Talk:Chiropractic/Archive 34

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but most chiropractic training is confined to classrooms with much time spent learning theory, adjustment, and marketing.[63]

Well, according to the wikipedia mantra, everything requires evidence. According to the following statement taken from the Chiropractic page, "much [of my education in classrooms was] spent learning theory, adjustment, and MARKETING" I spent most of my time in a marketing class. Well, please somebody tell me where to get a refund from my college because I do not recall even one day of marketing in my 5 years of chiropractic education at NYCC. In fact, friends that attended CMCC and AECC also do not recall ever 'spending much of their time in marketing', or any time at all in marketing while at university. It would be accurate to say that marketing is available to chiropractors in post-graduate or non-institution associated(chiropractic school) environments. But to say "much time spent in marketing" is insulting and wholly inaccurate. Whoever wrote that line needs to PROVIDE EVIDENCE from curriculums provided by all chiropactic educational institutions that we spend "much of our time in marketing" while at chiropractic school, or it SHOULD BE REMOVED. I recall taking basic science (like biochem) classes, anatomy, dissection (3 cadavers over a 1 year period), neuroanatomy plus dissection, physiology, technique, radiology,......but marketing?.....ah NO. In fact, this is actually LACKING in the curriculum of MOST chiropractic schools. I completed my degree in 1997 after an Honours in Biochemistry. I do not recall marketing being a class in that either.... The onus is on the person who has posted this information to back it up with fact, because there is no evidence provided in the article, or citation. A citation is not considered evidence if the information it provides does not have evidence to back it up as well. "Encyclopedic content must be verifiable." — Preceding unsigned comment added by 88.104.193.49 (talk) 17:10, 22 November 2011 (UTC)

While I agree that there is very little marketing taught at most chiropractic colleges these days, this doesnt matter on wikipedia unless there is a source to verify it. The sentence you are complaining about to is sourced to a narrative review written by an anti-chiropractic lawyer [1]. In his article, he quotes and sources a vanity press publication written by Kurt Butler called: "A CONSUMER’S GUIDE TO “ALTERNATIVE MEDICINE”: A CLOSE LOOK AT HOMEOPATHY, ACUPUNCTURE, FAITH-HEALING, AND OTHER UNCONVENTIONAL TREATMENTS" written in 1992. Now, I agree that this source is very weak, and I would not object if other editors also feel that this source is garbage and not worth including. I would be willing to remove this text, or move it to the controversies section for 2 reasons:

1. The fact that the 2010 source for this the controversial text [2] is not the correct source....it is simply quoting a vanity press publication from 1992. It is the 1992 vanity press publication that is the true source of this text and this is an outdated and unreliable source IMO.
2. The fact that the curriculum content of North American chiropractic and medical colleges with regard to basic and clinical sciences has been shown to be more similar than not, both in the kinds of subjects offered and in the time assigned to each subject [3]. This publication is also old (1998), but newer than the 1992 critical book and also not a vanity press publication, but rather a peer-reviewed source.

However, lets see what others say. In the meantime, I will replace the new sources used with the original sources that are simply quoted. I am not sure why these new sources were used rather than the original sources? Puhlaa (talk) 18:03, 22 November 2011 (UTC)

The Butler source is dated and weak. Vanity publications have no place in medical articles, and it doesn't meet MEDRS inclusion criteria. I do not object to it being removed based on these grounds. DVMt (talk) 03:24, 23 November 2011 (UTC)

The Butler source should be attributed since it's opinion, and such opinions are not subject to the rules at MEDRS, which only applies to biomedical claims.

As to the other matters above, I find it futile to comment since no one seems to really read my comments and repeats misinterpretations of them. I've studied the profession for decades, written a book about it, and have written several articles here related to it, but I'm not a glutton for punishment. Previously I found Puhlaa to be a reasonable collaborator, but those days seem to be over. Go ahead and whitewash the article and turn it into a sales brochure for your wishful thinking image of present day, modern chiropractic, rather than the comprehensive description of the whole profession, its history, and all angles of the subject, as required here. -- Brangifer (talk) 19:03, 23 November 2011 (UTC)

Hmmmm, I am sorry to hear that you think I am being unreasonable. I must admit that I am not sure where this accusation is coming from. I have offered to take my issues with our disagreement to a forum for other opinions; I believe I keep a level head and a friendly tone; I have never denigrated 'your' profession or 'your' perspectives (although the same courtesy is not always returned). Perhaps you wanted instant consensus and action? You should know that this is not possible at wikipedia, especially with a controversial topic. Maybe you think we should address your issues, but my issues are second rate? Did you ever comment on the fact that DVMt has reverted back to a version that actually had consensus?

Personally, I dont believe that anything that has been done here is against policy, and little that has been requested here on the talk page is against policy. I certainly disagree that anyone has been unreasonable. As an illustration of my feelings that we are doing everything right here according to policy, I am going to take my issue with the WHO to a medical forum anyways, to see if I am just looney for thinking it is a reliable stand-alone source. As always, I am happy to abide by consensus. Puhlaa (talk) 21:20, 23 November 2011 (UTC)

Yikes! Seems to be an admitted violation of WP:NPOV and an emotional response. It would appear you have consensus to delete the phrase in any case. As an non-chiropractic person I am only stating what I see here as an unbiased observer. I see the allegation still remains today 99.251.114.120 (talk) 05:16, 3 February 2012 (UTC)

Yikes. I agree with BR that this source NEEDS to be attributed, rather than stated as fact, if it is going to be included at all. Further, I would recommend that if it is to be included, it should be moved to later in the paragraph, rather than opening the paragraph with such a negative (and false) opinion. DigitalC (talk) 23:23, 7 December 2011 (UTC)

Recent Edit to Lead

Resolved

DVMt, when you have a moment, can we discuss this change [4]. While I agree that the word 'reject' is not in the text, the abstract does clearly state that 69% of chiropractors disagree with the CAM label. Personally, I think that the general statement that "...most chiropractors reject" is better than the list of numbers that you have added. What do you think about putting those specific numbers in the body of the article (if you think they are important) instead of the Lead. Personally, I think "reject" is ok, but if you disagree, can we find another way to make the statement more accurate...what about just using the word from the source: could we just change it to "A characterization that many chiropractors disagree with"? Puhlaa (talk) 21:33, 23 November 2011 (UTC)

I'm ok with changing the wording to disagree. I thought it was more informative by saying what term they were preferring as opposed to what term they were rejecting. Do you have a proposal that could maybe combine the disagree with and prefer "x". DVMt (talk) 00:05, 24 November 2011 (UTC)

I honestly do not see the value in including those specific numbers or descriptors in the Lead...which is only supposed to be a summary of the body. I think that the appropriate approach is to "summarize" the controversy regarding the CAM label. Saying "most chiropractors disagree" is a pretty good summary of this controversy. My opinion is to keep the specific numbers in the body and just use a descriptive summary in the Lead. If you strongly disagree then we can wait until another editor 'weighs in' for another opinion. Puhlaa (talk) 00:14, 24 November 2011 (UTC)

Puhlaa I see your point and don't strongly disagree. I think that it should state that chiropractors were also in favor of the term integrative medicine instead of a CAM but we can drop the numbers if you'd like. DVMt (talk) 06:54, 24 November 2011 (UTC)

Ok, do you mind changing your edit then, to more of a summary as we have discussed, and then we can re-evaluate once we see it and can discuss any other changes that are needed.Puhlaa (talk) 15:45, 24 November 2011 (UTC)

I had made the change but BR revised it shortly after to include the numbers that we agreed to drop. I'm not sure if he read this thread but hopefully there is not objection to taking out the numbers. DVMt (talk) 07:05, 25 November 2011 (UTC)

Oh....sorry about that! The grammar wasn't proper so I just went ahead and made some changes. I also wanted to ensure that it was understood that it didn't apply to the whole profession (even the survey is carefully worded to point that out). Would "a vast majority of those surveyed" do? Over 2/3 certainly qualifies for that! -- Brangifer (talk) 07:26, 25 November 2011 (UTC)

Forgive me for perhaps kicking a dead horse....I am still of the opinion that this change has not been an improvement!
The text has been changed from (original text):

"It is generally categorized as complementary and alternative medicine (CAM), a characterization that many chiropractors reject."

To (current text):

"It is generally categorized as complementary and alternative medicine (CAM), a term which 69% of chiropractors in a survey rejected, with 27% preferring the term integrative medicine."

I think that the new sentence reads very poorly and also violates WP:LEAD because it is not a summary of the body, it is a summary of a survey of chiropractors. Personally, I think that the original text in the Lead was a far better summary of the text in the body, now it is almost a replication of the text in the body. The body of the wiki article summarizes this study as well.
Text in the body:

"Mainstream health care and governmental organizations such as the World Health Organization consider chiropractic to be complementary and alternative medicine (CAM). A 2008 study reported that 31% of surveyed chiropractors categorized chiropractic as CAM, 27% as integrated medicine, and 12% as mainstream medicine."

Is it not enough to know that chiropractic is considered CAM (by all major medical organzations including WFC) and that a majority of practicing chiropractors reject that notion? Does the fact that 27% of surveyed chiropractors prefer 'Integrative' really worthy in the Lead? If 27% of major medical bodies agreed with 'Integrative', then I would definitely consider it worthy of the Lead. However, we are talking about 27% of DCs, less significant. Moreover, I dont think that a single survey of chiropractors warrants the weight it has been given in the LEAD by the addition of all these specific numbers and other details. Anyways, this is the last I will bring this up....not because I think you guys are being unreasonable...but if I am still remaining as the minority voice on this one, then I guess I am probably missing something.Puhlaa (talk) 16:28, 26 November 2011 (UTC)

You're being very reasonable and I share some of your concerns. It's too detailed. I was fine with the original version, but after really reading it, I see that it gives the impression that it applies to the whole profession, but even the survey is careful to not make that mistake. So....I'd vote for keeping the original version (without any numbers), but tweak it to note it's a specific survey. (Other surveys might have come up with very different results.) How about this:

Original text:

• "It is generally categorized as complementary and alternative medicine (CAM), a characterization that many chiropractors reject."

Tweaked (in bold):

• "It is generally categorized as complementary and alternative medicine (CAM), a characterization that most chiropractors in a survey rejected."

How's that for a compromise? -- Brangifer (talk) 20:53, 26 November 2011 (UTC)

How about we state that "it is generally categorized as CAM although most chiropractors surveyed preferred the term integrative medicine. Or we can just take it out of the lead all together and just say it's categorized as CAM. An opinion survey probably shouldn't be in the lead anyways. DVMt (talk) 03:45, 28 November 2011 (UTC)

Welcome back. Let's take a look at the results and conclusions of the survey. It will be easiest if we have it right here to look at:

• Results: Of 191 D.C. faculty invited to participate, 71 (37%) completed the survey. Of the 108 practicing D.C.s invited to participate, 61 (57%) completed the survey. Of the total sample of 132, 69% did not agree that chiropractic should be categorized as CAM. Twenty-seven percent (27%) of 132 thought that chiropractors should be classified as IM; 20% of practitioners and 6% of faculty considered chiropractic mainstream medicine.
  Conclusions: The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%).

I'm not totally sure how to interpret the 20 + 6 who considered it mainstream medicine. I made the mistake of assuming it was 26% of the total, but that's not certain. The only thing I can be certain of is that it's categorized as CAM, and that just over 2/3s of those surveyed didn't like that categorization.

So....I think your last suggestion is probably the safest, also as regards weight. We shouldn't be giving so much weight to a single survey, at least not enough to mention it in the lead. That we leave us with this:

• "It is generally categorized as complementary and alternative medicine (CAM)."

What do you think about that? Let's also wait for Puhlaa (or others) to chime in before doing anything. -- Brangifer (talk) 08:03, 28 November 2011 (UTC)

I agree with the 'generally categorized as CAM' option. Will wait for Puhlaa and others as per your recommendation. DVMt (talk) 16:28, 28 November 2011 (UTC)

I would be ok with the inclusion of 'most chiropractors surveyed prefered IM', or 'most chiropractors surveyed rejected'. However, I can see the point that the small survey with low response rates might not warrant inclusion in the Lede at all. That said, I think my preference is to leave it as 'generally characterized as CAM' with a good source like WHO or NCCAM, and leave the discussion of the 'controvery' with regard to this topic in the body.Puhlaa (talk) 01:53, 29 November 2011 (UTC)

Okay, let me give it a try and let's see how it looks. -- Brangifer (talk) 02:25, 29 November 2011 (UTC)

This works for me, it is appropriate for the lead. Puhlaa (talk) 02:47, 29 November 2011 (UTC)

Agreed. Consensus reached! DVMt (talk) 06:01, 29 November 2011 (UTC)

Good. I have marked this thread as "resolved". -- Brangifer (talk) 06:15, 29 November 2011 (UTC)

I support the final consensus version, but thought it is worth nothing that most chiropractors surveyed did NOT prefer the term IM, only 27% did. The previous version stating that many disagree with the categorization was fine too, but I have no problems with the shorter version. DigitalC (talk) 23:30, 7 December 2011 (UTC)

Picture

I don't know the proper term but the picture in the beginning of the article with Davinci's vitruvian man and the spine, etc... could be improved IMO by replacing it with the official chiropractic emblem as seen here in this link http://www.komkare.com/images/emblem.jpg. I don't know how attribution works in regard to 'borrowing' this image or if it falls under some common license, but I'd thought I'd ask first and check out opinions. Having the official chiropractic emblem does seem to make logical sense as opposed to the mish-mashed picture which doesn't seem specific to chiropractic. DVMt (talk) 03:52, 28 November 2011 (UTC)

I know that User:Dematt (a fine chiro) put some work into that image, but I can understand your point. One that is usually associated with the profession would be better, and the "chiropractic angel" caduceus is about the best one there is. I don't think the original symbol is copyrighted anymore, but we need a good, clear image, and we could get into trouble if we borrow the wrong version. There has got to be a version we could use. Here are a few links:

• http://www.komkare.com/images/emblem.jpg (the one you suggested)
• http://www.proemblems.com/goldbk2.htm
• http://www.shutterstock.com/pic-65444098/stock-vector-illustrated-caduceus-emblem-for-chiropractic-health-care.html

And a bit of history:

• Birth of the "chiropractic angel": a Caduceus counterpoint. Nash J, Keating JC.

Brangifer (talk) 08:19, 28 November 2011 (UTC)

Thanks BR! Didn't realize the history behind the angel, nor the term 'cauduceus'. Your last image seems to be the best of the three although I clicked on the site and there is a silver one other variations in terms of colors. Let's see if anyone is really opposed to changing the photo the the chiropractic caduceus, and if not, we can settle on some colors. Great find! DVMt (talk) 16:36, 28 November 2011 (UTC)

I also like the idea to replace the current image with the 'angel'. While on the subject, I am not really a fan of any of the pictures currently in the article. The table looks like it is from DD Palmers office and the massage chairs? they are just generic massage chairs, why are they there? Anyways, I know I went off topic a bit..... Puhlaa (talk) 02:06, 29 November 2011 (UTC)

The three pictures in the Scope of practice section really should go! Instead, there should be 2-4 relevant images spread around just to break up the monotony of only text. -- Brangifer (talk) 02:28, 29 November 2011 (UTC)

Scrolled down and noticed the picture and agree with BR that they are not relevant or specific to chiropractors or their practice. Before changing these one's can someone find out how we can make the change to the angel? I'm in over my head on this one! DVMt (talk) 06:04, 29 November 2011 (UTC)

Finding a free-use or fair-use image of the cauduceus will not likely be easy. The shutterstock one for example will be copyright. One suggestion is to look on flickr and wikimedia commons. DigitalC (talk) 23:33, 7 December 2011 (UTC)

Some images that might improve the article:

• Activator - treatment techniques section
• Loban Adjustment - image of adjustment from 1920 textbook
• Graston1 or Graston2 - treatment techniques section

Happy New Year!! It's been busy IRL, but hopefully I'll be able to edit periodically again. Still no movement on the Cauduceus it seems. How do I get this ball rolling? I'm sure it's fair use to use some image of it especially since we are using in it proper context. DVMt (talk) 19:03, 1 January 2012 (UTC)

a vitalistic notion ridiculed by the scientific and healthcare communities.

Second paragraph. This phrase needs to include the word "some" in it. Chiropractic is part of the "healthcare communities" and I would doubt they (the discipline) disagree with their own concepts. Perhaps this should be edited to read "a vitalistic notion ridiculed by some scientific and healthcare communities." to not imply that *ALL* healthcare and science disciplines ridiclue this notion. Even the word "most" could remove some of the bias in the phrase. 99.251.114.120 (talk) 03:32, 15 January 2012 (UTC)

In the first paragraph or the page, and in the first paragraph under "Scope of Practice" there is a sentence that reads: "chiropractic has more of the attributes of a medical specialty like dentistry or podiatry".

I believe this sentence to be flawed. Throughout this article, chiropractic is referred to as alternative form of medicine that has little (though increasing) amounts of evidence-based scientific approach. Dentistry and podiatry are very mainstream. They are, like allopathic medicine, based almost entirely on science. Dental and podiatry students go through the same classes in the same schools as medical students, mostly parting ways in the clinical years (though with some overlap).

The request: remove that sentence, in both places. — Preceding unsigned comment added by Paulkaloudis (talk • contribs) 01:17, 28 January 2012 (UTC)

WP:SOFIXIT :) N^oformation ^Talk 01:19, 28 January 2012 (UTC)

I would disagree with these statements and request. Doctors of Chiropractic, in many cases, have more medical science education than M.D. GPs and this makes your discredit style edits unjustified. Education standards are country dependent. Please check with wikipedia articles on medical education standards where you may evaluate your requests with more basis. In Canada and the USA Chiropractic Doctors are considered primary health care providers and their prescriptions for secondary health care services are accepted by most Extended HealthCare insurance coverage plans. Drugs? No. Chiropractors are not trained in drug based therapy 99.251.114.120 (talk) 04:52, 31 January 2012 (UTC)

mixers range of beliefs table edit

mixers range of beliefs table

i think i have also posted this in the archived section by mistake, sorry.

Hi I'm new to wiki editing so sorry if this has been mentioned before I did read some archives but not all . I presume because it has not been changed it hasn't been brought up.

In the belief of chiropractor straight vs mixers it suggests that the mixers philosophical orientation is 'materialistic' ha ha maybe this is an insult to the mixers but I think its probably meant to be 'mechanistic'

also in the introduction it states that 'A systematic review found that the risk of death from manipulations to the neck outweighs the benefits' I have read this article before (although the reference does not lead to the full article, without a subscription) and it is in-fact a collection of case studies over time and not a true systematic review (the abstract of the article also confirms this). I also believe that this particular claim that was made by the author was disputed because the study did not examine the benefits of manipulation. However i did read this article a long time ago and so I maybe wrong or confused it for another.

I will try to read the rest of the wiki post and offer some more suggestion, if i get time. From the archive I can see editors on both sides have strong opinions on this subject so apologies if i have offended anyone (particularly the Edward Ernst fans)

