Talk:Chiropractic/Archive 20

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Contents

Cost-benefit draft

The following draft was added to Chiropractic (not by me) without discussion, and then reverted (not by me). The article does need a cost-benefit section, so I've copied the draft here for further comments. Please put comments in #Cost-benefit 0 comments. Eubulides (talk) 21:31, 10 May 2008 (UTC)

Cost-benefit 0

The Manga Report was an outcomes-study funded by the Ontario Ministry of Health and conducted by three health economists led by Professor Pran Manga. The Report supported the scientific validity, safety, efficacy, and cost-effectiveness of chiropractic for low-back pain, and found that chiropractic care had higher patient satisfaction levels than conventional alternatives. The report states that "The literature clearly and consistently shows that the major savings from chiropractic management come from fewer and lower costs of auxiliary services, fewer hospitalizations, and a highly significant reduction in chronic problems, as well as in levels and duration of disability."[1]

In 1988, a study of 10,652 Florida workers' compensation cases was conducted by Steve Wolk. He concluded that "a claimant with a back-related injury, when initially treated by a chiropractor versus a medical doctor, is less likely to become temporarily disabled, or if disabled, remains disabled for a shorter period of time; and claimants treated by medical doctors were hospitalized at a much higher rate than claimants treated by chiropractors."[2] Similarly, a 1991 study of Oregon Workers' Compensation Claims examined 201 randomly selected workers' compensation cases that involved disabling low-back injuries: when individuals with similar injuries were compared, those who visited DCs generally missed fewer days of work than those who visited MDs.[3]

A 1989 study analyzed data on Iowa state records from individuals who filed claims for back or neck injuries. The study compared benefits and the cost of care from MDs, DCs and DOs, focusing on individuals who had missed days of work and who had received compensation for their injuries. Individuals who visited DCs missed on average 2.3 fewer days than those who visited MDs, and 3.8 fewer days than those who saw DOs, and accordingly, less money was dispersed as employment compensation on average for individuals who visited DCs.[4]

In 1989, a survey by Cherkin et al. concluded that patients receiving care from health maintenance organizations in the state of Washington were three times as likely to report satisfaction with care from DCs as they were with care from other physicians. The patients were also more likely to believe that their chiropractor was concerned about them.[5]

Cost-benefit 0 comments

I don't think a cost-benefit section needs to refer to the Manga report, or to 20-year-old workers' compensation studies. That material should be moved to Chiropractic history with a one- or two-sentence summary in Chiropractic #History. A cost-benefit section should be written based on current sources. Please see Talk:Chiropractic/Archive 17 #Newer cost-effectiveness sources and Talk:Chiropractic/Archive 17 #Newer risk-benefit sources. So, pretty much, I think a complete rewrite of this draft will be needed. Eubulides (talk) 21:31, 10 May 2008 (UTC)

Manga DID have a huge impact on the profession, so hopefully we can find a source that describes this, and put it in Chiropractic History. I agree that a cost-benefit section should be based on current sources, where the sources are focused on the cost-benefit of chiropractic care (ie - not somehow reductionistic).DigitalC ([[User

talk:DigitalC|talk]]) 00:12, 11 May 2008 (UTC)

By reductionistic, do you mean studies that focus on manipulation? I think the reviews of literature don't always distinguish between studies: is the study on the 'total encounter' of chiropractic or manipulation only. Anyway, I agree with Eubulides that Manga and the old worker's comp studies need to be moved to history. Manga is something of an icon but has huge problems (as was pointed out in refs that Eubulides provided a while ago.)
I found a site that collects studies on CAM, effectiveness, cost-effectiveness which may be of interest in finding more material. "National Knowledge Week on CAM for Low Back Pain
Evidence Update on CAM for Low Back Pain - October 2007
The following relevant studies on this topic have been published since 1 October 2002.
These studies have met our selection criteria."
[6] --—CynRN (Talk) 19:00, 11 May 2008 (UTC)
There are some good studies there, CynRN; however, many of them are about spinal manipulation in general and not chiropractic specifically. We just have to weed through and find the chiropractic specific studies. Eubulides, perhaps a good place to start would be to suggest the wording for Manga in terms of history. I think it should be 3-4 sentences, encompass the studies findings in general and why the findings were significant to chiropractic history. -- Levine2112 discuss 19:45, 11 May 2008 (UTC)
I see a consensus for a rewrite. This would include a new cost-benefit section and sources the describe Manga and not the original Manga report itself. QuackGuru 11:58, 14 May 2008 (UTC)

Biomechanics and obsesity

In an overweight patient lower extremity biomechanics are very different . When walking, obese people tend to take shorter wider steps and walk slower. The Q-angles are increased at the knee and significantly more abducted foot angles. Hyperpronation is greatly increased, with more eversion of the foot and more flat-footed weight acceptance. There is also greater ankle dorsiflexion, but less plantar flexion.Lvs2bAdjstd (talk) 18:14, 14 May 2008 (UTC)

Images

I propose we use the chiropractic emblem in this article. It was adopted in 1934 in Pittsburgh, USA and is more than relevant and valid. It should be free license too. The article should make better use of images that enhance the understanding of the material. We should have a picture of a chiropractic spinal manipulation. I'd be curious to see if this image really is OMM, CSMT, SMT, OMPT, etc. Thoughts? CorticoSpinal (talk) 01:12, 17 May 2008 (UTC)

I really like the images. That Caduceus is awesome. That cervical view is obviously an osteopathic manipulation as it includes too much head rotation. That would be a general cervical move. However, it is appropriate as a manipulation picture. I would add them for sure as long as they aren't copyrighted. -- Dēmatt (chat) 00:37, 19 May 2008 (UTC)
Thanks. Eubulides suggested the article needs more images and I would agree so long as they're relevant and obviously don't violate copyright. I think an SMT and the Caduceus are a great start and if there's no major objections I think we should include them. As for the SMT pic(s) I'd like to present a single pic that would include a cervical, thoracic and lumbar manipulation using the Diversified technique (the most common chiropractic manipulative technique). Thoughts? CorticoSpinal (talk) 00:41, 19 May 2008 (UTC)

History

The history section is way too long and covers effectiveness using outdated studies. We need to discuss the WP:WEIGHT problems with the huge and oudated history section. QuackGuru 17:46, 24 April 2008 (UTC)

Um, how can history be outdated? -- Levine2112 discuss 17:51, 24 April 2008 (UTC)
Because the studies are too old. We have newer studies available. QuackGuru 17:59, 24 April 2008 (UTC)
They are too old for history? Sorry, this doesn't seem to compute. -- Levine2112 discuss 18:00, 24 April 2008 (UTC)
Isn't it discussing effectiveness that's the problem? Jefffire (talk) 18:15, 24 April 2008 (UTC)
I don't see any problem with talking about historically important research. My issue there would be that the study should be discussed for its historical importances. Manga, for instance, was landmark research in helping to establish the scientific legitimacy of the profession. I read that somewhere. I'm sure we can dig up the source. -- Levine2112 discuss 18:20, 24 April 2008 (UTC)
If studies are presented for their historical impact then there is no issue. If they are presented as "establishing scientific legitimacy", then there is an issue since that's PoV. Jefffire (talk) 18:25, 24 April 2008 (UTC)
Historically, establishing chiropractic scientific legitimacy for treating low back pain is exactly what the Manga Report (and the second Manga Report) did. It also showed the cost-effectiveness of such treatments. -- Levine2112 discuss 18:29, 24 April 2008 (UTC)
That's PoV. Providing evidence for it would be a more neutral wording. Also, nudge you again on this - published =/= truth. Jefffire (talk) 18:32, 24 April 2008 (UTC)
Oh, sure. I see your point. Manga was one of the first of a few big scientific studies (such as the AHCPR) to come out after the Wilks case ended (and the AMA had been found guilty of suppressing supportive chiropractic research). Certainly Manga provided evidence which has helped to establish a growing trend towards scientific acceptance. Nudge to you... Wikipedia isn't about truth, it is about verifiability. Published information helps to establish verifiability. I encourage you to read WP:V when you have a moment. -- Levine2112 discuss 18:40, 24 April 2008 (UTC)
OK, since you agree with, we can work toward a neutral phrasing. Also, I think you've misinterprated my comment about published material. It's a common misconception that a published study must be true "true", which is not neccasery correct. Your wording missed that subtle point. Offtopic-Science isn't decided by trials. Jefffire (talk) 18:50, 24 April 2008 (UTC)
I would love to help work on that. I am heading out for the night right now, but if you draft something up, I will be back in the morning to review. I don't think that published studies are necessarily true. Science isn't a decision, but rather a process by which a decision can be made. -- Levine2112 discuss 18:54, 24 April 2008 (UTC)
I actually consider that current wording section on the Manga report to be presented in a generally neutral manner. Jefffire (talk) 19:58, 24 April 2008 (UTC)
The history section can definitely be tweaked; for example it neglects to cover important topics like the straight vs mixer evolution, the fight for licensure/regulation, the important steps in getting reimbursement under Medicaid/Medicare (US) and the expansion of the profession globally (what about history of the profession in Canada, Europe, and elsewhere?)
That's for another day though and we do not to resolve Scope of Practice first. CorticoSpinal (talk) 22:31, 24 April 2008 (UTC)
The history section has outdated effectiveness studies. When newer studies are available we can easily replace them with the newer studies. The oudated studies are mostly about effectiveness. Our goal is to replace the oudated studies with the newer studies. Makes sense? QuackGuru 03:57, 25 April 2008 (UTC)
New studies of effectiveness are irrelevant unless they comment on the impact of the Manga report. DigitalC (talk) 04:19, 25 April 2008 (UTC)
Recent effectiveness reviews do not cite the Manga report because it is of such low quality that it is not worth citing. The most recent mention I found of the Manga report in peer-reviewed literature is Grod et al. 2001 (PMID 11677551), and they dismiss it as an example of a low-quality study that they found cited in unreliable patient brochures. Any mention that Chiropractic makes of the Manga report should also describe its sad fate. Eubulides (talk) 08:16, 25 April 2008 (UTC)
I do not see any impact of the Manga report. QuackGuru 04:25, 25 April 2008 (UTC)
Hmm, yes, that's an important factor I missed. A reference from a medical textbook or something authoritative on it's impact on American medicine would be nice. Jefffire (talk) 07:29, 25 April 2008 (UTC)
If any editor wants to include the Manga report it must be rewritten using a newer ref (PMID 11677551) and also it should be explained why the need to keep the report in this or any article. This has not been done yet. Please propose a draft with your explanation and we can review it. Agreed? QuackGuru 17:11, 25 April 2008 (UTC)
Not agreed, why are you making demands that the Manga report(s) are suddenly crap and need to be taken out? The report is notable because professor Pran Manga (PhD) in economics, I believe, has made a strong and notable argument that chiropractic services should be integrated into mainstream health care, specifically in the public system. Are you disputing the verifiability of the report? It has stood the test of time here and no one has proposed at removing it until yourself. CorticoSpinal (talk) 17:15, 25 April 2008 (UTC)
The Manga report is not "suddenly crap". It was always low quality; see for example, Grod et al. 2001 (PMID 11677551), which says "The Manga report was not a controlled clinical trial but a review of the literature that offered an opinion that has not been experimentally established." Regardless of its initial quality, though, it is long obsolete and no longer deserves much (if any) coverage in Chiropractic. Eubulides (talk) 21:53, 25 April 2008 (UTC)
The report is outdated. We have much newer studies available. QuackGuru 17:20, 25 April 2008 (UTC)
If the Manga report is notable in the history of chiropractic then its place in the history section should be assured. I ask that material in the history section be explicitly dated so that the reader can understand the timeline offered. SmithBlue (talk) 07:32, 26 April 2008 (UTC)
The Manga report has zero historical impact and is an obsolete study. QuackGuru 07:38, 26 April 2008 (UTC)
The history section can easily be improved and could use a bit of expansion. The movement towards science section is very short and lacks a lot of information. Studies that describe Manga in historical terms would fit well in that section. QuackGuru 12:19, 14 May 2008 (UTC)

out with the old and in with the new (duplication)

There is a lot of oudated studies and sections that have very little or no impact on Chiropractic history. This includes The Manga Report, Workers' compensation studies, American Medical Association (AMA), and the British Medical Association.

The best approach is to delete the old studies and replace them with the newer studies. The old studies discuss mainly effectiveness. We are essentially removing duplication. QuackGuru 07:50, 26 April 2008 (UTC)

I would greatly appreciate it if you would show us how these studies and positions (which I have found in nearly every historical account of chiropractic) have had - as you say - little or no impact on the history of the Chiropractic profession. I personally don't see it and further think we should also include a mention of the AHCPR, which has been described as a "landmark" study. [1]. -- Levine2112 discuss 08:24, 26 April 2008 (UTC)
The dc doctor is an unreliable source. No evidence has been presented that the old studies had any "landmark" impact. QuackGuru 08:31, 26 April 2008 (UTC)

I do want to make explicit that a "History" section will usually refer to events and material that is dated. Hopefully QuackGuru will cite some RS sources on Chiropractic history that neglect to mention Manga. And at the same time some RS chiropractic histories that do include it would bolster its continued inclusion. SmithBlue (talk) 11:23, 26 April 2008 (UTC)

Some mainstream medical sources would be pretty welcome. History of medicine textbooks, medical textbook etc. Jefffire (talk) 11:50, 26 April 2008 (UTC)
Hopefully History of chiropractic articles, chiropractic textbooks, perhaps health policy articles such as "Chiropractic in the United States: Trends and Issues" as well. Doubtless there will be multiple POVs on chiro history. SmithBlue (talk) 12:28, 26 April 2008 (UTC)
There are indeed a plethora of chiropractic history sources, most notably Dr. Joseph Keating, PhD. He is "the" chiropractic historian. The article is about chiropractic, so let's talk about chiropractic, shall we? Mainstream, of course, can have their 2c, but let's tell the story of the art, science and philosophy of chiropractic. CorticoSpinal (talk) 17:35, 26 April 2008 (UTC)
A useful source, but one must bear in mind not a neutral one. Jefffire (talk) 18:25, 26 April 2008 (UTC)
When these studies and sections have no impact to Chiropractic history they should be deleted. We have newer studies available such as the proposed Effectiveness section. QuackGuru 17:42, 26 April 2008 (UTC)
For chiropractic history, we can include studies that are specifically about chiropractic history and not old or obsolete studies. QuackGuru 18:15, 26 April 2008 (UTC)
Precisely, and these studies (Manga, etc.) are important to chiropractic history as per their mention in many chiropractic history sources (Keating, etc.). -- Levine2112 discuss 22:46, 26 April 2008 (UTC)

Unlike science, history is of necessity subjective, POV based, filtered information producing a story. And not surprisingly who is telling the story and who is listening makes a great deal of difference in what is considred relevant. Unlike medical research, which (we hope) reduces human failings to a minimum, the medical view of chiropractic history can only be just another POV on chiro history. In the "History" section we will of necessity be presenting multiple POVs given the disparate views that exist on chiro history - if in one POV Manga is not important that does not in any way reduce its notability in another POV. SmithBlue (talk) 03:14, 27 April 2008 (UTC)

Levine, if a reference exists that discussed the Manga report in a historical context then provide the reference. We would use the reference that discusses the Manga report and not the Manga report itself anyhow. The Manga report itself does not qualify for the history section. If another source mentions older studies (Manga, etc.) then provide all those references to replace the older and obsolete studies. QuackGuru 04:00, 27 April 2008 (UTC)
No specific references have been provided to show that any of the older or obselete studies have any historical impact. If references are provided, we would use those references and not the original older studies. QuackGuru 04:13, 27 April 2008 (UTC)
Man I remember learning Manga in school. . . it represents a critical piece of research in chiropractic history. I am sure there are dozens of references out there discussing chiropractic history which detail the significance of Manga.TheDoctorIsIn (talk) 04:59, 27 April 2008 (UTC)
It represents a critical piece of research in chiropractic history? Please provide a reference discussing chiropractic history which details the significance of Manga. At the moment, no reference has been provided. These studies (Manga, etc.) have no impact to chiropractic history unless a reference is provided. QuackGuru 07:26, 27 April 2008 (UTC)
Levine wrote: Precisely, and these studies (Manga, etc.) are important to chiropractic history as per their mention in many chiropractic history sources (Keating, etc.).[2] <-- This comment implies Keating mentions the Manga report in a historical perspective. I do not see any evidence of that. Please provide a reference to support this claim. Got it? QuackGuru 18:00, 27 April 2008 (UTC)
For starters, how about this one from Keating? Get it? -- Levine2112 discuss 16:58, 28 April 2008 (UTC)
Thank you for the ref. The ref by Keating mentions the Manga report. We can replace the Manga report with the Keating ref. The Manga report itself is not specifically about chiropractic history but Keating seems to have some historical context. We can add the Keating ref and text. QuackGuru 18:48, 28 April 2008 (UTC)
I also added this ref which discusses Manga in terms of history. -- Levine2112 discuss 19:00, 28 April 2008 (UTC)
Oh, and this article describes Manga historically as having "caused ripples throughout the traditional medical community when it concluded that chiropractic management of low-back pain is both more effective and cost-effective than traditional medical treatment." -- Levine2112 discuss 19:03, 28 April 2008 (UTC)
As previously explained here all of the obsolete and outdated studies will be deleted. No argument has been made to keep these dated studies. The Manga Report, Workers' compensation studies, American Medical Association (AMA), and the British Medical Association are clearly obsolete when newer sources are available. For the Manga report there are newer studies that describe the report. We can use these newer studies as long as they have historical impact. We will remove the older studies and replace them with the newer effectiveness studies. This is essentially removing duplication and will make this article one step closer to a GA status. QuackGuru 20:34, 29 April 2008 (UTC)
You do not get to determine what has had historical impact on the chiropractic profession. Chiropractic historians do. Keating and others have mentioned it numerous times. You don't delete history QG because it doesn't conform to our personal POV. Effectiveness is not even on the horizon given that there is a clear lack of consensus (with majority opposed, I might add). Scope of Practice is sitting there ready to go in (despite a tendentious and stonewalling attempt by a certain editor to drag the process out over trivial points) CorticoSpinal (talk) 20:50, 29 April 2008 (UTC)
No evidence or reason has been provided to keep the obsolete studies. Removing outdated studies and replacing them with newer studies is common sense. We can add the Keating reference about the Manga report if it has historical impact. QuackGuru 20:56, 29 April 2008 (UTC)
For example, the Workers' compensation studies are outdated. Newer studies are available. Anyone can search PUBMED and retrieve newer studies ([7]). I hope this answered this question. QuackGuru 17:43, 30 April 2008 (UTC)
In this case, I disagree. This newer study isn't nearly as comprehensive. I would perhaps use both, but not remove the older, more comprehensive ones. -- Levine2112 discuss 17:47, 30 April 2008 (UTC)
The newer study is recent. I think it would be best to delete obsolete studies. If you want to find and and add more recent studies that is fine. QuackGuru 17:52, 30 April 2008 (UTC)
I still disagree. You are providing no new argument to change my position. I don't think that one newer but less comprehensive study trumps all the studies before it. This review for instance, provides excellent summaries of much of the research at hand, and perhaps would serve as the best source we currently have on the matter. It is a review of the literature and serves as the most comprehensive study we have found too date, in my opinion. Take a look and let me know your thoughts. -- Levine2112 discuss 17:56, 30 April 2008 (UTC)
I agree that we should be referring to recent reviews instead of to primary studies. Expert reviewers should be able to let us know which primary studies are with summarizing. We shouldn't be doing the reviewing ourselves, if reviews are available. Eubulides (talk) 18:06, 30 April 2008 (UTC)
No specific argument has been made to keep the outdated studies. If anything is worth keeping it should be put in the proper section. The obsolete studies have no historical impact. QuackGuru 22:23, 30 April 2008 (UTC)
You said the same thing about Manga, and that proved to be incorrect. Let's just cool down and discuss rationally before we go and remove/add anything to the article. -- Levine2112 discuss 22:30, 30 April 2008 (UTC)
The Manga report itself is not a historical reference and the section should be deleted. If editors prefer, they can use the references that describe the Manga report if those references are reliable and show historical impact. I said the Manga report should be deleted and I was correct. No argument has been presented for keeping the Manga report. We should not use the Manga report in the history section when the report is not a historical reference. There may be historical references decribing the Manga report and that is a different matter. We have newer references that discuss effectiveness that can replace the Manga report. The history section is about chiropractic history and not a place for outdated studies. Agreed? QuackGuru 22:46, 30 April 2008 (UTC)

older references are obsolete when newer references are currently available (common sense)

[outdent] No specific argument has been made for keeping outdated and obsolete studies in the history section. The studies are not about chiropractic history and the studies themselves have no historical impact. We have newer effectiveness/cost-benefit studies anyhow. In any event, it would be best to delete all the obsolte studies.

http://en.wikipedia.org/wiki/Chiropractic#The_Manga_Report

http://en.wikipedia.org/wiki/Chiropractic#Workers.27_compensation_studies

http://en.wikipedia.org/wiki/Chiropractic#American_Medical_Association_.28AMA.29

http://en.wikipedia.org/wiki/Chiropractic#British_Medical_Association

All the above sections contain old studies. They are obsolete. This has been discussed long enough. Going once... going twice... and it will be deleted if no specific objections are made. Please provide a specific reason if you disagree. Agreed? QuackGuru 06:38, 2 May 2008 (UTC)

Specific objections have been made, including "old does not equal obsolete". Further, don't remove anything without consensus. This conversation spans several area. Let's start a new section in which we propose specific revisions. -- Levine2112 discuss 06:48, 2 May 2008 (UTC)
P.S. As far as I know, the policies of the AMA and BMA with regards to chiropractic have not changed. Thus, those sections are clearly not obsolete. -- Levine2112 discuss 06:50, 2 May 2008 (UTC)
P.S.S. Where is the Wikipedia policy which supports: "older references are obsolete when newer references are currently available"? -- Levine2112 discuss 06:57, 2 May 2008 (UTC)
When newer references are available the older ones are obsolete. We have newer references that discuss the same or similar topics as the AMA and BMA does (examples,[8][9]). P.S., it is common sense to delete older studies and replace them when newer studies are available. Currently, the history section contains unrelated information that is not specifically about chiropractic history. Why should we keep older studies when newer studies are current and up to date? QuackGuru 07:18, 2 May 2008 (UTC)

Two things here Quack Guru -

  1. I support your push for the re-writing of the History section. At present Manga and the WC studies can too easily be read as providing information on effectiveness. We need RS sources naming the important events/studies/laws/milestones - (these will be Chiro and Medical and other sources). I have no doubt that Manga and WC studies will feature in the future History section but they will be described in terms of their effects in relation to Chiropractic with only a brief description of their actual findings. A fuller explanation of the findings and and effects would probably be better placed in a separate article on the Manga report if sufficient material is available.
  2. I find your claim that these sources[10][11] cover similar territory as the current History/AMA or History/BMA sub-sections incomprehensible. Please explain your claim. SmithBlue (talk) 08:40, 2 May 2008 (UTC)
These recent studies ([12][13]) cover a similar topic that AMA and BMA covers. AMA is about efficacy. We have newer source available. The BMA is is about referring patients to practitioners which we have newer sources available. These studies (AMA and BMA) are not about history. That is a separate issue. We have newer sources available for efficacy/benefit and references for historical content ([14][15][16][17][18][19]). The more recent studies about effectiveness/cost-benefit can replace the older studies. For the history section, the older obsolete studies should be deleted. The content is unrelated to history. There is no need to replace those obsolete studies in the history. We can replace those obsolete studies in new sections such as cost-benefit. The first step is to delete all the unrelated content to chiropractic history. I reviewed each and every source that is unrelated to chiropractic history. Those old sources are absolete. Newer sources covering similar topics exist.[20][21] The unrelated content to history should be deleted. If editors find specific references for the history section then those can be used but not the obsolete studies. If anyone thinks any of the obsolete studies are still current I would like that explained or we can delete the obsolete studies. There are a lot of newer sources available that cover effectiveness[22][23][24][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] / cost-benefit[51][52][53][54][55][56][57][58][59][60][61][62][63] that can replace AMA[3] and BMA[4] among other things [5][6] with newer sections such as Effectiveness and Cost-benefit. Anyone is free to rewrite the history section but that is not the point of this discussion. If no rewrite happens then I still think we should delete the unrelated content. It is important for editors to realize there is unrelated content in chiropractic history section. Those older studies are obsolete when we have plenty of newer studies available. I am saying we can delete the unrelated content to chiropractic history and to also use newer sources for new sections. I could update the history section with information about the Manga report from a historical perspective. But I think some editors want to take it slow or reject a rewrite. They want to keep the most if not all of the outdated studies and reject the newer studies. BTY, I have already rewritten part of the history section and finished the effectiveness section and started a new cost-benefit section. The newer sources about effectiveness are current and the older references on the same topic are obsolete. It's time to move the article forward. Adding the new information will be an improvement IMHO. QuackGuru 18:10, 2 May 2008 (UTC)
For what it's worth, I agree with SmithBlue and QuackGuru that Chiropractic#History needs to be rewritten, and that the Manga and WC studies should be supported by reliable sources on chiropractic history rather than by the studies themselves. I have not had time to read all those sources that QuackGuru mentions, but if QuackGuru has read them all then I suggest that QuackGuru draft a new History section based on them. I encourange the draft to cover the entire sweep of chiropractic history, not just on a few events. Eubulides (talk) 19:30, 2 May 2008 (UTC)

Quack Guru your appreciation of Chiropractic history, like mine, needs to expand, Chiropractic is a profession which we show, in Wilks etc, has been ostracised and conspired against by a very powerful profession (the medical profession) The AMS and BMA subsections address steps in Chiropractic gaining professional recognition. Removing them makes as much sense as removing a section on the Magna Carta from a "History of English law".

