Misplaced Pages

Revision as of 05:00, 23 September 2010

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: 14 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.

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. Citizendium Porting (inactive) This article is within the scope of WikiProject Citizendium Porting, a project which is currently considered to be inactive.Citizendium PortingWikipedia:WikiProject Citizendium PortingTemplate:WikiProject Citizendium PortingCitizendium Porting

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: 14 days

Neutrality tag

Why was the neutrality tag at the top of the page removed? Was there a discussion about this? The tag was not meant to be removed until the mediation had taken place --Javsav (talk) 01:13, 23 September 2010 (UTC)

We don't have multiple sections under dispute. See Talk:Chiropractic#POV tag. QuackGuru (talk) 03:24, 23 September 2010 (UTC)

Recent controversial edits

ASF violation when there is no serious dispute

Two reviews of published studies on chiropractic practices found a lack of good methodology in the studies that were examined.

This is attribution in the text and a violation of WP:ASF. This is also editorializing which is a common problem on Misplaced Pages. QuackGuru (talk) 06:43, 22 August 2010 (UTC)

Only one of the studies concludes what you attribute to two studies. And "low quality" is far too vague to be a useful statement.--Anon 07:25, 23 August 2010 (UTC)

"Two reviews of published studies on chiropractic practices" is still a violation of ASF whern there is no serious dispute. Which reference said there are two reviews. QuackGuru (talk) 17:04, 2 September 2010 (UTC)

Do we have recent reviews that say the evidence base is good / excellent? If there is no disagreement of equal quality than I agree WP:ASF.Doc James (talk · contribs · email) 05:53, 15 September 2010 (UTC)

What we mean is that when it is a fact (a piece of information about which there is no serious dispute) it can be asserted without prefixing it with "(Source) says that ...", and when it is an opinion (a matter which is subject to dispute) it can be attributed using this sort of inline-text attribution.

Most facts, except the most obvious ones - like “Mars is a planet” and “Plato was a philosopher” - must be verified through a reliable source regardless of whether it is a truthful statement. However, for WP:ASF, it is how we present the verified text from reliable sources.

Misplaced Pages is devoted to stating facts and only facts, in this sense. Where we might want to state opinions, we convert that opinion into a fact by attributing the opinion to someone. When asserting a fact about an opinion, it is important also to assert facts about competing opinions, and to do so without implying that any one of the opinions is correct. It's also generally important to give the facts about the reasons behind the views, and to make it clear who holds them.

Requiring an inline qualifier for widespread consensus of reliable sources on the grounds that it is "opinion" would allow a contrarian reader to insist on an inline qualifier for material about which there is no serious dispute, using the argument that the material is an "opinion". This would mean, in the end, that all material in Misplaced Pages would require an inline qualifier, even if only one Misplaced Pages editor insisted on it, which is not the goal of ASF. Presenting a "fact" as an "opinion" is needlessly attributing uncontroversial statements, and so creating the appearance of doubt or disagreement where there is none. QuackGuru (talk) 19:39, 15 September 2010 (UTC)

I don't see any valid reason why we should not comply with ASF. I think the original version without the ASF violation should be restored. QuackGuru (talk) 20:00, 16 September 2010 (UTC)

There are serious disputes, attribution should be given. "Mars is a planet" is a completely different kind of statement to "the risks outweigh the benefits" for example, especially considering the methodology of that particular study (I know we are referring to different reviews here but the principle remains the same) -Javsav (talk) 00:55, 23 September 2010 (UTC)

You have not shown there is a serious dispute among reliable sources. QuackGuru (talk) 03:24, 23 September 2010 (UTC)

The word Critics failed verification

There was another controversial edit. For example, the word "Critics" is WP:OR.

Critics is not necessarily OR. It depends on usage. If it is accurate, the word can help to accurately describe a debate, essential to NPOV.

The conclusion of the reference says "The results of the study suggest that the continuing education course was effective in enhancing knowledge in the evidence-based approach and that the presentation was well accepted." The word "can" was added. That word is unsourced and also WP:OR. QuackGuru (talk) 03:36, 23 August 2010 (UTC)

The word 'can' only helps distinguish between a finding and a plain fact. It is not "OR" since it doesn't change the meaning significantly. "The results of the study suggest that the continuing education course was effective" and "Continuing education can be effective" are basically identical. Ocaasi (talk) 09:37, 23 August 2010 (UTC)

Agreed. To call "can" OR is slightly ludicrous Javsav (talk) 16:29, 23 August 2010 (UTC)

Critics is OR and no editor provided verification. Which sentence from the reference verified the word "Critics". QuackGuru (talk) 17:04, 2 September 2010 (UTC)

Per OR: Misplaced Pages does not publish original research. The term "original research" refers to material—such as facts, allegations, ideas, and stories—not already published by reliable sources. It also refers to any analysis or synthesis by Wikipedians of published material, where the analysis or synthesis advances a position not advanced by the sources.

Per V: The threshold for inclusion in Misplaced Pages is verifiability, not truth—whether readers can check that material in Misplaced Pages has already been published by a reliable source, not whether editors think it is true.

Again, which sentence from the reference verified the word "Critics"? QuackGuru (talk) 19:59, 15 September 2010 (UTC)

I requested verification but none was provided for the word "Critics". It is "OR" since the word is not written in any of the sources given. QuackGuru (talk) 20:00, 16 September 2010 (UTC)

I requested verification from the editor who originally added the "Critics" OR but the editor refuses to provide V. Ocaasi, do you agree the OR should be removed? QuackGuru (talk) 15:42, 20 September 2010 (UTC)

"Critics" is not OR, it is referenced at the end of the sentence, those people who did that study are the critics. I don't see why you have a problem with this rewording, it is making the page read more smoothly -Javsav (talk) 02:56, 23 September 2010 (UTC)

The word "Critics" is OR. The claim "those people who did that study are the critics." is also OR. Where in the source does it say they are "Critics". QuackGuru (talk) 03:24, 23 September 2010 (UTC)

It doesn't have to say it in the source, I have read the source and you can make the inference that they are critics of vitalism from the context. --Axxaer (talk) 04:57, 23 September 2010 (UTC)

You know it is not in the source and if you make up stuff that is not in the source then it is OR. QuackGuru (talk) 05:00, 23 September 2010 (UTC)

Unreliable chiropractic literature failed RS

A 2010 review by Edzard Ernst focusing on deaths after chiropractic care stated that the risks of spinal manipulation "far outweigh its benefit". The study was refuted by Anthony L. Rosner, who labelled the study as "blatantly misleading", citing lack of risk-benefit analysis and inclusion of deaths that were found to be not related to chiropractic care.

Adding the name of the author is not the way we write text for this article. This text is not about effectiveness and an unreliable source was added to the article that was written by Anthony L. Rosner. QuackGuru (talk) 06:43, 22 August 2010 (UTC)

My version of the text quotes the Ernst study directly. I can hardly see how someone else's interpretation is better than a direct quote. Anthony L. Rosner published a detailed argument against the study, I don't see why it should not be included. We need to present both sides of the argument.---Anon 07:25, 23 August 2010 (UTC)

• Trying to "balance" Ernst's study like this is not good editing: "The study received criticism in chiropractic literature, with one review calling it "blatantly misleading", citing a lack of risk-benefit analysis and the inclusion of deaths that were not related to chiropractic care." You shouldn't juxtapose peer reviewed literature with the opinions of chiropracters. Of course chiropracters won't like a study that says that their practice can be dangerous. What was the reception of the review outside chiropracty? Fences&Windows 10:55, 27 August 2010 (UTC)
  • Give us a link then.--Anon 06:37, 28 August 2010 (UTC)

WP:SPAM and WP:RS. The reference is unreliable that has banner ads on the website. The reference is not even peer-reviewed or from a journal. QuackGuru (talk) 17:04, 2 September 2010 (UTC)

A 2010 systematic review found there is no good evidence to assume that chiropractic neck manipulation is effective for any medical condition.

Without explanation for the second time an editor removed the above sentence, added duplicate material about risk-benefit that is in another section, and added an unreliable source from ChiroACCESS. This unreliable reference is WP:SPAM. QuackGuru (talk) 17:09, 2 September 2010 (UTC)

Once you're done accusing me of being a spammer, I will discuss the links with you. Until you do, go have a long read of the pages that you link to and WP:NPA.--Anon 11:54, 4 September 2010 (UTC)

I was making note that the website does have banner promotional links. This is a fact. See it for yourself. Does any other editor see the banner links on the website. Anyhow, the website is unreliable per RS. This is not a response from a peer-reviewed journal. QuackGuru (talk) 02:03, 5 September 2010 (UTC)

Chiroaccess appears to be an unreliable reference for unscientific literature in the chiropractic community. This alone disqualifies it especially when it is not a peer-reviewed article. QuackGuru (talk) 06:19, 5 September 2010 (UTC)

It was obvious that Anon included the source for the purpose of its content and not the ads on the page. Ads are not a great sign of scientific rigor, but neither do they disqualify a source. The website, Chiroaccess appears to be the primary reference for scientific literature in the Chiropractic community. That it has ads promoting products which the profession uses shouldn't disqualify it. Ever looked at the stationary in a doctor's office? You can't assume the conclusion that ChiroAccess is unreliable--that is the claim being addressed. If you want to make that argument, you have to have reasons. What reasons or sources make Chiroaccess unreliable or unscientific?

• The 2010 review of Ernst's study was written by Anthony Rosner, who is not some random practitioner. Here's his bio:

Anthony Rosner became Research Director of the International College of Applied Kinesiology in September 2009. From 1992-2007, he had been a Director of Research and Education at the Foundation for Chiropractic Education and Research and Director of Research Initiatives at the Parker College of Chiropractic from 2007-2009. After obtaining his Ph.D. in Medical Sciences at Harvard in 1972 and conducting postdoctoral research at the NIH in Bethesda and at the CNRS in Gif-sur-Yvette, France, in 1973 and 1974, he directed research and clinical chemistry laboratories at Boston's Beth Israel Hospital and at an affiliate of the Mayo Clinic, then taught chemistry and served as Department Administrator in Chemistry at Brandeis University and managed research operations in neonatology at Children's Hospital in Boston until he joined FCER in 1992. He chaired one of six charter committees at the inception of the National Center for Complementary and Alternative Medicine in 1992 and has served on the editorial board of three peer-reviewed journals, authoring papers reviewing manual medicine, critiquing recent publications of questionable research design, and exploring the role of homocysteine in provoking spontaneous vertebral artery dissection.

A nice bio doesn't make it a systematic review, but it means it's not spam and not 'unscientific' on its face. Editing in good faith means avoiding the absolute worst insinuations possible and focusing on the ones that are both more likely and more relevant.

• On the merits, the source is a direct criticism of the primary evidence against spinal manipulation--Ernst's 2010 review. It does not 'equal' or 'refute' Ernst, but it raises serious points, cites relevant literature, and deserves some mention in the Chiropractic article, if for no other reason than to accurately describe the current debate amongst actual members of Chiropractic and the research community. RS is presenting the whole story. This is part of the story. We don't have to present it as an equal counterweight, but the reality that the chiropractic profession finds Ernst to be incorrect or biased, and that this article speaks for them, means it should be included. If you want to place it outside of the EBM section, because MEDRS standards strictly apply to scientific studies, then that is an option, but it should then be included in a "response" or "criticism" or "ongoing debate" section, in which Chiropractic literature can speak to the claims. Ocaasi (talk) 06:04, 5 September 2010 (UTC)

• We should take it to WP:NPOVN and WP:RSN, the 2010 review of Ernst as well as the 2006 review of Ernst and get some feedback on if, where, and how, to include them: 2006 critique 2010 critique If you're so sure that these sources have no place in this article then others should feel the same way. Ocaasi (talk) 06:54, 5 September 2010 (UTC)

Do you think the website is a peer-reviewed journal? I don't see how it meets RS let alone MEDRS. What part of RS shows that non-peer reviewed chiropractic literature is reliable. References like this were removed a long time ago from this article. They were replaced with peer-reviewed literature per WP:MEDASSESS. QuackGuru (talk) 07:10, 5 September 2010 (UTC)

The Chiroaccess link I posted here was intended as an example of criticism. It is NOT and was never intended to be an "assertion of fact" or a medical result. It is a criticism and was presented as such. I don't think it's that common to publish criticism of fringe studies in peer-reviewed journals (and I do believe Ernst there is a classic example of a WP:FRINGE point of view).--Anon 07:28, 9 September 2010 (UTC)

Chiroaccess cannot possibly be considered a reliable source, except for the opinions of the authors of the article, if they meet WP:SPS. — Arthur Rubin (talk) 21:29, 9 September 2010 (UTC)

