Talk:Chiropractic/Archive 35

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Criticsm of chiropractors

I added a section to the lead incorporating the criticisms of chiropractors. If anyone feels like I missed something or there is undue weight on this section we can comment here. DVMt (talk) 23:10, 13 January 2013 (UTC) Edit: Arc de Ciel removed my edit on criticism of chiropractors without any discussing it at talk like the rest of the editors are doing here with disagreements. Are any editors not in favor of addressing critical components of chiropractic in the lead? If not I'm going to continue with BRD! DVMt (talk) 23:35, 13 January 2013 (UTC)

BRD is not something you "continue with" - you keep discussing on the talk page until there is a consensus. I intervened only in response to the fact that you were already edit warring. Arc de Ciel (talk) 23:48, 13 January 2013 (UTC)

I'm discussing the edits on talk. Edit warring is strong accusation, which I reject. If you're talking about being bold, reverting, discussing changes and inserting changes from the original edit and repeating the process as concerns come up, that's how we are supposed to edit at WP. What I find contentious is your "intervention" which removes a direct quote from the WHO and removing verifiable information which I have provided from the sources. If you care to discuss your concerns specifically and provide alternative solutions please feel free to do so. If you're objecting without providing as to what your specifically objecting too, much like Alex, than your reverts are disruptive in nature since you're not engaging involved editors with specifics. DVMt (talk) 00:01, 14 January 2013 (UTC)

You're quickly progressing down the typical WP:TE editor path, and for your information there isn't anything but a big permanent ban waiting at the end of that road. — raekyt 00:13, 14 January 2013 (UTC)

Your accusation is disingenuous for a TE would not advocate for more criticism in the lead. User:DVMt

Is chiropractic a 'health profession'?

Your removal of health profession from the lead was an error since you're personal POV is that chiropractic=quackery. A health profession, by definition is considered to be regulated. Since chiropractic is a regulated in the countries where it is allowed to practice it fulfills the profession criteria. Unless you're suggesting that chiropractors are not involved in health care. Please clarify. DVMt (talk) 00:22, 14 January 2013 (UTC)

I think they're a step above crystal healers, and the WHO source does not use the phrase "health profession" to describe the practice. — raekyt 00:24, 14 January 2013 (UTC)

We're not supposed to be using opinion as fact that's what the sources are for. So your opinion on chiros being crystal healers and others thinking they're the best thing since sliced bread is irrelevant. If I can find a source that denotes they are a health profession per WP:V wouldthat satisfy you? DVMt (talk) 00:32, 14 January 2013 (UTC)

You see me inserting opinion into the article? No? Then its irrelevant. Such a source would need to be pretty authoritative and independent. — raekyt 00:34, 14 January 2013 (UTC)

Here [1] is the reference as requested. It appears in a medical journal. Meets WP:MEDRS and is V. Agreed? DVMt (talk) 00:45, 14 January 2013 (UTC)

Another POV edit from the WP:SPA! Big surprise. Anyway, we also have a reference calling it quackery, yet we don't say Chiropractic is complementary and alternative medicine quack profession... TippyGoomba (talk) 00:56, 14 January 2013 (UTC)

Reviewing your brief edit history, TippyGoomba, it is more likely that you are a WP:SPA. 67.127.253.101 (talk) 18:05, 14 January 2013 (UTC)

So, again, the edit is not being discussed on merit but rather personal accusations. That's twice today TG, you're forgetting WP:CIVIL? "We also have a reference calling it quackery". What is "it"? Chiropractic? Anyways, I provided proof and it's a ref already being used within the article so it can't be disputed. DVMt (talk) 01:06, 14 January 2013 (UTC)

Multiple reliable sources call Chiropractic a health profession, I have listed multiple high-quality sources below to provide WP:V. This information belongs in the article according to policy.

1. From the WHO source Glossary: "Chiropractic - A health care profession concerned with....."
2. From a Provincial government source: "Chiropractic has been a designated health profession under the Health Professions Act...."
3. Peer reviewed source in Archives of Internal Medicine:"Chiropractic, the medical profession that specializes in..."
4. From NIH/NCCAM: "Chiropractic is a health care profession that focuses on..."
5. From private insurance company WSIB: "The WSIB has completed a review of the fees paid to 12 health professions." *Note that chiropractic is #3 on the list of 12 health professions.

Are there any high-quality sources available that call the profession as a whole 'quackery'? If so, then according to policy, we also need to mention this description. However, I can only find such a statement from Ernst, a bunch of skeptic blog sites and some vanity-press publications like 'Trick or Treatment'. I cannot find any international medical organizations, governments, or secondary sources that say "Chiropractic is Quackery".Puhlaa (talk) 01:04, 14 January 2013 (UTC)

Indeed these sources are V and MEDRS compliant. I have reinserted the health care profession per our discussion. Can dissenters prove that chiropractic is not a CAM health care profession? If not I suggest they refrain from tendentious editing based on personal beliefs as opposed to what the sources actually say. DVMt (talk) 01:19, 14 January 2013 (UTC)

Two POV pushing WP:SPAs do not a consensus make. I'll not bother to quote policy, you've both read and/or ignored it all by now. TippyGoomba (talk) 01:48, 14 January 2013 (UTC)

Tippy you're being uncivil with your commentary and tendentiously editing. Raeky asked for verifiability and proof that it was a CAM health care profession. The material was provided by Puhlaa and myself. You ignored it and reverted it. On what grounds or you reverting the sourced content? Are you disputing the source? I'd ask kindly that you that you stick to the edit and not try to continue discrediting other editors and creating straw man arguments. — Preceding unsigned comment added by DVMt (talk • contribs) 01:54, 14 January 2013 (UTC)

WP:CONSENSUS overrides almost all other content policies. It's hard to advocate this as a valid medical health care profession that actually treats something, and isn't just a big scam that says it does far more than evidence says it does. There's almost no evidence it actually does anything, and definitely nothing that says it does it better than other medical treatments. — raekyt 02:03, 14 January 2013 (UTC)

You have failed to address the content change and wanted V and authoritative sources which were provided. Please discuss content and not your personal feelings. The claim isn't that it is a "valid" medical profession. It's rather that Chiropractic is a CAM health care profession. Do you disagree with the sources provided that confirm this? Regarding your statement "there's almost no evidence it does anything" you can read the effectiveness section which specifically states conditions (mainly MSK) conditions chiropractors treat. Again, I'd ask for you to stick to the WHO source which did in fact state "health care profession". I provided you with another ref and he provided another 4 for a total of 6. DVMt (talk) 02:11, 14 January 2013 (UTC)

A CAM health care profession. Kind of like military "music"? TippyGoomba (talk) 02:17, 14 January 2013 (UTC)

TippyGoomba and Raeky, you have both removed sourced text from the article [2] [3], even though the text has been verified with multiple reliable sources. You have not provided any high-quality sources to suggest that Chiropractic is not a health profession? You have also not provided any policy to support your insistence that the article exclude the verifiable fact that chiropractic is a health care profession? Can someone please provide a high-quality source that contradicts the idea that chiropractic is a health care profession, or challenge the inclusion of this fact with a policy, so that we can have a real discussion about the inclusion of this text. Tippy, you are building a reputation of making personal attacks here; however, none of your comments on this page seem to include policy or sources? Please keep your comment about sources and text. Puhlaa (talk) 02:25, 14 January 2013 (UTC)

WP:CONSENSUS, is it a health care profession when all you can MAYBE show is a marginal improvement in lower-back pain, everything else no scientific evidence that it has any measurable affect? I don't think so. — raekyt 02:27, 14 January 2013 (UTC)

I disagree with your interpretation of WP:CONSENSUS. TG is again making straw man and red herring and not discussing content which is a sure sign of that he is editing tendentiously while being uncivil. Raeky is using a smokescreen technique where he/she is not discussing the source but rather giving us his/her personal opinion on the subject. When a source is quoted verbatim (CAM health care profession) and it has been found to be V and MEDRS compliant you can just delete it because it conflicts with your belief system. Do you dispute the WHO (or other sources that you requested for proof) or not? It seems like you may be stonewalling here. I hope that isn't the case so I look forward to your reply. DVMt (talk) 02:34, 14 January 2013 (UTC)

A fascinating article on this very topic is here. I think the thrust of this piece is that within the healthcare world, chiropractic is a "marginal profession", having an internal debate about whether it wants to become mainstream or not ("everyday chiropractors are content with the current status quo as marginal professionals, wishing to remain tied to the traditionalist lexicon and an expansionist range of application and treatment authority"). Alexbrn ^{talk|contribs|COI} 12:23, 14 January 2013 (UTC)

And another very interesting source here: Attitudes towards chiropractic: an analysis of written comments from a survey of north american orthopaedic surgeons Alexbrn ^{talk|contribs|COI} 13:53, 14 January 2013 (UTC)

Trick or Treatment is not vanity press, it is a book published by a respected publishing house and written by two known and respected scholars - Singh a respected skeptic, Ernst the only professor of CAM in the world. The Archives of Internal Medicine article is from 2002, at 10 years old it's not the best source. The remaining sources are questionable and borderline, and would be better if they could be supplemented or replaced with recent scholarly publications. The 2011 article presented by Alexbrn is interesting, but primary; it could be used, but with care. It does present some interesting points though.

In situations like this, where the subject is neither wholly one thing, nor the other, the best is to present both perspectives, with discussion. Chiropractic is not wholly quackery, nor can it cure cancer or infectious diseases. There is evidence supporting chiropractic being useful in the treatment of musculoskeletal pain, primarily lower back pain. There is no evidence supporting other uses, particularly acute infections but many other complaints - but despite this, many chiropractors claim they can cure the 'flu, cancer and the like. A properly neutral page should explore both these perspectives using reliable sources - of which I am sure there are many. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:14, 15 January 2013 (UTC)

Thanks for commenting WLU. I see what you're saying but I'll simplify the argument. Is chiropractic a profession yes or no? Profession simply means it is regulated by law. If it's not a profession (CAM profession) then what is it? DVMt (talk) 02:21, 15 January 2013 (UTC)

I'd say it was a profession (in the sense of "you get paid for it"); but the question is whether the term "healthcare profession" is most apt. From this source, which explicitly addresses that issue, it seems "marginal healthcare profession" would be the most accurate, apt term we could pick. Alexbrn ^{talk|contribs|COI} 03:35, 15 January 2013 (UTC)

I Agree with DVMt; we are trying to determine if chiropractic is a health profession. I provided numerous sources that say it is a health profession; WP:RS says that the sources I provided, such as the WHO source and NIH/NCCAM are reliable.

I Agree with Alexbrn, chiropractic is definitely a healthcare profession; I also agree that it is still a marginal healthcare profession. The reliable source Alexbrn presented says: "In health care, orthodox medicine has professional dominance and possesses the largest jurisdiction,... Complementary and Alternative Medicine (CAM) has established itself as a “marginal profession” in relation to this framework." Thus, chiropractic is indeed marginal, because it is not part of the mainstream, it is CAM. As such, we could say chiropractic is a marginal healthcare profession OR chiropractic is a CAM healthcare profession, these are the same thing according to the source. However, I think 'complementary and alternative' is more informative to the reader than 'marginal'. In the last stable version of this article, the first sentence of the lead said "Chiropractic is a complementary and alternative medicine health care profession....".Puhlaa (talk) 05:22, 15 January 2013 (UTC)

Not sure if this source is being considered yet: American Public Health Association. With quote such as, "To promote collaboration between chiropractic and other health care professions" – I believe it is clear that this source considers Chiropractic to be a health care profession.

Further, Wikipedia agrees that a health care provider is "...an individual or an institution that provides preventive, curative, promotional, or rehabilitative health care services in a systematic way to individuals, families or communities." By that definition alone, it is clear that chiropractic is a health care profession; even if just limited to what is scientifically verifiable (MSK and what not). I seem to remember that there is some Wikipedia guideline that states that we don't even need a source to state something which is plainly obvious. (Something like: In France, they speak French.) I am not sure what's at play here, but it is an obvious matter of fact that chiropractic is a health care profession. Ample reliable sources have been provided to verify this fact even though this obvious fact requires no verification. 68.122.28.165 (talk) 22:42, 15 January 2013 (UTC)

That is a good source IP 68.... I agree that it's obvious that it is a health profession (CAM of course). The arguments being made by TG, Raeky and Alexbrn is to ignore what all these sources say. They haven't stated or proven that it is not considered a 'profession' or even WHY they're disputing that it NOT a profession despite finding several sources in doing so. Given that the APHA is a credible. non-chiropractic source, I'm going to add it to the lead. I have read your previous posts here on TALK and you seem like a level-headed editor. Your input on these ongoing discussions would be great even though you fear retribution for using your actual handle. That is a sad commentary on the state of WP when you're bullied into not using your own name. Given some discussions with certain editors here, I can see why you chose that path. DVMt (talk) 01:07, 16 January 2013 (UTC)

Here are a few more secondary sources that indicate that chiropractic is indeed a health care profession:

1. This source says: "Chiropractic is the best established of the alternative health care professions."
2. This source examined the attitudes/behaviours of health care professionals, of which, chiropractic is included.
3. This source says: "many patients seek care directly from health-care professionals other than their family doctor; for example, at least one third of back pain patients in Denmark now choose to see a chiropractor as their..."

Is anyone still objecting to having the article indicate that chiropractic is a complementary and alternative health care profession? If so, an argument based on a reliable source or policy would be appreciated so we can move forward. Puhlaa (talk) 05:17, 16 January 2013 (UTC)

1. This paper isn't peer reviewed, and isn't exactly flattering to chiropractic, it can be used to say it's "the vanguard of" CAM or is reviving "ever greater proportions of health expenditures" using his sources (this and this), but your quote is NOT in the article, and can NOT be supported with that source. The only place "health care professionals" appears in the article is right at the top under "Chiropractic in the age of Evidence-Based medicine" subheading, so are you pulling that quote out of your ass or what?
2. To use this source as a way to shoe-horn in "heath care professionals" is disingenuous. It's practically WP:OR to extract that meaning out of the wording of that article. It's also not peer reviewed, being a review article.
3. First off this is a review article, so it's not peer reviewed. I think the way this article is worded you'd still be grasping at straws to say Chiropractic is a health care profession.

The objection here is that "heath care profession(al)" is a title that is lending more credence to these people than is probably due, it can be misleading to someone with a back problem thinking they can go there and get real help and skip an actual doctor's visit. Chiropractic groups and doctors seem to be the MAIN people saying it's a "health care profession." — raekyt 13:08, 16 January 2013 (UTC)

Hi Raeky, it seems that perhaps you are not familiar with the scientific literature or with some of the wikipedia policies that are relevant here? Please read WP:MEDRS; secondary sources (review/systematic review, meta-analysis) are the highest-quality sources available according to MEDRS. The secondary sources presented above are indeed peer-reviewed; I would suggest that you get a second opinion from an editor you trust on your statement "it is a review so it is not peer-reviewed", as this is completely incorrect. You have also claimed that only chiropractors consider themselves health professionals, yet there have been sources presented in this thread that come from governments, from scientists, from insurance companies, from medical organizations and from chiropractic organizations. Please review your challenge. Puhlaa (talk) 16:15, 16 January 2013 (UTC)

Like it or not

Needs to be said. Chiropractic was an invention by a charlatan during a period when people were using a ton of quack medical devices and drinking cocaine mixed with Coke. Much like Scientology, which professes that we all evolved from clams in the ocean, with chiropractic, subjective statements, fairly simple to quantify, are grossly ignored.

During my years in med school, I'm proud to say that I had a part-time job working for a "Christian" chiropractor who still drove his double axle pickup truck used during his "pre-med" years as a drywall contractor. His office meetings encompassed prayer sessions for his patients and staff, (nice mix...ya' gotta' BELIEVE to heal and bill.)

I was hired to type his medical transcriptions which he recorded when he had new patients. Then, he had one of his "techs" do the admits (illegal) and I transcribed those too. Funny comparisons. The techs were more thorough and believable, but he still billed the same. He was delighted that I was a med student. He was appalled that I told him he can't "prescribe" estrogen’s from Mexico anymore. He fired an associate chiropractor who told a very sick patient, "Oh honey, you need to go to a DOCTOR."

I picked up on a transcription of a woman with a BP of 220/105 on her vitals. I followed through. "See you in two days" he said. I called her at home, told her to go to a quick care facility near her home.

I got a lecture, then he got a lecture from me. And I got a "promotion." I was now an Ultrasound tech. Not diagnostic, mind you, but rubbing a diathermy type tool over the sore muscles of aching patients. I wrote down the values he was using on his machines and went to the physical therapy department of a local hospital and asked a lot of questions. Sure enough, the guy wasn't following any rules, and he said I was "licensed under his license." Channel 7 news in Los Angeles was also doing a hidden camera expose on Chiropractors at the time. No, I didn't have anything to do with it. Honest injun. Really. Hmmmmmm.

This was a nice guy, mind you, but his basis in "medicine" was a long shot from any conventional reality. And I'm sad to say that followers of this "discipline" are pretty one-sided and without any realistic basis in useful facts to be trusted. Suffice it to say, if you're in an airplane and someone goes down with a heart attack, you don't want a chiropractor to help out unless he's got a basic CPR card...and even then, you've got to be en-guard before they espouse their recommendations in after care. "Yeah, we got him back, but he's gonna' need adjustments three times a week for two weeks, then twice a week for four weeks, (insurance exhausted) and then weekly for the rest of his life."

I was his best transcriptionist, using old Apple computers. I was making $8.00 an hour. Easy stuff and it helped me through school. The hardest part was behaving like a Christian, which I am certainly not. I'm a bought and paid for atheist.

I used macros and copy/pasted a whole lot of his junk, including his attorney's findings who padded his billings, trying to give an air of credibility at his attempts to recover his costs from insurance companies. Sometimes I'd pick up on an insurance adjustor who saw through the fraud. "Dr. Doctor: We note that you diagnosed a "tenderness" from spinal processes L4-L5 on your first filling, which seems to have been ignored on subsequent reports. Please support your findings as "tenderness" is not diagnostic on a set of full-spine x-rays in conventional medicine."

He hired an absolutely hot Asian Chiropractor. During slow times, she sat next to me typing his reports. My eight bucks an hour were a dream come true.

One day she told me that she was being let go. I took her for a long walk and it turned out that I typed 16 reports a day verses her 8. And she made ten dollars an hour...but, after all, she was a "doctor." But I was a medical transcriptionist/ultrasound tech and he got more bang for his buck from me. And since he was a "Christian," he didn't want to nail her, as I did.

The Asian chiro once asked for my help during a treatment. They had some ladies' knee hyper-extended and wanted me to hold it in position. They were using some clear, Lucite-type mallet, with a concave top on it. They held this mallet over the woman’s knee, while the doctor stuck her finger into some gunk and proceeded to wipe it back and forth over the indentation on the mallet making a "squeak, squeak" sound. They removed the mallet, did some range of motion, decided she needed some "more" and did it again. Hilarious.

But that was nothing. It was time to test her arm strength. I'm not making this up, okay? And you can find similar examples on the web.

They gave her a bottle of vitamins or something. She was told to hold it out arms length while one doctor pulled down on her arm. The patient couldn't resist and the arm came down. Used another bottle. This time the patient was able to hold her arm straighter without as much difficulty. Well, damn it, those were the drugs for her. And they weren't cheap.

I quit during my last year. He was "adjusting" a baby in the next room. A baby. If YOU are a chiropractor reading this, you ought to be ashamed.

Truthfully, you ought to be ashamed. Blondesareeasy (talk) —Preceding undated comment added 06:22, 27 January 2013 (UTC)

Spine or not; a reverted edit

In this edit, DVMt has moved some material I added to the "Scope of practice" section, adding the editorial characterization of it as "sociological commentary". He has also re-instated some material backed by a 2005 WHO document. (His edit summary: "move sociological commentary to philosophy, restate emphasis of the spine in scope of practice").

I disagree with this edit, for the following reasons:

1. The moved content is not accurately characterized as (just) "sociological commentary", but comes from a 2011 review article in Social Science & Medicine which analyzes, both from empirical data and from a review of the scholarly literature, the language used by chiropractors in describing themselves. Thus it is up-to-date and highly suitable when we want to describe what chiropractors "emphasize" as their practice.
2. The WHO document is now coming up for 8 years old, and appears to have had no formal peer review. This article leans rather heavily on it. I propose this source is deprecated in favour of superior alternatives, where possible.

I recommend re-instatement of this text at the head of the "Scope of practice" section:

Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM).[1] The chiropractic community, however, lacks consensus about its scope. According to Yvonne Villanueva-Russell (2011) there is a range of opinion: at one extreme some chiropractors believe that treatment should be confined to the spine, or neck and back pain; other vehemently disagree – a 2009 survey of American chiropractors found that the label "back and neck pain specialists" was regarded by 47% of them as a least desirable description, among alternatives proposed.[48]

Alexbrn ^{talk|contribs|COI} 04:24, 15 January 2013 (UTC)

I disagree that the WHO source is outdated in any way, it is a publication from an internationally recognized medical body, the WHO is explicitly mentioned at WP:MEDRS. However, I definitely agree that the paragraph Alexbrn mentions belongs in the 'Scope of Practice' section of the article and not the philosophy section. It is a discussion of a notable debate within the chiropractic profession regarding what the scope of practice should be. I would suggest starting with the WHO characterization of chiropractic scope of practice, it is consistent with the actual international situation. For example, the vast majority of jurisdictions where chiropractic is regulated limit the scope of practice to MSK conditions. If MSK is what chiropractors are limited to treating by law and evidence, then this is how the profession should be described with the most weight. This should be followed by the discussion of the controversy among chiropractors themselves over the scope of practice. I don't think that the specific mention of a single survey at the end of the paragraph is notable ("a 2009 survey of American chiropractors...") and I would remove it.Puhlaa (talk) 05:44, 15 January 2013 (UTC)

MEDRS says the WHO "may be [a] valuable encyclopedic source", and in particular that its guides are "generally less authoritative than the underlying medical literature". The WHO guide which forms the spine (hah!) of much of this article appears to be written by one person, is not peer-reviewed, and is 8 years old. Seems to me a lot less likely to describe truly what chiropractors "emphasize" than a contemporary peer-reviewed review article that addresses that question in detail based on a wide-ranging examination of data and other scholarly and non-scholarly sources. Alexbrn ^{talk|contribs|COI} 06:24, 15 January 2013 (UTC)

I would say that the WHO source is definitely peer-reviewed! It says "WHO acknowledges its indebtedness to over 160 reviewers, including experts and national authorities and professional and nongovernmental organizations, in over 54 countries who provided comments and advice on the draft text." I agree that it may be less-reliable than underlying medical literature, but in this case, there is no medical literature that disagrees, and as I said, almost all jurisdictions define chiropractic as MSK scope. Moreover, NIH/NCCAM, US Dept of Labor, Pubmed Health and Chiropractic organizations [4],[5] all have common descriptions of chiropractic scope of practice. This should receive the most weight. Then, the internal discourse over what scope of practice the chiropractic profession wants for itself, as described by your source, should come second. Also, for the last sentence, instead of picking just one specific survey from the entire discussion in the source to highlight, just describe the internal struggle; the profession is currently divided into 3 groups, those that want to be 'MSK specialists', those that want to be 'primary-care doctors' and those who believe they are 'subluxation specialists'.Puhlaa (talk) 06:59, 15 January 2013 (UTC)

What's your evidence for saying the WHO guide is peer-reviewed? One would expect a draft WHO document to be sent out for comments via their document distribution mechanisms, but there's zero description (I can see) of a peer review process, or transparency over how comments were handled. More particularly, the outdated WHO and Nelson sources appear to be giving a misleading description of chiropractic as being mostly "spine" based as against our up-to-date source, which paints a more nuanced picture. Alexbrn ^{talk|contribs|COI} 07:15, 15 January 2013 (UTC)

I quoted text above for evidence. Regardless, the WHO is itself reliable according to WP:MEDRS; the WHO source content is consistent with other reliable sources listed already; and the WHO source is consistent with the current law (chiropractic regulation limits their scope to treating MSK). If, despite these facts, you still challenge the WHO source, then the burden is on you to provide a reliable source that says we should question the WHO, or question the content of this specific WHO source about chiropractic? If there is such a source, then indeed you may have a point! I do not think that your own suspicions are sufficient reason to say that a source from the WHO is not reliable. I will not be at all offended if you want to run it past the reliable sources noticeboard to see if other editors feel it is reliable or not?

