Talk:Chiropractic/Archive 9

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This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Contents 1 Straight Summary Intro Problems 2 harrison 3 Balance - monthly statement 4 New Numbers in the Lead 5 Top dispute 6 Lead rearrangement 7 Duke, evidence, and Gareth's errors 8 Miller and Miller 9 Responses 10 Menstrual cycles, asthma, etc 11 Discussion page 12 Cochrane and Bandolier 13 Para 14 straight sentence 15 New and (hopefully) improved History 16 Very first sentence 17 Vertebral subluxation 18 New user, Randalllord 19 Merging definitions... 20 does not meet the standards of EBM 21 Found quote 22 External Links Reminder 23 moved and combined 24 Scientific investigation of chiro

Straight Summary Intro Problems

I see that this paragraph was modified to:

>Straight chiropractors are the oldest movement, operating half of the accredited schools and graduating 75% of practicing chiropractors. [9]. They largely follow the writings of chiropractic founder DD Palmer and his son BJ Palmer, but have expanded the earlier theories with alternative mechanisms. Straight chiropractors fully accept Palmer's hypothesis that spinal adjustments are able to remove interference to the human nervous system and improve communication between the brain and target tissues. Their treatments are assumed to remove a primary underlying risk factor for disease. Differentiating themselves from other chiropractic groups, objective straights hold that the diagnosis of patient complaints is not a part of their analysis. Rather, Straight Chiropractic analysis is used to detect the presence of vertebral subluxations and helps the practitioner elect the most appropriate straight chiropractic corrective procedure. [20] Despite the non-diagnostic philosophy, CCE standards require differential diagnosis be taught in every chiropractic program to guard against premature diagnosis and provide quality care. Furthermore, most chiropractic licensing boards require examinations in medical procedures. Most straight chiropractors limit their treatment to the spine.

This reads very poorly and is much more confusing than my earlier version. This paragraph has to be something that readers can understand, not chirobabble. Vertebral subluxation is not explained as a hypothesized biomechanical problem of the spine. So readers don't really know what it is. Further, they can be led to believe that it has more scientific support than it does. Right now all evidence shows that subluxations are effects of other underlying causes and that this is a primary reason why chiropractic analysis procedures don't work. There are also other problems like false positives from postural misalignments and anatomical asymmetries. A big problem with skipping differential diagnosis is that straight chiropractors never get to the cause of the misalignment and never correct it-setting patients up for lifetime palliative care while misleading patients to believe that they are really addressing the underlying cuase of their problems.

I agree that the readers need to be able to understand it, so words need to either be simple enough or explained well. However, prefacing it with - Right now all evidence shows that subluxations are effects of other underlying causes and that this is a primary reason why chiropractic analysis procedures don't work sounds too POV.--Dematt 19:25, 30 May 2006 (UTC)

The CCE accreditor comment seems out of place and breaks the flow. I think you should restore my previous version.Abotnick 11:44, 30 May 2006 (UTC)

I do agree with the CCE comment being confusing.--Dematt 19:25, 30 May 2006 (UTC)

I disagree. I think this reads much better than before. It flows nicely, and is much less POV. This paragraph and the mixer paragraph will get moved and incorporated into the Practice Styles section below as they are too lengthy and informative for the intro. By that point in the article, a reader will be well-versed in what a vertebral subluxation is (so we don't have to define it everytime it is used). We can WikiLink it to its article however. Also, this isn't the place to argue science and evidence. If we do that everytime a point is mentioned, then the article will be filled with they-say-this-while-these-people-say-this. We've been there before. It isn't pretty. There is a Chiropractic and Science area for these kinds of points. Let's limit the wages of scientific opinions to that section and save the rest of the article for presented the facts. IOW, our paragraphs on Mixer and Straight philosophies should be just that...paragraphs stating what the philosophies are and how they differ. Your point that chiropractic doesn't have a scientific consensus is made in the first paragraph. There is scientific evidence supporting chiropractric, but not enough to have an overwhelming scientific consensus. The reader gets this. Trust the reader. Levine2112 16:23, 30 May 2006 (UTC)

Dematt, I redid the straight paragraph taking into consideration your comments to tone down the POV but get the issues of contention across. Looking forward to your feedback. Abotnick 10:44, 1 June 2006 (UTC)

Abotnick, I think you were successful in your changes in getting your view across and it is more descriptive and understandable. It is also a very real point of contention within the profession and apparently has been since its inception. Is it defensible? Your reference leaves some question. In other words, the press release is about an allegation that is just beginning to be investigated and no decision has been reached as to guilt. It's like innocent until proven guilty. Do you have another reference that proves your point more definitively? If not, the other option would be to state something on the order of;

• rather than "some straight chiropractic schools have been found to have programs that violate accreditation..."
• "some straight chiropractic schools have programs that allegedly violate accreditation..."

Either of those options would be acceptable to me, though you potentially might have a problem with borderline "original research" with the current reference.

I hope you didn't mind. I also changed the "vertebral subluxations" to vertebral subluxations since the article has already referenced it several times by this point in the article. I also learned from previous interactions with editors that "quotes" can make it look like a "questionable" POV:)

Would you consider changing;

• This stance against diagnosing patient complaints has been a source of conflict in the field .. to
• This stance against diagnosing patient complaints has been a source of conflict within the profession .. I think it is more specific and hits home.

I am still concerned with an unreferenced proprietary, unvalidated chiropractic testing. If this is going to make it through and stand the test of time, we need to decide on the reference for this statement.

IMO, this paragraph has added a much needed element to this discussion. Keep it up. --Dematt 13:11, 1 June 2006 (UTC)

I would have to agree with Dematt. IMO, it is too POV and lists opinions without sources. It sounds like Abotnick has a big chip on his shoulder regarding his unhappiness with his education. I am not sure how this became a newsworthy "press release". I am skeptical of the two references Abotnick provided from PRWeb. Abotnick did you write them? You are listed as the contact person. Also USANeck911 is listed as well. This is a well-known very hostile chiro-hating extremist group owned by an MD. I don't think this qualifies as a neutral "press release". While I feel your pain Abotnick, please provide a references from neutral sources. Otherwise, PRWeb references should be removed. Thanks Steth 14:40, 1 June 2006 (UTC)

Dematt:

Thank you for the compliment.

>Is it defensible? Your reference leaves some question. In other words, the press release is about an allegation that is just beginning to be investigated and no decision has been reached as to guilt. It's like innocent until proven guilty. Do you have another reference that proves your point more definitively? If not, the other option would be to state something on the order of;

• rather than "some straight chiropractic schools have been found to have programs that violate accreditation..."
• "some straight chiropractic schools have programs that allegedly violate accreditation..."

Either of those options would be acceptable to me, though you potentially might have a problem with borderline "original research" with the current reference.

The Council on Chiropractic Education specifically admitted to the US Department of Education that Life University violated the standards and they were the largest college of chiropractic. A curriclum survey I did shows that over 50% have the curriculum problems described above (I will bring this up at the USDOE hearing). So these problems are not alleged. I think I need to change the reference to the letter from the CCE and preserve a direct link on the net.

>:I hope you didn't mind. I also changed the "vertebral subluxations" to vertebral subluxations since the article has already referenced it several times by this point in the article. I also learned from previous interactions with editors that "quotes" can make it look like a "questionable" POV:)

The condition is questionable, it hasn't been validated and there are known false positives with the analysis procedures. It should be in quotes.

Would you consider changing;

• This stance against diagnosing patient complaints has been a source of conflict in the field .. to
• This stance against diagnosing patient complaints has been a source of conflict within the profession .. I think it is more specific and hits home.

Yes within the profession would be an acceptable change.

>:I am still concerned with an unreferenced proprietary, unvalidated chiropractic testing. If this is going to make it through and stand the test of time, we need to decide on the reference for this statement.

Most chiropractic techniques are proprietary. That is why they are copyrighted by companies and sold. A list of companies would include: Activator Methods, Gonstead, etc. The only generic technique I can think of is Diversified which was developed from Osteopathic technques.

The sentence was accurate because the tests aren't validated as diagnostic methods, however I decided to take out that part because it seemed redundant to other passages.

IMO, this paragraph has added a much needed element to this discussion. Keep it up.

Thanks. Abotnick 16:57, 1 June 2006 (UTC)

I was okay with your initial changes, but it seems to have gone in another direction altogether. If we could back it up a few edits it would be sufficient as an encyclopedic article. The edits about Life college, though interesting in their own light, take the reader in a totally different direction - particularly for an introduction. Maybe we should save this deep a description for later in the article. I'm open as to where.--Dematt 18:34, 1 June 2006 (UTC)

I agree that the Life University mention takes the reader on a tangent. Why can't this paragraph just be a definition of straight chiropractic philosophy rather than an attack on it? Levine2112 19:22, 1 June 2006 (UTC)

Another option is to paraphrase in a short sentnence and link to Life University since the contoversy is already there.--Dematt 19:12, 1 June 2006 (UTC)

So I am still not clear on this point, Abotnick. Did you write the "press release" that you pointed the article to on PRWeb? If not, then who did? Thanks, Steth 18:17, 1 June 2006 (UTC)

Dematt,

I agree, that passage about the Life University/CCE matter was misplaced in the introduction so I took it out. Thank you for the editorial comment. If anyone thinks it fits better in another section please speak up.

Steth,

Yes I authored the press release on PRWEB. However, I am not the author for most of the attached files which are being referenced. Abotnick 19:33, 1 June 2006 (UTC)

Dematt just brought it to my attention that the reference for the 50% of chiropractic schools graduating 75% of the students was incorrect. The original reference is actually from the first document filed by Life University in the Life U v. CCE suit. If anyone wants to access it I think that it may be finally unsealed and accessible by PACER. Sorry about the mistaken reference. Other than that, I think the new paragraphs look great and explain some relevant and important points between the classes of chiropractic schools. This really shows wikipedia at its best. Abotnick 12:12, 2 June 2006 (UTC)

harrison

Levine the reference is on this talk page already. i've reverted Mccready 11:08, 31 May 2006 (UTC)

McCready, please provide the text from which you are referencing. You added: Nonetheless, a summary of an article by Harrison states that chiropractic analysis procedures are biomechanically inaccurate. Are you referencing the article itself or a summary? Please provide us with a link so we might read what you have read, (or if you only have a hard copy, please copy down just the part from which you are referencing). Additionally, the sentence that you are adding seems very out of place. It reads very poorly. You start it with "Nonetheless" and I don't know what you mean. Levine2112 16:11, 31 May 2006 (UTC)

Hi, Levine, I believe this is the ref Mc is talking about [1] which says that the standard method of describing misalignments using PRS or ASRP are not accurate enough. Mccready, I have stated that during my education (1999)we were taught the use of the cartesian coordinate system (ie. theta z, etc.), do you assume good faith that that is correct? If so, then your reference is inaccurate. If you want a link to an online reference as to what is taught in a chiropractic curriculum, I don't know if that is possible. You'll just have to assume good faith.--Hughgr 17:40, 31 May 2006 (UTC)

Thanks for that Hughgr. (The link doesn't go to the summary though). I'll assume good faith and trust what you have been taught in school as accurate. Levine2112 18:24, 31 May 2006 (UTC)

This should get you there.PMID 9502066 This is not the only mechanism that straights use as a method of analyzing is it? I also notice that one of the authors is a professor at Life Chiropractic. He has a long list of research. If we consider this research to be valid, can we assume his entire list of research is valid? Some appears to be pro and some appears to be con. --Dematt 19:03, 31 May 2006 (UTC)

This is his list Troyanovich,SD--Dematt 19:06, 31 May 2006 (UTC)

Thanks, Dematt. I speculate that this is the first time some of us have actually read that (despite citing it in the article). But so we are clear, even though this method is considered inaccurate (and perhaps due to the fact), this isn't taught anymore in chiropractic schools as a part of straight chiropractic analysis. Can we agree on that? Or can someone show us that this method is still being taught? Levine2112 19:06, 31 May 2006 (UTC)

Just to clarify, at PCC(IA), we were taught both the old and new. If you were to get the records from someone using the older method of analysis, it's nice to know what they ment.--Hughgr 20:25, 31 May 2006 (UTC)

The other part of this whole dialogue is;

• if Mccready will consider this research acceptable, then is there more research from this same group that would be considered acceptable and, therefore, would that not mean that there is research supporting chiropractic? Then we can answer the question in the intro as well with this one challenge.--Dematt 20:52, 31 May 2006 (UTC)

As always, Dematt, an excellent point. Levine2112 21:24, 31 May 2006 (UTC)

My guess would be the Mccready didn't know that the Harrison paper was just one volley in a debate amongst chiropractors, and chose it simply because it made a statement that appeared critical of chiropractic in general. Once you're a bit familiar with this particular editor's pattern, that becomes a pretty fair guess to, um, aim at. - Jim Butler 09:50, 1 June 2006 (UTC)

Jim, Welcome! Please feel free to stick around. I understand you have a science background so we'll be looking for some input from your POV. So settle in and enjoy!--Dematt 16:02, 1 June 2006 (UTC)

Jim, thanks for your insight. I also feel that you've presented a fair complaint about McCready on his talk page. I've tried to do the same in the past (perhaps not as eloquently as you), but he just deleted it from his talk page. Anyhow, as a person with a strong science background, I ditto Dematt's welcome above and hope you stick around to participate int he editing of the highly contentious chiropractic article. Levine2112 18:06, 1 June 2006 (UTC)

Thanks for the welcome Dematt and Levine2112! This is a big topic I don't know that much about, but I'll try to follow along, and am happy to pitch in if something is within my learning curve. I surmised the situation with Harrison by Googling around and noticing the faculty affiliations of the authors (which Dematt noticed too). cheers, Jim Butler 23:21, 1 June 2006 (UTC)

Another point that I've been trying to make is that we should stop adding arguments throughout the article. We did that before and it turned the entire article into a they-say-this-while-they-say-that. I feel that in this area (straingt and mixer paragraphs) we should just keep it on point and just describe what the two main chiropractic philosophies are and highlight some of their key differences. This shouldn't be another place to make anti (or pro) chiro arguments. Can we all agree with that too? Levine2112 01:16, 1 June 2006 (UTC)

Levine, I definitely hear you on this. I think the article needs a discussion on the straight/mixer dilemma that satisfies each POV and leaves the reader with a sense of understanding that is non-judgemental. Abotnick has done a good job of tempering his "disgust" in a NPOV and leaves us with the meat of his argument. You can tell just by the many edits that he went through to get to his final version. He basically toned himself down:) It may need a little tweak or two to refine, but overall he left us with a good paragraph on the debate for and against the straight concept that is not anywhere else in the article. We probably need to do something similar with the mixer paragraph. Then we can consider merging the two sections on "Practice styles". What do you think?--Dematt 15:37, 1 June 2006 (UTC)

I don't think the straight paragraph presents a balanced POV at this point. Right now it does two things: 1. defines the philosophy of straight chiropractic 2. criticizes straight chiropractic philosophy. Where's the balance there? I agree that Abotnick is tempering his disgust a bit (as I've seen the kinds of attacks and innuendos he has used against chiropractic), but I think the paragraph could be less of one-sided criticisms. I know that we could add supportive studies of straight chiropractic analysis, but they would either be promptly reverted or we would be lead down the road to a they-say-this-while-they-say-that article. I say to remove all the criticisms from this paragraph and just leave it as a definition of the philosophy. Save the criticisms (and the support) for the Science sections. Levine2112 18:00, 1 June 2006 (UTC)

As of this time, it leans too heavily toward the antiPOV, but that seems to change by the moment. You're starting to sound better all the time. I would like to hear from Hughgr as he is from a straight school, is he not?--Dematt 18:38, 1 June 2006 (UTC)

Hi all, been putting a new computer together and it's been glitchy:) As far as the above goes, I agree, flipping back and forth does not make a good reading article. I like the idea of describe what the ideas, thoughts, and motives are for each approach. The reader can then afford to make their opinion. As to grad. from a "straight" school :), Palmer used to be the straightest, but I think the school in Penn. has that crown now :) (forget the name, sorry). Palmer teaches differential diagnosis but PT was an option, not sure of the current status. Most of my understading of chiro philo and hist comes from my own investigation thru reading various books and listening to speakers at seminars.--Hughgr 20:25, 1 June 2006 (UTC)

>as far as the above goes, I agree, flipping back and forth does not make a good reading article. I like the idea of describe what the ideas, thoughts, and motives are for each approach. The reader can then afford to make their opinion.

