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Popularity

It must be this paragraph you're referring to:

Although chiropractic gained more acceptance from the 1960's, its popularity is declining. The U.S. National Center for Education Statistics reports that enrollments for sixteen U.S. chiropractic programs fell by 39.9% from 16,500 in 1996 to 9,921 in 2002, and the number of chiropractic patients fell by 25% from 1997 to 2002.

Maybe another word might be good, although "popularity" fits the bill without being explicitly POV editorializing. I'm not averse to trying other synonyms. "Utilization" applies to the patient part, but not to the educational part. -- Fyslee 21:18, 29 April 2006 (UTC)

Utilization works for me, though I am still trying to figure out the numbers as well. It sounds steep. --Dematt 04:34, 30 April 2006 (UTC)

I have reworded it now. I hope it is more accurate. The 39.9% number is very steep! It is quoted here. Just search for 39.9%.

I still think "popularity" makes this sound more judgemental as it makes it sound like the "people" no longer favor it. The next sentence in the source says:

Possible causes for the decline, identified during our recent interviews with chiropractic experts, include raising admission standards to 90 semester credit hours, a demographic drop in eligible students, rising tuition costs, the increasing burden of student loans, managed care’s affect on the chiropractic profession, and a reduction in referrals, recruiting, and encouragement from practicing chiropractors. In all likelihood, the drop in enrollments is due to a combination of factors mentioned. It was also noted that virtually all health professions saw a drop in applications during this period. In medical schools, where applications vastly exceeded openings, there was not a drop in enrollments.

Our interviews with the presidents of chiropractic colleges confirm a rise in enrollment levels since 2002. Some of the college presidents also noted that this increase will be supported by the demographic bulge as more of the millennial generation graduate from undergraduate programs and pursue graduate degrees. Chapman-Smith, David. (2000). The Chiropractic Profession. p. 51-2. Des Moines, Iowa: NCMIC

I think the statement above about "all health professions" puts the "steep" 39.9% drop in enrollment into perspective with what was happening in the US at the time. The contoversial rise of HMO's was painting a bleak picture for anyone who might be considering a career in the healthcare arena back then. Why would anyone go into any healthcare field? This was a time when every parent was pushing there kid into the computer industry. Now that's a number I would like to see:) If we use popularity, we at least have to give some reasons. --Dematt 21:46, 30 April 2006 (UTC)

Regarding chiropractic income levels, a survey by the ACA noted a decline in net chiropractic income from $101,000 in 1989 to $86,000 in 1997. This information could also be included, as it is a significant factor in decision-making regarding choice of education. -- Fyslee 13:28, 30 April 2006 (UTC)

This may tie in with the reason doctors were less likely to refer students to schools. Would you suggest someone go into a your career when your income was dropping? --Dematt 21:46, 30 April 2006 (UTC)

Conflicting "popularity" statistics

The U.S. Department of Labor, Bureau of Labor Statistics says just the opposite about chiropractic's popularity. Employment of chiropractors is expected to grow faster than average for all occupations through the year 2014 as consumer demand for alternative health care grows. So according to the U.S. Gov't Bureau of Labor Statistics, chiropractic's "popularity" or "utilization" is growing not declining. The lowered enrollment rates is not an indication of declining popularity with patients, but in the raising of admitance standards for chiropractic schools. The way it is worded now in the article seems to take a false logical leap... that because enrollment is down in chiropractic school, then the utilization of chiropractic by the public must also be down. Whether or not the enrollment stat is true, I don't see how that would be a direct indicator of chiropractic's popularity with patients. Levine2112 07:53, 30 April 2006 (UTC)

Here you can find an Analysis of the Chiropractic Section of the Occupational Outlook Handbook. -- Fyslee 13:28, 30 April 2006 (UTC)

Pretty much all of Stephen Barrett's analysis of anything chiropractic with be from avery negative POV. The Bureau of Labor Statistics on the other hand, is a non-biased agency. The report that the give on Chiropractic is also non-biased. Just statistics and information that can be concluded from said statistics. The main point of me mentioning it here is that it negates what is written in our article. Chiropractic is thriving as a profession despite the efforts of the Stephen Barretts of the world. Levine2112 04:55, 2 May 2006 (UTC)

The Bureau's publication is a predictive (not totally factual) work, largely based on the profession's own spin-doctored version of what they wish, and ignores actual statistics in its predictions. A more accurate picture is painted here - The Future of Chiropractic Revisited: 2005 to 2015 - where the various possibilities are painted, including the very real threats posed by other professions, and including the real statistics of what actually is happening. That publication was not influenced by Barrett, but was made with the cooperation of the profession (yet - amazingly! - containing very negative actual statistics and predictions). Barrett's own analysis should stand or fall on its own merits, and not on the usual ad hominem attacks on him as a person designed to detract attention from what he writes. To understand the issues, one needs to read and understand both "sides of the coin." -- Fyslee 07:01, 2 May 2006 (UTC)

You have made an accusation that the Bureau of Labor Statistics' report is the result of chiropractic spin-doctoring. Can you back up this claim? Levine2112 19:18, 2 May 2006 (UTC)

Okay, maybe that sounded too strong. Do you have another explanation for the very rosy picture that is painted? There isn't a single cautionary note (or reference to real statistics, which don't all point in the direction the report points). It seems to be a report based entirely on information supplied by the profession. Let's drop the word "spin-doctoring." Can you supply a better word that realistically explains the very one-sided sales talk? I have already supplied some statistics from real life that contradict this rosy prediction, and these two analyses are still very germane and reliable, because they reveal that there are more sides to the question:

• Analysis of the Chiropractic Section of the Occupational Outlook Handbook

• The Future of Chiropractic Revisited: 2005 to 2015

I would like to hear your explanation for the one-sided rosy picture. -- Fyslee 21:02, 2 May 2006 (UTC)

I think it the outlook is "rosy" because of chiropractic's success with patients. More and more people are waking up from the mass hypnotic spell that the AMA and Big Pharma has over this country. Chiropractic attracts health-conscious people who are aren't neccessarily satisfied with taking drugs to cover up symptoms of illness, but would rather prevent much dis-ease by keeping their bodies functioning the best is can. I think the non-invasiveness of chiropractic has also contributed to its rising popularity. It's also can be a low-cost alternative. Basically, I think an unbiased agency of the US Gov't such as The Bureau of Labor Statistics would paint such a rosy picture for chiropractic's future because the unbiased statistical evidence is pointing in that direction. Levine2112 00:05, 3 May 2006 (UTC)

Gee, Levine. I would imagine that since no one is killed going to a chiropractor, well OK maybe one or two a decade, compared with medicine's whopping 700,000 killed each year just from preventable errors (not counting the ones killed from proper practice or intentionally!), it is no wonder that maybe the outlook for chiropractic is rosy because it is safe.

Which is why I wonder why the article on Chiropractic seems to have a note of warning in practically every paragraph. What's that all about? I think this needs to be looked at again and corrected. What do you think? Steth 03:56, 3 May 2006 (UTC)

Statement retracted.-AED 05:50, 3 May 2006 (UTC)

Whoa! I think we are getting really off topic here and unneccessarily argumentative. My point -which hopefully isn't lost - is that this article makes a claim that chiropractic's popularity may be diminishing. However, I have provided evidence to the contrary. I am asking for a revision.

Here are a couple more links to articles all of which suggest that chiropractic's usage is increasing. With conflicting data, should would leave the part about chiropractic's popularity decreasing in the article?

• Small Business Development Center National Information Clearinghouse
• Use of chiropractic services from 1985 through 1991 in the United States and Canada
• ChiropracticResearch.org
• AHCPR
• Kapsner Chiropractic Centers
• American Public Health Association
• Chiropractic colleges worldwide
• World Federation of Chiropractic
• Chiropractic Density Map

Levine2112 05:29, 3 May 2006 (UTC)

I think Fyslee's links suggest that there may eventually be an oversupply of chiropractors, but I cannot find anything to suggest that the usage of chiropractic is decreasing percentage-wise or in the total number of chiropractic visits.-AED 05:50, 3 May 2006 (UTC)

So can we delete or change this to reflect that these statistics of a decling popularity may be subjective and/or inaccurate?

Although chiropractic experienced a boom in popularity from the 1960's, it has since experienced severe declines in enrollments and patient utilization rates in the U.S. The U.S. National Center for Education Statistics reports that enrollments for sixteen U.S. chiropractic programs fell by 39.9% from 16,500 in 1996 to 9,921 in 2002, and the number of chiropractic patients fell by 25% from 1997 to 2002.

Levine2112 06:49, 3 May 2006 (UTC)

Please indicate which part of the statement above is subjective or inaccurate. It mentions two factors:

1. Enrollments: National Center for Education Statistics, Integrated Postsecondary Education Data System, Retrieved online 8/15/2004 at Quoted here:

2. Patient utilization rates: Tindle HA. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005 Jan-Feb;11(1):42-9.

Are these statistics inaccurate? If so, in what way, and why do chiropractic authorities quote them? -- Fyslee 08:00, 3 May 2006 (UTC)

One trouble with the Tindle comparison is that there were 31,044 subjects in the 2002 survey, but only 2,055 subjects in the 1997 study. The methodology of collecting data was also different between the two. -AED 18:05, 3 May 2006 (UTC)

AED brings up a very good point. But I'm not trying to dismiss the stats that Fyslee is defending. I'm only demonstrating that there are conflicting stats out there. That's where the subjectivity and possible innacuracies lay. So before we leave a loaded statement such as "the popularity of chiropractic is declining" in the article, I think we should look at all of the evidence. I have cited a large body of evidence that shows that chiropractic's popularity is increasing not just in the U.S. but globally. Levine2112 18:27, 3 May 2006 (UTC)

You are using a straw man argument. That paragraph has long since been revised by myself. Here is what you just wrote:

"So before we leave a loaded statement such as "the popularity of chiropractic is declining" in the article,...."

You are beating a dead horse, right down to the precise wording.

Here is what the article now says:

"Although chiropractic experienced a boom in popularity from the 1960's, it has since experienced severe declines in enrollments and patient utilization rates in the U.S."

The original wording was much worse and it got changed. Now deal with the new wording. It seemed to be accepted as a much better, more accurate, and absolutely precise wording. -- Fyslee 21:16, 3 May 2006 (UTC)

First of all, "patient utilization rate" is not the same as "percentage of the population that uses chiropractic". Secondly, it appears to states that the usage of chiropractic has declined since the 1960s. What figures do we have from the '60s to verify that that is accurate? -AED 21:22, 3 May 2006 (UTC)

I agree with AED. The wording is rather misleading. Also, I don't appreciate Fyslee's remarks to us that we should just "deal with it". This is a collaborative effort. And while I appreciate his edits here, I don't find the current statement acceptable at all. Let's all work to revise it into something more accurate.

From the research that I have link to here, it seems that chiropractic has seen a steady growth since the 1960's in the United States. Plus, globally, chiropractic is recognized in so many more countries today than yesteryear. So, if we are to say anything at all about chiropractic's popularity, we should recognize its extrordinary growth. For a discipline that is but a 120 years ago, its popularity is rather remarkable. As the U.S. Dept. of Labor says: Because chiropractors emphasize the importance of healthy lifestyles and do not prescribe drugs or perform surgery, chiropractic care is appealing to many health-conscious Americans. Chiropractic treatment of the back, neck, extremities, and joints has become more accepted as a result of research and changing attitudes about alternative, noninvasive health care practices. The rapidly expanding older population, with its increased likelihood of mechanical and structural problems, also will increase demand for chiropractors. Levine2112 22:17, 3 May 2006 (UTC)

Suggesting what someone thinks about chiropractctic's future may be better under an article entitled "why my crystal ball is better than your crystal ball" but not here. Speculation over surveys should be removed. There are new schools opening in ever-increasing numbers in foreign countries. So it looks like chiropractic's popularity is doing OK. Steth 11:00, 3 May 2006 (UTC)

That's why the statistics that are cited are real, not predictive (like the ones cited by Levine2112). They are WP:VS, and not POV. They are established facts. The future outlook is also interesting, with several different scenarios. The profession considers it important enough to study and publish. BUT, the paragraph in question is not some POV opinion and speculation about the future. You apparently don't like those facts, and - not having answered my legitimate questions above - insist on deleting those facts. -- Fyslee 11:48, 3 May 2006 (UTC)

You are correct about the confusing wording. I have reworded it now. I hope it is more accurate. -- Fyslee 13:52, 30 April 2006 (UTC)

I think that the school point and the patient visits point both add to the article, but it needs at least possible reasons why. It would be great if they can be citations. For instance, is the decline in patient visits because of HMO's? etc... or is it because, people are looking for more EBM? etc... --Dematt 15:42, 30 April 2006 (UTC)

Rewording of "popularity" paragraph

Portions of the following have been highlighted to make it easier to follow the revisions.

The original:

"Chiropractic has gained general acceptance in the last 40 years as an appropriate treatment for certain back, neck and other spine-related problems."

That statement wasn't all that bad, but it didn't take into account the latest developments, which are reflected in the statistics.

That was then replaced with the following "popularity" wording that was problematic because it was too general and non-specific:

"Although chiropractic gained more acceptance from the 1960's, its popularity is declining."

I recognized that and revised it to this:

"Although chiropractic experienced a boom in popularity from the 1960's, it has in the later years experienced severe declines in enrollments and patient utilization rates."

Then it got changed to this (without me noticing it):

"Although chiropractic experienced a boom in popularity from the 1960's, it has since experienced severe declines in enrollments and patient utilization rates in the U.S."

That's where we are today, and that needs some revision, since "popularity" is too vague a word, and "since experienced" is not the same as "in the later years." There can be no question that chiropractic is "popular" among its users (7.4% of the USA population), and CAM is also popular. The question to be decided here is how to deal with the statistics that were so surprising to the Tindle group and those who did the Chiropractic Futures study.

I propose that we use some of the old wording and add something to account for the statistics:

"Although chiropractic has gained more acceptance in the last 40 years as an appropriate treatment for certain back, neck and other spine-related problems, statistics in the later years have been conflicting, and in some cases worrisome. Student enrollments fell 39.9% between 1996 and 2002, and adult patient utilization rates fell by 25% from 1997 to 2002.

• (Other actual statistics from real life, with the numbers and refs, can be added here to show the diversity of angles from which this subject can be analyzed. Merely listing references isn't good enough. Readers shouldn't have to read the references to find the numbers, only to check the context.)

The relevant enrollment statistics (in context) are quoted below:

The most important story about chiropractic education, and one not foreseen in our 1998 report, has been the dramatic decline in chiropractic enrollments. According to data published by the National Center for Education Statistics, fall enrollments for sixteen U.S. chiropractic programs fell 39.9% from 16,500 in 1996 to 9,921 in 2002.37

Possible causes for the decline, identified during our recent interviews with chiropractic experts, include raising admission standards to 90 semester credit hours,38 a demographic drop in eligible students, rising tuition costs, the increasing burden of student loans, managed care's affect on the chiropractic profession, and a reduction in referrals, recruiting, and encouragement from practicing chiropractors. In all likelihood, the drop in enrollments is due to a combination of factors mentioned. It was also noted that virtually all health professions saw a drop in applications during this period. In medical schools, where applications vastly exceeded openings, there was not a drop in enrollments.

Our interviews with the presidents of chiropractic colleges confirm a rise in enrollment levels since 2002. Some of the college presidents also noted that this increase will be supported by the demographic bulge as more of the millennial generation graduate from undergraduate programs and pursue graduate degrees.