Agree Chiroaccess is not a reliable source and cannot per WP:MEDRS be used to refute a review article. Now if Anthony L. Rosner published his own review and it came to different conclusions than yes we could add him.Doc James (talk · contribs · email) 05:29, 15 September 2010 (UTC)

The article in Chiroaccess is an opinion piece, with no evidence of peer-review or quality of editorial oversight for the publication process. It fails WP:RS. The only possible way Rosner's opinion could be considered to meet RS is to demonstrate here that he is an acknowledged, published expert in this field. Even then, it will fail WP:MEDRS, since it is a primary WP:SPS and cannot be used to rebut a secondary source such as Ernst's review. Many reviews will have critics, but there are no grounds for including every (or any) piece of criticism of a secondary source unless that criticism enjoys wide-spread support as evidenced by other reviews expressing that view. That does not appear to be the case here. --RexxS (talk) 08:47, 15 September 2010 (UTC)

I see WP:CON to remove the unreliable Chiroaccess article from the chiropractic page. QuackGuru (talk) 20:00, 16 September 2010 (UTC)

The guy is not a chiropractor.. he has a PhD in MEDICAL SCIENCES and works at a research institute. It doesn't matter what JOURNAL it was published in.. it was only published in chiroaccess because that is where people would read it. This criticism needs to be included and it raises VERY valid points -Javsav (talk) 21:45, 18 September 2010 (UTC)

If you are going with consensus, it is anon, ocaasi and myself against you and doc.. so the consensus is to include it --Javsav (talk) 21:47, 18 September 2010 (UTC)

Consensus is not a voting system, and you seem to have ignored 2/0 and myself. It is abundantly clear that there is undue weight being given to fringe opinion, which per WP:PSTS must not be used to rebut the results of reliable secondary sources. --RexxS (talk) 22:20, 18 September 2010 (UTC)

Have you read the critique? It makes very valid points. QuackGuru was the one citing WP:CON. A systematic review can not conclude that the risks outweigh the benefits. Only a reviewer (Ernst) can. The review possibly can if it employs some risk benefit analysis formulae, which his does not. Whether or not the risks outweigh the benefits is completely subjective. If someone was suicidal, then the benefits would definitely outweigh the risks (If Ernst opinion was correct). While this is an extreme example, it is an example used to prove the point that this type of sentence is completely subective ("the risks outweigh the benefits"). Even Ernst has admitted that his views regarding chiropractic are "hotly disputed." Ernst's review claims that there is no good evidence to assume that manipulation is an effective treatment for any condition, however another review says it is effective for back pain. From WP:MEDRS "The range of reviews examined should be wide enough to catch at least one full review cycle, containing newer reviews written and published in the light of older ones and of more-recent primary studies" As such, Ernst's review can not stand alone, as it is not published in the light of old reviews; there has not been one review cycle. In Ernst's review he admits proudly that this is "the first review of its kind published in the literature". Sure there were 26 deaths since 1937 (>22 of them before 2000 when chiropractic developed much stricter regulations regarding cervical manipulations) but per how many treatments. In fact, if you consider that, the incidence is ridiculously low. Maybe we should calculate the incidence based on this data - this would not be OR, this would be manipulation of data within the review, which is allowed on wikipedia. I don't know how you could call someone with a PhD in medical sciences from harvard who runs a research facility a fringe opinion, in fact I'd much sooner call Ernst a fringe opinion, considering he has admitted that his views are hotly disputed. Can you comprehend the number of years of training in MEDICAL science and the effort and length of time it takes to write a thesis in MEDICAL science. This guy can not be biased in the least. I find it amusing that you say consensus is not a voting system when it clearly is... when an article is nominated for deletion it is basically the more responders that it should stay or the more that say it should delete, determines whether or not it stays or is deleted. And when you say that I am forgetting 2/0 and yourself, you had not commented under this subheading at all until now. -Javsav (talk) 08:16, 19 September 2010 (UTC)

Yes I've read the critique, and I've also researched where it is published. Valid points are those made by reliable sources, which neither you nor the critique are. If you personally dispute Ernst's conclusion "The risks of this treatment by far outweigh its benefit", then get your view published in a scholarly journal, and your argument will be taken seriously here. It's not our place to produce our own analysis of reliable secondary sources, we trust the processes in the publishing journal and subsequent reliably-sourced commentary to do that. You need to find a MEDRS-compliant source that makes your arguments.

I agree that Ernst's review need not stand alone, but all reliable secondary sources since the last Cochrane review need to be considered (including Ernst). QG has offered half a dozen of them. It would be helpful if you would bring forward the reliable secondary source within the current review cycle that supports your assertions.

The mainstream view is that reflected in the majority of reliable secondary sources; fringe views are those which have little or no currency within such sources. While my own experience of producing a doctoral thesis is of no consequence here, I have seen sufficient fringe theories put forward to know that academic credentials are no guarantee of a reliable source. Thankfully, the consensus on Misplaced Pages agrees with me. You need to understand that I have no view on Rosner's credentials, experience, commitment, or possible bias, since they are not relevant. I do hold a strong view that Chiroaccess is not a reliable source. If Rosner gets his views published in a high-quality journal such as IJCP, then we can discuss how they might be used.

I'm sorry you found humour in the fact that WP:CON is a not a vote. It is a process of discussion, based upon our policies, to arrive at a solution which a neutral outsider would judge as a fair representation of the reasonable views expressed. I'd strongly recommend you study that policy and consider how you can help build consensus. AfD is rather off-topic, but the instructions to the closer require them to evaluate consensus by the strength of the arguments presented, and their compliance with policy. I would not be surprised if any of the regular AfD-closers were offended your belittling of their efforts.

Finally, I'll draw your attention to my contribution to the consensus – clearly visible above, dated 15 September – and expect you to revise your last sentence. --RexxS (talk) 10:13, 19 September 2010 (UTC)

I've just read this whole section and as an outside opinion who is not involved in this article I have to say I agree with the editors above who say this is not a reliable source. If this is the only way to get to this opinion piece than it needs to be removed per the arguments made above esp. from RexxS and QuackGuru. --CrohnieGal 12:21, 19 September 2010 (UTC)

I'll concede that this is not a reliable source, in fact I always knew in the back of my mind that it was not a reliable source per se, but if he published it in a journal it would be, and it does raise valid points. All involved please read this discussion re: adding of more reliable sources to balance POV and QG's responses. Quack guru refuses to consider anything other than a systematic review a reliable source, not even a review. By the way, I am a Medical Student, I am not biased, and I can prove this is if you request it from me by showing the relevant documentation. I apologise for the comment Rexx, I was in the wrong and I in no way meant to offend you, but I have been here for a lot longer than you putting up with QG's stubborn ways as this archived discussion will show, and it is taking its toll on me, because studying medicine is an exhausting thing to do while having to concurrently argue with QG. Archived discussion on edits to safety section of article. It is a long but necessary read to understand the scope of the problem here. Crohnie Gal, the piece doesn't need to be removed, it was never in there for more than a second until QuackGuru reverted it. Thats just what he does. -Javsav (talk) 07:44, 20 September 2010 (UTC)

And I think you guys need to keep an open mind when it comes to chiropractic. I found this story by Quentin Wilson, a presenter on "Top Gear" extremely inspiring, and I think I may even include it under a subheading in the article as it is from the telegraph, a reliable source. Give it a read and see what you think (not about including it, just what you think about the story. If it was included it would be included under something like "notable cases", though I don't see QG allowing me to do that any time in the future, but pigs may fly. Many of the doctors I know and work with visit a chiropractor.) http://www.telegraph.co.uk/health/alternativemedicine/3318749/He-was-lucky-to-be-walking.html --Javsav (talk) 08:24, 20 September 2010 (UTC)

Javsav, I appreciate your enthusiasm for this topic, and I accept that all your contributions are made in good faith. While you have been contributing to this article since 4 August (longer than I), you might want to consider whether you have become too close to a single topic, and spend more of your time on other medical articles (as you did in 2006). Personally, I'm quite happy to keep an open mind about this topic, but none of us should be letting our own views get in the way of producing the best quality encyclopedic content. That means we have to ignore our own knowledge when writing text, and scrupulously rely on reliable sources for the content of the encyclopedia. Our policies on sourcing, although frustrating at times, need to be observed because this is a collaborative project, and without using those policies we will not make progress in moving forwards to improve the article. I still think that drawing up a list of MEDRS-compliant sources and discussing them dispassionately with QG to reach consensus, then writing an agreed text, will produce a better result in the long run. --RexxS (talk) 09:12, 20 September 2010 (UTC)

Thanks Rexx, but as you could see, none of those sources violated MEDRS and they did not contradict Ernst's study, rather offered opposing viewpoints but he would have none of it. Even the WHO statement which is considered equivalent to systematic reviews on the reliable soruces page was disallowed. The article as it is is too one sided and can completely malign a whole profession - people with jobs whose income relies on the fact that their employess do not go on wikiepdia and read a blanket statement such as "the risks outweigh the benefits" which would completely deter them from visiting their chiropractor again. I like to edit pages with an unbalanced POV because I do not think it is fair to screw over alll those chiropractors like this. Originally the statment in the lead simply read "and the risks outweigh the benefits" and it took a lot to get QuackGuru to even budge from that. This kind of conduct is bullying. Ocaasi has always discussed these sources dispassionately with QG to no avail. Re your suggestion - if you rea the archived link, that is exactly what Ocaasi did and to no avail -Javsav (talk) 10:52, 20 September 2010 (UTC)

Furthermore, I find it patronising and offensive that you are telling me to edit medical articles. I have the right to edit whichever article I see fit to edit, and I am in no need of your suggestions of which article to edit. -Javsav (talk) 08:40, 21 September 2010 (UTC)

I have read the archive and I still don't see any reliable secondary sources that contradict "the risks outweigh the benefits". The WHO source talks solely about adverse affects, and does not make the risk–benefit analysis that Ernst 2010 does. There really isn't anything in there that would suggest there is "a serious dispute with other reliable sources".

I'm sorry you're unable to take my advice in the spirit in which it was intended. I was suggesting that you might consider other articles, not to dispute your right to choose where you edit, but because experience of a broader range of wikipedia (especially in the less contentious areas) might be good for you. I won't raise the issue again. --RexxS (talk) 18:09, 21 September 2010 (UTC)

It has required only the very rare reporting of these accidents to malign a therapeutic procedure that, in experienced hands, gives beneficial results with few adverse side effects. adverse effects and beneficial results is about risk benefit. "gives beneficial results" you see when you put few adverse effects/beneficial results you get a risk/benefit formula. The Journal of Manipulative Physiological Therapeutics similarly found, "the direct evidence suggests that the healthy vertebral artery is not at risk from properly performed chiropractic manipulative procedures." This is from a reliable source. A crossover study found that increased risks of VBA stroke associated with chiropractic and general practitioner visits was likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. A literature synthesis found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care. further quotes from RELIABLE sources as per MDERS. I think you are biased here RexxS and you refuse to concede per MEDRS that these are reliable sources. There was a spirit in which your suggestion was intended, and I believe it was a negative one - it equated to "edit other pages because you are not welcome here" --Javsav (talk) 01:06, 23 September 2010 (UTC)

You can't compare adverse effects and beneficial results until you evaluate the amount of beneficial effect and the seriousness/incidence of adverse effects. If the beneficial effect is relief of low back pain and the adverse effect is mortality, then it needs some incidence figures to arrive at a conclusion. WHO did not say "the benefits outweigh the risks". Ernst did say "the risks outweigh the benefits". The Journal of Manipulative Physiological Therapeutics has all of 38 hits on PubMed. Which one were you quoting? Your allegations of bias and refusal to AGF of a fellow editor is a violation of WP:CIVIL. Cut it out and start producing some real sources that we can discuss. --RexxS (talk) 01:33, 23 September 2010 (UTC)

Unreliable references against MEDRS

This edit added more unreliable references. The references are very old. See WP:MEDRS. QuackGuru (talk) 17:04, 2 September 2010 (UTC)

Per MEDRS: * Look for reviews published in the last five years or so, preferably in the last two or three years. The range of reviews examined should be wide enough to catch at least one full review cycle, containing newer reviews written and published in the light of older ones and of more-recent primary studies.

References from 1978 do not pass Misplaced Pages:Identifying reliable sources (medicine)#Use up-to-date evidence. QuackGuru (talk) 02:30, 5 September 2010 (UTC)

Per MEDRS: See the Reliable sources noticeboard for queries about the reliability of particular sources or ask at relevant Wikiprojects such as WikiProject Medicine or WikiProject Pharmacology.

