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Request for Comment: Excluding treatment reviews

Template:RFCsci

Should a Cochrane review on spinal manipulation be excluded from Chiropractic on WP:OR grounds? Similarly, should other reviews of treatments used by chiropractors be excluded from Chiropractic?

• Example of what's in the article now. Chiropractic #Effectiveness's coverage of chiropractic treatments talks about spinal manipulation (SM), and says "a 2004 Cochrane review () stated that SM or mobilization is no more or less effective than other standard interventions for back pain." This passage cites the current Cochrane review on SM therapy for low back pain, along with a systematic review of systematic reviews of SM. Chiropractic #Effectiveness also cites several other reviews of treatments used by chiropractors, e.g., Bronfort et al. 2008 (PMID 18164469), Chou et al. 2007 (PMID 17909210), and Gross et al. 2004 (PMID 14974063).

• Some background on the dispute. Some Misplaced Pages editors are objecting to citing mainstream reviews such as these, arguing that only sources specifically devoted to chiropractic should be cited by Chiropractic. This dispute has gone on for months; for previous discussions, please see Syn tag, SYN and implicit conclusions, Proposed wording for NOR/N, Chiropractic section on evidence basis, and A starting point for a look at the effectiveness section and introduction. A previous RfC on this issue (see Request for Comment, Possible OR violation at Chiropractic Effectiveness) does not specifically ask whether the abovementioned reviews should be excluded. This followup asks for clear advice on the core of the dispute.

Statements by editors previously involved in dispute

• Mainstream reviews of treatments commonly used by chiropractors should not be excluded from Chiropractic on WP:OR grounds. Such exclusion would be contrary to WP:WEIGHT, a fundamental Misplaced Pages principle. Eubulides (talk) 21:39, 16 September 2008 (UTC)

Comments

View by Ludwigs2

• Remove Cochrane Review. reading the review (as provided here), the review really says little, much less anything useful about chiropractic, and what it does say it says in a mildly biased fashion. summarizing the results, the review uses the following categories: 'sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful'. SHAM appears to be a placebo control, but chiropractic is not mentioned in the list, and it is not obviously clear where it would fall. even if we assume that chiropractic is considered to be a form of spinal manipulation, the review concludes that "There is no evidence that spinal manipulative therapy is superior to other standard treatments", which is simply a well poisoning way of saying that spinal manipulation is roughly equal in effectiveness to conventional treatments. since we don't know the relationship between Ch and SM, and SM is roughly equivalent to conventional treatments, this review tells us absolutely nothing about Ch. --Ludwigs2 00:53, 17 September 2008 (UTC)

The abstract says that SM comparably effective to some other standard treatments. I'm not sure why you think that is negative. Your point about chiropractic is relevant, though. Do we have any sources discussing the relationship between SM and chiropractic? Chou's review states that heat is moderately effective, and I know some chiropractors use heat. II | (t - c) 07:02, 17 September 2008 (UTC)

• Yes, we have sources describing the relationship between SM and chiropractic, and Chiropractic cites them. For example, Meeker & Haldeman (2002) wrote in the Annals of Internal Medicine 137 (8), p. 702, "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 course of recent mainstream research has followed this principle, without dissent by any reliable source that I know of.
• Ludwigs2's comment seems to be primarily about WP:NPOV, not WP:OR. NPOV is of course an important issue, but the RfC is about WP:OR, not WP:NPOV.

Eubulides (talk) 17:42, 17 September 2008 (UTC)

• Include SM reviews.I find it strange that you didn't mention that Ernst raised the exact point we have at issue here, saying that these SM studies are not relevant to chiropractic necessarily. And we have separate articles with the two -- and my attempt to connect the two was reverted. Until this relationship has been clarified more extensively, it's hard to say whether general SM research is really completely relevant to chiropractic. Are the providers who are being tested in the RCTs chiropractors? Anyway, I still want to keep the SM research summarized in the article, and I think its relationship to chiropractic is decently presented. However, Ernst's point that general SM research may not apply to chiropractic SM should be noted. II | (t - c) 07:42, 18 September 2008 (UTC)

• It would be appropriate to note that point and cite Ernst. Could you refresh our memories with a cited quote from Ernst about this? I don't recall his writing about it. Thanks. Eubulides (talk) 08:07, 18 September 2008 (UTC)

• I see that II made an edit along these lines, but it has problems. I have started a thread about this in #Ernst, Meeker, Haldeman below. Eubulides (talk) 22:13, 18 September 2008 (UTC)

• Remove Ernst and Cantor review. (subject to consideration). this review shares the same problems as the above review - it does not clearly speak to chiropractic, and its conclusion is oddly biased. if it can be demonstrated that SM and Ch are equivalent terms, this review would be useful for for pointing out the number of conditions that SM doesn't seem to work on; however, its general conclusions do not follow from its conclusions about back pain (e.g., they assert that SM is better than sham but not better than conventional treatments for back pain, but then they assert that "these data do not demonstrate that spinal manipulation is an effective intervention for any condition", which is patently false given their earlier statement. why use a source that can't be consistent over the space of three lines? --Ludwigs2 01:03, 17 September 2008 (UTC)

Would appreciate you linking these reviews as you kindly did the other one. II | (t - c)

sorry - I just took them from the links given above. but here you go. --Ludwigs2 07:45, 17 September 2008 (UTC)

• Here, Ludwigs2's comment seems to be primarily about WP:RS, not WP:OR. That is, Ludwigs2 seems to be primarily arguing that Ernst & Canter are contradictory and are not reliable.
• The results from Ernst & Canter 2006 (PMID 16574972) are consistent. They say that some reviews (e.g., Assendelft et al., Bronfort) say that SM is superior to sham for back pain, and that some reviews (e.g., Gross et al., Ferreira) say it's not. Their remark "Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition" says that the overall evidence is contradictory and that SM overall has not been demonstrated to be effective. This is a consistent position.

Eubulides (talk) 17:42, 17 September 2008 (UTC)

Keep the reviews. It's not us to decide whether or not they apply to SM, chiropractic, or both. If the authors state that they apply, we do not as editors contradict that. Ernst & Canter have clearly stated that in the reports themselves and in other writings ( a whole chapter in Ernst & Singh's book Trick or Treatment ) that these reviews apply to the effectiveness of chiropractic. We defer to the experts. Macgruder (talk) 14:28, 18 September 2008 (UTC)

If it can be demonstrated that Ernst's non-chiropractic studies have been applied to chiropractic by Ernst (or other researchers in published research), then I agree with you, MacGruder. If the researchers apply specific non-chiropractic research to chiropractic, then we can use the research (with the context explaining who said it was applicable). I'm am definitely not arguing against the inclusion of those cases. However, do you agree that we should not use other non-chiropractic SM research where no researcher has applied its conclusions directly to chiropractic? -- Levine2112 19:49, 18 September 2008 (UTC)

• It can indeed be demonstrated that Ernst & Canter 2006 (PMID 16574972) (which you call "non-chiropractic") is applied to chiropractic by published researchers. One example is the following source on chiropractic pain management, which discusses the evidence basis for spinal manipulative therapy (SMT) and uses Ernst & Canter as one of the citations supporting the claim "Recent systematic reviews have been contradictory and unable to clarify the role of SMT in spinal pain management." Here's the source: Kettner NW (2008). "Chiropractic pain management". In Audette JF, Bailey A (ed.). Contemporary Pain Medicine: Integrative Pain Medicine: The Science and Practice of Complementary and Alternative Medicine in Pain Management. Totowa, NJ: Humana. pp. 333–51. doi:10.1007/978-1-59745-344-8_16. ISBN 978-1-58829-786-0.
• This is one example, of course. More generally, though, we need not supply examples like this to support every use of a relevant source. That would simply be a recipe for excluding sources. It would tend to exclude recent sources, which are more up-to-date and therefore tend to be more-reliable, but are less-likely to be cited because they are so new. We need not wait for others to cite recent high-quality sources before citing them ourselves.

Eubulides (talk) 20:48, 18 September 2008 (UTC)

I am honestly undecided about Ernst. But just because Ernst cites a chiropractic specific study, doesn't mean that his non-chiropractic conclusion can be applied to chiropractic. What I want to see is that for every statement which we attribute to some source, that the statement can be shown to be referring to chiropractic specifically. From WP:OR: ...to demonstrate that you are not presenting original research, you must cite reliable sources that refer directly to the topic of the article, and that directly support the information as it is presented. This means that the statements we included must be cite in direct reference to chiropractic. If we have to infer that they are about chiropractic, we have created an OR violation. If we are inferring that the research could be applied to chiropractic based on an opinion given in some other wholly different research, then we have created an SYN violation. -- Levine2112 23:36, 18 September 2008 (UTC)

• What would help you decide about Ernst? Would another citation help? It should not be too hard to show from the literature that Ernst & Canter 2006 is an influential work in the study of the effectiveness of chiropractic care.
• The WP:OR part of your comment is outdated. WP:OR was recently changed to say that you must cite sources that are directly related to the topic of the article, not that refer directly. (This change was by editors I had never heard of, and I had no idea that it would happen until I just now checked WP:OR.) The change was to alter WP:OR to be more internally consistent, as WP:SYN already said "directly related". Clearly spinal manipulation is directly related to chiropractic: it's the core treatment of chiropractic, and is the reason for chiropractic's existence. There is no SYN here.

Eubulides (talk) 19:27, 19 September 2008 (UTC)

• I would like to see that Ernst is directly refering to chiropractic in the conclusions which we are using in our article. That's all really.

• I don't see much of a difference in the changed wording in terms of meaning. Ernst has stated that not all spinal manipulation studies are related to chiropractic. Thus, we cannot make the determination of which ones are related and which ones aren't related (though I would certainly like to read some insight into Ernst rationale). If we were to make the determination of which spinal manipulation research is directly related to chiropractic and which ones are not, then we would be engaged in original research. -- Levine2112 00:10, 24 September 2008 (UTC)

Remove Ernst and Cantor review. The very fact that you have these in the Chiro article is OR/SYNTH. Keep it for the SM article. I don't know why there is an issue here, why people would want to include or exclude. However, I know what the policy issue is, and I know that these have no business masquerading as chiropractic when they may or may not be relevant. Certainly, removing the tag as QG recently did is completely premature. Let me state it very clearly: unless you can prove that the statement is about chiropractic, don't include it. Period. Creating that connection when it is not specifically stated in the source is OR/SYNTH, and it is not allowed in Misplaced Pages, in any case whatsoever. The recent change to OR will not stand, so don't go citing that, it is not relevant to this conversation. ——Martin ☎ Ψ Φ—— 20:56, 30 September 2008 (UTC)

You are altering policy and making wild edits that might have direct impact on this particular dispute. The controversial edits to policy reflects your position in this specific content dispute. BTW, the outside observer supported the inclusion of the SM studies. QuackGuru 21:31, 30 September 2008 (UTC)

Outside view by WhatamIdoing

The Cochrane reviews should be included. Chiropractors in general accept studies on spinal manipulation as being directly relevant for the major technique of chiropractic manipulation. The ongoing assertion at this page that Misplaced Pages should exclude normal scientific information from highly reputable sources simply because a given paper wasn't written by a chiropractor is absurd. WP:WEIGHT prevents the exclusion of mainstream sources. However, if you want to follow up on that theme, it might be interesting to include a point published by Ernst: whether or not a given clinical study determines that chiropractic care is effective depends significantly on whether there's a DC writing the paper (not just doing the spinal manipulation).

The Ernst and Cantor review should be included. Editors with an opposing POV may want to make a case for including this editorial about it, although I found several of the complaints to be particularly weak. They will also want to carefully consider their position: if you accept this critical commentary, then you must also accept the fact that the Ernst and Cantor review is considered, by relevant experts in chiropractic itself, to have direct connections to chiropractic.

About the difference between "same effectiveness" (for one condition) and "not effective" in general: Increasingly, the standard for effectiveness is "better than what we've already got". However, the general reader isn't going to know that, and thus the conclusions should be presented in somewhat more detail: "no more or less effective than other standard interventions for back pain." In other words, exactly like it's currently in the article. I also don't understand why this is seen as disparaging information.

In short, the inclusion of these reviews does not violate WP:OR and they do provide necessary balance under WP:WEIGHT. WhatamIdoing (talk) 22:50, 17 September 2008 (UTC)

Your argument for inclusion hinges on this statement: Chiropractors in general accept studies on spinal manipulation as being directly relevant for the major technique of chiropractic manipulation. How do you know this? Plus, is this about what chiropractors accept or what the mainstream scientific community accepts? For instance, there was a case where chiropractors were using positive conclusions from a general spinal manipulation study to state things such as "Chiropractic works!" However, the researchers involved with the study were very critical of chiropractors doing so because their research was about spinal manipulation and not about chiropractic. Dr. Paul Shekelle of RAND released this statement:

"...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."

