Talk:Chiropractic/Archive 14

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Archive 14

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Contents 1 Chiropractic techniques 1.1 Article started 2 Removal of Opposing Views: Activator Technique 3 Web MD 4 TW 5 Unbelievable 5.1 Unbelievable - break 6 Chiropractors do not raise stroke risk 7 Snip from intro 8 Rearranged a bunch 9 Chiropractic Canada: Article RfC 10 Tendency Toward Quackery 11 Evidence-Based Updates on non MSK conditions: What does the recent literature suggest? 12 edits by anonymous 208 13 lede/lead changes 14 Mobilization vs Manipulation 15 Dematt's defence of the top 16 Ernst and safety 17 UNDUE weight 18 Safety issues 19 Recent Edits since Protection was Removed 20 Chiropractic College 21 ref#7 22 writing style

Chiropractic techniques

This article is missing a whole topic area of great importance!

Here are a couple excellent listings of

• Chiropractic Techniques. American Chiropractic Association.
• Chiropractic Applications. WebMD

from reliable sources. Could we use them as a start for a section which is missing? It could then be wikilinked to the various articles that go in-depth on each topic. (Any techniques which don't have articles should have them, even if they are stubs. That would be an interesting project for anyone who wants to learn more about chiropractic. It would also make the [[Category:Chiropractic]] much more valuable.) Other sources could be added to document other techniques that are used. I'm not suggesting an in-depth explanation of each technique here, or a listing of every one of the "100’s of different techniques" that exist, as that would be too big a task. I envision a simple listing in column format similar to what we use at Quackwatch#About_the_site. That will permit wikilinking and possibly (when appropriate) links to external sources. Since such a format doesn't take up much room in the article, we would be getting loads of information packed in without swamping the article. What think ye? -- Fyslee / talk 17:33, 21 November 2007 (UTC)

Since there has been no comment, I have gone ahead and added the content. To avoid any questions, I have included all items and provided the references. If anyone thinks there should be some revisions, let's discuss how this can be improved. -- Fyslee / talk 05:16, 23 November 2007 (UTC)

Hi Dematt. Thanks for developing this. You know far more about it. It looks like we may even have the basis for a short (and possibly long!) article. What about making an article and then just leaving the 15 most commonly used techniques (and the explanatory paragraph) here and moving the rest to the new article? (Of course those 15 should also be in the new article.) That way we don't overwhelm this article, much as I'd love to see it 30 times as long....;-) -- Fyslee / talk 06:58, 23 November 2007 (UTC)

Hey, you're developing, I'm just assisting ;-) This could easily grow considerably and are really along the lines of the different types of Spinal adjustments. I think we also need to expand the specialties as well, such as sports therapy, nutrition, neurology, radiology and orthopedics because each of these have their own techniques as well... or at least they use some techniques rather than others. All of which are too long for this article. -- Dēmatt (chat) 07:09, 23 November 2007 (UTC)

The numbered list at the bottom needs reformating somehow. I'll work on it, but if you have any ideas that would save me a lot of headache, that would be appreciated! -- Dēmatt (chat) 07:12, 23 November 2007 (UTC)

Yes, it could be very big, with new articles and wikilinking, we're talking about a major expansion of the Category:Chiropractic. How about just starting with a big stub called Chiropractic treatment techniques (temporary location), or something like that? That could function as a Grand Central Station for myriad articles, large and small. -- Fyslee / talk 07:15, 23 November 2007 (UTC)

When it comes to making tables, my HTML is zilch. I just copy what I find appealing. If you have a format, coding, and content, you can give me an assignment and I'll try to work on it. -- Fyslee / talk 07:23, 23 November 2007 (UTC)

I did what I think was some clean-up, but frankly I don't see the need for any of this information. Does it help the average reader understand Chiropractic? I think this addition should go.--Hughgr (talk) 23:14, 23 November 2007 (UTC)

Would we have complete coverage of the subject without some mention of techniques? We don't have to have every technique listed right here, but a short mention with some good examples and then a link to the new article that goes into much more depth, would be a great improvement of Wikipedia's coverage of chiropractic and a great service to readers who are interested. Those who aren't won't care, but those who do will be happy. -- Fyslee / talk 02:07, 24 November 2007 (UTC)

I think this section, even when kept small, would be better off further down, possibly where the MUA section is now. It seems premature to deal with this even before the history section. It makes more sense to let things flow from the lead, basic theory, history, and then onwards. -- Fyslee / talk 02:48, 24 November 2007 (UTC)

The 3 column table looked good, but that outline is terrible looking. So what's the plan? Are we going to create a technigues article and remove this stuff from this main article? -- Levine2112 ^discuss 18:49, 26 November 2007 (UTC)

I don't know where Dematt went, but we need to move forward. I agree that it doesn't look good, especially near the beginning of the article, and we don't need so much here. How about (for now) we start by removing the outline and moving the whole section down to the MUA (merge it) section at the bottom as suggested above? Then we can see how it looks. Further development can happen in my user space where an admin moved it. Apparently using an article talk page for development when the article is empty isn't allowed. Here's the link again:

• Chiropractic treatment techniques (temporary location)

See you there. -- Fyslee / talk 01:21, 27 November 2007 (UTC)

I think we should just remove it for now. Then, when Chiropractic treatment techniques is done, we'll have it there. -- Levine2112 ^discuss 03:39, 27 November 2007 (UTC)

I have tried what I mentioned above and have moved and shortened the treatment techniques section. Now it doesn't break the logical build up of the article. It was in a bad place to begin with. It is also so short as to not overwhelm the article. When the article is ready we can use its edit summary here and place a link to the article. -- Fyslee / talk 06:26, 27 November 2007 (UTC)

Article started

Chiropractic treatment techniques. It isn't for long explanations or lots of refs. That should be done in the individual articles. Hopefully this will also inspire editors to expand existing articles and create new ones, even if they are only stubs. Please place it on your watchlists and help develop this as an important Grand Central Station on the subject. -- Fyslee / talk 17:07, 2 December 2007 (UTC)

Removal of Opposing Views: Activator Technique

I am new to Wiki so allow me to progress with small steps. Most of the informative articles I have seen contain more than one point of view. Why would someone with so many Wiki awards (or whatever those "gold stars" are)be so keen on preventing opposing views. I have repeatedly tried to comment and to ask for explanation regarding the miraculous way the the "Activator Technique" used by so many DC's actually works. Levine2112 seems to have a sore spot regarding this and politely asks me to constrain my comments to the Discussion pages. I do not think that it is anyones place to claim validity by refusing to refute said claim. In the venacular "put up or shut up" . Either honor my request to explain the claim or at the very least allow opposing views. To reiterate: If you make a claim as fact and can't support it... If you refuse to allow opposing views... If you use circular logic... Why are you on a "Democratic" website? Surely you have a personal Blog to espouse purely your own opinion and no one else's. What of NPOV?

My edits were not rude, but stated clearly that there was no Cause-and-Effect explanations. Who moves the "tissues" into "normal" position...Thetans? Flargnog (talk) 20:46, 10 December 2007 (UTC)Flargnog Dec10th

—Preceding unsigned comment added by Flargnog (talk • contribs) 20:42, 10 December 2007 (UTC) 

Welcome to Wikipedia. You might want to place your question on the Talk:Activator technique talk page. You user page is here --Anthon01 (talk) 00:52, 11 December 2007 (UTC)

Agreed. I apologize to Flargnog if I gave some misunderstanding. I believe that the edit of your I removed was based on that it read like your opinion rather than information gathered from a reliable source. Anyhow, the proper forum for discussion of this is as Anthon01 indicates. If you have a more personal issue to discuss with me, please feel free to comment on my talk page. P.S. I don't maintain a blog at all and don't contribute to the web (or the world) on this topic in any venue other than Wikipedia. -- Levine2112 ^discuss 23:26, 11 December 2007 (UTC)

Web MD

An IP-based editor added a Web MD section. I don't know whether they are considered a WP:RS (I'd place them somewhat below quackwatch in reliability, but that's just my opinion). In addition, the two citations purport to reference peer-reviewed studies, and we should reference those studies in the appropriate section, and leave Web MD out of it. — Arthur Rubin | (talk) 15:45, 14 December 2007 (UTC)

OK, I've changed my mind. I accept that WebMD may be reliable for individual articles (even though the in-doctors-office version of the magazine is over 50% ads, mostly supported by nearby articles^{personal observation}), but the first sentence implies that the editors support Chiropractic, which is unjustified WP:OR. I think we should just locate the studies referenced in those articles, and move those references to the appropriate "studies" section(s), if not already there. — Arthur Rubin | (talk) 16:02, 14 December 2007 (UTC)

I don't mind citing WebMD so much, but you're right; it isn't a great source. It should certainly not have its own section in our article and the amount of space dedicated to its mention should be drastically reduced. -- Levine2112 ^discuss 18:38, 14 December 2007 (UTC)

TW

Levine, please stop using TW to revert edits. If you think they are vandalism, please state so. Thanks Shot info (talk) 23:00, 17 December 2007 (UTC)

What other ways should I use to revert? Is there a particular issue with using TW? -- Levine2112 ^discuss 01:33, 18 December 2007 (UTC)

Unbelievable

This article is like a commercial for chiropractic. It is a pseudoscience and must be indicated as such at the beginning of the entry. This is one of the bigger embarrassments for wikipedia. —Preceding unsigned comment added by 69.203.30.45 (talk) 02:34, 27 December 2007 (UTC)

I agree. It seems that the chiros are zealous in guarding the article so that nothing very damaging or negative stays on. As a neuroscience nurse, I have seen several strokes in young, healthy people, caused by cervical manipulation. There is no excuse for such devastating "side effects" from an essentially unnecessary treatment. I have also seen cancer patients, undiagnosed by the chiropractor, crippled by manipulation. I do what I can, as a health professional, to warn my circle of friends about chiropractic dangers. CynRNCynRN (talk) 09:10, 3 January 2008 (UTC)

Are you kidding? The risk rate is extremely low for cervical manipulations. Do you know how many iatrogenic deaths occur each year? Anthon01 (talk) 09:16, 3 January 2008 (UTC)

In the May , 2003 issue of Neurology, the author states, "Lack of demonstatable benefit for manipulation makes any risk too much"

"Over a five year period, in two stroke centers, 151 patients younger than 60 had arterial dissection and ischemic strike or transient ischemic attack...vertebral artery dissection was independently associated with spinal manipulation within 30 days" (see study for details) This same article states, "Past literature suggests rate of stroke from cervical manipulation from one in 100,000 to one in two million." The problem here is that there is no mechanism in place to track or tabulate incidences of neurological damage. Neither chiropractors or physicians are required to report manipulation caused strokes. The actual rate for strokes is unknown. http://www.medscape.com/viewarticle/455419

Anthony, I am not kidding; I have seen patients with devastating injuries from cervical manipulation. CynRNCynRN (talk) 20:59, 3 January 2008 (UTC)

I have no doubt that you see patients with devasting injuries, however I don't how you could conclusively determine that it was from cervical manipualtion. I am not denying that it occurs, just that an association isn't cause and effect proof. Anthon01 (talk) 23:56, 3 January 2008 (UTC)

Two points:

• Anthony, you are absolutely correct that association doesn't equal proof.
• Sometimes the association, especially in the presence of other symptoms and findings, is so clear as to constitute proof.

In a case where the patient starts convulsing and turning blue from the top down while on the treatment table (the Laurie Mathiason case), the practitioner is quite aware of what really happened. (Source link is now dead.) That chiropractor must have felt awful, and I really feel sorry for them. They were trying to help someone and it went wrong. What was critisable, IIRC, was that they repeated the procedure in spite of Laurie's complaint. They shouldn't have done that. Laurie died and her family ended up winning the lawsuit. There was an audio link at that website where her mother described witnessing it happening. I got goosebumps and felt the hair rising on my neck. Now this is an extreme case, but here there was no question about cause and effect. Other less dramatic cases are also pretty clear cut, especially when autopsy shows arterial dissection at the spot of the adjustment. It's rare, but catastrophal. There are several people who are alive and paralyzed who can also attest to what happened to them. Rare, but very real. -- Fyslee / talk 02:09, 4 January 2008 (UTC)

Anthony, the risk rate is indeed low, but devastating when it happens, and it's all avoidable. That's the point, and keeping out such information smacks of a coverup. There are plenty of V & RS sources that document and discuss this problem, including the low risk factor and the disastrous results when it does happen. While it is mainly a problem in chiropractic because of the number of "adjustments" performed (especially by Upper Cervical / HIO chiros), the procedure itself is the problem. Cervical manipulation should be a very rare procedure for any profession. While these consequences are rare but deadly, because of the known reporting problems (100% non-reporting in England) we know there is a serious problem, but we don't know exactly how large it is. We can see the top of the iceberg, but we have no idea how large the other part is. -- Fyslee / talk 21:48, 3 January 2008 (UTC)

No doubt. Regarding how frequently the procedure should be performed, I don't know. On a slightly different track, I remember a friend of mine who told me that after a accident which injured her upper lumbars, that she struggled with recurrent kidney infections accompanied with back pain. She finally went to see a chiro and her infections stopped. If she didn't get ana adjustment once every 2 weeks or so, her pain would return and soon after a recurrence of her kidney infection. Anthon01 (talk) 23:56, 3 January 2008 (UTC)

I don't doubt the anecdote. The possibility of back pain being caused by accidents and kidney problems is very well-documented in medical science. OTOH, the claimed correlation between vertebral subluxation and visceral complaints and organ systems are a matter that has been debunked by two chiropractic professors many years ago. Dale Nansel and Mark Szlazak found that:

• "BACKGROUND AND OBJECTIVES: Several theories have been put forth in attempts to explain the possible mechanisms by which patients presumed to be suffering from any of a variety of internal organ diseases are occasionally found to respond quickly and dramatically to therapies delivered to purely somatic structures (e.g., spinal manipulation). The purpose of this review is to examine the scientific bases upon which these sorts of clinical phenomenaight be interpreted. DATA SOURCES: A review was conducted of over 350 articles that have appeared in the scientific literature over the last 75 years. Initially, a MEDLINE search was performed; however, because of the variability of indexing terms employed by investigators within a wide variety of biomedical disciplines, most of this literature had to be located article by article. DATA SYNTHESIS: At present, there have been no appropriately controlled studies that establish that spinal manipulation or any other form of somatic therapy represents a valid curative strategy for the treatment of any internal organ disease. Furthermore, current scientific knowledge also fails to support the existence of a plausible biological mechanism that could account for a causal segmentally or regionally related "somato-visceral disease" relationship. On the other hand, it has now been firmly established that somatic dysfunction is notorious in its ability to create overt signs and symptoms that can mimic, or simulate (rather than cause), internal organ disease. CONCLUSIONS: The proper differential diagnosis of somatic vs. visceral dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, need to be appreciated by all portal-of-entry health care providers, to insure timely referral of patients to the health specialist appropriate to their condition. Furthermore, it is not unreasonable that this somatic visceral-disease mimicry could very well account for the "cures" of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to "holistic" health care claims on the part of such clinical disciplines."^[1]

I have the whole paper and it's fascinating reading. It is probably the most well-qualified scientific research ever performed by chiropractors up until that time. Naturally their conclusions and that research have been pretty much ignored in the chiropractic literature, although it is referenced by some, since it totally undermined the fundamental chiropractic hypothesis of vertebral subluxations affecting organ systems. -- Fyslee / talk 02:27, 4 January 2008 (UTC)

Your point is well taken. Just to clarify, the anecdote I provided was not an example of mimicry in that blood and urine test would confirm the diagnosis. I'll get a copy of the article and read it. Anthon01 (talk) 06:25, 4 January 2008 (UTC)

I think anyone that considers themselves science minded would agree that there is a difference between 'an association' and a 'causal relationship' when evaluating manipulation and stroke. Surely there is an association with patients who present to MDs with headaches that result in stroke after aspirin therapy is prescribed, but that does not correlate to causation. The headache may well be the symptom of the impending stroke that happened to show up in the MDs office that day. Right now, the subject is certainly a hot topic in all manual therapies. All the research allows us to say is that 'any' movement of the head - even examination or mobilization - may be related to stroke 'in the susceptible patient'. These 'susceptible' patients appear to have other factors in the form of collagen diseases that might help identify patients that are at higher risk. This is the way all health interventions are evaluated in order to find the best methods that have the most benefit with least risk. At this point, spinal manipulation for the treatment of neck pain has far less risk than ibuprofen and NSAIDs. I can get the numbers if we want to put them in the article. -- Dēmatt (chat) 03:58, 5 January 2008 (UTC)

Of course, there is a difference between cause and association. Are you saying that there is no strong association between cervical manipulation and cervical artery dissection? According to several studies, the association is compelling. A significant proportion of these patients may have underlying collagen diseases. Other risk factors for artery dissection may be alcohol use, birth control pills and hypertension. Do chiropractors screen for such conditions or life style factors before performing cervical manipulation? One argument, Dematt, that makes no sense to me is that the neck pain patient is subject to a choice between chiropractic or 'dangerous medications'. It is not "either/or". Why must he or she take any such risk? In a real world situation, however, the patient probably begins to self medicate with Advil or some other OTC pain killer before seeing the doctor. In other words, manipulation will not necessarily replace the taking of medications. CynRN71.198.30.242 (talk) 23:24, 7 January 2008 (UTC)

I would be interested in the figures you have for risk of ibuprofen and NSAIDs, even though I don't think they are relevant to the subject under discussion. CynRN71.198.30.242 (talk) 00:23, 8 January 2008 (UTC)

CynRN: Please consider signing in before you edit. That way you won't need to sign you name. You can used four tildes (~) and you name will be automatically signed. I also left a note on your talk page, User talk:CynRN Anthon01 (talk)

04:23, 8 January 2008 (UTC)

Under "Safety", I would like to see a warning about cervical manipulation. I predict that the dangers will become more recognized by the medical community and the public in the next few years. Not having a warning at all seems deceptive. This is what I would add to the "Safety" section. The American Cancer Society states, “Chiropractic is considered fairly safe. However, there have been some reported cases of paralysis, blindness, and rarely even death following chiropractic care. There have also been reports of misdiagnoses of patients’ conditions, resulting in delayed medical care and worse outcomes. Several people with cancer developed paraplegia (paralysis of the legs) and quadriplegia (full-body paralysis) after manipulation of the spine when cancer had spread to and weakened the bones.” http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Chiropractic.asp There also needs to be a new section under safety: "Contraindications for Chiropractic", or "Who Should Not Use Chiropractic", (for the layperson). —Preceding unsigned comment added by CynRN (talk • contribs)

Wikipedia is not a crystal ball and thus is not a collection of unverifiable speculation. You may be interested in looking through the surgery article. You may be interested in knowing that in spite of the comparatively high risks associated with surgical procedures, there is no discussion about complications, risks, and poor candidates for surgery. -- Levine2112 ^discuss 23:39, 8 January 2008 (UTC)

There has been quite a bit of publicity in Canada regarding strokes after cervical manipulation. It seems likely that, as more and more patients undergo this treatment, the same scenario could play out in the US, with horrendous effects on the chiropractic profession. As to your second point, I agree that there should be something in the surgery article about risks. On the other hand, everyone who has surgery, or even a blood transfusion, must sign a long,detailed consent accepting those risks. In other words, it's quite well known that there are risks! It is not well known that there is a risk (the actual odds are unknown) when one has cervical manipulation. I should have put this up in the "Caution" section, sorry. —Preceding unsigned comment added by CynRN (talk • contribs) 01:09, 9 January 2008 (UTC)

CynRN:

New Research Supports the Safety of Upper Cervical Adjustments

The first paper, from England, was published in Spine (32(21):2375-2378, October 1, 2007) and its conclusions are thus:

Of the over 50,000 cervical manipulations observed, there were no reports of serious adverse events. Minor side effects, occurring either immediately after, or within seven days after treatment, were slightly more common. Some of the side effects included:

fainting, dizziness, light-headedness in, at worst, 16 per 1,000 treatments,

numbness or tingling in upper limbs in, at worst, 15 per 1,000 treatments,

headache in, at worst, four per 100 treatments.

This data echoes that of three previous studies – Spine (1997), 22(4):435-440; JMPT (1997), 20(8):511-515; and JMPT (2004), 27(1): 16-25. They all point to the fact that the worst possible side effect, after an adjustment, is a little muscle ache, a bit of fatigue and some mild vasodilative responses. No blown discs, no broken ribs, no strokes.

The second study, reported at the WFC Conference in Portugal last May and again recently at the Bone & Joint Decade Task force on Neck Pain in Regina, will be published in the upcoming February 2008 edition of Spine. This project, headed by some well-known Canadian researchers, shows that the risk of dissective stroke is no different whether people seek care from a chiropractor or a medical doctor! Since physicians do not routinely adjust necks in their practices, this would strongly suggest that chiropractic neck adjustments have nothing to do with dissective strokes. Add to this the 2002 Symons study in JMPT which showed that to damage a vertebral artery would take 25 times more stretch than was possible with a rotary adjustment, and you can see that the "risk" is an illusion stemming from bad timing rather than a reflection of bad chiropractic. And, of special note, the numbers presented in the study are right around the traditional "one-in-a-million" rarity rates that chiropractors have traditionally advocated. To put that into perspective, consider your risk of death from the following:

in a car accident – 13,333 per million,

from prescription drugs – 3,200 per million,

from cigarettes – 1,667 per million

Hope that you don't let your inherent bias affect your ability to discern the evidence.

208.101.89.150 (talk) 04:35, 9 January 2008 (UTC)

Unbelievable - break

Interesting, thanks 208.101.89.150, to add to your list:

• Non-Steroidal Anti-inflammatories NSAIDS^[2]
  • Serious GI event
    • 3.2/1000 subjects (age 65+)
    • .39/1000 subjects (age <65)
    • 1/1000 subjects (all ages)
• Naprosyn^[2]
  • GI bleeding and or perforation - <1/100
  • Renal failure - <1/100
  • Congestive heart failure - <1/100

So thats 390 serious GI events per million for NSAIDs alone for normal people. Over 65 goes to 3,200 per million. NSAIDs Adverse effects-- Dēmatt (chat) 15:24, 9 January 2008 (UTC)

I read the abstract of the spinal manipulation study cited above. There were only 50,276 total manipulations studied out of 19,722 patients. If the risk of a serious side effect is "1/200,00 to one in several million" (according to this article), one would not expect to see a serious incident in a such a relatively small sample. What was very alarming to me, as a neuroscience nurse, was the high incidence of potentially serious symptoms, as listed above: "Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was "fainting, dizziness lightheadedness in, at worse [almost equal to]16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse [almost equal to]4 per 100, numbness/tingling in upper limbs in, at worse [almost equal to]15 per 1000 and fainting/dizziness/light-headedness in, at worse [almost equal to]13 per 1000 treatment consultations." What is causing numbness/tingling, headache and dizziness is such a large number of patients, if not nerve or vessel impingement? Were any reasons given in the study? Thanks for the stats on NSAIDs. They are still considered to have a good benefit/risk ratio. I am glad to have ibuprofen in my cupboard for the occasional ache or pain. It is still a fallacy, in my opinion, to contrast manipulation vs NSAIDs for the reasons I stated above. #1 Many people probably self-medicate with NSAIDs before seeking chiropractic treatment, so it's not "one or the other". #2 Just because NSAIDs have risks does not make it OK for cervical manipulation to have (life threatening)risk. —Preceding unsigned comment added by CynRN (talk • contribs) 19:43, 9 January 2008 (UTC)

CynRN,

With all due respect, as a 2006 graduate from CMCC and a certfied kinesiologist (BScKin), I know a thing or two about the neurosciences and applied neurology. Since when is 19 000 patients and 50+K manipulations a "small sample size"? Also, please make sure to read the study that will appear in Spine in Feb 2008 as it provides more evidence that suggests the cervical manipulation and the link to strokes is, at the very least overblown. As a contemporary DC who is practicing in Canada, I'm acutely aware of the stroke debate and am confident that the literature will validate the clinical successes that many DCs have experienced for over 100 years.

I'm a DC who works closely with MDs in a family health care team in Ontario and I can tell you confidently that once conventional medicine begins to understand manual/physical medicine approaches and as the wellness paradigm replaces the current illness model, these historical "turf wars" and misundestandings will begin to cease. So, while I respect fully your right to pop some ibuprofen and NSAIDS, there are significant benefits to choosing a holistic and manual approach for neuromusculoskeletal pain including cervical SMT.

208.101.89.150 (talk) 00:24, 10 January 2008 (UTC)

Please also consider this study which out and out states: "...the benefits of chiropractic care for neck pain seem to outweigh the potential risks." The NSAIDS comparison is not something which was thought up here, but in clinical studies. The comparison has been made by researchers who note that though the benefits of chiropractic versus NSAIDS can be equal, the risks of NSAIDS far outweigh the risks of chiropractic and thus chiropractic is recommend above NSAIDS. -- Levine2112 ^discuss 20:35, 9 January 2008 (UTC)

You stated "What is causing numbness/tingling, headache and dizziness is such a large number of patients, if not nerve or vessel impingement?"

Not sure if anyone knows the answer for sure, but I'll give you an opinion based on observation. Headaches and dizziness: Generally not a big deal. Upper cervical nerves contribute to whole body balance (reflexes involved with standing and balance). Adjusting the cervicals can cause observable changes in neck posture, in some cases immediately apparent. The change requires proprioreceptor recallibration. During the period prior to recallibration, a patient may encounter dizziness or headaches. (remember many headaches are muscular in nature)

numbness/tingling: could be and already encroach foramen getting irritated by the adjustment. More likely nerve than vessel. Anthon01 (talk) 21:00, 9 January 2008 (UTC)

The study you reference, by Rubinstein and Leboeuf, which has in the title, "The benefits outweigh the risks", actually is alarming to me. They state, "Adverse events after any of the first 3 treatments were reported by 56%, and 13% of the study population reported these events to be severe in intensity." One percent were very severe! There was no control group that didn't get any treatment or got something like massage. With all due respect, I don't see how this study proves anything positive about manipulation. Causing headaches, numbness or dizziness, if only transiently, seems dangerous to me. When I said "the study size was too small", I meant it would not be likely to catch a fatal or crippling artery dissection...if the incidence is 1/200,000 or 1 in 5 million. CynRN03:57, 10 January 2008 (UTC) —Preceding unsigned comment added by CynRN (talk • contribs)

CynRN

Let's re-visit this topic in Feb when the Spine publication comes out. It's clear that you do not understand or appreciate the positive impact of the manual medicine, including joint manipulation. But, I can tell you from my experience thus far, many "intractable" neurological and orthopaedic conditions that have been referred for surgery are simply neuromuscular imbalances that are very treatable by chiropractic care and manual therapies. Maybe it's time to revisit the notion that DCs just "crack backs".

