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Relevancy

Without any change to content, we can move the information to the most relevant section. See Chiropractic#Treatment techniques. QuackGuru 16:44, 3 October 2008 (UTC)

I disagree. The content in question seems to be more about Research rather than Treatment techniques. Thus I think right now it is aptly placed. -- Levine2112 17:18, 3 October 2008 (UTC)

• Certainly the 1st part of the content "Most research has focused ... research is equally of value regardless of practitioner" is aptly placed under Chiropractic #Evidence basis.
• However, QuackGuru makes a reasonable point about the 2nd part of the content "There is little consensus as to who should administer the SM ... treating backs and necks". This sentence is about the turf war between chiropractors and other professions over who should do SM. It's certainly a notable issue, but Chiropractic #Evidence basis is not a good place for this issue. Chiropractic #Treatment techniques looks like a better home for it. But exactly where in Chiropractic #Treatment techniques should it go? QuackGuru (or anyone else), do you have a suggestion? Eubulides (talk) 17:37, 3 October 2008 (UTC)

I recommend placing all the information I mentioned after the first paragraph at Chiropractic #Treatment techniques and then we can add a bit of context to the effectiveness section if necessary. QuackGuru 04:00, 4 October 2008 (UTC)

Please see my comment "We do have a section..." below. Eubulides (talk) 07:41, 4 October 2008 (UTC)

The information is in the Effectiveness section and we don't have a section called Research. It would be reasonable to move the information about research of a treatment technique to the appropriate section. The research is about the spinal manipulation treatment technique. The information does not describe the effectiveness of chiropractic. We can move the information and then add a little context about the research to the Effectiveness section if editors agree it would be appropriate. It can be expanded upon in the appropriate section. QuackGuru 17:46, 3 October 2008 (UTC)

• We do have a section Evidence basis, which is a reasonable synonym for "Research". If text is talking about research that is relevant to effectiveness or safety, Evidence basis is the best place for it now. There is a lot under Evidence basis that is relevant to spinal manipulation; I don't think we should move all that to another section. (If we did that, we'd be doing a giant refactoring of the article, and it's not at all clear it would be an improvement.) The 1st part of the content is about effectiveness research, so it's appropriate to put it under Chiropractic #Effectiveness.
• I'm afraid I'm not understanding all the suggestions here. There are too many. It'd be better to see specific wording changes.

Eubulides (talk) 07:41, 4 October 2008 (UTC)

Speaking of the turf war mentioned above, we don't even touch that topic. It includes lawsuits filed by the profession against other professionals who have used generic spinal manipulation without any intention to treat "vertebral subluxations", which is chiropractic's motivation for using SM. These lawsuits reveal a clear aim to limit all forms of spinal manipulation, regardless of intention, for the chiropractic profession. Here is something from an ACA press release that is quite relevant to this subject:

• “ACA President James A. Mertz, DC, DACBR, said, "With the latest response from HHS, the ACA's lawsuit against the Health Care Financing Administration (HCFA) has reached a critical point. While the ACA views the decision on physical therapists as a victory in itself, our fight is certainly not over. Nobody but a doctor of chiropractic is qualified to perform manual manipulation to correct a subluxation-not a medical doctor, not an osteopath. We will continue to pursue this lawsuit until we're assured that only doctors of chiropractic are allowed to provide this service to Medicare + Choice beneficiaries." (For the APTA's reaction to this, see the corresponding Practice Policy news brief "APTA Responds: PTs Will Continue to Perform Manipulation.")”

The ACA’s precise and correct choice of wording here is critical to an understanding of their meaning and intent. They pit two very different things against each other, quote:

• spinal manipulation performed by medical doctors, osteopaths, physical therapists, and other providers, in lieu of
• spinal manipulation to correct a subluxation performed by chiropractors.

The two purposes for manipulating, as well as the two groups who practice it, are contrasted. “Chiropractors”, with their roots in Palmerian biotheology, using manipulation "to correct a subluxation" (fiction), are pitted against “medical doctors, osteopaths, physical therapists, and other providers”, with their roots in evidence based medicine, performing “spinal manipulation” for real problems.

While the lawsuit mentioned in the press release seems to only limit their case to an attempt to reserve the right to manipulation performed by them "to correct a subluxation", later lawsuits have been filed (and even won) against others who did not perform manipulation for that purpose, thus revealing the profession's true motives. They want to take generic manipulation for any purpose - including legitimate ones - and which happens to predate chiropractic and has been used for centuries, and annex/steal it, by making it their own exclusive property. -- Fyslee / talk 01:10, 4 October 2008 (UTC)

I'm afraid the above discussion doesn't have an action item at the end. Could you please boil it down to a specific wording proposal? Certainly the turf-ware topic is notable and relevant. Presumably the wording would incorporate the one turf-war sentence we already have. Eubulides (talk) 07:41, 4 October 2008 (UTC)

Okay, here's a quick proposal that needs work. This is only a sketch with a few sources! I think we could logically include this as a subsection at the end of "Scope of practice":

Turf war over scope of practice 1

There is little consensus as to who should administer the SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors; the focus on SM has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.

Proposals for limiting the scope of practice have been made by now-retired reform chiropractor Samuel Homola:

How does that sound for starters? Let's discuss it and hammer it out into a consensus version. Its placement is also up for debate. -- Fyslee / talk 15:30, 4 October 2008 (UTC)

I have stricken this old version as it is only of historical relevance here. See the latest version below. -- Fyslee / talk 04:34, 8 October 2008 (UTC)

• The above discussion presents convincing arguments that this topic is more relevant to Chiropractic #Scope of practice than it is to Chiropractic #Treatment techniques. As I understand it, the basic idea is that Scope of practice should mention two notable issues:

• Whether chiropractors' scope of practice should be limited to backs and necks.
• Whether non-chiropractors' scope of practice should be limited to exclude spinal manipulation.

• However, the above proposal has only one sentence that is well-sourced, namely the "There is little consensus as to who should administer the SM..." sentence, which is already in Chiropractic but which would be moved to the new discussion, and which is sourced to Villanueva-Russell 2005 (PMID 15550303), a high-quality secondary source. The other text in the proposal is supported only by lower-quality primary sources (e.g., Homola, Seater, lawsuits). Two relatively high-quality sources were given, namely Murphy et al. 2008, PMID 18759966) and Nelson et al. 2005 (PMID 16000175), but they weren't used to support any claims. I suggest rewriting the proposal based on the three PMIDs mentioned in this bullet, dropping material that is less well-sourced (unless we can find better sources, of course).
• I expect that the two points can be made relatively briefly, in (say) a 3-sentence paragraph which could be appended to Chiropractic #Scope of practice. I suspect it wouldn't need to be a new subsection. Of course this is just a guess; we'd need to see the new material.
• I could try to propose something along the above lines, though I hope someone else will volunteer.

Eubulides (talk) 07:11, 6 October 2008 (UTC)

• If your arguments for not using some of the sources is based on WP:MEDRS, then I think it's a misapplication of MEDRS where it isn't relevant. It applies to scientific medical information, not political struggles, turf wars, and significant opinions, which is what this section is about. Here the relevant policies are V & RS. They justify inclusion of such sources in most of this article. MEDRS only applies to the nitty gritty details of scientific matters. I'm not saying that we should use all the sources I proposed, since I wrote that rather quickly, as I wrote in my introduction to the proposal. Significant views by Homola, other chiropractic sources and researchers, and non-chiropractic sources should be included if they are in V & RS, irrespective of MEDRS, since it doesn't apply here. -- Fyslee / talk 14:18, 6 October 2008 (UTC)

• I agree that WP:MEDRS is not applicable to turf wars per se: it's more for medical facts and figures. However, WP:RS does not justify the inclusion of primary sources such as the now-expired self-published advocacy website defendphysicaltherapy.com (one of the sources you cited). On the contrary, WP:RS #Primary, secondary, and tertiary sources says primary sources "must be used with extreme caution in order to avoid original research", and WP:RS #Self-published sources says "Self-published sources may be used only in limited circumstances, with caution." Now defendphysicaltherapy.com is an extreme case, but even Homola is iffy, as Homola is just one retired chiropractor who is expressing one person's viewpoint. It's much better to use sources such as Murphy et al. 2008 (PMID 18759966) and Nelson et al. 2005 (PMID 16000175), which are by multiple chiropractors and express less idiosyncratic viewpoints.
• Here are two other reliable secondary sources in this area that I just now found via a search:

• Theberge 2008 (PMID 18254831). This is specialized to sport medicine but has valuable comments to make in that area.
• Hilliard JW, Johnson ME (2004). "State practice acts of licensed health professions: scope of practice". DePaul J Health Care Law. 8 (1): 237–61.

• No doubt other reliable sources could be found. The point, though, is that we should prefer secondary sources, such as the four mentioned in this comment.

Eubulides (talk) 17:27, 6 October 2008 (UTC)

I fully agree that defendphysicaltherapy.com can't be used, but it does have some sources that could be of help. Homola is a very notable reform chiropractic author. He is what amounts to the Luther of chiropractic. His membership in the ACA was removed when he wrote his epic book Bonesetting, Chiropractic, and Cultism in 1963. Some thirty years later his dire predictions had been fulfilled, and the ACA restored his membership. Maybe they realized that history was catching up with them. No other chiropractor besides DD and BJ Palmer has been so controversial. Many of his writings are published in V & RS, and we can use those sources. Fortunately he is THE chiropractor who has earliest and most consistently represented the mainstream scientific POV within chiropractic, as his calls for legitimizing the profession by getting it to focus on a scientific and limited approach to treating back problems testifies. He has consistently sided with mainstream medicine, science, the insurance industry, and the law regarding their criticisms of quackery and healthfraud within the profession. As I mentioned above, my proposal was a quick attempt and it does need improvement, but not execution and amputation. The points made are legitimate, but may need some more and better sources. -- Fyslee / talk 03:38, 7 October 2008 (UTC)

Another reference from a very V & RS, and written by chiropractors, is related to the one above regarding sports chiropractic:

• "Australian chiropractic sports medicine: half way there or living on a prayer?" Pollard, et al, Chiropractic & Osteopathy 2007; 15: 14. Published online 2007 September 19. doi: 10.1186/1746-1340-15-14. PMCID: PMC2042981
• Abstract: "Sports chiropractic within Australia has a chequered historical background of unorthodox individualistic displays of egocentric treatment approaches that emphasise specific technique preference and individual prowess rather than standardised evidence based management. This situation has changed in recent years with the acceptance of many within sports chiropractic to operate under an evidence informed banner and to embrace a research culture. Despite recent developments within the sports chiropractic movement, the profession is still plagued by a minority of practitioners continuing to espouse certain marginal and outlandish technique systems that beleaguer the mainstream core of sports chiropractic as a cohesive and homogeneous group. Modern chiropractic management is frequently multimodal in nature and incorporates components of passive and active care. Such management typically incorporates spinal and peripheral manipulation, mobilisation, soft tissue techniques, rehabilitation and therapeutic exercises. Externally, sports chiropractic has faced hurdles too, with a lack of recognition and acceptance by organized and orthodox sports medical groups. Whilst some arguments against the inclusion of chiropractic may be legitimate due to its historical baggage, much of the argument appears to be anti-competitive, insecure and driven by a closed-shop mentality.sequently, chiropractic as a profession still remains a pariah to the organised sports medicine world. Add to this an uncertain continuing education system, a lack of protection for the title 'sports chiropractor', a lack of a recognized specialist status and a lack of support from traditional chiropractic, the challenges for the growth and acceptance of the sports chiropractor are considerable. This article outlines the historical and current challenges, both internal and external, faced by sports chiropractic within Australia and proposes positive changes that will assist in recognition and inclusion of sports chiropractic in both chiropractic and multi-disciplinary sports medicine alike."

This is all a different aspect than my proposal above, but can be added to it as something having a very limited and tangential relationship to turf wars, since it mainly deals with how chiropractors are still treated by mainstream professions, regardless of the issue involved. The major turf war is still over the fundamental treatment method of the profession - spinal manipulation. -- Fyslee / talk 04:04, 7 October 2008 (UTC)

Turf war over scope of practice 2

• Here's a newer version:

Turf wars have been waged by the profession over who should administer spinal manipulation (SM) because of concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors; the focus on SM has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Proposals for limiting the scope of practice to the care of neuromusculoskeletal problems of mechanical origin, with emphasis on back care, have been made by now-retired reform chiropractor Samuel Homola and other chiropractors.