Another quote in the same document:

According to the National Center for Education Statistics enrollments in chiropractic colleges dropped 42.6%.128 Based on our interviewees, and a recent upswing in enrollment numbers, it appears that enrollments will return to their prior levels and ultimately grow.

However, there are many additional major threats to chiropractic that were not recognized in 1998. These include the rise of DPTs and studies indicating equal efficacy for back problems from physical therapist, massage therapists, self care and chiropractors; and highly publicized lawsuits against chiropractors. All of these are addressed above in scenario 2. -- National Center for Education Statistics

The utilization statistics:

Overall CAM use for the 15 therapies common to both surveys was similar between 1997 and 2002 (36.5%, vs. 35.0%, respectively, each representing about 72 million US adults). The greatest relative increase in CAM use between 1997 and 2002 was seen for herbal medicine (12.1% vs.18.6%, respectively), and yoga (3.7% vs. 5.1%, respectively), while the largest relative decrease occurred for chiropractic (9.9% to 7.4%, respectively). CONCLUSIONS: The prevalence of CAM use has remained stable from 1997 to 2002. Over one in three respondents used CAM in the past year, representing about 72 million US adults. -- Tindle HA. Trends in use of complementary and alternative medicine by US adults: 1997-2002.

I have a question: What have been the highest patient utilization rates for chiropractic in the USA? Has it been much over 10% at any time? Something tells me it has been over, but I wonder what the numbers were? -- Fyslee 18:47, 4 May 2006 (UTC)

I will look into the stats as well. But in the meantime, what you have quoted above makes it sound that chiropractic college enrollment dropped for a little while but is now (as of 2002) on an upswing. Given the ebb and flow of things in the world, why even mention the temporary drop in enrollment if it only went back up? Further, perhaps this all would be better suited for the newly added Chiropractic Colleges wiki-article than here. Levine2112 18:57, 4 May 2006 (UTC)

Good. I think as long as we thoroughly cover the reasons why, it will all come together. I have a feeling the managed care problem is the big one. 1997 - 2002 were big managed care takeover years. Patient's were being pulled form our offices like candy because we weren't allowed on the lists. Of course we stopped referring patient's to schools. We were being pinched. Our big source for patients is word of mouth. And when you take them away, they also can't refer. It took chiro a little while to recover from this new tactic. I still don't like the word popularity just because I don't think it was actually by patient "choice" that they couldn't come. IMO with a level playing field, the numbers would have been different.--Dematt 19:35, 4 May 2006 (UTC)

I'd like to see that "colleges" link Wikilinked. Sounds interesting. -- Fyslee 19:19, 4 May 2006 (UTC)

It is wikilinked in the article under the education portion. Chiropractic school I also think that Dematt make a great point above. It puts the figure in the context of the time. Manage care was responsible for the so-called numbers drop. It wasn't due to a lack of popularity with patients, but the inability to choose. It's not fair to say that the patient numbers dropped without putting it in context. And we certainly can't say that chiropractic lost popularity given this context. Levine2112 19:53, 4 May 2006 (UTC)

Thanks for the link. The reasons for the statistics certainly should be explained. The "popularity" issue is a half-dead horse, since it was revised a while back (Wikitime). My proposition above removes the word completely. The education statistics didn't even take into account the Life debacle, since it happened later. The enrollment there is starting to climb again, so it would be truthful to say that the statistics are moving upwards again, although still far from up to what it was. It may get back up to the niveau before the Life debacle, but since there are more and more potential chiro students that are going other routes, it's hard to say. The Life debacle scared many away, and the huge student loan default rate among chiros is also very scary. Stanley Paris is now getting chiros into his school. He's started a special program that will allow chiros to upgrade to a DPT. Needless to say it's controversial. Will they really become PTs, or will they be Trojan Horses that just seek the degree for its prestige? -- Fyslee 20:30, 4 May 2006 (UTC)

Regarding the following proposal: "Although chiropractic has gained more acceptance in the last 40 years as an appropriate treatment for certain back, neck and other spine-related problems, statistics in the later years have been conflicting, and in some cases worrisome. Student enrollments fell 39.9% between 1996 and 2002, and adult patient utilization rates fell by 25% from 1997 to 2002. I have a couple concerns:

1. "statistics... have been... worrisome" 1) doesn't make sense and 2) could be interpreted as POV.
2. As I mentioned previously, I'm not convinced that Tindle's comparison of two studies suggesting that there is a decrease in usage should be held as Gospel. That is what the above statement does.
3. Utilization of chiropractic by a percentage of the population is one thing; the utilization by total number of chiropractic visits is another.
4. If the rates are decreasing, why is there no mention of why that may be?

-AED 21:13, 4 May 2006 (UTC)

1. It makes perfect sense, but different wording could be chosen, although articles by chiropractors express concern about those statistics. They believe them. Of course that would be chiropractic POV..... and because they are negative POV about negative very real statistics, would not be allowed here. Only positive facts or POV are allowed.
2. Please provide links to the two studies for me to look at. I'd like to examine them.
3. We're not talking about total number of chiropractic visits. (That's a different subject.) These statistics don't mention that. They are statistics of CAM use by adults. (There are fraud statistics regarding total number of visits. The larger the numbers, the greater the insurance fraud. Especially Texas has been notorious. Possibly Florida, if my memory serves me well. The numbers far exceed other professions and are indicators of exploitation of the system.)
4. Good question. If there is an explanation, I'd like to read documentation for it. There may be an explanation somewhere out there. -- Fyslee 22:06, 4 May 2006 (UTC)

1. To me, it reads as though statistics worry rather than cause worry. In context of "the last 40 years...", it also gives the impression that decreasing usage is cause for worry.
2. 1997: Long-term trends in the use of complementary and alternative medical therapies in the United States. 2002: Complementary and Alternative Medicine Use Among Adults: United States, 2002.
3. I understand that you are not talking about total number of chiropractic visits. My point is that usage can be viewed in multiple ways, so to say that it is decreasing by only viewing percentages is not necessarily accurate.
4. I think it may be notable to mention that chiropractors feel shut-out by managed care.

-AED 22:39, 4 May 2006 (UTC)

I just don't see the point of even mentioning anything about the dip without the mention of the Managed Care issue. Actually, I don't really see the point of having the statement about the popularity dipping then going back up at all. It's a pretty minor and speculative point in the grand scheme of this article that only seems to be added to take an unfair POV pot-shot at chiropractic. The numbers are unrreliable and the point is made without context. Maybe the Managed Care period could be brought up in the history and show how that lead to a temporary dip in chiropractic patient numbers but how the numbers have risen since. Levine2112 21:20, 4 May 2006 (UTC)

Precisely. I mentioned that an explanation would be appropriate. We're not speaking about a "popularity dip". That's a dead horse. Why do you insist on beating it? Repeating a straw man argument doesn't make it true. I have suggested different wording.

It is not POV, but verifiable RS fact. Misplaced Pages allows (requires) it. You haven't yet replied to my request for proof of unreliability. Instead you just make the claim.

Managed care could be a part of the explanation, but you are confusing the enrollment stats with the utilization stats. Enrollments are beginning to slowly climb, but patient visits are down. You claim that "the numbers have risen since." Where are your statistics that show they are climbing again? Maybe they are, but without the stats, it's just an undocumented claim. -- Fyslee 22:06, 4 May 2006 (UTC)

I was citing what you provided. Both articles say that there has been an upswing or rise in enrollment since 2002. Levine2112 21:48, 5 May 2006 (UTC)

I have already mentioned the rise in enrollment. It's the patient utilization rates I'm talking about. Do you have stats for them? -- Fyslee 21:59, 5 May 2006 (UTC)

I'm not sure what you're looking for here other than an argument. We have already pointed out the flaw in the Tindle study (31,044 subjects in the 2002 survey, but only 2,055 subjects in the 1997 study). Also, "patient utilization rate" is different from "percentage of the population that uses chiropractic". Levine2112 00:46, 6 May 2006 (UTC)

The managed care issue needs to be dealt with somewhere. I like your idea of putting it in the history, though chiros are still dealing with it. That's where Fyslee's future outlook info becomes important, too. We should be able to put it all together. --Dematt 21:46, 4 May 2006 (UTC)

Precisely. Managed care is affecting everybody. -- Fyslee 22:07, 4 May 2006 (UTC)

Exactly. "It was also noted that virtually all health professions saw a drop in applications during this period. In medical schools, where applications vastly exceeded openings, there was not a drop in enrollments." I imagine the only people that worried were those who pay the bills at the school. With vitually all sources noting that chiropractic patients are very satisfied with their care, the only thing chiros worry about is their patients not getting reimbursed, as do all health professions.(no reliable source:)--Dematt 01:53, 5 May 2006 (UTC)

New wording

It has been mentioned that there seems to be a discrepancy (or question of reliability?) between the patient use statistics between the 1997 and 2002 studies:

• (1) the Alternative Health/Complementary and Alternative Medicine supplement to the 2002 National Health Interview Survey (NHIS, N = 31,044) and
• (2) a 1997 national survey (N = 2055),

Apparently some think that it isn't proper to compare studies with such different population numbers, and in some cases this would be true, but in this case the authors (which include the kingpin of CAM - Eisenberg himself), don't seem to see it as a problem. They conclude it represents a reduction in percentage of the adult population that uses chiropractic -- it fell by 25% from 1997 to 2002.

If we consider ourselves to be wiser than that research team (!!), we could use another possible interpretation, which is also used at times: the larger study is taken as more reliable. This would indicate that there may not be a reduction at all, but that the original numbers were simply too high. This line of reasoning would indicate that chiropractic use has not been as great as earlier believed. Unfortunately for this article, we can't use that line of reasoning without a reliable source.

I propose that we use the following wording as a (temporary) improvement of the existing wording:

"Although chiropractic has gained more acceptance in the last 40 years as an appropriate treatment for certain back, neck and other spine-related problems, resulting in increased usage, statistics in the later years have shown some variations from these trends: student enrollments fell 39.9% between 1996 and 2002, and the percentage of the adult population that uses chiropractic fell by 25% from 1997 to 2002. The statistics for student enrollments seem to be rising again, while patient use statistics are still uncertain.

If anyone can provide reliable statistics for patient use trends, it would be helpful. -- Fyslee 22:45, 6 May 2006 (UTC)

The context is still missing. We need to discuss managed care here. Levine2112 01:22, 7 May 2006 (UTC)

Absolutely. More context can be added when reliable sources have been found.

I'd still like to see reliable statistics for patient use trends since 2002. Was that dip a temporary one that has begun to turn upwards yet?-- Fyslee 07:35, 7 May 2006 (UTC)

Future outlook analyzed

I would like to see how the following can be included in the article. It is such an excellent report (paid for and made in full cooperation with the profession) and analyzes the future of chiropactic (and chiropractic itself) in great detail. Such a resource deserves mention (with more than just a link) in the article. Just a casual reading of the report provides one with a great deal of knowledge about chiropractic - past, present, and future. This could be placed in the History section as the third subheading, or as a separate section:

Proposed heading: "Future outlook"

The future outlook for chiropractic is uncertain and has been analyzed in a report which describes four different scenarios based on an analysis of the following issues and trends in the profession:

• Chiropractic in the Healthcare Marketplace

• Chiropractic Education

• The Philosophy of Chiropractic

• Cultural Legitimacy and Integration into Healthcare

• The Practice of Chiropractic

• Managed Care

• User Demographics

• Technology

• Research on Chiropractic Care

The four scenarios are described as:

• 1. Slow, Steady Growth

• 2. Downward Spiral

• 3. Evidence Based Collaboration

• 4. Healthy Life Doctors

The report ends with a series of recommendations for dealing with these predicted scenarios:

• 1. Accelerate Research

• 2. Continue to Strive for High Standards of Practice

• 3. Develop Greater Integration with Mainstream Healthcare

• 4. Anticipate and Engage Consumer Directed Care

• 5. Create Greater Unity within the Profession

• 6. Enhance Individual DC's Contribution to Public Health

• 7. Prepare for the Future of Prevention & Wellness

From: The Future of Chiropractic Revisited: 2005 to 2015

-- Fyslee 09:17, 30 April 2006 (UTC)

Certainly have no trouble with that. It would be a great way to finish off the article with an outlook to the future. --Dematt 15:50, 30 April 2006 (UTC)

One thing I miss in the "recommendations" is a clear and separate point labeled "8. Dealing with quackery and unethical conduct." A search of the document for these key words - fraud, unethical, malpractice, straight - reveals it is mentioned (in passing), but since this subject is one of the major objections to the profession, it should be dealt with in a major way. Questions of effectiveness and appropriateness of the role of manipulation can always be cleared up by better research, but that doesn't solve the problem of widespread quackery, and thus the objections will continue to be raised. The problem needs to be dealt with more forcefully, since it creates undeserved problems for all the sincere and hardworking chiros who help lots of people.

Since the document fails to deal with it, this article can do so. Such a step would be hailed as a positive step by critics, and it would help to disarm them. -- Fyslee 07:22, 2 May 2006 (UTC)

Introduction - next paragraph

Okay guys. I've been struggling here in the next paragraph of the introduction. The facts that I have left to work with don't really go together well, so bear with me while I throw something out there. Once it's down there, you can go through it with the fine tooth comb. I'll try to keep it as neutral as a mixer chiro can, but i do want it interesting. Any input you guys want to put in is fine with me, just throw it in there - the same rules apply. I'm not going to get too deep in the intro, but I think I'm going to have to touch on some of the politics within and/or without the profession to bring it up to the 21st century. You know we have to be real, painful or not. No judgements about any of it - it is what it is. We made it through the first part. Mccready, do me a favor, I'm not going to have the time to look for references this first time around, so pls don't just delete it - note it for me and maybe one of us knows where to find it - you guys are all powerhouses of knowledge, so do your thing!--Dematt 01:57, 1 May 2006 (UTC)

On my reading you've done a great job. I've made a few copy edits and one change that should be explained - changed "no scientific evidence" to "no accepted scientific basis". In my ignorance I guess that for me, to say that people believe something despite no scientific evidence is to declare their beliefs to be religious, and I'd be reluctant to say this without this being a true reflection of how they characterise their own beliefs. I'm guessing that the truth is that most feel that their beliefs are rationally founded (i.e. on some evidence) though the evidence might be unconvincing to others.Gleng 08:48, 1 May 2006 (UTC)

I do agree with your statement, I personally don't consider myself as believing in a religious sense rather than waiting for science to catch up. To reasoning that if it is not scientific then it must be religious would make it an either/or logical fallacy.--Dematt 17:37, 1 May 2006 (UTC)

History revisited

I'm looking at the History section. I think this is where we can really spruce this thing up. DD was a very colorful man and apparently there was lots of contoversy and deceit, both for and against chiropractic. No-one really knows the truth here. I learned the watered down version at school, but now that I have read some of the Fyslee stuff, I am even more intrigued. I don't know the details like you guys do, so as I lay out the timeline, pls make any additions that you feel are necessary. We need it all, the osteopath link, the religious stuff, christian scientists, AMA attacks, DD's responses, the UCA, science of spinal manipulation, etc.. The problem is that I don't know where all the references are so I need you guys to put them in after I'm done. In other words, don't just delete something because it hasn't been referenced yet. Let me know where it came from or ask someone else to clear it up. If we have a conflict, we can discuss it here.

The important thing is that it all makes sense when we're done. When we put it into perspective of when all this was all happening, we should be able to get a feel for why it has happened. The amazing thing about chiropractic is that is still here. What is it that has allowed it to endure? Is it something special or is it stupid people who just don't know any better(you know what I mean:)? It is not up to us to decide. But, the premise of this exercise is that wikipedia has the potential of getting the story more right than it ever has been.