The single reference you supply for chiropractic history (Cooper 2003) is fine as far it goes. However it is just one POV - in history we are dealing with multiple POVs. We need to present all notable ones WP:NPOV. We need to present the Chiropractic profession's view of its own history as well as other views. We are dealing with the history of a profession here - professional recognition is rather central. SmithBlue (talk) 02:01, 3 May 2008 (UTC)

On further surfing I find Chiropractic history. So a detailed presentation of Chiro/History is not required here. Which leaves us to reach concensus on what is better included here. Have started new section below for this dicussion. (The layout of this page at present makes it very difficult to use.) SmithBlue (talk) 02:22, 3 May 2008 (UTC)

It would be best to use references that describe the AMA ([64]) and BMA ([65]) in a historical perspective instead of the references themselves.
The Manga Report as well as Workers' compensation studies sections are unrelated to chiropractic history and no specific reason has been given for keeping them. We have newer sources describing the Manga report ([14][15][66][67][68][69][70][71][72]) and newer sources on Workers' compensation ([73][74]). QuackGuru 04:30, 3 May 2008 (UTC)
The obsolete sources are old and newer sources exist. For the time being, we can delete the Manga report section and the Workers' coompensation studies section. Theses dated studies are unrelated to chiropractic history. We can use newer studies available that have historical interest. For example, we have newer sources availble that discuss the Manga report. And we have newer sources available for the workers' compensation studies for a new section under cost-benefit. My specific revision is to delete both of obsolete sections (Manga and WC studies) and editors can improve the article where appropriate. Going one... going twice... QuackGuru 20:30, 4 May 2008 (UTC)
We explained very clearly that the obsolete studies are not current. But no good reason has been given for keeping POV material in the article. This misleads the reader to readd obsolete studies to mainspace. The controversial edit did not benefit the project. Please provide evidence if any of the obsolete studies should be reworked in a rewrite. If no evidence is provided to rework any of the oudated studies it will be deleted again. Going once... going twice... QuackGuru 23:39, 5 May 2008 (UTC)
There are several sources already given on this talk page (such as this one) which discuss the historical significance of the studies such as Manga. I don't understand why you keep ignoring these. Further, there is no consensus to remove any of the content discussing these studies until a rewrite of the history section which incorporates these studies meets consensual agreement. -- Levine2112 discuss 23:52, 5 May 2008 (UTC)
The sources on the talk page (such as this one) differ from the sources in the article. I added many of the sources to the talk page. The claim of me ignoring them is false. There is no consensus for keeping a misrepresention of chiropractic information (misleading to the reader) in mainspace. No evidence has been provided for keeping any of the POV material or the obsolete sources in the article. Please provide any evidence that these outdated sources should be worked into a rewrite. QuackGuru 00:06, 6 May 2008 (UTC)
This edit added unsourced POV material to the article and added unrelated content to the history section. The Manga report failed verification and the Workers' compensation studies contains obsolete studies. We have newer sources available on both topics. For the Manga report, we have references that describe the Manga report. For the workers' compensation studies, we have newer sources available. Both sections should be deleted. This POV change should be reverted. The oudated workers' compensation studies are not current and the Manga report is not properly sourced. QuackGuru 04:07, 6 May 2008 (UTC)
This controversial change added a link to a promotional advocacy group called The Chiropractic Resource Organization. The link fails WP:RS. QuackGuru 08:57, 6 May 2008 (UTC)
The report is a reliable source. That is is hosted by the Chiropractic Resource Organization in it's entirely doesn't turn it unreliable. Oh, here's another source which discusses the historical impact of Manga. -- Levine2112 discuss 17:34, 6 May 2008 (UTC)
The report is unreliable and has no historical impact. Other sources should be used and not the Manga report itself. This is common sense. Further, according to this conversation here, Levine2112 acknowledged the current Manga text has no historical relevancy by stating in part:Historical context is currently not being mentioned, so for the way we are using it currently... No clear explanation has been provided for keeping oudated studies in the history section. Sources that describe the Manga report in a historical manner should be used rather than the sources themselves. As for the workers' comp studies we have newer sources available for a cost-benefit section. The workers' comp studies have no historical relevancy. QuackGuru 23:34, 6 May 2008 (UTC)
The obsolete studies are not written in a historical context. They are unrelated to the history section. Historical context is currently not being mentioned, so for the way we are using it currently... I agree. QuackGuru 17:12, 10 May 2008 (UTC)
As discussed in this section, the obsolete studies are unrelated to history. So, I made this edit. Unrelated content to history does not belong in the history section. There are plenty of references that discuss history and those refs can be used. The obsolete studies currently being used have no historical relevancy. Newer references covering the same topic currently exist. For history, it would be best to use references that discuss any history from a historical perspective. QuackGuru 22:09, 10 May 2008 (UTC)
There are two sections[7][8] in the history section that are unrelated to history. These two sections offer no historical context. So why keep it in the history section. There are newer sources available discussing history (from a historical perspective), Manga report (newer sources are available to expand the movement towards science section), and workers' comp studies (for a new cost-benefit section). QuackGuru 01:28, 11 May 2008 (UTC)
There was prior notification of the unrelated to history content.[9][10] There sections are not written in a historical context and newer studies are available. Levine2112 acknowledged: Historical context is currently not being mentioned, so for the way we are using it currently... but he has improperly restored unrelated content to history. There are references that describe and cover history and those references can be used. The original study of the Manga report has no historical context. There are references that discuss the historical impact of Manga. The dated studies (including the original Manga report) had no historical impact. There are newer sources on the talk page which differ from the older, obsolete sources in the article. This edit do not fix the source. The source is unreliable from a POV chiropractic research and advocacy group. The workers' comp studies are very old. In short, when newer references are available the older, dated studies can be deleted. Newer studies are current and exist. Why add unrelated content to history. QuackGuru 18:11, 11 May 2008 (UTC)
There is a need for a rewrite. In short, the obsolete studies are highly POV and we have numerous newer studies available. QuackGuru 12:16, 14 May 2008 (UTC)
The rewrite and NPOVing has begun. Newer sources are available and the dated sources are obsolete. See WP:MEDRS. QuackGuru 17:19, 23 May 2008 (UTC)

Medical opposition

The AMA and BMA information (along with a possible rewrite of AMA and BMA) should be under the Chiropractic#Medical opposition section and not its own sections. QuackGuru 18:04, 3 May 2008 (UTC)
My specific revision is to merge AMA and BMA sections into the medical opposition section. Going one... going twice... QuackGuru 20:33, 4 May 2008 (UTC)
Merge it and find other notable medical associations (i.e. Australia) and get their take on intedisciplinary collaboration with DCs. Not sure if it's appropriate under "opposition" per se; but we can always move the merged material later on if need be. CorticoSpinal (talk) 20:48, 4 May 2008 (UTC)
I prefer peer reviewed journals if available. Here is AMA's position statement on complementary medicine as of 2002. QuackGuru 21:04, 4 May 2008 (UTC)
Glad to see you prefer peer-reviewed sources, as do I. It would be preferred to get the official stance on 'chiropractic care/medicine' as CAM is large umbrella. CorticoSpinal (talk) 21:13, 4 May 2008 (UTC)
I prefer peer reviewed but if we can't find any peer reviewed sources we can always use the sources that are presently available. QuackGuru 21:25, 4 May 2008 (UTC)
We will go ahead and merge the content into the appropriate section. QuackGuru 04:31, 5 May 2008 (UTC)

sources for chiropractic history

  • Martin SC (1994). "'The only truly scientific method of healing'. Chiropractic and American science, 1895–1990". Isis 85 (2): 206–27. doi:10.1086/356807. PMID 8071054. 
  • Martin SC (1993). "Chiropractic and the social context of medical technology, 1895–1925". Technol Cult 34 (4): 808–34. PMID 11623404. 
  • (1994) Chiropractic: An Illustrative History. Mosby, 528 pages. ISBN 0801677351.  correct title: Chiropractic: An Illustrated History
  • 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.  Summarized in: 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). 
  • 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. 

commentary on sources for chiropractic history

:Quack Guru, let's discuss one of the sources you have given to show that Manga is not a notable part of the history of chiropractic; "Anything Can Cause Anything" by Keating. This appears to me to be a biography/memoriam of an individual who died in 1990. Not surprisingly the only sources includued for material after that date are directly connected to historical material on Harper himself.

The Manga reports you seek to remove from the History section was released in 1998.
Please explain how you see the absence of Manga from this article[[11]] on some-one deceased in 1990 as bearing on the importance of Manga (1998) to chiropractic history. SmithBlue (talk) 02:38, 27 April 2008 (UTC)
If you'll do the same for another source you give "Chiropractic: An Illustrated History isbn=0801677351" cause again I'll need you to explain how a book published in 1994 could reflect on the Manga(1998) report. Am now hoping these references are adressing Chiro history in a far broader way and are not adressing Manga inclusion/exclusion. SmithBlue (talk) 03:34, 27 April 2008 (UTC)

We can add relevant studies and articles and chiropractic history. The most notable chiropractic historian is Keating. QuackGuru 18:15, 26 April 2008 (UTC)

I'm not sure I get the point of the chiropractic history sources section. Is it about a rewrite for Chiropractic#History? If so, that's a big project; there's a lot wrong with that section (for one thing, it has serious bias problems aside from its presentation of the Manga and other obsolete reports). But if this is just about the Manga reports, then that's a different story. For example, Meeker & Haldeman 2002 cites multiple sources on cost but does not cite Manga; it cites more-recent sources that are far more reliable than Manga. Perhaps there is a reliable source somewhere that Manga is an important part of chiropractic history, but so far we haven't seen it cited here. Eubulides (talk) 08:46, 27 April 2008 (UTC)

The chiropractic history needs a bit more information. The older studies (including the Manga report) that have no impact to chiropractic history will be deleted. If editors are willing, they can add new information using references that are specifically about chiropractic history. This is not a rewrite proposal. This is a suggestion for anyone to work on to add more info to the history section if anyone is interested. QuackGuru 09:10, 27 April 2008 (UTC)
In a research paper from 1997 criticizing the unscientific and uncritical culture of chiropractic, Keating mentions the Manga study approvingly as a recent (at the time) study on cost-effectiveness.
“A cost-effectiveness study of chiropractic services commissioned by the Ministry of Health for the Canadian province of Ontario strongly endorsed chiropractic management of low back pain (Manga et al., 1993)” Manga is part of history and should be in this article. However, Manga has problems and these should be mentioned, as well. Look at how many DC websites still use The Manga Report as advertising.[12]CynRNCynRN (talk) 15:57, 28 April 2008 (UTC)

I have added 2 more sources to the list above. I highly recommend the book Chiropractic History - a Primer to anyone editing this page. (It does not mention Manga, but would also be a good source for integrative medicine, wouldn't it?) DigitalC (talk) 11:30, 3 May 2008 (UTC)

The Manga report has been rewritten using newer sources. This includes the usage of the Keating ref. QuackGuru 13:01, 14 May 2008 (UTC)

reference improvements

Does anyone have any objection if I improve a few references. I know some editors continue to blindly bulk reverts quality NPOV edits (heavily cited text) and that is not right. Please do not blindly revert. We hope the reference tampering stops. QuackGuru 13:47, 8 May 2008 (UTC)

I will improve references. Again, please do not revert reference improvements. Formatting references is an improvement. Blindly reverting ref improvements is unproductive. QuackGuru 03:02, 9 May 2008 (UTC)

You have proposed some changes which you admit might be controversial enough that someone might revert them. Then why do you do it? When are you going to learn? Try it out HERE first. If it flies, then, and ONLY then, do it. This advice applies to your editing in general, not just your proposed improvement of references. -- Fyslee / talk 03:39, 9 May 2008 (UTC)
Improving a ref is not controversial in any way. How is it controversial to improve a ref? It is not. I never said it might be controversial. Reverting a formatted ref is controversial. Claiming it might be controversial to format a ref is unproductive. Why improve a ref? Why would I do it? Formatting a ref is an improvement. A formatted ref will offer consistancy with the other formatted refs. QuackGuru 16:05, 9 May 2008 (UTC)
This comment does not address the issue at hand. A ref improvement is normal practice. QuackGuru 16:19, 9 May 2008 (UTC)
I propose I improve reference number 55[75] using a ref template. QuackGuru 08:18, 9 May 2008 (UTC)
The reference is in the Chiropractic#Vertebral subluxation section. QuackGuru 08:22, 9 May 2008 (UTC)

There is nothing controversial about this sort of change. The current citation is poorly done. Please improve its quality if you have a mind. I sense that there is some sort of misunderstanding here: others thought that the changes you were proposing were controversial (because you made them on the talk page). The proposals were vague enough that others couldn't see that they are not controversial. Eubulides (talk) 16:29, 9 May 2008 (UTC)

I do not see any misunderstanding. My comments were clear. I am specifically referring to ref improvements. This comment claims it is controversial to improve refs. QuackGuru 16:37, 9 May 2008 (UTC)
I don't understand the reasons behind the conflict here (I sense there's some Wikipedia history behind it) but for this particular case surely the reasons don't matter. The citation has a low-quality format and there should be no controversy in improving it. Sometimes it's easier to fix things than to argue about procedure and I hope this is one of those times. To help move things along, I made this change to improve the citation. Please feel free to make similar improvements to citation format; they should not be controversial. Eubulides (talk) 21:06, 9 May 2008 (UTC)
I could be wrong, but perhaps the issue is if the reference formatting is done at the same time as a more controversial edit, and the edit is reverted at the same time.DigitalC (talk) 02:07, 10 May 2008 (UTC)
We have proposed a non-controversial improvement. Changing a citation from a low quality to a high quality format is to be respected. Am I wrong? QuackGuru 05:57, 10 May 2008 (UTC)
No, you're not wrong. Let's move on to another topic, please. Eubulides (talk) 07:04, 10 May 2008 (UTC)

This change was not a ref improvement. It was an old obsolete version. QuackGuru 18:37, 15 May 2008 (UTC)

I thought it was the other way around. Feel free to revert that particular edit. -- Levine2112 discuss 18:40, 15 May 2008 (UTC)
The word "summary" was added. The word summary is the not part of the title of the article. --> (summary) <-- A "work" was added. --> work 671 F. Supp. 1465 (N.D. Ill. 1987) <-- The work refers to a court case. The ref is not a court case. QuackGuru 18:56, 15 May 2008 (UTC)
I recently improved a few refs and added a few refs where needed. QuackGuru 15:40, 23 May 2008 (UTC)

ref names

We have references that have ref names and some without ref names. For this article do we want all the refs to have ref names or do we want the refs with additional inline citations to only have ref names. QuackGuru 08:08, 9 May 2008 (UTC)

I think it would be nice to have the names.--—CynRN (Talk) 16:17, 9 May 2008 (UTC)
The style I prefer is to names only those references that are cited in two or more locations (so that you have to have ref names). That way, there's a clear indication to the editor that a reference is cited multiple times. This is low priority, but let's remove unused ref names from the text. Eubulides (talk) 16:29, 9 May 2008 (UTC)
I prefer every ref have a name. Is there specific policy on this. If not, there should be. QuackGuru 18:56, 9 May 2008 (UTC)
There is no policy on this, not even a guideline as far as I know. It is a style issue. It is not that important. All that being said, what is the advantage of giving every ref a name? It clutters up the article for editors. Eubulides (talk) 21:06, 9 May 2008 (UTC)
I try to add names to references, especially if I think the reference MAY be used again. I have seen editors removing cited text on controversial articles BECAUSE the reference was used twice, not named, and hence in the reference list twice. My $0.02 (completely off topic, but if the penny gets eliminated, will that phrase be eliminated?). Will have some references named and some un-named be a hinderance to GA status somewhere down the road?DigitalC (talk) 00:14, 10 May 2008 (UTC)
There is really no harm in always using ref names and the benefit is that you don't have to create one every time you want to dupe a ref. -- Levine2112 discuss 03:25, 10 May 2008 (UTC)
This is about having the same consistancy from ref to ref when using ref names. We need new specific policy on this. QuackGuru 03:31, 10 May 2008 (UTC)
Why is this an issue? Why do we need consistenancy from ref to ref? If you want a policy, here I'll create one. 1) If the reference is a journal, name it according to the authors name, then add a digit if the name is used more than once -ie: name="Keating1". 2) If the reference is a website, and no author is know, name it according to the first 4 letters of the website URL, and add a digit. Eg: name="CCE-1", "NCCA1" etc.". Happy? DigitalC (talk) 03:50, 10 May 2008 (UTC)
I thought discussion is important to resolve this issue because editors are doing different things to the refs. Some are adding ref names. Others think it clutters the article. I think the best place to have discussion on the ref names is at a policy page. Having an official detailed policy on this issue is a good idea. QuackGuru 04:09, 10 May 2008 (UTC)
Thanks QG for your explanation of what the issue is. I don't see it really cluttering up the page, but clearly others disagree (see Eubulides comment above). I think taking it to a policy page for discussion is a good idea, and is a better location for the discussion than here. Cheers, DigitalC (talk) 04:33, 10 May 2008 (UTC)
I'm not sure under which policy page is the best place to start a new dicussion on this trivial but important to resolve issue. QuackGuru 04:41, 10 May 2008 (UTC)
Check out WP:CITE#HOW. Your questions may already be answered, in a sense: Any style or system is acceptable on Wikipedia so long as articles are internally consistent. You should follow the style already established in an article, if it has one; where there is disagreement, the style or system used by the first editor to use one should be respected. -- Levine2112 discuss 04:45, 10 May 2008 (UTC)
That policy makes very little sense and does not mention ref names specifically. So much for policy. Oh well. QuackGuru 04:53, 10 May 2008 (UTC)

Prefer single-line inline citations

While we're on the subject of references styles, I prefer keeping a citation all on one line when possible, in the source (this issue doesn't affect what article readers see). Multiline citations make it harder to see differences when people insert citations. For example, this change simply added a citation, but because the citation is multiline the diff listing makes it hard to see that; it looks like it may have also changed some text, which is a bigger deal. In contrast, this change, which added to a citation, is clearly marked out in the diff as only changing that citation; had we used the multiline style that would have been much harder to see.

This is just a style issue; I don't know of any policy or guideline in this area. But I thought I'd mention it since we're talking about style. Eubulides (talk) 21:06, 9 May 2008 (UTC)

I can see what you mean about it being harder to see on diffs. However, I use Wickipedia CITE to automatically format most of my web references, and it formats them into multiline. I guess it would be less of a hassle to turn them into single line format than to create them by hand, but then... the whole reason I use Wickipedia CITE is to reduce the hassle. (See User:Jehochman for link to the tool).DigitalC (talk) 00:31, 10 May 2008 (UTC)
Ah, I see. I format them by hand. Others I know use Diberri's tool for journal citations, which defaults to uniline. I take it you wouldn't object to someone else reformatting to uniline? It's no big deal either way, of course. Eubulides (talk) 07:04, 10 May 2008 (UTC)
Thank you, this was posted before and I didn't bookmark, and it makes it so much easier. I have no objecting to reformatting to uniline, and will try to remember to re-format multiline citations to uniline instead. I had seen objections raised before, but didn't understand why it mattered. When looking at a diff though, I can understand. In fact, Diberr's tool can create URL citations, so I can use that tool. While not quite as easy to use as WP:CITE (where you right click any page and then click WP:CITE), its still easy enough. DigitalC (talk) 07:34, 10 May 2008 (UTC)

court case refs

At this time, court case refs should not be formatted using any template. These changes seems to have formatted two court case refs using a template. Here is the relevant link: Template:Cite court. Thanks. QuackGuru 06:14, 12 May 2008 (UTC)

Hi QG, I have self reverted for now. I see that we shouldn't use {cite court} as it is experimental, but does Wikipedia:Citing_sources#Say_where_you_found_the_material apply? DigitalC (talk) 06:25, 12 May 2008 (UTC)
Not sure. QuackGuru 06:30, 12 May 2008 (UTC)
I'd say that it's not needed for citing judicial opinions, unless there's serious doubt as to whether the web page is an accurate copy of the judicial opinion. The usual style in legal papers is to just cite the opinion and let the reader (who is presumed to have access to a law library) look it up. Wikipedia is not a legal paper, but the same basic idea would apply here, I think: the citation is to the actual judicial opinion, and the URL is for convenience. There's no need to say who's hosting the URL in the printed copy of Wikipedia. Eubulides (talk) 07:27, 12 May 2008 (UTC)
I think one of the court citations is still formatted using a template. QuackGuru 12:04, 12 May 2008 (UTC)
One of the court citations is still improperly formatted using a template. QuackGuru 19:41, 12 May 2008 (UTC)
That reference is not to a court case, it is to a summary of the court case at a website.DigitalC (talk) 00:05, 13 May 2008 (UTC)
The ref is a summary of a court case and should not be formatted using a regular template IMHO. For now, it can be typed without a template. In the near future, the cite court template can be used when it is ready for mainspace. There was prior discussion about these refs.QuackGuru 03:04, 13 May 2008 (UTC)
IMHO, we should reference the summary as a website, or not reference the summary at all. It is fine to just reference the court case, but if we are referencing the summary, than we need to cite it as such.DigitalC (talk) 04:20, 13 May 2008 (UTC)
I agree that we should keep judicial opinions separate from summaries. This particular summary was generated by one of the sides of the suit, and therefore we should warn the reader about that, since it's likely to be partisan. Eubulides (talk) 07:35, 13 May 2008 (UTC)
The ref is formatted using a template. The court cite template is not ready. What should we do for in this particular case. Should we format the ref using a template or hand type it. QuackGuru 09:14, 13 May 2008 (UTC)
This particular reference is not to a judicial opinion; it's to a web page generated by a chiropractic organization, which summarizes the case. For this case Template:Cite web is appropriate. Eubulides (talk) 19:59, 13 May 2008 (UTC)
I expanded the summary of the court case ref.[76] Any thoughts. QuackGuru 13:23, 14 May 2008 (UTC)

file not found ref

A ref linked to a file not found. So I fixed it. Here is the improved ref added to the Medical opposition section.[77] QuackGuru 13:33, 14 May 2008 (UTC)

to quote or not to quote (ref names)

Some ref names have "quotes" and some ref names do not have any quotes. For ref name consistancy it may be best to remove the quotations. QuackGuru 18:25, 14 May 2008 (UTC)

I prefer omitting the quotes unless they are needed (e.g., with names containing spaces). I also prefer names that lack spaces. All other things being equal, names should be short and easy for editors to work with. Eubulides (talk) 19:32, 14 May 2008 (UTC)
Learning curve! I thought they had to have quotes. I will take note for future changes.DigitalC (talk) 23:39, 14 May 2008 (UTC)
They have to have quotes with XHTML 1.0, but they do not have to have quotes in Wiki markup. The Wiki software adds the quotes automatically when generating the XHTML 1.0 article that gets sent to the user. Eubulides (talk) 23:47, 14 May 2008 (UTC)

DOI

This reference in the Teatment procedures section seems to have a DOI glitch.

Keating JC Jr (2003). "Several pathways in the evolution of chiropractic manipulation". J Manipulative Physiol Ther 26 (5): 300–21. doi:10.1016/S0161-4754(02)54125-7. PMID 12819626. 

Thoughts? QuackGuru 21:12, 19 May 2008 (UTC)

The DOI code was recently changed because of a problem with parsing special characters like "(" (which is in the DOI in question). This DOI still "works", albeit not as well, as the DOI itself is not blue but is simply followed by the hyperlink. Presumably they will improve this at some point. In the meantime I would leave Chiropractic alone and continue to use doi= as before. Please see Template talk:Cite journal #new #urlencode parserfunction and doilabel parameter for details. Eubulides (talk) 21:30, 19 May 2008 (UTC)

Sorry to stop by in the middle of a POV war

This talk page is too long for me to follow with the limited time that I have available, so basically I have to read the article and make edits as I see them. Hope you don't mind. You can always revert anything I may be misunderstanding.

I did remove this as it seems unsupported by the citation:

  • Opinions differ on the efficacy of SMT for nonspecific or uncomplicated low back pain.[78]

-- Dēmatt (chat) 02:01, 15 May 2008 (UTC)

The cited source (Murphy et al. 2006, PMID 16949948) says, "Inconsistencies in the evidence suggest that there is continuing conflict of opinion regarding: efficacy of SMT for treatment of nonspecific or uncomplicated LBP; optimal time in which to introduce this treatment approach; whether SMT is useful for treatment of chronic LBP; and finally, whether subacute LBP actually exists as a separate category requiring a specific treatment approach in its own right." Its conclusion says, "In conclusion, this study showed that the treatment of LBP remains as ambiguous as before and that the way best evidence is being interpreted could play a large role in this." I made this change to reword the statement to be closer to the cited source. Eubulides (talk) 02:20, 15 May 2008 (UTC)
The article is about guidelines for the treatment of nonspecific LBP. The cited source actually says:
  • RESULTS: According to best evidence from review of the Cochrane database of systematic reviews, there remains a lack of consensus regarding reported efficacy of spinal manipulative therapy for the treatment of nonspecific LBP. Furthermore, the guidelines reviewed in the present study have not changed significantly with respect to treatment recommendations for nonspecific LBP since the original review, and there is inconsistency between the guidelines regarding optimal time to introduce spinal manipulation to treat nonspecific LBP. CONCLUSION: Treatment recommendations for nonspecific LBP, particularly spinal manipulation, remain inconclusive. Guideline developers need to consider guidelines in neighboring countries and reach consensus on how evidence is graded and incorporated into guidelines. Guidelines should continue to be regularly updated to incorporate new evidence and methods of grading the evidence.
The source was actually about guidelines for the treatment nonspecific LBP. In my opinion, to cherry pick the SMT sentence from the results section when it is not mentioned under the authors conclusions, makes this statement very weak. We should be able to find better. I will make an attempt myself to make it less POV. Wish me luck. -- Dēmatt (chat) 02:41, 15 May 2008 (UTC)
Here was my attempt to clarify. -- Dēmatt (chat) 03:03, 15 May 2008 (UTC)
The "continuing conflict" quote is from the lead (2nd sentence) of the discussion section, not from the results section. The "the way best evidence is being interpreted" quote is from the conclusion. It is true that the source is primarily about nonspecific low back pain, and thanks for catching that: I was misled because the source does review a RCT for uncomplicated LBP and mentions this in the discussion section. The attempt-to-clarify replaced discussion of efficacy with discussion of recommended treatment, but this section of Chiropractic is the Effectiveness section, not the Treatment section, so this section should focus on what the source says about effectiveness, not on what the source recommends for treatment. And what the source says about effectiveness (and underlines in its conclusion) is that opinions differ widely and that experts are interpreting the best evidence quite differently. I made this change to bring the wording back to effectiveness, noting (as mentioned above) that the review is about nonspecific LBP and not about LBP in general. Eubulides (talk) 07:27, 15 May 2008 (UTC)

This doesn't seem suppported by the reference either:

  • An authoritative 2004 review found that SMT/mobilization is effective only when combined with other interventions such as exercise.[79]

-- Dēmatt (chat) 02:13, 15 May 2008 (UTC)

The cited source (Gross et al. 2004, PMID ) says in its conclusion, "Multimodal care, including mobilisation and/or manipulation plus exercise, is beneficial for pain relief, functional improvement and global perceived effect for subacute/chronic mechanical neck disorder with or without headache. The evidence did not favour manipulation and/or mobilisation done alone or in combination with various other types of treatments for pain, function, and global perceived effect." I made this change to reword the statement to be closer to the cited source. Eubulides (talk) 02:41, 15 May 2008 (UTC)
I added the details. Funny how they both say the same thing, but they feel so different? -- Dēmatt (chat) 03:13, 15 May 2008 (UTC)
That edit removed the very important detail that the evidence did not favor SMT and/or mobilization done alone. I made this change to restore that detail. The "with or without headache" didn't seem that important so I omitted it; please restore that phrase if you disagree. Eubulides (talk) 07:42, 15 May 2008 (UTC)
Ok with deleting headache. My impression is that my wording was as accurate as yours, but you chose the negative while mine chose the positive. Is there a middle ground? ---- Dēmatt (chat) 04:52, 16 May 2008 (UTC)
I disagree that your wording was as accurate, because it omitted the important detail that the evidence did not favor SMT and/or mobilization unless they were combined with exercise. That is, the original source did not merely look at SMT/mobilization + exercise and say "that's good"; it looked at SMT/mobilization + exercise and said "that's good" and it also looked at SMT/mobilization without exercise and said "that's no good". The second part of these results also needs to be mentioned. The exact wording I'm not that hung up on. Eubulides (talk) 07:35, 19 May 2008 (UTC)
Good point, let's try to make it a little more neutral by taking out "authorative" and rearranging it some while adding in the "not without exercise".
  • A 2004 review found that SMT and mobilization for the cervical spine are beneficial for pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder when combined with exercise. Without exercise, or with other modalites, SMT did not fair as well.
Or something like that.
-- Dēmatt (chat) 15:06, 19 May 2008 (UTC)
It's OK to remove "authoritative" (Chiropractic currently says "comprehensive") but "Without exercise, or with other modalites, SMT did not fair as well." is too vague; that could mean that SMT is still known to be effective without exercise, just not as effective as with exercise. It should say that the evidence does not favor SMT done without exercise. Is the current wording not neutral? It says "Of three systematic reviews of SMT published between 2000 and May 2005, one reached a positive conclusion, and a comprehensive 2004 review ([80]) found that SMT and mobilization are beneficial only when combined with exercise, the benefits being pain relief, functional improvement, and global perceived effect for subacute/chronic mechanical neck disorder.[28]" Eubulides (talk) 20:47, 19 May 2008 (UTC)
It's unfortunate that certain editors here try spin something that is neutral in the conclusions that ends up with a bad tone. For the record, Dematt, I have told Eubulides this since he first began editing at chiropractic in February 2008. Isn't it part of WP:AGF that we extend good faith to the article we're writing? You know, assume the best? We can't be skeptical at all parts at all times, this article and profession are treated like ultimate fringe when the reality is, it's practically mainstream. A serious POV shift needs to be take place for the skeptics. CorticoSpinal (talk) 23:36, 16 May 2008 (UTC)
This is not about spin; it is about summarizing the source accurately. Eubulides (talk) 07:35, 19 May 2008 (UTC)

Again, this source says nothing about 'prognosis':

  • A 2008 review found that educational videos, mobilization, and exercises appear more beneficial for whiplash than alternatives; that manual therapies and supervised exercise, low-level laser therapy and perhaps acupuncture are more effective for non-whiplash neck pain than alternatives but none of these treatments is clearly superior; and that there is no evidence that any intervention improves prognosis.[81] A 2007 review found that SMT and mobilization are effective for neck pain.[34]
The source says:
  • 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.
  • The cited source (Hurwitz et al., PMID 18204386) talks about prognosis in a "Key Points" box on page S149. There are 4 key points. The 3rd one is: "There is (1) no evidence that a particular course of care with any intervention improves the prognosis for whiplash or other neck disorders; (2) some evidence that high rates of health-care use may slow recovery from whiplash; and (3) little data on cost effectiveness." I noticed that your quote from Hurwitz says "there is evidence that X" rather than X, which is worth mentioning, so I put that in this change which restored the Hurwitz citation but mentioned the "evidence" bit.
My problem seems to be that I don't have access to something that you are looking at (the box). All I have is the pubmed abstract. Do you have the actual link to the article that you are looking at? ---- Dēmatt (chat) 04:44, 16 May 2008 (UTC)
I have the actual article from here. Unfortunately it is copyrighted and I cannot redistribute it. Perhaps your local library can get you a copy. Eubulides (talk) 07:35, 19 May 2008 (UTC)
Understandable. How about we ditch the "prognosis" part then. It makes it hard to verify. I will entertain other source though. -- Dēmatt (chat) 15:18, 19 May 2008 (UTC)
Most of Chiropractic's sources are copyrighted and are not freely readable; why discriminate against this one? This source is a recent high-quality review and is widely available (even if it's not free). We have verified the point in question by quoting one of the article's key points. Eubulides (talk) 20:47, 19 May 2008 (UTC)
  • There were actually two sources here. That same edit removed the sentence "A 2007 review found that SMT and mobilization are effective for neck pain." citing Vernon & Humphreys 2007 (PMID 17369783). But you didn't discuss that part of the change. Was it intended? If so, why? If not, then let's please restore that sentence and citation.
Eubulides (talk) 08:07, 15 May 2008 (UTC)
That was purely accidental - slip of the mouse! ---- Dēmatt (chat) 04:52, 16 May 2008 (UTC)
This change to a sentence does not seem to focus on the topic at hand (effectiveness). QuackGuru 03:00, 15 May 2008 (UTC)
Yes, that problem is further discussed above (sorry, I am working my way through the comments and didn't see yours until just now). As discussed above, I fixed that problem here. Eubulides (talk) 08:14, 15 May 2008 (UTC)
Mainspace may not be the place to ask questions.[13] QuackGuru 03:00, 15 May 2008 (UTC)
The reason it says "or mobilization" is because the source says it. Is mobilization irrelevant here? Chiropractors use mobilization, right? I don't see why the "or mobilization" was removed in that edit. Perhaps Dematt can explain? Eubulides (talk) 08:14, 15 May 2008 (UTC)

I've run out of time tonight. I only made it to the whiplash section. I haven't been able to make it through everything, but it looks close. I do agree with Eubilides that some of this was probably just added a little prematurely. I like the way you've been working it through on the talk page first. -- Dēmatt (chat) 03:38, 15 May 2008 (UTC)