Regarding your comment on the possible side effects (headaches, dizziness, numbness), pale in comparison to the side effects of many medications used to treat pain syndromes. Now, to clarify, I'm not against medications at all, however to fear manual therapy, including manipulation, is not supported by the research. To call my profession a pseudoscience shows either a lack of awareness of chiropractic in 2008 or ignorance (take your pick). In an evidence-based era, no health profession can escape the responsibility to demonstrate clinical efficacy and cost-effectiveness through research. I suggest you start reading manual medicine journals so that you can better inform your colleagues of contemporary physical/manual medicine practice. —Preceding unsigned comment added by 208.101.89.150 (talk) 06:55, 10 January 2008 (UTC)

CynRN Your reading an abstract not the article. You view is radically skewed. There are 70,000 chiropractors in the US. How do you imagine by any stretch of the imagination that chiropractors could remain viable if they were causing adverse effects in 56% of their patients undergoing manipulation? Can you see how your interpretation of the abstract makes no sense? For instance, post manipulation muscle soreness happens sometimes, like the kind you get the first day you garden in the spring. Any idea what that means? BTW, please end you post by signing your name. THe way to do that is by typying tilde four time like this -~~~~. Otherwise you can place the cursor at the end of your entry and click on the signature button at the top of the edit window; it is the 10th button on my computer. Anthon01 (talk) 07:15, 10 January 2008 (UTC)

Actually, I can quite easily imagine that a majority of patients undergoing manipulation having adverse effects, such as "post manipulation muscle soreness" and "delayed muscle soreness" (about 24-48 hours later). You cannot deny that those are adverse effects. The "Safety" section of this article should relate only to serious adverse effects, and I tend to agree that the literature doesn't supports a range of estimates of serious adverse effects from one in a million to absolutely undetermined. (The study that showed that none of the (small number of) serious effects following manipulation would have been counted under the methodologies estimating "one in a million".) — Arthur Rubin | (talk) 14:23, 10 January 2008 (UTC)

I think you hit the nail on the head on this, Arthur. ---- Dēmatt (chat) 18:02, 10 January 2008 (UTC)

I think we all agree. My comment to CynRN was poorly worded. I was responding to her alarm that 56% of patients have side-effects. We don't have the article so we don't know what "adverse effects" they are talking about. I mentioned muscle soreness as a trivial side-effect, perhaps even a positive side-effect instead of an "adverse effect". Whatever they are talking about it can't be serious since chiropractic remains viable regardless. Anthon01 (talk) 18:13, 10 January 2008 (UTC)

Just to clarify my position: I have friends, family and co-workers who have been greatly helped my chiropractors. I have never in my posts called chiropractic 'pseudoscience'. Where I come from is that I have personally seen patients hurt by chiropractic neck manipulation. Over and over, I hear in this forum the "one in 5 million" chance of harm. If chiropractors are honest they will admit that the risk of stroke could be, and probably is much higher. I am sure that relief of neck pain could be accomplished with massage, careful mobilization, heat/cold, etc. Why take a chance with someone's delicate vertebral arteries with a "high velocity thrust"? I don't want to see more patients damaged by this particular maneuver. To Arthur, the study I referenced was the Rubenstein, Leboeuf-Yde study. The adverse effects described in the study sound like what would happen if cerebral circulation was interrupted for a time, more than "sore muscles". J Manipulative Physiol Ther. 2007 Jul-Aug;30(6):408-18./entrez/utils/fref.fcgi?PrId=3048&itool=AbstractPlus-def&uid=17693331&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S0161-4754(07)00178-9/entrez/utils/fref.fcgi?PrId=3048&itool=AbstractPlus-def&uid=17693331&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S0161-4754(07)00178-9 Links CynRNCynRN (talk) 23:35, 10 January 2008 (UTC)

Honest is probably not a good word. How are chiropractors to know the odds are greater? You keep affirming that you have seen, but your evidence is anectdotal and far exceeds the numbers in the literature. The issue isn't the vertebral arteries themselves but the condition of the vertebral arteries. The benefits out weight the risks. Would you encourage NSAID consumers to stop taking NSAIDS? BTW, the link doesn't work. Anthon01 (talk) 23:59, 10 January 2008 (UTC)

Methinks you protest too much. The average age of the vertebral dissection patients is 38. It's usually a young, healthy woman. My personal evidence is anecdotal, of course, but why have I seen more than one victim if the incidence is "one in 5 million?" Arguing about NSAIDs is a False Dichotomy, as I have said before. Talking about the risks of auto accidents, likewise. Having neck manipulation doesn't 'immunize' one from the risk of NSAIDs. Who's to say the patient is not taking Advil before his or her chiro appointment? From Physical Therapy Online:"The risks are well documented. Vertebral artery accidents (VBA) leads the list accounting for about 70% of all damage caused by SMT. Following VBA, cauda equina syndrome/ disc prolapse and disc syndrome aggravation make up about 20% of injuries. The remainder are miscellaneous complications including fractures, nerve compression, hemorrhage, cerebral infarcts etc. The incidence of serious accidents varies with the study read. In a literature review through 1993 of all reported cases of spinal manipulation, Assendelft et al (J Family Pract 42(5):475-480 1996) found 295 cases of complications divided as follows: Complication All DC MD DO PT Other Unknown VBA 165 92 15 8 6 10 34 CEREBRAL 13 9 - - 1 1 2 CES & DISC HERNIA 61 11 24 3 2 - 21 OTHER 56 23 3 7 3 2 18 ALL 295 135 42 18 12 13 75 The average age of the VBA patient was 38. The cerebral incidents occurred mainly in the older patient who usually had a pre-existing condition that was not diagnosed. Disc herniation occurred in 56 cases in the lumbar spine with CES usually showing as a progression. Disc herniation occurred 4 times in the cervical spine and once in the thoracic. 49% of the lumbar disc enlargement occurred during MUGA and all cases resulted in surgery.

In a survey of Danish chiropractors, Klougart (J Manip Physiol Ther 19(6): 371-377) 1996) found one complication for every 1.3 million cervical treatment sessions, one for every 0.9 million upper cervical sessions and one in 400 thousand if rotation was used in the upper cervical spine. From this, rotational techniques in the upper spine are four times more likely to produce VBA than non-rotational. Rotation techniques in the lower spine were 2 almost 2.5 times more likely to produce VBA than non-rotational. The report all but recommended that rotational techniques should not be first choice in the upper spine.

In 2006, the Journal of Neurology published a German Vertebral Artery Dissection Study Group report about 36 patients who had experienced vertebral artery dissection associated with neck manipulation [16]. Twenty-six patients developed their symptoms within 48 hours after a manipulation, including five patients who got symptoms at the time of manipulation and four who developed them within the next hour. In 27 patients, special imaging procedures confirmed that blood supply had decreased in the areas supplied by the vertebral arteries as suggested by the neurological examinations. In all but one of the 36 patients, the symptoms had not previously occurred and were clearly distinguishable from the complaints that led them to seek manipulative care. This report is highly significant but needs careful interpretation. Although it is titled "Vertebral dissections after chiropractic neck manipulation . . . " only four of the patients were actually manipulated by chiropractors. Half were treated by orthopedic surgeons, five by a physiotherapist, and the rest by a neurologist, general medical practitioner, or homeopath. It is possible—although unlikely—that the nonchiropractors used techniques that were more dangerous than chiropractors use in North America. The authors suggested that the orthopedists' treatment was safer, but there is no way to determine this from their data. Regardless, the study supports the assertion that neck manipulation can cause strokes—which many chiropractors deny." I think patients should be warned about the small, but serious risk, and should have to sign a consent. CynRN71.198.30.242 (talk) 05:27, 15 January 2008 (UTC) Sorry the tables didn't show in the text above...Google "spinal manipulation, Assendelft et al." To find the Rubenstein, Leboeuf-Yde study, just Google "Benefits outweigh risks, Rubenstein Leboeuf." I would like to see the full "Benefits" study, if anyone can add a link.CynRN71.198.30.242 (talk) 05:34, 15 January 2008 (UTC)

I have never seen a Chiropractor in any Hospital. Do they have internationaly recognised medical degrees? The only chiropractors I have heard of in Europe (Where I live) are in Ireland, where they have a bad reputation and never work in hospitals.86.40.240.104 (talk) 23:38, 12 February 2008 (UTC)

http://hospitaldc.com/

http://www.stmichaelshospital.com/programs/chiropractic/index.php EBDCM (talk) 01:36, 13 February 2008 (UTC)

Chiropractors do not raise stroke risk

As promised, here is a link to the Spine 2008 article which examined neck pain associated disorders:

http://www.spinejournal.com/pt/re/spine/fulltext.00007632-200802151-00004.htm;jsessionid=HSQHcPMSkxnTnTkyrPTzcK6LHhry8QKLFyzlh2L2h08vVBxnfBf2!2092430889!181195628!8091!-1?index=1&database=ppvovft&nav=reference

Of particular importance is the following passage:

Vertebrobasilar Stroke Study Findings There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke.

Hence, there is no difference in association between stroke and DC and MD visits. This suggests that VB strokes are not necessarily caused by SMT or a visit to the DC but that they are already in progress prior to the visit. It should also be noted that there are 2 MDs involved in this study in case the argument of bias comes up. It will be interesting what CynRN and the stroke fear mongers have to say now that the evidence disputes their beliefs.

Furthermore, this study continues to demonstrate that chiropractic care is both safe and cost-effective in comparison to medical care for neck pain disorders. This study must be included in the Safety section. Lastly, the the chiropractic and manipulation skeptics here will have to confront their traditional belief systems and begin to objectively look at the EVIDENCE which is consistently demonstrating chiropractic SMT is inherently safe.

Whether or the decision to manipulate was correct is another story wherein the fault is a the PRACTITIONER and not the PROFESSION (Chiropractic) or a therapeutic modality (SPINAL MANIPULATION).

EBDCM (talk) 05:09, 22 January 2008 (UTC) Thanks very much for posting the Task Force recommendations. I don't agree that the phrase cited above, "similar association..with patients seeking general practitioner services", leads to the conclusion that "chiropractors do not raise stroke risk". I would have to have more details. When a patient, who is having prodromal signs and symptoms of vertebral dissection seeks care from an MD for neck pain, the MD is better able to diagnose this. From the case reports I have read, many chiropractors proceed to manipulate the neck, even after obvious signs of stroke.http://www.self.com/livingwell/articles/2007/04/0507chiropractors_6_of_6 Trying to separate the practitioner from the profession is impossible, since rotatory manipulation is the gold standard for neck pain. Second point: The task force doesn't give manipulation any advantage over mobilization, exercise, laser, or other 'active' therapies, "but none of the active treatments were clearly superior to any other in the short or long term. Educational videos, mobilization, manual therapy, exercises, low-level laser therapy, and perhaps acupuncture appeared to have some benefit." We all have 'belief systems' and bias to some degree. I am endeavoring to focus on studies and, furthermore, look at the studies very critically. Let's just put "There is a small risk of stroke associated with cervical manipulation" under Safety. CynRN71.198.30.242 (talk) 18:55, 23 January 2008 (UTC)

Snip from intro

I've just made a cut from the intro, thought I'd explain further

• "As a direct result of this criticism, as well as the relative dissatisfaction with its medical counterpart, surveys show that chiropractic patients have the highest satisfaction rate among the various healthcare disciplines"

Firstly, one cannot make the claim that it really a direct result. There's no way to verify that statement. It's complete OR. Secondly, the surveys about patient satisfaction presented as verification come from highly partisan sources. It might well be true (or not), but a more neutral publication would be infinitely preferable (eg. BMJ, etc.). After all, just about every CAM claims to have high patient satisfaction, and probably have their own surveys to demonstrate it. Hope that's a succinct summary, thanks. Jefffire (talk) 22:49, 3 January 2008 (UTC)

I thought that promotional OR had been deleted along time ago. -- Fyslee / talk 01:55, 4 January 2008 (UTC)

That OR was placed to balance the OR in the statement above it, so I took that one out, too. -- Dēmatt (chat) 04:03, 5 January 2008 (UTC)

Good point, but you took out a bit too much. I have restored it, but without the OR. -- Fyslee / talk 19:13, 6 January 2008 (UTC)

Okay, here is what the reference states. BTW, Dr. Winterstein was an MD who testified for the AMA in the WIlk suit, so that source should be reliable:

• Since its inception, Chiropractic has been the subject of controversy, criticism, and outright attacks regarding the metaphysical approach that the early profession had taken. This same criticism may well have been the catalyst that allowed the profession to take a more neuromuscular approach in their educational standards, leading them away from the more metaphysical explanations of their predecessors.^[3][4]

I went ahead and put it in, but am open to variations. -- Dēmatt (chat) 01:35, 7 January 2008 (UTC)

Beautiful work! A great improvement. BTW, the quote is good, but needs to be attributed (was it the AMA's attorney who said that?) -- Fyslee / talk 07:53, 7 January 2008 (UTC)

It was the AMA's attorney:

The AMA acknowledges that, after the Committee on Quackery disbanded, chiropractic improved (and the AMA takes partial, credit for it). For example, Mr. Carlson, one of the AMA's trial attorneys stated in final argument:

Dr. Winterstein testified that chiropractic has changed. And it has changed. And we suggest that one reason that it changed was because of the criticism of its bizarre methods. Now, do you hear in this courtroom anything about one cause/one cure? Sure don't. You hear about neuromusculo reasons, neuromusculo diagnosis, neuromusculo conditions. This is the new parlance. They have done away, for the most port, with the one cause/one cure. I understand there is one small element of chiropractic that still adheres to it. But it's not the major element. ... And they have improved ... Chiropractic, I think is still changing. It began really changing when the accrediting arm of the ACA (American Chiropractic Association), as opposed to the ICA (international Chiropractic Association), was accepted, was recognized by the Department of Education as the sole accrediting body for chiropractic.