We should end it just after the Wilk case, somewhere before the beginning of managed care. The net effect should feel exactly like chiropractic is now. Not Gods gift to man, but not the devil either. Then we can make the new section that Fyslee talked about with the future of chiropractic.

What do you think? If we do it the same way we did the intro, we should be okay. I know you guys have worked hard here. If you would rather I left it alone, say so now. Otherwise, do we need to have the bid bold section saying "conflicting statements for..." or can we just work the conflict into the narrative?--Dematt 18:18, 1 May 2006 (UTC)

Your track record speaks for itself. Go for it! (A little at a time....;-) When in doubt, try it here first. -- Fyslee 21:08, 1 May 2006 (UTC)

Introduction - First paragraph -2

I am not comfortable with the sentence. "Evidence for the clinical efficacy of chiropractic does not meet the scientific standards of evidence-based medicine." Since evidence does exist, e.g. AHCPR guidelines, among others, then this sentence is not accurate. I feel it should be removed. Steth 22:19, 1 May 2006 (UTC)

There is a BIG difference between "clinically effective" and "statistically effective". I agree with Steth, there is evidence to show that chiropractic is clinically effective. -AED 23:57, 1 May 2006 (UTC)

I agree too, there is a lot of clinical data showing the effectiveness for chiropractic care. It should be said why it's difficult to test chiropractic with a double blind rct.--Hughgr 00:40, 2 May 2006 (UTC)

Then it it essentially agreed that this is inaccurate, so I will remove it. ThanksSteth 01:43, 2 May 2006 (UTC)

How are the AHCPR guidelines evidence of anything? In any case what makes you think this evidence is up to the standards of evidence based medcine.Geni 01:48, 2 May 2006 (UTC)

Well, Geni, they (the guidelines) are evidence, regardless of what you or I think or feel. They are from an official sounding panel and body, what more do you need? They are about spinal manipulation which is what defines chiropractic.

Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guidelines No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December 1994.

Here is what they said: AHCPR Guideline recommended Spinal manipulation of low back during first month of symptoms with a ‘B’ rating. B = moderate research-based evidence (one relevant, high-quality scientific study or multiple adequate scientific studies).

Manipulation for patients with radiculopathy (C). Manipulation for patients with symptoms > 1 month (C). C = limited research-based evidence (at least one adequate scientific study in patients with low back pain).

I am just saying that since evidence exists, the statement that no evidence exists is false and should be removed. There was agreement with this. So why would you want to keep it in?

Here is more, indicating that evidence does exist. So read through this and lets be open to adding much of this information to the article and remove anti-chiropractic biased statements:

Spinal manipulation Steth 04:23, 2 May 2006 (UTC)

(Regarding that last link, the two non-chiropractors authors, Shekelle and Cherkin, appear to have good credentials.) In my opinion there are a number of problems with this statement: "As with many alternative/complementary treatments, chiropractic is controversial, with sceptics claiming that evidence for the clinical efficacy of chiropractic does not meet the scientific standards of evidence-based medicine." First of all, the inclusion of "sceptics claiming..." without a source or without specifying which skeptics believe that could be considered weasel wording. Secondly, it conveniently dismisses chiropractic in one fell swoop without addressing specific techniques and specific problems. Even Quackwatch's sister site, Chirobase, cites a summary of spinal manipulation that indicates chiropractic spinal manipulation has some efficacy in the treatment of neck and low back pain. If that summary, which suggests that spinal manipulation appears to be "extremely dangerous", is accurate, then the statement as written above is inaccurate. -AED 04:54, 2 May 2006 (UTC)

Although I agree with the statement "Evidence for the clinical efficacy of chiropractic does not meet the scientific standards of evidence-based medicine.", that particularly statement is POV as there have been (IMHO, questionable) studies which show effectiveness. May I suggest, as an alternative, when I just entered: "There is little scientific evidence as to the validity of the theory or effectiveness of the treatments." (You may replace "theory" by "theories", if you feel there is more than one in question.) — Arthur Rubin | (talk) 15:05, 10 May 2006 (UTC)

Ethical regulation

I think that Fyslee raises an important point which needs to be faced. In any profession there are some rogues and frauds, some who manipulate vulnerable or naive people for either monetary gain or status and influence; there are some who are cavalier with the truth, and I think that exposure of these is a great public service, so I support strongly this intent of Quackwatch. Scientists (my profession) are shamed and outraged by frauds amongst us, and there are some, and when they are uncovered then we can be pretty merciless - if a paper is withdrawn on these grounds the shadow taints everyone associated with it irrevocably. Science shouldn't be known by its frauds nor medicine or chiropractic by theirs, but knowing that a profession polices itself, how it regulates its members and how it sanctions breaches of conduct seems to me to be an important matter of public interest, and addressing it can be in the interests of chiropractic. I start from ignorance here, I do not know about professional codes of ethics in chiropractic, and how they are enforced, or if they can be effectively except by word of mouth and spread of reputation. I am sure that there is deep pride and honour amongst chiropractors - how do you deal with those who are less competent or less honest?

I think the article is now making real progress, please let's not get too hung up on particular phrases while it's evolving because, the overall shape and tone seems to be moving forward. Yes we'll need to come back over things, but sometimes what seems to be POV in isolation may just not be an issue in the whole context. (and feel free to wish me a happy birthday). Gleng 08:46, 2 May 2006 (UTC)

HAPPY BIRTHDAY! to Gleng. May you be blessed with good health and good Scotch....;-) -- Fyslee 09:14, 2 May 2006 (UTC)

HAPPY BIRTHDAY! AGAIN Gleng! What a great way to spend your day:) I have three problems with the Quack thing;

• 1. The first is the word itself; It stings like a racial slur such as WOP, wetback, etc.., it's hard to build consensus with a word that conjures up so much emotion. It does nothing to solve anything.
  2. In chiropractic's case, most Quackery comments are directed at whole professions rather than a particular professional. I think a more appropriate word would be charlatan for the issue that you raise.
  3. Who decides who is a quack or charlatan? There are too many unchecked judgements made already. Just because your competition calls you a quack, doesn't make it true. If that is the case, Louis Pasteur would have been a quack.

I think we should try to avoid the word "quack" when we deal with anti-chiro issues and be real careful who we call a charlatan.--Dematt 15:47, 2 May 2006 (UTC)

Oh I agree fully. I apologise unreservedly for using the word, I shouldn't have - it didn't occur to me that any of you would feel sensitive, but I should have remembered how my hackles rise when people use certain words even though I know they aren't directed at me personally. I should make it absolutely clear that I was using quack as a word to describe individuals who the profession itself would consider to be disreputable. Let's avoid this word by all means, the issue is not how the profession deals with criticisms from outside, but how it polices itself. Let's take my line of work - because I know about it - experiments are a) subject to Home Office inspection by full time ispectors b) projects have to have approval by Ethics committees as well as by the Home Office c) the University has codes of research ethics d) journals have ethical guidelines and sanctions - i.e. there is a stacked regulatory framework. It may not work well, but it expresses codes of conduct with sanctions that have considerable teeth to express clear ideas of what is acceptable and what is not. It doesn't stop abuse, but it reflects professional standards expected. The Law Society here regulates law, and the GMC regulates medicine much more formally of course. I'm not suggesting that this article should name and shame, or throw accusations about, far from it, that would be inappropriate and unfair. I am just suggesting that you and the other chiropractics explain what professional codes of practice exist to regulate chiropractic and protect the patient.Gleng 16:18, 2 May 2006 (UTC)

I'm with you(I've never seen you call anybody a quack).

In the US, every state has a body that regulates the profession and makes sure that everyone is practicing within the scope of the law of that state. Most are made of chiros and other citizens appointed or elected. Anyone (a citizen, an MD, a fellow chiro, etc..) can complain to the board of examiners in my state, and that will trigger an investigation. They may hire someone to pose as a patient and inconspiciously determine if you are practicing illegally or not. If they determine that you are, a hearing is scheduled where you are given a chance to explain your behavior. If it is determined that you are practicing illegally, your license may be suspended, revoked or you may be given a chance to change your behavior.

Advertising is strictly monitored in my state. Making false claims will get you in big trouble with the board.

You can lose your license if you are convicted of a felony, which potentially includes anything inside or outside the practice of chiropractic. I can cite some specific examples that I have been involved with if you would like, including one with a chiro who became bipolar and in his moment of grandeur started "treating" nearsightedness with rubbing alcohol claiming he had found the cure - even tried it on himself! But the board caught him and put an end to that before anybody got really hurt.

Most state associations have a code of ethics as well that usually go a step further to try to assure their memebrs practice even more ethically, but these can be skirted more easily and you don't have to join them. Same with the national associations.

I doubt this will satisfy those that think all chiros are charlatans by birth:), but it's a start. --Dematt 17:27, 2 May 2006 (UTC)

I'm really grateful to you for this exchange, I knew it was going to be sensitive, but if handled properly I think that a section on this in the article can convey the ethical principles that the profession aspires to, and how the profession seeks to ensure these. Perhaps the way to do this is to indicate what the profession itself would like to achieve in this respect, and where the profession believes that further progress is needed. If we can get a self critical appraisal from chiropractic in here, then it can maybe pre-empt external criticism.Gleng 11:10, 3 May 2006 (UTC)

I think you're right. Another eye opener. I think we chiros forget that persons outside the profession aren't aware of the things we just assume everybody knows. Does anybody else have information that we can work into this? Hughgr, are they doing anything new at the college level? --Dematt 17:11, 3 May 2006 (UTC)

I don't know what would be new, since I have only my experience to compare with :) I guess an example would be the teaching of George's Test to help determine if someone is at risk for a stroke. But I think I heard or read that George's Test is only a mild indicator and not full-proof. People have strokes in all kinds of situations like laying their head back in a wash sink at the beauty salon, or turning their head to back up their car, and even doing nothing! But at least it's a step in the right direction. Emphasis was placed on how to determine when it is not safe to give an adjustment, i.e. rule out fracture, Chiari malformation, etc. Is that what you ment? Or did you mean jurisprudence, not making false claims and other unethical advertising claims, as that was emphasised as well. Was that what you were looking for, or something else, let me know--Hughgr 19:52, 3 May 2006 (UTC)

More along the lines of policing the profession to keep charlatans from making false claims. What the college position on it? Does your state have ways to police you? --Dematt 19:56, 3 May 2006 (UTC)

Yes, it's called the state board, doesn't every state have one? Anyone can contact the state chiropractic board (in my state made up of 4 DC's and one other person) and file a complaint. The board then investigates said complaint for merit, if action is required, they take action by the usual methods related to the level of the complaint.--Hughgr 00:36, 4 May 2006 (UTC)

History rewrite - step one

This is the first step. I haven't put any of the references in, but all of it is in the information that each of you have provided at one time or another. It is really quite interesting and was hard to shorten it. I tried to give it a real feel of the 19th century to keep everything that happened in context for the times. Feel free to make suggestions now.

Daniel David Palmer (DD Palmer) was born near Toronto, Canada in the spring of 1845. His paternal ancestors came to this continent from England, and settled in New York State. His grandfather, Stephen Palmer, emigrated to what was then known as Canada West, now the Province of Ontario, where Daniel’s father, Thomas Palmer, was born in 1824. From all accounts, DD's father eaked out a meager existence as a shoemaker, then grocer and carried out functions as postmaster and school director for his community. When his business failed in 1856, he moved his family to Iowa, leaving 11 year old DD and his brother TJ in Canada.

In 1865 the War between the States had resulted in Canada's low wages and overrun labor markets. DD, now 20, packed his carpet bag and with his brother TJ made his way south to the states to rejoin his family. He spent the next 20 years in various occupations in teaching, raising fruit and honey, and the grocery business.

All the while, the country was well into the second industrial revolution, marked by innovation, invention and creativity. Man was conquering his environment with his ever advancing machinery. At this point, Medical science was in its infancy. Allopathy, fueled by Louis Pasteur's recent refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. Drugs and medicines were making their way across the countryside claiming cures for all sorts of ailments while Vitalists mostly in the form of magnetic healers continued with their claims of quick and drugless cures. Records indicate that it was during this time that Andrew Taylor Still, MD originally expressed his principles of osteopathy in 1874. A medical doctor, Still believed that diseases were caused by mechanical interference with nerve and blood supply and were curable by manipulation of "deranged, displaced bones, nerves, muscles -- removing all obstructions -- thereby setting the machinery of life moving." His autobiography states that he could "shake a child and stop scarlet fever, croup, diphtheria, and cure whooping cough in three days by a wring of its neck."

In 1885 DD began a career as magnetic healer in Burlington, then Davenport IA on 4th floor of Ryan building at corner of Second and Brady Streets and was quite successful. His records indicate, "During this period much of that which was necessary to complete the science(chiropractic) was worked out. I had discovered that many diseases were associated with derangements of the stomach, kidneys and other organs... One question was always uppermost in my mind in my search for the cause of disease. I desired to know why one person was ailing and his associate, eating at the same table, working in the same shop, at the same bench, was not Why? What difference was there in the two persons that caused one to have pneumonia, catarrh, typhoid or rheumatism, while his partner, similarly situated, escaped? Why? This question had worried thousands for centuries and was answered in September, 1895. Harvey Lillard..."

Thats just the beginning. From here we would go to... wow, it could go on forever. Go ahead, make your changes. Make it brutally honest:) --Dematt 03:40, 3 May 2006 (UTC)

I think this is all great, but would be more apropos on the DD Palmer article than here. Levine2112 04:54, 3 May 2006 (UTC)

Good point.--Dematt 14:55, 3 May 2006 (UTC)

Maybe, but it sounds so fresh it seems a shame too. It seems to me that Dematt has found a way of telling the story in the historical context that makes it just very interesting for itself. Go for it, whether here or there is a decision that can be taken later, and should be decided on what makes the articles best - and I can see here a real chance of everyone coming to agree. Sorry not to be doing more, I'm deep in exams and markingGleng 16:10, 3 May 2006 (UTC)

No problem, do make sure and check in. We all need your input if we're going to get this thing right.--Dematt 02:38, 4 May 2006 (UTC)

For excellent sources on chiro history, check out the archives:

• Chiropractic History Archive - Joseph C. Keating, Jr., Ph.D

"Dr. Keating is a former president (1994-95) of the Association for the History of Chiropractic (AHC) and currently serves on the board of directors."

