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External Links

I was disappointed by the available external links and would like to add something that balances the pro-chiropractic links that are currently available via dmoz. Unfortunately, I'm not really sure what links would be appropriate. Would like to discuss this further if possible. [E.g., if Cochrane reviews are cited in references section it may not be considered appropriate to link to Cochrane library in this section as well. Perhaps there is a webpage that has a broad overview of chiropractic that would be considered appropriate?] 325jdc (talk) 11:56, 20 August 2008 (UTC)

As per WP:LINKS the External links section should not devolve into a link farm. In particular, it's better to have a single link to another link farm (dmoz being perhaps the most well-known example) rather than building a link farm here. Certainly a Cochrane review would not be appropriate. Can you suggest a better link farm than dmoz? Eubulides (talk) 17:35, 20 August 2008 (UTC)

Where in WP:LINKS do you find the idea of a single link, or linking to a link farm? I'd like to read it. I find the idea of linking to a link farm particularly dubious, and a violation of the principles in our linking, V, and RS policies. It short circuits those policies by replacing well-chosen consensus links with content beyond our control. External links should be few and well-chosen.

Have you studied the history of our External links section? We originally had a true link farm including dubious and commercial links. That got refined until we actually had a very well-developed section of high quality links from significant POV that was free of commercial links, and included the detailed explanations required by WP:LINKS. It was developed through a fine and open collaboration between User:Gleng, MD, and User:Dematt, DC, and enjoyed wide support since it violated no policies and satisfied the desire of certain chiropractic editors to remove all criticism from the article, IOW it was a compromise. As a compromise it violated no policies, but did prevent some policies from being implemented fully. Then it all got deleted without a very good discussion or consensus, and was thus a misguided effort, and an (no doubt) inadvertent violation of AGF. It was a slap in the face to all the editors whose hard effort had helped us arrive at that point. Since it contained the critical sources that were not allowed in the article, no chiropractors complained about the deletion. How convenient. NPOV and weight was violated in the process by their silence. It satisfied them and left the other editors and POV high, dry, and pretty much gone. Ideally it all should have been included in the article, and the links shouldn't have been deleted until that process was completed. It should have been done gradually and the number of links accordingly reduced as they got moved into the article, not deleted entirely. I suspect that to some small degree that has later happened, but not completely.

The current link to a link farm of dubious quality is a miserable solution. Anyone can get their personal website in that linkfarm, and thus get it linked to from here. Many of those links are absolutely forbidden as links here, and yet we link to them. -- Fyslee / talk 05:16, 21 August 2008 (UTC)

• WP:ELMAYBE says that long lists of links are not appropriate, and suggests linking to dmoz with {{dmoz}}, which is what Chiropractic does now.
• I am not a student of the history of Chiropractic #External links, but do recall seeing an enormous External links section, e.g., this one, which clearly was inappropriate. Not only were those link lists way too long; worse, that article reflected an editing style in which supportive text gravitated toward the article proper, and critical text gravitated to the External links section. That was not a good editing style, and we should not resurrect it; Chiropractic should strive for an NPOV tone throughout, and should not put one side in an external-links ghetto.
• If the current link is of dubious quality, let's remove it, along with the External links section. Many high-quality articles have no External links section sat all. The most-recent featured article on a scientific subject, Noble gases, has no external links. The most-recent featured article on a biomedical subject, Genetics, has only one external link, to dmoz. This suggests that Chiropractic #External links is in good company to be so small (as in Genetics), or perhaps should be removed entirely (as in Noble gases).

Eubulides (talk) 09:05, 21 August 2008 (UTC)

That clears up where you found the mention of DMOZ. I still think it's a bad link, but better than nothing. Here's the wording:

• 3. Long lists of links are not appropriate: Wikipedia is not a mirror or a repository of links. If you find a long list of links in an article, you can tag the "External links" section with the {{External links}} template. Where editors have not reached consensus on an appropriate list of links, a link to a well-chosen web directory category could be used until such consensus can be reached. The Open Directory Project is often a neutral candidate, and may be added using the {{dmoz}} template.

That wording reveals that the basis for removal was fallacious, because there was a consensus. We obviously disagree on the meaning of "long". Your definition allows use of WP:ELMAYBE, whereas mine doesn't think it applies in this case. The list I linked to above wasn't very long, was much better than previous lists, and had been very carefully chosen. I still think it was perfectly appropriate.

I agree that the editing style was a problem, but we at least had reached a consensus solution, and that consensus was trashed and we were slapped in the face. The solution was as I suggested - gradually get that content into the article body and gradually remove the links from the list as that happened. Instead we were left with nothing. That's what I think.

I would sure like to at least see some measure of spirit that could lead to a compromise here. How about restoring the parts of the list (IOW make a shorter list) that haven't yet made it into the body of the article? That will work as a motivation to work on shortening the list by getting that content into the article. Right now the deletion of critical sources pleases one group here and violates NPOV and weight. Until then, at least keep the existing link. -- Fyslee / talk 14:22, 21 August 2008 (UTC)

(outdent) I'm having trouble following the above comment, as its phrase "The list I linked to above wasn't very long" points to a diff, not to a list; and it's a diff that doesn't mention external links. And when I look at one of the two versions compared in the diff, and examine its external links, I do see a very long list, with dozens of links organized into subsections and with fairly extensive commentary. This clearly runs afoul of WP:ELMAYBE.

I apologize for not knowing about the consensus earlier, and for deleting a long list of links without enough discussion, but the matter remains that the long list had serious problems and should not simply be reinstated. Even if we subtract the few links that have made it into the article, the resulting list would still be way too long, and worse, would be strongly partisan, as most of the links are strongly critical of chiropractic.

It would be reasonable to come up with a short list of links that has consensus. But short doesn't mean dozens. It doesn't even mean ten. It means a handful at most, preferably fewer. Having no external links (as in Noble gases) is just fine. Having one external link (as in Chiropractic or Genetics) is just fine. Having dozens of external links, with lots of commentary, is not so good.

With that in mind, can you propose a replacement for what is now in Chiropractic #External links? Eubulides (talk) 17:35, 21 August 2008 (UTC)

Recent edit by ScienceApologist

I reverted this edit by SA back to the consensus version. There has been much discussion about this section on the talk page, and any changes to it should be proposed here. I don't see that it is hard to understand in its present state. - DigitalC (talk) 23:10, 21 August 2008 (UTC)

Also please see #Antiscientific: suggested rewording 2, which contains comments by Levine2112 and by myself on that edit. Eubulides (talk) 23:13, 21 August 2008 (UTC)

Quotations within citations

This change introduced the following quote within a citation:

'Conclusion: The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%).'

This quote is slightly incorrect (it doesn't match the source), but more importantly it's not needed. It simply mimicks what is in the main text, which is this:

'A 2008 survey stated that 69% of DC chiropractors disagree with the categorization of chiropractic as CAM, with 27% having some preference for the term "integrated medicine."'

The quote in question is freely readable. This sort of style is not at all needed, and if used consistently would double the length of the article.

It is useful to include quotes at some times, if the source is not freely readable and the point is controversial or obscure. But this isn't one of those cases, so I reverted the change.

Come to think of it, perhaps the use of quote= could overcome our impasse over how to attribute words like "antiscientific" that are controversial to some editors here. Eubulides (talk) 19:30, 16 August 2008 (UTC)

It may be controversial to some editors but it is NOT controversial among reliable sources. We should edit according to the sources. Reference number nine has quotes that should be removed. The text should explain what type of ideas (pseudo-scientific) that are barriers to chiropractic and not in a footnote. QuackGuru 19:39, 16 August 2008 (UTC)

The part about ideas is still vague. Me thinks the reader will be left in the dark about the kind of ideas that are barriers to chiropractic. This should first be explained in the text and not in the footnote. QuackGuru 17:53, 17 August 2008 (UTC)

I don't see inappropiate vagueness here. The text accurately summarizes what the source says; the source gives one example, and the lead does too. The footnote doesn't give any more examples than the source does. (I think the quote in the footnote is unnecessary, but it's not a big deal either way.) This is the lead, after all: it's supposed to briefly summarize the source. The lead shouldn't go into a lot of detail. Eubulides (talk) 21:02, 18 August 2008 (UTC)

I know this is late, but the quote happens to be exact. It is a perfect reproduction of the conclusion, including the word "conclusion" itself. You can't follow the source more closely than quoting its conclusion. -- Fyslee / talk 20:23, 22 August 2008 (UTC)

Vaccination section must go

Chiropractic as a profession does not advocate against immunisation. This section does not belong in the article. --Surturz (talk) 12:31, 20 August 2008 (UTC)

There are surveys showing that a notable portion of chiropractors do not support immunisation. Do you have any refs that say otherwise? --—CynRN ^(Talk) 17:23, 20 August 2008 (UTC)

Chiropractic #Vaccination does not say that chiropractic as a profession advocates against immunization, so I don't understand the complaint. From what we've found there seems to be little dispute among reliable sources that vaccination remains controversial within the chiropractic community. If there are any reliable sources disagreeing with this, let's hear about them. Eubulides (talk) 17:35, 20 August 2008 (UTC)

So what? There are probably surveys that show a sizeable proportion of chiropractors don't support the Iraq war, but that doesn't mean we should mention the Iraq war in the article. It is irrelevant. The text itself says that anti-vaccination is a minority view. As such, inclusion of it smacks of chiropractic skeptics trying to push a POV. The section does not belong in the article, and a minority view of chiropractors does not warrant inclusion in the lead. --Surturz (talk) 00:18, 21 August 2008 (UTC)

Chiropractors want to be primary care providers for all ages. A chiropractor's stance on vaccination is indeed very relevant to the health of the individual pediatric patient or the health of the community at large. Many chiropractors give seminars on the problems and dangers of vaccination and have websites or blogs against vaccination. According to a 2005 survey, a majority would not encourage their patients to be immunized. --—CynRN ^(Talk) 01:16, 21 August 2008 (UTC)

Err, that's just a slight majority and it was only polling chiropractic in Kansas. This is a pretty weak references to base this section on. Was this study published or cited anywhere significant? At the moment, I am inclined to agree with Surturz here. -- Levine2112 ^discuss 01:20, 21 August 2008 (UTC)

Chiropractic #Vaccination does not cite the abovementioned study. It cites Busse et al. 2005 (PMID 15965414) and Campbell et al. 2000 (PMID 10742364), both reliable sources on the topic, and both published in refereed medical journals. Other sources could also be cited on the topic if necessary, e.g., Russell et al. 2004 (PMID 15530683). We know of no reliable source significantly disagreeing with what's in Chiropractic #Vaccination now, but if you know of one, please let us know. Eubulides (talk) 01:43, 21 August 2008 (UTC)

Levine, I believe we discussed the Kansas study a while back in the talk pages. I was using it to make the point to Surturz that vaccination is indeed very controversial in chiropractic.--—CynRN ^(Talk) 02:00, 21 August 2008 (UTC)

All the same, this issue seems tangential to Chiropractic and would be more appropriate at Vaccine controversy. -- Levine2112 ^discuss 03:20, 21 August 2008 (UTC)

It is not tangential to Chiropractic, for reasons that CynRN mentioned. The issue is discussed in more detail in Vaccine controversy but is worth mentioning more-briefly here as well. The issue is covered in multiple reliable sources published in peer-reviewed journals, articles with chiropractic in the title; this hardly counts as tangential to chiropractic. Eubulides (talk) 04:39, 21 August 2008 (UTC)

I know this is OR, but type "Chiropractic Vaccination" into Google and you will find a lot of anti-chiropractic websites, a few anti-vaccination websites, but no chiropractic websites. The minority of anti-vaccination chiropractors are being used by anti-chiropractic lobbyists to promote 'skepticism' about chiropractic. In other words, inclusion of the minority anti-vaccination view in this article is POV pushing. 'Chiropractic skeptics' are using anti-vaccination as a straw man with which to condemn chiropractic. --Surturz (talk) 03:33, 21 August 2008 (UTC)

That's odd: I typed "Chiropractic vaccination" into Google and the very first page of search results pointed to this entry in a chiropractic blog and this entry in chiro.org, both counting as chiropractic websites opposing vaccination. No entries in the first page belonged to chiropractors favoring vaccination. I agree that this Google search is OR, but I disagree with the assertion about motivation; for example, two of the three authors of Busse et al. 2005 (PMID 15965414) are DCs and it makes little sense to accuse them of being anti-chiropractic lobbyists. Eubulides (talk) 04:39, 21 August 2008 (UTC)

(outdent)I'm using Google from Australia, that may explain the different hit results. I'm not saying the citations are anti-chiropractic, I'm saying that the inclusion of vaccination as a topic in this article at all is POV pushing, since only a minority of Chiropractors oppose vaccination. There is a minority of medical doctors that use acupuncture, but to say that acupuncture is part of the medical profession is just as incorrect as saying that anti-vaccination is part of chiropractic. --Surturz (talk) 05:03, 21 August 2008 (UTC)

It is true that only a minority of chiropractors oppose vaccination, but (turning it around) chiropractors are a significant force in antivaccination sentiment in the U.S. and Canada, and a much higher percentage of chiropractors oppose vaccination than do MDs or RNs or any other mainstream medical profession. This is so significant that several peer-reviewed papers have been published on the topic. Chiropractic does not say "anti-vaccination is part of chiropractic", or anything like that. Eubulides (talk) 09:05, 21 August 2008 (UTC)

Correlation is not causation. Opinion polls are hardly scientific, particularly when they are commissioned by a pro-vaccination group as the abstract suggests. That study only interviewed students at one point in time; the conclusion that chiropractic study increases anti-vaccination sentiment cannot be inferred from the data - the study did NOT measure the CHANGE in vaccination views as a result of studying. Chiropractic is becoming more scientific in recent times; one alternate explanation could be that more scientific-minded students are studying chiropractic, and that each new cohort of students is more pro-vaccination than preceding ones. I've got no problem with editors trying to 'debunk' chiropractic in the article, but please do it with science and facts, not with opinion polls and straw man arguments. --Surturz (talk) 00:43, 22 August 2008 (UTC)

Opinion polls can be scientific if the object of study is people's opinion, which is the case here. I don't know where you got the idea that the study was "commissioned by a pro-vaccination group". Chiropractic does not say that "chiropractic study increases anti-vaccination sentiment", or anything like it; it reports the study's results accurately. Your alternate explanation is sheer speculation and is not supported by any reliable source. Eubulides (talk) 08:58, 22 August 2008 (UTC)

Also, I highly doubt that anti-vaccination is taught as part of any chiropractic curriculum. If it were part of the chiropractic discipline, wouldn't it be taught as part of the course? The course outline here: [1] makes no mention of vaccination, for example. --Surturz (talk) 05:14, 21 August 2008 (UTC)

As Busse et al. 2008 (PMID 18674581) suggests, this is not a question of what's part of curricula; it's a question of how chiropractors believe and act. A relatively high percentage of them oppose vaccination and advise their patients to not vaccinate themselves or their children. It appears from Busse et al. 2008 that this antivaccinate sentiment is acquired by chiropractic students outside of formal lectures. Eubulides (talk) 09:05, 21 August 2008 (UTC)

So if anti-vaccination sentiment is acquired outside the course, how is this relevant to the article? Your arguments just prove that anti-vaccination is not part of the chiropractic profession. --Surturz (talk) 00:48, 22 August 2008 (UTC)

No, it only indicates that the course didn't teach them such sentiments. Outside the course they are learning it from other, more experienced and influential chiropractors, from chiropractic seminars and speakers, from chiropractic writings, and from the WCA, ICA, and ICA Council on Chiropractic Pediatrics. When they get their first jobs they may also encounter it and be influenced to share such sentiments with their patients, if for no other reason than by peer pressure from their boss and colleagues. Just take a look at all the chiropractic websites and books that express such sentiments. It's not rare and is definitely a part of the profession in one way or another. It is a very fundamental part of its history and the profession has been very delinquent in discouraging and getting rid of such sentiments. If you aren't aware of this, then I suggest you do some homework before you continue here. -- Fyslee / talk 01:44, 22 August 2008 (UTC)

If you know anything about chiropractic, you will know about the very influential Tedd Koren, who supplies the whole profession with literature, including anti-vaccination literature. He has just held a talk in NYC: "Childhood Vaccination: Questions all Parents Should Ask", Monday, August 11, 2008, 7-9 PM. It is based on his book of the same name. -- Fyslee / talk 01:52, 22 August 2008 (UTC)

Planet Chiropractic.com is also an influential website. Here are the links to their collection of anti-vaccination stuff.

• http://www.planetc1.com/search/index.php?search=vaccination
• http://www.planetc1.com/search/index.php?search=vaccines

We would be remiss if we forgot this classic:

• The Chiropractic Position On Vaccines - Tim O'Shea, D.C.

Anti-vaccination sentiments are very alive and well in the profession. -- Fyslee / talk 02:02, 22 August 2008 (UTC)

"Sentiments" are nothing to do with the profession. Talk about 'sentiments' are political issues, and political issues have nothing to do with this article. Even though there is a sigificant group of chiropractors that are anti-vaccination, trying to extend that as a criticism against the whole profession is not right, when it is clear that vaccination issues are NOT taught as part of the course. This is not the forum to be campaigning against anti-vaccination chiropractors. I'm removing the text. --Surturz (talk) 04:02, 22 August 2008 (UTC)

It is clearly notable that a relatively large percentage of chiropractors opposes vaccination. We have several reliable sources on the subject, published in peer-reviewed journals. Chiropractic is political, as well as being medical, and politics are discussed in multiple places in the article, as they should be. Eubulides (talk) 08:58, 22 August 2008 (UTC)

This is the talk page. Discussion happens here. Your action in the article is clear vandalism. You have no consensus to do that. Please immediately restore the content or you will be reported for vandalism. -- Fyslee / talk 04:28, 22 August 2008 (UTC)

WP:AGF and WP:BRD. You are free to revert. Please do not report me for vandalism. --Surturz (talk) 05:04, 22 August 2008 (UTC)

It's fixed. Thanks for your cooperation. -- Fyslee / talk 05:31, 22 August 2008 (UTC)

In that case, would anyone object to me removing the repeated "vaccination is controversial" sentence from the lead. Since we all agree anti-vaccination is a minority view, can we all agree that it does not belong in the lead? --Surturz (talk) 10:04, 23 August 2008 (UTC)

I would agree that it doesn't belong in the lead. DigitalC (talk) 11:51, 23 August 2008 (UTC)

I don't see any repetition in the lead, unless you mean that the mention in the lead is a repetition of mention in the body of the article. Well, that happens to be the function of the WP:LEAD. The lead must not contain any content not dealt with in the body of the article. Any subject notable enough to have its own heading certainly deserves mention in the lead, if we are to fulfill the requirements of the LEAD guideline, which requires we shortly summarize the whole article. A five word sentence isn't too large a mention. It would be hard to make it shorter than that ;-)

Thanks for discussing this here before making such an edit. We always need input from a number of editors before making any potentially controversial changes on this article, so such a discussion should be allowed to lay here for some time (more than a few hours) before taking action. It's a minefield and we don't want any more edit wars. WP:BRD is bad news here. We try to build a broad consensus before making such edits. I see you just made an undiscussed deletion from the article. Please self-revert. -- Fyslee / talk 16:12, 23 August 2008 (UTC)

Vaccination, subluxation and its alleged effects on internal health, vitalistic approach and other controversial elements should be dealt with in its own section. As it stands now, there is a disproportionate amount of text and weight given to 'controversial' i.e. non-mainstream elements of chiropractic. I agree that the vaccination section seems to weak of WP:POINT in its current length and placement (it should not 'close' the article). Also, where does the rest of the profession, globally stand on the issue? Nevertheless, it should stay in the article somewhere but it could easily be rewritten to accomodate concerns by editors. Soyuz113 (talk) 16:48, 23 August 2008 (UTC)

Suggested improvements are always welcome - and there is certainly always room for improvement! Try making them here (functioning refs and all) and we can discuss and refine them, then include them when we have a consensus. That way we can avoid disruptions and edit wars. Let's hammer it out and make this article better. I have always hoped to see this article become the best article on the subject ever written. Most articles on chiropractic are written from one or another POV, for or against, etc., which is fine and legitimate on other websites, but here we aspire to do much more, including all significant POV and historical points of interest. So far we're moving forward and any good suggestions are appreciated. We are all sitting at the same editing table, so to speak, so welcome to the table! -- Fyslee / talk 16:59, 23 August 2008 (UTC)

Antiscientific: suggested wording of sentence

Suggested wording: "Evidence-based guidelines" are supported by one end of an ideological continuum among chiropractors; the other end employs a priori assertions without scientific substantiation in what commentators about chiropractic describe as an "antiscientific" stand." Please comment. ☺ Coppertwig (talk) 02:15, 5 August 2008 (UTC)

That sounds very good. Speaking of a priori assertions, here's an interesting critical comment about them:

• “The whole concept of Innate of course rests on accepting on faith the basic premises without hope of any concrete proof. From a strictly scientific viewpoint, Innate must be rejected out of hand because it fails the most fundamental requirement of science, namely testability. From the standpoint of logic, the whole concept of Innate depends on the logical fallacy called word magic. Giving names and definitions to unprovable spiritual entities like Innate and soul cannot guarantee their existence.”
• From: Subluxation – the silent killer - Ronald Carter, DC, MA, Past President, Canadian Chiropractic Association, quoting from: Wardwell W. Chiropractic: History and Evolution of a New Profession. St. Louis: Mosby Year Book, 1992:29.

While that quote doesn't use the exact term "unscientific", it comes as close as is possible and certainly describes it. -- Fyslee / talk 06:28, 5 August 2008 (UTC)

Thanks. Ah: "unscientific", yes, I agree that that quote is saying that. But not what I would call "antiscientific". "Unscientific" to me means scientific reasoning is not being used. "Antiscientific" to me means they believe scientific reasoning should not be used: it may be a much smaller fringe who believe that. And I'm not sure I agree with the first sentence of the quote. You might as well say "The use of the word 'instinct' implies that scientific proof will not be used, therefore behavioural psychologists are unscientific;" that would be false, in my opinion. ☺ Coppertwig (talk) 12:05, 5 August 2008 (UTC)

Ugh! My bad. Of course unscientific and antiscientific aren't the same thing. I just lost track of the exact thread here. Consider it just another bit of information. "Unscientific" is a word that would be supported by far more RS. -- Fyslee / talk 13:44, 5 August 2008 (UTC)

That was 1992. We shouldn't confuse the lack of RCTs as being unscientific. Case studies were used a lot in those days and were acceptable first steps in the scientific process even in medicine in the previous decades. That eventually led to scholarly interest in spinal manipulation and then the subsequent RCTs which have been extensive since. So what is unscientific or antiscientific about that? The next step is to design studies to address the next hypothesis that spinal dysfunction can cause other health issues. This is more difficult, of course, and expensive, but they in the works now that the financing is coming (slowly). What is unscientific or antiscientific about that? The only thing that the "other end" of chiropractic has done is identify that there are flaws in studies that do not consider all the variables that are involved in any vital system, or should I say complex emergent system. I think that is called skepticism. I suppose there are those that believe that there is some sort of Intelligent Design involved, but that is not limited to chiropractors, nor is it an anti-intellectual position to hold, or anti-science (though unscientific might apply?). Keating: "We would not reject psychiatry as science on the grounds that Freud's theories of anxiety, repression, or the unconscious have not been adequately tested. We do not reject the meaningfulness of a science of medicine on the grounds that most medical procedures have not been experimentally validated. Nor should we apply such standards to chiropractic as a determiner of its scientific viability." -- Dēmatt (chat) 15:56, 5 August 2008 (UTC)

I don't think the lack of RCTs is the major issue here. You'll have to take up your dispute with Carter and the other chiropractors mentioned in the article, who in 1992 (and already much earlier), based on the current data at the time and the obvious pseudoscientific nature of some traditional metaphysical chiropractic beliefs ((IOW evidence wasn't an issue and basically could (almost...;-) never be an issue in such cases)), were already criticizing the profession for not listening to the existing evidence and not attempting to catch up with it. Osteopathy had done that many years before, but chiropractic hadn't done it at the time, and still hasn't (unlike Osteopathic medicine) officially distanced itself from those original foundational beliefs. What is happening is a gradual slide towards science, but done in such a manner as to not wake too much notice. It would be damaging for the profession to openly admit it had been based on a fictive belief, and had been warned for a long time, but hadn't heeded the warnings. It's as if there is a hope that mainstream medicine won't notice the history, and will just accept a newer version "scientific" of chiropractic, without the majority of older (and younger) chiropractors being forced to give up their old beliefs. Division is seen as harmful to the profession. Maybe when enough of the old guard are gone from their leadership positions it will happen, but I really doubt it. -- Fyslee / talk 20:25, 5 August 2008 (UTC)

I don't think the lack of RCTs is the major issue here. I guess your right, otherwise half of medicine would be called pseudoscience. I think that is really the point here afterall; that mainstream is slowly moving toward chiropractic just as chiropractic is moving toward a more scientific explanation of what they do. The issue is whether chiropractic is a safe and effective way to treat patients as compared to the alternative which would be drugs or surgery. The super straights are definitely being dragged into mainstream, but they don't seem to want to give up their beliefs. The question is whether they have to (or should)? I guess that is why we need to make sure to remain NPOV. We need to make sure both (all) POVs are stated fairly without taking sides. If one side uses pejoratives, that is their choice, but wikipedians should recognize it as just that. We should explain that POV without the pejoratives. It's not that hard. If I wanted to call someone a "bastard", I could probably convince more to my side if I said that that person "stole my wife". Then he could either call me a "dick" or explain that I "wasn't paying attention to her." Then the reader could decide for themselves by wieght of the arguments. -- Dēmatt (chat) 15:33, 6 August 2008 (UTC)

Coppertwig, do any of the sources explicitly draw a relationship between Evidence based guidelines and the use of antiscientific reasoning. I have been looking and can't put the two together, I find that both sides have guidelines, but they disagree with each other. This is the web site for one side CCGPP and this is a powerpoint review of the straight's guideline process CCP. They both look reasonable. Keating's antiscience comment was made from the CCGPP group talking about the CCP group. -- Dēmatt (chat) 16:16, 5 August 2008 (UTC)

No, I didn't see any of the sources mentioning evidence-based guidelines in that context. I didn't write the first half of the sentence: I just copied what was there. Maybe the first half of the sentence needs to be reworded. The quotes I collected were focussed on the second half of the sentence and the "antiscientific" idea. Now we need to collect quotes about the scientific end. ☺ Coppertwig (talk) 12:48, 8 August 2008 (UTC)

That sounds reasonable. Yes, I think your version is an improvement over what is in there now. I still want to look at the EBM part of that sentence and then want to look at the "antiscientists" POV. -- Dēmatt (chat) 13:13, 8 August 2008 (UTC)

Thanks, Dematt. Well, if I'm subtracting correctly it's been over 3 days, and no one has objected ^{(17:14, 9 August 2008 (UTC))} to replacing what's there now with my suggestion at the top of this section, so I'm going ahead. We can continue to work on improving it; I think this version is better and meets the objection that it wasn't only Keating that said something like that. ☺ Coppertwig (talk) 13:20, 8 August 2008 (UTC)

There was an objection.[2] The current text has been watered down even more and it is hard to understand. The prior version only had the misleading text about only one researcher. The new text is worse. QuackGuru 17:54, 8 August 2008 (UTC)

Dear QuackGuru, I apologize for saying there was no objection and have struck out some of my words. I knew you didn't like the new text, but I also knew you didn't like the prior version. I'm sorry that I didn't understand that you thought the new text was worse. Thank you for your patience and calm manner in correcting my error. Here's another suggestion; I'm not sure if some aspects of this version have already been objected to by other editors or not; I welcome comments: ""Evidence-based guidelines" are supported by one end of an ideological continuum among chiropractors; the other end uses what chiropractic commentators describe as unsubstantiated claims and "antiscientific" reasoning." ☺ Coppertwig (talk) 17:14, 9 August 2008 (UTC)

We are discussing this matter.[3] The problems with the current text is worse than the previous text. The above proposal is readable. Here is a quick suggestion. Revert back to the previous version and focus only on improving the misleading part claiming it was only Keating. Just rewrite the Keating part and not the entire sentence. There is one thing missing from all of theses proposals by Coppertwig. There is the middle of the spectrum. QuackGuru 17:30, 9 August 2008 (UTC)

Thank you, QuackGuru. I had essentially done what you just suggested, though without actually reverting the article: I had gone back to the previous version and modified it to get the suggestion above. It seems to me that you're indicating that that last suggestion is better than the current or previous version. We need to wait for comments from others before putting it into the article; meanwhile feel free to suggest other versions. OK, maybe we need to say something about the middle. Do we have enough quotes from sources for that? Would you like to suggest some words about the middle? Also, the "evidence-based" end still needs work. ☺ Coppertwig (talk) 18:37, 9 August 2008 (UTC)

Here's a version; I think the only problem is that the sentence is now too long! "An idealogical continuum among chiropractors stretches from support for "evidence-based guidelines" at one end, through such principles as vitalism, holism and rationalism, to the use of what chiropractic commentators describe as unsubstantiated claims and "antiscientific" reasoning: a system of belief which commentators have called "ethically suspect" when practitioners' beliefs are to patients' detriment." ☺ Coppertwig (talk) 22:40, 10 August 2008 (UTC)

All this attribution is making the sentence longer. It would be easier to read if we left out the attribution. The reference is the attribtution anyhow. I don't understand the reason for having the quote marks. The text is verified. I think we can remove the quote marks. QuackGuru 02:44, 11 August 2008 (UTC)

Characterizing a subset of chiropractors as "antiscientific" sounds like an opinion to me, not a fact. If it's a fact, then it's not just a word, but something about the real world that can be expressed in different words. What do you think it means? Perhaps it could be stated, without prose attribution, in different terms which would seem to have a NPOV tone. I think "antiscientific" has multiple meanings, some of which are not accurate descriptions of the subset of chiropractors being talked about. ☺ Coppertwig (talk) 23:13, 13 August 2008 (UTC)

"Antiscientific" is the most common word used by reliable sources to refer to this phenomenon; we shouldn't shy away from the word, or insist on putting it in quote marks, simply because some Wikipedia editors think it's unpleasant. In Chiropractic the word "antiscientific" has its usual meaning, as described in Antiscientific: it describes a position that is critical of science and the scientific method. What other meanings did you have in mind? Eubulides (talk) 18:37, 14 August 2008 (UTC)

I thought Gleng had referred to more than one definition. In any case, if we can establish that chiropractors from that end of the spectrum refer to themselves as "antiscientific", then it can be considered NPOV terminology; otherwise, it's an opinion expressed by outside commentators.