geo4444spine 2/2/2012

```` — Preceding unsigned comment added by Geo4444spine (talk • contribs) 04:42, 2 February 2012 (UTC)

No offense taken. The things you mention are worded as they are because we are simply documenting the sources. That's what drives the works here. We document what reliable sources say, be they research, facts, opinions, criticisms, controversies, etc.. Since NPOV requires that we document all sides of the subject, the article includes many diverse, and even conflicting, items. Fortunately chiropractors have been deeply involved in the development of this article. The article used to be a hit piece against chiropractic. Then it tended in the opposite direction. There was constant edit warring and little progress. Finally an excellent editor (who happens to be a subluxation-based chiro) who understood that the article must not be a hit piece or a sales brochure, made a long and valiant effort to develop the article. He was willing to cooperate with editors of all persuasions and the article grew by leaps and bounds and became quite stable. Many other chiropractic articles also resulted from these efforts and I dare say that the subject of chiropractic is probably one of the best documented health care professions on Wikipedia. Welcome to Wikipedia! -- Brangifer (talk) 05:37, 2 February 2012 (UTC)

Poorly sourced recent additions

Unfortunately there are rather incorrect and poorly sourced additions being proposed: This recent edit [5] added some general comments about chiropractic beliefs about scoliosis. There are a number of problems with this addition:

1. The text in the first sentence fails WP:V and WP:RELY The first source [6] is a link to a picture of a plumb-line type apparatus with a one-sided description of how some chiropractors might use it. This source does not support the claim: “Chiropractic texts have been identified for their pseudo-scientific attempts to link scoliosis with progressively degenerating health”
2. The text in the second sentence fails WP:RELY The 2nd and 3rd sources [7][ http://www.chirobase.org/03Edu/C/homola.html] are links to individual anecdotes about chiropractors and scoliosis. Two anecdotes are not a valid source at Wikipedia for the statement: Chiropractors “claiming that "scoliosis affects most of the major systems of the body: nervous, digestive, musculoskeletal, endocrine, immune.”
3. The remaining text simply discusses that people with scolisis live normal lives....text is better sourced, but is irrelevant here considering that there is no reliably sourced text that exists yet claiming generally that chiropractors attribute crazy claims to scoliosis. However, this well-sourced text (last 3 sentences) about scoliosis can go in the scoliosis article.

For the above reasons, either the sources need to be improved or the text needs to be removed. Despite the above facts, my removal of this text has been reverted multiple times. @ Gregorik, Just who is vanadlizing the article is a matter of opinion here I think, threats of ANI do not change the fact that the text does not meet WP:V or WP:RELY. Puhlaa (talk) 17:24, 16 February 2012 (UTC)

I agree with all three of your points, Puhlaa. The sources are all very weak. There also seems to be so WP:OR at play here, which user Gregorik acknowledged in his reversion. — Preceding unsigned comment added by 68.120.90.147 (talk) 00:07, 17 February 2012 (UTC)

I largely share your concerns and will move it to this talk page so it can be discussed. Per BRD it should remain here until a consensus on its fate is reached. -- Brangifer (talk) 00:47, 17 February 2012 (UTC)

First, there's an obvious WP:COI going on as users who are obviously chiropractic practitioners will work to cast "controversial" additions to this article as poorly researched and redundant. This much is to be expected. Second, the new section reflects a much bigger issue in chiropractic than just finding more sources. The issue in question -- that chiropractic texts mislead people regarding the nature and prognosis of a common disorder -- is a day-to-day experience and the subject of countless articles. If the article is to reflect reality, it has to fit in there. The only thing I find odd is that no-one included it so far. Normally, it wouldn't be my job to introduce stronger sources, but the job of the regular editors of this article. "Weak" references is not the issue, reflecting the reality of chiropractic for the sake of a balanced encyclopedic article is. ᴳᴿᴲᴳᴼᴿᴵᴷ☺ᶤᶯᵈᶸᶩᶢᵉ 08:40, 17 February 2012 (UTC)

If you want to introduce something, you need to have high quality sources to back it up. See WP:V. DigitalC (talk) 15:52, 17 February 2012 (UTC)

It doesn't get any higher quality than the JAMA sources. On the other side, online chiropractic texts are rather hush-hush on this sensitive subject, and may seem lower quality sources at first glance. ᴳᴿᴲᴳᴼᴿᴵᴷ☺ᶤᶯᵈᶸᶩᶢᵉ 16:46, 17 February 2012 (UTC)

I believe the issue with the JAMA source is that it mentions nothing about chiropractic or spinal manipulation. However, you are using it to make a point about chiropractic/spinal manipulation. That is WP:OR. — Preceding unsigned comment added by SueDonem (talk • contribs) 18:13, 17 February 2012 (UTC)

Gregorik, we shouldn't throw stones when we live in glass houses. There is plenty of research into the field of manipulative therapy and JAMA is not the gold standard in this particular field of medicine. Your assertion that chiropractic "texts" (which ones) are misleading people is not backed by a WP:MEDRS reference. Agreed with SueDonem that this is OR. The article has plenty of issues, and could be argued that it is unbalanced going either way. DVMt (talk) 22:40, 17 February 2012 (UTC)

DVMT, when you're saying that a 50-yr longitudinal study published in JAMA is not reliable, that rubs off badly on your arguments. Yes, JAMA is the gold standard when it comes to scoliosis facts. The other source came from a US chiropractic site, how is that a wrong source? ᴳᴿᴲᴳᴼᴿᴵᴷ☺ᶤᶯᵈᶸᶩᶢᵉ 08:54, 18 February 2012 (UTC)

Scoliosis....moved from article for discussion

As mentioned in the previous section, there is dispute and edit warring over this matter, so I've moved it here for discussion. Per WP:BRD it should not be restored until a consensus has been reached: -- Brangifer (talk) 00:50, 17 February 2012 (UTC)

• Chiropractic texts have been identified for arguably pseudo-scientific attempts to link scoliosis with progressively degenerating health and lower life expectancy, claiming that "scoliosis affects most of the major systems of the body: nervous, digestive, musculoskeletal, endocrine, immune." However, a 50-year follow-up study published in the Journal of the American Medical Association (2003) asserts that scoliosis that interferes with normal systemic functions is "exceptional" and "rare", stating that "untreated [scoliosis] patients had similar death rates and were just as functional and likely to lead productive lives 50 years after diagnosis as people with normal spines". In an earlier University of Iowa follow-up study, 91 percent of idiopathic scoliosis patients displayed normal pulmonary function, and their life expectancy was 2 percent longer than that of the general population.

Discussion

One of my objections is the placement. The controversy section needs to remain fairly general, with long discussion of specifics placed in the main controversy article. Otherwise this section will get bloated and cause undue weight. The section should simply be a copy of the lede of the main article. -- Brangifer (talk) 01:06, 17 February 2012 (UTC)

OK, I obviously have no objection about the placement. I think mentioning a single hot topic (scoliosis) would make this Controversy section more informative and credible. Scoliosis is one of the hottest topics in chiropractics (as it affects about 4% of the US population) and as anyone would tell you, chiro attitude, treatment and marketing involving scoliosis remain controversial. The paragraph I wrote sums up this issue in a few lines, and I reckon the sources (JAMA mostly) are very good. The article remains incomplete if it fails to reflect this particular debate -- which is not even a debate really but distinctive marketing practices that run counter to actual peer-reviewed empirical studies. ᴳᴿᴲᴳᴼᴿᴵᴷ☺ᶤᶯᵈᶸᶩᶢᵉ 08:15, 17 February 2012 (UTC)

Controversy section - contents

I believe the best way to manage a section of this type (regardless of topic) - where a link to the "main" article precedes a short summation of that article - is to use the lede of that article. What say ye to that idea? -- Brangifer (talk) 01:09, 17 February 2012 (UTC)

I think that this is an acceptable approach.Puhlaa (talk) 01:30, 17 February 2012 (UTC)

I'm pretty sure that it was that way, and to some degree still is. I'll add an editorial note and then update the section according to this approach. Let's see how it works. Please give me some time because the refs will need to be included. -- Brangifer (talk) 02:16, 17 February 2012 (UTC)

Okay, I'm finished. It took quite a bit of work to get all the refs! Here's a diff that shows the difference. The full refs make it look like a lot more content, but it's not really that much. -- Brangifer (talk) 03:02, 17 February 2012 (UTC)

When comparing the before and after versions, I discovered that a whole paragraph would get lost. Since it was too much detail about a single issue, it belonged in the controversy article, so I moved it there. -- Brangifer (talk) 03:15, 17 February 2012 (UTC)

Quakery

https://www.google.com/search?pz=1&cf=all&ned=us&hl=en&tbm=nws&gl=us&as_q=chiropractor%20quack&as_occt=any&as_drrb=a&tbs=ar%3A1&authuser=0 Fasttimes68 (talk) 13:56, 1 April 2012 (UTC)

textual errors

There are several errors in the text of the page that I cannot correct because editing is restricted. Please correct these:

• The lead says "(a death rate less than 0.00002% of )". 0.00002% of what? It also seems that to come up with such a percentage would require a knowledge of the number of chiropractic treatments that have been performed over the past 80 years, information which is almost surely not available. I suggest removing the parenthetical unless it can be completed and substantiated.
• "a portion are inhibitory their function being to restrain secretion" -- A comma should be inserted between "inhibitory" and "their".
• "fear that the patient would refuse treatment despite knowing the moral responsibility" -- "Despite knowing the moral responsibility" refers to the chiropractor, not the patient. I suggest using "treatment, despite the chiropractor knowing his moral responsibility".
• "that is called ethically suspect when they let practitioners maintain their beliefs" -- What is the referent of "that"? This is not clear.
• "frequent, mild and temporary adverse effects" -- What is the structure here? Are "frequent", "mild", and "temporary" peers? I suggest either "frequent mild and temporary adverse effects" if not and "frequent, mild, and temporary adverse effects" if so.
• "serious manipulation related adverse effects" -- "manipulation related" should be hyphenated.
• "the risk-benefit is not evidently favorable" -- This should say something like "the risk-benefit analysis is not evidently favorable".

184.78.155.105 (talk) 03:13, 17 April 2012 (UTC)

Yikes, almost a month in and none of this has been tackled. I have fixed the first two, which I believe were just minor copyedits. I have also removed the sentence "that is called ehtically syspect when they let practitioners maintain their beliefs" because it was not relevant to the section at hand, and was certainly confusingly worded. It refers to suspension of disbelief/skepticism, which wasn't referred to. I will leave the rest for the moment to see if my edits are reverted or not. DigitalC (talk) 16:39, 13 May 2012 (UTC)

In regards to benifit

"A systematic review found 26 recorded deaths from manipulations to the spine during the period 1934-2009 (a death rate less than 0.00002%), concluding that the risk of cervical chiropractic treatment outweighs the benefits.[35]"

The above statment comes off as very biased. This claim is very minuit in the scope of iatrogenesis in traditional medicine. If one is to search Iatrogenesis in wikipedia then they will find the following included below. I am not stating that the statment should not be included but, should be compared to other treatments risks as well. A fuller scope of the risk benifit should be included. Although it is a systemic review, 26 deaths from 1934-2009 is not signifigant in the large scope. No health care provided is flawless however it appears as this profession is being attacked in this article.

"Iatrogenesis is a major phenomenon, and a severe risk to patients. A study carried out in 1981 more than one-third of illnesses of patients in a university hospital were iatrogenic, nearly one in ten was considered major, and, in 2% of the patients, the iatrogenic disorder ended in death. Complications were most strongly associated with exposure to drugs and medications.[16] In another study, the main factors leading to problems were inadequate patient evaluation, lack of monitoring and follow-up, and failure to perform necessary tests.[citation needed] In the United States, figures suggest estimated deaths per year of: [17] [18] [19] [20] • 12,000 due to unnecessary surgery • 7,000 due to medication errors in hospitals • 20,000 due to other errors in hospitals • 80,000 due to nosocomial infections in hospitals • 106,000 due to non-error, negative effects of drugs Based on these figures, iatrogenesis may cause 225,000 deaths per year in the United States (excluding recognizable error).[17] These estimates are lower than those in an earlier IOM report, which would suggest from 230,000 to 284,000 iatrogenic deaths.[17] These figures are likely exaggerated, however, as they are based on recorded deaths in hospitals rather than in the general population. Even so, the large gap separating these estimates, deaths from cerebrovascular disease would still suggest that iatrogenic illness constitutes the third-leading cause of death in the United States; heart disease and cancer are the first- and second-leading causes of death, respectively.[17]

16.^ Steel K, Gertman PM, Crescenzi C, Anderson J (1981). "Iatrogenic illness on a general medical service at a university hospital". N. Engl. J. Med. 304 (11): 638–42. doi:10.1056/NEJM198103123041104. PMID 7453741.

17.^ a b c d Is US Health Really the Best in the World? Barbara Starfield, MD, MPH JAMA, July 26, 2000 – Vol 284, No. 4. p. 483 http://jama.ama-assn.org/content/284/4/483.extract http://www.avaresearch.com/ava-main-website/files/20100401061256.pdf?page=files/20100401061256.pdf

18.^ Lucian L. Leape: Unnecessary Surgery. Annual Review of Public Health Vol. 13: 363-383 (Volume publication date May 1992) http://www.annualreviews.org/doi/abs/10.1146/annurev.pu.13.050192.002051

19.^ David P Phillips, Nicholas Christenfeld, Laura M Glynn: Increase in US medication-error deaths between 1983 and 1993 The Lancet, Volume 351, Issue 9103, Pages 643 - 644, 28 February 1998 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2898%2924009-8/fulltext

20.^ Jason Lazarou, MSc; Bruce H. Pomeranz, MD, PhD; Paul N. Corey, PhD: Incidence of Adverse Drug Reactions in Hospitalized Patients JAMA. 1998;279(15):1200-1205. http://jama.ama-assn.org/content/279/15/1200.full

— Preceding unsigned comment added by Erthom6173 (talk • contribs) 13:23, 17 May 2012 (UTC)

You have presented a couple of good quality sources that examine adverse events in a hospital setting and a different set of good sources from a different group regarding chiropractic safety. Then, you have combined these ideas together to address a different topic (comparative safety) and synthesized an intelligent conclusion. Although your conclusion is 100% correct in my personal opinion, on wikipedia we call this original research (see WP:OR) and it is not allowed. Once a good-quality, peer-reviewed, secondary source has been published that reaches the same conclusion, then it will be added. This is in accordance with wikipedia policy (see WP:MEDRS).Puhlaa (talk) 17:04, 17 May 2012 (UTC)

The latest 2 edits by Abotnick seem guilty of the same original research conflation. — Preceding unsigned comment added by 68.122.48.52 (talk) 22:30, 21 May 2012 (UTC)

Recent Edits

I have removed this recent edit [8] because it uses a single, old, paper by a single chiropractic author to synthesize an entire discussion about chiropractic listing systems. As it is, the added text is unsuitable because it violates WP:OR, the single source used has been grossly mis-represented, as it is actually only the opinion of Harrison; ie: The conclusion of the 1996 paper is "We believe that the term torque is misused in chiropractic literature"...."We strongly suggest that references to the term torque that are not biomechanically correct must be removed from all such sources." This in no way matches-up with the lengthy commentary added by editor Abotnick with regard to listing systems and chiropractic controversy; more and/or better sources will be needed to support the inclusion of a discussion about these listing systems I think. Puhlaa (talk) 00:46, 22 May 2012 (UTC)

Risk Benefit

I did some reading in the archives regarding this subject and I see that I am not the first to bring it up. I reviewed the cited article and this Wikipedia article seems to accurately reflect the conclusions of said article. However, there is a more recent article, conducted by a Medical school in conjunction with a Chiropractic school that showed quite the opposite. In keeping with Wikipedia's NPOV and evidence-based standards, obviously this needs to be looked at ASAP. I will attach the link here and I plan to edit this section soon so that it reflects both conclusions, allowing individuals to draw their own conclusion rather than scaring them with statements like "...the risk of death from manipulations to the neck outweighs the benefits." Here's the link to the article. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922298/?tool=pubmed Akdc14 (talk) 16:30, 3 March 2012 (UTC)

AKDC, While I understand and appreciate where your coming from on this one....we have had to enforce very strict adherence to wikipedia policy at this article in order to avoid massive POV editing. Wikipedia policy has unfortunately been very unforgiving in the area of risk/benefit, because Ernst was able to publish his case-series under the guise of a systematic review. According to wikipedia policy, higher-level evidence can contradict lower-level evidence, but not vice-versa. According to the strictest adherence to wikipedia policy, a study that is labelled "systematic review" or "meta-analysis" is the highest level of evidence (eg: Ernst), whereas the paper you link to (Murphy) is only a narrative review and does not hold near as much weight. Thus, your recent edits to the Lede use a lower level narrative review to contradict a higher-level systematic review....I suggest you revert these edits, as I guarantee that they will not gain concensus (just my advice). Surely, if you read much of the history, you would have seen that Murphy has been discused both here, and at the VAD article, but has never gained concensus because it is just a narrative (opinion) article. Once a systematic review or meta-analysis is published that provides a more balanced conclusion, then the Lede can be balanced in the wikipedia article. Until then, Ernst has maintained a monopoly in the Lede because his 'systematic review' is the newest and 'highest-quality' source available and no 'equally-weighted' source contradicts it.

As for your edits to the body of the article, in the risk/benefit section, these could add value to the body and a more balanced view, however there are modifications required. For example, your current version mis-represents the Murphy paper. You contradict Ernst by saying: "A more recent study found..." and reference Murphy. However, Murphy is not a 'study' with 'findings' that can contradict Ernst, it is only a narractive review. The text could perhaps say something like "opinions differ on the topic" and add some of the info from Murphy. However, this may not gain consensus either. We will have to wait and see. Puhlaa (talk) 02:04, 8 March 2012 (UTC)

You people never give up. It doesn't mean that it cant be mentioned that "Several scientific studies of lower significance have shown that..." Research is done by doctors... hence aren't the studies bound not be neutral to some degree? Loads of med students use wikipedia, are you one of them? Med students are also extremely persistent and of higher intelligence than the general populus - at least at my university.

Javsav (talk) 23:02, 22 May 2012 (UTC)

Large paragraph in lede moved here

The latest bit added to the lede seems rather inappropriate with regard to its proximity in this article. — Preceding unsigned comment added by 68.122.48.52 (talk) 23:43, 16 May 2012 (UTC)

I share your concern and have moved it here:

• A meta-analysis of 60 randomised controlled trials (RCTs) from 2000 to 2011 concluded that "Adverse effects are poorly reported in recent RCTs of chiropractic manipulations". The analysis found that 29 of the studies failed to mention any adverse effects of the treatment and, of the 31 trials where adverse effects were reported, 16 reported that none had occurred during the study. Guidelines for publishing clinical trials require that all adverse outcomes be published; if none, researchers should report that there were no adverse effects. Professor Edzard Ernst of the University of Exeter, who led the study, said "Imagine you have a drug where mild adverse effects are documented and, hopefully rare, adverse effects are being reported in case reports. Then somebody does a trial on this drug and doesn't even mention adverse effects. That, in anybody's book, must be unethical." He said "About 50% of patients seeing a chiropractor have adverse effects, which is staggering. In addition to these fairly mild adverse effects, which basically are pain at the site of manipulation and referred pain sometimes, which only lasts one or two days, we have about 500-700 cases of severe complications being reported." With extreme chiropractic movement of the neck, an artery can disintegrate and lead to a stroke, an outcome that is well-documented in medical literature. "We only see what is being published and that can only be the tip of the iceberg," said Ernst. "Some neurologist sees a stroke and he finds out that this was associated with chiropractic – in 99.9% of cases he won't publish that."

Now what to do with it? Some portions might be usable here or elsewhere, but it didn't belong in the lede, and it's too large to use at all here or elsewhere. -- Brangifer (talk) 05:12, 17 May 2012 (UTC)

The message and the source in the first sentence could be salvaged and used to support the mention of under-reporting of adverse events in the Safety section. However, Ernst' paper is not a meta-analysis, and the rest of the proposed paragraph is editorial and unecessary because the content under discussion is already included in the safety section. I suggest adding the Ernst source to the Safety section as follows:

• "Rarely,[1] 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[33] and children.[174] Estimates vary widely for the incidence of these complications,[172] and the actual incidence is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke.[33]" ADD "Adverse effects are poorly reported in recent studies investigating chiropractic manipulations" ref Ernst 2012.

Puhlaa (talk) 16:53, 17 May 2012 (UTC)

That seems like an excellent way to word it. The uncertainty is clearly stated. We just don't know for certain about some of these things. Go ahead and add it. -- Brangifer (talk) 05:02, 18 May 2012 (UTC)

The Ernst review of adverse event reporting was just re-added to the lede [9]; I have removed it, as per this discussion. It is not a meta analysis, it is too much detail for the lead, we have already added the under-reporting to the apppropriate part of the body of the article (here:[10]).

Also, I have again removed [11] an extensive and detailed summary of the Ernst source from the body of the article. We already use Ernst's systematic review to state the fact that under-reporting is a common problem; this lengthy, detailed summary is not necessary. Readers can pull the paper if they want to read the paper's discussion, there is no need to include it here. Puhlaa (talk) 19:14, 26 May 2012 (UTC)

I tend to agree, but was it really necessary to remove the short addition to the lede? Maybe, if tweaked, it could still be useful there. -- Brangifer (talk) 19:28, 26 May 2012 (UTC)

BR, I dont feel that it is NECESSARY to remove the short section from the lede, however, if we want to have a discussion of adverse events in the lede, then I would also like to add a brief mention of the issue of stroke prodrome (headache and neck pain) being a likely contributer to the association between chiropractic visits and VAD? Also, I think that a brief mention of the work by Herzog regarding the lack of sufficient forces to damage the VA could be added, he just published a review on the issue, etc. - But Really, I dont want to add any of this to the lede, I would rather just keep it a plain statement to the effect that the treatment is safe, but rarely asociated with serious adverse events (like the acupuncture article that you currently commented at). Clearly it wont be that bare here, as Ernst has recieved consensus for inclusion in the lede on numerous occassions, however, I dont want to start adding a 'mention' of every issue that surrounds safety in the lede. What do you think?Puhlaa (talk) 20:22, 26 May 2012 (UTC)

I can see what you mean. Bloating the lede wouldn't be much good. -- Brangifer (talk) 21:05, 26 May 2012 (UTC)

Edit request - repetitive sentence and poor reference

"For most of its existence it has battled with mainstream medicine, sustained by pseudoscientific ideas such as subluxation and innate intelligence[15] that are not based on solid science.[16]"

The end of this sentence is repetitive information as "not based on solid science" just echoes the meaning of "pseudoscientific ideas" and should be removed.

The attached reference is very poor quality and should be removed with the phrase mentioned above. It contains one link to a WP article, and two more links to tertiary, or even worse, review articles bordering on blog level. References have already been supplied after "innate intelligence" and more poor quality references just make clutter and look over biased making a point. 99.251.114.120 (talk) 03:47, 23 May 2012 (UTC)

In a sense it is repetitive, but it is a quote from a RS and informs the reader that the two ideas (subluxation and innate intelligence[15]) immediately before the last phrase "are not based on solid science.[16]" IOW, "pseudoscientific" is not used generally, but specifically about those two ideas. (It also applies to several other chiropractic concepts, but we don't deal with them in that sentence.)

Ref. 15 is sourced to Joseph C. Keating, Jr., the foremost chiropractic historian and (before his death) a professor at several chiropractic schools. I communicated with him several times and he was always very helpful. He was the top authority on pretty much everything chiropractic, including it's squabbles, quackeries, and unscientific ideas. Not being a chiropractor himself, he dared to speak out and was tolerated by some, at least enough to be able to work in the profession.

Ref. 16 is sourced to a peer-reviewed journal and provides this link: http://www.jpsmjournal.com/article/S0885-3924%2807%2900783-X/abstract, from which this wording is applied in the article: "The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science." I hope that explains why this cannot be removed or modified. It seems perfectly good. -- Brangifer (talk) 05:49, 23 May 2012 (UTC)

No. Your expanation does *not* explain why this cannot be removed. The writer's notability is not a consideration, only the quality of the source as defined by WP:RS. The first reference was not being disputed. The last reference is a multiple reference to reviews of reviews, regardless of the writer, tertiary, or worse, and a reference to a WP article, as I stated above, and not good sources. WP:RS states

"Wikipedia articles should be based mainly on reliable secondary sources. Tertiary sources such as compendia, encyclopedias, textbooks, obituaries, and other summarizing sources may be used to give overviews or summaries, but should not be used in place of secondary sources for detailed discussion".

These references, including the one to a WP artice itself do not fit the descriptions at WP:RS and need to be removed. WP:Pseudoscience is clearly defined by WP and needs no repetition of its definition, especially, inside the same sentence and in this article. The sentence structure is analogous to stuttering and is ridiculous. 99.251.114.120 (talk) 14:32, 23 May 2012 (UTC)

(1) The definition of "pseudoscience" is not being repeated, but illustrated with two examples. (2) The link to a Wikipedia article, while in the reference section, isn't the actual reference, but just a convenience link. I provided the part which is the real source. Look at all the references in any article at Wikipedia and you'll find such convenience links in the references section. They are not sources for the information used in the articles, but merely convenience links of a general nature. For example, if a reference backing up some content comes from the New York Times, you'll find such a wikilink in the reference. That's just a convenience link. The part of the reference that is of interest is one that actually links to the NYT off-wiki. (3) The writer's notability is definitely important in gauging the quality of a reference or other source of information. The writings of notable authorities on a subject, even when found on otherwise little known websites or sources otherwise not considered RS, can make "that content" a RS here, even if the website or source still remains of questionable value in general. I know that there's a lot to learn about how Wikipedia works, and this is just one area. You'll get it some day if you learn from those who have much more experience. -- Brangifer (talk) 06:22, 24 May 2012 (UTC)

I want to draw attention to your ad hominem attacks in the form of belittling an editor and your avoidance of the raised issues. You have not addressed any of the raised problems. My complaints regarding this sentence, as raised above, remain unchanged. The sentence ideas appear repetitive in order to support sources that do not meet WP standards. 99.251.114.120 (talk) 19:40, 25 May 2012 (UTC)

Okay, let's focus on one thing at a time. Which sources "do not meet WP standards"? Please list the sources and explain why they don't. -- Brangifer (talk) 04:55, 26 May 2012 (UTC)

I agree that this sentence is redundant and biased. It should be changed. User who brought this edit up, you are absolutely correct. It is interesting to me what a hostile environment is encountered on this page. Please continue to edit and don't be side-tracked by the distractions thrown out by those who obviously wish to keep this page biased. Akdc14 (talk) 20:22, 25 July 2012 (UTC) To further enhance your point, check this out: 4. Alternative theoretical formulations: Alternative theoretical formulations from within the scientific community are not pseudoscience, but part of the scientific process. Such theoretical formulations may fail to explain some aspect of reality, but, should they succeed in doing so, will usually be rapidly accepted. For instance, the theory of continental drift was heavily criticised because there was no known mechanism for continents to move. When such a mechanism was discovered, it became mainstream as plate tectonics. This is a section from the page "fringe" on wikipedia. This shouldn't even be referred to as pseudoscience. This article is about 90% in violation of the NPOV on wikipedia. Akdc14 (talk) 23:29, 25 July 2012 (UTC)

False biomechanics taught in chiropractic programs needs to be added

People are undoing additions I made to the controversy section. McSly commented that the comments were original research. This is not true and shows an ignorance of the literature by Mcsly. The revision as of 00:30, 22 May 2012 discussing torque and the lack of translation components in the Gonstead and Diversified biomechanical technique listings that are tested on by chiropractic boards have been published in Harrison's book Chiropractic Technique (blue) and torque is covered in the reference I cited. Ligament laxity is a known problem and it is obvious that chiropractic scope doesn't include provision to address it. Research on prolotherapy by osteopaths could be used for support. I know efficacy for prolotx isn't established yet but osteopaths don't combine it with biomechanical realigment so it is pending. Regardless it is important that people reading this article be informed that the claim that chiropractic is efficacious as a biomechanical treatment is false due to these problems. Also, it is important for readers to realize that physical therapists differ from chiropractors because PTs use clinical prediction rules and this affects outcomes in a negative way. Abotnick (talk) 13:00, 23 May 2012 (UTC)

I will stick with addressing the problems with Abotnicks edit; not going to touch the old-fashioned opinions included in the post above :) I removed the edit [12] because it uses a single, out-dated, paper by a single chiropractic author to synthesize an entire discussion about chiropractic listing systems. The added text is unsuitable because it violates WP:OR; the single source used seems to have been grossly mis-represented, it seems to be only the opinion of Dr. Harrison ("We believe that the term torque is misused in chiropractic literature"...."We strongly suggest that references to the term torque that are not biomechanically correct must be removed from all such sources."). This does not match-up with the lengthy commentary added by Abotnick with regard to listing systems and chiropractic controversy.

Perhaps it would also help frame the credibility of Dr. Harrison (the author of the 1996 source used by Abotnick) to mention that he has financial interest in a proprietary technique system that competes with the technique systems that use the listings he criticizes (sounds a little bit like Wakefield in the DC world). PS. Listings are not taught in Canada, however, I am uncertain to what extent they are still taught in the US in the 21st century. Puhlaa (talk) 13:37, 23 May 2012 (UTC)

