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Proposal: Philosophy: Straight and Mixer (2013 update) Version 2.001 (beta)

The philosophy of Chiropractic merges both elements of vitalism and materialism. Chiropractors emphasizes manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders The relationship between structure, especially the spine, and function, as modulated by the nervous system, is central to chiropractic and its approach to the restoration and preservation of health. Chiropractors examine the biomechanics of the spine and other joints of the neuromusculoskeletal system and examines its role in health and disease. It is hypothesized that clinically significant neurophysiological consequences may occur as a result of spinal dysfunction/subluxation, described by chiropractors as the vertebral subluxation complex Most practitioners currently accept the importance of scientific research into chiropractic. Foundational concepts of the philosophy of chiropractic includes the following principles:

• Vitalism accepts that all living organisms are sustained by a vital force that is both different from, and greater than, physical and chemical forces. Contemporary is it is referred to as "vis medicatrix naturae" (the healing power of nature).
• Holism postulates that health is related to the balanced integration of the individual in all aspects and levels of being: body, mind and spirit, including interpersonal relationships and the interplay between lifestyle, environment, and health.
• Naturalism states a preference for natural remedies. This is bound up with a set of philosophical principles which may be expressed as the body is built on nature’s order, it has natural ability to heal itself, that this is reinforced by the use of natural remedies, that it should not be tampered with unnecessarily through the use of drugs or surgery
• Humanism is based on the postulate that individuals have immutable rights, for example the right to dignity. In CAM there is extensive concern about dehumanizing procedures and the dehumanizing institutions that have been created for the ill. Partly it is recognition of the personal, social and spiritual aspects of health and a move away from simply the biology of health.
• Therapeutic Conservatism is the use therapies that have a low level of side effects and it tends to accept that the least care is the best care. This in some ways is derived from earlier principles. if the body is capable of healing itself, the role of the therapy is simply to initiate the process.

Upon its founding 1895, chiropractic's early philosophy was rooted in vitalism, magnetism, spiritualism and other constructs that were not amenable to the scientific method. A self taught healer, D.D. Palmer, attempted to merge science and metaphysics. In 1896, D.D. Palmer's first descriptions and underlying philosophy of chiropractic was strikingly similar to Andrew Still's principles of osteopathy established a decade earlier. Both described the body as a "machine" whose parts could be manipulated to produce a drugless cure. Both professed the use of spinal manipulation on joint dysfunction/subluxation to improve health. Palmer drew further distinctions by noting that he was the first to use short-lever HVLA manipulative techniques using the spinous process and transverse processes as mechanical levers. Additionally he described the effects of chiropractic spinal manipulation was mediated by the nervous system in contrast to osteopathy who believed the effects were attributed to the supremacy of the circulatory system. Palmer initially denied being trained by osteopathic medicine founder A.T. Still but later acknowledged osteopathy wrote that the "the underlying philosophy of chiropractic is the same as osteopathy... Chiropractic is osteopathy gone to seed."' By embracing both vitalism and materialism the philosophy of chiropractic has produced a diverse and eclectic mix of chiropractors which despite their emphasis of manual therapy they may vary on their perceived scope of practice, interventions and their role in the health care system.

"Straight" chiropractic

Also known as 'subluxation-based' and 'principled chiropractic', chiropractors educated from this paradigm espouse traditional Palmer principles and philosophy. Historically straight chiropractors regarded spinal joint dsyfunction/subluxation as the primary cause of "dis-ease" and could be corrected via specific chiropractic adjustments. This monocausal view of disease has been abandoned by the profession preferring a holistic view of subluxation that is viewed as theoretical construct in a "web of causation" along with other determinants of health. Palmerian philosophy focused on metaphysical constructs such as Innate Intelligence and Universal Intelligence to explain the effects of the chiropractic adjustment, whose intent was the reduce/correct spinal subluxations and improving the functioning of the nervous system. The subluxation was said to be "the cause of 95 percent of all diseases... the other five percent is caused by displaced joints other than those of the vertebral column." Misalignment of the vertebrae was believed to be cause impingement of the nerve root, a theory which has long been debunked Subluxation-based chiropractors view traditional chiropractic lexicon such as "analysis" and "adjustment" and as a critical distinction of chiropractic despite lack of prevalence of these terms in the chiropractic literature Subluxation-based chiropractors have been criticized both internally and externally for far-reaching claims of "killer" subluxations, pseudoscientific reasoning, dogmatic approaches unethical business practices that invoke religious themes and high-volume treatments for a variety of conditions that lack supportive scientific evidence. This metaphysical and dogmatic and singular approach to chiropractic care has been criticized for failing to engage in critical and rational thinking and embracing evidence-based medicine. Straight chiropractors use a subluxation-based model as opposed to the patient-centered model now favored in health care. Although they are the minority within the profession, they are considered to have a disproportionate influence as "purists".

"Mixer" chiropractic

Mixers form the majority of chiropractors and attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness; While D.D. Palmer considered vertebral misalignment to be the hallmark feature of subluxation, mixer pioneer Solon Langworthy asserted that intervertebral hypomobility, not misalignment, was subluxation’s cardinal biomechanical feature. This contrasting mechanistic emphasis, intervertebral misalignment vs. hypomobility, formed one the basis for a heated polemic in the profession. Although both misalignment and hypomobility are currently recognized as biomechanical features of subluxation, hypomobility has garnered much more attention in recent years. Mixers were disdained by the Palmers who disapproved of their use of instrumentation and mixing chiropractic diagnostic and treatment approaches with osteopathic, naturopathic and medical viewpoints.. MIxers combine both vitalistic and mechanistic viewpoints that has led to scientific investigation of chiropractic principles. Mechanistic underpinnings have led to testable hypotheses that structure affects function via the nervous system by the scientific study of joint dysfunction and the biological mechanisms underlying manipulative therapies Scientific chiropractors suggest that dropping "subluxation dogma" and similar hypotheses without evidence will allow chiropractic care to become integrated into the wider health care community. In contrast to subluxation-based chiropractors, evidence-based chiropractors favor and incorporate mainstream medical diagnostic and treatment approaches such as exercise, nutritional supplementation, self-care, physiotherapeutic modalities, and other natural approaches. A majority of mixers retain belief that spinal dysfunction/subluxation may be involved in somato-visceral disorders. This group may represent the 'silent majority' of centrists who embrace evidence-based medicine but feel comfortable retaining elements of the subluxation complex that have not been validated through empirical evidence.

References

Comments (Proposal: Straight and Mixer)

Are you proposing adding this to an article that is already >100k? (last edit made it 118,063 bytes). Per WP:TOOBIG the article is already WAY to big and ALMOST DEFINITELY needs divided and chopped up. Articles shouldn't exceed 50k, it's already over TWICE that. So obviously, no for adding this text to the article without serious cuts to it's content. — raekyt 05:21, 21 February 2013 (UTC)

It will be replacing the current version and has taken several sources from other parts of the article and incorporated them in the appropriate way. Prior to Doc James reversion, the article stood at a lean 91k down 30 over all and reflects all the sources accurately. We're going to go over them one by one. Unless you oppose specific sources, this material is essential to the article. Please specifically cite what changes you would like to see and what sources you are challenging. DVMt (talk) 05:52, 21 February 2013 (UTC)

The reason why you had half a dozen editors revert your changes was that we do not think your changes "reflected all the sources accurately." Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:54, 21 February 2013 (UTC)

I haven't even looked at the sources, but the existing History section is 2.6k this is 4.4k, almost twice the size. So it's headed in the wrong direction if we're trying to bring this article to a manageable size. Like 40k needs to be cut. Would a History of Chiropractic article be unreasonable, if something like it doesn't already exist, and WP:SPLIT out the history, and maybe split out other parts as well? — raekyt 05:58, 21 February 2013 (UTC)

That's incorrect Doc. Only you reverted the article in its entirety. Prior to that it stood for 10 days without any reversion. You assumed that sources were being misused despite not even having read the content in question. If you're not reading it and checking the sources directly, than how is it possible to make any accurate judgment on the material? DVMt (talk) 06:22, 21 February 2013 (UTC)

No, we have Yobol in this edit [1] and RexxS in this edit [2] who reverted all of it as well. We have other reverts of your changes by Raeky in this edit [3] and Alexbrn in this edit [4] plus me which brings us to 6 different editors who disagree with your changes.

Vote stacking doesn't count and they agreed with the admin in question. How could they have read all the material in 1 min? Not likely. Raeky thinks spinal manipulation is as effective as crystal healers so that covers that. You're also being misleading because Raeky and Alexbrn did not revert the whole article, only you did and had the troops on stand by. Regardless, that's water under the bridge. Feel free to stick around for the long haul and oversee the 2013 update. I wouldn't have it any other way. DVMt (talk) 01:06, 22 February 2013 (UTC)

"Vote stacking" "troops on stand by" Seriously.... Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:54, 22 February 2013 (UTC)

I did read the content and changes in question which is how I determined that the sources were being missed. And than I noticed that high quality sources that reflected less than positively on chiropractics had gone missing. So I restored said sources to the last stable version of the article per WP:BRD

With respect to it standing for 10 days with NO changes, uh, you made a 15 edits the day before and 4 edits the day before that and 8 edits the day before that? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:38, 21 February 2013 (UTC)

It's not called chiropractics. There is no 's'. Also, you're again taking thing out of context. The article had been revised for a total on 10 days without any reversions from Raeky, Alexbrn, TippyGoomba, Bobrayner or any other potential dogmatic skeptic. Primary sources went missing, replaced by secondary sources. But I suppose, as TippyGoomba suggested, that I'm being too focused on the science and should focus more on the magic. As for deleting sources, for your revert kiled 60 additional references a good chunk which were secondary and tertiary sources. DVMt (talk) 01:06, 22 February 2013 (UTC)

The old version has 179 refs your "update" has 139. I pointed out some recent (in the last 2 years) reviews that disappeared in your changes. But anyway it is up to you to convince the community that these where improvements. This has not been done. While return when I see a concrete proposal / RfC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:53, 22 February 2013 (UTC)

Primary studies were replaced with secondary sources which is why the count went down. You still deleted 60 additional sources. DVMt (talk) 16:01, 23 February 2013 (UTC)

Raeky I'm not opposed to the idea of a split once the proposed revision gets a hard look. Like I mentioned you said that 40k needed to go 30k is achieved with the 2013 revision. I think we could pare it down even more and if we can't a split is perfectly reasonable. DVMt (talk) 06:27, 21 February 2013 (UTC)

10 days? How about WP:NORUSH? Also, notice how only a single WP:SPA came to your defense when your massive white-wash was reverted. Anyway... back to the purposed edit... I actually think that this distinction between straight and mixer isn't adequately covered in the article. This relates to DVMt's white-washing efforts, he wants the article to be more about the science and less about the magic. But imagine if someone tried to edit the mystical bullshit out of the Yoga article. TippyGoomba (talk) 06:33, 21 February 2013 (UTC)

So Tiippy, you want the article to be less scientific then? DVMt (talk) 01:06, 22 February 2013 (UTC)

You have a version in your head and the reality is less scientific. The article should reflect reality. Put up some stats on how Chiropractors view innate intelligence and vaccinations which reflect reality and I will instantly change my view of how the article should be presented. TippyGoomba (talk) 02:27, 22 February 2013 (UTC)

There's a major difference between 'having a version in your head' and having reliable sources that supports the claims made. By adding 60 new references from 2005-2013 the tone did shift, moreso because there was scientific evidence thats now exists on given topics that didn't previously. As DigitalC mentioned somewhere at talk, the last major revision was in 2008. Five years have passed and now in 2013 there's a lot more sources that updates the "story" of chiropractic. It was being edited from a straight viewpoint (20%) as opposed to a straight and mixer (80%) viewpoints. Don't forget, globally there are virtually no straight schools. This decreases their numbers even further. As straight chiros get 'diluted' there will be socio-cultural change not only within the profession itself but also how collaborates with mainstream scientists. In 2018 the story will continue to evolve and change. But we must tell the whole story, history and present. Ok, to your other question. Innate intelligence is a weird term; cause it has different meanings apparently. Vis medicatrix naturae (healing power of nature) is a synonym and its also represents homeostasis. To straight chiropractors it's a separate philosophy tied in with subluxation this is about 20% of the chiros in the States. So, definitely a minority. Their views run counter to the chiropractic mainstream. The anti-vax is roughly the same 20-25%) because, again, the straights seem dogmatic with their views which fall are out of the mainstream in both chiropractic and medicine. DVMt (talk) 04:33, 22 February 2013 (UTC)

Would you happen to have sources for those numbers? Because that would change everything in my mind. TippyGoomba (talk) 04:51, 22 February 2013 (UTC)

I'm looking for secondary or tertiary sources that would be better than a primary study. Also most of the literature focuses on the US. When I find it I'll post it here. Any specific comments regarding the proposed straight vs mixer revision? DVMt (talk) 15:58, 23 February 2013 (UTC)

Since the material presented has not been challenged for several days, I will move into the main article to enhance the current 'straight vs.mixer' section. Regards, DVMt (talk) 02:09, 28 February 2013 (UTC)

Tippy has failed to discuss his controversial edit that removed non-challenged material. I will revert per BRD: and Tippy must discuss, specifically, his/her concern. DVMt (talk) 04:26, 28 February 2013 (UTC)

I do not see consensus here for the change DVMt? It is the person trying to make the change that needs the consensus not the other way around. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:40, 28 February 2013 (UTC)

Doc James, without discussion (again) [5] has reverted material that had been proposed and had 0 opposition until it's insertion tonight. Could both Tippy and Doc James specifically state what material they find controversial. DVMt (talk) 04:42, 28 February 2013 (UTC)

Consensus can be changed. You called the edit controversial, please explain what specifically you found offensive. DVMt (talk) 04:52, 28 February 2013 (UTC)

Ah just because there is not active opposition dose not mean there is support. All of a sudden these two section ended up under history? Yet they are still active concepts not just historical concepts. Thus disagree with them being subheadings. 05:05, 28 February 2013 (UTC) — Preceding unsigned comment added by Jmh649 (talk • contribs)

It wasn't exactly obvious what your changes were, but I looked through them. There were some good things, and some suboptimal things:

• On the good side, I like that you 'translated' the large box under Conceptual basis to prose, which Wikipedia prefers.
• Also good, you also translated the list of philosophy bullet points and the "Straights and mixers" table to prose.
• Also good was the separation of the "straight" and "mixer" concepts
• Not so good: You broke off some content from Conceptual basis and created a new History section, but there is already another History section, so you made a second one.
• You added a bullet point "Therapeutic Conservatism" as a part of Conceptual basis but it was just floating there by itself, and had some extraneous close-braces.
• Under your new History you added a large quote from Palmer in support of an argument as to whether Palmer got the idea from Still. Big quotes like that are not preferred, it'd be better to just state the point being made.
• Under "'Straight' chiropractic" you added a bunch of "scare quotes", that is not a preferred style.
• In general a lot of new content was added to this article which was already tagged as too large.

So I think the reverts were justified, there's some stuff to work on here. Zad68 05:09, 28 February 2013 (UTC)

Ok, these are great, insightful comments. The history was not meant to replace the current history section, but as a means of introducing the philosophy (ies) underlying chiropractors to it would read better. Removing the history subsection there would clarify it. It was also not the intent to make the straight vs. mixer distinction appear as a historical fact, indeed I recognize this is present currently. Regarding Palmer and Still, Palmer in fact did acknowledge that philosophically, the underpinnings of chiropractic are osteopathic which makes sense given their affinity for manipulation. The bullet point was a CE that can easily be undone. I will do this. The scare quotes are an actual article I believe, if I find it I can support the "killer" subluxations claim. The article is large, but my proposed revision was 30k less than this and this is a section at a time breakdown. These are good suggestions and interestingly, things I had not even considered controversial (such as the accidental classification of straight and mixer as "historical" were brought to attention. This is good because I believe there is a lot of common ground here. Thanks for your input Zad68. DVMt (talk) 05:20, 28 February 2013 (UTC)

Comments (Proposal: Straight and Mixer, Version 2.001 (beta))

As per the recommendations of Zad68 and Doc James, a revised proposal has been made (see the proposal 2.001b). Open for discussion and comments. DVMt (talk) 00:46, 1 March 2013 (UTC)

Note that the revised content is at the top of the section; named :Proposal: Philo of Straight and Mixer, 2013 DVMt (talk) 02:45, 1 March 2013 (UTC)

My comments on "Version 2.001 (beta)": In general, in parts, the tone is too "in-universe", meaning that it is written not as an academic, outside commentary or review of chiropractic philosophy, but rather it is written on top of the assumption that the philosphy or principles have an evidence base or are grounded in fact. Some of the terms used don't have any meaning to a non-specialist, and require in-line explaining or a Wikilink. Also, some of the words chosen are promotional rather than informative. Specific examples:

• Chiropractic medicine embraces naturalistic principles that suggest decreased "host resistance" of the body facilitates the disease process. - "Embraces" is too flowery; "naturalistic principles" isn't defined or wikilinked; "host resistance" likewise

• these terms where in the cited source. We can change them however. "Chiropractic medicine is part of the natural healing arts. Chiropractic theory suggests that decreased host-resistance of the body facilitates the disease process DVMt (talk) 04:48, 1 March 2013 (UTC)

• Chiropractors propose manual, conservative and natural interventions are preferable towards optimizing health and functional well-being. - Preferable to what? Is "conservative" here the same "conservative" as in "conservative treatment", the term found in medicine? "optimizing health and functional well-being" sounds purely like brochure-speak and isn't imparting actual encyclopedic information.

• Agreed this sentence is problematic. Chiropractors propose manual and manipulative interventions as part of a conservative treatment approach for neuromusculoskeletal disorders. DVMt (talk) 04:48, 1 March 2013 (UTC)

• Chiropractors emphasizes manual and manipulative therapies and as an alternative to medications and surgery for neuromusculoskeletal disorders. - This sounds "in-universe" because it's written on the assumption that chiropractic has been shown to be in general an equally valid alternative to medications and surgery.

• I disagree, for two reasons. One, there is proof of equivalency for LBP (thereby reducing meds and surgery) and the tertiary source, by Dr. Haldeman (MD, DC, PhD) et al. is a well regarded textbook amongst manual medicine practitioners and it's WP:MEDRS compliant. I acknowledge a source outside the profession would be nice but it would have to directly challenge the claim being made. DVMt (talk) 04:48, 1 March 2013 (UTC)

• The relationship between structure, especially the spine, and function as modulated by the nervous system, is central to chiropractic and its approach to the restoration and preservation of health. - Again "in-universe" written on the assumption that chiropractic has been shown to restore and preserve health.

• The source was quoted verbatim but I don't see why we couldn't change to "Chiropractic theory suggests the relationship between structure (primarily the spine) and function (modulated by the nervous system) is central to chiropractic and its approach towards the restoration and preservation of health.

Many more examples like this follow.

Some good things:

• It is hypothesized that clinically significant neurophysiological consequences may occur as a result of spinal dysfunction/subluxation, described by chiropractors as the vertebral subluxation complex. - This is good, the kind of tone we're looking for in a Wikipedia article, it's written from the point of view of an outsider critically examining chiropractic philosphy.
• Discussions of history seem good.

Sourcing: I think part of the issue of the tone of the prose is the choice of sourcing, not because it isn't authoritative or reliable - after Googling "Scott Haldeman", I can't imagine anyone more authoritative on chiropractic - but because it is mostly "in-universe" sourcing, meaning sources written by chiropractors and those involved in the promotion or management of chiropractic as a profession, and published in journals like Chiropractic and Osteopathy and Chiropractic and Manual Therapies. The WHO document was discussed earlier. I'm not saying not to use such sourcing, but rather when writing the article content you have to step outside the world of chiropractic and describe it as what "they" (chiropractors) think. This is done in some places but it has to be done everywhere.

• I understand your concern of the insourcing, but realistically, who knows more about the chiropractic profession then their own scholars? The sources all meet WP:MEDRS reliable sourcecs and are published in mainstream academic publishing houses. The same applies to any profession, medicine knowing the most about medicine, lawyers about law etc. The claims also aren't bold are controversial, their simply ones from better sources that are more current. CMT is now what CO was. It's indexed by pubmed, and the article in question is written by Gert Bronfort who co-authored Cochrane reviews. It's examples like these that we must have an outside source, such as yourself, to review the source in question and be educated, to a degree, on the main authors. A good discussion for later I'm sure!. DVMt (talk) 04:48, 1 March 2013 (UTC)

Grammar: There are a number of small things to clean up like subject/verb agreement, singular/plural errors, missing punctuation, etc.

