Talk:Chiropractic/Archive 29

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Nature of vaccination "disagreements" is unclear

Currently we have this statement:

• "Within the chiropractic community there are significant disagreements about vaccination,..."

I think this needs a couple words to clarify the nature of the disagreements:

• "Within the chiropractic community there are significant disagreements about the legitimacy of vaccination,..." [emphasis added]

In the lead the current wording is this:

• "Vaccination remains controversial among chiropractors."

I suggest we use similar wording there:

• "The legitimacy of vaccination remains controversial among chiropractors."

I'm not totally convinced that "legitimacy" is the right word (although it can cover many aspects of the current disagreements), and using more than one descriptive word might be desirable. Suggestions are welcome.

-- Fyslee / talk 02:24, 5 November 2008 (UTC)

I don't see the need to add the word "legitimacy". Do you think the current phrasing is misleading in some way? I don't think opposition to vaccination is solely centred around whether vaccination works or not... for example I suspect some (many?) anti-vaccination chiropractors would agree that vaccination does protect against disease, but think the side effects from mercury etc outweigh the benefits of immunity to diseases they see as unlikely to be contracted. Others might take issue with compulsion to vaccinate, or age to vaccinate etc. --Surturz (talk) 06:42, 5 November 2008 (UTC)

Thanks for the thoughts. This is what I was hoping for. I do think that "legitimacy" may not be the only appropriate word. I was just unsatisfied with the current wording which gives no hint as to why vaccination is "controversial" or why there are "disagreements" over it. We need some descriptive words. Please provide some more suggestions that can be included so that readers will get an idea of what's going on without them having to read all the sources. -- Fyslee / talk 07:26, 5 November 2008 (UTC)

If we have the sources to support it, how about this?

• "The safety and efficacy of vaccination remains controversial among chiropractors."

-- Levine2112 ^discuss 08:10, 5 November 2008 (UTC)

I still don't see the need for change... we are not going to cover all the disagreement in one sentence, and the rest of the paragraph covers the major disagreements (efficacy, harmful side effects, compulsion). Plus, there is now a hatnote link to vaccine controversy for those readers interested in reading more. This is an article about Chiropractic, not about Vaccination, so we really do not need an in-depth discussion of the issue - that is more than adequately covered in vaccine controversy. The specifically (fringe) chiropractic anti-vaccination argument - that diseases are caused by subluxations, not pathogens - is mentioned in this article. Other anti-vaccination arguments are not particularly chiropractic in nature (even though they are championed by some chiropractors), and deserve only cursory description in this article, if at all. That said, I would be in favour of Levine's suggested text if it meant the section was made smaller, ie. we replace other extant, longer text --Surturz (talk) 11:41, 5 November 2008 (UTC)

I agree with Surturz that adding "legitimacy" and/or "safety and efficacy" would be redundant here. Perhaps the wording could be improved, but we do need to make sure the revised wording is also well-supported by the cited sources. I'm not sure "legitimacy" is supported; and "safety and efficacy" is duplicative given the next sentence. To avoid reinventing the wheel it may help to review the extensive discussion on the current wording that we had a few months ago, e.g., in Talk:Chiropractic/Archive 26 #Vaccination redux. Eubulides (talk) 20:51, 5 November 2008 (UTC)

Okay. Thank you for your input. I'm convinced. -- Fyslee / talk 02:01, 6 November 2008 (UTC)

Moving forward

I asked waaaaay above if editors involved in this dispute would be willing to come up with a (very specific) list of current concerns that could be worked through one issue at a time. At present with the variety of threads and comments, issues are not being addressed and getting missed in all the fluff; a lot of arguments have to be made repeatedly in several threads and there still doesn't seem to be much resolution. Would everyone here be willing to try a mediation-style intervention? Shell ^babelfish 04:11, 6 November 2008 (UTC)

If you lead the mediation, I will support it. ScienceApologist (talk) 05:44, 6 November 2008 (UTC)

I've always been game for mediation and have suggested it multiple times. So yes, I would be willing to try such an intervention. -- Levine2112 ^discuss 06:16, 6 November 2008 (UTC)

I'd be willing as well. A quick note to the mediator: you might want to look at the previous mediation attempt, if only as a source of suggestions for what a mediator should not do during mediation of a Chiropractic dispute. Eubulides (talk) 07:45, 6 November 2008 (UTC)

I am absolutely willing to try to move forward with any form of dispute resolution. DigitalC (talk) 08:20, 6 November 2008 (UTC)

I am for mediation, as I have been for a long time. However, not lead by any admin who has so far been involved in pseudoscience or alt-med, and especially not by any admin previously involved on this page. We need an open mind, not contaminated by previous strife, or observation thereof. ——Martin^phi ☎ Ψ Φ—— 09:33, 6 November 2008 (UTC)

Martin's idea is simply not a good idea, and one I will not go for. The last mediation that occurred at cold fusion resulted in an article that is still subject to terrible nonsense due in large part to the fact that the "uninvolved" (now-)administrator was not familiar enough with the subject to be able to distinguish good sources from bad sources. An outsider is fine, but we need an outsider with enough subject knowledge about either science or medicine to do a decent job. Preferably someone with at least a college degree in a related subject if not an MD or a PhD. The alternative is to use an administrator who has worked enough with the subject and is familiar enough with the disputants tactics and the likely sources to be able to separate wheat from chaff. The nature of Wikipedia is that the latter is easier to come-by than the former. ScienceApologist (talk) 10:26, 6 November 2008 (UTC)

Involved admins are welcome. I support mediation, but use of admin sanctions based on the ArbCom conditions for this and other pseudoscience articles would be also be welcome and probably more effective. Disruptive editing, stonewalling, and circular arguments need to stop. Such sanctions might do more good than mediation. We've already seen alot of talk, and since talk prevents moving forward, more talk will also serve the same end, which might be just what some wish to see. -- Fyslee / talk 14:47, 6 November 2008 (UTC)

Let me see if I can answer a few things brought up here:

• Eubulides - Its unfortunate that the mediation went poorly. MedCab is a mixed bag, occasionally new mediators getting their feet wet make a few mistakes along the way. Hopefully that was a learning experience for everyone.
• Martinphi - I wasn't sure by your statement, did you mean to say you would not accept me as a mediator here? I think you'll find I've been called a fringe supporter and a science supporter depending on who was mad at me at the time - if editors can't figure out what "side" I'm on, I'd say that's probably a good thing.
• Fyslee - Part of any mediators job is to stop stonewalling or circular arguments and guide everyone towards consensus. I think simply by moving out of the general into the specific, many of those concerns will be resolved.

Since it looks like the majority of editors active here would like to give this a try, I'm going to start a page at Talk:Chiropractic/Mediation and see if we can't give it a shot. Start thinking about your major concerns for the article and come up with a top five "if I could change anything about the current article content...". Shell ^babelfish 18:14, 6 November 2008 (UTC)

Lower back pain review

A new article reviews the evidence for various interventions commonly used in the treatment of lower back pain. I am unable to read the full text of this article. Only the abstract is currently available. Thoughts? QuackGuru 18:30, 9 November 2008 (UTC)

Awkward sentence

Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness.

The second part of this sentence is a bit awkward. Perhaps we can rewrite it to be easier to read and more understandable. QuackGuru 03:45, 10 November 2008 (UTC)

It's more a problem as to the appropriateness of blatent special pleading in an article not about the subject of "other medical procedures". We don't normally allow such things. If the matter of "the efficacy of chiropractic treatment" is presented in an NPOV manner, special pleading is unnecessary and amounts to editorial "weight" shifting to detract from the original point. If there is any question as to the sourcing or NPOV presentation of the subject, the solution is not to add editorial special pleading, but to NPOV it. That last phrase should be removed, regardless of the good source, since it doesn't belong here. -- Fyslee / talk 03:59, 10 November 2008 (UTC)

Somewhere in the edit history of the article may be a better version than the current version in the article. Editors tweaked the original sentence and now it has lost its original meaning. Hopefully we can improve the second part of the sentence instead of removing it. QuackGuru 04:06, 10 November 2008 (UTC)

Maybe so, but if the subject matter in the second half isn't related to chiropractic at all, it shouldn't be included here. It's still inappropriate. -- Fyslee / talk 04:10, 10 November 2008 (UTC)

That sentence was the result of extensive discussion by Dematt, Coppertwig, and myself back in May; please see Talk:Chiropractic/Archive 22 #"Rigorously proven" for details. Briefly, the 2nd half is there because of a common theme in many sources that although chiropractic care has not been rigorously proven, in this respect it's in the same boat as many other forms of medical treatment. That's an important point, which should be made. All too often, chiropractic critics say "the science isn't there" without noting that the science isn't there for many other forms of medical treatment, too. Eubulides (talk) 09:31, 10 November 2008 (UTC)

Being more specific

Right now the introductory sentence to that section starts with:

• "Opinions differ as to the efficacy of chiropractic treatment;..."

We need to be more specific, since "chiropractic treatment" is vague and includes myriad methods. Since we are dealing with chiropractic's primary method (used during virtually every treatment session, with rare exceptions) I suggest we add a few words to "sharpen the point of that dull pencil":

• "Opinions differ as to the efficacy of chiropractic's main treatment method."

If we end up dealing with other methods, then it can be tweaked at that time. -- Fyslee / talk 04:19, 10 November 2008 (UTC)

I think this introductory sentence completely misrepresents the reference. The abstract reads:

Spinal manipulation has been used for its therapeutic effects for at least 2500 years. Chiropractic as we know it today began a century ago in a simplistic manner but has developed into to a well-established profession with 33 colleges throughout the world. During the initial, bumpy years, many people thought it had little more value than a placebo. Nevertheless, there have always been satisfied recipients of chiropractic care during the years, and the profession slowly gained prominence--mostly by word of mouth. More recently, personal opinions based on isolated incidents have given way to the results of numerous clinical and basic science studies, primarily regarding low back pain. As of 2002, 43 randomized trials of spinal manipulation for low back pain had been published with 30 showing more improvement than with the comparison treatment, and none showing it to be less effective. Other studies have shown that chiropractic care compared with medical care is safer, costs no more and often costs much less, and has consistently greater patient satisfaction for treatment of similar conditions. Consequently, there is now better public and professional opinion of chiropractic with coverage by insurance companies and government agencies. That trend is likely to continue.

The final sentence reads:

Inasmuch as studies consistently indicate that chiropractic treatment, at least for back pain, is as effective and safe (if not more so) than medical treatment, that the cost of chiropractic care is not more (and often is considerably less) than medical care, and that patients receiving chiropractic care are on average more satisfied with their care than patients receiving medical care are with theirs, it is not surprising that positive public and professional opinion and use of chiropractic are increasing.

How one derives "opinions differ" when the reference says "consistently indicate" is beyond me. I suggest the WP article text be replaced as follows:

"Studies consistently indicate that chiropractic treatment for back pain is effective and safe."

--Surturz (talk) 07:09, 10 November 2008 (UTC)

Are there no other references used in that section? Me thinks the introduction sums up the results of looking at all those references. -- Fyslee / talk 07:16, 10 November 2008 (UTC)

• The cited source (DeVocht 2006, PMID 16523145) says "Nevertheless, there are different views concerning the efficacy of chiropractic treatment, which is not surprising. Unfortunately, it is difficult to establish definitive, unarguable, and conclusive findings regarding much in the healing arts despite the millions of papers that have been written about presumably scientifically sound studies. Because of this difficulty, numerous medical procedures have not been rigorously proven to be effective either."
• As can be seen from this quote, it does not support Fyslee's proposed rewording, as it talks about chiropractic treatment in general, not about spinal manipulation.
• DeVocht 2006 is a bad source for claims about the effectiveness and safety of chiropractic treatment for back pain. It is far inferior to the sources that are already used. DeVocht is more of a high-level opinion piece; it is not a review, much less a systematic review. It is adequate for high-level points about opinions differing, and about the difficulty of conclusive findings; but that's about it.
• Please see Talk:Chiropractic/Archive 22 #"Rigorously proven" for more details about this wording and this citation; the current discussion on this topic is duplicating the earlier one, and it'll save us all some time to read the earlier one.

Eubulides (talk) 09:31, 10 November 2008 (UTC)

Two edit requests for admins

Here are two requests to admins to fix what should be obvious and noncontroversial bugs in the article:

• At the top of Chiropractic, the little image of a green lock, with alt text "This article is move-protected due to vandalism", is not quite right, as the article is currently protected against all edits. The little image should be a gold lock with alt text saying "This page is protected" or something like that. Can you please change this article source:

{{pp-move-vandalism|small=yes}}

to this:

{{pp-dispute|small=yes}}

• As has been discovered in Talk:Chiropractic/Mediation #Sentence 2a, one of the citations in Chiropractic is incorrect. The text is attempting to cite a 2007 clinical practice guideline of the American College of Physicians, but it's incorrectly citing the next article in the same journal. Can you please replace this article source:

<ref>{{cite journal |journal= Ann Intern Med |date=2007 |volume=147 |issue=7 |pages=492–504 |title= Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline |author= Chou R, Huffman LH; American Pain Society; American College of Physicians |pmid=17909210 |url=http://annals.org/cgi/content/full/147/7/492 |doi= 10.1001/archinte.147.3.492}}</ref>

with this:

<ref>{{cite journal |journal= Ann Intern Med |date=2007 |volume=147 |issue=7 |pages=478–91 |title= Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society |author= Chou R, Qaseem A, Snow V ''et al.'' |pmid=17909209 |url=http://annals.org/cgi/content/full/147/7/478}}</ref>

Please see this diff in my sandbox for the exact request that is being made here. The result of this change should be to alter this citation:

Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. doi:10.1001/archinte.147.3.492. PMID 17909210.{{cite journal}}: CS1 maint: multiple names: authors list (link)

to this one:

Chou R, Qaseem A, Snow V; et al. (2007). "Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society". Ann Intern Med. 147 (7): 478–91. PMID 17909209. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

(You might notice that the new citation lacks a DOI, but that's because DOIs don't work with that journal; the DOI for the wrong citation is itself incorrect and does not work for the wrong citation.)

Thanks. Eubulides (talk) 09:31, 10 November 2008 (UTC)

Admins please do NOT replace the reference as Eubulides asks, it is quite inappropriate for Eubulides to ask for this change when the section is currently being discussed a the mediation page. The existing reference is highly relevant and I am quite disappointed that Eubulides is displaying more WP:OWNership of this article when there seemed to be a new spirit of cooperation at the mediation page. You should be making the text fit the reference, Eubulides, not the other way around. Deciding on text and then looking for references to fit is the slippery slope to POV-pushing. --Surturz (talk) 14:31, 10 November 2008 (UTC)

The citation is clearly in error. The citation is indeed relevant to the subject, and this is being discussed in mediation and may result in further text being added, but there's no dispute that the citation is the wrong citation for the text that it currently sources. The citation was put in by mistake as a sort of off-by-one error (the adjacent journal article was meant to be cited). All this being said, if there is opposition to correcting a clear error then administrators should of course feel free to leave the error in. Eubulides (talk) 17:35, 10 November 2008 (UTC)

Done on the first part. It appears the second request is controversial, so I'm going to wait for consensus on it. Cheers. lifebaka++ 19:30, 10 November 2008 (UTC)

What is controversial about fixing an error? QuackGuru 20:40, 10 November 2008 (UTC)

It's an obvious error that should be fixed. -- Fyslee / talk 20:46, 10 November 2008 (UTC)

Someone disagreed with it, and the reason was decent, so I waited. It does appear that is consensus for it, objection or not, so I'll be making the change presently. Cheers. lifebaka++ 01:01, 11 November 2008 (UTC)

Why can't we have both references? They are both relevant and were published as a pair. --Surturz (talk) 02:47, 11 November 2008 (UTC)

It might make sense to change the text and to cite both sources, and this topic is currently under discussion at Talk:Chiropractic/Mediation. New text like that typically takes some days to gain consensus, though, if only to give editors enough time to read and think about it. In the meantime, as per WP:V it was relatively urgent to fix the obvious error in the citation to make it match the current text. Eubulides (talk) 07:26, 11 November 2008 (UTC)

Fix for awkward wording in Philosophy

As discussed without objection last week in what is now Talk:Chiropractic/Archive 28 #Awkward wording, please replace the 2nd and 3rd sentences of Chiropractic #Philosophy with the following, which is a minor rewording of those sentences.

A philosophy based on deduction from irrefutable doctrine helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic first principles rather than on the materialism of science.

Thanks. Eubulides (talk) 06:42, 14 November 2008 (UTC)

• This change was made. For what its worth, that section makes a lot more sense to me now :) Shell ^babelfish 11:12, 17 November 2008 (UTC)

"D. D." vs "D.D." and likewise for B.J.

In most cases Chiropractic spells D.D. Palmer's and B.J. Palmer's names without a space between the initials, but I just now noticed that there are two instances of "D. D." and one instance of "B. J.", with spaces between the initials. Whatever convention we use, we should be consistent. The majority of uses are avoiding the spaces now, so let's remove those three spaces. Here are the sentences that should be fixed:

• "D. D. Palmer founded chiropractic in the 1890s and his son B.J. Palmer helped to expand it in the early 20th century."
• "Straight chiropractors adhere to the philosophical principles set forth by D. D. and B. J. Palmer, and retain metaphysical definitions and vitalistic qualities."

Eubulides (talk) 22:00, 15 November 2008 (UTC)

I think we should use the common practice, IOW no space between. -- Fyslee / talk 19:12, 16 November 2008 (UTC)

Agree, article should be consistent.. no spaces is better. --Surturz (talk) 03:26, 17 November 2008 (UTC)

Fixed it so it's consistent with no spaces. Unless someone comes in here waving a huge WP:MOS flag (and I think they're all on dates right now), it oughta' be fine if we just leave it as is now. Cheers. lifebaka++ 16:28, 17 November 2008 (UTC)

Where is the criticism section?

This article appears to be lacking a criticism section. There is a significant opinion which believes that chiropractic is unscientific and dangerous quackery, and these criticisms should be noted in the article. --sciencewatcher (talk) 17:03, 18 November 2008 (UTC)

Generally speaking Wikipedia articles are best structured without explicit Criticism sections; see WP:STRUCTURE. Chiropractic currently has several critical comments (for example, "Chiropractic does not have the same level of mainstream credibility as other healthcare professions."). If there are any notable criticisms of chiropractic that are not covered by Chiropractic, could you please make a specific wording proposal to improve the article? Thanks. Eubulides (talk) 21:03, 18 November 2008 (UTC)

Overall the article appears to have a POV that chiropractic is a valid treatment that works, with little criticism. How about putting a paragraph in the intro saying that chiropractic is criticised by some people for being unproven and unscientific, with a link to chirobase.org. Also, a criticism section in this article might be useful, in order to balance the overly positive POV, unless you have any other ideas for achieving this. --sciencewatcher (talk) 21:38, 18 November 2008 (UTC)

Sciencewatcher, take a look around this talk page and mediation page. Just to add a non-controversial cited text to the article is like climbing a mountain. For example, the newly proposed text for #Public health is being rejected for no specific reason. QuackGuru 21:44, 18 November 2008 (UTC)

A brief statement in the lead might be appropriate, as might be a criticism section. It would depend on the wording, though. Quite possibly there would be no need for a separate criticism section, if the criticisms merely repeat what's already there, or add only a few points which could be added to relevant parts of the article. If you're interested in pursuing this, please propose specific wording along those lines. (And please be prepared for comments and criticism....) Eubulides (talk) 00:54, 19 November 2008 (UTC)

Okay, I'll think about it a bit more, do some more research, and post a proposal. I think maybe a single brief sentence in the lead, as well as a more detailed criticism section consisting of a few paragraphs. --sciencewatcher (talk) 01:10, 19 November 2008 (UTC)

The lead is a reflection of the body. For this article, when adding text to the lead we use references from the body of the article that are also in accordance with WP:MEDRS guideline. QuackGuru 01:15, 19 November 2008 (UTC)

The MEDRS guideline would only apply to the medical and scientific subject matter, not the rest of the subject of chiropractic, which includes far more than such matters. MEDRS has specific and limited usefulness and applicability here. -- Fyslee / talk 06:06, 19 November 2008 (UTC)

Public health 2

Here is a revised proposal for a replacement for the existing Chiropractic #Vaccination section. It takes into account the comments received for #Public health above, with a few minor wording tweaks of my own.

• Change the title of the Chiropractic #Vaccination section to Public health.
• Append "Opposition to water fluoridation" to the {{further}} hatnote at the start of the section.
• Prepend the following text to the section's only paragraph:

Some chiropractors oppose vaccination and water fluoridation, which are common public health practices. Chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive life-long chiropractic treatment.

• Remove the wikilink to Vaccination later in that paragraph, to avoid duplicate wikilinks.

This proposal mentions water fluoridation only very briefly, which addresses the WP:WEIGHT concerns mentioned above. Eubulides (talk) 21:03, 18 November 2008 (UTC)

This proposal is a WP:WEIGHT violation for excluding the relevant discussion about fluoridation according to the references presented. QuackGuru 21:30, 18 November 2008 (UTC)

I still don't like the fluoridation stuff, but at least your suggested text is NPOV. I don't think you can assert that chiropractors have a reputation for recommending repetitive life-long chiropractic treatment (it's also a bit out of context because life-long treatment is an individual, not a public health issue). However, I would support this if you replaced the entire extant vaccination section with those two sentences. This would address my WP:WEIGHT concerns. We don't need to have the anti-vaccination argument on this page - we can just state that a minority of chiropractors oppose compulsory vaccination and move on. No-one is saying that chiro treatment is a replacement for vaccination - all the chiro anti-vacc arguments are general anti-vacc arguments... so we don't need the detail. --Surturz (talk) 00:04, 19 November 2008 (UTC)

• That proposal goes too far in the other direction. For vaccination we have a much more-serious health issue, and much more-reliable sources describing the problem. It wouldn't be reasonable to omit almost all discussion of vaccination (thus removing those sources).
• The source does say that chiropractors have a reputation for recommending repetitive life-long chiropractic treatment; see the quote from the source in #Second sentence above.
• I'm afraid that some chiropractors do assert that chiro manipulation should be used instead of vaccination. See [3] for example. (I'm not suggesting including that source in the article.)

Eubulides (talk) 00:54, 19 November 2008 (UTC)

Indeed, chiropractic (much to the consternation of ethical chiropractors) is renowned for its reputation of recommending (and creating dependence on) lifelong treatments, even in the absence of symptoms. This is the renowned chiropractic "wellness" philosophy. Advocates of this view have been some of the most popular and high profile figures in the profession. It's a very public perception, and that's why there are several chiropractic jokes about the matter. And yes, chiropractors do recommend "adjustments" as a substitute for pretty much every form of well-documented medical treatment and public health recommendation.

Maybe they are a minority, but they are an extremely vocal minority, so loud as to make claims about them being a minority moot. An invisible majority is by default a minority opinion, since it has little influence in creating public perceptions about what chiropractic stands for. -- Fyslee / talk 06:16, 19 November 2008 (UTC)

OR tag removal and reversion

This comment is about the dispute over {{SectOR}} tag on Chiropractic #Evidence basis. The underlying dispute is over content, but the dispute about the tag is not about content; it is about procedure.

I see now that QuackGuru removed the tag, that Levine2112 reverted the removal, that QuackGuru re-reremoved the tag, and Levine2112 re-reverted the removal. This is getting fairly close to an edit war, I'm afraid.

This dispute is over whether we should tag Chiropractic's citation of reviews of spinal manipulation (SM) as constituting original research. A minority of editors say that the research is tainted because it is partly based on data generated by non-chiropractors. Most editors say there is no OR here, as SM is directly relevant to chiropractic. My own view is plain: it is standard practice, among both mainstream chiropractic and mainstream medical and scientific sources, to cite SM reviews when talking about the effectiveness or safety of chiropractic. Only a fringe subset of chiropractors argue that chiropractic SM significantly differs from general SM. Though we should mention the fringe opinion, we should not let it dictate our mainstream coverage of the effectiveness of chiropractic.

This dispute has been going on for months. Advocates of the tag have not suggested specific wording changes to the text, but have simply continued to repeat arguments about keeping the tag up. This sort of activity is an abuse of the dispute-tag system. Dispute tags are not intended to symbolize a minority's disapproval of article text: they are intended to reflect an ongoing dispute that is intended to result in an improvement to the article. Leaving the tag in for months, without specific attempts to fix the alleged problem with consensus, is a misuse of the tag.

For this reason I am reluctantly coming to the opinion that we should simply remove the tag and move on. Of course this will not resolve the underlying content dispute, which will continue and which (I hope) will result in further improvements to the article; but the tag itself (or any tag like it) has proved to be counterproductive to the article.

Eubulides (talk) 20:51, 5 November 2008 (UTC)

I am amazed that after all this time, you still have the dispute all wrong. First off all, we are not dealing with a minority of editors. I would say that overall, things have been split down the middle in terms of numbers. Second, this has nothing to do with research tainted by the inclusion of non-chiropractic SM. This is about using research that does not draw any conclusions specifically about chiropractic. We cannot go ahead and use such research to draw conclusions about chiropractic. That is blatant OR. After months of this debate, I think it is time that you addressed this point and not try and divert our attention. Here is what we know:

• There is no agreement in the research community that all spinal manipulation research is directly related to chiropractic. We have seen arguments both ways from chiropractic and from medical researchers.
• We are currently using conclusions from several pieces of research to discuss the efficacy of chiropractic even though these pieces of research do not discuss chiropractic in their conclusions.
• Using a source in a manner which was not intended by the author is a blatant violation of WP:NOR.

Address these points and these points alone, and maybe we can begin to get somewhere. -- Levine2112 ^discuss 22:35, 5 November 2008 (UTC)

I'm fairly certain I was clear, so please understand that this will be the only warning you receive. Obviously you do not agree that the studies on SM may be used to discuss Chiropractic. However, the most recent RfC (and others) have shown that the consensus of editors disagrees with you. You are welcome to discuss any other objection to the material or specific changes you believe need to be made, but any more posts claiming that SM is WP:OR in this context will result in a week ban from this article and talk page. Shell ^babelfish 22:58, 5 November 2008 (UTC)

I quote from the RfC:

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

I am talking about research above. The RfC was not about research. This is rather clear. What isn't clear - and is an entirely different matter - is your claim that there was some kind of consensus reached there that is applicable to this dispute. -- Levine2112 ^discuss 23:56, 5 November 2008 (UTC)

The above comments don't address the topic of this thread, which is about procedure, not about the underlying content dispute. Eubulides (talk) 07:45, 6 November 2008 (UTC)

There is original research in that section. Specific problems have been pointed out above (Johnson 2008, Fernández-de-las-Peñas, Bronfort 2004). The tag hasn't proved itself to be counterproductive, as you say, however it has not resulted in a conclusion of the dispute. It SHOULD remain, so that readers know that the section "may contain original research". You don't state how removing the tag is going to result in improvements in the article, and that certainly doesn't make intuitive sense. DigitalC (talk) 08:17, 6 November 2008 (UTC)

The specific problem about whether Johnson 2008, Fernández-de-las-Peñas, Bronfort 2004, etc. justify a claim about the low quality of spinal manipulation research is quite recent and is not why the tag is there. It is a relatively minor technical dispute that can be resolved either by adding sources or making minor changes to the wording. I would like to spend some time resolving it, but right now am bogged down in these higher-priority discussions (including mediation). The existence of the tag is causing us to waste time in endless circular discussions that are irrelevant to the evidence basis for chiropractic; this would be time better spent in resolving minor technical disputes, as well as improving the article in more-important ways. Eubulides (talk) 20:00, 6 November 2008 (UTC)

The existence of the tag is not causing us to waste time. Circular debates are causing us to waste time. I have asked you some specific questions which you have refused to answer and thus the circle continues. Hopefully in mediation you will be more inclined to answer these questions with straightforward responses. -- Levine2112 ^discuss 23:08, 6 November 2008 (UTC)

Restoring tag without discussion is not helpful

I see now that DigitalC has restored the tag without any discussion that addresses the above points. This is not helpful behavior. Eubulides (talk) 00:51, 6 November 2008 (UTC)

I have removed it. Tagging isn't constructive. -- Fyslee / talk 02:11, 6 November 2008 (UTC)

I re-re-re-re-removed the tag. We now have a pretty good list of the editors who are most problematic and continue to make false claims of (no) consensus. It's time for administrative action to be made against them. I recommend submitting to WP:ANI a list of the offenders. What do the administrators monitoring this page think? ScienceApologist (talk) 02:28, 6 November 2008 (UTC)

Did anyone ever consider that the amount of editors adding the tag back in indicates that there is no consensus? -- Levine2112 ^discuss 06:14, 6 November 2008 (UTC)

I'd also be interested in hearing opinion from administrators about the topic of this section. Again, it is a procedural issue, not a content issue. Eubulides (talk) 07:45, 6 November 2008 (UTC)

Disruptive tag reverts without discussion

An editor restored the tag without presenting any evidence of original research. QuackGuru 19:28, 6 November 2008 (UTC)

Perhaps the best way to resolve this would be to determine what particular phrases or statements the editors restoring the tag feel are OR and find a way to address those concerns? There are clearly a number of editors who dispute the tags removal. Shell ^babelfish 19:48, 6 November 2008 (UTC)

They dispute the removal of the tag but do not provide any reason for restoring the tag. QuackGuru 19:51, 6 November 2008 (UTC)

(outdent) QuackGuru is right. MaxPont reinstalled the tag without any discussion here. This is after TheDoctorIsIn reinstalled the tag, again without discussion here. As per WP:TAGGING #Removing tags adding tags without discussion is not helpful, and can be seen as disruptive editing, which should be discouraged. Editors, please address the points made at the start of this thread, and please do not indulge in driveby reverts. For now, I reverted MaxPont's driveby revert. Eubulides (talk) 20:00, 6 November 2008 (UTC)

MaxPont has previously contributed on the talk page, stating that he felt that the text (using general SM research to discuss chiropractic) should be removed. There is no need for him to further explain his rationale. For you to ask him to re-explain that he feels there may be an OR violation is in fact a violation of WP:IDHT. Although, strangely, his input to this page has been ignored before, and I have a feeling it wasn't counted towards the "consensus" that "exists". DigitalC (talk) 22:43, 6 November 2008 (UTC)

MaxPont hasn't contributed to the talk page for over a month, and as far as I know has not expressed an opinion on the tags, much less the topic of this thread (the procedure being used for tagging). MaxPont's reverting now (while not contributing to the discussion now) was a driveby revert, which was disruptive editing. Similarly for TheDoctorIsIn, I'm afraid. Eubulides (talk) 02:52, 8 November 2008 (UTC)

Do not dismiss my comments EUbilides. . . that is rude. . . my reverting was just. . . the disagreement continues and we need a tag there to say so.TheDoctorIsIn (talk) 04:08, 8 November 2008 (UTC)

DigitalC has been informed that spinal manipulation is directly connected to chiropractic but has not responded. QuackGuru 00:36, 7 November 2008 (UTC)

I support the retention of the tag. There are clearly several editors whom believe the tag should stay for the moment, and its removal without consensus is disruptive. --Surturz (talk) 22:52, 6 November 2008 (UTC)

Surturz has intentially ignored the evidence that spinal manipulation is directly related to chiropractic.[4][5] Part of consensus building is collaboration. QuackGuru 00:36, 7 November 2008 (UTC)

I count at least five editors who in the last day or two have supported keeping the tag in place (all of whom who have given their reasons and evidence of why they feel the tag is necessary). Given this, I'd say that there is no consensus to remove the tag. Let's leave it in place and see how mediation goes. I'm busy today but will try to put together my response at the mediation page. -- Levine2112 ^discuss 23:03, 6 November 2008 (UTC)

Levine2112 has not replied to my question about spinal manipulation and has not replied to my request to discuss his edit me. QuackGuru 00:36, 7 November 2008 (UTC)

• How about we make "What specifically needs to be changed to facilitate removing the OR tag?" the first thing to focus on in the mediation? P.S. Anyone interested in joining the mediation is welcome to hop over there and put in their opening statement to help us get started. Shell ^babelfish 23:36, 6 November 2008 (UTC)

That would be a good thing to focus on, yes. Sorry I didn't see that suggestion before writing my initial post there, so my initial post there is a bit unfocused. I assume at some point you'll repeat that suggestion there? Eubulides (talk) 02:52, 8 November 2008 (UTC)

A tag is to inform other Wikipedians about any possibility of OR and not to inform a reader. At this point, most or all involved editors are aware of this particular content diuspute. QuackGuru 00:36, 7 November 2008 (UTC)

WP:OR Tag edit war score

Removalists

• QuackGuru: 2
  
• Eubulides: 2
  
• Fyslee: 1
  
• ScienceApologist: 3
  

Inserters

• Levine2112: 2
  
• DigitalC: 2
  
• TheDoctorIsIn: 2
  
• MaxPont: 1
  

COMMENT: This is ridiculous, you are edit-warring over a TAG. --Surturz (talk) 05:19, 7 November 2008 (UTC)

I had not seen this tally before. . . Surturz, you make a good point. . . I added one to my score. . . maybe this should stop now?TheDoctorIsIn (talk) 05:22, 7 November 2008 (UTC)

Review of arguments and community discussion to determine consensus

Up to this point there have been numerous community discussions on this issue, both on the talk page of the article and at various noticeboards. The most pertinent of the discussion threads are at Talk:Chiropractic/Archive_18#RfC:_Effectiveness_of_chiropractic_care, Talk:Chiropractic/Archive_22#RfC:_Effectiveness_of_chiropractic_care, Wikipedia:No_original_research/noticeboard/Archive_4#Chiropractic_section_on_evidence_basis, Talk:Chiropractic#RfC:_Is_the_.22subject.22_of_spinal_manipulation_relevant_to_chiropractic.3F and recent discussion at Wikipedia:OR/N#Outside_views_needed.. I find it troublesome that in many places, the editors most involved in this dispute spend a great deal of time arguing with each other instead of allowing editors outside of the situation to comment. However, when those outside opinions are reviewed, a strong pattern emerges:

• All of the outside editors who commented on the RfCs felt that spinal manipulation belonged in the article and was integral to understanding chiropractic.
• All but one of the outside editors felt that general spinal manipulation studies were appropriate; a single editor suggested that studies should be specific to chiropractic spinal manipulation.
• All of the outside editors felt that spinal manipulation should be covered in detail at its own article, but that an overview of pertinent information was necessary in this article as well.
• In the areas reviewed, none of the outside editors agreed that the use of spinal manipulation studies in this article was original research.

There are several involved editors who feel very strongly that material on the efficacy of spinal manipulation is not appropriate for this article and they have argued extensively to this point. However, a review of these many discussions over the past months shows that despite the variety of arguments they have been unable to convince other involved editors, or even those editors who are not so involved. In Wikipedia parlance, this means that a general consensus has developed. So, unless there are additional reasons for the OR tag in the Effectiveness section, it needs to be removed. Shell ^babelfish 10:50, 9 November 2008 (UTC)

Some overlooked discussions: [6], [7]. And RFCs: [8], [9]. Please consider these and refactor your thoughts about the "consensus" if applicable. -- Levine2112 ^discuss 02:57, 12 November 2008 (UTC)

Shell Kinney stated "All of the outside editors who commented on the RfCs felt that spinal manipulation belonged in the article and was integral to understanding chiropractic". This is blatantly false, and a summary of the discussions here by an admin should be closer to the truth. User:MaxPont specifically stated that the information should be removed from the article, and he was an outside editor. Why is his input being continually ignored? At least 15 editors have commented in the various RfCs and talk page discussions disagreed with the idea that SMT research should be used in the chiropractic article. No consensus exists, yet we are being told that one does, seemingly based on only the latest RfC. DigitalC (talk) 10:45, 18 November 2008 (UTC)

MaxPont is not an outside editor, as MaxPont has contributed multiple nontrivial edits to Chiropractic, and if we count the latest dispute over the tag, MaxPont has participated in two mini edit-wars here.[10][11][12][13] I haven't seen 15 editors who disagree with Shell Kinney's statement that spinal manipulation belongs in the article; perhaps you can enumerate them and their comments? Eubulides (talk) 15:56, 18 November 2008 (UTC)

MaxPont has contributed less than 6 edits ever to Chiropractic ever; some of these have been after his input to the RfC. His edits prior to that had no relation or bearing on the OR dispute. You ignored his input on the talk page previously, and it is absurd to consider him to not be an outside editor and continue to ignore his input. Obviously I cannot enumerate all the editors and all their comments, as this discussion has been going on for the last 6 months, and that is a lot of comments. Again obviously, some of these comments were before Shell Kinney's recent involvement in the page, and they therefore couldn't necessarily be said to be disagreeing with Shell Kinney's statement. DigitalC (talk) 23:05, 18 November 2008 (UTC)

• Yes I counted 4 edits to Chiropractic by MaxPont, which are all referenced in my previous comment. Those edits uniformly remove or tone down text that presents negative information about chiropractic. One edit[14] was made after the OR RfC, the others predate it.
• I've been following the dispute fairly closely, and I don't recall anything close to 15 editors opposing the idea that spinal manipulation belongs in the article and is integral to understanding chiropractic. If finding all 15 is too much work, perhaps you could enumerate some of those editors (other than yourself, of course), along with pointers to diffs generated by those editors?

Eubulides (talk) 00:54, 19 November 2008 (UTC)

I think we can accept Shell's review as valid. In the RfCs Levine mentions: in this RfC in which Martinphi, I'clast, Ludwigs2 and MaxPont seem to be the outside editors, and all apparently agree that there was an OR violation (but there are problems with this RfC); whereas in [15], WhatamIdoing, MacGruder and TimVickers seem to be the outside editors and all apparently agree that the material should be included, i.e. that it isn't OR. In the first of those RfCs, however, where the outside editors agreed there was an OR violation, I think that the RfC statement was not well-formed. It contained a non-NPOV statement that "Chiropractic spinal manipulation (often times differentiated as spinal adjustment) differs from these other profession's version of spinal manipulation in intent, diagnosis, and technique", asserted as if it's fact, although I believe this contradicts the mainstream medical position; it said "Some nominal amount researchers have used some of these non-chiropractic studies to draw conclusions about chiropractic" and "since a marginal amount of researchers have drawn conclusions about chiropractic efficacy from certain non-chiropractic studies," although the words "nominal" and "marginal" contradict Eubulides' position that the studies some editors want to exclude are the best available studies. It also said "Please note that it is not standard practice in the scientific community to use studies about non-chiropractic spinal manipulation to make conclusions about chiropractic spinal manipulation effectiveness." which I think is also a non-NPOV statement that I think Eubulides would not agree with. So perhaps we can discount the results from that RfC as having been led by a misleading RfC statement, and accept Shell's evaluation as valid. ☺Coppertwig(talk) 15:14, 22 November 2008 (UTC)

Thanks Coppertwig; I felt the same way about that particular RfC, so its nice to know I wasn't completely out in left field there. In that case, the RfC seemed to say "This is wrong, the field thinks its wrong and its being used poorly." it shouldn't be a surprise that people agreed with the statement - they'd been led to believe that the answer was already a forgone conclusion. The other discussions and RfCs which didn't contain such leading seem to give a better picture of what the general community has had to say on the question. Shell ^babelfish 19:03, 22 November 2008 (UTC)

Rather than discounting the input of certain editors because you didn't feel the RfC was worded properly, a better worded RfC should be performed, with notes to all previously participating editor's talk pages. It should be noted that I absolutely disagree with the summary as provided by Shell. DigitalC (talk) 23:14, 22 November 2008 (UTC)

That's the point - there were other RfCs - repeated RfCs spanning many months. All of the rest of them disagree with the problematic one. Shell ^babelfish 01:07, 23 November 2008 (UTC)

Pardon my french. . . but what bullshit. . . there was lots of input from lots of editors in lots of RFCS. . . i feel that my input and theirs are being ignored by Shell-Kinney here. . . there is pov-pushing by original research afoot here and Shell-Kinney is oblivious to it. . . i don't think he should be mediating here anymore.TheDoctorIsIn (talk) 17:54, 23 November 2008 (UTC)

I believe Elonka is also taking a look at the discussions; if we'll give her a bit (there are a lot of discussions and RfCs to look at) hopefully she can give us some input on how she sees consensus in this situation. Shell ^babelfish 18:38, 23 November 2008 (UTC)

Proposed text for low back pain

This discussion has been closed. Please do not modify it.
The following discussion has been closed. Please do not modify it.
Low back pain. There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain; methods for formulating treatment guidelines differ significantly between countries, casting some doubt on their reliability. A 2008 review found strong evidence that SM is similar in effect to medical care with exercise. A 2007 review found good evidence that SM is moderately effective for low back pain lasting more than 4 weeks; a 2007 literature synthesis found good evidence supporting SM for low back pain regardless of duration. Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review stated that SM or mobilization is no more or less effective than other standard interventions for back pain. A 2005 systematic review found that exercise appears to be slightly effective for chronic low back pain, and that it is no more effective than no treatment or other conservative treatments for acute low back pain. Also, in Chiropractic #Treatment techniques, change this sentence: Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist. to this: Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist; a 2008 systematic review did not find enough evidence to make recommendations about its use for chronic low back pain. Comments on proposed text for low back pain After reviewing the different proposals on the mediation page I think this is the best proposal. It is much shorter than the current mainspace version and satisfies WEIGHT. This new proposal is for replaciing the low back pain section in Chiropractic#Effectiveness. QuackGuru 00:46, 18 November 2008 (UTC) As seen in Talk:Chiropractic/Mediation #Discussion, the shorter version is still evolving; let's see where it goes before deciding this. Eubulides (talk) 03:10, 18 November 2008 (UTC) I trimmed the proposal. QuackGuru 04:08, 18 November 2008 (UTC) FYI --Surturz (talk) 06:46, 18 November 2008 (UTC) This proposed section doesn't mention chiropractic once. This section should be in the spinal manipulation article, as it has no relevance or bearing here. We have a spinal manipulation article - lets use it. DigitalC (talk) 10:35, 18 November 2008 (UTC) Please move this discussion to the mediation page. It is unhelpful to have two parallel discussions on this section and QuackGuru deserves to be admonished for causing this to occur. --Surturz (talk) 10:38, 18 November 2008 (UTC) This section has been trimmed and can be discussed here and at the mediation page too. It is now ready to be reviewed. I am of the opinion that it is a good compromise to trim the SM research where feasible. QuackGuru 04:08, 20 November 2008 (UTC) Please stick to the mediation process. --Surturz (talk) 05:18, 20 November 2008 (UTC) Surturz has been informed not to archive the proposal. QuackGuru 05:25, 20 November 2008 (UTC) QuackGuru, please stop disrupting the mediation process by forking discussion on this section. If you want the proposal put on this page, gain consensus on the mediation page first please. Your opinion is not the only one of value, stop the unilateral action please. --Surturz (talk) 07:13, 20 November 2008 (UTC) This section has been trimmed and can be discussed here as well. It is now ready to be reviewed for inclusion in the article. QuackGuru 05:25, 20 November 2008 (UTC)

This section is currently being discussed at Talk:Chiropractic/Mediation#Limited_Edit_War_on_Chiropractic.23Low_back_pain --Surturz (talk) 02:40, 20 November 2008 (UTC)

• Both of you stop it. Quackguru - its not appropriate for you to sidestep the mediation by promoting your own proposals here. Surturz, there was really no reason to archive this or edit war. Both of you are being disruptive and if it continues, will find yourself under sanctions to limit that disruption which will most likely include a ban from this talk page. Shell ^babelfish 17:32, 20 November 2008 (UTC)
  • Sorry. --Surturz (talk) 02:36, 24 November 2008 (UTC)

Public health

Further information: [[:Vaccine controversy and alternative medicine]] and [[:Opposition to water fluoridation]]

Some chiropractors oppose vaccination and water fluoridation, which are common public health practices. Chiropractors' attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive life-long chiropractic treatment. Within the chiropractic community there are significant disagreements about vaccination, one of the most cost-effective forms of prevention against infectious disease. Most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous, ineffective, and unnecessary. Some chiropractors have embraced vaccination, but a significant portion of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that vaccines interfere with healing. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; a survey in Alberta in 2002 found that 25% of chiropractors advised patients for, and 27% against, vaccinating themselves or their children.

Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health.

Comments on Public health

Here is an improvement for the public health (vaccination) section. QuackGuru 17:25, 7 November 2008 (UTC)

• Probably don't have time to go through the entire thing, but the first line is taken out of context. The quote from the source is "Podiatrists became active members of the American Public Health Association (APHA) as far back as the 1950's, embracing and contributing to the advancement of accepted public health initiatives, in cooperation with others involved in public health. Podiatrists slowly gained an image as proponents of public health, at a time when many chiropractors aggressively (and dogmatically, without evidence [15]) opposed many public health measures such as vaccination and water fluoridation.". This would support that Chiropractors opposed public health measure in the 50s. The article does go on to suggest that "those chiropractors who dogmatically oppose common public health practices, such as immunization [15] and public water fluoridation, cease such unfounded activity", which implies that only some chiropractors oppose such measures - which is not what is implied by the proposed text. The inclusion of "unfounded activity" in the proposed text also reads ackwardly, some sort of rearrangement might make it flow better - it currently suggests that immunization and water fluoridation are unfounded activities.
• It continues to include unverified text, "one of the most cost-effective forms of prevention against infectious disease"
• It continues to violate NPOV, stating that "Most chiropractic writings on vaccination focus on its negative aspects", without noting that a minority of chiropractors produce these writings (which was sourced and included in old versions of the vaccination section).

118.208.237.133 (talk) 22:46, 7 November 2008 (UTC) —Preceding unsigned comment added by DigitalC (talk • contribs)

• The only things that are changed in QuackGuru's proposal are title, the proposed new 1st sentence, and the proposed new last paragraph, so I'll comment on these. I agree with DigitalC's comments on the new material, in DigitalC's first bullet. (The old material, discussed in the other two bullets, has already been discussed at length, where my opinion hasn't changed, and I'd rather not repeat that discussion again now.)
• The title should be "Public health" not "Public Health", as per Wikipedia style guidelines.
• The hatnote should also mention the fluoridation controversy, like this:

Further information: [[:Vaccine controversy and alternative medicine]] and [[:Opposition to water fluoridation]]

• The first sentence "Chiropractors are opposed to common public health practices, such as vaccination and public water fluoridation, which are unfounded activity" has several problems:

• I don't know what the phrase "which are unfounded activity" is supposed to mean. It sounds like it's asserting that vaccination and fluoridation are not founded in science, which is surely not intended.
• It is not true that chiropractors in general oppose vaccination and fluoridation. From surveys, we know that a minority of chiropractors support vaccination, and a minority opposes it. It's not accurate to summarize this position by saying "chiropractors oppose vaccination", or anything like that. I wouldn't be surprised if fluoridation was similar.
• The first sentence makes it sound like chiropractors oppose public health measures other than vaccination and fluoridation. But the cited source mentions no public health measures other than these two.
• I suggest replacing the first sentence with the following:

"Some chiropractors oppose vaccination and water fluoridation, which are common public health practices. Chiropractors' attempts to establish a reputation for public health are also compromised by their common recommendations for endless chiropractic treatments."

• The second paragraph cites the ICA website, a fringe primary source; it'd be better to stick with sources in refereed journals, preferably secondary sources, and to summarize their points. I suggest replacing the 2nd paragraph with the following, which tries to address the above comments:

"Early opposition to water fluoridation included chiropractors, some of whom continue to oppose it as being incompatible with chiropractic philosophy and an infringement of personal freedom. Recently, other chiropractors have actively promoted fluoridation, and several chiropractic organizations have endorsed scientific principles of public health."

• (Also, I made minor changes directly to the draft, to spruce up its citations.)

Eubulides (talk) 02:52, 8 November 2008 (UTC)

I made these changes to the proposed draft. I think we should keep the last sentence or move it to a subarticle: "Many chiropractors are aggressively against water fluoridation." QuackGuru 03:45, 8 November 2008 (UTC)

Oppose we've discussed this before and there was no consensus for this stuff. ICA website is not WP:RS --Surturz (talk) 07:12, 10 November 2008 (UTC)

The updated draft does not cite the ICA; perhaps Surturz's comment is about the earlier draft, which I also criticized for citing the ICA? Anyway, I have some further comments about the updated draft:

• The initial phrase "A prevalent portion of chiropractors" makes little sense to me; I don't see what prevalence has to do with portions. Let's just stick with the simple and accurate "Some chiropractors".
• The final sentence "Many chiropractors are aggressively against water fluoridation" is duplicative of the earlier phrase "some of whom continue to oppose it". Also, the final sentence is not supported by the cited source: its "many chiropractors aggressively" is talking about long-ago history, not about the present day. Let's omit the final sentence.

Eubulides (talk) 09:31, 10 November 2008 (UTC)

Without commenting on the thread itself, I'll comment on the attitude about citing the ICA. It is a notable and reliable source for straight chiropractic opinion. This article covers many aspects of the subject, some of which require documenting straight chiropractic opinion, and then the ICA is fine to quote. -- Fyslee / talk 21:02, 10 November 2008 (UTC)

I made this change to continue moving the draft forward. QuackGuru 01:06, 11 November 2008 (UTC)

Thanks. I see just one remaining problem: that draft begins with "A significant minority of chiropractors oppose vaccination and water fluoridation". However, the cited source (Murphy et al. 2008, PMID 18759966) nowhere says that a "minority" of chiropractors oppose vaccination and fluoridation; for all we know from that source, it could be a majority. Also, the cited source nowhere says that the fraction of chiropractors opposing vaccination and fluoridation is "significant". Let's just say "Some chiropractors" rather than "A significant minority of chiropractors"; that's good enough and is well supported by the source. A later sentence already says that "a significant portion of the profession" rejects vaccination, and we needn't repeat that in the topic sentence. Eubulides (talk) 01:21, 11 November 2008 (UTC)

I made this change. I think it is ready for inclusion in the article. QuackGuru 01:28, 11 November 2008 (UTC)

Thanks for all that work; it looks good to me too. Eubulides (talk) 01:34, 11 November 2008 (UTC)

Edit requested to Vaccination

I request an edit to the Vaccination section. Simply, replace the Vaccination section with the draft Public health section. QuackGuru 01:22, 12 November 2008 (UTC)

(This request is referring to #Public health above.) Eubulides (talk) 06:22, 17 November 2008 (UTC)

I echo the sentiments of 118.208.237.133 (DigitalC?) and Surturz and would request that this change not be implemented until these matters can be resolved. In particular, the last two bullet points mentioned by 118.208.237.133 have not been addressed but merely glossed over. We have unreference text and an NPOV violation. In short, the proposed text:

• continues to include unverified text, "one of the most cost-effective forms of prevention against infectious disease"
• continues to violate NPOV, stating that "Most chiropractic writings on vaccination focus on its negative aspects", without noting that a minority of chiropractors produce these writings (which was sourced and included in old versions of the vaccination section).

This text remains in the proposed version, un-cited. I don't see the rush to implement this substandard version when there is clearly still some work to be done. -- Levine2112 ^discuss 02:42, 12 November 2008 (UTC)

DigitalC concerns were about an earlier version. Surturz commented about the ICA. This version does not have the ICA reference. Everything is resolved at this point. Making vague comments to stop the improvements is not helpful. Levine2112 has not made any specific objections to the current proposal. QuackGuru 03:00, 12 November 2008 (UTC)

The last two bullets by DigitalC is not about the newly proposed improvements. QuackGuru 03:10, 12 November 2008 (UTC)

Thanks for your comments is a non-argument. Levine2112 has not made a specific objection to the current proposal. QuackGuru 03:15, 12 November 2008 (UTC)

Levine2112's objection is not about the current proposal. The text Levine2112 is disputing is already in the article. I hope an admin will review the current proposal and not get confused by Levine2112 objection which is not about the newly proposed text. QuackGuru 03:22, 12 November 2008 (UTC)

Levine2112, do you have any specific objections to the current proposal? QuackGuru 03:33, 12 November 2008 (UTC)

The text Levine2112 is against is already in the article. There is no specific objection to the newly proposed text. QuackGuru 03:41, 12 November 2008 (UTC)

• QuackGuru is correct in that no arguments have been presented yet against the proposed edit. The criticisms presented in this section are about a different topic in the existing text, a topic unaffected by the proposed edit. The proposed edit merely adds text about fluoridation; the last two bullets of DigitalC's comments, which Levine2112 echoed, criticize only vaccination-related text in the existing article. Vaccination-related changes can be discussed separately and need not derail fluoridation-related improvements.
• This raises a more-general question: is the article currently frozen against changes proposed on the talk page and for which there is consensus? (This more-general question is independent of whether consensus exists for this particular edit.)

Eubulides (talk) 09:01, 12 November 2008 (UTC)

The article was only locked to prevent edit warring over the OR tag. If everyone here could agree to keep talking things out instead of reverting, the article can be unlocked so that normal editing can continue. Shell ^babelfish 09:44, 12 November 2008 (UTC)

Sounds good. I recommend that the first time somebody adds the tag back in we go immediately back to protection to avoid it starting again. ScienceApologist (talk) 09:48, 12 November 2008 (UTC)

Oppose the addition of fluoridation stuff. In fact, I don't see why Public Health comments from individual chiropractors is relevant to the article. What next? Some chiropractor somewhere claims that tinfoil hats are useful for protection from orbital mind control lasers and we use that as justification to write off the entire profession as conspiracy theorists? Surely we should be concentrating on what is actually taught as part of the profession ie. treatment methods taught in chiro courses, and also in post-grad chiro education courses. Vaccination and Fluoridation are neither. --Surturz (talk) 18:35, 12 November 2008 (UTC)

According to the references it is relevant. I don't see any specific objection to the newly proposed text. I don't understand why would you oppose an improvement. Can you be specific? QuackGuru 19:43, 12 November 2008 (UTC)

• Chiropractic is not merely about what is taught in chiropractic school (though of course that's important); it's also about how chiropractic is actually practiced and what chiropractors actually do.
• The International Chiropractors Association (the leading straight group) is officially opposed to fluoridation,[16] so at least they think fluoridation is notable and relevant.
• Chiropractic's current opposition to fluoridation is not as notable as its opposition to vaccination. Historically fluoridation was a bigger deal, but that's history. As per WP:WEIGHT fluoridation shouldn't be mentioned as heavily as vaccination is. We can put more fluoridation details into History of chiropractic.
• There does seem to be a good case for briefly mentioning fluoridation here, as we have multiple reliable sources on the subject, published in peer-reviewed medical journals.
• Perhaps the proposed wording could be trimmed a bit, but that's an argument for improving it further, not for omitting it entirely. A simple way to go about this would be to install the proposed text and then improve it further. Another way would be for someone to suggest further improvements now, and then to install the improved version.

Eubulides (talk) 21:34, 12 November 2008 (UTC)

I strongly oppose the addition of the fluoridation text and thus have removed the editprotected template, which as Shell says below, should only be for non-controversial edits. --Surturz (talk) 03:22, 17 November 2008 (UTC)

What are your objections? -- Fyslee / talk 05:57, 17 November 2008 (UTC)

No specific objections have been made by Surturz and Surturz was previously asked what is the specific objection. It is not helpful to continue to object to an improvement without any specific objection. QuackGuru 06:09, 17 November 2008 (UTC)

{{editprotected}} is not only for noncontroversial edits, but also for edits that have consensus. Surturz has opposed the change but has given no reason for objection. The other objections raised have been about existing text (which would remain unchanged), and are not relevant to the change. I see that QuackGuru has restored the {{editprotected}} template; I am taking the liberty of moving it to just before the actual request, as its previous location was confusing to someone not following the discussion closely. With luck, an administrator with some free time can take a look at this request soon, as well as the other {{editprotected}} request on this talk page. Eubulides (talk) 06:22, 17 November 2008 (UTC)

Surturz, ignoring the comment is not collaboration. I have asked for a specific objection or a way to improve the section. At this point, we have consensus for the newly proposed text when non-specific objections are being made. QuackGuru 06:27, 17 November 2008 (UTC)

(outdent) I removed the editprotected template on the grounds that it clearly states that "this template should only be used to request edits, to fully protected pages, that are uncontroversial or supported by consensus." and this is clearly not the case. Please do not put the template back into this talk page until consensus has been reached. I would hate to see edit warring on the talk page leading to the talk page being locked! Ask an admin to reinstate it if you feel strongly.

Opposition to fluoridation is not a chiropractic specific issue and it is therefore undue WP:WEIGHT to include it here. You don't have to look far to find other research/health professionals (e.g. Arvid_Carlsson) that oppose fluoridation. Even pro-fluoridation doctors acknowledge that there is an ethical difference between public health ethics and private doctor-patient medical ethics (doi:10.1097/01.PHH.0000324563.87780.67). Chiro opposition to vaccination, fluoridation or any other public health measure stems from this difference. Chiros do not treat all diseases, and public health planning is not really within their demesne (although of course individual chiropractors, or even groups of chiropractors, may take an interest in public health issues).

By all means include a mention of chiropractors/chiropractic in the water fluoridation article, but to include it here implies that it is either part of the chiropractic profession (it isn't) or that almost all chiropractors would immediately tell you to stop using fluoridated toothpaste and to drink only filtered water immediately upon entering their clinic (they won't). It undermines the authority of this article and the reputation of wikipedia for us to allow such blatant anti-chiro POV pushing in the article. --Surturz (talk) 06:51, 17 November 2008 (UTC)

You have not provided a wiki-legitimate reason for keeping this out of the article. Deletionism isn't helpful, especially just to eliminate something because you don't like it. This is a misuse of the weight argument. The question to ask is: Is it sourced properly? If so, then find a way to include it. Chiropractic, like most of alternative medicine, has more than its fair share of promoters of POV that deviate significantly from mainstream medical practice and public health measures. This needs to be noted. And before you once again raise the false charge that this is an accusation against all chiropractors or the whole profession, it isn't. It just happens to be a significant enough detail to have been noted by various sources, and thus it needs to be mentioned. It should of course be written in such a manner as to not give the impression that all chiropractors support such POV. Please help in such endeavors instead of just deleting what you don't like to hear about what actually happens within the profession. -- Fyslee / talk 07:05, 17 November 2008 (UTC)

Surturz, thanks for your comments. However, the references are relevant to this article. The edit request template is for admins to review. QuackGuru 07:04, 17 November 2008 (UTC)

• I'd also like to thank Surturz for coming up with a specific objection. It's not yet clear whether there is consensus, even with the objection (after all, consensus does not equal unanimity), but further discussion should help us discover this.
• It's not generally the role of an administrator to insert an {{editprotected}} template; suggesting that we wait for an admin to do so is roughly equivalent to suggesting that we wait forever to make the change.
• It is true that opposition to fluoridation is not specific to chiropractors. But it is also true that lots of other things are not specific to chiropractors, including spinal manipulation (SM). Clearly Chiropractic should discuss SM, which is core to chiropractic. Now, fluoridation is not as central to chiropractic as SM is; but one cannot dismiss fluoridation because it "is not specific to" chiropractic, any more than one could dismiss SM for the same reason.
• The International Chiropractors Association's official positions on public health[17] mention only vaccination and fluoridation, which suggests that fluoridation is relevant here. That is, opposition is not limited to individual chiropractors.
• By my count, the proposal would add 46 words about fluoridation. Perhaps we could compromise by adding fewer words. For example, we could omit the phrases "as being incompatible with chiropractic philosophy and an infringement of personal freedom" and "and several chiropractic organizations have endorsed scientific principles of public health". These phrases could be moved to Opposition to water fluoridation. This would shrink it down to 27 words, thus helping to allay any WP:WEIGHT concerns.

Eubulides (talk) 08:23, 17 November 2008 (UTC)

• Specific objections have been made before, and ignored. Again it required admin involvement before they were addressed.

• If you can't convince an administrator that you have consensus over the objections of a single editor, then you don't have consensus. Adding the editprotected template is fine, but if an editor removes it, it is disruptive to add it back immediately... consensus should be gained first.
• "The SM is relevant to chiropractic therefore we should have text about non-chiro SM" is a tenuous argument that has been much argued on this page. Making the same argument about fluoridation borders on the absurd. The wearing of hats isn't specific to chiropractors, yet many chiropractors wear hats... does this mean we also need to mention hat wearing in the article? Of course not.
• We have already established that the ICA website is not a WP:RS. Quoting it is WP:OR.
• If you really, really, want to insert the fluoridation stuff, I'll give you my support if you can trim the entire section (vaccination+fluoridation) down to half the current visible word count or less. I count 145 words currently... if you can get your "public health" proposal down to 73 words or less, it will (somewhat) alleviate my WP:WEIGHT concerns for the section. Obviously, you can't just move the text to other sections, it must be actual reduction. --Surturz (talk) 11:54, 17 November 2008 (UTC)

I think there is consensus for the current version in mainspace and the newly proposed text. Surturz says we should trim the entire section in order to add the fluoridation part to the article. Surturz claims ICA is not reliable and quoting it is OR but it was explained to Surturz before we are not currently citing the ICA in the proposed text. Quoting the ICA is moot with the current draft because we are not citng the ICA. We should not trim the current vaccination section in order to get the newly propsed text in the article. The existing text and the newly proposed text are separate issues. Instead of shortening the newly proposed text I suggest we open a RFC specifically for the newly proposed text. QuackGuru 17:30, 17 November 2008 (UTC)

Second sentence

• Ok guys, I've removed the edit protected request *again*. Please remember that this request requires either uncontroversial edits or consensus - neither of which are the case here. I don't usually comment on the disputes themselves, but since this is more style than content - when I was looking at the paragraph above, I couldn't understand the second sentence - is it saying that chiropractors give unnecessary treatments or that the treatments are a public health issue or that their marketing undermines their credibility? Anyways, it was confusing to me, so it might need reworded for clarity. Shell ^babelfish 11:09, 17 November 2008 (UTC)

Same here on that last issue, I can't really tell what it's trying to say. Unless I'm mistaken, I think what it's trying to say is that Chiropractors are trying to give modern public health practices (such as vaccination and fluoridation) a bad name, but because they instead recommend the constant and endless use of chiropractic treatments as an alternative, they have yet to make any headway in this endeavor. If I am correct in this, it might be better to word the second sentence as "Chiropractors' attempts to establish a negative reputation for public health practices have been compromised by their recommendations for endless chiropractic treatments as an alternative." instead (unless someone's got a more concise way of wording it). Let me know if I accidentally changed the meaning of it, too, as this was not my intent. Cheers. lifebaka++ 16:23, 17 November 2008 (UTC)

I think the current sentence is trying to say: Chiropractors have attempted to establish a reputation for public health but has been hampered by their common recommendations for endless chiropractic treatments. The part about "their common recommendations for endless chiropractic treatments" leaves the reader asking how does endless recommendations for chiropractic treatments compromise the ability to establish a reputation for public health. QuackGuru 18:06, 17 November 2008 (UTC)

• The 2nd sentence is attempting to summarize the bottom half of page 3 of the source, which, among other things, discusses "the common perception (which is well supported, in our experience) that chiropractors are only interested in 'selling' a lifetime of chiropractic visits" and goes on to say "The recommendation for repetitive life-long chiropractic treatment compromises any attempt at establishing a positive public health image and needs to change." Perhaps someone can come up with a clearer way to summarize this?
• One idea is that, once we can come up with clearer wording, we can decouple the 2nd sentence, from the fluoridation-related parts of the proposed change, which are having a tougher time gaining consensus.

Eubulides (talk) 18:57, 17 November 2008 (UTC)

Me thinks this is clearer and we have a rough consensus for the newly proposed text. QuackGuru 17:17, 18 November 2008 (UTC)

OK, thanks, I followed up in #Public health 2 below.

The Talk:Chiropractic#Public health section is a reasonable proposal for improving the Vaccination section. I would like input on how to proceed. Where do we go from here? Perhaps a RFC? Anyhow, it would be a violation of WP:WEIGHT to exclude the relevant cited text from the article. QuackGuru 18:33, 22 November 2008 (UTC)

I don't offhand see how WP:WEIGHT would let us decide between #Public health and #Public health 2. I prefer #Public health but it's just a mild preference and I would be happy with either version. I do like expanding the section's scope from vaccination. Eubulides (talk) 08:32, 24 November 2008 (UTC)

I would like help starting a RFC. I suggest all the discussion about Public health be archived and we move the proposal Talk:Chiropractic#Public health to the bottom portion of the page. We can provide links to the archived discussion and request outside opinion. QuackGuru 01:36, 25 November 2008 (UTC)

ICA as a RS

Without using the RfC template to call outside commentators to come here, I'd like to call an informal RfC about this matter.

Once again the claim has been broached that the ICA website is not a RS. Let's get this settled once and for all. This is a matter of principle related to our understanding of the RS policy. Let's start with the latest claim:

• "We have already established that the ICA website is not a WP:RS. Quoting it is WP:OR." - Surturz

Other places (not necessarily in precise order) where the subject is mentioned:

• "The second paragraph cites the ICA website, a fringe primary source; it'd be better to stick with sources in refereed journals, preferably secondary sources, and to summarize their points." - Eubulides

• "The updated draft does not cite the ICA; perhaps Surturz's comment is about the earlier draft, which I also criticized for citing the ICA? Anyway, I have some further comments about the updated draft:" - Eubulides

• "ICA website is not WP:RS" - Surturz

• "The International Chiropractors Association (the leading straight group) is officially opposed to fluoridation,[18] so at least they think fluoridation is notable and relevant." - Eubulides

• "The International Chiropractors Association's official positions on public health[19] mention only vaccination and fluoridation, which suggests that fluoridation is relevant here. That is, opposition is not limited to individual chiropractors." - Eubulides

• "We have already established that the ICA website is not a WP:RS. Quoting it is WP:OR." - Surturz

• "Without commenting on the thread itself, I'll comment on the attitude about citing the ICA. It is a notable and reliable source for straight chiropractic opinion. This article covers many aspects of the subject, some of which require documenting straight chiropractic opinion, and then the ICA is fine to quote." - Fyslee

Now, per my statement above, I obviously believe it is a RS under the right circumstances. It looks like it's being rejected at the wrong times. What think ye? When is it a RS, and when is it not a RS? -- Fyslee / talk 07:25, 18 November 2008 (UTC)

ICA is a reliable source for only their opinion. QuackGuru 07:29, 18 November 2008 (UTC)

The ICA website is a reliable source for their opinion, but even then, if there is a reliable 3rd-party source on the same subject, it's better to cite the 3rd-party source, as it's more likely to provide a proper context. Eubulides (talk) 07:42, 18 November 2008 (UTC)

Given the internecine nature of discussions on this article, it is completely impractical to set the precedent that we start using non-RS websites as references. If you allow the fluoridation stuff, then you are also allowing in other ICA opinions. So editors could then put in such stuff as...

According to the ICA, chiropractic is the safest portal of entry health care available to the public today. The ICA cite records from court and insurance cases as evidence that chiropractic possesses safety and effectiveness unmatched in healthcare.

...this is an opinion of the ICA, and therefore under your criteria, may be allowed into the article. Of course, there will be an enormous argument as to what is "ICA Opinion" and what is "ICA Policy" and pedantic arguments that go on and on about what can and can't be included. It will be completely unproductive. You can't cherry pick just the fluoride stuff, you either let all of it in, or none of it in. It is not a WP:RS and should not be used as a reference. Include it in external links if you want, or start a separate article on the ICA if you want, but keep it out of this article. --Surturz (talk) 10:50, 18 November 2008 (UTC)

Exactly, as NPOV states, When we discuss an opinion, we attribute the opinion to someone and discuss the fact that they have this opinion. - describing the opinions of chiropractors is entirely relevant to this article, and this group are representatives of a major group of chiropractors. We have to use the source carefully, since it has an obvious bias, but the opinions this organization have are relevant to the subject of the article. Tim Vickers (talk) 21:13, 18 November 2008 (UTC)

<-- I agree with QG and Eubulides. They are a good source for (fringe chiropractic) opinion, and not a good source for scientific data. When they express opinions that aren't fringe, then a better source should be used. Unlike Surturz, I think in a less absolute manner and don't think it's an all-or-nothing situation. The ICA website is a RS for documenting very significant fringe chiropractic POV, some that many chiropractors would dissent with, but some which many chiropractors also agree with. If the ICA's POV only represented 5% or less of the chiropractic POV, then we could hardly justify using them for inclusion of very insignificant matters or POV, but they represent far more, and according to chiropractic researchers, their influence is far more than their numbers would indicate. We need to use common sense here, and I see QG and Eubulides using theirs. BTW, an article about the International Chiropractors Association is needed here, AND we are already using them as a RS here at Wikipedia. -- Fyslee / talk 21:13, 18 November 2008 (UTC)

How is this going to work in practice? Anything on their policy page will be allowable? For example, would you have any problem if the following was inserted into the article?

• ICA policy holds that the chiropractic spinal adjustment is unique and singular to the chiropractic profession
• According to the International Chiropractors Association, the subluxation complex includes any alteration of the biomechanical and physiological dynamics of contiguous spinal structures which can cause neuronal disturbances.
• The ICA states abnormal posture and spinal misalignment in children cause abnormal stresses, strains compression, tension, etc., on vertebral structures, para‑spinal tissues, the pelvis and lower extremities during development which may lead to permanent structural change and spinal malformation, e.g. scoliosis.
• International Chiropractors Association holds that anesthesia is inappropriate and unnecessary to the deliverance of a chiropractic adjustment.

I still don't think it is a good idea using the ICA website, but if you are SERIOUS about it (not just trying to POV-push your fluoridation stuff in) then you must also allow the rest of their policies into the article. Otherwise you are cherry-picking --Surturz (talk) 23:22, 18 November 2008 (UTC)

These views, clearly attributed as the opinions of a named organisation, would be most welcome. The article needs to describe what chiropractors believe, as well as describing the scientific evidence that assesses the accuracy of these beliefs. Tim Vickers (talk) 00:02, 19 November 2008 (UTC)

Chiropractic #Philosophy does attempt to describe what chiropractors believe; that would be a good home for additions along these lines. It needs to be mentioned, though, that the ICA is a small group espousing theories that are fringe even within chiropractic. This (dated and not-that-reliable) source says the ICA has over 2,000 dues-paying members, and that the ACA (the leading chiro group) has over 15,000. This suggests the article shouldn't be spending too much time discussing the ICA's views. Eubulides (talk) 00:54, 19 November 2008 (UTC)

Chiropractic includes everything from mainstream opinions to fringe opinions, and the article needs to document this fact. For fringe opinions, the ICA and WCA are excellent sources. We need to present the whole picture, rather than cherry picking only the mainstream opinions. -- Fyslee / talk 06:02, 19 November 2008 (UTC)

ICA as a RS (section break)

The International Chiropractors Association is against fluoridation of the nation's municipal drinking water supplies because they consider public water fluoridation is not proven safe and could possibly be harmful to the body.

If we are going to use ICA as a reliable source for their opinion we can discuss the wording. QuackGuru 00:48, 19 November 2008 (UTC)

This appears to be a violation in a couple of ways. First, the ICA represents only a fairly small fraction of chiropractors, so there's a WP:WEIGHT violation; it would be better to mention the ACA's position. Second, we already have a more reliable source on this issue, published in a refereed journal; why cite unreliable primary sources instead? Eubulides (talk) 00:54, 19 November 2008 (UTC)

We place things in context by comparing chiropractic majority (ACA) and minority (ICA, WCA) opinions with statements from mainstream scientific sources. That way we show the differing opinions that exist within the profession, and how they compare or deviate with mainstream scientific sources. We can simply present the nature of the situation by stating that chiropractic opinions on the subject range from the minority ICA opinion to the majority ACA opinion. We keep it factual and NPOV by (a) not choosing sides, by (b) attributing the statements and (c) framing the context (minority, majority, scientific). Since this is in the public health section, we show how chiropractic relates to mainstream public health policies. As far as WEIGHT goes, the ICA opinions are significant and controversial enough to deserve mention. They are far more influential than their numbers would indicate, as attested by chiropractic researchers. They are the oldest chiropractic organization, representing the original and "pure" chiropractic doctrines. -- Fyslee / talk 06:02, 19 November 2008 (UTC)

If the opinions of the ICA are so "significant and controversial", we shouldn't have any problem finding non-primary sources for them. If we can't find non primary sources for them, that is a warning sign that they are such a minority viewpoint that it would be undue to mention their opinions. DigitalC (talk) 02:56, 20 November 2008 (UTC)

That's a good point. If this organisation isn't mentioned in mainstream reviews of chiropractic by outside authorities, then they probably aren't important enough to be mentioned in this article. However, I must stress outside authorities, if there are two factions of chiropractors actively ignoring each other, they may still both be notable, even if neither organisation mentions the other in their own literature. Tim Vickers (talk) 03:26, 20 November 2008 (UTC)

Context is certainly good, and criticisms of the ultra-straight and unscientific ICA and WCA POV can be found in both chiropractic sources (chiropractors criticize each other quite a bit) and skeptical sources. OTOH, their opinions are still chiropractic opinions, and can thus be used in an article about chiropractic, just as is standard practice in any other article where primary sources are allowed in articles about themselves. All major (IOW not private websites) chiropractic sources are thus fair game in an article about chiropractic. -- Fyslee / talk 05:23, 20 November 2008 (UTC)

That all sounds great, Fyslee, but why then are you so opposed to labelling these minority views as such? You have strongly resisted the phrase "Vaccination is opposed by a minority of the chiropractic profession" in the past. You now seem to be saying that we can cherry-pick out the controversial views espoused by the ICA, but should not quote their more mainstream views. How is this not POV pushing? --Surturz (talk) 11:05, 20 November 2008 (UTC)

????! Are you kidding? I'm proposing that we present them as a minority POV! You are the one who has constantly misrepresented mine and others' edits as making minority views seem like they represent the whole profession. Not at all. That's your misunderstanding.

The only reason I have opposed that phrase is because it's not a fact born out by the sources we have looked at. The source we were dealing with could just as well have been used to support that a majority opposed vaccination, but it wasn't clearly one way or the other. A significant minority were clearly opposed, and a minority were in favor of vaccinations, with an undecided group somewhere in between. That group could easily swing either group into being a majority. My admittedly OR impressions are based on decades of studying the profession, reading and subscribing to its literature, participating and lurking on chiropractic discussion groups, and the explanations provided by numerous chiropractors, including my chiropractic friends (one of my two closest ones is a subluxation-based DC!). They have all given me the clear impression that the silent group is largely composed of less vocal DCs who follow the traditional teachings they received when they went to school, IOW they are loyal to chiropractic's fundamental foundational ideas, including opposition to most anything medical, including vaccinations, surgery, antibiotics, etc.. When you add them to the significant minority who are opposed to vaccinations, you have a majority in the profession who do so. THAT'S why I was opposed to twisting an equivocal source into an endorsement for something it didn't clearly say. I'm not going to support your OR interpretation, and I haven't proposed my own OR interpetation as a substitute. -- Fyslee / talk 05:36, 21 November 2008 (UTC)

My apologies, you did indeed support the "significant portion" phrase which I preferred, it was Eubulides who stopped it. [20]. My concern now, as it was then, is that the the text implies anti-vacc sentiments are more widespread than they are. Can we perhaps change the lead sentence to "A minority of chiropractors actively oppose vaccination, one of..."? Rather than try to read the minds of the silent majority of chiros, how about we summarise the observable behaviour? (I also have concerns about the claim that vaccination is one of the most cost effective forms of disease prevention - I would argue good sanitation, clean water and hand washing are more cost effective, but that is an argument for another day. Perhaps "cost effective medical forms of prevention.."?) --Surturz (talk) 02:48, 24 November 2008 (UTC)

We are both reading the minds of the silent majority and reach different conclusions based on our own experiences, etc.. Fair enough. I think that the bulk likely are against vaccination, and you think that "[t]he bulk either support or are silent on vaccination." So be it.

I'm not opposed to adding the word "actively", so we should let other editors provide their opinions. Maybe it will float.

I likewise think that adding the word "medical" would probably be an improvement. Let's see what the others think. Thanks for the suggestions. -- Fyslee / talk 06:16, 24 November 2008 (UTC)

• There seems to be some confusion here. Surturz is not merely proposing to add the word "actively" to the lead sentence of Chiropractic #Vaccination. Instead, Surturz is proposing to replace the lead phrase "Within the chiropractic community there are significant disagreements about vaccination..." with "A minority of chiropractors actively oppose vaccination..." But this rewriting doesn't accurately summarize the cited source, Ferrance 2002 (PDF), which begins "The discussion of vaccines is one that, more often than not, evokes some rather spirited disagreements within the chiropractic community." Furthermore, the rewriting doesn't capture the important fact that in surveys a minority of chiropractors support vaccination, a minority oppose it, and the rest are in the middle.
• Chiropractic #Vaccination does not say that vaccination is the most cost-effective form of disease-prevention; it says only that vaccination is one of the most cost-effective forms. That much is indisputable, so there's no reason to add the word "medical". Furthermore, the word "medical" is not in that part of the cited source; we shouldn't be adding important qualifiers that are not in the cited source.

Eubulides (talk) 08:32, 24 November 2008 (UTC)

• I disagree that it is indisputable, and I believe it should be adequately referenced, or removed. As for the cited source, there currently ISN'T a cited source for the statement that "vaccination is one of the most cost-effective forms of disease-prevention". The previous reference that has been used to cite this information is wholly inadequate, as it frames this statement as an opinion, and not a fact. DigitalC (talk) 23:37, 24 November 2008 (UTC)

• This has been discussed before. Fyslee and I prefer the phrase "a significant portion of the chiropractic profession opposes vaccination". The reference says "That there remains a significant portion of the chiropractic profession opposed to vaccinations is not exactly a secret, nor should it be a surprise." on p168, column 2. We all know that there is only a minority of chiropractors that actively oppose vaccination, the reference bears this out, and we should change the article text to reflect this. --Surturz (talk) 11:03, 24 November 2008 (UTC)

Thanks Eubulides, for catching that. That's what I get for only replying to the diff, and not remembering the original text we already have.

Yes Surturz, it has been discussed before, and it seems like we are beginning in the same rut of a circular argument again. The "significant portion" quote is a good one which doesn't imply that a only a minority of chiropractors oppose vaccination. What we do know is that a minority are activists on the subject, and that their writings compose the majority of chiropractic writings on the subject. A little OR extrapolation from that fact (which we can't use in the article) leads to the logical conclusion that since their writings support what has always been the historical position in the profession, it likely has the effect of influencing the silent group to maintain their anti-vax positions, or at least push them in that direction, thus meaning that a majority are actually opposed to vaccination. As to whether we should make changes to the current text, I think we should start that in a separate section with the original text compared to very specific new proposals. -- Fyslee / talk 15:14, 24 November 2008 (UTC)

A minority oppose it, a minority support it, and in the middle we have a bunch of people who don't feel strongly either way. I certainly wouldn't support the OR claim that the minority that are actively against it maintain the "anti-vax positions" of the "silent group". From my OR, those in the "silent group" may actually support vaccination, but don't feel strongly about the issue, in part because it is not within their scope of practice to comment on it. They may also support vaccination, but not compulsory vaccination. I do support the use of "a significant portion", as it is based on a reliable source, and it summarizes the "minority opppose, minority support, silent group" adequately enough. DigitalC (talk) 23:37, 24 November 2008 (UTC)

Well, it looks like we are agreed that our OR isn't usable here ;-), and that the phrase "a significant portion" is usable as part of that section. -- Fyslee / talk 02:35, 25 November 2008 (UTC)

Removal of references

I would like the following two references removed from the article:

• 1. How can chiropractic become a respected mainstream profession? The example of podiatry /Wi
• 2. Vaccinations: how about some facts for a change?

I would also like the associated article text removed. These two references are opinion pieces. Certain editors of this article are misusing them to present the opinions in those articles as established fact, in a thinly veiled attempt to discredit the chiropractic profession. This is in violation of WP:NPOV --Surturz (talk) 18:59, 12 November 2008 (UTC)

PMID 18759966 (How can chiropractic become a respected mainstream profession? The example of podiatry) is a review written by five expert authors, published in a specialist peer-reviewed journal. I think this is an excellent reference to include in the article and use to support factual statements. The other article, by Ferrance on vaccinations, is used to reference the statement that "Within the chiropractic community there are significant disagreements about vaccination". This does not seem a controversial statement to me, but this reference isn't as high-quality as the review, and the use of this citation could therefore be improved by attributing this as an opinion of the author. An additional reference on this point would be useful, such as PMID 15530683 or PMID 10742364 Tim Vickers (talk) 19:35, 12 November 2008 (UTC)

• I agree with TimVickers on both sources.
• The stronger source (Murphy et al. 2008 (PDF), PMID 18759966) is indeed an opinion piece, and its advocacy should not be stated as fact here; but its discussion of facts can be cited here as facts, which is what Chiropractic is doing.
• The weaker source (Ferrance 2002 (PDF)) is there because of a longrunning controversy over whether vaccination is controversial within chiropractic:

• Surturz objected to the former lead sentence of Chiropractic #Vaccination, which said that vaccination "remains controversial within the chiropractic community"[21] (citing Busse et al. 2005, PMID 15965414), on the grounds that Busse et al. used neither the word "controversial" nor the phrase "chiropractic community".
• After a long discussion involving Surturz and other editors (see Talk:Chiropractic/Archive 26 #Topic sentence of Vaccination and Talk:Chiropractic/Archive 26 #Topic sentence of Vaccination should summarize the section), the phrase was eventually changed to its current form "Within the chiropractic community there are significant disagreements about vaccination", citing Ferrance 2002. Ferrance 2002 was brought in not because it was a better source, but because its lead sentence's phrasings correspond more closely to the phrasing used in Chiropractic.

• I agree with TimVickers that Russell et al. 2004 (PMID 15530683) and/or Campbell et al. (PMID 10742364) would be better than Ferrance. Of the two, I'd prefer Campbell et al. as it's a review not a primary study. However, Busse et al. would be even better than Campbell et al., as it's newer and focuses on today's attitudes rather than focusing on a historical perspective.
• With the above in mind, perhaps the best approach would be to cite both Busse et al. and Campbell et al., instead of citing Ferrance. That is, we could replace this:

<ref>{{cite journal |journal= J Can Chiropr Assoc |year=2002 |volume=46 |issue=3 |pages=167–72 |title= Vaccinations: how about some facts for a change? |author= Ferrance RJ|url=http://jcca-online.org/client/cca/JCCA.nsf/objects/Issue+46_3/$file/Pages167-172.pdf |format=PDF}}</ref>

with this:

<ref name=Busse/><ref name=Campbell/>

• This would remove the reference to the weaker source. A possible objection to this change would be that neither Busse et al. nor Campbell et al. support a claim that there are significant disagreements about vaccination within chiropractic, but I don't think this objection would be a reasonable one, as both sources clearly establish the existence of the controversy.

Eubulides (talk) 21:34, 12 November 2008 (UTC)

• Procedural note - I've removed the actual edit protected template for the moment - the template should only be used for something completely uncontroversial (like spelling or grammar errors) or when the consensus already exists. It looks like things are headed in the right direction to get a consensus going, so as soon as there's a solution everyone would be happy with, feel free to pop the template back up there. Shell ^babelfish 21:50, 12 November 2008 (UTC)

No comments for five days. Can we take it that there's no objection to the most recent proposal, which was to replace the citation to Ferrance (the weaker source) with citations to Busse et al. and to Campbell et al.? Eubulides (talk) 07:08, 18 November 2008 (UTC)

{{editprotected}}

As described above, in Chiropractic #Vaccination, please replace this citation:

<ref>{{cite journal |journal= J Can Chiropr Assoc |year=2002 |volume=46 |issue=3 |pages=167–72 |title= Vaccinations: how about some facts for a change? |author= Ferrance RJ|url=http://jcca-online.org/client/cca/JCCA.nsf/objects/Issue+46_3/$file/Pages167-172.pdf |format=PDF}}</ref>

with these two citations:

<ref name=Busse/><ref name=Campbell/>

This was proposed in the above discussion, with no comment or dissent. Thanks. Eubulides (talk) 06:48, 26 November 2008 (UTC)

Done. Cheers. --MZMcBride (talk) 18:55, 28 November 2008 (UTC)

Add lay summaries to two citations

{{editprotected}} I recently found two lay summaries to citations used in Chiropractic. It would improve the article to use the laysummary= parameter of {{Cite journal}} to mention these, as they're easier for the general public to read. So here are two changes I propose for Chiropractic.