Puhlaa-Granted that Harrison competes with other systems however all techniques do this just as chiropractic competes with medicine, PT and osteopathy. It isn’t a reason to automatically discredit the reference which you didn’t even cite a specific reason for. American programs do teach spinal listings as a matter of course and this is tested on-a fact you didn’t dispute or even bother to confirm by looking up by surveying chiropractic college catalogs for technique offerings. I see a plethora of false listing based systems under the catalog for Palmer alone at http://www.palmer.edu/uploadedFiles/Pages/Marketing/Publications/Official_College_Documents/palmer_catalog.pdf. Page 96 lists SOT, Thompson and Upper cervical-all which are based on these flawed listing systems. You should not be reverting pages based on your own presumptions and shoddy fact finding. A reference for the necessity of translation movements can be easily found in any engineering textbook on statics, this isn’t groundbreaking research, and anyone knowledgeable in the Gonstead and Diversified methods knows that translatations aren’t included. There will never be a paper on it so to demand such is unreasonable. If Canada doesn’t teach static listings then they probably teach Motion Palpation listings which also lack the translation components. You can confirm this if you even know what translation is or bother to look it up. This is not outdated criticism in the least and US state laws define chiropractic as correcting misalignments (aka subluxation) which refer back to these techniques which are taught and tested on. The real travesty is that students attending chiropractic programs think this is real biomechanics. So my concerns are still valid. These are important subjects and they need to be included if the article is to be factual and not a cleaned up sales pitch for the chiropractic industry.Abotnick (talk) 14:07, 23 May 2012 (UTC)

@ Abotnick, You said in your above reply: "There will never be a paper on it so to demand such is unreasonable." I guess you have already solved this issue then...or perhaps you should read WP:MEDRS? Wikipedia policy says: if there is no source that says it, then it is not included. What you are doing is called WP:OR.Puhlaa (talk) 14:27, 23 May 2012 (UTC)

@Puhlaa I found additional refs but textbooks are considered acceptable secondary sources under WP:MEDRS so don't be ridiculous. Moreover Wikipedia already covers degrees of freedom so therefore it is already accepted see WP:Degrees of freedom (mechanics): "The position of a rigid body in space is defined by three components of translation and three components of rotation, which means that it has six degrees of freedom." and to substantiate chiropractic listing problems:

"Most postural movements result in complicated three-dimensional spinal coupling in six degrees of freedom. Previous spinal coupling results based upon two-dimensional radiographic studies are inadequate and inaccurate. It is important that chiropractic colleges and techniques use the three-dimensional spinal kinematics to update their curricula and advance chiropractic treatment procedures."

"Full three-dimensional investigations of spinal coupling patterns have shown that the vertebrae rotate and translate in all three axes and that previous theories of spinal coupling based upon two-dimensional studies are inaccurate and invalid. Postural rotations and translations, which are the main motions studied in spinal coupling research, and altered configurations of the normal sagittal plane curves are the cause of both normal and abnormal spinal coupling patterns in three dimensions. Chiropractic letter listings (such as PRS, ASRP, etc.) are outdated, incomplete, invalid representations of coupled segmental movements."

I rewrote to only cover peer reviewed criticism, "The biomechanical listing systems taught in chiropractic college chiropractic technique offerings have been criticized as inaccurate, inadequate and invalid.(Harrison DE. Three-dimensional spinal coupling mechanics: Part I. A review of the literature. J Manipulative Physiol Ther. 1998 Feb;21(2):101-13) (Harrison DE. Three-dimensional spinal coupling mechanics: Part I. A review of the literature. J Manipulative Physiol Ther. 1998 Feb;21(2):101-13.) Abotnick (talk) 16:27, 23 May 2012 (UTC)

The way Abotnick is (mis)using the source seems deceptive. The fact that he continues to re-introduce the text without a consensus seems like edit warring. Looking over Abotnick's edit history, he seems to be a single-purpose account. — Preceding unsigned comment added by 68.122.20.220 (talk) 19:19, 23 May 2012 (UTC)

New text is perfectly congruent with peer reviewed J Man Physiol therap Harrison citation with nothing else added. It reads, "The biomechanical listing systems taught in chiropractic college technique offerings have been criticized as inaccurate, inadequate and invalid.[194] "Abotnick (talk) 21:28, 23 May 2012 (UTC)

Your final version seems to fit nicely and the reference is good enough. It's only one sentence.

Otherwise you need to be more careful with how you edit. Avoid the appearance of edit warring. Discuss and seek consensus.

Now can we close this section? -- Brangifer (talk) 06:40, 24 May 2012 (UTC)

Looks satisfactory to me, now that all of the WP:OR is removed. Also, the new source is better than what was originally used. I agree that the current text is an appropriate summary of the source. Thanks Puhlaa (talk) 16:04, 24 May 2012 (UTC)

PLEASE UPDATE: Law for Advanced Practice Chiropractors Prescribing Rights Fails

A law which was claimed to have been designed to allow chiropractors the ability to fill the void of Primary Care Physicians in the state of New Mexico failed in the New Mexico Senate by several votes, after having passed the state house. http://www.theamericanchiropractor.com/articles-news-across-the-profession/5313-law-for-advanced-practice-chiropractors-prescribing-rights-fails.html Sommers6z (talk) 01:59, 1 June 2012 (UTC)

I don't believe that this is important enough to the entire discipline of chiropractic to deserve mention on this page. Why do you believe that people worldwide should know about this bill when they're reading about chiropractic? Nyttend (talk) 19:37, 15 July 2012 (UTC)

Might be an interesting tidbit in the "history of Chiropractic". — Preceding unsigned comment added by 24.217.40.70 (talk) 17:02, 23 July 2012 (UTC)

Copied from the Help Desk

The following section was posted at WP:HD:

I was just reading your article on chiropractic which seemed to be pretty well-informed. I was a little thrown, though, by the last sentence in the Intro (or first) section: "A systematic review found that the risk of death from manipulations to the neck outweighs the benefits.[35]"

I have been to a chiropractor several times over the years and always had amazing results, as have my friends/family that referred me. I found this sentence a little scary (like if I was reading this article for the first time prior to seeking chiropractic treatment, I might think twice) so read the article cited to justify this sentence: Deaths after Chiropractic: A review of published cases. The article actually states that there have been a total of 26 reported cases of death from chiropractic since 1934 (that's 26 deaths in 78 years of published data). Also, there were only 10 cases where the death occurred within one day of the treatment--the article states that the rest of the fatalities occurred up to 58 days following the treatment (not sure how linked the two can be with this amount of time--almost 2 months--passing between treatment and death).

I'm writing to Wiki to see if this sentence can't be deleted from the posted article...it seems really misleading to me and I know a lot of people read Wiki to get basic info on a subject and I would hate anyone else to be thrown by such a misleading sentence when the rest of the article seemed so well informed/impartial.

Ab9735 (talk) 18:52, 15 July 2012 (UTC)

Copied here, since this is the appropriate venue. Nyttend (talk) 19:31, 15 July 2012 (UTC)

Well, the response is simple: no. Unless you can provide reliable sources that contradict the claim. Arcandam (talk) 19:50, 15 July 2012 (UTC)

I note that the article is toned down relative to the source, which says that "The risks of this treatment by far outweigh its benefit" (my emphasis). It does not deny there can be a benefit - your experience - but it evaluates the attendant risks - which you have so far been lucky enough to avoid. --ColinFine (talk) 23:23, 15 July 2012 (UTC)

I agree that the sentencce should be changed as this is completely false and is based on ONE paper from several years ago. There have been numerous studies and literature reviews to negate these conclusions since then. Many of those references can be found in my previous edits, which have been reverted, but if you decide you'd like to join those of us who are up to date on the latest evidence, they are there for your perusal. Many more can be found on the ICL (Index to Chiropractic Literature). — Preceding unsigned comment added by Akdc14 (talk • contribs) 20:27, 25 July 2012 (UTC)

History, Effectiveness, and Intro

As you saw, I made several edits to these sections to reflect more current data, broader data, or to simply provide other resources to allow readers to draw their own conclusions.

Effectiveness: However, a recent literature review published in March of 2012 sheds light on the fact that the placebo effect is not the reason for the positive results seen with chiropractic care. Interestingly enough, the review was of the literature regarding chiropractic care of animals, of which there is data dating back to 1896. The review states,"Acknowledgement of these early contributions to animal chiropractic and its steady acceptance would contradict critics who may claim that any positive result obtained by spinal adjustments is psychological. Successful resolution by spinal adjustments of health conditions in animal patients negates such claims. It would be up to critics to demonstrate any so-called placebo effect in view of the demand, acceptance and development of this evolving profession."

Safety:

However, a study performed on the vertebral arteries of cadavers found that, during a chiropractic adjustment, the vertebral artery undergoes only one-ninth of the strain required to reach mechanical failure. While this is an isolated study, it is a better representation of causation (or lack thereof) than a simple correlational study.

History:

Much of this stems from the ideas of the founder Daniel David Palmer which were so radically different from the mainstream thinking about health at the time. While many have mistakenly thought that D.D. Palmer presented subluxation as the cause of disease and the adjustment as the cure for all diseases, D.D. Palmer was actually more concerned with the cause of health than with the cause of disease, a thought process that still guides the chiropractic profession today. The original definition of chiropractic included the word "dis-ease" which has been taken by many as just another way of saying "disease" or "illness." In actuality, according to the rest of D.D. Palmer's writings, he was using the word "dis-ease" to mean a lack of ease, incoordination, or lack of organization that occurs in the body whenever the subluxation interferes with nervous system function in the body.

If there is something you feel should be changed about these, let me know on here. The edits will be restored soon, hopefully with some input. Thanks. — Preceding unsigned comment added by Akdc14 (talk • contribs) 02:27, 16 July 2012 (UTC)

I would caution you against restoring your edit again; it's already possible you'll be blocked (though starting a discussion was smart) but if you revert again you'll definitely be blocked. Can you please provide links to these studies? Also, the tone of your writing is POV and I seriously doubt it mirrors the source's tone. Phrases like "Interestingly enough" are your opinion, not neutral encyclopedic writing. Lastly, if the review is not about humans then it will not suffice to replace our current sources. Sædon<sup>talk</sup> 02:34, 16 July 2012 (UTC)

(edit conflict) The edits should not be restored until you have consensus for them, or you may be blocked for editwarring. Use this page to find a compromise with a couple of Wikipedia editors based on reliable source for topics related to medicine. The references you are using are not reliable. Arcandam (talk) 02:35, 16 July 2012 (UTC)

(edit conflict)x2 The first two are not supported by reliable sources. Your "history" change is an interesting point, if accurate, and could be used (in part), if sourced to a real (i.e., non-chiropractic) reliable source. "... still guides the chiropractic profession today" is fringe, even within chiropractic. — Arthur Rubin (talk) 02:37, 16 July 2012 (UTC)

Going over your edit summaries, it appears you suffer from a common misconception that WP "tells both sides and lets the reader decide" and that WP is unbiased. Neither of these are true. For one, WP is WP:NEUTRAL but it is not unbiased; neutrality is a bias towards WP:RELIABLE SOURCES. Secondly, the "telling both sides" argument applies to journalistic entities such as newspapers; encyclopedias are WP:TERTIARY sources that give a broad overview on a topic. Our policies specify that we do so from a mainstream perspective giving appropriate WP:WEIGHT. While I haven't looked over your sources, it appears based on Arthur's comment that the sources you've used do not pass WP:MEDRS. Sædon<sup>talk</sup> 02:42, 16 July 2012 (UTC)

Many of the edits made by AKDC remove sourced mainstream information about chiropractic and replace it with material considered WP:FRINGE even within the profession itself. The edits replace the information from the World Health Organization with dogma from the world chiropractic alliance (A fringe group). The use of animal studies to challenge the contribution of the placebo effect is a narrative, thus given too much weight. The source regarding vertebral dissection is valid, but is also of insufficient weight (as per WP:MEDRS ) to directly refute the current sources, as it is only a single cadaver study. The philosophy/Palmer rewrite is POV and was more appopriate in its original state. Puhlaa (talk) 03:24, 16 July 2012 (UTC)

Ok, so let me get this straight...this is an article to provide information on the topic, in this case the topic is chiropractic, and yet a source written by a well educated memember of the profession isn't considered a "real" source. That's very interesting. Next, about the animal study...you mean to tell me that animal studies are not valid? Granted they can't always account for all differences between animals and humans so they are never 100%, but in this case the study gives some pretty good indication of the validity of the science. It's beginning to look like that's exactly why a few of you are so opposed to its inclusion in the article. Is that what we are dealing with here? — Preceding unsigned comment added by Akdc14 (talk • contribs) 20:32, 25 July 2012 (UTC)

I'm new to this article, but what think I hear the others are saying is that the source(s) you are attempting to introduce/restore to the article are either not considered reliable sources and/or they are fringe sources which must be used in such a way that they would not present undue weight. If that is the case, then those sources should not be added to the article. I'm assuming you have a POV and might feel these sources are getting short shrift. That happens all the time on wikipedia. I suggest you read Wikipedia:Dispute resolution and consider opening up a DR or RfC with respect to these two sources. Fasttimes68 (talk) 20:49, 25 July 2012 (UTC)

Thank you for your suggestions I was able to take a look at those resources. I will probably be utilizing them soon. Oh, and about wikipedia not being unbiased....have you not read the copious quantity of information regarding NOT introducing bias into an article by using words such as "claimed," etc? NPOV needs to be restored in this article ASAP. — Preceding unsigned comment added by Akdc14 (talk • contribs) 23:33, 25 July 2012 (UTC)

My personal experience with chiropractic medicine

Hide anecdote. Yes, "not a forum"
The following discussion has been closed. Please do not modify it.
I realize this is not a forum, and I'm not proposing any changes to the article, but I think it's important for people who are not familiar with chiropractic medicine and think it may help them to hear from personal testimony of someone who actually went through with it. Long story short, it's bullshit. I was having pain in my neck, and it would flare up and actually my neck would become crooked when I slept the wrong way. After many years of ignoring it, I thought I would go to a chiropractor and see if they could help me. About the only good they did was do an x-ray on my neck and told me that there was damage to the back of my neck. After thinking about how it was caused, I concluded it was probably do to my habitual nature to constantly crack my neck which I would do constantly without thinking about it. Apparently doing that for many years will cause real damage to the neck. Ever since I saw the chiropractor, I stopped cracking my neck, but everything else he did was worthless. He did all of his back and neck adjustments to me, and while it temporarily straitened my neck out for a few minutes, it went back to being crooked again, and actually got worse in the weeks following. I now sleep on my side with a pillow in front of me to keep me from sleeping on my belly (which forces me to turn my head to the side, which in turn causes my neck problems). So as long as I sleep like that, I don't have any neck problems, and I no longer crack my neck to further exacerbate any damage to my neck. But the chiropractor himself was essentially useless, and even if he did help, it would only provide temporary relief that doesn't provide any cures. ScienceApe (talk) 13:51, 28 July 2012 (UTC) This is an anecdote and this is not a forum. -- Brangifer (talk) 15:27, 28 July 2012 (UTC)

Edit request on 4 August 2012

Please change the last comment in the introduction which claims (X: "A systematic review found that the risk of death from manipulations to the neck outweighs the benefits.[35]" to (Y):"While adverse reactions do occur due to chiropractic intervention, further reserach is needed to confirm the prevalence and nature of these reactions to the interventions."firstly, becuase the vaguetries within the citation http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2010.02352.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+4+August+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance. While this is not a standalone strong request, it is important to note that this is a heavily critiqued study and has many flaws, and there have been many more complete and informative studies with much more open, descriptive and specific protocols that have been plainly spelled out, which have managed to produce actual figures, such as this article: http://bigbrother.logan.edu:2067/pubmed/19444054. Just by looking at the abstracts its plain to see, that as a stand alone citation the previous one is making strong conclussive statements that comes from what is three pages of writing total within the actual article, where the source and conclusion which I propose is a more realistic reflection of the public & political concerns with chiropractic. Thank you. 2602:306:3647:DE40:B4DD:855E:633E:9BEB (talk) 05:20, 4 August 2012 (UTC)

Not done: Requests must be in the form "change X to Y". Mdann52 (talk) 15:38, 5 August 2012 (UTC)

I agree that this should be changed. The answer you were given makes no sense. The talk page is about reaching consensus and I see nothing wrong with your proposed edit. I support replacing the current sentence with your version. Thanks for bringing this up! Akdc14 (talk) 20:02, 12 August 2012 (UTC)

I agree that the request is of the form "change X to Y". However, I don't see why we should replace a 2010 systematic review which draws conclusions with a 2009 systematic review which simply says "more research needed" (which the 2010 review is). TippyGoomba (talk) 21:39, 12 August 2012 (UTC)

Exscuse me sir, but the article that supports the previous claim is unscientific and unsuitable for making claims about an entire medical treatment based on 26 deaths since 1938, but I'm sure you would know if that if you had read the article... The one I proposed, though posted prior, is still more complete, and newer information, superior in virtually every way. Please read them. 2602:306:3647:DE40:D973:7D2:3B1:7726 (talk)

I cannot verify your claims against the current citation and I don't see that the two are in conflict. TippyGoomba (talk) 23:33, 13 August 2012 (UTC)

It seems both claims are about as in conflict as they can be. One claims certainty while the other admits ignorance.Also, there are about 5 hotlink critiques attached to the article I am questioning on pubmed. Look it up. — Preceding unsigned comment added by 2602:306:3647:DE40:D973:7D2:3B1:7726 (talk) 03:27, 14 August 2012 (UTC)

Not done: please establish a consensus for this alteration before using the {{edit semi-protected}} template.

Public Health

Public Health Section In light of the recent statement by the EPA, it would be valuable to readers to change the public health section of this article. The only part that needs changed is the part that includes fluoridation as an important public health practice. The profession has opposed fluoridation for years so that part doesn't need changed. Just the part that is inaccurate. Fluoridation, especially at previous levels, is not a good public health practice. http://www.foxnews.com/health/2011/02/22/epa-reverses-fluoride/ Akdc14 (talk) 19:35, 12 August 2012 (UTC)

I don't understand what you're proposing. Can you indicate the specific change you have in mind? TippyGoomba (talk) 21:50, 12 August 2012 (UTC)

Sure! Perhaps this section of the article should read, "The majority of the chiropractic profession has taken a stance against water fluoridation, a position that formerly cast doubt on the public health practices of the profession. However, with the recent statement issued by the EPA regarding water fluoridation, the some of the profession's public health policies have become recognized by mainstream environmental health data." Akdc14 (talk) 13:09, 13 August 2012 (UTC)

I don't think mentioning the EPAs alleged departure from mainstream science with respect to fluoridation warrants mention in a Chiropractic article. Further, your new claim that the majority of the chiropractic profession has taken a stance against water fluoridation requires a source. TippyGoomba (talk) 13:30, 13 August 2012 (UTC)

So, what you're saying is that the fluoridation issue was okay to mention in this article when it made chiropractors look like idiots but now that the EPA (that is the United States Environmental Protection Agency we are talking about here...)is showing that the profession has been right all along, you don't think it's such a good idea to include it? This isn't an "alleged departure from mainstream science." Fox news was reporting on a statement released by the EPA. I don't know how much more official it gets than that. You also mentioned that the statement about the profession's stance against fluoridation requires a source. Well, that's already stated in the article and has been there for quite some time, so I assume the source currently connected to that statement will continue to suffice. Would you like to suggest any changes to the wording I proposed in my initial response? If not, I think it's a good idea to continue with making these changes, as it is congruent with the previous content of the article...just updating it with new, more valid information. Akdc14 (talk) 21:36, 13 August 2012 (UTC)

Is that an opinion piece from Fox News of all places? Opinion pieces are not reliable sources. Only for the opinion of those who made them. --Harizotoh9 (talk) 22:14, 13 August 2012 (UTC)

more valid information, as you say, would be found in peer-reviewed scholarship, not EPA statements. You say I don't know how much more official it gets and I am telling you this is how much more official it gets. Perhaps you should take this to the fluoridation article. It's certainly more relevant there than here. TippyGoomba (talk) 22:25, 13 August 2012 (UTC)

No, this is not an opinion piece any more than any other news release would be. Here's an excerpt from the statement released by the EPA, found on the EPA's website: "it is likely that some children are exposed to too much fluoride at least occasionally." I will copy the link here so you can look it over and decide whether you think an official government document should suffice as official information. http://water.epa.gov/lawsregs/rulesregs/regulatingcontaminants/sixyearreview/upload/2011_Fluoride_QuestionsAnswers.pdf So, it appears that the best way to handle this situation is to go with the original wording I proposed and to cite the government issued document rather than the news article. Akdc14 (talk) 22:55, 13 August 2012 (UTC)

The EPA is not a valid source for this sort of claim, we go by the peer-reviewed scholarship. Please review Wikipedia:MEDRS#Choosing_sources before continuing. TippyGoomba (talk) 23:26, 13 August 2012 (UTC)

So based on what you're saying there are quite a few articles in violation of your ideas of what should be used. The actual article on water fluoridation on Wikipedia references the CDC, so clearly that should be changed. In the Chiropractic article, I guess that means that the book "Trick or Treatment" by Keating shouldn't be referenced either. Looks like there's a lot of work to do if this idea is going to be strictly adhered to. But I think we all know that not everything on Wikipedia absolutely has to come from peer reviewed sources. Yes it is the preferred method but there are obviously some things for which peer reviewed articles are either unavailable or uneccessary or both. I think we can all figure out too that things like CDC, EPA, WHO and national professional organizations are a valid source for providing standardized information. I agree they are not the only source, however they are A source. Thanks for your input though! In the efforts of keeping Wikipedia up to date and reliable though, it seems clear that the best option is to go ahead and update this section. P.S. the link you posted contradicts your own point. " Also, a few sources are in the public domain; these include many U.S. government publications, such as the Morbidity and Mortality Weekly Report of the Centers for Disease Control and Prevention." Thanks for that resource! Again, if you would like to suggest any changes to the wording before or after I edit the article, feel free to discuss it on the talk page with me! Akdc14 (talk) 00:42, 14 August 2012 (UTC)

My point is that the peer-reviewed literature does not support what you are claiming. As per WP:BOLD, you should definitely make changes to the article you deem appropriate. If anyone takes issue, we'll follow WP:BRD. TippyGoomba (talk) 00:51, 14 August 2012 (UTC)

Yep...I just sent the changes through. Sounds like a good plan! Akdc14 (talk) 00:54, 14 August 2012 (UTC)

I've read the whole thing, and it is an opinion piece by someone who promotes fringe science claims. The article is not simply a presentation of the facts, but is offering her own opinion. She slants this as "a reversal" when it's more accurate to call it a "revision". In any case, this doesn't belong here. Sort of WP:Coatrack perhaps. Chiropractic is not mentioned anywhere in any of the news articles relating to this, and it doesn't involve Chiropractic. Take this to other articles dealing with fluoridation--Harizotoh9 (talk) 01:32, 14 August 2012 (UTC).

Akdc14, have you read the source you cited in your recent edit? I don't see anything in here that the EPA opposes fluoridation (let alone anything about Chiropractic). TippyGoomba (talk) 01:55, 14 August 2012 (UTC)

The controversies over Fluoridation is far beyond the scope of this article. --Harizotoh9 (talk) 02:07, 14 August 2012 (UTC)

Ok, so if fluoridation doesn't belong in this article, then why don't we get rid of any mention of fluoridation in the article. Would that work better for you? Akdc14 (talk) 19:29, 14 August 2012 (UTC)

The intricacies of the controversy over public fluoridation are outside of the scale of this article. However, the Chiropractic professions' stance on fluoridation are within the scale. If people wish to delve deeper into the issue, there is a handy link to the related articles. The article is fine as it is. --Harizotoh9 (talk) 19:59, 14 August 2012 (UTC)

That makes sense...I agree that the stance of the profession is within the scale. However, so is an accurate representation of the thing we are mentioning they have a stance on. Right now, the article is inaccurate. A simple mention of the fact that water fluoridation is under review and that perhaps chiropractors aren't as far off their rockers as the original wording depicted them to be would suffice. Akdc14 (talk) 20:13, 14 August 2012 (UTC)

The current version is accurate. And yes, chiropractors are off their rockers. They are welcome to prove otherwise via peer-reviewed scholarship. TippyGoomba (talk) 20:27, 14 August 2012 (UTC)

That's funny that you say the current version is accurate...since it clearly has some holes. Seems like the best answer is to go ahead and put in the article that chiropractors oppose water fluoridation, the health benefits of which are currently being re-evaluated by the EPA. We have already established thath chiros oppose water fluoridation and we have also established that the situation is "under review" by the EPA...looks like that's a good compromise. Akdc14 (talk) 20:36, 14 August 2012 (UTC)

Please review WP:CON before making any further edits to this article. TippyGoomba (talk) 20:48, 14 August 2012 (UTC)

Well, this was an entertaining exercise. I always enjoy seeing how far some people will go to keep things biased in their favor. Akdc14 (talk) 01:45, 15 August 2012 (UTC)

Reality is a strict taskmaster. TippyGoomba (talk) 02:31, 15 August 2012 (UTC)

"However, so is an accurate representation of the thing we are mentioning they have a stance on. "

No. Because if you wish to include that, you then have to provide balance, clarification, history and context. So a simple few lines then blows up into paragraphs upon paragraphs that re-cover the Water fluoridation controversy article. If, say, Chiropractic researchers found information relavant to the issue, then that would be included into it. But we have WP:Coatrack as a policy as a reason. We don't want articles to go on tangents that are not really related to the article. Some Chiropractors have been against Flouridation, some haven't. That is a simple fact and we don't need to expand those sections.

Why stop at fluoridation? Why not also expand the section on vaccination? Why not include a lengthy section on the history of the anti-vaccination movement? --Harizotoh9 (talk) 15:31, 15 August 2012 (UTC)

Cite? All organized chiropractic groups, and (probably) most chiropractors, have been against flouridation. Vaccination is not as clear on the chiropractic side. — Arthur Rubin (talk) 16:25, 15 August 2012 (UTC)

Akdc14 seems to have departed, so the point is moot. There's no one left that is proposing changes. TippyGoomba (talk) 17:20, 15 August 2012 (UTC)

Thank you to whoever mentioned "However, so is an accurate representation of the thing we are mentioning they have a stance on." The point is not moot, I was taking a break. If you would like to expound on both fluoridation and vaccination, feel free to do so if you think that would be the best way to achieve accuracy here. That's a great idea! See, it just seems silly to mention that chiropractors oppose fluoridation and then inaccurately describe what fluoridation is. Perhaps we could just take out the part that says fluoridation is a valuable public health measure. That would eliminate the need to make the article any longer but it would still achieve accuracy.... Akdc14 (talk) 00:18, 7 September 2012 (UTC)

Anthonyhcole: Perhaps we could discuss what it was about my edit which you found 'bizarre'?

Template is from WikiProject Pseudoscience, here: Wikipedia:WikiProject_Pseudoscience#Headers_for_flagging_well-known_pseudoscience_topics

I'm new to wikipedia, so I'm not seeing what's 'bizarre' about that template, or understanding why you reverted my edit. Perhaps it's obvious to everyone else.

--Mknjbhvgcf (talk) 18:45, 5 October 2012 (UTC)

Hi Mk, and welcome to Wikipedia! This template is inappropriate for several reasons. One, it editorializes outside of the article itself. If there is a consensus of 'quackery' or 'pseudoscience' among the published reliable literature than that belongs in the article not above it. Further, an extremely bold claim such as 'most scientists agree...' requires unequivocal sourcing. As you can see by the review of scientific literature in this article, Chiropractic has demonstrated efficacy for several conditions, unclear or no proven efficacy for others, known risks and disputed risks, etc.. Simply, it appears to me that the claim 'most scientists believe Chiropractic is quackery' is unsourced, at least partly incorrect, and generally pejorative, as the term quackery is not neutral. Please let me know what you think. Ocaasi <sup>t | c</sup> 19:01, 5 October 2012 (UTC)

Not to suggest that chiropractic isn't bullshit, but the reader should be able to decide for themselves rather than be told by a header. Would you be able to point to other articles where this header is used? I'm finding a hard time imagining where and why it would ever be appropriate. TippyGoomba (talk) 02:52, 6 October 2012 (UTC)

I've raised this for discussion at the Fringe Theories Noticeboard: Wikipedia_talk:Fringe_theories/Noticeboard#Pseudoscience_.27warning.27_templates. Ocaasi <sup>t | c</sup> 10:58, 6 October 2012 (UTC)

Ocaasi, thank you for taking this through the appropriate wikipedia channels. I hadn't realised that the header was contentious.

As the template itself is already being fairly thoroughly discussed over on the fringe theories noticeboard, I'll restrict my comments here to what prompted me to add it in the first place:

My concern with this article is that the first four paras of the lede could easily give the impression that Chirporactic is a legitimate field of mainstream medicine.

The fact that it's 'controversial' doesn't come in until para 4 - which is 'below the fold', for me at least.

I'm looking at bits such as,

• "Chiropractic is a health care profession" (lead sentence)

• "A large number of chiropractors want to separate themselves from the traditional vitalistic concept of innate intelligence." (and therefore, it's implied, criticism of it doesn't apply to them)

• "Chiropractic is well establised .... most people who seek chiropractic care do so for lower back pain" (implies that a large number of people have pain reduced or are healed by chiropractic)

I'm also looking at the header on the article which asks for views from outside the USA. Here in the UK, Chiropractic has about equivalent status with homeopathy or faith healing - i.e. it has a core of adherents who believe that it works, but the view held by mainstream science is that it doesn't work (except in respect of the placebo effect).

So I can see that the article as it stands does have a pretty good discussion of the non-effectiveness of chiropractic, but none of that seems to be summarised in the first four paras of the lede.