• Yeah, that's for sure. DVMt (talk) 04:48, 1 March 2013 (UTC)

Zad68 03:48, 1 March 2013 (UTC)

Zad,I cleaned up the proposal for this section as per your suggestions. Can you give it a peek and give comments prior to insertion? DVMt (talk) 16:55, 2 March 2013 (UTC)

Might not be a bad idea to get a RfC and greater community attention than just the couple of us. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:35, 2 March 2013 (UTC)

At this point I think the collaborative version addresses the major concerns . Zads analysis was great and there's input from MDs a DC and a DVM. It couldn't have been done without all of us. Since the material isn't challenged it's pretty close being ready to go :). DVMt (talk) 19:08, 2 March 2013 (UTC)

I see you've made some changes, took out the jargon-y sentence. I'm not sure what "natural healing arts" means. Regarding words like "embrace", this is where you, as a Wikipedia article editor, need to look at the wording and context used in the source, which is a chiropractor talking to chiropractors, and translate it into a general Wikipedia article talking to nonspecialist readers. This often involves intentionally using less florid prose than the sources. I see there is a separate Philosophy of Chiropractic article, so this article should give only a brief introduction to the most important points and link to the main article. This might be a case where the content will go in and will get toned down by other editors or at a GA review. Zad68 04:23, 3 March 2013 (UTC)

What you must do is get a formal support that this new version is better than the previous. And what you plan to replace with it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:26, 3 March 2013 (UTC)

Ok. Will look at the proposal again and refine the language. Great tips again! I really appreciate your help Zad. I see you as a mentor figure. DVMt (talk) 04:34, 3 March 2013 (UTC)

Zad I'm not going to include the arts thing. It's wordy. Let me know if you find other issues you want to iron out, or just go ahead of change it yourself above. DVMt (talk) 05:09, 3 March 2013 (UTC)

Does anyone oppose the proposed text (which will replace the current philo/straight/mixer) section)? If not, I will insert it. DVMt (talk) 18:57, 5 March 2013 (UTC)

• By incorrectly saying science necessariy is is a materialistic and reductionist philosophy in your proposals you appear to be putting up a straw man that medicine does not take a holistic approach (which is not the case as the article holistic article and citations within make clear). From reading [6], which is written "in universe" I doubt its reliability for statements about science or medicine in general. Also, drop the use of the allopathic terminology, nothing says written by a quack louder than using the word allopathic to describe medicine. I'm not saying this is what you intended, just that this is the impression it would give off if added to an article, IRWolfie- (talk) 22:51, 5 March 2013 (UTC)

Thanks for chipping in IRWolfie. I didn't realize allopathic was pejorative, it just flowed with the chiropractic, osteopathic, allopathic. I believe I saw this terminology used at the Osteopathic Medicine page. It was not my intent though for it do come off as a judgemental, quack sounding term. Regarding the statement of materialsim, I have to look and see where it is. THe source said it incorporate both vitalistic and materialistic philosophies. But again, it's not aimed as a criticism of science. I do see more medicine using a holistic approach, but holism is predominantly associated with CAM. I will revise the proposal and feel free to comment again. DVMt (talk) 00:54, 6 March 2013 (UTC) Edit: Allopathic medicine is apparently a common term; the American Medical Student Association uses the term presently here [7]. Learn something new everyday! DVMt (talk) 01:38, 6 March 2013 (UTC)

It's common within alt med communities (who invented the term) like the one you just linked. It is not used in the mainstream medical community. As [8] makes clear, allopathy in its original use referred to pre-evidence based medicine. IRWolfie- (talk) 12:55, 6 March 2013 (UTC)

Yeah it seems definitions, over time, change to reflect the times and evidence. it's not a big deal to me, and it goes beyond the scope of this article. I replaced the word allopathic with medical, are there any other issues that need addressing? DVMt (talk) 17:37, 6 March 2013 (UTC)

You have: "By embracing mechanistic viewpoint, mixers balance the vitalistic notions with critical reasoning skills that led to legitimate scientific investigation of chiropractic principles." This violates NPOV. Firstly it implies that science is just one viewpoint equal to any other. Secondly, it implies that vitalism is its equal, and not an outdated concept which is rejected. The main issue really is that most of your sources aren't reliable for discussing the connection to standard medical practice (which are the majority of reliable sources). You need to extend your secondary sources outside of the chiropractic "in universe" sources if you want to do that. Essentially, it's still evident from the text that it is written by a chiropractor, using the chiropractic sources. Don't forget, wikipedia categorically does not aim to balance opposing views as equal. If the majority of scientific sources disagree with some notion like vitalism, then wikipedia should reflect that. Giving weight to viewpoints based on how the sources give weight is a summary of what NPOV is. Chiropractic sources can be used for stating their own views, but not for saying things about science or greater medical practice. IRWolfie- (talk) 11:36, 7 March 2013 (UTC)

I think it's just us interpreting the sentence differently. I don't read it as science as one POV equal to vitalism (i.e. healing power of nature). I see it rather as a mixer chiropractors combining elements of both vitalism and materialism, as opposed to them being equivalent. With respect to vitalism specifically, it's not my intent to push vitalism or to knock it down, merely just reporting the facts. We agree that chiropractic sources shouldn't be used to comment specifically on issues that pertain outside their scope. How about some different wording though to address your concerns: MIxers combine both vitalistic and mechanistic viewpoints that has led to scientific investigation of chiropractic principles." I think that reads better as well. DVMt (talk) 15:43, 7 March 2013 (UTC)

That you are talking about materialism (which you seem to use interchangeably with science) tells me you have missed the issue again. Science is not the same as materialism, and it isn't necessarily materialistic. Use of the word "Mechanistic" is alt med type terminology for biomed again.

On your proposed suggestion; Vitalism is not scientific, so combining it with standard viewpoints does not led to a scientific investigation. Looking at it purely from a biomedical perspective would be scientific i.e in this case purely in terms of looking at the efficacy and establishing there is something to look for, before positing theories (much like this guy suggested: http://www.chiromt.com/content/13/1/17 ). You need to get mainstream sources as they are the ones that would clarify the issue (look to MEDRS for good sources) . IRWolfie- (talk) 17:20, 7 March 2013 (UTC)

I'd suggest dumping it into the article now and we can tweak further from there. I think it needs a lot of work, but it's easier to do it from this stage in article. IRWolfie- (talk) 17:34, 7 March 2013 (UTC)

Ok. The gist of the source (my interpretation) is that chiro combines reductionistic (materialism/mechanistic) and vitalistic (vis medicatrix naturae, sum is greater than the whole of its parts). Mechanistic, as I understood it, was meant as a contrast to vitalism and one that could be investigated by the scientific method (as opposed to vitalism). I will proceed to dump it into the article as per your suggestion. Thanks for your comments again, they are insightful. Regards, DVMt (talk) 17:50, 7 March 2013 (UTC)

Literature synth source

I'm a bit confused with [9]. There conclusions, according to this article, are the opposite of the cochrane review, and they don't seem to declare the conflict of interest that they work for the Council on Chiropractic guidelines and practice parameters [10]. I also can't find text that supports "A 2008 literature synthesis found good evidence supporting SM for low back pain regardless of duration" in the conclusions (I don't have access to the full article), but from the conclusion it doesn't look like it supports that text. IRWolfie- (talk) 18:30, 10 March 2013 (UTC)

I'll double check the source. 2008 has likely been supplanted by more recent evidence, so that citation can go. I'll remove the claim. DVMt (talk) 20:11, 10 March 2013 (UTC) Does this pertain to the proposal or to the current text present in the article? DVMt (talk) 20:15, 10 March 2013 (UTC) The effectiveness section itself is dated with old reviews (2004-2005-2006) still here despite being usurped by newer reviews. Take a peek at my proposal which has an updated section on effectiveness (ie. research status). I've been chipping away at it now for over a month. DVMt (talk) 20:41, 10 March 2013 (UTC)

It's in the current article. I think any proposal on the page will just get messy. It's just not the usual approach to editing pages on wikipedia, and it doesn't work well for collaborative editing; we lose the edit history on the article. IRWolfie- (talk) 21:56, 11 March 2013 (UTC)

I never considered we would lose the edit history by collaborating on the talk page. I'll replace the current effectiveness section with the updated version. Yourself, Puhlaa, Doc James or whoever has issues can edit it on the main page. I think it's a pretty accurate summary; but James and I have had disagreements over language. Regardless, I trust that if you have any problems with it you'll edit as you see fit. DVMt (talk) 23:07, 11 March 2013 (UTC)

I must have misunderstood what you meant. I thought you were of the opinion that the current research status was outdated and needed better clarity. Regardless, it should be noted that the proposed content is up-to-date and removes any 'hanging' primary papers that have been reviewed since that point. DVMt (talk) 00:01, 12 March 2013 (UTC)

I don't think I stated anything about research being outdated in this thread. I had an issue with a source verifying text. You dropped 16000 words which were covered with citations, see WP:CAREFUL. IRWolfie- (talk) 00:06, 12 March 2013 (UTC)

If you are concerned about the need for clarity, an easy approach would be to drop all reviews that aren't in the core biomed journals highlighted here Wikipedia:MEDRS. IRWolfie- (talk) 00:11, 12 March 2013 (UTC)

I read into it; the fact that you had found an old 2008 lit synthesis which was outdated and still being used despite a newer review which covers that topic, etc. It's the same thing throughout the section. There's agreement between 2 sources, covering the same topic, and the older review stays in despite its redundancy. Regarding dropping 16 000 words, a lot of that is simply the references which takes a lot of "words" (bytes). The last time this article, according to older editors anyways, had a major lit review (effectiveness) was in 2008. It's the 5 year update (because a lot is out-of date). Regards, DVMt (talk) 00:19, 12 March 2013 (UTC) Edit: I'm familiar with MEDRS (thank you!) and when in doubt, I'll check impact factor, and if still in doubt, I go to WP:MED Talk. DVMt (talk) 00:26, 12 March 2013 (UTC)

Neutrality

I notice there is no mention of placebo in the Medicine article while it is prominent here. I also notice a tirade on pseudoscience in the intro prior to discussing what chiropractic is or does.

This is the intro to Medicine. Contrast it with the intro on chiropractic. You folks are having a problem with neutrality for sure.

"Medicine (Listeni/ˈmɛdsɨn/, Listeni/ˈmɛdɨsɨn/) is the applied science or practice of the diagnosis, treatment, and prevention of disease.[1] It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness in human beings.

Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication or surgery, but also through therapies as diverse as psychotherapy, external splints & traction, prostheses, biologics, ionizing radiation and others.

The word medicine is derived from the Latin ars medicina, meaning the art of healing" Anthon01

What do you propose? DVMt (talk) 16:40, 14 March 2013 (UTC)

RfC proceedings

There is a discussion here [11] regarding the the effectiveness of SMT for LBP. DVMt (talk) 19:22, 24 February 2013 (UTC)

Why did you label this section "RfC proceedings" since there is still no open RfC? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:57, 24 February 2013 (UTC)

Because it breaks up the page and the discussions for sectional revisions. I was trying to organize the page a bit for readability but if you want it kept, no biggie. DVMt (talk) 02:11, 4 March 2013 (UTC)

It will archive. Typically one never removed others comments from a talk page. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:28, 4 March 2013 (UTC)

Ok. The section seemed out of sorts was all. Didn't the discussion was critical for the page. But, if those are the rules, then so be it. DVMt (talk) 02:39, 4 March 2013 (UTC)

retract proposal DVMt (talk) 04:15, 8 March 2013 (UTC)

Comments (On hold:Ethics and medicolegal issues)

DVMt, is the text you have 'proposed' above meant to replace current article text? If so, which text and where? If not, where do you propose adding this text? More information will be help editors make insightful comments about your proposal.Puhlaa (talk) 05:29, 28 February 2013 (UTC)

It would condense the main arguments and controversies around chiropractic clearly, distinctly on all the topics. It would also cover the ethical questions surrounding chiropractors and the paradox of high patient satisfaction and the straight segment that really goes against the mainstream of chiropractors identified more clearly. Primary care definitions, etc. could also be done. It shortens the article somewhat but covers the pertinent topics in an objective manner. DVMt (talk) 06:06, 28 February 2013 (UTC)

• Oppose this version Concerns about chiropractics are more than just from SMT. There is also the concern that they will miss other diagnosis or treat conditions for which chiro is not effective resulting in overall harm to the patient. The current text sort of mentions these concerns however the above bit does not. So I do not see this as an improvement Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:32, 2 March 2013 (UTC)
  • What part of the current text are you referring to? Do you have a source regarding misdiagnosis, or treat conditions resulting in overall harm? These are bold claims that need evidence. DVMt (talk) 18:36, 2 March 2013 (UTC)

Given that no sources have been presented, the concerns appear more of conjecture than based on fact verifiable by the evidence. Please provide sources to support the claims. DVMt (talk) 00:34, 3 March 2013 (UTC)

There are sources. They are the ones you where hoping to delete such as this one [12].Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:35, 3 March 2013 (UTC)

I did not propose removing the Ernst critical review. More conjecture. It is used extensively in the page. Do you have other sources outside Ernst/Posadzki? DVMt (talk) 00:47, 3 March 2013 (UTC)

Yes I see it is still there however some of its conclusions have been removed. I do not see this bit "The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations." support by this 2009 review [13] Seems to have been replaced by a ref to an older review in the journal "Chiropractic Osteopathic" Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:32, 3 March 2013 (UTC)

This is the direct conclusion from the study you mentioned : There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic. Why don't we stick to what the source says? DVMt (talk) 01:37, 3 March 2013 (UTC)

Yes and the above was from the results section "Most of the adverse events reported were benign and transitory, however, there are reports of complications that were life threatening, such as arterial dissection, myelopathy, vertebral disc extrusion, and epidural hematoma. The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations." Additionally the full paper adds as key points "Complications associated with chiropractic procedures are frequent. Most of the adverse events reported are benign and transitory, however, some can be life threatening." The discussion section also states "The remarkable popularity of spinal manipulation is contrasted by a disappointing lack of well-conducted studies to assess efficacy."Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:48, 3 March 2013 (UTC)

Ok. So you are claiming there is a serious safety with spinal manipulation and that the studies to investigate efficacy are poor. Is that correct? DVMt (talk) 01:59, 3 March 2013 (UTC)

I don't think he is claiming anything, rather it is the paper that is, IRWolfie- (talk) 21:51, 11 March 2013 (UTC)

The 2008 conclusions on the Ernt review on "safety/risk/benefit" have been usurped by the 2012 Rubenstein et al. Cochrane review which states spinal manipulation is "relatively safe". I agree adverse effects need to be mentioned; it just a weight issue. I'll propose a revised safety section that addresses this, DVMt (talk) 05:27, 14 March 2013 (UTC)

DVMt, I also have some concerns regarding sources. IMO, this 2012 systematic review currently represents the best source available on the association between spine manipulation and stroke. It is in the current article, but I do not see it in your proposal. Notable findings in this review are 1) the lack of quality evidence either supporting or refuting a strong association; and 2) the lack of any accurate risk-benefit analysis available to date. Any discussion of stroke, again IMO, should be qualified with the fact that any evidence for or against the association is weak at best and any claims for or against the relative safety of the procedure are still based on conjecture. With regard to Doc James comments and in consideration of the best sources available, lets be careful not to give too much weight to any one author or source that seems to make too bold of claims about safety.Puhlaa (talk) 01:55, 3 March 2013 (UTC)

Comments on Treatment/Safety Proposal, March 2013

The proposed draft, for practical purposes, can be subdivided into 2 sections. Section 1 would include treatment, definitions, categories. Section 2 is the research status of manual therapy (effectiveness, safety, cost-effectiveness).

Let the discussion begin! DVMt (talk) 20:55, 7 March 2013 (UTC)

If no opposition, I will insert section 1 of 2. This is a descriptive section involving definitions, manual and manipulative therapy, categories of manipulative therapy. It's better organized and referenced than the current section. Regards, DVMt (talk) 01:13, 10 March 2013 (UTC)

Far too much at one time. Do a little at a time so we can see if any existing content will be deleted, and what will be added. Tweaking is a better procedure than blanket substitution. In case you hadn't noticed, that content has not been developed through collaboration. You are the sole creator. Try copying one paragraph from the article and placing it here. Then place your proposed changes right under it. Then we can see what's going on. Right now it's far too difficult to analyze. -- Brangifer (talk) 02:05, 10 March 2013 (UTC)

I'd second that. If you can go paragraph by paragraph it might be best. Despite your sincere efforts it's challenging to review large rewrites unless there's a section by section comparison. Ocaasi ^{t | c} 02:22, 10 March 2013 (UTC)

Ok, I've broken it down into 2 sections. The citations are far heavier in the research section. Thanks for the suggestions. DVMt (talk) 16:35, 10 March 2013 (UTC)

Comments on good looking women with good complexion some of whom are subject to copyright.

Sorry but what is with the pictures of the sexy women with the perfect completion? It makes the changes look like a promotional pamphlet. Also we seem to have some copyright infringe going on as this image is exactly the same as this one for sale here [14] Also what is with the two people looking at an Xray together. This also looks suspect. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:47, 10 March 2013 (UTC)

I'm not going to comment regarding the sexiness of the women, in case my wife is watching. Their complexion falls outside my expertise ;) The rationale behind the image insertion was a) women are more prevalent than men to use manual therapy 2) VBA stroke issue seems to be more prevalent in women and c) the debate is mostly concerning upper neck manipulation safety. Hence the palpation of the neck. We can always find a different image if required though. The image with the manipulations and the X-ray is being used at the osteopathic page (manual medicine or the OM page). DVMt (talk) 17:28, 10 March 2013 (UTC)

You marked the images as being your "own work". What exactly do you think that means? The "(c) Science Photo Library" was a very odd choice for you to have put in the metadata. TippyGoomba (talk) 18:01, 10 March 2013 (UTC)

Looks like a copyvio, IRWolfie- (talk) 18:17, 10 March 2013 (UTC)

Other images uploaded by DVMt seem to have been copied from a third party but claimed as own work. I've flagged them for deletion on Commons. I'm not going to embed images here because we shouldn't compound the copyvio problem. At this point it would be inappropriate to trust any image uploaded by DVMt. bobrayner (talk) 19:18, 10 March 2013 (UTC)

If only the content were to get as much as a look as the images... Ok, so the last image doesn't meet criteria, the first two do. Any comments about the written material itself? DVMt (talk) 19:55, 10 March 2013 (UTC)

Copyright violation, reverts, and lies ignorance

I removed another image which appeared to be copyvio; it's identical to this which is "© 2004-2013 All rights reserved - Bigstock®". DVMt reverted it with the edit summary "not copyvio". DVMt, can you explain? Perhaps you also own the stock photo business? bobrayner (talk) 21:30, 10 March 2013 (UTC)

Sure. This image was produced in the 1920s and is the official chiropractic symbol (cauduceus). It's part of the public domain. I don't see how any company can "own" an emblem that belongs to a profession. Just like the snake and staff, that is used as the symbol/image of medicine. DVMt (talk) 21:49, 10 March 2013 (UTC)

Do you have some evidence that that image - and not just a similar-looking one - is in the public domain? The problem is that I found an identical image with a credible copyright claim. Which site did you get that image from? bobrayner (talk) 22:00, 10 March 2013 (UTC)

Bob, I'd ask kindly that you remove the "reverts and lies" part of your section header. That is not assuming any good faith and is a personal attack. I don't recall the site I got it from; but it did not have any copyright on it that I saw. Also, it had no meta-data too. Your tone is rather aggressive, may be cool down a bit. DVMt (talk) 22:08, 10 March 2013 (UTC)

You've written that you are the copyright holder in the license. You need to find a proper license. I think you want to either argue some kind of fair use or find a public domain image. The solution is not to blatantly lie, pretending that you own the copyright. TippyGoomba (talk) 22:16, 10 March 2013 (UTC)

No one owns the copyright, hence the public domain. It's analogous to the medical symbol here [15]. I did in fact stencil the chiropractic caduceus. So does that make me the copyright owner then? DVMt (talk) 22:21, 10 March 2013 (UTC)

It does. Did you write it as an svg? Why did you convert it to jpg? TippyGoomba (talk) 22:30, 10 March 2013 (UTC)

It appears this is the work of John T. Takai and it must be purchased:

• http://www.shutterstock.com/pic.mhtml?id=33965233

Contrary to what is claimed, it is not DVMt's "own work," even if he stenciled it or otherwise copied it. The chiropractic caduceus comes in many variations, and most of them are copyrighted by the creators. We have previously dealt with exactly this same issue, since we wished to use one, but we never found one that wasn't copyrighted, so we haven't used it. -- Brangifer (talk) 06:49, 11 March 2013 (UTC)

Out of curiosity since we're on the topic. If someone were to purchase the image (shutterstock) could it then be used at WP, in general? I'm not suggesting I'm going to pay for it, but would this be allowed? With respect to public domain, how can we tell if it's public domain or copyright? IRWolfie mentioned above everything online is copyright, but that's probably a generalisation. It's a waste of everyone's time debating these images, I just want to learn how to do it right so we can all get back to being productive. DVMt (talk) 23:14, 12 March 2013 (UTC)

No, if you purchase an image you are not assigned the copyright automatically. IRWolfie- (talk) 17:25, 14 March 2013 (UTC)

Last paragraph lede

Current:

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, and some evidence of severe adverse effects from cervical vertebral manipulation. The ideas of innate intelligence and the chiropractic subluxation are regarded as pseudoscience.