The quote needs to be exact, especially since Winterstein was James Winterstein, D.C., not an MD. At least he is the only Winterstein named in that document. -- Fyslee / talk 08:09, 7 January 2008 (UTC)

I would remind you that large portions of the Chiropractic profession still utilise magical language, not all have gone scientific. As it stands the intro intimates that they have, so it'll need to be changed. (I'll just add that your being a bit american centric at the moment, there are a number of practices I've seen in the UK taking a blatent magical approach, which makes me wonder about the rest of europe) Jefffire (talk) 08:31, 7 January 2008 (UTC)

I agree with you. Your amendment is fine. -- Fyslee / talk 15:00, 7 January 2008 (UTC)

The clarifying changes look good to me as well, Jefffire and Fyslee. Sorry about the Winterstein debacle.. chalk it up to reading too much of this stuff! -- Dēmatt (chat) 20:32, 7 January 2008 (UTC)

Rearranged a bunch

I made an effort to rearrange the article by putting the things I think readers would want to know further up and moving the historical stuff downward some. I also consolidated some of the DD information that seemed to be repeating itself. It did it in such a way that it can be reverted if anyone is not happy with the re-arrangement. I don't think I changed the meanings, but do feel free revert it all if it doesn't look good. -- Dēmatt (chat) 04:55, 5 January 2008 (UTC)

I like your changes. Its got a better flow now, good job. :) --Hughgr (talk) 08:08, 6 January 2008 (UTC)

I think these two sections should still be immediately after the lead:

• Origins of Chiropractic and evolution of the concept of subluxation
• History

Without it readers jump into the subject without the necessary background for understanding what they are reading. Your original ordering of those two sections was actually quite logical. Otherwise some good changes. -- Fyslee / talk 19:11, 6 January 2008 (UTC)

I took another look and agree we can move them higher, but I still think that the reader will want to know what chiropractic is now before they read about what it was. The section on the chiropractic approach right after the lead explains the way a chiropractor looks at health - even includes some of the "wholistic" stuff that makes it controversial. Then it goes to treatment methods and then I moved the Origins and History above the Science and Safety. What ya think... I also think we should just take out the WebMD stuff and get rid of the NPOV tag altogether. Meanwhile, how close is this to becoming a FA? -- Dēmatt (chat) 01:50, 7 January 2008 (UTC)

I think it looks great. I'm not sure about the FA bit, but it's an excellent article, one of the best, and in large part thanks to your efforts. BTW, when are you going to run for adminship? You've got my vote. Another matter....what about developing the treatment article? It's pretty rough right now and deserves some attention. -- Fyslee / talk 07:56, 7 January 2008 (UTC)

My problem is that I am not real familiar with a lot of these treatments. I was hoping others would jump in that do know more about them. -- Dēmatt (chat) 20:34, 7 January 2008 (UTC)

Chiropractic Canada: Article RfC

See: Talk:Chiropractic_Canada#RfC:_Justification_for_article.3F -- Fyslee / talk 04:54, 9 January 2008 (UTC)

Is there any consensus with this or is this simply Fyslee's idea to kill the article? —Preceding unsigned comment added by 208.101.89.150 (talk) 00:11, 10 January 2008 (UTC)

This is just an RfC. I would like to get comments from others. That's how things are done here. -- Fyslee / talk 07:48, 10 January 2008 (UTC)

Tendency Toward Quackery

I have noticed, in my recent research on chiropractic, that there is a lot of hokum on individual chiropractor's websites. I see homeopathy, anti-vaccination rants, and applied kinesiology, just to name a few. Do the national organizations of chiropractors exert any influence on their members to keep them from "crossing the line"? CynRN71.198.30.242 (talk) 05:47, 15 January 2008 (UTC)

Not to my knowledge, except the Danish Chiropractic Association, which has distanced itself from homeopathy and AK, but especially AK. -- Fyslee / talk 06:32, 15 January 2008 (UTC)

My research shows that there are some MDs who also practice homeopathy, applied kinesiology, are anti-vaccination... Do you know if the AMA exert any influence on their members to keep them from "crossing the line"? -- Levine2112 ^discuss 05:50, 15 January 2008 (UTC)

Levine2112, MDs are not the subject. She asked a legitimate question. Keep on track. -- Fyslee / talk 06:32, 15 January 2008 (UTC)

I have no idea if they exert any influence and in turn I was wondering if the AMA exerts such influence. How is that not on track? -- Levine2112 ^discuss 06:59, 15 January 2008 (UTC)

It just came off as a diversionary tactic, one I've seen many times on chiropractic websites and discussion lists. Instead of dealing with criticism, it is deflected onto others. A common one is by deflecting criticism of upper cervical manipulation into an attack on the side effects of pharmaceuticals and neck surgery. I'll AGF and hope that wasn't your intention. It just looked that way. Criticisms should be dealt with. -- Fyslee / talk 07:09, 15 January 2008 (UTC)

What criticism? -- Levine2112 ^discuss 07:44, 15 January 2008 (UTC)

If I may be so bold as to criticise, but there often seems to be a blind spot amongst the "materialist" chiropractors about the sheer numbers of proponents of unrelated quackery in their community. I'm thinking about anti-vaccinationists, HIV deniers, big pharma scares and so-forth. I appreciate that the present company takes a scientific view, but it does seem that such a view is unrepresentative at times. Jefffire (talk) 09:13, 15 January 2008 (UTC)

What is the basis for your assessment of this "blind spot"? -- Levine2112 ^discuss 21:30, 15 January 2008 (UTC)

A)The fact that such anti-scientific individuals clearly exist in large numbers in chiropractic circles

B)The fact that they are rarely called up on their bs claims by their colleagues (as exemplified by yourself currently, do you deny they exist or what?)Jefffire (talk) 22:29, 15 January 2008 (UTC)

A) I wouldn't call them "anti-scientific".

B) I am not a chiropractor.

-- Levine2112 ^discuss 22:50, 15 January 2008 (UTC)

P.S. I had never heard of widespread HIV-denialism in chiropractic until you brought it up here. Where do you get your information? All of the research I have done has shown that chiropractic not only recognizes HIV, but is used to treat carriers to improve quality life. Here are some links which discuss treatment in the hospital setting and in clinical research: [1] [2] [3] [4] [5] [6]. Finally, here is the ACA's official stance:

1. "No patient should be denied chiropractic care based on real or perceive risk for HIV infection."
2. "HIV-infected chiropractors should not be restricted assuming they are capable of performing their duties in a responsible manner."
3. "Confidentiality of the HIV infection status of patients and staff must be maintained with disclosure limited to situations defined by local laws, statutes or regulations

Clearly, the ACA (the largest chiro organization) recognizes HIV/AIDs. They can't speak for every practitioner, but they do represent more chiros than any other org. I am now thinking that "AIDs denialism" in chiropractic is yet another overblown attack on the profession (similar to the overblown upper-cerv. risk stats, which at worst present an unsupported 0.00002% chance of serious risk.) -- Levine2112 ^discuss 23:20, 15 January 2008 (UTC)

And homeopathy, vaccine denialism and other stupidities? Do they speak up about those as well? Jefffire (talk) 08:33, 16 January 2008 (UTC)

The short answer is that I don't know. I can't say that I personally ever heard of a chiropractor working with homeopathic remedies (though I do know of several MDs [7] [8] [9] [10] and DOs ). That said, I remember a statistic from a while back (I think it was from the ACA) which stated that only about 5% of chiropractors work with homeopathy. Again, it was from a number of years ago. And I've never heard of a chiropractor who practices "vaccine denialism". Have you? Please elucidate with a reference of some kind. However, even the arguments listed in our own Wikipedia article on the subject does make me even pause for consideration. One more thing, I believe the use of the word "stupidities" in the context which you have provided comes off as a bit hostile (not necessarily to me, but perhaps to any of the two hundred-plus homeopathic practicing MDs/DOs listed here). -- Levine2112 ^discuss 18:06, 16 January 2008 (UTC)

Actually, I must say Levine has a good point. Many MDs, who should be expected to have a scientific viewpoint, are using homeopathy. My former veterinarian offered me homeopathy for my sheltie. I was offended and declined in no uncertain terms! Unfortunately, a huge percentage of Americans cling to 'magical thinking' and unscientific ideas. (I can back this up with studies and stats). Physicians have jumped on the bandwagon of CAM to increase patient satisfaction, I suppose. I had a hard time finding statistics, but it seems that about 37% of chiropractors use homeopathy (based on article below). It would be easy to do a quasi-scientific study 'Of those chiropractors (and MDs) who have websites, what percentage offer homeopathy?' 'Homeopathy: A Position Statement By The National Council Against Health Fraud Edited by William Jarvis The 1993 directory of the National Center for Homeopathy (Alexandria, VA) lists about 300 licensed practitioners. About half of these are physicians. The rest are mostly naturopaths, chiropractors, acupuncturists, veterinarians, dentists, nurses, or physician's assistants. A homeopathic marketing firm spokesperson believes that several hundred more consider themselves to be homeopaths, and that many conventional physicians utilize one or more homeopathic remedies (National Board of Chiropractic Examiners, 1993). However, no data have been published supporting these estimates. In 1991-2, 36.9 % of chiropractors reported using homeopathic remedies in their practices. http://www.logosresourcepages.org/NewAge/homeopos.htm CynRN71.198.30.242 (talk) 20:17, 16 January 2008 (UTC)

Here's some data from a slightly more recent source, though still dated: DCs report that 96 percent of their patients are treated with spinal manipulative therapy/adjustment, while nearly 56 percent receive physiotherapeutics, such as EMS or ultrasound, 47 percent receive soft-tissue massage, and 45 percent receive moist heat or ice. More than 23 percent of patients receive nutritional counseling from their doctors of chiropractic, and approximately 5 percent are given either acupuncture or homeopathy in the chiropractic office. Summary of the 2000 ACA professional survey on chiropractic practice, Journal of the American Chiropractic Association, Feb 2001. This article has some other stats and info which you all might find interesting. Anyhow, it does show that a relatively small percentage of patients receive acupuncture/homeopathy from chiropractors while the vast majority are receive joint manipulation/physiotherapeutic/nutritional counseling treatment for musculoskeletal conditions - all well within the scope of a scientific-based practice. -- Levine2112 ^discuss 20:58, 16 January 2008 (UTC)

I was thinking more of referrals rather than actually practicing such methods in their practice. It would be rather surprising if more than 5% actually did it themselves. For your digestion, [this survey] at least suggests that a "significant minority" hold views describable as anti-vaccinationist as recently as 1992, and I'm not aware of any kind of purge of such people by the major chiropractic organisations. And yes, I would describe an MD practicing homeopathy as utilising a stupidity, and it is quite proper to be hostile to such quackery. Why would the nature of their medical degree dissuade me from critising it? In any case, you've demonstrated quite clearly the blind spot I was referring to, so I don't see any need to continue. Jefffire (talk) 08:35, 17 January 2008 (UTC)

The issue of homeopathy is not settled. There are published studies that support and contest homeopathy. The government is currently spending money to research aspects of homeopathy, based upon the results of preliminary studies. Anthon01 (talk) 14:08, 17 January 2008 (UTC)

I believe this to be false, except for some studies about certain substances at "potency" levels of no "more" than 6X or 4C. The published studies I've seen have been shown fraudulent. — Arthur Rubin | (talk) 18:30, 17 January 2008 (UTC)

(unindented)
Here is a recent study published in highly regarded Chest journal using C30. [11]. The 3 listed trials are using C30 dilutions.

• Effect of the Homeopathic Remedy Kalium Bichromicum (Potassium Dichromate) on Viscosity and Amount of Sputum and Time to Extubation in Mechanically Ventilated ICU Patients.
  
• Efficacy Study of Homeopathic Potassium Dichromate to Treat Tracheal Secretions in Critically Ill Patients
  
• Effect of Homeopathic Remedy Kalium Bichromicum on Viscosity and Amount of Sputum Mechanically Ventilated ICU Patients.
  

There are currently 11 open homeopathy trials. Anthon01 (talk) 18:44, 17 January 2008 (UTC)

Let consider moving this to the Homeopathy talk page. If all this is about is that some chiropractors sometimes refer their patients to homeopaths, then it isn't really notable or all that relevant to this talk page. -- Levine2112 ^discuss 18:55, 17 January 2008 (UTC)

Hmmm. They seem reputable, even though the seminal (in modern science) Jacques Benveniste paper seems to have been discredited. I accept that studies are being done, whether or not there is any reputable theory which suggests the studies should have non-null results. Nonetheless, there is even less scientific or pseudo-scientific evidence that homeopathy "works" than that chiropractic "works" (for suitable definition of "works"), and, if Chiropractors generally accepted or used homeopathic techniques, that would generally tend to discredit the profession, so this discussion is not completely inappropriate for this article. (This first study doesn't make it clear whether the "placebo" group was given "globules" of any sort; if not, that would be a severe flaw in the study in terms of homeopathy. A proper test would require potassium dichromate globules, something mixed similarly with no attempt to add potassium dichromate, and something which (according to homeopathic theories) would have the reverse effect to potassium dichromate, also mixed in the same manner. The mechanical mixing process could easily lead to appropriate clinical effects.) — Arthur Rubin | (talk) 19:12, 17 January 2008 (UTC)

Some, but not all, of the controls I would think necessary were included in the study. It doesn't appear that 30"C" dilutions of water in water were done in the control globules, which I think might make a difference as to microscopic air bubble sizes within the water, if nothing else. — Arthur Rubin | (talk) 19:17, 17 January 2008 (UTC)

Please read this discussion as citations referred to which show that a tiny minority of chiropractors were using homeopathy in the past and the trend indicates that the percentages were dropping. There is absolutely no reference presented here which supports your if statement, making this discussion of the scientific merits of homeopathy wholly irrelevant for this article. -- Levine2112 ^discuss 19:22, 17 January 2008 (UTC)

• The first study says Same-sized globules for placebo in group 2 were impregnated with the same water-alcohol diluent used for the preparation of the globules in group 1, without inclusion of any drug. Placebo globules exhibited the same appearance as the homeopathic globules and were therefore indistinguishable from the globules of group 1 according to the double-blind design of the study. Neither patients nor members of the critical care team or members of the study group knew whether the globules administered to the respective patient belonged to group 1 or group 2.
• Providing reverse effect to these patients would be unethical.

• And you think air bubbles will persist over the course of time? "And does mechanical mixing process could easily lead to appropriate clinical effects."