The newer source you presented does not discuss what the actual chiropractic scope of practice is, it only discusses the controversy in the profession over what they want the scope to be and also gives a perspective based on public-demand. Shouldn't the scope of practice section give more weight to sources discussing what chiropractors really do? Eg: most jurisdictions limit the scope of practice to treatment of MSK conditions, most jurisdictions allow the use of Xray, etc.? The text from DVMt, using the WHO source, provides that. Thus, I still propose including both. Puhlaa (talk) 08:03, 15 January 2013 (UTC)

The fact that the WHO received feedback on their draft is not evidence of peer-review (in the scholarly sense of the term), and as I have said MEDRS does not say the WHO "is reliable" in a blanket way; it's rather more complicated than that - as I said, guides (such as this) are described by MEDRS as "generally less authoritative than the underlying medical literature". And 8 years ago is 8 years ago, so I just don't understand how you can disagree that it "is outdated in any way".

"What chirporactors really do" would be better discussed in the section called "Treatment techniques"; this section ("Scope") is a wider topic.

As it stands the text is using the WHO document to support a bald statement of what "chiropractors emphasize", in the face of high-quality up-to-date sources that paint a richer picture (in the section specifically entitled "Scope" in our newer source). Why? Alexbrn ^{talk|contribs|COI} 08:32, 15 January 2013 (UTC)

In fact, looking at Annex 1 of the WHO document, it seems the consultation participants are mostly chiropractors and CAM lobbyists (including the CEO of the FIH!!), with no declarations of conflict of interest given. Alexbrn ^{talk|contribs|COI} 09:10, 15 January 2013 (UTC)

I'm going to agree with Alexbrn here, the WHO document is clearly biased, not peer-reviewed and outdated, it should be replaced as a source wherever possible by more reliable sources. — raekyt 17:41, 15 January 2013 (UTC)

And, looking at this some more, the author of the "original text" of the WHO guide is John Sweaney, a life-long chiropractic advocate and former president of the World Federation of Chiropractic. With no COI declaration given, this is rather astonishing. Alexbrn ^{talk|contribs|COI} 18:00, 15 January 2013 (UTC)

Alexbrn, the newer source paints a different picture of scope because the newer source is about the internal conflict of the profession regarding self-perceived scope, or the internal conflict over preferred scope. This wikipedia article is not -primarily- about the internal conflict of chiropractic over preferred or perceived scope, this section of the article is -primarily- about the actual scope of practice of chiropractors, written for the general layperson. As I have said, there is indeed plenty of room for discussion of the internal professional conflicts over who wants what scope using your preferred source, but the section should give the most weight to a general/basic discussion of the current professional scope of practice of chiropractors. 'Treatment techniques' is not for a discussion of scope of practice, as you suggest, it is for a basic discussion of the 150 different chiropractic techniques that revolve around manipulation and any other manual and physical therapies that are commonly used. The 'scope' section is about scope of practice - and is more a legal issue. As far as the WHO source, we clearly disagree on it's reliability, as I still feel that it is a reliable and current source for a discussion of chiropractic. 8 years would make the source old if we had newer, equally reputable sources, saying that things had changed...I don't see a source that says this. Your 'new' source is discussing a long-standing issue over perceived identity among chiropractors; it does not contradict the WHO source, it is discussing a distinct issue - perceived/desired scope vs. actual scope. From my perspective, you are trying to pick-out little potential issues with the WHO source, based on your own analysis, to try to make us question the source as a whole. The WHO is indeed reliable according to policy and without another reliable source saying we should perhaps question the WHO in this specific case, I don't agree that we can use your analysis to say the WHO source is not reliable and outdated.Puhlaa (talk) 23:35, 15 January 2013 (UTC)

Alexbrn you are basically stating the WHO is not a reliable or credible organization. Also your personal analysis would be be in violation of WP:OR. But, if you want to open this can of worms, the same can be done for the Ernst articles which, in addition to be severely biased, represent the fringe of the medical community. Ernst does not speak for the medical community he speaks for the skeptical community. Otherwise how could you explain the ongoing integration of chiropractic on all levels? The V-R(2011) source was misused as Puhlaa stated. This article needs to stick to factual stuff, not "commentary". All commentary should be removed from the bloated article. I also noticed a random "driveby" revert by an editor not involved here. It's hard to AGF when strangers revert edits who aren't even part of the discussion.

DVMt (talk) 00:36, 16 January 2013 (UTC)

Guys, investigating the quality of sources - who wrote them and how they were produced - is a key part of editing WP. I would have thought that is common sense. The argument that investigation of source quality is "OR" is completely bogus. This WHO source is biased, out-of-date, and produced without rigorous review. WP prefers better sources - what you "feel" about it is beside the point.

"Scope of practice" means "scope of practice" - not some unspoken constrained subset of that term. Part of "scope" is how chiropractors see themselves and want they want to be selling. Again, common sense.

It is incorrect to characterize my argument as being that the WHO "is not a reliable or credible organization". They are an organization, like all others, with a variable track record. (Who can forget that they categorized homosexuality as a disease until 1990?) This document is, however, a poor source.

Re-reading this article I am also concerned by the way the WHO document has been used to lend a faux authority to certain statement by using the wording "According to the WHO ..." (or similar). If a statement has been issued by the WHO executive or agreed by its assembly there would be grounds for doing this, but not for this document. It is a bit like citing an International Standard by writing "According to ISO ..." - i.e. misleading. It is only according to the document (which is produced within the larger organization). Alexbrn ^{talk|contribs|COI} 06:27, 16 January 2013 (UTC)

Alexbrn, can you please clarify, are you suggesting that the WHO source is not reliable in general, or just that it is not reliable for a statement about chiropractic scope of practice in our 'scope' section? If your concern is with the specific text used in this specific context in the 'scope' section, then there are many other sources that can be used to describe the general 'scope' of chiropractors and we can get our focus back on the text you are proposing. However, if you are suggesting that the WHO source is not reliable in general, then there are much wider implications for this article and the discussion could probably be at the RS noticeboard. Do you agree? Puhlaa (talk) 07:36, 16 January 2013 (UTC)

Alexbrn is quite clearly saying that they are not a reliable source for the way in which DVMt is attempting to use it. It's a great source for describing things the WHO published, like it's used in the scope section. TippyGoomba (talk) 16:30, 16 January 2013 (UTC)

It's a reasonable source for chiropractor-to-chiropractor guidelines, as conceived in 2004/5 - but not a good source for any- and everything within the topic. Alexbrn ^{talk|contribs|COI} 17:13, 16 January 2013 (UTC)

DVMt used the WHO source in this edit to support text that is indeed found in the WHO source within the section "Philosophy and basic theories of chiropractic", ie: "Chiropractic practice emphasizes the conservative management of the neuromusculoskeletal system, without the use of medicines and surgery". This text originally comes from the WFC, but the WHO indeed quotes this exact phrase in their document. Alexbrn, is the use of the WHO source for this specific text your main concern? If so, would it be sufficient to remove the specific attribution to the WHO? In my opinion, the text in general does an excellent job of indicating the worldwide scope of chiropractors according to law - "the treatment of MSK conditions with no drugs or surgery", but I am happy to use another source if the WHO source is really a significant concern here. If this is not your main concern, Alexbrn, it would be helpful if you would please provide a specific 'bit' of text that is sourced to the WHO that you disagree with; then we can either find new source for the text or delete the text. As I said before, If you want to discuss the WHO source in general, then that is a different discussion we need to have.Puhlaa (talk) 21:19, 16 January 2013 (UTC)

The sources were being misused. The WHO document is a reference that sets out an idealized version of chiropractic; yet was being used to suggest it was a survey of reality. The Villanueva-Russell piece is a review article based on a range of current scholarship and empirical data, yet it was being used to suggest it merely dealt with philosophical discussion. This was 180° wrong, and badly misleading. I have married the two sources together and fleshed out the wording to make plain what each source is as well as what is says. Alexbrn ^{talk|contribs|COI} 05:20, 17 January 2013 (UTC)

Alexbrn, I think that this series of bold edits is a good start, however, I have a few concerns. If you are willing, I would prefer not to revert you per WP:BRD, but rather just discuss what is there and try to improve it. For clarity, I have listed my concerns:

1. The description of the WHO and V-Russell sources are too long and not relevant to ‘scope’. Both sources are high-quality and both are being used to support non-controversial statements (ie: I am not aware of sources that contradict them). Thus, I think we should just state the relevant content.
2. The text is editorialized with weasel words that should be removed. The source does not say "at one extreme some chiropractors believed…" The source says:"…has been advocated by several segments within the profession."
3. That several segments of the profession prefer chiropractic to be ‘MSK specialists’ is clearly described, but the current text does not describe the 'other' chiropractors preference for scope; according to Villanueva-Russell – those wanting chiropractic to be ‘primary care’.
4. The individual statistics are not appropriate. The source mentions 6 individual surveys in the small section about preferred 'scope' to describe the issue; how do we decide which of those 6 survey results to describe in this Wikipedia article?

I think that all the text that has been added could be summed up in 2 brief sentences that are clearer for the general reader, here is my suggestion:Puhlaa (talk) 07:28, 17 January 2013 (UTC)

• "Chiropractors are generally associated with the conservative management of the neuromusculoskeletal system, without the use of medicines and surgery (WHO). Within the chiropractic profession, several segments have advocated for a narrow scope as neuromusculoskeletal spine experts or back/neck pain specialists, while others prefer an expanded scope of practice, as primary-care providers with an emphasis on wellness (V-Russell)."

Some thoughts:

• Your proposed summary loses too much information, to the point where it becomes inaccurate.
• Not sure about "weasel" words - surely you mean in the other direction ... "elephant" words; this is to capture the sense in the source conveyed there by the words "vehemently opposed" when describing the different chiropractor camps
• We're not agreed the WHO source is "high-quality". I judge it to be biased, produced without rigour, out-of-date, and presenting only an idealized aspiration for chiropractic - so having limited usefulness
• The pair of statistic quoted you mention are also quoted alone as a pair in a source's paragraph, so mine is a fair use I think. I'm always open to add more stats however.

The overall problem is that there appears never to have been consensus on what chiropractic "is"; and the evidence points to this still being contested. The WHO document attempts to assert a position on what it is, and if we use that document that must be made clear. An up-to-date assessment of the current status of chiropractic scope is given in the conclusion of the V-H article:

everyday chiropractors are content with the current status quo as marginal professionals, wishing to remain tied to the traditionalist lexicon and an expansionist range of application and treatment authority.

If Wikipedia is offering up some bland statement about there being a "consensus" of what chiropractic scope is (sensible spine and neck treatment), then it's out of sync with scholarship, and with reality. We must be careful here. Alexbrn ^{talk|contribs|COI} 14:57, 17 January 2013 (UTC)

Alexbrn, out of my 4 clearly listed concerns, you failed to find any common ground on any of them whatsoever to help achieve consensus? This is unfortunate! I made it clear that I had concerns about your edits and I listed them for you. I made it clear that I was open to find consensus without using the R in WP:BRD, yet it seems that you have made no reciprocal attempt on any of the points? You seem to be goading me with "I am open to adding more stats"?. I have already said that adding individual stats from individual primary sources is not appropriate; this article should include a summary of the main point made by the secondary source, not the specific data from each individual primary source. Moreover, can you appreciate how boldly admitting to editorializing with "Elephant words" in order to better "capture the sense in the source" is antagonistic and may also violate WP:OR. Are you telling me that your preference is to use the BRD approach and goad one another, rather than work together towards a mutually agreeable version? Please reconsider some of your responses and try to consider how we can find common ground to achieve a consensus.Puhlaa (talk) 18:40, 17 January 2013 (UTC)

Errrr, what?!

The task at hand is not to find middle position between two editors (false equivalence) but to produce a good article. You are now arguing about process; I was primarily concerned with content. I took your question ("how do we decide which of those 6 survey results to describe in this Wikipedia article?") to be genuine, and answered it - that is not intended as goading; neither is trying to explain that my words "extreme positions" was, I thought, a fair paraphrase (what we are meant to do) of the "vehemently opposed" characterization of the source. We need to avoid plagiarism.

I will also note that, as as a COI-tainted editor, you should not be trying to POV-push. Why not abide by the recommendations of WP:COIU and WP:BESTCOI ?

It would be much more helpful if you stated any disagreement you have with the substantive points of content I make, backed-up with evidence, rather than appealing to non-arguments about process and implicitly threatening to perform COI/POV edits on the article, in the face of WP recommendations. Alexbrn ^{talk|contribs|COI} 18:57, 17 January 2013 (UTC)

I disagree with Alexbrns edits and his mischaracterization of the my edits. The WHO was not being misused it was used as veriable and reliable source. You are in fact doing OR by analyzing the document and drafting your own personal conclusions about them, then presenting them as fact and making a misleading edit summary based on that. The Watson and Crick paper is from 1955 and no one would say that it's poor because it's "old" 2005 is the most recent document on chiropractic safety and training and scope of practice. It was used appropriately in the scope of practice and education. You are being uncivil towards Puhlaa by using another straw man argument instead of answering his question directly. Weasel words like "scholarship and empirical data" do nothing to the article and in fact show a blatant attempt of puffing up that one source on your behalf. All research articles published in pubmed indexed journals are scholarly and contain empirical data of some sort. Also rather than throwing out accusations (COI/POV) which do not show good faith on your part how about you take your own advice and discuss edits first, as Puhlaa has always done. You, on the other hand have not do not have the moral high ground here. These edits do not improve the article and the VR (2011) does not belong in the scope section because it has nothing to do with the actual scope and is merely a survey done on American chiropractors (i.e. isn't global and does not reflect the profession globally). — DVMt (talk • contribs) has made few or no other edits outside this topic.

If you think discussing the content of sources is OR, then there's no saving any of us. TippyGoomba (talk) 03:14, 18 January 2013 (UTC)

Uncivil again TG. You also were uncivil in your edit summary and there was no consensus. I'll ask that you self-revert please. DIscussing content is not OR. Trying to frame it in a NPOV manner (contextually) is OR.— DVMt (talk • contribs) has made few or no other edits outside this topic.

Did you even read WP:COIU? TippyGoomba (talk) 03:41, 18 January 2013 (UTC)

Since discussion doesn't seem to be progress any closer to agreement with regards to the WHO source, I suggest that a neutrally written request for a 3rd Party Opinion be placed at WP:RSN. The request should include the text which you want to introduce to the article and a link to the source material. Beyond that, the request should not include any arguments for nor against the material, as not to poison the well either way. 67.127.101.63 (talk) 05:40, 18 January 2013 (UTC)

I'm not sure RSN is quite the right venue since we don't (yet) have nailed-down text for which we're querying whether the WHO document is an adequate source. Also perhaps this is a question on how the WHO source is used in comparison to others. Alexbrn ^{talk|contribs|COI} 06:25, 18 January 2013 (UTC)

Scope section

(Starting a new section for the sake of sanity.) I have tightened the opening paragraph of this section in an attempt to pull together the various strands in he discussions above. Are there remaining concerns? Specific proposed edits based specifically on the text will help carry us forward fastest, I think ... Alexbrn ^{talk|contribs|COI} 06:30, 18 January 2013 (UTC)

Alexbrn, In my opinion, your most recent edits to the ‘scope of practice’ section of the article are significant improvements! You removed the editorializing and have significantly shortened the previously excessive description of the sources ( point #1 & #2 above ). Thanks for giving thought to my concerns and trying to remedy some of them! I think that those issues that had concerned me the most are now resolved in this text. With regard to the individual surveys, I see that you are correct in saying that V-H places those two surveys together, so I won’t object any further to your inclusion of those numbers. I did modify the text some in this edit, to try and make it more accurate; do you agree with my changes?

I am still open to finding additional ways to improve this specific text if you want to discuss anything further. I still believe that attribution of the 2 sources is not required; if you wanted to pursue that discussion any further, either here or the RS notice board, I would be willing. However, it is lower on my priority list now that the attributions are shortened and NPOV, so I will not push this issue if you are satisfied with the current result. Regards, Puhlaa (talk) 18:50, 18 January 2013 (UTC)

A recent edit

Added[6] the following

Another review which examined adverse events from spinal manipulative therapy for musculoskeletal pain in pregnacy and post-partum periods concluded only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare.

as a summary of this. The article contains caveats and has this summary: "There are only a handful of reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period in the literature with the severity ranging from mild increases in pain that resolved quickly to significant life-threatening injuries. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare. Clearly future research into efficacy of this treatment for these populations and the rates of occurrence of adverse events is necessary to determine whether or not this is true."

I don't think the edit properly reflects the source, and have reverted it. It would be fairer I think to say that while research is scant, there is evidence of adverse events - rather than including speculation that such events "may be rare". Alexbrn ^{talk|contribs|COI} 21:06, 26 January 2013 (UTC)

The edit is directly from the source and is specific to post-partum and pregnancy SMT for musculoskeletal pain. The conclusions are directly from the article. Speculation is on your behalf as they sentence is verbatim. See here [7]. The issue is not whether there are "adverse events" which is the focus of the article, the issue is one of prevalence and severity. And, according to this systematic review, there are rare/scant adverse events with SMT in pregnant and post-partum women. Removing the whole source and verbatim text seems like a heavy handed response. I'll wait for your reply before re-addressing it. DVMt (talk) 21:15, 26 January 2013 (UTC)

Well, by not mentioning the severity of the events (as the source does) you text is "not much bad stuff happened, and hey! maybe not much ever will"; whereas the source is saying "some very serious things happened, but maybe it'll turn out they're just rare". See the POV problem? Alexbrn ^{talk|contribs|COI} 21:23, 26 January 2013 (UTC)

Alexbrn I did not editorialize the text whereas you just did with your commentary. The conclusions drawn by Stuber et al. are their own, not mine. The conclusions I stated where verbatim from the review. How about this alternative wording. "Adverse events SMT for musculoskeletal pain in pregnant and post-partum appears to be rare but future research is needed to address potential under-reporting" DVMt (talk) 21:33, 26 January 2013 (UTC)

The key thing you need not to omit is "significant life-threatening injuries"; is that something you can do? Alexbrn ^{talk|contribs|COI} 21:37, 26 January 2013 (UTC)

I don't see why not. I just don't want to violate WP:WEIGHT or WPL:UNDUE. The significant life-threatening injuries is already mentioned in the article several times. Perhaps this: Adverse events SMT for musculoskeletal pain in pregnant and post-partum appears, including serious-life threatening injuries appear to be rare future research is needed to address potential under-reporting".

Although significant life-threatening injuries can occur, these serious adverse effects appears to be rare" — Preceding unsigned comment added by DVMt (talk • contribs) 21:47, 26 January 2013 (UTC)

Conceptual basis

I added Coulter (2000) as a reference in the conceptional basis section which describes as to what actually is the foundational basis of the profession. TippyGoomba has reverted it without providing any reasoning so I'm curious as why it was reverted as the edit was not bold and I'd like to discuss it. DVMt (talk) 00:31, 27 January 2013 (UTC)

Review of old systematic reviews

Question: I noticed that in the effectiveness section older reviews (i.e. 2005) are still being used despite a newer review(s) on the same topic also being used. Why are the older reviews being kept if the newer review, which cites the older review its lit review can be used instead? Older sources are being used sometimes to contradict newer ones with respect to effectiveness and other sections in the article. I'd like to discuss this with involved editors so maybe we can "purge" some duplication from the effectiveness section. DVMt (talk) 20:15, 26 January 2013 (UTC)

(I don't know if this is related.) A 2013 review was recently added. Even if from a non-fringe reliable source, it's too soon, per WP:MEDRS. It's quite possible that, as have a number of studies, the results will be revised or withdrawn. — Arthur Rubin (talk) 18:43, 29 January 2013 (UTC)

Are you talking about this 2013 systematic review being 'too soon' to include? I do not agree that MEDRS says that secondary sources can be 'too new'. Puhlaa (talk) 19:09, 29 January 2013 (UTC)

Arthur, please quote (or link) where MEDRS indicates that new sources shouldn't be used? I see the opposite:

"Look for reviews published in the last five years or so, preferably in the last two or three years. The range of reviews you examine should be wide enough to catch at least one full review cycle, containing newer reviews written and published in the light of older ones and of more-recent primary studies."

