Talk:Chiropractic/Archive 19

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Archive 19

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1 Use of primary sources is permitted
2 Attribution does not require mentioning in the text
3 things to do list
4 Section Chiro/History
5 Safety sources again
6 tags
7 image/table
- 7.1 keep or delete table
8 Is Chiropractic Fringe?
9 Disruptive editing by Jefffire
10 draft for lead changes
- 10.1 commentary on draft for lead changes
- 10.2 lead improvements
11 Problem with worker's compensation section
12 POV issues as of 2008-05-03
13 2008-05-06 changes
14 philosophy
15 Failed verification tag - SOP
16 Table needs moving to right
17 unsourced material in scientific investigation
- 17.1 outdated POV material in scientific investigation
18 2008-05-07 changes
- 18.1 Not acceptable change regarding primary care/contact
- 18.2 deletion of cited text in medical opposition
19 References

Use of primary sources is permitted

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

Eubulides, you seem to be promoting a position here on primary sources that is at odds with Wikipedia policy.[It would not be right to reach down...] (I repeat "Those reliable reviewers can have a purpose skewed with respect to our purpose.") Changing WP policies will necessitate us engaging in other forums. Eubulides, is this your wish?

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

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

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

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

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

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

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

SmithBlue is correct on several points.

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

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

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

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

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

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

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

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

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

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

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

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

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

Attribution does not require mentioning in the text

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

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

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

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

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

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

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

things to do list

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

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

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

Per Eubulides, "More generally, the "Minority" section doesn't present the big picture, which is that chiropractic has always been riven by internal disputes, and that simplifying it to "straight" versus "mixer" is a bit like simplifying the history of American politics to "Republicans" versus "Democrats". There are always subgroups with their own agendas, the two examples given are just recent examples of this, and it's missing the bigger picture to mention only those two examples."[1] The big picture needs representation. There is a lot more to this story than the straight v. versus mixer evolution. There are internal conflicts too. QuackGuru 22:53, 4 May 2008 (UTC)

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

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

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

Section Chiro/History

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

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

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

New Study Finds Unity in Chiropractic

no obvious relav

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

no obvious relav

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

no relevant material: Canada postage stamp?

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

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

History of Chiropractic Care ACA

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

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

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

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

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

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

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

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

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

Safety sources again

This is a response to the question "Why is Haldeman et al and Cassidy et al. (who are the experts in manipulation and stroke) not be given equal weight (at the very least) to Ernst?" in Talk:Chiropractic/Archive 18 #Comments on claim of bias and proposal for fix above. As I understand it, the question is why Chiropractic#Safety does not give Cassidy et al. (PMID 18204390) and Haldeman et al. (PMID 18204400) at least equal weight as Ernst 2007 (PMID 17606755). This topic was previously discussed in #Talk:Chiropractic/Archive 17#Safety section and this section continues that old thread.

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

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

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

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

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

Suggested change re stroke wording

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

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

The cited source uses "but"; it says:

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

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

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

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

with this:

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

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

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

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

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

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

"Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[63] Strokes after cervical spine manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication.[64}"

They take the form:

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

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

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

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

"Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.^[1] These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation.^[2]"

with this:

"Strokes after cervical spine manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication.^[3] Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.^[1] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.^[4]"

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

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

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

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

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

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

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

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

with this:

"Several case reports show temporal associations between interventions and potentially serious complications.^[6] Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.^[6] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke.^[7]" (*)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation.^[8] This sentence was deleted. I think it added something to the article. Or was it duplication. QuackGuru 21:46, 3 May 2008 (UTC)

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

Significant (Deliberate?) Omissions from Safety

Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces.

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

Abstract: Study Design. Ecological study.

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

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

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

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

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

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

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

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

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

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

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

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

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

Best Evidence on Assessment and Intervention for Neck Pain

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

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

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

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

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

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

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

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

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

Please propose a suggestion (such a written sentence) for review using a ref (^[9]). QuackGuru 19:24, 29 April 2008 (UTC)

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

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

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

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

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

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

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

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

With increased chiropractic utilization, the increase in VBA stroke does not seem to be associated.^[10] This is a primary study. QuackGuru 17:41, 1 May 2008 (UTC)

Relevant papers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This controversial change added text from a primary study. We should not second-geuss the reviewers. QuackGuru 17:35, 6 May 2008 (UTC)

This edit added text to the article. Where in the source does it say that. Hmm. QuackGuru 17:57, 6 May 2008 (UTC)

Just adding clarity for the review, lest the readers think that the reviewers were only discussing CMT as performed by chiropractors. They were not. The reason why clarification is needed, because in an article about chiropractic, a reader might assume that CMT refers to a procedure only performed by chiropractors. This is not the case in this review. The alternative to clarifying this would be to remove mention of the study entirely. Take you pick. -- Levine2112 ^discuss 18:01, 6 May 2008 (UTC)

Your edit failed verification. Again, where in the source did it say that. QuackGuru 18:10, 6 May 2008 (UTC)

Where in the source does it say that the researchers were specifically studying CMT as only performed by chiropractors? If it doesn't say that, technically it shouldn't be in this article. -- Levine2112 ^discuss 18:12, 6 May 2008 (UTC)

Please address my comments instead of ignoring them.

We should not second geuss the latest state of the art reviews. QuackGuru 18:25, 6 May 2008 (UTC)

I have addressed your comment in the form of a counter-question. Please feel free to respond to it if you would like to continue this conversation. -- Levine2112 ^discuss 18:28, 6 May 2008 (UTC)

Please provide a reference or the unreferenced text will be deleted. Irrespective of the tag deletion it is still unreferenced. QuackGuru 19:55, 6 May 2008 (UTC)

As the whole text doesn't seem to be specific to the subject at hand - cheifly, Chiropractic - the {{nonspecific}} is more appropriate. And I agree in that if the entire reference cannot be shown to be specific to chiropractic, it should be deleted. If it is just about CMT in general (as performed by any number of practitioners and non-practitioners), it would be better suited for the spinal manipulation article. -- Levine2112 ^discuss 20:06, 6 May 2008 (UTC)

Do you think this edit is referenced? If so, where in the source does it say that. QuackGuru 20:12, 6 May 2008 (UTC)

You have asked this before and once again, I address your comment in the form of the same counter-question which you haven't answered: Where in the source does it say that the researchers were specifically studying CMT as only performed by chiropractors? -- Levine2112 ^discuss 20:18, 6 May 2008 (UTC)

This is about safety issues. The unreferenced text has been challenged. Please provide a reference or delete it. QuackGuru 20:29, 6 May 2008 (UTC)

Yes, this is about safety issues and chiropractic. The text which we are currently discussing doesn't seem to be about chiropractic specifically. Please provide a reference which shows it does or delete it. Essentially, why discuss a minor parenthetical portion when we should be discussing the relevance of the whole statement? -- Levine2112 ^discuss 20:33, 6 May 2008 (UTC)

(outdent) Miley et al. 2008 (PMID 18195663) covers evidence from both chiropractic and non-chiropractic sources. Briefly reviewing it, the strongest evidence comes either from chiropractic data (e.g., Rothewell et al. 2001) or from criteria that are independent of whether the data was generated from chiropractic or non-chiropractic care (e.g., our understanding of the mechanism of disease). It is standard practice nowadays, in both chiropractic and non-chiropractic reviews, to consider sources from both chiropractors (the main source of data for spinal manipulation) and non-chiropractors (a relatively minor source) when evaluating safety and effectiveness of SMT. Please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

image/table

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

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

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

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

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

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

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

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

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

keep or delete table

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

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

The table was deleted. Why did this happen. QuackGuru 15:56, 7 May 2008 (UTC)

The change log says it was deleted because CorticoSpinal thinks that as an illustration it is redundant and ugly. On both counts CorticoSpinal is correct: it is redundant, and it is ugly. However, it is still useful in an encyclopedia to give a diagram or illustration, as this can help new readers follow the exposition. A more-beautiful diagram would be nicer, but in the meantime it's what we have; there's little point to deleting a useful diagram from an article that is begging for decent illustrations. It's no big deal, but I would support restoring the diagram (or a more-beautiful version, if someone cared to write it). Eubulides (talk) 09:36, 8 May 2008 (UTC)

I prefer the useful table restored. QuackGuru 14:06, 8 May 2008 (UTC)

Is Chiropractic Fringe?

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

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

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

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

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

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

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

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

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

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

Keating JC Jr, Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF (2005). "Subluxation: dogma or science?". Chiropr Osteopat 13: 17. doi:10.1186/1746-1340-13-17. Here is a comprehensive ref about subluxation. QuackGuru 21:42, 4 May 2008 (UTC)

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

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

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

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

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

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

“

Right now chiropractors can go before any audience and say that there is sufficient science to discuss the neurological and clinical effects of the adjustment. It is no longer credible for anyone to state that "there is no scientific basis for spinal manipulation or the chiropractic adjustment." It is, however, essential that any proponent of chiropractic be very careful not to include leaps of faith and dogma when interpreting the research that is available.

”

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

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

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

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

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

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

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

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

Your point? Chiropractic uses standard billing codes and this has nothing to do with any questions of fringe or not fringe. All organizations that use those codes are of course signers. Keep in mind that many instances where chiropractic is mentioned in various places are in fact proof that chiropractic is still on the fringes and not in the center (as yet). Those mentions of exceptional occurrences (which is why they are noticeable!) where chiropractors are seen involved with or cooperating with mainstream practitioners or in mainstream institutions are examples of "the exception and not the rule," and such exceptional "fringe" mentions should not be use to make a case for "not fringe". Examples of this have been (mis)use of the fact that a chiropractor here or there has ER privileges or teaches in some medical school as proof that chiropractic is now mainstream. (Often those chiros are also MDs, which is why they are where they are.) No, those are exceptional cases. BTW, please sign above.-- Fyslee / talk 06:01, 8 May 2008 (UTC)

Disruptive editing by Jefffire

I would ask that Jefffire please refrain from editing agreed upon material with respect to scope of practice. The first sentence, which you have reverted twice, adequately and NEUTRALLY describes by and large the scope of chiropractic practice. Several discussions took place over this sentence and a neutral, agreed upon version claiming primary CONTACT (rather than care) was AGREED TO by the REGULAR editors here, including Eubulides, CynRN and myself. I would ask that you please desist from making any more reversions to agreed upon material or I will have to ask an uninvolved admin to lock the page if your disruptive and bogus edit summaries (POV) continue. Thank you. CorticoSpinal (talk) 20:26, 7 May 2008 (UTC)

Calm down a sec. There is no problem with making changes to an article. If adding a quote from the world health organisation which gives their view on chiropractic is so unbearably PoV then the other regular editors will chip in on it. Jefffire (talk) 21:40, 7 May 2008 (UTC)

You replaced an agreed sentence which has been under review for 2 months and replaced with a non-sequitur that is a duplication of the lead from the WFC. You replaced a statement by the WHO that was cited and attributed and agreed upon with something that was not. Then you ignored my reversion which stated the statement was agreed upon. Then, by divine right, Arthur Rubin comes down and reverts it again. You two are beginning to look awfully suspicious in the way you edit this article. You have not participated in the discussions so you have no moral right to come here and disrupt the progress being made. It's the same garbage wherever you edit chiropractic-related articles. Then you slag me on QGs talk page. How can you come across as credible and I'm to AGF when you constantly disrupt chiropractic-related pages? CorticoSpinal (talk) 21:46, 7 May 2008 (UTC)

Here was the consensus version for SCOPE OF PRACTICE. This had the input of all regular editors.

