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RfC: Effectiveness of chiropractic care

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

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

Criticisms of earlier proposed fix

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

  • Effectiveness of treatments should not be discussed in chiropractic; it should be discussed under each form of treatment. Most of the literature cited in #Scientific investigation 3 focuses on effectiveness of chiropractic treatment, not simply treatment by any practitioner. It is therefore inappropriate to move it to treatment pages per se. The few counterexamples are highly relevant to chiropractic; if there is a specific complaint about any of them, please mention it. To help underscore the relevance I have added a citation to Meeker & Haldeman 2002 about the relationship between chiropractic and research into SMT effectiveness.
  • Undue weight given to spinal manipulation. The weight given is appropriate: spinal manipulation is the core treatment modality of chiropractic, and is naturally heavily empahsized in reviews of the effectiveness of chiropractic care.
  • Clinical practice guidelines are omitted. They were present in the 1st draft, and were omitted from the 2nd draft in the interest of brevity. I have restored them in the 3rd draft.
  • Ernst is fringe. No, he's a mainstream researcher who gets cited a lot.
  • More sources are needed. None were suggested. I did turn up some more sources on my own, which are included in #Scientific investigation 3.

(Again, please place further comments below.)

Revised proposal for fix

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

(Again, please place further comments below.)

Scientific investigation 3

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

Effectiveness 3

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

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

Available evidence covers the following conditions:

  • Low back pain. Opinions differ on the efficacy of SMT for nonspecific or uncomplicated low back pain. An authoritative 2004 review found that SMT or mobilization is no more or less effective than other interventions. A 2008 review found strong evidence that SMT is similar in effect to medical care with exercise, and moderate evidence that SMT is similar to physical therapy and other forms of conventional care. A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain.
  • Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain. An authoritative 2004 review found that SMT/mobilization is effective only when combined with other interventions such as exercise. A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis. A 2007 review found that SMT and mobilization are effective for neck pain. A 2005 review found little investigative research into chiropractic manipulative therapy for acute neck pain.
  • Headache. An authoritative 2004 review found that SMT may be effective for migraine and tension headache, and SMT and neck exercises may be effective for cervicogenic headache. A 2006 review found no rigorous evidence supporting SMT or other manual therapies for tension headache. A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.
  • Other. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions. Other reviews have found no evidence of benefit for baby colic, bedwetting, fibromyalgia, or menstrual cramps.

(End of proposed replacement text.)

(Please place further comments below.)

Comments on Scientific investigation 3

(Please put comments here.)

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

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

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

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

Thank you Coppertwig, for coming back to weigh in on this edit! Please stick around as long as you can. I agree with your points. Spinal manipulation is fundamental and needs to be here in this article. Another objection often made is that studies of non-chiropractic manipulation are not relevant in considering effectiveness of SMT. Even Dr. Meeker, a prominent chiropractic researcher says that "research on spinal manipulation, like that of any other treatment method is equally of value regardless of the practitioner"(from #111, above)--—CynRN 16:24, 12 May 2008 (UTC)
While I do feel that this version is better than the previous versions, I am unsure about two things:
  1. That even though one researcher is saying it is okay to correlate general SMT studies with the effectiveness of chiropractic, our following this researcher's advice still may cause a WP:SYN violation. Even though we are spelling it out for the reader that these studies are about SMT and not chiropractic specifically, we are also implying (or rather now directly stating) that the conclusions of these general SMT studies can be applied to the effectiveness of chiropractic.
  2. DigitalC, CorticoSpinal, and several others have raised objections that Chiropractic is an occupation which employs many services and modalities and not any one specific modality. As such, the inclusion of the above material would be like the inclusion of an effectiveness section at the Dentistry article based on the effectiveness of Fluoride as administered by dentists, hygienists, the gov't via tap water, etc.
Levine2112 17:26, 12 May 2008 (UTC)
I hear the argument (re #2), but the fact is that SMT is the centerpiece of chiropractic. Is there much controversy about the effectiveness of a dentist removing caries from teeth? Is there a long, involved holistic philosophy connected with dentistry? Apples and oranges. There is controversy surrounding chiropractic, in part because of the whole subluxation paradigm. As long as the section explains again that chiropractors do a range of treatments besides SMT, the effectiveness of SMT really belongs here.There are plenty of studies, and reviews of same, regarding the effectiveness of SMT.--—CynRN 18:37, 12 May 2008 (UTC)
Actually, yes there is much controversy surrounding dental caries: Dental amalgam controversy. And holistic dentistry has been around for at least 30 years; specifically founded by the anti-mercury/amalgam movement. So you see, it's not apples to oranges after all. -- Levine2112 18:51, 12 May 2008 (UTC)
Of course, I figured you'd bring that up! How many holistic dentists are there as a percentage of all, vs 'holistic chiropractors'? Are there any non-holistic chiropractors? What is non-controversial, I would think, is 'treatment of dental decay'. Whether we choose composite fillings or amalgam is a different issue.--—CynRN 23:00, 12 May 2008 (UTC)
Holistic dentistry is quite different from Dentistry, just as Chiropractic is quite different from mainstream Medicine. If there were an article on Holistic dentistry (there isn't, yet), I'd expect it to cover effectiveness in some detail, as that's an important part of the controversy about holistic dentistry. Eubulides (talk) 07:35, 13 May 2008 (UTC)
"There are plenty of studies, and reviews of same, regarding the effectiveness of SMT". Agreed. There are pleny of sources discussing the effectiveness of SMT. However, SMT is not chiropractic, and the effectiveness of SMT belongs over at the SMT article. DigitalC (talk) 00:03, 13 May 2008 (UTC)
The cited sources in #Scientific investigation 3 are by and large not talking just about SMT. They are mostly talking about chiropractic care. Is there any particular source being objected to here? Eubulides (talk) 07:35, 13 May 2008 (UTC)
  • Re Levine2112's #1, it's not just "one researcher"; Meeker & Haldeman are two of the very top chiropractic researchers. For example, Haldeman is the editor in chief of PPC, the leading chiropractic textbook. These reliable sources say there's no significant distinction between chiropractic and non-chiropractic SMT. There doesn't seem to be any real controversy over this issue among reliable sources. It is not WP:SYN to report what these sources say. That being said, if there is a specific source being objected to on the grounds that it talks about SMT and not chiropractic SMT, which source is it and why? If this is just a matter of a few sources and how they're characterized perhaps we can come up with compromise wording that will address this concern.
  • Re Levine2112's #2:
More generally, the question is not whether #Scientific investigation 3 is perfect; it's not. The question is whether it's better than what's in Chiropractic now. It is. It's way better. It fixes serious POV problems, among other things. We should not let the relatively minor problems of the current proposal blind us to the fact that it's a real improvement and it therefore should go in. We can always improve it later. Eubulides (talk) 07:35, 13 May 2008 (UTC)
Well, I guess that's your opinion - that chiropractic is closer to Traditional Chinese medicine than it is to Dentistry. I don't share that opinion; not do I think that either of our personal opinions should dictate what kind of information we include in this article. -- Levine2112 16:15, 13 May 2008 (UTC)
  • All I meant was that chiropractic is neither fully mainstream (like dentistry) nor fully fringe science (like homeopathy). It has elements of both, as does traditional Chinese medicine. Even a cursory treatment of chiropractic needs to address the issue of whether it is effective, because this is a serious question as to commonly-practiced parts of chiropractic care. In this sense, chiropractic is more like traditional Chinese medicine than it is like dentistry.
  • One doesn't have to take my word for this. Just type "fringe chiropractic" into Google Scholar and you'll find lots of papers about chiropractic vis-a-vis fringe medicine. Type "fringe dentistry" and you'll find lots of papers about fringe benefits and fringe patterns, and precious little about fringe medicine. Or, please see Keating 1997, where it's explicitly stated that chiropractic uses scientific, antiscientific, and pseudoscientific rhetoric. One doesn't find similar articles about dentistry.
Eubulides (talk) 19:59, 13 May 2008 (UTC)

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

Actually, #Effectiveness 3 mentions laser, and supervised / customized exercise. It also mentions many other non-SMT treatments provided by chiropractors, including mobilization, assurance and advice to stay active, educational videos, acupuncture, and the entire clinical encounter of chiropractic care. It does not cover the other treatments you mention (ultrasound, IFC, orthotics, soft tissue therapy) because as far as I know the cited sources don't say anything definitive about those forms of treatment. If someone can dig up reliable sources for those treatment forms, that would be nice; in the meantime, the #Effectiveness 3 is much better than the effectiveness material that is in Chiropractic now. Eubulides (talk) 07:35, 13 May 2008 (UTC)
We should certainly think carefully about the WP:SYN issue raised by Levine2112. Note that the Meeker et al. (2007) study uses the word "chiropractic" as well as the phrase "spinal manipulation", so I see no SYN problem in citing it. For the other studies, I think it would be an improvement if we simply cited the studies, implying but not stating outright that SMT studies shed light on chiropractic effectiveness. I would delete the sentence "Research has focused on spinal manipulation therapy (SMT) rather than specifically on chiropractic SMT, but the distinction is not significant: chiropractors use all forms of SMT, more than 90% of SMT in the U.S. is done by chiropractors, and SMT research is equally of value regardless of practitioner type." I think this is good information for us to use here on the talk page while deciding whether the SMT studies can be used, but that including it in the article perhaps contributes to a SYN violation. If that sentence is deleted, the rest of the paragraph may need to be reorganized to flow smoothly.
Thanks, Eubulides, by the way, for your patience and diligence in coming up with yet another draft version.☺ Coppertwig (talk) 09:29, 13 May 2008 (UTC)
You're welcome. I removed that sentence from the draft in #Scientific investigation 3C. I agree that it's better to leave it out in future drafts as well; the citation was there only because of Levine2112's continuing concerns about generic SMT research versus research specifically on chiropractic care. Eubulides (talk) 20:55, 13 May 2008 (UTC)
I think that sentence was added to avoid any synthesis and to make it clearer to the reader. QuackGuru 09:36, 13 May 2008 (UTC)
I think that sentence is an attempt to justify the synthesis. Essentially, it may be the opinion of one researcheer (or one team of two researchers), but we can't then go ahead and apply it to the SMT research across the board. That is where the WP:SYN violation happens. That said, I maintain that we should remove all studies which are about SMT in general and do not make distinct conclusions about chiropractic specifically. These general SMT studies would be perfect for the spinal manipulation article. -- Levine2112 16:09, 13 May 2008 (UTC)
Spinal manipulation is inherent to chiropractic as its most commonly performed modality and we should not second-geuss the reviewers. QuackGuru 18:06, 13 May 2008 (UTC)

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

Researchers commonly apply regular SMT research and sources indicate there is no sigificant difference among the high quality studies. This version is a bit short and could use a slight expansion. QuackGuru 11:50, 14 May 2008 (UTC)
Here is what the scientific investigation (now renamed scientific research) section of the article was at the beginning of year. The current version includes newer peer-reviewed references and is very concise. QuackGuru 13:11, 14 May 2008 (UTC)

Proposal for fix 3C

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

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

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

Scientific investigation 3C

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

Effectiveness 3C

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

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

Available evidence covers the following conditions:

  • Low back pain. A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain. A 2008 critical review found that chiropractic SMT is possibly effective for back pain, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference.
  • Other musculoskeletal conditions. A 2005 review found little investigative research into chiropractic manipulative therapy for acute neck pain. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine).
  • Nonmusculoskeletal conditions. A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine. A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions. Other reviews have found no evidence of benefit for baby colic, bedwetting, or fibromyalgia.

(End of proposed replacement text.)

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

Comments on Scientific investigation 3C

(Please put comments here.)

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

This extremely short version runs afowl with NPOV. More importantly, the reader deserves to read a comprehensive version. A comprehensive version is more imformative for the reader. This lack of information version is not it. It is way to short and is below Misplaced Pages's standard. QuackGuru 11:45, 14 May 2008 (UTC)
Where does it run afowl with NPOV?DigitalC (talk) 23:43, 14 May 2008 (UTC)
I am happy with 3C.DigitalC (talk) 06:08, 15 May 2008 (UTC)
I'm guessing maybe QuackGuru means that by being too short, it's not giving due weight to effectiveness of SMT to reflect how much that's discussed in the sources. I apologize in advance if I got that wrong, QuackGuru. ☺ Coppertwig (talk) 02:57, 16 May 2008 (UTC)
I think this version gives far too much wait to this opinion: "A 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition." This comes from a major chiropractic critic often accused of bias and not necessarily a neutral researcher. As such it should be balanced or removed. That said, I am all for keeping this section brief if we have it at all. This is an article about Chiropractic and not about SMT. All of the details about every study ever conducted about SMT should be saved for spinal manipulation. -- Levine2112 03:10, 16 May 2008 (UTC)
A major chiropractic critic often accused of bias and not necessarily a neutral researcher? Please provide your evidence. Ernst is peer-reviewed and meets the inclusion criteria for this article. We should edit based on NPOV and exclude any personal opinion. Thus, we can include Ernst. QuackGuru 03:20, 16 May 2008 (UTC)
Yes, but this version gives his opinion far too much prominence. -- Levine2112 03:26, 16 May 2008 (UTC)
That's your opinion. Please provide evidence of any bias by Ernst. QuackGuru 03:33, 16 May 2008 (UTC)
Not even mainstream medicine listens to Ernst re: his views on the safety and effectiveness of spinal manipulation for back pain. His view is fringe. It can be proved. To repeat: Ernsts (MD) views on spinal manipulation is the FRINGE viewpoint within respect to mainstream medicine. It will be weighed as such. He is not an expert on SMT nor chiropractic, but is simply a vocal critic who is coming off as increasingly righteous and pig-headed despite the mounting evidence which negates his POV. CorticoSpinal (talk) 05:33, 16 May 2008 (UTC)
Ernst is not fringe. His works are often cited by his peers. I just now visited Google Scholar and typed the query "chiropractic Ernst". This returned about 2390 citations. In the first page, one source by Ernst (the 2001 desktop guide) was cited 280 times. Another by Ernst (the 2000 BBC survey) was cited 170 times. All of these numbers beat the query "chiropractic Haldeman" (1230 citations, top two sources on the 1st page cited 107 and 97 times). By this measure, or any other reasonably neutral measure, Ernst is one of the top current sources in the area. Eubulides (talk) 07:35, 19 May 2008 (UTC)
Citations does not necessarily translate into positive remarks on his work. It has also generated significant controversy and those same papers would have to cite his work in order to talk about it. Since it is the most vocal anti-SMT voice, both chiropractic researchers and healthcare researchers reference it as the most extreme, which I would assume would be considered the "fringe" of science.. but you know what assuming does. But, regardless, we can't just assume that citations translates into quality or mainstream. -- Dēmatt (chat) 11:51, 19 May 2008 (UTC)
I tested the theory that citations to Ernst are to cover the controversy by taking the most-cited work of Ernst mentioned above (the desktop guide), going to Google Scholar, finding which works cite it, looking at the first page of results, and reading each of the papers that cite it. I skipped the papers cowritten by Ernst himself for obvious reasons. None of the citations mentioned any controversy; they all simply cited Ernst as an authority. The papers I examined were Marty 2002 {{doi:10.1089/107555302317371523}}, Mason et al. 2002 (PMID 12376448), Bair et al. 2002 (PMID 12406817), Cohen & Eisenberg 2002 (PMID 11955028), and Cherkin et al. 2003 (PMID 12779300). These papers are all highly-cited (all have at least 45 citations). Of course this is just a spot-check, but it suggests that Ernst is not considered to be fringe by mainstream researchers. Eubulides (talk) 20:47, 19 May 2008 (UTC)
Evidence of bias by Ernst:
DigitalC (talk) 06:40, 20 May 2008 (UTC)
Yes, Ernst is strongly opposed by many in the chiropractic profession, and those citations illustrate this opposition. However, this does not undercut the claim that citations to Ernst by high-quality mainstream publications are, by and large, positive. Eubulides (talk) 07:20, 20 May 2008 (UTC)
Being opposed by many in the chiropractic profession doesn't have anything to do with research. Research doesn't oppose anything, it is what it is; it either supports or it doesn't. DigitalC's information does show that at least some of those 2390 citations are not positive, which, of course, was my point above. I would suggest that no-one has disagreed with Haldeman's research because he is a neurologist/chiropractor. Maybe that is why he has only half the citations :-) Anyway, I think this shows that Ernst is Ernst and we use his information just as we would Haldemans's or anyone else's. -- Dēmatt (chat) 13:23, 20 May 2008 (UTC)
Obviously some of the citations are negative. But my spot-check from Google Scholar suggests that most of them are positive. (It doesn't prove this, of course; it was only a spot-check.) And it is not true that nobody has disagreed with Haldeman; I can easily cite sources strongly criticizing Haldeman's work. I agree that we should cite Haldeman as well as Ernst; both are leading and reliable sources. Eubulides (talk) 22:16, 20 May 2008 (UTC)
If most of them are positive, then why is more weight being given to the negative ones in the version above? Featuring this - "chiropractic SMT has not been shown to be effective for any medical condition" - so prominently in the lead of this section seems to violate WP:WEIGHT - especially in the context given. I believe enough concern has been raised about Ernst's lack of objectivity, that giving his opinions so much weight seem unjust to the article. -- Levine2112 22:38, 20 May 2008 (UTC)
That quote is preceded by "Although a 2008 critical review found that with the possible exception of back pain" so it is not as strong as that out-of-context snipped would make it appear. Furthermore, the sentence containing quote also says "a 2008 supportive review found serious flaws in the critical approach, and found that SMT and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments" (citing Bronfort et al. 2008, PMID 18164469). This is a strong criticism that immediately undercuts Ernst's claims. If anything, this is being unfair to Ernst; it's not the sort of treatment that any other source is being given here. Given all this context, it's not out of line to let Ernst briefly have his say. Eubulides (talk) 02:16, 21 May 2008 (UTC)
A mischaracterization of what was posted above. In some of the papers there is no way to know what degrees/professions the authors have. For example, in the Bronfort et al. paper, we get these associated groups, but no degrees. (Chalmers Research Group, Evidence-based Practice Center, Departments of Pediatrics, Epidemiology and Community Medicine, University of Ottawa, 401 Smyth, Ottawa ON, K1H8L1, Canada; 4Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, The Netherlands; 5Texas Back Institute, 6300 W. Parker Road, Plano Texas 75093, USA; 6Department of General Practice and Nursing Home Medicine, LUMC Medical Centre, Leiden, The Netherlands). In addition, one of the Authors, Assendelft, is a prior co-author with Ernst, and an MD, NOT a Chiropractor. He's also writes cochrane reviews, so he probably knows how to assess evidence.DigitalC (talk) 07:56, 20 May 2008 (UTC)
It is not a mischaracterization. The Bronfort et al. paper has 10 authors, of which 5 have DCs (including Bronfort, the lead author) and 1 (Assendelft) has an MD. So it's strongly dominated by chiropractors. The other sources are even more strongly dominated by chiropractors. Ernst has cowritten more than a dozen Cochrane reviews so I daresay he knows how to assess evidence as well. What we have here is a difference of opinion among experts, a difference that should be reported fairly and neutrally; Ernst is not at all on the fringe here. Eubulides (talk) 09:17, 20 May 2008 (UTC)
It IS a misrepresentation of the sources to state as a summy that "Ernst is strongly opposed by many in the chiropractic profession", when the sources are not solely Chiropractors.DigitalC (talk) 11:20, 20 May 2008 (UTC)
It is not a misrepresentation. The sources given were:
  • A letter by a DC (Evans).
  • A paper with 5 DC and 1 MD coauthors, the lead being a DC (Bronfort et al.; 4 coauthors were neither DCs nor MDs)
  • A letter signed by 3 DCs and zero MDs (Hurwitz et al.).
  • A letter signed by 2 DCs and zero MDs (Morley et al.; 1 coauthor was neither DC nor MD).
  • An article about chiropractors lobbying against Ernst (Dynamic Chiropractic).
  • A position paper by the British Chiropractic Association.
  • A letter signed by 2 DCs and zero MDs (Breen et al.; 3 coauthors were neither DC nor MD).
It's true that there are some non-chiropractors there, but these sources are heavily dominated by chiropractors. They may represent the mainstream of opinion within chiropractic, but they do not represent mainstream opinion generally. They do not at all demonstrate that Ernst is a fringe researcher. Eubulides (talk) 22:16, 20 May 2008 (UTC)
I was responding to QG's request for evidence of claims of bias towards Ernst. That is what I provided.
Ernst's conclusions are fringe and so are his opinions on the subject. His work on SMT and Chiropractic care has been terrible. He's represents the extreme on one end; the WCA represents the fringe on the other end. Both views should be discarded because they are just that, extremist. Ernst has been used to 'bomb' CAM related articles with his 'reviews' which he essentially reviews himself. CorticoSpinal (talk) 12:50, 21 May 2008 (UTC)
We appreciate that's your belief, but just restating it isn't convincing. If an author is heavily cited then it's pretty clear that people are listening to him. Regardless of ones personal beliefs on his work that makes him a notable party. Jefffire (talk) 13:00, 21 May 2008 (UTC)

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

Once again Dematt comes up with the Solomonic solution - inclusion of all POV using good sources. I also agree with most of his comments. We are all biased, controversies occur, and those biases and controversies need to be documented here. We just need to do it properly. -- Fyslee / talk 14:38, 20 May 2008 (UTC)
That is the goal of #Scientific investigation 3. It includes both supportive and critical sources and cites them appropriately, with due weight given to all sides. Eubulides (talk) 22:16, 20 May 2008 (UTC)
Unfortunately it does not seem like your interpretation of Scientific Investigation 3 is shared by the majority of editors nor does it generally represent the conclusions of the scientific community (due to cherry picking of sources). CorticoSpinal (talk) 12:50, 21 May 2008 (UTC)
Looks quite sound to me. Could you give specific advice for how to improve it, rather than baseless sniping, thanks. Jefffire (talk) 13:00, 21 May 2008 (UTC)

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

The talk page is now archived automatically by a bot. Sections that haven't been changed for 14 days get archived. If you want the section back, you can resurrect it by hand from the archive. Eubulides (talk) 07:56, 31 May 2008 (UTC)
Effectiveness 3C has not been archived, it has been struckout struck out. As have comments of more than one editor in relation to it. DigitalC (talk) 07:58, 1 June 2008 (UTC)
Sorry, I misunderstood, and I don't know who struck it out or why or when. I assume the history could tell you? Eubulides (talk) 08:39, 2 June 2008 (UTC)
I assume the history COULD tell me, however the functionality of the history is subpar, IMHO, and it would take hours to try and sift through and find the diff. Since you drafted the section, and didn't strike it out yourself, and since CynRN didn't chime in to say she struckout her comment (which has since mysteriously been unstruck, as has QGs), I will unstrike the entire section.

Continued discussion of Scientific investigation 3C

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

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

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

It's true that evidence-based medicine is independent of philosophy. However, the point is that some chiropractors accept the principles of evidence-based medicine, and others don't. This is quite relevant to the subject of scientific investigation, because the entire philosophical basis of scientific investigation is questioned by a significant minority of chiropractors. For the purpose of this section, I agree "pseudoscience" isn't needed so I struck that instead. Eubulides (talk) 16:43, 21 May 2008 (UTC)
I'm not sure I'm buying that one, Eubilides. Let's put the groups scientific orientation in the sections that address their scope and leave this for the science - which doesn't care what race, creed, or color you are. -- Dēmatt (chat) 19:36, 21 May 2008 (UTC)
Other sections (notably Chiropractic#Philosophy already discuss this issue at some length. However, it's useful to put in a brief mention of the problem here. We can't expect every reader of this section to have read the whole article. Eubulides (talk) 20:13, 21 May 2008 (UTC)
Absence of adherence to EBM does not automatically imply pseudoscience. I wouldn't even go that far characterizing the straight wing. As on the Physical therapy page, a significant chunk of PTs don't use the evidence (thus far) but I would not call them pseudoscientific. Even the MDs who use outdated methods (antibiotics for sinus infections) for the last 40 years which was found to be of 0 benefit. I'm actually beginning to see some quality research designs by straight-leaning chiropractic schools in the US. I think they're getting it. Publish or perish (or lose market share to professions who will fill the gap). CorticoSpinal (talk) 18:06, 21 May 2008 (UTC)
The current 3C draft omits "pseudoscience", which should address the concerns mentioned here. Eubulides (talk) 20:13, 21 May 2008 (UTC)
because the entire philosophical basis of scientific investigation is questioned by a significant minority of chiropractors - Then what we would have to do is explain why, i.e. this is where Keating ref would come in with antiscience - it's not that they don't believe science or rational thinking, it is not trusting the scientist that is doing the research, i.e. drug companies performing the research on drugs, MDs evaluating chiropractic methods. It is more a distrust than a true antiscience. -- Dēmatt (chat) 18:29, 21 May 2008 (UTC)
It might be helpful to add a discussion of this point. However, the source (Keating 1997) does not address the trust issue, so we'd need a reliable source to justify the discussion. Eubulides (talk) 20:13, 21 May 2008 (UTC)

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

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

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

    • It does match the source. The source says "Nevertheless, there are different views concerning the efficacy of chiropractic treatment, which is not surprising. Unfortunately, it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts despite the millions of papers that have been written about presumably scientifically sound studies. Because of this difficulty, numerous medical procedures have not been rigorously proven to be effective either." The sentence in question is an abridged version of this quote. The stuff about "as of 2002" is obsolete and should not appear here. Also, in general it's not a good idea merely to quote the source; we should use the ideas and not degenerate into a list of quotes. Eubulides (talk) 16:43, 21 May 2008 (UTC)
      • While attempting to be constructive, Eubulides, the tone of your message to Dematt comes off rather condescending and paternalistic to a highly respected editor. I'm sure that was not the intent, but I had mentioned this concern before and hope you realize that Dematt's editorial skills are appreciated by both proponents and skeptics. CorticoSpinal (talk) 18:06, 21 May 2008 (UTC) I can tell he was smiling when he said that ;-) It's okay, really, down doggie, down :-)
I'm reading the Pubmed version and don't see your sentence there. The doi link is not working for me. -- Dēmatt (chat) 18:42, 21 May 2008 (UTC)
The source is copyrighted and only the abstract is freely readable. The above quote is from the "Efficacy and Patient Satisfaction" section of the source. Eubulides (talk) 20:13, 21 May 2008 (UTC)
Nevertheless, I think we can write it more neutrally and fit the source better if we say it this way:
  • Because it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts, most medical procedures have not been rigorously proven to be effective. Chiropractic fits this category as well.
-- Dēmatt (chat) 19:31, 21 May 2008 (UTC)
That's less neutral than the current summary, because the cited source does not say "most medical procedures"; it merely says "numerous". Also, I don't see how adding all that other verbiage makes the summary more neutral. What's not neutral about the much-shorter "Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective."? Eubulides (talk) 20:13, 21 May 2008 (UTC)
I merged the second sentence to make it shorter, but don't want to lose the qualifying section of the sentence that explains to our readers who have no idea what 'rigorously proven' means. They need something to compare it to. All the reader sees is, "chiropractic treatment has not been proven to be effective" and of course that is not NPOV. We have to qualify it and still keep it along the lines of what the author was intending to say (which in the abstract was actually positive towards chiropractic), otherwise we are creating and SYN error, or OR. The other option is number three, where we use the information from the abstract itself:
  • "Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective."?
  • "Because it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts; numerous medical procedures, including chiropractic care, have not been rigorously proven to be effective."
-- Dēmatt (chat) 20:50, 21 May 2008 (UTC)
It's not the case that 'All the reader sees is, "chiropractic treatment has not been proven to be effective"'. The reader also sees "Like many other medical procedures" at the start of the sentence. This places the claim in context. The wording also uses the word "rigorously" to make it clear that we're talking about proofs with a high degree of confidence. The quote from the source is wordy and the extra verbiage adds little; plus, we shouldn't just be stringing together quotes. I take it that the objection is that the summary does not mention the point that it's hard to establish definitive findings? Then how about rewording it to "It is hard to make definitive findings about much of medicine, and like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective." Eubulides (talk) 08:35, 22 May 2008 (UTC)

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

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

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

Thanks. But let's find a better home for it rather than just removing it. I unstruck it for now. Eubulides (talk) 16:43, 21 May 2008 (UTC)
I found one!, but you know that, it is below. I won't delete the other one until we're all happy with the new placement. -- Dēmatt (chat) 19:16, 21 May 2008 (UTC)


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

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

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

Again, I hope thatis the source that is not listed, or am I missing something with the doi ref? -- Dēmatt (chat) 19:19, 21 May 2008 (UTC)
Sorry, I don't follow. Many of the sources for Chiropractic are not free; Hawk et al. is one of them. That's life in the big research city, I'm afraid. All other things being equal we prefer free sources, but high-quality nonfree sources are fine when equal-quality free sources are not available. Eubulides (talk) 20:13, 21 May 2008 (UTC)


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

Okay, so much for the break, but I saw SC investigation 3 above and saw this sentence:
  • Research has focused on spinal manipulation therapy (SMT) rather than specifically on chiropractic SMT, but the distinction is not significant: chiropractors use all forms of SMT, more than 90% of SMT in the U.S. is done by chiropractors, and SMT research is equally of value regardless of practitioner type.
We could add the placebo reference here, like this:
  • Research has focused specifically on spinal manipulation therapy (SMT) rather than on the whole chiropractic visit and all that is involved in the patient encounter, some of which may be the result, as with all healthcare encounters, of the placebo effect, The distinction is not significant regarding who performs SMT for musculoskelatal conditions.
Still needs work, but you get the idea. -- Dēmatt (chat) 16:10, 21 May 2008 (UTC)
I don't see why we'd want to move the placebo sentence from the generic paragraph to the SMT paragraph. The placebo effect applies to all treatments, not just to SMT. Eubulides (talk) 16:43, 21 May 2008 (UTC)
If placebo applies equally to all Tx (which it does) why redundantly mention it? CorticoSpinal (talk) 18:06, 21 May 2008 (UTC)
I'm okay with putting it in the generic paragraph, I'll do it now to see what it looks like. -- Dēmatt (chat) 18:48, 21 May 2008 (UTC)
By "generic" I meant "generic to effectiveness", not "generic to all research". Safety studies generally don't use placebos. How about moving it back to where it was, which was in the generic-to-effectiveness paragraph? Eubulides (talk) 20:13, 21 May 2008 (UTC)

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

"Rigorously proven"

I agree with Dematt that the bit about "rigourously proven" is not a good abridgement of that source: it strikes me as implying much more strongly than the source does that chiropractic is unproven. I think a better abridgement of that source is the following direct quote from the source: "There are different views concerning the efficacy of chiropractic treatment." ☺ Coppertwig (talk) 00:10, 26 May 2008 (UTC)
And actually, I agree with Dematt that the quote about 30 of 43 studies is better. Eubulides, the quote you give from the source above does not actually state that the efficacy of chiropractic has not been rigorously proven. It leaves open the possibility, for example, that some people believe it to have been rigorously proven while others do not. Perhaps it implies that it has been rigorously proven and perhaps it does not, but it doesn't state it, so we shouldn't state it right out either based on that source. ☺ Coppertwig (talk) 01:31, 27 May 2008 (UTC)
  • Sorry, I don't know what you mean by "the quote about 30 of 43 studies"; there's no string "30 of 43" anywhere else on this talk page.
  • I don't see how to read the source in the way that you say. Nobody seriously argues that the efficacy of chiropractic care has been rigorously proven.
  • That quote is there because of a common theme in many sources that although chiropractic care has not been rigorously proven, in this respect it's in the same boat as many other forms of medical treatment. That's an important point, which should be made. All too often, chiropractic critics say "the science isn't there" without noting that the science isn't there for many other forms of medical treatment, too. Perhaps DeVocht is not the ideal source to make this point, but it will do until we find a better one.
  • We don't need DeVocht to support the claim that there are differing views of the subject; that claim is already stated elsewhere in the section, and is well-supported already (by better sources than DeVocht).
Eubulides (talk) 08:08, 27 May 2008 (UTC)
Thanks for your reply, Eubulides. Sorry I wasn't clearer. By "30 of 43" I meant "As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective." However, as you point out, this would leave out the point about comparing with the situation with medical treatments.
I dispute whether the source supports the claim that "chiropractic treatment has not been rigorously proven to be effective". You said this was an abridgement of a paragraph you quoted above. I don't see how to read that paragraph the way you do. One possibility might be changing the footnote to a source which clearly makes this claim, if one can be found.
May I suggest another alternative wording: "It is difficult to establish conclusive findings regarding either chiropractic treatment or numerous medical procedures." Would you agree that that's a reasonable abridgement of the paragraph quoted?
I'll assume what you say is true, that "nobody seriously argues that the efficacy of chiropractic care has been rigorously proven." However, based only on this, it would be Original Research for Misplaced Pages to state that the efficacy of chiropractic care has not been rigorously proven. To state that, we would need a source which claims that the efficacy of chiropractic care has not been rigorously proven. Regards, ☺ Coppertwig (talk) 00:29, 2 June 2008 (UTC)
  • That "30 of 43" comment is not worth mentioning here. Chiropractic#Effectiveness already cites far more-systematic (and more recent) reviews talking about SMT for low back pain, reviews that (like DeVocht) are favorable to chiropractic (e.g., Bronfort et al. 2008, PMID 18164469; or Meeker et al. 2007, no PMID), and DeVocht's opinion piece isn't close to being in their league. DeVocht is a reasonable source for supporting the argument that chiropractic care is like many other forms of medical treatment in that it hasn't been rigorously proven, but this is true mainly because the more-reliable sources don't address the point.
  • I don't see how the proposed alternate wording solves the (to my mind hypothetical) problem. DeVocht nowhere says in one brief quote that it is difficult to establish conclusive findings regarding "chiropractic treatment". The proposed alternate wording relies on the fact that DeVocht is obviously including chiropractic treatment as being part of "much of the healing arts". But if there is some reluctance to say what DeVocht is obviously saying (namely that chiropractic care, like many other medical treatments, is hard to test and has not been rigorously proven), then this (to my mind hypothetical) objection applies with equal force to the proposed alternate wording. In that case, why change the wording to something that is longer and more confusing?
Eubulides (talk) 08:39, 2 June 2008 (UTC)
Thank you for your reply, Eubulides.
Perhaps I see a distinction that you don't – in which case it should perhaps be easy to find wording we can both agree on.
The paragraph quoted from the source implies that chiropractic care has not been rigorously proven to be effective. However, as I see it, it does not state that. I believe the author deliberately refrained from stating that, because it would be a statement which would be hard to prove and which could go out-of-date if new studies are published. Regardless of the reason why it doesn't state it, since (IMO) it doesn't, we shouldn't (IMO) state it either.
To my mind, the source also leaves open the possible alternative interpretations of "Numerous chiropractic treatments, like numerous medical procedures, have not been rigorously proven to be effective" or, along with the previous sentence, "Much of chiropractic is difficult to prove effective ... numerous medical procedures have not been proven effective either." If I understand what you're saying, Eubulides, you mean that it's not completely clear whether all of chiropractic is intended to be included in "much of the healing arts".
To me, there is an important distinction between "it is difficult to establish conclusive findings," which implies but does not state that there is no rigorous proof, and "has not been rigorously proven," which states it outright and is a very strong, probably impossible-to-prove and therefore perhaps unscientific statement when applied to all of chiropractic care as opposed to being applied to an unspecified and therefore flexible set of medical procedures. A scientist can state that they have not seen proof of something and we can all conclude from that that there probably isn't proof, since the scientist probably keeps up with the literature; but a scientist is less likely to state confidently that no proof exists anywhere.
Just making a sentence a little longer and more confusing is a minor problem, to my mind, in comparison to the importance of adhering to WP:V and avoiding stating something which is not (IMO) stated in the source (as represented in that paragraph), and which you seem to be saying is not stated in the other, more reliable, sources either. However, the first three of the suggested alternative wordings below are shorter and arguably simpler than the current wording:
  • "Like many other medical procedures, chiropractic treatment is difficult to test." (short and simple.)
  • "As with numerous medical procedures, the effectiveness of chiropractic treatment is difficult to test."
  • "Like many other medical procedures, chiropractic treatment is difficult to rigorously prove effective."
  • "There are difficulties in trying to rigorously prove effectiveness for many health care treatments, including chiropractic treatment as well as numerous medical procedures."
  • "Numerous medical procedures have not been rigorously proven effective; this is also true of chiropractic treatments." (deliberately ambiguous – perhaps we shouldn't do that, though)
  • "Numerous medical procedures and chiropractic treatments have not been rigorously proven to be effective." (also deliberately ambiguous: does "numerous" apply to "chiropractic treatments"?)
Regards, ☺ Coppertwig (talk) 19:42, 3 June 2008 (UTC)

(outdent)

  • "Has not been rigorously proven," is a scientific statement and is quite common in scientific papers. Here are some examples of its use in high-quality scientific sources:
  • "Hyperglycemia has a key role in oxidative stress in diabetic nerve, whereas the contribution of other factors, such as endoneurial hypoxia, transition metal imbalance, and hyperlipidemia, has not been rigorously proven." (Obrosova 2002, PMID 12198815)
  • "The accuracy of the definition of the bottom of the nerve fiber ayer measurement has not been rigorously proven." (Jaffe & Caprioli 2004, PMID 14700659)
  • "Although it has been frequently proposed that AICD is a signalling molecule similar to the Notch intracellular domain, this has not been rigorously proven." (De Strooper 2007, PMID 17268505)
  • The source in question (DeVocht 2006, PMID 16523145) is two years old. It's fairly high level; I don't think it's much more out-of-date now than it was when it was published.
  • The source talks about "chiropractic treatment", not "chiropractic treatments". That is, it is not talking about particular treatments, but about chiropractic treatment as a whole.
  • The previous paragraph in the source says this about chronic headache: "Although not rigorously documented in large-scale, well-designed randomized control trials, as of 2001, there had been at least nine trials of various degrees of quality and size involving 683 patients with chronic headaches with reported clinical improvement." The source is saying that the literature on the effectiveness of chiropractic treatment (here, for chronic headache) has not rigorously documented effectiveness. This is what builds up to the "has not been rigorously proven" (for all chiropractic treatment) in the next paragraph.
  • How about this rewrite? It's derived by combining the 2nd and 5th of your proposals, along with changing the word "test" to the source's word "establish":
"As with many other medical procedures, the effectiveness of chiropractic treatment is difficult to establish and has not been rigorously proven."