Older reviews (2005) should be removed if we have newer reviews that say the same thing, or should be complemented with newer reviews if they disagree. What we did in 2008 was say "lets look at all the reviews on this topic from the last 5 years, summarize, and then add". It took a lot of work, and consensus making, but it was worth it. DigitalC (talk) 02:03, 1 February 2013 (UTC)

There is redundancy indeed in some of the sources and overt repetition in the article itself. That being said, the article is still "fat" and could stand to be put on a diet! A lot of the writing is either overtly vague or descriptive. Surely we can get down to the root of the arguments, pro/con and be as succinct as posible. As for the 2013 review, it does meet MEDRS standards and should be reinserted. DVMt (talk) 03:32, 1 February 2013 (UTC)

Heading - chiropractic medicine

There is chiropractic, and there is medicine. One is either a doctor of chiropractic, or a medical doctor. The two are separate and distinct. Different licences, different schools, different philosophies, and different results. The heading above the picture needs to be changed from "chiropractic medicine" to "chiropractic." Akdc14 (talk) 13:55, 8 February 2013 (UTC)

Disagree Akdc14. Chiropractic is considered an alterative medical system and this term is frequently used in the literature as well, proof being the 'Journal of Chiropractic Medicine' as seen here [8]. Furthermore, like other CAM disciplines such as naturopathic medicine and traditional and chinese medicine, it applies an approach to medicine not merely a set of technique system.Besides, the article itself is called 'Chiropractic' which is a excellent compromise in itself. DVMt (talk) 20:20, 8 February 2013 (UTC)

Edit request on 8 February 2013

In the third paragraph of Safety - Manipulative Therapy, surely "Stoke" should be replaced by "Stroke"? 89.240.224.59 (talk) 16:26, 8 February 2013 (UTC)

Done. And so it now is. Thanks! Rivertorch (talk) 19:50, 8 February 2013 (UTC)

POV Fork

The page chiropractic controversy and criticisms likely qualifies as a POV fork as commented previously [9] by two other editors. If there is consensus, I nominate this article for deletion. DVMt (talk) 06:48, 9 February 2013 (UTC)

Tags

I removed the neutrality and length tags. If anyone disagrees, please feel free to discuss. Regards, DVMt (talk) 01:14, 10 February 2013 (UTC)

Edit by John Snow II

The edit in question specifically attempts to insert NPOV language, furthermore language does not reflect what the source says (i.e. health care profession via the WHO). It should also be noted that Prof. Ernst also uses the word 'profession' in his own papers. Please discuss rationale for edits. Regards, DVMt (talk) 23:21, 10 February 2013 (UTC)

POV

This article misrepresents the conclusions of some of the source. This ref . PMID 21328304. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help) which states "High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain." to state "Manual and conservative therapies commonly used by chiropractors are effective for the treatment of low back pain". I think the ref means they are not effective. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:17, 11 February 2013 (UTC)

The source states that there is no difference between interventions, meaning equivalence interventions. Also, this was not part of the review and suggests a different conclusion. [10] DVMt (talk) 01:23, 11 February 2013 (UTC)

The source says, in it's plain-language summary: "The results of this review demonstrate that SMT appears to be as effective as other common therapies prescribed for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy." AND "In summary, SMT appears to be no better or worse than other existing therapies for patients with chronic low-back pain." Thus, to decide which interventions are best, the authors suggest that "Determining cost-effectiveness of care has high priority.". Moreover, other high-quality sources are more explicit, such as this. Puhlaa (talk) 01:29, 11 February 2013 (UTC)

When knee arthroscopy was found to be as good as conservative management for OA this did not result in the conslusion that "knee arthroscopy is effective for the treatment of knee OA" Why does the article not state that manipulation is equivalent to conservative treatment?

Much is also left out. Such as "Collectively, these data fail to demonstrate that spinal manipulation is an effective intervention for pain management." . PMID 22621391. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help) The benefits are presented as fact but their are many high quality sources which state no benefit. The best we could have is the benefits are questionable and tentative if any. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:34, 11 February 2013 (UTC)

Doc James you are arguing against scientific consensus regarding spinal manipulation and the management of back pain. Also your assertion that the "best we could have is the benefits are questionable and tentative if any" goes against the majority of the literature regarding SM and LBP. Are you aware of this? DVMt (talk) 01:39, 11 February 2013 (UTC)

It appears that this article is presenting half the literature. The half that shows benefit. While ignoring the half that does not. Our article than states without qualifications "Spinal manipulation, commonly used by chiropractors and other manual medicine practitioners are effective for the treatment of spinal pain, including low back pain, neck pain, some forms of headache and a number of extremity joint conditions such as shoulder and hip pain" supported the journal Chiropr Osteopat. Yet we have this more recent systematic review that states "Collectively, these data fail to demonstrate that spinal manipulation is an effective intervention for pain management." . PMID 22621391. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help) So I think we have a huge problem. It appears that our article just picks up the positive research and presents it while ignoring the research that disagrees. Have returned to a more neutral version. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:48, 11 February 2013 (UTC)

Since you disagree specifically with the section involved regarding the benefits, we shall critique that. I have restored the revised content which deletes over 50 added systematic reviews. — Preceding unsigned comment added by DVMt (talk • contribs) 01:51, 11 February 2013 (UTC)

Doc James, is your concern with this text in the lead?:

• "Manual and conservative therapies commonly used by chiropractors are effective for the treatment of low back pain,[11][12] and might also be effective for the treatment of lumbar disc herniation with radiculopathy,[13][14] neck pain,[15] some forms of headache,[16][17] and some extremity joint conditions [18][19]."?

Note that this text is very-well sourced and is qualified with "may be effective for...".Puhlaa (talk) 02:31, 11 February 2013 (UTC)

As per the concern of Doc James, I have removed specific reference to spinal manipulation in the UK Manual therapy review. Manual therapies though still apply. DVMt (talk) 02:32, 11 February 2013 (UTC)

It should also be noted that Doc James reference specifies 'spinal manipulation' . PMID 22621391. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help) and not manual therapy. This distinction is critical. DVMt (talk) 02:33, 11 February 2013 (UTC)

Part of the confusion was because Cochrane and Dagenais were cited instead of the UK Manual therapy report. Also since Dagenais and Rubinstein are SMT specific they aren't MT. I clarified the article here [20] to reflect this distinctionDVMt (talk) 02:51, 11 February 2013 (UTC)

Sure so the lead had left out the effectiveness of SMT entirely which is POV. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:36, 11 February 2013 (UTC)

Deletion of whole article

Jmh649 has recently deleted the whole article based on his one disagreement regarding the effectiveness of SMT for LBP. He is not a regular contributor to the article. His revision deleted 50+ mainstream systematic reviews that was added. Based on such mass deletion of sourced content I am reverting back to the stable version and we can discuss it one section at a time. DVMt (talk) 01:58, 11 February 2013 (UTC)

This . PMID 22621391. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help) source was used to dispute the smt for pain management. This author is also severely biased as he authors articles with Edzard Ernst who argues against scientific consensus regarding SMT and pain management. Also, the article clearly makes the distinction between manual therapy and manipulative therapy. Therefore in some instances non thrust soft tissue techniques are appropriate whereas SMT would not. To not make this distinction is to make a false equivalence between the two. DVMt (talk) 02:07, 11 February 2013 (UTC)

DVMt, you have reverted two experienced editors who have pointed out to you that the version you are removing is more neutral. I have restored that version and I will point out to you that we do not create articles by pushing our own preferred version against the advice of multiple other editors. That is edit-warring and not acceptable on Wikipedia. You also need to understand that you do not get to determine who can and cannot edit here. I strongly suggest you start from where we are now and try to convince the other editors how your removal of sources as strong as a Cochrane review could possibly be an improvement to the article. --RexxS (talk) 03:18, 11 February 2013 (UTC)

I understand your point regarding reviewing Cochrane and Dagenais, and also saw the disagreeing reviews you posted at WP:MED. I will propose a revision to the lead, which is really what is being disputed, as opposed to the body of the article -- and we can arrive at a mutually agreeable solution. I was disagreeing with the reverts because they deleted 50 additional systematic reviews and other sections of the article were not in dispute. I look forward to collaborating with you so we can get a consensus statement of manual therapy separate from SMT and a separate statement for SMT specifically as they are mutually exclusive in that regard. DVMt (talk) 03:23, 11 February 2013 (UTC)

{{od}Yes I removed the 60 plus edits made by a single editor DVMt. I can run through reasons for this reversal one by one.

Issues

• It stated "A 2011 study, however, demonstrated that maintenance spinal manipulative therapy is effective for the treatment of chronic nonspecific low back pain" the ref was broken but it is for this primary research paper of 60 people [21] We should not be using primary research and what was there was fair more balanced.
• It stated "Manual and conservative therapies commonly used by chiropractors are effective for the treatment of low back pain," No this is subterfuge. What chiropractors are known for and primarily do is spinal manipulation and the effectiveness has been left out of the lead all together. Only its safty is discussed. Yet we have this 2012 review of reviews that was summed up originally [22] which found no benefit.
• We have this line "Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery [1] with an emphasis on the spinal manipulation." I would not consider spinal manipulation "conservative therapy" so combining the two is incorrect. And then once this claim is made in the lead it states "might also be effective for the treatment of lumbar disc herniation with radiculopathy" basing it on a review of conservative therapy which does not mention chiropractic care [23] anywere
• We state without any qualifications that "Manual therapies, including spinal manipulation, has been found to be effective for mechanical neck pain" leaving out the evidence that it has been found not to be effective in neck pain per the review above. We have ignored this [24]
• Why did this ref disappear? It did not support manipulation for mirgraines. [25]

So my revert of these last 50 edits RESTORED a great deal of high quality evidence

Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:32, 11 February 2013 (UTC)

Proposal

The content dispute is specifically about the lead and the effectiveness of SMT in the lead. I propose that with the help of Yobol and his requests for additional sources be included in the revised lead. After we achieve a consensus on the effectiveness of SMT in the lead we can move forward. I'm going to take a little wiki-break but look forward to hearing from involved parties. DVMt (talk) 03:29, 11 February 2013 (UTC)

There were multiple issues with the changes made including an change in how chiropractic scope of practive is viewed. I am off to go skiing. But we will definitely need to discuss. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:35, 11 February 2013 (UTC)

Not a problem with discussion. It's why I brought the article to your attention. My rationale was if a representative(s) from WP:MED could review the lead and there were issues with language or the sources in question it would be good to be open about it instead of hoping edits would 'sneak by'. Enjoy the skiing. DVMt (talk) 02:06, 12 February 2013 (UTC)

Deletion of consensus material

Despite there being consensus here for the first two paragraphs of the revised lead, User:Raeky has deleted the consensus material here[26] citing a radical departure. I request that the user self-revert for undoing consensus material that is not being disputed. As per Doc James primary concerns was the citations and language surrounding the benefit of spinal manipulation for specific musculoskeletal conditions. DVMt (talk) 03:53, 14 February 2013 (UTC)

You're already treading on dangerous WP:TE user grounds... almost every one of your edits to this article has ultimately been reversed, yet you keep editing and reinserting it. I suggest you follow policies and stop trying push a WP:POV. — raekyt 04:03, 14 February 2013 (UTC)

I don't think you understand Raeky. The material you deleted has consensus as noted above in comments for revised lead. The concerns of both Doc James and Puhlaa were addressed a few days ago. Also, insinuations that these are not good faith edits, that I'm pushing a POV is nonsense. I espouse a scientific point of view (SPOV) to achieve NPOV in contentious articles. The sources nor the language of the first two paragraphs is in dispute. Given that neither the language or sources are in dispute by both the chiropractor and medical doctor for the first two paragraphs, how do you disagree with them? DVMt (talk) 04:08, 14 February 2013 (UTC)

Show me where anyone said to change the first sentence from "Chiropractic is a form of complementary and alternative medicine[1] concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health." to Chiropractic is a traditional/complementary and alternative medicine health care profession[1] concerned with the structural diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health." I don't see any consensus to make any changes just a beginning of a discussion to change something? The accusation that your pushing a POV is pretty self-evident I think to anyone who has been watching your edits here, and the statement that your approaching WP:TE, well I think it will be more evident as you go on and eventually we'll have to deal with it. That's my personal opinion there of course. — raekyt 04:15, 14 February 2013 (UTC)

The WHO basic guidelines on chiro are not in dispute which the citation you are opposing. The classification as traditional/CAM is not in dispute. The source specifically states "traditional/CAM". Thus, are you dispute the term 'health care profession'? That is also in the source. Even Edzard Ernst calls chiropractic a 'profession' in his 2008 Critical evaluation of chiropractic. The Ernst source in not in dispute. The language of the first two paragraphs are not in dispute. The sources in those 2 paragraphs aren't in dispute. In fact, they have reach consensus and it has been so for days, not minutes, as you implied at your talk page. So what exactly are you disputing Raeky? The burden is on you to state it clearly and specifically. Also, I might add, a POV pusher does not go to WP:MED and ask for RfC on the article itself. Doc James has kindly volunteered his time to address his concerns and hammer out a consensus on sources and language. DVMt (talk) 04:28, 14 February 2013 (UTC)

I'm objecting to your dramatic apparently unilateral changes to the lead sentence without any discussion on it's wording beforehand... — raekyt 04:30, 14 February 2013 (UTC)

Raeky you are being tendentious, I have asked you specifically what source or wording to you dispute? I might remind you that you are close to violation of WP:IDHT. DVMt (talk) —Preceding undated comment added 04:43, 14 February 2013 (UTC)

Still waiting for you to show me where the consensus was reached for those changes to the lead... We've talked about the WHO source before, it's definitely less than ideal was the consensus. — raekyt 04:48, 14 February 2013 (UTC)

I have shown it and described it. You are now in violation of IDHT. Also you have not provided any evidence for basis that there is NOT a consensus at talk. On the contrary the medical doctor and chiropractor agree on the language and sources of the opening 2 paragraphs. Consensus does not require unanimity. For the revised edit, supportive parties include a medical doctor (Doc James) a chiropractor (Puhlaa) and a veterinarian (DVMt). Only you are opposed to the edit in question. I can count 3 violations of WP alone now. WP:AGF, WP:MEDRS, WP:IDHT DVMt (talk) 04:55, 14 February 2013 (UTC)

Oh my a WP:TE editor is stacking up violations on me, whatever shall I do? No matter what "violations" you want to accuse me of, or no matter whatever consensus you've come up with in your head, it doesn't change that you're reinserting "health care profession" into the lead sentence again. I believe last discussion that was had on it (Talk:Chiropractic/Archive_35#Is_chiropractic_a_.27health_profession.27.3F) did NOT lead to a consensus for it's inclusion. SO again, EXACTLY where was this consensus for the wording your claiming, and by EXACTLY i mean an actual LINK to it, ideally the Diff showing the change being made or a link to the discussion at least. Your wearing on my nerves here. — raekyt 04:59, 14 February 2013 (UTC)

Let's hear a non WP:SPA agree with your change before we entertain the notion that you have support for any of this POV pushing. So far, I've only seen Doc James revert your massive whitewash of the article, I'm surprised you count him as a supporter. TippyGoomba (talk) 05:04, 14 February 2013 (UTC)

Thank you for identifying your concern the wording 'health care profession'. Doc James did not specifically mention this, however I will replace it with 'discipline' as previously agreed upon until there is clarification on the matter. Also, TG, I did not state he was a supporter of me. I stated that there was consensus for the first two paragraphs. Indeed Doc James reversed the article in its entirety which is why we are discussing it at talk. He specifically stated his concerns are we are addressing them. The remainder of the revised article shall too be up for discussion if he has additional concerns. How is collaboration between Doc James and Puhlaa whitewashing? I'm just helping them find the language. DVMt (talk) 05:10, 14 February 2013 (UTC)

Two WP:SPA and one other editor who hasn't even really weighed in on it one-way or the other for the BULK of those changes, is NOT consensus. You proposed that GIANT change just a couple days ago, and there's very low participation here. You can't ASSUME there is consensus yet. It's plainly obvious there isn't. So don't go making that massive change until its been given plenty of time to be discussed. — raekyt 05:13, 14 February 2013 (UTC)

The massive whitewash that was reverted. TippyGoomba (talk) 05:16, 14 February 2013 (UTC)

The bulk of the changes are not even being discussed. How can there be 'massive change' given that 95% of the article remains? Merely the first two paragraphs which has achieved consensus. However I will removing the wording 'traditional' and 'health care profession in the revised lead. You both will not dispute with those changes I assume. DVMt (talk) 05:25, 14 February 2013 (UTC)c

Depends on what else you change, why are you removing the infobox? — raekyt 05:27, 14 February 2013 (UTC)

I'm ok with the infobox being removed, it's awkward, but the "Alternative medical systems" box should be the first box on the page and needs to remain. — raekyt 05:29, 14 February 2013 (UTC)

I agree. I didn't realize it was gone to be honest. Ill combine the alternative medical systems box with the the chiropractic cauduceus. DVMt (talk) 05:41, 14 February 2013 (UTC)

Have been busy. I have little opinion on the non medical aspects of the article (such as history). I will review further but might take me a few days. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:30, 15 February 2013 (UTC)

POV Issues

For the sake of clarity I have copy and pasted Doc James' concerns here so they can be discussed and addressed.

Concern 1 - Use of primary research

It stated "A 2011 study, however, demonstrated that maintenance spinal manipulative therapy is effective for the treatment of chronic nonspecific low back pain" the ref was broken but it is for this primary research paper of 60 people [27] We should not be using primary research and what was there was fair more balanced.

• I agree with Doc James, secondary sources would be needed to make claims of effectiveness for maintenance care; one small primary study fails WP:MEDRS and WP:UNDUE.Puhlaa (talk) 03:20, 12 February 2013 (UTC)

Concern 2 - Is chiropractic care just spine manipulation

It stated "Manual and conservative therapies commonly used by chiropractors are effective for the treatment of low back pain," No this is subterfuge. What chiropractors are known for and primarily do is spinal manipulation and the effectiveness has been left out of the lead all together. Only its safty is discussed. Yet we have this 2012 review of reviews that was summed up originally [28] which found no benefit.

• This chapter from this source says that the vast majority of American chiropractors use exercise prescription/promotion, trigger-point therapy, physiotherapeutic modalities, thermotherapy, disease prevention advice, etc. That most chiropractic patients receive a wide range of manual therapies, active rehabilitation and health-promotion information is also verified in these sources: [29][30]. I agree that SMT is the primary technique most commonly associated with chiropractic, and that most efficacy studies have examined SMT. However, our article should reflect the reality of chiropractic treatment, which for most patients is multi-modal conservative therapy, usually including SMT.Puhlaa (talk) 03:22, 12 February 2013 (UTC)

• My main issue is lumping all that this profession does together. Yes there are aspects that are of benefit like recommending exercise. Throwing that in with aspects that may not have benefit confuses the matter.Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:52, 12 February 2013 (UTC)

• If we agree with reliable sources that say chiropractic treatment involves multi-modal therapy, then to me it seems more confusing to limit discussions of chiropractic efficacy in our article to only spine manipulation. It is important that the article indicate that SMT is only one of many therapies used by chiropractors to treat msk conditions. That said, as the existing literature tends to focuses on spinal manipulation, most of our discussion of efficacy will inevitably be focused on SMT as well.Puhlaa (talk) 16:08, 12 February 2013 (UTC)

Concern 3 - Is spine manipulation 'conservative care'?

We have this line "Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery [1] with an emphasis on the spinal manipulation." I would not consider spinal manipulation "conservative therapy" so combining the two is incorrect. And then once this claim is made in the lead it states "might also be effective for the treatment of lumbar disc herniation with radiculopathy" basing it on a review of conservative therapy which does not mention chiropractic care [31] anywhere.

• Reliable sources seem to suggest that SMT is indeed conservative care. For example, these sources [32][33] [34] all include spine manipulation in their assessment of conservative therapies. Doc James suggests that this review of conservative therapies for disc herniation with radiculopathy did not include SMT. However, it does indeed include SMT and concludes that "Moderate evidence favours manipulation over sham manipulation", thus supporting the text, which says that it "...may be effective for treatment of disc herniation...".Puhlaa (talk) 03:25, 12 February 2013 (UTC)

• So yes Chiropractics is a type of conservative care (ie primarily spinal manipulation) but it is not "conservative management" which is broader in scope. Yes the paper above does indeed mention manipulation but not chiropractic manipulation.Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:40, 12 February 2013 (UTC)

• The systematic review above includes studies that examined manipulation performed by any practitioner; the methodology section does not indicate that studies that included chiropractors were excluded. It seems that most of the sources examining SMT as a treatment for msk conditions have NOT considered it necessary to separate examinations of spine manipulation by who is administering the procedure. Cochrane reviews lump all manipulation studies together, as such I fail to see your justification for using the 'type of practitioner' as an issue here? The only review that I have seen that explicitly separates-out chiropractic manipulation from others was this one. It found: "...it is interesting to note that SMT was administered by DCs in all of the studies that reported greater pain reduction in the SMT group over control groups at one or more time points".Puhlaa (talk) 16:26, 12 February 2013 (UTC)

"I would not consider spinal manipulation "conservative therapy" so combining the two is incorrect." It doesn't matter what you would consider "conservative therapy", it only matters that reliable sources consider spinal manipulation to be conservative therapy/conservative management. DigitalC (talk) 19:47, 21 February 2013 (UTC)

Concern 4 - Does the evidence say spine manipulation is effective for neck pain?

We state without any qualifications that "Manual therapies, including spinal manipulation, has been found to be effective for mechanical neck pain" leaving out the evidence that it has been found not to be effective in neck pain per the review above. We have ignored this [35].

• The text in the lead (that was reverted) was qualified and said "...might also be effective for ... neck pain" and this is supported by this Cochrane review. The Cochrane review says, in the “Authors Conclusions”: "Cervical manipulation and mobilisation produced similar changes. Either may provide immediate- or short-term change; no long-term data are available. Thoracic manipulation may improve pain and function." The text in the body should also be qualified to say "May be effective for neck pain". This source, indicated by Doc James, should be included in the article, but should not get more weight than the Cochrane review, or other sources that are consistent with the Cochrane review. I think that MEDRS says that Cochrane reviews are better than other reviews.Puhlaa (talk) 03:29, 12 February 2013 (UTC)

Yes was referring to lower in the article. I think we can say "the effects of spinal manipulation are controversial, some fail to find any benefit while other find it is equivalent to mobalization" Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:09, 12 February 2013 (UTC)

The wording "the effects of SMT are controversial" can be improved IMO because the effectiveness isn't really controversial in itself although there is disagreement over the how effective may be (superior/equivalent/inferior. As such, I propose that we qualify the statement such as "SMT may be effective for..." Also, the controversial element of SMT specifically is for upper cervical manipulation. Furthermore, as Puhlaa indicated elsewhere, if SMT is contraindicated, then other modes of treatment could be applied that are within the scope of chiropractors (i.e. massage, mobilization, education, exercise, etc. DVMt (talk) 17:51, 12 February 2013 (UTC)

Concern 5 - Disappearing sources

Why did this ref disappear?[36] It did not support manipulation for mirgraines. [18] So my revert of these last 50 edits RESTORED a great deal of high quality evidence.