The profession has resisted such proposals:

• Is that better? -- Fyslee / talk 06:09, 7 October 2008 (UTC)

I have stricken this old version as it is only of historical relevance here. See the latest version below. -- Fyslee / talk 04:36, 8 October 2008 (UTC)

Comments on Turf war over scope of practice 2

Could you provide a quote from a reference that states that Homola is a Chiropractor (he is not), let alone a reform Chiropractor? DigitalC (talk) 00:27, 8 October 2008 (UTC)

Homola is a retired chiropractor. See: Homola S (2008). "Chiropractic: a profession seeking identity". Skept Inq. 32 (1): 37–43. Retrieved 2008-10-08. This is one of the sources cited above. (I haven't yet had time to review the above proposal; I'm just responding to the previous comment.) Eubulides (talk) 00:43, 8 October 2008 (UTC)

I see that Eubulides beat me to it. I am baffled that a chiropractor can claim that Homola isn't a chiropractor. He is a second generation DC and the profession's most notorious chiropractor (from the profession's POV). He is the first to have significantly challenged the basis for the profession (Vertebral subluxation), and to expose the quackery that is so fundamental to much of what happens in the profession. That cost him his membership in the ACA. He has written many books, most notably Bonesetting, Chiropractic, and Cultism (1963) and Inside Chiropractic: A Patient's Guide (1999). I suggest you read "Bonesetting...", it's free on-line. I have an original hard bound copy received from Homola himself. You will never be able to fully understand the profession until you have read it, not that that will do it alone, but it is very significant must reading. I suggest you also read The movement toward scientific reform. -- Fyslee / talk 02:03, 8 October 2008 (UTC)

No, Homola is not a retired chiropractor (he does not maintain retired licensure). He may have been a Chiropractor (when he was licensed), but his is no longer a Chiropractor. By legal definition, a Chiropractor is someone who is legally licensed as such. Chiropractors can in some locations maintain "retired licensure", which costs less. DigitalC (talk) 02:10, 8 October 2008 (UTC)

That's certainly a new twist on things, which is totally irrelevant to what is being dealt with in this section. Maybe you are describing some idiosyncracy in chiropractic regulations, but in medicine an MD is always an MD, even if (s)he is no longer licensed. (S)he is always justified in being addressed as "doctor" and in using "MD" after her/his name. I would think the same applies to chiropractors, since they are legally classified as physicians in many, but not all, states in the USA. I believe retired chiropractors can call themselves chiropractors, but not practice without a current license, just as with MDs. Whatever the case may be, it's irrelevant here. He was a chiropractor at the time he wrote and practiced, was defrocked and refrocked. -- Fyslee / talk 02:21, 8 October 2008 (UTC)

This is not a twist on things, and it is not new. It has been brought up here before. This is not an idiosyncracy in chiropractic regulations. An MD is always an MD, even if no longer licesned - as is a DC. However, an unlicensed MD is NOT free to refer to oneself as a Physician, just as a DC is not free to refer to oneself as a Chiropractor. I have yet to see any evidence that the source states that he is a "reform chiropractor". DigitalC (talk) 02:37, 8 October 2008 (UTC)

I would certainly dispute your claims above, and I don't recall we have discussed this here before. Please provide a diff to previous discussions. I'm willing to learn.

I'm not sure the source states it that way, but other ones make it clear he is a (retired) "reform" chiropractor, even if they don't juxtapose the words in exactly that manner. Are you disputing that he is a retired reform chiropractor (thus revealing possible ignorance of the subject), or are you just disputing the documentation? If the latter is the case, then your objections are just disruptive wikilawyering over technicalities regarding what is general and common knowledge in the chiropractic community, but that can easily be fixed by adding more references. (If that happens, please don't complain that we're using too many refs.) We can't assume that all readers are informed on these matters, and since we are dealing with bytes, not paper, we can clarify what a reform chiropractor is, and how Homola is a/the key person in the movement towards reform. The profession's vociferous opposition and criticism of him has provided plenty of documentation. Would you like to start the article on him? We can work together on it, just like Dematt and I have worked together. It's really great to collaborate in that manner.

But... this is getting us off-track here. The subject isn't about Homola, but about the history of propositions to limit the scope of chiropractic practice, and in that way we must name him and provide refs to his writings on the subject. -- Fyslee / talk 03:33, 8 October 2008 (UTC)

See and . I do believe you were active on the page in May and June of this year, but perhaps you missed that discussion. I am not "disputing" anything, I am asking for a quote from one of the sources that states that he was a "reform Chiropractor". I am not saying that it isn't true, what I AM saying is that it needs to be verifiable. This is NOT wikilawyering, and I would request that you refactor your comment above that implies that it is. DigitalC (talk) 11:23, 9 October 2008 (UTC)

Thanks for the explanation. I have stricken through that comment. Sorry about that.

Here are a couple searches where he is mentioned as a reformer, or in connnection with the word "reform" 1 2, and a general search. Of course searches are not the only method of finding information, since they also turn up false positives, but they are an interesting place to start. -- Fyslee / talk 03:31, 10 October 2008 (UTC)

Relevant Florida statute: "The term "chiropractic medicine," "chiropractic," "doctor of chiropractic," or "chiropractor" shall be synonymous with "chiropractic physician," and each term shall be construed to mean a practitioner of chiropractic medicine as the same has been defined herein." and "Chiropractic physician" means any person licensed to practice chiropractic medicine pursuant to this chapter.". and "Using the name or title "chiropractic physician," "doctor of chiropractic," "chiropractic medicine," or any other name or title which would lead the public to believe that such person is engaging in the practice of chiropractic medicine, unless such person is licensed as a chiropractic physician in this state." Anyone refering to themselves as a chiropractor while not licensed is in violation of the law, as they are technically practicing without a license. Homola does not hold a license, and to describe him as a chiropractor gives the appearance that he is licensed. DigitalC (talk) 02:46, 8 October 2008 (UTC)

Interesting, but irrelevant to the subject above. This is a technicality. Should we refer to him and all other retired chiropractors as "XXX, formerly known as chiropractor"? We aren't dealing with Prince here. I really doubt that anyone will prosecute him IF he mentions that he is a retired chiropractor. That says nothing about his current status, which is what the statutes mentioned above are dealing with. They aren't dealing with historical facts. "Retired" means someone who has "formerly practiced as", and is clearly not misleadingly implying current practice.

Can you document that any retired chiropractor who is truly retired and not practicing, has ever been rebuked or prosecuted for stating that they are a "retired chiropractor"? I'm not even sure if Homola does it, but lots of others call him that, and they cannot be prosecuted for doing so. Neither can we. I'm pretty sure many retired chiropractors who are speakers at chiropractic conventions have been introduced as "retired chiropractor", and no one blinked an eye, but applauded them. Let's not get pedantic here. -- Fyslee / talk 03:33, 8 October 2008 (UTC)

The proposed text did not call him a retired chiropractor or former chiropractor, it referred to him as a reform chiropractor. This is false. DigitalC (talk) 04:03, 8 October 2008 (UTC)

Interesting point. That can be easily fixed. I'll do it below. -- Fyslee / talk 04:32, 8 October 2008 (UTC)

It turns out that my new version below doesn't have this problem. Thanks for pointing out the possibility though. -- Fyslee / talk 05:00, 8 October 2008 (UTC)

"Limited scope of practice" (version 3)

I am proposing a different subheading, since this belongs under the "Scope of practice" heading. -- Fyslee / talk 03:02, 8 October 2008 (UTC)

In the early 1940s, C.O. Watkins, DC, Chairman of the Board for the National Chiropractic Association, wrote: "If we will not develop a scientific organization to test our own methods, organized medicine will usurp our privilege. When it discovers a method of value, medical science will adopt it and incorporate it into scientific medical practice." Some twenty years later, shortly after the death of B.J. Palmer in 1961, Samuel Homola, a second generation chiropractor, echoed those sentiments and wrote extensively on the subject of limiting the use of spinal manipulation, proposing that chiropractic could function as a medical specialty with special focus on conservative care of musculoskeletal conditions. Homola's membership in the newly formed American Chiropractic Association was not renewed, and his position was rejected by both straight and mixer associations. Other chiropractors have also aired similar ideas.

Because of concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors, turf wars have been waged by the profession over who should administer spinal manipulation (SM); the focus on SM has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.

The profession has resisted such proposals:

"It has long been the contention of FCER that to position chiropractors as "back doctors" would be disastrous for the future of the chiropractic profession and would only serve to limit the choice of treatments available to patients. Based on substantial anecdotal evidence supporting chiropractic intervention, FCER is funding research that investigates chiropractic treatment for the very ailments that Dr. Homola recommends that we back away from: colic, dysmenorrhea, and ear infection. It simply doesn't make good sense to deny the efficacy of chiropractic in these instances just because the preponderance of published data is on back pain."

The profession has waged lawsuits designed to prevent other professions from using SM. One was against the US Goverment's "Health Care Financing Administration" (HCFA):

“ACA President James A. Mertz, DC, DACBR, said, "With the latest response from HHS, the ACA's lawsuit against the Health Care Financing Administration (HCFA) has reached a critical point. While the ACA views the decision on physical therapists as a victory in itself, our fight is certainly not over. Nobody but a doctor of chiropractic is qualified to perform manual manipulation to correct a subluxation - not a medical doctor, not an osteopath. We will continue to pursue this lawsuit until we're assured that only doctors of chiropractic are allowed to provide this service to Medicare + Choice beneficiaries."

The Arkansas Chiropractic Board has also filed and won a lawsuit against a Physical Therapist.

Another source to add:

• "... if we are to thrive in the future, it will be as NMS specialists, and not anything else."

We could just add the reference itself. -- Fyslee / talk 06:12, 9 October 2008 (UTC)

Comments on "Limited scope of practice" (version 3)

What is the relevance of "shortly after the death of B.J. Palmer in 1961"? - DigitalC (talk) 03:09, 8 October 2008 (UTC)

You can ask Dematt. He wrote the article, and that is taken from this section: The movement toward scientific reform. I see its relevance since we are talking about history and this provides perspective. -- Fyslee / talk 03:36, 8 October 2008 (UTC)

Content about BJ Palmer's death in 1961 belongs in Chiropractic history where it is relevant, not in the scope of practice section. DigitalC (talk) 10:44, 9 October 2008 (UTC)

Where is this section being proposed to be added? DigitalC (talk) 03:53, 8 October 2008 (UTC)

Please read the above discussions and versions. It's stated there. Please do your homework instead of shooting from the hip without focusing on where your target is located. It's tiring and disruptive -- Fyslee / talk 04:41, 8 October 2008 (UTC)

I have read the discussions above, and was confused by the fact that you mentioned the we are "talking about history", yet as far as I could see this wasn't proposed for the history section. For you to assume that I did NOT read the above discussions is not assuming good faith, and your comment above could certainly be more civil. DigitalC (talk) 10:44, 9 October 2008 (UTC)

You asked "Where is this section being proposed to be added?" That's all I had to go on in my reply. Well, I had previously (immediately above at the very top of this whole section) written this:

• "I am proposing a different subheading, since this belongs under the "Scope of practice" heading."

That's why I replied as I did. Sorry if it came off badly. Maybe you hadn't noticed my statement, so I really do apologize. I was only responding to your one question, and thinking of my previously-made clear statement.