I think Dematt's NPOV approach that raises controversies and explains beliefs in an objective manner accomplishes that. A simple listing of unqualified beliefs removes all objectivity. The purpose of wikipedia is to use quality references to arrive at something objective. So even though you may have an article from the Journal of Non-Index Medicus Chirobabble this doesn't make it a good reference. If people think the issues raised are negative then this is a good thing because they might be seeing the true source of the controversy for the first time. Abotnick 15:29, 2 June 2006 (UTC)

Incorrect. A simple listing of the actual beliefs removes all subjectivity. This is what we should be aiming to accomplish in this section. Save you objective arguements for a more appropriate section. By putting them in these paragraphs you are confusing the article and taking it on tangents. And please, restrain your attacks on chiropractic. You are just getting under our skin more by saying things such as "Journal of Non-Index Medicus Chirobabble". How are we supposed to work together to make a great article with uncooperative behavior like that? Levine2112 17:56, 2 June 2006 (UTC)

Levine, Maybe you are a little too defensive if you can't see that the Journal comment was meant to make the point that there is high quality research and rubbish. Our job should be to distinguish between the two.

On the other hand it is apparent that the job of many chiropractors and organizations is to conceal the real issues and spin responses with conspiracy theories to avoid discussing what is really going on.

This article should not be an open invitation to do the kind of false advertising and misinformation that chiropractic programs use on their websites.

Anyone who has a problem with this should not participate. Abotnick 23:26, 2 June 2006 (UTC)

If I seem defensive it is because you are on the attack. Again, you slander chiropractors here accusing them of concealing the real issue and of spin responses. Your comment about "Journal of Non-Index Medicus Chirobabble" wasn't as you say meant to show that there is is high quality research and rubbish. You made that comment not attacking any one piece of research, but rather as an attack against any dedicated chiropractic research journal. As far as creating conspiracy theories... oh wait, the AMA was found guilty of conpriracy against chiropractic. I guess that was more than just a theory.

I am trying to remain civil here, but I will call you out when I see you're going down the path of unsubstantiated innuendos, no matter how clever and subtle you think you might be. This isn't a place for uncivil attacks and it is certainly not a place to exorcize your anti-chiropractic frustrations. You have you own chat board to do that. Keep it there, and we won't have a problem with you here. Levine2112 00:32, 3 June 2006 (UTC)

Levine, 1. Slander is verbal, libel is written. 2. Chiropractors do conceal the real issues. 3. Not all journals are of good quality. 4. You are not a mind reader. 5. Criticism does not = attack. In fact, some people use it to improve. Chiropractic can't because it is wedded to a false belief system and has nowhere to go so the only thing it can do is spin and deny. 6. The AMA Wilk case was a long time ago. Abotnick 10:07, 3 June 2006 (UTC)

Abotnick, our job here isn't to decide what evidence is valid or unvalid. We are not, for the most part, scientists. Our job is to point to references that can be verified. Because you have a "beef" with your education and chiropractic, you seem to have a tendancy to slide in your POV. While we all have a POV, using sneaky, NPOV wording will not fly, in the article, or on the talk pages. Like Levine said, keep it on your website please.--Hughgr 18:34, 3 June 2006 (UTC)

Balance - monthly statement

The notion of achieving balance by removing qualification to a section further down is unacceptable. Balance is a weasel word to replace the notion of truth or accuracy. We are not here to find balace (defend chiro or defend any particular school of chiro). We are here to write an encyclopedia and let the cards fall where they will.

I edit many articles on wikipedia, including many that deserve the appellation pseudoscience - actually James Randi put chiro in with the paranormal (with the execption of back pain relief). This is to let editors on this page know that I am very keen to reach consensus on this and am keen to talk, but perhpas not able to spend as much time as I'd like here. Please see my [Editing principles for Pseudoscience articles in wikipedia] and assume good faith. BTW the gratuitous and personal attack assumptions about my harrison edits were incorrect. Mccready 10:18, 2 June 2006 (UTC)

Mccready, all I am trying to decide is what you consider science. You seem to like the Harrison report so I was asking if you would consider other reports offered by him as credible. I am asking that in the most sincere sense. I think it would help for us to know. That way, at least I might know whether I might reference him. Otherwise, I'm wasting my time as it will be reverted. So far I have not seen you accept anything from anybody that supported a chiropractic claim. It is no wonder chiropractors scream foul. I am not a scientist and don't claim to know everything about the scientific method. I assume a scientist evaluates all the available evidence before making a statement, and then he will qualify that statement based on the strength of the evidence. I copied this from the Cochrane back groups site. I suggest we follow it's guidelines and seek help from people who are actually trained to evaluate science, such as Gleng and Jim Butler (if they would be so gracious as to help us through this maze of information).

Levels of evidence From Cochrane Back and neck pain group

• Strong => consistent finding among multiple high quality RCTs
• Moderate => consistent finding among multiple low quality RCTs &/or CCTs &/or one high quality RCT
• Limited => one low quality RCT and/or CCT
• Conflicting => inconsistent finding among multiple trials (RCTs &/or CCTs)
• No evidence from trials => no RCTs or CCTs

If James Randi thinks chiropractic is not pseudoscience when it comes to back pain/joint problems I consider that important, but he does not make available how he reaches that conclusion, so I still have to remain skeptical.

I look forward to your response. --Dematt 13:03, 2 June 2006 (UTC)

I was wondering the same thing too. What does Mccready think?--Hughgr 19:35, 2 June 2006 (UTC)

Science is the scientifc method. Don't make the error of thinking only experts are allowed to edit wikipedia. You, I or anybody are just as entitled to edit, contribute or examine evidence as anyone else. You have a brain and can use it. Spend the time to look at the evidence. Deferring to experts may result in the logical fallacy of appeal to authority. I have no view on Harrison at this stage. It appeared to me he was making a valuable point which other editors didn't like him making. Cochrane is not god either. It's composed of people who have agendas too. For my money anything less than the "strong" evidence from your cut and paste is second best. I certainly wouldn't want to risk my health on a bunch of low quality trials and one high quality one. My guess is that Randi probably knows less about chiro than we on this page. If you want to put him in, by all means go for it. Mccready 23:10, 2 June 2006 (UTC)

So who is left for you to believe, McCready? You have dismissed Cochrane, you have no view on Harrison, you despise anecdotal evidence, you ignored the over 300 scientific studies which I have highlighted here and now you say you won't even accept one of the foremost skeptics (Randi) who you introduced into this in one of your reverts today. Apparently the only person you trust is yourself... which is commendable and all, but you really don't have any basis to edit here then anymore then. Levine2112 23:48, 2 June 2006 (UTC)

New Numbers in the Lead

I just noticed new numbers in the lead. Does anyone have sources for either one or is this sentence just a figure of our collective imaginations:)--Dematt 17:19, 2 June 2006 (UTC)

I saw that as well. I don't know where the 2/3 came from, and now it's 1/3 I looks like user Weiniger made the change, I didn't check who put it in first.--Hughgr 20:10, 2 June 2006 (UTC)

the info is from Biggs further down in the article. Mccready 22:25, 2 June 2006 (UTC)

Mc, could you please be more specific, I couldn't find Biggs.--Hughgr 23:41, 2 June 2006 (UTC)

I guess this is my problem with it. The lead says, "An estimated two thirds of chiropractors believe obstructions to healing can be removed by adjusting subluxations of the spine and/or extremities."

Then, just below in the introduction it says, "Nevertheless, in 2003 90% of chiropractors believed the vertebral subluxation complex played a significant role in all or most diseases, and practiced accordingly.[2]" These are conflicting, but at least one is referenced, what shall we do?--Hughgr 00:35, 3 June 2006 (UTC)

Top dispute

This is now the fifth time I've asked for the ref in the lead from Cooperstein. The ref given doesn't support the claim. The ref is a ref to a ref. Circular reasoning and circular refs don't belong in WP. Can someone show me the Cooperstein? And on the Harrison which kept getting reverted. Unless someone can say why it shouldn't go back in ....Mccready 23:10, 2 June 2006 (UTC)

I didn't make the reference, so I don't know. You insist however that this research is disputed. By whom? Levine2112 23:49, 2 June 2006 (UTC)

If it helps you McCready, here is a page linking to a lot of research, clinical and case studies and reviews that provide more supportive evidence for chiropractic's claims to help with headaches. Levine2112 23:54, 2 June 2006 (UTC)

And here is another page providing more research supportive of this claim by chiropractic. Levine2112 23:56, 2 June 2006 (UTC)

And here's yet another page of scientific studies citing chiropractic's effectiveness with headaches... Levine2112 00:03, 3 June 2006 (UTC)

I don't know if this helps but I found this. Ontario Ministry of Health, stated emphatically that: "On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain...There would be highly significant cost savings if more management of low back pain was transferred from physician to chiropractors." Levine2112 00:00, 3 June 2006 (UTC)

Here's a page full of supportive scientific research of chiropractic's effectiveness with neck pain. Oh, and here's another page chocked full of more research supporting chiropractic's claim to be effective at relieving neck pain. Levine2112 00:06, 3 June 2006 (UTC)

Levine I think they are asking for studies on biomechanics not general efficacy.Abotnick 00:10, 3 June 2006 (UTC)

I think he is referring to this in the intro: Although disputed research suggests short term pain relief for tension headache and low back pain, there is no scientific consensus for chiropractic's effectiveness for other conditions. Given the 100+ pieces of research that I have just pointed us to (and that even skeptic-extrordinairre James Randi accepts chiropractic's effectiveness for headaches and low-back pain), will the anti-chiro lobby here at least now afford us to remove the word "disputed"? Levine2112 00:22, 3 June 2006 (UTC)

I am curious as well. Who says their disputed, other than Mccready?--Hughgr 00:35, 3 June 2006 (UTC)

No Levine, we've been through this before. I am not going to wade through hundreds of studies to find support for YOUR contention. Please provide ONE study that supports your claim. Since we cannot even examine the Cooperstein claim (this is the sixth time I'm asking) of course it's disputed. Makes sense to me. Let's see the refs guys. Mccready 01:36, 3 June 2006 (UTC)

All of the research I have cited support chiropractic's (not my) claim that chiropractic helps with headaches, back and neck pain individually. Collectively they show some kind of consensus. Your claim is that that this is disputed. Please provide us with reference that support YOUR contention. Levine2112 02:31, 3 June 2006 (UTC)

Oh dear, oh dear, oh dear Levine2112, all I'm asking is for ONE study. You CLAIM all support you. Well, please, pretty please, give one. One would be enough, only one, not ten, not twenty, not a hundred, not hundreds. Just one. Why is that hard for you? And also, the problem with the Cooperstein link remains (this is the seventh time now - has anybody got a copy of the study - if that is indeed THE one that Levine2112 wants to rely on. I might add that even the category listing for it in pubmed is erroneous – it is not randomized or controlled. Meantime I'm placing disputed in or perhpaps a big big tag at the top might be more appropriate? We've come a long way here, dear Levine2112. Don't blow it.Mccready 04:12, 3 June 2006 (UTC)

Your behavior is completely inappropriate, McCready. I feel incredibly embarrassed for you. Levine2112 06:50, 3 June 2006 (UTC)

I concur with Mccready. Chiropractic has little efficacy outside of fixing certain types of back problems. Of course, I'll concede that I'm biased since one of my relatives is a physician who sees the occasional refugee from chiropractic about twice a year. These patients are sick and tired of being overdiagnosed with all kinds of bizarre diseases that don't exist by losers who entered chiropractic because they didn't get good grades in chemistry and biology and failed the MCAT and couldn't get into a decent medical school (even one of those third-rate ones down in the Caribbean), osteopathic school, or veterinary school. --Coolcaesar 04:49, 3 June 2006 (UTC)

WOW Coolcaesar, calling chiropractors "losers" who couldn't get into med school...and your a lawyer as well. Did you pass the ethics class? Please try and keep a "cool head" Coolcaesar. You say your biased b/c a relative see's TWO "refugee's" per year???? OMG, I see that many in a week coming from the medical realm. The developer of chiropractic once said, "If medicine wants to get rid of chiropractic, all it has to do is get sick people well." Cheers--Hughgr 06:17, 3 June 2006 (UTC)

Well, I did pass the required professional responsibility course and the MPRE, but my professional ethical obligations have nothing to do with how I express my personal views about the relative efficacy of different approaches to healthcare. I have a lot more respect for osteopaths, who unlike chiropractors are well-trained in conventional, scientific medicine and actually understand gross anatomy, biochemistry, and cell biology; they have purged almost all of the hocus-pocus from their field. Plus the minimum GPA to get into chiropractic school is simply hilarious. --Coolcaesar 17:47, 4 June 2006 (UTC)

CoolCaesar, you contributions here thus far are not helping further this article. I encourage you to participate here, but please keep is useful for editing this article. Please no ad hominem attacks. Go Bruins! Levine2112 18:02, 4 June 2006 (UTC)

Lead rearrangement

I started to just rearrange the sentences to make a little more sense as we previously discussed with 1)Chiropractic, then 2)Chiropractic theory, then 3) Chiropractic care. Then the next couple sentences just seemed to flow well and seem to say the same thing. See what you think.--Dematt 06:30, 3 June 2006 (UTC)

If we are going to say that disputed research suggest relief for low back pain based on the idea that there is research that we can cite and some people dispute then can't we say just the same about all of the chiropractic claims where there is research suggesting benefits? IOW, couldn't we just shorten your last two sentences to read:

Disputed research suggests relief for low back pain, asthma, carpal tunnel syndrome, painful menstrual periods, migraine, chronic low back pain or menopausal symptoms.

Currently, it reads:

While Chiropractic theories do not claim to treat symptoms, disputed research suggests short term pain relief for low back pain[1]. There is insufficient evidence that chiropractic can help conditions such as asthma, carpal tunnel syndrome, painful menstrual periods, migraine, chronic low back pain or menopausal symptoms.

I'm taking out the first clause because that isn't entirely true. Chiropractic can be a preventative medicine, yes. But outside of an ultra strict straight practice chiropractors can and will treat symptoms.

For the rest of the sentences, wouldn't you agree that "disputed research suggests" is just another way of saying "insufficient evidence"? Both imply that while there is supportive evidence, it is not yet enough to have the world's scientific consensus. So if the qualifiers that start the two sentences are the same, why not combine it into one succinct sentence?

That way we can get rid of the Cooperstein Headache ;-) We could move it from the intro to the Science and chiropractic section and then turn that section into what it should be. A fair account of both the research that supports chiropractic as well as the research that refutes it. As of now, that section is nearly 100% devoid of any of the research supporting chiropractic. Clearly, it doesn't provide a fair nor an accurate depiction of the current state of chiropractic research.

Though this proposal is bold, I will be meek as the editor. I would like to hear some rational comments on this plan before moving ahead. Levine2112 07:26, 3 June 2006 (UTC)

Thanks for asking Levine2112. I can't agree. It would help if you put yourself in my shoes before suggestions like this. I think it's fairly predictable that I would say, correctly, that "disputed research suggests" is NOT the same as "insufficient evidence". Always think of the moon is made of blue cheese theory - I find it gives me emotional distance from the subject. Thus disputed evidence suggests the moon is made of blue cheese v there is insufficient evidence to say the moon is made of blue cheese. Not the same are they? Indeed in this case we could say it's highly likely the moon is not made of blue cheese. I liked your headache joke. Do I take it then that you have not found one supportive study on low back pain to back the Cooperstein claim? Mccready 08:09, 3 June 2006 (UTC)

McCready, this is excellent. Please go into detail about the difference as you see it between the phrases "disputed research suggests" and "insufficient evidence", because the "blue cheese" scenario as you have stated it doesn't help me to see your point.

Here's my point using your example: I think the two statements are - if not equivalent - deceptively similar. For if there is evidence that only suggests the mere possibility that the moon is made of cheese, and even that evidence is disputed (meaning: what it merely suggests - the moon is made of cheese - doesn't even have a consensual agreement), then it would seem to me that there is insufficient evidence (to gain a consensual agreement) that the moon is made of cheese? Same, same.

Please break your logic down as I have so I can see how you have reached your disparate interpretation of the two phrases. Please don't tell me where I went wrong in my interpretation or where my "logic flaw" is or suggest that your interpretation is "correct". We are two people on two different sides of the Earth with a lifetime of different experiences. It's only natural that we think differenlty. I truly believe it will be enlightening to compare your interpretation of the phrases to mine.

