Misplaced Pages

Revision as of 15:55, 24 April 2008

No plus sign pleaseIn order to keep the references listed at the bottom, please don't use the new section tab above, or the "click here to start a new topic" below to start a new section.

This is the talk page for discussing improvements to the Chiropractic article. This is not a forum for general discussion of the article's subject.

Put new text under old text. Click here to start a new topic. New to Misplaced Pages? Welcome! Learn to edit; get help. Assume good faith Be polite and avoid personal attacks Be welcoming to newcomers Seek dispute resolution if needed Article policies Neutral point of view No original research Verifiability

Find sources: Google (books · news · scholar · free images · WP refs) · FENS · JSTOR · TWL

Archives: Index, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40Auto-archiving period: 14 days

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

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

Template:Cleanup taskforce closed

This article has not yet been rated on Misplaced Pages's content assessment scale. It is of interest to the following WikiProjects:

Please add the quality rating to the {{WikiProject banner shell}} template instead of this project banner. See WP:PIQA for details. Alternative medicine This article is within the scope of WikiProject Alternative medicine, a collaborative effort to improve the coverage of Alternative medicine related articles on Misplaced Pages. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.Alternative medicineWikipedia:WikiProject Alternative medicineTemplate:WikiProject Alternative medicineAlternative medicine Please add the quality rating to the {{WikiProject banner shell}} template instead of this project banner. See WP:PIQA for details. Skepticism High‑importance This article is within the scope of WikiProject Skepticism, a collaborative effort to improve the coverage of science, pseudoscience, pseudohistory and skepticism related articles on Misplaced Pages. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.SkepticismWikipedia:WikiProject SkepticismTemplate:WikiProject SkepticismSkepticism High This article has been rated as High-importance on the project's importance scale.

This is the talk page for discussing improvements to the Chiropractic article. This is not a forum for general discussion of the article's subject.

Put new text under old text. Click here to start a new topic. New to Misplaced Pages? Welcome! Learn to edit; get help. Assume good faith Be polite and avoid personal attacks Be welcoming to newcomers Seek dispute resolution if needed Article policies Neutral point of view No original research Verifiability

Find sources: Google (books · news · scholar · free images · WP refs) · FENS · JSTOR · TWL

Archives: Index, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40Auto-archiving period: 14 days

Archives

Index 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 31, 32, 33, 34, 35, 36, 37, 38, 39, 40

Archive Index

This page has archives. Sections older than 14 days may be automatically archived by Lowercase sigmabot III.

Proposed section rewrites

Scope of practice

Although chiropractors have many attributes of primary care providers, they also have more of the attributes of a medical specialty like dentistry. Chiropractors are considered primary care providers who emphasize the conservative management of the neuromusculoskeletal systems without the use of medicines or surgery. The practice of chiropractic medicine involves the restricted acts of diagnosis and spinal manipulation and involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests, as well as other specialized tests as required. A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider. Common patient management involves:

• spinal manipulation and/or other manual and/or soft tissue therapies
• rehabilitative exercises
• health promotion
• physiological therapeutic modalities
• conservative and complementary procedures.
• health and lifestyle counseling

Chiropractors generally cannot write medical (pharmaceutical) prescriptions; however there has been a gradual shift within the profession with a slight majority of North American DCs favouring an expansion of scope of practice to include limited prescription rights. A notable exception is the state of Oregon which is considered to have an "expansive" scope of practice of chiropractic, which allows chiropractors with additional qualifications to prescribe over-the-counter drugs. With additional training and certification licensed chiropractors (DCs) and veterinarians (DVMs) can expand their scope of practice and practice veterinary/animal chiropractic which includes assessment, diagnosis and treatment of biomechanical disorders of animals that may be amenable to manual therapy. Chiropractors are also generally permitted to use adjunctive therapeutic modalities such as acupuncture and manipulation under anesthesia with additional training from accredited universities/colleges.

Currently, chiropractic is a regulated health care profession with licensure requirements in over 50 countries globally although chiropractic medicine is most established in North America, Australia as well as a few European countries. Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic.

CorticoSpinal (talk) 04:55, 13 April 2008 (UTC) CorticoSpinal (talk) 16:47, 13 April 2008 (UTC) CorticoSpinal (talk) Strikeouts. DigitalC (talk) 00:55, 15 April 2008 (UTC) CorticoSpinal (talk) 19:20, 18 April 2008 (UTC)

Comments Scope of Practice

Please put any notable stuff that may be missing from scope of practice below.

• animal chiropractic (i.e. non human practice) (expanded scope of practice with additional training/certification):* prescription of ergonomic devices (orthotics) and assistive devices, disability evaluations, IMEs, etc..
• practice of other regulated therapies (acupuncture (i.e does it require some kind of license to practice or is considered to be within the 'public domain'
• clinical specialities (most common only, i.e. sports sciences, rehabilitation sciences, neurology, radiology, etc...):* Practice demographics (solo, vs. multidiscipinary, integrative medicine (i.e. public health/governmental)
• Anything else? CorticoSpinal (talk) 05:41, 13 April 2008 (UTC)

This section is long and boring: it's a huge paragraph with no breaks and I suspect that nobody has read it. Does there really need to be this level of coverage here? It's too long by at least a factor of two, maybe three. Also, there's some duplication with the proposed Education and Licensing section (see below). Eubulides (talk) 08:15, 14 April 2008 (UTC)

It doesn't seem too long or boring to me. Changes may have been made to increase readability, but I think it reads well and is not too long. Any duplication should be taken care of. DigitalC (talk) 00:57, 15 April 2008 (UTC)

Several of the citations do not work for me. The Google Books citations don't work. Some of the citations are simply numbers in brackets; they don't work either. Please use proper citation templates ("cite journal", "cite book", etc.) As things stand the citations are too hard to follow. I fixed a couple of them but there are many more that need fixing, and it's hard to review the proposed text properly without seeing the citations. Eubulides (talk) 08:15, 14 April 2008 (UTC)

The section fully covers the scope of practice of chiropractic and represents the subtle ins and outs of scope of practice globally and within North America. Yes, there needs to be a full and appropriate coverage of chiropractic scope of practice in Chiropractic. This is done fully and completely in other regulated health profession in articles here. Duplication of material can be deleted.

Google Books citations work fine for me; where do I find citation templates? The citations are there; they take you to the relevant citations; are there any specifically that you dispute? If so, why? We can easily change formatting to increase readability and I will break the paragraph into 2. We could always add bullet points to highlight some of the major restricted acts or common treatment modalities in scope of practice as well. Thanks for your comments. CorticoSpinal (talk) 15:43, 14 April 2008 (UTC)

The Google Book citations don't work for me; I click on them and get a message "page unavailable for viewing". So I don't know what's being cited. You can find citation templates by looking at how books and journals are cited in #Effectiveness 1. Eubulides (talk) 09:12, 15 April 2008 (UTC)

This is reading well. IMHO, this is the kind of professional information perfectly suited for an article about Chiropractic. Nice work! -- Levine2112 19:36, 14 April 2008 (UTC)

As per Eubulides request, I will attempt to introduce good citation formatting; if it's not up to snuff, I apologize I'm still trying to learn how to use the various tools here at Misplaced Pages. Nonetheless, if there aren't significant objections, I propose we roll out scope of practice today.

It's not just the formatting (although that clearly needs to be fixed). The bigger problem is that some of the citations don't work at all, and I can't follow them to check them, and therefore cannot do what I feel would be a proper review. Please fix the citations first, so that people can have a day or two to review the whole thing. Eubulides (talk) 16:46, 16 April 2008 (UTC)

I can assure you that when I checked the citations they were functional and working but I'll make doubly sure they're still there. With all due respect I was pretty thorough in writing the section and made sure the citations met inclusion criteria. After all, I do have expertise in this field and know the salient points probably a bit better than other health professionals. CorticoSpinal (talk) 18:55, 16 April 2008 (UTC)

Thanks, but even if they work for you, they may not work for other readers. Google Books is notorious for this, since it may give a page to one reader but refuse access to others; please avoid URLs to it. Also, some of the references (e.g., "..") cannot possibly work for anybody; these clearly need fixing. Eubulides (talk) 19:11, 16 April 2008 (UTC)

Citations were done using the cite button (that's pretty handy!) as to conform to proper citation formatting. Section was added today as there appeared to be no significant objections for inclusion. Scope of practice section was moved to conform with other health professional articles and to increase readibility. Education section will be dealt with next; comments for that section are welcome there. CorticoSpinal (talk) 14:56, 17 April 2008 (UTC)

I asked "Please fix the citations first, so that people can have a day or two to review the whole thing." But that's not what happened. Some citations were changed, and the material was put into Chiropractic in a matter of hours. Worse, nontrivial changes were made the non-citation part of the material just before it was put in, without any review. For now, I am reverting the change, and propagating its fixes into #Scope of practice above. Please give us a day or two to review this revised proposal. (I don't have time right now to do a careful review, but I did notice that the Google Books URLs were not fixed, so at least that problem remains.) Eubulides (talk) 16:42, 17 April 2008 (UTC)

This section has been proposed already for a week, all the citations were there and looking at your contribs list I saw that you had been editing regularly over the past few days with little to no input on scope of practice of chiropractic. It's OK if it's not really a priority to you, but others shouldn't have to wait for one editor to give the final approval. Consensus doesn't work that way. If you have any specific objections than feel free to list them, otherwise I found your revert to be in poor taste. CorticoSpinal (talk) 17:58, 17 April 2008 (UTC) Actually on further review, I see you have misrepresented your statement once again. Nontrivial changes? Where, what, when? None were made, the citations were not changed this incorrect. Please be more careful in the future. CorticoSpinal (talk) 18:01, 17 April 2008 (UTC)

Significant changes to the text were made a few hours before it went in, with no time for anybody to reasonably comment. The citations that went in could not be followed (at least, not by me: Google Books URLs are not reliable, for reasons I've already stated). About four hours ago most of the citations in the draft were fixed well enough so that they can now be followed so I will take a look at them and then use them to review the proposed text. This will take a bit of time, since it requires reading not only the proposed text, but also the supporting sources. Please give the other editors a day or two to do that. Eubulides (talk) 22:08, 17 April 2008 (UTC)

One other comment about the citations (and then I really must run): the last two are so badly formatted that I cannot read them. Nothing happens when I click on the last citation, and the 2nd-to-the-last ends up with a weird long section of text that starts "{{<ref>{{cite web|url=http://www.chiroweb.com/…". Can you please fix this? And please check the other citations too: the Google Books URLs must go, for example. The idea here is to fix the proposal to have proper citations, and then give editors a day or two to review the proposal and check that it is adequately supported. Thanks. Eubulides (talk) 16:50, 17 April 2008 (UTC)

I have tried my best to format the citations for wikipedia but it's something I'm learning still. Regardless, the content is reliable, verifiable, accurate and notable and all the info is there. CorticoSpinal (talk) 17:58, 17 April 2008 (UTC)

Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic. This part seems a bit long and is not focused on Scope of practice. QuackGuru (talk) 17:37, 17 April 2008 (UTC)

Similar to other professions, chiropractors can specialize in certain disciplines and increase their breadth of scope of practice. Do you feel it would be better elsewhere? CorticoSpinal (talk) 17:58, 17 April 2008 (UTC)

I have made a concerted effort to repair the ref code. Let me know if I have overlooked anything though. -- Levine2112 18:08, 17 April 2008 (UTC)

There is a Chiropractice education article. Some of this material could be split up and put there. Currently, it is too long and needs more focus. QuackGuru (talk) 18:11, 17 April 2008 (UTC)

This doesn't seem to be about Chiropractic Education though, but rather about Scope of Practice. Are there any passages in particular which you think are more appropriate for Education? Can you specify please? Thanks. -- Levine2112 18:16, 17 April 2008 (UTC)

Exactly. Thanks Levine2112. Eubulides, I strongly object to these stall tactics; the majority of editors here won't wait for your exclusive approval. Judging by your contribs history you seem to be quite active, so if this is not a priority for you then please be so kind as to say so; otherwise we will implement this section tomorrow. One final note: please do not making misleading or false allegations in your edit summaries. To say that I made "non-trivial" changes is completely untrue and easily verifiable by the diffs. I would like to note that the last week or so here I have your contributions and collaborative style to be less than ideal as seen from a tendentious editing in the "appeal to drop effectiveness". There seems to be an issue with respecting the consensus of a majority of editors. So, in summary, I would please ask that you refrain from making misleading statements, mischaracterizing other editors comments. You're approaching a dozen times now. CorticoSpinal (talk) 19:58, 17 April 2008 (UTC)

• It is not "stall tactics" to ask for a day or two to review a new section before it goes in. Without proper citations, it wasn't really reviewiable.
• The difference between the last stable draft on the talk page and what was installed into the article shows that changes were made other than adding citations or trivial formatting changes. For example, the last stable draft talked about training for acupuncture, but the version that went into Chiropractic had a more-general claim about training for several "adjunctive therapeutic modalities".

Eubulides (talk) 22:31, 17 April 2008 (UTC)

Actually, the citations worked fine for everyone else. This section had been here for a week and you had no specific objections until, of course, it was time to put the section in the body. Acupuncture is an example of adjuctive therapeutic modality that requires extra training. So is manipulation under anaesthesia. What's your point? That DCs don't take courses to get certified in adjunctive therapeutics? You're kidding, right? PS: Please check my comment left at Dispuritive edits by OrangeMarlin section, regarding your complete refusal to acknowledge my concerns of your habitual tendency to mischaracterize and mislead. I'm simply giving you the heads up as I'm going to be taking this ANI if it happens again, if this were baseball you would have struck out 4 separate times. You're at 13 now. That's more than enough "notices". CorticoSpinal (talk) 23:03, 17 April 2008 (UTC)

All the citations worked fine for me. However, I cleaned one up using the Citation templates, and removed the link to Google Books from another, as no preview was available for that book. If anyone wants to follow the source, they'll have to go to the book. DigitalC (talk) 01:01, 18 April 2008 (UTC)

Thanks for the cleanup. So far, the revised citations are working for me, with only minor formatting issues. I will try to do further cleanup as I review the text more carefully. Eubulides (talk) 19:08, 18 April 2008 (UTC)

Scope of practice comments

Here are some detailed comments about #Scope of practice. These comments are incomplete, as I'm still working on it.

Scope of practice quality of sources

First, the quality of sources could be improved. As per WP:MEDRS it's better to use articles published in refereed journals, preferably secondary sources. Here is a are several higher-quality sources that are the sort of thing that should be used in the section. I hope to add more sources later as I find them.