Proposed:

Manual and manipulative therapies commonly used by chiropractors other manual medicine practitioners are used primarily to help treat low back pain and other neuromusculoskeletal disorders. Spinal manipulation appears as effective to other commonly prescribed treatments for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy. For acute low back pain, spinal manipulative therapy does not appear better than commonly recommended therapies such as analgesics, acupuncture, back pain education or exercise therapy. National guidelines regarding spinal manipulation vary country to country; some do not recommend, while others recommend a short course of manipulative therapy for those who do not improve with other interventions. Manipulation under anaesthesia, or medically-assisted manipulation, currently has insufficient evidence to make any strong recommendations. Spinal manipulation may be effective for lumbar disc herniation with radiculopathy, as effective as mobilization for neck pain, some forms of headache, and some extremity joint conditions. . There is insufficient evidence regarding the effectiveness of spinal manipulation on non-musculoskeletal conditions.[16]. There is considerable debate regarding the safety of spinal manipulation, particularly with the upper cervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare as spinal manipulation is relatively safe when employed skillfully and appropriately. Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches. Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent.

Discussion (Revised last paragraph, lead)

This has been on the table almost a month now. If there's no opposition to the material, I propose inserting this small text as the last paragraph of the lead. DVMt (talk) 16:41, 12 March 2013 (UTC)

Manual and manipulative therapies commonly used by chiropractors other manual medicine practitioners are used primarily to help treat low back pain, and other neuromusculoskeletal disorders Manual therapies appear to be as effective as standard medical care, exercise therapy and physiotherapy in the treatment of low back pain , and may be effective for non-specific neck pain, headaches, and extremity conditions. Athough serious injuries and fatal consequences can occur and may be under-reported, spinal manipulation is relatively safe when employed skillfully and appropriately.

More copyright violations

Here DVMt claims the image is his "own work", and after I removed the image from this article, he restored it. But it was apparently copied from this website. If that is not the case, then that website has stolen an image taken by DVMt's camera. What is it? Who is violating copyright here? Someone is not being honest. "Own work" means one has taken the image oneself. Should we contact that website to find out what's going on? -- Brangifer (talk) 16:07, 12 March 2013 (UTC)

The image was a google image search which I found hence the 'own work'. I also looked at the website in question and I don't notice any copyright on the page itself. As I understand, if an image is not copyright, it belongs to the public domain. If I'm wrong I don't oppose to removing the image. DVMt (talk) 16:17, 12 March 2013 (UTC)

You interpretation is incorrect. All material on the internet is copyrighted unless it explicitly states it is in the public domain, or if the copyright has expired due to age. (This makes me worry about the copyright status of the text you've inserted into the article now) IRWolfie- (talk) 16:35, 12 March 2013 (UTC)

The text was paraphrased from the sources as convention. Regarding the statement, all material on the internet is copyright, is there a source which states this? To be honest, pictures are a distant second to me in terms of importance compared to reviewing actual literature. Any comments regarding the change to the lead, as presented above? DVMt (talk) 16:39, 12 March 2013 (UTC)

All works in all forms automatically are covered by copyright, whether on the internet or anywhere else. Just google around and read up. I'm not about to track down specific sources for you. Just read the guidelines and do some research IRWolfie- (talk) 17:29, 14 March 2013 (UTC)

Ok. Thanks for the tips. DVMt (talk) 17:35, 14 March 2013 (UTC)

Merge?

Should these articles be merged in: Joint dysfunction, Spinal dysfunction. Both are nearly identical. IRWolfie- (talk) 16:42, 12 March 2013 (UTC)

My only concern would be that other health care professionals that practice manipulation (osteos, physios, vets, some MDs) might oppose to the merging of that independent article. It would be akin to merging spinal manipulation with chiropractic. DVMt (talk) 16:46, 12 March 2013 (UTC)

Both seem to be written from a chiropractic perspective. It might actually be better to merge them into one of the other overlapping chiropractic articles, and restart Joint dysfunction from a mainstream / evidence-based medicine perspective. bobrayner (talk) 18:22, 12 March 2013 (UTC)

What about joint dysfunction isn't evidence-based or mainstream? How are they written from a 'chiropractic perspective'? DVMt (talk) 21:57, 12 March 2013 (UTC)

IRWolfie, what part(s) if any of joint dysfunction do you want to add? I agree that a part of that could easily fit in here; definitions, biomechanics and theory. We can summarize it link to the main article if need be for brevity. DVMt (talk) 04:18, 14 March 2013 (UTC)

They are indeed so similar as to be easily mergeable. They are also written from a chiropractic perspective. Other professions have other diagnoses for the specific problems described, and they don't use manipulation or mobilisation for all of them.

The part that isn't evidence-based is all the "theoretical" part, which chiropractors take as gospel and have used as justification for treatment and profit for well over 100 years. Many of the problems they have treated with manipulation have other known and proven causes, with their own accepted diagnoses and treatments. Fortunately many modern chiropractors aren't claiming that spinal dysfunction causes diabetes, etc. anymore, and yet there are many who claim that allergies, ear infections, etc. are treatable with manipulation, and that regular manipulation strengthens the body's immune system and can make vaccinations unnecessary. That's BS. -- Brangifer (talk) 04:28, 13 March 2013 (UTC)

The other definitions are noted within the article (biomechanical lesion, subluxation, somatic dysfunction, non-allopathic lesion, etc.). The generic term for all these other diagnoses is joint dysfunction. The research is basic sciences research investigating the effects of spinal dysfunction on articulations and soft tissues. The mechanism of effects are neurophysiological. The 'problems treated' with manipulation are 90% MSK as the stats show in clinical practice. The woo of chiropractic is not that hard to see or to differentiate in this day in age. Only time will tell if they continue to evolve and prosper or if they bite the dust. Given it's increasing curricular alliances with the biomedical model and commitment to scientific investigation (by and large) they're likely here to stay. I agree we can and should criticize traditional straight chiropractors and their defiant ways; unjustified claims, alliances with religious practices, etc. So yes, definitely BS about the breadth of manipulation efficacy. You need a source that would back up your claim "many claim (diseases....) are treated with manipulation". The research shows it's used as a complementary as opposed to an alternative to conventional med. DVMt (talk) 04:49, 13 March 2013 (UTC)

I've repeatedly asked you for sources for these sorts of claims. Do you have a source for the proportion of chiropractors reject Palmer's more insane babblings about innate intelligence, which proportion rejects vaccinations, etc. TippyGoomba (talk) 05:55, 13 March 2013 (UTC)

DVMt, here are two articles which show what's happening in the real world of AM/CAM and chiropractic in Australia:

• Treatment isn't always a cure
• Chiropractic funding called into question

They discuss some of the real problems out there and the outright animosity and hatred of modern medicine which some practitioners of AM show. -- Brangifer (talk) 15:19, 13 March 2013 (UTC)

I tried redirecting one of the duplicate articles, but it got reverted. I tried removing some of the chiro propaganda, and that got reverted too, on the basis that the article had been "rated by WP:MED". This article-ownership is quite frustrating. Every attempt to remove copyvio, deal with fringe content and coatrack &c across various articles gets reverted automatically. bobrayner (talk) 10:40, 14 March 2013 (UTC)

• I mentioned merging the section, not deleting another different section. IRWolfie- (talk) 19:07, 14 March 2013 (UTC)

Ok. I'll try again later. All the salient point were covered (criticisms section) and some primary sources were replaced with better secondary sources (from non-chiro journals). 19:42, 14 March 2013 (UTC)

You censored more content about the connection between mainstream science and chiropractic, and material which reflects chiropractic in a negative light. Can you please knock it off. What you are doing is transparent and a bit annoying. This is the third or fourth time today you've tried to do this today to different sections. IRWolfie- (talk) 20:04, 14 March 2013 (UTC)

Points of discussion

IRWolfie, since the editing has been relatively productive so far, I'll make suggestions on the talk page and we can go over them here rather than getting involved in lots of reversions, etc... DVMt (talk) 21:20, 14 March 2013 (UTC)

First order of business (small). The wording in the last sentence in the lead does not accurately reflect the source [17]. The source states: The core concepts of chiropractic, subluxation and spinal manipulation, are not based on sound science. This should be inserted in the 2nd paragraph that deals specifically with subluxation (joint dysfunction) with the correct wording from the source, DVMt (talk) 22:22, 14 March 2013 (UTC)

Relevant parts for the article: "These systematic reviews usually include trials of spinal manipulation regardless of who administered it. Thus, they are not exclusively an evaluation of chiropractic. Collectively, their results fail to demonstrate that spinal manipulation is effective. The only possible exception is back pain. For this condition, manipulation may be as effective (or ineffective) as standard therapy". "Many national guidelines recommend chiropractic for acute or chronic low-back pain. The reason may not be the convincingly demonstrated effectiveness of chiropractic care but the fact that no therapy so far has been shown to make a real difference for back pain sufferers." "Few of the primary studies have been adequately controlled for placebo effects, an objective which is difficult but not impossible to achieve. Thus, some of the benefit reported in the above-mentioned studies could be due to a placebo response. A survey of 34 Australian ‘‘leaders of the chiropractic profession’’ suggested that the majority of chiropractors agree that the placebo effect is a major contributor to the perceived benefit of chiropractic. Some even felt that ‘‘at least half’’ of the chiropractic success is due to placebo effects."

I'll change the article tomorrow to reflect this source more, I think things need to cool down; you are trying to push too much. IRWolfie- (talk) 22:46, 14 March 2013 (UTC)

We agree on 95% of the content you and I and we were moving at a good clip. I too thought it was fast, but since we were collaboratively editing I was thinking you wanted to 'get it done'. Just let me know what is 'too much'. We can look at it one section at a time from here on in. I think there might be a miscommunication of what 'mainstream' is. Mainstream medicine embraces mainstream chiropractic for MSK issues. Even Ernst says this. The article does not reflect that basic fact. Mixers are the majority group, represent the mainstream and are the ones engaged in research and yet all evidence of this gets deleted. I agree in February when Doc James reverted the whole article (a white-wash vs. white-wash argument there). We were piecing this together after a lot of input from people: you, me, Puhaa, Zad68, etc. I disagree that there was 'no consensus at talk'. We did talk it through. Furthermore, you oversee fringe topics and we were collaboratively editing. It' not as though you didn't revert me when you saw fit. I can work like that and now that we've done a bit of work together, I know how to approach it. It's a learning curve. One last point: I see there is an edit war occurring today as a result of the bold edit by Doc without discussing it at Talk. I don't find it fair how one doesn't even participate meaningfully at an article and can have such complete, universal control of all content going in and out. To me that's owning the article and it's a behaviour issue. I'm no angel and my talk page reflects that, but we're all human and we make mistakes. Even admins. Regards, DVMt (talk) 02:26, 15 March 2013 (UTC)

• Note: Drk878 was a sock of DVMt, IRWolfie- (talk) 11:07, 15 March 2013 (UTC)

No. She is my wife and created her own account. I also started a facebook group which has drawn attention to the matter here. Thus, one can expect a potential influx of commentators and editors here and at CAM in general. Regards, DVMt (talk) 13:20, 15 March 2013 (UTC)

Hi IRWolfie, just wanting to clarify that I am DVMt's spouse. I created an account to help him with copy edits, as I'm a writer and editor. However, I follow the same belief system when it comes to health, specifically chiropractic. — Preceding unsigned comment added by Drk878 (talk • contribs) 14:10, 15 March 2013 (UTC)

It apparently doesn't matter. Another editor said that you are a WP:MEAT which is a rather vague term. It basically says that any new editor who shares the same POV are discouraged from contributing. I think this is nonsense. I guess we will see where it all ends up. DVMt (talk) 14:20, 15 March 2013 (UTC)

Eyes needed here

Please take a look here, comment, and edit accordingly:

• http://en.wikipedia.org/wiki/Talk:Joint_dysfunction#Massive_synthesis_problems

Brangifer (talk) 07:31, 16 March 2013 (UTC)

Merge

I merged back the controversy article as it looked like a POV fork. It removed many aspects critical of chiropractic from this article, and put them on another. My merger should not have removed any points in this article, though it may have moved them or used a better wording of the same point from the other article. IRWolfie- (talk) 13:47, 16 March 2013 (UTC)

Whoa! Not so fast. That article is a proper fork. There is lots of good information there and we can't include all of it here without creating an undue weight problem. We can discuss whether to enlarge the section here, but to go so far as to just redirect the other article, well, that's another matter. We still need it and the "main" link to it. All wait for comments. -- Brangifer (talk) 14:42, 16 March 2013 (UTC)

My instinctive reaction is that this was a copybook POV fork, and so the merge is good. BullRangifer - why do you think it a "proper" fork? Alexbrn ^{talk|contribs|COI} 14:44, 16 March 2013 (UTC)

I think the current article size is ok. The issue is that most of the content moved to the controversy section was actually mainstream response to specific issues. Removing that creates an NPOV issue in this article. The size of this article is fine, as DVMt pointed out, it's mostly in the refs. The Controversy article also had outdated efficacy information, and was slanted to a chiropractic POV through a cherry picking of sources and through SYNTH rebuttals. It looked a lot like a POV fork; removal all the criticism and then water it down. IRWolfie- (talk) 14:50, 16 March 2013 (UTC)

It's a proper fork because of weight issues. The subject cannot be done any justice within this article, yet it needs to be covered much more than can be done here. A nice compromise was reached some time ago about this issue. It didn't happen in the dark.

While I agree that chiropractic editors here loved having so much of the critical information separated from this article (a violation of NPOV), it did present a problem with so much criticism here, but a compromise was reached which allowed a short criticism section here (which, although not totally forbidden, is discouraged) and a much longer article there, which can be expanded much more. I'm certainly willing to consider expanding the section here a bit, but not too much. As far as the Controversy article, any issues with it should be dealt with there. (IRWolfie's comment..."removal all the criticism and then water it down"...is a real concern. That has happened, and can be fixed.) Without that article, we have no place for expansion of this topic, which happens to be very large. If anything, that article could be developed even further. Criticism and controversy has been a hallmark of chiropractic since its inception and the subject deserves its own article. -- Brangifer (talk) 17:30, 16 March 2013 (UTC)

I would worry about expansion and its implications when it starts to happen. There is no point worrying about an issue that doesn't yet exist. The expansion didn't happen when the it was forked either. IRWolfie- (talk) 18:43, 16 March 2013 (UTC)

I fully agree. I've been quite satisfied with what we had, but now we don't have much left. -- Brangifer (talk) 20:26, 16 March 2013 (UTC)

Interesting dissertation by Corrie Myburgh

A very interesting publication by a chiropractic researcher:

• PDF file: "Methodological and epistemological challenges for the chiropractic profession in health care - a study of the history, status quo and future of research and clinical practices." Myburgh, Corrie, Date Issued: 2011-10

• As a book: http://books.google.com/books/about/Methodological_and_Epistemological_Chall.html?id=rPNRYgEACAAJ

"The thematic analysis revealed that:

1. Beliefs and philosophical traditions play an active role in the practice and science of chiropractic.

2. The chiropractic investigative paradigm has started to mature.

3. The contextual role of research methods is being clarified.

4. Contemporary chiropractic practice is not as evidence-based as it should be.

5. The chiropractic model of practice is significantly different to the perceived standard medical model.

6. Chiropractic clinical practice has a fuzzy identity.

7. Chiropractic’s professional status is unclear.

8. The professional and disciplinary components of chiropractic are still institutionally immature.

9. Chiropractic’s legitimacy is questionable."

"Chiropractors entrenched themselves professionally mainly through public appeal and acquired legitimacy through legislation based on social relevance rather than scientific evidence." pp. 81-82

"The study has shown that chiropractic cannot claim full legitimacy within mainstream healthcare. Simply providing a worthwhile service to patients does not give chiropractic enough momentum to access the corridors of power. A network of professional integration and academic institutionalisation is required for this to occur." p. 253

Page numbers are from the PDF file.

Brangifer (talk) 22:13, 17 March 2013 (UTC)

No discussion of new POV fork material added (controversy and criticism)

This made the NPOV issue even worse. What is bizarre it was a bold series of edits without any discussion (as is customary). Hence the bold edit is being reverted and IRWolfie is free to discuss why this material should be added. DVMt (talk) 01:28, 3 April 2013 (UTC)

Please discuss matters in the talk page before making controversial changes. TippyGoomba (talk) 03:35, 3 April 2013 (UTC)

What part of BRD don't you understand? IRWolfie made a bold series of edits, with no discussion. Then I reverted it and talked about at the talk page. Then you, reverted me (BRRD). The policy is quite clear on this. DVMt (talk) 03:49, 3 April 2013 (UTC)

You should check with an admin on that. TippyGoomba (talk) 05:40, 3 April 2013 (UTC)

I think technically it would only be BRRD if the same editor reverted twice. As to the merge, as discussed above, I am in favour of it - it is needed to prevent a WP:POVFORK. Alexbrn ^{talk|contribs|COI} 05:52, 3 April 2013 (UTC)

I'm a little confused. DVMt said the article I merged from was a POV fork (and I agreed), yet he complains when I merge it back, IRWolfie- (talk) 00:15, 4 April 2013 (UTC)

Multiple edit requests from the same user

Edit request on 8 April 2013

24.15.12.217 (talk) 15:14, 8 April 2013 (UTC)

Cost-effectiveness

Analysis of a clinical and cost utilization data from the years 1999 to 2002 for an integrative medicine independent physician association (IPA) whose primary care physicians (PCPs) were exclusively doctors of chiropractic. This report updates the subsequent utilization data from the IPA for the years 2003 to 2005 found that the clinical and cost utilization of chiropractic services based on 70, 274 member-months over a 7-year period demonstrated ==decreases== of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 85% pharmaceutical costs when compared with conventional medicine IPA performance for the same health maintenance organization product in the same geography and time frame [201].

Chiropractic Career

Realistic median annual wage of chiropractors was $67,200 in May 2010 [64]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [65]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.

201. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract 202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm 203. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/

Edit request on 8 April 2013

Nobias500 (talk) 15:50, 8 April 2013 (UTC)

Cost-effectiveness of Chiropractic Care

Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) who looked at the chiropractic services utilization, found that the the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient cost associate with the following use of services by:

-60.2% in-hospital admissions, -59.0% hospital days, -62.0% outpatient surgeries and procedures, -85% pharmaceutical costs

when compared with conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame [36].

36. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract

Edit request on 8 April 2013

Nobias500 (talk) 16:01, 8 April 2013 (UTC)

Cost-effectiveness of Chiropractic Care

Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) who looked at the chiropractic services utilization, found that the the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient cost associate with the following use of services by:

-60.2% in-hospital admissions, -59.0% hospital days, -62.0% outpatient surgeries and procedures, -85% pharmaceutical costs

when compared with the use of conventional medicine (visit to a medical doctor primary care provider) IPA performance for the same health maintenance organization product in the same geography and time frame [201].

Chiropractic Career

Realistic median annual wage of chiropractors was $67,200 in May 2010 [202]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [203]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.

201. Richard L. Sarnat, MD, et. al, "Clinical Utilization and Cost Outcomes From an Integrative Medicine Independent Physician Association: An Additional 3-Year Update," Journal of Manipulative and Physiological Therapeutics, Volume 30, Issue 4 , May 2007 (263-269): http://www.jmptonline.org/article/S0161-4754(07)00076-0/abstract

202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm

201. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/

Chiropractic Career

Realistic median annual wage of chiropractors was $67,200 in May 2010 [202]. According to Health Resources and Services Administration (HRSA), Chiropractic Student Loan Default Rates for October 1999, May 2010, and January 2012 are 54%, 53.8%, and 52.8% respectively [203]. Chiropractic school graduates default on their loans more often than law school graduates, engineers, medical doctors, and business school graduates.

202. Occupational Outlook Handbook, Bureau of Labor Statistics, March 29, 2012: http://www.bls.gov/ooh/healthcare/chiropractors.htm 203. Health Resources and Services Administration (HRSA), January 2012: http://www.chirobase.org/03Edu/ — Preceding unsigned comment added by Nobias500 (talk • contribs) 16:03, 8 April 2013 (UTC)

Response to the above requests

I didn't realize Nobias500 (and their unlogged-in ISP) had requested this addition here. I saw that they had added these two identical sections to Chiropractic education and to Doctor of Chiropractic. I got them to fix the referencing of the "career" section and left it in both articles. I deleted the "cost effectiveness" section as irrelevant for those articles, reduced it to a sentence, and moved it to this article. I make no guarantees about this information, I just moved it as a favor to a newbie. If there are problems with the information or the sourcing, anyone may feel free to remove it. --MelanieN (talk) 04:40, 9 April 2013 (UTC)

Change request-Chiropractic mixer guidelines no longer meet the evidence based standard

Hello all, I'd like to dispute the text that reads, "Although mixers are the majority group" and subsequent parts that imply they use an evidence based standard. I think this was done to give the impression that chiropractors are less unethical than they really are and it is inaccurate. According to an appeal filed by Life University in 2001, straight programs are the majority group.

