Misplaced Pages

Revision as of 02:45, 5 June 2008

No "new section" button pleaseIn order to keep the references listed at the bottom, please don't use the new section tab above, and please don't use the "click here to start a new topic" below. Instead, please create new sections by hand, just before #References.

This is the talk page for discussing improvements to the Chiropractic article. This is not a forum for general discussion of the article's subject.

Put new text under old text. Click here to start a new topic. New to Misplaced Pages? Welcome! Learn to edit; get help. Assume good faith Be polite and avoid personal attacks Be welcoming to newcomers Seek dispute resolution if needed Article policies Neutral point of view No original research Verifiability

Find sources: Google (books · news · scholar · free images · WP refs) · FENS · JSTOR · TWL

Archives: Index, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40Auto-archiving period: 10 days

The subject of this article is controversial and content may be in dispute. When updating the article, be bold, but not reckless. Feel free to try to improve the article, but don't take it personally if your changes are reversed; instead, come here to the talk page to discuss them. Content must be written from a neutral point of view. Include citations when adding content and consider tagging or removing unsourced information.

Please stay calm and civil while commenting or presenting evidence, and do not make personal attacks. Be patient when approaching solutions to any issues. If consensus is not reached, other solutions exist to draw attention and ensure that more editors mediate or comment on the dispute.

Template:Cleanup taskforce closed

This article has not yet been rated on Misplaced Pages's content assessment scale. It is of interest to the following WikiProjects:

Please add the quality rating to the {{WikiProject banner shell}} template instead of this project banner. See WP:PIQA for details. Alternative medicine This article is within the scope of WikiProject Alternative medicine, a collaborative effort to improve the coverage of Alternative medicine related articles on Misplaced Pages. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.Alternative medicineWikipedia:WikiProject Alternative medicineTemplate:WikiProject Alternative medicineAlternative medicine Please add the quality rating to the {{WikiProject banner shell}} template instead of this project banner. See WP:PIQA for details. Skepticism High‑importance This article is within the scope of WikiProject Skepticism, a collaborative effort to improve the coverage of science, pseudoscience, pseudohistory and skepticism related articles on Misplaced Pages. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.SkepticismWikipedia:WikiProject SkepticismTemplate:WikiProject SkepticismSkepticism High This article has been rated as High-importance on the project's importance scale.

This is the talk page for discussing improvements to the Chiropractic article. This is not a forum for general discussion of the article's subject.

Put new text under old text. Click here to start a new topic. New to Misplaced Pages? Welcome! Learn to edit; get help. Assume good faith Be polite and avoid personal attacks Be welcoming to newcomers Seek dispute resolution if needed Article policies Neutral point of view No original research Verifiability

Find sources: Google (books · news · scholar · free images · WP refs) · FENS · JSTOR · TWL

Archives: Index, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40Auto-archiving period: 10 days

Archives

Index 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 31, 32, 33, 34, 35, 36, 37, 38, 39, 40

Archive Index

This page has archives. Sections older than 10 days may be automatically archived by Lowercase sigmabot III.

Is Lerner a reliable source?

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

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

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

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

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

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

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

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

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

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

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

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

to this:

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

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

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

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

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

The part about the tales of the Arabian nights was interesting. It grabs the reader. In fact, it pulled me in and I enjoyed reading the Arabian nights article. After reading the Arabian nights tidbit, I wanted to continue reading. It was spicey. QuackGuru 03:13, 26 May 2008 (UTC)

OK, I restored it, since I don't feel strongly about it. Adding spice is OK, I guess. (I retained my addition of the word "had" for the pluperfect tense.) It's OK as is. One problem I have with it is that it doesn't specify in what way the story was like the Arabian Nights, and the wikilink provides no clue about that. Maybe it's supposed to be obvious. Possibly adding a few words would clarify – or maybe that would be digressing too much. ☺ Coppertwig (talk) 22:52, 26 May 2008 (UTC)

RfC: Effectiveness of chiropractic care

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

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

Criticisms of earlier proposed fix

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

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

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

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

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

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

(Again, please place further comments below.)

Revised proposal for fix

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

(Again, please place further comments below.)

Scientific investigation 3

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

Effectiveness 3

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

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

Available evidence covers the following conditions:

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

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

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

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

(End of proposed replacement text.)

(Please place further comments below.)

Comments on Scientific investigation 3

(Please put comments here.)

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

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

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

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

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

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

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

Levine2112 17:26, 12 May 2008 (UTC)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Proposal for fix 3C

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

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

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

Scientific investigation 3C

In the current healthcare environment, The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which treatments are legitimate and perhaps reimbursable under managed care. Chiropractic treatments are evaluated using those same standards. Evidence-based guidelines are supported by many chiropractors while others remain pseudoscientific and antiscientific and make unsubstantiated claims. Research has focused specifically on spinal manipulation therapy (SMT) rather than on the whole chiropractic visit and all that is involved in the patient encounter, some of which may be the result, as with all healthcare encounters, of the placebo effect, The distinction is not significant regarding who performs SMT for musculoskelatal conditions.

Effectiveness 3C

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment. Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective. As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective. Chiropractic care, like all medical treatment, benefits from the placebo response. Few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality. The efficacy and cost-effectiveness of maintenance care in chiropractic is unknown.

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

Available evidence covers the following conditions:

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

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

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

(End of proposed replacement text.)

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

Comments on Scientific investigation 3C

(Please put comments here.)

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

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

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

I am happy with 3C.DigitalC (talk) 06:08, 15 May 2008 (UTC)

I'm guessing maybe QuackGuru means that by being too short, it's not giving due weight to effectiveness of SMT to reflect how much that's discussed in the sources. I apologize in advance if I got that wrong, QuackGuru. ☺ Coppertwig (talk) 02:57, 16 May 2008 (UTC)

I think this version gives far too much wait to this opinion: "A 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition." This comes from a major chiropractic critic often accused of bias and not necessarily a neutral researcher. As such it should be balanced or removed. That said, I am all for keeping this section brief if we have it at all. This is an article about Chiropractic and not about SMT. All of the details about every study ever conducted about SMT should be saved for spinal manipulation. -- Levine2112 03:10, 16 May 2008 (UTC)

A major chiropractic critic often accused of bias and not necessarily a neutral researcher? Please provide your evidence. Ernst is peer-reviewed and meets the inclusion criteria for this article. We should edit based on NPOV and exclude any personal opinion. Thus, we can include Ernst. QuackGuru 03:20, 16 May 2008 (UTC)

Yes, but this version gives his opinion far too much prominence. -- Levine2112 03:26, 16 May 2008 (UTC)

That's your opinion. Please provide evidence of any bias by Ernst. QuackGuru 03:33, 16 May 2008 (UTC)

Not even mainstream medicine listens to Ernst re: his views on the safety and effectiveness of spinal manipulation for back pain. His view is fringe. It can be proved. To repeat: Ernsts (MD) views on spinal manipulation is the FRINGE viewpoint within respect to mainstream medicine. It will be weighed as such. He is not an expert on SMT nor chiropractic, but is simply a vocal critic who is coming off as increasingly righteous and pig-headed despite the mounting evidence which negates his POV. CorticoSpinal (talk) 05:33, 16 May 2008 (UTC)

Ernst is not fringe. His works are often cited by his peers. I just now visited Google Scholar and typed the query "chiropractic Ernst". This returned about 2390 citations. In the first page, one source by Ernst (the 2001 desktop guide) was cited 280 times. Another by Ernst (the 2000 BBC survey) was cited 170 times. All of these numbers beat the query "chiropractic Haldeman" (1230 citations, top two sources on the 1st page cited 107 and 97 times). By this measure, or any other reasonably neutral measure, Ernst is one of the top current sources in the area. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Citations does not necessarily translate into positive remarks on his work. It has also generated significant controversy and those same papers would have to cite his work in order to talk about it. Since it is the most vocal anti-SMT voice, both chiropractic researchers and healthcare researchers reference it as the most extreme, which I would assume would be considered the "fringe" of science.. but you know what assuming does. But, regardless, we can't just assume that citations translates into quality or mainstream. -- Dēmatt (chat) 11:51, 19 May 2008 (UTC)

I tested the theory that citations to Ernst are to cover the controversy by taking the most-cited work of Ernst mentioned above (the desktop guide), going to Google Scholar, finding which works cite it, looking at the first page of results, and reading each of the papers that cite it. I skipped the papers cowritten by Ernst himself for obvious reasons. None of the citations mentioned any controversy; they all simply cited Ernst as an authority. The papers I examined were Marty 2002 {{doi:10.1089/107555302317371523}}, Mason et al. 2002 (PMID 12376448), Bair et al. 2002 (PMID 12406817), Cohen & Eisenberg 2002 (PMID 11955028), and Cherkin et al. 2003 (PMID 12779300). These papers are all highly-cited (all have at least 45 citations). Of course this is just a spot-check, but it suggests that Ernst is not considered to be fringe by mainstream researchers. Eubulides (talk) 20:47, 19 May 2008 (UTC)

Evidence of bias by Ernst:

• Evans, W. (2003). "Chiropractic Care: Attempting A Risk-benefit Analysis". American Journal of Public Health. 93 (4): 522. Retrieved 2008-05-20.
• Bronfort, G. (2006). "Review conclusions by Ernst and Canter regarding spinal manipulation refuted". Chiropractic & Osteopathy. 14 (1): 14. doi:10.1186/1746-1340-14-14. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
• Hurwitz, E.L. (2002). "Chiropractic care: a flawed risk-benefit analysis?". Am J Public Health. 92 (10): 1603–4. Retrieved 2008-05-20. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Morley, J. (2001). "Ernst Fails to Address Key Charges". The Journal of Alternative & Complementary Medicine. 7 (2): 127–128. doi:10.1089/107555301750164145. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• "Profession Responds Quickly to Negative U.K. Study on Spinal Manipulation". Retrieved 2008-05-20.
• SPINAL MANIPULATION DOES WORK: THE FACTS FROM THE BCA
• A balanced review of evidence?

DigitalC (talk) 06:40, 20 May 2008 (UTC)

Yes, Ernst is strongly opposed by many in the chiropractic profession, and those citations illustrate this opposition. However, this does not undercut the claim that citations to Ernst by high-quality mainstream publications are, by and large, positive. Eubulides (talk) 07:20, 20 May 2008 (UTC)

Being opposed by many in the chiropractic profession doesn't have anything to do with research. Research doesn't oppose anything, it is what it is; it either supports or it doesn't. DigitalC's information does show that at least some of those 2390 citations are not positive, which, of course, was my point above. I would suggest that no-one has disagreed with Haldeman's research because he is a neurologist/chiropractor. Maybe that is why he has only half the citations :-) Anyway, I think this shows that Ernst is Ernst and we use his information just as we would Haldemans's or anyone else's. -- Dēmatt (chat) 13:23, 20 May 2008 (UTC)

Obviously some of the citations are negative. But my spot-check from Google Scholar suggests that most of them are positive. (It doesn't prove this, of course; it was only a spot-check.) And it is not true that nobody has disagreed with Haldeman; I can easily cite sources strongly criticizing Haldeman's work. I agree that we should cite Haldeman as well as Ernst; both are leading and reliable sources. Eubulides (talk) 22:16, 20 May 2008 (UTC)

If most of them are positive, then why is more weight being given to the negative ones in the version above? Featuring this - "chiropractic SMT has not been shown to be effective for any medical condition" - so prominently in the lead of this section seems to violate WP:WEIGHT - especially in the context given. I believe enough concern has been raised about Ernst's lack of objectivity, that giving his opinions so much weight seem unjust to the article. -- Levine2112 22:38, 20 May 2008 (UTC)

That quote is preceded by "Although a 2008 critical review found that with the possible exception of back pain" so it is not as strong as that out-of-context snipped would make it appear. Furthermore, the sentence containing quote also says "a 2008 supportive review found serious flaws in the critical approach, and found that SMT and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments" (citing Bronfort et al. 2008, PMID 18164469). This is a strong criticism that immediately undercuts Ernst's claims. If anything, this is being unfair to Ernst; it's not the sort of treatment that any other source is being given here. Given all this context, it's not out of line to let Ernst briefly have his say. Eubulides (talk) 02:16, 21 May 2008 (UTC)

A mischaracterization of what was posted above. In some of the papers there is no way to know what degrees/professions the authors have. For example, in the Bronfort et al. paper, we get these associated groups, but no degrees. (Chalmers Research Group, Evidence-based Practice Center, Departments of Pediatrics, Epidemiology and Community Medicine, University of Ottawa, 401 Smyth, Ottawa ON, K1H8L1, Canada; 4Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, The Netherlands; 5Texas Back Institute, 6300 W. Parker Road, Plano Texas 75093, USA; 6Department of General Practice and Nursing Home Medicine, LUMC Medical Centre, Leiden, The Netherlands). In addition, one of the Authors, Assendelft, is a prior co-author with Ernst, and an MD, NOT a Chiropractor. He's also writes cochrane reviews, so he probably knows how to assess evidence.DigitalC (talk) 07:56, 20 May 2008 (UTC)

It is not a mischaracterization. The Bronfort et al. paper has 10 authors, of which 5 have DCs (including Bronfort, the lead author) and 1 (Assendelft) has an MD. So it's strongly dominated by chiropractors. The other sources are even more strongly dominated by chiropractors. Ernst has cowritten more than a dozen Cochrane reviews so I daresay he knows how to assess evidence as well. What we have here is a difference of opinion among experts, a difference that should be reported fairly and neutrally; Ernst is not at all on the fringe here. Eubulides (talk) 09:17, 20 May 2008 (UTC)

It IS a misrepresentation of the sources to state as a summy that "Ernst is strongly opposed by many in the chiropractic profession", when the sources are not solely Chiropractors.DigitalC (talk) 11:20, 20 May 2008 (UTC)

It is not a misrepresentation. The sources given were:

• A letter by a DC (Evans).
• A paper with 5 DC and 1 MD coauthors, the lead being a DC (Bronfort et al.; 4 coauthors were neither DCs nor MDs)
• A letter signed by 3 DCs and zero MDs (Hurwitz et al.).
• A letter signed by 2 DCs and zero MDs (Morley et al.; 1 coauthor was neither DC nor MD).
• An article about chiropractors lobbying against Ernst (Dynamic Chiropractic).
• A position paper by the British Chiropractic Association.
• A letter signed by 2 DCs and zero MDs (Breen et al.; 3 coauthors were neither DC nor MD).

It's true that there are some non-chiropractors there, but these sources are heavily dominated by chiropractors. They may represent the mainstream of opinion within chiropractic, but they do not represent mainstream opinion generally. They do not at all demonstrate that Ernst is a fringe researcher. Eubulides (talk) 22:16, 20 May 2008 (UTC)

I was responding to QG's request for evidence of claims of bias towards Ernst. That is what I provided.

Ernst's conclusions are fringe and so are his opinions on the subject. His work on SMT and Chiropractic care has been terrible. He's represents the extreme on one end; the WCA represents the fringe on the other end. Both views should be discarded because they are just that, extremist. Ernst has been used to 'bomb' CAM related articles with his 'reviews' which he essentially reviews himself. CorticoSpinal (talk) 12:50, 21 May 2008 (UTC)

We appreciate that's your belief, but just restating it isn't convincing. If an author is heavily cited then it's pretty clear that people are listening to him. Regardless of ones personal beliefs on his work that makes him a notable party. Jefffire (talk) 13:00, 21 May 2008 (UTC)

(Undent) Here is the rift here. If we were to accept that chiropractic researchers are biased, then that acknowledges that medical research is biased. I personally think they are equally biased, but that is just my experience. Therefore, we have two choices, use them both as equal, or consider them POV and attribute the findings to the different sources. One method requires a littel more writing, but either can be productive and get toward the end product. -- Dēmatt (chat) 13:01, 20 May 2008 (UTC)

Once again Dematt comes up with the Solomonic solution - inclusion of all POV using good sources. I also agree with most of his comments. We are all biased, controversies occur, and those biases and controversies need to be documented here. We just need to do it properly. -- Fyslee / talk 14:38, 20 May 2008 (UTC)

That is the goal of #Scientific investigation 3. It includes both supportive and critical sources and cites them appropriately, with due weight given to all sides. Eubulides (talk) 22:16, 20 May 2008 (UTC)

Unfortunately it does not seem like your interpretation of Scientific Investigation 3 is shared by the majority of editors nor does it generally represent the conclusions of the scientific community (due to cherry picking of sources). CorticoSpinal (talk) 12:50, 21 May 2008 (UTC)

Looks quite sound to me. Could you give specific advice for how to improve it, rather than baseless sniping, thanks. Jefffire (talk) 13:00, 21 May 2008 (UTC)

Is there a reason that effectiveness 3C has been struck out entirely, and that multiple editors comments are struck out as well? I seem to have missed something. DigitalC (talk) 06:42, 31 May 2008 (UTC)

The talk page is now archived automatically by a bot. Sections that haven't been changed for 14 days get archived. If you want the section back, you can resurrect it by hand from the archive. Eubulides (talk) 07:56, 31 May 2008 (UTC)

Effectiveness 3C has not been archived, it has been struckout struck out. As have comments of more than one editor in relation to it. DigitalC (talk) 07:58, 1 June 2008 (UTC)

Sorry, I misunderstood, and I don't know who struck it out or why or when. I assume the history could tell you? Eubulides (talk) 08:39, 2 June 2008 (UTC)

I assume the history COULD tell me, however the functionality of the history is subpar, IMHO, and it would take hours to try and sift through and find the diff. Since you drafted the section, and didn't strike it out yourself, and since CynRN didn't chime in to say she struckout her comment (which has since mysteriously been unstruck, as has QGs), I will unstrike the entire section.

Continued discussion of Scientific investigation 3C

Okay, back to work on SCI 3C. I've sticken through:

• Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs pseudoscientific and antiscientific reasoning and makes unsubstantiated claims.

Evidence based medicine does not care what your philosophy is, if it works it works. It doesn't matter which side of any arbitrary line you are on. This just seems like an opportunity to use the word pseudoscience, but it doesn't really fit. -- Dēmatt (chat) 13:55, 21 May 2008 (UTC)

It's true that evidence-based medicine is independent of philosophy. However, the point is that some chiropractors accept the principles of evidence-based medicine, and others don't. This is quite relevant to the subject of scientific investigation, because the entire philosophical basis of scientific investigation is questioned by a significant minority of chiropractors. For the purpose of this section, I agree "pseudoscience" isn't needed so I struck that instead. Eubulides (talk) 16:43, 21 May 2008 (UTC)

I'm not sure I'm buying that one, Eubilides. Let's put the groups scientific orientation in the sections that address their scope and leave this for the science - which doesn't care what race, creed, or color you are. -- Dēmatt (chat) 19:36, 21 May 2008 (UTC)

Other sections (notably Chiropractic#Philosophy already discuss this issue at some length. However, it's useful to put in a brief mention of the problem here. We can't expect every reader of this section to have read the whole article. Eubulides (talk) 20:13, 21 May 2008 (UTC)

Absence of adherence to EBM does not automatically imply pseudoscience. I wouldn't even go that far characterizing the straight wing. As on the Physical therapy page, a significant chunk of PTs don't use the evidence (thus far) but I would not call them pseudoscientific. Even the MDs who use outdated methods (antibiotics for sinus infections) for the last 40 years which was found to be of 0 benefit. I'm actually beginning to see some quality research designs by straight-leaning chiropractic schools in the US. I think they're getting it. Publish or perish (or lose market share to professions who will fill the gap). CorticoSpinal (talk) 18:06, 21 May 2008 (UTC)

The current 3C draft omits "pseudoscience", which should address the concerns mentioned here. Eubulides (talk) 20:13, 21 May 2008 (UTC)

because the entire philosophical basis of scientific investigation is questioned by a significant minority of chiropractors - Then what we would have to do is explain why, i.e. this is where Keating ref would come in with antiscience - it's not that they don't believe science or rational thinking, it is not trusting the scientist that is doing the research, i.e. drug companies performing the research on drugs, MDs evaluating chiropractic methods. It is more a distrust than a true antiscience. -- Dēmatt (chat) 18:29, 21 May 2008 (UTC)

It might be helpful to add a discussion of this point. However, the source (Keating 1997) does not address the trust issue, so we'd need a reliable source to justify the discussion. Eubulides (talk) 20:13, 21 May 2008 (UTC)

This statement does not match the source. I changed it as shown, it still needs work, but just to get it on paper disk.

• Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective. As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective.

-- Dēmatt (chat) 14:37, 21 May 2008 (UTC)

• • It does match the source. The source says "Nevertheless, there are different views concerning the efficacy of chiropractic treatment, which is not surprising. Unfortunately, it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts despite the millions of papers that have been written about presumably scientifically sound studies. Because of this difficulty, numerous medical procedures have not been rigorously proven to be effective either." The sentence in question is an abridged version of this quote. The stuff about "as of 2002" is obsolete and should not appear here. Also, in general it's not a good idea merely to quote the source; we should use the ideas and not degenerate into a list of quotes. Eubulides (talk) 16:43, 21 May 2008 (UTC)
    • While attempting to be constructive, Eubulides, the tone of your message to Dematt comes off rather condescending and paternalistic to a highly respected editor. I'm sure that was not the intent, but I had mentioned this concern before and hope you realize that Dematt's editorial skills are appreciated by both proponents and skeptics. CorticoSpinal (talk) 18:06, 21 May 2008 (UTC) I can tell he was smiling when he said that ;-) It's okay, really, down doggie, down :-)

I'm reading the Pubmed version and don't see your sentence there. The doi link is not working for me. -- Dēmatt (chat) 18:42, 21 May 2008 (UTC)

The source is copyrighted and only the abstract is freely readable. The above quote is from the "Efficacy and Patient Satisfaction" section of the source. Eubulides (talk) 20:13, 21 May 2008 (UTC)

Nevertheless, I think we can write it more neutrally and fit the source better if we say it this way:

• Because it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts, most medical procedures have not been rigorously proven to be effective. Chiropractic fits this category as well.

-- Dēmatt (chat) 19:31, 21 May 2008 (UTC)

That's less neutral than the current summary, because the cited source does not say "most medical procedures"; it merely says "numerous". Also, I don't see how adding all that other verbiage makes the summary more neutral. What's not neutral about the much-shorter "Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective."? Eubulides (talk) 20:13, 21 May 2008 (UTC)

I merged the second sentence to make it shorter, but don't want to lose the qualifying section of the sentence that explains to our readers who have no idea what 'rigorously proven' means. They need something to compare it to. All the reader sees is, "chiropractic treatment has not been proven to be effective" and of course that is not NPOV. We have to qualify it and still keep it along the lines of what the author was intending to say (which in the abstract was actually positive towards chiropractic), otherwise we are creating and SYN error, or OR. The other option is number three, where we use the information from the abstract itself:

• "Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective."?

• "Because it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts; numerous medical procedures, including chiropractic care, have not been rigorously proven to be effective."

-- Dēmatt (chat) 20:50, 21 May 2008 (UTC)

It's not the case that 'All the reader sees is, "chiropractic treatment has not been proven to be effective"'. The reader also sees "Like many other medical procedures" at the start of the sentence. This places the claim in context. The wording also uses the word "rigorously" to make it clear that we're talking about proofs with a high degree of confidence. The quote from the source is wordy and the extra verbiage adds little; plus, we shouldn't just be stringing together quotes. I take it that the objection is that the summary does not mention the point that it's hard to establish definitive findings? Then how about rewording it to "It is hard to make definitive findings about much of medicine, and like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective." Eubulides (talk) 08:35, 22 May 2008 (UTC)

The placebo source is excellent, but the sentence is misplaced. I just struck it out for now.

• Chiropractic care, like all medical treatment, benefits from the placebo response.

-- Dēmatt (chat) 14:58, 21 May 2008 (UTC)

Thanks. But let's find a better home for it rather than just removing it. I unstruck it for now. Eubulides (talk) 16:43, 21 May 2008 (UTC)

I found one!, but you know that, it is below. I won't delete the other one until we're all happy with the new placement. -- Dēmatt (chat) 19:16, 21 May 2008 (UTC)

This sentence has problems with the source, too. It's about chiropractic care with Type O problems. It's giving suggestions about how to improve studies. It's not making any judgements about 'low quality"?

• Many studies of chiropractic care are available, but they are typically of low quality.

-- Dēmatt (chat) 15:30, 21 May 2008 (UTC) Thanks for catching that. The source says "the number of studies on chiropractic care and/or SMT and other manual therapies for patients with nonmusculoskeletal conditions is relatively small, and the quality of the studies is generally not high.". I think there was a similar source for MS that said "many studies" that got removed by later editing; I'll take a look for it but for now I reworded the claim. Eubulides (talk) 16:43, 21 May 2008 (UTC)

Again, I hope thatis the source that is not listed, or am I missing something with the doi ref? -- Dēmatt (chat) 19:19, 21 May 2008 (UTC)

Sorry, I don't follow. Many of the sources for Chiropractic are not free; Hawk et al. is one of them. That's life in the big research city, I'm afraid. All other things being equal we prefer free sources, but high-quality nonfree sources are fine when equal-quality free sources are not available. Eubulides (talk) 20:13, 21 May 2008 (UTC)

I'll take a break now. I feel like this version (3C) so far still does not follow the sources well enough to represent what they are saying. I think we might be trying to fit things into our "Efficacy", but we're having to use sources that aren't really addressing that. We're still not there. We may have to go to some primary sources as well. Perhaps a combination of this and that other version that CS brought us and call it something different. -- Dēmatt (chat) 15:37, 21 May 2008 (UTC)

Okay, so much for the break, but I saw SC investigation 3 above and saw this sentence:

• Research has focused on spinal manipulation therapy (SMT) rather than specifically on chiropractic SMT, but the distinction is not significant: chiropractors use all forms of SMT, more than 90% of SMT in the U.S. is done by chiropractors, and SMT research is equally of value regardless of practitioner type.

We could add the placebo reference here, like this:

• Research has focused specifically on spinal manipulation therapy (SMT) rather than on the whole chiropractic visit and all that is involved in the patient encounter, some of which may be the result, as with all healthcare encounters, of the placebo effect, The distinction is not significant regarding who performs SMT for musculoskelatal conditions.

Still needs work, but you get the idea. -- Dēmatt (chat) 16:10, 21 May 2008 (UTC)

I don't see why we'd want to move the placebo sentence from the generic paragraph to the SMT paragraph. The placebo effect applies to all treatments, not just to SMT. Eubulides (talk) 16:43, 21 May 2008 (UTC)

If placebo applies equally to all Tx (which it does) why redundantly mention it? CorticoSpinal (talk) 18:06, 21 May 2008 (UTC)

I'm okay with putting it in the generic paragraph, I'll do it now to see what it looks like. -- Dēmatt (chat) 18:48, 21 May 2008 (UTC)

By "generic" I meant "generic to effectiveness", not "generic to all research". Safety studies generally don't use placebos. How about moving it back to where it was, which was in the generic-to-effectiveness paragraph? Eubulides (talk) 20:13, 21 May 2008 (UTC)

I see that more material was added here, but I confess I don't see the point. I thought that the idea behind the 3C draft was to avoid all mention of sources unless they specifically talk about chiropractic care. And yet now a lot of material has been added that talks about SMT irrespective of chiropractic. But that's what Chiropractic#Effectiveness does. Why not start with that version, rather than the old 3C version whose goal in excluding all but specifically chiropractic sources was different (and by the way, was a goal I didn't agree with)? Eubulides (talk) 08:35, 22 May 2008 (UTC)

"Rigorously proven"

I agree with Dematt that the bit about "rigourously proven" is not a good abridgement of that source: it strikes me as implying much more strongly than the source does that chiropractic is unproven. I think a better abridgement of that source is the following direct quote from the source: "There are different views concerning the efficacy of chiropractic treatment." ☺ Coppertwig (talk) 00:10, 26 May 2008 (UTC)

And actually, I agree with Dematt that the quote about 30 of 43 studies is better. Eubulides, the quote you give from the source above does not actually state that the efficacy of chiropractic has not been rigorously proven. It leaves open the possibility, for example, that some people believe it to have been rigorously proven while others do not. Perhaps it implies that it has been rigorously proven and perhaps it does not, but it doesn't state it, so we shouldn't state it right out either based on that source. ☺ Coppertwig (talk) 01:31, 27 May 2008 (UTC)

• Sorry, I don't know what you mean by "the quote about 30 of 43 studies"; there's no string "30 of 43" anywhere else on this talk page.
• I don't see how to read the source in the way that you say. Nobody seriously argues that the efficacy of chiropractic care has been rigorously proven.
• That quote is there because of a common theme in many sources that although chiropractic care has not been rigorously proven, in this respect it's in the same boat as many other forms of medical treatment. That's an important point, which should be made. All too often, chiropractic critics say "the science isn't there" without noting that the science isn't there for many other forms of medical treatment, too. Perhaps DeVocht is not the ideal source to make this point, but it will do until we find a better one.
• We don't need DeVocht to support the claim that there are differing views of the subject; that claim is already stated elsewhere in the section, and is well-supported already (by better sources than DeVocht).