-- Levine2112 23:51, 17 September 2008 (UTC)

You are again confounding "spinal manipulation" (a technique) with "chiropractic" (the profession), which is the same error made by the original chiropractors mentioned above, and scolded by Shekelle for doing so. They were trying to claim that spinal manipulation research that was positive was a green card for claiming that everything the profession did "works", which is far from the truth. Much in chiropractic is rejected as fringe, unscientific quackery, and Shekelle wasn't about to allow such misuse of the RAND study. The conclusions of the study only had relevance to the major technique performed by the profession, and upon which the profession is based. Chiropractic is not equal to spinal adjustment/manipulation (SM), but "no SM, no chiropractic". Chiropractic without SM would be like a nail without a hammer. They belong together.

We aren't discussing the RAND conflict here. We are discussing whether the subject of "spinal manipulation" is relevant to the chiropractic profession, and it is very relevant, as noted by their strong objections in the commentary mentioned above. If it were irrelevant, they would have been silent. BUT keep in mind, it is only relevant as regards the effectiveness of manipulation/adjustments, which are performed by chiropractors and thus such research is very relevant to them, even when it is about SM performed solely by non-DCs (a few such studies exist), or including a few non-DCs (usually the case). -- Fyslee / talk 04:50, 18 September 2008 (UTC)

I totally agree with this point. Macgruder (talk) 14:36, 18 September 2008 (UTC)

The fact that notable chiropractors and researchers consider general research about spinal manipulation relevant for the profession is explained quite clearly by Meeker and Haldeman, as noted above by Eubulides:

• Yes, we have sources describing the relationship between SM and chiropractic, and Chiropractic cites them. For example, Meeker & Haldeman (2002) wrote in the Annals of Internal Medicine 137 (8), p. 702, "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 course of recent mainstream research has followed this principle, without dissent by any reliable source that I know of.

Neither Eubulides nor myself know of any dissenting voices in reliable sources, and I think we should follow the sources, rather than Levine2112's (or other's) personal opinion. This is not a case of OR or SYNTH. -- Fyslee / talk 06:09, 18 September 2008 (UTC)

Your explanation illustrates the WP:SYN violation beautifully. You are wanting to use Meeker's explanation to justify the inclusion of research which Meeker didn't specifically analyze. Thus you are justifying Source A by using an explanation in Source B to create an Original Statement C (that the conclusions of non-chiropractic Source A is directly applicable to chiropractic). Please note that I have no problem including Meeker or the non-chiropractic research which they analyzed and directly applied to chiropractic. This issue here is with the other non-chiropractic research which has not been directly applied to chiropractic by any researchers. Merely following the lead of Meeker here with these other non-chiropractic studies creates original research and we cannot have that. -- Levine2112 07:58, 18 September 2008 (UTC)

There is no "original statement C" in Chiropractic #Evidence basis, so there is no WP:OR there. As you note, there are original statements on this talk page; but that's OK. A talk page is allowed to contain original research, and talk pages routinely contain OR; it's only the article itself that should not contain OR. Eubulides (talk) 08:07, 18 September 2008 (UTC)

Stating or implying that conclusions from non-chiropractic spinal manipulation efficacy or safety research is directly applicable to conclusion about the efficacy or safety of chiropractic is original research. This is what we are referring to as "Original Statement C". That you are justifying such an application on the notion that Meeker & Haldeman have done it in their research is why this is a synthesis violation. -- Levine2112 17:00, 18 September 2008 (UTC)

That is not a Statement C. SM research is relevant to chiropractic. QuackGuru 17:08, 18 September 2008 (UTC)

I agree with QuackGuru. The only "Original Statement C" is on the talk page. It is not WP:OR when the only occurrence of "Original Statement C" is on the talk page. Eubulides (talk) 17:29, 18 September 2008 (UTC)

Non-chiropractic SM efficacy/safety research is directly relevant to chiropractic efficacy/safety" is an implied statement we are making in the article by basing so many conclusion in the Chiropractic article on non-chiropractic SM efficacy/safety research; whereas commenting on chiropractic was not the expressed intention of the researchers. -- Levine2112 19:39, 18 September 2008 (UTC)

WP:OR governs what is put into Chiropractic. It does not govern the myriads of inferences that a reader might make from Chiropractic. As a trivial example, a reader might infer from Chiropractic that the profession is normally called "chiropractic" and not "chiropracty", because Chiropractic consistently uses the word "chiropractic" and never uses the word "chiropracty". But this does not mean that Chiropractic is guilty of WP:OR because it does not cite a source saying that "chiropractic" is a more common term than "chiropracty". Eubulides (talk) 20:48, 18 September 2008 (UTC)

I believe that after all this time you are still missing something major at WP:OR: ...to demonstrate that you are not presenting original research, you must cite reliable sources that refer directly to the topic of the article, and that directly support the information as it is presented. So if the non-chiropractic spinal manipulation research you want to include never mentions chiropractic , then you must concede that it is a source which doesn't refer directly to the topic of the article (namely, Chiropractic). Thus you have not demonstrated that you are not presenting original research. -- Levine2112 23:30, 18 September 2008 (UTC)

Again, the WP:OR part of this comment is outdated. WP:OR's lead was recently changed to say that you must cite sources that are directly related to the topic of the article, not that refer directly. This change was for consistency, as the body said "directly related". Eubulides (talk) 19:27, 19 September 2008 (UTC)

WP:OR: or if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research.

Spinal manipulation is directly related to chiropractic. QuackGuru 00:31, 19 September 2008 (UTC)

Related? Yes. Directly related? Well that's the topic of this debate. Meeker & Haldeman said it was okay for them to confound non-chiropractic SM research to draw conclusions about chiropractic; however, Ernst disagrees with them. So, according to the sources, it is questionable whether non-chiropractic spinal manipulation is directly related to chiropractic spinal manipulation. Let's look at the whole quote form WP:OR which you have mentioned: 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. Well, if a source is about non-chiropractic spinal manipulation and we are using it to draw conclusions about chiropractic spinal manipulation, then you have to admit that the source cited does not explicitly reach the same conclusion as that which we are presenting in the article. -- Levine2112 00:39, 19 September 2008 (UTC)

Ernst does not disagree with Meeker & Haldeman. He merely notes that they should state where their data came from. In a later work, Ernst 2008 (PMID 18280103), Ernst does what Meeker & Haldeman do, except he says where his data came from. Eubulides (talk) 19:27, 19 September 2008 (UTC)

I have explained it before that spinal manipulation is directly related to chiropractic and therefore it is reasonable to include it in this article. QuackGuru 00:46, 19 September 2008 (UTC)

Just because you explained it, does not make it true. I have show that several leading researchers disagree with you. So once again: Related? Yes. Directly related? That is a matter of debate. We can refer to the debate in our article, but we cannot perform original research based on the opinions of one side in the debate. Sorry. -- Levine2112 00:58, 19 September 2008 (UTC)

Again, it is not the case that "several leading researchers" are disagreeing with QuackGuru's point. QuackGuru's point agrees with the positions taken by Meeker, Haldeman, and Ernst. Eubulides (talk) 19:27, 19 September 2008 (UTC)

I do not see several researchers disagreeing with OR guidelines. It is reasonable to include related research. QuackGuru 01:07, 19 September 2008 (UTC)

Several researchers disagree with your position that non-chiro SM research is directly related to chiro SM research. Thus inclusion of non-chiro SM research in a section about Chiropractic effectiveness is a violation of WP:OR. -- Levine2112 01:22, 19 September 2008 (UTC)

Again, it is not the case that "several leading researchers" are disagreeing with QuackGuru's point. Meeker, Haldeman, and (later) Ernst are agreeing on this point. Eubulides (talk) 19:27, 19 September 2008 (UTC)

I know spinal manipulation is related to chiropractic. It is obvious that SM research is related to chiropractic. And the outside view at the NOR noticeboard supports the inclusion of the related text. QuackGuru 01:35, 19 September 2008 (UTC)

I'm sorry but you opinion means very little in terms of if non-chiro SM research is directly related to chiro SM. We must rely on the sources. Currently the sources show that there is disagreement on whether or not it is directly related. And yes, one outside view (from a newbie editor) at NOR agreed with your position. However, two outside views from more experienced editors agreed with my position. That's kind of a weak point on your point. Especially in the face of the current RfC which show majority support of my position. Sorry again. -- Levine2112 01:39, 19 September 2008 (UTC)

Again, it is not the case that "the sources show there is disagreement". On the contrary, Meeker & Haldeman agree with Ernst. Eubulides (talk) 19:27, 19 September 2008 (UTC)

The views from editors who agreed with Levine2112's position never provided any specific examples of OR. Specific examples are needed. QuackGuru 01:43, 19 September 2008 (UTC)

Yes, keep insisting that no examples were given, even though it is plainly obvious to everyone else that specific example were given and are even now currently being discussed (Murphy, Ernst, Cochrance, Haldeman & Meeker). Despite flying in the face of reality, you are doing a tremendous job of holding firmly to your position. -- Levine2112 01:49, 19 September 2008 (UTC)

Those researchers are not specific examples of OR. The views who claim there is OR have not demonstrated any OR. I request specific examples. Exactly which sentence is OR and why. QuackGuru 01:55, 19 September 2008 (UTC)

Until you are ready to accept the possibility that your opinions on the specific example which I have provided may be wrong, then there is really nothing further to discuss with you here. -- Levine2112 02:36, 19 September 2008 (UTC)

I request a specific example of OR and how it is OR. This is a simple request. A specific example of OR would be a specific sentence that is not verfified. Please explain exactly which sentence is OR and why. I hope this was helpful. QuackGuru 16:10, 19 September 2008 (UTC)

I have provided you with an example above. That you don't think it is a good example is beyond my power. Regardless, I have provided an example. Every outside commentator in this RfC agrees that there is an OR violation. Please respect their opinions. -- Levine2112 17:31, 19 September 2008 (UTC)

(outdent) QuackGuru is correct here. We need a specific example of wording in the article that contains OR which is not supported by the cited source. So far, no such examples have been supplied. Also, it is not correct that "Every outside commentator in this RfC agrees that there is an OR violation." So far, we've seen two outside commentators, Ludwigs2 and WhatamIdoing. WhatamIdoing clearly supports the material in question. Ludwigs2 opposes inclusion, but mostly on WP:NPOV and WP:WEIGHT grounds; those are different issues than the question raised by the RfC. Eubulides (talk) 19:27, 19 September 2008 (UTC)

Sorry. I got my RfC confused. The RfC above this one - which deals in generalities of OR existing in this specific section of the article - received comments from several outsiders, all of whom agreed that the section contains OR. There, in that RfC, the Murphy et al example was provided. This RfC deals with specific examples and doesn't strike at the core of the dispute - that in general, since there is no agreement in the scientific community that non-chiro SM research is directly relevant to chiro SM conclusions, by including such conclusions from non-chiro SM research in our Misplaced Pages article on Chiropractic violates WP:NOR. You will also note that the majority of respondents to the first RfC were in favor of moving the non-chiro SM research supported statements to the more apropos Spinal manipulation article. Please at least acknowledge these results from the first RfC. -- Levine2112 19:55, 19 September 2008 (UTC)

• OK, so we agree that the current RfC does not currently support the WP:OR claim.
• The previous RfC has comments from two uninvolved editors. One (MaxPont) supports moving SM material to the SM article, but does not say why; this is not agreement that the section contains WP:OR. The other (Martinphi) conditioned his response on whether the facts are properly presented in the RfC; this fairly slender reed would be stronger if Martinphi had read the section in question, but Martinphi unfortunately has not have the time to digest it.
• I myself have proposed trimming down Chiropractic #Evidence basis and moving some of its details to a subarticle. I am not opposed to that, nor is this RfC about that. This RfC is about whether it's OR to discuss spinal manipulation in Chiropractic, and to support the discussion with reliable sources on spinal manipulation.
• The Murphy et al. example was not part of the previous RfC. It is part of later commentary on the RfC, and no outsider has commented on Murphy et al.
• The specific examples in this RfC are the sources that are at the core of the dispute. It is better for RfCs to be specific, e.g., by proposing specific wording changes; otherwise, their conclusions are less useful.

Eubulides (talk) 20:58, 19 September 2008 (UTC)

• No. The current RfC neither supports or refutes the OR claim. Some commentators don't recognizethe OR violation while some commentators do.
• While I too wish MaxPont elaborated in his two responses, I believe it is clear that he feels that there is an OR problems here and that the material would be better located at the more general spinal manipulation article. MartinPhi's response is thorough. I don't think it is fair of you to assess that he didn't read the section in question. He may not have fact-checked every source, but his response accounts for that by stating that if what the RfC says about the sources in question is true, then he recognizes that there is an OR issue.
• Trimming is fine, especially if you are cutting out the non-chiropractic SM studies which currently may be in violation of OR. The ideal article to move them to is spinal manipulation as these are studies about spinal manipulation in general and not as performed by any specific kind of practitioner. Moving them to an article specifically about chiropractic adjustments or to a newly created article about chiropractic effectiveness, would essentially be moving the same OR problem to a different article.
• The Murphy example was added to that RfC just after you requested of me to provide a specific example.
• That RfC did propose a specific solution and that was moving the information sourced to general spinal manipulation research to the more apropos spinal manipulation article. I believe that every respondent was in favor of this proposal.