Levine? Lets move if all agree. Anthon01 (talk) 19:27, 17 January 2008 (UTC)

Discussion seems to have moved from Talk:Homeopathy to Talk:Potassium dichromate#COPD .... But the mixing could leave persistent microscopic air bubbles, remove trace materials from the water or add trace materials from the mixing vessels, etc. Remember polywater? — Arthur Rubin | (talk) 20:17, 17 January 2008 (UTC)

I did not think this discussion would devolve into a debate over the merits of homeopathy! My point was that chiropractors tend to use non-evidence based modalities. Regarding the "summary by ACA of chiropractic treatments (Paraphrase" cited by Levine, I suspect that homeopathy may be used in 5% of "visits". Here is an estimate by David Prescott, a chiropractor and attorney writing in The Chiropractic Journal in August 2007:"It is important to note at the outset that the National Board of chiropractic Examiners in a 1993 "Job Analysis of chiropractic By State" demonstrated (to a 95% statistical certainty) that between 36.5% and 49.3% of California chiropractors were using homeopathic remedies as of 1993." Maybe it's just California?http://www.worldchiropracticalliance.org/tcj/2007/aug/prescott.htm CynRN71.198.30.242 (talk) 17:44, 18 January 2008 (UTC)

Do you have something to discuss on this topic with regards to editing this article? -- Levine2112 ^discuss 17:54, 18 January 2008 (UTC)

The reference by Jarvis that 71.198.30.242 placed above mentions a North Carolina case.. homeopathy was basically outlawed for chiropractors that year as well as for MDs.. the only people that can practice it are NDs, I believe. But, I do want to make sure everyone understands that 1993 was 15 years ago and things have changed a lot.. they treated depression with Valium back then. However, California certainly has a more liberal law that may even allow obstetrics and gynecology for chiropractors, similar to Oregon that allows minor surgery procedures. The thing that we all have in common is that we do look at health from a holistic perspective, with perhaps the exception of the 'so-called' reform group. -- Dēmatt (chat) 00:54, 19 January 2008 (UTC)

To answer the question, "do I have a suggestion for edit?", it is this: "Homeopathy is allowed for chiropractors in 19 states, and is frequently offered to patients". I don't see it mentioned that herbal, vitamin and homeopathic remedies are very often offered along with manual therapy. IMO this is an important point. CynRN71.198.30.242 (talk) 06:21, 23 January 2008 (UTC)

Evidence-Based Updates on non MSK conditions: What does the recent literature suggest?

Undoubtebly one of the most contentious aspects of chiropractic care is the treatment of non-MSK disorders via manual treatment, specifically SMT. When reading the article is really dated with regards to the evidence of DCs treating non-MSK. Significant research has been compiled by the CCPG (USA) with respect to this topic and it is by far the most thorogh look at the literature as it pertains to chiropractic care for non MSK issues and the levels of supporting each for various conservative interventions.

There are also excellent clinical chiropractic guidelines on the treatment of mechanical neck pain not due to whiplash published by the Canadian Chiropractic Association. These sets of guidelines, prepared by a majority of DC/PhDs, have already carefully investigated the literature and make formal recommendations based on the evidence. These guidelines, done in 2007 and 2006, respectively should be included especially when dealing with controversial topics such as infantile colic, dysmennorhea, otitis media and other non-MSK complaints. —Preceding unsigned comment added by 208.101.89.150 (talk) 08:36, 19 January 2008 (UTC)

What is it that you feel needs to be added? ---- Dēmatt (chat) 06:09, 20 January 2008 (UTC)

I think that sections dealing with chiropractic care and non NMS conditions should use the most recent synthesis of evidence to get a better understanding on the validity or lack thereof of manipulation and other interventions for non NMS management by DCs.

http://www.ccgpp.org/view.htm —Preceding unsigned comment added by 208.101.89.150 (talk) 07:41, 21 January 2008 (UTC)

edits by anonymous 208

I think that with a little work, these multiple edits don't make significant changes in content, but do improve the article somewhat, so I'm okay with them. I would be willing to discuss some of them. -- Dēmatt (chat) 07:08, 20 January 2008 (UTC)

Good. Where to we begin? There is a lot of duplication in the article and a lot of information that needs modernizing given that there has been much more research published that gives a more accurate description of chiropractic practice and the professional directions in 2008. I also think that there should be an increased focus on non-USA chiro developments that would provide a better world wide POV.

What do you guys think? —Preceding unsigned comment added by 208.101.89.150 (talk) 07:34, 21 January 2008 (UTC)

I do agree that in the last five years there has been a shift to evidence based practice just as in medicine, but we can't just put our opinions in, we will need WP:verifiable and reliable sources. I also agree that this article badly needs a world view. Our problem is that we are already over the limit on size, so I suppose we are likely talking about small blurbs on this page, then linking to other articles specifically for each country, sort of like the one that you are defending in the RFC, Chiropractic Canada. Meanwhile, I think some of the cleanup edits that you made were good edits. If everyone else is okay with them, I will go ahead and put them in. -- Dēmatt (chat) 04:04, 22 January 2008 (UTC)

I agree with Dematt about him adding them. He can always be trusted to do the right thing in every way. I would add a caveat (or whatever it's called) regarding recent advances in the profession. Yes, they are happening, but at very different rates depending on the nation and school. They unfortunately don't negate the fact that the great majority of (older?) chiros are still products of their time, education, and mindset, which many younger and more evidence based chiros find unfortunate. In this they are adopting the mindset of the scientific and medical communities, as well as that of chiroskeptics. They would like to see reform, but they are often getting flack from their seniors, mentors, professors, and leaders of the associations (most notably the ICA and WCA). So, since this article deals with all aspects of chiropractic (except its future), we can't delete or hide the fact that there are wide differences in current practices and beliefs, with a minority of younger and progressive chiros trying to make their voices heard in a profession still dominated in many areas by their "old-fashioned" peers. IOW we can't paint an "ideal" or "wishful" or "predictive" picture. Tell it like it is. Just use all the V & RS there are, cost what it may. With time the V & RS will paint a different picture and the well-sourced descriptions of the objectionable aspects of the profession that are current realities will get moved to the "History" section of the article, and the wording changed accordingly from present tense to past tense. I think that will be a happy day for all concerned parties here! More about all this.... -- Fyslee / talk 05:05, 22 January 2008 (UTC)

Great post, Fyslee. I agree. Out of curiosity, what are the membership rates of the WCA and ICA vs ACA? I think we're unique and lucky in Canada that has 1 national organization (CCA) that can set some coherent policies and present a unified voice. Again, I'm genuinely looking forward to bringing a scientific viewpoint to "alternative" therapies. EBDCM (talk) 07:32, 22 January 2008 (UTC)

It's been awhile since I looked at this. I think that the ACA has about 25% of American chiros as members. The WCA and the NACM have had numbers in the low hundreds, or under 2%. Most American chiropractors are not members of any organization. I'm not sure of the WCA, but it is a minor player. Unfortunately (IMO), the ICA and WCA have much more influence than their membership numbers would indicate, and they are very active and filled with activists. They represent the "original" chiros. Here is an old quote:

• "There are two significant, well-established national chiropractic trade associations. The largest is the American Chiropractic Association (ACA), which is believed to include about 25 percent of chiropractors in the United States as members. The ACA (and its precursor organization the National Chiropractic Association) has historically been associated with a broad-scope approach to chiropractic practice and appears to be most representative of the mainstream of the profession. The International Chiropractors Association (ICA) is primarily a U.S.-based alternative to the ACA and has a much smaller membership (believed to count between 5-10 percent of chiropractors among its dues-paying members). The ICA tends to position itself as representative of members with more traditional chiropractic perspectives. A few other national groups identify with more extreme perspectives. The National Association of Chiropractic Medicine (NACM) supports limiting chiropractors to only the treatment of certain musculoskeletal conditions, while the World Chiropractic Alliance (WCA) promotes addressing only a single chiropractic spinal lesion, the vertebral subluxation. However, both organizations are proprietary (as opposed to being representative of their memberships) and have a very small number of members (believed to be in the low hundreds)." [12]

I hope that helps. -- Fyslee / talk 07:58, 22 January 2008 (UTC)

lede/lead changes

Hi EBDCM, I assume you are 208? I returned the lead to the previous format without changing your words. The lead needs to conform to WP:Lead and give a synopsis of what is to follow. It also needs to be NPOV.

Also, I have removed this sentence, not because I don't like it, but I realized that it has changed so many times since it was first placed that it no longer represents the referenced source. We need to find new rferences or re-write the sentence:

• While traditional chiropractors use the term vertebral subluxation and espouse a limited scope of practice (correcting the vertebral subluxation), contemporary chiropractors are differentiated by their broad scope approach and concentrate primarily on the neuromusculoskeletal components of spinal injury and rehabilitation of the spine.^[5]

Can you find anything to support what you are saying? Also, I think the word "limited" used above is a judgement made on our part. IOWs, some people think vertebral subluxation is the "broad" approach and the NMS approach is the "limited" approach.

-- Dēmatt (chat) 16:12, 22 January 2008 (UTC)

Perspective Attribute	Potential Belief Endpoints
Scope of practice:	narrow ("straight") <-- --> broad ("mixer")
Diagnostic approach:	intuitive <-- --> analytical
Philosophic orientation:	vitalistic <-- --> materialistic
Scientific orientation:	descriptive <-- --> experimental
Process orientation:	implicit <-- --> explicit
Practice attitude:	doctor/model-centered <-- --> patient-situation-centered
Professional integration :	separate and distinct <-- --> integrated into mainstream
Table 2. Range of Belief in CHiropractic Source: Phillips RB, Mootz RD. Contemporary chiropractic philosophy. In Haldeman S (ed). Principles and Practice of Chiropractic, 2nd Ed. Norwalk, CT: Appleton & Lange, 1992. Chart reprinted from Keating J (1995), D.D. Palmer's Forgotten Theories of Chiropractic[13]

Dematt,

I can see your point. I think I read it from a paper by Reed Phillips here http://www.ncschiropractic.com/ahcpr/part2.htm which suggested it was narrow scope. I would also like to see the 'beliefs systems' chart incorporated into the article and cutting down on the straight vs. mixer section. The chart is clearer, more concise and IMO fairly illustrates the different viewpoints in a succinct manner. Comments? EBDCM (talk) 02:44, 25 January 2008 (UTC)

I put together the chart. Interesting, there is a paradox here that needs explaining. The chart shows that straight is "narrow" such as you describe, which one would think means that the potential patient conditions treated would be narrow, but in reality, they believe in treating everybody, no matter what the condition. Whereas, the "broader" chiropractor (and the other extreme) restricts his/her practice to musculoskeletal problems that could be construed as "narrower". I think we need to make sure this distinction comes out somehow. I wonder if subluxation based chiropractors consider their scope narrow. -- Dēmatt (chat) 03:18, 26 January 2008 (UTC)

Right on and very discerning. Yes, straights "treat narrowly" (only the spine and subluxations), but "apply broadly" (to all health problems in the whole body). That's the classic "one cause, one cure" ultra straight position as advocated by DD and especially BJ, who developed the extreme form, in which only the upper cervicals - Hole-In-One technique (HIO) - needed to be adjusted. They operate using only one diagnosis, as epitomized by Sid Williams of Life University "fame". He taught students to ignore medical diagnoses because they knew that their patients only suffered from one pathology, diagnosed as the vertebral subluxation. That cost Life its accreditation for a time. Modern "broader" chiros are much more like the rest of the health care system, dealing with different pathologies, using varying diagnoses and different methods. Because their education still teaches them much about adjustments as a major method of dealing with many neuromusculoskeletal issues, they usually specialize in NMS issues and still use adjustments alot. Their chances of successfully cooperating with MDs and others is much greater than can be achieved by straights, and they also make chiropractic seem more reasonable to the mainstream.

Samuel Homola, DC, has just written an article for Skeptical Inquirer, which speaks directly about these matters. Well worth reading:

• Chiropractic - A Profession Seeking Identity. "The chiropractic profession is resisting changes that will establish it as a back-pain specialty while seeking an identity that will continue to allow chiropractors to treat a broad scope of health problems."^[6]

-- Fyslee / talk 03:37, 26 January 2008 (UTC)

Mobilization vs Manipulation

It seems that the practice of cervial manipulation is given more credit than it deserves, considering the risks. From Grieve's Modern Manipulative Therapy, 2005, p 536-537, "Complications of Cervical Spinal Manipulation by manipulative physiotherapists in Australia were mainly associated with...rotation." (Grimmer 1998)and "Because of this growing evidence manipulation using end-range rotation is generally not recommended, particularly in the upper cervical spine (Assendelft et al 1996, Carey 1995, DiFabio 1999, Gutman 1983, Michaud 2002, Terrett 1987)Yes, I know this talks about PTs, but it is generally accepted that rotation is what chiropractors do! This indicates that mobilization, although not free of risk, is just as effective: The Cochrane Collaboration updated their systematic review, Mobilization and Manipulation for Mechanical Neck Disorders and published it in April 2004. This review of 33 trials concluded that people with neck pain and people with neck pain and a headache lasting over one month who were treated with a multimodal program that included exercise plus either mobilization or manipulation had both better outcomes (pain and function) and higher perception of treatment effects than those who received no treatment.The evidence “did not favour manipulation and/or mobilisation done alone or in combination with various other physical medicine agents; when compared to one another, neither was superior.” http://www.cochrane.org/cochrane/revabstr/AB004249.htm CynRN71.198.30.242 (talk) 07:42, 23 January 2008 (UTC)

What risk? Anthon01 (talk) 12:54, 23 January 2008 (UTC)

Dematt's defence of the top

I propose we say Chiro is an "alternative medicine aiming to" etc. Dematt doesn't like this and claims consensus for his formulation chiro is an "alternative health care profession whose purpose is to" etc. I dispute there is consensus. I maintain my formulation is more concise, better gramatically and therefore more encyclopedic. I cannot understand why Dematt opposes. Pls discuss. Mccready (talk) 07:34, 24 January 2008 (UTC)

I don't like your edit either. And it looks like Levine doesn't either because he reverted you. Let it go man!--Hughgr (talk) 08:17, 24 January 2008 (UTC)

This is no way to behave Hugh. It's not a matter of your personal preference or mine. It's a matter of creating a good encyclopedia. Pls discuss rationally. We now have you and Levine (known as supporters of Chiro) reverting with no or inadequate discussion. I will revert once more before taking this to AN if needed. Mccready (talk) 08:28, 24 January 2008 (UTC)

I have just found this exchange on Hugh's talkpage "Hughr, Just thought "whose aims are" sounded a little more educated and more professional. Steth 20:11, 14 June 2006 (UTC)