I disagree with this edit. The reference is a 2004 ref. There is a 2006 Canter review of the 2004 ref. We should use the newer ref that says the 2004 ref as an authoritative source. The 2006 ref does not say all of this when I looked at it. We should use the newer 2006 ref that is currently available. The 2004 ref does not say it is an authoritative review. Thus, it fails verification. QuackGuru 04:05, 15 May 2008 (UTC)
As discussed above I made this change to change that wording to match the 2004 source (Gross et al.) better. The 2006 source (Ernst & Canter) is not as authoritative as the 2004 source, and it's not clear what the 2006 source brings to the table, other than saying that the 2004 source is "authoritative". Is there a serious challenge here as to whether Cochrane reviews are authoritative? I don't know of anybody seriously disputing that. If it's a real issue, perhaps the simplest thing is to remove the word "authoritative"; it hardly seems worth the trouble to plant a footnote after every use of that adjective. Eubulides (talk) 08:24, 15 May 2008 (UTC)
Yes Cochrane reports are authoritative, but it's preferable to avoid peacock terms. WP:PEACOCK lists authoritative in it's list of "Words and phrases to watch for". Jefffire (talk) 08:36, 15 May 2008 (UTC)

One undiscussed minor change made in the above run was to change "SMT is no more or less effective than other interventions" to "SMT is no more or less effective than standard interventions" when summarizing Assendelft et al. 2004 (PMID 14973958). However, the cited source actually says "There is no evidence that spinal manipulative therapy is superior to other standard treatments", which implies (contrary to what Chiropractic currently says) that SMT is a standard treatment. To match the source better I changed "standard" to "other standard". Eubulides (talk) 08:42, 15 May 2008 (UTC)

After the "massive edit", most of the above seems moot now, but for future reference, I think your overall edits brought the article too far back toward the "other POV", but I am pretty sure we would have gotten there eventually. Maybe we'll get another chance? It was fun working with you! ---- Dēmatt (chat) 04:39, 16 May 2008 (UTC)
I hope we do get another chance. I do appreciate working with you. With the big stampede of partisan edits (by both sides) this may be difficult, though. Eubulides (talk) 07:35, 19 May 2008 (UTC)
First, Eubulides fails to realize that Cochrane reviews are generally only good for 2 years. This is the length of time that they usually update their lit synthesis and modify the content. So, a 2004 "authoritative" Cochrane review is outdated 2 fold. It's these types of edits and wikilawyering that it's a "reliable review" to omit more recent evidence (i.e. 2007 American College of Physicians clinical practice guidelines for LBP) and more comprehensive studies (WHO Bone and Joint Decade 2000-2010 Neck Pain Task Force) which presents a vastly different conclusion (i.e. manual therapy is effective for grade 1,2 neck pain) but claiming that manual therapy is not effective for neck pain. I think Eubulides forgets he's dealing with other health care professionals and scientists who know how to appraise the literature and know the difference between what's generally right and what's generally BS. Eubulides edits promotes a fringe viewpoint of mainstream medicine while exploiting the fringe elements of chiropractic at the expense of the mainstream majority of the profession. CorticoSpinal (talk) 04:55, 16 May 2008 (UTC)
  • All of the Cochrane reviews currently cited by Chiropractic have "2008" on them when you visit them, which means Cochrane thinks they're up-to-date. They are periodically reviewed and can be kept unchanged, or unchanged with comments.
  • There are certainly other opinions out there, but the Cochrane reviews are very high quality, and are more authoritative than the alternatives mentioned.
Eubulides (talk) 07:35, 19 May 2008 (UTC)
Personally, I have no problem including as many studies as we need to fully discuss the issues. The net result is that, while the jury is out on the use of spinal manipulation for Type O (organ related) conditions, its use for low back pain, neck pain and headaches is at least as good as any other medical intervention and, regardless of opinion, it is relatively safe. Now, we can either say this in the two sentences that I have written above, or we can cite every source possible and I am quite sure the net result will be the same for spinal manipulation. Now for the issue of spinal adjustment - we have wiped the article pretty much clean of the fact that chiropractors do other things besides spinal manipulation. IOWs, chiropractic <> SMT, as Cortico and Digital suggest. -- Dēmatt (chat) 14:11, 16 May 2008 (UTC)
I don't think the evidence is quite as strong as that. For low back pain and relative safety I agree with you. But for whiplash, neck pain, and headache there is not a strong consensus that SMT is at least as good as any other medical intervention. And by "jury is out" do you mean "the evidence is weak" for organ-related conditions? Eubulides (talk) 07:35, 19 May 2008 (UTC)
Well, I would start with what we do agree with then:
  • Generally, the research supports the use of spinal manipulation for the treatment of low back pain as effective and relatively safe.(refs) For neck pain, whiplash and headaches, some evidence supports its use and yet some does not. So-and-so says blah blah blah(ref), while Yoman says blah, blah(ref). For the treatmetnt of type O, or organ related problems, there is a lack of research to make any determination either way (ref).
Of course, that is just a start. You could come up with the not so good research and I'll let Cortico come up with the other stuff :-) -- Dēmatt (chat) 18:42, 19 May 2008 (UTC)
Isn't that what this version did? Albeit at somewhat more length. (This is the version suggested in #Version suggestion below.) Eubulides (talk) 20:47, 19 May 2008 (UTC)
“ While the jury is out on the use of spinal manipulation for Type O (organ related) conditions, its use for low back pain, neck pain and headaches is at least as good as any other medical intervention and, regardless of opinion, it is relatively safe. Now, we can either say this in the two sentences that I have written above, or we can cite every source possible ”

I have been saying the same for the last 2 months yet the skeptical editors wanted to cherry pick the evidence and drum up a 'false consensus' that there was real doubt re: the effectiveness of SMT for mechanical spinal syndromes and certain HAs and completely negate the possible' validity of SMT for certain Type O conditions. I've always said that DCs will live and die by the research sword and that science will drive practice and philosophy (as per Triano) and not vice-versa. Publish or perish. It's that simple. If there really was no connection between SMT and visceral dysfunction clearly the notion of SMT as a Tx for this would have died. Yet its somehow survived for 113 years. Interestingly, as Hawk et al suggest reducing chiropractic to SMT and studying that instead of the whole clinical enccounter (which averages 18 min, its takes 10-30s for to deliver an adjustment) might have been the critical flaw in the research designs when looking at chiropractic care for Type 0 conditions. Also, with the increasing prevalent model of health promotion/wellness coming into play, it would be foolish to assume that this type of intervention doesn't not play a positive role in improving the quality of life of patients. Orthodox medicine fails miserably in really looking at all the determinants of health and want to find some kind of reductionistic measure. Qualitative research designs are much better suited for the type of research required to truly understand the value (if any) of DC care for Type O.

[outdent] Yetmore evidence demonstrating that mainstream medicine is embracing manual medicine. Who are the expert providers of manual therapy (done by hand)? Hint, it's in their name (done by hand). Skeptics focus so much on the outdated fringe chiropractic philosophy at the expense of the inclusion of the cold hard facts: philosophically, allopathic and chiropractic medicine at the opposite spectrum; but that doesn't mean the main methods used by chiropractors aren't valid. Manual medicine is a real, its a traditional form of medicine and we shall present this piece of the chiropractic story. Also, we really should the science of chiropractic; i.e. science of manual therapy and holistic, conservative health care. Scientific investigation right now is a sham; it's a SYN of SMT (which is great for the SMT article) and the generalizable points must be covered here at the main article; nonetheless, this is article is the story of chiropractic medicine. I shall begin a proposal after the long weekend. It will be a historical-to-present account of the major scientific developments within the profession which will surely raise eyebrows (because why would skeptics really want to get that out). To be perfectly fair, I also propose a Criticisms section where we can roll the main concerns/criticisms in a nice, tidy section and avoid dumb WP:POINT violations. For example, a criticsm of chiropractic care is a perceived lack of professionalism and ethics, improper advertising/marketing, the clinical value and weight of subluxation (note that mixers and straights give the VSC different weight, this is fundamental to understand), debates regarding safety, cost-effectivness of SMT and others I'm sure that QuackGuru will dig up. It's all fair game and must be treated fairly. So, I'm also proposing a Integration into the Mainstream section, with reviews, studies, sociological lit, government docs that demonstrate a move towards the mainstream with chiropractic at crossroads (a la Meeker and Haldeman) and the paradox of continued opposition from POLITICAL medicine despite the successess of integrative (MD-DC) models of care. The story of chiropractic is so interesting yet wacky, we can cover it NPOV but it will require a significant paradigm shift from skeptics who edit. Yes, there are fringe elements of the profession. We can highlight these but not at the expense of soiling the views and credibility of the mainstream (non-fringe) chiropractic. Mixers, for better or worse, are going to determine the eventual fate of mainstream integration (it won't be the straights for obvious reasons, the least being they don't want to integrate) and their story needs more focus here. Thoughts?

Recent edits made without discussion

After this huge change was installed, containing many components that were installed without discussion, other editors have now felt that it's OK to install major changes to Chiropractic without discussion, despite a notice at the top of this talk page saying "Please read this page and discuss substantial changes here before making them." I view this new practice with great dismay: it's a recipe for an edit war. To document what's going on a bit better, here is a list of controversial edits made recently without any discussion.

I agree. We need to avoid reverting all the way back to older versions. You guys have been working hard to fine tune and when someone just wipes them all out, well, that is just frustrating for everyone, I think. -- Dēmatt (chat) 14:25, 16 May 2008 (UTC)
I think the chiropractic education section was inadequate as it was. I have no problem with returning some content from the Chiropractic education article. -- Dēmatt (chat) 14:28, 16 May 2008 (UTC)
Actually this material was "hoisted" AWAY for no real good reason and it essentially omitted the meat and potatoes of education namely, what are the various degrees earned internationally and what are the common elements of all chiropractic education? Considering how lengthy of a topic this could be and the length of the education article, this size is absolutely fair game for the main article. It's well referenced, it's relevant, it's valid and it's NPOV. CorticoSpinal (talk) 16:25, 16 May 2008 (UTC)
Chiropractic currently spends far too much time on the WHO model for how chiropractic education ought to be, and too little time on how chiropractic education actually is. The text also does not clearly state when it's talking about the ideal, as opposed to the reality. Certainly the WHO model is not followed "across the globe", despite what Chiropractic seems to claim. Eubulides (talk) 07:35, 19 May 2008 (UTC)
  • This edit inserts an older primary source to argue with a recent reliable review. The review in question already covers the older primary source in question, and this edit attempts to overturn the review, in a clear violation of WP:MEDRS guidelines. The edit also mischaracterizes the recent reliable review as a "study".
I think that the concept of maintenance care needs to be fully discussed and Cortico's edit was a good start. WP:MEDRS are guidelines, we might not be able to follow them to the T. -- Dēmatt (chat) 14:32, 16 May 2008 (UTC)
It is certainly reasonable to talk about maintenance care, and Chiropractic#Philosophy already does that. It is not reasonable to argue with a review by emphasizing one of the primary source's reviews. It is not our job to argue with reviews. We should be presenting their results as neutrally as possible. Eubulides (talk) 07:35, 19 May 2008 (UTC)
I have made the same plea to Eubulides to stop wikilawyering about his very, very rigid interpretation of MEDRS guidelines. Guidelines. Not policy, guidelines. Guidelines, which have been used thus far to omit valid, reliable sources. Case and point are the American College of Physicians clinical practice guidelines which recommends many non-pharmacologic options for LBP which SMT is one of many EFFECTIVE alternatives to standard medical care (pills).
There is no good reason in this particular case to argue with the review. Let's stick with what the review says. Eubulides (talk) 07:35, 19 May 2008 (UTC)
Actually there is. You suggest that Ernst view of SMT represents the mainstream. That clearly cannot be the case for the American College of Physicians own clinical practice guidelines includes SMT as safe, effective alternative for LBP. So, when the most influential college of physicians in the world (the US) endorses SMT, that is the mainstream position. It shall stay, it more than meets WP inclusion criteria and the practice guideline itself is an expert review. CorticoSpinal (talk) 16:21, 20 May 2008 (UTC)
  • The ACoP has not "endorsed" SMT. Its current recommendation strongly advises advice to remain active and self-care, with medications as needed. For patients who do not improve with self-care, it weakly suggests adding other therapies, one of which is SMT, which it says has small to moderate short-term benefits (for acute LBP) and moderate benefits (for chronic LBP; this is among 8 possible alternative treatments). These recommendations do not apply to children, adolescents, pregnant women, or to nonspinal LBP. See Chou et al. (PMID 17909209). It is misleading to collapse these recomendations into a statement of "endorses" or (as Chiropractic does to say that SMT was "recommended" by the ACoP.
  • Did I use the word "endorse" or did you just misrepresent my statement yet again (18 and counting). Here's what I wrote: American College of Physicians own clinical practice guidelines includes SMT as safe, effective alternative for LBP. You should stop misrepresenting my words to strengthen your argument. That is a straw man tactic. Anything to mimize the effectiveness of SMT for LBP, eh? CorticoSpinal (talk) 18:59, 21 May 2008 (UTC)
  • Yes, you used the word "endorse". You wrote "when the most influential college of physicians in the world (the US) endorses SMT". Please don't be so quick to assume misrepresentation. Eubulides (talk) 20:13, 21 May 2008 (UTC)
Here's what I wrote in the article "[SMT was]recommended in the 2007 clinical practice guidelines of the American College of Physicians"[95]. I did not use the word endorse. I'm not being quick to assume any misrepresentation, however DigitalC also said you misrepresented evidence as well and Dematt (and myself) has suggested you may be cherry picking the evidence. These are serious concerns which you have ducked, dipped, dove and dodged over the past 4 months with discussions with various editors. Now, if we were playing dodgeball I would commend your skills, however, we are trying to collaborate and write an encyclopaedic article. Please do heed our concerns and address them. CorticoSpinal (talk) 15:22, 22 May 2008 (UTC)
You wrote "endorses" here, in the talk page. My comment objecting to "endorse" was immediate response to the claim that the ACoP "endorses SMT". As mentioned above, the ACoP has not endorsed SMT. It has weakly recommended SMT as one of several alternatives after standard treatments fail. Chiropractic currently describes this weak recommendation inaccurately, and this needs to get fixed, independently of whether Chiropractic uses the word "endorse". Eubulides (talk) 16:58, 22 May 2008 (UTC)
  • It would be reasonable to mention the ACoP position, as long as this was done accurately and neutrally, which is not the case now, as shown above. I suggest replacing ", although it was recommended in the 2007 clinical practice guidelines of the American College of Physicians [82]" with ". For example, a 2007 U.S. guideline weakly recommended SMT as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail,[83] whereas the Swedish guideline for low back pain was updated in 2002 to no longer suggest considering SMT for acute low back pain for patients needing additional help.[84]".
Weakly? Lol, sure... anything to continue the marginization of SMT... good thing the consensus is that it's effective for mechanical LBP. CorticoSpinal (talk) 18:59, 21 May 2008 (UTC)
The cited source says the recommendation is weak. Eubulides (talk) 20:13, 21 May 2008 (UTC)
Did you dig down to find that or is it in the abstract that is freely readable? So exercise and manipulation are weakly recommend by the ACoP? Just out of curiosity what does the ACoP strongly recommend for back pain? CorticoSpinal (talk) 15:22, 22 May 2008 (UTC)
Both the abstract and the body of that article are freely readable. Both the abstract and the body of the article say that the recommendation for SMT is "weak". The recommentation for exercise is also "weak". The ACoP has six strong recommendations, which you can find by reading the citation. Eubulides (talk) 16:58, 22 May 2008 (UTC)
  • This edit removed material about who should administer SMT, without discussion or consensus. It also broke a citation (turning it into a dangling red link).
This was probably more appropriate in the Spinal manipulation (wow, what happened to that link?) article anyway. -- Dēmatt (chat) 14:59, 16 May 2008 (UTC)
I could be talked into moving the material, yes. It was a great shame that the edit broke the citation. If it had been reviewed ahead of time that problem could have been reverted.
This is a huge problem with Eubulides' drafts (all 3) is that is synthesizes all SMT research and then attempts to pass it off as "effectiveness" of chiropractic. Much more specific and relevant to effectiveness of chiropractic care would be the NIH, New Zealand studies, Meade, Rand, Manga studies, the integrative models which demonstrated that DC care is effective and cost effective as well as the ongoing MEDICARE DEMONSTRATION PROJECTS occuring at the DoD, DVA and other major governmental agencies. What about the Kapansky-Giles article which talks about the effectiveness of chiropractic care at St-Mikes hospital in Toronto? This is SPECIFIC to chiropractic and it was a demo project that was made PERMANENT because it was such a rousing success in both clinical and financial terms. There's many more sources that adequately discuss the effectiveness of chiropractic care (i.e. the whole clinical encounter not just SMT some editors don't seem to understand). CorticoSpinal (talk) 16:25, 16 May 2008 (UTC)
None of these comments seem to have anything to do with the edit in quesiton. Eubulides (talk) 07:35, 19 May 2008 (UTC)
  • This edit also removed material without discussion. (I agree with the removal, not that that matters as far as procedure is concerned.)
It was probably fluff anyway. Could just take out the "Samual Homala" part. Save energy for issues that count. -- Dēmatt (chat) 15:02, 16 May 2008 (UTC)
  • This edit, without discussion or consensus, removed important sourced material about scientific versus antiscientific reasoning among chiropractors.
  • This edit, without discussion or consensus, attempts to undermine a reliable review of practice guidelines by citing just one guideline, on one side of the dispute. Again, this sort of tactic is contrary to the spirit of WP:MEDRS as it is attempting to overturn a review.
  • This edit, without discussion or consensus, again attempts to undermine a review-of-reviews by citing a review. It also uses unsourced peacock terms like "the most comprehensive study to date" and disparaging terms like "opined".
  • This edit, without discussion or consensus, attempts to undercut a source by characterizing it as being by a "vocal critic of chiropractic". It does not balance this by mentioning the many other sources that are by vocal supporters of chiropractic.
  • This edit, without discussion or consensus, removed sourced material.

Eubulides (talk) 22:33, 15 May 2008 (UTC)

Disagreed, Eubulides. All edits are supported by the sources. It's making the sections, which have been aded WITHOUT consensus relatively more NPOV. There's a lot of work to be done but we can get there. Since when is opined "giving an opinion" disparaging? Humphreys and Vernon were my PROFESSORS. I'm not going to slag them. And, do you disagree that the Neck Pain Task Force is the most comprehensive study on neck pain? Maybe this might shed more light on the topic. If we're to rush in edits without consensus then, inevitably, there will be much editing to try and present opposing views. Also, note that you're being completely redundant and trying to make a point with your repetitive use of discussion/consensus. The edits installed previously were very faulty and cherry picked evidence and did not fully attribute the information. CorticoSpinal (talk) 23:16, 15 May 2008 (UTC)
  • It's not true that all those edits are supported by the sources. Many edits removed sources. Some edits broke sources, leaving red links.
  • Using "opined" to talk about opinions favoring one side, while in contrast using words like "most comprehensive study" to talk about opinions favoring the other, is clear POV.
  • It's not a question of whether I think the study is the most-comprehensive. It's a question of WP:PEACOCK. The words "authoritative" were recently struck for the same reason, even though the reviews in question were indeed authoritative (and we have reliable sources saying so).
  • We should not rush in edits without consensus.
  • It is not right for a Wikipedia article to attempt to undermine a reliable review by highlighting results of a reviewed primary source that disagrees with the review. Wikipedia should defer to published expert reviewers, and not attempt to override them.
Eubulides (talk) 23:30, 15 May 2008 (UTC)
I think you both made some good edits and some not so good edits. We can't help our biases; we can only hope to keep them in check. Keep working on it. ---- Dēmatt (chat) 04:57, 16 May 2008 (UTC)

[outdent]. Eubulides still using the same tired arguments as the past 4 months. The problem is that this extremely controversial section, which has NO VALIDITY in that it looking at the effectiveness of SPINAL MANIPULATION and passing it off as "chiropractic care" and selectively cherry picked the literature to marginalize, minimize the effectiveness of SMT and pass it off as chiropractic. Lastly, yet, all edits were supported by the sources. There is one thing I want to note: you have a habit of selectively highliting negative points and not providing the full context or the major findings when you cite "supportive" sources of chiropractic care. You actually cited the CCAs Clinical Practice Guidelines of Neck Pain proving that "the are adverse effects" of neck manipulation while not mentioning a peep that evidence-based document actually supports the use of MANUAL THERAPY (not just SMT, please understand this point) and the benefits far outweight the risks. So, the edit goes in that essentially states that there are adverse effects to neck SMT and cites the CCA guidelines and doesn't cover the whole conclusion. Cherry picking. Dematt has said the same. CorticoSpinal (talk) 05:25, 16 May 2008 (UTC)

Most of the citations are to sources that talk about chiropractic care, not merely SMT. The other comment you make seems to be about safety, not effectiveness. The safety section talks about safety, not cost-benefit. Perhaps there should be a change to the cost-benefit section along the lines you suggest; could you propose a change? Eubulides (talk) 07:35, 19 May 2008 (UTC)
Please see Cost effectiveness 2a. CorticoSpinal (talk) 16:21, 20 May 2008 (UTC)
It may have been helpful if you had also done what I did - revert QuackGuru's this huge change. I know that you were against the huge change and you made that known somewhat on this page, but perhaps if you also reverted the huge change just once, it would have made your feelings that much stronger. Instead, I was left to revert it two or three times, and then accused of edit warring by the very editor who started the war; chiefly QuackGuru. The end result was QuackGuru and pals trying to make it appear that I was the only editor in support of reverting the huge change and that I was somehow ignoring a mysterious "broad consensus". Unfortunately, the truth of what was being ignored was that there were/are a large number of editors against QuackGuru's huge change, including me, you (Eubulides), CorticoSpinal, Dematt, DigitalC, TheDoctorIsIn, etc. I am typically against edit warring and I wouldn't ask you to participate in one, but I felt like QuackGuru was allowed to steamroll his version through, emboldened by supposedly "outside" editors (the usual gang of editors ready to do anything to bash CAM topics such as Chiropractic). I applaud CorticoSpinal for rising above myself, taking the higher ground, not edit warring, and instead effectively improving gross NPOV negligence on the part of QuackGuru. We have two paths we can take now. We can revert back to how the article read before QuackGuru's unfortunate and huge edit or we can move forward and pound away at his additions to try and make it comply with NPOV, RS and V. The former puts us back to discussing all major edits, hashing everything out, striving for a consensus before implementation; whereas the latter places us in a spot where we all just edit the article directly (because the content is live and we want it to be the best it can be immediately). Either way, I still encourage much discussion here to foster a better article and more cooperative spirit. -- Levine2112 discuss 00:33, 16 May 2008 (UTC)
I do not like to do revert wars, and did not understand the etiquette of reverting (such as at it is). Apparently I did not stay out of the war successfully; I was warned for 3RR, as my understanding of a revert did not agree with the official version. Sorry for being such a novice at this. Eubulides (talk) 07:35, 19 May 2008 (UTC)
All of these edits are highly POV and should be greeted with a revert. This article should not be turned into a POV promotional piece. Hopefully, we can get back on the right NPOV track. QuackGuru 01:32, 16 May 2008 (UTC)
See and I would say that all of these edits are highly POV and should have been greeted with a revert. This is why we need to discuss things first here before making such bold edits. Remember when you asked what's the harm in being bold with this article. Well, you were bold and a tad reckless IMHO and that led to edit warring, general incivility and now the article is locked. See the harm now? -- Levine2112 discuss 01:41, 16 May 2008 (UTC)
Well said Levine... what say ye'all. How do we want to do this? ---- Dēmatt (chat) 04:35, 16 May 2008 (UTC)
For what it's worth, lets "move forward and pound away at his additions to try and make it comply with NPOV, RS and V". That would be more productive and definitely more interesting!--—CynRN (Talk) 06:35, 16 May 2008 (UTC)
Hey, I vote for interesting every time! But we really can't be reverting.... that takes the fun out of it. We should agree to only add/fine tune? -- Dēmatt (chat) 15:06, 16 May 2008 (UTC)
I do have one question for CorticoSpinal - when you type, are you yelling in your head, or do you always talk that way :-D (just picking:-) -- Dēmatt (chat) 15:10, 16 May 2008 (UTC)
Lol, is that because of the CAPS? I'm too lazy to scroll up the page for bolding or italics, so if I want a word to get NOTICED I just hold down the shift key! In all seriousness though there are still major flaws with the validity of effectiveness of the chiropractic profession as the section (after 3 attempts you would have figured the author would have gotten the point that this was a no go) despite the fact that a compromise by CynRN (to include the highlights of SMT) was agreed upon by the majority of the editors. We're essentially here because many believe (as I do) that (1) QG and Eubulides want to pass off SMT as chiropractic care and (2)ignoring documents that are specific to the effectiveness of chiropractic care; i.e. the evidence-based CPGs of the profession. Not even one peep of soft tissue therapy in all 3 drafts? I think DigitalC has mentioned this 10 times (and I concurred) and yet a certain editor feels its not inclusion worthy. When a profession develops an evidence-based clinical practice guideline SPECIFICALLY for this, it's inclusion worthy, period. This gong show has gone on long enough and its time we cut bait: SMT goes into SMT article, a blurb can stay in chiro, we draft a specific to chiropractic care effectiveness section that is valid to chiropractic care, not a synthesis of DC, MD, PT, DO and other manipulative using profs. CorticoSpinal (talk) 02:37, 17 May 2008 (UTC)

Version suggestion

I suggest that this version be reinstated after protection is up. This is the best version with the most consensus per the RfC above. ScienceApologist (talk) 17:09, 18 May 2008 (UTC)

I agree that the version you mention is higher-quality and less-biased than the currently-protected version, and would support reinstating it over keeping the currently-protected version. The second and later bullets of #Recent edits made without discussion explain why I think so. However, I don't see the consensus that you mention; there is a lot of controversy over the big edit incorporated in that version (alluded to in the first bullet of #Recent edits made without discussion). Eubulides (talk) 07:35, 19 May 2008 (UTC)
If you look through the RfC comments, I think you'll see that most of the outsiders who commented support the addition of that content. ScienceApologist (talk) 19:36, 19 May 2008 (UTC)

I am concerned about the attempted railroading of the discussion by known alt med proponents and chiropractors. I have filed a Third opinion request to get outsider help:

As a practicing chiropractor, if there is a problem with my participation on this page, I will certainly leave it to you, but I suppose that would mean that SA shouldn't edit science and physics articles either, right? I think as long as we edit NPOV as best we can, that is what we are looking for, some expert guidance, I would hope. I wouldn't begrudge SA from working on Relativity or Eubilides from working on medicine or even Vaccination, so why would you point at me? -- Dēmatt (chat) 20:33, 19 May 2008 (UTC)
There is no problem with your participation on this page, and frankly, I have less of an issue with you than I do with other editors. I absolutely have issue with others using you as a shill to pretend that there is some legitimate controversy over text. I read you as saying you don't like edit wars. Fine. However, there are others who are implying that your position is in-line with some of the more stridently opposed. Note that below we have a particularly strident editor making a laundry list of all the people who agree/disagree with a proposal without so much as a qualification. It is that sort of lumping-and-running that I'm getting tired of. If we could limit chiropractic-supporting editors to just Dematt, I don't think we would have a problem. You are a very good editor who is aware of his own POV enough to be honest about it. However, when discussions happen where you find yourself surrounded by "the usual suspects" it might be better if you didn't entertain the more egregious game-playing. Just a suggestion. ScienceApologist (talk) 21:50, 19 May 2008 (UTC)
SA, thanks for clarifying. I appreciate your confidence, but I do want you to know that, at least as far as the edits that I see here on this page, CorticoSpinal has not improperly used my name. If he had, I would not have hesitated to set the record straight. Having said that, I do not hold any animosity for any editors here as they are all doing a very good job trying to get things right - from their POV. Quite the opposite, I appreciate all the work everyone is putting in trying to get it right. The problem is that we all come with preconceived ideas of what chiropractic is - even different chiropractors have a different understandings of what chiropractic is. As a result, there are no sides here; no-one agree with each other 100%. The version that was here previously that was stable for at least a year ignored reformed chiropractors mostly because the editors that were here didn't know any. Fyslee fought hard to make sure they were included, but the article talked mostly about straights. Well, then CorticoSpinal showed up. Apparently there are reformed chiropractors. The problem is that he rewrote the article from his POV, then Eubilides stopped in when he noticed that straight chiros preached against vaccination. He took that to heart and set out to rewrite the article from his POV. Well, there you have the fuel and the match. What I want you to notice, however, is that now we have no straight chiropractor representation, so the article is in a little bit of a disarray right now, but as Eubilides and CorticoSpinal struggle through their research, I'll do my best to represent those pesky straights. Otherwise, I really don't think that picking a particular version of anything in this transition phase is a good representation of NPOV for chiropractic. I hope you understand. If I thought that accepting that version would stop the bleeding at this article, I would be thanking you from the bottom of my heart, but I am afraid we will only make it harder to improve. Let's let them get it right first, then 'freeze it'. -- Dēmatt (chat) 01:39, 20 May 2008 (UTC)
  1. Talk:Chiropractic#Version suggestion. There was an RfC where uninvolved editors determined that a particular set of edits was an improvement. Now, many editors who are actively known to be chiropractic supporters are advocating for the removal of the edits in seeming defiance of the consensus achieved above. We need a neutral party unfamiliar with the disputes to review the discussion for bias in the editors remarks. Note that User:CorticoSpinal, User:Levine2112, User:Dematt, User:TheDoctorIsIn, User:SmithBlue, and User:DigitalC are all either practicing chiropractors or are alternative medicine promoters. ScienceApologist (talk) 19:23, 19 May 2008 (UTC)
Disagree. Dematt, myself, DigitalC, Levine2112, Doctorisin and SmithBlue have serious reservations about the draft. Perhaps it would be best if you did not embellish or claim a consensus where there is none. CorticoSpinal (talk) 19:24, 18 May 2008 (UTC)
That is funny :-) Wasn't that the version that started the edit war. I don't think Eubilides even liked that one. -- Dēmatt (chat) 22:17, 18 May 2008 (UTC)
I think that (generally) the version right before this edit was the version that was closest to a consensus. The article was pretty stable back then. Things changed after that edit. -- Fyslee / talk 22:35, 18 May 2008 (UTC)
Ha! That would be this guys first edit on chiropractic :) ---- Dēmatt (chat) 23:56, 18 May 2008 (UTC)
It's unfortunate that Fyslee seems to have it out for me. I cannot believe that he thinks that the pre Jan/08 version is superior to what we have now. I guess we will have to agree to disagree on this. How about comments on the images, new proposed cost-benefit and discussing the validity of calling effectiveness of SMT and passing it off as the effectiveness of chiropractic? CorticoSpinal (talk) 00:25, 19 May 2008 (UTC)
Ah, don't take it so tough. You dish it out pretty good yourself! We really shouldn't take stuff so seriously. I do like the images and , no, the effectiveness of SMT is not the same thing as effectiveness of chiropractic. There are other factors in the chiropractic encounter that need to be included, such as; time spent with the patient, touch, accessability, etc.. and of course there is that placebo effect thing. You know... is it true, or is it just in the imagination of weak minded people (just being facetious of course!) ---- Dēmatt (chat) 01:00, 19 May 2008 (UTC)
During your sabbatical a I went through a lot of BS including a few witch hunts and continued character assassination attempts. Essentially, skeptics are trying to portray me an as "anti-science" "POV warrior" who "cannot collaborate". Now that you are back on the scene I am confident that we will be able to better navigate these turbulent waters with you at the helm. I'd much rather find literature and revise existing weak sections and not have to be, at times, a defacto spokesperson for contemporary chiropractic. I hate coming on here and dealing with all the BS; but I'm not going to let dogmatic skeptics railroad changes in, claiming "NPOV" when it's clearly marginalizing, not valid or has an undue harsh tone. Then I have to deal with a certain editor who seems to have an unhealthy fixation on me and makes grandiose soliloquoys to admins that I'm pretty much exclusively responsible for the state of affairs here at chiropractic.
Your tone is likely going to be more diplomatic that mine, however, since your return you have pretty much raised the same concerns (validity of effectiveness of SMT and passing it off as chiro), cherry picking evidence and not fully attributing it, having a harsh/negative tone of something that should be neutral, suggestions that the effectiveness of SMT for LBP is in doubt, suggestions that manual therapy for neck pain is useless, etc. There are far more, but I'm heading out for the night so we can continue this discussion tomorrow if you'd like. CorticoSpinal (talk) 01:18, 19 May 2008 (UTC)
Well, as Fyslee and Levine can tell you, this page has been a lot hotter and a lot worse at times. I write better when there are two editors with two different POVs as I like to work toward a compromise. However, sometimes compromise is not the best solution, so it has to be grappled out in two balanced POV elements using verifiable sources with the right amount of weight for each. For that, we need people like you and Eubilides to see both sides, but each of you have to realize that you won't always end up with what You want, but it should be better than what would have been there without You. I think you're getting there. It took us two years to get to where we were before, but it was stable for more than a year after that. Hopefully we'll get back to that - and it will be a better article. ---- Dēmatt (chat) 03:37, 19 May 2008 (UTC)
That stability and collaboration is what I miss. I too think that the best articles are produced when editors with opposing POV collaborate and ensure that each other's POV is represented using good sources. That way no one is totally satisfied with the article, which may actually mean that NPOV has been reached...;-) -- Fyslee / talk 05:32, 19 May 2008 (UTC)

I think that there is too much well-poisoning going on here. I'm not pleased that the only person who is commenting on this issue who is not firmly aligned as a chiropractor or alt med proponent is Fyslee. I'm going to ask for a third opinion. ScienceApologist (talk) 19:17, 19 May 2008 (UTC)

Would it be considered well-poisoning to suggest there is a consensus where there clearly is none? -- Levine2112 discuss 18:28, 20 May 2008 (UTC)
I have 2 diffs that can be used if this point needs to be clarified and verified. I don't understand his sudden need to rock the boat here, last time I checked the waters were already rough. SA needs to stop treating chiropractic like fringe and then we can move ahead. Chiropractic is not fringe, it's mainstream. These words aren't from me. They're from Dr. Kapchuk, MD. When MDs say DCs are more mainstream than alternative (fringe?) I think its time the skeptics listen to the evidence and not some outdated dogmatic belief system. Thoughts? CorticoSpinal (talk) 00:35, 21 May 2008 (UTC)
I don't know what "this point" refers to, or what the "2 diffs" are. However, as mentioned in #2008-05-03 issues list, one of the POV problems in Chiropractic is that it characterizes chiropractic as complementary and alternative medicine, a view that is controversial. Other views should be given fairly. See, for example, Redwood et al. 2008 (PMID 18435599).

typos

I'd like to change intial to initial but the page is edit protected. Can someone fix this when you come to a concensus on the disputed bits? Jonathan Cardy (talk) 18:37, 16 May 2008 (UTC)

article improvements in the works

chiropractic schools tidbit

This is still a continuing source of debate within the chiropractic profession as well, with some schools of chiropractic (for example, Palmer School of Chiropractic[85]) still teaching the traditional/straight subluxation-based chiropractic, while others (for example, Canadian Memorial Chiropractic College[86]) have moved towards an evidence-based chiropractic that rejects metaphysical foundings and limits itself to primarily neuromusculoskeletal conditions but retains a holistic approach and an emphasis on manual therapy.[87]

commentary on chiropractic schools tidbit

This sentence seems a bit long. Any suggestions? QuackGuru 21:37, 18 May 2008 (UTC)

Make a proposal, QG. Never write down in 10 words what you can say in 5. That's the tough part about writing and editing. Anything to explain the apparent dichotomy that exists. CorticoSpinal (talk) 00:15, 19 May 2008 (UTC)
I think making a statement that Palmer still teaches the traditional metaphysical approach is not really accurate. That same website says this. If their first reference had said Innate Intelligence (Uppercase) rather than innate intelligence (lowercase), I might buy the argument, but Innate Intelligence is the metaphysical equivalent to the untestable vitalistic "spark of Life" while innate intelligence is the inborn intelligence that science embraces as reductionist to a point then emergent through the potentially millions of combinations that can occur. Fyslee understandsthis. IOWs, there is nothing metaphysical about innate intelligence, only Innate Intellingence. It's like placing all the intricacies of life in a metaphor called mother nature rather than calling what we don't quite understand, God. Nobody actually believes there is a Mother Nature, it's just a metaphor used to lump it all into one 'easy to communicate concept' so we don't have to describe everything in scientific terms. For instance, the birds and the bees. Once everyone knows what birds and bees means, we don't have to keep explaining about the spermatozoa and ovums, etc., etc.. You see what I mean? ---- Dēmatt (chat) 03:23, 19 May 2008 (UTC)
Innate Intelligence (Uppercase) and innate intelligence (lowercase) has been used both ways in the same article. QuackGuru 05:25, 19 May 2008 (UTC)
Excellent article QG, everyone should read it. Now compare that with Keating's Innate. Remember Keating was a psychologist that worked and taught in chiropractic colleges, in fact I think maybe both Palmer and Canadian Memorial, but don't hold me to it. Anyway, notice that he talks about "innate" as homeostasis, etc. initially, but then in 1906 the metaphysical Innate Intelligence starts - remember DD went to jail in 1906 for practicing medicine without a license. Your article shows how chiropractic cohorts at the time were against the change, it mentions Carver (who started several schools that are still around today) and John Howard of National Chiropractic College. These were major players in the mixer movement that denounced Innate Intelligence early in 1900s. There is so much more, but we better fo with one piece at a time. ---- Dēmatt (chat) 13:09, 19 May 2008 (UTC)
Lon Morgan (1998). "Innate intelligence: its origins and problems" 42 (1): 35-41.  Here is an article on innate. Any suggestions. QuackGuru 05:37, 19 May 2008 (UTC)
The differences between II and ii, as explained by Dematt, are very real, but usage of the words, regardless of capitalization differences, is still problematic. In the real world, including chiropractic writings, there is lack of consistency (except in ultra straight writings), and the words often have the same metaphysical connotations. If chiropractic and chiropractors wish to avoid being misunderstood when they are referring to non-metaphysical concepts, they should stop using those antiquated esoteric terms that historically have only had metaphysical meanings. They should simply call the natural healing processes, the immune system, and the self-limited nature of many diseases, what they are and with those words, just like everyone else does. There are various common terms that could be used, instead of continuing to use the "innate intelligence" words. It would save the profession from many misunderstandings and make the "chiropractic bull's eye" a smaller target for skeptics to hit. I'd favor that. -- Fyslee / talk 06:10, 19 May 2008 (UTC)
I entirely agree, but we're verging into discussion forum territory here. Back to work ;) Jefffire (talk) 14:54, 20 May 2008 (UTC)
You know what's absolutely amazing about the aforementioned discussion? I had no clue about the difference in capitalization, about the meanings etc of II vs ii, etc... The integrative curriculum at CMCC really did not emphasize/teach traditional philosophy. As if even the spelling means something different. CorticoSpinal (talk) 16:07, 20 May 2008 (UTC)
I didn't know it either till Fyslee turned me on to the chiropractic history archives that Keating donated to Chiro.org. We didn't learn it at Logan (a mixer school) in the early 1980s, only that DD discovered it and BJ developed it. The rest was sort of passed off as "you really don't want to know ;-)". Keep an open mind and you will learn a lot more, too. Especially that those darned straights aren't as bad as we make them sound :-) But, don't tell Fyslee I told you that, now, okay, I'll try to get back to work... remember I'm trying to present the straight POV. Where's Hugher when we need him? Levine? ---- Dēmatt (chat) 18:59, 20 May 2008 (UTC)
Oh I'm here. I just don't have much to comment on this. I always understood innate intelligence as the body's inclination toward homeostasis. A body typically "wants" to be healthy. A body "knows" how to be healthy. I know there is a vitalistic history to the concept, but how does materialism define the body's inborn ability to heal itself? Is there a mainstream term for this? If you cut me, I bleed - but my body will also form a scab, send out anti-bodies, cells will repair, and in time I will heel. My body just "knows" how to do this. Chiropractically speaking, the theory goes that only the body heals. Only the body cures. No medicine cures. No adjustment/manipulation heels. However, just as a band-aid may help the healing process of a would, alignment of the spine may help the body cure itself. That's my knowledge of innate intelligence in a nutshell. -- Levine2112 discuss 19:22, 20 May 2008 (UTC)
Exactly... there does not have to be anything vitalistic about innate intelligence (ii), no untestable force that can't be explained or measured, it accepts the same reductionist view that studies all the way down to DNA and evolution and whatever other science we can call it, then it falls into that same abyss that all complex systems fall into - some just call it emergence, others call it Mother Nature and still others call it innate intelligence. Sure, some believe that there is something vitalistic/untestable, but then there are scientists that believe in Creationism, too. Their are fringe people everywhere. That doesn't mean we call all scientists fringe, we try to differentiate them from the rest. Okay, I promise, I will stop! Dangit. -- Dēmatt (chat) 20:31, 20 May 2008 (UTC)
No specific suggestions have been made. I added the refs. QuackGuru 15:46, 23 May 2008 (UTC)

chiropractic professional tidbit

Most commonly, chiropractors obtain a first professional, second entry, degree in Chiropractic medicine.[14][15] Typically a 3 year university undergraduate education is required to apply for the chiropractic degree.[16][17]

commentary on chiropractic professional tidbit

Here is a bit information that can be improved. Thoughts? QuackGuru 21:37, 18 May 2008 (UTC)

No specific suggestions have been made. Therefore, I improved one of the sentences, formatted the refs, and chose the best refs I could find. QuackGuru 15:49, 23 May 2008 (UTC)

red link

Low-level laser therapy is now a red link. Is there another link that might be helpful or should we unlink it. QuackGuru 04:20, 19 May 2008 (UTC)

Sorry, I don't see the red link. In Chiropractic, "low-level laser therapy" is not wikilinked at at all, so how could it be a red link? I recall that there was a draft that wikilinked to LLLT (the page was Photobiomodulation) but that page was removed recently. Until/unless something like it gets added again, I suggest leaving the term alone, i.e., no wikilink. Eubulides (talk) 20:47, 19 May 2008 (UTC)
http://en.wikipedia.org/w/index.php?title=Chiropractic&oldid=212672736 I am specifically referring to this version just before CorticoSpinal's recent edits. I recommend removing the red link when the broader consensus version is restored. QuackGuru 20:58, 19 May 2008 (UTC)
Yes, that makes sense. Thanks for clarifying. Eubulides (talk) 21:10, 19 May 2008 (UTC)
Is there another wikilink we might use as an alternative that also covers low-level laser therapy. QuackGuru 21:17, 19 May 2008 (UTC)
I looked for another wikilink but did not find anything plausible. Eubulides (talk) 21:30, 19 May 2008 (UTC)

stable version

Here is a stable version from earlier this year. Is there anything worh merging with the newer version we are working on. We need to take a hard look and see if there was anything deleted that should be restored. QuackGuru 21:36, 19 May 2008 (UTC)

Old stable versions are considered controversial. QuackGuru 21:42, 21 May 2008 (UTC)

efficacy tidbit

The efficacy and cost-effectiveness of maintenance care in chiropractic is unknown. Original sentence.

The efficacy of maintenance care in chiropractic is unknown. Change to this sentence.

Now that we have a cost-benefit section the discussion about cost-effectiveness would be better in that section. QuackGuru 17:35, 20 May 2008 (UTC)

I agree with this change, so long as the obvious change is also made to the cost-effectiveness section. The latter section should say "The cost-effectiveness of maintenance care in chiropractic is unknown." and cite the same source. Eubulides (talk) 02:16, 21 May 2008 (UTC)
Not exactly as Descarreaux et al have demonstrated. You cannot ignore evidence, they're 2 different papers. Also, do you think maintenance care is simply an adjustment? Does is specify? A better sentence would be "The efficacy of maintenance spinal manipulation is unknown; preliminary evidence suggests that it may be beneficial in maintaning perceived post-intensive manipulation CorticoSpinal (talk) 05:04, 21 May 2008 (UTC)
Please see my comment immediately below DigitalC's. Eubulides (talk) 08:35, 22 May 2008 (UTC)

Maintenance Care in Chiropractic - what do we know?] Chiropractic & Osteopathy, May 2008. DigitalC (talk) 07:43, 22 May 2008 (UTC)

The review cited in Chiropractic (which DigitalC also cites in his comment) has reviewed the results of Descarreaux et al. and the reviewers have personally communicated with Descarreaux on the subject; it's not like this material is unknown to the reviewers. It is not our place to second-guess published expert reviewers on the subject. We should summarize what the reviewers say, and not reach down into a primary study to pull out details that favor one side. Eubulides (talk) 08:35, 22 May 2008 (UTC)

cost-benefit tidbit

The inclusion of chiropractic for low back and neck pain treatment had a reduction in the rate of advanced imaging, surgery, and plain-film radiographs, and inpatient care.[88]

Having access to chiropractic managed care is associated with a reduction in health care costs, having a clinical benefit, and may reduce overall health care expenditures.[89]

Here is some information I have been working on. Are these two studies useful or are there better references available? QuackGuru 18:12, 20 May 2008 (UTC)

I like these two studies a lot because they are specifically about "chiropractic care" and not SMT in general. I think they can be used in cost-effectiveness and quite possibly in efficacy as well. -- Levine2112 discuss 18:32, 20 May 2008 (UTC)
Are these two studies useful or are there better or newer references that generaly cover cost-benefit? We have a lot of references to choose from including reviews. QuackGuru 20:20, 20 May 2008 (UTC)
I think they are useful and are better (for our purposes at this article) than the references which discuss SMT in general. -- Levine2112 discuss 21:11, 20 May 2008 (UTC)
I like them and would like to see others as well. Good point about the "chiropractic care" and not only SMT. -- Dēmatt (chat) 21:50, 20 May 2008 (UTC)

Some definitions and basics

  • A primary source in medicine is one where the authors participated in research or documented their personal experiences. They examined the patients, injected the rats or filled the test tubes, or at least supervised those who did. Many, but not all, papers published in medical journals are primary sources. Most medical journals have high editorial standards and ensure research papers are peer reviewed.
  • A secondary source in medicine summarizes one or more primary or secondary sources, usually to give an overview of the current understanding of a medical topic. Review articles and specialist textbooks are examples of secondary sources. A good secondary source from a reputable publisher will be written by an expert in the field and be editorially or peer reviewed. Journalists writing in the popular press, and marketing departments who issue press releases, tend to write poorer secondary source material; however, such material may be appropriate for inclusion in some contexts.
  • A tertiary source usually summarizes secondary sources. Encyclopedias, including Wikipedia, are tertiary sources.

In general, Wikipedia's medical articles should be based upon published, reliable secondary sources whenever possible. Reliable primary sources should be used with great care because of the potential for misuse. For that reason, edits that rely on primary sources should only make descriptive claims that can be checked by anyone without specialist knowledge. Where primary sources are cited, they should be presented in a manner which hews closely to the interpretation given by the authors or by published, reliable secondary sources. Primary sources should not be cited in support of a conclusion which is not clearly adduced by the authors or by reliable secondary sources, as defined above (see Wikipedia:No original research).

Why should we cherry pick primary sources when recent reviews are available. We have good guidelines on Wikipedia (WP:MEDRS). Please provide a specific reason for ignoring them. QuackGuru 22:44, 20 May 2008 (UTC)

Umm, you brought these sources to our attention - so if any one is harvesting cherries, it would be you. That said, per the policy, we can still use these sources provided that we exercise caution and follow the suggestions MEDRS puts forward. -- Levine2112 discuss 22:48, 20 May 2008 (UTC)
I did not cherry pick these references for inclusion in this article. I am having a civil discussion here. When we follow the suggestions put forth by MEDRS we will avoid these primary sources when recent reviews are available. Get it? QuackGuru 22:56, 20 May 2008 (UTC)
Was it your intention to lay a trap for us as we tried to be gracious and collaborate with you? You won't mind if I no longer WP:AGF. I wish you well. -- Dēmatt (chat) 00:18, 21 May 2008 (UTC)
I had already mentioned those studies under my Cost Benefit 2a draft. Also, SmithBlue eloquently deconstructed the entire MEDRS debacle that is being used by certain editors here to prevent the inclusion of critical primary studies while using MEDRS as a policy and not as a guideline as suggested. Also, Dematt, I have noticed similar tactics by QG, but as a "valuable contributor" I guess certain editors have a lot more leeway. CorticoSpinal (talk) 00:23, 21 May 2008 (UTC)
Oh, I'm not so sure it is all QG. I think we are looking at something much bigger than QG. Didn't all this start on May 14th? [18]. I might owe QG an apology. -- Dēmatt (chat) 00:42, 21 May 2008 (UTC)
Correct. It was May 14th when the fiddle playing began. -- Levine2112 discuss 01:27, 21 May 2008 (UTC)
Oh, oh, my link suddenly dissappeared of QG talk page, good thing it is still in the history. That's the thing about WP, you can run but you can't hide. :-) Shame on you guys. I think you owe Eubilides an apology, too. So who was the target, Levine? CorticoSpinal? -- Dēmatt (chat) 01:36, 21 May 2008 (UTC)
I thought everyone knew that QG kept old versions of chirpractic in his sandbox :-D This is almost funny if it hadn't cuased so many hard feelings. -- Dēmatt (chat) 01:41, 21 May 2008 (UTC)
Just so I'm clear: how is this kind of stuff tolerated? Isn't ScienceApologist on some kind of arbitration/probation? He's also declared 2 false consensus' when there was clearly none (besides the railroad attempt to get QGs sandbox version in). This is surely disruptive, no? So long as blantant attempts to subvert the will of the community by gaming the system occurs true progress won't be made. Most of us here are trying to build bridges; I've tried to make alliances with the GPs here only to be rebuffed and treated like a POS with absolutely no professional courtesy or respect. My point? How can Wikipedia work if its editors don't extend good faith when they know your professional designation. It's absolutely horrid. Also, QuackGuru must be on 9 lives or something. He has ducked and dodged a recent ANI but surely a truly independent group of admins would look at the evidence presented by several editors over a period of time and come to a logical conclusion. He's even deleting incriminating evidence of potential canvassing with SA. CorticoSpinal (talk) 04:58, 21 May 2008 (UTC)

Can we drop the cloak and dagger theatrics? Unless there is something going on that hasn't been linked to, then all I'm seeing is SA and QG talking about gaining consensus. There is no reason that these two editors can't discuss these matters. Jefffire (talk) 16:01, 21 May 2008 (UTC)

Yup, water under the bridge, no harm no foul. Just learned a little lesson, that's all, WP:AGF, after all these years. -- Dēmatt (chat) 16:19, 21 May 2008 (UTC)
I think a brief mention of health care costs might improve this article. Any suggestions? QuackGuru 01:32, 23 May 2008 (UTC)

Ready to Unprotect article

In light of the fact that the edit war that occurred last week was created by outside influence and in reality, the editors were actually working relatively well here before that edit, we should ask that the article be unprotected, we drop the egregious RfC game, and begin to collaborate on this article in the manner in which wikipedia was designed to operate and worked just fine on Chiropractic for the last three years. -- Dēmatt (chat) 01:58, 21 May 2008 (UTC)

If that was "worked just fine" I'd hate to see what you would describe as "worked poorly"! Unfortunately I doubt whether edits will proceed well if the page is unprotected now. I'd rather have a longer cooling-off period. There's no rush. Also, I disagree that RfCs in general are a "game"; that one was poorly done, but they can work well if editors are genuinely trying to cooperate in improving the article. Eubulides (talk) 02:16, 21 May 2008 (UTC)
Well, I can appreciate what you feeling, but this RfC was most definitely a game, and we were the unwitting players. We may have been a little dysfunctional, but at least we can trust each other. This article does not need to be protected because the war was over QuackGuru's sandbox version that ScienceApologist convinced him to put in; a version that should have been reverted (as you did) and never returned (as SA did). The rest were about 50 edits trying to improve it. This was a spillover from something bigger that we do not want to be a part of. -- Dēmatt (chat) 02:48, 21 May 2008 (UTC)
Definitely agree. The RfC was a total sham; and the BS of this page has hit an all-time high. Let's open the page up and tackle 1 section at a time. I suggest we get safety and vaccination done right and roll it into a Criticisms section. The essential/major criticisms can go in the lead. Let's just get down to business; it's what the skeptics want so let get'er done tastefully than those that truly care for the article can begin to tackle other important issues such as chirorpractic and integrative medicine, the science of chiropractic (textbooks, theories, scientific contributions, technology developments, journals, interdisciplinary research, accreditation from the major educational bodies, integration in universities outside North America, etc.) Chiropractic medicine in 2008 is not the same as it was in 1966... CorticoSpinal (talk) 05:13, 21 May 2008 (UTC)
Chiropractic education certainly seems more scientific. Good science should definitely be in the article. Unfortunately, reliable surveys show that significant percentages of chiropractors offer unscientific treatments like applied kinesiology or homeopathy and oppose vaccination. I thought the vaccine section was hammered out with cooperation and consensus? How would you change it?--—CynRN (Talk) 16:48, 21 May 2008 (UTC)
Vaccination is fair game to tackle. That's not under dispute. Nor are the practices you've listed above (AK/Homeopathy). I'm not going to cover up for the BS of those practitioners. However, I object to 1) the undue weight put on the Cdn DCs 2) the undue weight given to the views of the majority of the profession (neutral or supportive) and 3) the cherry picking up on "con" sources that doesn't present the views of the mainstream (i.e. pro vax or neutral). My objections is more about the detail it covers that is puff and used to make a point and the harsh tone projects. So, I'd like to see Dematt or someone else considered to be non-partisan work both POVs together and add a few more references both pro and con. You had a Kansas survey that could be included; we would need to know whether or not thats the views of the Kansas State DCs, US DCs, whether or not they're from the ICA (generally not in favour of vax, is that correct Fyslee?). Perhaps it would help if I made a proposal and then we could pick it apart. Another concern of mine is safety; the section starts off by saying its relatively safe then spends 10 lines saying how bad SMT is for you (adverse effects, contraindications and even DEATH!) then there is a cherry picking of the lit which prevents us from discussing the findings of the experts of SMT and stroke, namely Haldeman, Cote and Cassidy. Had Eubulides decided not to play games with sources and prevent editors from including more than relevant and reliable studies we would not be here and have the same problem as we did 3 months ago. Safety is terribly flawed in design and execution and it should be summarized and roled into a Criticisms section. CorticoSpinal (talk) 17:41, 21 May 2008 (UTC)
This project, overall, is pretty overwhelming! I agree that it would be good to keep the page protected for now and discuss strategies to edit productively. I have a feeling it will take a long, long time to come up with a version everyone is comfortable with. We'll get back to vaccines when it comes up again, but I don't understand how the current version of vaccines is 'harsh'.--—CynRN (Talk) 19:13, 21 May 2008 (UTC)
Here's that 2005 survey, FYI.[19]--—CynRN (Talk) 19:26, 21 May 2008 (UTC)
Okay, if those of you that edit here are okay with it being protected, then that's okay with me. -- Dēmatt (chat) 21:05, 21 May 2008 (UTC)
I'm fine with leaving it protected, considering the editing POV I've just read. Edit wars are so tiring, and this way we can avoid them. BTW, as far as coming up with "a version everyone is comfortable with", I not only doubt that will ever happen, it can only happen if one of two things occur: every editor truly comes to understand NPOV, or NPOV is terriby ignored by editors who make a devil's pagt and compromise to keep the peace by leaving out any details that could offend editors who hold the opposite POV. Fat chance. If the article ends up (which never happens here) with all parties somewhat uncomfortable but willing to stop edit warring and leave well enough alone, then we'll likely have an NPOV article that offends everyone a little bit because it tells the whole story, and that's where we need to arrive. -- Fyslee / talk 04:18, 23 May 2008 (UTC)
My 2c to get beyond the stalemale is to let skeptics raise all controversies surrounding chiropractic, find the best sources to neutrally present the material and roll into into a Criticisms section. Then those who really care about intricacies and details of the chiropractic story can get on with the show and make the article interesting and not some big stats/research battleground. For the record, I completely agree 100% that effectiveness of chiropractic care is well established for low back disorders (just as good if not better) that manual therapy is effectiveness in neck pain (Task Force 2008) that the results seem favourable for certain types of headaches (TTH, migraine, cervicogenic/headache of cervical origin) and inconclusive and controversial for non-musculoskeletal disorders. Part of effectiveness too is patient satisfaction scores which patients routinely display a far greater preference for chiropractic care than medical care for LBP. This is the most succint and precise summary there is. We can toss the reference in and call it a day. A majority of editors agree that the current and past evidence, both in research and 3rd parties (governments) favours chiropractic care. We can't let Ernst' conclusions (which have been rebutted and invalidated) skew what is now generally accepted. Notice the terms too, generally, etc. CorticoSpinal (talk) 04:33, 23 May 2008 (UTC)
The article it unprotected and further improvments have been made. Happy reading. QuackGuru 16:05, 23 May 2008 (UTC)

potential misuse of primary sources

I hope editors will learn a good lesson here. For example, we should not reach down to primary sources to argue with recent reviews. Cherry picking primary sources has a potential for misuse. See WP:MEDRS. Get it? QuackGuru 16:34, 21 May 2008 (UTC)

Stop saying "get it?"! It makes you sound snarky and I'm sure you don't mean it that way.:)--—CynRN (Talk) 18:56, 22 May 2008 (UTC)
I agree with CynRN. It does sound snarky. -- Levine2112 discuss 19:37, 22 May 2008 (UTC)
Unless you're having a text reader speak these words for you, it doesn't sound like anything. Get it? ScienceApologist (talk) 23:03, 22 May 2008 (UTC)
I also agree with CynRN; it would be better to avoid "Get it?", which has the vague connotation that the reader may not be bright enough to follow what's going on. It's a small thing, but small things add up. Eubulides (talk) 23:16, 22 May 2008 (UTC)
I fully agree. It sounds snarky and condescending. A common one that QG often ends with is "agreed?", when agreement is obviously a few light years away. That's manipulative, condescending, and very insulting. Just say what you mean and leave it at that. -- Fyslee / talk 04:06, 23 May 2008 (UTC)
Agreed. Passive-aggressive editing (wikipedia civility hat) "is unbecoming and detrimentally affects the project" (real life) "blows." QuackGuru this is not the first time this particular issue has been brought up. Considering there are now 5 dissenters and its own special thread, I'd suggest you heed the advice of your co-editors. CorticoSpinal (talk) 04:39, 23 May 2008 (UTC)

Citation 80

{{editprotected}}

As I am restricted from editing this page, I am unable to fix the blatant problem with citation 80. If someone could fix the problem, it would be greatly appreciated. Alan.ca (talk) 20:35, 18 May 2008 (UTC)