CONSENSUS VERSION

Chiropractors are primary contact providers who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery.^[19]

JEFFFIREs CHANGE

The World Health Organisation described Chiropractic as "A health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on subluxations"

Jefffire's needlessly disruptive edit. Thanks for proving your [[WP:POINT}point]] but that change is not for the better and not valid. We are discussing the primary contact provider (or primary care). The sentence was succint and clear. It was relevant to the section. He reverted me twice and then Arthur Rubin came and and ignored the consensus version (that guy is an admin?)and reverted the consensus version. So, technically, Jefffire escapes 3RR but the spirit of the rule was still violated. Skeptics have gone too far. Uninvolved Admin Swatjester has already said that the section had been NPOV and properly referenced. Since I included it has been the target of persistent attacks and stonewalling tactics by both Jefffire and Arthur Rubin. What makes this even worse is that neither of those 2 were present for the discussions. So, they're essentially undoing the hard work it took to achieve consensus on the major points resulting in a low grade edit reversion. I apologize for going up to 2RR and I'm going to desist for tonight but Jefffires edits and Arthur Rubin's approval just go to show at what lengths skeptics will go to challenge anything that challenges their personal POV. CorticoSpinal (talk) 22:42, 7 May 2008 (UTC)

I share CorticoSpinal's distress at the way these reverts and reverts-of-reverts have been done. It would be better to discuss changes like this on the talk page first.
The existing text is not carved in stone; if there is a good reason to change it to include the other points, let's please hear about it on the talk page first: why is it a worthwhile improvement over the existing version?
Swatjester did not have the benefit of subsequent remarks explaining POV concerns about the text, and Swatjester has not weighed in on the discussion since then. It is not clear what Swatjester's opinion would be now, about either the original or the revised text.

For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

draft for lead changes

Traditionally, it is based on the premise that a vertebral subluxation or spinal joint dysfunction can interfere with the nervous system and result in many different conditions of diminished health. Today, the progressive view examines the relationship between structure and function and its impact on neurological mechanisms in both health and disease.^[20]^[21]^[22]^{[not in citation given]}

Chiropractic medicine focuses on the body's structure (primarily the spine) and its function (as coordinated by the nervous system) ~~are closely related~~, and suggests this relationship affects health. Chiropractic care is given with the goals of normalizing this relationship between structure and function and assisting the body as it heals.^[23]^[24]

commentary on draft for lead changes

There has been two differnent versions to the lead. Please discuss. QuackGuru 21:43, 7 May 2008 (UTC)

It's easy. The sources deleted by Arthur Rubin were authorative texts that specifically go over this issue and that UNIFIES all the theories into some basic premises that straights, mixers and anything in between agrees upon. It was NPOV, it was factual, it was relevant it was cited. Arthur Rubin, for an adminstrator, is displaying incredibly poor judgment and has been reverting me in some way for the last 2 weeks and all the reversions he made went back to the original version? Why? Because he does not familiarize himself with the salient points before jumping it. He's letting his chiro-skepticism get the best of him. The fact that there seems to be an unofficial alliance between Jefffire and Arthur Rubin is even more disconcerting, it's a way of going around 3RR by getting someone else to revert AGREED UPON MATERIAL. The scope of practice section will be THE downfall of the skeptical editors, you guys have clearly crossed the line with the billion stonewalls, reverts, tags, disputes, verifications and other BS to discredit, obstruct and marginalize the profession which you clearly view fringe. This is my last warning: continued disruptive and disingenious reversions to scope of practice, particularly the first sentence, will go to ANI. We now have Orangemarlin, Arthur Rubin, Jeffire all reverting consensus material without warning/discussion despite pleas from involved editors; Eubulides has the distinction of being lumped in with those guys. You already know where I stand with respect to your editing practices. —Preceding unsigned comment added by CorticoSpinal (talk • contribs)

If you're being reverted by 5 editors, and the edits are not being restored by any, doesn't that tell you something about consensus? — Arthur Rubin (talk) 23:28, 7 May 2008 (UTC)

5 editors? Sure. If you mean randoms like you and Jefffire disrupting and leaving like you have a history of doing. You have completely ignored and disregarded any of the talks discussion and you have been proven wrong in every single instance you have tried to stonewall Scope of Practice? How are those verification failed tags doing you put up at Scope of Practice? Every single one of them you put up has been taking down (by Eubulides no less!). You simply do not have a grasp of the salient issues here because unlike the regular who have spent the last 2 months trying to fix things, you're simply trying to disrupt them. You won't be able to get away with this crap, forever. You should be stripped of your admin status; rather than build bridges and consensus you seek to delete and destroy. You have also failed again to address any of the points I raised above before using a red herring fallacy to try and cover up your significant errorS in judgment. CorticoSpinal (talk) 23:44, 7 May 2008 (UTC)

I've been editing Chiropractic longer than you have, unless you have another account before your last change. And there is no evidence that there was consensus on what you call "the consensus version". I think you and possibly Levine just outshouted the other editors. And all of my {{verification failed}} tags were clearly supported (i.e., the text was clearly not supported by the reference).

And you've reverted 7 times in 72 hours. How is that in keeping with your 1RR parole? — Arthur Rubin (talk) 00:06, 8 May 2008 (UTC)

This controversial change added text to the lead (are closely related) that DigitalC previously striked out as makes no sense. QuackGuru 06:28, 8 May 2008 (UTC)

Chiropractic is "assisting the body as it heals." Is this true? QuackGuru 07:52, 8 May 2008 (UTC)

Changes like these should be discussed on the talk page before installing. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

Sorry, I don't follow what those two paragraphs in #draft for lead changes are intended to mean. What are they supposed to replace in the lead? Why is the replacement important? I agree the lead has real problems but I don't understand this as a concrete proposal for improving it. Perhaps it would be clearer and simpler to put a draft replacement for the entire lead as a subsection of this section? Eubulides (talk) 09:36, 8 May 2008 (UTC)

Let me explain. There was a recent edit war over the two different versions above. I thought discussion would be helpful. QuackGuru 12:38, 8 May 2008 (UTC)

lead improvements

The lead currently does not reflect the body of the article. We should not wait to finish the body. It may takes years that way things are going. I suggest the lead be improved where possible. QuackGuru 04:09, 8 May 2008 (UTC)

Yes, the lead should reflect the body today; we can't go on for months editing the body without fixing the lead to reflect the body. Eubulides (talk) 09:36, 8 May 2008 (UTC)

I recommend we start with Safety first per WP:LEAD. QuackGuru 16:25, 8 May 2008 (UTC)

Problem with worker's compensation section

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The article is currently locked up because a certain editor added original research and POV material to the article.[2][3] How is it preceived as disruptive to start a new stub in mainspace when this is normal practice. Improving the article is not harmful. If someone disagrees based on POV issues like the Scope of practice, that is a different matter. It is up to the editor who disagrees to provide a reason why it does not meet Wikipedia's standard. If it does meets Wikipedia's standard, it is harmful to the project to blatantly delete NPOV written text, especially when using the newest available sources. The worker's compensation studies do not belong in the history section. It belongs in a new section titled cost-benefit. Most if not all of those studies are outdated anyhow. If there is anything worth keeping it should be put in the proper section under cost-benefit. QuackGuru 21:57, 30 April 2008 (UTC)

And the time before that, it was you adding the not-ready Efficacy section [4] which lead to an edit war and the eventual block. See the pattern? See what happens when contentious material is added without consensus? Just be cool and let's discuss it first. That is the consensual wishes of everyone here. If anyone disagrees with me (anyone aside from QuackGuru) and rather thinks we should not discuss major edits first, please speak up now. Otherwise, this is the consensus on how we are going to move forward. We will discuss edits such as adding new sections/stubs to the article, work out a consensus version and then (and only then) insert in the article. -- Levine2112 ^discuss 22:06, 30 April 2008 (UTC)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

the reply was:

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

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

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

This thread is about the problems with worker's compensation studies. The workers' compensation studies are misleading because they are very old. Newer sources are available. Currently, we have a NPOV failure. Editors talk about a socalled consensus but ignore NPOV. But NPOV is the key. I would appreciate it if editors would make an attempt to collaborate on this discussion. CynRN commented that there is a survey that needs to be fixed. A study is in 1988 and not 1998. Insanity is when editors continue to post repeated comments that would make reasonable improvements and editors continue to ignore them. QuackGuru 07:02, 6 May 2008 (UTC)

Agreed with Fyslee, QG. It's your approach that is drawing criticism and detracting away from the point you're (trying) to make. Considering you narrowly escaped an ANI meeting last week and after seeing what happened to your buddy User:Mccready you'd think you'd lie low a bit and not push too much. We shall see how it all plays out, but other users have given you wise counsel and I strongly suggest you abide by it. CorticoSpinal (talk) 17:23, 6 May 2008 (UTC)

When both me and CorticoSpinal are agreeing with Fyslee, it is certainly time to pay attention, QuackGuru. Abide. -- Levine2112 ^discuss 17:37, 6 May 2008 (UTC)

Please consider addressing the POV issues mentioned above instead of ignoring them. Agreed? QuackGuru 17:44, 6 May 2008 (UTC)