Eubulides (talk) 08:08, 27 May 2008 (UTC)

Thanks for your reply, Eubulides. Sorry I wasn't clearer. By "30 of 43" I meant "As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective." However, as you point out, this would leave out the point about comparing with the situation with medical treatments.

I dispute whether the source supports the claim that "chiropractic treatment has not been rigorously proven to be effective". You said this was an abridgement of a paragraph you quoted above. I don't see how to read that paragraph the way you do. One possibility might be changing the footnote to a source which clearly makes this claim, if one can be found.

May I suggest another alternative wording: "It is difficult to establish conclusive findings regarding either chiropractic treatment or numerous medical procedures." Would you agree that that's a reasonable abridgement of the paragraph quoted?

I'll assume what you say is true, that "nobody seriously argues that the efficacy of chiropractic care has been rigorously proven." However, based only on this, it would be Original Research for Misplaced Pages to state that the efficacy of chiropractic care has not been rigorously proven. To state that, we would need a source which claims that the efficacy of chiropractic care has not been rigorously proven. Regards, ☺ Coppertwig (talk) 00:29, 2 June 2008 (UTC)

• That "30 of 43" comment is not worth mentioning here. Chiropractic#Effectiveness already cites far more-systematic (and more recent) reviews talking about SMT for low back pain, reviews that (like DeVocht) are favorable to chiropractic (e.g., Bronfort et al. 2008, PMID 18164469; or Meeker et al. 2007, no PMID), and DeVocht's opinion piece isn't close to being in their league. DeVocht is a reasonable source for supporting the argument that chiropractic care is like many other forms of medical treatment in that it hasn't been rigorously proven, but this is true mainly because the more-reliable sources don't address the point.
• I don't see how the proposed alternate wording solves the (to my mind hypothetical) problem. DeVocht nowhere says in one brief quote that it is difficult to establish conclusive findings regarding "chiropractic treatment". The proposed alternate wording relies on the fact that DeVocht is obviously including chiropractic treatment as being part of "much of the healing arts". But if there is some reluctance to say what DeVocht is obviously saying (namely that chiropractic care, like many other medical treatments, is hard to test and has not been rigorously proven), then this (to my mind hypothetical) objection applies with equal force to the proposed alternate wording. In that case, why change the wording to something that is longer and more confusing?

Eubulides (talk) 08:39, 2 June 2008 (UTC)

Thank you for your reply, Eubulides.

Perhaps I see a distinction that you don't – in which case it should perhaps be easy to find wording we can both agree on.

The paragraph quoted from the source implies that chiropractic care has not been rigorously proven to be effective. However, as I see it, it does not state that. I believe the author deliberately refrained from stating that, because it would be a statement which would be hard to prove and which could go out-of-date if new studies are published. Regardless of the reason why it doesn't state it, since (IMO) it doesn't, we shouldn't (IMO) state it either.

To my mind, the source also leaves open the possible alternative interpretations of "Numerous chiropractic treatments, like numerous medical procedures, have not been rigorously proven to be effective" or, along with the previous sentence, "Much of chiropractic is difficult to prove effective ... numerous medical procedures have not been proven effective either." If I understand what you're saying, Eubulides, you mean that it's not completely clear whether all of chiropractic is intended to be included in "much of the healing arts".

To me, there is an important distinction between "it is difficult to establish conclusive findings," which implies but does not state that there is no rigorous proof, and "has not been rigorously proven," which states it outright and is a very strong, probably impossible-to-prove and therefore perhaps unscientific statement when applied to all of chiropractic care as opposed to being applied to an unspecified and therefore flexible set of medical procedures. A scientist can state that they have not seen proof of something and we can all conclude from that that there probably isn't proof, since the scientist probably keeps up with the literature; but a scientist is less likely to state confidently that no proof exists anywhere.

Just making a sentence a little longer and more confusing is a minor problem, to my mind, in comparison to the importance of adhering to WP:V and avoiding stating something which is not (IMO) stated in the source (as represented in that paragraph), and which you seem to be saying is not stated in the other, more reliable, sources either. However, the first three of the suggested alternative wordings below are shorter and arguably simpler than the current wording:

• "Like many other medical procedures, chiropractic treatment is difficult to test." (short and simple.)
• "As with numerous medical procedures, the effectiveness of chiropractic treatment is difficult to test."
• "Like many other medical procedures, chiropractic treatment is difficult to rigorously prove effective."
• "There are difficulties in trying to rigorously prove effectiveness for many health care treatments, including chiropractic treatment as well as numerous medical procedures."
• "Numerous medical procedures have not been rigorously proven effective; this is also true of chiropractic treatments." (deliberately ambiguous – perhaps we shouldn't do that, though)
• "Numerous medical procedures and chiropractic treatments have not been rigorously proven to be effective." (also deliberately ambiguous: does "numerous" apply to "chiropractic treatments"?)

Regards, ☺ Coppertwig (talk) 19:42, 3 June 2008 (UTC)

(outdent)

• "Has not been rigorously proven," is a scientific statement and is quite common in scientific papers. Here are some examples of its use in high-quality scientific sources:

• "Hyperglycemia has a key role in oxidative stress in diabetic nerve, whereas the contribution of other factors, such as endoneurial hypoxia, transition metal imbalance, and hyperlipidemia, has not been rigorously proven." (Obrosova 2002, PMID 12198815)
• "The accuracy of the definition of the bottom of the nerve fiber ayer measurement has not been rigorously proven." (Jaffe & Caprioli 2004, PMID 14700659)
• "Although it has been frequently proposed that AICD is a signalling molecule similar to the Notch intracellular domain, this has not been rigorously proven." (De Strooper 2007, PMID 17268505)

• The source in question (DeVocht 2006, PMID 16523145) is two years old. It's fairly high level; I don't think it's much more out-of-date now than it was when it was published.
• The source talks about "chiropractic treatment", not "chiropractic treatments". That is, it is not talking about particular treatments, but about chiropractic treatment as a whole.
• The previous paragraph in the source says this about chronic headache: "Although not rigorously documented in large-scale, well-designed randomized control trials, as of 2001, there had been at least nine trials of various degrees of quality and size involving 683 patients with chronic headaches with reported clinical improvement." The source is saying that the literature on the effectiveness of chiropractic treatment (here, for chronic headache) has not rigorously documented effectiveness. This is what builds up to the "has not been rigorously proven" (for all chiropractic treatment) in the next paragraph.
• How about this rewrite? It's derived by combining the 2nd and 5th of your proposals, along with changing the word "test" to the source's word "establish":

"As with many other medical procedures, the effectiveness of chiropractic treatment is difficult to establish and has not been rigorously proven."

Eubulides (talk) 21:04, 3 June 2008 (UTC)

I acknowledge that some scientific articles state that some things are not rigorously proven. However, in this discussion we don't have any article that states (IMO) that the effectiveness of chiropractic treatment in general has not been rigorously proven. It says something about rigorous documentation with regard to treatment of headaches in particular; and it says it in an "although" clause. If we need to reach down into "although" clauses of less-reliable sources, maybe the statement is getting undue weight. I oppose the sentence you propose, which states that the effectiveness of chiropractic treatment has not been rigorously proven. I suggest: "As with many other medical procedures, the effectiveness of chiropractic treatment is difficult to establish." Or, how about saying something more similar to what the source says: "The effectiveness of chiropractic treatment is difficult to establish; many medical procedures also lack rigorous proof of effectiveness." (I posted the preceding at 22:28, 3 June 2008. ☺ Coppertwig (talk) 00:33, 4 June 2008 (UTC))

• These two suggested paraphrases suffer from the same issue (which I still don't see as being an important one) as the paraphase that is currently in Chiropractic. Neither suggested paraphrase logically follows from what the source formally states (even though they are both obvious paraphrases of what the source is saying). For example, both paraphrases say "The effectiveness of chiropractic treatment is difficult to establish", which is obviously supported by the source; but this is not a logical implication of what the source formally says. If the problem is that an obvious paraphase uses deduction that is formally unwarranted, then what makes these paraphrases acceptable but the paraphrase in Chiropractic unacceptable?
• Let's put it a different way. The source says "numerous medical procedures have not been rigorously proven to be effective either". The only plausible way I can see to interpret that either is as follows: although chiropractic treatment has not been proven to be effective, numerous medical procedures have not been rigorously proven to be effective either. Is there any other plausible way to interpret that either? If not, then Chiropractic's current paraphrase is fine, no?

Eubulides (talk) 07:24, 4 June 2008 (UTC)

Improved version RfC

It is my opinion that this change was for the better. Please give your opinion on the matter. ScienceApologist (talk) 15:01, 14 May 2008 (UTC)

The majority of these edits were contentious, still being discussed on this page, and still lack consensus. Accordingly, I have reverted. There were some decent housekeeping edits in the mix, but the bad outweighed the good in my opinion. -- Levine2112 17:45, 14 May 2008 (UTC)

I would not have made these edits at this time. That being said, the discussion in #Comments on Scientific investigation 3 seems to have petered out, with questions remaining for the dissenting editors but no replies from them recently. The edits that were already discussed are a big improvement over what was in Chiropractic. Surely they can be further improved, and we can discuss that here. Many edits were not previously discussed, though, and they are more problematic; please see #Several important changes were never discussed below for more about them. Eubulides (talk) 23:44, 14 May 2008 (UTC)

It has been discussed on this talk page previously that any contentious edits should be discussed on the page before being implented. In addition, rather than grouping large housekeeping edits and reference formatting with contentious edits, it is better to make a larger number of smaller changes.DigitalC (talk) 23:53, 14 May 2008 (UTC)

We are not bound by what has happened on this page in the past (see e.g. WP:BOLD, WP:IAR). The question is whether the edits were good. There is consensus that they are. ScienceApologist (talk) 19:34, 19 May 2008 (UTC)

• It is true that we are not bound; still, standard practice, as noted at the top of this talk page, is to discuss controversial changes before making them, which was (alas) not done here.
• Even if there was consensus that the big edit improved the article overall, that would not imply that consensus for each part of the big edit. None of the commenters backing the consensus have commented on detailed criticisms of the previously-undiscussed parts of the big edit. (These criticisms were not available to the commenters, precisely because the big edit was sprung on the regular editors without discussion.) So there is no real evidence for consensus for the previously-undiscussed parts of the big edit that have been criticized after the big edit was made.

Eubulides (talk) 20:47, 19 May 2008 (UTC)

• Agree with ScienceApologist: Surveying these changes, they appear to be quite reasonable and backed by reliable sources. I agree with SA that these changes constitute an excellent start at reform of this page, which is sorely needed to create something encyclopedic that conforms to WP:NPOV.--Filll (talk) 18:04, 14 May 2008 (UTC)

• It looks good, adds balance, especially to the section on the Manga report. The additions appear to be well-supported. Guettarda (talk) 18:26, 14 May 2008 (UTC)

• I think it's better, more NPOV. I'm not sure that adding back practice styles is worthwhile (this article is way long already!) and I believe it's hard to pigeon-hole any individual chiropractor, but I approve of most changes, esp. re. Manga and worker's comp studies.--—CynRN 19:07, 14 May 2008 (UTC)

• I will take a look at the edits one by one and add the ones that haven't been disputed; I'll then come back here and summarize what's remaining. Eubulides (talk) 19:32, 14 May 2008 (UTC)

• After I wrote the above comment, someone else added all the edits. So now I'm looking at them one by one and plan to take out the ones with the most problems. (If someone else doesn't revert again first.…). So far I've found mostly just citation problems, but I haven't got to the controversial stuff yet. Eubulides (talk) 20:13, 14 May 2008 (UTC)

• I found a serious problem with the edits: many of them have never been discussed on this page, even though they are potentially controversial. For now I have reverted them; please see Several important changes were never discussed]] below. Eubulides (talk) 23:44, 14 May 2008 (UTC)

• I agree that the changes meet NPOV, are well sourced and helps the article to be able to go forward. My comment is from an outside opinion who watches the article and the talk page. --CrohnieGal 19:39, 14 May 2008 (UTC)

• There is growing consensus for the recent changes that are being discussed in this RFC. However, a couple of edits deleted some information that was part of the recent changes discussed in this RFC. Any minor tweaks can be made in mainspace. QuackGuru 01:07, 15 May 2008 (UTC)

• This severely controversial change went against broad consensus. QuackGuru 01:12, 15 May 2008 (UTC)

• I've restored the content under discussion. It appears fairly well-sourced. It deserves to be discussed rather than removed on a whim without properly addressing the quality of the references and their use. Let's all follow WP:TALK and WP:CON here. Thanks. --Ronz (talk) 01:42, 15 May 2008 (UTC)

There are serious problems with many parts of the edit. This should have been discussed before insertion, as per consensus above that any contentious edit would be previewed on the talk page before being taken to mainspace.DigitalC (talk) 04:16, 15 May 2008 (UTC)

I do not see any serious problems. I see a very thoughtfully written improved version. My recent edits were discussed in this RFC. Please respect the external advise. QuackGuru 04:38, 15 May 2008 (UTC)

There is broad consensus among external observers in this new RFC discussing the recent changes I made. These edits went against the advise from external third-party input of this RFC. QuackGuru 04:38, 15 May 2008 (UTC)

That edit had two parts. First, it installed the changes proposed in #Scientific investigation 3 and discussed extensively earlier. Second, as mentioned below, that edit installed several changes that were never discussed before installation. None of the external observers have commented specifically on the second (previously-undiscussed) class of changes. It is not clear that they approve of the previously-undiscussed changes. It is not even clear that the observers even noticed the previously-undiscussed changes. I didn't notice them without doing a line-by-line analysis of the edit, which took quite some time. Eubulides (talk) 06:09, 15 May 2008 (UTC)

The external observers are commenting at this RFC about this recent change. QuackGuru 06:25, 15 May 2008 (UTC)

The discussion here has been fruitful in this RFC for this recent change but this edit went against established third-party consensus. QuackGuru 06:39, 15 May 2008 (UTC)

I will follow up at #Several important changes were never discussed below. Eubulides (talk) 06:48, 15 May 2008 (UTC)

I saw this dispute while reading Vassayana's talk page. I don't know the subject, but I can see two things: first, probably many of the changes are good. Second, that while bold edits are good, they were subsequently edit warred in, (these for example) which is against the processes of WP. Therefore, there is a need for obtaining consensus on the changes before they are considered more than suggestions. ——Martin ☎ Ψ Φ—— 02:07, 16 May 2008 (UTC)

There was growing consensus for the recent changes but it appeared a certain editor attempted to flout consensus by edit warring. QuackGuru 22:19, 19 May 2008 (UTC)

Or rather that certain editor was flouting the lack of consensus despite another certain editor touting that there was one. -- Levine2112 22:32, 20 May 2008 (UTC)

Martin, do you believe that the agreement seen by so many outside reviewers of the RfC that the content is good is not enough to establish that the content should be added? ScienceApologist (talk) 19:34, 19 May 2008 (UTC)

• Concerned Comment The biggest problem I have with this version is that it is being billed as a consensus from the community, but they have not shared in the conversation or the work that has been put in to improve upon the very version they are looking at. There is more work to do, but if you call this a consensus version, it will be virtually impossible to make any more edits - even minor ones - as a particularly eccentric editor will likely take it as his duty to defend the "consensus view from outside editors". So while I can work with anything, nobody can work with the constant reversions to "the RfC version that many outside members have agreed to". So, unless you really like this version, I would rather you suggest that we continue to work together in the manner that WP was meant to work - where anyone can edit anytime and collaboration is the preferred method to accomplish consensus. Let the ones that are working this article decide what the 'best version' is. -- Dēmatt (chat) 00:58, 20 May 2008 (UTC)
  • Again, well said. -- Levine2112 22:32, 20 May 2008 (UTC)
    • I agree. The "consensus version" has real flaws and can use further improvement. Eubulides (talk) 02:16, 21 May 2008 (UTC)
      • I have made further improvements. Please review. QuackGuru 15:31, 23 May 2008 (UTC)

Objective straights and reforms

Part of the change added material about objective straight and reform chiropractors, two groups which it's not clear still exist (we don't have good evidence that they exist, and we have weak evidence that they don't). As I recall this was last discussed at the end of the long section Talk:Chiropractic/Archive 18 #Problems with current Effectiveness draft, without a consensus about including the material in Chiropractic#Schools of thought and practice styles. I suggest moving this material to Chiropractic history or perhaps Chiropractic #History; I don't think it'd be controversial there. I removed this material for now, pending further discussion. Eubulides (talk) 20:54, 14 May 2008 (UTC)

I don't think the article needs the material about reform and objective straights, maybe not even in history. I don't think it's very notable.--—CynRN 21:20, 14 May 2008 (UTC)

I'm not sure that removing the material was altogether appropriate. I agree that the issue may be one of historical relevance rather than modern day relevance, but I found the material to be informative, interesting, and well-sourced. ScienceApologist (talk) 22:09, 14 May 2008 (UTC)

I don't feel strongly either way. The subject of the reform group especially got discussed ad nauseum on the talk pages a few months ago with no real consensus. History would be the place if it is to be included.--—CynRN 22:16, 14 May 2008 (UTC)

OK, for now I moved it to Chiropractic #History. Eubulides (talk) 22:25, 14 May 2008 (UTC)

I prefer the information under Internal conflicts be put at the end of the Schools of thought and practice styles section. QuackGuru 01:07, 15 May 2008 (UTC)

The internal conflicts section is relevant to the schools of thought and practice styles section. The internal conflicts has discussion about the varying thoughts, practices, and beliefs. QuackGuru 08:12, 15 May 2008 (UTC)

Sure, but almost everything in Chiropractic #History is relevant to some other section, and could be moved there. The point is that Chiropractic, by and large, is a discussion of chiropractic as it is today. Stuff that's no longer relevant should be put in Chiropractic #History to avoid cluttering up the rest of the sections with material that used to be true but is no longer true. That's how other historical material is treated, and this particular historical material should be no exception. Eubulides (talk) 02:06, May 15, 2008 (UTC)

I fear that statement reveals a misunderstanding (at least on this point) of Misplaced Pages. While I agree that purely historical and dated events (IOW no longer, unquestionably, and impossibly current in any manner) should be placed in the history section IF our sources also do so, this happens to be a different matter. Misplaced Pages articles should NOT limit themselves to the present picture of the subject. It would take alot of OR to achieve this with some things about chiropractic, since many DCs in practice TODAY believe, think, and act as described by what you term "historical" or what CorticoSpinal terms "progressive". Chiropractic today is a very broad spectrum of beliefs and practices, and we shouldn't limit mention of something we believe (or wish) is purely historical to the history section, since it is ALL current practice and belief many places. Ultra straight subluxationism and anti-subluxationism are all very current within the profession. They are all part of "progressive" chiropractic, depending upon one's own personal POV. The struggle for domination is far from over.

There is also a straw man at work here, which you (Eubulides) many not be aware of. Straw men can effectively be used to shoot down unpopular ideas. When this section was first written and later being developed further, the strawman of existence or nonexistence of groups and organizations was constantly being brought up as if it was an issue to this section. It is NOT an issue in this section. This section is about "schools of thought and practice styles". Let me illustrate. Luther is long since dead, but his "school of thought" still exists and is present in Protestantism, and we mention him, his thoughts, and the work of various protestant groups and denominations. Just so here. Even if the only organization that has been officially reform (the NACM) were to cease to exist (it happens to live a quiet existence, as always), it's school of thought is expressed by many chiropractors whose utterances reveal that they share "reform" thoughts and their practices as well. In this context it is OR to engage in speculations about the existence of an organization which is so unlike ordinary organizations that it has usually been relatively quiet and whose membership has been relatively secret. That question is totally irrelevant to this section.

What we need to focus on is: (1) Did that school of thought exist and (2) was it officially the position of one organization? Yes. Unquestionably. (3) Does that school of thought still exist? Unquestionably. That's all we need to know to include mention of the organization, its school of thought, and its role in the profession, past and present. In fact, a substantial portion of the proof of its influence and notability has been provided by its opposition. Notoriety is a pretty powerful form of notability which Misplaced Pages recognizes. If you want the strongest proof of something, get its enemies to provide it. The testimony of friends can't always be trusted, but the opposition of enemies can certainly be used as evidence. FYI, chiropractors wouldn't have access to VA hospitals today if it hadn't been for the influence of the representative of the NACM on the work committee where access was granted. That's a pretty powerful influence exerted by one little, minority, relatively secret, organization that has been very notably and vocally opposed by the whole profession. Although that representative was initially attacked quite viciously, that representative was actually thanked later for his role. Ultra straight organizations had actually opposed the idea. -- Fyslee / talk 04:38, 22 May 2008 (UTC)

Luther is dead, but the Lutheran church is very much alive: I can still call up the Lutheran church and someone will answer the phone. This is not the case for the NACM, by all reports. Let me take that analogy and run with it: Lutheranism only briefly mentions Pietism (in Lutheranism#See also), and this is appropriate. Pietism was formerly a very active branch of Lutheranism, but it's now dead as an organized group: you can't call any Pietist churches on the phone (the Pietists have an indisputable effect on current teachings of some Lutherans, but they're no longer active). In contrast, Lutheranism does mention the differences between reformism and confessionalism, an important and active distinction among Lutherans: one can currently call up the reformists and someone will answer the phone, and likewise for the confessionalists, and it's entirely appropriate to cover that as a current issue.

In that sense, I don't see any reliable evidence cited showing that reformers are still active. Their work may have influenced current thought (just as Pietists influenced current Lutheran thought), but outside the History section Chiropractic should cover current thought, not the historical influences. Eubulides (talk) 08:35, 22 May 2008 (UTC)

You're missing the point, which is that it doesn't make any difference if the organization is active or not. The school of thought and practice style (anti-subluxation) is very much alive. Those who express such views are reform chiropractors. -- Fyslee / talk 14:16, 22 May 2008 (UTC)

I agree with this. -- Dēmatt (chat) 13:10, 23 May 2008 (UTC)

If we can find reliable sources showing that anti-subluxation is very much alive now, then I agree that should be included in the school-of-thought section. But it should be called "anti-subluxation", not "reform", no? Eubulides (talk) 16:58, 22 May 2008 (UTC)

It's not anti-subluxation per se, but pro-mainstreaming (which means they think chiropractors must drop their garb). -- Dēmatt (chat) 13:12, 23 May 2008 (UTC)

OMG is "garb" not just the perfect word for it! We should write for living! -- Dēmatt (chat) 13:16, 23 May 2008 (UTC)

Unless something has changed since previous consensus existed that there was not sources to believe these groups still exist, they should ONLY be placed in the history section. I for one believe that reform chiropractors DO exist, they just don't use the name "reform chiropractors" - but alas, without the name, it is hard to find sources that back that up. In that sense, I guess they are just at the end of the ideological spectrum of mixers.DigitalC (talk) 00:21, 16 May 2008 (UTC)

Effectiveness and Cost-benefit sections

Both of these section were added without a consensus. They are still a lot of discussion about the wording and even about whether or not to add these sections at all. To me, this (and the addition of the Objective straight and Reform) were the most egregious of the mass edits and most in need of being removed. -- Levine2112 21:42, 14 May 2008 (UTC)

There's an RfC currently in the works. Most of the people commenting seem to think that the edits including these bits were good. You are free to explain exactly what your objections are, but I don't think removal at this time is appropriate. ScienceApologist (talk) 22:10, 14 May 2008 (UTC)

The RfC was about effectiveness, not about cost-benefit. The cost-benefit section was added without any discussion, which is not a good idea for a controversial article like this. Also, the effectiveness section that was added was not the effectiveness section that was proposed. For now, I reverted to what was proposed and copied the undiscussed stuff to the next subsection. Eubulides (talk) 23:44, 14 May 2008 (UTC)

The new RFC was linked to the recent edits. I see growing consensus to include the information from the comments in the new RFC. QuackGuru 01:07, 15 May 2008 (UTC)

Calling a consensus again when there is no such consensus?DigitalC (talk) 04:18, 15 May 2008 (UTC)

There is broad consensus among external observers in the new RFC which is to be respected. QuackGuru 04:26, 15 May 2008 (UTC)

Again, I disagree that the external observers have a consensus about (or even noticed) the previously-undiscussed changes in that edit. Eubulides (talk) 06:09, 15 May 2008 (UTC)

Several important changes were never discussed

The edit contains several important changes that were never discussed on the talk page. Some of them are quite likely controversial. Please discuss changes like these before putting them in. For now I removed the undiscussed changes and list them below for further comment. Eubulides (talk) 23:33, 14 May 2008 (UTC)

• The following text was added to the discussion of the British Medical Association:

'In 1997, the BMA has identified chiropractic health care that can be regarded as "discrete clinical disciplines" because it has "established foundations of training and have the potential for greatest use alongside orthodox medical care."'

• The version of Scientific investigation that was installed had serious discrepancies from what was proposed in #Scientific investigation 3. It appears to be some mixture of #Scientific investigation 3 and the older Talk:Chiropractic/Archive 18 #Scientific investigation 2. For now, I have changed it to the #Scientific investigation 3, as that seemed to have more consensus. Further edits will no doubt be needed, but this sort of thing should be discussed first.

• The new Cost-benefit section was never discussed. I enclose it below, for further discussion. Please put comments in #Comments on Cost-benefit 1 below.

Eubulides (talk) 23:33, 14 May 2008 (UTC)

The RFC was about all of my recent edits. QuackGuru 01:07, 15 May 2008 (UTC)

The external observers commented about the overall edit, most of which had been discussed earlier. There's no evidence that the observers noticed, much less approved of, the changes that were slipped into that edit without any previous discussion. The only comments they made were about the changes that had been discussed earlier. It is contrary to common practice on this page to install major, potentially-controversial changes without any discussion on the talk page. Please discuss these changes in the relevant sections of this talk page, now that the sections have been created. Eubulides (talk) 06:48, 15 May 2008 (UTC)

The external observers were commenting on this recent change. We have discussion from third-party input. Uninvolved Wikipedians did discuss my recent change in the new RFC. QuackGuru 07:08, 15 May 2008 (UTC)

Most of what you are calling "my recent change" consisted of material that had been previously discussed. The uninvolved Wikipedians commented on the entire edit, and could easily have been fooled (by the way earlier discussion occurred) into thinking that the edit was installing what had been discussed. None of the comments by the uninvolved Wikipedians indicate that they read, understood, or agreed with the not-previously-discussed part of the change. It is poor practice to take a proposed edit which has had a lot of discussion, to make unannounced and important changes to it, and to install the changed edit without bothering to notify people that the edit involves undiscussed changes. I cannot emphasize this enough. Major changes need to be discussed first, before installing them; that is the standard procedure on this page, and it's standard procedure for good reason. Eubulides (talk) 09:15, 15 May 2008 (UTC)

There is absolutely NO indication that any of the RfC respondents were fooled. This is pure obstructionism. I will assume good faith and simply ask you to abide by the new consensus that the additions are good and needed in the article. There is no policy or guideline that says someone has to discuss first. One can discuss after the changes are made. That is being done here. The current consensus is to keep the changes. Please also stop making up rules for editing. Your cooperation is appreciated. Thanks. ScienceApologist (talk) 14:39, 15 May 2008 (UTC)

• There is no evidence that the RfC respondents read or understood the not-previously-discussed changes. None of the RfC respondents have responded to the substance of the subsequent criticism of the not-previously-discussed changes; this appears in many sections on the talk page, including #Comments on Cost-benefit 1, #Sorry to stop by in the middle of a POV war, and #Objective straights and reforms.
• So it is not true that "the current consensus is to keep the changes"; there may have been a consensus at the point the previously-undiscussed changes were made, but now that problems have been pointed out with those changes, the consensus, if there was one, is no longer present.
• Your revert to an old state ignored discussion that occurred after the "new consensus" (see, for example, #Sorry to stop by in the middle of a POV war). This discussion resulted in several improvements in wording in citation to the material, improvements that have not been disputed, and thus your revert lost this useful information. Please do not ignore later discussion, and please do not blindly revert and inadvertently remove later improvements.