-- Levine2112 23:48, 19 September 2008 (UTC)

• Martinphi wrote "I have not digested the section in question. However, if the facts are properly presented above"; it's quite clear that this opinion is based on the wording in the RfC, and not on any careful reading of what's in Chiropractic.
• MaxPont's comment says nothing about OR; it does not support the claim that there is OR here.
• The Murphy example is not part of the RfC. It is part of later commentary on the RfC.
• The RfC did not specifically identify which sources were "general spinal manipulation research", and as such, it does not propose a specific solution.
• Trimming should use the WP:SUMMARY style, which should summarize everything of interest in this section.

Eubulides (talk) 07:11, 22 September 2008 (UTC)

When I say I didn't digest the section, that is because in order for my response to be incorrect, the RfC would have to be basically very wrong in its presentation of the facts. There is no reason I should read all the sources to respond here. I did read enough of the section to see that articles which are not really about chiro are being used. If there aren't sources specifically saying "this study of SM would apply equally to chiro," we have no business using them to draw conclusions about chiro. this has sub-sections which are clearly about SM, and at the very least to the extent they are being presented at the Chiropratic article, but may or may not be relevant, they are SYNTH/OR. The material is for a SM article, not Chiro. So, I think my comments relevant, unless you have specific reasons for saying they are not.

Thus, I think that you should simply cut the material, not summarize. You should only keep what is actually sourced to documents which discuss Chrio. But there should be a link to the SM article. The issue is a simple one of policy, not a content dispute in which I would have had to understand the sources and the way they are being used. If you're using sources which aren't about chrio, but about SM, then keep it for the SM article. Keep and use any good sources which talk about the relationship of Chrio to SM in general. But discuss SM only in another article when it is not directly about Chiro SM. ——Martin ☎ Ψ Φ—— 02:38, 24 September 2008 (UTC)

Do I really have to repeat the arguments. If I support a certain position it is because I find the other editors arguments in favour of that position convincing. MaxPont (talk) 13:09, 24 September 2008 (UTC)

I would help if specific examples of OR were presented. Please show there is OR rather than just asserting it would be helpful. If no OR is specifically presented we can reasonably conclude there is no OR in this article. QuackGuru 16:11, 24 September 2008 (UTC)

Of course you (MaxPont) don't have to repeat the arguments. It is sufficient to say that you agree or disagree. It is a request for comments from uninvolved editors. How much you wish to comment is up to you. Certainly the more you contribute, the better, but a simple "agree" or "disagree" is completely valid as well. Thank you for taking the time to respond.

Martinphi, also thank you for taking the time to respond to the RfC as an uninvolved editor. Hopefully, yours and MaxPont's (and Ludwig2's) (and I'clast) comments will not continue to be discounted by the opposition. -- Levine2112 17:38, 24 September 2008 (UTC)

It is not sufficient to claim there is OR when no evidence of OR has been presented. QuackGuru 17:45, 24 September 2008 (UTC)

Well I for one disagree with you. As does Martinphi, MaxPont, Ludwig2, and I'clast. I think I can speak for DigitalC, Surturz, Hughgr and Dematt who have also agreed that evidence of OR have been presented. I would even venture to guess that the "opposition" (such as Eubulides) will agree that evidence has been presented, even if they disagree with the evidence. I think you're on your own with this line of argumentation. -- Levine2112 17:56, 24 September 2008 (UTC)

Hughgr has commented on this RfC? Dematt has commented on this RfC? Where? Eubulides (talk) 07:36, 25 September 2008 (UTC)

You disagree with: It is not sufficient to claim there is OR when no evidence of OR has been presented.

You claim it is sufficient to assert there is OR without presenting evidence of OR. That's not a valid reason to delete research related to chiropractic. QuackGuru 18:02, 24 September 2008 (UTC)

Please just stop it. Accept that evidence has been provided but you simply don't agree with the evidence. To continue on like this with your head buried in the sand is just childish at this point (Sorry for the mixed metaphor). -- Levine2112 18:04, 24 September 2008 (UTC)

Please show me the evidence of OR rather than asserting it would be more helpful. QuackGuru 18:15, 24 September 2008 (UTC)

Evidence: 1) Murphy makes no mention of chiropractic specifically in any of its conclusions about spinal manipulation. 2) Edzard Ernst tells us that not all spinal manipulation studies are related to chiropractic. 3) WP:OR states that if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research.

There is your evidence. I have presented it. Please don't ever claim that I have not presented it because that would be a fabrication at this point. Whether or not you agree with the evidence is another matter. It is evidence and it has been presented. End of story. -- Levine2112 18:40, 24 September 2008 (UTC)

You have not explained specifically which if any spinal manipulation is not directly related to chiropractic. Based on your many comment you believe you do not have to give any specific examples of OR. I believe if anyone claims there is OR it is that editor's responsibility to present such evidence. Please explain specifically which sentence is OR and how it is OR. SM is performed by chiropractors, thus it is directly related to chiropractic. QuackGuru 18:52, 24 September 2008 (UTC)

It is OR to have SM which is not about Chiro in the Chiro article. You have SM which is not about Chiro in the Chiro article (evidence in this section). Therefore, you haven OR/SYNTH in the Chiro article. ——Martin ☎ Ψ Φ—— 22:40, 24 September 2008 (UTC)

(outdent) The source in question, Murphy et al. 2006 (PMID 16949948), refers directly to chiropractic. It would be inaccurate to call this source "SM which is not about chiro". Eubulides (talk) 07:36, 25 September 2008 (UTC)

I see only an abstract. The whole point is that we should indeed say what it says about Chiro, or about the relationship between Chiro and SM. But not assume that SM applies to Chiro. I can't review the source to say more than this. If you have it you could send it to me? ——Martin ☎ Ψ Φ—— 23:20, 25 September 2008 (UTC)

Sorry, I don't have the rights to send you a copy. WP:OR does not have the restriction that you mention, though. Eubulides (talk) 07:12, 26 September 2008 (UTC)

Then I would have to say that merely referring directly to Chrio is not enough: he could have been referring to the fact that SM is not the same as Chiro. ——Martin ☎ Ψ Φ—— 22:41, 26 September 2008 (UTC)

You can see the full text of Murphy here. Note that chiropractic is only mentioned in data collection and that the data is mixed with osteopathic data. In the conclusion (which is what we are citing in the article), chiropractic is never referred to. The conclusion is about spinal manipulation in general and not about chiropractic spinal manipulation specifically. There is no clear way for us to know which general spinal manipulation research can relate to chiropractic spinal manipulation and which ones cannot. Of the 43 published spinal manipulation RCTs, Edzard Ernst has said that the majority do not relate to chiropractic. For us to relate Murphy to chiropractic (when there is no other source out there doing so) qualifies as original research, because the authors of Murphy are not relating their studies to chiropractic. Nor is any other researcher relating Murphy to chiropractic. For us to present this relationship is original research. -- Levine2112 00:06, 27 September 2008 (UTC)

Murphy does directly refer to chiropractic, so WP:OR is satisfied. Most of the studies in its Table 2 are chiropractic studies, so Ernst's criticism does not apply to Murphy. Eubulides (talk) 03:32, 27 September 2008 (UTC)

Maybe the lay public does not understand this. . . but there is spinal manipulation and then there is chiropractic spinal manipulation. . . which we call spinal adjustments. There is a difference between the two as Levine212, Martin and DigitalC have rightly pointed out. . . the difference as far as research goes has been pointed out by Edward Enrst. . . as noted above. . . and others. It is without question that spinal manipulation research not about chiropractic spinal manipulation should not be used in your article about spinal manipulation. This is a violation of "OR" as it is written now and is rightly labeled.TheDoctorIsIn (talk) 23:56, 29 September 2008 (UTC)

Outside view by TimVickers

Since the consensus of both reliable sources and many chiropractors seems to be that research on spinal manipulation can be used to examine the effectiveness of one aspect of chiropractic medicine, adding this research is not OR since this connection is not a novel interpretation of a Misplaced Pages editor but one found in the mainstream medical literature. Indeed, I notice that most mainstream sources on this topic discuss the implications of research on spinal manipulation on chiropractic practice, for example this BBC article and this Times article on the Ernst review even quote the British Chiropractic Association discussing the relation of this work to chiropractic medicine.

An example of OR would be if somebody were to add commentary on research on the speed of light in black holes and its relation to chiropractic medicine to this article, since nobody has made that connection before and it would be a novel claim made on Misplaced Pages for the first time.

It would however be useful to add any opinions from prominent chiropractors that argue their form of spinal manipulation differs from other people's use of this technique, and to summarize the evidence in the mainstream medical literature for or against this argument. Tim Vickers (talk) 21:49, 30 September 2008 (UTC)

"Since the consensus of both reliable sources and many chiropractors seems to be that research on spinal manipulation can be used to examine the effectiveness of one aspect of chiropractic medicine, adding this research is not OR since this connection is not a novel interpretation of a Misplaced Pages editor but one found in the mainstream medical literature." - Please provide a quote from a RS which illustrates that such a consensus exists. To state that such a consensus exists is original research unless we have sources that say that such a consensus exists. If we had that, we wouldn't have this OR debate. - DigitalC (talk) 00:33, 8 October 2008 (UTC)

Precisely. -- Levine2112 00:43, 8 October 2008 (UTC)

There is no Misplaced Pages policy or guideline saying that we must cite a reliable source Y in order to justify the citing of a reliable and relevant source X. If that were the rule, hardly any article could ever cite anything. Furthermore, even if a source Y can be produced, a true skeptic could then argue that it's WP:OR to use Y to justify citing X. (Such an argument has been made on this talk page, to argue that reliable secondary reviews on spinal manipulation should be excluded.) Or a skeptic could then argue that one needs to come up with a reliable source Z to justify the application of reliable source Y to cite reliable source X. There are always arguments like that that one can come up with, if one has a mind to. But none of them are relevant to whether the source should be cited. What matters is whether the source is reliable and is directly relevant to the topic. Clearly spinal manipulation is directly relevant to Chiropractic. Eubulides (talk) 00:59, 8 October 2008 (UTC)

The problem here is one of misrepresentation. You keep claiming that source X is related to chiropractic, even though it says nothing about chiropractic. If you found a source Y which said that source X is related to chiropractic, then you could use source Y to talk about source X but only in as much as source Y discussed source X. But you still couldn't use source X directly. This is pretty well architected in WP:NOR. It's all about context here. Pay particular attention to "context" when reviewing NOR. -- Levine2112 03:26, 8 October 2008 (UTC)

The issue isn't so much about "source X", but about "subject X". Subject X (SM) is related to chiropractic. Period. SM is related to chiropractic. Period. SM is related to chiropractic. Period. SM is related to chiropractic. Period. SM is related to chiropractic. Period. Get the point? Ergo, research on that subject is relevant to chiropractic, and Meeker and Haldeman think so too. They are the two most highly educated DCs. Meeker has an M.P.H. degree, and Haldeman is an M.D., IOW they both have degrees that have legitimacy in the real world. I think you are forgetting who William Meeker is. Do some searching and you will soon find that you are disagreeing with one of the most influential chiropractors around. BTW, you seem to be the only one disagreeing with him, IOW you are seeking to impose your own private, straight, OR version of chiropractic on this article and discussion. It's disruptive and tiring. I'll take the undisputed (except by you) published views of a major chiropractic researcher, school president, and leader over yours any day. (And please stop using your misunderstanding/misrepresentation of Ernst's disagreement with him as an argument. You aren't convincing anyone.) -- Fyslee / talk 04:28, 8 October 2008 (UTC)

Please try to be more civil and open to the possibility that it is your understanding of Shekkelle and Ernst which is wrong. I'm certainly open to that possibility. -- Levine2112 18:29, 8 October 2008 (UTC)

Those are two examples of how the chiropractic profession considers research on SM, regardless of practitioner, as relevant to the profession. It deals with their core treatment method, and they are interested in the outcomes of all research related to the subject. Spinal manipulation is as related to chiropractic as an apple is to an apple tree. -- Fyslee / talk 01:21, 2 October 2008 (UTC)

What would be very useful for me to orientate myself in this discussion would be some sources discussing any differences between "chiropractic spinal manipulation" and other forms of this technique. Tim Vickers (talk) 01:43, 2 October 2008 (UTC)

In the research on effectiveness and safety, the difference is that chiropractic spinal manipulation is done by chiropractors, and the other forms are done by non-chiropractors. That is, the distinction (if any) is made solely on the basis of which profession does the manipulation. Eubulides (talk) 08:13, 2 October 2008 (UTC)

So the technique itself is performed in an identical fashion? Tim Vickers (talk) 16:10, 2 October 2008 (UTC)