I'd contrast that with Homeopathy, where the first para includes "Scientific research has found homeopathic remedies ineffective and their postulated mechanisms of action implausible.[2][3][4][5] Within the medical community homeopathy is generally considered quackery.[6] "

I think the lede of this article would benefit from something similar - the lede as it currently stands gives the impression that chiropractic is a specialty area of legitimate medicine, and that chiropractic 'doctors' are actual doctors.

--Mknjbhvgcf (talk) 18:33, 7 October 2012 (UTC)

I also have a problem with " Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry.[3]".

Here in the UK, a general practitioner has a minimum of 9 years training in proper medicine, a specialist such as a podiatrist even more. The comparison's just wildly invalid.

A chiropractic school is not a medical school, and although "Chiropractors often argue that this education is as good as or better than medical physicians'", I'm inclined to think that the medical physicians would disagree with them rather violently.

In brief: Chiropractic is a fringe theory; the lede as it currently stands does not treat it as such.

--Mknjbhvgcf (talk) 19:04, 7 October 2012 (UTC)

Mknjbhvgcf, please note that the lede is meant to be a summary of the body of the article. The first sentence of the current lede is a definition of the subject, this is the standard on almost all articles. The definition is taken from the World Health Organization, it is thus credible, consistent with reliable sources policy and represents a world view. The second sentence defines the profession as a CAM, which indicates that the profession is still not considered mainstream and contains elements of pseudoscience. The third sentence indicates that the view of chiropractic by the mainstream is as a treatment for some MSK conditions and not as primary care physicians. The current lede thus introduces the profession and the controversy in the first 3 sentences and then expands on it. That said, the lede of the article is very good as it is IMO.

That said, any wikipedia article benefits from a review of the content, to ensure that it accurately reflects new high-quality literature. Therefore, with general regard to your suggestions and criticisms of the wiki-article, I will point you to WP:RS and WP:NPOV and suggest that you come back with high-quality sources to support your claims. At that time I am sure that we could have a good discussion on the merits of each of your suggestions and see if any changes are required. Puhlaa (talk) 19:46, 7 October 2012 (UTC)

Sure, I'll take a look at possible sources and come back after some further research.

Incidentally, I don't agree with your assertion that the current lede "introduces the profession and the controversy in the first three sentences" - I don't see where, in the first para, the controversy is mentioned at all. Chirpopractic is characterised as alternative medicine; I don't agree that that's the same thing at all. I also don't agree it is true that "the view of chiropractic by the mainstream is as a treatment for some MSK conditions"; while this may be true in the US, it's not true here in the UK.

One possible source is the Simon Singh libel case in the UK High Court [13]. Singh claimed that the British Chiropractic Association 'happily promotes bogus treatments' even though there was 'not a jot of evidence' for them. The BCA sued for libel - and lost. I.e. the High Court was convinced that Singh's claims ('bogus treatments', 'not a jot of evidence') were correct.

[update - on further research, this statement is incorrect - the claims weren't tested in court, rather the BCA dropped the case - see below. --Mknjbhvgcf (talk) 22:15, 7 October 2012 (UTC) ]

The Guardian article reporting the case adds:

Yet there is no scientific basis for the concept of chiropractic "subluxation". Unsurprisingly, then, there is no good evidence that paediatric conditions respond to chiropractic manipulations.

This is true for "wellness care", adolescent idiopathic scoliosis, ear, nose and throat problems, digestive disorders and infant colic.

Even a report commissioned by the British General Chiropractic Council in the aftermath of the BCA vs Singh libel case confirmed this lack of sound evidence.

Another interesting source: "Real orthopaedic subluxations versus imaginary chiropractic subluxations", Focus on Alternative and Complementary Therapies, 2010 [14]

A largely ignored landmark review of the literature by Nansel and Szlazak,2 published in 1995, concluded that there is not a single appropriately controlled study to indicate that any dysfunction in structures of the spinal column is a cause of organic disease. ...

A review of the current evidence on the epidemiology of the subluxation construct also failed to find any credible evidence supporting the chiropractic vertebral subluxation theory.3 This review concluded that:

‘No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.’3

I'll take a look around the various sources when I have more time.

The article already has some relevant sources down in the Chiropractic#Effectiveness section; but the conclusions in that section - particularly the risk/benefit seciton - seem to be ignored by the lede, which gives the impression (I would argue a false impression) that chiropracty is a safe way of curing various ailments at minimal risk. The sources already in the Chiropractic#Effectiveness section don't agree with the positive tone which the lede takes about chiropractic - IMO the claims of chiropractic 'doctors' are being given undue prominence.

--Mknjbhvgcf (talk) 21:42, 7 October 2012 (UTC)

On further investigation, I made a mistake above - the claims in the libel case ('no evidence' etc) weren't tested in court, because the case was dropped by the BCA. [15] --Mknjbhvgcf (talk) 22:00, 7 October 2012 (UTC)

Please note that, even in the UK, the claim of critics like Singh were that "there is no good evidence that paediatric conditions ... wellness care", adolescent idiopathic scoliosis, ear, nose and throat problems, digestive disorders and infant colic." This is because, even in the UK, chiropractic is only accepted by the mainstream as a form of treatment for some msk conditions, not veisceral or genetic disorders. Note that even Singh, in the UK, did not state that there is no evidence for back pain treatment. Moreover, please also recognize that the lede already refers to subluxation as pseudoscience, so it is already consistent with your examples above. It cant all be in the first sentence, we have an entire lede to summarize the body.

My opinion is that it is best to limit the discussion to one change in the lede at a time, it is difficult to improve the article if we just get general complaints like "it sucks", or if 100 changes are proposed at once. If we can keep the discussion focused to one thing at a time it has a chance to work. A good example of how I would advise proceeding would be how we addressed this[16] change in the lede. This approach is not mandatory according to policy, as far as I am aware, but is more considerate of the fact that this is a controversial issue and change can be difficult. Puhlaa (talk) 22:08, 7 October 2012 (UTC)

I'm not asking for everything to be summarised in the first sentence, nor is my argument as simplistic as "it sucks", nor am I proposing 100 changes at once. Each of those three arguments are straw men.

The article already mentions - and indeed the lede already mentions - that chiropractic is pseudoscience; I'm saying that fact should be given greater prominence.

The most important thing for a reader to know about the field is that it's quackery; right now in the first four paras the only mention of this is "vitalistic notion ridiculed" - two problems with that:

• 1) it's immediately balanced by the part about how 'a number of' chiropracters (how many?) don't believe in 'innate intelligence' anyway (which implies that this criticism is invalid), and

• 2) 'ridiculed' suggests that the poor old chiropracters are being bullied by people who want to mock their beliefs, where the issue in fact is one of lack of evidence for chiropracty effectiveness.

I have no problem with one change at a time.

--Mknjbhvgcf (talk) 22:35, 7 October 2012 (UTC)

The UK Advertising Standards Authority's rulings on Chiropractic make interesting reading. [17] (link shows list of 22 adjudications re complaints about UK advertising by chiropracters, of which 21 complaints were upheld or part-upheld). For example, this adjudication[18] rules that the advertisers - who were chiropracters - may not claim that chiropractic is "proven to be effective for treating whiplash and chronic pain", and may not claim to be doctors without making it clear that they're not medical doctors. I'll read through the rest of the rulings when I have time, if they would be considered a worthwhile source (would they?). --Mknjbhvgcf (talk) 22:16, 7 October 2012 (UTC)

Newspaper article are very low quality sources here. Court rulings can be good sources, but it depends what you arre using them for. Here, these rulings would be good sources for a statement like "In the UK, chiropractors cannot legally claim to be doctors without stating they are chiropractors" or "in the UK, chiros cannot legally claim there is proof they can help whiplash". These would NOT be good sources to support the statement "chiropractors are quacks" Please read WP:VERIFY, WP:RS and WP:MEDRS.

Thanks. To be clear, the Advertising Standards Authority (United Kingdom) is not a court, but rather a media self-regulation body with the blessing of government. --Mknjbhvgcf (talk) 22:44, 7 October 2012 (UTC)

Reverting of recent edits

It seems that all the time I took to explain to an editor yesterday how controversial this article was a waste of time? These edit [19] change NPOV text that has gained consensus and replacce it with the POV of the editor making the changes. As was extensively discussed above, changes here (especialy in the lede) need to be discussed first and need to be supported by high-qiality sources. Please discuss such controversial changes here first, otherwsie it creates nothing but frustration for everyone involved in the project! I have reverted all of the POV and unsourced changes. Puhlaa (talk) 15:41, 8 October 2012 (UTC)

I disagree with your assertions:

• That your preferred version is 'the NPOV version'

• That I should have your permission before I edit (see WP:OWN).

• That my edits are 'POV edits'.

• That "Many of the changes remove sourced text and replace it with WP:OR" (below). They don't.

• That (from the edit notes) "changes need to be discussed at talk until consensus is reached". That's not my understanding. I don't need your permission.

--Mknjbhvgcf (talk) 16:05, 8 October 2012 (UTC)

The editor under question continues to revert consensus changes and replace with his own POV. Many of the changes remove sourced text and replace it with WP:OR. Moreover, there is no discussion first? Puhlaa (talk) 15:48, 8 October 2012 (UTC)

I have reverted to the status quo version and warned the editor. Edit warring isn't the way to go. They need to discuss AND reach a consensus version. ONLY after doing so should their edits a new version be added. -- Brangifer (talk) 15:53, 8 October 2012 (UTC)

I need your prior permission to edit? And will you give that permission if my edits are automatically considered to be 'POV' and the current version to be 'The NPOV Version'? I doubt it. --Mknjbhvgcf (talk) 16:07, 8 October 2012 (UTC)

Puhlaa continues to revert my edits and assert that I am not allowed to edit the article without prior permission. --Mknjbhvgcf (talk) 16:10, 8 October 2012 (UTC)

As was discussed yesterday, any wikipedia article benefits from a review of the content, to ensure that it accurately reflects new high-quality literature. However, it must be done in a way that is consistent with wikipedia policies like WP:OR and WP:NPOV and WP:MEDRS, moreover, it must be done in consideration of the fact that many editors volunteer here and there are many perspectives to consider beyond your own. Therefore, if you are willing to do it collaboratively, I am sure that we could have a good discussion on the merits of each of your suggestions individually and see what changes are beneficial to the article according to policy. If you keep trying to bully your changes through, it doesnt work well and creates frustration among your fellow editors. Please respect this fact. Puhlaa (talk) 16:18, 8 October 2012 (UTC)

I'm absolutely up for collaboration. However, it must be done in a way that is consistent with wikipedia policies like WP:OWN. See individual suggestion below. I am not "trying to bully [my] changes through" and I resent your condescending tone and your assertion that your favoured version is 'the NPOV version'. Please respect this fact. --Mknjbhvgcf (talk) 16:24, 8 October 2012 (UTC)

The way you've gone ahead and made several large edits without consensus and deleting sourced material because you personally disagree with it is a quick way to trigger an edit war, lose the faith of your fellow co-editors and generally poison the well if you well. I've read your proposed edits, and inserting your personal commentary into directly quoted sources is a no no. I agree with Bullrangifer and Puhlaa with their stance. You are in a minority position here. Please respect this fact. DVMt (talk) 19:18, 8 October 2012 (UTC)

I'm sorry, I don't see how I'm "inserting [my] personal commentary into directly quoted sources". If it's a direct quote, as in "The WHO states that Chiropractic is, "a b c and d"." - then of course I wouldn't mess with that. But if it's a sentence - drafted by us - with a source cited at the end, that that's different, isn't it? As long as the sentence accurately represents the source, it doesn't have to be a copy-and-paste verbatim quote, no?

How should I go about "respecting this fact" - you want me to grovel?

--Mknjbhvgcf (talk) 19:24, 8 October 2012 (UTC)

My edit reverted with argument from Wikipedia:Ownership of articles

I'm reading here that "This edit wasn't discussed first" isn't a good reason for a revert.

I'm inclined to thing that it's an even less good reason when discussion on the topic has been open for 3 days.

The article does not belong to any one wikipedian, and I don't need permission to edit it.

The current version is not 'The NPOV Version' - my edits are not automatically 'POV'.

I'd like to know what was wrong with (for example) this source here: Chiropractic - NHS Choices which I added, and which was deleted without explanation or discussion (except for a simple and unreasonable refusal to allow me to edit without gaining prior permission to do so).

--Mknjbhvgcf (talk) 16:03, 8 October 2012 (UTC)

You are quite correct...YOU do not own this article, so don't act like you can edit in an uncollaborative manner. We follow WP:BRD here as the de facto method of determining if an edit war is in progress and who started it. You need to slow down. This article will be here tomorrow. Stop editing the article and concentrate on using reasoned discussion on this talk page. Changes can be made in due time after you have reached a consensus version with other editors. Regardless of whether you are right or not, you will end up blocked if you continue to try to force your version. That's the way things work here. -- Brangifer (talk) 16:09, 8 October 2012 (UTC)

Neither of us owns the article. But the argument is being made that I am not allowed to edit the article without prior permission. To me that smacks of WP:OWN. It's not the "reasoned discussion" that you're recommending.

WP:BRD does not give you or any other user a right to say "don't edit this article".

You say "Stop editing the article". What or who gives you the authority to tell others what they should be doing?

What's wrong with a collaborative process of editing whereby I make some edits to the article, other users revert the ones they don't like (i.e. not just blind reversion of everything, but actual reading and editing).

What, for example, is wrong with this source?

[20]

--Mknjbhvgcf (talk) 16:15, 8 October 2012 (UTC)

Suggest add source - http://www.nhs.uk/conditions/chiropractic/Pages/Introduction.aspx - prettty please may I have permission to edit the article?

Hi,

As I'm being told that I'm not allowed to edit the article without prior permission from it's owners, I request permission to add this source:

Chiropractic - NHS Choices

Reasons why this is a good source:

• it's tertiary,

• it's intended for a lay audience,

• it's vetted by experts,

• it's from a quasi-governmental source,

• it evaluates the academic / scientific evidence (particularly here)

• it's non-US, and the article needs more non-US input.

So, owners of the article, please may I have your permission to add this source?

--Mknjbhvgcf (talk) 16:21, 8 October 2012 (UTC)

As we discussed yesterday, the appropriateness of a source is dependent upon what it is being used for. The source that you have suggested is an ok source, but may not be better than what is already in the article. The question becomes, what statement do you want to use the source to support and is it appropriate according to WP:OR and WP:MEDRS? Is a higher-quality source available that says something different? Is the staetment made consistent with the source? Does it carry the appropriate amount of weight? To start, please make a specific proposal (what do you want to add or remove from the article and where?) and we can discuss the appropriateness of the source you propose. Puhlaa (talk) 16:32, 8 October 2012 (UTC)

I suggest that the following sentence be added to the end of the first para:

"With the exception of back pain, the available evidence shows that chiropractic techniques are not clinically effective; they do not benefit the health of patients."

and that the sources to support it be the NHS one above, "Real orthopaedic subluxations versus imaginary chiropractic subluxations" in Focus on Alternative and Complementary Therapies, and the article's existing references named "Ernst-eval", "Kemper", and the existing reference (which you and your chums have not allowed me to name): Ernst E (2009). "Chiropractic manipulation, with a deliberate 'double entendre'". Arch Dis Child. 94 (6): 411. doi:10.1136/adc.2009.158170. PMID 19460920.

--Mknjbhvgcf (talk) 16:40, 8 October 2012 (UTC)

Right now the text says: "Many studies of treatments used by chiropractors have been conducted, often with conflicting results.[16][22] Manual therapies commonly used by chiropractors are effective for the treatment of low back pain,[23][24] and might also be effective for the treatment of lumbar disc herniation with radiculopathy,[25][26] neck pain,[27] some forms of headache,[28][29] and some extremity joint conditions.[30][31] The efficacy and cost-effectiveness of maintenance chiropractic care are unknown.[32]"

You will note that each condition listed is supported by the newest and highest-quality systematic reviews available on each condition. You are asking to change this to represent the findings of a narrative review (ie. real vs imaginary subluxations). According to WP:MEDRS systematic reviews and meta anaylsis are the best sources for medical claims. Thus, the current sources are higher-quality than the new editorial piece that you are suggesting we use. To keep the article WP:NPOV we must give the most weight to the best sources. Your suggested edit would give the most weight to a lower-quality source than what is currently used, thus I cannot support your suggested change. Puhlaa (talk) 17:57, 8 October 2012 (UTC)

No, I don't propose removing any existing sources. Giving the most weight to the best sources does not mean excluding sources with which you personally happen to disagree. Your own opinion is not automatically NPOV, whatever you may think. --Mknjbhvgcf (talk) 18:16, 8 October 2012 (UTC)

NB I also don't propose (right now) any change to the text you quoted (although I have some doubts about the independence of sources from chirporactic journals) - that's a different part of the article from the part to which I am referring. --Mknjbhvgcf (talk) 18:19, 8 October 2012 (UTC)

If you are not suggesting that we replace the current efficacy discussion in the lede with your proposed text, then you are asking to add text from a lower-quality source when we have higher-quality sources available. This is still in violation of wikipedia policies like WP:MEDRS. The article in wikipedia are meant to represent the highest-quality sources. The editorial you propose adding as a source is not appropriate for the lede when we currently have higher-quality sources available that discuss efficacy. Please try to understand that when the highest-quality sources are available, we use those sources. We have a discussion of efficacy in the lede that uses the best sources, why do you feel that we require another discussion of efficacy elsewhere in the lede that relies on lower-quality sources? Puhlaa (talk) 18:36, 8 October 2012 (UTC)

Puhlaa, "please try to understand" that I find your condescending tone insulting, and your refusal to countenance any change at all to 'your' article exasperating; I'm finding you very rude. I'm sure there's a wikipedia policy about courtesy - perhaps you could patronise me about that next?

I've explained more than once, here on this page, why I think it would be a good idea to put up higher in the lede the objections which critics raise to chiropractic. I don't much mind which source is used. I think the source I suggest as an additional one would be a useful addition to the article (wherever in the article it is placed). I don't think your wikilawyering to retain your preferred version of the text (or as you call it, 'the NPOV version') is helpful.

--Mknjbhvgcf (talk) 18:55, 8 October 2012 (UTC)

This is not an article about criticisms of chiropractic, there is a seperate article for you to emphasize controversy. Here we want a NPOV look at the profession as a whole. If you are very concerned with the order, we can discuss moving the current section in the lede that deals with efficacy to a 'higher' location, but I think other editors will object. Usually the lede mirrors the organization of the body. Puhlaa (talk) 19:13, 8 October 2012 (UTC)

Mkn... you are casting aspersions on the character of other editors here, particularly Puhlaa who has demonstrated the test of time that he is a proven collaborator, a respected editor who has seemingly successfully managed to improve the quality of the article by sticking to a very neutral approach when approaching edits and obtaining consensus prior to doing so. In the end, if editors who are editing medical-related articles do not understand the hierarchy of scientific evidence and MEDRS in general shouldn't be too surprised to see their edits fail to stick in comparison to more seasoned and experience editors in a particular field of expertise. I'd recommend taking a mini chiro-related wiki break, gather your thoughts and proposals and come back with something that is small first, so we can collaborate on it and take a piece-meal approach which tends to do better in controversial articles. DVMt (talk) 19:28, 8 October 2012 (UTC)

Changes needed in the lede?

The lede of the chiropractic article currently ends with the conclusion of Ernst's 2010 review of case-studies "A systematic review found that the risk of death from manipulations to the neck outweighs the benefits." However, a new systematic review, published in the International Journal of Clinical Practice [[21]], has examined the issue of stroke and cervical manipulation and states in it's discussion: "An accurate risk-benefit analysis for cSMT remains unavailable and additional research in this field is needed.". This seems to imply that Ernst review of case-studies was not considered an accurate risk-benefit assessment, thus its bold conclusions with regard to risk-benefit seem unjustified in this article. If nothing else, it seems that Ernst bold conclusions hold too much weight, as other 'experts' in the area seem to disagree with his conclusion. I propose that the lede be updated to better represent the current and accurate view, that "There is inconclusive evidence regarding a strong association or no association between cervical manipulation and stroke." Being an extremely controversial topic, I look forward to comments. Puhlaa (talk) 05:02, 27 September 2012 (UTC)

In reference to Ernst 2010 (citation 19), the Haynes 2012 article mentions:

There is controversy about the level of risk of stroke from cSMT, with one view claiming that there is a strong association between the two (19), and another suggesting that a strong association is absent (6)

TippyGoomba (talk) 05:45, 27 September 2012 (UTC)

TippyGoomba, the Ernst ref (19) you mention is not the 2010 review of case reports, it is a different study. I agree that the review says there is contoversy and they found 2 moderate-quality studies that have contradictory outcomes (but note that neither of those studies is that review of case-studies by Ernst). This was the reason they ultimately conclude that no good evidence exists to support or refute the association between stroke and cSM right now. This conclusion is in stark contrast to the current ending of the lede, which simply states that risk outweighs benefit.Puhlaa (talk) 16:29, 27 September 2012 (UTC)

What kind of journal is IJoCP? That would be the main issue. Is it a primary journal, is it high quality, etc. I haven't heard of it, but then again I don't read many journals so that doesn't mean too much. --Harizotoh9 (talk) 12:05, 27 September 2012 (UTC)

the journal is referenced by ISI but with low IF (2.2)MIRROR (talk) 12:56, 27 September 2012 (UTC)

The IJCP is the same journal that Ernsts 2010 review of case studies was published in 2 years earlier. When the debate was over whether to include Ernst' 2010 review of case-studies, it was called an exceptional journal of very high quality. Moreover, the new review is a review of 'higher-quality trials', unlike Ernsts review of case-reports (case reports were considered too low-quality for inclusion in this newer review & in the majority of systematic reviews published). Further still, the new review clearly states that they found no accurate risk-benefit analysis in the literature. [WP:MEDRS] says that if an older source is not covered by a newer secondary source, then the older source is considered dubious... Ernst 2010 review of case-studies is not covered in the new review. The ending of the lede will be more accurate and NPOV if we use the more balanced conclusion of the newest systematic review.Puhlaa (talk) 15:14, 27 September 2012 (UTC)

I was about to ask why the Ernst 2010 review wasn't mentioned, but your reference to [WP:MEDRS] seems to provide a possible answer. Since they're both in the same journal, I'm not sure I'd be so quick to shoot down the Ernst review. It's very unusual for scholars to not point out contradictory research in 'high-quality' journals. TippyGoomba (talk) 03:46, 28 September 2012 (UTC)

It is my personal opinion that the Ernst 2010 review is dubious, in that it makes very bold conclusions based on a collection of anecdotes. My suspicion is that the newer source' authors felt the same, however, I agree that it is odd that the Ernst 2010 review did not even warrant a mention in their review, particularly because they are both published in the same medical journal. I am open to any outcome from this discussion and am not intent on seeing Ernst 2010 discounted entirely, but the current lede seems quite problematic in light of the new review. Lets ignore that MEDRS might suggest that Ernst 2010 is dubious, and ignore that the newer source concludes that no accurate risk-benefit analysis currently exists; Ernst 2010 is still an 'older' source that is making a very bold conclusion about risk-benefit that is not supported by the newer source. Thus, even if Ernst 2010 retains some mention in the lede, it seems that the conclusions of the newer source should be given more weight.

Your reasoning is sound Puhlaa. This is the 'lightning rod' if you will of the chiropractic profession (neck manipulation and stroke). As with any research, things are always moving forward and the best articles on WP reflect that. I agree that the lede needs to be modified but as you suggest is should refrain from making any conclusions that aren't supported by the evidence. The updated systematic review should carry more weight but let's be careful of the language used to not trigger an edit war. DVMt (talk) 18:11, 29 September 2012 (UTC)

The current last sentence of the lede reads: "A systematic review found that the risk of death from manipulations to the neck outweighs the benefits (Ernst 2010)[22]"

I propose replacing it with: "There is controversy surrounding the level of risk of stroke from neck manipulation. A systematic review found that conclusive evidence was lacking for a strong association between neck manipulation and stroke, and also appeared to be lacking for no association (Haynes 2012)[23]

With this proposal, full-weight is given to the new, secondary source. Moreover, the controversy is mentioned in the lede and readers can find a full discussion of this controvery in the body of the article, where Ernst 2010 is still mentioned and referenced four times.Puhlaa (talk) 23:06, 29 September 2012 (UTC)

The reference and summary is good and fits in with NPOV and MEDRS. However I don't think it's appropriate for the neck manipulation/stroke issue to conclude the lede is that gives the impression that is the 'main' thing occurring with the profession. I would think that a statement summarizing the professions current state of affairs (expansion into non-traditional markets, collaborative endeavours the challenges that are facing the profession going forward would seem to 'sum up' the article in a more fluid way. My 2c DVMt (talk) 15:17, 2 October 2012 (UTC)

DVMt, I will wait a couple more days to allow others to contribute ideas or concerns, otherwise I will modify the article with my current suggestion. As for re-organizing the Lede, why dont you start a seperate thread for that discussion and we can work on that idea independently.Puhlaa (talk) 23:29, 2 October 2012 (UTC)

Well, I'll wait to see how your proposed addition goes, let that settle for a bit and see where it goes from there. DVMt (talk) 02:30, 5 October 2012 (UTC)

I made the above discussed changes to the lede. Note that I retained Ernst2010 as a source in the lede, with regard to the controversy surrounding safety, however, I gave the most weight to the newest and highest-quality systematic review.Puhlaa (talk) 21:06, 7 October 2012 (UTC)

Why are you even bringing up the educational standards in the UK? Did you not see the memo at the top of the page?? This is not intended as a WORLDWIDE discussion on this topc. It is only explaining the US applications. Whoever keeps insisting that chiropractors are quacks obviously lives under a rock and is invited to stay there for as long as they like but should stay out of the way of the grown ups who actually want to learn things and use logic. To the individuals who keep insisting on keeping this page ridiculously biased AGAINST chiropractic I suggest you make yourself VERY familiar with the Wilk vs AMA case and get comfortable with the idea that this profession does not take kindly to those who try to unjustly suppress it. Things tend to go rather poorly for those who try to do so. Chiropractic is NOT a fringe idea. Those of you who are intent on keeping the truth out of the public's view on the internet should revel in your short lived victory and realize that it will not be that way forever. Akdc14 (talk) 02:48, 10 October 2012 (UTC)

Here's another article supporting the recent changes. Perhaps this could be reflected under the "Risk-Benefit" heading as well? http://www.ncbi.nlm.nih.gov/pubmed/18204390# Akdc14 (talk) 18:05, 10 October 2012 (UTC)

Suggest delete sentence "Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry.[3]"

I suggest that this sentence be deleted from the first para:

"Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry.[3]"

Here's the source:

Meeker WC, Haldeman S (2002). "Chiropractic: a profession at the crossroads of mainstream and alternative medicine" (PDF). Ann Intern Med 136 (3): 216–27. PMID 11827498.

Link: [24]

The publicly visible part of the source content does not support the assertion that chiropracters are similar to either primary care physicians or to physicians who have a medical speciality.

Perhaps the part of the text which says that is in the non-public-access section? If so then maybe we could have a quote from it, to see what it says.

The idea that chiropracters have training or skills equivalent to a medically trained physician is a big claim; it needs sourcing really well if it's to be supported. Right now I'm not seeing anything supporting it.

--Mknjbhvgcf (talk) 16:33, 8 October 2012 (UTC)

The text you are referring to is comparing the professions with regard to their scope of practice, not their education. We could maybe qualify the sentence, if other editors agree, to clarify that it is scope of practice that we are referring to. For example, the text currently says: "Although chiropractors have many attributes of primary care providers, chiropractic has more of the attributes of a medical specialty like dentistry or podiatry" We could change it to something like: "Although chiropractors have many attributes of primary care providers, chiropractic scope of practice is more similar to medical specialties like dentistry or podiatry." This should retain the message of the original source, but clarify for readers what it is comparing between the professions. I will need to read the source again to ensure that my suggestion is accurate and not in violation of WP:OR. Also, lets see what other have to say?

I'd be happy enough for it to be retained in modified form. 'Attributes' is very vague. What exactly do they have in common? --Mknjbhvgcf (talk) 18:58, 8 October 2012 (UTC)

Lets see if other editors agree first. Attributes in common include: no referral required, covered by most insurance plans, ability to make a diagnosis and use imaging, can go by the title 'doctor', etc. these are discussed throughout the article. This is a brief intro/summary, so we dont want to have to go into each of these similarities and difference in detail here. Puhlaa (talk) 19:08, 8 October 2012 (UTC)

Suggest combine first two sentences

I suggest that:

Chiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine (CAM).

be amended to:

"A field of alternative medicine, Chiropractic claims to diagnose, treat and prevent disorders of the neuromusculoskeletal system and to improve general health.

My reasoning:

• 'Chiropractic is a health care profession' implies (falsely) that it is part of mainstream medicine. I'm aware that it's a verbatim quote from the WHO source; I think that source gives it context as part of alternative medicine which is lacking here in the article. Prepending "A field of alternative medicine" provides that context; editing to remove the words 'health care profession' makes it clear that chiropractic is not a mainstream health care profession (such as doctor, nurse, physiotherapist, etc).