As for the Cooperstein reference, I didn't add it and I don't like the idea of any footnote reference in the intro. I think Cooperstein (as I suggest above) should be moved into the "Science and Chiropractic" section along with more supportive chiropractic research. Levine2112 08:26, 3 June 2006 (UTC)

Exam period over (peculiarly difficult time here) so have a few free brain cells that will try to apply. Yes I caught this problem. For me I don't like the phrase "disputed evidence suggests" because to me this implies that it is the evidence that is disputed, whereas generally the evidence is not disputed but the interpretation is. The word disputed suggests that the evidence might be fraudulent or incompetently acquired. Evidence is evidence, it is not proof, usually to a greater or lesser degree the interpretation can be questioned. In the cases we are dealing with here, I think that there is evidence, although at least for for some people (and probably to everyone to a greater or lesser extent), the evidence is unconvincing, in being open to very different interpretations. Equally I don't like the word insufficient because this seems to imply that we know the conclusion is true it's just that we haven't yet gathered all the necessary proof. The evidence is inconclusive, not disputed, and not insufficient. OK, sorry to argue with everyone.Gleng 10:38, 3 June 2006 (UTC)

Welcome back Gleng! Hope all your students were paying attention and passed with flying colors! What you are saying would go something like this;

• current - While Chiropractic theories do not claim to treat symptoms, disputed research suggests short term pain relief for low back pain[1]. There is insufficient evidence that chiropractic can help conditions such as asthma, carpal tunnel syndrome, painful menstrual periods, migraine, chronic low back pain or menopausal symptoms.
• new - The evidence that chiropractic can help conditions such as low back pain, asthma, carpal tunnel syndrome, painful menstrual periods, migraine or menopausal symptoms is inconclusive.

Sorry guys, this use of the word "evidence" allows third grade crap from a low EBM tier. It's weasel words. OED gives evidence as The quality or condition of being evident; clearness, evidentness. then gives evident as Obvious to the sight; recognizable at a glance. The whole thrust is something which is clear and beyond doubt. Sneaking in low grade anecdotes which some EBM proponents like to call "evidence" is not acceptable. Mccready 13:17, 3 June 2006 (UTC)

Mccready, here is the Duke Report that talks about the headaches. It was up in the discussion above.--Dematt 15:17, 3 June 2006 (UTC)

This is marvelously supportive of chiropractic's claim to help with certain kinds of headaches. The researchers are MDs and PhDs and is part of the Duke University Evidence-based Practice Center. As mentioned in its above reference, this should certainly be added to the "Science and Chiropractic" section, which now is nearly devoid of any supportive research. Levine2112 19:47, 3 June 2006 (UTC)

Sorry Mccready; evidence is clear yes, but the interpretation may not be. Evidence is usually far from conclusive, very seldom beyond doubt. Conventional statistical tests accept a significance of P<0.5 implying a one in 20 chance of the results being due to chance alone, not beyond doubt, and this is evidence accepted as strong. Anecdotes are not necessarily low grade, and for an individual, direct experience is very strong evidence - it is strong for the individual (sometimes beyond reasonable doubt to them), just not strong for others who need to exclude observer effects. For most theories that I deal with, and science is all theories, we would charactise the evidence for and the evidence against; this is because all evidence is inconclusive and open to different interpretations; ultimately we weigh the balance of the evidence and come to a judgement as to the most likely interpretation - provisionally. For chiropractors - as for most medical practitioners, their direct experience constitutes the most important evidence governing how they practice. This is good evidence for them, and rightly so; however it is incomplete and ultimately inconclusive because it does not exclude observer effects for example, thus objectively we require independent objective evaluaton. This can take many forms - validation by controlled trials to exclude observer effects, but also and often more importantly, experimental evidence to test the proposed mechanisms of action. So there are several classes of evidence, none of whicjh alone are conclusive, and which have different weights for different people according to legitimately different perspectives. My professional perspective rates scientific evidence highest of all, and by this neither chiropractic nor a lot of conventional medicine fares well. On the other hand, nobody gets better or worse because of what I do, and if I was ill I'd go to an experienced doctor if I could, and I'd choose an experienced doctor probably over one of the students that I've just taught - because even I appreciate the importance of evidence gained by an individual through their experience. To be very specific - for me evidence is something clear and objective - like a measured concentraion of a hormone in blood in a particular condition, after a particular intervention. What it means - well that is where the controversy starts, did it change because of what I did, and if so exactly what caused it to change - obviously I had some theory and this was the prediction, but there are other possible explanations too. For a practitioner, the evidence maybe is that someone gets better after a particular intervention - equally clear and objective. Same problem though after - what does it mean - was it because of what I did, and if so exactly what was it that I did that made a difference?

Gleng 15:21, 3 June 2006 (UTC)

Just checked with wording of Cochrane pubs (quickly "There is not enough evidence to draw a conclusion about the effects of manual therapy by physiotherapists and chiropractors for adults or children with asthma" For me this is straightforward, the evidence is inconclusive. My vote is with Dematt here for what it's worth; maybe not next time. Anyone else?Gleng 15:36, 3 June 2006 (UTC)

I like Dematt's version too: The evidence that chiropractic can help conditions such as low back pain, asthma, carpal tunnel syndrome, painful menstrual periods, migraine or menopausal symptoms is inconclusive. It is straightforward and factual. Levine2112 17:21, 3 June 2006 (UTC)

I'd just like to interject that for chiropractors who are not correcting biomechanical problems in the spine then their treatments are actually merely treating symptoms through nerve stimulation that is not very different than acupuncture-the very thing that they criticize other health practitioners of doing-treating symptoms rather than underlying causes. Ironic isn't it? I'll leave it to others whether to discuss this in the main article.Abotnick 17:52, 3 June 2006 (UTC)

Hi Gleng, glad to have you back! I vote for "the evidence is inconclusive" but without listing each and every condition. Abotnick, I'm not sure what you are saying. That there are chiropractors who don't adjust the spine?--Hughgr 18:18, 3 June 2006 (UTC)

Hughgr, According to Harrison many chiropractic techniques are biomechanically inaccurate and don't work so they merely act as general mobilizations.Abotnick 20:36, 3 June 2006 (UTC)

Abotnick, What does this have to do with what we are talking about here? Please stay on topic.

Hughgr, please word the sentence how you would like to see it read. Something to this effect? The evidence that chiropractic can help a variety of conditions is inconclusive. Levine2112 20:59, 3 June 2006 (UTC)

Levine, I'd be fine with, "The evidence that chiropractic can help a variety of conditions is inconclusive".--Hughgr 23:37, 3 June 2006 (UTC)

I also think Dematt's wording sounds better. Abotnick 23:55, 3 June 2006 (UTC)

I prefer Dematt's wording and the inclusion of specifics. I don't really want to enter into this yet because I need to get better prepared, but I think it would be right to follow this statement with a However statement - along the lines of "However there is wide (though not universal) acceptance that chiropractic treatment can be beneficial for (at least some specific conditions)". So I'd rather keep things specific here for the moment.Gleng 00:18, 4 June 2006 (UTC)

Keep in mind - that specific list of conditions is currently noted in the cochrane and bandolier databases for evidence based medicine, so Steth knew that this is a an accurate and verifiable list, from any POV. It should be satisfactory to any passing editor.--Dematt 01:02, 4 June 2006 (UTC)

Okay. So we are back to: The evidence that chiropractic can help conditions such as low back pain, asthma, carpal tunnel syndrome, painful menstrual periods, migraine or menopausal symptoms is inconclusive. It seems like we have general agreement there. I will insert that for now.

Gleng, can you word more clearly the follow-up sentence that you would like to see? Levine2112 01:08, 4 June 2006 (UTC)

I thought we had a consensus here for changing the lead. Abotnick, Dematt, Hughgr, Gleng and myself all agreed with the proposal. Then I logged back in tonight to find that McCready has reverted it and left a message on my Talk page saying there was no agreement and as a matter of courtesy, I shouldn't have made the change. What do we do here? Levine2112 06:27, 4 June 2006 (UTC)

The proposed followup statement is just untrue. If that goes in, I'd go with McCready's version. The current version is marginally acceptable, but if any more pro-chiropractic statements go in the lead, even if true, a section-POV tag goes there. — Arthur Rubin | (talk) 07:49, 4 June 2006 (UTC)

Arthur, I think you are right. The overall balance is on the fine line. If there is anything else added, it would have to be weighted relatively equally so as to not change the overall attitude thus far. --Dematt 00:01, 5 June 2006 (UTC)

What's currently there now is neither pro nor anti... it is factual. The evidence is inconclusive. And as far as facts go, that is a pretty neutral one. Basically it says that while there is some evidence, we still don't know for sure. This is what Bandolier and Cochrane basically say. I didn't put the follow up sentence in yet because it wasn't discussed yet, but I think Gleng has a point there. It just needs to be flushed out here first. I think we are making fine progress. Let's keep it up, team! Levine2112 08:06, 4 June 2006 (UTC)

The balance (selection of which true statements to place in the lead) is pro-chiropractic at the moment. However, it is not true that there is wide acceptance that chiropractic can be beneficial for any (specific) condition. — Arthur Rubin | (talk) 08:10, 4 June 2006 (UTC)

I don't know. It depends on who is including in that "wide acceptance" group. I think if we are talking about the general public, it is well-known that you go to the chiropractor for a back or neck ache. I remember even seeing a hilarious The Simpsons episode a couple years back that dealt with chiropractors helping people with their back-aches (then Homer invents some gizmo that does the same thing and the chiropractors plot to put Homer out of business). So, basically this goes to show that "chiropractors for back-aches" is part of the pop culture nowadays. I think that shows some kind of wide acceptance. Then considering that tens of millions of Americans routinely opt for chiropractic services every year and the vast majority seek chiropractors out for back pain, I think we have a wide acceptance (in America, anyway). Now, I now this is hardly scientific acceptance, but I think public opinion should be a part of the article too. Levine2112 17:44, 4 June 2006 (UTC)

Reading Levine's criticism inspired me to rewrite the intro paragraph. I like this new version. What do you guys think?

"Chiropractic is a complementary and alternative health care profession which aims to diagnose, treat, and prevent mechanical disorders of the musculoskeletal system and their effects on the nervous system and general health. Chiropractic practice is based around the theory that subluxations of the spine interfere with the body's self-regulating mechanisms. Despite inconclusive evidence, 75% to 90% of practicing chiropractors believe that adjusting subluxations removes obstructions to healing and can help many health problems including low back pain, asthma, carpal tunnel syndrome, painful menstrual periods, migraine and menopausal symptoms. Chiropractic care emphasizes manual treatments including spinal adjustments, extremity manipulation and various trigger point therapies."Abotnick 23:14, 4 June 2006 (UTC)

You have my support. It basically says the same thing only a litte more accurate and flows much better. I like it.--Dematt 23:37, 4 June 2006 (UTC)

Glad to be an inspiration. But what do you guys think about public opinion here? I mean,who can say for sure what the public thinks of anything. I think I can find a source for this, but I have definitely heard and read that chiropractic has one of the highest patient satisfaction rates in health care. Levine2112 17:33, 5 June 2006 (UTC)

Levine, I'm not sure I'm understanding what you're asking? Do you mean public opinion in the lead? --Dematt 20:12, 5 June 2006 (UTC)

Not necessarily in the lead, but perhaps. I think it should be mentioned somewhere in the article. Levine2112 21:23, 5 June 2006 (UTC)

That's a great idea for the article. I think Arthur has already let us know that if the lead gets any more positive he is putting a label on it, so we should keep it out of there. Public opinion and demand are the reasons chiropractic is in insurance policies and written into state laws. Sure it is important. See what you can find and we can go from there.--Dematt 22:07, 5 June 2006 (UTC)

So far, I have this study which found that chiropractic patients express high levels of satisfaction with their doctors and the care they received. Levine2112 22:09, 5 June 2006 (UTC)

I also just found this page which, though is certainly presenting a pro-chiropractic viewpoint, it does have summaries from scientific research. Levine2112 22:11, 5 June 2006 (UTC)

This is from an article I just read: ...chiropractic enjoys an extraordinarily high degree of patient satisfaction. A recent article appearing in Spine found that of those patients seeking care from MDs and DCs, the chiropractic patients were more likely to feel that treatment was helpful (99% vs. 80%). They were also more likely to be satisfied with their care (96% vs. 84%) and less likely to have sought care from another provider for the same episode of back pain (14% vs. 27%). The high rate of chiropractic patient satisfaction documented in the Spine article correlates well with a study done for FCER by Research Dimensions, Inc., called "The Chiropractic Patient in Rural, Health Professional Shortage Areas of the United States." And these studies corroborate Cherkin's findings that chiropractic patients are three times more satisfied with their care than patients of family practice MDs. Furthermore, a Louis Harris poll revealed that 70% of the American public believes that chiropractic care should be a basic benefit of their health plan. Levine2112 22:17, 5 June 2006 (UTC)

Further, I have found that this research is often quoted by chiropractors in articles. Levine2112 22:17, 5 June 2006 (UTC)

Finally, here are some more positive stats from another survey about chiropractic patient satisfaction. Levine2112 22:23, 5 June 2006 (UTC)

Given the overall extremely high-levels of chiropractic patient satisfaction, we certainly need to mention and reference this. The question is: where? Within the intro section (not necessarily in the opening paragraph)? In the science section as a follow-up to the inconclusive evidence statement? Not sure. Anyhow, it need to be noted somewhere. Levine2112 22:23, 5 June 2006 (UTC)

It probably should be in the intro, but not in the lead. — Arthur Rubin | (talk) 01:56, 6 June 2006 (UTC)

I took out the 75 - 90 % number out. When we put the in list of conditions, it would be improper to assume that those numbers were correct and considering this is an encyclopedia, it may be referenced somewhere else improperly. Otherwise, as discussed previously, the evidence is inconclusive.

Duke, evidence, and Gareth's errors

I was aware of the Duke stuff. I haven't re-read it in full but have found this quote in my database:

among patients without a neck pain/dysfunction component to their headache syndrome – that is, patients with episodic or chronic tension-type headache – the effectiveness of cervical spinal manipulation was less clear. …. In one trial conducted among patients with episodic tension-type headache, manipulation conferred no extra benefit when added to a soft-tissue therapy (deep friction massage). In another trial conducted among patients with tension-type headache, amitriptyline was significantly better than manipulation at reducing headache severity during the 6-week treatment period; there was no significant difference between the two treatments for headache frequency during the same period. Interpretation of these results is difficult because all patients received the same relatively low dose of amitriptyline (30 mg).

If anyone wants to post something more supportive, let's look at it.

Gareth you're in danger of drowning in relativist waters. You also appear to contradict yourself. No evidence is conclusive you say, but then you point to blood tests. If I observed Plasmodium falciparum in my blood test that evidence would be quite conclusive enough for me and I suspect you.

Conclusive evidence of PF in your blood yes, but conclusive evidence that it explained all your symptoms?Gleng 11:15, 4 June 2006 (UTC)

Thus you are simply mistaken to argue the relativist line. It does a great disservice to the enquiring minds who write on this page to run such an argument. In a spirit of enquiry and to help me understand you,may I ask what is it you teach; what do you mean when you say most theories you deal with?

I teach physiology, neuroscience, medical students and science students. My research is neuroscience, and the theories are theories about how neural networks work - what they do and how they do it. Look me up on PubMed or on GoogleGleng 11:15, 4 June 2006 (UTC)

I think the source of your confusion arises partly in failing to distinguish continuous and discontinuous variables. I'm disappointed also to see you defending self-delusion.

If I see a squirrel in the garden, there's a squirrel in the garden. I don't consider it likely that I'm deluding myself, though I might be.Gleng 11:15, 4 June 2006 (UTC)

And it's simply erroneous to say for most medical practitioners, their direct experience constitutes THE [my emphasis] most important evidence governing how they practice.

Not what they tell me. Diagnosis is the most important bit, this is governed by experience. Gleng 11:15, 4 June 2006 (UTC)

Your argument also unravels at that point. The relativist fallacy is to say science is only theory. There comes a point when 99% possibility can be called fact. It's 99% sure you'll hit the ground when you jump off the cliff, it's 99% sure your well serviced bicycle with puncture proof tyres will get you to the shops and back.

Don't recognise the phrase "only" theory. For me the theory is the important bit because this takes us beyond what we know from experience to make predictions. I go with Popper hereGleng 11:15, 4 June 2006 (UTC)

Having said all that, back to chiro. I agree with you that we must be specific. Hugh, Levine, Dematt you cannot conclude on the basis of the asthma report that the evidence is inconclusive for other conditions. The evidence will ALWAYS be "inconclusive" because you cannot prove a negative. The question then is how likely is the theory to be true. Gareth, you also err by saying "there is not enough evidence" is equivalent to "the evidence is inconclusive". The former statement covers the condition where there is NO evidence at all and it covers the conditions where there is a 1 in a million chance the theory may be correct. The povish "inconclusive" tends to say the question is still open, perhaps 50:50, perhaps 80:20. Again, where do you draw the line and agree that what scientists are trying to tell you in their own careful measured strictly logcial way that something is crap. Scientists who dare to speak out in such language don't get any more research grants, they get booted out, they end up running websites trying to educate people about these things. What we want in the article is to tell the reader where the weight of evidence lies, what is the likelihood etc, not defend our emotional attachment to chiro.

