Misplaced Pages

Other than this statement, I will ignore Quackguru's silly statements. Eubilides. . . only DDS are strongly identified with filling cavities. . . what does that mean for the dentist wiki and its descriptions of effectiveness?TheDoctorIsIn (talk) 17:28, 20 April 2008 (UTC)

It means that it would be appropriate for Dentistry to discuss effectiveness and safety of filling cavities and similar treatments. For example, a brief discussion of Dental amalgam controversy would be entirely appropriate. Currently, Dentistry is in pretty sad shape (it's marked for expert attention) but if it were in good shape I would expect a short discussion of the topic. Mainstream opinion is more skeptical of the effectiveness of chiropractic than it is of the safety and effectiveness of dental care, so it's even more appropriate for Chiropractic to discuss effectiveness. Eubulides (talk) 18:40, 20 April 2008 (UTC)

Get a stable version of Effectiveness inserted at Dentistry. . . then we will talk.TheDoctorIsIn (talk) 22:34, 20 April 2008 (UTC)

Done. Now we can talk. QuackGuru 07:16, 4 May 2008 (UTC)

That sort of change is a really bad idea. First, it's not right that a dispute about chiropractic, which gives Dentistry as an example, ends up in somewhat-random edits being made to Dentistry. Second, that particular edit is low quality: it cites just a review of one relatively-minor dental treatment (ozone), which hardly constitutes a proper section on effectiveness. Third, it's not a stable edit (and I suspect it will be reverted, though I'm not the right person to do that) and Dentistry itself is not a high-quality article. All in all, please reconsider that change; I suggest you do the right thing and self-revert. Eubulides (talk) 07:33, 4 May 2008 (UTC)

This discussion is about Chiropractic, not Dentistry. The fact that Dentistry is weak (and is marked as being weak) does not mean that Chiropractic should be weak. Eubulides (talk) 08:19, 21 April 2008 (UTC)

Chiropractic is not weak, and to suggest it is another misrepresentation of the truth. Chiropractic, the article is rated higher than either Medicine or Dentistry and have far citations to back up claims made. You are being needlessly argumentative, you're essentially arguing with every regular editor here except for QG (no surprise) and a mild endorsement from CynRN who has displayed far greater wikiquette than yourself by making reasonable compromises and making a decent effort to break the impasse. On the other hand, you're simply stonewalling the SOP section and trying to insert (again) allopathic opinions on chiropractic scope of practice. At least you're facilitating my case.

The weakness comment was about Dentistry, and was intended to suggest that Chiropractic should not mimic a weak article like Dentistry (which would tend to make Chiropractic weak). I apologize if the comment was misinterpreted. The comment about "allopathic opinions" is a bit unclear: do you mean asking for the scope-of-care section to mention the dispute over whether chiropractors are primary-care providers? What problem would there be with mentioning an important mainstream opinion on the dispute, in a neutral way? Eubulides (talk) 08:41, 23 April 2008 (UTC)

TDII has a good idea for a test. Try inserting an "Efficacy" section at a "mainstream" health profession article such as Dentistry and let's see how it is received. Perhaps on an article which is less controversial than Chiropractic, we can better assess what to do in a situation such as this. -- Levine2112 18:18, 21 April 2008 (UTC)

Okay. See Dentistry#Effectiveness. QuackGuru 07:16, 4 May 2008 (UTC)

That's already been tried, with Homeopathy, an article that is far more controversial than Dentistry, and it seems to work there. Eubulides (talk) 09:41, 22 April 2008 (UTC)

Stop comparing homeopathy to chiropractic, they're not even in the same ballpark. CorticoSpinal (talk) 22:40, 22 April 2008 (UTC)

It's not just Homeopathy. It's also Acupuncture. In general, CAM professions like these have (and deserve) a large section on effectiveness. Chiropractic currently devotes considerable space to effectiveness too (the Manga report, etc.); it's just that it's done in a biased way, and without an explicit Effectiveness section. Eubulides (talk) 08:41, 23 April 2008 (UTC)

There is consensus that the effectiveness (or lack thereof) of chiropractic medicine is of relevance to this article. Any attempt to delete it on the part of editors whose positive-inclinations toward chiropractic medicine are known should be seen for for what it is. ScienceApologist (talk) 19:46, 20 April 2008 (UTC)

I disagree about such a consensus. I am definitely a chiroskeptic as far as the widespread continued support and promotion of quackery, the common false claims for spinal adjustments, and the tendencies to be anti-medical and anti-science, ad libitum, but I still think that a discussion of the effect of "chiropractic" should be very limited here. It should mostly occur on the spinal adjustment article, since that is the modality we all can agree is uniquely chiropractic, and which involves numerous controversial claims. It is the sacred cow that is intimately tied to the non-existent vertebral subluxation, not to be confused with real, objectively verifiable, orthopedic subluxations. Do it there, not here. Keep anything here to a minimum, according to the sources. Keep in mind that very, very, very!! often sources mention "effectiveness" and "chiropractic" in the same breath, when they are obviously referring to the "effectiveness" of chiropractic's use of "spinal adjustments", and aren't referring to some general effectiveness of the whole profession. Try to understand what is written, instead of getting stuck with the actual words. This only takes a bit of common sense. It's an extremely common phenomenon, and smart people shouldn't be so careless as to get caught doing superficial reading of sources that are careless with their wording. -- Fyslee / talk 20:08, 20 April 2008 (UTC)

The newer updated text is shorter than the previous outdated text. The Effectiveness 1 is written according to the sources in a very neutral way. QuackGuru (talk) 20:38, 20 April 2008 (UTC)

It isn't much shorter at all really. I think we can do better. We should begin by excluding any research which isn't specifically studying the efficacy of chiropractic techniques as performed by - and only by - chiropractors. Everything else is inapplicable here other than by WP:SYN. -- Levine2112 01:07, 21 April 2008 (UTC)

How can someone come here a declare that there is a consensus when there is obviously none?TheDoctorIsIn (talk) 22:34, 20 April 2008 (UTC)

It's shorter than what is there now, which means we can put it in now (to shorten things), and then improve it later as time permits. It would not be right, though, to exclude research that chiropractors themselves include when reviewing effectiveness of chiropractic care. Eubulides (talk) 08:19, 21 April 2008 (UTC)

This could be solved by changing the section title to Research The profession has accumulated enough evidence and research over the last 25 years now that it can stand on it's own. The shift towards evidence-based practices is definitely apparent, one needs to only look at the the quality, depth, breath of clinical practice guidelines which is *by far* the best source for "effectiveness" of conditions treated by chiropractors. Also, I'd like to know why this is such an issue as mainstream medicine now recommends spinal manipulation in their very own clinical practice guidelines. Isn't that what readers ultimately want to know? What treatments the experts recommend (and for what)?

ScienceApologist, it would be good for you to acclimatize yourself to the conversation first before making patently false declarations. CorticoSpinal (talk) 04:17, 21 April 2008 (UTC)

I agree with ScienceApologist that readers want to know the strength of the scientific evidence for chiropractic treatment. It was a comment by such a reader that prompted the drafting of #Effectiveness 1, and that reader liked an earlier draft of #Effectiveness 1 precisely because it covered a topic of real concern. Eubulides (talk) 08:19, 21 April 2008 (UTC)

While I think that may be a decent assumption you are making, I don't see why the reader wouldn't be opposed to clicking on the corresponding article of each modality used by the core of the chiropractic profession to learn about their relative effectiveness. #Effectiveness 1 still includes studies which include other professions performing SMT and thus are not appropriate for this article specifically about chiropractic. -- Levine2112 18:21, 21 April 2008 (UTC)

First, readers wouldn't know that clicking on the links would give them the effectiveness information they're looking for. Second, it would be quite inconvenient for readers to keep doing the clicky-clicky even if they knew it would give them the information they're looking for. A summary of effectiveness information here is a far better way to present the information to the average reader. Eubulides (talk) 09:41, 22 April 2008 (UTC)

Stop assuming what readers can and cannot do and the click argument has got to be one of the most ridiculous things I've heard since this discussion began. Eubulides, you're grasping for straws and your arguments while being completely repetitive and tendentious have grown incredibly weak as late. You also have failed to address, for over 2 weeks, any of the concerns raised by myself, Levine2112, DigitalC, Fyslee and DoctorIsIn. A classic case of WP:IDIDNTHEARTHAT. CorticoSpinal (talk) 22:40, 22 April 2008 (UTC)

I have answered the comments as best I can. We have several remaining disagreements, true. The click argument is a valid one; we want things to be easy to find on Misplaced Pages. Eubulides (talk) 08:41, 23 April 2008 (UTC)

While I commend our allopathic editors here for trying to get to the bottom of this, there is a fundamental flaw in their reasoning which is why that a majority of regular editors rejected the effectiveness proposal outright. The flaw is, chiropractic treatment, is not limited to a single modality, and the effectiveness of a treatment is specific to a given diagnosis. Lastly, research done by MDs, PTs and DOs is being passed off as effectiveness of chiropractic is a non-starter. We've also omitted the majority important documents in clinical chiropractic history (directly valid) which is somewhat of a problem. CorticoSpinal (talk) 19:26, 21 April 2008 (UTC)

Nothing is being passed off; #Effectiveness 1 clearly states when it's talking about SMT as opposed to chiropractic care. Chiropractic#History can talk about history; Effectiveness should stick with what's known now. Eubulides (talk) 09:41, 22 April 2008 (UTC)

"clearly states when it's talking about SMT as opposed to chiropractic care." Thank you for proving our point, i.e. this is better off in SMT article. Also, by passing off 99% of the most thorough evidence-based review of chiropractic care, it completely invalidates the section, in its current form. CorticoSpinal (talk) 22:40, 22 April 2008 (UTC)

A longer discussion of SMT effectiveness would be appropriate for the SMT article, but given the heavy identification of chiropractic care with SMT, a brief summary is appropriate here. Sorry, I don't know what the "passing off 99%" refers to. Eubulides (talk) 08:41, 23 April 2008 (UTC)

I have to agree that a brief summary of 'Effectiveness of SMT' should be inserted. SMT is the 'core procedure' and one of the 'most studied forms of conservative tx for spinal pain'.(Meeker?) Why should the reader have to dig to see a summary of the effectiveness of the treatment with SMT of back pain?CynRNCynRN (talk) 18:17, 23 April 2008 (UTC)

Efficacy of SMT belongs in the SMT article. Efficacy of SMT with back pain belongs in the SMT and the back pain article. If there are studies specifically about chiropractic care (and not SMT as performed by other professions) then perhaps there is an argument to include that in this article. I feel like we are going in circles here with our argumentation and the net result is that we are not getting anywhere. Meanwhile, I don't see any disagreement that the efficacy of SMT should not be in the SMT article. Perhaps, in the meantime, someone should just take the SMT efficacy material and place it in the SMT article. (And take the efficacy material of the other modalities and place them in their respective modality's article.) Is that a reasonable way to at least take a step forward out of this circular quagmire that we are in? -- Levine2112 18:44, 23 April 2008 (UTC)

There are a lot of old and obsolete studies that have no historical impact. We will be adding the newer studies and then we can delete the older studies. We are essentially removing duplication. See here. --> out with the old and in with the new (duplication). QuackGuru 07:56, 27 April 2008 (UTC)

It would be reasonable to add effectiveness sections to those other articles too. That'd be a lot of work, though. There are a lot of other articles. I quail at editing them all (just as I would quail at reading them all, if I were a reader interested in the topic of the effectiveness of chiropractic care). If somebody wants to volunteer to do that, though, all power to them. Eubulides (talk) 08:46, 27 April 2008 (UTC)

CfI: Scope of Practice

Chiropractors are considered primary contact 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.

Final thoughts? CorticoSpinal (talk) 23:13, 24 April 2008 (UTC)

• Sorry, what does "Cfl" mean?
• The first sentence contains a serious POV problem, discussed in #Scope of practice comments on primary care, which has not been addressed.
• The first two sentences are incoherent; the first says chiropractors have more of the attributes of a specialty, whereas the second says they are primary care providers. This is an important point. The current draft seems to contain leftover text from the POV problem discussed in #Scope of practice comments on primary care. Let's fix the problem by changing ". Chiropractors are considered primary care providers who" to "; they". The alternative approach of removing the first sentence would not fix the POV problem.
• The cited sources do not support the 3rd 2nd sentence's claim that diagnosis and spinal manipulation are restricted acts. Nor do they use the phrase "chiropractic medicine". On the other hand, they do say that SMT is the primary therapeutic procedure, an important point that should be mentioned. These issues were raised in #Scope of practice comments on therapy and diagnosis but have not been followed up on. They need to be fixed.

• Legal and or peer-reviewed sources will be found to verify that DCs, where regulated, are legally allowed to diagnose and adjust (perform spinal manipulative therapy). CorticoSpinal (talk) 06:38, 26 April 2008 (UTC)

• There should be no problem finding such sources. However, that is not what the text currently says. The text currently says that diagnosis and spinal manipulation are restricted acts. Restricted to whom? And in what jurisdictions is it restricted, and where isn't it restricted? The article needs a reliable source on this subject if it is to cover the issue. Eubulides (talk) 08:46, 27 April 2008 (UTC)

• The bullet list contains the jargon "physiological therapeutic modalities" that should be rephrased using words that ordinary readers will understand. The Google Books URL should go, as it's not reliable. The bullets themselves are not needed; an inline list should suffice. These topics were discussed in #Scope of practice comments on common patient management but have not been followed up on.

• Therapeutic modalities and adjunctive therapies/techniques is another section we shall add. I insist on the bullets for aesthetic purposes, improved readibility and syle. If you would like Scope of Practice in Medicine not to have bullets then I respect your professional judgment. CorticoSpinal (talk) 06:38, 26 April 2008 (UTC)

• There is already a section Chiropractic#Treatment procedures on that subject. The section is very weak, though (most of its text is about history!) and can be greatly improved. Eubulides (talk) 08:46, 27 April 2008 (UTC)

• The cited source does not support the claim that there has been a "gradual shift". The shift was from opposition to drugs, but the text doesn't say that. Since it's just one survey, it'd be better to say that, and give its date. There's no need for the (pharmaceutical) and the text should wikilink to Medical prescription. There is no need to repeat the phrase "scope of practice" here. The two citations about surveys are really just the same citation, and should be combined. All these problems would be fixed by the wording proposed in #Scope of practice comments on medical prescriptions, which has not been followed up on.

::*If the term 'shift' is preferred to 'gradual shift' as noted above; then that's fine but no need to mention the survey but should look for another source to help strengthen the claim. Agree it should link to medical prescription, pharmaceutical can go. If you feel the article is better if the citation is combined then so be it. CorticoSpinal (talk) 06:38, 26 April 2008 (UTC) :::* The previous version of the article (just before the edit war) mentioned the survey and its date. It is standard practice when there's just a single survey (as opposed to a review) to give the date and mention that it's just a survey. It took only 4 words in the article "in a 2003 survey" and that's a small price to pay. Eubulides (talk) 08:46, 27 April 2008 (UTC):* The claim about Oregon is unsourced and requires a source. See #Scope of practice comments on Oregon.

• The material on veterinary chiropractic is poorly sourced and is not notable. It'd be OK to mention it in one phrase, but it's way overkill to go on and on about it. This was discussed in #Scope of practice comments on veterinary chiropractic.
• The claim about acupuncture and MUA is unsourced and its "generally permitted" is misleading. See #Scope of practice comments on acupuncture and MUA.

I suggest you take a look at Veterinary chiropractic for notability purposes. If anything, we will be adding more due to the fact its virtually mainstream (according to the AVMA), it provides a new method of assessment, treatment and diagnosis (according to DVMs), the fact the only legal providers of animal/veterinary chiropractor are licensed DCs and DVMsinterprofessional collaboration between chiropractors and veterinarians, amazingly practical and good research by DCs, DVMs, PhDs, DVM/DC/PhD (it's true!). We can add a qualifying statement if you wish for acupuncture (in the Scope of 60% and rising in the US alone...) and we can get better sources on MUA. I do know its use is increasing too and it's DCs and MDs collaborating.

• Veterinary chiropractic is notable at the level of the Veterinary chiropractic article. It's not notable here to be worth spending 40 words and two citations on. That's more than the 18 words Chiropractic currently expends on explaining spinal manipulation ("involves directed thrust to move a joint past its physiological range of motion without exceeding the anatomical limit" is all it says)! A brief wikilinked phrase ("veterinary chiropractic") should suffice. The topic is controversial, as the official policy of the American Chiropractic Association Eubulides (talk) 08:46, 27 April 2008 (UTC)

• The claim about "50 countries" disagrees with the cited source, which says there are only 3 countries with a fully established profession. See #Scope of practice comments on global scope.

• Surely you don't suggest that there are far more than 3 countries where the profession is regulated and/or that have accredited schools of chiropractic medicine? If you would like a list of the "chiropractic top 10" we can do that as well, but I would insist, again, on bullets. CorticoSpinal (talk) 06:38, 26 April 2008 (UTC)

• The text should accurately reflect the source. Currently it does not. This must be fixed. I am not objecting to the source, just the draft's incorrect characterization of what the source says. It would not be appropriate to list the "20 or so" countries where "there is yet much to be done before the profession can claim to be fully established"; for one thing, the "20 or so" means the list isn't precise. Eubulides (talk) 08:46, 27 April 2008 (UTC)

• The section on specialties contains way too many words. A first cut at fixing this is in #Scope of practice comments on specialties.

• The wording is appropriate given the weight, notability and verifiability of the subject. CorticoSpinal (talk) 06:38, 26 April 2008 (UTC)

• The wording contains much duplication, which can be improved regardless of the notability of the subsection. Eubulides (talk) 08:46, 27 April 2008 (UTC)

• The quality of sources can be improved, as suggested in #Scope of practice quality of sources.

Overall, almost none of the comments made in #Scope of practice comments have been addressed; even most of the undisputed comments remain unaddressed. Most important, the draft takes a particular POV on the scope-of-practice controversy described in #Scope of practice comments on primary care; it should cover the controversy neutrally. Eubulides (talk) 08:16, 25 April 2008 (UTC)

• The quality of the sources are not in dispute nor necessarily is the content (until closer examination) what is disputed is the appropriateness of inserting opinion and making comment on legal matters. It's a precedent that it would set across all article's This is kinda like cherry picking the sources to support or refute a given POV and an example of malfeasant source mining. Let's go with WP:AGF here that my intent, the tone, the notability and factuality have been adequately captured of the profession, in a global POV. CorticoSpinal (talk) 06:38, 26 April 2008 (UTC)

• The quality of sources are indeed in dispute. That is what "The quality of sources can be improved" means. It is not "cherry-picking" to supply higher-quality sources and ask that the text reflect their contents. Eubulides (talk) 08:46, 27 April 2008 (UTC)

The sources suggested will be used for the criticisms and controversy section. Please do not take advantage of my good faith here. Criticisms and controversies must be NPOV and carry the right weight. Perhaps you can make a list of the controversies and then we can collect citations. CorticoSpinal (talk) 23:29, 5 May 2008 (UTC)

The first sentence was struck out. CynRN suggested primary contact. That is fair. Scope of practice is a legal right; editorial comments from allopaths can be placed in another section, perhaps medical opposition. Ironically enough, the proposed edits in question further support the conclusions by Theberge (2008) which orthodox medicine continuously tries to marginalize chiropractic. This is in action here. There was no "opposition" to drugs as implied; I know, I'm a DC. They were not favoured. There is a difference. The bullets stay; it improves readability and you even suggested it. More nitpicking. 50 countries is accurately according to the WFC, moreso the article goes out of its way to say it's primarily established in a in a CONTINENT (North America) as well as Australia and selected Euro counties. This is factual and it stays. Chiropractic medicine as a phrase is routinely used in both the literature and routinely in public. It stays as well; more stalling over trivial stuff noted though. The specialties is fine as is, in fact you are the only editor who has disputed any of the aforementioned. Time to cut bait, Eubulides. DigitalC provided a source for Oregon. The act of communicating a diagnosis and utilizing spinal manipulation are not within the public domain (i.e. anyone can do them) unlike say, exercise-prescription or soft tissue therapy. This is common knowledge. You are being extremely tendentious with this section and everyone involved has tried to appease you in some form. So, please bring better arguments because the regular editors have already addressed these concerns. Thanks. CorticoSpinal (talk) 15:58, 25 April 2008 (UTC)

• Sorry (again); what does "Cfl" mean?
• A Misplaced Pages article cannot cite an editor's expertise. It must cite reliable sources. "I know, I'm a DC" does not suffice.
• It is not common knowledge that "The act of communicating a diagnosis and utilizing spinal manipulation are not within the public domain". (Walk up to the average person on the street and say that sentence, and see what happens....)
• Not that this should matter, but the main source I suggested (MH2002) is by DCs. It is not "editorial comment by allopaths". And (again) it is more reliable than the sources given above.
• I did not suggest these bullets.
• The cited source does not say 50 countries; it says 3 for fully established profession, and 20 where much work needs to be done. Again, claims must be sourced; this claim disagrees with its source.

::* I will concede the "chiropractic medicine" point, though I still prefer using the terminology of the source.::* There is no source for Oregon in the text. If one gets added, that would remove that objection.

• There is a serious POV issue about scope of practice, which has not been addressed.
• Several other minor points remain unaddressed in the list above. I have struck out the addressed points.
• No other editor has addressed the concerns mentioned above.

Eubulides (talk) 21:53, 25 April 2008 (UTC)

CfI=candidate for insertion. So, to be clear, you want me to track down a reference that supports that DCs can diagnose and manipulate? This would be a legal document, as it is a legal matter. I know the Meeker is a DC and Haldeman a dual registrant. Their paper could easily go in medical opposition or a controversy section that I'm pondering of writing up but fear will be abused and gamed by a certain few editors thereby resulting is severe WP:WEIGHT or POV issues. It's a question of trust; I would be inclined to nominate CynRN to objectively oversee my writing of that section to make sure that it's adequate and represents orthodox concerns but doesn't come off as a condemnation hit piece. Controversial elements of safety and vaccination could be rolled into there as well. I shall provide the WFC document which lists 60 countries where there is some kind of regulation and perhaps include a blurb about it being practiced in an additional 40 with no formal regulation as of yet although that's probably not relevant to scope of practice necessarily but could be used in a practice demographics section I've working on offline. Thank you for the concession on chiropractic medicine. If DigitalC could supply the Oregon ref that would be helpful, I think it got carted away in the archive. How do you propose we resolve the purported serious POV issue? I argue that SOP should reflect the legal common scope of practice whereas you'd like to include some lit regarding some discussion re: scope of practice which I feel belongs in a separate section, even below scope if you'd like. Unfortunately I'm rather tied up this weekend and won't be able to contribute much and a breather would probably be OK anyways. I hope to chip away at these concerns; and if we achieve a consensus version, we can always ask an admin to add that section whilst keeping the article locked until we have resolved the other sections that need rewrites (education, safety, research (aka effectiveness) contemporary (to contrast with history), practice styles/schools of thought, etc. If we can continue what seems to be a slight thawing of relations here, it should bode well for the article. Please to realize that I don't want chiropractic to read as a promo piece, but I don't want it to read as a controversial allopathic criticism piece either. If it would be OK, I propose that I take a bit of the lead and draft some proposals and your discerning eye can pick apart the MAJOR content disputes and we can iron out the details in the future. Thoughts? —Preceding unsigned comment added by 208.101.118.196 (talk) 22:14, 25 April 2008 (UTC)

• Yes, please track down a reference. I suspect there's no single legal document, as each state/province has its own legal definition. The ideal reference, if one exists, would be a reliable summary of the legal statuses in the U.S., Canada, and Australia, along with the other countries with less-well-developed, all published in high quality a peer-reviewed journal. Most likely there won't be anything matching that ideal, but let's see what can be found. I suspect that it will be appropriate to briefly cite MH2002 on this, as it is a high-quality source of what the status is in practice (as opposed to what it is in law), but again, let's see what other sources say. Haldeman is a DC/MD yes, but he's the lead editor of a leading textbook on chiropractic, and is a source friendly to chiropractic.
• The Oregon reference and the other asked-for references (WFC? it's not clear to me what they would be) also need to be tracked down and checked against the text.
• The evidence-based section (Scientific investigation, which by the way I wouldn't mind retitling to Evidence-based medicine or Evidence-based health care) should focus on evidence, not controversy. To some extent it's impossible to ignore the controversy entirely, of course, but it would not do to put all controversial material off into a Controversy section, because then almost all of Chiropractic would go into the Controversy section. Instead, the controversy section should be reserved for political issues (AMA opposition, etc), leaving the technical issues (effectiveness, etc) for the technical sections.
• Similarly, a brief mention (one sentence, say) of the various possibilities for scope of practice should be mentioned in the scope of practice section, reserving any heavy-duty political stuff for the controversy section. Perhaps the legal review source will have this, or perhaps we can just use MH2002.
• I like your proposal for taking time to chip away at the various sections that are needed. There is no rush. I suggest doing one section at a time rather than trying to do them all at once. I do ask for progress on drafting Effectiveness first, as it was proposed a while ago (April 1) and it attempts to fix a serious POV problem in the existing text. As you know, my concerns are high-quality supporting citations (even for stuff that is obvious to practitioners), along with a careful (that is, neither dismissive nor subservient) coverage of skeptical sources.