• Let's change this citation:

Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972.

to this:

Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)

• And let's change this citation:

Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med. 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. PMID 17606755.

to this:

Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med. 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. PMID 17606755. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)

Eubulides (talk) 21:35, 20 November 2008 (UTC)

No objection for a week, so I added an {{editprotected}}. Eubulides (talk) 02:28, 28 November 2008 (UTC)

Done. Cheers. --MZMcBride (talk) 18:55, 28 November 2008 (UTC)

Update CCGPP citation

This discussion has been closed. Please do not modify it.
The following discussion has been closed. Please do not modify it.
THe CCGPP literature synthesis on low back pain has been published in a peer-reviewed journal, and Chiropractic should cite this version instead of merely citing the 2007 final draft on the CCGPP web site. I read the new version, and it contains editorial changes, but nothing that alters our summary of it, so Chiropractic should still cite the final draft as well (as the final draft is freely readable on the web, whereas the peer-reviewed version is not). This will involve changing just the citation, along with changing two "2007"s to "2008"s in the text. So, in Chiropractic#Effectiveness, please change this: A 2007 literature synthesis found good evidence supporting SM and mobilization for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain. to this: A 2008 literature synthesis found good evidence supporting SM and mobilization for low back pain and exercise for chronic low back pain; it also found fair evidence supporting customizable exercise programs for subacute low back pain, and supporting assurance and advice to stay active for subacute and chronic low back pain. and please change this: A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg. to this: A 2008 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg. You can see exactly which change is being proposed by looking at this diff to my sandbox. Eubulides (talk) 06:49, 28 November 2008 (UTC)

This section is subsumed by #Update to low back pain bullet below. Eubulides (talk) 19:46, 30 November 2008 (UTC)

Update to low back pain bullet

{{editprotected}} Our mediation in Talk:Chiropractic/Mediation #Proposed text (may be changed freely subject to rules above) seems to have converged on a working consensus, so let's install the changes we have so far (more later, we hope). The changes are mostly to the low back pain bullet in Chiropractic #Effectiveness, although one phrase is moved to another section and one citation is updated to a later version. Here is the change. First, in Chiropractic #Effectiveness, change the Low back pain bullet from this:

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

to this:

• Low back pain. There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain. A 2008 review found strong evidence that SM is similar in effect to medical care with exercise. A 2007 review found good evidence that SM is moderately effective for low back pain lasting more than 4 weeks; a 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration. Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review found that SM or mobilization is no more or less effective than other standard interventions for back pain. Methods for formulating treatment guidelines for low back pain differ significantly between countries, casting some doubt on their reliability.

Also, in Chiropractic #Effectiveness's Other bullet, please change this:

A 2007 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg.

to this:

A 2008 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg.

Finally, in Chiropractic #Treatment techniques, change this sentence:

Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist.

to this:

Medicine-assisted manipulation, such as manipulation under anesthesia, involves sedation or local anesthetic and is done by a team that includes an anesthesiologist; a 2008 systematic review did not find enough evidence to make recommendations about its use for chronic low back pain.

For reference, I have applied this change to my sandbox: you can see the diff here. Thanks. Eubulides (talk) 19:46, 30 November 2008 (UTC)

• Support as per the mediation page. I think there was one dissenting editor (DoctorIsIn), not sure about Levine2112. It should be noted that this change is not intended to address the WP:OR concerns raised elsewhere. But the new version is shorter, so therefore even editors that have WP:OR concerns should prefer it to the current article text. --Surturz (talk) 23:05, 30 November 2008 (UTC)

• Support. But agree with Surturz that it does not address the underlying WP:OR concerns. -- Levine2112 ^discuss 23:08, 30 November 2008 (UTC)

• No comment at this time except Congratulations for reaching a consensus on this change. ☺Coppertwig(talk) 00:04, 1 December 2008 (UTC)

• Support. It may not be perfect, but I find it encouraging that we are willing to accept improvement and slow progress over constant edit warring. This is a good thing. -- Fyslee / talk 06:44, 1 December 2008 (UTC)

   Done. I hope I did all right, if not contact me. Ruslik (talk) 09:23, 3 December 2008 (UTC)

Literature Synthesis

PMID 19028250 seems to be much more positive towards chiropractic than the other reviews, and appears to be biased because it is written by chiropractors whereas the other reviews are independent. I propose removing the literature synthesis, as it skews the NPOV. --sciencewatcher (talk) 16:21, 8 December 2008 (UTC)

• That's not the only review that is written by chiropractors. If you have the time, please take a look at Talk:Chiropractic/Mediation #Discussion (you'll have to expand Talk:Chiropractic/Mediation #Limited Edit War on Chiropractic#Low back pain to see Discussion), which talks about Meeker et al. 2007 (later published as Lawrence et al. 2008, PMID 19028250) in the context of the low back pain bullet of Chiropractic #Effectiveness. To put things into context, that bullet currently cites the following sources by chiropractors:

• Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S (2008). "Evidence-informed management of chronic low back pain with spinal manipulation and mobilization". Spine J. 8 (1): 213–25. doi:10.1016/j.spinee.2007.10.023. PMID 18164469.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Lawrence DJ, Meeker W, Branson R; et al. (2008). "Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis". J Manipulative Physiol Ther. 31 (9): 659–74. doi:10.1016/j.jmpt.2008.10.007. PMID 19028250. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) An earlier, freely readable version is in: Meeker W, Branson R, Bronfort G; et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. Retrieved 2008-11-28. {{cite web}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

and the following sources by non-chiropractors:

• Murphy AYMT, van Teijlingen ER, Gobbi MO (2006). "Inconsistent grading of evidence across countries: a review of low back pain guidelines". J Manipulative Physiol Ther. 29 (7): 576–81, 581.e1–2. doi:10.1016/j.jmpt.2006.07.005. PMID 16949948.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Chou R, Huffman LH; American Pain Society; American College of Physicians (2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Ann Intern Med. 147 (7): 492–504. PMID 17909210.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Assendelft WJJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG (2004). "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev (1): CD000447. doi:10.1002/14651858.CD000447.pub2. PMID 14973958.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med. 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |laysource= ignored (help); Unknown parameter |laysummary= ignored (help)

• Both of the cited chiropractic sources are in peer-reviewed journals, and can fairly be said to be from the mainstream, evidence-oriented side of chiropractic, not the fringe, anti-scientific side.
• If, after reviewing the above, you still think it is a WP:WEIGHT or WP:NPOV violation to cite these reviews, I suggest starting another draft of that bullet in a new section of Talk:Chiropractic/Mediation. There has been discussion in the mediation that the bullet might need more work. Thanks.

Eubulides (talk) 18:11, 8 December 2008 (UTC)

I haven't had time to read through all the reviews, that was just one that caught my attention. What actually is a "literature synthesis"? Is it as authoritative as a systematic review? The fact that it says at the start of the article that "A literature synthesis is an academically rigorous analysis" automatically worries me. Why would they need to say that? You don't see anything like that at the beginning of a Cochrane review because everyone knows it is academically rigorous. I would prefer just to have the Cochrane review, but if we can at least get rid of the literature synthesis I think it would be closer to NPOV.

Also: should all discussion regarding changes to this article now be done on Talk:Chiropractic/Mediation?--sciencewatcher (talk) 19:46, 8 December 2008 (UTC)

• A literature synthesis is a summary of the literature on a topic that attempts to synthesize everything that's known about the topic. Unlike a systematic review, it's not narrowly focused on a single question (e.g., "is spinal manipulation effective for low back pain?"); instead, it tends to be broader and bottom-up without a specific question in mind (e.g., "summarize everything that's known about chiropractic treatment"). A high-quality literature synthesis, done with academic rigor, can be authoritative for its (broader) topic, though it tends to be less authoritative for each narrow subtopic that it covers than a systematic review would be for that subtopic. A literature synthesis can be systematic, but need not be. For examples of literature syntheses in other areas, please see Goodell & Nail 2005 (PMID 15759060), Williams et al. 2002 (PMID 12100833), and Pierce et al. 2003 (PMID 14679709).
• Discussion of the low-back-pain bullet, and the next bullet in Chiropractic #Effectiveness, are probably best done in Talk:Chiropractic/Mediation right now, as they are (or perhaps soon will be) the focus of mediation. I'd suggest starting discussion of other changes here, at least for now, so that we can keep the mediation focused.

Eubulides (talk) 21:32, 8 December 2008 (UTC)

In recent decades

• No comment as to content, but I noticed that the sentence that starts "In recent decades" seems to be a run-on or reads somewhat like several sentences were glued together. Shell ^babelfish 08:04, 12 December 2008 (UTC)

• Thanks for pointing it out. I tried to fix that run-on sentence this way, along with fixing some suboptimal phrasing that recently crept into the lead. Eubulides (talk) 17:35, 12 December 2008 (UTC)

Style of writing

Emphasizes

The word "emphasizes" is used twice in the lead paragraph. I think we should not use the same word twice. I'm sure we can focus on an alternative word. QuackGuru 19:00, 12 December 2008 (UTC)

I changed the 2nd instance to "focuses on"; hope this helps. Eubulides (talk) 20:57, 12 December 2008 (UTC)

Rarely

In the safety section a sentence begins with the word "Rarely". I have rarely seen writing like this before. This is a bit odd to me. QuackGuru 19:15, 12 December 2008 (UTC)

It's that way so that the word "rarely" can be cited separately. It's not that unusual. See, for example this webpage by the American Pediatric Surgical Association, which says "Rarely, multiple esophageal duplication cysts have been observed." and "Rarely, they may arise primarily within the chest." This usage emphasizes the "rarely", which is appropriate here. Eubulides (talk) 20:57, 12 December 2008 (UTC)

Criticism

As discussed a while ago, I think there needs to be some sort of criticism section in the article. Currently it appears to be overly positive towards chiropractic, even though there is significant criticism within the medical and scientific community which the article doesn't give sufficient weight to.

To start with, I would suggest just adding a paragraph to the end of the lead summarising the main criticisms that are discussed within the article, something along these lines:

Chiropractic remains controversial, with critics pointing out that it is not based on solid science and it's effectiveness has not been demonstrated for any medical condition with the possible exception of lower back pain. The American Medical Association's Committee on Quackery labeled chiropractic an "unscientific cult" until they lost a lawsuit against the chiropractors in 1987 for restraint of trade.

sciencewatcher (talk) 22:20, 8 December 2008 (UTC)

• Oppose. Criticism sections (aka POV sections!) are awful and unencyclopedic. If we add one it will be an excuse for every nutcase and his dog to push in unsubstantiated [[wp:weasel|weaselly] anti-chiro rubbish. Half the article already argues against the profession on scientific grounds and accusations such as "prescribing endless treatments" etc. Your opinion that the article is overly positive towards chiro is just that - your opinion. I for one think it is overly negative. Trying to insert phrases such as "unscientific cult" into the article is clearly POV --Surturz (talk) 23:30, 8 December 2008 (UTC)
• Oppose. I agree with Surturz that a criticism section is not the way to go about it, as it is giving one POV an entire section. In addition, anything about the AMA Committee on Quackery belongs in the history section, not in the lead. DigitalC (talk) 00:24, 9 December 2008 (UTC)

Sometimes a criticism section is the best way to go. Have a look at the articles on naturopathy, homeopathy, acupuncture and you'll see they all either have a criticism section, or at least have a criticism paragraph in the lead, or sometimes both. And if the largest medical organisation representing doctors in the USA says that chiropractic is an "unscientific cult", that carries great weight (more than your opinion or mine). Hell, even the AMA article has a criticism section! However as Eubulides says below, I am just proposing to change the lead section for now. --sciencewatcher (talk) 00:25, 9 December 2008 (UTC)

The "largest medical organisation representing doctors in the USA" DOESN"T say that chiropractic is an "unscientific cult", it DID say that over 20 years ago. As such, that information is relevant in the history section. It is not an important enough fact to belong in the lead, as a summary of the history section. DigitalC (talk) 01:11, 9 December 2008 (UTC)

• Please see #Balancing lead's 3rd paragraph better below. Eubulides (talk) 00:22, 9 December 2008 (UTC)

Balancing lead's 3rd paragraph better

• There must be some confusion here. Sciencewatcher isn't proposing adding a Criticism section; he is proposing adding text to the lead that better summarizes the body. The text he's proposing (including the "unscientific cult") is already in the body; "unscientific cult" is clearly attributed to the AMA.
• Sciencewatcher is correct in that the lead's balance currently errs somewhat in support of chiropractic; it would be helpful for the lead to summarize the body with appropriate weight.
• Here are some more-detailed comments on Sciencewatcher's proposal:

• That last sentence doesn't sound right: the lawsuit was against the AMA, not against chiropractors.
• The statement "chiropractic remains controversial" is not directly supported by the cited source (Ernst 2008, PMID 18280103). That source is a critical evaluation of chiropractic, but it never says chiropractic is controversial.

That statement is supported by the chirobase article (title: "why chiropractic is controversial"). --sciencewatcher (talk) 03:52, 9 December 2008 (UTC)

Sorry, that wasn't clear from the citation given. I now see it was intended to cite this source: Jarvis WT (1990). "Chiropractic: controversial health care" (PDF). Ministry. 63 (5): 25–9. But this is a low-quality source. We prefer peer-reviewed medical journals, not non-peer-reviewed religious magazines. Also, we should not cite sources in the lead that are not also sourced in the body.

The article is also published on the National Council Against Health Fraud's website. There is also a peer reviewed article PMID 10573757 ("Quackery: the National Council Against Health Fraud perspective.") which discusses chiropractic, but I don't have access to the full-text. --sciencewatcher (talk) 16:09, 9 December 2008 (UTC)

• Please don't get me wrong: I agree with you that the current lead has weight problems, and that they should get fixed. However, any fixes should be supported by high-quality sources as per WP:MEDRS, and these sources should be used in the body as well as the lead, so that (as per WP:LEAD) the lead summarizes the body.
• The body of Chiropractic already cites some high-quality sources in this area. Can't we use those? That is, can't we summarize the existing body in the lead, rather than introduce new (and lower-quality) sources into the lead?
• The NCAHF website is better than nothing, but it's not peer-reviewed, and it doesn't stand up well in the company of the peer-reviewed journal articles that Chiropractic is already sourcing.
• I do have access to Jarvis 1999 (PMID 10573757). It is about quackery in general, not about chiropractic in particular. It has only two quotes about chiropractic:

• "Chiropractic and naturopathy claim to be natural and drug-free ways to health but lack proof of safety and efficacy." (no citation)
• "Patients of chiropractors were three times as likely as patients of family physicians to report that they were "very satisfied" with the care they received for low back pain. Satisfaction was linked to practice style rather than to factors related to safety or efficacy." (citing Cherkin & MacCornack 1989, PMID 2525303).

• In both cases, Chiropractic cites more up-to-date and more-relevant sources on the same points. Perhaps we can use those sources instead, and summarize the corresponding text in the lead? Here are the quotes I'm thinking of, taken from Chiropractic:

• "Spinal manipulation is associated with frequent, mild and temporary adverse effects, including new or worsening pain or stiffness in the affected region. They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours. Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children."
• "Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness. Many controlled clinical studies of spinal manipulation (SM) are available, but their results disagree, and they are typically of low quality.
• "Satisfaction rates are typically higher for chiropractic care compared to medical care, with a 1998 U.S. survey reporting 83% of persons satisfied or very satisfied with their care; quality of communication seems to be a consistent predictor of patient satisfaction with chiropractors."

• For my attempt at doing this sort of thing, please see #Alternative idea for 3rd paragraph below. Comments and suggestions for further improvements are welcome. For example, perhaps we could add summaries of the above well-sourced statements into the lead. Another possibility is that we could find more high-quality sources, and add them to both the body and the lead.
• Here's one other source that might be helpful, to be added to the body and the lead.

• Winnick TA (2005). "From quackery to 'complementary' medicine: the American medical profession confronts alternative therapies". Soc Probl. 52 (1): 38–61. doi:10.1525/sp.2005.52.1.38.

Eubulides (talk) 20:19, 9 December 2008 (UTC)

• The word "critics" is also not supported by that source: Ernst doesn't talk about critics of chiropractic.

Again, see the Jarvis article. --sciencewatcher (talk) 03:52, 9 December 2008 (UTC)

• Ernst doesn't say that chiropractic is not based on solid science; he says its concepts are not based on solid science. The distinction is a fine one, but one that we should preserve.
• Ernst doesn't make a claim about the "effectiveness" of chiropractic in general; his claim is about the effectiveness of "chiropractic spinal manipulation".
• Ernst doesn't say "possible exception of lower back pain"; he says "possible exception of back pain" without the "lower".
• There's no source for the "Committee on Quackery" sentence.

Jarvis --sciencewatcher (talk) 03:52, 9 December 2008 (UTC)

• The 3rd paragraph of Chiropractic's lead already talks about the controversy; it seems odd to add a 4th paragraph that duplicates some of the points. It'd be better to integrate the new points into the 3rd paragraph, no?

Yes, if you can. But I think we need a link to chirobase or similar to point out the significant criticisms. --sciencewatcher (talk) 03:52, 9 December 2008 (UTC)

We can and should do better than chirobase. We can cite peer-reviewed scientific or medical journals. Please see #Alternative idea for 3rd paragraph below for one way to do it; there are others. Eubulides (talk) 07:32, 9 December 2008 (UTC)

Alternative idea for 3rd paragraph

• How about this idea instead? Change the 3rd paragraph of Chiropractic as follows (deleted text struck out, inserted text in italics):

For most of its existence, chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are considered significant barriers to scientific progress within chiropractic that are not based on solid science. Vaccination remains controversial among chiropractors. The American Medical Association called chiropractic an "unscientific cult" and boycotted it until losing a 1987 restraint-of-trade court decision. In recent decades chiropractic has gained more legitimacy and greater acceptance among medical physicians and health plans and has had a strong political base and sustained demand for services, and evidence-based medicine has been used to review research studies and generate practice guidelines. Opinions differ as to the efficacy of chiropractic treatment; Chiropractic spinal manipulation has not been shown to be effective for any medical condition with the possible exception of back pain; the efficacy and cost-effectiveness of maintenance chiropractic care are unknown. Although spinal manipulation can have serious complications in rare cases, chiropractic care is generally safe when employed skillfully and appropriately.

Eubulides (talk) 00:22, 9 December 2008 (UTC)

• Look, trying to insert "unscientific cult" into the lead is clearly POV. It's a 30 year old accusation and not relevant to current chiropractic. I dislike the phrase 'solid science' too - what is unsolid science? --Surturz (talk) 00:51, 9 December 2008 (UTC)

• The phrase is quoted and properly attributed in the text as being part of the past. There's nothing inherently POV about that. "Solid science" is a common phrase meaning science that is firmly grounded on facts and the scientific method; see, for example, Black & Corcitto 1998 (PMID 9717854). An advantage of the "solid science" phrase is that it's clearer and shorter than the phrase it replaces. Eubulides (talk) 07:32, 9 December 2008 (UTC)

• It still fails WP:LEAD & WP:UNDUE. Why are we introducing something into the lead, when it doesn't deserve that much weight? It isn't a good summary of the history section, where such information belongs. DigitalC (talk) 04:42, 12 December 2008 (UTC)

• Per WP:LEAD: "The lead serves both as an introduction to the article below and as a short, independent summary of the important aspects of the article's topic". Do you really feel that this information about the AMA serves as an adequate summary of the History section? Do you believe that as proposed, it meets WP:NPOV, without the balancing statement that "in which the court found that the AMA had engaged in unreasonable restraint of trade and conspiracy"? DigitalC (talk) 01:07, 9 December 2008 (UTC)

• The proposed sentence already contains that balancing statement. It says that the AMA lost the restraint-of-trade case. Eubulides (talk) 07:32, 9 December 2008 (UTC)

I respectfully submit that it is dishonest to state that the proposed sentence already contains that balancing statement, when it clearly doesn't. The proposed text didn't say anything about conspiracy, and the article text was changed to not even mention restraint of trade. DigitalC (talk) 03:16, 15 December 2008 (UTC)

I did not remove the restraint-of-trade part; another editor did that, and I do not agree with that removal. The word "conspiracy" is a legalism that is invariably attached to restraint-of-trade cases; it doesn't need to appear in the lead. The basic point is that the AMA lost an antitrust court case; in fact, "antitrust" would be even better than "restraint of trade" since it's shorter. Eubulides (talk) 08:30, 15 December 2008 (UTC)

• I also feel that the statement "Opinions differ as to the efficacy of chiropractic treatment" is a better summary of the effectiveness section than "Chiropractic spinal manipulation has not been shown to be effective for any medical condition with the possible exception of back pain". DigitalC (talk) 01:09, 9 December 2008 (UTC)

• "Opinions differ" make it sound like opinions are all over the map. They're not that far apart, actually, among reliable sources. The proposed statement more accurately summarizes what reliable sources currently say. Eubulides (talk) 07:32, 9 December 2008 (UTC)

I disagree, I think that the older text (also based on what reliable sources say) is a more accurate summary. In addition, the proposed text disagrees with text in the article about headaches (which are not back pain), which suggests that SM may be effective for migraine, cervicogenic and tension headache. DigitalC (talk) 04:42, 12 December 2008 (UTC)

I strongly disagree with the current vague lead. The lead needs to summarize the history section. The current version about "opinions differ" is vague. There are obvious problems that we should fix. I prefer the new proposal to resolve the mainspace problems with the lead. QuackGuru 05:29, 12 December 2008 (UTC)

The vague tag leads to MOS#Unnecessary_vagueness, which has to do with accuracy of measurements. It certainly doesn't apply here. If there are obvious (non-controversial) problems, then fix them. There is nothing vague about "opinions differ", and it is further clarified within the body of the article. DigitalC (talk) 03:12, 15 December 2008 (UTC)

The part about "opinions differ" is clearly vague and deleting the sentence about history in the lead was controversial. Please see Talk:Chiropractic#WP:LEAD violation. QuackGuru 03:50, 15 December 2008 (UTC)

I disagree that there is anything vague about "opinions differ". It is clear to me. There is nothing controversial about WP:BRD, especially when you fail to obtain consensus for your edits on the talk page first. DigitalC (talk) 05:47, 15 December 2008 (UTC)

Adding vagueness to the lead is extremely controversial. It was a clear cut case of violating WP:LEAD. QuackGuru 06:19, 15 December 2008 (UTC)

There is nothing "extremely controversial" about reverting back to a version that had consensus. There is nothing here violating WP:LEAD, and there is nothing vague about "opinions differ" (which is also reliably sourced). DigitalC (talk) 06:40, 15 December 2008 (UTC)

The LEAD violation is very serious. Blocking improvements is not helpful. The article should continue to improve from edit ot edit. The LEAD violation alone would cause this article to fail WP:GA. QuackGuru 06:56, 15 December 2008 (UTC)

Template:Vague #Usage says that {{vague}} "should be used in articles where a sentence may be vague, ambiguous, or unspecific", which does apply here. The template's wikilink to Wikipedia:Manual of Style #Unnecessary vagueness gives one example of vagueness, but that's not the only example. Another possible template would be {{clarifyme}}, but either way, the text in question is too vague to accurately summarize Chiropractic #Effectiveness and Chiropractic #Cost-effectiveness. Eubulides (talk) 08:30, 15 December 2008 (UTC)

Whiplash and other neck pain

Are editors happy with the length of the Whiplash and other neck pain paragraph or do editors want to shorten it a bit. QuackGuru 22:38, 14 December 2008 (UTC)

I wouldn't mind shortening it a bit. It shouldn't be much longer than the low-back-pain paragraph, surely. We could try doing that in the mediation talk page, as the procedure worked fairly well for the low-back-pain para. Eubulides (talk) 08:30, 15 December 2008 (UTC)

I started a new section at the mediation page. QuackGuru 19:40, 15 December 2008 (UTC)

Mysterious yellow image

In the Chiropractic#History section the picture to the right seems to have a yellow lining on three sides of the picture. Am I seeing things? QuackGuru 22:46, 14 December 2008 (UTC)

No, it's there. No doubt we should get a better image anyway; that one is pretty low-resolution. Eubulides (talk) 08:30, 15 December 2008 (UTC)

I found a better image in Commons, and changed the article to use it. I also changed the portraits to not override user preferences on image sizes; overriding shouldn't be done except in unusual cases, which these portraits are not. 208.127.71.78 (talk) 17:21, 15 December 2008 (UTC)

Unnecessary citation to Ontario Chiro Assn

I don't see the need for this edit, which added a citation to an old web page (a primary source) put out by the Ontario Chiropractic Association that is not refereed. The same point is supported by a recent refereed journal article (Garner et al. 2008, PMID 18194787). Why cite an older lower-quality source when we have a recent higher-quality source on the same point? Eubulides (talk) 08:30, 15 December 2008 (UTC)

More on criticism/effectiveness/independence

In PMID 16574972 Ernst says "Our previous work has shown that the conclusions of reviews of SM for back pain appear to be influenced by authorship and methodological quality such that authorship by osteopaths or chiropractors and low methodological quality are associated with a positive conclusion. It is perhaps relevant to note that all three of the overtly positive recommendations for SM in the indications back pain, neck pain and headache originate from the same chiropractor". Can we include this somewhere?

One issue is blinding: do the studies in the reviews for back pain actually show that the patients are properly blinded? I don't have access to the full-text, so I can't check. I did find a small study (PMID 15750369) which looked into chiropractic blinding and they found that patients were not properly blinded. This would, of course, lead to an erroneously positive result in any study comparing chiropractic to sham treatment. This small study was done by chiropractors from the Parker Institute, so even the chirporactors are admitting that patients are not properly blinded in the studies! I think this should be mentioned in the article somewhere, perhaps where it currently discusses the placebo effect in the second paragraph of the effectiveness section. --sciencewatcher (talk) 20:50, 15 December 2008 (UTC)

• Bronfort et al. 2008 (PMID 18164469), pp. 217–9, have this to say about those claims in Ernst & Canter 2006 (PMID 16574972):

"The Ernst review is severely limited in its approach because of an incomplete quality assessment, lack of prespecified rules to evaluate the evidence, and several erroneous assumptions [PMID 16887028]. Ernst goes further to conclude that bias exists in systematic reviews performed by chiropractors, particularly members of our group. We refuted this assertion [PMID 16887028], and have attempted to be as transparent as possible in our methodology, which details a priori defined standard and acceptable methods for conducting systematic reviews [PMID 7933399, PMID 12829562]. Table 7 summarizes the conclusions from the latest systematic reviews. The conclusion of this review, which includes the results of the latest published RCTs, is consistent with the latest high-quality evidence-based systematic reviews [PMID 14973958, PMID 16320031]."

In the light of this disagreement among high-quality sources, I don't think we can mention just one side of the story. It might be OK to mention both sides (but not in the lead, I think); a specific wording proposal would be helpful.

I agree, not in the lead. I was suggesting in the effectiveness section, where we can give both sides. I'll try to come up with a proposal when I get time. --sciencewatcher (talk) 03:50, 16 December 2008 (UTC)

Thanks, that will be helpful. Eubulides (talk) 07:59, 16 December 2008 (UTC)

• Blinding is rare, because it's difficult; see Ernst & Harkness 2001 (PMID 11576805) and Hancock et al. 2006 (PMID 16764551). The reviews we're citing do not exclude studies merely because they're not double-blinded. This seems to be standard practice in the mainstream scientific and medical literature. On the subject of blinding, Chiropractic #Effectiveness currently says "It is hard to construct a trustworthy placebo for clinical trials of spinal manipulative therapy (SMT), as experts often disagree about whether a proposed placebo actually has no effect." Specific suggestions for improving this wording and/or coverage would be welcome.

Eubulides (talk) 21:22, 15 December 2008 (UTC)

I'm not saying we should exclude the studies, we should just have more info regarding the issues. PMID 11120730 by Ernst (in 2000) found that "Seven such studies were located. Their methodological quality was variable but three trials adhered to the highest standards of scientific rigour. Collectively these data do not show therapeutic effects beyond placebo. In particular, the three most rigorous studies were negative". And as I pointed out above, even the chiropractors admit that the patients in the placebo controlled trials are not properly blinded. I think we should add this info to the effectiveness section as well. --sciencewatcher (talk) 03:50, 16 December 2008 (UTC)

Having more info is OK, I guess, so long as we present the above issues fairly and neutrally. That is, we can't just use Ernst & Canter 2006 (PMID 16574972) on this subject, as there are reliable sources that strongly disagree with them. Choice of wording will be crucial here. Eubulides (talk) 07:59, 16 December 2008 (UTC)

3RR on talk pages?

On a related note, did I read correctly? User:QuackGuru admitted to reverting eight times on Levine2112's talk page? Does WP:3RR apply to talk pages? --Surturz (talk) 03:32, 16 December 2008 (UTC)

Violation of multiple Wikipedia policies

This controversial edit added a lot of text that is in violation of a number of policies including WP:MEDRS, WP:NPOV, and WP:WEIGHT. QuackGuru 01:49, 16 December 2008 (UTC)

After about five reverts, I'm still waiting for Levine2112 to try an communicate. The violations of WP:MEDRS is very serious. QuackGuru 02:12, 16 December 2008 (UTC)

WP:MEDRS is completely inapplicable to a section dealing with history. -- Levine2112 ^discuss 02:13, 16 December 2008 (UTC)

Where does it say that in WP:MEDRS? Where does it say in any Wikipedia policy it is preferable to add unreliable references instead of highly reliable and newer secondary sources? QuackGuru 02:19, 16 December 2008 (UTC)

I disagree with the premise of your questions. First, the source is not an unreliable source. If you believe it is, please take it to WP:RSN. Second, WP:MEDRS clearly is meant to apply to sections of biomedical articles which can be sourced to medical journals. It is not applicable to history sections. If that were the case, the majority of references used in the history section and their supported statements would have to be expunged. -- Levine2112 ^discuss 02:26, 16 December 2008 (UTC)

According to which policy MEDRS is not applicable to the history section. MEDRS is applicable to this article. Please explain how the source is reliable in accordance with MEDRS. We have far better sources available and it is a WEIGHT violation to include the newly added text. QuackGuru 02:33, 16 December 2008 (UTC)

You are misunderstanding WP:MEDRS. If you have a specific question about the policy, I encourage you take it up at Wikipedia talk:Reliable sources (medicine-related articles). You may wish to note that if your misunderstanding of MEDRS was true, it would obliterate about 90% of the Medicine article for instance. -- Levine2112 ^discuss 02:36, 16 December 2008 (UTC)

You have not shown I misunderstood WP:MEDRS and you have not shown how the source is reliable. Please show and not assert your view. QuackGuru 02:43, 16 December 2008 (UTC)

I believe I have described your misunderstanding clearly. If you wish to gain more clarity, I encourage you to discuss it at Wikipedia talk:Reliable sources (medicine-related articles). That said, I think my Medicine example illustrates the point with great clarity. Now then, if you feel that the source doesn't comply with WP:RS, then please justify that claim with an explanation. (i.e. "Please show and not assert your view." :-) -- Levine2112 ^discuss 02:50, 16 December 2008 (UTC)

After about the 8th revert, no explanation to the reliability of the source has been given. Please show how the source is reliable instead of claiming it is when it is not. QuackGuru 02:56, 16 December 2008 (UTC)

I apologize. So are you saying that the American Chiropractic Association is not a reliable source for the history of chiropractic? If so, I would say that the ACA is - per WP:RS - generally regarded as trustworthy or authoritative in relation to the subject at hand. -- Levine2112 ^discuss 03:06, 16 December 2008 (UTC)

• (outdent) User:QuackGuru is clearly in error. From Wikipedia:MEDRS#Popular_press: "On the other hand, the high-quality popular press can be a good source for social, biographical, current-affairs and historical information in a medical article." (emphasis mine). --Surturz (talk) 03:10, 16 December 2008 (UTC)
• QuackGuru, this is silliness bordering on wiki-lawyering. Obviously non-scientific aspects of the article do not need to be sourced per WP:MEDRS. If you feel they do, then you are also advocating the removal of the majority of Chiropractic#Education, licensing, and regulation, not to mention Chiropractic#History. DigitalC (talk) 03:16, 16 December 2008 (UTC)

When we currently have better sources available then why reach down into primary sources that are less reliable or unreliable? In any event, the controversial edit was a WP:WEIGHT violation. QuackGuru 03:22, 16 December 2008 (UTC)

If you believe that there is a better source available to reference this content, please share it. DigitalC (talk) 03:28, 16 December 2008 (UTC)

Chiropractic's victory over the AMA

That controversial edit has several problems.

• The edit cites an unreliable source. A press release or other self-published item published by one side of a lawsuit is biased, almost by definition. This is not a WP:MEDRS issue; it is a WP:RS issue.
• The edit gives the impression that the 7th Circuit found that AMA attempted to eliminate the profession of chiropractic. Even the cited source (biased as it is) did not claim that.
• The edit inserts text that essentially repeats the previous sentence, which already talks about chiropractic's victory in the Wilk case. Repeating this information introduces a WP:WEIGHT problem. There is no good reason to devote this much text to one case out of all the history of chiropractic. (It's not even the #1 legal case in chiropractic history.)
• The phrase "Following a decade of litigation" is incorrect in context. There was not a decade of litigation between the Wilk decision (in 1987) and the 7th Circuit's affirmation (in 1990).
• More generally, the edit emphasizes the Wilk case far out of proportion to its importance as given by reliable sources.
• It is disappointing to see a subtantial change like this inserted without any advance discussion whatsoever. I'd like to call editors' attention (again) to the note at the top of this talk page, which requests editors to discuss substantial changes like these on the talk page first.

Eubulides (talk) 07:59, 16 December 2008 (UTC)

• As far as I understood it, the source was the ACA, who was not part of the lawsuit (That was Wilks, and the AMA).
• I fully agree with you that substantial changes (or changes likely to be controversial) should be discussed on the talk page first.
• If any further information about the AMA lawsuit is to be added to the article, I agree that it should not be repeating what is already said.

DigitalC (talk) 12:28, 16 December 2008 (UTC)

The text from that edit comes directly from the Wilk v AMA article (bottom of the section). For this article, I don't see anything useful that it adds, that isn't already present in the article. Anything about the ruling being affirmed, or the Supreme Court declining to review it belongs in the lawsuit article, not this one. Ravensfire2002 (talk) 18:11, 17 December 2008 (UTC)

Opinions differ

This edit planted a {{vague}} tag after this phrase:

"Opinions differ as to the efficacy of chiropractic treatment".

I agree that the phrase is way too vague. I proposed a replacement in #Alternative idea for 3rd paragraph; DigitalC objected to the replacement on the grounds that the text says that SM may be effective for headache. The text I proposed does not disagree with that point, as it says that chiropractic treatment has not been "shown to be effective" for conditions other than back pain, and this is consistent with the idea that chiropractic treatment may be effective for other conditions. However, it is a good idea to mention that there's been a lot of research, with conflicting results; this is stated several times in the body and should be mentioned in the lead. To take this into account, I propose the following replacement instead:

"Treatments used by chiropractors have been heavily researched, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain. These reviews usually cover treatments independent of profession, and thus do not evaluate chiropractic in isolation."

This replacement text summarizes Chiropractic #Evidence basis fairly well, and is well-supported by the cited source, which says this on page 8:

"Numerous controlled clinical studies of chiropractic are now available, but their results are far from uniform. Rather than selecting single studies according to their findings, it is therefore preferable to consider the totality of this evidence. Table 3 gives an overview of the most up-to-date systematic reviews by indication. These systematic reviews usually include trials of spinal manipulation regardless of who administered it. Thus, they are not exclusively an evaluation of chiropractic. Collectively, their results fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain. For this condition, manipulation may be as effective (or ineffective) as standard therapy."

Eubulides (talk) 20:57, 12 December 2008 (UTC)

I'm getting confused by the separate locations of this discussion. From what I can tell, the latest proposal suggests that none of the treatments have been shown to be effective, with the "possible exception" of back pain. Something either is or isn't shown to be effective, and stating that SM "may be effective for headache", sounds like a "possible exception" to me. Further, does the source state that no chiropractic treatment has been "shown to be effective", or that SM has not been "shown to be effective" for conditions other than back pain? As has been noted previously, there are a lot of other treatments than SM (cryotherapy, exercise therapy, RICE, ultrasound, etc.), and we should be following the source closely on this matter. DigitalC (talk) 00:36, 17 December 2008 (UTC)

No, saying that SM "may be effective for headache" does not at all mean that SM has been demonstrated to be effective for headache. On the contrary, it merely means that SM has not been demonstrated to be ineffective for headache. Ernst's point is that SM has not been demonstrated (in the empirical, scientific sense) to be effective for any medical condition, except possibly for back pain, where opinions differ and some reliable sources say it has been demonstrated to be effective and others say it hasn't. Ernst's claim in this area is about SM, not about exercise etc. Ernst's claim is that SM has not been shown to be effective for conditions other than back pain. I agree that we should follow the source closely; the proposed wording does that. I also agree that the separate locations of this discussion have been confusing. Eubulides (talk) 20:42, 17 December 2008 (UTC)

As stated above, things can be shown to be effective, or shown to be ineffective. One cannot show that something is possibly effective (or ineffective with the possible exception). If a source has determined that the treatment is effective, and another source has stated that it isn't shown to be effective, then opinions differ. As noted below, I also think it might be of value to append a statement about the entire clinical encounter to your proposed text. DigitalC (talk) 02:10, 18 December 2008 (UTC)

Obviously opinions differ, but merely saying "opinions differ" doesn't suffice to summarize the article. I'll respond below to that suggestion. Eubulides (talk) 17:22, 18 December 2008 (UTC)

I made this change to fix the vagueness in the lead. QuackGuru 22:20, 14 December 2008 (UTC)

That change is close to what was proposed in #Alternative idea for 3rd paragraph above, except it removed "restraint-of-trade" from "restraint-of-trade court decision". DigitalC objected to several of the components of that change; in response, I proposed the above further wording improvements in this section, which were not included in that change. Perhaps some more thought is needed in this area before installing this change? Eubulides (talk) 08:30, 15 December 2008 (UTC)

WP:LEAD violation

This controversial change deleted a sentence about chiropractic history and added vagueness to the lead. We are supposed to summarize the article in the lead. Information about history belongs in the lead. Opinions differ is very vague. Opinions are not all over the map. The lead should be able to stand on its own. QuackGuru 03:46, 15 December 2008 (UTC)

I made this change in accordance with WP:LEAD. The lead should be able to stand alone as a concise overview of the article. QuackGuru 04:04, 15 December 2008 (UTC)

By doing so, you are edit-warring the information into the article. Please stop. Consensus does not exist to ADD the information about the AMA to the lead, and it was reverted per WP:BRD (which is not bold-revert-editwar). It was reverted to the last consensus version, unlike your recent edit-warring edit. There is nothing controversial about reverting a change that does not have consensus. Please self-revert unless/until consensus is established. DigitalC (talk) 05:44, 15 December 2008 (UTC)

Blocking clear improvements by stating no consensus is not a valid reason for the edits made by DigitalC. Continuing to violate WP:LEAD is not productive and it should stop. Violating the lead guideline is a serious matter. It is vague to add "opinions differ" and no valid explanation has been made to delete the summary of the chiropractic history from the lead too. QuackGuru 06:00, 15 December 2008 (UTC)

It is a misrepresentation of facts to state that I am "adding" "opinions differ". I merely reverted back to the last consensus version. (Yes, it had consensus, so you are also violating WP:CON). There is nothing vague about "opinions differ". A valid explanation for reverting the addition of trivial historical information to the lead was given above, or is this another of QuackGuru's many WP:IDHT violations? There is no consensus to add the information (thats 1 valid explanation for the revert), and it does not (per WP:LEAD) act as a "short, independent summary" of the history section of the article. The only historical information that should be in the lead should act as a short summary of the history section (thats the 2nd valid explanation for the revert). You seem to feel that violating WP:LEAD is a serious matter, so you should abide by it. DigitalC (talk) 06:37, 15 December 2008 (UTC)

DigitalC has been informed to comply with WP:LEAD. Continuing to violate WP:LEAD is not helpful. The lead should properly summarize chiropractic history and opinions ("opinions differ") are not all over the map. Why have vagueness in the lead and delete a summary of the history from the lead. QuackGuru 06:50, 15 December 2008 (UTC)

I agree, your continued violations of WP:LEAD are not helpful. The lead should stand as a summary of the article. The trivial AMA information is not an adequate summary of Chiropractic#History, and the AMA lawsuit is not even mentioned in Chiropractic history, nor is "unscientific cult". 0.1% of articles on Google scholar mention Chiropractic also use the term "unscientific cult", and only 1.2% of the articles discussing Chiropractic also mention both "AMA" and "lawsuit". To put this into the lead of the article is clearly violating WP:UNDUE. DigitalC (talk) 23:17, 15 December 2008 (UTC)

I don't follow this comment.

• The existing text in the lead doesn't mention the AMA at all. How can adding discussion of the AMA make the text less adequate?
• WP:LEAD is about whether the lead summarizes the body of the article, not about whether it summarizes some other article like Chiropractic history.
• Chiropractic #History does mention the "unscientific cult" quote, for good reason, and it's not necessarily unreasonable for this to be mentioned in the lead.
• By my count, about 1/8 of the Google Scholar sources that mention "chiropractic" also mention "AMA", so it seems quite relevant to discuss the war between the AMA and chiropractic. Some wording needs to be chosen; whatever wording is chosen will be used by only a tiny fraction (possibly zero) of Google Scholar sources, but that's OK, so long as we're summarizing them accurately.