I have absolutely no emotional attachment to chiro. As I've been involved here, I've come from a frankly instinctively ultra-sceptical view to recognising that, by the type of standards that I apply to evaluating conclusions (which I do a lot of as editor, referee, and in my teaching - I teach on evidence based medicine, evaluating trials etc) - objectively the issues are much more open than I had expected to find them. I try to deal with things objectively, not pretending I always succeedGleng 11:15, 4 June 2006 (UTC)

Specifically on the lead, in the last day it's gone from one erroneous formulation to the next (Bertrad Russell showed where you could end up when the first leg of your argument was false). So now we have the povish "there is limited evidence". How about something like "The weight of evidence" or "it is unlikely that..." If anyone here seriously believes chiro can have benefit for asthma, migraine etc then say so, source it, and say what the benefit is. I'll edit accordingly. Mccready 02:09, 4 June 2006 (UTC)

Okay, I suppose I have to raise my hand. I believe that a chiropractor can have benefit for asthma, migraine, etc. I'm sorry that the only evidence I can give you is anecdotal and experience. The benefits vary, but some migraines actually go away while most are reduced in frequency and intensity after a few months of working with them. I am sure you are aware of the risks and expense related to migraine medications today, so add that to the benefit list. I won't bore you with the rest. Suffice it to say; yes, there is a person here that thinks a chiropractor can have benefit for migraine...

PS Please, everybody, lets not use ad hominem attacks to make your own argument look better. It only diminishes your own POV in the eyes of the reader and creates an atmosphere that closes minds that might otherwise be open to your POV. --Dematt 05:18, 4 June 2006 (UTC)

dematt>Okay, I suppose I have to raise my hand. I believe that a chiropractor can have benefit for asthma, migraine, etc. I'm sorry that the only evidence I can give you is anecdotal and experience.

I'm a former asthmatic patient who was strung along with chiropractic for many years. After all the thoracic manipulations none of the biomechanical signs ever resolved (rib tenderness, interspinous process tenderness) and the only result was some muscle relaxation and feeling good from endorphin release that was very short lived. If a treatment is supposed to correct an underlying cause of a condition but then doesn't achieve this and has only temporary and mostly ineffective results as shown in controlled study then it begs the question why personal bias should overrule controlled studies to recommend the treatment for the condition. Abotnick 12:16, 4 June 2006 (UTC)

Abotnick, your description fits all treatments for asthma. There is no cure for asthma, but there are treatments from which you might benefit. The degree to which you benefit and the risk and cost are all factors that you ( the patient ) are most able to assess on an individual basis. If you were not getting benefit personally, you can stop at any time, as you apparently did. Even medications require that you continue to take them - and you agree to the risks, just as you would agree to the risk of stroke from adjustments, should you decide to take that route. The system worked. And besides, the the most recent review says; "Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma." The doctor who deals with healthcare everyday is ethically bound not to withdraw a treatment protocol based on this review. Personally, I think that it is more efficient to use the inhaler as necessary. But benefit is there for adjustments. There are some conditions that adjustments are no longer on the same level of confidence as medications, such as diabetes. There was a day when diabetes was out of control and there was no insulin. Once insulin showed its effects, patients and doctors choose that route. No problem. We are getting there as a society, but chiropractic and all so-called alternative healthcare methods continue to push the envelope of understanding until they are disproved or melded into fabric of the mainstream.

Also, just as a matter of example - with your continued pain at the level of the thoracic region, you demonstrate some form of clinical evidence for subluxation. The fact that the pain is still there supports the straight contention that they are not trying to affect your back pain, just your health. The question is; how is the asthma? My contention is; you must have had some benefit, as you applied to chiropractic school.

Sorry for the diatribe, but I felt that there needed to be some clarity on the DC POV. BTW, straight DC's don't consider me straight:)--Dematt 14:02, 4 June 2006 (UTC)

Dematt, >your description fits all treatments for asthma.

I don't think so. Albuterol is proven to stop wheezing in the short term. Chiropractic hasn't.

>There is no cure for asthma, but there are treatments from which you might benefit. The degree to which you benefit and the risk and cost are all factors that you ( the patient ) are most able to assess on an individual basis.

I think accreditation guidelines place the cost to benefit decision with the physician. If a treatment has no logical reason to think it might help (as in this case where there is no research supporting its use) then it doesn't make sense why a chiropractor would suggest it other than unethically for self gain.

>If you were not getting benefit personally, you can stop at any time, as you apparently did. Even medications require that you continue to take them - and you agree to the risks, just as you would agree to the risk of stroke from adjustments, should you decide to take that route. The system worked.

Not really. My former chiropractor used a guilt trip on me and made a disclaimer that I should keep getting thoracic manipulations even though they weren't helping my spine or lung function.

>But benefit is there for adjustments.

I don't see how you can say this. NEJM's trial showed that there was no significant benefit over sham. So you may as well sell them a vibrator and sham their treatment rather than waste the office visits.

>Also, just as a matter of example - with your continued pain at the level of the thoracic region, you demonstrate some form of clinical evidence for subluxation. The fact that the pain is still there supports the straight contention that they are not trying to affect your back pain, just your health. The question is; how is the asthma? My contention is; you must have had some benefit, as you applied to chiropractic school.

I said former asthmatic. I figured out how to cure the biomechanical problem and the spinal and lung symptoms resolved. The cure did not involve passive manipulation. Chiropractic doesn't fix the problem, it only covers up the symptoms for a little while. Abotnick 20:57, 4 June 2006 (UTC)

Miller and Miller

I've copied this here for reference of editors from Anecdotal evidence:

Miller and Miller (2005) list five standards of proof, by level of evidence ^[1]:

Kind	Level of Evidence	Standard
Regulatory, Legal		Precautionary Principle
Legal - Civil	*	More likely than not
Legal - Civil	**	Clear and convincing
Legal - Criminal	***	Beyond a reasonable doubt
Scientific	****	Irrefutable

Citing situations involving adverse drug reactions, Miller and Miller outline three events related to administration of the drug which can prove specific causation:

• challenge: the reaction occurs after the drug is given
• de-challenge: it resolves when the drug is discontinued
• re-challenge: the adverse event recurs when the drug is given a second time. (Cook County 2005)

Altman and Bland argue that the case report or statistical outlier cannot be dismissed as having no weight: "With rare and uncommonly occurring diseases, a nonsignificant finding in a randomized trial does not necessarily mean that there is no causal association between the agent in question and the disease." ^[2]

Miller and Miller conclude: "Most medical evidence does not meet the scientific standard of proof; and, as in law, it should be judged by a standard of proof appropriate to the fact or point in question. An 'anecdotal' case report can provide evidence of probative value, just like eyewitness testimony in a murder trial. And it can be similarly tested, by second opinions, re-examination, laboratory tests, and follow-up."^[1]

Give me something that is irrefutable. I don't think such a thing truly exists. Therefore, Miller and Miller's denotation is not helpful at all with our work on any scientific subjects. There are no absolutes except that there are no absolutes. Levine2112 02:57, 6 June 2006 (UTC)

Responses

First off, Thanks to everyone, and straight away let me say that I don't consider anything written above as remotely a personal attack on me; I take it all as honest and interesting critiques of a position. On the lead, as I said any follow up statement will need care and agreement and I don't want to get into that now because I'm not ready, and the resolution of a statement so clearly controversial would have to be on the basis of accepted V RS. I think I have found some V RS, but others might disagree. Either way I'd like to take the heat out of this by setting it aside for later. Broadly I know the science section needs a rewrite, so let any further addition to the lead await the outcme of consensus on that. "the evidence is inconclusive" etc. Well this is the V RS statement from Cochrane etc so on WP rules, I don't see any alterntive; it's not our job to interpret but to report in cases like this. Am I saying this because it's my POV? Well if it is it's an acquired POV through what I've read while being interested in this, and I guess none of us can escape our POVs though we all try to exclude them from the article. My POV is SPOV. I'm happy to declare my personal conclusions, just so everyone is aware of my POV and can help me to exclude it if it intrudes despite my best efforts.

I have been particularly impressed by the House of Lords select committee report. To clarify its status, because mostly you won't know anything about this select committee. The Lords is the upper house of Parliament- but very different to the Senate. The Lords are unelected, and largely apolitical. It had very many members, but miost active members are honorary, life appointments, for exceptional contributions in their fields of activity. They are unpaid, mostly retired, and the scientists there are very distinguished, and those that I've known I have very great respect for. The Lords has been notably awkward, comprising independent minded people with talent but little to lose or gain personally, who take pride in their consciences. The Select Committee report is certainly not a "political" document; the phrasing is reasonable and polite, but the underlying message is nonetheless clear, to the point, and frankly critical where this seems to be merited. Chiropractic comes off relatively well, but the grounds for that are clearly explained - in the UK it has strong independent regulation of training and practice, works well with conventional medicine in some areas, has gained respect and understanding in many quarters, takes the imporance of evidence based research into its effectiveness seriously etc etc. Some other alternative approaches come off very badly indeed. The interesting part of the report to me does seem to apply to chiropractic as I've come to appreciate it and understand it. To summarise briefly the conclusions that I've reached, influenced by the conclusions of this committee as I understand them. 1) The committee accepted that there was strong evidence that chiropractic was beneficial for some patients with some conditions. 2) Why chiropractic treatment is beneficial is far from clear. 3) The scientific basis is (arguably) plausible, but lacks validation 4) Placebo controlled trials are inappropriate because the intervention is a physical intervention 5) There is strong evidence of patient reported benefits 6) Chiropractors tend to spend much longer with their patients than conventional practioners, are more sympathetic, explain things in a way that are more clearly understood by the patient - build up a stronger climate of trust 7) Such a climate of trust, and the physical nature of the intervention are both likely to both predispose the patient to favourable reporting of outcomes - but also are likely to aid healing in themselves - the placebo effect is a real effect and a strong effect 8) Thus there is a possibility, perhaps a strong possibility, that the benefits of chiropractic have at least as much to do with this climate of trust and confidence as with the specific manipulation 9) Accordingly it is at present undecideable whther chiropractic is beneficial because of the specific nature of interventions 10) Thus it is important to extend efforts to investigate the scientific basis of interventions. 11) The scientific basis is plausible, in that spinal nerves do affect virtually all internal organs and can influence their regenerative activity and their physiological function. However what is lacking is objective diagnosis of appropriate conditions for intervention, and objective defined outcomes for specific conditions and interventions, and independent validation of the propsed mechanisms. 12) However, it is likely that some conditions might be caused by dysfunction of the spinal nerves, and that others might be ameliorated by altering nerve activity - if we knew how to diagnose these particular cases and who to intervene rationally. 13) As patients come to chiropractic often after other treatments have failed, it is possible that this subset comprises patients for whom conventional diagnosis has failed - i.e. known possible explanations of their conditions have been excluded already. This subset might well be enriched in examples where the aetiology is indeed nerve malfunction. 14) So it is open. Maybe those patients who go to chiropractic do include a proportion who will benefit specifically from spinal manipulation above and beyond any placebo effect.

I have read a fair amount beyond this report. In fact I've read every review in PubMed retrieved as (review chiropractic trial) since 2003, though mostly I wish I hadn't. Anyway all above is my acquired POV, though I think I could justify it mostly through V RS. I know it seems like I'm "taking the chiropractors side" here. I don't see it that way, I call things as I see them, and in many respects it's because of the grounds we're choosing to fight on. It is an unconfortable fact, or so my medical friends advise me, that for very many conditions, patients who come to conventional medicine, have objectively demonstrable illness for which no diagnosis can be validated - indeed for many conditions, typically about a third of patients have no clear diagnosis. i.e. there is no objectively determined cause for their symptoms, and they do not respond to treatment. Effectiveness of treatments depends on selection of patient group. The patients that come to chropractic are often patients for whom other treatments have already been tried and have failed. How therefore can we even compare treatments for this preselected subgroup? If we therefore judge chiropractic solely on evidence of efficacy, given the circumstances as we know them, it is difficult to be less than at leaast open about its value, and I think it is honest to accept its efficacy in some cases for whatever reasons. However, had we chosen different grounds to argue the case, my stance would have been very different. My personal POV is that for conventional treatments, trials are also generally pretty inconclusive annd often weak and unconvincing. I put a much greater value on scientific validation - demonstration of the mechanism of action as a way of objectively validating interventions. On these grounds you would find me a strong sceptic of chiropractic because of lack of evidence. In this respect, I might support statements stating that "there is no evidence for the claims" - where we are specifically talking about the claimed explanations. For efficacy however, there is plenty of evidence, often indistinguishable from the evidence that is considered as acceptable for conventional treatments. Compare as an extreme example, the evidence for ECT (which is another controversial article I've been looking at in part to find some path through our troubles here). So are scientists struggling in their povish way to say that chiropractic is crap? Well when we think we can show that something is crap, we do say it. In fact, in my own field I have a particular reputation for saying such things, I hope politely, but quite directly, I suspect my colleagues generally would smile wryly at the notion that I'm a paragon of tact. We cannot infer opinions, and if we try maybe we'll be right but maybe we'll be wrong. Here we can only go by what people say - this is the discipline of V RS; we have to accept that people say what they mean and mean what they say, and that's all we can do. I'm sorry this is long. I'll leave this up briefly and then remove it to my Chirpractic Talk page so it doesn't disturb the thread here. This is all an account of POV mine particularly, and is of no consequence to the article.  :) (Feel free to be as abusive of my opinions as you like, I won't take that personally, and I might even change my mind - we all have the right to do that). Gleng 11:15, 4 June 2006 (UTC)

Thanks Gleng, well stated. I look forward to your future assessments. --Dematt 14:32, 4 June 2006 (UTC)

Well put, Gleng. Levine2112 17:46, 4 June 2006 (UTC)

That was well put, thanks Gleng. I've wondered how some of the "detractors" here can have such strong opinions without any experience, either in healthcare or science.--Hughgr 02:28, 5 June 2006 (UTC)

Menstrual cycles, asthma, etc

Of course, there is inconclusive evidence for this, but these are very very minor (as in an astute chiropractor won't even think of treating these unless he/she is a quack). If these are present in the intro, then there are a hundred other conditions that might as well be there. There could be more of an elaborate discussion on this in the article, though. Anyone agree? Discuss, or provide a quick link to previous discussions as there is too much of archive to sift through. Drdr1989 00:53, 5 June 2006 (UTC)

then there are a hundred other conditions That's why I don't like having a list. It's been my experience that sometimes, sometimes rarely, sometimes never, sometimes in one patient but not the next, these and various other medical conditions will improve. It's extremely rare to have someone come into my clinic and ask to have one of those conditions treated. What I've found is that generally a patient will enter my clinic for another reason(usually spine related pain)and after getting chiropractic care will notice improvement in another area. I'm not naive enough to say to a patient that I can help every condition under the sun, but the fact is I have seen improvements in a wide variety of medical conditions, as well as improvements in general health. I can not merely ignore that just because "science" doesn't find it to be a statistically valid treatment. An interesting case I had was an 18 year old R.O.T.C. high school student whos coach asked him what he was doing different on Thursday's practice because his scores were consistantly higher on that day. The only thing he could think of that was different was getting an adjustment. That was enought for the coach to tell him to get an adjustment before his matches. Perhaps that's why there are a good number of athletes getting regular chiropractic care these days. Just a thought.--Hughgr 02:28, 5 June 2006 (UTC)

That's a good thought! And yes it is definitely okay to correct some of these other conditions incidentally. It's just that putting "menstrual cramps", "asthma" and stuff in the intro are no different than hundreds of other inconclusive, incidental conditions, and adding these few will give readers a false illusion that these conditions are common ones that chiropractors treat, which is obviously untrue unless, once again, they're a quack. The ones that are in the intro right now are common ones whereby efficacy is inconclusive. Further studies need to be done incorporating chiropractic with functional restoration, for example. Drdr1989 07:29, 5 June 2006 (UTC)

Drdr1989, thanks for joining us again! Start here and you should be able to catch up with this last conversation concerning this lead. Hughgr, I don't disagree with you, but remember, this sentence is the only sentence we have been able to reach consensus on in the last several months, because;

1. Apparently there are those out there who continue to treat these conditions,
2. There are those out there that continue to think chiropractors are quacks,
3. This list of conditions are the only conditions that can be referenced in the cochrane and bandolier databases,
4. And inconclusive evidence is better than disputed evidence or insufficient evidence.