Here's a suggested version with shorter sentences: "Chiropractic ideology stretches along a continuum. At one end is support for "evidence-based guidelines". Many types of principles, such as holism and naturalism, are found in the middle of the spectrum. The other end uses what chiropractic commentators describe as antiscientific reasoning and unsubstantiated claims; commentators have called this system of belief "ethically suspect" when practitioners' beliefs are to patients' detriment." ☺ Coppertwig (talk) 02:41, 15 August 2008 (UTC)

• It is bizarre to quote a phrase like "evidence-based guidelines". What's next? Why not quote "profession" and "diagnosis" while we're at it? Why not put quote marks into Chiropractic's lead sentence so that it ends up something like the following?

Chiropractic is a health care "profession" that focuses on "diagnosis", "treatment", and "prevention" of mechanical "disorders" of the musculoskeletal system and their "effects" on the nervous system and "general health", with special "emphasis" on the spine.

These questions are not entirely rhetorical: I fail to see any rhyme or reason to the overquoting being proposed. If the rule really is "If some editor thinks someone disagrees with a claim, then put the claim in quote marks." then large chunks of Chiropractic will eventually be quoted, which is silly. If the rule is something else, then I honestly don't know what it is.

• It is not at all necessary to 'establish that chiropractors from that end of the spectrum refer to themselves as "antiscientific"'. It is not our job to worry about the sensibility of fringe practitioners. It is not the job of someone proposing text to prove that it's NPOV; if that were the case, no text could ever be added to Wikipedia.
• All that is necessary is to use terminology used by reliable mainstream consensus sources. "Antiscientific" and "evidence-based guidelines" and "ethically suspect" are part of the mainstream consensus, and Chiropractic is inaccurately presenting the consensus when it puts quote marks around those phrases, just as it would be inaccurate if Chiropractic quoted terms like "profession" and "diagnosis" in the lead sentence.
• To get to the suggested wording: like Chiropractic, that version suffers from the problem that it incorrectly suggests that holism and naturalism are common in the middle of the spectrum but rare at the ends. On the contrary, holism is shared by most chiropractors of all persuasion.
• Furthermore, holism and naturalism are not that relevant in the context of the sentence, which is talking about evidence-based guidelines, their opponents, and proponents. (The current wording also shares this problem.)
• Furthermore, the proposed wording fits even worse into the context, which is talking about evidence-based medicine and guidelines.
• Furthermore, like the current wording, the suggested wording incorrectly talks about "a system of belief". The sources don't say that antiscientific reasoning and unsubstantiated claims are "a system of belief". They say that Palmer's Postulates are a system of belief, but that's quite a different thing.
• Furthermore, like the current wording, the suggested wording talks about "when practitioners' beliefs are to patients' detriment", which doesn't accurately summarize what the source actually says (namely, "when they allow the practitioner to maintain a 'faith, confidence and belief' in that paradigm to the patient's ultimate detriment").
• In short, the recent rewording has made this passage substantially worse: it has caused the passage to stray from the sources, and has introduced material that doesn't belong in a section on evidence basis.
• With all the above in mind, I suggest the following wording instead:

Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end employs antiscientific reasoning and unsubstantiated claims, tactics which are ethically suspect when they let practitioners maintain their beliefs to patients' detriment.

Eubulides (talk) 09:27, 15 August 2008 (UTC)

Whether it is fact or opinion is rather irrelevant. We include both as long as they are well-sourced. Unless it is basic and incontrovertible common knowledge, it needs attribution since Wikipedia is not about truth, but about well-sourced facts and opinions. -- Fyslee / talk 06:37, 15 August 2008 (UTC)

I agree that opinions and facts need sourcing; I disagree that the use of terms like "antiscientific" or "ethically suspect" requires quote marks or in-text attributions when the opinions containing those terms are not controversial (which they are not, among reliable sources). Eubulides (talk) 09:27, 15 August 2008 (UTC)

I don't like seeing too many individual words being in quotes. I'd rather see the whole sentence or sentences, which we can do under fair use, and we do all the time here at Wikipedia. There is no rule against it if done properly. We can sometimes abbreviate the quotes by ..... out the superfluous parts, leaving only the point we are trying to bring out in that section.

There are at least two reasons for using the quotes, one of which is reasonable, and the other a compromise because of editorial disputes if we don't. NPOV demands that we ensure that readers don't mistake what is written for editorial opinion. It must be clear it is the opinion of a source. That's not necessary when it's incontrovertible common knowledge. Unfortunately chiropractic patients, many chiropractors, and certain editors here consider obvious facts (to the mainstream) to be controversial, so we need to do it for them. This is also educational. That compromise also helps to defuse edit wars. Yes, it's a compromise, but the article needs to be written "from" all POV, and "to" all POV. Such a compromise won't hurt anything. -- Fyslee / talk 20:06, 15 August 2008 (UTC)

If the sources are using the Wikipedia definition of "antiscientific", then we can paraphrase it: "the other end is critical of science and the scientific method".

Here's an argument that "antiscientific" is not neutral in tone: One test for whether something is neutral in tone is whether it's used by people on both sides of a controversy. I argue that it's rare or nonexistent for anyone to characterize their own position as "antiscientific", and to support that: "unscientific" has 50 times as many Google hits as "antiscientific", but the two-word combination "our unscientific" has about 2000 times as many Google hits as "our antiscientific", and the 4 hits for the latter are all things like "our antiscientific opponents", i.e. are not about people calling their own views antiscientific. Similarly, "unsubstantiated claims" is not neutral in tone. I can see someone saying "what I'm saying is not supported by scientific evidence," but not likely "I'm making an unsubstantiated claim". "Claim" is listed in WP:Words to avoid.

Putting quote marks around something can't be "inaccurate" if the phrase is a correct quote.

By the way, I support this edit which inserts a prose attribution elsewhere: good NPOV edit, Eubulides. For the continuum sentence we're working on: actually, I'm OK with leaving off the quotation marks as such, as long as the prose attributions are there (e.g. "what commentators describe as..."). Again: NPOV requires a neutral tone, and that Wikipedia doesn't assert opinions.

I suggest the following, which I think addresses some of Eubulides' points: Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end uses what chiropractic commentators describe as unsubstantiated claims and antiscientific reasoning, which commentators have called "ethically suspect when they allow the practitioner to maintain a 'faith, confidence and belief' in that paradigm to the patient's ultimate detriment"." Or alternatively, "Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end uses what chiropractic commentators describe as unsubstantiated claims and antiscientific reasoning, which commentators have called ethically suspect when they let practitioners maintain their beliefs to patients' detriment.", which includes wording you had put in, Eubulides, for the ethics part, although I added prose attribution. ☺ Coppertwig (talk) 03:30, 16 August 2008 (UTC)

Let me start with a preliminary comment. Your closing wording seems pretty good, at least on a quick read through, and my further comments here should be taken as separate comments about your other remarks.

I feel that several straw men are being introduced.

• You write: "NPOV requires a neutral tone, and that Wikipedia doesn't assert opinions." Whatever it is you may mean, NPOV doesn't require that all content be neutral in tone. On the contrary. Yes, "'antiscientific' is not neutral in tone." So what? The tone of the authors should be preserved. We as editors should be neutral in our tone. We should not introduce our opinions and twistings of wordings to neutralize non-neutral sourced wordings. That would be improper editorializing. We should just be true to our sources. If we twist the POV wordings of our sources into something "neutral", we have violated NPOV by introducing editorial bias, IOW we are making "Wikipedia ... assert opinions." If we do that, why use sources? We use them to document that the precise opinions and wordings of the sources actually exist. It is not Wikipedia who is asserting an opinion, it is our sources.
• You also write: "it's rare or nonexistent for anyone to characterize their own position as "antiscientific"" Indeed. That would be expecting a near impossibility, which would be unusual and unreasonable. It's a straw man. We couldn't care less how they characterize "themselves" in this particular setting. We are documenting that critics say it, and that happens all the time. BUT...BUT, in this case chiropractic critics (so much for them not describing themselves as "antiscientific"! Wow! That's amazing) are actually doing that, which makes the case extremely strong. Chiropractors will brush off the accusations of outside critics as further evidence of an AMA conspiracy. It is much harder when it is chiropractic's leading historian, along with a chiropractic university president, a few professors, and some researchers, who are all saying it. THAT must not get lost in our furvor to NPOV everything by editiorially defusing the impact of what these chiropractors are saying about what is going on in their own profession.
• This reminds me of another similar situation, where accusations of quackery have been levelled at the profession since its inception, and promptly denied by the profession. Well, when the president of the American Chiropractic Association tried to claim that such claims were a myth, Keating immediately wrote a heated letter to the editor, in which he directly addressed the deception being perpetrated by the president: "The so-called "quackery myth about chiropractic" is no myth. If anyone doubts the continuity of quackery in the profession, he has only to turn to pages 31 and 35 of the same issue of Dynamic Chiropractic." and "It escapes me entirely how Dr. Downing, the ACA, MPI, and Dynamic Chiropractic can suggest that there is no quackery in chiropractic. Either these groups and individuals do not read the chiropractic literature or have no crap-detectors. I urge a reconsideration of advertising and promotion policies in chiropractic."[4] Note that Keating uses Jarvis of the National Council Against Health Fraud (NCAHF) as a source, since he knew that the NCAHF and Jarvis (it's then-president) were (and are) highly recognized experts on the subject of quackery, and they were correct about chiropractic. Chiropractic was (and is, IMO) filled with quackery. Keating was eulogized with these words: "Keating never varied in championing the good, ridiculing the quackery, and in urging us to explore and empirically test chiropractic."[5]

(Note that these are RS and can be used.) Other sources on this subject: [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]

BTW, I have used wiki indents instead of your "br" breaks, since this makes it easier to find line breaks, at least for me. I hope you don't mind. It shouldn't make any visible difference.

Please remember that my remarks aren't about your final wording. That would take more study by me before I'd give a final opinion on them. -- Fyslee / talk 07:13, 16 August 2008 (UTC)

It's fine if the word "antiscientific" is there, tone and all, as long as it's with prose attribution. If it were there as a direct Wikipedian assertion, that's when the tone would be a problem. WP:NPOV#Impartial tone says "The tone of Wikipedia articles should be impartial, neither endorsing nor rejecting a particular point of view." With an earlier version that baldly stated that one end of the spectrum was "antiscientific", I found it jarring: I would be reading along, thinking, yes, this sounds like a normal Wikipedia article, and then suddenly, "Hey, what's this doing here? This doesn't sound like Wikipedian tone at all. This sounds like something that's just been added and hasn't been reverted out yet." It's not a disagreement with what's being claimed, only with the way it's stated. Similarly, the word "quackery" is non-neutral in tone. If it's proven or admitted that someone knowingly made false claims, a Wikipedia article can state that the person "knowingly made false claims", but not, in my opinion, that they engaged in "quackery" (without prose attribution) even if it means the same thing: the word "quackery" is generally used only by critics. OK, I'll use indents in preference to line breaks. ☺ Coppertwig (talk) 12:28, 16 August 2008 (UTC)

I think we are basically in agreement. Readers shouldn't be in doubt about who says what, especially about controversial or strong wordings. In this case, we have leading chiropractors and leaders criticizing what they see going on in their own profession. They admit the outside critics are correct and they want to clean chiropractic up and make it acceptable. They know that this type of behavior, which is very traditional, needs to stop. Only then will they be able to get the cultural authority they desire. Another leader who makes the same points is Carter, a former president of the Canadian Chiropractic Association, who replies to a common claim "Subluxation – the silent killer", by showing how claims[18][19] about vertebral subluxations are killing the profession. Of course he is siding with Keating who describes how damaging "chiropractic gobbledygook", "shenanigans", and "outrageous claims" [20] are for the profession. (More RS...!) -- Fyslee / talk 15:09, 16 August 2008 (UTC)

(Handshake.) ☺ Coppertwig (talk) 15:47, 16 August 2008 (UTC)

Antiscientific: suggested rewording 2

Coppertwig's last proposal:

Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end uses what chiropractic commentators describe as unsubstantiated claims and antiscientific reasoning, which commentators have called ethically suspect when they let practitioners maintain their beliefs to patients' detriment.

still has problems.

• It says "commentators" twice, which is overkill.
• In the context where someone is saying something, "commentator" is an empty word. It is the same as saying "someone". It would be better to reword the sentence to avoid this empty word.
• The phrase "chiropractic commentators" isn't accurate, as not all the "commentators" in question are chiropractors. Notably, Keating himself was not a chiropractor. Other non-chiropractor "commentators" have made similar points, e.g., Cooper & McKee 2005 (PMID 12669653), or Giordano in Giordano & Keating 2005 (doi:10.1016/j.jmpt.2004.12.018).
• Perhaps the phrase "chiropractic commentators" was intended to mean "commentators on chiropractic" rather than "commentators who are chiropractors"? If so, the phrase is still empty: in the context of someone making comments it still just means "someone". Either way, the phrase is ambiguous, which is to be avoided.
• Here is a proposed rewrite that addresses the above issues, while (I hope) still addressing the issue of not making the opinion seem to be that of the Wikipedia editors.

Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end uses what are considered unsubstantiated claims and antiscientific reasoning which are ethically suspect when they let practitioners maintain their beliefs to patients' detriment.

Eubulides (talk) 07:28, 17 August 2008 (UTC)

No comment, so I installed that rewrite. Eubulides (talk) 21:32, 21 August 2008 (UTC)

Silence does not imply consent. This version you installed is flawed because it lacks necessary attribution. Please wait for some consensus before re-installation. -- Levine2112 ^discuss 21:52, 21 August 2008 (UTC)

As an outsider, I think ScienceApologist may have offered the clearest suggestion thus far. [21] -- Levine2112 ^discuss 22:24, 21 August 2008 (UTC)

No, unfortunately, the combined pair of edits introduced several problems.

• It duplicates the phrase about "ethically suspect". Surely this is not intended.
• It removes the clear connection about the "ethically suspect" phrase, and the source that supports it (Nelson et al. 2005, PMID 16000175). Surely this is not intended either.
• It introduced the word "detractors" without making it clear that the "detractors" in question are criticizing straight chiropractic dogma, not chiropractic in general. (Almost all the "detractors" are chiropractors.)
• It introduced the phrase "Critics have described guidelines that are not evidence-based as being ethically suspect" but the source does not talk about "guidelines that are not evidence-based", it talks about "stratagems to avoid the truth that Palmer's Postulates are unproven", which is quite a different thing.
• It introduces the phrase "run the risk", but the source doesn't talk about risk in this context.
• The version I suggested does have the necessary attribution. It cites its sources. And as a concession to the Simon-says style, preferred by some editors here, it has an "are considered" phrase to make it clear that we are talking about the sources' opinion, not Wikipedia's opinion.
• Given the above problems, some of which are serious mischaracterization of the sources, I again suggest the phrasing proposed above; it does not suffer from those problems. If there's some way that the phrasing is unclear, which is what ScienceApologist seemed to be suggesting in the change log, it would be helpful if it could be explained why it's unclear.

Eubulides (talk) 22:42, 21 August 2008 (UTC)

I agree that SA's edit made the text no longer match the source. However, I believe that "chiropractic commentators" should be put back in. I don't see this as being vague, I see it as clearly describing people who are commenting about chiropractic. - DigitalC (talk) 23:25, 21 August 2008 (UTC)

Thanks for your comment. If your interpretation is correct, then the phrase is empty; for example, "what chiropractic commentators describe as [something about chiropractic]" means "what people who are saying something about chiropractic say is [something about chiropractic]". Also, putting that same empty phrase twice in the same sentence is overkill, surely. Eubulides (talk) 23:46, 21 August 2008 (UTC)

I think that if we changed "commentators" to "critics", this may solve the issue - though I don't think this is that big of a deal. -- Levine2112 ^discuss 23:50, 21 August 2008 (UTC)

Critics is original research. QuackGuru 23:59, 21 August 2008 (UTC)

I don't think it needs to be included twice. However, some form of attribution is necessary to determine WHO considers it unsubstantiated claims. - DigitalC (talk) 00:27, 22 August 2008 (UTC)

Agreed. -- Levine2112 ^discuss 00:28, 22 August 2008 (UTC)

The Simon-says style is problematic unless you know who the Simon is that is saying something. Better to follow something like WP:ASF. The term "anti-science" is a bit novel, implying, according to our page on on the subject, both non-scientific ideas and direct opposition to scientific ideas. Why not simply say this? Guidelinese which are not evidence-based are neither based upon science and oppose scientific ideas. If this isn't what the reader is supposed to get out of this sentence, then what is it?

The nonsense about chiropractic commentators has to go. It is a meaningless phrase. My idea for phrasing would be to say something along the lines of what non-evidence based chiropractic guidelines are (in relation to scientific evidence, for example) and what the risks associated with those guidelines are. Please just state the facts plainly and clearly. Try to avoid WP:FRINGE#Particular attribution.

ScienceApologist (talk) 15:31, 22 August 2008 (UTC)

• I agree about "chiropractic commentators" of course. The current wording is "chiropractic researchers", which isn't that much better and in some sense is worse. Wikipedia is not supposed to say "researchers say".
• The original sources say "antiscience". If we were to expand this into a discussion of nonscientific ideas and direct opposition to scientific ideas, we'd be going beyond what the sources all say. If we focus on what just one source says (Keating, say) then we'd leave the impression that only Keating thinks that way. If we focused on what Keating said and then mentioned lots of other sources that agree, it'd get pretty long, but I suppose we could do it that way if there is consensus. (Consensus on this page! Hah!)
• Talking about chiropractic guidelines would be reasonable. Here is a proposal to do that: append the following wording to the lead paragraph of Chiropractic #Evidence basis:

Assessments of three major chiropractic treatment guidelines found that the Mercy guidelines (1993) are mostly valid but rely on dated scientific studies, that the 1998 version of the Council on Chiropractic Practice guidelines fail to address scientific evidence objectively, and that the International Chiropractors Association guidelines (2000) conflict with scientific evidence; the latter two guidelines were assessed as not suitable for use in clinical practice.

Eubulides (talk) 18:46, 22 August 2008 (UTC)

Two problems: "are considered" sounds a little too strong to me, as if everyone considers it; and the ethics part seems to being asserted without prose attribution.

Two more suggestions, trying to take your points into consideration:

"Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end uses what researchers about chiropractic describe as unsubstantiated claims and antiscientific reasoning, and have called ethically suspect when they let practitioners maintain their beliefs to patients' detriment."

"Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end uses what are described as unsubstantiated claims and antiscientific reasoning and have been characterized as ethically suspect when they let practitioners maintain their beliefs to patients' detriment."

I'm OK with putting in stuff about the middle of the spectrum. I oppose the use of words like "strategy" or "tactic" without prose attribution in connection with the ethics here (and I'm not sure the source used these words anyway); these words seem to imply that people are purposely believing things in order to achieve some goal, and therefore are not NPOV here since that's not a verifiable fact.

In any case, QuackGuru, please don't put in statements about ethics without prose attribution: it's a violation of NPOV. Wikipedia doesn't make assertions about what is or is not ethical. ☺ Coppertwig (talk)

The source (which you can follow; it's freely readable) says "strategem". If we're going to use prose attribution, which is what your proposals above are using, then we should use the words used by the source rather than watering them down. So I propose the following wording instead, based on your second suggestion:

"Evidence-based guidelines are supported by one end of an ideological continuum among chiropractors; the other end uses what are described both as unsubstantiated claims and antiscientific reasoning, and as stratagems that are ethically suspect when they let practitioners maintain their beliefs to patients' detriment."

Eubulides (talk) 09:33, 24 August 2008 (UTC)

That sounds excellent. When in doubt, quote the source. -- Fyslee / talk 17:41, 24 August 2008 (UTC)

Eubulides, you write above: "I agree about "chiropractic commentators" of course. The current wording is "chiropractic researchers", which isn't that much better and in some sense is worse. Wikipedia is not supposed to say "researchers say"." I'm not sure what you mean. "Chiropractic commentators" can mean anybody, including non-chiropractors, and is thus too vague. My substitution, "chiropractic researchers", describes the authors of the research. That's pretty neutral and is specific attribution, IOW it states they are from within the profession in one way or the other. (Keating wasn't himself a chiropractor, but a professor and its foremost historian.) When describing criticisms, it is especially important to state just who is doing it, hence my substitution. That substitution isn't a general "researchers say" (for lack of anything better to say), but is specific attribution and thus a desirable wording in this case. If that weren't the case, your observations would be on target. -- Fyslee / talk 20:41, 22 August 2008 (UTC)

I don't think we've established that Keating was a chiropractor. ☺ Coppertwig (talk) 21:56, 22 August 2008 (UTC)

Oops! Of course you're right. The phrase, strictly speaking, doesn't have to mean that each of the performers of the research is a chiropractor, but that they are from the chiropractic side of the fence, so to speak. I'll revise the above to avoid further misunderstandings. Keating was never a chiropractor, but a chiropractic professor in several schools and the premier historian for the profession, holding several positions of trust and honor. I don't think we need to change that wording, unless you think it might be misunderstood. If so, we should tweak it. We could even use the reference text to state the positions of each author, which is a pretty prestigious list of notables in the profession. -- Fyslee / talk 01:12, 23 August 2008 (UTC)

"Chiropractic researchers" can easily be misunderstood to mean researchers who are chiropractors. But even if we reword it as "researchers into chiropractic", or something like that, it's still an empty phrase. Wikipedia should not use phrases like "researchers say" or "scientists say". Eubulides (talk) 09:33, 24 August 2008 (UTC)

Okay....then what should we say? We need an accurate and unambiguous form of attribution. How about:

"... what is considered by several notable researchers within the profession many chiropractic researchers to be..."? (Italics are the newer wording.)

That's very accurate and certainly unambiguous. The only way to get more specific without OR is to actually name them and their prominent positions (possibly as text in the ref). It's quite the list. I have communicated with more than one over the years and they're amazing people who are fighting an uphill battle. -- Fyslee / talk 17:41, 24 August 2008 (UTC)

(outdent) The problem with this wording, as with any wording like "chiropractic researchers" and "researchers into chiropractic", is that it makes it sound like only DC researchers, or researchers whose research topic is chiropractic, share the opinion that some chiropractors have antiscientific beliefs. But this is far from the case; it's a mainstream opinion, which is shared by many eminent researchers that fall into neither category, including Arthur Kornberg, Baruj Benacerraf, Cornelis de Jager, Eugenie Scott, Martin Gardner, Kendrick Frazier, Mario Bunge, Elie Shneour, and Antony Flew. See Kondro 1999 (PMID 10075565) and DeRobertis et al. 1999. Hence my proposal avoids the phrases in question. Eubulides (talk) 22:05, 25 August 2008 (UTC)

Holism bullet rewrite

There are some problems with the Holism bullet in Chiropractic #Philosophy:

• It contains words like "appreciates" and "recognizes" that convey approval of the chiropractic worldview; this runs afoul of WP:NPOV.
• It contains two direct quotes from the source, but doesn't put these quotes in quote marks. The quotes are "appreciates multifactorial nature of influences (structural, chemical, and psychological) on the nervous system" and "recognizing dynamics between lifestyle, environment, and health" (for the latter, the source says "recognizes" rather than "recognizing" but the difference is trivial).
• Its use of the word "treats" is confusing, as it can easily be misunderstood to be referring to treatment, as in medical treatment.
• It uses "patient", which WP:MEDMOS #Audience frowns on.

The two quotes are from a public-domain source, so it's legal to quote them without using quote marks, but it's not polite. Also, the quotes don't really fit that well in this context and they are too long; they can be compactly summarized instead. So I propose fixing the problem by replacing the holism bullet with the following:

• (See below for an updated proposal.) Holism assumes the individual is an integration of body, spirit, and mind, whose health is influenced by lifestyle and environment.

The phrase "integration of body, mind, and spirit" appears in the source. Eubulides (talk) 21:55, 18 August 2008 (UTC)

I think this is a REALLY bad change. I will have to look at sources, but that "integration of body, mind, and spirit" is certainly not NPOV. What we have in there currently is much better. If it can be reworded to remove the words which you feel are a problem, that is one thing, but completely changing the context is a separate matter. The wording that is in there now is along the lines of bio-psycho-social holism—which is a mainstream view. - DigitalC (talk) 23:28, 18 August 2008 (UTC)

While I acknowledge that PPC does use the phrase "integration of body, mind, and spirit", I still feel that this is not NPOV. Looking at [22], we see "We are not doctors for particular diseases, or particular organs, or particular stages in the life cycle — we are doctors for people. People are complex, and live in complex communities in a complex world. All aspects of this world have an impact on the health of the people in it." This is much closer to what holism in Chiropractic is about. - DigitalC (talk) 00:30, 19 August 2008 (UTC)

Fair enough, but Chiropractic #Philosophy already has a "patient-centered" bullet, which captures the doctors-for-people-not-diseases point. Also, that same source then goes on to talk about the "spiritual dimension", and how that's controversial, and many people prefer "existential". So how about this bullet instead?

• Holism assumes that health is affected by everything in people's complex environments; some sources also include a spiritual or existential dimension.

Eubulides (talk) 07:29, 19 August 2008 (UTC)

Much better. DigitalC (talk) 23:05, 20 August 2008 (UTC)

Thanks. No further comment, so I installed the edit. Eubulides (talk) 22:05, 25 August 2008 (UTC)

Outcome measures in chiropractic research

A new literature review on outcome measures in chiropractic research has been published (Khorsan et al. 2008 (PMID 18558278), and I propose that we briefly summarize it in Chiropractic #Effectiveness by replacing this:

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment.

with this:

The effectiveness of chiropractic treatment depends on the medical condition and the type of chiropractic treatment, and there is a wide range of ways to measure treatment outcomes.

Eubulides (talk) 22:48, 20 August 2008 (UTC)

That sounds pretty neutral and factual. Go for it. -- Fyslee / talk 05:21, 21 August 2008 (UTC)

Thanks. No further comment, so I did that. Eubulides (talk) 22:05, 25 August 2008 (UTC)

1st sentence of Schools of thought

The first sentence of Chiropractic #Schools of thought and practice styles is not about schools of thought or practice styles; it is merely a repetition of the previous section, and it is supported by a weak source (one that talks about early-20th-century surveys). Also, it's in the position where the reader would normally expect the topic sentence to be, but it's not about the topic of that section. Since it's weak, duplicative, out of place, and distracting, I suggest removing it, as follows:

Common themes to chiropractic care include holistic, conservative and non-medication approaches via manual therapy. Still, sSignificant differences exist amongst the practice styles, claims and beliefs between various chiropractors.

Eubulides (talk) 22:42, 21 August 2008 (UTC)

Since it comes from a historian, then perhaps we should word it in a historical context: Common themes to chiropractic care historically have included holistic, conservative and non-medication approaches via manual therapy. Just a first thought. -- Levine2112 ^discuss 02:21, 22 August 2008 (UTC)

Sorry, I'm lost; are you suggesting that the duplicative sentence be moved to Chiropractic #History? If so, where? If not, then I don't see how the changed wording addresses the problems of the sentence being weak, duplicative, out of place, and distracting. Eubulides (talk) 08:58, 22 August 2008 (UTC)

No further comment, so I installed the change. Eubulides (talk) 22:05, 25 August 2008 (UTC)

Last paragraph of Schools of thought

• The last paragraph of Chiropractic #Schools of thought and practice styles contains many claims not supported by the source. Most of these claims are about treatment modalities (e.g., applied kinesiology) that are merely examples, so there's no harm replacing them with the examples the source actually gives. Another option would be to add reliable sources for these claims, if someone can find them.
• A hard-to-find and obsolescent source (Coulehan 1985, PMID 2934224) is cited to support the claim that mixers are the majority, but this claim is easily supported by easy-to-find and more-up-to-date sources.
• The phrase "myriad" overstates the source.

I propose the following rewrite to fix the above problems. New text is in italics and deleted is struck out. The new version would have only the one citation at the end.

Mixer chiropractors "mix" diagnostic and treatment approaches from naturopathic, osteopathic, medical, and chiropractic viewpoints. Unlike straight chiropractors, mixers believe subluxation is one of many causes of disease, and they incorporate mainstream medical diagnostics and employ myriad many treatments including joint and soft tissue manipulation, electromodalities, physiotherapeutic modalities, exercise-rehabilitation conventional techniques of physical therapy such as exercise, massage, ice packs, and moist heat, along with nutritional supplements, acupuncture, homeopathy, herbal remedies, and biofeedback, and applied kinesiology. Mixers tend to be open to mainstream medicine, and are the majority group.