If editors cannot agree we can take the recently added sources to one of the noticeboards. References from 1978 are not reliable because we have newer sources currently used in the article. QuackGuru (talk) 03:41, 6 September 2010 (UTC)

After requesting for the editor who added the 1978 studies against MEDRS to explain the edit the editor just reverted the comment. No explanation was made to use old studies to argue against newer ones. QuackGuru (talk) 03:14, 9 September 2010 (UTC)

I made this change to tag the unreliable references from 1978. QuackGuru (talk) 03:35, 9 September 2010 (UTC)

First of all it's a guideline not a rule. Second of all, you're quoting it out of context, the context is: "These guidelines are appropriate for actively researched areas with many primary sources and several reviews, and may need to be relaxed in areas where little progress is being made and few reviews are being published". Thirdly, I listed the studies in chronological order, with newer studies coming after, this shows that there have been conflicting results over the decades. Finally, if you have a newer study that compares joint mobilization to chiropractic manipulations please feel free to point it out.--Anon 07:21, 9 September 2010 (UTC)

I did not quote MEDRS out of context. I quoted the most relevant part. We don't need to relax the reference selection because there are currently plenty of sources on the topic of hand.

"A 2006 review found no rigorous evidence supporting SM 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. A 2004 review found that SM may be effective for migraine and tension headache, and SM and neck exercises may be effective for cervicogenic headache. Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of SM."

I don't see how there is little progress when we do have newer sources available. MEDRR is a guideline that is very easy to follow for this page especially when there are newer sources available. According to MEDRS we "Look for reviews published in the last five years or so, preferably in the last two or three years." So in this case we shouldn't use sources over the decedes. QuackGuru (talk) 02:46, 10 September 2010 (UTC)

I disagree and I think the studies have their place. Per my reasons above.--Anon 05:44, 10 September 2010 (UTC)

Actually, the dated studies don't have a place in this article per the progress made on this topic and extensive recent reviews. QuackGuru (talk) 18:27, 12 September 2010 (UTC)

There has not been little progress and there has not been a few reviews being published. In fact, there has been a lot of progress and clearly there has been more than a few reviews on the topic. MEDRS is not a policy but for alternative medicine articles like chiropractic editors have followed MEDRS. Using old unreliable references to argue against newer high quality references like the Cochrane Database Syst Rev is against MEDRS. QuackGuru (talk) 18:27, 12 September 2010 (UTC)

I still don't agree. But, how about we just write: "A 1978 study found <etc>. However, more recent studies <etc>"?--Anon 10:17, 13 September 2010 (UTC)

Articles from 1978 are not usually usable except maybe in a section on history or about conditions that no longer exist. Please use something from the last 10 years (3 to 5 years) is best. 1978 is \before the term evidence based medicine even existed.Doc James (talk · contribs · email) 05:40, 15 September 2010 (UTC)

Sir Anon, I disagree with your proposal. "A 1978 study found" is from a dated reference against MEDRS. "However, more recent studies" is editorialising which is against V and OR. At this point I think it is best to seek outside comments to help resolve the dispute over the references. See Misplaced Pages talk:WikiProject Medicine#Recent controversial edits. QuackGuru (talk) 05:49, 15 September 2010 (UTC)

Since there are multiple recent reviews from the Cochrane 2004 review onwards, the text of the Effectiveness/Headache section should be written to reflect the views expressed in those secondary sources. It is wholly inappropriate to introduce text based on a 30 year old source, particularly when it conflicts with current mainstream medical opinion as shown in the recent secondary sources. --RexxS (talk) 09:05, 15 September 2010 (UTC)

Let's stay away from 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.

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.

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; they are from many different authors. Other reliable review sources are welcome, as per the usual WP:MEDRS guidelines. Reaching down into primary studies is dubious.

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. QuackGuru (talk) 19:39, 15 September 2010 (UTC)

It may be considered a little arbitrary to simply pick a figure of 5 years old, as not all niche fields will have necessarily completed a review cycle in that period of time. A Cochrane review is often the most significant review in a cycle and may be expected to comprehensively summarise all significant previous studies. In this case, I'd humbly suggest that 6 years (the time since the 2004 Cochrane review) would be a justifiable cut-off point. I would therefore suggest that the 2004 Cochrane review should be the starting point for the text, built upon by taking into account the views expressed in later reliable secondary sources, where they introduce developments or aspects not already covered. It should go without saying that WP:ASF expects that we should assert these views as facts, without the distraction of attribution (after all, anyone can see the reference used for the text). Obviously the only exception to this is where two recent reliable secondary sources differ in their views, where it may be necessary to contrast the views and attribute each (although from what I've been able to read in the sources, it appears unlikely that it will be necessary in this case). --RexxS (talk) 20:38, 15 September 2010 (UTC)

Per Misplaced Pages:Identifying reliable sources (medicine)#Use up-to-date evidence:

"These are just rules of thumb. There are exceptions:

Cochrane Library reviews are generally of high quality and are routinely maintained even if their initial publication dates fall outside the above window."

I suggest we stick with about five years. When there is an older Cochrane review we will cite it until a newer Cochrane review is available. QuackGuru (talk) 20:52, 15 September 2010 (UTC)

I think we're pretty much in agreement then. When I considered the sources that you kindly provided in the collapse box above, I didn't want to lose Bondi (Jun 2005) because an arbitrary sharp 5 year cut-off would disqualify it (by a few months), and I didn't think that was the spirit of WP:MEDRS. It ought to be justifiable to consider such structured reviews, since they postdate the Cochrane review. Would you then agree that the sources in the collapse box could comprise the short list for sourcing the text in this section, or are there others that ought to be considered? --RexxS (talk) 21:56, 15 September 2010 (UTC)

Every section must have a certain amount of information to thoroughly cover each specific topic. I think we are going to keep the reference until a newer, similar reference would replace Bondi 2005. We can strive for 5 but don't disqualify a ref because it is six or seven years old. QuackGuru (talk) 20:00, 16 September 2010 (UTC)

I see WP:CON to remove the dated 1978 articles from the chiropractic page. Editors should try to stick within five years using recent reviews. If the section is very short then we can relax MEDRS a bit to include an additional ref or two. QuackGuru (talk) 20:00, 16 September 2010 (UTC)

Done. - 2/0 (cont.) 15:59, 20 September 2010 (UTC)

Failed verification

This change was made without explanation and does not seem to be written from a neutral point of view. The claim did not identify substantial benefits failed verification and seems to be the personal interpretation of an editor. We report what the source say not review the references ourselves. We don't put words in the cited source's mouth. See WP:V and WP:OR. QuackGuru (talk) 01:06, 8 September 2010 (UTC)

It might help to address editors directly. Also it's not great practice to make your points in discussion headings.

The edits were mine, as explained in the edit summary. Compared to the prior version, they improved upon both the unnecessary mention of Ernst's country of residence as well as clarified the logic which led him to his conclusion. It is not a personal opinion that Ernst does did not identify substantial benefits to spinal manipulation. That was my paraphrasing of his results. Can you suggest a different wording?

Referencing guidelines over and over does not help consensus, and implies editors are intentionally misusing or completely ignorant of policy. It also assumes your conclusion. It might be better to just offer alternatives or explain how something could be improved. That way it seems less like you're shooting down good faith edits and more like you're helping to educate and reach consensus. Ocaasi 03:15, 8 September 2010 (UTC)

It is a personal opinion that the review did not identify substantial benefits to spinal manipulation when it is not in the citation given and not in the results. The text failed verification because it is not in the source. The version of the sentence in the lead before the controversial changes were made was fine and sourced in accordance with V. If you still think it is sourced then what sentence in the article verified the text. QuackGuru (talk) 16:08, 8 September 2010 (UTC)

They might have been fine with you. I found them sub-optimal and think the more explanatory version is better to inform readers. It is not a personal opinion that Ernst did not identify substantial benefits. It is consistent with results. Could you rephrase that phrase so that it is more accurate? That would be better than constantly challenging under the pretense that other editors are trying to slip something past. I have a hunch that it is the word 'substantial' that is causing you a problem. Would you have a different word or phrase to consider? Ocaasi 17:02, 8 September 2010 (UTC)

You claim "It is consistent with results." But you did not provide verification which sentence supported your personal opinion. The previous consensus version before the controversial changes was made was well written and completely sourced. QuackGuru (talk) 17:13, 8 September 2010 (UTC)

This edit by Sir Anon did not provide verification for the part of the text that failed verification. The part "did not identify substantial benefits" is still original research. QuackGuru (talk) 03:10, 9 September 2010 (UTC)

Your comments towards others makes people reluctant to work with you. So it is all to easy to look at the article and try to fix it up without reading the pages and pages of comments you write here about what terrible policy-vioalting spammers the rest of us are.--Anon 07:24, 9 September 2010 (UTC)

I tried to discuss the matter with Sir Anon but the editor just reverted my comment without explanation. Sir Anon, please try to discuss here. QuackGuru (talk) 05:53, 9 September 2010 (UTC)

This statement is untrue and has nothing to do with the article, take it somewhere else.--Anon 19:35, 9 September 2010 (UTC)

It's not untrue, but it has little to do with the article. However, Anon's "correction" of Ernst's findings is not apparent from Ernst's paper itself; the {{fv}} tag is appropriate, regardless of whether QG's attempts to engage you on your talk page were appropriate. — Arthur Rubin (talk) 21:25, 9 September 2010 (UTC)

I've never corrected that sentence - you're mistaking me for another editor. With regards to the tag removal (which is my only change to that sentence), like I've already told QuackGuru above, I've misinterpreted the tag and at the time and I believed I was providing the requested verification in my edit summary. Apparently the dispute is about something else in that sentence, but I'm not part of that sub-dispute.--Anon 21:52, 9 September 2010 (UTC)

Sir Anon, you were told which part of the text failed verification but you did not restore the tag or provide verification. QuackGuru (talk) 02:46, 10 September 2010 (UTC)

I'm not paid to edit Misplaced Pages and I will only make edits I want to make myself. I believe that is my right.--Anon 05:46, 10 September 2010 (UTC)

@Anon, I made it very clear that the edits were mine at the beginning of this section. The diff shows as much. Either QG knows this already or isn't reading the posts. I offered to discuss the issue but QG seems to prefer his original version to finding a suitable phrasing for "did not identify substantial benefits".

@QG, if you want to find a different way of phrasing this, that would be better than just prodding editors to fix a problem that they either don't necessarily agree exists or have expressed an interest in your alternatives. The quotes from Ernst 2010 and the intertextual citation to Ernst's Critical Evaluation" paper are, respectively, as follows:

• "There is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition."
• "With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition."

It is true that Ernst did not identify substantial benefits to spinal manipulation. Is that the most accurate way to phrase his results? Perhaps not. I'm still open to your alternatives. We could just write that, the 2010 review, "concluded that since there is no evidence neck manipulation is an effective therapy for any medical condition..." Which was more or less the intention of my paraphasing. Do you have any thoughts about that? Ocaasi (talk) 08:21, 10 September 2010 (UTC)

Per WP:V: The threshold for inclusion in Misplaced Pages is verifiability, not truth—whether readers can check that material in Misplaced Pages has already been published by a reliable source, not whether editors think it is true.

All material in Misplaced Pages articles must be attributable to a reliable published source to show that it is not original research, but in practice not everything need actually be attributed. This policy requires that anything challenged or likely to be challenged, including all quotations, be attributed to a reliable source in the form of an inline citation, and that the source directly supports the material in question.