The District Court committed a further mistake of law by delving into the chiropractic profession’s philosophical debate about its health care role in an attempt to probe whether CCE harbored an improper motive for not reaffirming LUCC’s accreditation. The District Court refused to apply the Wilfred “great deference” standard based on its finding, which was unsupported by any evidence in the record, that “an aggressive group of leaders of the eight liberal chiropractic schools . . . had undertaken a series of corporate manipulations in order to reduce the representation and dominance of the eight conservative chiropractic schools (of which Life was one) . . . which were calculated to give dominance to the liberal minority group over the conservative majority group; [and] the end result has been the disaccreditation of the largest of all the colleges. . . .” R4-28-3-4. Such an inquiry and the District Court’s unfounded speculation were manifestly improper.16 (see page 43 of attached appeal (CCE vs Life University, US Court of Appeals. 11th cir. NO. 03-11020J. April 23, 2003.)

Granted this is from 2003. Since that time enrollment in straight programs has slowed while mixer ones has increased and one program has closed, the satellite branch of the Cleveland College of Chiropractic, regarded as straight by its president, in Los Angeles. (http://www.chirobase.org/03Edu/schoolphilosophy.html). So although the trend has shifted, straight programs traditionally graduate more graduates. In 2003 Life claimed that 2/3 of all practicing chiropractors were straight, a claim that is supported by the reference that states that a majority of chiropractors, whether they be mixer or straight, support the subluxation complex. If mixers were really evidence based they wouldn't support an outdated subluxation/somatic lesion practice model so the reference shows that assertion to be false.

I am having trouble locating that reference but it doesn't matter because I will show that regardless of orientation, all chiropractic programs, whether they be mixer or straight, are based on a form of subluxation diagnosis.

This brings me to my second request for changes. The article is inconsistent in that it cherry picks references from a few academics and minority practitioners to imply that this false majority of mixers is moving towards evidence based practice:

“and the principles of evidence-based medicine have been used to review research studies and generate practice guidelines.[16]”

"However, most practitioners currently accept the importance of scientific research into chiropractic,[5]and most practitioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness;[21] a 2008 commentary proposed that chiropractic actively divorce itself from the straight philosophy as part of a campaign to eliminate untestable dogma and engage in critical thinking and evidence-based research.[22]

EB practice isn’t a concensus of what chiropractors say it is, but must have an objective standard based in critical thinking. The mixer EB practice model is to perform a differential diagnosis which is followed by screening the musculoskeletal system for subluxations (pseudoscience). The primary difference between the straight version of this is that straights don’t diagnose diseases so will refer out far fewer patients due to undiagnosed illnesses."

Current thinking of the rest of the manipulative professions (PT, DO) recognizes that subluxations are not real lesions and mandates that manipulation is done solely to assist recovery from legitimate diagnosed conditions. (Peter Huijbregts, PT. Clinical Prediction Rules: Time to Sacrifice the Holy Cow of Specificity? The Journal of Manual & Manipulative Therapy. Vol. 15 No. 1 (2007), 5–8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565597/pdf/jmmt0015-0005.pdf)

So while in the past guidelines that recognized subluxation findings may have been justifiable as evidence based practice current analysis shows that the assessments are too flawed to use for diagnosis. Former NACM member and published author Tim Mirtz DC admits this is true and writes of the NACM's supposedly evidence based but now outdated subluxation/somatic lesion based guidelines of their time,

[Mirtz] Our guidelines were more stringent than that of the profession; but you are not judged by the guidelines of an organization but by the standard set forth by the state license.

[Botnick] Though they had good intentions at the start, the later years of NACM aren't anything to be proud of (due to not keeping up with the current research of the time that showed the subluxation/somatic lesion had been debunked).

[Mirtz] And hence we disbanded. I am not proud of it either but we had something then it just weathered away.

(Tim Mirtz DC MSE. Post to "Viva la revolution! Chirotalk outlasts NACM." Dec 28, 2012. http://chirotalk.proboards.com/index.cgi?board=leadership&action=display&thread=5831&page=1)

To a chiropractor, whether he be mixer or straight, the presence of a malady is not a requirement for treatment because evidence of subluxation by itself is considered a risk factor for future disease. So the only difference it makes is whether a DC bills the insurance carrier (for a diagnosed condition+subluxation) or not (subluxation only). Moreover, as more evidence that all chiropractors support subluxation, no chiropratic college teaches that clinical prediction rules be applied in order to stop treatment of patients who show only false positives from subluxation but are otherwise asymptomatic.

So these sections need to be re-written. As Life affirmed, the majority of practicing chiropractors, whether they be mixer or straight program graduates, treat subluxations (aka somatic lesions) in some form, all evidence based practice guidelines are based on subluxation and are not really evidence based, and historically the idea of eliminating subluxation diagnosis, has been defeated by the majority of the profession and is universally rejected by all organizations and schools. Only a few scattered academics have proposed abandoning subluxation diagnosis but there has been no movement to put this into practice, explaining why the majority support subluxation/somatic lesion diagnosis which is falsely portrayed as legitimate evidence based practice when it really is pseudoscience. Abotnick (talk) 13:04, 18 April 2013 (UTC)

You might just go ahead and making the changes you want. If you think they will be controversial, do one per day to give people time to revert and discuss, while letting less controversial changes through. That's one way to go about it anyway... TippyGoomba (talk) 01:26, 19 April 2013 (UTC)

Ok TippyG, I'll start working on it as I have time. Thanks.Abotnick (talk) 13:43, 19 April 2013 (UTC)

Recent controversial edits - profession vs. approach

The verifiable fact that chiropractic is a profession has been removed in this edit by John Snow 2 and again here by Alexbrn. This proposed change is against policy for a number of reasons. First, there is no consensus to remove the description of chiropractic as a profession (the current, stable, consensus version states that chiropractic is a profession) and the editors have chosen not to bring it to the talk page despite my sourced and policy based objections. Second, no source at all has been provided that suggests that chiropractic is not a profession, it has been the editors opinion that the word profession is ‘debatable’, but Wikipedia doesn’t care if John Snow can debate this term, we need reliable sources that could suggest that chiropractic is not a profession. Third, there are multiple reliable sources that verify the fact that chiropractic is indeed a profession:

1. From NIH/NCCAM: "Chiropractic is a health care profession that focuses on..."
2. From a peer-reviewed source in Archives of Internal Medicine: "Chiropractic, the medical profession that specializes in..."
3. From a peer-reviewed source in The Milbank Quarterly: "Chiropractic is the best established of the alternative health care professions."
4. From a peer-reviewed source in Arthritis Research & Therapy: "many patients seek care directly from health-care professionals other than their family doctor; for example, at least one third of back pain patients in Denmark now choose to see a chiropractor as their..."
5. From the chiropractic health care section of the American Public Health Association says that the "CHC Mission - To promote collaboration between chiropractic and other health care professions"
6. From the World Health Organization: "Chiropractic - A health care profession concerned with....."
7. In Brazil a Federal Judge has ruledthat: "chiropractic is a profession and not a technique"
8. In Canadian provinces, Chiropractic is regulated under the Health Professions Act. Here is verification for Alberta, British Columbia, etc.
9. American state legislatures describe chiropractic as a health profession; For example Vermont, Tennessee, Colorado, etc.

Puhlaa (talk) 15:06, 28 April 2013 (UTC)

It may be a profession, but it's not the principal defining characteristic of Chiropractic, so it shouldn't be ultra-prominent in the lede. Lots of things can be professionally pursued (e.g. photography), but these are not described, front and centre, as "professions" - that would be silly! Alexbrn ^{talk|contribs|COI} 16:26, 28 April 2013 (UTC)

Alexbrn, this is an article about the chiropractic profession. You have restored a controversial change to the lead by John Snow that I challenged; I reverted the change by John Snow according to WP:BRD, what policy are you relying on to support your revert of my challenge? You have provided no sources, no policy, just your opinion? I did not think you were new to wikipedia, but perhaps you need to read WP:V and WP:NPOV? Did you read any of the reliable sources I provided above that verify the fact that chiropractic is a profession; there is even one where a federal judge ruled that chiropractic is indeed a profession and not a 'technique'. Are you suggesting that your opinion deserves more weight than those sources? Puhlaa (talk) 16:44, 28 April 2013 (UTC)

This has already been settled a month ago with an RfC. John Snow and Alexbrn I suggested you read up. DVMt (talk) 16:52, 28 April 2013 (UTC)

Personal opinions aside, it's a profession by all definitions, while its methods are the "approaches". That BJ Palmer exploited it for commercial purposes has nothing to do with the matter, but does have current and historical interest if one is to understand the profession: "Chiropractic has had a strong salesmanship element since it was started by D.D. Palmer. His son, B.J. Palmer, asserted that their chiropractic school was founded on '…a business, not a professional basis. We manufacture chiropractors. We teach them the idea and then we show them how to sell it.'" -- Brangifer (talk) 17:38, 28 April 2013 (UTC)

Puhlaa — your reply is irrelevant: read my response again. This is not a controversial edit, just a common sense improvement. Alexbrn ^{talk|contribs|COI} 19:36, 28 April 2013 (UTC)

Your response is irrelevant Alexbrn, wikipedia requires sources and consensus to get a change, not your opinion that it is an improvement. Seems to me that you dont have sources to support your preferred edit, which is evident by the fact that you have presented none. Seems to me that you dont have consensus either, this is evident by the fact that that editors have challenged the edit. As such, the edit need to be discussed here at the talk page and get consensus before it is pushed through. Are you familiar with wikipedia policy? Did you read any of those that I linked?Puhlaa (talk) 19:51, 28 April 2013 (UTC)

No Alex, it is a very controversial edit. Even I, an arch chiroskeptic (my life has been threatened after I was officially declared Chiropractic Enemy Number One), recognize it as an unsourced, negative, POV put down. You'd have to have RS for that, and also have them trump myriad RS which describe chiropractic as a profession. Its methods are what we normally think of as its approaches. Of course, to run with your absurd idea, we could say that there is a Chiropractic "approach" to how chiropractors use manipulation, just as there is an Orthopedic "approach" to how MDs use manipulation, an Osteopathic "approach" to how Osteopaths use manipulation, and a Physical Therapy "approach" to how PTs use manipulation. Should they all be claimed to be "approaches", rather than "professions"? Really, get serious. Don't disrupt Wikipedia to make your point, because we all have our opinions on the matter, and we get your point. I'm a skeptic, but even I don't try to edit "pseudoscience", "religion", "scam", or "unscientific" profession into the article (without sources), although those are widely held opinions among scientists, more so among MDs, and universally held among scientific skeptics (it's a defining meme among them). No, your edit will not survive. -- Brangifer (talk) 19:59, 28 April 2013 (UTC)

Guys, I am not disputing that Chiropractic may be a profession (which you seem to think I am, hence your irrelevant replies). That is covered in the article body. But this article is on "Chiropractic", not "The Chiropractic Profession": hence it is undue to characterize it as first-and-foremost a profession when in truth it is first and foremost a "a practice which 'emphasizes the conservative management of the neuromusculoskeletal system, without the use of medicines and surgery'" (to quote from the article body). Ledes must summarize the body. Alexbrn ^{talk|contribs|COI} 20:09, 28 April 2013 (UTC)

I am glad that you are not disputing that chiropractic is a profession Alexbrn, because that would be silly considering the volume of sources that say otherwise. Since the article is about the chiropractic profession (ie: its scope of practice, legistlation and licensing, etc.) the lead is accurately summarizing the article by initially describing it as a CAM health profession - as does so many reliable sources that are found in this article and elsewhere.Puhlaa (talk) 20:34, 28 April 2013 (UTC)

Alexbrn, we've been down this road with you already before regarding the wording of profession. Please refrain from disruptive editing. I agree (for once) with Brangifer and Puhlaa. You should list all your concerns or grievances here so we can tackle them together. DVMt (talk) 20:46, 28 April 2013 (UTC)

Come off it. Describing Chiropractic primarily as a profession is undue. Let's see what really neutral sources have ... Britannica says: "A system of healing ..."; and Websters: "a system of therapy ...". Instead Wikipedia is now mirroring the definition of a chiropractic advocacy group, the World Federation of Chiropractic: "A health care profession concerned with the diagnosis, treatment and prevention ...". And this text is being reverted to (over 3RR now?) by an editor with a COI. Hmmmm. Alexbrn ^{talk|contribs|COI} 20:51, 28 April 2013 (UTC)

I agree that describing chiropractic as a profession is undue. The material in the article is primarily about the therapy, not about the profession. "Approach" is a more accurate term abd consistent with the reliable sources.Dominus Vobisdu (talk) 21:29, 28 April 2013 (UTC)

The article is not primarily about the therapy, that would be the article Chiropractic treatment techniques or manual therapy or spinal adjustment. This particular article is about the chiropractic profession. The article has a sub-section for the treatment techniques used by members of the profession, as well as for the professions history and the professions licensing and regulation and for the professions conceptual basis, etc. Perhaps the theme of Alexbrn's idea is better suited to the sub-section on conceptual basis? I believe that DVMt was trying to create a new article of chiropractic philosophy or the chiropractic approach, this would be an appropriate place to open the article with a discussion of an 'approach'.Puhlaa (talk) 21:46, 28 April 2013 (UTC)

Yes, it's primarily about the profession. Where else would that article reside here at Wikipedia?

Here's what our second source, the World Health Organization, says in its glossary:

• Chiropractic: A health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on subluxations. p. 3 (10/51) [18]

That's a pretty good definition, and we use part of it in the opening. We don't have to use the whole quote, but it's quite good, and "profession" is an appropriate word. It's been a very long-standing part of this article until recent (yesterday!), undiscussed, edits. We should keep the long-standing status quo until a consensus is reached to change it. Let it stay that way until we are agreed on a change. -- Brangifer (talk) 23:11, 28 April 2013 (UTC)

Except it's cherrying a definition out of a subsection in the middle of that document, rather than using the opening definition given in the Introduction, which is: "Chiropractic is one of the most popularly used forms of manual therapy." And besides, as had been discussed before, this is less-than-good source ... it is a non-peer-reviewed guidelines document offering a view of what Chiropractic should be and the consultation participants behind it are mostly chiropractors and CAM lobbyists (including the CEO of the FIH!!). Alexbrn ^{talk|contribs|COI} 06:06, 29 April 2013 (UTC)

Well, do you have myriad RS that refute that it's a profession? You'll need to provide good sources for any change. Please define "profession". To take this to the absurd, even nonsense can become professionalized! So, what's a "profession"? Define it, then tell us in what ways chiropractic fails the definition. -- Brangifer (talk) 07:29, 29 April 2013 (UTC)

To repeat, whether it's a profession or not is not the issue AFAIAC. The issue is whether it's the first thing that is mentioned (as though this is it principal attribute). It's undue, and out of line with serious sources. Alexbrn ^{talk|contribs|COI} 07:37, 29 April 2013 (UTC)

Well, that's a matter of opinion. I agree with B. J. Palmer that it's a "business", but that's my opinion and not a RS. What RS are you going to use to justify a change? You're going to have to convince other editors, because a collaborative change is the only thing that will work. Otherwise it'll just get reverted back, and if you edit war over it, you'll just get blocked. Then an RfC will run its course, and you can be sure than a majority of editors will vote against your position. You'll have to make a very strong case, using impeccable sources that contradict all other sources that call it a profession. -- Brangifer (talk) 15:05, 29 April 2013 (UTC)

I don't think that "profession" should be emphasised. Lots of activities can also be professions, but our article is about "Chiropractic" not about "Doing chiropractic as your day job". TO pick some random counterexamples; our article on Weaving says that it's a "method of fabric production", our article on poetry says it's a form of literary art; Quality assurance says that it's "engineering activities". Even though there are assuredly reliable sources which talk about professional poets, weavers, and quality-assurers, bobrayner (talk) 16:03, 29 April 2013 (UTC)

A lede must faithfully summarize the article. Currently the lede contains the word "profession" 4 times and it is the first characteristic given. However, in the article body, the strongest RS on this topic supports the rather more nuanced statement "Chiropractic is viewed as a marginal healthcare profession"; most of the article body is describing other characteristics of chiropractic than its professional status, chiefly its biomedical aspects. As I said above this edit (not mine originally, N.B.) seems to me to be "just a common sense improvement". Although it has been incorrectly dramatized as an attempt to remove the description of chiropractic as a profession, it is simply to balance the lede so that is accurately reflects the content of the article, rather than unduly promoting one aspect. Alexbrn ^{talk|contribs|COI} 16:04, 29 April 2013 (UTC)

• I would have though chiropractic as the approach makes most sense here. Purely for reasons of the article not making a lot of sense otherwise. For example, when the article talks about the efficacy of chiropractic we are assessing the approach, not of the profession. IRWolfie- (talk) 23:16, 29 April 2013 (UTC)

Alexbrn, your argument is weak. The lead already summarizes the body because the article as a whole is about the chiropractic profession. The article includes subsections that discuss professional scope of practice, licensing, etc. One of those subsections is probably appropriate to emphasize the chiropractic approach, but the article as a whole is about the profession, which has a lot of diversity. The extensive diversity within the profession is evidenced by the fact that there is an article just for this topic Chiropractic treatment techniques; hundreds of 'approaches' make up the chiropractic profession - hence an article just for that. This article is about a profession with a controversial history and a great deal of diversity in it's curent state.

Bobraynor uses the example of weaving, but this is ridiculous, does weaving have a section on professional scope of practice or licensing? Weaving would be a good analogy for an article like manual therapy, as they are both practices. However, as ruled by a Brazilian Federal judge, Chiropractic is a profession, not a technique - thus, a better analogy for this chiropractic article would be physical therapy, which also accurately describes it as a profession in the first sentence of the lead.Puhlaa (talk) 23:23, 29 April 2013 (UTC)

IRwolfie, this article has one subsection that discusses the efficacy of only spine manipulation - which is just one of the more commonly studied techniques used by chiropractors. We chose to include this subsection because spine manipulation has a lot of research, compared to the rest of the manual therapies, and is most commonly associated with chiropractors; however, the 150 some unique chiropractic approaches make it very difficult to discuss them all in an article that is really supposed to be about the profession (ie: this article). Thus, the 'approaches' used have their own article Chiropractic treatment techniques where discussions of the efficacy of different chiropractic approaches could be discussed.Puhlaa (talk) 23:28, 29 April 2013 (UTC)

Puhlaa — you assert "the article as a whole is about the chiropractic profession". But you only need to look at the section headings to see this is not so; the content of the article covers chiropractic as a whole. Alexbrn ^{talk|contribs|COI} 03:38, 30 April 2013 (UTC)

But then we agree Alexbrn, the article is about chiropractic as a whole. As I have pointed out, you and others have agreed and reliable sources have verified, chiropractic as a whole is a profession not a technique! This article is a great discussion of the profession - including it's conceptual basis, it's history, how it's members are licensed and regulated, the efficacy of the most common form of therapy used by it's members, etc. As I have already indicated, your idea would be best suited for a subsection on the 'approaches used' by chiropractors or an article in itself about the approaches used by chiropractors. This article is about the profession as a whole, not just the approaches/rationale used by members of the profession.(talk) 04:03, 30 April 2013 (UTC)

Have a look at this RS all about chiropractic - "Chiropractic: origins, controversies, and contributions" The first sentence of the abstract says "...the largest alternative medical profession", it does not say 'the largest alternative medicine approach'. Here is another RS that is also all about chiropractic, the first sentence of it's abstract also is a description of the profession. Puhlaa

I'm afraid I don't agree that "chiropractic as a whole is a profession not a technique" (if that opposition even makes sense). The article content we have tells us it's a whole bunch of things: a belief system, a technique, a profession, a fraud, a culture, etc. The lede must reflect that content, and not unduly over-promote one aspect. Alexbrn ^{talk|contribs|COI} 04:27, 30 April 2013 (UTC)

A thought from a random passer-by:
Why not state both? E.g. Chiropractic is a health care profession and an approach to healing concerned with...
This way those who feel that naysayers are trying to slight chiropractic by not explicitly stating the obvious - that it is a health care profession - will be satisfied. And those who feel strongly that the reader will benefit from knowing that it is also an approach to healing will also be satisfied. 68.120.91.227 (talk) 04:33, 30 April 2013 (UTC)

I would be satisfied with this suggestion. It is funny how the obvious solution is right there but can be missed by us involved editors even while we discuss the issue :) Puhlaa (talk) 04:41, 30 April 2013 (UTC)

Like I saw this conversation developing earlier today and was just stopping by here to suggest the same thing: include both. Zad68 04:43, 30 April 2013 (UTC)

Yes, that works :-) Alexbrn ^{talk|contribs|COI} 04:48, 30 April 2013 (UTC)

Done! Thank you everyone :) TippyGoomba (talk) 04:52, 30 April 2013 (UTC)

Excellent solution! -- Brangifer (talk) 07:22, 30 April 2013 (UTC)

Recent edit

This edit does a better job a giving a historical perspective to data offered in the dated reference. However, it also introduces information about safety that seems like a non sequitur to the subtopic: International reception. Whereas, a discussion of chiropractic's usage in the United States makes sense under such heading, the material about the serious complications seems out of place and frankly, argumentative there. I'd recommend removing that bit and reserving it for a more relevant section. 68.120.91.227 (talk) 03:36, 7 May 2013 (UTC)

Agree with the IP user. The historical info is relevant, but the added discussion on risks should be in the safety section or in the spine manipulation article. Also, the source is not attributing the risk to chiropractic, but to spine manipulation in general. Puhlaa (talk) 15:03, 7 May 2013 (UTC)

Edit request on 7 May 2013

I have found a reference for the "manipulative lesion" which says is in need of a citation.