Eubulides (talk) 16:14, 15 May 2008 (UTC)

• One other thing: I am not "making up rules for editing". The top of this talk page says "This is a controversial topic that may be under dispute. Please read this page and discuss substantial changes here before making them." This is a good rule, and should in general be followed. It was not followed for the previously-undiscussed changes. It is bad procedure to install changes into a controversial article without discussing them first. Eubulides (talk) 16:17, 15 May 2008 (UTC)

One thing is for sure, there is clearly no consensus to add these edits. It is truly a mystery why these editors are claiming that there is a consensus when so many editors disagree with these edits. -- Levine2112 19:32, 15 May 2008 (UTC)

Consensus is established above. ScienceApologist (talk) 17:11, 18 May 2008 (UTC)

I don't think so, SA. The question of validity still has not been addressed; i.e. why are Eubulides et QuackGuru trying to push an WP:SYN of SMT and pass it off as effectiveness of chiropractic. What is the effectiveness of medicine, dentistry and maybe more appropriately, physical therapy? If you can provide a sound rationale that would be helpful. CorticoSpinal (talk) 19:21, 18 May 2008 (UTC)

You are confused about what consensus is. Please read up on Misplaced Pages policies and guidelines. ScienceApologist (talk) 19:25, 19 May 2008 (UTC)

• Concerned Comment The biggest problem I have with this version is that it is being billed as a consensus from the community, but they have not shared in the conversation or the work that has been put in to improve upon the very version they are looking at. There is more work to do, but if you call this a consensus version, it will be virtually impossible to make any more edits - even minor ones - as a particularly eccentric editor will likely take it as his duty to defend the "consensus view from outside editors". So while I can work with anything, nobody can work with the constant reversions to "the RfC version that many outside members have agreed to". So, unless you really like that version, I would rather you suggest that we continue to work together in the manner that WP was meant to work - where anyone can edit anytime and collaboration is the preferred method to accomplish consensus. Let the ones that are working this article decide what the 'best version' is. -- Dēmatt (chat) 00:58, 20 May 2008 (UTC)
  • Here, here. Well said. -- Levine2112 22:29, 20 May 2008 (UTC)

Cost-benefit 1

The benefits of chiropractic care seem to outweigh the involved risk. The cost-effectiveness of SMT has not been demonstrated beyond a reasonable doubt. However, spinal manipulation for the lower back appears to be relatively cost-effective. Of the various interventions available, the most cost-effectiveness treatment for lower back pain could not be determined from the limited research available. The data indicates that SM therapy typically represents an additional cost to conventional treatment. Due to SM's popularity, higher quality research into the risk-benefit is recommended. Preliminary evidence suggests that massage but not spinal manipulation may reduce the costs of care after an initial therapy. When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SM. The small risk associated with manipulation of the cervical spine could be avoided with the use of nonthrust passive mobilization movements. There is no evidence that SM is superior to other treatment options available for patients with low back pain. In occupational low back pain, shorter chiropractor care had a benefit for reducing work-disability recurrence and longer chiropractic care did not show a benefit for preventing work-disability recurrence when analyzing tha data from workers' compensation claims data. SM helps to reduce time lost due to workplace back pain, and thus employer savings.

Comments on Cost-benefit 1

(Please put comments here.) Eubulides (talk) 23:33, 14 May 2008 (UTC)

• First comment is that any SM should be changed to SMT. I changed the first thinking it was a typo. This is going to run into similar problems as effectiveness, where the sources are talking about the cost-effectiveness of SMT, not the cost-effectiveness of chiropractic.DigitalC (talk) 00:02, 15 May 2008 (UTC)
• If There is no evidence that SM is superior to other treatment options available for patients with low back pain.is to be included, it should be changed to There is no evidence that SMT is either superior or inferior to other treatment options available for patients with low back pain. In accordance with the following quote from the conclusion of the article "Neither did we find evidence that these therapies are superior to spinal manipulative therapy.". However, this source is not EVEN on cost effectiveness of SMT, it is on effectiveness of SMT, and as such should not be in this section.
• after an initial therapy. is grammatically incorrect. After initial therapy, or after an intiial treatment would be grammatically correct.
• When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SM. Again, this falls into the trap of assuming that this is Cost-benefit of SMT, and not Cost-benefit of Chiropractic. Chiropractors use physiotherapeutic exercise as a treatment.
• The small risk associated with manipulation of the cervical spine could be avoided with the use of nonthrust passive mobilization movements. This one is a POV statement, and I will have to search for a source the backs that it is POV. From my understanding the risk is the same for any grade of mobilization. DigitalC (talk) 00:49, 15 May 2008 (UTC)

Actually, the research suggests that manipulation and mobilization carry the same risk. In fact, the same risk as performing a cervical range of motion exam. So not only is it POV, it's not accurate. Is there a reference for it? -- Dēmatt (chat) 03:43, 15 May 2008 (UTC)

Yes, it is referenced, but I agree with you that research suggests that any movement of the cervical spine carries the same risk.DigitalC (talk) 04:10, 15 May 2008 (UTC)

I am pretty much against the majority of the content which Quackguru added. . . moreover I am petrubed by the manner in which it was added. Discussion about Reformers should be removed. . . along with the contentious efficacy and research section.TheDoctorIsIn (talk) 01:03, 15 May 2008 (UTC)

I feel there are severe limitation still in this version although there is undoubtedly some good to it too. We can work with this and make it much better and more relevant, however. The validity some of the information presented here is highly suspect and there are major omissions still. For example, scientific research into chiropractic has been done by chiropractors, believe it or not, since the 1920's. I thought we are supposed to be discussing scientific investigation of chiropractic care, not SMT. They're not the same. What about the NIH study? That was a landmark one in 1976. The New Zealand study in 1979? The Meade study, the Rand study, etc? These are all SPECIFIC to CHIROPRACTIC CARE. Just because they're old doesn't mean that their invalid. The Crick and Watson paper (1955) after all, is holding up well. Also, there has been some pretty bad cherry picking that is either a violation of WP:POINT or WP:COATRACK. If our allopathic editors want to play that game, we can have a tit for tat war with inserting trivial facts that present the OTHER POV. For example, the addition of the "Canadian DCs don't know how to research" is a bit over the top. This study was done in the province of ALBERTA representing less than 15% of Cdn DCs most of whom graduated when the EBM era hadn't arrived. There are more examples, but I must go back to work. Too bad these edits had been railroaded in, and supported blindly by the usual suspects. Also, Fill -- your comment was in poor taste. If you think the Citizendium article with it's lead (with a direct quote taken from 1966) applies here, you're not up with the times. Also, the medical community here is editing against the evidence which I find distressing. Lastly, Ernst is being used throughout this article to negate, trump or override the sound opinion of EXPERTS in SMT and EFFECTIVE and CHIROPRACTIC CARE. This practice must stop. CorticoSpinal (talk) 16:58, 15 May 2008 (UTC)

• The current version emphasizes scientific investigation of chiropractic care. This inevitably means heavy coverage of SMT, since SMT is a core component of that care.
• If an old study is truly landmark it can be expected to affect current reviews. If not, then we shouldn't be mentioning it ourselves. We should rely on expert opinion as to what is important and what is not. We should not be making those calls ourselves, when the expert opinion is already available.

• No, and SmithBlue told you this already. If the purpose of the review is not congruent with the given topic, the review is not valid and should not be used. DCs would consider Manga to be landmark, MDs not so much. So we are to rely on MD reviews? CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)

• SmithBlue's argument, while valid, is not a get-out-of-jail-free card that will let an editor ignore a review whenever they please. It requires a good reason that the review is not congruent with the given topic. No reason has been advanced for any of the reviews cited in Chiropractic, so in no case has there been any justification for ignoring expert reviews and reaching down into the reviewed sources. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• I agree that reaching down and inserting trivial facts from primary studies is not the way to go. If that exists in Chiropractic now, we should fix it.
• The "Canadian DCs" stuff has been removed (for now; until someone reverts it again, I suppose). That stuff is contentious and was not discussed before inserting. I agree that it is potentially controversial and deserves careful review first.

• It was an attribution problem; and the Grod citation should have been used to demonstrate the opposing POV to make it NPOV. CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)

• Sorry, I don't follow this remark. Anyway, I don't see "Canadian DCs" in the current version, so perhaps this point is moot now? Eubulides (talk) 07:35, 19 May 2008 (UTC)

• Many (most?) cites to Ernst are not to things that override expert chiropractors. The exceptions are marked as such (e.g., "a critical review"). At least, that's the intent; if there are problems in this area then let's please discuss fixes.

19:18, 15 May 2008 (UTC)

• Ernst is pushed on every single CAM article and although his opinion is certainly notable (that's NEVER been debated) the weight, tone and influence of his words, especially in chiropractic has been a huge problem since he was pushed onto the scene in Feb 08. Mainstream doesn't even agree with his views on SMT, this is illustrated with the American College of Physicians recommending SMT for LBP whereas Ernst still says its "dangerous" with "no proven beyond a resonable doubt" and "adds costs". Essentially, all his statements are in direct conflict with bulk the mainstream literature. His star is fading as he continues his witch hunt and if he's reading this I think he's a massive douche bag and the quality of his papers re: chiropractic care are by far the most biased, unbalanced, unobjective and misleading ones out there. He should take a cue from Kaptchuk (1998) who can raise concerns but present both sides. CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)

• There is certainly a difference of opinion in mainstream medicine about the effectiveness of SMT. The American College of Physicians does not "recommend" SMT for LBP; it lists it as a "likely effective" therapy, along with massage therapy, acupuncture, willow bark extract, and devil's claw. There is substantial disagreement among low back pain guidelines, with some of them agreeing more with Ernst and some agreeing more with chiropractors (see Murphy et al. 2006, PMID 16949948). It is highly misleading to cite just one group in this area and to pretend that it is the final word, and Chiropractic should fairly represent all sides, including both the skeptics and the proponents of chiropractic. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Manipulation of the cervical spine (MCS) is used in the treatment of people with neck pain and muscle-tension headache. The purposes of this article are to review previously reported cases in which injuries were attributed to MCS, to identify cases of injury involving treatment by physical therapists, and to describe the risks and benefits of MCS. One hundred seventy-seven published cases of injury reported in 116 articles were reviewed. The cases were published between 1925 and 1997. The most frequently reported injuries involved arterial dissection or spasm, and lesions of the brain stem. Death occurred in 32 (18%) of the cases. Physical therapists were involved in less than 2% of the cases, and no deaths have been attributed to MCS provided by physical therapists. Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements). The literature does not demonstrate that the benefits of MCS outweigh the risks. Several recommendations for future studies and for the practice of MCS are discussed.

Here is the abstract from the Di Fabio RP ref. The risk can be avoided with the use of mobilization (nonthrust passive movements). Thanks. QuackGuru 04:23, 15 May 2008 (UTC)

As above, yes you have a source for it. However, it is POV, in that other sources state that the risk is the same for manipulation, mobilzation, range of motion examination, and shoulder-checking while driving.DigitalC (talk) 05:15, 15 May 2008 (UTC)

Please provide a list of other sources. QuackGuru 05:21, 15 May 2008 (UTC)

Please see Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
 • we deem that where it is the mere movement of neck tissues that causes a risk factor to be an absolute contraindication to an HVLA thrust, manipulation that is not HVLA or mobilization are equally contraindicated by this factor, see also Rome P.L. “Perspectives: An Overview of Comparative Considerations of Cerebrovascular Accidents”, Chiropractic Journal of Australia 1999; 29(3): 87-102, as well as Terrett A.G. Current Concepts in Vertebrobasilar Complications following Spinal Manipulation. Des Moines, Iowa: National Chiropractic Mutual Insurance Company, 2001. DigitalC (talk) 05:38, 15 May 2008 (UTC)

The word however was added to a sentence. I do not see any reason for this. QuackGuru 07:52, 15 May 2008 (UTC)

"However" is a connecting adverb meaning "nevertheless, in spite of that, etc". "However" used correctly in a sentence will suggest that that sentence disagrees in sense somewhat with the preceeding sentence(s). In this case, it was used to tie two sentences together to improve flow, so that it wasn't so choppy.DigitalC (talk) 00:39, 19 May 2008 (UTC)

I have not yet had time for a detailed review of #Cost-benefit 1 (I've been tied up with the aftermath of the recent Effectiveness changes) but here is a quick first reaction:

• It's much improved from #Cost-benefit 0, but still needs quite a bit of work.
• It refers directly to many primary studies. It should focus instead on what recent reviews say, e.g., van der Roer et al. 2005 (PMID 15949783), Canter et al. 2006 (PMID 17173105), Cherkin et al. 2003 (PMID 12779300). Primary sources should be used only with good reason (e.g., if they're too new to be reviewed and are obviously important). Eubulides (talk) 09:00, 15 May 2008 (UTC)
• Isn't Assendelft et al. 2003 (PMID 12779297) superseded by Assendelft et al. 2004 (PMID 14973958). Why cite the obsolescent source?
• Let's stay away sources older than 5 years old. They're too dated. If a subject hasn't been reviewed in the past 5 years, then it's probably not worth summarizing here.

This makes no sense. Historically chiropractic care has been shown to be cost effective, why ignore the data? There's a reason why DCs SPECIFICALLY have been invited to participate in integrative models of care. Result? Less costs again. CorticoSpinal (talk) 17:03, 15 May 2008 (UTC)

Again, there is no intent to ignore old data. If old data is still important, it should appear in a recent review. If it doesn't appear, that's good evidence that it wasn't that important after all, at least according to published expert reviewers. Eubulides (talk) 19:18, 15 May 2008 (UTC)

Again, you are missing the point regarding the validity of some of the reviews. Let me paraphrase, again, what SmithBlue and myself have been telling you for quite some time now: if the purpose of the review is not congruent with the topic at hand, then it is not valid. There are severe logical flaws in your reasoning and you've used the same excuse for 4 months to keep out extremely reliable and valid "primary" studies that are far more valid and academically robust than some of the reviews supported by yourself. A refusal to include studies which meets WP:RS, WP:V and are from indexed peer-reviewed journals will forever prevent from making this article NPOV. CorticoSpinal (talk) 23:18, 16 May 2008 (UTC)

No argument has been put forth that the reviews in question are incongruent with the topic at hand. On the contrary, the reviews are quite congruent with the topic of effectiveness. There is no good reason to disregard reliable reviews and to substitute our own opinion about the the reviewed studies. Eubulides (talk) 07:35, 19 May 2008 (UTC)

• The text flows poorly. Contradictory sentences are run together without any explanation. The text needs to tell a consistent story and hang together; currently it doesn't do that well at all.

Eubulides (talk) 09:00, 15 May 2008 (UTC)

And yet, attempts to make it flow better are met with objection.DigitalC (talk) 00:02, 16 May 2008 (UTC)

• Minor grammatical point: "the most cost-effectiveness treatment" Please delete "ness" from end of word. ☺ Coppertwig (talk) 03:08, 16 May 2008 (UTC)

I have updated the cost-benefit section. It flows very well now. QuackGuru 15:43, 23 May 2008 (UTC)

Cost-Benefit of Chiropractic Care 2a: Work in Progress

The benefits of chiropractic care seem to outweigh the involved risk. A 2007 retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs . This effect was greater on a per-episode basis than on a per-patient basis. Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain. A 4-year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399). The authors concluded: "Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care." In occupational low back pain, shorter chiropractor care had a benefit for reducing work-disability recurrence and longer chiropractic care did not show a benefit for preventing work-disability recurrence when analyzing tha data from workers' compensation claims data. In 2004, Workmans Compensation evaluated the effectiveness and cost-effectiveness of chiropractic care for acute low back injuries and demonstrated that chiropractic care was superior to physical therapy in reducing pain, inproving perceived disability, and lost work time (9 days for chiropractic care in comparison to 20 days for physiotherapy). . This is in general agreement with previous Workmans Compensation analyses' which chiropractic care is equal or superior to standard medical care. A 1999 Medicare study revealed that "The results strongly suggest that chiropractic care significantly reduces per beneficiary costs to the Medicare program. The results also suggest that Chiropractic services could play a role in reducing costs of Medicare reform and/or a new prescription drug benefit." A demonstration project regarding an expansion of coverage of chiropractic services was launched in 2005. Under this demonstration project, chiropractors will be allowed to bill medical, radiology, clinical lab and certain therapy services related to the treatment of neuromusculoskeletal conditions.

Comments of Cost-effectiveness 2a

Before I get hounded, this is a very quick draft; it is by no means complete and I will integrate the best of QGs draft into when I have a bit more time. There are tons of workmans comp studies to include but the bulk of them say chiropractic care (for NMS disorders) is cost effective and patients prefer it to standard medical care (don't know if PT is included in this or not, we should find out so we don't lump in PT care with med if appropriate). The preliminary results of the just completed Chiropractic Medicare Demonstration project in the US shows this trend continues, but I'm willing to simply state there's been a cost-effectiveness and effectiveness project done by the DoD, Medicare and DVA in the US to determine the merits of integrating chiropractic care into managed, governmental programs. St-Mikes deserves a mention too; I think its the first hospital in North America to have permanent inclusion of DCs on staff who are fully integrated (i.e. full time employee status). I'm not quite sure of the situation in the US; although I do know there is a small, but increasing # of DCs who have hospital privileges. The trend is that this is increasing too. CorticoSpinal (talk) 22:53, 16 May 2008 (UTC)

This draft relies on primary studies when it should rely on reliable reviews. For cost-effectiveness we have enough high-quality reviews that there's no need to reach down into primary studies ourselves. Chiropractic's current cost-benefit section is bad enough, but at least it cites some reviews relatively fairly; this proposed 2a replacement is far worse in that regard. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Well, it certainly appears thorough. I'll have to check the sources as Eubilides suggests, but it's a start. BTW, I haven't quite found my way around this talk page, so if there is something that is no longer of any use, how about archiving it so I don't strike up another conversation about something that is already settled. -- Dēmatt (chat) 19:41, 20 May 2008 (UTC)

• It's the "appears thorough" that worries me. By citing primary sources in addition to the secondary reviews, it's making the evidence appear stronger than it is, or it is arguing with the reviews (I don't know which, as I haven't had time to read all that stuff). Either way, it should be fixed, preferably by dropping citations to the primary sources (I don't see why they're needed, but again I haven't read the sources yet).
• Currently we're relying on auto-archiving; the page is getting a tad big to navigate through (or archive) by hand.

Eubulides (talk) 22:16, 20 May 2008 (UTC)

So, you haven't investigated the sources but object to them? Stop trying to omit valid studies that aren't covered by reviews. Geez, how many times in 4 months can you use the same argument, over and over again with many different editors disagreeing with the way you interpret MEDRS? CorticoSpinal (talk) 18:28, 21 May 2008 (UTC)

Has anybody actually read the sources? So far, I see no evidence that anybody has. As far as I can tell, this cost-effectiveness draft was generated by someone who read only the abstracts. Someone (and it will probably be me, sigh) will have to actually read the sources. I am skeptical that there will be any need to cite the primary sources, because I expect that review will cover the material in question. Eubulides (talk) 20:13, 21 May 2008 (UTC)

I've read the sources used in the draft. The claims are supported by the literature. Many of the papers are interdisciplinary collaboration, between DCs and MDs. So, a lot of bias goes out the window there. If we can find reviews that addresses all the points made above then obviously we can choose a review, however I doubt that one review will cover all the specific points. Tertiary sources such as governmental studies could be used as well. CorticoSpinal (talk) 23:23, 21 May 2008 (UTC)

By "reading the sources" I do not mean just reading the abstracts. I mean reading the entire papers. I still don't see any evidence that anybody has actually read the sources. Eubulides (talk) 08:35, 22 May 2008 (UTC)

I haven't read all the sources either, but I have now read the draft, and it is far inferior to what's in Chiropractic#Cost-benefit, a section that itself is not that strong. We'd be better off starting from the existing section than from this draft. Here are some specific comments. Some of these comments also apply to Chiropractic#Cost-benefit (as some of the text is in common).

• The most important complaint is that this section consists entirely of cites to primary studies. It should rely on reliable reviews where these are available. It should lead with the results from reviews, and should fill in with primary studies only when necessary. Currently it does just the opposite: it leads with primary studies, and emphasizes their results, and doesn't report reviews. This is backwards from what WP:MEDRS recommends, and means that there is all-too-great opportunity for our bias to leak into the text.

• "The benefits of chiropractic care seem to outweigh the involved risk." This is just a primary study, and should not be the lead sentence in the section. Also, the cited source does not talk about chiropractic care in general, just about chiropractic care for neck pain. Also, this relies on a single primary study and should say so. A better summary would be "A 2007 Dutch study found that the benefits of chiropractic care for neck pain seems to outweigh the involved risk." but this summary should not be used to lead the section. Eubulides (talk) 08:35, 22 May 2008 (UTC)
• "A 2007 retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone." Again, this is a primary study and should not be emphasized so strongly, at the start. The second "clearly demonstrates" sentence is POV and is not supported by the source. The source's conclusion makes it clear that these results are for one IPA and may or may not generalize to others. The first sentence is way too long, given that it's summarizing just one primary study. The study is just about costs, not cost-benefit, and as such is of limited use in this section. I suggest creating a new section Cost for material like this.
• "For the treatment of low back and neck pain, the inclusion of a chiropractic benefit resulted in a reduction in the rates of surgery, advanced imaging, inpatient care, and plain-film radiographs . This effect was greater on a per-episode basis than on a per-patient basis." Again, this is just one primary study. This is a direct and extended quote from the abstract, without quote marks, and as such is too close to being a copyright violation for comfort. The study is just about cost, not cost-benefit, so it'd be more appropriate for a Cost section.
• "Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction. Chiropractic care appeared relatively cost-effective for the treatment of chronic LBP. Chiropractic and medical care performed comparably for acute patients. Practice-based clinical outcomes were consistent with systematic reviews of spinal manipulation efficacy: manipulation-based therapy is at least as good as and, in some cases, better than other therapeusis. This evidence can guide physicians, payers, and policy makers in evaluating chiropractic as a treatment option for low back pain." Again, this is simply quoting the abstract from a single primary study; we can't do that. Somehow the quote managed to skip around the fact that this study found that chiropractic care costs were higher. This study is rarely cited elsewhere (I checked Google Scholar) and is suspect for that reason.
• "A 4-year retrospective claims data analysis comparing more than 700,000 health plan members within a managed care environment found that members had lower annual total health care expenditures, utilized x-rays and MRIs less, had less back surgeries, and for patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode-related costs ($289 vs $399). The authors concluded: "Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care." This is a higher-quality primary study, but there's way too much here for Chiropractic. Again, this is a copyright violation. Again, this is just a primary study; we should be focusing on the reviews.
• "In occupational low back pain, shorter chiropractor care had a benefit for reducing work-disability recurrence and longer chiropractic care did not show a benefit for preventing work-disability recurrence when analyzing tha data from workers' compensation claims data." Again, this is just citing a single primary study; here there is a bit more excuse for citing it (it's too recent to be reviewed) but the wording could be shortened quite a bit without harming this dicussion.
• The remaining text is supported by lower quality studies (some not peer-reviewed, some older) and I won't bother to review it here now.
• In short, this is a real step down in quality from what is in Chiropractic now. At least the current version cites three reviews and summarizes their results. This draft ignores the reviews. There is a great deal of possible bias inherent in going out and reviewing primary sources ourselves. We should resist that temptation by relying on reliable reviews whenever possible, as is largely the case here.

Eubulides (talk) 08:35, 22 May 2008 (UTC)

Your concerns of bias do not ring true. It is YOUR source, a secondary source nonetheless that has been demonstrated to be very biased and have severe design flaws. None of the primary studies cited have this deficiency. In other words, the review that is currently included is not valid and has been refuted but it being given a free ride despite the fact it's been rebutted. It's not a quality paper. You should resist the temptation of citing crap reviews that conform to your personal POV and goes against mainstream consensus. Yes, that's correct, Ernst's conclusions on SMT and chiropractic care goes against mainstream consensus. Which makes his opinion fringe. And his studies are flawed, so now we are citing flawed, fringe material as fact with 0 qualifiers. Is this the kind of "NPOVing" you want to bring to the article? CorticoSpinal (talk) 23:43, 26 May 2008 (UTC)

Misplaced Pages is not the place to conduct research reviews on our own, overriding reviews already published by experts in the field. Multiple reviews are cited in Chiropractic #Cost-benefit; they are not all by Ernst. Other reliable review sources are welcome, as per the usual WP:MEDRS guidelines. Reaching down into primary studies is dubious; Chiropractic #Cost-benefit already does way too much of this (and this should be fixed). Rewriting it to remove all mention of reviews, which is what is being proposed here, would be a step that is way, way in the wrong direction. Eubulides (talk) 08:08, 27 May 2008 (UTC)

Edzard Ernst/Scott Haldeman

Just to get this out of the way so there's no misrepresentation of my views (as frequently done by certain chiro-skeptic editors)

Edzard Ernsts' biased and flawed secondary source reviews on SMT and chiropractic can be used here at Chiropractic That is not in dispute.

Issues

• Breaking the spirit of WP:MEDRS and using it as a tool to:

a)Promote the viewpoint (and conclusions) of vocal critic Edzard Ernst despite serious methodological flaws and strong evidence of bias while b)not promoting the viewpoint (and conclusions) by neurologist/chiropractor Scott Haldeman c) To game the system and misrepresent the argument of dissenting editors in a straw man like manner using "reaching down" as a way to invalidate the views of the opposing party.

There are claims that Ernst POV is not presented in Chiropractic. Here are all the instances and where Ernst is used currently in the article

• SMT is a passive manual maneuver during which a three-joint complex is taken past the normal physiological range of movement without exceeding the anatomical boundary limit.
• The data indicates that SMT typically represents an additional cost to conventional treatment.
• Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults
• the incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern.
• After initial therapy, preliminary evidence suggests that massage but not spinal manipulation may reduce the costs of care. When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SMT.[
• SMT being passed off for chiropractic care (its in the safety section): Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.

Yet Eubulides insists that the editors here are "not being fair" to Ernst. To wit:

Eubulides (talk) 02:16, 21 May 2008 (UTC)

Does it look like Ernst hasn't already had his "brief say" despite the fact that his reviews are from a research methods POV, "pure shit?" Despite all of the above you still want more Ernst inclusions! All the while denying the use of the opinion of the expert in chiropractic care, SMT, SMT/neurological accidents, effectiveness of the experts whose primary study has never been rebuked and invalidated like Ernst.

Eubulides has argued against the inclusion of Haldeman, Cassidy, Cote and other expert researchers who dispute the conclusions of Ernst simply because "its a primary study" and that would "be reaching down". Actually, I think the case is that Eubulides "reached up" and advocates the use of flawed reviews (invalidates the conclusions) by Ernst all the while preventing the inclusion of robust primary sources that have none of the intrisic weaknesses in research design, but also none of the fringe views that Ernst advocates. His views are clearly fringe (i.e. not mainstream). His POV on safety, efficacy and cost effectiveness go directly against the majority of research that demonstrates SMT and chiropractic care is safe, effective and cost effectiveness. There's no amount of spinning he can do to change this fact. As a reminder, here is a brief inclusion of some sources that openly rebuke Edzard Ernsts studies citing severe bias, poor methodology and invalid conclusions:

Evidence of Bias and Methodological and critical flaws that invalidate the conclusions drawn by Ernst and Ernst-Cantor:

Evidence of bias by Ernst:

1. • Evans, W. (2003). "Chiropractic Care: Attempting A Risk-benefit Analysis". American Journal of Public Health. 93 (4): 522. Retrieved 2008-05-20.
   • Bronfort, G. (2006). "Review conclusions by Ernst and Canter regarding spinal manipulation refuted". Chiropractic & Osteopathy. 14 (1): 14. doi:10.1186/1746-1340-14-14. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
   • Hurwitz, E.L. (2002). "Chiropractic care: a flawed risk-benefit analysis?". Am J Public Health. 92 (10): 1603–4. Retrieved 2008-05-20. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
   • Morley, J. (2001). "Ernst Fails to Address Key Charges". The Journal of Alternative & Complementary Medicine. 7 (2): 127–128. doi:10.1089/107555301750164145. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
   • "Profession Responds Quickly to Negative U.K. Study on Spinal Manipulation". Retrieved 2008-05-20.
   • SPINAL MANIPULATION DOES WORK: THE FACTS FROM THE BCA
   • A balanced review of evidence?