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

I acknowledge that some scientific articles state that some things are not rigorously proven. However, in this discussion we don't have any article that states (IMO) that the effectiveness of chiropractic treatment in general has not been rigorously proven. It says something about rigorous documentation with regard to treatment of headaches in particular; and it says it in an "although" clause. If we need to reach down into "although" clauses of less-reliable sources, maybe the statement is getting undue weight. I oppose the sentence you propose, which states that the effectiveness of chiropractic treatment has not been rigorously proven. I suggest: "As with many other medical procedures, the effectiveness of chiropractic treatment is difficult to establish." Or, how about saying something more similar to what the source says: "The effectiveness of chiropractic treatment is difficult to establish; many medical procedures also lack rigorous proof of effectiveness." (I posted the preceding at 22:28, 3 June 2008. ☺ Coppertwig (talk) 00:33, 4 June 2008 (UTC))
  • These two suggested paraphrases suffer from the same issue (which I still don't see as being an important one) as the paraphase that is currently in Chiropractic. Neither suggested paraphrase logically follows from what the source formally states (even though they are both obvious paraphrases of what the source is saying). For example, both paraphrases say "The effectiveness of chiropractic treatment is difficult to establish", which is obviously supported by the source; but this is not a logical implication of what the source formally says. If the problem is that an obvious paraphase uses deduction that is formally unwarranted, then what makes these paraphrases acceptable but the paraphrase in Chiropractic unacceptable?
  • Let's put it a different way. The source says "numerous medical procedures have not been rigorously proven to be effective either". The only plausible way I can see to interpret that either is as follows: although chiropractic treatment has not been proven to be effective, numerous medical procedures have not been rigorously proven to be effective either. Is there any other plausible way to interpret that either? If not, then Chiropractic's current paraphrase is fine, no?
Eubulides (talk) 07:24, 4 June 2008 (UTC)
Good point, Eubulides, about my suggestions also being mere paraphrases. One answer to that is: if you see them as equally bad but I see the current sentence as worse, then why not just go with one of my suggestions? Another answer is: the paraphrases I suggest seem to me to be innocuous paraphrases, while the statement that there is no rigorous proof of effectiveness is a very strong statement which would require very careful sourcing.
Yes, I see plausible alternative interpretations of the "either" statement in the source. The best one seems to me to be this: "Opinions differ about the effectiveness of chiropractic treatment. Many people believe that the effectiveness of chiropractic treatment has not been rigorously proven; however, the effectiveness of many medical procedures has not been rigorously proven, either."
I suggest the following, which I think follows the source more closely: "As with some medical procedures, many of which also lack rigorous proof of efficacy, opinions differ as to the efficacy of chiropractic treatment." ☺ Coppertwig (talk) 10:06, 10 June 2008 (UTC)
I see your point, and your suggestion has merit, but it also has problems that mean it's a bit worse than what is in there now.
  • Most important, the source says "opinions differ" first, and then follows up with lack of rigorous proof as being a problem in settling the difference of opinion. But the suggested wording puts it the other way: it says there is a lack of rigorous proof, and therefore that opinions differ about efficacy, with the implication that this is the same as many other medical arts. But that is not what the source is saying. The source is saying that opinions about chiropractic treatment differ for whatever reason (philosophy, or turf-war, or whatever), and the difficulty of finding solid evidence hinders us from resolving the dispute.
  • I don't follow your interpretation of the word "either" in the source. The source does not say or imply that "Many people believe that the effectiveness of chiropractic treatment has not been rigorously proven". It says flatly "numerous medical procedures have not been rigorously proven to be effective" (followed by the word "either", which means chiropractic treatment is in the same boat). There is no implication that there's serious doubt about this flat claim. The "different views" the source mentions are different views about whether the treatment is efficacious (where there is not a consensus among experts), not about whether the the treatment's effectiveness has been rigorously proved (where the consensus is clear: it hasn't been rigorously proved).
  • The source talks about "much in the healing arts" and "numerous medical procedures", which clashes with the suggestion's "some medical procedures".
  • The source says "rigorously proven to be effective", which clashes slightly with the suggestion's "rigorous proof of efficacy". Effectiveness is not the same as efficacy, though they are related.
  • Given the continuing conflict we're having here, perhaps the simplest thing is to remove the sentence in question from Chiropractic. That's too bad, as I think it's important to mention that chiropractic treatment is in the same boat as many other medical procedures with respect to evidence. I'm confident DeVocht is making this point, but if the consensus is that he's not, then let's just remove the sentence entirely (until and unless we find some other source that is making the point).
Eubulides (talk) 19:43, 10 June 2008 (UTC)
I think this version addresses all of the points you raise above: "Opinions differ as to the effectiveness of chiropractic treatment; many medical procedures also lack rigorous proof of effectiveness." I thought you had said that several sources had made the point that medical procedures are in the same boat; I also think it's important to include this point. However, I'd rather just remove the sentence than leave it as is.
The source doesn't say that many people believe that effectiveness of chiropractic treatment has not been rigourously proven. It also doesn't say that everybody believes that. It just doesn't say explicitly anything about it. The word "either" is obviously alluding to something unstated: it could as easily be the unstated thing I suggest as the unstated thing currently in this article. I think the author refrained from stating that the effectiveness of chiropractic treatment has not been rigourously proven in order to avoid being challenged by people who believe that it has been, as well as to cover himself in case proof of effectiveness was just being published around the same time as that paper or would be published within a few years. ☺ Coppertwig (talk) 22:35, 10 June 2008 (UTC)
The source does not say that many people believe or disbelieve anything about rigor. It just says that many medical procedures haven't been rigorously proven (there's nothing about belief in that statement). I disagree that the "either" could just as easily cause us to interpret DeVocht as saying merely "Many people believe that the effectiveness of chiropractic treatment has not been rigorously proven"; he is saying that the effectiveness has not been rigorously proven, period. However, all that being said, the latest wording you proposed is adequate so I put it in after replacing an "effectiveness" with an "efficacy" (to match the source better) and adding an "other" (to avoid making the implication that chiropractic treatments are somehow not medical). Eubulides (talk) 23:25, 10 June 2008 (UTC)
That sentence that was just put in is still not worthy. The cited source doesn't back it's inclusion. It won't pass WP:SYN. This is what the source says. You can pick out the part that we have chosen to use:
  • "Although by far most chiropractic treatment is given for back pain, it seems able to affect a broader range of conditions as shown in the following few examples. Second to back pain, chiropractors probably are best known for treatment of chronic headaches. Although not rigorously documented in large-scale, well-designed randomized control trials, as of 2001, there had been at least nine trials of various degrees of quality and size involving 683 patients with chronic headaches with reported clinical improvement.2 In one study, subjects with chronic mechanical neck pain syndromes receiving spinal manipulation had an average increase in pressure pain threshold of 45% whereas a control group showed no change.48 There is some indication that chiropractic treatment may be helpful for some cases of temporomandibular disorders based on positive case reports 13,19,38 and the improvement of all nine patients in a small prospective case series.11 The edge light pupil cycle time, a reflex of the eye that is mediated through the autonomic nervous system, is influenced by high-velocity manipulation to the upper cervical spine.18 Mechanical stimulation of the spine of rats has an effect on blood pressure, heart rate, and the activity of sympathetic nerves.39 Some chiropractors report having successful treatment of otitis media such as in a case report by Saunders 40 that also includes reviews of a retrospective study of 46 children,16 a pilot study of 22 children,41 and two case series of five and 322 children.14,17
Nevertheless, there are different views concerning the efficacy of chiropractic treatment, which is not surprising. Unfortunately, it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts despite the millions of papers that have been written about presumably scientifically sound studies. Because of this difficulty, numerous medical procedures have not been rigorously proven to be effective either.24,44 Expert opinions vary on virtually every aspect of health care...."
IOWs, the author prefaces his statement about "rigorously proven" with a long diatribe about the research that supports chiropractic and then argues that people still don't believe it. So he states the obvious 'that it is difficult to establish definitive, unarguable, and conclusive findings for "anything"'. And nothing in medicine is rigorously proven because of this. His point is that we have to loosen up and realize that there is value there. If we don't represent this sentence in this fashion, then we are misrepresenting the author's intention. We are using the sentence to represent chiropractic treatment negatively, which is not the intention of the author. It would be like us saying that Ernst says "chiropractic care adds quality of life". -- Dēmatt (chat) 02:32, 11 June 2008 (UTC)
  • It would be quite reasonable to quote Ernst on the strengths of chiropractic. Indeed, #Cost-effectiveness 2 cites Ernst to support the claim "A 2006 UK systematic cost-effectiveness review found that the reported cost-effectiveness of chiropractic manipulation compares favorably with other treatments for back pain...".
  • More generally, it's a good thing, not a bad thing, to quote chiropractic critics on strengths of chiropractic, and to quote chiropractic supporters on weaknesses. A strength that is admitted even by critics is quite well supported, and conversely by weaknesses admitted even by supporters.
  • Research that supports chiropractic is already summarized in Chiropractic at length, supported by more-recent and far more-reliable sources than DeVocht. There is no point saying again here (simply because DeVocht says so) that research support exists for chiropractic treatment. The only reason to cite DeVocht here is because he makes the valid and important point (which the more-recent and far more-reliable sources do not) that it's hard to rigorously prove large chunks of medicine.
Eubulides (talk) 17:58, 11 June 2008 (UTC)
Thank you very much for making that change, Eubulides. I really appreciate it and think it's a big improvement. That paragraph now no longer seems to me to be a WP:V violation.
I agree with Eubulides that, when feasible, quoting critics on the strengths and supporters on the weaknesses is a good way to ensure that we're reporting solid facts.
In response to Dematt's point: I now notice that the first paragraph of "effectiveness" all seems rather negative: Since the first paragraph should serve as an introduction to the whole section, I think the paragraph could be improved by adding a few words meaning that there is in fact some evidence supporting the effectiveness of chiropractic treatment. For example, adding "Chiropractic treatment seems able to affect a broader range of conditions than back pain", based on the paragraph quoted by Dematt above. I'm trying to figure out where this could fit into the paragraph smoothly: I suggest putting it just before the last sentence, and joining it to the last sentence by inserting "but".☺ Coppertwig (talk) 23:42, 13 June 2008 (UTC)
  • Its 1st sentence is neutral: "The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment."
  • Its 2nd sentence defends chiropractic: "Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness."
  • Its 3rd sentence is both negative (it says chiropractic benefits from the placebo response) and positive (it defends chiropractic by saying all medical treatment does). Here's the sentence: "Chiropractic care, like all medical treatment, benefits from the placebo response."
  • Its 4th sentence states something negative about our knowledge, not about chiropractic: "The efficacy of maintenance care in chiropractic is unknown."
The proposed text "Chiropractic treatment seems able to affect a broader range of conditions than back pain" is not a good idea. That text is controversial and comes from a source (DeVocht 2006, PMID 16523145) that was partisan by design. That source was one side of a debate between two chiropractors: the other side of the debate was Homola 2006 (PMID 16446588). The two articles were published adjacently in the same volume of Clinical orthopaedics and related research. Both sides of this debate were chiropractors (so this was not a debate that covered the mainstream spectrum), but DeVocht was more pro-chiropractic than Homola was. In his debate piece, DeVocht does not attempt to be balanced. For example, his above-quoted discussion of chronic headache, otitis media (middle ear infection), and temporomandibular disorders gives only pro-chiropractic sources (and dated sources to boot) and does not at all reflect mainstream consensus. Eubulides (talk) 09:23, 14 June 2008 (UTC)
Again, Homola is not a Chiropractor, and has not been since 2000. To state that a 2006 debate between Homola and DeVocht was between two chiropractors is not true. DigitalC (talk) 05:25, 24 June 2008 (UTC)

(<<<outdent) In response to Eubulides' comment, I withdraw my proposal to add "Chiropractic treatment seems able to affect a broader range of conditions than back pain". ☺ Coppertwig (talk) 14:40, 14 June 2008 (UTC)

Improved version RfC

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

The majority of these edits were contentious, still being discussed on this page, and still lack consensus. Accordingly, I have reverted. There were some decent housekeeping edits in the mix, but the bad outweighed the good in my opinion. -- Levine2112 17:45, 14 May 2008 (UTC)
I would not have made these edits at this time. That being said, the discussion in #Comments on Scientific investigation 3 seems to have petered out, with questions remaining for the dissenting editors but no replies from them recently. The edits that were already discussed are a big improvement over what was in Chiropractic. Surely they can be further improved, and we can discuss that here. Many edits were not previously discussed, though, and they are more problematic; please see #Several important changes were never discussed below for more about them. Eubulides (talk) 23:44, 14 May 2008 (UTC)
It has been discussed on this talk page previously that any contentious edits should be discussed on the page before being implented. In addition, rather than grouping large housekeeping edits and reference formatting with contentious edits, it is better to make a larger number of smaller changes.DigitalC (talk) 23:53, 14 May 2008 (UTC)
We are not bound by what has happened on this page in the past (see e.g. WP:BOLD, WP:IAR). The question is whether the edits were good. There is consensus that they are. ScienceApologist (talk) 19:34, 19 May 2008 (UTC)
  • It is true that we are not bound; still, standard practice, as noted at the top of this talk page, is to discuss controversial changes before making them, which was (alas) not done here.
  • Even if there was consensus that the big edit improved the article overall, that would not imply that consensus for each part of the big edit. None of the commenters backing the consensus have commented on detailed criticisms of the previously-undiscussed parts of the big edit. (These criticisms were not available to the commenters, precisely because the big edit was sprung on the regular editors without discussion.) So there is no real evidence for consensus for the previously-undiscussed parts of the big edit that have been criticized after the big edit was made.
Eubulides (talk) 20:47, 19 May 2008 (UTC)
  • Agree with ScienceApologist: Surveying these changes, they appear to be quite reasonable and backed by reliable sources. I agree with SA that these changes constitute an excellent start at reform of this page, which is sorely needed to create something encyclopedic that conforms to WP:NPOV.--Filll (talk) 18:04, 14 May 2008 (UTC)
  • I think it's better, more NPOV. I'm not sure that adding back practice styles is worthwhile (this article is way long already!) and I believe it's hard to pigeon-hole any individual chiropractor, but I approve of most changes, esp. re. Manga and worker's comp studies.--—CynRN 19:07, 14 May 2008 (UTC)
  • I will take a look at the edits one by one and add the ones that haven't been disputed; I'll then come back here and summarize what's remaining. Eubulides (talk) 19:32, 14 May 2008 (UTC)
  • After I wrote the above comment, someone else added all the edits. So now I'm looking at them one by one and plan to take out the ones with the most problems. (If someone else doesn't revert again first.…). So far I've found mostly just citation problems, but I haven't got to the controversial stuff yet. Eubulides (talk) 20:13, 14 May 2008 (UTC)
  • I found a serious problem with the edits: many of them have never been discussed on this page, even though they are potentially controversial. For now I have reverted them; please see Several important changes were never discussed]] below. Eubulides (talk) 23:44, 14 May 2008 (UTC)
  • I agree that the changes meet NPOV, are well sourced and helps the article to be able to go forward. My comment is from an outside opinion who watches the article and the talk page. --CrohnieGal 19:39, 14 May 2008 (UTC)
  • There is growing consensus for the recent changes that are being discussed in this RFC. However, a couple of edits deleted some information that was part of the recent changes discussed in this RFC. Any minor tweaks can be made in mainspace. QuackGuru 01:07, 15 May 2008 (UTC)
  • I've restored the content under discussion. It appears fairly well-sourced. It deserves to be discussed rather than removed on a whim without properly addressing the quality of the references and their use. Let's all follow WP:TALK and WP:CON here. Thanks. --Ronz (talk) 01:42, 15 May 2008 (UTC)
There are serious problems with many parts of the edit. This should have been discussed before insertion, as per consensus above that any contentious edit would be previewed on the talk page before being taken to mainspace.DigitalC (talk) 04:16, 15 May 2008 (UTC)
I do not see any serious problems. I see a very thoughtfully written improved version. My recent edits were discussed in this RFC. Please respect the external advise. QuackGuru 04:38, 15 May 2008 (UTC)
There is broad consensus among external observers in this new RFC discussing the recent changes I made. These edits went against the advise from external third-party input of this RFC. QuackGuru 04:38, 15 May 2008 (UTC)
That edit had two parts. First, it installed the changes proposed in #Scientific investigation 3 and discussed extensively earlier. Second, as mentioned below, that edit installed several changes that were never discussed before installation. None of the external observers have commented specifically on the second (previously-undiscussed) class of changes. It is not clear that they approve of the previously-undiscussed changes. It is not even clear that the observers even noticed the previously-undiscussed changes. I didn't notice them without doing a line-by-line analysis of the edit, which took quite some time. Eubulides (talk) 06:09, 15 May 2008 (UTC)
The external observers are commenting at this RFC about this recent change. QuackGuru 06:25, 15 May 2008 (UTC)
The discussion here has been fruitful in this RFC for this recent change but this edit went against established third-party consensus. QuackGuru 06:39, 15 May 2008 (UTC)
I will follow up at #Several important changes were never discussed below. Eubulides (talk) 06:48, 15 May 2008 (UTC)

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

There was growing consensus for the recent changes but it appeared a certain editor attempted to flout consensus by edit warring. QuackGuru 22:19, 19 May 2008 (UTC)
Or rather that certain editor was flouting the lack of consensus despite another certain editor touting that there was one. -- Levine2112 22:32, 20 May 2008 (UTC)
Martin, do you believe that the agreement seen by so many outside reviewers of the RfC that the content is good is not enough to establish that the content should be added? ScienceApologist (talk) 19:34, 19 May 2008 (UTC)
  • Concerned Comment The biggest problem I have with this version is that it is being billed as a consensus from the community, but they have not shared in the conversation or the work that has been put in to improve upon the very version they are looking at. There is more work to do, but if you call this a consensus version, it will be virtually impossible to make any more edits - even minor ones - as a particularly eccentric editor will likely take it as his duty to defend the "consensus view from outside editors". So while I can work with anything, nobody can work with the constant reversions to "the RfC version that many outside members have agreed to". So, unless you really like this version, I would rather you suggest that we continue to work together in the manner that WP was meant to work - where anyone can edit anytime and collaboration is the preferred method to accomplish consensus. Let the ones that are working this article decide what the 'best version' is. -- Dēmatt (chat) 00:58, 20 May 2008 (UTC)

Objective straights and reforms

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

I don't think the article needs the material about reform and objective straights, maybe not even in history. I don't think it's very notable.--—CynRN 21:20, 14 May 2008 (UTC)
I'm not sure that removing the material was altogether appropriate. I agree that the issue may be one of historical relevance rather than modern day relevance, but I found the material to be informative, interesting, and well-sourced. ScienceApologist (talk) 22:09, 14 May 2008 (UTC)
I don't feel strongly either way. The subject of the reform group especially got discussed ad nauseum on the talk pages a few months ago with no real consensus. History would be the place if it is to be included.--—CynRN 22:16, 14 May 2008 (UTC)
OK, for now I moved it to Chiropractic #History. Eubulides (talk) 22:25, 14 May 2008 (UTC)
I prefer the information under Internal conflicts be put at the end of the Schools of thought and practice styles section. QuackGuru 01:07, 15 May 2008 (UTC)
The internal conflicts section is relevant to the schools of thought and practice styles section. The internal conflicts has discussion about the varying thoughts, practices, and beliefs. QuackGuru 08:12, 15 May 2008 (UTC)
Sure, but almost everything in Chiropractic #History is relevant to some other section, and could be moved there. The point is that Chiropractic, by and large, is a discussion of chiropractic as it is today. Stuff that's no longer relevant should be put in Chiropractic #History to avoid cluttering up the rest of the sections with material that used to be true but is no longer true. That's how other historical material is treated, and this particular historical material should be no exception. Eubulides (talk) 02:06, May 15, 2008 (UTC)
I fear that statement reveals a misunderstanding (at least on this point) of Misplaced Pages. While I agree that purely historical and dated events (IOW no longer, unquestionably, and impossibly current in any manner) should be placed in the history section IF our sources also do so, this happens to be a different matter. Misplaced Pages articles should NOT limit themselves to the present picture of the subject. It would take alot of OR to achieve this with some things about chiropractic, since many DCs in practice TODAY believe, think, and act as described by what you term "historical" or what CorticoSpinal terms "progressive". Chiropractic today is a very broad spectrum of beliefs and practices, and we shouldn't limit mention of something we believe (or wish) is purely historical to the history section, since it is ALL current practice and belief many places. Ultra straight subluxationism and anti-subluxationism are all very current within the profession. They are all part of "progressive" chiropractic, depending upon one's own personal POV. The struggle for domination is far from over.
There is also a straw man at work here, which you (Eubulides) many not be aware of. Straw men can effectively be used to shoot down unpopular ideas. When this section was first written and later being developed further, the strawman of existence or nonexistence of groups and organizations was constantly being brought up as if it was an issue to this section. It is NOT an issue in this section. This section is about "schools of thought and practice styles". Let me illustrate. Luther is long since dead, but his "school of thought" still exists and is present in Protestantism, and we mention him, his thoughts, and the work of various protestant groups and denominations. Just so here. Even if the only organization that has been officially reform (the NACM) were to cease to exist (it happens to live a quiet existence, as always), it's school of thought is expressed by many chiropractors whose utterances reveal that they share "reform" thoughts and their practices as well. In this context it is OR to engage in speculations about the existence of an organization which is so unlike ordinary organizations that it has usually been relatively quiet and whose membership has been relatively secret. That question is totally irrelevant to this section.
What we need to focus on is: (1) Did that school of thought exist and (2) was it officially the position of one organization? Yes. Unquestionably. (3) Does that school of thought still exist? Unquestionably. That's all we need to know to include mention of the organization, its school of thought, and its role in the profession, past and present. In fact, a substantial portion of the proof of its influence and notability has been provided by its opposition. Notoriety is a pretty powerful form of notability which Misplaced Pages recognizes. If you want the strongest proof of something, get its enemies to provide it. The testimony of friends can't always be trusted, but the opposition of enemies can certainly be used as evidence. FYI, chiropractors wouldn't have access to VA hospitals today if it hadn't been for the influence of the representative of the NACM on the work committee where access was granted. That's a pretty powerful influence exerted by one little, minority, relatively secret, organization that has been very notably and vocally opposed by the whole profession. Although that representative was initially attacked quite viciously, that representative was actually thanked later for his role. Ultra straight organizations had actually opposed the idea. -- Fyslee / talk 04:38, 22 May 2008 (UTC)
Luther is dead, but the Lutheran church is very much alive: I can still call up the Lutheran church and someone will answer the phone. This is not the case for the NACM, by all reports. Let me take that analogy and run with it: Lutheranism only briefly mentions Pietism (in Lutheranism#See also), and this is appropriate. Pietism was formerly a very active branch of Lutheranism, but it's now dead as an organized group: you can't call any Pietist churches on the phone (the Pietists have an indisputable effect on current teachings of some Lutherans, but they're no longer active). In contrast, Lutheranism does mention the differences between reformism and confessionalism, an important and active distinction among Lutherans: one can currently call up the reformists and someone will answer the phone, and likewise for the confessionalists, and it's entirely appropriate to cover that as a current issue.
In that sense, I don't see any reliable evidence cited showing that reformers are still active. Their work may have influenced current thought (just as Pietists influenced current Lutheran thought), but outside the History section Chiropractic should cover current thought, not the historical influences. Eubulides (talk) 08:35, 22 May 2008 (UTC)
You're missing the point, which is that it doesn't make any difference if the organization is active or not. The school of thought and practice style (anti-subluxation) is very much alive. Those who express such views are reform chiropractors. -- Fyslee / talk 14:16, 22 May 2008 (UTC)
I agree with this. -- Dēmatt (chat) 13:10, 23 May 2008 (UTC)
If we can find reliable sources showing that anti-subluxation is very much alive now, then I agree that should be included in the school-of-thought section. But it should be called "anti-subluxation", not "reform", no? Eubulides (talk) 16:58, 22 May 2008 (UTC)
It's not anti-subluxation per se, but pro-mainstreaming (which means they think chiropractors must drop their garb). -- Dēmatt (chat) 13:12, 23 May 2008 (UTC)
OMG is "garb" not just the perfect word for it! We should write for living! -- Dēmatt (chat) 13:16, 23 May 2008 (UTC)


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

Effectiveness and Cost-benefit sections

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

There's an RfC currently in the works. Most of the people commenting seem to think that the edits including these bits were good. You are free to explain exactly what your objections are, but I don't think removal at this time is appropriate. ScienceApologist (talk) 22:10, 14 May 2008 (UTC)
The RfC was about effectiveness, not about cost-benefit. The cost-benefit section was added without any discussion, which is not a good idea for a controversial article like this. Also, the effectiveness section that was added was not the effectiveness section that was proposed. For now, I reverted to what was proposed and copied the undiscussed stuff to the next subsection. Eubulides (talk) 23:44, 14 May 2008 (UTC)
The new RFC was linked to the recent edits. I see growing consensus to include the information from the comments in the new RFC. QuackGuru 01:07, 15 May 2008 (UTC)
Calling a consensus again when there is no such consensus?DigitalC (talk) 04:18, 15 May 2008 (UTC)
There is broad consensus among external observers in the new RFC which is to be respected. QuackGuru 04:26, 15 May 2008 (UTC)
Again, I disagree that the external observers have a consensus about (or even noticed) the previously-undiscussed changes in that edit. Eubulides (talk) 06:09, 15 May 2008 (UTC)

Several important changes were never discussed

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

  • The following text was added to the discussion of the British Medical Association:
'In 1997, the BMA has identified chiropractic health care that can be regarded as "discrete clinical disciplines" because it has "established foundations of training and have the potential for greatest use alongside orthodox medical care."'
  • The new Cost-benefit section was never discussed. I enclose it below, for further discussion. Please put comments in #Comments on Cost-benefit 1 below.

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

The RFC was about all of my recent edits. QuackGuru 01:07, 15 May 2008 (UTC)
The external observers commented about the overall edit, most of which had been discussed earlier. There's no evidence that the observers noticed, much less approved of, the changes that were slipped into that edit without any previous discussion. The only comments they made were about the changes that had been discussed earlier. It is contrary to common practice on this page to install major, potentially-controversial changes without any discussion on the talk page. Please discuss these changes in the relevant sections of this talk page, now that the sections have been created. Eubulides (talk) 06:48, 15 May 2008 (UTC)
The external observers were commenting on this recent change. We have discussion from third-party input. Uninvolved Wikipedians did discuss my recent change in the new RFC. QuackGuru 07:08, 15 May 2008 (UTC)
Most of what you are calling "my recent change" consisted of material that had been previously discussed. The uninvolved Wikipedians commented on the entire edit, and could easily have been fooled (by the way earlier discussion occurred) into thinking that the edit was installing what had been discussed. None of the comments by the uninvolved Wikipedians indicate that they read, understood, or agreed with the not-previously-discussed part of the change. It is poor practice to take a proposed edit which has had a lot of discussion, to make unannounced and important changes to it, and to install the changed edit without bothering to notify people that the edit involves undiscussed changes. I cannot emphasize this enough. Major changes need to be discussed first, before installing them; that is the standard procedure on this page, and it's standard procedure for good reason. Eubulides (talk) 09:15, 15 May 2008 (UTC)
There is absolutely NO indication that any of the RfC respondents were fooled. This is pure obstructionism. I will assume good faith and simply ask you to abide by the new consensus that the additions are good and needed in the article. There is no policy or guideline that says someone has to discuss first. One can discuss after the changes are made. That is being done here. The current consensus is to keep the changes. Please also stop making up rules for editing. Your cooperation is appreciated. Thanks. ScienceApologist (talk) 14:39, 15 May 2008 (UTC)
  • There is no evidence that the RfC respondents read or understood the not-previously-discussed changes. None of the RfC respondents have responded to the substance of the subsequent criticism of the not-previously-discussed changes; this appears in many sections on the talk page, including #Comments on Cost-benefit 1, #Sorry to stop by in the middle of a POV war, and #Objective straights and reforms.
  • So it is not true that "the current consensus is to keep the changes"; there may have been a consensus at the point the previously-undiscussed changes were made, but now that problems have been pointed out with those changes, the consensus, if there was one, is no longer present.
  • Your revert to an old state ignored discussion that occurred after the "new consensus" (see, for example, #Sorry to stop by in the middle of a POV war). This discussion resulted in several improvements in wording in citation to the material, improvements that have not been disputed, and thus your revert lost this useful information. Please do not ignore later discussion, and please do not blindly revert and inadvertently remove later improvements.
Eubulides (talk) 16:14, 15 May 2008 (UTC)
  • One other thing: I am not "making up rules for editing". The top of this talk page says "This is a controversial topic that may be under dispute. Please read this page and discuss substantial changes here before making them." This is a good rule, and should in general be followed. It was not followed for the previously-undiscussed changes. It is bad procedure to install changes into a controversial article without discussing them first. Eubulides (talk) 16:17, 15 May 2008 (UTC)
One thing is for sure, there is clearly no consensus to add these edits. It is truly a mystery why these editors are claiming that there is a consensus when so many editors disagree with these edits. -- Levine2112 19:32, 15 May 2008 (UTC)
Consensus is established above. ScienceApologist (talk) 17:11, 18 May 2008 (UTC)
I don't think so, SA. The question of validity still has not been addressed; i.e. why are Eubulides et QuackGuru trying to push an WP:SYN of SMT and pass it off as effectiveness of chiropractic. What is the effectiveness of medicine, dentistry and maybe more appropriately, physical therapy? If you can provide a sound rationale that would be helpful. CorticoSpinal (talk) 19:21, 18 May 2008 (UTC)
You are confused about what consensus is. Please read up on Misplaced Pages policies and guidelines. ScienceApologist (talk) 19:25, 19 May 2008 (UTC)
  • Concerned Comment The biggest problem I have with this version is that it is being billed as a consensus from the community, but they have not shared in the conversation or the work that has been put in to improve upon the very version they are looking at. There is more work to do, but if you call this a consensus version, it will be virtually impossible to make any more edits - even minor ones - as a particularly eccentric editor will likely take it as his duty to defend the "consensus view from outside editors". So while I can work with anything, nobody can work with the constant reversions to "the RfC version that many outside members have agreed to". So, unless you really like that version, I would rather you suggest that we continue to work together in the manner that WP was meant to work - where anyone can edit anytime and collaboration is the preferred method to accomplish consensus. Let the ones that are working this article decide what the 'best version' is. -- Dēmatt (chat) 00:58, 20 May 2008 (UTC)

Cost-benefit 1

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

Comments on Cost-benefit 1

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

  • First comment is that any SM should be changed to SMT. I changed the first thinking it was a typo. This is going to run into similar problems as effectiveness, where the sources are talking about the cost-effectiveness of SMT, not the cost-effectiveness of chiropractic.DigitalC (talk) 00:02, 15 May 2008 (UTC)
  • If There is no evidence that SM is superior to other treatment options available for patients with low back pain.is to be included, it should be changed to There is no evidence that SMT is either superior or inferior to other treatment options available for patients with low back pain. In accordance with the following quote from the conclusion of the article "Neither did we find evidence that these therapies are superior to spinal manipulative therapy.". However, this source is not EVEN on cost effectiveness of SMT, it is on effectiveness of SMT, and as such should not be in this section.
  • after an initial therapy. is grammatically incorrect. After initial therapy, or after an intiial treatment would be grammatically correct.
  • When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SM. Again, this falls into the trap of assuming that this is Cost-benefit of SMT, and not Cost-benefit of Chiropractic. Chiropractors use physiotherapeutic exercise as a treatment.
  • The small risk associated with manipulation of the cervical spine could be avoided with the use of nonthrust passive mobilization movements. This one is a POV statement, and I will have to search for a source the backs that it is POV. From my understanding the risk is the same for any grade of mobilization. DigitalC (talk) 00:49, 15 May 2008 (UTC)
Actually, the research suggests that manipulation and mobilization carry the same risk. In fact, the same risk as performing a cervical range of motion exam. So not only is it POV, it's not accurate. Is there a reference for it? -- Dēmatt (chat) 03:43, 15 May 2008 (UTC)
Yes, it is referenced, but I agree with you that research suggests that any movement of the cervical spine carries the same risk.DigitalC (talk) 04:10, 15 May 2008 (UTC)

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

I feel there are severe limitation still in this version although there is undoubtedly some good to it too. We can work with this and make it much better and more relevant, however. The validity some of the information presented here is highly suspect and there are major omissions still. For example, scientific research into chiropractic has been done by chiropractors, believe it or not, since the 1920's. I thought we are supposed to be discussing scientific investigation of chiropractic care, not SMT. They're not the same. What about the NIH study? That was a landmark one in 1976. The New Zealand study in 1979? The Meade study, the Rand study, etc? These are all SPECIFIC to CHIROPRACTIC CARE. Just because they're old doesn't mean that their invalid. The Crick and Watson paper (1955) after all, is holding up well. Also, there has been some pretty bad cherry picking that is either a violation of WP:POINT or WP:COATRACK. If our allopathic editors want to play that game, we can have a tit for tat war with inserting trivial facts that present the OTHER POV. For example, the addition of the "Canadian DCs don't know how to research" is a bit over the top. This study was done in the province of ALBERTA representing less than 15% of Cdn DCs most of whom graduated when the EBM era hadn't arrived. There are more examples, but I must go back to work. Too bad these edits had been railroaded in, and supported blindly by the usual suspects. Also, Fill -- your comment was in poor taste. If you think the Citizendium article with it's lead (with a direct quote taken from 1966) applies here, you're not up with the times. Also, the medical community here is editing against the evidence which I find distressing. Lastly, Ernst is being used throughout this article to negate, trump or override the sound opinion of EXPERTS in SMT and EFFECTIVE and CHIROPRACTIC CARE. This practice must stop. CorticoSpinal (talk) 16:58, 15 May 2008 (UTC)
  • The current version emphasizes scientific investigation of chiropractic care. This inevitably means heavy coverage of SMT, since SMT is a core component of that care.
  • If an old study is truly landmark it can be expected to affect current reviews. If not, then we shouldn't be mentioning it ourselves. We should rely on expert opinion as to what is important and what is not. We should not be making those calls ourselves, when the expert opinion is already available.
  • No, and SmithBlue told you this already. If the purpose of the review is not congruent with the given topic, the review is not valid and should not be used. DCs would consider Manga to be landmark, MDs not so much. So we are to rely on MD reviews? CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)
  • SmithBlue's argument, while valid, is not a get-out-of-jail-free card that will let an editor ignore a review whenever they please. It requires a good reason that the review is not congruent with the given topic. No reason has been advanced for any of the reviews cited in Chiropractic, so in no case has there been any justification for ignoring expert reviews and reaching down into the reviewed sources. Eubulides (talk) 07:35, 19 May 2008 (UTC)
  • I agree that reaching down and inserting trivial facts from primary studies is not the way to go. If that exists in Chiropractic now, we should fix it.
  • The "Canadian DCs" stuff has been removed (for now; until someone reverts it again, I suppose). That stuff is contentious and was not discussed before inserting. I agree that it is potentially controversial and deserves careful review first.
  • Many (most?) cites to Ernst are not to things that override expert chiropractors. The exceptions are marked as such (e.g., "a critical review"). At least, that's the intent; if there are problems in this area then let's please discuss fixes.
19:18, 15 May 2008 (UTC)
  • Ernst is pushed on every single CAM article and although his opinion is certainly notable (that's NEVER been debated) the weight, tone and influence of his words, especially in chiropractic has been a huge problem since he was pushed onto the scene in Feb 08. Mainstream doesn't even agree with his views on SMT, this is illustrated with the American College of Physicians recommending SMT for LBP whereas Ernst still says its "dangerous" with "no proven beyond a resonable doubt" and "adds costs". Essentially, all his statements are in direct conflict with bulk the mainstream literature. His star is fading as he continues his witch hunt and if he's reading this I think he's a massive douche bag and the quality of his papers re: chiropractic care are by far the most biased, unbalanced, unobjective and misleading ones out there. He should take a cue from Kaptchuk (1998) who can raise concerns but present both sides. CorticoSpinal (talk) 22:18, 16 May 2008 (UTC)
  • There is certainly a difference of opinion in mainstream medicine about the effectiveness of SMT. The American College of Physicians does not "recommend" SMT for LBP; it lists it as a "likely effective" therapy, along with massage therapy, acupuncture, willow bark extract, and devil's claw. There is substantial disagreement among low back pain guidelines, with some of them agreeing more with Ernst and some agreeing more with chiropractors (see Murphy et al. 2006, PMID 16949948). It is highly misleading to cite just one group in this area and to pretend that it is the final word, and Chiropractic should fairly represent all sides, including both the skeptics and the proponents of chiropractic. Eubulides (talk) 07:35, 19 May 2008 (UTC)

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

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

As above, yes you have a source for it. However, it is POV, in that other sources state that the risk is the same for manipulation, mobilzation, range of motion examination, and shoulder-checking while driving.DigitalC (talk) 05:15, 15 May 2008 (UTC)
Please provide a list of other sources. QuackGuru 05:21, 15 May 2008 (UTC)
Please see Anderson-Peacock E, Blouin JS, Bryans R; et al. (2005). "Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash" (PDF). J Can Chiropr Assoc. 49 (3): 158–209. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
 • we deem that where it is the mere movement of neck tissues that causes a risk factor to be an absolute contraindication to an HVLA thrust, manipulation that is not HVLA or mobilization are equally contraindicated by this factor, see also Rome P.L. “Perspectives: An Overview of Comparative Considerations of Cerebrovascular Accidents”, Chiropractic Journal of Australia 1999; 29(3): 87-102, as well as Terrett A.G. Current Concepts in Vertebrobasilar Complications following Spinal Manipulation. Des Moines, Iowa: National Chiropractic Mutual Insurance Company, 2001. DigitalC (talk) 05:38, 15 May 2008 (UTC)
The word however was added to a sentence. I do not see any reason for this. QuackGuru 07:52, 15 May 2008 (UTC)
"However" is a connecting adverb meaning "nevertheless, in spite of that, etc". "However" used correctly in a sentence will suggest that that sentence disagrees in sense somewhat with the preceeding sentence(s). In this case, it was used to tie two sentences together to improve flow, so that it wasn't so choppy.DigitalC (talk) 00:39, 19 May 2008 (UTC)

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

  • It's much improved from #Cost-benefit 0, but still needs quite a bit of work.
  • It refers directly to many primary studies. It should focus instead on what recent reviews say, e.g., van der Roer et al. 2005 (PMID 15949783), Canter et al. 2006 (PMID 17173105), Cherkin et al. 2003 (PMID 12779300). Primary sources should be used only with good reason (e.g., if they're too new to be reviewed and are obviously important). Eubulides (talk) 09:00, 15 May 2008 (UTC)
  • Isn't Assendelft et al. 2003 (PMID 12779297) superseded by Assendelft et al. 2004 (PMID 14973958). Why cite the obsolescent source?
  • Let's stay away sources older than 5 years old. They're too dated. If a subject hasn't been reviewed in the past 5 years, then it's probably not worth summarizing here.
This makes no sense. Historically chiropractic care has been shown to be cost effective, why ignore the data? There's a reason why DCs SPECIFICALLY have been invited to participate in integrative models of care. Result? Less costs again. CorticoSpinal (talk) 17:03, 15 May 2008 (UTC)
Again, there is no intent to ignore old data. If old data is still important, it should appear in a recent review. If it doesn't appear, that's good evidence that it wasn't that important after all, at least according to published expert reviewers. Eubulides (talk) 19:18, 15 May 2008 (UTC)
Again, you are missing the point regarding the validity of some of the reviews. Let me paraphrase, again, what SmithBlue and myself have been telling you for quite some time now: if the purpose of the review is not congruent with the topic at hand, then it is not valid. There are severe logical flaws in your reasoning and you've used the same excuse for 4 months to keep out extremely reliable and valid "primary" studies that are far more valid and academically robust than some of the reviews supported by yourself. A refusal to include studies which meets WP:RS, WP:V and are from indexed peer-reviewed journals will forever prevent from making this article NPOV. CorticoSpinal (talk) 23:18, 16 May 2008 (UTC)
No argument has been put forth that the reviews in question are incongruent with the topic at hand. On the contrary, the reviews are quite congruent with the topic of effectiveness. There is no good reason to disregard reliable reviews and to substitute our own opinion about the the reviewed studies. Eubulides (talk) 07:35, 19 May 2008 (UTC)
  • The text flows poorly. Contradictory sentences are run together without any explanation. The text needs to tell a consistent story and hang together; currently it doesn't do that well at all.

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

And yet, attempts to make it flow better are met with objection.DigitalC (talk) 00:02, 16 May 2008 (UTC)
I have updated the cost-benefit section. It flows very well now. QuackGuru 15:43, 23 May 2008 (UTC)

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

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

Comments of Cost-effectiveness 2a

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

This draft relies on primary studies when it should rely on reliable reviews. For cost-effectiveness we have enough high-quality reviews that there's no need to reach down into primary studies ourselves. Chiropractic's current cost-benefit section is bad enough, but at least it cites some reviews relatively fairly; this proposed 2a replacement is far worse in that regard. Eubulides (talk) 07:35, 19 May 2008 (UTC)
Well, it certainly appears thorough. I'll have to check the sources as Eubilides suggests, but it's a start. BTW, I haven't quite found my way around this talk page, so if there is something that is no longer of any use, how about archiving it so I don't strike up another conversation about something that is already settled. -- Dēmatt (chat) 19:41, 20 May 2008 (UTC)
  • It's the "appears thorough" that worries me. By citing primary sources in addition to the secondary reviews, it's making the evidence appear stronger than it is, or it is arguing with the reviews (I don't know which, as I haven't had time to read all that stuff). Either way, it should be fixed, preferably by dropping citations to the primary sources (I don't see why they're needed, but again I haven't read the sources yet).
  • Currently we're relying on auto-archiving; the page is getting a tad big to navigate through (or archive) by hand.
Eubulides (talk) 22:16, 20 May 2008 (UTC)
So, you haven't investigated the sources but object to them? Stop trying to omit valid studies that aren't covered by reviews. Geez, how many times in 4 months can you use the same argument, over and over again with many different editors disagreeing with the way you interpret MEDRS? CorticoSpinal (talk) 18:28, 21 May 2008 (UTC)
Has anybody actually read the sources? So far, I see no evidence that anybody has. As far as I can tell, this cost-effectiveness draft was generated by someone who read only the abstracts. Someone (and it will probably be me, sigh) will have to actually read the sources. I am skeptical that there will be any need to cite the primary sources, because I expect that review will cover the material in question. Eubulides (talk) 20:13, 21 May 2008 (UTC)
I've read the sources used in the draft. The claims are supported by the literature. Many of the papers are interdisciplinary collaboration, between DCs and MDs. So, a lot of bias goes out the window there. If we can find reviews that addresses all the points made above then obviously we can choose a review, however I doubt that one review will cover all the specific points. Tertiary sources such as governmental studies could be used as well. CorticoSpinal (talk) 23:23, 21 May 2008 (UTC)

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

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

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

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

Your concerns of bias do not ring true. It is YOUR source, a secondary source nonetheless that has been demonstrated to be very biased and have severe design flaws. None of the primary studies cited have this deficiency. In other words, the review that is currently included is not valid and has been refuted but it being given a free ride despite the fact it's been rebutted. It's not a quality paper. You should resist the temptation of citing crap reviews that conform to your personal POV and goes against mainstream consensus. Yes, that's correct, Ernst's conclusions on SMT and chiropractic care goes against mainstream consensus. Which makes his opinion fringe. And his studies are flawed, so now we are citing flawed, fringe material as fact with 0 qualifiers. Is this the kind of "NPOVing" you want to bring to the article? CorticoSpinal (talk) 23:43, 26 May 2008 (UTC)
Misplaced Pages is not the place to conduct research reviews on our own, overriding reviews already published by experts in the field. Multiple reviews are cited in Chiropractic #Cost-benefit; they are not all by Ernst. Other reliable review sources are welcome, as per the usual WP:MEDRS guidelines. Reaching down into primary studies is dubious; Chiropractic #Cost-benefit already does way too much of this (and this should be fixed). Rewriting it to remove all mention of reviews, which is what is being proposed here, would be a step that is way, way in the wrong direction. Eubulides (talk) 08:08, 27 May 2008 (UTC)

Integration: Sources

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

Requests for comment on Education, licensing, and regulation improvements

Education, licensing, and regulation 7

Chiropractors obtain a first professional degree in the field of chiropractic medicine. The U.S. and Canada require a minimum 90 semester hours of undergraduate education as a prerequisite for chiropractic school, and at least 4200 instructional hours (or the equivalent) of full‐time chiropractic education for matriculation through an accredited chiropractic program. The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.

The WHO guidelines suggest that health professionals with advanced clinical degrees can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours. In both cases (4200/2200 hours) this includes a minimum of 1000 hours of supervised clinical training. Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction. Depending on the location, continuing education may be required to renew these licenses.

In the U.S., chiropractic schools are accredited through the Council on Chiropractic Education (CCE). CCEs in the U.S., Australia, Canada and Europe have joined to form CCE-International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally. Today, there are 18 accredited Doctor of Chiropractic programs in the USA, 2 in Canada, and 4 in Europe. All but one of the chiropractic colleges in the U.S. are privately funded, but in several other countries they are in government-sponsored universities and colleges. Chiropractic education in the U.S. is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution.

Regulatory colleges and chiropractic boards in the U.S., Canada, and Australia are responsible for protecting the public standards of practice, disciplinary issues, quality assurance and maintenance of competency. There are an estimated 53,000 chiropractors in the U.S., 6500 in Canada, 2500 in Australia, and 1,500 in the UK.