In other words, this sentence is a compromise statement that is as close as we can get to consensus. If your sentence flies, it would be great, otherwise it appears that we have to accept a sentence that none of us totally agree with if we don't want to perpetually resort to revert wars. --Dematt 12:44, 5 June 2006 (UTC)

Dematt, I realize that cochrane and bandolier have these conditions listed. What I'm hoping to accomplish is to keep the lead simple and to the point. The c and b conditions could be listed in the science section and the lead should be generalizing, IMO. Because there are some chiropractors that treat specific conditions, IMO combining chiro with some other therapy (massage, nutrition, etc.) is irrelevent to the lead. I am beginning to wonder if a consensus can ever be reached on the lead. P.S.-another interesting case I've had involved a 23 yr old nurse who entered my clinic after a auto accid.. In her history, she mentioned she'd been getting (3-4 per year) nasty kidney infections since a ATV accident (~4yrs prior) that required major medical intervention. During her course of care at my clinic, she had another infection, but she told me it wasn't as bad as the previous ones and required no med. tx. Following that one, she didn't get any more.(2yr follow up) One of the areas that I adjusted was T12, which coincidentally has nerves that supply the kidneys. After that case, do I think that chiro care is a tx for kidney infections? No, not for the majority, but it was in that case.--Hughgr 19:07, 5 June 2006 (UTC)

Do we feel that the lead and/or the rest of the article should mention the "preventative" aspects of chiropractic? After all, chiropractic is often considered a "preventative medicine". Keeping the nervous system functioning properly will keep your immune system (for instance) functioning more efficiently, thus help prevent infection. I'm sure that while there is evidence out there to support this, it is - like the other claims - inconclusive. However, that chiropractic is also commonly thought of as a preventative medicine is a fact. Levine2112 22:36, 5 June 2006 (UTC)

Levine, I agree, and I think it should have it's own heading in the article. I feel there are various ways it can be looked at: 1. Mechanical 2. Philosophical. For example, on a purely mechanical note, the intervertebral disk between the spinal bones are avascular and get their nutrients via simple diffusion. Motion helps the process. Lack of proper motion would then hinder, thus an early breakdown or degeneration will happen. By keeping things in their proper juxtapostion, they will move and function as designed, there by preventing premature breakdown. Or, on a philosophical note, the idea that the any amount of nerve interferrence would be bad, so if a vertebral subluxation can be detected, regardless of symptoms or lack of symptoms(ie. lack of symptoms does not equal health) it should be addressed. The body will function more towards it's optimum potential, unique to the individual.

As an interesting sidenote, take a stroll through WP at the health and life articles and talk pages. They are as contentious as this one. At one point, I came to a web site that declared that there is a crisis in science on defining life, as the usual 5 signs can be used for other innanimate things. Interesting journey, none the less. --Hughgr 23:43, 5 June 2006 (UTC)

Discussion page

I just want to say that I think things are going really well here. I know it's tough to find common ground at times, but I think we are doing better than ever. Levine2112 02:38, 6 June 2006 (UTC)

Levine2112, I've reverted your revert and would prefer to discuss it rather than play this silly game. The error in your explanation is twofold. First, and most fundamentally, relativsm - which I wrote to Gareth about above. It's simply wrong to say there are no "absolutes" in medicine. There are plenty and as science progresses there are plenty more. And they are defined as 99.9% certainty or better. Second, you then indicate that you expect the same standards to apply to conventional medical fields. Levine2112, they do. If you can find any other medical article in wikipedia in which the lead should say there is no scientific proof then you should feel free to go and edit that article accordingly. What we are talking about here is chiro. The statement Despite lack of scientific proof, 75% to 90% of chiropractors believe that adjusting subluxations will eliminate obstructions to healing is eminently defendable on logical grounds as you should know.

Levine2112, in order to remove the statement from the lead you will have to provide scientific proof (comparable to the proof that Heliobacter pylori causes stomach ulcer and can be cured, and I can list dozens of others that are regarded as "absolute") that adjusting vertabral subluxations eliminates obstructions to healing. Please provide the proof before you revert.

Gareth, did you forget to say what it was you taught, I would you rather not say? Mccready 11:42, 6 June 2006 (UTC)

I put it in above (amongst annotations to your comment), but happy to repeat: I teach physiology, neuroscience, to medical students and science students. My research is neuroscience, and the theories are theories about how neural networks work - what they do and how they do it. Look me up on PubMed or on Google Gleng 16:40, 6 June 2006 (UTC)

Thank you for realizing that revert wars are a silly game. Your explanation above certainly helps us to see your POV. We would all appreciate it if you provided us with your thoughts before making a reversion in the future... especially on something a contentious as the intro paragraph.

Dematt added the word 'conclusive' to yout statement. While that makes it better, it still doesn't say that there is a lot of scientific evidence supporting chiropractic. 'Conclusive' kind of hints at the existence of the evidence, but not strongly enough (considering the ammount of evidence there is). Do you see the difference? Saying that there is 'no scientific proof' is an excessively harsh description of chiropractic. Is it true? Sure, it is true... in the same way that you could say 'grey' is not 'black', but you don't get a very accurate idea of what constitutes 'grey'. In the same way 'grey' is not 'black' until it gets 100% dark enough to be absolutely called 'black', given your method, no science can say that it has proof untill it reached 99.9% verifiability. But then how do we tell the difference between a science that has 2% verifiability and one that has 98%? I think what we were getting at before your reversion was a more accurate depiction of where chiropractic is in terms of scienitific verifiability. We accounted for the plethora of supportive research and evidence, yet still maintained that the jury was still out on chiropractic's effectiveness. Isn't that a more specific truth than 'there is no scientific proof? Levine2112 17:30, 6 June 2006 (UTC)

Mccready, you said, "comparable to the proof that Heliobacter pylori causes stomach ulcer and can be cured". I have a question for you, if H.pylori causes stomach ulcers, how do you explain a person with H.pylori and no ulcer? Or a person with an ulcer and no H.pylori? Both are very real cases, FYI. --Hughgr 17:57, 6 June 2006 (UTC)

I think there is good evidence that H pylori is a major contributory cause of stomach ulcers (not all, but many, maybe most). The evidence is correlative/circumstantial in that there is a strong correlation between condition and purported cause (not perfect but strong), and antibiotics are generally an efficient treatment when they are effective against H pylori and not when they are not. As far as I know though the causal mechanism is not known, though I might well be wrong here. It illustrates several things 1) although this disease has a single major cause it is not the only cause; many symptoms can have many different causes. 2) The cause is not fully penetrant, the cause may be present without symptoms. 3) the evidence is still mainly circumstantial, though in this case strong and convincing. The conservative statement is that there is strong evidence that in many cases, H pylori is a cause of stomach ulcers. It remains very possible that it is not a direct cause, but for instance that infection creates the environment that another causative agent can exploit, in which case we would conclude that infection predisposes rather than causes. It's generally pretty dangerous to be dogmatic, and actually the example you give is one of the best that I know - when first proposed, the theory that ulcers were caused by infection was frankly dismissed as unscientific and absurd. It's now accepted. It behoves us all to be humble sometimes and cautious alwaysGleng 19:58, 6 June 2006 (UTC)

Does any of what you said leave an opening for the contention that decreased nerve supply to the stomach lining can be a causative agent that allows the H pylori to exploit the stomach? And therefore a normal nerve supply does not allow H pylori to exploit it, thus we would find H pyloris without symptoms of infection. Or is this a logical fallacy? --Dematt 20:54, 6 June 2006 (UTC)

Certainly not a fallacy. The causes of diseases are usually multifactorial. Actually your suggestion sounds an interesting one. There may be reasons to dismiss it but I don't know enough to do so. It's the sort of suggestion that you really need an animal model for to test. The stomach has a very extensive and complex innervation that is relatively poorly understood, and is now known to be an active endocrine organ, releasing several hormones (ghrelin amongst them) that act back on the brain, but which also have local actions that are poorly defined. How this secretion is regulated is also poorly understood but there are reasonable grounds for thinking that there is at least neural modulation. Many nerves secrete peptides and growth factors that influence cell growth and function. The stomach is a pretty complex organ. Ghrelin was discovered only in 2000; the idea that we understand it well is, well, optimistic.. Gleng 21:10, 6 June 2006 (UTC)

Okay. I wish I could take credit for the suggestion, but the credit actually goes to DD. That is what chiropactors have been trying to get real scientists to study for the first step. The next step would be to determine if affecting the spine can affect the nerve. That current chiropractic direction remains focused on feedback loops along the recurrent spinal nerve somewhere within the facet capsules that synapse within the spinal cord (possibly lamina two or five), affecting the autonomic response for the spinal nerve and perhaps interneurons travelling up into the reticular formation... In other words, how far are we from knowing the answer to some of these questions? --Dematt 21:24, 6 June 2006 (UTC)

Thanks Gleng and Dematt, I was trying to illustrate for Mc that rarely are things of the health/disease realm black and white. Never say never or always. :) I was watching a Discovery channel show on increased rates of tuberculosis in an overcrowded N.Y. prison. They stated that 3/4 of the U.S. pop. has T.B. in their lungs. So the next logical question should be, "why don't we have an epidemic?". I believe the answer is germs are present all the time, only when the bodies resistance is lowered can they reek havoc. So the next question would be, what is resistance? The body working at a high level of performance? Would nerve interferrence lower the bodies performance? These are questions I would like to see science address.--Hughgr 23:03, 6 June 2006 (UTC)

Bottomline, is lack of conclusive scientific proof... the most accurate way to depict chiropractic? Or were we better off before Mc's undiscussed changes to the intro? Or, is there another way to word this that we haven't thought of yet? Levine2112 00:42, 7 June 2006 (UTC)

I agree the lead really doesn't answer much for the reader. Chiropractic is a science, an art, and a philosophy. While chiropractic is concerned with the proper alignment of the spine and function of the nervous system, chiropractors are legally licensed to treat any health condition that is allowed by the scope of law defined by their state and taught in chiropractic college. There are also chiropractors who may also be licensed to practice acupuncture, naturopathy, and other CAMs. While some chiropractors may choose to concentrate their treatment to the spine, others continue their education into chiropractic orthopedics(DABCO), chiropractic radiology(DACBR), nutrition(DACBN), sports injury(CCSP),internist, neurology, pediatrics, and at least a dozen others. The bottom line is that there are chiropractors treating everything out there. Some don't even use spinal manipulation. Most are doing a good job, at least their patients seem to think so. Insurance companies are certainly putting the squeeze on, but everyone else is feeling it, too.

I haven't heard of one chiropractor who has claimed treating an infection or cancer without also being treated by a their medical doctor, especially since that would be out of scope for most states and they would risk their license and malpractice. That is not to say that most chiropractors will not concomitantly treat patients who have infections or some cancers. Chiropractors do not use drugs or surgery, though there is a small movement that would like to see the use a of class medications for pain. There sure is a lot of anecdotal support and low to midlevel research out there and they need some RCT's and CCT's to see what's working and what's not.

I'm not sure that the reader would get that from reading our article, much less the lead, but lets work our way there.--Dematt 02:58, 7 June 2006 (UTC)

So do we want to work forward (i.e. get the lead in as good as shape as possible and tailor the rest of the article to that) or work backward (i.e. work on the article then tailor the lead to that)? At the very least, let's revert the intro paragraph back to where it was. It was certainly more agreed upon by our usual editors here than what is there now. Levine2112 03:21, 7 June 2006 (UTC)

It appears that Mccready really wants the no science words regardless of discussion. However, it doesn't fit with the list of conditions and therefore makes it sound as though none of chiropractic has a scientific base. So the two concepts need to be seperated. --Dematt 14:46, 7 June 2006 (UTC)

How do you think the two concepts should be seperated? Not sure what you mean. I agree that the lead had become jumbled and doesn't do as good of a job of describing chiropractic as it could.--Hughgr 19:02, 7 June 2006 (UTC)

O.K., I've made some edits to the current lead to (hopefully) clarify and would like your input.

Chiropractic is a complementary and alternative health care profession which aims to diagnose, treat, and prevent mechanical disorders of the spinal column and their effects on the nervous system and general health. Chiropractors believe misalignments, or subluxations of the spine interfere with the body's self-regulating mechanisms, primarily the nervous system. Despite a lack of decisive scientific evidence, most chiropractors believe that adjusting subluxations will eliminate an obstruction to healing and may help many disorders such as low back pain, asthma, carpal tunnel syndrome, painful menstrual periods, migraine and menopausal symptoms. Chiropractic care emphasizes manual treatments to the spinal aimed to reduce or correct spinal misalignments and manipulation of the extremities. A chiropractor may specialize in treating low back problems or sports injuries, or may combine chiropractic with physiotherapy, nutrition, or exercises to increase spinal stength.

Some of the changes were subtle, but I hoped they would better distinguish what the "average" chiropractor does. --Hughgr 20:14, 7 June 2006 (UTC)

I like that. Or switch a couple sentences around with a little cleanup and add some skeptical stuff and then defense?

Chiropractic is a complementary and alternative health care profession which aims to diagnose, treat, and prevent mechanical disorders of the spinal column and their effects on the nervous system and general health. Chiropractors believe misalignments, or subluxations of the spine interfere with the body's self-regulating mechanisms, primarily the nervous system. Chiropractic care emphasizes manual treatments to the spine to reduce or correct these misalignments. A chiropractor may specialize in treating low back problems or sports injuries, or may combine chiropractic with manipulation of the extremities, physiotherapy, nutrition, or exercises to increase spinal stength or improve overall health. There is no scientific proof for many of the claims that chiropractors make, but proponents suggest that, until more thorough scientific evaluation is made, anecdotal evidence of improvement is proof enough.

Any thoughts. Did I go too far? Mccready, your thoughts?--Dematt 21:37, 7 June 2006 (UTC)

The last sentence seems to be the toughest, eh :)--Hughgr 02:21, 8 June 2006 (UTC)

Not sure if I like "no scientific proof". This is rough. That last sentence is tough. We want to say a true statement about chiropractic in the eye of science, but as this is a much debated grey area, it will be hard to describe. I am going to try listing what we know for sure here and maybe it will help:

• There is scientific research supporting chiropractic's efficacy
• There is also scientific research that can't determine chiropractic's efficacy
• There is not enough scientific research in support of chiropractic's efficacy to satisfy a some amount of scientists and scholars
• The AMA had surpressed chiropractic's scientific research for years and actively appealed the court to be able to do so as recently as 1990
• There is a lack of high quality scientific research on chiropractic's efficacy
• There is a lot of anecdotal evidence supporting chiropractic's efficacy

• Anecdotal evidence is not the strongest form a scientific evidence

• There are a lot of case studies supporting chiropractic's efficacy

• Case studies are not the strongest form of scientific evidence

• The existence of the nervous system as the primary control mechanism of the body is an undisputed scientific fact
• Research show that chiropractic patients are more often satisfied with their treatment than not
• Scientific research, and records from insurance and court cases have consistantly shown that chiropractic is one of the safest portal of entry health care available to the public today

I hope this helps us formulate where chiropractic stands in the scientific community today. Levine2112 18:28, 8 June 2006 (UTC)

Chiropractic is a complementary and alternative health care profession which aims to diagnose, treat, and prevent mechanical disorders of the spinal column and their effects on the nervous system and general health. Chiropractors believe misalignments, or subluxations of the spine interfere with the body's self-regulating mechanisms, primarily the nervous system. Chiropractic care emphasizes manual treatments to the spine and uses spinal adjustments to reduce or correct these misalignments. A chiropractor may specialize in treating low back problems or sports injuries, or may combine chiropractic with manipulation of the extremities, physiotherapy, nutrition, or exercises to increase spinal strength or improve overall health. He/she may also use other complementary and alternative methods as a part of a holistic treatment approach. They do not prescribe drugs or perform surgery.

While there is evidence that spinal manipulation may be effective for low back pain, there is no scientific proof for many of the other claims that chiropractors make concerning the benefits to health. However, proponents suggest that, until more thorough scientific evaluation is made, anecdotal evidence of improvement is proof enough.

More comments?--Dematt 21:58, 8 June 2006 (UTC)

I don't like this sentence still: While there is evidence that spinal manipulation may be effective for low back pain, there is no scientific proof for many of the other claims that chiropractors make concerning the benefits to health. My feeling (and thus this may be just my POV) is that there is evidence for many of the other claims. The way this is worded now, it makes it seem like there isn't any evidence for the other claims. Okay, I know it is easier to critique than to actually write something. I apologize. But I think it is getting better and closer to the truest depiction of where chiropractic stands in the eye of science. Levine2112 00:23, 9 June 2006 (UTC)

O.K., the last sentence(s) are a killer. I agree with levine, there are conflicting studies for some conditions and anecdotal evidence for others(all?) What about, While there is evidence that spinal manipulation may be effective for low back pain and headaches, currently the evidence for many of the other claims that chiropractors make concerning the benefits to health are primarily anecdotal. I'm not sure if that should be expaned on or left where it stands? Let's continue to work it out....--Hughgr 00:42, 9 June 2006 (UTC)

I think that is really good. Grammar-wise, I would change "are primarily" to "is primarily" as I believe its object is "the evidence". And maybe we should qualify the "evidence" for low back pain and headaches... to make it more distinguished from the anecdotal evidence (i.e. "clinical evidence" or something better). Levine2112 00:48, 9 June 2006 (UTC)

Cochrane and Bandolier

These are the studies that we have referenced in this chiropractic article. I put them here for easy reference. I think there are many better studies both pro and con out there. We need to find them.