Eubulides (talk) 22:42, 21 August 2008 (UTC)

That looks pretty good. I'm not sure, but it might have been myself who added the AK part. It's not in the source, but is evident from the statistics of chiropractic techniques. We could leave it in and source it specifically, since it's a major technique. -- Fyslee / talk 19:59, 22 August 2008 (UTC)

I vote for leaving it in and sourcing it. Surveys indicate that over 40% of chiropractors use AK and that it's growing in prevalence. --—CynRN ^(Talk) 21:52, 22 August 2008 (UTC)

I think the % of chiros using the technique is less important then the number or % of patients who are being treated with it. Check this section here.[23]Anthon01 (talk) 18:41, 23 August 2008 (UTC)

The table gives us a pretty significant 13% for a technique (AK) that is considered pseudoscience at worst and suspect at best. It's notable. --—CynRN ^(Talk) 04:01, 24 August 2008 (UTC)

OK, thanks, I revised the proposal to mention AK and cite the source behind that table. Eubulides (talk) 09:33, 24 August 2008 (UTC)

Why are we mentioning AK and not SOT (which according to that table is used by more practitioners on more patients), or Activator technique or Cox or... While I agree with CynRN that AK is "pseudoscience at worst and suspect at best" I don't think we should give it more weight than other techniques used. As far as I understand, like other techniques listed in the table, AK has its own assessment protocol and treatment style and I see no reason to single AK out from that table. - DigitalC (talk) 11:01, 24 August 2008 (UTC)

I don't care one way or another; it's just an example. Any objections on the part of other editors to omitting AK here? Or perhaps suggest another wording? Eubulides (talk) 08:26, 25 August 2008 (UTC)

For now I have gone back to omitting AK from the proposal. Eubulides (talk) 22:05, 25 August 2008 (UTC)

Vague tag on "hampered by chiropractic philosophy"

This edit added a {{vague}} tag after "Serious research to test chiropractic theories did not begin until the 1970s, and was hampered by the chiropractic philosophy" and before "that sustained the profession in its long battle with organized medicine." One way to remove the vague tag would be to replace the phrase "chiropractic philosophy" with the same phrase used by the source, namely "anti-scientific and pseudo-scientific ideas". This would run afoul of other editors' desire to avoid saying "antiscientific" more than once. The word "pseudoscientfic" doesn't occur in Chiropractic, but just saying "pseudoscientific ideas" wouldn't accurately summarize the source. Any other suggestions for fixing the vagueness? Eubulides (talk) 21:32, 21 August 2008 (UTC)

Perhaps "vitalistic" or "holistic" would provide an adequate descriptor. -- Levine2112 ^discuss 22:26, 21 August 2008 (UTC)

"Holistic" would be an anachronism; "vitalistic" would be better but is still not right, as initially many medical doctors had vitalistic beliefs as well. As I understand it the essential point is that chiropractors obtained legal defense by saying that they had their own philosophy, which was not the same as the philosophy of medicine, and therefore they were not practicing medicine. Eubulides (talk) 22:42, 21 August 2008 (UTC)

The word "vitalistic" or "holistic" makes no sense. The current wording "chiropractic philosophy" is vague and also makes no sense. The words "anti-scientific and pseudo-scientific ideas" is NPOV and is faithful to the source. QuackGuru 00:26, 22 August 2008 (UTC)

"anti-scientific and pseudo-scientific ideas" is more vague. Which ideas are these referring to? Read the source. -- Levine2112 ^discuss 02:19, 22 August 2008 (UTC)

While it's "true" that vitalism is part of what has held the profession back, that would be OR and not following the source. There is really no good argument for not following the source. Just quote it. It's up to the readers to read the source and figure it out if they can. The source names one example, which we have also named, but beyond that we mustn't engage in OR. Just quote it accurately as the opinion of chiropractic researchers (who include university presidents, professors, etc.). We can't go wrong by following the source. -- Fyslee / talk 19:53, 22 August 2008 (UTC)

The words "anti-scientific and pseudo-scientific ideas" is a more detailed descriptor. QuackGuru 23:20, 24 August 2008 (UTC)

I fixed the vagueness and removed the tag. QuackGuru 01:49, 26 August 2008 (UTC)

It is non-controversial to fix vagueness in the article. QuackGuru 04:19, 26 August 2008 (UTC)

I agree that following the source is the safest way, but don't go making the edit and claim "consensus". Wait for more comments. If they aren't forthcoming in the next couple days, then do it. All this edit warring needs to stop. -- Fyslee / talk 05:18, 26 August 2008 (UTC)

Wait a second. This information was in the article for a while but Levine2112 removed it about a month ago. I restored the consensus version and Levine2112's suggestion does not follow the source. QuackGuru 05:22, 26 August 2008 (UTC)

QuackGuru's summary here is essentially correct, I'm afraid. That being said, it's OK to wait a bit for more comments. Eubulides (talk) 08:43, 26 August 2008 (UTC)

90% part of general SM research

I'm wondering how we can tweak this:

Most research has focused on spinal manipulation (SM) in general, rather than solely on chiropractic SM; chiropractors perform over 90% of all manipulative treatments in the U.S.

so it's clear that most SM research includes 90 or so percent chiropractic SM. My previous parenthesis wasn't the best way, although grammatically correct. Can we do it in a better manner?

Here's a suggestion:

Most research has focused on spinal manipulation (SM) in general, rather than solely on chiropractic SM. Since chiropractors perform over 90% of all manipulative treatments in the U.S., this research normally includes mostly chiropractic SM.

What think ye? -- Fyslee / talk 14:16, 22 August 2008 (UTC)

The claim is probably true, but it's not supported by the cited sources, so we can't word it that way. We would need a cited source that says 90% of SM research is on chiropractic SM and I doubt whether anyone has done a formal or informal study on that particular statistic. Eubulides (talk) 18:46, 22 August 2008 (UTC)

Maybe I'm missing your point, but don't we have descriptions of the available studies? As I recall, they specifically mention that chiropractors are major participants in those studies. Unless a study has specifically made it clear that this isn't the case (a large Dutch study used only PTs), then it's nearly always mostly chiropractic SM that makes up the bulk of the statistics in those studies. -- Fyslee / talk 20:13, 22 August 2008 (UTC)

Naysayers could claim OR in the claim that studies of SM include mostly chiropractors, but I am leaning toward Common Knowledge, so a study would not be needed. Some editors are going to say, however, that there are too many studies or reviews of same with PTs, MDs and osteopaths in the mix. Hmmm. --—CynRN ^(Talk) 22:08, 22 August 2008 (UTC)

Yes, naysayers and obstructionists will always pop up, but - to the best of my knowledge - there aren't many studies of SM that don't include mostly chiropractic SM and are exclusively performed by PTs, MDs, and DOs. That would usually give too small a base for a good study, of course depending on the study design. -- Fyslee / talk 01:35, 23 August 2008 (UTC)

Ugh... it will take me a long time to dig up the source on the internet if someone wants it, but IIRC, a large proportion of SM research is done by PTs, not DCs. There has been disucssion about this by Chiropractors in that (paraphrased)"PTs are owning the research field". I recall listening to a discussion between the authors of a paper that came out in Australia last year and authors of a clinical prediction rule, and I think that may be where this was discussed. Either way, without a source, I would say that it is definitely OR to say that most studies of SM include Chiropractors. Sorry to be the "naysayer" that CynRN predicted. I certainly wouldn't say that it is common knowledge, because I don't think it is even true. - DigitalC (talk) 06:36, 23 August 2008 (UTC)

You may be right about newer research produced by a mainstream profession. I'm referring to most of the research we have been citing, and to most of the previous research, but things are changing. If I'm wrong, I'm sure someone will correct me and we'll all be the wiser for it! -- Fyslee / talk 07:52, 23 August 2008 (UTC)

The research cited in Chiropractic #Evidence basis relies in large proportion on chiropractic data, but I agree with DigitalC that it would be OR to say that most studies of SM include chiropractors. Eubulides (talk) 09:33, 24 August 2008 (UTC)

I surrender. I guess we can't take the time to actually examine each single study here and actually quote the facts. That would take a huge amount of time that I'm not willing to invest in this subjec. Maybe my memory is tricking me, or the changing nature of the subject caused by the addition of some very recent and newer research I haven't noticed is making such a statement borderline and tipping the balance, but I don't think it's OR. Whatever the case, it's not worth fighting about. Let's move on. -- Fyslee / talk 17:41, 24 August 2008 (UTC)

The part about "chiropractors perform over 90% of all manipulative treatments in the U.S" is duplication and should be removed from the Evidence basis section. QuackGuru 22:41, 25 August 2008 (UTC)

I agree; it's redundant to give that fact twice. I suppose I could be talked into removing either copy, though I think it was fine the way it was, in Chiropractic #Treatment techniques. Eubulides (talk) 02:55, 26 August 2008 (UTC)

I removed the duplication but it got reverted without explanation. QuackGuru 04:21, 26 August 2008 (UTC)

I'm not sure, but maybe it got reverted because you made too many changes at one time (several times at that!), and the only way to save lots of grief and wasted time was for several editors to just revert your mass edits. Do your edits one at a time, and only when you are sure you have a solid consensus. The edit warring needs to stop, which is why I restored the last consensus version.-- Fyslee / talk 05:22, 26 August 2008 (UTC)

MANIPULATION AND COMPLICATIONS (CHIROPRACTORS/OSTEOPATHS/PT)

Here's an interesting source list I found here:

• Assendelft WJJ, Bouter LM, Knipschild PG 1996 Complications of spinal manipulation: A comprehensive review of the literature. J Family Practice 42: 475-480.
• DiFabio RP 1999 Manipulation of the cervical spine: risks and benefits. Phys Therapy 79: 50-65.
• Dvorak J, Orelli FV 1985 How dangerous is manipulation to the cervical spine? Case report and results of a survey. Manual Medicine 2: 1-4.
• Dvorak J, Valach L, Schmid S 1987 Injuries of the cervical spine in Switzerland. Orthopade 16: 2-12.
• Johnson K, Pasquarello G 2003 Position paper on osteopathic manipulation of the cervical spine. AAO Newsletter; http://www.academyofosteopathy.org
• Malone DG, Baldwin NG, Tomecek FJ, Boxell CM, Gaede SE, Covington CG, Kugler KK 2002 Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice. Neurosurg Focus 13(6)
• Patijn J 1991 Complications in manual medicine: a review of the literature. J Manual Med 6: 89-92
• Powell FC, Hanigan WC, Olivero SC 1993 A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery 33: 73-79
• Rothwell DM, Bondy SJ, Williams JI 2001 Chiropractic manipulation and stroke: a population-based case control study. Stroke 32: 1054-1060
• Rydell N, Raf L 1999 Spinal manipulation--treatment associated with a high risk of complications. Lakartidningen 96: 3536-3540.
• Shekelle PH, Phillips RB, Cherkin DC, Meeker WC 2001 Benefits and risks of spinal manipulation. Chapter XI (www.chiroweb.com/archives)
• Vick DA, McKay C, Zengerle CR 1996 The safety of manipulative treatment: a review of the literature from 1925-1993. JAOA 96: 113-115

Maybe we can use some of these. -- Fyslee / talk 04:03, 25 August 2008 (UTC)

Again, lets look at the age of these papers. Not one passes the cut-off proposed by Eubulides back when we were building the safety section. - DigitalC (talk) 07:22, 25 August 2008 (UTC)

I agree that these sources are too old, as is the di Fabio meta-analysis. The di Fabio work is cited by recent reviews that Chiropractic does cite (e.g., Miley et al. 2008), and that should suffice. Unless there's some reason to cite di Fabio in Chiropractic #History? But to do that we'd need a source commenting on di Fabio's historical importance. Eubulides (talk) 08:26, 25 August 2008 (UTC)

Have we inadvertently made a homegrown rule here, like Elonka's rules that have gotten her in such trouble? Each source should be examined and its useability be judged on an individual basis, regardless of age. It all depends on the topic matter. Old studies and results that are still legitimate are valid sources. Only when older studies have been superceded by newer studies that study and include the same statistics, and add to them, would it be legitimate to use the newer in lieu of the older. Lacking that, older studies can be added to newer ones which carry on from the older ones, but don't include them. Sources must be evaluated on their own merits, not some arbitrary rule made here that has no wiki-authority. That's the way in works in the research world and many scientific sources. -- Fyslee / talk 05:46, 26 August 2008 (UTC)

Again, it's not "homegrown rules"; it's in WP:MEDRS, which discusses this subject in some detail. Eubulides (talk) 08:43, 26 August 2008 (UTC)

As I wrote above, I'm not disputing that it's generally a good idea to use newer sources, but am agreeing with what you wrote above:

• "When reliable sources conflict with each other, we should not automatically pick the most recent one; that would be recentism and goes against WP:RECENT and WP:MEDRS. We should instead use good judgment and in many cases simply report the conflict."

Even when there is not a conflict, older and newer studies can supplement and complement each other, so let's just examine each source and see if it is worth using. -- Fyslee / talk 14:20, 26 August 2008 (UTC)

Please see my followup comment in #Safety: di Fabio metaanalysis above. Eubulides (talk) 14:45, 26 August 2008 (UTC)

Chiropractic-as-CAM out of utilization and satisfaction

On July 29 (now archived in Talk:Chiropractic/Archive 25 #Fix for CAM claim) I proposed moving text about chiropractic-as-CAM from the end of Chiropractic #Utilization and satisfaction rates, where it does not really belong, to the beginning of Chiropractic #Scope of practice. Nobody objected, but I see now that I didn't act on that proposal. I just now made the edit, updated as best I could for the changes made since then. Eubulides (talk) 08:26, 25 August 2008 (UTC)

Good job. It's good to collect similar stuff together. -- Fyslee / talk 05:47, 26 August 2008 (UTC)

three unreliable refs

New text was added to the Effectiveness section but the refs are not reliable.[24] QuackGuru 04:47, 26 August 2008 (UTC)

The first ref, perhaps fair enough, but since when have .gov.au sites been unreliable? Did you actually click on the links and check them?? --Surturz (talk) 05:00, 26 August 2008 (UTC)

Thanks for providing a better ref. I have formatted them. -- Fyslee / talk 06:07, 26 August 2008 (UTC)

Safety: di Fabio metaanalysis

The Safety section would be more complete if it included the results of the di Fabio metaanalysis. As far as safety studies go, it is the most thorough study of its type ever done. It specifically revealed that chiropractors are implicated in far more injuries and deaths than other professions:

• "Manipulation of the Cervical Spine: Risks and Benefits", by Richard P Di Fabio, Physical Therapy, Vol. 79, No. 1, January 1999, pp. 50-65.

• Figure 2 is relevant to this article.

It was a very thorough analysis, and none since has topped it. It is thus remarkable that we aren't using it. -- Fyslee / talk 04:03, 25 August 2008 (UTC)

When we worked through the safety section, it was proposed that we only use sources 3 years old or newer. This source definitely fails this, and in terms of age of research, this is ancient. Other sources have been removed from the article because they were too old—I don't think we should start adding more old sources in. - DigitalC (talk) 06:57, 25 August 2008 (UTC)

Old facts that are still facts are still facts and thus relevant. No later research has undone or changed the results of the di Fabio study. Homegrown rules don't trump Wikipedia policies or guidelines regarding sourcing. -- Fyslee / talk 05:37, 26 August 2008 (UTC)

That's just what I was thinking. There is not always a 'fresh, 3 year or less' study to be found on the specific subject at hand. Sometimes you need the older studies.--—CynRN ^(Talk) 07:03, 26 August 2008 (UTC)

The dangers of cervical spine adjustments by chiropractors is adequately described with the current references. Hard to see what additional text is needed on the subject. Inclusion of the 1999 study as an additional reference wouldn't take up much space, though. --Surturz (talk) 07:30, 26 August 2008 (UTC)

(outdent)

• It's not "homegrown rules" to prefer relatively-recent reviews to older material; it's in WP:MEDRS #Use up-to-date evidence (disclaimer: I contributed to that section).
• The claim that di Fabio is a "metaanalysis" is dubious. That paper does not claim to be a meta-analysis, or even a systematic review. It claims merely to be a review.
• The assertion "none has since topped" di Fabio is dubious as well. It's certainly a high-quality review, one of the best, if not the best, for its time; but lots of data has been gathered since then, and better reviews have come out since then, for example, Gross et al. 2004 (PMID 14974063), Assendelft et al. 2004 (PMID 14973958), Hurwitz et al. 2008 (PMID 18204386).
• Sometimes one may need older reviews, but that's not the case for cervical manipulation! I'd guess probably two reviews a year are published. The problem isn't finding a recent one; it's summarizing the recent ones fairly (there are several).

Eubulides (talk) 08:43, 26 August 2008 (UTC)

I'm not disputing that it's generally a good idea to use newer sources, but am agreeing with what you wrote above:

• "When reliable sources conflict with each other, we should not automatically pick the most recent one; that would be recentism and goes against WP:RECENT and WP:MEDRS. We should instead use good judgment and in many cases simply report the conflict."

Even when there is not a conflict, older and newer studies can supplement and complement each other, so let's just examine each source and see if it is worth using. -- Fyslee / talk 14:20, 26 August 2008 (UTC)

OK, then let's discuss the substantive points raised above: we do have newer and higher-quality reviews, which cite di Fabio in a larger context with more-recent data. There's no need to cite an old study directly unless it is historically compelling, which I don't yet see here. Eubulides (talk) 14:45, 26 August 2008 (UTC)

Okay, what studies are you thinking of? -- Fyslee / talk 19:55, 26 August 2008 (UTC)

For starters, the reviews I mentioned just above: Gross et al. 2004 (PMID 14974063), Assendelft et al. 2004 (PMID 14973958), Hurwitz et al. 2008 (PMID 18204386). There are others; this is just off the top of my head. Eubulides (talk) 20:42, 26 August 2008 (UTC)

The study itself is by scholarly accounts, obsolete, it has been supplanted by newer research on the subject and furthermore its not even specific to chiropractic care. I tend to agree here that the inclusion on this particular "meta-analysis" is a step backwards and there are frankly more pressing needs. Soyuz113 (talk) 16:45, 26 August 2008 (UTC)

Data that is still accurate is never "obsolete". The results that applied to chiropractic injuries and deaths is obviously very much "specific to chiropractic care." Is this more denialism, akin to the oft heard "rebuttals" from some chiropractors and editors here who claim that chiropractic high cervical adjustments have never killed anyone, and/or that's its not possible (per a flawed Canadian experiment on cadavers)? No, that part certainly applies and these objections just show how important that study is, since chiropractors want to bury it so much. It even took into account Terrett's findings of (two?) misattributions!

Now if we have better studies that include this data, then fine. I'm going to wait for Eubulides to provide the cites and URLs to them. -- Fyslee / talk 19:55, 26 August 2008 (UTC)

• I mentioned some above. Also, Miley et al. 2008 (PMID 18195663), which Chiropractic cites, mentions di Fabio and cites it multiple times. Miley et al. searched for all sources from 1950 until about September 15, 2007; they mentioned di Fabio (which is a sign it's a good source). Of the 28 sources they cite, only 6 are older than di Fabio. However, they use di Fabio only to support relatively noncontroversial things such as the fact that CMT has been used to treat neck pain; this suggests that di Fabio's results were not that useful, compared to the other studies they cite, for the core of the question whether CMT causes VAD and stroke. Certainly di Fabio's Figure 2, by itself, is not that useful: chiropractors perform the vast majority (90%?) of CMT, so if they're responsible for only 60 to 70% of cases then it could be argued (albeit via WP:OR) that they are safer than MDs for CMT.
• In briefly eyeballing Google Scholar, it appears that di Fabio was cited quite a bit, with cite counts high in the late 1990s and early 2000s, dropping off since then. That sounds about right; it's a good study for its time but somewhat dated now.

Eubulides (talk) 20:42, 26 August 2008 (UTC)

Your last comment doesn't take into account that we are referring to reported incidents. The fact that underreporting is a huge problem (Ernst uncovered a 100% rate in England) isn't discussed, but needs to be factored into this. With such huge degrees of underreporting, the percentages could be vastly larger.

I think I get your first point. We don't need more text. That jibes with what Surturz said above:

• "Hard to see what additional text is needed on the subject. Inclusion of the 1999 study as an additional reference wouldn't take up much space, though." --Surturz

How about I just add the link and we can move on. It's inclusion certainly won't hurt anything and will be a good additional source for readers to study. Can we do that as a compromise? -- Fyslee / talk 05:20, 27 August 2008 (UTC)

I expect underreporting is a huge problem in all fields; but we are straying into OR here. To get back to the point: sorry, I still don't see the point of adding that citation. The text does not rely on it. It would be like citing the Manga report, no? Eubulides (talk) 09:05, 27 August 2008 (UTC)

Underreporting is documented in V & RS, but extrapolating is OR. We just need to be aware of it when making OR statements ourselves, like your statement above "it could be argued", which you recognize. I just engaged in a bit of OR to counter your OR ;-) Nothing for the article. The comparison to Manga is an apple vs. oranges comparison. The di Fabio study just reports some actual injury and death statistics that never will change. It is thus still relevant as a source. -- Fyslee / talk 14:08, 27 August 2008 (UTC)

A defender of the Manga report could also say that it just reports some cost-benefit statistics that will never change, no? Let's put it this way: I am only slightly opposed to citing di Fabio per se (on the grounds that it's obsolete), and I wouldn't revert an edit that simply adds that source; my main worry is that adding it would become a justification or precedent for adding all sorts of obsolescent sources even when we've got plenty of up-to-date sources on a particular point, which would lead to undesirable citation bloat. Eubulides (talk) 16:54, 27 August 2008 (UTC)

Chiropractic physicians

This edit did a blanket substitution which is not appropriate (the common term is chiropractors, not chiropractic physicians), but still it raises the point that the phrase chiropractic physician should be present somewhere. I propose putting it at the start of Chiropractic #Scope of practice, so that it starts off "Chiropractors, also known as doctors of chiropractic or chiropractic physicians,...". Eubulides (talk) 14:45, 26 August 2008 (UTC)

I agree. That edit should be reverted and your suggested entry should do the trick. We've already had that wording here in the past. It will need to be qualified that it is only in the USA (and possibly Canada) that this applies, since chiropractors are not recognized as "physicians" in other countries, partially because their education isn't sufficient, and partially on legal grounds, depending on the country. In fact the designation is rather meaningless in the USA, since literally anyone, even a child, can legally call themselves a "physician" in most states. It isn't a protected title. -- Fyslee / talk 19:34, 26 August 2008 (UTC)

OK, let's change it to "Chiropractors, also known as doctors of chiropractic or chiropractic physicians in many jurisdictions,...." This would use Cooper et al. 1998 (PMID 9729991), a source we haven't used before, which says "Chiropractors are permitted to use titles such as doctor of chiropractic (DC) or chiropractic physician (CP) in most states, although 5 states restrict their title to chiropractor." Eubulides (talk) 20:01, 26 August 2008 (UTC)

Excellent solution. Go for it. -- Fyslee / talk 05:21, 27 August 2008 (UTC)

Attacks on vaccination section

We seem to be having a number of recent attacks on this section, not only by newbies or supposed newbies, but by regular editors as well. Unfortunately (since edit histories aren't accepted as RS) we can't use this documented abuse of the article as proof of continued anti-vax sentiments in the profession and in its supporters here, it is an interesting form of proof they are providing right here. It's amazing the weak excuses for straw man arguments being used. Instead of seeking improvement, deletion seems to be the name of the game. How about looking for more and better sources to strengthen this fact about the profession, instead of trying to whitewash and delete? Okay? -- Fyslee / talk 08:54, 24 August 2008 (UTC)

I dunno, I find the edits you made (after making the above comments) to not be an improvement. They make the vaccination section longer by inserting some Simon-says quotes, but the quotes don't say anything that the section didn't already say, and the section has grown considerably, from 170 words to 276 words, raising WP:WEIGHT issues. The Simon-says style is also unfortunate: it makes the section more argumentative (which is like adding oxygen to a fire). I did some relatively minor tweaks to fix some obvious gotchas in this edit, but all in all it'd be better to go back to the way this section was before the recent flurry of edits. Eubulides (talk) 10:12, 24 August 2008 (UTC)

Weight is not a matter of words but a matter of tone as well. The section based on a quick review of the history has always been disputed in some form and I agree with Surtuz that it smacks WP:POINT. Also, the omission of naturopathic college students who share the same attitude as DCs is significant; for it shows that it is moreso CAM than specifically chiropractic that has reservations of blanket immunisations. We can't simply cherry pick the information within a source that appeals to us personally, the message of the paper needs to be conveyed. That goes for both sides. Soyuz113 (talk) 16:43, 24 August 2008 (UTC)

A few comments on each point:

• The tone should clearly emphasize the controversial nature of the subject. If it wasn't controversial, the subject wouldn't be mentioned at all. It would be a non-issue. One way to improve any concerns about tone and weight would be to tweak the heading to make it clear this is about "Resistance to vaccination" and make it a subheading as follows: If the pro-vaccination POV in chiropractic is developed here, and I see no legitimate reason to hide it, it would be rather small, and then we would have a "Vaccination" heading, with "Support" and "Resistance" as subheadings. Maybe that would balance things better? Improvement and balance are always welcome. Deletionism is definitely not welcome.
• I don't see what POINT has to do with this. If you share Surturz understanding of POINT, then we have a problem regarding understanding of policies and guidelines here. I notice that you have the same POV and mirror each other in many ways.
• Precisely because the section is disputed, it needs to be strengthened. That's the way Wikipedia works. That can be done by enlarging it, providing better references, and/or providing better attribution, among other things. It should definitely not be weakened or eliminated as that would give the objectors an undeserved victory in their attempts to whitewash the article and violate NPOV. The subject (Chiropractic resistance to vaccination) is actually large enough in a historical context, its notable controversiality, its currently widespread presence on the internet, its documentation in V & RS, and in its current impact on the real world (we're talking about large numbers of unnecessarily dead children here), that it could/should be an independent article with lots of V & RS. It could be large or small, but it could be done. If that happens, then we could eliminate the current section's content here and replace it with a "main" article link and use that article's LEAD as the content here.
• I do agree that the placement of the section could be better, but where.... While there is no prohibition about collecting criticisms in one section, it is generally better to place them where applicable, IOW throughout the article. One downside to this is that it serves the purpose of whitewashers by hiding the criticisms where only readers of the finer details will discover them. That tactic has been used many times here at Wikipedia. Sometimes certain items just don't fit in in that manner, and thus a "criticisms/controversies/diverse POV" (use the appropriate label) section could still be legitimate for those items.
• I hadn't noticed that the naturopathic students weren't mentioned anymore, but maybe that's because it's off-topic here in the chiropractic article? That would be legitimate stuff for the Vaccine controversy article, but not here.

I hope I have addressed each of your concerns. Improvements are indeed welcomed. -- Fyslee / talk 18:55, 24 August 2008 (UTC)

• I'm afraid the point is being lost. First, the placement of the text, at the very end of the article, is problematic. Very much like the LEAD, good format would somehow enclose a neutral or non-controversial subsection.
• I see no shortage of criticisms of chiropractic whatsoever, I do however, see a lack of objectivity when editors suggest that having a controversy section dedicated to all aspects of chiropractic would somehow be "ghetto". I suppose it would be "ghetto" as "evidence basis" "schools of thought" and every other subsection.
• Vaccination, along with elements of straight chiropractic, such as subluxation and its role in internal health should be dealt with its own criticisms section. It could easily be written and include the current references.
• Other concerns still abound, but since vaccination seems to be the current hot topic perhaps we can deal with it first before to moving onto other major concerns. Soyuz113 (talk) 22:15, 24 August 2008 (UTC)

The controversy/criticism section was rejected on more than one occasion. CorticoSpinal wanted a criticism section but that never materialized.

The current vaccination version is too long and hard to follow. Let's restore the shorter version and work from there. QuackGuru 23:19, 24 August 2008 (UTC)

[ec] Okay Soyuz113. Let's read your proposed improvements right here. This is the right thread, or you can start a new one.

Personally I would write the article using main sections dealing with all major aspects of the subject, and more-or-less mandatory subsections in each one dealing with the relevant controversies and criticisms for that section, but that's just my opinion as regards formatting. To my way of thinking that would make for a very easily understood article and would ensure that each section contained all relevant POV, as per NPOV. Another great advantage is that it undermines the efforts of whitewashers, and ensures that no matter what section a reader happens to read, they get "the whole story," which is an ideal of Wikipedia. It would take a firm consensus of most major editors to put that kind of formatting in effect, although it seems we already do it to some degree, but in a hidden way. -- Fyslee / talk 23:35, 24 August 2008 (UTC)

I agree, the vaccine section was pretty good before the changes. Perhaps, it would have a better 'tone' if Haldeman's viewpoint from Principles and Practice of Chiropractic(pg 197) was worked in: "the objection (to vaccination) centers on two areas: freedom of choice and lack of true efficacy of vaccination". Both points are in there to a degree, but maybe they could be strengthened.