• Meeker & Haldeman 2002 ("MH2002" below)
• Cooper & McKee 2003 ("CM2003" below)
• Eisenberg et al. 2002 ("E2002" below)
• Pollentier & Langworthy 2007 ("PL2007" below)

Eubulides (talk) 19:08, 18 April 2008 (UTC)

It doesn't work that way, Eubulides. We don't get to formulate an "opinion" on scope of practice, because opinion doesn't matter. What we are doing is defining the legal boundaries of a profession. And, the WHO document, a tertiary source no less, representing the global POV reflects this legal fact. I'm not saying the sources aren't good to discuss the issue elsewhere, say, practice styles and schools of thought, but again, it's the validity of your argument, not the content that is fallacious. DCs are PCPs for NMS (this is specific) and the point is moot. Orthodox medical opinion has no place in the legal arena of scope of practice. It's that simple. CorticoSpinal (talk) 03:49, 21 April 2008 (UTC)

The sources in question (WHO, etc.) do not define the legal boundaries of chiropractic. They do not set the legal boundaries, they do not cite the legal boundaries, and they are not even particularly trying to summarize the legal boundaries. They are merely introducing the subject of chiropractic in order to get on with their main topics, which are education, safety, and accreditation. If they were really attempting to summarize the legal boundaries (which they are not), they would be talking about the wide diversity of scope of practice among the various jurisdictions. But they aren't doing that. Eubulides (talk) 08:19, 21 April 2008 (UTC)

The WHO sets up a global POV. The WHO is a tertiary source which amalgamated various sources from peer-reviewed literature. The WHO clearly spells out common scope of practice for DCs based on training. There is more confabulation occuring here; and I'm really getting tired of continuously getting involved in nominal arguments with an editor who has no expertise on the subject. Do you dispute, that legally, yes or no, that DCs are PCPs for NMS? Because we're getting off track here. CorticoSpinal (talk) 14:45, 21 April 2008 (UTC)

The WHO document is about basic training and safety. It does not mention scope of practice anywhere. In contrast, MH2002 mention scope of practice more than once. MH2002 is on point (and is published in a high quality peer-reviewed journal); the WHO document is not. Chiropractic should prefer higher-quality, relevant sources when they are available, as is the case here. I do not dispute that DCs are PCPs for NMS in some jurisdictions; however, I do dispute that this is the whole story. MH2002 explain why it's not the whole story. Eubulides (talk) 09:41, 22 April 2008 (UTC)

"It does not mention scope of practice anywhere". Page 19, paragraph 4. Moving on, shall we? There is no scope of practice "story". The "story" is commentary; we don't comment about legal scope of practice boundaries. It's our responsibility to present to readers what practice parameters are in place; i.e. what the health professional can and cannot do. That's it. That's also the way the scope of practice section written at every other health profession article on Misplaced Pages. Not disputing the papers (they're good) disputing the validity of your argument (it's not). PS -Don't come back with a comparison to Homeopathy or Flat Earth (which you've already done several times . That tune is overplayed. CorticoSpinal (talk) 04:17, 23 April 2008 (UTC)

Page 19, paragraph 4, is a vague, high-level description of chiropractic practice. It says that practice "involves" this and "emphasizes" that. But it doesn't ever say what the boundaries are, which is the essence of what scope is. Tellingly, the paragraph never uses the word "scope". It certainly doesn't talk about any legal aspects. In short, this is a low-quality source for scope of practice. It's far better to use a source whose main topic is scope of practice (the WHO document's main topic is something else). A source like MH2002, for example. Eubulides (talk) 08:41, 23 April 2008 (UTC)

The sources are fine. This is just another attempt to get more allopathic sources in there to dispute chiropractic scope of practice. You won't find a RCT on this, Eubulides.

CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

I agree with Eubulides, lets use the best sources AVAILABLE. Oh wait, I think we already are. We are talking about scope of practice, which is a legal entity. I have found a peer-reviewed article on scope of practice within the US, however it was old and outdated. DigitalC (talk) 07:24, 21 April 2008 (UTC)

I think, DigitalC, you are noticing a trend and pattern with Eubulides' editing style here at Chiropractic. IMO, it's gone overboard as of late, with this whole debate re: SOP as a perfect example of a case of civil POV pushing and disruption. There have been many instances of wikilawyering, violations of WP:IDIDNTHEARTHAT, WP:NPOV, WP:POINT, WP:SYN, gaming the system amongst others. My patience is now beginning to wear thin with these needlessly long debates that sap productive editing not only here, but elsewhere on the project. CorticoSpinal (talk) 16:06, 21 April 2008 (UTC)

I agree that this discussion has been needlessly long, and I think it's probably time we took it to dispute resolution. Eubulides (talk) 09:41, 22 April 2008 (UTC)

There wouldn't have been a need if you ceded the way to CynRN who has demonstrated an excellent ability to collaborate productively yet firmly represent the orthodox med POV. She would be my nominee to be the lead editor in mediation talks; she is a strong representative of the mainstream POV but is fluid and adapts her arguments based on knowledge, rather than dogma. What do you think Cyndy? :) CorticoSpinal (talk) 04:17, 23 April 2008 (UTC)

The only higher-quality source proposed so far is Meeker & Haldeman 2002 (MH2002). Are you disputing that it is a higher-quality source? If so, please explain the concerns with this source. Eubulides (talk) 19:08, 18 April 2008 (UTC)

The source is good, it's just in the wrong section. It also editorializes. CorticoSpinal (talk) 23:07, 18 April 2008 (UTC)

The source is more on point than the sources currently being cited for the first few sentences of this section. The source is a reliable one written by acknowledged experts in the field and published in a high-quality peer-reviewed journal. One could just as easily say that the WHO source "editorializes" as arguing that MH2002 "editorializes". That's what reliable sources are for: to give us their expert opinions. Eubulides (talk) 07:44, 19 April 2008 (UTC)

Addition: When discussing scope of practice; we don't need refereed journals per say, nor would they be appropriate. This could introduce heavy bias, for example an allopathic 'opinion' in a "secondary study" from a 'critic' like Ernst. We have already listed 2 excellent books which cover this aspect extremely well and they are thorough.

1. ^ Haldeman, Scott; Chapman-Smith, David, Petersen, Donald, Jr.. Guidelines for Chiropractic Quality and Practice Parameters (in English). Sudbury, MA: Jones and Bartlett, 111-113. ISBN 0-7437-2921-3. Retrieved on 2008-04-16.
2. Pybus, Beverly, E.; Cairns, Carol, S. A Guide to AHP Credentialing, C, hcPro, 241-243. ISBN 1-57839-478-3.

So, I don't see any justification for concerns regarding the quality of the sources but if other good ones can be found that's obviously OK too. CorticoSpinal (talk) 13:54, 18 April 2008 (UTC)

So far, I have reviewed only the first part of the proposed section, which does not use the sources you mention. The sources that it does use are lower-quality than MH2002, because they are principally on different topics (education, safety) and only briefly discuss scope of practice by way of introduction. Also, they are not published in peer-reviewed journals. In contrast, MH2002 focuses heavily on scope of practice and it was published in a very high quality peer-reviewed journal. Eubulides (talk) 19:08, 18 April 2008 (UTC)

This is the legal arena, Eubulides. Secondary sources for scope of practice aren't necessary not are they at all valid. I guess you are disputing now the notability of the World Health Organization. Interesting. CorticoSpinal (talk) 23:07, 18 April 2008 (UTC)

The WHO and CCE sources are no more apropos for the legal arena than MH2002 is. In none of these sources is the law the primary topic. I am not disputing the notability of the WHO. I am merely saying that for the topic of scope of practice, MH2002 is a more-reliable source than that WHO source is. The WHO source is primarily about education and safety, not about scope of practice. Similarly, the CCE source is primarily about education and accreditation, not about scope of practice. Eubulides (talk) 07:44, 19 April 2008 (UTC)

Actually they are. They describing the medical-legal realm of scope of practice. You're also confusing reliability with validity again, as I mentioned several times through this needlessly overdrawn debate. Next time, I'd ask that rather than reverting the entirely of scope of practice, like you did instead of either a) discussing your concern or b) editing the line you were concerned with would have been far more constructive and productive. I'd like for you to note, so I'm being clear, that I found that move to be a perfect example of a civilly disruptive move, ditto with your professional colleague Orangemarlin's incredibly convenient and timed reverts where he essentially deleted the whole scope of practice section without any comment whatsoever. And as of now, he still hasn't bothered to come here and explain his actions which was already cited as vandalism by admin Swatjester. CorticoSpinal (talk) 03:59, 21 April 2008 (UTC)

The sources do not discuss the legal scope of practice. I discussed concerns about the lack of proper sourcing well before the changes went in. Once citations were supplied (which happened only after the revert), problems were found with sources not matching the text. It's better to supply a complete proposal for a change, including proper citations, to avoid problems like these. Eubulides (talk) 08:19, 21 April 2008 (UTC)

You're the only editor concerned with the sources and the claims are well founded and well known. When a neutral, 3rd party observer, like admin Swatjester even calls it NPOV and well sourced, it should become readily apparent that your case is weak and are engaged in civil disruption. CorticoSpinal (talk) 14:45, 21 April 2008 (UTC)

Swatjester's assessment of the situation predates the criticisms raised here, and did not address them. I disagree that I am the only editor concerned with the sources. Eubulides (talk) 09:41, 22 April 2008 (UTC)

Where did Swatjester call it "vandalism"? Swatjester got reverted. Keep in mind you have a 1RR parole, which you just violated, so be careful. -- Fyslee / talk 04:47, 21 April 2008 (UTC)

Thanks for your concern Fyslee. Not only did Swatjester call say it once he actually said again here and also suggested it was disruptive here and again here. Seems like a pretty clear case of vandalism to me. CorticoSpinal (talk) 05:01, 21 April 2008 (UTC)

Thanks for those diffs. I wasn't aware of those conversations and thought you were referring to edit summaries in this article. -- Fyslee / talk 05:17, 21 April 2008 (UTC)

No problem. It seems documentation matters here, as much as real life. I'm glad I'm getting the hang of it; the concept of a digital footprint. I might trademark that before DigitalC does. ;) G'night. CorticoSpinal (talk) 05:32, 21 April 2008 (UTC)

Now, comments on specific sentences in #Scope of practice:

Scope of practice comments on primary care

• "Chiropractors are considered primary care providers who emphasize the conservative management of the neuromusculoskeletal systems without the use of drugs or surgery."

I would ask that you do not delete striked out material. This issue was not fixed, in fact it completely ignored by previous concern about using a qualifying statement to open scope of practice. I had also removed portal of entry, so I don't know what your objection is. CorticoSpinal (talk) 23:13, 18 April 2008 (UTC)

Could you please explain the concern about a "qualifying statement"? Is it the form of the first sentence that is the cause of concern? As for "portal of entry", the objection was written before the phrase was removed; now that the phrase is removed that objection is moot and struck out. Eubulides (talk) 07:44, 19 April 2008 (UTC)

The concern is that rather than stating DCs current scope of practice in the legal arena, we are using the opinion of a paper which there is debate whether or not DCs are moreso PCPs or med specialists. The current text, which says DCs are PCPs primarily for NMS is accurate. They are the first point of contact for a very common medical ailment, i.e. back pain, do not require any referrals and are entitled to communicate a Dx and carry out a Tx plan. That is what PCPs do. So, to open the scope of practice already with a sentence which suggests a debate or controversy, is needless, and under the current context here, needlessly disruptive. This is really splitting hairs here and ultimately dragging this out when we could be more productive and finishing off education, licensing and regulation for example. Let's get those 2 done, then we can focus on Safety, Vaccination and get those sections back on track with the appropriate weight and tone. CorticoSpinal (talk) 04:31, 21 April 2008 (UTC)

The current proposed text states one viewpoint (DCs are PCPs primarily for NMS). This may be the majority viewpoint within chiropractic, but there is a significant minority viewpoint that says that DCs are PCPs without being restricted to NMS. Furthermore, there is a widespread viewpoint in mainstream medicine that DCs are better thought of as specialists, not PCPs. It does not suffice to merely summarize one of these viewpoints accurately; they must all be summarized, fairly and neutrally. Eubulides (talk) 08:19, 21 April 2008 (UTC)

It's not that simple. PCP is not entirely synonymous with "portal of entry." DCs are portal of entry practitioners, but are hardly qualified or legally allowed to deal with all healthcare issues, as PCPs do. If they are seen as PCPs in any sense, then it is in a limited sense, like dentists or podiatrists. "Portal of entry" is not a controversial description, while PCP would need some qualifying. This qualifying would be especially embarrassing for the many DCs who actually claim to be unlimited PCPs, encouraging their patients to come to them for all their family's healthcare needs, which is a dangerous situation. This is unfortunately a widespread holdover of the ultra-straight, original philosophy, which a number of DCs still follow and advertise as a part of their "wellness" paradigm propaganda. This is in contrast to some of the more modern, science-based DCs who know how to appropriately limit their practice and cooperate with the rest of the medical system's players. -- Fyslee / talk 04:58,

21 April 2008 (UTC)

The initial version that got vandalized and reverted included PCP and portal of entry but this was objected by Eubulides. I think that portal of entry should go in that why I wrote it that way intially. PCP but for NMS or general health/lifestyle. Also, straights aren't the majority but they get the majority of the attention here. Time to represent the less contentious mainstream a bit more but obviously retain the notable and at times, questionable, practices of the straight wing. CorticoSpinal (talk) 05:10, 21 April 2008 (UTC)

I objected to "portal of entry" primarily because the sources did not say "portal of entry". If reliable sources can be used to justify "portal of entry" that would be fine. However, my impression is that the reliable sources generally talk about primary care, not about portal of entry, and that our emphasis should be similar. Eubulides (talk) 08:19, 21 April 2008 (UTC)

• The cited source does not use the phrase "portal-of-entry", which in any event is redundant with "primary care".

Portal of entry is specifically different than exclusively primary care, but if you want to omit portal of entry, I don't think it's that big of a deal but the CCE source I think mentioned it. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

• The source calls chiropractors "primary-contact health care practitioners"; "primary care practitioners" is a more-accurate paraphrase of the source than "primary care, portal-of-entry providers".
• The source says "chiropractic practice emphasizes the conservative management", but the current wording implies that chiropractic practice is limited to conservative management.

Emphasizes is a good word to add. No objections.

• The cited source says "medicines", not "drugs".

This is OK too and is probably more professionally sounding. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

I changed it to "medicines"; somebody changed it back to "drugs". Was that intended by you? The above comment suggests no. Eubulides (talk) 07:44, 19 April 2008 (UTC)

It should read medicines. CorticoSpinal (talk) 04:07, 21 April 2008 (UTC)

• MH2002 says "Chiropractors have many of the attributes of primary care providers and often describe themselves as such. Others point out that chiropractic has more of the attributes of a limited medical profession or specialty, akin to dentistry or podiatry. This is an ongoing internal and external debate affected by dynamic health industry forces." This is a better summary of both sides of a dispute about scope of practice.