• asthma,Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma

• carpal tunnel syndrome, Oral steroids, splinting, ultrasound, yoga and wrist mobilisation provide short-term relief from carpal tunnel syndrome, but other non-surgical methods have not been shown to help. ..Trials of magnet therapy, laser acupuncture, exercise or chiropractic care did not demonstrate symptom benefit when compared to placebo or control.

• painful menstrual periodsNot enough evidence to show the effects of spinal manipulation for painful period cramps

• migraine,There is limited evidence that spinal manipulative therapy may reduce the frequency and intensity of migraine attacks, but the evidence that spinal manipulation is better than amitriptyline, or adds to the effects of amitriptyline, is insubstantial.

• chronic low back painClinical bottom line: Based on a small, poor quality set of trials, there is no convincing evidence for long-term benefits of chiropractic interventions for acute or chronic low back pain. There may be some short-term pain relief, especially in patients with acute pain. Better quality evidence is required before the question of efficacy can be answered adequately.

• menopausal symptoms For all but one remedy there was no convincing evidence, or no evidence at all. Those for which there was no evidence in the form of randomised placebo-controlled studies included any herbal remedy, homeopathy, chiropractic, massage, exercise, acupuncture or relaxation techniques. Food supplements like vitamin E and evening primrose oil were found to have no benefit over placebo.

• http://www.journals.elsevierhealth.com/periodicals/ymmt/article/PIIS0161475499700035/abstract 1999 Wiberg RCT infantile colic] Spinal manipulation is effective in relieving infantile colic. (J Manipulative Physiol Ther 1999;22:517–22)

• and Norwegian RCT on Infantile colicChiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic.

--Dematt 15:36, 6 June 2006 (UTC)

• Hearing loss Suggests chiropractic care may benefit hearing loss and that chiropractic adjustments to various areas of the spinal column and locomotor system may have an effect on central auditory processing, though alternative explanations can not be disregarded.

• Somatic, visceral and immune complaints Analysis of 650 children reveals a pattern of pelvic dysfunction correlated with numerous somatic, visceral and immune complaints.

• Allergy and Crohn's Disease Vertebral subluxation in the thoracic and lumbar regions had a significant effect on the immune function of these allergy and Crohn's disease patients.

• Blood pressure Both systolic and diastolic blood pressures significantly lowered following chiropractic treatment.

• Cervicogenic headache and associated neck pain Preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache. The sustained therapeutic benefit associated with spinal manipulation seemed to result in a decreased need for over-the-counter medication.

• Headache Spinal manipulation seemed to be as effective as a well-established and efficacious treatment (amitriptyline), and on the basis of a benign side effects profile, it should be considered a treatment option for patients with frequent migraine headaches.

• Headache Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches.

• Indigestion and heartburn Relief of indigestion by manipulation is more common among those who report mid-back pain.

• Asthma Patients afflicted with asthma may benefit from spinal manipulation in terms of symptoms, immunological capacity, and endocrine effects.

• Asthma Upon stabilizing the upper cervical spine, objective improvement in all 47 asthmatic cases was 87-100 percent.

• Vertigo Improvement of cervicogenic vertigonous symptoms by chiropractic treatment.

• Athletic performance Significant athletic performance improvement following upper cervical chiropractic care.

• Ear infections Although there were several limitations to this study, it indicates that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children.

• Whiplash Chiropractic "Only proven effective treatment" for Chronic Whiplash.

• Bed-wetting Results of the present study strongly suggest the effectiveness of chiropractic treatment for primary nocturnal enuresis.

Levine2112 18:31, 6 June 2006 (UTC)

Para

Sorry to break the thread here, and sorry my contributions are so intermittent at present. On the suggestion above While there is evidence that spinal manipulation may be effective for low back pain and headaches, currently the evidence for many of the other claims that chiropractors make concerning the benefits to health are primarily anecdotal.

Anecdotal is somehow such an imprecise term. Pedantically I'd change may to can, and be more precise, thus:

While there is evidence that spinal manipulation can be effective for low back pain and headaches, currently many of the other claims that chiropractors make concerning the benefits to health are based mainly on subjective reports of clinical experience, and objective evidence from controlled trials is lacking.

I think this declares the inadequacy of evidence without implying either support for, or denigration of, the claims, and explains properly that chiropractic's belief in the claims has a rational foundation even if they are not objectively supportable.Gleng 08:31, 9 June 2006 (UTC)

So more like this;

Chiropractic is a complementary and alternative health care profession which aims to diagnose, treat, and prevent mechanical disorders of the spinal column and their effects on the nervous system and general health. Chiropractors believe misalignments, or subluxations of the spine interfere with the body's self-regulating mechanisms, primarily the nervous system. Chiropractic care emphasizes manual treatments to the spine and uses spinal adjustments to reduce or correct these misalignments. A chiropractor may specialize in treating low back problems or sports injuries, or may combine chiropractic with manipulation of the extremities, physiotherapy, nutrition, or exercises to increase spinal strength or improve overall health. He/she may also use other complementary and alternative methods as a part of a holistic treatment approach. They do not prescribe drugs or perform surgery.

While there is evidence that spinal manipulation can be effective for low back pain and headaches, currently many of the other claims that chiropractors make concerning the benefits to health are based mainly on subjective reports of clinical experience, and objective evidence from controlled trials is lacking.

--Dematt 12:45, 9 June 2006 (UTC)

Seems neutral to me. — Arthur Rubin | (talk) 13:53, 9 June 2006 (UTC)

Arthur, thanks for following along and giving us your input. That means a lot. --Dematt 14:57, 9 June 2006 (UTC)

One minor change: While there is evidence that spinal manipulation can be effective for low back pain and headaches, currently many of the other claims that chiropractors make concerning the benefits to health are based mainly on subjective reports of clinical experience and limited objective evidence from controlled trials. Thoughts? Levine2112 16:31, 9 June 2006 (UTC)

That strikes me as being very close. How about changing "limited" to "controversial"? Jefffire 16:35, 9 June 2006 (UTC)

I wouldn't say the evidence is controversial; however, I would say the results of the researh is disputed. My point with adding limited was not to suggest that there is a debate over it; only that there isn't a whole lot of controlled trials with conclusive evidence. Does this make sense? Or am I rambling? It happens. Sorry. Levine2112 17:12, 9 June 2006 (UTC)

"While there is evidence that spinal manipulation can be effective for low back pain and headaches, some of the other claims that chiropractors may make concerning the benefits to other conditions or health are based mainly on subjective reports of clinical experience, and objective evidence from controlled trials is lacking." I've bolded some wording changes I've felt were better. We're slowly getting there....:)--Hughgr 19:11, 9 June 2006 (UTC)

This last bit... and objective evidence from controlled trials is lacking' ...seems tacked on and reads oddly to me. Otherwise, I like it. How about this?

"While there is evidence that spinal manipulation can be effective for low back pain and headaches, some of the other claims that chiropractors may make concerning the benefits to other conditions or health are based mainly on subjective reports of clinical experience and a limited amount of objective evidence from controlled trials." Levine2112 19:16, 9 June 2006 (UTC)

I like that Levine, let's see what everyone else thinks.--Hughgr 20:07, 9 June 2006 (UTC)

OK guys, just stop when you're winning without trying to push too far :), let's not set off a new round of introspective warring. Some do make the claims, not may make them, and maybe relatively lttle evidence is better than a limited amount. We all agree the evidence from trials is inconclusive.Gleng 20:23, 9 June 2006 (UTC)

Thanks Gleng :) As I read it, it seemed to be saying that all chiros make extravagant claims, which didn't seem fair so I added some qualifiers. How's this-

While there is evidence that spinal manipulation can be effective for low back pain and headaches, some of the other claims that chiropractors make concerning the benefits to health are based mainly on subjective reports from clinical experience, while objective evidence from controlled trials is lacking.

Any better?--Hughgr 20:36, 9 June 2006 (UTC)

Point taken; fine by meGleng 21:33, 9 June 2006 (UTC)

I think that is find. Gleng makes a good point. Do you want ot implement it, Hughgr? Levine2112 21:50, 9 June 2006 (UTC)

minor pedantry

I'm making some minor adjustments to the style - if anyone doesn't like them please revert. I'll explain though - I'm sensitive to some problems that readers can have when English is not their first language, and the conditional tense (would encounter) etc can often be avoided without loss of clarity or meaning. I know this can by a nice stylistic flourish, but it can get in the way of clarity too Gleng 11:01, 10 June 2006 (UTC)

Think you're heading for Good Article (GA) status and then Featured Article (FA). Note it is important to keep the article stable and studiously neutral - avoid edit warring and disputes cropping up, build in the strongest sources. Think you're doing a great job togetherGleng 11:13, 10 June 2006 (UTC)

OK, looking at this article coolly, I really think you've done a fantastic job so far, building an interesting and informative article which respects sources, factual accuracy and NPOV. Looking ahead though to make a good article great, I think you collectively will need to address the criticisms issue. Every significant opinion should be represented on WP, not endorsed but represented honestly; how to do this will be a challenge but overcoming this challenge will ensure stability of this article and its defence from all sides. In my view the best hope would be for the chiros here to take on the challenge of "writing for the enemy" in a short section on "Criticisms of chiropractic". The opinions there should be clearly stated as opinions (not facts) and attributed. It shouldn't argue necessarily with the opinions, but state them. It might begin "Historically, chiropractic attracted considerable criticism from ( ) for ( ). Amongst the criticisms that have been levelled over time relate to 1) The early religious nature, suggesting that treatment was based on recieved dogma rather than empirical experience 2) extensive use of advertising, which might have promoted claims that were not objectively supportable, and is a practice regarded as unethical by some in the medical profession 3) weaknesses in training 4) weaknesses in regulation, in that the profession might not always have been attentive in distinguishing between expert ethical practitioners and self-certified opportunists 5) the impression sometimes given that the profession is dismissive of concerns about safety rather than keen to investigate them thoroughly. Obviously these criticisms have been largely if not fully addressed by the profession over the years, and this can be mentioned. It is also true that there was a deep antagonism between the AMA and chiropractic which has led to suspicion from both sides of the other, and which is not wholly dissipated now. This is a tough one; if one of you can prepare a draft, writing for the enemy in this way, and keeping the historical thread that is serving this article so well, it might be a real breakthroughGleng 13:14, 10 June 2006 (UTC)

I think we can do that. With all the reading I've been doing for for the history, I've seen a lot that explains some of the controversy that I'm hearing even today. Hopefully, when the history is finished it will help and some of the answers will become self evident as well.--Dematt 13:53, 10 June 2006 (UTC)

This is so good. It's really coming together. Gleng, you make excellent points above about adding a criticism section. In light of what user Abotnick was trying to do by starting a Chiropractic Skepticism, I think having a Criticisms section in the main chiropractic article should really satisfy him. I look forward to his input there.

Do you think that once we have a Criticism section firmly established, that we should remove/prevent the criticism that may appear throughout the rest of the article? Levine2112 17:51, 10 June 2006 (UTC)

Thanks everyone for your help. I also agree that there should be a criticism section as that should satisfy the need for balance. I know I can think of some of the controversies, but I may have a hard time expressing them in a NPOV way. :) But if we work together, I'm sure it can be done in a respectful manner. Looking forward, Kudos! --Hughgr 18:32, 10 June 2006 (UTC)

Hughgr, I would love for you to take a look at the section now entitled: Scientific Investigation of Chiropractic. I think as of now it reads heavily biased against chiropractic rather than a fair assessment of Chiropractic Science. Levine2112 22:04, 10 June 2006 (UTC)

I was wondering what Abotnick was meaning by:

• Despite significant research efforts, chiropractic has so far failed to validate its treatment approach.

Huh? Could you exlain what you ment Abotnick.

• There are three problem areas:

a failure to show efficacy for the conditions treated

implausible mechanisms of action

and the use of invalid biomechanical assessments.

Other than the "use of invalid assesments(Harrison), could you give us a reference for the other points you made in the article. Thanks.--Hughgr 22:46, 12 June 2006 (UTC)

---

Levine feels this statement is not established, I think he's wrong.

>Chiropractors tend to disregard research and are heavily biased in favor of personal experience.

This is called investigator bias. Chiropractic neither meets the burden of proof for efficacy nor having a plausable mechanism of action. It's assessments aren't even validated. Therefore it is heavily biased in favor of personal experience. If you read chiropractic admissions bulletins they are filled with statements like "based on the anecdotal experience of doctors". Levine you couldn't be more wrong on this.Abotnick 22:16, 10 June 2006 (UTC)

I don't disregard research. No chiropractor that I know (and I know a lot) disregard research. I don't think any of the chiropractors at the Journal of Vertebral Subluxation Research site disregard research. How about at Wikipedia? Any chiropractors here disregard research? Please let us know now.

On a sidenote Abotnick, I do appreciate that you are using the discussion board. We would all appreciate it if you could discuss your ideas for changes here first.Levine2112 22:35, 10 June 2006 (UTC)

The standard of education in biomechanics in chiropractic is so poor that there is a total lack of exposure to legitimate science so I suspect that you don't even know that you are missing anything. It is intellectual isolation. For example, how about the comment by Harrison that the most commonly used chiropractic techniques have erroneous biomechanics?Abotnick 23:34, 10 June 2006 (UTC)

Before you change the subject, your original point was Chiropractors tend to disregard research and are heavily biased in favor of personal experience. Do you at least see now that this statement is untrue? Levine2112 00:05, 11 June 2006 (UTC)

No I don't and since when is JVSR a credible journal? It's not index medicus and is a publication from the puppet organization WCA. Abotnick 00:29, 11 June 2006 (UTC)

Okay, now we know your POV. Nevertheless, JVSR performs peer-reviewed research which chiropractors don't disregard; rendering your statement (which I deleted) incorrect. They also don't disregard any of the research here for starters. Levine2112 00:42, 11 June 2006 (UTC)

A collection of vested chiropractic quackery vendors such as Christopher Kent (Chiropractic Leadership Alliance selling Subluxation Station SEMG) and the rest of the WCA affiliated shills is hardly a credible peer review team in my eyes. WCA isn't even a real organization, their President, Terry Rhondberg, is self appointed. Further, they are still not index medicus. Cochrane et al only pertains to efficacy not the basic underlying biomechanical assumptions, especially with the claims made. If chiropractors were claiming to treat conditions and did real diagnosis like mixers do then perhaps. However with the straights skipping it and claiming efficacy with causal biomechanical deficits then you have to measure them directly and rely on testing of the validity of the diagnosistic procedures and biomechanical outcomes. You can't claim to cure biomechanical problems of the spine but ignore biomechanics Levine. This is exactly why chiropractic is spinning its wheels and can't cure these types of problems. Abotnick 10:38, 11 June 2006 (UTC)

WP is not a soapbox. We all have POV, but the article is not the place to promote our opinions whatever they are. We are trying to build an encyclopedia. WP is about verifiable facts - it is not even about truth, just about reporting facts from verifiable reputable sources. Whether they are verifiable is objectively determinable, whether the sources are reputable is harder but there are conventions that we have to try to apply objectively. It is a V RS fact that major chiropractic associations declare their commitment to the importance of evidence as a basis for the development of treatment practice, and this is a fact that can and should be stated. If you feel that many chiropractors do not take this seriously, you may or may not be right, but it is an opinion and has no place here except as an opinion, if it can be attributed as an opinion of an authoratative significant source. We must not exclude criticisms of chiropractic, and everyone here acknowledges the importance of this. But we must keep a responsible disciple as to exactly how we report criticisms. Our personal opinions DO NOT COUNT here; they really don't. This is a constraint and sometimes an irritation (to all of us) but it also frees us, to work together, if we accept the common purpose of building a great encyclopedia within WP rules and conventions. Please join, but if we don't share a sense of common purpose then we will expend energy pointlesslyGleng 13:26, 11 June 2006 (UTC)

>it is not even about truth, just about reporting facts from verifiable reputable sources.