As to the "history" remark, the quote does touch on history and then leads to the present, but we can't relegate everything written in V & RS (IOW everything here is "history") to history sections. That would be very impractical. -- Fyslee / talk 02:52, 10 October 2008 (UTC)

What is the relevance of "Homola's membership in the newly formed American Chiropractic Association was not renewed" ? Unless we have something to state that the reason of his membership not being renewed was DUE to his position, it doesn't belong in this section. DigitalC (talk) 03:53, 8 October 2008 (UTC)

We are documenting the history of proposals to limit the scope of practice and its reception by the profession. Dematt is an honorable chiropractor and highly respected editor here, and he wrote that since it is a very relevant fact. Are you suggesting we censor Misplaced Pages of relevant historical facts? BTW, Homola's membership renewal was not disallowed because of any offense other than writing his 1963 book. Read it on-line and you'll see why they wouldn't allow him to renew his membership. Some 30 years later he received what amounted to an apology and was allowed to renew his membership. In spite of this treatment he remained a legitimately and legally practicing reform (IOW EBM) chiropractor in Florida until his retirement. He practiced what he preached and won the respect of local MDs as a skilled, science-based chiropractor who eschewed the quackery and unethical marketing practices that are so common in the profession. -- Fyslee / talk 04:41, 8 October 2008 (UTC)

I did not suggest any censorship, and I don't know how that could be construed from my comments. I am suggesting that the relevance was not clear to me, and therefore would not likely be clear to the average reader. I also agree with Eubulides that this proposal spends too much time on history, which should be dealt with in Chiropractic history. I was trying to work through the proposed section line by line, but only had a limited amount of time. DigitalC (talk) 11:00, 9 October 2008 (UTC)

Ah! Sorry about that. My apologies. -- Fyslee / talk 02:55, 10 October 2008 (UTC)

Although I agree with the idea of covering limited scope of practice and turf wars, this draft has some real problems:

• It spends way too much time on old history. Generally speaking, Chiropractic should discuss the current state of chiropractic, except that its History section should of course discuss history. Any source older than 10 years old is questionable as a description of the current state of chiropractic.
• It spends way too much time on Homola. While Homola's story is compelling, it's a tale of history and belongs in Chiropractic #History if it belongs anywhere in the article.
• WP:WEIGHT suggests that any discussion of scope-of-practice limitations should focus on more-recent, more-mainstream sources such as Murphy et al. 2008 (PMID 18759966), Nelson et al. 2005 (PMID 16000175), Theberge 2008 (PMID 18254831), and Hilliard & Johnson 2004, all mentioned above.
• It cites only 3 secondary sources and gives short shrift to two of them, namely Murphy et al. 2008 (PMID 18759966) and Nelson et al. 2005 (PMID 16000175). The only secondary source that is given much play is Villanueva-Russell 2005 (PMID 15550303), and even that is given only 1 sentence.
• It devotes way too much to isolated cases, as opposed to overall themes.
• The claim "The profession has waged lawsuits designed to prevent other professions from using SM" is unsourced.
• The claim "The profession has resisted such proposals" is a stretch, given the source. The FCER is not the profession.
• Overall, it's way too long. Turf wars are a real issue, but we don't need 5 long paragraphs about it. 1 paragraph should do. We shouldn't need a subsection header for this.
• The paragraph should follow the framework established by reliable secondary sources here; we shouldn't be reaching down into primary sources for this sort of thing.

Thanks for tackling the problem; hope this review helps. Eubulides (talk) 07:50, 8 October 2008 (UTC)

Thanks for the critique. Please tweak it and let's see what your version looks like. -- Fyslee / talk 02:49, 9 October 2008 (UTC)

I am trying to shake loose some time to read the sources I mentioned, and find some other sources. It won't happen right away; sorry. Eubulides (talk) 06:50, 9 October 2008 (UTC)

I agree here. I don't think Homola is all that notable and I question how much he is mentioned or references in this article and wonder if he should be given less or no space at all. -- Levine2112 18:36, 8 October 2008 (UTC)

I suggest you do some searching and reading of chiropractic literature. You'll discover he's quite notable. We could easily have a nice article about him. -- Fyslee / talk 02:47, 9 October 2008 (UTC)

Nah. I'd say he is of mediocre notability at best. Even within chiropractic. -- Levine2112 04:30, 9 October 2008 (UTC)

He's either notable or not notable. "Mediocre" is your opinion, unsurprisingly enough. It has no bearing on Misplaced Pages policies nor on inclusion criteria. You need to do more homework.

Here's an interesting series of quotes compiled by Terry Rondberg, President of the WCA. Note that Homola is quoted five times, more than any other single source. -- Fyslee / talk 05:09, 9 October 2008 (UTC)

What does Levine need to "do more homework" on? How is this a constructive comment that helps the development of the article? Homola's notability or non-notability is irrelevant unless you are planning on creating an article on him. What does matter is undue weight, which the current proposal is giving him. DigitalC (talk) 10:49, 9 October 2008 (UTC)

You should ask him if his comments were "constructive". His objections to Homola were bringing us off-track, but I replied anyway. You can fault me for that. My comments were directed at his obvious lack of knowledge about Homola's notability ("notoriety" in the profession). That's why I suggested he needed to do more homework. This requires some simple knowledge of the history of chiropractic controversies. Instead of being so cocky in his statements, he should do more homework and ask before commenting. I guess he could have asked on my talk page to avoid distracting this discussion with comments that weren't "help the development of the article". -- Fyslee / talk 02:41, 10 October 2008 (UTC)

A rude explanation to a rude comment. My discussion of Homola was on track. I was speaking of Notability in terms of WP:WEIGHT, clearly as I was in agreement with Eubulides' similar comment. You assumed bad faith and made an aspersion about my knowledge of chiropractic. And then followed it up with an even ruder rationale to justify such an aspersion. Just go back and read what is plainly obvious. You made this personal. Not me. Remember WP:NPA. Please. And peace. -- Levine2112 17:29, 10 October 2008 (UTC)

Following up on my recent comment: in looking at the more-reliable sources it appears that we'll need to do some surgery on the existing Chiropractic #Scope of practice section as well, as some of its current sources suffer from the same problem as the problems mentioned above. I'll open up a new thread to talk about this sometime soon. In the meantime, here's a draft of text that summarizes what one of the newly-discovered reliable secondary sources says about turf wars:

Spinal manipulation (SM) is also practiced by physical therapists. Some U.S. states prohibit physical therapists from performing SM, some states allow them to do it only if they have completed chiropractic training, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.

Eubulides (talk) 17:27, 9 October 2008 (UTC)

#Scope of practice 4 below contains some further thoughts on this subject. Eubulides (talk) 07:36, 11 October 2008 (UTC)

Fixing first paragraph under EFFICACY

I think the order of information should be rearranged here based on importance. Below is how I'd rework it. While I take issue with several claims here, I've kept the sentences the same along with their citation numbers, and just inject transitional language for smooth reading.

Many controlled clinical studies of SM are available, but their results disagree, and they are typically of low quality.. Although a 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference, a 2008 supportive review found serious flaws in the critical approach, and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments. In addition, most research has focused on spinal manipulation (SM) in general, rather than solely on chiropractic SM, so some of this research has been criticized as being misleading for failing to mention incorporation of data derived from studies of SM that do not relate to chiropractic SM;. That said, given that there is a wide range of ways to measure treatment outcomes, opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness.

Chiropractic care, like all medical treatment, benefits from the placebo response. Still, it is hard to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect. In any event, the efficacy of maintenance care in chiropractic is unknown.

I believe the next paragraph should not be under the Efficacy section. I personally don't think it's relevant enough for the article, but should other disagree, perhaps we could move to a a controversy section who who should be practicing SM. Anyway, I modified the order of sentences in that paragraph as follows; I also had to change the sentences a little to make it work:

There is little consensus as to who should administer the SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors. Those physicians argue that SM research is equally of value regardless of practitioner. The chiropractors, however, have raised concerns that the focus on SM will result in practice guidelines that could limit the scope of chiropractic practice to treating backs and necks.

Jordanotto (talk) 22:13, 3 October 2008 (UTC)

• Unfortunately those numbers in brackets change whenever someone edits Chiropractic. Let me try to restate your proposal with actual references. I'll try to improve it as I go, putting my changes in italics (for inserted words) and strikeouts (for deleted words). But first, some comments:

• The phrase "defenders have replied that SM research is equally of value regardless of practitioner" is not relevant to the "administer the SM" sentence. It is relevant to the "Some of this research has been criticized" sentence.
• Phrases like "In addition" shouldn't be needed. For one thing, they tend to introduce POV. For another, they're a sign of weak writing. Well-written text shouldn't need "In addition" linkage.
• "The chiropractors, however, have raised concerns..." actually, it's not chiropractors in general, just some chiropractors.
• The rewritten version starts off right away with SM. But chiropractic is more than just SM; this should be made clearer.

• With the above comments in mind, the revised proposal is to replace the first two paragraphs of Chiropractic #Effectiveness with the following:

Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness. Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree, and they are typically of low quality. Although a 2008 critical review found that with the possible exception of back pain, chiropractic SM has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference, a 2008 supportive review found serious flaws in the critical approach, and found that SM and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments. In addition, Most research has focused on spinal manipulation (SM) in general, rather than solely on chiropractic SM. so Some of this research has been criticized as being misleading for failing to mention incorporation of data derived from studies of SM that do not relate to chiropractic SM; defenders have replied that SM research is equally of value regardless of practitioner.

That said, given that There is a wide range of ways to measure treatment outcomes. Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness. Chiropractic care, like all medical treatment, benefits from the placebo response. Still, It is hard to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect. In any event, The efficacy of maintenance care in chiropractic is unknown.

and to move the following text out of Chiropractic #Evidence basis, inserting it after the 2nd paragraph of Chiropractic #Treatment techniques appending it to Chiropractic #Scope of practice:

There is little consensus as to who which profession should administer the spinal manipulation (SM), raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors. The chiropractors, however, have raised concerns that the focus on SM will result in A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines that could limit the scope of chiropractic practice to treating backs and necks.

Eubulides (talk) 07:41, 4 October 2008 (UTC)

We can move the 2nd part to Treatemnt techniques or Scope of practice. Both sections are appropriate. QuackGuru 04:02, 5 October 2008 (UTC)

Yes, thanks, that sounds reasonable. I've revised the above proposal accordingly. Eubulides (talk) 07:11, 6 October 2008 (UTC)

Nice edits. Transitional language makes for smoother reading, which is why I added it, but it's not a big point for me. The sentences still need serious cleaning. Jordan 20:58, 6 October 2008 (UTC) —Preceding unsigned comment added by Jordanotto (talk • contribs)

As for the 2nd part, I recommend it be moved to the appropriate section whenever an editor has an idea which part of Scope of practice would work best. QuackGuru 02:01, 9 October 2008 (UTC)

The above proposal is to simply append the 2nd part to Chiropractic #Scope of practice. As mentioned in #Comments on "Limited scope of practice" (version 3) below, I plan to propose further changes to Scope of practice soon; I expect that these further changes will move text around but the above text would be retained somewhere in Scope of practice. Eubulides (talk) 20:27, 9 October 2008 (UTC)

Please see #Scope of practice 4 for the proposed further changes. Eubulides (talk) 07:36, 11 October 2008 (UTC)

RfC: Is the "subject" of spinal manipulation relevant to chiropractic?

Template:RFCsci

Subject and "Rules of engagement"

• Is the "subject" of spinal manipulation relevant to chiropractic?

• I contend that it is, and that the profession and its top researchers think so too. So far no reliable mainstream or chiropractic sources have been mentioned here that dispute this point. What think ye, honored ladies and gentlemen? -- Fyslee / talk 05:00, 9 October 2008 (UTC)

Nota bene! Please follow these "Rules of engagement":

1. This RfC is NOT about "research" (we are discussing that elsewhere), only the "subject" of spinal manipulation and its relation to the chiropractic profession. More discussion of that matter can occur after and outside of this RfC.

2. This RfC is NOT about any relation between generic spinal manipulation and chiropractic spinal manipulation. We are also discussing that elsewhere. More discussion of that matter can occur after and outside of this RfC.

If these subjects are mentioned here, the comment will likely be removed and the contributor requested to resubmit the comment without such mentions. Such comments will only derail the discussion and be a repetition of other discussions. This discussion is delimited by well-defined and narrow boundaries. It must remain focused. Your cooperation will be appreciated. -- Fyslee / talk 05:00, 9 October 2008 (UTC)

The words "relevant" and "related" are synonyms, and "relevant" is used in that sense above. If this is a problem for some, then that can be discussed. It is already mentioned below because of the use of the word "related" in the OR policy, even though this RfC is not about the OR policy or other policies.