Thanks, and good luck. Eubulides (talk) 23:09, 25 April 2008 (UTC)

There are still POV problems with this Scope of practice. The problems may seem trivial but they are still problems. When it is up to Misplaced Pages's standard it can be restored. Until then, it is a no go. I want to see the Scope of practice section in the article as soon as the POV issues are fixed. QuackGuru 02:46, 1 May 2008 (UTC)

This recent controversial change added unsourced material to the article. QuackGuru 22:50, 5 May 2008 (UTC)

Another controversial change added unsourced material to the article. QuackGuru 22:55, 5 May 2008 (UTC)

You are calling the scope of practice section unsourced? CorticoSpinal (talk) 23:29, 5 May 2008 (UTC)

RfC: Effectiveness of chiropractic care

Template:RFCsci

Is Chiropractic's discussion of effectiveness biased, and if so, what should it be replaced with?

Claim of bias and proposal for fix

This subsection addresses a serious POV problem with the current version of Chiropractic, namely, heavy bias in its discussion of the effectiveness of chiropractic care. Much of the problem has been discussed extensively on this talk page for weeks, so far with no consensus. This subsection is an attempt to gather the issues together in one spot and propose a solution. This is a controversial issue that may require some work to resolve; please bear with the following exposition as it covers many issues. Eubulides (talk) 08:36, 24 April 2008 (UTC)

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

POV in existing coverage

There is conflicting evidence about the effectiveness of chiropractic care, and Chiropractic should present the evidence fairly without giving undue weight to minority views. Unfortunately Chiropractic currently falls seriously short of this goal. Here is a summary of POV problems in Chiropractic's treatment of effectiveness:

• Chiropractic gives a section to the Manga report, a 1993 effectiveness paper highly favorable to chiropractic that was not published in a peer-reviewed journal. Chiropractic does not mention the widespread peer-reviewed criticism of the Manga report (for example, "The Manga report was not a controlled clinical trial but a review of the literature that offered an opinion that has not been experimentally established." in Grod et al. 2001, PMID 11677551). In any event, the Manga report was long ago superseded by higher-quality work and is not now a reliable source for effectiveness.
• Chiropractic gives a section to worker's compensation studies that, like the Manga report, are old, disputed, and strongly pro-chiropractic. Contrary evidence is widely available in peer-reviewed journals, e.g., Hess & Mootz 1999 (PMID 10395430), Johnson et al. 1999, but Chiropractic does not mention it. Again, this material is obsolescent and low quality by today's standards, and is not now a reliable source.
• Chiropractic gives two sections (Chiropractic#American Medical Association (AMA) and Chiropractic#British Medical Association) that mention old endorsements about effectiveness and referrals. This material might be worth putting into the Chiropractic history subpage here, but it is way too much detail here, and it gives the mistaken impression that the old AMA statement reflects the best current science on effectiveness.
• Chiropractic#Scientific investigation repeats material from Chiropractic#Philosophy that (aside from being redundant) has little to do with scientific investigation: it approvingly describes some antiscientific components of chiropractic philosophy, which is POV. The section's second paragraph is highly dated (it talks about grant funding in 1994 and 1995, which again is material suitable for Chiropractic history but not here) and talks with almost entirely approving note about chiropractic research (again, POV coverage of a controversial subject). The section's third paragraph is entirely unsourced; that is not POV in itself, but it is a worrisome sign.

In short, Chiropractic's coverage of effectiveness (a core topic) is currently weak and is heavily biased in favor of chiropractic. Eubulides (talk) 08:36, 24 April 2008 (UTC)

(Again, please place further comments below.)

Criticisms of earlier proposed fix

To help fix this I proposed Effectiveness 1, a draft section on effectiveness that relies on recent high-quality scientific sources, along with a proposal to remove the obsolescent material. This draft has been discussed extensively in Draft effectiveness section and #An appeal: Drop the "effectiveness" discussion, so far with no consensus. To help move matters forward I have drafted a new section below, #Effectiveness 2, which attempts to respond to some (but not all) the concerns expressed about Effectiveness 1. These concerns (italicized below) included the following:

• Ernst is biased. (Edzard Ernst is a prominent critic of chiropractic, cited by Effectiveness 1.) However, all the sources for Chiropractic are biased to some extent. This includes Ernst (an MD/PhD/FRCP/FRCPEd who is critical of chiropractic) along with (say) Cheryl Hawk (a DC/PhD who is supportive). Misplaced Pages should not omit critics of chiropractic, any more than it should omit supporters. Ernst's work is well known and widely cited; for example, Google Scholar lists Ernst as one of the five key authors for the search "chiropractic effectiveness". The work of critics like Ernst should be summarized fairly and with due weight.

• The draft cites Ernst too often. To help address this problem, #Effectiveness 2 cites Ernst just twice.

• The draft is too long. It's shorter than what is in there now. By my count the entire proposed change, including removal of obsolescent material, would replace 928 words of text with 621 words, a 33% savings.

• Chiropractic is a profession, not a treatment, so this material should be moved to articles about each particular treatment.
  • This objection has not been raised against longstanding effectiveness-related text in the current article (Chiropractic#The Manga Report through Chiropractic#Scientific investigation), text which is heavily biased in favor of chiropractic. Why raise the objection now that a much-better-sourced and much-less-biased alternative has become available?
  • The effectiveness of chiropractic care is a core question of controversy in chiropractic, and should be summarized in Chiropractic even if the details are so voluminous that they need to be in a subpage.
  • The effectiveness question is already raised in Chiropractic#History, for example, which discusses allegations that chiropractic is "an unscientific cult". The answer to this charge should be addressed in Chiropractic, not in some subpage.
  • There is a reader-expressed need for coverage of effectiveness here. #Effectiveness 2 is derived from material written in response to a reader request for effectiveness, and the reader approved of an earlier draft.

• Other articles (Dentistry, for example), don't have effectiveness sections. Effectiveness is a core issue in Chiropractic because of the profession's controversial history. The fallout from that history is still with us, so the topic needs coverage in Chiropractic far more than in Dentistry. The text of #Effectiveness 2 is considerably shorter than (for example) Acupuncture #Scientific research into efficacy, Homeopathy #Research on medical effectiveness, and Traditional Chinese medicine #Efficacy, so the size of #Effectiveness 2 is not at all out of line for this sort of complementary and alternative medicine article. Again, Chiropractic has had substantial material about effectiveness for quite some time, so why raise this criticism now?

• The draft includes research on spinal manipulation performed by non-chiropractors, which is not relevant. It is standard practice include such research in high-quality reviews and practice guidelines, written by and for chiropractors (for example, Meeker et al. 2007; or Bronfort et al. 2008, PMID 18164469). We should not use a more-selective research standard than the published experts in the field; instead, we should defer to the experts' judgment. To help assuage concerns on this point, the revised draft (in #Scientific investigation 2 below discusses the issue, citing Villanueva-Russell 2005 (PMID 15550303).

• The draft should emphasize sources written by chiropractic researchers, as they are the experts on chiropractic. Misplaced Pages should give the most-detailed coverage to reliable mainstream scientific and medical views on effectiveness of chiropractic care, while of course also fairly representing minority viewpoints. This is as per the usual WP:WEIGHT policy.

Eubulides (talk) 08:36, 24 April 2008 (UTC)

(Again, please place further comments below.)

Revised proposal for fix

The revised proposed fix is to replace the sections Chiropractic #The Manga Report through Chiropractic #Scientific investigation with the following text (between the horizontal lines), and to change Chiropractic #Safety from a section (with two "=="s) to a subsection (with three "==="s), so that it becomes a subsection of the new Chiropractic #Scientific investigation section. Please see this listing of changes for details.

(Again, please place further comments below.)

Scientific investigation 2

The principles of evidence-based medicine have been used to review research studies and generate practice guidelines outlining professional standards that specify which chiropractic treatments are legitimate and perhaps reimbursable under managed care. This work has focused on spinal manipulation therapy (SMT) independently from the underlying philosophy of chiropractic, with little consensus as to who should administer the SMT, raising concerns by chiropractors that orthodox medical physicians could "steal" SMT procedures from chiropractors; the focus on SMT has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks.

Effectiveness 2

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment. Like many other medical procedures, chiropractic treatment has not been rigorously proven to be effective. Chiropractic care, like all medical treatment, benefits from the placebo response, and it is hard to construct a trustworthy placebo for clinical trials of SMT, as experts often disagree whether a proposed placebo actually has no effect. Many controlled clinical studies of SMT are available, but their results disagree, and they are typically of low quality.Although a 2008 critical review found that with the possible exception of back pain, chiropractic SMT has not been shown to be effective for any medical condition, and suggested that many guidelines recommend chiropractic care for low back pain because no therapy has been shown to make a real difference, a 2008 supportive review found serious flaws in the critical approach, and found that SMT and mobilization are at least as effective for chronic low back pain as other efficacious and commonly used treatments.

Available evidence covers the following conditions:

• Low back pain. Opinions differ on the efficacy of SMT for nonspecific or uncomplicated low back pain. An authoritative 2004 review found that SMT or mobilization is no more or less effective than other interventions. A 2008 review found strong evidence that SMT is similar in effect to medical care with exercise, and moderate evidence that SMT is similar to physical therapy and other forms of conventional care.

• Whiplash and other neck pain. There is no overall consensus on manual therapies for neck pain. An authoritative 2004 review found that SMT/mobilization is effective only when combined with other interventions such as exercise. A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis. A 2007 review found that SMT and mobilization are effective for neck pain.

• Headache. An authoritative 2004 review found that SMT may be effective for migraine and tension headache, and SMT and neck exercises may be effective for cervicogenic headache. A 2006 review found no rigorous evidence supporting SMT or other manual therapies for tension headache.

• Other. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, and a lack of higher-quality publications supporting chiropractic management of leg conditions. There is very weak evidence for chiropractic care for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. A 2007 systematic review found that the entire clinical encounter of chiropractic care (as opposed to just SMT) provides benefit to patients with asthma, cervicogenic dizziness, and baby colic, and that the evidence from reviews is negative, or too weak to draw conclusions, for a wide variety of other nonmusculoskeletal conditions, including ADHD/learning disabilities, dizzinesss, and vision conditions. Other reviews have found no evidence of benefit for baby colic, bedwetting, fibromyalgia, or menstrual cramps.

(End of proposed replacement text.)

(Please place further comments below.)

Comments on claim of bias and proposal for fix

(Please put comments here.)

• Thank you for starting the RfC Eubulides, there was no consensus to proceed and this was the best step forward. However, in my opinion, Effectivenes 2 suffers the same problems that were raised with Effectiveness 1. That is, undue weight is given to SMT. SMT and Chiropractic are not the same. Effectiveness of a particular procedure belongs on the article for that procedure. Chiropractic care consists of much more than SMT. For example, from the Chiropractic article, trigger point therapy is used in 45% of patients; Electrical stimulation is used in 46% of patients; Ultrasound is used in 30% of patients. None of these therapies are mentioned in effectivess 2. The problem with addressing the question of "What is the effectiveness of Chiropractic" is that it is too broad. Chiropractic is a profession, and not a treatment modality. As such, the question should be "What is the effectiveness of TREATMENT X". However, even that is too broad. We need to know what condition we are determining the effectiveness of the treatment for - for example, Therapeutic ultrasound may be effective in treating plantar fasciitis, but not in the treatment of symptomatic lumbar disc disease. So, the question must be "What is the effectiveness of TREATMENT X for condition Y". Effectiveness 2 spends the majority of the time talking about SMT (a treatment procedure that is performed by Physical Therapists, Osteopathic Doctors, Naturopathic Doctors, and some Medical Doctors), without giving due weight to other treatment modalities. The entire clinical encounter of a Chiropractic visit is more than just SMT, and therefore unless there are enough sources that discuss the effectiveness of CHIROPRACTIC, then the effectiveness of SMT belongs on the article for SMT.DigitalC (talk) 09:31, 24 April 2008 (UTC)

Interesting, but I think that there is very good cause to discuss the effectiveness of principal treatments. Certainly these should not go into great depths (expect in their individual articles). But a sentence or two on what evidence there is, or lack therof, would not go amiss, especially if they are primarily associated with the proffession. Jefffire (talk) 09:46, 24 April 2008 (UTC)

I agree, there is good cause to discuss the effectiveness of treatments. However, that belongs on the page for the treatment (whatever treatment modality that may be).DigitalC (talk) 11:06, 24 April 2008 (UTC)

I argue for nothing more than a sentence or two giving the positive and/or negative reviews for a few of the major treatments. There's no reason why even the briefest of discussions have to be entirely banished to the specialised articles. Jefffire (talk) 12:05, 24 April 2008 (UTC)

DigitalC has summed up my thoughts perfectly, so no need to repeat them. Suffice it to say that the research we include in this article about chiropractic should be research specifically about chiropractic and not research about DOs and PTs performing SMT which we can only apply to chiropractic by means of a WP:OR/WP:SYN violation. -- Levine2112 17:36, 24 April 2008 (UTC)

As far as I see it, there are 2 main issues. 1) the validity of PT, MD, DO research on SMT to determine the effectiveness of chiropractic care and b) the omission of expert, evidence-based clinical practice guidelines findings (such as the CCCGPP, for example). I myself have no objection to having a quick discussion of effectiveness of x treatment for y condition, as per DigitalC's recommendations and CynRNs suggestion. CorticoSpinal (talk) 15:55, 24 April 2008 (UTC)

The above remarks essentially repeat comments in #Criticisms of earlier proposed fix. Eubulides (talk) 08:16, 25 April 2008 (UTC)

Exactly, criticisms and concerns that YOU have not addressed since YOU insist in being the primary author of the science of chiropractic. Perhaps if chiropractors would be allowed to include research about chiropractic science and the development of chiropractic research things would flow better, no?

These comments are addressed in #Criticisms of earlier proposed fix. I have never insisted on being the primary author. #Effectiveness 2 contains extensive references to research reviews written by chiropractors. Eubulides (talk) 21:53, 25 April 2008 (UTC)

Agreed that that information is dated, could be pared and moved to history. I don't think that was really ever the issue; and as far as I can remember no one disputed that the info was dated. For example, that info was already moved to History without any peep from any regular editor here. CorticoSpinal (talk) 15:55, 24 April 2008 (UTC)

Clearly it (coverage of the Manga report etc.) should be pruned back severely. The current suggestion is to simply remove it. However, it addresses an important issue (namely effectiveness), which should be covered. Eubulides (talk) 08:16, 25 April 2008 (UTC)

There is absolutely no reason why Manga, which even Jefffire acknowledged read neutral needs to be pruned from 4 lines. It's already been moved to history. What's next, suggesting to remove Manga altogether? CorticoSpinal (talk) 16:29, 25 April 2008 (UTC)

Yes, the current proposal is to remove Manga altogether. The Manga report is not neutral, and the coverage of it in Chiropractic is heavily biased. This is discussed in #POV in existing coverage. I would not object to replacing it with neutral coverage, but that would be more work. The simplest thing is to remove it. That obsolete report is not that relevant now anyway. Eubulides (talk) 21:53, 25 April 2008 (UTC)

• No one had ever suggested of omitting Ernst. How an MD/PhD can be more "expert" in chiropractic effectiveness than a DC/PhD is beyond me, and the effectiveness, along with safety has omitted key papers that soundly refute Ernst. I am not proposing to delete Ernst, I am proposing to include strong DC/PhD papers. This is a reasonable suggestion, no?

• One of the first suggestions made for #Effectiveness 2 was to remove the sentence supported by Ernst 2008. Clearly there is some sentiment to omit Ernst's criticisms; but we can't really do that and remain NPOV.

Ernst represents the fringe of mainstream medicine, first and foremost. It is up to you to provide proof that he represents mainstream opinion on the subject, because mainstream medicine has pretty much acknowledged that a)chiropractic medicine is mainstream and b)chiropractic manipulation is safe. Ernst, IMO is a garbage POV pusher who blantantly mispresents large segments of the profession in an attempt to marginalize the profession. Looking at all CAM articles, it seems the good professor has a disproportionate amount of say. Good thing that his "conclusions" have been rebuked. We shall include this to remain NPOV. CorticoSpinal (talk) 16:29, 25 April 2008 (UTC)

Ernst is a mainstream medical researcher. I just typed the query "effective of chiropractic" into Google Scholar, and it responded with a page that contained "Key authors: E Ernst - W Assendelft - E Skargren - L Bouter - D Cherkin". He's first on the list. He's been a coauthor with Assendelft. It is true that he is critical of chiropractic, but he is a mainstream researcher and his work gets cited a lot. In no way is Ernst a "fringe" researcher. Eubulides (talk) 21:53, 25 April 2008 (UTC)

• #Effectiveness 2 already follows the suggestion of including strong DC/PhD papers. For example, it immediately follows the Ernst-2008 sentence with a sentence citing a strong DC/PhD paper that "found serious flaws" with Ernst's approach, and which gives that paper's conclusions as the final word in that paragraph. This is being pretty hard on Ernst already; it verges on being unfair to him. And this is not the only strong DC/PhD paper mentioned; there are lots of others, many more than there are citations to Ernst. I don't offhand see how the text could be any harder on Ernst without becoming POV.

Eubulides (talk) 08:16, 25 April 2008 (UTC)

When we are discussing the science of chiropractic, naturally DC/PhDs and those engaged in high quality research get highlited. It just happens that most, if not all disagree with Ernst. CorticoSpinal (talk) 16:29, 25 April 2008 (UTC)

Ernst gets highlighted. The other guys get highlighted too. Both sides deserve coverage. Ernst should not be ignored. Eubulides (talk) 21:53, 25 April 2008 (UTC)

• length is irrelevant to me so long as it covers all the salient points, provides proper context and is written in NPOV and has neutral tone. CorticoSpinal (talk) 15:55, 24 April 2008 (UTC)

• Yes, I agree. I have tried hard to keep #Effectiveness 2 short, while satisfying those other constraints. It is not an easy task. Eubulides (talk) 08:16, 25 April 2008 (UTC)

And I appreciate your efforts. There is some good research done here, definitely, but there are major topic omissions if we're going to do this section properly. I shall attempt a rewrite over the weekend which we can pick apart vociferously next week. CorticoSpinal (talk) 16:29, 25 April 2008 (UTC)

Thank you. Eubulides (talk) 21:53, 25 April 2008 (UTC)

It seems to me obvious that medical doctors are the most authoritative source on medical matters. They killed smallpox after all. One would not consider a homeopath an authoritative source on the effectiveness of his speciality, or a Ted Haggard on the age of the Earth.

Or to put it another way; there is no such thing as an authority on something that does not exist--Kenneth Cooke (talk) 04:07, 26 April 2008 (UTC)

I don't for a second doubt the authoritativeness of MDs on medical matters. But, the research has shown that MDs routinely a) do poorly at MSK medicine and b) DCs perform superiorly to MDs in MSK medicine; which is not surprising since it is their core focus. Which brings us to the argument at hand. Who is the authoratitive source on chiropratic matters? Traditionally, prior to the establishment of a literature base, it was MDs by default who at least had scientific research. That is no longer the case. The profession, really since 1983, or 25 years (who's counting?) has seen it's literature base grow to the point where we no longer need to rely on "medical" research from MDs to define the profession.

DC/PhDs, or chiropractic scientists are very real, have been integrated in various aspects in mainstream health care and research agencies, etc. So, let's cut to the chase. Why is Haldeman et al and Cassidy et al. (who are the experts in manipulation and stroke) not be given equal weight (at the very least) to Ernst? This argument is important to resolve because the same tactics have been applied to vaccination and now effectiveness. That is, treating Chiropractic as WP:FRINGE. Let's get to the bottom of this and then everything else will proceed a lot smoother. Thoughts? CorticoSpinal (talk) 22:28, 24 April 2008 (UTC)

Cassidy et al. (PMID 18204390) is about safety, not effectiveness; it's irrelevant here. Haldeman et al. (PMID 18204400) says nothing about effectiveness that is not already reported in #Effectiveness 2 (it cites the underlying review that Haldeman et al. cite). Eubulides (talk) 08:16, 25 April 2008 (UTC)

WP:IDIDNTHEARTHAT. Please read my statement above and address my concerns; they're the same one in effectiveness, safety and vaccination. CorticoSpinal (talk) 16:29, 25 April 2008 (UTC)

I started a new thread (#Safety sources again below) to address those concerns. Eubulides (talk) 21:53, 25 April 2008 (UTC)

Jefffire (talk) 18:08, 24 April 2008 (UTC)

• Perhaps one should mindful that the "effectiveness" controversy is kinda overblown and dated based on the various endorsements of SMT from mainstream practitioners. For example, SMT is now part of the American Physicians clinical practice guidelines for low back pain. So, I'm a bit confused how come the editor is citing a "effectiveness" controversy when an expert panel has recommended SMT as an effective, conservative approach to NMS problems and spinal issues specifically. CorticoSpinal (talk) 15:55, 24 April 2008 (UTC)

Nah, not really, there was one bypasser (DelvinKelvin) who want some clarification, but other than that it's been moreso hardcore skeptics and orthodox practitioners. It should be noted than no other health care profession has an effectiveness section; and the orthodox practitioners here are treating chiropractic care like WP:FRINGE when it's practically mainstream for all intents and purposes. Even the literature (orthodox sources to boot) say this. This is a fundamental flaw in the approach of certain editors here; treating Chiropractic more like homeopathy rather than Dentistry, Physical Therapy or even Osteopathic Medicine. CorticoSpinal (talk) 15:55, 24 April 2008 (UTC)

• Almost all of the comments on this talk page are by editors, but editors are not the best sources for what readers need, because editors know too much. It is quite valuable when a reader stops by and makes a helpful comment as to material that may be obvious to editors but is not obvious to the typical reader.

An admin once said "If you struggled with passing calculus, don't go mucking about with the taylor series article." That seems to be occuring here, to a large extent. You have not addressed my fringe concerns. Please do so. CorticoSpinal (talk) 16:29, 25 April 2008 (UTC)

Chiropractic is closer to Acupuncture or to Traditional Chinese medicine than it is to Homeopathy. Like chiropractic (and unlike homeopathy), acupuncture and traditional Chinese medicine have plausible scientific mechanisms. I would not call acupuncture fringe medicine, any more than I would call chiropractic fringe medicine. That being said, all three professions have serious questions about effectiveness, questions that need to be addressed in their respective articles. Eubulides (talk) 21:53, 25 April 2008 (UTC)

• Other health care professions have effectiveness sections, as noted in #Criticisms of earlier proposed fix. One example is Traditional Chinese medicine #Efficacy.
• Chiropractic should not be treated just like Homeopathy (it is not nearly as fringe as homeopathy is) but it does have aspects that require careful coverage. A closer (albeit still imperfect) analogy would be Acupuncture.