The source did not support the claim "did not identify substantial benefits" to spinal manipulation. It is true that the systematic review did not identify or say that were substantial benefits to chiropractic neck spinal manipulation. When the reference did not verify or support the claim that the source "did not identify substantial benefits" to spinal manipulation it is absolutely WP:OR. Per WP:V, the threshold for inclusion in chiropractic is verifiability, not truth. QuackGuru (talk) 18:27, 12 September 2010 (UTC)

Here is a copy-paste quote from the Ernst paper: "Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition (32) Thus, the risk-benefit balance for chiropractic neck manipulation fails to be positive." . I don't quite understand your and Arthur's objection to Ocaasi's summary of this. Do you have an alternative way of phrasing this in a few words?--Anon 10:23, 13 September 2010 (UTC)

Conclusions of a review article are not an "authors viewpoint" but a conclusion based on the evidence. We do not present review article conclusions like this.Doc James (talk · contribs · email) 05:49, 15 September 2010 (UTC)

The direct quote did not verify the claim "did not identify substantial benefits" per WP:OR or WP:V. But the direct quote did verify the claim "A 2010 systematic review found there is no good evidence to assume that chiropractic neck manipulation is effective for any medical condition.<ref name=Ernst-death/>" that Sir Anon deleted without a specific explanation. Hmm. QuackGuru (talk) 06:07, 15 September 2010 (UTC)

This change did not remove the text that failed verification or fix the the sentence that is not a concise summary. The part "while identifying no substantial benefits" is still OR. QuackGuru (talk) 15:42, 20 September 2010 (UTC)

I hope it was alright I removed the OR from the lead. QuackGuru (talk) 18:41, 20 September 2010 (UTC)

It is not OR - you have a very biased view of OR. Furthermore, you have been deleting my edits without discussion, and now only realising that this may have landed you in trouble you are now waiting for discussion to delete edits, and you have brought along with you two more biased editors. I may do similar to you and bring in some of my medical student friends with more of an open mind. --Javsav (talk) 01:09, 23 September 2010 (UTC)

QG is not in any sort of trouble, as he has not violated any policies. It is not acceptable to accuse another editor of "bias". QG did not bring along "two biased editors" and you need to retract that accusation. You have now threatened to violate our policies on meatpuppetry. I strongly suggest you stop attacking other editors and start discussing reliable sources. --RexxS (talk) 01:42, 23 September 2010 (UTC)

Javsav, it is OR and you have not even attempted to provide verification from the source being used. Moreover, you have previously overlooked the discussion and I hope you will at least try to keep an open mind on how other editors are editing in good faith. QuackGuru (talk) 03:24, 23 September 2010 (UTC)

Concise sentence

The first edit referred to in this thread was replacing the text "A systematic review determined that the risk of death from manipulations to the neck by far outweighs the benefits" by "A systematic review in England reported 26 deaths following manipulations, in the author's viewpoint far outweighing the potential benefits". WP:ASF is clear on this:

• "Assert facts, including facts about opinions—but do not assert the opinions themselves. A fact is a statement about which there is no serious dispute among reliable sources."

I see no serious dispute among reliable sources about the conclusion from the secondary source, so the attribution applied in that edit was a breach of the WP:NPOV policy. The original text needs to be restored. --RexxS (talk) 09:27, 15 September 2010 (UTC)

On further consideration, this is the lead of the article, and must be concise. The text of that sentence should read "The risk of death from manipulations to the neck far outweighs the benefits." --RexxS (talk) 09:39, 15 September 2010 (UTC)

"A systematic review determined that the risk of death from manipulations to the neck by far outweighs the benefits." (possible violation of ASF)

"The risk of death from manipulations to the neck far outweighs the benefits." (no serious dispute per ASF)

I agree the sentence should be concise. I'm fine with both versions but I prefer to assert the text because there is no serious dispute. QuackGuru (talk) 19:39, 15 September 2010 (UTC)

Unless other systematic reviews disagree it should be stated as fact. Doc James (talk · contribs · email) 22:29, 15 September 2010 (UTC)

There is a discussion here to restore the more concise version of the sentence but even more detail was reverted into the sentence. This is way too much detail for one sentence. We don't summarise the entire sentence in the lead. Another edit removed the word fatal from a previous sentence which was about fatal complications in rare cases. This balanced the next sentence which is about risk-benefit by far outweights the risk. Next, by far was removed which is sourced and the word neck was wikilinked which seems unnecessary. To state the year of the review in the lead is inappropriate and not a concise summary of the source. The date 2010 is not significant to chiropractic and is too much detail for the lead. Per WP:LEAD: The lead should be able to stand alone as a concise overview of the article. QuackGuru (talk) 16:38, 18 September 2010 (UTC)

A lot of problems were introduced into the article recently against MEDRS, ASF, V, and OR. There was also a lot of rephrasing that diluted the meaning of numerous sentences. At this point, I think the version that is closest to NPOV is this version. The difference between both versions can be reviewed here. QuackGuru (talk) 20:00, 16 September 2010 (UTC)

Relevant content was replaced with irrelevant content

The direct quote did verify the claim "A 2010 systematic review found there is no good evidence to assume that chiropractic neck manipulation is effective for any medical condition.<ref name=Ernst-death/>" that an editor deleted without a specific explanation. I think the relevant content should be restored and the irrelevant content along with the unreliable chiropractic article deleted. The section is about effectiveness not safety. QuackGuru (talk) 16:56, 19 September 2010 (UTC)

"A 2010 systematic review found there is no good evidence to assume that chiropractic neck manipulation is effective for any medical condition." I restored the sentence to Effectiveness since there was no explanation why it was removed in the first place. QuackGuru (talk) 18:37, 20 September 2010 (UTC)

Neutral talk page headings

This article is controversial enough without adding bias to the discussion headings. It prejudices interactions and can go against forming consensus. Talk page guidelines are pretty clear about this; I'm planning on rephrasing several of the headings on this page, unless there is objection consistent with the following:

• Misplaced Pages:Talk_page_guidelines#New_topics_and_headings_on_talk_pages

  Keep headings neutral: A heading should indicate what the topic is, but not communicate a specific view about it.

• Misplaced Pages:Talk_page_guidelines#Others.27_comments

  Section headings: Because threads are shared by multiple editors (regardless how many have posted so far), no one, including the original poster, "owns" a talk page discussion or its heading. It is generally acceptable to change headings when a better header is appropriate, e.g. one more descriptive of the content of the discussion or the issue discussed, less one-sided, more appropriate for accessibility reasons, etc. To avoid disputes it is best to discuss a heading change with the editor who started the thread, if possible, when a change is likely to be controversial.

Thoughts? Ocaasi (talk) 19:10, 9 September 2010 (UTC)

I tend to agree, but I expect the general meaning of the section headings to be retained, or your changes should and will be reverted. — Arthur Rubin (talk) 21:35, 9 September 2010 (UTC)

I'm glad you agree with the policy, but you seem unduly skeptical. Is there a reason you seem predisposed to doubt the motivations here or presume the need to act as an enforcer? If you check the edit history where this was addressed, I think you'll see the efforts were in line with policy. It is also fairly clear that current titles are not. Ocaasi (talk) 21:55, 9 September 2010 (UTC)

It was very provocative to dilute the meaning of the descriptive talk page headers. QuackGuru (talk) 02:46, 10 September 2010 (UTC)

Perhaps I should have ran it by you first, but I didn't see the guidelines until after; I was merely acting on an instinct for NPOV. That's why I used this section to discuss the changes. It seems policy backs it up, regardless of the motives you ascribe. I think it is beyond question that your versions of 'description' are reflective of your personal opinions rather than neutral headings. If you find that "diluting", then that is just part of the change from making a point in the heading to making the headings neutral and making a point in the section itself.

This is part of the issue about editing the same article as you, QG. By putting headings up such as "Failed verification" as opposed to "Verification and Ernst 2010" or something similar, it assumes your conclusions, presumptively shifts the burden of proof on others, denies the possibility of alternate good faith points of view or interpretations, and generally creates an atmosphere of contention rather than consensus. I don't think other editors will find my changes provocative, except to provoke a better editing atmosphere. Ocaasi (talk) 03:20, 10 September 2010 (UTC)

I have repeatedly asked for verification and you were not able to provide verification. The descriptive header name is clearly. QuackGuru (talk) 03:25, 10 September 2010 (UTC)

Two issues: The first is that you titled it 'Failed verification' before there was any response. That means that the outcome was determined before the discussion, which is the problem I am describing. The second is that regardless of the current state of our discussion (which hasn't even concluded), the outcome or accuracy of your claim is distinct from the topic itself. Headings are not verdicts; they are titles. They describe an area of debate, like 'climate change' as opposed to 'climate change deniers are wrong'. It is not relevant for the title whether the latter turns out to be true, because that is a matter for the discussion and not the header.

This small debate gets at the crux of our impasse. Your opinion is necessary but not sufficient to establish consensus. More importantly, it can be beneficial to explain your points rather than to just assert them. Like ASF for opinions, it creates a less adversarial environment to attribute opinions, especially where the assertion of them as fact seems to preempt or prejudice discussion. All that is easier accomplished under a neutral banner. I think that the same applies to more substantive disagreements, for adversarial dynamics can cloud or devolve broader debate as well. You seem to think that those aspects of civility are just attempts to 'muddy the water'. I think they're attempts to turn off the bullhorns. Ocaasi 04:02, 10 September 2010 (UTC)

I fully support more neutral talk page headings. QuackGuru, please consider this. We need to move forward.--Anon 05:43, 10 September 2010 (UTC)

Because policy appears unambiguous about this, and contentious editing has been a continual problem, I'm planning to change the headings and to assume that future sections will follow a similar convention. If QG would prefer to change his headings himself, go for it. If not, I'll put in neutral titles. Ocaasi (talk) 08:04, 10 September 2010 (UTC)

In regard "Failed verification":

1. There is no policy being violated; NPOV does not apply to talk pages.
2. The guideline suggests that the title should be changed; however, since the initial comment makes little sense with the proposed title, so this violates policy (and QG's moral rights, if not legal rights) by changing the meaning of others' comments by changing the context.

— Arthur Rubin (talk) 12:38, 10 September 2010 (UTC)

I've created a discussion on WP:AN with regards to this.--Anon 08:57, 11 September 2010 (UTC)

I think we should just change it, regardless of Arthur's comments. The "guideline" is on our side, while the "moral and legal rights" business has little to do with anything.--Anon 00:03, 12 September 2010 (UTC)

Actually, the guideline would only be in favor of you if you changed the section heading, and then reinserted the text (was "Section heading you consider objectionable") in the text just below the header. In that case, I would have no objection, even though QG may still have a valid objection to the change. — Arthur Rubin (talk) 02:31, 12 September 2010 (UTC)

• I don't support censorship as a way to form consensus, but there are certain ways of conducting discussions which keep the focus on issues rather than argumentativeness. Having a discussion under a section titled "You're wrong" is not ideal. I don't support the characterization that QG's rights are violated in any way, since the text of his argument remains 100% intact. All that changes is the title of the heading. For example, if I disagreed with you ardently and titled a section, "Why Editor x is completely, totally wrong", it would not really be civil, or conducive to discussion. That's akin to what is happening here, except the title says, "Why edit x is completely, totally wrong". The effect is the same, because it leads to a defense of an assertion rather than a discussion of a situation.
• It seems that the policy is overwhelmingly clear that headings are not owned by individual editors. What QG is actually doing it titling his comment. That's fine. If he wants to put put in bold Failed Verification:, like we do at an straw poll, that makes sense. But the title itself of the poll would never take a stance. Imagine the discussion about pending changes being titled "Pending changes is a waste of time". It would be preposterous. The heading would be "Pending changes", period, or "Is pending changes effective?", or "The future of pending changes". We discuss issues in a space defined by a title. The title is not supposed to take a side. I'm curious what Admin Noticeboard says. It might set an interesting precedent for controversial articles. Maybe we should throw out an RfC to clarify the policy.Ocaasi (talk) 02:44, 12 September 2010 (UTC)

It is very obvious that it is a fact that the text "did not identify substantial benefits" is not in the source given per WP:V. So the words did indeed fail verification. QuackGuru (talk) 18:27, 12 September 2010 (UTC)

Editing others comments is frowned upon and should not happen IMO. Yes the headings should probably be toned down but that is something you request the person who created them do themselves not something one should take upon themselves per "To avoid disputes it is best to discuss a heading change with the editor who started the thread".Doc James (talk · contribs · email) 06:16, 15 September 2010 (UTC)

I'm trying to catch up on discussions here since I haven't been watching for awhile. I have to state that I too agree that no editor has the right to change someone else's writing like being discussed above, unless it's not a discussion to improve the article. If you don't like the title ask the editor to change it. Right now you are discussing changes to heading that already have editors discussing things, so no you don't go changing what is said by anyone else. I would also suggest losing the us against them kind of comments that I see going on too. That also doesn't allow for nice conversations when editors decide who is with them or against them. Just talk about the disagreements going on, which from the looks of it are quite a few. No other comments as of yet since I am still 'catching up'. I left here because of circular conversations and bad attitudes so I'm looking to see if there is actually conversations to discuss the changes made to the article. Any help is welcomed to show me what the disagreements are that I maybe able help with. Thanks, --CrohnieGal 09:43, 18 September 2010 (UTC)

Crohnie Gal, please read the text quoted at the top of this section. Editing other users' comments is a no-no, but expecting fair and productive discussions to happen under talk page headers which serve double-duty as preemptive verdicts is not a good way to run a talk-page. And the guidelines pretty clearly support phrasing them neutrally. Ocaasi 07:24, 19 September 2010 (UTC)

Then you politely ask the editor who made the headers to change them to be more neutral. You don't wait until there is a lot of discussions going on under the headers and then say well these are wrong so I'm going to change them now. As is said above, it's frowned upon changing others editing here. I think if you ask QG, he may change them for you, have you even asked him? HTH, --CrohnieGal 12:28, 19 September 2010 (UTC)

The headings explain what the issues are because they are descriptive. Ocaasi prefers vague headings which do not explain the issues. I'm afraid Ocaasi has not yet provided verification for the controversial text Ocaasi added to the article. QuackGuru (talk) 16:17, 19 September 2010 (UTC)

Recent edits about Ernst

I have attempted to make changes to the description of Ernst 2010 "systematic review" of case reports describing "death from chiropractic", but it has been reverted each time. This "systematic review" has been used to conclude the section on safety of chiropractic, thus getting the final word in the section, and yet can not be given much weight at all in the overall debate. Critics of chiropractic (Ernst himself) have adamently refuted the use of case studies to support chiropractic efficacy for the treatment of any condition, and I am in 100% agreement with this. Case studies reflect anecdotal tales that are not able to be used to prove (or even suggest) causation. Thus, the description of Ernst 2010 review:

"A 2010 systematic review of published literature since 1934 found reports of 26 deaths that resulted from chiropractic manipulations... The dissection of a vertebral artery, typically caused by neck manipulation, was a likely cause"

is highly flawed. First, as mentioned, case reports cannot prove that the deaths resulted from chiropractic. These are anecdotal reports, and only support the need to do real research, they dont constitute research themselves. Further, A list of case reports (as represented by this review) are no more evidence than a single case report....simply a list of anecdotes. Finally, the last sentence is unsubstantiated, as vertebral artery dissections have not yet been proven in the literature to "typically result from neck manipulations".