Here is the whole ref: [24] -- Fyslee / talk 22:20, 18 May 2008 (UTC)
The whole ref with a sentence was removed which caused the broken citation. I recommend all of these edits be reverted to the last broader consensus version. QuackGuru 23:12, 18 May 2008 (UTC)
There is no consensus, Quack. Alan, what specifically is wrong with citation #80 and what is it's relevance to the purported effectiveness of chiropractic? CorticoSpinal (talk) 23:31, 18 May 2008 (UTC)
The problem with the ref is that it's red. It needs fixing. -- Fyslee / talk 05:50, 19 May 2008 (UTC)
Agreed. There is no consensus for these edits. QuackGuru 02:22, 19 May 2008 (UTC)
Y Done reference fixed, as a temporary measure. You need to establish whether or not the edits which broke it in the first place had consensus. And the |doi= parameter looks a bit wierd... Happy‑melon 09:39, 19 May 2008 (UTC)
Eubulides (talk) 20:47, 19 May 2008 (UTC)
There was no consensus for the edits that preceded it either. Had QG not railroaded in "effectiveness" we wouldn't be here, but that's water under the bridge now. CorticoSpinal (talk) 00:29, 21 May 2008 (UTC)
There was not universal consensus for either set of edits. However, the edits that broke it have far less consensus. Eubulides (talk) 02:16, 21 May 2008 (UTC)
Just so we're clear, no one agrees, save quack guru and yourself that effectiveness 3 is any more VALID that 2, and 1 were. I think it's pretty clear that chiropractic care is not simply SMT. So, effectiveness of chiropractic must be of chiropractic care. We have studies specifically on this. Governments have done some too (tertiary sources) as well as independent 3rd parties (workmans compensation). They are generally point to the same thing: chiropractic care is just as or more effective than standard medical care for musculoskeletal disorders. Jury is out on non-NMS, and even I think they'll be a few systemic dysfunctions that SMT can help out in select individuals. We'll toss in the dissenter (Ernst) but he shall not weigh down the section. Simply put, we'll have a blurb of SMT effectiveness (naturally it's the characteristic modality of chiropractors) as per CynRNs suggestion and the rest of the great research you have synthesized can go into Spinal manipulation with a few tweaks of course to better represent mainstream consesus on the topic, not the selective use sources that skews the reality of the situation. It's tactic Ernst himself used as was throttled for it above in the research by DigitalC on the subject. CorticoSpinal (talk) 05:25, 21 May 2008 (UTC)
That's an inaccurate summary of opinions expressed on this talk page. Many editors (most of them outside) expressed a favorable opinion of QG's big edit, which contained #Effectiveness 3 as a major component. The subject is indeed controversial (for example, I didn't agree with QG's big edit overall), but that does not mean #Effectiveness 3 advocates a minority position. Eubulides (talk) 20:13, 21 May 2008 (UTC)
I have issues with #Effectiveness 3, just haven't gotten there, yet.. I suppose I missed 1 and 2 :-) -- Dēmatt (chat) 03:17, 22 May 2008 (UTC)

We have another broken ref citation. It is citation 17 (Villanueva-Russell) this time. QuackGuru 19:53, 24 May 2008 (UTC)

Mass edits

The article was just unfrozen and, rather than fall into an edit war, I want to voice my objection to some of these edits. Some of the edits are controversial and have been reverted in earlier versions. I am concerned that they will start an edit war again. Please nobody revert while we consider here on the talk page about what to do with them -- Dēmatt (chat) 16:08, 23 May 2008 (UTC)

I agree with Dematt's appeal to avoid reverts and to do discussions. I continue to object to the practice of installing major changes without discussion. I disagree with some of QuackGuru's edits and agree with others. I have other matters to attend to, and cannot comment in more detail right now. Eubulides (talk) 16:21, 23 May 2008 (UTC)
I too agree with Dematts suggestion and lament QuackGurus large, disruptive edit which was not talked about in the least. Similarly to Eubulides, I agree with some, disagree with others, but its the principle of QG continuing to insert large edits which can trigger edit wars. The page should have remained protected until the May 26th (if not longer) and we could have inserted/revised a section at a time, got consensus then ask an admin to toss it in. Thoughts? CorticoSpinal (talk) 16:30, 23 May 2008 (UTC)
CorticoSpinal agreed with Dematt's suggestion but added a puffery piece to the Education, licensing, and regulation section.[20] Hmm. QuackGuru 16:56, 23 May 2008 (UTC)
I too lament the mass edits by QuackGuru - not necessarily for all of its content but mostly for his reasoning, his tone and his continued uncivil accusations. I think it is high time to start an RfC. Anyone disagree? -- Levine2112 discuss 18:16, 23 May 2008 (UTC)

I see now that User:ScienceApologist reverted to an older version that was worse than both (1) the version in place when Dematt issued his appeal, and (2) the version in place just before the revert.. Some of the reverted changes were uncontroversial improvements (e.g., additions of citations), and also some of the changes had been discussed with no disagreement. Again, I ask that editors please stop issuing blind reverts like this. I'll leave a note on ScienceApologist's talk page in case he missed this part of the discussion (quite possible, as it's such a huge talk page), and ask him to self-revert. Eubulides (talk) 20:03, 23 May 2008 (UTC)

Actually - BION - I am more comfortable with QuackGuru's version (plus the few amendments which followed before SA reverted to this controversial version). Again, I lament when editors make such huge edits in the name of some imaginary consensus. I am tempted to revert but will give SA an opportunity to self-revert first. -- Levine2112 discuss 22:42, 23 May 2008 (UTC)
A user conduct RfC is way overdue regarding QG. We have repeatedly explained to him that bold, solo editing is disruptive, uncollaborative, and ignores consensus. He is either lacking in intelligence (obviously not) or has some kind of pathology left up to a shrink to determine. While Einstein wasn't a psychiatrist, he did say that "Insanity is doing the same thing over and over again and expecting different results." (The diagnosis for someone who refuses to collaborate by ALWAYS getting consensus BEFORE editing anything other than spelling errors or fixing existing refs is another matter.) In either case this behavior has been going on for far too long and needs to stop. A topic ban (all major articles - and related articles and talk pages - he has ever edited at Wikipedia) would be a proper sanction. Chiropractic, History of Wikipedia, Larry Sanger, and Jimmy Wales would be good places to start. -- Fyslee / talk 04:31, 24 May 2008 (UTC)
I have been avoiding this place due to the editing habits of QG. I have been watching though and his habit of creating a sandbox of the article, making changes in his sandbox that he wants, then adding it wholesale without anyone's input is completely and totally against the idea of a wiki. Watching him shop for people to back his edits should be bad enough. I wonder how many people he's contacted via email looking for support... I don't know if a RfC will have any affect as he's been told many, many times to change to no avail. A topic ban would help but I recall this exact same behaviour at the Essjay Controversy article as well. He also seems blind to other people's input and advice. I originally thought Fyslee's comment above was a little harsh but he keeps doing the same thing over and over expecting a differnt result.... which means... :)--Hughgr (talk) 08:05, 24 May 2008 (UTC)
Yes, Hughgr, I see that your assessment makes sense. He seems to take everything he wants from our discussions (whether we have ruled them out or not) and then inserts them at random times. This in itself is not a problem as we can always discuss the edits, make appropriate changes according to the refs to reach a consensus and NPOV and go from there, but he will re-insert them again, perhaps days, weeks or months later. Mind you, he is not siding with a particular POV; he supports and antagonizes both sides of NPOV. It is that he continues to replace the edits. Maybe if he would only work on the talk page and be forced to abide by consensus. I don't know, though, if he is capable of co-operating, for whatever reason.
Meanwhile, I do see that Eubilides has made some minor changes that appear to be good as well as a couple others by CorticoSPinal and Levine that were reasonable, so let's start with this version. I do see that it has all the sections that we were discussing, but it does not incorporate any of the changes that I suggested, or the agreements that were made above. I think we should start by allowing Eubilides to replace the Science section in the article with one of the above science sections (of his choosing) and then copy it to a section below us where we can begin (again) to work our way through it. This time, though, since there are so many of us, let's go slow and give everyone a chance to chime in. There is no need to make changes in article space until we decide (at various time) to update the *section* - very similar to what we did with the philosophy section. It doesn't have to be perfect, just better each time. Is everyone okay with that?
-- Dēmatt (chat) 15:36, 24 May 2008 (UTC)
Sounds like a reasonable plan to me!--—CynRN (Talk) 18:21, 24 May 2008 (UTC)

I have revised my comment above. -- Fyslee / talk 18:29, 24 May 2008 (UTC)

I see a lot of people clamboring for a censorship of QG, but I think that there are other editors here who are working in much more disruptive ways. ScienceApologist (talk) 23:13, 24 May 2008 (UTC)
Not censorship. Just demands that he collaborate in his editing, use the talk page properly, and stop claiming consensus where there is none. Other disruptive influences are another matter. This is about QG. -- Fyslee / talk 23:57, 24 May 2008 (UTC)
If you want to talk about a particular editor's habits, might I suggest you do it elsewhere? This is the page to discuss the problems with the article. To that end, I see far more problems coming from another group of editors than from QG. Please, feel free to discuss your problems with QG at his user talk page. ScienceApologist (talk) 15:36, 25 May 2008 (UTC)

controversial edits

The cost-benefit section is about cost-effectiveness and risk-benefit. This edit moved content about the risk versus benefit for neck pain. The most appropriate section for this material would be the cost-benefit section. The word "potential" is synonamous (a synonym) for the word "possible". QuackGuru 15:20, 24 May 2008 (UTC)

QG, I disagree that the most appropriate place for that was under cost benefit, as the edit concerned relative risk. Do not change it. -- Dēmatt (chat) 15:40, 24 May 2008 (UTC)
The edit concerned risk and the cost-benefit section is also about risk-benefit. QuackGuru 15:45, 24 May 2008 (UTC)
The edit seems to have removed content without discussion and broke ref number 17 (Villanueva-Russell). Hmm. QuackGuru 15:45, 24 May 2008 (UTC)
The controversial edits have continued. Some of the edits mixed up the text and seem very strange. I suggest we revert back to the last edit by Eubulides QuackGuru 16:54, 24 May 2008 (UTC)
There has been more recent edits. The last stable and closest to NPOV version was Eubulides last edit. QuackGuru 21:56, 24 May 2008 (UTC)

the sum of all human knowledge

The last closest to NPOV/consensus version before the last protection was this edit.

I have made some clear improvements for the better. For example, the cost-benefit section has greatly improved.

Moreover, the WP:LEAD should reflect the body of the article. See lead improvements.

Here are the differences between the last NPOV edit before protection and the updated version after protection.[21] Enjoy! _-Mr. o G-_ 16:33, 23 May 2008 (UTC)

Note

I reverted "this" because it had be reverted by others plus it's a new account from today. I do not know though if the edit I made is per what everyone here wants so please if I have made a mistake please do not hesitate to revert me (of course I mean other editors other than the IP I reverted. I say this because what I have seen is that this IP is being reverted by regulars here. Again, please feel free to make any corrections, I am just trying to help. --CrohnieGalTalk 17:10, 24 May 2008 (UTC)

Thanks for your help. I reviewed the recent edits. It seems there is still some text missing and a ref citation is still broken.[22] I recommend we revert to the last edit by Eubulides. QuackGuru 17:16, 24 May 2008 (UTC)

I support this recommendation. I have done so, though there was one citation that was added that was good. I kept it. I'm not sure where discussion happened to in state the edits that were after Eubulides. ScienceApologist (talk) 23:11, 24 May 2008 (UTC)
The citation that you kept was not needed, since it is a duplicate of an existing citation. The wiki software detects the duplicate and acts as if your edit was not made, so there's no change visible to the user (which you can confirm by viewing the article both before and after your edit), but the resulting page is a bit more confusing to edit because it's longer (as it has the duplicate citation in the source). Eubulides (talk) 07:34, 25 May 2008 (UTC)
Sorry, honest mistake. ScienceApologist (talk) 15:37, 25 May 2008 (UTC)

Is Lerner a reliable source?

This change cites the Lerner manuscript, which was repudiated by its sponsoring organization and was never published by it. Is Lerner a reliable source? If so, shouldn't we also be citing it with respect to other parts of early chiropractic history? For example, Lerner says the Lillard story is "more than doubtful" and compares the story to the Tales of the Arabian Nights. Eubulides (talk) 01:41, 12 May 2008 (UTC)

Chiropractic sources and historians all treat it as very reliable. -- Fyslee / talk 02:03, 12 May 2008 (UTC)
Here is an interesting article (in the ultra straight WCA's journal) that discusses it:
-- Fyslee / talk 02:14, 12 May 2008 (UTC)

Thanks, then I propose that in Chiropractic#History, after "D.D. Palmer gave the first spinal adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895, reportedly resulting in a restoration of the man's hearing." we add the following text, citing Lerner:

"The story of Lillard's adjustment is at least partly apocryphal, as Palmer gave spinal adjustments before 1895; it may be that the story was concocted in order to give chiropractic a particular date of invention."

Eubulides (talk) 07:27, 12 May 2008 (UTC)

We have two contradictory statements. Per WP:NPOV, neither should be presented as fact. I see the first is referenced to Palmer's textbook, so the wording might be something like "D.D. Palmer reports having given the first ..." The second might be something like "According to Lerner, the story of Lillard's adjustment is at least partly apocryphal..." ☺ Coppertwig (talk) 10:29, 12 May 2008 (UTC)
Lillard's own daughter also had something to say. You can read it here. -- Fyslee / talk 06:27, 13 May 2008 (UTC)

OK, in the light of the above, how about if we change Chiropractic#History's first two sentences from this:

Chiropractic (also known as Chiropractic Medicine) was founded in 1895 by Canadian-American Daniel David Palmer in Davenport, Iowa, USA. D.D. Palmer gave the first spinal adjustment to a deaf janitor, Harvey Lillard, on September 18, 1895, reportedly resulting in a restoration of the man's hearing.[90]

to this:

Chiropractic (also known as Chiropractic Medicine) was founded in the 1890s by Canadian-American Daniel David Palmer in Davenport, Iowa, USA. Palmer and his son B.J. Palmer later wrote that the elder Palmer gave the first chiropractic adjustment to a deaf man, Harvey Lillard, on September 18, 1895, restoring the man's hearing.[91] Lillard's daughter disputed the account, saying that Palmer had merely slapped Lillard on the back after hearing a joke.[92] Investigator Cyrus Lerner found in 1952 that the Lillard story disagreed with other evidence published about the same time, speculated that B.J. concocted the date of the first adjustment in order to establish priority for chiropractic, and compared the Lillard story to the Tales of the Arabian Nights.[93].)
That's certainly much better than the previous version. While we probably can't outright call the Palmers liars (although they undoubtedly were), this at least reveals that things were not as the profession has generally been taught to believe. -- Fyslee / talk 14:17, 14 May 2008 (UTC)
I have learned a lot here about early chiropractic history. This is a great improvement. QuackGuru 14:27, 14 May 2008 (UTC)
I made this change to improve the section. QuackGuru 15:02, 14 May 2008 (UTC)
Thanks for editing that in, QuackGuru. I would delete the part about the tales of the Arabian nights. It seems unnecessary here. We don't need to repeat every colourful criticism or compliment of chiropractic.☺ Coppertwig (talk) 02:48, 16 May 2008 (UTC)
The part about the tales of the Arabian nights was interesting. It grabs the reader. In fact, it pulled me in and I enjoyed reading the Arabian nights article. After reading the Arabian nights tidbit, I wanted to continue reading. It was spicey. QuackGuru 03:13, 26 May 2008 (UTC)
OK, I restored it, since I don't feel strongly about it. Adding spice is OK, I guess. (I retained my addition of the word "had" for the pluperfect tense.) It's OK as is. One problem I have with it is that it doesn't specify in what way the story was like the Arabian Nights, and the wikilink provides no clue about that. Maybe it's supposed to be obvious. Possibly adding a few words would clarify – or maybe that would be digressing too much. ☺ Coppertwig (talk) 22:52, 26 May 2008 (UTC)

more controversial edits

This controversial change was a complete rewrite of the Education, licensing, and regulation. The first part is historical info and the second part is a text dump from the lead of Chiropractic education article. QuackGuru 05:27, 27 May 2008 (UTC)

It's not controversial QG and the "text dump" is the material I wrote in April on here. QuackGuru is being completely disrupting this page and I'm fed up with his antics. He can dump 3 entire sections (efficacy, cost-effectiveness, research) make major revisions to the lead all the while majority of editors here disagreed strongly on the validity of the content and the cherry picking up sources and the miuse of Ernst to subvert the majority mainstream viewpoint. Your conduct here is becoming very frustrating QG and this is echoed by many editors now. Please refrain from making deliberately misleading statements, thanks. CorticoSpinal (talk) 05:43, 27 May 2008 (UTC)
The info was written way back in April and was rejected (reverted) and now the text dump continues. QuackGuru 05:48, 27 May 2008 (UTC)
Actually no, its Eubulides who doesn't want the different educational paths listed for whatever reason. The draft had consensus all but from yourself in Eubulides. So, no it was not rejected like you say. Another misleading statement. You're on a roll tonight. Regardless, the added text is NPOV, is accurate and is from reliable and valid sources. There's no reason to drum up controversy when there is none. CorticoSpinal (talk) 05:59, 27 May 2008 (UTC)
I don't know what "The draft had consensus all but from yourself in Eubulides" means. The draft did not have consensus. It was put in anyway. Eubulides (talk) 08:08, 27 May 2008 (UTC)
Would you mind taking out the snide remarks and the innuendo? They don't help matters and only make you look bad. ScienceApologist (talk) 06:30, 27 May 2008 (UTC)
I'm sorry that you intepret it that way SA. As a true believer in QuackGuru, it must be difficult at times seeing your friend's approach at editing here being rebuked. I believe the possibility of a RfC was discussed a few days ago. Perhaps it is time to follow through based on tonight's festivities. CorticoSpinal (talk) 06:40, 27 May 2008 (UTC)

Disruptive editing (blind reversion) yet again.

This is at least the 3rd separate time Orangemarlin has disruptively and inaccurately deleted well cited material and has made misleading edit summaries at Chiropractic since mid-March 2008.

Why did you make blind reversion of my edit at practice styles regarding straight/focused scope chiropractors here? You wrote the source was not reliable. However, the same source is already being used elsewhere in the article. So, I'd ask that you please self-revert your edit. A failure to do so will be construed as a deliberate attempt to destabilize and censor relevant, valid, and reliable information. Considering that you have already done so twice already a RfC should be in order. CorticoSpinal (talk) 05:30, 27 May 2008 (UTC)

This controversial change added POV nonsense to the Chiropractic#Straight section. QuackGuru 05:34, 27 May 2008 (UTC)
I tend to agree. The situation is extremely strange because I see no discussion of the wording in this addition and the use of the term "stereotypes" to describe "focused-scope chiropractors" is hugely absurd. Since most people in the world including most people who have interacted with chiropractic have never had any exposure to the distinctions it is hardly reasonable to declare a "stereotype" regardless of how stridently a source puts it. Please workshop appropriate wording here before making this kind of addition. ScienceApologist (talk) 05:47, 27 May 2008 (UTC)
This word is in the cited source. The source is not in dispute, it's already being used elsewhere in the article. So, what's the big deal? Oh right, it debunks a lot of the myths skeptics promote. Well, sorry, SA, you're going to have to suck it up and deal with the fact the profession is maturing and is not fringe like you promote it to be. CorticoSpinal (talk) 05:54, 27 May 2008 (UTC)
I'm fine with a maturing profession. I'm not fine with borrowing the wording from marginal sources just to prove a point. Wikipedia is not the place to right great wrongs. Let the profession actually mature and then we'll talk. Until that time, we have an article to write from the most reliable, neutral, verifiable, and weighted-to-the-mainstream perspective possible. ScienceApologist (talk) 05:57, 27 May 2008 (UTC)
Please elaborate and prove your claim that McDonald (2003) is a marginal source. Chiropractic is mainstream. See Integrative medicine. Get over it. CorticoSpinal (talk) 06:03, 27 May 2008 (UTC)
It's marginal because it is a survey of chiropractors. If I surveyed creationists and then tried to "debunk the myths skeptics promote" from such a survey, that would also be a marginal source. ScienceApologist (talk) 06:29, 27 May 2008 (UTC)
Incredibly weak argument. Red herring with the creationists by the way; non-sequiturs are not useful in advancing your point which has been rebutted. McDonald is legit, the wording is in the source, the source is being used elsewhere in the article. Let me repeat: chiropractic is mainstream. Do you have proof it is fringe? Otherwise I'd suggest you stop treating it as such and making ridiculous comparisons to creationists. You skeptics tend to do that. It also got equated with Flat Earth and Homeopathy. It's much more like a medical specialization, such as Dentistry. Thanks. CorticoSpinal (talk)
I'm beginning to think you should be banned from this article. ScienceApologist (talk) 14:11, 27 May 2008 (UTC)
You're on your 29th life, SA. Banned for what? Exposing the weakness in your arguments and your disruptive editing here? Aren't you already on probation? What have you contributed to chiropractic, SA? You only delete and revert here. At least I attempt to author good material CorticoSpinal (talk) 23:17, 27 May 2008 (UTC)

Focused-scope chiropractors are mixers.

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.  Summarized in: 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 – Dyn Chiropr (2003-06-02). 

"The labels we traditionally use are not always helpful. Most self-reported broad-scope practitioners are 'straight' on the issues of subluxation and adjustment, and most focused-scope chiropractors 'mix' the adjustment with other regimens and therapies," McDonald observed.

The above text is from the marginal survey reference.

This controversial edit added text about mixers to the straight section. I am puzzled. QuackGuru 06:38, 27 May 2008 (UTC)

Focused scope is straight. Broad scope= mixer. This is well established in the literature. Please do not attempt to confuse readers seeing you are confused. The edit is pretty straight forward: even straights now (contemporary) aren't so much straights as they DDx and they recommend adjunctive therapies. There's a blending happening in the US, at least. Outside the USA, there is 1 straight school and 16 mixer ones and all are in or affiliated with public universities. Straights have no choice but the go with the EBM movement otherwise legislation will leave them behind along with the mainstream of chiropractic. CorticoSpinal (talk) 06:49, 27 May 2008 (UTC)


From McDonald "While Life graduates tended to label themselves focused scope and middle scope, National graduates tended to declare themselves broad scope and middle scope." And "While the subluxation is championed by the focused-scope camp and the spectrum of services is championed by the broad-scope practitioners, the typical chiropractor is eclectic. This type of contemporary practitioner values the adjustment, yet sees no contradiction in working to gain hospital privileges." It's pretty clear in the article that McDonald differentiates and knows the difference betweens straights and mixers. CorticoSpinal (talk) 06:54, 27 May 2008 (UTC)
This controversial edit failed verification. The added text is discussing mixers and not straights.
According to the marginal survey reference: "The labels we traditionally use are not always helpful. Most self-reported broad-scope practitioners are 'straight' on the issues of subluxation and adjustment, and most focused-scope chiropractors 'mix' the adjustment with other regimens and therapies," McDonald observed. The reference clearly states focused-scope chiropractors 'mix'... QuackGuru 07:05, 27 May 2008 (UTC)
The recently added text to the straight section is describing mixers according to the reference. QuackGuru 07:20, 27 May 2008 (UTC)

The term "focused scope" (instead of "straight") is not well-established in the literature. In the scholarly literature it is used only by this particular source (McDonald et al. 2003). Chiropractic should stick with standard terminology instead of oddball terminology used only by one source. Also, Chiropractic is not the place to advise straights to go into the evidence-based camp, or to predict which way legislation will go. Eubulides (talk) 08:08, 27 May 2008 (UTC)

I agree that "focused scope" vs. "broad scope" is not a well-established term. However, that does not mean this source should not be used. Further explanation that broad scope = mixer is here"# Broad-scope chiropractors, despite being tagged by their detractors as "medically" oriented, believe the subluxation is a "significant contributing factor" in a majority of visceral ailments.
  1. Furthermore, 89% of broad-scope practitioners are opposed to having the adjustment limited to musculoskeletal conditions."DigitalC (talk) 09:25, 27 May 2008 (UTC)

QG, why would you add a failed verification tag in one edit, and then remove the allegedly unsupported text in the next edit? This is not collaborative editing. ([23] & [24]) DigitalC (talk) 09:31, 27 May 2008 (UTC)

Focused and broad scope are used commonly in the chiropractic literature as synonyms for straight and mixer respectively. I removed the failed verification tags as it was a deliberate attempt by QuackGuru to disruptive and subvert the information being presented. CorticoSpinal (talk) 14:01, 27 May 2008 (UTC)
I disagree that they are common terms. Do you have a reliable source saying otherwise? Let's stick with "straight" and "mixer", which at any rate are far more-commonly used than "focused scope" and "broad scope". Eubulides (talk) 16:59, 27 May 2008 (UTC)

Replying to DigitalC's two previous comments: I agree that McDonald et al. 2003 can be used in Chiropractic; it is already used, and is a reliable source about chiropractic opinion in North America. However, I disagree with several elements of the edit in question:

  • That edit uses argumentative language like "X is refuted in research" which is not supported by the source.
    • It's in the source.
Regardless of what the source says, "refuted" is completely PoV language. Jefffire (talk) 14:05, 27 May 2008 (UTC)
On which page number is it in the source? I see "refuted" only in the lay summary, which is not the actual source. At any rate I agree with Jefffire that the term is hopelessly POV regardless of source. The source has not "refuted" anything of the sort. Eubulides (talk) 16:59, 27 May 2008 (UTC)
  • Also, it is NPOV, since it says that straights endorse many "mixer" principles, but it does not also make the point (which is made quite strongly in the source) that mixers endorse several important "straight" principles. This is unbalanced coverage. The source's main point is that mixers are close to straights and vice versa, a point that goes two ways and not just one.
    • We can add this to mixer as well, in fact I was going to before QG, SA and OM decided to gang up again and try to remove the edit citing WP:RS. CorticoSpinal (talk) 14:01, 27 May 2008 (UTC)
  • Regardless, a controversial change like this should be discussed before being installed: but even more important than discussion is that the change should be NPOV and be supported by the cited source, which is not the case here.
    • It's not a controversial change Eubulides because you or QG say it is. The whole section of Safety, Effectiveness, cost-effectiveness and vaccination is far more controversial then adding a blurb about the straights offering up DDx. CorticoSpinal (talk) 14:01, 27 May 2008 (UTC)

Eubulides (talk) 09:48, 27 May 2008 (UTC)

      • By "controversial" I meant controversial among the editors working on Chiropractic. It is indeed controversial by that measure, as this discussion proves. Eubulides (talk) 16:59, 27 May 2008 (UTC)
        • What this discussion proves that zombie editors and anti-chiropractic skeptics are obstructing anybody who disagrees with them. The zombie editing practices of the anti-chiropractic axis of Jefffire-OrangeMarlin-ScienceApologist with sleeper cell of Filll and Arthur Rubin will be exposed. You don't have all the wikipedia admins in your back pocket. What a fucking joke this place is. CorticoSpinal (talk) 23:14, 27 May 2008 (UTC)

Blind Reversion

The biggest reason why Chiropractic article is dsyfunction is the amount of "drive by" blind reversions done by the skeptics. So far, in 24 hours, ScienceApologist, Jefffire, OrangeMarlin have all made reversions of cited material, branded it as "controversial" and have deleted cited material that is supported by the claims.

How can we ever move forward in this article if admins to not stop these kind of disruptive edits? These guys don't even participate in Talk at all and just revert. This needs to be investigated. It's complete BS. CorticoSpinal (talk) 16:40, 27 May 2008 (UTC)

Dude, when it's only your edits being reverted and they contain blatant PoV violations (eg. "refute"), you should look at your own edits. Jefffire (talk) 16:45, 27 May 2008 (UTC)
"Dude" there was no blantant POV violations if and if had a problem with the word you can change it rather than deleting the cited text. Anyways, you guys are making this quite easy. Keep up the disruptive reversions to all chiropractic related articles. The diffs are piling up. CorticoSpinal (talk) 16:52, 27 May 2008 (UTC)
The reversions were done without comment, which I disagree with. However, the reverted material was inserted without previous discussion and had real problems, as discussed in #Education draft needed work below. Let's work together on the talk page to strengthen the material, instead of getting into install/revert wars. Eubulides (talk) 16:59, 27 May 2008 (UTC)
Agree. Please put any large insertion here and discuss it before installing.--—CynRN (Talk) 18:00, 27 May 2008 (UTC)
The section that was in place was a minor tweak that is better worded and had the exact same references. Skeptics just doesn't want the world to know they're handing out Bachelors and Masters degrees of Science to chiropractors. It's good enough for the WHO to mention yet not good enough for anti-chiropractic editors here. CorticoSpinal (talk) 22:46, 27 May 2008 (UTC)
I don't quite follow the previous comment, as the change in question altered quite a bit of text (it was not a "minor tweak"). Perhaps you are talking about some previous version of Chiropractic? If so, which one, exactly?