-- Fyslee 17:58, 3 May 2006 (UTC)

That's actually where most of it came from. I followed one of your earlier links. No doubt a lot of great information. Most of this was taken fromt he DD Palmer section as well as other timelines. --Dematt 18:13, 3 May 2006 (UTC)

Here is another fabulous resource for chiropractic history: AHCPR. It moves past just DD Palmer and gives a great overview of the complete history of chiropractic. Also, fromt he same resource, here's some info about the history of chiropractic research and education.Levine2112 18:29, 3 May 2006 (UTC)

This is good info for the research section, too. We can touch on some of it in the history section, but it will definitely make it harder to keep it short.--Dematt 02:09, 4 May 2006 (UTC)

Of course that was that other fabulous reference I was talking about. I have that one in my office!--Dematt 19:52, 3 May 2006 (UTC)

IMO I think we should be making this page more consice and to the point. There is already a DD and BJ page in WP so a lot of what they said and thought could be on their respective pages, just thinking of keeping the chiro page "neat" and to the point. Also, wasn't the idea of "one cause one cure" common thinking at the time (late 1800's)as evidenced by the germ theory, one germ caused one disease? Correct me if I'm wrong, but to judge a man by his thoughts and actions from 100 years ago, without addressing what was common thinking of the same period is attacking the person with knowledge that they were not privy too. Any thoughts? Like should it be worded like, "As was the understanding at the time......led to their conclusion that....caused all diseases. What do you think. --Hughgr 20:03, 3 May 2006 (UTC)

Another good point! I like your wording. Let me make sure, though, are you thinking that we should get rid of the history section all together, or leave what we have, or make it shorter? Actually what I was hoping to accomplish was to do exactly what your saying about judging the man out of context of the time. That's actually why I added all the other information for the times. So that the reader could get a feel for the period before making a judgement. You are right about the DD and BJ sections. The question is - Will a first time reader click on the link? I don't know - If they don't, then all they get is a pretty dry article on chiropractic. The good part about chiro is the history. What do you think?--Dematt 20:55, 3 May 2006 (UTC)

That's tough. DD was such a very colourful character. But alas, this is a chiropractic article, so let's just limit it to his involvement in founding chiropractic and keep the details for the dedicated DD Palmer page. There's approximately 120 years of history to cover, and - if we are to keep this article succinct - we will have to give just the general overview and save the details about specific people and events to their own articles. For instance, I think there is a Wiki article dedicated just to the Wilk case. Certainly, it is a major part of chiro history and should be included in this article, but just to generally say what the trial was about and what the outcome meant for chiropractic. I realize that being succinct is tough. I pointed to some great history of chiro page and none of them are all that succinct - most are longer than a typical Wiki article. I will help out in any way possible. Levine2112 22:29, 3 May 2006 (UTC)

I’m not saying there shouldn’t be any history, just a concise way of stating facts without going into every thought anyone involved with chiropractic ever had. D.D. had his idea’s, which could be extrapolated on the DD page, and BJ has some 39 books and they paint an interesting evolution of his thoughts, but I don’t think the average reader of an encyclopedia article would want all that info. In contrast, the Florida report was just dates and events, which seems too simplified IMO. I think somewhere in between a balance can be found. Perhaps we could hit on the highlights without going into minute detail. Discovery of; development of; prosecution of early DC’s; Wilk case; etc. It could get long real quick, maybe a brief section like Florida synopsis would work best, with links to the respective pages for more information, if only to keep this page reasonable in length. --Hughgr 00:30, 4 May 2006 (UTC)

Okay, after reading all your sources including re-reading the florida report, let me see if I can make it more about chiropractic and not so much about DD Palmer. Can't promise that it won't get longer though:) You guys ask for a lot, but want it all in one sentence or less:) It would't be so bad if you all agreed. By the way, the research section is going to need some work, too after this.--Dematt 02:34, 4 May 2006 (UTC)

I want it in one word or less. ;-) Thanks, Dematt. Levine2112 06:48, 4 May 2006 (UTC)

LOL, Thank you, Levine2112, you started my day on the right foot:)--Dematt 12:16, 4 May 2006 (UTC)

History rewrite 2

Try this one;

In 1885 the country was well into the second industrial revolution, marked by innovation, invention and creativity. Health care was no exception consisting primarily of competing treatments of vitalism, herbalism, magnetism and leeches, lances and tinctures. Scientific research played only a limited role, and often no role, in the choice of treatments. Neither consumers nor practitioners had much knowledge of either the causes of, or cures for, illnesses.. Allopathy, fueled by Louis Pasteur's recent refutal of the centuries old spontaneous generation theory in 1859, was growing rapidly. Drugs and medicines were making their way across the countryside, mostly unregulated and claiming cures for all sorts of ailments. Andrew Taylor Still, an MD dismayed by the shortcomings of drugs and surgery], ventured into magnetic healing and bonesetting in 1875, opening the American School of Osteopathy(ASO) in Kirksville, Missouri in 1892.] Daniel David Palmer, a teacher, grocer turned magnetc healer opened his office of magnetic healing in Davenport, IA. In 1886. On September 18, 1895, DD Palmer gave the first chiropractic adjustment to a deaf janitor, Harvey Lillard.

Of course there is more, but what do you think so far?--Dematt 15:53, 4 May 2006 (UTC)

At first glance, it seemed lengthy. However, on a second read, I think it does an excellent job of setting the climate in which chiropractic was born. We've never seen this approach before. I like it. Levine2112 17:35, 4 May 2006 (UTC)

I like it too. If you bring up osteopathy, I would describe the difference between the osteopathic manipulation and the chiropractic adjustment. Correct me if I'm wrong, but wasn't the O.M. more general to an "area" of the spine to increase blood flow where as chiropractic sought to find a specific vertebral mis-alignment causing nerve interference and only adjust that particular one? If your going to mention osteopathy, I think it should be pointed out how the two are different as well. So far, looks good though. Keep it up! --Hughgr 18:19, 4 May 2006 (UTC)

Me, too, Hughgr. That's what I learned in school as well - the whole difference was blood vs nerve and the more generalized manipulations vs specific, but I am not finding that yet in the literature. It does look awfully fishy though. I think that must be why DD made some changes shortly after he started, as did Still of course. Stay tuned though, we have to touch on that if we're going to be accurate, right! Get your sources ready:)--Dematt 19:53, 4 May 2006 (UTC)

Well done. Heading in the right direction. But need to acknowledge the growth of the scientific method. Also need to say it was a time of quackery and EMB has been tightening the noose on that for a couple of centuries now. Daniel Defore (1661-1731) in an essay called "A Quack Doctor" said "the quacks contribute more towards keeping us poor than all our national debts" then "I have had the curiosity to examine several of his medicines in a reverberatory, reducing compounds into their simples by a chemical analysis, and have constantly found a considerable proportion of some poisonous plant or mineral in every one of them. Arsenic, wolf's-bane, mercury and hemlock are sine quibus non". Need also to show the legislative changes that cracked down on quacks. Mccready 17:20, 5 May 2006 (UTC)

I would love to, although that would open a whole new bag of worms. Of course that would make it longer and if we added it to the chiro section, it would only be right that it was added to the medical section, wouldn't it? The Flexnor report closed more "medical" schools than anything else and that didn't come out till 1910. If we're not careful, it could come out looking like scientific medicine was conspiring to close down all their competition, though that would meld nicely with the next section of Wilk vs. AMA. Do we really want it to get that long?--Dematt

"The Flexner Report is the most important event in the history of American and Canadian medical education. It was a commentary on the condition of medical education in the early 1900s and gave rise to modern medical education." One could consider it the dividing line between quackery and modern medicine. Now it became possible to start distinguishing between the two and separating medicine from its former association with quackery, which were often practices based on long-established and ignorant ideas. The resulting educational revolution got rid of substandard schools that taught quackery and promoted ignorance. Chiropractic is still in need of its "Flexner report." Unfortunately there are too many vested interests involved in too many chiropractic organizations and schools to get this done very easily. If Life U. could survive its debacle - and it did - I see little hope in the near future. -- Fyslee 21:44, 5 May 2006 (UTC)

Absolutely, the Flexnor Report came out in 1910 (15 years after Osteo and Chiro) because the world was full of medical quacks before 1895. Andrew Still and DD Palmer sought to "save" the world from the drugs and potions of the times that were being used by medical doctors and saw the "light" long before the Flexnor Report. Andrew Still, MD said it all in his autobiography;

"I saw men and women dosed with drugs whose poisonous fangs showed the serpent of habit, that was as sure to eat its victim as a stone would return to the earth when cast into the air. I dreamed of the dead and dying who were and had been slaves of habit. I sought to know the cause of so much death, bondage, and distress of my race. I found the cause to be in the ignorance of our "Schools of Medicine." I found that he who gave the first persuasive dose was also an example of the same habit of dosing and drinking himself, and was a staggering form of humanity, wound hopelessly tight in the serpent's coil. "]

Chiro needs high quality publicly funded research. IMO, the Flexnor report was exactly what we all needed, but it has allowed medicine to channel itself all the public money and the best minds. It is long overdue to share some, especially the minds. If they would've spent some of their "anti-quack" money on real research, we might not be having this discussion. I think chiros' fear is; if it is proven to work, the name will be changed to "physicalsomething" and it will be claimed for themselves. There is a lot of distrust. But I don't have to tell you that.--Dematt 01:46, 6 May 2006 (UTC)

Could get interesting, though. I need some more input before I move on.--Dematt 02:00, 6 May 2006 (UTC)

Science and relativity

Hi Levine, your hosepipe edit wasn't accurate for a couple of reasons. 1) Relative to what? 2) you will need to provide scientific evidence for chiro subluxtion. Anecodotal evidence, as you know, is not evidence. It's an oxymoron. 3) the form of words was already a compromise (see above). 4) your link to anecdote as a tale was probably not what you meant. Also Your edit summary didn't say you had changed the top. We have agreed through long discussion here on the lead. Pls don't revert before we have consensus. Mccready 17:58, 5 May 2006 (UTC)

I just wanted to reitterate that there has been long discussion but no agreement on the lead. Regarding: "Evidence for the clinical efficacy of chiropractic does not meet the scientific standards of evidence-based medicine (cf. Cochrane collaboration).":

(a) It conveniently dismisses chiropractic in one fell swoop without addressing specific techniques and specific problems.

(b) The statement is inaccurate. There is no universally-acknowledged standard for what constitutes meeting "scientific standards of evidence-based medicine", and there is evidence to show that at least some chiropractic techniques have some clinically efficacy. Even Quackwatch's sister site, Chirobase, cites a summary critical of spinal manipulation that indicates chiropractic spinal manipulation has some efficacy in the treatment of neck and low back pain.

(c) There is a BIG difference between "clinically effective" and "statistically effective".

-AED 18:20, 5 May 2006 (UTC)

Mccready, I'll have to back AED on this one. I've pretty much stayed away from the discussions and editing of this particular part of the lead, simply because I have mixed feelings about it in many ways. While I believe it is basically true, it is also imprecise and thus can be an unfortunate choice of words, especially in the lead.

When commenting on "chiropractic" efficacy, one should be precise, since it's not "chiropractic" that is efficacious, but some of the techniques used by chiropractors (and others) that are efficacious. Thus the discussion should be about the technique, not chiropractic. OTOH, when discussing the popularity of "chiropractic," it's perfectly fine to mention that those who are already chiropractic patients (7.4% of Americans) are very satisfied with "chiropractic."

AED's second point is also true. Anecdotal evidence is a type of evidence, albeit the most uncertain and often misleading, but it's better than nothing, when there is nothing better. Both Quackwatch and Chirobase don't hesitate to admit that chiropractic is popular with its patients, and that chiropractors help people in several ways when they use sensible methods.

I think the statement should not be in the lead in its present form. When something takes its place, we should discuss it here first and reach some kind of consensus. These constant revert wars are unhelpful. -- Fyslee 21:12, 5 May 2006 (UTC)

Mccready, WP:LEAD is not policy, but a style guide.

Your concern is legitimate, in that the lead section should be a mini version of the article.

Likewise that "Evidence for the clinical efficacy of most chiropractic interventions does not meet the scientific standards of evidence-based medicine (cf. Cochrane collaboration)." Unfortunately that statement is too vague, and just mentioning Cochrane isn't a reference. It would be best to avoid using references in the lead.

The lead does need something to address this concern, but we haven't come up with anything yet. Start working on a formulation and let's discuss it here first.

The revert wars are very disturbing and since this is a collaborative effort we need to hammer this out together. See my earlier comments above.

-- Fyslee 07:28, 9 May 2006 (UTC)

Although testing medical interventions for efficacy has existed for several hundred years, and arguably more, it was only in the 20th century that this effort evolved to impact almost all fields of health care and policy. Professor Archie Cochrane , a Scottish epidemiologist whose book Effectiveness and Efficiency: Random Reflections on Health Services (1972) and subsequent advocacy, caused increasing acceptance of the concepts behind evidence-based practice. Cochrane's work was honoured through the naming of centres of evidence-based medical research — Cochrane Centres — and an international organisation, the Cochrane Collaboration. The explicit methodologies used to determine 'best evidence' were largely established by the McMaster University research group led by David Sackett and Gordon Guyatt. The term "evidence-based medicine" first appeared in the medical literature in 1992 in a paper by Guyatt et al. I'd say that makes it pretty new. Also, Critics of EBM say lack of evidence and lack of benefit are not the same, and that the more data are pooled and aggregated, the more difficult it is to compare the patients in the studies with the patient in front of the doctor, i.e. EBM applies to populations, not necessarily to individuals. In The limits of evidence-based medicine, Tonelli argues that "the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand." Tonelli suggests that proponents of evidence-based medicine discount the value of clinical experience.

Although evidence-based medicine is quickly becoming the "gold standard" for clinical practice and treatment guidelines, there are a number of reasons why most current medical and surgical practices do not have a strong literature base supporting them. First, in some cases, conducting randomized controlled trials would be unethical--such as in open-heart surgery--although observational studies are designed to address these problems to some degree. Second, certain groups have been historically under-researched (women, racial minorities, people with many co-morbid diseases) and thus the literature is very sparse in areas that do not allow for generalizeability. Third, the types of trials considered 'gold standard' (i.e. randomized double-blind placebo-controlled trials) are very expensive and thus funding sources play a role in what gets investigated. For example, the government funds a large number of preventive medicine studies that endeavor to improve public health as a whole, while pharmaceutical companies fund studies intended to demonstrate the efficacy and safety of particular drugs. Fourth, the studies that are published in medical journals may not be representative of all the studies that are completed on a given topic (published and unpublished) or may be misleading due to conflicts of interest (i.e. publication bias). Thus the array of evidence available on particular therapies may not be well-represented in the literature. Fifth, there is an enormous range in the quality of studies performed, making it difficult to generalize about the results.

Large randomized controlled trials are extraordinarly useful for examining discrete interventions for carefully defined medical conditions. The more complex the patient population, the conditions, and the intervention, the more difficult it is to separate the treatment effect from random variation. Because of this, a number of studies obtain non-significant results, either because there is insufficient power to show a difference, or because the groups are not well-enough 'controlled'.

Evidence-based medicine has been most practised when the intervention tested is a drug. Applying the methods to other forms of treatment may be harder, particularly those requiring the active participation of the patient because blinding is more difficult.