Eubulides (talk) 07:59, 16 December 2008 (UTC)

• The lead should be a summary of the article. Not everything from the body of the article should be mentioned in the lead, otherwise every trivial fact from the body would be in the lead and the body.
• Chiropractic#History should be a summary of Chiropractic history, per WP:SUMMARY. As such, if something isn't mentioned in Chiropractic history, then it shouldn't be mentioned in Chiropractic#History, and it would definitely be undue weight to be mentioning it in the lead of Chiropractic.
• I respectfully submit that it is undue weight to mention "unscientific cult" in the lead.
• Not every article discussing Chiropractic and AMA is going to necessarily be discussing the lawsuit. For instance, about 8% of the Google Scholar sources mention "chiropractic" and "AMA", but do NOT mention "lawsuit", "court", "Wilk", "Wilks", or "anti-trust". Therefore, even if it is determined by consensus that the lead should mention the relationship between the AMA and Chiropractic, that does not necessarily mean the lawsuit should be mentioned, and it certainly does not determine that we should be using the term "unscientific cult" in the lead of the article. DigitalC (talk) 00:25, 17 December 2008 (UTC)

• Yes, Chiropractic #History should summarize Chiropractic history; but flaws in Chiropractic history do not obligate us to reproduce similar flaws in Chiropractic #History. We can fix the problem here first, and there later. This talk page is about Chiropractic, not about Chiropractic history, so let's take up the task of fixing the latter article in its talk page.
• I agree that we need not mention the Wilk case in the lead. However, Sciencewatcher has made a reasonable case that the long and arduous struggle between organized medicine and chiropractic is currently underplayed in the lead (the lead currently devotes only the 5 words "has battled with mainstream medicine" to this topic, out of 290 words total), and this key issue of chiropractic it could stand a bit more emphasis.

Eubulides (talk) 20:42, 17 December 2008 (UTC)

It is a violation of WP:LEAD to not properly summarize the article. Problems have been identified and proposals have been made to fix the problems. QuackGuru 00:43, 16 December 2008 (UTC)

I agree wtih DigitalC here. The lead currently in place does a far better job of accurately summarizing the main tenets of the articles than the one suggested below at Talk:Chiropractic#Lead improvements, which overblows the AMA historical stance in a effort to denigrate the subject. More than a WP:LEAD violation, the proposed version below is also a WP:POVPUSH violation. Keep it neutral, folks. Keep it accurate. Keep it proportional. The current lead does just that. I see no need to change it at this time. -- Levine2112 ^discuss 01:08, 16 December 2008 (UTC)

This antagonism isn't helping things. Anyway, here are my suggestions for changes to the lead: [1] add the AMA info somewhere between "For most of its existence, chiropractic has battled with" and "in recent decades, it has gained more legitimacy". It is important historical info and should go in the lead. [2] remove the vague "Opinions differ" and put in the conclusions of the Cochrane reviews with regard to effectiveness. I would also suggest removing the efficacy studies done by chiropractors themselves and just leaving the independent reviews, such as Cochrane. This should be done in the Effectiveness section as well as in the lead. --sciencewatcher (talk) 20:04, 15 December 2008 (UTC)

The latest proposal just got completed at Talk:Chiropractic#Lead improvements. Please have a look. QuackGuru 20:41, 15 December 2008 (UTC)

Vague tag

The {{vague}} tag stems from the vagueness objection to the "opinions differ" phrase in the lead. This objection is that the article itself gives much more detail about the effectiveness of chiropractic, and summarizing that down to just "Opinions differ as to the efficacy of chiropractic treatment" is too much reduction/condensation, so much so that the summary is vague. Please see the start of this (top-level) section for a proposed fix. Eubulides (talk) 08:30, 15 December 2008 (UTC)

The vague tag is used inappropriately here. As noted previously, it leads to a section of the MOS dealing with accuracy of measurements. Further, I respectfully submit that there is nothing vague about the statement "opinions differ". DigitalC (talk) 22:53, 15 December 2008 (UTC)

The statement needs clarification. It is an entirely inadequate summary of Chiropractic #Effectiveness, which contains a large quantity of solid reviews that should not be summarized merely by an "opinions differ" statement. The reviews should be summarized as a whole in the lead. As things stand, the lead gives way too little weight to the issue of effectiveness. As there seems to be some confusion here about accuracy of measurements, which is just one form of vagueness (there are others), I substituted a {{clarifyme}} tag instead. Regardless of what the tag is, the problem needs to be fixed. Eubulides (talk) 01:44, 16 December 2008 (UTC)

As I stated below, "opinions differ" appears to be concise and accurate wording. The efficacy section includes reviews with a wide range of opinions about the efficacy of spinal manipulation. Some research says it is effective for such-and-such while other research says it is not effective for such-and-such; hence "opinions differ" seems to be concise and entirely accurate. -- Levine2112 ^discuss 02:02, 16 December 2008 (UTC)

Opinions differ is vague. I don't see how the current version is be more accurate than the new proposal. The new proposal accurately summarizes the article. QuackGuru 02:07, 16 December 2008 (UTC)

Why is it vague? Is it not accurate? Don't opinions differ? -- Levine2112 ^discuss 02:16, 16 December 2008 (UTC)

Eubulides, you stated that "Regardless of what the tag is, the problem needs to be fixed." However, Levine and I feel that there is no problem to fix. There is nothing vague about stating that "opinions differ". It is an accurate, concise and reliably sourced summary. DigitalC (talk) 03:26, 16 December 2008 (UTC)

• There certainly is something vague about saying "opinions differ". What are the opinions? Who holds them and why? What is the mainstream scientific opinion? These are common questions that any reasonable reader would have. We don't see Homeopathy's lead saying "opinions differ about the efficacy of homeopathy"; such a statement would technically be concise and accurate, but it wouldn't accurately convey the mainstream opinion that homeopathy's claims of efficacy are not supported by scientific evidence. Chiropractic's lead similarly has an obligation to fairly and accurately summarize the body of the article. Currently it does not at all do that in this area: it wimps out with an "opinions differ" statement. This is a problem that should get fixed.
• Even if we were merely counting heads, which we shouldn't be, we have three editors (QuackGuru[22], Sciencewatcher[23], and I) with serious objections to the current vague wording.

Eubulides (talk) 07:59, 16 December 2008 (UTC)

As Eubulides says, the problem is that the current lead doesn't summarise the effectiveness section. It should say that chiropractic hasn't shown to be effective for anything except possibly back pain. That is what the effectiveness section says, so that should go in the lead. We shouldn't fudge the facts by saying "opinions differ" just because some people don't like it. --sciencewatcher (talk) 00:54, 17 December 2008 (UTC)

I disagree. The efficacy section - even as it stands now - includes studies and reviews which demonstrate that chiropractic and/or spinal manipulation may be effective for a variety of conditions. Then again, the efficacy section also includes studies and reviews which say that chiropractic and/or spinal manipulation has not been shown to be effective for a lot of the same variety of conditions. Hence, "opinions differ" seems to be the most concise and accurate way to state this. It would be misleading if 99% of the studies said it was effective and 1% said it was not - and vice-versa. However, the current efficacy section looks pretty evenly split. I think this is telling of chiropractic's current perception in the scientific/medical community. Essentially it is on the cusp of being alternative and mainstream. About half of the science out there says that it is effective for such-and-such and the other half says that this efficacy has not been rigorously demonstrated. Hence, we see some medical doctors working side-by-side with chiropractors and we also see some medical doctors crucifying chiropractors. And the blame isn't entirely outside the profession of chiropractic. Some of the techniques which chiropractors employ have been shown to be effective for some conditions, while other techniques have not been shown to be effective. In any case, I think the current lead makes it simple and easy and if a reader wanted to know the details of "opinions differ" than can easy jump down the the efficacy section to get fuller coverage. -- Levine2112 ^discuss 01:13, 17 December 2008 (UTC)

[unindent] I read through the effectiveness section again, and looked at some of the reviews, and I see your point. There is some evidence that chiropractic might be effective for other disorders, although the quality of studies tends to be poor and the positive results may be due to the placebo effect. --sciencewatcher (talk) 03:14, 17 December 2008 (UTC)

Do you think that "opinions differ" needs to be clarified any way in the lead? If so, how would you suggest wording it? Or is "opinions differ" sufficient? -- Levine2112 ^discuss 03:41, 17 December 2008 (UTC)

Perhaps if we say something like "Chiropractic has not been conclusively demonstrated to be effective for any health condition, although some studies show that it may be effective for some conditions, with the strongest positive evidence being for back pain. However the quality of studies tends to be low and the placebo effect may account for the positive results." with the appropriate references, of course. --sciencewatcher (talk) 19:15, 17 December 2008 (UTC)

There is hardly anything that has been conclusively demonostrated to be effective for anything, so I don't understand the need for such a qualifier, especially one based on original research. The same goes for the supposed quality of the studies being low and the placebo effect statements. Those are unqualified opinion which we cannot present as facts. If we really want to rewrite the "opinions differ" text, I would suggest something more neutral and more based on the verifiable information presented in the article:

Scientific reviews and studies have varying conclusions about the efficacy of chiropractic and/or spinal manipulation for the treatment of an array of conditions with the strongest positive evidence being for back pain.

-- Levine2112 ^discuss 19:35, 17 December 2008 (UTC)

• The claim that "There is hardly anything that has been conclusively demonstrated to be effective for anything" is incorrect, if by "conclusively demonstrated" we mean the usual scientific levels of consensus (independently replicated empirical studies of high quality, with no serious dissent among reliable sources). For example, it's been conclusively demonstrated that polio vaccine is effective against polio, that water fluoridation is effective against tooth decay, and so forth.
• Neither Sciencewatcher's nor Levine2112's proposed wordings are directly supported by a reliable source. Also, Levine2112's proposed wording is still too vague; other than the words "back pain" and "spinal manipulation" it says little more than the existing text.
• I looked at all the comments, along with comments about my previously-proposed wordings, and suggest the following wording instead, which is directly supported by the cited source:

"Studies of treatments used by chiropractors have reported conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain,"

• The above would replace the lead's existing "Opinions differ as to the efficacy of chiropractic treatment".

Eubulides (talk) 20:42, 17 December 2008 (UTC)

I don't feel that the "Collective..." sentence is supported by the current efficacy section, since some of the other conditions (aside from low back pain) described do have reviews which present evidence that demostrate the efficacy of spinal manipulation. For instance, take the 2004 and 2005 reviews under headache which found weak to good evidence supporting spinal manipulation for various forms of headaches. Also, the whiplash and neck pain section presents multiple reviews which demonstrate spinal manipulation's efficacy for each of these conditions. Also, our article presents multiple reviews demonstrating fair to good evidence of the efficacy of spinal manipulation and/or chiropractic for sciatica, radicular leg pain, adult scoliosis, asthma, cervicogenic dizziness, and baby colic. Thus I don't think it is accurate to say that collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain. "Collectively" is vague and the overall sentence is thus misleading. It would be more accurate to say that the conclusions of the systematic reviews of chiropractic and/or spinal manipulation for a variety of conditions vary in terms of efficacy. -- Levine2112 ^discuss 23:16, 18 December 2008 (UTC)

This greatly misstates the evidence presented in Chiropractic #Effectiveness.

• The "2004 and 2005 reviews under headache" did not find "weak to good evidence supporting spinal manipulation". Biondi 2005 (PMID 15953306) did say that the evidence for chiropractic evidence is weak. Bronfort et al. 2004 (PMID 15266458) concluded only that SM "may" be effective. The other headache reviews (Astin et al. 2002, PMID ; Lenssinck et al. 2004, PMID ) were negative. Collectively, these reviews do not demonstrate the effectiveness of SM for headache; quite the contrary.
• The "whiplash and neck pain section presents multiple reviews" is true, but it's not true that these reviews "demonstrate spinal manipulation's efficacy for each of these conditions". In this case, the negative reviews (Gross et al. 2004, PMID 14974063; Ernst 2003, PMID 14622659) included a Cochrane review and are more reliable; the positive reviews (Hurwitz et al. 2008, PMID 18204386; Vernon & Humphreys 2007, PMID 17369783) are not enough to demonstrate effectiveness in the presence of this negative evidence.
• Chiropractic does not present "multiple reviews demonstrating fair to good evidence of the efficacy of spinal manipulation and/or chiropractic for sciatica, radicular leg pain, adult scoliosis, asthma, cervicogenic dizziness, and baby colic". Let's go through those conditions one by one:

• For sciatica and radicular leg pain it talks only about assurance and advice to stay active; this is hardly specific to chiropractic. And the evidence here is only fair. In our rewrite of the low-back-pain bullet we eliminated all evidence of this low a quality, and when we get around to rewriting the "other" bullet this stuff is likely to go as well.
• For adult scoliosis the evidence is "very weak".
• For asthma we have a high-quality Cochrane review (Hondras et al. 2005, PMID 15846609) that's negative, and a lower-quality review (Hawk et al. 2007, PMID 17604553) that says the evidence is adequate to support chiropractic care (not SM in particular); if you look at table 8 of Hawk et al., the positive evidence is almost all individual case reports and the RCTs are negative or very weakly positive.
• For cervicogenic dizziness the only source we cite is Hawk et al.: again, their evidence (Table 9 in this case) has positive results mostly from individual case reports, with the RCTs reporting no significant difference in dizziness. Even Hawk et al. say that this is not enough evidence to support any particular chiropractic treatment.
• For baby colic, we cite three reviews. Two are negative (Gotlib & Rupert 2008, PMID 18789139; Husereau et al. 2003, ISBN 1-894978-11-0). One review, again Hawk et al., is positive. Again, the positive data in Hawk et al. mostly consisted of case reports; the negative came from systematic reviews.

• In reviewing the above text it may be that we are ascribing too much weight to one review (Hawk et al.) that makes a lot of claims based on data that are relatively weak.
• Collectively, these systematic reviews do not demonstrate the effectiveness of chiropractic for any medical condition except (possibly) for back pain. The results of the reviews show some signs of promise in some areas, but that's it: that's not at all a demonstration of effectiveness.
• No doubt you disagree with this analysis. But you don't have to take my word for it. We have a reliable source by a published expert in the field who has reviewed the literature on the effectiveness of chiropractic care in general and of spinal manipulation in particular, and who has concluded that the results of these reviews "fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain. For this condition, manipulation may be as effective (or ineffective) as standard therapy."
• This conclusion is not controversial among reliable sources. It's pretty much the standard opinion. Reliable sources do disagree whether chiropractic has been proven to be substantially effective for back pain. For other conditions, reliable sources agree that chiropractic care is unproven.
• We have an obligation to present this standard consensus fairly and accurately. The current text, which says merely "opinions differ", does not satisfy this obligation. The proposed text does.

Eubulides (talk) 00:36, 19 December 2008 (UTC)

You hit the nail on the head. I disagree with your interpretation. Further, I don't see how you want to reduce Hawk's voice in the article but at the same time give Ernst - who is already cited a whopping 11 times in this article! - even more time in the lead. That will only exacerbate the weight issue we already have with Ernst. And I don't think we can assume that Ernst is any more authorative on the subject than any of the other researchers we are citing, yet we seem to be treating him that way with so many references. -- Levine2112 ^discuss 23:02, 19 December 2008 (UTC)

It is not my interpretation. It is the interpretation of a reliable source, namely Ernst 2008 (PMID 18280103). And we have no reliable sources disagreeing with Ernst on this point. Hawk et al. do not disagree; they merely say that in some areas there are some signs of promise (but on this point we do have reliable reviews, including a Cochrane review, which disagree). If we could find reliable sources that disagree with Ernst on this point, that would be a different matter; but Ernst is presenting the consensus mainstream opinion here, and that is what the lead should present. Hawk et al. are presenting the minority opinion, one well worth discussing in the body; but it should not be elevated in the lead to be at the same level as the mainstream opinion. Eubulides (talk) 00:55, 20 December 2008 (UTC)

You seem to be ignoring each of the systematic reviews which say that there is evidence that chiropractic or spinal manipulation is effective for foo. Each one of those effective disagree with Ernst's opinion. By you making a judgment that Ernst is more reliable, you are in effect ujsing OR to violate WEIGHT. Think about it. On one hand you are saying "collectively" but on the other hand you are ignoring most of the collection. -- Levine2112 ^discuss 01:55, 20 December 2008 (UTC)

Please see #Systematic reviews, collectively below. Eubulides (talk) 04:24, 20 December 2008 (UTC)

Systematic reviews, collectively

Following up on the claim in the previous section that I am ignoring systematic reviews:

• I am not ignoring any of the systematic reviews in question: I discussed every one of them Levine2112 brought up, and explained why they do not demonstrate that chiropractic care is effective for any condition (except perhaps back pain). In some cases the evidence they discuss is too weak to form any basis for conclusions; in some cases there are multiple reviews that disagree, with the higher-quality ones giving negative results; and so forth.
• That is why the proposed text does not say "there is no evidence that chiropractic is effective". It says "Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain", which is a high-quality and accurate summary of all the reviews.
• There is zero OR here. The proposed text accurately summarizes a reliable source, Ernst 2008 (PMID 18280103), which discusses systematic reviews on chiropractic and says (p. 8) "Collectively, their results fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain."

Eubulides (talk) 04:24, 20 December 2008 (UTC)

Let's go back to neck pain and whiplash. It seems to me that the reviews there are all concluding that there is a benefit with the various treatments which chiropractors employ or prescribe. I think you are stuck of Ernst's opinion and are trying to cite his as the authorative one. Unfortunately, this presents a WEIGHT violation. Ernst by no means is the authorative mainstream voice on this subject. Rather, he is a vocal critic. If anything, his opinons (which we cite no less that 11 times in this article!) should be taken with a grain of salt and probably cut back significantly in order to comply with WP:WEIGHT. -- Levine2112 ^discuss 09:07, 20 December 2008 (UTC)

• The reviews for neck pain and whiplash are not uniformly positive. As the text notes, of three systematic reviews of SM published between 2000 and May 2005, only one reached a positive conclusion, and the most-reliable review studied, the Cochrane 2004 review, found that SM and mobilization were not of demonstrable effectiveness by themselves, only when combined with exercise (and there was no evidence that the combination was any better than exercise alone).
• Ernst is not the only one who is saying this sort of thing. We also have the chiropractors Nelson et al. 2005, who say that the credibility of chiropractic manipulation for treatment of non-spinal conditions is debatable:

• Nelson CF, Lawrence DJ, Triano JJ; et al. (2005). "Chiropractic as spine care: a model for the profession". Chiropr Osteopat. 13: 9. doi:10.1186/1746-1340-13-9. PMID 16000175. Points of contention are the credibility of clinical claims for effectiveness of chiropractic manipulation for a variety of non-spinal conditions {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)

We also have the chiropractors Vernon & Humphreys 2007, who also conclude that reviews and guidelines disagree for neck pain:

• Vernon H, Humphreys BK (2007). "Manual therapy for neck pain: an overview of randomized clinical trials and systematic reviews" (PDF). Eura Medicophys. 43 (1): 91–118. PMID 17369783. At present, there is no overall consensus on the status of MTs [manual therapies] for neck pain.

• In other words, this is not just Ernst. It is the standard consensus, not only among mainstream science and medicine, but also among mainstream chiropractic. Ernst just happens to be the current leading published expert on the effectiveness of chiropractic treatment, so he's the best guy to quote.

Eubulides (talk) 03:47, 21 December 2008 (UTC)

Chiropractic is more than adjusting. . . the other treatments mentioned. . . mobilization, supervised exercise, low-level laser therapy and perhaps acupuncture (though I personally do not employ it in my practice. . . I know some who do). . . these are all part of chiropractic. . . not to mention nutritional counseling, stress management, massage. . . it is like you are wanted to write off chiropractic's effectiveness based on manipulation alone when chiropractic encompasses much more.TheDoctorIsIn (talk) 21:34, 21 December 2008 (UTC)

Yes, chiropractic is more than adjusting. But the cited source is talking about all of chiropractic care, and (rightly) focuses on adjusting (or spinal manipulation, SM), the core treatment of chiropractic. No reliable source does things differently: they all focus on SM. We need to follow what the reliable sources say. Eubulides (talk) 20:48, 23 December 2008 (UTC)

My reading of this. . . Levine's right on. . . we cannot say "collectively" because we are creating the collection and then making an evaluation. . . an entirely original one. Ernst is not an authoritative source and certainly a very vocal critic. . . giving his opinion to represent the scientific opinion is wrong. Obviously from just the reviews we have in this article, chiropractic has demonstrated effectiveness for more conditions than back pain.TheDoctorIsIn (talk) 01:39, 21 December 2008 (UTC)

There must be some confusion here. We are not saying "collectively", nor are "we creating the collection". We are citing a reliable source by an expert in the field, Ernst 2008 (PMID 18280103), who discusses systematic reviews on chiropractic and says (p. 8) "Collectively, their results fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain." Ernst has more recent refereeed publications in the area of the effectiveness of chiropractic treatments than anybody else does, and is certainly an authoritative source. No reliable sources have been presented to the contrary. We should not be substituting our own conclusions for his, nor should we be suppressing or downplaying them. Eubulides (talk) 03:47, 21 December 2008 (UTC)

We could solve this by accurately quoting and attributing this to Ernst, which will give readers an excellent opportunity to check out his reputation as an authoritative source on alternative medicine in general, and chiropractic in particular. Here are two versions:

1. After analyzing all the systematic reviews on spinal manipulation, Ernst summed up the results in this way: "Collectively, their results fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain."

2. Ernst has summed up his analysis of all the systematic reviews on spinal manipulation in this way: "Collectively, their results fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain."

Those are quick tries and may not be entirely accurate (was it "all" the reviews?). -- Fyslee (talk) 02:44, 23 December 2008 (UTC)

I am certainly not opposed to attribution of that kind, but I certainly don't think that it belongs in the lead either way. It's still "one guy's opinion" which our own article seems to show is without merit. Further, I really see what TDII and DigitalC are getting at - chiropractic is more than spinal manipulation. The lead should really concentrate on the topic at hand: chiropractic. Then, if we want to go into the specifics of the efficacy of each treatment which chiropractic generally advocates and employs, we can do that in the Efficacy section. Overall though, attribution could be a helpful way to settle this debate, but I don't think that it is proper to do so in the lead as it would be giving Ernst - who is already cited at least 11 times in this article! - far too much weight. -- Levine2112 ^discuss 02:57, 23 December 2008 (UTC)

Ernst has known biases. . . relying on his opinion alone is wrong. . . especially in the presence of conflicting opinions.TheDoctorIsIn (talk) 21:34, 21 December 2008 (UTC)

Who doesn't have known biases? Show me a person without biases and I'll show you a person who has no opinions worth listening to. He knows his biases (not the same as prejudices), and that's a big advantage for everyone. They have been formed by the evidence, rather than him attempting to manipulate the evidence to justify his biases. His biases were initially (as a practitioner of alternative medicine: homeopathy, spinal manipulation, etc.) favorable to altmed, and he took his professorship as an opportunity to scientifically validate those methods. Much to his consternation he found the evidence just wasn't there, and his department has continued to study and research many alternative medicine subjects. That is the only honest thing to do. His biases are to compare those methods with the available scientific evidence. Not a bad thing for his department to be doing. -- Fyslee (talk) 02:44, 23 December 2008 (UTC)

Edzard Ernst is the most vocal critic of Chiropractic, and some of his criticisms fail the stink test. We would clearly be failing WP:NPOV to be introducing only Ernst's point of view in the lead. 118.208.203.78 (talk) 02:59, 23 December 2008 (UTC)

Agreed. I think it is already a WP:WEIGHT violation citing Ernst the 11 times we do in the article currently. Given his opinion any more prominence may require us to retitle this article to "Chiropractic according to Edzard Ernst" and that would most surely be a POV fork indeed. -- Levine2112 ^discuss 08:40, 23 December 2008 (UTC)

Please provide evidence of so-called bias or a vocal critic of chiropractic. No evidence of bias has been presented. Please show and not assert your view. Ernst does a lot of research in this area. Being a researcher does not equal bias. Claiming Ernst is bias without presenting any evidence is unhelpful. QuackGuru (talk) 18:57, 23 December 2008 (UTC)

• Chiropractic, Reply, William C. Meeker, DC, MPH, and Scott Haldeman, DC, PhD, MD, FRCP, 15 October 2002, Volume 137, Issue 8, Page 702. Exceprt: The charge of bias cuts in many directions, as Dr. Ernst is well aware.

• Ernst Fails to Address Key Charges, Joseph Morley, Anthony L. Rosner, Daniel Redwood. The Journal of Alternative and Complementary Medicine. April 1, 2001, 7(2): 127-128. Excerpt: Professor Ernst fails to address directly some of the most serious examples we cited as evidence of apparent bias and academic misconduct.

• Profession Responds Quickly to Negative U.K. Study on Spinal Manipulation, Dynamic Chiropractic, May 22, 2006. Excerpt: The biases in this study are painfully apparent, rendering the sweepingly negative "findings" little more than the authors' personal opinions.

• New Zealand College of Chiropractic response to "Dr Who?" editorial, Kelly, B. New Zealand Medical Journal, 22 August 2008, Vol 121, No 1280. Excerpt: ...Ernst, a former specialist in physical medicine and rehabilitation who has long demonstrated extreme bias against chiropractic...

So, I'm not asserting that Ernst is biased. These sources from the research community are making this assertion. Whether he is or not is not the issue. The issue is whether we should be given any more prominence to the opinion of an accused biased author whom we have already cited no less than 11 times in our article here. His opinion is clearly not the authoritative one, so presenting as though it were in the lead certainly creates an even greater WP:WEIGHT violation. -- Levine2112 ^discuss 19:19, 23 December 2008 (UTC)

Those are opinions. No evidence of bias of the research has been given. I don't see any specific bias of Ernst's research. Anyone can have an opinion of Ernst's research. The links above show there is commentary about Ernst and not a bias by Ernst. On Wikipedia, we edit according to the references presented. QuackGuru (talk) 19:29, 23 December 2008 (UTC)

Please read the references in full. They either give us good reason to present these analyses of Ersnt's opinions or not to operate under the assumption that Ernst's opinions are the authoratative ones. I'd prefer the latter (so this article doesn't devolve into a shit-show). Opinions are opinions, and we have shown Ernst's opinions, we have shown Ernst's opinions contradicted by other pieces of research, and we have shown that some find Ernst's opinions to be biased. That said, you can no longer credibly state that "No evidence of bias of the research has been given" when clearly evidence has now been given just above. Whether you agree with these pieces of evidence is entirely up to you. But neither your agreement nor mine is consequential in the writing of this article. -- Levine2112 ^discuss 19:59, 23 December 2008 (UTC)

No evidence that Ernst's research is bias has been presented. If an editor thinks Ernst is bias that is there personal opinion but on Wikipedia we edit according to policy. Please ses WP:RS. Ernst passes the RS test with flying colors. QuackGuru (talk) 20:08, 23 December 2008 (UTC)

Without doubt, the research of Ernst presented in this article currently are all reliable sources, per WP:RS. No one is making a claim that they are not. However, just the same, all of the research currently presented in the article are also reliable sources. Some of that research contradicts Ernst's opinion: "Collectively, their results fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain." As such, we should not present this opinion of Ernst's in the lead as though it were the authoritative view. That's how we edit according to policy; WP:NPOV to be precise.

Your continued claim that "No evidence that Ernst's research is bias has been presented," is patently and obviously false. One only needs to looked over the four reference presented above. Each presents evidence that Ernst's chiropractic/spinal manipulation research is biased. Whether you agree with that this evidence is credible is entirely up to you and inconsequential at Wikipedia. So saying that no evidence has been presented is not a credible point any longer. If you'd like to admit that evidence has in fact been presented, that would be a wonderfully positive thing to do. Then again, if you wish to continue to assert that the evidence does not exist, then please know that I will now ignore your statements to that effect. Thanks. -- Levine2112 ^discuss 20:22, 23 December 2008 (UTC)

Editors are entitled to a personal opinion but on Wikipedia we stick to policy. Now then, please provide evidence that the citation of Ernst is patently false with another reference currently in the effectiveness section. QuackGuru (talk) 20:37, 23 December 2008 (UTC)

Just review my response below. I never said that Ersnt is patently false. Please reread my comments above. All I am saying is that his belief that chiropractic is only maybe beneficial for just low back pain is contradicting by sources such as as Cochrane which asserts that a chiropractic prescription (SM, mobilization, exercise) may also be beneficial for neck disorders. This seemingly contradicts Ernst's statement. As such, Ernst's opinion is not necessarily representative of current mainstream thinking, which would mean that Ernst's opinion should not be presented as an authoritative and definite statement of chiropractic. Rather, if used at all, it should be attributed and thus presented as an opinion. -- Levine2112 ^discuss 20:52, 23 December 2008 (UTC)

According to what policy it should be attributed? I don't see any evidence of contradicting the Ernst's citation. QuackGuru (talk) 21:02, 23 December 2008 (UTC)

[unindent] You just need to read the conclusions of the Cochrane reviews to see exactly what the effectiveness is for each condition. Some of the reviews, such as those done by chiropractors, I would take with a pinch of salt. Clearly they are going to paint their treatment in a more favourable light than independent reviewers. Take headache for example (PMID 15266458). Cochrane concludes that although there is some evidence that SM may be effective for headaches, "The clinical effectiveness and cost-effectiveness of non-invasive physical treatments require further research using scientifically rigorous methods. The heterogeneity of the studies included in this review means that the results of a few additional high-quality trials in the future could easily change the conclusions of our review." So if you don't like Ernst (and I'm not entirely happy with him myself) you can just combine the conclusions of the Cochrane reviews to get a NPOV summary of the effectiveness. --sciencewatcher (talk) 20:11, 23 December 2008 (UTC)

We should also include the conclusions of the other reviews as well in our attempt to summarize a statement for the lead. For instance, " a 2004 Cochrane review found that SM and mobilization are beneficial only when combined with exercise, the benefits being pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder." So here we have Cochrane saying that the chiropractic prescription (SM, mobilization and excercise) are beneficial for pain relief, functionality and global perceived effect of mechanical neck disorders. This is the kind of evidence which would contradict the Ernst-only statement in the lead, where he asserts chiropractic is only maybe beneficial for back pain. -- Levine2112 ^discuss 20:28, 23 December 2008 (UTC)

• The 2004 Cochrane review (Gross et al. 2004, PMID 14974063) did not find any benefit to spinal manipulation alone. It could be that all the benefit was due to exercise. Of course we cannot mention that possibility in the lead (that's OR); but neither can we highlight this review in the lead, over and above all the other reviews on the subject.
• There are dozens of systematic reviews on treatments used by chiropractors. We cannot summarize them all in the lead; there's not enough room. We cannot pick and choose between them; that's synthesis. What we can do, and what the proposed text does, is to summarize a peer-reviewed synthesis of all these reviews, a synthesis that is mainstream opinion.
• It shouldn't be too surprising that the chiropractic community reacts strongly against Ernst, who has presented critical evaluations of the field. However, Ernst remains the leading published researcher on the topic of chiropractic effectiveness, which is the reason we cite him so often. His opinion is an important part of the mainstream, and we should not exclude citations to him from the lead merely because chiropractors object to his work.
• Again, no reliable sources have been presented that dispute this particular claim by Ernst, which is a mainstream opinion.
• We have often disputed whether to include Ernst, with supporters of chiropractic strongly opposed to citing Ernst; the above comments merely repeat stuff that we've seen before. I don't sense that any editor in this discussion is in the "gathering evidence" phase. It may well be that mediation is the best way to proceed here.

Eubulides (talk) 20:48, 23 December 2008 (UTC)

Exercise is part of the chiropractic prescription. So whether is was the spinal manipulation, the mobilization, the exercise or some combination, it goes to support the efficacy of chiropractic (the subject of this article) in the treatment of neck disorders. This contradicts Ernst's claim. We are not disputing whether or not to include Ernst, only whether or not to give him as much prominence as we currently do. Eleven citations to any researcher is a lot for any one article, let alone one who has been contradicted by other reliable sources, and consistently accused of professional bias. -- Levine2112 ^discuss 20:55, 23 December 2008 (UTC)

Exercise is not always part of the chiropractic prescription. Ernst's citation is not contradicted by other reliable sources. No evidence of professional bias has been given. An opinion of Ernst is not evidence of any bias. QuackGuru (talk) 21:20, 23 December 2008 (UTC)

The proposed change has been added to the article. Please see Talk:Chiropractic#Comments on lead improvements. QuackGuru (talk) 19:09, 24 December 2008 (UTC)

Hypertension study

Here's a relatively new study which implies a link between hypertension and upper cervical manipulation as performed by chiropractors: Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients, Journal of Human Hypertension (2007). According to ABC News, this study suggests that a specific type of neck adjustment may reduce hypertension. And according to WebMD, this placebo-controlled study suggests that a special chiropractic adjustment can significantly lower high blood pressure. The lead researcher, George Bakris, MD director of the University of Chicago hypertension center states, "This procedure has the effect of not one, but two blood-pressure medications given in combination. And it seems to be adverse-event free. We saw no side effects and no problems." This study is published in a respected peer-reviewed journal and it is well-documented by third-party news sources. I'd like to see it incorporated into the Efficacy section somehow. -- Levine2112 ^discuss 18:39, 17 December 2008 (UTC)

How come they say it is "double blind" if they don't actually check to see if the patients were successfully blinded? It's well established that sham chiropractic procedures are generally distinguishable from the actual procedure by patients. Also, because the clinician is aware of which procedure the patient is getting then surely it is single-blind and not double-blind? It is a reliable journal, so I must just have missed something. --sciencewatcher (talk) 19:03, 17 December 2008 (UTC)

I don't think it is "well established" that sham manual procedures are generally distinguisable from actual manual procedures, and I don't think one could use conclusions from one sham technique to discuss another sham technique.

The study discusses in depth how the patients we sufficiently blinded. Yes, the journal is reliable and the lead research, Bakris, is kind of giant in the field. He has three board certifications, is the editor of another major scientific journal, and sits on the review board of several others. This study is just that - a study. It is not a review. No review of these kinds of studies exist yet - or I am unaware of any. That said, when we include this material, we should cite commentary such as this one which qualifies the findings with:

In conclusion, the study by Bakris et al. provides new interesting information on the favourable blood pressure lowering effects of microvascular decompression caused by chiropractic procedure. Before recommending this therapeutic strategy in the current clinical practice, however, it seems reasonable to wait for the results of large-scale clinical trials aimed at defining the long-term effects of the intention on clinic and ambulatory blood pressure as well as on some surrogate end points, such as cardiac and vascular target organ damage.

Sound reasonable? If so, let's work on the actual text to insert. -- Levine2112 ^discuss 19:43, 17 December 2008 (UTC)

Sorry, but you haven't answered my questions. I read through the full text of the study, including the info about blinding, and nowhere did it mention any survey of patients asking which procedure they thought they had had. Without such a survey the study is pretty much worthless. And why did they call it "double blind" when it is clearly and obviously single blind? As you say, it appears to be a respected peer-reviewed journal so I must be missing something here. Someone please point out my errors or misunderstanding... And as Eubulides says below, we really shouldn't be quoting primary sources for effectiveness anyway. --sciencewatcher (talk) 20:48, 17 December 2008 (UTC)

Your question about blinding aren't relevant to inclusion or exclusion on WP. We don't use original research to determine the quality of study before including it (otherwise we wouldn't be including many of the Ernst studies), although you may want to see my OR on this study below. They may not have done a post-sham survey because this was only a pilot study. As Eubulides explained below, it was double blinded in that both the patient and the person evaluating the blood pressure were blinded. DigitalC (talk) 00:07, 18 December 2008 (UTC)

By "double blinding" I expect that they mean that both the patients and the followup evaluators were blinded (although it is weird that they don't explicitly say this about the evaluators in their "Post-intervention assessment" section). The chiropractor administering the treatment obviously was not blinded. I agree that they should have surveyed patients as to which procedure they thought they had. Also, as per Hancock et al. 2006 there may well be questions whether the sham treatment was actually a sham. But of course our opinions of this pilot study count for far less than a peer-reviewed published expert review would. Eubulides (talk) 22:31, 17 December 2008 (UTC)

• Claims that chiropractic treatment are effective against high blood pressure (hypertension) have been reported in the literature for many years; see, for example Plaugher & Bachman 1993 (PMID 8263434) and Beck et al. 2003 (PMID 12754366). Claims to the contrary have also been presented. I've also seen a case report of chiropractic neck adjustment causing (unintended) lower blood pressure, leading to paralysis of eye muscles (which, luckily for that patient, eventually turned out to be temporary); see Kurbanyan & Lessel 2008 (PMID 18156388).
• However, I'd like to remind editors (again) that as per WP:MEDRS we should be using reliable reviews to source medical claims like this, rather than dipping directly into primary studies such as the above, as primary studies are individually not all that reliable.
• As it happens, we are already citing a review (Hawk et al. 2007, PMID 17604553) which surveys 10 primary studies on the subject and says (p. 498) that "chiropractic care is not of great clinical utility to a broad population of hypertensive patients". Hawk et al. did not review this new study (as it's too new) but I am skeptical that this one extra study would have significantly changed their conclusions.
• To summarize all this I suggest we add "high blood pressure" to the list of conditions in the penultimate sentence of Chiropractic #Effectiveness, which summarizes Hawk et al. Here's what the resulting sentence would look like:

"A 2007 systematic review found that few studies of chiropractic care for nonmusculoskeletal conditions are available, and they are typically not of high quality; it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) 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, dizziness, high blood pressure, and vision conditions."

Eubulides (talk) 20:42, 17 December 2008 (UTC)

Perhaps we should append some of this information to your proposed addition to the lead, such as "it also found that the entire clinical encounter of chiropractic care (as opposed to just SM) 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." DigitalC (talk) 00:48, 18 December 2008 (UTC)

I don't think we can put such a blanket statement into the lead. Let's take asthma for an example. The claim that chiropractic is beneficial for asthma is not well-supported by reliable sources. Chiropractic already mentions Hondras et al. 2005 (PMID 15846609), a Cochrane review that concluded there's insufficient evidence that manual therapy benefits asthma; this is by far the most-authoritative review of the subject. As for the entire context of clinical care, there's also Markham & Wilkinson 2004 (PMID 15115165), Bielory et al. 2004 (PMID 15603200), also with negative results. Emphasizing Hawk et al. 2007 (PMID 17604553) by putting it into the lead, while ignoring the Cochrane review and others, would not be presenting mainstream opinion fairly. The situation for dizziness and colic is similar. Part of the problem here is that Hawk et al. rely heavily on low-quality studies (case reports, for example), which as we know are prone to publication bias, whereas the Cochrane reviews and others insist more strongly on high-quality evidence. Eubulides (talk) 17:22, 18 December 2008 (UTC)

It is a statement that is already in the article, and supported by a reliable source. We shouldn't be second guessing the sources here. You are comparing apples to oranges when stating that "Hondras et al. 2005 (PMID 15846609), a Cochrane review that concluded there's insufficient evidence that manual therapy benefits asthma". The review we have ISN'T talking about manual therapy - it is talking about the entire Chiropractic clinical encounter. Please note that not all Chiropractic treatment is manual therapy - (eg: Ultrasound, IFC, LLLT, advise to stay active, nutrtiional counselling, ergonomic advice, exercise prescription, etc. etc.). Again, we don't conduct OR to determine the quality of the study, and the studies that Hawk et. al used are irrelevant to our use of Hawk et al. in the lead. This is coming off as a POV-push. 118.208.203.78 (talk) 22:30, 19 December 2008 (UTC)

What we have in the article are two reliable sources which disagree, and one is more reliable than the other. Hawk et al. 2007 (PMID 17604553) base their asthma-related claims entirely on studies involving manipulation, not necessarily chiropractic manipulation (one study was osteopathic), so it is apples-to-apples in terms of what is being studied. The main difference is that Hawk et al. have much lower quality standards, and accept individual case reports as evidence, whereas the Cochrane review (Hondras et al. 2005, PMID 15846609) insists on high-quality trials. We certainly can discuss the reliability of sources here, on the talk page, and by any reasonable standard the Cochrane review is higher quality than Hawk et al. It would greatly misrepresent the state of affairs to summarize in the lead only the claims of Hawk et al., the less-reliable source here. Eubulides (talk) 00:55, 20 December 2008 (UTC)

One is more reliable than the other? According to whom? Original research much?TheDoctorIsIn (talk) 01:41, 21 December 2008 (UTC)

It's common knowledge that Cochrane reviews are generally of high quality; see WP:MEDRS #Use up-to-date evidence and WP:MEDRS #Search, for example. In this particular case the difference is striking: Hawk et al. spends a relatively small amount of space on asthma, and relies on low-quality evidence, whereas Hondras et al. focuses entirely on asthma and does not rely on low-quality evidence. Eubulides (talk) 03:47, 21 December 2008 (UTC)

Its an interesting problem, in that per WP:NPOV/WP:UNDUE, we should mention something about this study, as it has received a LOT of press coverage (unfortunately, IMHO). However, as Eubulides states above, we shouldn't include it per WP:MEDRS. When it comes to OR, I think this study is flawed in its basic design, and not due to blinding concerns outlined by Sciencewatcher. I would like to see the research on the construct validity (correct term?) of supine leg length checks for determining atlas "mal-alignment". If that study was a wikipedia article, I would be dropping tags through its introduction section. Perhaps I need to go and read the studies they have cited, but I certainly don't follow their conclusions in the introduction section such as "Thus, alterations in Atlas anatomy can generate changes in the vertebral circulation that may be associated with elevated levels of BP.". I don't think we should be citing pilot studies in the article no matter what, and it would be best to see if a review of this article with the other research on SM for BP comes forward. DigitalC (talk) 23:59, 17 December 2008 (UTC)

Okay. Then let's wait. In general though, WP:MEDRS does not prohibit us from using primary research as sources; it just recommends the use of reviews if available. Here is a case where no review on the subject is available. -- Levine2112 ^discuss 23:02, 18 December 2008 (UTC)

I agree that we should wait. Particularly in this case, where a review on the subject is available. But even if no review were available, we should be quite leery of mentioning individual studies that make extraordinary claims. Eubulides (talk) 00:36, 19 December 2008 (UTC)

I made this change to add high blood pressure using an existing reference currently in the article. See WP:MEDRS. QuackGuru (talk) 21:33, 23 December 2008 (UTC)

Chiropractic management of low back pain

There is a new study on low back pain. QuackGuru (talk) 20:20, 23 December 2008 (UTC)

This is a wonderful piece of research. Thank you for sharing it. This is a nice review of literature and can certainly be incorporated into the "Low back pain" subsection of the Efficacy portion of our article. Any suggested wording? -- Levine2112 ^discuss 20:39, 23 December 2008 (UTC)

Done. Chiropractic #Effectiveness already cites that study, once under the low-back-pain bullet and once under "other". I wrote that several months ago. Eubulides (talk) 20:48, 23 December 2008 (UTC)

Yes. I see it now. Thanks. -- Levine2112 ^discuss 20:59, 23 December 2008 (UTC)

Simon Singh to put chiropractic on trial in UK

We should probably mention this here in this article. Some sources for reading:

The original BCA brochure: http://www.chiropractic-uk.co.uk/gfx/uploads/textbox/Happy%20families.pdf

April 2008 - Simon Singh's "Comment is Free" piece in the Guardian (removed from Guardian site, but here hosted on a Russian server!): http://svetlana14s.narod.ru/Simon_Singhs_silenced_paper.html

August 2008 - The news of the claim: http://www.telegraph.co.uk/news/newstopics/mandrake/2570744/Doctors-take-Simon-Singh-to-court.html

August 2008 onwards - Material on the web summarised at: http://holfordwatch.info/2008/08/16/british-chiropractors-join-the-legal-intimidation-party/

November 2008 - Summary of BCA's Legal Claim: http://jackofkent.blogspot.com/2008/11/on-bcas-case-against-simon-singh.html

November 2008 - Summary of Simon Singh's Defence: http://jackofkent.blogspot.com/2008/11/on-putting-chiropractic-on-trial.html

November 2008 - Article on the influential Quackometer site: http://www.quackometer.net/blog/2008/11/chiropractic-folly-and-nature-of.html

And on the Blog of philosopher Stephen Law: http://stephenlaw.blogspot.com/2008/11/simon-sigh-sued-by-british-chiropractic.html

December 2008 - Case features in Private Eye.