Yet, under WP:MEDRS guideline he insists that the studies on SMT and chiropractic care done by Edzard Ernst are not biased and is a "strong, reliable secondary source". According to Eubulides, we "shouldn't reach down into primary sources". Essentially, Eubulides has argued that (a) Edzard Ernst POV is not represented enough in the article and (b) his reviews cannot be refuted by Scott Haldeman who would represent the proponent of SMT and chiropractic care (despite the fact he's also an MD and a PhD).

So, plainly and simply

(1) Why do we permit the use Edzard Ernst citations which (a) has demonstrable methodological flaws (2) are severely biased (3) are not valid and not afford the same courtesy to the work of Scott Haldeman who is the expert in spinal manipulative therapy research in the topics of safety and effectiveness.

(2)Why is Chiropractic using Edzard Ernsts definition of spinal manipulation which is incorrect characterization of healing art.

• • This definition by Ernst is seriously flawed; in fact it's not even close to the definition of spinal manipulation provided by the World Health Organization "Includes all procedures where the hands or mechanical devices are used to mobilize,

adjust, manipulate, apply traction, massage, stimulate or otherwise influence the spine and paraspinal tissues with the aim of influencing the patient’s health." We could also use Principles and Practice of Chiropractic textbook which provides a good definition as well.

(3)Why does Eubulides refuse to allow scientifically robust, primary sources written by notable experts in the field (i.e. Haldeman, Cote, Cassidy) to counter the claims by Ernst that SMT is "dangerous" "adds additional costs" "risk outweighs the benefit" "has not been proven beyond a reasonable doubt" has "many adverse effects".

(4) Do we not present the view/research of Scott Haldeman DC,MD,PhD more prominently who, unlike Edzard Ernst, is much more respected, credible and truly representative source on the topics of safety and effectiveness

(5) Why are we allowing Ernsts critique of effectiveness of SMT being equated and passed off as effectiveness of chiropractic care? His severely biased view is already springing a leak article at various junctures as though to sink the article. CorticoSpinal (talk) 04:48, 22 May 2008 (UTC)

Comments on Edzard Ernst vs. Scott Haldeman

• Chiropractic contains more citations to Haldeman than to Ernst, so I don't understand the claim that it is somehow "not promoting" Haldeman.
• As mentioned above, the "evidence of bias" consists of sources dominated by chiropractors, who are hardly neutral observers in this controversy.
• WP:MEDRS suggests preferring reliable reviews for good reason. In an area like this, where there are hundreds of primary studies to choose from, it's all too easy to come up with material that is apparently well-sourced (as it cites many primary studies) but still does not present the evidence neutrally as per the usual Misplaced Pages rules about mainstream consensus. It's much better to rely on reliable reviews, which tend to avoid this problem much better than Misplaced Pages editors do.
• The context of my "unfair to Ernst" comment was somehow omitted. The point was that particular text (which referred to Ernst) was immediately followed by the summary of a review by Bronfort et al. that directly criticized Ernst. Chiropractic does this to Ernst, but to no other source.
• I am not aware of anyone advocating "more Ernst inclusions" over what is in Chiropractic now. Perhaps I missed a proposal somewhere? It is a large talk page.
• The definition of SMT cites Ernst, but Ernst is merely citing the American Chiropractic Association. Chiropractic should be fixed to point to the ACA's policy statment on SMT directly instead of indirectly via Ernst. The ACA defines manipulation as:

"a passive manual maneuver during which the three-joint complex may be carried beyond the normal voluntary physiological range of movement into the paraphysiological space without exceeding the boundaries of anatomical integrity."

This is pretty much the same wording as Ernst (any slight differences may be due to the fact that the ACA updated their policy statement after Ernst's paper was published). I disagree that this definition is "seriously flawed"; it is the definition in the official policy of the leading chiropractic professional organization.

• The review by Haldeman, Côté, Cassidy and others (Hurwitz et al. 2008, PMID 18204386) is cited twice and at length in Chiropractic#Safety. You disagree with their review and wish to emphasize details about their primary studies that they themselves did not think worth summarizing in their own review. Let's stick with the expert reviewers' opinion of their own work, rather than overriding them and reaching down into their primary studies ourselves. Eubulides (talk) 08:35, 22 May 2008 (UTC)
• I am not aware of any place in Chiropractic where SMT is being "passed off" as chiropractic care. Material about SMT is labeled as being about SMT.
• Text in Chiropractic like "According to a vocal critic of chiropractic, Edzard Ernst, MD" (added during an edit war just before the article got frozen) is designed to discredit a reliable source, is clearly POV, and should be removed as per Misplaced Pages policy. It would be equally out of place to add text like "According to a committee dominated by chiropractors" to nearby material that is supportive of chiropractic. This kind of partisan edit warring should be avoided.

Eubulides (talk) 08:35, 22 May 2008 (UTC)

• • The citations used by Haldeman do not unduly sway the tone or content of the article. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

Statements used by Haldeman sources with respect to safety, efficacy

• Research has focused on spinal manipulation therapy (SMT) in general,

So, what about this claim that Haldeman contains more citations than Ernst? It sure doesn't seem like Haldemans "sources" have been used to counter the claims by Ernst. Why would that be? Ernst severely biased and flawed reviews are presented yet strong primary studies which disagree with Ernst cannot be used. Strange. CorticoSpinal (talk) 13:48, 22 May 2008 (UTC)

• • The question is the methodological flaws that invalidates the conclusions of Ernst. It's a critique of the research. Stop confabulating. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
  • You have used MEDRS as a tool to promote a weak quality review that is flawed and biased (Ernst) whilst preventing the inclusion of strong primary sources. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
  • The placement of Ernst's opinion (severely flawed review) is used to contradict the mainstream opinion of research. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

The ACA does not determine what SMT is. It's a multidisciplinary consensus at best, or it can come from PPC. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

See above. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

• • A complete misrepresentation of my views (#19). I do not disagree with their review I disagree with the fact that the reviews covers everything that was presented in the Feb 08 issue of Spine. Somehow the most authoritative study ever done on neck pain and manipulation/stroke is getting thumped by a) Ernst and b) Miley et al. You're cherry picking the evidence to present a picture that disagrees with the general scientific consensus. You are deliberately omitting far stronger, valid and reliable primary sources. I'm not asking for Ernst to get deleted (deletionism policy) I'm asking we balance it out by adding the research of the experts (inclusion policy). Regardless, you're wrong in your assessment, 5 separate editors have specifically challenged your assessment of the research and you have violated WP:IDHT now close to 2 dozen times. How can the concern of 5 separate editors regarding your stance keep going unnoticed? Surely an admin must step in now as this is gotten to the point where the system is being gamed (violation of WP:NPOV and the spirit of WP:MEDRS has been broken. It's also an example of tendentious pushing, another violation of wikipedia policy. We have a way around this. It's called WP:IAR. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
  • Actually no. It's under the safety section. Safety section in chiropractic where the majority of the discussion is on the negative effects of SMT. Hardly balanced. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

• • Attribution is not a problem, and considering the source you want included is severely flawed attributing it to Ernst rather than outright deletion of the review. Is Ernst not a vocal critic of chiropractic? We can take out vocal if you'd like. You seem to have a real problem with separating the quality of research and then confabulating it with professional designation. Science doesn't care if you're a DC or and MD. The research stands on its own and the scientific community will pick it apart. Anyways, you have failed to address the concerns raised above and your defiant tone is noted. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

• Haldeman and Ernst both bring their own biases, and they both represent mainstream opinions in their own ways. Both sources should be cited as appropriate; in both cases, we should keep the sources' biases in mind.
• The goal of Chiropractic is not to refute Ernst by citing Haldeman. It is to present encyclopedic coverage of a complicated and controversial topic. It would be unseemly for Chiropractic to follow each citation of Ernst by a countering citation of Haldeman (or vice versa, for that matter). Let's focus on the topic rather than conduct a war.
• The "evidence of bias" is produced by sources that are (understandably) biased themselves. I could easily produce "evidence of bias" on the other side. But what would be the point? This is not supposed to be a debating society; it is supposed to be a discussion of how to produce an encyclopedic article.
• The "strong primary sources" are covered indirectly, by a strong review that summarizes those sources well. This review (Hurwitz et al., 18204386) is not coauthored by Ernst. I don't see what Ernst has to do with that particular dispute.
• Ernst needs to be covered, and the coverage needs to be placed somewhere. No matter where it's placed, it will "contradict" other researchers whose work is more supportive of chiropractic. The other researchers are not the only "mainstream opinion of research"; they are one mainstream view (typically, the mainstream of chiropractic), but there are other mainstream views (notably, mainstream medical opinion), and Ernst's view, which is a mainstream view, should be fairly represented.
• The ACA's definition of SMT is an important one. No doubt other views could also be represented. However, the ACA's definition is not an "incorrect characterization of healing art", as was claimed above.
• The review in question (Hurwitz et al.) also appeared in the February issue of Spine and it summarizes the primary studies appearing in that same issue, along with many other studies. You continue to disagree with the author's review of their own work, which is published in the same issue of Spine. As far as I can see, you are alone in the campaign to reach down into the primary source in question and override the opinions of the expert reviewers (who are reviewing their own work!).
• I am unaware of anything in Chiropractic#Safety which "passes off" research about SMT as if it were research about chiropractic in general, or about chiropractic SMT in particular. Could you please be specific about this "passing off"?
• Are Haldeman et al. not chiropractors? Should we be putting "according to a committee dominated by chiropractors" after every citation to Spine issue? No, that would be attempting to undercut the source, and would represent POV, even though it's the literal truth. It is similarly POV to attempt to undercut claims supported by Ernst by taking time to poison the well in that particular case. The footnote is adequate citation, in both cases.

Eubulides (talk) 16:58, 22 May 2008 (UTC)

• • This is not the point. The point is the quality of the research. Haldemans far surpasses Ernst. Haldemans has interdisciplinary consensus. Ernst does not. Equating Edzard Ernst to Scott Haldeman is grossly inappropriate. One holds a fringe viewpoint and produces low quality research on SMT and chiropractic care (Ernst). Haldeman does the opposite. Haldeman is also a medical doctor, Eubulides and specifically a neurologist. He might know a thing or 2 about SMT, safety, effectiveness of chiropractic care. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • The goal of chiropractic is to present both points of view and selecting the best evidence to do so. The topic is this: you preventing the inclusion of strong primary sources and advocating the use of flawed secondary sources that promotes and given it more weight (verbally) than it deserves. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • No. You are confusing the situation. It's not MDs vs DCs. It's about the quality of the research that Ernst produced with respect to SMT and chiropractic care. The research produced by Ernst has severe flaws. If you can find me severe methodological flaws and evidence of bias in the reviews or studies than that would be helpful. Otherwise you have no argument here and are speculating. We've provided the evidence of bias and flaws in Ernst' research. I'm talking about the quality of his review. Stop ducking the subject. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • Red herring, not on topic. What are you possibly talking about? CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • Ernst is already covered. That is not in debate. I've already said so at the very begining of this thread. Stop ignoring evidence and making misleading statements. You are cherry picking data here and are presenting an academically dishonest view of the literature. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • The ACAs definition is irrelevant to the discussion. The problem was replaced a definition of SMT provided by the WHO. Somewhere along the lines the definition of SMT was changed from the WHO reference to the Ernst reference. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
• No. You are missing the point. I am not disagreeing with Hurwitz. STOP ACCUSING ME OF DOING SO. I have asked you three times. I'm stating that you have ignored the evidence that WAS NOT COVERED IN HURWITZ and (b) The conclusions of the task force have been pruned to such a degree that it does not cover adequately nor in proper context the conclusion. Boyle et al. shall be included as will Cassidy and Haldeman. It's not to 'override' anything its to provide balance to it and they meet inclusion criteria as per MEDRS. If you could be so kind to provide me with specific Misplaced Pages policy that prevents the inclusion of strong, peer-reviewed primary studies I'd appreciate it. SmithBlue already asked you do this as well, it would be nice to give us an answer to a direct question. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • How convenient. You're unaware that the safety section cites manipulation can cause death (despite the extremely low risk). Safety should be specific to chiropractic care. Lumping it German MDs who practice SMT (2 week course) call themselves "chirotherapists" and kill people with inappropriate use of spinal manipulation and attributing it to "chiropractic manipulation" is a problem. This is the slippery slope you advocate? Terrible! CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • That is not the point. You are missing the point yet again. Let me perfectly clear: it's about the quality of the research. You are disagreeing with the WHO Task Force on Neck pain now. The experts. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)

• There is no evidence that "Haldemans far surpasses Ernst" in quality of research. On the contrary, Google Scholar suggests that Ernst is cited more often than Haldeman is. A spot-check of the citations to Ernst showed only positive citations. Obviously some are negative, but the spot-check suggests they're relatively rare. There is also no evidence that Ernst's viewpoint is "fringe"; this is merely a naked assertion. Obviously we have competing opinions here (Ernst and Haldeman); both expert opinions should be presented fairly and neutrally.
• The secondary source in question (Hurwitz et al., PMID 18204386) is by the same group that produced the "strong" primary source (Boyle et al. 2008, PMID 18204389). No reason has been presented to reach down into the primary source in order to obtain information that the research group in question did not think worth summarizing in its own review of its own research.
• Haldeman, like Ernst, has had serious criticism of his work. A quick web search finds Kapral & Bondy 2001 (PMID 11599330), which criticizes the paper of Haldeman et al. 2001 (PMID 11599329) for its risk analysis of "1:5.85 million cervical manipulations". Kapral & Bondy point out that malpractice claims data used by Haldeman et al. are inaccurate and that the risk of stroke remains unknown, despite the numbers Haldeman et al. report. I am sure there are other criticisms of Haldeman's work, but frankly, I would rather not head in this direction. Anybody whose goal is to dig up dirt about a particular researcher is sure to find something bad to say about their work. That has been done for Ernst, by chiropractic sources who have obvious motivations in going after a strong critic of the profession. It has not been done for Haldeman, because a similar motivation does not exist for going after Haldeman. Heavy criticism of Ernst does not necessarily mean that Haldeman is right and Ernst is wrong; it could just as plausibly mean that Ernst is stepping on people's toes and Haldeman is not.
• I'm not sure what the "red herring" comment refers to.
• Nor do I know what the charge of being "academically dishonest" refers to.
• The ACA's definition is quite relevant to this discussion. This discussion started with a long criticism of Ernst saying, among other things, "Why is Chiropractic using Edzard Ernsts definition of spinal manipulation which is incorrect characterization of healing art. This definition by Ernst is seriously flawed...." But Ernst was merely quoting the ACA. If this is the sort of criticisms Ernst gets, no wonder he has so many critics! Even if Ernst just repeats what the ACA says, a critic will say that Ernst incorrectly characterizes chiropractic. Perhaps some of the other criticisms of Ernst are also misguided?
• The safety-related conclusions of Hurwitz et al. have not been "pruned". They are presented in full in Chiropractic.
• Overriding a published expert review, based only on the naked opinion of a single Misplaced Pages editor of what constitutes "balance", violates the Misplaced Pages POV policy. It introduces bias to "balance" a review by reaching down into a primary study done by the very same group that produced the review. Such an action constitutes arguing with expert reviewers about their own work, and is well beyond what responsible Misplaced Pages editors should do.
• Ernst 2007 (PMID 17606755) cites 22 cases of severe adverse effects of chiropractic SMT with outcomes ranging from full recovery to paraplegia. I would support replacing "death" with "paraplegia" in Chiropractic.
• Chiropractic is not disagreeing with the task force on neck pain. It cites their review fully on the subject of safety.

Eubulides (talk) 23:16, 22 May 2008 (UTC)

• Actually there is, and your tired use of Google Scholar is not valid. Do you understand validity, Eubulides? Because I don't think you do. Google scholar (the instruement) does not assess quality of research. It provides hits. Ernst has been refuted for the last 7 years. His conclusions have been invalidated. His positions such as (SMT adds costs) goes against the majority of the literature describing SMT as cost effective. His conclusions go against the general consensus. His view is an extreme one, just like the World Chiropractic Alliance represents the other extreme. They're both fringe views. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)

• • The study by Boyle is independent of the task force hence it can and will be used. You are not going to get away with omitting evidence that demonstrates chiropractic care is a risk factor for stroke. It's not going to happen. It's too critical of an issue. Your edit on safety is a very, very poor one that cherry picks the evidence exclusively in your favour, that is, suggestive of chiropractic care causing strokes. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)

• This is patently untrue and you have missed the point (yet again) besides not producing a valid argument. The Haldeman article you are referring to is not being used here at chiropractic.((PMID 11599329). So, since you refuse to collaborate I propose we do not use the flawed review of Ernst. Haldeman has not had any 'serious criticism' of his work. That's why he led the International Neck Pain Task Force. He's a bigger player than Ernst. Ernst is a terribly biased researcher who, during the past 7 years, has been rebuked annually for his papers on SMT and chiropractic care. Heavy criticism has nothing to do with 'stepping on toes' it has to do with the quality of the research. Stop dodging the *&*&ing issue. It's about the research, Eubulides. Research, not designations. Ernst' studies here are pure crap and scientists have exposed the flaws in his research that you are pushing on us. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)
• Sigh, whatever.
• More confabulation. Taking the ACA definition and trying to spin it into misguidings of Ernst. When was that definition of the ACA produced, Eubulides and why is it superior to the definition provided by the World Health Organization?
• You not only pruned it, it was chopped in half. I have never met such an intellectually dishonest editor. You use "supportive" sources of chiropractic/SMT to bash chiropractic/SMT, just like you did with the CCA Neck Pain Guidelines. Then you claim "there are far more supportive sources in favour of chiropractic". You're gaming the system. A brief review: SmithBlue has said that your stance on MEDRS was faulty, DigitalC has said that you're misrepresenting views, Dematt has said you may have cherry picked the evidence, and I have told you all the above. What is your response to that, or will you again duck the question?

• • It's not overriding if the review isn't congruent with the subject at hand. POV is already violated because you have a) cherry picked sources b) have not attributed the view properly and have omitted relevant passages which supports the opposing view. You have misrepresent my view yet again. Pathetic. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)

• Chiropractic SMT? You mean, manipulation done by a chiropractor? Not likely. Ernst is a German. Look what his German buddies are doing here. They're killing people with improper neck manips and then attributing it to Chiropractic SMT. Think it's not plausible that Ernst is beefing up his stats with misattribution? Definitely a strong possibility. This is the kind of research you espouse? How can you be serious? Do you not critically appraise the studies which you cite?

• Chiropractic cites an executive summary and it does not cover the 5 main conclusions of the multidisplinary panel of experts, it lists 1. Ernst is a solo MD on a mission. You cannot compare the reputation of Dr. Haldeman to Ernst. One leads international task forces one writes severely biased and flawed reviews on SMT by himself. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)

• Google Scholar is not a perfect indicator of course, but it is better than nothing. It has provided evidence that Ernst is cited more often than Haldeman is, and that the top cites to his work are positive. No evidence has been presented to the contrary. Ernst's conclusions do go against mainstream consensus within chiropractic, but mainstream chiropractic is not the same thing as mainstream opinion overall.
• Boyle et al. 2008 (PMID 18204389) was not "independent of the task force". The task force review (Hurwitz et al. 2008, PMID 18204386) says that Boyle et al. was "original research conducted by the Neck Pain Task Force" and that Boyle et al.'s results "were included in the analysis of these intervention modalities".
• My point was merely that Haldeman's work has been criticized, which it has been. In science, serious criticism is a normal thing. It is not unusual. One can easily find more criticism of Haldeman, but I'm not going to bother. I don't want this to descend into an attempt to cast aspersions on the character of Haldeman; that is certainly not intended. It would be just as silly and counterproductive to do that as to cast aspersions on the character of Ernst.
• Ernst's work is high quality and is often cited, in a positive way, by serious researchers.
• The ACA's definition of manipulation was done in 2003. You can verify this by reading the cited document; it is freely readable. It's a high-quality definition; I don't see why anybody would characterize it as "incorrect characterization of healing art" or "seriously flawed". Certainly there are different definitions of SMT floating around, and the WHO's definition isn't a bad one, but it wouldn't be right to say that the definition in the WHO training/safety guideline is the definitive one.
• Nothing was "chopped in half". All the safety-relevant conclusions of Hurwitz et al. are in Chiropractic.
• I disagree with your characterization of the comments by SmithBlue et al. For example, SmithBlue and I pretty much agree on WP:MEDRS.
• The review in this particular case (Hurwitz et al.) is directly on topic.
• Yes, by "chiropractic SMT" I meant SMT done by a chiropractor. Ernst 2007 (PMID 17606755) cites 22 cases of severe adverse effects of chiropractic SMT.
• I think it implausible that Ernst engaged in scientific misconduct in his review. I don't see any evidence that he did.
• Chiropractic does not cite the task force executive summary.
• Ernst and Haldeman both have good reputations. Both of them write reliable sources on the subject, and both their opinions should be fairly summarized on Chiropractic.

Eubulides (talk) 09:03, 23 May 2008 (UTC)

• • • I don't believe anyone has presented any information demonstrating bias or flaws is Haldeman's research. However, many flaws and bias in Ernst have been demonstrated. My main contention with Ernst is his "A systematic review of systematic reviews of spinal manipulation" study. I don't think that this should be used at all in Chiropractic because it does not study chiropractic specifically but rather SMT in general. I really don't care how clearly we explain to the reader that the SMT studied by Ernst was not necessarily performed by chiropractors, merely including the conclusions from this study on Chiropractic leaves it open to reader confabulation. My other chief contention with Ernst is not only in how much we rely on him as a source, but the prominence his biased and flawed conclusions are given. -- Levine2112 18:16, 22 May 2008 (UTC)
      • See the discussion of Kapral & Bondy 2001 above for one criticism of Haldeman's work. I disagree that readers will be confused by text that clearly distinguishes SMT research from research on chiropractic care. Also, Ernst's latest critical review (PMID 18280103) is about chiropractic, not about SMT; surely there's no objection to citing that. Eubulides (talk) 23:16, 22 May 2008 (UTC)
        • • A disagreement by 2 MDs with the Haldemans method of determining the 1 in 1.85 million risk of dissecting stroke is not even close to the numerous rebuttals and outright bias of Ernst' reviews include a refutation of his methods in his reviews. This has never happened with any Haldeman research. This is why Haldeman was selected by the World Health Organization to lead the Bone and Joint Decade (2000-2010) Neck Pain Task Force. He's got lots of credibility amongst a multitude of disciplines. Ernsts credibility is in doubt and he does not enjoy broad mainstream support. That's where you've got it wrong. There is multidisciplinary consensus in Haldemans work, and none in Ernsts'. CorticoSpinal (talk) 05:50, 23 May 2008 (UTC)
            • It was just one example found by a quick web search. It was not intended to be an indictment of Haldeman, and I do not intend to go down the path of casting aspersions on researchers on one side of this issue or another. Again: in science, serious criticism is a normal thing. It is not unusual. The fact that Haldeman's work is sometimes criticized does not mean his work is unreliable or low quality. Similarly for Ernst. Eubulides (talk) 09:03, 23 May 2008 (UTC)

Expecting too much from scientists

Confabulation, I like that word :) Part of the problem is that we are expecting too much from our scientists. They can only say so much. They seem to pretty much agree that SMT is very well studied and is at least as good as any other standard medical treatment for neck pain and headaches and better than some for the treatment of low back pain. For Type O conditions, there is not enough information to draw any conclusions. We could throw in there that there is risk associated with using smt for the cervical spine, but then we would need to address that the other standard methods have risks as well. Ernst would fit in there somewhere for sure. -- Dēmatt (chat) 21:24, 22 May 2008 (UTC)

I disagree that scientists "pretty much agree" that SMT is "at least as good as any other standard medical treatment for neck pain and headaches and better than some for the treatment of low back pain. For example, the American College of Physicians only weakly recommends SMT as an alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail. Admittedly the ACoP is just one group, but it's an important one, and it disagrees with the contention that SMT is "better than" the ordinary treatments. Eubulides (talk) 23:16, 22 May 2008 (UTC)

Good point, that could go on forever. We should quote our best prochiro POV review (CS chooses) and then our best antichiro POV review (Eubilides chooses) in Chiropractic then link them to Scientific investigation of chiropractic where we can use the entire page to talk about any kind of research on anything we want.... It's an option? -- Dēmatt (chat) 01:02, 23 May 2008 (UTC)

It couldn't hurt to try. A few questions before: does a multi-disciplinary review carry more weight to due less bias than a review by a single profession (i.e. MD or DC?) CorticoSpinal (talk) 05:11, 23 May 2008 (UTC)

It would not be appropriate to break things out now into a subarticle, for reasons discussed in #Scientific investigation subarticle below. Eubulides (talk) 09:03, 23 May 2008 (UTC)

Hey, how do they handle things on the Surgery page? (I just thought of that while typing so I put a link in so I could click on it.) -- Dēmatt (chat) 21:37, 22 May 2008 (UTC)

They don't handle science on the surgery page... I do like the Medicine article, though. They don't handle the science part on the page either. No wonder. Why are we trying to handle science here? Why not on each type of treatment? I know we've discussed it before, and isn't that why we created the Scientific investigation of chiropractic article? -- Dēmatt (chat) 21:49, 22 May 2008 (UTC)

Medicine is a very broad topic. Perhaps a more confabuliciously specific professional article such as Internal medicine would be a more apt comparison to Chiropractic. That said, there are no science or effectiveness section there either. -- Levine2112 22:11, 22 May 2008 (UTC)

Maybe the reason we feellike we are swimming upstream is because we are trying to cram too much into this article. For instance, osteopaths, chiros, and PTs all use SMT - we can explain all the stuff about SMT over there. Only chiropractors use Spinal adjustments so we explain that over there. Here we just do a skeleton article that includes things like the history, scope and education with lots of links to the other articles... That is the way everyone else is doing it. I know we've discussed this before, but not with everyone here. Thoughts (again)-- Dēmatt (chat) 22:29, 22 May 2008 (UTC)

• We try to handle effectiveness and safety here, just as we do in Acupuncture and Traditional Chinese medicine and Homeopathy, because they are legitimate and core issues to the subject. I agree that it would make sense, if Chiropractic#Scientific investigation gets too long, to create a subarticle for it. I disagree that the material should be moved to Spinal manipulation though; most of the material in that section is about chiropractic care, not about SMT in general.Eubulides (talk) 23:16, 22 May 2008 (UTC)

• I haven't read the TCM article, but Acupuncture and Homeopathy are bad analogies, because they use 1 treatment modality.DigitalC (talk) 00:42, 23 May 2008 (UTC)

• No article is a perfect analogy, but these articles do have something important in common with Chiropractic, namely, they all involve treatments for which there are serious questions about efficacy or safety. Ayurveda is another example. Eubulides (talk) 09:03, 23 May 2008 (UTC)

• Are you saying Medicine is less risky and more efficacious? Or are you saying that it is just more mainstream? Anyway, maybe we should look at medical articles that are FA status? -- Dēmatt (chat) 13:53, 23 May 2008 (UTC)

Scientific investigation subarticle

• I disagree that the current section is so long that a subarticle is necessary. It's way shorter than Chiropractic#History, for example. And the current discussion is about the same length as it was back when the coverage of effectiveness was heavily biased in the pro-chiropractic direction. We should be careful not to give the impression that there is an interest in moving this material elsewhere merely because it's less supportive of chiropractic than it used to be.