We really shouldn't be making editorial contents on what the is going on behind the scenes although I don't object to mention that it is shifting towards a specialty is you want that it in there. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

MH2002 is a reliable source: we are not making editorial comments (I assume that's what you meant) simply by summarizing it and citing it. Eubulides (talk) 19:08, 18 April 2008 (UTC)

MH2002 is not a valid source for this section and does not conform with global POV and is being used as a red herring tool, i.e to distract that legislatively DCs are PCPs for NMS. CorticoSpinal (talk) 23:13, 18 April 2008 (UTC)

MH2002 is a better source than the sources currently being used: it is published in a peer-reviewed journal of high quality, and its subject is on point (rather than being education or safety). The current draft, by presenting only one side of this dispute, is POV; this needs to get fixed. Eubulides (talk) 07:44, 19 April 2008 (UTC)

There is no dispute Eubulides. A scope of practice is pretty straight forward. It's an act of legislation what a health profession can and cannot do as it forms the basis of regulation and licensure. To repeat, MH2002 is a good source, it's more apropos at practice styles/schools of thought and then we could give orthodox med its 2c there. Also, you're forgetting that the WHO is a tertiary document that is far more robust and valid here than MH2002. CorticoSpinal (talk) 04:07, 21 April 2008 (UTC)

The WHO document is neither far more robust nor more valid than MH2002 on this particular topic. The WHO document is not about scope of practice; MH2002 is. The WHO document is not published in a high-quality peer-reviewed journal; MH2002 is. Eubulides (talk) 08:19, 21 April 2008 (UTC)

You are questioning the validity and notability of a document that is produced by the leading health organization in the whole world, right Eubulides? A document that itself is well sourced. This is just a clear cut example of using a paper (MH2002) to undermine what common legal fact that DCs are considered PCPs for NMS. How can you possibly dispute this fact? CorticoSpinal (talk) 15:03, 21 April 2008 (UTC)

I am not questioning the validity or notability of the WHO document for the subject that it addresses (namely, basic training and safety). I am questioning whether it's appropriate to pick bits and pieces out of that document for a different topic (scope of practice), a topic that the WHO document does not mention. It is far better to use a source that is directly aimed at scope of practice. Eubulides (talk) 09:41, 22 April 2008 (UTC)

• To summarize, let's replace the above quote with:

Although chiropractors have many attributes of primary care providers, they also have more of the attributes of a medical specialty like dentistry. They emphasize conservative management of the neuromusculoskeletal system without medicines or surgery.

This can go in a different section other than scope of practice as should the below reference. Let's work together here. CorticoSpinal (talk) 04:07, 21 April 2008 (UTC)

If the "scope of practice" section is only going to be about legal issues, then it should use legal citations. My impression from the existing text and sources, though, was that it was not merely or even primarily about legal scope of practice, but about de facto scope of practice. I prefer having the article talk about practical issues rather than legal ones; I think that's more helpful to the average reader. Eubulides (talk) 08:19, 21 April 2008 (UTC)

It's not a matter of individual preferences, its a matter of accurately reflecting the state of the profession. And, when we are discussing a section, such as Scope of Practice, a legal arena, we musn't use more WP:SYN to mention potential debates in scope of practice. I could easily find a paper by MDs who dispute the expanded scope of practice of Nurse practitioner but I won't because a) a paper should mined and used to advance an agenda that way and b) it is not valid. Hopefully you catch the drift. CorticoSpinal (talk) 15:03, 21 April 2008 (UTC)

Sorry, I don't catch your drift. Surely you are not saying that Meeker & Haldeman are MDs who dispute the expanded scope of practice of chiropractors, or that they wrote a "mined" paper (sorry, I don't know what that is). Eubulides (talk) 09:41, 22 April 2008 (UTC)

• CM2003 say "Although most chiropractors consider themselves to be specialists in NMS conditions, many also view chiropractic as a form of primary care. For some, this means 'primary contact' for NMS conditions, but for most it is seen in its larger context....". This nicely encapsulates the 3-way controversy about chiropractic and primary care; the current draft covers only one of the three points of view. Eubulides (talk) 08:28, 20 April 2008 (UTC)

Does the source say 'more attributes'? Chiropractors have many attributes of primary care providers but are also being increasingly seen as specialists, like dentistry.

Yes, as mentioned above, the source says "chiropractic has more of the attributes of a limited medical profession or specialty". Since there seems to be no objection to this suggestion, I've put it in. Eubulides (talk) 19:08, 18 April 2008 (UTC)

Actually I have objected to it, 2x now, but someone keeps on deleting my comments here on talk. That is in very, very poor taste. CorticoSpinal (talk) 23:13, 18 April 2008 (UTC)

Are the comments deleted now? If not, where are they? Eubulides (talk) 07:44, 19 April 2008 (UTC)

struck out the suggestion with the comment "the very first sentence should not be a qualifier. The source would be more apropos in practice styles or potentially education". Is the first part of the comment about English style, or something else? As for the source, it contains a lot of material about scope of practice and is highly relevant here; I don't see why it should be excluded. More important, the change fixes a real POV problem in the first sentence. It is controversial whether chiropractors are primary care (i.e., they are valid substitutes for primary care physicians) or specialists (i.e., they're somebody like a podiatrist that you go for specific problems). Chiropractic should cover this controversy neutrally: it should not just report the primary-care side. For now, I'm restoring that particular change; if there is an English-language issue let's fix it. Eubulides (talk) 20:11, 18 April 2008 (UTC)

, a POV problem in the first sentence? DCs are LEGISLATED as PCPs. You're going to have to argue with your state representative for that one. Furthermore, you have a nasty habit of "restoring" stuff on the spot that you seem to like and drag out and stall stuff which you don't. That's not good editing style. So, to be clear you dispute that DCs are PCP despite the evidence presented to the contrary? CorticoSpinal (talk) 23:13, 18 April 2008 (UTC)

Yes, there is a POV problem in the first sentence. I am not disputing that some people say that chiropractors are primary care providers, or that chiropractors are legally primary care providers in many jurisdictions. I am disputing that this is the only viewpoint. The article should be encyclopedic and present all significant viewpoints. The other viewpoint, which is that chiropractors have more of the attributes of a medical specialty, should also be presented. Eubulides (talk) 07:44, 19 April 2008 (UTC)

I have added more sources on this point: PL2007, E2002, CM2003. They are in agreement that the current #Scope of practice draft oversimplifies the primary-care versus specialist issue. Eubulides (talk) 08:28, 20 April 2008 (UTC)

So I'm clear, you are disputing the suggestion that DCs are legally PCPs? Is that the fundamental issue here? CorticoSpinal (talk) 04:07, 21 April 2008 (UTC)

I am not disputing that chiropractors are legally primary care providers in many jurisdictions. I am disputing that this is the only thing that should be said about scope of practice. The other viewpoints should be given. And the controversy about whether chiropractors are PCPs just for NMS, or for all medical conditions, should also be covered. Eubulides (talk) 08:19, 21 April 2008 (UTC)

To make it perfectly clear, I don't know of any jurisdiction where DCs are not legislated as PCPs for NMS. The claim is not that they are PCPs for all medical conditions. Yet another mispresentation of the the discussion or my comments specifically. I'd also like to note that I feel that you're being disruptive now trying to make a point. So, you don't dispute that DCs are legally PCPs for NMS. So why are we having this conversation again? CorticoSpinal (talk) 15:03, 21 April 2008 (UTC)

DCs are not legislated as PCPs in New York; see (dated 2005). I'm sure there are other examples. The point is that the rules vary quite a bit from one jurisdiction to another, and the assertion "DCs are legally PCPs for NMS" is not correct in general. Eubulides (talk) 09:41, 22 April 2008 (UTC)

"I am not disputing that chiropractors are legally primary care providers in many jurisdictions. I am disputing that this is the only thing that should be said about scope of practice. The other viewpoints should be given." - We should not be adding controversy here. Lets stay to the FACTS, shall we? Not what some people think about the facts? DigitalC (talk) 00:08, 22 April 2008 (UTC)

The other viewpoints are just as much "facts" as the viewpoint that chiropractors are just primary care practitioners for the the neuromusculoskeletal system. Eubulides (talk) 09:41, 22 April 2008 (UTC)

The first sentence should say "primary contact". The way it is written sounds like DCs all offer primary care, only with an emphasis on MSK. The differences pointed out by Fyslee between DCs in how they practice, i.e. 'self-limited to MSK' vs offering to treat nearly everything (some straights) are important. WHO says 'primary contact'. 'Primary care' sounds like my family doctor, to whom I bring toenail fungus, rectal bleeding, abd pain and the like.CynRNCynRN (talk) 18:11, 23 April 2008 (UTC)

Scope of practice comments on therapy and diagnosis

• "The practice of chiropractic medicine involves the restricted acts of diagnosis and spinal manipulation and involves a range of diagnostic methods including skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests, as well as other specialized tests as required."

• The cited source does not use the phrase "chiropractic medicine".

This is commonly used. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

The phrase may be commonly used, but it is also somewhat controversial, and the cited source doesn't use it. Let's stick with what the source says. Eubulides (talk) 19:08, 18 April 2008 (UTC)

• The source does not say that diagnosis is a "restricted act". Nor does it say that spinal manipulation is a "restricted act".

Are you disputing that diagnosis and the application of SMT are not regulated, restricted acts? CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

Yes. Diagnosis in general is not a restricted act. And SMT's restrictions vary from one jurisdiction to another: in many countries it is not regulated at all. Regardless of the truth of the claim, though, it must be sourced; currently it's not. Eubulides (talk) 19:08, 18 April 2008 (UTC)

So you claim that the act of communicating a diagnosis is in the public domain? CorticoSpinal (talk) 23:18, 18 April 2008 (UTC)

No, I did not claim that; and anyway it's not important what I claim. What is important is that the material must be sourced. Eubulides (talk) 07:44, 19 April 2008 (UTC)

• The source says "Spinal manipulative therapy is the primary therapeutic procedure used by chiropractors"; this point is important and should be mentioned. (To underscore this point, Meeker & Haldeman 2002 have an entire subsection "Spinal manipulation: the chiropractic adjustment" in their practice-characteristics section.) The source also mentions "other manual therapies, rehabilitative exercises, supportive and adjunctive measures, patient education and counselling." That complete list is a bit long but some therapies other than spinal manipulation should be mentioned.
• The source does not mention nutritional counselling, just "counselling".

This in the sources listed; it's there. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

It may be somewhere in some listed somewhere in the section, but it is not in the cited source. Claims must be supported directly by cited sources. Eubulides (talk) 19:08, 18 April 2008 (UTC)

Good grief Eubulides, its already mentioned elsewhere in the article several times and you know it's there. Why not collaborate and add it rather than drawing this out and making needless drama out of it? CorticoSpinal (talk) 23:18, 18 April 2008 (UTC)

The point is now moot, since nutritional counseling was removed from the claim.

• The current wording characterizes nutritional counseling as a diagnostic method, which is surely not intended.

Agreed, it's a management. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

• The source does not mention "specialized tests as required".

This is in the CCE standards. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

That is not the cited source. Eubulides (talk) 19:08, 18 April 2008 (UTC)

Yes, take a look. CorticoSpinal (talk) 23:18, 18 April 2008 (UTC)

The CCE standards were added as a source, after the above comment was made. That fixed the problem; thanks. Eubulides (talk) 07:44, 19 April 2008 (UTC)

• To summarize, let's replace the above quote with:

Chiropractic diagnosis methods include skeletal imaging, observational and tactile assessments, orthopedic and neurological evaluation, laboratory tests, and other specialized tests.

Nah, this is a very watered down version of the above. The current draft is better. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

The only parts that are "watered down" are the parts that were unsourced. Without proper sourcing, they can't go in. For now, I've added a "Failed verification" tag to remind us to fix this. Eubulides (talk) 19:08, 18 April 2008 (UTC)

All the unsourced stuff is common knowledge and don't need citations. Look at Nurse practitioner SOP as an example and come back here and tell us our section is not stronger sourced (by far). CorticoSpinal (talk) 23:18, 18 April 2008 (UTC)

It may be common knowledge to experts, but it isn't common knowledge to the average Misplaced Pages reader. Sources need to be added for it, even if every expert would know it. Eubulides (talk) 07:44, 19 April 2008 (UTC)

Eubulides, when I say it's common knowledge it should automatically be implied that is common knowledge, i.e. most people know it, not amongst experts. Again, as I've mentioned numerous times now, where was all these concerns when the proposed draft sat there for 5 days without you making a comment? DigitalC, myself, Levine2112 and even admin Swatjester already found this section to be NPOV. Even if, for example, you were seriously concerned about a particular claim, then still assume good faith that I have done my homework when I wrote the section. We have similar goals, to make this article is scientifically, yet accurate as possible, but where we disagree, is the fact that you routinely dismiss high quality, peer-reviewed literature by DC/PhDs. And, the fact that you're doing this over the stroke issue to me is the biggest slap in the face of all. The tone of the safety section is hardly NPOV, and you're using orthodox lit to dictate the POV while vehemently lobbying to keep up notable experts on manipulation and stroke Haldeman and Cassidy out. It's this tendentious behaviour and civil POV push (to disproportionately increase mainstreams weight (which is not measured in words, I might add, but in tone) so that it not only dictates overall tone, but that the word of MD/PhDs gets the final say over DC/PhDs on chiropractic topics and ultimately at Chiropractic. That's not right, nor fair and you won't be able to wikilawyer your way out it. The precedent it sets for established (i.e. they could be considered mainstream and have their own, high quality literature base) CAM professions. Sometimes, we need to invoke WP:IAR and in order to strengthen the project and I'm doing it now. CorticoSpinal (talk) 04:48, 21 April 2008 (UTC)

• I disagree that the unsourced stuff was common knowledge. But if it becomes properly sourced then there isn't a problem.
• The scope-of-practice section had some serious POV issues, which were pointed out only after the section was given proper citations that everybody could follow. The editors you mention have not weighed in on these issues.
• Let's focus on scope-of-practice here; safety issues are best discussed in a thread devoted to safety.

Eubulides (talk) 08:19, 21 April 2008 (UTC)

This is getting ridiculous. So far, I think that you're *the* classic example of a civil POV pusher; and the more this section gets dragged through the mud needlessly the more it becames apparent. I also note that you conveniently ducked my question yet again which is itself disruptive, considering I've ask this in some form, for close to 2 months now, without a response from you. Classic example of WP:IDIDNTHEARTHAT. You've also violated, in some form, most of these points already. I want to give you a clear heads up, that the longer you drag this out and stonewall it in effect; the stronger you make my case. The same editing tactics have been used elsewhere, particularly at Safety and Vaccination and even Philosophy. So, it's been 3 months of this nonsense; you've almost made me quit the project because your continued civil obstruction and trying to disproportionately affect tone (so that it reads negative) and continued insistence to reject perfectly good papers which I am now invoking WP:IAR since your wikilawyering of this issue has already caused enough stress and aggravation that was entirely preventable. CorticoSpinal (talk) 15:15, 21 April 2008 (UTC)

I am not aware of any "mud" or "negative tone" related to scope of practice. I am trying to get the best sources on scope of practice, and to have the draft section reflect those sources as accurately and neutrally as possible. That is how Misplaced Pages is supposed to work; it is in no way "gaming the system". If you wish to discuss safety again, please start a new thread on that topic (as the old threads are archived) and I'll be happy to discuss it in that thread. Eubulides (talk) 09:41, 22 April 2008 (UTC)

Scope of practice comments on referral

• "When indicated, the doctor of chiropractic consults with, co-manages with, or refers to other health care providers." (fixed)

• This is a direct quote from the last line of page 15 of the cited source. I'm uncomfortable with taking an entire sentence from the source without using quote marks. Also, MH2002 cover the same point (they say "Essentially, patients may receive a trial of chiropractic care, be referred for co-management, or be referred to an appropriate specialist.") and are a refereed source that is more on-point; let's use them
• To summarize, let's replace the above quote with:

A chiropractor may also refer a patient to an appropriate specialist, or co-manage with another health care provider.