December 2008 - Useful round up on Dr Aust's site: http://draust.wordpress.com/2008/12/23/it%E2%80%99s-quiet%E2%80%A6-too-quiet/

December 2008 - And strong support from Phil Plait of Bad Astronomy: http://blogs.discovermagazine.com/badastronomy/2008/12/24/uk-quackery-on-trial/

ScienceApologist (talk) 20:42, 24 December 2008 (UTC)

While this topic is clearly notable, it's not clear that it is important enough to mention a merit in Chiropractic itself. The most important trial in the history of chiropractic (namely the 1906 Morikubo trial) isn't mentioned in Chiropractic; why should the far less important Singh case be mentioned? I suggest adding this material to Chiropractic history instead; or (if there's enough text) you could create a new article for it, perhaps using Wilk v. American Medical Association as a model. Please keep WP:Recentism in mind when this is done. Eubulides (talk) 21:35, 24 December 2008 (UTC)

Lead improvements

For most of its existence, chiropractic has battled with mainstream medicine, sustained by ideas such as subluxation that are not based on solid science. Vaccination remains controversial among chiropractors. The American Medical Association called chiropractic an "unscientific cult" and boycotted it until losing a 1987 antitrust case. Chiropractic has had a strong political base and sustained demand for services; in recent decades, it has gained more legitimacy and greater acceptance among medical physicians and health plans, and evidence-based medicine has been used to review research studies and generate practice guidelines. Many studies of treatments used by chiropractors have been conducted, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain. The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. Although spinal manipulation can have serious complications in rare cases, chiropractic care is generally safe when employed skillfully and appropriately.

Comments on lead improvements

In order to reach WP:GA status we should improve the lead. This is mandated under WP:LEAD which says: The lead should be able to stand alone as a concise overview of the article. QuackGuru 19:14, 15 December 2008 (UTC)

I agree the lead needs improving, particularly the vague part. However, the above text is identical to the text proposed in #Alternative idea for 3rd paragraph. I don't see the point of repeating the same proposal here: that would merely lead to duplication of comments. Let's continue the discussion above instead of restarting it here. Eubulides (talk) 19:41, 15 December 2008 (UTC)

The talk page is too long. I think we should archive all the other discussions about the lead and put a summary of the discussion here. We can also provide links to the archive of the old discussions if they were archived. This proposal is slightly different. It uses the word antitrust instead of the phrase that is hard to understand. It is better to be concise. QuackGuru 19:48, 15 December 2008 (UTC)

Sorry, I didn't see that wording change. I suggest replacing "antitrust court decision" with "antitrust case"; that's shorter and to the point, and the wikilink to United States antitrust law will help explain things. As described in #Opinions differ above, I also suggest expanding "Chiropractic spinal manipulation has not been shown to be effective for any medical condition with the possible exception of back pain;". Here's a suggested rewording: "Many studies of treatments used by chiropractors have been conducted, with conflicting results. Collectively, systematic reviews of this research have not demonstrated that spinal manipulation is effective, with the possible exception of back pain. These reviews usually cover treatments independent of profession, and thus do not evaluate chiropractic in isolation." Eubulides (talk) 20:09, 15 December 2008 (UTC)

I made this initial change to the proposed text. The second part of the proposal seems a bit long but it is accurate. QuackGuru 20:21, 15 December 2008 (UTC)

I made this change to the proposed text. This is concise and in accordance with WP:LEAD. QuackGuru 20:35, 15 December 2008 (UTC)

I don't think that this version is an improvement of the current lead in place in the article. This does a worse job at accurately summarizing the body of the article and seems to be focusing only on the negative POV. I'd say that this lead fails WP:LEAD, WP:POVPUSH and most notably WP:NPOV. What is wrong with the current lead? It seems to do a fine job of accurately summarizing the article in a more neutral way than the version suggested above. The current lead is able to stand alone as a concise overview of the article. So, what's the issue. Can the current lead not stand alone right now? If you think so, please specify why. Is the current lead not a concise overview of the article? If you think so, again please specify why. Please be SPECIFIC. For instance, I've read the efficacy section - and "opinions differ" seems to be a very concise and accurate way to describe the efficacy of chiropractic for various conditions. I see some research which says it is effective for such-and-such and I see some research which says it is not effective for such-and-such; hence, "opinions differ". -- Levine2112 ^discuss 01:11, 16 December 2008 (UTC)

What is wrong with the current lead? The vaguenss of "opinions differ" and not properly summarizing chiropractic history. QuackGuru 01:19, 16 December 2008 (UTC)

The problems are not fixed. QuackGuru 01:26, 16 December 2008 (UTC)

I have been specific. I did explain why the current lead is vague. I did explain why the lead should be able to stand alone. See WP:LEAD. QuackGuru (talk) 20:01, 23 December 2008 (UTC)

i don't care for this new lead very much. . . it seems to be pushing the negative.TheDoctorIsIn (talk) 07:32, 16 December 2008 (UTC)

Please be specific. Vague comments are not helpful. QuackGuru (talk) 19:54, 23 December 2008 (UTC)

Please see my followup comments in #Vague tag above. Eubulides (talk) 07:59, 16 December 2008 (UTC)

I made this change to fix the vagueness in the lead. The lead should be a concise overview and a reflection of the article. QuackGuru (talk) 19:05, 24 December 2008 (UTC)

While I'm in favor of that change overall, it did more than just fix the vagueness in the lead; it also shortened the 1st sentence in the paragraph and added a new sentence about the AMA's opposition. It's better to not combine changes like this, particularly in this controversial area where no consensus has been reached. We have seen some opposition to all those changes, in one form or another; I think it would be better to consider those two sets of changes separately rather than all together. Also, given that discussion has been going around in circles about these changes, it'd probably be better to take this up in mediation. Eubulides (talk) 20:13, 24 December 2008 (UTC)

I support this change and consensus is growing for a lead that properly summarizes the article. See WP:CCC. One of the arguments against improving the lead is that Ernst is a vocal critic which is false. Ernst is a leading researcher of chiropractic. The references added to the lead support the newly added text. The history section should be summarized in the lead. The AMA thingy is notable part of history and belongs in the lead. Editors should remember that the lead is a summary of the article and per WP:LEAD, should stand alone. Opinions differ is way too vague. QuackGuru (talk) 19:41, 25 December 2008 (UTC)

Two changes to the lead

In response to the recent edit war I have started a new section Talk:Chiropractic/Mediation #Two changes to the lead. Eubulides (talk) 10:06, 26 December 2008 (UTC)

I have responded to the two great improvements. -- Fyslee (talk) 03:14, 27 December 2008 (UTC)

Treatment techniques

After reviewing the article, I think the Chiropractic#Treatment techniques is the weakest section. Readers may want to know more about what techniques chiropractors employ such as explained in this article. Thoughts? QuackGuru (talk) 07:07, 27 December 2008 (UTC)

We have two whole articles for that purpose. That's what the "main" links are for. Maybe a minor cleanup, but no need for enlargement. -- Fyslee (talk) 08:19, 27 December 2008 (UTC)

• I agree that Chiropractic#Treatment techniques should be relatively brief and should use summary style, but I also agree with QuackGuru that the section is weak right now: its last two paragraphs are boring laundry lists, and are not that useful for non-expert readers. For example, I'd guess that not one Wikipedia reader in 10,000 knows what "extremity adjusting" is, and yet that phrase is used without explanation.
• The source listed by QuackGuru lists over 60 techniques, which is far too many for us to list here. We need reliable sources that summarize and organize these techniques well. Here are some possibilities:

• Cooperstein R, Gleberzon BJ (2004). Technique Systems in Chiropractic. Churchill Livingstone. ISBN 0-443-07413-5. (This source is already cited, but is hard for most editors to obtain.)
• Gleberzon BJ (2001). "Chiropractic 'Name Techniques': a review of the literature" (PDF). J Can Chiropr Assoc. 45 (2): 86–99.
• Hooper PD (2005). "Introduction to specific treatment methods". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. pp. 745–910. ISBN 0-07-137534-1. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link) (This is Section IV of the leading textbook on chiropractic. Hooper is the editor, and there are 10 chapters in the section, each with different authors, which should be cited separately as needed.)
• Mootz RD, Shekelle PG (1997). "Content of practice". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 67–91. OCLC 39856366. {{cite book}}: |access-date= requires |url= (help); |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) AHCPR Pub No. 98-N002. (This source is already cited by Chiropractic #Scope of practice.)

• Also, we have been using the NBCE job analysis survey to decide which techniques to mention, but I'd prefer a more-reliable source if we can find one.

Eubulides (talk) 09:02, 27 December 2008 (UTC)

That sounds reasonable. Go for it. -- Fyslee (talk) 09:12, 27 December 2008 (UTC)

Broken URL to Cherkin & Mootz 1997

A URL that Chiropractic links to no longer works. Another copy of this public-domain source is available at another web site. To fix this, in Chiropractic #Education, licensing, and regulation, please replace this:

|url=http://curziechiropractic.com/forms/ahcpr/uschiros.pdf |accessdate=2008-05-11

with this:

|url=http://chiroweb.com/archives/ahcpr/uschiros.PDF |accessdate=2008-12-27

Thanks. Eubulides (talk) 09:02, 27 December 2008 (UTC)

Since this seems as non-controversial as they get, I've gone ahead and made the change. If there's any objections after the fact, feel free to drop me a note (you can even send email or IM and I'll respond promptly (leaving a note here might take a bit longer ;) ). Shell ^babelfish 23:49, 27 December 2008 (UTC)

Incorrect citation for "unscientific cult"

Currently Chiropractic's lead says that the AMA "called chiropractic an 'unscientific cult'", summarizing Chiropractic #History's statement "Until 1983, the AMA labeled chiropractic 'an unscientific cult' and held that it was unethical for medical doctors to associate with an 'unscientific practitioner'." Both these statements cite Cherkin 1989 (PMID 2817179). However, Cherkin does not contain the phrase "unscientific cult". The AMA actually did call chiropractic an "unscientific cult" but we need to cite a source accurately for that. I suggest Johnson et al. 2008 (PMID 18722194), a freely-available and recent article; this article is primarily on a different subject but it is reliable for this quote and it's possible we'll need this article for Chiropractic #Public health anyway.

Also, the statement "Until 1983, the AMA labeled chiropractic 'an unscientific cult' and held that it was unethical for medical doctors to associate with an 'unscientific practitioner'." does not accurately summarize Cherkin. Cherkin says nothing about 1983, and instead says that the AMA allowed physicians to refer patients to chiropractors starting in 1978 and removed proscriptions against "unscientific practitioners" in 1980.

A minor point but one that still needs correcting: Cherkin says "unscientific practitioners" but the quote in Chiropractic omits the trailing "s".

Also, a nit: the word "an" is quoted in the body but not in the lead, which is inconsistent.

To fix these problems, in the lead let's replace this:

The American Medical Association called chiropractic an "unscientific cult"

with this:

The American Medical Association called chiropractic an "unscientific cult"

and in Chiropractic #History let's replace this:

Until 1983, the AMA labeled chiropractic "an unscientific cult" and held that it was unethical for medical doctors to associate with an "unscientific practitioner".

with this:

The AMA labeled chiropractic an "unscientific cult" in 1966, and until 1980 held that it was unethical for medical doctors to associate with "unscientific practitioners".

Eubulides (talk) 08:51, 28 December 2008 (UTC)

I added "in 1966" to the proposal above, in response to Dematt's suggestion below. Eubulides (talk) 00:18, 29 December 2008 (UTC)

Good catch. That looks like an improvement of the current content, but of course not an improvement in the real world (now MDs are allowed to associate with unscientific practitioners). -- Fyslee (talk) 16:12, 28 December 2008 (UTC)

We should use the dates for accuracy: In the lead:

In 1966, the American Medical Association called chiropractic an "unscientific cult"

And in the history:

In 1966, the AMA had chiropractic labeled as an "unscientific cult", and, until 1980, held that it was unethical for medical doctors to associate with "unscientific practitioners".

-- Dēmatt (chat) 23:27, 28 December 2008 (UTC)

We don't need to add more dates to the lead. It can be confusing. The history section has the additional, accurate details. QuackGuru (talk) 23:34, 28 December 2008 (UTC)

I support correcting the citations. QuackGuru (talk) 23:41, 28 December 2008 (UTC)

The topic of the "in 1966" phrase also came up just now in Talk:Chiropractic/Mediation #Battle between chiropractic and the AMA, and for the reasons discussed there I agree with QuackGuru that the 1966 date should not be in the lead (as the extra detail might easily confuse inexpert readers into thinking that the war between the AMA and chiropractic began in 1966). However, the 1966 date is clearly useful info for the body, and is not confusing there, so I added it to the proposed wording above. I put it at the end of the phrase so that it's easier to compare it to the adjacent "1980" at the start of the next phrase. Eubulides (talk) 00:18, 29 December 2008 (UTC)

Edit warring and arbitration restrictions

I am confident that everyone here is aware that edit warring is not acceptable practice on Wikipedia. Despite repeated warnings, article protection and special Arbitration restrictions, some editors seem to be unwilling or unable to modify their problematic behavior. In order to avoid this persistent disruption to the article and to editors who are willing to edit collaboratively, from this point there will be no additional warnings issued. Any further actions deemed by an uninvolved administrator to be edit warring will be met with either a block or article ban. Please see later clarifications.

Due to the holidays, I will wait a day or two to ensure everyone has read this notice before unlocking the article. Shell ^babelfish 08:35, 26 December 2008 (UTC)

This is just a method for the POV-pushing group to get their way. I give up on this article, let the cruft stay. This is precisely what is wrong with Wikipedia. The anti-science crowd gets these restrictions placed, which allows them to push their fringe theories. Seriously, I'm not going to waste energy on this cruft-ridden article. Eubilides and Quackguru apparently have more energy and patience than I do. Good luck to them. OrangeMarlin ^{Talk• Contributions} 15:26, 26 December 2008 (UTC)

It would help if the actions that Shell considers disruptive were explicitly pointed out so that we could discuss what about them was "disruptive". I see two edits that markedly improved the article followed by reverts by users who, it has been pointed out for months, have obvious pro-alt-medicine agendas. The typical pattern is that a proposal is made, it is rejected for vague and sometimes truly disingenuous reasons by the pro-alt-med crowd, the others try to discuss around their disruption, the change is imposed, and the pro-alt-med crowd reverts claiming "no consensus". How can we reach consensus when their is such a tacit ignorance of the discussion? We cannot. It is simply not fair that the pro-alt-med group get away with this tactic.

To that end, I do not think it fair when users who are observing the article who are not in the pro-alt-med camp and who are respected Wikipedians who take the time to carefully consider the situation try to undo the actions of the pro-alt-med crowd are lumped together with them. What has happened is that the pro-alt-med crowd have found a loophole: since they can unilaterally "block" consensus on any issue the claim will be constantly made "edit warring happened on both sides". It seems to me that when User:Hughgr reverted, he should have immediately been reverted back and blocked. That was the disruptive action and no administrator took any action against him. He got away with it, so it was only natural that User:Levine2112 would act similarly. We are lacking an effective and swift administrative response to the disruption happening at this article.

Let me propose the following: when someone plans on making an edit, they discuss it first on the talk page. QG did this. The normal means of "consensus" are simply not possible with the tactics employed by the pro-alt-med camp, so we need to take their objections (and object they ALWAYS do) with the appropriate grain of salt. Sometimes they will have valuable input, but because WP:CON has been so abused at this page, they are simply used to disagreeing with every proposal made that is not their own. This sort of obstructionism should be ignored. After a reasonable length of time (and in my view, QG left a reasonable length of time), the edit, if there are no substantive objections, should be in-placed.

If the pro-alt-med crowd really feel strongly that the edit should be reverted, the onus should now be on them to start a discussion of it on the talkpage. A new discussion that is separate from the last discussion that spells out clearly the reasons they want to revert. Then they should be required to find a third opinion: an outside editor not in the pro-alt-med crowd to support them. If it is a truly good reason someone who isn't famous for their support of chiropractic should support it. A similar process of discussion should commence and if consensus is formed, a revert should happen. However, I believe that the person with the third-opinion should be the one reverting: not the pro-alt-med crowd.

If that process is taken seriously then we will find an end to the tired problems on this page. Anyone not following this procedure should be blocked immediately.

That's my proposal.

ScienceApologist (talk) 15:58, 26 December 2008 (UTC)

In reply to ScienceApologist,^{(14:54, 27 December 2008 (UTC))} Your proposal doesn't spell out clearly in what situations it would apply. The controversial template already requests discussion on the talk page before editing. It's normal per BRD for new material to be reverted until there is sufficient discussion. We need to try to find real consensus, but if after a period of time that doesn't succeed, compromise or rough consensus can apply. ☺Coppertwig(talk) 18:17, 26 December 2008 (UTC)

I oppose your approach, Shell. Think of something else that does not put tendentious editors on equal footing with editors who are trying to create quality content. Jehochman ^Talk 18:19, 26 December 2008 (UTC)

If everyone is done telling me what a horrible idea it is to enforce the arbitration restrictions already in place, perhaps we could talk about what this really means. ;) The point of "no more warnings" is to stop the tendentious editors who have already been warned repeatedly yet still hamper both the development of the article and other editors who are working in good faith. Please try to assume that I'm not advocating blocking folks willy-nilly here and that administrators helping out at this page do have some sense.

In regards to points that ScienceApologist made: This is exactly what is meant to stop. The blind reverting is spectacularly unhelpful as is the inability of some editors to put the stick down and back away from the horse. Clearly in this case, sock/meat puppets were used to continue reverting and give appearances of a larger group disputing the change that in reality, received no substantive argument on the talk page. This warning is meant to inform editors using such tactics that if this happens again, their sock/meat puppets will be blocked without further discussion and they will get a break from editing this page.

Coppertwig: There is always a place for BRD, however, that is not what happened here this time, nor any of the other times this article needed to be locked to stop reverting warring. This warning is not a request to throw out common sense and normal editorial processes, but instead strictly about revert warring and the use of sock/meat puppets to assert ownership on article content. Many editors here are using the talk page to discuss changes first because they know their edits will be immediately reverted, sometimes even when talk page discussion already exists.

Jehochman: If I were simply going to block anyone who ever reverted or changed the page, I can understand your concern. As I've said though, I'm not advocating some sort of "zero-tolerance" policy or tossing out judgment and common sense. Perhaps it would have been helpful if I'd been more specific about who I was warning and what would have happened in this situation. In this particular case, Hughgr and the two IP addresses would have received short blocks; Levine would have received a page ban. In essence, I (and I hope other uninvolved administrators) would like to take a harder line against tendentious editing since repeated warnings aren't resolving the problem. Shell ^babelfish 21:38, 26 December 2008 (UTC)

Very good. As long as we understand that all reverts are not equal. If somebody is reverting damage to the encyclopedia, we should help them by applying sanctions to those who caused the damage. If somebody is violating WP:NPOV, WP:NOR, or WP:MEAT by performing reverts, they need to be stopped. We're going to stop the revert wars, but we do not do so blindly. Jehochman ^Talk 21:56, 26 December 2008 (UTC)

I've notice some concern here and at other pages that indicates I was horribly unclear in my first post. I did not intend to suggest I was advocating a revert limit like 1RR or similar. Also, as Coppertwig pointed out, there are legitimate places for reverts in the BRD process. My warning was not intended to place any special restrictions on the article, simply to inform tendentious editors who've receive multiple warnings that continuing to use this article as their personal battleground is not going to be tolerated. Any further appearance of sock/meat puppets to influence discussions or revert the article will result in blocking and page bans. Further revert wars will result in any parties who are damaging the encyclopedia receiving a block. I've struck out my original comment in the hopes that this later discussion is a much better picture of what was actually meant. Shell ^babelfish 22:31, 26 December 2008 (UTC)

I was tempted to comment previously when this all was started by QG, but decided to refrain. Well, I've changed my mind. While I agree with most of his edit and its sourcing, he has been warned time and time again that BRD doesn't work in these types of situations, and generally not on controversial articles, and that consensus must be obtained before making such changes. The tag at the top of this page makes it clear that edits must be discussed here first. There was no consensus, so no matter how "right" his edit, it was wrong to make the edit without obtaining consensus.

I agree with SA that the pro altmed crowd often block consensus, and something needs to be done about it, but starting edit wars by preemptive Bold editing is not the way. When QG anyway made a Bold edit, it was properly Reverted per the BRD cycle, and that should have been the end of it. (I couldn't care less who did it or their motivation, it was the right thing to do!) Anything beyond that was edit warring. Even Eubulides commented (vaguely) on the inappropriateness of the way this was started by QG, and QG needs to be put back in the doghouse. That one week block didn't seem to have the desired effect. He has simply repeated his endless pattern: (1) solo, bold editing; (2) not responding properly to objections, but repeating his agreement with his own edit; (3) repeat cycle again and again to the great irritation of all editors, including those who share his POV. -- Fyslee (talk) 03:02, 27 December 2008 (UTC)

QG's edits are good edits. Whether he followed some vague "process" or not is up for debate. The ridiculous game-playing that substitutes for "discussion" at this page has likely confused some of the long-time editors. He made his case, the edits were by any measure I can see good edits, and the "proper reversion" was not based on any discussion but rather non-discussion. You are ignoring the actions of Hughgr and Levine2112 neither of whom put forth any good arguments as to why those edits needed to be reverted. Faulting QG for going out on a limb with edits that improved the article is backwards indeed: we aren't going to get a better encyclopedia by chastising those who improve it while giving a bye and trying to be chummy with those who are not improving it. ScienceApologist (talk) 03:11, 27 December 2008 (UTC)

SA, you fail to agree with my point because you and QG edit in the same manner, a confrontational manner. That makes editors like myself, who share your POV alot of the time, to stand back and let you battle alone. We can't support your editing style that always gets you in trouble and makes skeptics look bad. There was nothing "vague" about the faulty process QG usually follows. It has been the subject of many long discussions and has caused much disruption here. He discusses (by endless repetition), then makes a bold edit that starts an edit war. He has been blocked for such behavior before and he needs to stop it. (So do you....) -- Fyslee (talk) 03:18, 27 December 2008 (UTC)

He does not discuss by "endless repetition". He makes a point that no one addressed directly. Then when false claims of (non)consensus are made, he imposes the edit as he described it. The "confrontational" manner is due to the fact that he is not paying mind to the disruptive tactics of those who would whitewash (and for a long time did whitewash) the article. The comments about editing "style" would be moot if the group of opposing editors were banned from this article. If this were to happen, you undoubtably would be editing happily alongside QG and myself and we'd have meaningful communications with long, meaningful discussions that would take the place of the feet dragging and bizarre exchanges that tend to revolve around process rather than content on this page. If you want to collaborate with the pro-alt-med editors to see if you can create a better article without the disruptive influence of QG and myself, there are sandboxes where you can attempt your experiment. I would like to see it myself. In fact, I've actually seen such an experiment. We ended up with an article that was quite bad yet superficially good enough to pass FA despite relying on a great deal of terrible sourcing (parapsychology). The best articles we have at Wikipedia on controversial subjects related to pseudoscience were not created out of pandering to the people hoping to accomodate the pseudoscience. I guess I would take more stock in your position if you actually had some evidence to back yourself up. QG has two edits which you yourself support. That's evidence that he is at least pushing this article in the right direction. What evidence do you have that you are doing a better job? Or, if you are truly "stepping back" why are you clamboring for disciplining and punishing the editor who actually improved the article? I'm sorry, I just don't buy this whole "I like the content but not the way the content gets into the article" nonsense. We aren't here to build a community or a social networking feel-good session. We're here to write an encyclopedia. ScienceApologist (talk) 03:29, 27 December 2008 (UTC)

I agree with much of what you say about the problems created by the foot dragging and the administrative pandering to the pro pseudoscience crowd here. It does irritate the heck out of me, but I haven't written the rules here. Because of it, we are having to use a mediation page to get effective editing to actually occur. There we can discuss under the direct supervision of admins who can step in and referee the situation. It shouldn't have to be that way, but until Levine2112 and his kind are topic banned or worse, we'll be stuck having to get all our edits here approved by the American Chiropractic Association, ICA, and WCA before we can make them. It sucks, and I wish the admins would do something about it, but they are hampered by our rules that favor civil POV pushing of fringe POV. Mainstream POV and criticisms of fringe POV have a hard row to hoe here. Those rules need to be tweaked. Right now QG's edits have a chance of success by doing it at the mediation page where disruptive editors (of all persuasions) can get bounced rather quickly. -- Fyslee (talk) 04:03, 27 December 2008 (UTC)

QuackGuru has been known to be a bit abrasive, but I don't think he was in the wrong in this case. It is difficult to edit, improve an article and manage to stay civil when there are editors who actively block that process and refuse to substantially discuss the issues. These repetitive argument tactics that don't address the actual issue at hand have become a serious problem here, so much so that I actually had to step in with a consensus decision on an argument that had been drawn out for months based on the same handful of editors continuing to stall and argue (for example, more than 70% of arguments against the consensus were made by a single editor). As Fyslee pointed out, some sections have moved forward on the mediation but begrudgingly and not without serious difficulty. At the same time, the coincidental appearance of certain editors many of whom appear to be SPAs is also a concern especially when they appear simply to skew consensus or revert changes not supported by a certain group. I would like to see editing return to normal on this article, and since warnings and brief bans haven't helped, I'm seriously considering issuing lengthy article/topic bans for editors who continue to edit tendentiously. Shell ^babelfish 05:00, 27 December 2008 (UTC)

Bingo! You seem to be proposing what should be the case all the time - that BRD should still apply when the edit is right, even when a consensus fails to exist because of footdragging, stalling and stonewalling designed to prevent inclusion of POV some editors don't like. That stonewalling should not be rewarded by recognizing the lack of consensus that is achieved by illegitimate means. When such stonewalling obviously exists, brave admins should cut to the chase and break the deadlock by handing out blocks and subject bans. There have got to be limits to how far civil POV pushing can be used as a tactic to prevent inclusion of good material, or used to ensure the inclusion of improperly presented fringe material.

The next problem is how to apply our policies which punish QG and SA. Admin Guy has repeatedly pointed out that the real and fundamental problem is found in the situations that drive otherwise good editors like QG, but especially SA, to behave in an incivil manner. We need to be able to deal with their opponents quicker and more firmly. NOTE: I am NOT defending their methods or incivility, but only appealing for something to be done before things get that far. The ones who provoke them should be blocked or banned quicker. Other policies need to be enforced quickly, before sanctions against their incivility become relevant. It shouldn't be necessary for good editors to fight so hard to get good edits included. It shouldn't be an uphill battle to include common sense, or to prevent nonsense from being presented as truth. Those who block their editing should be dealt with before things get that far. A long time ago I wrote my POV on NPOV and some other thoughts that may apply:

1. The best articles are produced through the collaborative efforts of editors who hold opposing POV, who truly understand the NPOV policy, and who either "write for the enemy" themselves, or who at least don't suppress it. As regards other's POV, they are inclusionists, rather than deletionists who exercise POV suppressionism. Collaborative editors work in a "checks and balances" relationship. This ensures that all significant POV are presented without being promoted. What could be more Wikipedian than that? It's fantastic when it works, but such a relationship is rare on controversial subjects.
2. Wikipedia's NPOV policy must not be misused so it becomes synonymous with revisionism, censorship, whitewashing, or political correctness. Editors must actively enable the presentation of all significant sides of any controversy without violating the Undue weight aspects to promote fringe POV. To leave out one side amounts to promoting the other side's POV. Wikipedia should include more information than other encyclopedias, not less.
3. Consensus can sometimes be used to violate NPOV policy, especially on controversial subjects. Instead of following Wikipedia's method of describing points of view, the use of Coup d'état methods is often encountered here. Such a consensus is often made by a group of editors who attempt to deal with a conflict situation by quickly gathering a majority of editors supporting their POV or by using even a minority of editors to block other POV, and who then use their far-from-neutral "consensus majority" or "lack of consensus" to suppress opposing POV, thus allowing them to slant the direction of an article's contents toward support for their fringe POV, or to prevent their fringe POV from being criticized and exposed as being fringe.

What we have been seeing is an editor ("arguments against the consensus were made by a single editor") who claims to be a scientific skeptic, but who in every way behaves like a protector of fringe POV, and who uses every civil stonewalling tactic imaginable to block the inclusion of POV he doesn't like, IOW he's an exclusionist and deletionist. He has recently been blocked from the chiropractic article for a short time, and it looks like it's time to consider maybe doing it again if things don't change. Without his influence, maybe others who have supported him would begin to respect our policies more. He's not the only "ringleader", but he's a major one. Others can be dealt with if they decide to "step up to the plate" in his absence. What we need here is a return of User:Dematt, an editor who could bring strong chiropractic POV to the article, and still allow other POV to be presented. He didn't block progress. -- Fyslee (talk) 08:13, 27 December 2008 (UTC)

archived unrelated discussion.
The following discussion has been closed. Please do not modify it.
A lot of bluster, but no evidence, Fyslee. I'm totally opposed to almost all of what you say due to what I see happening on various articles. For example, intelligent design is a much better article than this article due to the exclusionism and deletionism practiced there, which, I remind you, are not anathema to Wikipedia and are perfectly legitimate philosophies. You have ignored the most important aspects of NPOV, namely WP:WEIGHT and WP:FRINGE (not to mention WP:MAINSTREAM). ScienceApologist (talk) 21:15, 27 December 2008 (UTC) ??? I just defended you and then you attack me? Hmmm... The "single editor" mentioned above is obviously not you. A look through the history will reveal whom Shell was referring to. The whole thing has been caused mostly by one editor, who has held this article hostage by civil stonewalling tactics. -- Fyslee (talk) 16:25, 28 December 2008 (UTC) I take very strong objections to you attacking the "single editor". I think your celebrating his blocking on other user's page is beyond the pale. ScienceApologist (talk) 19:45, 28 December 2008 (UTC) Wrong editor. This is just baiting on your part and has nothing to do with improving article content. You're sore that I don't agree with you so you pull out something so you can attack me. You are pathetic. -- Fyslee (talk) 23:47, 28 December 2008 (UTC) We should celebrate? QuackGuru (talk) 19:57, 28 December 2008 (UTC) And piling on with diffs that don't apply? Baiting is the word for this. -- Fyslee (talk) 23:47, 28 December 2008 (UTC) I'm really beginning to wonder if at least one of you is a reincarnation of a banned editor, most likely User:KrishnaVindaloo. Same MO, editing style, and use of pointy attacks and reversals as a method of revenge. What's a "pointy reversal"? It's when a user reverses their editing style as a revenge against editors who hold the same POV but don't agree with them. They then start making the same types of edits they previously opposed. QG is known to do this, and KrishnaVindaloo did too. It's a serious type of WP:POINT violation because of its disruptive effect. Since their comments and attacks here are just baiting and aren't designed to lead to anything constructive, I'm bowing out. -- Fyslee (talk) 23:47, 28 December 2008 (UTC) Or maybe you are trying to create a distraction away from your behaviour. QuackGuru (talk) 23:58, 28 December 2008 (UTC)

I apologize for not being clear, Shell. I wasn't criticizing your approach. I haven't had time to look at recent edits yet, and I trust your handling of this situation. My response was to ScienceApologist's proposal.

In reply to Jehochman: Rules such as Shell is enforcing naturally impact those who tend to break such rules more than those who abide by them, so I don't understand your objection. Part of your comment seems to me to be pressuring Shell to make decisions about article content; but Shell is acting as an uninvolved admin here. Shell has been doing good work here and doesn't deserve a lot of criticism. ☺Coppertwig(talk) 14:54, 27 December 2008 (UTC)

Note for admins: An editor has intentially ignored discussing article content with me and has left a reminder on his user page to continue ignoring me. QuackGuru (talk) 23:12, 28 December 2008 (UTC)

Where did the editor learn this bahaviour from. I think from another editor. QuackGuru (talk) 23:18, 28 December 2008 (UTC)

And what does your running to mommy have to do with improving article content? When other editors don't respect you, do something positive for once to get their respect. -- Fyslee (talk) 23:28, 28 December 2008 (UTC)

The best respect is improving the article in accordance with Wikipedia's policies. QuackGuru (talk) 23:58, 28 December 2008 (UTC)

Ok, obviously this has gotten a bit off topic, but there's a few things I think need to be addressed.

QuackGuru, if editors ask you to stay off their talk pages, please respect that. So long as they are communicating here, there's no need to take discussion directly to their talk - if they are not participating here and need to be, let someone uninvolved handle it. I will try to keep a closer eye on discussions and comment if the points are being ignored or circular discussion starts, but feel free to leave me a note if you feel there's a problem in a current discussion.

Fyslee, your comments are starting to border on attacks; your recent celebrating of another editor's block wasn't good form. Lets see if we can get back to working on article content.

And folks, you are welcome to ping me any time you feel something needs looked at. I can't promise I'll always agree with your assessment, but I will give things a fair look and hopefully we can stop issues before they get out of control. Remember, the end goal here is to eventually reach a point where the article doesn't require special administrator attention. And trust me, if I feel someone is blowing things out of proportion, has turned into a tattle-tale or is causing their own problems, I'm going to tell them.

I'm going to try unprotecting the article now, so lets please remember to solve our problems without an edit war. Shell ^babelfish 10:12, 29 December 2008 (UTC)

URL to Skeptical Inquirer

This change, which added |url=http://www.csicop.org/si/index/c.html to the Skeptical Inquirer citation, is not right. The url= parameter is supposed to point to the full free text of a source, but http://www.csicop.org/si/index/c.html merely points to an index that provides zero additional information to the reader. Eubulides (talk) 07:50, 31 December 2008 (UTC)

Can we remove the literature synthesis?

I would like to remove "a 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration". This literature synthesis was done by chiropractors and it appears to give a more rosy conclusion than the independent reviews. We should remove this and just leave the independent reviews. Any objections? --sciencewatcher (talk) 16:04, 29 December 2008 (UTC)

Lawrence et al. 2008 (PMID 19028250) does give a rosier conclusion, and almost all its authors are chiropractors (11 DCs vs. 1 MD), but we can't eliminate it simply on those grounds. It's a recent high-quality review published in a peer-reviewed journal and easily meets the Wikipedia guidelines (WP:RS and WP:MEDRS) for secondary sources. The methodology and process used to develop that literature synthesis are discussed in companion articles, Triano 2008 (PMID 19028248) and Globe et al. 2008 (PMID 19028249), and these appear quite sound. The low back pain bullet of Chiropractic #Effectiveness currently cites 5 reviews on effectiveness, of which 2 are primarily by chiropractors and 3 are primarily by non-chiropractors; this does not on its face appear to give undue weight to chiropractic opinion. Eubulides (talk) 19:13, 29 December 2008 (UTC)

The source seems reliable but when I took a closer look at the literature synthesis source, the source itself cites chiropractors as the writers of the source. QuackGuru (talk) 19:28, 29 December 2008 (UTC)

I don't see anything wrong per se with Chiropractic citing a reliable source written mostly by chiropractors, any more than I see anything wrong per se with Fluoride therapy citing Ismail & Hasson 2008 (PMID 18978383), a systematic review written by dentists and commissioned by the American Dental Association. Eubulides (talk) 19:57, 29 December 2008 (UTC)

Where in guidelines (WP:RS and WP:MEDRS) does it discuss this type of situation when a source is written mosty by industry insiders is okay or not okay. We may not have specific policy that covers this. But for this article we have plenty of other sources available that are independent and more reliable. QuackGuru (talk) 20:42, 29 December 2008 (UTC)

I agree that WP:RS and WP:MEDRS do not address this specific situation, but the default is to allow reliable sources unless there's a good reason to reject them. I agree that the non-chiropractic sources are more independent, but it's not clear that they are so much more reliable than Lawrence et al. 2008 (PMID 19028250) that we should be excluding Lawrence et al. I don't know of any reliable source questioning the methodology or results of Lawrence et al. (admittedly it is a new source). Also, Lawrence et al. do not disagree so sharply with the conclusions of other reliable reviews. Eubulides (talk) 22:46, 29 December 2008 (UTC)

If you look at the Fluoride therapy article, you'll see that there are no other, conflicting studies/reviews. But in this case we have multiple, disagreeing reviews for chiropractic effectiveness for low back pain. Clearly if you look at the same studies you should come to the same conclusions about effectiveness. So how come the chiropractors seem to have come to a different conclusion to the Cochrane reviewers? Did things change that much in the 2 or 3 years between the reviews? I've looked through both the Cochrane review and the literature synthesis, and it's not immediately apparent why/how they came to different conclusions. One possibility is that the Cochrane review was just more rigorous - they re-analyzed the data in all of the included studies, whereas the literature synthesis only did this if they deemed the quality to be poor. Also, the literature synthesis based their conclusions on a Brontfort review from 2002, but the reference appears to be missing in the pdf and I can't find it anywhere on pubmed. --sciencewatcher (talk) 21:36, 29 December 2008 (UTC)

• That "Bronfort review from 2002" was published as Bronfort et al. 2004 (PMID 15125860). I expect the "2002" refers to a prepublication draft.
• how come the chiropractors seem to have come to a different conclusion to the Cochrane reviewers? As it happens, that question too also has been asked in the scholarly literature! See Canter & Ernst 2004 (PMID 15989112). And, as you might expect, you get different answers depending on who you talk to. Ernst & Canter 2006 summarize their position with:

"Our previous work has shown that the conclusions of reviews of SM for back pain appear to be influenced by authorship and methodological quality such that authorship by osteopaths or chiropractors and low methodological quality are associated with a positive conclusion. It is perhaps relevant to note that all three of the overtly positive recommendations for SM in the indications back pain, neck pain and headache originate from the same chiropractor." (The chiropractor in question is Bronfort.)

Ernst makes a similar summary (albeit without mentioning the "same chiropractor" in Ernst 2008 (PMID 18280103. Bronfort et al. 2008 (PMID 18164469) summarize their reply as follows:

"Ernst goes further to conclude that bias exists in systematic reviews performed by chiropractors, particularly members of our group. We refuted this assertion (Bronfort et al. 2006), and have attempted to be as transparent as possible in our methodology, which details a priori defined standard and acceptable methods for conducting systematic reviews (Oxman et al. 1994, PMID 7933399; Kaptchuk 2003, PMID 12829562)."

It might make sense to cover this dispute in Chiropractic, but we'd need to present both sides fairly.

Eubulides (talk) 22:46, 29 December 2008 (UTC)

Probably most authors of these studies are either chiropractors, or medical doctors, or closely connected to one or the other. Either could be biassed one way or the other. It would be better to present both sets of results and let the reader decide. ☺Coppertwig(talk) 01:26, 30 December 2008 (UTC)

As far as I am aware, the Cochrane studies are completely independent, and are not done by chiropractors. They should be the least biased of any review. But no matter how much methodology you use, a review can still be subjective. For example, the literature synthesis decided to use the Bronfort review as their base, which gave it a more positive conclusion than if they had based it on the Cochrane review. At the very least we should probably note in the article that the literature synthesis was "by chiropractors". --sciencewatcher (talk) 15:41, 30 December 2008 (UTC)

We can't simply add the phrase "by chiropractors", as the literature synthesis in question (Lawrence et al. 2008, PMID 19028250) was done by 11 chiropractors and 1 MD. The phrase would have to be something like "almost all by chiropractors". And, since (as QuackGuru notes below) we refer to the literature synthesis twice, we'd have to add the "almost all by chiropractors" twice. And then, to be "fair", when we refer to reviews that are done by medical doctors, or mostly by medical doctors, etc., we'd have to add phrases like "mostly by medical doctors" every time we cite a review. That way lies madness. Let's leave it alone. The review in question is high-quality, and is a reliable source by any reasonable standard. It may be slightly biased, but the reviews on the other side may be slightly biased too, and Wikipedia is not the place to ajudicate disputes like this. The reviews are cited and any reader who wants to find out the professional affiliations of the reviewers can easily do so. Eubulides (talk) 19:22, 30 December 2008 (UTC)

A 2008 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg.

The reference done by chiropractors is favorable to sciatica and radicular pain in the leg treatments. This may be WP:UNDUE weight to have a reference written by chiropractors to have such prominence. QuackGuru (talk) 18:47, 30 December 2008 (UTC)

I suggest that this matter be brought up whenever we get around to mediating the bullet for "Other" in Chiropractic #Effectiveness. Given that we've removed reviews of non-SM treatment modalities for low back pain, we might be inclined to remove this review as well, since it's not about SM. Eubulides (talk) 19:22, 30 December 2008 (UTC)

I brought the issue up at Talk:Chiropractic/Mediation#Effectiveness mediation. QuackGuru (talk) 20:33, 30 December 2008 (UTC)

Lawrence is a reliable source and a review of literature to boot. . . passes the sniff test for sources used in this article.TheDoctorIsIn (talk) 01:10, 2 January 2009 (UTC)

Consistency v. accuracy

This edit rounded the number off for consistency but is it accurate. QuackGuru (talk) 18:22, 2 January 2009 (UTC)

It is indeed less accurate to replace "6,526" with "6,500" to match the precision of the other numbers. However, it is more consistent and more in line with what traditional encyclopedias would do. I don't have a strong feeling either way, but very mildly prefer consistency here. Eubulides (talk) 19:01, 2 January 2009 (UTC)

"by Joseph C. Keating, Jr."