Eubulides (talk) 23:16, 22 May 2008 (UTC)

• You seem to disagree with every regular editor here except QuackGuru. Perhaps you should re-evaluate your commitment to collaborating with others. Chiropractic is not TCM, it's not homeopathy. You even pushed for an article that suggests is "more of a medical specialization, like Dentistry. So, how can chiropractic be a medical specialization and fringe like you claim it is? Medicine, Optometry, Osteopathic Medicine, Physical Therapy, Dentistry and other professional articles do not have effectiveness, safety, science, cost-effectiveness, etc. For good reason too. You are pushing a CAM double standard used to discredit and marginalize CAM, which incidentally had more visits to their practioners than "mainstream" ones. So, who's mainstream again? Bottom line: stop disagreeing with everybody. Nobody but QG shares your views. SA and then anti-chiro skeptic alliance (ACSA) can randomly drop by here and bomb the article and try to railroad changes, but as Dematt had already mentioned falsifying consensus by uninvolved observers is not good editing. (I meant - to use outside editors to determine what version of an entire article was 'consensus' was not a good idea while it is being developed because it would be too hard to make necessary improvements ~Dematt).CorticoSpinal (talk) 00:36, 23 May 2008 (UTC)

Could we possible hold a discussion without people who disagree with you being part of an evil alliance of villainy, thanks. Comment on edits, not editors. If you have a problem with a users conduct, file a RfC. Jefffire (talk) 13:17, 23 May 2008 (UTC)

• I have not said that chiropractic is fringe. Chiropractic is a complicated beast: it has elements of primary care and elements of specialization; it has elements of science and elements of antiscience (or "fringe" or whatever you want to call it); and so forth. These elements should be covered. Chiropractic should not attempt to present a sanitized version of chiropractic as we wish it might be; it should present chiropractic as it is, warts and all. Eubulides (talk) 09:03, 23 May 2008 (UTC)

• I don't remember saying that? But I could be wrong? -- Dēmatt (chat) 01:17, 23 May 2008 (UTC)
• I am not concerned whether the article is too long, it's too boring. -- Dēmatt (chat) 01:17, 23 May 2008 (UTC)

"Too boring" that gave me a chuckle, Dematt.--—CynRN 06:31, 23 May 2008 (UTC) It's the talk pages that are really exciting!

I agree the article is too boring. More spice, please! Eubulides (talk) 09:03, 23 May 2008 (UTC)

Hehe, the spice is on the talk page! If we could just transfer that to the article space! :D -- Dēmatt (chat) 12:57, 23 May 2008 (UTC)

I am finding this talk page very hard to follow. However, I wanted to respond to Eubulides statement that "No reason has been presented to reach down into the primary source in order to obtain information that the research group in question did not think worth summarizing in its own review of its own research." The review does not cover the primary study does it? It is OR to decide why it was not covered in the review. If a review does not exist that covers the article in question, then it is totally acceptable to use the primary source.DigitalC (talk) 00:42, 23 May 2008 (UTC)

The review in question (Hurwitz et al. 2008, PMID 18204386) does cover the primary study in question (Boyle et al. 2008, PMID 18204389). Which is understandable, since the review and the primary study were both put out by the same task force. Eubulides (talk) 09:03, 23 May 2008 (UTC)

Hard to follow, indeed!I guess the skeptics are outnumbered!:)"there is an interest in moving this material elsewhere merely because it's less supportive of chiropractic than it used to be." That's how it comes across to me. My apologies if that is not what is going on. So certain medical articles don't have 'safety and effectiveness'? The Chiropractic article can be better than that by including it. I don't see why the effectiveness of SMT can't be summarized succinctly and be included here. Chiropractic researchers have been researching SMT. Chiropractors do about 90% of it(?), so if a PT study gets mixed in somewhere, does that invalidate all the reviews of studies of SMT? Some chiropractors have suggested that chiropractors should redefine themselves as "MSK pain specialists" because that is really what they are in practice. All the philosophy stuff confuses the public. Instead of attacking Eubulides, concrete suggestions should be made for the content of the article.

Actually DigC has made an interesting point... --—CynRN 00:53, 23 May 2008 (UTC)

Yes, DigitalC's point is a reasonable one, but it doesn't apply here, since the review in question covers the primary study in question. Eubulides (talk) 09:03, 23 May 2008 (UTC)

No apologies needed. I thought we were all skeptics :-) But really, hopefully we are all working toward turning the article that had GA (good article) status to FA (featured article). It won't be possible unless we all are able to pull together and create a NPOV and thorough succinct and interesting article. -- Dēmatt (chat) 01:17, 23 May 2008 (UTC)

For the record, I don't object to having the effectiveness material on this article, please see my support for Effectiveness 3C (although the addition of STT research would be good?), the only version that doesn't have a SYN violation by including SMT provided by non-chiropractors. I also support a similar section being written for the SMT article, without mention of other chiropractic interventions (Laser, IFC, US, Soft tissue, etc. etc.) - and then having a wikilink between the sections. Cyn is correct that Chiropractic researchers have been researching SMT. They may apply that to Chiropractic SMT, but *WE* are bound to follow WP policy such as WP:SYN, WP:OR, and WP:NPOV, policies which DON'T apply to researchers.DigitalC (talk) 01:54, 23 May 2008 (UTC)

my two cents. . . leave out non chiro specific research.TheDoctorIsIn (talk) 01:59, 23 May 2008 (UTC)

DigitalC, I'm not sure I am following what you are suggesting. Can you clarify? What is it that CYN thinks is a good idea? I can't follow this page either. -- Dēmatt (chat) 02:30, 23 May 2008 (UTC)

Is it Scientific Investigation 3C (with all the strike-outs) found above that should be a scaffold for current editing, DigC?--—CynRN 03:15, 23 May 2008 (UTC)

Effectiveness 3C has no SYN violations because it only uses sources that talk about chiropractic SMT, not SMT in general. I think that current attention should go towards 3C, to gather a consensus version for insertion. This would at least allow us to move forward in SOME direction.DigitalC (talk) 03:54, 23 May 2008 (UTC)

This approach could likely create the odd and untenable situation of producing two antithetical scenarios: (1) chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI), and (2) all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors. What the heck am I saying?! That's already the case, and has been for years! -- Fyslee / talk 04:44, 23 May 2008 (UTC)

I think Chiropractic SMT still includes SMT studies and reviews that are performed by nonchiros. I think he is just saying not to include studies that have others performing SMT, am I right Digital? -- Dēmatt (chat) 14:20, 23 May 2008 (UTC)

Correct. It isn't the source that matters, it is the data. If it is not explicitely stated that it is talking about Chiropractic SMT, it shouldn't be in this section (But SHOULD be in a section of effectiveness over at SMTDigitalC (talk) 04:59, 25 May 2008 (UTC)

The problem with this approach is that it disagrees with the opinion of expert chiropractic researchers, who have said that the distinction between SMT performed by chiropractors and non-chiropractors is not significant as far as effectiveness research goes; see Meeker & Haldeman 2002. I don't see a good reason here to override the opinions of experts in the field. Eubulides (talk) 07:34, 25 May 2008 (UTC)

It doesn't disagree with the opinion of those researchers at all. However, we are in a different realm than the researchers, we are in the realm of wikipedia, with its own policies. For example, from WP:SYN - "if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research". The sources on (generic) SMT effectiveness are NOT directly related to the subject of Chiropractic. However, they ARE directly related to the subject of Spinal Manipulation. Outside of WP, I would totally agree with you that the source of the SMT doesn't necessarily matter. DigitalC (talk) 09:44, 27 May 2008 (UTC)

I dunno about this Fyslee: "chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI)," These researchers are either MS or PhD holding DCs. They're there (nice!) to advance the science of manipulation and its applications (or lack thereof) in primarily musculoskeletal disorders and some select non MS disorders. Your description sounds like they'd fudge the research just to validate chiropractic SMT at any cost. That's not exactly AGF ;)

"all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors." This implies that chiropractic researchers do not care about identifying risk factors. Steering cleer of negative results is a bit rich, no? Anyways, I favour Dematts suggestion of a few sentences with general impressions on LBP, neck pain, headache for SMT. Extremity adjusting is technically not spinal manipulation anyways. I also want to include the research of SMT with respect to animal models in addition to the neurophysiological effects of spinal manipulation (recalibration of the gamma motor system, resting EMG tone, sensorimotor integration at the level of the cortex, the breaking of fibrous adhesions to to immobility (fixation/subluxation), the biomechanical consequences of subluxation(vertebral joint dysfunction), the reduction of inflammatory markers (TNF-alpha, IL 1-6) the mechanical reduction of inflammation in the IVF via spinal manipulation (mechanical movement of the inflammation), the call by Hawk for Whole System Research (WSR) in investigating the whole clinical encounter not just the application of manipulation; etc. Science section is lacking but we should include specific chiropractic spinal manipulation studies since they generally place greater value on manipulation and research it in a different, more specific manner. CorticoSpinal (talk) 05:33, 23 May 2008 (UTC)

"This approach could likely create the odd and untenable situation of producing two antithetical scenarios: (1) chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI), and (2) all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors.". I fully support the development of a "Effectiveness of SMT" section over at SMT as well (which then would not include other chiropractic interventions).DigitalC (talk) 05:41, 23 May 2008 (UTC)

I agree. I still think it is inappropriate to deal with the effectiveness of individual treatment methods here. It needs to be done....at their respective articles. The effectiveness of the clinical encounter can be mentioned here, since that has to do with how the profession relates to the patient encounter. -- Fyslee / talk 06:12, 23 May 2008 (UTC)

Agree. -- Dēmatt (chat) 13:06, 23 May 2008 (UTC)

Likewise. CorticoSpinal (talk) 17:08, 23 May 2008 (UTC)

(outdent)

• Most of Chiropractic#Scientific investigation is about chiropractic treament, not SMT in general (or any other particular treatment outside of chiropractic). It would be inappropriate to move this material to treatment articles, because the material is specific to chiropractic.
• I still find it curious that there's a desire to move effectiveness-related material elsewhere now. Why wasn't there a similar desire during the long period when the effectiveness-related coverage was all strongly pro-chiropractic?

Eubulides (talk) 09:03, 23 May 2008 (UTC)

1)It will still be appropriate in the Scientific investigation of chiropractic article, too. That article would be a lot bigger and be able to include your reviews and CS's 'primary' sources as well as NPOV discussions of all the reason's why somebody's research is better/worse/outdate/orwhateverotherexcusethatcanbeimagined without bagging this page down. This will be the 'portal of entry' for chiropractic. 2) I wasn't here? -- Dēmatt (chat) 12:51, 23 May 2008 (UTC)

As a clarification Dematt, I'm not advocating whatsoever that primary sources trump secondary sources. That's not right. However, when the secondary review is not congruent with the claim being made than primary studies can definitely fill the void. Also, I'd like to get some opinions on how Ernst' reviews are being used here (I last counted 8 separate references to Ernst in "safety" "effectiveness" and "cost effectiveness". This is problematic; his reviews are methodologically unsound and his conclusions go against the bulk of the literature but are being given equal weight. We need to solve Ernst first and foremost then we can tackle other things. We need to set priorities for the page otherwise we're spinning our wheels having 15 different discussions at once. I propose we deal with Ernst fist, then we can move onto Effectiveness of Chiropractic Care making a new draft that incorporates my suggestions with Eubulides draft that specifically deals with chiropractic care. Othewise there's confabuluation happening (gotta love that word). CorticoSpinal (talk) 17:08, 23 May 2008 (UTC)

This approach could likely create the odd and untenable situation of producing two antithetical scenarios: (1) chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI), and (2) all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors. This works both ways.. I'm sure that is what you meant :-) Or are you saying that PhDs, MDs, PTs, DOs have no COIs? Oh wait a minute! Can we say WILKS! (more shock and awesome sarcasm :-D ) -- Dēmatt (chat) 13:06, 23 May 2008 (UTC)

Since this comment is coming from a good friend, I'll accept it in the constructive criticism spirit in which it is intended. Yes Dematt, it's very true that all professions are subject to the natural human foibles and tendencies that make it easy to consciously or unconsciously slip into COI thinking, to ignore personal blindspots, and to cherish tendencies to avoid uncomfortable conclusions. Absolutely true. That applies to mainstream and other professions, my own included.

In this case I was being specific about SMT research, which has an interesting history. This history is interesting to follow because of the changing culture for scientific research in chiropractic. It is only a relatively short time ago that truly scientific research (without chiro philosophy dictating and dominating the research) began in chiropractic. Before that such research was totally untrustworthy. (What can be expected when DC students were told to cross out whole pages in their scientific textbooks of anatomy and other subjects because BJ deemed it untrue?) Now we have more and more chiropractic research that is more trustworthy, but usually because the ones doing it are DC/MD/PhDs, not only DC degreed. This is in contrast to mainstream professions which have much longer and well-established traditions for doing non-philosophy-dominated (there is no real philosophy that dominates modern medicine) scientific research. The specific case of SMT involves THE profession's core foundational treatment method and chiro research has been notoriously unreliable on this point (but that's changing) because the philosophy has dictated that the results must be positive. Call it blindspots, deliberate fudging, carelessness, ignorance of how to do truly objective scientific research, ignoring plenty of medical research on the same subject, or whatever, the COI of chiropractic on this point bears no comparison to research on the same subject performed by medical professionals without that COI. (Older chiropractic research doesn't deserve AGF.) Other medical professionals have been looking at this subject from many more angles than DC research and without the same blinders, and thus have been more open to admitting where the evidence might be weak, or where side effects should be openly discussed. Few chiro researchers (at least previously) literally "dared" to do that. They got attacked as traitors and could lose their jobs. This explains why little chiropractic research pays much attention to potentially serious side effects and why other researchers have actually tried to examine that question. The two groups of researchers approach the subject very differently, which was my point above. Ernst actually did concrete research and found a 100% rate of non-reporting, which makes all talk of actual percentages for risks of cervical manipulation nonsensical. No chiropractic researchers have done that. They have used methods that could easily be distorted because they made extrapolations from incomplete data, while Ernst went directly to the source, asked, and got concrete results from a whole nation. The results were shocking to all, and many chiropractic leaders have been in denial since then. Yes, mainstream professionals could be in danger of doing the same thing in specific areas where they might have a COI, but this isn't one of them. -- Fyslee / talk 23:47, 24 May 2008 (UTC)

I really meant it with a twist of humor rather than criticism, but you're right, it is hard to write in such a way that get's the emotion just right :-), but rest assured, regardless of your skewed politics (I'm pickin'), I do consider you a friend. Your point about 'reporting adverse events' is well taken on these ears and I do respect that this was an important issue. If you remember our 2006 version of this issue, it ended with this statement: 'that any attempt to determine percentages of risk were nonsensical...", because that was the new and important feature of Ernst's research. Well, since that time, the neck task force has taken another important step by trying to determine if he might be right, "that the numbers might actually be higher" and I don't have to tell anyone here what they determined by comparing patients from other primary care doctors and those from chiropractors and determined that the numbers were identical. Their research did not support Ernst's assertion. This does not mean he is wrong, only that he is not supported with this form of evaluation. This should not be a problem to repeat this type test, and there will be more types of evaluation in the future that will either support or negate these findings. If there are enough of these from different sources, this hypothesis will be formally debunked. If not, it will become part of mainstream thought. Now, you can choose not to 'believe' the task force because you 'believe' there is a conflict of interest, but then you would be committing the same fallacious thinking that you attribute to chiropractors, a type of appeal to your authority. All I am asking is that you give 'your' sources the same skeptical assessment that you give 'mine'. I am betting that if you did, you would realize that we were all rational, reliable, and good intentioned people. The problem is not us, but that science has not yet provided us with the knowledge that we all seek. -- Dēmatt (chat) 04:26, 25 May 2008 (UTC)

I agree that the task force work did not support Ernst's assertion. Nor did it argue against Ernst's assertion; it could be, for example, that the risks are so rare that they were not picked up by the techniques used by the task force. There is some (although very small) risk, since we do have a few cases where chiropractic SMT caused severe adverse effects. With that in mind, Chiropractic should mention both the task force work (which it does) and Ernst's assertion (which it does). Eubulides (talk) 07:34, 25 May 2008 (UTC)

Why should the Task Forces report and Ernst' study be given the same weight? CorticoSpinal (talk) 23:53, 26 May 2008 (UTC)

The Task Force report represents the chiropractic mainstream (although the task force has some MD members, it is dominated by chiropractors). Ernst represents critics of chiropractic, which includes much of the medical mainstream, a far bigger group of people than chiropractors. Both sides make good points, and both should be fairly represented. Eubulides (talk) 08:08, 27 May 2008 (UTC)

This is a flawed argument. The Task Force represents the scientific/medical mainstream. It is not a chiropractic document. It is a research document. Done by a multidisciplinary panel of health care scientists reaching a consensus on topics such as efficacy, effectiveness, validity, safety. So, why should Ernsts, one man, severely biased, methodologically flawed' paper a) being presented as majority mainstream opinion and b) should be given the same weight to the World Health Organization Task Force? (which is the far superior document in both depth, breadth, scientific consensus and notable involvement of universities and governments from all over the world). I do expect a reply, Eubulides, so I'll give you advance notice not to use WP:IDIDNTHEARTHAT like you've done so in the past when I've asked you this question in the past. Thanks. CorticoSpinal (talk) 04:48, 28 May 2008 (UTC)

The Task Force is led by a chiropractor and is dominated by chiropractors. It does have MD members but it represents mainstream chiropractic opinion, which is not the same thing as the scientific/medical mainstream. Ernst is just one critic, true, but is a suitable representative for many in science and medicine, some who hold stronger anti-chiropractic opinions than he does. Eubulides (talk) 09:05, 28 May 2008 (UTC)

The Task Force is a World Health Organization sponsored organization of expert scientists (we are talking about research, not professional affilitations, Eubulides, please stop mixing the 2 together). It does not represent mainstream 'chiropractic' opinion. It simply represents the findings of the expert scientists. So, it's a scientific document produce by mainstream scientists. The fact that chiropractors are included in this proves its mainstream; the fact that the lead editor is a neurologist and a chiropractor proves this even moreso. Also, where in the cited source does it say it represents mainstream chiropractic opinion? I didn't think so. Are you disputing the notability of the Task Force report? Your source is disputed. It's been invalidated and this his been verified and proven. Go find another one, according to you they're easy to find. CorticoSpinal (talk) 06:47, 29 May 2008 (UTC)

The task force is not directly sponsored by the WHO. It is a bit amusing to see it continually being cited here as a "World Health Organization sponsored organization". It would be more accurate to describe it as a "World Federation of Chiropractic sponsored organization" (the WFC, unlike the WHO, is a direct sponsor). The task force is dominated by chiropractors. It produces scientific documents reflecting mainstream chiropractic opinion. I am not disputing the notability or reliability of the task force reports within the context of mainstream chiropractic, but I am disputing that it definitively represents mainstream medical and scientific opinion. It does not. Eubulides (talk) 08:47, 29 May 2008 (UTC)

So you are suggesting the WHO is not involved in the BJD Neck Pain Task Force? So, to review: you do not dispute the source, and you acknowledge that it is not fringe? I need a bit of clarification on your stance on that. Next, you dispute the claim that the document represents mainstream scientific opinion? Yes/No? Finally, you claim the BJD Task Force is "dominated by chiropractors" is this correct? I don't want to misrepresent your argument so I'll allow you to clarify before proceeding with a possible rebuttal. Cheers. CorticoSpinal (talk) 15:42, 29 May 2008 (UTC)

I'm sure there is some sort of connection between the WHO and the task force, yes; it's a small world, after all, and undoubtedly some of the people in that large task force have something to do with the WHO at some point. I haven't seen any evidence, though, that it's a WHO-sponsored organization. I do not think that the task force is "fringe". But that does not mean that it is "mainstream" either. It is mainstream chiropractic, I'd say; undoubtedly many straights would disagree with it, but straights are in the minority within chiropractic. It does not represent the definitive mainstream scientific opinion, no. The task force is dominated by chiropractors, yes; this dominance is far out of proportion to their relatively minor influence in mainstream medicine and science. Eubulides (talk) 16:56, 29 May 2008 (UTC)

"I really don't care how clearly we explain to the reader that the SMT studied by Ernst was not necessarily performed by chiropractors, merely including the conclusions from this study on Chiropractic leaves it open to reader confabulation." I think this word should be "conflation". Confabulation: "A fantasy that has unconsciously emerged as a factual account in memory, based partly on fact or complete construction of the imagination" Conflation: Treating two distinct concepts as if they were one, i.e. (some would say) SMT and chiropractic treatment. --—CynRN 19:03, 24 May 2008 (UTC)

I will prove that, as currently being used, Ernst's opinions (fringe) are used to undermine and subvert the mainstream consensus. The placement of Ernst' text within Safety, Efficacy, Cost Effectiveness is done is a manner that is inconsistent with the general consensus. It's being used to open and close paragraphs instead of representing the dissenting opinion on a topic where the majority of the research favours the opposite stance. Not to mention that the reviews by Ernsts are severely flawed from a methodological perspective. So now we're citing flawed, biased research and passing it off as 'mainstream' when it clearly goes against mainstream. Its a violation of WP:OR in that the evidence has been cherry picked to present a different conclusion than is generally agreed upon. Tertiary sources prove this as well. CorticoSpinal (talk) 23:53, 26 May 2008 (UTC)

Mainstream chiropractic opinion clearly opposes Ernst, but that is not at all the same thing as saying that mainstream scientific or medical opinion opposes Ernst. Ernst's work is approvingly cited by a wide variety of non-chiropractic sources. It is not "fringe" work by any reasonable non-chiropractic standard. Eubulides (talk) 08:08, 27 May 2008 (UTC)

Yes, it should be clearly explained to readers that while 95% does apply to chiropractors, certain DC editors wish to make sure everyone knows that 5% might not apply to them, so therefore (because maybe 5% weren't DCs) the whole thing can't be used here, even in the cases where the ones conducting the study were chiropractors who were studying the effects of SMT (the irony of it all ;-) -- Fyslee / talk 23:14, 24 May 2008 (UTC)

Integration: Sources

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2384186 - CorticoSpinal 16:47, May 21, 2008

Independent Studies of Chiropractic

Most commentaries regarding chiropractic (pro and con) come from sources with a distinct bias, and therefore their interpretations of existing data tend to conform to their preexisting opinions. That would be the case with this article, and with the article published with this one by Homola. The most objective evaluations of chiropractic would be expected to come from independent sources if they have no vested interests, but rather simply have a need to know. There have been two such major studies done by the governments of two nations seeking to determine whether it would be in the best interests of their citizens to include chiropractic in their systems of socialized health care.6,28

The first one was done in New Zealand more than 25 years ago.6 After a lengthy, exhaustive inquiry, a comprehensive 377-page report was compiled that listed many findings including the following quotes that were taken from the Summary of Principle Findings: 1. Spinal manual therapy in the hands of a registered chiropractor is safe. 2. The education and training of a registered chiropractor are sufficient to enable him to determine whether there are contra-indications to spinal manual therapy in a particular case, and whether the patient should have medical care instead of or as well as chiropractic care. 3. Spinal manual therapy can be effective in relieving musculoskeletal symptoms such as back pain, and other symptoms known to respond to such therapy, such as migraine. 4. Chiropractors should, in the public interest, be accepted as partners in the general health care system. No other health professional is as well qualified by his general training to carry out a diagnosis for spinal mechanical dysfunction or to perform spinal manual therapy.

The other independent study was done by the government of Ontario for which a group of health economists was commissioned to study chiropractic management of low back pain (LBP).28 The following quotes were taken from the Executive Summary of their findings: 1. On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP. Many medical therapies are of questionable validity or are clearly inadequate. 2. There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low-back pain. 3. There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management. We reviewed numerous studies that range from very persuasive to convincing in support of this conclusion. The lack of any convincing argument or evidence to the contrary must be noted and is significant to us in forming our conclusions and recommendations. The evidence includes studies showing lower chiropractic costs for the same diagnosis and episodic need for care. 4. There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management. Patient satisfaction is an important health outcome indicator and adds further weight to the clinical and health economic results favoring chiropractic management of LBP. 5. Despite official medical disapproval and economic disincentive to patients (higher private out-of-pocket cost), the use of chiropractic has grown steadily over the years. Chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians. CorticoSpinal 21:53, May 22, 2008

Yes, the NZ report is rebutted by the US government! (Reply to edit summary)

• New Zealand report not "trustworthy"
• A review of the New Zealand report prepared by the United States Congress' Office of Technology Assessment found "'serious problems' in the Report's treatment of safety and efficacy issues..... It concluded .... that the New Zealand Report's review of the safety issue was 'unsatisfactory.'...In light of this thorough and well-considered appraisal of the New Zealand Report, with which I agree, I do not find the Report's conclusions trustworthy. The request for admission for the purposes of showing the truth of the matter asserted is therefore denied."

The judge in the Wilks case wasn't happy with the NZ Report. -- Fyslee / talk 05:19, 23 May 2008 (UTC)

• The rebuttal is fair game too, of course. We can either include both or neither. To your knowledge has any government rebutted Manga besides Tardif? CorticoSpinal (talk) 05:37, 23 May 2008 (UTC)

Several independent studies have been done in Europe, as part of national practice guidelines for low back pain. Five of them are reviewed in Murphy et al. 2006 (PMID 16949948). We should be using reliable reviews like this rather than doing the research ourselves. The Manga report is so dated now that we shouldn't be citing it anywhere outside the History section. Eubulides (talk) 09:03, 23 May 2008 (UTC)

I wasn't suggesting we add the text per se; that exerpt is taken from DeVocht, 2006. I was wondering more if anyone found anything useful for any section from that exerpt. If not, we can junk it. Manga could easily fit into cost-effectiveness/effectiveness as well as it was a landmark study. We just need to attribute it to 1994. CorticoSpinal (talk) 16:40, 23 May 2008 (UTC)

The obsolete Manga report has only historical impact and is already mentioned in the history section. See the movement towards science section. We should not add the Manga report to argue with newer references in the cost-benefit section. See WP:MEDRS. QuackGuru 17:10, 23 May 2008 (UTC)

I don't understand why the Manga report is considered obselete when it is still being cited by scientific papers (and yet we can't cite it). , , , , , , , , ALL cited Manga between 2000 and 2006.DigitalC (talk) 00:58, 25 May 2008 (UTC)

• The first citation you mention (Bronfort et al. 2004) criticises the Manga report, saying its "conclusion is almost exclusively based on analysis of retrospective and nonrandomized studies, which do not allow conclusions about clinical effectiveness."
• The 3rd citation is a URL that does not work for me.
• The 6th citation (Dagenais & Haldeman 2002, doi:10.1016/S0095-4543(01)00005-7) says of Manga and similar reports: "A detailed analysis of this literature by Baldwin et al., however, has revealed many methodologic flaws in this literature and concludes that these studies fail to clarify whether medical or chiropractic care is more cost-effective."
• The 7th citation (Oakley et al. 2005, PMID 17549209) primarily refers to politics, not to effectiveness. It says "Since 1975, the chiropractic profession has enjoyed improved political support in a number of countries due to some published analyses favorable to chiropractic care." and cites Manga among 4 other studies.
• The other citations are all primary studies, not reviews of Manga et al.