No objections there. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

OK, done. Eubulides (talk) 19:08, 18 April 2008 (UTC)

That's it for now; more later. Eubulides (talk) 07:33, 18 April 2008 (UTC)

What does "emphasize conservative management" mean? I think I understand the gist of it, but could a clearer wording be given? Jefffire (talk) 07:52, 18 April 2008 (UTC)

We could list examples "such as..." conservative pretty much means the opposite of surgery of invasive procedures. CorticoSpinal (talk) 13:40, 18 April 2008 (UTC)

Anti-surgery? I presume you mean to say the absence. It would be vastly less pretentious to say "non-invasive" rather than conservative. Jefffire (talk) 14:08, 18 April 2008 (UTC)

Simpler would be to omit "conservative" entirely, since the very next phrase says "without medicines or surgery", which neatly summarizes "conservative" and makes the "conservative"/"non-invasive" bit redundant. Also, "conservative" is already discussed at length under Chiropractic#Philosophy and doesn't need to be repeated here. I've removed "conservative" in the draft above. Eubulides (talk) 19:08, 18 April 2008 (UTC)

It would simpler to remove it, except it's pretty much the core of clinical practice. Also, conservative also implies the treatments selected and holistic and natural preferences of those methods. To object to using the word conservative in the scope of practice section, is, IMO, preposterous. Also, to clarify for Jefffire who seems to not understand what conservative means, it doesn't mean anti-surgery (?!) it means trying to resolve things without surgery first. CorticoSpinal (talk) 00:25, 19 April 2008 (UTC)

OK, then let's keep "conservative". Eubulides (talk) 07:44, 19 April 2008 (UTC)

Scope of practice comments on common patient management

OK, starting up with some more review of quotes from the #Scope of practice draft.

• "Common patient management involves:

*spinal manipulation and/or other manual and/or soft tissue therapies
*rehabilitative exercises
*health promotion
*physiological therapeutic modalities
*conservative and complementary procedures."

• This sentence duplicates material in the 2nd ("spinal manipulation") sentence. We shouldn't have two sentences that talk about spinal manipulation. It's better to have one phrase on diagnostics, and another on therapy, as #Scope of practice comments on therapy and diagnosis proposes.
• The list of treatments is redundant with the list a
• "conservative" is redundant for reasons discussed above.

• important hallmark of clinical practice, used in nearly all sources provided CorticoSpinal (talk) 00:33, 19 April 2008 (UTC)

• OK, let's keep "conservative". Eubulides (talk) 07:44, 19 April 2008 (UTC)

• "complementary procedures" nearly content-free; it can go.

• we can make a list, it's not content free, to suggest so is allopathic arrogance. CorticoSpinal (talk) 00:33, 19 April 2008 (UTC)

• An example or two would be helpful, yes. Without examples, the non-expert reader won't know what it's talking about. Eubulides (talk) 07:44, 19 April 2008 (UTC)

• "physiological therapeutic modalities" is jargon that the average Misplaced Pages reader won't follow. It should be replaced by non-jargon.

• It seems that any common medical language is deemed "jargon" at Chiropractic, but kosher for other articles about health professions. What's next, calling it "buzzing machines?" CorticoSpinal (talk) 00:33, 19 April 2008 (UTC)

• The Misplaced Pages audience is the general reader, not medical experts. Few general readers will know what "physiological therapeutic modalities" are. Eubulides (talk) 07:44, 19 April 2008 (UTC)

• The Google Books URL should go: it is not reliable. Google Books puts a quota on each reader and if you go over quota it won't show the citation to you. Quota enforcement is erratic, and works for some users but not others under an algorithm that Google does not publicize but which I suspect depends at least in part on reader location. Also, the URL gives more-detailed information to Google about the editor who originally read the book, and allows Google to determine extra information about people who read Misplaced Pages; it would be better not to go into those privacy issues.

• You've advocated using Google Books in the past, now I find a great source and it suddenly has to go. No thanks, Eubulides. This is sinking to unheard of depths now, citing a red herring privacy concern.

• Google Books is a good way to read books. It's not a good way to cite books. I am not saying the source has to go: the citation can stay, obviously. It's the the URL that should go. Eubulides (talk) 07:44, 19 April 2008 (UTC)

• There is no need for "language=English" in an English-language article. By default, citations are to English-language sources.
• The bullet list is undesirable. The list items aren't long enough to deserve bullets. The original draft lacked bullets, and was better that way.

Nah, it's fine there, and it improves readibility which you were concerned about before. So far you claimed to not to have liked it without bullets, then not with bullets and now without bullets again. Look at Nurse practitioner. Bullets galore. We can add a few if there's not enough, I was holding back. CorticoSpinal (talk) 00:33, 19 April 2008 (UTC)

Perhaps you're confusing me with someone else? I don't recall giving a different opinion about these bullets. Sometimes bullets are good, sometimes not; this is one of the places where they're not needed. Eubulides (talk) 07:44, 19 April 2008 (UTC)

• To summarize, this sentence should be removed; it is no longer needed once the change in #Scope of practice comments on therapy and diagnosis is made. Eubulides (talk) 20:11, 18 April 2008 (UTC)

Anything to water it down, eh, Eubulides? CorticoSpinal (talk) 00:33, 19 April 2008 (UTC)

Scope of practice comments on medical prescriptions

• "Chiropractors generally cannot write medical (pharmaceutical) prescriptions; however there has been a gradual shift within the profession with a slight majority of North American DCs favouring an expansion of scope of practice to include limited prescription rights."

• The cited source does not support the claim that there has been a "gradual shift" within the profession; that is, the source does not exclude the possibility that there was a sudden shift, or that the popularity of prescription rights goes up and down.

Historically DCs opposed meds. Now a small majority are in favour. What do you call that? Is it not a shift? CorticoSpinal (talk) 00:39, 19 April 2008 (UTC)

The objection is to "gradual shift", not to "shift". The cited source does not say "gradual". Eubulides (talk) 07:44, 19 April 2008 (UTC)

• Since it's just one survey, it'd be better to say that, and give its date.

It was OK in the beginning, as you had no objections (this was in the article for 6 months) and now it's suddenly an issue. Bunk. CorticoSpinal (talk) 00:39, 19 April 2008 (UTC)

When it was in the article, it said that this was just one survey, and it gave the year. I'm asking that this be retained. Eubulides (talk) 07:44, 19 April 2008 (UTC)

• There's no need for the "(pharmaceutical)". The standard phrase in Misplaced Pages is Medical prescription and we can use that.
• The text should wikilink to Medical prescription.

Good idea. CorticoSpinal (talk) 00:39, 19 April 2008 (UTC)

• The phrase "however there has been a gradual shift" makes little sense here. The gradual shift was from opposition to drugs to a slight majority favoring the right to prescribe drugs. But the current text doesn't mention the opposition to drugs.

Common knowledge, Eubulides. It's stated also in Philosophy and the lead. Why dispute something so obvious?

• It is not common knowledge to the average reader. Neither Philosophy nor the lead mention opposition to drugs. Eubulides (talk) 07:44, 19 April 2008 (UTC)

• There is no need to repeat "scope of practice" here; this is the "Scope of practice" section.
• The two citations at the end should be combined to one, to avoid the syndrome. They are essentially the same source anyway.

If they're separate sources, keep them separate. What's essentially mean? Is that your call? CorticoSpinal (talk) 00:39, 19 April 2008 (UTC)

• One is just a brief summary of the other. They are written by the same authors on the same subject. They resemble the Anderson-Peacock sources in Chiropractic, which are also combined into a single reference. Eubulides (talk) 07:44, 19 April 2008 (UTC)

• Typically, "A; however B" is better rewritten "Although A, B" so that the reader has a heads-up that a contrary clause is coming up.
• To summarize, let's replace the above sentence with:

Although chiropractors traditionally opposed prescription drugs and generally cannot write medical prescriptions, a 2003 survey of North American chiropractors found that a slight majority favored limited prescription rights.

Eubulides (talk) 23:46, 18 April 2008 (UTC)

I'll propose an alternate version a bit later, though this one is not too bad; though it needs to be mentioned that there has been a shift in thought. To say there hasn't is inaccurate and the section needs to acknowledge this. CorticoSpinal (talk) 00:39, 19 April 2008 (UTC)

Scope of practice comments on Oregon

• "A notable exception is the state of Oregon which is considered to have an "expansive" scope of practice of chiropractic, which allows chiropractors with additional qualifications to prescribe over-the-counter drugs."

• This claim is unsourced, and was marked with a Fact template last month. It's still unsourced now, but somehow the Fact template got removed in the draft. The claim should be either sourced or removed. I suggest removing it. For now, I've restored the Fact template.

Eubulides (talk) 23:46, 18 April 2008 (UTC)

I'm surprised there has been a reference for that; that is common knowledge amongst DCs about the Oregon situation. Minor surgery too. Definitely not average scope of practice, and it's notable. I'll track it down, it shouldn't be too hard. CorticoSpinal (talk) 00:40, 19 April 2008 (UTC)

Licenseinfo.orgon.gov states that for surgery/proctology, they must have "36 hours of undergraduate or postgraduate education in minor surgery/proctology", as well as rotation under licensed "physicians (including, but not limited to DCs, MDs, or NDs)". According to this source, , Chiropractors in Oregon can NOT write prescrptions for "drugs", where drugs does NOT include over-the-counter non-prescription medicine. That is, they can write prescriptions for over-the-counter non-prescription medicine.DigitalC (talk) 05:47, 21 April 2008 (UTC)

Scope of practice comments on veterinary chiropractic

• "With additional training and certification licensed chiropractors (DCs) and veterinarians (DVMs) can expand their scope of practice and practice veterinary/animal chiropractic which includes assessment, diagnosis and treatment of biomechanical disorders of animals that may be amenable to manual therapy. "

• These citations are weak: the first is the home page for the CACCP, and says almost nothing about scope of practice. The second is about certification, not about scope of practice. For example, neither source says anything about DVMs, or biomechanical disorders of animals, or manual therapy.
• I suggest removing this sentence; it's not key to scope of practice. For now, I've added a "Failed verification" template for each source.

Eubulides (talk) 23:46, 18 April 2008 (UTC)

Eubulides, it's not up to you to suggest it failed verification. The site clearly proves, beyond a shadow of a doubt the claims made. Again, the obvious: DCs and DVMs can practice veterinary chiropractic (they're trained together), manual therapy is what veterinary chiropractic is mostly about at this point in time, third in order to practice veterinary chiropractic you need additional training and certification for DCs and DVMs. This is directly a scope of practice issue. This type of nit-picking is a complete waste of time and energy. Also, another effort by you to water down the scope of practice. It's time to let the experts on chiropractic (i.e. chiropractors and chiropractic scientists). I cannot believe you honestly don't think that veterinary chiropractic is a) notable and b) a scope of practice issue. To make the point more clear; I'm a DC but cannot practice veterinary chiropractic. It's not within my scope and I don't have my accreditation. CorticoSpinal (talk) 00:48, 19 April 2008 (UTC)

I read the sources and they do not support the claims. The claims may well be true, but "Failed verification" is appropriate when the sources do not support the claims. I disagree that the claims are obvious to the average Misplaced Pages reader; so they need to be sourced. I think it's reasonable to discuss veterinary chiropractic briefly; what's not clear is whether it needs to be discussed in this section. Eubulides (talk) 07:44, 19 April 2008 (UTC)

None of the peer-reviewed sources on chiropractic scope of practice (MH2002, CM2003, E2002) mention veterinary chiropractic. It sounds like veterinary chiropractic is not notable within the scope-of-practice arena. Veterinary chiropractic may be suitable for other sections of Chiropractic, but it doesn't sound suitable for this one. Eubulides (talk) 08:28, 20 April 2008 (UTC)

It's already been discussed ad nauseum re: the validity of those sources for scope of practice, and again, the legal right to treat animals, which was historically ONLY done by DVMs has now been expanded to include DCs. It's a scope of practice issue plain and simple. Name me another profession besides DCs and DVMs who can treat animals. Not even MDs can do it. CorticoSpinal (talk) 05:59, 21 April 2008 (UTC)

Yes, it's a scope-of-practice issue; but there are lots of scope-of-practice issues that are more important than this one. Again, none of the peer-reviewed sources mention it, which suggests it's not notable here. Eubulides (talk) 08:19, 21 April 2008 (UTC)

Again, this section is about Scope of Practice - something that is NOT generally covered by peer reviewed sources. Just because they do not mention it does NOT suggest it isn't notable. DigitalC (talk) 00:45, 22 April 2008 (UTC)

#Scope of practice quality of sources lists four peer-reviewed sources on scope of practice, which should be enough to address this sort of question. And if it's not enough, I'm sure more such sources exist. Eubulides (talk) 09:41, 22 April 2008 (UTC)

When peer reviewed sources do not generally cover Veterinary chiropractic, it means it is not notable. AFD anyone? QuackGuru (talk) 01:30, 22 April 2008 (UTC)

Scope of practice comments on sports chiropractic

• Pollard H, Hoskins W, McHardy A, Bonello R, Garbutt P, Swain M, Dragasevic G, Pribicevic M, Vitiello A (2007). "Australian chiropractic sports medicine: half way there or living on a prayer?". Chiropr Osteopat. 19 (15): 14. PMID 17880724.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Can we include a brief mention about sports chiropractic. QuackGuru (talk) 19:52, 19 April 2008 (UTC)

MH2002 and E2002 both briefly mention sports chiropractic (just the phrase, nothing more), and we could do likewise, citing them. Eubulides (talk) 08:28, 20 April 2008 (UTC)

First as above, QuackGuru wants a mention of sports chiropractic in the main article and cites a paper. Today he proposes to delete the article at an AfD. Something smells fishy here... there wouldn't have been any canvassing going on here would there? I mean, surely there's a more rational explanation than that. It's all so very strange, yet oddly familiar... CorticoSpinal (talk) 05:31, 22 April 2008 (UTC)

Scope of practice comments on acupuncture and MUA

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

• This sentence is not sourced. CM2003 says "... chiropractors have obtained the licensed authority to administer acupuncture in 30 states,..." which suggests the "generally permitted" is a bit much: "permitted in most U.S. states" would be more accurate, at least for acupuncture. Unless the number of states has grown recently? Either way, we need a source.

• this is more splitting hairs. There are 50 US states. 30/50 (60%) permit it currently, hence "generally permitted". Also, more States are changing the laws to permit DCs, MDs, DOs to practice acu which will increase the total from 30. No need to mention the US, it the same situation in Canada. The article needs to reflect a global POV, remember? CorticoSpinal (talk) 15:25, 21 April 2008 (UTC)

• I disagree that "generally permitted" means 60%. It would be better to simply say "30 states". If we were to use a global perspective, the vast majority of the world's population lives in countries which don't have such laws at all. Eubulides (talk) 09:41, 22 April 2008 (UTC)

• CM2003 also says "some chiropractors are attempting to elevate SMT to a new level by administering it under short-term general anesthesia, but most are moving in the opposite direction by incorporating other manual techniques in combination with exercise and various physical modalities". It's not clear from this whether MUA is "generally permitted"; we need a better source for that.