In managed healthcare systems evidence-based guidelines have been used as a basis for denying insurance coverage for some treatments some of which are held by the physicians involved to be effective, but of which randomized controlled trials have not yet been published. See also --Hughgr 19:38, 5 May 2006 (UTC)

Hi guys - I really think you're getting on brilliantly without me, but I've set up a page to play with the science section on User:Gleng/chiropractic - so far I've just started to dump stuff in there, but please feel free to add suggestions and experiment. I've been a bit distracted by something else that seemed to need help, but will try to get to this soon. Have to say that I am really impressed with how this article is shaping up - I hope someone can import some illustrations, I've noticed some very neat cartoons on the web, some nice historical vignettes and some useful diagrams to explain subluxation. I think that this should become a featured article one dayGleng 19:47, 6 May 2006 (UTC)

Images

• has a photograph of BJ Palmer plus pony with legend that he adjusted animals?
• has a photo of Harvey Lillard and a photo labelled "first adjustment"
• photo of plastic spine used by chiropractors on
• Wilk's book
• Manipulation in China
• Cartoons are probably impossible - there's one I like about the stone age chiropractor balking at a dinosaur.. but then I have a very childish sense of humourGleng 16:22, 7 May 2006 (UTC)

Okay, I'll check into the copyright status and send off some emails to see if we can get permission to use some of these. I learned the hard way that wikipedia won't let you use anything but free use pictures.--Dematt 18:29, 7 May 2006 (UTC)

Thanks Guys. Good discussion. I'll try to address all the points. First AED. 1.Yes I see it may dismiss chiro in one fell swoop - in that case we may have to talk about which parts of chiro it applies to and which it doesn't. 2. There is agreement on EMB -see cochrane 3. need to define what you mean by clinically effective. If a clinician thinks so, that is not sufficient for obvious reasons. That's why epidemiological stats are useful - a huge breakthrough in human health in fact. Thanks Fyslee I agree with your sentiments - which is why we need to define chiro in two ways - those who accept science and those who put their own clinical experience above science. We'd need to work on the wording. Your second point is covered by placebo - a very powerful thing. Hughgr, good points. yes lack of benefit and lack of evidence are not the same. However, it's still true to say there is no scientific evidence of chiro subluxation. i'm not sure you've interpreted Tonelli correctly. If you have then there's a conundrum to address ie lots of clinical experience combined = stats = evidence. In regard to using the lowest common denomintor in EMB - this is a course of action proposed by those whose evidence is not strong, and therefore we need to point it out. If I was dying of cancer i'd prefer a healthcare provider who knew the difference. The expense of trials is not a reason to accept hypothesis as fact. The NIH link you provided was interesting. But not all things in pubmed are true or can be relied on. I'm not saying this about Tonelli and agree with him that "The importance of clinical research for the practice of clinical medicine is immense and undeniable." The exceptions and their importance is where we may differ. Where would we be without the Ottowa protocols for example. And the Canadian initiative to publish "best practice guidelines" can only be applauded. I actually agree with him to some extent about hierarchies of evidence, though not with his application to all EMB proponents (like chiro it has shades of meaning)- which is why the gold standard should be the standard. Tonelli is certainly no green light for the anti-EMB anti-science portion of the altmed industry. Consequently I've compromised with the statement: "Evidence for the clinical efficacy of most chiropractic interventions does not meet the scientific standards of evidence-based medicine (cf. Cochrane Collaboration)." The task then is to say which parts stand up to evidence.

Finally, I would appreciate some discussion about my edit: "This "pinched hose theory" has long been abandoned. However, the concept of the subluxation, for which there is no scientific proof, remains an integral part of the typical chiropractic practice." Nobody has yet shown this to be incorrect. happy editing. Mccready 09:04, 8 May 2006 (UTC)

I'll just address your last comment about the "pinched hose theory." It has definitely not been abandoned by all chiros. One often finds variations on the theme in chiropractic literature and websites. One also often finds variations on the "adjusting misplaced bones back into place" theme. First of all they aren't "out of place," (a rare occurrence not usually amenable to HVLA manipulation/adjustment). -- Fyslee 11:02, 8 May 2006 (UTC) (continued below)

I'm not sure we can relate metaphors used to explain concepts to patients with the actual belief system of the chiropractor himself. For example, how many times do MD's allow their patients to believe the drug is to kill an infection when they know it is a virus and they are just trying to prevent the superinfection (or some other more important reason that the patient has no "tools" to understand). That doesn't mean the MD believes it.--Dematt 14:09, 8 May 2006 (UTC)

Secondly, even if they are pinching a spinal nerve (which certainly does happen), it has no effects on general health, but only to the part affected by that nerve, and that is usually (except for lumbar and sacral nerves, which can affect functions in the pelvic region) sensation and motor function. One can sever nerves to inner organs and they continue to function fine. And yes, the chiropractic vertebral subluxation is still in the pseudoscientific realm. Gotta run now. -- Fyslee 11:02, 8 May 2006 (UTC)

Now we're probably getting down to the real crux of the problem. Maybe we should be looking for some research for this assertion; "One can sever nerves to inner organs and they continue to function fine".--Dematt 14:51, 8 May 2006 (UTC)

Are we talking about CNS (Brain and Spinal Cord) or PNS? Cranial nerves are motor, sensory, or mixed, and all (but the vagus nerve) are involved with the head and neck region... (the vagus nerve manages the internal organs). So if we are talking about a spinal cord injury (SCI), then the first thing to note is that respiratory complications are often an indication of the severity of spinal cord injury. About one-third of those with injury to the neck area will need help with breathing and require respiratory support. SCI are classified either as complete or incomplete. An incomplete SCI means that the ability of the spinal cord to convey messages to or from the brain is not completely lost. People with incomplete SCI retain some motor or sensory function below the injury. A complete SCI results in a total lack of sensory and motor function below the level of injury. People who survive a spinal cord injury will most likely have medical complications such as chronic pain and bladder and bowel dysfunction, along with an increased susceptibility to respiratory and heart problems. Levine2112 19:30, 8 May 2006 (UTC)

Two MDs provided these commentaries to my assertion "One can sever nerves to inner organs and they continue to function fine":

1. "Transplantation. We take hearts and kidneys and other organs out of one body and put them in another; there is no nerve connection whatsoever, yet they function immediately."

2. "You don't need an experiment. Just look at those unfortunate enough to suffer complete spinal cord transection due to severe trauma. These patients are quadriplegic, incontinent, and may need help breathing but their kidneys function normally, their hearts beat unaided, their small intestine absorbs nutrients etc, etc. Chiropractors tend to forget this when they prattle on about subluxations causing organ specific disease."

Levine2112's comments above are correct. Other than that the inner organs still function fine with no nervous system control at all. This is where the subluxation based Meric system loses touch with reality. -- Fyslee 19:45, 8 May 2006 (UTC)

I am not asserting that the spinal nerves have nothing to do with the bodies organs. Are you? As I said above... people who survive SCI are likely to have digestive, respitory and circulatory problems. Clearly there is a relationship. Levine2112 21:39, 8 May 2006 (UTC)

The “organs without nerves function fine” makes me laugh, sorry. Earlier it was said that the heart keeps beating without any nerves going to it. True, it has a built in (S-A node, A-V node) regulatory mechanism, but that doesn’t make it normal when it doesn’t have nerves from the CNS! Normal means it has a nerve supply. Without a CNS connection to the heart, it beats about 100 times per minute. It never varies, whether that person is running or resting. Are they alive? Yes. Are they normal? No. What is the consequence of not having CNS supply to the heart? I don’t know the exact physiological detriment, suffice it to say, the quality of life of that patient is not as good as one with a proper nerve supply. And with any transplant, the patient must take immuno-suppressive drugs for the rest of their life, which leads to, among other things, an increased risk of cancer.

It could be argued that all the internal abdominal organs of the body can carry on their functioning without any nerves telling them what to do, due to the vagus nerve, but what about the sympathetic nervous system. Without a control mechanism (CNS), there will not be coordination between all the various parts of the body. Lack of coordination leads to malfunction. Wouldn’t malfunction be the precursor to disease? Also, people with severed spinal cord have a much shorter lifespan.

On the “pinched hose” theory. I agree, it is commonly used as the average layperson can understand that, as opposed to “sensory apparatus in ligaments detect tension and reflexivly cause muscles to contract leading to spasm, and due to the close relationship of the nerves at the nerve root, a process called facilitation causes other nerves to fire aberrantly, which may be going to an organ, or changing the sensory input signal, there by leading to an incorrect response by the CNS”. Yes, it can be easier to say “pinching the hose” to get the idea across.

As far as the subluxation theory, it is true that in the lower lumbar area the disc and/or bony exostosis can “pinch” the nerve. Consider this, the disc is the largest avascular structure in the body. It gets nutrients in, and waste products out, by a process of simple diffusion due to “blood pooling” in the end plates of the adjoining vertebrae. What helps aid simple diffusion is motion. Even breathing causes a pumping action helping the diffusion process. Now consider that a vertebrae is not moving as it should. Wouldn’t that lead to an increase in the breakdown of the disc, all things being equal, even if the process takes years. The end result being a disc herniation, pinching a nerve. When was the prudent time to address the lack of motion. At the onset of symptoms? As far as existence of subluxation research, I also feel it is an area that needs attention. Some have taken it upon themselves to that end. Check this out. Yes, it is only a one person study, but it should, at the very least, open the door for further investigation.--Hughgr 23:30, 8 May 2006 (UTC)

RE: "True, it has a built in (S-A node, A-V node) regulatory mechanism, but that doesn’t make it normal when it doesn’t have nerves from the CNS!" What nerves from the CNS go to the heart? -AED 23:48, 8 May 2006 (UTC)

FYI Nerve supply eminating from the lower cervical and upper thoracic region join the vagus nerve in coordinating heart rate to regulate blood pressure and vasomotor effects in the extremities and head. In other words, when we go from laying to standing, there must be a cooresponding increase in heart rate to elevate blood pressure while simultaneously constricting the peripheral vessels to increase pressure so that we do not lose blood supply to the brain and pass out. Here's a simplified version.

The autonomic nerves are part of the CNS and regulate the heart, blood vessel muscles and glands. Hughgr, please correct me if I am wrong... but a vertebral subluxation isn't exactly a pinched nerve. When the vertebrae move out of place, the soft tissue around it becomes inflamed and that is what presses on spinal nerves... not the actual vertebrae themselves. Levine2112 00:03, 9 May 2006 (UTC)

I thought the autonomic nervous system was part of the peripheral nervous system (which I believe includes the vagus nerve), not the central nervous system. -AED 16:39, 10 May 2006 (UTC)

AED-a part of the peripheral nervous system is called the autonomic nervous system (almost automatic :). The visceral nuclei of origin are all located within the central nervous system. There are two neurons associated with the ANS: a preganglionic neuron in the CNS, and a postganglionic neuron outside the CNS. For the heart, these preganglionic nerves arise at the spinal levels of the 1st thoracic to the 4th thoracic.

From Guyton’s Textbook of Medical Physiology, pg. 107, “The pumping effectiveness of the heart is highly controlled by the sympathetic and parasympathetic (vagus) nerves, which abundantly supply the heart. The amount of blood pumped by the heart each minute, the cardiac output, can often be increased more than 100 percent by sympathetic stimulation. By contrast, it can be decreased to as low as zero or almost zero by vagal (parasympathetic) stimulation. Strong sympathetic stimulation can increase the heart rate in the human to as high as 200 and rarely 250 beats per minute in young people. Also, sympathetic stimulation increases force with which the heart muscle contracts, therefore also increasing the volume of blood pumped as well as increasing the ejection pressure. Thus, sympathetic stimulation can often increase the cardiac output as much as twofold to threefold.”

Levine-yes, I think it is rare to have a “bone on nerve” situation. Sure, joint inflammation can compromise the intervertebral foramen thru which the nerve root passes. There are other hypothesis’ that seem to “more correctly” fit at other times. There can, of course, be more than one thing going on at one time.

Lastly, I would like to add that sometimes a patient will come to a chiropractor because of persistent headaches. They’ll report taking a lot aspirin for a long time. Now aspirin is known to cause stomach and kidney problems when taken for an extended period of time. If the adjustment helps relieve their headaches, they no longer need to take aspirin, thus secondarily reducing their risk of stomach and kidney trouble.--Hughgr 02:15, 9 May 2006 (UTC)

RE: "a part of the peripheral nervous system is called the autonomic nervous system (almost automatic)". Although your edition of Guyton's is probably more current than mine, I thought the autonomic nervous system was part of the peripheral nervous system, not the central nervous system. I believe the vagus and the spinal nerves are part of the PNS, but this is probably all semantics given the preganglionic role of the spinal cord. -AED 16:39, 10 May 2006 (UTC)

AED Check this out Especially note; "There may then be a reflex response to this involving autonomic efferent fibres causing contraction of smooth muscle in certain organs (e.g. blood vessels, eyes, lungs, bladder, gastrointestinal tract) and influencing the function of the heart and glands. The efferent limbs of these reflexes may also involve the somatic nervous system (e.g. coughing and vomiting). Simple reflexes are completed entirely within the organ concerned, whereas more complex reflexes are controlled by the higher autonomic centres in the CNS, principally the hypothalamus"

If there is anything that I hope we can get from this discussion is that science does have explanations that may explain the mechanisms for what chiros and their patients claim are happening. We just have to find a way to scientifically measure it that is acceptable for everyone.--Dematt 17:45, 10 May 2006 (UTC)

I'm not sure what you specifically want me to note. My point is that autonomic nervous system is typically considered to be part of the peripheral nervous system, not the central nervous system. The hypothalamus is part of the CNS that regulates the ANS, but is not considered to be part of the ANS. I'm fairly certain that there are no nerves directly from the hypothalamus to the heart. -AED 18:21, 10 May 2006 (UTC)

I'm sorry, I certainly didn't mean to make things more confusing. I took it a step too far. Suffice it to say the preganglionic fibers of the sympathetic ns originate in the spinal cord.--Dematt 03:24, 11 May 2006 (UTC)

Thank you Hughgr for giving us all (doctors, health practitioners, and laymen alike) a good education on the complexities of the nervous system. I too was surprised at the misguided "inner organs still function fine with no nervous system control at all" comment above - I just couldn't answer it as descriptively as you have. Any comment on Fyslee's other assertion... that vertebral subluxations are pseudoscience - or rather in the realm of pseudoscience? Levine2112 03:04, 9 May 2006 (UTC)

To add to Hughgr's great description for Levine, and for the benefit of others, current thinking is also along the lines of innervation surrounding the facets and posterior disc feeding back to the different laminar levels in the spinal cord when injury and perhaps the stretch from misalignment occur in the joint. These nerves synapse(dump their chemicals)into the lamina where millions of interneurons may or may not respond by carrying that information to the brain and/or other spinal cord levels. This is where endorphins(the body's morphins) play their part along with several others including substance P that plays a role in injury and inflammation. It gets really interesting, but much more research needs to be performed to find out if this is where the effects of subluxation occur.

As far as pseudoscience.. how can you defend against that. The word's purpose was to discredit. Yet, I never hear it used on anything medical. Do YOU?--Dematt 03:44, 9 May 2006 (UTC)

Good point. You never do hear it used that way. Hmm. Levine2112 04:53, 9 May 2006 (UTC)

Here is another list of chiropractic research. Some more case studies but also some population studies. Levine2112 07:56, 9 May 2006 (UTC)

Hi guys, just to let you know that I'm listening to you all here. Don't want to get involved in the arguments here, but just to touch base on a consensus 1) There is extensive efferent innervation of (I think) all internal organs, and afferent pathways arise from (I think) all of these to the CNS. Many (but not all) of these nerves travel via spinal pathways. The physiological role of these is often not clear. 2) How 'important' these are depends on what you mean by important. Organ transplantation would be pretty hopeless if they were critical to organ survival and essential function. However maintaining essential function isn't necessarily maintaining full normal function. 3) "pseudoscience" is actually often applied to medical topics in my circles, where it is used as a challenge, when the proposed explanation seems to have major gaps. Well most explanations have major gaps, but the problem I guess is when an elaborate explanation for an observed finding is proposed with rather sketchy foundation - the word doesn't question the truth of the finding so much as the value of the explanation. If the explanation can produce non trivial predictions then fine, but when an explanation has no 'meat', then it invites the term "pseudoscientific", meaning that it has the appearance of an explanation but doesn't actually explain anything. I guess I'm asking you to forgive us when we use the word, it's become a part of continuing robust and lively (and mostly friendly) debate between 'real scientists' (e.g. me) and 'pretend scientists' (e.g. medics). Hope you recognise the smile in this as I write. It's not a word we'd use in print, but if someone said that I'd given an explanation that was pseudoscientific, I'd take it seriously, and respond, but not feel that it was meant personally and not get offended. Gleng 09:11, 9 May 2006 (UTC)

Gleng, thank you for that. I did not realize that it meant something real to true scientists and if that is the case, then you do have the right to use it in any discussion here. You do make two important points in your discussion.