Sincerely, 173.206.208.87 (talk) 11:05, 18 September 2010 (UTC)

173.206.208.87, please visit the Misplaced Pages:Mediation Cabal/Cases/2010-08-23/Chiropractic. This has been a problem for quite some time and QuackGuru will revert any edit without discussion. He is a bully. ---Javsav (talk) 13:13, 18 September 2010 (UTC)

IP 173, you may be right, and I also find flaws with the methodology, but we need to find published sources which say so, and the more reliable the better. We're currently debating whether Rosner's 2010 critique qualifies. There is also a published critique from 2006. I'm not sure if we can report on general issues with case studies that don't explicitly mention chiropractic, but it's worth figuring out.

Javsav, please strike your 'bully' comment. As I've said before, there are situations where it is worse to say it than to deal with it other ways.

Generally, while the mediation is going, we should try to use that as the forum to gain consensus, rather than letting edit-warring distract from it. These are complicated issues about research, bias, and policy, etc. that could use clarification on before changing.Ocaasi 04:51, 19 September 2010 (UTC)

Good comments above Ocaasi, nice to see. :) Is there a mediation page going on somewhere that I've missed? Thanks in advance, --CrohnieGal 12:31, 19 September 2010 (UTC)

Sorry, internet problems this morning. I missed the above comment about the mediation, my apologies for that. If I can stay online long enough I'll continue reading it. Thanks, --CrohnieGal 13:13, 19 September 2010 (UTC)

The mediation is going to officially start sooner or later when there is a mediator. The mediation is at Misplaced Pages:Mediation Cabal/Cases/2010-08-23/Chiropractic. QuackGuru (talk) 16:11, 19 September 2010 (UTC)

Conducting our own original research

Javsav, you suggested you want to average out the numbers. But you stated "Basically all they are doing is looking at each study and stating the numbers, they didn't even average it out." Averaging out the studies is conducting your own original research and a clear violation of WP:OR. When they didn't even average it out and you want to average it out yourself, you trying to put words in the cited source's mouth. QuackGuru (talk) 20:33, 18 September 2010 (UTC)

I think Javasv was suggesting we report on the study's methodology, not average the numbers ourselves.

As repeated before, accusing editors of violating policy assumes a whole host of not good faith things, namely that: a) you accurately understand what they want to change; b) that your interpretation of policy is correct; c) that the proposed change in fact violates policy; d) that there are not other reasonable interpretations of policy; e) that another textual change might not be suggested which improves the article nonetheless without violating policy; and f) in a word, that you're right and they're wrong. Starting discussions with these assumptions is why editing with you is more painful than necessary and less productive than it could be. If you're right, when all is said and none other editors will agree with you, even if you don't try to prosecute the outcome from the beginning of a discussion. Ocaasi 04:59, 19 September 2010 (UTC)

What source are you going to use to report on the review's methodology? Misplaced Pages editors have no remit to analyse and comment upon reliable sources, because that is original research. The place for such analysis is in scholarly journals, not in an encyclopedia. We reflect, in as neutral a manner as possible, what the reliable sources say. In Misplaced Pages terms, an expert is not someone who can tell you what the facts are; an expert is someone who can tell you where to find the best sources describing the facts. --RexxS (talk) 07:46, 19 September 2010 (UTC)

We don't need a tertiary source; we have the study itself. Why can't we describe its methodology? In specific, relevant places, details about how a study reached its results will inform readers about the current state of research and how studies have arrived at their conclusions. This allows readers to understand how research is progressing. We shouldn't make particular judgments, but we shouldn't be prohibited from detailing aspects of a study if they add explain the research findings using the study itself as a source. |Ocaasi]] 09:04, 20 September 2010 (UTC)

It's not a study; it's a review. What you are suggesting is not a description, but an amateur analysis of how you think a secondary source reached its conclusions. You are not qualified to do that. Nobody's suggesting using a tertiary source. If a later review includes an earlier review (secondary source) in its considerations, it does not make the later one a tertiary source. A secondary source performs analysis on earlier sources, and reaches its own conclusions; a tertiary source (such as an encyclopedia) merely aggregates other sources without performing its own analysis. We have no remit to provide our own unsourced interpretations of reliable sources, and attempting to explain what we think about such sources is prohibited. I hope that is clearer now. --RexxS (talk) 10:12, 20 September 2010 (UTC)

QuackGuru, I never said I was going to and never intended on averaging the values, however correct me if I am wrong, but is manipulation of data in that sense actually original research? RexxS, stating a study's methodology is not an analysis. It is a statement. --Javsav (talk) 08:37, 21 September 2010 (UTC)

If you say, for example, "The methodology was to review 200 studies and look for common trends", then you are describing the methodology – but that's an unnecessary detail in an article, particularly when the reader can click on the reference and see that if they are interested. If you were to say "He made a mistake by not averaging out" or "He was wrong to mention that study in his conclusions", then you are analysing the source, even though "it is a statement". You need to stop imposing your own value judgements on reliable sources. The place for that is in the scholarly literature. Get your analysis published in a quality journal, and then we can discuss it here. --RexxS (talk) 17:14, 21 September 2010 (UTC)

Actually, although you may be correct about the methodology of the study, the text cited in the page is from the abstract, which does not accurately reflect the study - and i never would plan on saying "he made a mistkae by not averaging it out" - what do you take me for? Please stop putting words into my mouth - this is harassment. Re the methodology - if we are talking about the methodology of the text from the abstract cited in the page the statement would read more along the lines of "The methodology was to review 200 studies and identify that with the lowest incidence and that with the highest incidence." - BUT that would only be if the text remains as it is in the page as it is currently because the way that it is written currently is not properly reporting upon the DATA of the review, that sentence is simply from the abstract. The true methodology of the review is different to this and I will compose a better sentence (not on the methodology, but on the data from the review from the discussion section directly from the review). And please stop continually patronising me by suggesting me that my analysis should be published in a Journal - I am am a medical student and do not have the resources or time for this, and as such you are implicitly harassing me by repeating this over and over again and I request that you would please cease this immediately --Javsav (talk) 00:47, 23 September 2010 (UTC)

Read WP:HARASS and collect your evidence as difs, then take your accusation to WP:ANI as described. Be aware that falsely accusing another editor of harassment is treated very seriously, per WP:HA#NOT. --RexxS (talk) 01:54, 23 September 2010 (UTC)

Violation of ASF when there is no serious dispute

This controversial change by Javsav added attribution in the text where there is no serious dispute and added "in a small scale Australian questionnaire" which is also a violation of ASF which implies there is a dispute when there is none. There was previous discussion about ASF violations. See Talk:Chiropractic#ASF violation when there is no serious dispute. QuackGuru (talk) 20:42, 18 September 2010 (UTC)

Mentioning the "small scale..." is undermining. But using attribution for the systematic review is okay. The recent and evolving state of research means that these issues are not "plain facts" per ASF. Editorial discretion allows us to use attribution if it will improve the article, especially in borderline cases. I think that trying to verifiably characterize the weight of findings, or mentioning the size/scope/date of studies helps readers to ascertain the state of research. That is an encyclopedic bonus, even if it prevents asserting all recent findings as definitive. Even a "Recent research suggests/has found..." is a way to contextualize these ongoing developments. As for findings like Ernst's risk/benefit balance, attribution can be useful, particularly if there is not corroboration through other sources; describing statements as "Current scientific consensus" is also a way to bridge the gap between relatively recent findings and the unequivocal status of textbook medicine which matures through decades of confirmation. Ocaasi 07:12, 19 September 2010 (UTC)

I'm afraid that MEDRS makes it clear that the contents of an undisputed secondary source are "plain facts" per ASF. Our encyclopedia reflects the current mainstream state of knowledge and is not news. It would be helpful to carefully review the advice contained in WP:MEDRS#Respect secondary sources, particularly the second and last paragraphs. It is acceptable to cite a primary study that illustrates a novel point, but it must be attributed. What is not acceptable is to use such primary sources to rebut conclusions already covered in a reliable secondary source, nor is it acceptable to present the findings of a reliable secondary source in the manner that implies they have the status of a primary. In other words: no, it is not ok to attribute reliable secondary sources, unless other reliable secondary sources offer different findings. It is not our job to "contextualise" secondary sources as a way of hinting that we personally disagree with their findings. We offer the references to the reader so that they can form their own judgements, but we don't allow our own judgements to colour the way we present the article text. --RexxS (talk) 08:07, 19 September 2010 (UTC)

Rexxs, I read the section closely and found no explicit support for treating systematic reviews (SRs) as plain facts. SRs are clearly supposed to predominate, to not be held on the same level as recent primary studies, and to be presented as scientific consensus if undisputed. But nowhere did I see anything about not mentioning where conclusions came from, in other words, attributing consensus to a systematic review, particularly when the review is the only one which draws a certain conclusion. In the case of Ernst's 2010 review, it was the first time anyone asserted unequivocally that the risk outweighs the benefits. That's fine. I disagree with aspects of his reasoning, but I have no problem presenting that view as described. I just want to attribute the conclusion to his systematic review, since that is where it came from, since the review was particularly recent, since the risk-benefit analysis was secondary to his study on deaths, and since he explained in his own words how he came to the risk-benefit conclusion, which we can paraphrase or quote for the reader's understanding. All of that traces back to Ernst. Why shouldn't we mention him and the prominence of his studies in shaping this scientific consensus? Ocaasi 09:23, 20 September 2010 (UTC)

From Misplaced Pages:Identifying reliable sources (medicine)#Definitions:

• "Literature reviews, systematic review articles and specialist textbooks are examples of secondary sources, as are position statements and literature reviews by major health organizations." (my emphasis)

From Misplaced Pages:Neutral point of view#A simple formulation:

• "Assert facts, including facts about opinions—but do not assert the opinions themselves. A fact is a statement about which there is no serious dispute among reliable sources."
• "An "opinion" on the other hand, is a statement which expresses a value judgment, or a statement construed as factual that does not reflect the consensus in other reliable sources."
• "Values or opinions must not be written as if they were in Misplaced Pages's voice. Factually attribute the opinion in the text to a person, organization, group of persons, or percentage of persons, and state as fact that they have this opinion, citing a reliable source."

It is abundantly clear from the above that a statement in a reliably published systematic review is a "fact" by our definition, not a mere "opinion", unless it is disputed by other reliable sources. When you decide to attribute a statement to a reliable secondary source, you are mimicking our convention to attribute opinions, which unjustifiably casts an aspersion on the authority of the fact. Your decision therefore introduces your unsupported POV, which indirectly disputes the statement. That is why such suggestions will be strongly rejected. If you have sourced information about the prominence of Ernst's studies in shaping scientific consensus in this field, then the article Edzard Ernst is the proper place for it. If you feel readers of this article would like to know more about Ernst's work, then a simple wikilink to his article will suffice. I'll add that now. --RexxS (talk) 10:43, 20 September 2010 (UTC)

Ocaasi, It is not that we should necessarily treat every systematic review as plain fact, it is that we need to concentrate on describing chiropractic without getting diverted by irrelevancies. In articles where the topic has only a few scientific papers, it can be appropriate to devote a detailed section to describing the nuances of each. In this case, though, that would severely overburden the article, distracting focus from presentation of the topic itself; this is doubly true in the lead section, which should be kept to no more than a few hundred words at most. - 2/0 (cont.) 12:34, 20 September 2010 (UTC)

If QuackGuru had alerted me to this discussion on the talk page I would have not continued edit warring.