Comments on Education, licensing, and regulation 7

I started this thread. Please do not comment above of my comments. Interleaving comments can be confusing. There are other drafts. For example, there is draft 3: Talk:Chiropractic#Education.2C_Licensing.2C_Regulation_3. I consider draft 3 to be obsolete and irrelevant now. QuackGuru 18:29, 8 June 2008 (UTC)

I have made some important improvements with this draft. All of the unnecessary references should be deleted. If an editor thinks any ref is unnecessary then please consider removing it. QuackGuru 21:55, 3 June 2008 (UTC)

I am of the opinion that this version is slightly better than the other 6 above. Are there any dissenting opinions? ScienceApologist (talk) 23:21, 3 June 2008 (UTC)

My eyes continue to glaze over when reading this stuff. In some ways, 7 is better than 3 (it fixes some obvious bugs in the wording). In some ways it's worse. We should combine the virtues of both. In the spirit of doing that, here are some comments on 7 that would help improve it so that it's better than 3.
  • The usual style is "U.S.", no? 7 sometimes says "US", sometimes "USA". It should be consistent.
  • "prerequisite before applying to a chiropractic school" → "prerequisite for chiropractic school"
  • "no less than a 4200 student/teacher contact hours" → "at least 4200 student/teacher contact hours"
  • "in four years of full‐time education during school" → "of full‐time education" (the extra details aren't needed)
  • "Internationally, to help standardize and ensure quality of chiropractic education, in 2005 the" Remove.
  • "The WHO voluntary guidelines" → "The WHO guidelines" Guidelines are voluntary; no need to say it twice.
  • "suggest for health professionals" → "suggest that health professionals"
  • ", such as medical doctors," Remove; not needed.
  • "that includes a minimum of 1000 hours of supervised clinical training". This 1000-hour requirement also applies to the 4200 number. It sounds odd to see it mentioned only with the 2200 number. The simplest fix would be to remove this phrase. A better fix would be to reword it to make it clear that the 1000 applies to both the 4200 and the 2200 number.
  • "Upon finishing chiropractic education" → "Upon graduation"
  • "Depending on the location (state or province)" → "Depending on the location"
  • "(CE)" Remove; not used.
  • "with the stated purpose of insuring the quality of chiropractic education" Remove this advertising fluff. We should say what the organizations do and not repeat their promotional material.
  • "CCE standards has accrediting bodies worldwide." This sentence is not clear. CCE is U.S., right?
  • "These councils have developed CCE - International in an effort to maintain chiropractic education standards globally." Here, 3 is much better than 7 as it is more specific about CCE-I's goals and actions. Use 3's wording: "The CCE-USA has joined with CCEs in Australia, Canada, and Europe forming CCE - International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally."
  • "All but one of the chiropractic colleges in the US are privately funded, but in several other countries they are in government-sponsored universities and colleges. Today, there are 18 accredited Doctor of Chiropractic programs in the USA, 2 in Canada, and 4 in Europe." Reverse the order of these two sentences.
  • "The Federation of Chiropractic Licensing Boards (FCLB) is a member list of most regulatory bodies." This sentence is not clear. Perhaps remove it?
  • "There are an estimated 53,000 - 70,000 chiropractors in the USA, 6000 in Canada, 2500 in Australia, 1,500 in the UK, and about 90,000 internationally." Don't use the 70,000 estimate; it's older and from a less-reliable source. The 2006 number for Canada was 6526; use the source in draft 3 for this. I don't see anywhere in the source http://www.ccea.com.au/images/PDF/Migration/Attachment%20E%20-%20Recognised%20Quals.pdf where there's an estimate of 2500 in Australia; remove that source and remove the "2500". The 90,000 estimate is dubious and should be removed; it relies an an estimate of 65,000 in the U.S. which is worrisomely higher than the more-reliable BLS estimate.
Hope this helps. Sure wish we could get this section out the door; the continuing "dueling drafts" is worrisome. Eubulides (talk) 07:24, 4 June 2008 (UTC)
Thanks for the input Eubulides. Hopefully we can hammer out a version for education within the next week. DigitalC (talk) 03:02, 5 June 2008 (UTC)

Again, one of the big differences I see between Education 3 and Education 7 is the treatment of the WHO guidelines. On that basis alone, I have to say that Education 3 is better. DigitalC (talk) 03:02, 5 June 2008 (UTC)

There were comments inserted above my comments which was rude. QuackGuru 18:29, 8 June 2008 (UTC)
I am sorry that you considered it rude QuackGuru, however opening an RfC on draft #7 without mentioning that there are other drafts under consideration that outside editors might not be aware of (ie - responding to the RfC) was disruptive, and I was attempting to fix the situation. I do not see how it could be considered confusing in this instance, and you have been warned before about altering others comments. Now that you have mentioned that there are other drafts, I don't mind my comment being moved. However, although you may consider draft 3 to be "obselete and irrelevant now", that does not make it so. DigitalC (talk) 01:11, 10 June 2008 (UTC)
Is there any specific objections to draft #7. I think this is the only draft worthy of mainspace. QuackGuru 01:37, 11 June 2008 (UTC)
  • The way that "In the U.S., Chiropractic education is divided into straight or mixer (progressive) educational curriculums depending on the philosophy of the institution." is included flows poorly. The paragraph talks about regulatation, the number of chiropractors, and then this non sequiter.
  • Not enough detail is given to the WHO guidelines on education. Draft 3 is much better in this respect. DigitalC (talk) 03:12, 11 June 2008 (UTC)
The way that the straight or mixer (progressive) educational curriculums is included flows great. Please provide a specific suggestion on how to improve the flow if you disagree.
Too much detail is given to the WHO guidelines on education in draft #3. The long end run of WHO quotes are suggestions and not official world standards. Draft #7 fixes the problems with the WHO quotes. QuackGuru 06:31, 11 June 2008 (UTC)
  • My specific suggestion would be to remove it entirely. It definitely does not flow great, as it is not related to the number or chiropractors worldwide, nor to regulation.
  • Please stop with the strawman argument that they "are not official world standards". No one is claiming that they are standards. They are however official WHO guidelines. I have pointed this out previously, and this appears to be a case of WP:IDIDNTHEARTHAT. DigitalC (talk) 06:52, 11 June 2008 (UTC)
The WHO guidelines are merely suggestions and not world standards. The suggestions should not be given so much weight as in draft #3 because they are not official standards and the quote are boring. Draft #7 fixed the WHO problem quotes. The educational curriculums is about education and thus related to Education, licensing, and regulation section. QuackGuru 07:06, 11 June 2008 (UTC)
Another occurence of WP:IDIDNTHEARTHAT. No one is claiming that the WHO guidelines are 'world standards'. Please stop with this strawman argument, it is disruptive and tendentious editing. DigitalC (talk) 00:22, 13 June 2008 (UTC)

For those of us who have not been following the debate between drafts 3 and 7 (and I admit that I am one of them: let's face it, this stuff is really boring), can someone please briefly summarize the differences between them and why these differences matter? Eubulides (talk) 17:58, 11 June 2008 (UTC)

ScienceApologistwrote in part above: I am of the opinion that this version is slightly better than the other 6 above.
Eubulides wrote in part above: In the spirit of doing that, here are some comments on 7 that would help improve it so that it's better than 3.
Draft 7 is clearly better than draft 3. Draft 7 fixes the WHO problem quotes, draft 7 is fully referenced, and draft 7 has the educational curriculums. QuackGuru 16:46, 12 June 2008 (UTC)
The last I saw, Levine, me, and DigitalC agreed with 3 and Eubilides had issues with both 3 and 7 if his issues were fixed. Did you address those fixes in Eubilides' list above? Maybe if we put both versions here we can compare them again one to one. There might still be some tweaks we can do to both. -- Dēmatt (chat) 17:01, 12 June 2008 (UTC)
Levine2112 never saw the finished versions of draft 3 or 7. Eubilides had objections with draft 3 that were never fixed such as the WHO quotes. Draft 7 is NPOV while draft 3 has the WP:WEIGHT problems with the WHO quotes. Draft 7 is fully referenced while draft 3 has a lack of references. QuackGuru 17:08, 12 June 2008 (UTC)
I agree that draft 7 in some ways is better than draft 3, and would like to see these improvements merged into Chiropractic. But I'm afraid I haven't yet seen a concrete proposal as to how to do this. QuackGuru, how about if you propose specific changes to what's in Chiropractic now? This could be in the form of a bullet list. It's helpful if each change is isolated in the list. Obviously it's easy to generate a diff listing between the two drafts, and I'm not asking for that; I'm asking for a brief description of each particular change to Chiropractic and why it's needed. Eubulides (talk) 17:18, 12 June 2008 (UTC)
  • The long WHO quotes should be removed from draft 3.
  • Draft 3 is not fully referenced like draft 7.
  • Draft 7 has more info on the chiropractic numbers worldwide.
  • Draft 7 includes educational curriculums.
  • Draft 7 explains: "In both cases (4200/2200 hours) this includes a minimum of 1000 hours of supervised clinical training."
  • Draft 7 uses the same U.S. style.
  • Draft 7 has already merged parts of draft 3 into draft 7 such as "The CCE-USA has joined with CCEs in Australia, Canada, and Europe forming CCE - International (CCE-I) as a model of accreditation standards with the goal of having credentials portable internationally."
The changes are needed in order to achieve NPOV. For example, the end run of WHO quotes are merely suggestions that are undueweight and not necessary. QuackGuru 17:48, 12 June 2008 (UTC)
  • From QuackGuru - The long WHO quotes should be removed from draft 3.
Your argument that it is undue weight doesn't make sense. If we don't quote the WHO then all we do is reference the countries (like this and this) themselves that use those methods. If it's the formatting you don't like, well, that is just your preference and that is not enough. If there is a reason that the source is wrong, thent hat is another thing, but you haven't shown that. More later.. -- Dēmatt (chat) 18:45, 12 June 2008 (UTC)
It's boring to have such an extensive length of quotes. This sort of detail is not needed in Chiropractic. It might be useful for Chiropractic education. The section is supposed to be a summary and not a block of quotes or a reference to those countries that use the methods. QuackGuru 18:58, 12 June 2008 (UTC)
I disagree that it is boring, and really doesn't matter if it is. Besides, that is not a valid reason to delete valuable information. -- Dēmatt (chat) 19:12, 12 June 2008 (UTC)
This section is supposed to be summary of Chiropractic education. Why should we overly promote suggestions that are not official world standards yet. Misplaced Pages should not be used to promote suggestions to become official world standards. These WHO quotes are being given too much prominence. QuackGuru 19:24, 12 June 2008 (UTC)
  • From QuackGuru - Draft 3 is not fully referenced like draft 7.
Which ones aren't referenced? -- Dēmatt (chat) 19:23, 12 June 2008 (UTC)
  • From QuackGuru - Draft 7 has more info on the chiropractic numbers worldwide.
I have no problem with adding those numbers to 3, but I think Eubilides was concerned about the quality of one of the sources. more later... -- Dēmatt (chat) 19:34, 12 June 2008 (UTC)
I have a problem with adding those numbers to 3. We should start with draft 7 and move forward. Draft 3 is a step backwards from draft 7.
Writing "more later..." will not change the fact that draft 7 is far better than draft 3.
Once graduated, the chiropractor may... is not referenced. Starting with a lower quality draft 3 is odd. There is information that is not referenced and the references are not fully formatted. These problems are fixed by using draft 7. Draft 7 is better worded and includes interesting information such as educational curriculums.
I removed the source that Eubilides had a concern with and used a book to reference the remaining chiropractic numbers. Gordon Waddell (2004). The Back Pain Revolution. Churchill Livingstone. {{cite book}}: Cite has empty unknown parameter: |chapterurl= (help) If editors prefer, the remaining chiropractic numbers can be removed from draft 7.
Again, this section is supposed to be summary of Chiropractic education. Why should we overly promote suggestions that are not official world standards yet. Misplaced Pages should not be used to promote suggestions to become official world standards. The disputed blocks of WHO quotes are being given too much prominence.
Draft 7 is better than draft 3. Draft 3 is on the wrong end of NPOV and should be greeted with a revert for the reasons stated above. QuackGuru 19:58, 12 June 2008 (UTC)
  • Repeatedly stating that draft 7 is better than draft 3 does not make it so. Draft 3 is not "promoting" the WHO guidelines any more than draft 7 is. What specific information do you feel is not referenced? DigitalC (talk) 00:18, 13 June 2008 (UTC)
I have explained specifically what is not referenced in my previous comment. Draft 3 is overly promoting the WHO standards while draft 7 is not. The WHO quotes are not law. The block of WHO quotes are merely suggestions. QuackGuru 00:27, 13 June 2008 (UTC)
Again, please stop with the strawman arugment. No one is stating that the WHO guidelines are Law. Neither draft 3 nor draft 7 are PROMOTING the WHO guidelines. The WHO guidelines are not "merely suggestions", they ARE Official World Health Organization International Guidelines. However, a guideline is not a standard, a rule, or a law (and again, no one is claiming that it is) - it is just that, a guide. Please, for the sake of moving forward on this article, stop with the WP:IDIDNTHEARTHAT] DigitalC (talk) 00:34, 13 June 2008 (UTC)
  • QG stated - "I removed the source that Eubilides had a concern with and used a book to reference the remaining chiropractic numbers. Gordon Waddell (2004). The Back Pain Revolution." This source was removed from draft 3 because it was unreliable for this information. That is, the numbers in it disagree with more reliable sources (for example, see the number of chiropractors this source states are in the US). DigitalC (talk) 00:34, 13 June 2008 (UTC)
Because the WHO quotes are suggestuions and not world standards we should not use them in an education section that is supposed to be a summary. The WHO guidelines are official for WHO but are not offical world standards. They are merely a guide or a suggestion to have world standards.
DigitalC stated in part: "This source was removed from draft 3 because it was unreliable for this information. That is, the numbers in it disagree with more reliable sources (for example, see the number of chiropractors this source states are in the US)." Please provide the differences and evidence that it was removed from draft 3. Please provide the evidence that the book is unreliable for the international chiropractic numbers. QuackGuru 00:47, 13 June 2008 (UTC)
  • The source states that there are "about 70,000 Chiropractors" in the US. We know from more reliable sources (ie - US government Bureau of Labour and Statistics) that there are closer to 53,000 Chiropractors in the US. Why would we assume that this source gives accurate numbers for the others? Further, this also deserves a failed verification tag, as the source does not comment on the number of Chiropractors in Australia. I will add that shortly. DigitalC (talk) 01:15, 13 June 2008 (UTC)
  • QuackGuru wrote "Because the WHO quotes are suggestuions and not world standards we should not use them in an education section that is supposed to be a summary." This doesn't seem to make sense. You use the same source in draft 7, yet fail to explain what the 3 educational paths are. A source is either valid (RS & V), or not - if it is, then quoting it seems fine, and if it isn't, it shouldn't be used at all. Are you objecting to the use of the WHO guidelines as a source? DigitalC (talk) 01:22, 13 June 2008 (UTC)
Using the long end run of boring WHO quotes is overly promoting a guideline that are not world standards.
DigitalC wrote: "Back Pain Revolution, by Gordon Waddell (page 62). states 70,000 in the US, 6000 in Canada, 1500 in the UK, and 90,000 internationally. For the record, this information has been in the article for ages. You cry foul when others object to information that has been in the article previously, but then turn around and do the same. Now do you understand that while we are discussing something on the talk page, we might as well get it right?"
I thought the source was good enough for DigitalC. QuackGuru 06:35, 13 June 2008 (UTC)
  • I disagree that quoting the WHO is promoting their guidelines, let alone overly promoting them. DigitalC (talk) 07:24, 13 June 2008 (UTC)
  • Perhaps we should get more input on this issue. Should we be using sources that disagree with facts (not opinions) stated in more reliable sources? Both the pediatrics article QG referenced, and the Waddell book state 70,000 Chiropractors in the US (While the US BLS states ~53,000). One gives 5000 for Canada, one gives 6000, and the currently cited source uses 6500. One says 1300 for the UK, the other 1500. The pediatrics article says there are smaller numbers in ~50 other countries, while a more reliable source says ~90 countries. How do we deal with such variation in the sources?

(outdent) As for the "70,000", the Pediatrics article (Campbell et al. 2000, PMID 10742364) merely cites an older advocacy source (FACTS Bulletin VI, 1999) for the "70,000". The FACTS Bulletin is less reliable than the Bureau of Labor Statistics, and its numbers are also significantly older. I assume the Waddell book is similar (Google Books won't let me read Waddell); certainly it's older. I see no good reason to mention numbers from older, less-reliable sources. As for the "50" versus "90" countries, which two sources are we talking about? I'd rather not wade through all of the above discussion to tease this out. Eubulides (talk) 17:20, 13 June 2008 (UTC)

There are an estimated 53,000 chiropractors in the U.S., 6526 in Canada, 2500 in Australia, 1,500 in the UK, and about 90,000 internationally. Here is the complete sentence. We are not talking about the 70,000 number. We are talking about a few other numbers: "2500 in Australia, 1,500 in the UK, and about 90,000 internationally." What numbers and what sources should we use to verify the other numbers. 2,500, 1,500, and 90,000 is sourced but are there better sources and numbers we should use instead or is the sentence adequate. QuackGuru 18:05, 13 June 2008 (UTC)
We've been here before - Eubulides wrote "The 90,000 estimate is dubious and should be removed; it relies an an estimate of 65,000 in the U.S. which is worrisomely higher than the more-reliable BLS estimate." If Waddell gets the 70,000 wrong, why would we assume that he is reliable for the 90,000 figure? DigitalC (talk) 03:22, 17 June 2008 (UTC)
All things being equal, I still prefer version 3 over version 7 (for many of the weaknesses outlined above by various editors). -- Levine2112 23:03, 13 June 2008 (UTC)

In looking up you guy's quote, and reading the above, I searched for the word "suggestion," and didn't find it. Then I searched for the quote, and found this:

There are many slight variations on the following models: however, in general, there are three major educational paths involving full‐time education: • A four‐year full‐time programme within specifically designated colleges or universities, following 1‐4 years of suitable pre‐chiropractic training in basic sciences at university level; for an example, see Annex 2. • A five‐year bachelor integrated chiropractic degree programme offered within a public or private university, with student entrance based upon the applicant’s matriculation status and the university’s admission requirements and quota restrictions. • A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree.


In the index that's under Models of chiropractic education

QG says "Why should we overly promote suggestions that are not official world standards yet......the WHO quotes are suggestuions and not world standards we should not use them in an education section that is supposed to be a summary." But that's what they are, a summary, no?

I agree with QG about the quotes, they should be summarized, it's better writing. And if these are not suggestions but a summary of what is, there is no need to quote because it's just a common account of things, not something in any way controversial. ——Martin ☎ Ψ Φ—— 05:38, 14 June 2008 (UTC)

I agree with Martinphi and QuackGuru that the quotes should be summarized. Martinphi's arguments are good ones. Eubulides (talk) 09:23, 14 June 2008 (UTC)
I agree that we can shorten them, so I did (and of course removed the quotes). I think it still catches the drift without the extra verbiage, especially when adding the MSc and BSc. I think more people know what this means anyway.
  • 1 - 4 years of pre-requisite training in basic sciences at university level followed by a 4 year full‐time program; DC.
  • A 5 year bachelor degree; BSc (Chiro).
  • A 2 - 3 year Masters following a bachelor; MSc (Chiro).
Hopefully, this helps settle this one? -- Dēmatt (chat) 17:56, 14 June 2008 (UTC)
This is better than what's in Chiropractic now, so let's go with it as an improvement. We can work on adding the other draft-7 improvements later. However, Misplaced Pages style guidelines suggest we should spell out the single-digit numbers. Eubulides (talk) 19:20, 16 June 2008 (UTC)
I disagree with the block text and the unecessary details. Draft 7 does not have the problems that draft 3 has. QuackGuru 18:02, 14 June 2008 (UTC)
Which details would you consider "unnecessary'? This is about as simple as we can state the different degrees that chiropractors are licensed with internationally. I think the point that was made above was that, since readers were likely unaware that chiropractors had any specific training, it was important to show it here. I agree with that assessment and consider that not including it would be similar to not including it in Medicine, which is pretty similar to length and discussion as ours. Only ours looks better, thanks to the bullets. -- Dēmatt (chat) 16:18, 16 June 2008 (UTC)
The blocked text is unecessary details. Draft #7 has better wording. For example, draft #7 explains: "In both cases (4200/2200 hours) this includes a minimum of 1000 hours of supervised clinical training." Draft #7 includes educational curriculums and has more info on the chiropractic numbers worldwide. For the chiropractic numbers worldwide, I used the best sources I could find. If better sources are found, we can use those instead. All the references in draft #7 are formatted.
Multiple editors have problems with draft 3. This includes: OrangeMarlin, Martinphi, Eubulides, and QuackGuru. ScienceApologist wrote in part: "I am of the opinion that this version is slightly better than the other 6 above." Clearly draft #7 is better. QuackGuru 16:55, 16 June 2008 (UTC)
All those things that you mention above were in draft 3 previously but were removed at one time or another because there were various flaws that were discussed and worked out together. You can find the discussions and subsequent fixes to the language starting here. ---- Dēmatt (chat) 17:44, 16 June 2008 (UTC)
I did change the 4200/2200 hour sentence as version 7 suggests as this does addrress both pathways to licensure. I also see that version 7 has 'morphed' to look quite a lot like version 3. I suppose that is a good sign that we are reaching consensus. I'm not sure that we need all those refernces thet version 7 has listed. -- Dēmatt (chat) 18:01, 16 June 2008 (UTC)
Some of those things I have mentioned are still problems with draft #3. Draft #7 has better information. For example, Draft #7 includes educational curriculums and has more info on the chiropractic numbers worldwide. For the chiropractic numbers worldwide, I used the best sources I could find. If better sources are found, we can use those instead. All the references in draft #7 are formatted.
The blocked text still in draft #3 is unnecessary and should be removed. Draft #7 fixes all the current problems in draft #3.
All of the unnecessary references can be deleted. Select the better refs and delete the extra references. Dēmatt, if you think any ref is unnecessary, please consider deleting it. QuackGuru 18:18, 16 June 2008 (UTC)

Comments on draft 7:

  • (Done.) Wikilink first professional degree.
  • (Done.) 3rd sentence "Matriculation..." Please clarify whether this applies in general or only to the U.S. and Canada. If only the U.S. and Canada, I suggest "The U.S. and Canada require a minimum 90 semester hours of undergraduate education as a prerequisite for chiropractic school, and at least 4200 student/teacher contact hours (or the equivalent) of full‐time education for matriculation through an accredited chiropractic program." (The word "includes" got lost in the rearrangement of the sentence, but can perhaps be considered to be redundant with "at least"). If it applies more widely than the U.S. and Canada, then I suggest simply switching the order of sentences 2 and 3, thus: "Matriculation through an accredited chiropractic program includes at least 4200 student/teacher contact hours (or the equivalent) of full‐time education. The U.S. and Canada require a minimum 90 semester hours of undergraduate education as a prerequisite for chiropractic school."
  • Are these talking about two different things? "a conversion program for people with other health care education " and "also suggest that health professionals with advanced clinical degrees, such as medical doctors, "? Since medical doctors clearly have "other health care education", this is rather confusing.
  • (Done.) "Upon graduation, the chiropractor may then be required to pass ..." I'm not sure whether it makes sense to refer to the person as a "chiropractor" before they pass the exams, therefore I suggest rewording this to "Upon graduation, there may be a requirement to pass ..." Optionally, the word "chiropractor" could be inserted as "before the chiropractor is licensed to practice"; IMO it's OK to refer to the person as a "chiropractor" at this later point in the sentence, at the moment they're being licensed.
  • Paragraph 3 sounds overly U.S.-centric. Do we know whether chiropractic schools are accredited through CCE in countries other than the U.S.? If so, those countries can be included in the first sentence. In the second sentence, if several CCE's are joining together, I see no reason to single one of them out as the subject of the sentence. How about "CCEs in the U.S., Australia, Canada and Europe have joined to form CCE-International (CCE-I)..." I think it's OK to mention the U.S. first since it has a lot more chiropractors.
  • "Today, there are..." Please specify the date, e.g. "As of 2008, there are..." (if that's supportable by the reliable sources).
  • (Done.) "There are an estimated 53,000 chiropractors in the U.S., 6526 in Canada, 2500 in Australia, 1,500 in the UK, and about 90,000 internationally" If we don't delete the 90,000 figure as someone suggested, then this sentence needs to be reworded to clarify whether the 90,000 figure includes the other figures. Assuming it does, I suggest "There are estimated to be 90,000 chiropractors worldwide, including estimates of 53,000 in the U.S., 6526 in Canada, 2500 in Australia, and 1,500 in the UK."
  • (Done.) Take the last sentence of the last paragraph, about "straight" and "mixer", and move it up to become the last sentence of the previous paragraph, where I think it has a little more of a logical connection with the other stuff in the paragraph. ☺ Coppertwig (talk) 02:22, 17 June 2008 (UTC)
Coppertwig, here is a copy of the text from the book on page 62. There are now about 70,000 chiropractors in the US, 6000 in Canada, 1,500 in the UK and about 90,000 internationally (Chapman-Smith 2000, www.chiropracticreport.com) Source: Gordon Waddell (2004). The Back Pain Revolution. Churchill Livingstone. {{cite book}}: Cite has empty unknown parameter: |chapterurl= (help) The reference is a bit dated but it is the best reference I could find to verifiy the 1,500 in the UK, and 90,000 internationally numbers. QuackGuru 06:23, 17 June 2008 (UTC)
I made some changes based on the new suggestions. I would like to see other editors edit Education 7. QuackGuru 07:06, 17 June 2008 (UTC)
Version 3 *is* Version 7 with all the unnecessary refs deleted or statements fixed already. Remember, that is where you got the sentences in the first place; from previous versions. -- Dēmatt (chat) 02:21, 17 June 2008 (UTC)

It looks to me as if everyone but on editor agrees to put in draft 3 and revisit the subject after the rest of the article has been set right. It would be better for there to be a complete consensus, but this is consensus. With or without my change, it could be put in. This might help . ——Martin ☎ Ψ Φ—— 05:32, 17 June 2008 (UTC)

There seems to be some confusion here. Draft 3 was already put in. I disagree that Education should wait until "after the rest of the article has been set right". I see no reason to wait indefinitely before improving this part of the article. We shouldn't rush, of course; but there is no real reason to wait for many days (or weeks, or months, or years...) before improving Education. Eubulides (talk) 16:57, 17 June 2008 (UTC)
Yes, 3 is in but there have been two changes since; adding the 4200/2200 sentence and removing the quotation marks and shortening the WHO statement as all three of you suggested. QuackGuru's version 7 appears to be very similar, but removes the three paths for education as he claims it is a weight violation, but I disagree; considering it essential information and answers the question that readers want to know about chiropractors, "What kind of schooling do chiropractors go through?" I am not sure why he wouldn't want this information in there, especially when it is so nicely laid out by the WHO for an international audience. Anything else we would do would involve sourcing the different countries with this same curriculum - after all, they are all CCE approved programs. This is certainly the most efficient way to do it. Martin's version took them out as well. -- Dēmatt (chat) 18:41, 17 June 2008 (UTC)
The WHO suggestions are guidelines and not law. This section should be a summary of the main chiropractic education article. QuackGuru 19:08, 17 June 2008 (UTC)
The two changes since Draft 3 was installed are an improvement to 3. However, as per the usual Misplaced Pages guidelines, the numbers should be spelled out, and the bullet list should be replaced by inline text without bullets. Sorry, but I don't recall what the other differences between drafts 3 and 7 were; they might also be relevant. Eubulides (talk) 08:29, 18 June 2008 (UTC)

Please see WP:SUMMARY.

Rationale

This style of organizing articles is somewhat related to news style except it focuses on topics instead of articles. The idea is to summarize and distribute information across related articles in a way that can serve readers who want varying amounts of detail. Thus giving readers the ability to zoom to the level of detail they need and not exhausting those who need a primer on a whole topic.

This is more helpful to the reader than a very long article that just keeps growing, eventually reaching book-length. Summary style is accomplished by not overwhelming the reader with too much text up front by summarizing main points and going into more detail on particular points (sub-topics) in separate articles. What constitutes 'too long' is largely based on the topic, but generally 30KB of prose is the starting point where articles may be considered too long. Articles that go above this have a burden of proof that extra text is needed to efficiently cover its topic and that the extra reading time is justified.

Sections that are less important for understanding the topic will tend to be lower in the article (this is news style applied to sections). Often this is difficult to do for articles on history or that are otherwise chronologically based unless there is some type of analysis section. Organizing in this way is important due to the fact that many readers will not finish reading the article.

Levels of desired details

Misplaced Pages is not divided into a macropædia, micropædia, and concise versions as is the Encyclopædia Britannica — we must serve all three user types in the same encyclopedia. Summary style is based on the premise that information about a topic should not all be contained in a single article since different readers have different needs;

  • many readers need just a quick summary of the topic's most important points (lead section),
  • others need a moderate amount of info on the topic's more important points (a set of multi-paragraph sections), and
  • some readers need a lot of detail on one or more aspects of the topic (links to full-sized separate articles).

The parent article should have general summary information and the more detailed summaries of each subtopic should be in daughter articles and in articles on specific subjects. This can be thought of as layering inverted pyramids where the reader is shown the tip of a pyramid (the lead section) for a topic and within that article any section may have a {{main|<subpage name>}} or similar link to a full article on the topic summarized in that section (see Yosemite National Park#History and History of the Yosemite area for an example using two featured articles). The summary in a section at the parent article will often be at least twice as long as the lead section in the daughter article. The daughter article in turn can also serve as a parent article for its specific part of the topic. And so on until a topic is very thoroughly covered. Thus by navigational choices several different types of readers get the amount of detail they want.

With regard to the three educational paths suggested from WHO, this section (Education, licensing, and regulation) should only be a summary of the main chiropractic education article. Draft #7 accomplishes this. QuackGuru 19:19, 17 June 2008 (UTC)

This seems to fit WP:Summary pretty well. The section on education is a very short paragraph (which reminds me that we need to link to the other main article for regulation). This is about as simple as we can state the different degrees that chiropractors are licensed with internationally. I think the point that was made above was that, since readers were likely unaware that chiropractors had any specific training, it was important to show it here. I agree with that assessment and consider that not including it would be similar to not including it in Medicine, which is pretty similar to length and discussion as ours. Only ours looks better, thanks to the bullets. -- Dēmatt (chat) 16:18, 16 June 2008 (UTC) -- Dēmatt (chat) 19:57, 17 June 2008 (UTC)
Medicine's education section is low quality; we should do better than that. Dentistry's and Nursing's treatments are better (and shorter). Eubulides (talk) 08:29, 18 June 2008 (UTC)
Seriously? Dentistry doesn't even have an education section, but has it all in the lead and not mentioned again which is not suggested according to WP:Lead; obviously the article has problems. Nursing doesn't even mention education. Are you suggesting that we scrap the section? -- Dēmatt (chat) 13:21, 18 June 2008 (UTC)
They're better primarily because they are shorter. For example, Nursing#Nursing as a profession mentions education only very briefly, in one sentence: "There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theory and practice and training in clinical skills." I'm not saying this is perfect, only that it demonstrates a better sense of proportion. Eubulides (talk) 22:20, 18 June 2008 (UTC)
Tell you what, you dump Education and I'll dump Effectiveness and we'll save both of us another month of headaches! Nah, it would just get reverted :-D -- Dēmatt (chat) 02:35, 19 June 2008 (UTC)

Coopertwig wrote: *Are these talking about two different things? "a conversion program for people with other health care education " and "also suggest that health professionals with advanced clinical degrees, such as medical doctors, "? Since medical doctors clearly have "other health care education", this is rather confusing.

Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.

The WHO guidelines also suggest that health professionals with advanced clinical degrees can meet the educational and clinical to practice as a chiropractor in 2200 hours. In both cases (4200/2200 hours) this includes a minimum of 1000 hours of supervised clinical training.*

The current sentences are above. The last two additional sentences (beginning with The WHO guidelines also suggest that health professionals*) may be too much detail for a summary of the main education article. The second and third sentence explains the amount of hours is recommended. I'm not sure how to make this more concise. I suggest removing the extra details (the last two additional sentences) from this article. QuackGuru 00:31, 20 June 2008 (UTC)

Arbitrary section break 1

Draft 7 seems to fit very well per WP:Summary. The extra details about WHO guidelines are for the main education article. We have a link to the main article that resolves this issue. QuackGuru 20:07, 17 June 2008 (UTC)
A compromise would be to summarize the WHO recommendations in just a few words, but I think they would be difficult or impossible to summarize extremely briefly. Instead, I suggest mentioning one of the three paths as an example. The easiest to summarize in a few words is the 5-year one, I think. So I suggest: "The World Health Organization (WHO) guidelines suggest three major full-time educational paths, for example a five-year university degree; besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic." ☺ Coppertwig (talk) 00:50, 18 June 2008 (UTC)
I like this summary; it captures the idea in much fewer words than Draft 3 uses, and it's much more engaging (if anything can be engaging about education....). Eubulides (talk) 08:29, 18 June 2008 (UTC)
I'll change the numerals to text in Draft 3.
I think it is important that we keep the different degrees if we are going with CopperTwigs version. I would be satisfied with "The World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic."
-- Dēmatt (chat) 15:02, 18 June 2008 (UTC)
Thanks, I also like this summary. Eubulides (talk) 22:20, 18 June 2008 (UTC)
Me three. QG had struck out the bulleted text, so I replaced it with this summary. I think Draft #3 is in especially good shape. Can we agree on this as the consensual version and then move onto the next topic at hand? Any dissenters on this proposal? If there are none, I would suggest implementing this text in full and then archiving all of the related discussion off this page in order to provide greater clarity for the other topics to be discussed. -- Levine2112 01:01, 19 June 2008 (UTC)
Count me in. -- Dēmatt (chat) 02:39, 19 June 2008 (UTC)

(<outdent) I put my suggestion for reducing U.S.-centrism into draft 7. I also deleted "also", because apparently it's not talking about a different educational path from what was already mentioned in the previous paragraph. ☺ Coppertwig (talk) 00:53, 20 June 2008 (UTC)

If you took out some of those extraneous references we'd be good to go I think. -- Dēmatt (chat) 21:55, 20 June 2008 (UTC)

Education is currently the "hot topic". However, at this point I'm a little lost as to exactly where we stand, and how we're moving forward. I do like Dematt's suggestion which inclused the Degrees that Chiropractors obtain. DigitalC (talk) 01:08, 20 June 2008 (UTC)

I think we're pretty close. Then we can go to History. -- Dēmatt (chat) 21:55, 20 June 2008 (UTC)
Dematt, would you please be specific about which references you think need to be removed? Are you advocating removing all the refs cited in draft 7 but not in draft 3? I think these are the refs listed in draft 7 but not draft 3: (re first professional degree). (re requirements in U.S. and Canada) (3 refs re particular jurisdiction) (3 refs re continuing education) Re portable internationally: I think perhaps CCEI – Worldwide Quality Assurance for Chiropractic Education is a better link than CCEI – History and Purpose of The Councils on Chiropractic Education International from draft 3. (Draft 3 version of this ref) (Draft 7 version)) (other portable internationally refs in draft 7) (number of accredited programs) (straight or mixer)
I think some of the refs as listed in draft 7 need reformatting or information to be added; I'll likely do that later today (and have done one already).
Re 90 semester hours and 4200 contact hours: We need both refs here, since one of the refs is for U.S. only. Both refs mention 4,200 hours, but only the U.S. ref semms to contain "90" or "semester hours", so I think we need to change the wording re prerequisites in Canada. (I'm not sure what to change it to.)
The number "6526" of chiros in Canada (2006 data) should be rounded off so as not to suggest overly precise information, or else attributed and the year given. I suggest "about 6500 in Canada". The date of the data should be taken into account. It would be accurate to say "the number of chiropractors has been estimated as ..." but is not accurate to say "the number of chiropractors is estimated to be" because the present tense implies that the current number has been estimated, whereas actually the refs are based on data from 2006 (U.S., Canada), 2000 (Australia) and 2004 (U.K.) I suggest "The number of chiropractors has been estimated (in 2006 or earlier) as 53,000 in the U.S., about 6500 in Canada, 2500 in Australia, and 1,500 in the UK."
(By the way, QuackGuru, thanks for inserting some of my suggestions into draft 7 a few days ago.) ☺ Coppertwig (talk) 14:29, 21 June 2008 (UTC)
It sounds like your on the right track. Eubulides and DigitalC and I have pretty much hashed through all the ones in version 3, so I'm pretty sure those are satisfactory to everyone. I think version 7 just has some extra ones that were left over or we decided that they weren't reliable. One is the ref that we took the 90,000 number from that we all agreed in 3 that it was not as reliable as the government numbers so we took it out. That was why we went with 53,000, but don't hold me to that. Maybe Eubulides or DigitalC remember better than I do. Also, I think Martin made some changes to 3 that he felt better reflected the WHO source, too. Other than that, I think some of the references are just left over from stuff QuackGuru took out but left the reference in. He might be able to tell better which ones those were. We might just have to go through each one, one at a time. -- Dēmatt (chat) 20:41, 21 June 2008 (UTC)
Wait -- I had been editing draft 7, not draft 3. I'm just going through comparing them and will have comments shortly. ☺ Coppertwig (talk) 00:30, 22 June 2008 (UTC)
This could go on forever. Let's just put one or the other in and move on as Eubulides suggests. -- Dēmatt (chat) 00:39, 22 June 2008 (UTC)
Wait -- no -- just a few mintues. I'm almost finished a merged vesrion incoroporating version 3 and 7. ☺ Coppertwig (talk) 00:44, 22 June 2008 (UTC)

Education, Licensing, Regulation 8

Chiropractors obtain a first professional degree in the field of chiropractic medicine. Canada and the U.S. require a minimum 90 semester hours of undergraduate education as a prerequisite for chiropractic school, and at least 4200 instructional hours (or the equivalent) of full‐time chiropractic education for matriculation through an accredited chiropractic program. Internationally, the World Health Organization (WHO) guidelines suggest three major full-time educational paths culminating in either a DC, DCM, BSc, or MSc degree. Besides the full-time paths, they also suggest a conversion program for people with other health care education and limited training programs for regions where no legislation governs chiropractic.

The WHO says that health care professionals with advanced clinical degrees can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours. In both cases (4200/2200 hours) this includes a minimum of 1000 hours of supervised clinical training. Upon graduation, there may be a requirement to pass national, state, or provincial board examinations before being licensed to practice in a particular jurisdiction. Depending on the location, continuing education may be required to renew these licenses.

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

Regulatory colleges and chiropractic boards in Australia, Canada, Mexico, the U.S. and U.S. territories are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. The number of chiropractors has been estimated (in 2006 or earlier) as 53,000 in the U.S., about 6500 in Canada, 2500 in Australia, and 1,500 in the UK.