• 1. The organs are surrounded by "extensive" innervation which arises from the CNS. And your right, "the physiologic role is not always clear". That is what the chiropractor is waiting for. Lets find out if that is where the possible effects of subluxation occur. We know the vagus nerve is mostly parasympathetic and innervates the entire gut and exits the spine directily from the foreman magnum just above the atlas(C1). Could this be why BJ Palmer found that all he needed to adjust was the atlas(Hole in one) to have an effect on health? The thoracic region is full of sympathetic nerves that often "compete" with the parasympathetic nerves of the Vagus, perhaps having a balancing effect on smooth muscle peristalsis. Could this be why adjustments in the midthoracic region may sometimes improve different types of stomach upset? I don't know for sure, because nobody has looked into enough to find out. This in itself should be enough to pull chiropractic out of the pseudoscientific category at least until somebody checks it out. BTW, it has to be a real scientist if anyone is going to believe it. How about YOU!
  2. Pseudoscience. "It is not a word we would use in print" tells me that the intent is to challenge among fellow scientists as you said. It would be considered a cheap shot to use the word in an article where the uneducated mind would not understand. Your profession appears to respect that. We certainly can throw it around here in our discussions, but it does not belong in an article where it's only purpose is to defame so that the opposing argument sounds better.--Dematt 12:15, 9 May 2006 (UTC)

To keep things in perspective... I think that AED, Hughr, Levine, Dematt have summed things up very well. You have also demonstrated a clear command of the study of neurology, anatomy, neuroanatomy, etc., which should be enough to silence the critics.

But keep in mind, using weasle words like 'pseudoscience' and other phrases are deliberate attempts to disparage chiropractic. You must also keep in mind that they are added to this article by laymen/lay-persons with a pre-occupation with chiropractic, not by one trained/educated with the extensive background in the human body that one gets in chiropractic or medical school.

Just my 'thots. Thanks Steth 12:46, 9 May 2006 (UTC)

2 forms

Re the two main groups of Chiropractors (mechanists v vitalists), is it true to say the former do not believe in chiro subluxation? Mccready 10:50, 9 May 2006 (UTC)

Your terminology is a bit unfamiliar to me. The usual grouping is Straights, Mixers, and Reformers (Straights and Mixers try to ignore Reformers away as if they don't exist.....;-). All Straights and most Mixers believe in the chiropractic vertebral subluxation. All Reformers renounce it. There is a very wide variation in beliefs among chiropractors.. -- Fyslee 18:14, 9 May 2006 (UTC)

I have heard the terms Mechanist and Vitalist used, but I wouldn't go far as to say that one believes in VS and the other doesn't. The difference is more about the intended purpose of the adjustment. A Vitalist, like a Mechanist, often adjusts to correct purely mechanical issues. However, a Vitalist also recognizes that the body functions better overall when musculoskeletal's mechanical issues are minimized. I wouldn't say that a Mechanist doesn't recognize this - it is pretty obvious - but the Mechanist's intention is just to correct the mechanical. The resultant benefit to the rest of the body is just a bonus. Oh, and Vitalist/Mechanist are not chiropractic exclusive terms... In the philosophical world, a vitalist and mechanist differ in the way they view what life is. A mechanist sees the living body as a machine, but a vitalist recognized that there is a life-force. Some call is a "soul". Some call it "energy". Some call is "innate intelligence". It's really just two philosophies that each attempts to answer that aged-old question that has plagued humankind for all of existence: "What is life?" Levine2112 19:13, 9 May 2006 (UTC)

DD Palmer claimed to have answered that question:

"I am the originator, the Fountain Head of the essential principle that disease is the result of too much or not enough functionating. I created the art of adjusting vertebrae, using the spinous and transverse processes as levers, and named the mental act of accumulating knowledge, the cumulative function, corresponding to the physical vegetative function -- growth of intellectual and physical -- together, with the science, art and philosophy -- Chiropractic. It is now being followed, more or less, by 2,000 Chiropractors, and its use is being attempted by several other methods. It was I who combined the science and art and developed the principles thereof. I have answered the time-worn question -- what is life?"

-- Fyslee 19:51, 9 May 2006 (UTC)

Fyslee, you seem to have a compulsion for D.D. Palmer as you frequently reference what he said. He said a lot of interesting (strange) things back in his day. Are you trying to assert that we modern chiropractors are "cult" followers of D.D.?--Hughgr 21:01, 9 May 2006 (UTC)

Yes, DD Palmer said many interesting things, and so did B.J.. I doubt that there are that many modern chiros that could be accused of being "cultish" followers of D.D., but more (likely a minority) are labeled as being members of "the cult of BJ Palmer," (Keating, chiropractic's foremost historian):

"After 12 years of teaching and research at several chiropractic colleges, I can say with confidence that chiropractic is both science and anti-science. Yes, there is a meaningful science of chiropractic, but just as surely there is an anti-scientific mind-set and even a cult within chiropractic (for example, the cult of B.J. Palmer, son of the founder of chiropractic). Moreover, if University of Connecticut sociologist Walter Wardwell, Ph.D. is correct (Wardwell, 1992), the belief systems of a majority of DCs lie somewhere between these two poles: chiropractic as science vs. chiropractic as unscientific, uncritical dogma and circus. Perhaps a consideration of the nature of science will aid in understanding how the chiropractic profession does and does not approximate the rigors of science." Faulty Logic & Non-skeptical Arguments in Chiropractic, also Chiropractic: science and antiscience and pseudoscience side by side

After Levine2112 had both paraphrased the context and quoted precisely that question, it was sort of difficult to not think of it. It was just provided for information purposes. I often receive mails from chiropractors, and some of them would definitely be considered - even by yourself - as cultish fanatics. But people who are unbalanced and indulge in threats and foul language can be found in any group, not just chiropractic, so they have no influence on my opinion of chiropractors in general. -- Fyslee 18:33, 10 May 2006 (UTC)

The terms are in the article. Would it be true to say that the main distinction between chiros is belief or not in subluxation? Mccready 00:45, 10 May 2006 (UTC)

No.--Hughgr 01:43, 10 May 2006 (UTC)

Thanks Hugh, in that case, what do you feel is the main distinction? Mccready 02:14, 10 May 2006 (UTC)

I'm not sure one can draw exact parallels between "mechanistic" (non-subluxation based) and "Vitalistic" (subluxation-based) chiropractors, although it would generally be true. While some mechanistic chiros may choose to limit their practice, they can still be Vitalists. OTOH, Vitalism is an integral part of the belief in vertebral subluxations (VS). It all depends on how you choose to define Vitalism. In a general sense, all healthcare practitioners know that the body has inherent abilities to heal itself. This has never been unique to chiropractic and predates it. Vitalism in its religious/metaphysical sense also predates chiropractic and Palmer, but is the basis for Palmer's development of the concepts of Universal Intelligence (UI) and Innate Intelligence (II). I can conceive of some subluxation-based chiropractors not being conscious and informed believers in UI, IOW they are actually mechanistic subluxation-based chiros. (Even some professed atheists can believe in some sort of supernatural entity......;-)) They will tend to confuse VS for orthopedic subluxations, considering them to be the same. Truly informed and practicing Vitalistic subluxation-based chiros (the Planet chiro and F.A.C.E. type) are normally members of the ICA or WCA, and understand the difference, and that is that VS has a metaphysical element that is the unique property of chiropractic. Without this principle difference, chiropractic loses its uniqueness. When it comes down to it, belief in VS is the most fundamental difference between chiropractors, and influences many other things about the way they think and practice.

Here is something about chiropractic and Vitalism:

The debate over whether life is controlled by spiritual or material forces peaked in the nineteenth century. By this time, scientists endorsing "spiritual" control began to refer to themselves as "vitalists." Vitalism, according to the Merriam-Webster dictionary, is the doctrine that the processes of life are not explainable by the laws of physics and chemistry alone and that life is in some part self-determining. Vitalists contended that some vital factor, as distinct from physiochemical factors, was involved with "controlling" the body's structure and function. Since the definition of vitalism emphasizes that its character is beyond the laws of physics (measurement), vitalistic mechanisms were outside of the defined parameters of modern science. In spite of its metaphysical nature, vitalism was still endorsed by many traditional nineteenth century scientists.

The support for vitalism was soundly shaken in 1859 when Charles Darwin published his Origin of Species. In his treatise on evolution theory, Darwin emphasized that internalized "hereditary factors" (the existence of genes had not yet been recognized) were responsible for controlling the character of evolving species. Within a decade of its presentation, Darwinian theory was endorsed by the majority of conventional scientists. Darwin's theory of evolution denied the role of spirit or life force in the unfoldment of life on this planet. Consequently, scientists myopically focused on the search for the internalized material elements that "controlled" biological organisms.

D. D. Palmer was very sensitive to scientists' displeasure concerning concepts related to spirit and vital forces. In formulating the original science of Chiropractic, he coined the terms Universal Intelligence and Innate Intelligence to refer to the inherent organizing intelligence of the Universe and of life.

"In the early years of Chiropractic I used the terms Innate (Spirit), Innate Intelligence (Spiritual Intellect), Universal Intelligence (God) because they were comprehensive, and the world was not prepared to receive the latter terms just mentioned in parentheses. It may be even now premature to use them." (page 542, The Science, Art and Philosophy of Chiropractic).

Since vitalism is at the heart of chiropractic philosophy, and vitalism is perceived as metaphysics, the philosophy of chiropractic is not recognized by conventional medical science. Though modern medicine consider chiropractic as "unscientific," it has not been able to ignore the large number of their patients that have been increasingly satisfied with chiropractic care. The success of Chiropractic in recent years has fueled the antagonism between conventional medical physicians and chiropractors. Biomedical research scientists are at a loss to explain the efficacy of chiropractic adjustment for it is in direct opposition to contemporary knowledge concerning biological "control" mechanisms. -- Bruce H. Lipton, Ph.D., Today's Chiropractic, Sept-Oct 1998: 16-19

Another interesting quote:

What is the philosophy of Chiropractic?

From the time chiropractic exists, when Harvey Lillard got the first chiropractic adjustment on September 18, 1895, following which he recuperated the sense of hearing after he had lost it seventeen years before, millions of people all over the world have been the living proof that the body can recover from so many different conditions if only the interference between brain and tissue cell is removed. The beauty of it is that never chiropractors have been fighting diseases but rather have facilitated health by removing the major obstacle to a normal functioning i.e. the vertebral subluxation; therefore the effect is global: different conditions can be fixed at the same time, even those that we don't know about yet, as it is too early for the body to show symptoms. That is why the philosophy of chiropractic is vitalistic in nature; chiropractors call "innate intelligence" what pathologist emeritus William Boyd, author of a classic pathology textbook, call "mysterious wisdom"; that innate intelligence is a fundamental characteristic present in all living things, including plants, from the unicellular organism to the most complex ones and allowing them to be what they are, giving them all there properties and actions. It allows the organism to prosper, reproduce, adapt, defend and repair itself in normal circumstances. This means that the qualities of the environment, internal as well as external, should remain within normal limits for that particular organism; once exceeded the physiological resistance to stress, the organism perishes. Excessive heat or cold, lack of oxygen, malnutrition, heavy traumatism, poisons, for instance, are not compatible with sustained life in spite of innate intelligence. But given that a living organism, a human body for the matter, is benefiting from favorable environmental conditions, one thing that will prevent the innate intelligence to express itself correctly through matter, is an interference - to the life force transmitted by the nerve pathways as they pass through the spinal chord and nerves - due to a vertebral subluxation. Therefore, the logical thing to do: eliminate the interference so that innate intelligence can manifest itself at full power. If not too late, healing will take place and people will keep saying that "Chiropractic adds life to Years and years to Life".

-- Fyslee 18:33, 10 May 2006 (UTC)

Thanks Fyslee, I'd add from "Conventional medical research has emphasized that genes are the responsible elements “controlling” health and disease. It is implied in the Primacy of DNA dogma that genes function as self-regulatory elements. Fundamental to this assumed truth is the requirement that genes must be capable of “controlling” their own expression. By definition, genes must be able to switch themselves on and off, as suggested in the concept of a cancer gene “turning itself on.”

However, the notion of the Primacy of DNA has been soundly challenged by current research which reveals that the existence of a self-regulatory property for genes is a patently incorrect assumption. An important article by H. F. Nijhout (Metaphors and the Role of Genes in Development, BioEssays 12:441, 1990) describes how concepts concerning genetic “controls” and “programs” were originally conceived as a metaphor to help define and direct avenues of research. Widespread repetition of this compelling hypothesis over time has resulted in the “metaphor of the model” becoming the “truth of the mechanism,” despite the absence of substantiative supporting evidence.

Nijhout elegantly and succinctly redefined the truth as follows, “When a gene product is needed, a signal from its environment, not a self-emergent property of the gene itself, activates expression of that gene (emphasis mine).” Simply stated, a gene can not turn itself on or off, it is dependent upon a signal from its environment to control its expression. Genes are indeed involved with the structure and behavior of an organism, however they are not the source of “control.”

Gene expression is under the influence of specialized proteins referred to as regulatory proteins. Regulatory proteins bind to DNA and mask the activity of genes. In order to activate a specific gene, its regulatory proteins must be removed from the DNA strand. The binding and release of DNA regulatory proteins is controlled by “environmental” signals. Rather than recognizing the Primacy of DNA, it is more correct to acknowledge the Primacy of the Environment as causal in shaping biological expression.

The fact that the cell’s nucleus and its enclosed genes do not represent the controlling element or “brain” of the cell is easily verified in studies wherein the cell is structurally or functionally enucleated. Cells in such experiments continue to express complex behavioral repertoires and purposeful interactions with their environment and may survive for months despite the absence of functional genes. Consequently, genes can not be invoked to be the source of “control” in regulating cell behavior.

In addition to Lipton, another interesting take is Strang's book(1984) "We know that homeostasis involves negative feedback. We even know some of the mechanisms entailed. But this knowledge does not really touch the deeper mystery of how the body "thinks" physiologically: sensory information must be endlessly integrated and efferently activity determined. The stringing together of mechanisms cannot be expected to capture the overall reality of organic, dynamic activity. Classic mechanistic thinking is rooted in the notion that the parts explain the whole. This is true of mechanistic processes such as gearing or even electronic computing. But as Aristotle observed, nature is a world of purpose. In such a world, mechanisms are merely the instruments through which superimposing purposes work their wills. It is this marvelous, innate(inborn), purposeful nature which is the predominant, practical reality behind the mechanisms of homeostasis."

Interesting discussion.--Hughgr 23:36, 10 May 2006 (UTC)

Thanks again, Fyslee, and I would add from the conclusion of the same article "There is clearly an upheaval of conventional thought brewing in the allopathic ranks. The interesting nature of these new considerations is that it is bringing conventional biomedicine into closer alliance with D. D. Palmer’s original Chiropractic Philosophy. The uniqueness of chiropractic is that it has a vitalistic foundation. Leading edge cellular and molecular research is now proving that Chiropractic should embrace and promote its vitalistic roots."

I definitely agree with this article? I would like to see our science section move along in these lines. I think that this guy has pretty much said it all from a NPOV. I hope everybody read it all.