• The critical Ernst reference should not have been removed, if it indeed was. However, it also does not deserve to be given equivalent weight as this Cochrane review, which is a better source. Moreover, other sources seem to agree with the Cochrane review, thus, the Ernst source could be seen as going against the general scientific consensus.Puhlaa (talk) 03:41, 12 February 2013 (UTC)

The Cochrane review was from 2004 the Ersnt review is from 2011. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:00, 12 February 2013 (UTC)

WP:MEDRS says "Cochrane Library reviews are generally of high-quality and are routinely maintained even if their initial publication dates fall outside the above window." Also, the conclusions of this 2011 source are consistent with the findings of the Cochrane review.Puhlaa (talk) 04:57, 12 February 2013 (UTC)

And all three of them agree that the evidence is poor. So maybe we should just state what they all agree on "the evidence for an effect on migraines is poor" Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:44, 12 February 2013 (UTC)

As opposed to 'poor' perhaps more neutral wording such as 'low levels of evidence' might be preferred as that is the language typically used in EBM. DVMt (talk) 17:54, 12 February 2013 (UTC)

Agreed with DVMt - The level of evidence is low, but the evidence itself is not poor. It may be stated that "Low levels of evidence suggest that spinal manipulation is effective for treating migraines". etc. DigitalC (talk) 19:52, 21 February 2013 (UTC)

See also - http://www.ncbi.nlm.nih.gov/pubmed/21640251 "Evidence suggests that chiropractic care, including spinal manipulation, improves migraine and cervicogenic headaches" DigitalC (talk) 20:05, 21 February 2013 (UTC)

And http://www.ncbi.nlm.nih.gov/pubmed/15266458 "For the prophylactic treatment of migraine headache, there is evidence that spinal manipulation may be an effective treatment option with a short-term effect similar to that of a commonly used, effective drug (amitriptyline)." "For the prophylactic treatment of chronic tension-type headache, amitriptyline is more effective than spinal manipulation during treatment." "However, spinal manipulation is superior in the short term after cessation of both treatments." But they also state, " This conclusion rests upon a few trials of adequate methodological quality. Before any firm conclusions can be drawn, further testing should be done in rigorously designed, executed, and analyzed trials with follow-up periods of sufficient length." — raekyt 21:19, 21 February 2013 (UTC)

Other remarks

I do not have the time to sort through all of DVMt's edits that were reverted by Doc James, Yobol and RexxS. However, I follow WP:BRD and if Doc James, etc., take issue with the edits, then the burden now lies with DVMt to justify his edits. In my opinion, the 5 concerns listed to date by Doc James do not seem like enough justification for blanket reverting DVMt's edits, but as noted by Doc James, there are more concerns than those he listed; as such, I would encourage him to further clarify why he chose to remove all of DVMt's work. I note that DVMt made an attempt to seek input on his edits at the project medicine page and received a blanket revert of all of his work for a response.... Regardless of all this, per WP:BRD, the burden now lies with DVMt and I suggest that he/she initiate discussion for the changes, slowly so we can follow, to try and achieve consensus.Puhlaa (talk) 03:53, 12 February 2013 (UTC)

Comment (POV issues)

Please recall that I did in fact voluntarily bring this up at WP:MED to get additional input so there can be consensus (at least as of Feb 2013), from a scientific point of view, regarding spinal manipulation. My reasoning for doing so is because there are other professions such as osteopathic medicine, physical therapy and naturopathic medicine (in addition to some MDs) who practice manipulative therapy. For consistency across WP the consensus achieved here logically should be consistent with their 'views' on SMT and effectiveness (for example the osteopathic manipulative medicine article with respect to SMT should be consistent with chiropractic and physical therapy with respect to SMT and effectiveness. I apologize for the reverts yesterday, it was not to remove your dispute on the issues that were raised but rather on the massive amount of research, time and energy spent on collecting a lot of new reviews, but also in organizing the article and having it written an an encyclopaedic manner. It was unwise on my part as I got caught up in the emotion and strayed from WP editing principles. Again, I do not want to violate WP:OWN and I fully support collaborate editing, which is why I brought the article to your attention in the first place. I hope that yesterdays debacle doesn't erode good faith on either side. So again, I'm sorry for last night. I do hope I've been able to communicate my concern though when you reverted all the work (not just the section in question) which removed over 50 additional citations added into non-disputed parts of the article such as philosophy, training, etc. DVMt (talk) 04:42, 12 February 2013 (UTC)

Proposed Lead

Chiropractic' is a complementary and alternative medicine discipline concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual and manipulative therapy and its role in joint dysfunction/subluxation . Currently, chiropractors practice in over 100 countries[[37]], however chiropractors are most prevalent in North America, Australia and parts of Europe. The majority of mainstream health care and governmental organizations classify chiropractic as traditional/complementary alternative medicine Most people who seek chiropractic care do so for primarily for low back pain.

Chiropractic was founded in 1895 by magnetic healer, D.D. Palmer, in Davenport, Iowa, United States. Chiropractic theory on spinal joint dysfunction/subluxation and its putative role in non-musculoskeletal disease has been a source of controversy since its inception in 1895. The controversy is due in part to chiropractic's vitalistic and metaphysical origins, and use of terminology that is not always amenable to scientific investigation. Far reaching claims and lack of scientific evidence supporting spinal joint dysfunction/subluxation as the sole cause of disease has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system. Although there is external and internal debate within the chiropractic profession regarding the clinical significance of joint dysfunction/subluxation, the manipulable lesion remains inextricably linked to the profession as basis for spinal manipulation.

While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. Manual and conservative therapies commonly used by chiropractors may be effective for the treatment of low back pain and may be effective for the treatment of lumbar disc herniation with radiculopathy, neck pain, some forms of headache, and some extremity joint conditions. There is insufficient evidence or known mechanisms for effects of chiropractic manipulation on non-musculoskeletal conditions. The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. There is considerable debate regarding the safety of the core clinical act of chiropractors: spinal manipulation, particularly with the uppercervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare as spinal manipulation is relatively safe when employed skillfully and appropriately.

Comments on revised lead

I think it's best if we look at the lead and work from there. As Puhlaa mentioned, everything was reverted but the primary concern is proper language for effectiveness. We can add our comments here to discuss proposed changes to the lead. DVMt (talk) 04:30, 12 February 2013 (UTC)

Some comments:

1. The first sentence is a very editorialized version of the WHO source. The first sentence is controversial and needs a good source to have any stability. I suggest maintaining a definition more closely resembling the high-quality WHO source and include the source for the first sentence.
2. That chiropractic is a complementary and alternative medicine profession needs to be included in the first sentence in order to satisfy WP:NPOV. The last stable version of the article qualified the WHO definition of chiropractic with the fact that it is a CAM; ie., "Chiropractic is a CAM health care profession concerned with....."
3. Third sentence says "chiropractic medicine", which is sure to cause conflict; maintain NPOV by sticking to chiropractic profession, chiropractors or doctors of chiropractic (where appropriate)
4. I cant find anywhere in the WHO source that supports the text "Currently, chiropractic medicine is regulated and practiced in over 100 countries, however chiropractors are most prevalent in...". I apologize if I missed it, if so, can you quote the appropriate text. Otherwise, an appropriate source would be needed for this text.
5. Last sentence of first paragraph says "...and other neuromuscular complaints". To maintain NPOV and avoid conflict, the lead should maintain WP:UNDUE and stick to the majority issue that has scientific consensus, that is back pain. Back pain is the reason for 80% of visits and unquestionably notable for our lead. However, all other conditions combined is only 20% of visits and may not be noteworthy for the lead. I suggest removing "and other NMSK complaints" to help ensure stability of your text and avoid conflicts.

There is more, perhaps I will have another look tomorrow. Hopefully others will also have comments. Puhlaa (talk) 06:04, 12 February 2013 (UTC)

• With respect to "While spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain, the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial." It would be more accurate to say "spinal manipulation is more or less equivalent to conservative treatment for musculoskeletal complaints,[38][39] the use of spinal manipulation to treat non-musculoskeletal has not been found to result in benefit"[40] Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:20, 12 February 2013 (UTC)
• I think this bit is balanced "There has been considerable debate over the safety of the core clinical act of chiropractors: spinal manipulation, particularly with the cervical spine.[20] Although serious injuries and fatal consequences can occur and may be under-reported,[21] these are generally considered to be rare with spinal manipulation being relatively safe[22] when employed skillfully and appropriately.[1]"Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:18, 12 February 2013 (UTC)

• How about "spinal manipulation is equivalent to other conservative therapies for musculoskeletal complaints,[41][42] the use of spinal manipulation to treat non-musculoskeletal controversial and inconclusive(cite budgell 2012, ernst 2008).
• There has been considerable debate over the safety of the core clinical act of chiropractors: spinal manipulation, particularly with the [upper] cervical spine.[20] Although serious injuries and fatal consequences can occur and may be under-reported,[21] these are generally considered to be rare with spinal manipulation being relatively safe[22] when employed skillfully and appropriately.[1] I think that specifically mentioning the upper cervical spine would be more beneficial to readers to inform themselves. DVMt (talk) 18:14, 12 February 2013 (UTC)

I disagree that the first sentence is controversial, and it doesn't need a source for it, as long as it accurately summarizes the information from the body of the article (See WP:LEAD). DigitalC (talk) 21:00, 21 February 2013 (UTC)

Proposed manual and manipulative therapy effectiveness (final paragraph in lead)

Manual and conservative therapies commonly used by chiropractors may be effective for the treatment of low back pain as well as lumbar disc herniation with radiculopathy, neck pain, some forms of headache, and some extremity joint conditions. In general, spinal manipulation is equivalent to other conservative measures for musculoskeletal complaints.[43][44]. There is insufficient evidence regarding the effectiveness of spinal manipulation on non-musculoskeletal conditions.[45]. The efficacy and cost-effectiveness of maintenance chiropractic care are unknown. There is considerable debate regarding the safety of the core clinical act of chiropractors,pinal manipulation, particularly with the upper cervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare as spinal manipulation is relatively safe when employed skillfully and appropriately.

References

Comments (Proposed lead)

This is a proposed synthesis of a new, improved and neutral review of manual and manipulative therapy based on the concerns raised by Doc James and Puhlaa. Due to the high scientific nature of this section, please keep in mind that WP:COMPETENCE applies. DVMt (talk) 20:14, 15 February 2013 (UTC)

Also keep in mind, WP:NPOV, WP:WEIGHT, WP:DUE, WP:SPA, WP:COI. — raekyt 05:13, 21 February 2013 (UTC)

Edit request on 14 February 2013

This edit pertains to the professional identity of chiropractic. Dr. Bill Meeker DC, President of Palmer College of Chiropractic West Campus, recently conducted a poll pertaining to the professional identity of chiropractic. He found that when asked if chiropractic has a professional identity, 40% of those polled said no, 56% said not sure, and 4% said yes. Commonly, when chiropractic is defined it is often lengthy and full of jargon. This leads to confusion and ambiguity within the public. People look to Wikipedia for simple definitions and explanations to all types of subject matter. After three years of work, Dr. Bill Meeker DC developed an identity statement. All that I ask is that the first line of the entry for chiropractic on Wikipedia is the professional identity statement that was developed. This way, when the public looks to Wikipedia for information on chiropractic, it is presented in a descriptive yet easy to understand manner. Here is the statement:

"Chiropractic is the primary care profession for spinal health and well being."

You can find this statement here: http://www.palmer.edu/Palmer/Pages/Page.aspx?id=454#Identity_Statement

If you could please address this request, I'd greatly appreciate it. This edit will help simplify the public's view of chiropractic.

Wil (talk) 02:04, 14 February 2013 (UTC)

Seriously doubt that this definition has wide-spread acceptance in the medical community, and I have serious issues with it myself. Sooo.. Deined on, WP:NPOV, WP:WEIGHT, WP:DUE, etc... — raekyt 03:01, 14 February 2013 (UTC)

The source is reliable and verifiable. It should be included on the notability alone, Palmer being the "fountainhead" or first ever chiropractic school. I read it in one of the articles I reviewed here by Joseph Keating. DVMt (talk) 03:17, 14 February 2013 (UTC)

Is there a reliable secondary source that indicates how influential Meeker is in particular, or that indicates that this definition is widely used within the chiropractic community? If so, then it could probably be included with attribution to Meeker: "Bill Meeker defines chiropractic as..." As this is a primary source it is insufficient for replacing the article's definition of chiropractic, which really needs to be sourced to independent reliable secondary sources. Zad68 03:58, 14 February 2013 (UTC)

Good point Zad68. A more neutral source comes from the World Health Organization, the one currently being used in opening sentence. DVMt (talk) 16:25, 14 February 2013 (UTC)

And you know that's a lie, the WHO document is ANYTHING but neutral. It's entirely a chiropractic lobbyist paper, nothing neutral about it. — raekyt 16:27, 14 February 2013 (UTC)

Are you disputing the credibility and neutrality of the WHO? What's in it for them? DVMt (talk) 17:11, 14 February 2013 (UTC)

Not everything that comes out of the WHO is credible or neutral, of course. — raekyt 16:18, 21 February 2013 (UTC)

This is a very new development for Palmer to have developed this "identity". It does however fit with the World Congress of Chiropractic or World Federation of Chiropractic's identity. It has been covered in secondary sources, reliable secondary sources, but not ones that would meet WP:RS. (See:The Chiropractic Report, probably Dynamic Chiropractic) DigitalC (talk) 21:10, 21 February 2013 (UTC)

Proposed lead: revisions paragraph 1

Chiropractic' is a complementary and alternative medicine health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual and manipulative therapy and its role in joint dysfunction/subluxation . Currently, chiropractors practice in over 100 countries in all regions of the world, however chiropractors are most prevalent in North America, Australia and parts of Europe. Most people who seek chiropractic care do so for primarily for low back pain.

Is Chiropractic a Health Profession? Take 2

• Wow, "health care profession" is back.... WP:POVPUSH much? — raekyt 15:35, 14 February 2013 (UTC)
  • First sentence: Chiropractic is a CAM, should be stated, not "a form of". Third the 2005 WHO source is very poor and should NOT be used to support the first sentence. — raekyt 15:43, 14 February 2013 (UTC)

• Can you point me to the discussion of the WHO document that explains why it's sub-par? Zad68 15:51, 14 February 2013 (UTC)

• Talk:Chiropractic/Archive_35#Spine_or_not.3B_a_reverted_edit — raekyt 15:52, 14 February 2013 (UTC)

• As for "health care profession" being used to describe Chiropractic, for me to accept that I'd need RELIABLE sources that the MAINSTREAM medical community accepts it as a health care profession. Sources that have a COI with chiropractic (i.e. from chiropractors or people who lobby for them like the WHO document) is IMO not sufficient to state it. — raekyt 16:14, 14 February 2013 (UTC)

• And the recent discussion on this: Talk:Chiropractic/Archive_35#Is_chiropractic_a_.27health_profession.27.3F. — raekyt 16:17, 14 February 2013 (UTC)

• I rather prefer the current version to this. If we weeded out all of the POV, I suspect we'd get exactly the current version. TippyGoomba (talk) 16:20, 14 February 2013 (UTC)
  • Most likely, so why not start there... is there anything wrong with the current version? — raekyt 16:23, 14 February 2013 (UTC)

Raeky, you have specifically mentioned the use of the WHO source in the first sentence as a reason for reverting DVMt's edits to the lead, however, in the same thread you endorse the current version, which also uses the WHO source for the first sentence. I agree with your assessment that the first sentence is currently good, except that I think that it should include the fact that chiropractic is a health profession. We had this discussion before, but I never heard back from you after I asked you to verify your claim that "It is a review article so it is not peer-reviewed" at the end of this thread.Puhlaa (talk) 18:12, 14 February 2013 (UTC)

Multiple reliable sources call Chiropractic a health profession, I have listed multiple high-quality sources below to provide WP:V. This information belongs in the article according to policy.

1. From the WHO source: "Chiropractic - A health care profession concerned with....."
2. From a peer-reviewed source in Archives of Internal Medicine: "Chiropractic, the medical profession that specializes in..."
3. From a peer-reviewed source in The Milbank Quarterly: "Chiropractic is the best established of the alternative health care professions."
4. From a peer-reviewed source in Arthritis Research & Therapy: "many patients seek care directly from health-care professionals other than their family doctor; for example, at least one third of back pain patients in Denmark now choose to see a chiropractor as their..."
5. From NIH/NCCAM: "Chiropractic is a health care profession that focuses on..."
6. From a Provincial government source: "Chiropractic has been a designated health profession under the Health Professions Act...."
7. From private insurance company WSIB: "The WSIB has completed a review of the fees paid to 12 health professions." *Note that chiropractic is #3 on the list of 12 health professions.
8. This source examined the attitudes/behaviours of health care professionals, of which, chiropractic is included.

— Preceding unsigned comment added by DVMt (talk • contribs) 17:23, 14 February 2013 (UTC)

• I agree with DVMt that chiropractic is considered a health profession by multiple reliable sources, as verified above. DVMt, I have amended your list above with a few additional reliable sources; I hope you dont mind. Puhlaa (talk) 18:03, 14 February 2013 (UTC)

This is not a question answered predominantly with reference to their recognition by other healthcare professionals but rather in terms of their legal status, recognition by representative, state or international bodies, public usage, education (and other bars to professional entrance) and relationship to health insurers. It's not a question about the efficacy of chiropractic methods or it's scientific status. Frankly, they could be killing people every day and it wouldn't matter to such a definition. Are there registration acts in relevant jurisdictions covering chiropractors? Are they described therein as health professionals or under some analogous term? Do health insurance companies pay out for chiropractic treatment? Do studies of public usage indicate a popular perception that they provide a form of treatment aimed at the improvement of "health"? Is there occupational closure in terms of entry to the profession (chiropractic schools cover that)? Do they have professional assocations and self-describe themselves as operating in the field of health? Do these associations have legal status or recognition by state or representative international bodies? Is chiropractics recognised or defined by representative international or state bodies involved in healthcare? The appropriate secondary sources should cover these issues. In my opinion, the WHO, as an international representative body involved in global healthcare, while insufficient on its own, is an appropriate source to support such a statement irrespective of whether, or whether anyone thinks, that such a definition is the result of lobbying, bribery or extortion. The next thing to determine would be whether other large international or state bodies, (the EU, US Federal law, etc) also recognise chiropractics as a health care profession. FiachraByrne (talk) 14:32, 20 February 2013 (UTC)

Seriously, this seems like WP:TE to me. How can anyone dispute that chiropractic is a health care profession? DigitalC (talk) 21:48, 21 February 2013 (UTC)

"Chiropractors, like other health care professions, whose clinical specialty is to detect and diagnose musculoskeletal and nervous system problems..." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391779/ DigitalC (talk) 21:55, 21 February 2013 (UTC)

NPOV Noticeboard

I have request comments from outside the article here [46] regarding the whether or not the sources support the claim of health care profession, and is the sources are reliable. Feel free to discuss there or add additional citations that support or refute the premise. DVMt (talk) 18:08, 14 February 2013 (UTC)

with no links to current and past discussions? That's not good practice, I would add them now exept it's a bit hard on my phone... — raekyt 18:26, 14 February 2013 (UTC)

Agree with Raeky that it would be good to link to the last time we discussed if Chiropractic is a health profession here so that editors new to the discussion can gain context. Editors will then note that after the same sources were presented in the archived discussion, it seemed that only Raeky was left arguing that chiropractic is not a health profession. However, the argument he/she last presented was that the sources provided were not reliable because review articles are not peer reviewed? I asked him/her to fact-check this claim, but then never heard back? It is my opinion that the sources provided in the list above are all reliable according to WP:RS and clearly WP:verify that chiropractic is a health profession. It will be helpful to see if other editors think that chiropractic is, or is not a health profession.Puhlaa (talk) 18:42, 14 February 2013 (UTC)

Not quite accurate, I said they're all sources from chiropractors, not something that shows that the medical community from outside the confines of chiropractic regards it as such. I also stated that review articles in a journal is generally NOT peer review in the full sense. Theres an editorial process at the journal to review it but are generally not sent out for a formal review process as a research paper would be. Theres also a much wider latitude of allowable topics in review articles that wouldn't normally be accepted as a submitted research paper. For source #2, Dr. Ted Kaptchuk is a CAM doctor, so not exactly far removed from the subject, and a review article. Source #3, Dr. Richard Cooper seems legit, and I don't know what kind of journal/paper it is, it's a weird layout but it uses "alternative health care profession" as the wording, which isn't quite the same as "a health care profession." Paper #4, Dr. Nadine Foster is also a mainstream doctor, but I think it's a stretch t to take her wording to state "chiropractic is a health care profession." I think it's probably your poorest source in that list to support that position based on the wording. Sources #1, the biased propaganda lobbyist piece, Source #5-7 are not mainstream medical sources, so basically irrelevant for the topic, and #8 is a paper by a PhD candidate in Physiotherapy so not yet a doctor, and a review article. Are these the best sources you have to make this claim? — raekyt 23:06, 14 February 2013 (UTC)

Eisenberg is an MD, not a 'CAM' doctor, from Harvard Medical School no less. Where as your sources that suggest the WHO is 'biased, propaganda lobbyist piece'? It is a peer-reviewed production and is signed off by an MD. Also, I really don't think you understand, in the academic sense, what a 'review' paper is. Any article that is published in a scientific journal indexed at PubMed has to go through 'peer review' prior to publication. Systematic reviews are the analysis of many papers on a given topic (hence the 'review') and have more weight because they are secondary sources. With respect to the 'latitude of wider topics' this is conjecture and speculation not to mention being completely wrong and irrelevant. When other professions, other than chiropractors such as MDs and PTs refer to chiropractic as a 'health profession' that is significant in itself. The burden is on you, Raeky, to prove your cases that all these sources, indexed in PubMed, are not reliable sources. All we have so far is your opinion on the matter which is irrelevant given that we are looking at facts. WP:V, WP:MEDRS, and WP:RS are the guidelines we are going by. DVMt (talk) 23:54, 14 February 2013 (UTC)

Raeky, of all the sources listed above, the one you agree is most reliable is #3, which states that chiropractic is an alternative health care profession. I assume that you realize that DVMt's proposal was for the text to read "Chiropractic is a complementary and alternative health care profession", as such I am not sure why you are concerned? Moreoever, I disagree entirely with your assessment of the sources provided. First, review articles are definitely peer-reviewed and such secondary sources are preferred according to WP:MEDRS; 3 of the listed sources are secondary sources, thus highest quality according to MEDRS. Secondly, I don't see agree that any of the sources are from chiropractors, they are almost all from well-respected medical bodies and/or journals. That "Kaptchuk is a CAM doctor" is irrelevant according to MEDRS, the source is a review, published in a well-respected mainstream journal. We are still now left at the same point as the last time this discussion arose. Hopefully we will hear from some uninvolved editors so that we can move forward.Puhlaa (talk) 23:56, 14 February 2013 (UTC)