"Further research is needed"

This change installed the text "Further research is necessary to determine the acceptable level of risk associated with both the benefits and the harms of CMT." Let's remove this sentence. First, it uses "CMT" without defining the acronym. Second, and more important, it basically just says "Further research is needed". That is not notable. Every research paper says "further research is needed". There's no particular reason to make that point here, as opposed to the many dozens of other places in Chiropractic that cite sources saying further research is needed. Eubulides (talk) 09:57, 27 May 2008 (UTC)

Totally agree. I removed the offending text. ScienceApologist (talk) 14:21, 27 May 2008 (UTC)
Here is a copy of the CONCLUSIONS: Weak to moderately strong evidence exists to support causation between CMT and VAD and associated stroke. Ultimately, the acceptable level of risk associated with a therapeutic intervention like CMT must be balanced against evidence of therapeutic efficacy. Further research, employing prospective cohort study designs, is indicated to uncover both the benefits and the harms associated with CMT.
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. 
Here is the reference. Some editors expressed an interest in the Safety section weighing in on the risk-benefit. I gave it a try.
Perhaps we can shorten it or tweak it to bring it up to Wikipedia's standard. Any thoughts for improving the Safety section? QuackGuru 15:00, 27 May 2008 (UTC)

Question: How come when a chiropractic skeptic makes want to remove a claim, SA and QG are there to bulldoze it through (with Jeffire and Orangemarlin seemingly on stand by for reversions) without any discussion, yet the same courtesy is not offered to those who disagree with Eubulides? CorticoSpinal (talk) 16:55, 27 May 2008 (UTC)

The sentence "the acceptable level of risk associated with a therapeutic intervention like CMT must be balanced against evidence of therapeutic efficacy" might be useful to source the introduction to a new Risk-benefit section. Otherwise I don't see the use of the other quoted sentences in that source. Eubulides (talk) 16:59, 27 May 2008 (UTC)

even more controversial edits

This controversial change added controversial material and moved text out of the cost-benefit section. I do not see any consensus for this. QuackGuru 17:56, 27 May 2008 (UTC)

There is no consensus for the version from which it was changed. In essence, the edits that made and continue to restore that version are controversial. At least the logic behind grouping "Risk vs. Benefit" with Safety actually makes sense; whereas putting a statement about Risk vs. Benefit in the Cost-Benefit makes little to no sense. -- Levine2112 discuss 18:00, 27 May 2008 (UTC)
It is inappropriate to claim anything has consensus at this point. False claims of consensus should be stopped. We have page protection now, so we can discuss what should and should not be changed after protection is removed on the 30th of May. ScienceApologist (talk) 18:04, 27 May 2008 (UTC)
This controversial change moved material out of the cost-benefit section without any consensus. QuackGuru 18:04, 27 May 2008 (UTC)
QuackGuru, please desist from calling every single edit controversial that does not fit with your POV. Critique the source and stop reverting. Your deletionist editing style and red herring attacks are pushing this over the edge. Please stop. Thanks. CorticoSpinal (talk) 18:44, 27 May 2008 (UTC)

Independent Studies of Chiropractic

Most commentaries regarding chiropractic (pro and con) come from sources with a distinct bias, and therefore their interpretations of existing data tend to conform to their preexisting opinions. That would be the case with this article, and with the article published with this one by Homola. The most objective evaluations of chiropractic would be expected to come from independent sources if they have no vested interests, but rather simply have a need to know. There have been two such major studies done by the governments of two nations seeking to determine whether it would be in the best interests of their citizens to include chiropractic in their systems of socialized health care.6,28

The first one was done in New Zealand more than 25 years ago.6 After a lengthy, exhaustive inquiry, a comprehensive 377-page report was compiled that listed many findings including the following quotes that were taken from the Summary of Principle Findings: 1. Spinal manual therapy in the hands of a registered chiropractor is safe. 2. The education and training of a registered chiropractor are sufficient to enable him to determine whether there are contra-indications to spinal manual therapy in a particular case, and whether the patient should have medical care instead of or as well as chiropractic care. 3. Spinal manual therapy can be effective in relieving musculoskeletal symptoms such as back pain, and other symptoms known to respond to such therapy, such as migraine. 4. Chiropractors should, in the public interest, be accepted as partners in the general health care system. No other health professional is as well qualified by his general training to carry out a diagnosis for spinal mechanical dysfunction or to perform spinal manual therapy.

The other independent study was done by the government of Ontario for which a group of health economists was commissioned to study chiropractic management of low back pain (LBP).28 The following quotes were taken from the Executive Summary of their findings: 1. On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP. Many medical therapies are of questionable validity or are clearly inadequate. 2. There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low-back pain. 3. There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management. We reviewed numerous studies that range from very persuasive to convincing in support of this conclusion. The lack of any convincing argument or evidence to the contrary must be noted and is significant to us in forming our conclusions and recommendations. The evidence includes studies showing lower chiropractic costs for the same diagnosis and episodic need for care. 4. There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management. Patient satisfaction is an important health outcome indicator and adds further weight to the clinical and health economic results favoring chiropractic management of LBP. 5. Despite official medical disapproval and economic disincentive to patients (higher private out-of-pocket cost), the use of chiropractic has grown steadily over the years. Chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians. CorticoSpinal 21:53, May 22, 2008

Yes, the NZ report is rebutted by the US government! (Reply to edit summary)
  • New Zealand report not "trustworthy"
  • A review of the New Zealand report prepared by the United States Congress' Office of Technology Assessment found "'serious problems' in the Report's treatment of safety and efficacy issues..... It concluded .... that the New Zealand Report's review of the safety issue was 'unsatisfactory.'...In light of this thorough and well-considered appraisal of the New Zealand Report, with which I agree, I do not find the Report's conclusions trustworthy. The request for admission for the purposes of showing the truth of the matter asserted is therefore denied." [25]
The judge in the Wilks case wasn't happy with the NZ Report. -- Fyslee / talk 05:19, 23 May 2008 (UTC)
  • The rebuttal is fair game too, of course. We can either include both or neither. To your knowledge has any government rebutted Manga besides Tardif? CorticoSpinal (talk) 05:37, 23 May 2008 (UTC)

Several independent studies have been done in Europe, as part of national practice guidelines for low back pain. Five of them are reviewed in Murphy et al. 2006 (PMID 16949948). We should be using reliable reviews like this rather than doing the research ourselves. The Manga report is so dated now that we shouldn't be citing it anywhere outside the History section. Eubulides (talk) 09:03, 23 May 2008 (UTC)

I wasn't suggesting we add the text per se; that exerpt is taken from DeVocht, 2006. I was wondering more if anyone found anything useful for any section from that exerpt. If not, we can junk it. Manga could easily fit into cost-effectiveness/effectiveness as well as it was a landmark study. We just need to attribute it to 1994. CorticoSpinal (talk) 16:40, 23 May 2008 (UTC)
The obsolete Manga report has only historical impact and is already mentioned in the history section. See the movement towards science section. We should not add the Manga report to argue with newer references in the cost-benefit section. See WP:MEDRS. QuackGuru 17:10, 23 May 2008 (UTC)
I don't understand why the Manga report is considered obselete when it is still being cited by scientific papers (and yet we can't cite it). [26], [27], [28], [29], [30], [31], [32], [33], [34] ALL cited Manga between 2000 and 2006.DigitalC (talk) 00:58, 25 May 2008 (UTC)
  • The first citation you mention (Bronfort et al. 2004) criticises the Manga report, saying its "conclusion is almost exclusively based on analysis of retrospective and nonrandomized studies, which do not allow conclusions about clinical effectiveness."
  • The 3rd citation is a URL that does not work for me.
  • The 6th citation (Dagenais & Haldeman 2002, doi:10.1016/S0095-4543(01)00005-7 ) says of Manga and similar reports: "A detailed analysis of this literature by Baldwin et al., however, has revealed many methodologic flaws in this literature and concludes that these studies fail to clarify whether medical or chiropractic care is more cost-effective."
  • The 7th citation (Oakley et al. 2005, PMID 17549209) primarily refers to politics, not to effectiveness. It says "Since 1975, the chiropractic profession has enjoyed improved political support in a number of countries due to some published analyses favorable to chiropractic care." and cites Manga among 4 other studies.
  • The other citations are all primary studies, not reviews of Manga et al.
Given all the above, it appears that the scientific reviews of the Manga report were unfavorable, and that we should not be relying on its results in the scientific investigation section. It would be reasonable to talk about Manga with respect to the historical politics of chiropractic, though, so coverage in Chiropractic #History would be reasonable (although it should be noted even there that the Manga report does not represent scientific consensus). Eubulides (talk) 07:34, 25 May 2008 (UTC)
The original Manga report is obsolete when newer references discuss the Manga report. We are currently using newer references that describe the Manga report in historical terms in the movement towards science section. QuackGuru 02:28, 25 May 2008 (UTC)
DigitalC makes a good point, but I tend to like to include everything, pro and con. I really feel that if we do, we are more likely to reach a stable GA article status, because every chiro that reads this article is going to ask the same question. -- Dēmatt (chat) 06:28, 25 May 2008 (UTC)
Perhaps chiros would be satisfied if we include some of the citations above, explaining why the Manga report's results have been so questioned? Eubulides (talk) 07:34, 25 May 2008 (UTC)
Manga is flawed and biased. Dr. Manga was a 'satisfied chiropractic patient'. He used ancient studies as old as from 1930. They were not RCTs. He discounted large studies with results he didn't like in favor of small ones with favorable results. Eubulides provided links to critiques of Manga a few thousand words ago.--—CynRN (Talk) 03:17, 28 May 2008 (UTC)

POV issues as of 2008-05-25

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 19 #POV issues as of 2008-05-03, and reflects changes made to the article since 2008-05-03 as well as discussion since then and some other POV problems I noticed recently. Comments welcome; please make them in #Comments on 2008-05-25 issues list below. I would like to strike out items as they are addressed. Thanks. Eubulides (talk) 07:34, 25 May 2008 (UTC)

2008-05-25 issues list

  1. 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.
  2. 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.
  3. Chiropractic #Safety is backed by reliable reviews, except for its concluding sentence "The benefits of chiropractic care for neck pain seems to outweigh the potential risks.", which is backed only by a primary source. The primary source in question is too new to have been reviewed, but the text should highlight that it's a single primary study, e.g., "A 2007 Dutch study found that the the benefits of chiropractic care for neck pain seem to outweigh the potential risks." But there's another problem: this sentence seemingly contradicts the following statement in Chiropractic #Cost-benefit: "When compared with treatment options such as physiotherapeutic exercise (also performed by a chiropractor), the risk-benefit balance does not favor SMT." These two sentences should be placed next to each other (I suggest in Chiropractic #Cost-benefit) and the wording clarified to make this issue clearer. As things stand the reader of Chiropractic #Safety might reasonably conclude that there's no contoversy whether benefits outweigh risks here. (This example illustrates some of the dangers of our mentioning primary studies ourselves.)

Eubulides (talk) 07:34, 25 May 2008 (UTC)

Which editor here removed and censored my edit adding to the list of POV issues]. I propose an immediate block for the editor who has done so, this is completely ridiculous now the downright disruptiveness and dirty tactics used by the anti-chiropractic editors. Again, why were my additions to the POV list deleted without any consent, discussion, explanation. Is this normal editing practices? I mean, can the anti-chiropractic brigade really get away with absolutely everything including deleting talk page comments of other editors? CorticoSpinal (talk) 05:00, 28 May 2008 (UTC)
Nothing was removed or censored. The problem was that your edit moved my signature into a single bullet item, and put your signature at the bottom of the entire list of items; this caused the resulting talk page section to look like you wrote the whole list of items (and that I contributed just one of the items). The usual etiquette in Wikipedia talk pages is to avoid inserting commentary in such a way that the authorship of others' comments becomes unclear. I naturally assumed you did not intend to create any such confusion, so in my next comment I repaired my signature to the way that it looked before, and moved your added commentary into a section of its own; this approach avoided the confusion in question. I suggest that you add comments after other people's comments (where signatures are part of the comments, of course); that will avoid similar confusion in the future. Eubulides (talk) 09:05, 28 May 2008 (UTC)

Comments on 2008-05-25 issues list

I made this change to help organize things. QuackGuru 08:28, 25 May 2008 (UTC)

I agree with the first and the last POV-issues. The middle issue is a bit more confusing. Just because 69% of DC disagree doesn't mean that the categorization of Chiropractic as CAM is controversial. We are under the obligation to describe things as verifiably, neutrally, and reliably as possible. Most health insurance companies consider chiropractic to be CAM. Most mainstream doctors consider chiropractic to be CAM. I'm pretty sure it's fairly straightforward to find sources for these facts. If most reliable, verifiable sources view chiropractic this way, then Wikipedia should not shy from using the designation. After all, Wikipedia is not the place to right great wrongs. ScienceApologist (talk) 15:42, 25 May 2008 (UTC)
I think we can mention it the utilization and satisfaction rates section about CAM versus integrated medicine chiropractic beliefs. Perhaps this would resolve this issue. QuackGuru 17:47, 25 May 2008 (UTC)
An IP made controversial changes in mainspace again. I recommend it be reverted. QuackGuru 17:47, 25 May 2008 (UTC)
I made this change to describe the CAM versus integrated medicine beliefs. QuackGuru 18:40, 25 May 2008 (UTC)
I made this change to focus the conversation on medical opposition. QuackGuru 19:19, 25 May 2008 (UTC)

With regards to Eubulides' issue number 3 above, I agree with noting it as a study and not a review, however, it makes far greater sense to include this information in the "Safety" section as this is a about "Risk vs. Benefit" and has nothing to do with "Cost". -- Levine2112 discuss 19:13, 25 May 2008 (UTC)

The "Risk vs. Benefit" and has has to to do with "Cost-Benefit." The section is about costs as well as benefits. QuackGuru 19:19, 25 May 2008 (UTC)
Not sure what the poorly worded response above means, but I think I understand the gist. My question is: What does this study have to do with "Cost"? The answer: Nothing. The Cost-Benefit section is about weighing the financial cost of chiropractic care versus benefit. Whereas the "Safety" section is about safety (aka Risk) and presumably should weigh "Risk vs. Benefit"; hence the study is clearly more properly apropos under "Safety" than "Cost-Benefit". -- Levine2112 discuss 19:26, 25 May 2008 (UTC)
We do not have a section called "Cost" or "Risk." The section is titled Cost-benefit. That said, the section is about the cost-effectiveness as well as the risk-benefit. QuackGuru 19:39, 25 May 2008 (UTC)
I think we all would agree that "Risk" is more akin to "Safety" than it is to "Cost". Does anyone disagree? -- Levine2112 discuss 21:33, 25 May 2008 (UTC)
I think we do not have a section called "Cost". The cost-benefit section is also about risk-benefit. QuackGuru 03:04, 26 May 2008 (UTC)
No, the cost-benefit section is about cost-benefit, not risk-benefit. The cost-benefit section should be about cost-effectiveness, and the respective text should be in the risk section.DigitalC (talk) 07:12, 26 May 2008 (UTC)
The cost-benefit section covers two topics. Cost-effectiveness as well as risk-benefit (Cost-benefit). QuackGuru 07:24, 26 May 2008 (UTC)
If editors want I could add a small blurp about risk-benefit to the Safety section but we should do this using a higher quality source per WP:MEDRS. I will review all the refs and do my best to address the concerns. QuackGuru 08:35, 26 May 2008 (UTC)
  • We could add a brief Risk-benefit section.
  • The primary study in question (Rubinstein et al. 2007, PMID 17693331) is a dubious source for the claim that "the benefits of chiropractic care for neck pain seem to outweigh the potential risks". First, the study had no control group, so it did not measure either the benefits or the adverse effects of chiropractic care alone; instead, it was measuring the combination of chiropractic care and natural history. For all we can tell from that study, it could be that chiropractic care has negative benefits (compared to no treatment) and positive risks (again, compared to no treatment). Second, the study had no benefits-risk model, that is, it did not even attempt to quantify the value of the benefits versus the value of the risks; and therefore its data cannot be used to support any claim that benefits "outweigh" risks. The simplest way to fix this problem is to remove the unwarranted claim that the benefits outweigh the risks. (And this illustrates the problems I see with citing primary sources in the absence of reliable reviews.) Eubulides (talk) 08:08, 27 May 2008 (UTC)
This is again flawed logic. You are violating WP:OR as you are making your personal opinion override the stated claim. Remember not to argue with experts? You said that. You should stick to it too. Unless there is a rebuttal in the literature somewhere then your personal interpretation is not valid for disqualifying the study. Thanks. CorticoSpinal (talk) 05:06, 28 May 2008 (UTC)
It is not flawed logic to look at a primary study carefully. After all, primary studies about chiropractic are a dime a dozen, and one can easily find a primary study giving just the opposite impression to this one about risks and benefits. This particular primary study, like many primary studies about chiropractic, is of low quality, because it has no controls and it does not have any measures of the weights of risks versus benefits. For that reason we should be extremely careful about mentioning it in Chiropractic, if we mention it at all; the current mention is obviously not careful enough. Eubulides (talk) 09:05, 28 May 2008 (UTC)
I thought you held the belief that we should not be questioning the researchers? Regardless, this is about placement, and I have not seen a good argument about keeping the statement in the entirely unrelated "Cost-Benefit" section. Certainly we can all agree that "Risk-Benefit" is more akin to "Safety" than to "Cost-Benefit". -- Levine2112 discuss 17:38, 27 May 2008 (UTC)
My comments were not about the researchers; they were about the study in question. It is not clear that risk-benefit is closer to safety than to cost-benefit. Chiropractic #Safety does not talk about benefits at all (by design), whereas Chiropractic #Cost-benefit does compare downsides to benefits. It could be that the match to "compares downsides to benefits" is closer than the match between risk and safety. At any rate, putting this stuff in a new Risk-benefit section would address the issue. Eubulides (talk) 20:52, 27 May 2008 (UTC)

This controversial change added an old reference when newer references are available. In fact, the previous sentence has a 2008 ref covering the same topic. 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.  Per WP:MEDRS, the dated 2003 ref should be deleted. QuackGuru 03:33, 26 May 2008 (UTC)

I reverted that good-faith change, as I agree with you that the previous sentence uses a much newer reference covering the same topic.DigitalC (talk) 07:18, 26 May 2008 (UTC)
I agree with the removal of the dated material.[35]. QuackGuru 07:24, 26 May 2008 (UTC)
I started new sections below to help focus the discussion. QuackGuru 22:22, 26 May 2008 (UTC)

Chiropractic#Safety

Editors have expressed some interest in adding a tidbit about risk-benefit to the Safety section. At the moment, I am reviewing all the references in the Safety section. QuackGuru 22:22, 26 May 2008 (UTC)

Croft AC, D'Antoni AV (2008). "Chiropractic manipulation: reasons for concern?". Clin Neurol Neurosurg 110 (4): 422-3. doi:10.1016/j.clineuro.2007.12.014. PMID 18242824.  Has anyone read this 2008 study? Maybe we can use it. QuackGuru 03:05, 27 May 2008 (UTC)

I've read it. It's not a study; it's just a letter to the editor. I don't think it's directly useful for Chiropractic, though some of its citations may be useful. It comments on Gouveia et al. 2007 (PMID 17904731), a primary study which is too new to be the subject of any of our reviews. (I would not favor citing that primary study, unless we start adding other primary studies to the scientific-investigation section, which is something I would not favor either, as we have plenty of reliable reviews). Eubulides (talk) 08:08, 27 May 2008 (UTC)

Chiropractic#Medical opposition

http://en.citizendium.org/wiki/Chiropractic http://en.citizendium.org/wiki/Critical_views_of_chiropractic

Here are related wiki articles that may help give us some ideas on improving the Medical opposition section of this article. Thoughts? QuackGuru 22:22, 26 May 2008 (UTC)

Other POV issues

  1. [[Chiropractic #Safety] Innacurately cherry picks the evidence, does not discuss relative risk compared to NSAIDs, surgery or other treatments used for mechanical spinal disorders and strikes a fear mongering tone by not addressing the benefits and effectiveness (clinical and cost)
  2. The research and POV of Edzard Ernst has been used in a civil POV push. Ernst'research and conclusions on SMT and chiropractic care, which have been rebuked by his colleagues and other mainstream health professinals, and go against majority consensus in the literature. It's being used to subvert the efficacy, cost-effectiveness and safety of chiropractic care. A misleading argument that "Ernst is not being presented enough" is also being promoted which completely exacerbates the problem.
  3. Chiropractic #Efficacy is a synthesis and mixture of SMT and chiropractic care. Chiropractic specific references should be used as already agreed upon by the majority of editors. Ernst is again being used to subvert mainstream opinion (chiropractic care is just as if not more effective, safe and cost-effectiveness for LBP and that patients overwhelmingly prefer chiropractic management for LBP in comparison to standard medical care. This is the most succint way to put it. An editor here has used Ernst to undermine the mainstream consensus and has cherry picked reviews (which is in violation of WP:OR to warp the mainstream scientific and independent 3rd party consensus.
  4. Research is not at all specific to chiropractic care, and ignores every major research milestone in the history of the profession.
  5. Chiropractic #History seems to want to discredit Palmer from the start, focus all on subluxations and does not make any account to anything other than controversy.

CorticoSpinal (talk) 06:29, 27 May 2008 (UTC)

  • It would be helpful to discuss relative risk, if we can find reliable sources on that topic, preferably reliable reviews. We can't discuss the topic without reliable sources.
  • Ernst goes against consensus in the chiropractic mainstream, but that's not the same thing as going against mainstream consensus overall. Ernst represents an important part of the medical mainstream. These critical views of chiropractic should be covered fairly and neutrally.
  • Chiropractic#Effectiveness relies heavily on reliable reviews published in referred scientific journals. These reviews do synthesize work on chiropractic care and SMT, but that is standard practice in evidence-based reviews of chiropractic these days, and it is not synthesis for Chiropractic to report what the experts are saying.
  • The first two sentences of Chiropractic #History are complimentary to Palmer.
  • I agree that much of Chiropractic#Vertebral subluxation is misplaced. It does not belong in Chiropractic #History. Most of that section (and all of the long paragraph at the end) has nothing to with history. I suggest moving this subsection to Chiropractic #Philosophy, where it fits much better.
  • Chiropractic #History does not overly emphasize controversy. On the contrary: if anything it currently plays the controversy down, and this makes it boring compared to what it could be. Compare Chiropractic history, which devotes a higher percentage of its content to controveries. Chiropractic history has been dominated by controversy.

Eubulides (talk) 08:08, 27 May 2008 (UTC)

A qucik note on #4 on the list above:

  • "The benefits of chiropractic care for neck pain seems to outweigh the potential risks.", which is backed only by a primary source. The primary source in question is too new to have been reviewed, but the text should highlight that it's a single primary study, e.g., "A 2007 Dutch study found that the the benefits of chiropractic care for neck pain seem to outweigh the potential risks." But there's another problem: this sentence seemingly contradicts the following statement in Chiropractic #Cost-benefit: "When compared with treatment options such as physiotherapeutic exercise (also performed by a chiropractor), the risk-benefit balance does not favor SMT."
I see no problem; the first sentence says "chiropractic care". The second sentence says "SMT" and even modifies it to be "performed by a chiropractor". This suggests (accurately) that, while chiropractic care sometimes includes SMT, SMT <> chiropractic care. I have no trouble with attributing the source, but the same holds true for the gander.
I am also concerned that while eradicating statments that appeared POV to some, we are left with other unbalanced POV statments. As chiropractic is a complicated POV subject, we will not likely get one NPOV statement. The only solution will be to balance the POV statements. IOWs, criteria for removal of the POV tag for Eubilides may mean return of the tag for CorticoSpinal. The only solution will be to allow each their due balanced in a fair and neutral way. -- Dēmatt (chat) 15:24, 27 May 2008 (UTC)
I assume by "#4 on the list above" you mean #3 in #2008-05-25 issues list? I agree about the distinction between chiropractic care and SMT. However, it's still a problem that the two sentences were planted in different sections with no care taken to clarify the confusion. By the way, I see further problems with that particular primary source, which I don't have time to go into now (I haven't yet had time to read the source carefully, and I indeed that no editor here has actually read the source), but intend to do so later. This is another problem with citing primary sources: it's really much better to rely on reviews! Eubulides (talk) 16:59, 27 May 2008 (UTC)

Wording in lead

This wording doesn't make sense: "Chiropractic's greatest contribution to health care may be its patient-physician relationship which is done by hand" How can a relationship be done by hand? Change to '...patient-physician relationship and hands-on treatment.'--—CynRN (Talk) 16:19, 26 May 2008 (UTC)

I made this change to improve the sentence. QuackGuru 16:33, 26 May 2008 (UTC)
Much better, thanks.--—CynRN (Talk) 16:40, 26 May 2008 (UTC)

By the way: I was asked to comment on what's going on at this page and have put some comments here: (diff) (talk) (archive). When participating at this page, I don't expect to express my personal views (if any) about chiropractic but will strive to edit according to NPOV based on the sources, even if that sometimes means putting in material I disagree with or removing material I agree with. I've been participating in discussion at User talk:Raul654/Civil POV pushing and have previously participated at pages I arrived at via Mediation Cabal, and a large part of my purpose in participating here is to try to help resolve disputes. (I hope this post is not taking up too much space with meta-discussion.) ☺ Coppertwig (talk) 01:53, 27 May 2008 (UTC)

Coppertwig, I value very much your contributions here at Chiropractic and felt that your previous participation here led to major improvements in the article. I'm looking forward to working with you again here. My biggest concern with the article, at the moment is the civil POV of Edzard Ernst and how his flawed and biased reviews are being used 'neutrally' to subvert the mainstream consensus on critical topics such as effectiveness, safety, cost-effectiveness and scientific research. What is occuring here is misuse of research to advance a fringe viewpoint upon the majority. The difference is, Edzard Ernst, who is being presented as the mainstream viewpoint research goes againt the vast majority of research over the last 25 years. This is despite the fact thatthe Ernst secondary sources have been refuted and invalidated, with severe methodological flaws and heavy bias Then, at a clear gaming of the system, uses WP:MEDRS as a defense to prevent the inclusion of primary studies that are more academically robust, come from multidisciplinary colloboration (hence consensus and no particular bias) under the wikilawyering guise of "reaching down". I propose we investigate the use or rather misuse of Edzard Ernst here at chiropractic in a civil POV push. I believe this at the core of the last 4 months of dysfunction. CorticoSpinal (talk) 03:37, 27 May 2008 (UTC)
The consensus on Wikipedia is that Ernst is WP:NPOV and WP:RS despite the reservations. For example, see the homeopathy article. QuackGuru 03:48, 27 May 2008 (UTC)
I agree. Ernst is an excellent source. I don't know what is "flawed" or "biased" about his reviews of subjects other than the fact that he sticks to reality rather than fantasy. ScienceApologist (talk) 05:08, 27 May 2008 (UTC)
I disagree. Ernst is a biased POV source, and flaws in his methodology have been pointed out via WP:RS on this page. If you "don't know what is 'flawed' or 'biased' about his reviews", then perhaps you may wish to read those sources if you have not already.DigitalC (talk) 05:28, 27 May 2008 (UTC)
Ernst is one of the most NPOV sources available. Ernst reviews are highly relevant and on target. QuackGuru 05:41, 27 May 2008 (UTC)
I await a source that criticizes Ernst who is not themselves being criticized by Ernst. The reliability of Ernst is that he is a third-party who does not derive his profession from the alternative medicine world. Those who criticize Ernst have an obvious incentive to misappropriate and malign him. Attacking the reliability of Ernst is a non-starter. If the alternative medicine fans here disagree, they should take it up on WP:RSN and get a consensus of outside opinion that Ernst is "unreliable". Until such time, this conversation should be tabled as pointless character asssassination and sour grapes. ScienceApologist (talk) 05:52, 27 May 2008 (UTC)
If you're hanging your hat on that rationale this shall be a quick and embarassing exit for the skeptics. You do realize that tertiary sources, leading national health agencies, 3rd party payers, and mainstream opinion disagree with the conclusions of Edzard Ernst re: SMT and chiropractic care don't you? QG, Ernst is NPOV? Please explain. Thanks. CorticoSpinal (talk) 07:07, 27 May 2008 (UTC)
Certainly there are chiropractic sources that explicitly criticize some of Ernst's work. A leading example of this is Bronfort et al. 2008 (PMID 18164469), whose criticism of Ernst's work is discussed and cited in Chiropractic# Effectiveness. However, I am not aware of any "national health agencies, 3rd party payers, and mainstream opinion" that directly criticize Ernst's work. Can you please supply some? It would strengthen Chiropractic if we could cite those sources, instead of merely citing Bronfort et al. Thanks. Eubulides (talk) 08:08, 27 May 2008 (UTC)
The reliability of Ernst' conclusions on SMT and chiropractic are in doubt because they disagree with mainstream consensus on the issue. They don't criticize Ernst per se; but the national health agencies, 3rd party payers, tertiarty sources, the World Health Organization and mainstream research opinion on chiropractic care and smt disagrees with his conclusions. Any attempt to 'cite' these sources have been rebuffed by yourself because of wikilawyering and claiming that if it wasn't expliciity a 'secondary source'. You should not play so coy. You've been doing this for 4 months now, Eubulides. Except, over time your civil POV push for Ernst representing the mainstream opinion has been exposed as a farce. Ernst's specific conclusions on SMT and chiropractic care doesn't represent the mainstream and it is in itself the fringe viewpoint which is being passed off as the majority one. That is so underhanded and I'll called you on it since day 1 but you have ignored every concern brought to you regarding the misuse of Ernst, the cherry picking of sources (aka mining papers) to promote the fringe viewpoint that is Ernst's conclusions at the expense of the mainstream consensus (safe, effective, cost effective). Shame on you. CorticoSpinal (talk) 05:22, 28 May 2008 (UTC)
  • Ernst etc.'s conclusions do not disagree with mainstream consensus. They disagree with mainstream chiropractic, which is not the same as mainstream in general.
  • Some national health agencies do not recommend chiropractic; others do. There is not a mainstream consensus in this area. And national health agencies' opinions have changed with time, not always in a direction favorable to chiropractic. See, for example, Murphy et al. 2006 (PMID 16949948).
  • Chiropractic #Scientific investigation cites both the WHO guidelines and mainstream chiropractic opinion, at some length. This hardly constitutes a "rebuff" of these sources.
  • There is nothing underhanded about citing reliable mainstream reviews such as Ernst. Obviously Ernst is a critic of chiropractic, but all citations to his work are fairly balanced by citations to works that are supportive of chiropractic.
Eubulides (talk) 09:05, 28 May 2008 (UTC)

Dispute

Please discuss the edits below this line. Thanks, PeterSymonds (talk) 18:00, 27 May 2008 (UTC)

Driveby Reverts

Since January 08 I have noticed important trends used by the anti-chiropractic editors here. It would be important to list those who have disrupted progression of the article by doing "drive by" or blind reverts. The overwhelming majority of these users do not participate in the Talk discussions. So, in essence, they are reverting blindly. All the aforementioned users revert to material exclusively to drafts by QuackGuru or Eubulides. So, these users are potentially defacto meat puppets or zombie editors at Chiropractic who potentially game the system by engaging in covert edit wars to try and bulldoze edits that fit the anti-chiropractic agenda. These include deleting sourced material that meets inclusion criteria.