As for the section being at the end of "chiropractic"...you are assuming that more than a hardy handful of folks would be able to have the attention span to read it all the way through to the end! :).--—CynRN ^(Talk) 00:14, 25 August 2008 (UTC)

It's looking like most editors commenting on the topic agree that the vaccine section was better without the lengthy quotes. Any other comments? If not, I'm inclined to change it back. Eubulides (talk) 08:26, 25 August 2008 (UTC)

I think this version was the last consensus version. QuackGuru 22:10, 25 August 2008 (UTC)

Either version is still to WEIGHTy. The section should be removed. -- Levine2112 ^discuss 01:41, 26 August 2008 (UTC)

I restored the shorter version but I was reverted. QuackGuru 01:44, 26 August 2008 (UTC)

You were reverted because you included a lot of other non-consensual edits into your reversion. -- Levine2112 ^discuss 02:23, 26 August 2008 (UTC)

I agree with Levine2112 that this change contained a mixture of relatively uncontroversial changes (such as restoring the shorter version) along with some other more-controversial changes, that require more time to give others a chance to respond to the edit proposals. Eubulides (talk) 02:52, 26 August 2008 (UTC)

I agree. There were far too many edits made at one time (as I have commented above), so I reverted to the last consensus version. Too many edits at one time are a bad idea and often lead to edit/revert wars.-- Fyslee / talk 05:35, 26 August 2008 (UTC)

I agree with Levine2112 that the section should be removed and I suggest relevant info moved into a controversy section. As far as I can tell, so far, controversy (at least perceived one's here) seem to be everything related to straight chiropractic, vaccination, subluxation, classification of chiropractic, history of chiropractic, pediatric chiropractic and non-musculoskeletal approaches. Does that pretty much summarize the biggest "controversies" that currently face the profession today? Also, threats should be kept to a minimum, we're all here to make the article a true representation of the real thing. The weight of vaccination here is in question (not the notability) and the amount of detail given to this. Soyuz113 (talk) 00:02, 27 August 2008 (UTC)

Here's a thought. Remove the vaccination section completely, but then in the Schools of Thought/Practice Styles section, mention that a minority of the profession rejects vaccination. -- Levine2112 ^discuss 00:10, 27 August 2008 (UTC)

There is no evidence that opposition to vaccination is limited to straight chiropractors; on the contrary, the survey was at a mixer school. I agree that a separate section for the vaccination material is not necessary; it would be OK to move the text into Schools of thought and practice styles (but banishing it to a controversy ghetto would not be a good idea). However, the text should not be cut down substantially; chiropractic has an important role in opposition to vaccination. Eubulides (talk) 09:05, 27 August 2008 (UTC)

Sure, chiropractic may be important to vaccination opposition. But is vaccination opposition important to chiropractic? My point being that chiropractic should and is mentioned in Vaccine controversy but should it be the other way around. That said, I think the first step here which we can all agree to is to minimize "vaccine opposition" discussion in this article. A sentence or two in "Schools of thought" may be just what the doctor ordered. -- Levine2112 ^discuss 17:53, 27 August 2008 (UTC)

• I did a quick Google Scholar search to try to address this question. (Obviously this is just a rough estimate, but it's better than nothing). The query "chiropractic vaccine OR vaccination" found 502 recent articles (less than five years old). The query "chiropractic" found 10,800 recent articles. So, 4.6% of recent articles that mention chiropractic also mention vaccines or vaccination. The previous version of this section (which there seems to be consensus to revert to) is 170 words, which is about 3.2% of the article's length of 5194 words. So, once we trim, we'll be in a plausible ballpark.
• In contrast, Google Scholar reports 190,000 recent articles for "vaccine OR vaccination". So it appears that, relatively speaking, the topic of vaccination is far more important to chiropractic, than chiropractic is to vaccination.
• I realize that Google Scholar counts are not at all authoritative, and that these numbers are not a scientific test or anything like that; still, it's undeniable that recent scholarly papers do mention vaccination quite a bit when the subject is chiropractic.

Eubulides (talk) 18:11, 27 August 2008 (UTC)

You are correct. Those Google searches mean absolutely nothing at all in terms of our discussion here. -- Levine2112 ^discuss 06:54, 28 August 2008 (UTC)

Levine2112 agreed with Eubulides by stating: "You are correct." but then changed his view by claiming the Google searches "mean absolutely nothing..." Levine2112's comment makes no sense. Google scholarly demonstrates there is a lot of coverage on vaccination and thus it is relevant. QuackGuru 16:03, 28 August 2008 (UTC)

I think this section is currently well written and well sourced. Verbal chat 10:49, 27 August 2008 (UTC)

It's in poor taste to refer to a proposed section as 'ghetto'. I favor CynRNs approach, i.e. making it much more cut and dry and getting rid of the excess fluff. Essentially what the paper is saying is that chiropractic and naturopathic students circa 1999 in Toronto develop anti-vaccination attitudes outside the classroom. Shouldn't this be stated as such? Also, I have yet to hear a compelling argument regarding the weight of this section. We are in agreement that it should be moved. Soyuz113 (talk) 17:08, 27 August 2008 (UTC)

As I understand it CynRN is proposing adding text to a previous (shorter) version of the section. CynRN's proposal seemed to be a reasonable one. Perhaps CynRN (or someone else) could put a draft new version here, so that we can discuss something concrete? I agree that the section needs trimming, and proposed a trim here about 3 days ago, which simply reverts to the previous (shorter) version. Most of the commentary since then has agreed with the trim but I'm waiting for another day for further comments, before making that change. Perhaps a new draft could be proposed assuming the trim has been made? You can start with this version, which was the consensus version before the recent additions. Eubulides (talk) 17:37, 27 August 2008 (UTC)

Sorry, forgot to reply to the "shouldn't this be stated as such?" question. The paper does say that CMCC does not formally teach anti-vaccination views, but points out that lecturers may discuss the topic on their own. It goes on to say that students may get anti-vaccination information from the Internet, from chiropractic magazines, and from informal settings such as student clubs. Much of this sort of detail comes from the discussion section of the paper, and is somewhat speculative; I don't think it needs to be discussed in Chiropractic (as I mentioned before, I'm not even convinced the survey needs mentioning at all). However, please feel free to draft new text and discuss it here; that's what the talk page is for. Eubulides (talk) 17:54, 27 August 2008 (UTC)

I support the vaccine section as it was previously, for the most part. It could be tweaked a bit. I am sorry that the scientific chiropractors don't like it or think it reflects negatively, but a big chunk of their fellows oppose this important public health measure. It's notable since chiropractors want to be primary care providers and see infants and children. Here are my two cents for a version, adding more about freedom of choice and striking out a few words for brevity and in a spirit of compromise:

Insurance and subsidies

The edits adding a paragraph on insurance and subsidies is the start of an important topic (yay!), but the edit itself has some problems:

• Insurance and subsidies are important, but they are a distinct issue from cost-effectiveness. This material should not be in Chiropractic #cost-effectiveness, nor in its parent section Chiropractic #Evidence basis.
• The edit talks only about Australia. Chiropractic should have a global view; most chiropractors are in the U.S.
• The Medicare Benefits Schedule - Item 10964 and Medicare Item 10964 processed from July 2007 to June 2008 are primary sources of relatively low quality. Readers should not have to wade through statistics spreadsheets from funding agencies. It verges on original research to be citing primary data directly like this.
• Also, as a rule, Wikipedia should not use "https:" URLs.
• Normally I'd just move the text in question (which was added without any previous discussion; not good practice) to the talk page, but given that an edit war is in progress for now I'll instead note that this text needs work.
• For now I have made an edit to add tags to the new paragraph and put it in a new section "Insurance and subsidies" (suggestions for better names are welcome); but it would have been far better to discuss this controversial change on the talk page first, which was not done in this case.
• For starters, I propose that the new section be moved to just after Education, licensing, and regulation, where it's more at home.

Eubulides (talk) 08:43, 26 August 2008 (UTC)

• I have never heard of this "rule" that Wikipedia should not use links that use a secure connection (that is what https: means). Do you have a link to this rule?
• I think a better name for the section would be "Third party coverage", as this seems to be a more commonly used term.

DigitalC (talk) 04:53, 27 August 2008 (UTC)

I see no problems with the sources. They are V & RS. "Third party coverage" sounds fine, too. -- Fyslee / talk 06:32, 27 August 2008 (UTC)

I don't have a link to this rule. I do have a browser (Lynx) that complains about the https: link. The browser says the https: link is to a site that has botched its credentials. I don't think it's worth worrying about the https: all that much here, since the source is of such a low quality. We should not be citing detailed spreadsheet items in government websites. Surely there are better sources (ones not limited to Australia), and once we include them the problem will fix itself. Eubulides (talk) 09:05, 27 August 2008 (UTC)

This has useful data on insurance coverage in U.S., percentage of private insurance, Medicare, etc.: --—CynRN ^(Talk) 16:49, 28 August 2008 (UTC)

Flaws, Weight and Bias Widespread throughout article

Upon review, Chiropratic has many small, but significant flaws which has introduced bias in several areas:

• The focus and undue weight on the perceived deficiencies of 'straight' chiropractic at the expense of the rest of the article. Criticisms and controversies should be dealt with in one section rather than being littered throughout the article
• Even though the lead and the article suggests that the 'mixer' brand of chiropractic forms the majority it is not accorded such status in terms of weight in the article itself nor it is represented robustly in its own section
• The lead refers to 'traditional' chiropractic without contrasting it against 'modern' chiropractic. It's preferable to have a sentence which represents all chiropractic belief systems not just one vs. another
• The evidence basis section needs a complete rewrite; older sources are being used to dispute newer ones
• Minority held viewpoints are being unjustly weighted and spread throughout the article rather than having self-contained sections that deal with the scientific and mainstream criticism of chiropractic
• A lack of global viewpoint is apparent; controversies and status issues in North America may not be present in other parts of the world, in particular in Europe
• Lack of adequate coverage of non-controversial chiropractic-related subjects in particular formal integration in various governmental and public community based health care delivery systems

There are more, however a piecemeal approach would be best to address these deficiencies; the most obvious is the non-reliable use of scholarly sources. Given that Wikipedia suffers from credibility and reliability issues, it's of fundamental importance that information be portrayed in the most objective neutral manner. Tone of articles should reflect the tone of major, credible, reliable organizations so that bias, in either direction is not used directly or indirectly to advance editorial agendas. There are a lot of comments to read through, but it seems as though there are clearly 2 camps here and the gap must be bridged. Soyuz113 (talk) 16:27, 23 August 2008 (UTC)

Just to address one point: A lack of global viewpoint is apparent; controversies and status issues in North America may not be present in other parts of the world, in particular in Europe North America birthed the profession and has the lion's share of chiropractors, thus the emphasis. That said, it would be interesting to have a section about chiropractors in the rest of the world. --—CynRN ^(Talk) 05:11, 24 August 2008 (UTC)

Suggested improvements are always welcome - and there is certainly always room for improvement! Try making them here (functioning refs and all) and we can discuss and refine them, then include them when we have a consensus. That way we can avoid disruptions and edit wars. WP:BRD is a bad idea here. Let's hammer it out and make this article better. I have always hoped to see this article become the best article on the subject ever written. Most articles on chiropractic are written from one or another POV, for or against, etc., which is fine and legitimate on other websites, but here we aspire to do much more, including all significant POV and historical points of interest. So far we're moving forward and any good suggestions are appreciated. We are all sitting at the same editing table, so to speak, so welcome to the table! -- Fyslee / talk 05:23, 24 August 2008 (UTC)

• What Fyslee said. :-)
• Criticisms and controversies should not all be put into one section. Chiropractic has many controversial aspects. It is not a good style to have one ghetto section with critical comments, with the rest of the article containing only supportive comments. The article should attempt to fairly and neutrally summarize all facets of chiropractic, and the topic order should be whatever is needed to cover the subject.
• Mixers should indeed be covered better, but there is a good reason to weight straight chiropractic somewhat more heavily than the modern percentage of straight chiropractors would suggest. Straights have an influence on their profession that is larger than their numbers. Part of this is for historical, legal, and philosophical reasons, but those are important reasons that should be covered.
• The sentence in the lead before the "Traditionally" sentence talks about modern chiropractic; perhaps this could be stated more clearly?
• Which "older sources are being used to dispute newer ones"? Examples, please.
• I agree with CynRN; the vast majority of chiropractors are in North America and the article should reflect this.
• "formal integration in various governmental and public community based health care delivery systems" is not "non-controversial". On the contrary, like many aspects of chiropractic, formal integration is highly controversial. That is not to say that the topic shouldn't be covered better, of course.
• What "non-reliable use of scholarly sources"? Examples, please.

Eubulides (talk) 09:33, 24 August 2008 (UTC)

• Controversies SHOULD be put into one section as there are certainly accepted mainstream elements of chiropractic (treating musculoskeletal) and non-mainstream (treating non musculoskeletal). To have criticisms spread throughout every section is fairly dubious. Who suggested the other sections would have "supportive comments"? Commentary should be kept to a minimum on either side. Currently the article does not reflect that and this needs to change.
• Straights have more influence according to whom and where exactly? There is a lot of conjecture here without supporting facts that highlight these alleged are important to anyone but a group of editors here who seem to be literally re-writing history
• According to my research there are more schools of chiropractic operating outside continental United States than within it. As such the American viewpoint should not supercede a global one, especially if reliable information is available on other programs and models of chiropractic.
• Formal integration is highly controversial with whom? To chiropractors? Medical doctors? It's not our job as editors to "spin" facts; rather we are here to report them. For example, there's no mention of any kind of department of veterans affairs formal chiropractic program, no mention of hospital-based chiropractors
• Sources, in particular in the evidence basis section have not been used reliably, in fact, they are misleading the reader as to the 'effectiveness' of modalities used by bodyworkers including chiropractors. When a 2008 review declares "manual therapy to be effective for neck pain" that should not be superceded by a 2007 review that declares it to be "unknown". Especially when the 2008 review covered the 2007 paper. Instances like these are littererd the article.
• I fail to see how come it is appropriate to insert words into cited text; the "hypothesized" word was re-introduced despite it not being in the cited source with an edit summary suggesting "it's in the article". The cited source is being, pardon the pun, "manipulated" and which is not how scholarly articles are written. Soyuz113 (talk) 16:38, 24 August 2008 (UTC)

• I agree that commentary should be kept to a minimum. But it should not be put into a ghetto; comments should be made where appropriate.
• Straights clearly have more influence than their numbers might indicate. Here's one example reliable source to this effect (there are many others): "Since the 1930s, straights have been a very distinct minority in the profession. Nonetheless, they have been able to transform their status as purists and heirs of the lineage into influence dramatically out of proportion to their numbers." (Kaptchuk & Eisenberg 1998, PMID 9818801).
• There are far more chiropractors inside North America than outside; the center of the profession is clearly in North America, its history began in North America, and it's clearly appropriate to emphasize North America in the article.
• Formal integration is controversial both among chiropractors and among physicians, yes.
• When reliable sources conflict with each other, we should not automatically pick the most recent one; that would be recentism and goes against WP:RECENT and WP:MEDRS. We should instead use good judgment and in many cases simply report the conflict. For example, an older Cochrane review might well be more reliable than a more recent review published in the Seychelles Medical and Dental Journal.
• The word "hypothesized" is supported by the cited source (Nelson et al. 2005, PMID 16000175), which emphasizes the point that the idea in question is a hpothesis: it says "hypothesis" 9 times by my count, and has a section entitled "What is the Chiropractic Hypothesis?".

Eubulides (talk) 08:26, 25 August 2008 (UTC)

I see that Surturz removed "hypothesized" without further discussion. This is distressing, as "hypothesized" is quite well-justified by the previous comment, and nobody has made any further comment since then. Also please see Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead for the discussion and justification that originally motivated and eventually inserted "hypothesized", without dissent, after a 6-day wait for comments. Eubulides (talk) 02:19, 26 August 2008 (UTC)

'Hypothesized' may have previously had consensus for inclusion. However, I am now disputing the inclusion of the term. It is a POV word in that it is making a judgement on the efficacy of chiro treatments. It is a weasel word; *who* is 'hypothesizing'? I would like someone to either qualify the term with a subject, or remove the term entirely. --Surturz (talk) 03:59, 26 August 2008 (UTC)

• The word "hypothesis" is not used in the lead to judge the efficacy of treatments: it is used, as in the cited source, to describe the core chiropractic set of beliefs.
• It is not necessary, and would bloat the text, to say explicitly "'who' is doing the hypothesizing". It is obvious from the context that chiropractors are responsible for the chiropractic hypothesis.
• "Hypothesis" and "hypothesized" are not weasel words, either in the lead, or in the cited source. As mentioned, in Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead it is important that Chiropractic not appear to endorse the chiropractic hypothesis.
• Again, your comments have not addressed the point that the word is well-supported by the cited source (Nelson et al. 2005, PMID 16000175), which repeatedly uses the word "hypothesis" to talk about the chiropractic belief that there is an important relationship between the spine and health, mediated by the nervous system.

Eubulides (talk) 05:00, 26 August 2008 (UTC)

I disagree, as previously described. The word is quoted out of context. You no longer have consensus for the use of the word 'hypothesized' --Surturz (talk) 05:23, 26 August 2008 (UTC)

The use of the word (or a similar one) is definitely justified by NPOV, which requires that Wikipedia not appear to endorse a POV. Since that POV is a chiropractic POV/opinion and belief system that is disputed by mainstream science, it is especially important that readers not get the impression that the chiropractic POV is undisputed by stating it as fact when it isn't a fact. NPOV and the source allow use of "hypothesized".

Surturz, you have no consensus to edit war. If you can't collaborate and get a consensus before you change things, please go somewhere else. So far your presence here is very reminiscent of an indef banned editor who wreaked similar havoc on this subject. I'd hate to see you reported and an RfCU run on you, but that may be necessary. -- Fyslee / talk 05:32, 26 August 2008 (UTC)

Please stop threatening me with administration whenever I make an edit. All my edits so far have been in good faith, and all of them have been instantly reverted. I am merely stating that I do not agree with the inclusion of the word 'hypothesize' and that you cannot now claim consensus for its inclusion. I have not edit-warred over the word, contrary to your accusation. --Surturz (talk) 05:41, 26 August 2008 (UTC)

Okay, I'll AGF. To avoid starting edit wars in the future, please don't make any edits that might be controversial. Start here and discuss them, IOW, you basically need to ask permission. I know that sounds awful, but this article is a minefield and WP:BRD (which is a poor idea at controversial articles) doesn't work very well here. If someone reverts your edit, don't restore it. Discuss until there's a solid consensus. -- Fyslee / talk 06:14, 26 August 2008 (UTC)

In this case, the consensus is no longer universal, since Surturz is disagreeing with it; however, that does not mean that we no longer have a working consensus. I'd like to hear other editors' opinion on the subject (other than via edit war :-). Certainly the text without "hypothesis" has a POV problem, as described in Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead above. Something needs to be done about it. "Hypothesize" is well-supported by the source. If there's no better alternative, we should use "hypothesize". Eubulides (talk) 08:43, 26 August 2008 (UTC)

Section break

I agree that hypothesized should not be placed in the lead. It should go.

• the reference quoted (Eisenburg, 1998) that discusses the "straights out of proportion" argument is obsolete and is a directly an American POV from 1998. Currently there are more chiropractic schools outside the US than within in; accordingly a global POV must predominate not simply America and everything else.
• It would be wise to firmly delineate all controversial (medical aspects) of chiropractic care. Currently editors are sniping that this is or isn't controversial mixing in conjecture with fact. Clearly not all aspects of modern chiropractic practice are controversial; and the article appears to be needlessly 'political'.
• Although I agree that not all recent papers are necessarily the best, there does appear to be obvious (to academics at least) no-no's in the way evidence-basis and other sections have been handled. I see the section is under dispute and it is quite wordy. It needs to be trimmed down considerably. Also, while on the topic, I am skeptical that the evidence is 'conflicting' for chiropractic treatment for low back pain. Also, the opening statement for neck pain (no consensus for manual therapy, Vernon, 2007) contradicts the more recent 2008 study that demonstrates equivocally that manual therapy is effective for neck pain. Given that the 2007 paper was reviewed in the 2008 one, why lead the topic with a) an older study that b) contradicts the newer research? Is this a mistake? Judgment calls of this nature are clearly wrong (academically, at least) and if Wikipedia strives to be a reliable source editors should reliably uses the sources and promote any POV or agenda they may have.
• Formal integration is occurring regardless of what individual chiropractors and medical doctors think. Wikipedia is not a battleground for idealistic priciples, but is here to neutrally and accurately represent the facts, as you are aware. This article currently seems to want to include all controversial aspects at the expense of minimising the non-controversial aspects, portray the majority as a minority and cover the minority as if it were the majority, include CAM=chiropractic and manipulative medicine=chiropractic and other troublesome confabulations.
• This article would be far better off if it were to use neutral language as found here. The National Institute of Health is a reliable source; furthermore it gives us a good template to work around. Conclusions drawn here should not deviate significantly from major governmental health agencies. Soyuz113 (talk) 23:45, 26 August 2008 (UTC)

I think Souz113's assessment is spot on. I think we all have been dealing with this article for so long that it is hard for us to step back and look at it objectively. Soyuz comes to us with fresh eyes and I tend to agree with his description of various issues plaguing this article. -- Levine2112 ^discuss 23:57, 26 August 2008 (UTC)

Levine2112, while you're right about our need for stepping back occasionally, we aren't dealing with an inexperienced or new user who has "fresh" eyes. We've read these same arguments before from an indef banned user.

Soyuz113, you seem to be ignoring Eubulides post above, so I'll copy from it, since his points are highly relevant:

• "Certainly the text without "hypothesis" has a POV problem, as described in Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead above. Something needs to be done about it. "Hypothesize" is well-supported by the source. If there's no better alternative, we should use "hypothesize"."

The issue isn't just about the source, which abundantly supports use of "hypothesize", but of NPOV, which requires that we not endorse the chiropractic hypothesis as if it weren't a hypothesis, as explained by Eubulides in the "Simon says" section above:

• "In reviewing Talk:Chiropractic/Archive 25 #Simon-says in 2nd sentence, I noticed a similar problem in the lead's summary of that sentence. The first sentence in the lead appears to endorse the chiropractic theory that mechanical disorders of the musculoskeletal system have a leading role in general health. The cited source talks about this theory in its section "What is the Chiropractic Hypothesis", so I propose the following simple solution, supported by the source, which is to add the word "hypothesized" to the lead sentence, as follows ..."

His arguments are far more compelling than yours. It is clearly a hypothesis that is uniquely chiropractic and not supported by the evidence or mainstream medical sources. While musculoskeletal disorders are certainly significant health problems, the chiropractic hypothesis that spinal subluxations are connected with nearly every dis-ease, and that correcting them will somehow heal them (or directly aid in their healing), is very fringe. Such hypothetical chiropractic statements must be neutralized by abiding by NPOV. We do that by adding words like "hypothesize", which in this case is supported by a good source.

Your proposition of using the NIH source as a model for this article isn't new..... You know that we've been over this before.... Such a model for editing would violate policies here and the intention of Wikipedia to be different, more, and better, than other sources. NPOV forces unique deviations from the NIH article, and we edit by Wikipedia policies, not NIH editorial guidelines. -- Fyslee / talk 05:03, 27 August 2008 (UTC)

• Fyslee, I think we need to abide by WP:AGF & WP:BITE, unless you are going to invoke WP:DUCK, and if so you should formally do so elsewhere.
• I don't see any POV problems with removing "hypothesized". While the source does use the term, in the wording that is used, there cannot be any reasonable disagreement. Is there any evidence that people disagree with the fact that musculoskeletal disorders affect the nervous system? Isn't PAIN a clear sign that the nervous system is affected? If health is the absence of disease (WHO def), then having a (neuro)musculoskeletal disorder is obviously also affecting health.

DigitalC (talk) 10:32, 27 August 2008 (UTC)

Of course musculoskeletal disorders can affect the nervous system; there's no real disagreement about that. But the chiropractic hypothesis goes beyond that: it postulates a special role of the spine on general health, a postulate that goes beyond the mainstream consensus. This postulate is a core part of the chiropractic philosophy, which is why it's mentioned in the lead; but the lead should not give the mistaken impression that the postulate is widely accepted outside chiropractic. There is certainly evidence that this postulate is disputed; if necessary (which I don't think is the case here), we can supply citations to this effect from reliable sources. Eubulides (talk) 16:54, 27 August 2008 (UTC)

The wording is:

• "Chiropractic is a health care profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and their hypothesized effects on the nervous system and general health, with special emphasis on the spine".(emphasis mine)

This to me doesn't mention anything about a special role of the spine, it states that "Chiropractic is a health care profession... ...with special emphasis on the spine". I don't think that is hypothesized. What this sentence does imply, is that effects from mechanical disorders are only hypothesized. The postulate that you mention is well described by:

• "Traditionally, it assumes that a vertebral subluxation or spinal joint dysfunction can interfere with the body's function and its innate ability to heal itself".(emphasis mine).

The word 'assumes' here is appropriate to prevent the impression that this is accepted outside (straight) chiropractic. DigitalC (talk) 01:16, 28 August 2008 (UTC)

• The chiropractic hypothesis, which is not shared by mainstream medicine and science, includes the postulated effects of mechanical disorders on general health, as mediated by the nervous system. This is what is described in the phrase "effects on the nervous system and general health", and this is the phrase needs some sort of qualification, so that it doesn't appear that Wikipedia endorses the chiropractic hypothesis.
• Another way to reword the sentence would be as follows:

Chiropractic is a health care profession that focuses on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, with special emphasis on the spine, under the hypothesis that these disorders affect general health via the nervous system.

Would that be clearer?

Eubulides (talk) 02:38, 28 August 2008 (UTC)

It is certainly clearer, but what source are we using for it? It certainly isn't NPOV, because it then doesn't include the reform POV which rejects the hypothesis that the disorders affect general health "via the nervous system". - DigitalC (talk) 22:58, 28 August 2008 (UTC)

The source we are using is the source we are already citing there, namely Nelson et al. 2005 (PMID 16000175). That source is freely available, please see its section "What is the Chiropractic Hypothesis?" Eubulides (talk) 01:18, 29 August 2008 (UTC)

• Chiropractic does not say "the evidence is 'conflicting'"; it says "There is continuing conflict of opinion on the efficacy of SMT for nonspecific (i.e., unknown cause) low back pain", which is a different claim. This claim is supported by the cited source (Murphy et al. 2006, PMID 16949948).
• The 2008 paper (Hurwitz et al., PMID 18204386) does not review or cite the 2007 paper (Vernon & Humphreys, PMID 17369783). When reviews disagree, and neither clearly trumps the other, the article should mention both results as fairly and neutrally as possible.
• Formal integration remains controversial, and should not be reported as if it were noncontroversial; that would not be accurate.
• As far as I can see, Chiropractic does not claim that CAM=chiropractic, nor that manipulative medicine=chiropractic.
• What is the source for the claim "there are more chiropractic schools outside the US than within"? Chiropractic #Education, licensing, and regulation says that there are 18 accredited D.C. programs in the U.S., 2 in Canada, and 4 in Europe. Even if the "outside the US" claim were true, it would not overcome the facts that chiropractic is based in the U.S., and that U.S. chiropractors outnumber the rest of the world.
• The word "hypothesized" is well-supported by the cited source. It was put in for good reasons, summarized in Talk:Chiropractic/Archive 25 #Simon-says in 1st sentence of lead. These reasons need to be addressed. Arguments against it that merely say "it must go" are not persuasive. Without "hypothesized", or something similar, the sentence appears to endorse the chiropractic hypothesis, which is not what Wikipedia should do.
• No evidence has been presented that the "straights out of proportion" point is obsolete. We have a reliable source making that claim, and no reliable sources disputing it. It is unlikely that chiropractic has seen a revolution in the past decade that have made straights obsolete.
• It would be wise to firmly delineate all controversial (medical aspects) of chiropractic care." Controversies in chiropractic are not limited to medical aspects. They go through all parts of the field, from philosophy to history to scope of practice to billing. There is an old joke about chiropractors: ask five of them a question and they'll respond with a dozen vehemently disagreeing answers.
• Every section in Chiropractic is under some sort of dispute or another. That's the way this article is, I'm afraid.
• I agree that the material in the section could be shortened by moving it into a subarticle, and have mentioned this more than once. This has been lower priority than the other problems with the article. The length of the section is not excessive; a similar length was in effect for many months, in a section that was hopelessly out-of-date and hopelessly POV in favor of chiropractic (it cited no critical sources whatsoever), and there were no complaints about the length back then. The complaints about length came only when the section came closer to balance.
• Chiropractic is supposed to be an encyclopedia article; as such its audience and goals differ considerably from those of a government agency set up to support and promote complementary and alternative medicine.

Eubulides (talk) 09:05, 27 August 2008 (UTC)

• "*Formal integration remains controversial, and should not be reported as if it were noncontroversial; that would not be accurate." It is POV to NOT discuss integration because "it is controversial". Remember, Wikipedia doesn't care about accuracy, it cares about verifiability. If we have reliable sources that discuss the controversy, then we should include those too.
• Where is the source for the claim that "chiropractic is based in the U.S."? A quick look at List of chiropractic schools 19 Chiropractic schools outside the US. Again, per NPOV we should strive to obtain a world-wide view. Wikipedia's readers and editors are not all American.
• "It is unlikely that chiropractic has seen a revolution in the past decade that have made straights obsolete.". Strange, because I happen to think that such a revolution has been occuring. I believe it was Corticospinal that mentioned that back in 1999? CMCC switched to an evidence-based curriculum. I have certainly read that evidenced based chiropractic has been increasing in Europe as well. However, once again, we go back to WP:V, and the fact that WP strives for verifiability, not accuracy—you win this one!