• "concerned with the diagnosis, treatment, and prevention of" implies (falsely - see sources) that it can actually diagnose, treat and prevent disorders of the neuromusculoskeletal system. The replacement, "claims to ..." is more accurate.

• "disorders of the neuromusculoskeletal system and the effects of these disorders on general health" implies that general health is affected by disorders of the neuromusculoskeletal system, i.e. it implies that the chiropractic idea that all disorders emanate from problems with the spine, is true. This is not the case (again, see linked sources).

Both the sources are retained.

--Mknjbhvgcf (talk) 16:52, 8 October 2012 (UTC)

This proposal is in violation of WP:OR, a policy that discusses original research, please read this policy. You are asking us to use the current source to say something that the source doesnt actually say. The first sentence is a direct summary of the WHO definition of chiropractic. You want to replace it with your own definition of chiropractic but keep the WHO source? Puhlaa (talk) 18:12, 8 October 2012 (UTC)

No, of course I don't want to attribute my own definition of chiropractic to the WHO. That's an absurd straw man argument. I would be grateful if you would show a little more courtesy and refrain from putting words in my mouth.

If you want to use a direct quote from the WHO then put one in - otherwise, drafting text is necessary if the whole of wikipedia is to consist of anything other than copy-and-paste from the sources. Drafting text does not consist of [[WP::OR]], and you are not the sole arbiter of what is or is not consistent with wikipedia's policies.

--Mknjbhvgcf (talk) 19:11, 8 October 2012 (UTC)

In its "Foreword", the WHO document implies that chiropractic is "traditional and complementary/alternative medicine". although this is not directly linked to the statement in the "Glossary". My recommendation:-

Chiropractic is an alternative medicine health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health.

Axl ¤ [Talk] 18:54, 8 October 2012 (UTC)

Axl, you suggestion is definitely more NPOV. That said, it seems like your suggestion is the same thing as what is currently there, except 'CAM' is given more weight than 'scope'. This seems rather like a POV change as opposed to an improvement to our encyclopedia. What is the rational for why this is better? Puhlaa (talk) 19:04, 8 October 2012 (UTC)

" Chiropractic is an alternative medicine health care profession concerned with" sounds good to me. I'd prefer we mention that it claims to be able to do the stated things; the sentence as it stands seems (to me) to imply that it factually can do them, a contention which (except perhaps in the case of back pain) the sources don't seem (to me) to support. --Mknjbhvgcf (talk) 19:07, 8 October 2012 (UTC)

'Claims' is weasel words and is not an accurate representation of the WHO source. Axl's suggestion may be acceptable if we can understand why it is an 'improvement' to switch the order in the first sentence? I feel it may just be a way to push a POV; I guess it depends if editors feel that the most weight should be given to chiropractic as a CAM or to chiropractic as a form of msk treatment. I think that many editors will agree that chiropractic is moving towards the mainstream and not vice-versa, at least that is what mainstream experts have expressed in high-quality sources (see this source: [25]). Thus, I think that the proposed switch in order is actually a step backwards for the article, with regard to where more weight should be given. Puhlaa (talk) 19:21, 8 October 2012 (UTC)

I do not agree it's an improvement for the simple reason is that the 'alternative med' label seems to apply only in certain jurisdictions and contexts whereas leaving it out altogether as it currently stands is a better option since a global evaluation would suggest that chiropractic in some countries is already part of the mainstream health care. DVMt (talk) 19:34, 8 October 2012 (UTC)

The WHO document implies that chiropractic is a type of CAM. Many of the references also have this implication. Therefore I believe that chiropractic should be labelled as such in the first sentence. I accept that chiropractic is in a process of transition between CAM and "mainstream" medicine. There is room for different viewpoints and disagreement between editors as to how far along chiropractic is in this process.

The WHO document does not use the word "claims" in this context. Use of the word "claims" implies that the assertion is contested. The WHO document does not imply that. Therefore I believe that the use of the word "claims" is a misrepresentation of the WHO document. It is an expression of doubt that is not supported by the reference. Axl ¤ [Talk] 20:08, 8 October 2012 (UTC)

I agree that most mainstream 'bodies' accept chiropractic as a CAM, even as it is going through transition. Thus, I do not object to reversing the order in the sentence on that basis. I think that the text should retain 'complementary and alternative medicine' if the change is made, as the distinction between the two terms (complementary/alternative) is a whole other controversial debate, even within mainstream literature. I could find as many sources that call chiro complementary as those that call it alternative. Most just stick with CAM to avoid this debate. Puhlaa (talk) 20:18, 8 October 2012 (UTC)

The second sentence in the lede already mentions that chiropractic, for the most part is considered CAM. "It is generally categorized as complementary and alternative medicine (CAM).[2]. There's no need to insert in the first sentence and make it redundant. I agree with the CAM label its the most neutral wording at this point in time. For the record, the WHO source represents not only the WHO's official stance on chiropractic but also the WFC. If we are going to try and make this article represent a more global view than surely we can't cherry pick more or less favourable "definitions" based positive or critical sources. The WHO is a neutral, respected and highly reliable source. DVMt (talk) 02:46, 11 October 2012 (UTC)

"The second sentence in the lede already mentions that chiropractic, for the most part is considered CAM.... There's no need to insert in the first sentence and make it redundant."

My recommendation includes deletion of the second sentence, not to keep redundant text in two consecutive sentences.

"If we are going to try and make this article represent a more global view than surely we can't cherry pick more or less favourable "definitions" based positive or critical sources."

I'm not sure who that text is directed at. I haven't seen any evidence of anyone "cherry picking" sources. If the statement is directed at me, please make that explicitly clear.

Based on Puhlaa's and DVMt's comments regarding CAM, my new recommendation:-

"Chiropractic is a complementary and alternative medicine health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health."

Axl ¤ [Talk] 10:13, 11 October 2012 (UTC)

I see no reason to object, according to policy, if the change is made as most recently suggested by Axl. That said, as I mentioned previously, I am still not completely in agreement that this change improves the article. I think that by removing 'generally classified as CAM' we only remove the indication that there is a growing controversy over the label. The lede does include other references to the professional evolution, however, so I will not object to the loss of this particular mention of controversy in the lede, if you indeed decide to make the change :) Puhlaa (talk) 02:50, 12 October 2012 (UTC)

In the absence of further comments by DVMt or other editors, I have changed the introductory sentence. Of course I would be happy to discuss this again upon request. Axl ¤ [Talk] 17:03, 15 October 2012 (UTC)

• I would suggest people look at more sources than just what the WHO says. IRWolfie- (talk) 09:20, 9 October 2012 (UTC)

You've succeeded.

WP:NOTFORUM
The following discussion has been closed. Please do not modify it.
The group beating I've undergone on this page has succeeded in driving me away from Wikipedia. I'm losing sleep over this; it isn't worth it. Bye. --Mknjbhvgcf (talk) 07:42, 9 October 2012 (UTC)

It's amazing

WP:NOTFORUM
The following discussion has been closed. Please do not modify it.
I find it amazing how such a well written article, with its various descriptions and terms, as well as all 195 references can be summed up with one single word: quackery. I find this talk page quite funny as well, a subtle struggle between those who want to make it more apparent that chiropractic is fraudulent, and those who want to make it appear as more legitimate. And just imagine, this is only one single article. I've learned alot from witnessing the changes to this article and the discussions contained from this talk page over the years, though the fundamentals never change: push towards fraudulency, pull towards legitimacy. If anything positive can be said, I think it's that you can learn alot just watching these, might I say, cordial conflicts. 97.88.182.72 (talk) 17:51, 12 October 2012 (UTC)

FTN

Just to let everyone know that I started a thread at WP:FTN. Arc de Ciel (talk) 09:53, 27 October 2012 (UTC)

Recent Edits

A recent good-faith edit [26] has changed the meaning of the text. The original text stated that the 'battle between mainstream medicine and chiropractic has been sustained by pseudoscientific ideas such as subluxation'. The new version of the text "...chiropractic has been sustained by..." is saying something different and should either be reverted to the original version or re-edited to give the correct meaning. Puhlaa (talk) 00:40, 28 October 2012 (UTC)

After looking at the source, it seems that the original text was not consistent with the source either. The Keating source says: "A significant and continuing barrier to scientific progress within chiropractic are the anti-scientific and pseudo-scientific ideas [subluxation and innate intelligence] which have sustained the profession throughout a century of intense struggle with political medicine." Thus, the current text should not be reverted to the original version, as I originally suggested. However, the current text may still not be a good representation of the source, as it excludes the context that Keating gives to the mention of pseudoscientific ideas. Any thoughts? Puhlaa (talk) 01:58, 28 October 2012 (UTC)

IMO this text is getting dated and could be better worded or even omitted. A lot of the lede and, indeed the article itself feels like at times things are "bandaged" together which changes context or really does nothing that adds serious contributions from the articles. Especially on op-ed pieces like Keating and Ernst. I would be in favour of striking that paragraph and rewording it entirely. DVMt (talk) 18:21, 3 November 2012 (UTC)

Introduction revision

Wikiped has flagged the intro as being too long. After reading it I agree. Much of the mixer/straight discussion needs to be in the appropriate section. I don't like the WHO definition for chiropractic-it isn't germane to chiropractic practice in the USA and was likely inserted by former Life U president Sid Williams DC who was affiliated with the straight ICA assoc. and wanted to push chiropractic as a universal panacea. Chiropractors aren't allowed to treat neurological conditions, they either diagnose subluxation or a musculoskeletal condition or they will not get paid by third party payers and the US government.

I am suggesting you start with this as the intro:

Chiropractic (chiro- "hand" + praktikos "practical", means "done by hand.") is a complementary and alternative[1] health care profession that seeks to use spinal manipulation beyond the medically accepted use of providing pain therapy and rehabilitation for recognized musculoskeletal disorders (i.e. acute low back pain) and instead advocates a controversial prophylactic approach of regular manipulation sessions based on chiropractic analysis methods which are claimed as being vital to maintain the biomechanical integrity of spinal joints and are believed by many to result in general health improvement through improved nervous system function.

I think this catches the essence of why chirop is different from medicine which is important to state after listing it as a C&A health care prof. It also introduces the idea of basing a wider mixer scope around a narrow treatment manipulation. In fact, some states (NJ for example) will not allow a DC to treat a patient unless vertebral subluxation is diagnosed concurrently. Abotnick (talk) 01:33, 5 December 2012 (UTC)

I would suggest moving all the but the first paragraph into the body of the article. We could work re-adding things after that. TippyGoomba (talk) 02:31, 5 December 2012 (UTC)

I agree Tippy, I just wanted to make sure that people were ok with it before I started revising the body. I've seen a tendency to lose focus and over cite, probably because chiros are afraid of being portrayed in a negative light. I've revised it a little more. Here's the new paragraph.

Chiropractic (chiro- "hand" + praktikos "practical", means "done by hand.") is a complementary and alternative[1] health care profession that seeks to use spinal manipulation beyond the medically accepted use of providing pain therapy and rehabilitation for recognized musculoskeletal disorders (i.e. acute low back pain) and instead advocates a controversial prophylactic approach of regular manipulation sessions (aka adjustments) based on chiropractic analysis methods. This approach is accepted by most chiropractors as being vital in maintaining the biomechanical integrity and mobility of spinal joints which they presume confers protection against spinal degenerative joint disease (aka osteoarthritis). Many chiropractors also claim that general health improvement results from their manipulations through optimized nervous system function and that this improvement can help or possibly cure a nearly unlimited variety of diseases.Abotnick (talk) 04:00, 5 December 2012 (UTC)

The current lead is well-written and well-cited. It is currently 5 paragraphs in length. If the lead is too long, then I would recommend cutting paragraphs 2 and 4, while maintaining paragraphs 1, 3, and 5. No rewrite beyond that is warranted. Paragraphs 2 and 4 are well-covered in the rest of the article. 67.127.247.159 (talk) 18:10, 5 December 2012 (UTC)

UTC I have to disagree. Please disclose conflicts of interest regarding this article. Although ref. 1 is cited, it is a misleading term that portrays chiropractors as primary care physicians in a larger scope of practice than is legally permissible in many states such as NJ which I stated above. A minority of chiro colleges teach the mixer model emphasizing primary care using naturopathic type treatment (National teaches naturopathy alongside chiropractic). While some states recognize this expanded role, many do not, and all states are built around or include the idea that DCs use manipulation to treat biomechanical problems of the spine to improve health (which is unproven). Further, this primary care role is rejected by Medicare which only allows DCs to diagnose and treat vertebral subluxation complex, a biomechanical disorder recognized for chiropractors. The definition of primary care recognized by the federal gov is that a provider is qualified to treat 90% of conditions presented by the general public.

Here's Illinois state law for chiros where National resides:

"Chiropractic physician" means a person licensed to treat human ailments without the use of drugs and without operative surgery. Nothing in this Act shall be construed to prohibit a chiropractic physician from providing advice regarding the use of non-prescription products or from administering atmospheric oxygen. Nothing in this Act shall be construed to authorize a chiropractic physician to prescribe drugs. http://ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1309&ChapAct=225%26nbsp%3BILCS%26nbsp%3B60%2F&ChapterID=24&ChapterName=PROFESSIONS+AND+OCCUPATIONS&ActName=Medical+Practice+Act+of+1987%2E

National also has a program in Florida so look at their scope:

""Practice of chiropractic" means a noncombative principle and practice consisting of the science, philosophy, and art of the adjustment, manipulation, and treatment of the human body in which vertebral subluxations and other malpositioned articulations and structures that are interfering with the normal generation, transmission, and expression of nerve impulse between the brain, organs, and tissue cells of the body, thereby causing disease, are adjusted, manipulated, or treated, thus restoring the normal flow of nerve impulse which produces normal function and consequent health by chiropractic physicians using specific chiropractic adjustment or manipulation techniques taught in chiropractic colleges accredited by the Council on Chiropractic Education. No person other than a licensed chiropractic physician may render chiropractic services, chiropractic adjustments, or chiropractic manipulations.-http://www.chiropractic.org/statutes/florida.htm"

Notice there is no mention of primary care, just portal of entry treating biomechanical problems and giving concurrent care for relative lifestyle issues, exactly like NJ. So this idea that DCs are neuromusculoskeletal doctors is laughable. It is like calling foot reflexologists liver specialists because they think they can affect the liver by rubbing a spot on the sole of one's foot.

Clearly primary care is beyond chiropractic scope due to bans on drugs and surgery. At best chiropractors are unconventional portal of entry providers for musculoskeletal problems and any care beyond this is completely rejected as not medically necessary by third party payers and the federal government. At best you could say that although some states allow chiropractors to diagnose and treat diseases without drugs and surgery, the majority limit chiropractors to treatment of the biomechanical disorders of the spine along with concurrent lifestyle, exercise and nutritional recommendations. Just because the citation is a definition accepted by a recognized organization (WHO) doesn't mean that it is correct and neutral. Since both mixers and straights claim biomechanical problems and none qualify under the definition of primary care it is a bad idea to use the WHO definition. -Abotnick (talk) 20:31, 5 December 2012 (UTC)

I believe Abotnick's is relying on too much synthesis. I prefer TippyGoomba's suggestion of just leaving the first paragraph and incorporating the rest into the body. 98.151.187.104 (talk) 23:52, 9 December 2012 (UTC)

Agree. That would be a sensible first step. Alexbrn (talk) 14:19, 15 December 2012 (UTC)

World Chiropractic Alliance is being AfDed

Wikipedia:Articles for deletion/World Chiropractic Alliance

If anyone wants to improve it, please do, because it is notable, even if it's in an infamous way. -- Brangifer (talk) 17:25, 15 December 2012 (UTC)

Avoid using the word "tendentious"

This is just a suggestion to avoid edit-warring and hard feelings. I would advise all editors to avoid using the word tendentious in talking about other users' editing. It's kind of jarring and unhelpful. Thanks for listening. GeorgeLouis (talk) 05:17, 31 December 2012 (UTC)

Unless it is (which is the case with Puhlaa, who is a chiropractor editing to protect his commercial interests). Guy (Help!) 11:39, 31 December 2012 (UTC)

Let's keep personal opinion out. On the flip side, you're adamant about defending the credibility of your buddy Sheldon Brown on bicycle related things via appeal to popularity without producing secondary evidence to back your assertion Cantaloupe2 (talk) 00:38, 3 January 2013 (UTC)

A case in point: how documents are quoted

Summary: The devil is in the detail. I am currently checking the detail. I am an admin and have no financial interest in chiropractic.

TL;DR version:

Puhlaa, a chiropractor, has repeatedly reverted in text stating that "Chiropractic care is generally safe when employed skillfully and appropriately" based on the WHO document. What that document actually says is: "When employed skilfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems. There are, however, known risks and contraindications to manual and other treatment protocols used in chiropractic practice."

Note the significant caveats: skilfully and appropriately, and known risks and contraindications. So this cannot be taken as an unequivocal statement that chiro is safe, because the entire reason the document exists is that in many cases, as it states in the introduction, chiro is notused skilfully and appropriately.

The document itself is framed in terms of an idealised practice of chiropractic which provably does not match the actual practice by many within the chiropractic community; this goes to the heart of why chiropractic has not become, like osteopathy in the US, an accepted mainstream, medical profession.

Another common one in the UK is chiros claiming to treat infant colic (discussion). This is quackery, pure and simple. There is absolutely no evidential basis for it; CAM proponent George Lewith tries to make the case in a Cochrane review but is forced to conclude that when you exclude trials with poor methodology, there is no significant result.

This is an absolutely classic CAM scenario: an implausible claim, with no credible mechanism, backed by observational data highly prone to bias, asserted as fact with demands that science-based medicine disprove the claim rather than through the correct scientific mechanism of testing the claim. And that's the kind of thing we have to be careful of here because supporters will claim: "The majority of the included trials appeared to indicate that the parents of infants receiving manipulative therapies reported fewer hours crying per day than parents whose infants did not, based on contemporaneous crying diaries, and this difference was statistically significant", but the entire text is "The studies included in this meta-analysis were generally small and methodologically prone to bias, which makes it impossible to arrive at a definitive conclusion about the effectiveness of manipulative therapies for infantile colic. The majority of the included trials appeared to indicate that the parents of infants receiving manipulative therapies reported fewer hours crying per day than parents whose infants did not, based on contemporaneous crying diaries, and this difference was statistically significant. The trials also indicate that a greater proportion of those parents reported improvements that were clinically significant. However, most studies had a high risk of performance bias due to the fact that the assessors (parents) were not blind to who had received the intervention. When combining only those trials with a low risk of such performance bias, the results did not reach statistical significance. Further research is required where those assessing the treatment outcomes do not know whether or not the infant has received a manipulative therapy. There are inadequate data to reach any definitive conclusions about the safety of these interventions".

The correct conclusion from this is that chiro is not effective, not cost-effective and not indicated for infant colic, because the strongest studies, with the best methodology, show no significant benefit over doing nothing. It's important because infant colic is incredibly distressing for the parents (trust me, I've sat through those long nights), so, like cancer patients, you have a vulnerable community whose emotions are easily manipulated. In medicine, it is not enough to claim that you can't prove something doesn't work, you have to prove that it does work, and that it works better than the alternative. In our case the effective treatment was to push the lad round in a pram or take him for a drive in the car, which worked like a charm (until you stopped).

What's even more worrying is that adverse effects were only even considered in one of the studies reviewed. This blindness to potential adverse effects is also common in CAM.

The idea of "maintenance adjustments" is particularly problematic. From the outside, this looks like a money-making scam. There's no credible reason to suppose that maintenance adjustments are anything other than fraud. Studies in the US have found that once you take into account the number of treatments stated to be needed, chiro comes out very poorly in a value for money assessment - although manipulation works as well as any other manipulation for lower back pain, chiros typically seem to want you to go to them for longer, and ideally to keep going regularly forever.

So: any sources for safety and/or efficacy of this or any other CAM intervention have to be assessed very carefully, and we must only accept the studies which are methodologically rigorous and published in reputable journals, because as the Cochrane review shows the world of CAM, in which chiro is no exception, has its own walled garden of low impact low quality journals which will publish supportive studies pretty much regardless of methodological quality. This is not specific to chiro, as I say, but is a core principle behind WP:MEDRS, and allows us to keep fringe views in their proper context. We must also guard against implicitly extending claims; chiro is cost-effective for lower back pain based on 6 treatments does not mean chiro is cost effective for lower back pain period, because some chiros will want between 12 and infinity sessions.

There is little doubt that if chiropractors as a class restricted themselves to musculoskeletal pain in the lower back and stuck to the best evidence-based guidelines, there would be very little controversy. There is solid evidence that a very large number do not do this. That's why there is controversy, and lots of it. And that's why we must be careful with sources and reflect the generality of practice not an idealised model of practice, per the WHO guideline, which is not what happens in reality. And that is why I am reading throught he article very carefully now, checking the claims, and assessing the sources in context. Guy (Help!) 12:29, 31 December 2012 (UTC)

Removal of sourced info

This edit [27] removed sourced information from the body of the article. I have reverted it as there is no consensus to remove information from reliable sources.Puhlaa (talk) 01:30, 31 December 2012 (UTC)

A consumer survey is about as reliable as an internet poll. Check out confirmation bias for details. TippyGoomba (talk) 01:37, 31 December 2012 (UTC)

Tippy, try not to revert by reflex and actually read the text first. The section is "Utilization, satisfaction rates, and third-party coverage". Like the WHO source, I challenge you again with regard to this source quality. Consumer reports is a good source for a statement about patient satisfaction. Do you actually think otherwise? I will be taking this source and the WHO source to the reliable sources noticeboard, please watch for the notification.Puhlaa (talk) 01:44, 31 December 2012 (UTC)

I have posted this concern at the Reliable Sources NoticeBoard [28] Puhlaa (talk) 02:23, 31 December 2012 (UTC)

Once again, you reverted three times in 24h to return to your preferred wording. This is not acceptable. You are a chiropractor, you have a conflict of interest, and you are edit warring to make the article on chiropractic reflect your more positive view of the subject. That is simply not allowed. Guy (Help!) 11:36, 31 December 2012 (UTC)

Please focus your comments on the quality of sources rather than about other editors. Instead of addressing policy and source-based concerns regarding your recent edits, you are just repetitively discussing my COI. This is frustrating and does not help us resolve the issue.Puhlaa (talk) 01:47, 1 January 2013 (UTC)

Consumer Reports as reliable source

It seems to me that Consumer Reports is a reliable source for that which is reports on, but be sure that you quote it or abstract from it accurately. The magazine certainly did not say or even imply that "A 2011 consumer report survey found that the public considered chiropractic to outperform all other available back and neck pain treatments." If you don't have access to the magazine on line, I do, and I can send you the text if need be. There were 45,000 surveys returned to the magazine, and the readers' experience with chiropractic ranged all over the place. GeorgeLouis (talk) 05:14, 31 December 2012 (UTC)

GeorgeLouis, I agree that Consumer Reports is a reliable source for this information. However, I disagree with your assessment of what the Consumer Report source says. The very first sentence in the 'back pain' section indeed says: "Chiropractic outperformed all other back-pain treatments...." I understand from your comment at the noticeboard that you take issue with the words "the public"? The text in our wikipedia article could be changed to say: "A 2011 consumer report survey of 45,000 readers found that chiropractic outperformed all other available back and neck pain treatments." Puhlaa (talk) 05:32, 31 December 2012 (UTC)

Looks good to me. Other editors might disagree, citing WP:Weight or some other bylaw. But capitalize and italicize Consumer Reports, and explain what the magazine is (for non-American readers). GeorgeLouis (talk) 05:38, 31 December 2012 (UTC)

No problem with the capitalization and italics, but would wiki-linking Consumer Reports be enough for an explanation of the organization? Puhlaa (talk) 06:10, 31 December 2012 (UTC)

Customer satisfaction surveys do not have any real utility here. One of the core features of chiropractic practice building training is in manipulating customer feelings so they feel validated in their choice. We should be very careful when using subjective data to assert effectiveness for what is, after all, a field riddled with quackery. We should also avoid using low impact factor journals with strong findings in one direction to "balance" much weightier journals with more equivocal or opposite findings. Guy (Help!) 11:34, 31 December 2012 (UTC)

Consumer Reports is reliable in what it does. Whether what it reports is of value in context is a case-by-case issue. "A 2011 consumer report survey of 45,000 readers found that chiropractic outperformed all other available back and neck pain treatments". Whoever wrote it that way editorialized it to boost it in his favor. A 2011 phone survey of ~45,651 collected that 38% or so reported using chiropractor and of the 38%, 68% self reported "helpful". I just guessed the values from memory so you have to go back and check the source. You can't interpret the data and make your own conclusion to advance your position, because that is original research. Cantaloupe2 (talk) 23:01, 31 December 2012 (UTC)

Exactly, we cant make our own conclusions. The source has been determined to be reliable, is there a reliable source that suggests the report was editorialized for anyones favour, or that Consumer Reports is known for Bias? The source says that "chiropractic outperformed all other treatments". This was likely concluded because less than 64% of respondents who had tried other back pain treatments found them equally as satisfying. To bring-up specific numbers and do our own analysis and make our own conclusion is OR, lets just stick to the conclusion of the reliable source.Puhlaa (talk) 23:32, 31 December 2012 (UTC)

Quoting the report itself... A total of 30,332 survey respondents gave us their perceptions of the helpfulness of treatments for their most bothersome conditions over the past two years. The respondents were Consumer Reports subscribers, and our findings might not be representative of the general population. Respondents based their opinions on personal experience, so the results can't be compared with scientific clinical trials. And our results do not take into account the power of the placebo effect, the tendency of people to find even simulated or sham interventions helpful.

No facts, science, or statistics, just a bit of uninformative trivia. TippyGoomba (talk) 23:44, 31 December 2012 (UTC)

Yep, which is why we attribute it to Consumer Reports and mention that it was a survey. As Consumer Reports is a non-profit, independent organization (as per our wiki article) that is known for advocating for consumers, it is no surprise that the majority opinion so far at the reliable sources noticeboard has been that the Consumer Reports is reliable for this purpose - to describe the opinions of consumers. Of course, when/if we re-ad the Consumer Reports source with the appropriate text, we can also support and explain its findings with peer-reviewed sources like this: [29] "The mean satisfaction score for chiropractic patients was greater than the score for medical patients....Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients' satisfaction." Do you know of any reliable sources that refute the patient satisfaction findings of Consumer Reports or this peer-reviewed source, which may give us cause to question these findings? Puhlaa (talk) 00:13, 1 January 2013 (UTC)

I'm not sure which reference it was, but it was another pmid.gov. I seem to recall that the references from here I read last night said there's a correlation between interpersonal interaction and satisfaction rating, but the correlation between effectiveness and satisfaction was lacking sufficient evidence. Cantaloupe2 (talk) 02:35, 1 January 2013 (UTC)

I am not sure that I have seen that specific study Cantaloupe. However, there is no lack of studies in mainstream journals that consistently indicate a high-level of satisfaction among chiropractic patients; here are 2 more [30] & [31]. Most suggest that it is the doctor-patient interaction that results in the largest differences in satisfaction. This is a reasonable assumption, as most efficacy studies show about equivalent efficacy outcomes between chiropractic manual therapies and other therapies, meaning it is likely other factors that account for the increased satisfaction among chiropractic patients. I would be ok with the inclusion of a brief discussion of 'why' as part of this section, however, this current discussion is about the Consumer Reports source and if it is acceptable for inclusion. It has been called reliable on the relevant noticeboard, it's conclusions are consistent with peer-reviewed sources, the text attributed the findings and it was in a section of the body of the article called "...satisfaction rates...". Thus, I fail to see why this is an issue for some editors. Puhlaa (talk) 03:27, 1 January 2013 (UTC)

I have added a brief discussion of patient satisfaction to the section titled "Utilization, satisfaction rates, and third-party coverage", using reliable, peer-reviewed, mainstream sources [32]. I have tried to qualify "why" chiropractic patients are more satisfied. I would still like to restore the Consumer Reports source, but will await the conclusion of discussion at the reliable sources noticeboard and here. I would also propose adding another Consumer Reports source from 2009 [33], which gave results consistent with the peer-reviewed sources just added and the 2011 Consumer Reports survey currently under discussion. Puhlaa (talk) 18:36, 2 January 2013 (UTC)