For example, I made 5 edits yesterday, all of which were reverted within minutes by either QuackGuru, ScienceApologist or Orangemarlin. Essentially, I cannot edit this article as every one of my edits is being censored despite the fact that I had used reliable sources and had added material that conforms to wikipedia NPOV.

So, we have a situation here whereby the anti-chiropractic editors and the zombie sleeper crew bulldoze edits they favour that are being actively discussed on Talk (i.e. consensus has yet to be achieved) and delete material that they do not like. It's a double standard. It's uncivil. It's got to stop. We need an investigation into this matter. CorticoSpinal (talk) 20:24, 27 May 2008 (UTC)

  • I also dislike the widespread use of reverts and have protested against them (see #Several important changes were never discussed and #Mass edits made by QuackGuru, which complain about blind reverts done by skeptics), as has QuackGuru (see #reference improvements, which complains about blind reverts done by proponents of chiropractic). Blind reverts are being done by both sides, and we should strive to avoid them.
  • That being said, the edits made yesterday were neither NPOV nor well-sourced. They had problems in both areas, as discussed in #Education draft needed work above. It's much better to draft a new version on the talk page and then discuss it, rather than simply install it without discussion. Doing that will help to avoid revert wars in the future.
Eubulides (talk) 20:52, 27 May 2008 (UTC)
This is patently untrue. Prove to me the edits were NPOV. Even Fyslee agreed with focused scope edit and he's a skeptic. Blind reverts are NOT being done by both sides. Prove to me that this is happening both ways, blindly. Editors who participate at Talk on an ongoing basis are not blindly doing anything. You are misleading others yet again. It might be time for a RfC, I have enough evidence now of your repeated misleading statements and your refusal to acknowledge concerns. This is uncivil. You don't walk on water, Eubulides... CorticoSpinal (talk) 23:10, 27 May 2008 (UTC)
  • Fyslee did not agree with the terminology "focused scope". It is nonstandard terminology used in only one source. It is not "well established".
  • NPOVness is not something that admits to formal proof. However, there were NPOV problems with the edits: please see #Disruptive editing (blind reversion) by Orangemarlin yet again. and search for "POV".
  • Certainly blind reverts were done by both sides.
  • Here is one by ScienceApologist (a critic of chiropractic) which removed this harmless reference fix (among other harmless fixes).
  • Here is one by Levine2112 (a proponent of chiropractic) which removed the reference improvements from this fix.
Eubulides (talk) 09:05, 28 May 2008 (UTC)
Does anyone have a policy or guideline reference for "blind reverts"? ScienceApologist (talk) 21:34, 27 May 2008 (UTC)
Yes, of course. And also here. Now that you know that these policies/guidelines exist and that we are dealing with a controversial article, will you please abide by our agreement to discuss all major changes first and work to establish a consensus? -- Levine2112 discuss 21:40, 27 May 2008 (UTC)
Those policies/guidelines do not discuss blind reverts. They do discuss the problem of making major changes without discussion, saying these can lead to reverts; but that is not the same thing as discussing blind reverts per se. Help:Reverting does suggest to "reword, rather than reverting", which is good advice, but it is neither policy nor guideline. Eubulides (talk) 21:56, 27 May 2008 (UTC)
So you are endorsing the blind reversions by Filll, Orangemarlin and ScienceApologist? CorticoSpinal (talk) 23:06, 27 May 2008 (UTC)
I would say that "the problem of making major changes without discussion" is the very definition of "blind reverting". -- Levine2112 discuss 00:19, 28 May 2008 (UTC)

I would encourage those who like to use this terminology to try to get it included in policy/guidelines somewhere before continuing to use it. ScienceApologist (talk) 22:00, 27 May 2008 (UTC)

Either way, its disruptive. SA, you're treading on thin ice. You have conditions on your probation. You've broken several of them already in the last 24 hrs here at Chiropractic including edit warring, blind reverting, harrassing editors with spam on their talk page, claiming false consensus. Either way it's unacceptable. CorticoSpinal (talk) 23:06, 27 May 2008 (UTC)

Note. Arguments about whether or not "blind reverting", as so phrased, is prohibited by policy are besides the point and unhelful. The behavior itself is prohibited by the edit warring policy in the very first sentence of the lede: "Edit warring occurs when individual editors or groups of editors repeatedly revert content edits to a page or subject area." Further disruption of this sort from either "side" will not be tolerated. If you are reverting or be reverted, I strongly recommend taking the advice of WP:BRD. I also strongly recommend that the disputing parties take the time afforded by the protection to focus on discussion and draft building, rather than arguing (somewhat disruptively) about minutiae, exact wording or blame assignment. Vassyana (talk) 07:38, 28 May 2008 (UTC)

The behavior itself is prohibited by the edit warring policy in the very first sentence of the lede: "Edit warring occurs when individual editors or groups of editors repeatedly revert content edits to a page or subject area.": This isn't quite correct: some people have made only one revert and have been accused of "blind reverting". In any case, the gist of what you are saying is fine, but there is a tendency for some people to take certain parts of WP:BRD to heart and not others. For example, they think that they should revert any revert when they disagree with it without talking about it. Others find this behavior distressing and revert the revert of the revert with the excuse that there was no discussion. The point is that if people would simply be less accusatory and more willing to discuss matters, things would settle down almost immediately. So I move to table all mention of specific editing patterns on the article talk pages and simply stick to discussing what content is agreeable and what content isn't. ScienceApologist (talk) 21:57, 28 May 2008 (UTC)

Edzard Ernst/Scott Haldeman

Just to get this out of the way so there's no misrepresentation of my views (as frequently done by certain chiro-skeptic editors)

Edzard Ernsts' biased and flawed secondary source reviews on SMT and chiropractic can be used here at Chiropractic That is not in dispute.

Issues

  • Breaking the spirit of WP:MEDRS and using it as a tool to:

a)Promote the viewpoint (and conclusions) of vocal critic Edzard Ernst despite serious methodological flaws and strong evidence of bias while b)not promoting the viewpoint (and conclusions) by neurologist/chiropractor Scott Haldeman c) To game the system and misrepresent the argument of dissenting editors in a straw man like manner using "reaching down" as a way to invalidate the views of the opposing party.

There are claims that Ernst POV is not presented in Chiropractic. Here are all the instances and where Ernst is used currently in the article

  • SMT is a passive manual maneuver during which a three-joint complex is taken past the normal physiological range of movement without exceeding the anatomical boundary limit.[94]
  • The data indicates that SMT typically represents an additional cost to conventional treatment.[121]
  • Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults[113]
  • 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.[113]
  • After initial therapy, preliminary evidence suggests that massage but not spinal manipulation may reduce the costs of care.[123] When compared with treatment options such as physiotherapeutic exercise, the risk-benefit balance does not favor SMT.[
  • SMT being passed off for chiropractic care (its in the safety section): Although most contraindications apply only to manipulation of the affected region, some neurological signs indicate referral to emergency medical services; these include sudden and severe headache or neck pain unlike that previously experienced.[112]


Yet Eubulides insists that the editors here are "not being fair" to Ernst. To wit:


“ If anything, this is being unfair to Ernst; it's not the sort of treatment that any other source is being given here. Given all this context, it's not out of line to let Ernst briefly have his say. ”

Eubulides (talk) 02:16, 21 May 2008 (UTC)

Does it look like Ernst hasn't already had his "brief say" despite the fact that his reviews are from a research methods POV, "pure shit?" Despite all of the above you still want more Ernst inclusions! All the while denying the use of the opinion of the expert in chiropractic care, SMT, SMT/neurological accidents, effectiveness of the experts whose primary study has never been rebuked and invalidated like Ernst.

“ 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) ”

Eubulides has argued against the inclusion of Haldeman, Cassidy, Cote and other expert researchers who dispute the conclusions of Ernst simply because "its a primary study" and that would "be reaching down". Actually, I think the case is that Eubulides "reached up" and advocates the use of flawed reviews (invalidates the conclusions) by Ernst all the while preventing the inclusion of robust primary sources that have none of the intrisic weaknesses in research design, but also none of the fringe views that Ernst advocates. His views are clearly fringe (i.e. not mainstream). His POV on safety, efficacy and cost effectiveness go directly against the majority of research that demonstrates SMT and chiropractic care is safe, effective and cost effectiveness. There's no amount of spinning he can do to change this fact. As a reminder, here is a brief inclusion of some sources that openly rebuke Edzard Ernsts studies citing severe bias, poor methodology and invalid conclusions:

Evidence of Bias and Methodological and critical flaws that invalidate the conclusions drawn by Ernst and Ernst-Cantor:

Evidence of bias by Ernst:


Yet, under WP:MEDRS guideline he insists that the studies on SMT and chiropractic care done by Edzard Ernst are not biased and is a "strong, reliable secondary source". According to Eubulides, we "shouldn't reach down into primary sources". Essentially, Eubulides has argued that (a) Edzard Ernst POV is not represented enough in the article and (b) his reviews cannot be refuted by Scott Haldeman who would represent the proponent of SMT and chiropractic care (despite the fact he's also an MD and a PhD).


So, plainly and simply

(1) Why do we permit the use Edzard Ernst citations which (a) has demonstrable methodological flaws (2) are severely biased (3) are not valid and not afford the same courtesy to the work of Scott Haldeman who is the expert in spinal manipulative therapy research in the topics of safety and effectiveness.

(2)Why is Chiropractic using Edzard Ernsts definition of spinal manipulation which is incorrect characterization of healing art.

    • This definition by Ernst is seriously flawed; in fact it's not even close to the definition of spinal manipulation provided by the World Health Organization "Includes all procedures where the hands or mechanical devices are used to mobilize,

adjust, manipulate, apply traction, massage, stimulate or otherwise influence the spine and paraspinal tissues with the aim of influencing the patient’s health." We could also use Principles and Practice of Chiropractic textbook which provides a good definition as well.

(3)Why does Eubulides refuse to allow scientifically robust, primary sources written by notable experts in the field (i.e. Haldeman, Cote, Cassidy) to counter the claims by Ernst that SMT is "dangerous" "adds additional costs" "risk outweighs the benefit" "has not been proven beyond a reasonable doubt" has "many adverse effects".

(4) Do we not present the view/research of Scott Haldeman DC,MD,PhD more prominently who, unlike Edzard Ernst, is much more respected, credible and truly representative source on the topics of safety and effectiveness

(5) Why are we allowing Ernsts critique of effectiveness of SMT being equated and passed off as effectiveness of chiropractic care? His severely biased view is already springing a leak article at various junctures as though to sink the article. CorticoSpinal (talk) 04:48, 22 May 2008 (UTC)

Comments on Edzard Ernst vs. Scott Haldeman

  • Chiropractic contains more citations to Haldeman than to Ernst, so I don't understand the claim that it is somehow "not promoting" Haldeman.
  • As mentioned above, the "evidence of bias" consists of sources dominated by chiropractors, who are hardly neutral observers in this controversy.
  • WP:MEDRS suggests preferring reliable reviews for good reason. In an area like this, where there are hundreds of primary studies to choose from, it's all too easy to come up with material that is apparently well-sourced (as it cites many primary studies) but still does not present the evidence neutrally as per the usual Wikipedia rules about mainstream consensus. It's much better to rely on reliable reviews, which tend to avoid this problem much better than Wikipedia editors do.
  • The context of my "unfair to Ernst" comment was somehow omitted. The point was that particular text (which referred to Ernst) was immediately followed by the summary of a review by Bronfort et al. that directly criticized Ernst. Chiropractic does this to Ernst, but to no other source.
  • I am not aware of anyone advocating "more Ernst inclusions" over what is in Chiropractic now. Perhaps I missed a proposal somewhere? It is a large talk page.
  • The definition of SMT cites Ernst, but Ernst is merely citing the American Chiropractic Association. Chiropractic should be fixed to point to the ACA's policy statment on SMT directly instead of indirectly via Ernst. The ACA defines manipulation as:
"a passive manual maneuver during which the three-joint complex may be carried beyond the normal voluntary physiological range of movement into the paraphysiological space without exceeding the boundaries of anatomical integrity."
This is pretty much the same wording as Ernst (any slight differences may be due to the fact that the ACA updated their policy statement after Ernst's paper was published). I disagree that this definition is "seriously flawed"; it is the definition in the official policy of the leading chiropractic professional organization.
  • The review by Haldeman, Côté, Cassidy and others (Hurwitz et al. 2008, PMID 18204386) is cited twice and at length in Chiropractic#Safety. You disagree with their review and wish to emphasize details about their primary studies that they themselves did not think worth summarizing in their own review. Let's stick with the expert reviewers' opinion of their own work, rather than overriding them and reaching down into their primary studies ourselves. Eubulides (talk) 08:35, 22 May 2008 (UTC)
  • I am not aware of any place in Chiropractic where SMT is being "passed off" as chiropractic care. Material about SMT is labeled as being about SMT.
  • Text in Chiropractic like "According to a vocal critic of chiropractic, Edzard Ernst, MD" (added during an edit war just before the article got frozen) is designed to discredit a reliable source, is clearly POV, and should be removed as per Wikipedia policy. It would be equally out of place to add text like "According to a committee dominated by chiropractors" to nearby material that is supportive of chiropractic. This kind of partisan edit warring should be avoided.

Eubulides (talk) 08:35, 22 May 2008 (UTC)

    • The citations used by Haldeman do not unduly sway the tone or content of the article. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)

Statements used by Haldeman sources with respect to safety, efficacy

  • Research has focused on spinal manipulation therapy (SMT) in general,[88]
So, what about this claim that Haldeman contains more citations than Ernst? It sure doesn't seem like Haldemans "sources" have been used to counter the claims by Ernst. Why would that be? Ernst severely biased and flawed reviews are presented yet strong primary studies which disagree with Ernst cannot be used. Strange. CorticoSpinal (talk) 13:48, 22 May 2008 (UTC)
    • The question is the methodological flaws that invalidates the conclusions of Ernst. It's a critique of the research. Stop confabulating. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
    • You have used MEDRS as a tool to promote a weak quality review that is flawed and biased (Ernst) whilst preventing the inclusion of strong primary sources. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
    • The placement of Ernst's opinion (severely flawed review) is used to contradict the mainstream opinion of research. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
The ACA does not determine what SMT is. It's a multidisciplinary consensus at best, or it can come from PPC. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
See above. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
    • A complete misrepresentation of my views (#19). I do not disagree with their review I disagree with the fact that the reviews covers everything that was presented in the Feb 08 issue of Spine. Somehow the most authoritative study ever done on neck pain and manipulation/stroke is getting thumped by a) Ernst and b) Miley et al. You're cherry picking the evidence to present a picture that disagrees with the general scientific consensus. You are deliberately omitting far stronger, valid and reliable primary sources. I'm not asking for Ernst to get deleted (deletionism policy) I'm asking we balance it out by adding the research of the experts (inclusion policy). Regardless, you're wrong in your assessment, 5 separate editors have specifically challenged your assessment of the research and you have violated WP:IDHT now close to 2 dozen times. How can the concern of 5 separate editors regarding your stance keep going unnoticed? Surely an admin must step in now as this is gotten to the point where the system is being gamed (violation of WP:NPOV and the spirit of WP:MEDRS has been broken. It's also an example of tendentious pushing, another violation of wikipedia policy. We have a way around this. It's called WP:IAR. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
    • Actually no. It's under the safety section. Safety section in chiropractic where the majority of the discussion is on the negative effects of SMT. Hardly balanced. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
    • Attribution is not a problem, and considering the source you want included is severely flawed attributing it to Ernst rather than outright deletion of the review. Is Ernst not a vocal critic of chiropractic? We can take out vocal if you'd like. You seem to have a real problem with separating the quality of research and then confabulating it with professional designation. Science doesn't care if you're a DC or and MD. The research stands on its own and the scientific community will pick it apart. Anyways, you have failed to address the concerns raised above and your defiant tone is noted. CorticoSpinal (talk) 13:32, 22 May 2008 (UTC)
  • Haldeman and Ernst both bring their own biases, and they both represent mainstream opinions in their own ways. Both sources should be cited as appropriate; in both cases, we should keep the sources' biases in mind.
  • The goal of Chiropractic is not to refute Ernst by citing Haldeman. It is to present encyclopedic coverage of a complicated and controversial topic. It would be unseemly for Chiropractic to follow each citation of Ernst by a countering citation of Haldeman (or vice versa, for that matter). Let's focus on the topic rather than conduct a war.
  • The "evidence of bias" is produced by sources that are (understandably) biased themselves. I could easily produce "evidence of bias" on the other side. But what would be the point? This is not supposed to be a debating society; it is supposed to be a discussion of how to produce an encyclopedic article.
  • The "strong primary sources" are covered indirectly, by a strong review that summarizes those sources well. This review (Hurwitz et al., 18204386) is not coauthored by Ernst. I don't see what Ernst has to do with that particular dispute.
  • Ernst needs to be covered, and the coverage needs to be placed somewhere. No matter where it's placed, it will "contradict" other researchers whose work is more supportive of chiropractic. The other researchers are not the only "mainstream opinion of research"; they are one mainstream view (typically, the mainstream of chiropractic), but there are other mainstream views (notably, mainstream medical opinion), and Ernst's view, which is a mainstream view, should be fairly represented.
  • The ACA's definition of SMT is an important one. No doubt other views could also be represented. However, the ACA's definition is not an "incorrect characterization of healing art", as was claimed above.
  • The review in question (Hurwitz et al.) also appeared in the February issue of Spine and it summarizes the primary studies appearing in that same issue, along with many other studies. You continue to disagree with the author's review of their own work, which is published in the same issue of Spine. As far as I can see, you are alone in the campaign to reach down into the primary source in question and override the opinions of the expert reviewers (who are reviewing their own work!).
  • I am unaware of anything in Chiropractic#Safety which "passes off" research about SMT as if it were research about chiropractic in general, or about chiropractic SMT in particular. Could you please be specific about this "passing off"?
  • Are Haldeman et al. not chiropractors? Should we be putting "according to a committee dominated by chiropractors" after every citation to Spine issue? No, that would be attempting to undercut the source, and would represent POV, even though it's the literal truth. It is similarly POV to attempt to undercut claims supported by Ernst by taking time to poison the well in that particular case. The footnote is adequate citation, in both cases.

Eubulides (talk) 16:58, 22 May 2008 (UTC)

    • This is not the point. The point is the quality of the research. Haldemans far surpasses Ernst. Haldemans has interdisciplinary consensus. Ernst does not. Equating Edzard Ernst to Scott Haldeman is grossly inappropriate. One holds a fringe viewpoint and produces low quality research on SMT and chiropractic care (Ernst). Haldeman does the opposite. Haldeman is also a medical doctor, Eubulides and specifically a neurologist. He might know a thing or 2 about SMT, safety, effectiveness of chiropractic care. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
    • The goal of chiropractic is to present both points of view and selecting the best evidence to do so. The topic is this: you preventing the inclusion of strong primary sources and advocating the use of flawed secondary sources that promotes and given it more weight (verbally) than it deserves. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
    • No. You are confusing the situation. It's not MDs vs DCs. It's about the quality of the research that Ernst produced with respect to SMT and chiropractic care. The research produced by Ernst has severe flaws. If you can find me severe methodological flaws and evidence of bias in the reviews or studies than that would be helpful. Otherwise you have no argument here and are speculating. We've provided the evidence of bias and flaws in Ernst' research. I'm talking about the quality of his review. Stop ducking the subject. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
    • Red herring, not on topic. What are you possibly talking about? CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
    • Ernst is already covered. That is not in debate. I've already said so at the very begining of this thread. Stop ignoring evidence and making misleading statements. You are cherry picking data here and are presenting an academically dishonest view of the literature. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
    • The ACAs definition is irrelevant to the discussion. The problem was replaced a definition of SMT provided by the WHO. Somewhere along the lines the definition of SMT was changed from the WHO reference to the Ernst reference. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • No. You are missing the point. I am not disagreeing with Hurwitz. STOP ACCUSING ME OF DOING SO. I have asked you three times. I'm stating that you have ignored the evidence that WAS NOT COVERED IN HURWITZ and (b) The conclusions of the task force have been pruned to such a degree that it does not cover adequately nor in proper context the conclusion. Boyle et al. shall be included as will Cassidy and Haldeman. It's not to 'override' anything its to provide balance to it and they meet inclusion criteria as per MEDRS. If you could be so kind to provide me with specific Wikipedia policy that prevents the inclusion of strong, peer-reviewed primary studies I'd appreciate it. SmithBlue already asked you do this as well, it would be nice to give us an answer to a direct question. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
    • How convenient. You're unaware that the safety section cites manipulation can cause death (despite the extremely low risk). Safety should be specific to chiropractic care. Lumping it German MDs who practice SMT (2 week course) call themselves "chirotherapists" and kill people with inappropriate use of spinal manipulation and attributing it to "chiropractic manipulation" is a problem. This is the slippery slope you advocate? Terrible! CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
    • That is not the point. You are missing the point yet again. Let me perfectly clear: it's about the quality of the research. You are disagreeing with the WHO Task Force on Neck pain now. The experts. CorticoSpinal (talk) 18:01, 22 May 2008 (UTC)
  • There is no evidence that "Haldemans far surpasses Ernst" in quality of research. On the contrary, Google Scholar suggests that Ernst is cited more often than Haldeman is. A spot-check of the citations to Ernst showed only positive citations. Obviously some are negative, but the spot-check suggests they're relatively rare. There is also no evidence that Ernst's viewpoint is "fringe"; this is merely a naked assertion. Obviously we have competing opinions here (Ernst and Haldeman); both expert opinions should be presented fairly and neutrally.
  • The secondary source in question (Hurwitz et al., PMID 18204386) is by the same group that produced the "strong" primary source (Boyle et al. 2008, PMID 18204389). No reason has been presented to reach down into the primary source in order to obtain information that the research group in question did not think worth summarizing in its own review of its own research.
  • Haldeman, like Ernst, has had serious criticism of his work. A quick web search finds Kapral & Bondy 2001 (PMID 11599330), which criticizes the paper of Haldeman et al. 2001 (PMID 11599329) for its risk analysis of "1:5.85 million cervical manipulations". Kapral & Bondy point out that malpractice claims data used by Haldeman et al. are inaccurate and that the risk of stroke remains unknown, despite the numbers Haldeman et al. report. I am sure there are other criticisms of Haldeman's work, but frankly, I would rather not head in this direction. Anybody whose goal is to dig up dirt about a particular researcher is sure to find something bad to say about their work. That has been done for Ernst, by chiropractic sources who have obvious motivations in going after a strong critic of the profession. It has not been done for Haldeman, because a similar motivation does not exist for going after Haldeman. Heavy criticism of Ernst does not necessarily mean that Haldeman is right and Ernst is wrong; it could just as plausibly mean that Ernst is stepping on people's toes and Haldeman is not.
  • I'm not sure what the "red herring" comment refers to.
  • Nor do I know what the charge of being "academically dishonest" refers to.
  • The ACA's definition is quite relevant to this discussion. This discussion started with a long criticism of Ernst saying, among other things, "Why is Chiropractic using Edzard Ernsts definition of spinal manipulation which is incorrect characterization of healing art. This definition by Ernst is seriously flawed...." But Ernst was merely quoting the ACA. If this is the sort of criticisms Ernst gets, no wonder he has so many critics! Even if Ernst just repeats what the ACA says, a critic will say that Ernst incorrectly characterizes chiropractic. Perhaps some of the other criticisms of Ernst are also misguided?
  • The safety-related conclusions of Hurwitz et al. have not been "pruned". They are presented in full in Chiropractic.
  • Overriding a published expert review, based only on the naked opinion of a single Wikipedia editor of what constitutes "balance", violates the Wikipedia POV policy. It introduces bias to "balance" a review by reaching down into a primary study done by the very same group that produced the review. Such an action constitutes arguing with expert reviewers about their own work, and is well beyond what responsible Wikipedia editors should do.
  • Ernst 2007 (PMID 17606755) cites 22 cases of severe adverse effects of chiropractic SMT with outcomes ranging from full recovery to paraplegia. I would support replacing "death" with "paraplegia" in Chiropractic.
  • Chiropractic is not disagreeing with the task force on neck pain. It cites their review fully on the subject of safety.

Eubulides (talk) 23:16, 22 May 2008 (UTC)

  • Actually there is, and your tired use of Google Scholar is not valid. Do you understand validity, Eubulides? Because I don't think you do. Google scholar (the instruement) does not assess quality of research. It provides hits. Ernst has been refuted for the last 7 years. His conclusions have been invalidated. His positions such as (SMT adds costs) goes against the majority of the literature describing SMT as cost effective. His conclusions go against the general consensus. His view is an extreme one, just like the World Chiropractic Alliance represents the other extreme. They're both fringe views. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)
    • The study by Boyle is independent of the task force hence it can and will be used. You are not going to get away with omitting evidence that demonstrates chiropractic care is a risk factor for stroke. It's not going to happen. It's too critical of an issue. Your edit on safety is a very, very poor one that cherry picks the evidence exclusively in your favour, that is, suggestive of chiropractic care causing strokes. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)
  • This is patently untrue and you have missed the point (yet again) besides not producing a valid argument. The Haldeman article you are referring to is not being used here at chiropractic.((PMID 11599329). So, since you refuse to collaborate I propose we do not use the flawed review of Ernst. Haldeman has not had any 'serious criticism' of his work. That's why he led the International Neck Pain Task Force. He's a bigger player than Ernst. Ernst is a terribly biased researcher who, during the past 7 years, has been rebuked annually for his papers on SMT and chiropractic care. Heavy criticism has nothing to do with 'stepping on toes' it has to do with the quality of the research. Stop dodging the *&*&ing issue. It's about the research, Eubulides. Research, not designations. Ernst' studies here are pure crap and scientists have exposed the flaws in his research that you are pushing on us. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)
  • Sigh, whatever.
  • More confabulation. Taking the ACA definition and trying to spin it into misguidings of Ernst. When was that definition of the ACA produced, Eubulides and why is it superior to the definition provided by the World Health Organization?
  • You not only pruned it, it was chopped in half. I have never met such an intellectually dishonest editor. You use "supportive" sources of chiropractic/SMT to bash chiropractic/SMT, just like you did with the CCA Neck Pain Guidelines. Then you claim "there are far more supportive sources in favour of chiropractic". You're gaming the system. A brief review: SmithBlue has said that your stance on MEDRS was faulty, DigitalC has said that you're misrepresenting views, Dematt has said you may have cherry picked the evidence, and I have told you all the above. What is your response to that, or will you again duck the question?
    • It's not overriding if the review isn't congruent with the subject at hand. POV is already violated because you have a) cherry picked sources b) have not attributed the view properly and have omitted relevant passages which supports the opposing view. You have misrepresent my view yet again. Pathetic. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)
  • Chiropractic SMT? You mean, manipulation done by a chiropractor? Not likely. Ernst is a German. Look what his German buddies are doing here. They're killing people with improper neck manips and then attributing it to Chiropractic SMT. Think it's not plausible that Ernst is beefing up his stats with misattribution? Definitely a strong possibility. This is the kind of research you espouse? How can you be serious? Do you not critically appraise the studies which you cite?
  • Chiropractic cites an executive summary and it does not cover the 5 main conclusions of the multidisplinary panel of experts, it lists 1. Ernst is a solo MD on a mission. You cannot compare the reputation of Dr. Haldeman to Ernst. One leads international task forces one writes severely biased and flawed reviews on SMT by himself. CorticoSpinal (talk) 00:28, 23 May 2008 (UTC)
  • Google Scholar is not a perfect indicator of course, but it is better than nothing. It has provided evidence that Ernst is cited more often than Haldeman is, and that the top cites to his work are positive. No evidence has been presented to the contrary. Ernst's conclusions do go against mainstream consensus within chiropractic, but mainstream chiropractic is not the same thing as mainstream opinion overall.
  • Boyle et al. 2008 (PMID 18204389) was not "independent of the task force". The task force review (Hurwitz et al. 2008, PMID 18204386) says that Boyle et al. was "original research conducted by the Neck Pain Task Force" and that Boyle et al.'s results "were included in the analysis of these intervention modalities".
  • My point was merely that Haldeman's work has been criticized, which it has been. In science, serious criticism is a normal thing. It is not unusual. One can easily find more criticism of Haldeman, but I'm not going to bother. I don't want this to descend into an attempt to cast aspersions on the character of Haldeman; that is certainly not intended. It would be just as silly and counterproductive to do that as to cast aspersions on the character of Ernst.
  • Ernst's work is high quality and is often cited, in a positive way, by serious researchers.
  • The ACA's definition of manipulation was done in 2003. You can verify this by reading the cited document; it is freely readable. It's a high-quality definition; I don't see why anybody would characterize it as "incorrect characterization of healing art" or "seriously flawed". Certainly there are different definitions of SMT floating around, and the WHO's definition isn't a bad one, but it wouldn't be right to say that the definition in the WHO training/safety guideline is the definitive one.
  • Nothing was "chopped in half". All the safety-relevant conclusions of Hurwitz et al. are in Chiropractic.
  • I disagree with your characterization of the comments by SmithBlue et al. For example, SmithBlue and I pretty much agree on WP:MEDRS.
  • The review in this particular case (Hurwitz et al.) is directly on topic.
  • Yes, by "chiropractic SMT" I meant SMT done by a chiropractor. Ernst 2007 (PMID 17606755) cites 22 cases of severe adverse effects of chiropractic SMT.
  • I think it implausible that Ernst engaged in scientific misconduct in his review. I don't see any evidence that he did.
  • Chiropractic does not cite the task force executive summary.
  • Ernst and Haldeman both have good reputations. Both of them write reliable sources on the subject, and both their opinions should be fairly summarized on Chiropractic.
Eubulides (talk) 09:03, 23 May 2008 (UTC)
      • I don't believe anyone has presented any information demonstrating bias or flaws is Haldeman's research. However, many flaws and bias in Ernst have been demonstrated. My main contention with Ernst is his "A systematic review of systematic reviews of spinal manipulation" study. I don't think that this should be used at all in Chiropractic because it does not study chiropractic specifically but rather SMT in general. I really don't care how clearly we explain to the reader that the SMT studied by Ernst was not necessarily performed by chiropractors, merely including the conclusions from this study on Chiropractic leaves it open to reader confabulation. My other chief contention with Ernst is not only in how much we rely on him as a source, but the prominence his biased and flawed conclusions are given. -- Levine2112 discuss 18:16, 22 May 2008 (UTC)
        • See the discussion of Kapral & Bondy 2001 above for one criticism of Haldeman's work. I disagree that readers will be confused by text that clearly distinguishes SMT research from research on chiropractic care. Also, Ernst's latest critical review (PMID 18280103) is about chiropractic, not about SMT; surely there's no objection to citing that. Eubulides (talk) 23:16, 22 May 2008 (UTC)
            • A disagreement by 2 MDs with the Haldemans method of determining the 1 in 1.85 million risk of dissecting stroke is not even close to the numerous rebuttals and outright bias of Ernst' reviews include a refutation of his methods in his reviews. This has never happened with any Haldeman research. This is why Haldeman was selected by the World Health Organization to lead the Bone and Joint Decade (2000-2010) Neck Pain Task Force. He's got lots of credibility amongst a multitude of disciplines. Ernsts credibility is in doubt and he does not enjoy broad mainstream support. That's where you've got it wrong. There is multidisciplinary consensus in Haldemans work, and none in Ernsts'. CorticoSpinal (talk) 05:50, 23 May 2008 (UTC)
              • It was just one example found by a quick web search. It was not intended to be an indictment of Haldeman, and I do not intend to go down the path of casting aspersions on researchers on one side of this issue or another. Again: in science, serious criticism is a normal thing. It is not unusual. The fact that Haldeman's work is sometimes criticized does not mean his work is unreliable or low quality. Similarly for Ernst. Eubulides (talk) 09:03, 23 May 2008 (UTC)