This RfC is limited to the bare question, as it reads. This is about logic and about knowledge of chiropractic and its main treatment method. -- Fyslee / talk 14:21, 9 October 2008 (UTC)

ADDENDUM: Invalid "vote(s)". As originally noted immediately above, "this RfC is limited to the bare question, as it reads." The question is a stand-alone question. If other contexts are influencing your decision, then your "vote" doesn't count and is invalid. Either answer the question, or don't vote at all. Deal with the other issues elsewhere or later. -- Fyslee / talk 13:45, 17 October 2008 (UTC)

RfC comments

• Agree, as stated above. -- Fyslee / talk 05:00, 9 October 2008 (UTC)

• Agree that spinal manipulation is directly related to chirorpractic, and is relevant to chiropractic. Eubulides (talk) 07:00, 9 October 2008 (UTC)

• Comment. Since WP:OR consistently uses the words "directly related" rather than "relevant", I suggest that you rephrase the question by uniformly substituting the words "directly related" for "relevant". Otherwise, other editors might say that even if the conclusion is that SM is relevant to chiropractic, that doesn't mean that it's directly related to chiropractic. Eubulides (talk) 05:36, 9 October 2008 (UTC)

• I had thought of that, but since they are synonyms (and "relevant" sounds better in that question), we might be better served to get the word "relevant" added to the language of the OR policy. Do you see a significant difference -- relevant<-->related. "Definiton: Relevant: Related to the matter at hand." Anyone who disputes my wording can take it up with the dictionaries. Is this a solid argument, or am I wrong here? -- Fyslee / talk 06:21, 9 October 2008 (UTC)

• WP:OR recently went through some sort of dispute over whether it should use "relevant" or "directly related", so I expect that some editors think there's an important difference between the two terms. In that case, why not just stick with the terms that WP:OR uses? It might avoid future confusion. Or, if you prefer, we can mention both terms in the RfC. Eubulides (talk) 06:50, 9 October 2008 (UTC)

• I have added a comment about the terminology matter above. Anyone who has already commented is welcome to refactor or enlarge their comments accordingly. I see that the RfC bot hasn't picked up this RfC yet, but it should do so within the next 24 hours, so this will already be a part of what outside commentators will find here. -- Fyslee / talk 14:21, 9 October 2008 (UTC)

• The RfC bot cannot handle more than two RfCs on the same talk page. It lists only the first one on the page. This is a longstanding bug in the bot which has not been fixed. I have added this RfC manually to Misplaced Pages:Requests for comment/Maths, science, and technology. Eubulides (talk) 14:55, 9 October 2008 (UTC)

• If it helps, we can archive the older RfC on this page. I think that one has been milked long past its expiration. -- Levine2112 23:28, 9 October 2008 (UTC)

• I wasn't aware of that glitch. Maybe that is a good idea to archive the old RfC. -- Fyslee / talk 04:33, 10 October 2008 (UTC)

• Done. Eubulides (talk) 04:48, 10 October 2008 (UTC)

• BTW, this RfC isn't about OR or other policies. It is limited to the bare question, as it reads. This is about logic and knowledge of chiropractic. -- Fyslee / talk 06:24, 9 October 2008 (UTC)

• Disagree. No such conclusion can be made, because the question is too vague and due to the constraints put on the discussion. Further, you state that this RfC is not about research, but then state that its "top researchers" think it is relevant. Overall, the answer is "not necessarily". DigitalC (talk) 07:49, 9 October 2008 (UTC)

• Comment about invalid "vote(s)". The question is a stand-alone question. IF other contexts are influencing your decision, then your "vote" doesn't count and is invalid. Either answer the question, or don't vote at all. Deal with the other issues elsewhere or later. -- Fyslee / talk 13:42, 17 October 2008 (UTC)

• Comment. The opinions of others are welcome here, including the opinions of researchers about the "subject". It is the circular discussions about research itself we wish to avoid here. It should be easy to answer the above question. It's a no-brainer. There is nothing wrong with answering more than once, or adding qualifiers to an "agreed" answer. This isn't a deletion discussion, or other type of discussion where "voting" twice is not allowed. You can make multiple comments after making your one "agree" or "disagree" remark. You can even make a "yes and no" type answer, so go for it. Your understanding of this matter is valued. -- Fyslee / talk 14:30, 9 October 2008 (UTC)

• Agree. My personal experiences with this term has been with using chiropractic care, so I associate this to a chiropractor. --CrohnieGal 11:38, 9 October 2008 (UTC)

• Agree that spinal manipulation is directly related to chiropractic, and is relevant to chiropractic.--—CynRN 18:38, 9 October 2008 (UTC)

• Agree SM is the main mode of treatment in Chiropractic, while other things are related to Chiropractic as well, SM forms the core of this form of medical practice and is therefore directly related to the topic. Tim Vickers (talk) 18:53, 9 October 2008 (UTC)

• No. In terms of Misplaced Pages, spinal manipulation is not "relevant" to chiropractic. Chiropractic spinal manipulation is relevant to chiropractic. Disagree. The profession and its top researchers don't necessarily agree either. In fact, we have highlighted reliable sources demonstrating such disagreement in the professional and research worlds. -- Levine2112 20:46, 9 October 2008 (UTC)

• Comment about invalid "vote(s)". The question is a stand-alone question. If other contexts are influencing your decision, then your "vote" doesn't count and is invalid. Either answer the question, or don't vote at all. Deal with the other issues elsewhere or later. -- Fyslee / talk 13:42, 17 October 2008 (UTC)

• Comment:I see nothing invalid about Levine2112's vote. This is Misplaced Pages, so it would be nonsensical and off-topic to ask people to answer separately from the context of Misplaced Pages. Since you've cited the opinions of unnamed "top researchers" supporting your side of the question, Fyslee, it's only fair that Levine2112 be able to do the same to support the other side. If Levine2112 has included off-topic information (e.g. about "chiropractic spinal manipulation") in addition to a valid vote, I think it would be counterproductive to discount the entire vote on that basis. What is it about the vote that leads you to state that it's invalid, Fyslee? ☺ Coppertwig (talk) 18:06, 17 October 2008 (UTC)

• He is not answering the question as it is stated, which is the problem. This is a question of logic and knowledge of chiropractic, not just about Misplaced Pages. It is fundamental knowledge that colors most editors' way of editing, and we need to find out their views on the subject. While there is nothing overtly and openly stated in his statement above that would make it invalid, his motivations for not answering in a clear manner, but in a convoluted manner, are plainly evident from the myriad discussions that have led up to this RfC. He is plainly afraid to answer directly. Your statement indicates that you may not have followed these discussions as closely as the rest of us, which is okay. We happen to have learned his way of thinking quite well now and we don't have to assume bad faith or anything of that kind when we address his way of dealing with this issue. This is simple, very civil plain talk, and a request for straightforward and simple answers. Note that I wrote: "IF other contexts are influencing your decision...", which leaves it up to him to refactor his comments IF other contexts are at work here. I want him to be honest and to refactor, providing a straightforward answer that is not influenced by other factors. I want to find out about his basic knowledge of chiropractic.

• The "unnamed researchers" are known to all the regular editors here. I was just stating my reasons for starting this RfC. The opinions of others isn't the direct issue here, and no rebuttal naming others is necessary to answer the simple question. Naming others would only bring in other issues that are not part of this RfC, as stated above.

• This RfC mustn't get bogged down with the other issues which he has used to keep us going in circles for months, and which his recent comments below are doing. Such comments are specifically not allowed here, as stated above. That's why I have worded this RfC as simply as it's possible to word it. We need honest answers, not politically driven answers. A simple answer to a simple question is what is needed. Leave the qualifiers for other discussions. -- Fyslee / talk 20:11, 17 October 2008 (UTC)

• I don't understand "he is not answering the question as stated". What part of "No" do you not understand? The word "No" seems to me to be a simple, direct answer to the question as stated. ☺ Coppertwig (talk) 01:10, 18 October 2008 (UTC)

• Maybe I have confused you by too many words regarding esoteric knowledge here among the regular editors. You are excused for not understanding it. The question is not qualified by "In terms of Misplaced Pages". It is a real, very simple question presented without connection to Misplaced Pages policies or issues being discussed elsewhere here. It is a question designed to test the basic logic and basic knowledge of chiropractic possessed by anyone who answers the question. Of course this still has relevance to our editing here since the answers provided can used to further our understanding of each other's thinking, which makes it easier to collaborate and avoid misunderstandings. It is thus of direct relevance to our editing here and isn't a waste of time. If the answers here are later used in other connections, so be it, but right now we need to concentrate on the question at hand, without making qualifications, exceptions, etc. -- Fyslee / talk 01:31, 18 October 2008 (UTC)

• I apologize for the tone of my response and have struck out some of my words and replaced them with different ones. ☺ Coppertwig (talk) 01:50, 18 October 2008 (UTC)

• No reliable source has been presented saying that spinal manipulation is not relevant to chiropractic. Apparently this comment is referring to Ernst 2002 (PMID 12379081). However, Ernst doesn't say that SM is irrelevant to chiropractic; he says that some studies of SM (presumably, studies of osteopathic SM, or whatever) are not relevant to chiropractic SM. Nowhere does Ernst say or imply that the topic of SM is irrelevant to chiropractic. The claim that Ernst says SM is irrelevant to chiropractic disagrees with pretty much every paper Ernst has written about chiropractic. Eubulides (talk) 23:18, 9 October 2008 (UTC)

• I am glad that you are finally acknowledging that Ernst did in fact say that some (Ernst says "most") studies of SM are not relevant to chiropractic SM. I think this acknowledgment is a good step in resolving this dispute and if nothing else comes from this rather innocuous RfC, I'm happy with at least getting this much. -- Levine2112 23:26, 9 October 2008 (UTC)

• Ernst did not say that "most" studies of SM are not relevant to chiropractic SM. He merely said that most of the randomized controlled trials of SM for low back pain cited in Meeker & Haldeman 2002 (PMID 11827498) do not relate to chiropractic SM. Chiropractic #Evidence basis does not cite any of those randomized controlled trials; as far as I know, it doesn't cite any RCTs at all. It cites general reviews. Eubulides (talk) 23:52, 9 October 2008 (UTC)

• That's still not entirely accurate. Ernst states that most of the published RCTs of SM for back pain are not related to chiropractic SM. He did not limit it to just those Meeker and Haldeman cited. But again, I am glad you are finally acknowledging at least this much. -- Levine2112 00:44, 10 October 2008 (UTC)

• I think you are really nitpicking on this one, and it's getting us nowhere. This is so trivial, as is all nitpicking. I hope you are satisfied with this supposed "acknowledgment". Can you leave the poor nit alone now so it can sleep a bit? The poor thing is getting tired, and this type of trivial stuff gets very poor mileage and reflects poorly on the one who keeps it going. -- Fyslee / talk 00:55, 10 October 2008 (UTC)

• Not only is it nitpicking, it is incorrect nitpicking. The "them" in the Ernst 2002 (PMID 12379081) comment "most of them do not relate to chiropractic spinal manipulation" clearly refers to the "43 randomized, controlled trials of spinal manipulation for back pain" that were cited by Meeker & Haldeman 2002 (PMID 11827498). Eubulides (talk) 01:27, 10 October 2008 (UTC)

• One man's nitpicking is another man's thorn in his side. I apologize if I keep pointing out Eubulides' errors, but when you keep making them and are editing based on these errors, I feel they should be brought to light for others to consider. For instance, Ernst does not limit RCTs to just the ones cited by Meeker & Haldeman. He says that of the 43 RCTs which M & H claim to exist in publication, most of them do not relate to chiropractic spinal manipulation.SM added later. Eubulides thus is in error when he says that Ernst is limiting to his comment to just those that were "cited" by M & H. -- Levine2112 17:24, 10 October 2008 (UTC)

• The previous comment is incorrect. All 43 RCTs were cited by Meeker & Haldeman 2002 (PMID 11827498). They are the RCTs in citations 48 and 51–94 of their paper; see the first three rows in Table 2, page 221, of Meeker & Haldeman. (I expect that the number of citations slightly exceeds the number of studies because some studies were reported in more than one paper.) Ernst is clearly referring to just the 43 SM RCTs cited by Meeker & Haldeman: he is not referring to any of the sources cited in Chiropractic, and he is not referring to any reviews of SM. Eubulides (talk) 17:44, 10 October 2008 (UTC)

• As you know, I continue to disagree with you on this point. Enough said. -- Levine2112 19:28, 10 October 2008 (UTC)

Levine2112's previous statement repeats, once again, one of his frequent misquotings of Ernst, and attributes a statement to Ernst which he never made:

• "most of them do not relate to chiropractic" - Levine2112
• "most of them do not relate to chiropractic spinal manipulation." - Ernst

This fundamental error has been repeated by him many times now and he's been called on it several times, including here (NORN) and here (misquoting problem). When will this stop? He thinks he's "pointing out Eubulides' errors", but is using fallacious arguments based on misquotings in such attempts. It's getting tiresome. -- Fyslee / talk 19:26, 10 October 2008 (UTC)