Eubulides (talk) 08:16, 25 April 2008 (UTC)

Acupuncture is a modality. Chiropractic is a profession. The comparison ends there unless you can point to me that acupuncturists are licensed and regulated in all 50 states and are indeed a profession. CorticoSpinal (talk) 16:29, 25 April 2008 (UTC)

Acupuncture is also a profession. It is one of the four largest CAM professions in the U.S. (the others are chiropractic, massage therapy, and naturopathy; my source is Cherkin et al.' 2002, PMID 12463292). Eubulides (talk) 21:53, 25 April 2008 (UTC)

It should go then, if that would solve issues. CorticoSpinal (talk) 15:55, 24 April 2008 (UTC)

• Vehemently disagree on 2 fronts. 1) It still treats chiropractic as WP:FRINGE when it's clearly not, 2)given allopathic views greater weight even within Chiropractic's own article which is a separate, distinct and autonomous branch of health care and 3)is used as a tactic to subvert the inclusion of research by DC/PhDs on chiropractic in chiropractic's own article! CorticoSpinal (talk) 15:55, 24 April 2008 (UTC)

Effectiveness 2 is scholarly and comprehensive. It addresses the fact that SMT is not the only treatment modality, but is an important one; as well as acknowledging the fact that other professions practice it. The 'total patient encounter' is also discussed. I agree that Manga and the worker's comp stuff must be taken out for the reasons given.Perhaps some stuff from CCCGPP can be worked in? I hope we can agree on the new Effectiveness, but I'm not optimistic!CynRNCynRN (talk) 17:05, 24 April 2008 (UTC)

When commenting, please don't insert comments into a draft. Copy a phrase and take it down here to comment on it. Chopping up a draft with commments makes things very confusing.CynRN —Preceding unsigned comment added by CynRN (talk • contribs) 17:08, 24 April 2008 (UTC)

I think I did that and I apologize. Effectiveness 2 is a step in the right direction, if can narrow the focus to the big 3, (back pain, neck pain, HA) that would be helpful. I'm going to include and track down clinical practice guidelines recommendations; after all that is directly related to practice. CorticoSpinal (talk) 22:16, 24 April 2008 (UTC)

Where effectiveness 2 and its predecessor fails is looking at the effectiveness of the various types of treatments used by DCs. The most common ones would be soft tissue tx, exercise-rehab, ergo advice/ and some kind of education/counseling/reassurance. Let's broaden it a bit and not make contemporary practice and the mainstream of chiropractic (i.e. mixers) look like one trick ponies. A good ref would also be Theberge(2008) that is used at the sports chiropractic article as well as the conclusions from the CCCGPP CorticoSpinal (talk) 22:16, 24 April 2008 (UTC)

I agree that the reader should know that DCs do a lot of different things. The article already goes into these quite a bit, however. I don't think there is the volume of studies on the other treatments that there is on SMT. Maybe a qualifier in Effectiveness 2 that chiropractors use many other modalities?CynRNCynRN (talk) 02:50, 25 April 2008 (UTC)

(outdent) I like the suggestion of mentioning other modalities; even if the evidence is lacking, we can just say it's lacking. Also, I could put the CCGPP stuff back in (it was in Effectiveness 1 but I took it out in the interests of brevity). Do these suggestions sound OK? Eubulides (talk) 08:16, 25 April 2008 (UTC)

We're moving in the right direction at least. I will attempt to make a hybrid proposal this weekend that addresses the main concerns raised by myself and other editors. Productive dialogue is good; but a qualifying statement hardly does justice to the various other common clinical things DCs do. Remember, the whole clinical encounter, not just a reductionistic approach that focuses on SMT. An analogy is sorta like sex; you just don't go "in there" and start thrusting away! The adjustment takes 10s to deliver; yet the average appointment runs 18 min. There is a beautiful example in Theberge (2008) where a DC illustrates this point when a PT attempted to marginalize the DCs role (they can't assess core dysfunction). Misunderstandings and miseducation are common in dealing with chiropractic medicine. I'm here to help clean that up, clear the air and foster better inteprofessional relations, just like I'm doing IRL. CorticoSpinal (talk) 16:29, 25 April 2008 (UTC)

Comments on scientific investigaton

Highly inappropriate to base scientific investigation on 1 source, even more is the "fear" tone implied by it. "Steal SMT procedures" "raise concerns that scope would be reduced"; I mean; it's this kind of writing, tone and source selection that has turned off a majority of regular editors here. Where are sources from Coulter? He's THE expert in sociological development in chiropractic. Also, where any mention of the scientific journals in chiropractic that are at least indexed? Where is the mention of the FCRE, the establishment of DCconsult (evidence-based resource), mention of the ICL (index to chiropractic literature), the development of evidence-based clinical practice guidelines? I mean, this article is about chiropractic and this is about the science of chiropractic. To skeptics, they will say this in an oxymoron or patently untrue; but anybody who is objective and moral will see that the science of the profession is very real, and it's not limited to just SMT. But, outsiders, and orthodox practitioners wouldn't know (or possibly care to know) about these things. So, let's fix this massive oversight right now. CorticoSpinal (talk) 22:41, 24 April 2008 (UTC)

More sources would be welcome. This was by far the best peer-reviewed source I found on the sociology of evidence-based medicine and chiropractic. I am unaware of any recent work that Coulter has published on the subject. I do know of Mootz, Coulter & Hansen 1997 (PMID 9127258) but it's pretty dated; it's an old proposal of what to do, not a description of what's been done. The text does briefly mention the development of evidence-based guidelines. The other evidence-based stuff would be worth a brief mention, though that'd need a reliable source (preferably a peer-reviewed paper; not ICL or DCconsult itself). Eubulides (talk) 08:16, 25 April 2008 (UTC)

I know of much more recent lit that Coulter has done; it's just not on PubMed. The humanities must have their own lit base indexed somewhere, anybody know what it's called? ICL and DCconsult are important in the fact that they are clear cut examples of the movement towards science and developing and implementing evidence-based practice. They're both very notable; in particular the ICL. I haven't even attempted to bring a source from there yet; but I won't be overlooking it much longer; the allopathic database is predominantly allopathic; and ICL focuses predominantly on chiropractic. DC/PhDs are also writing article in journals such as Journal of Chiropractic Education. We need to include those as well to get a full picture. CorticoSpinal (talk) 16:29, 25 April 2008 (UTC)

Please cite the more recent literature; that would be helpful. Eubulides (talk) 21:53, 25 April 2008 (UTC)

Dammit Eubulides, please stop reverting the struck out text. We've been doing this now for 3 months, just look above at Education as an example. I'll give you time to respond before reinseting my edit, but I do find you 2 reversions to be in bad taste and you haven't even bothered to respond to any of my concerns. To be clear: don't delete struck out material; those are points being contested. Thanks. CorticoSpinal (talk) 23:05, 24 April 2008 (UTC)

The intent of that long comment was to provide a single, complete summary of the problem and proposed solution. Jefffire had earlier expressed frustration when trying to follow commentary inserted within other commentary, so with that in mind the long comment asked for followups to come after, rather than being interspersed within it. If this idea doesn't work well we can go back to doing things the old way, but for this particular comment let's try it the way Jefffire suggested. If we want to come up with an improved draft, I suggest starting a new section for it, #Scientific investigation 3 say. I will respond to followup comments soon, but would like to wait a few hours to give things a chance to settle down. Eubulides (talk) 00:41, 25 April 2008 (UTC)

The best approach is to combine the best of effectiveness 1 and 2. QuackGuru 22:19, 30 April 2008 (UTC)

Let's give that a try on the talk page and see how it looks. I just want to make sure that the following concerns are addressed in the newest draft:

* Chiropractic is a profession. And like Dentistry, measuring the overall effectiveness of a profession is difficult or at least seemingly odd. If there are studies/reviews which discuss the efficacy of the entire clinical encounter with a chiropractor, I feel that would be best.

* Therefore, if we are limiting ourselves to discussion about the effectiveness of certain chiropractic techniques, then the studies/reviews cited should be measuring chiropractic techniques as performed by chiropractors specifically and not include similar techniques performed by other practitioners (unless the results of each profession is kept separate somehow).

* Detailed discussion about specific modalities should be saved for the corresponding modality's article and not be included in this article.

That's really my only concerns. As long as they are addressed, I'll be satisfied. -- Levine2112 22:28, 30 April 2008 (UTC)

• Chiropractic is not just about the profession; it is also about chiropractic care, just as Traditional Chinese medicine is not just about the profession but is also about the techniques used. Large chunks of Chiropractic are about chiropractic care, not about the profession; this includes Chiropractic#Treatment procedures, Chiropractic#Utilization and satisfaction rates, Chiropractic#The Manga Report, Chiropractic#Workers' compensation studies, Chiropractic#Scientific investigation, and Chiropractic#Safety. And there's good reason for this: when people think "chiropractic"; they are typically thinking of the care, not just of the profession. It would be odd to rip all these sections out of Chiropractic on the grounds that Chiropractic should only be about the profession. It would be very odd to exclude from Misplaced Pages common usage such as is found in the ACA's web page Chiropractic: A Safe Treatment Option.
• We should follow our reliable sources, which include data from studies of spinal manipulation performed by non-chiropractors. This is standard practice now. It's not controversial among recent reliable reviews. We should not second-guess the expert reviewers in the field.
• I agree that detailed discussion about particular spinal manipulation techniques, or other techniques used in chiropractic care, belong in their respective articles. However, an overall discussion belongs in Chiropractic, due to its strong association with particular treatments, notably spinal manipulation.
• Chiropractic has long discussed the effectiveness of chiropractic care at quite some length; why stop now?

Eubulides (talk) 09:27, 1 May 2008 (UTC)

It is easy to write about chiropractic. The controversial nature of chiropractic does not make it difficult to write about it when we follow the sources in a neutral way. This has been done already. Minor adjustments can be done in mainspace. Taking the best from each effectiveness draft will create something wonderful called NPOV. QuackGuru 02:40, 1 May 2008 (UTC)

Chiropractic is a healthcare profession like Dentistry. Chiropractic#Treatment procedures describes some of the procedures chiropractors use. Chiropractic#Utilization and satisfaction rates, Chiropractic#The Manga Report, and Chiropractic#Workers' compensation studies describe studies specifically about chiropractic. Chiropractic#Scientific investigation and Chiropractic#Safety are two disputed sections of this article and should not be used as cause to move forward on something with similar problems. It remains intellectually disingenuous to use studies involving other kinds of practitioners to make an assessment about the efficacy of chiropractic care. Sure, you can use these studies to assess the efficacy of spinal manipulation in general and that would be good info for the spinal manipulation article. But unless a study makes conclusions about chiropractic specifically, we shouldn't be using it on this article because it would create a WP:SYN violation. So let's create some version 3 of the efficacy section which addresses these concerns and let's see what we have. Perhaps it will be a version which we can all live with -- the very definition of consensus. -- Levine2112 18:03, 1 May 2008 (UTC)

There is no SYN when the text is written according to the sources in a neutral way. This is the definition of NPOV. QuackGuru 18:14, 1 May 2008 (UTC)

The problem here is that we have sources which study SMT as performed by a host of practitioners and don't conclude anything specific about chiropractic. Then we are taking these sources and we are making a conclusion about chiropractic specifically (if only by including these non-chiropractic specific studies in our article about chiropractic). That's the definition of a WP:SYN violation. As it stands, a host of editors here are against including this section for this very reason. Remove all of the source which do this, and then we can continue discussing this topic. Otherwise, we are stuck and can't move forward. -- Levine2112 18:30, 1 May 2008 (UTC)

The proposed rewrite is severely biased in the representation of research. This is typical of Eubulides' drafts. Notwithstanding; it seems like the edits go out of their way to drum up more fear or controversy

• afraid they might steal
• limit their scope
• the most authoritative (2004 Cochrane?) sorry, it's the 2008 WHO Neck Pain Task Force
• no benefit of manual therapy for neck pain (false)
• no mention of any additional treatments provided by DCs
• Does not consider recent WSIB stats
• Does not reference the effectiveness of SMT which has been included in allopathic physicians' clinical practice guidelines
• Violations of WP:SYN, WP:OR, WP:POINT, WP:NPOV, WP:CON amongst others. This is old new. Until we get representation from the chiropractic profession, this is just a blantant marginalization and subversion of DC/PhD research. It's the same old, same old "shouldn't reach down argument" which SmithBlue has debunked. As I mentioned before, I think it's time to apply WP:IAR and get past this stalemate. Scope of practice needs to be finished and education is dangling. Those are by far less contentious than this and we need to make progress. Once we can include the needed DC/PhD research to attain NPOV we can tweak safety and move onto the science of chiropractic. That means science of manual therapies and conservative care; in case someone out there needs a translation.

(outdent)

• The quotes are supported by reliable sources.

• • Every single source ever brought here is a condemnation of chiropractic. There is a severe lack of balance in the sources brought to the table here and major omissions (Coulter is THE expert in sociology and chiropractic).

• Not true. #Scientific investigation cites many sources that are quite supportive of chiropractic. Examples include DeVocht 2006 (PMID 16523145), Bronfort et al. 2008 (PMID 18164469), Hurwitz et al. 2008 (PMID 18204386), and Hawk et al. 2007 (PMID 17604553). There are other examples. Coulter is certainly a leading expert on the sociology of chiropractic, and recent citations from his work would certainly be welcome if someone can dig up some; in the meantime the current draft cites reliable sources (just one example: one of the coauthors of Hawk et al. is Rahelah Khorsan, one of Coulter's colleagues at the Samueli Institute) and there is no reason to reject it simply because it does not cite Coulter. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• "raising concerns by chiropractors that orthodox medical physicians could 'steal' SMT procedures from chiropractors" is supported by the following paragraph:

"Anderson (2002) noted that the ‘‘Fugelli Tactic,’’ or the idea that ‘‘if you can’t beat ‘em, join ‘em’’ ideology, might very well apply to orthodox medical physicians faced with mounting evidence that manipulation primarily performed by alternative medical practitioners had proved a valuable and effective treatment (p. 197). The Fugelli Tactic might better be described as ‘‘if you can’t beat ‘em, steal from ‘em,’’ instead, as the practice involved the dominant actor learning and becoming proficient in the practice so that they could better compete and maintain their monopoly share of the market. Anderson discussed the possibility that manipulation might become permanently ‘‘borrowed’’ by orthodox medical physicians if they saw it as beneficial and easily learned at continuing education weekend seminars. (Villanueva-Russell 2005, PMID 15550303; this is citing Anderson 2002, PMID 12006128)

Relevance to the science of chiropractic (besides it being needlessly inflammatory)? CorticoSpinal (talk) 17:07, 4 May 2008 (UTC)

It's not inflammatory. It's highly relevant to concerns about evidence-based chiropractic. Eubulides (talk) 08:15, 5 May 2008 (UTC)

Please provide link to this much discussed draft. Material quoted ("Anderson (2002) noted...) will need a source saying its relavant to "concerns about evidence-based chiropractic". Out of context it appears WP:OR, in context? SmithBlue (talk) 11:15, 5 May 2008 (UTC)

• "the focus on SMT has also raised concerns that the resulting practice guidelines could limit the scope of chiropractic practice to treating backs and necks" is supported by the following paragraph:

The draft is in #Scientific investigation 2. The above quotation about Anderson (2002) is taken from Villanueva-Russell 2005 (PMID 15550303), a reliable source cited by the draft. This source's subject is evidence-based medicine and its implications for chiropractic, which is directly on-topic. Eubulides (talk) 21:24, 5 May 2008 (UTC)

"If positivistic science was the means to achieve an ‘‘established’’ rating for a technique and if the only scientific studies evaluated for the rating were done by non-chiropractors on ‘‘manipulation’’ for lower back pain, the result was an overly narrow standard of care that reinforced the neuromusculoskeletal, limited professional status of chiropractic. Clinical practice guidelines would serve to further institutionalize chiropractic’s marginal structural position and circumscribe the scope and range of practice to lower back pain doctors, or those that addressed ‘‘sprains and strains.’’" (Villanueva-Russell 2005, PMID 15550303) There are two more paragraphs in the same vein, which I am loath to copy for concerns of copyright violation, but the last paragraph ends, "Had chiropractic become a victim of its own rhetoric—trapped as a limited-scope back and neck doctor?".

We should not milk the same source to prove a point. Where is the DC POV on this, incidentally? I thought so. CorticoSpinal (talk) 17:07, 4 May 2008 (UTC)

Other highly-reliable sources are welcome. For now, the draft is based on a reliable source. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• Cochrane reviews are widely regarded as the gold standard in evidence-based medicine. We have a reliable source (Ernst 2006, PMID 16574972) which says that the two Cochrane reviews in question are authoritative. No reliable source has been presented to the contrary. The proposed draft in #Effectiveness 2 does not say "most authoritative" (even though Ernst does); it merely says "authoritative", which is inarguable.

This is supplanted by the Feb 2008 issue of Spine and the WHO Task Force report. CorticoSpinal (talk) 17:07, 4 May 2008 (UTC)

It's not supplanted. We have no reliable saying it's supplanted. The Cochrane reviews are very high quality. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• The proposed draft in #Effectiveness 2 does not say "no benefit of manual therapy for neck pain".

It omits the proven benefit as highlighted by the task force report. CorticoSpinal (talk) 17:07, 4 May 2008 (UTC)

No, it doesn't omit that. It says "SMT, mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives". Eubulides (talk) 08:15, 5 May 2008 (UTC)

• #Effectiveness 2 does mention other treatments provided by DCs, including educational videos, mobilization, and exercises.

One sentence on all the other "mixes" is insufficient to be NPOV. CorticoSpinal (talk) 17:07, 4 May 2008 (UTC)

There is more than one sentence on that. Multiple sentences talk about mobilization. Multiple sentences talk about exercise. If there is something missing, please suggest some additions that are based on reliable sources. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• Every attempt has been made to use the best sources published in peer-reviewed journals. If those sources base their results on WSIB stats, they have been used. If not, they haven't. Given the amount of reviews in this area, it is not really our job to dive down into the WSIB stats ourselves.

WP:IAR. You have used this argument to keep good literature and findings out. CorticoSpinal (talk) 17:07, 4 May 2008 (UTC)

Generally speaking, we should rely on high-quality reviews to decide whether literature and findings are good. This is standard practice in medical articles, as per WP:MEDRS, and is quite helpful in avoiding bias. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• The criticism that allopathic physicians' clinical practice guidelines have been ignored is a curious one. On the one side, we're supposed to ignore traditional medical sources when they publish extensive critical reviews about effectiveness in refereed high-quality journals; on the other hand, we're supposed to pull out short sentences that appear in clinical practice guidelines on some other subject? I'm not opposed to all citation of practice guidelines, but let's not put the cart before the horse: the section on effectiveness should primarily use sources on effectiveness, not little bits taken from sources that are primarily about other things and for which effectiveness of chiropractic care is not a central concern.

This is another misrepresentation of my argument (#16 now). CorticoSpinal (talk) 17:07, 4 May 2008 (UTC)

The argument you made was "Does not reference the effectiveness of SMT which has been included in allopathic physicians' clinical practice guidelines". The comment directly responded to that argument. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• It is not right to omit all controversial material, simply because it is controversial. The controversial side of chiropractic must be covered, as well as the not-so-controversial side. Omitting the central points of controversy results in the strongly-biased article that we have today.

19:30, 2 May 2008 (UTC)

(#17). No one has ever said to omit controversial material. The article is not as biased as you think; however your attempts to keep out scope of practice and education (both relatively non-controversial) sections is duly noted. It would be nice if your edits and proposals were not always controversial and you stopped arguing with the majority of the regular editors here. CorticoSpinal (talk) 17:07, 4 May 2008 (UTC)

Certainly there have been attempts to strike out controversial material from critics of chiropractic, and arguments that we should focus on "less contentious" sections. This would continue leave important gaping holes in the article and (more important) would leave the article strongly biased. Bias like that is contrary to Misplaced Pages policy. I'm sorry that it is so controversial, but violations of policy need to get fixed. Eubulides (talk) 08:15, 5 May 2008 (UTC)

What does "representation from the chiropractic profession" mean? QuackGuru 02:38, 2 May 2008 (UTC)

In chiropractic's early years, influences from both straight and mixer concepts were incorporated into its construct. Chiropractic has both materialistic qualities that lend themselves to scientific investigation and vitalistic qualities that do not. This info is about philosophy and not scientific investigation. It is duplication and should be deleted. QuackGuru 21:13, 3 May 2008 (UTC)

Asking for informal mediation

Discussion seems to have died down in this thread without consensus. The bias in the current article continues to be a problem, so I am asking for informal mediation. Eubulides (talk) 21:24, 5 May 2008 (UTC)

History

The history section is way too long and covers effectiveness using outdated studies. We need to discuss the WP:WEIGHT problems with the huge and oudated history section. QuackGuru 17:46, 24 April 2008 (UTC)

Um, how can history be outdated? -- Levine2112 17:51, 24 April 2008 (UTC)

Because the studies are too old. We have newer studies available. QuackGuru 17:59, 24 April 2008 (UTC)

They are too old for history? Sorry, this doesn't seem to compute. -- Levine2112 18:00, 24 April 2008 (UTC)

Isn't it discussing effectiveness that's the problem? Jefffire (talk) 18:15, 24 April 2008 (UTC)

I don't see any problem with talking about historically important research. My issue there would be that the study should be discussed for its historical importances. Manga, for instance, was landmark research in helping to establish the scientific legitimacy of the profession. I read that somewhere. I'm sure we can dig up the source. -- Levine2112 18:20, 24 April 2008 (UTC)

If studies are presented for their historical impact then there is no issue. If they are presented as "establishing scientific legitimacy", then there is an issue since that's PoV. Jefffire (talk) 18:25, 24 April 2008 (UTC)

Historically, establishing chiropractic scientific legitimacy for treating low back pain is exactly what the Manga Report (and the second Manga Report) did. It also showed the cost-effectiveness of such treatments. -- Levine2112 18:29, 24 April 2008 (UTC)

That's PoV. Providing evidence for it would be a more neutral wording. Also, nudge you again on this - published =/= truth. Jefffire (talk) 18:32, 24 April 2008 (UTC)

Oh, sure. I see your point. Manga was one of the first of a few big scientific studies (such as the AHCPR) to come out after the Wilks case ended (and the AMA had been found guilty of suppressing supportive chiropractic research). Certainly Manga provided evidence which has helped to establish a growing trend towards scientific acceptance. Nudge to you... Misplaced Pages isn't about truth, it is about verifiability. Published information helps to establish verifiability. I encourage you to read WP:V when you have a moment. -- Levine2112 18:40, 24 April 2008 (UTC)

OK, since you agree with, we can work toward a neutral phrasing. Also, I think you've misinterprated my comment about published material. It's a common misconception that a published study must be true "true", which is not neccasery correct. Your wording missed that subtle point. Offtopic-Science isn't decided by trials. Jefffire (talk) 18:50, 24 April 2008 (UTC)

I would love to help work on that. I am heading out for the night right now, but if you draft something up, I will be back in the morning to review. I don't think that published studies are necessarily true. Science isn't a decision, but rather a process by which a decision can be made. -- Levine2112 18:54, 24 April 2008 (UTC)

I actually consider that current wording section on the Manga report to be presented in a generally neutral manner. Jefffire (talk) 19:58, 24 April 2008 (UTC)

The history section can definitely be tweaked; for example it neglects to cover important topics like the straight vs mixer evolution, the fight for licensure/regulation, the important steps in getting reimbursement under Medicaid/Medicare (US) and the expansion of the profession globally (what about history of the profession in Canada, Europe, and elsewhere?)