• MUA is definitely a scope of practice issue and we can find a source, it's easy.

• The simplest fix is to remove the sentence. Or it could be sourced and rewritten to match the sources. Eubulides (talk) 08:28, 20 April 2008 (UTC)

• All your proposed "simple fixes" involve removing material that is relevant and notable to chiropractic scope of practice. I've already mentioned to you several times that your attempts to water down scope of practice that it conforms with *your* personal POV, is not what the project is about. Stop inserting your subjective opinions here and accept the fact that scope of practice, as currently written is indeed factual. CorticoSpinal (talk) 15:25, 21 April 2008 (UTC)

• It's fine if the material is properly sourced and rewritten to match the sources, which was the alternate (and more-complicated) suggestion. Eubulides (talk) 09:41, 22 April 2008 (UTC)

• might come in handy. CorticoSpinal (talk) 05:38, 22 April 2008 (UTC)

Scope of practice comments on global scope

• "Currently, chiropractic is a regulated health care profession with licensure requirements in over 50 countries globally although chiropractic medicine is most established in North America, Australia as well as a few European countries. "
• The cited source never says "50 countries". It says "there are only three countries where the profession is fully established with legal protection and can practice the full measure of the training. These are: the USA, Canada and Australia." It says there are "20 or so countries" where "there is yet much to be done before the profession can claim to be fully established".
• The simplest fix is to rewrite the sentence to match the quotes from the source.

Eubulides (talk) 08:28, 20 April 2008 (UTC)

• Cherry picking, again, eh? Let's go to the WFC and get those stats for you. CorticoSpinal (talk) 05:40, 22 April 2008 (UTC)

Scope of practice comments on specialties

• "Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic. "
• "Similar to other primary contact health providers" is redundant and can be removed. It's also similar to medical specialists, no? And to electrical engineers?
• "in different areas of chiropractic medicine" is also redundant.
• Which of the sources say that the given list is the most common, and where?
• The phrase "which generally require 2-3 additional years of study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic" is not that important and can be removed. It's also hard to parse; most of it is about getting a license, but it's in a section that talks about continuing education?
• In short, these two sentences should be trimmed way down. There's no need for 3 citations; one should do.

Eubulides (talk) 08:28, 20 April 2008 (UTC)

If its hard to parse, perhaps a suggestion to rephrase it? The section is not talking about continuing education, it is talking about specialization. It is within the scope of practice to become a specialist, which requires further education and subsequent licensing exams. DigitalC (talk) 06:56, 21 April 2008 (UTC)

OK, here's a proposed rephrasing:

"Chiropractors can gain accreditation in radiology, orthopedics, neurology and other specialties by taking 2– to 3–year postgraduate programs and passing competency examinations."

Eubulides (talk) 08:19, 21 April 2008 (UTC)

• "Similar to other primary contact health providers, licensed chiropractors can continue their education and specialize in different areas of chiropractic medicine. The most common post-graduate diplomate programs include neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology which generally require 2-3 additional years of additional post graduate study following completion of chiropractic school and passing all state, provincial and national board exams to obtain the necessary license to practice chiropractic and passing competency examinations. "

The refs should be kept; Pybus is a independent 3rd party textbook on credentialing although we can add Meeker. The refs support the claims made, and it makes it harder for a skeptic to parade through and vandalize the section by taking out one ref. If there's a few there, its harder to "ignore". CorticoSpinal (talk) 15:30, 21 April 2008 (UTC)

• "Similar to other primary contact health providers," is not needed and can be removed.

Disagree, other health care professionals have subspecialties. It should stay.

A wide variety of topics in Chiropractic are in common with other health care professionals. But we don't have a phrase "Similar to other health care professionals" in front of all those other sentences. Why have that sentence here? Also, is this sentence sourced? Eubulides (talk) 08:41, 23 April 2008 (UTC)

• "of chiropractic medicine" is also redundant and can be removed.

• It should stay.

• Is it not redundant? If not, what does it add? It is already in a sentence that makes it clear that it's talking about chiropractic. Eubulides (talk) 08:41, 23 April 2008 (UTC)

• In "The most common post-graduate diplomate programs include" "The most common" is not necessary and reads weirdly when connected with "include"; let's remove "The most common". Also, please add veterinary chiropractic here; that should suffice to cover that subject (assuming the sources mention it).

• It doesn't read weird; the sentence is perfectly fine. Veterinary chiropractic is a scope of practice issue. No minimizing it, Eubulides. It's also completely outside your scope of expertise and you should recuse yourself to the experts who know of this issue much more than yourself. CorticoSpinal (talk) 22:58, 22 April 2008 (UTC)

• Briefly mentioning it, with a wikilink to the article on veterinary chiropractic, should suffice, just as a brief metion of sports medicine should suffice. My personal expertise is irrelevant here. Eubulides (talk) 08:41, 23 April 2008 (UTC)

• "neurology, sports sciences, clinical sciences, rehabilitation sciences, orthopedics and radiology" is too many subjects. Please trim it down to three or so.

• Why not list the whole sha-bang then? It's already done in Medicine. I wanted to list the most common, feeling that there wouldn't be any objections or insinuations of puff. Now you want to pair down the most common. It's not going to happen; they are all important. More attempts to minimize noted. CorticoSpinal (talk) 22:58, 22 April 2008 (UTC)

• I think it weakens Chiropractic to include that list, because it makes Chiropractic look a bit like a sales pitch; but if you feel strongly about the current list, let's keep it. Eubulides (talk) 08:41, 23 April 2008 (UTC)

• "2-3 additional years of additional post graduate study" is way redundant. Remove both "additional"s; the "post graduate" implies "additional".
• Extra sources should be added only if they are needed to have a good encyclopedia; they should not be added merely as cannon fodder for edit wars (wars that they would have no effect on, at any rate). MH2002 is a good source here, since it's high quality and freely readable; I don't see what the other sources add here.

• The sources back the claims. There's no need to remove them. CorticoSpinal (talk) 22:58, 22 April 2008 (UTC)

• It's not a huge deal, but redundant citations do add up, and in the end they'll need to be trimmed; we can't have an article with a thousand citations. Eubulides (talk) 08:41, 23 April 2008 (UTC)

Eubulides (talk) 09:41, 22 April 2008 (UTC)

Forget it, Eubulides. I tried to compromise. It's clear to me now that your intent is to stall as much as possible, to insert as much controversy as possible, to blow up minor controversies as much as possible and to civilly push your POV as much as possible. A great recipe to drive certain editors batshiat crazy. I've been fallen for these tricks once already. Not again. CorticoSpinal (talk) 22:58, 22 April 2008 (UTC)

The intent is to have a neutral section on scope of practice that is solidly based on reliable sources. The draft isn't so very far from that; it has only a few major problems (most of them are minor). Please don't assume the worst of honest criticism. Eubulides (talk) 08:41, 23 April 2008 (UTC)

Watering Down Scope of Practice: Tendentious editing

What turned out to be a pretty straight forward, NPOV section has resulted in a needless edit war and an attempt to essentially castrate the section. Amongst proposed changes made by Eubulides include

1. suggesting that a qualifying statement be made in the very first line of SOP "Although..."
2. suggesting that DCs are not PCPs
3. suggesting that veterinary chiropractic is not a scope of practice issue
4. suggesting that conservative care should be taken out
5. suggesting that DCs performing minor surgery and writing medical prescription in the state of Oregon is not notable
6. suggesting that common knowledge stuff like restricted acts of diagnosis and SMT are not restricted and are fall within the public domain
7. suggesting to take out a Google Book source which supports claims being made citing privacy issues and some kind of bandwith problem (talk about grasping for straws)
8. suggesting that DCs opinions of wanting limited Rx rights does not represent a shift from the historical "without drugs or surgery" approach
9. more

These types of objections are completely trivial and represent more stall and delay tactics and disruptive editing practices. Note, that NO objections were raised by Eubulides et al. for a whole week until I suggested we include the SOP section. Then suddenly, objections started flying out left and right, first with apparent citations problems (that no one else had) then pleading for more time to review (while actively editing other articles on wikipedia the whole time).

I raised one objection early: the citations were missing or busted. This problem remained until a day or two ago. Once usable citations went in, I started to review. Most of the comments are minor, but that's how reviews work. Some of the comments are definitely nontrivial, though. In particular, the dispute about whether chiropractors are better thought of as primary care practitioners or as specialists is an important one, one that the current draft presents only one side of; this is a serious POV issue. The review is not done yet, alas, as I have other responsibilities (plus this discussion to attend to :-) and have found more problems than I expected. I hope to finish it soon, though. Eubulides (talk) 07:44, 19 April 2008 (UTC)

There 2 key points here that should be highlighted. 1) no other user but yourself claimed the citations were busted and not working for them. 2) more importantly, you have a penchant for making small things turn into very big things, i.e. blowing of a controversy out of proportion. Also your language (...and have found more problems than I expected) is a classic example how you continuously insert little shots here and there that don't necessarily cross a civility line but taken altogether over the past 2 months suggests a bigger problem. Also, a whole sections titled "Scope of Practice: Comments by Eubulides" is a bit much, no? CorticoSpinal (talk) 05:42, 22 April 2008 (UTC)

• What can I say? I had problems following the citations. Clearly the citations that went in were busted, independetly of whether an editor mentioned that fact.
• POV issues are not little things; they are a major problem with Chiropractic.
• I've changed the subsection title, and I'm sorry if its name offended anybody. That was not its intent.

Eubulides (talk) 09:41, 22 April 2008 (UTC)

• Regardless of POV issue that YOU think the article may have, the bigger problem is your editing style which perfectly reflects that of a civil-POV pusher. When you factor this with the fact that you have grossly obstructed the SOP section, an area where you have 0 expertise in becomes even a bigger issue. Then, lastly, and most importantly, your refusal to include indexed, peer-review literature that I present that clearly refutes your argument, you engage in more tendentious wikilawyering. You have disrupted this article so make a point. I'm offering you one final chance: please collaborate productively with the chiropractic experts. There is absolutely no reason why this cannot be sorted out in a fair, just manner. But you're going to have to change your approach here and start treating this article as a profession and not some medication that can be picked apart, reduced, quantified, etc. This line of exclusive thinking, reductionism, is not always valid nor the best approach. CorticoSpinal (talk) 22:50, 22 April 2008 (UTC)

• It is not obstruction to present detailed and useful criticism of the draft section. Most of the points raised were minor, but (when fixed) will improve the quality. There is a significant POV issue that does need fixing, and some other stuff that needs to be better sourced and/or rewritten to match the existing sources. Eubulides (talk) 08:41, 23 April 2008 (UTC)

I've finished the review of #Scope of practice. The section has mutated while I was reviewing it so there are some rough edges no doubt. But it's a reasonable first cut. Eubulides (talk) 08:33, 20 April 2008 (UTC)

Education, Licensing, Regulation

Chiropractic medicine is currently formally regulated in approximately 60 countries although chiropractors are also practicing in several other countries where there is no formal legal recognition of the profession at this time . To help standardize and ensure quality of chiropractic education and patient safety, in 2005 the World Health Organization published the official guidelines for basic training and safety in chiropractic Most commonly, chiropractors obtain a doctoral-level second entry, first professional degree in Chiropractic medicine. The degrees obtained include Doctor of Chiropractic (Medicine) (DC or DCM) in North America whereas a Bachelors or Masters degree in Chiropractic Sciences (BChiro, MChiro, BAppSc) degrees are granted in Australia and selected countries in Europe, Asia and Africa. Typically a 3 year university undergraduate education is required to apply for the chiropractic degree. In general, the World Health Organization lists three major educational paths involving full‐time chiropractic education across the globe:

• A four‐year full‐time programme within specifically designated colleges or universities, with suitable pre-requisite training in basic sciences at university level;
• A five‐year bachelor integrated chiropractic degree programme offered within a public or private university
• A two or three‐year pre‐professional Masters programme following the satisfactory completion of a specifically designed bachelor degree programme in chiropractic or a suitably adapted health science degree.

Regardless of the model of education utilized, prospective chiropractors without relevant prior health care education or experience, must spend no less than 4200 student/teacher contact hours (or the equivalent) in four years of full‐time education. This includes a minimum of 1000 hours of supervised clinical training. Health professionals with advanced clinical degrees, such as medical doctors, can can meet the educational and clinical requirements to practice as a chiropractor in 2200 hours, which is most commonly done in countries where the profession is in its infancy. Upon meeting all clinical and didactic requirements of chiropractic school, a degree in chiropractic medicine is granted. However, in order to legally practice, chiropractors, like all self regulated health care professionals, must be licensed.

All Chiropractic Examining Board requires all candidates to complete a 12 month clinical intership to obtain licensure. Candidates must successfully pass a written cognitive skills examination to be eligible for the clinical skills examination. Licensure is granted following successful completion of all state/provincial and national board exams so long as the DC maintains malpractice insurance. Nonetheless, there still some variations in educational standards internationally depending on admission and graduation requirements. For example, Canadian chiropractic accrediting standards are higher than the United States, and it's admission requirements into the Doctorate of Chiropractic Degree programme are the strictest in North America. Chiropractic medicine is regulated in North America by state/provincial statute. The regulatory colleges are responsible for protecting the public, standards of practice, disciplinary issues, quality assurance and maintenance of competency. Each state or province has a regulatory college established by legislation in the same manner, and with the same structure and similar regulations, as the regulatory bodies for other health care professions.