• NOTE: Levine2112 has refactored his incorrect statement without comment or edit summary. I have added a link to it in the interest of openness so no one who reads his and my statements will get confused. -- Fyslee / talk 19:49, 10 October 2008 (UTC)

• Fyslee, you know this wasn't intentional. I have explained this to you several times now. Who is the one nitpicking now? -- Levine2112 19:52, 10 October 2008 (UTC)

• Did I say it was intentional? I think not. To make sure readers here understand the background of this, I'll just repeat what I wrote to you at NORN: "I don't want to call this deliberate dissembling on his part because it really is complicated, but the effect on Misplaced Pages is the same. It games the system and fools people into believing his OR interpretation, and it keeps Talk:Chiropractic hostage to a very long discussion that drags on forever and goes in circles." -- Fyslee / talk 21:13, 10 October 2008 (UTC)

• WP:POT --Surturz (talk) 11:00, 17 October 2008 (UTC)

• Agree. Of course spinal manipulation is relevant to Chiropractic. While it's not the beginning and end of the field, it is their signature treatment. Just imagine this article trying to write this article without mentioning spinal manipulation -- and yes, that's exactly what you'd have to do, if you decided that spinal manipulation was actually irrelevant to Chiropractic. WhatamIdoing (talk) 18:21, 10 October 2008 (UTC)

• Agree. The majority of editors agree there is no OR violation and the editors who claim there is OR are aware top researchers are doing the same thing we are doing. We are following the lead of the top researchers. Chiropractic is strongly associated with spinal manipulation. It can't be original research when we are following the lead of expert reviewers. QuackGuru 17:30, 15 October 2008 (UTC)

• Disagree. While I would agree with the statement stand-alone without any context, I disagree because of previous discussions on this talk page. There is a difference between chiro SM and non-chiro SM and the generalisation "SM is relevant to chiropractic" should not be used to insert material about non-chiro SM into the article. --Surturz (talk) 11:00, 17 October 2008 (UTC)

• Comment about invalid "vote(s)". Well, the question is a stand-alone question. IF other contexts are influencing your decision, then your "vote" doesn't count and is invalid. Either answer the question, or don't vote at all. Deal with the other issues elsewhere or later. This likely applies to the other two dissenting "votes" as well.

• In this case, you are openly stating that your "vote" is influenced by other considerations, so it really is invalid. Please refactor your response and answer the question as is, or remove or strike through your comments.

• As to your personal attack above (WP:POT), I suggest you remove it, as also requested here.. -- Fyslee / talk 13:42, 17 October 2008 (UTC)

• Question and comment. Question: Would someone please cite sources that support the position that spinal manipulation is relevant to chiropractic? Comment: I agree with Surtuz's statement that ""SM is relevant to chiropractic" should not be used to insert material about non-chiro SM into the article." ☺ Coppertwig (talk) 18:06, 17 October 2008 (UTC)

• Lots of reliable sources support the position that spinal manipulation is relevant to chiropractic. (SM is not merely "relevant": it's core to chiropractic and is the reason that chiropractic exists.) Here are a few sources off top of my head (more could easily be cited):

• Principles and Practice of Chiropractic 3rd ed. (ISBN 0-07-137534-1), the leading textbook on chiropractic. For example, see chapters 1, 8, 9, 19, 37, 38, 43, and 57.
• Christensen & Kollasch 2005 (PDF)
• NCCAM 2005 (PDF)
• American Chiropractic Assn 2003 (PDF)
• Cooperstein & Gleberzon 2004 (ISBN 0443074135)
• Villanueva-Russell 2005 (PMID 15550303)
• Meeker & Haldeman 2002 (PMID 11827498) and their 2002 followup letter (PDF)
• Ernst 2008 (PMID 18280103)
• Council on Chiropractic Guidelines and Practice Parameters 2007 (PDF)

• In contrast, no reliable source claims that spinal manipulation is irrelevant to chiropractic.
• In its coverage of effectiveness and safety, Chiropractic neither discusses nor cites research that is specifically about "non-chiro SM". It does discuss and cite research about SM in general, but that's fine: SM is identified with chiropractic, and chiropractors do over 90% of SM.

Eubulides (talk) 19:11, 17 October 2008 (UTC)

Can you help me out here? I just perused Christensen & Kollasch 2005 (PDF) and I can't find where it says that spinal manipulation is relevant to chiropractic. Can you please provide a direct quote?

The same goes for NCCAM 2005 (PDF) where instead of seeing the relevance of one to another, I see the source drawing a clear distinction between chiropractic "adjustments" and spinal manipulation as performed by practitioners other than chiropractors.

Villanueva-Russell 2005 (PMID 15550303) also draws the distinction between chiropractic adjustments and general manipulation: "It should be noted that chiropractors consider the technique of "adjustment" to be exclusive to their profession, and distinguish the clinical procedure as separate from the more general medical term of "manipulation," which is a more generic, often long-lever movement of joints, not restricted to the spinal vertebrae, alone."

I am of the belief that spinal manipulation is somewhat relevant to chiropractic in the same way that X-rays are somewhat relevant to chiropractic. However, just as a general X-ray study which makes no conclusions about chiropractors use of X-rays (termed here as a nonchiropractic x-ray study) is irrelevant to the Wikiepdia chiropractic article, so irrelevant is a general spinal manipulation study which makes no conclusions about chiropractors use of spinal manipulation (termed here as a non-chiropractic spinal manipulation study). Just as the non-chiropractic X-ray study would be more appropriate at the X-ray article, so would the non-chiropractic spinal manipulation study be more appropriate at the Spinal manipulation study. -- Levine2112 19:28, 17 October 2008 (UTC)

• The first source you mention, Christensen & Kollasch 2005 (PDF), says in Table 10.12 (page 135) that 96% of chiropractors use the Diversified technique, and that most chiropractors use other spinal-manipulation techniques such as Gonstead.
• The second source you mention, NCCAM 2005 (PDF), leads its section 2 (page 2) with the sentence "Chiropractic is a form of spinal manipulation, which is one of the oldest healing practices."
• That quote from Villanueva-Russell 2005 (PMID 15550303) makes it clear that chiropractic adjustment is an important special case of manipulation. This supports the position that manipulation is relevant to chiropractic. Other parts of the same source (e.g., page 553) talk at length about the turf war over SM between chiropractic and other professions. For example, page 553 quotes Sportelli 1995 as saying "Chiropractic must lay claim and full ownership to what the general public already associates with chiropractors—spinal manipulation." This also supports the position that SM is relevant to chiropractic.
• The other 6 sources, which you didn't mention, also clearly support the position that SM is relevant.
• The claim that spinal manipulation is merely "somewhat relevant" to Chiropractic is incorrect, just as a claim that X-rays are "somewhat relevant" to Radiography would be incorrect. X-rays are core to radiography and are the reason for radiography's existence. It's perfectly reasonable for Radiography to cite sources about X-rays. Likewise for spinal manipulation and Chiropractic.
• Clearly SM is directly related to Chiropractic. No credible argument to the contrary has been presented here. Let's move on.

Eubulides (talk) 20:31, 17 October 2008 (UTC)

Christensen & Kollasch 2005 (PDF) never mentions the word "manipulation". So I don't see how we can infer it is drawing the conclusion that spinal manipulation is relevant to chiropractic. Again, I am not sure what "relevance" is going to give us. IF this is a discussion about WP:OR violation, then the standard is "directly related". NCCAM 2005 (PDF) certainly tells us that chiropractic is a form of spinal manipulation. Form is the operative word. Chiropractic is not spinal manipulation, but rather employs some form of spinal manipulation which differs from other forms. And yes Villanueva-Russell 2005 (PMID 15550303) makes it clear that the chiropractic adjustment is a special case of manipulation; "special case" because it is different from other forms of spinal manipulation. So from just those sources, we know that there are sources which positively identify "chiropractic spinal manipulation" (spinal adjustments) as different from "non-chiropractic spinal manipulation". I stopped there and didn't go into the other sources as I felt that enough has been presented for us to make this conclusion. But if you want to look into Ernst 2008, for instance, he too differentiate chiropractic spinal manipulation from other forms of spinal manipulation: Numerous forms of spinal manipulation exist but "the short-lever technique-touchingthe vertebrae directly at high velocity and low amplitude, i.e., by moving a small distance-with the spinal or transverse process as a fulcrum, is considered the typical chiropractic manoeuver. "Somewhat relevant" is a realistic claim; whereas "directly related" is the burden needed to satisfy WP:OR and thus far, that burden has not been upheld by those supporting inclusion of non-chiropractic specific spinal manipulation research. You say that "SM is directly related to Chiropractic". Show us that in terms of sources. Remember, "relevant to" and "direct related to" are not equivilent. Beyond that, the OR discussion goes to more detail and you must show that non-chiropractic-specific spinal manipulation research is directly related to chiropractic (the topic of this article). Thus far, just the opposite has been shown (with quotes from leading researchers such as Ernst stating that the majority of spinal manipulation RCTs for LBP are not related to chiropractic SM. And if something isn't related, then it certainly is not directly related. -- Levine2112 22:18, 17 October 2008 (UTC)

• Levine2112, you write: "If this is a discussion about WP:OR violation..." No, it isn't, as clearly stated above, and your comments are dragging this RfC back into your endless discussions of matters not related to this RfC. Please stop or your comments will be moved to a different thread. This is an off-topic discussion.

• Other editors, please do not participate in this type of off-topic diversion. -- Fyslee / talk 01:39, 18 October 2008 (UTC)

• Diversified is the most widely used form of SM. As Christensen & Kollasch state, 96% of chiropractors use Diversified; most of them also use other SM techniques. Clearly SM is directly related to chiropractic.
• If chiropractic is a form of SM, then SM is directly related to chiropractic.
• Whether chiropractic SM differs from non-chiropractic SM is irrelevant to this topic.
• The topic is whether SM is directly related to chiropractic. Which it clearly is. The Ernst 2008 quote is another quote supporting this position.
• Our last few comments in this subthread have not made any progress. Please feel free to have WP:THELASTWORD.

Eubulides (talk) 23:49, 17 October 2008 (UTC)

I appreciate that. All I ask is that you look at your use of the word "form" in your last response and realize that if chiropractic is just a form of SM then it is to that form of SM which chiropractic is DIRECTLY related. The other forms of SM may possibly be somewhat related to chiropractic, but they certainly aren't directly related. For instance, the form of use of a hypodermic needle which medical doctors employ is directly related to Medical doctors. However, a heroin addict's form of use of a hypodermic needle is plausibly somewhat related to Medical doctors, but it certaily isn't directly related. Therefore the topic "Hypodermic needles" is somewhat related to Medical doctors, but certainly not directly related. After all, if there was a study documenting the dangers of heroin addicts' use of hypodermic needles, you would expect to find that study on the Medical doctor article in the context of "Medical doctors use hypodermic needles a great deal. According to research studying heroin addicts, hypodermic needles are dangerous." Take some time. Step back. Think about it. I promise I'll do the same. -- Levine2112 00:35, 18 October 2008 (UTC)

Please stop this off-topic discussion. -- Fyslee / talk 01:39, 18 October 2008 (UTC)

I'd say that a discussion of "knowledge and logic" outside of the realms of a Misplaced Pages application of such knowledge and logic is a discussion which is off-topic. From WP:Talk#How_to_use_article_talk_pages: Talk pages are for discussing the article, not for general conversation about the article's subject... Keep discussions on the topic of how to improve the associated article. Irrelevant discussions are subject to removal. -- Levine2112 02:02, 18 October 2008 (UTC)

• Agree, qualified by Surtuz' comment that ""SM is relevant to chiropractic" should not be used to insert material about non-chiro SM into the article." (Apologies for the repetition.) A narrow question has been asked and my answer pertains only to that, not to other questions.
  Thank you very much for the list of references, Eubulides. Based on those references, I found the following some of which in my opinion support the RfC question:

  • Principles and Practice: I'm not sure if I have easy access to this book.
  • Christensen & Kollasch 2005: does not contain the string "spinal m"
  • NCCAM: "Chiropractic is a form of spinal manipulation".
  • American Chiropractic Association: The mere fact that they published a document entitled "Spinal Manipulation Policy Statement"; also the section heading "Spinal Manipulation Therapy is a Chiropractic Science"; also the quote "The general description, spinal manipulative therapy, has long been used to broadly describe theprimary manual techniques utilized by a doctor of chiropractic (chiropractic physician)." and the quote "This supports the premise that by far the providers currently best qualified by education and practical skill and testing to perform spinal manipulation are doctors of chiropractic (chiropractic physicians)."; incidentally, the phrase "chiropractic spinal manipulation" also appears several times.
  • Villanueva-Russell: (This quote tends to contradict the RfC question) "The existing scientific research refers to spinal manipulation generally and without reference to specific technique or practitioner."
  • Villanueva-Russell quotes Sportelli: "Chiropractic must lay claim and full ownership to what the general public already associates with chiropractors-spinal manipulation. (1995, p. 39; emphasis added)"
  • Meeker and Haldeman: "Much of the positive evolution of chiropractic can be ascribed to a quarter century-long research effort focused on the core chiropractic procedure of spinal manipulation."
  • Ernst 2008: "This article attempts to critically evaluate chiropractic. The specific topics include ... the concepts of chiropractic, particularly those of subluxation and spinal manipulation;..."; and also "The core concepts of chiropractic, subluxation and spinal manipulation," and "Recent definitions of chiropractic:" of 12 definitions, 3 mention "spinal manipulation"; the phrase also appears in a summary of the "The three main hypotheses of modern chiropractic"; there's also this quote: "Chiropractors therefore developed spinal manipulations to correct such subluxations,... "
  • Council on Chiropractic Guidelines...: Inconclusive; I didn't find "chiropractic" and "spinal manipulation" in the same sentence.