That's for another day though and we do not to resolve Scope of Practice first. CorticoSpinal (talk) 22:31, 24 April 2008 (UTC)

The history section has outdated effectiveness studies. When newer studies are available we can easily replace them with the newer studies. The oudated studies are mostly about effectiveness. Our goal is to replace the oudated studies with the newer studies. Makes sense? QuackGuru 03:57, 25 April 2008 (UTC)

New studies of effectiveness are irrelevant unless they comment on the impact of the Manga report. DigitalC (talk) 04:19, 25 April 2008 (UTC)

Recent effectiveness reviews do not cite the Manga report because it is of such low quality that it is not worth citing. The most recent mention I found of the Manga report in peer-reviewed literature is Grod et al. 2001 (PMID 11677551), and they dismiss it as an example of a low-quality study that they found cited in unreliable patient brochures. Any mention that Chiropractic makes of the Manga report should also describe its sad fate. Eubulides (talk) 08:16, 25 April 2008 (UTC)

I do not see any impact of the Manga report. QuackGuru 04:25, 25 April 2008 (UTC)

Hmm, yes, that's an important factor I missed. A reference from a medical textbook or something authoritative on it's impact on American medicine would be nice. Jefffire (talk) 07:29, 25 April 2008 (UTC)

If any editor wants to include the Manga report it must be rewritten using a newer ref (PMID 11677551) and also it should be explained why the need to keep the report in this or any article. This has not been done yet. Please propose a draft with your explanation and we can review it. Agreed? QuackGuru 17:11, 25 April 2008 (UTC)

Not agreed, why are you making demands that the Manga report(s) are suddenly crap and need to be taken out? The report is notable because professor Pran Manga (PhD) in economics, I believe, has made a strong and notable argument that chiropractic services should be integrated into mainstream health care, specifically in the public system. Are you disputing the verifiability of the report? It has stood the test of time here and no one has proposed at removing it until yourself. CorticoSpinal (talk) 17:15, 25 April 2008 (UTC)

The Manga report is not "suddenly crap". It was always low quality; see for example, Grod et al. 2001 (PMID 11677551), which says "The Manga report was not a controlled clinical trial but a review of the literature that offered an opinion that has not been experimentally established." Regardless of its initial quality, though, it is long obsolete and no longer deserves much (if any) coverage in Chiropractic. Eubulides (talk) 21:53, 25 April 2008 (UTC)

The report is outdated. We have much newer studies available. QuackGuru 17:20, 25 April 2008 (UTC)

If the Manga report is notable in the history of chiropractic then its place in the history section should be assured. I ask that material in the history section be explicitly dated so that the reader can understand the timeline offered. SmithBlue (talk) 07:32, 26 April 2008 (UTC)

The Manga report has zero historical impact and is an obsolete study. QuackGuru 07:38, 26 April 2008 (UTC)

out with the old and in with the new (duplication)

There is a lot of oudated studies and sections that have very little or no impact on Chiropractic history. This includes The Manga Report, Workers' compensation studies, American Medical Association (AMA), and the British Medical Association.

The best approach is to delete the old studies and replace them with the newer studies. The old studies discuss mainly effectiveness. We are essentially removing duplication. QuackGuru 07:50, 26 April 2008 (UTC)

I would greatly appreciate it if you would show us how these studies and positions (which I have found in nearly every historical account of chiropractic) have had - as you say - little or no impact on the history of the Chiropractic profession. I personally don't see it and further think we should also include a mention of the AHCPR, which has been described as a "landmark" study. . -- Levine2112 08:24, 26 April 2008 (UTC)

The dc doctor is an unreliable source. No evidence has been presented that the old studies had any "landmark" impact. QuackGuru 08:31, 26 April 2008 (UTC)

I do want to make explicit that a "History" section will usually refer to events and material that is dated. Hopefully QuackGuru will cite some RS sources on Chiropractic history that neglect to mention Manga. And at the same time some RS chiropractic histories that do include it would bolster its continued inclusion. SmithBlue (talk) 11:23, 26 April 2008 (UTC)

Some mainstream medical sources would be pretty welcome. History of medicine textbooks, medical textbook etc. Jefffire (talk) 11:50, 26 April 2008 (UTC)

Hopefully History of chiropractic articles, chiropractic textbooks, perhaps health policy articles such as "Chiropractic in the United States: Trends and Issues" as well. Doubtless there will be multiple POVs on chiro history. SmithBlue (talk) 12:28, 26 April 2008 (UTC)

There are indeed a plethora of chiropractic history sources, most notably Dr. Joseph Keating, PhD. He is "the" chiropractic historian. The article is about chiropractic, so let's talk about chiropractic, shall we? Mainstream, of course, can have their 2c, but let's tell the story of the art, science and philosophy of chiropractic. CorticoSpinal (talk) 17:35, 26 April 2008 (UTC)

A useful source, but one must bear in mind not a neutral one. Jefffire (talk) 18:25, 26 April 2008 (UTC)

When these studies and sections have no impact to Chiropractic history they should be deleted. We have newer studies available such as the proposed Effectiveness section. QuackGuru 17:42, 26 April 2008 (UTC)

For chiropractic history, we can include studies that are specifically about chiropractic history and not old or obsolete studies. QuackGuru 18:15, 26 April 2008 (UTC)

Precisely, and these studies (Manga, etc.) are important to chiropractic history as per their mention in many chiropractic history sources (Keating, etc.). -- Levine2112 22:46, 26 April 2008 (UTC)

Unlike science, history is of necessity subjective, POV based, filtered information producing a story. And not surprisingly who is telling the story and who is listening makes a great deal of difference in what is considred relevant. Unlike medical research, which (we hope) reduces human failings to a minimum, the medical view of chiropractic history can only be just another POV on chiro history. In the "History" section we will of necessity be presenting multiple POVs given the disparate views that exist on chiro history - if in one POV Manga is not important that does not in any way reduce its notability in another POV. SmithBlue (talk) 03:14, 27 April 2008 (UTC)

Levine, if a reference exists that discussed the Manga report in a historical context then provide the reference. We would use the reference that discusses the Manga report and not the Manga report itself anyhow. The Manga report itself does not qualify for the history section. If another source mentions older studies (Manga, etc.) then provide all those references to replace the older and obsolete studies. QuackGuru 04:00, 27 April 2008 (UTC)

No specific references have been provided to show that any of the older or obselete studies have any historical impact. If references are provided, we would use those references and not the original older studies. QuackGuru 04:13, 27 April 2008 (UTC)

Man I remember learning Manga in school. . . it represents a critical piece of research in chiropractic history. I am sure there are dozens of references out there discussing chiropractic history which detail the significance of Manga.TheDoctorIsIn (talk) 04:59, 27 April 2008 (UTC)

It represents a critical piece of research in chiropractic history? Please provide a reference discussing chiropractic history which details the significance of Manga. At the moment, no reference has been provided. These studies (Manga, etc.) have no impact to chiropractic history unless a reference is provided. QuackGuru 07:26, 27 April 2008 (UTC)

Levine wrote: Precisely, and these studies (Manga, etc.) are important to chiropractic history as per their mention in many chiropractic history sources (Keating, etc.). <-- This comment implies Keating mentions the Manga report in a historical perspective. I do not see any evidence of that. Please provide a reference to support this claim. Got it? QuackGuru 18:00, 27 April 2008 (UTC)

For starters, how about this one from Keating? Get it? -- Levine2112 16:58, 28 April 2008 (UTC)

Thank you for the ref. The ref by Keating mentions the Manga report. We can replace the Manga report with the Keating ref. The Manga report itself is not specifically about chiropractic history but Keating seems to have some historical context. We can add the Keating ref and text. QuackGuru 18:48, 28 April 2008 (UTC)

I also added this ref which discusses Manga in terms of history. -- Levine2112 19:00, 28 April 2008 (UTC)

Oh, and this article describes Manga historically as having "caused ripples throughout the traditional medical community when it concluded that chiropractic management of low-back pain is both more effective and cost-effective than traditional medical treatment." -- Levine2112 19:03, 28 April 2008 (UTC)

As previously explained here all of the obsolete and outdated studies will be deleted. No argument has been made to keep these dated studies. The Manga Report, Workers' compensation studies, American Medical Association (AMA), and the British Medical Association are clearly obsolete when newer sources are available. For the Manga report there are newer studies that describe the report. We can use these newer studies as long as they have historical impact. We will remove the older studies and replace them with the newer effectiveness studies. This is essentially removing duplication and will make this article one step closer to a GA status. QuackGuru 20:34, 29 April 2008 (UTC)

You do not get to determine what has had historical impact on the chiropractic profession. Chiropractic historians do. Keating and others have mentioned it numerous times. You don't delete history QG because it doesn't conform to our personal POV. Effectiveness is not even on the horizon given that there is a clear lack of consensus (with majority opposed, I might add). Scope of Practice is sitting there ready to go in (despite a tendentious and stonewalling attempt by a certain editor to drag the process out over trivial points) CorticoSpinal (talk) 20:50, 29 April 2008 (UTC)

No evidence or reason has been provided to keep the obsolete studies. Removing outdated studies and replacing them with newer studies is common sense. We can add the Keating reference about the Manga report if it has historical impact. QuackGuru 20:56, 29 April 2008 (UTC)

For example, the Workers' compensation studies are outdated. Newer studies are available. Anyone can search PUBMED and retrieve newer studies (). I hope this answered this question. QuackGuru 17:43, 30 April 2008 (UTC)

In this case, I disagree. This newer study isn't nearly as comprehensive. I would perhaps use both, but not remove the older, more comprehensive ones. -- Levine2112 17:47, 30 April 2008 (UTC)

The newer study is recent. I think it would be best to delete obsolete studies. If you want to find and and add more recent studies that is fine. QuackGuru 17:52, 30 April 2008 (UTC)

I still disagree. You are providing no new argument to change my position. I don't think that one newer but less comprehensive study trumps all the studies before it. This review for instance, provides excellent summaries of much of the research at hand, and perhaps would serve as the best source we currently have on the matter. It is a review of the literature and serves as the most comprehensive study we have found too date, in my opinion. Take a look and let me know your thoughts. -- Levine2112 17:56, 30 April 2008 (UTC)

I agree that we should be referring to recent reviews instead of to primary studies. Expert reviewers should be able to let us know which primary studies are with summarizing. We shouldn't be doing the reviewing ourselves, if reviews are available. Eubulides (talk) 18:06, 30 April 2008 (UTC)

No specific argument has been made to keep the outdated studies. If anything is worth keeping it should be put in the proper section. The obsolete studies have no historical impact. QuackGuru 22:23, 30 April 2008 (UTC)

You said the same thing about Manga, and that proved to be incorrect. Let's just cool down and discuss rationally before we go and remove/add anything to the article. -- Levine2112 22:30, 30 April 2008 (UTC)

The Manga report itself is not a historical reference and the section should be deleted. If editors prefer, they can use the references that describe the Manga report if those references are reliable and show historical impact. I said the Manga report should be deleted and I was correct. No argument has been presented for keeping the Manga report. We should not use the Manga report in the history section when the report is not a historical reference. There may be historical references decribing the Manga report and that is a different matter. We have newer references that discuss effectiveness that can replace the Manga report. The history section is about chiropractic history and not a place for outdated studies. Agreed? QuackGuru 22:46, 30 April 2008 (UTC)

older references are obsolete when newer references are currently available (common sense)

No specific argument has been made for keeping outdated and obsolete studies in the history section. The studies are not about chiropractic history and the studies themselves have no historical impact. We have newer effectiveness/cost-benefit studies anyhow. In any event, it would be best to delete all the obsolte studies.

http://en.wikipedia.org/Chiropractic#The_Manga_Report

http://en.wikipedia.org/Chiropractic#Workers.27_compensation_studies

http://en.wikipedia.org/Chiropractic#American_Medical_Association_.28AMA.29

http://en.wikipedia.org/Chiropractic#British_Medical_Association

All the above sections contain old studies. They are obsolete. This has been discussed long enough. Going once... going twice... and it will be deleted if no specific objections are made. Please provide a specific reason if you disagree. Agreed? QuackGuru 06:38, 2 May 2008 (UTC)

Specific objections have been made, including "old does not equal obsolete". Further, don't remove anything without consensus. This conversation spans several area. Let's start a new section in which we propose specific revisions. -- Levine2112 06:48, 2 May 2008 (UTC)

P.S. As far as I know, the policies of the AMA and BMA with regards to chiropractic have not changed. Thus, those sections are clearly not obsolete. -- Levine2112 06:50, 2 May 2008 (UTC)

P.S.S. Where is the Misplaced Pages policy which supports: "older references are obsolete when newer references are currently available"? -- Levine2112 06:57, 2 May 2008 (UTC)

When newer references are available the older ones are obsolete. We have newer references that discuss the same or similar topics as the AMA and BMA does (examples,). P.S., it is common sense to delete older studies and replace them when newer studies are available. Currently, the history section contains unrelated information that is not specifically about chiropractic history. Why should we keep older studies when newer studies are current and up to date? QuackGuru 07:18, 2 May 2008 (UTC)

Two things here Quack Guru -

1. I support your push for the re-writing of the History section. At present Manga and the WC studies can too easily be read as providing information on effectiveness. We need RS sources naming the important events/studies/laws/milestones - (these will be Chiro and Medical and other sources). I have no doubt that Manga and WC studies will feature in the future History section but they will be described in terms of their effects in relation to Chiropractic with only a brief description of their actual findings. A fuller explanation of the findings and and effects would probably be better placed in a separate article on the Manga report if sufficient material is available.
2. I find your claim that these sources cover similar territory as the current History/AMA or History/BMA sub-sections incomprehensible. Please explain your claim. SmithBlue (talk) 08:40, 2 May 2008 (UTC)

These recent studies () cover a similar topic that AMA and BMA covers. AMA is about efficacy. We have newer source available. The BMA is is about referring patients to practitioners which we have newer sources available. These studies (AMA and BMA) are not about history. That is a separate issue. We have newer sources available for efficacy/benefit and references for historical content (). The more recent studies about effectiveness/cost-benefit can replace the older studies. For the history section, the older obsolete studies should be deleted. The content is unrelated to history. There is no need to replace those obsolete studies in the history. We can replace those obsolete studies in new sections such as cost-benefit. The first step is to delete all the unrelated content to chiropractic history. I reviewed each and every source that is unrelated to chiropractic history. Those old sources are absolete. Newer sources covering similar topics exist. The unrelated content to history should be deleted. If editors find specific references for the history section then those can be used but not the obsolete studies. If anyone thinks any of the obsolete studies are still current I would like that explained or we can delete the obsolete studies. There are a lot of newer sources available that cover effectiveness/cost-benefit that can replace AMA and BMA among other things with newer sections such as Effectiveness and Cost-benefit. Anyone is free to rewrite the history section but that is not the point of this discussion. If no rewrite happens then I still think we should delete the unrelated content. It is important for editors to realize there is unrelated content in chiropractic history section. Those older studies are obsolete when we have plenty of newer studies available. I am saying we can delete the unrelated content to chiropractic history and to also use newer sources for new sections. I could update the history section with information about the Manga report from a historical perspective. But I think some editors want to take it slow or reject a rewrite. They want to keep the most if not all of the outdated studies and reject the newer studies. BTY, I have already rewritten part of the history section and finished the effectiveness section and started a new cost-benefit section. The newer sources about effectiveness are current and the older references on the same topic are obsolete. It's time to move the article forward. Adding the new information will be an improvement IMHO. QuackGuru 18:10, 2 May 2008 (UTC)

For what it's worth, I agree with SmithBlue and QuackGuru that Chiropractic#History needs to be rewritten, and that the Manga and WC studies should be supported by reliable sources on chiropractic history rather than by the studies themselves. I have not had time to read all those sources that QuackGuru mentions, but if QuackGuru has read them all then I suggest that QuackGuru draft a new History section based on them. I encourange the draft to cover the entire sweep of chiropractic history, not just on a few events. Eubulides (talk) 19:30, 2 May 2008 (UTC)

Quack Guru your appreciation of Chiropractic history, like mine, needs to expand, Chiropractic is a profession which we show, in Wilks etc, has been ostracised and conspired against by a very powerful profession (the medical profession) The AMS and BMA subsections address steps in Chiropractic gaining professional recognition. Removing them makes as much sense as removing a section on the Magna Carta from a "History of English law".

The single reference you supply for chiropractic history (Cooper 2003) is fine as far it goes. However it is just one POV - in history we are dealing with multiple POVs. We need to present all notable ones WP:NPOV. We need to present the Chiropractic profession's view of its own history as well as other views. We are dealing with the history of a profession here - professional recognition is rather central. SmithBlue (talk) 02:01, 3 May 2008 (UTC)

On further surfing I find Chiropractic history. So a detailed presentation of Chiro/History is not required here. Which leaves us to reach concensus on what is better included here. Have started new section below for this dicussion. (The layout of this page at present makes it very difficult to use.) SmithBlue (talk) 02:22, 3 May 2008 (UTC)

It would be best to use references that describe the AMA () and BMA () in a historical perspective instead of the references themselves.

The Manga Report as well as Workers' compensation studies sections are unrelated to chiropractic history and no specific reason has been given for keeping them. We have newer sources describing the Manga report () and newer sources on Workers' compensation (). QuackGuru 04:30, 3 May 2008 (UTC)

The obsolete sources are old and newer sources exist. For the time being, we can delete the Manga report section and the Workers' coompensation studies section. Theses dated studies are unrelated to chiropractic history. We can use newer studies available that have historical interest. For example, we have newer sources availble that discuss the Manga report. And we have newer sources available for the workers' compensation studies for a new section under cost-benefit. My specific revision is to delete both of obsolete sections (Manga and WC studies) and editors can improve the article where appropriate. Going one... going twice... QuackGuru 20:30, 4 May 2008 (UTC)

We explained very clearly that the obsolete studies are not current. But no good reason has been given for keeping POV material in the article. This misleads the reader to readd obsolete studies to mainspace. The controversial edit did not benefit the project. Please provide evidence if any of the obsolete studies should be reworked in a rewrite. If no evidence is provided to rework any of the oudated studies it will be deleted again. Going once... going twice... QuackGuru 23:39, 5 May 2008 (UTC)

There are several sources already given on this talk page (such as this one) which discuss the historical significance of the studies such as Manga. I don't understand why you keep ignoring these. Further, there is no consensus to remove any of the content discussing these studies until a rewrite of the history section which incorporates these studies meets consensual agreement. -- Levine2112 23:52, 5 May 2008 (UTC)

The sources on the talk page (such as this one) differ from the sources in the article. I added many of the sources to the talk page. The claim of me ignoring them is false. There is no consensus for keeping a misrepresention of chiropractic information (misleading to the reader) in mainspace. No evidence has been provided for keeping any of the POV material or the obsolete sources in the article. Please provide any evidence that these outdated sources should be worked into a rewrite. QuackGuru 00:06, 6 May 2008 (UTC)

This edit added unsourced POV material to the article and added unrelated content to the history section. The Manga report failed verification and the Workers' compensation studies contains obsolete studies. We have newer sources available on both topics. For the Manga report, we have references that describe the Manga report. For the workers' compensation studies, we have newer sources available. Both sections should be deleted. This POV change should be reverted. The oudated workers' compensation studies are not current and the Manga report is not properly sourced. QuackGuru 04:07, 6 May 2008 (UTC)

Medical opposition

The AMA and BMA information (along with a possible rewrite of AMA and BMA) should be under the Chiropractic#Medical opposition section and not its own sections. QuackGuru 18:04, 3 May 2008 (UTC)

My specific revision is to merge AMA and BMA sections into the medical opposition section. Going one... going twice... QuackGuru 20:33, 4 May 2008 (UTC)

Merge it and find other notable medical associations (i.e. Australia) and get their take on intedisciplinary collaboration with DCs. Not sure if it's appropriate under "opposition" per se; but we can always move the merged material later on if need be. CorticoSpinal (talk) 20:48, 4 May 2008 (UTC)

I prefer peer reviewed journals if available. Here is AMA's position statement on complementary medicine as of 2002. QuackGuru 21:04, 4 May 2008 (UTC)

Glad to see you prefer peer-reviewed sources, as do I. It would be preferred to get the official stance on 'chiropractic care/medicine' as CAM is large umbrella. CorticoSpinal (talk) 21:13, 4 May 2008 (UTC)

I prefer peer reviewed but if we can't find any peer reviewed sources we can always use the sources that are presently available. QuackGuru 21:25, 4 May 2008 (UTC)

We will go ahead and merge the content into the appropriate section. QuackGuru 04:31, 5 May 2008 (UTC)

sources for chiropractic history

• Kaptchuk TJ, Eisenberg DM (1998). "Chiropractic: origins, controversies, and contributions". Arch Intern Med. 158 (20): 2215–24. PMID 9818801.

• Keating JC Jr (2008). "William D. Harper, Jr, MS, DC: Anything Can Cause Anything". JCCA J Can Chiropr Assoc. 52 (1): 38–66. PMID 18327301.

• Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther. 26 (5): 300–21. doi:10.1016/S0161-4754(02)54125-7. PMID 12819626.

• Homola S (2006). "Chiropractic: history and overview of theories and methods". Clin Orthop Relat Res. 444: 236–42. doi:10.1097/01.blo.0000200258.95865.87. PMID 16446588.
• DeVocht JW (2006). "History and overview of theories and methods of chiropractic: a counterpoint". Clin Orthop Relat Res. 444: 243–9. doi:10.1097/01.blo.0000203460.89887.8d. PMID 16523145.

• Martin SC (1994). "'The only truly scientific method of healing'. Chiropractic and American science, 1895–1990". Isis. 85 (2): 206–27. doi:10.1086/356807. PMID 8071054.

• Martin SC (1993). "Chiropractic and the social context of medical technology, 1895–1925". Technol Cult. 34 (4): 808–34. PMID 11623404.

• Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med. 136 (3): 216–27. PMID 11827498.

• Chiropractic: An Illustrative History. Mosby. 1994. pp. 528 pages. ISBN 0801677351. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help) correct title: Chiropractic: An Illustrated History

• McDonald WP, Durkin KF, Pfefer M; et al. (2003). How Chiropractors Think and Practice: The Survey of North American Chiropractors. Ada, OH: Institute for Social Research, Ohio Northern University. ISBN 0972805559. {{cite book}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) Summarized in: McDonald WP, Durkin KF, Pfefer M (2004). "How chiropractors think and practice: the survey of North American chiropractors". Semin Integr Med. 2 (3): 92–8. doi:10.1016/j.sigm.2004.07.002. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)CS1 maint: multiple names: authors list (link)

• Chiropractic in the United States: Training, Practice, and Research Chapter I: A Brief History of Chiropractic by Reed B. Phillips, DC, PhD
• History of Chiropractic Care ACA

• Keating, Joseph C. (2004). "Chiropractic History: a Primer" (PDF). Association For The History Of Chiropractic. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Martin, S. (1993). "The Limits of Medicine: A Social History of Chiropractic, 1893--1930". Chiropractic History. 13 (1): 43. (Yes, there is a journal, Chiropractic History)
• THE EVOLUTION OF CHIROPRACTIC — SCIENCE & THEORY Haldeman 2000 evolution of Chiro theory

• Keating JC Jr (1997). "Faulty logic & non-skeptical arguments in chiropractic" (PDF). Retrieved 2008-03-15. {{cite journal}}: Cite journal requires |journal= (help)

• Grod JP, Sikorski D, Keating JC Jr (2001). "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". J Manipulative Physiol Ther. 24 (8): 514–9. doi:10.1067/mmt.2001.118205. PMID 11677551.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• "Canada Celebrates 100 Years of Chiropractic". Dynamic Chiropractic. July 17, 1995. Retrieved 2008-05-01. {{cite web}}: Cite has empty unknown parameter: |coauthors= (help)

• Lowry F (1994). "Orthopedists have bone to pick with economist over report on chiropractic". CMAJ. 150 (11): 1878–81. PMID 7802764.