There ya go. THIS "CONCLUSIONS: The evidence about the factors that underlie high levels of chiropractic satisfaction is not consistent. Communication quality seems to be a consistent predictor of patient satisfaction with chiropractors. More research is needed to understand the role of perceived effectiveness of treatment, intensity of use, accessibility, and financing issues in determining patient satisfaction levels." Cantaloupe2 (talk) 00:25, 3 January 2013 (UTC)

Thanks for the discussion Cantaloupe! You have made reference to an article in JMPT that was included in the article previously, but was also removed as part of JzG (GUY's) deletion of the Consumer Reports source. I think it was deleted it because it is a chiropractic journal (in my experience, chiropractic sources are often deleted when the outcomes are favorable and retained if the outcome is critical). The general conclusions of the JMPT article you present are that the researchers were unsure why chiropractic patients are more satisfied than other patients, but they think it is primarily due to communication issues. The source also says :"Satisfaction levels with chiropractic care are quite high (83% of persons are satisfied or very satisfied)" Thus, this source is also very consistent with the Consumer Reports sources and the peer-reviewed sources I have already listed! Unfortunately, the article you listed from JMPT has no control group or method of comparison at all, making it fairly low-quality (plus it is a favorable conclusion in a dreaded chiropractic journal). I have avoided including any chiropractic sources here, but I am very open to using any good chiropractic sources that are available, if this is the consensus! Puhlaa (talk) 02:07, 3 January 2013 (UTC)

Deletion of more reliable sources

JzG (Guy), you have again deleted reliable sources in the article without any prior discussion. This edit [34] removed 2 systematic reviews, one from European Spine Journal [35] and one from the Journal of Electromyography and Kinesiology [36]. Can you explain why you do not think that these are suitable for the body of the article under the section 'cost-effectiveness'.Puhlaa (talk) 19:11, 31 December 2012 (UTC)

There has been no attempt to justify the removal of these two secondary sources from the article, so I have restored them for now [37]. I am still willing to discuss this if editors feel there is a policy-based reason to exclude these sources? Puhlaa (talk) 18:38, 2 January 2013 (UTC)

POV fork

Since it looks like editors are starting to fix some of the main problems with the article, I'd like to point out that there is a POV fork (Chiropractic controversy and criticism) containing a lot of material that's underrepresented in this article, and it would probably be easiest to fix this problem now as well. Arc de Ciel (talk) 01:04, 1 January 2013 (UTC)

Agreed, and that should help fix the NPOV issues with the article, which I certainly agree is excessivelt flattering to a field which has a long way to go before it is anything like respectable. Guy (Help!) 23:15, 4 January 2013 (UTC)

Recent Edits 2

I have reverted these [38] recent edits according to WP:BRD. I reverted the bold edits for a number of reasons:

1. The edits removed a definition from a reliable source and replaced it with an unsourced definition; see WP:RS.
2. The edits replaced a current definition with a historical perspective. It does not make sense to begin the article by defining the profession according to what it was "historically", it makes more sense, and is more consistent with other articles about professions, to start with a current definition. There is plenty of "historical" discussion later in the lead.
3. The edits added details of a topic that is not found anywhere in the body of the article; the lead is supposed to represent the body, see WP:MOS.
4. The edits added details of a specific issue that is not be noteworthy for the lead per WP:UNDUE.
5. The edits added a significant amount of text regarding a single current event that is taking place in the United States to the lead of an article that is already flagged as "not representing a world view" and the "lead is too long".
6. The edits removed a flag indicating that the "lead is too long", but did not attempt to resolve this issue, in fact did the opposite (see point #5).

Puhlaa (talk) 01:13, 28 December 2012 (UTC)

And since you'd already reverted to your preferred version once and ignored the discussion, and there were contribs from multiple users which fixed tagged problems with the article, I have undone your reversion. Your opinion that the attempt by chiros to be classed as primary care practitioners does nto appear to be shared by them. They have lobbied at the Congressional and State levels for this, and if they are not classed as primary care practitioners then it may have a profound impact on their profitability (which is, as far as I can tell, the single most important thing in chiropractic, certainly that appeared to be DD's view. The WHO source was not a "definition of a reliable source", it was a misrepresentation of an opinion piece published under the auspices of the WHO. We've been there before with other pseudosciences. And the "lede too long" tag was removed because - wait for it - I shortened the lede. That's what maintenance tags are for. Being an admin of some years' experience I do know what I'm taking about there! Guy (Help!) 19:17, 30 December 2012 (UTC)

JzG (Guy), Please provide a link to where we discussed your proposed changes.... Of course, your changes were not discussed, hence why I reverted them again. The "multiple" editors did not fix any problems, your edits added repetitive and unnecessary text (I explain this above in my list of concerns) and Arc's edits just copy-edited your edits. You have not addressed the concerns of lead length or the US-focus, so do not remove those tags. You have not addressed any of the concerns I raised above, so I reverted your changes again. Please address my concerns, which I have thoughtfully listed above for you to examine and discuss. A lack of willingness to discuss your edits, but your continued insistence at restoring those edits, is called editing tendentiously. If you are an admin then you should know very well that you are not editing collaboratively by forcing your edits in even though there are policy-based challenges being raised. Admins are held accountable for their edits like anyone else. WHO is a reliable source, if you disagree then lets take it to the reliable sources noticeboard; It is certainly more reliable than the non-existent source you are replacing it with. Also, we already discuss pseudoscience in the lead in 2 locations, you are adding it at the end of the lead again for no reason. There is no text that says chiropractors are primary care practitioners, so you point regarding this issue is moot. Please address my concerns above regarding your edits. Puhlaa (talk) 19:44, 30 December 2012 (UTC)

Or you could just stop reverting to your preferred version. That's two reverts by you today, and I am currently working through on weasel words. Guy

(Help!) 20:25, 30 December 2012 (UTC)

Would you kindly stop removing the sourced definition of chiropractic and replacing it with an unsourced "histoical" perspective. The discussion above is attempting to determine how to best shorten the lead and your edits are not helpful in this regard. NO one has agreed to your POV edits that add repetitive text and "historical" perspectives in place of sourced and WP:NPOV text.Puhlaa (talk) 20:31, 30 December 2012 (UTC)

Nothing is being removed, the source is still cited and linked. I am reordering statements to prune the lede and otherwise tighten the rambling special pleading scattered throughout the article. As a chiropractor you have a conflict of interest and your views are not neutral. In short, you are not the arbiter of what is significant, neither am I of course but you very definitely aren't because your livelihood depends on people believing in chiropractic. I don't care whether they do or not, only that they have a properly summarised lede and a decently comprehensive description of the field especially as it is seen by the reality-based community. You seem to be confusing MPOV with NPOV. Guy (Help!) 20:51, 30 December 2012 (UTC)

You still have not addressed my concern that you are replacing a current and sourced definition of chiropractic with a historical perspective with no source. WP:RS says that the WHO definition is preferred over your unsourced definition. Moreover, your definition seems to be WP:OR. What policy do you feel supports your opinion that your OR definition based on a historical perspective is better than a current sourced definition from WHO? Perhaps you are the one confusing NPOV with MPOV? Admins are held to the same standards as other editors, do you agree? My COI is presented on my profile and there is no policy that suggests that my edits or opinions are worth any less than yours.Puhlaa (talk) 22:43, 30 December 2012 (UTC)

In the same regard, can you please provide a source that says: "The scientific consensus is that chiropractic is on a par with other manual therapies for...." or is this more of your WP:OR? As an admin, it is suprising that you dont understand how we rely on sources here.Puhlaa (talk) 22:45, 30 December 2012 (UTC)

Please review WP:Battleground. It was trivial to find a source for that def. Since you claim to be educated on the subject, I presume you already knew that. Odd, very odd. TippyGoomba (talk) 23:01, 30 December 2012 (UTC)

And WP:COI and WP:FRINGE for that matter. As a chiropractor I am sure Puhlaa is very keen to show the world how wonderful chiropractic is, but that's not what Wikipedia is for; there is a broad spectrum of chiropractic practice, a large chunk of which is fraudulent (e.g. claims to treat infant colic, and the side-specialty of craniosacral therapy which is commonly offered by chiros). We're not going to cast the article in the form of the few more or less ethical chiros and ignore the great swathes of quackery which in my country at least vastly outweigh any legitimate practice, that would be a fundamental violation of policy. The scientific consensus is what it is: manipulation therapy is valid for lower back pain, abject nonsense for most other things, and there is a mountain of evidence to the effect that chiropractors are more interested in getting people coming in every week for manipulations whose medical value is, to put it charitably, unproven, than in curing and discharging a patient. Virtually every practice-building seminar focuses on getting them young, getting them hooked, and reinforcing their habit. Guy (Help!) 23:08, 30 December 2012 (UTC)

@ JzG (Guy), your ad-hominum attacks and accusations of COI are interesting; I have only challenged your edits with policy and all you have brought back to address my challenges is personal attacks. Is this typical admin behaviour? Tippy, thank you for adding a 1987 source to help improve lead. I presume that by this edit you are agreeing with JzG that a historical perspective is more appropriate to start our lead than a current definition from an international medical body? Either of you care to inquire at the neutral sources, or reliable sources noticeboard? Puhlaa (talk) 23:12, 30 December 2012 (UTC)

I'd go one step further, quote Palmer directly, mentioning innate intelligence. But I doubt anyone would agree. TippyGoomba (talk) 23:22, 30 December 2012 (UTC)

You would prefer to start the article with a 100 year old quote?.....I also think that no one would agree.Puhlaa (talk) 01:14, 31 December 2012 (UTC)

A proposal

Well Tippy or JzG (Guy), neither of you have addressed my concerns regarding the removal of the WHO-sourced definition from the first sentence of the lead diff and replacing it with a "historical" definition from a 1987 narrative? The WHO is the better source IMO (no one has challenged this), and is a current definition. The 1987 source is weaker and provides a "historical" perspective. No one has explained why a "hitorical" perspective is better than a current definition to start the lead? I propose restoring the sourced WHO definition in the first sentence, but lets retain the historical perspective you added for the second sentence, to attempt to avoid further dispute. Is this satisfactory? Puhlaa (talk) 02:47, 31 December 2012 (UTC)

Well for starters, the WHO reference fails to reference innate intelligence. That's kinda like astrology without the planets, isn't it? TippyGoomba (talk) 03:22, 31 December 2012 (UTC)

Tippy, perhaps 100 years ago I would say you are correct, however, we should be using a current definition to start, not a historical one, do you agree? Only skeptical organizations that use history to attack the chiropractic profession and the odd fringe traditional chiropractic cult still push the innate intelligence idea as integral to chiropractic. The vast majority (if not all) reliable sources on the topic, both mainstream or chiropractic sources, now define and discuss chiropractic with regard to the musculoskeletal system and manual therapy and not with regard to innate intelligence or vitalism or any other pseudoscience. For example:

• International medical bodies like WHO [39]: “Chiropractic is health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health."
• National medical bodies like NIH/NCCAM[40]: Chiropractic is a health care profession that focuses on the relationship between the body's structure—mainly the spine—and its functioning.
• International chiropractic bodies like WFC[41]: A health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health.
• National chiropractic bodies like ACA [42]:"Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health."
• Government bodies like The US Dept of Labor[43]: "Chiropractors treat patients with health problems of the musculoskeletal system, ... They use spinal manipulation and other techniques..."
• Pubmed Health[44] also does not use the word innate intelligence at all in its discussion of chiropractic. Puhlaa (talk) 04:10, 31 December 2012 (UTC)

Puhlaa, again you are trying to whitewash the subject. A Google search for chiropractic innate gets nearly 800,000 results, many chiros are still wedded tot he idea, it is still taught in chiro schools and training sessions. I am quite willing to believe that you are one of the small number of chiros who rejects the pseudoscientific notions of innate and subluxation, I would be happy to be told that you also reject cervical spine manipulation due to the risk of stroke, and don't treat anything other than lower back pain, and happier still if you could reassure us that you support the medically recommended programme of vaccination and don't treat children, but the fact remains that a very large number of your fellows do not come anywhere close to these ethical minima. I do not believe your view of chiro reflects the overall picture, and your edits, reverts and suggestions in general serve to promote an idealised picture of chiro that is at odds with numerous well-supported critical assessments by independent observers. If you do reject the pseudoscience then I suggest you contact Sam Homola and offer assistance at chirobase.org, I am confident he could do with new blood.

And pointing out that as a chiropractor you have a COI, is not an ad hominem attack, it is a statement of fact, and as an administrator I am pointing out to you something that is actually quite important. Guy (Help!) 11:47, 31 December 2012 (UTC)

JzG (Guy), it is not whitewashing the issue to present high-quality reliable sources to support the inclusion of a definition that is currently under discussion. According to WP:UNDUE the majority view gets the most weight; I have shown the majority view for the definition of chiropractic with reliable sources above. If you disagree with all of their definitions of chiropractic (which are all similar to one another) and would prefer another definition, It would be nice if you could also provide reliable sources that are pertinent to the discussion so we can determine what should get the most weight. Continually bringing up my COI does not help your argument as much as providing reliable sources would.Puhlaa (talk) 19:26, 31 December 2012 (UTC)

Do you have a source for you claim that the majority or chiropractors reject innate intelligence? It would be neat to find some kind of survey about what kind of nonsense they actually believe but I haven't been able to find one. TippyGoomba (talk) 19:41, 31 December 2012 (UTC)

I do not know of a source that explicitly says the majority of chiropractors reject Innate intelligence, however, even 15 years ago, Kaptchuk & Eisenberg [45] suggest in a mainstream, peer-reviewed, medical journal that: "Today, a substantial number of chiropractors are anxious to sever all remaining ties to the vitalism of innate intelligence." Further, I have provided multiple high-quality sources above that define chiropractic without mention of innate intelligence, but rather as a manual therapy discipline dealing with conditions of the musculoskeletal system. I cant find a single national, state or provincial chiropractic association that currently discusses innate intelligence when they describe the profession; only skeptical organizations and some fringe chiropractic groups still push this idea. Not to say that pseudoscientific ideas like innate intelligence have been completely dropped within the profession, but it is not the majority view, nor is it taught in most DC colleges today (if any). Besides, I have never suggested editing the current discussion of innate intelligence in the lead, I have suggested that replacing the WHO definition of chiropractic that formerly started the lead with a "historical" perspective from the 1987 source is inappropriate (which was done here [46]. Puhlaa (talk) 20:50, 31 December 2012 (UTC)

Review of discussion and proposal

I am still hoping to hear more from editors about the changes made to the -first sentence- in the lead as part of this recent edit. I am concerned by the removal of "Chiropractic is a complementary and alternative medicine [1] health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health [WHO]" and replacing it with "Chiropractic is a form of alternative medicine [1] historically based on the idea that misalignment of the spine can cause a wide range of diseases [1987 source]."

It has been suggested that "The WHO source was not a definition of a reliable source...". However, the WHO are specifically listed here as very reliable. It has also been suggested that “the WHO reference fails to reference innate intelligence”. However, this should not be a concern because the edit that I am asking others to review does not deal with innate intelligence; the discussion of innate is found in a separate section of our lead and I am not questioning the inclusion of that text.

I have proposed that "restoring the WHO definition in the first sentence, but lets retain the historical perspective you added for the second sentence...". I think that this proposal will ensure that the article effectively conveys to the reader both the current and the historical aspects of ‘what is chiropractic’ and will then also by consistent with policy like WP:UNDUE by giving more weight to the current situation rather than the historical perspective. Case in point, even the 1987 source that is supporting the “historical" definition in the lead says: "Although osteopathy and chiropractic emerged as medical revitalization movements with a similar disease theory during the late 19th century...chiropractic has evolved into a musculoskeletal speciality." Thus, there is no contradiction between the WHO and the 1987 source, both could exist in the lead, as per my proposal. Puhlaa (talk) 06:51, 6 January 2013 (UTC)

Restored the WHO source as it is well within WP:MEDRS and provides relief to noted shortcomings of the article i.e. US-centric and an equal balance of historical and current chiropractic practices. DVMt (talk) 19:08, 6 January 2013 (UTC)

As I have made clear above, I like the idea of restoring the current majority view of the WHO. However, I do not necessarliy think that the "historical" definition needed to be totally excluded; it does put the history of the profession in context and is therefore relevant. DVMt, do you think the "historical" definition is not apropriate at all? or might it offer some value if it is retained somewhere in the lead? I had proposed keeping it right after the current WHO definition? Puhlaa (talk) 19:18, 6 January 2013 (UTC)

The historical definition can be used for historical purposes, but it doesn't necessarily mean that this is a valid and accurate definition of chiropractic in the 21st century and is one that provides a global perspective. IMO there is already a weight issue in the article wrt the history as it dominates the article almost in it's entirety. The history should be kept in the history and there should be a modern/current/contemporary section to offset the weight of history provided that appropriate references can be found.DVMt (talk) 19:30, 6 January 2013 (UTC)

Recent bold edits

This series of edits [47] by one editor has removed the sourced information that chiropractic is 3rd largest doctored profession (in 2 places and 2 sources), removed citation-needed tags without added sources, and removed the word profession from anywhere it was used to describe the chiropractic profession. These seem like edits that are meant to promote a single POV; ie: that chiropractors are not doctors and are not professionals; however, sources disagree. The edits have since been copy-edited and these cannot be undone by a regular editor (I think)? I am requesting someone with rollback privileges to examine the edits and comment or remove them.Puhlaa (talk) 16:36, 3 January 2013 (UTC)

The Smith source appears to have been conference proceedings. Any indication the source is RS? (the fact it seems to have disappeared from the web suggests it isn't). Alexbrn (talk) 16:54, 3 January 2013 (UTC)

Hello Puhlaa. You're always welcome to discuss edits directly with editors, you know - at least you are in my case! The removal of references to 'doctoring' and 'profession' were intended to add neutrality. I don't have any particular axe to grind personally, but it is clear that many medical professionals and doctors do not regard chiropractic as an equivalent discipline. Whether or not one agrees with that point of view, the fact that there is disagreement suggests that neutral language is preferable in the article, to my mind (but of course I am open to challenge if I've misunderstood). Incidentally, in the UK chiropractors have their own regulatory council, partly in order to ensure that they are not confused with doctors or other health practitioners, and chiropractors could attract firm regulatory challenge through less than rigorous use of language - certainly any who described themselves as doctors would be heading for trouble if they did not also have a recognised medical qualification. So it may be in the interests of chiropractors too to be careful about how the discipline is described. John Snow II (talk) 17:32, 3 January 2013 (UTC)

Thanks for the discussion JohnSnow and Alexbrn. Chiropractors do not get in any trouble for saying they are doctors, at least not in North America; In Australia they are not doctors at all (they only attain an MSc); I am not familiar with the UK situation. I cannot seem to get a hold of the NIH abstract that discusses the "third-largest doctored..." either... not that this inherently means it is not reliable. If I search the internet for the title of the abstract I get 100s of hits to pages/articles that have sourced that same NIH abstract for the same text (many of them are chiropractic sources though). This means the source is, at the very least, popular :) However, I will not further object to the removal of this text and source, if others agree that it should be removed. Thanks for reviewing it. I do still suggest that one [48] of the of the edits are inappropriate (the citation-needed tag was restored already, so this is no-longer an issue). The fact that medical physicians are becoming more open to chiropratic was removed, yet the source says "Historically, chiropractic has had a difficult relationship with medicine, but collegiality between chiropractors and physicians is growing. One in ten now practices as a member of a multidisciplinary group that includes physicians (Stultz 2001). Almost all chiropractors refer to physicians (Cherkin and Mootz 1997), and 80 percent report receiving referrals from physicians, accounting for one-fourth of their patients, double the level reported only seven years earlier (ACA 1994; Jackson 2001)." Yet the edits removed all mention that physicians are also becoming more open to chiropractic. Would anyone object to restoring this information?Puhlaa (talk) 17:45, 3 January 2013 (UTC)

You're very welcome Puhlaa, and thanks for your courteous response. I agree that the citation-needed tag required restoring. Regarding your latter suggestion to introduce text around the relationship between physicians and chiropractors, could I suggest that you first seek input on how this is developing in health economies other than your own? I'm not clear if the sources you quote capture the picture beyond North America, and the article is intended to summarise knowledge about chiropractic internationally, after all. Secondly, if I might offer some advice, it may be wise to be cautious around making claims to physicians being 'open to' chiropractic, and especially to avoid implying that medical doctors are convinced of chiropractic's efficacy or validity - a willingness to accept patients' wishes to try alternative medicine does not necessarily constitute a new scientific consensus, and such a suggestion would probably be challenged by other editors. John Snow II (talk) 20:39, 3 January 2013 (UTC)

JohnSnow, I always enjoy respectful discussion on this topic and try to always be open to improvements to the article :) I agree that many of the referals from MDs to DCs have been shown to be a result of patient preferences [49] and we should be careful how we present this information; however, it does not change the significance of the fact that physicians attitudes have changed. By editing the text as you did, you removed any mention of this fact, however the source seems clear on it. When coming from the perspective that until 1983 the AMA held that it was unethical for medical doctors to associate with an "unscientific practitioner," and labeled chiropractic "an unscientific cult" [50], it seems quite significant that now ~25% of DC patients are coming from MD offices. Puhlaa (talk) 20:56, 3 January 2013 (UTC)

It certainly sounds as if the AMA's official position has changed, but there are two caveats I'd reiterate here Puhlaa. Firstly, this is again just looking at the US situation, and focusing unduly upon one country will attract criticism from other editors as well as perhaps not reflecting the full detail of what's happening around chiropractic internationally - so it really would be worthwhile liaising with your opposite numbers overseas if possible. Secondly, if you believe the attitude of physicians as a profession is changing - i.e. the way that medical doctors behave, not just what their representative body or bodies say - there need to be some really solid references for this to be claimed as a 'fact'; a single source which suggests an apparent trend does not look like uncontestable fact. All the best, John Snow II (talk) 13:35, 4 January 2013 (UTC)

Hi John Snow, Yes, things have come a long ways since the AMA was penalized for prohibiting MDs from referring to DCs. I understand your concerns regarding a US-centric POV and only a single source. I have tried to remedy those concerns here with reliable sources from multiple countries. The changing attitude of physician towards some CAMS is very well known and documented, I have provided some sources that indicate physicians in all countries are starting to acknowledge the value of Chiropractic for musculature conditions.

1. Review of international studies in Archives of Internal Medicine:"This review of 19 international surveys suggests that large numbers of conventional physicians are either referring patients to or practicing some of the more prominent and well-known forms of CAM. Across studies, acupuncture had the highest rate of physician referral (43%), followed by chiropractic (40%)... Approximately half of the surveyed physicians believed in the efficacy of acupuncture (51%), chiropractic (53%)..."
2. Survey of Canadian and American orthopedic surgeons in Spine:"Approximately half (51.4%) of respondents reported that they refer patients for chiropractic care..." AND "attitudes toward chiropractic were diverse, with 44.5% endorsing a negative impression, 29.4% holding favorable views, and 26.1% being neutral. The majority of surgeons believed that chiropractors provide effective therapy for some musculoskeletal complaints (81.8%)."
3. Survey of German and UK physicians in Complementary Therapies in Medicine: "Both nations have an overall positive attitude toward and a high interest in CAM." AND "The most popular CAM therapies that UK GPs referred their patients to were chiropractic treatment, acupuncture and osteopathy. German GPs referred their patients mainly to acupuncture treatment, chiropractic treatment and herbal medicine. Seventy percent of British GPs and 76% of German GPs thought it is safe to prescribe complementary medicine and therapies to patients."
4. Survey of Swiss Chiropractors in JMPT: "Chiropractic practice in Switzerland is a government-recognized medical profession with significant interprofessional referrals resulting in earlier chiropractic treatment for many patients." Here is the web site for a medical clinic in Switzerland that discusses this [51]
5. Plus the original US source from our article [52]:"Historically, chiropractic has had a difficult relationship with medicine, but collegiality between chiropractors and physicians is growing...Almost all chiropractors refer to physicians and 80 percent report receiving referrals from physicians, accounting for one-fourth of their patients, double the level reported only seven years earlier"

I do not think that we need to add a bunch of additional sources to the article to further illustrate this point, however, I do still contend that you should revert the changes you made in this edit [53], where you removed reference to the changing opinion of medical doctors.Puhlaa (talk) 07:00, 5 January 2013 (UTC)

The problem is that Puhlaa, a chiropractor, wants to pusht he article towards documenting an idealised form of chiropractic that bears little resemblance to reality. In the main, and certainly in the UK, chiropractors are generally anti-vaccination, promote manipulation for infants with no good evidence, are in denial about the risks of cervical manipulation and at the same time hoplelessly optimistic of its benefits, and many still cleave to the unverifiable "subluxation" as a cause of organic disease; they also routinely use full spine x-rays while claiming in legislative testimony that they treat soft-tissue disorders. It's a field rife with quackery and false claims, as the poor record on fraud clearly shows, and when Simon Singh wrote about that, they tried to sue him to suppress the facts rather than fix the problem. At one time a quarter of all chiropractors in the UK were under formal investigation for documented false claims. That is not a reputable health profession. (Personal attack removed) We are not here to advertise chiropractic, we are here to document it, warts and all. There are an awful lot of warts. Guy (Help!) 23:07, 4 January 2013 (UTC)

Well yes — in this case the useful guidelines of WP:COIU could be well heeded. Alexbrn (talk) 07:36, 5 January 2013 (UTC)

Alexbrn, do you have a specific concern about one or more of my edits? or are you just goading JzG (Guy)? Also, I am interested as to exactly which category of COI you feel that I would belong to? Finally, consider that if I did not voluntarily post my profession on my public profile, then we would now be discussing the article content and sources I have provided above, rather than having this pointless conversation.

JzG (Guy), I have asked you before, please try to keep the discussion specifically about the text or sources in the article that are under consideration. In all the threads above, I don't know that I can find a single one where you just present reliable sources and make a specific comment with regard to the discussion at hand. Everything you have posted here is COI accusations and your critical opinion about the chiropractic profession? Rather than repeating your COI warnings about me in every single thread, perhaps you can just start a new thread to specifically discuss your accusations against me? Better yet, if you have a specific concern, then I would suggest that you just report me at the appropriate noticeboard so that we can move the discussion of my COI to the appropriate location and let this talk page stay focused on improving the article. Your rhetoric is getting very tiresome and unless you have some specific concern about an edit I made, then you need to stop or I am going to have to report the behavior and let other admins decide if you are acting appropriately.Puhlaa (talk) 08:38, 5 January 2013 (UTC)

Puhlaa — I have had very little experience of this article, but I have quite some experience with COI (including my own, on a completely unrelated topic to this). The thing about COI is that it is not a content issue, it is a person issue – and that makes it particularly toxic since other editors will always be aware of it when controversial edits happen, and it will inevitably get raised. If your profession is chiropractic then you obviously have a COI. In my experience COI-afflicted editors genuinely believe they are neutral and working to improve the article, but are completely unaware of the decentered point of view they in fact have; they often think they are the "exception" to Wikpedia's rule, and can continue editing against the advice of the guidelines. Wikipedia:Best practices for editors with conflicts of interest has some material in it you might find interesting. My advice is that if you want to make substantive edits to an article on a topic for which you are conflicted, then think twice – it is quite likely to end up being a frustrating and unfulfilling experience. Alexbrn (talk) 09:09, 5 January 2013 (UTC)