  ☺ Coppertwig (talk) 02:08, 18 October 2008 (UTC)

Gallup Poll revisited

We have already cited the Gallup Poll in this section. I have found a chiropractic reference to it. While the poll results are devastating, it is also encouraging that these chiropractors are not denialists or wagon circlers, but admit the real and true causes for the poll results, and they want to do something about it:

• 1. Public image reform - Chiropractors are the most disrespected and mistrusted health care practitioners, as demonstrated in a recent CNN/USA Today/Gallup Poll,1 regarding people's opinions about the honesty and ethics of various professions. We must respond firmly to the fraud, abuse, charlatanism and quackery, as we feel that this is likely the primary reason for our low ranking in the public's perception of honesty and ethics among health care providers.

We should add this reference (not the whole quote) to the mention. It's already formatted. The primary reference is good, but this is (1) a chiropractic source and it's (2) not a primary source, so it should also be used. What think ye? -- Fyslee / talk 05:58, 9 October 2008 (UTC)

This reference appears to be an earlier and not-peer-reviewed version of Murphy et al. 2008 (PMID 18759966), which is already cited in Chiropractic. Shouldn't we stick with the more-recent and more-reliable version? Eubulides (talk) 06:50, 9 October 2008 (UTC)

They are two different documents, with the 2008 document only mentioning the earlier one. Both sources should be used. We only prefer peer-reviewed sources and follow MEDRS when dealing with the nitty gritty details of scientific matters. Other sources are fair game the rest of the time, even when dealing with scienfic matters, though it is then we would like to use (may prefer) good peer-reviewed sources as well. Misplaced Pages's policies require that sources be V & RS, not that they are peer-reviewed. We shouldn't use MEDRS to violate or nullify V & RS. Non-peer reviewed sources that are V & RS are still allowed. It's just a matter of editorial discretion when we use what, and with this type of information (political, news, public opinion, etc.), peer-review is hardly relevant (but I wouldn't turn down such a source if it existed, and it does here ;-). Murphy et al (not exactly the same group of editors) only make a weak reference to the earlier mention. The earlier mention is written to chiropractors and contains significantly stronger language. It thus covers the subject better than the later document. This isn't an either/or situation, but if I had to choose, I'd choose the previous document. Let's just use both refs. -- Fyslee / talk 13:37, 9 October 2008 (UTC)

The later document does not merely "only mention" the earlier one; it covers the same point as the one quoted above, except with more temperate and solid language, which is exactly the sort of thing that one would expect from peer review. Here's the more-temperate language:

• "However, in spite of this, the profession has not gained a level credibility and cultural authority in mainstream society that is required to establish itself on equal ground with other healthcare professions. The profession still finds itself in a situation in which it is rated dead last amongst healthcare professions with regard to ethics and honesty..."
• "Patients place their faith in the professional, and trust that they will not be subject to fraud, abuse or quackery. This is the social contract as it applies to chiropractic physicians."
• "The chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and quackery, which are more rampant in our profession than in other healthcare professions."

Perhaps the non-peer-reviewed source makes some important points that the later, peer-reviewed source does not cover. In that case we may need to cite to the non-peer-reviewed source. But we should take great care in doing so: the non-peer-reviewed source is less reliable. It would be better to cite a more-reliable source. Eubulides (talk) 14:55, 9 October 2008 (UTC)

The only part from the later source that relates directly to the Gallup Poll is this mild statement (contrasted with the previous statement):

• "The profession still finds itself in a situation in which it is rated dead last amongst healthcare professions with regard to ethics and honesty."

• Chiropractors are the most disrespected and mistrusted health care practitioners, as demonstrated in a recent CNN/USA Today/Gallup Poll,1 regarding people's opinions about the honesty and ethics of various professions. We must respond firmly to the fraud, abuse, charlatanism and quackery, as we feel that this is likely the primary reason for our low ranking in the public's perception of honesty and ethics among health care providers.

The two statements are so different that they could be written in one paragraph, without any serious repetition. Just read the first and continue reading the second, without pausing. You get the whole story right there.

The previous version, written at the time and just as "reliable" a source for this type of stuff (in any sense, including Misplaced Pages's definition), is much more honest and straightforward. It doesn't smother itself and whitewash its language in politically correct terminology. They tell it like it is, and it's very refreshing. Normally, political correctness is a tool used to sweep the truth under the carpet, and we should avoid such sources when better ones are available.

This is all written by chiropractors, not evil anti-chiropractic science zealots, or pseudoscientific skeptics, as one of our editors here would like to think. Much to his chagrin, real, very influential chiropractors are admitting that the charges that chiroskeptics have made for years are true, and they wish the profession would do something constructive about it. -- Fyslee / talk 01:14, 10 October 2008 (UTC)

Now that I've read the sources again, I think the parts you have quoted, while not directly related to the Gallup Poll, make important points that could be mentioned in the article here. -- Fyslee / talk 01:46, 10 October 2008 (UTC)

• The statements "Chiropractors are the most disrespected and mistrusted health care practitioners, as demonstrated in a recent CNN/USA Today/Gallup Poll,1 regarding people's opinions about the honesty and ethics of various professions" and "The profession still finds itself in a situation in which it is rated dead last amongst healthcare professions with regard to ethics and honesty" are on exactly the same topic, and are supported by exactly the same source; it's just that the latter statement more accurately summarizes the source, is more recent, and is peer-revered. We should prefer the more-reliable source on this point.
• The statement "We must respond firmly to the fraud, abuse, charlatanism and quackery" is a vague piece of advocacy. Much more concrete is "The chiropractic profession has an obligation to actively divorce itself from metaphysical explanations of health and disease as well as to actively regulate itself in refusing to tolerate fraud, abuse and quackery, which are more rampant in our profession than in other healthcare professions." The latter is more recent and is peer-reviewed. The latter is advocacy as well, and as advocacy would require in-text attribution, but why cite the earlier, vaguer, and lower-quality source when we have something far better?
• "Patients place their faith in the professional, and trust that they will not be subject to fraud, abuse or quackery. This is the social contract as it applies to chiropractic physicians." is indeed a new point in the latter source, and could also be summarized here.

Eubulides (talk) 04:14, 10 October 2008 (UTC)

I believe "advocacy" is the wrong word here, at least in the Misplaced Pages sense. I think you mean "opinion". It's an opinion expressed by very notable chiropractors, and since it is in a V & RS, it's quite acceptable as a well-sourced opinion (and should be attributed to the very notable chiropractors). I fear we are getting too bogged down by misapplications of MEDRS and we are overly restricting ourselves to peer-reviewed sources when not required to do so. This is really impeding progress here and deviates from Misplaced Pages's overall policies that allow V & RS, regardless of source. Only in situations where there is a clear discrepancy or disagreement should peer-reviewed sources be required to trump other sources, and then only if they are dealing with nitty-gritty scientific matters. We aren't allowed to make our own rules that overrule the V & RS policies. I think you are so used to editing mainstream medical and scientific articles, where MEDRS and peer-reviewed sources are used much more, that you are forgetting we are dealing with chiropractic, a subject that is only partially scientific, and concerns much subject matter of a fringe and political nature. This means we need to include many other types of information from many other types of sources.

Having said all that, the other quotes you mention are certainly acceptable.

Let me make something clear: I have not (originally) been advocating an addition of words, but only an addition of the more original ref alongside the newer ref. Since then I now favor some tweaking of the wording to enlarge the statement describing the situation, using wording from both sources. Let's just improve what we have with a few more words and include both refs. There is no policy that forbids it, it is standard practice to do so, and it will help our readers understand the situation better. Some readers will actually benefit from reading the refs we provide. -- Fyslee / talk 04:58, 10 October 2008 (UTC)

As a side note, the 2008 article is clearly written by reform chiropractors, as one of their closing paragraphs clearly describes the NACM position, which was radical when first proposed by the NACM, and indicates that that position will (if the author's wishes prevail) become the sole chiropractic mainstream position in the future, with straights and subluxationists becoming extinct dinosaur artifacts:

"We must finally come to the painful realization that the chiropractic concept of spinal subluxation as the cause of "dis-ease" within the human body is an untested hypothesis . It is an albatross around our collective necks that impedes progress. There can be no unity between the majority of non-surgical spine specialist chiropractic physicians and the minority of chiropractors who espouse metaphysical, pseudoreligious views of spinal subluxations as "silent killers" . The latter minority group needs to be marginalized from the mainstream majority group, and no longer should unrealistic efforts be made toward unification of these disparate factions within the profession.

Conclusion: Reform of the chiropractic profession is long overdue."

That quote would be good in the Vertebral subluxation article. When their wish becomes public and official chiropractic policy, and actually gets effectuated, then, and only then, will the profession be in a position to achieve the acceptance and cultural authority it desires. This quote from another source is poignant here:

"We lament efforts to generate unity within the profession through consensus statements concerning subluxation dogma, and believe that cultural authority will continue to elude us so long as we assert dogma as though it were validated clinical theory."

-- Fyslee / talk 05:26, 10 October 2008 (UTC)

• I agree that the newer source is a good source and makes good points. It would be helpful to make specific wording suggestions to improve Chiropractic along the lines that you mention. (I hope it wouldn't involve long quotes from the source. :-)
• However, the older source is not needed for that. This is not merely a matter of WP:MEDRS; it is a matter of WP:SOURCES. The newer source, Murphy et al. 2008 (PMID 18759966), published in the peer-reviewed journal Chiropr Osteopat, is far more reliable by the standards of WP:SOURCES than is the older source, Murphy et al. 2005, published in the trade magazine Dyn Chiropr. The older source is by the same group, and expresses similar points, but does so in a lower-quality and less-reliable way; it is completely dominated by the newer source on the points at hand. Citing multiple and duplicative sources on the same points, from the same group, would raise WP:WEIGHT issues as well. Let's just stick with the better source.
• More generally, we should not settle for just any reliable source: we should use the most reliable sources available. And we shouldn't cite lower-quality sources merely because they use stronger words that we happen to like better; that could weaken the credibility of Chiropractic.

Eubulides (talk) 05:47, 10 October 2008 (UTC)

Moving my comments to Eubulides' talk page. -- Fyslee / talk 14:26, 10 October 2008 (UTC)

I'll try to come up with alternate proposed wording, but I haven't yet had time to do this. Eubulides (talk) 07:36, 11 October 2008 (UTC)

Please see #Proposed changes from Murphy et al. 2008 below for the alternate proposed wording. Eubulides (talk) 16:42, 12 October 2008 (UTC)

See also

I recommend we add the article List of pseudosciences and pseudoscientific concepts to a new see also section. QuackGuru 17:49, 10 October 2008 (UTC)

I disagree with that recommendation. -- Levine2112 19:24, 10 October 2008 (UTC)

I also disagree. I don't think it would be helpful or that relevant to this subject. Eubulides (talk) 07:36, 11 October 2008 (UTC)

I too disagree. We need to stick with more specific things. -- Fyslee / talk 15:09, 11 October 2008 (UTC)

X-rays

Chiropractors use them (some critics say "too often"). Historically, the profession is credited with much of the advances in the field of Radiology.