DigitalC (talk) 10:32, 27 August 2008 (UTC)

• I agree that Chiropractic should discuss integration. Currently it does that only in minor snippets under Philosophy and Scope of practice; it would be nice to expand on that a bit. My point was merely that coverage of integration should not give the mistaken impression that it is noncontroversial. I think we're pretty much in violent agreement on this point.
• Many of the schools in that list are not accredited according to the CCE-I standards. If one counts just as-per-CCE-I accredited programs, as I understand that Chiropractic #Education, licensing, and regulation does, the vast majority (18 of 24) of accredited D.C. programs are in the U.S. Also, if you count D.C. chiropractors, the estimates in Chiropractic #Education, licensing, and regulation are that the vast majority of chiropractors are in the U.S.
• I agree with you that straights have lost some influence over the profession in the past twenty years. However, I think they still retain notable and considerable influence. Of course, these are just my opinions; we would need reliable sources about any changes of influence before we could put text like that into the article.

Eubulides (talk) 16:54, 27 August 2008 (UTC)

• Why would we only count schools that are accredited per CCE-I? For the record, there are schools accredited to CCE-I standards not included in Chiropractic #Education, licensing, and regulation such as the schools in [edit: New Zealand, Australia and] Japan. DigitalC (talk) 00:49, 28 August 2008 (UTC)

source for accrediation of Australasian programs - perhaps that SHOULD be added to the article? - DigitalC (talk) 00:55, 28 August 2008 (UTC)

Good catch, thanks! I added that. That should cover Australia, New Zealand, and Japan. Non-accredited schools should probably not be mentioned in that section, though; anybody could start one. And the existence of non-accredited schools in some other countries wouldn't undermine the basic point that chiropractic is heavily dominated by the U.S., far more than (say) surgery is. Eubulides (talk) 02:38, 28 August 2008 (UTC)

• The cited (Nelson) text does not include the word hypothesis in the passage. It's inclusion is hardly a violation of WP:NPOV. I don't see the logic behind the Simon-says argument.
• No one suggested straights were obsolete. What is being questioned is how the reference is being used and interpreted and the predominence of straight chiropractic within the US and globally.
• I would appreciate if you could produce evidence that suggests chiropractic philosophy, billing and other things are controversial. Alas, I'm afraid you my question has not been answered. What justifies treating the minority like the majority and listing all controversies at the expense of non-controversies?
• With respect to the reviews, if neither review trumps the other, as you suggest, why make the claim there is no consensus for manual (manipulative?) medicine on neck pain? Also, a quick look at the sources suggests that the Vernon 2007 study is an inferior one, academically speaking, to the Hurwitz 2008 study. Another example of non-reliable use of a source occurs in the lead itself using a 2006 commentary on chiropractic as "proof" that chiropractic treatment is not effective. This needs to be fixed. The lead also fails to include other sections in the article such as utilization/satisfaction.
• The "old joke" analogy is rather distasteful; it again, is conjecture and it would be best to leave speculation at the door so to speak. The issue here isn't the opinions of chiropractors, it's about finding agreement on important topics.
• To suggest a reliable agency such as the NIH is somehow complicit in perpetuating anything other than research into CAM is surprising. Wikipedia is already considered by most scholars to be non-reliable; we can do better. Soyuz113 (talk) 17:28, 27 August 2008 (UTC)

• I don't like the Simon-says style either, but there was consensus that it should be used to avoid giving readers the impression that Wikipedia endorses a position that editors find controversial. Please see Talk:Chiropractic/Archive 25 #Antiscientific reasoning along with the next few talk-page sections after that.
• The cited (Nelson) text mentions the chiropractic "hypothesis" about 10 times.
• I lack the time right now to produce citations suggesting that the philosophy etc. of chiropractic are controversial. Surely this is a given? The mainstream rejects many elements of chiropractic philosophy, and the mixers and the straights argue about it. Whether chiropractors should be able to bill insurance companies is a constant sore spot. Controversies abound in chiropractic.
• I don't see how Chiropractic treats "the minority like the majority".
• The claim that there is no consensus is supported by a reliable source, and the claim is quite relevant to the evidence basis issue. Too often, both skeptics and supporters generate accounts that make it sound like chiropractic care doesn't work at all, or is well supported for many conditions; but in reality this is a controversial area and it's important to make that point.
• Hurwitz et al. 2008 (PMID 18204386) is given substantially more space in Chiropractic than Vernon & Humphreys (PMID 17369783), and the latter source is used only to support points that are not controversial. Vernon & Humphreys (PMID 17369783) is a reliable source, and there's no reason to shut it out.
• The lead does not say or imply that chiropractic treatment is not effective. It merely says that opinions differ on the subject; this at least is not controversial among reliable sources.
• Currently the lead sentence "Chiropractic is well established in the U.S., Canada and Australia." is intended to (very briefly) summarize the utilization and satisfaction section, along with the last paragraph of the "Scope of practice" section (these to some extent overlap). The structure of both the article and the lead could be improved here; suggestions are welcome.
• Sorry you didn't like the joke. The point of it was not that there is controversy on this talk page, but that there is controversy among chiropractors. This controversy should be covered fairly and neutrally.
• The NCCAM (the alt-med part of NIH) was set up by Congress, not by scientists. It is a reliable source about some aspects of chiropractic (e.g., federal research funding), but it is not a good source for others. Its main web page on chiropractic, for example, is entirely silent about the effectiveness of chiropractic care; that is a huge omission.

Eubulides (talk) 07:19, 30 August 2008 (UTC)

Law suit against Simon Singh and broader issues of controversy

British Chiropractic Association has issued a lawsuit against Simon Singh.

http://wiki.riteme.site/wiki/Simon_Singh

This lawsuit is part of broader controversy about Chiropractic in the UK and NZ which this article doesn't really imply.

Ben Goldacre for example criticises the Association for resorting to legal methods over scientific ones: http://www.badscience.net/2008/08/silence-dissent/

"While chiropractors struggle to manifest to their customers an air of academic rigour, their actions in this letter demonstrate more than anything else how little they understand the simple day to day business of academic journals, journal clubs, work in progress seminars and indeed the entirety of medicine: we take the piss out of each others ideas. We criticise them. We tear them apart, mercilessly. When we criticise survival stats, or the interpretation and analysis of data, make no mistake: we are accusing each other of killing patients unnecessarily. This is the bread and butter of academia and medicine. Only very occasionally does anyone take personal offense."

The impression I get is that in Britain at least Chiropractic is viewed in much the same light as Homoepathy. This article I think should reflect more that there is a substantial voice that view Chiropractic as totally ineffective. Macgruder (talk) 10:55, 28 August 2008 (UTC)

I don't think that the BCA lawsuit against Singh deserves much attention here. It is much more relevant to Simon Singh than it is to Chiropractic. As for the article reflecting a "substantial voice", we need to keep a neutral point of view. If there were reliable sources that described this "substantial voice that [views] Chiropractic as totally ineffective", it might warrant inclusion. - DigitalC (talk) 23:25, 28 August 2008 (UTC)

I agree with DigitalC; it's not worth mentioning in the top-level Chiropractic article. It might be worth mentioning in some subarticle, though I don't offhand know what that would be. Eubulides (talk) 01:18, 29 August 2008 (UTC)

Chiropractors Try to Silence Simon Singh, Beware the spinal trap, and Trick or Treatment: The Undeniable Facts about Alternative Medicine Simon Singh is an expert on chiropractic. We can use the reference. I think it is relevant. A book called Trick or Treatment written by Simon Singh may also be relevant for this article. QuackGuru 02:00, 29 August 2008 (UTC)

These sorts of highly partisan topics are best avoided here as they are needlessly inflammatory and highly political. For example, where is the proof that Sighn is a "expert on chiropractic". To let in a book of that nature (skeptical) we would also have to let in pro-partisan books as well which would quickly escalate a battle between POV. This article needs to better separate the "beliefs" and the "theories" from what the public, governments, health-care agencies, insurers and scientists accepts as "mainstream". Based on another thread somewhere here, it says that chiropractic therapy for muscle and joint problems is OK, but for asthma, ear infections and similar complaints it is quackery? Why not make a distinction clear? —Preceding unsigned comment added by Soyuz113 (talk • contribs) 03:31, 29 August 2008 (UTC)

You're missing the point here. You don't need to be an expect in Chiropractic to talk about scientific method and comment on the fact a law suit is happening. I think it is relevant because I know of no other health body in the UK at least, or scientific body for the matter, that has resorted to a legal challenge to their methods over a scientific one. (Where is the proof that sociologist Dr. Yvonne Villanueva-Russell is an expert either.) Macgruder (talk) 05:22, 29 August 2008 (UTC)

• Villanueva-Russell is not an expert on biomechanics or anything like that, but she is an expert on the sociology of chiropractic, e.g., issues such as the politics of evidence-based guidelines.
• As WP:MEDRS suggests, it's better to cite sources in peer-reviewed medical journals than to cite popular books, when talking about biomedical topics. Trick or Treat is coauthored by Ernst, and I expect that anything interesting it has to say about the evidence basis has already appeared in some peer-reviewed medical journal article by Ernst, which we can cite. Perhaps I'm wrong; if so, please enlighten us.

Eubulides (talk) 07:19, 30 August 2008 (UTC)

Chiropractors in Finland

A new survey:

• Chiropractors in Finland - a demographic survey, Chiropractic & Osteopathy 2008, 16:9 doi:10.1186/1746-1340-16-9

-- Fyslee / talk 00:28, 29 August 2008 (UTC)

My kneejerk reaction is that it looks a bit specialized for here, but might be suitable for a subarticle. Eubulides (talk) 01:18, 29 August 2008 (UTC)

There might be some usable information for schools of though/practice styles, when it states: "The vast majority described their scope of practice to be based on a musculoskeletal approach" or "Most reported to have a musculoskeletal approach, using mainly Diversified Manipulation Technique, Soft Tissue Techniques and Activator Instrument. These are methods previously reported frequently to be used in Europe" or "Finnish chiropractic profession is relatively young, these chiropractors appeared to have a traditional practice profile: solo practice, a musculoskeletal approach, allowing good time for examination and treatment". - DigitalC (talk) 23:59, 29 August 2008 (UTC)

Well, I'm not entirely opposed, depending on the detailed wording that would be proposed. But surely the stuff that is not specific to Finland (e.g., musculoskeletal preference) can be sourced more globally? Diversified is #1 in the U.S. too, no? And the stuff that are specific to Finland (e.g., young profession) isn't notable enough for this article, unless I'm missing something. Eubulides (talk) 07:19, 30 August 2008 (UTC)

If we had a source that stated that "the vast majority describes their scope of practice to be based on a msuculoskeletal approach" that was sources globally, I think it would fix at lot of the issues here. I also haven't seen much mention in the article of soft tissue therapy, which is used extensively by Chiropractors. - DigitalC (talk) 02:04, 1 September 2008 (UTC)

NPOV language towards end of Philosophy intro

The following text at the end of the Chiropractic #Philosophy intro has multiple WP:NPOV issues:

This "straight" philosophy, taught to generations of chiropractors, rejected the inferential reasoning of the scientific method, and relied on deductions from vitalistic principles rather than on the materialism of science.

As chiropractic has matured, most practitioners accept the importance of scientific research into chiropractic. Balancing the dualism between the metaphysics of their predecessors and the materialistic reductionism of science, their belief systems blend experience, conviction, critical thinking, open-mindedness, and appreciation of the natural order. They emphasize the testable principle that structure affects function, and the untestable metaphor that life is self-sustaining. Their goal is to establish and maintain an organism-environment dynamic conducive to functional well-being of the whole person.

Here are some of the POV issues:

• The first sentence uses past tense "rejected"/"relied", which implies that straight philosophy is obsolete. It should use present tense.
• The second sentence uses "matured", which implies that mixer chiropractic is better than straight.
• The "Balancing" sentence contains many POV words and phrases, including "balancing", "blend", "experience", "conviction", "critical thinking", "open-mindedness", "appreciation of the natural order".
• The "They emphasize" sentence gives the impression that Wikipedia editors agree with chiropractic theories that there is a "testable principle that structure affects function" and an "untestable metaphor that life is self-sustaining".
• The "Their goal" sentence gives the impression that Wikipedia editors agree with the theory that chiropractors "establish and maintain an organism-environment dynamic conducive to functional well-being of the whole person".

Also, the last three sentences are uncomfortably close to plagiarism, in the sense that they quote too directly from the source without using quote marks. There is no legal problem with this (the source is public-domain), but still there is an ethical problem. Here's what the source says:

Contemporary chiropractic belief systems embrace a blend of experience, conviction, critical thinking, open-mindedness, and appreciation of the natural order of things. Emphasis is on the tangible, testable principle that structure affects function, and, the untestable, metaphorical recognition that life is self-sustaining and the doctor’s aim is to foster the establishment and maintenance of an organism-environment dynamic that is the most conducive to functional well-being.

Furthermore, aside from introducing POV, the last three sentences overall don't say much that is not said elsewhere in Chiropractic #Philosophy. What they do is add a sales pitch, which is not Wikipedia's function.

To fix the above problems, I propose replacing the above text with the following:

This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic principles rather than on the materialism of science. However, most practitioners currently accept the importance of scientific research into chiropractic, and attempt to "mix" the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness.

Eubulides (talk) 22:48, 20 August 2008 (UTC)

You need a period before "However". That second sentence also needs a qualifier to contrast it with the first sentence about "straight" philosophy. -- Fyslee / talk 05:28, 21 August 2008 (UTC)

Thanks, fixed the period. What sort of qualifier did you have in mind? The 2nd sentence uses "mix"; would you prefer "mixer", as a better contrast from "straight"? Eubulides (talk) 09:05, 21 August 2008 (UTC)

Yes, that sounds like a possibility. Let's see how it looks:

This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic principles rather than on the materialism of science. However, most mixers currently accept the importance of scientific research into chiropractic, and attempt to "mix" the materialistic reductionism of science with the metaphysics of their predecessors, as well as with the holistic paradigm of wellness.

How's that? I replaced "practitioners" with "mixers" and "and" with "as well as". -- Fyslee / talk 02:52, 22 August 2008 (UTC)

Unfortunately I think the source says most practitioners, not most mixers. Eubulides (talk) 08:58, 22 August 2008 (UTC)

Good point. We could clarify that "most practitioners - who also happen to be mixers - currently accept ..." without doing any OR. That's a documented fact. Somehow that can be tweaked to make it clear. -- Fyslee / talk 14:22, 22 August 2008 (UTC)

I dunno, it's pretty close to OR to combine the "most practitioners are OR" and "most practitioners accept scientific research" into "most practitioners, who also happen to be mixers, accept scientific research". One can easily construct scenarios where the first two facts are true but the rewritten combination is false. For example, the currently-cited sources do not exclude the (admittedly bizarre) possibility that 60% of DCs are mixers, 60% of DCs accept scientific research, but only 33% of DC mixers accept scientific research. Come to think of it, my proposal suffers from this problem as well. How about the following tweak instead?

This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic principles rather than on the materialism of science. However, most practitioners currently accept the importance of scientific research into chiropractic, and most practioners are "mixers" who attempt to combine the materialistic reductionism of science with the metaphysics of their predecessors and with the holistic paradigm of wellness.

Eubulides (talk) 22:05, 25 August 2008 (UTC)

Sounds like a good solution, without the problems. -- Fyslee / talk 05:15, 26 August 2008 (UTC)

No further comment, so I installed that change. Eubulides (talk) 01:35, 2 September 2008 (UTC)

Busse et al. 2008

The following text was added to Chiropractic #Vaccination without discussion:

At two majors complementary and alternative medicine colleges in Canada, a minority of students were anti-vaccination and the majority of students were supportive of vaccination.

There are some problems with this addition:

• The word "majors" doesn't make sense to me.
• Those results are too vague; they report only "minority" and "majority".
• The study covered a chiropractic college and a naturopathic college, and it separated out the two colleges' results; there's no reason to report the combined results when results specific to chiropractic are available. The naturopathic college need not even be mentioned.

If that study is mentioned, which is not clear to me that it should be, here is some other information that's relevant:

• The study reported that, for the chiropractic-college students, "the proportion of respondents who stated that they were against vaccination in general increased along with year of study: 4.5% (5/112) first year students, 8.3% (10/121) second year students, 13.9% (16/115) third-year students, and 29.4% (35/119) fourth year students."
• Students said that their most important source of vaccine information was informal, and that this tendency was far more pronounced as the class-year went up. First-years said 2% of their vaccination information came from formal and 0% from informal sources; fourth-years said 7% of their vaccination information came from formal and 46% from informal.
• The study was longitudinal; that is, it was all done the same year, and did not follow single students from one year to the next.

I propose that that the text be removed, as I don't think it adds much to the section; but if it is kept it really needs improvement. For now I've given it a vague tag. Eubulides (talk) 02:09, 21 August 2008 (UTC)

The more important question is whether the students were being taught anything about vaccination as part of their chiropractic studies. How is a survey about vaccination any more notable than a survey about Britney Spears? --Surturz (talk) 05:25, 21 August 2008 (UTC)

Vaccination is a health topic; Britney Spears is not. Some chiropractors aim to be primary health care providers; they do not typically aim to be Britney Spears fans (at least, they don't write papers about it :-). Eubulides (talk) 09:05, 21 August 2008 (UTC)

Eubulides, I agree with you. The addition is poorly worded and needs improving. The study is significant, especially since it shows that anti-vaccination sentiments increased among students, IOW future chiropractors, IOW the profession of the future. The mention of students should be included in a properly worded manner. I suggest it be included and merged with the following:

• Historically, chiropractic strongly opposed vaccination based on its belief that all diseases were traceable to causes in the spine, and therefore could not be affected by vaccines; Daniel D. Palmer, the founder of chiropractic, wrote, "It is the very height of absurdity to strive to 'protect' any person from smallpox or any other malady by inoculating them with a filthy animal poison." Vaccination remains controversial within chiropractic. The American Chiropractic Association and the International Chiropractic Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; however, surveys in Canada in 2000 and 2002 found that only 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children. Although most chiropractic writings on vaccination focus on its negative aspects, antivaccination sentiment is espoused by what appears to be a minority of chiropractors.

This content is from the Vaccine controversy article and has already passed muster as properly written and reliably sourced content. -- Fyslee / talk

• That material all used to be in Chiropractic, if memory serves, but got edited down using the argument that all that detail wasn't needed here.
• Actually, the study doesn't demonstrate that antivaccination sentiment increased in any particular student, since it took a cross-section of students.
• More recently, the text in question has been altered to make it even less coherent, here. I attempted to fix the immediate problem with this change. I am still not convinced this material about CMCC students needs to be in Chiropractic though; it's a bit marginal. Perhaps it should be moved to Vaccine controversy?

Eubulides (talk) 09:05, 21 August 2008 (UTC)

It should be somewhere. If here, then in a shortened version. -- Fyslee / talk 03:05, 22 August 2008 (UTC)

No it shouldn't be used anywhere. It is a badly constructed, politically motivated opinion poll and should not be considered a WP:RS. --Surturz (talk) 05:27, 26 August 2008 (UTC)

The study is published in a peer-reviewed journal by experienced authors. No evidence has been presented that it is politically motivated or badly constructed. Surveys are an important part of research, when the subject, as in this case, is opinion. Eubulides (talk) 08:43, 26 August 2008 (UTC)

At the moment I don't think I have access to the full-article. Is the 2008 study really publishing data obtained back in 1999-2000? Wasn't this data published back in 2002 by Busse & Injeyan? - DigitalC (talk) 00:37, 28 August 2008 (UTC)

Yes, it's studying data gathered in 1999-2000. I don't know of a 2002 study by Busse & Injeyan; do you have a citation for that? Eubulides (talk) 02:38, 28 August 2008 (UTC)

Here is a link. Looks like the same data to me. cmaj.ca. - DigitalC (talk) 05:52, 28 August 2008 (UTC)

In #Vaccination draft below I am proposing to remove the (updated) version of this sentence. Eubulides (talk) 01:37, 2 September 2008 (UTC)

I prefer we keep the updated sentence in the article. The student bit is an important point. Students are being taught by chiropractic authors about antivaccination in chiropractic circles. QuackGuru 02:39, 2 September 2008 (UTC)

OK; could you please raise this point in #Vaccination draft? That will make it easier to keep track. Note that the study did not conclude that students are being taught by chiropractic authors; it wasn't sure where the influence was. Eubulides (talk) 07:31, 2 September 2008 (UTC)

Opening Paragraph contains weasel words, and other issues.

"In recent decades chiropractic has gained more legitimacy(who?) and greater acceptance among physicians(who?) and health plans(who?) and has had a strong political base(?) and sustained demand(by who?) for services,[11] and evidence-based medicine has been used to review research studies and generate practice guidelines.[12]"

The source given certainly cannot make all these claims. It should be balanced with a recent study

From the Journal of The Royal Society of Medicine http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

Collectively, these data suggest that spinal manipulation is associated with frequent, mild and transient adverse effects as well as with serious complications which can lead to permanent disability or death [...]. In conclusion, spinal manipulation, particularly when performed on the upper spine, has repeatedly been associated with serious adverse events. Currently the incidence of such events is unknown. Adherence to informed consent, which currently seems less than rigorous,75 should therefore be mandatory to all therapists using this treatment. Considering that spinal manipulation is used mostly for self-limiting conditions and that its effectiveness is not well established, we should adopt a cautious attitude towards using it in routine health care.

The does not imply 'more legitimacy', 'greater acceptance' but rather totally the opposite. I think the Medical Journal contains substantially more weight here than a paper Dr. Yvonne Villanueva-Russell who is a sociologist. Certainly the above sentence strongly implies a broad support of the effective of chiropractic which top medical journals don't seem to support. Macgruder (talk) 05:24, 29 August 2008 (UTC)

This kind of problem runs through the whole article. Take a typical sentence like this:

Opinions differ as to the efficacy of chiropractic treatment; many other medical procedures also lack rigorous proof of effectiveness.[13]

This kind of sentence has no place in an encyclopedia. Qualifying that chiropractic may not work but some other stuff, which we won't mention, doesn't work either seems to me to be a sign of desperation to hide the fact that chiropractic simply does not have any weight of evidence behind its effectiveness, and as the above citation shows may be in fact the opposite. Macgruder (talk) 09:06, 29 August 2008 (UTC)

• There are undoubtedly some biases in the article. It would be helpful to propose detailed solutions, in form of the exact textual changes that should be made, along with why they need to be made. I suggest starting with one or two small change proposals.
• "gained more legitimacy" comes from the cited source, Cooper & McKee 2003 (PMID 12669653), which says in its 1st sentence, "From its origins as an unconventional therapy in the late 19th century through decades of marginalization during the 20th century, chiropractic has acquired legitimacy and prominence"
• "greater acceptance", "physicians", "health plans", and "sustained demand" comes from the same source, which says the following in its 2nd and 3rd sentences: "Signs of its success abound. They include a broadening of the laws and regulations affecting its licensure, scope of practice, and reimbursement; greater acceptance by both physicians and health plans; and a sustained demand for its services."
• "strong political base" comes from its 4th sentence: "Chiropractic's political base is strong, and it enjoys a high degree of patient satisfaction."
• The balancing source you suggest, namely Ernst 2007 (PMID 17606755), is already cited in Chiropractic. It is cited four times, more often than Cooper & McKee, so in that sense the article is already balanced.
• The claims supported by Cooper & McKee do not conflict with the quoted claims made by Ernst 2007. For example, it is quite conceivable for a profession to gain legitimacy even if the profession espouses a risky treatment.
• The "Opinions differ" quote is supported directly by the cited source, namely DeVocht 2006 (PMID 16523145). The quote makes what on the surface is a reasonable point, which is that many medical fields lack strict proof of effectivenes (e.g., randomized controlled trials). Heart transplants are one example, I expect: I'd hate to be the patient receiving the placebo!

Eubulides (talk) 07:19, 30 August 2008 (UTC)

Unfortunately, here we're talking about the introduction to Chiropractic, so although there may be balance later on in the article, this balance needs to occur in the introduction itself. Furthermore, the paper you are citing at great length within this introduction is simply one paper referring to chiropractic in the States (the fact that C was developed in the States is irrelevant to the need for a world viewpoint). It needs to be balanced with the fact that in the UK at least Chiropractic is more regarded as quack medicine.

Futhermore, the introduction reads like original research to me in that although the citations themselves are obviously not original research, the selection and presentation of them is. Commentators like Ben Goldacre are relevant to the introduction because he is Guardian journalist/physician who specializes in writing about the scientific method. The objection 'Ben Goldacre is not an expert in Chiropractic' is mistaken: His writings contain the necessary citations and by using a respected commentator you are not falling into the trap of original research by inappropriate synthesis. (Of course, this can be balanced by a respected source with an opposite viewpoint if one exists).

I think the whole intro should be rewritten to be honest to reflect the fact that in other countries Chiropractic like Homeopathy is not very highly regarded. On top of which I think the efficacy issue should be given bigger weight. These are just my thoughts. Macgruder (talk) 08:58, 31 August 2008 (UTC)

Just goes to show how the UK remains backwards :) Chiropractic in Australia is well respected, the courses are taught in major universities, our health funds cover chiro treatment, and the government subsidises chiropractic treatments when referred by a GP. There are chiropractors in most suburbs of Sydney. I am not saying the Aus medical profession don't generally disdain chiro - they do - but no more than they disdain everything else by non-doctor health providers (dietitians, physio, nursing etc etc). --Surturz (talk) 12:14, 31 August 2008 (UTC)

• Specific suggestions for wording improvement would be helpful; it's hard to respond to vague "selection and presentation" criticisms.
• Most chiropractors are in the U.S., so a U.S.-centric viewpoint is appropriate here. Of course the rest of the world should not be neglected.
• Ben Goldacre is a reliable source for many things; I haven't seen any arguments here against him.

Eubulides (talk) 22:36, 1 September 2008 (UTC)

• Cool. Sometime, I'll see if I can up with something.
• However, "Most chiropractors are in the U.S., so a U.S.-centric viewpoint is appropriate here." is certainly not Wikipedia policy WP:BIAS and of course it breaks the pillar of Wikipedia WP:NPOV ( and here WP:SUBSTANTIATE that I brought up). Most English speakers are in the U.S. too, but that doesn't mean that the English article should be U.S.-centric.

Macgruder (talk) 07:32, 2 September 2008 (UTC)

• Thanks; we appreciate whatever effort you can provide.
• This is a bit off the subject, but List of countries by English-speaking population disagrees with the claim that most English speakers are in the U.S.; it says there are more outside the U.S. than in. In contrast, according to Chiropractic #Education, licensing, and regulation, the vast majority of licensed chiropractors are in the U.S.

Eubulides (talk) 07:41, 2 September 2008 (UTC)

Only if you include 2nd language speakers :-) It's beside the point. It doesn't matter what percentage. Because if you think about it by definition societies that have deemed Chiropractic ineffective won't have many practitioners, but it wouldn't make their viewpoint any less significant. Macgruder (talk) 09:05, 2 September 2008 (UTC)

I hadn't thought of that. Do you have a reliable source that makes that point? If so, we could write up some wording to that effect. Eubulides (talk) 18:01, 2 September 2008 (UTC)

Only a legal defense?

I have long questioned the idea that the religious/metaphysical beliefs of Palmer were only invented as a legal defense. Palmer was a spiritualist, vitalist, and magnetic healer long before "inventing" chiropractic. His religous ideas weren't new ones invented to serve as a legal defense, although they were certainly used for that purpose

While he wasn't above historical revisionism, exaggeration, and deception (the twisted version of the Lillard story, with BJ Palmer perpetuating the myth), I think the following article has a point. It is in Today's Chiropractic Lifestyle, a RS as far as chiropractic opinion is concerned:

There is a revisionist trend in the history of chiropractic today, which claims that the philosophy of chiropractic was only developed to win legal battles. And now that the profession is established, the philosophy should be abandoned. This trend is partially true; the philosophy was indeed used to legalize chiropractic. The first landmark court case to establish chiropractic’s legitimacy was in 1907, Wisconsin vs. Morikubo. In the case it was shown that chiropractic had a distinct philosophy. After this case, B.J. Palmer had the faculty grant him a Ph.C., he re-titled his 1906 book to include philosophy in the title, and then in 1910 D.D. Palmer’s book was published and it, too, addressed philosophy. According to this revisionist approach to history, the philosophy of chiropractic was a legal ploy. Chiropractic became a distinct profession in the courts because it had a distinct philosophy and approach to health.