The word "pseudoscience" is not in the article

Just in case it's not clear, I do not like the word "pseudoscience to be associated with this article, because its use is inescapably linked with derogatory implications whether intended or not - it is just inherently POV. My plea was merely to allow us all some license to be relaxed in Talk pages to engage in robust debate amongst friends.Gleng 16:04, 9 May 2006 (UTC)

It is not being used in the article (Steth's charge is untrue).

The only place the word appears is in the "Critiques" links section, from a chiropractic source:

• Chiropractic: science and antiscience and pseudoscience side by side -- Joseph C. Keating, Jr, PhD

It is indeed a POV that should be presented (not advocated), and it must be done in a NPOV way, IOW in the criticism's section stating that many scientists and medical physicians believe it is based on a pseudoscientific idea -- the chiropractic vertebral subluxation (VS). It is VS, not chiropractic, that is considered to be pseudoscientific. The difference is important. I certainly have no intentions of approaching that matter in the near future, but Misplaced Pages policies allow the possibility. If labeled properly it will not violate NPOV. -- Fyslee 18:13, 9 May 2006 (UTC)

Making a mockery of NPOV

I was very surprised to see this by one of our 'contributors', Fyslee. I was wondering if anyone else might feel that NPOV may be difficult (impossible?) for him to attain here at Misplaced Pages regarding the Chiropractic article.Billboards in Connecticut Steth 17:51, 9 May 2006 (UTC)

Connecticut Chiropractic Council- "We must persevere to break down this group and their information tactics."

Did they mean to say misinformation tactics perhaps? Ironic Fruedian slip...

Seriously though there is no reason why an editor cannot contribute in a NPOV fashion just because they have a POV in real life. This reeks of ad hominem. Jefffire 18:01, 9 May 2006 (UTC)

That was received from one of my many chiropractor friends. The last sentence was written by the Connecticut Chiropractic Council.

Steth is using this as yet another opportunity to use ad hominem attacks on me. He consistently fails to Assume Good Faith. Of course I have a POV both on Talk pages and outside of Misplaced Pages. The article is where NPOV must prevail. Steth seems to fail to understand that his POV is just as much a POV as my POV. I recognize that, but he seems to think his POV is NPOV. -- Fyslee 18:25, 9 May 2006 (UTC)

I agree that one should be able to express POV on this discussion. And that Fyslee spends his time drumming up anit-chiro support off this site is his own business. He even once accused me of representing the "unscientific POV" in an attempt to get more of his crew to the Misplaced Pages Chiropractic article. I wonder if it worked. Anyhow, that he considers my POV unscientific is his POV. That I considered my POV to be wholly scientific is my POV. That I consider Fyslee's POV to be hate-mongering is also just my POV. We are all certainly entitled to our own POV... in the U.S., in Denmark, and certainly on the Internet (except maybe in China). Also, if you are Chiropractic Assistant and you want to rat out the chiropractor you work for, you might want to check out this important message from Fyslee. Levine2112 19:53, 9 May 2006 (UTC)

Levine, that would be funny if it weren't so sad.--Hughgr 20:26, 9 May 2006 (UTC)

OK guys, I just wish we could go for a drink together sometime. Whatever your views, this article is turning into something good, and better for all of you. Just my humble opinion. If you don't want to work with people who hold totally different opinions, Misplaced Pages is not a goood place, but sometimes the opposite opinions are the ones most interesting. There are regularly calls for animal house assistants to whistle-blow on abuse of animals, and for what it's worth I'd pass them a whistle myself because if there are rotten apples, they don't belong in my barrel, and I'm sure they don't belong in yours either. Yes, I worry that such calls just invite malcontents to exaggerate and cause trouble, and I'm sure they do to some extent, but if the pressure keeps the house clean it's not all bad either.Gleng 21:37, 9 May 2006 (UTC)

Here, here, I'll tip one back with ya! LOL This article is improving, and as B.J. Palmer said, conflicts clarify! I'm working on a vertebral subluxation break down to be discussed here. Maybe some of it can be used in the article when it's done being hashed out. If nothing else, used in the VS article. Take er easy (or any way you can get her :)--Hughgr 22:01, 9 May 2006 (UTC)

I'll buy the first round! All's well that ends well. I think we all pretty much know where each of us stand already. If you ask me, Fyslee, you have shown great restraint in not allowing your personal POV to take over this article. I think we should all follow his example. Something tells me we'll all be okay with the final product.--Dematt 06:32, 10 May 2006 (UTC)

Dematt, we share the same goal - to present the best article about chiropractic ever written. Most articles suffer from being one-sided. Skeptical articles write only from the skeptical viewpoint, and articles written by most chiropractors and associations naturally write from a promotional viewpoint. There is nothing wrong with that, but Misplaced Pages deserves and requires much more. There is much to write about this fascinating subject, and readers should feel that they have been well-informed by the finished product. -- Fyslee 09:15, 10 May 2006 (UTC)

Well, I agree with you Jefffire, there is no reason why an editor cannot contribute in a NPOV fashion just because they have a POV in real life. And everyone has a POV, now don’t they? But an article is supposed to have NPOV, isn’t it?

Flysee’s claim that his POV is as valid as my POV is missing the point. This article isn’t about POV. It is about NPOV, namely, here is what chiropractic is. It’s NOT about ‘here is how I interpret studies so I think chiropractic is a pseudoscience, or doesn’t work or will kill you, etc. so I want this included in the article.’ So when Fyslee or Macreedy adds their ‘coloration’, then those with an NPOV have to balance things by adding still more to the article, etc. creating an interminable morass.

Unlike practically all other articles that state cleanly what something is about, this article gets bogged down into two sides: On one side are chiropractors and non-chiropractors trying to develop an informative article versus non-chiropractors who are pre-occupied with chiropractic, and some who might also happen to actively participate in professional bigotry openly with blogs and websites, who don’t believe chiropractic deserves to exist and aims to do something about it and who just adds disparaging, anti-chiropractic spin edits.

My POV is to remove anti-chiropractic POV from the chiropractic article, making it more NPOV. It seems to me that this should be a concise, informative article, not unlike most articles on WP. Instead, it has become a way too long, battleground, filled with headings and sub-headings. That’s the issue. Steth 23:12, 9 May 2006 (UTC)

Steth, take a chill pill and help us with the next part:)--Dematt 06:39, 10 May 2006 (UTC)

Misunderstanding NPOV

Steth wrote: "That's the issue."

Okay, that is your issue, and your statements above bring up a very fundamental problem with your understanding of the NPOV policy, and thus explains why your editing often tends to be deletist ("My POV is to remove anti-chiropractic POV from the chiropractic article, making it more NPOV.") or where you consider your POV to be the same as NPOV ("...then those with an NPOV have to balance things by adding still more to the article...").

First of all, you misquote me:

"Flysee's claim that his POV is as valid as my POV is missing the point."

Here is what I actually wrote:

"Steth seems to fail to understand that his POV is just as much a POV as my POV. I recognize that, but he seems to think his POV is NPOV." (Nothing about "validity" there.)

Your statements above just proved my point, and that is that you misunderstand and therefore misuse NPOV.

NPOV is not about deleting POV (especially opposing POV) or preventing POV in articles, it is about presenting all POV, without advocating a POV, IOW all viewpoints should be presented without taking sides. Editors should seek to present the facts about each side's POV. Scientific evidence should be presented as it is - the best knowledge we have at present.

All viewpoints should be presented to ensure balance, otherwise the article ends up being a sales talk for chiropractic, rather than an article describing chiropractic in all its facets, which includes much controversy. The controversy should also be presented.

The scientific and medical world is skeptical of chiropactic. That skepticism, being the majority viewpoint, must also be presented here, according to the rules of NPOV.

Misplaced Pages's POV policy must not be misused so it becomes synonymous with revisionism, censorship, whitewashing, or political correctness. One must present both sides of any controversy. To leave out one side amounts to promoting the other side's POV. Misplaced Pages should include more information than other encyclopedias, not less.

This article is not like many other articles, simply because it is one of many controversial subjects dealt with here at Misplaced Pages. Such articles cannot be presented in some short concise way. That's the way it is and we need to accept that fact.

The article is about chiropractic, and therefore the many different chiropractic viewpoints should be presented thoroughly, without selling them. This is not a soapbox for chiropractic, and the article must not be written from the chiropractic POV, but should describe those POV, as well as other POV.

Readers should come away from the article with a feeling of "Wow! I've never read such a thorough coverage of all the aspects about chiropractic. Now I've heard all sides of the issue and can make up my own mind. I have also been presented with enough information and references to start doing my own research." -- Fyslee 08:22, 10 May 2006 (UTC)

Thank you for your ‘clarification’, Fyslee. Have you considered that you see things from the inside of a fishbowl? From your perspective, chiropractic is controversial and must be destroyed. You demonstrate this through your participation in various activities, including working with Kinsinger, MD, who is behind the billboards, and who, with you, worked feverishly to stop the chiropractic school in Florida in conjunction with Florida State University. What were you thinking there? War on chiropractic?

“The scientific and medical world is skeptical of chiropactic. That skepticism, being the majority viewpoint, must also be presented here, according to the rules of NPOV.”

Oh? How do you know this? Have you spoken to most in the medical field? The AMA, with around 300,000 members, doesn’t seem to have a statement or policy that puts chiropractic in a negative light. So that accounts for a large group of MD’s right there. In fact, they say (with the help of a courtroom) that it is OK to associate with chiropractors. So immediately I recognize that you again are passing off your opinion as fact (original research, perhaps?).

Do local MD’s dislike chiropractic? It seems that MD’s and DC’s work together well, referring back and forth, partnering in practices at an increasing rate. They participate in organizations and groups together to benefit the community. There are a number of hospitals across the US have DC’s on staff. It seems to be OK with many in the medical field. They even get….ADJUSTED!!! How do you explain that?

You see, the several MD’s you hang with seem to spend most of their retired time coming up with attacks on chiropractic, which you actively endorse and enthusiastically participate in. Is that very professional? But that’s why you think MD’s don’t like chiropractic.

The point being, that since you look at chiropractic through thick, myopic eyeglass lenses with your nose pressed against your 15” monitor on your kitchen table in Denmark between massages, you feel that this is how human beings interact in the rest of the world. Just not so, but trying to create this world through the internet, while you have had some successes, is a bit self-serving, not to mention weird.

I bring this all up to refute your contention that chiropractic is the most controversial thing you can think of according to most in the medical profession. What I find very odd is that a physical therapist living in Denmark would take such an active, militant interest in deliberately hindering and preventing chiropractic from progressing and improving, progress you claim that chiropractic needs so desperately. What’s that all about?

“The article is about chiropractic, and therefore the many different chiropractic viewpoints should be presented thoroughly, without selling them. This is not a soapbox for chiropractic, and the article must not be written from the chiropractic POV, but should describe those POV, as well as other POV.”

You know something, Fyslee? I agree with some things you say. (!) This article is about chiropractic, so chiropractic viewpoints should be presented. But it’s not about what some people think about chiropractic. What should not be presented is why a PT or some MD’s have emotional reactions about the word ‘chiropractic’. This is not a soapbox as you keep attempting to make it, nor is it to promote your viewpoint. It is about chiropractic. Yours, Steth 18:02, 10 May 2006 (UTC)

Do you really believe what you have just written about me? Your hatred seems to know no bounds. First you don't even quote me correctly (and don't apologize for doing so), then you use straw man attacks (I don't work with Kinsinger in any way, among other false allegations above), then you smear me all over the place in a very cheap and mean way. Do you feel good now? Have you somehow boosted your self image by putting someone else down? If that's what it takes, I pity you. If I had done even half of what you have just done, you'd be screaming "ban the guy," "let's start an RFC against him" (oh, that's right, you've already tried that tactic....). -- Fyslee 18:28, 10 May 2006 (UTC)

Oh, c'mon Fyslee. Don't be so sensitive. What did I write that was inaccurate? I got this stuff from links to your websites that you openly provided. You seem to have no qualms about smear campaigns and people, chiropractic, chiropractors, politicians, etc. Here is one example: Stop FSU I was just wondering why a PT in Denmark would reach over to Florida and become so personally involved. Wasn't there any coordination of efforts with Kinsinger on your part? So chill out. Have a cup of tea or a busy little Zin. Steth 20:52, 11 May 2006 (UTC)

Reminder

Per Misplaced Pages:Etiquette and Misplaced Pages:Talk page guidelines, try to avoid personal attacks and be concise with your comments. The increased activity here is good, however, I think a bit more adherence to those guidelines will help all of us to follow some of the discussions better. Cheers! -AED 18:53, 10 May 2006 (UTC)

The lead (again)

The lead currently includes: "There is little scientific evidence as to the validity of the theory or effectiveness of the treatments." It appears as though there has been no discussion regarding this particular inclusion, so it might be wise if we had some. My initial question is this: What is "the theory" (emphasis mine) that supposedly has little evidence supporting its validity? My understanding is that there is no such thing as "the chiropractic theory". Whatever it is, it should be mentioned explicitly prior to stating that there is no evidence of its validity. -AED 20:43, 10 May 2006 (UTC)

I have been having a revert war with user Arthur Rubin, who I haven't seen trying to discuss this change here. Until it gets discussed here, I will continue to revert within WP:3RR--Hughgr 21:26, 10 May 2006 (UTC)

Perhaps you could help things by explaining specifically why you think it is not appropriate.-AED 21:32, 10 May 2006 (UTC)

Some of the reasons have been pointed out above, mainly it's generalizing, "little scientific evidence", what evidence, shouldn't there be more studies instead of saying that since there is litte, that means it's a done deal. What theories are valid and which are invalid. Are all treatments ineffective or just some?--Hughgr 21:49, 10 May 2006 (UTC)

I'm willing to drop the "theories", as they're not mentioned in the lead (as long as the lack of scientific evidence for the theories is listed with reasonable prominence where the the theories are listed.) However, the fact that there is little scientific (or even anecdotal) evidence as to the clinical efficacy of chiropractic needs to be in the lead. — Arthur Rubin | (talk) 00:51, 11 May 2006 (UTC)

Whether there should be more studies is clearly a violation of WP:NPOV. And it's as accurate as the first two sentences — the claims that chiropratic includes diagnosis, and that mechanical disorders of the musculoskeletal system has effects on the function of the nervous system are disputed. I don't think the previous version ("Evidence for the clinical efficacy of chiropractic does not meet the scientific standards of evidence-based medicine.") belongs in the lead, but some statement that chiropractic has limited scientific recognition should be in the lead. — Arthur Rubin | (talk) 01:00, 11 May 2006 (UTC)

Regarding latest update: "There is little scientific evidence as to the effectiveness of the treatments." If I'm reading this for the first time, I'm wondering: "There is little scientific evidence as to the effectiveness of spinal manipulations for what purpose?" According to Quackwatch: "There is substantial evidence that spinal manipulative therapy (SMT) has value in relieving back pain and improving the range of impaired spinal motion at least temporarily. Although SMT is probably no more effective than other modalities in the long term, it appears to offer faster relief in about one third of patients." Is Quackwatch wrong? -AED 01:14, 11 May 2006 (UTC) edited 01:27, 11 May 2006 (UTC)

Hi Art and welcome. Please read through the Talk pages and familiarize yourself with some of the history. It might save you (and us!) a lot of wasted time and energy.

Regarding your POV reverts, here is what I posted to Geni that might clarify things for you indicating that, in addition to AED's reference that there is substantial evidence cited above, moderate and adequate evidence exists according to the experts cited below. So maybe we should change the word 'little' to 'adequate' or 'substantial'? Would that work for everyone?:

Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guidelines No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December 1994.