For the one millionth time, please suggest rewording at talk and I will be happy to discuss it with you. -- Levine2112 ^discuss 17:48, 6 May 2008 (UTC)

I already explained what we should do with the dated studies but I was ignored. We should delete the dated studies. QuackGuru 14:04, 8 May 2008 (UTC)

The 1988 study says 1998 but it is 1988. My specific revision is to fix the date. QuackGuru 18:54, 9 May 2008 (UTC)

I fixed that. Stuff like this is minor and noncontroversial and doesn't really need to be discussed on the talk page before fixing. Thanks for noticing it. Sorry, I didn't see your earlier comments (this talk page is quite large and I expect that no single person has read it all). Eubulides (talk) 21:06, 9 May 2008 (UTC)

POV issues as of 2008-05-03

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

2008-05-03 issues list

The sections Chiropractic #Movement toward science through Chiropractic #Scientific investigation are heavily biased on the subject of effectiveness. They present only old sources that promote the effectiveness and cost-effectiveness of chiropractic treatment, and discuss neither the mainstream viewpoint that disputed these old sources, nor more modern sources on the subject that present a more-balanced approach. One simple way to fix the problem would be to replace these sections with a new section for which we have a draft #Scientific investigation 2. This draft was inspired by a reader who wanted clear information on whether chiropractic treatment is effective [5] and who thought that an earlier version of the draft "is the sort of clear descriptive information that will make the article easier to read."[6] We rarely get comments from readers, so the few we do get should be listened to when at all possible. (Done, by a controversial edit. Eubulides (talk) 07:30, 25 May 2008 (UTC))

Chiropractic #Medical opposition describes the feud between conventional medicine and chiropractors in a heavily biased way. For example, chiropractors are described by a lengthy quote as having "progressive minds" whereas conventional doctors are said to "have failed to realize exactly what is meant by disease processes". Both sides (traditional medical and chiropractic) have attacked and have victories and losses, but the current discussion focuses almost exclusively on attacks by the medical profession, on chiropractic victories, and on areas where chiropractic is said to be superior to conventional medicine. The dispute should be covered neutrally. ~~There is no need for a separate section Chiropractic #Wilk et al. vs. American Medical Association with a lot of detail, for example, unless there is also similar detail devoted to the other side.~~ (Separate section removed. Eubulides (talk) 07:30, 25 May 2008 (UTC))

The sections Chiropractic #The Manga Report, Chiropractic #Workers' Compensation studies, Chiropractic #American Medical Association (AMA), and Chiropractic #British Medical Association are merely a laundry list of endorsements of chiropractic. These sections should be removed, with their useful content moved to appropriate sections, as citations. (Fixed. Eubulides (talk) 07:30, 25 May 2008 (UTC))