No, "identical" is too strong. The term "spinal manipulation" covers a wide variety of techniques (e.g., Diversified technique, Gonstead, Thompson, etc.). There is variation among chiropractors, as well as variation among osteopaths and other practitioners. When one chiropractor says "I'm using technique A" and another says "I'm using technique B", they may actually be doing something that is physically similar; conversely, when two chiropractors both say "I'm using technique A" they may actually be doing something that is physically different. (It's a bit of a mess, huh? Just like most of medicine. :-) I know of no evidence-based research that characterizes effectiveness or safety in terms of the named technique, much less in terms of the specific biomechanics involved. Generally speaking, the effectiveness research is in terms of generic "spinal manipulation", which is any technique that involves high velocity low amplitude (HVLA) thrust to a joint. Eubulides (talk) 17:07, 2 October 2008 (UTC)

Identical is certainly too strong. But so is "similar" and so is "dissimilar". Why? Because we don't know how to make the comparison between spinal manipulation as performed by other practitioners and chiropractic spinal manipulation. We don't know because there is no general consensus of the relationship in the scientific community. There is only dispute at this point. In terms of research, some feel that the two are directly comparable, some feel that they are only somewhat comparable, and others feel that they are not comparable at all. Over the past few months, we have all seen voices from the scientific community matching each one of these positions. We have read about chiropractic researchers who said that the difference is not significant. We have read mainstream scientists who states that most spinal manipulation research is not related to chiropractic spinal manipulation. And we've read opinions from mainstream thinktank researchers who have come down on the chiropractic community for using non-chiropractic specific spinal manipulation research to support the theories of chiropractic. In essence, there is far too much disagreement in the real world for us to take any stand in the Wiki world. Using non-chiropractic spinal manipulation research to discuss the effectiveness of chiropractic spinal manipulation is a violation of WP:OR because we are using the non-chiropractic spinal manipulation research in a manner which was not intened by its authors, nor is there a consensus for such a usage by the scientific community. -- Levine2112 19:32, 2 October 2008 (UTC)

Please provide some reliable sources that analyze what these differences are - not isolated phrases or short quotes that might imply a difference, but sources that discuss any differences as their specific subject. Tim Vickers (talk) 19:58, 2 October 2008 (UTC)

Consider Edzard Ernst, who in specifically studies chiropractic spinal manipulation as opposed to nonchiropractic spinal manipulation in studies such as this one where he wrote:

RCTs that tested the effectiveness of nonchiropractic spinal manipulation were excluded. I would argue that this, in fact, is the strength of this article. There are considerable differences between spinal manipulation as practiced by chiropractors or other manual therapists. One such difference lies in the rationale for treatment; chiropractors view a “ malalignment” of spinal structures as the target for their interventions, whereas other professionals have reservations about this concept. Another, more tangible difference lies in the fact that chiropractors abundantly use high-velocity, low-amplitude, short-lever thrusts to the upper spine in the treatment of neck pain whereas other professionals use this type of manipulation more sparingly...

For more discussion about these differences, feel free to read the source in full. Again, the other Ernst quote pretty much sums up his stance that most RCTs for spinal manipulation do not relate to chiropractic spinal manipulation. And if something doesn't relate, then it does not directly relate, which is the source-to-subject threshhold set by WP:OR. -- Levine2112 20:16, 2 October 2008 (UTC)

Do you have a verifiable source (URL) where we can read the whole article? Without it we can't verify what you are saying in your interpretations.

What is clear from just the part you quote is that the differences are not what we have been discussing. The differences in rationale are unrelated to any physical differences in technique. The oveuse by DCs of high cervical manipulation is also not related to any physical differences in technique. These two differences would be good to mention in the Spinal adjustment article, citing that source. The abundant use of high cervical manipulation by DCs would also be relevant to mention in the safety sections, since it is these techniques that pose the greatest danger to patients as compared to SM of other parts of the spine. -- Fyslee / talk 02:17, 3 October 2008 (UTC)

OK, that's a good source, we need to note this view in the article and attribute it to Ernst. We also need to note the views of other authors (eg PMID 11827498) that there is no significant difference and discuss the research as a whole. Obviously we can not take any particular stance ourselves on if chiro and non-chiro SM are comparable (that would indeed be OR), so our discussion of this point needs to summarise both the research that used all the available evidence on SM, and the smaller amount of research that focused specifically on CSM. Does that seem fair? Tim Vickers (talk) 20:28, 2 October 2008 (UTC)

I agree with you in that we cannot take any particular stance ourselves on if chiro and non-chiro SM are comparable. Thus, I believe that by including the non-chiro SM research in the Chiropractic article, we are in fact taking a stance - implying that non-chiro SM research is related enough Chiro SM to include it in this article. Alternatively, what I propose is to move the well-written, well-sourced prose detailing the conclusions on non-chiro SM research to the more apropos Spinal manipulation article, which covers all forms of spinal manipulation including chiro SM. And then, here at Chiropractic, we keep all of the conclusions about Chiro SM specific studies and further discuss (as you suggest) the various opinions about whether or not non-chiro SM research can be applied to chiropractic SM. And in this discussion, we include a link directly to Spinal_manipulation#Effectiveness. So, a poorly written version of such a discussion might read:

Researchers disagree whether or not non-chiropractic spinal manipulation research is relevant to the study of chiropractic spinal manipulation.

Again, poorly written. But I think it communicates the idea which we are presenting here. By not presenting the non-chiro specific SM, we are not taking any sides (thus not violating WP:OR). And by presenting the position that some researchers feel that non-chiro SM research is relevant to chiro SM, and by providing the reader with a direct link to Spinal_manipulation#Effectiveness, we are meeting WP:NPOV. Does this seem like a reasonable compromise? -- Levine2112 21:05, 2 October 2008 (UTC)

I don't think I agree with that conclusion, if group A argues that some research is relevant, and group B argues that it is not relevant, to not include the research is to agree with group B. Instead NPOV requires that we describe both the research and the opinions on this research, to allow our readers to make up their own minds on the controversy. In any case, I think we agree that since the link between this research and chiropractic has been made in reliable sources, to summarise these sources' conclusions is not OR, since this link (although controversial) is not novel and has been published elsewhere. Tim Vickers (talk) 21:31, 2 October 2008 (UTC)

Following your statement, to include the research is to agree with group A that it is relevant. The controversy itself can be discussed here under NPOV, but to mention spinal manipulation effectiveness under the heading of Chiropractic#effectiveness continues to be OR - it should be discussed at spinal manipulation#effectiveness, with a link to it from Chiropractic. DigitalC (talk) 00:41, 8 October 2008 (UTC)

There is no group B here. No reliable source is claiming that reliable reviews on spinal manipulation are irrelevant to chiropractic. It is not WP:OR to follow what reliable sources say and do. Eubulides (talk) 00:59, 8 October 2008 (UTC)

Good point. We already know that chiropractic research, which is generally viewed as of poorer quality than mainstream research, tends to paint a rosier picture of SM/adjustments than mainstream literature, and the Meeker & Haldeman research even left out some negative research, so limiting the inclusion criteria here to only chiro research would clearly make this article a sales brochure. -- Fyslee / talk 02:26, 3 October 2008 (UTC)

Yes, to satisfy NPOV, we should include research such as Meeker & Haldeman where the researcher says that despite them looking at non-chiro SM studies, they feel their research is still relevant to chiro SM. However, we should not choose non-chiro SM studies for inclusion willy-nilly, regardless of who wrote it or where it was published. We should only pick ones where the actual researchers or some reliable third-party have applied that specific piece of research to chiro SM. (And even then, we should be sure to include such research with the proper context.) But for us to choose non-chiro research which has no reliable party has relating it to chiropractic would be a NPOV violation because we would be taking sides in the very unresolved real world dispute and an OR violation because we would be using the source in an original way.

To your second point, yes, we should summarize the arguments for and against applying non-chiro SM research to chiro SM. However, we should not take that as an invitation to include at non-chiro SM research in this article. Rather, we should only include non-chiro SM research where either the researchers or some reliable third-parrty have made the application of that specific non-chiro SM research to chirop SM. Make sense?-- Levine2112 21:46, 2 October 2008 (UTC)

So, to see that I understand your argument, you would say we could include both Murphy 2006 since it is cited in PMID 18564952 (see link), and Gross 2004 since it is cited in PMID 17142164 (see link), but could not cite reviews that either did not discuss chiropractic, or were not linked to chiropractic by other reliable sources? Tim Vickers (talk) 22:46, 2 October 2008 (UTC)

Not exactly. I am saying that we could include non-chiro SM specific research such as Murphy in context. That means, we can include it in the context it was used in the third-party source (if that context in fact links it to chiropractic SM). "Context" - as you know - is a large part of WP:OR: Take care, however, not to go beyond what is expressed in the sources or to use them in ways inconsistent with the intent of the source, such as using material out of context. and Even with well-sourced material, however, if you use it out of context or to advance a position that is not directly and explicitly supported by the source used, you as an editor are engaging in original research and It is important that references be cited in context and on topic. How's that sound? Fair? -- Levine2112 01:00, 3 October 2008 (UTC)

OK, I think we agree then, we include this research, as you say above, and use it to discuss the general consensus on the effectiveness of SM. We then cite the sources that state that chiropractic SM is different, and summarise the research on chiropractic SM in particular. That allows us to present our readers will all the data in context and allow them to make up their own minds on the controversy. Is that plan OK with you? Tim Vickers (talk) 03:49, 3 October 2008 (UTC)

Yes. We detail the argument about whether or not general SM is related to chiro SM where we link to Spinal_manipulation#Effectiveness and move all of the non-chiro SM related research to that section of that article. Here, at this article, we only leave the research which is directly related to chiro SM (either demonstrated by the research directly saying so, or in the context of some reliable third-party source which makes such a relationship). Sounds like a plan. -- Levine2112 08:15, 3 October 2008 (UTC)

Tim, be careful here. As I have noted above, this tactic will result in an NPOV violation by leaving this subject's coverage here one-sided so it will read more like a chiropractic profession sales brochure, with a rosier picture than is warranted by the sources. -- Fyslee / talk 13:34, 3 October 2008 (UTC)

I am not too sure what anyone of us needs to be afraid of. The plan which Tim and I agree on will result in bringing this section in line with NPOV and NOR. The coverage certainly need not be one-sided. I think Fyslee is confusing "research performed by chiropractors" with "research about chiropractic". It is simply the latter which we need to comply with NOR. For instance, in our plan, we will include both Ernst's chiropractic research as well as Meeker and Haldeman's; there we have two different sets of researchers with differing conclusions about the efficacy of chiropractic (extremely negative and somewhat positive, respectively). I don't imagine that the conclusions of Ernst's chiropractic research would be found in any chiropractic sales brochure. There is nothing in Tim's and my plan which would limit the inclusion criteria to just ones that paint a rosy picture; the only limitation is that the sources comply with WP:NOR simply by being demonstratably and directly related to chiropractic. -- Levine2112 17:16, 3 October 2008 (UTC)

I didn't see anything in Tim's comment which suggested that we move a bunch of stuff out of Chiropractic. He was proposing to add context, not to remove material. Adding more context sounds like a good idea, if it can be done well (supported by reliable sources, with NPOV, and without OR). Eubulides (talk) 17:37, 3 October 2008 (UTC)

Yes, as I have said, removing material because one group of people says it is not relevant is non-neutral since it molds the article to fit this particular view. This article needs to summarise all the research that has been linked to chiropractic and summarise all the views on this research. I honestly can't see why you think it would be acceptable to remove sources from the article that both deal with the major technique used in chiropractic and have discussed in relation to chiropractic in reliable sources. Some people may disagree with this link, and the article should note and discuss this disagreement, but it cannot take sides on the matter. Tim Vickers (talk) 18:10, 3 October 2008 (UTC)

Keeping that material in, because one group of people says it is relevant (er, again, where is the RS on that?) is non-neutral since it molds the article to fit THAT particular view. This article needs to summaraze all the research that has been DIRECTLY linked to chiropractic (per WP:OR), and summarise all the views on THAT research. The artcile can discuss the disagreement on whether this research is related or not, but it cannot take sides on the matter. DigitalC (talk) 01:00, 8 October 2008 (UTC)

It's not just "one group of people". It's the mainstream consensus. No reliable source argues that general SM reviews are irrelevant to chiropractic. On the contrary, reviews of chiropractic routinely cite general SM reviews. Eubulides (talk) 07:50, 8 October 2008 (UTC)

The difference is that each piece of research which we include should be explicitly related to chiropractic (or chiropractic spinal manipulation). There are a few studies which we are currently using which are about spinal manipulation in general and by themselves draw no conclusions about chiropractic nor chiropractic spinal manipulation. Further, with these studies, there is no third-party source relating the conclusions of these studies to chiropractic nor chiropractic spinal manipulation. Thus, by including these such pieces of research, we are making an original assumption that they are directly related chiropractic or chiropractic spinal manipulation and thus we are violating WP:OR with their inclusion. Again, we can include both sides of the "Is Non-chiro SM related to Chiro SM in terms of research?" debate. We can include research which uses non-chiro SM data if the researchers relate it to chiro SM. We can include non-chiro research which has been related to chiro SM by a reliable third-party source in the context of that third-party source. However, we cannot include and should remove any non-chiro research which has not been directly related to chiropractic SM. It's not enough to say that some researchers have said its okay to relate non-chiro SM to chiro SM, and thus we have free reign to do the same here with all non-chiro SM research. Especially in the face of more notable and mainstream researchers (such as Edzard Ernst) who clearly disagree. To include such reseach, ammounts to taking side in this unresolved real world dispute and thus, not only violates WP:NOR, but WP:NPOV as well. Does this make sense? Tim, I thought you understood me when above you said we "could not cite reviews that either did not discuss chiropractic, or were not linked to chiropractic by other reliable sources". I apologize if I misunderstood your understanding of my position. Anyhow, let me know if you understand and agree with it now. Thanks. -- Levine2112 20:21, 3 October 2008 (UTC)