The manipulative lesion, also known as a spinal biomechanical lesion is deifined as "a pathological condition involving discontinuity (loss of cohesion) of tissue, and loss of normal vertebral joint function (kinesio-pathology) that often has injury as its cause"

Reference: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56115

Thanks DJFryzy (talk) 08:58, 7 May 2013 (UTC) DJFryzy (talk) 08:58, 7 May 2013 (UTC)

DJFryzy, Thank you for trying to find a source for the article. Unfortunately, the source you provided is not appropriate because it is a chiropractic trade magazine. For information about what makes a good source, please read WP:MEDRS.Puhlaa (talk) 14:58, 7 May 2013 (UTC)

Thanks for your reply Puhlaa

I have done some further investigation to find a citation for this "manipulative lesion" which I feel as though I have found a higher level of evidence. It appears more commonly in the literature as "manipulable lesion" or "functional spinal lesion". The reference is attached.

Biomechanics of spinal manipulative therapy John J Triano, DC, PhD The Spine Journal Volume 1, Issue 2, March–April 2001, Pages 121–130http://www.sciencedirect.com/science/article/pii/S1529943001000079 http://dx.doi.org/10.1016/S1529-9430(01)00007-9,

This is a much better source, thanks DJFryzy. Why don't you go ahead and make the required edit (insert the reference), then we can see if any other editors take any issue. Let me know if you have any problems and I am happy to help.Puhlaa (talk) 02:26, 8 May 2013 (UTC)

Unfortunately I am unable to edit this page. Possibly due to the semi-restricted nature. Are you able to insert the reference? Or if there is some "back door" route that I'm not able to see could you point me in the right direction? Thanks. DJFryzy (talk) 05:33, 8 May 2013 (UTC)

You should be able to edit this article by now....This article is semi-protected, meaning only autoconfirmed users can edit it; see here for an explanation. By making more than 10 edits on wikipedia, you are now an autoconfirmed user.Puhlaa (talk) 06:00, 8 May 2013 (UTC)

You should be able to edit this article yourself now. -Nathan Johnson (talk) 15:32, 9 May 2013 (UTC)

Thanks for the heads up. Just about to add the reference in and the appropriate term.

Update of evidence in regards to safety of Chiropractic

"A 2009 review evaluating maintenance chiropractic care found that spinal manipulation is routinely associated with considerable harm and no compelling evidence exists to indicate that it adequately prevents symptoms or diseases, thus the risk-benefit is not evidently favorable.[183]" -does sometone have a copy of this journal article they could look over. where is he citing evidence from that "spinal manipulation is routinely associated with considerable harm"...? thanks. — Preceding unsigned comment added by 66.190.94.157 (talk) 18:43, 6 June 2013 (UTC)

I would like to discuss proposed changes in relation to a section within the introduction as well as the safety section within this article.

Currently the introduction contains "and some evidence of severe adverse effects from cervical vertebral manipulation.[10] ". I feel this would be better represented within the "Safety" section. In addition to this, a more appropriate source is warranted to verify this.

Furthermore, the safety article is lacking the most up to date studies in regards to the more serious complications that have previously been reported in relation to spinal manipulative therapy (SMT) and vertebral artery dissection (VAD).

Below I have added areas which I would like to see looked at either adding to the current safety section, or changing dated and bias statments.

The most recent in-depth review, published in the Feb 15, 2008 Spine Journal was completed by members of the Spine Decade Task Force. These researchers reviewed 10 years worth of hospital records, involving 100 million person-years. These clinical records revealed no increase in vertebral artery dissection risk with chiropractic, compared with medical management, and further stated that “increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection (already in progress) seeking care before their (eventual) stroke.”

It is now apparent that chiropractors prematurely accepted the notion that cervical adjusting/manipulation could be a “causative” event for VAD. That was a reasonable and professional response to case-studies and reports in the peer-reviewed medical literature, which was often based on a pattern of medical mis-reporting, as was later documented by Terrett.

The recently published “Current Concepts: Spinal Manipulation and Cervical Arterial Incidents 2005” (NCMIC) concludes in it's Executive Summary: “Unfortunately, opinion rather than fact has tended to dominate discussions regarding CVAs and chiropractic, even though there has been no definitive evidence that chiropractic adjustments (actually) cause strokes. This monograph notes that a causative relationship between chiropractic manipulation and stroke is unlikely. There is an associative relationship between the two because people may go to chiropractors for relief of stroke-related symptoms”.

DJFryzy (talk) 04:32, 14 May 2013 (UTC) Thanks for your time and looking forward to editing with you.

You may be interested in following the pattern outlined at WP:BRD. Essentially, you make any change you want, anyone who disagrees will revert, and then we discuss until there's a consensus. Of course, if you think the changes will be controversial, it's wise to discuss them first. TippyGoomba (talk) 04:40, 14 May 2013 (UTC)

Thanks TippyGoomba. I feel as though WP:BRD may be a way, however I feel that interested parties may be wanting to discuss this before we go through the WP:BRD process. DJFryzy (talk) 07:34, 14 May 2013 (UTC)

Split

I have just removed a split tag, again. If you think there should be a split then please explain why here so that it may be discussed. Op47 (talk) 22:25, 16 May 2013 (UTC)

Chiropractics - not a medical field

As far as i know, a medial diagnosis is generally given only by Doctors of Medicine and at more specific occasions, Psychologists. a Chiropractic, on the other hand, is not a medical adviser, nor a medical pathologist. he treats. not more. correct me if I'm wrong. Ben-Natan (talk) 07:17, 17 May 2013 (UTC)

Ben-Natan, it may be that only 'medical doctors' can provide a 'medical diagnosis', but our article does not claim that chiropractic is a 'medical' profession, nor that they make 'medical' diagnoses. The general act of making or communicating a diagnosis is within the scope of practice of many doctored health professions. I am most familiar with the Canadian laws, for example, in Canada one of the authorized acts that chiropractors can perform is "Communicating a diagnosis identifying, as the cause of a person's symptoms, a disorder arising from the structures or functions of the spine or of the joints of the extremities.[19]" Another example is Optometrists in Canada, who can make a diagnosis related to the eyes. Dentists in Canada can diagnose conditions related to the teeth or jaw. Even some non-doctored professions, such as physiotherapists have now been given the privilege to "Communicating a diagnosis identifying a disease". That said, I am not aware of any Canadian provinces that allow chiropractors to make diagnoses that are not related to the musculoskeletal system, for example they cannot communicate a diagnosis of cancer or diabetes. The same could be said for dentists, who are restricted to only making diagnoses related to the teeth and jaw; Optometrists restricted to the eyes, etc. Puhlaa (talk) 08:19, 17 May 2013 (UTC)

I find reason in what you wrote, and hence suggests that the article will mention the specific type of the not-medical diagnosis that chiropractors can make. you said "musculoskeletal", if this is how exactly it's named, than i believe it should be emphasized at the beginning of the article. Ben-Natan (talk) 10:44, 17 May 2013 (UTC)

I am glad that you find my comment reasonable Ben-Natan. With regard to your suggestion, the article already emphasizes the fact that chiropractic is CAM (not Medicine) and that those in the profession make neuromusculoskeletal diagnoses; as per the WHO sources, the article says in the first sentence: "Chiropractic is a complementary and alternative medicine health care profession and an approach to healing concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system..."Puhlaa (talk) 15:56, 17 May 2013 (UTC)

Your pardon, i missed the word "neuromusculoskeletal", i completely agree with the current wording. regards. Ben-Natan (talk) 02:37, 18 May 2013 (UTC)

Lillard

This article has just copy-pasted some paragraphs from the article Chiropractic history, on Harvey Lillard. It is completely taken out of context, it makes absolutely no sense as it stands, and it seems at first to be connected to the words before. I see no reason why it has been added.

If it is important, one should include the rest from the article Chiropractic history (or an edited version). As it stands now, the opening words (“However, this version was disputed by Lillard's daughter”) seems to be related to the closing words of the paragraph before (“One student, his son Bartlett Joshua (B.J.) Palmer, became committed to promoting chiropractic, took over the Palmer School in 1906, and rapidly expanded its enrollment”). We must either include the whole (or at least an edited) paragraph on Harvey Lillard, or just delete the two paragraphs (and mention/link to the part on Harvey Lillard from the the article Chiropractic history). Carissimi (talk) 13:48, 21 July 2013 (UTC)

Removing these two paragraphs seems to address the problem for now.

Extended content

However, this version was disputed by Lillard's daughter, Valdeenia Lillard Simons. She said that her father told her that he was telling jokes to a friend in the hall outside Palmer's office and Palmer, who had been reading, joined them. When Lillard reached the punch line, Palmer, laughing heartily, slapped Lillard on the back with the hand holding the heavy book he had been reading. A few days later, Lillard told Palmer that his hearing seemed better. Palmer then decided to explore manipulation as an expansion of his magnetic healing practice. Simons said "the compact was that if they can make [something of] it, then they both would share. But, it didn't happen." In spite of the fact that Lillard could hear well enough to tell jokes, B.J. Palmer claimed under sworn testimony that Lillard had been "thoroughly deaf". Since 1895, the story of Palmer's curing a man of deafness has been a part of chiropractic tradition. Palmer's account differs significantly from what actually happened, in that, according to Lillard's daughter, his improved hearing was likely caused by an accidentally fortuitous jarring of Lillard's body and not, as claimed by D.D. Palmer, caused by a "specific" adjustment. It was after this event that Palmer began to experiment with manipulation. He also claimed that his second patient, a man with heart disease, was also cured by spinal manipulation.

The first paragraph is already in the Chiropractic history article. The second is not. Should we incorporate the second back into the Chiropractic history article? Should we summarize the paragraphs in this article? I would suggest answers yes and no. TippyGoomba (talk) 18:25, 21 July 2013 (UTC)

It's an important fact about Palmer's megalomania and deceptive historical revisionism, especially important since it's the myth upon which the profession is built. We need to keep it in some manner, even if revised. Go for it. -- Brangifer (talk) 19:27, 21 July 2013 (UTC)

Effectiveness: grammar correction

Wanted to suggest a quick correction for a confirmed user to tackle - the 6th paragraph under the "Evidence" section reads "There is a wide range of ways to measure treatment outcomes.", which I believe should be "There are a wide range of ways to measure treatment outcomes.". Luke831 (talk) 04:28, 23 July 2013 (UTC)

"range" is singular, so "is" is right. Alexbrn ^{talk|contribs|COI} 05:27, 23 July 2013 (UTC)

I Don't Understand

I just don't get it. This page has the feel that it was written in 1950's. Chiropractic has never before been as widely accepted as it is now. I know that is not saying much but this is just sad. Its a step backward and I feel that the "medical" people posting on this site are more truely unaware of chiropractic and only have E.Ernst's view of what we do. Is there much evidence for chiropractic? nope. But it does help plenty of people. and this site just steers others who could be helped away. This is a page about COMPLAMENTARY AND ALTERNATIVE MEDICINE and should be moderated as such not Medicines view of Chiropractic and its voodoo old farty unchanging ways and crazy ideas about subluxation and innate intelligence. All I as is that the lines pertaining to Objections to Chiropractic be put in a Controversy secetion. Because the way it reads now I would have no idea what chiropractic is other than a scary psuedo-science made up by some old guy who thought he knew how to heal people and only did it for money. Seriously thats the impression I get. How about adding a section on what some of the names of Chiropractic techniques are. There is Diversified, Logan Basic Technique, Webster, Applied Keniesiology, Graston, Cox flexion distraction, Gonstead, Activator, Upper cervical, Thompson. Ect. Please let me know what I need to do to make some of this happen. Thank you for your time and I apologize for the spelling grammar errors (Airport edit). — Preceding unsigned comment added by 108.206.8.214 (talk) 06:40, 26 July 2013 (UTC)

What you need to do to make this happen is edit the page. If your edits present an unencyclopedic view of chiropractic, someone will change them if they can be fixed easily or revert them if not. 198.199.134.100 (talk) 06:53, 26 July 2013 (UTC)

The article must contain information covering history, controversies, diverse POV, etc.. That's why you see some negative information here. We don't write sales brochures. Since long and detailed content on each aspect would overwhelm the article and make it needlessly long, we have created subarticles, such as History of chiropractic and Chiropractic education. If you look at the category link at the bottom of the article, you'll see a link to Category:Chiropractic. Check it out.

We try not to use controversy sections here. While not forbidden, they are strongly frowned upon. That's why you'll find it spread out throughout the article. Since the profession has been extremely controversial since its beginning, there is a section which touches on the subject and links to the full article about Chiropractic controversy and criticism.

This article also links to a separate article about Chiropractic treatment techniques. -- Brangifer (talk) 15:01, 26 July 2013 (UTC)

Feedback on the article

As a long-time recipient of chiropractic care, I found this article to be very informative on the subject. However, for purely semantic reasons, I think the article puts chiropractic care in an excessively bad light by overemphasizing perspectives of 'straight' chiropractors, who are overwhelmingly in the minority if I'm not mistaken, and using unintentionally negative phrasing such as "chiropractic is only beneficial in dealing with back-pain." (Generally, non-chiropractors don't view it as accomplishing anything else, though I understand this belief's proliferation in the chiropractic community.) I may attempt to fix these issues soon, but I thought it'd be good to list these concerns here. --69.246.185.35 (talk) 01:39, 24 August 2013 (UTC)

Thank you for expressing your concerns, and we welcome attempts to improve the article. If you have specific wordings which you believe are not supported by their sources, or if you have reliable sources we could use, please discuss them here on the talk page and we can work towards improving the article. Thanks again. -- Brangifer (talk) 02:02, 24 August 2013 (UTC)

Like it or not, the "straights" are a major source of public danger. I don't know if this case was straight or mixer, but the fact is that any chiro who has an ethical bone in their body should drop the idea of "maintenance" adjustments, abandon subluixations altogether and that will make them a physiotherapist not a chiropractor. Guy (Help!) 16:57, 28 September 2013 (UTC)

"as the sole cause of disease"

This deceptive phrasing implies that the controversy is over whether the spinal dysfunction causes all disease or only some of it, and conceals the actual controversy over whether chiropractic is a working therapy or merely total snake-oil quackery with dangerous disregard for objective reality.

It should be rephrased to something like "as a possible cause of disease".192.249.47.181 (talk) 16:46, 15 October 2013 (UTC)

I agree DJFryzy (talk) 02:35, 20 October 2013 (UTC)

No, we base our content on RS, not personal POV. I have fixed the problem, just for you. See:

• https://en.wikipedia.org/wiki/Chiropractic#cite_note-Chiropractors_Adjuster_2-8

Palmer is a RS for this content. He believed in one cause, one cure.

 Done -- Brangifer (talk) 03:13, 20 October 2013 (UTC)

Scope of practice/article photos

I was reading this article and it the images seemed to be appear outdated and look shabby. First and foremost I would propose adding an image of a chiropractor working with a patient receiving a manipulation as this is probably what people associate most strongly with chiropractic. Secondly the caption below the picture of the outdated x-ray machine lacks citation about controversy. I would suggest that radiology usage is an issue within all health professions (not unique to chiropractors). Recent evidence in Australia would put most chiropractors referring for an average of 18.667 x-rays per year. http://www.australiandoctor.com.au/news/latest-news/chiropractors-defend-referral-rates/ Compared to Australian medical usage rates of 10% of patients being sent for radiological studies. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442472723

Whilst I do agree chiropractic deserves its fair share (if not more) of criticism it does not need be littered throughout the article. I propose controversial/skeptic/pseudoscience arguments be neatly explored in the Controversy/Criticism section which is already present. Whether you the use of radiology is excessive or not (Australian data seems to paint a different picture) this is not related to scope of practice and in my opinion should be altered to a more neutral statement. May I suggest- "Many chiropractors are licensed to take their own X-rays although this practice is usually confined to the spine as per regulations". http://www.arpansa.gov.au/Publications/Codes/rps19.cfm

As I see many edits are often revised quickly and changing images is quite a big edit I decided to post here before making the edit.

To summarize I would like to:

1.) Add a picture of a chiropractor treating with a chiropractic patient with spinal manipulation 2.) Change picture of X-ray machine to something more modern looking and the quote below it to reflect that chiropractors are licensed and regulated by the same body as radiographers to take x-rays. (more neutral wording) 3.) Change pictures of chairs and tables to be more aesthetically pleasing/modern

Thanks for your consideration, I eagerly await feedback. — Preceding unsigned comment added by 19TC88 (talk • contribs) 10:12, 20 May 2013 (UTC)

1. I think that would be good
2. A modern x ray machine would be good. Caption not happy -- should be balanced and include mention of the controversy surrounding the use of x-rays in chiropractic. Many feel they are unnecessary exposures.
3. sounds non controversial change, I think that would be fine. Lesion (talk) 12:47, 5 June 2013 (UTC)

I have begun the process of undertaking your desired changes. I have also updated the transclusion to bring together information into a more appropriate box (and avoid doubling up the information). As always, new sources or changes have been appropriately referenced. DJFryzy (talk) 10:48, 17 August 2013 (UTC)

in relation to lesions point 2. I have included the latest data in the safety section where there is already mention of xray utilisation DJFryzy (talk) 11:49, 17 August 2013 (UTC)

It didn't take long, but all the edits have been undone. I think this would be the appropriate forum to talk about this, as the consensus has been for some time that

1.) Add a picture of a chiropractor treating with a chiropractic patient with spinal manipulation 2.) Change picture of X-ray machine to something more modern looking and the quote below it to reflect that chiropractors are licensed and regulated by the same body as radiographers to take x-rays. (more neutral wording) 3.) Change pictures of chairs and tables to be more aesthetically pleasing/modern DJFryzy (talk) 12:01, 17 August 2013 (UTC)

The images you have added appear to be copyright violations. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:06, 17 August 2013 (UTC)

File:Chiropractic Thoracic Adjustment.jpg

Chiropractic Thoracic Adjustment

File:Xray Radiography.jpg

Xray Radiography

File:Chiropractic students learning anatomy.jpg

Chiropractic students learning anatomy

In light of the previous issues with editing this page, I thought that I would place the reviews here prior to adding them. Please review and critique these as you feel suitable. All photos have been copyright approved.

1)Add a picture of a chiropractor treating with a chiropractic patient with spinal manipulation

2)Change picture of X-ray machine to something more modern looking and the quote below it to reflect that chiropractors are licensed and regulated by the same body as radiographers to take x-rays. (more neutral wording)

3)Change pictures of chairs and tables to be more aesthetically pleasing/modern. I thought it may be more relevant to delete the chairs and add in a picture into the education category DJFryzy (talk) 05:55, 19 August 2013 (UTC)

You took these yourself I take it? TippyGoomba (talk) 06:58, 19 August 2013 (UTC)

I think it would be a shame to get rid of the chairs. They convey an old fashioned torture modern therapeutic approach to the whole article, which is ideal for the subject matter. Roxy the dog (talk) 09:37, 19 August 2013 (UTC)

Your bias is obviousRoxy the dog. Wikipedia is not a place for bias such as this.DJFryzy (talk) 02:59, 20 August 2013 (UTC)

Back on to the pictures, the license says they're your property. How did you come by them. Did you take them yourself? TippyGoomba (talk) 03:33, 20 August 2013 (UTC)

Yes, as per the copyright via wiki commons pertains DJFryzy (talk) 04:06, 20 August 2013 (UTC)

That's great! Please add them to the article as you see fit. Roxy the dog will let us know if he misses the chairs too much. We can tweak the info boxes as needed. TippyGoomba (talk) 04:44, 20 August 2013 (UTC)

Thank you TippyGoomba. Please feel free to edit the position of the pictures as you see fit DJFryzy (talk) 05:08, 20 August 2013 (UTC)

DJFryzy, did you edit with another account before you started using the DJFryzy account? bobrayner (talk) 22:49, 13 October 2013 (UTC)

Did you edit with another account before you started using the DJFryzy account? bobrayner (talk) 02:01, 21 October 2013 (UTC)

Unethical behaviour by Aussie and UK Chiropractic

Something to consider in this article - from The Age in Australia - and a blog post with a great deal of detail.