If that is true then there is no point in having an article on chiropractic. There is enough misinformation out there from chiropractic sources as it is. It is very easy to state a false mission and then create loopholes and do the opposite. If a chiropractic association makes a statement which is then later contradicted by their actions it should not be taken seriously. Abotnick 17:08, 11 June 2006 (UTC)

This is WP policy, quoted directly below One of the keys to writing good encyclopedia articles is to understand that they should refer only to facts, assertions, theories, ideas, claims, opinions, and arguments that have already been published by reputable publishers. The goal of Wikipedia is to become a complete and reliable encyclopedia, so editors should cite reliable sources so that their edits may be verified by readers and other editors "Verifiability" in this context does not mean that editors are expected to verify whether, for example, the contents of a New York Times article are true. In fact, editors are strongly discouraged from conducting this kind of research, because original research may not be published in Wikipedia. Articles should contain only material that has been published by reliable sources, regardless of whether individual editors view that material as true or false. As counterintuitive as it may seem, the threshold for inclusion in Wikipedia is verifiability, not truth.Gleng 17:35, 11 June 2006 (UTC)

Thanks for the clarification Gleng. Actually I understand where it is coming from, however this emphasizes what I said earlier, that we have to carefully judge the reliability of sources and recognize when issues of conflicts of interest and poor quality are apparent. This is why we have to drop references like JVSR. Abotnick 23:01, 12 June 2006 (UTC)

Why do you think JVSR is not reliable? Levine2112 23:39, 12 June 2006 (UTC)

straight sentence

This sentence is in the intro and everytime I read it, I don't feel comfortable that we are sure about these numbers. Especially since in the practice style section we state that the straight group is the smallest group. What's with that?

• Straight chiropractors are the oldest movement, operating half of the accredited schools and graduating 75% of practicing chiropractors.

--Dematt 20:46, 12 June 2006 (UTC)

I feel the problem exists due to the differing catagories of "straights". There used to be only two types of chiropractors: straights, adhering to the Palmer method and philosophy; and those who 'mixed" chiropractic with anything else. As time went by, the straights seemed to have been seperated into traditional straights who followed the Palmer's philosophy, and most currently the "objective" straights, who define what they do by their objective, adjusting subluxations. The objective straights are the group who vehamently oppose any form of medical diagnosis. Maybe there needs to be a better description of the "groups" in chiropractic.--Hughgr 22:15, 12 June 2006 (UTC)

The name "objective" is definitely new to me. Maybe that is it. The number 75% is including all of Palmer schools and then only "objective" straights in the practice styles category. Abotnick put this sentence in. Where does Life fit in? I think this whole concept is very important in explaining where chiropractic has come from and where it is today. For example, you stated that Palmer is teaching PT and I assume other methods as well. That is certainly not straight in the original sense of the word. When did it change and is it now considered mixer? Or do they still call themselves straight while refering to the others as "objective" straights. When did that happen? I think anyone who reads the history learns that Palmer grads are straight chiros so they assume that all the information pertaining to straights pertains to Palmer students. Help me understand this. --22:42, 12 June 2006 (UTC)

Hi Dematt, here are a couple of quotes from the book, “Refined by Fire, an evolution of straight chiropractic” by Joseph Strauss 1994. pgs 234-244)

“In August 1976 while the ICA was voting to accept a seat on the CCE, a group of chiropractors were meeting in the Clayton House in Davenport, IA…they were forming a new chiropractic organization called the Federation of Straight Chiropractic Organizations (FSCO)."

"Traditional straight chiropractors still held to B.J.’s definition of chiropractic, “Chiropractic is a philosophy, science and art of things natural; a system of adjusting the segments of the spinal column by hand only, for the correction of the cause of dis-ease.”"

"The creation of the FSCO had repercussions within the chiro community. The mixers, of course, had mixed emotions. They saw it splitting the straight community. Most of the FSCO membership had been ICA members. This would further weaken the ICA. But, on the other hand, there was a new organization of straights lead by very radical, very articulate Reggie Gold, who would be a thorn in their side. The formation of this new organization had come when they had almost gotten the ICA to come to the CCE for acceptance. The ICA, however, saw only negative in the FSCO. It would surely affect their membership. What was worse, the FSCO would be a reminder to them of what they should be, what the ICA had been under B.J. Palmer, John Q. Thaxton, Leonard Rutherford and William Day."

"Traditional Straight vs. Objective Straight- There appears to be two problems that traditional straight chiropractors were not able to handle. Had they been able to handle these problems, traditional straight would have made an easy transition into objective chiropractic as those in the authority phase did into the traditional phase. No one would have noticed the change. Unfortunately, the leadership could not resolve them and result was a violent upheaval, one from which modern-day straight chiropractic, the objective phase, emerged. The traditional straights allowed their philosophy to be weakened as a result of association with those in the profession with a mixing objective. They also found it difficult to change the practice of chiropractic to fit into the modern health care delivery system without changing the philosophy."

"Traditional straight chiropractic made getting sick people well its objective. Objective straight chiropractic made the correction of vertebral subluxation its sole objective."

OK, I know that was long but I hope it gets the idea across. There's more if you need it. As far as Palmer teaching PT, it wasn't part of the core curriculum, but an elective. I took it because I needed it for my states license requirement. I'm not sure how to look at the debate between straight and mixers today. It seems like the FSCO has become the 'straightest' these days, but I can tell Life College was pretty close. I think the history will make these things more clearly understood. I'll get some more quotes for your history page shortly.--Hughgr 01:24, 13 June 2006 (UTC)

Thanks Hughgr, it definitely got the idea across. I am pretty sure that number of 75% reflects Palmer schools. Remember that Palmer WAS the creator of the ICA and they were voting to join CCE in 1976 (15 years after BJ died). That tells me that the minority(otherwise they would not be breaking off) were holding on to the old guard. Certainly Sid Williams from Life was one of them. That was 30 years ago. How many people are we talking about in the objective straights? I would consider that the majority practice very similar to mixers, but maybe a little less adjunctive procedures. I don't think we can assume that just because you graduate from a straight school you will practice objective straight or visa-versa --Dematt 02:20, 13 June 2006 (UTC)

Not sure about the numbers who are members and/or practice the objective straight way. And you are correct that you can not judge how a person practices by what school they graduated from. IMO, a lot of times graduates will practice according to what their state law allows. Interestingly, when I was at Palmer, Reggie Gold had been banned from speaking on the campus due to his criticism of Palmers direction. Then, towards the end of my college career:) I believe he'd been allowed back. That was when Reikeman was president, so I can only guess what their doing now. As far as current practice styles, wasn't there a survey done a few years ago in the US? I thought it was done by the NBCE or the FCLB? I remember getting the survey and filling it out and checking the box for getting a copy of the results, but never got them??? Do you know what happend to that?--Hughgr 17:46, 13 June 2006 (UTC)

After further reading, the objective straight group has an opposing view to the "mixer" group, not so much of a "I use therapy in addition to the adjustment" kind of mixing. As I understand it, early chiropractors went from the cure of all diseases, to curing some disease, to curing a cause of dis-ease. (a lack of EASE=lack of health). So the main difference then, as well as today, seems to be the focus of the objective straights on improving health (or the bodies performance) vs. treating a disease. They see getting an adjustment as being equal to exercising or eating healthly food, all will allow the body to work better. One of the problems that comes to mind is the definition of health is pretty ambiguous. It can have different meanings to different people, but I think the idea of improving health vs. treating a disease needs to be explained in the article. Another problem that Strauss mentions is the fact that chiropractors have positioned themselves as primary care providers, thus being able to differential diagnose would be necessary. What do you guys think?--Hughgr 17:52, 14 June 2006 (UTC)

I think this is very valuable information that explains a lot. I'm going to go ahead and put my new history in tonight and then you need to take a look and see how we can show the transition to this objective straight. The way you explained it is very NPOV so you are close already. There is nothing wrong with their line of thinking. It fits in well with Abotnicks definitions above as well. Now it is starting to make sense. Good work!!!--Dematt 19:19, 14 June 2006 (UTC)

Wow. This is great. I never could quite put my finger on the exact differences. Now it makes sense! Levine2112 19:35, 14 June 2006 (UTC)

New and (hopefully) improved History

Alright, I put the updated history in. It is definitely longer, but it is hard to understand the issues without the history so maybe everybody here will be able to be on the same page when we discuss science, etc.... Some parts are controversial, so feel free to comment.--Dematt 20:36, 14 June 2006 (UTC)

I am so impressed and grateful. Thank you. Levine2112 00:40, 15 June 2006 (UTC)

Yes, this new intro looks great. Great job, Dematt! Drdr1989 01:18, 15 June 2006 (UTC)

Very first sentence

Currently reads: Chiropractic is a complementary and alternative health care profession whose aims are to diagnose, treat, and prevent mechanical disorders of the musculoskeletal system and their effects on the nervous system and general health.

My feeling is that "whose" is out of place grammatically. "Whose" (as with its root "who") refers to a person. Chiropractic - the subject of the sentence - is not a person. It would be more proper to use "which" rather than "whose". However, I note that Steth added "whose" in an attempt to make the sentence read - as he put it - less hillbilly. I think "aims" is the source of the "hillbilliness". I am going to update the word "aims" with its near synonym "focuses". Levine2112 17:11, 15 June 2006 (UTC)

Looks like a good change. Jefffire 17:29, 15 June 2006 (UTC)

Looks good to me.--Hughgr 17:40, 15 June 2006 (UTC)

I like it Levine! Y'all come back now, y'hear? Steth 11:19, 16 June 2006 (UTC)

I likes it alaught:) --Dematt 13:10, 16 June 2006 (UTC)

Vertebral subluxation

I've done some editing of the first paragraph under vertebral subluxation. Let me know if this is inaccurate or incomplete.--Hughgr 01:07, 16 June 2006 (UTC)

Looking good. Levine2112 01:32, 16 June 2006 (UTC)

I have no problem with the explanation. If we had a reference for it, that would be even better. Did DD actually say it?--Dematt 02:43, 16 June 2006 (UTC)

New user, Randalllord

While we welcome all contributors to this article, please desist in adding the link to the ChiroTalk proboards forum. It is Wikipedia policy that forums generally don't make for good encyclopedic external links. Please review Wikipedia policy. I understand that you are a Senior Member of the Chirotalk site and it is frustrating that you cannot link to your own site. If you are looking to publicize your site, might I suggest submitting it to search engines. Levine2112 21:14, 16 June 2006 (UTC)

Just like to confirm that forums aren't accpetable as external sources. I'm happy to have another editer helping, but please read Wikipedia's rules on verifiability, which state that all content has to be confirmed from reliable sources. Jefffire 21:19, 16 June 2006 (UTC)

I have posted Randalllord's noncompliance and disregard for the rules on the appropriate Administrator's Noticeboard. Levine2112 21:37, 16 June 2006 (UTC)

You know, technically, you (Levine2112) have violated 3RR if those aren't overt vandalism. (Although I agree with you, you should let other editors, such as Jefffire and me get in on the fun...). — Arthur Rubin | (talk) 21:53, 16 June 2006 (UTC)

I didn't think of it that way. I guess I was thinking that I was enforcing a policy. Hmm. Who am I to enforce policy? You make a great point. Please feel free to help us explain the rules to Randalllord and get it on the reverting fun. Thank you. Levine2112 21:57, 16 June 2006 (UTC)

I'll try to help out too. TheDoctorIsIn 23:49, 16 June 2006 (UTC)

Merging definitions...

Hey Dematt, I like what you've done in the lower definition section, took the words right out of my mouth. :) What do you (and others here) think about merging the intro definitions into that section, while expanding a little on the paragraph in the into...without getting into too much detail, which would then be in the lower part. There are two main groups of chiropractors, known within the field as "straights" and "mixers". Both groups treat patients using a subluxation based treatment system. Differences are based on the reasons for giving adjustments, claims made about the effects of those adjustments, and various additional treatments or sub-specialities provided.--Hughgr 18:57, 21 June 2006 (UTC)

Seems like a solid idea to me. Levine2112 19:31, 21 June 2006 (UTC)

I thought you would like that:] I think we have to try. If it doesn't work, we can always put it back. One thing for sure, we will end up with something better. Everytime we work on something together, it seems to end up good.--Dematt 00:54, 22 June 2006 (UTC)

does not meet the standards of EBM

Jefffire, I noticed that you replaced while objective evidence from controlled trials is lacking. with does not meet the standards of evidence based medicine. I'm not sure I understand what the "standards" of evidence based medicine are. Is there a better way to say it that is more clear? Otherwise, I like Gleng's version better: while objective evidence from controlled trials is lacking.--Dematt 13:48, 22 June 2006 (UTC)

Basically I'm trying to make it clear that some of the wilder claims (healing cancer, and the like), which I hasten to add I don't believe most chiropracters believe in, aren't based on scientific evidence like evidence based medicine is. My objection to the previous wording is that that feels slightly ungainly. Essentially they say the same thing, so my arguement is chiefly an aesthetic one. Jefffire 16:21, 22 June 2006 (UTC)

Why does there need to be citations for those statements?--Hughgr 18:20, 22 June 2006 (UTC)

Umm...because they are important claims from both sides. I think I may be missing something from your question. Jefffire 18:27, 22 June 2006 (UTC)

Oh, I guess I did leave out a bit:) I was thinking that the wording had been agreed upon as a generalization which was covered in the article, and it reads better without a citation after every sentence. I realize what what your saying though, and it looks like dematt covered your problem. Cheers. --Hughgr 18:44, 22 June 2006 (UTC)

Jefffire, you do bring up a really good point about the cancer thing that is not mentioned anywhere in the article. It needs to be noted that even though 100 years ago, chiropractors (along with all practitioners) treated cancer, diabetes, and infectious diseases - it is no longer considered the treatment of choice due to the advent of penicillin, insulin and advances in chemotherapy. This is not to say that chiropractors do not treat patients that have cancer (because they also may have pain) but chiropractors do not treat the cancer and in fact are trained to differentially diagnose and refer these patients to the appropriate fields. Does anyone disagree with this? I'm not sure, but I think even objective straights would agree. In fact, the problem here is that they don't want the responsibility of diagnosing it as they don't feel that they are qualified and feel they might miss something so they would rather not diagnose at all. Does this sound right? --Dematt 18:52, 22 June 2006 (UTC)

Dematt, I agree with what you've said above, but I wouldn't say the objective straights "don't want the resposibility" per se, I think they want it to be made clear that the art of diagnosis is best made by the profession who makes it their entire forte. They see that their job is to solely find and adjust subluxations,(like going to a dentist for a cavity) because they see a subluxation as a detriment to health, so regardless of disease condition, they should be adjusted, as long as the adjustment can be safely delivered. Thus they wouldn't be "treating" any disease, rather the condition of "subluxation". From what I've read about their frame of thinking, if something unusual is seen/discovered, they inform the patient but do not make a recommendation as to whom to see (specialist) but rather tell the patient see a GP, who would then make a referral. It looks like they (objective straights) don't want to be seen as primary care physicians, and encourage their patients to have a "family physician" (GP/MD) to take care of thier "medical needs".--Hughgr 20:31, 22 June 2006 (UTC)

Excellent! You say that so well:) Do you know of any group or school of DC's that claim they are treating cancer or diabetes?--Dematt 20:49, 22 June 2006 (UTC)

This is going beyong my realm of knowledge, so I'll respectfully bow out till it returns. In the mean time I'd just like to congratulate all contributing editors on a good natured cooperation despite differences of opinion. Truely an excellent example of Wiki editting. Jefffire 21:13, 22 June 2006 (UTC)

No Dematt, I don't know of any school nor chiropractors who claim that and adjustment is a cure for cancer. Although, there are always those within every profession who don't know their limitations or get overzealous in what they do, hence make exagerated claims. And thanks for the compliment Jefffire.--Hughgr 00:21, 23 June 2006 (UTC)

Found quote

Hey Dematt, here is a quote from DD's 1910 book (pg 20) to justify my edit earlier on subluxation paragraph:

Physiologists divide nerve-fibers, which form the nerves, into two classes, afferent and efferent. Impressions are made on the peripheral afferent fiber-endings; these create sensations which are transmitted to the center of the nervous system. Efferent nerve-fibers carry impulses out from the center to their endings. Most of these go to muscles and are therefore called motor impulses; some are secretory and enter glands; a portion are inhibitory their function being to restrain secretion. Thus, nerves carry impulses outward and sensations inward. The activity of these nerves, or rather their fibers, may become excited or allayed by impingement, the result being a modification of functionating—too much or not enough action—which is disease.

If you could add the necessary reference, I be grateful. Cheers.--Hughgr 00:57, 23 June 2006 (UTC)

Awesome! I think we should use the entire quote somewhere. I'll put the reference in for now, but lets see if we can find a place to put it. If that was the 1910 book, then that was before the God reference in his 1914 book. Maybe I can work it into the end of the history. --Dematt 11:58, 23 June 2006 (UTC)

That'd by fine, thanks for the assistance! --Hughgr 17:57, 23 June 2006 (UTC)

External Links Reminder

Just a headsup on the external links policy. Links which are in our opinion POV are still acceptable, if they are notable. Thus it is perfectly acceptable to, for example, include a link to Answersingenesis.org on the creationism page and to include the link to talk.origins (which creationists feel is biased). Forums and other Wiki's are what we watch out for, as well as personal sites or otherwise non-notable riff-raff. Jefffire 14:27, 26 June 2006 (UTC)

Thanks for the headsup, Jefffire. I agree and understand about the forums not being acceptable. But why is a so-called 'skeptic's dictionary' notable? Someone decides to write a dictionary, adding their view of the world to the definitions, and voila! They now have the same importance, reputation, good-standing and high regard in academia as Webster or Oxford? Not that I have seen. I fail to see the 'notability' here. Is this so-called "dictionary" used in research by periodicals, publications, universities, newspapers, etc., etc.? As you know, if someone puts up a website, it ain't necessarily so.