• Manga P, Angus D (1994). "Report on chiropractic". CMAJ. 151 (8): 1107–8. PMID 7922936.

• Chapman-Smith DA (1994). "Report on chiropractic". CMAJ. 151 (8): 1108. PMID 7802806.

• Hoaken PC (1994). "Report on chiropractic". CMAJ. 151 (8): 1110. PMID 7922937.

• Tardif GS (1994). "Is the chiropractic management of low-back pain the solution? What can physicians learn from the Manga report?". CMAJ. 151 (9): 1247–9. PMID 7954171.

• Manga P (1994). "Defending the Manga report on the chiropractic management of low-back pain". CMAJ. 151 (9): 1250–1. PMID 7954172.

commentary on sources for chiropractic history

:Quack Guru, let's discuss one of the sources you have given to show that Manga is not a notable part of the history of chiropractic; "Anything Can Cause Anything" by Keating. This appears to me to be a biography/memoriam of an individual who died in 1990. Not surprisingly the only sources includued for material after that date are directly connected to historical material on Harper himself.

Please explain how you see the absence of Manga from this article] on some-one deceased in 1990 as bearing on the importance of Manga (1998) to chiropractic history. SmithBlue (talk) 02:38, 27 April 2008 (UTC)

If you'll do the same for another source you give "Chiropractic: An Illustrated History isbn=0801677351" cause again I'll need you to explain how a book published in 1994 could reflect on the Manga(1998) report. Am now hoping these references are adressing Chiro history in a far broader way and are not adressing Manga inclusion/exclusion. SmithBlue (talk) 03:34, 27 April 2008 (UTC)

We can add relevant studies and articles and chiropractic history. The most notable chiropractic historian is Keating. QuackGuru 18:15, 26 April 2008 (UTC)

I'm not sure I get the point of the chiropractic history sources section. Is it about a rewrite for Chiropractic#History? If so, that's a big project; there's a lot wrong with that section (for one thing, it has serious bias problems aside from its presentation of the Manga and other obsolete reports). But if this is just about the Manga reports, then that's a different story. For example, Meeker & Haldeman 2002 cites multiple sources on cost but does not cite Manga; it cites more-recent sources that are far more reliable than Manga. Perhaps there is a reliable source somewhere that Manga is an important part of chiropractic history, but so far we haven't seen it cited here. Eubulides (talk) 08:46, 27 April 2008 (UTC)

The chiropractic history needs a bit more information. The older studies (including the Manga report) that have no impact to chiropractic history will be deleted. If editors are willing, they can add new information using references that are specifically about chiropractic history. This is not a rewrite proposal. This is a suggestion for anyone to work on to add more info to the history section if anyone is interested. QuackGuru 09:10, 27 April 2008 (UTC)

In a research paper from 1997 criticizing the unscientific and uncritical culture of chiropractic, Keating mentions the Manga study approvingly as a recent (at the time) study on cost-effectiveness.

“A cost-effectiveness study of chiropractic services commissioned by the Ministry of Health for the Canadian province of Ontario strongly endorsed chiropractic management of low back pain (Manga et al., 1993)” Manga is part of history and should be in this article. However, Manga has problems and these should be mentioned, as well. Look at how many DC websites still use The Manga Report as advertising.CynRNCynRN (talk) 15:57, 28 April 2008 (UTC)

I have added 2 more sources to the list above. I highly recommend the book Chiropractic History - a Primer to anyone editing this page. (It does not mention Manga, but would also be a good source for integrative medicine, wouldn't it?) DigitalC (talk) 11:30, 3 May 2008 (UTC)

Straight v. mixer

State laws to regulate and protect chiropractic practice were eventually introduced in all fifty states in the US, but it was a hard-fought struggle. Medical Examining Boards worked to keep all healthcare practices under their legal control, but an internal struggle among DCs on how to structure the laws significantly complicated the process. Initially, the UCA, led by BJ Palmer and armed with his philosophy, opposed state licensure altogether. Palmer feared that such regulation would lead to allopathic control of the profession. The UCA eventually caved in, but BJ remained strong in the opinion that examining boards should be composed exclusively of chiropractors (not those who mixed chiropractic with other remedies). Mixers campaigned to alter education standards toward those of medical schools and consistent with the tenets of the medical profession while Palmer resisted any alteration in standards away from his conceptualization of the chiropractic profession.

Comments for Straight v. mixer

Here is some old info. Is this too old for the history section? QuackGuru 04:16, 25 April 2008 (UTC)

This is the kind of quality that is fitting of encyclopaedic content. Annals of Int Med has a few reliable and verifiable statements about the straight vs. mixer debate. Interestingly enough, I've been reading some of the research activities of the straight wing. The most notable thing is that they're not even really straight anymore because most of them do counseling, exercise prescription and ergo/postural correction as well. The sophistication of the research designs using a qualitative, whole system research yields compelling preliminary evidence in a few notable non-nms conditions, including recently a study on chiropractic care and addiction which showed demonstrable increases in quality of life and function as well as a pretty plausible theoretical model. In short, there is beginning to be the buds of decent subluxation-based (i.e. mechanical joint dysfunction as described by Gatterman) research which comes from better clinical questions from DCs and DC/PhDs. I'm going to check out some of the non-chiropractic peer-reviewed journals that apparently published subluxation-based chiropractic care interventions. The abstract was good but I'll try reading the article and see if it's worthy of consideration for inclusion. With big claims requires big evidence. We shall see. CorticoSpinal (talk) 05:05, 25 April 2008 (UTC)

If we want to cover history encyclopaedically we need to bring more Keating (PhD) and Coulter (PhD) are considered chiropractic history and sociology experts, respectively. This is going to be a damn fine article when we get done with it. Featured article material, fo shizzle!

The straight v. mixer proposal needs a lot of work. First of all, it needs a lot more refs to verifiy the facts. Or maybe we can WP:IAR. QuackGuru 17:15, 25 April 2008 (UTC)

If you keep up the same good work as demonstrated above, I see no problem with you running with the ball. Important stuff does need to be noted 1) straights are the minority 2)straights are evolving to include more than just adjustment for vert sub correction (use their terms) 3) mixers are the majority 4)mixers and the EBM movement. Those are 4 key things which jumped out right off the bat. The Annals of Int Med piece (i forget the author) has some good points which I can personally attest to being truthful and correct (even though wikipedia isn't about truth it's always easier if it takes that into strong consideration). So, if it's OK, and you have the time, tighten up straight vs. mixer, but please be fair, use references from both sides of the fence (MD, DC) and make the tone right. Give it a shot and hopefully you can continue to surprise like above. CorticoSpinal (talk) 17:22, 25 April 2008 (UTC)

Safety sources again

This is a response to the question "Why is Haldeman et al and Cassidy et al. (who are the experts in manipulation and stroke) not be given equal weight (at the very least) to Ernst?" in #Comments on claim of bias and proposal for fix above. As I understand it, the question is why Chiropractic#Safety does not give Cassidy et al. (PMID 18204390) and Haldeman et al. (PMID 18204400) at least equal weight as Ernst 2007 (PMID 17606755). This topic was previously discussed in #Talk:Chiropractic/Archive 17#Safety section and this section continues that old thread.

To summarize the issue: in Chiropractic#Safety, Haldeman et al. is used to support the claim "Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions". Ernst is used to support the claim "The incidence of these complications is unknown, due to rarity, high levels of underreporting, and difficulty of linking manipulation to adverse effects such as stroke, a particular concern", which I believe is the point of controversy here.

Cassidy et al. is a primary study that is reviewed by Hurwitz et al. (PMID 18204386). Hurwitz et al. have this to say on the subject:

"There are, however, a number of case reports and case series which show temporal associations between interventions and potentially serious complications (e.g., Martienssen and Nilsson, 1989; Haldeman, 1999). These temporal relationships do raise the question about the potential of side effects from most noninvasive interventions. This is a field that deserves considerable further study and, as part of its mandate, the Neck Pain Task Force studied the relationship between chiropractic treatment and vertebrobasilar artery (VBA) strokes (these findings are summarized below).

"In a population-based case-control study, Rothwell et al showed an increased risk of VBA dissection within a week of a chiropractic visit among persons under age 45 years (odds ratio = 5.03, 95% CI = 1.32, 43.87). As part of the Neck Pain Task Force mandate, Cassidy et al extended these findings using both a case-control and case-crossover research design (a research design in which cases serve as their own controls until the event). This study confirmed an increased risk of VBA, but found a similar increase in risk of this form of stroke after visiting a primary care physician for neck pain. These findings suggest that the increased risk of VBA stroke associated with chiropractic and primary care physician visits is likely due to patients with headache and neck pain from VBA dissection (in the prodromal stage) seeking care before their stroke. Thus, although cervical spine manipulation cannot be ruled out as a potential cause of some VBA strokes, any potential risk is very small."

As per WP:MEDRS it is better to use a reliable review when one is available, as is the case here. I think the Misplaced Pages summary of the situation matches the union of Hurwitz et al. and Haldeman et al. and Ernst fairly closely. However, if you'd like to propose better wording based on Hurwitz et al.'s review, please feel free. For example, it would be fine to say "risk is very small" instead of "rare". Eubulides (talk) 21:53, 25 April 2008 (UTC)

Suggested change re stroke wording

Suggest change to "Vertebrobasilar artery stroke has similar statistical associations with both chiropractic services in persons under 45 years of age, and with general practitioner services, suggesting that these associations are likely explained by preexisting conditions." I see no reason for us to be contrasting the safety of DC and GP services by using "but" when the reference says that in this mmeasure they are similar.

I also note that the sentence whichs follows "Vertebrobasilar artery stroke is statistically associated..." appears to be a non sequitur - "These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation." - appears to refer to the strokes that have in the previous sentence described as likely due to "pre-existing conditions". If we are presenting a separate view/model of VBA with this latter sentence we need to let the reader know this. SmithBlue (talk) 06:52, 26 April 2008 (UTC)

• The cited source uses "but"; it says:

"There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke." (Haldeman et al. 2008, PMID 18204400)

Given that the cited source is contrasting the two services, shouldn't we be doing something similar?

• Thanks for noticing and mentioning the confusion with the "These strokes" sentence. We can fix that by replacing this:

"These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation."

with this:

"Strokes after cervical spine manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication."

which should clear up the confusion (and is shorter to boot).

Eubulides (talk) 08:46, 27 April 2008 (UTC)

I am unconvinced that we benefit the reader by continuing the "surprise of similar risk" of GP and chiro services here. What do you wish to communicate to the reader by using "but" instead of "and"? If you think communicating "surprise!" here is helpful I can live with that.

The "but" is there for the same reason it's there in the source. There's a finding that manipulation of the cervical spine is slightly risky, but there's a similar risk in GP care for the same sorts of problems, suggesting that the risk is caused by the underlying problems and not by the care. Eubulides (talk) 06:58, 28 April 2008 (UTC)

The problem with the juxtaposition of the sentences remains, whether as they are at present, or as you suggest.

1. "Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. Strokes after cervical spine manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication.[64}"

They take the form:

1. "A is similarly associated with B and C, likely that A is related to pre-existing D. A is caused by E."

2nd sentence contradicts 1st sentence. If we are shifting explanation/model/source then we must make explicit that these statements are reflecting differing explanations/models/sources.

The serious problem with these sentences is that they reflect works by the same researcher; Haldeman - the first source is published in 2008, the second is published in 2002. Normally in such situations the older source might be presented 1st as history and then the new source presented as the current understanding. Why is this development being presented as a contradiction? SmithBlue (talk) 11:11, 27 April 2008 (UTC)

There is no contradiction between these two sentences. The first sentence talks about a statistical association. The second sentence talks about causation. They are not the same thing. It is possible for A to cause B even though A is not statistically associated with B; this can happen if B is also caused by other factors with much greater statistical association, which swamps the statistical association between A and B so that we cannot measure it. If you would prefer putting the second sentence first, to reflect the historical order of the sources, that would be fine. Also, since this subject seems likely to come up again, it would help to mention the distinction between association and causation. In other words, how about if we replace this:

"Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation."

with this:

"Strokes after cervical spine manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke."

? Eubulides (talk) 06:58, 28 April 2008 (UTC)

1. Haldeman (2002) says its inherent.
2. Haldeman(2008) says evidence suggests the likely explanation is common pre-existing condition.

These are contradictions. Given that both are Haldeman, presenting them as a development of understanding of VA stroke would be common practice. To present them as you suggest (or as at present) is misleading and confusing. SmithBlue (talk) 08:16, 28 April 2008 (UTC)

They are not contradictions, for the reasons explained: the first is about causation, the second is about statistical association. The third reference (Miley et al. 2008) cited in the proposed rewrite is also about causation. This is not a case of "development of understanding": Miley et al. is the most recent citation. It is a case of the difference between statistical association and causation. Eubulides (talk) 16:35, 28 April 2008 (UTC)

Haldeman 2002 is a study on 64 cases of cerebrovascular accidents temporally associated with cervical spine manipulation. Haldemans suggested explanation of risk to patients, for these temporal associations, was, "It is, however, possible to inform the patient of this risk, to discuss the relative risk ..., and to explain that according to the current understanding of this problem, cerebrovascular symptoms are unpredictable, inherent, and rare complications of cervical manipulation."

Haldeman 2008 clearly states that the most likely explanation for the associations is a pre-existing conditions. Associations here refers to the statistically significant temporal assocition between either GP or DC service and VA stroke.

Haldeman 2002 is no more relevant to causation than Haldeman 2008. Haldeman 2002 did not research the mechanism of the stroke - only statistical correlates such as putative risk factors, symptoms after stroke, treatment, outcome etc. To cherry pick the presently used quote from an outdated 2002 study on statistical associations is misleading. The presently used 2002 quote was expressedly "the current understanding" for patient education. The other expression of this point stated in the article "These complications appear to be unpredictable, and should be considered as inherent and idiosyncratic" is in far less definite language. ANd is superceded by Haldeman 2008 as his view of the current understanding. The material we include about this supercession will need to clearly tell the reader that we are discussing a changing view. SmithBlue (talk) 01:14, 29 April 2008 (UTC)

That's a good point. Chiropractic#Safety is about the current understanding, not about history (that's for Chiropractic#History), so let's drop Haldeman 2002 entirely, then, since it's superseded by more-recent material. Also, as noted below, the current text somewhat-confusingly refers to the executive summary of the review, rather than the review itself; it'd be better to just cite the review and summarize what it says. Combining all these suggestions, how about if we replace this:

"Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation."

with this:

"Several case reports show temporal associations between interventions and potentially serious complications. Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke." (*)

? Eubulides (talk) 06:58, 28 April 2008 (UTC)

Unfortunately I do not have online journal access and am unable to read more than the abstract which precludes me giving a useful reply at present. SmithBlue (talk) 08:56, 30 April 2008 (UTC)

Excellent point, SmithBlue. I also question why the full findings of the Task Force, which has been described as the "one of the most important research and policy documents ever published for the chiropractic profession" here gets exactly 1 sentence. Undue weight? Surely. Time to fix this. CorticoSpinal (talk) 22:54, 27 April 2008 (UTC)

SmithBlue's point is discussed above. The safety findings of the Task Force on Neck Pain, as expressed in its executive summary (Haldeman et al. 2008, PMID 18204400), are fully summarized in Chiropractic#Safety. Eubulides (talk) 06:58, 28 April 2008 (UTC)

I think working from full documents, not summaries, allows for a better distillation of the source. Who's got access? SmithBlue (talk) 08:16, 28 April 2008 (UTC)

When there are a reliable review sources, as is the case here, it is not our job to reach down into primary studies and distill them ourselves. There are thousands of primary studies, and it would be all too easy for us to introduce bias by distilling studies, or parts of studies, whose results we happen to prefer. In cases like this, as per WP:MEDRS, we should be relying on reliable secondary reviews to do the distillation for us: we should not substitute our judgment for the judgment of experts in the field. Eubulides (talk) 16:35, 28 April 2008 (UTC)

If Eubulides would be kind enough to show a cite stating that exectutive summaries of reports are considered reliable review sources? SmithBlue (talk) 01:14, 29 April 2008 (UTC)

The executive summary summarizes the review in Hurwitz et al. (PMID 18204386), whose findings about the primary study in question are quoted in #Safety sources again above. The primary study, the review, and the executive summary are all by the Task Force on Neck Pain. Chiropractic#Safety says everything about the primary study that the review and the executive summary says. Eubulides (talk) 08:29, 29 April 2008 (UTC)

And if that source could also state that the existence of an executive summ absolutely preludes the use of the full paper? SmithBlue (talk) 01:24, 29 April 2008 (UTC)

WP:MEDRS does not absolutely preclude anything. It is guideline, not policy. However, it is a guideline that works well and makes a lot of sense. Without that guideline, it's all too tempting for Misplaced Pages editors to reach down into primary studies to pick out tidbits that agree with their personal opinions. It's far better to rely on the opinions of published experts in the field instead, and to use the experts' reviews when available. Eubulides (talk) 08:29, 29 April 2008 (UTC)

If such sources are not to be found I will ask Eubulides to remember that we are here to further develop WP and that seeking to prevent even the exploration on the talk page of the full document, as Eubulides has done above, is not congruent with our purpose (or the primary WP:IAR). SmithBlue (talk) 02:31, 29 April 2008 (UTC)

First, there seems to be some confusion here about the executive summary and the review it summarizes, which I have attempted to fix in the latest draft wording. Second, I have not attempted to prevent the exploration on the talk page of the full document. Please feel free to talk about the full document here. Eubulides (talk) 08:29, 29 April 2008 (UTC)

For the record, this is the same kind of argument and wikilawyering Eubulides has used to prevent the inclusion of high quality "primary studies" whilst keeping weak "secondary" studies. It's always "reaching down" and "substituting judgment". This is the tactic used to keep out high quality, peer-reviewed, scientific chiropractic research by DC/PhDs out of chiropractic and, especially, out of safety. There is a huge weight violation by neutering and spaying the WHO Joint Task Force Neck Pain report conclusions and mentioning one tiny line that Eubulides' later rebuts with a dated study. Not cool. CorticoSpinal (talk) 23:51, 28 April 2008 (UTC)

All of the the executive summary's and the corresponding review's conclusions about chiropractic safety have been presented in the revised wording. It would not be right to override these experts by reaching down into primary studies that they have reviewed, and to present our own, differing opinions of those studies. Eubulides (talk) 08:29, 29 April 2008 (UTC)

Thank you for your detailed reply. On reviews - my understanding is that reviews are conducted to draw out specific and relevant finding for a specific purpose. The purposes of a reviewer may or may not accord with WP needs for documenting evidence on a specific topic. If we need to reach down into these reviewed studies, which may well have been conducted for purposes not wholely aligned with our article topic, there is nothing in WP:RS or WP:MEDRS that prevents us doing so. If we do reach down we will need to excercise far greater caution than usual to ensure that we are not presenting WP:OR. Hopefully all editors here would contribute to that caution. SmithBlue (talk) 09:03, 29 April 2008 (UTC)

The presentation of these safety studies does not attain WP:NPOV "representing significant views fairly, proportionately and without bias." SmithBlue (talk) 02:31, 29 April 2008 (UTC)

I have proposed a change in wording, marked (*) above, that attempts to address the issues you raised. Eubulides (talk) 08:29, 29 April 2008 (UTC)

No objection was made to the proposed change marked (*), so I installed that change. Eubulides (talk) 19:38, 2 May 2008 (UTC)

What does SmithBlue's objection just above refer to: "The presentation of these safety studies does not attain WP:NPOV 'representing significant views fairly, proportionately and without bias'"? Further, I think that any of the studies which confound general SMT with that performed by a chiropractor specifically should be removed. This is the chiropractic article and thus if safety is to be discussed, it should be discussed as the "Safety of Chiropractic" and not as the "Safety of SMT". -- Levine2112 19:44, 2 May 2008 (UTC)

I believe SmithBlue's objection refers to the old wording, which was replaced by the change. The change did not address the other issue that you mention, as the old and the new versions both cite studies which talk about SMT (as opposed to chiropractic care). So that issue is orthogonal to this change, though obviously it is an issue that might be a subject of future changes. Eubulides (talk) 19:54, 2 May 2008 (UTC)

These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation. This sentence was deleted. I think it added something to the article. Or was it duplication. QuackGuru 21:46, 3 May 2008 (UTC)

That was removed because SmithBlue objected that the cited source (Haldeman et al. 2002, PMID 11805635) was to some extent obsoleted by the more-recent source (Hurwitz et al. 2008, PMID 18204386; Haldeman was part of the same Task Force as Hurwitz). To some extent the removed text was duplicative of the newly added sentence that is supported by Miley et al. 2008 (PMID 18195663). Eubulides (talk) 06:58, 4 May 2008 (UTC)

Significant (Deliberate?) Omissions from Safety

Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces.

Spine. 33(4S) Supplement:S170-S175, February 15, 2008. Boyle, Eleanor PhD *+; Cote, Pierre DC, PhD *+++; Grier, Alexander R. DC, MBA ; Cassidy, J David DC, PhD, DrMedSc *+++

Abstract: Study Design. Ecological study.

Objectives. To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization.

Summary of Background Data. Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level.

Methods. All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates.

Results. The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period.

Conclusion. In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study.

Spine. 33(4S) Supplement:S176-S183, February 15, 2008. Cassidy, J David DC, PhD, DrMedSc *+++; Boyle, Eleanor PhD *; Cote, Pierre DC, PhD *+++; He, Yaohua MD, PhD *; Hogg-Johnson, Sheilah PhD +; Silver, Frank L. MD, FRCPC ; Bondy, Susan J. PhD + Abstract: Study Design. Population-based, case-control and case-crossover study.

Objective. To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke.

Summary of Background Data. Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke.

Methods. Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls.

Results. There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke.

Conclusion. VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

Treatment of Neck Pain: Noninvasive Interventions: Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

Best Evidence on Assessment and Intervention for Neck Pain

Spine. 33(4S) Supplement:S123-S152, February 15, 2008. Hurwitz, Eric L. DC, PhD *; Carragee, Eugene J. MD, FACS +++; van der Velde, Gabrielle DC **; Carroll, Linda J. PhD ++; Nordin, Margareta PT, DrMedSc ++++; Guzman, Jaime MD, MSc, FRCP(C) ; Peloso, Paul M. MD, MSc, FRCP(C) ***; Holm, Lena W. DrMedSc +++; Cote, Pierre DC, PhD **; Hogg-Johnson, Sheilah PhD ; Cassidy, J David DC, PhD, DrMedSc **; Haldeman, Scott DC, MD, PhD **** Abstract: Study Design. Best evidence synthesis.

Objective. To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders.

Summary of Background Data. No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade.

Methods. We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis.

Results. Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.

Conclusion. Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.

These omissions don't even take into account the negative tone as implied by Eubulides' drafts (going on 4 now). A casual reader will leave with the impression that manual therapy (predominantly manipulation) is riddled with "minor and adverse side effects" and listed tons of contraindications. Safety ignores that manual therapy has been proven to be effective in grades I, II non-traumatic neck pain. There are other major omissions but I'd like to get feedback first. For the record, SB, I now have full access to journals once again, so if you ever need me to reproduce a certain subsection I can do so, as long as I'm not violating some kind of copyright. CorticoSpinal (talk) 20:34, 29 April 2008 (UTC)

• Of the three sources mentioned, the review (Hurwitz et al. 2008, PMID 18204386) is already cited by the most-recent proposed safety rewrite. The other two sources are primary studies and we don't need to mention them directly. There are dozens of primary studies on all sides of the safety issue: reaching down and citing just the ones we like, which is what seems to be proposed here (it's not exactly clear), is a recipe for introducing editorial bias.
• Minor adverse side effects are common and are worth mentioning briefly.
• Effectiveness is a different issue; this is the safety section, not the effectiveness section.