If you read the study:Gouveia LO, Castanho P, Ferreira JJ (2009). "Safety of chiropractic interventions: a systematic review". Spine 34 (11): E405–13. doi:10.1097/BRS.0b013e3181a16d63. PMID 19444054.

You will realise that the estimate of 5 strokes in 100,000 manipulations is from a small scale australian study using a questionnaire. All the review does is compare different studies rather than averaging incidence. The first estimate is from one small australian study. As such, I have changed it to:

"A systematic review found that estimates for serious adverse events varied between 5 strokes in 100,000 manipulations (from a small scale Australian study using questionnaires) to 1.46 serious adverse events in 10,000,000 manipulations and 2.68 deaths in 10,000,000 manipulations"

QuackGuru consistently reverts this without alerting me to the discussion for no reason. Please respond with your reasoning QuackGuru. The way that this study is represented in the text now is blatantly misleading. The fact that the estimate of 5 strokes in 100,000 was an Australian study using a questionnaire is very relevant. --Javsav (talk) 04:15, 21 September 2010 (UTC)

Please don't edit-war. The only result of edit warring is that the page gets protected and that delays making improvements to the article. I was the one who changed the text to assert the findings of the review as fact (rather than attributing them). Your last edit to re-insert attribution was reverted by 2/0, and when multiple editors are reverting you (not just QG), you should be heading for the talk pages sooner.

Would you have another look at my second response to Ocaasi above (dated 10:43, 20 September 2010 (UTC))? It saves me having to repeat the same arguments to you. I do understand that you are unhappy with the findings of Gouveia 2009, but you need to have other reliable secondary sources publish the analysis you are making for it to carry any weight. While a reliable secondary source has its findings uncontested by another reliable source, those findings remain "facts" as far as Misplaced Pages is concerned. I hope you can see the point I'm making above: that if you treat an undisputed reliable source as if it were an opinion (by attribution), you are effectively expressing your personal disagreement with the source's findings to the readers, albeit subtly. On your final point, you are missing the fact that when a secondary source reproduces findings taken from a primary source, those findings then carry the authority of the secondary source, which has considered a broad range of the available sources and analysed them. We are not citing a small Australian primary study; we are citing a reliable, undisputed, secondary review, with all the weight that it carries according to WP:MEDRS. --RexxS (talk) 05:19, 21 September 2010 (UTC)

Actually, you seem to be missing my point. I am not unhappy with the findings, I just think there needs to be a clarification of what those findings were. The way that it is portrayed in the text in the article at the moment is ambiguous. especially because there is a huge disparity between 5 strokes in 100,000 manipulations to the other figures. Do you really think that is a realistic figure - there would be a lot more dead patients around if it were? A systematic review is meant to analyse multiple studies and average incidences, but the way that this review has been used in the text is that the author (QG) has simply stated the findings of a few studies. He may aswell have cited those studies rather than the systematic review. That was not a finding of the review, that was the finding of a small study. If you read the mediation cabal page I actually TOLD quack guru that I was going to reword it and he did not say anything to stop me. --Javsav (talk) 06:06, 21 September 2010 (UTC)

Javsav, I think you are confusing systematic review with meta-analysis.

Citing the systematic review is very different from merely citing the cited studies. The review gives both relevance to the numbers chosen and some assurance that a comprehensive search was undertaken. In this case, the finding being cited is that the true incidence is unknown and estimates vary widely, with the numbers being provided to inform the reader of both the range bracketed and the degree of variability. When someone comes out with a good estimate of the incidence of complications (preferably a large prospective trial of some sort), we can add that or even replace the current numbers. For now, though, we have to use the best sourcing available without editorializing. - 2/0 (cont.) 13:54, 21 September 2010 (UTC)

Violation of MEDRS when citing the 2010 systematic review

Well, it is unlucky for you that it was not a Cochrane review, because that means that the Ernst review is not allowed on the page as per MEDRS: "The range of reviews examined should be wide enough to catch at least one full review cycle, containing newer reviews written and published in the light of older ones and of more-recent primary studies." As such having only the Ernst review is violating MEDRS. -Javsav (talk) 20:58, 18 September 2010 (UTC)

According to the above comment in mediation it is a violation of MEDRS to use the 2010 systemativ review. I disagree. It would be a violation of MEDRS to not cite the 2010 review. Other reviews are being cited and no serious disagreement with the 2010 systematic review has been presented. QuackGuru (talk) 21:25, 18 September 2010 (UTC)

Third-party perspective here: This article is largely dominated by references to just one researcher: E ERNST. I've counted about 35 references to the one person. Be that as it is, I would say that this article suffers from a limited perspective.66.75.82.49 (talk) 04:52, 19 September 2010 (UTC)

Yes Ernst is a prolific reviewer and one of the most published authors on the subject. The Cochran collaboration has also been referenced 4 or 5 times. Increasing it us would be a good idea.Doc James (talk · contribs · email) 06:08, 19 September 2010 (UTC)

I am just pointing out that from my perspective, this article seems heavily one-sided. I would very much appreciate more and diverse sources. I don't know the rules of article writing too well but I would think that limiting the scope so narrowly does not make for good writing.66.75.82.49 (talk) 06:29, 19 September 2010 (UTC)

The way we write articles is by finding and reading the best reliable sources, and then reflecting what they say. When there is a content dispute between editors, the normal step is for them to bring to the talk page as many reliable sources as they can find, and then reach a consensus on the talk page what to include by using our policies of WP:RS, WP:NPOV, WP:UNDUE, and in this case WP:MEDRS. QG has offered half a dozen in a collapse box in the section Unreliable references against MEDRS above. Everyone else is able to make their suggestions. It is not productive to bemoan the limited number of sources already used, because that does nothing to move us forward. It is productive to discuss the sources already on the table, and add to them if you are able. That way lies consensus. --RexxS (talk) 07:34, 19 September 2010 (UTC)

A systematic review is the most efficient way to access high-quality information. No study, regardless of its type, should be interpreted in isolation. Thus, a systematic review is generally considered one of the best forms of evidence. Systematic reviews synthesize multiple studies, enabling increased and efficient access to evidence. QuackGuru (talk) 20:00, 19 September 2010 (UTC)

Ernst is completely antichiropractic and has admitted that his views are "hotly disputed". As such, this page suffers from bias --Javsav (talk) 06:03, 21 September 2010 (UTC)

Ernst is the leading researcher on chiropractic and his views are disputed in the chiropractic community but not in scholarly journals. QuackGuru (talk) 06:12, 21 September 2010 (UTC)

(comment removed) -Javsav (talk) 06:16, 21 September 2010 (UTC)

I've removed the previous comment by Javsav (talk · contribs · deleted contribs · page moves · block user · block log) for clear violation of WP:BLP, which applies to all pages on this project. --RexxS (talk) 06:40, 21 September 2010 (UTC)

Let me rephrase what I was saying, it is MY opinion that Ernst is clearly biased against chiropractors, his studies speak for themselves -Javsav (talk) 07:37, 21 September 2010 (UTC)

Your opinion is not WP:RS and is obviously WP:OR. QuackGuru (talk) 03:24, 23 September 2010 (UTC)

Way to point out the obvious QuackGuru, wow, my OPINION is OR? I'm flabbergasted that an OPINION is OR. How amazingly surprising. Well, pigs can fly after all. Ernst's studies are being given undue weight (WP:UNDUE) -Javsav (talk) 04:46, 23 September 2010 (UTC)

Yes, your opinion is OR if it was included in the article. Ernst studies have been carefully weighted. QuackGuru (talk) 04:53, 23 September 2010 (UTC)

Controversial change to 2010 systematic review

A 2010 systematic review of published literature since 1934 found 26 anecdotal case reports that associate death with chiropractic manipulations, with suspected substantial underreporting. The dissection of a vertebral artery was suggested to be the cause.

A 2010 systematic review of published literature since 1934 found reports of 26 deaths that resulted from chiropractic manipulations, with suspected substantial underreporting. The dissection of a vertebral artery, typically caused by neck manipulation, was a likely cause.

This controversial change moved and changed the wording of the text. I think the text should be restored and moved back. QuackGuru (talk) 17:22, 19 September 2010 (UTC)

• With regard to the descriptor "anecdotal", I am in agreement...."anecdotal" was a biased adjective...I have removed it.
• With regard to the movement of the text, this is appropriate, as the description of the Ernst article is now located with the section that already described case reports of death following manipulation. The Ernst article is a review of all those case reports, thus it is best placed following the first sentence that states that there are case reports describing death after manipulation.
• With regard to the criticism of the text that was altered to say "association" of death with neck manipulation, The original interpretation was biased and incorrect. The Erst review article presents cases where "deaths that resulted after chiropractic manipulations" (a statement of association), this is not the same as the original version of the wikipedia text, which altered the true wording to state "deaths that resulted from chiropractic manipulations" (a statement of causation).
• Similarly, with regard to the criticism of the text changes "suggested to be caused by manipulation", I also disagree. The original text is unsubstantiated editorializing, the new wording is an accurate representation of the current state of the literature. I am unable to find any literature that has shown vertebral artery dissections are "commonly caused by neck manipulation". The Ernst review states "extension and rotation of the neck beyond the physiological range of motion, is thought to be the underlying mechanism". Thus, this mechanism is a suggested cause.173.206.208.87 (talk) 21:13, 19 September 2010 (UTC)

The case reports in the beginning of the paragraph are about stroke not death. So the text should be moved back. It was more than merely an association. Death resulted directly after chiropractic manipulation. The review states "extension and rotation of the neck beyond the physiological range of motion, is thought to be the underlying mechanism". But the review went on to say more along the lines of a "likely cause". So the cause was plausible and after manipulations. QuackGuru (talk) 21:31, 19 September 2010 (UTC)

• "the likely cause" and "the cause" are in no way the same thing. Further, the review describes the "alleged pathology", an admission that causation was not verified in any of the cases. Also, the "alleged pathology" was almost always due to stroke, thus it belongs with the first sentence describing cases of stroke after manipulation, that is, Ernst picked out those cases where the stroke ultimately resulted in death. 173.206.208.87 (talk) 21:52, 19 September 2010 (UTC)

Stroke and death are two different things. This is confusing to move the text about death to the beginning about stroke. You seem to know the source says "the likely cause" but you changed the text to weaken its original meaning. QuackGuru (talk) 22:03, 19 September 2010 (UTC)

• I still fail to see how the statement "a likely cause" is anything more than an association? Perhaps I am missing something, but a "likely cause" is not "the cause" until it has been proven through original research (or I guess in a court of law). This review presents 26 case studies where each case "alleges" (taken straight from the review itself) that manipulation was the cause. Causation was not shown in any of the cases. You seem to know this, but have changed the text to strengthen its original meaning and sensationalize the outcome. 173.206.208.87 (talk) 22:24, 19 September 2010 (UTC)

The statement "the likely cause" following chiropractic manipulation is from the source per WP:V. To claim it was just associated with manipulation weakened the claim. The study was about death not stroke. Do you have a copy of the Ernst review? Other studies do claim causation. CONCLUSIONS: Weak to moderately strong evidence exists to support causation between CMT and VAD and associated stroke. QuackGuru (talk) 02:15, 20 September 2010 (UTC)

I have the article, it doesnt change the facts. If the weak to moderate evidence that supports causation is your bottom line, then use it in the sentence, ie., "26 published case reports of death following cervical manipulation were found; weak to moderate evidence supports the suggestion that neck manipulation resulting in vertebral artery dissection was the cause."

I honestly think this review is already given far to much weight in the debate anyways, as it is simply a collection of anecdotes. It is solely the fact that it was somehow allowed to be labelled a review that it is getting this much attention in the wikipedia article. Another contributer, 2over0 has a great quote on his profile: "The plural of anecdote is confirmation bias." 209.183.26.162 (talk) 14:28, 20 September 2010 (UTC)

Here is a quote from Ersnt himself. "Many chiropractors claim that, because arterial dissection can also occur spontaneously, causality between the chiropractic intervention and arterial dissection is not proven. However, when carefully evaluating the known facts, one does arrive at the conclusion that causality is at least likely (e.g. 30,31)." QuackGuru (talk) 15:42, 20 September 2010 (UTC)

"The published literature contains reports of at least 26 deaths since 1934 following chiropractic manipulations. The dissection of a vertebral artery, typically caused by neck manipulation, is a causality that is at least likely."