Could you list these studies please? I've already shown that both Murphy and Gross are linked by 3rd-party RS to Chiropracty, and this article by Ernst and PMID 17142164 give general reviews of such sources, linking them directly to chiropracty, which other sources do you still see as problematic? Tim Vickers (talk) 20:24, 3 October 2008 (UTC)

Pssst! It's "chiropractic", not "chiropracty".... -- Fyslee / talk 14:35, 4 October 2008 (UTC)

Absolutely. Though there are two things which I need you to do first:

1. Show me how Murphy is not just linked but rather directly related (the requirement set forth by WP:NOR) to chiropractic by the third-party sources which you have provided. Please provide quotes from the third-party sources which you believe make/assert such a direct relationship.
2. Before I put in the legwork for you, I need to know if you agree with the basic premise of my position. So let's say that there is research by Dr. X which though studies spinal manipulation as performed by a mixed bag of professions (chiropractors, osteopaths, physiotherapists, etc.), makes no conclusions about chiropractic spinal manipulation specifically. Rather, Dr. X only discusses spinal manipulation in general in her conclusions. And let's say that her conclusions are very positive for spinal manipulation's effectiveness in treating chronic foo. In our chiropractic article, let's say we have a section discussing the effectiveness of chiropractic at treating foo and in this section about chiropractic's effectiveness we are citing Dr. X's conclusions to say that spinal manipulation has been shown to be extremely effective at treating chronic foo. Do you agree that we should remove the statement and source? Why?

Thanks. -- Levine2112 21:24, 3 October 2008 (UTC)

TimVickers, re the last paragraph of your comment at the top of this thread: thank you so much for bringing a fresh perspective and new idea into this debate!! ☺ Coppertwig (talk) 21:09, 3 October 2008 (UTC)

First, let's look at this generally, general reviews of "spinal manipulation" are cited routinely in reviews of chiropractic research, so the argument that doing the same in this article is OR cannot be true, since this generalisation is common in the literature - if you haven't read PMID 17142164 I'd strongly recommend you do so (e-mail me if you need a Pdf). Second, Murphy is cited in that article on the effectiveness of chiropractic as a review (ref 21) that questions the effectiveness of spinal manipulation

Much has been written about manipulation in the treatment of LBP, and while it has been accepted over the past decade as a treatment for acute LBP (lower back pain) ,2,10,25–28 its effectiveness in the treatment of CLBP (chronic lower back pain) remains under scrutiny.10,16,21

We just need to follow the literature here, that isn't OR, it's just sensible. Tim Vickers (talk) 22:49, 3 October 2008 (UTC)

Nowhere here do you answer either of my requests. You are presenting a logical fallacy with the assumption that "general reviews of 'spinal manipulation' are cited routinely in reviews of chiropractic research". Sure, some chiropractic researchers (such as Haldeman and Meeker) have cited "spinal manipulation" in their chiropractic research; however, mainstream researchers such as Edzard Ernst show us that this is problematic and is actually not generally accepted. Where are you getting that this is routinely done? If it is from that PDF, the yes, please send it to me.

Further, the quote that you provide doesn't show us how the source directly relates the research of Murphy to chiropractic. If it did, we would be able to use that quote to formulate how we would write the text in the proper context. But as this quote says absolutely nothing about chiropractic, it is impossible to for us to know if it is directly relating anything to chiropractic. What we would need is a third-party source that uses the conclusions of Murphy to say something specific about chiropractic. And in that case, we would not be citing Murphy, but rather the third-party source. That is partly what is meant by "proper context". Using Murphy as we do now is out of context, and creates an NPOV and NOR violation because Murphy by itself does not directly relate to chiropractic. If I am not being clear enough with what I am requesting, please let me know and I will spell it out further. -- Levine2112 01:22, 4 October 2008 (UTC)

A logical fallacy is something that cannot be true from its premises, such as 2+2=7, please do not try to use terms you do not understand, it does not help this discussion in the slightest and does not help people to take your arguments seriously. As I said, you need to e-mail me if you wish a copy of that paper, you might not realise this, but you can't attach files to e-mails sent through the Wiki interface. Tim Vickers (talk) 03:29, 4 October 2008 (UTC)

Your premise is flawed (general reviews of 'spinal manipulation' are cited routinely in reviews of chiropractic research) thus with that assumption (similar to a 2+2=7 assumption) then all that follows is a logical fallacy. Make sense? Do you really want to have a semantic debate with me or do you want to stick to the substance of our discussion? If you are going to be insulting, then there's no reason to continue this conversation. -- Levine2112 03:35, 4 October 2008 (UTC)

I wasn't trying to be insulting, I was just pointing out that if you use terms like logical fallacy incorrectly it will make your arguments less persuasive. Tim Vickers (talk) 15:26, 4 October 2008 (UTC)

TimVickers's premise is correct. Here's one recent example: Meeker et al. 2007 (PDF), a freely-readable literature synthesis by the Research Commission of the Council on Chiropractic Guidelines and Practice Parameters, routinely cites general reviews of spinal manipulation. For example, it cites Assendelft et al. 2004 (PMID 14973958). Eubulides (talk) 07:41, 4 October 2008 (UTC)

Sure, but that's still just Meeker and company. We already know that Meeker thinks its okay to cite non-chiro studies to discuss chiro. Mainstream scientists such as Ernst, however, disagree. No source has been presented to support the fallacious premise that general reviews of "spinal manipulation" are cited routinely in reviews of chiropractic research. -- Levine2112 07:50, 4 October 2008 (UTC)

No, Ernst does not disagree. Ernst 2008 (PMID 18280103) is a review of chiropractic research, and it cites general reviews of spinal manipulation; for example, it cites Assendelft et al. 2004 (PMID 14973958). This sort of thing is routine. Every recent general review of chiropractic research that I'm aware of does it routinely, and no reliable source objects to the practice. The only objection (which is the objection Ernst makes) is to citing general reviews without saying that they're general reviews. Eubulides (talk) 08:13, 4 October 2008 (UTC)

Yes, Ernst does disagree. Ernst thinks its okay to cite certain general reviews of spinal manipulation to discuss chiropractic, but not all. Unfortunately, Ernst doesn't provide us with any criteria to judge which ones are acceptable and which ones are not. However, he does tells us that the majority of SMT trials are not related chiropractic SM. ("The authors also claim that 43 randomized, controlled trials of spinal manipulation for back pain have been published, but they fail to mention that most of them do not relate to chiropractic spinal manipulation.") You say that "This sort of thing is routine" but Ernst shows us that this is not true. The only researchers whom we have seen doing this sort of thing are Haldeman/Meeker and they were rebuked by Ernst for doing so. Please reread Ernst's objection. -- Levine2112 21:08, 7 October 2008 (UTC)

(outdent)

• The claim "Ernst thinks its okay to cite certain general reviews of spinal manipulation to discuss chiropractic, but not all" is not correct. Ernst 2002 (PMID 12379081) does not that make that claim. He merely criticizes Meeker & Haldeman for not mentioning that most of the randomized controlled trials (not reviews) do not relate to chiropractic spinal manipulation. He didn't say it wasn't OK to cite the RCTs. Nor was he criticizing citations of "certain general reviews". It is routine to cite general reviews of spinal manipulation in articles discussing chiropractic. Ernst does it routinely (e.g., he does so in Ernst 2008, PMID 18280103). Ernst even does it in his 2002 letter (PMID 12379081): it cites Brox et al. 1999 (PMID 10394281) and van Tulder 1999.
• It's not true that the only researchers who cite SM reviews are "Haldeman/Meeker and they were rebuked by Ernst for doing so":

• Meeker & Haldeman were not citing SM reviews.
• Ernst did not rebuke Meeker & Haldeman for citing reviews.
• Most important, many other researchers on chiropractic cite SM reviews. Here's just one example: DeVocht 2006 (PMID 16523145), which is about chiropractic, makes this claim:

"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."

The is Bronfort et al. 2002 (PMID 11562654); this is a generic review about SM and headache, and incorporates data not only from SMT performed by chiropractors, but also from SMT performed by physical therapists and by MDs.

• I can cite many, many more examples of this. It's totally routine in current effectiveness research about chiropractic. No reliable source objects to it.

Eubulides (talk) 23:50, 7 October 2008 (UTC)

I guess it comes down to us disagreeing on what Ernst meant when he wrote: "The authors also claim that 43 randomized, controlled trials of spinal manipulation for back pain have been published, but they fail to mention that most of them do not relate to chiropractic spinal manipulation." To me, this means that Ernst acknowledges that most of the published RCTs of SM for back pain do not relate to chiropractic SM. To you, this means something else entirely. I am baffled that you cannot see what Ernst seems to be clearly (IMHO) stating, and I think I am done trying to open your eyes to this. Perhaps we should start an RfC just based around the meaning of what Ernst is saying here. -- Levine2112 00:43, 8 October 2008 (UTC)

An RCT is not a review; your previous claim was about reviews, not about RCTs, and was therefore incorrect, as Ernst was writing about RCTs. Ernst did not rebuke Meeker & Haldeman for citing the RCTs; he rebuked them for not stating what the sources of the data were. Nor did Ernst say that "most of the published RCTs of SM for back pain do not relate to chiropractic SM". He merely said that most of the RCTs that M&H cited did not relate to chiropractic SM, which is an entirely different thing. Eubulides (talk) 00:59, 8 October 2008 (UTC)

Exactly, we need to put such general reviews in context and state the objections a few sources have to considering these in relation to chiropractic, but we need to follow the literature in using these sources - to do otherwise would fail NPOV. Tim Vickers (talk) 15:14, 4 October 2008 (UTC)

We cannot include general SMT reviews which say nothing specifically about chiropractic SM. We can however include a relationship made betweeen these reviews and chiropractic SM, if we cite a reliable source describing such a relationship. -- Levine2112 21:08, 7 October 2008 (UTC)

(outdent) This seems to be proposing a rule that one cannot cite a reliable source X unless another reliable source Y says it's OK to cite X. No such rule is required for Misplaced Pages article. Eubulides (talk) 23:50, 7 October 2008 (UTC)

Nope. This is proposing that reliable sources should be used only in context. Of course, this is not a proposal at all, but rather a faithful description of WP:NPOV, one of the pillars of Misplaced Pages. -- Levine2112 00:43, 8 October 2008 (UTC)

Ah, sorry, then I misunderstood the proposal. However, the premise for the proposal is incorrect, as Chiropractic can cite sources that are directly relevant to chiropractic, as SM reviews clearly are. Eubulides (talk) 00:59, 8 October 2008 (UTC)

. How are SM reviews clearly directly relevant to chiropractic? Where are the sources that state this? Obviously chiropractic spinal manipulation is directly related to chiropractic. However, how is spinal manipulation performed by a physiotherapist relevant to Chiropractic? DigitalC (talk) 01:07, 8 October 2008 (UTC)

General SM reviews are directly relevant to chiropractic. See Meeker & Haldeman 2002; this point is not contradicted by any reliable source. Reviews of chiropractic routinely cite general SM reviews; this is true for both reviews supportive of chiropractic (e.g., DeVocht 2006, PMID 16523145), and reviews critical of chiropractic (e.g., Ernst 2008, PMID 18280103). No reliable source disputes this routine use of SM reviews. Eubulides (talk) 07:50, 8 October 2008 (UTC)

I have previously shown that Meeker & Haldeman 2002 do NOT state the General SM review are directly relevant to chiropractic. You are continuing to misrepresent the source. Reviews of chiropractic routinely perform original research - this is NOT something we can do at Misplaced Pages. DigitalC (talk) 11:14, 9 October 2008 (UTC)

We are going around in circles here. Several of us think that Ernst (and Shekelle) dispute that all SM is related (much less directly related) to chiropractic SM. Several of us think the oppoisite. Why don't we move on with WP:DR and open to RfC just the issue of what Ernst meant when he stated: "The authors also claim that 43 randomized, controlled trials of spinal manipulation for back pain have been published, but they fail to mention that most of them do not relate to chiropractic spinal manipulation." We don't have to give the question any context into the ramifications of this debate. Just show third-parties the quote, provide a link to the full-text, and ask people what they think Ernst means. SOund like a reasonable way forward? -- Levine2112 18:33, 8 October 2008 (UTC)

• It's not relevant whether "Ernst (and Shekelle) dispute that all SM is related". Nobody is arguing that all SM is related to chiropractic. The dispute is over whether Chiropractic should cite general SM reviews (i.e., reviews of SM based on both chiropractic and non-chiropractic data). This RfC has asked about the sources Bronfort et al. 2008 (PMID 18164469), Chou et al. 2007 (PMID 17909210), and Gross et al. 2004 (PMID 14974063) and so far two of three outside editors have agreed that reviews such as these should be included.
• It's not the case that "several of us" think that Shekelle disputes the point. You are the only editor who is claiming that Shekelle's comment casts doubt here. All other editors commenting on that claim have been skeptical. (I just now checked the archives back to May.) Shekelle's comment is about the distinction between chiropractic and SM (all reliable sources agree that they're distinct), not about whether SM is related to chiropractic (all reliable sources agree that they're related).
• An open-ended question will not be that useful. Any question should be specific.
• This topic is already reached the point of RfC exhaustion. We've had several RfCs on essentially the same point since April, including RfC: Effectiveness of chiropractic care (April 24), RfC: Effectiveness of chiropractic care (May 12), its followup Improved version RfC (May 14), Request for Comment, Possible OR violation at Chiropractic Effectiveness (September 10), and this RfC (Request for Comment: Excluding treatment reviews, September 16). We've also had a NOR noticeboard Chiropractic section on evidence basis (July 29). Now another RfC is being suggested, on the relatively minor point of how to read a 2002 letter to the editor? We should save RfCs for more important issues than that.
• It is not helpful to issue RfCs over and over again on the same issue. This issue has been beaten into the ground (on this we agree), outside opinion is not unanimous but favors the inclusion of general SM reviews, and we should accept that and move on.