We are unfortunately in the exact same spot as last time where Raeky disagrees with the quality of the sources despite being WP:MERDS compliant. She is presenting her opinion as fact to discredit reliable sources. Obviously the claim of 'health care profession' is verifiable and is not inherently POV in itself as we are directly quoting the source. The burden still remains on Raeky to prove that it is not a CAM health profession. Cautiously optimistic that this can be resolved. DVMt (talk) 03:36, 15 February 2013 (UTC)

Reliable sources noticeboard

Given that Raeky is challenging the veracity, integrity and reliability of the sources, I have opened up a discussion here [47]. I don't know if the protocol for there is different that WP:NPOV, but if there's any changes that need to be made just let me know. Thanks! DVMt (talk) 03:56, 15 February 2013 (UTC)

Let the record indicate that the RS noticeboard unanimously declared, on the sources provided (and additional sources they found) that chiropractic is a 'health care profession'. The discussion can be seen here[ http://en.wikipedia.org/wiki/Wikipedia:Reliable_sources/Noticeboard#Is_chiropractic_a_health_care_profession.3F]. If there aren't any other specific challenges to the first two paragraphs of the lead I will be inserting it following time for commentary. DVMt (talk) 19:58, 15 February 2013 (UTC)

I have inserted the revised first two paragraphs of the lead based on the discussions here and at WP:RS. DVMt (talk) 16:36, 16 February 2013 (UTC)

Second Sentence

You want to change it from "Chiropractors primarily practice manual therapy, with an emphasis on manipulation of the spine." to "There is an emphasis on manual and manipulative therapy and its role in joint dysfunction/subluxation." The current second sentence is more accessable to the layman, it doesn't use words like "dysfunction/subluxation," can those be wikilinked to definitions so the reader can understand them? and what is wrong with the current version? — raekyt 16:42, 16 February 2013 (UTC)

Yes, they can be wiki-linked. Given that joint dysfunction/subluxation is a central part of chiropractic, it should be included as, again, it's quoting the source. I will wiki-link it. DVMt (talk) 16:51, 16 February 2013 (UTC)

But are the technical terms best to use in the second sentence, assuming the reader has no knowledge of chiropractic what so ever? — raekyt 16:53, 16 February 2013 (UTC)

You ask me to WL so I do it and then you revert discussed material. You did not challenge anything other than 'health care profession'. The terms being used are in plain English. What again are your specific concerns with the additions? DVMt (talk) 17:02, 16 February 2013 (UTC)

You can change the FIRST sentence... the rest is still open for discussion, which hasn't occurred yet. — raekyt 17:03, 16 February 2013 (UTC)

Please don't be condescending and tell me what I can and cannot do. The revised lead has been posted here since Feb 10/13 and the only concerns brought up where by Doc James regarding effectiveness of SMT. Again, I will ask you directly: what are your specific concerns (please list them). You are being too vague. Are you disputing the sources? Are you disputing the language? DVMt (talk) 17:08, 16 February 2013 (UTC)

Language, according to WP:MOSINTRO the language used should be the most accessable as possible. I don't think the way you have it worded is the BEST language for someone who doesn't know these terms. Technical terms can be used in the body of the article, but shouldn't be in the lead. — raekyt 17:16, 16 February 2013 (UTC)

Ok, but remember MEDMOS applies here. What is your proposal? Manual and manipulative therapy is straight forward and joint dysfunction/subluxation is straight forward. Subluxation appears in the second paragraph too. We can't separate joint dysfunction/subluxation from chiropractic which would violate WP:NPOV. Can you restore the cauduceus? You accidentally deleted it by reverting 2 edits (the caudeceus add we discussed 2 days ago) instead of just the material you opposed. Thanks! DVMt (talk) 17:20, 16 February 2013 (UTC)

That's how I'd perfer the cauduceus be added, I said days ago that the CAM box should be first, and ideally only box at the top. And again what's wrong with the current second sentence, it sounds fine to me? — raekyt 17:28, 16 February 2013 (UTC)

We can't add the cauduceus to the CAM info box though as I mentioned in the edit summary. I have simply added the term joint dysfunction/subluxation as it appears in the source. Do oyu not think that joint dysfunction/subluxation should be part of the lead? DVMt (talk) 17:34, 16 February 2013 (UTC)

I think they're slightly technical terms which would make the lead less accessible... — raekyt 17:44, 16 February 2013 (UTC)

'Manipulation of the spine' is already in the current form and that is a 'technical term'. Raeky, this article falls under WP:MEDRS so there are going to be technical terms discussed. Even you say you concern is 'slight'. Do you have alternate language that is supportive by a MEDRS source? Otherwise we can't stray too much from the citation in risk of WP:NPOV. DVMt (talk) 17:51, 16 February 2013 (UTC)

MEDRS is for reliable sourcing, but WP:MOS, WP:LEAD and WP:MEDMOS take priority for actual article wording. Technical terms are fine, but should be avoided in the lead, the lead should always be most accessible. The term "manipulation of the spine" is accessible because everyone can understand that, but the term dysfunction/subluxation is a bit technical. The current second sentence is accessible to the general public. Also keep in mind WP:MEDMOS states the audience is the general public. I'm not even sure what the dysfunction part means in this context. Subluxation is a partial dislocation of a joint I think, basically I think it's saying it's problems or slight dislocation of joints. Is there anything incorrect with the current wording? — raekyt 18:01, 16 February 2013 (UTC)

I can see your confusion regarding joint dysfunction/subluxation. Chiropractors and medical doctors use the term differently which is why the generic term 'joint dysfunction' is used interchangeably with subluxation. Orthopedic (medical) subluxations are indeed slight dislocation of joints, whereas joint dysfunction isn't a dislocation just joint that isn't moving well in biomechanical terms. How about "Chiropractors emphasize manual and manipulative therapy and its role in joint dysfunction". — Preceding unsigned comment added by DVMt (talk • contribs) 18:09, 16 February 2013 (UTC)

How about, "Chiropractors emphasize manual and manipulative therapy for the treatment of joint dysfunctions" ? — raekyt 18:12, 16 February 2013 (UTC)

Agreed. I will make the change. DVMt (talk) 18:20, 16 February 2013 (UTC)

Remaining rest of paragraph

I don't have an issue with the remaining changes in this paragraph. — raekyt 18:25, 16 February 2013 (UTC)

Make a section like this for 2nd paragraph? — raekyt 18:27, 16 February 2013 (UTC)

Ok, sounds good. Paragraph 2:

Proposed revision: Paragraph 2

Proposed Change

Chiropractic was founded in 1895 by magnetic healer, D.D. Palmer, in Davenport, Iowa, United States. Chiropractic theory on spinal joint dysfunction/subluxation and its putative role in non-musculoskeletal disease has been a source of controversy since its inception in 1895. The controversy is due in part to chiropractic's vitalistic and metaphysical origins, and use of terminology that is not always amenable to scientific investigation. Far reaching claims and lack of scientific evidence supporting spinal joint dysfunction/subluxation as the sole cause of disease has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system. Although there is external and internal debate within the chiropractic profession regarding the clinical significance of joint dysfunction/subluxation, the manipulable lesion remains inextricably linked to the profession as basis for spinal manipulation.

Current Paragraph

Chiropractic was founded in 1895 in Davenport, United States, by magnetic healer D.D. Palmer who posited that dysfunctional spinal joints dubbed vertebral subluxations was responsible for disease by interfering with innate intelligence, the body's natural healing mechanism. Early graduates of Palmer's chiropractic rejected his "straight" monocausal view that all disease originated from the spine and opened competing schools which incorporated mainstream diagnostic approaches which incorporated spinal manipulations with other adjunctive forms of therapy such as massage and exercise.

Comments (Proposed revision: Paragraph 2)

This revision replaces a 1993 article with 2012 review and adds a tertiary source to replace unsourced text and concisely examines the controversy of chiropractors using SMT for visceral disorders. It also accurately describes the 2 central tenets of chiropractic which is spinal manipulation and joint dysfunction; how each are inter-related and are the basis for each other, which is also cited in the 2012 review. This revised paragraph adds much important WP:MEDRS sources, which are from 2005-2012. The language is neutral, it does not criticize or support chiropractors, it merely explains objectively what they believe in, their rationale for SMT, and the controversy surrounding the profession. DVMt (talk) 19:01, 16 February 2013 (UTC)

If there is no opposition I will insert the 2nd paragraph as there does not seem to be any opposition to the sources or language. DVMt (talk) 17:00, 17 February 2013 (UTC)

Might take a few days for people to even see it, theres not much traffic here and I don't know how much time I have today. — raekyt 17:15, 17 February 2013 (UTC)

I'll give it another 24 hours or so. I don't think that paragraph should be too controversial; it adds good secondary sources (much needed) and covers the topic well. I believe the language is NPOV too. Anyways, as per our work on the first paragraph we can hammer it out here. DVMt (talk) 17:19, 17 February 2013 (UTC)

As there is no opposition to insertion with the revised 2nd paragraph I have inserted it. Onto the 3rd and final paragraph of the proposed, revised lead! DVMt (talk) 17:04, 18 February 2013 (UTC)

Proposed final paragraph of lead: effectiveness of manual and manipulative therapy

Manual and manipulative therapies may be effective for the treatment of low back pain, lumbar disc herniation with radiculopathy, neck pain, some forms of headache, and some extremity joint conditions. In general, spinal manipulation is equivalent to other conservative measures for musculoskeletal complaints.[48][49]. There is insufficient evidence regarding the effectiveness of spinal manipulation on non-musculoskeletal conditions.[50]. Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches. There is considerable debate regarding the safety of spinal manipulation, particularly with the upper cervical spine. Although serious injuries and fatal consequences can occur and are likely to be under-reported, these are generally considered to be rare as spinal manipulation is relatively safe when employed skillfully and appropriately.

References

Comments (Proposed final paragraph of lead)

This is a proposed synthesis of a new, improved and neutral review of manual and manipulative therapy based on the concerns raised by Doc James and Puhlaa. Due to the high scientific nature of this section, please keep in mind that WP:COMPETENCE applies. DVMt (talk) 20:14, 15 February 2013 (UTC)

Some comments:

- First sentence, should "Manual and conservative therapies..." be changed to "Manual and manipulative therapies commonly used by chiropractors..."?

- First sentence, "...may be effective for the treatment of low back pain as well as...". I think that a comma could replace the "...as well as..."

- First sentence, [this] source could be added to help wp:verify the "neck pain" claim. I don't think that any text needs to be added to the proposal, just the source.

- Should the newest systematic review on safety of cervical manipulation be included as a source somewhere in the discussion of safety?

Note: The references in the reflist do not match those in the proposal text, but I am unsure how to fix this for you...sorry Puhlaa (talk) 00:57, 17 February 2013 (UTC)

I have changed the first sentence to include manipulative and inserted the comma. Thank you that reads better and reflects the content well. Feel free edit or place the new safety review where you think it might be good. I'm not sure how to get the references to start off 'fresh' for the new subsection. I will hopefully figure it out! Regards, DVMt (talk) 05:17, 17 February 2013 (UTC)

I have asked Zad68 and Doc James to comment a few days ago. I don't want to bother them, but this proposal has been here for 4 days now without comment from them. Suggestions to proceed? DVMt (talk) 02:41, 20 February 2013 (UTC)

How about "Spinal manipulation has been found to be more or less equivalent to conservative management for musculoskeletal complaints.[51][52] The use of manipulation to treat non-musculoskeletal issues has not been found to result in benefit"[53] One needs a proper comparator to take into account the placebo effect. The above paragraph does not give one. As this is more or less what we already have which is better than what is proposed I have restored what was there before. I would like to see clear consensus preferably via a RfC at least before you change it again. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:48, 21 February 2013 (UTC)

Unfortunately your proposal omits the majority of the sources we have proposed above. Also, the proposed language is unacademic and does not reflect the language and tone used within the source itself. Your suggestion regarding a proper comparator is not in the sources stated. Do you have a source that states this on directly compares SMT and placebo? We agree with the RfC. How do you we ensure competence and neutrality of editors? These should be discussed prior to initiating the RfC process. DVMt (talk) 05:20, 21 February 2013 (UTC)

We are a general source encyclopedia and are not trying to write in "journal level" prose which is much of the time incomprehensible. We are trying for an easy to understand lead which the version I have proposed achieves. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:46, 21 February 2013 (UTC)

This raises two big red flags. First, that's a cop-out that the saying a MEDRS should be dumbed down to the point where it looses coherence, and second, what is hard to understand about the proposed revision? MMT may not be a priority of yours, but it's a topic that hold great interest to many people and we are doing it a disservice by reducing effectiveness and safety down to 2 sentences that use 3 instead of 17 sources. Please state what problem you have exactly with the language or wording of the proposed revision so that the RfC can be better served by clearly delineating your position. DVMt (talk) 16:16, 21 February 2013 (UTC)

You need to be EXTREMELY careful throwing around WP:COMPETENCE, because that can EASILY break WP:CIVIL, and that's a serious problem. Also I don't think you understand WP:NPOV, it doesn't mean we give equal weight to all arguments. Carefully re-read it. — raekyt 05:26, 21 February 2013 (UTC)

No one is 'throwing' around competence, but when we're discussing effectiveness and safety of any given intervention, based on evidence-based medicine principles, you need to have extreme competence in a the subject. Hence, the RfC should target qualified professionals. We don't need a bunch of dogmatic skeptics weighing in and 'vote stacking' the RfC. This is an extremely important and scientific topic which has never been resolved at WP. Once we can get a true scientific consensus going with the RfC there can be peace over this intervention which could easily be argued has gone mainstream. DVMt (talk) 05:38, 21 February 2013 (UTC)

Only thing I can do is give you advice, calm down on calling people incompetent, and I HIGHLY advise you not too, ever. And re-read WP:NPOV because your not understanding it. If you all proceed with a RfC I can assure you that you're not going to be able to cherry pick editors that are pro-chiropractic to backup your WP:FRINGE views. — raekyt 05:44, 21 February 2013 (UTC)

As for the last paragraph, "spinal manipulation is relatively safe." The word "relatively" is a weasel word, relative to what? Also the word "pseudoscience" needs to appear in the lead, and the scientific consensus needs to be predominately featured. You're white-washing the article of anything critical and that's a SERIOUS problem for conflict of interest single purpose accounts. — raekyt 05:09, 21 February 2013 (UTC)

The source (Cochrane 2012) used the term 'relatively' safe. We can just call it safe if that's what you want. The article is not white-washing anything critical, the 2nd paragraph in the lead goes over the controversy of subluxation in detail. This is actually expanded upon in the revised article. This is the third time you've insulted me by accusing me of white-washing the article amongst other personal attacks. You're constantly attacking me personally, the editor, as opposed to the edit. And the fact that you didn't even think a systematic review was peer reviewed suggests that, with respect to the 'medical' side of things, you may be over your head. DVMt (talk) 05:27, 21 February 2013 (UTC)

As for your training as a vet I have probably more scientific background than you with finishing my final semester as a undergraduate biology major and being accepted into a top university for a masters program in botany, I'm not totally ignorant as you seem to suggest. Please be mindful of WP:AGF and WP:CIVIL, accusing people of being incompetence can result in blocks and being brought up at WP:DR or WP:ANI. It's also interesting that you're not aware of the way academic journals work after your vet schooling, or not. Reviews do not get the same review process as a research paper, and if you don't believe me go find out yourself by doing a bit of research. — raekyt 05:35, 21 February 2013 (UTC)

I have my Bachelors of Science (Hons). in Biology then my Doctor of Veterinary Medicine degree. 8 years of university. I have incorporated animal chiropractic in my practice and have done extensive research on the subject since. There's a difference between a rational skeptic and dogmatic skeptic. If you indeed say that you abide by science and the scientific method then follow the sources. Read them, investigate them and draw your arguments from the sources. Otherwise it may come off as hot-air to editors. As for your upcoming MSc. in Botany, good luck. But for now that's really just speculating. Also, a systematic review means that it is a review of all research papers on a given topic and specific question. Your suggestion that systematic reviews aren't 'research papers' is rather astonishing. Then you tell me I should do a bit of research? There's really no words to describe it. So a picture [54] instead. DVMt (talk) 06:16, 21 February 2013 (UTC)

I disagree with the wording suggested by Raeky, ""Spinal manipulation has been found to be more or less equivalent to conservative management for musculoskeletal complaints" because spinal manipulation is a type of conservative management. As such, the sentence does not make sense. I would also remind all editors to AGF and avoid ad hominem attacks. DigitalC (talk) 22:13, 21 February 2013 (UTC)

Sure than how about "Spinal manipulation has been found to be more or less equivalent to other types of conservative management with respect to musculoskeletal complaints" Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:42, 21 February 2013 (UTC)

Philosophy of Chiropractic

Is Philosophy of Chiropractic a POV fork of Chiropractic? bobrayner (talk) 23:48, 18 February 2013 (UTC)

No more so than Chiropractic controversy and criticism. It was approved by WP:MED a few days ago. DVMt (talk) 23:52, 18 February 2013 (UTC)

That's odd; I see no mention of Philosophy of Chiropractic on Wikipedia talk:WikiProject Medicine. I'll ask there. bobrayner (talk) 00:01, 19 February 2013 (UTC)

I'm mistaken, but yes, we shall ask if MEDRS applies. Good call. DVMt (talk) 00:06, 19 February 2013 (UTC)

My apologies. It was approved already by WP:MED. See here [55]. DVMt (talk) 00:43, 19 February 2013 (UTC)

I wouldn't really call that approval; WhatamIdoing just gave it a rating. Based on the length of the current article I guess there's a rationale for creating sub-articles that could develop aspects of the topic. However, some of the material in the parent article is excluded from the "Philosophy of chiropractic" article; if it were integrated into the new child article it should remove, I think, any concerns that a POV fork had been created. FiachraByrne (talk) 00:56, 19 February 2013 (UTC)

Perhaps 'reviewed' would have been a choice of words. The point remains, that WP:MED rated the article and must be edited per WP:MEDRS standards. There is no "philosophy of" section in the current article. The closest thing we have is a "straight vs mixer' debate which is currently lacking in gravitas and depth (as well as sources) for this huge debate within the profession. Perhaps certain sections can be incorporated and modernized? DVMt (talk) 01:11, 19 February 2013 (UTC)

Back to the point, then. What do other editors think? Is Philosophy of Chiropractic a POV fork of Chiropractic? I'm concerned that it mainly exists to show what chiropractic thinks about itself, plus a bit of cherrypicked stuff from the outside world where it's favourable, without really showing what independent sources think about chiropractic. bobrayner (talk) 06:39, 19 February 2013 (UTC)

I'd be concerned about WP:WG as well. For both issues, I don't see a reason this stuff can't be integrated into the main article. TippyGoomba (talk) 08:23, 19 February 2013 (UTC)

The concerns about creating a walled garden are legitimate but there's no reason existing criticism and detail from this article section on "Concepts" could not be incorporated into the "Philosophy of chiropractic" article. There's no doubt the "Philosophy of chiropractic" article requires a significant rewrite as it reads from an internalist rather than encyclopedic perspective. Also, much of the text from the Philosophy of Chiropractic article appears to have been copy-pasted from the Doctor of Chiropractic article; aside from issues of attribution there's no necessity to duplicate this information over several articles. FiachraByrne (talk) 09:25, 19 February 2013 (UTC)

The "philosophy of chiropractic" article has now been expanded to include various other things which are definitely not philosophy. Strangely, the main thing it hasn't inherited from the main Chiropractic article is the balanced coverage of efficacy, safety, and whether or not chiropractic is snake oil. bobrayner (talk) 17:28, 19 February 2013 (UTC)

I agree that there are content problems with the article (probably best to discuss on that article's talk page). Also, it would seem that content was at least partially created through a copy and paste from the article Doctor of Chiropractic. I wouldn't see efficacy and safety issues as so relevant to an article on chiropractic theory if they're adequately covered here - criticism should be directed where relevant at how that theory might contradict scientific norms, accepted systems of knowledge, etc.FiachraByrne (talk) 17:41, 19 February 2013 (UTC)

The reason why this article is under dispute (NPOV) is the fact that we are trying to get a balanced look efficacy and safety. There has been a RfC sent already to 3 MDs who are overviewing the proposed text for the lead (see paragraph 3) which covers both efficacy and safety. That will clearly delineate the claims of effectiveness and safety of manual and manipulative therapies. DVMt (talk) 17:47, 19 February 2013 (UTC)

Philosophy of Chiropractic is a newly-minted pov-fork with, what, three or four watchers? Meanwhile the Chiropractic article has 550 watchers. I think our chances of outside input and broad-based discussion are better on this talkpage. bobrayner (talk) 19:49, 19 February 2013 (UTC)

I agree that the discussion about philosophy of chiro should be held at the other talk page. Interestingly, Bob says it's a POV fork but does not consider Chiropractic controversies and criticism a POV fork. Bob could you please clarify if you do think that the controversies and criticicms is a POV-fork. Also, besides the obvious red-herrings here, does Bob disagree with the WP:MEDRS compliant sources? Why does Bob remove systematic reviews? Bob can you shed some light on your rationale? DVMt (talk) 20:01, 19 February 2013 (UTC)

To get back on topic... Anyone feel like merging Philosophy of Chiropractic into this article or is there some reason for its existence I've missed in my careless reading of the discussion above? TippyGoomba (talk) 03:46, 20 February 2013 (UTC)

Whatever the concerns, the extra-workload in monitoring, the repetition of content from other chiropractic articles, or the inclusion of irrelevant material in the current article, it's a notable topic [56] and it should be possible to construct an article in its own right that solely covers chiropractic theory/philosophy with relevant critiques of same. More work for the dwindling editorial corps, of course. I'd also reemphasise that a lot of the relevant content is already contained in (was copied from) the article Doctor of chiropractic and indeed in the main article. FiachraByrne (talk) 03:08, 21 February 2013 (UTC)

I'm in it for the long haul, there was a job started in mid-Jan for a main article rewrite (the last significant one was in 2008 according to DigitalC). A five year update is good. How about we insert the updated straight vs. mixer section first, with the history. That should be non-controversial and pretty straight forward. I do want to follow WP:PSMED with the Mos and formatting for medical specialities. DVMt (talk) —Preceding undated comment added 03:20, 21 February 2013 (UTC)

Whoisinthewhatnow? Insert what? Insert where? FiachraByrne (talk) 03:41, 21 February 2013 (UTC)

Edit request on 19 February 2013

You should include the latest Cochrane review.