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

Several phrases are inserted to strengthen the argument for chiropractic by giving the qualifications of sources when they are favorable to chiropractic. Sources should be mentioned in the citation, not in the main text; there is no need to puff up the main text. The following quotes can be removed (with some rewording necessary to fill the gaps):
- ~~~~"the Ontario Ministry of Health and conducted by three health economists led by Professor Pran Manga"~~ (Fixed. Eubulides (talk) 07:30, 25 May 2008 (UTC))~~
- ~~"by Steve Wolk"~~ (Fixed. Eubulides (talk) 07:30, 25 May 2008 (UTC))
- ~~"by Cherkin et al."~~ (Fixed. Eubulides (talk) 07:30, 25 May 2008 (UTC))
- "The British Medical Association notes that"

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

Chiropractic #Philosophy claims "Evidence-based chiropractic balances this dualism by emphasizing both the tangible, testable principle that structure affects function, and the untestable, metaphorical recognition that life is self-sustaining." but the cited source does not talk about evidence-based chiropractic. Removing "Evidence-based" would fix this problem. (Fixed. Eubulides (talk) 07:30, 25 May 2008 (UTC))

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

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

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

I don't recall the earlier discussion. What I do see now is text that is not supported by its source. This needs to be fixed. Please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

The lead also has several POV problems, which can get fixed once the body gets fixed:
- The lead should reflect the body of the article. The lead currently lacks summaries for some entire sections, including Safety, Scientific inquiries, Vaccination. The overall effect is to minimize the controversial parts of the body. (Fixed. Eubulides (talk) 07:30, 25 May 2008 (UTC))
- ~~The lead has a POV phrase that needs rewording: "Today, the progressive view".~~

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

The usual terms for this division, and the one used elsewhere in the article, is "straight" and "mixer"; let's stick with that rather than "traditional" and "progressive". Eubulides (talk) 08:15, 5 May 2008 (UTC)

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

None of the three cited sources ([7], [8], [9]) say either "traditional" or "progressive". I just now checked. This is a mismatch between the lead and its sources, which needs to be fixed. I will add a "failed verification" tag; please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

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

The "progressive view" is unverified. QuackGuru 12:11, 14 May 2008 (UTC)

Comments on 2008-05-03 issues list

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

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

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

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

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

If there is a problem with the tone, please make a specific suggestion for improving the wording. The suggestion should be supported by reliable sources, as is usual for this section. Eubulides (talk) 09:25, 7 May 2008 (UTC)

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

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

Benefits are for the Effectiveness or Cost-effectiveness sections, not the Safety section. #Effectiveness 2 is a draft for the first of these. We should have the second one too. Eubulides (talk) 09:25, 7 May 2008 (UTC)

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

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

It occurs often enough to be highlighted by reliable reviews in the area; it's a notable topic that deserves coverage. Eubulides (talk) 09:25, 7 May 2008 (UTC)

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

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

Please do not argue with reliable secondary reviews by highlighting results of primary studies that have been reviewed. This is contrary to the WP:MEDRS guidelines and there is good reason for this: it is too prone to editor bias. We need good reasons to disregard expert opinion in this area, and no good reasons have been supplied. Please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

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

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

The Spine articles do not dispute a causative relationship between SMT and stroke. They merely state that there's good reason to believe that the statistical association is explained by other causes. Statistical association is not the same as causation, so the two sources do not disagree here. The mainstream opinion (not just Miley et al., but also Haldeman and others; these are DCs as well as MDs) is that causation occurs in some cases. Eubulides (talk) 09:25, 7 May 2008 (UTC)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scope of Practice: Sources dispute

If Arthur Rubin would like to explain his concerns regarding the scope of practice section which according regarding the "relevance or reliability of the sources presented that would be helpful. I do believe they all meet our inclusion criteria per WP:RS, WP:V and thensome. Also, if you would please abide by WP:NPA and WP:CIVIL and not make attacks [10] in your edit summaries that would be appreciated as well. I've gone ahead and brought an highlighted some of the sources you dispute

Council on Chiropractic Education which is accredited by the US Department of Education
^[25]^{[verification needed]} You've got to be kidding, right?
^[26]^{[unreliable source?]} Since when is Dr. Haldeman not credible, nor a respected publishing house?

^[27]^[28]^{[unreliable source?]} This journal is credible. Are you seriously disputing this?

^[29]^{[unreliable source?]} The credibility Ian Coulter sir, is not in doubt.

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

There we go? What in the world is that supposed to mean? I don't know.

This controversial edit changed the entire meaning of the text. Now it is POV again. The reference formatting does not work properly. QuackGuru 16:26, 6 May 2008 (UTC)

QG, the addition by Eubulides is a poor one but I won't revert it today. Whether you agree with it or not, DCs are at the very LEAST primary CONTACT and most are legislated as primary CARE. I've conceded the primary CARE, as per CynRN's suggestion so stop crying wolf. These constant cries of NPOV for the scope of practice section are definitely misleading and not as warranted as you make it seem to be. CorticoSpinal (talk) 17:03, 6 May 2008 (UTC)

Please adrress the issue at hand and help fix the POV problems. Two refs need to be fixed. They are not properly working after your recent edit. QuackGuru 17:14, 6 May 2008 (UTC)

So, to be clear, you are disputing that chiropractors are primary contact providers for conservative care of the neuromusculoskeletal system? That's the POV? Please provide clarification so I can be address your concern. CorticoSpinal (talk) 17:18, 6 May 2008 (UTC)

When I added the templates:

Re verify-source templates: The versions I saw, at the time I added the tags, did not support the statements made. Quite simple. Some of them might have been broken, and some google books references are automatically broken for most people. Please refer DIRECTLY to the book using {{cite book}}. If google books works, you can get there through the links, or add a google books reference in the URL field.

Re verify-reliability templates: The use of a chiropractic source for legal information as to scope of practice is self-serving. Because of the history of dispute between medical doctors and chiropractic doctors, we would need sources from both for inclusion, as well you should know.

Specifics.

I'd never heard of Jones & Bartlett. Are they primarily a medical publishing house? A chiropractic publishing house?
Chiroweb and "Dynamic Chiropractic" are not credible sources except as to the opinions of chiropractors. "Semin Integr Med" (by the way, there was a discussion elsewhere, which suggests journal abbreviations should NEVER be used, as there isn't a one to one correspondance between abbreviations and names), might be, and the doi: link doesn't list the actual name of the journal for me.
The credibility of Ian Coulter is not seriously in doubt, but he's only one of the co-authors of the source, and we don't know he had final editorial control, that his reputation has sufficient standing that it is considered implausible he would assist a friend or colleage in supporting something that he doubted the accuracy of, or that AHCPR (which, again, shouldn't have been abbreviated -- I can think of at least 2 relevant organizations known by those initials, and you didn't list the journal or book title) isn't a chiropractic organization.

The sources and text have been significantly changed since I added the tags, so I'm not sure that the tags would still be correct. — Arthur Rubin (talk) 18:47, 6 May 2008 (UTC)

You are either misleading the readers and other editors, are mispeaking but the sources have stayed the same as they did when I originally put them in and when Eubulides checked them out. In fact, since you are an administrator, I find your conduct to be very unbecoming of someone who is to be a voice of reason and a calming influence. Rather, it seems that your last change here is more of the same as I written above. Also, if you could be so kind as to point out policy that chiropractic sources cannot be used as you have alluded to above would move this discussion further. Thanks. CorticoSpinal (talk) 19:45, 6 May 2008 (UTC)

Weasel wording attribution was added here. QuackGuru 23:08, 6 May 2008 (UTC)

QG, you are crossing the line making false allegations. Jefffire routinely does the exact same thing (but much worse) at Sports Chiropractic and he gets a free pass, I mention that it's a research paper (weasel?) and you cry foul. A bit of consistency from you would be nice. Thanks. CorticoSpinal (talk) 00:03, 7 May 2008 (UTC)

The source is from a high quality journal (^[25]) and not a chiropractic POV source. We need more medical journal representation on Wikipedia. Attribution is weaseling in this particular case. QuackGuru 00:17, 7 May 2008 (UTC)

Please see #2008-05-06 changes below for more. Eubulides (talk) 09:25, 7 May 2008 (UTC)

2008-05-06 changes

Reviewing these changes made to Chiropractic since 2008-05-06 noon UTC, along with the comments made above:

The lead talks about "progressive view" but none of the three cited sources ([11], [12], [13]) say "progressive". This is a mismatch between the lead and its sources, which needs to be fixed. For now, let's add a "failed verification" tag.
- It's clearly in the US Dept. of Education, Eubulides. Why you seem to dispute everything here is beyond me. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)
  - Text must be directly supported by cited sources. Surely this is not controversial. The current text is not supported by the sources this cites. This is not controversial either. So the tag is appropriate. Eubulides (talk) 09:36, 8 May 2008 (UTC)
The wording in Chiropractic#Scope of practice has strayed to include material like "legislated as" that is not supported by the source, and the phrase "according to a research paper" which is out of place in a Wikipedia article (it is attempting to undercut the source). It's better to stick to what the sources say. The simplest approach is to keep the first sentence "primary contact providers" as-is, citing the WHO, and to have the second sentence use "primary care providers" and cite Meeker & Haldeman. That way, the text matches the sources, and it more accurately reflects the underlying controversy without getting bogged down in the dispute. Rewording it this way lets us avoid the "failed verification" tag.

You have included that piece which was absolutely no bearing on the actual scope of practice of chiropractors. It shall be moved to the appropriate section, opinions of any kind, do not belong SOP. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

Every source used in Chiropractic gives an opinion. If a source could be excluded merely because it expresses an "opinion" that would give license to exclude any source whatsoever, which is surely not intended. The source in question (Meeker & Haldeman 2002^[25]) is high-quality and discusses scope-of-practice issues in a relatively neutral way, giving adequate weight to the wide variety of opinions on this subject. Eubulides (talk) 09:36, 8 May 2008 (UTC)

The discussion of veterinary chiropractic is still supported by dubious citations. The discussion says DCs and DVMs "can practice veterinary chiropractic" but neither source says that. For now let's add "Failed verification" tags to these sources.

Sorry that you find anything less than a double blind RCT "dubious" but had you actually read the sources, it says it clearly. I'm going to remove the tags, they are unneccessary and are a further example of questionable editing practices. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

It's not a question of whether the sources are reliable. It's a question of whether the sources support the claim.

Neither of the two source cited ([14], [15]) support the claim that veterinary chiropractic "includes assessment, diagnosis and treatment of biomechanical disorders of animals that may be amenable to manual therapy"; neither of talk about assessment, or about diagnosis, or about biomechanical disorders, or about amenability to manual therapy.