Eubulides (talk) 20:01, 8 October 2008 (UTC)

This issue has been beaten into the ground, but there is no consensus. In fact, I disagree that outside opinion favours the inclusions of general SM reviews. DigitalC (talk) 11:17, 9 October 2008 (UTC)

"outside opinion is not unanimous but favors the inclusion of general SM reviews" = an incorrect statement. Shekelle is discussing why it was inappropriate to apply his general SM research to chiropractic. It is highly relevant and others have discussed it here. Ernst is clearly stating that not all SM research is related to chiropracticSM; I'm glad you agree with that. So who are we to decide which SM research is related to chiropratic SM? I'm sorry, but I am not willing to move on until this dispute is settled. Currently, we are disputing exactly what is meant by Ernst's statement and thus I see no issue in using the RfC process to get some outside opinions here. If you have another suggestion per WP:DR, please let us know. I am all ears and eager to settle this amicably. -- Levine2112 21:02, 8 October 2008 (UTC)

I'd suggest you follow the lead of the recent systematic reviews on the subject. Since they cite such reviews and meta-analyzes, so should you. Tim Vickers (talk) 21:18, 8 October 2008 (UTC)

"Following the lead" can and has lead to wP:SYN. We would be basing inclusion of source X based on a contentious explanation in some source Y (which says nothing specifically about source X) and thus creating an original thought Z here. X + Y = Z = WP:SYN violation. Thus far, no evidence that all of the non-chiropractic SM research which we are including in this article about chiropractic is directly related to chiropractic. Without such evidence demonstrated, the article stands in violation of WP:OR. -- Levine2112 21:22, 8 October 2008 (UTC)

• By "outside opinion" I meant the opinion of outside Misplaced Pages editors, not the opinion of reliable sources.
• We decide whether research is directly relevant by seeing what reliable reviews do and by using our editorial judgment. We need not find a reliable source X that explicitly says "It's OK to cite source Y in Misplaced Pages".
• Shekelle is saying it's not appropriate to give an inaccurate summary of his generic SM research; he's not saying generic SM research should not be cited at all.
• Ernst's statement (in Ernst 2002, PMID 12379081) is clear. The interpretation you place on it is contradicted by Ernst's own behavior in Ernst 2008 (PMID 18280103), a review of chiropractic that cites generic SM reviews. This is not the only example of such behavior; it's routine in reviews about chiropractic, not only reviews by critics such as Ernst, but also reviews by supporters such as DeVocht 2006 (PMID 16523145).
• There is no statement "Z" in Chiropractic #Evidence basis.
• The sources that Chiropractic #Evidence basis are citing are not "non-chiropractic SM research". They are generic SM research, based largely on chiropractic data, but also incorporating some non-chiropractic data.
• It's time to move on, but please feel free to have the last word here.

Eubulides (talk) 00:06, 9 October 2008 (UTC)

The OR conversation has been going around in circles for about half a year on and off. It was started up again because of Levine2112. I think it would be best if Levine2112 would remove the OR tag from the article and we can move on from this to focus on achieving WP:GA status. QuackGuru 02:01, 9 October 2008 (UTC)

No. It is not time to remove the OR tag. It is as ever appropriate as it is now. Yes, this debate has been going on a long time. That's why I am suggesting WP:DR remedies such as a new, more focused RfC. Ernst's statement (in Ernst 2002, PMID 12379081) is clear. Yes. He does not contradict that at all in Ernst 2008 (PMID 18280103). Ernst doesn't say that all SM RCTs are not related to chiropractic SM, only that most of them don't relate. Evidently, Ernst cites the ones which he believes relates in PMID 18280103. Anyhow, I am going to look into starting another RfC as described above in the next coming days when I have some more time. -- Levine2112 02:09, 9 October 2008 (UTC)

New topic

It seems unfair to assess the risk of spinal manipulation as practised by well-trained chiropractors alongside that associated with untrained therapists (Tables 1 and 2). Chiropractors may argue that it takes years of experience to learn the fine psychomotor control required for skilled manipulations. Certainly skill and experience are important, and it is relevant to differentiate between different professions, as done in Tables 1 and 2. On the other hand, skill is a quality not easily controlled for in such research; even some chiropractors may be more skilled than others. Moreover, this review is aimed at evaluating the risk of an intervention (spinal manipulation) and not that of a profession (chiropractic).

So to answer your question, Ernst notes that while chiropractors claim to be more skilled, not all of them will be more skilled, and says that he is interested in examining the technique, not who performs it. He therefore directly states that his review will examine the intervention and not make any distinction between different practitioners. Therefore to try to use such a review to argue that the intervention is different when used by different practitioners is inconsistent with what the text says. Tim Vickers (talk) 01:18, 1 October 2008 (UTC)

I don't understand your argument. "it is relevant to differentiate between different professions", "this review is aimed at evaluating the risk of an intervention (spinal manipulation) and not that of a profession (chiropractic)" ... so how is it relevant to use that reference in an article about chiropractic? Your quote explicitly states that it isn't about the profession, but about Spinal manipulation - the article that reference truly belongs in. Not only is spinal manipulation only a part of what chiropractors do, chiropractic spinal manipulation is only a part of the whole of spinal manipulation. --Surturz (talk) 01:28, 1 October 2008 (UTC)

I seems some editors are reading way too much into what the source says. The text is explaining more or less the risk assessment of spinal manipulation. QuackGuru 01:52, 1 October 2008 (UTC)

Indeed, to make this clearer, imagine the review was assessing the risk of damaging a car in an intervention called an "oil change". The author might state that some people called "mechanics" claim to be better at performing this intervention than others and examine the relative risk of damage posed by a "mechanic oil change" versus an "owner oil change". However, it would be obviously false to use such an analysis to argue that "mechanic oil change" and "owner oil change" are two different things. Tim Vickers (talk) 05:00, 1 October 2008 (UTC)

In your analogy, however, it would be false to say that "mechanics use a highly risky technique called the oil change" if the bulk of engine damage is being caused by owner oil changes. It would be FUD to say 'we don't know the risks of mechanic oil changes' when we do know the incidence is low. Also, it would be undue WP:WEIGHT if the "Safety" section of "car mechanics" article implied that car mechanics only provide the "Oil change" service. This is the current state of the 'Safety' section of this article. Of course there should be text saying that cervical chiropractic adjustments have a low-to-very-low risk of severe/fatal damage, everyone knows that and all the references agree on that point. But the current text implies that all of chiropractic is similarly risky. The safety section is NOT talking only about Spinal Manipulation, it is talking about Chiropractic as a whole. Just as in the 'Vaccination' section, User:Eubuildes and User:Fyslee are inflating criticisms of one part of chiropractic to encompass the whole profession. --Surturz (talk) 05:30, 1 October 2008 (UTC)

Surturz, please drop that false accusation. You have been flogging that "encompass the whole profession" dead horse for too long without evidence. -- Fyslee / talk 06:22, 1 October 2008 (UTC)

That analogy to Chiropractic #Safety is seriously flawed. Chiropractic #Safety says the incidence is low: for example, the first sentence of the section starts out saying "Chiropractic care in general is safe...", and it says that serious complications happen "rarely". The rest of that analogy is flawed, too: for example, the vast majority of spinal manipulation is done by chiropractors. (Unlike people doing their own oil changes, patients don't do spinal manipulation on themselves.... :-) Eubulides (talk) 06:38, 1 October 2008 (UTC)

(outdent) Look, rather than try some car mechanic analogy, why don't we pick a more relevant one like drugs. Sure, there are illicit drugs and medicinal drugs and even drugs that don't do anything. They are all 'drugs'. However, it is a bit nonsensical to make sweeping statements about the safety of drugs in general. It depends on which ones are being used, the manner they are prescribed, etc. Same for Spinal Manipulation. --Surturz (talk) 21:07, 2 October 2008 (UTC)

By the same argument, it would be "nonsensical" to make sweeping statements about the safety of (say) dental amalgam. The safety depends on which what kind of amalgam is used, the condition of the patient, where the amalgam is used, etc., etc. Using that line of reasoning, shouldn't we remove Dental amalgam controversy and Dental amalgam #Dental amalgam toxicity controversy, since only "nonsensical" statements can be made about the safety of dental amalgam? Eubulides (talk) 06:19, 3 October 2008 (UTC)

Requesting page protection

I request that the admins watching this article protect it for a week. The edit warring and additions and deletions of controversial material without first achieving consensus is getting out of hand. Please force editors to hammer things out on the talk page first. -- Fyslee / talk 05:40, 30 September 2008 (UTC)

If protection is put into place, I suggest protecting the page at something like its somewhat-stable state, rather than protecting it immediately after an undiscussed controversial change like this has been installed. Eubulides (talk) 05:51, 30 September 2008 (UTC)

That has since been fixed and even improved with the addition of the reference from the CMAJ. I was surprised we hadn't used it already, since we were referring to that research. -- Fyslee / talk 06:13, 30 September 2008 (UTC)

• Oppose Fyslee and Eubulides seem to feel they should have the right of veto on all edits to this article. They have consistently reverted all edits made by other editors. They refer other editors to the talk page, where they oppose all changes they did not instigate. This request for page protection is just more ownership from these two editors. --Surturz (talk) 06:48, 30 September 2008 (UTC)
• Oppose per Surturz. The level of WP:OWN that Eubulides especially has demonstrated in this article is beyond ridiculous. It seems to be his version or nothing here. An admin has pointed this out to him in the past and it still hasn't slowed him down. I think he is a good editor and excellent researcher, but I think Eubulides is going to far with his prrotectionism here. -- Levine2112 07:27, 30 September 2008 (UTC)

•  Not done. There isn't a terribly high level of edit waring, and the editing to the page doesn't appear to be disruptive. Protection wouldn't be terribly useful, as Elonka stated below. I do, however, encourage editors to discuss major edits on the talk page before putting them into the mainspace. Also, as a note, us admins only protect meta:The Wrong Version. Cheers, everyone. lifebaka++ 16:44, 30 September 2008 (UTC)

• I oppose Fyslee's most recent edit, namely the addition of the citation to Ernst 2002 (PMID 11800245), for the reasons cited above: it's a dated opinion piece, and it's less reliable than the source we are already citing to support the same claims, namely Ernst 2007 (PMID 17606755), a systematic review. There's no reason to cite Ernst 2002 here.
• I have not consistently reverted all edits made by other editors. For example, I did not revert Levine2112's most recent edit; instead, I reworked the text to address the problem raised.
• I have, however, consistently said that possibly-controversial edits should be discussed on the talk page first. Much of the problem here is the large number of controversial edits that are installed without discussion. Many of these edits remove well-sourced text that is not controversial among reliable sources. This is not a good way to improve the encyclopedia.

Eubulides (talk) 08:21, 30 September 2008 (UTC)

I'm surprised you oppose the addition of a good reference. Adding supportive references isn't usually controversial, and is seen as constructive. That reference deals with the proven case of 100% underreporting among ALL British neurologists. Now if the other reference deals with that case, then we don't need the reference. If it doesn't include it, then we should use both references. -- Fyslee / talk 13:58, 30 September 2008 (UTC)

BTW, I have taken your advice and removed the reference. -- Fyslee / talk 13:41, 1 October 2008 (UTC)

• Yes, the other reference (Ernst 2007, PMID 17606755) deals with that case. That was my main point, and that is why we don't need to cite Ernst 2002. Sorry if I wasn't clear. Here is some text from Ernst 2007 that cites that case (there is other text, but this should be enough to make it clear). The context for this quote is that Ernst is talking about estimates by chiropractors of the safety of cervical manipulation: "Retrospective investigations have repeatedly shown that under-reporting is close to 100%. This level of under-reporting would render such estimates nonsensical." (p. 336). Could you please revert the addition of the citation to Ernst 2002?
• More generally, there are thousands of sources about chiropractic in the literature. Most of them are obsolete and are supplanted by better sources. There is not room in Chiropractic to cite them all, and even if there was room we should not refer to these older, less-reliable sources unless there's a good reason (e.g., a discussion of chiropractic history). This is particularly true when there's a newer, more reliable source covering the same point. For more, please see WP:MEDRS #Use up-to-date evidence.