Thank you for your clarification and warning Alexbrn; I think that any editor would benefit from the advice to "think twice", so this is a valid point that I thank you for. However, as I said above, unless you have a specific concern about any of my edits, or can please indicate which category of COI you feel I belong to, I think that this is really a non-issue here and only serves to distract us all from the relevant discussion aimed at improving the article. I respectfully disagree that the COI policy has any provisions for a health care professional that is editing an article related to their profession; I have seen this rational for ignoring an editors source/policy based suggestions fail here before. I will continue to edit and provide reliable sources and policy to support my concerns or edits, just like any other editor has the right to do. If other editors, like JzG (Guy), don't like my edits or talk page concerns, they also have the right to provide reliable sources and/or policy to challenge me at the talk page. This constant renewal of discussions about a COI and always discussing the editor instead of the edits is called ad-hominem (a logical fallacy) and implies that those editors don't actually have any reliable sources or policy-based rational to discuss, in which case, I suggest they move-on.Puhlaa (talk) 16:18, 5 January 2013 (UTC)

I like the way you totally dismiss COI concerns as irrelevant. I guess that means this gong show will continue. TippyGoomba (talk) 19:01, 5 January 2013 (UTC)

Tippy, I am not particularly fond of the way you have chosen to continue discussing other editors, rather than discussing reliable sources and policy. The discussion here doesn't have to be a gong-show at all; all you need to do is address any policy based concerns with reliable sources and the discussion could remain constructive. A look at the history of my comments here shows that I have provided reliable sources and policy-based reasoning to accompany all of my comments; would a review of your edit history here show the same? Finally, as I said above to Alexbrn and JzG (Guy), if you have a specific concern about any of my edits, I would encourage you to report my behavior to the appropriate forum and allow us to stay focused on article content and reliable sources here.Puhlaa (talk) 20:37, 5 January 2013 (UTC)

Being knowledgeable and an expert is not a COI, but heavy handed editors, lack of consensus types such as Guy -- inflamed an already hot topic. Looking at the history of the article Puhlaa has demonstrated while a chiropractor, he is a chiropractic scientist (obtaining his PhD) who has published articles freely available on his personal page. This article does need shortening indeed, and quickly glancing through the article there are several mass duplications of "historical" items that already have their own page. I would be willing to help see this through provided there's no unnecessary drama and we stick to highest quality, reliable sources. DVMt (talk) 01:09, 6 January 2013 (UTC)

Bold edits and conflicts of interest are best dealt with through extensive reference to the most reliable secondary sources available. There are many personal opinions here, but what is important are sources. A COI is only problematic if it results in poor editing; looking above, Puhlaa is indeed citing MEDRS articles. However, the first point is old, the second is primary, the third is old and primary, the fourth is primary (and focused on Switzerland, making its use on this page a little complicated; at minimum I would be curious to see what Swiss chiros thought their focus of practice was) and the fifth is just on the cusp of being too old to be useful making it also a complex source to deal with. The true measure of a COI editor is what they do when they receive feedback. Edit warring on the basis of ideas that do not change is bad. Seeking better, newer sources is good and outside input on those sources is good. I suggest the latter path. WLU (t) (c) Wikipedia's rules:<sup>simple</sup>/<sub>complex</sub> 03:40, 8 January 2013 (UTC)

Thank you for your objective comment about the sources I presented WLU. I enjoy civil, academic discussion on this topic! Just to be clear, I am not proposing the addition of any sources to the article; I simply expressed concern about this bold edit, which removed longstanding, sourced text that mentioned a changing attitude among physicians. I indicated here that the source does indeed support the text that was deleted. However, it was expressed here that there was only one source, the source was US-centric and individual physicians may not have changed like 'official bodies'. In response, I provided multiple reliable sources, from peer-reviewed journals, to support the source in our article. They were intended to show (using the best sources I could find) that a significant number of physicians, internationally, are referring to chiropractors and acknowledge that chiropractic is effective for some musculoskeletal conditions.

I admit, the secondary source I presented is older, however, it is the newest secondary source on the topic that I am aware of. The secondary source support the sourced text in our article that was removed. So far, no one has provided any better sources on the topic; also, no one has provided any reliable sources that contradicts the source in our article or the sources I presented. It would be illogical to change my opinion in the absence of any evidence that my opinion were incorrect, right? I would be happy to learn of a newer or better source on the topic of 'physician attitude toward chiropractic', no matter what the findings! However, until then, I see no reason to doubt that the edit I am questioning has indeed just removed sourced, notable and verifiable information from the article about a changing attitude among physicians.Puhlaa (talk) 07:05, 8 January 2013 (UTC)

Ya, but this is not a forum, so try to keep it short if possible.

The "bold edit" does seem curious as the source is reliable (but old) and does address that point explicitly, I suggest bringing Snow's attention to your points on his talk page and politely asking why he made the change. Whether to include that sort of information is also the kind of focused, specific question that a WP:RFC could answer. This might be a place where a local consensus could be garnered to support the judicious use of primary sources regarding acceptance of chiropractic by physicians, and (very important) for what. I do think far too much time is being spent on discussing your alleged failings and motivations, and nowhere near enough time spent discussing the sources you are presenting. I think this is to the detriment of the page, because clearly while chiropractic is controversial (and has some outright loons in the profession) it can not be labelled simple quackery. WLU (t) (c) Wikipedia's rules:<sup>simple</sup>/<sub>complex</sub> 14:34, 8 January 2013 (UTC)

WLU, I brought these concerns to Snows talk page, as clearly and politely as possible here. As soon as I produced all those sources, Snow decided then to only focus on my COI and that I should take a break. When I present reliable sources and the response is 'take a wikibreak', and then I also get accused of COI/POV editing....it is very confusing to me! Puhlaa (talk) 16:01, 8 January 2013 (UTC)

If your points are valid and have not been addressed, and the sources adequate, I would suggest replacing the section as part of a WP:BRD cycle. WLU (t) (c) Wikipedia's rules:<sup>simple</sup>/<sub>complex</sub> 22:45, 8 January 2013 (UTC)

Ok, I have re-added the sourced information that was removed by this edit. I also added a qualifying statement; that the greater legitimacy is with regard to the treatment of some musculoskeletal conditions. Discussion is always welcome :) Puhlaa (talk) 05:31, 9 January 2013 (UTC)

GeorgeLouis, I was hoping you would be willing to discuss your rational for these changes? My edits may indeed not have been optimal, so perhaps we can collaboratively determine a better way to express the conclusions of the source? Here is full text.

• With regard to physician acceptance, the source says: "Historically, chiropractic has had a difficult relationship with medicine, but collegiality between chiropractors and physicians is growing. One in ten now practices as a member of a multidisciplinary group that includes physicians (Stultz 2001). Almost all chiropractors refer to physicians (Cherkin and Mootz 1997), and 80 percent report receiving referrals from physicians, accounting for one-fourth of their patients, double the level reported only seven years earlier (ACA 1994; Jackson 2001)."
• With regard to health plans, the source says: "...legal efforts have....greatly expanded chiropractors’ access to patients and to third-party reimbursement. Three-fourths of workers in employer-sponsored health plans now have some degree of chiropractic coverage (Jensen, Roychoudhury, and Cherkin 1998). In 1970, approximately 75 percent of chiropractors’ revenue came directly from patients and 25 percent from insurance, but now these percentages have been reversed (ACA 1994; Jackson 2001)."
• With regard to Political support, this section, entitled "The Intersection of Chiropractic, Politics, and Managed Care" discusses the changes that have occurred.
• I felt it appropriate to add the caveat regarding the idea that it is MSK conditions that chiropractors have been receiving increased legitimacy, because the source discusses this in this section entitles "Chiropractic in the Age of Evidence-Based Medicine".

My thought was that attribution was not necessary because this seems to be more than just the opinion of the authors, this review relies on multiple other sources to make the conclusions. What is your perspective on this suggestion? Thanks Puhlaa (talk) 18:14, 9 January 2013 (UTC)

Additions to the lead

Once again JzG (Guy) has added a discussion of US chiro's trying to become PCP into the lead, however, this is a US-centric issue and is not worth any weight according to WP:UNDUE. I have already mentioned this issue above, including a suggestion that it should at least be added to the body first, but rather than discuss it, JzG (Guy) continually just restores it in the lead and is unwilling to discuss it here. This is an example of tendentious and uncollaborative editing. JzG (Guy), is there a reason that you refuse to discuss the problems with this edit and rather just keep re-instating the text? Have you read WP:MOS? what about WP:UNDUE? Puhlaa (talk) 01:21, 31 December 2012 (UTC)

PCP? PCP 1. Slang. phencyclidine, Origin: perhaps p ( hen ) c ( yclidine ) + ( peace ) p ( ill ), an earlier designation. 2.pneumocystis pneumonia. 3. primary-care physician. The last, I guess. (Not all editors are in on the jargon.) GeorgeLouis (talk) 05:20, 31 December 2012 (UTC)

PCP = Primary Care Physician. Text in question: "Recent attempts by chiropractors to be classified as primary care providers in the United States have generally failed due to the requirement to follow evidence-based practice." Text was added to the lead as part of this major edit [54], which also removed WHO-sourced text from the lead despite no consensus and ongoing discussion above.Puhlaa (talk) 05:41, 31 December 2012 (UTC)

It is sourced and significant. Your preferred version included weasel text about chiro as a primary care practice, your issue seems to be that the source correctly identifies a failure to follow evidence based practice as an obstacle to this in current lobbying. Since the lobbying verifiably exists at Congressional and State level, it would seem that your opinion that it is not significant is not shared by your fellow chiropractors. Guy (Help!) 11:41, 31 December 2012 (UTC)

I am challenging your addition of the text to the lead that is not appropriate for the lead. The text is regarding a specific controversy created by a specific group of chiropractors in a specific country at a specific point in time. It does not seem to merit any weight in the lead per WP:UNDUE. The text you added is sourced to a skeptical website, which is OK, but is not a high-quality source per WP:RS, so again, it does not seem overtly noteworthy for the lead. The lead is supposed to summarize the body per WP:MOS, yet the information you added to the lead and those sources are not found in the body. Until these issues have been addressed, I presume that I will prefer the version where the lead does not include this information. Puhlaa (talk) 01:41, 1 January 2013 (UTC)

No, you are challenging my addition of text to the lede which you, as a chiropractor, would prefer was not there. See the difference? Guy (Help!) 23:33, 9 January 2013 (UTC)

JZG, here is another example where you deny Puhlaa a respectful conversation about policy and instead attack him on a personal level by presuming that he has ignoble motivations. Please refrain from the attacks and instead address his editorial points. 67.127.253.101 (talk) 00:57, 10 January 2013 (UTC)

If the quote were US chiro's becoming PCP's because they were acknowledged to have followed evidence-based practices, The WP:SPA would not be raising these objections. TippyGoomba (talk) 03:53, 10 January 2013 (UTC)

TippyGoomba, you are just continuing with the bad faith example which JZG has set for you. Please refrain from the personal attacks and address the editorial arguments which Puhlaa has made. 67.127.253.101 (talk) 06:26, 10 January 2013 (UTC)

History of chiropractic

The current History section seems too long and detailed for an introductory article. There are already separate pages at Chiropractic history and Chiropractic controversy and criticism. I've placed a proposed shorter version for this section at Chiropractic/sandbox, and I invite all interested editors to visit it and make comments on the Sandbox Talk Page. I think the proposed section could actually be shortened again. Yours, GeorgeLouis (talk) 20:02, 8 January 2013 (UTC)

GL, agreed the history section is too long and should be trimmed. Your idea of a sandbox for this is a great one. I hope all involved editors can agree this is a good approach and will participate in the revision. DVMt (talk) 02:29, 9 January 2013 (UTC)

GL I have made some revisions and trimmed it down a bit but could use your eye and help whittling it down some more. DVMt (talk) 22:17, 11 January 2013 (UTC)

Well, I didn't see any of your changes in the proposed article. GeorgeLouis (talk)

RfC perspective from new set of eyes

There's an ongoing feud in this article over WP:RS, WP:COI, WP:POV and a constant edit warring. Most of the feud appears to be between User:JzG and User:Puhlaa.JzG is an involved admin whose affiliation I don't know. Puhlaa is a chiropractor. There are a handful of editors now involved in editing this article, so it is no longer material for WP:3O. Can I get a fresh set of eyes to comment on about the discussion that is going back and forth? -Cantaloupe2 (talk) 07:59, 7 January 2013 (UTC)

Comment from involved editors

Comment from Alexbrn

I am a relative newcomer to this article: I have made one edit to it, and two contributions to Talk. Out of caution however I will classify myself as "involved".

What I am seeing here is a classic instance of the problems caused by COI editing. A discussion of issues around content, feuding, etc. would be largely beside the point as it swerves around this root concern of neutrality. As WP:BESTCOI has it, "the whole point of WP:COI is that editors with a conflict are not considered sufficiently impartial to make subjective editorial decisions regarding [conflicting] issues". The excessive heat and edit warring we are seeing in the article is the symptom of not adequately addressing this COI issue, in my view.

A look at User:Puhlaa's contributions shows he has restricted himself to this article, and other related and CAM articles. He has been actively pushing a certain view of Chiropractic, for example by adding it to a list of healthcare professions[55][56], and then "roosting" on the edits [57][58][59]. He edits this article boldly.

As I have mentioned on the Talk page, I don't think any of this is to blame User:Puhlaa. Conflicted editors honestly and truly believe in their "cause" and the rightness of their edits; many (most?) of them don't recognize their COI and think they are an exception to WP's recommendations in this area. The "solution", which in my view addresses the root cause, is for User:Puhlaa to acknowledge his COI and follow the WP:COIU guidelines. This page could also usefully include a Template:Connected_contributor template. Alexbrn (talk) 10:08, 7 January 2013 (UTC)

Alexbrn, the diffs that you have provided to illustrate your concerns point to 5 edits over a period of 2 years at one page? Is this really indicating a pattern of behavior you think? Also, editors who look at those diffs should realize that in them I was adding 'Chiropractic' to a list that already includes EVERY other profession that exists that attain doctorate degrees. Restoring chiropractic to that list, whenever it is specifically removed from the list without consensus or explanation, is actually called fighting vandalism. It is common for IP editors to selectively remove one or more professions from the list when they don't agree with it - commonly chiropractic, optometrist and physiotherapist are removed and need to be restored. You will note that one of the diffs Alexbrn gives shows me also restoring 'Optometrist" to the list.Puhlaa (talk) 22:03, 7 January 2013 (UTC)

The diffs are over a 6 month period. You were not repairing vandalism; see WP:NOTVAND. Alexbrn (talk) 22:23, 7 January 2013 (UTC)

You are correct, Alexbrn, the diffs you are concerned about span a 6 month period, and occur over 1 year ago at 2 different articles (neither of them this article). [60] & [61] show me adding Chiropractic in two different articles, where it was missing from lists of all the doctored professions. [62] & [63] show me restoring chiropractic to the lists after it was removed by another editor. Finally, [64] shows me restoring both chiropractic and optometry to the list, after vandalism removed both professions from the list. I admit, I fail to see your concern with these edits? Also, I do not understand how does making 5 legitimate edits, over a 6 month period, all taking place over a year ago, illustrates anything here? Puhlaa

Comment from John Snow II

I too have contributed to this discussion recently so also have to identify as 'involved', although I do not have a special interest in the topic. My feeling is that there is potential for conflict here, but this has largely been averted by the admirable restraint of both of the main protagonists. I would echo Alexbrn's comment that I have no doubt about Puhlaa's good faith. I do, however, feel that there is an increasingly clear conflict of interest here. I hope I have not overstepped the mark in advising Puhlaa to take some time out, contribute to a different part of Wikipedia for perspective, and later return to this with a more objective approach if possible. In the meantime, I have attempted to clear up some of the inconsistencies and imprecise phraseology which had appeared in this article and welcome the assistance of other editors in doing so; my own view is that it has improved. John Snow II (talk) 12:49, 7 January 2013 (UTC)

Comment from Puhlaa

I personally do not see a major problem of edit-warring by anyone, I believe no reverts have been made in over a week. For the most part, edits here have been constructive and improved the article. I do have a few remaining concerns about some of the edits, however, these should be easily dealt with if editors are willing to discuss sources and content. However, there has been a pattern of behavior from the editors involved, where they continually choose to discuss other editors instead of edits, content or sources. Initially it was only a single editor, JzG (Guy) who was accusing me of COI in every thread I comment in here. For example:

1. I suggest some edits are inconsistent with policy here and defend the WHO as a reliable source; in return I get COI accusations here.
2. I make a proposal to try and appease both ‘sides’ here and provide numerous high-quality, reliable sources here to support my perspective; in return I get a non-sourced commentary of chiropractic and more accusations of COI here.
3. I suggest that there was sourced text removed inappropriately here; in return I get accusations of COI here. I take the issue to the reliable sources noticeboard here; I receive more accusations of COI from the same editor at the noticeboard here.
4. I asked an objective editor from the RS noticeboard if I was acting appropriately here [65], or I would take a wikibreak. The response was that “you seem to be editing in the proper spirit” [66]. That same objective editor posted a request here to stop the accusations of tendentious editing, so I struck where I had made an accusation [67], but in return I just get more accusations against me from JzG (Guy) right under the warning.
5. Most recently, I posted at the talk page that some newer edits from John Snow may have been inappropriate. After some polite discussion, it turns out that 1 of my concerns was unjustified, 1 was remedied; thus, I continued polite discussion about the remaining item that concerned me here. As usual, this polite discussion was again moved by JzG (Guy) to one about me as an editor with this post. Unfortunately, if you follow the rest ofthis thread, multiple editors choose to ignore the active discussion oif edits, content, or sources and instead choose to examine me as an editor. I have explained to each one, as politely as possible, that if there are specific concerns, I am willing to address them at the appropriate noticeboard. Otherwise, I prefer to stay focused on content and sources here.

I have repeatedly asked editors to indicate specific behaviors that were concerning, but none have been presented. A review of my posts above will reveal that in every instance I have always posted with sources and discussion of content or policy. Rather than respond with policy, sources or content, editors have chosen repeatedly to discuss other editors. It is amazing that this has all resulted in me having to justify my behavior here!Puhlaa (talk) 21:55, 7 January 2013 (UTC)

As a long time lurker and a mild contributor to the chiropractic article, I have seen the page constantly been the source of conflicting viewpoints and at worst, witch hunting from both sides of the fence. The RoC has nothing to do with the quality of sources or his edits but moreso on personality and a COI. Puhlaa has stated clearly on his talk page that he was a chiropractic student and had been editing this, and other articles, for years without incident until this fiasco. It seems only at WP one's expertise is a liability. Chiropractic seems to be at a cross-roads or in a grey zone straddling that fence between mainstream medicine and alternative medicine and, as such, it often difficult to edit without accusations of POV pushing going on. Objective editing involves refraining from any personal editorializing of the scientific literature and stating facts. In this regard, I find that Puhlaa has excelled. He has been gracious in always discussing major edits on the talk page and seeking consensus prior to editing. It can be clearly seen from the chiropractic talk pages and other pages he has edited. Alt-med has it proponents and its opponents and too often we comment on the on editors rather than the edits themselves. It's difficult enough to have good editors (collaborative and knowledgeable) here at the chiropractic page, and to cast aspersions on Puhlaa at this point seems to be not be based on "facts" or "merit" but rather by focusing on his profession. Editors who are knowledgeable on chiropractic know that it's had a topsy turvey relationship with medicine but that this relationship has, in fact, matured and progressed significantly the past 20-30 years. I don't reprehend Puhlaa for bringing modern sources to the article that legitimately reflect current practices globally. DVMt (talk) 00:16, 8 January 2013 (UTC)

Comment from TippyGoomba

In my opinion, there isn't any particular content issue that we can nail down in this RfC. The issue is a Puhlaa is a WP:SPA with an agenda. That's not something a RfC can resolve, as I understand it. TippyGoomba (talk) 05:07, 9 January 2013 (UTC)

Comment from JzG

I have no affiliation. This is not a feud, it's a perfectly routine case of WP:COI and an editor who doesn't properly understand that Wikipedia is not going to document chiropractic in the way chiropractors would, because that would violate our content policies. I'm not the only one to have pointed this out by now. Chiropractic is slightly unusual in that as a manipulation therapy it has some plausible mechanistic explanations for effect on certain conditions, but this anchor in reality is pulled hither and yon by great sails of pseudoscience, WP:FRINGE nonsense and outright fraud. The case of Sam Homola is instructive: this is a man who has taken on the chiropractic profession's questionable practices and yet is still criticised by skeptics for failing to acknowledge the elephant in the room. The difficulty is that unlike homeopathy, chiro is not blatant pseudoscience, but historically much of it has been and though Puhlaa says that modern chiropractic education is moving away from the pseudoscience, there is plenty of it still around - for example the McTimoney College of Chiropractic in the UK is still teaching abject nonsense, and the UK's General Chiropractic CXouncil ended up with a very large dose of egg on its face when it tried to use libel law to suppress statement of the fact that it happily promotes bogus treatments. Matters are not helped by the fact that chiropractic organisations are wise to the criticisms and advise their members not to be open about the crank elements, even if they then use them in patient consultations. So chiro may indeed be on the way from a form of quackery claiming to treat all disease to a much more restricted and evidence based practice, but the journey is far from over and in many cases barely begun. Wikipedia cannot be part of making this happen, or blaze the trail in telling the world about how it will be when the quackery is expunged, that is not our job. My advice to Puhlaa if he is sincere about promoting evidence-based practice in chiropractic is to volunteer at chirobase.org where this will be absolutely on mission, rather than try to shoehorn his mission into Wikipedia, where I'm afraid it doesn't really fit. Guy (Help!) 10:07, 9 January 2013 (UTC)

JZG's comments here are more revealing about his own personal biases and highlights why he has not been a neutral editor on this subject matter. He has his opinion and has been trying to skew the article to present just that and that alone. This violates our content policies. I suggest that JZG steps away from this article or finally addresses Puhlaa's grievances with his bold edits rather than continue to attack Puhlaa. 67.127.253.101 (talk) 17:02, 9 January 2013 (UTC)

You seem to be confusing the scientific consensus with personal bias. That is not surprising if you are genuinely inexperienced here, but of course less so if you are not. Guy (Help!) 17:41, 9 January 2013 (UTC)

You consistently mistake your personal bias as scientific consensus. And then bully through that bias relying on personal attacks (the COI accusation in this case) and avoiding sincere discussion about editorial policy. 67.127.253.101 (talk) 21:05, 9 January 2013 (UTC)

You're wrong of course, but since you have no edit history outside this debate that I can refer to, it is not easy for me to understand which of the many possible reasons for being wrong is at play here. Scientific consensus is that chiro is equivalent to other manual manipulations for lower back pain, neck manipulation can be lethal, and claims to treat diseases other than musculoskeletal pain are generally fraudulent. This is nicely summed up by Ernst & Singh. I don't gfeel in any way threatened by this, neither do friends who have used chiro for lower back pain. The main objection to this view seems to come from people who would rather this was kept quiet, for whatever reason. No idea why, osteopaths went down the route of evidence ad have ended up as respected health professionals, not borderline quacks as so many chiros are. Guy (Help!) 23:38, 9 January 2013 (UTC)

The fact that you desire to know my edit history so you can assess why I am "wrong" is proof-positive of the characteristically poor behavior you exhibit. My edit history is irrelevant to this discussion, yet your instinct is to find out what you can about me and my personal views so as to attack me. Well, I am not giving you that satisfaction. I don't know about Ernst and Singh, but I guarantee that these two people's opinions do not constitute the sum of scientific consensus. It would be one thing if all of the serious research concluded that chiropractic is not effective for this or that. Rather, what I read as presented in this article is a mixed bag. I see some critical reviews which support and some which refute chiropractic's effectiveness for conditions other than lower back pain. Admittedly, all I know is what I am reading in the current article. But there is enough there to say that your opinion – the one which you have been attempting to bully into this article – is in fact wrong. 67.127.253.101 (talk) 00:55, 10 January 2013 (UTC)

Guy seems to be using Ernst and Singh as proof that there exists a "medical consensus" on the appropriateness of chiropractic care. I agree with anon that Guy is displaying behaviors unbecoming of an admin and certainly has his own agenda which is alt-med=quackery and fraud. Given that his expertise lies in computer sciences is uninformed opinion is understable. I'm sure he would feel the same frustation if uninformed editors were to go to the computer sciences page and start hacking it up. The recent edits by Mr. Snow too do not improve NPOV but rather eliminate basic information that chiropractors are part of a profession and not an "activity" and so on. THere are major weight issues regarding the historical vs. modern perspective. The division of straight and mixers is getting rather antiquated as well and certainly does not represent chiro outside the US. There are many issues with this article, length first and foremost. I'm going to attempt to condense it a bit. DVMt (talk) 21:10, 11 January 2013 (UTC)

As an aside, if you have any detail about what they actually believe and practice, it would be greatly appreciated. If they were found to have totally dropped the pseudoscience bullshit, almost all the criticism of the bullshit could be relegated to the history section. TippyGoomba (talk) 01:45, 12 January 2013 (UTC)

That's a loaded question but I'll try my best: the majority of chiropractors now know that they're generally regarded as back doctors for the most part. The pseudoscience bullshit is really based whether or not you think getting cracked or massaged helps you move and feel better (hence the manual therapy/musculoskeletal specialization) or that they can cure all diseases with their adjustments. Logically chiros wouldn't be gaining more mainstream acceptance over the years if they completely full of shit. They've basically seem to have accepted the fact that no one is going to confuse them with a medical doctors and will be more regarded as a specialist as opposed to a primary care physician. At least that's what the majority of them believe. All the research that involves chiropractic does so for MSK issues. Basically anything that isn't MSK related is fringe. DVMt (talk) 07:19, 12 January 2013 (UTC)

I'm looking for sources which give some idea of what chiropractic means today. I agree with your differentiation of with respect to "pseudoscience bullshit". If this article were only dealing with MSK, I'm not sure I'd considerer it enough of a pseudoscience to stay on my watchlist. TippyGoomba (talk) 07:41, 12 January 2013 (UTC)

What sort of sources do you want? http://dcincome.com/, for example? The gibbering idiocy posted by chiros in the comments to this admittedly snarky piece? http://www.quackometer.net/blog/2012/11/the-royal-college-of-vestigial-victorian-fairground-mystic-bone-setters.html Or this fruit-loopery? http://storify.com/chapmancentral/chiropractic-antivaccination-nonsense Ernst & Singh seem to me to have it pretty much nailed: there is much talk of responsibility and evidence, but a lot of it turns out on investigation to be a smokescreen, which is why at one point one in four British chiropractors were under investigation. I am all for a move away from the pseudoscience, the aggressive practice-building ("Go to the supermarket and have your secretary call and get you Tannoyed"), the manipulations on babies and young children, the craniosacral therapy, the antivaccination activism and so on - that would be excellent progress. It's what the osteopaths did, it worked for them. The first thing that needs to happen is a voluntary moratorium on cervical spinal manipulation. There is simply no evidence that it offers a benefit over the standard of care t offset the obvious risk. I will be the first to add evidence of material changes in the profession as it cleans up its act, if it does. Guy (Help!) 20:06, 13 January 2013 (UTC)

Guy the article ever get to a balanced viewpoint if your only source is a layperson book and noted critic Ernst. Also your commentary on cervical manipulation reflects a personal or sentimental viewpoint and not that of the scientific literature. All of you concerns regarding pediatric, vaccination stance, over treatment were in fact listed in my edit which put all these critical elements into the lead which explains the mainstreams relunctance to embrace chiropractors. Tippy and I don't seem to disagree on the MSK applications of chiro nor do we disagree on their fringe practices and apparently we don't either. What are we disagreeing with then? — Preceding unsigned comment added by DVMt (talk • contribs) 20:25, 13 January 2013 (UTC)

comment from uninvolved editors

Comment from NickCT Ok. Couple comments. 1) This is a bad RfC. There don't appear to be any specific questions to address, rather than it seems to be an invitation to simply continue the debate that's raging above. 2) A brief glance at User:Puhlaa's contribution history shows a fairly stark example of a single-purpose account (SPA). SPAs are fairly strong indications of an editor with potential WP:COI/WP:POV issues, and as such, I'd guess User:Alexbrn's comment that Puhlaa "has been actively pushing a certain view of Chiropractic" is likely correct. Furthermore, I might imagine that User:John Snow II's "advising Puhlaa to take some time out" is justified. I could even suggest referring this matter for a topic ban; however, at first glance Puhlaa's comments generally seem cordial, so a topic ban may be unnecessary. NickCT (talk) 19:55, 7 January 2013 (UTC)