It found chiropractic SMT no better than sham treatment.

http://www.ncbi.nlm.nih.gov/pubmed/23169072

209.52.84.50 (talk) 16:37, 19 February 2013 (UTC)

Not done: This is not an absolute "no" response to this request, but this request requires 1) specific text to add to the article, and 2) consensus for this addition since it adds controversial information to the article. —KuyaBriBri^Talk 17:17, 19 February 2013 (UTC)

Well, useful to point out anyway and, as it's a Cochrane review, its findings should be incorporated into the article.FiachraByrne (talk) 17:20, 19 February 2013 (UTC)

If you see fit to incorporate the OP's request I will not object. Cheers, —KuyaBriBri^Talk 17:45, 19 February 2013 (UTC)

I'll leave it to someone more competent to do so. FiachraByrne (talk) 02:51, 21 February 2013 (UTC)

Cochrane reviews most definitely must be incorporated. DVMt (talk) 17:48, 19 February 2013 (UTC)

Of course, this is an entirely notable and reliable source. — raekyt 05:22, 21 February 2013 (UTC)

Proposal: Philosophy: Straight and Mixer (2013 update) Version 2.001 (beta)

The philosophy of Chiropractic merges both elements of vitalism and materialism. Chiropractors emphasizes manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders The relationship between structure, especially the spine, and function, as modulated by the nervous system, is central to chiropractic and its approach to the restoration and preservation of health. Chiropractors examine the biomechanics of the spine and other joints of the neuromusculoskeletal system and examines its role in health and disease. It is hypothesized that clinically significant neurophysiological consequences may occur as a result of spinal dysfunction/subluxation, described by chiropractors as the vertebral subluxation complex Most practitioners currently accept the importance of scientific research into chiropractic. Foundational concepts of the philosophy of chiropractic includes the following principles:

• Vitalism accepts that all living organisms are sustained by a vital force that is both different from, and greater than, physical and chemical forces. Contemporary is it is referred to as "vis medicatrix naturae" (the healing power of nature).
• Holism postulates that health is related to the balanced integration of the individual in all aspects and levels of being: body, mind and spirit, including interpersonal relationships and the interplay between lifestyle, environment, and health.
• Naturalism states a preference for natural remedies. This is bound up with a set of philosophical principles which may be expressed as the body is built on nature’s order, it has natural ability to heal itself, that this is reinforced by the use of natural remedies, that it should not be tampered with unnecessarily through the use of drugs or surgery
• Humanism is based on the postulate that individuals have immutable rights, for example the right to dignity. In CAM there is extensive concern about dehumanizing procedures and the dehumanizing institutions that have been created for the ill. Partly it is recognition of the personal, social and spiritual aspects of health and a move away from simply the biology of health.
• Therapeutic Conservatism is the use therapies that have a low level of side effects and it tends to accept that the least care is the best care. This in some ways is derived from earlier principles. if the body is capable of healing itself, the role of the therapy is simply to initiate the process.

Upon its founding 1895, chiropractic's early philosophy was rooted in vitalism, magnetism, spiritualism and other constructs that were not amenable to the scientific method. A self taught healer, D.D. Palmer, attempted to merge science and metaphysics. In 1896, D.D. Palmer's first descriptions and underlying philosophy of chiropractic was strikingly similar to Andrew Still's principles of osteopathy established a decade earlier. Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction/subluxation to improve health. Palmer drew further distinctions by noting that he was the first to use short-lever HVLA manipulative techniques using the spinous process and transverse processes as mechanical levers. Additionally he described the effects of chiropractic spinal manipulation was mediated by the nervous system in contrast to osteopathy who believed the effects were attributed to the supremacy of the circulatory system. Palmer initially denied being trained by osteopathic medicine founder A.T. Still but later acknowledged osteopathy wrote that the "the underlying philosophy of chiropractic is the same as osteopathy... Chiropractic is osteopathy gone to seed."' By embracing both vitalism and materialism the philosophy of chiropractic has produced a diverse and eclectic mix of chiropractors which despite their emphasis of manual therapy they may vary on their perceived scope of practice, interventions and their role in the health care system.

"Straight" chiropractic

Also known as 'subluxation-based' and 'principled chiropractic', chiropractors educated from this paradigm espouse traditional Palmer principles and philosophy. Historically straight chiropractors regarded spinal joint dsyfunction/subluxation as the primary cause of "dis-ease" and could be corrected via specific chiropractic adjustments. This monocausal view of disease has been abandoned by the profession preferring a holistic view of subluxation that is viewed as theoretical construct in a "web of causation" along with other determinants of health. Palmerian philosophy focused on metaphysical constructs such as Innate Intelligence and Universal Intelligence to explain the effects of the chiropractic adjustment, whose intent was the reduce/correct spinal subluxations and improving the functioning of the nervous system. The subluxation was said to be "the cause of 95 percent of all diseases... the other five percent is caused by displaced joints other than those of the vertebral column." Misalignment of the vertebrae was believed to be cause impingement of the nerve root, a theory which has long been debunked Subluxation-based chiropractors view traditional chiropractic lexicon such as "analysis" and "adjustment" and as a critical distinction of chiropractic despite lack of prevalence of these terms in the chiropractic literature Subluxation-based chiropractors have been criticized both internally and externally for far-reaching claims of "killer" subluxations, pseudoscientific reasoning, dogmatic approaches unethical business practices that invoke religious themes and high-volume treatments for a variety of conditions that lack supportive scientific evidence. This metaphysical and dogmatic and singular approach to chiropractic care has been criticized for failing to engage in critical and rational thinking and embracing evidence-based medicine. Straight chiropractors use a subluxation-based model as opposed to the patient-centered model now favored in health care. Although they are the minority within the profession, they are considered to have a disproportionate influence as "purists".

"Mixer" chiropractic

Mixers form the majority of chiropractors and attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness; While D.D. Palmer considered vertebral misalignment to be the hallmark feature of subluxation, mixer pioneer Solon Langworthy asserted that intervertebral hypomobility, not misalignment, was subluxation’s cardinal biomechanical feature. This contrasting mechanistic emphasis, intervertebral misalignment vs. hypomobility, formed one the basis for a heated polemic in the profession. Although both misalignment and hypomobility are currently recognized as biomechanical features of subluxation, hypomobility has garnered much more attention in recent years. Mixers were disdained by the Palmers who disapproved of their use of instrumentation and mixing chiropractic diagnostic and treatment approaches with osteopathic, naturopathic and medical viewpoints.. MIxers combine both vitalistic and mechanistic viewpoints that has led to scientific investigation of chiropractic principles. Mechanistic underpinnings have led to testable hypotheses that structure affects function via the nervous system by the scientific study of joint dysfunction and the biological mechanisms underlying manipulative therapies Scientific chiropractors suggest that dropping "subluxation dogma" and similar hypotheses without evidence will allow chiropractic care to become integrated into the wider health care community. In contrast to subluxation-based chiropractors, evidence-based chiropractors favor and incorporate mainstream medical diagnostic and treatment approaches such as exercise, nutritional supplementation, self-care, physiotherapeutic modalities, and other natural approaches. A majority of mixers retain belief that spinal dysfunction/subluxation may be involved in somato-visceral disorders. This group may represent the 'silent majority' of centrists who embrace evidence-based medicine but feel comfortable retaining elements of the subluxation complex that have not been validated through empirical evidence.

References

Comments (Proposal: Straight and Mixer)

Are you proposing adding this to an article that is already >100k? (last edit made it 118,063 bytes). Per WP:TOOBIG the article is already WAY to big and ALMOST DEFINITELY needs divided and chopped up. Articles shouldn't exceed 50k, it's already over TWICE that. So obviously, no for adding this text to the article without serious cuts to it's content. — raekyt 05:21, 21 February 2013 (UTC)

It will be replacing the current version and has taken several sources from other parts of the article and incorporated them in the appropriate way. Prior to Doc James reversion, the article stood at a lean 91k down 30 over all and reflects all the sources accurately. We're going to go over them one by one. Unless you oppose specific sources, this material is essential to the article. Please specifically cite what changes you would like to see and what sources you are challenging. DVMt (talk) 05:52, 21 February 2013 (UTC)

The reason why you had half a dozen editors revert your changes was that we do not think your changes "reflected all the sources accurately." Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:54, 21 February 2013 (UTC)

I haven't even looked at the sources, but the existing History section is 2.6k this is 4.4k, almost twice the size. So it's headed in the wrong direction if we're trying to bring this article to a manageable size. Like 40k needs to be cut. Would a History of Chiropractic article be unreasonable, if something like it doesn't already exist, and WP:SPLIT out the history, and maybe split out other parts as well? — raekyt 05:58, 21 February 2013 (UTC)

That's incorrect Doc. Only you reverted the article in its entirety. Prior to that it stood for 10 days without any reversion. You assumed that sources were being misused despite not even having read the content in question. If you're not reading it and checking the sources directly, than how is it possible to make any accurate judgment on the material? DVMt (talk) 06:22, 21 February 2013 (UTC)

No, we have Yobol in this edit [57] and RexxS in this edit [58] who reverted all of it as well. We have other reverts of your changes by Raeky in this edit [59] and Alexbrn in this edit [60] plus me which brings us to 6 different editors who disagree with your changes.

Vote stacking doesn't count and they agreed with the admin in question. How could they have read all the material in 1 min? Not likely. Raeky thinks spinal manipulation is as effective as crystal healers so that covers that. You're also being misleading because Raeky and Alexbrn did not revert the whole article, only you did and had the troops on stand by. Regardless, that's water under the bridge. Feel free to stick around for the long haul and oversee the 2013 update. I wouldn't have it any other way. DVMt (talk) 01:06, 22 February 2013 (UTC)

"Vote stacking" "troops on stand by" Seriously.... Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:54, 22 February 2013 (UTC)

I did read the content and changes in question which is how I determined that the sources were being missed. And than I noticed that high quality sources that reflected less than positively on chiropractics had gone missing. So I restored said sources to the last stable version of the article per WP:BRD

With respect to it standing for 10 days with NO changes, uh, you made a 15 edits the day before and 4 edits the day before that and 8 edits the day before that? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:38, 21 February 2013 (UTC)

It's not called chiropractics. There is no 's'. Also, you're again taking thing out of context. The article had been revised for a total on 10 days without any reversions from Raeky, Alexbrn, TippyGoomba, Bobrayner or any other potential dogmatic skeptic. Primary sources went missing, replaced by secondary sources. But I suppose, as TippyGoomba suggested, that I'm being too focused on the science and should focus more on the magic. As for deleting sources, for your revert kiled 60 additional references a good chunk which were secondary and tertiary sources. DVMt (talk) 01:06, 22 February 2013 (UTC)

The old version has 179 refs your "update" has 139. I pointed out some recent (in the last 2 years) reviews that disappeared in your changes. But anyway it is up to you to convince the community that these where improvements. This has not been done. While return when I see a concrete proposal / RfC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:53, 22 February 2013 (UTC)

Primary studies were replaced with secondary sources which is why the count went down. You still deleted 60 additional sources. DVMt (talk) 16:01, 23 February 2013 (UTC)

Raeky I'm not opposed to the idea of a split once the proposed revision gets a hard look. Like I mentioned you said that 40k needed to go 30k is achieved with the 2013 revision. I think we could pare it down even more and if we can't a split is perfectly reasonable. DVMt (talk) 06:27, 21 February 2013 (UTC)

10 days? How about WP:NORUSH? Also, notice how only a single WP:SPA came to your defense when your massive white-wash was reverted. Anyway... back to the purposed edit... I actually think that this distinction between straight and mixer isn't adequately covered in the article. This relates to DVMt's white-washing efforts, he wants the article to be more about the science and less about the magic. But imagine if someone tried to edit the mystical bullshit out of the Yoga article. TippyGoomba (talk) 06:33, 21 February 2013 (UTC)

So Tiippy, you want the article to be less scientific then? DVMt (talk) 01:06, 22 February 2013 (UTC)

You have a version in your head and the reality is less scientific. The article should reflect reality. Put up some stats on how Chiropractors view innate intelligence and vaccinations which reflect reality and I will instantly change my view of how the article should be presented. TippyGoomba (talk) 02:27, 22 February 2013 (UTC)

There's a major difference between 'having a version in your head' and having reliable sources that supports the claims made. By adding 60 new references from 2005-2013 the tone did shift, moreso because there was scientific evidence thats now exists on given topics that didn't previously. As DigitalC mentioned somewhere at talk, the last major revision was in 2008. Five years have passed and now in 2013 there's a lot more sources that updates the "story" of chiropractic. It was being edited from a straight viewpoint (20%) as opposed to a straight and mixer (80%) viewpoints. Don't forget, globally there are virtually no straight schools. This decreases their numbers even further. As straight chiros get 'diluted' there will be socio-cultural change not only within the profession itself but also how collaborates with mainstream scientists. In 2018 the story will continue to evolve and change. But we must tell the whole story, history and present. Ok, to your other question. Innate intelligence is a weird term; cause it has different meanings apparently. Vis medicatrix naturae (healing power of nature) is a synonym and its also represents homeostasis. To straight chiropractors it's a separate philosophy tied in with subluxation this is about 20% of the chiros in the States. So, definitely a minority. Their views run counter to the chiropractic mainstream. The anti-vax is roughly the same 20-25%) because, again, the straights seem dogmatic with their views which fall are out of the mainstream in both chiropractic and medicine. DVMt (talk) 04:33, 22 February 2013 (UTC)

Would you happen to have sources for those numbers? Because that would change everything in my mind. TippyGoomba (talk) 04:51, 22 February 2013 (UTC)

I'm looking for secondary or tertiary sources that would be better than a primary study. Also most of the literature focuses on the US. When I find it I'll post it here. Any specific comments regarding the proposed straight vs mixer revision? DVMt (talk) 15:58, 23 February 2013 (UTC)

Since the material presented has not been challenged for several days, I will move into the main article to enhance the current 'straight vs.mixer' section. Regards, DVMt (talk) 02:09, 28 February 2013 (UTC)

Tippy has failed to discuss his controversial edit that removed non-challenged material. I will revert per BRD: and Tippy must discuss, specifically, his/her concern. DVMt (talk) 04:26, 28 February 2013 (UTC)

I do not see consensus here for the change DVMt? It is the person trying to make the change that needs the consensus not the other way around. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:40, 28 February 2013 (UTC)

Doc James, without discussion (again) [61] has reverted material that had been proposed and had 0 opposition until it's insertion tonight. Could both Tippy and Doc James specifically state what material they find controversial. DVMt (talk) 04:42, 28 February 2013 (UTC)

Consensus can be changed. You called the edit controversial, please explain what specifically you found offensive. DVMt (talk) 04:52, 28 February 2013 (UTC)

Ah just because there is not active opposition dose not mean there is support. All of a sudden these two section ended up under history? Yet they are still active concepts not just historical concepts. Thus disagree with them being subheadings. 05:05, 28 February 2013 (UTC) — Preceding unsigned comment added by Jmh649 (talk • contribs)

It wasn't exactly obvious what your changes were, but I looked through them. There were some good things, and some suboptimal things:

• On the good side, I like that you 'translated' the large box under Conceptual basis to prose, which Wikipedia prefers.
• Also good, you also translated the list of philosophy bullet points and the "Straights and mixers" table to prose.
• Also good was the separation of the "straight" and "mixer" concepts
• Not so good: You broke off some content from Conceptual basis and created a new History section, but there is already another History section, so you made a second one.
• You added a bullet point "Therapeutic Conservatism" as a part of Conceptual basis but it was just floating there by itself, and had some extraneous close-braces.
• Under your new History you added a large quote from Palmer in support of an argument as to whether Palmer got the idea from Still. Big quotes like that are not preferred, it'd be better to just state the point being made.
• Under "'Straight' chiropractic" you added a bunch of "scare quotes", that is not a preferred style.
• In general a lot of new content was added to this article which was already tagged as too large.

So I think the reverts were justified, there's some stuff to work on here. Zad68 05:09, 28 February 2013 (UTC)

Ok, these are great, insightful comments. The history was not meant to replace the current history section, but as a means of introducing the philosophy (ies) underlying chiropractors to it would read better. Removing the history subsection there would clarify it. It was also not the intent to make the straight vs. mixer distinction appear as a historical fact, indeed I recognize this is present currently. Regarding Palmer and Still, Palmer in fact did acknowledge that philosophically, the underpinnings of chiropractic are osteopathic which makes sense given their affinity for manipulation. The bullet point was a CE that can easily be undone. I will do this. The scare quotes are an actual article I believe, if I find it I can support the "killer" subluxations claim. The article is large, but my proposed revision was 30k less than this and this is a section at a time breakdown. These are good suggestions and interestingly, things I had not even considered controversial (such as the accidental classification of straight and mixer as "historical" were brought to attention. This is good because I believe there is a lot of common ground here. Thanks for your input Zad68. DVMt (talk) 05:20, 28 February 2013 (UTC)

Comments (Proposal: Straight and Mixer, Version 2.001 (beta))

As per the recommendations of Zad68 and Doc James, a revised proposal has been made (see the proposal 2.001b). Open for discussion and comments. DVMt (talk) 00:46, 1 March 2013 (UTC)

Note that the revised content is at the top of the section; named :Proposal: Philo of Straight and Mixer, 2013 DVMt (talk) 02:45, 1 March 2013 (UTC)

My comments on "Version 2.001 (beta)": In general, in parts, the tone is too "in-universe", meaning that it is written not as an academic, outside commentary or review of chiropractic philosophy, but rather it is written on top of the assumption that the philosphy or principles have an evidence base or are grounded in fact. Some of the terms used don't have any meaning to a non-specialist, and require in-line explaining or a Wikilink. Also, some of the words chosen are promotional rather than informative. Specific examples:

• Chiropractic medicine embraces naturalistic principles that suggest decreased "host resistance" of the body facilitates the disease process. - "Embraces" is too flowery; "naturalistic principles" isn't defined or wikilinked; "host resistance" likewise

• these terms where in the cited source. We can change them however. "Chiropractic medicine is part of the natural healing arts. Chiropractic theory suggests that decreased host-resistance of the body facilitates the disease process DVMt (talk) 04:48, 1 March 2013 (UTC)

• Chiropractors propose manual, conservative and natural interventions are preferable towards optimizing health and functional well-being. - Preferable to what? Is "conservative" here the same "conservative" as in "conservative treatment", the term found in medicine? "optimizing health and functional well-being" sounds purely like brochure-speak and isn't imparting actual encyclopedic information.

• Agreed this sentence is problematic. Chiropractors propose manual and manipulative interventions as part of a conservative treatment approach for neuromusculoskeletal disorders. DVMt (talk) 04:48, 1 March 2013 (UTC)

• Chiropractors emphasizes manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders. - This sounds "in-universe" because it's written on the assumption that chiropractic has been shown to be in general an equally valid alternative to medications and surgery.

• I disagree, for two reasons. One, there is proof of equivalency for LBP (thereby reducing meds and surgery) and the tertiary source, by Dr. Haldeman (MD, DC, PhD) et al. is a well regarded textbook amongst manual medicine practitioners and it's WP:MEDRS compliant. I acknowledge a source outside the profession would be nice but it would have to directly challenge the claim being made. DVMt (talk) 04:48, 1 March 2013 (UTC)

• The relationship between structure, especially the spine, and function as modulated by the nervous system, is central to chiropractic and its approach to the restoration and preservation of health. - Again "in-universe" written on the assumption that chiropractic has been shown to restore and preserve health.

• The source was quoted verbatim but I don't see why we couldn't change to "Chiropractic theory suggests the relationship between structure (primarily the spine) and function (modulated by the nervous system) is central to chiropractic and its approach towards the restoration and preservation of health.

Many more examples like this follow.

Some good things:

• It is hypothesized that clinically significant neurophysiological consequences may occur as a result of spinal dysfunction/subluxation, described by chiropractors as the vertebral subluxation complex. - This is good, the kind of tone we're looking for in a Wikipedia article, it's written from the point of view of an outsider critically examining chiropractic philosphy.
• Discussions of history seem good.

Sourcing: I think part of the issue of the tone of the prose is the choice of sourcing, not because it isn't authoritative or reliable - after Googling "Scott Haldeman", I can't imagine anyone more authoritative on chiropractic - but because it is mostly "in-universe" sourcing, meaning sources written by chiropractors and those involved in the promotion or management of chiropractic as a profession, and published in journals like Chiropractic and Osteopathy and Chiropractic and Manual Therapies. The WHO document was discussed earlier. I'm not saying not to use such sourcing, but rather when writing the article content you have to step outside the world of chiropractic and describe it as what "they" (chiropractors) think. This is done in some places but it has to be done everywhere.

• I understand your concern of the insourcing, but realistically, who knows more about the chiropractic profession then their own scholars? The sources all meet WP:MEDRS reliable sourcecs and are published in mainstream academic publishing houses. The same applies to any profession, medicine knowing the most about medicine, lawyers about law etc. The claims also aren't bold are controversial, their simply ones from better sources that are more current. CMT is now what CO was. It's indexed by pubmed, and the article in question is written by Gert Bronfort who co-authored Cochrane reviews. It's examples like these that we must have an outside source, such as yourself, to review the source in question and be educated, to a degree, on the main authors. A good discussion for later I'm sure!. DVMt (talk) 04:48, 1 March 2013 (UTC)

Grammar: There are a number of small things to clean up like subject/verb agreement, singular/plural errors, missing punctuation, etc.