The revisionists would have us believe the surface only. The fact is, there were about 3,300 court cases against chiropractors won on these grounds. B.J. was an expert witness in many of the trials. Are we to leave it at that or go deeper? I wish chiropractic school had prepared me to discuss these questions. This revisionist argument implies that D.D. Palmer used his final years to create a fictitious philosophical legal defense (that, by the way, was a clear descendent from his Mesmeric, and Spiritualist roots). Are we also to believe that his son B.J. was to spend the next 54 years espousing and evolving a philosophical system of life, health and spirit just for legal reasons? [25]

Should this be added as a qualifying source to balance what we already have in the article? -- Fyslee / talk 06:59, 2 September 2008 (UTC)

I don't see any claim in Chiropractic that its philosophy was developed only to win legal battles. It's not clear to me what this somewhat-speculative article would add to Chiropractic. Perhaps a (presumably brief?) wording-change proposal would clear up my confusion? Eubulides (talk) 07:31, 2 September 2008 (UTC)

Vaccination draft

Although vaccination is one of the most cost-effective forms of prevention against infectious disease, it (Vaccination) remains (is) controversial within the chiropractic community. Most chiropractic writings on vaccination focus on its negative aspects,[10] claiming that it is hazardous or ineffective.[107] Additionally, a segment of chiropractors support freedom of choice as opposed to compulsory vaccination. (Principles and Practice of Chiropractic, pg 197) Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease.[59] The Canadian Chiropractic Association supports vaccination; surveys in Canada in 2000 and 2002 found that 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children.[10] A survey of Canadian Memorial Chiropractic College students in 1999–2000 reported that more-senior students opposed vaccination more strongly, with 29.4% of fourth-year students opposing vaccination.[108]--—CynRN ^(Talk) 06:34, 28 August 2008 (UTC)

---

If vaccination is taken out as a section and put in somewhere else, I am not sure where it would fit? As has been pointed out, the anti-vac stance is not limited to straight chiropractors. The large minority of chiropractors who are 'anti' or neutral is notable and deserves some 'weight' in the article. The wording can be tweaked, as I did above with the strikeouts, to soften the tone. The sentence "evidence-based chiros....disease cannot be affected by vaccines" could theoretically be thrown out, for further brevity, and the section would still make it's point...--—CynRN ^(Talk) 06:28, 29 August 2008 (UTC)

• As for location, I proposed in Talk:Chiropractic/Archive 26 #Attacks on vaccination section (this edit) to put it in Chiropractic #Schools of thought and practic styles, but nobody has agreed with that so I'm loath to do it.
• Striking out the last sentence is reasonable, as it's not that notable. However, the first sentence is supported by the source and is an important part of the dispute. I agree that the idea could be worded less contentiously. How about starting with "Vaccination is controversial" and then putting the cost-effective bit later? The "support freedom of choice" wording repeats what is already in the phrase "support individual exemptions to compulsory vaccination laws", but is far more POV; I would omit it as redundant and POV. Here is a proposed revision that reflects the above proposals:

Vaccination is controversial within the chiropractic community. Although it is one of the most cost-effective forms of prevention against infectious disease, most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective. Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; surveys in Canada in 2000 and 2002 found that 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children.

Eubulides (talk) 07:19, 30 August 2008 (UTC)

I like the lead-in better in your draft. Less POV, maybe. I think the vaccine controversy deserves it's own section here in the article. Potential or current chiropractic patients should have this information. I see someone's taken out the 'Evidenced-based' sentence. I didn't mean for that to happen without discussion. Everything in your draft is sourced and sounds pretty neutral. I don't really understand all the objections.--—CynRN ^(Talk) 17:24, 30 August 2008 (UTC)

version by Soyuz is much better. I don't think it deserves any mention at all, but at least Soyuz' version is NPOV and not attempting to paint the entire chiropractic discipline with the anti-vaccination brush. --Surturz (talk) 22:35, 30 August 2008 (UTC)

Please see the followup in #Vaccination redux below. Eubulides (talk) 22:36, 1 September 2008 (UTC)

The version starting with Vaccination is controversial within the chiropractic community. is good except it is missing the additional improvements at the end of the section. QuackGuru 02:33, 2 September 2008 (UTC)

• There are two sentences at the end of Chiropractic #Vaccination that I assume you are referring to as improvements.
• "A survey of Canadian Memorial Chiropractic College students in 1999–2000 reported that seniors opposed vaccination more strongly than freshmen, with 29.4% of fourth-year students opposing vaccination." I don't have a strong opinion about this sentence one way or another; it's OK, but it isn't that important. Perhaps other editors can opine about it.
• "There appears to be a small group of chiropractic authors who promote antivaccination citing questionable research." This sentence is almost entirely duplicative of earlier material in the same paragraph: "it remains controversial within the chiropractic community, with most chiropractic writings on vaccination focusing on its negative aspects, claiming that it is hazardous or ineffective." There is no need to say the same thing twice, surely. If there's something new in the "small group" sentence, perhaps it should be mreged into the "it remains controversial" phrase?

Eubulides (talk) 07:31, 2 September 2008 (UTC)

There is a difference with the last sentence. It explains about chiropractic authors promote antivaccination. The last sentence could be merged into the chriopractic writings and the first sentence broken into two sentences as I proposed before. The first sentence in vaccination is too long. QuackGuru 17:17, 2 September 2008 (UTC)

Thanks, could you please identify the "as I proposed before" wording? Or copy it here? There are a lot of wordings being proposed and I'm not sure which one you mean. Eubulides (talk) 18:01, 2 September 2008 (UTC)

Vaccination is controversial within the chiropractic community. Although it is one of the most cost-effective forms of prevention against infectious disease, most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective.

My proposal before was to split the first sentence in two sentences. But now we can merge the last sentence into the second proposed sentence.

"There appears to be a small group of chiropractic authors who promote antivaccination citing questionable research."

This is the last sentence in vaccination that can be merged and shortened into another sentence. The point being made is that antivaccination is being promoted. QuackGuru 18:17, 2 September 2008 (UTC)

I propose to delete this section and maybe give this vaccination discussion a brief mention elsewhere in the article. This is really overblown nonsense. I suspect it deserves maybe a one-sentence mention in the article - if that. -- Levine2112 ^discuss 01:28, 3 September 2008 (UTC)

It is not "overblown nonsense" to summarize a notable departure by a substantial number of chiropractors from a widely accepted and important public health practice. Several peer-reviewed papers have been written on the subject, and it is well worth summarizing in a brief paragraph; one sentence wouldn't do it justice (unless it was a very long sentence :-). Eubulides (talk) 01:50, 3 September 2008 (UTC)

(outdent) OK, thanks to QuackGuru for the clarification. Here is a proposed rewording that tries to take QuackGuru's comments into account:

Vaccination is controversial within the chiropractic community. Although it is one of the most cost-effective forms of prevention against infectious disease, what appears to be a relatively small number of authors generate most chiropractic writings on vaccination, focusing on its negative aspects and claiming that it is hazardous or ineffective. Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; surveys in Canada in 2000 and 2002 found that 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children. A survey of Canadian Memorial Chiropractic College students in 1999–2000 reported that seniors opposed vaccination more strongly than freshmen, with 29.4% of fourth-year students opposing vaccination.

Eubulides (talk) 01:50, 3 September 2008 (UTC)

The second sentence is confusing to me. I'm not sure how to merge this short sentence into the second sentence. A relatively small number of authors continue to promote an antivaccination philosophy. QuackGuru 02:49, 3 September 2008 (UTC)

The short sentence is already merged into the 2nd sentence of this latest draft. Obviously there is some confusion here though; can you please explain the confusion you see in the 2nd sentence there? Eubulides (talk) 04:08, 3 September 2008 (UTC)

The 2nd sentence in the latest draft does not flow well and is hard to follow. QuackGuru 04:20, 3 September 2008 (UTC)

Too long and too overblown. This would be better suited at Vaccine controversy. Here it is just a minor subtopic, too tangential to go into such detail on. -- Levine2112 ^discuss 05:38, 3 September 2008 (UTC)

• OK, how about replacing the first two sentences with the following instead?

Vaccination is controversial within the chiropractic community. A relatively small number of authors generate most chiropractic writings on vaccination, one of the most cost-effective forms of prevention against infectious disease; these authors focus on vaccination's negative aspects and claim that it is hazardous or ineffective.

• The proposed rewording would slightly shorten the section in question (by my count, it's 5 words shorter), so it should be a slight improvement from Levine2112's viewpoint, even if it obviously does not accomplish everything Levine2112 wants.

Eubulides (talk) 20:40, 3 September 2008 (UTC)

We can keep the sentence as is or simply delete it. I prefer to delete it instead of the proposed merge because the original meaning is lost. Or we can readd the short sentence at the end. QuackGuru 00:27, 4 September 2008 (UTC)

Adding the words However, only to the beginning of the sentence is unnecessary. QuackGuru 00:34, 4 September 2008 (UTC)

Moving CAM issue from Scope of practice

This recent change was installed with neither discussion nor consensus; this is not a good procedure. A fairly recent thread, Talk:Chiropractic/Archive 25 #Fix for CAM claim contained a discussion of that very point. It was proposed on July 29 to move the text in question to Chiropractic #Scope and practice; a bit of discussion ensued, and on August 25 the change was finally made (please see Talk:Chiropractic/Archive 26 #Chiropractic-as-CAM out of utilization and satisfaction for the announcement). This is in sharp contrast with today's change. I don't see why today's change is for the better, as the matter seems more relevant to scope of practice (where does chiropractic fit into the rest of the world?) rather than schools of thought (what distinguishes straights from mixers?); but regardless of my opinion, changes like these should be discussed first. Eubulides (talk) 01:50, 3 September 2008 (UTC)

As a controversial undiscussed change, it should be restored to its original consensus location. -- Fyslee / talk 04:06, 3 September 2008 (UTC)

Done, including other undiscussed edits, and even one by CorticoSpinal himself, using an IP. -- Fyslee / talk 05:42, 3 September 2008 (UTC)

Other procedures lack rigorous proof

I disagree with this recent edit, which removed the phrase "many other medical procedures also lack rigorous proof of effectiveness". That phrase is there because of a common theme in many sources that although chiropractic care has not been rigorously proven, in this respect it's in the same boat as many other forms of medical treatment. That's an important point, which should be made. All too often, chiropractic critics say "the science isn't there" without noting that the science isn't there for many other forms of medical treatment, too. We had a long discussion about this in Talk:Chiropractic/Archive 22 #"Rigorously proven" and the current wording is the result of quite a bit of consensus-searching. Let's keep it. Eubulides (talk) 07:48, 2 September 2008 (UTC)

Well, there are lots of problems with the statement.

• The scientific method is unconcerned with whether other perhaps unrelated disciplines are 'proven' or not. Being 'guilty of not working' is not mitigated by the fact that other procedures may not work.(This is the section about efficacy after all)
• The science is not there for other procedures. The doesn't mean anything scientifically. Science and medicine is not relative to other results - burden of proof is independent. Medicine is required to show that a procedure works better that the placebo. If it doesn't it's not medicine. If chiropractic shares this lack of efficacy with other procedures then all you can say is 'Chiropractic has not been proved to work beyond the placebo effect'. No doubt not working is shared with many other procedures: prayer, applying leeches, etc. What doesn't work 'medically' (after being subjected to the scientific method) is by definition not medicine. Of course, new procedures are tried all the time, and they are subjected to trials. If after being subjected to these trials they are not shown to be effective they tend to be discarded or modified and tested again.
• It is for this reason that some scientific/medical commentators (such as Richard Dawkins) call the term 'alternative medicine' misleading. 'If a medicine is shown to work it is simply medicine.' If it cannot be shown to work it isn't. (Obviously new procedures and treatment in the midst of trials may in future be shown to work).
• Saying 'many other medical procedures' fails Wikipedia policy for a number of reasons. First it's weasel words, and to paraphrase Wikipedia policy itself is easily countered with a statement such as 'so what if leeching and homeopathy lack rigorous proof'. See here: WP:SUBSTANTIATE and here: WP:WEASEL which says "This page in a nutshell: Avoid using fuzzy, estimated statistics..."
• This whole idea that the 'science isn't there for other things' is really just an excuse in the scientific world for when something doesn't work. If the science is not there for 'these other things' (weasel words!) then 'those other things' don't work either. That's all there is to it. Scientifically, if that is the case, this and those other things get consigned to the trash can equally. Now, if there is an issue with the Wikipedia articles about 'those other things', then go to those pages and make the appropriate edits there.

As an aside, it's a myth that science/medicine is somehow not open to new ideas. Quite the opposite. Medicine simply requires something to work (beyond placebo). I'll stand on my head and listen to Abba backwards to cure an ailment if it passes scientific rigour. And doctors will equally prescribe it as treatment.

Macgruder (talk) 08:41, 2 September 2008 (UTC)

I am sympathetic to many of these points, but I disagree with the blanket statement "Medicine is required to show that a procedure works better that the placebo." Medicine is not science, and physicians must sometimes act even when they don't have a course of action that has been scientifically proven. In some cases these actions turn out to be wrong when science has its say, but that doesn't mean that they weren't best medical practices at the time. Assessing Medical Technologies (ISBN 030903583X, page 562) gives the examples of gastric freezing in the treatment of peptic ulcer disease, and internal mammary artery ligation for coronary artery disease; these were widely accepted medical practices that lacked scientific evidence. I expect that many current practices are in the same boat. Eubulides (talk) 18:01, 2 September 2008 (UTC)

Well, you seem to contradicting yourself here:

"Medicine is not science, and physicians must sometimes act even when they don't have a course of action that has been scientifically proven. In some cases these actions turn out to be wrong when science has its say, but that doesn't mean that they weren't best medical practices at the time."

This action is precisely the scientific method (you are confusing 'proven with science' with 'science' itself: i.e. the scientific method) . If the result of an action is unknown, you can still carry it out. But to decide whether it works the scientific method is required. Besides take a look at the medicine article itself where it clearly states that medicine is a science; at least what cannot be under ANY dispute is when talking about the efficacy of a medical approach then that is science. My edit was in the efficacy section. (It is probably for this very reason that 'medical' procedures such as 'homeopathy', 'chiropractic' command little respect amongst the scientific community: if you are not prepared go by results subjected to the rigor of science then it's no more than anecdotal evidence.) A well-known example is Einstein's Laws of Relativity. When he proposed them, they had not yet been subjected to testing, but it was still science. The first step of the procedure: the proposal of a theory. Then they were subjected to the scientific method, and the theory matched the observation, then the theory is accepted.

Obviously there is a grey area. Here we are not talking about a particular treatment like a new drug. We are talking about a whole branch of treatment that has been around for over 100 years. If correctly carried out testing has not shown any statistically efficacy of the treatment then there becomes a point where it is rejected as medicine (like applying leeches). Unfortunately, the paper in your introduction that talks about the testing is written by a practitioner from Palmer College of Chiropractic which has a vested interest in saying that Chiropractic works (and besides which it is not a scientific review paper) . More recent papers doing scientific analysis (a scientific review paper) on previous studies say : ' "no convincing evidence from systematic reviews to suggest that [spinal manipulation] is a recommendable treatment option for any medical condition."'

For the efficacy section, you must just stick to the science.

Obviously, much of this 'science' discussion is moot regarding the edit. The way it stands breaks Wikipedia policy as I have written above anyway (and regards the science - there is no avoiding it when talking about efficacy )

The short version as quoted by Ben Goldacre: "Evidence based medicine is the applied science (that has probably saved more lives in the last 50 years than any other)" .

Macgruder (talk) 08:52, 3 September 2008 (UTC)

• Again, I am sympathetic with most of what you're writing. Still, the grey area you mention is larger than we'd like, even in well-accepted areas of medicine. Most available evidence in surgery comes from non-scientific studies: surgeons routinely consult narrative or qualitative reviews, or cohort studies, but rarely consult randomized controlled trials or meta-analyses. Part of this is due to the difficulty of doing evidence-based surgery: it is hard, for example, to construct a good placebo that resembles open-heart surgery! For more on this subject, please see Slim 2005 (PMID 15827835).
• DeVocht 2006 (PMID 16523145) is pretty recent. As far as I can see, none of the more-recent reviews that you allude to are relevant to the "many other medical procedures also lack rigorous proof of effectiveness" wording. They talk about evidence of effectiveness of procedures that chiropractors use; that is a different subject. So I don't see why they are relevant to this particular wording change.

Eubulides (talk) 20:40, 3 September 2008 (UTC)

• You're giving DeVocht undue weight WP:UNDUE. DeVocht is an assistant professor at the Palmer College of Chiropractic (i.e. a college that promotes the effectiveness of the treatment) . A single paper by an assistant professor that is giving just an overview as part of an introduction cannot be compared to a scientifically controlled review study or a systematic review of Cochrane. DeVocht paper is not attempting to be a review paper, the focus is totally different. My new section adds what I feel is an appropriate source: Ernst.
• 'Still, the grey area you mention is larger than we'd like, even in well-accepted areas of medicine. Most available evidence in surgery comes from non-scientific studies: surgeons...' Perhaps this is true, but it's original research to apply it here unless any of your sources directly allude to it. The difficulty of constructing a placebo is irrelevant to this article beyond what is in sources themselves. Those issues belong in the research based medicine article. Good luck with that!
• Let end this discussion here, and move it to below. Macgruder (talk) 05:17, 5 September 2008 (UTC)

Integrative medicine in the lead

This edit introduced changes that were not supported by the source. The cited source (Redwood et al. 2008, PMID 18435599) does not demonstrate a "preference for integrative medicine"; it shows that only 27% of the surveyed chiropractors preferred the term "integrative medicine". Nor does the cited source say that chiropractic "shares elements of mainstream medicine"; it talks about exhibiting characteristics of "mainstream health care", which is quite a different thing. As the top of this talk page suggests, "Please read this page and discuss substantial changes here before making them." Perhaps some change to the lead is needed, but let's discuss it here first, please. I undid the change for now. Eubulides (talk) 20:51, 28 August 2008 (UTC)

The words were taken from the source. Please self-revert, for it seems as though WP:OWN is beginning to be an issue here. The change itself was not substantial, it was done as the current text "many chiropractors dispute" is misleading. Soyuz113 (talk) 21:04, 28 August 2008 (UTC) ^{(Edits of indef blocked user stricken.)}

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:53, 8 September 2008 (UTC)

• The words were not taken from the source. The source never says "shares elements of mainstream medicine". Nor does the source say "demonstrating a preference for the term integrative medicine"; it says "The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%)." It is substantially misleading to turn 27% into "demonstrating a preference for the term integrative medicine".
• How is the phrase "many chiropractors dispute" misleading? Would you prefer "reject" to "dispute"? That would be a well-supported change, which I would support.

Eubulides (talk) 21:21, 28 August 2008 (UTC)

Whether or not it is a plurality, is it still a fact that the source explicitly stated that a majority of surveyed chiropractors said they preferred the term integrative medicine. Indeed the words were taken from the source, but the current text was not. Perhaps we can add "demonstrate a preference for the term integrative medicine. I would also favor removing it altogether from the lead and letting the classification of CAM stand for now as no major health organization classifies chiropractic care other than CAM. My problem was the sense that, again, a needless WP:POINT was being made and attempting (perhaps inadvertently) to drum of controversy. Another phrasing such as "a majority of surveyed DCs in the United States favor the term of integrative medicine". —Preceding unsigned comment added by Soyuz113 (talk • contribs) 22:47, 28 August 2008 (UTC) ^{(Edits of indef blocked user stricken.)}

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:53, 8 September 2008 (UTC)

• No, the survey did not say a "majority" preferred the term IM. It explicitly stated exactly the opposite: it said that more chiropractors preferred the term "CAM" (31%), than the term "IM" (27%). Please see Table 2 (page 364) of the source, which is briefly summarized in the 1st paragraph of Chiropractic #Scope of practice.
• "demonstrate a preference for the term integrative medicine" is not right either, since it implies to the unwary reader that most chiropractors prefer the term IM, which isn't correct.
• "a majority of surveyed DCs in the United States favor the term of integrative medicine" isn't right either, since only 27% of those surveyed preferred the term IM.
• All of the above suggestions are needless wordy. The lead should not go into details here; it should be short. The body of the article talks about this subject at more length, and that is were any longer explanation should go.
• Omitting the point entirely from the lead wouldn't be right, as gives the mistaken impression that Wikipedia endorses the view that chiropractic is CAM; see Talk:Chiropractic/Archive 25 #Fix for CAM claim for why something needs to be said here.
• I repeat my suggestion of going back to the old version, substituting "reject" for "dispute". Here's what the resulting sentence would look like:

Chiropractic is generally considered to be complementary and alternative medicine, a characterization many chiropractors reject.

"Reject" is better than "dispute" here, since it avoids some POV and it is what the source actually says.

• Again, it would have been better to propose a controversial change like this on the talk page, instead of just installing it. Lots of things in Chiropractic are controversial and the choice of words can be tricky. Proposing the change first here can avoid the addition of misleading text.

Eubulides (talk) 01:18, 29 August 2008 (UTC)

I agree with Eubulides here. The source says 27% thought that chiropractors should be classified as IM, not a majority. ☺ Coppertwig (talk) 02:13, 29 August 2008 (UTC)

• • I'm sorry if you find it controversial that the text added was almost a direct quote from the conclusion of the article, but it does provide the accurate representation of the paper.
  • What is known is that 69% of chiropractors rejected the term compared to 31% approved. Hence a majority of those surveyed rejected the categorization as CAM. The study does not state that the majority of those surveyed rejected the categorization of IM. To assume so is a violation of WP:OR.
  • Redwood concludes: The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%). The added text to the lead was "but a majority of surveyed American chiropractors rejected being characterized as CAM practitioners, showing some preference for the term integrative medicine." Again I fail to see how the added text was in anyway controversial. If anything perhaps slight quotation marks could be placed!
  • It was said that chiropractic did not share elements of mainstream medicine, however a source cited here (Cooper 2003) stipulates "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.
  • Surely it cannot be argued that chiropractic therapy is not legitimate in some, if limited form. If so the article should explicit state what the mainstream characteristics of chiropractic therapy are, what elements are not, and for both to which degree.
  • "Omitting the point entirely from the lead wouldn't be right, as gives the mistaken impression that Wikipedia endorses the view that chiropractic is CAM; see Talk:Chiropractic/Archive 25 #Fix for CAM claim for why something needs to be said here.". This is a rather weak argument, Chiropractic is already classified as CAM on Wikipedia. If we are suggesting that chiropractic isn't CAM (are at least not completely) then it should be placed under the Wikipedia Medicine banner. In fact, since the article is being edited under WP:MEDRS and we have reliable sources suggesting it is, at least partially, part of mainstream health care, why not re-classify Chiropractic into Wikiproject Medicine which would cut down on a lot of BS WP:POINT. WP:OR, WP:WEIGHT, WP:OWN and other misgivings that weigh this article and editors down. Soyuz113 (talk) 03:09, 29 August 2008 (UTC)

^{(Edits of indef blocked user stricken.)}

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:53, 8 September 2008 (UTC)

• The study uses uses "rejected" to mean the opposite of "accepted"; its saying that 69% of the chiropractors rejected being characterized as CAM is entirely equivalent to its saying that 31% of the chiropractors accepted the CAM label (the study says both things, obviously).
• The total figures, by the way, were as follows: 31% CAM, 27% IM, 14% not CAM, but no alternative suggested, 12% mainstream medicine, 7% any, depending on practitioner, 5% its own category, 2% primary care providers, 2% categorize by level of education, and 2% no opinion. Responses may not total to 100% due to missing values and rounding.
• The mainstream view of chiropractic is indeed that it is CAM, so it is appropriate for Wikipedia to use that categorization in Wikipedia's own organization.
• Though the lead should emphasize the mainstream view, it should not exclude the significant minority opinion among chiropractors themselves. A large majority of chiropractors rejects the CAM label, even though the CAM label has the plurality among chiropractors (31%). The IM label is 2nd among chiropractors (27%). The lead should not misrepresent this situation with confusing wording like "showing some preference for the term integrative medicine", without bothering to mention that CAM was a more popular label than IM.
• Again, there is a WP:WEIGHT violation in this addition. With this addition, the mainstream view is given only 10 words ("Chiropractic is generally considered to be complementary and alternative medicine") but the minority view is given 21 words. The lead had only 286 words total, before this change bloated it; it is too valuable a resource to waste it on the minutiae of what is just a single survey. The 5 words "a characterization many chiropractors reject" is much more appropriate weight to summarize the minority view.

Eubulides (talk) 03:48, 29 August 2008 (UTC)

• I'm sorry; I don't understand what is being disputed here, the study clearly demonstrated that chiropracty as labelled CAM was rejected; and there was a slight preference for IM. I have not misquoted the paper, in fact it is almost verbatim.
• "The lead should not misrepresent this situation with confusing wording like "showing some preference for the term integrative medicine", without bothering to mention that CAM was a more popular label than IM." How is the lead misrepresenting the conclusions of the paper? Also, the point may have been lost but I will repeat it again: a majority of those surveyed rejected the term CAM. They did not reject the term IM. To suggest otherwise I'm afraid is extrapolation and is WP:OR.
• The lead is bloated, but not with this minor addition. The entire straight vs. mixer description is beyond the scope of the lead anyways, the evidence for and against chiropractic therapy could be presented in a much clearer fashion. Conclusions regarding the characteristic treatment, manipulative medicine should be presented as to what it is and is not useful, currently the cited source is not the appropriate one to determine the efficacy of spinal manipulation.
• WP:WEIGHT is not violated in this addition, what is a problem, that has not yet been addressed despite my repeated queries, is how come the minority segment of chiropractic seems to be the "target" of undue weight at the expense of the article as a whole.
• "The mainstream view of chiropractic is indeed that it is CAM, so it is appropriate for Wikipedia to use that categorization in Wikipedia's own organization." I'm afraid that is not what the cited source says. The source (Cooper 2003) said that chiropractic was part of mainstream health care. The author appears to hold the M.D. designation as well which should rule out some considerable cries of COI. Unless a specific source says that "CAM cannot be mainstream at any point" if evidence suggests that Chiropractic therapy (or parts of it) are now considered mainstream medicine then the it would be wise to re-classify the article. It is a tough call; the passage in the article said it shares elements of both alternative and mainstream medicine. To tie it back into integrative medicine, it would be worthwhile to see what elements of chiropractic are being integrated, what ones are being rejected and that should help us decipher what is the accepted view of chiropractic care and what is not accepted (i.e. quackery, pseudoscientific elements).

Soyuz113 (talk) 04:51, 29 August 2008 (UTC)

^{(Edits of indef blocked user stricken.)}

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:53, 8 September 2008 (UTC)

Soyuz, I think the meaning gets lost without the preceding discussion from the source that enumerates the different results. 69% say ‘not CAM’, so 31% say they are CAM. Yes, 27% say they prefer “IM” but when the stats are left out of that sentence it seems to mean “a majority show a slight preference for IM” which is not the case at all. It's trivial at first glance but the source doesn't show a huge preference for 'IM' and we shouldn't imply this. --—CynRN ^(Talk) 01:45, 30 August 2008 (UTC)

• What CynRN said. It is misleading to summarize that paper's data to make it sound like chiropractors prefer IM to CAM in that study. They didn't. More preferred CAM than preferred IM.
• With that longwinded addition, about 10% of the lead was given over to the CAM-vs-IM dispute. Less than 1% of the body is given to the same dispute. The expanded lead was clearly overweighting this dispute heavily.
• The cited source about CAM is not Cooper; it is Chapman-Smith & Cleveland, in Principles and Practice of Chiropractic. However, Soyuz113 did mention Cooper, so let's check: the first sentence of Cooper & McKee's abstract (PMID 12669653) says "Chiropractic is the best established of the alternative health care professions." i.e., it falls under the CAM umbrella.
• The claim I objected to was calling chiropractic "mainstream medicine", not "mainstream health care". Cooper & McKee do not call chiropractic "mainstream medicine".
• Other specific suggestions for improving the lead are welcome, but this thread is focusing on the CAM vs IM issue. The other points in Soyuz's comment seem to address issues that are outside the scope of this talk-page section.

Eubulides (talk) 07:19, 30 August 2008 (UTC)

Actually, this is OR in your part. The conclusion of the article specifically states ". CONCLUSIONS: The majority (69%) of the chiropractors in this sample rejected being characterized as CAM practitioners, showing some preference for the term IM (27%)." We should not "spin" studies to suit our own agendas, otherwise reliable sources are not being used reliably. I am not misleading I am representing the conclusions of the study. That is a major problem with this current incarnation of Chiropractic. It's a problem that needs to be fixed and I hope we can co-operate and get it done together!

The addition that was made should have said "mainstream health care" and not mainstream medicine. I erred, and apologize for that mistake

I have removed the "dispute" claim primarily because it's not being said what is disputed. Also, if you suggest that it represents less than 1% of the body of the article why include it in the lead? Soyuz113 (talk) 16:32, 30 August 2008 (UTC)

^{(Edits of indef blocked user stricken.)}

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:53, 8 September 2008 (UTC)

The "dispute" claim is attached to the sentence saying that chiropractic is characterized as CAM; that is what is being disputed. It is not OR to quote the body of the study in question, which is what I have done. We should not selecting isolated phrases from the abstract, without accurately presenting their context. Please see Talk:Chiropractic/Archive 25 #Fix for CAM claim for why a phrase like "a characterization most chiropractors dispute" is needed. Eubulides (talk) 22:36, 1 September 2008 (UTC)

Mainstream elements of chiropracty; pseudoscientific elements of chiropracty

My interpretation thus far (please correct me if I'm wrong) is that the sceptical editors here see everything related to chiropracty as controversial. However, sources in the article suggest it is far more "mainstream" than critics suggest. Also, the use of the literature in this article is quite distressing and yet regular editors here seems to be avoiding my concerns. I'll WP:AGF for now but here are the major problems once again

1. Undue weight on the minority aspect of chiropracty in relation to the majority
2. Vagueness of controversial aspects of chiropracty in relation to accepted aspects
3. Misuse of scientific literature by editors in the evidence-basis section
4. Debate whether or not Chiropractic should be moved into Wikimedicine project
5. Apparent case of WP:OWN

I understand that it is difficult to edit and create an scholarly article based (especially when editing anonymously) but great care is required, especially so, when we are discussing a medically related topic and a whole profession. Browsing through the archives (and there are plenty!) I see a constant back and forth between partisans. We need to clearly establish what is quackery and what isn't and more importantly differentiate between chiropractic theory and the effectiveness of their methods. Soyuz113 (talk) 16:32, 30 August 2008 (UTC)

^{(Edits of indef blocked user stricken.)}

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:53, 8 September 2008 (UTC)

What does being anonymous have to do with editing? We should not worry about whether the other editors are chiropractors, doctors or laymen. It's the content and verifiability of the edit that matters. Also, in an article as contentious as this one, it's imperative (and extremely tedious!) to read the backstory in the archives and tread very carefully. Propose, discuss, get consensus...then make changes.