Comments on Education, Licensing, Regulation 8

This version draws on both Draft 3 and Draft 7. The references are as in draft 3. Many minor changes in wording that had been put in in draft 7 have been incorporated, making the wording almost the same as draft 7; the two drafts were very similar already anyway. In a few minutes I might post a list of differences between the various drafts. ☺ Coppertwig (talk) 00:48, 22 June 2008 (UTC)

Well, everything looks pretty good. I still think it could use the more WHO info, but if everyone else is okay with it, I'll take it. I say put it in now so we can move on to history! -- Dēmatt (chat) 01:01, 22 June 2008 (UTC)
I just made one more change: putting the names of countries in alphabetical order in the last paragraph. I assume that's a non-controversial change.
Description of draft 8 in comparision to drafts 3 and 7:
  • wikilinked and unhyphenated "first professional degree" as in draft 7
  • Joined sentences 2 and 3 into one sentence as in draft 7
  • It says "instructional hours" as in draft 3, rather than "student/teacher contact hours"
  • The WHO sentence begins "Internationally," as in draft 3
  • Deleted "also" from first sentence of 2nd paragraph as in draft 7
  • Worded sentence "...there may be a requirement to pass..." as in draft 7
  • Worded sentence re CCEs from various countries joining as in draft 7
  • It says "Europe and the UK" as in draft 3 when mentioning numbers of schools; should this be changed to just "Europe"?
  • I left off the last sentence of the 3rd paragraph (straight or mixer) as in draft 3.
  • Changed "United States" to "U.S." The MOS is a little vague as to whether one or the other is preferred in general, I think; Eubulides seemed to be saying "U.S."
  • First sentence of last paragraph, re responsibilities of regulatory colleges, is worded as in draft 3, excapt that I put the countries in alphabetical order.
  • Sentence re numbers of chiros in various countries: I put in the version I had suggested in the comments to draft 7. In this sentence, the refs may not be the same as in draft 3; I put in the access date to one of them as in draft 3 (the Canadian one, I think). Other than that sentence, the references are as in draft 3.
Feel free to edit draft 8; please also describe your edits here in the comments section to bring attention to them.
Can we say we have consensus and can put in draft 8 and move on to History? ☺ Coppertwig (talk) 01:54, 22 June 2008 (UTC)
(The heading of the section should not be all capitalized, though; presumably it should remain "Education, licensing and regulation" as it is currently in the article.) ☺ Coppertwig (talk) 02:04, 22 June 2008 (UTC)
Looks good to me. I preferred the way it was with the WHO info bulleted, but that didn't seem to gain consensus. DigitalC (talk) 02:07, 22 June 2008 (UTC)
I object to this version. Here are a few reasons. The WHO sentence begins Internationally. What is the purpose of adding the word Internationally. The last sentence of the 3rd paragraph (straight or mixer) is missing. Regulatory colleges and chiropractic boards in Australia, Canada, Mexico, the U.S. and U.S. territories... I do not see a reason for the extra details about such U.S. territories and I disagree with the order of the countries too. More prominent countries should be first. I also disagree with this > (in 2006 or earlier). What is the reason for adding the date 2006. QuackGuru 06:54, 22 June 2008 (UTC)

← Because these drafts are on a forward-moving basis, is it OK if some of the older ones are archived? Would improve flow on talk, imo. Don't mean to detract from the conversation, just wondering :-) Xavexgoem (talk) 07:08, 22 June 2008 (UTC)

It's OK with me to remove "Internationally".
The straight or mixer sentence may be undue weight. I think the differences between straight and mixer should be mentioned somewhere in the article, probably in the Philosophy section, and don't need to be repeated elsewhere except perhaps briefly in the lead. I'm not convinced that the schools are actually clearly divided into all-straight schools and all-mixer schools: this web page says there's a spectrum of philosophies. Do we have any other refs claiming that the schools can be clearly categorized into two types? Do we have, for example, a list of schools which indicates their type? The ref given for the straight or mixer sentence does not contain the word "mixer", therefore the sentence needs to be deleted or modified per WP:V.
It's OK with me to archive old drafts. I was thinking of archiving Lead Rewrite 2 but don't know what the usual procedure is. Alternatively, I think it works to just wait for Mizsabot to archive them.
It's OK with me to leave out the mention of U.S. territories (assuming it's sort-of covered by mentioning the U.S.?) and it's OK with me to put the countries in order of the number of schools or in order of the number of chiropractors rather than alphabetical. I suggest that the same order of countries be used throughout the article. Here's a suggested order, based on the number of chiropractors as far as we know: U.S., Canada, Australia, Europe or U.K., Mexico. (though we don't know the number of chiropractors in Europe or Mexico; at least we have a number for U.K. so I put Europe before Mexico.)
The reason for the date 2006 is per WP:Manual of Style#Chronological items, subsection "Precise language". I'm sorry I forgot to explain why I changed "has been" in the estimate of chiropractors: the past tense should perhaps be used for the act of estimating, but use of "has been" for the existence of the chiropractors sounds to me as if it might imply that these chiropractors no longer exist. ☺ Coppertwig (talk) 10:52, 22 June 2008 (UTC)
Mizsa is totally preferable - but if a section is edited for whatever reason, it'll just linger. Which is why I'm pushing for Just One Focus :-p Xavexgoem (talk) 11:14, 22 June 2008 (UTC) other options is to {{collapse top}} & {{collapse bottom}}
I'm thinking collapsing can help me navigate this page better. -- Dēmatt (chat) 03:25, 23 June 2008 (UTC)

Reply to Coppertwig: You write: "The straight or mixer sentence may be undue weight." Actually the significance of the difference and its history cannot be overestimated. It is extremely significant and explains much of the tension, conflict, and criticisms regarding the profession. Not much about chiropractic can be understood (and it will present many conundrums) if one does not understand this. Yes, there is a wide spectrum of philosophies, as is often expressed by stating that "there are just as many definitions of chiropractic as there are chiropractors," yet two basic schools still exist. The straights are the most narrowly (though not necessarily smallest in numbers) and most "purely" defined ("Vertebral Subluxation Correction: Nothing More, Nothing Less, Nothing Else"), while the widest diversions and variations are found among mixers (anyone who is not "straight"). (Keep in mind that probably most mixers still believe in subluxations, they just add other treatment methods to their toolbox and don't exclusively use adjustments.) There are schools and organizations who clearly identify themselves as "straight", either in their titles or in their guidelines and other position statements. The Federation of Straight Chiropractors and Organizations is the official umbrella organization for straights, with the Portland Project as an active part of its efforts ("the silent majority"). The Foundation for the Advancement of Chiropractic Education should also be mentioned. Sherman College of Straight Chiropractic uses "straight" in its name, while a number of others have always been clearly straight in their orientation, most notably all of the Life and Palmer colleges. Straight schools operate in a strange limbo which may confuse non-chiropractic onlookers, since they are forced by accreditation laws to teach differential diagnosis and therapeutics. Don't be fooled. They are still non-therapeutic (do not treat disease, only VS) in their approach and whatever they teach on those subjects is just for show to keep their accreditation. Life University (Marietta branch, and the largest chiro school in the world) lost its accreditation over this issue a few years ago (2002) but got it back. The students were taught there was only one valid diagnosis (VS), and to ignore all medical diagnoses as irrelevant, and that got Life in trouble. The World Chiropractic Alliance and the International Chiropractors' Association (the world's oldest chiropractic professional organization) are very straight and still fight to preserve "real chiropractic". The schools of thought are very real and the straights, in spite of what may seem like small numbers (in their official organizations), wield a huge influence. -- Fyslee / talk 15:41, 22 June 2008 (UTC)

I agree that the straight mixer issue is a very big issue, though we can probably handle it without as much weight as we gave it in the previous version. The challenge will be to present them in such a way that does not take sides. I think for the education section which we are currently working with, it is not needed. The CCEs accredit all of them the same, regardless of philosophy. The source seems to imply that there are two different paths, straight and progressive, which is the only place I've ever seen them explained this way. Fyslee is also correct that straight and mixer are two different approaches that are independent of the school that they went to. You can be from Life College (from straight roots) and be a mixer and be from National (from mixer roots) and practice straight. In fact, I would venture to say that the large majority of Life graduates practice mixer, i.e. use all sorts of methods. -- Dēmatt (chat) 03:25, 23 June 2008 (UTC)
Sorry: I missed listing a few small differences.
  • I've just changed draft 8 to fix the wikilink to first professional degree and to not capitalize "Chiropractic".
  • draft 8 has "full-time chiropractic education" rather than just "full-time education".
  • draft 8 has "The WHO says that health care professionals...". I like having the word "care" in there, but I actually prefer the draft 7 words "guidelines suggest", because I'm not sure that the WHO has the authority to state what people have to do to become able to practice in a given country.
  • later in that sentence, the word "requirements" seems to be missing after "can meet the educational and clinical" in draft 7, apparently just a mistake.
There could be other things I missed. ☺ Coppertwig (talk) 14:10, 22 June 2008 (UTC)
The date of 2006 or earlier is not precise. The or earlier part is not accurate. Each reference has the exact date of each chiropractic number. The current wording in mainspace is better. The correct present tense is probably best.
The straight and mixer ref uses the word progressive but the word (progressive) is not clear for the reader. I have included mixer so that the reader will understand. QuackGuru 16:07, 22 June 2008 (UTC)
  • I agree with using the "2006 or earlier". Please use the talk page to come to consenus before making edits to the page.
  • I believe the straight vs. mixer section could be discussed on the Chiropractic education article, in a section about US education. Worldwide, this split does not exist, and we should not be giving undue weight to the US education in this summary. This article has had a heavy US POV in the past, and I'd hate to see that start again. DigitalC (talk) 01:05, 23 June 2008 (UTC)
"I believe the straight vs. mixer section could be discussed on the Chiropractic education article". Good idea, then we could expound on these schools of thought without adding too much weight to this article. Though, realistically, straights and mixers probably could have their own articles just to explain what they are without having to constantly compare and contrast the differences every time we mention the word chiropractor. -- Dēmatt (chat) 03:31, 23 June 2008 (UTC)
I disagree with using the "2006 or earlier". The or earlier part is vague. Each reference has the date noted for the reader.
There are about 53,000 chiropractors in the U.S., larger than any other country. The interesting tidbit about straights and mixers education in the U.S. is suitable for this article. QuackGuru 06:11, 23 June 2008 (UTC)
I'm not convinced that chiropractic schools in the U.S. are clearly divided into two distinct types. If presented with prose attribution, the sentence can go in the chiropractic education article. If you find an additional source confirming it and giving it greater weight, perhaps it could go here. If the schools really are divided clearly into two types, it should be possible to find more sources confirming that; they don't have to be cited in the article. I did a couple of web searches and didn't find a confirming source, but found this which seems to me in its abstract to disagree: "Despite such tensions, chiropractors have maintained a unified profession with an uninterrupted commitment to clinical care." I agree with the addition of "progressive" in parentheses (if the sentence is included, which I oppose) and think it would be even better to put "progressive" without parentheses and "mixer" in parentheses. I think "progressive" is less confusing: to the reader new to this topic, "mixer" is merely chiropractic jargon, while "progressive" gives the reader some idea about what the difference is between the two types; besides being the vocabulary actually used in the source. (A reader seeing simply "straight" and "mixer" could be confused as to which is the earlier, vitalistic philosophy.)
I don't consider that website sufficiently reliable to make this claim, for the following reasons. It's simply a government website. Therefore that particular sentence might have been written by a single individual and not thoroughly verified by anyone else. The people maintaining that particular website are probably not specialists in knowledge about chiropractic. It could have been copied from some other website or from some pamphlet, and it could be out-of-date or inaccurate.
The sentence is essentially claiming that no school has a mix of teachers of different philosophies, and that no school has a philosophy intermediate between straight and mixer; I find this difficult to believe, and therefore it would require more verification than just one sentence on one website. While the statement is not highly exceptional, I find it somewhat exceptional, and therefore "Exceptional claims require exceptional sources" applies to some extent here in my opinion.
Although you've stated that it's suitable for this article, QuackGuru, I don't think you've stated any reason why you think it's suitable. ☺ Coppertwig (talk) 11:05, 23 June 2008 (UTC)

(<<<outdent) Progressive is more confusing. We have a section called Schools of thought and practice styles that says mixers but does not use the word progressive. It would confuse the reader if we called mixers progressive chiropractors. The way it is currently in the article is fine, mixer then progressive in parentheses.

There are about 53,000 chiropractors in the U.S. We can give the chiropractic education in the U.S. its due weight since chiropractic numbers in the U.S. is larger than any other country. The straight teaching movement is very much alive.

"Palmer College of Chiropractic, General Information". Palmer College of Chiropractic is generally a straight chiropractic college.

Kevin A. Rose, Alan Adams (2000). "A Survey of the Use of Evidence-Based Health Care in Chiropractic College Clinics" (PDF). The Journal of Chiropractic Education. 14 (2): 71–7.

From the above source: Strengths and Limitations: One strength of this survey was that the respondents included a range of colleges worldwide. There was also a broad range of chiropractic ideologies represented, from Sherman College of Straight Chiropractic to Western States Chiropractic College.

"Straight" means a total commitment to the teaching, research and practice of chiropractic focused on correcting vertebral subluxation. The word "straight" is in the college's name to identify it with this distinct mission.

Sherman College has indeed become the vanguard of chiropractic - playing a highly visible and important leadership role in advancing straight chiropractic.

Here is a quick search for reference. QuackGuru 17:50, 23 June 2008 (UTC)

Challenge

Template:RFCsci I claim that WP:FRINGE applies to this article. Who disagrees/agrees and why? ScienceApologist (talk) 19:38, 29 May 2008 (UTC)

You're not giving me a chance to say I agree? OrangeMarlin 19:42, 29 May 2008 (UTC)
What theory are you asserting that WP:FRINGE applies to? DigitalC (talk) 01:18, 30 May 2008 (UTC)
It's not a poopularity contest, SA. It's about evidence. Remember Stephen Colbert and African Elephants? You can easily manipulate and distort "facts" if you are uninformed and don't provide any reliable evidence to support the claims made. Anyone can canvass anyone to get "consensus". You, or any other anti-chiropractic editor has yet to provide any evidence that suggests chiropractic is fringe. There is compelling evidence to the contrary, however. CorticoSpinal (talk) 02:34, 30 May 2008 (UTC)

I would agree that WP:FRINGE applies to this article, but I am starting to think that it is too dangerous to hold that position.--Filll (talk | wpc) 19:31, 30 May 2008 (UTC)

I also agree that WP:FRINGE applies to this article. Chiropractic does have strong fringe elements; a sizeable minority of chiropractors are straights, for example, and are definitely fringe by the standards mainstream science. However, I disagree that every topic in chiropractic is covered by WP:FRINGE. There are areas where chiropractic is merely controversial, and is not fringe; evidence-based treatment of low back pain, for example.
Filll, you have nothing to be afraid of here. If so, I would have been dead a long time ago. -- Dēmatt (chat) 00:42, 31 May 2008 (UTC)

Commenting here as an uninvolved editor, I think that there might be a case both ways. Chiropractic is not yet quite mainstream, but is almost mainstream- see this source. However, I think there should be little argument here, because as I see it, the most mainstream sources such as the NIH give chiro an NPOV treatment, in that they are not overly negative or overly positive. Thus there should be little argument about the best sources. Because of this, saying that chiro is covered by FRINGE would not help to promote either the POV of debunkers or the POV of those who wish to present chiro as completely accepted and scientifically fully established.

This concluding quote from what looks to me like one of the more critical sources should not be any problem:

"Contemporary chiropractic philosophy recognizes its partnership with the greater body of philosophy and science in general. Most contemporary chiropractors and their organizations distinguish between what is known and what is believed. Chiropractic belief systems embrace the holistic paradigm of wellness while incorporating deterministic materialism for the establishment of valid chiropractic principles. Chiropractic’s philosophic foundation serves as the basis for theoretical development, not a substitution for it (Phillips, 1992)."

This is also a mainstream source, and should not be objectionable to those who promote chrio:

"Scientifically rigorous general population-based studies comparing chiropractic with primary-care medical patients within and between countries have not been published."

I doubt anyone wants to say that chiro is completely established. There should not be too much contention here, because I don't think there is much tension between the "chiropractic POV" and the "mainstream POV" as reflected in the sources. Most of the article can probably be written without too much attention to attribution of opinion, because most of it will be agreed upon between the two perspectives, if the mainstream sources are followed.

The CNN article is highly negative, but one of the lesser sources.

It would help to have a summary of the debate, and it would help if you archived this talk page.

If you want to achieve consensus, and avoid sanction in the end, stop the name calling completely. ——Martin ☎ Ψ Φ—— 19:34, 30 May 2008 (UTC)

Thanks for the comments. I agree with their overall thrust; unfortunately the devil is in the details.
  • The sources you give are a too old to be included in this article, compared to what's already there, and the sources already included in the article make the same basic points; the problem is that these points are under dispute here.
  • This talk page is archived; any topic not touched in 14 days is automatically archived by a bot.
  • It would indeed help to have a summary of the debate, but nobody has taken the (considerable) time to write one. It would take a lot of time to write one primarily because editors would argue a lot about what its contents should be. It really is quite dysfunctional, I'm afraid.
Eubulides (talk) 01:08, 31 May 2008 (UTC)
Ok, a question. And please bear in mind I never knew anything about chiro before today.... and basically I'm not sure how effective requesting comments on such a complex issue is going to be. But, what is the mainstream view of chiro? I mean, if it isn't what I see at NIH and the other sources. I know that the mainstream view of the philosophy is that it is not supported- no form of vitalism is supported by mainstream science at least. But the other part, the part where they are doing good to backs- what is the mainstream view of that? What are the sources there? I get the impression that most of the sources say it does good, but one or two question that. So is the mainstream view that it does good, per the NIH, or something else? And, shouldn't the info in "Scope of practice" be above the philosophy section? ——Martin ☎ Ψ Φ—— 02:23, 31 May 2008 (UTC)
  • You have to be careful here. The "NIH" source you cite is actually the U.S. National Center for Complementary and Alternative Medicine. Although it falls under the NIH umbrella, it is not a mainstream-medicine organization; it focuses on CAM, which by definition is not mainstream medicine. In the past NCCAM has supported obvious pseudoscience such as remote viewing and distant healing. It has its supporters (enough to get Congressional funding, after all; NCCAM was created for political reasons, not for scientific ones) but it also has sharp critics (for example, ).
  • The mainstream view of chiropractic is what is being disputed here. On the one side we have proponents of chiropractic who say that the mainstream view is represented by the The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders and that sources critical of chiropractic are fringe. On the other side we have those less supportive of chiropractic, who would point to (say) the American Pain Society/American College of Physicians clinical practice guideline, which only weakly recommends spinal manipulation as one alternative therapy (among many) for spinal low back pain in nonpregnant adults when ordinary treatments fail (see Chou et al. 2007, PMID 17909210), or maybe to the Swedish guideline for low back pain, which removed chiropractic manipulation as a treatment option in 2002 (see Murphy et al. 2006, PMID 16949948).
  • That's just the short version. For more details about what mainstream sources say about effectiveness, please see Chiropractic #Effectivness.
Eubulides (talk) 07:56, 31 May 2008 (UTC)
  • Lets look at those ACP guidelines again. For acute LBP, how "many" "alternative" therapies are recommended? One could also point out that those 2002 Swedish Guidelines are obsolete - and that they have been replaced by the European guidelines way back in 2006. For acute LBP they recommend "Consider (referral for) spinal manipulation for patients who are failing to return to normal activities". They also state that "Back schools (for short-term improvement), and short courses of manipulation/mobilisation can also be considered." for chronic LBP (among other options). And now we're back to equating SMT w/ Chiropractic again. DigitalC (talk) 03:34, 5 June 2008 (UTC)
  • For acute low back pain, the ACP guidelines recommend the consideration of only one alternative therapy (SMT) for patients who do not improve with standard care. For chronic or subacute LBP, they recommend consideration of eight therapies, one of which is SMT. My understanding is that the European guidelines do not replace national guidelines; is that incorrect? Do you have a source on this point? If the Swedish guidelines have been replaced, Chiropractic should be updated; no point referring to obsolete guidelines. Eubulides (talk) 07:05, 5 June 2008 (UTC)
Why would the European guidelines NOT replace national guidelines? What are they for then? Interestingly enough, I can't find a 2002 guideline for backpain from SBU, only a 2000 guideline, which DOES recommend SMT ("For chronic low back pain, there is strong evidence (A) that: • manual treatment/manipulation, back training, and multidisciplinary treatment are effective in relieving pain."). Looks like I will have to chase the sources. DigitalC (talk) 07:50, 5 June 2008 (UTC)
I am still confused why we are refering to the 2002 Swedish Guidelines, when we have the more recent European Guidelines, of which, Sweden was a member country (that, and as far as I can tell, the 2002 Swedish Guidelines have been repealed, as they no longer appear on the website, but the 2000 guidelines do). DigitalC (talk) 07:25, 12 June 2008 (UTC)
Chiropractic does not cite the 2002 Swedish guidelines directly; it cites Murphy et al. 2006 (PMID 16949948), which talks about the Swedish guidelines along with four other national guidelines. I wouldn't expect the European guidelines to supersede the Swedish, any more than I would expect the WHO guidelines on education to supersede CCE accreditation standards in the U.S. I'm leery about assuming that the 2002 guidelines have been repealed and the 2000 guidelines reverted to; that sounds like an extraordinary event and I'd expect some documentation of it. Eubulides (talk) 08:15, 12 June 2008 (UTC)
  • Disagree. If we have to debate over whether it's WP:FRINGE or not, it's probably not. Obviously there are a lot of WP:FRINGE elements in some chiropractic practices, and some claims about chiropractic medicine are WP:FRINGE, but mark them as such individually if necessary, or present a WP:NPOV discussion of the issues. This is really an issue of regional differences -- some countries consider Osteopathy and Chiropractic to be main-steam, and other areas they're unheard of. NoDepositNoReturn (talk) 23:54, 16 June 2008 (UTC)
  • I agree with much of what you said, but I'm afraid the argument "if we have to debate over whether it's WP:FRINGE or not, it's probably not" doesn't make sense, as it essentially argues that there is no such thing as a fringe theory. After all, for every fringe theory there is a debate over whether the theory is fringe, as the theory's adherents obviously won't think it is. Anyway, I do agree that the "fringe!" / "not-fringe!" argument is oversimplified, and that chiropractic has some aspects of being fringe and some of being mainstream. Eubulides (talk) 01:30, 17 June 2008 (UTC)
  • Okay, that was overly simplistic. My point was that this debate, as opposed to many other WP:FRINGE debates that I've witnessed, seems to be taking place between rational people. I should have indicated a more tongue-in-cheek tone. I stand by my argument that it should not be considered WP:FRINGE though for the reasons stated above, minus the part about us debating it. NoDepositNoReturn (talk) 04:03, 19 June 2008 (UTC)

A little context helps

"In contrast, the more recently updated guideline (2002) made no recommendation to use SMT as a treatment intervention for the acute phase of LBP, possibly because the guideline developers based their treatment recommendations on grade of recommendation “A,” which represents the highest level of evidence. ... Meanwhile, the Danish guideline (2000) based all of their treatment recommendations on a grade of recommendation B" - A little context helps. They don't provide a reference to the 2002 guideline. DigitalC (talk) 08:08, 5 June 2008 (UTC)

Yes, context helps. Similar context is given in Chiropractic, which makes a similar contrast between the Swedish guidelines and the American. Eubulides (talk) 19:46, 5 June 2008 (UTC)
No similar context is given. "There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain. For example, a 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail, whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help." This statement implies that the Swedish guidelines are evidence of controversy regarding efficacy, and that the Swedish guidelines don't consider SMT effective. However, the source used explains that the change might not be due to any controversy, but due to the fact that the Swedish guideline developoers "based their treatment recommendations on grade of recommendation "A"..." DigitalC (talk) 23:30, 5 June 2008 (UTC)
  • I agree that two points are conflated here.
  • The first point is that there is continuing conflict on efficacy; this is supported by the following quote from the start of the source's "Discussion" section: "Our study showed that there is insufficient evidence to suggest that the 5 LBP guidelines reviewed should be updated based on best evidence (1999–2004). Inconsistencies in the evidence suggest that there is continuing conflict of opinion regarding: efficacy of SMT for treatment of nonspecific or uncomplicated LBP; optimal time in which to introduce this treatment approach; whether SMT is useful for treatment of chronic LBP; and finally, whether subacute LBP actually exists as a separate category requiring a specific treatment approach in its own right."
  • The second point is that there is doubt about the reliability of the guidelines due to the levels-of-evidence issue that you mentioned. This is supported by the following quote from the start of the 3rd paragraph of the "Discussion" section: "The mostt surprising finding, and a factor that casts some doubt on the reliability of the recommendations made, was that the levels of evidence and/or grades of recommendation used for formulating treatment recommendations varied so significantly between countries."
  • Chiropractic#Effectiveness currently mentions only the first point; it should also mention the second.
  • The "For example" in Chiropractic#Effectiveness is not in the source and should be removed. The source does not give the 2007 U.S. guideline as an example.
  • I propose the following change to take the abovementioned points into account. In Chiropractic#Effectiveness under Low back pain, change from this:
"There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain. For example, a 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail, whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help."
to this:
"There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain. Methods for formulating treatment guidelines differ significantly between countries, casting some doubt on the guidelines' reliability. A 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail, whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level."
Eubulides (talk) 06:12, 6 June 2008 (UTC)
No further comment, so I installed the above change with the further minor editorial change of replacing a period by a semicolon. Eubulides (talk) 04:32, 9 June 2008 (UTC)
I haven't looked through this section or followed this conversation, so I reserve judgement for now. Just right off the top, I would wonder why we use a 2002 study after a 2007 study. I'll take a better look a little later and if I have any concerns I'll bring them up then. -- Dēmatt (chat) 12:34, 9 June 2008 (UTC)
I don't know what is meant by "2002 study" here. Both the original and the revised text cite Murphy et al. 2006 (PMID 16949948) and Chou et al. 2007 (PMID 17909210). Eubulides (talk) 20:01, 9 June 2008 (UTC)
I've taken a look at the sources and am concerned that we have again reached conclusions that were not reached by the sources. IOWs, we have created a little WP:SYN. The juxtapositioning of the text seems as if we are casting a negative light on something that we should presenting NPOV. -- Dēmatt (chat) 13:12, 9 June 2008 (UTC)
By "negative light" which phrases do you mean? Certainly there are several negative phrases in the low back pain section of Chiropractic #Effectiveness (e.g., "no longer suggest considering SMT"), but there are several positive phrases too (e.g., "good evidence supporting SMT"). The area is controversial, and Chiropractic needs to present both sides as fairly as possible; inevitably this means that some negative light will be cast, as well as some positive light. Eubulides (talk) 20:01, 9 June 2008 (UTC)
Ok, I'll try and review more of those sources later. My general impression is that the mainstream view could be summed up overall as "chiro is not completely proven but is widely accepted even within medical practice for back pain, but sometimes incorporates mystical elements which do not have any support in medical science." Is that right? If the article could be written with that general tone, would that be a good article? ——Martin ☎ Ψ Φ—— 23:51, 31 May 2008 (UTC)
I'm not sure I'd agree with the "chiro is not completely proven but is widely accepted..." wording. More accurate would be "it is controversial whether chiropractic care is effective, but it is partly accepted...". Quoting Chiropractic#Effectiveness, "There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain. For example, a 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail, whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help." This is not what I'd call "wide acceptance" or "not completely proven". Eubulides (talk) 08:39, 2 June 2008 (UTC)

Challenge continued

  • I doubt given our respective histories on CAM articles that either Martinphi or I may be considered completely uninvolved, but I broadly agree with the above assessment. Clearly, anything involving subluxations is obviously fringe at best, but even Quackwatch agrees that chiropractors can treat neuromusculoskeletal problems. If I recall correctly, the profession is currently debating with itself over whether it should practice specialized physical therapy or abandon itself to mysticism. WP:FRINGE applies to the latter view, but not to the view of chiropractic as a minor health-allied profession. We should make this distinction clear and report on percentages as appropriate. - Eldereft ~(s)talk~ 22:03, 30 May 2008 (UTC)
Yes, exactly, very good analysis. I've had one or two edits to Homeopathy article and just a few on the talk page- that's about all for me on alternative med. ——Martin ☎ Ψ Φ—— 23:20, 30 May 2008 (UTC)
A very interesting comment by Eldereft. I agree with 90% of it. I wouldn't call it a "minor allied health profession" because frankly, the sources don't even come close to saying that but they do some primary contact provider for NMS. The "debate" that you referred to is over, the World Federation of Chiropractic, in 2005 has positioned chiropractic as the spinal health care experts in the health care system. It also states that chiropractic should focus on
  • Ability to improve function in the neuromusculoskeletal system, and overall health, wellbeing and quality of life.*
  • Specialized approach to examination, diagnosis and treatment, based on best available research and clinical evidence with particular emphasis on the relationship between the spine and the nervous system
  • Tradition of effectiveness and patient satisfaction
  • Without use of drugs and surgery, enabling patients to avoid these where possible
  • Expertly qualified providers of spinal adjustment, manipulation and other manual treatments, exercise instruction and patient education.
  • Collaboration with other health professionals
  • A patient-centered and biopsychosocial approach, emphasizing the mind/body relationship in health, the self-healing powers of the individual, and individual responsibility for health and encouraging patient independence.

So, it's a done deal. Primarily NMS yet with a overall holistic approach to health and well-being. The percentages are also clear: 90-95% of DCs treat NMS disorders (primarily back and neck pain), 5-10% treat non-NMS. I've been trying to get this crucial point across for months now. CorticoSpinal (talk) 00:01, 31 May 2008 (UTC)

I view with great skepticism any claim that the debate is "over" or that "it's a done deal". Remember, this is chiropractic we're talking about: put 3 chiropractors in the room and ask them a question, and you're bound to get at least 4 strongly held and widely varying answer. Certainly the WFC approach is not universally held by chiropractors: Homola, a chiropractor, argues that the WFC's definition is "plunging the profession deeper into pseudoscience and away from establishing an identity for chiropractors as back-pain specialists". See: Homola S (2008). "Chiropractic: a profession seeking identity". Skept Inq. 32 (1).
Maybe what we need to get from this is that when we talk about Neuromusculoskeletal(90-95%) we can use mainstream editing, but when we talk about the vitalistic (non-materialistic) aspects of subluxation and innate intelligence(5-10%), whether past or present, we need to treat it as a Fringe theory - meaning that we explain it NPOV, but give the mainstream view more weight. I'm okay with that... does that work for others? The trick is that we have to be able to differentiate who uses what concepts, because it is not fair to either side (reform or straight) to burden them with the other's baggage or jargon. -- Dēmatt (chat) 00:35, 31 May 2008 (UTC)
Those percentages do not sound right, as I expect that far more than 5-10% chiropractors are straights. (I have no idea where those percentages came from; can anyone cite a source?) Furthermore, the vitalistic stuff is important when explaining chiropractic history, so it needs to be covered more than just the current percentage of practitioners would suggest, if only in Chiropractic #History. Finally, as the McDonald survey shows, the distance between straights and mixers is not as far as a simple "straights vitalistic, mixers materialistic" discussion would suggest. Eubulides (talk) 01:08, 31 May 2008 (UTC)
Being a straight DC doesn't imply fringe. Straights by and large majority treat MSK issues, they're just more likely to treat non NMS ones. Vitalism was used to differentiate legally and is better represented by holism today. The concept still stands: the whole is greater than the sum of its parts. Was it Aristotle or Plato who said that? Regardless, I support Dematts suggestion its sensible, but lets not bring skeptical inquirer articles and Homola into this: We have DC/PhDs who produce far better articles with better content on the same subject. Homola has direct ties with Stephen Barrett and his views are completely fringe. See his article in 2006 in Clin Ortho which was rebutted by Dr. Hart and throttled by DeVocht's counterpoint which was a far superior piece of research. Bottom line should be, the identity issue is officially put to rest, primarily NMS yet overall health, and the majority of the profession should not be discredited because of the fringe aspects of a minority of practitioners. Good call by MartinPhi as well. We're moving in the right direction; this is positive, productive dialogue for a change. CorticoSpinal (talk) 01:46, 31 May 2008 (UTC)
Not surprisingly I disagree with the characterization of Homola's recent publications: I think they're of higher quality than DeVocht's paper. I also disagree that the identity issue has been put to rest. It's not just Homola who says that chiropractic still suffers from a high degree of internal confusion. See, for example, the WCA's take on the WFC's position. Eubulides (talk) 07:56, 31 May 2008 (UTC)
The WCA is the most fringe element of the profession and they are not to be taken seriously whatsoever. We don't give the WCA any weight because the WCA has no credibility, inside or outside chiropractic. Again, you want to drum up a false sense of controversy, using a fringe source and more fringe association (WCA) and make it doubt the mainstream view. This line of argumentation now is getting very weak and tiresome. I think you've exhausted your last life line, the WCA card has been played and it will be summarily debunked and proven as fringe. Another attempt to have the fringe view of chiropractic exploited to discredit and dispute the notability and credibility of the mainstream view regarding chiropractic identity and the WFC. CorticoSpinal (talk) 09:33, 31 May 2008 (UTC)
In reply to CorticoSpinal's message of 19:46, 30 May 2008 (UTC): I think what you're talking about has nothing to do with the WP:FRINGE guideline (or if it does, would someone tell me which part? though see re parity, below). Rather, I think it's about what sources are considered reliable sources of sufficient reliability and notability to be worth mentioning. However, even here I think labelling some things as "fringe" or not is of little use. WP:Reliable sources#Extremist and fringe sources says that fringe stuff "should be used only as sources about themselves and in articles about themselves or their activities". So if some chiropractic sources are fringe, then this article is the place to use them. If they are not fringe, then this is still the place to use them. How would labelling chiropractic as fringe or not make any difference to the content of this article?
On the other hand, labelling some particular parts of chiropractic philosophy as being on the fringe of chiropractic, as Eubulides suggests (last section of , and "I agree that the article should only cover the chiropractic fringe the way that..."), does seem useful to me. Besides presenting the mainstream science POV of chiropractic, this article should describe the beliefs held by most chiropractors, and those held by a minority of chiropractors should also be more briefly mentioned, but those fringe views held by a tiny minority of chiropractors should not be mentioned, per WP:UNDUE.
QuackGuru also mentioned WP:Fringe theories#Parity of sources. I'm puzzled as to why it's those who think this article is already too pro-chiropractic who are trying to get it labelled as "fringe" so that sources not normally classified as RS can be used to describe the chiropractic point of view or in order to override Misplaced Pages:WikiProject Medicine/Reliable sources#Using primary sources to "debunk" the conclusions of secondary sources to allow use of certain sources, presumably the ones CorticoSpinal is trying to get included but which have been called primary sources. Anyway, I think there are enough good sources about chiropractic that we don't need to invoke WP:FRINGE to allow lower quality sources: we only need to debate which sources are good and why. I think labelling all of "chiropractic" as either "fringe" or "mainstream" would be an overgeneralization that would not be particularly useful for that.
Sorry, Dematt, but I don't understand at all what you mean by "mainstream editing".
Trying to get a single yes-or-no answer as to whether all of "chiropractic" is "fringe" and using that to switch this article to one of two very different forms depending on the answer to that question is not my idea of how WP:NPOV works. (If at some later date chiropractic gradually crosses some threshold and becomes no longer "fringe", would the article have to suddenly switch to a very different form at the precise moment chiropractic is determined according to Wikipedian consensus to have crossed that threshold?)
I think Fyslee has hit the nail on the head in this diff: "Come on now guys." ☺ Coppertwig (talk) 14:10, 31 May 2008 (UTC)
  • The main point of WP:FRINGE, as I understand it, is a comparative one: that fringe views should not receive undue weight when compared with the general mainstream. So, when the topic is Chiropractic, the issue is the weight with which the several schools of practise should be presented. If the McTimmoney school, for example, is a minor one, then it should not get too much attention. If one is taking a wider view of chiropractic's merits vs osteopathy, physiotherapy, surgery, acupuncture or whatever, then this would be addressed in a more general article such as Back pain. This article is not the place to make this comparison since the topic here is specifically Chiropractic. So, in conclusion, it seems logically obvious that Chiropractic cannot be fringe within its own article. Colonel Warden (talk) 20:01, 31 May 2008 (UTC)
    • The dispute is not over whether chiropractic's merits should be compared to osteopathy etc. Almost none of that is in Chiropractic now. The dispute is over what weight to give sources supportive of chiropractic, as opposed to sources critical of chiropractic, in sections like Chiropractic#Effectiveness and Chiropractic#Safety; also, whether to include sources whose effectiveness or safety results are partly derived from non-chiropractic data. Eubulides (talk) 08:39, 2 June 2008 (UTC)
  • That is a different issue and the key factor there would be the independence of the sources to avoid COI. We should look for impartial judges of such issues. This would tend to exclude those with a commercial interest in promoting or denigrating the practise. Note also that we should not give undue weight to such issues. The article's section on cost effectiveness seems dubious for example - I'd like to see some evidence that the cost-effectiveness of this form of treatment is a significant issue which merits the attention given. If the idea is that the FRINGE label can be used as an excuse to turn the article into an attack like the homeopathy one then the answer is an emphatic NOT. Colonel Warden (talk) 23:43, 3 June 2008 (UTC)
  • If we excluded everybody who had a commercial interest in promoting or denigrating chiropractic, the article would become practically empty. No D.C. could be a source; no M.D. either. Such a standard is unrealistic. The vast majority of high-quality sources on chiropractic are by D.C.s or M.D.s (or both).
  • The cost-effectiveness of chiropractic is a valid topic. Dozens (perhaps hundreds) of scholarly papers have mentioned the subject. For a few recent examples, see Leboeuf-Yde & Hestbæk 2008 (PMID 18466623), Stochkendahl et al. 2008 (PMID 18377636), Ernst 2008 (PMID 18280103), and Bronfort et al.' 2008 (PMID 18164469).
Eubulides (talk) 07:24, 4 June 2008 (UTC)
Don't know what it's like in other countries, but in Australia, chiropractic pretty much means musculoskeletal. When you go there you get an adjustment, and the cost of an adjustment at various concessions is the only price on the wall. In order to practice as one you have to have a Bachelor of Applied Science from a university - ironically the same ones that hand out medical and physiotherapy degrees. Normal health funds here (e.g. , ) will pay part of an adjustment and a fair percentage of chiropractic X-rays (in fact I got the latter on Medicare! ) It's certainly not fringe science. That being said, claims reminding one of 1920s ads of things that can cure cancer or AIDS or epilepsy or whatever, would certainly be fringe if they were put as fact. Orderinchaos 20:43, 4 June 2008 (UTC)
I have to agree wholeheartedly with Colonel Warden here. WP:FRINGE is not intended to permit attacks on a practice or procedure within its own context, or to enforce evaluations of the relative merits of practices in a larger context. WP:FRINGE's primary purpose is to maintain encyclopedic style - preventing articles from becoming overburdened with a plethora of small, disorganized, tangential discussions. use of WP:FRINGE as an evaluative tool is clearly biased.
I'll add a further caution about the use of the term 'effective' in this discussion. the correct term is 'legitimized'. it is true that effectiveness of a treatment is used to legitimize a practice or procedure in the medical community, but it would be a logical fallacy to assert from that that the lack of legitimization by the medical community implies a lack of effectiveness. --Ludwigs2 06:27, 18 June 2008 (UTC)
well, I was think about this passage (which admittedly comes a couple of lines before Chiropractic #Effectiveness): "Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs pseudoscientific and antiscientific reasoning and makes unsubstantiated claims." which aside from being brutally POV, is deeply confused about the relationship between evidence and legitimacy. the more I look through this article, the more I see that, in fact: it's quite disturbing. --Ludwigs2 10:02, 18 June 2008 (UTC)
That quote is about evidence-based guidelines, and which chiropractors support them. It is not about legitimacy. The legitimacy stuff is in Chiropractic #Scope of practice. As for POV, the quoted text is based on a reliable source (Keating, perhaps the leading historian of chiropractic in the past two decades), and I don't know of any reliable source seriously disputing it. Eubulides (talk) 22:20, 18 June 2008 (UTC)
On the surface, I have to agree with Ludwigs on this one. That section needs work, but I am waiting for the priority list because I only want to say things once this time. -- Dēmatt (chat) 02:45, 19 June 2008 (UTC)

Removed Scientific research on 6/9/2009

I have been bold and am moving this section of Chiropractic to the talk page as it seems to have several synthesis problems and therefore is not appropriate in article space. We can replace sections of this as we fix them. Some have already been discussed and agreed to changes that are not yet in this version. -- Dēmatt (chat) 14:34, 9 June 2008 (UTC)

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care. Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs pseudoscientific and antiscientific reasoning and makes unsubstantiated claims. A 2007 survey of Alberta chiropractors found that they do not consistently apply research in practice which may have resulted from a lack of research education and skills. Evidence-based chiropractors possess the ability to apply research in practice. Continued education enhances the scientific knowledge of the practitioner.

Effectiveness (current version)

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

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

Available evidence covers the following conditions:

Low back pain (current version)

  • Low back pain. There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain; methods for formulating treatment guidelines differ significantly between countries, casting some doubt on the guidelines' reliability. A 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail, whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level. A 2008 review found strong evidence that SMT is similar in effect to medical care with exercise, and moderate evidence that SMT is similar to physical therapy and other forms of conventional care. A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain. Of four systematic reviews published between 2000 and May 2005, only one recommended SMT, and a 2004 Cochrane review () stated that SMT or mobilization is no more or less effective than other standard interventions for back pain.

Research and guidelines (renamed from Effectiveness - work in progress)

Chiropractors may use one or more of several modalities or methods in any combination to treat neuromusculoskeletal (NMS) conditions. They include several types of spinal manipulation(SMT)/mobilization(MOB), flexion/distraction, massage, ice/heat, physiotherapeutics, exercise, and ergonomic type advice. Depending on their training they may also use acupuncture, nutritional advice or other alternative medicine techniques. Some researchers consider that something unique to the doctor-patient encounter common to alternative medicine practitioners plays a role in effectiveness as well. Guidelines are generally consensus statements by experts in the field based on the best available evidence, including meta-analysis and systematic reviews where available.

  • Low back pain. Guidelines for the treatment of low back pain divided into 3 categories; acute pain (less than 6 weeks duration), subacute (6 to 12 week) and chronic (more than 12 weeks). The efficacy for the use of any of these modalities varies depending on the category. There is still conflict of opinion concerning the proper frequency and duration of any of the interventions, or whether the guidelines accurately reflect effectiveness. However, most guidelines based on best evidence support the use of SMT for nonspecific (i.e., unknown cause) chronic low back pain (CLBP). A 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail. The Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help, possibly because the guideline's recommendations were based on a high evidence level. A 2008 review found strong evidence that SMT is similar in effect to medical care with exercise, and moderate evidence that SMT is similar to physical therapy and other forms of conventional care. A 2007 literature synthesis found good evidence supporting SMT for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain. Of four systematic reviews published between 2000 and May 2005, only one recommended SMT, and a 2004 Cochrane review () stated that SMT or mobilization is no more or less effective than other standard interventions for back pain. Flexion/distraction was determined to be as effective as exercise... Massage was beneficial during the chronic phase but was not effective or recommended during the acute phase. Physiotherapeutics have little support on their own, though may have some benefit when used in combination with other modalities. Exercise is not recommended during the acute phase, though is strongly supported in subacute and chronic phases. Ergonomic advice and pamphlets alone were found to have little effect in any phase.
Low back pain comments

Comment #1

  • There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain; methods for formulating treatment guidelines differ significantly between countries, casting some doubt on the guidelines' reliability.
This is the first statement we make about SMT. As nonspecific low back pain is only one type of low back pain and has different stages; acute, subacute, and chronic that all have different guideline suggestions for SMT, I suggest this is a not the balanced majority view, yet is given the first sentence. It leaves the reader with a negative POV about any of the guidelines. What are the guildeines saying? Which of the guidelines are wrong? All of them? Is one right? Are none right? If we use this sentence at all, we should use it after we have explained the guidelines as well as the controversy and then the doubt will be cast based on the evidence, not because we said so. It's a question of juxtapositioning and NPOV#Neutrality and verifiability. Our first sentence should make a net return statement that is explained with the subsequent information. Something like; "Spinal manipulation/mobilzation is effective to varying degrees for the treatment of low back pain depending on the cause of the pain, duration of the pain, and attitudes of the patient." Then we can go into guidelines if we want and even argue them back and forth if we must. Though guidelines are not really science, they are based on science, but they are usually consensus statements formed by top people in the fields that deal with the problems. Which is one of the reasons we should consider renaming this section.
-- Dēmatt (chat) 14:44, 10 June 2008 (UTC)
  • It isn't the first statement made about SMT in Chiropractic#Scientific research. There are several earlier statements. For example: "Many controlled clinical studies of SMT are available, but their results disagree, and they are typically of low quality."
  • Earlier sentences in the section already talk about guidelines. Here is one example among several: "The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care."
  • The source does not answer questions like "Which of the guidelines are wrong? All of them? Is one right?". We'd all love to know the answers to those questions, but I'm afraid definitive answers are not available.
  • There is already an introductory statement saying something along the lines you suggest. Here it is: "The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment."
  • I agree that Scientific research is not a good name for the section, and have proposed a different name, but the proposal didn't gain consensus. I don't recall what the name was now, but it was something about being evidence-based. I still think a name like Evidence basis would be better than Scientific research.
Eubulides (talk) 19:43, 10 June 2008 (UTC)
"It isn't the first statement made about SMT in Chiropractic#Scientific research." We're getting back into being pedantic. It is clearly the first sentence in the subsection about low back pain. I agree with Dematt that this section doesn't seem to be NPOV. In fact, to me it reads like a negative POV sandwhich - put in the beginning negative (continuing conflict of opinion on efficy), sandwhich the positive POV in the middle, and then end with negative POV again (of 4 systematic reviews, ONLY 1, AND...). DigitalC (talk) 00:31, 11 June 2008 (UTC)
I apologize for referencing the wrong section, and thank you DigitalC for stating it clearly. -- Dēmatt (chat) 03:02, 11 June 2008 (UTC)
  • There is a paragraph about low back pain (not a subsection) that is part of a Chiropractic#Scientific research section and Chiropractic#Effectiveness subsection that clearly establish context for that paragraph. This context applies to all the paragraphs in the subjection: not just low back pain, but also whiplash and other neck pain, headache, etc. It is not "pedantic" to mention prefatory remarks, which are applicable to several paragraphs in the section, as being part of context for that section. Copying this context over and over again into each paragraph would make the article longer, more repetitive, and more boring.
  • Furthermore, the paragraph on low back pain is not a simple sandwich. Here's what it does:
  • It leads with the fact that there is conflict (neutral).
  • It says that this casts doubts on guidelines' reliability (neutral, because since some guidelines favor chiropractic and some don't).
  • It mentions the 2007 U.S. guideline (positive).
  • It mentions the 2002 Swedish guideline (negative).
  • It mentions the 2008 review (positive).
  • It mentions the 2007 literature synthesis (positive).
  • It briefly summarizes four pre-2006 reviews (negative).
  • This isn't a sandwich: it is a smorgasbord, and it is a faithful attempt to write an NPOV summary of high-quality reviews in this area. The order is reverse-chronological within source type (where the types are overviews, guidelines, and reviews). There was no attempt to write a "sandwich", and the resulting order is not that of a "sandwich".
Eubulides (talk) 17:58, 11 June 2008 (UTC)
It is NPOV when we closely follow the sources. If editors do not like Scientific research then my second choice would be Evidence basis. QuackGuru 01:48, 11 June 2008 (UTC)
You added that without consensus again. If we are to continue to work with consensus rules then I would ask that you revert your edit. "Evidence base" does not fit what we have written either. We woud have to edit it differently with a name like that. -- Dēmatt (chat) 03:02, 11 June 2008 (UTC)
Thanks for reverting yourself. How about "Research and guidelines"? -- Dēmatt (chat) 13:26, 11 June 2008 (UTC)
Me thinks something along the lines of Evidence-based medicine and research would be a better name. QuackGuru 17:49, 11 June 2008 (UTC)
Shorter names are better. Eubulides (talk) 17:58, 11 June 2008 (UTC)

Whiplash and neck pain

  • Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain. A 2008 review found evidence that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis. A 2007 review found that SMT and mobilization are effective for neck pain. Of three systematic reviews of SMT published between 2000 and May 2005, one reached a positive conclusion, and a 2004 Cochrane review () found that SMT and mobilization are beneficial only when combined with exercise, the benefits being pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder. A 2005 review found limited evidence supporting SMT for whiplash.