Eubulides (talk) 15:49, 30 September 2008 (UTC)

Please review WP:MEDRS. I am in favor of removing the old 2002 reference. Adding old references is an invitation for editors to cherry-pick old references to argue with recent reviews. I oppose page protection. I prefer admins enforce NPOV. QuackGuru 14:38, 30 September 2008 (UTC)

I'm not seeing that page protection would be that useful at this time; however, a revert restriction might be. What do the editors here think about the idea of a 1RR restriction? This would limit all editors to a maximum of one revert per day. A revert would be defined as something that might be done with the "undo" or "rollback" buttons. However changes to text, especially towards the goal of finding a compromise wording, would be allowed. The restriction would also of course not apply to vandalism, or removing additions of unsourced information. Might this be helpful? Or what other admin-imposed restrictions might be of use here, to assist in reducing disruption? Feel free to brainstorm anything: All suggestions are welcome.  :) For an example of creative restrictions that have been tried on other articles: Telling certain editors that they could only work on an article if they spent 50% of their time working on other articles as well (to reduce single-purpose editing). Banning one or more editors from a section of the article, but allowing them to work on the rest of it. Setting up a draft subpage article, and requiring that all article changes go through the subpage before they could go into the "live" article. Bans on removing citations. Etc., etc. So, feel free to be creative.  :) --Elonka 15:23, 30 September 2008 (UTC)

Editors are adding old references which is a violation of WP:MEDRS. It would increase disruption if we would ban removing old references that could be used to argue with recent state of the art reviews.

A 1RR restriction for all editors would be supporting disruption. The editors who are reverting NPOV violations should not be put on a par with the editors who violate NPOV. The best idea is to enforce NPOV. QuackGuru 15:38, 30 September 2008 (UTC)

• I also do not see how a 1RR restriction would be helpful. The main problem in recent changes is that editors who are supportive of chiropractic are deleting material that is well-sourced, or are introducing POV text into the material, not because there is genuine controversy among reliable sources, but because those editors don't like what the reliable sources say. A 1RR restriction would likely help that campaign, and this would weaken the article. Lessening the amount of disruption would be a good thing, but it shouldn't come at the cost of the article itself. Articles are the primary goal of Misplaced Pages; minimizing disruption is secondary to that goal.
• A better approach would be to warn editors who are engaging in the disruptive behavior of that disruption. This may well require some technical expertise in the area, I'm afraid; it's not always easy to know what the sources say, or to know which sources are more reliable.
• The dispute about Ernst 2007 vs. Ernst 2002 in this section may help to illustrate some of the issues involved. Adding Ernst 2002 was not a disruptive edit (it didn't introduce POV nor did it eliminate sourced text), but it did lower the quality of the article somewhat, by citing an obsolete and duplicative source. I did not remove this source, because I am already near the 3RR limit. If I were at a 1RR limit, I would be even more hampered in fixing obvious article quality-problem issues like this.

Eubulides (talk) 15:49, 30 September 2008 (UTC)

I think 1RR may be a good idea. It will certainly help to curb the WP:OWN violations at this article. -- Levine2112 17:13, 30 September 2008 (UTC)

Some general advice on administrators' views on removing disruptive editors from an article (note, I'm not speaking for all administrators, but I think most would agree). Generally, we're happy to remove disruptive editors, but the trick is in defining what "disruption" means in this situation. In most cases on Misplaced Pages, disruption is fairly obvious, such as if someone is adding unsourced information, or adding information that's coming from unreliable sources. Or, if an editor is adding information that comes from a reliable source, but they are misinterpreting information from that source, admins can take action on that as well.

Here at Chiropractic though, we seem to have a much more complex situation, where information is being added from seemingly reliable sources. Also, the information which is being added appears to be (reasonably) accurate in reflecting what is in those sources. But the problem, as I'm understanding it so far, is either that some editors may be using outdated reliable sources, or that some editors may be putting undue weight onto some particular aspect of the topic, and cherry-picking reliable sources. IMHO, the best way to help administrators in this kind of situation, is to prove that there's a consensus on one of those points. For example, if editor A wishes to prove that editor B is using information from an outdated source, then widen the number of opinions, via an RfC or a thread on a noticeboard, so it's not just Editor A making the charge. If there's a clear RfC result that editor B is showing poor judgment and is repeatedly using outdated sources, or other cherry-picked sources which are being shot down by consensus, then an administrator has more justification to act.

On the other side, if we're in an endless deadlock here, with one group of editors saying "RED! BLOCK THE EDITORS WHO SAY BLUE!" and another group of editors saying "BLUE! BLOCK THE EDITORS WHO SAY RED!", and RfC/Noticeboards/Mediations are not bringing clarity to the issue from the wider community, well, my position as an admin is going to be, "Include both colors," even if both sides are claiming that this ruins the article. In short, if there's an obvious problem, then reasonably uninvolved editors are going to be able to see it, and the community's consensus will be clear. If it's not an obvious problem, then it can't hurt that much to include multiple views. Remember, our job on Misplaced Pages is not to determine the "truth", but simply to report all the significant views on a subject. If there are many editors who want to include a view, and they have many reliable sources which support that view, and most other uninvolved editors don't have a preference either way, I'd say that makes that view significant enough to include. --Elonka 18:18, 30 September 2008 (UTC)

I disagree with a 1RR restriction but if we were going to have a revert limit it should be done properly. For example: The editors who violate MEDRS or NPOV would have their reverts limited and the editors who revert the violations would be granted more reverts. The goal is to improve the article. Reducing the NPOV violations can be done by having restrictions on the editors who violate policy. QuackGuru 19:41, 30 September 2008 (UTC)

Seeing as it is likely that both parties will believe Their Version is the NPOV version that adheres to MEDRS, I believe a quantitative (1RR) restriction is superior to a qualitative restriction. Additionally, being Right does not give one the privilege of edit warring. If content is disputed, it should be discussed, not revert-warred over to shoehorn it in or out of the article. MBisanz 19:46, 30 September 2008 (UTC)

I agree with the point about edit-warring, but I'm skeptical about the claim for 1RR. What evidence is there that 1RR would help with Chiropractic? Are there recent edits such that Chiropractic would be in better shape than it is now, if only 1RR had been in effect? Eubulides (talk) 06:38, 1 October 2008 (UTC)

• Eubulides, what a laughable defence to my accusation of your ownership of this article. You say you didn't revert Levine2112's edit, but the OR tag he added is removed in your edit, and your 'fix' does nothing except move a few words around. The edit history for the vaccination section shows how you robustly edit-warred over the lead sentence, replacing a more-or-less direct quotation of the reference with your own preferred text. The current lead sentence doesn't have consensus, I just got sick of fighting for it i.e. I just let you win with your ownership. What was the last substantial addition to the article (that survives) that wasn't heavily modified by you? None in the last two months, AFAICT. --Surturz (talk) 00:33, 1 October 2008 (UTC)

Surturz, please find a way to comment on content rather than personalizing the dispute. If you feel there is a significant problem with one specific editor, it's best to pursue dispute resolution or discuss it with one of the admins monitoring this article, rather than attacking them with rhetoric and snide edit summaries. MastCell  16:17, 1 October 2008 (UTC)

(outdent)

• "the problem, as I'm understanding it so far, is either that some editors may be using outdated reliable sources, or that some editors may be putting undue weight onto some particular aspect of the topic, and cherry-picking reliable sources". Both those problems have occurred, but the most serious dispute right now is over WP:OR issues, not over outdated sources or WP:WEIGHT.
• "widen the number of opinions, via an RfC or a thread on a noticeboard" We have had several RfCs to try to address these points. The response to RfCs has fallen with time. It's not clear that further RfCs will succeed in drawing outside opinion, as Chiropractic is suffering from RfC fatigue. Certainly it would be unwise to use an RfC to solve relatively minor issues like whether Ernst 2002 is out of date: if we were to use RfCs for that, I expect we'd need more than an RfC per day on average, an unsustainable rate.
• "the OR tag he added is removed in your edit" I removed the OR tag because my edit addressed the OR issue that Levine2112 raised, namely, that the cited source didn't support a particular use of the word "although". Eubulides (talk) 06:38, 1 October 2008 (UTC)
• "you robustly edit-warred over the lead sentence, replacing a more-or-less direct quotation of the reference with your own preferred text" The text I preferred was the more-or-less stable version, and is a better summary of the source; the "direct quotation of the reference" was a version you attempted to edit-war in, without discussing it beforehand and without any consensus afterward.
• "What was the last substantial addition to the article (that survives) that wasn't heavily modified by you?" That would be the addition of a {{SectOR}} tag, an addition made about four hours before the question was asked.

Eubulides (talk) 06:38, 1 October 2008 (UTC)

I oppose a 1RR restriction, per Eubulides. ☺ Coppertwig (talk) 01:53, 5 October 2008 (UTC)

Misleading sentence

The way this sentence is written is misleading. QuackGuru 01:38, 1 October 2008 (UTC)

I'm afraid this comment is not very specific. In what way is the phrase misleading? What incorrect implications might a reader plausibly draw from that phrase? Better yet, what rewording of the phrase would make it not misleading? For reference, here's the phrase you tagged: "Some of this research has been criticized as being misleading for failing to mention incorporation of data derived from studies of SM that do not relate to chiropractic SM;". Eubulides (talk) 06:38, 1 October 2008 (UTC)

I won't pretend to know what QG is thinking of, but he's got me thinking about it, and maybe there is some truth to the matter. I have written something about the matter that might be relevant. There are several issues that are the basis for the criticism, and only one is mentioned in the current sentence, and I don't recall that it is one of Ernst's criticisms. He is concerned about three issues which should be mentioned:

Ernst criticized them (1) for not mentioning that some of the included research was research on chiropractic SM, (2) for excluding contradictory research, and (3) for making "biased interpretations". The inclusion of positive chiropractic research and the omission of mainstream negative research resulted in "biased interpretation" by them. The omission was his point. Chiropractic research alone can't be trusted, and the readers of such research should have been forewarned by making it clear that such one-sided research was included, while contradictory research was left out. They were stacking the deck by selective inclusion and exclusion and then made misleading statements. Here's the source.

I'm not sure how to solve this problem without a rewording of that paragraph. -- Fyslee / talk 13:41, 1 October 2008 (UTC)

I'd certainly be open to reword the paragraph. Any specific suggestions for rewording? Or perhaps QuackGuru can give it a shot? So long as the current point continues to be made, I don't see why we can't improve its wording for clarity, or add the additional points. Eubulides (talk) 16:06, 1 October 2008 (UTC)

I'd reword it to state that "One review of this research has been criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular; however the chiropractors who wrote the review stated that they did not consider this difference to be a significant point as all research on SM is equally useful and does not depend on which practitioner provides it." Tim Vickers (talk) 20:45, 1 October 2008 (UTC)

That sounds like a useful way to go, but the proposed wording has some problems:

• The usual style in Chiropractic would be to say "A 2002 review of randomized clinical trials of SM" rather than the relatively-vague "One review of this research".
• Meeker & Haldeman did not write "all research on SM is equally useful" and would not agree with such a claim; they wrote "research on spinal manipulation, like that on any other treatment method, is equally of value regardless of the practitioner providing it."
• It's not necessary here to state that the reviewers were chiropractors; it's not important to this point, and it is a bit ad hominem to bring it up here.
• "has been" should be "was".
• Comma after "however".
• Here is a proposed rewording to address the above points:

A 2002 review of randomized clinical trials of SM was criticized for not distinguishing between studies of SM in general, and studies on chiropractic SM in particular; however the review's authors stated that they did not consider this difference to be a significant point as research on SM is equally useful regardless of which practitioner provides it.

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

This proposal works for me and is consistant with the current writing style of the article. QuackGuru 02:01, 9 October 2008 (UTC)

Some comments on uncontroversial parts of the text

• "percent of visceral ailments that subluxation significantly contributes to" - not very clear, I know myself that the viscera are the internal organs, but not all of our readers will realize this. Perhaps say "disorders of internal organs, such as heart disease, cancer or strokes" - or whatever examples are appropriate.
• "therefore visible on static imaging studies" - again a bit opaque, perhaps "therefore visible in X-rays or MRI."
• "past the normal physiological range of movement without exceeding the anatomical boundary limit" - unclear, perhaps "past the normal range of movement, but not so far as to dislocate or damage the joint"

Tim Vickers (talk) 22:54, 1 October 2008 (UTC)

I see your points:

• The "visceral" part could use a tweaking.
• The x-rays one could also use tweaking, but it's a precise WHO quote, so be careful.
• The ROM one could also be improved.