Given all the above, it appears that the scientific reviews of the Manga report were unfavorable, and that we should not be relying on its results in the scientific investigation section. It would be reasonable to talk about Manga with respect to the historical politics of chiropractic, though, so coverage in Chiropractic #History would be reasonable (although it should be noted even there that the Manga report does not represent scientific consensus). Eubulides (talk) 07:34, 25 May 2008 (UTC)

The original Manga report is obsolete when newer references discuss the Manga report. We are currently using newer references that describe the Manga report in historical terms in the movement towards science section. QuackGuru 02:28, 25 May 2008 (UTC)

DigitalC makes a good point, but I tend to like to include everything, pro and con. I really feel that if we do, we are more likely to reach a stable GA article status, because every chiro that reads this article is going to ask the same question. -- Dēmatt (chat) 06:28, 25 May 2008 (UTC)

Perhaps chiros would be satisfied if we include some of the citations above, explaining why the Manga report's results have been so questioned? Eubulides (talk) 07:34, 25 May 2008 (UTC)

Manga is flawed and biased. Dr. Manga was a 'satisfied chiropractic patient'. He used ancient studies as old as from 1930. They were not RCTs. He discounted large studies with results he didn't like in favor of small ones with favorable results. Eubulides provided links to critiques of Manga a few thousand words ago.--—CynRN 03:17, 28 May 2008 (UTC)

POV issues as of 2008-05-25

Here is a list of POV problem areas that I see with Chiropractic as it stands now. Fixing these problems would suffice to remove the articles POV tag. This list is updated from Talk:Chiropractic/Archive 19 #POV issues as of 2008-05-03, and reflects changes made to the article since 2008-05-03 as well as discussion since then and some other POV problems I noticed recently. Comments welcome; please make them in #Comments on 2008-05-25 issues list below. I would like to strike out items as they are addressed. Thanks. Eubulides (talk) 07:34, 25 May 2008 (UTC)

2008-05-25 issues list

1. Chiropractic #Medical opposition describes the feud between conventional medicine and chiropractors in a heavily biased way. For example, chiropractors are described by a lengthy quote as having "progressive minds" whereas conventional doctors are said to "have failed to realize exactly what is meant by disease processes". Both sides (traditional medical and chiropractic) have attacked and have victories and losses, but the current discussion focuses almost exclusively on attacks by the medical profession, on chiropractic victories, and on areas where chiropractic is said to be superior to conventional medicine. The dispute should be covered neutrally.
2. Several places, including the lead, characterize chiropractic as complementary and alternative medicine. This characterization is controversial and alternative views should be given. See, for example, Redwood et al. 2008 (PMID 18435599), in which 69% of surveyed DC faculty disagreed with the proposition that chiropractic is CAM.
3. Chiropractic #Safety is backed by reliable reviews, except for its concluding sentence "The benefits of chiropractic care for neck pain seems to outweigh the potential risks.", which is backed only by a primary source. The primary source in question is too new to have been reviewed, but the text should highlight that it's a single primary study, e.g., "A 2007 Dutch study found that the the benefits of chiropractic care for neck pain seem to outweigh the potential risks." But there's another problem: this sentence seemingly contradicts the following statement in Chiropractic #Cost-benefit: "When compared with treatment options such as physiotherapeutic exercise (also performed by a chiropractor), the risk-benefit balance does not favor SMT." These two sentences should be placed next to each other (I suggest in Chiropractic #Cost-benefit) and the wording clarified to make this issue clearer. As things stand the reader of Chiropractic #Safety might reasonably conclude that there's no contoversy whether benefits outweigh risks here. (This example illustrates some of the dangers of our mentioning primary studies ourselves.)

Eubulides (talk) 07:34, 25 May 2008 (UTC)

Which editor here removed and censored my edit adding to the list of POV issues]. I propose an immediate block for the editor who has done so, this is completely ridiculous now the downright disruptiveness and dirty tactics used by the anti-chiropractic editors. Again, why were my additions to the POV list deleted without any consent, discussion, explanation. Is this normal editing practices? I mean, can the anti-chiropractic brigade really get away with absolutely everything including deleting talk page comments of other editors? CorticoSpinal (talk) 05:00, 28 May 2008 (UTC)

Nothing was removed or censored. The problem was that your edit moved my signature into a single bullet item, and put your signature at the bottom of the entire list of items; this caused the resulting talk page section to look like you wrote the whole list of items (and that I contributed just one of the items). The usual etiquette in Misplaced Pages talk pages is to avoid inserting commentary in such a way that the authorship of others' comments becomes unclear. I naturally assumed you did not intend to create any such confusion, so in my next comment I repaired my signature to the way that it looked before, and moved your added commentary into a section of its own; this approach avoided the confusion in question. I suggest that you add comments after other people's comments (where signatures are part of the comments, of course); that will avoid similar confusion in the future. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Comments on 2008-05-25 issues list

I made this change to help organize things. QuackGuru 08:28, 25 May 2008 (UTC)

I agree with the first and the last POV-issues. The middle issue is a bit more confusing. Just because 69% of DC disagree doesn't mean that the categorization of Chiropractic as CAM is controversial. We are under the obligation to describe things as verifiably, neutrally, and reliably as possible. Most health insurance companies consider chiropractic to be CAM. Most mainstream doctors consider chiropractic to be CAM. I'm pretty sure it's fairly straightforward to find sources for these facts. If most reliable, verifiable sources view chiropractic this way, then Misplaced Pages should not shy from using the designation. After all, Misplaced Pages is not the place to right great wrongs. ScienceApologist (talk) 15:42, 25 May 2008 (UTC)

I think we can mention it the utilization and satisfaction rates section about CAM versus integrated medicine chiropractic beliefs. Perhaps this would resolve this issue. QuackGuru 17:47, 25 May 2008 (UTC)

An IP made controversial changes in mainspace again. I recommend it be reverted. QuackGuru 17:47, 25 May 2008 (UTC)

I made this change to describe the CAM versus integrated medicine beliefs. QuackGuru 18:40, 25 May 2008 (UTC)

I made this change to focus the conversation on medical opposition. QuackGuru 19:19, 25 May 2008 (UTC)

With regards to Eubulides' issue number 3 above, I agree with noting it as a study and not a review, however, it makes far greater sense to include this information in the "Safety" section as this is a about "Risk vs. Benefit" and has nothing to do with "Cost". -- Levine2112 19:13, 25 May 2008 (UTC)

The "Risk vs. Benefit" and has has to to do with "Cost-Benefit." The section is about costs as well as benefits. QuackGuru 19:19, 25 May 2008 (UTC)

Not sure what the poorly worded response above means, but I think I understand the gist. My question is: What does this study have to do with "Cost"? The answer: Nothing. The Cost-Benefit section is about weighing the financial cost of chiropractic care versus benefit. Whereas the "Safety" section is about safety (aka Risk) and presumably should weigh "Risk vs. Benefit"; hence the study is clearly more properly apropos under "Safety" than "Cost-Benefit". -- Levine2112 19:26, 25 May 2008 (UTC)

We do not have a section called "Cost" or "Risk." The section is titled Cost-benefit. That said, the section is about the cost-effectiveness as well as the risk-benefit. QuackGuru 19:39, 25 May 2008 (UTC)

I think we all would agree that "Risk" is more akin to "Safety" than it is to "Cost". Does anyone disagree? -- Levine2112 21:33, 25 May 2008 (UTC)

I think we do not have a section called "Cost". The cost-benefit section is also about risk-benefit. QuackGuru 03:04, 26 May 2008 (UTC)

No, the cost-benefit section is about cost-benefit, not risk-benefit. The cost-benefit section should be about cost-effectiveness, and the respective text should be in the risk section.DigitalC (talk) 07:12, 26 May 2008 (UTC)

The cost-benefit section covers two topics. Cost-effectiveness as well as risk-benefit (Cost-benefit). QuackGuru 07:24, 26 May 2008 (UTC)

If editors want I could add a small blurp about risk-benefit to the Safety section but we should do this using a higher quality source per WP:MEDRS. I will review all the refs and do my best to address the concerns. QuackGuru 08:35, 26 May 2008 (UTC)

• We could add a brief Risk-benefit section.
• The primary study in question (Rubinstein et al. 2007, PMID 17693331) is a dubious source for the claim that "the benefits of chiropractic care for neck pain seem to outweigh the potential risks". First, the study had no control group, so it did not measure either the benefits or the adverse effects of chiropractic care alone; instead, it was measuring the combination of chiropractic care and natural history. For all we can tell from that study, it could be that chiropractic care has negative benefits (compared to no treatment) and positive risks (again, compared to no treatment). Second, the study had no benefits-risk model, that is, it did not even attempt to quantify the value of the benefits versus the value of the risks; and therefore its data cannot be used to support any claim that benefits "outweigh" risks. The simplest way to fix this problem is to remove the unwarranted claim that the benefits outweigh the risks. (And this illustrates the problems I see with citing primary sources in the absence of reliable reviews.) Eubulides (talk) 08:08, 27 May 2008 (UTC)

This is again flawed logic. You are violating WP:OR as you are making your personal opinion override the stated claim. Remember not to argue with experts? You said that. You should stick to it too. Unless there is a rebuttal in the literature somewhere then your personal interpretation is not valid for disqualifying the study. Thanks. CorticoSpinal (talk) 05:06, 28 May 2008 (UTC)

It is not flawed logic to look at a primary study carefully. After all, primary studies about chiropractic are a dime a dozen, and one can easily find a primary study giving just the opposite impression to this one about risks and benefits. This particular primary study, like many primary studies about chiropractic, is of low quality, because it has no controls and it does not have any measures of the weights of risks versus benefits. For that reason we should be extremely careful about mentioning it in Chiropractic, if we mention it at all; the current mention is obviously not careful enough. Eubulides (talk) 09:05, 28 May 2008 (UTC)

I thought you held the belief that we should not be questioning the researchers? Regardless, this is about placement, and I have not seen a good argument about keeping the statement in the entirely unrelated "Cost-Benefit" section. Certainly we can all agree that "Risk-Benefit" is more akin to "Safety" than to "Cost-Benefit". -- Levine2112 17:38, 27 May 2008 (UTC)

My comments were not about the researchers; they were about the study in question. It is not clear that risk-benefit is closer to safety than to cost-benefit. Chiropractic #Safety does not talk about benefits at all (by design), whereas Chiropractic #Cost-benefit does compare downsides to benefits. It could be that the match to "compares downsides to benefits" is closer than the match between risk and safety. At any rate, putting this stuff in a new Risk-benefit section would address the issue. Eubulides (talk) 20:52, 27 May 2008 (UTC)

This controversial change added an old reference when newer references are available. In fact, the previous sentence has a 2008 ref covering the same topic. Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist. 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.{{cite journal}}: CS1 maint: multiple names: authors list (link) Per WP:MEDRS, the dated 2003 ref should be deleted. QuackGuru 03:33, 26 May 2008 (UTC)

I reverted that good-faith change, as I agree with you that the previous sentence uses a much newer reference covering the same topic.DigitalC (talk) 07:18, 26 May 2008 (UTC)

I agree with the removal of the dated material.. QuackGuru 07:24, 26 May 2008 (UTC)

I started new sections below to help focus the discussion. QuackGuru 22:22, 26 May 2008 (UTC)

Chiropractic#Safety

Editors have expressed some interest in adding a tidbit about risk-benefit to the Safety section. At the moment, I am reviewing all the references in the Safety section. QuackGuru 22:22, 26 May 2008 (UTC)

Croft AC, D'Antoni AV (2008). "Chiropractic manipulation: reasons for concern?". Clin Neurol Neurosurg. 110 (4): 422–3. doi:10.1016/j.clineuro.2007.12.014. PMID 18242824. Has anyone read this 2008 study? Maybe we can use it. QuackGuru 03:05, 27 May 2008 (UTC)

I've read it. It's not a study; it's just a letter to the editor. I don't think it's directly useful for Chiropractic, though some of its citations may be useful. It comments on Gouveia et al. 2007 (PMID 17904731), a primary study which is too new to be the subject of any of our reviews. (I would not favor citing that primary study, unless we start adding other primary studies to the scientific-investigation section, which is something I would not favor either, as we have plenty of reliable reviews). Eubulides (talk) 08:08, 27 May 2008 (UTC)

Chiropractic#Medical opposition

http://en.citizendium.org/Chiropractic http://en.citizendium.org/Critical_views_of_chiropractic

Here are related wiki articles that may help give us some ideas on improving the Medical opposition section of this article. Thoughts? QuackGuru 22:22, 26 May 2008 (UTC)

Other POV issues

1. Innacurately cherry picks the evidence, does not discuss relative risk compared to NSAIDs, surgery or other treatments used for mechanical spinal disorders and strikes a fear mongering tone by not addressing the benefits and effectiveness (clinical and cost)
2. The research and POV of Edzard Ernst has been used in a civil POV push. Ernst'research and conclusions on SMT and chiropractic care, which have been rebuked by his colleagues and other mainstream health professinals, and go against majority consensus in the literature. It's being used to subvert the efficacy, cost-effectiveness and safety of chiropractic care. A misleading argument that "Ernst is not being presented enough" is also being promoted which completely exacerbates the problem.
3. Chiropractic #Efficacy is a synthesis and mixture of SMT and chiropractic care. Chiropractic specific references should be used as already agreed upon by the majority of editors. Ernst is again being used to subvert mainstream opinion (chiropractic care is just as if not more effective, safe and cost-effectiveness for LBP and that patients overwhelmingly prefer chiropractic management for LBP in comparison to standard medical care. This is the most succint way to put it. An editor here has used Ernst to undermine the mainstream consensus and has cherry picked reviews (which is in violation of WP:OR to warp the mainstream scientific and independent 3rd party consensus.
4. Research is not at all specific to chiropractic care, and ignores every major research milestone in the history of the profession.
5. Chiropractic #History seems to want to discredit Palmer from the start, focus all on subluxations and does not make any account to anything other than controversy.

CorticoSpinal (talk) 06:29, 27 May 2008 (UTC)

• It would be helpful to discuss relative risk, if we can find reliable sources on that topic, preferably reliable reviews. We can't discuss the topic without reliable sources.
• Ernst goes against consensus in the chiropractic mainstream, but that's not the same thing as going against mainstream consensus overall. Ernst represents an important part of the medical mainstream. These critical views of chiropractic should be covered fairly and neutrally.
• Chiropractic#Effectiveness relies heavily on reliable reviews published in referred scientific journals. These reviews do synthesize work on chiropractic care and SMT, but that is standard practice in evidence-based reviews of chiropractic these days, and it is not synthesis for Chiropractic to report what the experts are saying.
• The first two sentences of Chiropractic #History are complimentary to Palmer.
• I agree that much of Chiropractic#Vertebral subluxation is misplaced. It does not belong in Chiropractic #History. Most of that section (and all of the long paragraph at the end) has nothing to with history. I suggest moving this subsection to Chiropractic #Philosophy, where it fits much better.
• Chiropractic #History does not overly emphasize controversy. On the contrary: if anything it currently plays the controversy down, and this makes it boring compared to what it could be. Compare Chiropractic history, which devotes a higher percentage of its content to controveries. Chiropractic history has been dominated by controversy.

Eubulides (talk) 08:08, 27 May 2008 (UTC)

A qucik note on #4 on the list above:

• "The benefits of chiropractic care for neck pain seems to outweigh the potential risks.", which is backed only by a primary source. The primary source in question is too new to have been reviewed, but the text should highlight that it's a single primary study, e.g., "A 2007 Dutch study found that the the benefits of chiropractic care for neck pain seem to outweigh the potential risks." But there's another problem: this sentence seemingly contradicts the following statement in Chiropractic #Cost-benefit: "When compared with treatment options such as physiotherapeutic exercise (also performed by a chiropractor), the risk-benefit balance does not favor SMT."

I see no problem; the first sentence says "chiropractic care". The second sentence says "SMT" and even modifies it to be "performed by a chiropractor". This suggests (accurately) that, while chiropractic care sometimes includes SMT, SMT <> chiropractic care. I have no trouble with attributing the source, but the same holds true for the gander.

I am also concerned that while eradicating statments that appeared POV to some, we are left with other unbalanced POV statments. As chiropractic is a complicated POV subject, we will not likely get one NPOV statement. The only solution will be to balance the POV statements. IOWs, criteria for removal of the POV tag for Eubilides may mean return of the tag for CorticoSpinal. The only solution will be to allow each their due balanced in a fair and neutral way. -- Dēmatt (chat) 15:24, 27 May 2008 (UTC)

I assume by "#4 on the list above" you mean #3 in #2008-05-25 issues list? I agree about the distinction between chiropractic care and SMT. However, it's still a problem that the two sentences were planted in different sections with no care taken to clarify the confusion. By the way, I see further problems with that particular primary source, which I don't have time to go into now (I haven't yet had time to read the source carefully, and I indeed that no editor here has actually read the source), but intend to do so later. This is another problem with citing primary sources: it's really much better to rely on reviews! Eubulides (talk) 16:59, 27 May 2008 (UTC)

Wording in lead

This wording doesn't make sense: "Chiropractic's greatest contribution to health care may be its patient-physician relationship which is done by hand" How can a relationship be done by hand? Change to '...patient-physician relationship and hands-on treatment.'--—CynRN 16:19, 26 May 2008 (UTC)

I made this change to improve the sentence. QuackGuru 16:33, 26 May 2008 (UTC)

Much better, thanks.--—CynRN 16:40, 26 May 2008 (UTC)

By the way: I was asked to comment on what's going on at this page and have put some comments here: (diff) (talk) (archive). When participating at this page, I don't expect to express my personal views (if any) about chiropractic but will strive to edit according to NPOV based on the sources, even if that sometimes means putting in material I disagree with or removing material I agree with. I've been participating in discussion at User talk:Raul654/Civil POV pushing and have previously participated at pages I arrived at via Mediation Cabal, and a large part of my purpose in participating here is to try to help resolve disputes. (I hope this post is not taking up too much space with meta-discussion.) ☺ Coppertwig (talk) 01:53, 27 May 2008 (UTC)

Coppertwig, I value very much your contributions here at Chiropractic and felt that your previous participation here led to major improvements in the article. I'm looking forward to working with you again here. My biggest concern with the article, at the moment is the civil POV of Edzard Ernst and how his flawed and biased reviews are being used 'neutrally' to subvert the mainstream consensus on critical topics such as effectiveness, safety, cost-effectiveness and scientific research. What is occuring here is misuse of research to advance a fringe viewpoint upon the majority. The difference is, Edzard Ernst, who is being presented as the mainstream viewpoint research goes againt the vast majority of research over the last 25 years. This is despite the fact thatthe Ernst secondary sources have been refuted and invalidated, with severe methodological flaws and heavy bias Then, at a clear gaming of the system, uses WP:MEDRS as a defense to prevent the inclusion of primary studies that are more academically robust, come from multidisciplinary colloboration (hence consensus and no particular bias) under the wikilawyering guise of "reaching down". I propose we investigate the use or rather misuse of Edzard Ernst here at chiropractic in a civil POV push. I believe this at the core of the last 4 months of dysfunction. CorticoSpinal (talk) 03:37, 27 May 2008 (UTC)

The consensus on Misplaced Pages is that Ernst is WP:NPOV and WP:RS despite the reservations. For example, see the homeopathy article. QuackGuru 03:48, 27 May 2008 (UTC)

I agree. Ernst is an excellent source. I don't know what is "flawed" or "biased" about his reviews of subjects other than the fact that he sticks to reality rather than fantasy. ScienceApologist (talk) 05:08, 27 May 2008 (UTC)

I disagree. Ernst is a biased POV source, and flaws in his methodology have been pointed out via WP:RS on this page. If you "don't know what is 'flawed' or 'biased' about his reviews", then perhaps you may wish to read those sources if you have not already.DigitalC (talk) 05:28, 27 May 2008 (UTC)

Ernst is one of the most NPOV sources available. Ernst reviews are highly relevant and on target. QuackGuru 05:41, 27 May 2008 (UTC)

I await a source that criticizes Ernst who is not themselves being criticized by Ernst. The reliability of Ernst is that he is a third-party who does not derive his profession from the alternative medicine world. Those who criticize Ernst have an obvious incentive to misappropriate and malign him. Attacking the reliability of Ernst is a non-starter. If the alternative medicine fans here disagree, they should take it up on WP:RSN and get a consensus of outside opinion that Ernst is "unreliable". Until such time, this conversation should be tabled as pointless character asssassination and sour grapes. ScienceApologist (talk) 05:52, 27 May 2008 (UTC)

If you're hanging your hat on that rationale this shall be a quick and embarassing exit for the skeptics. You do realize that tertiary sources, leading national health agencies, 3rd party payers, and mainstream opinion disagree with the conclusions of Edzard Ernst re: SMT and chiropractic care don't you? QG, Ernst is NPOV? Please explain. Thanks. CorticoSpinal (talk) 07:07, 27 May 2008 (UTC)

Certainly there are chiropractic sources that explicitly criticize some of Ernst's work. A leading example of this is Bronfort et al. 2008 (PMID 18164469), whose criticism of Ernst's work is discussed and cited in Chiropractic# Effectiveness. However, I am not aware of any "national health agencies, 3rd party payers, and mainstream opinion" that directly criticize Ernst's work. Can you please supply some? It would strengthen Chiropractic if we could cite those sources, instead of merely citing Bronfort et al. Thanks. Eubulides (talk) 08:08, 27 May 2008 (UTC)

The reliability of Ernst' conclusions on SMT and chiropractic are in doubt because they disagree with mainstream consensus on the issue. They don't criticize Ernst per se; but the national health agencies, 3rd party payers, tertiarty sources, the World Health Organization and mainstream research opinion on chiropractic care and smt disagrees with his conclusions. Any attempt to 'cite' these sources have been rebuffed by yourself because of wikilawyering and claiming that if it wasn't expliciity a 'secondary source'. You should not play so coy. You've been doing this for 4 months now, Eubulides. Except, over time your civil POV push for Ernst representing the mainstream opinion has been exposed as a farce. Ernst's specific conclusions on SMT and chiropractic care doesn't represent the mainstream and it is in itself the fringe viewpoint which is being passed off as the majority one. That is so underhanded and I'll called you on it since day 1 but you have ignored every concern brought to you regarding the misuse of Ernst, the cherry picking of sources (aka mining papers) to promote the fringe viewpoint that is Ernst's conclusions at the expense of the mainstream consensus (safe, effective, cost effective). Shame on you. CorticoSpinal (talk) 05:22, 28 May 2008 (UTC)

• Ernst etc.'s conclusions do not disagree with mainstream consensus. They disagree with mainstream chiropractic, which is not the same as mainstream in general.
• Some national health agencies do not recommend chiropractic; others do. There is not a mainstream consensus in this area. And national health agencies' opinions have changed with time, not always in a direction favorable to chiropractic. See, for example, Murphy et al. 2006 (PMID 16949948).
• Chiropractic #Scientific investigation cites both the WHO guidelines and mainstream chiropractic opinion, at some length. This hardly constitutes a "rebuff" of these sources.
• There is nothing underhanded about citing reliable mainstream reviews such as Ernst. Obviously Ernst is a critic of chiropractic, but all citations to his work are fairly balanced by citations to works that are supportive of chiropractic.

Eubulides (talk) 09:05, 28 May 2008 (UTC)

more controversial edits

This controversial change was a complete rewrite of the Education, licensing, and regulation. The first part is historical info and the second part is a text dump from the lead of Chiropractic education article. QuackGuru 05:27, 27 May 2008 (UTC)

It's not controversial QG and the "text dump" is the material I wrote in April on here. QuackGuru is being completely disrupting this page and I'm fed up with his antics. He can dump 3 entire sections (efficacy, cost-effectiveness, research) make major revisions to the lead all the while majority of editors here disagreed strongly on the validity of the content and the cherry picking up sources and the miuse of Ernst to subvert the majority mainstream viewpoint. Your conduct here is becoming very frustrating QG and this is echoed by many editors now. Please refrain from making deliberately misleading statements, thanks. CorticoSpinal (talk) 05:43, 27 May 2008 (UTC)

The info was written way back in April and was rejected (reverted) and now the text dump continues. QuackGuru 05:48, 27 May 2008 (UTC)

Actually no, its Eubulides who doesn't want the different educational paths listed for whatever reason. The draft had consensus all but from yourself in Eubulides. So, no it was not rejected like you say. Another misleading statement. You're on a roll tonight. Regardless, the added text is NPOV, is accurate and is from reliable and valid sources. There's no reason to drum up controversy when there is none. CorticoSpinal (talk) 05:59, 27 May 2008 (UTC)

I don't know what "The draft had consensus all but from yourself in Eubulides" means. The draft did not have consensus. It was put in anyway. Eubulides (talk) 08:08, 27 May 2008 (UTC)

Would you mind taking out the snide remarks and the innuendo? They don't help matters and only make you look bad. ScienceApologist (talk) 06:30, 27 May 2008 (UTC)

I'm sorry that you intepret it that way SA. As a true believer in QuackGuru, it must be difficult at times seeing your friend's approach at editing here being rebuked. I believe the possibility of a RfC was discussed a few days ago. Perhaps it is time to follow through based on tonight's festivities. CorticoSpinal (talk) 06:40, 27 May 2008 (UTC)

Disruptive editing (blind reversion) yet again.

This is at least the 3rd separate time Orangemarlin has disruptively and inaccurately deleted well cited material and has made misleading edit summaries at Chiropractic since mid-March 2008.

Why did you make blind reversion of my edit at practice styles regarding straight/focused scope chiropractors here? You wrote the source was not reliable. However, the same source is already being used elsewhere in the article. So, I'd ask that you please self-revert your edit. A failure to do so will be construed as a deliberate attempt to destabilize and censor relevant, valid, and reliable information. Considering that you have already done so twice already a RfC should be in order. CorticoSpinal (talk) 05:30, 27 May 2008 (UTC)

This controversial change added POV nonsense to the Chiropractic#Straight section. QuackGuru 05:34, 27 May 2008 (UTC)

I tend to agree. The situation is extremely strange because I see no discussion of the wording in this addition and the use of the term "stereotypes" to describe "focused-scope chiropractors" is hugely absurd. Since most people in the world including most people who have interacted with chiropractic have never had any exposure to the distinctions it is hardly reasonable to declare a "stereotype" regardless of how stridently a source puts it. Please workshop appropriate wording here before making this kind of addition. ScienceApologist (talk) 05:47, 27 May 2008 (UTC)

This word is in the cited source. The source is not in dispute, it's already being used elsewhere in the article. So, what's the big deal? Oh right, it debunks a lot of the myths skeptics promote. Well, sorry, SA, you're going to have to suck it up and deal with the fact the profession is maturing and is not fringe like you promote it to be. CorticoSpinal (talk) 05:54, 27 May 2008 (UTC)

I'm fine with a maturing profession. I'm not fine with borrowing the wording from marginal sources just to prove a point. Misplaced Pages is not the place to right great wrongs. Let the profession actually mature and then we'll talk. Until that time, we have an article to write from the most reliable, neutral, verifiable, and weighted-to-the-mainstream perspective possible. ScienceApologist (talk) 05:57, 27 May 2008 (UTC)

Please elaborate and prove your claim that McDonald (2003) is a marginal source. Chiropractic is mainstream. See Integrative medicine. Get over it. CorticoSpinal (talk) 06:03, 27 May 2008 (UTC)

It's marginal because it is a survey of chiropractors. If I surveyed creationists and then tried to "debunk the myths skeptics promote" from such a survey, that would also be a marginal source. ScienceApologist (talk) 06:29, 27 May 2008 (UTC)

Incredibly weak argument. Red herring with the creationists by the way; non-sequiturs are not useful in advancing your point which has been rebutted. McDonald is legit, the wording is in the source, the source is being used elsewhere in the article. Let me repeat: chiropractic is mainstream. Do you have proof it is fringe? Otherwise I'd suggest you stop treating it as such and making ridiculous comparisons to creationists. You skeptics tend to do that. It also got equated with Flat Earth and Homeopathy. It's much more like a medical specialization, such as Dentistry. Thanks. CorticoSpinal (talk)

I'm beginning to think you should be banned from this article. ScienceApologist (talk) 14:11, 27 May 2008 (UTC)

You're on your 29th life, SA. Banned for what? Exposing the weakness in your arguments and your disruptive editing here? Aren't you already on probation? What have you contributed to chiropractic, SA? You only delete and revert here. At least I attempt to author good material CorticoSpinal (talk) 23:17, 27 May 2008 (UTC)

Focused-scope chiropractors are mixers.

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

"The labels we traditionally use are not always helpful. Most self-reported broad-scope practitioners are 'straight' on the issues of subluxation and adjustment, and most focused-scope chiropractors 'mix' the adjustment with other regimens and therapies," McDonald observed.

The above text is from the marginal survey reference.