I'm not suggesting that this goes into the article yet, as I'm uncertain of "The Age" as an RS, but this appears to be totally despicable behaviour by chiroquacks, sneakily treating hospital patients behind the hospitals back. Not good. --Roxy the dog (quack quack) 13:17, 30 September 2013 (UTC)

The blog is useless but news article should be fine. I'd put something in Chiropractic controversy and criticism, if anywhere. TippyGoomba (talk) 03:32, 1 October 2013 (UTC)

Here is another blog, again not a suitable source, but a good analysis of what went on. --Roxy the dog (quack quack) 08:44, 21 October 2013 (UTC)

Is there much coverage outside the The Age and The Australian? I see the ABC is investigating. It might take a 4 Corners report to turn it into a notable controversy. --Anthonyhcole (talk · contribs · email) 11:33, 21 October 2013 (UTC)

It seems like we may never find the truth? There were a number of media outlets that reported on a baby having their neck broken, but so far I have only found one article in the Australian that has reported on the findings of the AHPRA: [20]; however the 'blog' that Roxy posted above seems to question what was presented in the Australian's article. Seems like this will be another correlation/causation debate, nothing new.Puhlaa (talk) 15:11, 21 October 2013 (UTC)

Treatment, Safety (Proposed revision, March 2013) Part 1 of 2

Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include:

• manual procedures, particularly spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques;
• exercise, rehabilitative programmes and other forms of active care;
• psychosocial aspects of patient management;
• patient education on spinal health, posture, nutrition and other lifestyle modifications;
• emergency treatment and acute pain management procedures as indicated;
• other supportive measures, which may include the use of back supports and orthotics;
• recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals.

Manual and manipulative therapy

Lumbar, cervical and thoracic chiropractic spinal manipulation.

The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniques as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine. Spinal manipulation gained mainstream recognition during the 1980s. Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. It is the most common and primary intervention used in chiropractic care; In North America, chiropractors perform over 90% of all manipulative treatments with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment. There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately.

Definitions

High-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as adjustment, thrust manipulation, and Grade V mobilisation It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques.

Categories

Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety. Manual and mechanically-assisted articular manipulative procedures can include:

• HVLA manipulation
• HVLA manipulation with recoil
• LVLA manipulation (mobilization)
• Drop tables and terminal point manipulative thrust
• Flexion-distraction and traction-type tables
• Pelvic blocks
• Instrument assisted manipulative devices

Manual non-articular manipulative procedures can include:

• Reflex and muscle relaxation procedures
• Muscle energy techniques
• Myofascial ischemic compression procedures
• Myofascial, and soft tissue manipulative techniques

show full draft

Chiropractors primarily use a manual and conservative approach towards neuromusculoskeletal disorders. Interventions are typically multi-modal and can include: manual procedures, particularly spinal manipulation, other joint manipulation, joint mobilization, soft‐tissue and reflex techniques; exercise, rehabilitative programmes and other forms of active care; psychosocial aspects of patient management; patient education on spinal health, posture, nutrition and other lifestyle modifications; emergency treatment and acute pain management procedures as indicated; other supportive measures, which may include the use of back supports and orthotics; recognition of contraindications and risk management procedures, the limitations of chiropractic care, and of the need for protocols relating to referral to other health professionals. Manual and manipulative therapy Lumbar, cervical and thoracic chiropractic spinal manipulation. The medicinal use of spinal manipulation can be traced back over 3000 years to ancient Chinese writings. Hippocrates, the "Father of Medicine" used manipulative techniques as did the ancient Egyptians and many other cultures. A modern re-emphasis on manipulative therapy occurred in the late 19th century in North America with the emergence of the osteopathic medicine and chiropractic medicine. Spinal manipulation gained mainstream recognition during the 1980s. Spinal manipulation/adjustment describes techniques where the hands are used to manipulate, massage, mobilize, adjust, stimulate, apply traction to, or otherwise influence the spine and related tissues. It is the most common and primary intervention used in chiropractic care; In North America, chiropractors perform over 90% of all manipulative treatments with the balance provided by osteopathic medicine, physical therapy and naturopathic medicine. Manipulation under anesthesia or MUA is a specialized manipulative procedure that typically occurs in hospitals administered under general anesthesia. Typically, it is performed on patients who have failed to respond to other forms of treatment. There has been considerable debate on the safety of spinal manipulation, in particular with the cervical spine. Although serious injuries and fatal consequences can occur and may be under-reported, these are generally considered to be rare when spinal manipulation is employed skillfully and appropriately. Definitions High-velocity low amplitude (HVLA) spinal manipulative therapy (SMT) is also known as adjustment, thrust manipulation, and Grade V mobilisation It is distinct in biomechanics from non-thrust, low-velocity low amplitude (LVLA) manipulative techniques. Categories File:Flexion distraction.jpg A chiropractor using a flexion-distraction table and manual therapy to the lumbo-sacral spine for low back pain Manual and manipulative techniques can be categorized by different modes depending on therapeutic intent, indications, contraindications and safety. Manual and mechanically-assisted articular manipulative procedures can include: HVLA manipulation HVLA manipulation with recoil LVLA manipulation (mobilization) Drop tables and terminal point manipulative thrust Flexion-distraction and traction-type tables Pelvic blocks Instrument assisted manipulative devices Manual non-articular manipulative procedures can include: Reflex and muscle relaxation procedures Muscle energy techniques Myofascial ischemic compression procedures Myofascial, and soft tissue manipulative techniques Neuromusculoskeletal and somatovisceral disorders Manual and manipulative therapies is a common intervention used primarily by manual medicine practitioners for the treatment of neuromusculoskeletal disorders. Spinal manipulation is widely seen as a reasonable treatment option for biomechanical disorders of the spine, such as neck pain and low back pain. However the use of spinal manipulation to treat non-musculoskeletal complaints remains controversial. Research status Acute low back pain: It is not known if chiropractic care improves clinical outcomes in those with lower back pain more or less than other treatments. A 2012 Cochrane review found that spinal manipulation was no more effective than standard medical care, sham manipulation, physiotherapy or exercises therapy or inert intenventions. A 2010 systematic review found that most studies suggest SM achieves equal or superior improvement in pain and function when compared with other commonly used interventions for short, intermediate, and long-term follow-up. In 2007 the American College of Physicians and the American Pain Society jointly recommended that spinal manipulation be considered for people who do not improve with self care options. Chronic low back pain: The effectiveness of spinal manipulation appears to be the same as other commonly prescribed treatment for chronic low-back pain, such as, exercise therapy, standard medical care or physiotherapy. Some national guidelines consider its use optional, some do not recommend and others suggest a short course in those who do not improve with other measures. Manipulation under anaesthesia, or medically-assisted manipulation, currently has insufficient evidence to make any strong recommendations. Radiculopathy: There is moderate quality evidence to support the use of spinal manipulation for the treatment of acute lumbar radiculopathy and acute lumbar disc herniation with associated radiculopathy. The evidence for chronic lumbar spine-related extremity symptoms and cervical spine-related extremity symptoms of any duration is low or very low and no evidence exists for the treatment of thoracic radiculopathy. Neck pain: The effectiveness of spine manipulation for the treatment of neck pain is controversial. Cervical spine manipulation and mobilisation may provide immediate- or short-term improvements for mechanical neck pain; neither manipulation nor mobilisation have been found to be superior to one another and no long-term data are available. Thoracic spinal manipulation has a therapeutic benefit to some patients with neck pain and therefore it may also be a suitable intervention to use in combination with other interventions in the treatment of non-specific neck pain. Other manual therapies such as massage have also been found to be effective for mechanical neck pain. Extremity conditions: Manual and manipulative therapy added to an exercise program for the treatment of knee osteoarthritis resulted in better pain relief then a supervised exercise program alone and suggested that manual therapists consider adding manual mobilisation to optimise supervised active exercise programs. There is silver level evidence that manual therapy is more effective than exercise for the treatment of hip osteoarthritis, however this evidence could be considered to be inconclusive. The addition of cervical spine mobilization to a treatment regimen for lateral epicondylosis (tennis elbow) result in significantly better pain relief and functional improvements in both the short and long-term. There is a small amount of research into the efficacy of chiropractic treatment for upper limbs, limited to low level evidence supporting chiropractic management of shoulder pain and limited or fair evidence supporting chiropractic management of leg conditions. Headache: Spinal manipulation may improve migraine and cervicogenic headaches but cautioned type, frequency, dosage, and duration of treatments should be based on guideline recommendations, clinical experience, and findings. Evidence for the use of spinal manipulation as an isolated intervention for patients with tension-type headache remains equivocal. SM might be as effective as propranolol or topiramate in the prevention of migraine headaches, as well as other types of headaches. Cervicogenic dizziness: There is moderate evidence to support the use of manual therapy for cervicogenic dizziness. Pediatrics: The use of manual therapy for pediatric health conditions is supported by only low levels of evidence Mental health: There is evidence that spinal manipulation improves psychological outcomes compared to verbal interventions. Other: A 2013 Cochrane reviews found some effectiveness of manipulative therapy as an complementary intervention for pneumonia in adults. Current evidence suggests manipulative therapy reduces the duration of hospital stay, duration of intravenous antibiotic use, and total antibiotic use, but did not improve primary patient outcomes including fever, improvement on X-ray, cure rate, or mortality. In 2013, a systematic review and meta-analysis of five randomized controlled trials concluded that existing evidence suggests that SMT may improve lower urinary tract symptoms in adult women such as urinary incontinence (involuntary leakage of urine), nocturia (waking up at night to urinate), and urinary hesitancy, but called for further study with additional large, rigorous randomized controlled trials. There is insufficient low bias evidence to support the use of spinal manipulation as a therapy for the treatment of hypertension. There is very low evidence for spinal manipulation for adult scoliosis (curved or rotated spine) and no scientific data for idiopathic adolescent scoliosis. There is insufficient evidence from reviews to draw definitive conclusions for a wide variety of other non-neuromusculoskeletal conditions, including ADHD/learning disabilities, vision and other conditions. Other reviews have found no evidence of significant benefit for asthma, baby colic, bedwetting, carpal tunnel syndrome, fibromyalgia, gastrointestinal disorders, kinetic imbalance due to suboccipital strain (KISS) in infants, menstrual cramps, or pelvic and back pain during pregnancy. Safety The safe application of spinal manipulation requires a thorough medical history, assessment, diagnosis and plan of management. Manual medicine practitioners, including chiropractors, must rule out contraindications to HVLA spinal manipulative techniques. Absolute contraindications refers to diagnoses and conditions that put the patient at risk to developing adverse events. For example, a diagnosis of rheumatoid arthritis and other conditions that structurally destabilizes joints, is an absolute contraindication of SMT to the upper cervical spine. Relative contraindications, such as osteoporosis are conditions where increased risk is acceptable in some situations and where mobilization and soft-tissue techniques would be treatments of choice. Most contraindications apply only to the manipulation of the affected region. Adverse events in spinal manipulation studies appear to be under-reported and appear to be more common following HVLA manipulation than mobilization. Mild, frequent and temporary adverse events occur in SMT which include temporary increase in pain, tenderness and stiffness. These events typically dissipates within 24–48 hours Serious injuries and fatal consequences can occur, and are believed to result from upper cervical rotatory manipulation. but are regarded as rare when spinal manipulation is employed skillfully and appropriately. There is considerable debate regarding the relationship of spinal manipulation to the upper cervical spine and stroke. Stroke is statistically associated with both general practitioner and chiropractic services in persons under 45 years of age suggesting that these associations are likely explained by preexisting conditions. Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy and vertebrobasilar artery stroke. A 2012 systematic review determined that there is insufficient evidence to support any association between cervical manipulation and stroke. Cost-effectiveness Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches. Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent. References

placing a signed comment at the end of this section to place timestamp for archiving. - - MrBill3 (talk) 23:32, 21 October 2013 (UTC)

Education and stress

I propose this change. QuackGuru (talk) 01:16, 22 November 2013 (UTC)

It is indeed a secondary source

The lead need to be updated with the relevant information. It is indeed a secondary source. QuackGuru (talk) 01:44, 22 November 2013 (UTC)

Outdated and wrong

64.122.219.100 (talk) 17:57, 23 November 2013 (UTC) The information on here is not only biased but is outdated and needs updating. For your knowledge, yes there are HUNDREDS if not thousands of medical research on chiropractic. So to say, there is no research supporting chiropractic is not true. People use wikipedia all the time so the information on here needs to be correct. please change:

"Collectively, spinal manipulation failed to show it is effective for any condition.[14] 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, and some evidence of severe adverse effects from cervical vertebral manipulation.["

to:

There is research supporting spinal manipulation and it has been shown to be effective for most conditions (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563165/) also, (http://www.ncbi.nlm.nih.gov/m/pubmed/24262386/?i=1&from=Is%20chiropractic; "Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Neck Pain." AuthorsBryans R, et al. Show all Journal J Manipulative Physiol Ther. 2013 Nov 19. pii: S0161-4754(13)00237-6. doi: 10.1016/j.jmpt.2013.08.010. [Epub ahead of print] Affiliation Guidelines Development Committee (GDC) Chairman; Chiropractor, Clarenville, Newfoundland, Canada."

The scientific consensus is that chiropractic may be on a par with other manual therapies for some musculoskeletal conditions such as lower back pain, and there is credible evidence for effects on other conditions (ex. treating hypertension with chiropractic has been shown to be successful)

"Spinal manipulation for the treatment of hypertension: a systematic qualitative literature review."

AuthorsMangum K, et al. Show all Journal J Manipulative Physiol Ther. 2012 Mar-Apr;35(3):235-43. doi: 10.1016/j.jmpt.2012.01.005. Epub 2012 Feb 17.

Affiliation Private Practice, Riverside, CA, USA.

And please change this line: "...and some evidence of severe adverse effects from cervical vertebral manipulation."

to: No research has been found to be specifically correlated with severe adverse effects. The research claiming this failed to state the preexisting conditions of the patient.

or just leave that sentence out because you cannot claim something that isn't completely true. Oh and it only happened a few times in history and it's not relevant to the profession at hand.

Nonsense. These changes are not acceptable. --Roxy the dog (resonate) 19:19, 23 November 2013 (UTC)

The evidence on chiropractic's is mixed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:23, 23 November 2013 (UTC)

The evidence based on a critical evaluation of a systematic review of systematic reviews is clear. This is an authoritative source. I changed the sentence. "A critical evaluation found that collectively, spinal manipulation failed to show it is effective for any condition." This was according to a critical evaluation of a systematic review of systematic reviews. QuackGuru (talk) 02:03, 24 November 2013 (UTC)

I would expect changes be made to the description of chiropractic. The main authors are people who believe the chiropractic profession are quacks. If they researched medical studies done on chiropractic instead of finding articles that they believe should be displayed. Actually more people are realizing that chiropractic does wonders. Read the medical studies and get up to date on chiropractic instead of picking and choosing what articles fit your description of chiropractic. Ya there is controversy but how many great medical studies are successful on chiropractic? How many are against it? Successful out weigh the non successful. The research your claiming about serious adverse affects like stroke from chiropractic was already a pre existing condition and I would expect you mention that. This whole description of the profession is a joke. The evidence IS out there that the benefits FAR out weigh the adverse effects. I've personally seen hundreds of people be healed from their neuromusculoskeletal disorders by utilizing chiropractic. chronic pain gone just from seeing a chiropractor. Clinical case studies are far better than any other study done because it's with the patients not overseeing and speculating from a review. Hear it from the people. — Preceding unsigned comment added by ChiroQ (talk • contribs) 22:48, 26 November 2013 (UTC)

Please link these studies and we'll be glad to read them. Your own research and assorted testimonies won't hold any weight here by the way. Samwalton9 (talk) 22:54, 26 November 2013 (UTC)

Not pseudoscience

There may be some aspects of chiropractic which are considered pseudoscientific . . . but as a whole the majority of the profession . . . yes it is a profession . . . is evidence-based and scientific. TheDoctorIsIn (talk) 21:18, 21 January 2014 (UTC)

Per WP:FRINGE/PS, Chiropractic is not generally considered a pseudoscience and therefore should not be categorized as such. TheDoctorIsIn (talk) 22:20, 21 January 2014 (UTC)

That sounds like the curate's egg. Oh, some parts of chiropractic are evidence-based! The "profession", I can live with; there is no doubt that some make a career out of it. bobrayner (talk) 23:09, 21 January 2014 (UTC)

Regardless of your personal feelings about chiropractic . . . the scientific community does not generally consider chiropractic to be pseudoscience . . . therefore categorizing this article as pseudoscience is a violation of WP:FRINGE/PS. This article (Chiropractic#Effectiveness) alone shows that there is a reasonable amount of academic debate still existing about chiropractic. Show me that the scientific community does generally consider chiropractic to be a pseudoscience . . . otherwise there is nothing to talk about here. TheDoctorIsIn (talk) 00:14, 22 January 2014 (UTC)

The ideas of innate intelligence and the chiropractic subluxation are regarded as pseudoscience.[9] This is in the lead. QuackGuru (talk) 02:43, 22 January 2014 (UTC)

QG is correct, so that part is settled. The next issue is whether we can categorize the whole profession as pseudoscience. No, we can't, for many reasons. It's too complex to label the whole profession in that way, especially since there is a move away from previously held positions. We would also violate the PSI Arbcom decision by doing that, so we should simply keep the content we have which mentions the pseudoscientific elements still held by some chiropractors, but the template and category have got to go. In fact, chiropractic should be removed from the template, as that too is a violation of the Arbcom decision. I'm doing that right now. -- Brangifer (talk) 05:39, 22 January 2014 (UTC)

Hmmm. Not sure about that; that it's a profession is unrelated to its scientific soundness (there are, after all, professional homeopathy practitioners). And insofar as it deals with science, its theories are pseudoscientific are they not? Before such a major change as this it would be wise to get a wider view, perhaps at WP:FT/N. Alexbrn ^{talk|contribs|COI} 06:06, 22 January 2014 (UTC)

Way to early for BullRangifer to charge in changing things without proper discussion and consensus. I agree with Alexbrn - any change to the Wiki voioce on this needs much wider discussion. I oppose btw. Chiropractic is pseudoscience to the core. --Roxy the dog (resonate) 12:28, 22 January 2014 (UTC)

Just to chip in, the majority of sources I can find refer to chiropractic as either pseudoscience or in one case "struggling to throw off the shackles of the pseudoscience it was born from". It definitely deserves the category tag.SPACKlick (talk) 13:01, 22 January 2014 (UTC)

The only arguments being made here to keep the incorrect categorization are mostly based on personal opinion . . . "I feel that chiropractic is pseudoscience therefore is should be categorized as such" . . . if you are saying that the majority of the reliable scientific sources are calling chiropractic a pseudoscience, then please show us those sources . . . this article shows that there is a lot of fair to high quality research out there with conflicting conclusions about the effectiveness of chiropractic for this or that ailment . . . Vertebral subluxation and innate intelligence are very much pseudoscientific and those articles should be categorized as such . . . nobody is arguing otherwise . . . however, modern chiropractic is making all attempts to leave those concepts in the past . . . condemning all of chiropractic as pseudoscience for these historical theoretical concepts would be to some degree similar to calling medical science a pseudoscience based on the practices of bloodletting and leeching. TheDoctorIsIn (talk) 05:49, 23 January 2014 (UTC)

For most of its existence, chiropractic has been sustained by pseudoscientific ideas such as subluxation and innate intelligence[16] which are not based on solid science.[9] See Chiropractic#Conceptual basis. If a chiropractor would leave their history in the past they would be called a physical therapist. QuackGuru (talk) 06:33, 23 January 2014 (UTC)

The operative word here is "history" . . . Chiropractic is not currently generally considered pseudoscience. Please provide a reliable scientific source stating otherwise . . . this article shows that there is a lot of fair to high quality research out there with conflicting conclusions about the effectiveness of chiropractic for this or that ailment . . . this means that the scientific status of chiropractic is inconclusive at this point . . . seemingly there is some scientific evidence to support it while there is also scientific evidence to refute it. TheDoctorIsIn (talk) 18:31, 23 January 2014 (UTC)

Verging into WP:NOTAFORUM.

What specific improvements to the article are being suggested? If none are, then this topic should be closed. --Harizotoh9 (talk) 07:16, 23 January 2014 (UTC)

The improvement is to fix the miscategorization of this topic as a pseudoscience . . . as it stands now this article is in violation of WP:FRINGE/PS . . . removing the miscategorization would therefore be an improvement. TheDoctorIsIn (talk) 18:31, 23 January 2014 (UTC)

"this article is in violation of WP:FRINGE/PS" ← how? Alexbrn ^{talk|contribs|COI} 19:18, 23 January 2014 (UTC)

3. Questionable science: Hypotheses which have a substantial following but which critics describe as pseudoscience, may contain information to that effect; however it should not be described as unambiguously pseudoscientific while a reasonable amount of academic debate still exists on this point.