Headache

  • Headache. A 2006 review found no rigorous evidence supporting SMT or other manual therapies for tension headache. A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine. A 2004 review found that SMT may be effective for migraine and tension headache, and SMT and neck exercises may be effective for cervicogenic headache. Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of SMT.

Other

  • Other. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions. Other reviews have found no evidence of benefit for baby colic, bedwetting, fibromyalgia, or menstrual cramps.

Questions

  • What is this section about - is it about effectiveness of chiropractic or is it about effectiveness of SMT. As chiropractors use more than SMT, it would not be NPOV to discuss SMT as if it were chiropractic any more than we would discuss spinal injections as if it were medicine. Medicine may use injections as one option for treatment in the management of low back pain, but that is not all that medicine does, so when the evidence does not support the use of injections, we do not suggest that medicine is not effective, only that injections are not effective. I see that we have three options; either 1) move this to the Spinal manipulation article, or 2) we keep something like this and add details of effectivness of some of the treatment methods that chiropractors use. These would include massage, exercise, nutrition, elctrical muscle stimulation, ultrasound, ice, heat, stretching , trigger point work, acupuncture, etc., etc.. Or 3) we only discuss chiropractic in the general terms and we use the sources appropriately to talk about chiropractic in general without any inferences to any specific treatment modality. Of course any NPOV discussion of chiropractic effectiveness would have to address "compared to what". I think I have seen a few of those sources available. -- Dēmatt (chat) 15:07, 9 June 2008 (UTC)
  • The main motivation for Chiropractic #Scientific research is, as User:Delvin Kelvin put it, "answering simple questions that the reader will have in mind" about scientific evidence. He went on to say "Clearly chiropractic has some sort of benefit according to science. But as with all science views they use limitations, delineations and they are critical. Please lets have that information presented so it is clear for the reader...".
Then why aren't we telling Delvin Kelvin that chiropractic uses many approaches and each approach has benefits and limitations? -- Dēmatt (chat) 13:57, 10 June 2008 (UTC)
Chiropractic currently covers several treatment forms; it's not just SMT. I agree that coverage of other treatments could be better. Eubulides (talk) 19:43, 10 June 2008 (UTC)
We agree that we need to cover them better. -- Dēmatt (chat) 02:52, 11 June 2008 (UTC)
  • The material in Chiropractic#Scientific research is mostly not suitable for Spinal manipulation. Most of it is about topics other than SMT, and these topics already include exercise, self-care, advice to stay active, and others. If we can find reliable reviews of the other topics we can add them.
Agreed, this material should be under an SMT section of Low back pain, Whiplash, Neck pain, and the various symptoms that chiropractors treat that are not tiny minorities.
The material could also be briefly summarized there as well; but there is still a need to briefly summarize the effectiveness of chiropractic care here, in Chiropractic. Eubulides (talk) 19:43, 10 June 2008 (UTC)
We agree that Chiropractic should be about chiropractic care. IOWs, if we are going to label a section Low back pain, then it needs to address all the things that chiropractors do for low back pain, not just SMT. However, the brief summary should be here while the details should go in the related articles where it doesn't matter who performs them and therefore we don't have to worry about undue weight. -- Dēmatt (chat) 02:52, 11 June 2008 (UTC)
I would favor addressing all the things chiropractors do about low back pain. We need to find reliable sources, though, preferably reviews as reliable as what we have already for SMT. If there are good sources we should summarize them too. If this section gets too long we can summarize it and put it into a subarticle, but we are not there yet. Eubulides (talk) 17:58, 11 June 2008 (UTC)
If we can balance this with everything else that chiropractors use, we might be able to present it without undue weight, but a lot has not been evaluated with reviews, so we might be relegated to primary studies to present it with fairness of tone. How would we handle it on the Physical therapy article? -- Dēmatt (chat) 13:57, 10 June 2008 (UTC)
Sorry, I'm lost. Primary studies about what? The main and most common form of treatment chiropractors use is adjustment. They also routinely encourage patients to change lifestyles, and frequently perform procedures other than adjustment, but these are less common than adjustment. So I don't see how a focus on adjustment in Chiropractic #Scientific research is undue weight. Eubulides (talk) 19:43, 10 June 2008 (UTC)
Because the section is on low back pain, not spinal adjustment. -- Dēmatt (chat) 02:52, 11 June 2008 (UTC)
There are plenty of reliable reviews and treatment guidelines on low back pain; we shouldn't need to reach down into primary sources to discuss treatment modalities. Eubulides (talk) 17:58, 11 June 2008 (UTC)
This article is currently a work in progress. Your opinion is just as valid as mine. As far as I am concerned, you can make whatever changes you want in article space or here. If I disagree, I'll let you know. I expect you to address my biases just as I address yours. That is what makes WP work, though sometimes dysfunctionally. If we all remain rational and reasoned, the tools that WP provides us, NPOV, VER and RS will allow us to end up with something that we are all equally satisfied with. -- Dēmatt (chat) 13:57, 10 June 2008 (UTC)
Fair enough; I'll keep that in mind. Eubulides (talk) 19:43, 10 June 2008 (UTC)
Eubulides (talk) 20:01, 9 June 2008 (UTC)
I am sure that you can understand that when we equate SMT with chiropractic, we inadvertantly equate SMT's limitations as chiropractic's limitations. IOWs, when we say that SMT is not suggested for acute low back pain, we are inadvertantly telling the reader that chiropractic is not suggested for acute low back pain. We are not even attempting to let the reader know that chiropractors are perfectly capable of managing acute low back pain using scientifically validated methods and modalities- and this is verifiable. This entire section is a violation of NPOV for this reason - giving undue weight to this modality and synthesizing it to equate to chiropractic. If we can't fix it then we need to delete it. -- Dēmatt (chat) 13:21, 10 June 2008 (UTC)
I agree that Chiropractic #Scientific research should not attempt to equate SMT with chiropractic care, and that it should make it clear that the two are not the same thing. If the wording can be improved to make this more clear, let's by all means do that. But clarifying this point is not the same as removing the mention of all research about SMT-in-general: it's common among chiropractic sources to cite and rely on such research, even when the research is derived partly from non-chiropractic data, and we should follow the experts' lead in this matter. Eubulides (talk) 19:43, 10 June 2008 (UTC)
We agree on this. -- Dēmatt (chat) 02:52, 11 June 2008 (UTC)
"Chiropractic #Scientific research obviously has some problems, but its problems are relatively minor compared to the rest of Chiropractic. Any problems with WP:NPOV that it has are dwarfed by the NPOV problems in Chiropractic #History, for example." WP:OTHERCRAPEXISTS. Just because there are problems with other sections, does not mean that we should not be dealing with this section. Consensus was not reached on this section before someone inserted it, and therefore it should be removed until we can reach such consensus - otherwise editors will continue to insert large edits without consensus. I noticed several editors voicing support for effectiveness 3C, yet that seemed to be ignored. There is a major WP:SYN violation here that has been brought up several times, and ignored several times. DigitalC (talk) 00:38, 11 June 2008 (UTC)
We agree on this. -- Dēmatt (chat) 02:52, 11 June 2008 (UTC)
  • I agree with the WP:OTHERCRAPEXISTS point: I do not object to attempts to improve coverage of effectiveness. What I objected to was the procedure of removing everything until a consensus can be reached. That is a recipe for removing nearly everything in Chiropractic, my point about Chiropractic#History was merely that blanking sections is not a reasonable way to fix NPOV problems like this.
  • We have a continuing problem with people inserting changes without consensus, a problem that predates my involvement with Chiropractic, and a problem that will persist indefinitely unless we figure out some way to fix it. I suspect formal mediation will be the next step in that process.
  • There is some support for 3C, but also much opposition. I do not favor 3C, since it arbitrarily excludes research on SMT-in-general, even though we have reliable sources (e.g., Meeker & Haldeman) saying such research should not be excluded.
Eubulides (talk) 17:58, 11 June 2008 (UTC)

I suggest combining the sections "Utilization and satisfaction rates" and "Scientific research" into a single section which might be named "Effects", "Results", "Effectiveness and safety", or "Effectiveness, safety and patient satisfaction", which could have subsections on cost-effectiveness, utilization etc. The name "scientific research" doesn't seem to be a very good heading for a section to me: the research is what supplies us with the facts, but this article should focus more on the facts; in other words, scientific research may be used as references to support information in any of the sections of this article, but the heading should indicate what sort of results are being reported in that section. Also, it seems to me that there is a logical similarity between the topic of utilization and satisfaction, and the topics of effectiveness, safety etc., so I'd like them to be at least adjacent sections (without History in between them) and preferably combined into one section. ☺ Coppertwig (talk) 00:50, 18 June 2008 (UTC)

I agree that "Scientific research" is a bad title. None of the titles you suggest for a combined section work all that well, I'm afraid. "Effects" and "Results" are too vague, and none of those titles cover the topic of utilization. Other titles have been suggested but none have reached consensus. Here's a list of recently-suggested titles (which includes your suggestions):
  • Effectiveness and safety
  • Effectiveness, safety, and patient satisfaction
  • Effects
  • Evidence base
  • Evidence basis
  • Evidence-based medicine and research
  • Research and guidelines
  • Results
Of these suggestions, Evidence base makes the most sense to me, as it's the shortest title that covers the subsections' topics. Also, the current introduction to Chiropractic #Scientific research would fit well under that title. Eubulides (talk) 08:29, 18 June 2008 (UTC)

Scientific evaluation of methods 2

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which treatments are legitimate and perhaps reimbursable under managed care.

Effectiveness

Many medical procedures have not been rigorously proven to be effective, including many of the methods that chiropractors use. This does not infer that they are not effective for some conditions under certain conditions, only that their effectivenss has not been adequately studied. Particularly, though many chiropractors suggest maintenance care, the effectiveness of this type care is unknown.

Comments on "Scientific evaluation of methods 2"

Is #Scientific evaluation of methods 2 a draft of a replacement for Chiropractic #Scientific research? It's just a stub and would need much work to be an adequate replacement. Eubulides (talk) 20:01, 9 June 2008 (UTC)

Yes, Eubilides, I was just working, then got interrupted, but, no, this is not the replacement - a work in progress. -- Dēmatt (chat)


no agreement for blanking entire sections

Sections have been blanked. There is no agreement for blanking entire sections. QuackGuru 19:25, 9 June 2008 (UTC)

I agree.
  • It's quite unhelpful to remove Chiropractic #Scientific research because of perceived NPOV problems. There are NPOV problems with several sections of Chiropractic. Currently Chiropractic #History is by far the worst, as it presents chiropractic as a profession attacked by mainstream medicine, and it presents mainstream medicine as being essentially clueless about disease, without fairly presenting the mainstream side. Despite these NPOV problems, which are much worse than any POV problems in Chiropractic #Scientific investigation, nobody has simply removed Chiropractic #History.
  • If one could remove an entire section simply because it "has problems and no consensus", then all the sections in Chiropractic could be removed. They all have problems. There is not a universal consensus for any of the sections.
  • Removing Chiropractic #Scientific research also turned several citations into red links; this is a relatively minor problem but it's another reason changes like these should be discussed first.
  • Removing all discussion of effectiveness is an even bigger, and to my mind more-controversial, change than QuackGuru's controversial edit of last month (which I also opposed). This is not the right way to edit this article. Effectiveness, safety, and cost-effectiveness are valid and important topics that should be covered in Chiropractic.
  • Again, let's discuss major controversial changes like this before installing the change. I have put my discussion of the content (as opposed to the procedure) in #Questions above.
Eubulides (talk) 20:01, 9 June 2008 (UTC)
It hasn't been blanked. It has been moved to the talk page. I think that is better than replacing it with the version that was there previously, which I was happy with but others were not. Nothing says that we have to leave something in that has no consensus and has issues concerning NPOV and OR that we need to correct. -- Dēmatt (chat) 20:05, 9 June 2008 (UTC)
This doesn't address the above bullet points. Other sections have major POV problems and lack full consensus; should they be removed as well? Removal is an extreme step and requires better justification than a terse comment about "issues concerning NPOV and OR". Please reconsider the removal in the light of the discussion above and in #Questions. Eubulides (talk) 20:37, 9 June 2008 (UTC)
I didn't realize a conversation was going on here about this, and I rarely participate in long, tendentious discussions on controversial articles, but I undid the blanking of content. Dematt is a regular, so he doesn't deserve a template, but if I had seen this with someone I didn't know, I'd have given them a Level 2 or 3 warning about deleting content. Whatever you feel about QC's additions, a simple deletion is undeserved. OrangeMarlin 21:01, 9 June 2008 (UTC)
I think you all have misunderstood what I am doing. I am not reverting anyone's edits. I am not replacing it with anything that is controversial, I am only moving it here to the talk page till we do reach consensus. Unfortunately, I have to work in spurts and can't react to all of your issues as fast as you like, but AGF.-- Dēmatt (chat) 21:36, 9 June 2008 (UTC)
  • I see; but from the point of view of the article, this was a big deletion, and big deletions can be controversial and can lack consensus too. I realize that the text being deleted is controversial, but still I'd feel more comfortable discussing an improved version here first than simply deleting the old version (leaving a big hole in the article) and waiting (for quite some time, most likely) for a new consensus. The newer version wouldn't have to be perfect; just better than what is there now.
  • #Cost-effectiveness 2 contains a draft replacement for Chiropractic #Cost-benefit, the last subsection of the deleted-then-restored text. I hope this proposal addresses some of the concerns raised. This draft was proposed five days ago, discussed quite a bit in #Cost-effectiveness 2 comments, and revised in response to the discussion; no comment has been made since then. Perhaps it's time to install it? Again, it doesn't have to be perfect; just better than what's in there now. We can discuss and improve it further later.
Eubulides (talk) 23:14, 9 June 2008 (UTC)
I didn't remove the Chiropractic #Cost-benefit section, just the intro and the Effectiveness section of Scientific evaluation. I am encouraged that you changed the sourcing of first sentence, but am waiting to get to the library for that source before I comment further. Let me take a better look at both versions again before replacing them to avoid the perception of "consensus versioning" again, making it impossible for anyone to change anything. I am also ready for education 3 to go in as well if it works for you. -- Dēmatt (chat) 11:45, 10 June 2008 (UTC)
We can fix any problems in wording once you've gotten to the library and checked the citation. In the meantime there doesn't seem to be any serious objection to #Cost-effectiveness 2 and there's been no further comment on it for several days, so I installed it. Eubulides (talk) 18:32, 11 June 2008 (UTC)
Okay, I'll put in Education 3 as well since everyone but QG seems okay with that version. We can work on any other issues that aren't perfect from there. It will be good to get some of these under our belts. -- Dēmatt (chat) 03:48, 12 June 2008 (UTC)
Ah, sorry, I didn't notice that you did not remove the Safety and Cost-benefit subsections. I support either education 3 or education 7 as improvements over what's in Chiropractic now. Eubulides (talk) 19:43, 10 June 2008 (UTC)

(unindent) I've tagged several of the issues with {{Syn}} until we can fix them. I stopped after the first two paragraphs so it wouldn't look quite so bad. -- Dēmatt (chat) 15:54, 11 June 2008 (UTC)

  • I don't think those tags were appropriate. Each single statement in Chiropractic#Effectiveness is directly supported by material in the corresponding section; that is, the cited sources explicitly reach the same conclusion that is summarized in the statement. So there is no WP:SYN problem at the statement level.
  • I don't see any WP:SYN problem in Chiropractic#Effectiveness; but if there is one, it must be something about the overall section, a gestalt if you will, and it therefore is not a property of any single statement.
  • I see now that QuackGuru removed the individual tags and kept the tag for the whole section, and I agree with that removal.
Eubulides (talk) 17:58, 11 June 2008 (UTC)
Well, the whole reason for the {{Syn}} template was to be specific about which sentences I considered needing work and remind us and motivate us to fix it since bringing it to the talk page caused some upset. But, as long as we work them through quickly and get them fixed quickly, I'll leave them off and instead work on them above again. -- Dēmatt (chat) 04:10, 12 June 2008 (UTC)
Dematt and QuackGuru (and everyone else), please don`t make significant changes without prior discussion, whether blanking sections or adding new material. Small changes such as fixing grammatical errors may not require discussion.
Eubulides, re "then all the sections of chiropractic could be removed": LOL, that reminds me of this comment by Jakew at Circumcision: "...or b) have no material whatsoever in the lead. Since the latter outcome is absurd, ..." ☺ Coppertwig (talk) 01:01, 13 June 2008 (UTC)
The problem is that we have changes that lack consensus, violate WP:NPOV and WP:SYN, that have been boldly railroaded into the article. Per WP:BRD, we should be reverting those changes, and THEN discussing it on the talk page. However, we also have an agreement by most of the editors here not to install major changes into the article without consensus, and to NOT use the BRD editing cycle, as it results in edit wars. Until EVERYONE abides by this editing style though, it won't work, and we will have to revert the significant changes that are installed into mainspace without consensus. DigitalC (talk) 04:32, 13 June 2008 (UTC)
I support the reverting of major changes installed without consensus. ☺ Coppertwig (talk) 00:53, 14 June 2008 (UTC)
I have always, in many articles, supported reverting to the version before nonconsensus edits began. Then build consensus from there. This not only upholds the principle of consensus, it makes edit warring useless, and thus eliminates one of the main problems. ——Martin ☎ Ψ Φ—— 01:13, 14 June 2008 (UTC)
  • Alas, for Chiropractic there is no "version before nonconsensus edits began". You can go back as far as you like: you'll never find a consensus version.
  • I opposed QuackGuru's May 14 edits on procedural grounds. But on content grounds, the edits were a clear improvement over what came before. The pre-May-14 version (a version that also suffered from nonconsensus edits) had severe POV problems. Every single one of the effectiveness sources it cited were strongly pro-chiropractic, dated, low-quality, primary studies; the overall effect was astonishingly biased in favor of chiropractic. In contrast, the current Chiropractic#Effectiveness cites both supportive and critical sources, and uses recent high-quality reviews. As far as quality of sources go, it's night and day compared to the low-quality stuff that was in the older version. The new version is also less biased. It's not perfect; far from it. But it's much better than the pre-May-14 version was.
  • In short, we should not go back to the pre-May-14 version; it's much worse than what we have now. We should work on improving what we have now.
Eubulides (talk) 09:23, 14 June 2008 (UTC)
I agree that we should not go back to the May 14th version, but the current version is a problem as well. This was my rationale for just bringing it to the talk page where we could work on it - get it out of mainspace. I thought I would have support. My concern was that nothing would be been done on this section if not - and nothing has been since it was edit warred back in... instead that editor moved on to something else because they are happy to have their version in mainspace - not to mention they don't have to work anything through when they have outside help who is willing to edit war to keep anything in before they even read it. I think in principle, we all agree that we can work things out here, but in spirit, we all equally lack the necessary committment. I will be able to work with either way we want to do it, but if it is good for the goose, it has to be good for the gander. And the other geese need to back it up. -- Dēmatt (chat) 18:14, 14 June 2008 (UTC)

History improvements

#History 2 is a draft replacement for Chiropractic #History. Please add comments in #Comments on History 2 below. Eubulides (talk) 17:22, 12 June 2008 (UTC)

History 2

Main article: Chiropractic history
File:Ddpalmer3.jpg
D.D. Palmer

Chiropractic was founded in the 1890s by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease. Although initially keeping the theory a trade secret, in 1898 he began teaching it to a few students at his new Palmer School of Chiropractic. One student, his son Bartlett Joshua (B.J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment. To survive accusations of practicing medicine without a license, B.J. argued that chiropractic was separate and distinct from medicine, as chiropractors "analyzed" rather than "diagnosed", and "adjusted" subluxation rather than "treated" disease. Early chiropractors believed that all disease was caused by interruptions in the flow of innate intelligence, a vital nervous energy or life force that represented God's presence in man; chiropractic leaders often invoked religious imagery and moral traditions, and B.J. seriously considered declaring chiropractic a religion, deciding against it partly to avoid confusion with Christian Science. Early chiropractors also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertisement, aligning themselves with the common man against intellectuals and trusts, among which they included the American Medical Association (AMA).

File:BJPalmer2.jpg
B.J. Palmer

Although most early chiropractors were "straight" and disdained scientific instruments, a minority, which B.J. scornfully called "mixers", advocated their use. In 1910 B.J. changed course and endorsed the use of X-rays for diagnosis; this resulted in a significant exodus from Palmer of more-conservative faculty and students. At the same time the mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight. That year, B.J. began promoting a new patented temperature-sensing device, the neurocalometer; although highly controversial among B.J.'s fellow straights, this was another sign of chiropractic's gradual acceptance of medical technology. Despite heavy opposition by organized medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S. The longstanding feud between chiropractors and medical doctors continued for decades. Until 1983, the AMA labeled chiropractic "an unscientific cult" and held that it was unethical for medical doctors to associate with an "unscientific practitioner". This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic.

Serious research to test chiropractic theories did not begin until the 1970s, and was hampered by antiscientific and pseudoscientific ideas that sustained the profession in its long battle with mainstream medicine. By the mid 1990s there was a growing scholarly interest in chiropractic, which helped efforts to establish improve service quality and establish clinical guidelines that recommended spinal manipulation in some cases. In recent decades chiropractic gained legitimacy and greater acceptance by physicians and health plans, and enjoyed a strong political base and sustained demand for services; like other forms of complementary and alternative medicine, chiropractic became more integrated into mainstream medicine. However, its future seemed uncertain: as the number of practitioners grew, evidence-based medicine insisted on treatments with demonstrated value, managed care restricted payment, and competition grew from massage therapists and other health professions. The profession responded by marketing natural products and devices more aggressively, and by reaching deeper into alternative medicine and primary care.

Comments on History improvements

Me thinks these two sections (Medical opposition and Movement toward science) requires further improvements and can be shortened. Feel free to edit both sections. QuackGuru 18:55, 11 June 2008 (UTC)

It's not just those two subsections of Chiropractic #History. The entire History section requires further improvements and should be shortened. The section should be about three paragraphs total, and should use standard WP:SUMMARY style to summarize Chiropractic history. Relatively-minor details should be moved into Chiropractic history (if they're not there already). You can see an example of this in the way that Biology #History summarizes History of biology, or in the way that Mathematics #History summarizes History of mathematics. Eubulides (talk) 19:27, 11 June 2008 (UTC)
Chiropractic has a long history. We would loose a lot of interesting facts if we shortened the entire history section. QuackGuru 19:37, 11 June 2008 (UTC)
We would not lose any facts, any more than Biology #History loses facts with its summary of History of biology, or Mathematics #History loses facts with its summary of History of mathematics. All the less-important details would be in Chiropractic history. This is standard Misplaced Pages style; see WP:SUMMARY. Eubulides (talk) 19:50, 11 June 2008 (UTC)
Well, some information may be minor while other information may be important. I would like to see WP:BOLD editing on the above sections. QuackGuru 21:05, 11 June 2008 (UTC)
Chiropractic history already includes everything that is here. All we have to do is prune this one. -- Dēmatt (chat) 04:13, 12 June 2008 (UTC)

Comments on History 2

OK, I drafted a pruned version above. It still needs work (particularly, it needs coverage of the recent evidence-based and managed-care revolution), but I hope you get the idea of the desirable length anyway. Eubulides (talk) 17:18, 12 June 2008 (UTC)

I added material about the recent evidenced-based and managed-care changes, and pruned some of the older text. #History 2 is now ready to be reviewed with the idea of putting it into the article. Please note that, like #Education, licensing, and regulation, this draft contains some material not in its subarticle; the intent is to migrate this new material into the subarticle as well. Eubulides (talk) 06:36, 13 June 2008 (UTC)

When mentioning the Manga Report, put a footnote to the actual Manga Report, since that's what the reader will want to see. Also, in the text mention the jurisdiction (Ministry of Health of where?). "its future seemed uncertain" does not seem NPOV to me. Perhaps the sentence could be re-phrased beginning something like "In response to pressure from ...". ☺ Coppertwig (talk) 13:33, 13 June 2008 (UTC)

Thanks for the comment. To respond to your two points:
  • Manga report. The stuff about the Manga report was inserted without comment by QuackGuru, along with a bunch of other stuff. I disagree that this level of detail belongs in a brief summary of over a century chiropractic history. Certainly citing the Manga report directly would be a mistake: we should be citing secondary sources (high-level summaries of chiropractic history), not primary documents. Also, we should not be citing documents from websites of defunct organizations to highlight their minor contributions to a big field. This detail should be moved to Chiropractic history; it should not be here. I've removed the unnecessary detail, removing any need to cite the Manga report.
  • Future seemed uncertain. The cited source (Cooper & McKee 2003, PMID 12669653) says this in its introduction, after the first paragraph which talks about its successes:
"Even so, chiropractic's future seems uncertain. Recent expansions of chiropractic colleges are swelling the ranks of practitioners while managed care is restricting payment for what chiropractors do and evidence-based medicine is demanding that what they do must have demonstratable value. At the same time, chiropractors are experiencing greater competition from acupuncturists and massage therapists, whose ranks also are growing."
Several other reliable sources indicate that chiropractic's future seemed uncertain. See, for example, Phillips 2005 (PMC 1840027), Nelson et al. 2005 (PMID 16000175), the 2005 IAF report, and the debate between DeVocht 2006 (PMID 16523145) and Homola 2006 (PMID 16446588). I don't know of any reliable source saying that chiropractic's future seemed or seems certain.
Eubulides (talk) 17:20, 13 June 2008 (UTC)
Me thinks the history rewrite is a bit too short. So I expanded it a bit. QuackGuru 17:54, 13 June 2008 (UTC)
That expansion is more than just "a bit". It grows the length of the summary by about 40%. It adds material that is poorly sourced compared to what's already in there. The new material cites primary sources, which is undesirable. Let's stick with what high-level reviews say rather than telling the history of chiropractic directly from primary sources in in our own idiosyncratic way; that will help us maintain perspective and avoid bias. I am not opposed to a brief mention of further conflicts among chiropractic, or a brief expansion of evidence-based medicine, so long as they are both supported by reliable general-chiropractic-history sources. But that's not what this "a bit" change does. I am reverting it for now. If, despite these comments, you continue to prefer the much-longer version, I ask that you generate a new one and call it "History 3". Eubulides (talk) 18:42, 13 June 2008 (UTC)

I agree it's short. I'm not a fan of long and agree it was too long before, but we can't sacrifice content for brevity. Are we wanting to put all of chiropractic into one bucket? If so, that is okay, but we should make sure that we don't put it in one bucket and label it straight or mixer. You almost pull it off, but I see only one source that is probably a good source for the outlook of the straight perspective, but it neglects the other 25000 chiropractors. BJ held the patent on the neurocalimeter and only allowed 5000 sold and only to straight chiropractors. This was a turning point that swelled the number of mixers against him. And remember - it was mixers that made the move against BJ toward science instead of Innate Intelligence. Yes, BJ made an attempt to become scientific with his research in which he used MDs to verify his diagnosis and results, yes he investigated and was responsible for developement of Xray to actually see these spinal distortions, but it was mixers that pushed for the education and reform of the profession. However, BJ and the straight philosophy was the only thing that could keep them out of jail, so everyone rallied behind the 'subluxation' flag. BJ constantly sabotaged mixer attempts to define chiropractic in medical terms. It split the profession. It was the push for education from the mixers starting in the 1930s and again in the 1950s (Homola spoke up during this time) that eventually earned them respect in the late 1970s during a turbulant time in US history. It wasn't until after the Wilk suit that finally ended in the early 1990s that the chiropractic institutions began dropping 'subluxation' and redefining their profession in materialistic terms. Managed care and EBM enter the scene removing any concern for 'philospohy' from both chiropractic and medical equations and only considering results of the particular intervention. Manga was the first report that stated that if chiropractors were gatekeepers, the costs would go down and this boosted chiropractics prestige. Of course there was on outrage from the medical community, but then the The US guidelines put spinal manipulation at the top of the list as alternatives for treating acute low back pain - suggesting that 90% of surgeries were unnecessary. Again chiropractic's prestige was boosted - but this time medicine became interested in performing spinal manipulation. This is why we are seeing a resurgence of the effectiveness of SMT for lbp and other MSK conditions and we are seeing competition for deciding who gets paid to do it. I don't think we have captured these important features quite yet. But don't worry, I don't think the other version did either. -- Dēmatt (chat) 14:32, 14 June 2008 (UTC)

  • The intent is that Chiropractic #History should be a brief summary of Chiropractic history. Obviously any such summary will have to leave things out; but content won't be "sacrificed", it'll be in Chiropractic history.
  • There are two main sources for #History 2: Martin 1993 (PMID 11623404) and Cooper & McKee 2003 (PMID 12669653). Both sources talk about both straights and mixers.
  • I removed the sentence "B.J. helped shift chiropractic from craft to profession, by emphasizing formal education, establishing a professional journal in 1904, and founding a professional organization in 1906." from #History 2; I think this fixes several of the problems you mention about the B.J. coverage.
  • #History 2 doesn't cover the history between 1930 and 1983 well. A high-level reliable source on that would help. (The current Chiropractic#History also neglects this period.)
  • I don't think Manga was the first to say chiropractors were cheaper. Nor did the Manga report talk about making chiropractors gatekeepers.
  • The U.S. guidelines do not put spinal manipulation at the top of the list for treating acute low back. The top of the list is advice to stay active, effective self-care, and medications with proven benefits; these are all strong recommendations. Spinal manipulation is suggested only for patients who do not improve with standard treatment; this is a weak recommendation.
Eubulides (talk) 19:20, 16 June 2008 (UTC)
  • Sure. They're in the arsenals of chiropractic and of conventional medicine alike. But Dematt's point was that chiropractic's prestige was boosted because U.S. guidelines mentioned spinal manipulation. Had the guidelines stopped after mentioning advice to stay active, and self-care, they would have not had any effect on chiropractic's prestige. Eubulides (talk) 16:57, 17 June 2008 (UTC)
The intent is that Chiropractic #History should be a brief summary of Chiropractic history. Obviously any such summary will have to leave things out; but content won't be "sacrificed", it'll be in Chiropractic history.
Well, for instance, when we leave out that DD was put in jail in 1906 for practicing medicine without a license and he sells the shop to BJ and leaves the state a beaten man we lose some of the explanation of "why". For instance, it was then that BJ came up with a "vitalistic" approach that "adjusted cause" rather than "treated disease"; Keating and Lerner suggest that this was to protect the profession from organized medicine. There are sources that say he believed that Innate Intelligence was an extension of God (Universal Intelligence) - but this was really DDs invention from his 1914 book that wasn't published until after he died, and apparently nobody bought. It was DD that wanted chiropractic to go the way of Christian Scientists - but that would mean that DD would be the spiritual leader. DD and BJ hated each other - so some sources consider this the reason BJ didn't want to go the Christian Science route. The point is that there are competing views on "who believed what and why".
We should try to write this concise version without any of this, but when we say that "Early chiropractors believed that...", we don't really know what they believed, only what they did. They built a system of healthcare based on vitalistic principles that assumed that all health was directed by a vital force that made it impossible to become part of organized medicine. -- Dēmatt (chat) 04:21, 17 June 2008 (UTC)
We can find DD expressing these religious views in 1911 in a letter. It also expresses his antagonism to his son, and the competitive nature of their relationship. While DD really did believe these religious views, I believe he (and possibly BJ) also consciously considered using them to protect the profession. -- Fyslee / talk 06:04, 17 June 2008 (UTC)
The source doesn't talk about B.J.'s or D.D.'s beliefs in particular; it talks about the belief of early chiropractors in general. Let's put it this way: if a reliable source says "Early Christians believed Christ would soon return", should we say, well, that doesn't tell the whole story, and that the belief wasn't shared by all early Christians, and there were competing views within early Christianity, and that the belief acted as a mechanism for winning converts more effectively, etc., etc. (all these points are valid ones, by the way); or should we just go with what the reliable source says is a reasonable brief summary of an important early Christian belief? After all, it is a brief summary we're talking about here. Eubulides (talk) 16:57, 17 June 2008 (UTC)
There are two main sources for #History 2: Martin 1993 (PMID 11623404) and Cooper & McKee 2003 (PMID 12669653). Both sources talk about both straights and mixers.
Still suggest Keating in those first two paragraphs as some of the "facts" seem skewed in favor of BJs world vision of chiropractic rather than the whole of chiropractic. Keating studied all the schools of chiropractic. -- Dēmatt (chat) 04:21, 17 June 2008 (UTC)
Agreed. Keating was the supreme chiropractic historian, and his work is especially valuable because he maintained a degree of objectivity towards the subject that would be impossible for a chiropractor to achieve. That's just the way it works. He both praised and criticized the profession, and devoted his life to delving into its history, to his teaching as a chiropractic professor, and to his many jobs in valuable positions of trust in the profession, most notably as president of the Association for the History of Chiropractic. We need an article about this remarkable man. -- Fyslee / talk 06:11, 17 June 2008 (UTC)
I agree that Keating is a good source. But he's cited. The other cited sources are equally reliable. Which "facts" still seem skewed? Without a more specific criticism, I don't see how to improve the draft. Eubulides (talk) 16:57, 17 June 2008 (UTC)
I removed the sentence "B.J. helped shift chiropractic from craft to profession, by emphasizing formal education, establishing a professional journal in 1904, and founding a professional organization in 1906." from #History 2; I think this fixes several of the problems you mention about the B.J. coverage.
That is an improvement, thanks. There are still more addressed above as well. If the source we are using is verifiable, then it's just a matter of adding another source from a different perspective such as Keating and we should end up with something acceptable to all POVs. -- Dēmatt (chat) 04:21, 17 June 2008 (UTC)
#History 2 doesn't cover the history between 1930 and 1983 well. A high-level reliable source on that would help. (The current Chiropractic#History also neglects this period.)
This is the vaccine period ;-) A very turbulent and defining time for the future of chiropractic. -- Dēmatt (chat) 04:21, 17 June 2008 (UTC)
I don't think Manga was the first to say chiropractors were cheaper. Nor did the Manga report talk about making chiropractors gatekeepers.
Manga was the first Phd at such a high level of government that was seen to validate what chiropractors felt; that being integrated at the same level as medical doctors (without having to go through the medical gatekeeper see R1 and R2 especially) would save the system millions. That was big to chiropractors and chiropractic history. -- Dēmatt (chat) 04:21, 17 June 2008 (UTC)
  • Manga's recommendations echoed a long list of chiropractor wishes that had been around for decades. For example, R2 talks about insurance covering chiropractic, but that had been true to some extent for decades, and the profession became more broadly eligible for insurance in the 1970s. Manga doesn't represent a revolution in this regard.
  • Keating et al. 2005's "Chiropractic History: a Primer" does not mention Manga once. Why should we mention Manga in a 3-paragraph summary when Keating et al. don't see fit to mention Manga in a 50-page description?
Eubulides (talk) 16:57, 17 June 2008 (UTC)
The U.S. guidelines do not put spinal manipulation at the top of the list for treating acute low back. The top of the list is advice to stay active, effective self-care, and medications with proven benefits; these are all strong recommendations. Spinal manipulation is suggested only for patients who do not improve with standard treatment; this is a weak recommendation.
This is historical: (1994) the AHCPR guideline 14 came out for acute low back pain. Check out the Physical Methods section. The only physical method to be considered effective for low back pain was spinal manipulation. And yes, advice to stay active and effective self-care were things that are part of chiropractic care as DigitalC understands. IOWs, this was very supportive of what chiropractors did, but it was also going to be something that everyone was now going to want to do as well. Insurance companies start covering chiropractic care on an equal basis as medical... Chiropractic practices boom... then comes managed care and competition (though we should not be repeating statements about "the future of chiropractic is full of doom" - this may well depend on the social structure of the medical system in each individual country)... -- Dēmatt (chat) 04:21, 17 June 2008 (UTC)
OK, but the current #History 2 draft already talks about managed care and competition, and it doesn't say anything about doom, merely about lack of certainty. To summarise the AHCPR stuff I added "guidelines that recommended spinal manipulation in some cases" to #History 2. Eubulides (talk) 16:57, 17 June 2008 (UTC)
Mirtz TA, Long P, Dinehart A; et al. (2002). "NACM and its argument with mainstream chiropractic health care". J Controv Med Claims. 9 (1): 11–8. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) Here is a fun article to read. This reference might be useful for History or even the schools of thought section. QuackGuru 06:55, 19 June 2008 (UTC)
I think we can add this to the article now. No specific improvements have been recommended recently. QuackGuru 18:37, 21 June 2008 (UTC)
I suggest waiting. I haven't had a chance to look at it yet. Soon History will be the "hot topic". I would appreciate it if you would wait until a consensus version has been agreed on during the time that it's the "hot topic"; I think that's the procedure that's been agreed on.☺ Coppertwig (talk) 18:54, 21 June 2008 (UTC)
The idea was that we should focus our attention on particular topics and try to achieve consensus on each topic. However, this idea does not preclude people responsibly editing other sections in the meantime, in ways that are not obviously controversial. In our earlier discussion of this idea I wrote "I don't object if others want to work on Education, but to my mind History comes first, and it can be worked on in parallel". Nobody disagreed with working in parallel. Obviously when our focus turns to History we can review whatever changes have been added there, but no objections have been made to the draft in #History 2 and it's been sitting here for quite some time and has been fixed in response to reviews; so I don't see any objection to installing it now. Naturally it can be edited further later when it comes under focus. Eubulides (talk) 20:51, 21 June 2008 (UTC)
No way, I haven't even looked at history. I'm still waiting to finish education. I thought that was the idea. If we put History 2 in now, that would be like making a large edit without consensus wouldn't it? -- Dēmatt (chat) 21:50, 21 June 2008 (UTC)
  • I don't think we agreed to freeze all other work on Chiropractic for what? six months? Currently there are 8 topics listed and up to 3 weeks devoted to each, and that would add up to nearly six months, which is way too long for a freeze. When talking about the proposal I suggested parallel work on other sections and nobody disagreed. I don't recall any consensus for a long freeze.
  • What I thought was that there was a consensus to focus on one section at a time, and to try to work to achieve consensus on that section. That does not preclude parallel work in other sections.
  • When you have a chance to look at #History 2, please feel free to comment on it. There's no rush, and that remains true regardless of whether it's on the talk page or installed into Chiropractic.
Eubulides (talk) 22:51, 21 June 2008 (UTC)
Okay, We probably do need to get science cleaned up pretty quick, too. I'll go ahead and put education 3 in now. -- Dēmatt (chat) 23:06, 21 June 2008 (UTC)
Don't panic about the tags. I'm using them more as markers while I look for sources so that you can see why I am concerned. -- Dēmatt (chat) 00:53, 22 June 2008 (UTC)
I can understand your concern. For example, DD Palmer did have about eight years of formal education, mixers probably quickly became a majority (but still believed in subluxations, just as most of them do today), etc.. This history section just doesn't jibe with the understanding of chiropractic history I have in my head, and I've read quite a bit. I would prefer we used Keating more, as he is a more reliable historian. Some other chiropractic historians include plain wrong information. -- Fyslee / talk 05:49, 22 June 2008 (UTC)

(<<outdent) Nobody's asking you to wait six months. Education may be finished or almost finished; maybe we can put it in now or in a few minutes/hours. (I'm making a list of differences between the different drafts.) I'm OK with putting in Education 8. Then we can make History the hot topic. Anyway soon I'll be looking through History in more detail. I didn't see any problems on initial reading, but hope to be able to check the refs. So, some patience with History would be appreciated. ☺ Coppertwig (talk) 01:35, 22 June 2008 (UTC)