Perhaps, someone like Levine, Hughgr, or Dematt can offer their level-headed viewpoint. Steth 17:22, 26 June 2006 (UTC)

Hey everybody, hope you had a great weekend. I've reviewed the links added and its my opinion the skeptics dictionary [2] does not seem notable, while having some accurate information, it appears very poorly written. Not sure how WP judges the notability factor on web sites though. The other one, NCAHF[3]seems OK to me, but I'd add the authors name (William T. Jarvis, Ph.D.) like the other links. Their name (NCAHF) makes them sound like a government agency though, and is merely another web site in the ring ran by Barrett. From the Cornell Law Library, "Don't expect impartiality: chiropractic medicine, acupuncture, herbal treatments, radionics--it's all quackery to the National Council on Health Fraud."[4] --Hughgr 18:57, 26 June 2006 (UTC)

Okay, I looked at Skeptic's Dictionary: chiropractic. Seems to say about the same thing we have so no problems there. In fact, some things are actually more prochiro than our article. There may be a problem with the sales links to amazon.com at the bottom, a little self promoting. I'm not sure we want to open that bag of worms (it goes both ways). I'll take a look at NCAHF a little later. --Dematt 19:49, 26 June 2006 (UTC)

Thanks for viewpoints, guys!

Well I'm skeptical about the so-called 'notability' of the so-called 'dictionary'. It just isn't notable. It's not used by any reputable body as a source of anything except poorly written personal opinions and editorializing, unbecoming of a reference. Why would anyone think this could add anything constructive? Oh yes, the five or so links at the bottom to Stephen Barrett (Please donate money!) is a BIG red flag, too!

As for NCHAF, it's name is misleading - National Council - a euphamism for 'owned and operated by the headmaster of hate, ex-psychiatrist Barrett'. Oh and please contribute donations! Should Wikipedia be used to funnel money to a private fund? This really smells as bogus. Clearly, it is unreliable. They both should be removed. Steth 23:05, 26 June 2006 (UTC)

Speaking of NCAHF and Steven Barrett, has anybody else heard that Barrett was part of the AMA's covert part of the Committee on Chiropractic (later Quackery) that was ultimately responsible for the Wilk vs AMA antitrust suit? Then he surrendered his MD license in order to continue his antichiropractic work without implicating the AMA? I wasn't sure if this was true, but it seems that Tedd Koren dug it up somehow. I can't remember where I read it or how reliable the info was.

Jefffire, Do you think maybe we could find critical links and articles that keep their arguments pertaining to more technical objections that are defensible rather than ad hominem type attacks from which there is no real information gained? Surely there are sources out there that can make an argument against chiropractic without stooping to playing the "quack" card. Can't we find something that can rationally make an objection without name calling and stone throwing? Chiropractic has it's problems, lets get them out in an intelligent way that maintains the professionalism that each POV deserves. Health Fraud, Quackery, Charlatan... come on, the reader is smarter than that. Let's give them the respect they deserve. Make this article about the issues, not the issuer. --Dematt 03:38, 27 June 2006 (UTC)

You know, Dematt, I think you verbalized (in writing) quite well what I was thinking about sources that are professionally written vs. ad hominem attacks. It seems that it doesn't matter which orifice of Stephen Barrett it drips from, it is still considered, by those who are consumed with chiro-hatred, to be golden drops of wisdom-filled nectar. (If I may make take some poetic license) IMO, these sources are not worthy of inclusion in Wikipedia.

Not to mention that they solicit donations to help wipe out chiropractic (and anything else on Barrett's enemies list that is not drug therapy). I don't think WP should be used to collect cash for personal corporations. Just my opinions. Steth 12:34, 27 June 2006 (UTC)

We need to watch out for overtly commercial site, not just any site that has some money gathering part of it. It's quite hard to find decent sites nowadays without a "donate" function to them. Anyway, although I agree that some of the criticisms may tend toward ad hominem, that still doesn't make it unsuitable as an external link. Both of these sites are fairly high traffic sites which deal with alternative health matters, so in my opinion they should be included as links for this, even if we have some disagreement with the content (since no editor will agree 100% with all link contents). Jefffire 13:01, 27 June 2006 (UTC)

Remember that whatever is decided works both ways. How many sites do we want linked to this page? There are probably hundreds more prochiro sites that fit that definition. We can't indiscriminately ban one site over another. The criteria needs to be tight or it will get out of control. It's supposed to be hard to find sites that can link, otherwise WP would become a web index. If there are no more sites that meet WP criteria, then so be it, that does not mean we should lower the threshold, lest we open pandora's box. The same goes for the advocacy as for critiques. --Dematt 17:44, 27 June 2006 (UTC)

It's one thing to have a REAL non-profit organization asking for donations that benefits others. It's totally different if the so-called 'non-profit' organization is completely owned and operated by one person with an opinion and agenda who decides how to spend the 'donations'. That's why the numerous sites like Barrett's are questionable. IMO based on the above, these sites don't rate as encyclopedic and don't measure up to WP standards.

The same thing with the 'skeptic's dictionary'. Someone decided to write out all the things that cause him emotional distress, and put it into the form of a dictionary. So now it qualifies as scholarly and should be referenced as if it were of some importance? I don't think so. This, IMO, dilutes any article and honest and hard work by editors who are trying to present neutral, unbiased information for WP readers.

My vote is they should be removed. Steth 18:06, 27 June 2006 (UTC)

I've looked around for alternatives, perhaps you'd like to look at these; Craig Nelson's articles seem interesting as a critique from within chiropractic; the others seem to be society based rather than private websites, and seem on a quick look to avoid ad hominem attacks or unduly offensive characterisations. I don't claim that they are ideal, I'd rather see published critical reviews rather than websites, if only because whatever a website contains today it might carry something completely different tomorrow, so without clear confidence in the sustainability of the website and in its commitment to authenticity, I think they are best avoided if the information is available in other sources, unless the site is clearly notable and widely (not necessarily universally) respected. This is not to disparage websites, they may well serve a purpose and be honoroubly intended and may indeed be of high standard, but who's in a position really to judge this. Craig Nelson's accounts clearly qualify as published and reputable critiques. http://theskepticexpress.com/Chiropractic.php http://www.theness.com/articles.asp?id=5 http://www.skepticssa.org.au/pdf/chiropractic.pdf http://www.chiroweb.com/archives/12/07/04.html Gleng 13:48, 28 June 2006 (UTC)

Thanks Gleng, those were all interesting. My problem is that most have bias and inaccuracies such as The Skeptic Express stating, "Palmer claimed to have cured a man of deafness...Interestingly, the nerves that are involved with hearing do not connect to the brain via the spine.", which is false. The sympathetic nerves arising from the lateral horns of the upper thoracic levels form the upper cervical ganglion which has postganglionic fibers that arise to supply, among other things, the blood vessels related to the hearing structures. So there is a possibility that it could have happened, but the authors want the reader to believe there is no rationale, thus come to the conclusion that Palmer was a crank. In this one [5] the author states, "Others advocate chiropractic treatment over antibiotics for the treatment of ear infections, leading, in at least two known cases, to the first reappearance of mastoiditis, a severe infection of the bones adjacent to the middle ear, in the modern antibiotic era." That is overtly misleading, using chiropractic care to avoid antibiotics, which do nothing for a viral infection, leading to the "first reappearance" of mastoiditis? One of my friends got mastoiditis while I was in school (1995), and he doesn't go to chiropractors...so what was the cause there? I like the Chiropractic Scope of Practice, Part III [6]. It is an honest look at the problems within the profession without the slander or misinformation. I think that is what we should be looking for.

On a side note, most critisims of chiropractic point to a "belief" in an innate intelligence. While there are other euphemisms to describe this idea (mother nature, chi, etc.) it seems to be the one that garners the most criticism. In my opinion, when a scientist in a lab can assemble and cause to function a single cell, I'll drop my vitalistic mentality. Cheers--Hughgr 18:34, 28 June 2006 (UTC)

Thanks Gleng! It is so good to hear from you again!!! These are better. Not because they are saying different things, but they state the controversies and their POV without dropping into denigrating diatribe that detracts from the point. The http://theskepticexpress.com/Chiropractic.php can go as far as I am concerned, more because of the links that accompany it tend to cheapen the article. The last three are fairly well written and states the issues relatively well considering their skeptic POV. That is what we are looking for.

Hughgr, as far as the ear infections, I agree. An educated reader will realize that even the national pediatric associations have admonished doctors about using antibiotics too soon for ear infections. Their own research shows that the overuse of antibiotics for viral infections has caused resistant strains. Evidence Based Medicine would thus require that they no longer practice this way, however many continue. Yet we were chastised for suggesting that they wait a few days, watch for signs of regression and refer if they don't improve. Now that is their current advice and they pretend we didn't know what we were talking about. Go figure. I just saw my first case of mastoiditis this year (after 23 years), and that 2 year old had been on antibiotics since she was 11 months old (never been to a chirorpactor, totally cared for by her pediatrician the entire time, tubes and all). So it happens to every type of physician who dares to accept the responsibility for the lives of a people in need. That's just what we do. Let scientists debate the consequences and give us direction, but the responsibility for our daily decisions is ours alone. So we don't need the criticism, but we do appreciate the critique. Okay, I'll step down now:)--Dematt 19:14, 28 June 2006 (UTC)

Thanks Gleng, but IMO, the so-called 'skeptic' websites are nothing more than hate-sites that were given the Good Hate-keeping seal of approval by Barrett and gang. In return, they have awarded him numerous times what amounts to the chiro-hater of the year award. They pass off their biased opinions as facts and paint the whole profession with a wide brush. BTW, ragging on Barrett's wacky field of psychiatry (the gold-standard of pseudoscience) is strictly verboten by the HateFurher.

So I agree with Dematt that they should go. These sites are not notable, they are unprofessional, and are very biased which all adds up to leaving them out of WP. But thanks for doing the research. Steth 21:51, 28 June 2006 (UTC)

Please do note that, as much as I understand and appreciate your candid Barrett description Steth, I reluctantly have to repeat what I actually did say; "The http://theskepticexpress.com/Chiropractic.php can go as far as I am concerned, more because of the links that accompany it tend to cheapen the article. The last three are fairly well written and states the issues relatively well considering their skeptic POV. ":) Obviously we could do without any of them, but it wouldn't be right to only put my POV in the critique section :)--Dematt 03:01, 29 June 2006 (UTC)

Still looking; the Craig Nelson article(s) were the ones I was most happy with; the SAskeptics article seems reasonable in tone to me but is short on verifiable information. In hunting I came across this though which I think deserves a link.[7] We should be clear as to why we exclude links to some websites, so that our reasons will stand up to scrutiny. Most importantly we must not exclude sites because we don't like the opinions expressed, or to restrict access to inconvenient information; this would be quite wrong. On the other hand, WP is not Google, so we should not feel obliged to insert links, and should only do so if the sites are stable, non-commercial and robust; by non-commercial, I would not exclude sites that invite donations but would disfavour those that extensively sell or promote commercial products; excluding sites that invite donations would exclude most charitable sites. Really, we should be inserting links to sites that are gateways to larger amounts of verifiable information that cannot reasonably be included in the article, or which are clear statements of perhaps a significant minority opinion that is not developed extensively within the article. A significant minority opinion might be misinformed, but that opinion nevertheless should be reported in some form at least. A substantial number of medical practitioners still are wary of chiropractic, fearing that the possible risks outweigh the distinctive benefits, so the skeptical view cannot be dismissed as a one man hate crusade. For opinion sites, I would prefer to be able to attach the opinion to a body rather than an individual, and the larger or more significant the body the better, simply because this demonstrates how widely held the perhaps minority opinion is. Gleng 13:44, 29 June 2006 (UTC)

Good points Gleng, in regards to [8], I feel we should wait until they are finished, I think they are close...then we could link to their finalised version. BTW Gleng, good work on the science section, you cleaned up my "junk" rather nicely :) Thanks!--Hughgr 18:16, 29 June 2006 (UTC)

Agreed on Skeptics SA and definitely a good find, The people on the list are all good names in chiro research as well. It is nice to see that they are working in the right direction. And Hughgr, you got the ball rolling! We were all grumbling about it and not doing it till you started. Don't stop, we have several paragraphs to go and we haven't really said much about the type and quality of research that is available.

moved and combined

I've moved and edited the "groups" from the intro to the lower part. If you see I've missed something or 'gasp' made an error in my editing, please correct or add. Thank you for your support. :)--Hughgr 19:17, 29 June 2006 (UTC)

Well done! I like it. It consolidates all the relevant information into one section and makes the intro less confusing as well. Kills two birds with one big rock:) --Dematt 20:31, 29 June 2006 (UTC)

Scientific investigation of chiro

I'm thinking for this section, we could follow this "three problem areas: a failure to show efficacy for the conditions treated; an implausible mechanisms of action; and the use of invalid biomechanical assessments." and address each one. The first, "failure to show..." is pretty much addressed now, but for a balance, I would like to see something like these added: [9], [10], [11].

Next, for the "implausible..." part, I'd assume Allen was talking about vertebral subluxation. We could mention some of the hypothesiseses:) and the why some think they aren't possible. Off the top of my head, I've heard that cadaver studies have shown that there is "ample room" in the IVF for the nerve, but this is contradicted by the fact that nerves shrink tremendously upon death, and a corpse doesn't have an action potential....etc. I think BJ went overseas and did a quick-freeze and then a slice and dice to show the IVF was "filled", but I'm gonna have to look that up. :)

Finally, "mechanism of ...." is primarily based on Harrison's study, which I've reviewed and he mainly critisised the historical listing of misalignments for being two dimensional (x-ray), but as I pointed out earlier, I was taught to use the cartesian coordinate system, so I'm not sure how to handle this one. Does it even need mentioning? I'm sure there are "old timer" :) chiro's who still use the aforementioned method...

What do ya-all think of my plan....and please add your ideas, Gleng, I'm especially interested what you think the format should be due to your background. Cheers!--Hughgr 22:10, 29 June 2006 (UTC)

As far as "implausable...". I think the skeptic POV would state that the nerve takes up less than 1/3 of the intervertebral foramen in the lumbar spine and a little more in the cervical region. The remainder is taken up by vascular and fatty tissues. Yes, the nerve can be "pinched" in this region, but not likely as the result of "misalignment" to the minor degree that 90% of DC's consider as subluxated. Space occupying lesions (SOLs), as a result of disc bulges, osteophytic activity, and lost disc height are all parts of the degenerative effects of "subluxation" that can fit in the "pinch" category, but you have to admit, the subluxations that cause the controversy are the ones that aren't that obvious. I think it is a simplified model that is useful in these cases and as a simple descriptive tool, such as the cavity for a dentist.

However, there is evidence of other plausible mechanisms that explain the facilitation of the nerve root that DC's seem to be describing. Consider the increased tenderness at the level that patients are always impressed that we are able to locate. Consider the temperature changes that can be picked up. These are signs of subluxation that DD and BJ described long ago. We know that the sinuvertebral nerve exits the IVF and innervates the facet, the posterior disc and the transverse process and then returns to the spinal cord. These are structures that are full of mechanoreceptors that feed back to the CNS information about proprioception, posture and could be the mechanism that, when stretched beyond normal, facilitates the protective or splinting of the paravertebral musculature of the rotators, multifidi and erector groups. But the tenderness and temperature changes would be more likely autonomic responses, and if that is the case, it is not a far leap to realize there is a link to a "less than optimal" nerve supply to an organ that is innervated from sympathetic activity from that level. This is certainly plausable and there should be citable sources for it. DD's theory is that subluxation causes disease. The question is, how well can an organs function under these circumstances and can disease result. Then can adjustments fix it? And how much depends on a particular chiropractor's ability to find and fix them? Is the placebo effect also facilitated through the ANS on an emotional level and can we seperate the responses in order to test them? etc..--Dematt 03:07, 30 June 2006 (UTC)

Well said Dematt, something of that nature should go towards the top of this section. As far as signs and symptoms go, [12] describes the subluxation as syndrome and describes it as: altered alignment; aberrant motion; palpable soft tissue changes; localized/referred pain; muscle contraction or imbalance; altered physiological function; reversible with adjustment/manipulation; focal tenderness.--Hughgr 17:10, 30 June 2006 (UTC)