Misplaced Pages

This is an old revision of this page, as edited by Dematt (talk | contribs) at 20:33, 5 May 2006 (Moving it in the science section). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

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

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

Template:Cleanup taskforce closed

Archives
Mar 2003 to Apr 2004 Sep 2004 to Oct 2004 Feb 2005 to Jul 2005 Aug 2005 to Oct 2005 Nov 2005 to Dec 2005 Jan 2006 to Mar 2006 Talk:Chiropractic/Archive 7

Conflicting "popularity" statistics

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

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

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

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

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

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

• Analysis of the Chiropractic Section of the Occupational Outlook Handbook

• The Future of Chiropractic Revisited: 2005 to 2015

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

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

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

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

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

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

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

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

Levine2112 05:29, 3 May 2006 (UTC)

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

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

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

Levine2112 06:49, 3 May 2006 (UTC)

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

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

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

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

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

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

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

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

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

Here is what the article now says:

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

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

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

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

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

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

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

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

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

Rewording of "popularity" paragraph

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

The original:

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

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

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

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

I recognized that and revised it to this:

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

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

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

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

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

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

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

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

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

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

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

Another quote in the same document:

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

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

The utilization statistics:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Future outlook analyzed

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

Proposed heading: "Future outlook"

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

• Chiropractic in the Healthcare Marketplace

• Chiropractic Education

• The Philosophy of Chiropractic

• Cultural Legitimacy and Integration into Healthcare

• The Practice of Chiropractic

• Managed Care

• User Demographics

• Technology

• Research on Chiropractic Care

The four scenarios are described as:

• 1. Slow, Steady Growth

• 2. Downward Spiral

• 3. Evidence Based Collaboration

• 4. Healthy Life Doctors

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

• 1. Accelerate Research

• 2. Continue to Strive for High Standards of Practice

• 3. Develop Greater Integration with Mainstream Healthcare

• 4. Anticipate and Engage Consumer Directed Care

• 5. Create Greater Unity within the Profession

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

• 7. Prepare for the Future of Prevention & Wellness

From: The Future of Chiropractic Revisited: 2005 to 2015

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

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

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

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

Introduction - next paragraph

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

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

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

History revisited

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

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

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

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

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

Introduction - First paragraph -2

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

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

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

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

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

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

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

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

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

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

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

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

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

Ethical regulation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

History rewrite - step one

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

History rewrite 2

Try this one;

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

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

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

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

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

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

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

Science and relativity

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

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

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

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

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

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

Although testing medical interventions for efficacy has existed for several hundred years, and arguably more, it was only in the 20th century that this effort evolved to impact almost all fields of health care and policy. Professor Archie Cochrane , a Scottish epidemiologist whose book Effectiveness and Efficiency: Random Reflections on Health Services (1972) and subsequent advocacy, caused increasing acceptance of the concepts behind evidence-based practice. Cochrane's work was honoured through the naming of centres of evidence-based medical research — Cochrane Centres — and an international organisation, the Cochrane Collaboration. The explicit methodologies used to determine 'best evidence' were largely established by the McMaster University research group led by David Sackett and Gordon Guyatt. The term "evidence-based medicine" first appeared in the medical literature in 1992 in a paper by Guyatt et al.

I'd say that makes it pretty new. Also, Critics of EBM say lack of evidence and lack of benefit are not the same, and that the more data are pooled and aggregated, the more difficult it is to compare the patients in the studies with the patient in front of the doctor, i.e. EBM applies to populations, not necessarily to individuals. In The limits of evidence-based medicine, Tonelli argues that "the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand." Tonelli suggests that proponents of evidence-based medicine discount the value of clinical experience.

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

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

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

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

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

• Misplaced Pages controversial topics