• Could we use a study about chiropractor's use of X-rays in this article? (i.e. to support a statement such as "According to study A, chiropractic use of X-ray is regarded as safe/dangerous"?
• Could we use a study about X-ray use in general (not necessarily performed by chiropractors) in this article? (i.e. to support a statement such as "According to study A, the use of X-rays is safe/dangerous")?

I am thinking about this in terms of WP:NOR, but I am interested in any input about any policies as well regarding this. -- Levine2112 19:24, 10 October 2008 (UTC)

I think it'd be helpful to put in a brief discussion of chiropractic and X-rays. The topic is already discussed in Chiropractic #History but only from a historical viewpoint, and it'd be helpful to cover it from today's. Sources that we might want to take a look at include French et al. 2003 (PMID 17987210) and Ernst 2002 (PMID 9616232).

I am a bit leery about using Ernst so much. His bias is of concern and with so much from him already going into this article, there is a legitimate WP:WEIGHT concern. Anyhow, while I want to pursue this conversation, I would really like to use this space to discuss my two hypothetical scenarios above. It seems like you would say "Yes" to scenario 1, given your post; but what about scenario 2. Could we put the conclusions of a general (non-chiropractic) X-ray study here and discuss the relative safety of X-rays based on that study? For instance, let's say we found a review of literature which says X-rays are completely safe. Could we include that conclusion in this article where we are talking about chiropractors use of X-rays? -- Levine2112 07:49, 11 October 2008 (UTC)

Lets stay on topic. The Ernst ref is relevant and freely readable too. Click on Begin manual download if it does not go straight to the PDF file. QuackGuru 18:14, 11 October 2008 (UTC)

As a matter of fact,t he topic of this thread is what I defined it to be when I started it. Could you answer it please? -- Levine2112 18:29, 11 October 2008 (UTC)

I will answer your question the the form of a question. Do you think X-rays are strongly associated with chiropractic to the same degree as spinal manipulation according to the expert reviewers? QuackGuru 17:35, 15 October 2008 (UTC)

I don't know. I have not looked at the expert reviewers take on X-rays and chiropractic. Does that really matter in the case of my hypothetical question above? -- Levine2112 17:43, 15 October 2008 (UTC)

It may be best for you to strike your questions. You don't know what experts think about this and you claim: Does that really matter in the case of my hypothetical question above? At this point, I don't see any reason to continue a discussion on this hypothetical question. Time to move on. QuackGuru 17:57, 15 October 2008 (UTC)

I suggest you strike out your repeated hypothetical question too. It serves no purpose to the OR discussion here. The noticeboard is not a policy page or for general discussion. QuackGuru 18:06, 15 October 2008 (UTC)

This is an attempt to discuss policy and people's understanding of such policy. NORN is the perfect place to do that, I think. -- Levine2112 19:16, 15 October 2008 (UTC)

Scope of practice 4

The following proposal builds on the wording proposed in #"Limited scope of practice" (version 3), and also the wording proposed in #Fixing first paragraph under EFFICACY. In #Comments on "Limited scope of practice" (version 3) it was suggested to "Please tweak it and let's see what your version looks like". As I mentioned toward the end of that section, more surgery than a "tweak" is needed. The current proposal (below) make several changes to Chiropractic #Scope of practice, instead of merely appending text to it. Here is the proposal:

• Move the following sentence from Chiropractic #Effectiveness, to Chiropractic #Scope of practice as shown in the proposed (modified) wording below:

No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors; the focus on SM has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.

• Move the following (modified) text from Chiropractic #Scope of practice to the end of 2nd paragraph of Chiropractic#Education, licensing, and regulation, as it talks about education rather than scope-of-practice:

Specialty training is available through part-time postgraduate education programs such as chiropractic orthopedics and sports chiropractic, and through full-time residency programs such as radiology or orthopedics.

• Move the following (modified) text from Chiropractic #Scope of practice to the beginning of 3rd paragraph of Chiropractic#Education, licensing, and regulation, as it is more relevant to accreditation than to scope of practice, and it will then immediately precede text that talks about the U.S., etc.

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

• Replace Chiropractic #Scope of practice with the following:

Scope of practice

Chiropractors, also known as doctors of chiropractic or chiropractic physicians in many jurisdictions, emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery, with special emphasis on the spine. Chiropractic combines aspects from mainstream and alternative medicine: although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry. It has been proposed that chiropractors specialize on nonsurgical spine care, instead of attempting to also treat other problems; but the more-expansive view of chiropractic is still widespread. Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM); however, a 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine.

The practice of chiropractic medicine involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, and orthopedic and neurological evaluation. A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. Common patient management involves spinal manipulation (SM) and other manual therapies to the joints and soft tissues, rehabilitative exercises, health promotion, electrical modalities, complementary procedures, and lifestyle counselling.

Chiropractors cannot write medical prescriptions or perform major surgery. In the U.S. their scope of practice varies by state in areas such as conducting laboratory tests or diagnostic procedures, dispensing dietary supplements, and using other therapies such as homeopathy and acupuncture; in the state of Oregon they can become certified to perform minor surgery and to deliver children via natural childbirth. A 2003 survey of North American chiropractors found that a slight majority favored allowing them to write prescriptions for over-the-counter drugs. A related field, veterinary chiropractic, applies manual therapies to animals and is recognized in a few U.S. states, but is not recognized by the American Chiropractic Association as being chiropractic.

Spine care is offered by several other professions, including massage therapists, osteopaths, and physical therapists. No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that orthodox medical physicians could "steal" SM procedures from chiropractors. A focus on evidence-based SM research has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks. Some U.S. states prohibit physical therapists from performing SM, some states allow them to do it only if they have completed chiropractic training, and some states allow only chiropractors to perform SM, or only chiropractors and physicians. Bills to further prohibit non-chiropractors from performing SM are regularly introduced into state legislatures and are opposed by physical therapist organizations.

Eubulides (talk) 07:38, 11 October 2008 (UTC)

That sounds pretty good to me. There is one point at which I hesitate, and that is where the word "steal" could be understood to mean that chiropractic already owns SM, which is not the case. They are seeking to own it by preventing other professions from using it. It's a Liebensraum political move. One cannot steal something from someone who doesn't own it. SM predates chiropractic and has been used by other professions for a long time, in some cases before chiropractic came into existence. The Villanueva cite should include a URL to the whole article, if possible. -- Fyslee / talk 00:14, 12 October 2008 (UTC)

Thanks for catching that. The proposal doesn't talk about stealing SM, it talks about stealing SM procedures. To make this point clearer I replaced "There is little consensus as to which profession should administer spinal manipulation," with "No single profession "owns" spinal manipulation," in the proposal. The cited source supports both wordings, but the latter is clearer on this point (and is much easier to read to boot). Eubulides (talk) 06:28, 12 October 2008 (UTC)

The wording change is confusing. It sounds as if there is a concern over who owns SM. QuackGuru 06:55, 12 October 2008 (UTC)

Sorry, I don't see the confusion. There is a concern over who "owns" SM. Some chiropractic groups do want to "own" it; after all, SM is chiropractic's core treatment form, and it's the reason chiropractic exists. Conversely, PTs, MDs, DOs, etc. dispute the "ownership", and say they can do SM as well. The mainstream consensus is that no group "owns" SM, which is what the new text says. However, if the new text is confusing to you, perhaps we should go back into the old text. It's been that way in the article for months, and I'd rather not have this overall edit be sidetracked by a question over whether this particular change is confusing. Eubulides (talk) 13:31, 12 October 2008 (UTC)

I think we should keep the updated version. The attempts to gain "ownership" by chiropractic goes against the grain of how medicine historically works. Mainstream, authorized professions have always reserved the right to use or adopt any method that is effective or has some legitimacy, or even if not totally proven yet, using it as an experimental treatment, with MDs having absolute rights in this regard, and subordinate professions like PTs choosing to concentrate on methods within their scope of practice, which is why SM is a logical part of their armamentarium of treatment techniques. Any method, including currently alternative medicine methods, ceases to be "alternative" and becomes mainstream if proven effective, and thus becomes legitimate game for mainstream professions. If I had access to the full text version I'd be able to contribute more effectively here. -- Fyslee / talk 18:35, 12 October 2008 (UTC)

Me thinks we should keep the original version and if editors agree we can add the new material No single profession "owns" spinal manipulation. right before the old material for context. QuackGuru 02:30, 13 October 2008 (UTC)

OK, thanks for the suggestion, I did that. Eubulides (talk) 07:06, 15 October 2008 (UTC)

uncontroversial edits

I like this edit, especially replacing the bit about anatomical boundary with "not so far as to dislocate or damage the joint": I can understand it better now! ☺ Coppertwig (talk) 14:58, 11 October 2008 (UTC)

Manipulation under anesthesia

Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment.

Something shorter than the above for brevity about Manipulation under anesthesia might help improve this article. This could be added to the Chiropractic#Treatment techniques if shortened per WP:SUMMARY. QuackGuru 17:52, 11 October 2008 (UTC)

Do chiropractors administer adjustments under anaesthesia? I don't think they do... --Surturz (talk) 18:25, 11 October 2008 (UTC)

Yes they do, and personally I'd like to see the pros and cons about this procedure. My son is trying to arrange this procedure so I'd love to be able to read more about it before it is done. Thanks, --CrohnieGal 18:39, 11 October 2008 (UTC)

Mentioning MUA, MUJA, and MUESIs would be reasonable, but those are low-quality sources: one merely lists 4 case studies and the other is a proposal. A much better source is Dagenais et al. 2008 (PMID 18164462): it's more recent, it's a review article, and it's high-quality. Eubulides (talk) 21:12, 11 October 2008 (UTC)

It's already covered here: Chiropractic treatment techniques. If mentioned in this article's "Treatment techniques" section, it should just be a mention and wikilink to Manipulation under anesthesia . -- Fyslee / talk 21:26, 11 October 2008 (UTC)

• Wiklinking to manipulation under anesthesia sounds dubious, as that article is very low in quality and it's not at all clear to me that it's accurate. Also, MUA is just one of the ways to do medicine-assisted manipulation, and may not be the most-popular way.
• Here's a specific proposal. Let's append the following to the 2nd paragraph of Chiropractic #Treatment techniques:

Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist.

and insert the following before the last sentence of the Low back pain bullet of Chiropractic #Effectiveness:

A 2008 systematic review found insufficient evidence to make any recommendations concerning medicine-assisted manipulation for chronic low back pain.

Eubulides (talk) 06:28, 12 October 2008 (UTC)

It sounds like your references need to be used on the MUA article. It would be best to improve it first. We don't need too much detail here, and a wikilink should be sufficient to help us avoid bloating that section. -- Fyslee / talk 06:36, 12 October 2008 (UTC)

You can improve another article if you want but editors are not obligated to improve another article first before improving this article. Let's mention manipulation under anesthesia here in this article. QuackGuru 06:47, 12 October 2008 (UTC)

I have refactored my comment. If an article isn't good, it needs fixing. Of course we can improve this one without improving that one, but the details need to go there, not here. We have already dealt with a bloated Treatment techniques" section by eliminating nitty gritty details and starting the section with "main article" links. Let's not go against our previous decision. That article is where the details need to go. That is my main point. I have already made it clear that MUA can be mentioned here, but only briefly. A very short sentence should be enough. -- Fyslee / talk 07:01, 12 October 2008 (UTC)

Unless I'm missing something, the above comments don't disagree with the proposed text. The proposed text mentions medicine-assisted manipulation, a more-general term that includes manipulation under anesthesia as a special case. That is, the proposed text uses a brief summary style and avoids bloating Chiropractic (which is what Fyslee's comment asks for), and it also (indirectly) mentions MUA (which is what QuackGuru asks for). Eubulides (talk) 13:31, 12 October 2008 (UTC)

It doesn't create bloating, but is missing the wikilink, which is standard practice here. Refusing to wikilink to another article because of questions regarding the quality of that article is a POV editorializing decision, and indicates that the article needs improvement, not that we should refuse to wikilink. The MAM terminology is very, very rare compared to MUA, and the more common MUA terminology, especially within chiropractic, should be preferred for chiropractic articles. -- Fyslee / talk 16:23, 12 October 2008 (UTC)

OK, I added the wiklink to the proposed text. That article is bad, and I disagree that one has an obligation to wikilink to bad articles, but I suppose the article could be improved later. Eubulides (talk) 16:42, 12 October 2008 (UTC)

I wouldn't say "obligation to", but it's standard practice here. That article definitely needs improvement, and inclusion of your sources there would help to improve it. Including information and links about the relatively rare MAM terminology would also improve it. The MUA wikilink serves as a substitute for source linking here, since inclusion here is merely an uncontroversial mention of MUA as an interesting technique, which differs from all other chiropractic techniques in that it involves the (for chiropractic forbidden) use of drugs and the direct oversight and involvement of MDs, especially anesthesiologists.