Eubulides (talk) 18:06, 30 April 2008 (UTC)

Please propose a suggestion (such a written sentence) for review using a ref (). QuackGuru 19:24, 29 April 2008 (UTC)

Use a direct quote from the conclusion "At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.". Simple, consise, clear, relevant and factual. CorticoSpinal (talk) 20:34, 29 April 2008 (UTC)

That primary source (Boyle et al. 2008, PMID 18204389) was reviewed by Hurwitz et al. 2008 (PMID 18204386), which is already cited in the proposed safety text. It would not be right to reach down and highlight a primary source that reliable reviewers have already deemed not worth notice. If that were allowed, skeptics of chiropractic would rightly ask why they couldn't also add "simple, concise, clear, relevant, and factual" statements like these: "Chiropractic by not being a drug nor a medical device has not been submitted to formal evaluation by the medicinal agencies. Similarly, its safety profile escapes to the pharmacovigilance networks." and "The described serious adverse events promptly recommend the implementation of a risk alert system." These are quotes from a primary source, namely Gouveia et al. 2007 (PMID 17904731), which is an example of dozens of critical primary sources that one could easily add to Chiropractic if standards were so low as to include that quote from Boyle et al. 2008. Eubulides (talk) 18:06, 30 April 2008 (UTC)

That sound simple and reasonable. -- Levine2112 20:57, 29 April 2008 (UTC)

It is a bad idea. Per WP:COPYVIO. QuackGuru 04:39, 30 April 2008 (UTC)

A single line quoted from an article is NOT a copyright violation. It is covered by fair use. DigitalC (talk) 05:56, 30 April 2008 (UTC)

I agree it's not a copyright issue. An entire sentence taken unchanged should be quoted and attributed, or (better) paraphrased carefully; either way, it would not be a copyright violation. The problem with the proposed addition is not copyright violation, it is that it highlights a primary study that our expert reviewers cite but do not highlight. We should not override the opinion of the published expert reviewers. Eubulides (talk) 18:06, 30 April 2008 (UTC)

Quack Guru, you seem to be working with a very unusual interpretation of WP policy. Unfortunately your interpretation, at least in this instance, could have the effect of disrupting editing. Quoting sentences, and paragraphs, is accepted and standard practice on WP. WP:MOSQUOTE gives details on how to quote multiple paragraphs. I suggest you retract your above comment suggesting that quotes are copyright violations. SmithBlue (talk) 06:09, 30 April 2008 (UTC)

I have rewritten the sentence hours ago without using any quotes. QuackGuru 07:56, 30 April 2008 (UTC)

With increased chiropractic utilization, the increase in VBA stroke does not seem to be associated. This is a primary study. QuackGuru 17:41, 1 May 2008 (UTC)

Relevant papers

I will the relevant passages from relevant papers to help bring the tone to more NPOV. We simply cannot pass over high quality lit by stroke and manipulation experts because of an arbitrary interpretation of a guideline. Invoking WP:IAR on this one. CorticoSpinal (talk) 17:38, 26 April 2008 (UTC)

I do not understand what arbitrary interpretation of a guideline should be avoided in order to invoke WP:IAR. QuackGuru 18:09, 26 April 2008 (UTC)

Well, here is the issue, as I understand it, from the orthodox med perspective on SMT and safety: 1) DCs and stroke are related and potentially causative 2) SMT is inherently dangerous with serious safety risks which results, at worst, in death 3) SMT is not a proven treatment for neck pain. So, when I find and present literature that tackles these 3 subjects and very soundly refutes it, it is argued that the studies don't belong. Well, I'm sorry, but I completely disagree and in order to preserve the reliablity of the project, I need to invoke WP:IAR so that the whole story is presented. Because as it stands, we don't even have 1 peep from the experts in stroke and manipulation, namely, Haldeman, Cassidy and Cote. CorticoSpinal (talk) 18:47, 26 April 2008 (UTC)

Please provide the references along with proposed text on the talk page for review. Keep in mind that when newer studies review older studies, we should use the newer studies. Makes sense? QuackGuru 19:18, 26 April 2008 (UTC)

QG, it's getting very tiring of hearing your demands and condescending tone. No, it doesn't make sense; the quality of the study, not the "recentness" matters in advacing the evidence in either direction. Clearly your knowledge of research and evidence-based methods is tenuous, at best, right now, but you can improve by reading up on Sacketts levels of evidence here; it will help you better appraise the quality, notability, reliability, validity and applicability of the sources you bring to the table. We are in the evidence-based era now (should be evidence-informed, but that's a separate matter) and research is the currency when staking claims. I hope you keep this in mind when you are editing other chiropractic medicine related articles; there's no point in having the same discussion 5+ times elsewhere. Cheers. CorticoSpinal (talk) 01:19, 27 April 2008 (UTC)

The quality of a study is obvious. For example, a primary study is weaker than a more recent review of the primary study. That said, a recent review study is much stronger and holds more weight. Sacketts lack of evidence here; is outdated and very old. It is clearly obsolete (unreliable). For example, Sacketts mostly uses references that are older than a decade. We have higher quality sources that are already in this article. QuackGuru 03:46, 27 April 2008 (UTC)

That simply isn't true. WP:MEDRS would have us believe that a review is higher quality than a primary study, but that is not the truth. A poorly designed systematic review, or a biased editorial review, should not hold more weight than a high quality, well designed primary study. DigitalC (talk) 22:53, 27 April 2008 (UTC)

It is true that a high-quality primary study is a better source than a bad review. But that is not what is happening here. The review in question (Haldeman et al. 2008, PMID 18204400) is high quality and is put out by the same group (the Task Force on Neck Pain) that sponsored the primary study in question (Cassidy et al. 2008, PMID 18204390). It would make little sense to reject the Task Force's own review of its own study. Eubulides (talk) 06:58, 28 April 2008 (UTC)

This doesn't appear to be a review, it appears to be an executive summary of the findings. DigitalC (talk) 22:46, 28 April 2008 (UTC)

The review is Hurwitz et al. (PMID 18204386). The executive summary summarizes this review. The review's coverage of this issue is quoted above, in #Safety sources again. As far as I am concerned, either the review or the executive summary could be cited in Chiropractic; the main reason the executive summary is cited in Chiropractic#Safety is that it's freely readable (the review is not). However, given the resulting confusion the latest draft (marked (*) above) cites the review instead. Eubulides (talk) 08:29, 29 April 2008 (UTC)

I've already mentioned this to him and it seemed to more of the same with his editing here WP:IDIDNTHEARTHAT. He also completely refuses to include the results of Cote et al. (2008) here published in Spine. Coincidence? I don't think so anymore, it's his attempt to not only to get allopathic med POV here, but it's to treat chiropractic like and marginalize the profession (just like the whole "dispute" over chiropractic scope of practice. The trend is unmistakingly clear now... CorticoSpinal (talk) 00:05, 29 April 2008 (UTC)

This is the first I recall hearing of Cote et al., although so many studies have been mentioned in this thread over the past couple of months that it's quite possible I forgot it. Shouldn't that be Boyle et al. 2008 (PMID 18204389), not Cote et al.? Anyway, that is a primary study that doesn't add much. Hurwitz et al. briefly mention Boyle et al. as being one of the task force studies, but they seem to think little of it, and do not mention it anywhere else that I can see. Unlike Cassidy et al., they mention it neither in their discussion of chiropractic safety nor in their conclusion. Let's stick with what the review (Hurwitz et al.) has to say here, since they already reviewed this primary study. Eubulides (talk) 08:29, 29 April 2008 (UTC)

. It's this type of editorial arrogance (Anyway, that is a primary study that doesn't add much) that prolongs this dispute. How many editors is it now that disagree with your stance? 5-6? This is a violation of WP:POINT, WP:IDIDNTHEARTHAT and a violation of WP:NPOV. This is getting out of hand. CorticoSpinal (talk) 20:39, 29 April 2008 (UTC)

Hurwitz et al. (PMID 18204386) review the source in question (Boyle et al. 2008, PMID 18204389), and don't think much of it. In contrast, they highlight the results of Cassidy et al. 2008 (PMID 18204390). We should follow the lead of the reliable reviewers and highlight Cassidy et al.'s result; we should n not substitute our own judgment for that of published experts in the field. It is not "arrogance" to prefer summaries of the opinion of expert reviewers; on the contrary, it is humility to avoid one's own opinion as much as possible, and to instead simply summarize the opinions of published experts. Eubulides (talk) 18:06, 30 April 2008 (UTC)

I have heard this same, tired argument time and time again and the majority of editors disagree with you here. I'm going to add the conclusions of the Boyle study as it is appropriate. CorticoSpinal (talk) 16:58, 4 May 2008 (UTC)

This is an incorrect summary of what the other editors have said on this subject. On the contrary, there is considerable sentiment that we should defer to reliable reviews in the area. Eubulides (talk) 08:15, 5 May 2008 (UTC)

Wilks v. AMA

Is there a reason that this section in the Chiropractic article doesn't link to the main article, here? DigitalC (talk) 01:57, 29 April 2008 (UTC)

I think it does link there. However, since it may be lost in the Wikilink, we may consider adding a Main article link such as the one at the top of the "Treatment procedures" section. -- Levine2112 02:23, 29 April 2008 (UTC)

Chester A. Wilk, DC from Chicago initiated an antitrust suit against the AMA and other medical associations in 1976 - Wilk et al. vs AMA et al. Here is the current sentence with the wikilink and it clearly works. QuackGuru 18:55, 29 April 2008 (UTC)

Totally. I think in addition to that we should add a Main article link such as the one at the top of the "Treatment procedures" section. -- Levine2112 18:59, 29 April 2008 (UTC)

What would be the purpose for having duplicate links. QuackGuru 19:07, 29 April 2008 (UTC)

The same as the History section does with vertebral subluxation. Making sure that the main article is easy to find for the casual reader. -- Levine2112 19:09, 29 April 2008 (UTC)

The section is too short to have a main article link. I can easily spot the main article link in that short section. QuackGuru 19:27, 29 April 2008 (UTC)

Disagree. It's a vital landmark in the profession. Another article which needs definite attention is verterbral subluxation. Skeptics have had field day with this and regular use it as a straw man to marginalize the profession and destabilize the main chiropractic article. Rightly or wrongly (I'm in the latter) the profession has chosen to retain this term. Hence it needs to be given the scientific treatment; as per the texts by Gatterman, Leach, Haldeman, Beck and Lederman. That will cool off the jets of more edit wars, reliable sources citing the experts in the field. CorticoSpinal (talk) 20:45, 29 April 2008 (UTC)

I don't think it is a big deal either way in terms of adding the Wilk main article link. But even DigitalC - a frequent contributor - overlooked the Wikilink and that is significant. As adding the main article link doesn't advance or detract from any specific viewpoint, I don't see the harm in adding it per DigitalC's request. -- Levine2112 21:08, 29 April 2008 (UTC)

I think the 1st sentence of this section could be re-written to be clearer which could well make the link more obvious too. SmithBlue (talk) 08:28, 30 April 2008 (UTC)

That should work. Any suggestions? -- Levine2112 17:24, 30 April 2008 (UTC)

If that works does it mean the main article link should be avoided now. QuackGuru 17:30, 30 April 2008 (UTC)

Let's see what the rewrite looks like and it that satisfies DigitalC's concern. -- Levine2112 17:42, 30 April 2008 (UTC)

I guess we should rewrite that first sentence either way, but I don't understand reasoning for NOT having a main article link. —Preceding unsigned comment added by DigitalC (talk • contribs) 23:13, 30 April 2008 (UTC)

There really isn't any reasoning against it. I don't mind adding it if only to make Wikipedian research easier. -- Levine2112 00:13, 1 May 2008 (UTC)

Problem with worker's compensation section

The last paragraph in the worker's comp section doesn't relate to the title of the section, as it is about patient satisfaction. Furthermore, the reference given, the Cherkin survey, doesn't support patient satisfaction. It talks about chiropractor's and physician's attitudes toward treatment of back pain: "Random samples of 605 family physicians and 299 chiropractors in Washington were surveyed to determine their beliefs about back pain and how they would respond to three hypothetic patients with back pain". This disconnect has been bothering me. Someone fix it please!CynRNCynRN (talk) 02:40, 30 April 2008 (UTC)

CynRN, there are a lot more problems with the Workers's compensation studies. For example, The text says in "1998" when the reference says "1988." A 1988 study is way too old when newer sources are available. QuackGuru 23:51, 1 May 2008 (UTC)

I explained about it in this thread. It contains obsolete studies. It will be deleted. That's my fix. QuackGuru 04:35, 30 April 2008 (UTC)

OK, sounds good. Will there be an updated summary of worker's comp studies?CynRNCynRN (talk) 16:07, 30 April 2008 (UTC)

I already did that hours ago. I will add an update to the article when it becomes unprotected. QuackGuru 17:19, 30 April 2008 (UTC)

Can you point me to where the updated summary of worker's comp studies are? It doesn't appear to me to be any consensus to delete this material. But perhaps I am overlooking it on this rather huge discussion page. Thanks. -- Levine2112 17:23, 30 April 2008 (UTC)

Got it? QuackGuru 17:46, 30 April 2008 (UTC)

So despite you adding that just after my request here, there still doesn't seem to be a consensus nor an updated summary as you suggest just above. All that is there is your opinion on the matter and much disagreement with your opinion. Thus, if you were to "add an update to the article when it becomes unprotected", it would be considered a tendentious edit. Please strive to work out a consensus version first, lest we find ourselves with a blocked article for another week or more. Make sense? -- Levine2112 18:00, 30 April 2008 (UTC)

Also, let's carefully consider this source which provides a comprehensive review of the literature. I think this may very well qualify as the best source we have. -- Levine2112 18:02, 30 April 2008 (UTC)

(outdent) As I understand it, the intent is to write a new cost-effectiveness/risk-benefit/etc. section based on the latest reviews of the subject. (A draft of sources for this section can be found in Talk:Chiropractic/Archive 17#Sources for risk-benefit and cost-effectiveness.) If these reviews refer to those old worker's compensation studies the new section should summarize them; if not, it won't. Either way, the new section will summarize higher-quality stuff that has come out more recently; that should suffice to cover the topic. This new section should be drafted and discussed on the talk page before going in. Eubulides (talk) 18:06, 30 April 2008 (UTC)

We also have from 2004 an updated Workmans Comp (WSIB)study performed by an independent 3rd party consulting firm. Conclusion? Go see for yourself! This should be included in any revision. I'm also a bit leary of any intent to do a risk/benefit section for the exact same reasons as described by the majority of editors when the proposed effectiveness went thud. CorticoSpinal (talk) 18:09, 30 April 2008 (UTC)

The proposed effectiveness section is still under discussion. Like any substantial change in a controversial article, we can expect a lot of discussion. Even in the unlikely event that the discussion results in no changes to Chiropractic's coverage of effectiveness, a failure to improve one part of the article does not mean we should give up trying to improve another part. Eubulides (talk) 18:37, 30 April 2008 (UTC)

Please point me to the specific policy where Wikipedians cannot start a stub section in mainspace. I will use newer, high quality studies and delete the obolete studies. Starting a stub section in mainspace is done everyday on Misplaced Pages. QuackGuru 18:29, 30 April 2008 (UTC)

For controversial articles like this one, it is common practice (and a good idea) to propose specific changes on the talk page first, so that they can be discussed. Please try that in this case. For non-controversial articles things are quite a bit easier, but this article is controversial. Eubulides (talk) 18:37, 30 April 2008 (UTC)

There was an edit conflict here, but Eubulides essentially took the words right out of my mouth. QG, please work to form a a consensus here first before inserting anything into the article. This article is too delicate to risk anything which might appear to be tendentious editing. Make sense? -- Levine2112 18:42, 30 April 2008 (UTC)

My question was not answered. Again. Please point me to the specific policy where Wikipedians cannot start a stub section in mainspace. QuackGuru 19:08, 30 April 2008 (UTC)

Agreed with Eubulides and Levine2112 on this one. Sure some studies like the old workmans comp can be pruned, but should be amalgamated with newer workmans comp stuff. So long as the studies are in the proper historical context and have the proper significance (Manga was a landmark study for the profession regardless of the controversy it may have generated afterwards) and that's important to note. I trust the judgment of chiropractic historians, such as Keating, PhD to determine the appropriate impact and weight rather than a skeptical editor who seems to abide by a deletionist policy rather than the favoured inclusionist one. Also, if there is no (majority) consensus for a stub, there's no stub. That's one of the important tenets of wikipedia per WP:CON. Your efforts and edits will be much better if you approach it that way, methinks. CorticoSpinal (talk) 19:12, 30 April 2008 (UTC)

Again QG, please consider WP:CON. While it doesn't prohibit you from making article edits on articles, it certainly recommends discusses edits first on talk. Given the contentious nature of this article and all of the recent article blocks, I and the other editors all agree to abide to talking out edits first. I hope you can see to it to abide by this too as bold edits to the article at this point may be viewed as disruptive. Further, please consider WP:DE as well as it may answer your question above even more directly. -- Levine2112 19:34, 30 April 2008 (UTC)

I do not see any harm for starting a new stub section in mainspace. This is done every single day on Misplaced Pages and this is normal practice. QuackGuru 20:08, 30 April 2008 (UTC)

The harm is that all the other editors who have spoken about this here would prefer if you didn't because it would be perceived as disruptive. Instead of posting your new stub section article space, all we are asking is that you post it here first so we can discuss. The block which the article is currently in was in effect started by you performing a similar action (installing the efficacy section before it had achieved consensus). The result was that was an edit war, the article was locked, morale fell, and civility and the spirit of cooperation dropped. So, you ask us now what's the harm in doing it once again when I should think it is plainly obvious from last time what the harm is. -- Levine2112 21:26, 30 April 2008 (UTC)

The article is currently locked up because a certain editor added original research and POV material to the article. How is it preceived as disruptive to start a new stub in mainspace when this is normal practice. Improving the article is not harmful. If someone disagrees based on POV issues like the Scope of practice, that is a different matter. It is up to the editor who disagrees to provide a reason why it does not meet Misplaced Pages's standard. If it does meets Misplaced Pages's standard, it is harmful to the project to blatantly delete NPOV written text, especially when using the newest available sources. The worker's compensation studies do not belong in the history section. It belongs in a new section titled cost-benefit. Most if not all of those studies are outdated anyhow. If there is anything worth keeping it should be put in the proper section under cost-benefit. QuackGuru 21:57, 30 April 2008 (UTC)

And the time before that, it was you adding the not-ready Efficacy section which lead to an edit war and the eventual block. See the pattern? See what happens when contentious material is added without consensus? Just be cool and let's discuss it first. That is the consensual wishes of everyone here. If anyone disagrees with me (anyone aside from QuackGuru) and rather thinks we should not discuss major edits first, please speak up now. Otherwise, this is the consensus on how we are going to move forward. We will discuss edits such as adding new sections/stubs to the article, work out a consensus version and then (and only then) insert in the article. -- Levine2112 22:06, 30 April 2008 (UTC)

Adding a new stub section is not a major edit. The obsolete studies have no place in the history section. And the Effectiveness seems ready now. QuackGuru 22:13, 30 April 2008 (UTC)

I am sorry, but I disagree. And so do others. You are going to have to wait. -- Levine2112 22:14, 30 April 2008 (UTC)

QG, you would be wise to heed Levine2112s and Eubulides advice. You're also ignoring the points we've mentioned above already; we're not suggesting we keep the obsolete studies, we suggest in making sure they're relevant and put in the proper context. Unilaterally deciding what stays, what goes is not the right way to go about this. CorticoSpinal (talk) 22:38, 30 April 2008 (UTC)

It makes sense to delete the obsolete studies that are unrelated to history. The proper context is to replace the outdated studies with the newer effectiveness studies. A stub section is not a major edit. Agreed? QuackGuru 22:59, 30 April 2008 (UTC)

We're going in circles here. Round and round. QuackGuru, you know everyone's position here. -- Levine2112 00:11, 1 May 2008 (UTC)

We can reach and strive for a better article and not the status quo. Just around the corner is a great improvement and thus a better article because of our efforts. It can be done easily, especially when arguments such as this makes sense. Please provide a reason for your desire to keep oudated studies and ignore newer effectiveness studies. Small improvements such as starting a new stub section (cost-benefit) will encourage thought and development to reach that elusive GA status. We can do this. Trust me, okay. QuackGuru 02:18, 1 May 2008 (UTC)

Disagreeing with isn't a lack of |good faith, QG. What perplexes me is how you do not seem to understand what we are proposing. Just because Manga is an old study does not mean it's not relevant to the profession. Keating says so many times as well. I don't know why you want this study gone so badly. We agree that we must use the best, recent and relevant sources for an update. I appreciate your efforts in attempting to bring this article to FA (featured article) not GA (I thought it was a typo, the f and g key are side by side!) status and we'll get there if we can avoid disruptive conversations on the Talk page of all places. 208.101.118.196 (talk) 04:21, 1 May 2008 (UTC)

I think we can reach common ground with the Manga report. The Manga report is out and it can be replaced with historical refs such as Keating. We can do the same with the other obsolete studies. They are also out and the newer studies are in. Sounds reasonable? QuackGuru 04:43, 1 May 2008 (UTC)

So I take it that you don't stand by this comment anymore? That you at least agree that Manga is of historical significance to Chiropractic? Yes? -- Levine2112 05:16, 1 May 2008 (UTC)

The Manga report itself is an obsolete study and no argument has been made to keep it. The Manga report itself has no historical impact. The Keating reference might be used as a historical reference. There are also more obsolete studies that should also be deleted. Agreed? QuackGuru 16:58, 1 May 2008 (UTC)

I sincerely apologize but continue to disagree with the same argument you keep repeating over and over again. Additionally I find it hard to understand that you maintain that the Manga Report has zero historical impact considering not just the Keating source, but the others I and others have provided above. Consider, for instance, this source. My feeling remains that Manga (and a few other of the landmark studies following Wilk) should be discussed for their historical context in our article. -- Levine2112 17:20, 1 May 2008 (UTC)

References that decribe the Manga report might be used if they are reliable and have historical impact. But the original Manga report is obsolete and should be deleted. The same goes for the other obsolete studies. Agreed? QuackGuru 17:29, 1 May 2008 (UTC)

Instead of talking about it like this, let's draft it up on this page. That way our discussions can be more tangible. -- Levine2112 17:53, 1 May 2008 (UTC)

The draft for the obsolete studies would be blank. QuackGuru 18:08, 1 May 2008 (UTC)

Why? I have already provided at least three sources above which show some of their significance in terms of chiropractic history. -- Levine2112 18:32, 1 May 2008 (UTC)

The obsolete studies would be blanked because we have newer studies available such as the ready effectiveness section. If you want to add new information using historical references about history that is a different issue. Feel free to edit the article and add historical information according to the sources. QuackGuru 19:10, 1 May 2008 (UTC)

All I am saying is don't blank, add, edit, remove, or delete anything from the article without a consensus to do so. This article is too volatile at the moment. Let's just take it slow. -- Levine2112 19:16, 1 May 2008 (UTC)

Please provide a reason for keeping obsolete studies and completely rejecting newer and ready effectiveness studies. Anyone is free to update the history section with references that discuss history. QuackGuru 19:23, 1 May 2008 (UTC)

No one is completely rejecting the newer studies. I just don't agree that they necessarily render the older studies obsolete. The older studies are seemingly much more comprehensive. Let's start first by drafting up a version which we can all live with before we make any further edits to the article. I think we have all agreed to abide by this except for you. This is out of interest of stopping any future edit wars and subsequent locking of the article. I think we all want to know that you will at least agree to abide by this. -- Levine2112 19:27, 1 May 2008 (UTC)

The obsolete studies have no place in the history section. The history section is specifically for chiropractic history and not a place for outdated studies. If there is anything worth keeping it should be added to the appropriate section. Newer studies on the same specific topic renders the older studies obsolete. A draft of obsolete studies? That would not be an improvement for this article. QuackGuru 19:59, 1 May 2008 (UTC)