Go for it! Provide your suggested improvements here and let's see if it looks good.

I have trouble with the "three-joint complex" part. That's not clear to laymen. A "motion segment" is what I usually think of, and even that isn't clear to laymen. Yes, the spinal movements are dependent on a "three-joint complex" (intervertebral joint and two facet joints), but a manipulation doesn't "pop" the intervertebral joint. It usually pops only one of the facet joints, if done specifically. So a spinal manipulation/adjustment is usually directed at only one of the facet joints. Of course there will still be some effect on joints above and below the specific motion segment, but the intention is to limit the manipulation to one facet joint. -- Fyslee / talk 02:08, 2 October 2008 (UTC)

Do you have a reliable source saying this? I don't see anything like that in the cited source (the ACA policy statement). Eubulides (talk) 08:13, 2 October 2008 (UTC)

We would have to look elsewhere in the spinal manipulation literature for such explanations. I doubt that they would be part of research, but are most likely part of books, syllabi, and other instruction materials. We aren't bound to use the ACA source, since using it alone can leave a somewhat misleading impression on lay readers. I don't think it is wrong to use it, but it's not complete enough, since the "three-joint complex" would apply more to joint movements than to the specific object of a single manipulation while making those movements, and the expression is far too technical for lay readers without some kind of wikilink. We could keep what we have and add a short sentence about how the specific target of SM is normally a facet joint.

There are also non-HVLA mobilisation techniques where cavitation is not attempted, where the target is either a specific facet joint, or a mobilisation of all structures in a single motion segment, or including neighboring motion segments, but mobilisation is not the subject here. FYI, my teachers in manual therapies (including SM) were other PTs, MDs, DOs, and to a lesser degree DCs. The DC information has been from DC friends, and secondarily from chiropractic literature that describes their techniques. When it comes to descriptive literature, MDs and DOs have been the producers of some of the best literature, because they did not consider SM to be a trade secret, and they have thus shared their knowledge for the benefit of mankind, with books and articles that date way back in time. -- Fyslee / talk 02:00, 3 October 2008 (UTC)

Chiropractic advocacy reference

I recommend we remove this less than reliable chiropractic reference. QuackGuru 04:49, 2 October 2008 (UTC)

Of course. We have been over this before and have settled on only the DMOZ link. -- Fyslee / talk 05:12, 2 October 2008 (UTC)

Yes, I recall our discussing this at length in Talk:Chiropractic/Archive 26 #External Links, with the conclusion you mentioned. The chiro.org link by itself is promotional and it's NPOV to link just to it. Also, it doesn't meet the criteria of WP:LINKS. I removed it. Eubulides (talk) 08:13, 2 October 2008 (UTC)

After the above discussion I removed the link. Four days later this edit reverted the removal, restoring the link; the only discussion was the change log entry which said "rv WP:OWN". Three hours after that, this edit reverted the revert, removing the link again; again, the only discussion was the change log "rvt. "OWN" is no reason to rvt against unanimous consensus; you have not participated in the discussion and given no legitimate reason". I agree with the link removal; if there's further disagreement I suggest discussing the topic here first. Eubulides (talk) 17:39, 6 October 2008 (UTC)

Proposed heading change

There has been discussion about a proposed heading change for Vaccination. A short and descriptive section name is Public health. This article may help expand the section but I do not have a copy of the full article. QuackGuru 16:30, 3 October 2008 (UTC)

I think we should figure out the content before we change the heading of the section. Currently - though I dispute the existence of the section - the heading is aptly named. -- Levine2112 17:19, 3 October 2008 (UTC)

I agree with Levine2112. The proposal to change the name to Public health would make sense only if we also change the contents to talk about public health in general, not just vaccination. I think such a change would be a good one, but it's more work than just a title change. Eubulides (talk) 17:37, 3 October 2008 (UTC)

Did you look at my sandbox. I am working on expanding the section. Does anyone know of any freely readable references on this topic. I can start the expansion and editors can improve on it. QuackGuru 17:51, 3 October 2008 (UTC)

Here is a copy of the full text of the article. We can easily expand the Vaccination (Public health) section. QuackGuru 19:24, 3 October 2008 (UTC)

As long as you post your proposed version here and then get it worked over into a consensus version before posting it, I see no problem with starting. Go for it! -- Fyslee / talk 01:16, 4 October 2008 (UTC)

For more on this subject, please see #Comments on Public health below. Eubulides (talk) 07:41, 4 October 2008 (UTC)

Relevancy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Turf war over scope of practice 1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Turf war over scope of practice 2

• Here's a newer version:

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

The profession has resisted such proposals:

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

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

Comments on Turf war over scope of practice 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Limited scope of practice" (version 3)

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

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

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

The profession has resisted such proposals:

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

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

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

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

Another source to add:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fixing first paragraph under EFFICACY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Public Health

The International Chiropractors Association states that citizens around the world are facing complex issues with respect to drinking water. The ICA is against fluoridation of the nation's municipal drinking water supplies because they conclude public water fluoridation is not proven safe and could possibly be harmful to the body. Some chiropractors provide fluoride information to families including websites, books, and research papers so that parents can make their own decision for their children. In the U.S., chiropractics have supported fluoridation and also opposed it.

Traditionally, chiropractic focuses on the individual patient rather than on public health issues. Although chiropractic has had several external barriers, it has become more involved within public health activities.

Comments on Public health

Here is a proposal to expand the Public health (Vaccination) section. QuackGuru 01:39, 4 October 2008 (UTC)

Alas, QuackGuru installed the version directly into Chiropractic. That is not a good practice. QuackGuru, would you please revert that? It's better to discuss the proposed change first. Thanks. Eubulides (talk) 07:41, 4 October 2008 (UTC)

Commenting on the above draft:

• The claim "Some chiropractors provide fluoride information to families including websites, books, and research papers so that parents can make their own decision for their children." is not supported by the cited source. It doesn't say anything about what some chiropractors do, as far as I can see.
• The ICA is a relatively small group; its position statement should not be taken as representing chiropractors.
• The Jones et al. 1989 source is better, but it's quite old (1989) and describes just one case.
• All in all, the 1st paragraph depends on primary sources and is too weak to appear in Chiropractic. We need better sources; they should be secondary sources.
• The 2nd paragraph uses the best source of all. But the summary is too generic: it doesn't tell us much about chiropractic and public health. It needs to say specifically what's going on with chiropractic and publich health.
• After seeing the draft merged into Chiropractic #Public health, I'm afraid that I see several problems. The resulting section does not hang together: it's just the concatenation of three paragraphs. There is no topic sentence, and nothing tying the section together. It needs to be reworded to be coherent. Again, please revert and let's work on the draft here, first.

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

I went ahead and reverted it since he doesn't usually heed such requests. His changes were made without consensus in spite of a clear warning not to do so, which is definitely disruptive editing. I really don't see any hope for any change from him in this regard because he has been warned numerous times by many different editors on all sides of the issues, yet he persists. Numerous edit wars and long discussions have been caused by this common editing style he favors. It's pretty tiring and something needs to be done. "Consensus" and "collaboration" don't seem to find lodging in his brain. -- Fyslee / talk 14:51, 4 October 2008 (UTC)

We edit as individuals and work together towards consensus as a team. WP:GA is possible.

It would be helpful if Wikipedians would edit the proposal to public health. Feel free to edit.

We can start by removing all the primary references. We can expand the 2008 reference if editors have any ideas. QuackGuru 04:02, 5 October 2008 (UTC)

• Support as long as it is understood that the ICA website is then considered a reliable source for this WP article. --Surturz (talk) 10:49, 5 October 2008 (UTC)

We could include the ICA's position as long as we have a major group's position such American Chiropractic Association statement on fluoride. We need to find references that represent the majority view first before we include the minority view. See WP:WEIGHT. QuackGuru 19:15, 5 October 2008 (UTC)

The ICA website has always been a reliable source for their viewpoints. They don't speak for all chiropractors, and that should be made clear, but they do represent the traditional chiropractic POV, and their influence is far larger than their membership numbers would indicate. -- Fyslee / talk 03:01, 6 October 2008 (UTC)

Here is an article that touches on public health issues. QuackGuru 19:29, 5 October 2008 (UTC)

• I agree that the ICA website is a reliable source for the ICA's viewpoints, but they represent only a minority of chiropractors and are fringe (in the sense of WP:FRINGE). They should not be treated as a reliable source for chiropractic in general or for public health.
• The article QuackGuru mentions is a reliable source for this topic, and it would be reasonable to write better text based on it. I can volunteer to do that at some point (my time is a bit limited, though, so I hope someone else does it...). Unfortunately, the current draft is too weak to go in as-is, for reasons described above.

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

• Then no I do not support. It's either a reliable source or it isn't. You should not be allowed to cherry-pick content that supports your POV. If you are using it as a primary source for the fluoride stuff, then it is WP:OR - you should find a reliable secondary source that mentions the fluoridation policy (to establish notability). If you can't do that, then you are clearly pushing a POV. --Surturz (talk) 09:19, 6 October 2008 (UTC)

• I think you are confusing "pushing a POV" with "documenting a POV" (the ICA's POV). The last is what we do here. If we were to include the ICA's POV as if it were a legitimate, non-fringe POV, we would be pushing their POV. Maybe you wouldn't object if we were doing that? -- Fyslee / talk 14:11, 6 October 2008 (UTC)

• BTW, what POV do you think we are pushing? -- Fyslee / talk 14:26, 6 October 2008 (UTC)

• There are books covering this subject that might be useful. QuackGuru 16:58, 6 October 2008 (UTC)

Topic ban

Since the majority view seems to be that QuackGuru's editing, while sometimes problematic, is not seriously disruptive, I'll give him some clear guidance on how to work more effectively with other editors of this article and avoid the need for editing restrictions. If this warning is not heeded, action will follow swiftly. Tim Vickers (talk) 17:04, 6 October 2008 (UTC)

For reference purposes, here is a diff to the guidance discussion. Read the "Editing Chiropractic" section on that version of his talk page. -- Fyslee / talk 03:43, 8 October 2008 (UTC)

Updated systematic review

The health benefits for chiropractic manipulation treating pediatric health conditions has low levels of supportive scientific evidence.

Comments on updated systematic review

Here is a new reference that might be useful for the article. Thoughts? QuackGuru 04:02, 5 October 2008 (UTC)

Gotlib & Rupert 2008 (PMID 18789139) is an excellent source: it's up-to-date, it's a systematic review, and it's highly relevant. Thank you for bringing it up. I propose to work its claims into Chiropractic as follows:

• After the sentence "Many controlled clinical studies of SM are available, but their results disagree, and they are typically of low quality.", insert:

Health claims made by chiropractors about using manipulation for pediatric health conditions are supported by only low levels of scientific evidence.

• Replace "baby colic," with "baby colic,".
• After "fibromyalgia,", add "kinetic imbalance due to suboccipital strain (KISS) in infants,".

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

Good suggestions. Feel free to add the improvements to the article. QuackGuru 02:01, 9 October 2008 (UTC)

Unnecessary comma and redundant word

A recently added comma seems unnecessary. QuackGuru 02:01, 9 October 2008 (UTC)

This recently added word seems redundant. QuackGuru 16:50, 9 October 2008 (UTC)

Generally speaking I wouldn't worry about minor editorial changes like that as a single comma or word that is unnecessary to you may help some other reader get the gist of what is after all a complex bit of prose. Eubulides (talk) 17:12, 9 October 2008 (UTC)

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

Template:RFCsci

Subject and "Rules of engagement"

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

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

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

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

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

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

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

This RfC isn't about OR or other policies. It is limited to the bare question, as it reads. This is about logic and about knowledge of chiropractic and its main treatment method. -- Fyslee / talk 14:21, 9 October 2008 (UTC)

RfC comments

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

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

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

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

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

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

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

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

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

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

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

• Agree. My personal experiences with this term has been with using chiropractic care, so I associate this to a chiropractor. --CrohnieGal 11:38, 9 October 2008 (UTC)
• Agree that spinal manipulation is directly related to chiropractic, and is relevant to chiropractic.--—CynRN 18:38, 9 October 2008 (UTC)
• Agree SM is the main mode of treatment in Chiropractic, while other things are related to Chiropractic as well, SM forms the core of this form of medical practice and is therefore directly related to the topic. Tim Vickers (talk) 18:53, 9 October 2008 (UTC)
• No. In terms of Misplaced Pages, spinal manipulation is not "relevant" to chiropractic. Chiropractic spinal manipulation is relevant to chiropractic. Disagree. The profession and its top researchers don't necessarily agree either. In fact, we have highlighted reliable sources demonstrating such disagreement in the professional and research worlds. -- Levine2112 20:46, 9 October 2008 (UTC)

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

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

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

Gallup Poll revisited

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

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

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

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

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

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

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

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

References

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