Comments on finished History 2

Please review History 2. If you have concerns please be specific. QuackGuru 19:15, 21 June 2008 (UTC)

History 3 improvements

I have withdrawn the obsolete History 3 because History 2 has greatly improved. QuackGuru 00:28, 17 June 2008 (UTC)

Comments on History 3 improvements

Here is another choice for editors to review. The history of chiropractic should tell a story. For example, the landmark Manga report is part of the story. This draft 3 could be a good replacement for Chiropractic #History. Feel free make suggestions and edit the above draft 3. QuackGuru 19:50, 13 June 2008 (UTC)

  • I agree that the history should tell a story. But the Manga report is not nearly so important that it deserves to be mentioned at this level, much less emphasized. The Manga report is just one of dozens of similar reports and is a small part of a long overall debate about the effectiveness and cost-effectiveness of chiropractic. For example, Cooper & McKee 2003 (PMID 12669653), a general survey that is of high quality, has about eight pages summarizing the history of evidence-based investigation of chiropractic. It cites the Manga report as one of five citations suppporting the phrase "In the early 1990s, reviews and metanalyses of more than 30 such trials concluded that SMT was safe and effective" and then goes on at considerable length (about three pages, with dozens of citations) for what happened after that, with respect to effectiveness and cost-effectiveness. The word "Manga" never appears in the discussion; it appears only in the abovementioned citation to one of 5 sources.
  • Chiropractic #History should be summarizing the likes of Cooper & McKee 2003; it should not be reaching down and emphasizing one of Cooper & McKee's dozens of citations, far more than Cooper & McKee themselves do. I am not saying that we have to follow Cooper & McKee weightings slavishly, of course; what I am saying is that Cooper & McKee's coverage of Manga suggest that #History 3's emphasis of Manga is way out of line compared to the weighting given by reliable sources.
  • The Manga report is not the only problem with #History 3. It also greatly overemphasizes the "objective straight" and "reform" movements, which had a relatively minor effect on the history of chiropractic. This overemphasis, again, is not supported by reliable historical surveys of chiropractic. Cooper & McKee, for example, mention neither objective straights nor reforms in their 32-page paper (despite spending about half a page on straights and mixers).
  • This exhausts the main set of differences between #History 2 and #History 3; I see no reason, supported by reliable high-level sources, to prefer #History 3 to #History 2.
Eubulides (talk) 20:28, 13 June 2008 (UTC)
  • "It's future seemed uncertain" is taken out of context. I suggest restoring the context by including the following words right after it: "the ranks of practitioners swelled,".
  • I think the activator is far more notable than the neurocalometer, and is not mentioned anywhere in the article. (I did a few web searches (e.g. "activator chiropractic" in google scholar) and got many times the hits for activator than for neurocalometer.) I suggest stating somewhere in the article the date of invention of the activator and the name of the inventor. E.g. this link has that info.
  • I agree with Eubulides that there's too much material on straights and mixers or whatever. The Wilks thingy works well as the end of the paragraph; the other stuff coming after it seems out of place.
  • I'd like to see some info on the spread of chiropractic to countries other than the U.S., and the pattern of chiropractic schools, e.g. if there was a particular time period when a lot of new schools opened; the link given above also mentions a lot of schools closing at one point. ☺ Coppertwig (talk) 00:53, 14 June 2008 (UTC)
Thanks for your comments. Here's what I did:
  • In #History 2 I added "as the number of practitioners grew" after "future seemed uncertain". This is a bit less poetic than "swelled", but I thought the "swelled" would be a bit confusing for non-native English readers.
  • In #History 2 I removed moved the "other stuff coming after it".
and here are some other thoughts:
  • The activator is more notable in the current practice of chiropractic (and this explains your Google Scholar results), but the neurocalometer is far more notable as far as the history of chiropractic goes. See, for example, Chiropractic history: a primer, which gives a couple of sentences to the activator while giving a page and a half to the neurocalometer.
  • I don't know of any good source (i.e., a high-quality recent review) for the recent (as opposed to pre-1930) history of the education of chiropractic. It's not clear to me that it's worth mentioning at this level. The above-cited chiro history primer doesn't mention it.
  • Nor do I know of a good source for the expansion of chiropractic to countries other than the U.S. Again, the chiro history primer doesn't mention it.
Eubulides (talk) 09:23, 14 June 2008 (UTC)

I like that this version attempts to be more thorough, but reflects some major errors that would require delving deeper into the sources. It also seems to give BJ a lot of credit, for instance - it says he professionalized the profession and adds that because he started a journal - well everyone had a journal. If this source considrs that the reason the profession developed, I would begin to question the source. The whole issue of trying to predict the future is WP:Crystal ball and should be abandoned, even if it said that the future looked bright. Cooper is from 2003 anyway and things are vastly different as research has been added in rapid amounts. I also disagree that we can only use summaries and I'm not aware of anything that states that this needs to be the case for history sections - though it is important not to re-invent history and create a pseudohistory such as both of these versions. Keating is considered the most reliable source for chiropractic history. He worked within it, but was not a chiropractor and is quite often critical of chiropractic. He has several books and papers published in peer reviewed journals. His primary research is available online as well as most of his articles in JMPT, PubMed and elsewhere. -- Dēmatt (chat) 14:54, 14 June 2008 (UTC)

Many of these comments apply also to #History 2.
  • I have removed from #History 2 some of the credit given to B.J., by removing this sentence: "B.J. helped shift chiropractic from craft to profession, by emphasizing formal education, establishing a professional journal in 1904, and founding a professional organization in 1906." This should address the B.J. part of the comment.
  • Cooper & McKee 2003 (PMID 12669653) is being cited about history in the past few decades. That history has not changed.
  • In a controversial area like this, we are much better off using historical summaries from reliable sources. It's far too easy to pick and choose our own historical tidbits and give a misleading picture. This is supposed to be a summary section, after all: it's better to rely on a reliable source to give us that summary, instead of using our own opinion to decide what's important enough to summarize and what isn't.
  • I agree Keating is a reliable source on chiropractic history, and he'd be a fine source for Chiropractic #History. I suggest his Chiropractic History: a Primer.
Eubulides (talk) 19:20, 16 June 2008 (UTC)
I have included information using Keating as a source. At this point, which version do editors prefer. The current mainspace version, history 2, or history 3. QuackGuru 20:00, 14 June 2008 (UTC)
I merged some of the suggestions (including using Keating as a source) into #History 2. #History 2 now covers the same general material as #History 2, in what I hope is a more concise and encyclopedic way. #History 2 cites the Keating et al. history primer rather than Keating's individual articles, as I think the primer provides a better overall summary of history. Eubulides (talk) 19:20, 16 June 2008 (UTC)
History 2 has been improved and now is better than History 3. QuackGuru 19:38, 16 June 2008 (UTC)

History 4?

Moving History 2 here with my concerns marked for now.

Chiropractic was founded in the 1890s by Daniel David (D.D.) Palmer in Davenport, Iowa. Palmer, a magnetic healer, hypothesized that manual manipulation of the spine could cure disease. He began teaching it to a few students at his new Palmer School of Chiropractic before being incarcerated for practicing medicine without a license in 1906. His son, Bartlett Joshua (B.J.) Palmer, took over the school and became committed to promoting chiropractic; rapidly expanded its enrollment.To survive accusations of practicing medicine without a license, B.J. argued that chiropractic was separate and distinct from medicine, as chiropractors "analyzed" rather than "diagnosed", and "adjusted subluxation" rather than "treated disease". Early chiropractors believed that all disease was caused by interruptions in the flow of an innate intelligence, a vital nervous energy or life force; chiropractic leaders often invoked religious imagery and moral traditions. They also tapped into the Populist movement, emphasizing craft, hard work, competition, and advertisement, aligning themselves with the common man against intellectuals and trusts, including the American Medical Association (AMA).

File:BJPalmer2.jpg
B.J. Palmer

Although most early chiropractors were "straight" and disdained scientific instruments, which B.J. scornfully called "mixers", advocated their use. In 1910 B.J. changed course and endorsed the use of X-rays for diagnosis; this resulted in a significant exodus from Palmer of more-conservative faculty and students. At the same time the mixer camp grew until by 1924 B.J. estimated that only 3,000 of the U.S.'s 25,000 chiropractors remained straight. That year, B.J. began promoting a new patented temperature-sensing device, the neurocalometer; although highly controversial among B.J.'s fellow straights, this was another sign of chiropractic's gradual acceptance of medical technology((really)). Despite heavy opposition by organized medicine, by the 1930s chiropractic was the largest alternative healing profession in the U.S. The longstanding feud between chiropractors and medical doctors continued for decades. Until 1983, the AMA labeled chiropractic "an unscientific cult" and held that it was unethical for medical doctors to associate with an "unscientific practitioner". This culminated in a landmark 1987 decision, Wilk v. AMA, in which the court found that the the AMA had engaged in unreasonable restraint of trade and conspiracy, and which ended the AMA's de facto boycott of chiropractic.

History 4 is a work in progress

Made a start and feel good about first paragraph... Taking a break for the night. -- Dēmatt (chat) 02:39, 22 June 2008 (UTC) Okay

This is not a good start or a proposal. QuackGuru 18:46, 22 June 2008 (UTC)
Thanks for the vote of confidence :-) I'll keep working on it. Do you have any specific suggestions for improvements? -- Dēmatt (chat) 02:49, 23 June 2008 (UTC)
There already is a finished History draft. Please review the completed History 2 and provide specific suggestions for improvements. That's my specific suggestion. QuackGuru 06:22, 23 June 2008 (UTC)
Not inadvertant. Didn't want to bite off more than I could chew. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I agree with removing the "no formal education" from #History 2; it's not important enough to be worth emphasizing here.
Agree. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I agree with removing "21-year-old", for similar reasons.
Good news. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I disagree with removing the point that B.J. was D.D.'s student.
I'm okay with that. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I agree with replacing "gained control of" with "took over".
We're on the same page so far. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I agree with moving the "To survive accusations" sentence up to just after the "took over" sentence.
Makes more sense there. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I disagree with removing the trade-secret issue; that's more important.
You might be right. It's the word 'trade secret' that sticks out at me considering that there really wasn't a trade. Keep an open mind on this and see if there is another source that uses something similar? Otherwise, I'll agree to stick with 'trade'. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I disagree with ending D.D.'s career at the Palmer School with "before being incarcerated for practicing medicine without a license in 1906". This gives a misleading impression that D.D. had to give up control of Palmer because he was jailed. That's not what happened: he got into a fight with B.J. I don't think the incarceration is that important (it would be more relevant to cite the fight between D.D. and B.J., but I don't think that's so important either, in the big scheme of things we're reporting here).
Hmmm. You're interpretation is unusual. We might have some sources that disagree, likely because only DD and BJ know for sure. No doubt there was bad blood, but I've never read that it was the reason BJ's wife bought the college for $2000. Let's keep looking. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I disagree with removing "that represented God's presence in man". Both D.D. and B.J. believed that innate intelligence was a fraction of the Almighty.
I'm not sure we can be sure what DD or BJ believed. One thing for sure, they both wanted control of the profession and making it vitalistc would keep it in their hands. DDs ultimate life force was Universal Intelligence which is not really a God per se. Though, no doubt some interpreted it this way. Again, we might have to compare some sources. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I disagree with removing "and B.J. seriously considered declaring chiropractic a religion, deciding against it partly to avoid confusion with Christian Science". It's worth emphasizing the importance of religion of early chiropractic (as this is quite different from the role of religion in chiropractic now, and is not discussed elsewhere in the article).
They were accused of being a religion, but never saw anyone saying they were. During the years of trying to keep chiros out of jail, DDs letter suggests he was wanting to go the way of Christian Science so that they could be protected from Medicine and of course he could be the leader (and get the school from BJ), but obviously BJ wouldn't go for that. Of course, I'll give way to reliable sources. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • I disagree with removing "a minority," from the 2nd paragraph. Mixers did start out being a minority. Also, removing the phrase makes the sentence ungrammatical.
How do you know mixers were a minority... ever? Most of DDs first students went on to start mixer chiropractic colleges. Solon Langsworthy started the mixer school right after he graduated... It was only after 1902 that DD even coined the phrase mixer to describe those like Solon. I'm not sure we can reliably say there was ever a minority of mixers. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • The ((really)) and Template:fact in the 2nd paragraph aren't needed; the source (Martin) makes the point explicitly.
Again, those were notes for me to verify, I also thought they were interesting.
  • I changed #History 2 to incorporate the above bullet points.
It's much better. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)
  • These are all the points I see in #History 4? so far; if I missed any, please let me know.

Eubulides (talk) 08:18, 23 June 2008 (UTC)

That's it so far. I didn't get to work on it today, but I still have concerns about paragraph two that I'll work with and we can work it this way. I don't feel comfortable changing your work directly as we tend to lose what was there and we may want to go back to it. -- Dēmatt (chat) 03:52, 24 June 2008 (UTC)

Comments on moving information

Objective Straight chiropractors, who were an off-shoot of straights, only focused on the correction of chiropractic vertebral subluxations while traditional straights claimed that chiropractic adjustments are a plausible treatment for a wide range of diseases. Reform chiropractors were an evidence-based off-shoot of mixers who rejected traditional Palmer philosophy and tended not to use alternative medicine methods.

I suggest we move this information back to the Schools of thought and practice styles section. QuackGuru 18:23, 14 June 2008 (UTC)

This material doesn't belong under Chiropractic #Schools of thought and practice styles, as those groups are no longer active. A good place for this material is Chiropractic history. Eubulides (talk) 19:20, 16 June 2008 (UTC)
I think this material is interesting information for Chiropractic#Schools of thought and practice styles, as this is part of the schools of thought. QuackGuru 00:33, 17 June 2008 (UTC)
Do we have any sources that shows that these groups still exist (by name)? DigitalC (talk) 03:38, 17 June 2008 (UTC)
The section is about Schools of thought and practice styles. This is part of the schools of thought. I used the correct tense in the sentences. For example, who were an off-shoot of straights... The word were makes it clear to the reader. QuackGuru 08:03, 17 June 2008 (UTC)
It is very strange to be citing the web sites of seemingly-nonexistent organizations to demonstrate the current importance of their philosophies. This material is not that relevant to the current state of chiropractic. It is of relatively minor historical interest at this point. It belongs in Chiropractic history, not in the current section. Eubulides (talk) 16:57, 17 June 2008 (UTC)

Egads! Structure!

I am having difficulty following this talk page, and I don't think I'm alone (at least I really hope not :-p). There appears to be about 10 disputes happening all at once, and I'm having trouble following them. I'm hoping this discussion can be centralized a bit more for the sake of our collective sanity. Might this be why there is difficulty moving forward? Xavexgoem (talk) 19:05, 13 June 2008 (UTC)

What would it mean for the discussion to be "centralized"? Would it mean someone would write a brief summary of open topics, and keep it up-to-date as new topics emerged? That sounds like a lot of work, but if someone (perhaps you?) would volunteer to write and maintain such a summary, I'm sure it'd be welcome here. Eubulides (talk) 20:40, 13 June 2008 (UTC)
I'm not entirely sure. Everyone is all over the talk page. It might help to collapse (with {{collapse}} templates) or remove/archive some of the stuff from talk. But I don't know what's still disputed and what's been dealt with (I see many of the drafts have been blanked), so I'd need a quick summary (which could be used to write the summary you suggested). But right now, I'm just aiming to keep everything more compacted :-) Xavexgoem (talk) 21:03, 13 June 2008 (UTC)
  • We are currently automatically archiving all threads with no activity for 10 days (recently shortened from 14 days). We could shorten the interval to 7 days, I suppose, but at some point if we keep shortening that interval it will become too short.
  • I'm afraid that pretty much everything in Talk:Chiropractic is part of a dispute that is currently live. It's a contentious article, alas.
Eubulides (talk) 21:37, 13 June 2008 (UTC)
OK. I was initially thinking of collapsing some of the older headers (particularly the blanked drafts). I should probably ask for QuackGuru's input on that, though (or leave it the way it is). I think reorganizing will help a lot here. Or is communication relatively OK? Xavexgoem (talk) 22:50, 13 June 2008 (UTC)
I don't know. I am a regular commenter here and I took two weeks off. I came back today to get caught up and it is pretty unorganized. Too many versions of suggested rewrites floating around. If everything could be re-arranged and each topic of discussion somehow grouped together that would be helpful. Is it unusual/disallowed to have sub-pages for discussing particular issues (i.e. Could we create a Talk:Chiropractic/History page where we can solely discuss the proposed rewrites of the History section?) -- Levine2112 23:00, 13 June 2008 (UTC)
Certainly allowed, albeit a little unusual. Although it might be best to simply focus on one thing at a time for now :-) Xavexgoem (talk) 23:06, 13 June 2008 (UTC)
For examples of such pages, see Talk:Abortion/First paragraph and Misplaced Pages talk:Attribution/Role of truth (Misplaced Pages talk:, not Misplaced Pages:18:44, 15 June 2008 (UTC)) I think it's probably a good idea, at least for a few of the most active discussions. Perhaps ideally a draft would be on a subpage of its own: one advantage would be that the page history would be easier to follow. (OK, starting now I'll try to follow Eubulides' example in combining many comments in a single edit, though that also causes problems in trying to refer back to one of those comments.) A disadvantage of subpages, though, is that people might not notice them or might not take the time to go there to participate. We would need some sort of prominent template informing people of the existence of such subpages. ☺Coppertwig (talk) 00:53, 14 June 2008 (UTC)
That's my main concern: sub-pages tend to go unnoticed, and discussion tends to lag (although I'm positive this can be mitigated, but one step at a time...). I know that nearly the entire contents of this article are under dispute, but what do you (or anyone) think is the most important thing that needs discussion? I think we need a starting point :-) Xavexgoem (talk) 01:03, 14 June 2008 (UTC)
Eubulides (talk) 09:44, 14 June 2008 (UTC)

(undent). Well, again, part of our problem is that one person re-writes a section then, before we finish satisfying the concerns raised by other editors, two new sections are started that distract us from what we were working on. As a result we end up with fragmented discussion about three different sections and then, as no-one has been active on the initial discussion, someone mistakenly assumes consensus has been reached because everyone has moved on. He/she then re-inserts it into the main article without satisfying the concerns of NPOV, SYN and OR. When an editor then reverts because the section was added too soon, outside parties then join into an edit war - making it difficult to keep reach a version we can all agree on. Essentially, this is distracting and the cycle repeats. For instance, we really haven't finished the education and science sections and we are working into history and now, below (even while having this discussion) we open a thread about the lead. It would be nice if we all concentrated on one section at a time instead of spreading ourselves so thin. It would likely be a less stressful experience for all of us and likely get things done a lot faster in the long run. All we would have to do is agree that we will not move on until at least those of us that are here consistantly agree on the section and re-insert it together. -- Dēmatt (chat) 12:49, 14 June 2008 (UTC)

Idea: identify in a template at the top of this talk page one topic as the "hot topic" that everybody is supposed to focus on primarily, with a link to the section where it's being discussed. Discussion can also proceed on other topics, but for major changes to be inserted into the article, they must have consensus while the topic is a "hot topic" for at least 48 hours. People can add topics to the bottom of a list. Once a topic is done, we move to the next one on the list. People could be encouraged to do RfC's only for the current "hot topic", if possible, and any RfC's could also be listed in the "hot topic" template. If no consensus is achieved within 3 weeks we can demote a topic back to the bottom of the list for later consideration. ☺ Coppertwig (talk) 18:44, 15 June 2008 (UTC)
Oooh... I like it :-D would make for a good template generally.
There's no consensus on where to start, though. Eubulides has said that the histories are the most POV. Any ideas (from anyone?). Focus will help... Granted, page protect won't be lasting long. Xavexgoem (talk) 22:28, 15 June 2008 (UTC)
I think we are closest on a consensus for Education. Specifically, version #3 has garnered the most acceptance. -- Levine2112 00:55, 16 June 2008 (UTC)
Version #3 has multiple problems, including the blocked text. These extra details are unnecessary and have been rejected. QuackGuru 03:25, 16 June 2008 (UTC)
I suggest the following order, based, according to my possibly imperfect analysis, on sections of the article for which there's been discussion within the past week, listed in the order they appear on this talk page:
  • Current hot topic: Education
  • Next hot topic: Cost-benefit/cost-effectiveness
  • Scientific research
  • History
  • Lead
If others are willing to go along with this, I suggest that Education be designated the hot topic for at least 48 hours starting when a template announcing it is placed at the top of this talk page. If there appears to be consensus at the end of 48 hours, we can then edit the material in (or request {{editprotected}}). Meanwhile, people can be already discussing the other topics, perhaps especially the one that will be the next "hot topic". I suggest the following message to be placed at the top of this talk page.
Current hot topic: Education, licensing and regulation
☺ Coppertwig (talk) 02:12, 16 June 2008 (UTC)
Sounds like a plan. I like the order. -- Levine2112 02:36, 16 June 2008 (UTC)
This is very innovative. Very good idea (: ——Martin ☎ Ψ Φ—— 04:30, 16 June 2008 (UTC)
Multiple editors have rejected the blocked text. See Talk:Chiropractic#Comments on Education.2C licensing.2C and regulation 7.
Cost-benefit/cost-effectiveness and Scientific research are already NPOV.
History 3 is slightly better than History 2.
The lead can easily be improved by shortening it to four paragraphs. QuackGuru 06:21, 16 June 2008 (UTC)
Thanks for your support, everyone. OK, I'm being bold and adding a section "List of hot topics" below, and placing a template at the top of this talk page, although I realize that not everyone has had a chance to comment yet. Feel free to discuss whether to have this system at all and the details of its implementation. ☺ Coppertwig (talk) 12:56, 16 June 2008 (UTC)
Awesome idea! Way to go, this should help considerably and keep us focused till we get things finished. Thanks, CopperTwig for such a wnoderful innovation!!! -- Dēmatt (chat) 15:52, 16 June 2008 (UTC)
  • The idea of focusing makes sense, but I disagree with the priorities mentioned. This talk page mutates randomly, and the order of the topics in this talk page has little to do with a good order for addressing the problems. The order listed above doesn't even make sense, as Cost-effectiveness is a subtopic of Scientific research. Eubulides (talk) 19:20, 16 June 2008 (UTC)
  • Also, The proposed schedule is unrealistic. Not everyone can visit this talk page in every 48-hour window. Eubulides (talk) 19:20, 16 June 2008 (UTC)
  • The most important problem in this Chiropractic is its POV. POV is a violation of a core Misplaced Pages policy. The other stuff is secondary. We should focus on sections that have the worst POV problems. Right now, Chiropractic #History is by far the worst section in that area, and deserves the highest priority. I don't object if others want to work on Education, but to my mind History comes first, and it can be worked on in parallel (it's mostly done anyway, as #History 2 has merged in the improvements from #History 3 and I hope it doesn't have any serious objections). Eubulides (talk) 19:20, 16 June 2008 (UTC)
The OR violations is science are pretty important as well, after all, that reflects current chiropractic. I've only just begun to look at history. -- Dēmatt (chat) 20:44, 16 June 2008 (UTC)
I'm thinking that everyone has some different priority - but it appears we all agree that something is wrong with each. I'm of the opinion that OR should be solved first, since that can be solved to an ideal level; NPOV is harder.. not that it's an impossibly endless struggle, just that it's a lot to swallow when so much is flying around. (but that's just me) Xavexgoem (talk) 00:24, 17 June 2008 (UTC)
In the ideal case, OR would be simpler. But in this particular case I don't think OR will be any simpler; quite the contrary. Every claim in Chiropractic #Scientific investigation is backed by a reliable source. Claims are not glued together with conclusions supplied by Misplaced Pages editors. With that in mind, the allegation that Misplaced Pages's prohibition on original research is violated because the section contains WP:SYN is an odd one. This allegation is not based on anything simple like the examples seen in WP:SYN; it is based on something more esoteric, something that has not been explained well on this talk page. Threshing this out will take a lot of time. Eubulides (talk) 16:57, 17 June 2008 (UTC)
I'm willing to start with education. It is the closest to being finished and more likely to be agreeable to everyone. QuackGuru and I sure could use some more eyes on it to get us over the last hump. -- Dēmatt (chat) 01:53, 17 June 2008 (UTC)
Dematt is very well aware of the problems with Education 3. Education 7 is better. QuackGuru 02:00, 17 June 2008 (UTC)
(ec)Thanks for your comments, Eubulides. I realize that I went ahead and put up the template before you had a chance to comment; as I said, I consider that discussion on this is still open. Perhaps you would like to suggest a different order for the topics. I don't really care what order they're in as long as everybody agrees on one order. I thought it might make sense to do Education first since I was under the impression that it was practically finished, and I tried to use objective criteria to establish the initial order to try to avoid argumentation about the order. Re not everybody being able to visit the page every 48 hours: I've thought of three possible solutions; there may be more: one is to have a waiting period after something has been a "hot topic" and before the new material is inserted into the article. Better, I think, though, is for people who visit the page less often to comment on the one or two topics that are scheduled to be "hot topics" next, so that they don't necessarily have to comment during the actual time they're a "hot topic". A third possibility is to use a longer minimum time that a topic has to remain a "hot topic": perhaps you'd like to suggest a length of time, Eubulides. Coppertwig (talk) 02:22, 17 June 2008 (UTC)
I agree that this is a good idea, and agree with Dematt that it feels like some editors are moving on to other sections once they feel they have gotten the version they like inserted into the article. We have never come to a consensus on Effectiveness or Education, yet some editors have moved on to History. I agree with starting with Education because we are almost there. DigitalC (talk) 03:53, 17 June 2008 (UTC)
I'm feeling a consensus! :-) Which is strange; it's usually so intangible ;-) Xavexgoem (talk) 04:06, 17 June 2008 (UTC)
It isn't actually that strange to get consensus here. For example, we had consensus to not make any major changes to the article without obtaining consensus on those changes first. However, consensus doesn't mean unanimous, and we may see that certain editors will ignore this new good idea. DigitalC (talk) 07:58, 17 June 2008 (UTC)
I guess I don't mind putting Education first, since people are anxious to get it out the door. That will let us experiment with this procedure with a less-controversial section. But after that I suggest looking at the sections that have had the longest-standing and most-major POV or OR beefs first. This suggests the order History, Effectiveness, Cost-effectiveness, Scientific research (intro only), and Lead, with the proviso that any significant changes to earlier sections be coordinated with simultaneous changes to the lead, and that we work on the lead per se more as an exercise in brevity (it's currently too long) rather than removing policy violations (which should all be gone by then). Eubulides (talk) 16:57, 17 June 2008 (UTC)
Thank you, Eubulides. Levine2112 and everyone else, what do you think of the order suggested by Eubulides? ☺ Coppertwig (talk) 00:50, 18 June 2008 (UTC)
I forgot to comment about the 48 hour business. I suggest that we try 96 hours (not merely 48 hours) as a time to wait to see whether consensus has developed. Eubulides (talk) 08:29, 18 June 2008 (UTC)
96 hours sounds OK to me. I forgot to mention that Philosophy, having already been added to the bottom of the list, would come next after the order you suggested. I would appreciate your help, Eubulides, in figuring out where exactly on this talk page each topic should link to (which might change as the discussions progress). ☺ Coppertwig (talk) 12:27, 18 June 2008 (UTC)
96 works better for me, too. -- Dēmatt (chat) 14:46, 18 June 2008 (UTC)
It occurs to me that I was not here for the month that others worked on the Effectiveness or Scientific Research section and that others may be burned out on the science, so I'll agree to go with History next, provided I can take a day to recover from celebrating Education. Eubulides, in the meantime, way up in the Scientific research 3C (I think) you and I discussed taking out the word pseudoscience from that statement about EBM. I would feel a lot better if we took that out while we waited to finish History. Are you alright with that? -- Dēmatt (chat) 02:59, 19 June 2008 (UTC)
Yes, that's right, I had forgotten that long ago in #Continued discussion of Scientific investigation 3C you made a convincing argument that pseudoscientific is irrelevant in this particular context. I removed the "pseudoscientific and" from Chiropractic #Scientific research. Eubulides (talk) 06:25, 19 June 2008 (UTC)
Keating JC Jr (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skept Inq. 21 (4): 37–43. Retrieved 2008-05-10. Please read the reference. The word pseudoscience is referenced and it is one of the main points of the article. QuackGuru 06:16, 19 June 2008 (UTC)
It seems to me that there's consensus for Eubulides' suggested order of topics, so I've put them in. I hope that this is settled and that from now on we can just add new topics to the bottom. ☺ Coppertwig (talk) 00:53, 20 June 2008 (UTC)

suggestions for next hot topics

Current hot topics: History & Lead. (schedule of hot topics)

Both the history and the lead are finished and are ready for mainspace. I suggest we make both rewrites the next hot topics. QuackGuru 19:46, 21 June 2008 (UTC)

I commend QuackGuru's enthusiasm and energy, which helps keep us moving. However, I weakly oppose QuackGuru's suggestion (apparently) to increase the number of hot topics at one time to two, though not strongly enough to block consensus. I feel strongly that there should not be more than three. The whole idea of having a "hot topic" is to increase the focus on a section; having more than one dilutes that focus. Any increase in the number of "hot topics" might start us down a slippery slope.
As I see it, it's OK to make small changes and non-controversial changes to sections that are not "hot topics". I would prefer that people hesitate a lot before implementing major changes such as a rewrite of an entire section that is not a "hot topic"; I would prefer just waiting to make these changes when it does become a "hot topic", but as a compromise I have another suggestion: "warm topics": if a draft has already been worked on by multiple people and they believe they can get consensus for it, I suggest listing it in a central location (e.g. a "List of warm topics" below the "List of hot topics"), waiting a few days (96 hours?) and then if there are no objections putting it into the article. Maybe there should be a limit to only one "warm topic" at a time. However, I would prefer not having a "warm topics" system at all for slippery slope reasons.
Just for reasons of stability, I also weakly oppose QuackGuru's proposal to change the order of topics, again not strongly enough to block consensus. The less often we make changes in the order of topics, the less time we'll spend discussing the order of topics and the more time we'll spend discussing and finishing the actual article content, allowing us to move through the hot topics list faster. Also, there may be people who have relied on the stated order of hot topics to know that they probably don't urgently need to visit this page in the next few days; changing something unexpectedly could be unfair to them. In any case, I think we should wait at least a couple of days (96 hours?) for those who edit less often to comment before making either of these two changes. ☺ Coppertwig (talk) 10:52, 22 June 2008 (UTC)
Cost-effectiveness is not a hot topic.
Scientific research (intro only) is not a hot topic.
Vertebral subluxation is not a hot topic.
Cost-effectiveness is an old topic. The scientific research intro is not being debated on chiropractic talk. The debate is about the SYN tag. Vertebral subluxation is not being discussed. QuackGuru 20:07, 22 June 2008 (UTC)
Why is it that you get to decide what is, or is not, a hot topic? DigitalC (talk) 01:29, 23 June 2008 (UTC)
Why is it that you think I get to decide what is, or is not, a hot topic? QuackGuru 05:52, 23 June 2008 (UTC)
I put Vertebral subluxation at the bottom of the list because it needs to be updated along with he rest of this article and I have some new stuff to put in, but will wait till we get to that section... provided, of course, that the list doesn't just keep changing. And I am concerned about cost effectiveness and Scientific Research, too. I seem to keep having to say this. -- Dēmatt (chat) 02:55, 23 June 2008 (UTC)
Dematt put Vertebral subluxation at the bottom of the list of hot topics without a specific proposal. If you have concerned about cost-effectiveness or Scientific research then please discuss it. QuackGuru 05:52, 23 June 2008 (UTC)

(outdent)

  • My concern is that the list of "hot topics" would serve to freeze the article unduly. Under the current schedule, it might take nearly six months to get through the list of "hot topics". That is a glacial pace, not a hot one. Having a current hot topic should not preclude work in parallel in other areas. This point particularly applies to proposals that were already drafted on this talk page before the "hot topic" idea was proposed. It would not be right for proposals with no substantive negative comments to languish in limbo for six months.
  • I'd rather avoid the bureaucratic overhead of the "warm content" idea unless the bureaucracy is truly necessary, which I hope it isn't. The "hot topics" idea is complicated already; let's not overcomplicated it.
  • I'm sympathetic to QuackGuru's point that History and the lead have specific proposals for improvement, and in that sense are hotter topics than Effectiveness (syn tag), Cost-effectiveness, and Scientific research, which do not have any specific wording proposals for improvement. I expect that sections without specific proposals will take considerably more time to discuss.
  • I'm also sympathetic to Dematt's point that the POV issues are more serious in Effectiveness, Cost-effectiveness, and Scientific research. I don't mind addressing them first, but we need specific wording suggestions to make progress there.
  • I see no reason to have 3 separate items in the list of hot topics for Effectiveness, Cost-effectiveness, and Scientific research. It is essentially the same dispute about all three. I propose we merge these 3 items into one. This will help allay some of my worries that this process will drag on too long.

Eubulides (talk) 08:18, 23 June 2008 (UTC)

List of hot topics

Add new topics to the bottom of the list. Each topic should focus on a section of the article where major changes are needed, or on a new section to be added to the article. A topic will remain "hot" for at least 96 hours and no longer than 3 weeks. People can change which section of this talk page a topic is linked to, as long as it's essentially the same topic – or provide more than one link for a topic.

Lead rewrite

I deleted this cut and paste of the lead since no specific changes were made to the text. I see editors are editing the lead in mainspace instead. QuackGuru 05:53, 16 June 2008 (UTC)

Comments on lead rewrite

The lead is a bit long and some parts of the lead may need a rewrite to match the changing article. Feel free to edit the above draft. Any thoughts? QuackGuru 20:33, 13 June 2008 (UTC)

This is much better than the current lead, but way too long IMO. Also a bit too technical. ——Martin ☎ Ψ Φ—— 04:14, 16 June 2008 (UTC)

This was a cut and paste of the lead. QuackGuru 05:45, 16 June 2008 (UTC)

Lead Rewrite 2

Chiropractic (from Greek chiro- χειρο- "hand-" + praktikós πρακτικός "concerned with action") is a complementary and alternative medicine health care profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the functions of the nervous system and general health. It emphasizes manual therapy including spinal adjustment and other joint and soft-tissue manipulation.

A chiropractor usually has a first professional degree and can develop and carry out a comprehensive treatment and management plan that can include spinal adjustments, soft tissue therapy, prescription of exercises, and health and lifestyle counseling.

Chiropractic was founded in 1895 by D. D. Palmer in the USA, and is practiced in more than 100 countries. Since its inception, chiropractic has been controversial, both within the profession and in the medical and scientific community, particularly regarding the metaphysical approach espoused by its founders and advocated by "straight" chiropractors.Traditional and evidence-based chiropractic beliefs range from vitalism to materialism. Vaccination remains controversial within the chiropractic community.

The principles of evidence-based medicine have grown in prominence and have been used to review research studies and generate practice guidelines. Chiropractic care is generally safe when employed skillfully and appropriately. Patients are usually satisfied with the treatment they have received.

Comments on Lead Rewrite 2

I deleted some stuff, trying to keep what seemed most essential. I moved a few sentences and condensed two sentences into one for the beginning of the 2nd paragraph. This version retains at least a brief mention of each of the major topics in the article. Feel free to make a few minor changes in the above draft by using strikeout to remove and italics to add stuff. WP:LEAD says "up to four paragraphs"; this version satisfies that.

In reference to the version posted by QC, in detail what I've done is: Deleted the last two sentences of the first paragraph. Taken little more than the mention of "first professional degree" from the first sentence of the second paragraph, deleted the second sentence, and combined the mention of "first professional degree" with the third sentence. I kept the first 2 sentences of the history paragraph, deleted the third sentence and almost all of the 4th paragraph (re "straights" and "mixers"), the last sentence of which I joined to the previous paragraph. I discarded most of the 5th paragraph, but took the last sentence, about patients usually being satisfied, and put it at the end of the following paragraph. I moved the mention of vaccination from the last paragraph to form the end of an earlier paragraph mentioning philosophy. I left out the 2nd and 4th sentences of the last paragraph (re effectiveness and cost-effectiveness). ☺ Coppertwig (talk) 18:17, 15 June 2008 (UTC)

This is much better per length. I would put in something not quite what QG has, but something like that there is a movement of chiro from its metaphysical and practical roots as an all-encompassing healing system toward accepting only those parts which can be made in harmony with EBM. While some straights still adhere to the original manner of practice and belief. ——Martin ☎ Ψ Φ—— 04:18, 16 June 2008 (UTC)

This version is too short but it gave me good ideas for improving the lead. QuackGuru 05:48, 16 June 2008 (UTC)
Thank you for your comment, QuackGuru. Do you have a draft somewhere that you're working on? Would you provide more information about how you consider it too short: what particular topics do you think need more coverage in the lead? WP:LEAD says four paragraphs, but these paragraphs are rather short – one is a single sentence, I think – so there's room to add a little more information. ☺ Coppertwig (talk) 13:42, 16 June 2008 (UTC)
Per Lead, four paragraphs. It is that simple. Each paragraph can be about four sentences. I recommend you edit mainspace and give it a try. The lead in mainspace is way too long and should be fixed. QuackGuru 17:04, 16 June 2008 (UTC)
  • There is no requirement that the lead be four paragraphs. It can be three, and many editors prefer that. I suggest keeping it quite short, and three paragraphs would be better than four. Eubulides (talk) 19:20, 16 June 2008 (UTC)
  • A quick review of #Lead Rewrite 2: it is too repetitive in some cases (e.g., it has adjacent sentences that talk about spinal adjustments and soft-tissue therapy, which are essentially duplications). More importantly, it omits crucial topics. It says nothing about effectiveness, which is the central issue in the controversy between chiropractic and mainstream medicine.
  • Would you rather I wrote a new draft, or edited #Lead Rewrite 2 in place?
Eubulides (talk) 19:20, 16 June 2008 (UTC)

Lead Rewrite 3

Chiropractic (from Greek chiro- χειρο- "hand-" + praktikós πρακτικός "concerned with action") is a complementary and alternative medicine health care profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and their effects on the nervous system and general health. It emphasizes manual therapy including spinal manipulation and other joint and soft-tissue manipulation, and includes exercises and health and lifestyle counseling. Traditionally, it assumes that a vertebral subluxation or spinal joint dysfunction can interfere with the body's function and its innate ability to heal itself.

D. D. Palmer founded chiropractic in the 1890s and his son B.J. Palmer helped to expand it in the early 20th century. It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence, spinal adjustments, and subluxation as the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture. Most chiropractors practice in the U.S.; it is also well established in Canada and Australia.

For most of its existence chiropractic battled with mainstream medicine, and was sustained by the antiscience philosophy of the straights. Vaccination remains controversial among chiropractors. In recent decades chiropractic gained legitimacy and greater acceptance by physicians and health plans, enjoyed a strong political base and sustained demand for services, and became more integrated into mainstream medicine, and evidence-based medicine has been used to review research studies and generate practice guidelines. Opinions differ as to the efficacy of chiropractic treatment; the efficacy and cost-effectiveness of maintenance chiropractic care is unknown. Although spinal manipulation can have serious complications in rare cases, chiropractic care is generally safe when employed skillfully and appropriately.