Comments about Education, Licensing Regulation

Stuff to be added could include

1. self-regulation status
2. continuing education requirements
3. sub-specialities, (common ones)
4. differentiation between straight and mixer schools (this difference is noted in the US Dept of Edu; but this problem is not so much an issue in the rest of the world)

# regulatotry status globally, where it is, is not, and the in between

1. more? CorticoSpinal (talk) 18:57, 13 April 2008 (UTC)

Again, this is waaaay too long. I suspect nobody has read it other than its author; it's a guaranteed put-you-to-sleep text. There is duplication of material between this section and the Scope of Practice draft (both talk about licensing). How about combining the two sections and shortening the result? Also, I have similar problems with citations here. For example, there is a URL to an IP address that appears to be some sort of cache; this didn't work for me. Please use proper citation format; it's hard to review stuff that isn't properly cited. Thanks. Eubulides (talk) 08:15, 14 April 2008 (UTC)

Nah, if there's overlap with scope of pratice we can chop out duplication. We need to cover the section adequately and it is being done so now, remember, we're talking about the profession globally and need to represent, at best, a global POV. Regardless of the length, it's the content that is most important. Do you dispute any of the content there? If so, which ones? What citations do not work? What is the proper citation format and how is it done? CorticoSpinal (talk) 15:37, 14 April 2008 (UTC)

I think a lot of this may be found (or should be found) at Chiropractic education. Perhaps we should have a brief summary of the information above and then link to Chiropractic education from this main article (pretty much as we do now, but with a more solid detailed summary - perhaps just a short paragraph or two in length). Then let's strive to make sure that Chiropractic education matches the excellence on the draft above. -- Levine2112 19:39, 14 April 2008 (UTC)

We definitely could move some stuff to chiropractic education; but think we should keep the types of degrees granted, self-regulation and licensure stuff here because some stuff we missing from the body but mentioned a bit in the lead. Details re: the types of common courses taken I was going to add here but would be better suited at chiropractic education and/or chiropractic school. Still, we need to add stuff about CE (it's required to maintain licensure in almost every state/province/jurisdiction. Again, we need to make sure that a global POV is respected here which is why some editors have quite rightly said it's not always a doctoral level degree (outside NA) where the term first professional degree is better used to adequately reflect the status of the degree outside the US and Canada. CorticoSpinal (talk) 19:51, 14 April 2008 (UTC)

That sounds perfectly reasonable. Perhaps start with updating Chiropractic education with all of this information? -- Levine2112 19:53, 14 April 2008 (UTC)

That makes sense to me too. I still have having trouble following the citations, though, as per above discussion. Eubulides (talk) 09:12, 15 April 2008 (UTC)

An appeal: Drop the "effectiveness" discussion

Please, please, please!! Drop this extremely divisive and contentious discussion. It is causing an awful waste of time here, right where it doesn't belong. I repeat my previous comments and would like a response from all concerned parties:

• I basically agree with CorticoSpinal on this one. We are spinning our wheels by attempting to discuss the "effectiveness" of a whole profession, when only individual techniques and methods can properly be the subject of an "effectiveness" discussion. It would save a whole lot of effort and avoid alot of unpleasant discussions if effectiveness was only dealt with on the article devoted to each technique. Then we can simply state that chiropractors use this, that, and another technique, and wikilink each one. Then readers can hop over to those articles and find an "effectiveness" section in each one. By simply dropping the whole line of discussion on this matter here, we can sidestep an issue that shouldn't be under discussion here. Save such discussions for each of those articles.

• A pressing issue would be to end the discussion of "effectiveness" of chiropractic, as you (and I, and Levine2112) suggested above. That would free up everyone's minds to deal with other things.

A whole profession can't be dealt with in this way. It's unheard of (except for things like homeopathy and acupuncture, where the profession is synonymous with the method). Only individual techniques and methods can be dealt with in this manner. The only place where chiropractic can be dealt with in this manner is on any one of the various Chiropractic treatment techniques articles, especially Spinal adjustment. It can legitimately happen there, since that is the only thing unique about chiropractic, and where it's claims are significantly differently from those made for spinal manipulation. -- Fyslee / talk 05:23, 12 April 2008 (UTC)

It is not at all unheard of. It's done all the time. It's done on the web (see, for example The Austin Chiropractic Center's web page on chiropractic effectiveness. It's done in peer-reviewed journals (see, for example, Kingston 2007, PMID 17970361). It's done by Chiropractic right now, which cites sources on this subject at length (the Manga report was titled "A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain").

A summary of the effectiveness of chiropractic care is sorely needed in Chiropractic. The current summary (currently found in Chiropractic#Movement toward science) is obsolescent and highly biased. This does not mean it should be removed: effectiveness is a core topic! It means it should be fixed. Eubulides (talk) 08:34, 13 April 2008 (UTC)

I will concede that a short section dealing with the few sources that - as DigitalC mentions below - "compare the entire clinical encounter of one profession to another", might be in order. But this detailed analysis of many different techniques and methods is improper here. It should be dealt with, but is better dealt with elsewhere. -- Fyslee / talk 05:32, 14 April 2008 (UTC)

That is too selective. Most of our reviews on effectiveness refer to some studies like that, but they're relatively rare and tend to be less reliable. The reviews spend more time talking about effectiveness studies of particular treatments, because that's where most of the research has been (including most of the higher-quality research). We should not be ignoring all this research; we should be summarizing it briefly, as it's quite relevant. Eubulides (talk) 09:15, 14 April 2008 (UTC)

Agree. Cost-effectiveness of care could be a fair play; and 3rd party sources should also be considered (such as Workman Compensation, integrative medicine models and recently completed and active demonstration projects. I need the sources to back me up but I'm almost positive that chiropractic care is usually significantly cheaper (>20%) and gets similar if not better results than conventional medicine for neuromusculoskeletal complaints. This is not surprising, naturally, as chiropractors are on one hand specialists in neuromusculoskeletal medicine yet offer a distinct form of health care due to their holistic heritage that relies on conservative and complementary therapies most of which are natural as DCs cannot prescribe nor perform surgery. CorticoSpinal (talk) 06:16, 14 April 2008 (UTC)

Cost-effectiveness is another section that should get written, and we have collected in #Sources for risk-benefit and cost-effectiveness a list of sources for such a section. But we should not limit Chiropractic's discussion to just cost-effectiveness. Effectiveness is an important topic in its own right, and has been studied a lot more and has more to report. Eubulides (talk) 09:15, 14 April 2008 (UTC)

Actually the reasoning and application is completely invalid. Validity, as a refresher refers to the degree to which a study accurately reflects or assesses the specific concept that the researcher is attempting to measure. How can you attempt to measure the effectiveness, risk/benefit, safety, cost-effectiveness, etc. of a profession? We're not studying a technique, a modality or a drug here where the aforementioned apply. This argument is further reinforced as even Medicine does not have sections on "effectiveness" "cost-effectiveness" "safety" and "risk/benefit". It's not that Medicine as an article has shortcomings (as incorrectly suggested) but rather that these sections cannot be applied readily or measured reliably to WHOLE professions. It's invalid to think so. Majority of editors agree. Please respect and accept the consensus of the majority of your fellow editors, many of whom who have far more experience editing this topic that yourself and myself combined. Thanks. CorticoSpinal (talk) 04:41, 15 April 2008 (UTC)

Nobody is proposing that we measure the effectiveness etc. of a profession; we are just proposing that it covers effectivenss of common treatments for which research exists. The effectiveness of those techniques is a core issue of chiropractic: it's the main reason it has been controversial for so many years. The current version of Chiropractic talks about cost-effectiveness of chiropractic care at length with blatant pro-chiropractic POV; why didn't this objection that "We're not studying a technique" apply to what's in Chiropractic now? Eubulides (talk) 09:12, 15 April 2008 (UTC)

Do you have a reference that backs up your statement that effectiveness of, presumably, manipulation is the reason why "it has been controversial for so many years". Because I would disagree with that statement; and so does American Pain Society and American College of Physicians who recommend spinal manipulation in their clinical practice guidelines. In fact, I quote "The expert panel noted that physicians should consider the following noninvasive, nonpharmacologic therapies that have been proven effective in evidence-based trials: exercise therapy, spinal manipulation, acupuncture, yoga, intensive interdisciplinary rehabilitation, cognitive-behavioral therapy, and progressive relaxation". A summary can be found here. So, to be clear; is your argument that allopathic medicine is concerned about manipulation (which it now recommends) or is allopathic medicine concerned by manipulation performed by chiropractors? CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

I don't quite follow the question, but I'll try to answer it anyway. Mainstream medicine (which you call "allopathic") is concerned both about the safety of SMT, and about its effectiveness against the wide variety of conditions that it is promoted for. Although this concern is independent of whether SMT is performed by chiropractors, it is highly relevant to chiropractic, because chiropractic is so strongly identified with SMT. I think even the harshest mainstream critics of chiropractic would concede that there's some evidence that chiropractic SMT is as effective for low back pain as anything else is (which they would say is "not much"). Of course there is a big gap between what the critics say and what most chiropractors say, and we shouldn't report only what the critics say. However, the issue should be fairly and neutrally covered in Chiropractic. Eubulides (talk) 19:08, 18 April 2008 (UTC)

This is getting quite tendentious, Eubulides. A majority of editors disagree with you, and for one reason or another the argument that a reductionistic model (which I argued was core to medicine) cannot be done to analyze professions' 'effectiveness' no matter what you claim. Many editors here have already sought to compromise with you and have made alternative suggestions and wish to collaborate however it seems increasingly apparent that this feeling is not being reciprocated. Anyways, the point is moot, there is agreement by the majority of regular editors that we're not going to go down your suggested route and Fyslees recommendation is a sensible one. CorticoSpinal (talk) 15:27, 13 April 2008 (UTC)

I agree that the discussion has been divisive and contentious. But the subject of effectiveness is an important one, and the current coverage of it in Chiropractic is biased and misleading: we cannot simply ignore the problem. Eubulides (talk) 08:34, 13 April 2008 (UTC)

It should not be ignored, but for the most part (all the details) it should be dealt with elsewhere. -- Fyslee / talk 05:44, 14 April 2008 (UTC)

One could write hundreds of pages of details, and I agree for the most part these should be elsewhere. However, Chiropractic should have a reasonable summary of the issue of chiropractic effectiveness, as that is a core question about the field. Currently Chiropractic has a highly-biased and obsolescent summary of effectiveness that should be replaced by something better. #Effectiveness 1 has been drafted and is miles better than the effectiveness discussion in Chiropractic now. Plus, it's shorter. So what's not to like? Eubulides (talk) 09:15, 14 April 2008 (UTC)

See above comment. Invalid application. CorticoSpinal (talk) 04:41, 15 April 2008 (UTC)

Replied to above. Eubulides (talk) 09:12, 15 April 2008 (UTC)

Fyslee, myself, DigitalC, Levine2112, the DoctorIsIn and others have never suggested 'ignoring' the problem. Please, this is the 4th time I've asked you now, do not mispresent or mischaracterize other editors statements or at least ask for clarification if you're confused. We have offerred alternative solutions to compromise and collaborate whereas your position seems to be crystallized. CorticoSpinal (talk) 15:44, 13 April 2008 (UTC)

If we leave Chiropractic alone, and keep its current blatantly-biased treatment of effectiveness, then we are ignoring the problem of bias. Merging #Effectiveness 1 into a subarticle (the alternative solution proposed) does not solve this problem. Eubulides (talk) 09:15, 14 April 2008 (UTC)

It's incorrect to say that only individual techniques can be studied for effectiveness. A research study, for example, can compare patients in chiropractic care to patients using traditional medical care. Studies like that have been done, and are cited (via reviews) in #Effectiveness 1. Furthermore, reviewers themselves can (and do) synthesize practice guidelines and effectiveness surveys out of primary studies investigating individual techniques, and we can cite those reviews.

It certainly makes sense to do detailed discussion of effectiveness of chiropractic care into the respective detailed articles, but effectiveness of important techniques (notably, SMT) should be summarized in Chiropractic itself, and should not be ignored there. It would be extremely awkward for readers to have to go to each subarticle to see any discussion of effectiveness. #Effectiveness 1 was written partly in response to a reader's natural request to see good coverage of effectiveness here, and the reader indicated that an earlier draft was the sort of thing being sought. Misplaced Pages, in the end, is supposed to be for readers, not for editors. Eubulides (talk) 08:34, 13 April 2008 (UTC)

It's those types of comparisons that can be mentioned here, since there are sources that do it, but the detailed descriptions for each method should be dealt with in their own respective articles. If you want to examine chiropractic's special relationship to SMT, then do it in the spinal adjustment article, where there is place for detailed descriptions of that very special and unusual relationship, an analysis and description that would be inappropriate in the SMT article. -- Fyslee / talk 05:44, 14 April 2008 (UTC)

#Effectivness 1 does not contain "detailed descriptions for each method". It doesn't describe the methods at all. It merely gives known effectiveness results. This draft could be pruned, but why? I don't understand an objection based on length. #Effectiveness 1 is shorter than the text it would replace. Why object to its length, when there is no similar objection to the longer and much-lower-quality material on effectiveness that is in Chiropractic now? Eubulides (talk) 09:15, 14 April 2008 (UTC)

Disagreed. It's a violation of WP:SYN as argued by Levine2112 above when you insist on choosing SMT studies done by various professions (DO, PT, MD) and cite it as effective for/against the chiropratic profession. Invalid application again. CorticoSpinal (talk) 04:41, 15 April 2008 (UTC)

I didn't choose the SMT studies: a reliable review by and for chiropractors chose those studies, and for good reasons, which has been explained by the experts. We should not substitute our own judgment for that of published experts in the field. Eubulides (talk) 09:12, 15 April 2008 (UTC)

You did not address my argument: regardless of who chose the studies it is a WP:SYN violation to take studies on manipulation performed by physical therapists, osteopathic and allopathic physicians and pass it off as effectiveness of chiropractic. I would also note that you're using the same, tired argument (substitute judgement) that has already been addressed several times on several threads here on Talk. CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

It is not synthesis to report what reliable reviewers say. Published expert reviewers are supposed to do synthesis. That's their job. WP:SYN says Misplaced Pages editors are not supposed to do synthesis on their own. WP:SYN does not say that Misplaced Pages articles cannot report the results of reliable expert reviews simply because those reviews happened to do some syntheses. Eubulides (talk) 19:08, 18 April 2008 (UTC)

Please, Eubulides, it's time to drop this now. How many times can ask you to please step back from this? It's not necessarily about length; it's about content, validity and the generalizability of the studies back to the effectiveness of 'chiropractic'. Fyslee, myself, DigitalC, Levine2112 and DoctorIsIn disagree with your stance and approach. This doesn't even take into account that no health care profession has an effectiveness section within it here at wikipedia (besides from acupuncture/homeopathy which was already discussed earlier) Also, it omits major findings from the CCGPP clinical practice guidelines and gives disproportionate amount of weight to allopathic sources. Nowithstanding, a lot of editors, myself included dispute the authoritativeness (which seems to be arbitrary). Regardless, this point is moot there is majority agreement that this section will not continue as currently planned and consensus is that we talk about various modalities/treatment in their respective pages. 208.101.118.196 (talk) 19:21, 14 April 2008 (UTC)

First, I disagree that there is consensus. The recent edit war is evidence that there is not consensus. Second, and more important, Chiropractic currently has blatant pro-chiropractic POV in its treatment of effectiveness. I have pointed this out several times; none of the replies have addressed this issue. Blatant POV is a violation of Misplaced Pages policy and must be fixed. Third, there is a reason that CAM fields such as homeopathy require an effectiveness section more than non-CAM fields such as (say) brain surgery: their effectiveness is far more a topic of interest and dispute. Eubulides (talk) 09:12, 15 April 2008 (UTC)

First, look at the thread. You're the ONLY editor here who consistently opposes the consensus of the majority minus a few words occasionally from QG. The edit war in question has no bearing of what has occurred subsequently over the past 10 days where we have discussed this issue at length and have come to a conclusion. Second, where does Chiropractic have blantant POV in its treatment of effectiveness? Do you have any specific examples? Also, perhaps you can tell me why according to the panel of experts American College of Physicians physicians should consider the following noninvasive, nonpharmacologic therapies that have been proven effective in evidence-based trials: exercise therapy, spinal manipulation, acupuncture, yoga, intensive interdisciplinary rehabilitation, cognitive-behavioral therapy, and progressive relaxation. Remember, according to your very own words "We should not substitute our own judgment for that of published experts in the field." I would also like to note that the majority of the above nonpharmacologic therapies can and are provided by DCs and fall within its scope of practice. These should be noted as well.