I tried to get rid of the "aim" word a long time ago. Mccready put it in and kept reverting it back.--Dematt 20:25, 14 June 2006 (UTC)" It would appear that you have some objection to the form of the verb which allows the redundant "purpose" etc to be removed for concision's sake? Mccready (talk) 08:35, 24 January 2008 (UTC)

Mcready,

This statement comes from the WFC directly. It should be left as is, IMO. EBDCM (talk) 20:52, 24 January 2008 (UTC)

Agreed. McCready, I hope you are starting to understand that there is in fact a consensus here and with good reason. -- Levine2112 ^discuss 20:54, 24 January 2008 (UTC)

I don't like aims either, as it doesn't sound encyclopedic to me, and it sounds like it 'aims' to denegrade the profession. ;-) Anthon01 (talk) 03:47, 25 January 2008 (UTC)

You can't make consensus by stating there is when there isn't. Pls check the meaning of the word. Aims is a perfectly normal word. You will need to produce evidence, other than the idiosyncrasies of chiros and fellow travellers, that it is used in a derogatory fashion, or that a general reader would view it this way. You need to provide a cite for you WTC claim. Then you need to show what wiki principle means we should accept their definition above any other. Interesting to note that the OED, despite attempts by some chiros to move themselves to science based practices instead of the founder's hoodoo vooodoo, says chiro "practises or is concerned with the curing of disease by manipulation of the structures of the human body, esp. those of the spinal column." The head really should acknowledge the percentage of chiros who actually believe they can cure serious diseases. Further argument to support my case is that the "alternative" hyperlink currently there takes the reader to alternative medicine. So, further, you need to explain why not have the hyperlink read alternative medicine. BTW Hugh, you owe me an apology for your mistaken accusation that I had reverted contrary to wiki rules. Mccready (talk) 05:54, 25 January 2008 (UTC)

I believe that you will find that little to no chiropractors make the claim that they can cure any disease. A very basic tenet of chiropractic is that only the body cures. Question for McCready, what is wrong with the current wording and why do you believe specifically your version is better? -- Levine2112 ^discuss 06:21, 25 January 2008 (UTC)

Read the top of the section Levine. Then do me the honour of answering the issues raised. ie you may be able to suggest wording that would satisfy us both using alternative medicine and purpose/aim. Over to you. Mccready (talk) 12:06, 25 January 2008 (UTC)

Mccready,

To be frank your edit and approach to this is disingenious. While you a clearly a chiroskeptic, and are entitled to be, modifying the opening lead which is a direct quote of the World Federation of Chiropractic representing the viewpoints of over 100 national organizations is neither necessary nor acceptable. Their aforementioned WFC definition of chiropractic is in itself a consensus statement and your edit has been voted down by the majority of the wikipedia chiropractic editors.

To be frank, I call a spade a spade. You seem bent on trying to discredit chiropractic and CAM therapies in general by adopting a very rigid approach, not unlike the dogma present in some chiropractic circles. Regardless of your personal BELIEFS, unless you are willing to increase your understanding of current trends in the CAM professions then your input and consequently, impact, will be limited here. 208.101.89.150 (talk) 22:12, 25 January 2008 (UTC)

Hi Mccready, I agree that the constuction of the current sentence is not optimal:

• Chiropractic (from Greek chiros and praktikos meaning "done by hand") is an alternative health care profession whose purpose is to diagnose and treat mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health.

The problem is that yours isn't any better and therefore is not worth changing without reaching a new consensus. Specifically, this sentence (and yours) is really not grammatically correct. A diagnosis is not something that anyone "aims" to do or "whose purpose" is to perform. You either diagnose or you don't diagnose. Here's the definition of diagnosis:

1. The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data.

2. The opinion derived from such an evaluation.

1. A critical analysis of the nature of something.

2. The conclusion reached by such analysis.

A person doesn't have a purpose to have an opinion derived from an evaluation. A person just has an opinion. A person doesn't aim to make a critical analysis of the nature of something. They just make the critical analysis. The word "diagnosis" already encompasses the "opinion" portion of the educated guess. It in no way assumes that any doctor's opinion is correct, only that he has stated his opinion based on the information at hand. The diagnosis is constantly changed as more information is advanced, i.e. the working diagnosis is the temporary diagnosis that we work with until new information causes us to change it. For example, if I diagnose non-specific low back pain, I have made a preliminary diagnosis. I haven't aimed to make a diagnosis, I just made it. As things don't progress as hoped, I might order an MRI and find a protruded disc. At that point, I would upgrade my diagnosis to lumbar intervertebral disc syndrome. This says nothing about whether this is what is causing the patient's problem, only my educated guess. So when we say that an medical doctor aims to make an educated guess, that just rubs me as not only wrong, but makes the writer look ignorant - just as if we were to say a medical doctor's purpose is to diagnose and treat something. That is not his purpose, he just diagnoses and treats. He may be totally wrong and his treatment may be totally crankish, but we have no idea what his purpose is. If we were to evaluate what his purpose was, I would think it is more accurate to say that his purpose is to help people in the best way he knows how.

So you see, this is not my sentence. This is a consensus sentence that was forced last year by someone wanting to add "aim" and others finally gave in to "whose purpose" as an olive branch. But I would be glad to drop "aim" and "whose purpose" and just leave it as "Chiropractors diagnose and treat ..."

I hope that helps. ---- Dēmatt (chat) 04:18, 26 January 2008 (UTC)

To 208.101.89.150 I repeat. You cannot claims consensus that doesn't exist. Check wiki policy. We at wiki do not need to accept at face value the self serving definitions that subjects of our articles may come up with. To Dematt, you thinking is logically flawed. Of course you can aim to diagnose. Of course it isn't black and white. You ack this yourself with your own category of "preliminary". My formulation is better because it is shorter and removes redundancy. "Health care profession" is redundant. Simple as that. Chiro is an altmed. Simple as that. The link links to altmed. Simple as that. Could you please suggest a set of words we might all agree on? Mccready (talk) 05:46, 27 January 2008 (UTC)

Mccready, your rebuttal does not suffice in rejecting my response. "Preliminary" is not a substitute for "aim". Try again. Meanwhile, the current version is acceptable unless everyone agrees that there is no need for the words "whose purpose is". -- Dēmatt (chat) 07:09, 27 January 2008 (UTC)

D, and you still owe me an apology, "aim" to do something is the same as having a purpose to do something is it not? My formulation is more concise. You have failed to address the other points I makde. Pls do so.Mccready (talk) 09:36, 27 January 2008 (UTC)

Mc, if I hurt your feelings I am sorry, why do I owe you an apology? I don't recall doing anything? Regardless, I see that you agree that neither "aim" or "whose purpose" is appropriate. You might have missed what I wrote. I'll restate my formulation from above:

• So you see, this is not my sentence. This is a consensus sentence that was forced last year by someone wanting to add "aim" and others finally gave in to "whose purpose" as an olive branch. But I would be glad to drop "aim" and "whose purpose" and just leave it as "Chiropractors diagnose and treat ..."

I'm not sure, but I believe that someone that we were trying to accomodate was you. -- Dēmatt (chat) 17:02, 27 January 2008 (UTC)

Sorry Kevin, aim and having a purpose are not even close to being synonymous. And, accordingly, your formulation is NOT more concise. Your personal opinions notwithstanding, it seems fairly obvious that you want you have no interest in collaborating with the rest of the editors here and want to steam roll your edits.

IMO, you really don't have any credibility and your antagonistic demeanour simply reinforces my observations. 208.101.89.150 (talk) 15:52, 27 January 2008 (UTC)

I don't know what thesaurus the anonymous 208.101.89.150 uses. But you are simply wrong, as the proposal by Dematt would indicate. Your gratuitous opinion on my credibility is laughable. Dematt I am not happy with "Chiros diagnose and treat" for the reasons I've already stated. Sometimes the diagnoses is wrong. Your proposal would lead a reader to assume that the diagnosis was correct, would it not?? Mccready (talk) 08:33, 28 January 2008 (UTC)

Mccready, most diagnoses are wrong, but they are still diagnoses. A diagnosis is just an opinion, some are right and some are wrong, but it is still an opinion. We don't "aim" to have opinions and our "purpose" is not to have opinions. Again, we either treat or we don't. We don't "aim" to treat. It doesn't mean we are treating it correctly. Now, if we were to say "Chiropractors aim to accurately diagnose and treat...", that would be grammatically correct and an accurate statement to make, how do you feel about that? -- Dēmatt (chat) 18:53, 28 January 2008 (UTC)

Fine. Accepted except for split infinitive - Better to says "aim to diagnose accurately and treat". Now we have to look at 2 more things in the top. 1. There are multiple defns of chiro - so need to bring the mixer reform etc stuff to defn section. 2. UNDUE weight in the top. We need to ack that science says the bulk of conditions that most chiros aim to handle are not amenable to chiro. Mccready (talk) 01:37, 30 January 2008 (UTC)

Nah, diagnose accurately is not the same as accurately diagnose, anything wrong with "aim to accurately diagnose and effectively treat.. "

1)Agree with multiple defs and probably can be shortened, but again we are looking at different types of chiros so take away one def and no longer NPOV. 2)Bring me the verifiable and reliable sources that say that "most of the conditions that most chiros aim to handle are not amenable to chiro" then we can discuss how to place it. ---- Dēmatt (chat) 02:20, 30 January 2008 (UTC)

Dematt. Do you enjoy being obtuse? Look up "split infinitive". You make yourself look ridiculous. For science try reading the article. There are MULTIPLE refs to conditions where chiro has no effect. And you will be well aware no doubt of this: "Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation."[14]. Then again perhaps you recall your post "Hey Hughgr, yeah, I know how you feel about the lead. But, I don't see any real problem with including asthma and migraine and anything else. I see people like these everyday and have similar results as you. Yeah, I treat them for back pain and they tell me their bladder symptoms that their MD diagnsoed years ago go away. These patients come back because of their bladders not their backs. Because the science is not there, you and I don't go yelling it across the hilltops, but when it does...The thing I am waiting to see is if Mccready or Arthur revert. Then we'll try something else. Keep kicking!--Dematt 19:57, 5 June 2006 (UTC)" and you have the effrontery to accuse me of trolling. Do you want to create an encyclopedia or a fan club for chiro? Mccready (talk) 06:55, 30 January 2008 (UTC)

Mccready, cut it out! Whatever your point may be, be pleasant and cooperative. Dematt is in his full right to defend an excellent lead. -- Fyslee / talk 07:28, 30 January 2008 (UTC)

Mccready

I agree with Dematt and Fyslee. They're both trying to be cooperative and the lead is fine as it is. You should know by know that Ernst is a vocal critic of chiropractic (and manipulation) and, frankly, his section is too long and has been soundly refuted by the latest WHO Task Force on Neck Pain Study (which I will be including on the safety section since it is the biggest and most complete study looking at the VBA/stroke and manipulation issue.

Also, you should realize that depending on the stats, 87-94% of DCs treat neuromusculoskeletal complaints which is very much within our scope of practice. To devote significant attention to the otitis media/colic/and non NMS disorders would be a violation of WP:UNDUE. Nevertheless, as I had mentioned already in the talk page early, there has already been a comprehensive, evidence-based review of chiropractic care for non NMS conditions most of demonstrated a level 'C' of evidence which is inconclusive. So to suggest that DC care for these condtions is useless is not supported by the literature, but it's usefulness has not been proven either. That, my friend, is the EVIDENCE BASED BALANCED view that the editors here are espousing and stick to. You should try to do the same.

EBDCM (talk) 20:28, 30 January 2008 (UTC)

I am in complete and utter agreement with EBDCM here. -- Levine2112 ^discuss 20:31, 30 January 2008 (UTC)

Sorry to say it but you chiros have little idea how science works. It's dumb to say it's usefulness hasn't been proven. That my friends is NOT evidence based. That is wishful thinking and the logical equivalent of saying it hasn't been proven that the moon is made of blue cheese. "Depending on the stats" which you seem to pluck out of the air is not good enough. Your personal views of chiro or you personal practices are irrelevant here. So until you can show what percentage of chiros claims to be able to treat what types of conditions you have no basis whatsoever for the claim that UNDUE WEIGHT is violated. Mccready (talk) 11:35, 2 February 2008 (UTC)

McCready,

Have you not already been banned from Wiki previously for disruptive edits? It seems that you have not learned your lesson. I have 8 years of university education in the health sciences relating to neuromusculoskeletal medicine. Since it's been awhile since you were in school, let me explain to you EBM: you develop a clinical question, you research the literature, you choose the best evidence, you apply it then review outcomes.

Personal views have no room in this article, including yours. Every edit that I make it strongly support by PEER REVIEWED research of the highest evidence available (1a). Don't suggest I don't know this stuff since I attended McMaster University where EBM was founded and CMCC where the curriculum was EBM as well (since it's only 45 min from McMaster).

Not only do I % of what DCs treat, I have 2007 stats from our national survey in Canada. Between 87-93% treat NMS disorders, period. Lastly, your "study" that shows 90% of DCs believe in subluxation and disease is completely flawed, as exposed previously on this talk page by DigitalC. That was 90% of DCs SURRVEYED and not 90% of DCs. This doesn't even take into account of chiropractic practice WORLDWIDE which has also been a topic of discussion here that suggests this article is already too US-centric. 208.101.89.150 (talk) 14:43, 2 February 2008 (UTC)

Ernst and safety

There is an entire paragraph already dedicated to Ernst and his minority view of a merely hypothesized 0.00002% chance of risk:

There is evidence that spinal manipulation is effective for the treatment of acute low back pain, tension headaches and some musculoskeletal issues, but not all studies support this conclusion.[31] A systematic review of systematic reviews in 2006 by Ernst and Cantor concluded that "Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment."[32] In 2007, Ernst performed another review, drawing similar conclusions.[33] A commentary from a chiropractic and osteopathic journal disputed Ernst and Cantor's conclusion as, "..definitely not based on an acceptable quality review of systematic reviews and should be interpreted very critically by the scientific community, clinicians, patients, and health policy makers. Their conclusions are certainly not valid enough to discredit the large body of professionals utilizing spinal manipulation.