This edit inserted the text "by Joseph C. Keating, Jr. et. al." into the phrase saying that chiropractic "was hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine". The edit's change log said "facts about opinions -- NPOVify by attributing statement". However, this particular phrase is not merely an opinion held by Keating and his coauthors in that paper: it is the opinion held by every reliable mainstream source we've found on the topic, including the leading textbook on chiropractic (written by chiropractors). In such cases an in-text attribution like this causes far more problem than it cures, as it suggests to a naive reader that there is some controversy over the claim in question, where in fact there is none among reliable sources. WP:NPOV does not require in-text attributions when summarizing mainstream opinion that is not contested by reliable sources.

The current wording was arrived at after extensive discussion in Talk:Chiropractic/Archive 25 #Inserting "Keating says", Talk:Chiropractic/Archive 25 #Reliable sources, Talk:Chiropractic/Archive 25 #Antiscientific three times, Talk:Chiropractic/Archive 26 #Antiscientific: suggested wording of sentence, and no doubt other threads. For editors unaware of the long history behind that text, I suggest taking a look at these threads to save us all some time in the future. In the mean time I reverted the edit.

Eubulides (talk) 00:07, 5 January 2009 (UTC)

Hi Eubulides -- are you familiar with the section of NPOV called WP:PSCI? Just as there are particular policies to follow with BLP's, there are particular policies with regard to purported pseudosciences. Please read that section and compare "generally considered pseudoscience" with "questionable science", and then share your opinion (backed up by RS's, of course) as to which category chiropractic falls into. We do have notable commentators saying it is pseudo, but unless we have RS's showing that chiro is generally considered pseudo by the sci community, we cannot categorize or characterize it as pseudo. Which means, among other things: don't put it in category:pseudoscience; and do use inline attribution. That is a higher bar than your noting that "every reliable mainstream source we've found on the topic" seems to agree with Keating, but that is the policy we are obliged to work with. regards, Backin72 (n.b.) 04:26, 5 January 2009 (UTC)

While I don't think that the statement given necessarily characterizes chiropractic as a pseudoscience, I think it is important to note that the given Keating source is speaking from a historical context. As such, perhaps a good compromise here would be a simple change in verb tense:

Serious research to test chiropractic theories did not begin until the 1970s, and was hampered by what were characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine.

I think this gives fair credence to the historical nature of the source and lets the reader know that chiropractic is not currently a "generally considered pseudoscience". -- Levine2112 ^discuss 04:41, 5 January 2009 (UTC)

The source has not been contradicted by independent reliable sources since then. Therefore, I think it works well for what QG proposes. ScienceApologist (talk) 05:04, 5 January 2009 (UTC)

Which is... not characterizing chiropractic as pseudoscience? Is that what you're all saying? --Backin72 (n.b.) 05:13, 5 January 2009 (UTC)

When you read the archives, I made previous proposals in accordance with WP:ASF. No serious disagreement exists among the sources presented in the article. Therefore, we can assert it without attribution. QuackGuru (talk) 05:21, 5 January 2009 (UTC)

• The ideas in question are still active, and are actively defended by fringe chiropractors, and are still characterized as being antiscientific etc. (See the quote from Phillips below.) So we shouldn't change the "are" to a "were".
• Chiropractic as a whole is neither in the "generally considered pseudoscience" nor the "questionable science" categories of WP:PSCI. It has some elements of the former, and some of the latter. It even has some elements of the "alternative theoretical formulations" category of WP:PSCI. It would be a mistake for Chiropractic to claim that chiropractic is any of these three categories. Fortunately for us, Chiropractic does not make any such claim.
• A significant minority of chiropractors, the so-called "straights", adhere to ideas like innate intelligence and its relation to subluxation that are generally considered antiscientific (or pseudoscientific or antiintellectual or whatever-you-want-to-call it). There is no dispute about this among reliable sources.
• I don't blame Backin72 for not wanting to slog through the abovementioned discussions to find these sources, so I have dredged some of them here:

• "The segment of the profession that continues to hold firmly to Palmer's Postulates do so only through a suspension of disbelief. Given that one of the philosophical pillars of science is skepticism, a suspension of disbelief or a lack of skepticism, is evidence of antiscientific thinking. These stratagems to avoid the truth that Palmer's Postulates are unproven might be beneficial to the chiropractor, but are ethically suspect when they allow the practitioner to maintain a 'faith, confidence and belief' in that paradigm to the patient's ultimate detriment." —Nelson et al. 2005 (PMID 16000175).
• "This protective shield apparently prompted a segment of the profession to extend its comfort zone by adopting not only an antimedicine but an antiscientific stand.... Although this antiintellectual position persists in a small percentage of chiropractors in this twenty-first century, the profession never developed a broad-based consensus around Stephenson's 33 principles." —Reed B. Phillips, page 72 of the latest edition of Principles and Practice of Chiropractic (2005), ISBN 0-07-137534-1. This is the leading textbook on chiropractic.
• "Lastly, the ACC claims that chiropractors use the 'best available rational and empirical evidence' to detect and correct subluxations. This strikes us as pseudoscience, since the ACC does not offer any evidence for the assertions they make, and since the sum of all the evidence that we are aware of does not permit a conclusion about the clinical meaningfulness of subluxation." —Keating et al. 2005 (PMID 16092955)
• "Finally, alternative care often seems to shelter an antiscience attitude. For instance, women with breast cancer who believe that cancer spreads by air and that chiropractic care is an effective anticancer therapy often present at a late stage, which is associated with great suffering, short survival, and staggering cost of care." —Tanvetyanon 2005 (PMID 15956016)

• Other sources are available, but I hope this is enough.

Eubulides (talk) 05:45, 5 January 2009 (UTC)

Especially after reading the Keating source there is a problem with the tense when the pseudoscience ideas have continued. QuackGuru (talk) 05:49, 5 January 2009 (UTC)

Thanks Eubulides; I did actually go back and read those diffs, but good to have them here. Do you have a response directly addressing my comment above? Again, discussing WP:PSCI, which is a particular policy that is to pseudoscience as WP:BLP is to living people: "We do have notable commentators saying it is pseudo, but unless we have RS's showing that chiro is generally considered pseudo by the sci community, we cannot categorize or characterize it as pseudo. Which means, among other things: don't put it in category:pseudoscience; and do use inline attribution. That is a higher bar than your noting that "every reliable mainstream source we've found on the topic" seems to agree with Keating, but that is the policy we are obliged to work with." regards, Backin72 (n.b.) 22:40, 5 January 2009 (UTC)

Backin72, do you have a response to my previous comment. When you read the archives, I made previous proposals in accordance with WP:ASF. No serious disagreement exists among the sources presented in the article. Therefore, we can assert it without attribution. QuackGuru (talk) 22:48, 5 January 2009 (UTC)

Yes, ASF says inline citations generally should be used unless the information is an established "fact" on the level of "the HIV virus causes AIDS". I don't see that level of certainty with regard to Keating's ideas. And anyway, WP:PSCI specifically applies to alleged pseudosciences, as I mentioned above. I'm retiring from WP, though, so whatever. Others will carry on fighting the pointless good fight. --Backin72 (n.b.) 23:57, 5 January 2009 (UTC)

"Do you have a response directly addressing my comment above?" Sorry, I thought I had addressed that comment; what did I miss? Again, it is not necessary to find a reliable source "showing that chiro is generally considered pseudo by the sci community", because Chiropractic does not say chiro is pseudoscience, nor does it place chiro in category:pseudoscience. That being said, I don't see where WP:PSCI says or implies that "unless we have RS's showing that chiro is generally considered pseudo by the sci community, we cannot categorize or characterize it as pseudo". All that WP:PSCI says is that theories that "are generally considered pseudoscience by the scientific community may properly contain that information and may be categorized as pseudoscience". Eubulides (talk) 00:46, 6 January 2009 (UTC)

According to Backin72: "WP:PSCI specifically applies to alleged pseudosciences, as I mentioned above." This is not alleged and the sources are not under dispute.

According to WP:ASF: By value or opinion,[2] on the other hand, we mean "a matter which is subject to dispute." Please show that this matter is under dispute or there is no dispute. When there is no serious dispute, we can assert opinions as facts. QuackGuru (talk) 02:05, 6 January 2009 (UTC)

Correct tense according to source

According to the source: A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas (Keating 1997b) which have sustained the profession throughout a century of intense struggle with political medicine. According to the source the antiscientific and pseudo-scientific ideas are a continuing barrier. Per the source, we need to get the tense corrected. QuackGuru (talk) 18:15, 5 January 2009 (UTC)

I made this change to fix the tense. QuackGuru (talk) 18:21, 5 January 2009 (UTC)

Chiropractic entry

There is discussion at a list for a chiropractic entry. See Talk:List of pseudosciences and pseudoscientific concepts#Proposed text for Chiropractic entry. QuackGuru (talk) 06:38, 7 January 2009 (UTC)

Chiropractics/Chiropracty?

Is there a reason why this article is "Chiropractic" (an adjective) instead of "Chiropractics" (compare robotic with robotics) or "Chiropracty"? I don't have much knowledge of the field, but "Chiropractic" looks wrong.--Marcus Brute (talk) 20:50, 18 January 2009 (UTC)

The field is normally called "Chiropractic". Please see any of the citations in Chiropractic #References. Eubulides (talk) 23:46, 18 January 2009 (UTC)

Merge

There is a discussion about whether the information from Doctor of Chiropractic might be best merged into either the Chiropractic article or Chiropractic education (or not at all). I personally have no preference, but anyone who has an opinion is encouraged to participate in the discussion at Talk:Doctor of Chiropractic#Background to chiropractic section. --Elonka 22:55, 22 January 2009 (UTC)

Differences from Osteopathy?

I think this article (and Osteopathy) would benefit from a short section describing how they are different from each other. I am certainly not qualified to write it - any takers? – ukexpat (talk) 21:15, 21 January 2009 (UTC)

It's an interesting comparison for sure. Are there reliable sources making such a comparison? (I'm sure there are). We should first compile a list of such sources and then see what we have in terms of usable content. Perhaps it will only warrant one line. Perhaps it will warrant a whole section. Perhaps it may even warrant it's own article! -- Levine2112 ^discuss 21:36, 21 January 2009 (UTC)

• To address this issue I propose changing the 1st sentence of the last paragraph of Chiropractic #Scope of practice from this:

Spine care is offered by several other professions, including massage therapists, osteopaths, and physical therapists.

to this, inserting a paragraph break after the replacement:

Chiropractic overlaps with several other manual-therapy professions, including massage therapy, osteopathy, and physical therapy. Chiropractic is autonomous and competitive with mainstream medicine and osteopathy outside the U.S. remains primarily a manual medical system; physical therapists work alongside and cooperate with mainstream medicine, and osteopathic medicine in the U.S. has merged with the medical profession. Members distinguish these competing professions with rhetorical strategies that include claims that, compared to other professions, chiropractors heavily emphasize spinal manipulation, tend to use firmer manipulative techniques, and promote maintenance care; that osteopaths use a wider variety of treatment procedures; and that physical therapists emphasize machinery and exercise.

• I also propose replacing the following phrase, which begins the 3rd sentence of Chiropractic #History:

Although initially keeping the theory a family secret, in 1898 he began teaching it

with the following text:

Chiropractic competed with its predecessor osteopathy, another medical system based on magnetic healing and founded by a charismatic midwesterner in opposition to conventional medicine; however, where osteopathic postulated improved blood flow via manipulation, chiropractic postulated improved neural transmissions. Although initially keeping chiropractic a family secret, in 1898 Palmer began teaching it

• This diff in my sandbox shows what the above change would look like when applied to Chiropractic.

Eubulides (talk) 06:15, 22 January 2009 (UTC)

No further comment, so I made the change. Eubulides (talk) 06:58, 29 January 2009 (UTC)

Manipulation of bones

This edit inserted the sentence "The main treatment involves the manipulation of bones." immediately after the lead sentence. That's not quite right, since it's the manipulation of the spine, other joints, and soft tissue; but the edit is helpful in pointing out the fact that the main treatment modality of chiropractic is not mentioned until the 3rd sentence, which is somewhat late. I made this edit to replace the new sentence with a more-accurate description, moved up from what used to be the 3rd sentence, and reworded a bit to not use such fancy and hard-to-understand words. Eubulides (talk) 06:58, 29 January 2009 (UTC)

Better source for lead's claim about treatment

Currently, this sentence in the lead:

"The main treatment involves manual therapy including manipulation of the spine, other joints, and soft tissue; treatment also includes exercises and health and lifestyle counseling."

is supported by this citation:

• "Standards for Doctor of Chiropractic programs and requirements for institutional status" (PDF). The Council on Chiropractic Education. 2007. Retrieved 2008-02-14.

But this citation is about regulatory standards for DC programs and programs; it's not about chiropractic practice. It's not immediately clear how this citation supports the claim. Instead, let's change the citation to:

• Mootz RD, Shekelle PG (1997). "Content of practice". In Cherkin DC, Mootz RD (eds.) (ed.). Chiropractic in the United States: Training, Practice, and Research. Rockville, MD: Agency for Health Care Policy and Research. pp. 67–91. OCLC 39856366. {{cite book}}: |access-date= requires |url= (help); |editor= has generic name (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help) AHCPR Pub No. 98-N002.

The proposed citation is already used in Chiropractic #Scope of practice to support an extended version of the lead's claim, and it directly supports the lead's claim. Eubulides (talk) 22:35, 31 January 2009 (UTC)

Explanation of TS's revert of edits by 76.105.171.107

I've reverted a set of 11 consecutive undiscussed edits by 76.105.171.107 on the grounds that, in their current form at least, they appear to be against our Neutral point of view policy. This doesn't mean there may not be good material in there, but it's bound up by stuff like describing vaccination as "likely autism-causing". --TS 12:08, 31 January 2009 (UTC)

How could this happen? I thought the article was protected from IP edits. Please make that protection work. -- Fyslee (talk) 16:15, 31 January 2009 (UTC)

The edit wasn't vandalism so there's no need for protection. According to the log there was full protection due to an edit war twice recently, in November and December. --TS 17:24, 31 January 2009 (UTC)

WP:SEMI says that semi-protection is also appropriate for heavy and persistent violations of WP:NPOV and other content policies. The recent IP edits certainly had serious NPOV problems. I assume semi-protection wasn't appropriate because that sort of IP edit has not been persistent recently. Eubulides (talk) 22:35, 31 January 2009 (UTC)

Oh, things have changed, then. I must say I hadn't realised that the protection policy now applied semiprotection beyond persistently vandalized pages. --TS 09:12, 1 February 2009 (UTC)

Does Chiropractic ‘Add Years to Life’?

Interesting research on a common claim/cliche:

• Does Chiropractic ‘Add Years to Life’?

-- Fyslee (talk) 07:07, 2 February 2009 (UTC)

Move protection

A recent edit pointed out that Chiropractic had indefinite pp-move-vandalism protection, but when full protection got enabled and then disabled, apparently the move protection went away. Can the move protection please be restored indefinitely? It seems appropriate. I'd ask this on the request-protection page normally, but this article is a special case in many respects.... Eubulides (talk) 21:25, 4 February 2009 (UTC)

Done; see my user talk page for details. — {{Nihiltres|talk|log}} 12:40, 5 February 2009 (UTC)

Pseudoscience and quackery

This edit inserted the claim that chiropractic is a "pseudoscientific alternative health care profession", added a See also section wikilinking to List of pseudosciences and pseudoscientific concepts and to Quackery, and added [[Category:Pseudoscience]]. However, the only cited source (PDF) does not directly support the newly inserted text: it mentions neither pseudoscience nor quackery. I've therefore taken the liberty of reverting the change. The top of this talk page says "Please discuss substantial changes here before making them", which is good advice for controversial changes like these. Eubulides (talk) 23:08, 30 January 2009 (UTC)

Chiropractic fills all the criteria of the definition of "pseudoscience". It A) does not adhere to the scientific method, B) lacks supporting evidence or plausibility and C) otherwise lacks scientific status. It is thus an unproven medical practise, i.e. quackery. Currently the article does not state this fact clearly enough. Mvaldemar (talk) 23:20, 30 January 2009 (UTC)

The article undoubtedly has problems with not stating things clearly enough, but the edit in question added controversial claims without citing reliable sources that directly support the claims, which ran afoul of the Wikipedia policy on verifiability. Please see WP:MEDRS for the sort of sources that would be appropriate for claims about medical facts and figures, and WP:RS for a guideline about reliable sources in general. I suggest drafting on this talk page the proposed wording for a change to clarify the article, and that the proposal contain relevant citations to reliable sources. You can use the existing sources in the article too, of course. Eubulides (talk) 23:38, 30 January 2009 (UTC)

Perhaps say that some people believe it is pseudoscience, along with links to more reliable sources (e.g. quackwatch). Also, Chiropractic is listed in the pseudoscience category and the list of pseudoscientific concepts, so we should probably be linking to those. --sciencewatcher (talk) 23:35, 30 January 2009 (UTC)

Would "Chiropractic is an alternative health care profession, considered by some medical professionals as pseudoscience, that emphasizes..." be an acceptable wording? With proper sources, of course. Mvaldemar (talk) 23:58, 30 January 2009 (UTC)

That's better (assuming we get proper sources) but I'm afraid it still needs work. The phrase "considered by some medical professionals" is weak and WP:WEASELly and causes the sentence to convey little useful information. For example, the sentence "Chelation therapy is considered by some medical professionals as a valuable treatment for autism" is a true statement, but it doesn't at all mean that chelation is a valuable treatment for autism; which means that the statement, though true, is too weak to be useful. Here's another example: the statement "Chiropractic is an alternative health care profession, considered by some medical professionals as the most effective way to treat musculoskeletal disorders and other diseases,..." is just as true (and just as weaselly) as the proposed one. We need to do better than that here. Eubulides (talk) 00:12, 31 January 2009 (UTC)

I will change the wording to "scientifically controversial alternative health care profession". The controversy is already adequately detailed in the article. Mvaldemar (talk) 00:43, 31 January 2009 (UTC)

Still weaselly.TheDoctorIsIn (talk) 01:21, 31 January 2009 (UTC)

What's the issue? There is controversy (the article clearly states this) and chiropractic is an alternative medical system. There's nothing "weaselly" about stating this upfront. Mvaldemar (talk) 01:35, 31 January 2009 (UTC)

Mvaldemar, just a bit of advice. I'm sure your edits are well-intentioned, and many would agree with the basic idea, but, as mentioned by Eubulides, the guidelines for this page (and really for all controversial subjects at Wikipedia) are good ones: "Please discuss substantial changes here before making them." Let's work this out here, and when we have a consensus version, WE (not just one editor) can decide to include the approved version. Until then, please don't edit war. I'll remove it and restore the existing version. I'll make some suggestions soon. -- Fyslee (talk) 01:55, 31 January 2009 (UTC)

Even before working out an acceptable version, I think we could include the word "controversial" at the very beginning: "Chiropractic is a controversial health care profession..." We've had that in the past, and it might make the article more realistic. If there is anything that characterizes the profession, it is that one word. No other profession has such a controversial history - past, present and future - both within and without the profession. No profession has such internal battles and history of factionism. The degree of controversy on these pages and archives are a small reflection of the very real controversies surrounding chiropractic in the real world. Can we start by agreeing on including that one word as the fourth word in the lead? This is one word in the lead sentence, and then we can work out a more complete version that can be included further down in the lead. -- Fyslee (talk) 02:14, 31 January 2009 (UTC)

"health care profession" should be either removed or the word "alternative" should be added to the beginning. Many countries do not consider chiropractic to be a legitimate medical profession. The articles on acupuncture and homeopathy do not use the term. "controversial health care system" would be acceptable. Mvaldemar (talk) 02:37, 31 January 2009 (UTC)

Yes, let's at least add the word controversial. Here in Canada chiro is mainstream, and considered a legitimate health care system, as it is in some other countries. But it is also clearly based mostly on pseudoscience, and therein lies the problem. According to WP:NPOV we have to mainly represent the majority scientific view, which (I believe) is that chiro is somewhere between "generally considered pseudoscience" and "questionable science". But at the moment the article is too far towards the "questionable science" and has excessive weight towards the viewpoint that chiro is valid. --sciencewatcher (talk) 03:55, 31 January 2009 (UTC)

Controversial at the very beginning

• "I think we could include the word "controversial" at the very beginning:" I'm afraid that reliable sources don't seem to do that. Ernst 2008 (PMID 18280103) has a helpful table (Table 1, p. 2) of definitions of chiropractic taken from other reliable sources. None of the definitions of chiropractic use the word controversial or anything like controversial. If this is what reliable sources do, then we should too. The other sources define chiropractic as lots of things: a "system of healthcare", a "manual form of outpatient treatment", a "therapeutic system", a "system of healing", a "medical profession", a "health profession", a "profession", a "branch of the healing arts", a "health care profession", and a "form of health care". The last phrase is quoted from NCCAM's web page accessed in 2006, and is the term Ernst himself uses in his definition of chiropractic; in the mean time NCCAM has changed its web page, which now says that chiropractic is a "health care approach".
• That being said, it is certainly true that chiropractic is controversial, and that reliable sources say that it is controversial, and this should be mentioned in the lead.
• "'health care profession' should be either removed or the word 'alternative' should be added to the beginning." As can be seen from the first bullet, the terms used to describe chiropractic vary among reliable sources. "Health care profession" is one such term; for this term, Ernst cites Hadler 2000 (PMID 10680197) and we cite Nelson et al. 2005 (PMID 16000175) and I'm sure other reliable sources could be found. So "health care profession" is certainly well-supported. However, it would be also be fine to substitute the NCCAM terminology (either "form of health care", or "health care approach") for "health care profession". Since chiropractic is a profession in some countries, but not others (where it is not licensed), using the word "approach" rather than "profession" does provide more of a global view, which is one of Wikipedia's goals.
• As for alternative, it is controversial whether chiropractic is alternative medicine. Please see Redwood et al. 2008 (PMID 18435599). This point is briefly covered in the lead paragraph and is discussed further in Chiropractic #Scope of practice. Given this controversy about whether chiropractic is CAM, I'm a bit leery of a bald claim in the lead sentence that chiropractic is CAM. Doesn't the last sentence of the (current) lead paragraph already cover the point adequately?
• Also please see #Better source for lead's claim about treatment for a comment about one of the lead's citations.
• With all the above in mind, I suggest changing the lead paragraph to be the following:

Chiropractic is a health care approach and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system. It is generally considered to be complementary and alternative medicine, a characterization many chiropractors reject. The main treatment involves manual therapy including manipulation of the spine, other joints, and soft tissue; treatment also includes exercises and health and lifestyle counseling. Traditionally, chiropractic assumes that a vertebral subluxation or spinal joint dysfunction can interfere with the body's function and its innate intelligence, a notion that brings ridicule from mainstream science and medicine.

Eubulides (talk) 22:35, 31 January 2009 (UTC)

• The first part about adding "controversial" mentions "definition" several times, but I think you have also noticed that the LEAD isn't a definition. It's more than that, and thus would differ from definitions found in RS. We can add the word based on the RS we already use. We do mention it, but the single word should be right at the beginning.

• Yes, many chiropractors object to being described as CAM, "alternative", etc., but they are objecting to what is a fact - chiropractic IS classified as alternative medicine in practically every imaginable source, whether it be governmental, mainstream medicine, alternative medicine, skeptical, internet classification trees, and within the profession. That's the situation, and we should describe it in that way, even while we do mention that some chiros object, and lots of others don't, even insisting that the profession remain separate from anything related to evil mainstream medicine and science. The chiropractors who are objecting don't determine "if" or "why" chiropractic is classified as "alternative", it is the history of the profession, its teachings, practices, and its claims about itself, that make the classification quite accurate.

• Your better source below does seem like a reasonable move.

• Without doing a close comparison with the current version, your version does flow very smoothly.

• My suggestion for improvement would be to add "is a controversial alternative medicine profession and approach to health care that emphasizes..." right at the beginning, while keeping the longer, explanatory sentences we have where they are. This essentially makes the first sentence a summary/LEAD sentence for the LEAD, which is an approach found in some other articles. Some even have such a summary sentence at the beginning of each major section. This style of writing makes for an easily understandable article, which is especially helpful to readers who don't know much about the subject. -- Fyslee (talk) 06:43, 1 February 2009 (UTC)

• "the LEAD isn't a definition". True, but I was talking about the lead sentence, which is a definition, not the whole lead. Here is the lead sentence:

• "Chiropractic is a health care profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system."

• Similarly, the lead sentences of similar articles in Wikipedia are definitions. Here are some that I just now retrieved off the top of my head.

• "Acupuncture is a technique of inserting and manipulating fine filiform needles into specific points on the body to relieve pain or for therapeutic purposes."
• "Homeopathy (also homœopathy or homoeopathy; from the Greek ὅμοιος, hómoios, "similar" + πάθος, páthos, "suffering") is a form of alternative medicine based upon principles first defined by Samuel Hahnemann in 1796."
• "Osteopathy is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease."
• "Applied Kinesiology (AK) is a practice of using manual muscle-strength testing for medical diagnosis and a subsequent determination of prescribed therapy."

• It's not surprising that these lead sentences are all definitions, since WP:LEAD #First sentence says that the lead sentence should say what the subject is.
• None of these lead sentences say that the topics are "controversial", though they all are. Chiropractic should be similar to other Wikipedia articles in this respect, and should not say "controversial" in its lead sentence.
• Reliable sources by and large do not start off by immediately saying that chiropractic is controversial. Ernst 2008 (PMID 18280103), for example, is a critical evaluation of chiropractic, but its main text begins with "Chiropractic is a popular form of health care for which many definitions can be found.", which does not say that chiropractic is controversial. Chiropractic should be similar to other reliable sources in this respect.

• "chiropractic IS classified as alternative medicine in practically every imaginable source, whether it be governmental, mainstream medicine, alternative medicine, skeptical, internet classification trees, and within the profession". I agree that mainstream sources almost invariably consider chiropractic to be CAM, but Redwood et al. 2008 (PMID 18435599) show that most chiropractors don't think that chiropractic is CAM. Also, I don't see that "practically every imaginable source" calls chiropractic "alternative medicine", so that part of the proposed wording is dicey. Most of the sources that I checked called it CAM, not "alternative medicine".
• I see no problem having the lead call chiropractic both an "profession" and an "approach", as in your proposed wording.

Eubulides (talk) 08:01, 1 February 2009 (UTC)

Following up on my previous comment: I added the word "and profession" to the lead sentence of the proposed wording. Also, the proposed wording emphasizes the CAM aspect by devoting the 2nd sentence of the lead paragraph to CAM. Eubulides (talk) 18:47, 1 February 2009 (UTC)

No further comment, and it's been a week, so I installed the change. Eubulides (talk) 09:14, 8 February 2009 (UTC)

Looks good. CAM is good enough, since it includes alt med. If you are interested in checking out how it's categorized elsewhere, you'll find CAM and alternative medicine websites include chiropractic in their listings of methods, IOW the world of CAM considers chiropractic "one of their own." What many chiropractors think about it is irrelevant to the fact that it is classified as such elsewhere, and classified as such by many chiropractors. That some object is interesting and it's mentioned, which is proper. -- Fyslee (talk) 02:47, 9 February 2009 (UTC)

Related discussion

See Talk:List of topics characterized as pseudoscience#Chiropractic. QuackGuru (talk) 19:22, 9 February 2009 (UTC)

Strong evidence for lower back pain?

Can someone please inform me what constitutes "strong evidence" within this statement "A 2008 review found strong evidence that SM is similar in effect to medical care with exercise" I cannot access the article in question but I have read the abstract and it does not seem like your typical meta-analysis; "Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors" It sounds like "leading spine practitioners and researchers" hand picked articles, as opposed to your traditional review process in which all avaiable articles on the topic are collated and categorized based on their methodological quality. Is this correct? What types of studies did they cite? Also what does "blending narrative and systematic review" mean and how where these reserachers selected? JamesStewart7 (talk) 07:31, 12 February 2009 (UTC)

• A similar topic came up earlier; please see Talk:Chiropractic/Archive 29 #Can we remove the literature synthesis? for some detailed comments.
• The abstract for that article (Bronfort et al. 2008, PMID 18164469) is terrible: it's just a generic statement about the special issue of the journal, and the "blending" part applies to the entire issue, I expect. I'd ignore the abstract.
• The article itself is a systematic review (not a meta-analysis) and a best evidence synthesis; it's an updated version of Bronfort et al. 2004 (PMID 15125860).
• The review's authors are all chiropractors and the review is written from the mainstream chiropractic viewpoint.
• The authors of the review attempted to review all articles describing randomized controlled trials evaluating the therapeutic efficacy of spinal manipulative therapy (which they define to be equivalent to what the American Chiropractic Association calls "spinal manipulation") or spinal mobilization for the management of chronic low back pain. The RCTs were required to have at least 10 treatment subjects and the main outcome measures had to be patient oriented.
• The authors write "All eligible RCTs were considered regardless of their results.... Methodological quality and statistical significance were then considered to determine the evidence level." They also write that they "have attempted to be as transparent as possible in our methodology, which details a priori defined standard and acceptable methods for conducting systematic reviews." (citing Oxman et al. 1994, PMID 7933399, and Kaptchuk 2003, PMID 12829562).
• The authors' definition of "strong evidence" is two or more RCTs with validity score ≥ 50 (out of 100). The method for computing a validity score is described in Bronfort et al. 2004 (PMID 15125860).

Eubulides (talk) 08:21, 12 February 2009 (UTC)

Thanks for the information. I have to cringe a little at their definition of "strong evidence" though. Just as one example (value score = 50), in thier 2004 review (same criteria as you say), they characterised Cherkin (1998) and noted that their study did not have blinding patients, blinding of attention/provider bias, did not report and account for dropouts and did not report and account for missing data. A failure to satisfy any one of their 8 criteria on their critical evaluation list could lead to false positives yet a study which failes half of them was characterized as high quality. Furthermore the vast majority of the scores were <80 with not one study meeting all 8 critical evaluation criteria (again 2004 review).

Assuming the situation is similar for the 2008 review, I have two problems: their definition of strong evidence is questionable. In the "Low back pain" section the wording (strong evidnece, good evidence) may lead readers to the erroneous conclusion that trials finding positive results are of higher quality than trials publishing negative results (the opposite appears to be the case). To rectify this is suggest that we replace words such as "strong evidence" with descriptive statements of what the authors considered strong evidence eg. "A 2008 review concluded that SM is similar in effect to medical care with exercise.[94]. Their analysis was based on RCTs containing 10 or more participants which exhibited at least four of eight quality criteria such as "blinding of patients" and accounting for dropouts in the analysis." I believe this description is more neutral and avoids problems with the subjectivity/relativity of words like "strong" JamesStewart7 (talk) 09:23, 12 February 2009 (UTC)

• You're the first editor in quite a while who has wanted that section to be longer! We spent quite some time in November, in Talk:Chiropractic/Mediation/Archive 1 #Limited Edit War on Chiropractic#Low back pain, trying to trim that section down. Perhaps you might want to take a look in the comments there?
• If it helps, here's the quote from p. 220 of Bronfort et al. 2008 (PMID 18164469) that supports the claim in question:

"The literature provides moderate to strong evidence regarding the efficacy of SMT for mixed (but predominantly chronic) LBP (Table 10). In terms of short- and long-term patient-rated pain and disability, there is strong evidence that SMT is similar in effect to a combination of medical care with exercise or exercise instruction [12,56]", the last two numbers being cites to UK BEAM 2004 (PMID 15556955) and Hurwitz et al. 2002 (PMID 11898014).

• Looking at those two cited RCTs, the UK BEAM study found that SM had slightly better effect than exercise alone, but Hurwitz et al. 2002 (PMID 11898014) doesn't have anything to do with the question, as it studied whether it's beneficial to add physical modalities (heat therapy, ultrasound, and electrical muscle stimulation) to spinal manipulation, and came up with a negative answer. The latter citation appears to be a typo: I believe the authors actually intended to refer to their [53], which is Hurwitz et al. 2002 (PMID 12394892) (i.e., same 1st author and year, but different study), which was a RCT that compared chiropractic to medical care and found they were about the same. My belief is reinforced by the first line of Table 10 (p. 222) of Bronfort et al., which does refer to PMID 12394892.
• "may lead readers to the erroneous conclusion that trials finding positive results are of higher quality than trials publishing negative results (the opposite appears to be the case)" Sorry, I don't follow this point. I don't know of any reliable RCTs that claim otherwise. That is, I don't know of any reliable RCTs claiming that SM or chiropractic care is much better than medical care with exercise, or that it's much worse. Perhaps the problem is in the wording our claim "SM is similar in effect to medical care with exercise"; is it giving the wrong impression somehow?

Eubulides (talk) 18:54, 12 February 2009 (UTC)

Looking at the talk page, many of the commenters seem to be more concerned about the amount of weight given to each reference than about length but I understand the need for brevity. I may have been unclear with my wording before. While Bonfort et al (2008) is a suitable reference did use the term "strong evidence", their definition of strong evidence is not universal. For example while Bronfort et al (2008) a Chou (2007) adopted similar criteria for grading evidence (half or more points satisfied form the methodological checklist), Bronfort referred to this level of evidence as "strong" and said a value score >50 is "high quality" evidence whereas Chou referred to this level of evidence as "good" and said 5 out of 10 criteria satisfied constitutes "higher quality" evidence. So I feel if we simply adopt the authors wording it will appear that Bronfort et al found higher quality evidence where they simply used strong wording. Further more other criteria for evaluating evidence adopts widely different standards, for example the GRADE criteria states that evidence is of high grade when "further research is unlikely to change our confidence in the estimate of effect". It is very unlikely such a criteria has there is still debate about the effectiveness of SM, as evidenced by the negative reviews. In summary I think words like "strong evidence" are too ambiguous and until there is some wider consensus about what constitutes "strong evidence" they should probably not be used without reference to a specific criteria. I hope there is a way to rectify this without effecting the length of the section. JamesStewart7 (talk) 00:31, 13 February 2009 (UTC)

There is a problem with the longer phrasing being suggested here, though: it would greatly increase the length of the summary of one study compared to others, suggesting to naive readers that the one study is more important or definitive than the others. Here's a simpler proposal: how about if we just change "strong" to "good"? That way, we're using consistent terminology, and fix the misimpression that you're rightly worried about. Eubulides (talk) 00:46, 13 February 2009 (UTC)

Personally, I don't think we should be providing any re-interpretation of what the sources are saying, especially comparitively. If we are trying to set a baseline and even the playing field, then it seems we are opening a huge can of worms here. We are going to have to scrutinize every source under the same microscope. This seems like a monumentally bad idea which flies in the face of WP:OR. -- Levine2112 ^discuss 02:11, 13 February 2009 (UTC)

I'd have to agree with Levine2112 here. We shouldn't violate WP:OR by changing the text from what the source stated to what one believes, nor to a longer summary of the study because one doesn't agree with what the source states. 70.71.22.45 (talk) 06:33, 13 February 2009 (UTC)

Well, the solution might be to not use the source, or to not quote it. We are not obligated to use it, and if because its wording is misleading or overly promotional, then we shouldn't quote it. -- Fyslee (talk) 07:14, 13 February 2009 (UTC)

"Misleading" and "overly promotional" are your own judgments, hence WP:OR again and thus have no basis in this discussion. -- Levine2112 ^discuss 07:49, 13 February 2009 (UTC)

I would also be against not using the source. I would not say the source is "overly promotional" and I actually think the authors did a decent job on the review. They just used different language to some other authors. They clearly defined what they meant in their article but that is missing from the wikipedia article (justifiably due to length issues). To bypass concerns about reinterpretation of the article we could say "evidence from randomized clinical trials" (used elsewhere in the article) or "evidence from trials which the authors considered high quality" or "consistent support" (assuming this is the case). I'm sure there are plenty of terms the authors used which are less ambiguous than "strong". We could even write something like "The authors of a 2008 review concluded that their was strong evidence that SM is similar in effect to medical care with exercise". This would attribute the definition to the authors. This would also not change the relative lengths of each summary if we adjust the rest of the paragraph in line with this. We actually already attribute the judgements to the author with one sentence "Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review[103] found that SM or mobilization is no more or less effective than other standard interventions for back pain"[my emphasis], which somewhat problematically, covers all the reviews finding negative results. JamesStewart7 (talk) 10:11, 13 February 2009 (UTC)

• I don't see the advantage of replacing "A 2008 review found strong evidence" with "The authors of a 2008 review concluded that their was strong evidence". The latter phrase contains more verbiage but conveys no more information. And if we rewrite this sentence this way, for consistency and fairness we'd also have to rewrite all the other sentences that contain phrases like "A 2008 review found". There are dozens of such phrases in Chiropractic #Evidence basis, and such a rewrite would seriously bloat the text for essentially zero return. It's better to leave the text alone than to head down that path.
• The word "recommended", and the nearby coverage of reviews finding negative results, is not our research; it's taken directly from the cited source, Ernst & Canter 2006 (PMID 16574972), which says "We found 4 systematic reviews of SM for low back pain of which only one recommended its use. The remaining three systematic reviews concluded that there was little evidence to support such advice."

Eubulides (talk) 10:26, 13 February 2009 (UTC)

Ok fair enough. I still have reservations about shifting definitions of strong and good within the paragraph but unless anyone else has some more ideas we may have to accept the current state of the section even if it is somewhat imperfect. JamesStewart7 (talk) 10:52, 13 February 2009 (UTC)

Reflexology

This edit added material about reflexology that has nothing to do with chiropractic, material that is supported by a source (Norman 1989) that has nothing to do with chiropractic. This is an article about chiropractic, not about reflexology. Chiropractic's brief mention of reflexology in relation to chiropractic is well-sourced (the source being Murphy et al. 2008, PMID 18759966); it would be a WP:WEIGHT violation for us to go into more detail about reflexology than our relevant source does, even if our extra information is supported by a reliable (but irrelevant) source. For now, I removed this addition. Eubulides (talk) 06:29, 1 March 2009 (UTC)

Marriage of convenience

This edit added opinion from Murphy et al. 2008 (PMID 18759966) that chiropractic is "a marriage of convenience that has not worked, and that there can be no unity between the two groups" along with a long quote to support this opinion. I don't agree that the quote supports the text; it could well be talking about many groups, not just two. Also, this addition raises WP:WEIGHT concerns; we are already emphasizing the opinions of Murphy et al. heavily in that paragraph, and it doesn't feel right to push this one source so much further. Furthermore, it's hardly ever necessary to put a long quote in a citation when the reader can just go read the source (it's freely readable). For now, I undid the change. Eubulides (talk) 06:29, 1 March 2009 (UTC)

Standard format

This edit changed the format. I prefer the standard paragraph format. QuackGuru (talk) 01:00, 30 March 2009 (UTC)

I restored the formatting to the standard paragraph format. QuackGuru (talk) 02:02, 30 March 2009 (UTC)

I agree that standard paragraphs should be preferred. I vaguely recall this being discussed on the talk-page before, with the consensus being to prefer in-text discussion to bullet lists. The Wikipedia manual of style has a preference in that direction as well, if memory serves. Eubulides (talk) 07:14, 30 March 2009 (UTC)

Wording changes

Is this wording change better. QuackGuru (talk) 04:25, 30 March 2009 (UTC)

No, the cited source (Cooper & McKee 2003, PMID 12669653, p. 107), says "massage therapists", not "physical therapists". We should stick to what the source says. Eubulides (talk) 07:14, 30 March 2009 (UTC)

Changes to lead

I made this change to reflect the body of the atricle. QuackGuru (talk) 04:32, 30 March 2009 (UTC)

Please see #2009-03-30 edit war below. Eubulides (talk) 07:14, 30 March 2009 (UTC)

2009-03-30 edit war

I see that a small edit war has recently broken out, as follows:

• Adding a "pseudoscience".

• Reverting the above edit.
• Reinstalling the above edit (plus some other things).
• Reverting the above edit (plus some other things).
• Reinstalling the above edit (plus some other things).
• Reverting the above edit (plus some other things).

• Rewriting "It is generally often considered to be a form of complementary and alternative medicine, a characterization that many chiropractors reject though many chiropractors reject that characterization."

• Reverting the above edit (plus some other things).
• Reinstalling the above edit (plus some other things).
• Reverting the above edit (plus some other things).
• Reinstalling the above edit (plus some other things).

• Rewriting "a notion that brings ridicule from discounted by mainstream science and medicine"

• Reverting the above edit (plus some other things).
• Reinstalling the above edit (plus some other things).
• Reverting the above edit (plus some other things).
• Reinstalling the above edit (plus some other things).

• Quoting the words "solid science".

• Reverting the above edit (plus some other things).
• Reinstalling the above edit (plus some other things).
• Reverting the above edit (plus some other things).
• Reinstalling the above edit (plus some other things).

Please don't edit-war like this. Edits like these should be discussed before installing them; at the very minimum they must be discussed when they are reverted. The above edits were installed and reverted and reinstalled etc. without any discussion whatsoever; this is inappropriate here.

Many of these edits have been discussed at some length before. Some comments:

• There is no need to say both "pseudoscience" and "not based on solid science". This is redundant. We should use one phrase or the other.
• There is no need to quote "solid science". No reliable source claims that the chiropractic theory of subluxations is a scientific one, or is rigorously scientific, or is based on solid science, or anything like that. Reliable sources agree that chiropractic subluxations are more of a philosophical construct. Placing unnecessary quotes around "solid science" impeaches the reliable source, which inserts our editorial opinion, and this is inappropriate.
• The replacement of "generally" with "often" strays from reliable sources, which agree that chiropractic is generally considered to be CAM. It's not just the cited source; for example, Jekel et al. 2001 (ISBN 0721690793), p. 332, says "The boundaries of what constitutes CAM are not clearly defined. Some disciplines generally considered alternative, such as chiropractic and acupuncture, ..."
• The replacement of "that brings ridicule from" with "discounted by" is not supported by the cited source, Keating et al. 2005 (PMID 16092955), which says "ridicule from the scientific and health care communities and confusion within the chiropractic profession". The source never says "discounted by" or anything like "discounted by".