• Yeah, that's for sure. DVMt (talk) 04:48, 1 March 2013 (UTC)

Zad68 03:48, 1 March 2013 (UTC)

Zad,I cleaned up the proposal for this section as per your suggestions. Can you give it a peek and give comments prior to insertion? DVMt (talk) 16:55, 2 March 2013 (UTC)

Might not be a bad idea to get a RfC and greater community attention than just the couple of us. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:35, 2 March 2013 (UTC)

At this point I think the collaborative version addresses the major concerns . Zads analysis was great and there's input from MDs a DC and a DVM. It couldn't have been done without all of us. Since the material isn't challenged it's pretty close being ready to go :). DVMt (talk) 19:08, 2 March 2013 (UTC)

I see you've made some changes, took out the jargon-y sentence. I'm not sure what "natural healing arts" means. Regarding words like "embrace", this is where you, as a Wikipedia article editor, need to look at the wording and context used in the source, which is a chiropractor talking to chiropractors, and translate it into a general Wikipedia article talking to nonspecialist readers. This often involves intentionally using less florid prose than the sources. I see there is a separate Philosophy of Chiropractic article, so this article should give only a brief introduction to the most important points and link to the main article. This might be a case where the content will go in and will get toned down by other editors or at a GA review. Zad68 04:23, 3 March 2013 (UTC)

What you must do is get a formal support that this new version is better than the previous. And what you plan to replace with it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:26, 3 March 2013 (UTC)

Ok. Will look at the proposal again and refine the language. Great tips again! I really appreciate your help Zad. I see you as a mentor figure. DVMt (talk) 04:34, 3 March 2013 (UTC)

Zad I'm not going to include the arts thing. It's wordy. Let me know if you find other issues you want to iron out, or just go ahead of change it yourself above. DVMt (talk) 05:09, 3 March 2013 (UTC)

Does anyone oppose the proposed text (which will replace the current philo/straight/mixer) section)? If not, I will insert it. DVMt (talk) 18:57, 5 March 2013 (UTC)

• By incorrectly saying science necessariy is is a materialistic and reductionist philosophy in your proposals you appear to be putting up a straw man that medicine does not take a holistic approach (which is not the case as the article holistic article and citations within make clear). From reading [62], which is written "in universe" I doubt its reliability for statements about science or medicine in general. Also, drop the use of the allopathic terminology, nothing says written by a quack louder than using the word allopathic to describe medicine. I'm not saying this is what you intended, just that this is the impression it would give off if added to an article, IRWolfie- (talk) 22:51, 5 March 2013 (UTC)

Thanks for chipping in IRWolfie. I didn't realize allopathic was pejorative, it just flowed with the chiropractic, osteopathic, allopathic. I believe I saw this terminology used at the Osteopathic Medicine page. It was not my intent though for it do come off as a judgemental, quack sounding term. Regarding the statement of materialsim, I have to look and see where it is. THe source said it incorporate both vitalistic and materialistic philosophies. But again, it's not aimed as a criticism of science. I do see more medicine using a holistic approach, but holism is predominantly associated with CAM. I will revise the proposal and feel free to comment again. DVMt (talk) 00:54, 6 March 2013 (UTC) Edit: Allopathic medicine is apparently a common term; the American Medical Student Association uses the term presently here [63]. Learn something new everyday! DVMt (talk) 01:38, 6 March 2013 (UTC)

It's common within alt med communities (who invented the term) like the one you just linked. It is not used in the mainstream medical community. As [64] makes clear, allopathy in its original use referred to pre-evidence based medicine. IRWolfie- (talk) 12:55, 6 March 2013 (UTC)

Yeah it seems definitions, over time, change to reflect the times and evidence. it's not a big deal to me, and it goes beyond the scope of this article. I replaced the word allopathic with medical, are there any other issues that need addressing? DVMt (talk) 17:37, 6 March 2013 (UTC)

You have: "By embracing mechanistic viewpoint, mixers balance the vitalistic notions with critical reasoning skills that led to legitimate scientific investigation of chiropractic principles." This violates NPOV. Firstly it implies that science is just one viewpoint equal to any other. Secondly, it implies that vitalism is its equal, and not an outdated concept which is rejected. The main issue really is that most of your sources aren't reliable for discussing the connection to standard medical practice (which are the majority of reliable sources). You need to extend your secondary sources outside of the chiropractic "in universe" sources if you want to do that. Essentially, it's still evident from the text that it is written by a chiropractor, using the chiropractic sources. Don't forget, wikipedia categorically does not aim to balance opposing views as equal. If the majority of scientific sources disagree with some notion like vitalism, then wikipedia should reflect that. Giving weight to viewpoints based on how the sources give weight is a summary of what NPOV is. Chiropractic sources can be used for stating their own views, but not for saying things about science or greater medical practice. IRWolfie- (talk) 11:36, 7 March 2013 (UTC)

I think it's just us interpreting the sentence differently. I don't read it as science as one POV equal to vitalism (i.e. healing power of nature). I see it rather as a mixer chiropractors combining elements of both vitalism and materialism, as opposed to them being equivalent. With respect to vitalism specifically, it's not my intent to push vitalism or to knock it down, merely just reporting the facts. We agree that chiropractic sources shouldn't be used to comment specifically on issues that pertain outside their scope. How about some different wording though to address your concerns: MIxers combine both vitalistic and mechanistic viewpoints that has led to scientific investigation of chiropractic principles." I think that reads better as well. DVMt (talk) 15:43, 7 March 2013 (UTC)

That you are talking about materialism (which you seem to use interchangeably with science) tells me you have missed the issue again. Science is not the same as materialism, and it isn't necessarily materialistic. Use of the word "Mechanistic" is alt med type terminology for biomed again.

On your proposed suggestion; Vitalism is not scientific, so combining it with standard viewpoints does not led to a scientific investigation. Looking at it purely from a biomedical perspective would be scientific i.e in this case purely in terms of looking at the efficacy and establishing there is something to look for, before positing theories (much like this guy suggested: http://www.chiromt.com/content/13/1/17 ). You need to get mainstream sources as they are the ones that would clarify the issue (look to MEDRS for good sources) . IRWolfie- (talk) 17:20, 7 March 2013 (UTC)

I'd suggest dumping it into the article now and we can tweak further from there. I think it needs a lot of work, but it's easier to do it from this stage in article. IRWolfie- (talk) 17:34, 7 March 2013 (UTC)

Ok. The gist of the source (my interpretation) is that chiro combines reductionistic (materialism/mechanistic) and vitalistic (vis medicatrix naturae, sum is greater than the whole of its parts). Mechanistic, as I understood it, was meant as a contrast to vitalism and one that could be investigated by the scientific method (as opposed to vitalism). I will proceed to dump it into the article as per your suggestion. Thanks for your comments again, they are insightful. Regards, DVMt (talk) 17:50, 7 March 2013 (UTC)

Literature synth source

I'm a bit confused with [65]. There conclusions, according to this article, are the opposite of the cochrane review, and they don't seem to declare the conflict of interest that they work for the Council on Chiropractic guidelines and practice parameters [66]. I also can't find text that supports "A 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration" in the conclusions (I don't have access to the full article), but from the conclusion it doesn't look like it supports that text. IRWolfie- (talk) 18:30, 10 March 2013 (UTC)

I'll double check the source. 2008 has likely been supplanted by more recent evidence, so that citation can go. I'll remove the claim. DVMt (talk) 20:11, 10 March 2013 (UTC) Does this pertain to the proposal or to the current text present in the article? DVMt (talk) 20:15, 10 March 2013 (UTC) The effectiveness section itself is dated with old reviews (2004-2005-2006) still here despite being usurped by newer reviews. Take a peek at my proposal which has an updated section on effectiveness (ie. research status). I've been chipping away at it now for over a month. DVMt (talk) 20:41, 10 March 2013 (UTC)

It's in the current article. I think any proposal on the page will just get messy. It's just not the usual approach to editing pages on wikipedia, and it doesn't work well for collaborative editing; we lose the edit history on the article. IRWolfie- (talk) 21:56, 11 March 2013 (UTC)

I never considered we would lose the edit history by collaborating on the talk page. I'll replace the current effectiveness section with the updated version. Yourself, Puhlaa, Doc James or whoever has issues can edit it on the main page. I think it's a pretty accurate summary; but James and I have had disagreements over language. Regardless, I trust that if you have any problems with it you'll edit as you see fit. DVMt (talk) 23:07, 11 March 2013 (UTC)

I must have misunderstood what you meant. I thought you were of the opinion that the current research status was outdated and needed better clarity. Regardless, it should be noted that the proposed content is up-to-date and removes any 'hanging' primary papers that have been reviewed since that point. DVMt (talk) 00:01, 12 March 2013 (UTC)

I don't think I stated anything about research being outdated in this thread. I had an issue with a source verifying text. You dropped 16000 words which were covered with citations, see WP:CAREFUL. IRWolfie- (talk) 00:06, 12 March 2013 (UTC)

If you are concerned about the need for clarity, an easy approach would be to drop all reviews that aren't in the core biomed journals highlighted here Wikipedia:MEDRS. IRWolfie- (talk) 00:11, 12 March 2013 (UTC)

I read into it; the fact that you had found an old 2008 lit synthesis which was outdated and still being used despite a newer review which covers that topic, etc. It's the same thing throughout the section. There's agreement between 2 sources, covering the same topic, and the older review stays in despite its redundancy. Regarding dropping 16 000 words, a lot of that is simply the references which takes a lot of "words" (bytes). The last time this article, according to older editors anyways, had a major lit review (effectiveness) was in 2008. It's the 5 year update (because a lot is out-of date). Regards, DVMt (talk) 00:19, 12 March 2013 (UTC) Edit: I'm familiar with MEDRS (thank you!) and when in doubt, I'll check impact factor, and if still in doubt, I go to WP:MED Talk. DVMt (talk) 00:26, 12 March 2013 (UTC)

Neutrality

I notice there is no mention of placebo in the Medicine article while it is prominent here. I also notice a tirade on pseudoscience in the intro prior to discussing what chiropractic is or does.

This is the intro to Medicine. Contrast it with the intro on chiropractic. You folks are having a problem with neutrality for sure.

"Medicine (Listeni/ˈmɛdsɨn/, Listeni/ˈmɛdɨsɨn/) is the applied science or practice of the diagnosis, treatment, and prevention of disease.[1] It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness in human beings.

Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication or surgery, but also through therapies as diverse as psychotherapy, external splints & traction, prostheses, biologics, ionizing radiation and others.

The word medicine is derived from the Latin ars medicina, meaning the art of healing" Anthon01

What do you propose? DVMt (talk) 16:40, 14 March 2013 (UTC)

RfC proceedings

There is a discussion here [67] regarding the the effectiveness of SMT for LBP. DVMt (talk) 19:22, 24 February 2013 (UTC)

Why did you label this section "RfC proceedings" since there is still no open RfC? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:57, 24 February 2013 (UTC)

Because it breaks up the page and the discussions for sectional revisions. I was trying to organize the page a bit for readability but if you want it kept, no biggie. DVMt (talk) 02:11, 4 March 2013 (UTC)

It will archive. Typically one never removed others comments from a talk page. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:28, 4 March 2013 (UTC)

Ok. The section seemed out of sorts was all. Didn't the discussion was critical for the page. But, if those are the rules, then so be it. DVMt (talk) 02:39, 4 March 2013 (UTC)

retract proposal DVMt (talk) 04:15, 8 March 2013 (UTC)

Comments (On hold:Ethics and medicolegal issues)

DVMt, is the text you have 'proposed' above meant to replace current article text? If so, which text and where? If not, where do you propose adding this text? More information will be help editors make insightful comments about your proposal.Puhlaa (talk) 05:29, 28 February 2013 (UTC)

It would condense the main arguments and controversies around chiropractic clearly, distinctly on all the topics. It would also cover the ethical questions surrounding chiropractors and the paradox of high patient satisfaction and the straight segment that really goes against the mainstream of chiropractors identified more clearly. Primary care definitions, etc. could also be done. It shortens the article somewhat but covers the pertinent topics in an objective manner. DVMt (talk) 06:06, 28 February 2013 (UTC)

• Oppose this version Concerns about chiropractics are more than just from SMT. There is also the concern that they will miss other diagnosis or treat conditions for which chiro is not effective resulting in overall harm to the patient. The current text sort of mentions these concerns however the above bit does not. So I do not see this as an improvement Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:32, 2 March 2013 (UTC)
  • What part of the current text are you referring to? Do you have a source regarding misdiagnosis, or treat conditions resulting in overall harm? These are bold claims that need evidence. DVMt (talk) 18:36, 2 March 2013 (UTC)

Given that no sources have been presented, the concerns appear more of conjecture than based on fact verifiable by the evidence. Please provide sources to support the claims. DVMt (talk) 00:34, 3 March 2013 (UTC)

There are sources. They are the ones you where hoping to delete such as this one [68].Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:35, 3 March 2013 (UTC)

I did not propose removing the Ernst critical review. More conjecture. It is used extensively in the page. Do you have other sources outside Ernst/Posadzki? DVMt (talk) 00:47, 3 March 2013 (UTC)

Yes I see it is still there however some of its conclusions have been removed. I do not see this bit "The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations." support by this 2009 review [69] Seems to have been replaced by a ref to an older review in the journal "Chiropractic Osteopathic" Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:32, 3 March 2013 (UTC)

This is the direct conclusion from the study you mentioned : There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic. Why don't we stick to what the source says? DVMt (talk) 01:37, 3 March 2013 (UTC)

Yes and the above was from the results section "Most of the adverse events reported were benign and transitory, however, there are reports of complications that were life threatening, such as arterial dissection, myelopathy, vertebral disc extrusion, and epidural hematoma. The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations." Additionally the full paper adds as key points "Complications associated with chiropractic procedures are frequent. Most of the adverse events reported are benign and transitory, however, some can be life threatening." The discussion section also states "The remarkable popularity of spinal manipulation is contrasted by a disappointing lack of well-conducted studies to assess efficacy."Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:48, 3 March 2013 (UTC)

Ok. So you are claiming there is a serious safety with spinal manipulation and that the studies to investigate efficacy are poor. Is that correct? DVMt (talk) 01:59, 3 March 2013 (UTC)

I don't think he is claiming anything, rather it is the paper that is, IRWolfie- (talk) 21:51, 11 March 2013 (UTC)

The 2008 conclusions on the Ernt review on "safety/risk/benefit" have been usurped by the 2012 Rubenstein et al. Cochrane review which states spinal manipulation is "relatively safe". I agree adverse effects need to be mentioned; it just a weight issue. I'll propose a revised safety section that addresses this, DVMt (talk) 05:27, 14 March 2013 (UTC)

DVMt, I also have some concerns regarding sources. IMO, this 2012 systematic review currently represents the best source available on the association between spine manipulation and stroke. It is in the current article, but I do not see it in your proposal. Notable findings in this review are 1) the lack of quality evidence either supporting or refuting a strong association; and 2) the lack of any accurate risk-benefit analysis available to date. Any discussion of stroke, again IMO, should be qualified with the fact that any evidence for or against the association is weak at best and any claims for or against the relative safety of the procedure are still based on conjecture. With regard to Doc James comments and in consideration of the best sources available, lets be careful not to give too much weight to any one author or source that seems to make too bold of claims about safety.Puhlaa (talk) 01:55, 3 March 2013 (UTC)

Comments on Treatment/Safety Proposal, March 2013

The proposed draft, for practical purposes, can be subdivided into 2 sections. Section 1 would include treatment, definitions, categories. Section 2 is the research status of manual therapy (effectiveness, safety, cost-effectiveness).

Let the discussion begin! DVMt (talk) 20:55, 7 March 2013 (UTC)

If no opposition, I will insert section 1 of 2. This is a descriptive section involving definitions, manual and manipulative therapy, categories of manipulative therapy. It's better organized and referenced than the current section. Regards, DVMt (talk) 01:13, 10 March 2013 (UTC)

Far too much at one time. Do a little at a time so we can see if any existing content will be deleted, and what will be added. Tweaking is a better procedure than blanket substitution. In case you hadn't noticed, that content has not been developed through collaboration. You are the sole creator. Try copying one paragraph from the article and placing it here. Then place your proposed changes right under it. Then we can see what's going on. Right now it's far too difficult to analyze. -- Brangifer (talk) 02:05, 10 March 2013 (UTC)

I'd second that. If you can go paragraph by paragraph it might be best. Despite your sincere efforts it's challenging to review large rewrites unless there's a section by section comparison. Ocaasi ^{t | c} 02:22, 10 March 2013 (UTC)

Ok, I've broken it down into 2 sections. The citations are far heavier in the research section. Thanks for the suggestions. DVMt (talk) 16:35, 10 March 2013 (UTC)

Comments on good looking women with good complexion some of whom are subject to copyright.

Sorry but what is with the pictures of the sexy women with the perfect completion? It makes the changes look like a promotional pamphlet. Also we seem to have some copyright infringe going on as this image is exactly the same as this one for sale here [70] Also what is with the two people looking at an Xray together. This also looks suspect. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:47, 10 March 2013 (UTC)

I'm not going to comment regarding the sexiness of the women, in case my wife is watching. Their complexion falls outside my expertise ;) The rationale behind the image insertion was a) women are more prevalent than men to use manual therapy 2) VBA stroke issue seems to be more prevalent in women and c) the debate is mostly concerning upper neck manipulation safety. Hence the palpation of the neck. We can always find a different image if required though. The image with the manipulations and the X-ray is being used at the osteopathic page (manual medicine or the OM page). DVMt (talk) 17:28, 10 March 2013 (UTC)

You marked the images as being your "own work". What exactly do you think that means? The "(c) Science Photo Library" was a very odd choice for you to have put in the metadata. TippyGoomba (talk) 18:01, 10 March 2013 (UTC)

Looks like a copyvio, IRWolfie- (talk) 18:17, 10 March 2013 (UTC)

Other images uploaded by DVMt seem to have been copied from a third party but claimed as own work. I've flagged them for deletion on Commons. I'm not going to embed images here because we shouldn't compound the copyvio problem. At this point it would be inappropriate to trust any image uploaded by DVMt. bobrayner (talk) 19:18, 10 March 2013 (UTC)

If only the content were to get as much as a look as the images... Ok, so the last image doesn't meet criteria, the first two do. Any comments about the written material itself? DVMt (talk) 19:55, 10 March 2013 (UTC)

Copyright violation, reverts, and lies ignorance

I removed another image which appeared to be copyvio; it's identical to this which is "© 2004-2013 All rights reserved - Bigstock®". DVMt reverted it with the edit summary "not copyvio". DVMt, can you explain? Perhaps you also own the stock photo business? bobrayner (talk) 21:30, 10 March 2013 (UTC)

Sure. This image was produced in the 1920s and is the official chiropractic symbol (cauduceus). It's part of the public domain. I don't see how any company can "own" an emblem that belongs to a profession. Just like the snake and staff, that is used as the symbol/image of medicine. DVMt (talk) 21:49, 10 March 2013 (UTC)

Do you have some evidence that that image - and not just a similar-looking one - is in the public domain? The problem is that I found an identical image with a credible copyright claim. Which site did you get that image from? bobrayner (talk) 22:00, 10 March 2013 (UTC)

Bob, I'd ask kindly that you remove the "reverts and lies" part of your section header. That is not assuming any good faith and is a personal attack. I don't recall the site I got it from; but it did not have any copyright on it that I saw. Also, it had no meta-data too. Your tone is rather aggressive, may be cool down a bit. DVMt (talk) 22:08, 10 March 2013 (UTC)

You've written that you are the copyright holder in the license. You need to find a proper license. I think you want to either argue some kind of fair use or find a public domain image. The solution is not to blatantly lie, pretending that you own the copyright. TippyGoomba (talk) 22:16, 10 March 2013 (UTC)

No one owns the copyright, hence the public domain. It's analogous to the medical symbol here [71]. I did in fact stencil the chiropractic caduceus. So does that make me the copyright owner then? DVMt (talk) 22:21, 10 March 2013 (UTC)

It does. Did you write it as an svg? Why did you convert it to jpg? TippyGoomba (talk) 22:30, 10 March 2013 (UTC)

It appears this is the work of John T. Takai and it must be purchased:

• http://www.shutterstock.com/pic.mhtml?id=33965233

Contrary to what is claimed, it is not DVMt's "own work," even if he stenciled it or otherwise copied it. The chiropractic caduceus comes in many variations, and most of them are copyrighted by the creators. We have previously dealt with exactly this same issue, since we wished to use one, but we never found one that wasn't copyrighted, so we haven't used it. -- Brangifer (talk) 06:49, 11 March 2013 (UTC)

Out of curiosity since we're on the topic. If someone were to purchase the image (shutterstock) could it then be used at WP, in general? I'm not suggesting I'm going to pay for it, but would this be allowed? With respect to public domain, how can we tell if it's public domain or copyright? IRWolfie mentioned above everything online is copyright, but that's probably a generalisation. It's a waste of everyone's time debating these images, I just want to learn how to do it right so we can all get back to being productive. DVMt (talk) 23:14, 12 March 2013 (UTC)

No, if you purchase an image you are not assigned the copyright automatically. IRWolfie- (talk) 17:25, 14 March 2013 (UTC)

Last paragraph lede

Current:

The scientific consensus is that chiropractic may be on a par with other manual therapies for some musculoskeletal conditions such as lower back pain, but that there is no credible evidence or mechanism for effects on other conditions, and some evidence of severe adverse effects from cervical vertebral manipulation. The ideas of innate intelligence and the chiropractic subluxation are regarded as pseudoscience.

Proposed:

Manual and manipulative therapies commonly used by chiropractors other manual medicine practitioners are used primarily to help treat low back pain and other neuromusculoskeletal disorders. Spinal manipulation appears as effective to other commonly prescribed treatments for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy. For acute low back pain, spinal manipulative therapy does not appear better than commonly recommended therapies such as analgesics, acupuncture, back pain education or exercise therapy. National guidelines regarding spinal manipulation vary country to country; some do not recommend, while others recommend a short course of manipulative therapy for those who do not improve with other interventions. Manipulation under anaesthesia, or medically-assisted manipulation, currently has insufficient evidence to make any strong recommendations. Spinal manipulation may be effective for lumbar disc herniation with radiculopathy, as effective as mobilization for neck pain, some forms of headache, and some extremity joint conditions. . There is insufficient evidence regarding the effectiveness of spinal manipulation on non-musculoskeletal conditions.[72]. There is considerable debate regarding the safety of spinal manipulation, particularly with the upper cervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare as spinal manipulation is relatively safe when employed skillfully and appropriately. Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches. Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent.

Discussion (Revised last paragraph, lead)

This has been on the table almost a month now. If there's no opposition to the material, I propose inserting this small text as the last paragraph of the lead. DVMt (talk) 16:41, 12 March 2013 (UTC)

Manual and manipulative therapies commonly used by chiropractors other manual medicine practitioners are used primarily to help treat low back pain, and other neuromusculoskeletal disorders Manual therapies appear to be as effective as standard medical care, exercise therapy and physiotherapy in the treatment of low back pain , and may be effective for non-specific neck pain, headaches, and extremity conditions. Athough serious injuries and fatal consequences can occur and may be under-reported, spinal manipulation is relatively safe when employed skillfully and appropriately.