I'm not at all sure that the majority of chiropractors are 'uncontroversial'. I've seen the stats on belief in subluxation (by major chiropractic organisations and schools), the belief in the far-reaching ramifications of said subluxation, the use of activators, the use of homeopathy, AK, and the like. Some of this has been left out, perhaps suppressed, from the article. If anything, many 'fringe' aspects of chiropractic have been de-emphasized. That said, the article should give the science-minded chiropractors their due weight. We should get the feel of both ends of the spectrum and perhaps try to explain how most fit into the middle. --—CynRN ^(Talk) 20:41, 30 August 2008 (UTC)

Well, the anonymity here is actually a bad, thing, IMHO. For example, a 12 year old with no background in medical sciences can freely edit, rewrite, delete factual material put in my a medical doctor. Same thing can be occuring here. There is quite a disparity between finding a source and using it appropriately. This, I'm afraid, is what is occuring at evidence basis and other sections. I noticed that some can edit this article with impugnity (look at the the recent history) whereas others are reverted on the spot. The rules need to go both ways.

I agree that chiropracty has both mainstream and fringe elements. This is what is making this article so hard to edit properly. It seems to straddle that middle ground but what objective criteria here are being used to label aspects of chiropracty fringe? I very much like your proposal, however I noticed that subluxation is something that seems to be quite weighty in this article as opposed to say, something more significant such as the long road to professional licensure. What elements of subluxation are fringe, what elements are mainstream? Perhaps we can start there! I have removed puffery from the subluxation section and vaccination section for now, but we can propose better wordings here. Soyuz113 (talk) 21:04, 30 August 2008 (UTC)

^{(Edits of indef blocked user stricken.)}

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:53, 8 September 2008 (UTC)

I agree that chiropractic has both mainstream and fringe elements, and that this makes editing this article applies. Sometimes WP:FRINGE applies; sometimes it doesn't. What is "puffery" to one editor is an important part of the explanation to another. Discussing the problem at this high level is unlikely to make much progress; specific proposals for wording changes would be better. Eubulides (talk) 22:36, 1 September 2008 (UTC)

Controversial edits made without discussion

This edit by MaxPont (soon reverted) was made without any discussion on the talk page.

This edit by Soyuz113 says the wording "the characterization many chiropractors dispute" does not have consensus (because Soyuz113 opposes it), and installs wording "although there is also some preference for the term integrative medicine" that has already been rejected as misleading by the consensus in #Integrative medicine in the lead. Chiropractors mildly preferred complementary and alternative medicine to integrative medicine in that survey.

This edit by TheDoctorIsIn, made without discussion, removed substantial text from the vaccination section, text that is directly supported by the cited sources. It also removed citations, causing the resulting text to be incorrectly attributed.

Again, I urge editors to discuss changes first, on this talk page, before installing controversial edits like that, which disrupt the article and introduce errors. Eubulides (talk) 16:34, 30 August 2008 (UTC)

I can't see why my edit was controversial. It is not obvious that vaccination is the most effective method (compared to e.g. antibiotics). And we dont have direct refs to support that claim. I only changed the wording slightly and made it more neutral. MaxPont (talk) 18:46, 30 August 2008 (UTC)

I agree. Relatively minor changes I've made that follow the source to a 'T' has been called 'controversial' when they're really not so. I won't suggest that it's crying wolf, but I could easily call into question several of a similar regard and label them controversial as well. There's definitely instances of puffery here, vaccination being one of them. I favor your change as well, but would also like it conform to a more global view. Soyuz113 (talk) 19:35, 30 August 2008 (UTC) ^{(Edits of indef blocked user stricken.)}

Soyuz113, may I call you CorticoSpinal? These two controversial edits were not minor, was not NPOV, and turned ref citations red. A lot of text was deleted. QuackGuru 01:25, 31 August 2008 (UTC)

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:38, 8 September 2008 (UTC)

Please self revert, Soyuz. There was no consensus for your sweeping changes.--—CynRN ^(Talk) 06:14, 31 August 2008 (UTC)

Yes, CS, please self-revert. Your heavy handed tendencies toward ownership are all too familiar and recognizable. -- Fyslee / talk 06:28, 31 August 2008 (UTC)

Again, we need to abide by WP:AGF and WP:BITE here. Assuming this new user is CS is NOT assuming good faith. DigitalC (talk) 02:41, 1 September 2008 (UTC)

BITE applies to truly new users, and we're not dealing with a new user, just a new username. This one knows these discussions and their history pretty well. Note. -- Fyslee / talk 19:36, 1 September 2008 (UTC)

Here is another attempt to chop up the vaccination section. A ref citation is now red. This was an extremely controversial edit. QuackGuru 03:13, 2 September 2008 (UTC)

I am not sure why a ref name was added to a ref. There is consensus to have a ref name only when necessary for this article. It better to have consistancy throughout this article. QuackGuru 17:08, 2 September 2008 (UTC)

This is minor point, but I agree with QuackGuru that there is no need to give names to refs that are used just once. Eubulides (talk) 18:01, 2 September 2008 (UTC)

"Significant" minority

The third paragraph in the LEAD contains this phrase:

• "Vaccination remains controversial among a minority of chiropractors."

Since it's far from a small minority, and includes two major organizations, I think inclusion of the word "significant" is warranted as being more accurate. The existing wording could easily be interpreted as if it was a tiny minority of fringe chiropractors with no influence, when this is far from the case. The new wording would look like this:

• "Vaccination remains controversial among a significant minority of chiropractors."

What think ye? -- Fyslee / talk 05:36, 2 September 2008 (UTC)

Disagree. Significant to whom? 'Minority' is factual. 'Significant minority' is an opinion. Why don't we stay factual? IMO we should rely on facts and science, not opinions and opinion polls. Bludgeoning the reader of this article with vaccination arguments just gives the impression that the anti-vaccination chiropractors have credibility or are speaking for the entire profession. I am of too generous a nature to presume that other editors of this article would use the anti-vaccination minority as a means of damning the entire profession. --Surturz (talk) 07:01, 2 September 2008 (UTC)

• Before today's changes, the text read "Vaccination remains controversial among chiropractors." This was more accurate than either of the wordings above. The wordings above imply that, among the minority, vaccination is controversial, i.e., that some of the minority oppose vaccination and some favor it. But that's not the case: the minority in question opposes vaccination.
• If we're going to say something about a significant minority, it should say "A significant minority of chiropractors opposes vaccination." That's nearly as short, and is just as accurate as the older text.
• However, let's go back to the more-accurate text before today's changes: it's shorter and is thus more appropriate for the lead. Also, it answers Surturz's objections.

Eubulides (talk) 07:31, 2 September 2008 (UTC)

"A significant minority of chiropractors opposes vaccination." is very accurate, and was the whole point of my suggestion. The sources back up such a description, as it is not a small minority, and is an important opinion that is directly supported or not opposed ("unsure") by a majority of the 2000 graduating class at CMCC, as born out by the research:

• "One might presume, therefore, that the Canadian chiropractic profession maintains a similar perspective on vaccination. Nevertheless, a recent survey of 621 students (75.2% response rate) attending the Canadian Memorial Chiropractic College (CMCC), the only English-language chiropractic college in Canada, found that approximately 29% of students graduated in the year 2000 with antivaccination attitudes, 40% being supportive of vaccination, with 31% unsure.5 Further, a 2002 survey of Alberta (Canada) chiropractors, many of whom will have graduated from CMCC, found that 27.2% advised patients against vaccinating themselves or their children.6" [26]

Here's the math: 29% oppose vaccination + 31% unsure = 60%, as opposed to only 40% who support vaccination.

While this is OR (although research and historical sources would probably back this up), it would be quite reasonable to assume that adding the older generation of DCs to this mix, IOW the majority of practicing DCs who have even stronger anti-vaccination POV, would bring this percentage even higher than 60%. So "significant" minority is putting it very lightly. "Majority" would be more accurate.... I can understand why Surturz would feel uncomfortable with this, but he's in the minority of the profession who supports vaccination, even if he might be among a majority within his circle of DC friends, thus giving him a feeling that his is a majority position, when it isn't.

Your wording sounds good. Go for it. -- Fyslee / talk 19:53, 2 September 2008 (UTC)

While it's OK to speculate, it's not OK to synthesize and extrapolate.

Since when does unsure=opposed?

Using a survey done in 1999 at one school to "paint" as Surturz said the profession? Unacceptable. There is already a WP:WEIGHT and WP:POINT violations, there are editors actively involved here who want the section gone and this is how the response is? Adding fuel to the fire?

Please cease with the accusations and insinuations, I am here to help. WP:OWN is moreso a concern of mine, I see that only certain editors can edit Chiropractic, only those of the sceptical kind. Soyuz113 (talk) 21:28, 2 September 2008 (UTC)

^{(Edits of indef blocked user stricken.)}

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:53, 8 September 2008 (UTC)

• The proposed text does not assume "unsure=opposed". It says merely that a significant minority of chiropractors opposes vaccination, which is what reliable sources say. Chiropractic #Vaccination is not merely using "a survey done in 1999"; it also mentions a 1995 survey of US chiropractors which found that about 1/3 of them think that immunizations cause more disease than they prevent, and a 2002 survey of Alberta chiropractors which found that 27.2% advised patients against vaccinating themselves or their children. These are all significant minorities, and we have found no reliable source that disagrees with these sorts of numbers.
• Changes that are installed with discussion and consensus have a greater chance of surviving. For more on this, please see #Moving CAM issue to Schools of thought below.

Eubulides (talk) 01:50, 3 September 2008 (UTC)

According to that study, it would seem that the largest percentage of chiropractors actually support vaccination. Hence, all of the space we are dedicating to "vaccination" is just trumped up controversy in violation of WEIGHT. -- Levine2112 ^discuss 01:25, 3 September 2008 (UTC)

It is highly notable that only a minority of chiropractors support one of the two most important public-health procedures of the last two centuries (the other being clean water supplies). This controversy is not "trumped up"; it is an important one, that is cited often in the peer-reviewed literature. Eubulides (talk) 01:50, 3 September 2008 (UTC)

"spiritual inspiration"

The Philosophy section contains this wording:

• "Chiropractic's early philosophy was rooted in spiritual inspiration and rationalism."

I suggest that the words "magnetic healing" and "vitalism" be included. This is pretty fundamental to chiropractic history.

If the phrase "spiritual inspiration" is referring to "spiritualistic inspiration" (which would be very true and logical, since Palmer claimed to have received chiropractic "from the other world", and was an active spiritualist), then the phrase should be wikilinked as "spiritual inspiration". The suggested version would look like this:

• "Chiropractic's early philosophy was rooted in spiritual inspiration, magnetic healing, vitalism, and rationalism." ^{Vitalism is already wikilinked.}

While it looks like alot with all the coding, the only real differences are wikilinking the phrase, adding "magnetic healing" and "vitalism", and the refs. What think ye? -- Fyslee / talk 06:25, 2 September 2008 (UTC)

Unnecessary This is already covered in the History section. Actually, IMHO the philosophy section should only cover current Chiro philosophies (a lot of the historical stuff in the philosophy section could be moved to 'History'). A comparison with the coverage of barber surgeons in the surgery article is useful. --Surturz (talk) 07:14, 2 September 2008 (UTC)

• The cited source (Keating 2005, in PPC) says "spiritual inspiration" many times; it talks about "spiritualism" only once, and in a context that wouldn't support claims that chiropractic was derived from spiritualism. It defines "spiritual inspiration" as "insight from ethereal sources", if that helps; but I think "spiritual inspiration" is pretty clear by itself. I think it does mean something different from "spiritism", and should not be wikilinked to "spiritism".
• If it helps, Keating's summary says "Chiropractors have employed a wide range of epistomologies (ways of knowing) to defend their art and professional autonomy. This diversity has included critical and uncritical rationalism (e.g., so-called deductive science), spiritual inspiration, and the scientific method."
• Keating mentions magnetic healing and vitalism on several occasions; he even points out that D.D. originally called chiropractic "magnetic manipulation", a point that should perhaps be made. I don't see the need to cite Beck 1991 or the religion cite as well, given that we have a far-more-recent and more-respected source on the same topic, which integrates it for us. So I suggest simply adding "magnetic healing, vitalism" without adding any more citations.

Eubulides (talk) 07:31, 2 September 2008 (UTC)

Disagree as well. This is again promoting a minority and old viewpoint which is another WP:WEIGHT violation. Soyuz113 (talk) 21:31, 2 September 2008 (UTC) ^{(Edits of indef blocked user stricken.)}

Soyuz113 has "been blocked indefinitely from editing in accordance with Wikipedia's blocking policy for sockpuppetry, edit warring, disruption and block evasion." I have stricken his remarks, as striking or removal is customary in such situations. -- Fyslee / talk 06:53, 8 September 2008 (UTC)

Eubulides, There is a huge difference between including 'Spiritualism', which is still part of some chiropractor's philosophy and "magnetic healing", which is not. 'Spiritualism' does not open the door for 'magnetic healing'. 'Magnetic healing' deserves the same weight as 'barber surgeon' in 'surgery' i.e. not much. You and will Fyslee will have an easier time gaining consensus if you restrict historical chiropractic practice to the history section, rather than attempting to equate current day chiropractic with the chiropractic of a hundred years ago. --Surturz (talk) 00:37, 3 September 2008 (UTC)

Agreed. -- Levine2112 ^discuss 01:23, 3 September 2008 (UTC)

What part of "Chiropractic's early philosophy was rooted in.." don't you all understand? "...was rooted in..." is past tense, ergo, we are talking about history and making no statement about current practice in that sentence. What's the big deal? Are you all questioning the accuracy of the terminology or of the history? The addition of these terms should be totally uncontroversial, unless one is uncomfortable with admitting the origins of the profession.

Now Surturz thinks this should be in the history section, which is another matter. Right now let's get the wording down, and then discuss its proper placement, which is a legitimate concern. -- Fyslee / talk 13:58, 3 September 2008 (UTC)

Whatever the literal reading of the text, if 'magnetic healing' appears in the 'philosophy' section, it will give the impression that magnetic healing is relevant to modern chiropractic, and I think you know that this is the impression it will give. It is not possible to discuss the wording divorced from the placement. Why are you so keen to mention magnetic healing a second time in the article, anyway? Your suggested text does not improve the article - it does not provide new information, nor does it improve the clarity of the text. --Surturz (talk) 01:33, 4 September 2008 (UTC)

No it won't "give the impression that magnetic healing is relevant to modern chiropractic," and you are assuming very bad faith when you accuse me: "and I think you know that this is the impression it will give." I have absolutely no desire to give such an impression. I only want to provide the accurate facts about the historical aspects of the chiropractic philosophy. Keep in mind that I did concede your point about placement.

Right now we can easily resolve this problem, since the Chiropractic #Philosophy section is already divided into two parts, an "early philosophy was rooted in" section (at the end), and an "Although a wide diversity of ideas exists among chiropractors" section (at the beginning), but unfortunately they are in the wrong order, and this can be fixed. I suggest we reverse their order, so there is a logical historical progression, and make the distinction clearer by adding one little word - "currently":

• "early philosophy was rooted in .... Although a wide diversity of ideas CURRENTLY exists among chiropractors"

I would like to try that edit as an experiment below Eubulides' comment below. -- Fyslee / talk 03:40, 4 September 2008 (UTC)

I'll comment below that edit. Eubulides (talk) 16:18, 4 September 2008 (UTC)

• I agree that "vitalism" should appear somewhere in the body of Chiropractic. Currently "vitalism" appears only in the lead, which is a no-no; the lead should summarize the body.
• I also agree that Chiropractic #Philosophy is an appropriate place to talk about vitalism. That section currently talks about holism, conservatism, rationalism, and spiritual inspiration; vitalism is just as important as these if not more so, and should be mentioned in Chiropractic #Philosophy. No editor has opposed adding "vitalism" here. I suggest the wording "Chiropractic's early philosophy was rooted in vitalism, spiritual inspiration and rationalism." (italics mark the new word).
• Magnetic healing is a different matter. Unlike vitalism, it is not a significant part of modern chiropractic philosophly. Chiropractic #History already talks about magnetic healing; I don't see what additional mention would be useful there. Perhaps you could propose specific wording within the context of History?

Eubulides (talk) 20:40, 3 September 2008 (UTC)

I fear you are making the same mistaken assumption that Surturz did above. "Magnetic healing" (IOW Mesmerism, or animal magnetism) relates to original chiropractic philosophy, IOW its history, and has little to do with modern chiropractic. Therefore it deserves just as much mention in that one sentence. Palmer didn't suddenly stop believing and practicing his magnetic healing when he started manipulating people's joints. He continued to manipulate their minds just as much as before, but now along with a physical method to boot. BJ Palmer developed this even further with his circus background in trickery, illusion and deception, and later his expert salesmanship and pioneering mass marketing of chiropractic:

• ^{"D.D. Palmer’s son, B.J. Palmer, became involved in the chiropractic movement early on, during the formative years. B.J shared his father’s metaphysical bent (prior to chiropractic, he worked with a mesmerist and worked in the circus), his tendency to make sweeping statements about health without justification, and his ignorance of contemporary scientific knowledge. He was reported to state, for example, “When I saw there was no use for a sympathetic nervous system, I threw it out, and then just had to put something better in its place, so I discovered Direct Mental Impulse.” B.J. also discovered a non-existent “Duct of Palmer” connecting the spleen to the stomach. In 1907 B.J. engineered a hostile take over of his father’s school of chiropractic." [27]}

The two words can be included as I proposed - as a part of that one sentence. This shouldn't be controversial. It's a highly recognized part of chiropractic history. It's about who Palmer was and how he thought, and that's what produced chiropractic. -- Fyslee / talk 04:06, 4 September 2008 (UTC)

Experimental version

... with reversed order, as proposed above:

Chiropractic's early philosophy was rooted in vitalism, spiritual inspiration and rationalism. A philosophy based on deduction from irrefutable doctrine helped distinguish chiropractic from medicine, provided it with legal and political defenses against claims of practicing medicine without a license, and allowed chiropractors to establish themselves as an autonomous profession. This "straight" philosophy, taught to generations of chiropractors, rejects the inferential reasoning of the scientific method, and relies on deductions from vitalistic principles rather than on the materialism of science. However, most practitioners currently accept the importance of scientific research into chiropractic, 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.

Although a wide diversity of ideas CURRENTLY exists among chiropractors, they share the belief that the spine and health are related in a fundamental way, and that this relationship is mediated through the nervous system. Chiropractors study the biomechanics, structure and function of the spine, along with what they say are its effects on the musculoskeletal and nervous systems and its role in health and disease.

Chiropractic philosophy includes the following perspectives:

• Holism assumes that health is affected by everything in people's complex environments; some sources also include a spiritual or existential dimension.

• Conservativism considers the risks of clinical interventions when balancing them against their benefits. It emphasizes noninvasive treatment to minimize risk, and avoids surgery and medication.

• Homeostasis emphasizes the body's inherent self-healing abilities. Chiropractic's early notion of innate intelligence can be thought of as a metaphor for homeostasis.

• A patient-centered approach focuses on the patient rather than the disease, preventing unnecessary barriers in the doctor-patient encounter. The patient is considered to be indispensable in, and ultimately responsible for, the maintenance of health.

Now that is the original text (without the diagram), but with a reversed order of the first and last paragraphs, and the addition of one word - "currently". Doesn't that make it clear who believed what and when, and doesn't it now read with a logical historical progression, as good writing should do? -- Fyslee / talk 03:40, 4 September 2008 (UTC)

That change to the text makes sense to me. But is removing the diagram part of the proposal? It's not clear from the text whether you're proposing to remove the diagram as well. Eubulides (talk) 16:18, 4 September 2008 (UTC)

No, I am not proposing removing the diagram. I only left it out to save space here. (Whether we think the diagram is appropriate, pretty, etc., is another topic for another time. I think it is well made, but creates a cluttered appearance due to varying monitor sizes, etc.)

If no one objects, then the change can be made shortly, so go for it when you feel the time is right. -- Fyslee / talk 06:06, 5 September 2008 (UTC)

Lack of Controversy?

I just happened to browse this article and was shocked (shocked I tell you!) to find that it was lacking a section on Controversies. I cannot think of any other Wikipedia article of such weight that lacks such a section. In addition, the controversies surrounding this field are numerous, significant, and persistent. I haven't started any research yet, but anecdotally, my experience is that a large percentage (but perhaps still a minority) of chiropractors are quacks (yes, that's a technical term). Before doing any such research, can any of the regulars here tell me:

Why is this section lacking? (Was there some nuclear edit war in the past?)

Is someone already doing or working on this section?

I believe I can save a lot of time if someone were to answer these questions. Thanks! 99th Percentile (talk) 03:12, 3 September 2008 (UTC)

Many Wikipedia articles of similar weight, or even greater weight, lack controversy sections. As a general rule, controversy sections are a sign of editing problems. I just now checked Wikipedia:Featured articles #Health and medicine, and none of the 36 articles listed there have a section with the word "controversy" in its name. Eubulides (talk) 04:08, 3 September 2008 (UTC)

Obviously, I meant topics that are inherently controversial, as this one is. I would expect articles on vaccinations, crash diets, and homeopathy to also have such sections. Comparing this to mainstream medicine as a citation for why the section is lacking is kind of missing my point. 99th Percentile (talk) 04:04, 4 September 2008 (UTC)

Vaccination does not have a Controversy section. Nor does Crash diet. Nor does Homeopathy. Generally speaking having a Controversy section is contrary to the goal of writing an encyclopedic article, as it attempts to migrate disputed material into a Controversy ghetto, instead of having the article be organized according to topic. Eubulides (talk) 16:18, 4 September 2008 (UTC)

I understand your point 99th Percentile. However, be aware that although there isn't a discrete segment on the controversies surrounding chiropractic, many of the topics you have in mind have probably been covered in other parts of the article. If you have relevant topics to discuss and add please do so. I for one, feel that issues raised as controveries need to be included and only help to form a more complete and accurate description of the subject. —Preceding unsigned comment added by Medic88888 (talk • contribs) 23:37, 9 September 2008 (UTC)

Lead's coverage of manipulation risk

This recent edit by an IP address removed the lead's claim that serious adverse events are "rare cases", I guess on the ground that the cited source (Ernst 2007, PMID 17606755) doesn't use the word "rare". I added a source to support the "rare", but now another IP address is making fairly extensive edits to the lead, edits which employ a Simon-says style to disparage claims supportive of chiropractic (a style that is unnecessary here and which clearly introduces WP:POV problems), edits which emphasize the risk issue in the lead all out of proportion to what's in the body (this introduces WP:WEIGHT problems).

For now I suggest that we revert to the lead the way it was yesterday, before these controversial and undiscussed edits were made, and then discuss here any changes to the lead that might be needed. Eubulides (talk) 18:25, 9 September 2008 (UTC)

The lead should be a summary. Too much detail has been added to the lead. I made that mistake before. Would this version be best to revert to. QuackGuru 18:36, 9 September 2008 (UTC)

Yes, that version would be fine as well (it merely adds a citation to the lead). Eubulides (talk) 18:39, 9 September 2008 (UTC)

Further edits along similar lines

I see now that 90.192.147.98 has made further edits along similar lines.

• One edit removed the "in rare cases" along with the supporting citation from the lead, with the comment "Previous version mis-quotes source 'ref name=Ernst-adverse'". I suggest addressing this concern by rephrasing that sentence as "Although spinal manipulation can have serious complications, these are rare and chiropractic care is generally safe when employed skillfully and appropriately." This should work because the second citation (the WHO safety guidelines) do say that serious adverse effects are rare.
• Another series of edits removed the claim of "rarity" and "difficulty of linking manipulation to adverse effects such as stroke, a particular concern" from the reasons why the incidence of these complications is unknown.
  • Removing the word "rarity" makes sense, as the cited source (Ernst 2007, PMID 17606755) doesn't make the claim about rarity. So let's remove "rarity" there. Rarity is mentioned elsewhere in the section, and need not be repeated here.
  • Removing the "difficulty of linking manipulation to adverse affects..." phrase does not sound correct, though. Ernst writes that "causal inferences are, of course, problematic. Vascular accidents may happen spontaneously or could have causes other than spinal manipulation. A temporal relationship is insufficient to establish causality, and recall bias can further obscure the truth." This passage was summarized as "difficulty of linking manipulation to adverse affects" in Chiropractic. I don't see anything inaccurate about the summary; if a different wording would be better we should of course use it, but we shouldn't simply remove the point entirely. If something closer to the source is desired, I suggest rewording it as "problems of inferring whether a manipulation caused adverse effects...".

Eubulides (talk) 20:13, 9 September 2008 (UTC)

Judging by this IP's and the other IP's edits (probably the same editor), I think these edits are motivated by the desire to push a very specific point of view. -- Levine2112 ^discuss 20:21, 9 September 2008 (UTC)

I agree that the IP has a viewpoint. However, the IP did point out at least one useful thing, namely that Ernst 2007 cannot be used to justify a claim that serious adverse effects are rare. I contributed that text a while ago after reading Ernst's paper. It came as quite a surprise just now to reread the paper and discover that Ernst made no claim about the frequency of adverse effects (it had been "obvious" to me that he had said the effects were rare; but he didn't!). I'm glad the IP caught my error: every claim in this article should be sourced. Eubulides (talk) 23:16, 9 September 2008 (UTC)

Here is the specific change to Chiropractic #Safety that I am proposing, to fix the "rarity" bug (the change to the lead is proposed above). Italics are the new stuff, and struck-out the old:

Rarely, spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death; these can occur in adults and children. The incidence of these complications is unknown, due to rarity, high levels of underreporting, and to the difficulty of linking manipulation to adverse effects such as stroke, a particular concern.

Eubulides (talk) 23:27, 9 September 2008 (UTC)

Scope of practice lead

Following up on #Analogy to podiatry above, I propose changing the lead sentence of Chiropractic #Schools of thought and practice styles from this:

Significant differences exist amongst the practice styles, claims and beliefs between various chiropractors.

to this:

Chiropractic is often described as two professions in one. Unlike the distinction between podiatry (a science-based profession for foot disorders) and foot reflexology (an unscientific philosophy which posits that many disorders arise from the feet), in chiropractic the two professions attempt to live under one roof.

It's all right. Though I don't think it should replace the other text. Maybe placed in conjunction with it. This needs to be discussed a little more though. -- Levine2112 ^discuss 20:23, 9 September 2008 (UTC)

Vaccination redux

It is already reverted. I changed the text slightly and removed the references to vaccination as cost-effective. We only need to state that it is widely accepted - or a similar wording.MaxPont (talk) 18:32, 31 August 2008 (UTC)

It is relevant that it is cost-effective. The claim that it is not relevant is not true because chiropractors claim vaccination is ineffective. QuackGuru 18:36, 31 August 2008 (UTC)

I have tweaked it to include both of your edits, since you both made good contributions. I have left out the word "cost", since actual "effectiveness" (no matter in which manner) is the most important point, regardless of cost. By including the word "cost" we are limiting and lessening the point. Can you both accept that solution as an improvement? -- Fyslee / talk 19:24, 31 August 2008 (UTC)

Indeed, the source only says this about cost-effectiveness: "Although most public health authorities would agree that vaccination constitutes one of the most cost-effective infectious disease control measures of the last century" (would some disagree? sounds like opinion that needs attribution, not fact) , but does state "In the face of now overwhelming evidence to show that vaccination is an effective public health procedure." In light of this, I made this change, which follows the source closely. - DigitalC (talk) 02:55, 1 September 2008 (UTC)

Well, you did follow the source ;-) at least part of it. It's accurate enough. Including more would have highlighted the contrast and thus more clearly revealed the controversial nature of the resistance to vaccination. But at least you followed the source. -- Fyslee / talk 05:41, 1 September 2008 (UTC)

Including more would have given more weight than this section deserves, which some editors here feel is none. - DigitalC (talk) 06:14, 1 September 2008 (UTC)

I think the first sentence it too long. We can start with: Vaccination is controversial within the chiropractic community. and then include the rest of the information in a second sentence. A quick adjustment will fix it. QuackGuru 19:05, 1 September 2008 (UTC)

This comment makes no sense. It is not about including more or less information. The current text is inaccurate and does not follow the source close enough for the important point of the sentence. We can keep it short and follow the source more closely at the same time. QuackGuru 19:15, 1 September 2008 (UTC)

You're welcome to propose a new version here. -- Fyslee / talk 19:39, 1 September 2008 (UTC)

Vaccination is controversial within the chiropractic community. Although it is one of the most cost-effective forms of prevention against infectious disease, most chiropractic writings on vaccination focus on its negative aspects, claiming that it is hazardous or ineffective. QuackGuru 20:11, 1 September 2008 (UTC)

That version was already proposed in #Vaccination draft above, where two editors favored it and one opposed. This makes three to one on this particular change. I expect further improvements can be made, but this does appear to be an improvement over what's in there now. Eubulides (talk) 22:36, 1 September 2008 (UTC)

As stated previously, I don't think there should be a vaccination section at all. But if certain editors insist on its inclusion, the section should not imply that anything more than a (vocal) minority of the chiropractic profession are anti-vaccination, and it certainly should not imply that anti-vaccination is taught as part of chiropractic qualifications. This is my proposed rewrite:

A minority of chiropractors oppose vaccination. Several prominent chiropractors have written articles claiming that vaccination is hazardous or ineffective.[107] Additionally, a segment of chiropractors support freedom of choice as opposed to compulsory vaccination. (Principles and Practice of Chiropractic, pg 197) Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, while the Canadian Chiropractic Association supports vaccination.[10]

Anti-vaccination is a crusade by a minority of chiropractors, it is NOT taught as part of the profession, and it is NOT a majority view. The text should reflect that, rather than the 'spin' use of terms such as 'most writings' and implying that vaccination is controversial among the whole chiropractic community when it is a minority view. --Surturz (talk) 01:53, 2 September 2008 (UTC)

You think we should not have a vaccination section and your proposal chopped up the vaccination section almost in half. Chripractors are learning from chiropractic authors to have an antivaccination philosophy. QuackGuru 02:47, 2 September 2008 (UTC)

This proposed rewrite has several problems:

• The phrase "A minority of chiropractors oppose vaccination" doesn't convey to the reader how large and significant that minority is. A minority of MDs oppose vaccination too, but it's a tiny and insignificant minority. In contrast, many chiropractors oppose vaccination, and less than a majority supports it; this fact should be noted clearly.
• Another way to put it is that antivaccination is not simply "a crusade by a minority". Only a minority of the profession favors vaccination; this lack of support for a widely-accepted and important public-health measure would be remarkable for any health-care profession.
• Using the phrase "freedom of choice" without qualification promotes the antivaccination POV. The freedom-of-choice business is subsidiary to the main argument, which is that vaccination is hazardous or ineffective.
• Percentages of chiropractors that support or oppose vaccination should be given, so that readers can see for themselves how important this issue is.
• There is redundancy in the paragraph about how a minority of the profession rejects vaccination.