Given all of the fair to high quality research out there with conflicting conclusions about the effectiveness of chiropractic for this or that ailment . . . clearly there is a reasonable amount of academic debate about the scientific aspects of chiropractic . . . however the article is currently categorizing (an unambiguous description) as pseudoscience . . . therefore the article is currently in violation of WP:FRINGE/PS. TheDoctorIsIn (talk) 23:34, 23 January 2014 (UTC)

I agree with what TheDoctorIsIn has just said and agree that it violates WP:FRINGE to try and characterize the entire profession as pseudoscience. I believe that BullRangifer also mentioned that it violates some ArbCom decision to label the profession as pseudoscience outright; perhaps he could ellaborate on that? Moreover, a RS in JAMA Int Med suggests that "Today, a substantial number of chiropractors are anxious to sever all remaining ties to the vitalism of innate intelligence. For these practitioners, the notion of the innate serves only to maintain chiropractic as a fringe profession and to delay its "transition into legitimate professional education, with serious scholarship, research, and service." And the body of our wiki article mentions that traditional straights are the minority. Thus, while it is great to mention the pseudoscientific heritage, traditions, etc., it is equally, perhaps even more important to indicate that a significant shift has/is occurring for 'a substantial part of the profession'. Puhlaa (talk) 02:08, 24 January 2014 (UTC)

• There are two questions, 1) Should Category:Pseudoscience be removed from the article; 2) Should Chiropractic be removed from the {{Pseudoscience}} template and therefore have that template not appear at this article. I really think they're two separate questions and need to be considered individually. Categories are more broad and not as selective as a template. The Pseudoscience category has 280 pages in it and 28 subcategories, each with their own pages; the template lists only 30 specific examples.

  I think there's a decent case for keeping the category, if there's reliable sourcing that indicates that some fundamental aspects of the topic are generally considered pseudoscience. I haven't reviewed the sourcing well enough to know for sure, but I do see a few sources supporting it in the article. I don't think it's a requirement for inclusion in a category that the article topic falls 100% within it. For example, there are plenty of biographies for people involved in more than one discipline that have multiple categories, like Michelangelo is in categories for both painters and sculptors.

  I think the case for keeping chiropractic in the template is weaker, because it's more selective. Does the authoritative reliable sourcing consider chiropractic to be a foremost example of pseudoscience? I am genuinely unsure. Zad68 03:00, 24 January 2014 (UTC)

I think it is worth noting that if you remove the pseudoscience from chiropractic, what you have left is massage. --Roxy the dog (resonate) 05:36, 24 January 2014 (UTC)

The aspects which are pseudoscientific can be labelled as such in this article, and they are. They can also, per the PSI ArbCom, be categorized as such in their own articles. To label a whole profession is problematic. This isn't homeopathy, a classic example of pseudoscience. That's why I think we should remove chiropractic from the template, remove the template, and remove the category. That way we won't be in conflict with the PSI ArbCom decision, while still labeling the pseudoscientific elements as such, which the PSI ArbCom allows. This is a simple solution which does not remove our properly sourced obligation to label the PSI elements for what they are. -- Brangifer (talk) 05:38, 24 January 2014 (UTC)

The main point I think is that (as we say in the very opening sentence) Chiropractic is both an approach and a profession, and because it has this dual aspect the categorizations we use will apply apply to either those aspects. So some categories (such as "Physical exercise") apply to the "approach" rather than the "profession" aspect of chiropractic. So it is with "pseudoscience". The fact that "Chiropractic" has its own entry in Shermer's encyclopedia of pseudoscience gives us a central RS-based reason why this category applies. I'm not bothered about the template. Alexbrn ^{talk|contribs|COI} 06:37, 25 January 2014 (UTC)

Brangifer's analysis is precisely correct . . . If we follow the guidelines of Wikipedia and the reality of Chiropractic today there is really no other way to interpret the way forward here. Alexbrn . . . do you recognize that science does support chiropractic spinal manipulation as a benefit for some limited conditions and there are a variety of other conditions where there is weak to moderate evidence supporting it? And there are conditions for which science positively refutes chiropractic manipulation as a treatment. This is not just about physical exercise, nutritional counseling . . . This is about the scientific door not being closed on chiropractic spinal manipulation . . . it's very much open as research continues. The scientific debate continues . . . Therefore per FRINGE categorizing chiropractic as pseudoscience is a Wikipedia rule violation and worse . . . it is factually incorrect. TheDoctorIsIn (talk) 06:55, 25 January 2014 (UTC)

There is no scientific debate: the question of whether the precepts underlying chiropractic are pseudoscientific is settled: they are. Separately to that, some parts of the chiropractic movement are trying to de-emphasize those aspects or make a land-grab to "own" generic spinal manipulation, as we relate in our article here. What is the difference between "spinal manipulation" in general and what you call "chiropractic spinal manipulation"? According to reliable sources that consider the matter, it is pseudoscience - chiropractic's defining differentiatior. Alexbrn ^{talk|contribs|COI} 07:06, 25 January 2014 (UTC)

Spinal manipulation is chiropractic. Other professions may do it, but manipulation of the spine is chiropractic . . . The land-grab goes the other way . . . as spinal manipulation is found to be scientifically effective for a variety of ailments other healthcare professions are co-opting the techniques. Chiropractic has gotten results in some cases . . . The original hypothesis as to why these results were occurring has been falsified . . . However the techniques remain and science is now finding out the actual why and how these manipulation cause these benefits for some ailments. TheDoctorIsIn (talk) 07:23, 25 January 2014 (UTC)

Non-chiropractors have long performed spinal manipulation in the limited number of scenarios where it is merited. According to RAND, even in 1991, 6% of the spinal manipulations in the US were performed by non-chiropractors. The fact that chiropractic is being investigated (and found wanting) does not bear on the question of whether it is pseudoscience. Homeopathy is still being "investigated". But in the end, we need to avoid original research and go by reliable sources on pseudoscience which consider the question of whether or not chiropractic should be so categorized. As I say, it's got an entry in Shermer's volumes. What other sources directly address this question? Alexbrn ^{talk|contribs|COI} 07:40, 25 January 2014 (UTC)

Chiropractic is linked with "pseudoscience". When it is no longer linked with pseudoscience they would be called a physical therapist and the word "chiropractor" would no longer be used. On the contrary, you have not established consensus to delete it from the template. It was in the template for a long time. QuackGuru (talk) 07:11, 25 January 2014 (UTC)

Statement by an admin re. ArbCom sanctions

• I think there is a strong case to be made for Puhlaa being excluded from directly editing this article. The lengthy history of non-consensus edits advocating an idealised form of chiropractic whihc is at odds with common practice, places Puhlaa firmly on the wrong side of WP:FRINGE. Puhlaa, for the next month, I suggest you propose all changes on talk first, with existing text, suggested replacement, reasons for the change, and sources. I suggest you do this one small change at a time. If you do not, then I think you will find that arbitration enforcement sanctions will be requested, whihc will likely exclude you form the article altogether. Consider this a free drink at the Last Chance Saloon; the next one will not be free. Guy (Help!) 09:28, 25 January 2014 (UTC)

Some concerns from a bunch of numbers

Hi all, I've got some problems with the sections I've posted below (from the SAFETY section):

"Chiropractic care in general is safe when employed skillfully and appropriately. Manipulation is regarded as relatively safe, but as with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications. Absolute contraindications to spinal manipulative therapy are conditions that should not be manipulated; these contraindications include rheumatoid arthritis and conditions known to result in unstable joints.[2]

Sustained chiropractic care is promoted as a preventative tool, but unnecessary manipulation could present a risk to patients. Some chiropractors are concerned by the routine unjustified claims chiropractors have made.[9]"

First I'm not sure chiropractic care is seen as generally safe anymore (eg.). What is the general consensus to changing this statement to be a little less sure of itself?

Secondly what is meant by "when employed skillfully and appropriately"? This seems, to me, like a way of saying "When chiropractic care is administered safely it is safe" a subtly worded case of begging the question.

Thirdly the second sentence contradicts the first - if Chiropractic treatment is safe why would anyone be concerned with ongoing treatment?

Fourthly the reference in this sentence (from Edzard Ernst) implies that it is Chiropractors that are concerned by their own claims - the article written by Ernst doesn't mention that it is Chiropractors who are concerned specifically with the claims, and is highly critical of the efficacy of the whole field.

I'd also like to get rid of the weasel words throughout; perhaps this is a start:

Due to a lack of rigorous research and systematic under-reporting of negative affects it is difficult to gauge the safety of Chiropractic therapy 1. Most chiropractic practitioners report high levels of safety with their therapies (another ref) As with all therapeutic interventions, complications can arise, and it has known adverse effects, risks and contraindications.

I feel this is more in line with research, and also with the rest of the section which goes into detail about some of the risks associated with Chiropractic therapy. 203.38.24.65 (talk) 05:30, 28 January 2014 (UTC)

"Chiropractic care in general is safe when employed skillfully and appropriately" is a meh kind of statement. We might as well say "Chiropractic care in general is safe when done safely". What source is behind this spin? Alexbrn ^{talk|contribs|COI} 06:58, 28 January 2014 (UTC)

That is the text straight out of the current article. I'm not sure if you are asking me to source it? If so you might want to read my post above (where you are almost paraphrasing me funnily enough). 203.38.24.65 (talk) 07:21, 28 January 2014 (UTC)

It's that 2005 "WHO" document behind it (again). This is not a reliable source and needs filleting out of the article I think. Alexbrn ^{talk|contribs|COI} 07:27, 28 January 2014 (UTC)

Are you saying the first sentence came out of a WHO article? There is no reference provided in text so I thought it was just unnecessary verbiage (at best). 203.38.24.65 (talk) 07:31, 28 January 2014 (UTC)

Well, the whole para is sourced to that document (which is actually a document by chiropractors painting an idealized vision of what they should be doing). I didn't verify the precise text though. Alexbrn ^{talk|contribs|COI} 07:35, 28 January 2014 (UTC)

Well the statement is straight out of the sourced document (slightly paraphrased). I'm not sure of the provenance of the WHO document (although it's references are very out of date), regardless I feel that we could find reliable sources that confirm both points of view. I think the current statement that it is "generally safe" is over-confident given sources positing the opposite and pointing out the lack of quality research on the issue. That's why my proposed new text is kind of 'on the fence'. 203.38.24.65 (talk) 07:44, 28 January 2014 (UTC)

Well, the BBC source is not strong enough for biomedical information (see WP:MEDRS). Something from PMID 23069244 (say) would be better:

Much is known about common adverse events following SMT. These events have been described in prospective, multicenter studies. In general, adverse events are mild to moderate in intensity, have little to no influence on activities of daily living ... Serious (or life-threatening) adverse events following SMT are, on the other hand, extremely rare. Because they are rare, less is known about them ...

(Add) But the systematic review behind the BBC report is definitely worth mentioning. We have enough here for something of a re-write. Alexbrn ^{talk|contribs|COI} 08:18, 28 January 2014 (UTC)

(EC) Ok, the article I provided points back to this study which paints a different picture to the one above. Both articles note that the research into the issue has used less rigorous methodologies and findings are not clear:

In that regard, to our knowledge, only 4 case-control studies22, 23, 24, 25 have been identified that have examined this issue, 3 of which demonstrated a strong association.22, 24, 25 However, these studies did not exclude the possibility that the observed association was related to protopathic bias (ie, a form of bias that occurs when there is a lag in time from the appearance of the initial symptoms and start of treatment yet before the actual diagnosis).

My feeling is that the similarity across articles is that the research is poor and this should be noted in the article, but I'm not sure if this is original research or contravenes whatever other WP policies I'm ignorant of. 203.38.24.65 (talk) 08:27, 28 January 2014 (UTC)

Furthermore these two studies are not the only ones to come to this conclusion, so do this one, this one and this article has a useful summary in its introduction. 203.38.24.65 (talk) 08:40, 28 January 2014 (UTC)

Just as a note, if no-one objects soon, I will go ahead and rewrite the relevant section to emphasise the low quality of research into the safety of Chiropractic therapy and variable estimates of harm. 203.161.85.114 (talk) 09:55, 29 January 2014 (UTC)

Massive deletion and manipulation of text throughout the article

Previous lead sentence. Chiropractic is a form of alternative medicine[1] that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.[2] It is generally categorized as complementary and alternative medicine (CAM),[1] a characterization that many chiropractors reject.[3]

https://en.wikipedia.org/w/index.php?title=Chiropractic&oldid=442127826

Check the edit history. The lead is currently a mess and the body of the article was severely hacked.

All over the article text is missing. For example, this was in the history section: Serious research to test chiropractic theories did not begin until the 1970s, and is continuing to be hampered by what are characterized as antiscientific and pseudoscientific ideas that sustained the profession in its long battle with organized medicine. QuackGuru (talk) 19:34, 23 January 2014 (UTC)

You are introducing redundancy into the lead with this edit. Why have you added a second reference to Chapman-smith in the first paragraph of the lede? Before your edit it said: "Chiropractic is a complementary and alternative health profession... (1)." and now you have also added "Chiropractic is generally classified as CAM...(1)" These are saying the same thing, why do you feel they are both needed? One of the two needs to be removed, I have removed the one you added.Puhlaa (talk) 20:08, 23 January 2014 (UTC)

QG, it seems that with this edit you may have also removed the text that Alexbrn had included following this discussion. He was editor who wanted text that represented the Villanueva-Russell included in the scope section, you should probably read the archived talk. I think your edit has removed that source? You were banned from editing for a year and a lot changed while you were banned, perhaps just restoring the article to what it looked like before you were banned is not the best idea? Some of the changes were agreed to be improvements.Puhlaa (talk) 20:18, 23 January 2014 (UTC)

Villanueva-Russell is a good source. The point here is that the "WHO" document is produced by chiroporactors and paints an idealized picture of chiro (TL;DR "we just do spines, sensible us"); Villanueva-Russell's more up-to-date material suggests many chiros are still ploughing the systemic health claim furrow. I would junk the WHO document entirely; it's a non-independent out-of-date source. Alexbrn ^{talk|contribs|COI} 21:19, 23 January 2014 (UTC)

The 2011 research by Yvonne Villanueva-Russell is in the article now.

Editors at the time thought the lead should not be changed. This edit changed the lead using the "WHO" document produced by chiropractors.

The Villanueva-Russell source and other sources are better sources. The text must be written to match the source or sources now. QuackGuru (talk) 21:41, 23 January 2014 (UTC)

There was no consensus to remove the WHO source from the lede, previous discussion I linked found consensus to include the V-R source in the 'scope' section. The WHO source is the best descriptive source we have for an article that is meant to represent a world view. I have restored the WHO source to the lede, will need to discuss (again) if you want such a good source removed in favour of sources that are US-centric. Puhlaa (talk) 22:06, 23 January 2014 (UTC)

I don't see consensus to remove the "Nelson" source from the lead. Most of this article was hacked. Show me where was the consensus that the Nelson source was a bad source. The Villanueva-Russell source is recent source. Do you believe the Who is a non-independent and out-of-date source or do you think is it an independent and recent source. QuackGuru (talk) 00:52, 24 January 2014 (UTC)

QG, you pointed to a [2011 edit that removed Nelson from the lede and asked me to show you the consensus for that change? This is irrelevant, the article has come a long way over 3 years. The consensus now is that Nelson is not in the lede, if you think Nelson should be added back into the lede (as you did in this edit today ), I think you will need consensus. I am not saying it cannot be added to the lede, but it seems like a fairly US-centric source and it is regarding a specific topic (scope of practice in the US), thus it is not helpful as a source for the generic definition of chiropractic in the lede. The Villanueva-Russell source is also about scope of practice of US chiropractors, thus, while it could have it's place in the lede, it is not a good source for a general definition of the global profession, where you had placed it. The WHO source is vetted by an internationally recognized, mainstream medical organization (The World Health Organization) and it is an attempt to standardize the terminology/training/safety/etc of the chiropractic profession internationally. Moreover, the source says that the:

"WHO took every precaution to verify the information contained in this publication" and

"WHO acknowledges its indebtedness to over 160 reviewers, including experts and national authorities and professional and nongovernmental organizations, in over 54 countries who provided comments and advice on the draft text.".

I think it is a great and authoritative and impartial source for a general definition of chiropractic and a general discussion of the training standards and licensing for the profession internationally. Are you aware of another source on the topic by an international medical body that could be used to introduce a topic of international significance instead of the WHO source? Puhlaa (talk) 02:38, 24 January 2014 (UTC)

Many chiropractors reject with the characterization that chiropractor is considered CAM. This text should be restored.

"No single profession "owns" spinal manipulation and there is little consensus as to which profession should administer SM, raising concerns by chiropractors that other medical physicians could "steal" SM procedures from chiropractors.[16]"

The lead already says profession enough times with this sentence above.

"The other great divide within chiropractic concerns the question of whether or not chiropractic is a primary care profession. Unfortunately, just as the word "philosophy" is routinely misused, so is the concept of "primary care." Paradoxically, even the extremes of the profession on the philosophy question (e.g., Sherman College and National University) both endorse the notion of chiropractic as a primary care profession. This agreement does not suggest that chiropractic, as primary care is a valid and compelling concept. Rather, it suggests that the concept has been unexamined and hastily adopted. This section will examine the meaning of primary care as it applies to chiropractic."[21]

The Nelson source is a good independent source that explains the controversy. It is relevant the Nelson source was deleted without consensus. An editor knew something happened to the article. The lead should not say it is a profession in the first sentence in WP's voice when there is disagreement. Do you think we should assert it as an objective fact in the first sentence when there is disagreement. QuackGuru (talk) 20:17, 24 January 2014 (UTC)

As I said above, I am not against Nelson or V-H sources being used, but it is not helpful to point to 2011 edits for discussions of 2014 content; please keep the discussion geared towards a current, specific proposal(s). If you make a clear proposal for the addition of Nelson and V-H to the lede then we can discuss the merits of that proposal. I have mentioned already that they are not good sources for the first sentence, which is a general definition of the international profession.

With regard to restoring old text to the lede that discussed the controversy over the term CAM (ie: many DCs surveyed rejected the term); RS seem to agree that chiropractic is considered a CAM profession; I think that the disagreement by DCs over the CAM characterization is not really noteworthy for the lede. Similarly, the debate over primary care is purely academic and dependent on what definition of primary care is used (the term is often mis-used). I dont think we should use this term in the lede at all. Puhlaa (talk) 22:03, 24 January 2014 (UTC)

See the lede here. It summarises the body. The current lede does not summarise the body at all. Would you like me to summarise the body in the WP:LEAD. It would only take a couple of minutes to update the lede. Chiropractic is a "form" of alternative medicine. We can't assert it as alternative medicine or CAM in the lede when it is "generally" considered CAM. These differences are noteworthy. "Chiropractic is an alternative medicine[1]" is WP:OR. The source does not assert it as alternative medicine. Chiropractic is a form of alternative medicine. This is neutrally written and passes V policy. Larry Sanger created simply policies for editors to adhere to but Wikipedia administrators do not enforce V or NPOV policy. So now the very first sentence in the article is OR. It is very helpful to point to 2011 edits when the problems happened. I asked you to show where was the consensus to delete the Nelson source but you failed to show there ever was consensus. For what seems link a number of years, you have been arguing against many editors against improving the lede sentence when editors know sources disagree. For example, you accused User:JzG in 2011 of vandalising the lede sentence when all along you are the editor who violated NPOV. I already explained we can't say it in WP's voice. See WP:ASSERT. Editors have previously pointed out the problems with using the Who source in the lede. When chiropractic is viewed as a marginal healthcare profession[40], we can't assert it in the lede sentence that chiropractic is a healthcare profession. You are beating a dead horse over this for a very long time now. Please move on. QuackGuru (talk) 06:20, 25 January 2014 (UTC)

QG, I have tried my best to adress each of your points:

1) You said "The current lede does not summarise the body at all. Would you like me to summarise the body in the WP:LEAD?"

• Response: I think the lede is a mostly good summary of the body, but there is always room for improvement. For example, I think the last paragraph of the lede is innacurate and OR. I am working on making a specific proposal for changes there.

2) You said: "Chiropractic is a "form" of alternative medicine. We can't assert it as alternative medicine or CAM in the lede when it is "generally" considered CAM. These differences are noteworthy. "

• Response: I do not see the notable difference between 'CAM' and 'a form of CAM' and 'generally considered CAM' that you suggest.

3) You said: "Chiropractic is an alternative medicine[1]" is WP:OR. The source does not assert it as alternative medicine."

• Response: You state in point (2) that the source says it is "is a form of alternative medicine". As I said above, I do not really see the notable difference between 'CAM' and 'form of CAM' and 'generally considered CAM'.

4) You pointed to WP:ASSERT and said: “When chiropractic is viewed as a marginal healthcare profession[40], we can't assert it in the lede sentence that chiropractic is a healthcare profession."

• Response: The lede sentence does not assert what you claim; the lede sentence says it "is an alternative medicine healthcare profession". Chiropractic is considered a 'marginal' healthcare profession because it is generally considered 'CAM' and 'CAM' is not part of the mainstream - Please see This recent mainstream source which says in the first 2 sentences of the abstract "Chiropractic is the best established of the alternative health care professions. Although marginalized for much of the 20th century, it has entered the mainstream of health care, gaining both legitimacy and access to third-party payers." Our lede does not try to say that it is a mainstream profession, our lede maintains that it is a "CAM healthcare profession", as such, I do not think that our lede is asserting anything that is inconsistent with the RS. Our lede sentence is a good summary of current RS. Puhlaa (talk) 02:18, 26 January 2014 (UTC)

The lede says it is a "alternative medicine healthcare profession" but a newer 2011 source say it is tied to a marginal professional status. When there is disagreement you can't assert it as fact in the lede that it is an alternative medicine healthcare profession. It is generally considered CAM but not CAM or alternative medicine. The OR should be removed from the lede. The source you stated is from 2003. It is not used in the lede sentence and it is not a recent source. The first part of the lede sentence is still OR and there is a disagreement among sources. You haven't given a reason to assert it as fact in the first sentence when there is a disagreement. The part "alternative medicine[1] health care profession" is putting two sources together that to come to a new conclusion. It is WP:SYN. Chiropractic is an alternative medicine[1]" is WP:OR but your response did not address the OR. It is not about you don't see the notable difference. It is about OR and sources disagree. The previous lede summarised the body. The current lede is poorly writing and does not summarise the body well at all. The WHO source is not consistent with newer sources. For example, it says under Chiropractic: "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." Now we are going to have to replace it. QuackGuru (talk) 04:42, 26 January 2014 (UTC)

"concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health." This is what the WHO source says.

"concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health." This is what the current article says. This is a COPYRIGHT violation. QuackGuru (talk) 18:24, 26 January 2014 (UTC)

QG, you said: "The lede says it is a "alternative medicine healthcare profession" but a newer 2011 source say it is tied to a marginal professional status. When there is disagreement you can't assert it as fact in the lede that it is an alternative medicine healthcare profession."

Response: Did you read the newer source? The newer source you refer to is Yvonne_VRussell. You keep suggesting the phrase "The dilemma of remaining tied to a marginal professional status must be balanced against considerations of integration." is inconsistent with our lede. However, I dont think you have read the full text? I tried to explain this concept to you in my last response, perhaps I wasn't clear. In the full text of Yvonne_VRussell’s source, she explains what she means by 'marginal':

"In health care, orthodox medicine has “professional dominance” and possesses the largest jurisdiction , although much discussion of the decline of this hegemonic power has also occurred in the literature. Complementary and Alternative Medicine (CAM) has established itself as a “marginal profession” in relation to this framework."Yvonne_VRussell

Yvonne_VRussell is clearly using ‘marginal’ to describe a CAM professions placement relative to the mainstream and in this source she is specifically discussing the CAM health profession 'chiropractic'. This description of chiropractic is perfectly consistent with other sources, like [22],[23],[24],[25], which have been presented to you previously.

Bottom line, there are good reliable sources that call chiropractic a health profession [26] [27] ; an alternative healthcare profession [28]; a marginal (CAM) healthcare profession [29]; and even a medical profession [30]. In the year you were blocked from editing chiropractic there were editors who wanted the CAM designation included in the first sentence, there were also editors who wanted the profession status included in the first sentence. You can see that the consensus version that currently exists was able to achieve both, while staying consistent with the sources available. I think that future discussion would be more fruitful if you just made specific proposals based on RS that we can reasonably discuss. Puhlaa (talk) 20:08, 26 January 2014 (UTC)

You are not collaborating at this talk page because you ignored my concerns about the SYN and copyright violations. Editors cannot have a reasonable discussion with you here. The WHO source did not verify the claim "alternative medicine healthcare profession". As I said before putting two sources together to come to a new conclusion is SYN. Do you agree it was SYN and copyright violations in the lede sentence. If we use the Yvonne VRussell source it could start by saying "Chiropractic is a marginal heath care profession in the field of complementary and alternative medicine whose practitioners emphasize..." QuackGuru (talk) 18:43, 28 January 2014 (UTC)

Proposal

Current lede sentence: Chiropractic is a health care profession in the field of complementary and alternative medicine whose practitioners emphasize manual manipulation of the spine, sometimes with the unevidenced claim this can treat a wide variety of human ailments.[1]

Proposal to replace lede sentence. '''Chiropractic''' is a form of [[alternative medicine]]<ref name=Chapman-Smith/> that emphasizes diagnosis, treatment and prevention of mechanical disorders of the [[musculoskeletal system]], especially the [[vertebral column|spine]], under the hypothesis that these disorders affect general health via the [[nervous system]].<ref name=Nelson/> It is a marginal [[complementary and alternative medicine]] [[health care profession]].<ref name="V-H"/> QuackGuru (talk) 05:34, 29 January 2014 (UTC)

As author of that current lede sentence, let me just explain a couple of the thoughts behind it:

• By saying what chiros do right after mentioning "profession", I hopes to make clear that chiropractic is both a method and a profession while avoiding the mouthful of explicitly saying so
• I think the "sometimes unevidenced" wording is useful as it lets readers know we have something suspect here. I think it's important for this to be apparent early so this doesn't look like a legitimate form of medicine until we arrive at the criticism paragraph. Alexbrn ^{talk|contribs|COI} 05:46, 29 January 2014 (UTC)

The part "sometimes with the unevidenced claim this can treat a wide variety of human ailments.[1] is too vague. There is also a lot of stuff missing from the first paragraph and entire lede that is more specific and better written. The part "It is a marginal complementary and alternative medicine health care profession." can be expanded using the Yvonne VRussell’s source. QuackGuru (talk) 06:26, 29 January 2014 (UTC)

There are a lot of proposals and discussion now in this one thread, perhaps some new threads with clear proposals could be started? I am replying here to QG comment at 18:43 on Jan 28.Puhlaa (talk) 06:44, 29 January 2014 (UTC) QG, I have already explained to you that I do not think our lede sentence has any synthesis! Our lede says: “’’ Chiropractic is an alternative medicine health care profession’’” We have RS source that says”’’ Chiropractic is the best established of the alternative health care professions’’”. You claim that the WHO source does not support that chiropractic is an alternative healthcare profession, but the WHO starts it’s chiropractic guidelines with a foreword all about traditional/alternative/complementary medicine. Remember I pointed you to this consensus-building discussion that generated the current lede sentence; you will see that editors pointed-out this fact then as well.

You want to add the term 'marginal' to the first sentence of the lede along with the alternative medicine description. I have already shown you that Yvonne_VRussell explains in her source what she means by 'marginal' – alternative medicine professions are 'marginal' to mainstream medicine, just as they are also 'alternative' to mainstream medicine. There is no need to describe chiropractic as 'marginal' AND 'alternative' in the lede sentence, as you propose, when they are referring to the same characteristic – their position relative to mainstream medicine.

With regard to you newest concern; I dont think we are violating any copyright policy by using a half-sentence from the WHO guidelines source. However, if you feel strongly that this is a big problem, perhaps you could show good intent and start a thread for a clear proposal for how to address your copyright concerns without also trying to change all the other components of the lede sentence where there are no problems and where we have good consensus. For example, there is no reason, based on WP:copyright to remove the WHO source, or to remove the general description of chiropractic the WHO gives us; but perhaps we can re-word the general description so that you are confident we are not copying the WHO too closely. Puhlaa (talk) 06:44, 29 January 2014 (UTC)

I would say a new consensus needs to be developed for the lede, this is appropriate as new RS is available. The WHO source is not appropriate MEDRS as it is biased as discussed by Alexbrn above. I agree with the editors who have expressed concern that chiro being described as a healthcare profession early in the lede can create an improper impression, "healthcare profession" is suggestive of mainstream healthcare. - - MrBill3 (talk) 06:57, 29 January 2014 (UTC)

You stated "We have RS source that says”’’ Chiropractic is the best established of the alternative health care professions’’”." That is not the WHO source. The WHO source does not explicitly say it is an "alternative medicine health care profession". A cut and paste copy of the WHO source is a copyright violation. But that is not the main issue here. We have better independent sources. QuackGuru (talk) 07:05, 29 January 2014 (UTC)

QG, the source used in the article, from "Principles and Practice" also verifies the text in the lede; chiropractic as a CAM profession. If you are struggling with the lack of sources used in the lede, we could discuss adding some of the many sources that have been discussed that support the current lede. The V-H source and the source from Milbank Quarterly, which is a very respectable medical journal, could simply be added to the lede with the current source and it would be consistent with our current text. However, each of these sources is all about US chiropractic. Chiropractic is an international profession and this article is supposed to represent a world view. The current sources, Chapter:International status, standards, and education of the chiropractic profession and the WHO guidleines are of international relevance and consistent with the text. As such, while I am open to adding US-centric sources, I am not open to deleting internationally relevant sources until new internationally relevant sources are available. Puhlaa (talk) 07:43, 29 January 2014 (UTC)

MrBill, you only need to look at the threads above to see the list of international sources that all support the description of chiropractic as a profession and the vast majority of editors have acknowledged this fact. Also, the WHO source is definitely not biased, but I agree that this is Alexbrn's view. I have suggested we take the WHO source to the RS noticeboard in previous discussions on this same topic...perhaps this is the time to get a good consensus on the value of this document for it's use here? I think it is the best source we have for this article, with regard to international education and safety standards for the chiropractic profession. Puhlaa (talk) 07:43, 29 January 2014 (UTC)

QG, I am not sure why you decided to split this discussion with this edit now into "Proposal", when it is a continuous discussion with the thread above. Now my replies to your comments are split between two threads. Perhaps you could start a new thread each time BEFORE you start a new proposal or discussion, instead of changing topics within a thread quickly before other editors have time to reply to your original topic and then splitting the thread? It gets hard for other editors to follow when discussion are split and then no one will join in the discussion. Puhlaa (talk) 07:47, 29 January 2014 (UTC)

The WHO source can't be used to verify the text because it is SYN. It must be deleted. We can't add a source. We can replace the source with another source. The Milbank Quarterly is from 2003. The V-H source is more recent. QuackGuru (talk) 07:55, 29 January 2014 (UTC)

The WHO source verifies the second part of the sentence and is also consistent with the first part of the sentence. I have explained repeatedly that there is no Synthesis violation in the lede sentence and your repeatedly listing those policies without any rationale does not add credibility to your argument. With regard to the 'newness' of V-H, it would be against WP:MEDDATE to automatically give preference to V-H just because it is a few years newer when there is no disagreement with the other sources we use; since the Milbank Q. and the V-H sources both agree that chiropractic is an alternative medicine health profession there is no disagreement. However, as I said already, I don't really care which, or if any, of these US-centric sources we agree to add to the lede, as long as the internationally relevant sources stay - unless you have newer internationally relevant sources that we can discuss? Puhlaa (talk) 08:11, 29 January 2014 (UTC)

The WHO source verifies the second part of the sentence because it is a direct cut and paste copyright violation. The first part uses another source for the alternative medicine. This is the definition of SYN when you need two sources to verify "alternative medicine[1] health care profession". Because the WHO source did not verify "alternative medicine health care profession" you added the another source at the end of alternative medicine. The Milbank Q. fails verification for "It is a marginal complementary and alternative medicine health care profession." It does not verify the whole sentence and the Milbank Q. is too old. You claim it is a few years newer. I disagree. 2011 versus 2003 is more than a few years difference. QuackGuru (talk) 19:10, 29 January 2014 (UTC)

Puhlaa discusses recent edits by Alexbrn

Alexbrn, I would like to discuss this series of recent edits you made. Improvements to the article, in my opinion, were the addition of the sceptical source to the ‘further reading’ section, done with these 2 edits and the addition of criticism to the ‘Conceptual basis’ section done with this edit. I did not modify these edits in any way. I did find some edits controversial and I have reverted them, per WP:BRD. I have tried to clearly explain what I reverted and why. Puhlaa (talk) 06:55, 29 January 2014 (UTC)

Deletion of 2 reliable sources and associated text

These edits removed text from the body of the “Scope of Practice” section and replaced it with text using a different source. I have reverted these edits because there is no consensus to remove the WHO and Nelson sources from this section at this time, nor the text that was associated with the sources. However, I believe that there is merit to the additions. I suggest we add the ad your new text back into the article without removing the existing text.

My suggestion: “Chiropractors emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery,[31] with special emphasis on the spine.[ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1185558/] They generally emphasize spinal manipulation but sometimes offer other treatments, such as advice on diet and lifestyle, provide exercises, or perform acupuncture.[32]" Puhlaa (talk) 06:55, 29 January 2014 (UTC)

The trouble with your revert is that as well as using the problematic WHO source, it fails to present a key controversial aspect of chiropractic: that all kinds of quack claims are made for its systemic effects on human health; your edit presents chiro like some kind of regular medical "modality". It's not neutral. Alexbrn ^{talk|contribs|COI} 08:26, 29 January 2014 (UTC)

I can kind of see what you are saying with regard to 'presenting like a medical modality', especially for the text associated with the Nelson source. What if we removed the reference to Nelson source there and the text "special emphasis on the spine", but kept the WHO source and the description from that source: "emphasize the conservative management of the neuromusculoskeletal system without the use of medicines or surgery", which is consistent with all the descriptions I have seen, birth inside and outside the profession - see your NHS source. We could still include your addition after the general statement. Puhlaa (talk) 08:38, 29 January 2014 (UTC)

Re-write of the lede sentence

These edits removed the WHO guidelines and the general description/definition of chiropractic from the lede and replaced it with text about unsupported claims of efficacy and a source from The National Health Service – chiropractic. My concerns:

1. The WHO guidelines that were removed is the best source we have for this article. It is the only source we have that is vetted by an international medical organization. Key features of the WHO source: "WHO took every precaution to verify the information contained in this publication" AND "WHO acknowledges its indebtedness to over 160 reviewers, including experts and national authorities and professional and nongovernmental organizations, in over 54 countries who provided comments and advice on the draft text". The general description/definition the WHO guidelines provides is impartial and relevant for the profession in every country where it is licensed.
2. I cannot seem to WP:Verify the text that was added to replce the general description of chiropractic from the NHS source. I cannot find anything that says "sometimes with the unevidenced claim this can treat a wide variety of human ailments".
3. The added text gives considerable WP:weight to controversy about claims of efficacy by placing this controversy in the first sentence of the lede. However, the NHS source that was added gives the most weight - it starts it article with - the same general definition/description of chiropractic that these controversial edits removed from our lede sentence – that used by the WHO guidelines (and apparently by the GCC in the UK).Puhlaa (talk) 06:55, 29 January 2014 (UTC)

In answer,

1. The chiropactors' guidelines published by the WHO document are old (2005) and partial; there are later stronger sources so that document should not be used so prominently here.
2. The NHS text has "Some chiropractors, however, treat a wider range of conditions, including asthma, infant colic, irritable bowel syndrome and many others" and "There is no evidence that treatments offered by chiropractors are effective for other conditions [than musculoskeletal ones]".
3. Yes, we need to include controversy per WP:LEDE; even more importantly our policy on pseudoscience obliges us to ensure it is apparent to readers when something fringe is being presented. Your version is a bit of a whitewash. Alexbrn ^{talk|contribs|COI} 08:08, 29 January 2014 (UTC)

Hey Alexbrn, thanks for your response. I have continued to organize my comments numerically,

1. I agree that the WHO guidelines are from 2005, but no newer source of equal quality exists yet and I think that probably the WHO hasn't changed their mind on the contents yet, or they would publish a new version. I suggest we go to the RS noticeboard and get a consensus on this source! We have had this debate so many times and it would be so much easier if we just got an impartial consensus and abide by it until the next round of RS shows up. Do you want to draft an impartial request that could be posted there?
2. Thank you for verifying the text you added. I trust it is there; but can you tell me what section you see that content? Is it the first paragraph of the NHS source? Is it the first page? I suggest that we rely on RS like this one for guidance on how much weight to give each topic. If RS like this one put the controversy at the top then I definitely think we should as well. I think I saw the WHO definition at the top of the NHS source :)
3. We have a discussion of this controversy over efficacy in the second paragrah of our lede: "Far-reaching claims and lack of scientific evidence supporting spinal dysfunction/subluxation as the sole cause of disease[8][9] has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system"[10] We could certainly discuss expanding that section if you think it is not sufficient. Puhlaa (talk) 08:25, 29 January 2014 (UTC)

1. It's not a question of reliability, the document is a reliable source for what a panel of altmed people wrote in 2005, which was then published by the WHO. That's not in question. The question is over the weight that such a source can have, and the consequent neutrality effects.
2. It's right there on the page (use your browser's find function to help). Yes you did see the WHO definition there, carefully framed as what chiropractors say about themselves - a model of neutrality your edits fall short of. (BTW you can't deduce the importance of part of a document from its location.)
3. We need to have chiropractic's dubious nature front and centre from the outset, and avoid sanitized and partial descriptions. Alexbrn ^{talk|contribs|COI} 08:44, 29 January 2014 (UTC)

For what it's worth I agree on Alexbrn in this issue - the WHO report is written as an idealised version of how Chiropractic therapy should be used, rather than how it is used. I also note that many of the references are out of date - a particularly problematic issue when the methodological quality of studies into Chiropractic therapy are only starting to achieve the minimum required level of rigour in the last decade or less. 203.161.85.114 (talk) 09:59, 29 January 2014 (UTC)

1. I guess we disagree on how much weight the WHO source deserves. I think that when the WHO puts it's stamp on a source and says "they did everything they could to verify the source and ensure it's accuracy", it becomes the voice of the WHO. It is the WHO verifying and acknowledging the accuracy of the document that gives it it's weight. We have had this discussion before - If you strongly feel that the WHO source is less valuable for the lede than other sources we have, then lets go the the RS noticeboard.
2. I see that the first mention of controversy appears in the 6th paragraph of the NHS source. If you claim that location in the document does not imply relevance, why are you so concerned about the location of the controversy in our wikipedia article? Personally, I think that the NHS started their article with the general definition of chiropractic because it is a good way to start a good article about the profession.
3. Why do you think our article should "have chiropractic's dubious nature front and centre from the outset" when the NHS think it is more important to put the general definition of chiropractic "front and centre" and the first mention of a "dubious nature" in paragraph 6? You thought the NHS source was good enough for the 1st sentence of our lede, but will not acknowledge it's value for organizational/weighting decisions? Puhlaa (talk) 16:42, 29 January 2014 (UTC)

Reply:

1. The document is not peer reviewed; it is a decade old; it's written by altmed people (so, lacks independence); it sets out "guidelines". We should not use it for anything other than a statement of what Chiropractors wanted to say about themselves in 2004. We have better sources now.
2. and 3. The NHS no doubt have their own style for document writing, we have ours. Policy requires us to make the fringe nature of fringe things explicit. Alexbrn ^{talk|contribs|COI} 16:55, 29 January 2014 (UTC)

Response to Alexbrn,

1. The WHO source was peer-reviewed; the WHO tells us that "WHO acknowledges its indebtedness to over 160 reviewers, including experts and national authorities and professional and nongovernmental organizations, in over 54 countries who provided comments and advice on the draft text."
2. Do you think we are not explicit about the controversy in our lede when we say that "Far-reaching claims and lack of scientific evidence supporting spinal dysfunction/subluxation as the sole cause of disease[8][9] has led to a critical evaluation of a central tenet of chiropractic and the appropriateness of the profession's role in treating a broad spectrum of disorders that are unrelated to the neuromusculoskeletal system"[10]? You point to PSCI, but we also have WP:NPOV and WP:Weight that guide us - one of these is a pillar of wikipedia! What sources do you think we should use to determine the relative weight of each topic for our article? I think we use other sources that have described chiropractic; like NIH, Archives of Internal Med, Milbank Quarterly, etc. None of these seem to highlight controversy in the first sentence; the worst I see in the first sentence of any of these sources is that chiropractic is 'alternative', or 'marginal', to mainstream medicine! We already say that in our lede sentence. In fact, our current lede sentence is nearly identical to the first sentence of all of these sources: "Chiropractic is an alternative medicine health care profession" Puhlaa (talk) 17:48, 29 January 2014 (UTC)

"The WHO source was peer-reviewed" ← Ah! You're saying it was peer-reviewed (in the normal sense of the term we use on WP when discussing RS)? I missed that. Your source for this? Alexbrn ^{talk|contribs|COI} 18:46, 29 January 2014 (UTC)

Yes, I am saying that the WHO source was peer-reviewed; I provided a quote of the WHO that verifies that they had over 160 reviewers internationally before they were willing to put their stamp of approval on it. I do understand your point Alexbrn, 'it is not a peer-reviewed medical journal article'. Don't get me wrong, if we have a medical journal article that gives a definition of chiropractic that is in disagreement with the WHO, I think that policy would require us to note the controversy. However, I have not seen this disagreement in the literature. All sources we use seem to agree on what chiropractic is. Your concern with the WHO definition (and the GCC definition and what the NHS uses in it's information source) is that it focuses on musculoskeletal treatment and you think that this ignores the controversy surrounding the treatment of non-MSK conditions - am I correct in my interpretation of your concern? I want to point out that RS say that, in North America, "patients seek chiropractic care almost exclusively for musculoskeletal symptoms"[33]. Also, "A range of conditions are managed by chiropractors in Victoria, Australia, but most commonly these conditions are musculoskeletal-related."[34]. In the UK, chiropractors have been described as "private musculoskeletal practitioners"[35] and the National Health Service starts it's chiropractic information page with the same general definition we use from the WHO. It seems that all sources agree that chiropractic is primarily concerned with the musculoskeletal system. The discussion of controversy over non-msk conditions is 'Sixth paragraph type information according to NHS' - of much less importance than the musculoskeletal stuff. Puhlaa (talk) 19:34, 29 January 2014 (UTC)