This controversial edit added text about mixers to the straight section. I am puzzled. QuackGuru 06:38, 27 May 2008 (UTC)

Focused scope is straight. Broad scope= mixer. This is well established in the literature. Please do not attempt to confuse readers seeing you are confused. The edit is pretty straight forward: even straights now (contemporary) aren't so much straights as they DDx and they recommend adjunctive therapies. There's a blending happening in the US, at least. Outside the USA, there is 1 straight school and 16 mixer ones and all are in or affiliated with public universities. Straights have no choice but the go with the EBM movement otherwise legislation will leave them behind along with the mainstream of chiropractic. CorticoSpinal (talk) 06:49, 27 May 2008 (UTC)

From McDonald "While Life graduates tended to label themselves focused scope and middle scope, National graduates tended to declare themselves broad scope and middle scope." And "While the subluxation is championed by the focused-scope camp and the spectrum of services is championed by the broad-scope practitioners, the typical chiropractor is eclectic. This type of contemporary practitioner values the adjustment, yet sees no contradiction in working to gain hospital privileges." It's pretty clear in the article that McDonald differentiates and knows the difference betweens straights and mixers. CorticoSpinal (talk) 06:54, 27 May 2008 (UTC)

This controversial edit failed verification. The added text is discussing mixers and not straights.

According to the marginal survey reference: "The labels we traditionally use are not always helpful. Most self-reported broad-scope practitioners are 'straight' on the issues of subluxation and adjustment, and most focused-scope chiropractors 'mix' the adjustment with other regimens and therapies," McDonald observed. The reference clearly states focused-scope chiropractors 'mix'... QuackGuru 07:05, 27 May 2008 (UTC)

The recently added text to the straight section is describing mixers according to the reference. QuackGuru 07:20, 27 May 2008 (UTC)

The term "focused scope" (instead of "straight") is not well-established in the literature. In the scholarly literature it is used only by this particular source (McDonald et al. 2003). Chiropractic should stick with standard terminology instead of oddball terminology used only by one source. Also, Chiropractic is not the place to advise straights to go into the evidence-based camp, or to predict which way legislation will go. Eubulides (talk) 08:08, 27 May 2008 (UTC)

I agree that "focused scope" vs. "broad scope" is not a well-established term. However, that does not mean this source should not be used. Further explanation that broad scope = mixer is here"# Broad-scope chiropractors, despite being tagged by their detractors as "medically" oriented, believe the subluxation is a "significant contributing factor" in a majority of visceral ailments.

1. Furthermore, 89% of broad-scope practitioners are opposed to having the adjustment limited to musculoskeletal conditions."DigitalC (talk) 09:25, 27 May 2008 (UTC)

QG, why would you add a failed verification tag in one edit, and then remove the allegedly unsupported text in the next edit? This is not collaborative editing. ( & ) DigitalC (talk) 09:31, 27 May 2008 (UTC)

Focused and broad scope are used commonly in the chiropractic literature as synonyms for straight and mixer respectively. I removed the failed verification tags as it was a deliberate attempt by QuackGuru to disruptive and subvert the information being presented. CorticoSpinal (talk) 14:01, 27 May 2008 (UTC)

I disagree that they are common terms. Do you have a reliable source saying otherwise? Let's stick with "straight" and "mixer", which at any rate are far more-commonly used than "focused scope" and "broad scope". Eubulides (talk) 16:59, 27 May 2008 (UTC)

Replying to DigitalC's two previous comments: I agree that McDonald et al. 2003 can be used in Chiropractic; it is already used, and is a reliable source about chiropractic opinion in North America. However, I disagree with several elements of the edit in question:

• That edit uses argumentative language like "X is refuted in research" which is not supported by the source.
  • It's in the source.

Regardless of what the source says, "refuted" is completely PoV language. Jefffire (talk) 14:05, 27 May 2008 (UTC)

On which page number is it in the source? I see "refuted" only in the lay summary, which is not the actual source. At any rate I agree with Jefffire that the term is hopelessly POV regardless of source. The source has not "refuted" anything of the sort. Eubulides (talk) 16:59, 27 May 2008 (UTC)

• Also, it is NPOV, since it says that straights endorse many "mixer" principles, but it does not also make the point (which is made quite strongly in the source) that mixers endorse several important "straight" principles. This is unbalanced coverage. The source's main point is that mixers are close to straights and vice versa, a point that goes two ways and not just one.
  • We can add this to mixer as well, in fact I was going to before QG, SA and OM decided to gang up again and try to remove the edit citing WP:RS. CorticoSpinal (talk) 14:01, 27 May 2008 (UTC)
• Regardless, a controversial change like this should be discussed before being installed: but even more important than discussion is that the change should be NPOV and be supported by the cited source, which is not the case here.
  • It's not a controversial change Eubulides because you or QG say it is. The whole section of Safety, Effectiveness, cost-effectiveness and vaccination is far more controversial then adding a blurb about the straights offering up DDx. CorticoSpinal (talk) 14:01, 27 May 2008 (UTC)

Eubulides (talk) 09:48, 27 May 2008 (UTC)

• • • By "controversial" I meant controversial among the editors working on Chiropractic. It is indeed controversial by that measure, as this discussion proves. Eubulides (talk) 16:59, 27 May 2008 (UTC)
      • What this discussion proves that zombie editors and anti-chiropractic skeptics are obstructing anybody who disagrees with them. The zombie editing practices of the anti-chiropractic axis of Jefffire-OrangeMarlin-ScienceApologist with sleeper cell of Filll and Arthur Rubin will be exposed. You don't have all the wikipedia admins in your back pocket. What a fucking joke this place is. CorticoSpinal (talk) 23:14, 27 May 2008 (UTC)

Blind Reversion

The biggest reason why Chiropractic article is dsyfunction is the amount of "drive by" blind reversions done by the skeptics. So far, in 24 hours, ScienceApologist, Jefffire, OrangeMarlin have all made reversions of cited material, branded it as "controversial" and have deleted cited material that is supported by the claims.

How can we ever move forward in this article if admins to not stop these kind of disruptive edits? These guys don't even participate in Talk at all and just revert. This needs to be investigated. It's complete BS. CorticoSpinal (talk) 16:40, 27 May 2008 (UTC)

Dude, when it's only your edits being reverted and they contain blatant PoV violations (eg. "refute"), you should look at your own edits. Jefffire (talk) 16:45, 27 May 2008 (UTC)

"Dude" there was no blantant POV violations if and if had a problem with the word you can change it rather than deleting the cited text. Anyways, you guys are making this quite easy. Keep up the disruptive reversions to all chiropractic related articles. The diffs are piling up. CorticoSpinal (talk) 16:52, 27 May 2008 (UTC)

The reversions were done without comment, which I disagree with. However, the reverted material was inserted without previous discussion and had real problems, as discussed in #Education draft needed work below. Let's work together on the talk page to strengthen the material, instead of getting into install/revert wars. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Agree. Please put any large insertion here and discuss it before installing.--—CynRN 18:00, 27 May 2008 (UTC)

The section that was in place was a minor tweak that is better worded and had the exact same references. Skeptics just doesn't want the world to know they're handing out Bachelors and Masters degrees of Science to chiropractors. It's good enough for the WHO to mention yet not good enough for anti-chiropractic editors here. CorticoSpinal (talk) 22:46, 27 May 2008 (UTC)

I don't quite follow the previous comment, as the change in question altered quite a bit of text (it was not a "minor tweak"). Perhaps you are talking about some previous version of Chiropractic? If so, which one, exactly?

Education draft needed work

I see a new draft of Chiropractic #Education was published, again without discussion or comment or consensus, and then was reverted by someone else. Again, it's not right to put in changes like this without discussion. Before the section was reverted, I took the time to review it, and to draft an improved version of it, which I enclose below. My own feeling is that even with the improvements, it's inferior to the current version, but perhaps the best features of both versions could be combined. Eubulides (talk) 09:18, 27 May 2008 (UTC)

First, the draft that I installed originally was the consensus version. Only you objected to it. The draft currently in place was not discussed and was disagreed upon by a majority of editors. So, you're spinning this the wrong way. Your version has serious shortcomings, as most of your edits do. Every edit you have made has tried to marginalize the chiropractic profession Think about this. You're always trying to cover up anything that makes the profession sound respectable. Why do you do this? CorticoSpinal (talk) 22:51, 27 May 2008 (UTC)

• No recent version of Education ever reached consensus. Others have objected strongly to the Education rewrite that was abruptly installed, both by reverting the change that installed it and by objecting on the talk page.
• It's not true that every edit I have made "has tried to marginalize the chiropractic profession". Here is a list of my ten most recent edits to Chiropractic:

• This one did not marginalize the chiropractic profession.
• Nor did this one.
• Nor this one.
• Nor this one.
• Nor this one. Amusingly enough, it consists of a removal of a citation to Ernst, the critic of chiropractic that you have voiced vehement objections to.
• Nor this one.
• Nor this one.
• Nor this one.
• Nor this one.
• Nor this one.

Eubulides (talk) 09:05, 28 May 2008 (UTC)

Quite frankly, it's annoying seeing how the skeptics continuously refer to non-controversial edits as controversial. Everything in the section is from a reliable, valid source, it's NPOV and it presents the highlights of the educational paths. This is simply sour grapes. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

The edit is controversial among the editors here. I don't see how one can argue otherwise, given the revert war. The section has material that is not supported by reliable sources and it has POV issues as mentioned below. Eubulides (talk) 16:59, 27 May 2008 (UTC)

The edit is controversial among the meat puppet and the zombie editors. You're pushing a false consensus. Everything in the draft I provided is supported by reliable sources To insist they are not is is untruthful. I ask that you retract your statement which is misleading (yet again, #20). CorticoSpinal (talk) 22:51, 27 May 2008 (UTC)

Perhaps you're talking about a version other than the one that was installed? The version that was installed certainly does have problems with a lack of reliable sources. Its very first sentence, for example, is unsourced, and is inaccurate to boot (it gets the date wrong). This is just one example; that edit has several other real problems with lack of sourcing or with failed verification of sources. Please see #Education draft needed work and #Comments on Education, licensing, and regulation drafts for more info. Eubulides (talk) 09:05, 28 May 2008 (UTC)

The following comments are based on the new draft as it appeared in this version:

• "The first school of chiropractic was opened in 1896 in Davenport, Iowa, USA." This claim is unsourced and belongs in Chiropractic#History after it becomes sourced.

• The claim is appropriately sourced and it is relevant to education.

• There was no citation after the claim. It is more relevant to history. Eubulides (talk) 16:59, 27 May 2008 (UTC)

• I think that it makes a good introduction to the education system, and could easily be sourced in anyone doubts the statement.DigitalC (talk) 04:01, 28 May 2008 (UTC)

• A source is needed. The statement is incorrect, as the year is wrong. The statement does not appear in Chiropractic education, which is an indication that it's not that important here. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Sorry Eubulides, I thought it was 1897 too, but Peterson/Wiese (1994 Chiropractic an Illustrated History) said it was 1896 with the first graduate in 1897. Palmer did not open any school in 1895. Also, that information is not at chiropractic education because the edit was first proposed 2 days ago here on the main page. Information doesn't have to appear on subarticles first, unless you can point a specific policy that says so. So, to be clear, you are disputing the inclusion of the very first chiropractic school in history at chiropractic? Really? CorticoSpinal (talk) 05:22, 29 May 2008 (UTC)

The 189x school was called the "Palmer School of Magnetic Cure"; and it was not strictly a chiropractic college. It would be reasonable to discuss this sort of thing in Chiropractic #History. That is what History is for. The education section should talk about the current state of chiropractic, not history. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "Chiropractic education is unique in the United States that it is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution." The cited source does not support the claim. It does not say the practice is "unique in the United States".
  • The cited source is from the US Department of Education. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

• True, but the cited source does not say the practice is "unique in the United States". Eubulides (talk) 16:59, 27 May 2008 (UTC)

Find me another country that separates the curriculums into progressive and straight and then we'll talk. It is unique in the US. Deal with it CorticoSpinal (talk) 23:01, 27 May 2008 (UTC)

To claim that it is unique would be OR without a RS. However, we can reword this to "Chiropractic education in the US is divided into straight or mixer eduational curriculums, depending on the philosophy of the institution.<ref></ref> And then use a DIFFERENT source to explain that elsewhere in the world, mixer philsophy is taught.DigitalC (talk) 04:07, 28 May 2008 (UTC)

Yes, that rewrite would be fine, as it matches the source. Thanks. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• "In the United States, all but one of the chiropractic colleges are privately funded, but the colleges in Australia, South Africa, Denmark, one in Canada, and two in Great Britain are located in government-sponsored universities and colleges." Details about which countries have which colleges are better left to the subarticle.
  • Actually no, its quite relevant to Chiropractic because skeptics such as yourself promote that Chiropractic is fringe and is pseudoscientific. All schools outside North America save 1 are in government universities. This is notable and its critical it appear in the article. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

• It is relevant that many schools outside the U.S. are supported by the government. It is a minor detail as to where those schools are, a detail that isn't that important here. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Stop trivializing the matter. They're not supported by the government. They're part of mainstream, public universities. You claim chiro is fringe and is like homeopathy. Last time I checked there were no Bachelors and Masters degrees in homeopathic science. CorticoSpinal (talk) 23:01, 27 May 2008 (UTC)

I am not claiming that chiro is fringe, nor that it is "like homeopathy" full stop. My proposal would not affect wording that says that the outside-the-U.S. colleges are government universities. So what's the problem with the proposal? Eubulides (talk) 09:05, 28 May 2008 (UTC)

You have not said Chiropractic is like Homeopathy? Final answer? CorticoSpinal (talk) 05:28, 29 May 2008 (UTC)

Chiropractic is like homeopathy in some respects, and unlike it in others. Surely this is obvious. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "In 1971, National College of Chiropractic (now known as National University of Health Sciences) became the first federally recognized and accredited college by the United States Department of Education. This led the way to important grants in federal funding for research as well as grants and loans to chiropractic schools and prospective chiropractic students." This event does not appear in the NUHS's own web page on accreditation or on the NUHS's own web page on its own history. If even the NUHS itself doesn't think it's notable, it is not notable enough to make the cut for Chiropractic education, much less Chiropractic itself.
  • It doesn't matter if it makes the NUHS website, what matters is that the source supports the claim. It does. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

One can find sources for all sorts of non-notable material. Having one source doesn't prove that something is notable. Misplaced Pages is about notability as well as verifiability. If the institution in question doesn't think a fact is notable, it's a strong indication that the fact is indeed not notable. Eubulides (talk) 16:59, 27 May 2008 (UTC)

You're so off base here I don't know where to begin. Let's but it plainly: do you have a source that suggests it's not notable? Because National College of Chiropractic being the first chiro institution in the world to be accredited by a federal governent is a notable thing. Dematt your thoughts? CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

I disagree that it is not notable if NUHS doesn't mention it on their website. If there is a reliable source for the claim, then it is notable by the fact that there IS a source for that claim.DigitalC (talk) 04:10, 28 May 2008 (UTC)

• That is a very strange standard for notability. But if that's the standard, shouldn't we add "The chiropractic college at Marycrest International University closed in 2002.", and cite Homola 2006 (PMID 16446588)? After all, this is a claim about education for which we have a reliable source (considerably more reliable, as it is published in a refereed journal).
• I dispute that the NCC was the first "federally recognized and accredited college by the U.S. Dept of Education". The DoE does not do accreditation for chiropractic, and does not recognize chiropractic colleges directly; the CCE does that.

Eubulides (talk) 09:05, 28 May 2008 (UTC)

• The claim is supported by the source Wiese/Peterson (1994). Do you have a source of evidence that disputes this or do we just have to take your word for it? CorticoSpinal (talk) 05:28, 29 May 2008 (UTC)

Well, your dispute would be correct, they were the first chiropractic college to achieve "federally recognized regional accrediation" by the New York State Department of Education. The CCE wasn't recognized by the US Commissioner on Education until 1974.. As for notability, that doesn't really apply - perhaps you mean that you feel that we are giving undue weight to the issue? Speaking of undue weight, was the Marycrest University a milestone? Was it the first college to close? The last college to close?

The Marycrest University is just as much of a milestone as the 1971 event, if what is required for something to be notable merely that a reliable source supports it. There is nothing particularly notable about the 1971 New York State event, worthy of inclusion here. It might be worth mentioning in Chiropractic education. Eubulides (talk) 08:47, 29 May 2008 (UTC)

Eubulides, please read my statement again, or is this a case of WP:IDHT? Notability doesn't apply here. Perhaps you mean WP:UNDUE? How was Marycrest a milestone? Was it the FIRST of something? Was is the LAST of something? Has it been listed as a milestone in a reference? DigitalC (talk) 05:19, 30 May 2008 (UTC)

Yes, sorry, notability is wrong (that is for article topics, not particular bits of content), and undue weight is the right issue. Just as Marycrest wasn't important enought to be worth citing here, and the 1971 NCC event wasn't that important either. The 1971 NCC event isn't even worth citing on the NCC's own website! Why should we mention it here? Eubulides (talk) 11:39, 30 May 2008 (UTC)

• "Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine." This claim is plausible but is unsourced. A source is needed.
• "In North America, typically a 3 year university undergraduate education is required to apply for the chiropractic degree." The cited source gives the requirements for one university, which does not support the claim that it is a "typical" requirement. In any event, this requirement is not notable enough for Chiropractic. It is suitable for Chiropractic education.

You do not get to determine what is notable for chiropractic. Listing common pre-reqs is fair game. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

Neither of us, individually, gets to determine anything. Prerequisites are low-level and unimportant details. They can be put into the subarticle. Eubulides (talk) 16:59, 27 May 2008 (UTC)

They belong in the main article. Suddenly the fact that DCs need 3 years of sciences pre-reqs low level? Lol, sure, sure  :) CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

This source supports the claim that it is a tyical requirement. "All matriculants must furnish proof of having earned a minimum of 90 semester hour credits of appropriate pre-professional education courses at an institution or institutions accredited by a nationally recognized agency" - . If we can find a source for it, we may as well include that the majority of students have a bachelor's degree or higher. DigitalC (talk) 05:43, 28 May 2008 (UTC)

Yes, thanks, that would support the claim that entrants to accredited U.S. schools must have at least 90 semester hour credits. It does not support the claim about 3 years, though, so the claim would need rewording. I still fail to see, however, why this low-level detail is worth mentioning at the level of Chiropractic. Maybe Chiropractic education, the subarticle; but why Chiropractic?

90 semester hours is typically 3 years of University. However, I support changing the wording to 90 semster hours, because it isn't as vague (for example, you can't take 1 course a year for 3 years and then get in). DigitalC (talk) 05:10, 29 May 2008 (UTC)

It's notable because it is the basic requirement to apply for the chiropractic degree. And, in the section Chiropractic Education (the main article) it's not unreasonable to include this detail. Are you disputing the source? If no, let's move on. As a compromise I support including both 3 years (90 semester hours), DigitalC. CorticoSpinal (talk) 05:42, 29 May 2008 (UTC)

The source says only 90 semester hours, right? Let's not extrapolate beyond what the source actually says. And again, this material is better left to Chiropractic education, the subarticle that is designed for it. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• A direct and lengthy quote is made from the WHO guidelines without quote marks. This is plagiarism and is a copyright violation. Also, there is too much about full-time training programs and not enough about conversion and limited training programs.

It is attributed and I shall put the quotation marks.

It would be better to briefly summarize the material, rather than include long and boring quotes from the source. That is what is done in the draft below. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Your opinion of long and boring differs from many other editors. CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

On the contrary, CynRN, the only other editor who has spoken up on the subject, thinks that the education draft was boring and thought that there should not be a whole lot on education. Eubulides (talk) 09:05, 28 May 2008 (UTC)

There you go again, misrepresenting (#21) and conflating again. CynRN has said the section is boring and does not interest her, she does not dispute the material. There's a difference. CorticoSpinal (talk) 05:17, 29 May 2008 (UTC)

I was responding to the claim "Your opinion of long and boring differs from many other editors." CynRN agrees that the draft is boring, so in that sense my opinion does not differ from hers. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training." This text is misleading, because it's just a guideline, not a requirement. Also, it's longwinded and should be shortened.

• Than we can specify its a guideline. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

• Or, we can include that it is a guideline worldwide, but a requirement in the US. "The DCP must require each student awarded the D.C. degree to have successfully completed not less than 4,200 instructional hours, and must have earned not less than the final 25% of the total credits required for the D.C. degree from the program that confers the degree."DigitalC (talk) 05:47, 28 May 2008 (UTC)

• Yes, thanks, that's a good idea for the 4,200-hours detail. The other details still have the problem, though. And, again, why is it worth mentioning 4,200 hours in Chiropractic? This seems such a low-level detail. We have a subarticle in Chiropractic education; why not use it? Eubulides (talk) 09:05, 28 May 2008 (UTC)

How is it a low level detail? 4200 hours is what it takes to earn the degree. There's people out there who think Chiropractic is a 1 year program after highschool. We are simply providing the readers with reliable, verifiable information that is supported by reliable sources. CorticoSpinal (talk) 05:47, 29 May 2008 (UTC)

The stuff about 4200 hours of this and 1000 hours of that and 25% of this is really boring stuff. Go look at (say) the Misplaced Pages entry for Harvard; does it talk about how many hours it takes to graduate? Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "Health professionals with advanced clinical degrees, such as medical doctors, can can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy." I don't see anything in the source about this being "most commonly done in countries where the profession is in its infancy". Again, the wording can be trimmed without losing information.
  • This is directly taken from the source. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

Where? What page? I didn't find it. Anyway, the material should be trimmed here. Eubulides (talk) 16:59, 27 May 2008 (UTC)

• "Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted." This sentence is too much detail; it's kind of obvious that one goes to school to get a degree, no? It can be put in Chiropractic education. It needs sourcing, though.

Common knowledge does not need to be sourced. CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)

If the knowledge is that common, it need not be placed here at all, no? But at any rate it is unimportant detail suitable for the subarticle. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Another logical fallacy in your argumentation. Common knowledge doesn't need to be referenced, Eubulides. CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

The main point is that unimportant detail, whether sourced or not, does not need to be in the article. 09:05, 28 May 2008 (UTC)

• "However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed." This needs a source. In particular, it needs to state which countries where this requirement is in place. It is not true in all countries.
  • In all countries that wish to use the designation chiropractic and chiropractor it is a requirement. Othewise you get stuck with the situation in Germany and Brazil CorticoSpinal (talk) 16:35, 27 May 2008 (UTC)
    • Again, the statement needs a reliable source, and should be rewritten to match the source. Eubulides (talk) 16:59, 27 May 2008 (UTC)
• "Regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency." The cited source supports this claim only for Canada.

Are you really disputing this? That regulatory colleges are NOT responsible for protecting the public? This seems a little pedantic to me. DigitalC (talk) 05:57, 28 May 2008 (UTC)

I am disputing that it is a requirement worldwide, certainly. At any rate the claim needs to be accurately sourced; currently it is not. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Nowhere does it claim to be a requirement worldwide.DigitalC (talk) 05:10, 29 May 2008 (UTC)

The requirement was stated as a blanket one. The default scope in Misplaced Pages is global. If the requirement is sourced only for Canada, the text should say that. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• "Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the U.S. and 2 in Canada," The cited source does not mention Canada.

Here is another source, which lists the 18 locations in the US, the 2 in Canada, as well as Australia and Japan. DigitalC (talk) 05:57, 28 May 2008 (UTC)

Unfortunately that source does not suffice for the claim, as it does not say that the colleges in question are accredited. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Again, this is getting pedantic. Do you doubt that the colleges are accredited? Attribution is only needed if the data is challenged, or likely to be challenged. How about, "There are 15 accredited Doctor of Chiropractic programs in 18 locations in the US, 4 in Europe, 3 in Australia, and 2 in Canada." We lose out on RMIT Japan, but we increase our world view, and have a a reliable source for the content as well. DigitalC (talk) 00:45, 29 May 2008 (UTC)

That is a better source, since it talks about accreditation. However, it disagrees with the numbers in the proposed quote. It lists 13 accredited DC programs in the US, at 19 locations. It lists 2 in Australia. It lists 1 in NZ. The article should match the source. I suggest adding "as of 2003" since it is an old source. It is not pedantic to insist that statements be sourced; it is a core property of Misplaced Pages. Eubulides (talk) 08:47, 29 May 2008 (UTC)

• " and an estimated 70,000 chiropractors in the USA, 6500 in Canada, 2500 in Australia, 2,381 in the UK, and smaller numbers in about 80 other countries" The cited source does not contain any information about numbers of chiropractors.

• Back Pain Revolution, by Gordon Waddell (page 62). states 70,000 in the US, 6000 in Canada, 1500 in the UK, and 90,000 internationally. For the record, this information has been in the article for ages. You cry foul when others object to information that has been in the article previously, but then turn around and do the same. Now do you understand that while we are discussing something on the talk page, we might as well get it right? DigitalC (talk) 06:51, 28 May 2008 (UTC)

• That URL does not work for me; Google Books responds "You have either reached a page that is unavailable for viewing or reached your viewing limit for this book." The book is dated 2004. The U.S. Bureau of Labor Statistics reports "Chiropractors held about 53,000 jobs in 2006." and I suggest using this figure instead for the U.S., as it is more recent and the BLS gives a date for its estimate, which is better. Eubulides (talk) 09:05, 28 May 2008 (UTC)

• The URL works for me, and I stated above the numbers it gives. I agree that the BLS stats are probably better for the US, but we can use both references. DigitalC (talk) 05:10, 29 May 2008 (UTC)

Here is my attempt at an improved version (which is still not as good as what Chiropractic got reverted to):

Chiropractic education is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution. In the United States, all but one of the chiropractic colleges are privately funded, but in several other countries they are in government-sponsored universities and colleges.

Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine. The World Health Organization guidelines suggest three major educational paths involving full‐time chiropractic education, along with a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic. For full-time education the guidelines suggest at least 4200 student/teacher contact hours, and for conversion they suggest at least 2200 hours; in both cases including at least 1000 hours of clinical experience.

In some jurisdictions chiropractors, like other health care professionals, must be licensed in order to legally practice. In Canada, regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the U.S.,

Eubulides (talk) 09:18, 27 May 2008 (UTC)

Your draft omits critical information (as it usually seems to be the case). My draft is superior and more succint.

I don't follow the "succinct" remark, as my draft is considerably shorter. At any rate, both drafts are considerably inferior to what's in Chiropractic now. Also, #Education, licensing, and regulation draft is better than what's in Chiropractic now. Though it's obviously not perfect, it's a better starting point for future improvements. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Shorter and missing the relevant info. Listen. You seem to think that you're the only editor here who can make drafts. Your draft leaves out key information. You push Ernst on us. Give it a break. CorticoSpinal (talk) 22:58, 27 May 2008 (UTC)

We have no shortage of drafts! Four editors, four drafts. I have never said or implied that I am the only editor who can make drafts. On the contrary, I have written none of the four drafts. Eubulides (talk) 09:05, 28 May 2008 (UTC)

This is the first time this has ever occurred that 4 editor had 4 drafts. Nice try though. How many times did you attempt for Safety (4-5?) Effectiveness (4-5?) They're still bogus too. See Chiropractic is fringe for rational. CorticoSpinal (talk) 05:17, 29 May 2008 (UTC)

Sorry, I didn't follow that remark at all. Eubulides (talk) 08:47, 29 May 2008 (UTC)

"Further research is needed"

This change installed the text "Further research is necessary to determine the acceptable level of risk associated with both the benefits and the harms of CMT." Let's remove this sentence. First, it uses "CMT" without defining the acronym. Second, and more important, it basically just says "Further research is needed". That is not notable. Every research paper says "further research is needed". There's no particular reason to make that point here, as opposed to the many dozens of other places in Chiropractic that cite sources saying further research is needed. Eubulides (talk) 09:57, 27 May 2008 (UTC)

Totally agree. I removed the offending text. ScienceApologist (talk) 14:21, 27 May 2008 (UTC)

Here is a copy of the CONCLUSIONS: Weak to moderately strong evidence exists to support causation between CMT and VAD and associated stroke. Ultimately, the acceptable level of risk associated with a therapeutic intervention like CMT must be balanced against evidence of therapeutic efficacy. Further research, employing prospective cohort study designs, is indicated to uncover both the benefits and the harms associated with CMT.

Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist. 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Here is the reference. Some editors expressed an interest in the Safety section weighing in on the risk-benefit. I gave it a try.