NickCT, you have described me as single-purpose editor, yet this says I have edited 93 different pages over 3 years. You state that "as such, I'd guess User:Alexbrn's comment that Puhlaa "has been actively pushing a certain view of Chiropractic" is likely correct" However, you only base this on another 'involved' editors comments and a "brief-glance" at the talk page; and before you have even heard from the 'other side'? You will note that in 3 years I have not been blocked, or formally reprimanded. If you review the 10 or so threads included at the chiropractic talk page, you will see that I have not posted anything other than reliable sources and policy-based concerns anywhere I have edited. Moreover, I have asked those editors continually accusing me of COI to please indicate which category of COI they feel that I would belong to? But I receive no answer. NickCT, I am asking you to please ensure that you have correctly identified a problem before you just climb on a bandwagon with some of the 'involved' editors. This is supposed to be an objective review; it concerns me that you are already be making conclusions and assumptions after only hearing from 2 editors on 'one-side' of the discussion and a having a "brief-glance".Puhlaa (talk) 22:19, 7 January 2013 (UTC)

re "I have edited 93 different pages over 3 years" - Listen Puhlaa. No offense mate, but you are clearly clearly a SPA. I've just scanned over your past 500 edits, and I can't see you working on a single article that isn't somehow related to chiropractic/alternative medicine. That is, quite frankly, extraordinary.

re " in 3 years I have not been blocked, or formally reprimanded" - That's correct. And, as I'd said, being polite gets you far on WP. I'm not sure I'd support a block.

re "asked those editors continually accusing me of COI to please indicate which category of COI" - Did someone say you have fit into one of those categories to have a COI? Of course not. Those categories aren't meant to cover all possible COIs. Look, if a gastroenterologist started working editing articles in such a way that suggested gastroenterology was very efficacious or desirable, that would potentially be COI. Same with a astrologer promoting astrology, or a baker promoting the health benefits of baked goods. If you can't see how a professional working on articles related to the efficacy of their profession might raise COI flags, then I'm not sure we're going to be able to have an intelligent debate.

re "I have not posted anything other than reliable sources" - I've dealt with 100s of editors pushing a POV who've made this claim. It's easy to push a particular line of thought using reliable sources.

re "you are already be making conclusions and assumptions after only hearing from 2 editors" - I freely admit this was just a cursory review, but I really don't want to read through pages of text. If there is some specific issue you want me consider, please highlight it for me. NickCT (talk) 13:46, 8 January 2013 (UTC)

There's no problem with being a SPA though, the problem is not editing in accordance with the policies and guidelines. It seems like it would be helpful if everyone on this page focused on sources - missing sources, inappropriate sources, over-used sources, low quality sources and parity sources - rather than on motivation. Focusing on how many pages Puhlaa has edited, high or low numbers, is less important than focusing on what edits were problematic (and conversely, what edits were dismissed as POV-pushing by a SPA without a review of the edit itself). WLU (t) (c) Wikipedia's rules:<sup>simple</sup>/<sub>complex</sub> 14:05, 8 January 2013 (UTC)

re "no problem with being a SPA though" - Agreed. By itself, it's not a problem. But SPAs often have trouble with "editing in accordance with the policies and guidelines".

re "focused on sources" - Agreed. It would nice if someone could point out which edits and sources that Puhlaa's adding are in question. NickCT (talk) 15:17, 8 January 2013 (UTC)

Your second point may be the real nub here - the fact that Puhlaa is a chiropractor is being used as a reason to ignore his suggestions. Some of those suggestions are incorrect, but they should be identified as such, not used as an excuse for personal attacks. WLU (t) (c) Wikipedia's rules:<sup>simple</sup>/<sub>complex</sub> 22:35, 8 January 2013 (UTC)

Ok. Can you give me an example of where "the fact that Puhlaa is a chiropractor is being used as a reason to ignore his suggestions"? NickCT (talk) 13:25, 9 January 2013 (UTC)

Way off the point, both WLU and Nick. Everybody would like the conversation to focus on the article, not individual editors. It might be best just to swallow one's pride and simply drop this angle of the conversation. GeorgeLouis (talk) 16:06, 9 January 2013 (UTC)

What part of the article are we meant to focus on!?!? Can I get an example? Can anyone give me a specific question that this RfC is trying to address?..... No they can't, because, as I'd said initially, this is a bad RfC. NickCT (talk) 16:17, 9 January 2013 (UTC)

I agree with Nick's frustration. It might be better to taper off here, so I've removed the RFC tag at the top of this section. (Anybody can put it back.) GeorgeLouis (talk) 16:27, 9 January 2013 (UTC)

That was the right thing to do. Kudos. NickCT (talk) 17:45, 9 January 2013 (UTC)

Comment from IP I know my comments will be given discount weight given the anonymity, but JZG has a lot of friends and I fear reprisal from his and his cabal. More than that, I feel that someone needs to say what's not being said. Chiefly, that it is user JZG who seems to have brought all of the recent conflicts to this otherwise stable article as of late. A review of JZG's long edit history reveals an editor who has very much been on the attack against anything not considered by himself to be the scientific mainstream. What worse, his manner seems to be consistently rude and dismissive to any editor standing in his way. I am not saying that this is JZG's single purpose, but it does seem to be his dominant purpose on Wikipedia.

Puhlaa has respectfully questioned some of JZG's rather bold edits; politely citing Wikipedia policy and trying to start a discussion. Instead of engaging Puhlaa and addressing his points, JZG has consistently and unapologetically attacked Puhlaa as an editor.

I don't recognize any COI on the part of Puhlaa, who has progressed this article nicely, keeping it up to date with the latest reliable sources. Saying that a chiropractor can't edit Chiropractic without a COI is tantamount to saying no architect can edit Architecture. That's a ridiculous loss of professionals writing what they know best and cannot serve the purpose of Wikipedia.

My advice is for JZG to back down and not make this article yet another one of his battlegrounds. If JZG can now address - politely - Puhlaa's questions, that would be best. If not, the JZG should move along. I think we as a community need to keep a mindful eye on JZG to make sure he is not bullying his preferred point of view into article space and not abusing his admin status. 67.127.253.101 (talk) —Preceding undated comment added 23:11, 7 January 2013 (UTC)

The problem for you here is that I get my views of what is the scientific mainstream form the scientific mainstream, whereas you apparently get yours from... well, who knows where. HealthDanger? Guy (Help!) 18:10, 9 January 2013 (UTC)

Here's but another example of your modus operandi. Rather than address the points which I bring up here, you insist on launching into a personal attack on me. I understand that when a dog is backed into a corner, he will lash out. If you believe that I am forcing you to finally answer for your behavior, well then I can see why you feel cornered. So forget about me and my charge above. Instead, will you finally engage in a discussion of Puhlaa's editorial points or will you continue with the personal attacks? How about the next editor you encounter who has a difference in editorial opinion than you? Will your respectfully engage their salient points or will launch into ad hominem? You've been on Wikipedia a long, long time. Maybe it is time for you to step back and examine the way you engage people with who you disagree. 67.127.253.101 (talk) 22:36, 9 January 2013 (UTC)

Comment by WLU - part of the issue seems to be treating chiropractic as if it were a single entity. There is a diverse range of chiropractors, ranging from self-defined ex-chiropractor Samuel Homola who sees his (former) profession as merely a specialized form of physiotherapy, all the way to chiropractors who believe the spine controls all functions of the body and thus are capable of treating any and all conditions. The reality is, some chiropractors are quacks whose claims have little relation to reality, some voluntarily restrain themselves to the treatment of musculoskeletal pain, and many are in between. I say this less for the actual page and more for the editors involved. I will also remind editors that all edits, particularly on controversial articles, should be verified by reliable sources. JzG's status as an admin is irrelevant unless he uses his tools inappropriately (in which case, start a discussion at WP:ANI). Puhlaa's status as a chiropractor is irrelevant unless he claims his experience is sufficient to change the main page (in which case, WP:OR and WP:RS come into play). The current lead seems to do a reasonable job of portraying the profession, the current body is riddled with references; may I suggest editors follow the cycle of finding, integrating and reviewing reliable sources?

Puhlaa, I will point out that edits like this are inappropriate; the sources used are rather old (1989 is really almost irrelevant in 2012) and appear to be primary sources when we are supposed to use secondary sources (i.e. review articles and books). However, as you correctly state in this diff, these are secondary sources and I am happy to see they are still in the article. This edit added a source that is questionable for two reasons - it is relatively primary, and not a MEDRS; better sources should be found for the information if at all possible, otherwise consensus should be reached on the talk page on whether to include it (my inclination is to leave it out; also, surveys of patient satisfaction say nothing about the actual efficacy of practice, an issue that should inform how the sources is used, but not necessarily bar it from inclusion - better is if a RS can be found that makes the point for us). I have only reviewed a very small number of your edits, but these are fundamental points that should be understood if you are going to edit a controversial article like this one. I do support the removal of sciencebasedmedicine - much as I love the website, and I LOVE SBM, it's not a MEDRS. WLU (t) (c) Wikipedia's rules:<sup>simple</sup>/<sub>complex</sub> 03:29, 8 January 2013 (UTC)

My status as an admin is relevant in that it means I have a decent understanding of Wikipedia policy. Puhlaa's status as a chiropractor is absolutely relevant per WP:COI. He has a direct vested interest in the content of the article. Guy (Help!) 16:55, 9 January 2013 (UTC)

Comment from Anthonyhcole - Just a comment on COI. It's not relevant. We have plenty of topic experts editing in the health area and they're rarely a problem. If Pulhaa is misusing sources or breaching any of our other content norms, that needs addressing, but please don't characterise it as a COI issue. If he were inserting references to his own work, or being paid to edit here, that would be a COI issue. --Anthonyhcole (talk) 17:21, 8 January 2013 (UTC)

Do you see bias in current sources?

• Some, yes. The problem is that science mainly ignores chiropractic due to the pseudoscience. The comparison with osteopathy is informative - osteopaths dropped the pseudoscience, took up proper standards of care, and are recognised as mainstream practitioners; DD and BJ rejected this in favour of aggressive practice building, which still dominates chiropractic. So it's hard to find good dispassionate analytical sources. Trick Or Treatment is useful but covers many subjects so only has room for a chapter on chiro. Guy (Help!) 09:43, 9 January 2013 (UTC)

What issues do you think needs to be addressed?

1. A fair bit of special pleading, a tendency to portray the idealised model of chiropractic rather than the reality of daily practice (which includes a lot of antivaccination and other quackery, including claims to treat infant colic and the like which are completely unsupportable), and a need to focus very clearly on the correct burden of proof. It is not enough to say "here are some studies which appear to support chiro for X implausible thing" when we know for a fact that CAM journals typically do not publish negative findings. There is a risk of getting into tooth fairy science, studying the amounts left by the tooth fairy, the correlation with first versus subsequent teeth and so on, without ever addressing the fact that the tooth fairy does not exist. There is a pretty solid consensus that the chiropractic subluxation complex is a fantasy. It is not real. The use of X-rays, especially full-spine X-rays, is seruously controversial because there is absolutely nothing objectively detectable. Huge doses of radiation for absolutely no provable benefit.

I think wee're all agreed that if chiros stuck to treating lower back pain and never touched anyone's neck, then there would be very little controversy. That's not what they do. It would be badly wrong to describe an idealised version of chiropractic where they did, and ignore the fact that this is not what happens in the real world, to the extent that controversy over questionable and in some cases fraudulent practices forms a very substantial part of independent discussion of chiropractic. Guy (Help!) 09:52, 9 January 2013 (UTC)

What else do you suggest?

Keep the discussion to the article itself. Stop sniping at individual contributors and questioning their motives. GeorgeLouis (talk) 17:27, 8 January 2013 (UTC)

Second that. If there is actual problematical behaviour, like deliberately misrepresenting sources, take it to another venue for resolution. Leave ad hominem out of article talk page discussions, it doesn't help. --Anthonyhcole (talk) 17:50, 8 January 2013 (UTC)

Indeed. CAM practitioners and promoters will often attempt to use wikipedia as a soapbox, misrepresenting sources, cherry-picking shoddy sources and engaging in original research to push their POVs. Puhlaa does not appear to be doing this, or at least I have not seen evidence of it. Puhlaa's civilly-delivered sources and concerns should be addressed with equal civility, and not merely dismissed. WLU (t) (c) Wikipedia's rules:<sup>simple</sup>/<sub>complex</sub> 22:54, 8 January 2013 (UTC)

Up to a point. I am sure Puhlaa is sincere, and certainly civil, but he is a chiropractor and he is in favour of documenting an idealised form of chiropractic that does not reflect the real world. His input should be taken with some caution. But he is open about his conflict of interest, at least. However, he does need to accept that his views are not NPOV and that his interpretations of some sources have been sufficiently idiosyncratic that we're not going to take his word on anything without checking the source. Guy (Help!) 09:56, 9 January 2013 (UTC)

If Puhlaa is capable of documenting his "idealized" version of chiropractic in RS, then NPOV suggests that it should become part of the article. These are decisions that should be made on an individual basis for sources and edits rather than being dismissed with "you are a chiropractor". The page should definitely discuss the rhetorical and scientific flaws of chiropractors and opposition to vaccination, along with the absurdly all-encompassing mandate of many chiropractic approaches. But there are some scientifically well-founded chiropractic approaches for MSK complaints, and their signatory manipulation therapies are being adopted by physiotherapists. While we should restrict the page to high-quality secondary sources when discussing what chiropractic is effective for, neutrality requires acknowledging when there is high-quality secondary sources for efficacy.

I would be far more comfortable with the conversation if editors were addressing Puhlaa's specific sources and arguments rather than dismissing them with claims of a COI. There are SPA that ignore science, cherry-pick sources and shoehorn data. When I encounter such editors, I methodically examine the sources according to MEDRS, point out when they can't be used and point to the policies that render the edits inappropriate. If the editor continues to push, refuses to learn and is unreasonable, that is when I stop being polite and move on to a different approach like a noticeboard. Over the long term, this is a far more effective strategy at producing a high-quality consensus version that long-term editors from both perspectives of a POV dispute will defend. Saying someone has a COI is never as strong an argument (in general or on wikipedia) as pointing out they are cherry-picking primary sources, ignoring secondary sources or making unsourced claims. As an admin, I would expect you to be able to easily and authoritatively provide commentary on individual sources and edits that are convincing for a well-intentioned, reasonable editor and (more importantly) the community at large. I'm not endorsing all of Puhlaa's edits, I've criticized some of the sources he has provided [68], but so far I haven't seen much of this sort of specific, fine-grained and necessary comments on edits and sources that are important and support a long-term, stable consensus regarding sources and specific factual points. Admittedly I haven't read the entire page top to bottom, but I am concerned over the number of times "COI" is used as an argument rather than a reason for scrutiny.

Again, I'm not endorsing Puhlaa's beliefs or edits. Many chiros are deluded quacks better trained in rhetoric than they are in science. I just think the page, and the wiki, is better-served by dealing with the substance of his edits and sources in a meaningful way than simply dismissing them out of hand with "but you have a COI". It's the same reason that "Big Pharma" isn't an argument when sCAMsters make it. WLU (t) (c) Wikipedia's rules:<sup>simple</sup>/<sub>complex</sub> 17:58, 9 January 2013 (UTC)

It already is part of the article, the proiblem is that he wants the article to reflect the field as he wishes it to be, not as it is. There are chiros who restrict themselves to that which can be supported by evidence, but there are many (and on the face of it a vast majority) who do not. For example, I was talking to a chiro on Twitter. He posted a link to a new study showing some benefit from "maintenance adjustments", which said it was the first study to show benefit from these. So I asked him if that meant he had not offered maintenance adjustments in the absence of evidence. Tumbleweed. Maintenance adjustments are a great way of keeping your bank balance healthy, but are studiously ignored when discussing cost/benefit because an evidence-based physio will discharge a patient after a number of sessions whereas all the practice-building manuals tell chiros never to discharge a patient, always to get them hooked on maintenance adjustments. And then he started telling me that zero percent of vaccines are effective and that no diseases have ever been prevented by vaccination. A friend of mine was subjected to full-body X-rays without pelvic shielding, as an adolescent female, by a chiropractor. This is not misleading vividness, it is perfectly normal. I would be very happy for chiro to salvage the core of evidence-based practice from the sea of quackery that surrounds it, but I don't think we can be part of blazing that trail. Guy (Help!) 10:47, 13 January 2013 (UTC)

I don't see evidence that Puhlaa is trying to change the entire article, what edits I've seen seemed limited and reasonable, though in some cases required improved sourcing. If the majority of chiropractors undertake treatment that is not supported by evidence, I would expect this fact to be found in a reliable source since talking to an individual chiropractor on twitter isn't a representative sample or a reliable source. The reality is, there is some support for chiropractic interventions - so much so that physiotherapists are beginning to adopt manual adjustments for lower back pain. Portraying the profession as nothing but quackery is inaccurate, as inaccurate as leaving out the fact that many chiropractors (perhaps most, I'd have to see a source) oppose vaccination, inappropriately use x-rays and get a lot of training on how to increase revenues. A neutral page incorporates both good and bad aspects of chiropractic, in the balance found in reliable sources. Right now that balance in most mainstream sources is the good of chiropractic comes bundled with a lot of questionable or dangerous practices. But there is some proven treatments for muskuloskeletal conditions. This should be found in the page. WLU (t) (c) Wikipedia's rules:<sup>simple</sup>/<sub>complex</sub> 02:30, 15 January 2013 (UTC)

Proposed split: Effectiveness of Chiropractic

It has been proposed (since December 2012) to split out the lengthy section now headed "Effectiveness" into a new article. One proposed name is "Effectiveness of Chiropractic." Please provide comments below on whether this idea should be adopted, and, if so, what the title should be. Thank you. GeorgeLouis (talk) 18:12, 8 January 2013 (UTC)

• Agree. The section is rather lengthy and involves the efforts of many editors who have access to and knowledge of sources. A shorter section would be easier to edit. And readers would be assisted because the main "Chiropractic" article would be shorter and they could quickly move to an entirely separate article giving the pros and cons of the effectiveness of the practice at greater length. GeorgeLouis (talk) 18:12, 8 January 2013 (UTC)

I don't have any policy-based objection to this idea, and I actually like the idea of an article dedicated to 'effectiveness of chiropractic', or perhaps more general, like 'effectiveness of manual and physical therapies'. However, it is noteworthy that the exact opposite thing has been discussed for the section on 'Controversy/Criticism' here. Thus, my only concern would be, if we are packaging-up and removing 'effectiveness' material from this 'main' article, but doing the opposite with material on 'criticisms', it will greatly effect the overall 'balance' in the article. Any thoughts? Puhlaa (talk) 18:57, 8 January 2013 (UTC)

The decisions should be made, I think, on the basis of what should be in an introductory article for the layman. GeorgeLouis (talk) 20:25, 8 January 2013 (UTC)

Correct. We should describe what goes on in chiropractic offices right now, that should dominate the article. And that means, I'm afraid, unnecessary X-Rays, antivaccination propaganda, cranial osteopathy and other pseudoscientific nonsense, and of course the occasional stroke, about which chiros are in denial. Message to the world of chiropractic: fix your shit, then we'll fix Wikipedia. Guy (Help!) 11:17, 13 January 2013 (UTC)

Duplication

I have removed duplication in the article and have attempted to organize it better by putting the criticisms in the controversy and criticisms section. There are a lot of fluff in the article which can be avoided by making a simple statement "chiropractors are criticized for their uneven stance on water fluoridation and vaccination" as opposed to rambling on about politics. I also noticed that there is repeated use of one author who is cited alarmingly more often than all others. I understand that Ernst is a hero to many of the "anti-CAM" ilk, but his "conclusions" are disputed by many of his own colleagues and other researchers and the article should reflect that as well in a balanced way. Also, older sources are being misused as their conclusions are dated and have been replaced by more current literature on the same topic. Overall I hope we can find a middle groud where all sides are content but we should stick to the article as opposed to wikilawyering. DVMt (talk) 22:16, 11 January 2013 (UTC)

There is a real danger in segregating the criticisms. We need to reflect the scientific consensus throughout the article, not write a brochure and tack a disclaimer on the end. Guy (Help!) 11:18, 13 January 2013 (UTC)

Agreed that it should not resemble of brochure. A lot of the article is more about politics than actual scientific consensus though and it's generally regarded, as I mentioned to Tippy, than anything that chiropractors treat that is not MSK related is fringe. I think you will find that the revisions I've made eliminates duplication while maintaining both arguments of critics and supporters alike and is written in encyclopaedic language. There's still a long way to go but I don't think both side are far apart, it's just more a matter of presentation. Regards, DVMt (talk) 18:35, 13 January 2013 (UTC)

I object to your edits; certain high-quality sourced content went AWOL and the balance of the article was considerably altered to be more POV in my view. I have restored to a prior state. Alexbrn <sup>talk|contribs|COI</sup> 18:47, 13 January 2013 (UTC)

The edits maintained all critical sources and critical elements. How was the balance altered to more POV? Central themes including critical themes of adverse reactions to upper cervical manipulation, questionable ethical practices, questionable public health positions, questonable effectiveness for non-MSK were all maintained as well of mention of unproven benefits for excess care. The only "change" per say was the restoration of the literature review of effectiveness of chiro may be good for. Fringe elements are exposed and called so. The balance of the article was not slanted in either direction we're just eliminating repetition from the article. The lead accurately reflects the body. What specific problems do you have issue with? I'm going to restrict myself to 1RR as an act of good faith but I do hope you can provide specifics to the edits and what sources you feel were potentially omitted that hasn't already been said elsewhere. DVMt (talk) 19:14, 13 January 2013 (UTC)

I note DVMt has just reverted my revert, skipping any customary prior discussion. In the 990 bytes removed from the article, the content sourced to Reggars, J. W. (2011). "Chiropractic at the crossroads or are we just going around in circles?". Chiropractic & Manual Therapies 19: 11–67. was removed (at least, I have not checked other sourced content). From a quick glance it appears the pseudoscience / skeptical / critical materials has gone from early parts of the article, as well as well-sourced material stating it was unproven. A POV edit in my view. I think my revert was justified. Alexbrn <sup>talk|contribs|COI</sup> 19:23, 13 January 2013 (UTC)

A WP:SPA making POV edits? Say it ain't so. Your revert is inline with WP:BRD, I've restored the consensus version until DVMt successfully makes his case. TippyGoomba (talk) 19:52, 13 January 2013 (UTC)

You're accusing me of making POV edits. What specifically do you have problems with? All the critical elements were maintained and beefed up. The straight vs. mixer section was clarified a critical paragraph was added to the lead. If the addition of critical elements were not only maintained but added how can I have made the article more POV? It is up to you and Alex to state what specifically you are opposed to instead of me negotiating with myself. Also, I will caution TG to remain civil and not use sarcasm. DVMt (talk) 20:02, 13 January 2013 (UTC)

I don't think anyone here disputes the straight and mixer viewpoints? I've tweaked it a bit and see if we can arrive at a consensus by breaking it down into individual paragraphs. — Preceding unsigned comment added by DVMt (talk • contribs) 20:09, 13 January 2013 (UTC)

Well, I did mention some specifics but have had no response. But really. Here [69] is the diff showing the net effect of your edits. If you can't see why this might be viewed as POV, then I'm not sure it's even worth continuing a discussion. Alexbrn <sup>talk|contribs|COI</sup> 20:38, 13 January 2013 (UTC)

I did notice that Reggars was accidentally omitted. I addressed your concerns regarding the skeptical/critical viewpoint by adding its own paragraph in the lead. You haven't addressed my previous talking points of what it was in my edit changed POV. I kept all the same sources and essentially copy and pasted the effectiveness for MSK conditions into the lead where it had been residing for a long time without controversy prior to it being removed in Dec 2012 without any justification for its removal since it's in the body of the article. You're going to have to clearly state how the edit altered NPOV so I can know what exactly your main concern is. Do you have any concerns against condensing all critical elements of the profession to the lead so it forms some kind of coherence to readers and laypersons? DVMt (talk) 20:51, 13 January 2013 (UTC) Edit: Alexbrn is not offering any alternative suggestions to the edits and has reverted the straight vs. mixer lead, nor did he mention what he found controversial about the edit. It appears he "just doesn't like it" as opposed to having specific suggestions that can be improved upon. DVMt (talk)

I notice you have just re-reverted again, with no discussion of the point of my edit summary. You are now duplicating body text in the lede in an already bloated article (the duplicated text is, incidentally, broadly "positive" commentary on chiropractic). As to your broader edits, it's up to you to make the case. I'm not going to point out each and every POV tweak you have performed, but will ask a couple of questions by way of example:

1. Why did you change the text from "The scientific consensus is that chiropractic may be on a par with other manual therapies for some musculoskeletal conditions such as lower back pain, but that there is no credible evidence or mechanism for effects on other conditions" to "Critics of certain chiropractic practices describe the profession of being uneven with proven public health measures such as water fluoridation and vaccination,[ref to Busse] and claims spinal manipulation are effective for a variety of non-musculoskeletal conditions such as infantile colic, asthma and ailments not related to biomechanical disorders. " ?
2. Why did you change the text from "The ideas of innate intelligence and the chiropractic subluxation are generally regarded as pseudoscience" to "Others[ref to Ernst] go further saying that chiropractic is not based on solid science." ?

—isn't this what is called "watering-down" (and it's ungrammatical at that)? Alexbrn <sup>talk|contribs|COI</sup> 21:16, 13 January 2013 (UTC)

I did discuss my edit above again. What is positive commentary when I'm stating facts from the sources themselves? The article itself is bloated not the lead itself. Addressing your points specifically

1. There is no real scientific consensus on "chiropractic" the profession only what the evidence suggest regarding what therapies chiropractors use useful for which is primarily MSK. The bit where it states there is no credible evidence for non-MSK was stated clearly. Also you're using a lay book Trick or Treatment as your source and that's not a MEDRS reliable source. I simply inserted the a brief mention of the effective conditions which was part of the lead originally but removed for no reason.
2. Ideas of innate intelligence/chiropractic subluxation is an opinion piece of Ernst which wrongfully indicates that Ernsts POV reflects mainstream medicine which cannot be considering some medical doctors are now collaborating with chiropractors. It's well known that mainstream med establishment recognizes chiropractors being legitimate providers for MSK. The majority of their clientele is for MSK conditions I believe representing 95% of all visits to chiropractors.
3. All criticisms of chiropractic include vaccination, fluoridation, treating kids, treating non-MSK, unethical practice behaviors were all represented my revision of the lead. How do you find this watering down? I look forward to your reply. — Preceding unsigned comment added by DVMt (talk • contribs) 21:46, 13 January 2013 (UTC)

Right, so when your edit summaries (e.g. "concision and condense of lead, integration of background, highlighting both critical and supportive viewpoints") implied merely a reorganization of content, this wasn't in fact quite accurate. You performed a major re-wording to address what you consider to be deficiencies of the sources, bias and inaccuracy from the authors of the sources, and deficiencies in the text as supported by the sources. And in the process criticism of chiropractic was watered-down or eliminated in favour of blander, more favourable, or simply confusing statements. Alexbrn <sup>talk|contribs|COI</sup> 22:01, 13 January 2013 (UTC)

Not sure which edit you guys are discussing, but if it is this most recent revert of Alexbrn by DVMt, then I dont see any watering-down or elimination of criticisms; I only see an expansion of the discussion of chiropractic history - may be unecessary, but it doesnt seem to even touch the crtiticisms discussed in the lead? Can you guys please clarify what you are debating here? Puhlaa (talk) 22:25, 13 January 2013 (UTC)

No it's this. Alexbrn <sup>talk|contribs|COI</sup> 22:28, 13 January 2013 (UTC)

I would appreciate it Alex if you don't mischaracterize my edits. Criticism was expanded, not watered down, as per your view and if blander language was used, perhaps this is a good thing as to not write any inflammatory statements. What do you find confusing? I certainly don't want to confuse readers. Puhlaa I have asked already Alex to specific comment on what part of my edit upset him he has thus far refused to engage me in this regard. He apparently doesn't like it on a whole and has yet to reply to my specific comments a few posts above. It's like a moving target where I can't get a straight answer unfortunately. He accuses me of removing criticism when in fact addressed the criticisms (all that I know of anyways) directly. DVMt (talk) 22:53, 13 January 2013 (UTC)

This edit that Alexbrn points to is too complex to go through properly....DVMt, if you break your edits into smaller pieces and make clear edit summaries then editors with concerns will only revert those specific edits that concern them and not all of your work. This makes it easier to discuss as well. If Alexbrn has concerns with regard to specific parts of your edit and he follows WP:BRD, then he has no choice but to revert your edit in its entirety. Some of what you did seems benign and helpful, but you attributed two criticisms to 'critics', which may not be appropriate and it seems as though you may have removed some discussion of criticism (or moved it, I cant tell) thus grounds for discussion. Puhlaa (talk) 01:25, 14 January 2013 (UTC)

Thanks for your courteous reply Puhlaa. I understand what you are saying. I did not remove any criticism from the page and, as you can see from the section below I even added some to it. I have repeatedly asked other the other involved editors here (TG, Alex, Guy) to specifically state what they were in disagreement with, it would be much easier to proceed. However, as you can see for yourself, even the mention of the word "CAM health profession" which is V is being reverted for no other reason than they don't approve of the word "profession" even though the cited source states it. I will do my best and take your advice and breaking it into smaller chunks. DVMt (talk) 01:39, 14 January 2013 (UTC)