Using wikilinks and very minimal mention helps to avoid bloating the "techniques" section, which was a potentially serious problem before we shortened it. It's all about how to avoid article and section bloat. We chose to move all the nitty gritty details, explanations, and most of the documentary references to their respective articles, and also to add "main article" links. This approach has served readers well by giving them a brief overview of the subject and wikilinks to the relevant articles for those who wish more information. -- Fyslee / talk 18:15, 12 October 2008 (UTC)

Interesting articles

• James J. Lehman, DC, MBA and Paul J. Suozzi, PhD. "Founding Integrative Medicine Centers of Excellence: One Strategy for Chiropractic Medicine to Build Higher Cultural Authority." J Chiropr Educ. 2008 Spring; 22(1): 29–33. PMCID: PMC2384195

• William Meeker, DC, MPH, FICC. "Cultural Authority, Best Practices, and Chiropractic Theory: A Dilemma for Chiropractic?." Dynamic Chiropractic – January 29, 2005, Vol. 23, Issue 03

-- Fyslee / talk 04:42, 12 October 2008 (UTC)

Proposed changes from Murphy et al. 2008

Here are some changes proposed as a followup to the above discussion in #Gallup Poll revisited:

• Make the following changes to the last paragraph of Chiropractic #Education, licensing, and regulation (new text in italics):

A 2008 commentary proposed that the chiropractic profession actively regulate itself to combat abuse, fraud, and quackery, which are more prevalent in chiropractic than in other health care professions, violating the social contract between patients and physicians. A study of California disciplinary statistics during 1997–2000 reported 4.5 disciplinary actions per 1000 chiropractors per year, compared to 2.27 for MDs; the incident rate for fraud was 9 times greater among chiropractors (1.99 per 1000 chiropractors per year) than among MDs (0.20).

• Make the following changes to the last sentence of the first paragraph of Chiropractic #Utilization, satisfaction rates, and third party coverage, and break it into a new paragraph instead of being appended to the previous paragraph (new text in italics):

Chiropractic does not have the same level of mainstream credibility as other healthcare professions. Public perception of chiropractic compares unfavorably with mainstream medicine with regard to ethics and honesty: in a 2006 Gallup Poll of U.S. adults, chiropractors rated last among seven health care professions for being very high or high in honesty and ethical standards, with 36% of poll respondents rating chiropractors very high or high; the corresponding ratings for other professions ranged from 62% for dentists to 84% for nurses.

• Make the following change to the last sentence of the first paragraph onf Chiropractic #Philosophy (new text in italics):

However, most practitioners currently accept the importance of scientific research into chiropractic, and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness; a 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.

Eubulides (talk) 16:42, 12 October 2008 (UTC)

Time to remove tags

Discussion seems to have died down about the two maintenance tags in Chiropractic. It's time to fix this as discussed.

First, Chiropractic #Effectiveness has a {{Mergeto}} tag that has been discussed in great detail in #Relevancy and in #Scope of practice 4 above. It can be removed by applying the change discussed in #Scope of practice 4.

Second, Chiropractic #Evidence basis has a {{SectOR}} tag that has been discussed in enormous detail, in several places, including:

• RfC: Effectiveness of chiropractic care (April 24)
• RfC: Effectiveness of chiropractic care (May 12)
• Its followup Improved version RfC (May 14)
• Chiropractic section on evidence basis (July 29)
• Request for Comment, Possible OR violation at Chiropractic Effectiveness (September 10)
• Request for Comment: Excluding treatment reviews (September 16)
• Outside view believes spinal manipulation is relevant (September 30)
• RfC: Is the "subject" of spinal manipulation relevant to chiropractic? (October 9)

While there is not universal agreement in the above threads, there is a consensus that the text in question is not original research. Further reopening of RfCs and NORN issues is likely to be not useful, as we've reached the point of RfC exhaustion. It's time that we brought this discussion to a close, removed the tag, and moved on to further improving the article. Eubulides (talk) 07:06, 15 October 2008 (UTC)

There is no consensus that the text in question is not a violation of WP:OR. Saying so is a gross distortion of the truth. I'd say that it is time to remove the text in question and move on to further improving the article. However, I am not going to suggest that until this conversation is truly over. As of now, the conversation is hardly over. I still plan on opening the new RfC and continuing with WP:DR. How come you never answered my X-ray questions above? -- Levine2112 17:21, 15 October 2008 (UTC)

We are doing the same thing experts outside of Misplaced Pages are doing and you know this. I'm sure of it. On Misplaced Pages we do not lead but follow the latest references carefully. That's exactly what we are doing. QuackGuru 17:51, 15 October 2008 (UTC)

Actually, Levine, consensus is relatively clear in the RFC. Further discussion there may yet be useful to come up with suggestions on how to minimize perceived WP:OR violations, but I highly doubt that consensus will change due to it. Cheers. lifebaka++ 19:02, 15 October 2008 (UTC)

Which RfC are you referring to? We've had several. Some editors who responded in earlier ones did not respond in newer ones. And some of the newer RfC don't really discuss whether or not the OR tag is appropriate. -- Levine2112 19:07, 15 October 2008 (UTC)

The one above at #RfC: Is the "subject" of spinal manipulation relevant to chiropractic? was what I was referring to specifically. If you have links to older RfCs on the topic, I'll be happy to look over them. It is true that this specific RfC does not directly address the issue of OR, and perhaps another RfC based on its outcome would be appropriate. Cheers. lifebaka++ 19:12, 15 October 2008 (UTC)

Thanks for the response. Yes, that RfC does not address the possible OR violation directly. Whereas, this one does. You will note that the majority (if not all) of the outside respondents agreed that there was an OR violation. -- Levine2112 19:14, 15 October 2008 (UTC)

Editors claimed there was OR but specific exmples are needed. See Talk:Chiropractic/Archive 27#Examples needed. The OR concerns are only concerns. No evidence of OR has been presented. For this article, Wikipedians are doing the same thing top researchers are doing. Time to move on. QuackGuru 20:06, 15 October 2008 (UTC)

Interesting, but I don't see consensus either way in that one. Outside participation in the linked RfC was very low, though you are correct that it favored the position that an OR violation had been committed. Cheers. lifebaka++ 22:36, 15 October 2008 (UTC)

What is more interesting is that the editors who claim OR are unable to produce any evidence of OR. Outside participation was very low. Some of the editors are involved editors and not outside observers. Hmm. QuackGuru 04:39, 16 October 2008 (UTC)

Indeed, Lifebaka. I'd say there was a very clear consensus that no OR is involved in following the literature and using these references in the same way as other publications on the topic. Tim Vickers (talk) 19:10, 15 October 2008 (UTC)

And I would disagree. When one looks at the totality of the discussion (including here), no clear consensus exists. DigitalC (talk) 08:07, 16 October 2008 (UTC)

• The totality of the discussion includes all 8 threads I listed at the start of this section. The thread that you and Levine2112 cite is the one most-favorable to the contention that OR exists. And that particular thread is a slender reed indeed: the RfC itself is vaguely worded and contains no specific examples, outside respondents' opinions contain statements like "I have not digested the section in question" which make it clear that their opinions are uninformed, and the resulting comments don't establish consensus either way. And that's the thread most-favorable to the contention that OR exists; the other 7 threads listed above are unfavorable to the contention.
• Levine2112 has stated multiple times an intent to continue this months-long campaign of opening RfCs and other dispute-resolution options, with comments like "The conversation is hardly over" (e.g., , ). As part of this campaign, for example, there's a currently-open thread at WP:NOR/N #A hypothetical which raises a hypothetical question about X-rays within chiropractic. The questions in this campaign are vague or hypothetical questions, sometimes contain inaccurate summaries of what is actually in Chiropractic, and do not propose specific changes to the wording in the article. Such questions are unlikely to result in any improvements to Chiropractic. Much better would be specific wording proposals, such as the one in #Proposed addition re X-ray safety below.

Eubulides (talk) 17:02, 16 October 2008 (UTC)

This comment seems irrelevant IMHO. This is how consensus policy can easily be gaming the system. The editors who claim OR have not presented any evidence of OR. Should we respect the opinion of editors who make a claim of OR when they refuse to demonstrate any evidence of OR exists or should we move on to other parts of the article? This is when admins may want to step in an make an executive decision. Should editors continue to argue (continue to recycle old arguments) or move on to bigger and better things (possibility of WP:GA)? QuackGuru 18:08, 16 October 2008 (UTC)

It's time to move on when no evidence of WP:OR has been presented

In order to stop the continued OR discussion we may need a specific topic ban on editors who never stop claiming there is OR when we are doing exactly what researchers outside of Misplaced Pages are doing. The topic ban would be anything directly related to the original research discussion. This would not be an article ban but only a ban on this specific topic. We could have an article ban on any editor who continues the original research discussion if editors believe it to be necessary. QuackGuru 17:51, 15 October 2008 (UTC)

Note. Consensus can easily be gamed when editors attempt to block consensus and improvements without a valid reason. WP:IDONTLIKEIT is not a rational reason. QuackGuru 18:25, 16 October 2008 (UTC)

An editor has a hard time understanding MEDRS policy and assumed bad faith (read the edit summary). QuackGuru 20:50, 16 October 2008 (UTC)

Levine2112 has been informed that chiropractic is strongly associated with spinal manipulation according to the reliable references presented. QuackGuru 20:49, 17 October 2008 (UTC)

Coppertwig has been informed it is not productive to continue to support there is original research when no evidence of OR has been presented. QuackGuru 20:49, 17 October 2008 (UTC)

Proposed addition re X-ray safety

There's been some discussion on procedural grounds about a hypothetical example involving chiropractors and X-rays. That topic is clearly relevant and notable to Chiropractic, so I propose to append the following text to Chiropractic #Safety, as a new paragraph. This is not intended to be a hypothetical example: this is a real proposal to improve the article.

Chiropractors sometimes employ diagnostic imaging techniques such as X-rays and CT scans that rely on ionizing radiation; practice guidelines aim to reduce unnecessary radiation exposure, which causes cancer in proportion to the amount of radiation received.

Eubulides (talk) 20:45, 15 October 2008 (UTC)

Is general spinal manipulation (GSM) technically different than chiropractic spinal manipulation (CSM)?

There has been a lot of discussion about original research but what is the difference? Is there any significant difference? According to what source there is any specific difference between GSM and CSM. QuackGuru 05:20, 16 October 2008 (UTC)

To get useful answers you'll need to use standard terminology. Please explain more specifically what you are referring to. Is GSM the same as HVLA spinal manipulation, and is CSM the same, but performed by a chiropractor, and thus if it is a straight chiropractor, will be termed a spinal adjustment? If so, the only difference is the performer and the intention. A chiropractor (especially a straight one) manipulates/adjusts with the intention of "correcting" vertebral subluxations (VS). Regardless of intent, both practitioners are causing the same effect on the structures being manipulated, but will be causing different beliefs about what is happening in the minds of their patients. Physically equal, but mentally different.

If by CSM you are allowing the myriad techniques that are also (in addition to HVLA spinal manipulation) included under the umbrella term spinal adjustment, then the sky's the limit, as techniques vary quite a bit, including mechanical and electrical devices, and including techniques that don't have an earthly chance of having any real effect on a spinal motion segment.

Basically, "adjustment" is a code word for the claimed "correction" of anything any chiropractor claims is a VS, and thus is the manipulation of an imaginary lesion. There is often no known objective method of identifying them. When the original Medicare requirements for objective proof (x-rays) were made, it turned out that such proof was not forthcoming, and finally the requirement was dropped in 2000. Now there is no requirement for proof. Medicare just accepts the subjective word of any chiropractor that they have corrected a VS. -- Fyslee / talk 05:58, 16 October 2008 (UTC)

Possibly misleading text or a weight violation from a source was added without discussion or consensus

Please revert and discuss major changes to the text. Or are we back to being WP:BOLD for this article. We can remove the controversy template that is towards the top of the talk page if editors agree. QuackGuru 01:53, 18 October 2008 (UTC)

References

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