Neither source says that DCs and DVMs "can practice veterinary chiropractic". The first source is an advertisement for a training course; it says nothing about practice or scope of practice. The second source talks about the examination process for getting an ACCC certification. It does say "examinations are designed to evaluate the suitability for practice in the international animal chiropractic environment" but that's too vague. Does it mean passing the test lets one practice veterinary chiropractic in (say) Mongolia? But one doesn't need a certificate to do that; one can just go ahead and do it; the Mongolian authorities won't care one way or another.

Let's find a source that directly supports the claim that this is a genuine scope of practice issue, as opposed to a meaningless and unenforced certificate that one can hang on the wall. And let's find a source that supports the other stuff about biomechanical disorders and diagnosis and so forth.

In short, I am not saying the text is incorrect; it's just that it's unsourced. Claims need to be sourced. Eubulides (talk) 09:36, 8 May 2008 (UTC)

The ACA, the leading chiropractic association, opposes veterinary chiropractic as a matter of official policy. This should be mentioned briefly, as the existing text gives only the positive POV of veterinary chiropractic. I propose adding the text "However, the official position of the American Chiropractic Association is that applying manipulative techniques to animals does not constitute chiropractic and that veterinary chiropractic is a misnomer." and citing the abovementioned source. Eubulides (talk) 09:25, 7 May 2008 (UTC)

- This has no bearing to scope of practice and it completely ignores the subsequent survey which demonstrated de-facto support. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

Sure it has bearing on the scope of practice. The leading chiropractic organization opposes the very existence of "veterinary chiropractic". Subsequent surveys do not change the fact that the topic is a controversial one, and all sides should be fairly covered. Eubulides (talk) 09:36, 8 May 2008 (UTC)

No further comment, so I made that change. Eubulides (talk) 07:27, 12 May 2008 (UTC)

The cited source for where chiropractic medicine is more established[16] lists (on page 23, under "Thinking things through") that the U.S., Canada, and Australia are "established" but that other countries such as England, Denmark, South Africa, and New Zealand are merely "advancing". This does not support Chiropractic's claim that chiropractic medicine is "most established" in North America (North America includes Mexico, which is surely not intended) or the U.K. Let's fix this problem by rewording it to "Chiropractic medicine is established in the U.S., Canada, and Australia, and is present to a lesser extent in many other countries."

It's a big player in UK and they are producing good research and have a good journal as well. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

The cited source says that chiropractic is not established in the UK. Claims made in Chiropractic should match their cited sources. Eubulides (talk) 09:36, 8 May 2008 (UTC)

The expansion to Chiropractic#Education, licensing, and regulation was added not only without consensus, but with an undisputed outstanding suggestion in its review to put the new text in Chiropractic education first, and to propose a briefer version here. I'll move the expansion to Chiropractic education as a first step to implement that suggestion. Eubulides (talk) 09:25, 7 May 2008 (UTC)

The section is NPOV and this is yet another attempt by yourself to supress any information that you personally disagree with. I have restored the version as it is well cited, factual amd all significant claims are sourced. Please desist from deleting cited material that is directly applicable to chiropractic. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

The material is duplicative of material that is already in Chiropractic. When the material reviewed two editors expressed their opinions; both suggested putting it in Chiropractic education and drafting a shorter version here. Nobody expressed a different opinion. The suggestions should not have been silently ignored. Eubulides (talk) 09:36, 8 May 2008 (UTC)

The phrase "(not necessarily performed by a chiropractor)" was inserted. A clarification is useful as the sentence appears right after a sentence talking about chiropractic care, but the parenthetical remark could be worded a bit more briefly. I suggest "(whether chiropractic or not)". I verified that the source, although it does not limit itself to chiropractic care, does emphasize chiropractic studies and/or arguments that apply equally well to chiropractic versus non-chiropractic care for its stronger results, so the "nonspecific" tag can be removed.
A citation was added to a primary study (Boyle et al. 2008, PMID 18204389) in order to argue with secondary reviews. This is not in accordance with the WP:MEDRS guidelines, which states that Wikipedia should not use primary studies to argue with secondary reviews due to the possibility of introducing our bias. In this particular case arguing with the secondary review is particularly inappropriate:

We have discussed already this many times and Boyle et al. can be added in accordance with WP:IAR (at worst) and the guidelines does not preclude us from using high impact, quality, peer-reviewed articles. Unlike say, Miley et al. which does not mention chiropractic, and is rather about cervical manipulation (thus should not really be in the article, but rather SMT) Boyle is about chiropractic safety and utilization CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

WP:IAR is not a good basis for writing a reliable encyclopedic article in a controversial area. It is a recipe for generating low-quality material that endlessly mutates. The Boyle citation is lower-quality for reasons already mentioned, none of which have been disputed; it was reviewed by Hurwitz et al. 2008 (PMID 18204386), and all of its results mentioned by Hurwitz (that is, the empty set) were already covered. Citing Boyle et al. is disagreeing with a reliablye high-quality review by reaching down into a primary study to obtain material used to dispute another high-quality review. This sort of behavior is a recipe for building ureliable and tendentious material. You are incorrect about Miley et al. 2008 (PMID 18195663); that study mentions chiropractic heavily and relies on chiropractic studies for some of their strongest results. Eubulides (talk) 09:36, 8 May 2008 (UTC)

- One of the cited reviews (Hurwitz et al. 2008, PMID 18204386) covers the primary study in question and did not highlight the result in question.
- The Hurwitz et al. review is by the same task force as the primary study, so this is not a hostile or critical review we're talking about here; they would be expected to summarize the primary study with some sympathy.

It would be best not to speculate, Eubulides. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

The point is that there's no reason to expect Hurwitz to review Boyle unfairly. They are on friendly terms. Even a friendly review found nothing worth summarizing about this study. Eubulides (talk) 09:36, 8 May 2008 (UTC)

- The measurement technique used by the primary study (an "ecologic" one) is crude, so it's not surprising that the study reports no significant results.

- Please abide by WP:AGF and don't doubt the experts. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

I am assuming good faith of the experts. The experts here (Hurwitz et al. 2008, PMID 18204386) do not think the report's results are worth mentioning. As per WP:MEDRS, their opinions should take precedence over primary studies. We need a good reason to refuse to follow guidelines. No good reason has been presented, other than WP:IAR, and "ignore all rules" is not a reason. Eubulides (talk) 09:36, 8 May 2008 (UTC)

- Other primary studies, using different techniques, have measured a statistical association between chiropractic services and stroke.
- Nobody is seriously disputing that this statistical association exists. The Task Force review acknowledges it, among other reviews.
- The text claims that the weak Boyle et al. result "is in contrast" to the Miley et al. review. But this is not the case. The Boyle et al. result (i.e., their crude technique could not detect a statistical association that other techniques can detect) does not disagree with or contrast with the Miley et al. review (i.e., there is weak to strong evidence of causation).
- A Wikipedia article should not mislead the leader into thinking that Boyle et al.'s weak result casts any doubt on the other results.
  - Where does it mention that the results are 'weak'? Are you injecting your personal commentary and inuendo or is there a source which suggests Boyle et al is weak? Please clarify. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

The experts in this case (Hurwitz et al. 2008, PMID 18204386) have reviewed the study do not think its results are worth mentioning. We should not override their opinion in an effort to undercut the results of another reliable review. Eubulides (talk) 09:36, 8 May 2008 (UTC)

For now, I'll remove the citation and the text. If there is real sentiment that Wikipedia should cover Boyle et al.'s primary study, I suggest putting it into a subarticle on scientific investigation, along with coverage of dozens of other primary studies. 09:25, 7 May 2008 (UTC)

For now, I'll restore the citation and the text. It's a study that directly investigates chiropractic care and stroke. It's published in a high-impact journal. It's a study funded by the WHO. It's part of an international task force. Weak? Hardly. CorticoSpinal (talk) 13:28, 7 May 2008 (UTC)

It's a study that has been reviewed by the same group that produced the study (Hurwitz et al. 2008, PMID 18204386) and they did not think its results worth mentioning. We should not override published expert opinion. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

I made this change to implement the above suggestions. All in all, though this has been a lot of work and obviously there is some disagreeement here, I think we're making some real progress. Thanks to everyone who has contributed. Eubulides (talk) 09:25, 7 May 2008 (UTC)

This controversial change added the POV wording of significance of subluxation. What happened to the 2002 survey?

If we are going to use a primary source we should use something that adds value to the article. I find this sentence to be both comprehensive and informative. --> These strokes after manipulation appear to be unpredictable and are an inherent, idiosyncratic, and rare complication of cervical spine manipulation.^[30]

That sentence was removed after comments by SmithBlue in the #Suggested change re stroke wording thread. His feeling was that the sentence is to some extent superseded by the 2008 reviews and executive summary by Haldeman et al. published in Spine. I don't feel strongly about it either way, but SmithBlue did, so I removed it. Please review the above thread before re-adding that sentence. The citation is not a primary source, by the way; it is a review, which is a secondary source. Eubulides (talk) 09:36, 8 May 2008 (UTC)

This recently added sentence, is written biasly. It starts off by saying "This is contrast to the conclusions that suggest..." This is POV and should be deleted. The cherry picked source does not add much to the article. It is saying that the risk does not increase with additional chiropractic care. The reviews did not think much of this too. This sentence seems misleading too. It is giving me the impression there is no risk with more chiropractic care. Please fix it. I think the text flowed better with the previous version. This change does not flow well. QuackGuru 15:49, 7 May 2008 (UTC)

The "biasly" text and "cherry picked source" was added by CorticoSpinal for no stated reason other than WP:IAR. No other editor supports it, and due to its serious problems it should be removed. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

Chiropractors are primary contact providers who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery.^[19] <-- This sentence is POV. The next sentence explains about the primary contact providers debate. QuackGuru 16:04, 7 May 2008 (UTC)

This quote was not what I had in mind. Fixing the previous sentence about the primary contact providers issue is easy. Just remove the primary contact providers words. QuackGuru 16:19, 7 May 2008 (UTC)

Given the controversy I thought it would avoid the whole mess by removing possibly PoV paraphrasing and go for a direct quote. I thought it worked rather well, but I would be happy to discuss this if you would elaborate on your objection. Jefffire (talk) 17:00, 7 May 2008 (UTC)

Quotes are a good starting point. But when we have an original Wikipedia sentence it is better to use our own writings. Quotes are fine is some circumstances. QuackGuru 17:07, 7 May 2008 (UTC)

I agree that it isn't ideal. I viewed it as a compromise until an elegant NPoV wording could be found. Jefffire (talk) 17:34, 7 May 2008 (UTC)

Asking for elegance is probably asking for too much here. It should suffice if the wording is accurate and not overly clumsy. Accuracy is more importance than elegance. But I attempted to supply more-elegant wording; please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

There was NPOV wording before but someone added the POV wording (primary contact providers). QuackGuru 17:46, 7 May 2008 (UTC)

The cited source says "primary-contact health care practitioners", so let's use that phrase. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

This is a misleading edit summary and the POV wording has returned. QuackGuru 18:13, 7 May 2008 (UTC)

QuackGuru, everywhere that DCs are legislated and regulated (hence scope of practice) they are considered PRIMARY CARE. I have compromised and took CynRNs suggestion to replace care with contact. Now skeptics won't even allow the disemination of information that DCs are PCPs for neuromusculoskeletal. Give me a break. CorticoSpinal (talk) 18:25, 7 May 2008 (UTC)