(Citations that already appear in the body of Chiropractic: )

Comments on Lead Rewrite 3

Here is a shorter version than the current lead. Feel free to edit this improved lead. QuackGuru 19:46, 16 June 2008 (UTC)

I joined the "internal conflicts" sentence so the sentences wouldn't be so short. I moved vaccination up into the 3rd paragraph. I replaced the "rigorously proven" sentence with the "opinions differ" sentence per WP:V, and moved it so it could be joined with a semicolon to another sentence.☺ Coppertwig (talk) 02:22, 17 June 2008 (UTC)
There are three refs at the end of the first paragraph. I recommend we delete the unnecessary ref(s). QuackGuru 02:40, 17 June 2008 (UTC)
Is the cost-effectiveness of maintenance care really important enough to be in the lead? DigitalC (talk) 04:54, 17 June 2008 (UTC)
That is a sticky one, especially since insurance companies explicitly exclude maintenance care from their coverage and/because quality evidence for a beneficial effect of treating asymptomatic individuals with adjustments is notably lacking. There are other versions that include other treatments, but the classic chiropractic version is basically repeated adjustments. -- Fyslee / talk 05:55, 17 June 2008 (UTC)
I'm just not sure that it is an appropriate summary of the cost-effectiveness section, and doesn't seem to be balanced per NPOV for this one tidbit to be in the lead. DigitalC (talk) 06:05, 17 June 2008 (UTC)
I tend to agree, but the solution would be to develop the article content on the subject a bit more, and then tweak the sentence in the lead to summarize it better. Right now the lead states:
  • "The cost-effectiveness of maintenance chiropractic care is unknown."
That summarizes a section including this content in the article:
  • "For some, prevention includes a concept of "maintenance care" that attempts to "detect and correct" structural imbalances of the neuromusculoskeletal system while in its primary, or functional state.
My comments below are about this aspect of maintenance care, which emphasizes detection and correction while in the primary (IOW asymptomatic) state. Right now we are barely mentioning this important and growing paradigm that straight chiropractors are cultivating as their "safe haven". They are going over to cash practices so that they can avoid Medicare and insurance company limitations and regulations that refuse to recognize this type of practice as legitimate. That's how traditional "real chiropractors" plan to survive in a profession that is slowly evolving in another (and more scientific) direction. This is part of the whole story and should not be ignored, but covered. It could be developed even more in a separate article about straight chiropractic, which is definitely a very notable subject, with lots of documentation and an interesting history. It's very much alive. If you want to get the focus of discussions about chiropractic quackery diverted away from this article (leaving only a short mention here), that would be the article where it would be proper to document it as an important part of the whole story. In this article it would hopefully become part of the history section, while in that article it is current history. -- Fyslee / talk 06:44, 17 June 2008 (UTC)
I agree that, as the article is written now, "the cost-effectiveness of maintenance care is unknown" appears as a non-sequitur.
We do need to consider that there are several perspectives to every controversy. Fyslee explains one side really well (and quite colorfully;-) But, for instance, maintenance care and wellness care mean different things to different people. These are parts of every health care practitioner's office. There is nothing wrong with physicians promoting healthy lifestyles with exercise and good nutrition to manage blood pressure, stress, and healthy attitudes. An occasional check-up to make sure everything is still moving well isn't that bad of an idea is it? I don't know, do you? I would think that people want their doctors to do that. Insurance never paid for wellness care, whether for infants in the pediatrician or checkups at your family practitioner. BTW, I'm not sure that we would be mentioning the cost-effectiveness in articles about them (whether it was cost-effective or not - much less unknown). Now, whether or not it is quackery, well - it depends on who we use as a source. If we define quackery as overpromotion, then I think practically all healthcare professionals fit into this category (just look at all the drug commercials promoting a happy sex life:-). Where do we draw the line for promotion of healthy lifestyles and overpromotion of healthy lifestyles. If we handle this at all, it would have to be NPOV showing all sides of the picture without making judgements about any side because basically all the SPOV says is "unknown" which is different than "proven wrong". -- Dēmatt (chat) 15:22, 17 June 2008 (UTC)

#Lead Rewrite 3 was a good first draft, but it was somewhat disjointed and a bit too long. I tweaked and trimmed it. One principle that I'd like us to adopt is that every citation in the lead should also be a citation the body. It makes very little sense for a citation to appear only in the lead, as the lead is supposed to be summarizing the body. I've edited #Lead Rewrite 3 along those lines. It still needs work, though. Eubulides (talk) 08:29, 18 June 2008 (UTC)

The Lead looks reasonable after your changes. I changed antiscience to vitalistic as that particular source did not use antiscience (though Keating did when he was describing the different thought patterns of the different chiropractic groups). This source notes DDs change from materialistic to vitalistic approach in his second theory in 1904 (about the time he was being accused of stealing osteopathy from Andrew Still) so I think it probably is more appropriate to choose the word "vitalistic" as what sustained chiropractic during those years when medicine was absorbing all of the healing arts, because medicine could not absorb vitalism. There might need to be some changes later once we finish the rest of the article per WP:Lead which is why this should be last on our list of priorities. -- Dēmatt (chat) 13:59, 18 June 2008 (UTC)
Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Retrieved 2008-06-16.{{cite web}}: CS1 maint: multiple names: authors list (link)
Page 37: A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. QuackGuru 19:00, 18 June 2008 (UTC)

Wellness (maintenance) care

For background, here's a bit of history:

The nature of the chiropractic "wellness" movement has long/always been based on the regular and lifetime treatment of asymptomatic individuals, using spinal adjustments to treat vertebral subluxations. The creator of the concept of wellness chiropractic was Joseph Flesia. He developed a very successful "subluxation-based wellness procedure" of mentally manipulating patients into better "compliance" and into "increasing PVAs" (Patient Visit Average) for the chiropractor who successfully mastered this "vitalistic" procedure. Here are a few quotes expressing the classic chiropractic wellness treatment paradigm:

  • "Subluxation based Wellness Chiropractic is vitalistic in nature. A concept medicine and allopathic chiropractors have dismissed as quackery many long years ago. The "Wellness" movement that is in full swing and acceptance in the industrial countries is vitalistic in nature. The philosophy of the "Wellness" marketplace is fundamentally the same as real Chiropractic. The subluxation innate based Chiropractic movement fits so very well on its own VSC ladder with you on the top rung under the "Wellness" umbrella. The CBS sponsored Wellness seminars that I present teach the details and the reality of this new "position" for the real Chiropractor, creating large volume subluxation based Wellness practices. These new profile "safe haven" practices (not a political safe haven but a practice safe haven) are populated, for the most part, with patients who are already deeply involved in the "Wellness" paradigm. They accept us as part of their "health pie" working with the elimination of the Vertebral Subluxation Complex so they can further express their innate human potentials." A Safe Haven, Joseph M. Flesia, D.C.
  • "For example, national PVAs are five for acute patients and 17 for the entire practice, whereas in Renaissance and Dr. Guy Riekeman's Quest the statistics are 30-35 PVAs for initial care and more than 100 PVAs for wellness care. The Renaissance wellness procedure works and I highly recommend it to all doctors.
With this as a basis for your new wellness procedure, next time I will begin to outline a 16-point in-office clinical and general patient education strategy that can start you on your journey to a large wellness practice."
  • "... the well care patient: these patients are specifically referred into this pre-care lecture, first. They are healthy people who are interested in learning about their true health potential, and the role of chiropractic in the improvement of their "wellness" for a lifetime, with their family. This represents 81% of the people in America. Well care patients have the opportunity and privilege of participating in our well patient care family fee system." Narrative for 37 Patient Education Visits, Joseph Flesia
  • "My position is that the 81% of society into wellness today are ALL prospective subluxation-based, vitalistic/innate intelligence chiropractic wellness patients. With their entire families, children and parents -- for a lifetime, of course. Renaissance Seminars has been teaching and maturing this very same message for 21 years." - Joseph Flesia, DC

Of course reform chiropractors and insurance companies have objected to this approach:

  • "I understand there are many who feel that a "real" chiropractor would not practice this way. Fine. If being a real DC means wellness care, asymptomatic care, excessive x-rays, poor working relationships with MDs, rejection of scientific data, bizarre techniques, outrageous claims, and the same treatment each visit regardless of the problem, then I don't want to be a "real" DC." - Food for Thought 2000, G. Douglas Andersen, DC

-- Fyslee / talk 05:55, 17 June 2008 (UTC)

I think a real chiropractor does anything that he can to get that 250 pound, sugar consuming couch potatoe to develop a healthy lifestyle. That's part of being a real doctor. Chiropractors just don't use drugs or surgery. The only problem is the one that tells that patient that they will lose that weight *as the result* of spinal manipulation. -- Dēmatt (chat) 15:32, 17 June 2008 (UTC)

article improvements

ref improvement

The Keating 1997 ref has the final version of the article but the orginal version is readable and requires no signup. I suggest we combine both refs together. QuackGuru 19:16, 14 June 2008 (UTC)

I changed the URL to a different one that requires no signup. Odd; the old one didn't require me to sign up; I guess it depends on the IP address of the reader or something. Thanks for pointing out the problem. Eubulides (talk) 19:20, 16 June 2008 (UTC)

long run on sentence

...but retains a holistic approach and an emphasis on manual therapy. I suggest we remove the last part of the long run on sentence in the Chiropractic#Vertebral subluxation section. QuackGuru 19:16, 14 June 2008 (UTC)

Is est a expertus intended parumper imprimis user. Is rudimentum impetro a panis of three reverto sceptrum. EGO puto user sentio proprietas of page. Commodo operor non take esca. --Samuel Pepys (talk) 20:40, 14 June 2008 (UTC)
Gratias ago vos. EGO diligo vestri changes. Vestri consultum est bonus quoque. EGO mos operor meus optimus sumo vestri consultum. -- Dēmatt (chat) 00:45, 15 June 2008 (UTC)

unreferenced sentence

Chiropractors are also generally permitted to use adjunctive therapeutic modalities such as acupuncture and manipulation under anesthesia with additional training from accredited universities/colleges.

This unreferenced sentence requires a reference or it could be deleted soon. QuackGuru 07:41, 16 June 2008 (UTC)

It's been tagged for weeks, with no progress on finding a source. For now I removed it. It can be re-added later if someone finds a good source. Eubulides (talk) 19:20, 16 June 2008 (UTC)
I think it would be hard to find a good source that chiropractors are "Generally permitted" to do anything. However, if we think that acupuncture is worth adding to the article, we could add that "As a result of the professional and public demand for acupuncture by doctors of chiropractic, 37 states have enacted legislation or regulated the practice through their respective state boards of chiropractic examiners. Acupuncture is clearly a vital part of the chiropractic profession.". Or that, "About 10 percent of chiropractic clinicians perform acupuncture, and approximately 66 percent perform acupressure or meridian therapy" . DigitalC (talk) 07:20, 17 June 2008 (UTC)
The first is way too promotional. The second is not really a scope-of-practice statement or source; it's more suitable for Chiropractic #Treatment procedures. Also, that source simply cites another source for the information in question; we should simply cite the original source. Eubulides (talk) 08:29, 18 June 2008 (UTC)
Good idea, perhaps we should have in SOP that "37 states have regulated the practice of acupuncture by Chiropractor", while in #Treatment procedures, we include the information about percentage using acupuncture or acupressure. DigitalC (talk) 01:16, 23 June 2008 (UTC)

duplication in Scope of practice

Similar to other primary contact health providers, chiropractors can specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2–3 additional years of additional post graduate study and passing competency examinations. Chiropractors may further specialize in fields such as Chiropractic Orthopedics (DABCO), Chiropractic Radiology (DABCR), and Chiropractic Sports Physician (DABCSP) by completing additional study and passing the specified boards that are separate and distinctly different than medical boards.

The above has some duplication with regard to chiropractors can further specialize in fields such as orthopedics and radiology. QuackGuru 19:14, 16 June 2008 (UTC)

It would be helpful if you would propose specific wording changes, briefly, so that other editors can easily understand the proposal. It's less helpful to merely copy big chunks of text into the talk page along with brief critical comments. For more on this topic, please see #Comments on Philosophy rewrite below. Eubulides (talk) 19:20, 16 June 2008 (UTC)

Syn tag

In response to this comment: SMT is the centerpiece of chiropractic. If there is other information missing from the effectiveness section then bring on the appropriate references or remove the Syn tag. QuackGuru 16:20, 19 June 2008 (UTC)

Is there any statements in there drawing from conclusions made from research about Spinal Manipulation in general or as performed by practitioners other than just chiropractors? If so, usage of such statements present a clear SYN violation and thus should be removed (even if we express that this is about SMT in general). Until then, removing the SYN tag would be - IMHO - wholly unjustified. -- Levine2112 19:56, 19 June 2008 (UTC)
This argument has come up several times before, e.g., Talk:Chiropractic/Archive 18 #Specific to chiropractic?. The objection is that Chiropractic should cite only studies derived entirely from chiropractic data. However, this objection disagrees what reliable sources say and do. Here are two examples:
  • Haldeman & Meeker 2002 write, "We agree that many of the randomized trials we described were on spinal manipulation rather than specifically on chiropractic manipulation itself, but we believe that this is not a significant point. Chiropractors use all forms of manipulation. In the United States, more than 90% of all spinal manipulation services are provided by chiropractors, and research on spinal manipulation, like that on any other treatment method, is equally of value regardless of the practitioner providing it."
  • The 2007 CCGPP literature synthesis of chiropractic management of low back pain, a document written by and for chiropractors, cites sources derived from non-chiropractic data. For example, it cites Aure et al. 2003 (PMID 12642755) to support manual therapy for low back pain, even though Aure et al. specifically disallowed chiropractic manipulation.
No recent reliable sources have been found that criticize the practice of using data derived partly from non-chiropractic sources to assess the effectiveness or safety of chiropractic treatments. In short, I don't know why that SYN tag is present, and its presence needs to be justified better. Eubulides (talk) 20:28, 19 June 2008 (UTC)
It's quite simple really. If we have a source doing the synthesizing for us - such as Haldeman & Meeker - then by all means, we can cite Haldeman's analysis of those general, non-chiropractic-specific SMT studies. However, to go ahead and apply Haldeman et al's rationale to all non-chiropractic-specific SMT studies constitutes a SYN violation. Think of it this way: Haldeman says that the randomized trials he described were on spinal manipulation rather than specifically on chiropractic manipulation itself but he believes that this is not a significant point. Let's call Haldeman's conclusion "Statement A". Then let's take another independent reviewer of SMT (as performed by osteopaths and PTs) who found that SMT is beneficial with treating lower back pain. Let's call this conclusion "Statement B". Now then, by using only Statements A and B in our article to claim that chiropractic adjustments are beneficial with treating lower back pain absolutely creates a SYN violation. Because the only way we can derive such a conclusion is through combining two bits of separate information (since "B" shows that SMT is effective for such-and-such and since "A" says that there is no significant difference between chiropractic adjustments specifically and SMT in general; therefore chiropractic adjustments must be effective for such-and-such). That's textbook synthesis. With this in mind, I encourage you all to re-read WP:SYN. The Smith and Jones/Chicago Manual of Style example given there is nearly identical to the situation we have here.
Okay. What about the argument that I've read that says, "But we aren't saying that Chiropractic is effective or not effective based on these studies. We are only talking about SMT in general"? My response is that if you are not talking about chiropractic specifically, then it shouldn't be in this article. If it is about SMT in general, then it can go in the spinal manipulation article. Putting conclusions here about SMT in general will lead readers to associate those conclusions with chiropractic specifically. And hence, once again, a SYN violation. -- Levine2112 22:13, 19 June 2008 (UTC)
This argument would make sense if there were a "Statement B" in Chiropractic. But I don't know of any "Statement B". Chiropractic's sources for statements about SMT are backed by studies that include chiropractic data. For example, consider Ernst & Canter 2006 (PMID 16574972), a controversial and critical review of SMT. Its sources are derived from chiropractic data as well as from non-chiropractic. Its results are highly relevant to chiropractic, as can be seen (for example) in comments about it in Bronfort et al. 2008 (PMID 18164469), a source which is written by chiropractors and from the chiropractic point of view. It would not be right for us to cite Bronfort et al. and not Ernst & Canter, as that would introduce POV by citing only the supportive-of-chiropractic side. It would be equally wrong to cite neither source: both sources are of high quality and are highly relevant to the topic of the effectiveness of chiropractic care. Eubulides (talk) 23:22, 19 June 2008 (UTC)
Does Ernst and Canter draw any conclusions specifically about chiropractic? Are the statements which we are sourcing from Ernst specifically about chiropractic? If the answer is no, then we cannot use the source to make any conclusions about chiropractic. At the same time, if Bronfort is using Ernst to draw conclusions about chiropractic, then Bronfort can arguably be used. Still, Ernst cannot be used. It's not a matter of POV being unbalanced. And to "balance" what you deem an inequity would not require us to cite Ernst because that would introduce a SYN violation. Of course, if we were to cite some source which uses Ernst to draw negative conclusions about chiropractic specifically, then that can arguably be used. However, be aware that this line of thinking of yours confuses NPOV. NPOV is not a matter of balancing every positive statement with a negative one. Rather it is a matter of representing all significant viewpoints fairly, proportionately and without bias. If there is no viewpoint (from an RS of course) which uses Ernst to highlight something negative about chiropractic, then we are in no way required to omit or balance a viewpoint which uses Ernst to highlight something positive. -- Levine2112 23:33, 19 June 2008 (UTC)
Oh, and as for a Statement B being used to draw a conclusion C about chiropractic specifically even though the source behind Statement B is not specifically about chiropractic but rather SMT in general - Hmm, let's just pick one at random. Okay, how's this one from "Low Back Pain": "A 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail..." Okay this one isn't even about chiropractic. It's about SMT in general. So what is it doing in this article? Let's look at the source. The only mention of chiropractic there is this: The evidence is insufficient to conclude that benefits of manipulation vary according to the profession of the manipulator (chiropractor vs. other clinician trained in manipulation) or according to presence or absence of radiating pain. That's it! There's no other mention of chiropractic in the entire research and recommendations. So again, why are we using this material here in this article? The only basis which you have provided for using non-chiropractic specific sources such as this has been based on what Haldeman and others say - that there is no significant difference in SMT as performed by chiropractors and other practitioners. That's SYN. And, funny enough, this randomly selected low back pain research even says that the evidence is insufficient to conclude that benefits vary from one practitioner to another. So even if we could ignore SYN to justify inclusion of general SMT studies, well here's an opinion which says that there is not enough evidence to make such synthesis. -- Levine2112 23:49, 19 June 2008 (UTC)
Eubulides wrote - "The 2007 CCGPP literature synthesis of chiropractic management of low back pain, a document written by and for chiropractors, cites sources derived from non-chiropractic data. For example, it cites Aure et al. 2003 (PMID 12642755) to support manual therapy for low back pain, even though Aure et al. specifically disallowed chiropractic manipulation.". Authors elsewhere are not bound by WP:SYN. However, editors here are. Just because synthesis occurs in the literature, doesn't mean it can be done here. SYN is a type of OR, and OR is obviously acceptable in the literature - however, that wouldn't make it ok for us to start using OR. I absolutely agree with Levine2112 that this is a violation of WP:SYN. That was my whole reason for supporting Effectiveness 3C - it was free of SYN violations. Again, I support the creation of an effectiveness section over at Spinal manipulation (and hopefully other articles, for effectiveness of LLLT and US etc), and having that wikilinked from the effectiveness section of Chiropractic. For clarification, from WP:SYN "...if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research." - The sources here are not directly related to Chiropratic, they are directly related to Spinal manipulation, as such it is a WP:SYN violation. DigitalC (talk) 00:49, 20 June 2008 (UTC)
For clarity, from WP:SYN "if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research." The reliable sources we are citing are directly related to chiropractic. Spinal manipulation is the centerpiece of chiropractic, as such it is WP:NPOV. We are following the lead of the expert reviewers. QuackGuru 01:30, 20 June 2008 (UTC)
Incorrect. Using general SMT studies to tell about the effectiveness of chiropractic specifically is - in essence - saying that the two are one in the same. Now some expert reviewers say this is true. But if we were to follow their lead - as you say - and apply their opinion here to all SMT studies to draw a conclusion in this article about chiropractic, then we would clearly be in violation of WP:SYN, in that we are taking what some researchers say to do with their research (Source A) and then we are using this advice to analyze wholly different pieces of research (Source B) and synthesizing the two together to make an original statement in our article (Conclusion C) - it's textbook WP:SYN. QED. -- Levine2112 01:41, 20 June 2008 (UTC)
I'm moving to history, but, yes, Levine and DigC described the reason I put the tag on pretty well. I don't see any reason to waste too much energy here, yet. I'll take a look at history tomorrow. -- Dēmatt (chat) 03:24, 20 June 2008 (UTC)
For outside observers, spinal manipulation is related to chiropractic.
For clarity, from WP:SYN "if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research." The reliable sources we are citing are directly related to chiropractic. Spinal manipulation is the centerpiece of chiropractic, as such it is WP:NPOV. We are following the lead of the expert reviewers.
Incorrect? How is the above comment incorrect? No specific explanation has been given. How is it clearly a violation of WP:SYN?
I know spinal manipulation is related to chiropractic. What is source A and what is source B and where is conclusion C? Vague comments makes no sense.
What are the original statements? Everything is verified and accurate.
Dematt wrote in part: There are too many factors to leave it to one drug that they use to treat one condition. That is what we are doing with chiropractic. Chiropractic care is not SMT. We are synthesizing sentences together to make it look that way.
What are the too many factors? How are we synthesizing sentences together to make it look that way?
Please explain specifically or remove the Syn tag. Which specific sentences are synthesis.
Spinal manipulation is the most common modality in chiropractic care. No? QuackGuru 06:28, 20 June 2008 (UTC)
We are not talking about WP:NPOV here QG, we are talking about WP:SYN. A source that is discussing SMT, and not mentioning Chiropractic is NOT directly related to Chiropractic, it is directly related to Spinal Manipulation. Whether or not SMT is the most common modality in chiropractic care is a strawman argument. DigitalC (talk) 07:54, 20 June 2008 (UTC)
How is it a strawman argument when chiropractors perform spinal manipulation on their patients. This is easy to understand spinal manipulation is related. QuackGuru 08:08, 20 June 2008 (UTC)

(<<<outdent) Misplaced Pages:These are not original research#Compiling facts and information says "Identifying synonymous terms, and collecting related information under a common heading is also part of writing an encyclopedia." Perhaps the question is: is SMT essentially synonymous with chiropractic? Although chiropractors do other things too, I think an argument can be made that SMT is not only the thing most frequently done by chiropractors, but also that it is a fundamental, defining characteristic of chiropractors. (Are there chiropractors who do not do SMT?) Even if we decide that SMT and chiropractic cannot be considered essentially synonymous, nevertheless they are clearly closely related subjects, as QuackGuru points out, and it may be perfectly valid to collect information about them both within the same article. Perhaps it might help if the SMT effectiveness studies were mentioned under a subheading such as "Effectiveness of SMT" rather than just "Effectiveness", which implies that they're stating a conclusion about effectiveness of chiropractic. I think the SYN argument has considerable validity but am undecided as to what we should do. ☺ Coppertwig (talk) 10:57, 20 June 2008 (UTC)

Chiropractors are known for spinal manipulation. Therefore, this is part of writing an encyclopedia. QuackGuru 17:02, 20 June 2008 (UTC)
From WP:SYN:
Material published by reliable sources can inadvertently be put together in a way that constitutes original research. Synthesizing material occurs when an editor comes to a conclusion by putting together different sources. If the sources cited do not explicitly reach the same conclusion, or if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research. Summarizing source material without changing its meaning is not synthesis; it is good editing. Best practice is to write Misplaced Pages articles by taking claims made by different reliable sources about a subject and putting those claims in our own words on an article page, with each claim attributable to a source that makes that claim explicitly.
Editors should not make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article to come to the conclusion C. This would be synthesis of published material which advances a position, which constitutes original research. "A and B, therefore C" is acceptable only if a reliable source has published this argument in relation to the topic of the article.
A sentence states in WP:SYN: If the sources cited do not explicitly reach the same conclusion, or if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research.
The last part of the above sentence states: or if the sources cited are not directly related to the subject of the article Spinal manipulation is related to chiropractic because it is a commonly performed modality.
The article states: Research has focused on spinal manipulation therapy (SMT) in general, rather than specifically on chiropractic SMT.
We are following the lead of the expert reviewers and the research we are using has a close relationship to the topic of this article.
Spinal manipulation research is related to chiropractic because chiropractors perform spinal manipulation. Spinal manipulation is related to the subject of the article. It's time to remove the synthesis tag. QuackGuru 17:02, 20 June 2008 (UTC)
Incorrect. By "following the lead" of the researchers - as you are saying - and applying their reasoning in their research to other research we find, we are committing a clearcut SYN violation. Some researchers say that the difference between SMT and chiropractic adjustments are negligible. Some say that there is a significant difference. Some say that is unclear whether there is a difference. Who are we to choose which researchers are right? This is an article about chiropractic; not about spinal manipulation and not even about spinal adjustment. The research we use in this article, therefore, should be directly about chiropractic specifically and not about research which may be round-about related to chiropractic according to some researchers who have not specifically commented about said research. Again, if a researcher is specifically drawing conclusions about chiropractic from SMT general research, then fine; use that researcher's conclusions. However, we cannot and will not draw our own conclusions about chiropractic from research not specifically about chiropractic. To do so would be a clear violation of WP:SYN. -- Levine2112 17:41, 20 June 2008 (UTC)
Spinal manipulation is closely related to chiropractic because chiropractors perform spinal manipulation. We are using research that is related to chiropractic. QuackGuru 18:13, 20 June 2008 (UTC)
Bottom line, we would be coming to a conclusion about chiropractic by putting together different sources. Don't forget about the first part of that sentence you keep mentioning in the SYN policy: "If the sources cited do not explicitly reach the same conclusion... then the editor is engaged in original research." Behind Door A, we have some researchers saying that it is okay for them to use general SMT research to reach their own conclusions about chiropractic. And behind Door B, we have some general SMT research reaching some conclusions about SMT in general. Now you want to "follow the lead" of the researchers from behind Door A by applying the conclusions about general SMT from behind Door B to chiropractic and thus form an original piece of Research C here a Misplaced Pages? A SYN violation doesn't get more clearcut than that. "A and B, therefore C" is acceptable only if a reliable source has published this argument in relation to the topic of the article. The topic of this article is , not SMT. Chiropractic does not equal SMT. If it did, we would have cause to merge the articles. -- Levine2112 23:50, 20 June 2008 (UTC)
Please provided specific examples for "A and B, therefore C" based on the current text in the article. For example, which text is SYN? The conclusions of the sentences are verified using spinal manipulation research that is closley related to chiropractic. I don't see any multiple doors in the information we are using. When spinal manipulation is related to chiropractor we can use spinal manipulation research. QuackGuru 00:21, 21 June 2008 (UTC)
Please refer to my sixth and seventh entry to this thread for a specific example of "A and B, therefore C" currently employed in the article. It deals with this statement in the article: "A 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail..."
BTW, even if there is just the implication of a conclusion "C" without actually some sentence "C", we've committed a SYN. Meaning that by merely including the result of general SMT (non-chiropractic) research in the article based on the borrowed rationale from Haldeman et al. (that in terms of analysis, the difference between chiropractic adjustment research and SMT are not significant), we are implying that these results apply specifically to chiropractic (even though the research was not about chiropractic). That the SYNful conclusion "C". By implying or stating these conclusions are about chiropractic based on non-chiropractic research, we have created original research over and over again and hence we are guilty of original SYN and must be banished from the Garden of WikEdenPedia. ;-) -- Levine2112 01:36, 21 June 2008 (UTC)
Levine2112 wrote in part: It deals with this statement in the article: "A 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail..."
The above sentence is statement A. Where is statement B? QuackGuru 06:44, 21 June 2008 (UTC)
"Research has focused on spinal manipulation therapy (SMT) in general, rather than specifically on chiropractic SMT." Really look at this statement and the sources from which it is derived. -- Levine2112 06:50, 21 June 2008 (UTC)
The above sentence is verified and makes it more clear for the reader. QuackGuru 07:00, 21 June 2008 (UTC)

Arbitrary section break (SYN cont'd)

(outdent)

  • I see no clear example of an "A and B, therefore C" in Chiropractic #Scientific research. The abovementioned text "A 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail" is not a "therefore" statement and is not an example.
  • I just now checked, and the pattern "A and B , therefore C " doesn't occur anywhere in Chiropractic #Scientific research that I can see. With one minor exception, every statement in Chiropractic #Scientific research is supported by a specific citation. (The minor exception is the linking text "Available evidence covers the following conditions:", which is not controversial.)
  • "even if there is just the implication of a conclusion "C" without actually some sentence "C", we've committed a SYN". I strongly disagree. Every well-written Misplaced Pages article has countless implications that a reader can draw, implications that are not explicitly in the text. Often the authors are not even aware of those implications. Let's take today's featured article Phishing, for example. Its section Phishing#Filter evasion says "Phishers have used images instead of text to make it harder for anti-phishing filters to detect text commonly used in phishing e-mails." An obvious implication is that filters can work around this problem by altering or deleting messages containing images. But it is not a SYN violation that this implication is neither written down nor sourced in Phishing. There's no way in the world that an author can source every implication of every statement he makes. More generally, it is not a SYN violation to write an encyclopedia article that readers can make inferences from.
  • "There's no other mention of chiropractic in the entire research and recommendations. So again, why are we using this material here in this article?" Again, I strongly disagree. Encyclopedia articles about topic X are allowed to, and even encouraged to, cite sources that do not mention X. Again, let's look at today's featured article Phishing. It cites many sources that do not mention phishing. For example, it discusses the homograph attack, one technique for doing phishing, and cites Gabrilovich & Gontmakher 2002, a source about homograph attacks that never mentions phishing. And yet this is not SYN, not at all: homograph attacks are obviously relevant to phishing and citing a source on homograph attacks is precisely what an encyclopedic article on phishing should do.
  • The biggest problem I see with the proposed overly-strict interpretation of WP:SYN is that it disagrees with how the relevant research is being reviewed by high-quality sources. Gone are the bad old days where chiropractors published in their own journals and never looked at or influenced the mainstream world. Instead, authors like Bronfort et al. (PMID 18164469) are publishing high-quality reviews of treatments for conditions like low back pain in non-chiropractic-only journals, without putting the word "chiropractic" in their title or abstract. That is how mainstream chiropractic works, and Chiropractic should respect this rather than attempt to impose its own idiosyncratic view of what counts as a proper "chiropractic" paper and what doesn't.

Eubulides (talk) 07:51, 21 June 2008 (UTC)

If the source says "chiropractic" and the conclusions which we are using are specifically about "chiropractic" then by all means use the source. However, once we start using the conclusions of Haldeman or others (Source A) to dictate how we treat studies about general SMT (those which make no mention of chiropractic or don't distinguish between chiropractic and SMT... Source B) then we are guilty of SYN in the placement of Source B in our article to imply that Source B's conclusions are relevant to some conclusion about chiropractic (Conclusion C). That is where the A and B, therefore C has been done over and over again through this section. Dump those references (whether they are positive or negative about SMT) and maybe move them to the apropriate location: the spinal manipulation article. But they serve no purpose here other than to create original research by violating WP:SYN. -- Levine2112 03:34, 22 June 2008 (UTC)
Source a and b are different. Source a is being used to make it clearly for the reader. Source b is related to chiropractic. There is not a conclusion C written in the article. There never was any OR or SYN. QuackGuru 15:55, 22 June 2008 (UTC)
Yes! Thank you. Source A and B are different. And how you say Source A is being used to make it clear for the reader, is actually Source A being used to make a certain unsourced POV clear for the user - that all of the Source B's should be interpreted in a way which none of the Source B's explicitly state. Thus, Conclusion C is that based on Source A, all of the Source B's are actually about to chiropractic; even though the sources don't say so. Hence, OR and specifically SYN. Now then, I think by now you understand my point, and Digital C's point, and Dematt's point, and CorticoSpinal's point, etc. Finally. -- Levine2112 17:17, 22 June 2008 (UTC)
Source a and b be are different. Each source has its own sentence and ref. They are not explicitly joined together. Source A is not being misused to make certain sourced NPOVs clearer for the user. I don't see any unsourced POV. I understand your point has an implied conclusion C that is not written in the article. Hence, the argument of OR or SYN is incorrect. QuackGuru 18:27, 22 June 2008 (UTC)
Source A is being used to justify the inclusion of Source B, despite Source B having nothing to do with chiropractic directly. The synthesized conclusion which any reader would come to is that the claims of Source B are relevant to Chiropractic based on what Source A says. A + B = C. Hence, SYN. The solution is to remove all of the "Source Bs" (i.e. any source which we are attempting to use to make so conclusion about chiropractic despite the source itself not mention such a conclusion. -- Levine2112 19:00, 22 June 2008 (UTC)
I do not see how source a is being used to justify the inclusion of source b. Source a is being used to make it clearer for the reader. Source b is related to chiropractic. The non-existent conclusion c is not written in the article. Where is conclusion c written in the article? QuackGuru 19:19, 22 June 2008 (UTC)
Let's put it this way: How do you know that Source B is related to Chiropractic when Source B doesn't mention Chiropractic? How does the casual reader know this? -- Levine2112 19:23, 22 June 2008 (UTC)
I will answer your question in the form of a question. Where does it say it in WP:SYN that the reader must know that source b is related?
We are using related references which is okay. According to which policy we must explain to the reader which ref is related.
The casual reader understands that chiropractors perform spinal manipulation and spinal manipulation is related. QuackGuru 19:41, 22 June 2008 (UTC)
Just let me know how you know that Source B's research conclusions can be used to make conclusions about chiropractic when Source B itself was not expressly studying chiropractic nor does it make any make any direct correlation to chiropractic nor does it make any reference whatsoever to chiropractic. So how do you know that Source B's conclusions can be applied to chiropractic? -- Levine2112 19:49, 22 June 2008 (UTC)
Because source b is related to chiropractic. QuackGuru 19:57, 22 June 2008 (UTC)
And what are you basing this opinion of yours on? I mean, Source B does not outright say nor imply that it is related to chiropractic. You are saying it is. Is this just your opinion that the conclusions of general SMT research which makes no claims about chiropractic can be used at Misplaced Pages to infer claims about chiropractic? Or is there something I am missing in Source B which actually does say that the conclusions of Source B can be applied to Chiropractic? Or is there something else? Please be explicit. -- Levine2112 21:39, 22 June 2008 (UTC)
Source b is related to chiropractic because...
...spinal manipulation is commonly performed by chiropractors.
Where is conclusion c written in the article?
There never was a conclusion c.
Conclusion d: It's time to remove the tag. QuackGuru 23:39, 22 June 2008 (UTC)
You're creating a logical fallacy by evading the question. How do we know that research about SMT in general is directly applicable to chiropractic specifically? -- Levine2112 00:33, 23 June 2008 (UTC)
Further, please note that a few moons ago, there was a RAND study on the appropriateness of spinal manipulation which came out quite favorable for SMT. When chiropractors jumped on that research to proclaim things such as "Chiropractic works!", the chiropractors were in turn jumped on by the researchers who said that these studies were not about chiropractic specifically, but rather SMT and that chiropractors were in effect misusing these studies. So you see, it is a double-edge sword. RAND spokesperson Dr. Paul Shekelle, released this statement in 1993:
"...we have become aware of numerous instances where our results have been seriously misrepresented by chiropractors writing for their local paper or writing letters to the editor....RAND's studies were about spinal manipulation, not chiropractic... Comparative efficacy of chiropractic and other treatments was not explicitly dealt with."
Now I may not be recounting this totally correct. If Fyslee is around, he knows this tidbit better than I do. But the point still goes to show that some researchers say that confounding SMT with chiropractic is a no-no. Thus, "Conclusion D" (as you put it) would actually be to excise all general SMT studies/reviews from this section regardless of whether they are supportive of spinal manipulation or not. And if you still don't agree, I ask you once again and urge you not to evade: How do we know that the conclusions of research about SMT in general may be directly applied as conclusions about chiropractic specifically? -- Levine2112 00:41, 23 June 2008 (UTC)
I will answer your question in the form a question. Do the majority of chiropractors perform spinal manipulation? If yes, then spinal manipulation is related. QuackGuru 06:00, 23 June 2008 (UTC)
The above discussion does not cast much light on the issue, I'm afraid. None of the bullet points in my previous comment were addressed. Eubulides (talk) 08:18, 23 June 2008 (UTC)
  • "For example, it discusses the homograph attack, one technique for doing phishing" - forgive me for my ignorance of phishing. Can a homograph attack be used outside of phishing? Wouldn't the effectiveness of a homographic attack be better addressed at Homograph attack rather than at phishing? I'm not sure this is a clear analogy.
  • As far as I can tell, the purpose for including the sentence "Research has focused on spinal manipulation therapy (SMT) in general, rather than specifically on chiropractic SMT." is to ALLOW the synthesis that is being performed.
  • "Its section Phishing#Filter evasion says "Phishers have used images instead of text to make it harder for anti-phishing filters to detect text commonly used in phishing e-mails." An obvious implication is that filters can work around this problem by altering or deleting messages containing images. But it is not a SYN violation that this implication is neither written down nor sourced in Phishing." I don't see this as an obvious implication. However, it is obvious that we are implying that research that doesn't explicitly mention chiropractic when discussing smt is the same as research that does mention chiropractic.
  • "* The biggest problem I see with the proposed overly-strict interpretation of WP:SYN is that it disagrees with how the relevant research is being reviewed by high-quality sources." - Again, high-quality sources are not restricted by WP:SYN, as they are outside the world of wikipedia. In other sources, saying "A is true, and B is true. C." is not a problem. However, it is against wikipedia policy. It is 100% original research for us to conclude that general SMT is valid when discussing chiropractic SMT, when those sources have NOT been discussed in such a manner elsewhere. DigitalC (talk) 01:13, 24 June 2008 (UTC)

Coppertwig wrote - "Perhaps it might help if the SMT effectiveness studies were mentioned under a subheading such as "Effectiveness of SMT" rather than just "Effectiveness", which implies that they're stating a conclusion about effectiveness of chiropractic. I think the SYN argument has considerable validity but am undecided as to what we should do.". This is basically what I have proposed, except that it would be located on Spinal manipulation, with a wikilink from the Effectiveness section at Chiropractic. Obviously, the effectiveness section over at Spinal manipulation would not include other treatment modalities such as LLLT, Ultrasound, IFC, acupuncture, etc. No one has stated a valid reason for NOT doing it this way. DigitalC (talk) 01:13, 23 June 2008 (UTC)

However, spinal manipulation is related to chiropractic. QuackGuru 06:00, 23 June 2008 (UTC)
It would be reasonable to have a more-extensive discussion of SMT effectiveness at Spinal manipulation. (By "more-extensive", I mean, more extensive than what is in Chiropractic now.) However, a summary is still in order here. Chiropractic is strongly associated with spinal manipulation, and vice versa. It would make little sense for a discussion of effectiveness of chiropractic treatments to not focus on the effectiveness of SMT. Eubulides (talk) 08:18, 23 June 2008 (UTC)
Chiropractic is closely associated with spinal manipulation. Information on the effectiveness of SMT is relevant. QuackGuru 18:14, 23 June 2008 (UTC)
You are still evading my question: How do we know that it is okay to directly attribute conclusions about general SMT with that of chiropractic? -- Levine2112 19:25, 23 June 2008 (UTC)
Could this be presented in more mainstream terms? Wouldn't an article about medicine discuss prescription drugs? This could avoid SYN issues, if the two weren't so tightly connected as they are now. Xavexgoem (talk) 01:28, 24 June 2008 (UTC)
Medicine is too broad an article to compare to Chiropractic. Perhaps Internal medicine may equate, but that may not even be specific enough. However for the sake of comparison, at Internal medicine, would you expect to find conclusions about the efficacy of drugs sourced to a review of literature concerning itself with drugs as administered by non-internists? What if the reason for the editor's applying such reviews to Internal medicine was based on another piece of research which in fact said it was okay to confound research about the efficacy of non-internists' use of drugs with the efficacy of Internists' use of drugs (at least in terms of their research)? So we have a review about the efficacy of drugs as administered by non-internists (Source A) and we have a piece of research which confounds a different study about the efficacy of drugs as administered by non-internists with the efficacy of drugs as administered by internists (Source B). So, by the rationale of Source B, the editor says it's okay to apply the research of Source A to internists by placing it in the Internal medicine article (Conclusion C). Would that not be a textbook SYN violation? And what if the only other argument presented by the editor in favor of violating SYN with such an inclusion is that Internists prescribe the most drugs, therefore we should just disregard that the non-internists might not be diagnosing their patients or prescribing drugs in the same manner as actual internists would diagnose and prescribe? Forgive my run-ons galore. :-) -- Levine2112 01:58, 24 June 2008 (UTC)
What I suggest is separating source A so far from source B that no conclusion C can be reached :-) Xavexgoem (talk) 02:02, 24 June 2008 (UTC)
The separation would have to be the distance of two separate articles. Whereas, Source A is only expressly about SMT in general and therefore can be placed at Spinal manipulation. The whole justification of using Source A here at chiropractic is inextricably entangled with the rationale given in Source B. So no matter the distance of separation within this article, including Source A is always a SYN violation. -- Levine2112 02:07, 24 June 2008 (UTC)
It's only a suggestion, at any rate; maybe Source A could have another justification, though, if all goes wrong :-p Xavexgoem (talk) 02:17, 24 June 2008 (UTC)
I am always open to suggestions. I appreciate it. And I am always willing and ready to change my mind - do a complete 180 - if the right suggestion/explanation is given. And yes, Source A (research about SMT in general with no expressed implications about chiropractic) does certainly need another justification other than the tired ones already debunked here if we are going to use the likes of Source A at all in article space. I have yet to read such a justification. Therefore I continue to voice my support of the shared proposal of the majority of editors here - to remove any such "Source A's" from the article and rather rely on research/reviews which explicitly makes conclusions about the particular subject at hand: Chiropractic. -- Levine2112 02:42, 24 June 2008 (UTC)
I think we have to consider this; researchers do not use the words 'chiropractic care' and 'spinal manipulative therapy'(SMT) interchangeably because chiropractic care includes multitudes of variables that cannot be isolated. However, they can make statements about spinal manipulation because they can isolate that procedure and study it. The purpose of that research is to inform everyone in the field of the effectiveness of that specific treatment under those specific conditions. There are some studies that specifically evaluate 'chiropractic care'. Most of those are surveys. Those would certainly be appropriate here because they do consider the entire chiropractic encounter, but they cannot say anything specific about SMT, because they are not synonymous. Our hearts and minds really want to assimilate this information into a simple package for our readers, but Misplaced Pages makes rules about this so that we don't make this mistake. They are part of WP:NOR and WP:SYN. We are working too hard here. Let's just look for sources that use 'chiropractic care' and let's see what we come up with. Menawhile, we know that the information that we have can at least be used in the spinal manipulation article. -- Dēmatt (chat) 03:24, 24 June 2008 (UTC)

renaming scientific research

If we are going to rename the scientific research section I suggest we rename it with something that starts with Evidence such as Evidence basis. QuackGuru 16:20, 19 June 2008 (UTC)

Article locked before that Canadian case with the woman suing for 500 million, due to the whole body paralysis caused by strokes, caused by chiropractics was adequately added

Somebody should fix this instead of just locking the article —Preceding unsigned comment added by 24.65.42.159 (talk) 04:42, 15 June 2008 (UTC)

I'm not sure that the article needs to be changed at all just because of a case in the news involving a single individual. Do we urgently re-write the article on automobiles every time the newspapers report a collision that caused serious injuries? However, if a change does need to be made, someone would have to suggest a specific edit, and if there's consensus for it it can be added by requesting an edit to a protected page using the {{editprotected}} template. ☺ Coppertwig (talk) 19:01, 15 June 2008 (UTC)
Case not even closed yet, is it? ——Martin ☎ Ψ Φ—— 04:33, 16 June 2008 (UTC)
I see nothing about the case that suggests it's important enough to be mentioned in Chiropractic. Eubulides (talk) 19:20, 16 June 2008 (UTC)

Philosophy rewrite

Two chiropractic belief system constructs
THE TESTABLE PRINCIPLE   THE UNTESTABLE METAPHOR
Chiropractic Adjustment Universal Intelligence
↓ ↓
Restoration of Structural Integrity Innate Intelligence
↓ ↓
Improvement of Health Status Body Physiology
 
MATERIALISTIC:     VITALISTIC:
— operational definitions possible — origin of holism in chiropractic
— lends itself to scientific inquiry — cannot be proven or disproven
taken from Mootz & Phillips 1997

Traditional and evidence-based chiropractic belief systems vary along a philosophical spectrum ranging from vitalism to materialism. These opposing philosophies have been a source of debate since the time of Aristotle and Plato. Vitalism, the belief that living things contain an element that cannot be explained through matter, was responsible for legally and philosophically differentiating chiropractic from conventional medicine and thereby helping ensure professional autonomy. Chiropractic also retains elements of materialism, the belief that all things have explanations, which forms the basis of science. Evidence-based chiropractic balances this dualism by emphasizing both the tangible, testable principle that structure affects function, and the untestable, metaphorical recognition that life is self-sustaining.