Here is what they said: AHCPR Guideline recommended Spinal manipulation of low back during first month of symptoms with a ‘B’ rating. B = moderate research-based evidence (one relevant, high-quality scientific study or multiple adequate scientific studies).

Manipulation for patients with radiculopathy (C). Manipulation for patients with symptoms > 1 month (C). C = limited research-based evidence (at least one adequate scientific study in patients with low back pain).

I am just saying that since evidence exists, the statement that no evidence exists is false and should be removed. There was agreement with this. So why would you want to keep it in?

Here is more, indicating that evidence does exist. So read through this and lets be open to adding much of this information to the article and remove anti-chiropractic biased statements:

Spinal manipulation Steth 04:23, 2 May 2006 (UTC)

Thanks Steth 02:08, 11 May 2006 (UTC)

I had read the entire talk page. There is still little scientific evidence of the effectivness of chiropractic, or of spinal manipulations (which are not exactly the same). (I was particularly amused — when I saw it — by a study showing that spinal manipulation was effective on lower back pain, independent of which manipulations were performed. That supports spinal manipulations as being effective, but chiropractic, as a whole, as not being effective.)

We need some comment in the lead about the value of chiropractic being questioned by sincere researchers. — Arthur Rubin | (talk) 03:33, 11 May 2006 (UTC)

What the article needs is accuracy. It is because chiropractic and spinal manipulations are not exactly the same that your addition to the lead was inaccurate. Still, I'm glad you grasped the point with a bit of amusement. -AED 05:14, 11 May 2006 (UTC)

It's your move. Any action I take in the next 12 hours could rationally be considered WP:3RR but I expect something about the controversy in the lead shortly.— Preceding unsigned comment added by Arthur_Rubin (talk • contribs)

Regarding the latest update: "According to the experts, there is substantial and adequate scientific evidence as to the effectiveness of the treatments." Again, if I'm reading this for the first time, I'm wondering: "There is little scientific evidence as to the effectiveness of spinal manipulations for what purpose?" Chiropractors assert that spinal adjustments are useful for more than "relieving back pain and improving the range of impaired spinal motion" and that update does not make that clear. -AED 03:11, 11 May 2006 (UTC)

Art, why do you "demand" that something about controversy be in the lead? I mean, why is this so important to you? There is infinite detail already in the article. Why would you want to put a big "red flag" in the lead? There has already been much discussion. Besides, chiropractic being controversial is only a viewpoint by some, many others don't feel it is controversial. So have a cup of tea. Thanks, Steth 11:47, 11 May 2006 (UTC)

Only someone who has absolutely no knowledge of the subject would describe it as uncontroversial. I think you've confused controversial with pseudoscience. Jefffire 12:36, 11 May 2006 (UTC)

(Edit conflict) Ahhh, there you're wrong, on two points.

There hasn't been much discussion on the lead, except the pro-chiropractic principle editors removing various anti-chiropractic comments. (I haven't read the full talk archive — if there is further discussion on the lead, could someone point me to it.) Mine seems neutral — the previously discussed comment, although acurate, probably doesn't belong in the lead.

Chiropractic being controversial is a fact. It should be in the lead. The article, as a whole, seems balanced (at the moment). ‐ although the study that showed little effect as to which adjustment was made on the efficacy against lower back pain probably should be noted here or in a related article. (I'll see if I can find my reference to that study, and add it to the appropriate section.) There may be a slight lean toward the pro-chiropractic point of view. (On the other hand, the note here about the potential 100% unreporting of serious injuries caused by chiropractic should probably also be copied to the adjustment article.) — Arthur Rubin | (talk) 12:51, 11 May 2006 (UTC)

I just checked the previous two archives. There's no agreement on the lead. What there is is a revert war on the lead lasting at least 3 months, if not the entire life of the article. (I'm the current "anti"-chiropractic participant, with the usual suspects on the pro-chiropractic, and AED seems to be attempting to act as a peacemaker, although leaning "pro".) — Arthur Rubin | (talk) 13:36, 11 May 2006 (UTC)

I'm leaning "accurate", not "pro". Had you read my post from "03:11, 11 May 2006" (a few paragraphs up), it's quite evident that I treat Steth's edits the same way I treat yours. -AED 14:34, 11 May 2006 (UTC)

Well, Art, shouldn't "anti-chiropractic" comments be removed from the lead and the whole article? What in the world has this article got to do with being pro- or "anti-chiropractic'? I resent Art Rubin characterizing anyone who is not "anti-chiropractic" to be a "suspect". This article should not be about anti- or pro-, but about Chiropractic. It is not about why a lay-person has negative thoughts about chiropractic, therefore WP should be used has his soapbox. By revealing that he is "anti-chiropractic" then clearly, the purpose of his edits is only to add his extremely biased colorations to this article. The result, as we can see, is revert wars. See what I mean? Steth 20:44, 11 May 2006 (UTC)

Alternatives to controversial lead

Hey guys, saw that there is still controversy on the lead with the last sentence. While reading the "thousands" of pages that Fyslee and Levine have provided, I ran across this. It looks NPOV and it is cited if you want to look into it;

Chiropractors’ ingenuity in devising assessment and adjusting strategies has been phenomenal, and today dozens of brand-name and “generic” techniques (see Table 7) are taught at chiropractic schools (e.g., Gleberzon 2002) and practiced within the profession (Bergman et al. 1993). Clear favorites are apparent (National 2000), but none has yet received the scientific investigation that can justify claims for effectiveness or superiority. However, a specific procedure, side-posture lumbar manipulation, has enjoyed considerable success in clinical trials for patients with low back pain and is highly regarded by expert reviewers (Cooperstein et al., 2001;Gatterman et al., 2001).see page 29.--Dematt 14:07, 11 May 2006 (UTC)

Not bad. I think we'd need to paraphrase it (copyright considerations; we'd have to include their references as ours, and "yet" is a violation of Misplaced Pages is not a crystal ball (and slightly misleading — some modalities have been shown ineffective)), but an excellent choice of a starting point. — Arthur Rubin | (talk) 14:24, 11 May 2006 (UTC)

Excellent reference! It could be summed up in this way:

While there is no satisfactory evidence for claims for effectiveness made for many chiropractic procedures, there is evidence that one of the most used procedures -- side-posture lumbar manipulation -- is effective for lower back pain.

That may be a bit clumsy, but I have to run now. -- Fyslee 15:00, 11 May 2006 (UTC)

With a slight reword it could fit in splendidly. Jefffire 18:29, 11 May 2006 (UTC)

My lord, what part of discuss in the talk page first, don’t you guys understand…. In regards to the overwhelming majority of research with manual therapy, manipulation, and/or chiropractic adjustment, the most recurring and thus most accurate statement is “Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with (insert condition here)”. Notice the support OR refute part. So you can’t use “little scientific evidence as to the effectiveness….”, as this is inaccurate. Not that I think “any” evidence would change your minds. see last sentence

The most accurate would then be, “There is little scientific evidence to support or refute the effectiveness of the treatments for anything other than back pain and impaired spinal motion.”--Hughgr 18:50, 11 May 2006 (UTC)

If we're going to do that, we need to distinguish the levels of "little". "There is very little scientific evidence to support, but little scientific evidence to refute, the effectiveness of treatments for anything other than lower back pain and impaired spinal motion." Or perhaps no evidence to support, but little evidence to refute.... — Arthur Rubin | (talk) 18:57, 11 May 2006 (UTC)

What about this;

Chiropractic, or chiropractic care, is a complementary and alternative medicine health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. It emphasizes the bodies own natural ability to heal itself and works to remove obstructions to this process, principally the chiropractic subluxation. There is an emphasis on manual treatments including spinal manipulations termed adjustments. While there is no satisfactory evidence for claims for effectiveness made for many chiropractic procedures, there is evidence that one of the most used procedures -- side-posture lumbar manipulation -- is effective for lower back pain.

It does seem to flow better. You guys can keep fighting over the last sentence, but how about the other part. We still need to add info related to what ends up being in the article, but first we need to finish the article.--Dematt 19:17, 11 May 2006 (UTC)

I think that is neutral, but then I only came along to say stop the edit war. At this point the options are: protect the article (at the wrong version, naturally); block everyone for WP:3RR and disruption; or you all sit down and play nicely. Which looks like what's happening. Well done :-) Just zis Guy you know? 20:43, 11 May 2006 (UTC)

Alright, I think I have it. How about this:

Chiropractic, or chiropractic care, is a complementary and alternative medicine health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. It emphasizes the bodies own natural ability to heal itself and works to remove obstructions to this process, principally the chiropractic subluxation. There is an emphasis on manual treatments including spinal manipulations termed adjustments. Preliminary evidence suggests benefits in patients with tension headache and low back pain. Better research is needed to make a strong conclusion.

Steth 20:55, 11 May 2006 (UTC)

Editorialising and POV. Reword. Jefffire 21:02, 11 May 2006 (UTC)

Shall we try changing the last two sentences to

Preliminary evidence suggests benefits only in patients with tension headache and low back pain.

— Arthur Rubin | (talk) 21:09, 11 May 2006 (UTC)

Are you guys sure you don't want;

While there is no satisfactory evidence for claims for effectiveness made for many chiropractic procedures, there is evidence that one of the most used procedures -- side-posture lumbar manipulation -- is effective for lower back pain.

--Dematt 21:29, 11 May 2006 (UTC)

Actually, I prefer that phrasing. As an "anti" (or, at least, a skeptic), I don't think it's my part to (re)introduce "no evidence" claims. (At least, if I didn't think it would be reverted within a few minutes....) — Arthur Rubin | (talk) 21:49, 11 May 2006 (UTC)

"Preliminary evidence suggests benefits only in patients with tension headache and low back pain", I feel "only" should be substituted with primarily or mostly.--Hughgr 22:32, 11 May 2006 (UTC)

I think that starting to talk about preliminary evidence in something that's been around for this long sounds rather silly. I didn't see much of a problem with Dermatt's version. Just zis Guy you know? 22:45, 11 May 2006 (UTC)

I'm not sure if you guys missed this part of the change to the lead;

"It emphasizes the bodies own natural ability to heal itself and works to remove obstructions to this process, principally the chiropractic subluxation. "

Nobody seemed to mind it and it does tie in with what we are hopefully working toward in the body of the article. You may have been more concerned with the last sentence and missed it. I went ahead and put it in, but we can still pull it.--Dematt 01:38, 12 May 2006 (UTC)

While we're on the subject, and without touching that last sentence, how about we simplify that "complementary and alternative medicine health profession". I've heard alternative healthcare profession, complementary and alternative heathcare profession, etc. but never the way we have it. For now I'll change it to complementary and alternative medicine healthcare profession which still sounds a little long but I suppose is necessary.--Dematt 01:53, 12 May 2006 (UTC)

I like the "It emphasizes the bodies....." Looks good

As far as "complementary and alternative medicine healthcare profession", I like the way it was before. IMHO--Hughgr 02:34, 12 May 2006 (UTC)

I suppose it is body's..:] and no problem on the healthcare, I wasn't real happy with that one anyway. Quite a day, huh.--Dematt 03:08, 12 May 2006 (UTC)

RE: "It emphasizes the body's own natural ability to heal itself and works to remove obstructions to this process, principally the chiropractic subluxation." It really doesn't make much sense to me. Concerns that come to mind:

1. What precisely does it mean to "emphasize the body's own natural ability to heal itself"? Perhaps the author of this comment meant "enhances the body's own natural ability to heal itself" or something else.
2. That chiropractic "works to remove obstructions to " is a claim , not a fact. Perhaps it attempts to remove those obstructions.
3. What adjective or verb is "principally" supposed to be modifying here?

-AED 04:12, 12 May 2006 (UTC)

AED, thanks. Maybe you can help me say it more clearly.

1. I wasn't trying to say that chiropractic "enhances" (as I felt that would be opinion at this point), rather that chiropractic's roots are vitalistic and they feel that "the body heals itself", thus chiropractic emphasizes this point - though I have no problem with using a different word, especially since it is used again in the next sentence.
2. attempts is better.
3. No, I see what your saying, the obstruction is "principally" the chiropractic subluxation. There can be other obstructions.--Dematt 12:41, 12 May 2006 (UTC)

{{totallydisputed}}

The article was flagged for disputed factual accuracy and neutrality. I read it, it does not seem too bad - a bit "he-said-she-said" in places, and could do with being about a third shorter, but it did not seem to me to be a horrible article and (wonder of wonders!) it actually cites sources. There are islands of POV in there, but I would not say it is pushing a barrow. Perhaps those who dispute the accuracy could identify the individual claims they find problematic? Or maybe tag them with {{fact}} so that they can be cited? I'll start:

• the citation for the increasing popularity of chiropractic, which contains insinuations of health benfits, is form the Department of Labor, which is not a recognised medical authority, and is in fact merely saying that if you go into chiropractic the income prospects are good. The same could be said for bank robbery...
• Stylistically, the history should be contiguous. At present it is split in two. I would say the history should go first, then the discussion of purported benefits and current state of evidence.

What other things need fixing? Just zis Guy you know? 22:59, 11 May 2006 (UTC)

'Evidence' for tension headaches should be in the lead

Since there is definitive evidence regarding tension headaches, then that should also be in the lead.

As for 'side-posture', it is too much detail for the lead. It can be placed somewhere in the article, just for the sake of brevity. Steth 03:27, 12 May 2006 (UTC)

Here is the reference: http://www.umm.edu/altmed/ConsConditions/HeadacheTensioncc.html Steth 03:32, 12 May 2006 (UTC)

First of all, that reference states: "Evidence supporting the use of tension headaches that originate in the neck is quite clear; however, studies examining the effectiveness of spinal manipulation for other types of tension headaches have been less conclusive." I don't think the article should mention the first part without mentioning the second part. Perhaps this information would be better suited elsewhere in the article rather than the lead. Secondly, it would be preferable to have the primary sources (i.e. the actual studies) of this information if possible. -AED 04:22, 12 May 2006 (UTC)

You are right, of course, AED. Here is the study: Duke Report Thanks Steth 11:22, 12 May 2006 (UTC)

That could also be in the science or intro sections as well.--Dematt 12:54, 12 May 2006 (UTC)

Good idea, Dematt! Please go ahead and add it and be sure to note that it is from Duke University for reference purposes. Thanks Steth 14:18, 12 May 2006 (UTC)

1.Isn't the most recent (2006) and comprehensive study best in the lead? It concluded "these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment."

2. I'd also agree with the other editors who suggest: "While there is no satisfactory evidence for claims for effectiveness made for many chiropractic procedures, there is evidence that one of the most used procedures -- side-posture lumbar manipulation -- is effective for lower back pain." But could I have a cite please for the claim?

3. I disagree that this should be included: "It emphasizes the bodies own natural ability to heal itself and works to remove obstructions to this process, principally the chiropractic subluxation." This does not represent the views of the whole profession.

4. I'd prefer to say in the lead that the profession includes those who believe in subluxation (90% ) and a significant minority, together with mainsteam medicine, who don't believe in it. Mccready 14:59, 12 May 2006 (UTC)

1. Tindle HA. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005 Jan-Feb;11(1):42-9.)
2. ^ National Center for Education Statistics, Integrated Postsecondary Education Data System, Retrieved online 8/15/2004 at Quoted here:
3. ^ Tindle HA. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005 Jan-Feb;11(1):42-9.
4. Bezold C (2005). The Future of Chiropractic Revisited: 2005 to 2015. Institute for Alternative Futures
5. "The Chiropractic Profession and Its Research and Education Programs",Final Report, pg 41, Florida State Univerisity, MGT of America, December 2000

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