Perhaps we can shorten it or tweak it to bring it up to Misplaced Pages's standard. Any thoughts for improving the Safety section? QuackGuru 15:00, 27 May 2008 (UTC)

Question: How come when a chiropractic skeptic makes want to remove a claim, SA and QG are there to bulldoze it through (with Jeffire and Orangemarlin seemingly on stand by for reversions) without any discussion, yet the same courtesy is not offered to those who disagree with Eubulides? CorticoSpinal (talk) 16:55, 27 May 2008 (UTC)

The sentence "the acceptable level of risk associated with a therapeutic intervention like CMT must be balanced against evidence of therapeutic efficacy" might be useful to source the introduction to a new Risk-benefit section. Otherwise I don't see the use of the other quoted sentences in that source. Eubulides (talk) 16:59, 27 May 2008 (UTC)

Education, licensing, and regulation drafts

Education, licensing, and regulation 1

This draft I wrote and now deleted is obsolete. QuackGuru 19:33, 2 June 2008 (UTC)

Education, Licensing, Regulation 2

The first school of chiropractic was opened in 1896 in Davenport, Iowa, USA. Chiropractic education is unique in the United States that it is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution. In the United States, all but one of the chiropractic colleges are privately funded, but the colleges in Australia, South Africa, Denmark, one in Canada, and two in Great Britain are located in government-sponsored universities and colleges.. In 1971, National College of Chiropractic (now known as National University of Health Sciences) became the first federally recognized and accredited college by the United States Department of Education. This led the way to important grants in federal funding for research as well as grants and loans to chiropractic schools and prospective chiropractic students.

Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine. In North America, typically a 3 year university undergraduate education is required to apply for the chiropractic degree. In general, there are 3 major educational paths involving full‐time chiropractic education across the globe:

• A four‐year full‐time programme within specifically designated colleges or universities, with suitable pre-requisite training in basic sciences at university level;
• A five‐year bachelor integrated chiropractic degree programme offered within a public or private university
• A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree.

Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training. Health professionals with advanced clinical degrees, such as medical doctors, can can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy. Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed.

Regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Today, there are 15 accredited Doctor of Chiropractic programs in 18 locations in the USA and 2 in Canada, and an estimated 70,000 chiropractors in the USA, 6500 in Canada, 2500 in Australia, 2,381 in the UK, and smaller numbers in about 80 other countries.

Education, Licensing, Regulation 3

Chiropractors obtain a first-professional degree in Chiropractic medicine. Canada and the U.S. require a minimum 90 semester hours of undergraduate education as a pre-requisite before for applying to chiropractic school. Matriculation through an accredited chiropractic program includes no less than 4200 instructional hours (or the equivalent) of full‐time chiropractic education. Internationally, the World Health Organization (WHO) suggests 3 major educational paths involving full‐time chiropractic education:

• "A four‐year full‐time program within specifically designated colleges or universities, with a 1 - 4 year pre-requisite training in basic sciences at university level;
• " A five‐year bachelor integrated chiropractic degree programme offered within a public or private university;
• " A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree."

The WHO also suggests that health care professionals with advanced clinical degrees can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours that includes a minimum of 1000 hours of supervised clinical training. Upon finishing chiropractic education, the chiropractor may then be required to pass national, state or provincial boards before being licensed to practice in a particular location. Depending on the state or province, continuing education (CE) may be required to renew these licenses

In the United States, chiropractic schools are accredited through the Council on Chiropractic Education (CCE). The CCE-USA has joined with CCEs in Australia, Canada, and Europe forming CCE - International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally. Today, there are 18 accredited Doctor of Chiropractic programs in the USA, 2 in Canada, and 4 in Europe and the UK. All but one of the chiropractic colleges in the United States are privately funded, but in several other countries they are in government-sponsored universities and colleges.

Regulatory colleges and chiropractic boards in the U.S., Canada, Australia, Mexico and U.S. territories are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. In 2006, there were approximately 53,000 chiropractors in the United States and over 6500 chiropractors licensed in Canada.

Comments on Education 3

• I prefer this draft to the others. However, I think that this line from Eubulides, "but in several other countries they are in government-sponsored universities and colleges" is better than "but the colleges in Australia, South Africa, Denmark, one in Canada, and two in Great Britain are located in government-sponsored universities and colleges". DigitalC (talk) 05:55, 30 May 2008 (UTC)
• I support this draft as well. I removed the strikeouts that QG inserted for the educational paths; his argument that its too much weight is unfounded; moreover, not all degrees conferred to chiropractors are the same. As the section suggests, some are 2-3 years MSc (chiro), some are 4 years BSc(chiro) and in North America, it's 4 years after a minimum of 3 (total of 7). The article needs to reflect this global perspective. The source is not in dispute, the source is not fringe so I don't know where the weight argument comes from. I think it's more WP:IDONTLIKEIT than anything else. CorticoSpinal (talk) 00:30, 31 May 2008 (UTC)
• This draft is still mutating so I hesitate to make comments on it, but on the offchance that people are taking it seriously I will say that the draft is disappointing, as it has essentially ignores many of the comments in #Education draft needed work. For example, I don't see anything in the cited source about the 2200 hours being "most commonly done in countries where the profession is in its infancy", and I am quite skeptical that that 2200-hour claim is true. This is just one example of a comment being ignored; there are others. Dematt, have you had a chance to read the bullets at the start of #Education draft needed work? (Just the top-level bullets; you can ignore all the to-and-fro underneath if you like....) Eubulides (talk) 01:08, 31 May 2008 (UTC)

I took out the infancy part. In my rewrite, I apparently inadvertently addressed some of the bullet points. It looks like I agreed with you on some and with others on others. I am hoping to equally satisfy/dissappoint everyone, yet remain true to the sources. Rather than me reading through all that above again, are there specific issues that you feel strongly enough about that you cannot support it? -- Dēmatt (chat) 02:25, 31 May 2008 (UTC)

Education 3 improvement suggestions

OK, I took the time to review the section completely. Here is the revised set of bullet points.

• "Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine (DC or DCM)." The cited source does not say anything about "Most commonly". It says only that DC or DCM are the recognized first-professional degrees. The source is a U.S. source so this would be for the U.S., which should be stated in the text (or a better source should be found).
  • I agree that this is a problem sentence, mostly because I have never seen a DCM degree in the US, yet this is a US source. I could be very wrong, but I would feel better with a better source. I think we do need to say something about what the degree is (DC or DCM) if there is one somewhere. Also, this is the source that says the degree differentiates straight and progressive. I highly doubt that myself, but again could be wrong. I would like to see another source calling anyone progressive? However, because it is a verifiable and reliable source, I will put it in if that is what everyone decides. I'm just thinking we would be looking rather dated at the very least and quite possibly just wrong. -- Dēmatt (chat) 13:59, 31 May 2008 (UTC)
    • I see someone removed the "DC or DCM". But my objection was to the "Most commonly", not to the "DC or DCM". The sentence as written implies that chiropractors uncommonly do something other than get a first professional degree in chiropractic medicine. Is that really true? I'm skeptical. And the source doesn't say "most commonly". Or perhaps I'm misunderstanding the phrase "obtain a first professional degree"? In that case, the sentence needs to be clarified. Eubulides (talk) 08:39, 2 June 2008 (UTC)

• "In North America, a 3 year university undergraduate education (90 semester hours) is required before applying to chiropractic college," The 2nd citation (ccachiro) has nothing to do with the claim; it says nothing about prerequisites. It can be removed. The 1st citation (FPEH) is only about Canada, so the text should be changed from "North America" to "Canada" or better citations should be found. The claim is not true for all of North America (it's not true for Mexico). Neither source says anything about "90 semester hours", so that part should be removed from the text (or a better source found).

• "followed by no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training." The citation is to the WHO guidelines, which are a guideline curriculum for the world, and do not place any requirements per se on Canada (or North America). And yet the text is worded as if the WHO was imposing curriculum rules on North America. The text needs to be reworded to make it clear that this is just a voluntary guideline, not a requirement.

• "Internationally, the World Health Organization (WHO) suggests 3 major educational paths involving full‐time chiropractic education:" This "suggests" bit could perhaps be moved in front of the "4200" bit, to make it clear that the "4200" is part of the suggestion.

• "
  • "A four‐year full‐time programme within specifically designated colleges or universities, with a 1 - 4 year pre-requisite training in basic sciences at university level;
  • " A five‐year bachelor integrated chiropractic degree programme offered within a public or private university;
  • " A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree."

" It's tacky to have such an extensive quote. This should be reworded and trimmed. This sort of yawningly-boring detail is not needed in Chiropractic; it might be suited for Chiropractic education.

Besides you thinking this vital detail, which comes from a reputable source (WHO), which gives a representative sampling of the various degrees and educational paths obtained by details worldwide (to give a global POV), which is written neutrally, which is a core part of the education subsection, and which directly provides evidence that chiropractic is scientific (as opposed to a pseudoscience or fringe science as advocated by SA, OM, Jefffire, QG) is there a legitimate reason, besides 'boring' that you want to remove it? CorticoSpinal (talk) 18:21, 31 May 2008 (UTC)

• The WHO guidelines are not "a representative sample"; they are guidelines, which various countries are free to accept or reject, and which have not been accepted by the governments of most of the world's population. They represent a reasonable point of view which should be covered, but they are not by any means definitive, and should not be presented as the current state of affairs in practice.
• They are boring. This is not just my opinion; multiple other editors have agreed on that point. They may well be worth mentioning in a subarticle, but they can be just summarized here.

Eubulides (talk) 08:39, 2 June 2008 (UTC)

Again, boring is a subjective, personal point of view, and opinions differ between editors. They may not have been accepted by government of most of the world's population, but they HAVE been accepted by the CCEs of the countries with the majority of chiropractic colleges. DigitalC (talk) 00:00, 3 June 2008 (UTC)

• "Health care professionals with advanced clinical degrees can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours." Again, this is part of a international guideline, not strictly a requirement; this is not made clear in the text. Also, it's not made clear that the 2200 hours includes 1000 hours of supervised clinical training. Eubulides (talk) 05:13, 31 May 2008 (UTC)
  • "not less than 2,200 hours over a two or three-year full-time or part time program, including not less than 1000 hours of supervised clinical training" - The 2200 hours includes the 1000 hours, however I agree that it should be worded to clarify that this is a guidelines, not a requirement. On the other hand, we may be giving undue weight to the 2200 hours by including it, as I don't know if this recommendation is followed anywhere.
    • Thanks, I'd support removing the 2200 hours issue from here, and moving it to Chiropractic education. It is rather an unimportant detail. Eubulides (talk) 08:39, 2 June 2008 (UTC)
• "Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted." This sentence is too much detail and is unsourced. At the very least it needs to be sourced. Eubulides (talk) 05:13, 31 May 2008 (UTC)
  • "Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. The chiropractor may then be required to pass national, state, or provincial boards before being licensed to practice in a particular jurisdiction." I recommend that this is changed to "Upon finishing chiropractic education, the chiropractor may then be required to pass national, state or provincial boards before bring licensed to practice in a particular location". I disagree that this needs to be sourced. See WP:Reference#When_adding_material_that_is_challenged_or_likely_to_be_challenged. This is not the type of material that is contentious and likely to be challenged. On the otherhand, in QG's draft #6 (now struck out), he uses this site as a reference, which might satisfy requests of other editors, as may this . DigitalC (talk) 11:16, 31 May 2008 (UTC)
    • That wording is much better, thanks. Some quibbles: non-experts won't know what "boards" are, so perhaps change "boards" to "examinations"? Also, change "national, state or provincial" to "national or local", for brevity and completeness (it could be that some localities are neither states nor provinces). Finally, it should be cited, and any one of the local sources would suffice as a citation for this (less-general) claim. Eubulides (talk) 08:39, 2 June 2008 (UTC)
      • How about "board examinations"? Does local really imply provincial or state level? Refernces are directly above your comment and can easily be incorporated. DigitalC (talk) 00:00, 3 June 2008 (UTC)
        • "Board examinations" would be better, thanks. Sorry, I guess I assumed there were exams in countries other than the U.S., Canada, and Australia, countries that might not have either states or provinces. But now that I think of it, those are the only 3 countries that have board exams, right? In that case, the list of the 3 countries should be mentioned, to avoid giving the incorrect impression that this is a universal practice. Eubulides (talk) 06:34, 3 June 2008 (UTC)
          • Its not just these 3 countries. For example, to practice in Europe or Australasia, one may need to write 'board' exams. The term 'board' exam is used, although it may be an exam for a regulatory college, or CCE exam. I don't see how it could give the impression that it is a universal practice, as it states "the chiropractor may then be required to pass national, state or provincial..." (my emphasis).
• "The chiropractor may then be required to pass national, state, or provincial boards before being licensed to practice in a particular jurisdiction. Depending on the state or province, continuing education (CE) may be required to renew these licenses and chiropractors may further specialize in fields such as Chiropractic Orthopedics (DABCO), Chiropractic Radiology (DABCR), and Chiropractic Sports Physician (DABCSP) by completing additional study and passing specified boards that are separate and distinctly different than medical boards." This material is completely unsourced. It needs a source. There is some duplication between this material and the "radiology" and "sports sciences" of Chiropractic #Scope of practice; I suggest trimming the material either here or there, as we don't need it both places. Eubulides (talk) 05:13, 31 May 2008 (UTC)
  • I'm not sure which section it is better in, Scope of Practice, or Education. I think that Education is probably a better spot for it, although a blurb that they can specialize would still be good in SOP. DigitalC (talk) 00:24, 3 June 2008 (UTC)
• "In the United States, chiropractic schools are accredited through the Council on Chiropractic Education (CCE) and recognized by the US Department of Education with the stated purpose of insuring the quality of chiropractic education by means of accreditation, educational improvement and public information and allowing for grants and loans to chiropractic schools and prospective chiropractic students." This material needs to be sourced. Does the DoE really recognize chiropractic schools directly? Also, this stuff is really boring and too much detail and doen't all belong here. "insuring the quality of"? "public information"? "grants and loans"? "prospective chiropractic students"? My goodness but the unnecessary words are really thick here.

• "Recently, CCE standards were integrated into the English speaking countries of Australia/New Zealand, Canada, and Europe. These councils have since developed CCE - International in an effort to maintain chiropractic education standards globally. The cited source says nothing about "recently" or "integrated" or "Australia" or "New Zealand" or "Canada" or "Europe". The text needs to be reworded to match the source, or a better source found. Eubulides (talk) 05:13, 31 May 2008 (UTC)
  • I propose a rewording to "The US CCE has integrated with CCEs in Australia, Canada, and Europe forming CCE - International to "assure excellence in chiropractic education and quality in the profession through accreditation"using this as a reference. DigitalC (talk) 11:47, 31 May 2008 (UTC)
    • That's better, but it still says "integrated". CCE - International is not an "integration". The quote is not accurate, as it contains wording like "assure" that is not in the source. (Ouch! Quotes must be accurate.) But let's not simply quote the source; let's say what CCEI does. CCEI's main accomplishment is to generate model accreditation standards with the goal of having credentials be portable internationally. Let's say this rather than quoting its nearly-vacuous text about "excellence in chiropractic education". Eubulides (talk) 08:39, 2 June 2008 (UTC)
      • CCE-I is an integration, the source uses "join" (as in "join together" to "form one whole"). Further, the quote IS accurate, and the word "assure" is directly from the source, directly from the quoted section. DigitalC (talk) 00:00, 3 June 2008 (UTC)
        • Sorry about the quote: I must have been looking at the wrong citation. You're right, the quote is indeed accurate. However, the other points remain: let's talk about what CCEI does rather than just quoting their blurb about "excellence". Eubulides (talk) 06:34, 3 June 2008 (UTC)
• "Today, there are 18 accredited Doctor of Chiropractic programs in the USA, 2 in Canada, and 4 in Europe and the UK." The cited sources cover just the U.S. and Canada; they do not mention Europe. Please just copy the sentence and citations from #Education, licensing, and regulation 6.

• "Regulatory colleges and chiropractic boards are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency." The cited source is just about Canada, and only about regulatory colleges; it does not mention chiropractic boards. Eubulides (talk) 05:13, 31 May 2008 (UTC)
  • If we include the following reference as well, it will also cover boards. DigitalC (talk) 12:14, 31 May 2008 (UTC)
    • Yes, that covers the boards (in the U.S.), but there's still the issue about Canada & colleges vs. boards and the U.S. Eubulides (talk) 08:39, 2 June 2008 (UTC)
      • Ah, I see what you are saying here. I think that is easily fixed with an and/or statement, as each location would have one or the other. So "Regulatory college and/or chiropractic boards are responsible..." DigitalC (talk) 00:24, 3 June 2008 (UTC) . In fact, I think it is fine the way it is. Reguatory boards, AND regulatory colleges are repsonsible, just not in the same jurisdiction. DigitalC (talk) 03:55, 3 June 2008 (UTC)
        • I suppose so. But now the current draft says there are colleges or boards in Mexico! How did that sneak in? I didn't see Mexico in the sources when I read them earlier. Is it really true that Mexico has boards? Eubulides (talk) 06:34, 3 June 2008 (UTC)
          • Yes they have a regulatory college, the "Colegio De Profesionistas Cientifico-Quiropracticos De Mexico" (College of Professional Scienfific-Chiropractors of Mexico). As currently referenced. DigitalC (talk) 07:08, 3 June 2008 (UTC)
• "The Federation of Chiropractic Licensing Boards (FCLB) oversees most of these regulatory bodies." The cited source does not mention "overseeing"; it's just a list of member bodies. The FCLB is more of a clearinghouse and forum; it does not have a formal oversight role. Eubulides (talk) 05:13, 31 May 2008 (UTC)
  • I agree with Eubulides that the FCLB does not oversee the boards, and I think it may be undue weight to mention the FCLB in this section. DigitalC (talk) 12:14, 31 May 2008 (UTC)

• Nothing is said about the distinction between straight and mixer schools. (QuackGuru also raised this point.) The straight/mixer distinction is worth mentioning briefly here, far more than the eye-glazing material about student loans. We do have a source for it, no? Eubulides (talk) 05:13, 31 May 2008 (UTC)

• Have you read #Education, licensing, and regulation 6 carefully? It has some good ideas, some along the above lines, some independent. I think it might help if you tried to read that draft carefully, just as we've tried to read this draft carefully. It does have flaws, but it has one important virtue: it's far better sourced.

Thanks. Eubulides (talk) 05:13, 31 May 2008 (UTC) :*"The cited sources cover just the U.S. and Canada; they do not mention Europe." The cited source clearly mentioned Europe, however there was a formatting error in the citation template. DigitalC (talk) 09:37, 31 May 2008 (UTC)

• ""Most commonly, chiropractors obtain a first professional degree in Chiropractic medicine (DC or DCM)." The cited source does not say anything about "Most commonly". It says only that DC or DCM are the recognized first-professional degrees. The source is a U.S. source so this would be for the U.S., which should be stated in the text (or a better source should be found)." I think the best way around this is to use QuackGurus wording, which is "Most commonly, chiropractors obtain a first professional degree in the field of chiropractic medicine." this then covers the B.AppSci, M.Sc (Chiro) etc. DigitalC (talk) 09:52, 31 May 2008 (UTC)
• "In North America, a 3 year university undergraduate education (90 semester hours) is required before applying to chiropractic college" - This should be changed to "In the United States...", using the CCE standards as a ref (p. 22). This is not true for Mexico or Canada(UQTR). Although, I guess using a CMCC reference as well, it could be said for Canada and the US, since UQTR is a university, not a chiropractic college... but thats just semantics. FTR, UQTR students enter directly from CEGEP .DigitalC (talk) 10:04, 31 May 2008 (UTC)

:*"followed by no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training." Again, this should be referenced using the CCE standards and CFCRB standards, removing the 1000 hours part, which isn't mentioned in either document. Or, as Eubulides mentioned, it could all be rephrased to show the suggestions of the WHO, although I think its better to show the requirements. DigitalC (talk) 10:32, 31 May 2008 (UTC)

• "It's tacky to have such an extensive quote. This should be reworded and trimmed. This sort of yawningly-boring detail is not needed in Chiropractic; it might be suited for Chiropractic education." It is interesting to see differing POVs (and I'm not talking NPOV here). I actually see this section as one of the highlights of this draft. It breaks up with wall of text with some bullet points. I see no reason to not quote the source here, and don't find it tacky. I also see this as an important detail, not a boring detail. There isn't WP:Policy over this type of thing, so it is best to get further input on disagreements like this. DigitalC (talk) 10:39, 31 May 2008 (UTC)

Unfortunately, it seems like Vassyana's plea to avoid nitpicking over minutiae was not followed by a couple of editors. I also disagree with Eubulides' claim that version 6 is "far better sourced". To me this is more of WP:IDONTLIKEIT than genuine concerns about content. There is a continuous attempt to remove the educational paths from the cited WHO source. Besides Eubulides personal opinion of it being 'boring' is there a more valid reason why it shouldn't be included? CorticoSpinal (talk) 18:16, 31 May 2008 (UTC)

Take another look at 3

I'm a little dizzy after trying to incorporate the suggestions above, but I think I got most. I'm still not happy with the first sentence, so could use some input there. I agree with DigitalC that the WHO statement with the formatting as it is actually makes the section more interesting, so I left it like that. Other changes were mostly fixing and adding references (thanks DigC) and moving and deleting what was already there... I agree that #6 is very close to being something I could agree to with a few changes (mostly cleanup)... see if we are any closer. -- Dēmatt (chat) 05:40, 1 June 2008 (UTC)

The long end run of WHO quotes is boooring stuff and undueweight. QuackGuru 09:47, 1 June 2008 (UTC)

Please explain how it is undue weight. This is the section on education and these are the international guidelines for chiropractic education expressed in a succinct and understandable way. I chose to use the exact quote in a bulletted fashion to highlight them and breaks up the text. We could rephrase them to remove the quotes, but I would still like to see the bulletted formatting. I unstruck the text. -- Dēmatt (chat) 14:09, 1 June 2008 (UTC)

They are just suggestions and guidelines and not something official. No reason has been given to give so much weight to something unofficial. This is the section on education and not education suggestions. Too much weight is being given for the suggestions. Besides, they are boring. There is a chiropractic education article for more detailed stuff. QuackGuru 16:00, 1 June 2008 (UTC)

One of the complaints that we get is that the article is too US-centric. Do you have any other sources about the requirements in other countries that we might consider as a replacement. I suppose we could use the CCE-International guidelines, but those, too, have to adopted by a country before they are effective. The WHO guidelines, especially using your suggestion to use the word "suggests", seems to be a good way to handle it? Remember, this does not mean that the techniques and procedures that chiropractors use (such as SMT) cannot be used by other professions; only that if they want to call it "chiropractic", they have to meet these guidleines. -- Dēmatt (chat) 18:14, 1 June 2008 (UTC)

I thought there was more detailed info about CCE - International but it got deleted. "The WHO guidelines, especially using your suggestion to use the word "suggests", seems to be a good way to handle it?" I disagree. The best way to handle the quotes is to delete the quotes. Draft 3 is very disappointing and a big step backwards. Draft #3 has been chopped up and detailed information has removed and the long WHO quotes remain. QuackGuru 20:43, 1 June 2008 (UTC)

I suppose we could put everything back in? Maybe just specific parts. Which ones do you want back in? -- Dēmatt (chat) 20:52, 1 June 2008 (UTC)

What is it that you oppose about the "WHO guidelines on basic training and safety in chiropractic"? Also, why is it that you feel that these are "not something official"? They are the official WHO guidelines. DigitalC (talk) 01:35, 2 June 2008 (UTC)

The guidelines does not always equal official standards. The guidelines are suggestions according to draft number 3. The quotes are boring, they are too long, and have weight problems. At this point, this draft has too many problems. This draft has things backwards. The boring quotes have been kept and useful information has been removed. For potential chiropractors, this section is essential. I hope we can create something that is both detailed and concise. I do not understand why quality information has been removed. QuackGuru 02:41, 2 June 2008 (UTC)

Actually, I preferred the longer version, but others wanted some things dropped out. I'm thinking it is going to be hard to make something that everyone likes, so we might have to go with things that are V and RS and NPOV. Then if we have disagreements, all we have to do is RfC again. Lets see what everyone else thinks. -- Dēmatt (chat) 03:19, 2 June 2008 (UTC)

QG, Just because the guidelines are recommendations/suggestions (thats what a guideline is, a guideline is not a requirement) does not mean they are not official. I for one think that they are what set this draft apart from the others as being better, and disagree with the assertion that they "are boring are too long", which is really just a personal point of view. Specifically, which quality information was removed that you are objecting to? I believe that some things were removed per WP:RS, and others due to WP:UNDUE. DigitalC (talk) 04:27, 2 June 2008 (UTC)

The guidelines are not official world stanadards. The end run of quotes can be removed due to WP:UNDUE. QuackGuru 02:22, 3 June 2008 (UTC)

Please read my previous comments along with this edit summary. QuackGuru 19:45, 2 June 2008 (UTC)

I have read your previous comments, and they do not provide a valid reason for objecting to the WHO guidelines, nor do they explain specifically which "quality information" you object to the removal of. DigitalC (talk) 00:36, 3 June 2008 (UTC)

And in reply to your subsequent edit, no one is stating that they ARE official world standards. However, they are official WHO guidelines. Again, this is not a reason for their removal, and I don't see how it is undue weight. DigitalC (talk) 03:15, 3 June 2008 (UTC)

They are not official world standards. So therefore too much weight is being given to have long block quotes for merely suggestions. QuackGuru 03:47, 3 June 2008 (UTC)

Frankly, my eyes are starting to glaze over looking at this text, which is to me quite boring, for what must be the 10th time. But let me try again:

• "Most commonly" The cited source does not say anything about "Most commonly".
  • deleted. -- Dēmatt (chat) 14:13, 3 June 2008 (UTC)
• "In the U.S., minimum prerequisites" is supported by two sources, one of which is for Canada, not the U.S. Please drop the Canadian reference, or rewrite the text to match the source.
  • rewrote. -- Dēmatt (chat) 14:13, 3 June 2008 (UTC)
• "followed by no less than 4200 student/teacher contact hours". This sentence is worded as if the 4200 hours are a prerequisite for applying to chiropractic school! Please fix the wording. The 4200 hours are during school, not a prerequisite for school.
  • rewrote. -- Dēmatt (chat) 14:13, 3 June 2008 (UTC)
• Again, the quoted three bullet-points should be shortened and summarized. I'm not opposed to the material, or even to the bullets; but there is too much detail here.
  • I think the quote is likely the most succinct I can think to write it. You can give it a try, but I like the bullets. -- Dēmatt (chat) 14:13, 3 June 2008 (UTC)
• The 2200 hours are part of the same suggestion as the 4200 hours; this should be stated. Also, the 1000 hours applies equally to the 4200 hours and to the 2200 hours. This should also be stated.
  • Not clear on this one. -- Dēmatt (chat) 14:13, 3 June 2008 (UTC)
• "state or provincial" -> "local"
  • some provinces or states could be HUGE. Local sounds small. -- Dēmatt (chat) 14:13, 3 June 2008 (UTC)
• A source is needed for "Upon finishing .... licenses". And a period is needed after it.
  • Really?
• "has integrated with" isn't supported by the source.
  • How about "joined". -- Dēmatt (chat) 14:13, 3 June 2008 (UTC)
• The "assure excellence in ... accreditation" quote is fluff. Just say that the CCE-I has generated model accreditation standards with the goal of having credentials be portable internationally. It's much better to say what the CCE-I has done than to quote its fluff about what it wants to do.
  • agree, rewrote. -- Dēmatt (chat) 14:13, 3 June 2008 (UTC)
• "Regulatory colleges and chiropractic boards..." The cited source says this is true for the U.S., Canada, and Australia, but apparently it's not true elsewhere. Please mention that this statement applies only to these 3 countries.
  • It may be true elsewhere. If we just put in those three, we lose others. -- Dēmatt (chat) 14:13, 3 June 2008 (UTC)

Hope this helps. Eubulides (talk) 08:39, 2 June 2008 (UTC)

• It does. Thanks to DigitalC above as well-- Dēmatt (chat) 14:13, 3 June 2008 (UTC)

Education, licensing, and regulation 4

This draft I wrote and now deleted is obsolete. QuackGuru 19:35, 2 June 2008 (UTC)

Comments on Education, licensing, and regulation 4

I have made some small adjustments. Some of the unnecessary references can be removed. Happy reading. _-Mr. G-_ 03:45, 28 May 2008 (UTC)