Except in doing so, you disregarded the consensus on compromise that was achieved by myself, Eubulides and CynRN who felt that setence was appropriate. You have an increasingly worrisome habit of popping by the article, making an edit/reverting without even being part of the discussion that proceeded it. CorticoSpinal (talk) 18:25, 7 May 2008 (UTC)

Quotes are a good starting point. But when we have an original Wikipedia sentence it is better to use our own writings. Quotes are fine is some circumstances. QuackGuru 17:07, 7 May 2008 (UTC)

I agree that it isn't ideal. I viewed it as a compromise until an elegant NPoV wording could be found. Jefffire (talk) 17:34, 7 May 2008

I attempted to supply some more-elegant wording. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

It is a NPOV sentence. It's only POV to chiropractic skeptics who seem to have a warped sense of what constitutes POV. CorticoSpinal (talk) 18:25, 7 May 2008 (UTC)

That has ALWAYS been part of the draft, QG, there are many, many diffs to prove this. If I might give you some friendly advice, if you are going to cast stones, make sure you don't live in a glass house. Your attitude here lately is unbecoming of an experienced editor and you have failed to agree to consensus as demonstrated above. I will remind you, yet again, that you narrowly escaped an ANI investigation into your disruptive tendencies on chiropractic and related articles and the diffs are accumulating since that time. For the good of the project, fellow editors and the article, please desist from inflammatory statements and false accusations. Consider this a gentle nudge! Take care, CorticoSpinal (talk) 18:25, 7 May 2008 (UTC)

I must say that this was an unexpectedly hostile reaction to providing a quote from the world health organization. Jefffire (talk) 19:00, 7 May 2008 (UTC)

I'm not going to take your bait, Jefffire ("unexpectedly hostile". You have not participated here through building of the draft so naturally, you have no context to the situation. Go fish elsewhere. CorticoSpinal (talk) 20:26, 7 May 2008 (UTC)

This controversial edit is in direct contradiction to the next sentence. The first sentence declares chiropractors as "primary contact providers" but the next sentence explains the primary contact providers controversy. The sentences appear to be contradictory. QuackGuru 18:42, 7 May 2008 (UTC)

That's because Eubulides went against consensus and inserted an opinion of Haldeman and Meeker. It was struck out in the original draft and several editors felt it belonged ELSEWHERE. There was agreement however on the first sentence (primary CONTACT) and if anything the second sentence should be moved into the practice styles section or where OPINIONS belong.

I did not go "against consensus"; I went against only your opposition to including the relevant points from Haldeman & Meeker. It is not the case that "several editors felt it belonged ELSEWHERE". Eubulides (talk) 09:36, 8 May 2008 (UTC)

Here is another controversial edit. Please fix it. QuackGuru 19:51, 7 May 2008 (UTC)

Here is another controversial change that declares chiropractors as "primary contact providers" but the next sentence explains the primary contact providers controversy. QuackGuru 07:31, 8 May 2008 (UTC)

If there is a legitimate controversy about the status, then I think the appropriate thing to do would be to cut the "primary" stuff from the first sentence, and then explain the controversy in the second. Jefffire (talk) 07:55, 8 May 2008 (UTC)

Removing the POV material (primary contact providers) from the first sentence works for me. QuackGuru 07:58, 8 May 2008 (UTC)

Apparently I have missed something. How is it POV to say that DCs are primary contact when they are? If someone can demonstrate a reason why it should be changed (ie - how is it POV?), then it should be changed BACK to primary care. DigitalC (talk) 08:15, 8 May 2008 (UTC)

The next sentence explains the controversy. It should be changed back where there was no mention of primary contact providers or primary care. QuackGuru 08:24, 8 May 2008 (UTC)

(outdent) I gave a shot at rewording it in the light of the above comments. For more, please see #2008-05-07 changes below. Eubulides (talk) 09:36, 8 May 2008 (UTC)

QG, the next sentence does not explain the controversy. In fact, the second sentence could be deleted completely imho. Chiropractors are primary care/primary contact health care providers. That is a fact. It is not POV. Eubulides, I don't think that edit is acceptable, because now it seems like they aren't primary care/contact, they only have "many" attributes of primary care/contact, and then goes on to qualify it. Why the watering down of the fact that chiropractors ARE primary care/contact?DigitalC (talk) 11:46, 8 May 2008 (UTC)

It is not a universal "fact" that DCs are PCPs. They are PCPs in some jurisdictions, but not in others. For example, DCs are not legislated as PCPs in New York; see [17] (dated 2005). I'm sure there are other examples. The point is that the rules vary quite a bit from one jurisdiction to another, and the assertion "DCs are legally PCPs for NMS" is not correct in general. Eubulides (talk) 09:41, 22 April 2008 (UTC)

Thank you for that source. It has been my experience up to this point that legally, Primary Care has met the defintion of [18], in that there is no need for referral. Obviously, I was mistaken, and an agreed upon definition does not necessarily exist. I still fail to see the controversy about the first sentence calling chiropractors primary contact health care providers.DigitalC (talk) 00:33, 9 May 2008 (UTC)

I think the controversy is because the first sentence ("Chiropractors are primary-contact health care practitioners who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery.") seems to conflict with the second sentence ("Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry.") A naive reader will see that and say, "OK, which is it? Primary care or specialty?" Opinions differ, the rules are different in different jurisdictions, and it is hard to summarize this confusing state in a non-confusing way. We may have to settle with what we've got now, unless someone can come up with a reliable source that explains things better. Eubulides (talk) 16:29, 9 May 2008 (UTC)

The next sentence clearly explains the controversy in a neutral way. The next sentence explains it accurately. QuackGuru 16:20, 8 May 2008 (UTC)

philosophy

recognizes the centrality of the nervous system and its intimate relationship with both the structural and regulatory capacities of the body

The word intimate seems like a WP:PEACOCK term. QuackGuru 13:32, 8 May 2008 (UTC)

I will remove the peacock term. Going once... going twice... QuackGuru 02:58, 9 May 2008 (UTC)

Is it peacock or descriptive? Hmmm... Is there another word you'd prefer?--Hughgr (talk) 03:57, 9 May 2008 (UTC)

Is it peacock or descriptive? I think it is a peacock term. Is there a reference that verifies the word intimate? I could not find any reference. I could not think of another word. I recommend we delete the peacock term. QuackGuru 16:23, 9 May 2008 (UTC)

The cited source (Mootz & Phillips 1997) says "intimate". This source is dated but unless we find a better one I'd leave the word alone. Eubulides (talk) 16:29, 9 May 2008 (UTC)

Irrespective of what any source says it is still a peacock term. We can tone down the sentence by removing the WP:PEACOCK word. QuackGuru 05:39, 10 May 2008 (UTC)

I'm not sure I agree that it is peacock. When Prescher 2000 (PMID 10963915) says "an intimate relationship exists to the tendon of the long bicipital head and in about 55% of cases", is that a peacock term too? If not, why is a similar use of "intimate" peacock here? Eubulides (talk) 07:04, 10 May 2008 (UTC)

About 55% of cases? That is not a large majority. Irrespective of sourcing I believe the word itself as it is currently being used is a peacock word. QuackGuru 17:17, 10 May 2008 (UTC)

The "55%" quote was not taken from a chiropractic article. The quote was given to illustrate the point that "intimate" is commonly used in a medical sense that has nothing to do with emotional intimacy. Eubulides (talk) 21:31, 10 May 2008 (UTC)

Its a word commonly used in anatomy and physiology. I think your out in left field on this one.--Hughgr (talk) 18:07, 10 May 2008 (UTC)

Agreed. Not a peacock term. Let's move on. -- Levine2112 ^discuss 18:31, 10 May 2008 (UTC)

Failed verification tag - SOP

With the addition of the RMIT reference (and rewording to match the source), are we prepared to remove the respective failed verification tag? The tag was included with the following comment, which I think has been cleared up: 'The two cited web pages do not mention "assessment" or "diagnosis" or "treatment" or "biomechanical disorders" or "amenable" or "manual therapy". Please rewrite the claims to match the sources, or find better sources'.DigitalC (talk) 00:46, 10 May 2008 (UTC)

Yes, thanks; I removed the tag. Eubulides (talk) 07:04, 10 May 2008 (UTC)

Should all three citations remain, or should at least one of them be removed? I will look for sources for acupuncture next. I already know that it will be similar in that some areas allow Chiropractors to practice acupuncture, and others don't.DigitalC (talk) 07:41, 10 May 2008 (UTC)

Let's please remove sources that are not needed to support the article. There's little sense sending readers on wild goose chases. Thanks. Eubulides (talk) 21:31, 10 May 2008 (UTC)

Table needs moving to right

I just tweaked a table to make it look better, but it needs to be at the right, and I'm unsure how to do it. [19] -- Fyslee / talk 15:20, 11 May 2008 (UTC)

Does adding all those lines to the diagram really make it work better? Or does it distract the reader by suggesting relationships that aren't really there, such as the relationship between "operational definitions possible" and "origin of holism in chiropractic"? One of Edward Tufte's design principles is to prefer white space to ink unless the ink is really needed. The original source (see page 10) doesn't have the lines, and I suspect the inferior HTML version has lines only because the HTML transcriber didn't bother to remove them (the lines are the defaults with tables in HTML). Anyway, for now I moved the table to the right and went back to the style used in the original PDF source. Eubulides (talk) 16:21, 11 May 2008 (UTC)

The lines aren't essential. It was more the background color I was after, and the wikitable format does that. If you can just color the background, that would do it. -- Fyslee / talk 16:37, 11 May 2008 (UTC)

unsourced material in scientific investigation

When testing the efficacy of health treatments, double blind studies are considered acceptable scientific rigor. These are designed so that neither the patient nor the doctor knows whether they are using the actual treatment or a placebo (or "sham") treatment. However, chiropractic treatment involves a manipulation; "sham" procedures cannot be easily devised for this, and even if the patient is unaware whether the treatment is a real or sham procedure, the doctor cannot be unaware. Thus there may be "observer bias" - the tendency to see what you expect to see, and the potential for the patient to wish to report benefits to "please" the doctor. Similarly, it is often difficult to devise a sham procedure for surgical procedures, but it is not impossible. It is also a problem in evaluating treatments; even when there are objective outcome measures, the placebo effect can be very substantial. Thus, DCs have historically relied mostly on their own clinical experience and the shared experience of their colleagues, as reported in case studies, to direct their treatment methods. Consequently there has been a call to increase qualitative research studies that can better examine the whole chiropractic clinical encounter.^{[citation needed]}

Please provided a quality reference or in accordance with Wikipedia policy the unreferenced material should be deleted. QuackGuru 01:57, 7 May 2008 (UTC)

The proposal on the table is to replace that material with #Scientific investigation 2. Eubulides (talk) 09:25, 7 May 2008 (UTC)

This unsourced text will be deleted if no references are provided. QuackGuru 15:17, 7 May 2008 (UTC)

Does anyone prefer we delete this material or should we keep it? QuackGuru 18:43, 9 May 2008 (UTC)

I prefer deleting the outdated material and replacing it with the new material. That change is controversial, though; please see Wikipedia:Mediation Cabal/Cases/2008-05-05 Chiropractic. Are you suggesting that while trying to gain consensus on a new Scientific investigation we delete the sections Chiropractic #The Manga Report through the lead two pargraphs of Chiropractic #Scientific investigation? That sounds a bit drastic. Perhaps a smaller deletion? If so, exactly what would it be? We need a specific proposal here. Eubulides (talk) 21:06, 9 May 2008 (UTC)

That change is controversial or drastic? I did not know improving on NPOV is controversial. BTY, the scientific investigation 2 is highly bias. It is missing information from Effectiveness 1. It looks like the effectiveness has been chopped in half. Some Wikipedians believe we should not have an effectiveness section though. Maybe Levine2112 has some specific ideas we can work on. QuackGuru 02:25, 10 May 2008 (UTC)

It wasn't chopped in half, but some material was removed in the interests of brevity. Perhaps too much was removed. I plan to draft an #Effectiveness 3 to try to address this (and other) issues. Eubulides (talk) 07:04, 10 May 2008 (UTC)

I'd prefer to hash it out at the Med Cabal page and in the interim all agree not to make any controversial edits to the article. -- Levine2112 ^discuss 02:45, 10 May 2008 (UTC)