I rewrote the text to more accurately reflect the source presented. QuackGuru (talk) 18:35, 20 September 2010 (UTC)

There is no way that it can be proven that that was the cause as vertebral dissection is often spontaneous. I am in agreement with 209.183.26.163--Javsav (talk) 06:21, 21 September 2010 (UTC)

Misplaced Pages is not about proving things. I provided verificationn and wrote the text in accordance with V. QuackGuru (talk) 06:23, 21 September 2010 (UTC)

Misplaced Pages is not about proving things? I never said wikipedia was about proving things. All I am saying is that on the part about risk benefit it should say that it was only assumed that chiropractic was the cause -Javsav (talk) 07:39, 21 September 2010 (UTC)

The part about risk benefit should not say that it was "only assumed that chiropractic was the cause" because this would be reviewing the reference ourselves and conducting our very own original research. QuackGuru (talk) 19:31, 21 September 2010 (UTC)

It is not OR, it says in the review that "The dissection of a vertebral artery, typically caused by neck manipulation, is a causality that is at least likely" As such, it is assumed that chiropractic was the cause - he says so himself in the review. There was no way of proving this, he said that it is a causality that is at least likely - but not proven. CONCLUSIONS: Weak to moderately strong evidence exists to support causation between CMT and VAD and associated stroke. weak to moderate evidence --Javsav (talk) 01:54, 23 September 2010 (UTC)

As such, it is assumed that chiropractic was the cause? We don't conduct our own review of the source presented. That would be OR. QuackGuru (talk) 03:24, 23 September 2010 (UTC)

It is not OR. The dissection of the vertebral artery WAS suggested to be the cause as per Ernst's review. You don't have to quote the study word for word, in fact that would be plagiarism. Ernst did suggest that VA dissection was the cause -Javsav (talk) 04:49, 23 September 2010 (UTC)

Controversial changes to safety

More recent research has contradicted the suggestion that neck manipulation can result in vertebral artery dissection, as the stresses and strains on the vertebral artery during chiropractic spinal manipulation of the neck were always much smaller than those produced during simple passive neck range of motion.

Further, animal models of the human vertebral artery have suggested that repetitive stresses of several magnitudes greater than that which result from spinal manipulation are required to produce any microtrauma in the arterial tissues.

This controversial change and this controversial change added original research and an unreliable reference that is not a systematic review of safety information. QuackGuru (talk) 21:57, 19 September 2010 (UTC)

• As was stated in the arbitration forum:

"There is no concept of "level of evidence" on Misplaced Pages." and "We substitute expert judgement here with a reliance on the outside world to make the judgements for us." and "No editor on Misplaced Pages is qualified to substitute their individual opinion on a reliable secondary source for the process involved in publishing that source." and "If it is weak or flawed, then scholarly literature will make those points."

• In this case, the article presented is peer reviewed and published, it is not our place to judge the evidence to be strong or weak at this point. If you dispute the evidence presented then you need to find equivalent or better research that disputes the outcome of this study. —Preceding unsigned comment added by 173.206.208.87 (talk) 22:02, 19 September 2010 (UTC)

It is our place to judge the reliability of the sources used. There is the concept of WP:MEDRS. QuackGuru (talk) 22:06, 19 September 2010 (UTC)

• If it is our place to judge the reliability of evidence which has already been accepted by the scientific community through peer review, then the crticism of my comments regarding Ernst review (a list of case reports, and the lowest possible level of evidence) still holds. As I was told that "No editor on Misplaced Pages is qualified to substitute their individual opinion on a reliable secondary source for the process involved in publishing that source" I hold to my claim that you cannot personally argue with a paper that has been peer reviewed and published in a legitimate journal. You are required to present research that refutes the findings of the Herzog paper, your opinion of its quality or level of evidence is irrelevant.173.206.208.87 (talk) 22:14, 19 September 2010 (UTC)

You have not shown how theses sources meet MEDRS. QuackGuru (talk) 22:15, 19 September 2010 (UTC)

Ok, I see what you are referring to (MEDRS), I will look into it before I further refute your opinion of the article I have presented. Thanks 173.206.208.87 (talk) 22:27, 19 September 2010 (UTC)

• Many thanks for pointing me to MEDRS, as it was very helpful in supporting my use of the Herzog article. MEDRS states that "Controversies or areas of uncertainty in medicine should be illustrated with reliable secondary sources describing the varying viewpoints." The article presented by Herzog "The biomechanics of spinal manipulation" is a secondary source (a review, invited by the editors of the Journal of Bodywork and Movement Therapies), thus is an acceptable source to refute earlier works. Further, in regards to the way I used the review by Herzog to make the claim of safety of spinal manipulation, this is also valid as the review "itself directly makes such a claim" (quoted from MEDRS) that: "Combined, the results of this study suggest that spinal manipulative treatments produce stretches of the vertebral artery that are much smaller than those that are produced during normal everyday movements, and thus they appear harmless."

Thus, it is a valid reference to support the point I made in the text of the wikipedia article, that "More recent research has contradicted the suggestion that neck manipulation can result in vertebral artery dissection". 173.206.208.87 (talk) 22:44, 19 September 2010 (UTC) I will compromise though, and remove the text that references the primary source, which describes an animal model. 173.206.208.87 (talk) 22:55, 19 September 2010 (UTC)

It seems your removal of the Austin 2010 study was reverted, and I will not revert a reversion, so I've gone ahead and attributed it as well as adding its caveat and Haynes' criticism of it. I leave to others to decide if there is now undue weight on the animal model topic, although it's the only study that seems to examine possible mechanisms of arterial dissection.

On the point you make above, I am by no means convinced that Herzog 2010 is actually a secondary source. However I can only see the abstract, but it seems to be written as describing a study, rather than a review of other studies. If someone who has access to the full text can clarify that it actually is a secondary source, I'd be grateful if they would amend my text to reflect that. --RexxS (talk) 00:46, 20 September 2010 (UTC)

I have no problem with any of the changes you have made...I feel that they very accurately reflect the current state of the literature and the controversial issue. As far as the Herzog paper goes, I do believe that it constitutes a secondary source. It is listed as an "Invited Review" on the journals table of contents , further the introduction of the article ends with: "Here, I will attempt to briefly review what is known about the external forces applied by chiropractors during HVLA manipulative treatments on patients, discuss selected effects of these forces, and then focus specifically on an increasingly important topic of internal force transmission: the stresses and strains experienced by the vertebral artery during HVLA neck manipulations." Thanks and best regards 173.206.208.87 (talk) 01:13, 20 September 2010 (UTC)

"Controversies or areas of uncertainty in medicine should be illustrated with reliable secondary sources describing the varying viewpoints." is irrelevant to this situation. There is no controversy or disagreement over the systematic reviews covering safety, thus is an unacceptable source to refute earlier works.

Herzog W. (2010). "The biomechanics of spinal manipulation". Journal of Bodywork and Movement Therapies. 14 (3): 280–286. PMID 20538226.

"The biomechanics of spinal manipulation" is not even a review according to the PubMed listing. Using this article to argue against systematic reviews is not appropriate per MEDRS. QuackGuru (talk) 02:30, 20 September 2010 (UTC)

QG, would you be willing to consider the point I mentioned above? I do not view the Herzog paper as a direct contradiction of Ernst, in that Ernst's review produces a convincing case for causality of arterial dissection by cervical spinal manipulation, but does not suggest the mechanism; while the Herzog and Austin papers explore possible mechanisms, without being able to reach an explanation (although Haynes' clarification does go some way to suggest a possibility). I also read allusions to the possibility that SM may exacerbate pre-existing conditions – which in no way invalidates Ernst's conclusions – and may explain the inability of Herzog and Austin to find a mechanism. I'd be content to see all of this removed from the article text on the grounds of undue weight, but I think you may be mistaken in suggesting the text be excluded on the grounds of non-compliance with MEDRS. --RexxS (talk) 09:35, 20 September 2010 (UTC)

QG it seems you are interpreting MEDRS to exclude other reliable sources. While systematic reviews are given prominence, their presence does not mean that any other reliable secondary (or recent primary) studies can't be included, proportionately, and accurately. This is not debunking Ernst; it is mentioning all relevant reliable research. MEDRS requires giving weight depending on source quality. It appears that you are trying to give Ernst 100% weight by excluding all other studies. Where does MEDRS support that? There is a way we can include these studies to accurately describe the state of research. Ocaasi 10:00, 20 September 2010 (UTC)

It seems QG is correctly interpreting MEDRS to leave out unreliable references before the section becomes bloated with irrelevant text. I am shocked there is a ref about rabbits in safety. If editors still feel strongly about the Herzog paper it can be moved to one of the spinal manipulation articles. QuackGuru (talk) 15:42, 20 September 2010 (UTC)

It seems that QG is incorrectly interpretting MEDRS to mean leave out any reference that does not support his view. The Herzog paper is a secondary source that deals with the biomechanical and anatomical considerations of vertebral artery dissection with regard to manipulation of the neck. This article most certainly belongs in the safety section of the article. I am in agreement with QG criticism of the inclusion of the animal studies, although it has been stated by a third aprty above that it may represent the only paper that deals with mechanism for VA dissection, thus its inclusion here may hold some value.209.183.26.162 (talk) 16:15, 20 September 2010 (UTC)

QuackGuru, you have a misinterpretation of MEDRS. You are allowed to add other reliable sources that aren't systematic reviews to include additional information. This paper should definitely be included in the safety section. You are biased against anything that has opposing views to yours and this is unhelpful to the development of a page with a NPOV -Javsav (talk) 02:04, 23 September 2010 (UTC)

You have stated it is merely a paper. A paper is an opinion piece and not worth mentioning. QuackGuru (talk) 03:24, 23 September 2010 (UTC)

Stooping to semantics now QuackGuru, how mature of you. It is a review. When you print out a review, it is a paper. You just don't want it included because it goes against your opinion. Stop commandeering this page -Javsav (talk) 04:51, 23 September 2010 (UTC)

Herzog 2010

This reference from Journal of Bodywork and Movement Therapies is being used in #Safety to support the text: A 2010 study by Herzog concluded that "stresses and strains on the vertebral artery during chiropractic spinal manipulation of the neck were always much smaller than those produced during simple passive neck range of motion." This is fine as far as it goes, but the relevance remains to be established. This is far from a top-tier journal, and the article does not directly address the question of safety. If this source is to be used, it should not be in such a way as to invite synthesis in contradiction to a more recent and more reliable source. - 2/0 (cont.) 15:12, 20 September 2010 (UTC)

So your presumption is that a review of the relevant literature dealing with the biomechanical and anatomical plausibility of vertebral artery dissection from manipulation (Herzog review) is less meaningful to the issue of safety then a review of case studies where death likely resulted from manipulation? I disagree whole-heartedly!! The Herzog review is valid and relevant to the issue of safety! 209.183.26.162 (talk) 15:49, 20 September 2010 (UTC)

Moreover, Your more recent and reliable source is a list of case-studies. I refer you to your own profile where you state: "The plural of anecdote is confirmation bias" As such, you are attempting to use confirmation bias to outweight a relevant review of biomechanical and anatomical considerations of the issue at hand. Please see "Controversial changes to safety" above where this has already been discussed and some consensus has already been achieved. The Herzog article is a review of the literature and thus constitutes a secondary source as per MEDRS. 209.183.26.162 (talk) 16:00, 20 September 2010 (UTC)

The Herzog paper is listed as an "Invited Review" on the journals table of contents , further the introduction of the article ends with:

"Here, I will attempt to briefly review what is known about the external forces applied by chiropractors during HVLA manipulative treatments on patients, discuss selected effects of these forces, and then focus specifically on an increasingly important topic of internal force transmission: the stresses and strains experienced by the vertebral artery during HVLA neck manipulations."209.183.26.162 (talk) 16:38, 20 September 2010 (UTC)

It fails WP:MEDRS, and I'm not entirely sure about regular WP:RS. It seems to be an inappropriate journal to discuss the results, and it may be a Chiropractic journal, making it inappropriate as a reliable source for "facts" in an article about Chiropractic. — Arthur Rubin (talk) 16:52, 20 September 2010 (UTC)

First, The Journal of Bodywork and Movement Therapies is not a chiropractic journal. Second, if it were, how would that compromise its relevence? Should we go to the entry on the usefullness of aspirin in the prevention of heart disease and see how many of the articles are not in medical journals? or to the satellite entry and see how many articles are not published in physics journals? 209.183.26.162 (talk) 18:53, 20 September 2010 (UTC)