. This has hit a new low. GQ, you are misrepresenting Levine2112's point. The fact that 3 sources (so far) has mentioned Manga as an important study illustrates the point that it's a notable. Next, there is confabulation with other topics which prevents this discussion from moving forward in a productive manner. CorticoSpinal (talk) 19:47, 1 May 2008 (UTC)

Anyone is free to update the article using historical references that mention the Manga report. But the Manga report itself is an obsolete study when we have newer effectiveness studies available. QuackGuru 19:59, 1 May 2008 (UTC)

Perhaps, but I just want your assurance that you will abide by the consensus here to discuss all changes (including removing, add, amending content) first and to arrive at some agreement before making changes to article space. Once you agree, I would very much be interested in moving forward discussing this matter with you and drafting up new versions of the content. -- Levine2112 20:02, 1 May 2008 (UTC)

I am not interested in drafting up new versions of outdated studies. QuackGuru 20:09, 1 May 2008 (UTC)

That's not what I am asking. I am asking you if you are willing to abide to our agreement not to edit the article without a consensual agreement here first. Are you willing to abide by this? -- Levine2112 20:11, 1 May 2008 (UTC)

If it's any consolation. . . I will abide by this too. . . Are we unanimous now (save Quackguru)?TheDoctorIsIn (talk) 04:17, 2 May 2008 (UTC)

Yes, as far as I can tell. Thanks, Doc. -- Levine2112 05:57, 2 May 2008 (UTC)

Me too. (for getting consensus on this before editing article) SmithBlue (talk) 06:21, 2 May 2008 (UTC)

How does Misplaced Pages work? An experienced administrator explained it best: CBM wrote in part: "we encourage people to edit the page first." Got in? QuackGuru 03:43, 5 May 2008 (UTC)

And a follow up reply from the same thread. - "Only newbies are expected to edit controversial articles as if talk pages do not exist. An experienced editor coming to a controversial article is expected to read the talk page history." DigitalC (talk) 03:00, 6 May 2008 (UTC)

That "experienced administrator" was foolishly encouraging grief. Here is my comment that immediately preceded the one quoted by QG:

• Generally any potentially controversial edit, especially on a controversial article, should be discussed on the talk page before even attempting the edit. Discuss it there, reach a consensus, and then make (or not make) the edit. It will then have a much better chance of surviving and edit wars will be avoided. -- Fyslee

the reply was:

• That isn't the way wikipedia is set up: we encourage people to edit the page first. -- CBM

Well, the typical BOLD, REVERT, DISCUSS editing pattern causes an awful lot of grief and edit wars on controversial articles, and I think that consensus is also an important part of policy, hence my comment. It would be nice if we could get a couple sentences echoing what I've written above included in policy here. We sorely need a whole paragraph or more dealing with how to edit controversial articles, because they definitely aren't like other articles, and editing them as if they were only leads to grief. If this could somehow cut down on the edit wars and bold, solo editing by various editors, it would sure make editing here a more pleasurable experience. -- Fyslee / talk 03:53, 6 May 2008 (UTC)

Reading this whole thread is quite an experience! One thing stands out, and it's QG's failure to seek to edit collaboratively. His continual insistance that bold, solo editing is OK is getting very tiring. Einstein stated that "Insanity is doing the same thing over and over again and expecting different results." QuackGuru, wake up and smell the flowers. They are over there, about 8 million light years away from Misplaced Pages. Go pick some and enjoy them......there. -- Fyslee / talk 04:02, 6 May 2008 (UTC)

Use of primary sources is permitted

I see a need to emphasise that the use of primary sources is standard, accepted and common practice on WP. WP:RS and WP:MEDRS do not in any way preclude their use. Reviews are conducted for specific purposes, they filter information in other studies and leave out what is not relevant to their specific purpose. Our purpose in improving Misplaced Pages will frequently not be a close match with the purpose of the review. It is only if there was an great similarity of the reviews purpose and our purpose that we might ignore primary studies. What has been promoted here in terms of ignoring primary studies can easily lead to important material on a topic being missed. WP needs to consider all relevant material. Checking for RS, NPOV, NOR or NSYNTH is the function of editors - attempting to tie our hands or blinker us on primary sources is not for the best of WP. Material from primary studies does need to be subjected to rigorous examination by editors, which I am confident will occur here.

Eubulides, you seem to be promoting a position here on primary sources that is at odds with Misplaced Pages policy. (I repeat "Those reliable reviewers can have a purpose skewed with respect to our purpose.") Changing WP policies will necessitate us engaging in other forums. Eubulides, is this your wish?

If your intention is to show that a specific review's purpose closely matches ours then I suggest that discussing the purpose of the review relative to our purpose here will at least promote useful discussion and be in-line with policy. SmithBlue (talk) 01:43, 1 May 2008 (UTC)

Recent reviews are better than the older primary studies covering the specific topic at hand. Our hands will be tied if we continue with the older studies and not emphasize the latest state of the art sources. QuackGuru 02:02, 1 May 2008 (UTC)

In your opinion do we need to closely consider the match between our topic and the purpose of the review? SmithBlue (talk) 02:20, 1 May 2008 (UTC)

I am not sure I understand your question. What I do know is this. Reviews evaluate primary studies for us. Know need to re-examine an older study. The review did it for us. QuackGuru 02:28, 1 May 2008 (UTC)

You have missed SmithBlue's point, QG. It boils down to this: research done DC/PhDs, MD/PhDs, PT/PhDs and published in a high impact journal (Spine) suddenly doesn't meet Eubulides criteria. I have argued that such studies and not only reliable and valid for inclusion, but by not including it we can not obtain NPOV. We had a secondary source by ONE author (Ernst) in a low impact journal whose conclusions are far difference than the WHO Neck Pain Task Force studies re: spinal manipulation, safety, stroke, efficacy, cost-effectiveness and evidence. (published in 2008 no less, hence no review available) To not include these types of studies in a blantant violation of WP:NPOV and I believe a majority of editors would agree. This is the 6th editor who disagrees with Eubulides on this issue yet it persists. This is the kind of tendentious POV push which compromises the reliability and validity of the project. For the record, Vaccination has some serious POV issues as well and weight issues as well. 208.101.118.196 (talk) 04:33, 1 May 2008 (UTC)

It is best to stick to newer reviews that examine older primary studies. This will help eliminate personal opinion or POV from being injected into the article. Makes sense? QuackGuru 04:46, 1 May 2008 (UTC)

Who's personal opinion are you referring to? The Misplaced Pages editor's? The researcher? Or the reviewers? -- Levine2112 05:17, 1 May 2008 (UTC)

SmithBlue is correct on several points.

• WP:RS and WP:MEDRS are guidelines, not policy; the argument "it would not be right" was based on guidelines, not policy. Similarly, when several of us urged QuackGuru a few hours ago not to make unilateral changes to Chiropractic, this was based on guidelines, not policy. In both cases there are very good reasons for the guidelines, but they are not absolute requirements.

• We do need to consider why the reviews were written. Reviews that are written for some other purpose may not be reliable sources for our purpose. In general, this needs to be evaluated on a case-by-case basis.

• The problem of reviews being some other purpose is not a significant one in practice here. For example, in this particular case the review (Hurwitz et al. 2008, PMID 18204386) goes into more depth than we do, in a narrower topic area. The review has a section on the safety of neck-pain interventions which devotes about 250 words to the topic of VBA stroke after cervical spine manipulation. This is far more than the roughly 110 words that Chiropractic#Safety devotes to all serious complications (not just VBA stroke) after all spinal manipulation.

• It would be very odd for us to reach down into primary studies and highlight points in the review's topic area, when hte more-focused and more-detailed review does not mention those points.

In short, I agree that use of primary sources is permitted, but there are important reasons that WP:MEDRS strongly prefers reviews, and these reasons all apply here. It's not like Chiropractic is the only article with medical controversies: they come up all the time, in lots of different articles. Sticking with reviews is a good way to ensure high quality and avoid introducing POV inadvertently. Eubulides (talk) 09:27, 1 May 2008 (UTC)

208.101.118.196's characterization of this dispute is incorrect on several counts.

• This is not a case where there's "no review available". All the primary studies under dispute have been reviewed by the very Neck Pain Task Force that commissioned the studies, so it would be very odd for us to override those reviews; to do that, we should cite a reliable source that disagrees with those reviews, and no such sources have been cited.
• Nor is this a case where research "suddenly doesn't meet Eubulides criteria". The criteria in this case are not new: they are the criteria in WP:MEDRS, which says that secondary sources should be preferred to primary sources, as it's too easy to use primary sources to push particular points of view.
• Critics are not publishing in low quality journals. For example, Ernst 2008 (PMID 18280103) was published in this month's issue of the Journal of Pain and Symptom Management, which has an impact factor of 2.437; this is a bit higher than Spine's 2.351 in the latest (2006) ISI JCR list. Not that I think such questions should be resolved by whoever has the higher rating, but there's no way around the fact Ernst's criticisms are mainstream criticism, and Chiropractic should summarize them fairly and neutrally as per the usual Misplaced Pages standard.
• Chiropractic#Vaccination is a different section, for which (as far as I can recall) this particular issue of primary versus secondary sources has not come up.

Eubulides (talk) 09:27, 1 May 2008 (UTC)

Explain to me why when 6 different editors disagree with your interpretation of WP:MEDRS that you insist on tendentiously pushing the point that we cannot inclued Haldeman, Cote and Boyle et. al. You also have misrepresented my statement again (15th time). Your argument has not changed for the past 2 months whereas a plethora of editors now have raised a multitude of points and different arguments that point to a deficiency in the logic used. Until we can cite and use the appropriate materials by DC/PhDs the safety, effectiveness and vaccination will remain NPOV with a harsh tone. Can you find evidence that Ernst POV is the mainstream POV? Also, why haven't you acknowledged that MDs disagree with Ernst? Regardless, SmithBlue has thoroughly deconstructed your argument as others have done as well. There is a strong case here for a civil POV push case as well, so I strongly urge you to reconsider your stance otherwise, as suggested above, this discussion will have to carry at a different forum. CorticoSpinal (talk) 22:58, 1 May 2008 (UTC)

• I don't count 6 different editors disagreeing with the idea that we should prefer reliable reviews to reaching down into primary sources. On the contrary, I see real concern that we be very careful about highlighting details that the reviewers did not highlight.
• Chiropractic#Safety, Chiropractic#Vaccination, and #Effectiveness 2 all cite materials by DC/PhDs. And it's not just a few materials: most of the citations in those sections are from DCs or PhDs. The dispute here is not whether DC/PhD material should be included; it obviously should be. It's whether material from non-DCs should be discounted. It should not be discounted.
• I acknowledge that some MDs disagree with Ernst. The same is true for chiropractors, of course: some of them disagree with (say) Haldeman. Mainstream opinion is not unanimous on every detailed point. That being said, many mainstream physicians are quite critical of chiropractic care's effectiveness; some have even stronger opinions than he does.
• I'm not aware of any deconstruction of any argument here, but I am not an expert on deconstruction so I may well be missing something.

Eubulides (talk) 19:30, 2 May 2008 (UTC)

Eubulides re: "there are important reasons that WP:MEDRS strongly prefers reviews, and these reasons all apply here." If you have in mind a specific review then I can't comment meaningfully yet. I agree that we, the editors, need to reach consensus on whether each specific review meets our purposes, and makes primary studies on that specific issue unnecessary, on a case by case basis. You and I agree that it is not "primary study=bad review=good". SmithBlue (talk) 03:53, 2 May 2008 (UTC)

Yes, I have in mind a specific review: Hurwitz et al. 2008 (PMID 18204386), as mentioned above (there is an extensive quote from it near the start of #Safety sources again). This review is directly on point, it reviews all of the primary studies under dispute, and it covers the issue of VBA stroke and chiropractic care for neck pain in far more detail than #Effectiveness 2 does. We'd need a good reason, supported by a reliable source, to override its opinion. Eubulides (talk) 19:30, 2 May 2008 (UTC)

Section Chiro/History

As noted above article Chiropractic history already exists. Now we just need to reach concensus on what is better included in Chiropractic/History. I suggest we find a few references from each notable POV and work from there? Other's ideas? SmithBlue (talk) 03:18, 3 May 2008 (UTC)

Finding sources is good. Please see #sources for chiropractic history for a draft list. Eubulides (talk) 07:48, 3 May 2008 (UTC)

At this article we need a v brief overview of Chiro history. Very brief descript of sources found and history content in point form

• New Study Finds Unity in Chiropractic

no obvious relav

• How Chiropractors Think and Practice: The Survey of North American Chiropractors

no obvious relav

• Canada Celebrates 100 Years of Chiropractic Dynamic Chiropractic July 17, 1995

no relevant material: Canada postage stamp?

• Chiropractic: history and overview of theories and methods. Homola (abstract only sighted)

Palmer DD 1st adj, Palmer BJ dev prof (more in article?)

• History of Chiropractic Care ACA

2 relv para; 1895 founded profession, legal recognition 50 states, report: Chiropractic in New Zealand 1979, 1993 Manga study.

• Chapter I: A Brief History of Chiropractic by Reed B. Phillips, DC, PhD

~14 relav short para; 1st adj 1895, early 20th allopathic greater cultural authority - chiro lexicon, adversity economic/political/legal nnec clinical, State Board Licensing Exams 1925, Council on Chiropractic Education 1974, allopathic attacks, Research was neglected early, Foundation for Chiropractic Education and Research 1977? 4 Fed research grants 1996, increased collab (Mootz 1995), LBPain(Shekelle, 1992), recommended treatment in the Federal guidelines for the treatment of acute low back pain (Bigos, 1994). (research emphasis in this history)

• Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine, Meeker & Haldeman

3 para (+1 events timelist): 1st adj, Palmer innate, professional self-regulation and independent legal status were crucial to survival, 1923 Alberta, 1923 Zurich, now most countries, (Timelist: 1905 license Minnesota, 1922 license California, USCSCE 1933 (now FCLB), FCER 1944, NBCE 1963, Louisiana last license 1974, USCCE recog by US Dep Ed 1974, Journal of Manipulative and Physiological Therapeutics 1976 indexd NLM, US Supreme Court uphold Wilks 1987, U.S. Agency for Health Care Policy and Research findings 1994, Consortial Center for Chiropractic Research est by NIH grant 1997. (emphasis: education and research dev, legislation)

SmithBlue (talk) 09:31, 3 May 2008 (UTC)

Please review this of the FCER, which was made in 1944, however it had a predecessor the NCA as well. Skeptics do not realize that the chiropractic sciences had been in development for many years but strigent opposition from the allopathic community severely hampered the ability to get funds and make partnerships for research. CorticoSpinal (talk) 04:47, 6 May 2008 (UTC)

I added some more sources to #sources for chiropractic history. One is freely readable and worth looking at: Kaptchuk & Eisenberg 1998 (PMID 9818801). Eubulides (talk) 10:25, 3 May 2008 (UTC)

Factors so far: beginnings, relationship with medical mainstream developments, legislative developments, educational developments, international spread, scientific research development, research outcomes, effectiveness study developments SmithBlue (talk) 10:34, 3 May 2008 (UTC)

POV issues as of 2008-05-03

Here is a list of POV problem areas that I see with Chiropractic as it stands now. Fixing these problems would suffice to remove the articles POV tag. This list is updated from Talk:Chiropractic/Archive 17 #POV issues as of 2008-03-12, and reflects changes made to the article since 2008-03-12 as well as discussion since then and some other POV problems I noticed recently. Comments welcome; please make them in #Comments on 2008-05-03 issues list below. I plan to strike out items as they are addressed. Thanks. Eubulides (talk) 07:48, 3 May 2008 (UTC)

2008-05-03 issues list

• The sections Chiropractic #Movement toward science through Chiropractic #Scientific investigation are heavily biased on the subject of effectiveness. They present only old sources that promote the effectiveness and cost-effectiveness of chiropractic treatment, and discuss neither the mainstream viewpoint that disputed these old sources, nor more modern sources on the subject that present a more-balanced approach. One simple way to fix the problem would be to replace these sections with a new section for which we have a draft #Scientific investigation 2. This draft was inspired by a reader who wanted clear information on whether chiropractic treatment is effective and who thought that an earlier version of the draft "is the sort of clear descriptive information that will make the article easier to read." We rarely get comments from readers, so the few we do get should be listened to when at all possible.

• Chiropractic #Medical opposition describes the feud between conventional medicine and chiropractors in a heavily biased way. For example, chiropractors are described by a lengthy quote as having "progressive minds" whereas conventional doctors are said to "have failed to realize exactly what is meant by disease processes". Both sides (traditional medical and chiropractic) have attacked and have victories and losses, but the current discussion focuses almost exclusively on attacks by the medical profession, on chiropractic victories, and on areas where chiropractic is said to be superior to conventional medicine. The dispute should be covered neutrally. There is no need for a separate section Chiropractic #Wilk et al. vs. American Medical Association with a lot of detail, for example, unless there is also similar detail devoted to the other side.

• The sections Chiropractic #The Manga Report, Chiropractic #Workers' Compensation studies, Chiropractic #American Medical Association (AMA), and Chiropractic #British Medical Association are merely a laundry list of endorsements of chiropractic. These sections should be removed, with their useful content moved to appropriate sections, as citations.

Merge them. -- Dēmatt (chat) 03:41, 13 March 2008 (UTC)

• Several phrases are inserted to strengthen the argument for chiropractic by giving the qualifications of sources when they are favorable to chiropractic. Sources should be mentioned in the citation, not in the main text; there is no need to puff up the main text. The following quotes can be removed (with some rewording necessary to fill the gaps):
  • "the Ontario Ministry of Health and conducted by three health economists led by Professor Pran Manga"
  • "by Steve Wolk"
  • "by Cherkin et al."
  • "The British Medical Association notes that"

• Several places, including the lead, characterize chiropractic as complementary and alternative medicine. This characterization is controversial and alternative views should be given. See, for example, Redwood et al. 2008 (PMID 18435599), in which 69% of surveyed DC faculty disagreed with the proposition that chiropractic is CAM.

• Chiropractic #Philosophy claims "Evidence-based chiropractic balances this dualism by emphasizing both the tangible, testable principle that structure affects function, and the untestable, metaphorical recognition that life is self-sustaining." but the cited source does not talk about evidence-based chiropractic. Removing "Evidence-based" would fix this problem.

• Need I remind you of the conversation which it was requested BY YOURSELF to change it from contemporary to evidence-based because YOU felt the word contemporary was too PEACOCKISH? Please decide on a term, evidence-based or contemporary. CorticoSpinal (talk) 16:42, 4 May 2008 (UTC)

• Evidence-based is not in the source, and it's inaccurate to boot in this context, so it should go. "Contemporary" is peacockish, so it should go too. Let's just say "Chiropractic" without the adjective. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• Disagreed. You can't have it both ways, Eubulides. We had contemporary you said EB. Now you want EB gone and not cite contemporary which is in the source. Just accept the fact that contemporary chiropractors exist, they're EB and we go with it. Stop constantly trying to minimize any hint of the maturation of the profession. Lastly, I'll point out that your POV re: chiropractic is in direct conflict with the trend and literature demonstrating the efficacy and importance of integrative medicine. Speaking of which, what ever happened to that proposed section? I'll go dig it out of the archives, that was another section squashed by the skeptics for no good reason. CorticoSpinal (talk) 04:31, 6 May 2008 (UTC)

• The lead also has several POV problems, which can get fixed once the body gets fixed:
  • The lead should reflect the body of the article. The lead currently lacks summaries for some entire sections, including Safety, Scientific inquiries, Vaccination. The overall effect is to minimize the controversial parts of the body.
  • The lead has a POV phrase that needs rewording: "Today, the progressive view".

• • Need I remind you of the conversation already had earlier which the the progressive view is a directly taken from the US Department of Education who divides the Chiropractic programmes into straight and progressive?

• The usual terms for this division, and the one used elsewhere in the article, is "straight" and "mixer"; let's stick with that rather than "traditional" and "progressive".

• The cited source does not say "straight" or "mixer" it refers to the educational paradigns as "traditonal" and "progressive". Why the constant nit-picking of trivial stuff, Eubulides? You play with the rules; when it suits YOUR POV it's pliable, when it doesn't it's rigid. This example is case and point of this. CorticoSpinal (talk) 04:31, 6 May 2008 (UTC)

Eubulides (talk) 08:15, 5 May 2008 (UTC) Eubulides (talk) 07:48, 3 May 2008 (UTC)

Comments on 2008-05-03 issues list

• Safety The safety section omits valuable resources from DC/PhDs that contest the findings of Ernst and give more appropriate context to the article at hand. Considering the February 2008 issue of Spine dedicated a whole issue to the WHO Task Force, surely the 1 sentence currently at Safety is undue weight, no?

• 1 sentence might be undue weight, yes. But Chiropractic#Safety currently devotes 5 sentences to the WHO safety guidelines and 2 sentences to the February 2008 issue of Spine, so this doesn't appear to be a problem. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• The tone of the article is fear mongering. SMT is a relatively safe procedure. The section reads as though there is no real benefit to it; instead it relies heavily on Ersnt that side effects are very common (implied risk is great that benefit) that there are catastrophic consequence (permanent neurological impairment and even DEATH (insert scary music here). You have no problem with adding Miley et al, a study which contradicts the majority of the safety literature, yet Boyle, Cassidy and Haldeman cannot be included who are expert researchers in SMT and stroke. Anyways, the tone of the section is uneven and comes off as harsh. It reads like it's written by someone who is against manips rather than neutral. Again, I need to make my point clear: it's not the amount of sentences or references (lack thereof of the best ones available that are relevant), it the WORDS BEING USED TO DESCRIBE THEM. This needs to be fixed asap. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

• Chiropractic#Safety is not fear mongering: it starts off saying "Chiropractic care in general is safe when employed skillfully and appropriately."

• ...which subsequently degenerates into an oratory that SMT is dangerous and hurts. Gimme a break. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

• The section is about safety, not effectiveness, and so a discussion of benefits would be irrelevant; #Effectivness 2 is a draft for benefits.
• There is no serious dispute that mild side effects are very common.

• There is no mention what the benefits are. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

• There is no serious dispute that in rare cases there are very serious complications.

• Occurs infrequently and unpredictably enough to not warrant the the spotlight as you've done. This is more allopathic arrogance and bias. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

• Miley et al. 2008 (PMID 18195663) is a structured evidenced-based clinical neurologic practice review; it is not a primary study. As per WP:MEDRS, secondary sources like Miley et al. are preferable to primary studies.
• The sources you refer to are primary studies that are reviewed in Hurwitz et al. 2008 (PMID 18204386), which Chiropractic#Safety cites heavily in this area, and which do not mention the parts of the primary studies that you wish to emphasize. Reaching down into primary studies to select points that reliable reviewers do not mention is something we should avoid, as it is too easily a source of bias.

• Why do you fail to understand that your argument has been debunked by myself, Levine2112, DigitalC and most recently by SmithBlue? For the very last time, stop saying reaching down into primary studies. This is not the case. You have been stonewalling this issue for close to 3 months. I'm getting fairly annoyed now. Stop it. I have been gracious is debating this with you for the amount of time and have let other editor chime in. You are wrong. I'm going to include the relevant passages. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

• Miley et al. 2008 does not contradict the majority of the safety literature. On the contrary, it agrees with the mainstream opinion, which is that cervical manipulative therapy causes stroke in rare cases.

Actually, this is patently false. Mainstream opinion, as evidenced by the Spine articles suggests the opposite conclusion. You are trying to portray the WHO Task Force as a DC source when it's clearly not. It's a multidisciplinary panel which gives it more credibility. You are cherry picking data to support your case while wikilawyering from preventing a rebuttal. This is a very tendentious, and highly unethical approach. CorticoSpinal (talk) 22:29, 5 May 2008 (UTC)

• Specific suggestions about wording changes to correct tone are welcome; obviously any such changes must respect the sources and should follow WP:MEDRS guidelines.