Improvinng an article is non-controversial. It was never controversial to begin with (NPOVing). But some feel even improving a reference is controversial. Hmm. QuackGuru 03:11, 10 May 2008 (UTC)

Suffice it to say that your version of "improving" and "NPOV" is different from mine and that of most every other editor here. Hence, mediation may be the best place to handle this at the moment. -- Levine2112 ^discuss 03:21, 10 May 2008 (UTC)

We don't need to wait to make article improvements. QuackGuru 17:04, 10 May 2008 (UTC)

I removed the unsourced material from mainspace. No references was provided and plenty of time has been given. QuackGuru 05:39, 12 May 2008 (UTC)

outdated POV material in scientific investigation

In 1994 and 1995, half of all grant funding to chiropractic researchers was from the US Health Resources and Services Administration (7 grants totaling $2.3 million). The Foundation for Chiropractic Education and Research (11 grants, $881,000) and the Consortium for Chiropractic Research (4 grants, $519,000) accounted for most of the rest. By 1997, there were 14 peer-reviewed chiropractic journals in English that encouraged the publication of chiropractic research, including The Journal of Manipulative and Physiological Therapeutics (JMPT), Topics in Clinical Chiropractic, and the Journal of Chiropractic Humanities. However, of these, only JMPT is indexed in MEDLINE. Research into chiropractic, whether from Universities or chiropractic colleges, is however often published in many other scientific journals.^[31]

Here is more oudated stuff in the article. Time for a cleanup. QuackGuru 01:57, 7 May 2008 (UTC)

The notion that historical information can be outdated is rather ironic. I think this information is well-cited, relevant and important to chiropractic history. It should stay. -- Levine2112 ^discuss 07:52, 7 May 2008 (UTC)

This information is not part of the history section. It is in the scientific investigation section. The notion that you believe it is historical information is not the point. Even if the information is historical it has no historical impact. The text is highly one-sided from a less than a reliable website. Get it? QuackGuru 15:10, 7 May 2008 (UTC)

Certainly historical material can become outdated. The information in question is highly biased: it does not present the other side of the argument, which was available contemporaneously in high-quality sources. This must get fixed. Again, the proposal is to replace that material with #Scientific investigation 2. Details about these obsolete studies can go into the history subarticle; they are not that relevant here. Eubulides (talk) 09:25, 7 May 2008 (UTC)

Scientitic investigation, as it stands, is about investigation of SMT and not of the profession of chiropractic or any of the significant scientific milestones of the profession (Palmer clinic circa 1920's, FCER foundation 1944, CCE accrediation (funding for scientific investigations was a directed consequence of accreditation) conference on manipulation 1975 USA (they could not call it chiropractic for fear of a boycott (Petersen/Wiese 1994), the New Zealand commission 1979, Index Medicus JMPT 1983, major medical publishing houses publishing chiropractic textbooks 80s, 90s, WHO recognition (90s), integrative medicine (2000s). Also, scientific investigation as proposed by Eubulides violates WP:NPOV, WP:OR,WP:SYN and applies questionable WP:COATRACK tactics. Seeing as there may be an impasse here I'll make a quick draft that is more relevant and valid to the topic at hand, namely the science of chiropractic. CorticoSpinal (talk) 15:39, 7 May 2008 (UTC)

#Scientific investigation 2 dicusses forms of treatment other than SMT.
People who are reading about scientific studies of effectiveness and safety want to know today's best results, not about old stuff. Historical material should be put into Chiropractic history with a brief summary in Chiropractic #History.
The effectiveness of chiropractic care is a core issue; the scientific bureaucracy behind the scenes is not.
#Scientific investigation 2 relies on high-quality recent reviews, from both chiropractic and non-chiropractic sources, and is far superior to what's in Chiropractic now, both in terms of quality of sources and lack of bias.

Eubulides (talk) 09:36, 8 May 2008 (UTC)

According to Levin2112 the information should stay. But the information is in the scientific investigation section and has no historical value. QuackGuru 18:21, 7 May 2008 (UTC)

That's your opinion (which is nowhere in line with any consensus). -- Levine2112 ^discuss 03:23, 10 May 2008 (UTC)

Accordinng to this comment the text is relevant and important to chiropractic history This dated information is in the scientific investigation section and not the history. The highly bias text has no historical impact. Going once... twice... QuackGuru 03:09, 9 May 2008 (UTC)

This too is just your opinion. -- Levine2112 ^discuss 03:23, 10 May 2008 (UTC)

This too is just your opinion? I am referring to Levine2112's opinion too which claims the text is related to history. Then why is it still in the scientific investigation section. QuackGuru 21:48, 11 May 2008 (UTC)

That is your opinion that the text is related to history but it is in the scientific investigation section. QuackGuru 17:04, 10 May 2008 (UTC)

This is outdated POV material and newer higher quality studies exist. QuackGuru 12:07, 14 May 2008 (UTC)

2008-05-07 changes

Reviewing these edits made from 2008-05-07 11:00 through 2008-05-08 08:00 UTC, I see the following problems:

As discussed above there is considerable dispute over the phrase "primary contact". The cited source (the WHO guidelines) uses the phrase "primary-contact health care practitioners" and I suggest we stick to the source's wording.
As discussed above, there's some confusion about the seeming contradiction between the 1st two sentences in Scope of practice re primary contact etc. I tried to reword it to avoid confusion.

This edit undid the change with this comment that "Eubulides, I don't think that edit is acceptable, because now it seems like they aren't primary care/contact, they only have "many" attributes of primary care/contact, and then goes on to qualify it. Why the watering down of the fact that chiropractors ARE primary care/contact?" The problem is that chiropractors are primary care in some jurisdictions, but not in others. For example, they are not legislated as PCPs in New York; see [20]. We need to briefly summarize, somehow, that there are important diverging views on this subject; the article cannot simply state that chiropractors are primary-care or primary-contact without also covering alternate views with proper weight. I will try another way to phrase it, since this way obviously didn't work for you. Here's what I'll try: "Chiropractors are primary-contact health care practitioners who emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery." citing the WHO, followed by "Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry." citing Meeker & Haldeman.

This edit introduced substantial and controversial changes to the lead (for example, it removed the notion of vertbral subluxation) without any advance discussion or comment. Please don't do that; it understandably caused a mini-revert war. Let's please go back to the old lead and discuss the changes first here on the talk page.

Why is it important to have vertebral subluxation in the lead? DigitalC (talk) 11:55, 8 May 2008 (UTC)

Certainly vertebral subluxation is important in the historical development in chiropractic. But the point here is not to argue about what should be in the lead; the point is that there should be discussion about controversial changes like this before installing them. That was not done in this case: the lead was fairly stable for weeks, and then all of a sudden a substantial change was made to it without advance discussion. That is contrary to the proper practice for this controversial article. Eubulides (talk) 16:35, 8 May 2008 (UTC)

This edit removed a diagram from Chiropractic#Philosophy. The diagram is indeed ugly, but it's functional and it illustrates some of the relationships in Philosophy. Let's keep it until we get a better illustration. Illustrations are good; Chiropractic needs more of them.
This edit added a citation for Oregon and adjusted the text to match the citation. Thanks, that is an improvement. A couple of minor points: there's no need for the phrase "with no additional qualifications" here; also the cited source says "substances" rather than "drugs" so we should use the more-general "substances" term.

I changed it from "with additional training", because they DON'T need additional training. I feel that it is notable that they DON'T need additional training to prescribe OTC "substances", but maybe it isn't, and I certainly don't have a source that says its notable. Feedback from others?DigitalC (talk) 11:37, 8 May 2008 (UTC)

The cited source doesn't say that they don't need additional training; why should Chiropractic highlight something that's not in the cited source. Eubulides (talk) 16:35, 8 May 2008 (UTC)

This edit removed a couple of failed-verification tags, and reworded the text at the same time (presumably to make the text match the cited sources better). But I just now went to the two cited sources, and I can't see anything like that text there. The two cited web pages do not mention anything being "in accordance with state or provincial licensing boards". They do not mention "assessment" or "diagnosis" or "treatment" or "biomechanical disorders" or "amenable" or "manual therapy". The first web page does not mention "practice". The second web page does say "The examinations are designed to evaluate the suitability for practice in the international animal chiropractic environment" but it is not clear that this "practice" is recognized by any legal authority. Please rewrite the claims to match the sources, or find better sources. I'll add a comment to that effect to the text, along with a "Failed verification".

I did have some problems with this, as I tried to add another source that stated that veterinarians and chiropractors could perform animal chiropractic with additional training and licensure, but WP has blacklisted that URL.
However, if we change (or add?) the first reference to [21], it is stated there that"Qualified Doctors of Chiropractic or Veterinary Medicine can practice Animal Chiropractic in accordance with the standards set forth by their respective provincial or state licensing boards."

Thanks for that URL. This addresses the concern that none of the cited sources talk about "accordance with state or provincial licensing boards" or "practice". However, the other concerns remain: none of the cited sources talk about "assessment" or "diagnosis" or "treatment" or "biomechanical disorders" or "amenable" or "manual therapy". Please find a source that talks about these things, and add that; in the meantime I'll use the adjusted URL and restore the "failed verification" tag with the smaller remaining set of concerns. Eubulides (talk) 16:35, 8 May 2008 (UTC)

Again, please comment on RMIT - Animal Chiropractic – Master of Chiropractic Science incorporating Graduate Diploma. www.rmit.edu.au. Retrieved on 2008-05-08.. It is not a cited reference yet, but rather than insert it and get in an edit war, I'd like opinions on it first. DigitalC (talk) 23:16, 8 May 2008 (UTC)

Sorry, I missed that comment the first time around. (This page is too big!) That URL says RMIT offers a postgraduate animal chiropractic program that covers diagnosis and management. This would address the concerns about mentioning "diagnosis", and if "treatment" is changed to "management" it would address those concerns as well. The remaining words not covered would be "assessment", "biomechanical disorders", "amenable", and "manual therapy". A couple of thoughts: first those remaining words could simply be dropped, surely. Second, I'm a bit uncomfortable with gluing together bits and pieces from various universities etc., and would prefer rewording it so that there's one phrase supported by each source if possible.
I did a bit more Googling and found this source, for Nevada: [22] (PDF). Note that it says any vet can practice veterinary chiropractic, but DCs can practice it only after jumping through hoops and only under the direction of a vet. Of course Nevada is just one state, but this is a worrisome datum, since it suggests that in Nevada at least chiropractors aren't really independent actors, and the summary currently presented in Chiropractic doesn't correctly state the relationship between DVMs and DCs (at least in Nevada). Here is one other source, in a journal: doi:10.2460/javma.2003.222.1679. It pretty much is in line with the Nevada source. If these are right, it looks like the current text has some real problems.

Eubulides (talk) 00:00, 9 May 2008 (UTC)

That was part of the reason for the inclusion of the "in accordance with...". Perhaps this could be changed to "In some locations..."?. Given that health care regulations vary from state to state, province to province, and that we want a global POV, I would assert that it would be NPOV to use "In some locations". ?DigitalC (talk) 01:04, 9 May 2008 (UTC)

Yes, "In some locations" sounds better. I made that change. Eubulides (talk) 16:29, 9 May 2008 (UTC)

As for "diagnosis", and "treatment", would this be a RS? Not every word needs a citation. This source backs up claims that treatment includes "injuries" (ie - of the biomechanical kind, not lacerations), and we are allowed to paraphrase. RMIT - Animal Chiropractic – Master of Chiropractic Science incorporating Graduate Diploma. www.rmit.edu.au. Retrieved on 2008-05-08.DigitalC (talk) 11:26, 8 May 2008 (UTC)

Yes, please see above. (I missed this comment at first.) Eubulides (talk) 00:00, 9 May 2008 (UTC)

As for NEEDING additional trainig, this is Australia-centric, but I just chanced across it while looking for the proper RMIT url above, [23] DigitalC (talk) 12:02, 8 May 2008 (UTC)