I am not the only editor who thinks #Effectiveness 1 is a real improvement over the blatant POV in the current article. There is a big difference between considering chiropractic SMT for low back pain (which I suspect most physicians would agree with) and considering it for (say) vision problems (which I suspect they wouldn't). I plan to address the POV again later; it's still a major problem, and it still needs to be fixed. Eubulides (talk) 19:08, 18 April 2008 (UTC)

Third, comparing homeopathy to brain surgery is ridiculous. To suggest that the effectiveness of homeopathic tinctures is of a greater concern or relevant in the medicine than brain surgery is laughable. Furthermore, it's hard to measure the effectiveness of brain surgery as there are different prognoses for different brain conditions. More appropriate would be the effectiveness of back or neck surgery where I last read the were less than 50% including many unncessary surgeries which is why the recent Neck Pain Task Force clearly made note of this and made a classification system (1-4) to prevent excessive surgery or invasive measures.

The reason effectiveness is of more concern to Homeopathy is that the mainstream opinion is that it has no effect at all. That's not the case for brain surgery. The effectiveness of chiropractic is under dispute: not as much dispute as homeopathy of course, but still, it's under serious dispute, for many conditions that it is promoted for. It's entirely appropriate to cover that dispute in Chiropractic. Eubulides (talk) 19:08, 18 April 2008 (UTC)

In general, it seems to be like you're making up policy on the spot "there is a reason that CAM fields require an effectiveness section more than non-CAM fields their effectiveness is far more a topic of interest and dispute". First, where is the policy that states the above? Did you make it up or is there something you can quote for us? Second, CAM therapies can indeed be studied and a relative effectiveness determined, CAM professions cannot. Third, Chiropratic should not follow the exception to the rule of Homeopathy which is a non player in terms of regulation in North America and most of Europe and Australia. So, it's not comparable. CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

It's blatant POV that violates Misplaced Pages policy, which is all that I said about policy. #Effectiveness 1 is about the effectiveness of chiropractic care, which is a notable topic of considerable interest, one that Chiropractic currently covers in a way that's blatant POV. The regulation (or absence thereof) of chiropractic is a different issue, one that is appropriate for a licensing section and inappropriate for a discussion of effectiveness. Eubulides (talk) 19:08, 18 April 2008 (UTC)

Fyslee is right here. The most interesting and perplexing thing of it all, is I believe that adjustment belongs in the SMT article. I can tell why later; but it can be done tastefully that covers both straight and mixer interpretations. I happen to excel in this particular chiropractic legal arena and we must carefully consider as well the weight of mainstream chiropractic vs. the minority (but vocal) straight DCs who retain Palmer Philosophy and Practice Principles. For example, straight DCs would always, always, (always!) refer to manipulation as "spinal adjustment". The intent; and purpose is distinct; the correct dysfunctional vertebral segments (dubbed vertebral subluxation which is to be differentiated from VS COMPLEX) to improve neurological function (or the inverse; "remove nerve interference" (i.e. the chiropractic boogie man). In contrast, mixer DCs and all evidence-based practitioners use spinal manipulation and adjustment INTERCHANGEABLY. The focus in not necessarily the "intent" but rather than biomechanical kinematics that are involved in a HVLA manipulative protocol. Subtle, but EXTREMELY IMPORTANT, and understanding these 2 viewpoints within the profession is crucial. They're both very real, both notable but from here on in, mainstream (mixer) chiropractic view gets more weight but we're cognizant that straight chiropractic needs to be represented NPOV as well, despite the fact that we may have serious reservations about some elements of their style of practice CorticoSpinal (talk) 06:16, 14 April 2008 (UTC)

These points are reasonable ones but are appropriate more for the straight-vs-mixer section than for the effectiveness section. Eubulides (talk) 09:15, 14 April 2008 (UTC)

You're missing the point. We're not going to have an effectiveness section; at least not the way it's currently in place or drafted. Why are you not collaborating with your fellow editors here? 208.101.118.196 (talk) 19:21, 14 April 2008 (UTC)

The topic of this thread is effectiveness. Certainly changes could be made to #Effectiveness 1 before it goes in; it's not cast in stone. But the current Chiropractic is severely biased and must get fixed; #Effectiveness 1 is a vast improvement on what is there now. Eubulides (talk) 09:12, 15 April 2008 (UTC)

No, the topic of this thread is an APPEAL TO DROP EFFECTIVENESS. An appeal which the majority of the editors here and heeding with yourself being a notable exception. CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

We cannot simply drop the matter, due to blatant POV in the current treatment of effectiveness. I plan to take up the issue further in a later section. Eubulides (talk) 19:08, 18 April 2008 (UTC)

It's incorrect to try and impose the same argument time after time despite the fact it has been rejected by a majority of editors. It's incorrect to say allopathic sources are preferred and should be weighed more than chiropractic sources especially given the fact we're talking about evidence-based literature. It's incorrect to include a section here which is not present in other health professions (for good reason, you can't measure the effectiveness of the 'medical profession' or the 'osteopathic profession' or the 'physical therapy' profession or the veterinary profession. It's incorrect to give such prominence to a chiropratic critic who has 0 expertise in the subject and not at least give equal weight to a source that refutes (soundly) Ernst's claims. It's incorrect to not use expert sources such as Haldeman and Cassidy et al when they're right there and published in Feb 2008. It's incorrect to incorrect to assume that regular editors here don't know that Misplaced Pages is for the readers not for the editors. It's incorrect to keep pursuing this and comparing the profession to a modality which is a fundamental flaw in reasoning by a few choice editors new to Chiropractic and who lack the expertise in this field. CorticoSpinal (talk) 15:44, 13 April 2008 (UTC)

• I disagree that the idea of an effectiveness section has been rejected by a majority of editors.

• 4 editors have pleaded with you and have even made an appeal section to voice their concerns. You're the only editor who disagrees with our consensus. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• The recent edit war indicates that there is no consensus. I agree that some editors would rather not have an effectiveness section in Chiropractic right now. However, the POV concerns that have been expressed are real, and a violation of Misplaced Pages policy of this magnitude cannot be simply ignored. #Effectiveness 1 is a good way to address these issues and is a proposal on the table. No other proposal has been made. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• This argument has been debunked above. You have not listed any examples of violation of wikipedia policy. Also, you continue to misrepresent the opinion of other editors. The frequency at which this has been occuring is problematic. I have asked you no more than half a dozen times already to not do this or to ask for clarification. Several counter proposals have been made; which is another misrepresentation of editors arguments. This penchant is getting to be quite problematic and irritating. The argument is that there should not be an effectiveness section in chiropractic PERIOD, not right now. As DigitalC mentioned already, any profession that uses a given modality that is being listed here should have that listed on their page as well. CorticoSpinal (talk) 15:15, 15 April 2008 (UTC)

• None of the counterproposals have addressed the fundamental issue here, which is the blatant POV in favor of chiropractic with respect to effectiveness. I plan to write a further section about this, as this thread is getting pretty long. Eubulides (talk) 19:08, 18 April 2008 (UTC)

• Sources should be given appropriate weight according to Misplaced Pages policy; as there still seems to be some dispute about what that means here, I will look into asking the experts on those policies.

• No need, I'm already on that as well. I'm sure we'll have an interesting conversation about this. CorticoSpinal (talk) 05:07, 15 April 2008 (UTC)

• An effectiveness section is present for some professions, like homeopathy, and it would not be out of place for others; we should not let weaker articles prevent us from making Chiropractic better]].

• Nah, red herring argument. The application of it is invalid; and no mainstream med profession has this because it's not valid to measure the effective of a profession. This is simply a double standard being pushed on CAM articles. Besides, no health profession article lists these sections. Homeopathy is not the standard; it's the exception to the rule. CorticoSpinal (talk) 05:07, 15 April 2008 (UTC)

• Homeopathy is not an exception: it's an example of how to do things well. It is far higher quality than Chiropractic is. Coverage of effectiveness and safety would be quite apropos for Medicine as well. But our focus in this thread is Chiropractic, not Medicine. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• #Effectiveness 1 gives plenty of weight to sources that disagree vehemently with Ernst, and does not give undue prominence to Ernst.

• It does not read that way. Besides, Ernst has no expertise in safety of SMT nor does he have expertise in effectiveness; he's just a mainstream critic. Experts on safety on SMT are the researchers who study it. I'd give Flynn and Childs, both PT/PhDs far more weight on expertise on SMT since they're actively studying the topic. Also, Herzog, Kawchuck et al. should be mentioned in safety. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• In what specific way can #Effectiveness 1 be improved so that it satisfies your concerns about weight? A specific suggestion, with specific citations, could help us improve it. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• Cassidy et al. (PMID 18204390) is about safety and is irrelevant to effectiveness; I'm not sure what you mean by "Haldeman" (PMID 18204400, perhaps? but that wouldn't add anything to #Effectiveness 1 that isn't there already).

• It's about the same topic, i.e. an editor who claims superiority of allopathic sources and prevents the inclusion of notable, verifiable, high quality chiropractic sources. It's the principle being applied on this aborted section, safety and vaccination. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• Again, this sounds like a different thread, one about safety. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• I have never assumed "regular editors here don't know that Misplaced Pages is for the readers not for the editors"; on the contrary, I have based some of my arguments on the assumption that editors know Misplaced Pages is for readers.

• Thanks for the clarification. But you have also insinuated that other editors don't know what they're doing which will result in a "mediocre" article. That kind of language is regretable under rather tense conditions. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• Again, my assumption has always been that editors know that the goal is to write encyclopedic articles even about controversial subjects, and to summarize those subjects, controversies and all, in a neutral way. My arguments have been based on the understanding that editors know that articles which avoid important controversies are lower-quality than articles that cover them. That is what I intended when I wrote "We should be striving for what's best for this article. Settling for a substandard article simply because the subject is contentious, or because other articles have similar problems, is a recipe for continued mediocrity." If this comment was interpreted in some other way, which hurt your feelings, then I apologize for that; it really wasn't intended. Eubulides (talk) 09:12, 15 April 2008 (UTC)

• #Effectiveness 1 does not compare the profession to a modality: it talks about the effectiveness of chiropractic treatments, which is a core issue in chiropractic.

Eubulides (talk) 09:15, 14 April 2008 (UTC)

• No it does not. It talks about the effectiveness of SMT; as performed by chiropractors, physical therapists, osteopathic doctors and medical doctors. And the section tries to pass it off under the guise of "chiropractic" effectiveness. PTs use ultrasound in clinical practice, should we generalize the effectiveness of PT based on the effectiveness of the ultrasound modality? Because that's essentially what you're suggesting here. It's an invalid application to the article and that's why it's getting the boot. CorticoSpinal (talk) 05:04, 15 April 2008 (UTC)

• The section talks about all forms of chiropractic care for which we have scientific evidence. A large fraction of this is SMT because that's where the evidence is. The section does not try to "pass off" anything: it clearly states when it's talking about SMT versus other treatments. For better or for worse, chiropractic is strongly associated with its characteristic treatment, SMT, and it's entirely appropriate for the effectiveness section to focus on SMT, just as it's entirely appropriate for the safety section to do so, or for the treatment section to list an SMT treatment first. Eubulides (talk) 09:12, 15 April 2008 (UTC)

You cannot determine the effectiveness of a profession. SMT is not chiropractic, and although I don't have the sources to back it up, I would believe that soft tissue therapy is used as much by chiropractors as SMT is. Now, if you want to determine the effectiveness of each treatment procedure used by chiropractors (SMT, STT, LLLT, US, IFC, Vibration therapy, etc. etc. etc.), for each condition they are used for (IE - is SMT effective for low back pain? is STT effective for lateral epicondylitis, is ultrasound effective for plantar fasciitis) then that would work, however those effectiveness sections really belong on the article for the respective treatment. That said however, the entire clinical encounter may be more effective than the sum of its parts - however, we do not have enough sources to compare the entire clinical encounter of one profession to another (although I have seen articles advocating for research encompassing the clinal encounter). DigitalC (talk) 23:55, 13 April 2008 (UTC)

Again, #Effectiveness 1 talks about effectiveness of treatments, not about effectiveness of a profession. Chiropractic#Treatment procedures says that the most popular treatment, in terms of % of patients receiving it, is diversified (full-spine manipulation), not soft tissue therapy. Meeker & Haldeman 2002 says "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." #Effectiveness 1 already talks about the entire clinical encounter, but reliable sources say that's just part of the picture; we shouldn't limit ourselves to just one corner of it. Eubulides (talk) 09:15, 14 April 2008 (UTC)

"Again, #Effectiveness 1 talks about effectiveness of treatments, not about effectiveness of a profession.". That is exactly the point. Chiropractic is a profession, and Effectiveness 1 talks about effectiveness of treatments. The effectivenss of those treatments belongs on the articles for those treatments, not on Chiropractic. DigitalC (talk) 23:58, 14 April 2008 (UTC)

These treatments, and their effectiveness, are fundamental to chiropractic. One of the most natural questions about chiropractic, given its history and controversy, is "When does it work?" Any encyclopedic article on chiropractic must seriously address this issue. The current Chiropractic article spends a considerable time on this, using blatantly POV sources (and obsolescent ones to boot). What is the justification for excluding a high-quality and relatively unbiased discussion of effectiveness from Chiropractic, while keeping a low-quality and blatantly biased discussion? Eubulides (talk) 09:12, 15 April 2008 (UTC)

FTR, the source used for Chiropractic#Treatment Procedures doesn't mention soft tissue therapy, but does suggest that trigger point therapy (a subset of soft tissue therapy) is used in 45% of patients. Electrical stimulation is used in 46% of patients, ultrasound in 30%, and LLLT not included. DigitalC (talk) 00:30, 15 April 2008 (UTC)

Now we're getting somewhere. Indeed, it is the whole clinical counter that is "chiropractic care" not merely the application of spinal manipulation (whereby DCs are the expert provider) whch can also be done in limited amount by osteopaths, medical doctors, ] and selected other naturopaths. The reference that DigitalC has mentioned is PMID: 17604553, the Hawk et al found in JACM, whereby Hawk is a leading pioneer in WSR (whole systems research). This bodes well for designing better observational studies looking at the whole (holistic) clinical encounter in chiropractic medicine and should lead to good answers (and good questions) on the validity of manipulative therapy and chiropractic care for nonmusculoskeletal disorders (visceral). Incidentally, it is worth noting that the WSR approach is in direct contrast to the typical, allopathic reductionistic model that has stagnated and is only now begining to understand the merits of holistic and integrative medicine. CorticoSpinal (talk) 05:42, 14 April 2008 (UTC)

#Effectiveness 1 cites Hawk et al. 2007 (PMID 17604553) more often than any other source. It's a good source, but it is not the whole story, and other reliable sources should be used as well. Eubulides (talk) 09:15, 14 April 2008 (UTC)

I tend to agree with this argumentation that chiropractic is a career and thus cannot be measured for its effectiveness any more than we can measure the effectiveness of a dentist or veterinarian or a surgeon. We are just going in circles here discussing information which really has no place in this article. -- Levine2112 18:03, 14 April 2008 (UTC)

Chiropractic is more than just a career, and this article is not just about professional qualifications and certifications. Eubulides (talk) 09:12, 15 April 2008 (UTC)