Expecting too much from scientists

Confabulation, I like that word :) Part of the problem is that we are expecting too much from our scientists. They can only say so much. They seem to pretty much agree that SMT is very well studied and is at least as good as any other standard medical treatment for neck pain and headaches and better than some for the treatment of low back pain. For Type O conditions, there is not enough information to draw any conclusions. We could throw in there that there is risk associated with using smt for the cervical spine, but then we would need to address that the other standard methods have risks as well. Ernst would fit in there somewhere for sure. -- Dēmatt (chat) 21:24, 22 May 2008 (UTC)

I disagree that scientists "pretty much agree" that SMT is "at least as good as any other standard medical treatment for neck pain and headaches and better than some for the treatment of low back pain. For example, the American College of Physicians only weakly recommends SMT as an alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail.[100] Admittedly the ACoP is just one group, but it's an important one, and it disagrees with the contention that SMT is "better than" the ordinary treatments. Eubulides (talk) 23:16, 22 May 2008 (UTC)
Good point, that could go on forever. We should quote our best prochiro POV review (CS chooses) and then our best antichiro POV review (Eubilides chooses) in Chiropractic then link them to Scientific investigation of chiropractic where we can use the entire page to talk about any kind of research on anything we want.... It's an option? -- Dēmatt (chat) 01:02, 23 May 2008 (UTC)
It couldn't hurt to try. A few questions before: does a multi-disciplinary review carry more weight to due less bias than a review by a single profession (i.e. MD or DC?) CorticoSpinal (talk) 05:11, 23 May 2008 (UTC)
It would not be appropriate to break things out now into a subarticle, for reasons discussed in #Scientific investigation subarticle below. Eubulides (talk) 09:03, 23 May 2008 (UTC)
Hey, how do they handle things on the Surgery page? (I just thought of that while typing so I put a link in so I could click on it.) -- Dēmatt (chat) 21:37, 22 May 2008 (UTC)
They don't handle science on the surgery page... I do like the Medicine article, though. They don't handle the science part on the page either. No wonder. Why are we trying to handle science here? Why not on each type of treatment? I know we've discussed it before, and isn't that why we created the Scientific investigation of chiropractic article? -- Dēmatt (chat) 21:49, 22 May 2008 (UTC)
Medicine is a very broad topic. Perhaps a more confabuliciously specific professional article such as Internal medicine would be a more apt comparison to Chiropractic. That said, there are no science or effectiveness section there either. -- Levine2112 discuss 22:11, 22 May 2008 (UTC)
Maybe the reason we feellike we are swimming upstream is because we are trying to cram too much into this article. For instance, osteopaths, chiros, and PTs all use SMT - we can explain all the stuff about SMT over there. Only chiropractors use Spinal adjustments so we explain that over there. Here we just do a skeleton article that includes things like the history, scope and education with lots of links to the other articles... That is the way everyone else is doing it. I know we've discussed this before, but not with everyone here. Thoughts (again)-- Dēmatt (chat) 22:29, 22 May 2008 (UTC)
  • I haven't read the TCM article, but Acupuncture and Homeopathy are bad analogies, because they use 1 treatment modality.DigitalC (talk) 00:42, 23 May 2008 (UTC)
  • No article is a perfect analogy, but these articles do have something important in common with Chiropractic, namely, they all involve treatments for which there are serious questions about efficacy or safety. Ayurveda is another example. Eubulides (talk) 09:03, 23 May 2008 (UTC)
  • Are you saying Medicine is less risky and more efficacious? Or are you saying that it is just more mainstream? Anyway, maybe we should look at medical articles that are FA status? -- Dēmatt (chat) 13:53, 23 May 2008 (UTC)

Scientific investigation subarticle

  • I disagree that the current section is so long that a subarticle is necessary. It's way shorter than Chiropractic#History, for example. And the current discussion is about the same length as it was back when the coverage of effectiveness was heavily biased in the pro-chiropractic direction. We should be careful not to give the impression that there is an interest in moving this material elsewhere merely because it's less supportive of chiropractic than it used to be.
Eubulides (talk) 23:16, 22 May 2008 (UTC)
  • You seem to disagree with every regular editor here except QuackGuru. Perhaps you should re-evaluate your commitment to collaborating with others. Chiropractic is not TCM, it's not homeopathy. You even pushed for an article that suggests is "more of a medical specialization, like Dentistry. So, how can chiropractic be a medical specialization and fringe like you claim it is? Medicine, Optometry, Osteopathic Medicine, Physical Therapy, Dentistry and other professional articles do not have effectiveness, safety, science, cost-effectiveness, etc. For good reason too. You are pushing a CAM double standard used to discredit and marginalize CAM, which incidentally had more visits to their practioners than "mainstream" ones. So, who's mainstream again? Bottom line: stop disagreeing with everybody. Nobody but QG shares your views. SA and then anti-chiro skeptic alliance (ACSA) can randomly drop by here and bomb the article and try to railroad changes, but as Dematt had already mentioned falsifying consensus by uninvolved observers is not good editing. (I meant - to use outside editors to determine what version of an entire article was 'consensus' was not a good idea while it is being developed because it would be too hard to make necessary improvements ~Dematt).CorticoSpinal (talk) 00:36, 23 May 2008 (UTC)
Could we possible hold a discussion without people who disagree with you being part of an evil alliance of villainy, thanks. Comment on edits, not editors. If you have a problem with a users conduct, file a RfC. Jefffire (talk) 13:17, 23 May 2008 (UTC)
  • I have not said that chiropractic is fringe. Chiropractic is a complicated beast: it has elements of primary care and elements of specialization; it has elements of science and elements of antiscience (or "fringe" or whatever you want to call it); and so forth. These elements should be covered. Chiropractic should not attempt to present a sanitized version of chiropractic as we wish it might be; it should present chiropractic as it is, warts and all. Eubulides (talk) 09:03, 23 May 2008 (UTC)
  • I don't remember saying that? But I could be wrong? -- Dēmatt (chat) 01:17, 23 May 2008 (UTC)
  • I am not concerned whether the article is too long, it's too boring. -- Dēmatt (chat) 01:17, 23 May 2008 (UTC)
"Too boring" that gave me a chuckle, Dematt.--—CynRN (Talk) 06:31, 23 May 2008 (UTC) It's the talk pages that are really exciting!
I agree the article is too boring. More spice, please! Eubulides (talk) 09:03, 23 May 2008 (UTC)
Hehe, the spice is on the talk page! If we could just transfer that to the article space! :D -- Dēmatt (chat) 12:57, 23 May 2008 (UTC)

I am finding this talk page very hard to follow. However, I wanted to respond to Eubulides statement that "No reason has been presented to reach down into the primary source in order to obtain information that the research group in question did not think worth summarizing in its own review of its own research." The review does not cover the primary study does it? It is OR to decide why it was not covered in the review. If a review does not exist that covers the article in question, then it is totally acceptable to use the primary source.DigitalC (talk) 00:42, 23 May 2008 (UTC)

The review in question (Hurwitz et al. 2008, PMID 18204386) does cover the primary study in question (Boyle et al. 2008, PMID 18204389). Which is understandable, since the review and the primary study were both put out by the same task force. Eubulides (talk) 09:03, 23 May 2008 (UTC)
Hard to follow, indeed!I guess the skeptics are outnumbered!:)"there is an interest in moving this material elsewhere merely because it's less supportive of chiropractic than it used to be." That's how it comes across to me. My apologies if that is not what is going on. So certain medical articles don't have 'safety and effectiveness'? The Chiropractic article can be better than that by including it. I don't see why the effectiveness of SMT can't be summarized succinctly and be included here. Chiropractic researchers have been researching SMT. Chiropractors do about 90% of it(?), so if a PT study gets mixed in somewhere, does that invalidate all the reviews of studies of SMT? Some chiropractors have suggested that chiropractors should redefine themselves as "MSK pain specialists" because that is really what they are in practice. All the philosophy stuff confuses the public. Instead of attacking Eubulides, concrete suggestions should be made for the content of the article.
Actually DigC has made an interesting point... --—CynRN (Talk) 00:53, 23 May 2008 (UTC)
Yes, DigitalC's point is a reasonable one, but it doesn't apply here, since the review in question covers the primary study in question. Eubulides (talk) 09:03, 23 May 2008 (UTC)
No apologies needed. I thought we were all skeptics :-) But really, hopefully we are all working toward turning the article that had GA (good article) status to FA (featured article). It won't be possible unless we all are able to pull together and create a NPOV and thorough succinct and interesting article. -- Dēmatt (chat) 01:17, 23 May 2008 (UTC)
For the record, I don't object to having the effectiveness material on this article, please see my support for Effectiveness 3C (although the addition of STT research would be good?), the only version that doesn't have a SYN violation by including SMT provided by non-chiropractors. I also support a similar section being written for the SMT article, without mention of other chiropractic interventions (Laser, IFC, US, Soft tissue, etc. etc.) - and then having a wikilink between the sections. Cyn is correct that Chiropractic researchers have been researching SMT. They may apply that to Chiropractic SMT, but *WE* are bound to follow WP policy such as WP:SYN, WP:OR, and WP:NPOV, policies which DON'T apply to researchers.DigitalC (talk) 01:54, 23 May 2008 (UTC)

my two cents. . . leave out non chiro specific research.TheDoctorIsIn (talk) 01:59, 23 May 2008 (UTC)

DigitalC, I'm not sure I am following what you are suggesting. Can you clarify? What is it that CYN thinks is a good idea? I can't follow this page either. -- Dēmatt (chat) 02:30, 23 May 2008 (UTC)
Is it Scientific Investigation 3C (with all the strike-outs) found above that should be a scaffold for current editing, DigC?--—CynRN (Talk) 03:15, 23 May 2008 (UTC)
Effectiveness 3C has no SYN violations because it only uses sources that talk about chiropractic SMT, not SMT in general. I think that current attention should go towards 3C, to gather a consensus version for insertion. This would at least allow us to move forward in SOME direction.DigitalC (talk) 03:54, 23 May 2008 (UTC)
This approach could likely create the odd and untenable situation of producing two antithetical scenarios: (1) chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI), and (2) all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors. What the heck am I saying?! That's already the case, and has been for years! -- Fyslee / talk 04:44, 23 May 2008 (UTC)
I think Chiropractic SMT still includes SMT studies and reviews that are performed by nonchiros. I think he is just saying not to include studies that have others performing SMT, am I right Digital? -- Dēmatt (chat) 14:20, 23 May 2008 (UTC)
Correct. It isn't the source that matters, it is the data. If it is not explicitely stated that it is talking about Chiropractic SMT, it shouldn't be in this section (But SHOULD be in a section of effectiveness over at SMTDigitalC (talk) 04:59, 25 May 2008 (UTC)
The problem with this approach is that it disagrees with the opinion of expert chiropractic researchers, who have said that the distinction between SMT performed by chiropractors and non-chiropractors is not significant as far as effectiveness research goes; see Meeker & Haldeman 2002.[101] I don't see a good reason here to override the opinions of experts in the field. Eubulides (talk) 07:34, 25 May 2008 (UTC)
It doesn't disagree with the opinion of those researchers at all. However, we are in a different realm than the researchers, we are in the realm of wikipedia, with its own policies. For example, from WP:SYN - "if the sources cited are not directly related to the subject of the article, then the editor is engaged in original research". The sources on (generic) SMT effectiveness are NOT directly related to the subject of Chiropractic. However, they ARE directly related to the subject of Spinal Manipulation. Outside of WP, I would totally agree with you that the source of the SMT doesn't necessarily matter. DigitalC (talk) 09:44, 27 May 2008 (UTC)
I dunno about this Fyslee: "chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI)," These researchers are either MS or PhD holding DCs. They're there (nice!) to advance the science of manipulation and its applications (or lack thereof) in primarily musculoskeletal disorders and some select non MS disorders. Your description sounds like they'd fudge the research just to validate chiropractic SMT at any cost. That's not exactly AGF ;)
"all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors." This implies that chiropractic researchers do not care about identifying risk factors. Steering cleer of negative results is a bit rich, no? Anyways, I favour Dematts suggestion of a few sentences with general impressions on LBP, neck pain, headache for SMT. Extremity adjusting is technically not spinal manipulation anyways. I also want to include the research of SMT with respect to animal models in addition to the neurophysiological effects of spinal manipulation (recalibration of the gamma motor system, resting EMG tone, sensorimotor integration at the level of the cortex, the breaking of fibrous adhesions to to immobility (fixation/subluxation), the biomechanical consequences of subluxation(vertebral joint dysfunction), the reduction of inflammatory markers (TNF-alpha, IL 1-6) the mechanical reduction of inflammation in the IVF via spinal manipulation (mechanical movement of the inflammation), the call by Hawk for Whole System Research (WSR) in investigating the whole clinical encounter not just the application of manipulation; etc. Science section is lacking but we should include specific chiropractic spinal manipulation studies since they generally place greater value on manipulation and research it in a different, more specific manner. CorticoSpinal (talk) 05:33, 23 May 2008 (UTC)
"This approach could likely create the odd and untenable situation of producing two antithetical scenarios: (1) chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI), and (2) all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors.". I fully support the development of a "Effectiveness of SMT" section over at SMT as well (which then would not include other chiropractic interventions).DigitalC (talk) 05:41, 23 May 2008 (UTC)
I agree. I still think it is inappropriate to deal with the effectiveness of individual treatment methods here. It needs to be done....at their respective articles. The effectiveness of the clinical encounter can be mentioned here, since that has to do with how the profession relates to the patient encounter. -- Fyslee / talk 06:12, 23 May 2008 (UTC)
Agree. -- Dēmatt (chat) 13:06, 23 May 2008 (UTC)
Likewise. CorticoSpinal (talk) 17:08, 23 May 2008 (UTC)

(outdent)

  • Most of Chiropractic#Scientific investigation is about chiropractic treament, not SMT in general (or any other particular treatment outside of chiropractic). It would be inappropriate to move this material to treatment articles, because the material is specific to chiropractic.
  • I still find it curious that there's a desire to move effectiveness-related material elsewhere now. Why wasn't there a similar desire during the long period when the effectiveness-related coverage was all strongly pro-chiropractic?

Eubulides (talk) 09:03, 23 May 2008 (UTC)

1)It will still be appropriate in the Scientific investigation of chiropractic article, too. That article would be a lot bigger and be able to include your reviews and CS's 'primary' sources as well as NPOV discussions of all the reason's why somebody's research is better/worse/outdate/orwhateverotherexcusethatcanbeimagined without bagging this page down. This will be the 'portal of entry' for chiropractic. 2) I wasn't here? -- Dēmatt (chat) 12:51, 23 May 2008 (UTC)
As a clarification Dematt, I'm not advocating whatsoever that primary sources trump secondary sources. That's not right. However, when the secondary review is not congruent with the claim being made than primary studies can definitely fill the void. Also, I'd like to get some opinions on how Ernst' reviews are being used here (I last counted 8 separate references to Ernst in "safety" "effectiveness" and "cost effectiveness". This is problematic; his reviews are methodologically unsound and his conclusions go against the bulk of the literature but are being given equal weight. We need to solve Ernst first and foremost then we can tackle other things. We need to set priorities for the page otherwise we're spinning our wheels having 15 different discussions at once. I propose we deal with Ernst fist, then we can move onto Effectiveness of Chiropractic Care making a new draft that incorporates my suggestions with Eubulides draft that specifically deals with chiropractic care. Othewise there's confabuluation happening (gotta love that word). CorticoSpinal (talk) 17:08, 23 May 2008 (UTC)

This approach could likely create the odd and untenable situation of producing two antithetical scenarios: (1) chiropractic researchers who have a hard time being objective because they are so deeply indebted to confirming the value of chiropractic SMT coming up with positive results (COI), and (2) all kinds of mainstream researchers (PhDs, MDs, PTs, DOs, etc.) who also research SMT without such a vested interest who come up with different results because they are less inclined to steer clear of negative results and risk factors. This works both ways.. I'm sure that is what you meant :-) Or are you saying that PhDs, MDs, PTs, DOs have no COIs? Oh wait a minute! Can we say WILKS! (more shock and awesome sarcasm :-D ) -- Dēmatt (chat) 13:06, 23 May 2008 (UTC)

Since this comment is coming from a good friend, I'll accept it in the constructive criticism spirit in which it is intended. Yes Dematt, it's very true that all professions are subject to the natural human foibles and tendencies that make it easy to consciously or unconsciously slip into COI thinking, to ignore personal blindspots, and to cherish tendencies to avoid uncomfortable conclusions. Absolutely true. That applies to mainstream and other professions, my own included.
In this case I was being specific about SMT research, which has an interesting history. This history is interesting to follow because of the changing culture for scientific research in chiropractic. It is only a relatively short time ago that truly scientific research (without chiro philosophy dictating and dominating the research) began in chiropractic. Before that such research was totally untrustworthy. (What can be expected when DC students were told to cross out whole pages in their scientific textbooks of anatomy and other subjects because BJ deemed it untrue?) Now we have more and more chiropractic research that is more trustworthy, but usually because the ones doing it are DC/MD/PhDs, not only DC degreed. This is in contrast to mainstream professions which have much longer and well-established traditions for doing non-philosophy-dominated (there is no real philosophy that dominates modern medicine) scientific research. The specific case of SMT involves THE profession's core foundational treatment method and chiro research has been notoriously unreliable on this point (but that's changing) because the philosophy has dictated that the results must be positive. Call it blindspots, deliberate fudging, carelessness, ignorance of how to do truly objective scientific research, ignoring plenty of medical research on the same subject, or whatever, the COI of chiropractic on this point bears no comparison to research on the same subject performed by medical professionals without that COI. (Older chiropractic research doesn't deserve AGF.) Other medical professionals have been looking at this subject from many more angles than DC research and without the same blinders, and thus have been more open to admitting where the evidence might be weak, or where side effects should be openly discussed. Few chiro researchers (at least previously) literally "dared" to do that. They got attacked as traitors and could lose their jobs. This explains why little chiropractic research pays much attention to potentially serious side effects and why other researchers have actually tried to examine that question. The two groups of researchers approach the subject very differently, which was my point above. Ernst actually did concrete research and found a 100% rate of non-reporting, which makes all talk of actual percentages for risks of cervical manipulation nonsensical. No chiropractic researchers have done that. They have used methods that could easily be distorted because they made extrapolations from incomplete data, while Ernst went directly to the source, asked, and got concrete results from a whole nation. The results were shocking to all, and many chiropractic leaders have been in denial since then. Yes, mainstream professionals could be in danger of doing the same thing in specific areas where they might have a COI, but this isn't one of them. -- Fyslee / talk 23:47, 24 May 2008 (UTC)
I really meant it with a twist of humor rather than criticism, but you're right, it is hard to write in such a way that get's the emotion just right :-), but rest assured, regardless of your skewed politics (I'm pickin'), I do consider you a friend. Your point about 'reporting adverse events' is well taken on these ears and I do respect that this was an important issue. If you remember our 2006 version of this issue, it ended with this statement: 'that any attempt to determine percentages of risk were nonsensical...", because that was the new and important feature of Ernst's research. Well, since that time, the neck task force has taken another important step by trying to determine if he might be right, "that the numbers might actually be higher" and I don't have to tell anyone here what they determined by comparing patients from other primary care doctors and those from chiropractors and determined that the numbers were identical. Their research did not support Ernst's assertion. This does not mean he is wrong, only that he is not supported with this form of evaluation. This should not be a problem to repeat this type test, and there will be more types of evaluation in the future that will either support or negate these findings. If there are enough of these from different sources, this hypothesis will be formally debunked. If not, it will become part of mainstream thought. Now, you can choose not to 'believe' the task force because you 'believe' there is a conflict of interest, but then you would be committing the same fallacious thinking that you attribute to chiropractors, a type of appeal to your authority. All I am asking is that you give 'your' sources the same skeptical assessment that you give 'mine'. I am betting that if you did, you would realize that we were all rational, reliable, and good intentioned people. The problem is not us, but that science has not yet provided us with the knowledge that we all seek. -- Dēmatt (chat) 04:26, 25 May 2008 (UTC)
I agree that the task force work did not support Ernst's assertion. Nor did it argue against Ernst's assertion; it could be, for example, that the risks are so rare that they were not picked up by the techniques used by the task force. There is some (although very small) risk, since we do have a few cases where chiropractic SMT caused severe adverse effects. With that in mind, Chiropractic should mention both the task force work (which it does) and Ernst's assertion (which it does). Eubulides (talk) 07:34, 25 May 2008 (UTC)
Why should the Task Forces report and Ernst' study be given the same weight? CorticoSpinal (talk) 23:53, 26 May 2008 (UTC)
The Task Force report represents the chiropractic mainstream (although the task force has some MD members, it is dominated by chiropractors). Ernst represents critics of chiropractic, which includes much of the medical mainstream, a far bigger group of people than chiropractors. Both sides make good points, and both should be fairly represented. Eubulides (talk) 08:08, 27 May 2008 (UTC)
This is a flawed argument. The Task Force represents the scientific/medical mainstream. It is not a chiropractic document. It is a research document. Done by a multidisciplinary panel of health care scientists reaching a consensus on topics such as efficacy, effectiveness, validity, safety. So, why should Ernsts, one man, severely biased, methodologically flawed' paper a) being presented as majority mainstream opinion and b) should be given the same weight to the World Health Organization Task Force? (which is the far superior document in both depth, breadth, scientific consensus and notable involvement of universities and governments from all over the world). I do expect a reply, Eubulides, so I'll give you advance notice not to use WP:IDIDNTHEARTHAT like you've done so in the past when I've asked you this question in the past. Thanks. CorticoSpinal (talk) 04:48, 28 May 2008 (UTC)
The Task Force is led by a chiropractor and is dominated by chiropractors. It does have MD members but it represents mainstream chiropractic opinion, which is not the same thing as the scientific/medical mainstream. Ernst is just one critic, true, but is a suitable representative for many in science and medicine, some who hold stronger anti-chiropractic opinions than he does. Eubulides (talk) 09:05, 28 May 2008 (UTC)
The Task Force is a World Health Organization sponsored organization of expert scientists (we are talking about research, not professional affilitations, Eubulides, please stop mixing the 2 together). It does not represent mainstream 'chiropractic' opinion. It simply represents the findings of the expert scientists. So, it's a scientific document produce by mainstream scientists. The fact that chiropractors are included in this proves its mainstream; the fact that the lead editor is a neurologist and a chiropractor proves this even moreso. Also, where in the cited source does it say it represents mainstream chiropractic opinion? I didn't think so. Are you disputing the notability of the Task Force report? Your source is disputed. It's been invalidated and this his been verified and proven. Go find another one, according to you they're easy to find. CorticoSpinal (talk) 06:47, 29 May 2008 (UTC)
The task force is not directly sponsored by the WHO. It is a bit amusing to see it continually being cited here as a "World Health Organization sponsored organization". It would be more accurate to describe it as a "World Federation of Chiropractic sponsored organization" (the WFC, unlike the WHO, is a direct sponsor). The task force is dominated by chiropractors. It produces scientific documents reflecting mainstream chiropractic opinion. I am not disputing the notability or reliability of the task force reports within the context of mainstream chiropractic, but I am disputing that it definitively represents mainstream medical and scientific opinion. It does not. Eubulides (talk) 08:47, 29 May 2008 (UTC)
So you are suggesting the WHO is not involved in the BJD Neck Pain Task Force? So, to review: you do not dispute the source, and you acknowledge that it is not fringe? I need a bit of clarification on your stance on that. Next, you dispute the claim that the document represents mainstream scientific opinion? Yes/No? Finally, you claim the BJD Task Force is "dominated by chiropractors" is this correct? I don't want to misrepresent your argument so I'll allow you to clarify before proceeding with a possible rebuttal. Cheers. CorticoSpinal (talk) 15:42, 29 May 2008 (UTC)
I'm sure there is some sort of connection between the WHO and the task force, yes; it's a small world, after all, and undoubtedly some of the people in that large task force have something to do with the WHO at some point. I haven't seen any evidence, though, that it's a WHO-sponsored organization. I do not think that the task force is "fringe". But that does not mean that it is "mainstream" either. It is mainstream chiropractic, I'd say; undoubtedly many straights would disagree with it, but straights are in the minority within chiropractic. It does not represent the definitive mainstream scientific opinion, no. The task force is dominated by chiropractors, yes; this dominance is far out of proportion to their relatively minor influence in mainstream medicine and science. Eubulides (talk) 16:56, 29 May 2008 (UTC)

"I really don't care how clearly we explain to the reader that the SMT studied by Ernst was not necessarily performed by chiropractors, merely including the conclusions from this study on Chiropractic leaves it open to reader confabulation." I think this word should be "conflation". Confabulation: "A fantasy that has unconsciously emerged as a factual account in memory, based partly on fact or complete construction of the imagination" Conflation: Treating two distinct concepts as if they were one, i.e. (some would say) SMT and chiropractic treatment. --—CynRN (Talk) 19:03, 24 May 2008 (UTC)

I will prove that, as currently being used, Ernst's opinions (fringe) are used to undermine and subvert the mainstream consensus. The placement of Ernst' text within Safety, Efficacy, Cost Effectiveness is done is a manner that is inconsistent with the general consensus. It's being used to open and close paragraphs instead of representing the dissenting opinion on a topic where the majority of the research favours the opposite stance. Not to mention that the reviews by Ernsts are severely flawed from a methodological perspective. So now we're citing flawed, biased research and passing it off as 'mainstream' when it clearly goes against mainstream. Its a violation of WP:OR in that the evidence has been cherry picked to present a different conclusion than is generally agreed upon. Tertiary sources prove this as well. CorticoSpinal (talk) 23:53, 26 May 2008 (UTC)
Mainstream chiropractic opinion clearly opposes Ernst, but that is not at all the same thing as saying that mainstream scientific or medical opinion opposes Ernst. Ernst's work is approvingly cited by a wide variety of non-chiropractic sources. It is not "fringe" work by any reasonable non-chiropractic standard. Eubulides (talk) 08:08, 27 May 2008 (UTC)
Yes, it should be clearly explained to readers that while 95% does apply to chiropractors, certain DC editors wish to make sure everyone knows that 5% might not apply to them, so therefore (because maybe 5% weren't DCs) the whole thing can't be used here, even in the cases where the ones conducting the study were chiropractors who were studying the effects of SMT (the irony of it all ;-) -- Fyslee / talk 23:14, 24 May 2008 (UTC)