More copyright violations

Here DVMt claims the image is his "own work", and after I removed the image from this article, he restored it. But it was apparently copied from this website. If that is not the case, then that website has stolen an image taken by DVMt's camera. What is it? Who is violating copyright here? Someone is not being honest. "Own work" means one has taken the image oneself. Should we contact that website to find out what's going on? -- Brangifer (talk) 16:07, 12 March 2013 (UTC)

The image was a google image search which I found hence the 'own work'. I also looked at the website in question and I don't notice any copyright on the page itself. As I understand, if an image is not copyright, it belongs to the public domain. If I'm wrong I don't oppose to removing the image. DVMt (talk) 16:17, 12 March 2013 (UTC)

You interpretation is incorrect. All material on the internet is copyrighted unless it explicitly states it is in the public domain, or if the copyright has expired due to age. (This makes me worry about the copyright status of the text you've inserted into the article now) IRWolfie- (talk) 16:35, 12 March 2013 (UTC)

The text was paraphrased from the sources as convention. Regarding the statement, all material on the internet is copyright, is there a source which states this? To be honest, pictures are a distant second to me in terms of importance compared to reviewing actual literature. Any comments regarding the change to the lead, as presented above? DVMt (talk) 16:39, 12 March 2013 (UTC)

All works in all forms automatically are covered by copyright, whether on the internet or anywhere else. Just google around and read up. I'm not about to track down specific sources for you. Just read the guidelines and do some research IRWolfie- (talk) 17:29, 14 March 2013 (UTC)

Ok. Thanks for the tips. DVMt (talk) 17:35, 14 March 2013 (UTC)

Merge?

Should these articles be merged in: Joint dysfunction, Spinal dysfunction. Both are nearly identical. IRWolfie- (talk) 16:42, 12 March 2013 (UTC)

My only concern would be that other health care professionals that practice manipulation (osteos, physios, vets, some MDs) might oppose to the merging of that independent article. It would be akin to merging spinal manipulation with chiropractic. DVMt (talk) 16:46, 12 March 2013 (UTC)

Both seem to be written from a chiropractic perspective. It might actually be better to merge them into one of the other overlapping chiropractic articles, and restart Joint dysfunction from a mainstream / evidence-based medicine perspective. bobrayner (talk) 18:22, 12 March 2013 (UTC)

What about joint dysfunction isn't evidence-based or mainstream? How are they written from a 'chiropractic perspective'? DVMt (talk) 21:57, 12 March 2013 (UTC)

IRWolfie, what part(s) if any of joint dysfunction do you want to add? I agree that a part of that could easily fit in here; definitions, biomechanics and theory. We can summarize it link to the main article if need be for brevity. DVMt (talk) 04:18, 14 March 2013 (UTC)

They are indeed so similar as to be easily mergeable. They are also written from a chiropractic perspective. Other professions have other diagnoses for the specific problems described, and they don't use manipulation or mobilisation for all of them.

The part that isn't evidence-based is all the "theoretical" part, which chiropractors take as gospel and have used as justification for treatment and profit for well over 100 years. Many of the problems they have treated with manipulation have other known and proven causes, with their own accepted diagnoses and treatments. Fortunately many modern chiropractors aren't claiming that spinal dysfunction causes diabetes, etc. anymore, and yet there are many who claim that allergies, ear infections, etc. are treatable with manipulation, and that regular manipulation strengthens the body's immune system and can make vaccinations unnecessary. That's BS. -- Brangifer (talk) 04:28, 13 March 2013 (UTC)

The other definitions are noted within the article (biomechanical lesion, subluxation, somatic dysfunction, non-allopathic lesion, etc.). The generic term for all these other diagnoses is joint dysfunction. The research is basic sciences research investigating the effects of spinal dysfunction on articulations and soft tissues. The mechanism of effects are neurophysiological. The 'problems treated' with manipulation are 90% MSK as the stats show in clinical practice. The woo of chiropractic is not that hard to see or to differentiate in this day in age. Only time will tell if they continue to evolve and prosper or if they bite the dust. Given it's increasing curricular alliances with the biomedical model and commitment to scientific investigation (by and large) they're likely here to stay. I agree we can and should criticize traditional straight chiropractors and their defiant ways; unjustified claims, alliances with religious practices, etc. So yes, definitely BS about the breadth of manipulation efficacy. You need a source that would back up your claim "many claim (diseases....) are treated with manipulation". The research shows it's used as a complementary as opposed to an alternative to conventional med. DVMt (talk) 04:49, 13 March 2013 (UTC)

I've repeatedly asked you for sources for these sorts of claims. Do you have a source for the proportion of chiropractors reject Palmer's more insane babblings about innate intelligence, which proportion rejects vaccinations, etc. TippyGoomba (talk) 05:55, 13 March 2013 (UTC)

DVMt, here are two articles which show what's happening in the real world of AM/CAM and chiropractic in Australia:

• Treatment isn't always a cure
• Chiropractic funding called into question

They discuss some of the real problems out there and the outright animosity and hatred of modern medicine which some practitioners of AM show. -- Brangifer (talk) 15:19, 13 March 2013 (UTC)

I tried redirecting one of the duplicate articles, but it got reverted. I tried removing some of the chiro propaganda, and that got reverted too, on the basis that the article had been "rated by WP:MED". This article-ownership is quite frustrating. Every attempt to remove copyvio, deal with fringe content and coatrack &c across various articles gets reverted automatically. bobrayner (talk) 10:40, 14 March 2013 (UTC)

• I mentioned merging the section, not deleting another different section. IRWolfie- (talk) 19:07, 14 March 2013 (UTC)

Ok. I'll try again later. All the salient point were covered (criticisms section) and some primary sources were replaced with better secondary sources (from non-chiro journals). 19:42, 14 March 2013 (UTC)

You censored more content about the connection between mainstream science and chiropractic, and material which reflects chiropractic in a negative light. Can you please knock it off. What you are doing is transparent and a bit annoying. This is the third or fourth time today you've tried to do this today to different sections. IRWolfie- (talk) 20:04, 14 March 2013 (UTC)

Points of discussion

IRWolfie, since the editing has been relatively productive so far, I'll make suggestions on the talk page and we can go over them here rather than getting involved in lots of reversions, etc... DVMt (talk) 21:20, 14 March 2013 (UTC)

First order of business (small). The wording in the last sentence in the lead does not accurately reflect the source [73]. The source states: The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science. This should be inserted in the 2nd paragraph that deals specifically with subluxation (joint dysfunction) with the correct wording from the source, DVMt (talk) 22:22, 14 March 2013 (UTC)

Relevant parts for the article: "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". "Many national guidelines recommend chiropractic for acute or chronic low-back pain. The reason may not be the convincingly demonstrated effectiveness of chiropractic care but the fact that no therapy so far has been shown to make a real difference for back pain sufferers." "Few of the primary studies have been adequately controlled for placebo effects, an objective which is difficult but not impossible to achieve. Thus, some of the benefit reported in the above-mentioned studies could be due to a placebo response. A survey of 34 Australian ‘‘leaders of the chiropractic profession’’ suggested that the majority of chiropractors agree that the placebo effect is a major contributor to the perceived benefit of chiropractic. Some even felt that ‘‘at least half’’ of the chiropractic success is due to placebo effects."

I'll change the article tomorrow to reflect this source more, I think things need to cool down; you are trying to push too much. IRWolfie- (talk) 22:46, 14 March 2013 (UTC)

We agree on 95% of the content you and I and we were moving at a good clip. I too thought it was fast, but since we were collaboratively editing I was thinking you wanted to 'get it done'. Just let me know what is 'too much'. We can look at it one section at a time from here on in. I think there might be a miscommunication of what 'mainstream' is. Mainstream medicine embraces mainstream chiropractic for MSK issues. Even Ernst says this. The article does not reflect that basic fact. Mixers are the majority group, represent the mainstream and are the ones engaged in research and yet all evidence of this gets deleted. I agree in February when Doc James reverted the whole article (a white-wash vs. white-wash argument there). We were piecing this together after a lot of input from people: you, me, Puhaa, Zad68, etc. I disagree that there was 'no consensus at talk'. We did talk it through. Furthermore, you oversee fringe topics and we were collaboratively editing. It' not as though you didn't revert me when you saw fit. I can work like that and now that we've done a bit of work together, I know how to approach it. It's a learning curve. One last point: I see there is an edit war occurring today as a result of the bold edit by Doc without discussing it at Talk. I don't find it fair how one doesn't even participate meaningfully at an article and can have such complete, universal control of all content going in and out. To me that's owning the article and it's a behaviour issue. I'm no angel and my talk page reflects that, but we're all human and we make mistakes. Even admins. Regards, DVMt (talk) 02:26, 15 March 2013 (UTC)

• Note: Drk878 was a sock of DVMt, IRWolfie- (talk) 11:07, 15 March 2013 (UTC)

No. She is my wife and created her own account. I also started a facebook group which has drawn attention to the matter here. Thus, one can expect a potential influx of commentators and editors here and at CAM in general. Regards, DVMt (talk) 13:20, 15 March 2013 (UTC)

Hi IRWolfie, just wanting to clarify that I am DVMt's spouse. I created an account to help him with copy edits, as I'm a writer and editor. However, I follow the same belief system when it comes to health, specifically chiropractic. — Preceding unsigned comment added by Drk878 (talk • contribs) 14:10, 15 March 2013 (UTC)

It apparently doesn't matter. Another editor said that you are a WP:MEAT which is a rather vague term. It basically says that any new editor who shares the same POV are discouraged from contributing. I think this is nonsense. I guess we will see where it all ends up. DVMt (talk) 14:20, 15 March 2013 (UTC)

Eyes needed here

Please take a look here, comment, and edit accordingly:

• http://en.wikipedia.org/wiki/Talk:Joint_dysfunction#Massive_synthesis_problems

Brangifer (talk) 07:31, 16 March 2013 (UTC)

Merge

I merged back the controversy article as it looked like a POV fork. It removed many aspects critical of chiropractic from this article, and put them on another. My merger should not have removed any points in this article, though it may have moved them or used a better wording of the same point from the other article. IRWolfie- (talk) 13:47, 16 March 2013 (UTC)

Whoa! Not so fast. That article is a proper fork. There is lots of good information there and we can't include all of it here without creating an undue weight problem. We can discuss whether to enlarge the section here, but to go so far as to just redirect the other article, well, that's another matter. We still need it and the "main" link to it. All wait for comments. -- Brangifer (talk) 14:42, 16 March 2013 (UTC)

My instinctive reaction is that this was a copybook POV fork, and so the merge is good. BullRangifer - why do you think it a "proper" fork? Alexbrn ^{talk|contribs|COI} 14:44, 16 March 2013 (UTC)

I think the current article size is ok. The issue is that most of the content moved to the controversy section was actually mainstream response to specific issues. Removing that creates an NPOV issue in this article. The size of this article is fine, as DVMt pointed out, it's mostly in the refs. The Controversy article also had outdated efficacy information, and was slanted to a chiropractic POV through a cherry picking of sources and through SYNTH rebuttals. It looked a lot like a POV fork; removal all the criticism and then water it down. IRWolfie- (talk) 14:50, 16 March 2013 (UTC)

It's a proper fork because of weight issues. The subject cannot be done any justice within this article, yet it needs to be covered much more than can be done here. A nice compromise was reached some time ago about this issue. It didn't happen in the dark.

While I agree that chiropractic editors here loved having so much of the critical information separated from this article (a violation of NPOV), it did present a problem with so much criticism here, but a compromise was reached which allowed a short criticism section here (which, although not totally forbidden, is discouraged) and a much longer article there, which can be expanded much more. I'm certainly willing to consider expanding the section here a bit, but not too much. As far as the Controversy article, any issues with it should be dealt with there. (IRWolfie's comment..."removal all the criticism and then water it down"...is a real concern. That has happened, and can be fixed.) Without that article, we have no place for expansion of this topic, which happens to be very large. If anything, that article could be developed even further. Criticism and controversy has been a hallmark of chiropractic since its inception and the subject deserves its own article. -- Brangifer (talk) 17:30, 16 March 2013 (UTC)

I would worry about expansion and its implications when it starts to happen. There is no point worrying about an issue that doesn't yet exist. The expansion didn't happen when the it was forked either. IRWolfie- (talk) 18:43, 16 March 2013 (UTC)

I fully agree. I've been quite satisfied with what we had, but now we don't have much left. -- Brangifer (talk) 20:26, 16 March 2013 (UTC)

Interesting dissertation by Corrie Myburgh

A very interesting publication by a chiropractic researcher:

• PDF file: "Methodological and epistemological challenges for the chiropractic profession in health care - a study of the history, status quo and future of research and clinical practices." Myburgh, Corrie, Date Issued: 2011-10

• As a book: http://books.google.com/books/about/Methodological_and_Epistemological_Chall.html?id=rPNRYgEACAAJ

"The thematic analysis revealed that:

1. Beliefs and philosophical traditions play an active role in the practice and science of chiropractic.

2. The chiropractic investigative paradigm has started to mature.

3. The contextual role of research methods is being clarified.

4. Contemporary chiropractic practice is not as evidence-based as it should be.

5. The chiropractic model of practice is significantly different to the perceived standard medical model.

6. Chiropractic clinical practice has a fuzzy identity.

7. Chiropractic’s professional status is unclear.

8. The professional and disciplinary components of chiropractic are still institutionally immature.

9. Chiropractic’s legitimacy is questionable."

"Chiropractors entrenched themselves professionally mainly through public appeal and acquired legitimacy through legislation based on social relevance rather than scientific evidence." pp. 81-82

"The study has shown that chiropractic cannot claim full legitimacy within mainstream healthcare. Simply providing a worthwhile service to patients does not give chiropractic enough momentum to access the corridors of power. A network of professional integration and academic institutionalisation is required for this to occur." p. 253

Page numbers are from the PDF file.

Brangifer (talk) 22:13, 17 March 2013 (UTC)

No discussion of new POV fork material added (controversy and criticism)

This made the NPOV issue even worse. What is bizarre it was a bold series of edits without any discussion (as is customary). Hence the bold edit is being reverted and IRWolfie is free to discuss why this material should be added. DVMt (talk) 01:28, 3 April 2013 (UTC)

Please discuss matters in the talk page before making controversial changes. TippyGoomba (talk) 03:35, 3 April 2013 (UTC)

What part of BRD don't you understand? IRWolfie made a bold series of edits, with no discussion. Then I reverted it and talked about at the talk page. Then you, reverted me (BRRD). The policy is quite clear on this. DVMt (talk) 03:49, 3 April 2013 (UTC)

You should check with an admin on that. TippyGoomba (talk) 05:40, 3 April 2013 (UTC)

I think technically it would only be BRRD if the same editor reverted twice. As to the merge, as discussed above, I am in favour of it - it is needed to prevent a WP:POVFORK. Alexbrn ^{talk|contribs|COI} 05:52, 3 April 2013 (UTC)

I'm a little confused. DVMt said the article I merged from was a POV fork (and I agreed), yet he complains when I merge it back, IRWolfie- (talk) 00:15, 4 April 2013 (UTC)

Multiple edit requests from the same user

Edit request on 8 April 2013

24.15.12.217 (talk) 15:14, 8 April 2013 (UTC)

Cost-effectiveness

Analysis of a clinical and cost utilization data from the years 1999 to 2002 for an integrative medicine independent physician association (IPA) whose primary care physicians (PCPs) were exclusively doctors of chiropractic. This report updates the subsequent utilization data from the IPA for the years 2003 to 2005 found that the clinical and cost utilization of chiropractic services based on 70, 274 member-months over a 7-year period demonstrated ==decreases== of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame [201].

Chiropractic Career

Realistic median annual wage of chiropractors was $67,200 in May 2010 [64]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [65]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.

201. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract 202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm 203. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/

Edit request on 8 April 2013

Nobias500 (talk) 15:50, 8 April 2013 (UTC)

Cost-effectiveness of Chiropractic Care

Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) who looked at the chiropractic services utilization, found that the the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient cost associate with the following use of services by:

-60.2% in-hospital admissions, -59.0% hospital days, -62.0% outpatient surgeries and procedures, -85% pharmaceutical costs

when compared with conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame [36].

36. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract

Edit request on 8 April 2013

Nobias500 (talk) 16:01, 8 April 2013 (UTC)

Cost-effectiveness of Chiropractic Care

Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) who looked at the chiropractic services utilization, found that the the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient cost associate with the following use of services by:

-60.2% in-hospital admissions, -59.0% hospital days, -62.0% outpatient surgeries and procedures, -85% pharmaceutical costs

when compared with the use of conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame [201].

Chiropractic Career

Realistic median annual wage of chiropractors was $67,200 in May 2010 [202]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [203]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.

201. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract

202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm

201. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/

Chiropractic Career

Realistic median annual wage of chiropractors was $67,200 in May 2010 [202]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [203]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.

202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm 203. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/ — Preceding unsigned comment added by Nobias500 (talk • contribs) 16:03, 8 April 2013 (UTC)

Response to the above requests

I didn't realize Nobias500 (and their unlogged-in ISP) had requested this addition here. I saw that they had added these two identical sections to Chiropractic education and to Doctor of Chiropractic. I got them to fix the referencing of the "career" section and left it in both articles. I deleted the "cost effectiveness" section as irrelevant for those articles, reduced it to a sentence, and moved it to this article. I make no guarantees about this information, I just moved it as a favor to a newbie. If there are problems with the information or the sourcing, anyone may feel free to remove it. --MelanieN (talk) 04:40, 9 April 2013 (UTC)

Change request-Chiropractic mixer guidelines no longer meet the evidence based standard

Hello all, I'd like to dispute the text that reads, "Although mixers are the majority group" and subsequent parts that imply they use an evidence based standard. I think this was done to give the impression that chiropractors are less unethical than they really are and it is inaccurate. According to an appeal filed by Life University in 2001, straight programs are the majority group.

The District Court committed a further mistake of law by delving into the chiropractic profession’s philosophical debate about its health care role in an attempt to probe whether CCE harbored an improper motive for not reaffirming LUCC’s accreditation. The District Court refused to apply the Wilfred “great deference” standard based on its finding, which was unsupported by any evidence in the record, that “an aggressive group of leaders of the eight liberal chiropractic schools . . . had undertaken a series of corporate manipulations in order to reduce the representation and dominance of the eight conservative chiropractic schools (of which Life was one) . . . which were calculated to give dominance to the liberal minority group over the conservative majority group; [and] the end result has been the disaccreditation of the largest of all the colleges. . . .” R4-28-3-4. Such an inquiry and the District Court’s unfounded speculation were manifestly improper.16 (see page 43 of attached appeal (CCE vs Life University, US Court of Appeals. 11th cir. NO. 03-11020J. April 23, 2003.)

Granted this is from 2003. Since that time enrollment in straight programs has slowed while mixer ones has increased and one program has closed, the satellite branch of the Cleveland College of Chiropractic, regarded as straight by its president, in Los Angeles. (http://www.chirobase.org/03Edu/schoolphilosophy.html). So although the trend has shifted, straight programs traditionally graduate more graduates. In 2003 Life claimed that 2/3 of all practicing chiropractors were straight, a claim that is supported by the reference that states that a majority of chiropractors, whether they be mixer or straight, support the subluxation complex. If mixers were really evidence based they wouldn't support an outdated subluxation/somatic lesion practice model so the reference shows that assertion to be false.

I am having trouble locating that reference but it doesn't matter because I will show that regardless of orientation, all chiropractic programs, whether they be mixer or straight, are based on a form of subluxation diagnosis.

This brings me to my second request for changes. The article is inconsistent in that it cherry picks references from a few academics and minority practitioners to imply that this false majority of mixers is moving towards evidence based practice:

“and the principles of evidence-based medicine have been used to review research studies and generate practice guidelines.[16]”

"However, most practitioners currently accept the importance of scientific research into chiropractic,[5]and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness;[21] a 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.[22]

EB practice isn’t a concensus of what chiropractors say it is, but must have an objective standard based in critical thinking. The mixer EB practice model is to perform a differential diagnosis which is followed by screening the musculoskeletal system for subluxations (pseudoscience). The primary difference between the straight version of this is that straights don’t diagnose diseases so will refer out far fewer patients due to undiagnosed illnesses."

Current thinking of the rest of the manipulative professions (PT, DO) recognizes that subluxations are not real lesions and mandates that manipulation is done solely to assist recovery from legitimate diagnosed conditions. (Peter Huijbregts, PT. Clinical Prediction Rules: Time to Sacrifice the Holy Cow of Specificity? The Journal of Manual & Manipulative Therapy. Vol. 15 No. 1 (2007), 5–8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565597/pdf/jmmt0015-0005.pdf)

So while in the past guidelines that recognized subluxation findings may have been justifiable as evidence based practice current analysis shows that the assessments are too flawed to use for diagnosis. Former NACM member and published author Tim Mirtz DC admits this is true and writes of the NACM's supposedly evidence based but now outdated subluxation/somatic lesion based guidelines of their time,

[Mirtz] Our guidelines were more stringent than that of the profession; but you are not judged by the guidelines of an organization but by the standard set forth by the state license.

[Botnick] Though they had good intentions at the start, the later years of NACM aren't anything to be proud of (due to not keeping up with the current research of the time that showed the subluxation/somatic lesion had been debunked).

[Mirtz] And hence we disbanded. I am not proud of it either but we had something then it just weathered away.

(Tim Mirtz DC MSE. Post to "Viva la revolution! Chirotalk outlasts NACM." Dec 28, 2012. http://chirotalk.proboards.com/index.cgi?board=leadership&action=display&thread=5831&page=1)

To a chiropractor, whether he be mixer or straight, the presence of a malady is not a requirement for treatment because evidence of subluxation by itself is considered a risk factor for future disease. So the only difference it makes is whether a DC bills the insurance carrier (for a diagnosed condition+subluxation) or not (subluxation only). Moreover, as more evidence that all chiropractors support subluxation, no chiropratic college teaches that clinical prediction rules be applied in order to stop treatment of patients who show only false positives from subluxation but are otherwise asymptomatic.

So these sections need to be re-written. As Life affirmed, the majority of practicing chiropractors, whether they be mixer or straight program graduates, treat subluxations (aka somatic lesions) in some form, all evidence based practice guidelines are based on subluxation and are not really evidence based, and historically the idea of eliminating subluxation diagnosis, has been defeated by the majority of the profession and is universally rejected by all organizations and schools. Only a few scattered academics have proposed abandoning subluxation diagnosis but there has been no movement to put this into practice, explaining why the majority support subluxation/somatic lesion diagnosis which is falsely portrayed as legitimate evidence based practice when it really is pseudoscience. Abotnick (talk) 13:04, 18 April 2013 (UTC)

You might just go ahead and making the changes you want. If you think they will be controversial, do one per day to give people time to revert and discuss, while letting less controversial changes through. That's one way to go about it anyway... TippyGoomba (talk) 01:26, 19 April 2013 (UTC)

Ok TippyG, I'll start working on it as I have time. Thanks.Abotnick (talk) 13:43, 19 April 2013 (UTC)