I see now that these edits were just now reverted with the comment "Discuss on talk page and get consensus first.", a comment I agree with. However, two of the edits were discussed in mediation first, with consensus; please see #Noncontroversial edits so far below. Eubulides (talk) 07:14, 30 March 2009 (UTC)

Noncontroversial edits so far

Of all the edits made and reverted in the past day or so, two were discussed in mediation and were not controversial there, and I think they were reverted in error (perhaps under the mistaken impression that they were controversial)?. I suggest that they be installed. Here they are:

• Remove "A 2008 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg." This edit had been discussed a while ago in Talk:Chiropractic/Mediation#Other, and had never been disagreed with.
• Remove "the benefits being pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder". Again, this edit was discussed a while ago in Talk:Chiropractic/Mediation#Comments on whiplash and other neck pain and never disagreed with.

Eubulides (talk) 07:14, 30 March 2009 (UTC)

Why do you feel these passages whould be removed? (In my view, mediation was a failure and is dead now as only one editor is using it to carry on a conversation with himself. Let's not assume that anything this editor writes there has any semblance of consensus.) -- Levine2112 ^discuss 07:26, 30 March 2009 (UTC)

I think mediation had some successes and some failures. But to turn to these passages, the first one highlights relatively-low-quality ("fair") evidence, which raises a WP:WEIGHT issue, as the rest of the section focuses on higher-quality evidence. The second passage discusses one review at greater length than other reviews, by mentioning where it found improvements (this wasn't done for other reviews), again raising a WP:WEIGHT issue. In both cases, the text is bulking up a section that editors seem to agree is overly long; since the text is of marginal utility and has weight problems here, it's reasonable to remove it. Eubulides (talk) 07:32, 30 March 2009 (UTC)

I disagree that "Lawrence-2008" should be eliminated just because it found "fair" evidence. The current wording is quite explicit at describing the findings. And the second one also presents the findings rather succinctly. Granted, the second one does come from Ernst who is cited no less that 13 times in this article, so I can see a general WEIGHT violation in the overuse of Ernst as source, but I see no reason to pick out this passage in particular. -- Levine2112 ^discuss 07:52, 30 March 2009 (UTC)

(outdent) I see that this same subject has come up again in the past few hours, with QuackGuru again removing the text in question, and Levine2112 again reinstating it. So far we've heard from two editors (QuackGuru and myself) who think this evidence is of relatively low quality ("fair") or has unnecessary detail ("the benefits being ...") and should not be mentioned at the level of Chiropractic, and one editor (Levine2112) who thinks it should stay. Does any other editor have an opinion on these two passages? Eubulides (talk) 20:27, 16 April 2009 (UTC)

I agree that those two deserve deletion. The other deletion by QG (first one, which is not mentioned here) is another matter. That type of attribution/qualification for a statement of opinion is okay in such a situation, and I don't think QG should have touched it. -- BRangifer (talk) 04:47, 17 April 2009 (UTC)

I think it should stay... it's sourced & i dunno about it really being a weight issue maybe take it to NPOVN 70.71.22.45 (talk) 18:37, 17 April 2009 (UTC)

Reading over it since I have been away from this article for a while, Eubulides's comments on quality, weight, and encyclopedic benefit seem spot-on. - Eldereft (cont.) 18:50, 23 April 2009 (UTC)

Within the past 24 hours QuackGuru[24][25] and Levine2112[26][27] have edit-duelled (again) on this topic, without discussing it here, though QuackGuru did briefly comment on the mediation page.[28] The discussion seems to be leaning somewhat in the direction of removing the text in question. Any further comments? Eubulides (talk) 20:57, 23 April 2009 (UTC)

I agree that they should be removed. The first is not a recommendation of SM and mobilization, but shows that it was the exercise that had the documented effect, not the SM and mobilization. The second about "assurance and advice to stay active" is generic and has nothing especially to do with chiropractic. It is standard medical and physical therapy practice which some chiropractors are following. Those long sentences act as a special pleading that is not justified or necessary. I thought we had a consensus to delete them, and Levine2112 and the IPsock are the only ones who have objected for some unknown reason. -- Brangifer (talk) 04:33, 24 April 2009 (UTC)

I disagree. I don't think they shoulI think it is as strong or stronger than the Ernst reviews, if you look at the number of studies they looked at to draw their conclusions:

Ernst cites:

• 11. just a paragraph talking about the study.. but no abstract - no conclusions.. full study not accessible to public.

Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.

• 17. 32 studies. "suspected to be harmed" used.. not definitive.

Ernst E (2007). "Adverse effects of spinal manipulation: a systematic review". J R Soc Med 100 (7): 330–8. doi:10.1258/jrsm.100.7.330. PMID 17606755. http://www.jrsm.org/cgi/content/full/100/7/330. Lay summary – Med News Today (2007-07-02).

• 90. conclusions drawn from 15 papers

Ernst E, Canter PH (2006). "A systematic review of systematic reviews of spinal manipulation". J R Soc Med 99 (4): 192–6. doi:10.1258/jrsm.99.4.192. PMID 16574972. http://www.jrsm.org/cgi/content/full/99/4/192. Lay summary – BBC News (2006-03-22).

• 95. just a comment... letter to the editor

Ernst E (2002). "Chiropractic" (PDF). Ann Intern Med 137 (8): 701.

PMID 12379081. http://annals.org/cgi/reprint/137/8/701.pdf.

as opposed to

• 101 Number of source documents: 887 source documents were identified; Conclusions were drawn from 64 RCTs, 12 guidelines and 13 systematic reviews and 11 cohort studies

Lawrence DJ, Meeker W, Branson R et al. (2008). "Chiropractic management of low back pain and low back-related leg complaints: a literature synthesis". J Manipulative Physiol Ther 31 (9): 659–74. doi:10.1016/j.jmpt.2008.10.007. PMID 19028250. An earlier, freely readable version is in: Meeker W, Branson R, Bronfort G et al. (2007). "Chiropractic management of low back pain and low back related leg complaints" (PDF). Council on Chiropractic Guidelines and Practice Parameters. http://ccgpp.org/lowbackliterature.pdf. Retrieved on 2008-11-28.

also, reference 90 is used 4 times. If it good enough for the other references, then why remove it for just this one instance?

--strmlbs|talk 06:54, 24 April 2009 (UTC)

The previous comment misunderstands the criticism of the text in question. Nobody is questioning the reliability of the sources. What editors are questioning is the WP:WEIGHT given to relatively-unimportant points made by the sources. Eubulides (talk) 07:38, 24 April 2009 (UTC)

I'm not talking abut the reliability of the sources either. These cites point to reviews of multiple studies. The more studies picked, the more weight you give a conclusion. The number of studies that Ernst uses to draw broad conclusions is smaller than the number of studies that the other review uses.

--strmlbs|talk 07:45, 24 April 2009 (UTC)

• Again, this shows a misunderstanding of the dispute. In the case we're talking about here, the reliable source (Lawrence et al. 2008, PMID 19028250) explicitly says that many of its conclusions are more-questionable because they come from a lower-quality body of evidence. In such a case, it doesn't matter whether Lawrence et al. are citing hundreds of studies on some other topic; what matters is that the studies they're citing on this topic are relatively low quality.
• Furthermore, a simple head-count of citations is greatly misleading and is completely inappropriate to use as a basis for WP:WEIGHT. For example, Ernst & Canter 2006 (PMID 16574972) cite 16 high-quality systematic reviews, each of which represents many, many primary sources. It is not reasonable to say that, because Lawrence et al. looked at 887 source documents that their conclusions must be weighted significantly more than Ernst & Canter's. This is because most of those 887 source documents were of relatively low quality. In the end, Lawrence et al. cite fewer systematic reviews than Ernst & Canter do; and these systematic-reviews are the highest-quality sources they cite.

Eubulides (talk) 08:32, 24 April 2009 (UTC)

Eubulides.. I didn't say that the reviews were based on 887 documents.. if you look at what I cited from the study, it says ""Conclusions were drawn from 64 RCTs, 12 guidelines and 13 systematic reviews and 11 cohort studies. And where does it explicitely say "many of its conclusions are more-questionable because they come from a lower-quality body of evidence."? I couldn't find it, either in the link that you gave or in the PDF. They went through a selection process, just like Ernst did. The selection process they went through was discussed in the study. The conclusion that you want to remove got a grade of B - fair. The study says "Assurance and advice to stay active in Activities of daily living (ADL)- Grade B - Supported by fair evidence from relevant studies". The sentence says "A 2008 literature synthesis found fair evidence supporting assurance and advice to stay active for [[sciatica]] and [[radicular pain]] in the leg". That sentence is properly sourced. I don't think there is any reason to take it out.

--stmrlbs|talk 06:55, 26 April 2009 (UTC)

• "a grade of B - fair". Yes, and grade B is relatively-low quality, compared to the other results given in this section, and this is the main reason to eliminate this result. It's weird, from the WP:WEIGHT point of view, for the article to be mentioning this result (supported only by grade B evidence) in the presence of the other better-supported results, particularly since this particular treatment (assurance and advice to stay active) is not part of the core treatment of chiropractic.
• "That sentence is properly sourced" Yes, but that's irrelevant to the discussion here. Nobody is arguing that the sentence is not properly sourced."
• "I didn't say that the reviews were based on 887 documents" Again, this head-count is misleading in addition to being irrelevant to the discussion here, but since you mention it: your earlier comment said "if you look at the number of studies they looked at to draw their conclusions" and then listed Lawrence et al. 2008 (PMID 19028250) as being based on "Number of source documents: 887 source documents were identified" along with a bunch of other numbers. It compared these numbers unflatteringly with Ernst & Canter 2006 (PMID 16574972) by saying of the latter only "conclusions drawn from 15 papers", with the clear implication that this much-smaller number indicates a much-less reliable conclusion. However, this implication was quite incorrect: Ernst & Canter based their results on 16 systematic reviews, the highest-quality sources we have, and this was a larger number of systematic reviews than Lawrence et al. used. Many of these systematic reviews in turn covered the sources that Lawrence et al. cited directly.

Eubulides (talk) 07:26, 26 April 2009 (UTC)

There is indeed a misunderstanding of what's been happening. This has nothing to do with the quality of the reports, but of their relevance to the subject. The first one is kept, with only the last part of a sentence removed, as it can give the misleading impression that the SM and mobilization had the effect, which is not the case. It was the exercise that did it, not any specific effect of chiropractic SM and mobilization. The second is removed for the same reason. It says nothing about chiropractic, and is a finding first made by non-chiropractic researchers and long ago incorporated in PT and MD guidelines. No, this isn't about the quality of the sources, just their applicability in this precise situation. -- Brangifer (talk) 13:43, 24 April 2009 (UTC)

No argument has been made to keep a long run sentence that is longer than similar sentences. So I shortened it. The other sentence was WP:UNDUE weight. The edits I made are noncontroversial. QuackGuru (talk) 18:07, 25 April 2009 (UTC)

This edit was strange. The edit summary is even stranger. QuackGuru (talk) 18:11, 25 April 2009 (UTC)

These research studies are reliable and relevant to chiropractics. The passages are well written. I do not see any good reason to eliminate or alter them. 32.174.126.62 (talk) 02:51, 26 April 2009 (UTC)

Stmrlbs makes it all but obvious that these sources are strong and relevant. I think it is plainly clear that such a removal constitutes a "controversial" edit; hence the titular change to this section. -- Levine2112 ^discuss 01:54, 27 April 2009 (UTC)

There are serious weight issues. No logical reason has been made for including them. QuackGuru (talk) 02:02, 27 April 2009 (UTC)

Yes, there is no dispute here over whether the sources are reliable and relevant. The dispute is over WP:WEIGHT, and Stmrlbs has not addressed the weight issue. Eubulides (talk) 02:11, 27 April 2009 (UTC)

Both myself and Stmrlbs cited that WEIGHT should be applied more toward the overly cited Ernst. That's where the real weight issue lays. "Fair evidence" does not mean a weight issue. And just because you disagree with our arguments does not mean that one hasn't been made. Both Stmrlbs and myself have made such arguments. -- Levine2112 ^discuss 03:04, 27 April 2009 (UTC)

You have not specifically addressed the WEIGHT issue. QuackGuru (talk) 03:07, 27 April 2009 (UTC)

I'm afraid I have to agree with QuackGuru here. The edits in question are not about Ernst. The edits are about whether Chiropractic should give undue weight to lower-quality evidence, and to the details of a particular result (more than other, similar results are detailed). Eubulides (talk) 03:52, 27 April 2009 (UTC)

Ernst is fair comparison and I am not convinced that the research in question is of any less quality. Stmrlbs has made a fair assessment as a third-party (a few others have too, but they are anonymous IPs) and has found the research in question to be high enough quality to warrant inclusion. I understand that you disagree with the third-party opinions here. That's your right. But please recognize that this in not a "noncontroversial edit", nor does it have a consensus to be implemented. -- Levine2112 ^discuss 04:21, 27 April 2009 (UTC)

• Ernst & Canter 2006 (PMID 16574972) is not at all comparable: we have a reliable source, Lawrence et al. 2008 (PMID 19028250), which itself says that its evidence is lower quality (grade B), but there is nothing similar for Ernst & Canter. Ernst & Canter base their work only on the highest-quality sources (systematic reviews), whereas Lawrence et al. explicitly allow lower-quality sources.
• No third-party request was made for this thread, nor is one appropriate, as more than 2 editors are involved.
• Stmrlbs is in no sense an uninvolved 3rd party. Stmrlbs has been engaged in a dispute with QuackGuru concerning Stephen Barrett, a dispute that Levine2112 is surely aware of; see [29] for an example edit by Levine2112 immediately followed by an edit by Stmrlbs disagreeing with QuackGuru. This dispute casts serious doubt on any claim that Stmrlbs is making a fair and uninvolved assessment here.
• Consensus does not require universal agreement. What is needed here is discussion on the merits of the dispute.

Eubulides (talk) 05:01, 27 April 2009 (UTC)

Eubulides, grade B is the 2nd highest grade. You keep said the report "explicitly says that many of its conclusions are more-questionable because they come from a lower-quality body of evidence", but couldn't show me where it said that. Perhaps this was your interpretation. But, it is not mine. This is what it says about grade B:

GRADE B: Supported by fair evidence from relevant studies.

Explanation

• The evidence consists of results from studies based on appropriate research

designs of sufficient strength to answer the questions addressed, but there is

some uncertainty attached to the conclusion because of inconsistencies among

the results from the studies, or because of minor doubts about generalizability,

bias, and research design flaws, or adequacy of sample size.

• Alternatively, the evidence consists solely of results from weaker designs for the

question addressed, but the results have been confirmed in separate studies and

are consistent with minor exceptions at most.

Examples

• Supporting evidence might consist of a several RCT’s with differing results

although overall the results support the conclusion.

--stmrlbs|talk 05:38, 27 April 2009 (UTC)

Grade A-Z!!! So what? If it's not relevant, then it doesn't belong there, and that's what's happening. We need to keep irrelevant information out. That's the only way to legitimately keep the article from bloating. Even if it were Grade A, it wouldn't make it any more relevant. -- Brangifer (talk) 05:55, 27 April 2009 (UTC)

• The report explicitly states in its Table 2 (page 670) where its conclusions rely on lower-quality evidence. It is true that some topics have even lower-quality evidence than grade B, but grade B is pretty bad. This paper is notable among our sources in its willingness to accept lower-quality evidence.
• Also please see #Lawrence et al. summarized incorrectly on leg problems below.

Eubulides (talk) 06:22, 27 April 2009 (UTC)

Notice and NPOV

I wanted someone to nominate this article for Featured Article ('coz it's pretty NPOV), but looking at the notice, I'm wondering if it's possible?-NootherIDAvailable (talk) 13:37, 16 April 2009 (UTC)

If it ain't NPOV, I'm sure V can have a POV tag on the article.-NootherIDAvailable (talk) 13:41, 16 April 2009 (UTC)

Which "notice" is that? Sorry, I don't understand the "ain't NPOV" comment. Also, I had been thinking of nominating it for GA first; that'd be the first step. Eubulides (talk) 16:58, 16 April 2009 (UTC)

Ridicule and confusion

A recent edit altered the lead's discussion of subluxation, replacing this:

a notion that brings ridicule from mainstream science and medicine.

with this:

a "notion [that] brings ridicule from the scientific and health care communities and confusion within the chiropractic profession."

This change runs afoul of WP:LEAD, which says that the lead should use summary style and should summarize what the body says. This quote does not summarize what the body says. Even if it did summarize the body, the quote is lengthy enough that it raises significant WP:WEIGHT issues: why should the lead devote so much space to the ridicule and confusion caused by subluxation? I suggest that the change be reverted for now and discussed here first. Eubulides (talk) 07:19, 30 March 2009 (UTC)

Good points. I was only reacting to Ludwigs2's attempt to significantly alter the statement, which was backed up by Levine2112. Let it return to its previous state before it was subjected to tampering. -- Fyslee (talk) 13:49, 30 March 2009 (UTC)

Alberta will no longer pay for chiropractic

Under its new budget, Alberta will no longer pay for chiropractic services. They calculate it will save $53 million. They will also no longer pay for sex change operations.

• Chiropractic care delisted from Alberta health plan

-- Fyslee (talk) 03:08, 8 April 2009 (UTC)

is that really relevant? 70.71.22.45 (talk) 18:38, 17 April 2009 (UTC)

It has to do with the subject of regulations governing billing for chiropractic services, and is directly related to this section. We do mention the subject and this could be added as another reference. -- BRangifer (talk) 23:05, 17 April 2009 (UTC)

Two recently published reviews

[30][31] Here are two refs that might be useful. QuackGuru (talk) 19:07, 16 April 2009 (UTC)

Yes, both are useful, and both are already cited. I added them on January 6 and on April 8, respectively. Eubulides (talk) 20:34, 16 April 2009 (UTC)

17 and/or 18

Although spinal manipulation can have serious complications in rare cases,[17][18]

Is it necessary to have two references or is one enough to verify the claim. QuackGuru (talk) 06:29, 26 April 2009 (UTC)

It's not necessary, but it is helpful and surely it does little harm here: both sources are used multiple places elsewhere in the article, and it consumes very little space (both in terms of text, and in terms of the readers' time) to cite both here. Eubulides (talk) 06:38, 26 April 2009 (UTC)

Lawrence et al. summarized incorrectly on leg problems

I just now reread Lawrence et al. 2008 (PMID 19028250) looking for the part of it that directly supports the claim "A 2008 literature synthesis found fair evidence supporting assurance and advice to stay active for sciatica and radicular pain in the leg" in Chiropractic #Effectiveness. I couldn't find the direct support. Where exactly in the paper does it say that? The paper's table 2 (page 670) says that the strength of the evidence in this area is grade B, but the table doesn't say that the evidence supports the treatment for sciatica and radicular pain in the leg. The conclusions section of the paper talks only about the treatment for low back problems, not for leg problems. It appears that Chiropractic is incorrectly summarizing the paper's conclusions here, regardless of the WP:WEIGHT issues involved. Since the paper's conclusions section does not mention this topic, Lawrence et al. clearly did not feel that the topic was all that important anyway. For now, I've tagged the claim with {{Not in source}}. The simplest way to fix this problem is to remove the claim in question. Eubulides (talk) 06:22, 27 April 2009 (UTC)

"Strength of evidence" obviously means "strength of supportive evidence". The grading scale indicates a recommendation of each treatment for the particular ailment based on the quality of evidence. Both the abstract summary and the conclusion discuss radiating leg pain and sciatica. The review also mentions other conclusions which we are not - but perhaps should be - including in this article. Such as:

• As much or more evidence exists for the use of SMT to reduce symptoms and improve function in patients with chronic LBP as for use in acute and subacute LBP.

• Use of exercise in conjunction with manipulation is likely to speed and improve outcomes as well as minimize episodic recurrence.

With regard to the second bulleted conclusion, remember, chiropractic is much more than a doctor performing spinal manipulation. A chiropractic prescription includes treatments such as exercise, massage, electrical modalities, and lifestyle and nutritional counseling. Perhaps we should also include studies about the efficacy of these treatments as well in this article. I'm unsure why we tend to limit the scope of this to mostly spinal manipulation when the scope of chiropractic is much broader. I'd love to see some some studies on general exercise's efficacy on LBP in this article. Or a study on nutritional counselling and its effect on general health (such as this one for instance). -- Levine2112 ^discuss 21:35, 28 April 2009 (UTC)

It's not at all obvious that "strength of evidence" means "strength of supportive evidence". The text does not say that; it merely says that the table summarizes the "strength of evidence" for the "conclusions". For Chiropractic to claim that the article directly supports a claim of effectiveness for leg conditions, we'd need to see a conclusion in the source about the effectiveness of these treatments for leg conditions. Neither of the quotes mentioned above are about leg conditions, so the cited source does not support the claim. I'm restoring the tag for now. Eubulides (talk) 23:52, 28 April 2009 (UTC)

"Evidence" means "evidence in support of". If you look at the entire study, you will see that it discusses research looking at the efficacy of various treatments for these conditions. If doesn't treat the word "evidence" to mean the existence of some efficacy data positive or negative, but rather clearly as the existence of positive efficacy data. Compare the other findings in the table to the conclusions made (i.e. "As much or more evidence exists for the use of SMT to reduce symptoms..." and "There was less evidence for the use of manipulation for..." and "There was little evidence for the use of manipulation for...". It's quite clear from statements such as these what the authors mean by "evidence". They mean evidence of efficacy or - in their words - "evidence for the use". That's why they describe "Table 2" as such: "Table 2 summarizes the recommendations of the team, based on the review of the evidence." If you don't believe that this is what the authors meant, then please tell us what recommendations you think the authors are making with Table 2. -- Levine2112 ^discuss 01:28, 29 April 2009 (UTC)

• "[Lawrence et al.] doesn't treat the word "evidence" to mean the existence of some efficacy data positive or negative, but rather clearly as the existence of positive efficacy data." No, not at all. For example, Chiropractic currently claims that there's fair (grade B) evidence supporting advice to stay active as treatment for sciatica. But the text of the cited source (Lawrence et al. 2008, PMID 19028250) specifically mentions that treatment for sciatica in only two places. First, page 661 says "For sciatica patients, fair evidence shows no real difference in pain and functional status between bed rest and staying active." (Bed rest, of course, is one of the worst treatments for sciatica, and this is a negative conclusion.) Second, page 661 also says "The Cochrane review by Hilde et al. included 4 trials and concluded a small beneficial effect for staying active for acute, uncomplicated LBP, but no benefit for sciatica." Again, this is a negative conclusion. In short, Lawrence et al. says that there's fair evidence that the advice to stay active has no benefit for sciatica. So the claim in Chiropractic not only is not supported by the source, it is contradicted by the source.
• "'Evidence' means 'evidence in support of'". No, "evidence" means "evidence". And as can be seen from the previous bullet, the evidence is sometimes negative. Which is to be expected: any serious review article should discuss both positive and negative evidence.

Eubulides (talk) 05:04, 29 April 2009 (UTC)

Evidence means only and exactly evidence - that is part of the point of doing evidence-based medicine. On the second page (660, or 14-15 of the ccgpp.org convenience link), the authors detail precisely what they mean by Grade B. They graded explicitly and solely based on whether the quality of evidence was such that valid conclusions could be confidently drawn from it. Also, we should concentrate on letting the references drive the article content - let us summarize the major results from this review, which do not include sciatica, and avoid dropping in citations that willy-nilly happen to mention a point. The conclusions deal entirely with manipulation and manipulation with adjunct therapy, and with the quality of the evidence base. - 2/0 (formerly Eldereft) (cont.) 18:16, 29 April 2009 (UTC)

And to that end, we are leaving many of the conclusions out - as mentioned above. In terms of LBP, I'd like to mention of these two conclusions for sure: As much or more evidence exists for the use of SMT to reduce symptoms and improve function in patients with chronic LBP as for use in acute and subacute LBP. and Use of exercise in conjunction with manipulation is likely to speed and improve outcomes as well as minimize episodic recurrence. -- Levine2112 ^discuss 20:51, 29 April 2009 (UTC)

That is a different topic, which would be appropriate for some other thread. The original point of this thread is that Chiropractic contains text which is not supported by (and even contradicts) the cited source. Clearly the text in question should be removed. Eubulides (talk) 06:16, 30 April 2009 (UTC)

Magically disappeared

This edit mysteriously deleted a sentence from the philosophy section. QuackGuru (talk) 00:33, 3 May 2009 (UTC)

That seems to have been there for some time, and IIRC, is in the source, so it should be restored, especially since it was a deletion without any edit summary or discussion made by a mysteriously familiar IP... -- Brangifer (talk) 06:29, 3 May 2009 (UTC)

With a single click it can magically reappear. QuackGuru (talk) 06:54, 3 May 2009 (UTC)

I agree with restoring the sentence. QuackGuru (talk) 08:55, 4 May 2009 (UTC)

Rooted in mystical concepts

Expanding the straights and mixers section may improve the article.

From Ernst: Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today. QuackGuru (talk) 01:04, 3 May 2009 (UTC)

The Ernst quote would be a good part of the introduction to the section. It establishes the historical reason for why the split exists. -- Brangifer (talk) 06:31, 3 May 2009 (UTC)

The reader is missing part of the story. There is a gap in the article. QuackGuru (talk) 06:54, 3 May 2009 (UTC)

Chiropractic originated from mystical ideas which led to internal conflict within the profession.<ref name=Ernst-eval/> Here is a start. QuackGuru (talk) 07:13, 3 May 2009 (UTC)

Please see #Schools of thought and practice styles below. Eubulides (talk) 09:27, 4 May 2009 (UTC)

Useful source about subluxations

The followng contains a couple interesting items that can be used at Wikipedia:

In his book, Mr. Chapman‑Smith categorically stated that subluxations are not structural entities and cannot be detected on x‑ray.

In a paper titled, "Chiropractic in the 21st Century," Mr. Chapman‑Smith recommended that chiropractic follow the path of osteopathy in changing terminology. He wrote: "Chiropractors must do something similar with chiropractic subluxation ‑ use the term internally because of its rich history, but use another externally. I would recommend joint dysfunction. They must acknowledge that adjustment is manipulation, albeit precise and skilled, and that they do nothing unique ‑ they just do an interesting blend of things better." [32]

It would be best to use the original source, rather than the fringe ultra-straight WCA. -- Brangifer (talk) 07:15, 3 May 2009 (UTC)

Straights and mixers is too narrow

When Significant differences exist among the practice styles, claims and beliefs of various chiropractors.[26] the section name needs to be broader. QuackGuru (talk) 00:21, 3 May 2009 (UTC)

I agree. The previous heading was a better description, but Eubulides disagrees. Let's discuss it here and find a compromise. -- Brangifer (talk) 06:15, 3 May 2009 (UTC)

A description of the section is better. The current version is misleading because there are splinter groups and significant differences exist among chiropractors. QuackGuru (talk) 06:54, 3 May 2009 (UTC)

• This is to some extent repeating the discussion in #Splinter groups below; I'm responding here.
• The complaint seems to be that the current section is misleading because it doesn't adequately describe splinter groups. We've discussed this issue in the past, and if I recall, the problem was that we could not find any current reliable sources talking about these splinter groups; the only sources we found were so old that they were appropriate for the History section, but it there were concerns that it would be misleading to present that material in other sections as if it were current.
• QuackGuru quotes Chiropractic's "Significant differences exist among the practice styles" with the implication that this is misleadingly summarized by the section header "Straights and mixers". However, the cited source for that claim, Healy 1990, begins "Mixers and straights ...", so I don't see a problem; it's yet another source that emphasizes the disputes among mixers and straights.
• In short, Chiropractic #Straights and mixers is almost entirely about straights and mixers now, so the title is currently accurate. If the contents change, of course, then the title may well have to change.

Eubulides (talk) 18:24, 3 May 2009 (UTC)

As I recall, you were strongly influenced to accept the misleading arguments of editors who wished to keep any mention of reform in any form out of the article. They used specious arguments, and nothing could cause you to see through them. Even the fact that the whole controversial history, right from the beginnings of the profession, has received lots of notable coverage in chiropractic and other literature, and we have a well-sourced (using just a few of the available sources) article about the NACM, the subject is ignored. (It makes no difference whether the NACM is active or not anymore.) We gave up on you as a reliable editor on this point. On this point you went over to the dark side. I wish you would do some study on the subject. -- Brangifer (talk) 19:18, 3 May 2009 (UTC)

Do you have a specific proposal in mind along with the references to verify the text. QuackGuru (talk) 19:26, 3 May 2009 (UTC)

I don't have one right now. It's a big topic and since Eubulides doesn't support the effort, and has actually opposed it, it's hopeless to even try. -- Brangifer (talk) 22:39, 3 May 2009 (UTC)

Mainstream chiropractors oppose the minority view of limiting the scope of practice to an evidence basis from using manipulation and physiotherapy methods to treat only musculoskeletal disorders.[33]

Here is a start. QuackGuru (talk) 20:11, 3 May 2009 (UTC)

Here are the references from that article. -- Brangifer (talk) 22:39, 3 May 2009 (UTC)

It is better to describe the section than to label it. For example, the Vaccination section was renamed to Public health. QuackGuru (talk) 18:43, 3 May 2009 (UTC)

(outdent)

• "misleading arguments of editors" I don't recall those arguments. I do recall looking hard for reliable sources in this area myself, and coming up dry. Without reliable sources we're pretty much forced to say nothing. The http://www.accessmylibrary.com/coms2/summary_0286-25525357_ITM source mentioned above is not that reliable: first, it's obsolete, and second, it's not written by a 3rd party. We need a reliable 3rd-party source that places the splinter groups in context; otherwise, we are at risk of giving these splinter groups greater WP:WEIGHT than reliable sources do. Because we lack reliable sources, the text proposed above is questionable.
• "It makes no difference whether the NACM is active" If the NACM is inactive, we cannot insert text that would mislead the reader into thinking that it is a currently-important organization. The proposed text would be misleading in this way, I'm afraid.
• "It is better to describe the section than to label it." Sorry, I don't know what this comment is referring to.

Eubulides (talk) 09:27, 4 May 2009 (UTC)

We could include the history of the profession's very vocal (myriad internal and external sources) resistance to reform attempts and persecution of reformers. The NACM is just a more recent part of that history, but also the most significant attempt. Some of the sources are mentioned in that article. The role of Samuel Homola and the treatment of him is also quite significant, and there are many sources. -- Brangifer (talk) 14:01, 4 May 2009 (UTC)

This sounds like a good strategy, except we need a reliable source on it. Relying on the NACM or on Homola to describe their own role in chiropractic does not qualify, as Wikipedia requires reliable 3rd-party sources. I just now looked on Google Scholar for reliable published sources on Homola and chiropractic, and came up empty, except for sources written by Homola. There's a similar problem with the NACM, I'm afraid. Eubulides (talk) 22:01, 4 May 2009 (UTC)

There are plenty of chiropractic sources, which in this case are quite compelling, since they are adversarial sources that help to document/establish notability and show the profession's reaction to reform attempts. Google scholar would only be relevant for scientific information, and not very much for controversies. -- Brangifer (talk) 23:10, 4 May 2009 (UTC)

I don't see why Google Scholar would be mostly irrelevant to chiropractic controversies. On the contrary, a quick search for articles since 2005 with "chiropractic controversy" yields over 1000 sources, including the following (I list only the top 3):

• Lewis CE (2006). "Appeals Court rejects federal jurisdiction over chiropractors challenge to Medicare coverage-Am. Chiropractic Ass'n, Inc. v. Leavitt". J Law Med Ethics. 34 (2): 472–4. doi:10.1111/j.1748-720X.2006.00056.x. PMID 16789972.
• Hart J (2007). "Correlation of health outcomes with physician and chiropractor ratios in the United States". J Chiropr Med. 6 (3): 105–9. doi:10.1016/j.jcme.2007.06.003.
• Villanueva-Russell Y (2009). "chiropractors as folk devils: published and unpublished news coverage of a moral panic". Deviant Behav. 30 (2): 175–200. doi:10.1080/01639620802050254.

The whole idea that there is a significant controversy among significant splinter groups in chiropractic, and that this controversy is not covered at all among the scholarly literature, is a little weird; scholars love this sort of thing. Eubulides (talk) 23:42, 4 May 2009 (UTC)

I'm sorry if I gave the impression that it is "mostly irrelevant" (your words) to chiropractic controversies. I would welcome all information found using Google Scholar. You said you had "just now looked on Google Scholar for reliable published sources on Homola and chiropractic, and came up empty,...". You came up empty because you either used the wrong search terms or stopped your search too soon, using only Google Scholar. You'll have to look elsewhere to find the bulk of the controversies. (BTW, Homola's first book is available online and is a scholarly work of excellent quality.) My point is that most of the information we'd find about these controversies is found in chiropractic trade literature, websites, and some books. The various Association websites are RS for this purpose. Try Dynamic Chiropractic, the most widely read and circulated chiropractic trade publication. For the controversies and news, it is a RS here. Much of this isn't about scientific nitty gritty, but about opinions and historical events, so MEDRS is of limited usefulness (although definitely usable when it provides anything), and Google Scholar the same. V & RS come in many forms, and we must use the ones which discuss the controversies. The sources will direct us. Scholars do love this type of stuff, but very few scholars outside of chiropractic pay attention to it. It's a fringe subject to them. Keating and a few other chiropractic scholars are the ones to read. -- Brangifer (talk) 01:08, 5 May 2009 (UTC)

BTW, here's one I just found:

• Spinal Manipulation and Chiropractic: Views of a Reformist Chiropractor By Dr. Craig F. Nelson

Another source is material written by Joseph C. Keating, Jr., a scholar and chiropractic's top historian, who wrote much about the controversies and often sided with the reformers.

-- Brangifer (talk) 01:08, 5 May 2009 (UTC)

And more:

• How can chiropractic become a respected mainstream profession? The example of podiatry - Donald R Murphy,1,2,3 Michael J Schneider,4,5 David R Seaman,6 Stephen M Perle,7 and Craig F Nelson8 (We already use this source, and it's a very reform POV.)

• Chiropractic as spine care: a model for the profession - Craig F Nelson1 , Dana J Lawrence2 , John J Triano3 , Gert Bronfort4 , Stephen M Perle5 , R Douglas Metz1 , Kurt Hegetschweiler1 and Thomas LaBrot1

• In the Quest for Cultural Authority - By Joseph Keating Jr., PhD, Thomas E. Hyde, DC, DACBSP, J. Michael Menke, DC, David Seaman, DC, MS, DABCN and Richard E. Vincent, DC, FICC, also featuring Larry H. Wyatt, DC, DACBR

-- Brangifer (talk) 04:18, 5 May 2009 (UTC)

• I didn't come up empty with Homola; I came up empty finding reliable 3rd-party sources about Homola. The distinction is crucial. Homola is not a 3rd-party source on himself.
• We have to be careful when citing publishers like Dynamic Chiropractic, as it contains some stuff of very low quality; and similarly, we have to be careful about citing primary sources from Dyn Chiropr to build a case, as that's too much like original research. I'm not saying it can't be done, but it'd be an uphill battle to do it well.
• Nelson 1999 is dated; isn't everything that it says, that is significant and still-relevant, also said in his later papers (Nelson et al. 2005, PMID 16000175; Murphy et al. 2008, PMID 18759966)? Also, later in your comment, you cite these two sources approvingly, but Chiropractic is already relying on them heavily, no? If not, what's missing?
• Keating's work is generally good, and Chiropractic cites 7 of his papers. It might not hurt to cite him a bit more. Keating et al. 2004 is a position paper, and would need to be cited very carefully. As a position paper, it is a reliable source for its own position, but it's not clear to me offhand how much WP:WEIGHT to ascribe to it. But perhaps someone else can propose a concrete change based on this source.

Eubulides (talk) 05:31, 5 May 2009 (UTC)

Of course we have to be careful when citing chiropractic sources, including Dynamic Chiropractic. It does contain junk, but it also publishes reliable history, commentary, and opinions. We'd cite that. Let's not get all defeatist and give up without trying. Here are a few:

• Bonesetting, Chiropractic and Cultism by Samuel Homola, DC - A Guest Review by Joseph C. Keating, Jr., Ph.D.

• Ethics Aren't Only for Medics By Louis Sportelli, DC

"However, there is little comfort in condemning the medical/drug cartel, while at the same time ignoring the obvious transgressions within our own professional house.

An obvious, often conveniently overlooked fact is that we (the chiropractic community) do not often give acknowledgment or recognition to the authors of probing, skeptical, self-critical articles published in medical journals (in this case, BMJ). The NEJM and JAMA have, in the past, also published articles and editorials containing harsh criticism of the medical profession, condemning their actions, ethics and behavior, and exposing their shortcomings and weaknesses. This kind of action is the mark of a profession, as well as positive proof of the determination of self-regulation, which is vital to avoiding mandated governmental oversight.

Can you imagine the kind of backlash and indignation that would result if Dynamic Chiropractic, the ICA Review, the Journal of the ACA, or Chiropractic Economics wrote a scathing expos or critical article dealing with some ethical, clinical, professional or business aspects of chiropractic? An outcry of righteous indignation demanding the editors be "tarred and feathered" would soon begin. Some within the profession would regard the authors and their publications as nothing short of traitors. Canadian DC Jaroslaw Grod and his co-authors have tasted just such a backlash for their criticisms of the unsubstantiated claims made by various chiropractic organizations.2 Fortunately for them, but not for the profession, few chiropractors subscribe to or read JMPT. The critique, Bonesetting, Chiropractic & Cultism,3 earned its author, Sam Homola, DC, a 30-year exile from the profession. Chiropractor John J. Nugent's 20-year quest to critique and improve chiropractic education earned him a forced retirement and scorn as the "Antichrist of chiropractic."4"

• Wish List for Chirohistory By Joseph Keating Jr., PhD

"heretics and reformers in chiropractic (including William C. Schulze, Frank R. Margetts, C.O. Watkins, W.A., Budden, John J. Nugent, A.E. Homewood, Samuel Homola, Scott Haldeman, Joseph Janse, Roy W., Hildebrandt, and Herbert J. Vear);"

• A Cure for the Curse of Chiropractic, Part Two By David Seaman, DC, MS, DABCN

• Experts urge cautious approach with chiropractors treating colic

• Pain in the Neck

• http://en.wikipedia.org/wiki/Chiropractic_history#The_movement_toward_scientific_reform

• BONUS on another topic: Strokes Due to Chiropractic Cervical Manipulation: References Long list of references on the subject (not about reform)

-- Brangifer (talk) 06:47, 5 May 2009 (UTC)

• The 1st citation is a 20-year-old book review, and is too limited and dated. The 2nd is a recent opinion piece by one author; it would be tricky to use it, since it's so obviously advocacy, but perhaps something could be done (not sure what it says that's important and that Chiropractic doesn't already say, though). The 3rd is a 9-year-old news article on colic that is far inferior to the three sources Chiropractic already cites on colic. The 4th is a reasonable tertiary source on neck pain, but it doesn't cite its sources and as per WP:MEDRS it'd be better to cite its sources rather than it. The 5th is Wikipedia, which is not a reliable source (for Wikipedia purposes). The 6th is a somewhat obsolete list of articles on cervical manipulation; the articles Chiropractic cites on that topic are generally newer and better.
• Sorry if I seem overly critical, but I've looked at a lot of sources on chiropractic. Most of them are dreadful. There are thousands of sources on chiropractic, and we shouldn't be wasting our time on the lower-quality sources.

Eubulides (talk) 07:15, 5 May 2009 (UTC)

Splinter groups

A brief mention that chiropractic has had splinter groups would improve this article. This could be explained in the straights and mixers section. QuackGuru (talk) 01:11, 3 May 2009 (UTC)

That's one of the elephants in the room and a big hole in the article. It has to do with the controversial nature of the profession, and one of the many results of the controversies is that many splinter groups have and do exist. -- Brangifer (talk) 06:33, 3 May 2009 (UTC)

There was a book that mentioned the splinter groups. But I can't remember which book. QuackGuru (talk) 06:54, 3 May 2009 (UTC)

This seems to be to some extent duplicating the discussion in #Straights and mixers is too narrow above; I've followed up there. Eubulides (talk) 18:23, 3 May 2009 (UTC)

The lead says It has two main groups: "straights", now the minority, emphasize vitalism, innate intelligence and spinal adjustments, and consider subluxations to be the leading cause of all disease; "mixers" are more open to mainstream and alternative medical techniques such as exercise, massage, nutritional supplements, and acupuncture.[8]

The lead indicated there are two main groups. This can be explained in more detail in the body of the article.

Chiropractors have historically fallen into two main groups, "straights" and "mixers"; both have had splinter groups.<ref name=History-PPC/><ref name=Kaptchuk-Eisenberg/>

The WP:LEAD and body go together. QuackGuru (talk) 19:14, 3 May 2009 (UTC)

Something like that might be OK; but where exactly do those two sources say that both have had splinter groups? Eubulides (talk) 09:27, 4 May 2009 (UTC)

Page 94 of PPC is a good place to start. QuackGuru (talk) 18:34, 4 May 2009 (UTC)

I thought this was notable: "The diversity of beliefs among chiropractors defies comprehensive description. However, several clustering of these ideas may provide a useful mental shorthand, and seem to parallel some of the major political divisions within the profession. The practicial (clinical) and ethical implications of these groupings (e.g., evidence-based chiropractic, traditional straight chiropractic, purpose-straight chiropractic) deserve thougthful study by the profession." QuackGuru (talk) 20:30, 4 May 2009 (UTC)

I assume this is the Keating05 citation in Chiropractic? But Keating doesn't say that purpose-straight and evidence-based chiropractic groups are active now; on the contrary, he says the purpose-straight group is dead. See Talk:Chiropractic/Archive 15 #Elimination of reform chiro. So it would be misleading for us to imply that these groups are a significant factor now. Eubulides (talk) 22:01, 4 May 2009 (UTC)

This is from the PPC book. This verified the claim that chiropractic does have splinter groups. QuackGuru (talk) 23:26, 4 May 2009 (UTC)

It verifies the existence of some groups at some time in the past. It does not verify their current existence and importance. And other comments in the same source indicate that purpose-straight is dead. Eubulides (talk) 05:31, 5 May 2009 (UTC)

Chiropractors have historically fallen into two main groups, "straights" and "mixers"; both have had splinter groups.<ref name=History-PPC/><ref name=Kaptchuk-Eisenberg/>

The point is that it does verify the text being proposed for inclusion. I think it is important to briefly mention this in the article. According to the source it does "deserve thougthful study by the profession". This indicates it is important. The sentence explains which groups are the main groups and then ever so briefly states there has been splinter groups. Before there was two whole paragraphs about the splinter groups. A brief mention of the splinter groups satisfies WP:WEIGHT. QuackGuru (talk) 06:29, 5 May 2009 (UTC)

Sorry, I don't see how the quote verifies any claim about "splinter groups", as it doesn't mention anything splintering. Nor does the quote verify the claim that any of the groups is a descendant of any other. This brief quote is quite a slender reed on which to base any claim about the groups. If it's just one sentence in a long chapter, it suggests the topic of these groups isn't that important. Which would be understandable, since the NACM and the super-duper-extreme-straights don't exist any more as groups. Eubulides (talk) 07:15, 5 May 2009 (UTC)

I previously verified the text. The small quote was quoting the end of a sentence which indicates it is important.