The chiropractor's purpose is to foster the establishment and maintenance of an organism-environment dynamic that is the most conducive to functional well-being of the person as a whole. Principles such as holism, naturalism, therapeutic conservatism, critical rationalism, and thoughts from the phenomenological and humanistic paradigms form an important part of the philosophy of chiropractic."

Chiropractors can adopt or share vitalist, naturalist, or materialist viewpoints and emphasize a holistic, patient-centered approach that appreciates the multifactorial nature of influences (i.e. structural, chemical, and psychological) on the functioning of the body in health and disease and recognizes the dynamics and interplay between lifestyle, environment, and health. This holistic paradigm is also blended with a biopsychosocial approach, which is also emphasized in chiropractic care. In addition, chiropractors also retain naturopathic and naturalist principles that suggest decreased "host resistance" of the body facilitates the disease process and that natural interventions are preferable towards strengthening the host in its effort to optimize function and return to homeostasis. Chiropractic care primarily emphasizes manipulation and other manual therapies as an alternative than medications and surgery.

Chiropractors also commonly use nutrition, exercise, patient education, health promotion and lifestyle counseling as part of their holistic outlook towards preventive health care. Chiropractic's claim to improve health by improving biomechanical and neural function by the manual correction of joint and soft tissue dysfunctions of the neuromusculoskeletal system differentiates it from mainstream medicine and other complementary and alternative medicine (CAM) disciplines, but is also rooted, in part, in osteopathy and eastern medicine interventions. All chiropractic paradigms emphasize the spine as their focus, but their rationales for treatment vary depending on their particular belief system.

The philosophy of chiropractic also stresses the importance of prevention and primarily utilizes a pro-active approach and a wellness model to achieve this goal. For some, prevention includes a concept of "maintenance care" that attempts to "detect and correct" structural imbalances of the neuromusculoskeletal system while in its primary, or functional state. The objective is early identification of mechanical dysfunctions to prevent or delay permanent pathological changes.

In summary, the major premises regarding the philosophy of chiropractic include holism, conservatism, and manual and biopsychosocial approaches.

Comments on Philosophy rewrite

I suggest we improve the philosophy section. The section starting with *Holism should be briefly summarized. Here is an archived discussion. A better idea may be to rewrite the entire philosophy section. QuackGuru 08:30, 16 June 2008 (UTC)

  • I (and I suspect other editors) currently lack the time to work on this. I suggest we defer this until other, more-pressing matters get resolved. However, if you have the time to come up with a good rewrite, please feel free to draft one here.
  • More generally, in the future, if you think a section needs improvement, but don't have a proposal with complete specific wording, please don't copy the section into talk space. Please just say what improvements are needed. That will make this talk page smaller and easier for others to read, and will help us improve the article faster.
Eubulides (talk) 19:20, 16 June 2008 (UTC)
Philosophy was rewritten just two months ago and you were here for that. As active as you are, I doubt that I will even be able to follow all of your conversations, much less read the sources, so I'll be working on the priority list. Please don't consider anything having my support unless I specifically said I support it. You can always ask me to take a look at something if you want, and I will do the same for you. -- Dēmatt (chat) 21:38, 16 June 2008 (UTC)
I did not really participate in the Philosophy rewrite. I think this edit is an improvement. QuackGuru 23:08, 16 June 2008 (UTC)

Comments on the very boring bulleted text

  • Holism

boring text

  • Conservatism

more boring text

  • Manual and biopsychosocial approaches

even more boring text

There is an extensive long end run of bulleted text in the Philosophy section. Me thinks this change is a great improvement. We can fix this boring stuff by simply summarizing it. QuackGuru 00:00, 17 June 2008 (UTC)

I absolutely disagree. I don't find this section boring, and holism, consevatism, and chiropractics manual BPS approaches are extremely important. DigitalC (talk) 07:39, 17 June 2008 (UTC)
This is far more boring than the blocked quotes/text in education 3. There are also WP:WEIGHT problems. QuackGuru 07:50, 17 June 2008 (UTC)
Is the bulleted text necessary?
The bulleted text is hard to follow and extremely boring.
Here is text and a summary from one of the references found in Philosophy: Mootz RD, Phillips RB (1997). "Chiropractic belief systems". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research (PDF). AHCPR Pub No. 98-N002. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. Retrieved 2008-05-11. {{cite book}}: |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
Holism represents a philosophic perspective on the integration of body, mind, and spirit that posits that health depends on obedience to natural laws and that deviation can result in illness. Holism is based on the doctrine of teleology, which implies that there is a design or purpose in nature. An idealistic or vitalistic component can be seen in teleology. Based on the vitalism and metaphysics of his time, D.D. Palmer provided chiropractic a teleological metaphor when he expounded the concept that there is a "universal intelligence" that is manifest in living things as an "innate intelligence," which provides purpose, balance, and direction to all biologic function (Palmer, 1910). The classic medical concept of homeostasis also has its roots in the teleology of holism.
A complete reliance on a holistic universal intelligence entails dogma and is not acceptable in current chiropractic philosophy or practice (Phillips, 1992). Although untestable scientifically, the concepts proposed by chiropractic's metaphor (and holistic models in general) can still be subject to critical review and refinement (Milus, 1995). Popper (1960) suggested that the formulation of proper lines of questioning about new knowledge and ideas can be useful. For example, rather than defending assertions (or questioning the source of knowledge) about the body’s self-healing capacity, one might try to identify and revise conceptions regarding self-healing that are inconsistent with available evidence.
G. Summary
Traditional chiropractic belief systems focused on the body's ability to self-heal, the nervous system's role in overall health, and the role body structure was thought to play in function of the nervous system. Early articulation of these concepts by chiropractors was often cloaked in terminology that conveyed spiritual connotations. In addition, vitalistic explanations of self-healing confounded many outside the profession when used by early chiropractors to deny the value of quantitative evidence on clinical effectiveness.
Contemporary chiropractic belief systems embrace a blend of experience, conviction, critical thinking, open-mindedness, and appreciation of the natural order of things. Emphasis is on the tangible, testable principle that structure affects function, and, the untestable, metaphorical recognition that life is self-sustaining and the doctor’s aim is to foster the establishment and maintenance of an organism-environment dynamic that is the most conducive to functional well-being.
Contemporary chiropractic philosophy recognizes its partnership with the greater body of philosophy and science in general. Most contemporary chiropractors and their organizations distinguish between what is known and what is believed. Chiropractic belief systems embrace the holistic paradigm of wellness while incorporating deterministic materialism for the establishment of valid chiropractic principles. Chiropractic’s philosophic foundation serves as the basis for theoretical development, not a substitution for it (Phillips, 1992).
The above text is more clear and explains which chiropractor is being discussed, whether it is straight (traditional) or mixers (contemporary). The bulleted text is not clear which chiropractor believes in Holism, Conservatism, or Manual and biopsychosocial approaches and is confusing.
Per Misplaced Pages:Manual of Style#Bulleted and numbered lists. Do not use lists if a passage reads easily using plain paragraphs. QuackGuru 17:12, 17 June 2008 (UTC)
Both mixers and straights believe in Holistic, Conservative, Manual and BPS approaches. So do many 'mainstream' practitioners. For example, any wellness based health care (diet, exercise, etc.) are holistic in nature, and are also conservative in nature. All chiropractic treatment is conservative in nature (Chiropractors can't use invasive treatments such as surgery that is not conservative), etc. etc. DigitalC (talk) 10:09, 18 June 2008 (UTC)

copyrighted text in philosophy

… noninvasive, emphasizes patient's inherent recuperative abilities

… recognizes dynamics between lifestyle, environment, and health

… emphasizes understanding cause of illness in an effort to eradicate, rather than palliate, associated symptoms

… recognizes the centrality of the nervous system and its intimate relationship with both the structural and regulatory capacities of the body

… appreciates multifactorial nature of influences (structural, chemical, and psychological) on the nervous system

… balances benefit versus risk of clinical interventions

… recognizes as imperative the need to monitor progress and effectiveness through appropriate diagnostic procedures

… prevents unnecessary barriers in the doctor-patient encounter

… emphasizes a patient-centered, hands-on approach intent on influencing function through structure

… strives toward early intervention emphasizing timely diagnosis and treatment of functional, reversible conditions

Mootz RD, Phillips RB (1997). "Chiropractic belief systems". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research (PDF). AHCPR Pub No. 98-N002. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. Retrieved 2008-05-11. {{cite book}}: |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)

Here is a copy of the text from the above source. There seems to be a WP:COPYVIO problem in the philosophy section starting with the Holism bulleted text. QuackGuru 23:47, 17 June 2008 (UTC)

  • The cited source is in the public domain, so there is no copyright violation. However, I agree that it's disturbing that so much text was lifted from the source without proper attribution. It should be quoted if we're quoting it that much; merely citing the source isn't enough for proper credit. The simplest way to fix the problem is to put quote marks around the quoted text, making sure each quote is followed by a citation (this can wait until the end of the sentence).
  • I also agree that Chiropractic #Philosophy is long and repetitive and boring. A better-motivated and better-sourced replacement for its introduction can be found in Talk:Chiropractic/Archive 15 #Philosophy 2. That version was rejected by the editors at the time, but not all of them are still active, so perhaps this can be revisited at some point.
  • Although Chiropractic #Philosophy could be improved, it doesn't have serious POV problems as some other sections do, so it is lower priority for me.
Eubulides (talk) 08:29, 18 June 2008 (UTC)
The current mainspace version is very boring and can be improved. I have proposed Philosophy 2 rewrite below. QuackGuru 18:18, 18 June 2008 (UTC)

Philosophy 2 rewrite

Although a wide diversity of belief exists among chiropractors, they share the principle that the spine and health are related in an important and fundamental way, and this relationship is mediated through the nervous system. Chiropractors pay careful attention to the biomechanics, structure and function of the spine, its effects on the nervous and musculoskeletal systems, and the role these systems play in preventing disease and restoring health.

Chiropractic philosophy goes beyond simply manipulating the spine. Like naturopathy and several other forms of complementary and alternative medicine, chiropractic assumes that all aspects of a patient's health are interconnected, which leads to the following perspectives:

  • Holism treats the patient as a whole, and appreciates the multifactorial nature of influences (structural, chemical, and psychological) on the nervous system, recognizing dynamics between lifestyle, environment, and health.
  • Conservativism carefully considers the risks of clinical interventions when balancing them against their benefits. It emphasizes noninvasive treatment to minimize risk, and avoids surgery and medication.
  • Homeostasis emphasizes the body's inherent self-healing abilities. Chiropractic's early notion of innate intelligence can be thought of as a metaphor for homeostasis.
  • A patient-centered approach focuses on the patient rather than the disease, preventing unnecessary barriers in the doctor-patient encounter. The patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health.

Chiropractic's early philosophy was rooted in spiritual inspiration and rationalism. A philosophy based on deduction from irrefutable doctrine helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejected the inferential reasoning of the scientific method, and relied on deductions from vitalistic principles rather than on the materialism of science.

As chiropractic has matured, most practitioners accept the value that the scientific method has to offer. Balancing the dualism between the metaphysics of their predecessors and the materialistic reductionism of science, their belief systems blend experience, conviction, critical thinking, open-mindedness, and appreciation of the natural order. They emphasize the testable principle that structure affects function, and the untestable metaphor that life is self-sustaining. Their goal is to establish and maintain an organism-environment dynamic conducive to functional well-being of the whole person.

Comments on Philosophy 2 rewrite

This version tells a story and is concise. It will capture the reader. The long and repetitive mainspace version is very boring to read. QuackGuru 18:18, 18 June 2008 (UTC)

The figure isn't needed and can be removed, so I removed it. That was the only change from the previous draft, so this draft is now equivalent to what is in the previous draft. I suppose it can be further edited now, but as I said before, this is low priority for me. Eubulides (talk) 22:20, 18 June 2008 (UTC)
For what it's worth, I like this draft much better than what's up now. I understand the point about priorities, though. --—CynRN 23:47, 19 June 2008 (UTC)

References

References
  1. ^ Villanueva-Russell Y (2005). "Evidence-based medicine and its implications for the profession of chiropractic". Soc Sci Med. 60 (3): 545–61. doi:10.1016/j.socscimed.2004.05.017. PMID 15550303. Cite error: The named reference "Villanueva-Russell" was defined multiple times with different content (see the help page).
  2. ^ Keating JC Jr (1997). "Chiropractic: science and antiscience and pseudoscience side by side". Skept Inq. 21 (4): 37–43. Retrieved 2008-05-10. Cite error: The named reference "Keating-1997" was defined multiple times with different content (see the help page).
  3. DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.
  4. Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med. 136 (11): 817–25. PMID 12044130.
  5. Leboeuf-Yde C, Hestbaek L (2008). "Maintenance care in chiropractic - what do we know?" (PDF). Chiropr Osteopat. 16 (1): 3. doi:10.1186/1746-1340-16-3. PMID 18466623.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  6. Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med. 137 (8): 702.
  7. Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972.
  8. ^ Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW (2007). "Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research". J Altern Complement Med. 13 (5): 491–512. doi:10.1089/acm.2007.7088. PMID 17604553.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. Quality of SMT studies:
    • Fernández-de-las-Peñas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC (2006). "Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache". J Orthop Sports Phys Ther. 36 (3): 160–9. PMID 16596892.{{cite journal}}: CS1 maint: multiple names: authors list (link)
    • Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW; Expertise-Based RCT Working Group (2008). "The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review". Spine. 33 (8): 914–8. doi:10.1097/BRS.0b013e31816b4be4. PMID 18404113.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. Hancock MJ, Maher CG, Latimer J, McAuley JH (2006). "Selecting an appropriate placebo for a trial of spinal manipulative therapy" (PDF). Aust J Physiother. 52 (2): 135–8. PMID 16764551.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.
  12. ^ Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S (2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J. 8 (1): 213–25. doi:10.1016/j.spinee.2007.10.023. PMID 18164469.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. Murphy AY, van Teijlingen ER, Gobbi MO (2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther. 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ Meeker W, Branson R, Bronfort G; et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. Retrieved 2008-03-13. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  16. ^ Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews" (PDF). Eura Medicophys. 43 (1): 91–118. PMID 17369783.
  17. Gross AR, Hoving JL, Haines TA; et al. (2004). "Manipulation and mobilisation for mechanical neck disorders". Cochrane Database Syst Rev (1): CD004249. doi:10.1002/14651858.CD004249.pub2. PMID 14974063. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  18. Hurwitz EL, Carragee EJ, van der Velde G (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders". Spine. 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. Haneline MT (2005). "Chiropractic manipulation and acute neck pain: a review of the evidence". J Manipulative Physiol Ther. 28 (7): 520–5. doi:10.1016/j.jmpt.2005.07.010. PMID 16182027.
  20. Bronfort G, Nilsson N, Haas M; et al. (2004). "Non-invasive physical treatments for chronic/recurrent headache". Cochrane Database Syst Rev (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  21. Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". Clin J Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  22. Biondi DM (2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
  23. McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (2008). "Chiropractic treatment of upper extremity conditions: a systematic review". J Manipulative Physiol Ther. 31 (2): 146–59. doi:10.1016/j.jmpt.2007.12.004. PMID 18328941.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  24. Hoskins W, McHardy A, Pollard H, Windsham R, Onley R (2006). "Chiropractic treatment of lower extremity conditions: a literature review". J Manipulative Physiol Ther. 29 (8): 658–71. doi:10.1016/j.jmpt.2006.08.004. PMID 17045100.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  25. Everett CR, Patel RK (2007). "A systematic literature review of nonsurgical treatment in adult scoliosis". Spine. 32 (19 Suppl): S130–4. doi:10.1097/BRS.0b013e318134ea88. PMID 17728680.
  26. Romano M, Negrini S (2008). "Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review". Scoliosis. 3: 2. doi:10.1186/1748-7161-3-2. PMID 18211702.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  27. Kingston H (2007). "Effectiveness of chiropractic treatment for infantile colic". Paediatr Nurs. 19 (8): 26. PMID 17970361.
  28. Glazener CM, Evans JH, Cheuk DK (2005). "Complementary and miscellaneous interventions for nocturnal enuresis in children". Cochrane Database Syst Rev (2): CD005230. doi:10.1002/14651858.CD005230. PMID 15846744.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  29. Sarac AJ, Gur A (2006). "Complementary and alternative medical therapies in fibromyalgia". Curr Pharm Des. 12 (1): 47–57. PMID 16454724.
  30. Proctor ML, Hing W, Johnson TC, Murphy PA (2006). "Spinal manipulation for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev (3): CD002119. doi:10.1002/14651858.CD002119.pub3. PMID 16855988.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  31. Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med. 136 (11): 817–25. PMID 12044130.
  32. Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med. 137 (8): 702.
  33. DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.
  34. Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med. 136 (11): 817–25. PMID 12044130.
  35. Leboeuf-Yde C, Hestbaek L (2008). "Maintenance care in chiropractic - what do we know?" (PDF). Chiropr Osteopat. 16 (1): 3. doi:10.1186/1746-1340-16-3. PMID 18466623.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  36. ^ Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.
  37. Haneline MT (2005). "Chiropractic manipulation and acute neck pain: a review of the evidence". J Manipulative Physiol Ther. 28 (7): 520–5. doi:10.1016/j.jmpt.2005.07.010. PMID 16182027.
  38. McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (2008). "Chiropractic treatment of upper extremity conditions: a systematic review". J Manipulative Physiol Ther. 31 (2): 146–59. doi:10.1016/j.jmpt.2007.12.004. PMID 18328941.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  39. Hoskins W, McHardy A, Pollard H, Windsham R, Onley R (2006). "Chiropractic treatment of lower extremity conditions: a literature review". J Manipulative Physiol Ther. 29 (8): 658–71. doi:10.1016/j.jmpt.2006.08.004. PMID 17045100.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  40. Everett CR, Patel RK (2007). "A systematic literature review of nonsurgical treatment in adult scoliosis". Spine. 32 (19 Suppl): S130–4. doi:10.1097/BRS.0b013e318134ea88. PMID 17728680.
  41. Biondi DM (2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
  42. Kingston H (2007). "Effectiveness of chiropractic treatment for infantile colic". Paediatr Nurs. 19 (8): 26. PMID 17970361.
  43. Glazener CM, Evans JH, Cheuk DK (2005). "Complementary and miscellaneous interventions for nocturnal enuresis in children". Cochrane Database Syst Rev (2): CD005230. doi:10.1002/14651858.CD005230. PMID 15846744.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  44. Sarac AJ, Gur A (2006). "Complementary and alternative medical therapies in fibromyalgia". Curr Pharm Des. 12 (1): 47–57. PMID 16454724.
  45. Evans, W. (2003). "Chiropractic Care: Attempting A Risk-benefit Analysis". American Journal of Public Health. 93 (4): 522. Retrieved 2008-05-20.
  46. Bronfort, G. (2006). "Review conclusions by Ernst and Canter regarding spinal manipulation refuted". Chiropractic & Osteopathy. 14 (1): 14. doi:10.1186/1746-1340-14-14. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)
  47. Hurwitz, E.L. (2002). "Chiropractic care: a flawed risk-benefit analysis?". Am J Public Health. 92 (10): 1603–4. Retrieved 2008-05-20. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  48. Morley, J. (2001). "Ernst Fails to Address Key Charges". The Journal of Alternative & Complementary Medicine. 7 (2): 127–128. doi:10.1089/107555301750164145. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  49. "Profession Responds Quickly to Negative U.K. Study on Spinal Manipulation". Retrieved 2008-05-20.
  50. DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.
  51. Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med. 136 (11): 817–25. PMID 12044130.
  52. Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med. 137 (8): 702.
  53. Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med. 136 (11): 817–25. PMID 12044130.
  54. Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med. 137 (8): 702.
  55. ^ DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.
  56. Chapman-Smith DA (1997). "Legislative approaches to the regulation of the chiropractic profession". Med Law. 16 (3): 437–49. PMID 9409129.
  57. Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW (2007). "The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study". J Manipulative Physiol Ther. 30 (6): 408–18. doi:10.1016/j.jmpt.2007.04.013. PMID 17693331.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  58. Haas M, Sharma R, Stano M (2005). "Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain". J Manipulative Physiol Ther. 28 (8): 555–63. doi:10.1016/j.jmpt.2005.08.006. PMID 16226622.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  59. van der Roer N, Goossens ME, Evers SM, van Tulder MW (2005). "What is the most cost-effective treatment for patients with low back pain? A systematic review". Best Pract Res Clin Rheumatol. 19 (4): 671–84. doi:10.1016/j.berh.2005.03.007. PMID 15949783.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  60. Canter PH, Coon JT, Ernst E (2006). "Cost-effectiveness of complementary therapies in the United kingdom—a systematic review". Evid Based Complement Alternat Med. 3 (4): 425–32. doi:10.1093/ecam/nel044. PMID 17173105.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  61. Rothwell DM, Bondy SJ, Williams JI (2001). "Chiropractic manipulation and stroke: a population-based case-control study". Stroke. 32 (5): 1054–60. PMID 11340209.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  62. Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. (June 3, 2003). "A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain" (PDF). Ann Intern Med. 138 (11): 898–906. PMID 12779300.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  63. ^ Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972.
  64. Di Fabio RP (1999). "Manipulation of the Cervical Spine Risks and Benefits". Phys Ther. 79 (1): 50–65. PMID 9920191.
  65. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2003). "Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies". Ann Intern Med. 138 (11): 871–81. PMID 12779297.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  66. Wasiak R, Kim J, Pransky GS (2007). "The association between timing and duration of chiropractic care in work-related low back pain and work-disability outcomes". J Occup Environ Med. 49 (10): 1124–34. PMID 18000417.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  67. Frank J, Sinclair S, Hogg-Johnson S, Shannon H, Bombardier C, Beaton D, Cole D (1998). "Preventing disability from work-related low-back pain. New evidence gives new hope--if we can just get all the players onside". CMAJ. 158 (12): 1625–31. PMID 9645178.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  68. Rubinstein SM, Leboeuf-Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW (2007). "The benefits outweigh the risks for patients undergoing chiropractic care for neck pain: a prospective, multicenter, cohort study". J Manipulative Physiol Ther. 30 (6): 408–18. doi:10.1016/j.jmpt.2007.04.013. PMID 17693331.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  69. "Clinical Utilization and Cost Outcomes from an Integrative Medicine Independent Physician Association:". J Manipulative Physiol Ther. (4) (30): 263–9. May 2007. ISSN 17509435 PMID: 17509435. {{cite journal}}: Check |issn= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  70. "Effects of a Managed Chiropractic Benefit on the Use of Specific Diagnostic and Therapeutic Procedures in the Treatment of Low Back and Neck Pain". J Manipulative Physiol Ther. 8 (Oct, 28): 564–9. 2005. ISSN 16226623 PMID: 16226623. {{cite journal}}: |access-date= requires |url= (help); Check |issn= value (help); Check date values in: |accessdate= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  71. "Cost-effectiveness of Medical and Chiropractic Care for Acute and Chronic Low Back Pain". J Manipulative Physiol Ther. 8 (Oct 28): 555–563. 2005. ISSN 16226622 PMID: 16226622. {{cite journal}}: |access-date= requires |url= (help); Check |issn= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  72. "Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs". Arch Intern Med. 164 (18) (Oct 11): 1885–1892. 2004. ISSN 15477432 PMID: 15477432. {{cite journal}}: |access-date= requires |url= (help); Check |issn= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  73. Wasiak R, Kim J, Pransky GS (2007). "The association between timing and duration of chiropractic care in work-related low back pain and work-disability outcomes". J Occup Environ Med. 49 (10): 1124–34. PMID 18000417.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  77. Smith MG, Windmill IM (2006). "A comparison of entrance and graduation requirements for the Au.D. with other first professional degrees". J Am Acad Audiol. 17 (5): 321–30. PMID 16796299.
  78. "First-professional studies". U.S. Network for Education Information, U.S. Department of Education. Retrieved 2008-06-21.
  79. "Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status" (PDF). The Council on Chiropractic Education. 2007.
  80. "Standards for Doctor of Chiropractic Programmes" (PDF). Canadian Federation of Chiropractic Regulatory and Educational Accediting Boards. 2006.
  81. ^ World Health Organization (2005). "WHO guidelines on basic training and safety in chiropractic" (PDF). Retrieved 2008-03-03. {{cite journal}}: Cite journal requires |journal= (help)
  82. "State Chiropractic Licensure". Life University. 2007.
  83. "CFCREAB - Becoming a Chiropractor". Canada Federation of Chiropractic Regulatory and Educational Accrediting Boards.
  84. Grod, J.P. (2006). "Continuing Health Education in Canada". Journal of the Canadian Chiropractic Association. 50 (1). The Canadian Chiropractic Association: 14.
  85. Stuber KJ, Grod JP, Smith DL, Powers P (2005). "An online survey of chiropractors' opinions of Continuing Education". Chiropr Osteopat. 13 (22). PMID 16242035.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  86. "The Council on Chiropractic Education (CCE)". The Council on Chiropractic Education.
  87. "History and Purpose of The Councils on Chiropractic Education International". The Councils on Chiropractic Education International. 2005.
  88. "Accredited Doctor of Chiropractic programs". The Council on Chiropractic Education.
  89. "CFCREAB - Accreditation of Educational Programmes".
  90. "Institutions holding Accredited Status with the Council". The European Council On Chiropractic Education.
  91. "First-professional studies". U.S. Network for Education Information.
  92. "Facts & FAQs". Canadian Chiropractic Association.
  93. "Chiropractic Regulatory Boards". Federation of Chiropractic Licensing Boards.
  94. "Chiropractors". U.S. Department of Labor Bureau of Labor Statistics. 2006.
  95. "Number of Licensed Chiropractors in Canada". Canadian Chiropractic Association. 2006.
  96. James B. Campbell, Jason W. Busse, H. Stephen Injeyan (2000). "Chiropractors and Vaccination: A Historical Perspective" (PDF). Pediatrics.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  97. Gordon Waddell (2004). The Back Pain Revolution. Churchill Livingstone. {{cite book}}: Cite has empty unknown parameter: |chapterurl= (help)
  98. "Chiropractors". U.S. Department of Labor Bureau of Labor Statistics. 2006.
  99. "Number of Licensed Chiropractors in Canada". Canadian Chiropractic Association. 2006.
  100. Gordon Waddell (2004). The Back Pain Revolution. Churchill Livingstone. {{cite book}}: Cite has empty unknown parameter: |chapterurl= (help)
  101. Smith MG, Windmill IM (2006). "A comparison of entrance and graduation requirements for the Au.D. with other first professional degrees". J Am Acad Audiol. 17 (5): 321–30. PMID 16796299.
  102. "University PreRequisite Courses for Chiropractic" (PDF). Canadian Memorial Chiropractic College. 2005.
  103. "FPEH Guide to Chiropractic Programs" (PDF). Faculty of Physical Education and Health, University of Toronto. 2008.
  104. "Chiropractic education". Canadian Chiropractic Association. 2008.
  105. "State Chiropractic Licensure". Life University. 2007.
  106. Stephen M Perle (2003). "Credentialing CAM providers" (PDF). J Can Chiropr Assoc. 47 (2): 81–3.
  107. "Becoming a Chiropractor". Canadian Chiropractic Examining Board.
  108. "Chiropractic Act 1888 of 1986" (PDF). Pennsylvania Department of State. 2003.
  109. "Chiropractic Physician Practice Act Rules" (PDF). Utah Division of Occupational and Professional Licensing. 2004.
  110. Stuber KJ, Grod JP, Smith DL, Powers P (2005). "An online survey of chiropractors' opinions of Continuing Education". Chiropr Osteopat. 13 (22). PMID 16242035.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  111. "Chiropractic Education Worldwide". cceintl.org. Retrieved 2008-06-13.
  112. "Worldwide Quality Assurance for Chiropractic Education". The Councils on Chiropractic Education International. 2005.
  113. "Statement Regarding Equivalence of Accreditation Standards of CCEI Member Agencies". The Councils on Chiropractic Education International. 2005.
  114. Mosby (1994). Chiropractic: An Illustrated History. Peterson & Wiese. p. 528. {{cite book}}: Cite has empty unknown parameter: |chapterurl= (help)
  115. "Chiropractic Colleges". The World Chiropractic Alliance.
  116. "First-professional studies". U.S. Network for Education Information.
  117. "Chiropractors". U.S. Department of Labor Bureau of Labor Statistics. 2006.
  118. "Number of Licensed Chiropractors in Canada". Canadian Chiropractic Association. 2006.
  119. James B. Campbell, Jason W. Busse, H. Stephen Injeyan (2000). "Chiropractors and Vaccination: A Historical Perspective" (PDF). Pediatrics.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  120. Gordon Waddell (2004). The Back Pain Revolution. Churchill Livingstone. {{cite book}}: Cite has empty unknown parameter: |chapterurl= (help)
  121. "First-professional studies". U.S. Network for Education Information. Retrieved 2008-05-27.
  122. "The Council on Chiropractic Education Standards for Doctor of Chiropractic Programs and Requirements for Institutional Status" (PDF). Council on Chiropractic Education. January 2007. Retrieved 2008-06-13. {{cite web}}: line feed character in |title= at position 48 (help)
  123. {{cite web |url=http://www.cfcrb.org/english/pdf/Standards_for_Doctor_of_Chiropractic_Programmes.pdf CFCRB standards |title=Standards for Doctor of Chiropractic Programmes |accessdate=2008-06-13 |date=2006-10-21 |publisher=Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards
  124. "CFCREAB - Becoming a Chiropractor". Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards. Retrieved 2008-06-13.
  125. Grod, J.P. (2006). "Continuing Health Education in Canada". Journal of the Canadian Chiropractic Association. 50 (1). The Canadian Chiropractic Association: 14. Retrieved 2008-06-13.
  126. "Chiropractic Education Worldwide". cceintl.org. Retrieved 2008-06-13.
  127. "Accredited Doctor of Chiropractic programs". The Council on Chiropractic Education. Retrieved 2008-02-22.
  128. "CFCREAB - Accreditation of Educational Programmes". Retrieved 2008-05-28.
  129. "Institutions holding Accredited Status with the Council". Retrieved 2008-05-28.
  130. "Facts & FAQs". Canadian Chiropractic Association. Retrieved 2008-05-08.
  131. "FCLB - Member Boards". www.fclb.org. Retrieved 2008-06-17.
  132. "Chiropractors". U.S. Department of Labor Bureau of Labor Statistics. 2006.
  133. "Number of Licensed Chiropractors in Canada". Canadian Chiropractic Association. 2006. Retrieved 2008-05-28.
  134. James B. Campbell, Jason W. Busse, H. Stephen Injeyan (2000). "Chiropractors and Vaccination: A Historical Perspective" (PDF). Pediatrics.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  135. Gordon Waddell (2004). The Back Pain Revolution. Churchill Livingstone. {{cite book}}: Cite has empty unknown parameter: |chapterurl= (help)
  136. ^ Murphy AYMT, van Teijlingen ER, Gobbi MO (2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther. 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948.{{cite journal}}: CS1 maint: multiple names: authors list (link) Cite error: The named reference "Murphy" was defined multiple times with different content (see the help page).
  137. Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. PMID 17909210.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  138. Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. PMID 17909210.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  139. Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. PMID 17909210.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  140. Suter E, Vanderheyden LC, Trojan LS, Verhoef MJ, Armitage GD (2007). "How important is research-based practice to chiropractors and massage therapists?". J Manipulative Physiol Ther. 30 (2): 109–15. doi:10.1016/j.jmpt.2006.12.013. PMID 17320731.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  141. Feise RJ, Grod JP, Taylor-Vaisey A (2006). "Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care". Chiropr Osteopat. 24 (14): 14:18. PMID 16930482.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  142. Kaptchuk TJ (2002). "The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance?" (PDF). Ann Intern Med. 136 (11): 817–25. PMID 12044130.
  143. ^ Leboeuf-Yde C, Hestbæk L (2008). "Maintenance care in chiropractic - what do we know?" (PDF). Chiropr Osteopat. 16 (1): 3. doi:10.1186/1746-1340-16-3. PMID 18466623.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  144. Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med. 137 (8): 702.
  145. Quality of SMT studies:
    • Fernández-de-las-Peñas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC (2006). "Methodological quality of randomized controlled trials of spinal manipulation and mobilization in tension-type headache, migraine, and cervicogenic headache". J Orthop Sports Phys Ther. 36 (3): 160–9. PMID 16596892.{{cite journal}}: CS1 maint: multiple names: authors list (link)
    • Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW; Expertise-Based RCT Working Group (2008). "The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review". Spine. 33 (8): 914–8. doi:10.1097/BRS.0b013e31816b4be4. PMID 18404113.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  146. Hancock MJ, Maher CG, Latimer J, McAuley JH (2006). "Selecting an appropriate placebo for a trial of spinal manipulative therapy" (PDF). Aust J Physiother. 52 (2): 135–8. PMID 16764551.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  147. Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. PMID 17909210.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  148. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  150. Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. PMID 17909210.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  151. Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  152. Cite error: The named reference Hurwitz-2008 was invoked but never defined (see the help page).
  153. Gross AR, Hoving JL, Haines TA; et al. (2004). "Manipulation and mobilisation for mechanical neck disorders". Cochrane Database Syst Rev (1): CD004249. doi:10.1002/14651858.CD004249.pub2. PMID 14974063. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  154. Conlin A, Bhogal S, Sequeira K, Teasell R (2005). "Treatment of whiplash-associated disorders—part I: non-invasive interventions". Pain Res Manag. 10 (1): 21–32. PMID 15782244.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  155. Fernández-de-las-Peñas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA (2006). "Are manual therapies effective in reducing pain from tension-type headache?: a systematic review". Clin J Pain. 22 (3): 278–85. doi:10.1097/01.ajp.0000173017.64741.86. PMID 16514329.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  156. Biondi DM (2005). "Physical treatments for headache: a structured review". Headache. 45 (6): 738–46. doi:10.1111/j.1526-4610.2005.05141.x. PMID 15953306.
  157. Bronfort G, Nilsson N, Haas M; et al. (2004). "Non-invasive physical treatments for chronic/recurrent headache". Cochrane Database Syst Rev (3): CD001878. doi:10.1002/14651858.CD001878.pub2. PMID 15266458. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  158. McHardy A, Hoskins W, Pollard H, Onley R, Windsham R (2008). "Chiropractic treatment of upper extremity conditions: a systematic review". J Manipulative Physiol Ther. 31 (2): 146–59. doi:10.1016/j.jmpt.2007.12.004. PMID 18328941.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  159. Hoskins W, McHardy A, Pollard H, Windsham R, Onley R (2006). "Chiropractic treatment of lower extremity conditions: a literature review". J Manipulative Physiol Ther. 29 (8): 658–71. doi:10.1016/j.jmpt.2006.08.004. PMID 17045100.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  160. Everett CR, Patel RK (2007). "A systematic literature review of nonsurgical treatment in adult scoliosis". Spine. 32 (19 Suppl): S130–4. doi:10.1097/BRS.0b013e318134ea88. PMID 17728680.
  161. Romano M, Negrini S (2008). "Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review". Scoliosis. 3: 2. doi:10.1186/1748-7161-3-2. PMID 18211702.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  162. Kingston H (2007). "Effectiveness of chiropractic treatment for infantile colic". Paediatr Nurs. 19 (8): 26. PMID 17970361.
  163. Glazener CM, Evans JH, Cheuk DK (2005). "Complementary and miscellaneous interventions for nocturnal enuresis in children". Cochrane Database Syst Rev (2): CD005230. doi:10.1002/14651858.CD005230. PMID 15846744.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  164. Sarac AJ, Gur A (2006). "Complementary and alternative medical therapies in fibromyalgia". Curr Pharm Des. 12 (1): 47–57. PMID 16454724.
  165. Proctor ML, Hing W, Johnson TC, Murphy PA (2006). "Spinal manipulation for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev (3): CD002119. doi:10.1002/14651858.CD002119.pub3. PMID 16855988.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  166. ^ Martin SC (1993). "Chiropractic and the social context of medical technology, 1895-1925". Technol Cult. 34 (4): 808–34. PMID 11623404.
  167. ^ Keating JC Jr, Cleveland CS III, Menke M (2005). "Chiropractic history: a primer" (PDF). Association for the History of Chiropractic. Retrieved 2008-06-16.{{cite web}}: CS1 maint: multiple names: authors list (link)
  168. Cherkin D (1989). "AMA policy on chiropractic". Am J Public Health. 79 (11): 1569–70. PMC 1349822. PMID 2817179.
  169. ^ Cooper RA, McKee HJ (2003). "Chiropractic in the United States: trends and issues". Milbank Q. 81 (1): 107–38. doi:10.1111/1468-0009.00040. PMID 12669653.
  170. Cherkin D (1989). "AMA policy on chiropractic". Am J Public Health. 79 (11): 1569–70. PMC 1349822. PMID 2817179.
  171. "Position Paper One — What is Objective Straight Chiropractic?". Foundation for the Advancement of Chiropractic Education (F.A.C.E.). Retrieved 2008-03-24.
  172. Mirtz TA, Long P, Dinehart A; et al. (2002). "NACM and its argument with mainstream chiropractic health care". J Controv Med Claims. 9 (1): 11–8. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  173. ^ Cite error: The named reference ccestandards was invoked but never defined (see the help page).
  174. "What is chiropractic?". Ontario Chiropractic Association. Retrieved 2008-05-12.
  175. Tetrault M (2005). "Country support groups". Chiropractic Diplomatic Corps. Retrieved 2008-05-06.
  176. Cite error: The named reference Keating-subluxation was invoked but never defined (see the help page).
  177. Jaroff, Leon (February 27, 2002). "Back Off, Chiropractors!". CNN. Time magazine. Retrieved 2008-02-10.
  178. ^ Keating JC Jr (2005). "Philosophy in chiropractic". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 77–98. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
  179. ^ Cite error: The named reference Busse was invoked but never defined (see the help page).
  180. ^ Cite error: The named reference Kaptchuk-Eisenberg was invoked but never defined (see the help page).
  181. ^ Keating JC Jr (2005). "A brief history of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 23–64. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
  182. Tetrault M (2005). "Country support groups". Chiropractic Diplomatic Corps. Retrieved 2008-05-06.
  183. Cite error: The named reference Ernst-adverse was invoked but never defined (see the help page).
  184. Canadian Chiropractic Association (1996). "Glenerin guidelines: preventive maintenance care". Retrieved 2008-02-26.
  185. {{cite web |url=http://www.chiroweb.com/archives/22/18/01.html |title=Why Every Full-Scope DC Should Practice Acupuncture/Meridian Therapy |publisher=www.chiroweb.com |accessdate=2008-06-17
  186. "CHIROWEB". www.chiroweb.com. Retrieved 2008-06-17. {{cite web}}: Text "DC Archives - (DCs Who Perform Acupuncture -Turf War, or Question of Training?)" ignored (help)
  187. Chiropractic training:
    • Pybus, Beverly, E. A Guide to AHP Credentialing. C. hcPro. pp. 241–3. ISBN 1-57839-478-3. {{cite book}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: multiple names: authors list (link)
    • Coulter ID, Adams AH, Sandefur R (1997). "Chiropractic training". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research (PDF). AHCPR Pub No. 98-N002. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. Retrieved 2008-05-11. {{cite book}}: |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)CS1 maint: multiple names: authors list (link)
    • Mestan MA, Taylor JA, Blackshaw GL, McDonald JC (2006). "Commentary: establishing an accredited Master of Science in Diagnostic Imaging degree at a chiropractic college". J Manipulative Physiol Ther. 29 (5): 410–3.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  188. "Approved Chiropractic Specialty Programs" (PDF). American Chiropractic Association.
  189. Mr. Wales disapproves of synthesized historical theories and states: "Some who completely understand why Misplaced Pages ought not create novel theories of physics by citing the results of experiments and so on and synthesizing them into something new, may fail to see how the same thing applies to history." (Wales, Jimmy. "Original research", December 6, 2004)
  190. Meeker WC, Haldeman S (2002). "Chiropractic: in response" (PDF). Ann Intern Med. 137 (8): 702.
  191. ^ Mootz RD, Phillips RB (1997). "Chiropractic belief systems". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research (PDF). AHCPR Pub No. 98-N002. Rockville, MD: Agency for Health Care Policy and Research. pp. 9–16. OCLC 39856366. Retrieved 2008-05-11. {{cite book}}: |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) Cite error: The named reference "Chiro Beliefs" was defined multiple times with different content (see the help page).
  192. ^ Phillips RB (2005). "The evolution of vitalism and materialism and its impact on philosophy". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed. ed.). McGraw-Hill. pp. 65–76. ISBN 0-07-137534-1. {{cite book}}: |edition= has extra text (help); |editor= has generic name (help)CS1 maint: multiple names: editors list (link)
  193. Hansen DT, Mootz RD (1999). "Formal processes in health care technology assessment: a primer for the chiropractic profession". In Mootz RD, Hansen DT (ed.). Chiropractic technologies. Jones & Bartlett. pp. 3–17. ISBN 0834213737.
  194. Rupert RL (2000). "A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors, maintenance care: part I". J Manipulative Physiol Ther. 23 (1): 1–9. doi:10.1016/S0161-4754(00)90107-6. PMID 10658870.
  195. Rupert RL, Manello D, Sandefur R (2000). "Maintenance care: health promotion services administered to US chiropractic patients aged 65 and older, part II". J Manipulative Physiol Ther. 23 (1): 10–9. doi:10.1016/S0161-4754(00)90108-8. PMID 10658871.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  196. Canadian Chiropractic Association (1996). "Glenerin guidelines: preventive maintenance care". Retrieved 2008-02-26.
  197. Vear HJ (1992). "Scope of chiropractic practice". In Vear HJ (ed.) (ed.). Chiropractic Standards of Practice and Quality of Care. Gaithersburg, MD: Aspen. pp. 49–68. OCLC 23972994. {{cite book}}: |editor= has generic name (help)
  198. Gay RE, Nelson CF (2003). "Chiropractic philosophy". In Wainapel SF, Fast A (eds.) (ed.). Alternative Medicine and Rehabilitation: a Guide for Practitioners. New York: Demos Medical Publishing. ISBN 1-888799-66-8. {{cite book}}: |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)
  199. ^ American Chiropractic Association. "History of chiropractic care". Retrieved 2008-02-21.
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