Eubulides (talk) 21:24, 5 May 2008 (UTC)

• Vaccination. There is undue weight on the Canadian chiropractors who hold an anti-vaccination stance. These DCs form an estimated 0.02% of the world chiropractic tally. So much space is dedicated to them and not enough to those who aren't against or neutral towards vaccination.

• "0.02%"? Really? I thought it was more like 5%. Anyway, sources on the rest of the world would be welcome, but in the meantime we have to rely on the sources we have. Eubulides (talk) 08:15, 5 May 2008 (UTC)

I don't know how many chiropractors there are in the world, but if you figure 80,000 then the Canadians are about 3%, but 5% may be more accurate. But, the point from the reference regarding the Canadian DCs was that, given the scientific emphasis in the Canadian Chiropractic College, Canadian chiropractors should be more likely to embrace vaccination than not, and their opposition/neutrality was surprising.--—CynRN 16:49, 5 May 2008 (UTC)

Nice new font Cyn! Looks good. There are a few caveats that need to be illustrated. First, the data was collected in 2000. The new integrative curriculum began in 1999. Hence, the cohort studied was significantly different than those who have graduated since. This brings up the reliability of these stats. Secondly, the CCA unmistakeably favours vaccination as a cost-effective and effective method of public health. Also, the 3-5% you are quoting asssumes that all 60000 (at the time, it's closer to 7k now) were all anti-vaccination; which was not the case. Regardless, Eubulides continues to ignore my point that it's a weight issue, not a notability issue. I've mentioned this now for close to 3 months. Please justify the undue weight you have put on the fringe element of the profession (anti-vaccination) whilst ignoring the stance of the majority (neutral -> pro). Thanks. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

• More recent data would be welcome, if we can find a reliable source for it. Particularly for the U.S., which has far more chiropractors, and which appears to be more anti-vaccination than Canada does.
• Obviously it's not the case that the Canadian statistics mean 0.02% or 3% or 5% (or whatever) of chiropractors are against vaccination. It was a small sample, and in that sample, 25% opposed vaccination. A larger 1995 sample of U.S. chiropractors found that a larger fraction (about 1/3) did not believe that there was proof that immunization prevents disease. Based on all this, it'd be reasonable to guess that about 30% of chiropractors worldwide oppose vaccination. Of course this is just a guess, and cannot be reported in the article. But the point is that there is a significant opposition to vaccination among chiropractors. It's not "0.02%"; it's more than 20%.
• The CCA supports vaccination, but they represent a much smaller fraction of the world's chiropractors than the ACA, which supports exemptions to compulsory vaccination laws. It is certainly notable that the leading chiropractic association is so ambivalent about vaccination. The ACA is not the fringe; it's mainstream chiropractic.

Eubulides (talk) 21:24, 5 May 2008 (UTC)

From the Kansas survey of American chiropractors, 2005: "Immunizations are effective in the prevention of disease." strongly agree 12.0%, agree 30.7%, neutral 12.1%, disagree 19.3%, strongly disagree 19.9%.

"Encouraged patients to be immunized." yes 16.3%, no 54.2%, under certain circumstances 29.5%"

So as recently as 2005, 40% say vaccinations are 'ineffective'. So the article really should emphasize the belief (by 30-40% of chiropractors) that vaccines are 'ineffective'.--—CynRN 04:25, 6 May 2008 (UTC)

• Effectiveness/Science The proposals are grossly inappropriate, especially the into to science which has exactly 0 DC sources. This article is about Chiropractic and chiropractors. The science of chiropractic medicine, goes far beyond simple manips. Also, there is 0 mention of the evidence-based clinical practice guidelines the foundings of the CRF/FCRE the development of university-based masters programs in chiropractic SCIENCE, etc. This is simply another vehicle for the allopathic physician editing here to marginalize chiropractic

• It is not necessary for a source to be written by a DC for it to be reliable. The sections in question go far beyond simple manipulation. #Scientific investigation 2 explicitly mentions practice guidelines. The source for #Scientific investigation 2 was not written by an "allopathic physician", not that that matters. Eubulides (talk) 08:15, 5 May 2008 (UTC)

• I never said that. I said that there was 0 sources from chiropractic scientists and chiropractic historians or chiropractic experts. The article is about chiropractic, the section on the science of chiropractic. Hence it is not valid when you omit all relevant, reliable and valid DC sources. I have mentioned this time and time again, but you have insisted that my sources does not meet inclusion criteria despite the fact that several other editors agree including independent 3rd parties. Anyways, it's a poor intro and does not even come close to tackling the fundamental issues as noted already by SmithBlue in a separate thread. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

• You wrote "0 DC sources". The introduction is backed by a recent reliable source in a peer-reviewed journal. It is far better than what is in Chiropractic#Scientific investigation now, most of which is entirely unsourced (and the only source is lower quality). No doubt it could be improved further, but it's far better than what's there now, and unless specific further improvements are suggestion there's no reason it can't go in now. Eubulides (talk) 21:24, 5 May 2008 (UTC)

• The lead does not accurately reflect the body of the article which is missing vital importances from Scope of Practice, to Education, to History-(PRESENT) to Integrative Medicine, to subspecialities, etc. We all know that our resident MD wants to include every controversy under the sun in the lead; however this would be a serious violation of WP:WEIGHT

Yes, the lead should accurately reflect the body of the article. Eubulides (talk) 08:15, 5 May 2008 (UTC)

Then we agree it's the last thing to be changed. Finish the body, then we can touch-up the lead. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

I used to think that, but it's becoming clear now that the body will never be "finished", and we should strive to keep the lead in sync with the body. Eubulides (talk) 21:24, 5 May 2008 (UTC)

• Treating the fringe elements of chiropractic as mainstream and the mainstream as fringe. This is by far the biggest violation of the approach by certain skeptical editors. This needs to change.

Yes, this should be fixed. What specific instances of this are there? Eubulides (talk) 08:15, 5 May 2008 (UTC)

Practice Styles and schools of thought, Vaccination, safety, science, history, subluxation, etc. Take your pick. CorticoSpinal (talk) 19:26, 5 May 2008 (UTC)

That's a bit vague. Please suggest specific wording changes. Eubulides (talk) 21:24, 5 May 2008 (UTC)

Scope of Practice: Sources dispute

If Arthur Rubin would like to explain his concerns regarding the scope of practice section which according regarding the "relevance or reliability of the sources presented that would be helpful. I do believe they all meet our inclusion criteria per WP:RS, WP:V and thensome. Also, if you would please abide by WP:NPA and WP:CIVIL and not make attacks in your edit summaries that would be appreciated as well. I've gone ahead and brought an highlighted some of the sources you dispute

• Council on Chiropractic Education which is accredited by the US Department of Education
• You've got to be kidding, right?
• Since when is Dr. Haldeman not credible, nor a respected publishing house?

This journal is credible. Are you seriously disputing this?

• The credibility Ian Coulter sir, is not in doubt.

However, with tendentious edits like this that seem to raise a point are not helpful in the least. I would hope that good faith would be extended to me however you seem to be making a habit of contesting a lot of my edits on some questionable grounds. Nonetheless, if you would participate in talk perhaps you would be familiarized on some of the salient points raised over the last few months. There's a lot of material to go over, but seeing as you have a long history with this article you might as well invest the time like the regulars have since January 08. Cheers. CorticoSpinal (talk) 02:37, 6 May 2008 (UTC)

image/table

The image in the scientific investigation section is about philosophy and not scientific investigation. Possibly, it can be placed in the philosophy section. QuackGuru 21:54, 3 May 2008 (UTC)

Yes, that image clearly belongs under Chiropractic#Philosophy. Eubulides (talk) 06:58, 4 May 2008 (UTC)

My specific revisions is to delete the unrelated content in the scientific investgation section and move the image to the appropriate philosophy section. Going once... going twice... QuackGuru 20:37, 4 May 2008 (UTC)

No, "clearly" that image does not belong in philosophy. If the image in question is BJ, the "developer" he is a historical figure (now dead) and belongs in history. We don't put pictures of random individuals in Philosophy, Eubulides and QG. If you want to kill the image altogether, go ahead I'm cool with that. CorticoSpinal (talk) 20:44, 4 May 2008 (UTC)

This is not a picture of a person. The image is in the scientific investigation section. And it is clearly about philosophy. Unrelated content remains in the scientific investigation section. QuackGuru 20:47, 4 May 2008 (UTC)

This table was not an improved on Dematts. If we can find Dematt's table (better aesthetically by far) I see no problem moving this to Practice Styles/Schools of Thoughts where it was ORIGINALLY. CorticoSpinal (talk) 21:16, 4 May 2008 (UTC)

There already is a table in the Schools of thought and practice styles section. See at the end of the Chiropractic#Mixer's section. QuackGuru 21:30, 4 May 2008 (UTC)

Can we move the table to the philosophy section and delete the unrelated content in scientific investigation now? QuackGuru 00:09, 5 May 2008 (UTC)

This comment was made over a day ago. No objections have been raised. The table in the scientific investigation section is about philosophy. It can be moved to a more appropriate place. QuackGuru 04:00, 5 May 2008 (UTC)

keep or delete table

We added the table to the philosophy section. Should we keep the table or delete it. Please discuss. QuackGuru 04:22, 5 May 2008 (UTC)

The table is kind of corny, but it's better than nothing. In general, having a few illustrations is nicer than just having plain text. If we can find a better illustration for Chiropractic#Philosophy, let's use it; but in the meantime let's keep the table. Eubulides (talk) 08:15, 5 May 2008 (UTC)

Attribution does not require mentioning in the text

This change changed a claim of the form X to a claim of the form 'A doctor of chiropractic, Robert S. Francis, states that "Spinal manipulative therapy gained recognition by mainstream medicine during the 1980s".' Generally speaking, this sort of change is a bad idea. Citations are the right place for attribution; if we were to put attributions into the text of the article all the time, it would be littered with junk like "Dr. So-and-so said" which gets in the way of the primary topic of the article, namely chiropractic. I realize that this particular case is an exceptional one (the sentence was stolen, without attribution, from a primary source) but in general it's better to paraphase the source than to quote it and then said "Dr. So-and-so said". This section is ripe for rewriting from scratch, so I'd rather spend time on that than twiddling this particular quote, so for now I suppose we should leave it alone. Eubulides (talk) 07:33, 4 May 2008 (UTC)

Delete it then. I added attribution because it seems extra ordinarily unwise to quote as fact a doctor of chiropractic who works for a obscure chiropractic organization. Talk about an unreliable source. So I attributed according to Misplaced Pages:Neutral_point_of_view#Attributing_and_substantiating_biased_statements Jefffire (talk) 08:34, 4 May 2008 (UTC)

The original source of this statement was the Meeker and Haldeman paper (2002) and someone changed it to a weaker source. Hmmmm, why would that be? Is anyone disputing that "Spinal manipulative therapy gained recognition by mainstream medicine during the 1980s".? CorticoSpinal (talk) 16:45, 4 May 2008 (UTC)

Given your COI, I would be reluctant to rely entirely on your opinion on this. If an authoritative mainstream source, like a standard textbook for medical students says that, then cool. If it's in a paper, then it needs to be attributed since it may still be just the authors opinions. If it's the AUM, then quite frankly it should be deleted. Jefffire (talk) 17:54, 4 May 2008 (UTC)

Given your persistent accusations, I'd ask you to please stop making insinuations that I'm violating some kind of policy. Indeed, you are being needlessly disruptive and your lack of AGF is noted. The Haldeman article is published in the Annals of Int Med. You don't seem to get it; chiropractic textbooks published by majority publishing houses are just as notable and more relevant to chiropractic than a 'medical' text is. For the record, chiropractic texts are also classified under medical too, so I don't really understand your point. CorticoSpinal (talk) 17:59, 4 May 2008 (UTC)

Misplaced Pages:Neutral_point_of_view#Attributing_and_substantiating_biased_statements is policy. Jefffire (talk) 10:31, 5 May 2008 (UTC)

You are violating the spirit of the rule by insinuating that the sources and authors represent a fringe viewpoint. This is not the case. If you feel differently, feel free to chime in at the fringe thread below. Thanks. CorticoSpinal (talk) 19:28, 5 May 2008 (UTC)

Is Chiropractic Fringe?

It seems like a lot of the endless debate, POV wars, edit wars, disruption, bans, blocks, etc could be attributed to a fundamental differences that proponents and skeptics view the chiropractic profession.

I have been told by skeptics that DCs and chiropractic care is fringe, and, in effect is no different than Homeopathy and Flat Earth. Skeptics also suggest that chiropractic medicine is a pseudoscience. Let's have an open debate about these points and we shall see the strength of the arguments on both sides. The floor is open. CorticoSpinal (talk) 18:58, 4 May 2008 (UTC)

To begin with, statements by chiropractors that chiropractic is not fringe can and should be disregarded by all, unless backed up by evidence not generated by chiropractors. That's just self-serving, even if published in (chiropractic)-peer-reviewed journals.

My feeling is that the evidence supports chiropractic working for some muscular-skeletal conditions, there is marginal evidence for some not-obviously muscular-skeletal conditions, such as headaches, and no evidence that it works for any conditions considered "diseases" by the medical community. There is no scientific support of chiropractic theory, even to the extent of whether:

1. Vertebral subluxations cause disease (illness, or whatever non-standard term for such that chiropractors claim to cure).
2. Chiropractic adjustments correct vertebral subluxations.

So, in summary, chiropractic theory is WP:FRINGE, but, chiropractic, itself, is marginal. — Arthur Rubin (talk) 19:27, 4 May 2008 (UTC)

Thanks for starting the conversation, Arthur. So, to summarize, chiropractic is "marginal" hence not "mainstream" and chiropractic "theory" is fringe. Also, chiropractic sources, regardless of their reliability and validity are to be disregarded, correct? Are there particular elements of the theory that is fringe and what is your understanding of vertebral subluxation (complex) and adjustments (just to specify so I clearly understand). Cheers. CorticoSpinal (talk) 19:52, 4 May 2008 (UTC)

There appears to be no definition of chiropractic adjustments which distinguishes them from other spinal manipulations, as we seem to have agreed in Talk:spinal manipulation, even if we allow ourselves to consider definitions supplied by chiropractors. (That should have been an additional point above in the "clearly fringe" list. My bad.)

And we cannot use statements supplied by chiropractors or published in chiropractic journals as WP:RS as to the efficacy of chiropractic, but we can use them toward definitions as understood by chiropractors, provided it's made clear. Even under WP:FRINGE, statements by practitioners as to what they (think they're) do(ing) are allowable. — Arthur Rubin (talk) 21:35, 4 May 2008 (UTC)

Thanks for the reply but you didn't really address my questions above. Also, you've raised another point which I need to clarify; namely that we cannot use chiropractic sources, as per WP:RS to discuss the effectiveness of chiropractic care. Is that correct? I think before we proceed I do need you to address the questions I've raised above so I clearly understand your position. Many thanks in advance. CorticoSpinal (talk) 21:49, 4 May 2008 (UTC)

Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat. 13: 17. doi:10.1186/1746-1340-13-17.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link) Here is a comprehensive ref about subluxation. QuackGuru 21:42, 4 May 2008 (UTC)

What about Gatterman, Leach and Haldeman? The Keating et al. paper talks primarily about the fringe (but vocal) viewpoint of vert sub. What about what the majority of the profession and vert sub? CorticoSpinal (talk) 21:49, 4 May 2008 (UTC)

What questions haven't I answered? And, in your opinion, what is the mainstream chiropractic theory? I'm just looking for opinions at this point, not requesting that they be backed up with sources. — Arthur Rubin (talk) 21:59, 4 May 2008 (UTC)

Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med. 136 (3): 216–27. PMID 11827498. I think this insightful ref can be used to improve this article. This ref answers a lot of questions. QuackGuru 22:07, 4 May 2008 (UTC)

I just want to confirm a few things before I answer your question. To summarize, chiropractic is "marginal" is not "mainstream" and chiropractic "theory" is fringe. Also, chiropractic sources, regardless of their reliability and validity are to be disregarded, correct? Lastly, that we cannot use chiropractic sources, as per WP:RS to discuss the effectiveness of chiropractic care. I want to make sure I understand your position clearly so we can have more effective communication. CorticoSpinal (talk) 22:11, 4 May 2008 (UTC)

Almost. Because of obvious conflicts of interest, chirpractic sources as to the effectiveness of chiropractic cannot be reliable. Chiropractic sources as to the definition of chiropractic, and as to what the chiropractic theories are, can be appropriate. Chiropractic sources as to the history of chiropractic can usually be used if noted. Chiropractic sources as to other aspects can be considered separately, keeping in mind obvious conflicts of interest. — Arthur Rubin (talk) 22:17, 4 May 2008 (UTC)

Some sources are RS and some are SPS for example. There are a lot of different types of sources. We should use the best sources available. If that means using less than reliable sources than RS then that is fine in some circumstances. Some sources are okay as long as proper attribution is given. It all depends on the specific circumstance. Blogs are sometimes considered reliable when written by a notable expert on the topic. QuackGuru 22:20, 4 May 2008 (UTC)

Does this accurately sum of the state of affairs today, NPOV? CorticoSpinal (talk) 05:11, 5 May 2008 (UTC)

This seems like a COI source from a chiropractic advocacy group. POV? Surely. QuackGuru 05:20, 5 May 2008 (UTC)

Quack, could you please elaborate on your concerns that a statement on chiropactic science and theory by Dr. Haldeman is not fair game? He is THE leading chiropractic scientist, IMO. YOu should also note that the FCER merely reproduced the transcript. I also think you don't understand the purpose, notability, relevance and signifance of the FCRE in both historical and modern contexts. To not have this at science of chiropractic is a serious error that needs to be corrected. As soon as I can roll out SOP and education, (which has been waiting patiently since April 13/08) I'd be more than happy to invest time and effort to help rewrite the scientific section. CorticoSpinal (talk) 19:40, 5 May 2008 (UTC)

There is no purpose in evaluating this source when we can't use this unreliable source. More reliable sources are currently available. QuackGuru 19:52, 5 May 2008 (UTC)

Scott Haldeman is an unreliable source on chiropractic science? Is this what you are suggesting? CorticoSpinal (talk) 20:25, 5 May 2008 (UTC)

Good question. That statement may not be very precise, and therefore risks being labelled a (unintentional) straw man argument, since it may miss it's mark ever so slightly, and lead to lots of wasted time on futile discussions. Who says it, and what is the setting? That might make a difference. It might be advisable to refine it. There are even chiropractic sources that admit nearly the same thing and therefore urge caution in making claims. It would be the claims themselves that often lack scientific evidence. -- Fyslee / talk 05:23, 5 May 2008 (UTC)

Feel free to tweak the sentence(s) as you see fit so long as it can be backed up with a source, if need be. Don't forget that was also said in 2000. There's been significant scientific developments since that time. CorticoSpinal (talk) 19:40, 5 May 2008 (UTC)

The International Classification of Diseases is the gold-standard diagnostic text for classifying, billing and coding. Look at the list of signatories. Fringe company?

things to do list

Per Talk:Chiropractic/Archive 17#Treatment procedures suggestions, a description of how spinal manipulation is performed is an improvement. QuackGuru 22:40, 4 May 2008 (UTC)

You can take the description of it from the safety section and duplicate it. Do we have a source for that just in case its contested? CorticoSpinal (talk) 22:42, 4 May 2008 (UTC)

I already have a more descriptive source in mind. QuackGuru 22:53, 4 May 2008 (UTC)

Per Eubulides, "More generally, the "Minority" section doesn't present the big picture, which is that chiropractic has always been riven by internal disputes, and that simplifying it to "straight" versus "mixer" is a bit like simplifying the history of American politics to "Republicans" versus "Democrats". There are always subgroups with their own agendas, the two examples given are just recent examples of this, and it's missing the bigger picture to mention only those two examples." The big picture needs representation. There is a lot more to this story than the straight v. versus mixer evolution. There are internal conflicts too. QuackGuru 22:53, 4 May 2008 (UTC)

There are only 2 groups, no one but yourself promotes this. I had been on the fence with reform, but that is simply the maturation of the mixer POV. Do you know when the straight vs. mixer debate happened? To you know the relevance to it with respect to innate intelligence and subluxation? These are fundamental points to grasp. Please do let me know, otherwise we'll need a history lesson before we proceed. CorticoSpinal (talk) 19:33, 5 May 2008 (UTC)

We have reliable references that disagree with your point of view. QuackGuru 20:00, 5 May 2008 (UTC)

It's not my POV, it's the POV of the chiropractic historians and researchers. What is your source incidentally? You do realize that you are the only editor here who is promoting the "more than 2 groups" thing, right? Your POV (or that of your sources) disagrees with the overwhelming majority of the literature. CorticoSpinal (talk) 20:23, 5 May 2008 (UTC)

tags

There is a content dispute tag at the top of the article. There is no need to additionally add tags to the Safety and Vaccination sections. It looks spammy. QuackGuru 23:04, 4 May 2008 (UTC)

I thought content dispute tags were added to the article. The tags are relevancy tags. I think Safety and Vaccination topics are relevant for this article and are in the appropriate section. QuackGuru 23:26, 4 May 2008 (UTC)

Someone felt obliged to add the same 'spam' to effectiveness and history. Skeptics aren't the only ones who have NPOV issues with the article. To note, Eubulides' recent change of safety with the inclusion of Miley but not Boyle made it that much worse. At least stuff like that makes my case that a double standard is being used that much easier to prove. It's unfortunate that an otherwise good editors would get snagged in something like this; but their edits are out of my control. Edit conflict: since you have more experience at Misplaced Pages, please put a NPOV tag or a weight tag. That would be more appropriate but I don't know how to do it CorticoSpinal (talk) 23:28, 4 May 2008 (UTC)

I thought the recent addition to the safety section was an improvement. NPOV as ever. QuackGuru 23:40, 4 May 2008 (UTC)

First of all, the wrong tags were added to the Safety and Vaccination sections. It should of been specifically the content dispute tags. However, at the top of the page is a content dispute tag for the whole article. It would be duplication to add more content dispute tags. QuackGuru 23:36, 4 May 2008 (UTC)

Thanks for clarifying that for me, QG. You definitely know your dispute tags well, for whatever reason. Anyways, let's take down the main dispute tag and leave it for the sections that are disputed. How does that sound? CorticoSpinal (talk) 23:39, 4 May 2008 (UTC)

There are too many sections under dispute. Even improving references (formatting) is under dispute. QuackGuru 23:42, 4 May 2008 (UTC)

Generally speaking when there are this many disputes it's better just to have one tag at the start rather than litter the article with tags. I made this change to coalesce the tags that way. Eubulides (talk) 08:15, 5 May 2008 (UTC)

I made this change to reflect that the unrelated content has been removed. Now we can get to work on the rewrite. QuackGuru 08:33, 5 May 2008 (UTC)

QG, you have removed content that we, as editors, had asked you to please not remove until we got consensus (Manga report). I'm going to give you the opportunity to restore that, otherwise it will look like a disruptive edit. We don't want to page to be locked down again, so let's co-operate here. Thanks. CorticoSpinal (talk) 19:31, 5 May 2008 (UTC)

I explained my reasons for removing the obsolete studies. We have consensus for a rewrite anyhow. QuackGuru 19:58, 5 May 2008 (UTC)

I think you are mistaken, QG. Please reinsert Manga as per our discussion above. Thank you. CorticoSpinal (talk) 20:20, 5 May 2008 (UTC)

I agree with Cortico here. There is no consensus to remove, though there is one to rework them into the history section. Let's rework them first and then remove. Not having these important studies included in the interim is egregiously not including topical information from the article. -- Levine2112 20:24, 5 May 2008 (UTC)

We have newer sources available that decribe the Manga report. QuackGuru 20:11, 5 May 2008 (UTC)

References