Page 94 "The diversity of beliefs among chiropractors defies comprehensive description. However, several clustering of these ideas may provide a useful mental shorthand, and seem to parallel some of the major political divisions within the profession. The practicial (clinical) and ethical implications of these groupings (e.g., evidence-based chiropractic, traditional straight chiropractic, purpose-straight chiropractic) deserve thougthful study by the profession."

Since the source indciates it does "deserve thougthful study by the profession" it is important according to the source. QuackGuru (talk) 07:25, 5 May 2009 (UTC)

Please see #Differences among schools of thought and practice styles below. Eubulides (talk) 04:17, 6 May 2009 (UTC)

Long run on sentence

There is a sentence that is longer than other similar sentences. For now I tagged the sentence. QuackGuru (talk) 00:12, 3 May 2009 (UTC)

When I look at the source, I (too?) question whether our wording is in harmony with the source. Can a better wording be formulated here and worked on until we have a consensus version? -- Brangifer (talk) 06:08, 3 May 2009 (UTC)

The best way to fix the problem is to shorten the sentence to about the same length as similar sentences. QuackGuru (talk) 06:54, 3 May 2009 (UTC)

Length alone isn't a legitimate argument. Relevance is more important. -- Brangifer (talk) 07:06, 3 May 2009 (UTC)

There are two problems with the long run on sentence. The first problem is the WP:WEIGHT issue. It is longer than other similar sentences. The other problem is that it gives a misleading conclusion that the spinal manipulation and mobilization had the benefit, but that is not accurate. The addition of exercise was the effect, not SM. It is not that important to go into such detail with the benefit of exercise. QuackGuru (talk) 07:30, 3 May 2009 (UTC)

(outdent) I reread the cited source (Ernst & Canter 2006, PMID 16574972) and found nothing in it that directly supports, or even indirectly supports, the claim "the benefits being pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder" that currently appears in Chiropractic. For now I tagged the claim with {{Fv}}. Eubulides (talk) 18:23, 3 May 2009 (UTC)

Agreed. If anything (which would be a reason to keep the source, but reword our presentation of it), it is an example of negative evidence, IOW it shows a lack of effect of SM, whereas it shows that the exercise was the significant factor in the improvement. The way it is worded (spun!) implies that the SM had some positive effect. The spin should be removed. -- Brangifer (talk) 19:09, 3 May 2009 (UTC)

I made this change to trim the long run on sentence. QuackGuru (talk) 19:09, 6 May 2009 (UTC)

No specific objection to shorten the long run on sentence has been made. QuackGuru (talk) 21:08, 6 May 2009 (UTC)

This edit has consensus. The edit was revert again without explanation. After editors discussed the change it was reverted. QuackGuru (talk) 00:26, 7 May 2009 (UTC)

Indeed, that edit had been discussed and there have been no objections here, so the reversion was obstructionism. -- Brangifer (talk) 03:43, 7 May 2009 (UTC)

This has been happening for a number of years now. But we must assume blind faith. QuackGuru (talk) 03:48, 7 May 2009 (UTC)

Since no source has been produced despite the {{Fv}} tag for several days, I removed the phrase in question. Eubulides (talk) 07:36, 7 May 2009 (UTC)

Consistency

The reference style for this article is to abbreviate. This edit contradicts that style. QuackGuru (talk) 00:19, 3 May 2009 (UTC)

That labels the source, but is not a reference in the style like the references in the reference section. I can understand the reason for the change, since using a redirect violates other standards here. To avoid that and still use what appears to be an abbreviation, we could use a piped link: OED That would be an acceptable solution. -- Brangifer (talk) 06:13, 3 May 2009 (UTC)

Why would using "[[OED]]" violate any standards? It is almost entirely equivalent in behavior to using the piped link "[[Oxford English Dictionary|OED]]", and the very slight differences don't matter here. Eubulides (talk) 18:24, 3 May 2009 (UTC)

Since our policies and guidelines have undergone lots of changes since I started here, I'm not sure about the exact policy wordings, but we try to avoid redirects, which cause a drain on servers. Using piped links solves that problem. -- Brangifer (talk) 19:10, 3 May 2009 (UTC)

This is a minor issue. I suggest we go back to the previous version when no preceived problems existed. QuackGuru (talk) 19:22, 3 May 2009 (UTC)

I don't care that much one way or another; it would be fine with me to go back to "[[OED]]". Current guideline is not to bother with pipes like "[[Oxford English Dictionary|OED]]" etc.; see WP:R2D. Eubulides (talk) 09:27, 4 May 2009 (UTC)

Thanks for that link. I wasn't aware of it. -- Brangifer (talk) 13:55, 4 May 2009 (UTC)

I made this change to the abbreviated version. QuackGuru (talk) 19:06, 6 May 2009 (UTC)

No specific objection to abbreviate it has been made. QuackGuru (talk) 21:07, 6 May 2009 (UTC)

There was consensus for this change. After the edit was made then editors reverted it. QuackGuru (talk) 00:23, 7 May 2009 (UTC)

I abbreviated the wikilink. QuackGuru (talk) 22:55, 10 May 2009 (UTC)

Schools of thought and practice styles

This proposal is to change === Straights and mixers === to === Schools of thought and practice styles === and to expand the intro paragraph to the section.

Chiropractic originated from mystical ideas which led to internal conflict within the profession. Chiropractors have historically fallen into two main groups, "straights" and "mixers"; both have had splinter groups. Chiropractic is often described as two professions masquerading as one. Unlike the distinction between podiatry (a science-based profession for foot disorders) and foot reflexology (an unscientific philosophy which posits that many disorders arise from the feet), in chiropractic the two professions attempt to live under one roof. Significant differences exist among the practice styles, claims and beliefs of various chiropractors.

Comments on Schools of thought and practice styles

Here is a proposal to expand the intro of the Straights and mixers section. You are free to edit the above proposal. Unlike the current version, this version tells a story. QuackGuru (talk) 06:50, 4 May 2009 (UTC)

The mystical origins should be specified. Palmer was a spiritualist who claimed to have gotten his ideas from the spirit of a Dr. Atkins, who had been dead for 50 years. That's where he claims to have gotten his "one cause, one cure" idea. In reality he most likely got his ideas from observing traveling medicine men and his education at A. T. Stills Osteopathy school. -- Brangifer (talk) 07:18, 4 May 2009 (UTC)

What would be the best way to clarify this if clarity is needed. A wikilink and/or changing it from "mystical ideas" to "spiritual ideas". QuackGuru (talk) 07:25, 4 May 2009 (UTC)

For now I added a wikilink. QuackGuru (talk) 07:45, 4 May 2009 (UTC)

This is atrocious. I most certainly hope this most biased claptrap never enters this article. —Preceding unsigned comment added by 32.154.164.246 (talk) 08:40, 4 May 2009 (UTC)

You have a nice sense of humor. I appreciate it. QuackGuru (talk) 08:52, 4 May 2009 (UTC)

• Now that I've restored the longstanding "vitalism" text, doesn't that lessen the need to mention mystical ideas?
• The cited source explains that the quasi-mystical concepts it is referring to were folk medicine, magnetic healing, innate intelligence; the article already talks about magnetic healing and innate intelligence, and it's not clear it's worth saying it again in this subsection. A stronger case could be made that folk medicine (bonesetting) should be mentioned in History, or that the quasi-mystical stuff should be mentioned at the start of Philosophy.
• The proposals to mention the NACM and to rename the section have problems, as discussed in #Straights and mixers is too narrow above.

Eubulides (talk) 09:27, 4 May 2009 (UTC)

There is a need to mention the mystical ideas. This explains why there is internal conflict, splits among different groups, and different schools of thought. I think on page 94 of the Chiropractic book is mentions the different schools of thought, internal conflict, and describes the splinter groups. See Talk:Chiropractic/Archive 16#Lead for past discussion. There is a need to explain the mainstream chriopractic opposition to evidence basis and the minorty view. This explains why there are different groups. The section needs to tell a story. This is accomplished with this proposal. The reference being used to verify the text is the best reference to verify and explain why there is opposition from the mainstream view to the minority view. There is internal conflict and this is part of the story. QuackGuru (talk) 17:50, 4 May 2009 (UTC)

By the way, in the book Health Beyond Medicine: A Chiropractic Miracle on page 166 it says "Today there are four main groups of chiropractors: traditional straights, objective straights, mixers, and reforms. All groups, except reforms, treat patients using a system based on the technique of subluxation." QuackGuru (talk) 18:21, 4 May 2009 (UTC)

In the book A Consumers Guide to Alternative Medicine: A Close Look at Homeopathy, Acupuncture, Faith-Healing, and Other Unconventional Treatments on page 70 it says:

The main chiropractic organizations are the American Chiropractic Association (ACA), the straighter International Chiropractors Assocation (ICA), and even straighter Federation of Straight Chiropractic Organizations (FSCO) and World Chiropractic Alliance (WCA). They all promote chiropractic mythology and self-serving propaganda to the public and to legislatures. The ACA is by far the largest of the groups. In a recent poll, 65 percent of WCA members who responded said that their patient education material referred to subluxation as the "silent killer". While most chiropractors continue to promote the dogma that their manipulations can help in systemic ailments, there is no credible research to support the claim. A reformist group, the National Association for Chiropractic Medicine (NACM), requires applicants to a pledge to "openly renounce the historical chiropractic philosophical concept that subluxation is the cause of disease." Its members limit their practice to musculoskeletal problems and have denounced unscientific methods used by their colleages.

I propose we inlcude information about chiropractic associations. QuackGuru (talk) 19:52, 4 May 2009 (UTC)

Neither of these sources are nearly as reliable as Keating 2005. The Chiropractic Miracle book is promotional fluff (are we going to cite its "five secrets to superior health and longevity"? or "why a chiropractor may become your family doctor"?), and the Consumers Guide is ancient (1992). Please, let's come up with reliable sources in this area, preferably review articles in refereed journals. Eubulides (talk) 22:01, 4 May 2009 (UTC)

Mainstream chiropractors tend to oppose the minority view of limiting the scope of practice to an evidence basis from using manipulation and physiotherapy methods to treat only musculoskeletal disorders.

For now I moved this out of the proposal. QuackGuru (talk) 23:47, 4 May 2009 (UTC)

Here is another book. On page 9 it has information on various chiropractic organizations. Educational Opportunities in Integrative Medicine: The A-to-Z Healing Arts Guide and Professional Resource Directory. Does this book meet RS? QuackGuru (talk) 00:08, 5 May 2009 (UTC)

I dunno: that's a job-hunter's book, written by an MBA, for job categories ranging from ayurveda to yoga training. That can't be all that good a source for this topic. Eubulides (talk) 05:31, 5 May 2009 (UTC)

Please see #Differences among schools of thought and practice styles below. QuackGuru (talk) 02:18, 6 May 2009 (UTC)

Differences among schools of thought and practice styles

This proposal is to change === Straights and mixers === to === Schools of thought and practice styles === and to expand the intro paragraph to the section.

• Chiropractors have historically fallen into two main groups, "straights" and "mixers"; both have had splinter groups.<ref name=History-PPC/><ref name=Kaptchuk-Eisenberg/>

Part of the conclusion of the chapter on page 94: "The diversity of ideas in the profession defies comprehensive, but several more or less distinct grouping of principles may be identied. Among the more prominent of there are evidence-based chiropractic, traditional straight chiropractic, purpose-straight chiropractic. Differences among these schools of thought form the basis for intraprofesional disputes, and failure to coalesce around a shared set of principles has hampered formation of a united front for a interprofesional activity."

Part of the summary of the chapter on page 94: "The diversity of beliefs among chiropractors defies comprehensive description. However, several clustering of these ideas may provide a useful mental shorthand, and seem to parallel some of the major political divisions within the profession. The practicial (clinical) and ethical implications of these groupings (e.g., evidence-based chiropractic, traditional straight chiropractic, purpose-straight chiropractic) deserve thougthful study by the profession."

Keating JC Jr (2005). "A brief history of the chiropractic profession". In Haldeman S, Dagenais S, Budgell B et al. (eds.) (ed.). Principles and Practice of Chiropractic (3rd ed.). McGraw-Hill. p. 94. ISBN 0-07-137534-1. {{cite book}}: |editor= has generic name (help)CS1 maint: multiple names: editors list (link)

The text from Principles and Practice of Chiropractic verifies chiropractic has had splinter groups and specifically states there are "Differences among these schools of thought". The title Schools of thought and practice styles would be a good fit for the section name.

• Chiropractic originated from mystical ideas which led to internal conflict within the profession.<ref name=Ernst-eval/>

From Ernst 2008: "Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today."

Ernst E (2008). "Chiropractic: a critical evaluation". J Pain Symptom Manage. 35 (5): 544–62. doi:10.1016/j.jpainsymman.2007.07.004. PMID 18280103.

It is reasonable to specifically state chiropractic is rooted in mystical ideas which explains why there is internal conflict, splits among different groups, and different schools of thought. It establishes the historical reason for why the split exists. QuackGuru (talk) 02:18, 6 May 2009 (UTC)

• That quote from PPC verifies nothing about "splinter groups". The quote talks about groupings of principles, not of people. And it contains no implication that any of these groupings are splinter.
• Furthermore, the PPC quote says that "implications ... deserve thoughtful study"; i.e., it is a call for more research. Lots of papers call for more research; this is hardly a notable point and if anything indicates that any conclusions in this area are speculative or tentative.
• In short, the PPC quote does not at all verify the proposed text: it's quite a different point than the point made by the text.
• The section header "Schools of thought and practice styles" is verbose and confusing. It does not summarize the section; the section does not mention schools of thought and it talks about "practice styles" just once. In contrast, it mentions straights and mixers multiple times each. "Straights and mixers" is a much better title: not only does it it summarize the section more accurately, it uses more-vivid wording.
• The proposed text "Chiropractic originated from mystical ideas which led to internal conflict within the profession." might be reasonable, with some questions.
  1. Where would it be placed?
  2. Shouldn't the surrounding text be altered to avoid duplication?
  3. "Mystical ideas" should wikilink to Mysticism, not to Spirituality.
  4. The source would better support "has led" than "led", as the conflict is continuing.

Eubulides (talk) 04:17, 6 May 2009 (UTC)

Chiropractic originated from mystical ideas which has led to internal conflict within the profession.<ref name=Ernst-eval/>

The reader is not going to understand why divisions among chiropractors exists without this sentence in the article. I'm not sure how to alter it to avoid any perceived duplication. I propose this new sentence be the first sentence of the "Straights and mixers" or somewhere in the intro paragraph. QuackGuru (talk) 05:55, 6 May 2009 (UTC)

Oppose. This article already suffers a WP:WEIGHT violation through it's over-sourcing of Ernst (13x!). The last thing this article needs is yet another opinion from Ernst. -- Levine2112 ^discuss 07:11, 6 May 2009 (UTC)

The reader has no idea what caused chiropractic to have internal conflicts. The best thing for the "Straights and mixers" section is to explain this in the intro. QuackGuru (talk) 07:19, 6 May 2009 (UTC)

That's your opinion. Per my comment above, I disagree that it is the best thing for the article. -- Levine2112 ^discuss 07:32, 6 May 2009 (UTC)

Your argument is a good reason to include the information because you did not say anything was wrong with the text. Hopefully we can work together on improving this page instead of others getting involved. QuackGuru (talk) 07:44, 6 May 2009 (UTC)

Levine2112, where in the article does it explain what caused internal conflicts. We should not let the reader be blind to the historical reason which led to internal differences. QuackGuru (talk) 18:08, 6 May 2009 (UTC)

Levine2112, can you explain where in the article the reader will understand why chiropractic had internal conflicts. QuackGuru (talk) 21:21, 6 May 2009 (UTC)

(outdent) The proposed sentence summarizes (and is therefore largely duplicative of) the 1st paragraph of Philosophy. That paragraph therefore seems to be a better location for the sentence. But the other sentences of that paragraph need to be adjusted slightly; merely prepending the sentence to the paragraph would be jarring. Come to think of it, the 1st paragraph of Philosophy is largely duplicative of Straights and mixers. Perhaps we should take this opportunity to merge the two; this should let us trim some of the duplication while we're at it. Eubulides (talk) 15:58, 6 May 2009 (UTC)

Chiropractic's early philosophy was rooted in vitalism, spiritual inspiration and rationalism;<ref name=Keating05/> the early mystical ideas has led to internal conflict within the profession.<ref name=Ernst-eval/>

I'm not sure the best way to merge these two sentences but I gave it a try. I don't know what else needs merging between the two sections. For now I would like to finish this sentence or you could start a new thread with the proposed merge of both sections along with the new proposed sentence. QuackGuru (talk) 18:08, 6 May 2009 (UTC)

Surely it would be better to merge the "internal conflict" bit with the "However" later in that paragraph, as the "However" introduces the idea of conflict. Also, I would change "the early" to "these", and "has led" to "have led". I'll see what I can do about a more-ambitious merge proposal, but there's no rush. Eubulides (talk) 23:10, 6 May 2009 (UTC)

Chiropractic's early philosophy was rooted in vitalism, spiritual inspiration and rationalism;<ref name=Keating05/> these mystical ideas have led to internal conflict within the profession.<ref name=Ernst-eval/>

I'm not sure where the best placement is for this sentence but what I do know is that it will greatly improve the page. QuackGuru (talk) 00:07, 7 May 2009 (UTC)

Again, it's better to integrate this into the "However" sentence rather than in the 1st sentence (which is what was done in the previous comment). Eubulides (talk) 07:36, 7 May 2009 (UTC)

However, these mystical ideas have led to internal conflict within the profession;<ref name=Ernst-eval/> most practitioners currently accept the importance of scientific research into chiropractic,[21]

I'm not sure about placement of the text. QuackGuru (talk) 07:49, 7 May 2009 (UTC)

That's better, but it still doesn't flow smoothly. The reader should clearly understand that the conflict between the straights and the mixers comes from the disputes over whether the mystical concepts should trump science. Admittedly it won't be trivial to word this. Eubulides (talk) 19:49, 7 May 2009 (UTC)

I added the "mystical ideas" to the chiropractic history page. QuackGuru (talk) 22:55, 10 May 2009 (UTC)

A patient-centered approach?

Currently we have a list at the bottom of the Philosophy section that ends with a generic paragraph about "a patient-centered approach" that applies to all health care professions. So far so good:

• A patient-centered approach focuses on the patient rather than the disease, preventing unnecessary barriers in the doctor-patient encounter. The patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health.

That statement has some truth to it, but it shouldn't stand alone. The section is referenced, but I have had some trouble finding the source in that reference, and have found something that backs it up, but not completely:

• Page 87: "Holism also involves the belief that the patient is a potent and indispensable factor in recovery from disease and the maintenance of health. A corollary is the notion that the patient is ultimately responsible for her or his own health and illness." [34]

The reason it shouldn't stand alone is that it lacks a significant factor that exists in chiropractic, in glaring contrast to mainstream health care. It is also a major chiropractic criticism of mainstream health care. In the mainstream health care system, the patient's responsibility is primary, with the patient being responsible for their own preventive maintenance, only bringing the MD into the picture when things go wrong further down the line. This is done by the patient keeping abreast of the latest knowledge published by scientists, MDs, and other allied health professionals, as reported in the media and public health materials. In chiropractic, the chiropractor is at the top of the line, with the patient being educated to seek the chiropractor, regardless of whether they have any objective health issues, since the fact that they exist means they have dangerous vertebral subluxations, and only a chiropractor can fix them. Thus chiropractic adjustments become a preventive treatment that is required on a regular basis. A good portion of the patient's responsibility is thus moved to the chiropractor, resulting in a chiropractor-centered approach.

To balance the current listing, we need to tweak the current wording with a slight addition:

• A patient-centered approach focuses on the patient rather than the disease, preventing unnecessary barriers in the doctor-patient encounter. The patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health. This is an approach shared with the mainstream health care system.

and then add another paragraph that makes it all relevant and specific to chiropractic:

• A chiropractor-centered approach that incorporates the chiropractor as an important part of the patient's preventive health maintenance, since chiropractors educate their patients to believe that they all have dangerous vertebral subluxations, and that only a chiropractor can treat them through the regular use of chiropractic adjustments.

The reference for this approach is found here:

• Page 212: "Paternalism places authority in the hands of physicians to decide upon the needs for a patient, or to lead a patient substantively to a decision, as long as they place the needs of the patient above their own needs or the needs of others. Paternalism allows a physician to coerce a patient into making choices that serve the patient's best interests.... Paternalism does not alleviate the duty to relate truthfully and forthrightly with patients. A physician who feels strongly about a test or treatment might be tempted to "simplify" the decision variables to suit the physician's desired outcome, especially if the physician is concerned that the patient may not be entirely cooperative or clear about complicated information. The temptation to provide a simple lie instead of a complicated truth is a difficult position, ...." [35]

While the above applies to all physicians, it applies in a special manner to chiropractic, as it is there one finds the unique concept of adjustments as a necessary preventive measure. I have deliberately chosen the portions of the quote that apply to the reality of what is seen in chiropractic practice. The part about a "simple lie" would be recognized as true by skeptics and denied by chiropractors, since all but a very few believe it is true that subluxations are a major causative factor in disease. Chiropractic patient education is directed at convincing the patient of the truth of this historical chiropractic dogma, and the most glaring examples are found in the highly profitable practice building industry. Here patient education scripts are copyrighted and closely guarded tools that are sold for high prices to clinic owners. Here every word is weighed and designed to turn patients into customers for life, and any employee who deviates from the script can get fired. Complete patient compliance with the established treatment plan is the name of the game.

So what we need is a small tweak and an added paragraph. It can be sourced with appropriate chiropractic references (not necessarily the ones about scripts ;-).

-- Brangifer (talk) 22:41, 25 April 2009 (UTC)

Nice original research. --Hughgr (talk) 23:36, 25 April 2009 (UTC)

Not when it gets properly referenced. Right now this is a proposal on the talk page and before it can be used it needs sourcing. As a chiropractor, you of course recognize that what I've written is true, so the next step is to stop making accusations of OR and to help source it. That would be collaborative and make the entry more NPOV. BTW, the whole subject of practice building hasn't been touched.... -- Brangifer (talk) 00:32, 26 April 2009 (UTC)

I'm new here but this does not seem like a productive way to write an entry. BR has come up with an original premise and then expects others to find research which correlates with the supposition. That's ass backards. Or is that how it's done here? - MSchreiber —Preceding unsigned comment added by 32.174.185.155 (talk) 02:40, 26 April 2009 (UTC)

I agree with Hughgr and 32.174.185.155. Plus, this article is long enough. Plus.. I don't think that mainstream medicine is "patient-centered" in the way that BullRangifer has defined. If they were, they wouldn't be putting people with no evidence of heart disease on statins for the rest of their life. If you want to contrast mainstream medicine with chiropractic medicine, then contrast the risks of pain killers (which alleviate pain, but don't cure anything, and you have to keep going to the doctor to get painkillers if you have chronic pain), surgery [36] (time out of work, success rate, etc.). I'm sure there are statistics on that. Even with that... I'm not sure that really falls in the scope of this article. Perhaps the whole subject of contrasting mainstream medicine vs chiropractic for the conditions that chiropractic handles could be the base of another article. --stmrlbs|talk 07:32, 26 April 2009 (UTC)

I too agree with Hughgr and the IP editor. Further, Stmrlbs has a good point about mainstream medicine not necessarily being patient-centered. Certainly, chiropractic tends to be more pro-active (preventative), but it also is used to treat patients with complaints/existing symptoms. I'd even venture to guess that more patients come to chiropractors to treat existing conditions than those who come in as a preventative measure. -- Levine2112 ^discuss 01:36, 27 April 2009 (UTC)

Would it fix matters if we were to follow the cited source better? It presents the sea change in patient attitudes towards health care from practitioner-centered (old paternalistic model) topatient-centered as part of how our society is changing, with chiropractic poised to take advantage of the movement.

Failing that, rather than digress into a discussion of medicine, why not simply remove the termpatient-centered? It is really a non-term, meaningless fluff which does not increase reader understanding on any point, and will need to be nixed or fixed if we ever want this article to pass FA. Read the sentence replacing A patient-centered approach with The chiropractic approachto see what I mean. - 2/0 (formerly Eldereft) (cont.) 18:09, 28 April 2009 (UTC)

That would certainly be the simplest way to improve the paragraph, without dealing with the obvious lack as described. We could do that for now, and if we ever wish to really improve this, deal with the other as a separate matter later. It still has wording which I don't find in the source. -- Brangifer (talk) 01:40, 29 April 2009 (UTC)

Tagged as {{Not in source}} - Keating only mentions patient-centered in the context of why vitalism interferes with positive treatment outcomes. Checking the other references for that section to see if I can find where that language originates. - 2/0 (formerly Eldereft) (cont.) 18:30, 29 April 2009 (UTC)

It's in Mootz & Phillips 1997, which was cited at the start of that list and I guess needs to be cited for this list entry as well. I added a citation and removed the tag. Eubulides (talk) 19:38, 29 April 2009 (UTC)

Thanks for clearing up the source of the "patient-centered" wording. Now the OR needs fixing. It is placed in an order not in the source, and uses wording not there about in what manner it is patient-centered. The source should be followed, in lieu of OR.

That source also contains wording that backs up my "chiropractor-centered" approach. It is explicitly stated by the chiropractic authors in this section: "Table 2. Range of Belief Perspectives in Chiropractic".

The authors contrast "doctor/model-centered" with "patient/situation-centered". Both approaches are used in chiropractic, and both should be mentioned. The second is used by some, and is an ideal, not a description of the real state of affairs among all chiros.

There we have the straight model which I have described, and which is practiced by straights and many, if not most, mixers, and the mixer approach which is used by a few mixers who practice the ideal which is described. It's an ideal, not a description of real practice. The description of the straight method is a desription based on long historically proven methods used by most chiropractors, who have been straights until more recent times. So there is a good source for my description. That section needs to be added and ascribed to straights, while the existing "patient-centered" approach part should be ascribed to mixers. -- Brangifer (talk) 02:52, 30 April 2009 (UTC)

Sorry, I don't see a specific proposal here, and I'm having some trouble following the previous comment. Among other things, it's not necessarily WP:OR to discuss topics in a different order than the source. Eubulides (talk) 06:16, 30 April 2009 (UTC)

Sorry for causing confusion. I have tweaked my comment above.

My proposal is to tweak the original "patient-centered" point and to add another one about "chiropractor-centered", since the "patient-centered" one applies to mixers, and the "chiropractor-centered" one applies to straights, according to "Table 2...". Since both groups are part of chiropractic, we shouldn't only mention one as if they represent all of chiropractic. We know and have sources that confirm that straights have a far greater influence than their numbers would imply. The wording of my proposal above isn't final, and can be discussed and should probably be tweaked, but the general gist needs to be used. It would also need more sourcing for certain parts of it, but they are true and can be documented.

The OR is in the way things that are listed separately in the original source are here placed in a different order and connnected as if one was conditional and dependent on the other. There is no such connection made in the source, and that's synthesis/OR. -- Brangifer (talk) 14:40, 30 April 2009 (UTC)

Sorry if I'm slow, but I still don't see a specific wording proposal in the (adjusted) "Thanks for clearing up the source" comment, i.e., a proposal that says something like, "In Chiropractic #History, change the text 'a b c' to 'd e f'." Since Chiropractic reproduces all of the source's Table 2, I don't see how Chiropractic can be criticized as unfairly weighting part of Table 2. Also, other than Table 2 I don't see anything in the source that talks about a "doctor-centered" or "chiropractor-centered" approach, so if we add text about a doctor- or chiropractor-centered approach then we would be emphasizing that idea more than the source does, no? Eubulides (talk) 16:52, 30 April 2009 (UTC)

Straights and mixers

I wasn't making any criticism of our article here for "unfairly weighting" the table, which does happen to be reproduced in the article. When I look at the article as a whole (which I wasn't doing), rather than focusing on the four points immediately preceding the table, I think the solution would be to simply remove the last point about "patient-centered" since it doesn't say anything that's unique to chiropractic, and is simply promotional fluff, and an ideal which all health care professions aspire to reach. The table presents both approaches. I do wonder about why there are four bulleted points, when there are other points in the immediately preceding text that could just as well be bulleted. It seems the bulleted points are partial duplication of things mentioned above them. Why not just eliminate the bulleting and then combine like subjects?

My proposed addition would not be used at this time. It could still be useful if we decided to fill in the existing hole in the article, which exists because we are not dealing with the effect of a practice building mentality, which makes much of chiropractic practice more "chiropractor-centered" than "patient-centered".

The next section does need two subheadings to make the straight and mixer sections more noticeable. They are very important. On any other website we would simply make them bold, but here that isn't according to MoS, and italics just isn't clear enough. I suggest two simple headings. I'll try it and we can see how it looks. -- Brangifer (talk) 03:10, 1 May 2009 (UTC)

• I could certainly go along with the proposal for "patient-centered". As I understand it, you'd combine the 2nd and 3rd (bulleted) paragraphs of Chiropractic #Philosophy, eliminating the "patient-centered" bullet and combining the other bullets into paragraph text. Care to take a stab at a draft?
• The new "Straight chiropractic" and "Mixer chiropractic" subheads have problems. They repeat the article title (which is frowned upon by the MOS) and they nearly repeat the first words of the following paragraphs, which is offputting. I suggest eliminating them, and instead, replacing the subhead Schools of thought and practice styles with Straights and mixers. There are a lot of things to like about Straights and mixers: it's shorter, more informative, and more vivid than the subhead it would replace.

Eubulides (talk) 03:37, 1 May 2009 (UTC)

• I'll make a try of it here and we can work on it.

• Someone has already changed what I did, and it might be better. I did it the way I did to keep the TOC from getting too long, but it is actually rather short for such a large article. The main subheading provides context for why we mention straights and mixers, so it's important. A good TOC can actually summarize an article if it's made properly. This section used to be much more informative, but now it fails to mention some schools of thought, largely due to attempts to censor information and make the article read like a sales brochure. Notability and an abundance of RS were ignored and trashed. Too bad. The article is poorer for it.

-- Brangifer (talk) 05:11, 1 May 2009 (UTC)

• I'm afraid the change, while an improvement over the non-TOC section headers, is still not the best. The article shouldn't have single-paragraph sections, which is what the recently-introduced Straights and Mixers sections are; that's too stubby. And the article shouldn't have sub-sub-sections at all; it's not that big an article.
• If memory serves, the schools of thought you're thinking of no longer exist, or at least, we have no reliable source saying they currently exist. Coverage of these schools may be appropriate for History but they're not that appropriate for a Schools of thought section.
• The section's text is about straights and mixers; the title Schools of thought and practice styles is not only verbose, but a bit misleading (the phrase "school of thought" appears nowhere in the section's contents, for example).
• For now, I renamed the subsection to Straights and mixers and removed the subsubsection headers Straight and Mixer. This addresses the concerns mentioned above.

Eubulides (talk) 06:13, 1 May 2009 (UTC)

Proposed revision

From the Philosophy section:

Chiropractic philosophy includes the following perspectives:

• Holism assumes that health is affected by everything in people's complex environments; some sources also include a spiritual or existential dimension. In contrast, reductionism in chiropractic reduces causes and cures of health problems to a single factor, vertebral subluxation.

• Conservatism considers the risks of clinical interventions when balancing them against their benefits. It emphasizes noninvasive treatment to minimize risk, and avoids surgery and medication.

• Homeostasis emphasizes the body's inherent self-healing abilities. Chiropractic's early notion of innate intelligence can be thought of as a metaphor for homeostasis.

• A patient-centered approach focuses on the patient rather than the disease, preventing unnecessary barriers in the doctor-patient encounter. The patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health.

I propose we delete the last bulleted point, but am uncertain as to whether it would be a good idea to combine the other three into a text version. Maybe we should just keep them. -- Brangifer (talk) 05:25, 1 May 2009 (UTC)

Keeping them would be OK. So, the only proposal on the table is to delete the last bullet. That's also OK with me. Eubulides (talk) 06:15, 1 May 2009 (UTC)

Fine. -- Brangifer (talk) 06:19, 1 May 2009 (UTC)

I made this change to match the proposed revision. QuackGuru (talk) 19:03, 6 May 2009 (UTC)

No specific objection to remove the questionable text was made. So I removed it. QuackGuru (talk) 21:10, 6 May 2009 (UTC)

I don't see any justification for the deletion of the last bullet. -- Levine2112 ^discuss 21:28, 6 May 2009 (UTC)

I don't see any reason being given to keep the last bullet. QuackGuru (talk) 21:29, 6 May 2009 (UTC)

It was clearly explained why we should remove it. QuackGuru (talk) 21:37, 6 May 2009 (UTC)

There was agreement for this edit. But editors only after the edit was made then it was disputed for no specific reason. No reason has been made to keep it. QuackGuru (talk) 00:30, 7 May 2009 (UTC)

For now I tagged the obsolete information. No reason has been given to keep the last bullet. QuackGuru (talk) 08:08, 7 May 2009 (UTC)

What is the specific objection to this text? -- Levine2112 ^discuss 15:40, 7 May 2009 (UTC)

It was previously explained the reason to remove it. What is the specific reason for keeping the text. QuackGuru (talk) 17:49, 7 May 2009 (UTC)

I disagree that it is original research. The sources quite clearly support the text. (i.e. "emphasizes a patient-centered, hands-on approach intent on influencing function through structure" from refname Chiro Beliefs and "Holism also involves the belief that the patient is a potent and indispensable factor in recovery from disease and the maintenance of health." from refname Keating05) -- Levine2112 ^discuss 18:12, 7 May 2009 (UTC)

That's your opinion. Anyhow, no specific reason has been made to keep it. QuackGuru (talk) 18:17, 7 May 2009 (UTC)

That's no opinion. It's a fact that the sources directly support the two statements. Do you really believe otherwise? -- Levine2112 ^discuss 18:38, 7 May 2009 (UTC)

It is a fact the text is not neutral in tone and promotional. Why keep it? QuackGuru (talk) 19:08, 7 May 2009 (UTC)

no specific reason has been made to keep it? how about the reason that we dont just go around deleting sourced information? what is the problem with this text? why is it questionable text? 70.71.22.45 (talk) 18:41, 7 May 2009 (UTC)

Villanueva-Russell Y (2008). "An ideal-typical development of chiropractic, 1895–1961: pursuing professional ends through entrepreneurial means". Soc Theory Health. 6 (3): 250–72. doi:10.1057/palgrave.sth.8700104.

Grod JP, Sikorski D, Keating JC (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)

Singh S, Ernst E (2008). Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. p. 170. ISBN 978-0-393-06661-6.

Other sources disagree chiropractic is a patient centered approach. The text is puffery. QuackGuru (talk) 19:08, 7 May 2009 (UTC)

So by your logic, we should leave out the material because is it disputed by other sources. So in essence, the sources for inclusion here are cancelled out by the sources for inclusion of the #Brochure information below. So if you truly believe that one refutes the other, then you must agree that the sentences proposed below in "Brochure" should be left out because it is refuted by the sources used for inclusion here. Agreed? -- Levine2112 ^discuss 19:19, 7 May 2009 (UTC)

The information seems dated. For example, The "Chiro Beliefs" cites: Palmer, DD. The Science, Art, and Philosophy of Chiropractic. Portland, OR: Portland Printing House, 1910. 1910 is very old. The text is promotional jargon. We have better sourcing available and proposed text which is not promotionally written. QuackGuru (talk) 19:33, 7 May 2009 (UTC)

You keep changing your argument everytime I refute your previous one. What is your objection truly? (BTW "Chiro Beliefs" is a source published in 1997. Not too old at all for the context of what it is sourcing, so please tell me that you are not objecting this text based on the age of the source.) -- Levine2112 ^discuss 19:50, 7 May 2009 (UTC)

The existing text is well-sourced, but there is a reasonable concern that it is one-sided. As mentioned previously, are also reliable sources saying that chiropractic is in part "chiropractor-centered" rather than "patient-centered". One way to fix the text (the better way, I think) is to present a balanced approach of both views. The other option is to remove the existing unbalanced text. Eubulides (talk) 19:49, 7 May 2009 (UTC)

The most reasonable option is to remove the puffery. We have better sourcing available. QuackGuru (talk) 20:34, 7 May 2009 (UTC)

I opposed this option based on arguments already given. No need to continue this circular argument. -- Levine2112 ^discuss 20:42, 7 May 2009 (UTC)

You have not given any good reason to keep the text. But editors have explained why it should be removed. QuackGuru (talk) 20:48, 7 May 2009 (UTC)

I removed the disputed text. QuackGuru (talk) 22:55, 10 May 2009 (UTC)

No explantion was given to restore the disputed text. QuackGuru (talk) 19:41, 11 May 2009 (UTC)

Explanations are given above. The text is well-sourced. There is a discussion to modify the text, but there certainly is no consensus to remove the text. -- Levine2112 ^discuss 19:47, 11 May 2009 (UTC)

Explanations was given to remove it. No specific proposal has been made to modify it and there is consensus to remove it. QuackGuru (talk) 19:50, 11 May 2009 (UTC)

Better sources for practice-building

I agree that better sources are needed, as the text and sources proposed above are far too much like original research to be acceptable for Wikipedia. I also agree that the topic of practice-building should be addressed in Chiropractic, as it's an important part of the profession. I suggest the following sources (most of which I currently lack access to and have not read):

• Baer HA (1996). "Practice-building seminars in chiropractic: a petit bourgeois response to biomedical domination". Med Anthropol Q. 10 (1): 29–44. PMID 8689442.
• Grod JP, Sikorski D, Keating JC (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)
• Villanueva-Russell Y (2008). "An ideal-typical development of chiropractic, 1895–1961: pursuing professional ends through entrepreneurial means". Soc Theory Health. 6 (3): 250–72. doi:10.1057/palgrave.sth.8700104.
• Singh S, Ernst E (2008). Trick or Treatment: The Undeniable Facts about Alternative Medicine. W.W. Norton. ISBN 978-0-393-06661-6. On page 170 this book says "For example, chiropractors, particularly in America, have hearned a reputation for zealously recruiting and unnecessarily treating patients. Practice-building seminars are commonplace and there are numerous publications aimed at helping chiropractors find and retain patients. In many cases the emphasis seems to be placed on economics rather than healthcare .... Many chiropractors are embarrased by the zealous profiteering of their colleagues....

Eubulides (talk) 05:57, 26 April 2009 (UTC)

Treatment of patients

I made this change and this change to get the ball rolling. QuackGuru (talk) 20:10, 6 May 2009 (UTC)

As Schumpeter (1961) suggested, entrepreneurs should rightly pursue profit, however this was not the sole objective of the endeavor. Profit was not to be denied as a goal, but in the end, was only a fringe benefit of an underlying service ethos for chiropractors. Vedder (1924) asserted that chiropractor's training created a duty for chiropractors to disseminate their enlightened knowledge with others. 'Knowing that he has the ability to relieve distress and suffering and pain and sickness it becomes not only a privilege to do so, but an obligation and it likewise becomes an obligation for him to apprise the greatest number of people of that ability' (p. 78). If patients had to be 'sold' in order to agree to care, this commercial trickery was justified because chiropractors were obligated to convert all patients to their paradigm of health.

After all, chiropractors were simply being honest and forthcoming about their advertising and salesmanship. Orthodox medical practitioners also advertised, but attempted to obscure the practice. Medical doctors often had their pictures in the newspaper performing some service and this was no more than a subtle form of free advertising (Dye, 1939, p. 238). Gilmore (1960) asserted that osteopaths and medical doctors were 'openly and vigorously promoted by the various drug firms from which they obtained their prescribed medicines.' And surgeons also, utilized a form of salesmanship involving fear and the desperation of the client: 'Surgeons 'sell' their services, too – they say surgery is absolutely needed and people are willing to bear great expense, pain, and threat of death in pursuit of health'(Johnson and Johnson, 1928, p. 46–47). Chiropractors who repudiated medicine and rejected professionalization in favor of entrepreneurial means felt such practices were justified, honest and righteous, and therefore, deserving of the public's trust.

Villanueva-Russell Y (2008). "An ideal-typical development of chiropractic, 1895–1961: pursuing professional ends through entrepreneurial means". Soc Theory Health. 6 (3): 250–72. doi:10.1057/palgrave.sth.8700104.

Here is some information from the source. QuackGuru (talk) 20:32, 6 May 2009 (UTC)

A recent pair of edits added new text to the article. Any suggestions on where is the best place to put it and improve the text would be appreciated. This article may help improve this page too. QuackGuru (talk) 00:42, 7 May 2009 (UTC)

The largest chiropractic associations in the U.S. and Canada distributed patient brochures which contained unsubstantiated claims. Chiropractors, especially in America, have a reputation for unnecessarily treating patients. In many circumstances the focus seems to be put on economics instead of health care.

Here is the proposal. QuackGuru (talk) 03:41, 7 May 2009 (UTC)

I commented on this in #Brochures below; please follow up there. Eubulides (talk) 07:36, 7 May 2009 (UTC)

CONTINUED BELOW

References

(The following resolve otherwise-dangling references: )