Yes, that source means there's a legal scope of practice in Victoria for animal chiropractic. Again, please see above. (I missed this comment at first.) Eubulides (talk) 00:00, 9 May 2008 (UTC)

This edit replaced a brief summary of Chiropractic education with a copy of that article's lead section. So far, three editors' comments in #Comments about Education, Licensing Regulation have disagreed with putting this lengthy discussion here rather than in the subpage. Please address the concerns by adding to the discussion there; it's not constructive to silently ignore other editors' concerns and revert their changes. I will attempt to address the concerns myself, by drafting a brief summary; no doubt there will be problems with this draft but at least it should be a step forward.
The same edit created a broken citation to the CCE-USA web site.
The same edit lost the hyperlinks to Chiropractic education and List of chiropractic schools; surely this wasn't intended.
This edit's log said "moving contraindications to top where it flows better." but it did far more than that: it made significant changes to the wording without discussion. It's OK to move the contraindications, but it's not OK to make significant changes like that without discussion and with a misleading change log entry. Perhaps the wording can be improved, but this needs to be discussed first. For now, I'll restore the old wording.
The same edit changed "high levels of underreporting" to "potential high levels of underreporting". The cited source does not say "potential". Again, this is a significant change in wording with a misleading change log entry. For now, I'll restore the old wording.
The same edit changed "is similarly associated with general practitioner services" to "is similarly associated with general practitioner services for all ages". The cited source (Hurwitz et al. 2008, PMID 18204386) does not mention the "all ages" detail; it merely says "This study confirmed an increased risk of VBA, but found a similar increase in risk of this form of stroke after visiting a primary care physician for neck pain." Since the cited source does not mention this detail we should not reach down into the (uncited) primary study and highlight it. Again, this is a significant change in wording with a misleading change log entry. For now, I'll restore the old wording.
The same edit added a "content" tag but there's nothing in the log entry saying why. Since the entire article has a "content" tag it's redundant to put it on this section.
This edit inserted a controversial citation to Boyle et al. 2008, reaching down into a primary study, and supplying linking text "This is in contrast to" that is WP:OR. This change has not reached consensus; on the contrary, two editors have opposed the change, and no one (other than the editor who made the change) has supported it. The change violates WP:MEDRS guidelines, and the only argument made for it seems to be WP:IAR, which is not a good policy for a controversial article like this. Also please see the discussion in #2008-05-06 changes above. Please discuss further options for this change on the talk page first. If we start adding primary sources because we disagree with what reliable reviews say, there will be no end to problems with editors adding marginal sources; hundreds if not thousands of primary sources would be available as ammunition for this sort of thing. For now, I'm reverting the change.
One other detail: there was a "nonspecific" tag that I said can be removed in #2008-05-06 changes, but due to a typographical error I forgot to remove it. There's been no discussion since then so I assume it's OK.

I made this change to implement the above suggestions. Eubulides (talk) 09:36, 8 May 2008 (UTC)

Not acceptable change regarding primary care/contact

I saw this controversial change and now I am shaking my head. The controversial changes have continued. This edit reverted a reference improvement among other things. The primary study was reverted back in the safety section. The table was deleted. QuackGuru 13:41, 8 May 2008 (UTC)

Yes, that edit undid many changes without explanation. The change log entry did say "Not acceptable change regarding primary care/contact" with this further comment. I attempted to addressed these concerns, and the few other concerns that were explained and installed a change to try to accommodate them, while restoring the changes that were not commented upon. Here is the set of changes that result from the combination of these edits. Eubulides (talk) 16:35, 8 May 2008 (UTC)

I'm willing to admit I may have made a mistake here. Is there a way to undo one part of a large edit without undoing the rest? DigitalC (talk) 23:11, 8 May 2008 (UTC)

No automated that I know of, alas; one must simply create the desired page by hand. (Nor do I know of a good way to edit giant talk pages like this one. Ouch, it's large!) Eubulides (talk) 00:00, 9 May 2008 (UTC)

Make small edits, save them, and continue. Any single edit that might be controversial (in this article that's just about anything other than spelling changes..;-) should be aired here first and only added after a consensus has been reached. -- Fyslee / talk 03:32, 9 May 2008 (UTC)

deletion of cited text in medical opposition

This controversial change deleted cited text. Hmmm. QuackGuru 17:10, 8 May 2008 (UTC)

To be specific, that change removed the text 'According to a 2002 survey, 68% of chiropractors believed that "most diseases are caused by spinal malalignment," although only 30% agreed that "subluxation was the cause of many diseases."' with a citation to Biggs et al. 2002. The log comment for the change said "this is not in the proper chronological order (at the very least)". A few thoughts:

I assume the log comment is referring to the problem in citing a 2002 survey after a discussion of events in 2005 and 2006. This criticism makes sense, and can be addressed by moving survey results earlier in the text, so that it's clear the survey results are talking about chiropractic attitudes a few years ago rather than chiropractic attitudes today.
Isn't McDonald et al. 2003 a better survey? Larger, more comprehensive, better questions, etc.? It's already cited by Chiropractic and it would make sense to cite it instead of Biggs 2002 unless there's some reason to cite Biggs 2002.
I understand there's been a long-running dispute as to how much Chiropractic should emphasize survey results, but to be honest I don't recall all the details. Is there a short summary of the dispute that would make sense to people who haven't been following it all that carefully?

Eubulides (talk) 19:24, 8 May 2008 (UTC)

The 2002 survey is very clear and concise. If something similar is written from the 2003 survey it can replace the 2002 survey or we can add both surveys. For now I think we should restore the 2002 survey. We would have to write something in order to replace the 2002 survey. I don't see any proposal. If you are sure you have something good in mind then by all meaans add the 2003 survey to the article at any time. QuackGuru 02:54, 9 May 2008 (UTC)

OK, how about the following change instead?

Change "The significance of subluxation" to "The concept of subluxation".
Before "This is still a continuing source of debate", insert "A 2003 survey of North American chiropractors found that 88% wanted to retain the term vertebral subluxation complex, and that when asked to estimate the percent of visceral ailments that subluxation significantly contributes to, the mean response was 62%." and cite McDonald et al. 2003 (already cited elsewhere in Chiropractic).

Eubulides (talk) 16:29, 9 May 2008 (UTC)

Sounds good. Insert the survey there.--—CynRN ^(Talk) 18:03, 9 May 2008 (UTC)

Both surveys are a bit different. Why not both. "The concept of subluxation" is correct. "The significance of subluxation" is POV wording. QuackGuru 05:42, 10 May 2008 (UTC)

If one survey is clearly better than the other (more recent, more surveyed) then let's not bother with the redundant one. The reader's patience is limited, even if ours isn't. Eubulides (talk) 07:04, 10 May 2008 (UTC)

After review, the 2003 survey is fine. Before "As of 2005, the chiropractic subluxation was defined by the World Health Organization as" insert the 2003 survey. This would problably be the best placement. "The concept of subluxation" can be restored. QuackGuru 12:01, 14 May 2008 (UTC)

References

^ ^a ^b ^c Haldeman S, Carroll L, Cassidy JD, Schubert J, Nygren Å (2008). "The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders: executive summary". Spine 33 (4 Suppl): S5–7. doi:10.1097/BRS.0b013e3181643f40. PMID 18204400.
^ Haldeman S, Kohlbeck FJ, McGregor M (2002). "Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation". Spine 27 (1): 49–55. PMID 11805635.
^ Haldeman S, Kohlbeck FJ, McGregor M (2002). "Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation". Spine 27 (1): 49–55. PMID 11805635.
^ Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.
^ Haldeman S, Kohlbeck FJ, McGregor M (2002). "Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation". Spine 27 (1): 49–55. PMID 11805635.
^ ^a ^b Hurwitz EL, Carragee EJ, van der Velde G (2008). "Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders". Spine 33 (4 Suppl): S123–52. doi:10.1097/BRS.0b013e3181644b1d. PMID 18204386.
^ Miley ML, Wellik KE, Wingerchuk DM, Demaerschalk BM (2008). "Does cervical manipulative therapy cause vertebral artery dissection and stroke?". Neurologist 14 (1): 66–73. doi:10.1097/NRL.0b013e318164e53d. PMID 18195663.
^ Haldeman S, Kohlbeck FJ, McGregor M (2002). "Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation". Spine 27 (1): 49–55. PMID 11805635.
^ Boyle E, Côté P, Grier AR, Cassidy JD (2008). "Examining vertebrobasilar artery stroke in two Canadian provinces". Spine 33 (4 Suppl): S170-5. PMID 18204389.
^ Boyle E, Côté P, Grier AR, Cassidy JD (2008). "Examining vertebrobasilar artery stroke in two Canadian provinces". Spine 33 (4 Suppl): S170-5. PMID 18204389.
^ Grod JP, Sikorski D, Keating JC Jr (2001). "Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies". J Manipulative Physiol Ther 24 (8): 514-9. doi:10.1067/mmt.2001.118205. PMID 11677551.
^ Canada Celebrates 100 Years of Chiropractic. Dynamic Chiropractic (July 17, 1995). Retrieved on 2008-05-01.
^ Lowry F (1994). "Orthopedists have bone to pick with economist over report on chiropractic". CMAJ 150 (11): 1878–81. PMID 7802764.
^ Manga P, Angus D (1994). "Report on chiropractic". CMAJ 151 (8): 1107–8. PMID 7922936.
^ Chapman-Smith DA (1994). "Report on chiropractic". CMAJ 151 (8): 1108. PMID 7802806.
^ Hoaken PC (1994). "Report on chiropractic". CMAJ 151 (8): 1110. PMID 7922937.
^ Tardif GS (1994). "Is the chiropractic management of low-back pain the solution? What can physicians learn from the Manga report?". CMAJ 151 (9): 1247–9. PMID 7954171.
^ Manga P (1994). "Defending the Manga report on the chiropractic management of low-back pain". CMAJ 151 (9): 1250–1. PMID 7954172.
^ ^a ^b World Health Organization (2005). "WHO guidelines on basic training and safety in chiropractic" (PDF). Retrieved on 2008-02-29.
^ National Center for Complementary and Alternative Medicine (2007). An introduction to chiropractic. Retrieved on 2008-02-14.
^ American Chiropractic Association. A history of chiropractic care. Retrieved on 2008-02-14.
^ Chiropractic Care and Back Pain. WebMD. WebMD LLC (2008-02-24). Retrieved on 2008-02-25.
^ Leach, Robert, A. (November, 2003). The Chiropractic Theories: A Textbook of Scientific Research, 4th, Lippincott, Williams & Wilkins. ISBN 0683307479.
^ (Sep 20 2004) in Haldeman, Scott: Principles and Practice of Chiropractic, 3rd, McGraw-Hill Medical, 1200. ISBN 0071375341.
^ ^a ^b ^c Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med 136 (3): 216–27. PMID 11827498.
^ Haldeman, Scott; Chapman-Smith, David, Petersen, Donald, Jr.. Guidelines for Chiropractic Quality and Practice Parameters (in English). Sudbury, MA: Jones and Bartlett, 111-113. ISBN 0-7437-2921-3.
^ McDonald WP, Durkin KF, Pfefer M et al. (2003). How Chiropractors Think and Practice: The Survey of North American Chiropractors. Ada, OH: Institute for Social Research, Ohio Northern University. ISBN 0972805559.
^ McDonald WP, Durkin KF, Pfefer M (2004). "How chiropractors think and practice: the survey of North American chiropractors". Semin Integr Med 2 (3): 92–8. doi:10.1016/j.sigm.2004.07.002. Lay summary – Dynamic Chiropractic (2003-06-02).
^ |title=CHIROPRACTIC TRAINING|coauthors=Ian D. Coulter, PhD Alan H. Adams, DC; Ruth Sandefur, DC, PhD|publisher=AHCPR|language=English|accessdate=2008-04-17}}
^ Haldeman S, Kohlbeck FJ, McGregor M (2002). "Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation". Spine 27 (1): 49–55. PMID 11805635.
^ Chirofind.com Chiropractic Research

Categories: Talk archives

Talk:Chiropractic/Archive 19

From Wikipedia, the free encyclopedia

Contents

Use of primary sources is permitted

Attribution does not require mentioning in the text

things to do list

Section Chiro/History

Safety sources again

Suggested change re stroke wording

Significant (Deliberate?) Omissions from Safety

Relevant papers

tags

image/table

keep or delete table

Is Chiropractic Fringe?

Disruptive editing by Jefffire

draft for lead changes

commentary on draft for lead changes

lead improvements

Problem with worker's compensation section

POV issues as of 2008-05-03

2008-05-03 issues list

Comments on 2008-05-03 issues list

Scope of Practice: Sources dispute

2008-05-06 changes

philosophy

Failed verification tag - SOP

Table needs moving to right

unsourced material in scientific investigation

outdated POV material in scientific investigation

2008-05-07 changes

Not acceptable change regarding primary care/contact

deletion of cited text in medical opposition

References

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