Eubulides (talk) 07:31, 2 September 2008 (UTC)

I agree with Surturz. . . We are letting a vocal minority misrepresent the views of the majority. . . The text ought to reflect that.TheDoctorIsIn (talk) 03:09, 2 September 2008 (UTC)

I think you might have a hard time understanding NPOV. The section is now a stub and in need of serious expansion. Please explain why you turned a ref citation red. QuackGuru 03:23, 2 September 2008 (UTC)

::I find it amusing that you are accusing me of POV, and refer everyone to an archive of your talk page, and particularly the "medicare website unreliable?" section. Enjoy your 'semi-retirement' --Surturz (talk) 03:44, 2 September 2008 (UTC)

Surturz wrote in part: I find it amusing that you are accusing me of POV I do not see any evidence of an accusation towards Surturz.

I was asking a question to TheDoctorIsIn but Surturz replied. Hmm. I still would like an answer to the red ref problem. I will get to work on the Insurance and subsidies section soon enough. QuackGuru 03:57, 2 September 2008 (UTC)

My apologies, I didn't see TheDoctorIsIn's comment, I thought it was directed at me. Although I think TDII's change was un-reverting mine (which in turn was restoring Soyuz' superior text). --Surturz (talk) 04:13, 2 September 2008 (UTC)

And neither was instituted as a result of any consensus agreement here, so I have restored the existing version. Let's work on it and improve it HERE. -- Fyslee / talk 05:31, 2 September 2008 (UTC)

I agree with this restoration for now. I have a draft for an improved version in #Vaccination draft above. Eubulides (talk) 07:31, 2 September 2008 (UTC)

• (outdent) I have replaced the vaccination section with the following version:

A minority of chiropractors oppose vaccination. A relatively small number of chiropractic authors continue to disseminate antivaccination views, claiming that it is hazardous or ineffective. Evidence-based chiropractors have embraced vaccination, but a minority of the profession rejects it, as original chiropractic philosophy traces diseases to causes in the spine and states that diseases cannot be affected by vaccines. The American Chiropractic Association and the International Chiropractors Association support individual exemptions to compulsory vaccination laws, and a 1995 survey of U.S. chiropractors found that about a third believed there was no scientific proof that immunization prevents disease. The Canadian Chiropractic Association supports vaccination; surveys in Canada in 2000 and 2002 found that 40% of chiropractors supported vaccination, and that over a quarter opposed it and advised patients against vaccinating themselves or their children.

I realise this is a revert, and I apologise that it is necessary for I need to show there is no consensus for the current version. In the original version of particular specific offense to me is the chiro student opinion poll, but also the way the wording talks about the whole profession rather than the anti-vaccination minority. We should talk about the minority directly, not spinning the wording to give the impression the whole profession is anti-vaccination. For example I cannot see why the phrase "A minority of chiropractors oppose vaccination" is not acceptable to everyone, and people are insisting on "Chiropractic is controversial in the chiropractic community". --Surturz (talk) 23:41, 6 September 2008 (UTC)

That change is an attempt to reinstall a controversial change that was rejected by a majority of editors above. I reverted it for now. Please try to gain consensus for controversial changes first. There are other ways to word it; please take in mind the above comments. Eubulides (talk) 23:45, 6 September 2008 (UTC)

That's my point, some editors own the current version and are unwilling to talk about changes. I need to revert to indicate that there is no consensus for the current version. What do you, User:Eubulides, think about the difference in phrases; "A minority of chiropractors oppose vaccination" vs. "Chiropractic is controversial in the chiropractic community" --Surturz (talk) 17:45, 7 September 2008 (UTC)

There is not a unanimous consensus for the current version, but there is a working consensus. Only a minority of editors favors the wording "A minority of chiropractors oppose vaccination". I do recall explaining that the proposed "minority" wording is misleading, as it'd be equally accurate (and nearly as misleading) to write "A minority of chiropractors supports vaccination". The phrase "Chiropractic is controversial in the chiropractic community" summarizes the situation described by the source, much more accurately. Perhaps the current wording could be improved, but "A minority of chiropractors oppose vaccination" doesn't do the job: it worsens the text by making it more misleading. Eubulides (talk) 20:42, 7 September 2008 (UTC)

See, here you are factually wrong. The source does not use the word 'controversial' at all except in a quote. It clearly states that the majority of chiropractors are either pro-vaccination or pro-choice. In fact, it states that Ontario chiros are expected to avoid advising on vaccination issues otherwise they may be fined or imprisoned. Nor does the source use the phrase 'chiropractic community'. The only mention or measure of the prevalence of anti-vaccination views in the source is reference to a survey of 621 chiropractic students, which I would argue should be discounted for the small sample size. Using that source to justify "Chiropractic is controversial in the chiropractic community" is bordering on OR. --Surturz (talk) 00:30, 8 September 2008 (UTC)

Topic sentence of Vaccination

It is not "factually wrong" to say that "Chiropractic is controversial in the chiropractic community" summarizes the situation described by the source, more accurately than "A minority of chiropractors oppose vaccination" does. The latter phrase is so vague that it would describe a situation where only 0.5% of chiropractors oppose vaccination and 99.5% support it; the former phrase more accurately describes the proportions reported, where a minority of chiropractors support vaccination, a minority oppose it, and a minority neither supports nor opposes it. Anyway, to try to save us time quibbling over this wording, I added another source that leads with a description of "spirited disagreements within the chiropractic community" over vaccines and then goes on to cite papers by Busse and by others. I see no dispute among reliable sources over whether this controversy exists. Eubulides (talk) 06:43, 8 September 2008 (UTC)

(outdent) It is indeed factually wrong to assert that the original source (Busse) infers that "chiropractic is controversial in the chiropractic community". The word 'controversial' is not even used by the author(s), nor is the phrase 'chiropractic community'. Your newer source does not infer "chiropractic is controversial in the chiropractic community" either, it only says that a significant portion of chiros oppose vaccination. Your new reference says there are three camps - one loud minority opposing vaccination, a bigger group in favour of vaccination, and a 'pro-choice' group that don't want to irritate the anti-vaccinationists. There is nothing approaching 50%-50% for and against vaccination which is what the phrase "chiropractic is controversial in the chiropractic community" implies. If a small minority makes something controversial, then one could say the more general "Vaccination is controversial." - that is wrong, too! --Surturz (talk) 07:40, 8 September 2008 (UTC)

• The phrase "controversial" does not at all imply 50%–50%. For example, there is a controversy in the U.S. over the legality of late-term abortion, but that does not mean that 50% of Americans support the legality of late-term abortion, and 50% oppose it.
• I did not write that Busse et al. 2005 (PMID 15965414) "infers" anything. I wrote that the phrase "chiropractic is controversial in the chiropractic community" more accurately summarizes Busse et al. than the phrase "A minority of chiropractors oppose vaccination". The topic sentence of the paragraph should summarize the paragraph as accurately as possible.
• I see now that you changed the topic sentence of Chiropractic #Vaccination again without discussion in advance here. This change unfortunately makes the topic sentence less-accurate as a summary. The change log read "Change text to match new reference - see ref p168 column 2". It is indeed true that the source's page 168 column 2 says "there remains a significant portion of the chiropractic profession opposed to vaccinations". However, that quote is just a part of the story; another part of the story is that a significant minority of chiropractors supports vaccination. To tell the whole story briefly, it is more accurate to say that there is a controversy, than to mention just one of the two minorities.
• The newly cited source (Ferrance 2002) clearly supports a statement that there is a controversy about vaccinations. The new source mentions this controversy in a position of prominence, in the very first sentence of the cited source. The new source's lead is a more accurate summary of the situation. Similarly, Chiropractic #Vaccination should use a more-accurate summary of the situation.
• For now, I reverted the change. Perhaps we can come up with a different way of wording the topic sentence, which does not lose accuracy. However, I don't know what the objection is to having the topic sentence say that there is a controversy, and it's difficult for me to propose a rewording without knowing what the objection is.

Eubulides (talk) 09:14, 8 September 2008 (UTC)

Eubulides, you are misrepresenting sources again. The Ferrance2002 source does not mention anything about controversy. If it is so easily stated that "Vaccination is controversial within the Chiropractic community", then find a source that says so. - DigitalC (talk) 23:24, 8 September 2008 (UTC)

• I take your position to be that "is controversial" does not accurately summarize "evokes some rather spirited disagreements"? In what sense is that summary inaccurate?
• With strong claims like "misrepresenting sources" and "factually wrong" flying around, it does appear that we've found yet another controversial subject in chiropractic: but this time, it's controversy about whether there is controversy!
• Anyway, I made this change to alter Chiropractic to use phrases closer to the cited source. Hope this helps. Eubulides (talk) 00:35, 9 September 2008 (UTC)

• My problem is that the various phrasings you have preferred have talked about the whole chiropractic profession rather than the minority that are anti-vaccination. Opposition to vaccination is a minority view, and the text should reflect that. I've even put in the word 'significant' which User:Fyslee supports, below. Your latest version about 'spirited discussion' is silly and unfactual - it is a conversational figure of speech in the reference. A minority of chiropractors oppose vaccination, that is the fact, and that is what should be in the article. --Surturz (talk) 01:38, 9 September 2008 (UTC)

• It is also true that support of vaccination is a minority view among chiropractors, and the text should reflect that as well. If the topic sentence says only that a significant minority opposes vaccination, then a naive reader will most likely infer, incorrectly, that a majority supports vaccination. We need a wording that avoids this likely misinterpretation. That word doesn't have to be the "controversy"; it could be something else, like "disagreement" or "debate" or something like that. But if the lead merely says that a minority, or even a significant minority, opposes vaccination, then it is omitting an important part of what the sources say. Eubulides (talk) 05:17, 9 September 2008 (UTC)

"Vaccination evokes spirited disagreements within the chiropractic community." is certainly an improvement. I have been wondering why there was so much opposition to the phrase "Chiropractic is controversial in the chiropractic community." After thinking about it for awhile, I have come up with a possible explanation based on my own observations, and have no idea if it is even close to the reasons why some editors have objected so strongly. My experiences from observing, studying and reading about the profession; participating and lurking on chiropractic discussion lists; being moderator of such a list and the only non-DC member, etc., cause me to agree to some degree with their objections to that wording. Vaccination isn't a "hot topic" that is actively debated with an eye to arriving at a new consensus and standpoint for the whole profession. On the contrary, those who advocate vaccination are either silent or rather quiet, with a few exceptions whom we quote. Keep in mind that pro-vax dissenters against traditional views are considered traitors by many of their colleagues and can suffer various forms of abuse and ostracism at their hands if they openly stand up against the traditional chiropractic opposition to vaccination. In some circles (reformers) it is acceptable to voice support for vaccination, but they are a small minority.

I think your new wording gets further away (but is it far enough away?) from implying that it's a hotly debated topic, which it isn't. There are just some strongly worded voices of disagreement, and they aren't supported very much. Fortunately they are well-known researchers, professors, and a college president, who publish their views in V & RS. With time their views may become so influential that the tide will turn and more and more chiros will dare to express pro-vax sentiments, finally moving the ACA and ICA to change their official positions. -- Fyslee / talk 01:33, 9 September 2008 (UTC)

Surturz has found a Solomonic solution, and that is to basically quote the source:

• "A significant portion of the chiropractic profession is opposed to vaccinations."[28]

This relieves us of battling out whether it's a majority or minority opinion. It is certainly a significant "portion" of the profession. That one sentence is good enough to use as the only mention in the LEAD.

That version is defensible against all attacks and if we just adopt the source's wording we can move on to other matters. -- Fyslee / talk 05:00, 9 September 2008 (UTC)

• It is not a Solomonic solution, because it still is likely to lead the reader to conclude that a majority of chiropractors support vaccination. They don't. Only a minority of chiropractors support vaccination, among the reliable sources we've found.
• The wording "Vaccination evokes spirited disagreements within the chiropractic community" is just as well-supported by the reliable source, and it summarizes the subject better. I'm not wedded to that wording, just as I'm not wedded to the word "controversy"; but we should not have a misleading topic sentence that gives the naive reader the incorrect impression that a majority of chiropractors favor vaccination.
• I wish I shared your optimism about turning the tide and so forth, but I wouldn't hold my breath. The last time the ACA changed its official position on the subject back in the 1990s, it changed the position to be further against vaccination. In a 2002 survey on the subject (not mentioned in Chiropractic; perhaps it should be?), slightly more chiropractors recommended against immunization than for it; see Russell et al. 2004 (PMID 15530683).
• I suspect that much of the chiropractic opposition to vaccination comes not from the straights, but from many mixers who have adopted popular CAM anti-vaccination positions. Given the numbers mentioned above, I think it unlikely that only the straights oppose vaccination.

Eubulides (talk) 05:17, 9 September 2008 (UTC)

I think the further content should go into more detail regarding the majority/minority matters, but the "topic sentence" and the sentence we should use in the LEAD are best served by using the near-quote from the source. This still allows for more detailing in the section. This discussion is about the "topic sentence", so can't we get that matter settled first? "...evokes spirited disagreements" won't survive many of the wiki style editors who will visit this article. It will get trashed as unencyclopedic style and we need to avoid more controversies over such details, especially when we can avoid them by quoting the source. Let's just use the quote and move on-- Fyslee / talk 05:52, 9 September 2008 (UTC)

Both phrases are near-quotes from the source, no? The topic sentence should summarize the controversy as accurately as is possible in a short sentence; it is misleading to merely say that a minority opposes vaccination. Another possibility is to say "There are significant disagreements about vaccination within the chiropractic community.", or some reasonable variant of that. Eubulides (talk) 07:56, 9 September 2008 (UTC)

• Well, the idea of a topic sentence is new to me in this context. We have a requirement that the LEAD serve that purpose for the whole article, but no requirement for the existence of a topic sentence.
• If you insist on having a topic sentence, then your proposed sentence sounds good to me. That doesn't preclude using the near quote from Randy in that section. It is a pretty good statement about "a significant portion ..." that ought to be used. It makes it clear that it's not a little minority who are anti-vax. You are correct about the ACA's last position change for the worse. Sooner or later it will be forced to change for the better. As usual, the profession fights against aligning itself with the scientific majority position on many matters and is thus way behind the curve. Forced by the evidence, it usually has to get dragged, kicking and screaming, into conformity to newer advances in knowledge, but it doesn't openly admit that its traditional POV have been wrong all along.
• The matter of minority/majority is a matter that should be dealt with in that section. "A significant portion..." and then (without comment) simply mentioning known statistics, may be the best we can do without engaging in OR or SYNTH violations. -- Fyslee / talk 03:34, 10 September 2008 (UTC)

Topic sentence of Vaccination should summarize the section

I see now that Surturz again has removed the topic sentence summarizing the paragraph, and has instead inserted a sentence that merely says that a significant minority portion is opposed to vaccination. Not only is this misleading as it does not summarize the paragraph well, it also has a misleading wikilink from the phrase "opposed to vaccination" to Vaccine controversy. I in turn just now replaced this with the sentence proposed above, which Fyslee agreed with. We seem to have a working (but not unanimous) consensus here that the topic sentence should not limit itself to saying that a minority of chiropractors oppose vaccination. Further suggestions for improving wording are welcome, but it won't help the encyclopedia to repeatedly insert wording that is rejected by the others who are commenting. Again, please discuss possibly-controversial changes like that here first. Eubulides (talk) 04:53, 10 September 2008 (UTC)

I am under the impression User:Fyslee agreed with my version, actually, and I don't think you can claim any sort of consensus. "[B]ut it won't help the encyclopedia to repeatedly insert wording that is rejected by the others" is the pot calling the kettle black; it should be obvious to you that I oppose the wording that you keep reinserting. --Surturz (talk) 07:03, 10 September 2008 (UTC)

BTW you are, once more, factually wrong. The phrase I added was "a significant portion", not "a significant minority". --Surturz (talk) 07:07, 10 September 2008 (UTC)

AND to imply I have not been discussing the issue here is quite disingenuous. --Surturz (talk) 07:11, 10 September 2008 (UTC)

• The most recent comment by Fyslee replied to the proposed topic sentence "There are significant disagreements about vaccination within the chiropractic community"; Fyslee wrote "If you insist on having a topic sentence, then your proposed sentence sounds good to me." As I recall, Fyslee also agreed on an earlier topic sentence that you drafted (and also indicated that he's tired of this controversy, which is quite understandable).
• A topic sentence saying that vaccination is controversial within chiropractic has been present for months. See, for example, the April 1 version. Obviously you oppose such a topic sentence. But as far as I can recall, you are the only editor to oppose it, and we have multiple editors supporting the idea of saying that vaccination is controversial within chiropractic. Certainly reliable sources agree on this subject.
• Sorry about misquoting the text; I corrected it in my previous comment above. The misquote was minor and doesn't affect later discussion as far as I can see, so I hope no harm was done.
• The discussions have been occuring after controversial changes are installed. That is not a good way to do things. What I've been asking for, and what the top of this discussion page asks for, is that editors discuss such changes here before installing them. That is a much better way to collaborate. Eubulides (talk) 07:25, 10 September 2008 (UTC)

Eubulides (talk) 07:25, 10 September 2008 (UTC)

• It is a pretty good statement about "a significant portion ..." that ought to be used. is what I took away from User:Fyslee's comment. Consensus isn't permanent either. The April 1 version has lost consensus. I have been discussing the phrasing ad nauseum both before and after my edits. What you have failed to address is why you are favouring phrases that talk about the entire profession, when it is clear that only a portion/minority are anti-vaccination. No-one has disputed the fact - why not make the text match the fact? --Surturz (talk) 07:36, 10 September 2008 (UTC)

• It is also clear that only a portion/minority are pro-vaccination. Nobody is disputing that fact. The pro-vaccination side is just as important as the anti-vaccination side, and should be summarized in the topic sentence. Surely together we can come up with a topic sentence that summarizes the whole paragraph, rather than focuses just on the anti-vaccination side. How about this idea: "There are disagreements about vaccination within the chiropractic community, with significant portions both opposed to and supportive of vaccinations." Or perhaps you can suggest something better (on the talk page first, please). Eubulides (talk) 07:42, 10 September 2008 (UTC)

• Undue weight. Keep in mind that I and User:Levine2112 feel that pretty much the whole section should be deleted. That you are reverting even the smallest changes to the section shows that you are not really interested in trying to establish consensus with editors who have a different opinion from you. I see absolutely no compromise on your part, no effort to make the section smaller, no agreement to remove the dodgy opinion poll at the end, no effort to use phrases that don't paint the entire profession as anti-vaccination. --Surturz (talk) 07:54, 10 September 2008 (UTC)

• Why is it undue weight to mention a controversy that obviously exists, and which is supported by reliable sources? And why is it better to for the topic sentence to mention just one side of the controversy, without mentioning the other? That section's wording has changed since you started editing it, which I accept; this is evidence that I am not opposed to changes in general. It is not just me who opposed removing mention of controversy from the topic sentence. My previous comment proposed yet another attempt at compromise wording. If you could respond constructively to that proposal, we might be able to come up with a mutually acceptable solution. Eubulides (talk) 08:19, 10 September 2008 (UTC)

• We definitely can't say that a significant portion support vaccination since it is most likely that many of the silent majority (undecided) favor the traditional position against vaccination. It would be OR to make such a statement unless we have a source for it and attribute the quote. The statistics show a significant minority openly oppose vaccination, and we have a source that states "a significant portion" of the profession opposes it, which could easily mean a majority, but we can't state a majority support it.

• Surturz, please stop the edit warring and get agreement here before installing changes. I once suggested a checkuser on you as your edit warring style is very similar to CorticoSpinal's and I thought you might be another one of his incarnations, but I decided against it. Regardless of your identity, your style can get you in the same trouble he has gotten in, since edit warring can get you blocked or banned. Please stop it. -- Fyslee / talk 14:15, 10 September 2008 (UTC)

I really wish you would stop threatening me. Assuming I am a sock puppet violates WP:AGF. The talk page was flagged as controversial before I got here, which impugns editors that have been here longer than I. I think this is a clear case of WP:OWN by you and Eubilides. Somehow edits made by you and Eubilides don't need to be discussed first, but any changes I make need unanimous agreement on the talk page before putting them in the article? Making sure an editor which disagrees with you gets banned? --Surturz (talk) 19:58, 10 September 2008 (UTC)

Take it easy. No one is threatening you and I'm not assuming you're a sock puppet. A warning is not a threat. It's preventive medicine ;-) The "controversial" flag is meant as a warning to new users to be very careful. You should take it in that spirit and edit accordingly. Articles like this are minefields and are not suited to the WP:BRD method of editing. On the contrary, that only results in edit wars and frayed nerves. Seemingly uncontroversial edits don't need previous discussion. If they turn out to be controversial we shouldn't reinstate them without arriving at a consensus. (That's an application of BRD.) That's where you often jump the gun by repeatedly reinstalling edits that have been contested and are still under discussion. That's called disruptive editing. The WP:3RR rule is often invoked for fewer than three reverts when it's the same edit that gets repeatedly made in this manner. Such editing violates the spirit of collaborative and consensus editing. -- Fyslee / talk 03:19, 11 September 2008 (UTC)

I regularly discuss my proposed changes here before installing them, when they are potentially-controversial. See, for example, this recent change, which I proposed about 4 days earlier on the talk page, here. I attempted to engage in a discussion above of a better way to word the topic sentence (this attempt has, so far, been ignored). In contrast, Surturz's most recently proposed wording "A significant portion of the chiropractic profession is opposed to vaccination" was installed directly into Chiropractic with the misleading log message "rvv". The first time that wording was installed, here, there was no advance discussion of it. There is longstanding consensus here that the controversy over vaccination should be mentioned one way or another. This continuing single-topic set of reverts (with misleading summaries like "rvv") is disruptive. Eubulides (talk) 21:42, 10 September 2008 (UTC)

I only concede that it should be mentioned minimally, if at all. One to two sentences, not called out into its own section. Way to much weight given to it as it. -- Levine2112 ^discuss 03:53, 11 September 2008 (UTC)

I agree it could be shortened a bit, but two sentences is too short (unless those sentences are looong). I just now removed one sentence, a removal that was proposed by QuackGuru a few days ago without disagreement, but not acted on. Two weeks ago I proposed to strike out Chiropractic #Vaccination's last sentence (the student survey at CMCC) but this proposal did not reach consensus. And I see now that Levine2112 just reverted my removal of that sentence, saying "No consensus for most of this.Please seek one out before restoring." If the proposal by QuackGuru, without disagreement for several days, was not consensus, then what would constitute consensus? Eubulides (talk) 07:45, 11 September 2008 (UTC)

(outdent) The only comment on the latest proposal was by Fyslee, who said "We definitely can't say that a significant portion support vaccination". True; the source doesn't support that. So I removed that part of the claim, and replaced the topic sentence with "There are disagreements about vaccination within the chiropractic community, with a significant portion opposed to vaccination." This compromise attempts to satisfy both sides to some extent, by mentioning both sides' topics. Hope this helps. Eubulides (talk) 07:01, 11 September 2008 (UTC)

Levine2112 soon reverted this proposed compromise, saying "No consensus for most of this.Please seek one out before restoring". I suppose we can discuss the matter further here, and try to gain consensus. So far I don't see any comments here opposing this latest compromise proposal, but I suppose if we wait a bit, some will show up.... Eubulides (talk) 07:45, 11 September 2008 (UTC)

Proposed heading change

I propose that we change the existing "Vaccination" heading to something more descriptive, such as "Controversiality of vaccination", or something to that effect. -- Fyslee / talk 03:37, 13 September 2008 (UTC)

"Controversiality"? Naaaah. Plain Vaccination is shorter and clearer. But also please see #Public health above, for a different suggestion. Eubulides (talk) 06:08, 13 September 2008 (UTC)

Oppose I believe the topic does not even deserve its own heading. --Surturz (talk) 16:47, 14 September 2008 (UTC)

We are aware of that, but until we figure a way to include this in the body of the article, I'm asking for improvements on the heading. Please provide something. Maybe the "Public health" suggestion is a way forward, since there are other public health measures that are opposed by some chiropractors. -- Fyslee / talk 19:21, 14 September 2008 (UTC)

How about "Controversies"? Then have subheadings for Vaccination and Flouride or whatever.--—CynRN ^(Talk) 05:49, 15 September 2008 (UTC)

That's a distinct possibility, which isn't identical to a "Criticisms" section, which Eubulides is opposed to having, although it is allowed at Wikipedia, especially for controversial articles. He believes such criticisms should be merged into the relevant spots in the article, and I suspect many chiropractors would find that approach more paletable, since it makes the controversies less visible to most readers who only skim an article.

A "Controversies" or "Controversial beliefs and practices" section could mention the significant areas where chiropractic as a profession, or minorities in the profession, hold POV and practices that are at deviance with mainstream medicine, science, advertising laws, and good ethics. We could try to make a list of them here. I'll start with a few:

1. Vaccination
2. Fluoridation
3. Pseudoscientific diagnostic methods: Applied kinesiology, Iridology, Activator leg length discrepancy, skin surface temperature differences, Nervoscope type devices, pendulum divining, electroacupuncture, reflexology, hair analysis, herbal crystallization analysis, computerized "nutritional deficiency" questionnaires, Meric system, cytotoxic food allergy test, Reams urine and saliva test, etc.. Needless to say, many if not most of these things are related to methods and ideas designed to convince patients that they suffer from vertebral subluxations which need to be corrected regularly for a lifetime in order to maintain health, even in the absence of any symptoms of ill health.
4. Pseudomedical therapies: magnetic therapy (placing magnets on the body), NAET, homeopathy, herbology, Insight 7000, colonics, colored-light therapy, megavitamin therapy, Spinal Analysis Machine (S.A.M.), radionics (black box devices), bilateral nasal specifics (inserting a balloon in the nose and inflating it), craniosacral manipulation, etc..
5. Sales of nutritional supplements directly to patients.
6. Misuse and overuse of x-rays
7. Questionable practice building techniques
8. Use of "scripts" to manipulate patients into becoming compliant patients and advertisers for the chiropractor. [29] [30] [31]
9. "Wellness" care (treatment of asymptomatic individuals for a lifetime).
10. Anti-medical propaganda [32] [33]
11. Upfront prepayment for long series of treatments.

This chiropractic article lists several things an ethical chiropractor should not do, but which many chiropractors do.

I could go on, but this is probably too much and may include subjects not suited for such a section. It would also be very timeconsuming to find the necessary references, so we should probably keep it to a minimum. Please add any suggestions you may have. -- Fyslee / talk 06:50, 15 September 2008 (UTC)

• As Fyslee anticipated, I think a Controversies section would not work well, unfortunately. First, some aspects of public health and chiropractic are not particularly controversial (e.g., ergonomic advice about workstation height). Conversely, there are many controversies about chiropractic other than public-health issues. Nearly every section in Chiropractic contains controversial material (mixers vs. straights, veterinary chiropractic, evidence basis, etc., etc.), so a section entitled Controversies would take over most (or at least, a huge chunk of) the article. It's better to simply cover the topics in Chiropractic in a logical order, irrespective of which topics happen to be controversial.
• Fyslee's list of potential topics is a good one: there are several things in that list that should be covered in Chiropractic, if only briefly. We would need reliable sources, of course. Perhaps a new section Practice building could be added? It would cover many of the topics Fyslee raised (which tend to be critical of chiropractic), along with ethical practice-building techniques (which would tend to be supportive).

Eubulides (talk) 07:03, 15 September 2008 (UTC)

Much of what Fyslee mentions are the questionable diagnostic and therapeutic modalities, like AK, which I've seen played down or kept out of the article. Conversely, some say the article stresses the non-scientific straights to the detriment of science-based chiropractors! Could there be a section called Public health, which could include old opposition to flouride and current opposition to vaccines, but also chiropractic involvement in the American Public Health Assoc?--—CynRN ^(Talk) 22:54, 15 September 2008 (UTC)

Yes, that sounds like a good idea. #Public health above suggests Johnson et al. 2008 (PMID 18722194) as a source; that source talks about all the topics you mention (fluoride, vaccination, and the APHA). Eubulides (talk) 23:16, 15 September 2008 (UTC)

References

(The following resolve otherwise-dangling references:)