This is getting repetitive very fast. Besides being tendentious continuing this discussion doesn't make much sense; where past the point of diminishing returns. It's been a week, the majority of editors disagree with the position taken by Eubulides and that's basically as cut and dry as we can have it. I also strong recommend AGAINST doing any risk/benefit section right now; that's another contentious and heated one ready to come, especially if the trend continues were allopathic sources routinely gets to trump chiropractic sources which are being incorrectly omitted and described at times as low quality and inappropriate and misleading suggestions as "reaching down". I'm gonna take the rest of the day off from Chiropractic to sit back and unplug; I just see so many unfair and unjust standards trying to be applied here which fly in the face of precedent setting pages of other health professions. I'm also going to make sure that somewhere on Chiropractic a blurb about it being a profession and not a modality gets put it; there's far too much confusion about this still and it's at the heart we're even having this debate. CorticoSpinal (talk) 19:32, 14 April 2008 (UTC)

Chiropractic already has multiple risk/benefit sections. The problem is that they are blatantly POV. This must get fixed, and #Effectiveness 1 fixes them. This has nothing to do with whether chiropractic is a profession; it has everything to do with a core question on the subject, which is when and whether chiropractic care works. Eubulides (talk) 09:12, 15 April 2008 (UTC)

Effectiveness 1 talks about effectiveness of chiropractic treatments, which is about effectiveness of a chriopractor's profession. This is exactly the point. Chiropractic is a profession, and Effectiveness 1 talks about effectiveness of chiropractic treatments. The effectiveness of those treatments belongs on the chiropractic article. Chiropractors perform those treatments and therfore it is relevant to have the material about Chiropractic's effectiveness. QuackGuru (talk) 00:46, 15 April 2008 (UTC)

Medical doctors, Osteopaths, Naturopaths and physical therapists can perform many of the treatments as well. Is it relevant to have the same material copied to those various pages? DigitalC (talk) 01:15, 15 April 2008 (UTC)

Agree with DigitalC here. Dentistry is a profession which uses fluoride as a treatment; yet the article for dentistry makes no mention of the effectiveness of fluoride treatments. How come? Maybe it is because the wise souls who edit these articles know that discussion about the effectiveness of specific treatments belong in articles about those specific treatments and not in the articles of the various professions that use such treatments. -- Levine2112 01:23, 15 April 2008 (UTC)

Again --> Effectiveness 1 talks about effectiveness of chiropractic treatments, which is about effectiveness of a chriopractor's profession. This is exactly the point. Chiropractic is a profession, and Effectiveness 1 talks about effectiveness of chiropractic treatments. The effectiveness of those treatments belongs on the chiropractic article. Chiropractors perform those treatments and therfore it is relevant to have the material about Chiropractic's effectiveness. Another article's format or inclusion or lack of inclusion of information is irrelavant to NPOVing this article. It is a strawman argument to say another article's info does not contain effectiveness so therefore we should exclude it here. Homeopathy contains effectiveness info anyhow. Readers want to know it's effectiveness. We can discuss chiropractic's effectiveness when the references discuss it's effectiveness. We are following the lead of the reviewers such as Ernst. So far I do not see any valid reason for excluding relevant chiropractic's effectiveness material. Thank you. QuackGuru (talk) 05:38, 15 April 2008 (UTC)

Agree with DigitalC above as well. The application of effectiveness to Homeopathy is also invalid. That article is the exception not the rule. The current standard one would presume would be Medicine and no sections are found there regarding safety, effectiveness, risk/benefit or any other proposed ones that are suitable to study a drug or a therapy/modality, but not valid to be studying a profession. Ernst is but one critic, in fact to say he represents the opinion of mainstream opinion would be highly debatable, especially when the US Surgeon General, an MD, supports Chiropractic and spoke at a recent ACA conference.

Homeopathy is a method and therefore it's perfectly proper to have an effectiveness section in that article. -- Fyslee / talk 05:33, 15 April 2008 (UTC)

Homeopathy is not the exception or the rule. The standard is not a Medicine article. The standard are the reviewers. We are here to follow their lead. Ernst represents a mainstream view. Thanks again. QuackGuru (talk) 05:38, 15 April 2008 (UTC)

No thanks. QuackGuru, please stop talking down to us. If you're going to disagree, just do it without the "Thanks again" and such like tacked on at the end. It's insulting. BTW, I don't buy your argument. -- Fyslee / talk 05:52, 15 April 2008 (UTC)

It's not insulting to say thanks to someone. It is being polite. By the way, this chiropractic article has a section on chiropractic's methods. It is called Chiropractic#Treatment_procedures. For example, spinal manipulation is the most common modality in chiropractic care. We can discuss the treatment procedures as well as it's effectiveness. Thanks for listening. QuackGuru (talk) 08:15, 15 April 2008 (UTC)

Sure we can mention which modalities chiropractors use in this article, but then to go into each modality's effectiveness gets a tad tangential and tedious. We have an electronic encyclopdia with fancy-schmancy Wikilinks. Let's take advantage of the exciting technology and write this article in the Wonderful Wiki Way. (BTW, unless someone here is utilizing a text-to-voice reader, it is inappropriate to say, "Thanks for listening." Rather, "Thanks for reading," would be the more correct way to express your obviously sincere gratitude.) -- Levine2112 17:23, 15 April 2008 (UTC)

When we can mention which modalities chiropractors use in this article, it is equally relevant to include the modaliy's effectiveness. It does not get tangential or tedious, because we have followed the sources and respected NPOV. We can take advantage of wiki technology by including the relevant effectiveness info in this article. The same can be done for the Veterinary chiropractic‎ article. QuackGuru (talk) 19:13, 16 April 2008 (UTC)

This argument is well-worn territory which has been refuted in many previous exchanges. Rather than going in circles, please review the responses above and know that I still haven't changed my mind despite your repetition. If you wish to continue repeating yourself, please know that I may not respond. If you wish to move forward with some other form of dispute resolution, I am happy to fascilitate. Thank you. -- Levine2112 21:38, 16 April 2008 (UTC)

A noticeboard may be another option per WP:DR. http://en.wikipedia.org/Wikipedia:DR#Ask_for_help_at_a_relevant_noticeboard QuackGuru (talk) 02:10, 17 April 2008 (UTC)

Sure but I am unsure which noticeboard would be applicable here. -- Levine2112 17:44, 17 April 2008 (UTC)

relevancy (a central issue) & strawman arguments (oh my)

The effectiveness of chiropractic is relevant. The main reason why chiropractic is controversial is because of it's effectiveness. Chiropractic is a specific career. This is the same as Veterinary chiropractic‎ is a specific career. The references discuss the resulting effectiveness of chiropractor treatments. There is no SYN because we are following the sources faithfully in a measured, rationale way. We should not ignore the relevant references. We are using peer-reviewed journals. A core issue to Chiropractic is it's Effectiveness. Some Wikipedians claim the information is not relevant to chiropractic profession or it would be better left to add to other articles. That is a strawman argument. In some matter, effectiveness can be discussed in this article. The reviewers (refs) think it is relevant. They are discussing the chiropractic profession. For example, the researchers are discussing the effectiveness of chiropractic treatments. We can do the same here. The best we can do is to continue to follow the lead of the references. Saying Ernst is bias is POV-pushing. Ernst is neutral and notable and meets the inclusion criteria. It seems a few editors may not be thrilled with what the effectiveness says. However, this would benefit the project when we include and not suspend the effectiveness bit. The argument/claim that this information is not relevant doesn't fly with me. They want to permanently suspend the section. Nah. The effectiveness is a central issue and would be an improvement for this article. I think this is a case of WP:IDONTLIKEIT and nothing more. One of the goals of the project is to provide the most appropriate information available on each topic. The Effectiveness 1 accomplished this goal at least with respect to chiropractic's effectiveness. We can have further success/improvements by including the Effectiveness 1 which would benefit the reader and also meets the inclusion criteria.

Of course we can mention which modalities chiropractors use in this article, and then we can go into each modality's effectiveness. This is easy because we simply follow the sources. This can be done. Wait a second. This has been already done. The Effectiveness section seems to be completed now. It is clearly WP:NPOV. We have an online encyclopedia, with the vision of its founders (or at least Jimbo's vision). Consistant with that vision, we can create the sum of all knowledge about chiropractic. This article should not be the wild, wild west of wiks. Yes, the subject matter is contentious but that is not the point. The point is we have written something the meets the inclusion criteria and now we can improve this article. The modalities of chiropractic, controversy since its inception and effectiveness are all linked together. Rather than making it difficult for the reader by splitting up the well sourced text, it would be easiest and best (at least for the reader) if we included the Effectiveness 1 in this article. Irrespective of the chiropractic controversy surrounding it's effectiveness, it is reasonable to include neutrally written material (NPOV) which is a core issue about the field, in the main chiropractic article. Respectively, QuackGuru (talk) 19:13, 16 April 2008 (UTC)

I disagree with this rationale and maintain that the efficacy section should be split off under each modalities article. I think that is well aligned with the vision of Jimbo, the founder of Misplaced Pages. I actually think the efficacy section as written comes off very favourable for chiropractic; however as we can't distinguish SMT research from chiropractic specific research without a deadly SYN and since chiropractic is an occupation and not any singular modality with an efficacy that can be measured overall, the inclusion of an efficacy section here seems inappropriate. -- Levine2112 19:40, 16 April 2008 (UTC)

We have neutrally written SMT research and we should not second-geuss the reviewers. There is no SYN of words. Only well sourced facts. The text is relevant to chiropractic. For example, the most common modality is chiropractic spinal manipulation. When we can discuss the chiropractic's modalities we can discuss chiropractic's effectiveness in the same article as well. They are intimately related. Readers are curious about this kind of stuff. This is part of the mission of the project to improve this article (the sum of all human knowledge). ☺ QuackGuru (talk) 02:46, 17 April 2008 (UTC)

And the Oscar goes to... ;) That's a bit rich, Quack. You have not addressed any of the points made by myself, Levine2112, DigitalC and Fyslee. We, however have heard the argument and have addressed it in so many ways. I agree with Levine2112 that this is getting repetitive and tendentious. I'm not going to talk about it anymore, it's been 7 days. CorticoSpinal (talk) 03:35, 17 April 2008 (UTC)

QuackGuru is essentially correct in the argument that effectiveness is a high-importance topic for chiropractic and needs to be discussed in this article. Chiropractic currently expends a significant amount of text on effectiveness, more than the proposed text (#Effectiveness 1) that would replace it. This alone casts serious doubt on any claim that effectiveness is not a proper subject for Chiropractic. Eubulides (talk) 19:08, 18 April 2008 (UTC)

I find it a little surprising that some editors want to completely drop "Effectiveness", when this topic, ie, the effectiveness of SMT has been studied extensively. Since approx 90% of patients of chiropractors receive SMT , I don't see why the effectiveness of this modality can't be presented. The only suggestion might be that the section could address the two or three main things chiropractors treat, low back and neck pain, or perhaps headaches, and leave off the other conditions. As for the point about some studies including PT or osteopath studies, so they are not relevant, well, doesn't Manga include those also? I haven't popped the $20 to buy the full 1993 Manga report and I can't find those details in other sources. But plenty of reviews used by chiropractors use studies of SMT not exclusively performed by chiropractors. I would say, the Effectiveness section could be shortened but not eliminated!CynRNCynRN (talk) 21:24, 18 April 2008 (UTC)

Clearly, a discussion about the effectiveness of SMT belongs in the article about . I tend to agree with the logic that the effectiveness of chiropractic can no more easily be discussed that the effectiveness of dentistry, medicine or veterinarians. I don't feel that either of these points have been addressed and refuted in such a way to merit my changing opinions on this matter. Again, some other form of WP:DR may be a better solution than just rehashing ineffective arguments over and over again. -- Levine2112 21:45, 18 April 2008 (UTC)

I have tried hard to resolve this issue here, and have resisted bringing in dispute resolution, but I am coming to the reluctant conclusion that you may be right, and we are not getting much closer to consensus here. Eubulides (talk) 22:08, 18 April 2008 (UTC)

Trying hard to resolve an issue is not to tendentious push the same point over and over again like you've done in the Appeal section. Fyslee, myself, DigitalC, Levine2112 and DoctorisIn have at all one time or another made numerous suggestions on how to overcome this impasse whereas your proposed suggestion of keeping the status quo and violating WP:SYN in doing so is, in part, to blame why we're at this point. At least CynRN compromises and make good counter-suggestions. CorticoSpinal (talk) 23:45, 18 April 2008 (UTC)

I would not object to shortening #Effectiveness 1 somewhat, which was CynRN's countersuggestion. However, several of those editors have objected to any discussion of the effectiveness of chiropractic care, on the grounds that chiropractic is a profession and one cannot measure the effectiveness of a profession. These objections wouldn't be overcome by shortening the section. Eubulides (talk) 07:44, 19 April 2008 (UTC)

I agree that the Effectiveness of medicine or nursing cannot be measured because these are way too diverse. I understand that chiropractors use many modalities, as well. However, the key thing that they do is manipulate backs for back pain. This is their unique specialty. The effectiveness of this subset of their treatment should be included in the article and if readers want to know about the effectiveness of manipulation of, say, asthma, they can go to the SMT article via a link. Sorry about beating this poor, dead horse!CynRNCynRN (talk) 18:41, 19 April 2008 (UTC)

Speaking as a DC with a spouse who is an RN. . . your assessment could not be further from the truth. . . The key thing I do is no more "manipulate for back pain" than my wife's is checking for blood pressure. . . We can no more assess the effectiveness of a DC than we can a RN. . . an MD. . . a PT. . . a DO. . . a DDS. . .TheDoctorIsIn (talk) 21:45, 19 April 2008 (UTC)

Reliable sources tend to agree with CynRN. For example, "The core clinical action that all chiropractors agree upon is spinal manipulation." I can't imagine anyone seriously saying "The core clinical action that all RNs agree upon is checking for blood pressure." Chiropractic is heavily identified with SMT, and SMT with chiropractic; in this respect DCs differ greatly from RNs. Eubulides (talk) 22:22, 19 April 2008 (UTC)

Well I do not agree. . . there are lots of professions practicing spinal manipulation. . . and I check blood pressure during my Dx. . . is that factored into my career's effectiveness? Besides. . . your explanation requires us piecing together information from various sources. . . something which is a no-no here.TheDoctorIsIn (talk) 07:49, 20 April 2008 (UTC)

Lots of professions may practice spinal manipulation, but only chiropractic is strongly identified with it, and more than 90% of the spinal manipulations in the U.S. are done by chiropractors. Reliable review papers are doing the piecing together for us: they are combining results from various professions to issue recommendations for chiropractic spinal manipulation. It is not WP:SYN to report what these sources say. Eubulides (talk) 08:28, 20 April 2008 (UTC)

Piecing together neutrally written and highly relevant information from various sources in known as NPOV. Vague comments of a "no-no here" is unhelpful. So that makes your argument moot. When we follow the lead of the latest state of the art sources, we are keeping the faith with the expert reviewers. We will keep the faith with the vision of Misplaced Pages. QuackGuru (talk) 08:45, 20 April 2008 (UTC)

• Misplaced Pages controversial topics
• All unassessed articles
• A-Class Alternative medicine articles
• A-Class Skepticism articles
• High-importance Skepticism articles
• WikiProject Skepticism articles