroid or anticoagulant therapy, and many other factors. Although most contraindications apply only to manipulation of the affected region, a few exceptions, such as a new, sudden, severe and persistent headache, apply to any manipulation.

Spinal manipulation is associated with frequent, mild and transient adverse effects, which two prospective studies reported occur in 30% to 61% of patients. The most common minor side effects reported in a 2007 study of cervical spine manipulation were new or worsening neck pain (reported for about 7.3% of consultations during the follow-up period), shoulder or arm pain (4.8%), reduced movement or stiffness of neck, shoulder, or arm (3.9%), headache (3.9%), upper, mid back pain (2.5%), numb or tingling upper limbs (1.3%), and fainting, dizziness, or light-headedness (1.1%). Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.

Spinal manipulation, particularly on the upper spine, can also result in rare, serious complications that can lead to permanent disability or death. The most commonly reported serious adverse effect is vertebral artery dissection, a tear in the artery that can lead to stroke. The incidence of severe effects is unknown, due to their rarity, to high levels of underreporting, and to the difficulty of linking manipulation to its adverse effects. Chiropractic services are associated with subsequent vertebrobasilar artery stroke in persons under 45 years of age, but general practitioner services have a similar association, suggesting that these associations are likely explained by preexisting conditions. Spinal manipulation is common among children; serious adverse events have been identified, but their incidence is unknown.

Manipulation poses a minor risk to the chiropractor, particularly to the wrists, shoulder, and lumbar spine. The main risky activities seem to be transferring patients to positions and applying dynamic treatments. This risk has not been quantified.

(End of redraft for Chiropractic #Safety.)

Eubulides (talk) 00:15, 5 March 2008 (UTC)

Please edit responsibly

The initial response to the above draft was a complete strikeout of the entire draft. This is not constructive. Please be responsible in editing comments on the talk page. I have reverted that change. Eubulides (talk) 00:45, 5 March 2008 (UTC)

It was mostly crap. Here we go. EBDCM (talk)

There's a START. More to go after dinner. EBDCM (talk) 01:10, 5 March 2008 (UTC)

Comments on safety 3

(Please put comments on #Safety 3 here.)

This will NEVER see the light of day as it is. FEAR MONGERING BY EUBULIDES! FEAR MONGERING BY EUBULIDES! Run, run, before the DCs kill you with their manipulations. Let's only find med articles that list the most severe reactions and frequencies. Hey eubulides, how come in 2 years of practice and 1 year of internship that I have NEVER had one adverse reaction to any adjustment I've given? It's because you don't know jack about the art and science of manipulation and you have to listen to quack guru. 0.0000002% yet let's have an entire paragraph about this. What a joke. My vote is to kill the whole section again we have begun the slippery slope and Eubulides editing now has hit a new low. EBDCM (talk) 00:31, 5 March 2008 (UTC)

References

• Misplaced Pages controversial topics
• A-Class Skepticism articles
• High-importance Skepticism articles
• WikiProject Skepticism articles
• A-Class Alternative medicine articles