This is already pushing the boundaries of WP:UNDUE. Any further mention certainly constitutes the straw the broke the camel's vertebrae. ;-) -- Levine2112 ^discuss 22:19, 24 January 2008 (UTC)

The Ernst quote in "safety" should be edited down, but WP:UNDUE suggests that if the obviously biased ICA report is there, then some critical studies should be there. Perhaps just the WHO report, both positive and negative, should be included in this article. Still, the study which showed a 0% injury reporting rate (which is not Ernst) seems relevant to restrospecitive analyses. — Arthur Rubin | (talk) 22:26, 24 January 2008 (UTC)

Agree with Arthur above: edit down Ernst and take out the ICA statement. I am not sure what the ref to the retrospective analysis is, but it sounds like a good idea. Concerning stroke; EBDCM gave us the source that solves our problem. We have read and digested a lot of studies that are each flawed in some way, including biases from both sides of the extremes. Regardless of what any of us think or our backgrounds or beliefs, we are first and foremost required to edit NPOV and not synthesize information into anything that would be considered WP:OR. The net result of anything that we might be able to put together will be almost the same as what the Neck Pain Decade findings have stated. In other words, they have got to be the most qualified source on the internet at this moment in time. If they are not WP:Reliable, then nothing is.

• "In 2000, The Task Force on Neck Pain and Its AssociatedDisorders was established. In 2002, the Task Force was given official status by the Steering Committee of the Bone and Joint Decade, an initiative of the United Nations and the World Health Organization. Over its lifespan, the Task Force consisted of a 5-member Executive Committee, a 13-member Scientific Secretariat, a 17-member Advisory Committee, and 18 research associates and graduate students. Committee members originated from 9 countries and represented 19 clinical and scientific disciplines or specialties. The TaskForce was affiliated with 8 collaborating universities and research institutes in 4 countries, and 11 professional organizations agreed to become nonfinancial sponsors. Members of the Neck Pain Task Force feel that the most productive use of this review is to inform and empower the public—more specifically people with neck pain or who are at risk of developing neck pain. The most valuable outcome and contribution will be a change of attitudes and beliefs about neck pain and its prevention, diagnosis, treatment, and management."

I think we should quote them verbatum and attribute it to them. The beauty of it is that this is pretty much what we are all coming close to understanding anyway. We did well. Here is their quote to sum up the chiropractic stroke situation, they say nothing more and nothing less, it is just a statement of their findings:

• According to the Bone and Joint Decade 2000-2010 Task Force on Neck Pain, a multidisciplinary research initiative associated with the United Nations and World Health Organization, "There was an association between chiropractic services and subsequent vertebrobasilar artery stroke in persons under 45 years of age, but a similar association was also observed among patients receiving general practitioner services. This is likely explained by patients with vertebrobasilar artery dissection-related neck pain or headache seeking care before having their stroke."^[7]

-- Dēmatt (chat) 02:14, 26 January 2008

I am glad the editors are considering putting the risk of VAD in the article. From the W.S. Smith UCSF study May 2003 Chir. Treatment of the Neck Can be a Risk Factor for Stroke:, "In the absence of randomized controlled trial evidence demonstrating the effectiveness of cervical manipulation, the best current evidence suggests that the small risk of dissection and stroke outweighs the benefit of this treatment modality for patients with acute neck pain."CynRN71.198.30.242 (talk) 19:03, 26 January 2008 (UTC)

CynRN,

I would say by and large most editors of the chiro wiki are level headed and are interested in making a good, factual article that represents both sides of the argument while being cognizant of historical and contemporary POV of the profession.

Your comment that the risks outweigh the benefits is simply not supported by the majority of the evidence and the millions of patients receiving cervical SMT from their DCs. I have treated many patients with acute neck pain and the overwhelming majority get pain relief and improved function from their neck adjustments. I'm all for including the risks of any SMT; but suggesting that the risks outweigh the benefits is not a valid conclusion based on the majority of the literature and the anectodal reports of manipulative therapists. 208.101.89.150 (talk) 20:31, 26 January 2008 (UTC)

Anecdotal...forget it...not scientific at all. From the Task Force on Neck Pain: "A number of nonsurgical treatments appeared to be more beneficial than usual care, sham, or alternative interventions but none of the active treatments were clearly superior to any other in the short or long term. Educational videos, mobilization, manual therapy, exercises, low-level laser therapy, and perhaps acupuncture appeared to have some benefit." Does this imply that manipulation is superior? Exercise and education may be just as valuable as twisting the neck.CynRN71.198.30.242 (talk) 09:47, 27 January 2008 (UTC)

CynRN

...yet you reference the shape article. Right. Also, since when does the clinical experience of thousands of DCs and millions of patients not count? If you know ANYTHING about evidence based medicine you would realize that clinical decision making is based on the best available evidence and CLINICAL EXPERIENCE. So, yeah, "anectodal" evidence does count. Regardless, here are the evidence based Chiropractic CPGs for neck pain:

http://www.accchiro.org/Client/cca/cca.nsf/web/JCCA-49-3-p15?OpenDocument&PFV=1&Lan=E

Sorry Cyn, SMT is safe, effective, and like I mentioned above, 2 major reviews in the last 3 months have pretty much validated what manipulative doctors/therapists have been saying for the last 25 years. Since when don't you agree with MDs task force recommendations? You can't have it both ways.

208.101.89.150 (talk) 15:43, 27 January 2008 (UTC) The Bone and Joint Task Force study alleging "Chiropractors don't raise stroke risk" was led by a chiropractor (DC, phD) and only showed correlation between GP/DC office visits and stroke determined by billing records. This study does not invalidate several well designed studies showing a strong temporal connection between "visit to chiropractor and stroke", i.e. (Chiropractor Manipulation and Stroke, Stroke, 2001, Rothwell)and(Ontario, Canada, 2001: "stroke patients under 45 were 5 times more likely than controls to have visited chiropractor within a week of the stroke." The hundreds of "anecdotal" case reports published in the medical literature describing strokes happening during manipulation or directly following manipulation have inspired these larger case control studies.CynRN71.198.30.242 (talk) 16:57, 4 February 2008 (UTC) Regarding "MD task force recommendations"; here is another viewpoint:Sixty-two clinical neurologists from across Canada, all certified members of the Royal College of Physicians and Surgeons, have issued a warning to the Canadian public and provincial governments about the dangers of neck manipulation. The signers include private neurologists as well as chiefs of neurology departments of major teaching hospitals. Calling their concerns significant, they warn that stroke and death due to neck manipulation has been reported in the scientific literature for over 50 years and that manipulation is one of the leading causes of stroke in the under 45-age group(Brad Stewart, MD FRCPC, et al, Feb 2002).CynRN71.198.30.242 (talk) 17:07, 4 February 2008 (UTC)

CynRN

You do realize that the 2008 Neck Pain Force findings was co-authored by two medical neurologists, don't you? I don't think you understand that this review of neck pain was the most comprehensive study ever done on manipulation and stroke. As per the articles findings, there is an increased association with dissecting stroke in patients under the age of 45, but there is NO DIFFERENCE in stroke rates between MDs and DCs. As the entire stroke issue really gained notoriety in Canada (and elsewhere, I'm sure) it's fitting that it effectively ends here in Canada, specifically Ontario.

If you claim to be evidence-based, than surely this study will change your intellectual understanding, but something tells me no amount of data will change your opinion on neck manipulation and stroke. There's a many words for that, dogma and ignorance come to mind. Hopefully I'm wrong.

EBDCM (talk) 23:04, 4 February 2008 (UTC)

UNDUE weight

The lead as currently formulated contains undue weight to sources supportive of chiro. This needs to change. Most research shows chiro is ineffective. eg for infantile colic, asthma, carpal tunnel syndrome, painful menstrual periods, migraine etc etc. Pls discuss. Mccready (talk) 01:58, 31 January 2008 (UTC) Incorrect (again). The CCPG has done a thourough literature review and have determined that non-NMS management with manipulation is inconclusive (for either way). Furthermore, the evidence suggests that SMT is as effective as amitryptiline for migraine HA. McCready, what is your scientific credentials? You don't seem to know how to research or how to apply it. You would save us all a lot of time if you at least provided some kind of scientific data to support your assertions. Anything less will not cut it. 208.101.89.150 (talk) 03:48, 31 January 2008 (UTC)

As a disinterested observer (I knew absolutely nothing about chiropractics before reading this article), I came away with the impression that chiropractics in the United States have transitioned unevenly from pseudoscience into something generally more scientific, and that there is evidence that at least "reform" chiropractics are moderately, if not mind-blowingly, effective. So if you want to know what disinterested readers are taking away from this article, there it is. As for whether sources critical of chiro are excluded, you're just going to have to be more specific as to which sources you'd like to see referenced. --Hyperbole (talk) 19:56, 31 January 2008 (UTC)

Mmm I'm not so sure about that. From my first reading it looks like chiropractic is effective (at risk costs - stroke etc) for loosening up the back, as you would have expected. But its not so good for the other things it is used for (everything under the sun apparently). That would probably mean its pseudoscientific on the whole. The definition of chiropractic seems to be the same as it ever was. I'd say the article needs information on the non-skeletal applications of chiropractic, such as eye problems and so on, and to have the opinions of scientists on those matters. Delvin Kelvin (talk) 06:30, 1 February 2008 (UTC)

Per WP:LEAD, I aded some information to balance the lead. Quack Guru 19:04, 1 February 2008 (UTC)

Safety issues

The World Health Organization are opinions and not fact. I restored the cited material. Any removal of the reference is an NPOV violation. The text can be shorted a bit. Quack Guru 19:04, 1 February 2008 (UTC)

Okay, I'm seeing some POV issues. First, I'm concerned with your verbs - the WHO "claims" while Ernst "concludes"? These are semi-synonyms for "reports" that have very different connotations. Second, I'm wondering if we really should be referencing Ernst four times as well as linking to him - is he really that much of a leading world expert on chiropractics? Also, the Edzard Ernst article itself has several nasty POV problems and seems to exist primarily to make the claim (without citation) that criticism of Ernst is meritless. --Hyperbole (talk) 19:37, 1 February 2008 (UTC)

World Health Organization are opinions. Those opinons are not notable and should be deleted. The safety issues needs to be more balanced and include more studies. Quack Guru 19:43, 1 February 2008 (UTC)

Generally speaking, on Wikipedia, the opinions of a notable organization are notable. I'm really trying to assume good faith here, but I'm having trouble seeing a reason rooted in policy for tagging the WHO's assertions as "claims" and Ernst's as "conclusions." --Hyperbole (talk) 20:02, 1 February 2008 (UTC)

The reference to WHO fails WP:RS, WP:V, and WP:ATT policies (and is an opinion) whereas Ernst's conclusions were published in a medical journal and is verifiable. Quack Guru 20:19, 1 February 2008 (UTC)

I think you're going to have a very hard time finding a Wikipedian who would agree that the WHO is not a reliable source, let alone that its reports are not verifiable. I'm not even sure exactly where you're coming from with that one - is it the Finnish webhost for the cite that you object to? You should probably be aware that this article is on probation: if an admin finds that either of us are editing with any agenda beyond writing an NPOV encyclopedia, we could receive a block or ban on the entire topic of homeopathy and related articles. --Hyperbole (talk) 20:25, 1 February 2008 (UTC)

Please explain how the reference is WP:RS, a Finnish webhost. If not, then it should be deleted. Thanks. Quack Guru 20:32, 1 February 2008 (UTC)

Do we have any reason to believe the site is hosting a doctored copy of the WHO report? Certainly, if the report is hosted in a more official place, that should be the reference, but a knee-jerk removal of everything the report says based on the fact that the current reference is hosted in Finland is simply not the appropriate remedy. --Hyperbole (talk) 20:40, 1 February 2008 (UTC)

How would a copy of the World Health Organization report on a webhost site meet WP:RS? Quack Guru 20:45, 1 February 2008 (UTC)

How wouldn't it? I frankly don't understand the nature of your complaint at all. I did, however, replace the link to the PDF with one actually hosted on the WHO's servers. --Hyperbole (talk) 20:49, 1 February 2008 (UTC)

See WP:RS. The WHO is an organization and the claims were not published in a journal for example. According to what policy does an organization's website meet verification? Quack Guru 21:00, 1 February 2008 (UTC)

I assure you I've read many times. The WHO is a UN authority on international public health. I am positive that the consensus on Wikipedia is that it is a reliable source and that the existence of one of its reports on its website verifies that the report exists. --Hyperbole (talk) 21:08, 1 February 2008 (UTC)

Where in Wikipedia policy does a UN authority on international public health (WHO) is WP:RS? See WP:PROVEIT. Quack Guru 21:14, 1 February 2008 (UTC)

(moving to left margin) Wikipedia policy doesn't (and can't) spell out exactly which sources are reliable and which aren't. If you're trying to read WP:SOURCES to mean that only peer-reviewed academic journals can be Wikipedia sources, you're reading it wrong. However, consensus is that large and/or prominent organizations are notable enough that their stances should often be included in relevant articles, and that their websites are certainly reliable enough to serve as sources at least for the fact that they hold those stances. --Hyperbole (talk) 21:22, 1 February 2008 (UTC)

From your comments, your are unable to WP:PROVEIT and you have declared WP:CON. Where is this consensus you are talking about that large organization websites are certainly reliable? Quack Guru 21:32, 1 February 2008 (UTC)

No, my comments assert that the editor who added the WHO's stance adequately PROVEDIT. As for consensus that large and/or prominent organizations' publications are reliable sources, you can find it all over Wikipedia. You may want to start at Special:Whatlinkshere/World_Health_Organization, where you can see some of the dozens of articles where the WHO's position has been deemed worthy of inclusion. --Hyperbole (talk) 21:37, 1 February 2008 (UTC)