It possibly meets RS. "Journal of Bodywork and Movement Therapies is the official journal of the Association of Neuromuscular Physical Therapists, Australian Pilates Method Association, and the National Association of Myofascial Trigger Point Therapists" is not exactly encouraging, and I can't see the editorial policy. However, it's published online by Elsevier, and gets around 1490 hits on Google Scholar, although a mere 136 on PubMed. I wouldn't agree that being an "X" journal necessarily makes a journal inappropriate as a reliable source for the "X" article (Nat. Rev. Cancer in Cancer? – it would just need to be treated with caution). It's the reputation of a journal in the scholarly literature that is the acid test, and examining its editorial and peer-review policies, along with how often its papers are externally cited that lets us make that determination. I'm undecided in this case, so perhaps someone more familiar with this field than I, can put this journal into context. --RexxS (talk) 18:59, 20 September 2010 (UTC)

"and it may be a Chiropractic journal" Firstly, it isn't. Secondly, do you realise the ludicrousness of your statement? All of the ERNST papers are completely antichiropractic - they are the antithesis of chiropractic, so by your logic they should also not be included in the article due to bias -Javsav (talk) 02:13, 23 September 2010 (UTC)

Austin 2010

This reference from Journal of Manipulative and Physiological Therapies is being used in #Safety to support the text: A 2010 study by Austin et al on the rabbit vertebral artery suggested that repetitive stresses of several magnitudes greater than that which result from spinal manipulation are required to produce any microtrauma in the arterial tissues, although the authors cautioned that "the results should not be translated to the human VA (vertebral artery) without due consideration." The quote from the authors and the Haynes 2010 following pretty much make the point here, but it is worth elaborating. While animal studies are a necessary part of medical advancement, there is a distinct issue of undue weight here. This is very early stage recent preliminary research, and care should be taken in this article that we do not present it as definitive or conclusive. It is interesting that people are doing this research, but the caveats strictly limit its usefulness to this article. Given the availability of higher quality and more directly relevant research, this paper should not be used at this time. If the relevant academic community takes note of the paper and begins discussing it in the proper context, then we should re-examine the issue. - 2/0 (cont.) 15:12, 20 September 2010 (UTC)

I am content with the suggestions of 2over0 with regard to the animal studies by Austin. I would be satisfied with its removal.209.183.26.162 (talk) 16:20, 20 September 2010 (UTC)

Template

I moved CONSISELEAD to {{Verbose}}, which makes it more general and less shouty. Rich Farmbrough, 05:20, 20 September 2010 (UTC).

Thanks, but you also changed "]" to "], Iowa", which I find a wholly unnecessary change. I'm more concerned by your changes of "specialty" to "speciality", "skillfully" to "skilfully" and "disproven" to "dis-proven", which appears to be a clear breach of WP:ENGVAR (unnecessarily changing from en-us to en-gb). These are not minor changes (in the Misplaced Pages sense of indisputable) and should not have been marked as such, especially when you fail to provide an edit summary. --RexxS (talk) 09:55, 20 September 2010 (UTC)

Those wording changes were unnecessary. I think a shortcut for {{Concise}} would also work. QuackGuru (talk) 15:42, 20 September 2010 (UTC)

Attribution of secondary sources

I've reverted this edit because it attributes a reliable secondary source that, at present, is not subject to serious dispute among reliable sources. WP:ASSERT is quite clear about this:

• "Assert facts, including facts about opinions—but do not assert the opinions themselves. A fact is a statement about which there is no serious dispute among reliable sources."

This includes the "5 strokes in 100,000 manipulations" fact, because it is sourced to, and relies for its authority upon, the same reliable secondary source, not simply the original Australian study. "Drilling down" within a secondary source to examine the primaries which it evaluates is discouraged, because it misses the point that the secondary source exercises an overview of multiple studies, which elevates the status of the finding.

The convention of attribution of secondary sources is reserved on Misplaced Pages for when multiple secondary sources differ in their findings, since it then becomes helpful to the reader to be able to identify which source stated what. Attribution is also appropriate for primary sources whose results are not examined by secondaries, since it then becomes clearer that the text is reporting an as-yet uncorroborated statement. Of course, attribution is expected when the text of any source is quoted directly.

I understand that Javsav feels that the findings of Ernst 2010 are disputed, but no reliable secondary source has been brought forward yet to support that. It is perfectly possible that such a source may exist (or may emerge in the future), but until such a source is found, we should not be diminishing the authority of a secondary source on the grounds that we find it misleading. Hope that helps. --RexxS (talk) 08:43, 20 September 2010 (UTC)

Javsav wrote this needs clarification as it is misleading without this, please stop reverting this quackguru without discussion. I did not remove the attribution in the text. RexxS removed it. It is misleading to imply there is serious dispute with Simon-says style attribution. I don't see Javsav disputing the results of Ernst 2010 with another reliable source per MEDRS. There is no serious disagreement. Attribution in the text is reserved for a serious disagreement. Here is some advise: When you're drilling down into a hole of primary sources, stop digging. QuackGuru (talk) 15:42, 20 September 2010 (UTC)

There is plenty of disagreement among reliable sources, read: Talk:Chiropractic/Archive_31#Proposed_edits_to_Safety Javsav (talk) 06:25, 21 September 2010 (UTC)

Exactly which reference disputes the varied estimates. QuackGuru (talk) 06:30, 21 September 2010 (UTC)

Converting a plain fact into a disputed opinion is a breach of ASSERT

The recently added phrase "studies from" is unnecessary attribution in the text. QuackGuru (talk) 06:43, 21 September 2010 (UTC)

I agree that between studies is suboptimal - the numbers cited are given relevance by the review article (I changed the text to Estimates ... vary instead of varied, but am leaving the between studies text for now - there is entirely too much edit warring at this article already). This sentence immediately follows one cited to the same review stating that the actual incidence is currently unknown. The fact that the estimates given come only from actual studies rather than just being numbers someone made up should be assumed. Am I missing the issue here? - 2/0 (cont.) 13:19, 21 September 2010 (UTC)

The part vary between accurately explains the context of the text but adding the words studies from is a breach of WP:ASSERT when no evidence of a dispute has been presented. The Estimates ... are a plain fact but unintentionally converting a "fact" into an "opinion" is needlessly attributing uncontroversial statements, and so creating the appearance of doubt or disagreement where there is none. QuackGuru (talk) 19:18, 21 September 2010 (UTC)

"Content" tag on Effectiveness section

There is currently a tag {{Content}} in Chiropractic#Effectiveness questioning the relevance of some of the material in that section. I removed the bit about deaths, as it is covered more appropriately at #Safety. Is this tag still necessary, or can we get by with discussion and more specific tags? - 2/0 (cont.) 16:08, 20 September 2010 (UTC)

The tag can be removed now. This is the edit that deleted relevant content and added irrelevant content to Effectivenss. QuackGuru (talk) 16:46, 20 September 2010 (UTC)

SYN tag

Quackery is more prevalent in chiropractic than in other health care professions which is a violation of the social contract between patients and physicians.

Chiropractic authors stated that fraud, abuse and quackery is more prevalent in chiropractic than in other health care professions.

I rewrote the sentence while removing the SYN tag. QuackGuru (talk) 18:20, 20 September 2010 (UTC)

POV tag

We don't have a dispute over the entire article. A lot of the problems were a few editors did not understand that they were adding unreliable references or violating ASF. There was OR added to the article and text that failed verification. I don't see a good reason to continue having a tag that is for a content dispute over the entire article when we don't have multiple sections under dispute. QuackGuru (talk) 18:27, 20 September 2010 (UTC)

Give it 24 hours, but unless anyone else objects I think we can remove the tag and work on individual sections. - 2/0 (cont.) 21:50, 20 September 2010 (UTC)

Sentence blanking

An IP deleted a sentence and also deleted two references from a sentence without explanation so I reverted it. I forgot to put in an edit summary for my edit. QuackGuru (talk) 19:21, 20 September 2010 (UTC)

"A systematic review determined that the risk of death from manipulations to the neck by far outweighs the benefits."

"In conclusion, numerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly." This is a copy from the full text PDF file which verified the claim per V policy. QuackGuru (talk) 06:02, 21 September 2010 (UTC)

Systematic review about safety

QuackGuru consistently is reverting my edits (4 times now without discussion) to the section about safety regarding a systematic review. The text as it was currently standing was "Estimates for serious adverse events varied between 5 strokes in 100,000 manipulations to 1.46 serious adverse events in 10,000,000 manipulations and 2.68 deaths in 10,000,000 manipulations"

If you read the study:Gouveia LO, Castanho P, Ferreira JJ (2009). "Safety of chiropractic interventions: a systematic review". Spine 34 (11): E405–13. doi:10.1097/BRS.0b013e3181a16d63. PMID 19444054.

You will realise that the estimate of 5 strokes in 100,000 manipulations is from a small scale australian study using a questionnaire. All the review does is compare different studies rather than averaging incidence. The first estimate is from one small australian study. As such, I have changed it to:

"A systematic review found that estimates for serious adverse events varied between 5 strokes in 100,000 manipulations (from a small scale Australian study using questionnaires) to 1.46 serious adverse events in 10,000,000 manipulations and 2.68 deaths in 10,000,000 manipulations"

QuackGuru consistently reverts this without discussion for no reason. Please respond with your reasoning QuackGuru. To revert without discussion of this completely reasonable edit is against wikiepdia's guidelines. -Javsav (talk) 03:33, 21 September 2010 (UTC)

I believe that this is being discussed at #Violation of ASF when there is no serious dispute. - 2/0 (cont.) 04:12, 21 September 2010 (UTC)

Me thinks there is also a discussion at #Attribution of secondary sources. Javsav, please don't accuse me of reverting your edit when another editor deleted the WP:ASSERT violations. I tagged the text. QuackGuru (talk) 05:09, 21 September 2010 (UTC)

Request citation

Two U.S. states (Washington and Arkansas) prohibit physical therapists from performing SM, I request a reference for the non-controversial text. See under Chiropractic#Scope of practice. QuackGuru (talk) 20:13, 21 September 2010 (UTC)

This Seattle Times blog article cites both states but indirectly. I'm looking for the actual legislation, but the citations are a bit tricky to pin down. In Washington, it's the WA PT Act of 1988. It's all over the news, since they're lobbying to change it, but I can't find links to the statutes themselves. Ocaasi (talk) 06:25, 22 September 2010 (UTC)

Request images

I request images of chiropractor spinal manipulations for the Treatment techniques section and historical chiropractic images for the History section. QuackGuru (talk) 20:20, 21 September 2010 (UTC)

"Brings Ridicule"

Keating writes of subluxation: "Acceptable as hypothesis, the widespread assertion of the clinical meaningfulness of this notion brings ridicule from the scientific and health care communities and confusion within the chiropractic profession." The last sentence of the first paragraph in our article paraphrases this describing subluxation: "a vitalistic notion that brings ridicule from mainstream science and medicine".

I don't think it sounds very encyclopedic. It maybe technically true, but the encyclopedic point is that subluxation has no support in mainstream science and has been an obstacle to the reputation of chiropractic as a legitimate modality. Something like that. But the way it is now focuses on the ridicule rather than scientific consensus or the historical significance which is that Vitalism has not been good for advancing the profession. Also, 'brings' in the present tense seems to be the wrong tense, and as a grammatical point, 'science and medicine' can't ridicule, since they are academic disciplines not speaking agents. Thoughts? Ocaasi (talk) 05:36, 22 September 2010 (UTC)

It maybe technically true? We are not dealing with truth here. We are repeating what is written in the source per WP:V. Do you think your rewrite suggestion that "subluxation has no support in mainstream science and has been an obstacle to the reputation of chiropractic as a legitimate modality." is verifiable. When proposing a rewrite it would help if you can show the text you want to include is sourced. The present tense for 'brings' is the way it is written in the Keating article. Changing the tense would say it is no longer ridiculed by maintream health care. It is 'mainstream science and medicine' not 'science and medicine'. The word 'mainstream' is another way of writing 'community' for brevity. It is best to keep the lead concise. QuackGuru (talk) 17:45, 22 September 2010 (UTC)

1. ^ Cite error: The named reference Ernst-death was invoked but never defined (see the help page).
2. ^ Cite error: The named reference Murphy-pod was invoked but never defined (see the help page).

• Misplaced Pages controversial topics
• All unassessed articles
• B-Class Alternative medicine articles
• B-Class Skepticism articles
• High-importance Skepticism articles
• WikiProject Skepticism articles