Anyone can add a reference to any article. That does not WP:PROVEIT for this specific claim. This is a controversial article and the claims have been challeged. Please provide a WP:RS reference for this claim. The claims made by WHO are opinions and not fact. Agreed? Quack Guru 21:57, 1 February 2008 (UTC)

Do you really want to get into the philosophical nature of what constitutes a "fact"? Suffice to say that the WHO's assertions are assertions. Keep in mind that the reference completely proves what the article actually says. The article says "In a 2005 report, the World Health Organization states that (blah, blah, blah)"; the reference proves beyond a shadow of a doubt that, yes, they state that in a 2005 report. That's exactly what WP:PROVEIT asks of us - that any claim made in an article is supported by evidence. --Hyperbole (talk) 22:05, 1 February 2008 (UTC)

Per WP:PROVEIT, All quotations and any material challenged or likely to be challenged should be attributed to a reliable, published source using an inline citation. Any claim made in this article should be supported by a WP:RS ref. This controversial claim (not supported by any studies) has been challeged. The section says: "In a 2005 report, the World Health Organization claims... At least for now add the word claims back in. Agreed?Quack Guru 22:19, 1 February 2008 (UTC)

No one has challenged the claim of the article: all the article says is that the WHO says certain things. We've proven, as well as can possibly be expected, that the WHO's opinion is what it is. If you think the WHO's opinion shouldn't be mentioned, WP:RS and WP:V aren't the relevant policies - you should be looking at stuff like WP:FRINGE (which, by the way, doesn't apply). With respect to the verb we use, my take is this: the word "claims" implies "what you are about to read is probably false." The word "concludes" implies "what you are about to read is probably true." The words "states" or "asserts" are probably the most value-neutral I can think of; it simply says "this is what this organization said." I think we should make an attempt to use value-neutral words whenever possible. --Hyperbole (talk) 22:30, 1 February 2008 (UTC)

I have challeged the claim. It is a claim that does not pass WP:PROVEIT. WP:RS, WP:V, and WP:ATT are the polices we should also be looking at. The things WHO claims is not from a reliable reference. The opinions expressed were not published in a WP:RS and therefore should be worded using the word claims. Quack Guru 22:43, 1 February 2008 (UTC)

No, you haven't challenged the claim *of the article* - you've challenged the claim *of the WTO*. That's very different. The article uses a reliable source to prove that what it says is true. You cannot challenge the claim of an organization using Wikipedia; that is the very definition of original research. And you shouldn't use the article to imply that its editors challenge those claims by choosing words with negative connotations - again, that's OR. --Hyperbole (talk) 22:47, 1 February 2008 (UTC)

I have 2 issues with the edits and the general gist of Quack Guru

(1) The Feb 2008 journal of Spine is dedicated to the BJTF 2000-2010 report on neck pain. It is completely evidence based and analyzed over 6 years of data. What did the evidence say? No additional risk of SMT vs. other types of treatments for mechanical neck pain.

(2) The evidence overwhelmingly suggests that SMT is effective for both acute and chronic back/neck pain. In fact, the American Physicians and Surgeons guidelines on LBP RECOMMEND SMT for uncomplicated back pain. Both chiropractic and medical clinical practice guidelines for LBP are the same. So, this goes against Hyperboles edit which quotes Ernst who says that SMT is not therapeutically beneficial. Ersnt has way too much UNDUE weight and he has been soundly refuted by both medical and chiropractic researchers. 208.101.89.150 (talk) 22:49, 1 February 2008 (UTC)

For the record, I didn't put the Ernst quote in the article - I just trimmed it to make the article flow better. Personally, I haven't seen any reason to doubt either Ernst's or the WHO's credentials - to me, they just seem like two conflicting authorities. --Hyperbole (talk) 23:01, 1 February 2008 (UTC)

The Ersnt conclusions, published in a medical journal, meets WP:RS. Quack Guru 23:04, 1 February 2008 (UTC)

That doesn't make any sense. A conclusion is not a source. --Hyperbole (talk) 23:17, 1 February 2008 (UTC)

Response to Hyperbole. Hyperbole wrote in part: The article uses a reliable source to prove that what it says is true.

Per WP:PROVEIT, it fails to meet the inclusion criteria for a reliable source and it is just claims. Quack Guru 23:04, 1 February 2008 (UTC)

WP:PROVEIT insists that an article prove what it says. The article says that the WHO said certain things in its report. The cite proves the the WHO said those things. The WHO's website is the most reliable source possible to prove that. I don't think you're reading the policies correctly, because they are being followed here to the letter. --Hyperbole (talk) 23:16, 1 February 2008 (UTC)

Hyperbole wrote: WP:PROVEIT insists that an article prove what it says.

Where in the policy does it say that is all that is needed to add anything to any article?

WP:PROVEIT states "The burden of evidence lies with the editor who adds or restores material. All quotations and any material challenged or likely to be challenged should be attributed to a reliable, published source using an inline citation." The WHO website is not a reliable source. Please take your arguments to Wikipedia:Reliable sources/Noticeboard or we can delete the claims. Quack Guru 23:44, 1 February 2008 (UTC)

Again, the "material" in question is the sentence "In a 2005 report, the World Health Organization states that (blah, blah, blah)." The editors who added that have "proven" it with the most reliable source possible - the WHO's own website. You don't seem to understand that WP:PROVEIT doesn't suggest that no viewpoint can exist within Wikipedia if that viewpoint hasn't been proven objectively true to the satisfaction of any particular editor; if that were the case, the majority of Wikipedia simply couldn't exist. Quite the contrary, Wikipedia policy is that "the article should fairly represent all significant viewpoints that have been published by a reliable source, and should do so in proportion to the prominence of each." You can try to argue that the WHO website isn't a reliable source per WP:RS at the Reliable Sources Noticeboard, but I'm pretty positive they'll laugh you out of there. And if you remove the material, considering that this article is on probation, I suspect the admins will take a very dim view of that. --Hyperbole (talk) 23:59, 1 February 2008 (UTC)

I will repsect your views about the reference. Hyperbole, I will try to restore the WHO reference and other cited material we worked on together. It seems someone deleted the reference. My next edit to the article will be in honor of you (and NPOV). QuackGuru (talk) 07:59, 13 February 2008 (UTC)

I restored the cited material and greatly improved the article. Please review. Thanks, QuackGuru (talk) 08:53, 13 February 2008 (UTC)

Hyperbole, I will try again to restore the World Health Organization reference the that was deleted repeatedly. A citaton is needed. QuackGuru (talk) 04:18, 16 February 2008 (UTC)

I tried to restore the reference but it was deleted again. Thoughts. QuackGuru (talk) 19:27, 16 February 2008 (UTC)

Recent Edits since Protection was Removed

I've noticed that there new edits re: safety and the continuing controversy of manipulation for non NMS management.

As already mentioned previously in the talk page, there has been a recent review of the literature (fall 2007) which looked at chiropractic care for conditions such as infantile colic, dysmennorhea, otitis media, geriatric and pediatric chiropractic.

These in turn were turned into clincal practice guidelines. The level of evidence was "C" or inconclusive. For those not academically inclined, this means that it's usefulness or lack thereof has not been determined. Consequently, any statement made on the wiki that does not reflect this is inaccurate or deliberately misleading.

Re: the safety, the most controversial aspect of this is upper cervical spine SMT. The recent BJD task force which compiled 6 years of data in Ontario demonstrated that there there is NO increased risk of stroke and manipulation. The stroke issue really began in Ontario, and it now ends in Ontario. Since this study is Feb 2008, it supplants the old WHO 2005 statement. I will be making an edit to the wiki accordingly.

To be fair, the most common types of side effects from SMT will be included (headache, sprain/strain, light headedness)as well as the recommedations to avoid excessive rotation in upper C-spine SMT, which is already in the Canadian chiropractic guidelines for Neck pain not due to whiplash. This can be found indexed on pubmed, BMJ or JCCA.

EBDCM (talk) 14:58, 2 February 2008 (UTC)

Chiropractic College

The Canadian Memorial Chiropractic College website is not a reliable reference. Thanks, Quack Guru 18:05, 2 February 2008 (UTC)

Considering it is the best rated chiropractic school in the world and has the highest output of research and publications of any chiropractic college, it is indeed a reliable and credible reference.

Besides, if the #1 chiropractic institution who was the first to implement and EBM curriculum in 1999 cannot define define a contemporary view of chiropractic, who can? Sorry guru, you're going to have to do better than that.

To validate my point, check out the research symposium held there YESTERDAY. Notice the presenters from the Mayo and Harvard clinics and the interprofessional collaboration model. I'm all for skeptics, but get into the 21st century.

http://www.cmcc.ca/events/2008_ResearchSymposiumWeb.pdf EBDCM (talk) 18:14, 2 February 2008 (UTC)

The link provided above is not a reliable reference. It is from a chiro college. Quack Guru 18:19, 2 February 2008 (UTC)

http://en.wikipedia.org/w/index.php?title=Chiropractic&curid=7738&diff=188636685&oldid=188605247

Another reference added is unreliable. It is not written in the English language. Quack Guru 18:27, 2 February 2008 (UTC)

The link to NCBI is undeniably reliable by Wikipedia standards; it's to a peer-reviewed scientific study that appears in a scientific journal and has been archived by the U.S. NIH. I do think that the authorship of the study is something that needs to be mentioned in the article, so I added it.

Wikipedia policy on non-English sources can be found at WP:RSUE - foreign-language sources are acceptable, but if we can find an English-language source of equal quality, we should use that one instead. --Hyperbole (talk) 19:27, 2 February 2008 (UTC)

The current link in the article is to the front page of the Canadian Memorial Chiropractic College website. The foreign-language link is to a chiro department and not a reliable source. Quack Guru 19:44, 2 February 2008 (UTC)

Let me make something very clear. The fact that something doesn't say what you want it to say does not make it an unreliable source. That's not even close to what WP:RS is about. Consider this: WP:NPOV says "NPOV says that the article should fairly represent all significant viewpoints that have been published by a reliable source, and should do so in proportion to the prominence of each." Now, if Wikipedia editors were qualified to say "Anything that says X is a reliable source; anything that says Y is not a reliable source," then Wikipedia could *never* contain conflicting viewpoints on any issue. Your interpretation of WP:RS would completely destroy WP:NPOV and turn Wikipedia into a soapbox. Is that really what you want? The bottom line is this: sources are reliable when they can adequately and reliably set forth a significant viewpoint - regardless of whether you personally accept that viewpoint. Claiming that first the WHO and now the NCBI are unreliable sources badly damages our ability to assume good faith. --Hyperbole (talk) 23:17, 2 February 2008 (UTC)

Well. I tried again to restore the WHO reference but it got deleted again. Any suggestions. QuackGuru (talk) 04:11, 17 February 2008 (UTC)

Quack Guru,

Do you have any intention of being constructive about this, or are you simply trolling around? I provided a supplementary reference re: the contemporary view. My point of including the French version (which says the exact same thing as CMCCs) is that ALL DC SCHOOLS IN CANADA use a scientific, evidence-based contemporary view of chiropractic (primarily for NMS disorders). Being the the CCA, CMCC and UQTR are amongst the most progressive institutions and associations in the world, and represent the whole direction of chiropractic in Canada, which is a leader in contemporary chiropractic education, it's totally fair game. If you're going to piddle-paddle and objective to the reliability of the links in these articles, then I'm all for scrutinizing the majority of the "skeptical" sources/references included in this wiki, for starters the links from the "skeptical inquirer".

I would strongly recommend that you think twice in the way you deal with this. I'm as scientific and "reform" as any DC could get, and I only come to play with solid research and evidence supporting my positions. You're not dealing with an old school quack, but a fresh grad with 8 years of university studies in the neuromusculoskeletal system whose 2 degrees came from an EBM paradigm. You won't be able to pull any fast one's on me. That being said, I have my pointed critiques of the profession as well and am all for including opposing viewpoints provided that they are up to the same standard as I and other editors provide.

Good luck. EBDCM (talk) 20:11, 2 February 2008 (UTC)

Reference number three is unreliable. It is a chiro department. Quack Guru 23:24, 2 February 2008 (UTC)

Quack Guru,

A chiropractic department within the University of Quebec at Three Rivers (UQTR). The university itself approved of the definition of chiropractic provided. It didn't come out of thin air. Since when are publically funded universities not reliable? EBDCM (talk) 00:17, 3 February 2008 (UTC)

This sentence in the lead section could be improved: The contemporary view examines the relationship between structure and function and its impact on neurological mechanisms in both health and disease. Quack Guru 01:06, 3 February 2008 (UTC)

Hello. Being a chiropractic department, I would say it is strongly biased, and accountability in how they choose results from chaff would make their reliability quite suspect. What are the independent views on this matter, if any? Delvin Kelvin (talk) 03:27, 4 February 2008 (UTC)

ref#7

In the reference section there is a large paragraph. I recommend it be shortened or deleted. Quack Guru 00:56, 3 February 2008 (UTC)

I agree: narrative has no place in the references. I removed the narrative. There might be a place for it somewhere under the history subhead, but that section is already pretty thorough and this article is already too long. --Hyperbole (talk) 01:00, 3 February 2008 (UTC)

Good edit. QuackGuru (talk) 04:20, 16 February 2008 (UTC)

writing style

Collapsing odd section

Chiropractors generally do not have the authority to write medical prescriptions. I prefer this writing style. QuackGuru (talk) 07:29, 16 February 2008 (UTC) Ummm, wow...--Hughgr (talk) 08:48, 16 February 2008 (UTC) Yes, that's a rather odd and unhelpful comment. -- Fyslee / talk 08:57, 16 February 2008 (UTC) I am left scratching my head... I prefer to scratch my pancreas. -- Levine2112 discuss 09:01, 16 February 2008 (UTC) How galling...;-) -- Fyslee / talk 09:09, 16 February 2008 (UTC) Gut wrenching. :D

Maybe we should collapse this section, too. I'm sure QG didn't mean it the way it came out? -- Dēmatt (chat) 13:21, 16 February 2008 (UTC)

Done. -- Fyslee / talk 08:07, 17 February 2008 (UTC)